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Tag: Pandemic

  • Four years after shelter-in-place, covid-19 misinformation persists

    Four years after shelter-in-place, covid-19 misinformation persists

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    From spring break parties to Mardi Gras, many people remember the last major “normal” thing they did before the novel coronavirus pandemic dawned, forcing governments worldwide to issue stay-at-home advisories and shutdowns.

    Even before the first case of covid-19 was detected in the U.S., fears and uncertainties helped spur misinformation’s rapid spread. In March 2020, schools closed, employers sent staff to work from home, and grocery stores called for physical distancing to keep people safe. But little halted the flow of misleading claims that sent fact-checkers and public health officials into overdrive.

    Some people falsely asserted covid’s symptoms were associated with 5G wireless technology. Faux cures and untested treatments populated social media and political discourse. Amid uncertainty about the virus’s origins, some people proclaimed covid didn’t exist at all. PolitiFact named “downplay and denial” about the virus its 2020 “Lie of the Year.” 

    Four years later, people’s lives are largely free of the extreme public health measures that restricted them early in the pandemic. But covid misinformation persists, although it’s now centered mostly on vaccines and vaccine-related conspiracy theories.

    PolitiFact has published more than 2,000 fact checks related to covid vaccines alone.

    “From a misinformation researcher perspective, [there has been] shifting levels of trust,” said Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security. “Early on in the pandemic, there was a lot of: ‘This isn’t real,’ fake cures, and then later on, we see more vaccine-focused mis- and disinformation and a more partisan type of disinformation and misinformation.”

    Here are some of the most persistent covid misinformation narratives we see today:

    A loss of trust in the vaccines

    Covid vaccines were quickly developed, with U.S. patients receiving the first shots in December 2020, 11 months after the first domestic case was detected.

    Experts credit the speedy development with helping to save millions of lives and preventing hospitalizations. Researchers at the University of Southern California and Brown University calculated that vaccines saved 2.4 million lives in 141 countries starting from the vaccines’ rollout through August 2021 alone. Centers for Disease Control and Prevention data shows there were 1,164 U.S. deaths provisionally attributed to covid the week of March 2, down from nearly 26,000 at the pandemic’s height in January 2021, as vaccines were just rolling out.

    But on social media and in some public officials’ remarks, misinformation about covid vaccine efficacy and safety is common. U.S. presidential candidate Robert F. Kennedy Jr. has built his 2024 campaign on a movement that seeks to legitimize conspiracy theories about the vaccines. PolitiFact made that its 2023 “Lie of the Year.”

    PolitiFact has seen claims that spike proteins from vaccines are replacing sperm in vaccinated males. (That’s false.) We’ve researched the assertion that vaccines can change your DNA. (That’s misleading and ignores evidence). Social media posts poked fun at Kansas City Chiefs tight end Travis Kelce for encouraging people to get vaccinated, asserting that the vaccine actually shuts off recipients’ hearts. (No, it doesn’t.) And some people pointed to an American Red Cross blood donation questionnaire as evidence that shots are unsafe. (PolitiFact rated that False.)

    Experts say this misinformation has real-world effects.

    A September 2023 survey by KFF found that 57% of Americans “say they are very or somewhat confident” in covid vaccines. And those who distrust them are more likely to identify as politically conservative: Thirty-six percent of Republicans compared with 84% of Democrats say they are very or somewhat confident in the vaccine.

    Immunization rates for routine vaccines for other conditions have also taken a hit. Measles had been eradicated for more than 20 years in the U.S. but there have been recent outbreaks in states including Florida, Maryland, and Ohio. Florida’s surgeon general has expressed skepticism about vaccines and rejected guidance from the CDC about how to contain potentially deadly disease spread.

    The vaccination rate among kindergartners has declined from 95% in the 2019-20 school year to 93% in 2022-23, according to the CDC. Public health officials have set a 95% vaccination rate target to prevent and reduce the risk of disease outbreaks. The CDC also found exemptions had risen to 3%, the highest rate ever recorded in the U.S.

    Unsubstantiated claims that vaccines cause deaths or other Illness

    PolitiFact has seen repeated and unsubstantiated claims that covid vaccines have caused mass numbers of deaths.

    A recent widely shared post claimed 17 million people had died because of the vaccine, despite contrary evidence from multiple studies and institutions such as the World Health Organization and CDC that the vaccines are safe and help to prevent severe illness and death. 

    Another online post claimed the booster vaccine had eight strains of HIV and would kill 23% of the population. Vaccine manufacturers publish the ingredient lists; they do not include HIV. People living with HIV were among the people given priority accessduring early vaccine rollout to protect them from severe illness.

    Covid vaccines also have been blamed for causing Alzheimer’s and cancer. Experts have found no evidence the vaccines cause either conditions.

    “​​You had this remarkable scientific or medical accomplishment contrasted with this remarkable rejection of that technology by a significant portion of the American public,” said Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. 

    More than three years after vaccines became available, about 70% of Americans have completed a primary series of covid vaccination, according to CDC figures. About 17% have gotten the most recent bivalent booster.

    False claims often pull from and misuse data from the Vaccine Adverse Event Reporting System. The database, run by the CDC and the FDA, allows anybody to report reactions after any vaccine. The reports themselves are unverified, but the database is designed to help researchers find patterns for further investigation.

    An October 2023 survey published in November by the Annenberg Public Policy Center at the University of Pennsylvania found 63% of Americans think “it is safer to get the covid-19 vaccine than the covid-19 disease” — that was down from 75% in April 2021.

    Celebrity deaths falsely attributed to vaccines

    Betty White, Bob Saget, Matthew Perry, and DMX are just a few of the many celebrities whose deaths were falsely linked to the vaccine. The anti-vaccine film “Died Suddenly” tried to give credence to false claims that the vaccine causes people to die shortly after receiving it.

