By our special correspondent
Scanning the health pages of almost any major news outlet, you might be hard-pressed to find a whole lot that isn’t related to COVID-19. For almost two years, the coronavirus pandemic has dominated news headlines, and the emergence of the new Omicron variant has ushered in a fresh wave of stories and concern.
While the pandemic warrants obvious and necessary attention — it has caused the deaths of more than 5 million people and up-ended many of our lives — 2021 has also seen the development of several major health breakthroughs. Here are four of the biggest health stories you might have missed this year.
World Health Organization endorses first malaria Vaccine
Malaria is transmitted through the bite of an infected mosquito. In a moment the World Health Organization Director-General Tedros Adhanom Ghebreyesus described as “historic”, the WHO recommended the widespread use of the world’s first malaria vaccine among children in Africa.
The RTS, S — or Mosquirix — vaccine has been in development for more than three decades, and was proven effective six years ago. In October, after the success of a large-scale pilot program in three African countries, the WHO announced the vaccine would be rolled out across sub-Saharan Africa and in other regions with moderate to high malaria transmission.
Malaria kills about half a million people every year, with children under five accounting for the majority of deaths. The greatest burden of the disease is felt in Africa. “The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” Dr Ghebreyesus said. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”
The vaccine has been shown to prevent three in 10 cases of severe malaria. It will be used alongside other infection control measures such as insecticide-treated bed nets. “This is a huge step forward,” said Julian Rayner, director of the Cambridge Institute for Medical Research. “It’s an imperfect vaccine, but it will stop hundreds of thousands of children from dying.”
New Alzheimer’s drug approved — and mired in controversy
In June, the United States’ Food and Drug Administration (FDA) approved the first new Alzheimer’s drug in almost 20 years, despite warnings from independent advisers that it had not been shown to slow the brain-destroying disease. The new medication, made by Biogen, is estimated to cost $72,000 per year.
Aducanumab — marketed as Aduhelm — is the first approved Alzheimer’s therapy to attack the underlying disease process, rather than to just ease the symptoms. The drug helps clear a protein called beta-amyloid from the brain. Amyloid plaques have become one of the defining characteristics of Alzheimer’s disease, and are widely believed to play a role in causing (and potentially treating) it. The FDA said it approved the drug, made by US biotech company Biogen, based on results that it seemed “reasonably likely” to benefit people with Alzheimer’s disease.
But just months before its approval, an independent panel of neurological experts found there wasn’t enough evidence to show the drug was effective and that it carried serious risks of harm. Before applying to the FDA, Biogen conducted two large phase 3 clinical trials of Aducanumab, which were both shut down because the drug didn’t appear to be helping people. The drug was later resurrected after Biogen re-analyzed the data and found participants receiving the highest dose of the drug in one trial experienced a very slight slowing of cognitive decline.
The FDA’s top drug regulator acknowledged that “residual uncertainties” surround the drug, and under the terms of its accelerated approval, Biogen is required to conduct a follow-up study to confirm benefits for patients. But the decision has sparked major controversy, leading to the resignation of three FDA advisers, one who described the approval as “probably the worst drug approval decision in recent US history”.
Since the drug was green lit, concerns about its safety have intensified, with data from clinical trials showing 41 per cent of participants who received a high dose experienced brain bleeding or swelling. The Therapeutic Goods Administration is currently evaluating Aducanumab for the treatment of Alzheimer’s disease in Australia, and is expected to make a decision in 2022.
New Zealand bans smoking for next generation
Earlier this month, New Zealand announced it would outlaw smoking for anyone born after 2010 as part of its ambitious Smokefree 2025 plan. It will become an offence to sell or supply smoked tobacco products to anyone aged 14 or under when legislation kicks in, with the legal smoke age set to increase every year. The New Zealand government also pledged to reduce the number of retailers selling cigarettes, and to weaken the amount of nicotine in tobacco products to very low levels.
“Smoking is still the leading cause of preventable death in New Zealand and causes one in four cancers,” associate health minister Ayesha Verrall said. “We want to make sure young people never start smoking … people aged 14 when the law comes into effect will never be able to legally purchase tobacco.”
In New Zealand, 13 per cent of people smoke, but among Māori New Zealanders, that figure jumps to 31 per cent. The country’s Smokefree 2025 goal is to limit smokers to 5 per cent of the total population. “If nothing changes, it would be decades till Māori smoking rates fall below 5 per cent, and this government is not prepared to leave people behind,” Dr Verrall said. If the legislation passes, New Zealand’s tobacco industry will be one of the most restricted in the world, just behind Bhutan, where cigarette sales are banned outright.
