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We underestimate this virus at our peril

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Despite the almost miraculous development of effective vaccines against COVID-19 in 2020, the virus continued to spread and mutate throughout the last year, with much of the blame placed on a lack of effective global collaboration as a key reason for the prolonged pandemic. 2021 also saw the launch of a UN-backed programme to help developing countries protect their populations against the virus, and steps were taken to prepare for future global health crises.

The UN could have been forgiven for saying ‘I told you so’ when it became clear in November that a fast-spreading COVID-19 variant, named after the Greek letter Omicron, was a cause for concern, seemingly spreading far more quickly than the dominant Delta variant.

But whilst the fears were understandable, the arrival of Omicron shouldn’t have been a surprise, given the consistent warnings from the UN that new mutations were inevitable, given the failure of the international community to ensure that everyone, not just the citizens of wealthy countries, are vaccinated.

Briefing journalists in mid-December, the WHO chief Tedros Adhanom Ghebreyesus, warned that Omicron was “spreading at a rate we have not seen with any previous variant…Surely we have learned by now, that we underestimate this virus at our peril.”

‘A catastophic moral failure’

In January, António Guterres, the UN Secretary-General, was already lamenting the self-defeating phenomenon of “vaccinationalism”, with many countries unwilling to look beyond their own borders when it comes to inoculations.

The head of the World Health Organization in Africa, Matshidiso Moeti, condemned “vaccine hoarding” which, she said, would only prolong and delay the continent’s recovery: “It is deeply unjust that the most vulnerable Africans are forced to wait for vaccines while lower-risk groups in rich countries are made safe”.

At the same time, WHO was prophetically warning that the longer it takes to suppress the spread of COVID-19, the greater the risk that new variants, more resistant to vaccines, emerge, and Tedros described the unequal distribution of vaccines as a “catastrophic moral failure”, adding that “the price of this failure will be paid with lives and livelihoods in the world’s poorest countries”.

As the months went by, the WHO continued to ram home the message. By July, with the emergence of the Delta variant, which became the dominant form of COVID-19, and the grim milestone of four million deaths attributed to the virus (this had risen to five million just four months later), Tedros pinned the blame squarely on a lack of equitable vaccine production and distribution.

In an attempt to support the most vulnerable, WHO spearheaded the COVAX initiative, which is the fastest, most coordinated, and successful global effort in history to fight a disease.

Funded by richer countries and private donors, who have raised more than $2 billion, COVAX was launched in the early months of the pandemic, to ensure that people living in poorer countries would not be left out, when successful vaccines came onto the market.

The rollout of vaccines to developing countries via the COVAX initiative, began with Ghana and Côte d’Ivoire in March, and Yemen, a war-torn country in desperate financial straits, received its first batch of vaccines in March, a moment health experts described as a game-changer in the fight against COVID-19. By April, batches of vaccines had been sent to more than 100 countries via COVAX.

However, the problem of vaccine inequity is far from solved: the WHO announced on 14 September that more than 5.7 billion vaccines doses had been administered globally, but only 2 per cent had gone to Africans.

Education, mental health, reproductive services

As well as directly affecting the health of millions of people around the world, the pandemic has had many knock-on effects, from the treatment of diseases, to education and mental health.

Cancer diagnosis and treatment, for example, was severely disrupted in around half of all countries; over a million people have missed out on essential tuberculosis care; widening inequalities prevented those in poorer countries from accessing AIDS services; and reproductive services were upended for millions of women.

UN agencies believe that, in South Asia alone, severe disruptions in health services due to the COVID-19 pandemic may have resulted in an additional 239,000 child and maternal deaths last year, whilst in Yemen, the deepening impact of the pandemic have led to a catastrophic situation in which a woman dies in childbirth every two hours.

A heavy toll on children

In terms of mental health, the last year has had a major impact worldwide, but the toll has been particularly heavy on children and young people. The UN children’s agency (UNICEF) revealed in March that children were now living a “devastating and distorted new normal”, and that progress has gone backwards across virtually every key measure of childhood.

Children in developing countries have been particularly affected, with rates of child poverty estimated to have risen by around 15 per cent: an additional 140 million children in these countries are also projected to be in households living below the poverty line.

As for education, the effects have been devastating. 168 million schoolchildren worldwide missed out on almost a year of classes since the beginning of the pandemic, and more than one in three, were unable to access remote learning, when schools were closed.

UNICEF reiterated its message from 2020 that school closures must be a matter of last resort. The agency’s chief, Henrietta Fore, said in January that “no effort should be spared” to keep children in school. “Children’s ability to read, write and do basic math has suffered, and the skills they need to thrive in the 21st century economy have diminished”, she declared.

In August, following the Summer holidays, UNICEF and WHO issued recommendations for a safe return to the classroom, which included making school staff part of nationwide coronavirus vaccination plans, and for the immunization of all children aged 12 and above.

COVID-19 not ‘a one-off disaster’

Alongside calls for greater vaccine equity during the year, the UN repeatedly drove home the importance of devising a new way to respond to future pandemics, citing the patent failure of the international response to COVID-19.

A series of meetings were convened by the WHO, involving scientists and policymakers, and in May, the creation of an international hub for pandemic control in Berlin was announced, aimed at ensuring better preparedness and transparency in the fight against likely future global health threats.

In July, the G20 group of the world’s biggest economies published an independent report on pandemic preparedness, which concluded that global health security is dangerously underfunded.

The panel’s co-chair, Singaporean politician Tharman Shanmugaratnam, noted that COVID-19 was not a one-off disaster, and that the funding shortfall meant that “we are consequently vulnerable to a prolonged COVID-19 pandemic, with repeated waves affecting all countries, and we are also vulnerable to future pandemics”.

However, the year has ended on a positive note with regards to international collaboration: at a rare special session of the WHO’s World Health Assembly at the end of November, countries agreed to develop a new global accord on pandemic prevention.

WHO chief Tedros acknowledged that the there is still a heavy workload ahead but he hailed the agreement as a “cause for celebration, and cause for hope, which we will need”.

Health & Wellness

High blood pressure? A heart app prescribes musical therapy

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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.

Heartfelt tunes

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.

Personal perspective

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.

Shifting views

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.

Musical escapes

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.

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Pandemic shock must propel stronger health systems in Latin America and the Caribbean

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Health Ministers from the region; authorities of the World Health Organization and the Pan American Health Organization; and World Bank authorities during the ministerial meeting held on January 24, 2022 in Santiago, Chile. Photo: The World Bank

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.

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Baby foods take centre stage in push for more safety and quality

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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.

Quality controls

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.

Healthy trade-off

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.

Tailor-made diets

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.

Laser-sharp

‘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.

FOOD 2030

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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