    Céline Gounder, editor-at-large for public health at KFF Health News and an infectious disease specialist, said these claims proliferate because of two things: cognitive bias and more insidious motivated reasoning. 

    “It’s like saying ‘I had an ice cream cone and then I died the next day; the ice cream must have killed me,” she said. And those with preexisting beliefs about the vaccine seek to attach sudden deaths to the vaccine.

    Gounder experienced this personally when her husband, the celebrated sports journalist Grant Wahl, died while covering the 2022 World Cup in Qatar. Wahl died of a ruptured aortic aneurysm but anti-vaccine accounts falsely linked his death to a covid vaccine, forcing Gounder to publicly set the record straight.

    “It is very clear that this is about harming other people,” said Gounder, who was a guest at United Facts of America in 2023. “And in this case, trying to harm me and my family at a point where we were grieving my husband’s loss. What was important in that moment was to really stand up for my husband, his legacy, and to do what I know he would have wanted me to do, which is to speak the truth and to do so very publicly.”

    Out-of-control claims about government control

    False claims that the pandemic was planned by government leaders and those in power abound.

    At any given moment, Microsoft Corp. co-founder and philanthropist Bill Gates, World Economic Forum head Klaus Schwab, or Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, are blamed for orchestrating pandemic-related threats.

    In November, Rep. Matt Rosendale (R-Mont.) falsely claimed Fauci “brought” the virus to his state a year before the pandemic. There is no evidence of that. Gates, according to the narratives, is using dangerous vaccines to push a depopulation agenda. That’s false. And Schwab has not said he has an “agenda” to establish a totalitarian global regime using the coronavirus to depopulate the Earth and reorganize society. That’s part of a conspiracy theory that’s come to be called “The Great Reset” that has been debunked many times.

    The United Nations’ World Health Organization is frequently painted as a global force for evil, too, with detractors saying it is using vaccination to control or harm people. But the WHO has not declared that a new pandemic is happening, as some have claimed. Its current pandemic preparedness treaty is in no way positioned to remove human rights protections or restrict freedoms, as one post said. And the organization has not announced plans to deploy troops to corral people and forcibly vaccinate them. The WHO is, however, working on a new treaty to help countries improve coordination in response to future pandemics.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • WHO and IPU renew partnership to promote and protect the health, well-being of all people

    WHO and IPU renew partnership to promote and protect the health, well-being of all people

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    The Inter-Parliamentary Union (IPU) and WHO today signed a new Memorandum of Understanding, reaffirming the critical role that parliamentarians play in enabling good health to foster stable and equitable societies.

    The new five-year memorandum was signed by Mr Martin Chungong, IPU Secretary General, and Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the 148th IPU Assembly, which is taking place in Geneva from 23 to 27 March 2024. Both organizations commit to continue working together to promote, provide and protect the health and well-being of all people, everywhere. It renews a historic commitment made in 2018 to leverage their respective scientific and political mandates to address persistent and emerging challenges facing populations worldwide.

    The memorandum reinforces critical areas of cooperation that align with global health priorities, namely universal health coverage, global health security, health promotion and reducing health inequities, especially in relation to sexual and reproductive health and rights.

    It also adds new cross-cutting areas of work, including responding to climate change, support to the government-led negotiations on a new pandemic agreement, and sustainable financing for health. This includes collaboration on this year’s first WHO Investment Round to overcome the historic imbalance between assessed and voluntary contributions, the distortions this creates, and the issues WHO faces with insufficiently predictable and flexible financing.

    WHO Member States are staging their latest round of negotiations on an international agreement on pandemic prevention, preparedness and response before scheduled consideration of a proposal for adoption at the 77th World Health Assembly in May 2024. The proposed agreement aims to provide a basis for international cooperation that was lacking during the COVID-19 pandemic. Parliaments are instrumental in supporting the process towards adoption, as well as in guiding the follow-up considerations at a national level.

    Parliamentarians play an essential role in setting policies, prioritizing investments and ensuring accountability to advance public health. Political leadership in service of the public saves lives and protects health by ensuring communities and countries are better prepared and designed to be healthier and safer. WHO looks forward to working even closer with the IPU and parliamentarians worldwide to advance efforts to protect and promote people’s well-being, from negotiating a pandemic agreement to prevent a repeat of the impacts of the COVID-19 pandemic, to investing in universal health coverage.”


    Dr. Tedros Adhanom Ghebreyesus, WHO Director-General

    Mr Martin Chungong, IPU Secretary General, said: “The COVID-19 pandemic was not an isolated occurrence. Another pandemic will happen. It is not a question of if, but when. Parliaments have a key role, which is why we will continue working with WHO at all levels to raise awareness among parliamentarians on the pandemic agreement and other global health processes; to give parliamentarians access to technical expertise and information; and to support them to pursue their national health priorities and back them with the necessary legislation and resources.”

    Milestones of the IPU and WHO’s previous collaboration include a landmark IPU resolution in 2019 on achieving universal health coverage, a number of practical resources for parliamentarians such as a recent handbook on universal health coverage, and numerous events which have brought together health experts and parliamentarians.

    Source:

    The World Health Organization

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  • Study explores factors contributing to rural-urban difference in cervical cancer screening

    Study explores factors contributing to rural-urban difference in cervical cancer screening

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    Study reveals English proficiency, income, and area-level unemployment are among the influential factors and highlights need for tailored interventions to increase screening rates. 