Hepatitis B in Nigeria: fresh data to inform prevention and care
Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV). Nearly 300 million people worldwide live with this virus, which resulted in an estimated 820,000 preventable deaths in 2019. The virus is most commonly spread from mother to child during birth and through contact with the bodily fluids of an infected person. Infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. Patients with chronic HBV infection have an increased risk of progressive liver damage and scarring liver disease, liver cancer and even death. It can be prevented through vaccination, but there is no cure for it yet. Medications are available to reduce the viral load and slow the progression of liver cancer.
Reliable national data on the number of people infected with HBV are crucial to design public health control measures. Unfortunately, these data for most low- and middle-income countries are either lacking or outdated. This is due to inadequate surveillance of disease patterns, ill-equipped laboratories and poor healthcare services. This makes it difficult to develop evidence-based policy and decisions for timely action.
The World Health Organization (WHO) recognizes HBV as a leading cause of death worldwide. In 2016, WHO outlined a goal to end viral hepatitis as a public health problem by 2030. Up-to-date national and sub-national data on infection levels in the community is the key to measuring progress towards this goal.
In a recent review, we systematically collected data to estimate the levels of HBV infection in Nigeria. This information will be critical for meeting global and national elimination goals. We found a prevalence of 9.5% – which is nearly 20,083,000 Nigerians. That is a high percentage. Infection rates differed by geographical area. The results point to the size of the potential liver disease crisis in Nigeria and where to focus prevention and care efforts with limited resources.
We conducted a meta-analysis, consisting of studies published between 2010 and 2019, to determine HBV prevalence. There were 47 studies and a sample size of 21,702 people. The prevalence rate of 9.5% that emerged from our analysis means that Nigeria meets the WHO’s criteria for high endemicity. Importantly, we found differences in infection levels across different geo-political zones and settings. Higher rates of HBV infection were found in the North-West geo-political zone (12.1%), compared with the South-East (5.9%). HBV infection rates in rural areas were also much higher (10.7%) than those in the cities (8.2%). Our study could not provide the reasons for this, but it is possible that it may be due to inequities in access to health services, and due to differences between culturally diverse groups.
Cultural beliefs can create barriers to HBV care. For example, in northern Ghana, spiritual poisons, curses and witchcraft have been identified as the main cultural beliefs associated with causing HBV in rural communities. Also, the allocation of healthcare resources in Nigeria is skewed towards secondary and tertiary services, which are mostly in urban areas.
What does this mean for Nigeria?
HBV infection in Nigeria requires ongoing efforts towards improving identification and testing, and treatment as part of routine care, along with vaccination to prevent new infections. Despite the existence of a national response to viral hepatitis, less than 5% of people with viral hepatitis B have ever used clinical services. This is particularly important for rural dwellers who make up a significant community of people with HBV in Nigeria. To improve access to prevention and care for rural populations, the national viral hepatitis plans need to be sensitive to diverse cultural attitudes. This may enhance communication and the likelihood that patients will accept healthcare providers’ recommendations.
Ensuring all Nigerians with hepatitis B are diagnosed early and receive appropriate care is critical to avert a liver disease crisis in Nigeria. Given the limited availability of funds at the global level, hepatitis response plans need to be adequately funded through national health budgets. This will minimize out of pocket costs, and ensure access to relevant services without financial hardship to any patients.
Meeting the 2030 elimination targets
In February 2020, heads of states and governments from African Union member states, including the Nigerian government, pledged to eliminate hepatitis as a public health threat by 2030. Despite the challenges of COVID-19, with renewed political commitments, clearly defined targets and financial support, Nigeria can prevent hundreds of thousands of unnecessary deaths. To be on course to the elimination targets, Nigeria must improve access to affordable diagnosis and care for its population. People living with HBV should not have to wait for care until their infection becomes chronic and liver disease reaches an advanced stage. HBV diagnostics need to be affordable and accessible now, so people can be linked to care in a timely manner.
Ensuring high uptake of the vaccine at birth for babies is crucial to prevent new infections. In Nigeria, the current coverage for HBV vaccination is 57% and offers room for improvement. Other measures, such as robust pre-conception screening, and the implementation of “test and treat” interventions at low cost for infected couples, are important to prevent mother-to-child transmission of infection. Stigma and discrimination are notable barriers that prevent people from accessing health services, which can delay diagnosis and care. Marginalizing populations who are vulnerable to HBV, such as people who inject drugs, often leads to their exclusion from testing and clinical care. Hepatitis B elimination will only be possible if we ensure that no one is left behind.