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Posts Tagged ‘public health

Science Policy Around the Web January 9th, 2020

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By Silvia Preite, PhD

Image by kalhh from Pixabay 

New administration strategy revitalizes century-old Tuberculosis vaccine (BCG)

 Tuberculosis (TB) is a disease caused by the airborne bacteria Mycobacterium tuberculosis. TB is one of the deadliest human infections, especially in poor and developing countries, leading to 1.7 million deaths and 10 million new cases each year. The only available licensed vaccine against TB is the Bacillus Calmette-Guérin (BCG), a live attenuated strain of the related pathogen Mycobacterium bovis. Significant efforts have resulted in the administration of this century-old vaccine to more than one billion people worldwide. BCG is administered intradermally (i.d.) and is mainly effective against disseminated TB in children. However, its efficacy in preventing the transmissible pulmonary form in adults is limited, especially in countries where the infection is endemic. Therefore, developing a more effective vaccine is a high-priority effort to curb the spread of this infectious disease. 

 In a recent paper published in Nature, Darrah et al. compared the traditional i.d. administration route to several alternatives including, aerosol inhalation and intravenous (i.v.) injection in non-human primates. Six months after vaccination, Darrah et al. infected the animals with M. tuberculosis and followed the disease progression. The results were quite striking: the authors found only modest protection through i.d. and aerosol administration, in contrast, i.v. administration led to almost complete protection from the disease. Immunological mechanisms behind this extraordinary results remain to be entirely determined. However, a greater influx of adaptive immune cells called T lymphocytes in the lung upon i.v. administration could contribute to this major vaccine efficacy. 

 This study opens new possibilities for future BCG vaccination strategies and more effective TB prevention. Notably, i.v. administration is not a preferred administration strategy in developing countries because it requires expert medical personal and continuous refrigeration. Nevertheless, this publication sheds new light on a tried-and-tested vaccine, opening up new exciting possibilities to improve TB vaccination efforts. Moreover, this work could further drive investigations into the immunological mechanisms behind these events.

(Source: P. A. Darrah et al. Nature 577, 95–102; 2020)

Written by sciencepolicyforall

January 9, 2020 at 3:18 pm

Science Policy Around the Web December 17th, 2019

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By Mary Weston, PhD

Source: Wikimedia

E-cigarettes linked to lung problems, first long-term study on vaping finds

The first study evaluating long-term health effects of electronic cigarettes (e-cigarettes) has found that vaping increases the risk of developing a chronic lung disease. 

Researchers tracked the smoking habits and health of over 32000 U.S. adults who, at the beginning of the study, showed no signs of lung disease. After monitoring for only three years (2013-2016), they found that those who used e-cigarettes were more likely to develop a chronic lung disease compared to non-users. These respiratory diseases include asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). 

Adults who smoke combustible cigarettes had a higher chance of developing lung diseases compared to e-cigarettes, but many adults tend to use both forms of tobacco, an activity which compounds disease threat. “The risks of e-cigarettes and cigarettes are independent of each other, and so if you’re a dual user — meaning you’re smoking and using e-cigarettes at the same time — you have the risks of smoking multiplied by the risks of e-cigarette use,” said one of the study’s authors Stanton Glantz

Specifically, the odds of an e-cigarette user acquiring a respiratory disease increased by a factor of 1.3, combustible smokers saw an increase in 1.6, and dual users were 3.3 times more likely to develop a disease.  

In this study, the surveyed participants self-reported their habits and health conditions, which may lead to recall bias and could have influenced the researchers’ results/conclusions. However, this paper contributes to increasing evidence that vaping can cause physical harm, including lung tissue chemical burns and clogs from the carrier oil vitamin E acetate. Further, this research did not include a separate form of vaping-related illnesses, EVALI (e-cigarette or vaping associated lung injury), an outbreak that is still not completely understood, but has affected more than 2400 people and caused 52 deaths as reported by the CDC

(Ericka Edwards, NBC News)

Written by sciencepolicyforall

December 17, 2019 at 9:49 am

The Emerging Policy and Public Health Crisis at the U.S.-Mexico Border

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By Emma Kurnat-Thomas, PhD, MS, RN

A photo released by the DHS Office of Inspector General on May 30, 2019 shows migrants waiting for immigration processing at a crowded Customs and Border Protection detention center in El Paso, TX

One of the agencies comprising the U.S. Department of Homeland Security, Customs and Border Protection (CBP), is the largest federal law enforcement organization in the U.S. and is tasked with securing the county’s border. CBP employs 45,600 federal agents/officers and enforces U.S. trade, customs and immigration regulations. There are 328 ports of entry (airports, seaports, and land checkpoints) and an additional 14 pre-clearance locations around the world. Hired officers and agents must meet stringent application and performance requirements, and depending on their role and assignment, must execute arduous tasks and obligations that are both physically demanding and dangerous as they protect the U.S. from terrorism. 