    In the United States, community health centers (CHCs) mainly serve historically marginalized populations. New research reveals that both before and during the COVID-19 pandemic, females receiving care at rural CHCs were less likely to be up to date with cervical cancer screening than those in urban CHCs. Factors associated with these differences included the proportion of patients with limited English proficiency and low income, as well as area-level unemployment and primary care physician density. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society. 

    In the analysis of data from CHCs in operation across all 50 states and the District of Columbia, investigators found that 38.2% of females receiving care at rural CHCs were up to date on cervical cancer screening during 2014–2019, compared with 43.0% of females receiving care at urban CHCs. This difference widened during the pandemic to 43.5% versus 49.0%. 

    The rural-urban difference in screening was mostly explained by differences in CHC-level proportions of patients with limited English proficiency. This accounted for 55.9% of the difference. Differences in the proportions of patients with income below the poverty level accounted for 12.3% of the rural-urban difference in screening, and the proportion of females aged 21–64 years accounted for 9.8% of the difference. Differences in area-level unemployment accounted for 3.4% of the difference, and differences in primary care physician density accounted for 3.2% of the difference. Differences between rural-urban CHCs were counterbalanced (meaning that differences were reduced) by the proportion of uninsured patients and patients with Medicaid coverage. (There were lower proportions of uninsured or Medicaid patients in rural CHCs. If rural CHCs had equal or larger proportions of uninsured or Medicaid patients as urban CHCs, the rural-urban gap would have been larger.) 

    The contributing factors’ effects on rural-urban differences in cervical cancer screening generally increased during the pandemic in 2020–2021. 

    “In our study, a higher proportion of patients best served in a language other than English in urban CHCs was the top contributor to rural-urban differences in up-to-date cervical cancer screening. A possible explanation for this finding might be greater access to language translation services in urban CHCs, as clinics serving a greater proportion of racial and ethnic minority groups are more likely to provide better translation services,” said lead author Hyunjung Lee, PhD, MS, MPP, MBA, of the American Cancer Society.

    Increasing access to language translation services or adaptation of patient navigator interventions might improve completion and timeliness of cancer screening in CHCs and among patients with limited English proficiency, especially in rural CHCs. Insufficient funding remains a challenge to initiate and manage these activities, particularly in rural CHCs.” 

    Hyunjung Lee, PhD, MS, MPP, MBA, Lead Author, American Cancer Society

    Dr. Lee stressed that the prevalence of cervical cancer screening in CHCs is generally lower than in the general population, underscoring the need to improve cancer screening rates in both rural and urban CHCs to detect the disease at earlier stages, when treatment is most successful.

    Source:

    Journal reference:

    Lee, H., et al. (2024). Factors contributing to differences in cervical cancer screening in rural and urban community health centers. Cancer. doi.org/10.1002/cncr.35265.

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  • WHO’s global network for coronavirus expertise

    WHO’s global network for coronavirus expertise

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    WHO has launched a new network for coronaviruses, CoViNet, to facilitate and coordinate global expertise and capacities for early and accurate detection, monitoring and assessment of SARS-CoV-2, MERS-CoV and novel coronaviruses of public health importance.

    CoViNet expands on the WHO COVID-19 reference laboratory network established during the early days of the pandemic. Initially, the lab network was focused on SARS-CoV-2, the virus that causes COVID-19, but will now address a broader range of coronaviruses, including MERS-CoV and potential new coronaviruses. CoViNet is a network of global laboratories with expertise in human, animal and environmental coronavirus surveillance.

    The network currently includes 36 laboratories from 21 countries in all 6 WHO regions.

    Representatives of the laboratories met in Geneva on 26 – 27 March to finalize an action plan for 2024-2025 so that WHO Member States are better equipped for early detection, risk assessment, and response to coronavirus-related health challenges.

    The CoViNet meeting brings together global experts in human, animal, and environmental health, embracing a comprehensive One Health approach to monitor and assess coronavirus evolution and spread. The collaboration underscores the importance of enhanced surveillance, laboratory capacity, sequencing, and data integration to inform WHO policies and support decision-making.

    Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high threat coronaviruses like SARS, MERS and COVID-19 and to detect novel coronaviruses. This new global network for coronaviruses will ensure timely detection, monitoring and assessment of coronaviruses of public health importance.”


    Dr. Maria Van Kerkhove, Acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention

    Data generated through CoViNet’s efforts will guide the work of WHO’s Technical Advisory Groups on Viral Evolution (TAG-VE) and Vaccine Composition (TAG-CO-VAC) and others, ensuring global health policies and tools are based on the latest scientific information.

    Source:

    The World Health Organization

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  • Experts call for mandatory indoor air quality standards to boost health and economy

    Experts call for mandatory indoor air quality standards to boost health and economy

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    There should be mandatory indoor air quality standards, say an international group of experts led by Professor Lidia Morawska.

    Professor Morawska, Vice-Chancellor Fellow at the University of Surrey and Distinguished Professor at Queensland University of Technology, led the appeal to the World Health Organization to recognize the airborne transmission of the virus which causes COVID-19 early in the pandemic – and help minimize it.

    Now, in a paper published by the prestigious journal Science, Professor Morawska’s international team recommends setting standards for ventilation rate and three key indoor pollutants: carbon dioxide (CO2), carbon monoxide (CO) and PM2.5, which are particles so small they can lodge deep in the lungs and enter the bloodstream. 

    Professor Morawska said: 

    “Most countries do not have any legislated indoor air quality performance standards for public spaces that address concentration levels of indoor air pollutants. 

    “To have practical value, indoor air quality standards must be implementable by designing new buildings that are built, operated and maintained to standard or retrofitted to meet the standards.

    “While there is a cost in the short term, the social and economic benefits to public health, wellbeing and productivity will likely far outweigh the investment in cost in achieving clean indoor air.” 

