Blanket COVID-19 vaccine booster programmes could prolong the pandemic and increase inequity, the Director-General of the World Health Organization (WHO) warned on Wednesday.
“And boosters cannot be seen as a ticket to go ahead with planned celebrations, without the need for other precautions,” he added.
Diverting vaccine supply
The WHO Strategic Advisory Group of Experts on Immunization (SAGE) has issued interim guidance on booster doses, expressing concern that mass programmes for countries that can afford them, will exacerbate vaccine inequity.
Currently, around 20 per cent of all vaccine doses administered are being given as boosters or additional doses.
“Blanket booster programmes are likely to prolong the pandemic, rather than ending it, by diverting supply to countries that already have high levels of vaccination coverage, giving the virus more opportunity to spread and mutate,” said Tedros.
He stressed that the priority must be on supporting countries to vaccinate 40 per cent of their populations as quickly as possible, and 70 per cent by the middle of 2022.
“It’s important to remember that the vast majority of hospitalizations and deaths are in unvaccinated people, not un-boosted people,” he said. “And we must be very clear that the vaccines we have, remain effective against both the Delta and Omicron variants.”
Against vaccine inequity
Tedros reported that while some countries are now rolling out blanket programmes – for a third, or even fourth shot, in the case of Israel – only half of WHO’s 194 Member States have been able to inoculate 40 per cent of their populations due to “distortions in global supply”.
Enough vaccines were administered globally in 2021, he said. Therefore, every country could have reached the target by September, if doses had been distributed equitably through global solidarity mechanism COVAX and its African Union counterpart, AVAT.
“We’re encouraged that supply is improving,” said Tedros. “Today, COVAX shipped its 800 millionth vaccine dose. Half of those doses have been shipped in the past three months.”
He again urged countries and manufacturers to prioritize COVAX and AVAT, and to work together to support nations furthest behind.
While WHO projections show sufficient supply to vaccinate the entire global adult population by the first quarter of 2022, and to give boosters to high-risk populations, only later in the year will supply be sufficient for extensive use of boosters in all adults.
Hope for 2022
Reflecting on the past year, Tedros reported that more people died from COVID-19 in 2021 than from HIV, malaria and tuberculosis combined, in 2020.
Coronavirus killed 3.5 million people this year, and continues to claim some 50,000 lives each week.
Tedros said although vaccines “undoubtedly saved many lives”, inequitable sharing of doses resulted in many deaths.
“As we approach a new year, we must all learn the painful lessons this year taught us. 2022 must be the end of the COVID-19 pandemic. But it must also be the beginning of something else – a new era of solidarity,”
Guidance for health workers
New WHO guidance recommends that health workers use either a respirator or medical mask, in addition to other personal protective equipment (PPE), when entering the room of a patient with suspected or confirmed COVID-19.
Respirators, which includes masks known as N95, FFP2 and others, should especially be worn in settings with poor ventilation.
As many health workers across the world are unable to access these items, WHO is urging manufacturers and countries to scale up production, procurement and distribution of both respirators and medical masks.
Tedros stressed that all health workers must have all the tools they need to do their jobs, which includes training, PPE, a safe work environment, and vaccines.
“It’s frankly difficult to understand how a year since the first vaccines were administered, three in four health workers in Africa remain unvaccinated,” he remarked.
High blood pressure? A heart app prescribes musical therapy
By ANTHONY KING
The opening of a Beethoven symphony thrills the heart – but not just figuratively. While music touches us emotionally, it stimulates the heart physically and can lower blood pressure.
More than one in five people aged 15 years and over in the EU have reported having high blood pressure, which can lead to failure in the heart, kidneys or brain. Lowering blood pressure even slightly can reduce the risks of cardiovascular disease.
From the Science and Technology of Music and Sound Laboratory in Paris to King’s College London, Professor Elaine Chew is developing an app for smartphones to boost heart health as part of an EU-funded project called HEART.FM.
‘We’re creating an app that will monitor people’s response as they listen to music and then tailor that music to benefit them,’ said Chew, a professor of engineering at King’s who collaborates with St Bartholomew’s Hospital in London.
The app uses measurements of the person’s heart and artificial intelligence algorithms to create a listening regimen that regulates blood pressure.
While HEART.FM stands to help people today, another EU-funded project called GOING VIRAL looks back at how public perceptions and uses of music in Europe have evolved through the course of disease outbreaks over the past four centuries.
