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Quantifying the impact of a broadly protective sarbecovirus vaccine in a future SARS-X pandemic.
Get PDFCOVID-19 has underscored the need for more timely access to vaccines during future pandemics. This has motivated development of broad-spectrum vaccines providing protection against entire viral families, which could be stockpiled and deployed rapidly following detection. Using mathematical modelling, we assess the utility of a broadly protective sarbecovirus vaccine during a hypothetical SARS-X outbreak, for a range of implementation strategies including ring-vaccination, spatial-targeting and mass vaccination of high-risk groups. Broadly protective sarbecovirus vaccine ring- or spatial strategies alone are insufficient to contain epidemics driven by a SARS-CoV-2-like virus, but when paired with rapid isolation and quarantine, can achieve containment of a SARS-CoV-1-like virus. Where suppression fails, broadly protective sarbecovirus vaccine utilisation still reduces the effective reproduction number and slows epidemic growth - buying valuable time for health-system response and virus-specific vaccine development. Vaccination of high-risk populations with the broadly protective sarbecovirus vaccine ahead of virus-specific vaccine availability could reduce mortality and enable shorter and less stringent non-pharmaceutical interventions to be imposed; results are sensitive to vaccine properties (e.g., efficacy), health system capabilities (e.g. rollout speed) and timeline to virus-specific vaccine availability. Our modelling suggests that broadly protective sarbecovirus vaccine delivery to those aged 60+ years could have averted 21-78 % of COVID-19 deaths during the pandemic's first year, depending on the size of the stockpile. Realising this potential impact will require investment in manufacturing, delivery capacity and equitable access ahead of future pandemics
Valuing health across groups: a cross-sectional population-based willingness-to-pay survey in Bhutan.
Get PDFINTRODUCTION: Context-specific cost-effectiveness thresholds (CETs) informed by societal willingness to pay (WTP) are crucial for healthcare resource allocation in low- and middle-income countries. This study investigated WTP for health per quality-adjusted life year (QALY) in Bhutan. METHODS: A WTP survey was conducted alongside the 2023 National Health Survey in Bhutan, sampling 1869 households. Using contingent valuation, respondents assigned monetary values to three hypothetical scenarios: 1 year of cancer symptom-free life, 1 year of perfect health and 5 years of perfect health. We used generalised linear regression to estimate WTP, controlling for demographic, socioeconomic and health-related factors, as well as elicitation methods. Multilevel analyses examined WTP variations within and between districts. RESULTS: WTP estimates were 76 836 Bhutanese ngultrum (BTN) (0.26 times gross domestic product (GDP) per capita; 95% CI: 71 397 to 82 275) for a year without cancer symptoms, 104 381 BTN (0.35 times GDP per capita; 95% CI: 96 405 to 112 357) for 1 QALY and 235 237 BTN (0.78 times GDP per capita; 95% CI: 218 674 to 251 800) for 5 QALYs. WTP variations were driven by within-district individual characteristics, particularly income and education, rather than between-district differences. CONCLUSION: Minimal between-district WTP variations support a national-level CET for Bhutan. However, WTP-based CETs would be biased upward by wealthier and more educated groups. This bias could justify expensive technologies that strain public resources in Bhutan's government-funded healthcare system
Human health evidence in the global treaty to end plastic pollution: a survey of policy perspectives
Get PDFAbstract
Science shows mounting global health risks associated with plastics life cycle pollution. Leveraging evidence and streamlining research to inform policy is critical to safeguarding people and planet. We conducted an electronic survey questionnaire, between 16th April and 16th August 2024, amongst United Nations government delegates developing the Global Plastics Treaty. We explored (1) perceptions and prioritisation of human health evidence, (2) preferred plastic pollution mitigation strategies, and (3) priorities for health research. Responses were collected in Qualtrics and analysed using summary statistics, the Fisher’s Exact Test, and thematically mapped to the Policy Cycle Framework. We received 27 survey responses, balanced by gender and career stage, including 23 countries and all World Bank country income classifications and regions, but greater representation from high-income and European countries. Human health was the highest-ranking concern related to plastics risks (Sum of rank scores (SRS) = 54). Most delegates expressed strong conviction in evidence of risks associated with plastics chemicals, polymers, products, microplastics and broader life cycle emissions. Reducing plastics production (SRS = 53) and eliminating chemicals, polymers and products of concern (SRS = 53) were prioritised, even amongst those affiliated with waste management departments or less convinced of health risks. We found the least regard for recycling as a strategy to protect health (SRS = 4–5) and eliminating open burning was the most prioritised downstream measure (SRS = 15). Generating quantitative, causal data on risks across plastics life cycles, identifying emerging health hazards, defining criteria, safe lists and substitutes for chemicals, polymers and products were government delegate priorities for research, alongside tools to track policy impacts on health and greater bilateral communication between scientists and delegations. Health risks of all forms of plastic pollution were a concern for most delegates responding to our survey. We identified key priorities for policy-driven research to strengthen the science-policy interface and support evidence-based plastics policy that protects human health
Global Maternal Child Health Initiatives and Programs 1974 to 2023.