    People living in urban and industrialized societies spend more than 90% of their time indoors, yet there are few controls over the quality of the air they breathe there. 

    Professor Prashant Kumar, co-author of the paper and Director of the University of Surrey’s Global Centre for Clean Air Research (GCARE), said: 

    “There’s no doubt that managing indoor air quality is complicated and modeling is difficult because every space is different. But this can’t be an excuse. We propose solutions using readily available, inexpensive monitors, focusing on three indicator pollutants.” 

    CO2 is one of the easiest parameters to measure and can serve as a proxy for occupant-emitted contaminants and pathogens, as well as being useful for effectively assessing ventilation quality. “By limiting levels of CO2 indoors, we can reduce the spread of diseases spread by respiratory pathogens, like COVID-19, colds and flu.” 


    Professor Catherine Noakes, Professor of Environmental Engineering for Buildings, University of Leeds

     The paper ‘Indoor air quality standards in public buildings’ is published in Science.

    This research demonstrates the University of Surrey’s contribution to the United Nations Sustainable Development Goals (SDG). These include SDG 3 (Good Health and Wellbeing) and SDG 11 (Sustainable Cities and Communities).

    Source:

    Journal reference:

    Morawska, L., et al. (2024) Mandating indoor air quality for public buildings. Science. doi.org/10.1126/science.adl0677.

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  • Global leaders set ambitious targets to end tuberculosis epidemic

    Global leaders set ambitious targets to end tuberculosis epidemic

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    World leaders at the United Nations General Assembly’s High-Level Meeting on Tuberculosis have approved a Political Declaration with ambitious new targets for the next five years to advance the global efforts towards ending the TB epidemic.

    The targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027. 

    For millennia, our ancestors have suffered and died with tuberculosis, without knowing what it was, what caused it, or how to stop it. Today, we have knowledge and tools they could only have dreamed of. The political declaration countries approved today, and the targets they have set, are a commitment to use those tools, and develop new ones, to write the final chapter in the story of TB.”


    Dr, Tedros Adhanom Ghebreyesus

    Progress made towards 2018 targets

    Taking stock of progress towards targets set in 2018 for a five-year period, WHO reported that while global efforts to combat TB have saved over 75 million lives since the year 2000, they fell short of reaching the targets, mainly due to severe disruptions to TB services caused by the COVID-19 pandemic and ongoing conflicts. Only 34 million people of the intended 40 million people with TB were reached with treatment between 2018 and 2022. For TB preventive treatment, the situation was even more grim, with only 15.5 million of the 30 million people targeted to be reached with preventive treatment accessing it.

    Funding for TB services in low- and middle-income countries fell from US$ 6.4 billion in 2018 to US$ 5.8 billion in in 2022, representing a 50% financing gap in implementing the required TB programmes. Annual funding for TB research ranged from US$ 0.9 billion to US$ 1.0 billion between 2018 and 2022, which is just half of the target set in 2018.

    This has placed an even heavier burden on those affected, especially the most vulnerable. Today, TB remains one of the world’s top infectious killers: annually more than 10 million people fall sick, and over 1 million lose their lives to this preventable and curable disease. Drug-resistant TB continues to be a major contributor to antimicrobial resistance with close to half a million people developing drug-resistant TB every year.

    “Uniting around the TB response by world leaders, for a second time, provides an opportunity to accelerate action and strengthen health systems capable of not only addressing the TB epidemic, but also protecting the broader health and well‑being of communities, strengthening pandemic preparedness and building on lessons learnt during the COVID-19 pandemic,” said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Averting TB-related financial hardship and preventing the development of the disease in vulnerable groups will help diminish inequities within and between countries, contributing to the achievement of the Sustainable Development Goals.”

    TB incidence and deaths have risen between 2020 and 2021 but coordinated efforts by countries, WHO and partners are resulting in a recovery of essential services.

    Launch of the TB vaccine accelerator council

    In the lead-up to this historic meeting, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, officially launched the TB vaccine accelerator council to facilitate the development, licensing and use of new TB vaccines. The Council, supported by the WHO secretariat, will be led by a ministerial board, consisting of nine members who will serve on a rotating basis, for a term of two years. The Council will also have subsidiary bodies to support its interaction and engagement with different sectors and stakeholders broadly, including the private sector, scientists, philanthropy, and civil society.

    BCG is currently the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and young children, it does not adequately protect adolescents and adults, who account for the majority (>90%) of TB transmission globally.

    The Council aims to identify innovative sustainable financing, market solutions and partnerships across public, private, and philanthropic sectors. It will leverage platforms like the African Union, Association of Southeast Asian Nations (ASEAN), BRICS countries (Brazil, Russian Federation, India, China and South Africa), G20, G7 and others to strengthen commitment and actions for novel TB vaccine development and access.

    Source:

    The World Health Organization

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  • Global fight against TB misses 2020 WHO milestones, despite progress in certain age groups

    Global fight against TB misses 2020 WHO milestones, despite progress in certain age groups

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    In a recent study published in The Lancet Infectious Diseases, researchers assessed the global, national, and regional burden and trends in tuberculosis.

    Study: Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Image Credit: SewCreamStudio/Shutterstock.comStudy: Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Image Credit: SewCreamStudio/Shutterstock.com

    Background

    Tuberculosis is a significant contributor to the global disease burden despite being a preventable and curable disease. It accounts for over a million deaths each year, and in 2019, it was the leading cause of death due to a single infectious agent. Global initiatives to address tuberculosis have been prominent since the 1990s.

    The World Health Organization (WHO) End TB Strategy aims to accelerate progress by reducing tuberculosis incidence and deaths by 90% and 95% between 2015 and 2035.

    Therefore, evaluations of the trends in the global tuberculosis burden are necessary to assess progress in achieving these targets.