Foreign conflicts, trade arrangements, immigration policy, and U.S. Presidential priorities and executive orders drives what CBP encounters at our borders. Unfolding over the past 12-24 months, an immigration crisis is emerging at the U.S.-Mexico border that carries significant health policy and scientific policy ramifications. Beginning in January 2017, U.S. Administration officials aimed to set a strong deterrent against illegal immigration and human trafficking. This included a “zero tolerance” policy targeting illegal border crossings that separated thousands of children from their parents and reclassified them as “Unaccompanied Alien Children”, (UAC’s). UAC are individuals <18 years old who lacks lawful immigration status and are without a U.S. parent or legal guardian. UACs who are received at ports of entry at the Southwest border are examined and processed in accordance with the terms of applicable laws (Trafficking Victims Protection Reauthorization Act of 2008, P.L. 110-457; the Homeland Security Act of 2002, P.L 107-296; and the Flores Settlement Agreement of 1997). CBP apprehends and detains UACs, arranges for transfer to temporary custodial care provided by the Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR), until the U.S. government (Immigration and Customs and Enforcement) can arrange for repatriation or removal. As part of this process, DHS and ORR implemented a biometric and biographic information-sharing agreement

Health Policy Implications: Sanitation, Health and Communicable Diseases 

Aggressive immigration enforcement at the Southwest border has resulted in additional space, services, funding, agency personnel, equipment and infrastructure requirements to support the increasing numbers of children and families detained at CBP facilities and UACs transferred to DHHS ORR (Vought Office of Management and Budget Letter to Vice President Pence, 2019). A number of news outlets regularly cite deteriorating health and humanitarian conditions at strategic CBP stations, such as El Paso, TX. Several DHS Inspector General investigations in May and June 2019 found evidence of detainees and child migrants exposed to severe overcrowding, prolonged detention beyond that permitted by law, improper food, laundry, hygiene, water, and that conditions could be classified as ‘squalid’. Further, they cited an immediate risk to the health and safety of DHS agents and officers that were tasked with executing these policies. Extended migrant and child migrant detention in overcrowded and squalid conditions has resulted in unintended public health consequences including the spread of communicable diseases, such as influenza. Immigrants and migrant detainees are physically and psychologically vulnerable to infectious diseases, particularly if they are travelling from areas with inadequate nutrition, insecurity, and dangerous living conditions. Influenza in particular has taken a severe toll, resulting in the deaths of several children (diagnosed on autopsy report), and sickening hundreds of detainees and CBP officers and agents. To address these ongoing issues, the Centers for Disease Control (CDC) recently visited the El Paso, TX facility and made recommendations to assist CBP and DHS. Specifically: “to prioritize screening and isolation of ill migrants, early antiviral treatment, and flu vaccinations for all staff”, and provision of flu vaccines “at the earliest feasible point of entry for all persons at least six months of age”, but particularly for pregnant women and children. However, there are components of these recommendations CBP leadership has elected not to follow due to resource and logistics limitations.    

Science Policy: Genetic Testing and Confidentiality  

On October 2, 2019, the DHS announced a plan to obtain DNA profiles for all immigrant detainees and place them in the Federal Bureau of Investigations database used for criminal forensics, the Combined Index Data System (CODIS). Bioethicists and legal scholars have criticized the plan because it wrongfully targets one of the most vulnerable populations. Migrants fleeing political violence, criminal oppression, and civil wars are at risk of not having sufficient material or educational means to fully understand privacy and discrimination implications of this policy. CODIS uses Short Tandem Repeats (STRs)—short repeating DNA segments of the noncoding portions of the genome. Approximately 20 STR makers are used to establish an individual’s DNA profile in CODIS. A 2017 study in PNAS using two data sets for 872 people (one with 642,563 genome-wide Single Nucleotide Polymorphisms and one with 13 STRs used in forensic applications) found 90-98%  accuracy can be obtained when connecting forensic STR records to SNP records (in either direction), suggesting privacy risks. These potential risks would extend to individuals, and their families who may or may not be legal citizens of the U.S., if genetic profile data from CODIS were to be combined with health research or ancestry databases. And as CODIS increases use of STR marker loci number—accuracy and ease of making these linkages also increases. There is concern among scientists of scope creep. Collecting migrant samples and information for a defined purpose now, may in the future expand to further use of detainee samples and genetic information in unanticipated ways without their informed consent

If It’s Foreign Policy and Executive Decision-Making–What Can Scientists Do?  

