People In Low-income Countries Research Articles

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae, has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis, remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

High life satisfaction reported among small-scale societies with low incomes

Global polls have shown that people in high-income countries generally report being more satisfied with their lives than people in low-income countries. The persistence of this correlation, and its similarity to correlations between income and life satisfaction within countries, could lead to the impression that high levels of life satisfaction can only be achieved in wealthy societies. However, global polls have typically overlooked small-scale, nonindustrialized societies, which can provide an alternative test of the consistency of this relationship. Here, we present results from a survey of 2,966 members of Indigenous Peoples and local communities among 19 globally distributed sites. We find that high average levels of life satisfaction, comparable to those of wealthy countries, are reported for numerous populations that have very low monetary incomes. Our results are consistent with the notion that human societies can support very satisfying lives for their members without necessarily requiring high degrees of monetary wealth.

The Fight for Global Health Justice: The Advocacy of International Humanitarian and Development NGOs During the COVID-19 Pandemic

AbstractThe increasing health inequity and injustice of the COVID-19 pandemic rendered visible the inadequacy of global health governance, and exposed the self-interested decision-making of states and pharmaceutical companies. This research explores the advocacy activities of humanitarian and development international non-governmental organizations (INGOs) in responding to this inequality and investigates how they framed alternatives for global health justice. It reviews 47 organizational documents and 43 media articles of five INGOs (ActionAid, Médecins Sans Frontières, Oxfam, Save the Children, and World Vision) and points to the importance of understanding advocacy frames in analyzing how these organizations prioritize agendas and advocacy strategies. The dominance of the ‘human rights’ frame, sometimes in combination with ‘scientific evidence’ and ‘security’ frames, reflects the identities, mandates, and histories of campaigning and collaboration of these INGOs. This paper contends that the advocacy of humanitarian and development INGOs highlights both deontological and teleological ethics, promoting the voices of people in lower-income countries, clarifying duty bearers and their accountabilities, and addressing structural barriers from a human rights perspective in a global health agenda setting.

Folate-producing bifidobacteria: metabolism, genetics, and relevance.

Folate (the general term for all bioactive forms of vitamin B9) plays a crucial role in the evolutionary highly conserved one-carbon (1C) metabolism, a network including central reactions such as DNA and protein synthesis and methylation of macromolecules. Folate delivers 1C units, such as methyl and formyl, between reactants. Plants, algae, fungi, and many bacteria can naturally produce folate, whereas animals, including humans, must obtain folate from external sources. For humans, folate deficiency is, however, a widespread problem. Bifidobacteria constitute an important component of human and many animal microbiomes, providing various health advantages to the host, such as producing folate. This review focuses on bifidobacteria and folate metabolism and the current knowledge of the distribution of genes needed for complete folate biosynthesis across different bifidobacterial species. Biotechnologies based on folate-trophic probiotics aim to create fermented products enriched with folate or design probiotic supplements that can synthesize folate in the colon, improving overall health. Therefore, bifidobacteria (alone or in association with other microorganisms) may, in the future, contribute to reducing widespread folate deficiencies prevalent among vulnerable human population groups, such as older people, women at child-birth age, and people in low-income countries.

Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data

The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A1c available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5-42·8]) were considered at high risk of diabetes (20·6% [19·8-21·5] in low-income countries, 38·0% [37·2-38·9] in lower-middle-income countries, and 57·5% [54·3-60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6-41·4) for physical activity counselling, 37·1% (35·9-38·4) for weight loss counselling, 42·7% (41·6-43·7) for dietary counselling, and 37·1% (34·7-39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6-71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4-50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6-9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5-23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020.

COVID-19 vaccines, perceptions and trust amongst vaccine refusers: A qualitative thematic analysis study

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has resulted in huge morbidity and mortality since its onset in 2019. By June 24, 2023, only 32.2% of people in low-income countries have received at least one dose. This paper explores the perceptions and trust of vaccine refusers based on the thematic analysis. MethodsIn this study, we used a descriptive qualitative research design to explore the perceptions of the persons who did not believe in receiving the COVID-19 vaccine in Iraqi Kurdistan. This approach allowed us to explore the COVID-19 vaccine issue in-depth. Individual interviews were conducted with 14 participants in Kurdistan, Iraq. ResultsResults showed that the participants had a great fear of the serious side effects of COVID-19 vaccines. Some believed that the virus was not natural and had been made by humans for different reasons including making profits from vaccines. Some believed that there was a silver material inside the vaccine that would force people to receive more doses in the future. Few believed that receiving COVID-19 vaccines was crossing the borders of God. Reinfection was a factor in selling more doses of vaccines. The participants were affected by the advice of the community and social media and not receiving the COVID-19 vaccines from healthcare workers, lack of responsibility from the government and companies, and not having trust in vaccines in this region. ConclusionsConspiracy thinking, perceived negative effects, fear, reinfection, side effects of COVID-19 vaccines could be related to perceived vulnerability and seriousness among vaccine refusers.