    About the study

    In the present study, researchers examined the levels and trends in global tuberculosis burden and age-specific achievement of incidence and mortality milestones. They used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021.

    The team included data on vital registration, mortality surveillance, and minimally invasive tissue sample diagnoses for tuberculosis mortality in those without human immunodeficiency virus (HIV) coinfection.

    The cause-of-death ensemble modeling generated mortality estimates in those without HIV coinfection by age, sex, location, and year. Further, a population-attributable fraction approach was used to estimate age-specific deaths among those with HIV.

    In parallel, age-specific tuberculosis prevalence, incidence, and mortality were modeled using disease-model Bayesian meta-regression. Tuberculosis deaths attributable to risk factors were computed.

    Further, the impact of the coronavirus disease 2019 (COVID-19) pandemic on mortality was evaluated for countries with at least 10 tuberculosis deaths in 2019 for each age group.

    Tuberculosis incidence and mortality estimates were aggregated by HIV status, and all-form tuberculosis burden estimates were presented for five age groups – < 5, 5–14, 15–49, 50–69, and ≥ 70 years. Incidence- and mortality-specific annualized rates of change (ARCs) were reported.

    Findings

    Overall, 9.4 and 1.35 million tuberculosis cases and deaths occurred in 2021, respectively. Of these, tuberculosis and HIV coinfection cases accounted for a million cases and 205,000 deaths. The age-standardized incidence and mortality rates were 115 and 16.2 per 100,000 population, respectively. These rates declined by 37% and 61.1% between 1990 and 2021.

    In 2021, 3.8% of incident cases and 4.5% of deaths were reported in those under five years, and 4.7% of cases and 1.5% of deaths occurred in the 5–14 age group. Most cases (54.9%) and deaths (36.4%) in 2021 occurred in the 15–49 age group.

    In 2021, incidence rates exceeded 100 per 100,000 individuals in those aged five or younger across 34 countries and 5–14 across 14 countries.

    Further, incidence rates surpassed 500 per 100,000 individuals in the 15–49, 50–69, and ≥ 70 age groups in nine, 33, and 50 countries, respectively.

    Mortality rates were greater than 25 per 100,000 individuals in the < 5, 5–14, and 15–49 age groups in 20, 1, and 37 countries, respectively. Notably, mortality rates exceeding 300 per 100,000 individuals were observed in the 50–69 and ≥ 70 age groups in eight and 44 countries, respectively.

    ARCs in tuberculosis incidence were the largest in those aged <5 and 5–14 between 2020 and 2021, reducing by 4.1% and 3.7%, respectively, whereas reductions in adult age groups were around 2%.

    Moreover, the largest ARCs for mortality rates were observed in the same age groups. Central Asia and Central and Eastern Europe had the largest age-standardized ARCs between 2010 and 2021.

    Globally, all-age incidence rates reduced by 6.26% between 2015 and 2020, with a 4.9% decline in males and 7.9% in females. In the same period, global deaths due to tuberculosis declined by 11.9%, with a greater change in females (13.8%). Global tuberculosis deaths decreased to one million after removing the cumulative effects of risk factors (diabetes, smoking, and alcohol use).

    Forty-one countries were included in the analysis of the impact of COVID-19. Accordingly, 50,900 deaths due to tuberculosis were expected in 2020 compared to 45,500 deaths observed, corresponding to 5,340 fewer deaths than expected.

    Twenty countries continued to report data through 2021. In these countries, 39,600 deaths were expected compared to 39,000 observed.

    Conclusions

    The first WHO End TB interim milestones were not achieved in 2020, with only 6% and 12% reductions in incidence and mortality rates between 2015 and 2020, respectively.

    There was differential progress across age groups; people under 15 showed the sharpest decreases, whereas the older groups had minimal declines.

    The End TB incidence and mortality milestones were reached in 2020 by only 15 and 17 countries, respectively.

    As such, control programs should evaluate these countries to explore the drivers of their progress. Moreover, the impact of the COVID-19 pandemic was heterogeneous and uncertain, warranting additional data.

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  • Abortion, FDA’s authority, and return to 1873 obscenity law

    Abortion, FDA’s authority, and return to 1873 obscenity law

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    Lawyers from the conservative Christian group that won the case to overturn Roe v. Wade are returning to the U.S. Supreme Court on Tuesday in pursuit of an urgent priority: shutting down access to abortion pills for women across the country.

    The case challenges the FDA’s regulation of mifepristone, a prescription-only drug approved in 2000 with a stellar safety record that is used in 63% of all U.S. abortions.

    Viewed across decades of anti-abortion activism, the case brought by the Alliance Defending Freedom represents a “moonshot” couched in technical arguments about pharmaceutical oversight and the resuscitation of an 1873 anti-obscenity law. A victory would lay the groundwork for a de facto nationwide abortion ban.

    Abortion is illegal in 14 states, but abortion pills have never been more widely available.

    During the covid-19 pandemic, the FDA suspended — and later formally lifted — the requirement that patients be at a health care facility when taking mifepristone, the first of two pills used in medication abortion. Physicians can now prescribe the drug online through telemedicine and pharmacies can dispense it through the mail.

    “You don’t need to be handed the pill in the office,” said Linda Prine, a family medicine physician, sitting on a couch in her Manhattan apartment answering texts and calls from patients about abortion care.

    “It’s very effective,” she said. “I don’t even have medications that are 98 to 99% effective. Our blood pressure medicines aren’t effective like that.”

    Prine, a co-founder of the Miscarriage and Abortion Hotline, works with other doctors operating under New York state’s shield law to prescribe and send abortion pills to people across the country. A review of Prine’s call log, stripped of personal information, showed hundreds of requests for pills from Texas, Louisiana, Tennessee, and other states where it is illegal for women to stop a pregnancy.