In the 17th century, music was believed by many people in Europe to have the power to stop or even prevent an outbreak of the plague, according to Professor Marie Louise Herzfeld-Schild, who leads GOING VIRAL and is a musicologist at the University of Music and Performing Arts Vienna.
The two projects show how popular views of music have changed since the days of Handel, and the heightened power of music when combined with modern technology.
Chew has a personal connection to the project. She had suffered from an irregular heartbeat, which was successfully treated. The experience made Chew conscious of her own and others’ heart health.
‘Medicine made it possible for me to have a much better quality of life and it led me to rethink the purpose of what it is I do,’ she said.
A professional-level piano player herself, Chew has since 2018 studied how people’s hearts respond to music, starting with patients who have pacemakers.
A pacemaker is used to treat some abnormal rhythms – called arrhythmias – that can cause the heart to beat too slowly, too fast or irregularly. The pacemaker enables a patient’s heart to beat regularly by sending electrical pulses to it.
Chew and colleagues at St Bartholomew’s Hospital discovered some good news: the recovery time between beats of the hearts of people with pacemakers could be modulated by music. In general, quicker recovery times signal stress, while longer ones indicate relaxation or calm.
Chew is drawing on the findings of her work involving pacemaker patients to develop the HEART.FM app for a much broader group of people.
‘People enjoy music as a pleasurable pastime – the difference here is that we are monitoring how the body responds,’ she said.
HEART.FM’s goal is to fingerprint the cardiovascular responses of people listening to music. Chew often hooks up students to the testing device and then sends them data from the app so they can see their own physiological response to music.
The app in development would be downloaded onto a smartphone by users to track their heart’s rhythmical responses to music and to guide them on a therapeutic path to lower blood pressure. The plan is to make the app globally available for download from app stores.
Under GOING VIRAL, funded by the European Research Council, Herzfeld-Schild is interested in how Europeans of bygone eras felt about music.
Her project is investigating and comparing the emotional experiences that people had from music during three epochs of disease outbreaks in Vienna: plague in 1679 and 1713, cholera in 1831 and flu in 1918-19.
Herzfeld-Schild believes that emotional experiences differ through the periods of history.
‘The way we navigate the world emotionally is bound to our upbringing and what we learned about the world,’ she said. ‘That changes how we feel about music.’
During the plague outbreaks, people in western Europe often blamed the planets and believed music could influence them and, as a result, end or ward off the pestilence.
At the same time, there was also a belief that contaminated items could make you sick. Records exist of people burning instruments or sheet music.
‘Music in that context was dangerous,’ said Herzfeld-Schild. ‘Religion was quite important, so people understand the plague to be a punishment from God.’
Alternatively, they would blame Jews or foreigners from the East, she said.
During the 1700s, perceptions in Europe evolved again to embrace the idea of music as a source of listening bliss.
‘The idea of a universal kind of “true” music and that music is good for everyone begins in the 18th century,’ said Herzfeld-Schild. ‘Also, in the late 18th century, there arises this idea of music as a kind of religious experience, like a revelation, or escape from this bleak life.’
By the time of the cholera outbreak in the 19th century, medical practices and popular attitudes to music had shifted. Once people realised that this disease had its origins in dirty water, charity balls were run in Vienna for cholera victims and even featured new music from the composer Johann Strauss.
The final outbreak that Herzfeld-Schild will investigate is the so-called Spanish flu, which started in 1918. It came when some people could buy early versions of gramophones and listen to music in their own homes.
This was a tumultuous time for Austria because the first flu outbreak coincided with the end of the First World War, collapse of the monarchy and disappearance of the Habsburg Empire.
‘There’s really a lack of knowledge about how music was perceived emotionally during these times of diseases,’ said Herzfeld-Schild.
During the Covid-19 pandemic that started in 2020, she noticed that people seemed to assume a shared experience with those who faced disease outbreaks in earlier eras. But this supposition seemed wrong to Herzfeld-Schild based on her study of the history of music, medicine and emotions for more than a decade.
‘From everything I know, right now, the emotional experiences of music during pandemics have been different throughout times and throughout places,’ she said. ‘I’m sure it was very different for people in the past.’
Research in this article was funded via the EU’s European Research Council (ERC). This article was originally published in Horizon, the EU Research and Innovation Magazine.