Often news and medical research articles present understandingly shocking pictures and dramatic aspects of this debate without suggesting what can be done about it. As scientists, we can all use our voices within our various specialties to promote the dignity and welfare of those needing the most help in whatever occupational role, standing, that we carry the authority to use (i.e. infectious disease, genetic testing and confidentiality, nutrition and sanitation, ethical legal social implications, social science and integrity of childhood development, the protection of children and families, or the health and welfare of the police officers/CBP agents exposed to harsh conditions and witnessing these traumatic events). There seems to be a need for clarity and data around the impacts these policies beyond ‘how many apprehended immigrant detentions in FY 2016 vs FY 2019’. For example, how can we use the science we do have to make solid policy decisions to support our nation’s health in trying circumstances—and by providing compassionate health care to detained unassisted child minors, ensuring privacy and confidentiality of migrants and their families. What types of science do we need to understand more about what is going on—particularly in terms of communicable disease outbreaks, transmissions, and genetic privacy and confidentiality.  

We can use our voices within our respective professional circles of influence and we can express our concern in written letters to our elected government officials. We can volunteer or donate funds as permitted within our Hatch-Act restriction requirements. While we can’t solve the immigration crisis, we can do our part as scientists to support the health of the least—which impacts the prosperity of our whole. 

This Christmas season, I wanted to use my nursing scientist voice for children, families, and others impacted by these events. This blog post represents my “policy” part in not remaining silent despite the onslaught of worrisome Southwest-border health and science policy news headlines. It’s our duty to help spread hope for those impacted by such tragic circumstances when there seems to be a lack of it—especially at Christmas—so I encourage others to do the same!  

Written by sciencepolicyforall

December 3, 2019 at 4:19 pm

Science Policy Around the Web November 29th, 2019

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By Maria Disotuar, PhD

Source: Pixneo

To Drive Down Insulin Prices, W.H.O. Will Certify Generic Versions

Without insulin, a person with type 1 diabetes cannot survive, and the cost and accessibility to insulin continues to be a problem for individuals suffering from this incurable autoimmune disease. Diabetes mellitus is a chronic metabolic disease characterized by high blood glucose levels. There are two types of diabetes, Type 1 diabetes results from the loss of pancreatic β-cell function, resulting in an inability to produce insulin, a peptide-based hormone. On the other hand, Type 2 diabetes patients are resistant to insulin. Those suffering from Type 1 diabetes require daily insulin therapy to stay alive, and patients with type 2 diabetes require insulin therapy to maintain a healthy lifestyle. Currently, more than 400 million people worldwide have diabetes and this number is expected to increase in the coming years. The main problem being that there are no generic forms of insulin and the price for current insulin analogs has gone from approximately $20 per vial to $250 per vial depending on the type of insulin. This price increase over the past 20 years has made insulin unaffordable for many individuals particularly for younger generations of Americans struggling to pay student loans. For these individuals, seeing the price of insulin jump from $4.34 to $12. 92 per milliliter has meant rationing the lifesaving drug to the bare minimum – a deadly decision for some.

As a response to the growing demand for insulin and skyrocketing prices, the World Health Organization (WHO) has proposed a two year prequalification pilot project, which will allow pharmaceutical companies to produce generic insulin to be evaluated by WHO for efficacy and affordability. These types of pilot projects have been previously deployed to improve the accessibility of life saving drugs for malaria, HIV, and tuberculosis. These efforts have led to an increase in production and market competition leading to reduced costs for individuals.

Currently, the major producers of insulin, Eli Lilly, Novo Nordisk, and Sanofi have welcomed the prequalification program, vowing to be a part of the solution not the problem. According to WHO, companies in several countries, including China and India, have already expressed interest in the pilot project. This shift in insulin production would allow companies producing insulin domestically to enter the global market. As WHO-certified suppliers, these new competitors could dramatically drive down the price of insulin and improve accessibility on a global scale. Despite this positive global outlook, there are still some hurdles to cross for Americans to obtain these generic insulin products. The main one being that the pharmaceutical market is regulated by the FDA and the review process can be expensive for smaller companies. Nonetheless, Americans are fighting back to reduce the cost of insulin and other life savingdrugs, prompting lawmakers, presidential candidates, and the President to prioritize reduced drug prices for Americans. These mounting pressures will hopefully lead to a faster solution for this life or death situation.

(Donald G. McNeil Jr., The New York Times)

Will Microneedle Patches Be the Future of Birth Control?

In 2018, the The Lancet reported that between 2010 and 2014 44% of all pregnancies in the world were unplanned. Despite medical advances in sexual and reproductive health, new contraceptive methods are needed to expand accessibility and improve reliability for women. In the United States, the establishment of the Affordable Care Act (ACA) and health policies such as the Federal Contraceptive Coverage Guarantee, which requires private health plans to include coverage for contraceptives and sexual health services, has improved family planning for women of reproductive age. Despite the social and economic benefits of improved family planning and enhanced accessibility, conservatives continue to challenge these beneficial health policies. Unfavorable changes to these policies could result in major barriers for women to access some of the most effective, yet pricier forms of contraceptives such as intrauterine devices (IUDs) and implants. Studies show these long-acting forms of birth control are up to 20 times more effective in preventing unintended pregnancies than shorter-acting methods such as the pill or ring. Thus, new long-term contraceptives with reduced cost barriers would be essential in reducing unintended pregnancies and enhancing economic benefits on a global scale.

To address this issue, researchers at the Georgia Institute of Technology and University of Michigan in partnership with Family Health International (FHI) – a non profit human development organization, have developed a long-acting contraceptive administered by a patch containing biodegradable microneedles. The patch is placed on the surface of the skin and the microneedles painlessly come into contact withinterstitial fluid resulting in the formation of carbon dioxide bubbles, which allow the microneedles to detach from the patch within 1 minute of application. The needles themselves do not introduce a new contraceptive hormone, rather they provide levonorgestrel (LNG), which is regularly used in IUDs and has been deemed as safe and efficacious. After dissociation from the patch the needles slowly release LNG into the bloodstream. 

Thus far, the pharmacokinetics of the patches has been tested on rats and a placebo version has been tested in humans to test the separation process between the patch and the needles. The in vivo animal studies indicate the patch is able to maintain LNG concentrations at acceptable levels for more than one month and the placebo patch was well tolerated among study participants with only 10% reporting transient pain or redness at the site of patch application. Lastly, the researchers analyzed conceptions and acceptability of this new contraceptive method among American, Indian, and Nigerian women compared to oral contraceptives and monthly contraceptive injections administered by a physician. The results indicate women overwhelmingly preferred the microneedle patch method over the daily pill (90%) or monthly injections (100%). The researchers expect the patch to be simple to mass produce and a low-cost contraceptive option, which will reduce cost barriers and improve accessibility for women. Although the results of the study are promising, additional studies will have to be completed to address some of its limitations. Future studies will have to increase the number of animals used in the study and the number of human participants. Additionally, the release profile for LNG will likely need to be extended beyond 1-month to truly address the need for new long-acting forms of contraceptives. Finally, clinical trials will have to be completed to test the efficacy and general reliability of this method at reducing unintended pregnancies. If the microneedle patch is approved, it would be the first self-administered long-term birth control to enter the market, which could ultimately lead to enhanced accessibility for women with limited access to health care.

(Claire Bugos, Smisothian) 

Science Policy Around the Web September 13th, 2019

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By Neetu M. Gulati PhD

Image by mika mamy from Pixabay 

Genetically modified mosquitoes breed in Brazil

An experiment to curb the population of tropical disease-carrying mosquitoes in Brazil may have failed. In 2013 and 2015, mosquitoes with a modification called OX513A, which prevents these mosquitoes from reaching adulthood and being able to reproduce, were released into a region of Brazil. This experiment was meant to limit the spread of mosquito-borne infectious diseases that plague the area, including zika, dengue, and yellow fever. 

Initially, the goal of the genetic modification experiment was to reduce the mosquito population by 90%, which was successful during the field trial. Only about 4% of genetically modified mosquitoes were expected to be able to reach adulthood, and it was hypothesized that these mosquitoes would be too weak to reproduce. However, about 18 months after the experimental trial period ended, the mosquito population has returned to pre-trial levels. A recent study has revealed that the gene modification has been passed on in 10-60% of the mosquitoes in the area, suggesting they were able to reproduce. Furthermore, modified mosquitoes are as able to carry infectious diseases as non-modified mosquitoes. Critics of the experiment warn that not enough was known about these mosquitoes and there may be unintended consequences to the genetic modification, including a possibility of making the species more robust. The authors of the new study posited “These results demonstrate the importance of having in place a genetic monitoring program during releases of transgenic organisms to detect unanticipated consequences.”

(Fabian Schmidt, Deutsche Welle

America is in danger of losing its “measles-free” status

In 2000 the United States was declared measles-free, 37 years after the introduction of the measles vaccine in the US and Canada. Now, almost two decades later, the US is at risk of losing an official designation of “measles-elimination” status in October. This status is only given to countries without continuous measles transmission for at least one year, where cases of the disease can be linked back to a traveler who brought the virus from another place where it has been circulating. An outbreak of measles in New York state now jeopardizes this. The CDC reported over 1,200 measles cases in the US, with over 75% of the cases occurring in the state of New York. 

This is occurring because it is common in some groups to opt out of the measles vaccine. And it is not just the US; measles cases have increased around the world, and some other countries have also lost measles-free status in the last year.

The outbreak in New York can be traced back to Ukraine, which has had tens of thousands of measles cases in the last year. It then spread throughout a tight-knit community of people who chose not to vaccinate for perceived safety concerns. So while this outbreak can be linked to a traveler, many are concerned that if vaccine coverage rates continue to decline, the virus could spread enough, especially in under-vaccinated communities, that the outbreaks will begin to be “homegrown.”

(Julia Belluz, Vox)

Written by sciencepolicyforall

September 13, 2019 at 10:53 am

Science Policy Around the Web – July 3rd, 2019

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By Neetu Gulati, Ph.D.

Image by Arek Socha from Pixabay 

The US opioid epidemic is driving a spike in infectious diseases

Opioid use has skyrocketed in the US in the past 20 years, and addiction kills tens of thousands of people each year. Now, opioid use has been linked to an increase in infectious diseases as well, which may pile on to an already extreme public health concern.

One cause for concern is that opioids themselves may be making people more susceptible to infection, though the reason for this is unclear. One study found that people treated at veterans’ health facilities who took medium or high doses of prescribed opioids for pain management were more susceptible to pneumonia, for example. Another cause for concern is that unsafe injection practices may mean that users of illicit opioids could lead to an increase of infections. Bacterial infections, such as those caused by Staphyloccocus aureus, can enter the bloodstream of opioid users through non-sterile needle usage or unclean sites of injection. If these bacteria reach the heart, it can lead to damage and possibly the need for a transplant. For example, a study done in North Carolina found a tenfold increase in heart infections among drug users in the state over a 10-year period.

As if the increase in infections was not bad enough, another major challenge is that the pattern of outbreaks associated with drug use may not be the same as that of non-drug-affiliated outbreaks, meaning it is difficult to predict where and when infections might occur. Furthermore, as Georgiy Bobashev, a data scientist at RTI International, pointed out, drug users “don’t have good practices and they don’t have good connections with people who have been injecting drugs for a long time.” In tackling the problem, it will be important to consider the social component of predicting outbreak patterns among drug users. It will also be important to treat opioid use as a disease without stigmatizing drug users, commented Carlos Del Rio, a global-health researcher at Emory University.

(Sara Reardon, Nature)

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Written by sciencepolicyforall

July 3, 2019 at 3:13 pm

Science Policy Around the Web – June 25th, 2019

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By Ben Wolfson, Ph.D.

Image by Darwin Laganzon from Pixabay 

North Korea claimed to be free of HIV. But infections appear to be surging

Since its first diagnosis 1981, HIV/AIDS (Human immunodeficiency virus infection and acquired immune deficiency syndrome) has infected more than 70 million individuals worldwide and resulted in 35 million deaths.

HIV/AIDS is classified as a pandemic, with infected individuals found throughout the world. However, as of a December, 2018 World AIDS Day event, North Korea reported no known cases, crediting this to widespread testing and prevention methods.

A new paper has reported that these data were false, and that in fact following a North Korean “patient zero” in 1999, HIV/AIDS infections have slowly ballooned. These findings come from a collaboration between North Korean scientists and DoDaum, a nonprofit in North America that runs health and education projects in North Korea. While officials originally asked DoDaum not to discuss the increasing prevalence of HIV/AIDS in North Korea, the North Korean Ministry of Public Health felt they had to overcome traditional reticence in order to seek help in targeting HIV/AIDS.

While both a cure and vaccine remain elusive, widening usage of Pre-Exposure Prophylaxis (PrEP), also called Truvada, has the potential to significantly reduce new HIV infection. PrEP has been shown to be more than 90% effective at preventing new HIV infections, and remains underutilized in most countries, including the USA. This is in part due to cost, a factor which is the subject of a new bill introduced in the Senate that would make PrEP free to most patients.

(Richard Stone, Science)

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Written by sciencepolicyforall

June 25, 2019 at 5:37 pm