Mobile Health-Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study.

Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)-supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (κ), the receiver operating characteristic curve, sensitivity, and specificity analysis. A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (κ=0.54, 95% CI 0.46-0.60). In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases.

Improving agricultural relations and innovation: financial inclusion through microfinancing

Purpose Although microfinance (MF) has been established as an effective approach to provide access to financial services for people in low income countries, close to one-third of adults worldwide, about 2 billion people, are still without access. The purpose of this study is therefore to provide knowledge on how MF institutions (MFIs) can innovate and scale their services to improve financial inclusion for more people in need, particularly small holder farmers. Design/methodology/approach Recent research suggests that Grameen Foundation builds on well-established MF models and focuses on continuously improving the design and increasing the reach of its services. Based on a retrospective longitudinal design, this study draws on dynamic capability theory to identify important lessons in MF innovation at Grameen through analyses of seven key agricultural MF programs. Findings This study finds that Grameen innovated these programs by sensing country-specific needs; seizing opportunities to use existing technology; creating linkages across multisector partners; adopting a business model that enabled replicability and sustainability of innovation transfer; and 5 integrating solutions that enabled process automation and scaling of outcomes. A key theoretical finding in applying dynamic capabilities theory to studies of innovation in MF revealed the core concepts to be transferrable, valuable, imitable and nonsubstitutable resources. Research limitations/implications Using these insights, this study discusses theoretical, practical and policy implications of MF innovation to improve financial inclusion in low-income countries. Practitioners and researchers should assess the transferability of our findings to other MFIs and economic development contexts.

Environmental Perceptions and Sustainable Consumption Behavior: The Disparity among South Africans

The aim of this study is to assess the impact of sociodemographic factors on the environmental perceptions and sustainable consumption behavior in South Africa, a country with the highest record of inequality in the world. Few studies have examined the ways in which people in low-income countries perceive social and environmental problems. By using the International Social Survey Programme Environment III dataset for 2010, this study assessed the impact of sociodemographic factors on the environmental perceptions and sustainable consumption behavior of South Africans. The results show that environmental concern rates are highest among those with low socioeconomic status and African people. Since these individuals constitute the majority of the most vulnerable population in society, it supports the exposure to degradation hypothesis in a South African context. In contrast, sustainable consumption behavior rate is highest among those with high socioeconomic status, suggesting a strong post-materialist effect on pro-environmental consumption. From a policy perspective, environmental policymakers in South Africa could take note of the strong environmental concerns among those more vulnerable to daily environmental degradation and provide further incentives and support their transition to sustainable consumption behavior changes that would assist in environmental protection.

COVID-19 vaccination coverage in Egypt: a large-scale national survey – to help achieving vaccination target, March-May, 2022

BackgroundOnly 57 countries have vaccinated 70% of their population against COVID-19, most of them in high-income countries, whereas almost one billion people in low-income countries remained unvaccinated. In March–May 2022, Egypt's Ministry of Health and Population (MoHP) conducted a nationwide community-based survey to determine COVID-19 vaccine coverage and people's perceptions of vaccination in order to improve COVID-19 vaccination uptake and confidence among Egyptians, as well as to prioritize interventions.MethodsA cross-sectional population-based household survey among Egyptians ≥ 18 years of age was implemented in two phases using a multistage random sampling technique in all of Egypt’s 27 governorates. A sample of 18,000 subjects divided into 450 clusters of 20 households each was calculated in proportion to each governorate and the main occupation of the population. Participants were interviewed using a semistructured questionnaire that included demographics, vaccination information from the vaccination card, history of COVID-19 infection, reasons for vaccine refusal among the unvaccinated, and vaccination experience among vaccinated subjects. Vaccination coverage rates were calculated by dividing numbers by the total number of participants. Bivariate and multivariate analyses were performed by comparing the vaccinated and unvaccinated to identify the risk factors for low vaccine uptake.ResultsOverall 18,107 were interviewed, their mean age was 42 ± 16 years and 58.8% were females. Of them, 8,742 (48.3%) had COVID-19 vaccine and 8,020 (44.3%) were fully vaccinated. Factors associated with low vaccination uptake by multivariate analysis included: age groups (18–29 and 30–39) (ORs 2.0 (95% C.I. 1.8–2.2) and 1.3 (95% C.I.1.2–1.4), respectively), residences in urban or frontier governorates (ORs 1.6 (95% C.I. 1.5–1.8) and 1.2 (95% C.I. 1.1–1.4), respectively), housewives and self-employed people (ORs 1.3 (95% C.I. 1.2–1.4) and 1.2 (95% C.I. 1.1–1.4), respectively), married people (ORs 1.3 (95% C.I. 1.2–1.4), and primary and secondary educated (ORs 1.1 (95% C.I. 1.01–1.2) and 1.1(1.04–1.2) respectively). Vaccine hesitancy was due to fear of adverse events (17.5%), mistrust of vaccine (10.2%), concern over safety during pregnancy and lactation (6.9%), and chronic diseases (5.0%).ConclusionsSurvey identified lower vaccination coverage in Egypt compared to the WHO 70% target. Communication programs targeting the groups with low vaccine uptake are needed to eliminate barriers related to vaccination convenience, side effects, and safety to effectively promote vaccine uptake. Findings from the survey could contribute significantly to vaccination promotion by guiding decision-making efforts on the risky groups and preventing vaccine hesitancy.