Pandemic shock must propel stronger health systems in Latin America and the Caribbean
Strengthening health systems in Latin America and the Caribbean in the wake of COVID-19 must be a priority, according to a new World Bank publication entitled “Building Resilient Health Systems in Latin America and the Caribbean: Lessons Learned from the COVID-19 Pandemic”. Investing in cost-effective interventions such as high-performing primary health care and better public health surveillance systems can build resilience against future pandemics. More investments are also needed to address pressures on health care services exacerbated by COVID-19, including mental health services, and to lay the ground for better human development outcomes and economic growth.
“The pandemic has shown that health systems need to be well funded and able to deal with shocks and surges,” said Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank. “Many countries in Latin America and the Caribbean have developed effective, innovative measures, including the expansion of telemedicine and telehealth services, increased the use of data in decision-making and new public-private partnerships that have expanded access to care during pandemic peaks. These innovations can be catalyzed, and propel broader, lasting reforms for better resilience in the health sector”.
Despite improvements in health care over the last 30 years, the Covid-19 pandemic encountered a region that faced many systemic challenges. Most healthcare systems in LAC underperform compared to the average for the Organization for Economic Cooperation and Development (OECD). Healthcare fragmentation is a key source of waste in the region, leading to duplication of tasks, substantially reducing system efficiency, and exacerbating inequalities. On average, health spending, although it grew in recent years, stands at only 25 percent of OECD countries’ expenditure per capita adjusted for purchasing power.
Limited health system capacity also impaired countries’ abilities to deal with shocks and surges in demands, as underinvestment in public health before the pandemic left health systems in LAC severely underprepared. The region has had one of the highest global rates of deaths and excess mortality due to COVID-19, and the pandemic has led to a significant increase of mental health conditions.
The publication was launched during an event organized by the Government of Chile and the World Bank, with the presence of the health and finance ministers of the region, high-level officials, and representatives of international organizations to discuss the challenges faced by health systems in the aftermath of the pandemic. The event culminated in a joint statement about the importance of investing in resilient health systems and mental health to strengthen human capital and the economy in Latin America and the Caribbean.
“For Chile it is very relevant to host this meeting, which is in line with the priorities of President Gabriel Boric’s government in Health, where we are working on three strategic lines for this period: reducing waiting times; Mental Health, which has worsened especially with the pandemic; and moving towards the reform of a Universal Health system that recognizes universal primary care as a central element, with a community approach, of favoring care and access through different mechanisms,” said Chile’s Minister of Health, Ximena Aguilera.
Since the outset of the pandemic, the World Bank has doubled its financial support to the health sector in the region. The World Bank’s Health, Nutrition and Population (HNP) portfolio in LAC totals US$ 3.9bn in commitments (29 operations), of which US$2.3bn (18 operations) are specifically aimed at strengthening the resiliency of health systems in the region. The World Bank is supporting new lending operations in Argentina, Chile, Colombia, the Dominican Republic, and Honduras via planned investments in primary healthcare, telemedicine, and health information and surveillance systems that are expected to contribute to the ability of health systems to effectively respond to future shocks including those related to climate change.
Baby foods take centre stage in push for more safety and quality
By DANIELA DE LORENZO
If we are what we eat, as the saying goes, food quality is key to our health. And as food production and trade increase in response to greater global demand, controls on safety and quality have become even more vital.
The impact of diet on health is hard to overstate. Obesity worldwide has almost tripled since 1975 and, in Europe, affects almost 60% of adults and nearly one in three children. Diabetes is also on the rise and Europe has a markedly high number of children with type 1 – 295 000 in 2021.
Eating a varied and healthy diet can enhance overall well-being and reduce the risk of long-term illness. In addition, consumers are demanding greater food-chain transparency following food-fraud incidents such as the contamination of infant milk formula with melamine in 2008, the discovery of fipronil in eggs in 2017 and sporadic outbreaks of salmonella.
‘Food safety systems in Europe are generally effective, but we believe that it is possible to further improve the safety and quality levels,’ said Dr Erwan Engel, research director at the French National Institute for Agriculture, Food and Environment (INRAE).
Engel coordinates the EU-funded SAFFI project that brings together major research organisations and infant-food producers from Europe and China. With babies, children and young people being more vulnerable and needing high-quality nutrition to grow, the project is investigating ways to ensure greater safety in production.
