Vaccines, therapeutics, and diagnostics for covid-19: redesigning systems to improve pandemic response

Advancing collaborative research for health: why does collaboration matter?

The calls for health research to be collaborative are ubiquitous-even as part of a recent World Health Assembly resolution on clinical trials-yet the arguments in support of collaborative research have been taken for granted and are absent in the literature. This article provides three arguments to justify why health research ought to be collaborative and discusses trade-offs to be considered among the ethical values guiding each argument.

The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics

BACKGROUND AND PURPOSE

The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023.

METHODS

An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects.

RESULTS

We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues.

CONCLUSIONS

Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.

An elephant in the glasshouse? Trade-offs between acceleration and transformation in COVID-19 vaccine innovation policies

Against the backdrop of a failing vaccine innovation system, innovation policy aimed at creating a COVID-19 vaccine was surprisingly fast and effective. This paper analyzes the influence of the COVID-19 landscape shock and corresponding innovation policy responses on the existing vaccine innovation system. We use document analysis and expert interviews, performed during vaccine development. We find that the sharing of responsibility between public and private actors on various geographical levels, and the focus on accelerating changes in the innovation system were instrumental in achieving fast results. Simultaneously, the acceleration exacerbated existing societal innovation barriers, such as vaccine hesitancy, health inequity, and contested privatization of earnings. Going forward, these innovation barriers may limit the legitimacy of the vaccine innovation system and reduce pandemic preparedness. Next to a focus on acceleration, transformative innovation policies for achieving sustainable pandemic preparedness are still urgently needed. Implications for mission-oriented innovation policy are discussed.

The Relationship of COVID-19 Vaccination Status with Health Literacy of Syrians Living in Istanbul

Health literacy is an important determinant of health care use among refugees and migrant communities. This present study aimed to evaluate the relationship between health literacy levels, sociodemographic characteristics, and the status of receiving the COVID-19 vaccine in Syrians under "Temporary Protection" in Istanbul. This study was conducted in February, March, and May 2022 in an Extended Migrant Health Center in Istanbul, with a survey prepared in Arabic under observation. A total of 571 questionnaires were analyzed. The mean age of the participants was 31.92 ± 6.14, and 80.7% were female and 26.6% were high school graduates. A total of 55.0% of Syrians have not had any of the COVID-19 vaccines. The health literacy level of 1.1% of the immigrants was determined as "excellent", 68.7% as "inadequate", 20.7% as "problematic/limited", and 9.6% as "adequate". According to the logistic regression model, being male, of elder age, middle and above economic status, and having a chronic disease in the family were determined as the variables associated with the status of being vaccinated against COVID-19. Refugees are a group often exposed to inequalities in access to health services. Increasing health literacy in these groups will provide a significant improvement in access to and use of health services.

Controlled human infection models in COVID-19 and tuberculosis: current progress and future challenges

Controlled Human Infection Models (CHIMs) involve deliberately exposing healthy human volunteers to a known pathogen, to allow the detailed study of disease processes and evaluate methods of treatment and prevention, including next generation vaccines. CHIMs are in development for both tuberculosis (TB) and Covid-19, but challenges remain in their ongoing optimisation and refinement. It would be unethical to deliberately infect humans with virulent Mycobacteria tuberculosis (M.tb), however surrogate models involving other mycobacteria, M.tb Purified Protein Derivative or genetically modified forms of M.tb either exist or are under development. These utilise varying routes of administration, including via aerosol, per bronchoscope or intradermal injection, each with their own advantages and disadvantages. Intranasal CHIMs with SARS-CoV-2 were developed against the backdrop of the evolving Covid-19 pandemic and are currently being utilised to both assess viral kinetics, interrogate the local and systemic immunological responses post exposure, and identify immune correlates of protection. In future it is hoped they can be used to assess new treatments and vaccines. The changing face of the pandemic, including the emergence of new virus variants and increasing levels of vaccination and natural immunity within populations, has provided a unique and complex environment within which to develop a SARS-CoV-2 CHIM. This article will discuss current progress and potential future developments in CHIMs for these two globally significant pathogens.