Get PDFAIM: This review paper aims to review Global MCH initiatives and note trends across the last five decades (1974-2023). METHODS: As an organizing framework, MCH initiatives and programs have been classified into five categories: Global Health Conferences, Declarations or Strategies; Global Health Surveys; Global MCH Programs; Global MCH related Data Initiatives or Working/Advisory Groups; and Global MCH Partnerships or Networks. RESULTS: Over 50 Global MCH initiatives and programs have been implemented during this period. The first International Conference on Primary Health Care and the Alma Ata Declaration in 1978 initiated a new era of global public health. International conferences building on Alma Ata with a focus on population health and MCH, along with global surveys to measure the health status of populations across countries and global working groups to analyze these data, emerged over the next decades. Global MCH partnerships also emerged for advocacy and coordination of an increasing number of efforts to improve maternal, newborn, child and adolescent health and well-being-towards achieving the Millennium (2000-2015) and Sustainable (2016-2030) Development Goals. CONCLUSION: Four trends were noted across these five decades: (1) MCH Mortality decreased but unacceptable inequities persist with COVID-19, ongoing conflicts and climate change threatening these gains. (2) Implementation of primary health care (PHC) as envisioned by Alma Ata in 1974 continues to see a debate about selective versus comprehensive programs. (3) As mortality declined (Survive), the field expanded focus to child well-being (Thrive) and across preconception through adolescents (Transform). (4) Global MCH issues are relevant across high-income (HIC) and low-middle income (LMIC) settings to achieve health and well-being of all women and children everywhere
Exploring context, mechanisms and outcomes in group interpersonal therapy for adolescents with depression in Nepal: a qualitative realist analysis.
Get PDFInterpersonal Psychotherapy (IPT) is an evidence-based treatment for adolescent depression. However, since it does not work for all adolescents in all settings, more research on its heterogeneous effects is needed. Using a realist approach, we aimed to generate hypotheses about mechanisms and contextual contingencies in adolescent group IPT in Nepal. We analysed 26 transcripts from qualitative interviews with IPT participants aged 13-19, facilitators, supervisors and trainers. We analysed data using the Framework Method. The qualitative analytical framework was based on the VICTORE checklist, a realist tool to explore intervention complexity. Sharing, problem-solving, giving and receiving support, managing emotions and negotiating emerged as mechanisms through which adolescents improved their depression. Participants perceived that girls and older adolescents benefitted most from IPT. Girls had less family support than boys and therefore benefitted most from the group support. Older adolescents found it easier than younger ones to share problems and manage emotions. Adolescents exposed to violence and parental alcoholism struggled to overcome problems without family and school support. We formulated hypotheses on group IPT mechanisms and contextual interpersonal and school-level factors. Research is needed to test these hypotheses to better understand for whom IPT works and in what circumstances
Establishment of a Lassa Fever Specimen Biobank in Nigeria.
Get PDFDespite being a dangerous disease found across West Africa, with occasional cases imported elsewhere, few medical countermeasures for Lassa fever are available, with no vaccine or validated treatment, and limited regulatory-approved diagnostics. Scientific research on the Lassa virus (LASV) is needed to accelerate the development of such tools but is dependent on access to high-quality biological samples. To meet this need, we have established a well-curated biobank to prospectively collect, process, and store high-quality, well-characterized clinical specimens from patients with Lassa fever at the Federal Medical Center Owo (FMCO) in Nigeria. Patients presenting to FMCO with symptoms of Lassa fever were tested for LASV by polymerase chain reaction and screened for eligibility. Samples of whole blood, plasma, and serum were collected at baseline, and at 4- and 8-weeks post-baseline from LASV-positive (LASV+) participants. Of 197 participants enrolled, 99 were LASV+ and 98 LASV-negative. In total, 3,599 sample aliquots were stored, comprised of 264 whole blood, 1,572 serum, and 1,763 plasma samples. The Lassa fever biobank now provides support for scientific research, including the evaluation of diagnostics and biomarkers, as well as the development and validation of other medical countermeasures for the detection, prevention, and control of Lassa fever. Processes for accessing samples are described
Associations of prior wasting malnutrition with later indicators of glucose tolerance across 4 countries in Africa and Asia: The Severe Acute Malnutrition - the Role of the Pancreas (SAMPA) study.