    Anti-abortion groups unsuccessfully petitioned the FDA at least twice before, in 2002 and 2019, to revoke mifepristone’s approval and curtail its availability. But in November 2022, following its victory in overturning federal abortion rights, the Alliance Defending Freedom filed a federal lawsuit in Amarillo, Texas, claiming the FDA’s safety review of mifepristone was flawed.

    U.S. District Judge Matthew Kacsmaryk, who was appointed by President Donald Trump and openly opposes abortion, ruled to invalidate the FDA’s approval of mifepristone. An appeals court later said the drug should remain available, but it reinstated restrictions, including prohibitions on telehealth prescriptions and mailing the medication. That ruling was put on hold while the Supreme Court considers the case.

    The Biden administration and a manufacturer of mifepristone, Danco Laboratories, have argued in legal filings to the Supreme Court that federal judges do not have the scientific and health expertise to evaluate drug safety and that allowing them to do so undermines the FDA’s regulatory authority.

    That view is supported by food and drug legal scholars who wrote in court filings that the lower courts had replaced the “FDA’s scientific and medical expertise with the courts’ own interpretations of the scientific evidence.” In doing so, they wrote, the courts “upend the drug regulatory scheme established by Congress and implemented by FDA.”

    In his ruling, Kacsmaryk cited two studies purporting to show an increase in emergency room visits and a greater risk of hospitalizations from medication abortion. They were retracted in February by medical publisher Sage Perspectives. The journal said the researchers erred in their methodology and analysis of the data and invalidated the papers “in whole or in part.”

    The research, supported by the Charlotte Lozier Institute, an anti-abortion group that filed a brief in the mifepristone case, “made claims that were not supported by the data,” said Ushma Upadhyay, a professor of reproductive sciences at the University of California-San Francisco.

    Legal scholars say the Supreme Court’s conservative justices have demonstrated a willingness to accept discredited abortion-related health claims. Justice Samuel Alito, writing the majority opinion in Dobbs v. Jackson Women’s Health Organization, which overturned the constitutional right to abortion, cited statements about harm to maternal health presented by the state of Mississippi that contradict mainstream medical consensus.

    “If this case is successful, it will be because the Supreme Court decided to ignore evidence that demonstrated mifepristone’s safety and said to a federal agency, the expert on drug safety, ‘You were wrong,’” said Rachel Rebouché, dean of Temple University Beasley School of Law.

    The mifepristone case crystallizes “the politicization of science” in abortion regulation, Rebouché said. “But the stakes are getting higher as we have courts willing to strip federal agencies of their ability to make expert decisions.”

    Rebouché said that if the Supreme Court overrides the FDA’s expertise in regulating a 24-year-old drug like mifepristone, anti-abortion groups, like Students for Life of America, could find judges receptive to false claims that birth control pills, intrauterine devices, emergency contraception, and other forms of hormonal birth control cause abortion. They do not, according to reproductive scientists and U.S. and international regulatory agencies.

    Justice Clarence Thomas wrote in his concurring opinion in Dobbs that the Supreme Court should reconsider the 1965 decision that guaranteed a constitutional right to contraception, Griswold v. Connecticut, and decide whether to return the power to allow or regulate access to birth control to the states.

    Tucked into the Alliance Defending Freedom’s filings is what scholars describe as an audacious legal strategy once on the fringes of the conservative Christian movement: an appeal to the Supreme Court’s conservative members to determine that the Comstock Act, a dormant 1873 anti-vice law, effectively bans medical and procedural abortion nationwide.

    Passed at a time when the federal government did not give women the right to vote and the prevailing medical literature summed up women’s sexuality by saying that “the majority of women (happily for them) are not very much troubled with sexual feelings of any kind,” the long unenforced law carried a five-year prison sentence for anyone mailing “every article, instrument, substance, drug, medicine or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.”

    References to the Comstock Act appear throughout anti-abortion legal filings and rulings: Kacsmaryk wrote that the act “plainly forecloses mail-order abortion in the present”; the 5th Circuit Court of Appeals wrote if Comstock was “strictly understood” then “there is no public interest in the perpetuation of illegality”; Republican attorneys general threatened legal action against Walgreens and CVS last year citing Comstock as did anti-abortion cases in New Mexico and Texas.

    “State attorneys general need to go after and prosecute those who are illegally mailing abortion drugs into their state,” said Kristan Hawkins, president of Students for Life of America.

    “It’s very simple. If your state has passed a law saying that preborn human beings deserve, at the very minimum, the right not to be starved and killed,” she said, “then those who are committing those crimes and violating the federal Comstock Act by shipping chemical abortion pills over state lines, there should be consequences.”

    Tracking abortion pills by mail is difficult — and that’s the point, Rebouché said.

    “These more diffuse and mobile ways to terminate a pregnancy,” she said, “really threaten the control that anti-abortion advocates seek to exercise over who and where and how someone can seek an abortion.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Overweight and obesity in 3- and 4-year-olds has decreased after the pandemic

    Overweight and obesity in 3- and 4-year-olds has decreased after the pandemic

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    The prevalence of overweight and obesity in the group of 3- and 4-year-olds in Sweden has decreased after the pandemic. The increase during the pandemic thus appears to have been temporary. These are the findings of a study conducted at the University of Gothenburg and Uppsala University.

    The study, published in the journal JAMA Pediatrics, is based on data on 50,833 children aged 3-5 years. Healthcare data about the children are sourced from regular check-ups at pediatric healthcare centers, BVC. Participating regions were Dalarna, Jönköping County and Sörmland.