The Future of Epidemic and Pandemic Vaccines to Serve Global Public Health Needs

This Review initiates a wide-ranging discussion over 2023 by selecting and exploring core themes to be investigated more deeply in papers submitted to the Vaccines Special Issue on the "Future of Epidemic and Pandemic Vaccines to Serve Global Public Health Needs". To tackle the SARS-CoV-2 pandemic, an acceleration of vaccine development across different technology platforms resulted in the emergency use authorization of multiple vaccines in less than a year. Despite this record speed, many limitations surfaced including unequal access to products and technologies, regulatory hurdles, restrictions on the flow of intellectual property needed to develop and manufacture vaccines, clinical trials challenges, development of vaccines that did not curtail or prevent transmission, unsustainable strategies for dealing with variants, and the distorted allocation of funding to favour dominant companies in affluent countries. Key to future epidemic and pandemic responses will be sustainable, global-public-health-driven vaccine development and manufacturing based on equitable access to platform technologies, decentralised and localised innovation, and multiple developers and manufacturers, especially in low- and middle-income countries (LMICs). There is talk of flexible, modular pandemic preparedness, of technology access pools based on non-exclusive global licensing agreements in exchange for fair compensation, of WHO-supported vaccine technology transfer hubs and spokes, and of the creation of vaccine prototypes ready for phase I/II trials, etc. However, all these concepts face extraordinary challenges shaped by current commercial incentives, the unwillingness of pharmaceutical companies and governments to share intellectual property and know-how, the precariousness of building capacity based solely on COVID-19 vaccines, the focus on large-scale manufacturing capacity rather than small-scale rapid-response innovation to stop outbreaks when and where they occur, and the inability of many resource-limited countries to afford next-generation vaccines for their national vaccine programmes. Once the current high subsidies are gone and interest has waned, sustaining vaccine innovation and manufacturing capability in interpandemic periods will require equitable access to vaccine innovation and manufacturing capabilities in all regions of the world based on many vaccines, not just "pandemic vaccines". Public and philanthropic investments will need to leverage enforceable commitments to share vaccines and critical technology so that countries everywhere can establish and scale up vaccine development and manufacturing capability. This will only happen if we question all prior assumptions and learn the lessons offered by the current pandemic. We invite submissions to the special issue, which we hope will help guide the world towards a global vaccine research, development, and manufacturing ecosystem that better balances and integrates scientific, clinical trial, regulatory, and commercial interests and puts global public health needs first.

Overcoming barriers and enhancing facilitators to COVID-19 vaccination in the Hispanic community

BACKGROUND

Hispanic communities in the United States have been disproportionately affected by COVID-19 infections, hospitalizations, and death. Vaccination against COVID-19 is critical for controlling the pandemic; however, higher levels of vaccine hesitancy and reduced vaccine uptake constrain efforts to mitigate the pandemic and could perpetuate disparities. The aim of this study was to understand barriers and facilitators to COVID-19 vaccination through the lived experiences of Hispanic persons living in Arkansas.

METHODS

Bilingual community partners facilitated recruitment, made initial contact with potential participants, and scheduled interviews and focus groups. Individuals over the age of 18 who identified as Hispanic were invited to participate. Data was collected from 49 participants in 10 individual interviews and five focus groups. This study used a qualitative exploratory design and thematic analysis.

RESULTS

Five themes emerged as barriers for Hispanic participants: technological literacy and pre-registration, language and literacy, health insurance/health care costs, immigration status, and location and transportation. Three themes emerged as facilitators: workplace vaccination, health care provider recommendations, and engagement through schools.

CONCLUSIONS

Based on the findings of this study, a multi-modal and flexible approach will be implemented by the authors to address barriers to vaccine uptake among the Hispanic community in Arkansas.

A treaty to break the pandemic cycle

An evidence-based treaty must balance prevention, preparedness, response, and repair

Global challenges in preparedness and response to epidemic infectious diseases

Lessons drawn from successes and failures with coronavirus disease 2019 (COVID-19) and Ebola virus disease (EVD) should help shaping a robust health innovation system for infectious disease epidemics. Epidemic response research and development (R&D) can be mobilized quickly for public health priorities and yield medicinal products within months. However, to resolve epidemics, technological advances must be equitably accessible and deployed, and these examples expose the limitations of a supply-driven, fragmented R&D ecosystem relying primarily on the private sector to deliver health products. Efficient epidemic response requires a coordinated public health-focused, end-to-end R&D ecosystem for the development, registration, availability, and use of pharmaceutical products. Because pivotal clinical trials can only be conducted during outbreaks, significant preparation must be done beforehand: strengthening clinical research capacity and developing pre-positioned trial protocols and clinical characterization protocols, as well as conducting discovery and pre-clinical research, manufacturing, and early clinical testing of candidate products. This will allow for speedy execution of clinical research early into an outbreak and delivering products within a short time. Effective interventions should be adopted and deployed ensuring equitable access during the ongoing outbreak. Measures to make products available where and when needed must be integrated throughout the R&D value chain.