Other than breast milk, infant formulas and baby foods are the most important part of a child’s diet in the first year of life. Preventing microbial or chemical contamination in the processing chain is a priority.
60 million mouths
SAFFI is addressing food for the EU’s 15 million and China’s 45 million children under the age of three. The partners are focusing on four popular infant-food lines: formula, sterilised mixed vegetables with meat or fish, infant cereals and fruit purees.
The project has carried out tests on the premises of five participating international infant-food companies – Netherlands-based FrieslandCampina, HiPP in Germany, Greek producer YIOTIS and two Chinese companies, Beingmate and YFFC.
The aim is to identify the main risks from both microbial hazards, including bacteria, and potential chemical contaminants in the food chain.
Chemical contaminants include environmental pollutants such as dioxins or lead, crop-treatment residues like pesticides and substances generated during processing including furan.
‘We need to convince the industry that it is important to focus on chemicals too,’ said Engel. ‘Although the effects on health are not as immediate as for microbes, they can still be significant in the longer term.’
SAFFI also aims to help food producers and authorities predict where potential problems could arise and, as a result, reduce the threat of contamination at every stage of production.
Classical processes based on thermal treatments, for instance, could be replaced with pulse combustion dryers, radio frequency heating and high-pressure processing, which are better at sterilising foods while maintaining the optimal nutritional value of fresh products.
‘We check the effectiveness of these innovative processing technologies to control the growth, inhibition and inactivation of pathogens, as well as their ability to slow food degradation and limit the integration of certain chemicals,’ said Engel.
The food and drinks sector, which includes foods for infants, is a major contributor to the EU economy with exports of €110 billion in 2019. By investing in training and sharing know-how, SAFFI will help to improve safety standards in the EU and China and reduce potential barriers to trade.
It will cooperate with other research projects under the EU-China Food, Agriculture and Biotechnology (FAB) Flagship Initiative, with all seeking continued improvement in food safety control.
Such cooperation can increase EU-China commerce and give European food companies greater opportunities to expand on the international market. In addition, the standards laid down by SAFFI in the infant-food sector could be extended to other food categories, according to Engel.
When it comes to health, food variety and quality also count. A balanced diet can help prevent illnesses from arising in the first place. It can also enable people with serious diseases to heal and have more stable lives.
However, people respond differently to the same foods or nutrients, depending on genetic and lifestyle factors. These include stress, exercise levels, individual microbiome composition and exposure to environmental toxins.
The EU-funded NUTRISHIELD project has set out to create personalised diets tailored to individual biomarkers, with a particular focus on children with obesity and/or diabetes and on lactating mothers.
The project is analysing a range of biomarkers related to nutrition and health disorders, taking into account the way each child responds to different nutrients and food types.
NUTRISHIELD involves research and clinical partners from across Europe. The project is coordinated by a Swiss company called Alpes Lasers, which has developed specialised mid-infrared laser technology for use in clinical settings.
‘Unlike current processes used to analyse body fluids, laser technology can work with very small samples of urine – a necessity when little patients can only produce minimal quantities,’ said Miltos Vasileiadis, business developer and project manager at Alpes Lasers.
The company has provided project partners with laser technology used to build analysers for urine, breath and human milk. Samples collected are analysed at a molecular level, allowing nutritionists to give detailed, personalised and easy-to-follow advice.
This may include the amount of each food group an individual needs and how often, how much exercise and sleep are necessary and even which particular variety of fruit or grain is required for proper nutrition.
A study on young diabetes patients is running at the San Raffaele Hospital in Milan, Italy, while the Health Research Institute Hospital La Fe in Valencia, Spain is working with lactating mothers and newborns. Studies conducted at Radboud University in the Netherlands aim to understand how nutrition can assist and enhance cognitive development in children.
The tools developed by NUTRISHIELD are designed to be portable and easy to use, making biomarker analysis faster and more cost-effective. In the longer term, these could be used in different medical settings to assist patients of any age.
The EU’s FOOD 2030 research and innovation policy aims to transform food systems and ensure everyone has enough affordable, nutritious and safe food to live a healthy life.
The initiative covers the entire food system, linking primary production sectors (such as agriculture and fisheries) to food processing, retail and distribution, packaging, waste and recycling, catering services and consumption.
Research in this article was funded by the EU. This article was originally published in Horizon, the EU Research and Innovation Magazine.
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