Get PDFBACKGROUND: Prenatal or infant wasting malnutrition followed by later overweight is associated with increased risk of chronic diseases, including type 2 diabetes. OBJECTIVES: In a pooled analysis of 6 longitudinal cohorts, we investigated associations between prior malnutrition (PM) early in life or in adulthood and subsequent glycemic status. METHODS: We identified cohorts in Tanzania, Zambia, India, and the Philippines in whom low birth weight or wasting malnutrition in childhood or as adults following human immunodeficiency virus or tuberculosis infection had been measured. Anthropometry, body composition, and glycemic status, determined by hemoglobin A1c (HbA1c), and glucose at 120 min in an oral glucose tolerance test (glucose120), were assessed 3-38 y after PM and in non-PM (NPM) controls. HbA1c and glucose120 were compared between PM and NPM participants by linear regression, controlling for age, sex, and socioeconomic status and, in pooled analyses, for cohort also. RESULTS: In the full cohort of 2251 participants, there was no overall association between PM and diabetes risk. Child participants aged ∼12 y who were hospitalized with PM when <2 y had higher glucose120 compared to NPM (difference 0.50 mmol/L; 95% CI: 0.10, 0.91 mmol/L). In pooled analyses across adult cohorts controlling for cohort, age, sex, and socioeconomic status, PM participants, compared to NPM, may have higher glucose120 (difference 0.33 mmol/L; 95% CI: -0.27, 0.92 mmol/L) if still underweight, and higher HbA1c (difference 0.41%; 95% CI: -0.07%, 0.89%) and glucose120 (difference 0.70 mmol/L; 95% CI: -0.25, 1.66 mmol/L) if currently obese. CONCLUSIONS: Childhood PM is associated with greater adult dysglycemia, whereas adulthood PM may have heterogeneous outcomes dependent on subsequent presence/absence of weight gain. Clinicians and public health managers should be aware of the long-term risk and intervene to promote some weight gain but prevent excess weight gain in people who were previously malnourished
Conceptual framework of women's food environments and determinants of food acquisition and dietary intake in low- and middle-income countries: a scoping review.
Get PDFWomen in low-income and middle-income countries (LMICs) are disproportionately affected by malnutrition in all its forms. Diets link human health and environmental sustainability; however, existing food environment frameworks rarely consider the unique needs of women that can differ due to sociocultural norms and lower social status, potentially reducing the effectiveness of nutrition initiatives. We conducted a systematic scoping review of peer-reviewed literature published in English, Spanish, Portuguese, and French to identify determinants of food acquisition and dietary intake of women in LMICs. By synthesising evidence from 518 studies across 125 countries, we identified 143 eco-social, structural, and individual-level determinants to develop an empirically grounded food environment conceptual framework for women. Women's agency-encompassing decision making and financial autonomy, bargaining power, control over time, and freedom of movement-emerged as a prominent mediator of food acquisition practices and dietary intakes across diverse regions and the rural-urban continuum. Our findings highlight the importance of addressing legislative, structural, and sociocultural determinants mediating women's agency, alongside other key external and individual-level food environment determinants influencing procurement and consumption of nutritious diets. This empirically grounded conceptual framework can guide research priorities and analytical approaches and identify intervention points for policies and programmes to optimise women's nutrition
Unique genetic signatures in HIV-1 subtype A1 and A1D recombinant envelope glycoprotein distinguish contemporary transmitted/founder viruses from historical strains in East Africa.
Get PDFINTRODUCTION: The envelope glycoprotein (Env) of HIV-1 Transmitted/Founder (T/F) viruses in subtypes B and C carries distinct genetic signatures that enhance transmission fitness, augment infectivity and immune evasion. However, there is limited data on such signatures in T/F subtypes A1, D and A1D recombinants that predominate East Africa's HIV epidemic. METHODS: We used phylogenetically corrected approaches to detect distinct genetic signatures by comparing 44 contemporary HIV-1 T/F Envs with 229 historical Envs of the same subtype in East Africa. RESULTS AND DISCUSSION: Subtype analysis based on the full-length Env gene of contemporary T/F viruses revealed a high proportion of subtype A1, followed by A1D recombinants, and fewer subtype D. Signature analysis revealed that the contemporary subtype A1 T/Fs were more likely to select distinct amino acids, including M22 in the signal peptide, R82 in gp120, A172 in the V2 loop, E230 in the glycosite 230, K275 in the D loop, Y317 in the V3 loop, K476 and N477 in the CD4 contact site, when compared with the historical Envs (q-value < 0.2). Conversely, the contemporary subtype A1 T/F Envs were less likely to carry the amino acids Q432 in the CD4 contact site, and the L784 signature within the LLP-2 (q-value < 0.2). The A1D recombinant T/Fs were more likely to select the D620 in the C-helix, but under selected the L34 in gp120, P299 in the V3 loop and Y643 in the Heptad repeat-2, compared to the historical Envs (q-value < 0.2). The distinct signature sites reported in this study may contribute to the successful establishment of acute infection as well as the persistence of long-term infection. Therefore, effective therapeutics and vaccines may target these distinct amino acid signatures especially for the East African region as it may be necessary to employ subtype-specific vaccines according to the subtype distribution
Climate change trauma and collective dissociation: Unraveling the impact on mental health and advocating for collective action.
Get PDFThe climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis