Science Policy For All

Because science policy affects everyone.

Posts Tagged ‘vaccination

Conspiracy Theories and Ebola: How a US Federally Funded Research Facility in the Heart of Sierra Leone’s Ebola Outbreak Acerbated Local Misconceptions about Ebola

leave a comment »

By: Caroline Duncombe

ebola-549471_1920.jpg

An inherent distrust follows what one does not understand; scientific endeavors if not explained properly are easily misunderstood. From climate skeptics to CERN’s 666 logo, the world is wrought with conspiracy theories surrounding science. The role of conspiracies should not be underestimated or neglected, especially since such theories are interspersed with layers of truth. Usually conspiracies reside harmlessly on the edge of the web, but during the Ebola outbreak in Sierra Leone an unaddressed rumor resulted in fatal consequences. Rumors revolving around a Tulane University research facility located in Kenema Government Hospital prompted a breakdown in relations between the local populations and international health care workers. This mistrust led to the refusal to permit blood draws for diagnostic purposes during the critical initial stages of the Ebola outbreak. By underestimating the importance of cultural and religious symbolism surrounding scientific research U.S. federal funding agencies, laboratory researchers, and private companies made a crucial mistake. By analyzing this curious conspiracy theory, scientists, funding agencies, and health practitioners can learn from past mistakes and become more aware of the impact of research beyond pure scientific pursuit.

Background

            On May 24th, 2014,a young woman miscarried in Kenema Government Hospital. Given the recent outbreak in nearby Gueckedou, Guinea, Ebola was suspected. A day later, the same hospital reported the first confirmed case of Ebola in Sierra Leone. Soon after, Kenema became a hot zone – the entry point for the Ebola virus to spread throughout Sierra Leone and eventually the world. The repercussions of the Ebola outbreak extend well beyond the 11,310 death count in West Africa to economic, social, medical, and cultural spheres.

The Kenema Government Hospital was not a typical Sierra Leonian public hospital. In fact, the hospital was well-equipped, with the only Lassa fever isolation ward anywhere in the world. The lab dated to 2005, when Tulane University received a $10 million grant from the U.S. National Institutes of Health to study “Diagnostics for Biodefense against Lassa fever”. Since previous investigations of sporadic Lassa fever outbreaks were based out of Kenema, the natural choice for the establishment of first-rate laboratory infrastructure was Kenema Government Hospital.

As the years passed, the Tulane research laboratory acquired more grants and partnerships. One of the principal collaborators was the private for-profit company, Metabiota, which received grants from two U.S. Department of Defense (DoD) agencies – Defense Threat Reduction Agency and Biological Engagement Program – to primarily study the pathogenesis of Lassa fever, a ‘US bioterror threat’. Due to stipulations in NIH grant funding, the substantial amount of money flowing into this “shiny new” research laboratory could not be applied to assisting patients in the “dilapidated, cramped, and poorly resourced Lassa ward only some 50m away” (Bausch). During the Ebola outbreak, the Lassa laboratory’s focus shifted to Ebola, continuing research until the NIH did not renew funding in 2014, primarily due to safety reasons.

The Conspiracy Theory

Following the 2014 outbreak, a conspiracy theory circulating throughout Sierra Leone, essentially claiming that the U.S. created Ebola, or a Lassa-Ebola hybrid, and either intentionally or accidentally released this bioterror weapon from the U.S. NIH and DoD-funded research facility at Kenema Government Hospital. While such a rumor lacked credible evidence, there were specific circumstances surrounding the policies of the research outpost that fed into the narrative – truths that should have been addressed through culturally sensitive policies.

Four main factors converged into a superstitious and suspicious narrative about the Lassa research laboratory. First, by branding the Lassa research facility with a bioterrorism component, the project assisted in drawing out a natural conclusion that bioterror weapons were also present in the laboratory. Tulane University’s initial grant application in 2005 framed Lassa virus as a US biosecurity threat through key words such as “Diagnostics for Biodefense” and “LASV as a biological weapon directed against civilian or military targets necessitates development of… diagnostics.” The framing of the diagnostic development laboratory in terms of a biodefense strategy against the NIAID Category A classification was not an accident, but rather a necessity to gain funding. As Annie Wilkins puts it “whether the prospect of weaponization is regarded as sensationalism or a real concern, all researchers are aware of the utility the bioweapons threat has in obtaining funding.” By emphasizing biodefense and collaborating with the U.S. DoD via Metabiota’s funding stream, a natural linkage between the work of the research outpost and bioweapons developed.

The second factor was out of the control of Tulane University: A suspicious coincidence. Due to its proximity to Guinea, laboratory capacity, and fluidity in movement across the Sierra Leone-Guinea border, the first confirmed case of Ebola in Sierra Leone occurred in Kenema Government Hospital. Although there potentially were other cases of Ebola in Sierra Leone, none of the primary health care clinics in the area had the laboratory capacity to officially diagnose Ebola. A natural speculation ensued: what are the chances that the one Biodefense laboratory in Sierra Leone, where the hemorrhagic Lassa fever virus was located, was also the site of the first confirmed case of a “new” bioterror threat that also causes hemorrhagic fever, Ebola? Money draws attention, and the money flowing into this singular laboratory was substantial when compared with other public hospitals in Sierra Leone. For reference, the Sierra Leone Ministry of Health and Sanitation allocated U.S. $20 million budget to run the entire national health system in 2009.

Third, a nurse from Kenema Government Hospital claimed to an audience at a fish market that “the deadly [Ebola] virus was invented to conceal “cannibalistic rituals”. The statement and an already distrustful community culminated into a riot at the hospital on July 25th, 2014. Such a case further cemented the people’s suspicions that the laboratory was “stealing” the blood of Sierra Leonians. Even though collecting blood is necessary for diagnostic tests, there are many deeply held cultural beliefs about blood in Sierra Leone, and many people are reluctant to participate in blood test as a result.

Fourth, the research facility suspiciously and suddenly shut down right at the beginning of the outbreak without much explanation to the community. Additionally, many of the Sierra Leonian staff who could have addressed the suspicions about the facility pre-outbreak have since died while bravely combatting Ebola. All of these factors accumulated into the conspiracy theory that actors involved with the bio-defense grant and the US government created a bioterror weapon and unleashed it on West Africa.

Policy Considerations

The accumulation of these factors demonstrate the importance of cultural sensitivity and awareness when implementing scientific research policies. In 2018, Tulane University and a variety of partners received a new $15 million federally funded grant to study how Ebola and Lassa survivors fought off the diseases. Hopefully, the researchers are opening this facility with a new awareness and increased precautions on the spiritual and social baggage they bring to Kenema. This is especially important when considering the potential for further stigmatization of Ebola survivors if called to Kenema Government Hospital for research or treatment purposes.

There are several policy considerations that could alter the course of this conspiracy and help acclimate the community to both the presence of a well-equipped laboratory and blood draws for diagnostic purposes. Research institutions should refrain from using vocabulary such as “biodefense” and “bioweapon” to describe the purpose of research. A clinician in the Lassa ward pointed out that “The average Sierra Leonian won’t see Lassa Fever as a bioweapon threat. Only in the Western world do they see it like that.” Since the potential for contracting Lassa and Ebola is an everyday reality for Sierra Leonians, research initiatives on such diseases should be spoken about in terms of their potential for public health. Additionally, universities seeking to do medical research should consider the cultural significance of their location, and contemplate ways, including shifting location, that might reduce any negative connotations. Engaging influential spiritual leaders in productive information partnerships could also assist in assuaging local concerns.

Policy considerations should also be contemplated by grant funding institutions like the NIH and DoD. First, grant stipulations should integrate a layer of flexibility for distributing certain supplies and resources for patient care. Second, the NIH and DoD should be cognizant of their bias in funding grants that are written in terms of biodefense interests of the US, especially when related to countries where such a ‘bioweapon’ is an everyday reality. This is especially important because such bias incentivizes deleterious narratives that invokes cultural, social, and medical consequences.  Lack of funding for neglected infectious diseases that only burden developing countries by the US is a complex and important issue that will require deep structural changes – and would require another blog post to contemplate. Yet, a simple solution would be to require scientific grant applications to contain a section in which the applicant considers the cultural and social impact of the work within the community of interest. In addition, community outreach with intentional dialogue on assuaging concerns about sensitive research activities should made be mandatory.

The conspiracy theory exacerbated the already high level of mistrust in Western interventions during the outbreak. As the Washington Post emphasizes, the lesson from this case study is “that winning the trust of communities at risk is absolutely indispensable to limiting the impact of the inevitable next Ebola epidemic in West Africa.” Hopefully, the Tulane University research center in Kenema Government Hospital has learned from past mistakes, and seeks to engage the community and douse suspicions against their research upon re-opening the laboratory this year. Conspiracy theories usually integrate truth with speculation. The traditional method of ignoring such theories or flat out denying (as was the case with Tulane University) may have detrimental consequences as seen during the Ebola outbreak in Sierra Leone. The power in a conspiracy theory is not necessarily its truth, but it’s power to persuade people that it is true. And as scientists who are often focused on the facts, we often have a hard time understanding that concept. When doing research, it is crucial to be cognizant of the social perception of science and attempt to build bridges between gaps of understanding on cultural practices and scientific endeavors.

 

Have an interesting science policy link? Share it in the comments!

Advertisements

Written by sciencepolicyforall

January 17, 2019 at 6:34 pm

Vaccination Politics: Exploring the policy measures needed to lower the risk of vaccine-preventable disease outbreaks

leave a comment »

By: Allison Cross, Ph.D.

Usmap

Source: Wikimedia

Thanks to modern medicine, many of the diseases that plagued our ancestors can now be prevented by vaccination.  Although there are no federal vaccination laws in the US, there are state laws making vaccination mandatory for children attending public schools. All 50 states require public school children to be vaccinated against diphtheria, tetanus, pertussis, polio, measles, rubella, and varicella (chicken pox). There are exceptions to these requirements, however, with all states allowing medical exceptions, 47 states allowing religious exemptions, and 17 states allowing personal belief exemptions.  A recent study published in PLOS medicine found that in states that allow personal belief exemptions, the rates of these exceptions has increased two-thirds in the last decade.  The study warns that numerous states and large metropolitan centers that have shown increases in non-medical exceptions (NMEs) may become increasingly vulnerable to outbreaks of vaccine-preventable disease.  This raises the question of whether policy measures should be taken to increase rates of vaccination.

Many parents who apply for personal belief exemptions for vaccinations do so because of concerns of vaccine safety and efficacy. The most influential milestone of the current anti-vaccination movement came in 1998 with an article published by Dr. A Wakefield in the Lancet linking the MMR vaccine to autism; the story was later featured on 60 minutes. Dr. Wakefield’s research has since been debunked, his paper has been retracted from the Lancet, and he was stripped of his medical license. Despite this, many parents remain fearful of vaccination and these fears continue to be fueled by the media, celebrities, and politicians.  While safety concerns keeps some parents from vaccinating their children, others choose not to vaccinate because they believe their children have a low risk of contracting vaccine preventable diseases due to their low prevalence.  Still others hold beliefs that natural immunity is better than vaccine acquired immunity.  In addition to personal beliefs against vaccination, some individuals oppose vaccination on the basis of their religious beliefs.

It is critical to maintain high vaccination rates among the population to provide protection to those who cannot be vaccinated or who have not yet developed immunity.This concept is known as herd immunity. There is a very small proportion of children that cannot be vaccinated due to medical reasons, but this small percentage of the population generally does not compromise herd immunity.  However, when parents refuse to vaccinate their children based on religious or personal beliefs, the percentage of unvaccinated children can rise and compromise herd immunity.   The percentage of the population that needs to be vaccinated for herd immunity to be effective depends on how contagious the germ is.  In 2017, the CDC reported that 83.4% of children from 19-35 months were vaccinated against diphtheria, tetanus and pertussis, 91.9% against polio, 91.1% against measles, mumps and rubella, and 90.6% against varicella.  Though these numbers may sound high they may not be high enough; for example the vaccination rate required to achieve herd immunity for measles is believed to be roughly 96% or higher.

Currently there are only three states that solely allow medical exemptions for school vaccination; Mississippi and West Virginia banned NMEs more than 30 years ago while California recently banned NMEs in January of 2016.  The strict rules on vaccination exemptions in Mississippi and West Virginia are linked to increased rates of vaccination.  In the 2014-2016 school year, over 99% of kindergarteners in Mississippi were reported to have received their MMR and DPT vaccines. On the contrary, states that permit both personal belief and religious exceptions are reported to have 2.5 times higher rates of vaccine exemptions.  California passed its statewide ban of NMEs after a 2015 measles outbreak that was linked to the Disneyland Resort in Anaheim, California.  Investigations into the outbreak reported that the exposed population had a vaccination rate of only 50-86%.  After passing the NME ban, California reported a record high level of vaccination with 95.6% of kindergarteners receiving all required vaccinations during 2016-2017.

Considering that the states that allow personal and religious exemptions to vaccination generally have higher levels of vaccine exemptions, one must consider whether more states should act to ban NMEs.   While these policies may increase vaccination rates, they may also come with other undesirable side-effects.  For example, although California reported a dramatic increase in vaccination rates following its ban of NMEs, a study by Mohanty S. et. al. also reported a significant increase (from 0.2% in 2015–2016 to 0.7% in 2017–2018) in medical exceptions, with the strongest increase reported in regions with high rates of personal belief exemptions prior to the NME ban.  This suggests that parents with personal beliefs against vaccination were able to find physicians willing to exercise “broader discretion” in providing medical exceptions.   Even more troubling, the study found that some physicians were charging steep fees to sign off on “medical” exceptions for parents who previously sought non-medical vaccination exemptions.  These findings suggest that the potential long-term benefit of the NME ban in California may not be achieved without further legal changes, including some form of standardized review of medical exemptions.

Though eliminating NMEs may be a successful means of raising vaccination rates to the levels needed to achieve herd immunity, other less drastic legislation changes may have similar results while respecting both the pro- and anti-vaccination viewpoints.  Some proposed alternatives include financial disincentives and stricter exception policies. Navin M.C. and Largent M.A.  proposed an “inconvenience approach”, which allows non-medical exceptions to continue but makes the application process more burdensome. Similarly, Billington J.K. and Omer. S.B. proposed the use of processing fees as a financial disincentive to discourage NMEs.  They suggest that states require annual renewal of NMEs and require a processing fee for each renewal.  They further recommend that these fees be administered in a “sliding-scale” to avoid income-based discrimination.  Billington and Omer argue that these fees will “help tilt the balance of convenience in favor of vaccination”.  Another approach could be requiring parental counseling on vaccine risks and benefits to obtain NMEs. After Washington state passed a law in 2011 requiring counseling intervention for NMEs they reported a relative 40.2% decrease in exception rates, with an absolute reduction of 2.9%.   Although elimination of NMEs is linked to higher vaccination rates, the less drastic proposals above could provide increased rates of vaccination without evoking the public backlash of eliminated NMEs entirely.

In states that allow medical and religious vaccination exemptions, policy makers attempting to crack down on religious exceptions can expect to face a lot of criticism from individuals who hold strong anti-vaccination beliefs.  In April, New Jersey lawmakers faced harsh criticism after advancing a proposal to make it harder for children to receive religious exemptions for vaccinations. New Jersey is among the 33 states that do not allow personal belief exemptions but permit both medical and religious vaccine exceptions.  Lawmakers decided to take action after noticing a dramatic increase in the number of children citing religion as a reason for refusing vaccination, from 1,641 students in the  2005-2006 school year to 10,407 children in 2016-2017. The proposed legislation would require parents to provide a notarized statement about their religious beliefs, including proof that their beliefs are ongoing, and to specifically explain how immunization conflicts with their religious tenets.  The proposed measured are intended to curb the percentage of parents who use the religious exceptions as a way to avoid vaccination due to personal beliefs or fears about vaccination.

Individuals who oppose vaccination, whether for religious or personal reasons, strongly believe that the government should not be able to force vaccination on anyone. However, childhood immunizations prevent serious illness and death along with billions of dollars of costs to society each year.  Furthermore, the choice not to vaccinate does more than effect the unvaccinated individual, as it also puts at risk those individuals who cannot receive vaccinations due to medication reason and those who have not yet developed immunity. Although rates of vaccine preventable diseases are currently very low in the US, the CDC has made it clear that maintaining high levels of vaccination is essential to prevent diseases from making a comeback. Strong anti-vaccination sediments and subpar MMR vaccination rates are being blamed for the current and ongoing measles outbreaks in Romania, France, Greece, and Italy; outbreaks across the EU have resulted in 33 deaths this year. It is clear that policies promoting vaccination are important for disease prevention but determining the best policy measures to increase vaccination rates, while considering the ethical debate of mandatory vaccination, while continue to be a struggle for policy makers.

Have an interesting science policy link? Share it in the comments!

Written by sciencepolicyforall

December 20, 2018 at 9:37 am

Science Policy Around the Web – April 21, 2017

with one comment

By: Rachel F Smallwood, PhD

Source: pixabay

Scientific Awareness

Earth Day and the March for Science

This Saturday, April 22, is Earth Day and the day scientists have chosen to hold demonstrations in the name of science. The March for Science primary demonstration will be held in Washington, D.C., with over 500 satellite events in other locations around the world. According to their website, the goal of the marches, rallies, and teach-ins is to “defend the vital role science plays in our health, safety, economies, and governments.” In a time where there has been increasing disregard and disdain for sound scientific research, scientists and science enthusiasts are passionate about raising awareness of the importance of scientific research and the funding and support of that research. Many scientists are also hoping to clear up commonly held stereotypes and allow people to see the diversity in scientific careers and that careers can be collaborative, interesting, and enjoyable.

There are those, however, who disagree that these demonstrations and events are the way to bolster funding and awareness. The March for Science professes to be non-partisan, but there are some who see it as a chance to protest against President Trump and his controversial views and statements on various scientific matters. Those who oppose the march feel that there could be unintended consequences for speaking out against a political figure or party, and many believe science should remain objective and not politicized in general. There are many supporters of the march who agree that science should remain politically unbiased but are further motivated to march given the recent budget proposals that would significantly cut funding to the National Institutes of Health and the Environmental Protection Agency.

Not surprisingly, there will also be scientists working at the March for Science. Sociologists from the University of Maryland will be conducting surveys of march attendees. Their goal is to learn more about the people who protest in support of science: their motivations, work backgrounds, and political activism levels. They hope to better understand our current political culture and attitudes about science, as well as see what kind of impact these demonstrations have in the future. (Adam Frank, NPR)

Vaccination

California Vaccination Rate Hits New High after Tougher Immunization Law

Following an outbreak of measles in Disneyland in late 2014, California passed a law that abolished the right for parents to refuse to have their children vaccinated based on personal beliefs. The students enrolling in kindergarten for the 2016-2017 academic year were the first that this law applied to. Comparing this year to the previous, vaccination rates increased from 92.8 percent to 95.6 percent, making this California’s highest year for vaccination rates since the new set of requirements was instated fifteen years ago. This rate is considered high enough to prevent measles transmission which, after being eliminated in 2000, has reemerged as a risk due to an increase in parents exempting their children from receiving vaccinations because of personal beliefs.

California still has a number of at-risk students and residents, however. These requirements have only been in place for the current school year, meaning older class years still have many students whose parents opted to not vaccinate them based on personal beliefs. There are even more unvaccinated adults who were already through school before the current set of requirements. California is still being vigilant to protect the unvaccinated. An unvaccinated high school student in Laguna Beach contracted measles earlier this month, and the school quickly moved to identify other unvaccinated students in the school and bar them from returning until it could be assured that transmission would not occur. The Centers for Disease Control and Prevention (CDC) provide a recommended schedule for vaccination of children (and adolescents and adults) who have no health contraindications. To provide the maximum resistance to measles, a highly contagious disease, the CDC recommends vaccinating between 12-15 months and again between 4-6 years of age. It will likely take some time before the long-term effect of the new law can be observed. (Lena H. Sun, The Washington Post)

Have an interesting science policy link?  Share it in the comments!

Containing Emerging and Re-emerging Infections Through Vaccination Strategies

leave a comment »

By: Arielle Glatman Zaretsky, PhD

Source: CDC [Public Domain], via Wikimedia Commons

           Throughout history, humans have sought to understand the human body and remedy ailments. Since the realization that disease can be caused by infection and the establishment of Koch’s postulates, designed to demonstrate that a specific microbe causes a disease, humans have sought to identify and “cure” diseases. However, while we have been successful as a species at developing treatments for numerous microbes, viruses, and even parasites, pure cures that prevent future reinfection have remained elusive. Indeed, the only human disease that has been eradicated in the modern era (smallpox) was eliminated through the successful development and application of preventative vaccines, not the implementation of any treatment strategy. Furthermore, the two next most likely candidates for eradication, dracunculiasis (guinea worm disease) and poliomyelitis (polio), are approaching this status through the use of preventative measures, via water filtration and vaccination, respectively. In fact, despite the recent pushback from a scientifically unfounded anti-vaxxers movement, the use of a standardized vaccination regimen has led to clear reductions in disease incidence of numerous childhood ailments in the Americas, including measles, mumps, rubella, and many others. Thus, although the development of antibiotics and other medical interventions have dramatically improved human health, vaccines remain the gold standard of preventative treatment for the potential of disease elimination. By Centers for Disease Control and Prevention [Public domain], via Wikimedia Commons

Recently, there have been numerous outbreaks of emerging or reemerging infectious diseases. From SARS to Ebola to Zika virus, these epidemics have led to significant morbidity and mortality, and have incited global panic. In the modern era of air travel and a global economy, disease can spread quickly across continents, making containment difficult. Additionally, the low incidence of these diseases means that few efforts are exerted to the development of treatments and interventions for them, and when these are attempted, the low incidence further complicates the implementation of clinical trials. For example, though Ebola has been a public health concern since the first outbreak in 1976, no successful Ebola treatment or vaccine existed until the most recent outbreak of 2014-2016. This outbreak resulted in the deaths of more than 11,000 people, spread across more than 4 countries, and motivated the development of several treatments and 2 vaccine candidates, which have now reached human trials. However, these treatments currently remain unlicensed and are still undergoing testing, and were not available at the start or even the height of the outbreak when they were most needed. Instead, diseases that occur primarily in low income populations in developing countries are understudied, for lack of financial incentive. Thus, these pathogens can persist at low levels in populations, particularly in developing countries, creating a high likelihood of eventual outbreak and potential for future epidemics.

This stream of newly emerging diseases and the re-emergence of previously untreatable diseases brings the question of how to address these outbreaks and prevent global pandemics to the forefront for public health policy makers and agencies tasked with controlling infectious disease spread. Indeed, many regulatory bodies have integrated accelerated approval policies that can be implemented in an outbreak to hasten the bench to bedside process. Although the tools to identify new pathogens rapidly during an outbreak have advanced tremendously, the pathway from identification to treatment or prevention remains complicated. Regulatory and bureaucratic delays compound the slow and complicated research processes, and the ability to conduct clinical trials can be hindered by rare exposures to these pathogens. Thus, the World Health Organization (WHO) has compiled a blueprint for the prevention of future epidemics, meant to inspire partnerships in the development of tools, techniques, medications and approaches to reduce the frequency and severity of these disease outbreaks. Through the documentation and public declaration of disease priorities and approaches to promote research and development in these disease areas, WHO has set up a new phase of epidemic prevention through proactive research and strategy.

Recently, this inspired the establishment of the Coalition for Epidemic Preparedness Innovations (CEPI) by a mixed group of public and private funding organizations, including the Bill and Melinda Gates Foundation, inspired by the suggestion that an Ebola vaccine could have prevented the recent outbreak if not for the lack of funding slowing research and development, to begin to create a pipeline for developing solutions to control and contain outbreaks, thereby preventing epidemics. Instead of focusing on developing treatments to ongoing outbreaks, the mission at CEPI is to identify likely candidates for future outbreaks based on known epidemic threats and to lower the barriers for effective vaccine development through assisting with initial dose and safety trials, and providing support through both the research and clinical trials, and the regulatory and industry aspects. If successful, this approach could lead to a stockpile of ready-made vaccines, which could easily be deployed to sites of an outbreak and administered to aid workers to reduce their morality and improve containment. What makes this coalition both unique and exciting is the commitment to orphan vaccines, so called for their lack of financial appeal to the pharmaceutical industry that normally determines the research and development priorities, and the prioritization of vaccine development over treatment or other prophylactic approaches. The advantage of a vaccination strategy is that it prevents disease through one simple treatment, with numerous precedents for adaptation of the vaccine to a form that is permissive of the potential temperature fluctuations and shipping difficulties likely to arise in developing regions. Furthermore, it aids in containment, by preventing infection, and can be quickly administered to large at risk populations.

Thus, while the recent outbreaks have incited fear, there is reason for hope. Indeed, the realization of these vaccination approaches and improved fast tracking of planning and regulatory processes could have long reaching advantages for endemic countries, as well as global health and epidemic prevention.

Have an interesting science policy link?  Share it in the comments!

Written by sciencepolicyforall

January 26, 2017 at 9:47 am

Science Policy Around the Web – December 9, 2016

leave a comment »

By: Amy Kullas, PhD

Infectious Diseases

Current Mumps Outbreak is the Worst in Recent History

2016 has been the worst in recent history for mumps outbreaks. According to a report released by the Center for Disease Control (CDC), almost 4,000 cases of mumps have been reported. This number is almost triple the number of cases reported in 2015. Mumps symptoms include: puffy cheeks and a swollen jaw (due to swollen salivary glands), fever, headache, tiredness, and loss of appetite.

In prevention of mumps, the measles, mumps, and rubella (MMR) vaccine is ~88% effective when a person gets both of the recommended doses and ~78% effective when a person received a single dose. The mumps vaccination program began in 1967. Prior to this, mumps was considered a ‘classical’ childhood disease in the United States. Some clinicians say, “the efficacy of the vaccine wanes after 10 to 15 years.”

Though mumps outbreaks can still occur in vaccinated communities (particularly in close-contact settings like colleges), high vaccination rates aids to limit the size, length, and spread of the outbreak. This ongoing outbreak is hard-hitting college campuses. In fact, some universities have scaled back dining hall hours in addition to asking students to “cancel nonmandatory social gatherings” in an attempt to thwart the infectious disease. Other universities have begun to recommend and offer a third dose of the mumps vaccine to students. (Melissa Korn, The Wall Street Journal)

Vaccination

Antivaxers Meet with Trump

Andrew Wakefield, the orchestrator of the “anti-vaccine movement”, met with Donald Trump this past summer. This misguided movement began with a paper published in 1998 by the now discredited Wakefield in The Lancet. The authors claimed that 2/3 of children developed autism soon after receiving the measles, mumps, and rubella (MMR) vaccine. Though this study has been disproven numerous times and has been retracted, the impact still flows not only through the scientific community, but also into the general public. This is why the scientific community cringed when Trump appeared to be sympathetic towards their cause.

When parents refuse to vaccinate their children, they cite the belief that vaccines cause autism or state that vaccines are “unnecessary”. Vaccination is an extremely effective strategy for preventing infectious diseases. However, this strategy is only successful when the vast majority of individuals are immunized against a particular pathogen in order to offer some protection to individuals who are not medically able to receive the vaccine.

Wakefield stated, “For the first time in a long time, I feel very positive about this, because Donald Trump is not beholden to the pharmaceutical industry. He didn’t rely upon [drug makers] to get him elected. And he’s a man who seems to speak his mind and act accordingly.” While Trump has appeared to be interested and open-minded on vaccines, there are limits to what he can do to undercut vaccination policies. But the antivaxers remain hopeful that Trump will be a powerful ally who would trigger more of a cultural impact as opposed to passing laws. (Rebecca Robbins, STAT news)

Have an interesting science policy link?  Share it in the comments!

Written by sciencepolicyforall

December 9, 2016 at 9:40 am

Science Policy Around the Web – September 6, 2016

leave a comment »

By: Amy Kullas, PhD

Vaccines

Parents remain apprehensive of vaccine safety and efficacy

In a recent survey published by the American Academy of Pediatrics, an alarming percentage of parents are refusing or delaying important vaccines. This percentage continues to increase because “parents believe they are unnecessary”. This phenomenon has directly resulted in outbreaks of measles and mumps in the United States, and polio in Syria.

The misguided “anti-vaccination movement” began with a paper published by Andrew Wakefield in The Lancet in 1998. The authors alleged that eight children (out of a very small sample size of 12) developed autism shortly after receiving the measles, mumps and rubella (MMR) vaccine. The impact of this now-retracted paper still ripples through the scientific community and beyond, to within the general public in the United States.

Numerous celebrities (Jim Carrey, Robert De Niro, Jenny McCarthy-just to name a few) and the Republican party nominee, Donald Trump, continue to fuel the anti-vaccine fire spreading through the United States. Trump has gone as far to say: “Autism has become an epidemic. Twenty-five years ago, 35 years ago, you look at the statistics, not even close. It has gotten totally out of control.” Further, he said, “Just the other day, two years old, 2½ years old, a child, a beautiful child went to have the vaccine, and came back, and a week later got a tremendous fever, got very, very sick, now is autistic.” The ultimate result has been a “dangerous drop in MMR vaccinations” according to public health officials. Given Trump’s stance on vaccination and how the candidate has made vaccine policy into a political topic could have grave consequences on American youth for years to come.

Interestingly, there has been a change in reasoning as to why parents refuse vaccines for their children. In 2006, the number one reason cited was parental belief that vaccines caused autism. In 2013, this was no longer the popular belief; instead parents are stating vaccines are “unnecessary” and are failing to vaccinate their children. The “parental noncompliance” with the CDC’s recommended vaccination strategy continues to be “an increasing public health concern.” (Ariana Eunjung Cha, The Washington Post)

Zika and Insecticides

Millions of honeybees killed after insecticide spraying to combat Zika-carrying mosquitos

In an effort to annihilate Zika-carrying mosquitos in South Carolina, officials in Dorchester County approved an aerial spraying of Naled-a common insecticide. This decision ultimately led to millions of honeybees getting killed. The majority of the victims were from Flowertown Bee Farm and Supply. Co-owner, Juanita Stanley stated, “the farm looks like it’s been nuked.” The farm lost close to 50 hives which housed ~2.5 million bees.

Naled was approved for “mosquito control” in 1959. The Environmental Protection Agency (EPA) notes that Naled “is not a risk for humans” and they “aren’t likely to breath or touch anything that has enough insecticide on it to harm them.” Unfortunately, Naled does not discriminate bees from mosquitos and efficiently kills them both. The EPA does recommend spraying the chemical between dusk and dawn, when bees are not typically foraging.

The county insists they gave residents plenty of notice prior to the spraying through a newspaper announcement and a Facebook posting. However, some residents suggest otherwise, stating “Had I known, I would have been camping on the steps doing whatever I had to do screaming, ‘No you can’t do this.’” The Dorchester county officials have issued a statement stating that they are “not pleased that so many bees were killed” and they have not offered to compensate the beekeepers for their losses. (Ben Guarino, The Washington Post)

Health

Bye-bye to antibacterial soaps

On the Friday before the holiday weekend, the U.S. Food and Drug Administration (FDA) released its final ruling that will ban specific ingredients, such as triclosan and triclocarban, commonly used in antibacterial and antimicrobial soaps. Soap manufacturers will have an additional year to negotiate over less common ingredients, like benzalkonium chloride. Altogether, the FDA has taken a stance against 19 chemicals, which are used in almost half of soap products. Reasons behind the ban include: “are not generally recognized as safe and effective…and are misbranded.” To date, the manufacturers have not shown that these ingredients are safe for daily use as well as failed to demonstrate an increase in efficacy when compared with plain soap. Hand sanitizers and antiseptic products used in healthcare or the food industry are not affected by this ban.

In 2013, the FDA first issued a warning to the industry that unless it could provide substantial proof that compounds like triclosan and triclocarban were more beneficial than harmful, the chemicals would need to be removed. Triclosan is in more than 90% of the liquid soaps labeled as ‘antibacterial’ or ‘antimicrobial’. Triclosan disrupts the bacterial cell wall, breaking it open and ultimately killing the bacterium. However, this mechanism of killing occurs over a couple hours, much longer than it takes a person to wash his or her hands. Additionally, researchers found that triclosan can disturb hormone balance to interrupt the normal development of the reproductive system and metabolism in animals. Scientists warned that there could be similar effects in humans. Some of the large companies have been proactive and started removing the chemicals from their products. (Sabrina Tavernise, New York Times)

Have an interesting science policy link?  Share it in the comments!

Written by sciencepolicyforall

September 6, 2016 at 9:15 am

Science Policy Around the Web – August 16, 2016

leave a comment »

By: Melissa Pegues, PhD

Photo source: Hu et al, 2016, under ACS AuthorChoice License

Public Health

Researchers find unsafe levels of industrial chemicals in drinking water of 6 million Americans.

A recent study by University of California Berkeley and Harvard University scientists found unsafe levels of firefighting chemicals in drinking water throughout the U.S. Over 36,000 samples collected by the Environmental Protection Agency (EPA) were analyzed for levels of polyfluoroalkyl and perfluoroalkyl substances (PFAS). Levels were detectable with 194 water supplies, but levels exceeded the EPA’s recommended safety limit in 66 of those water supplies. Those 66 water supplies were found across 14 states and affect up to 6 million people.

PFAS are use in a wide variety of products that include food wrappers, clothing, non-stick coating on pans, and firefighting foam. The study’s lead author, Xindi Hu, stated that “virtually all Americans are exposed to these compounds”. The chemicals are also commonly found at airports and military bases where firefighting foam is used in large volumes during training exercises and can then wash into surface and ground waters. They are also found at industrial plants that use them in manufacturing. They have been used for decades and persist once they are in the environment. Hu added, “They never break down. Once they are released in to the environment, they are there”.

The chemicals have been associated with a variety of health problems that include cancer, hormonal changes, thyroid problems, and high cholesterol. The federal government does not currently regulate PFASs, but they are on the EPA’s list of unregulated contaminants. Although it is difficult for the EPA to issue new regulations for contaminants, the agency has issued health advisories for these substances that urge utilities around the country to follow more stringent guidelines. Some communities have reacted to this advisory with one Alabama community declaring its tap water unfit to drink until officials could install a high-powered filter. Other communities in New Hampshire are receiving bottled water until the problem is addressed. (Brady Dennis, The Washington Post)

Global Health

A study takes the globe’s blood pressure and finds a dramatic rise

A recent study has found that greater than 30 percent of the global population now suffer from high blood pressure. Researchers at Tulane University’s School of Public Health and Tropical Medicine looked at numerous studies of individuals to determine rates of high blood pressure. The group led by Dr. Jiang He focused on people over the age of 20 and gathered data from 90 countries to assess the change in rates of hypertension between 2000 and 2010. The group found that there has been a dramatic increase in hypertension rates in low- and middle-income countries with an increase from 24% to 32%. Dr. He stated that “definitely it’s an epidemic”. Dr. Andrew Moran of Columbia University gave a cautionary interpretation of the study results citing that the current study inferred rates of hypertension from many countries, rather that collecting direct measurements. However, the trends from this study correlate with increases in obesity in low- and middle-income countries, further supporting the results of this new study. Additionally, the study did find a decrease in hypertension rates in high-income countries.

High blood pressure, also referred to as hypertension, can contribute to heart disease, chronic kidney disease, and stroke. Hypertension is currently the leading preventable cause of death world wide, and the World Health Organization is striving to reduce rates of non-communicable diseases. The increase in hypertension rates are thought to be associated with urbanization in low- and middle- income countries. Urban diets tend to be high in fat and sodium, and when coupled with high stress and low physical activity are thought to lead to hypertension. Although there are drugs available to effectively treat high blood pressure, many people in less wealthy nations may not have access to health care or be able to afford the cost of medications. Lifestyle changes have been demonstrated to reduce hypertension rates. Moran commented that “it’s probably more realistic to focus on improving diets of people in rapidly urbanizing developing world by encouraging lower calorie intake as well as reducing salt in people’s diets”. (Richard Harris, NPR)

Polio

Polio eradication faces setback as Nigeria records first cases in two years

Nigeria has faced a major setback to the eradication of polio with its first cases of wild poliovirus in more than two years. In July, two children were found paralyzed by polio in the Gwoza district of the Nigerian state of Borno. In response to these new cases, health officials have stated that they will begin emergency-vaccination campaigns.

Polio causes paralysis in approximately 1 in every 200 infections. Although once feared worldwide, efforts to eradicate the disease, such as the Global Polio Eradication Initiative, have reduced the number of cases by 99%. Because wild poliovirus cannot survive outside the human body, it is possible to eradicate the disease. Stopping the virus before it spreads further from Nigeria is crucial to the success of eradication efforts and will require millions of dose of vaccine and the coordination of several countries and numerous health organizations. The first of six vaccine campaigns will target children in the state of Borno. Further vaccination campaigns will extend to reach children across northeastern Nigeria and neighboring countries of Chad, Cameroon, and Niger.

Eradication efforts have been hampered by violent attacks by Boko Haram, an Islamic militant group, that has targeted the northeastern states of Nigeria. Global Polio Eradication Initiative spokesperson, Oliver Rosenbauer, said that “clearly cases were missed” and that “It was to be expected that there would be problems with the quality of surveillance”. Although there will be setbacks and more cases are likely, Nigeria and the rest of the world can eradicate poliovirus eventually. Nigeria now joins Afghanistan and Pakistan as the only other countries that have never interrupted the spread of polio. However, significant gains have been made in battling the virus in recent years. (Ewen Callaway, Nature)

 

Have an interesting science policy link?  Share it in the comments!

Written by sciencepolicyforall

August 16, 2016 at 10:09 am