    The researchers have previously been able to demonstrate increased overweight and obesity during the pandemic among 3- and 4-year-olds in Sweden. According to the current study, today’s 3- and 4-year-olds are at about the same levels as 3- and 4-year-olds before the pandemic. The group of 5-year-olds has not had similar weight changes.

    The studied time periods are before the COVID-19 pandemic (up to and including April 2020), early pandemic (May 2020-May 2021), late pandemic (June 2021-March 2022) and post-pandemic (from April 2022).

    Increasing and decreasing BMI

    In the group of 3-year-olds, the proportion with obesity increased from 2.4 percent before the pandemic to 3.4 percent during the early pandemic, and then decreased to 2.3 percent during the late pandemic. After the pandemic, the proportion of 3-year-olds with obesity was 2.6 percent.

    The development of overweight in 3-year-olds follows the same pattern. The proportion of overweight children went from 11.6 to 13.2 percent, followed by a decline to 11.3 during the late pandemic. After the pandemic, the proportion of overweight 3-year-olds was 11.9 percent.  

    In the group of 4-year-olds, BMI (body mass index) also changed significantly. The obesity rate increased from 2.6 percent before the pandemic to 3.7 percent during the early pandemic, then declined to 3.1 percent during the late pandemic and to 2.5 percent after the pandemic.

    The proportion of overweight in the group of 4-year-olds rose from 10.3 percent before the pandemic to 11.7 percent during the early pandemic, and then decreased to 9.9 percent during the late pandemic and after the pandemic.  

    Unhealthy weight can regress

    Globally, weight gain in young children during the pandemic has been explained by changes in dietary habits and reduced physical activity as a result of social restrictions and closed preschools. In Sweden, preschools were up and running, but the weight trend remained the same as in other countries, which, according to the researchers, may be due to the fact that many children missed out on nutritious food and regular outdoor activity.

    The fact that the weight trend has now been broken is also of great importance in the long term. Childhood obesity increases the likelihood of continued obesity in adulthood, with an increased risk of cardiovascular disease, cancer, and lower quality of life.

    Responsible for the study are Anton Holmgren, Pediatrician at Halland Hospital, who conducts research in pediatrics at Sahlgrenska Academy, University of Gothenburg, and Anna Fäldt, Researcher at Uppsala University within pediatric health and parenthood.

    The fact that the proportion of overweight and obese 3- and 4-year-olds has decreased indicates that the weight gains were related to the pandemic, and that an unhealthy weight status can be reversed. This also applies at the individual level, a significant proportion of the children where we had repeated measurements dropped to a lower BMI class after the pandemic.”


    Anton Holmgren, Pediatrician at Halland Hospital

    Source:

    University of Gothenburg 

    Journal reference:

    Fäldt, A., et al. (2024). Childhood Overweight and Obesity During and After the COVID-19 Pandemic. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2024.0122.

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  • After Appalachian hospitals merged into a monopoly, their ERs slowed to a crawl

    After Appalachian hospitals merged into a monopoly, their ERs slowed to a crawl

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    In the small Appalachian city of Bristol, Virginia, City Council member Neal Osborne left a meeting on the morning of Jan. 3 and rushed himself to the hospital.

    Osborne, 36, has Type 1 diabetes. His insulin pump had malfunctioned, and without a steady supply of this essential hormone, Osborne’s blood sugar skyrocketed and his body was shutting down.

    Osborne went to the nearest hospital, Bristol Regional Medical Center. He said he settled into a wheelchair in the emergency room waiting area, where over the next few hours he drifted in and out of consciousness and retched up vomit, then bile, then blood. After 12 hours in the waiting room, Osborne said, he was moved to an ER bed, where he stayed until he was sent to the intensive care unit the next day. In total, the council member was in the ER for about 30 hours, he said.

    Osborne said his ordeal echoes stories he’s heard from constituents for years. In his next crisis, Osborne said, he plans to leave Bristol for an ER about two hours away.

    “I want to go to Knoxville or I want to go to Roanoke, because I do not want to further risk my life and die at a Ballad hospital,” he said. “The wait times just to get in and see a doctor in the ER have grown exponentially.”

    Ballad Health, a 20-hospital system in the Tri-Cities region of Tennessee and Virginia, benefits from the largest state-sanctioned hospital monopoly in the United States. In the six years since lawmakers in both states waived anti-monopoly laws and Ballad was formed, ER visits for patients sick enough to be hospitalized grew more than three times as long and now far exceed the criteria set by state officials, according to Ballad reports released by the Tennessee Department of Health.

    Tennessee and Virginia have so far announced no steps to reduce time spent in Ballad ERs. The Tennessee health department, which has a more direct role in regulating Ballad, has each year issued a report saying the agreement that gave Ballad a monopoly “continues to provide a Public Advantage.” Department officials have twice declined to comment to KFF Health News on Ballad’s performance.

    According to Ballad’s latest annual report, which was released this month and spans from July 2022 to June 2023, the median time that patients spend in Ballad ERs before being admitted to the hospital is nearly 11 hours. This statistic includes both time spent waiting and time being treated in the ER and excludes patients who weren’t admitted or left the ER without receiving care.

    The federal government once tracked ER speed the same way. When compared against the latest corresponding federal data from 2019, which includes more than 4,000 hospitals but predates the covid-19 pandemic, Ballad ranks among the 100 hospitals with the slowest ERs. More current federal data is not available because the Centers for Medicare & Medicaid Services retired this statistic in 2020 in favor of other measurements.

    Newer data tells a similar story. The Joint Commission, a nonprofit that accredits health care organizations, collected this same measurement for 2022 from about 250 hospitals that volunteered the data, finding a median ER speed of five hours and 41 minutes — or about five hours faster than Ballad’s latest annual report.

    Ballad Health spokesperson Molly Luton said in an email statement that, by holding patients in the ER, where they are observed while waiting for a bed, Ballad avoids “overwhelming” its staff. Luton said ER delays are also caused by two nationwide crises: a nursing shortage and fewer admissions at nursing homes and similar facilities, which can create a backlog of patients awaiting discharge from the hospital.

    Luton added that Ballad’s ER time for admitted patients has dropped to about 7½ hours in the months since the company’s latest annual report.

    “On those issues Ballad Health can directly control, our performance has rebounded from 2022, and is now among the best in the nation,” Luton said.

    Luton also noted that Ballad performs better than or close to the national average on several other measurements of ER performance, including having fewer patients who leave without being treated. CMS data shows the national average is about 3%. Ballad reported 1.4% in its latest annual report.

    Osborne, the Bristol council member, attributed this statistic to Ballad’s monopoly.

    “Just because they aren’t leaving the ER doesn’t mean they are happy where they are,” he said. “It just means they don’t have anywhere else they could be.”

    Ballad’s big monopoly

    Ballad Health was formed in 2018 after state officials approved the nation’s biggest hospital merger based on a so-called Certificate of Public Advantage, or COPA, agreement. COPAs have been used in about 10 hospital mergers over the past three decades, but none has involved as many hospitals as Ballad’s.

    State lawmakers in Tennessee and Virginia waived federal anti-monopoly laws so rival hospital systems — Mountain States Health Alliance and Wellmont Health System — could merge into a single company with no competition. Ballad is now the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina.

    The Federal Trade Commission warns that hospital monopolies lead to increased prices and decreased quality of care. To offset the perils of Ballad’s monopoly, officials required the new company to commit to a long list of special conditions, including dozens of quality-care metrics spelled out with specific benchmarks.

    In its latest annual report, Ballad improved on many quality-of-care metrics over the prior year, including several that the company prioritized, but still fell short on 56 of 75 benchmarks.

    ER time for admitted patients is one of those. The benchmark was set at three hours and 47 minutes in the original COPA agreement. Ballad met or nearly met this goal for three years, according to its annual reports. Then the ERs slowed.

    In 2022, Ballad reported a median ER time for admitted patients of about six hours.

    In 2023, it reported the same statistic at seven hours and 40 minutes.

    In the latest report, ER time for admitted patients had reached 10 hours and 45 minutes.

    CMS, which grades thousands of hospitals nationwide, warns on its website that timely ER care is “essential for good patient outcomes,” and that more time spent in the ER has been linked to higher complication rates and delays in patients getting pain medication and antibiotics.

    Ben Harder, chief of health analysis for U.S. News & World Report, said extensive ER times can be a symptom of slowdowns throughout a hospital, including in the operating room.

    “A long delay in getting patients admitted is both a risk in itself, in that a test may not get conducted as promptly,” Harder said. “But it’s also an indication that the hospital is backed up, and that there are problems getting patients moved from one unit to another.”

    Bill Christian, a spokesperson for the Tennessee Department of Health, said Ballad’s rising ER times had been “noted” but did not say if the agency had taken or was considering any action. Christian directed questions about Ballad’s latest stats to the company itself.

    ‘A nightmare for community members’

    Ballad has also fallen short — by about $191 million over the past five years — of its obligation to Tennessee to provide charity care, which is free or discounted care for low-income patients, according to health department documents and Ballad’s latest report. The health department waived this obligation in each of the past four fiscal years. Ballad has said it would ask for another this year.

    In a two-hour interview last year, Ballad CEO Alan Levine defended his company and said that because the Tri-Cities region could not support two competing hospital companies, the COPA merger had likely prevented at least three hospital closures. Levine attributed Ballad’s failure to meet quality benchmarks to the pressure of the covid pandemic and said charity care shortfalls were partly caused by Medicaid changes beyond Ballad’s control.

    “Our critics say, ‘No Ballad. We don’t want Ballad.’ Well, then what?” Levine said. “Because the hospitals were on their way to being closed.”

    Some residents see Ballad as a savior. John King, who runs a physical therapy clinic in the core of Ballad’s region, said at a public hearing last June that in multiple visits to Ballad ERs, including one for a stroke, he found their care to be quick and compassionate.

    “If it weren’t for Ballad Health, I literally would not be here today,” King said, according to a hearing transcript.

    Ballad’s failures to live up to the terms of the COPA agreement were detailed in a KFF Health News investigation last September, and the company faced a new wave of criticism in the months that followed.

    Local leaders in Carter County, Tennessee, in October debated but did not pass a resolution calling for Ballad to be better regulated or broken up. Tennessee Attorney General Jonathan Skrmetti, a Republican, said in an interview with the Tennessee Lookout published in November that Ballad must be constantly monitored in light of community complaints. Earlier this month, Tennessee state Rep. David Hawk (R-Greeneville), who represents a region within Ballad’s monopoly, called for Levine’s resignation, according to wjhl.com.

    In response, Ballad Health said in a statement it has “strong relationships with the majority of elected officials” in Carter County and welcomed scrutiny from the Tennessee attorney general. Ballad said Hawk’s “opinion certainly does not reflect our broader relationships” within the area. Tennessee lawmakers are also considering legislation to forbid future COPA mergers in the state, which Ballad said “risks putting more hospitals at risk for closure.”

    The bill was introduced by state Sen. Heidi Campbell (D-Nashville) and state Rep. Gloria Johnson (D-Knoxville), who is running for the U.S. Senate. Johnson said the bill would end Ballad’s protection from antitrust laws.

    “It’s just been a nightmare for community members out there,” Johnson said. “And they have no other option.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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