Cataract Surgery in Low-Income Countries: A Good Deal!

Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service.

COVID-19 prophylaxis with immunoglobulin Y (IgY) for the world population: The critical role that governments and non-governmental organizations can play

Fewer than 25% of people in low-income countries are estimated to have received at least one COVID-19 vaccine dose to date, in contrast to 68% of the world population [1]. Besides the local culture and social conditions that contribute to vaccine hesitancy, multiple inequities inherent to global public health complicate the ability to vaccinate against […]

Research agendas for alcohol policymaking in the wider world

From comparisons of World Health Organization statistics, it is clear that people in lower-income countries experience more harms per litre of alcohol and different types of harms compared to those from higher-income countries. Yet studies in higher-income countries dominate research on policies to prevent alcohol problems. The paper reports on results of collaborative work to map priority areas for research relevant to low- and middle-income countries. Research focus areas were identified and discussed among potential coauthors from diverse fields with relevant knowledge, with agreement reached on an initial list of seven research priority areas.  Areas identified include: (1) the effects of choices (e.g., national vs. local, monopoly vs. licensing system) in organising the alcohol market; (2)  involvement/separation of alcohol industry interests in decisions on public health regulation; (3) options and effectiveness of global agreements on alcohol governance; (4) choices and experience in controlling unrecorded alcohol; (5) means of decreasing harm from men’s drinking to family members; (6) strategies for reducing the effects of poverty on drinking’s role in harms; and (7) measuring and addressing key alcohol-induced low-and middle-income country (LMIC) health harms: infectious diseases, injuries, digestive diseases. Paths ahead for such research are briefly outlined.

Striking a Balance between Livelihood and Forest Conservation in a Forest Farm Facility in Choma, Zambia

Charcoal production is an essential energy source and income source for many people in low-income countries, such as Africa. Charcoal production is also associated with deforestation—a global issue that significantly affects the environment and ecosystems. Therefore, promoting strategies that can balance forestry protection and people’s livelihoods in low-income countries is critical. This study investigated the factors affecting Zambia’s rural households’ participation in the natural regeneration (NR) program—the program initiated by the Forest and Farm Facility program (FFF) of the United Nations Food and Agricultural Organization (FAO) in Zambia in 2015. Using household survey data collected from Choma District in Southern Zambia, this study used descriptive statistical analysis and a logit model to detect the factors that affect the use of the NR program. The results indicate that charcoal production enhances the livelihoods of rural households when forest conservation is reconciled with household income and forest-management methods that abandon traditional practices. Participation in the NR program seems to be mainly driven by household income. The results indicated that the relationship between forest-resource utilization and conservation in Choma is encouraging. The implementation of the Forest and Farm Facility program is recommended to be spread to other communities to improve both livelihoods in local communities and forest conservation.

Time to redefine a primary vaccination series?

In the third year of the COVID-19 pandemic, it is getting harder to define what a full-dose COVID-19 vaccination series is, especially in the era of emerging variants such as omicron (B.1.1.529). The definition might differ depending on the dominant variant in circulation, the availability of vaccines, the risk factors of vaccine recipients, and the availability of surveillance and COVID-19 vaccine safety and effectiveness data. Inequitable vaccine availability adds to the problem as on one hand, in many high-income countries, a fourth dose of an mRNA vaccine is offered and gives well tolerated boosting of cellular and humoral immunity,1Munro APS Feng S Janani L et al.Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial.Lancet Infect Dis. 2022; 22: 1131-1141Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar and on the other hand, only 19·7% of people in low-income countries have received at least one dose of any COVID-19 vaccine.2Our World in DataShare of people who received at least one dose of COVID-19 vaccine.https://ourworldindata.org/grapher/share-people-vaccinated-covid?country=High+income~Upper+middle+income~Lower+middle+income~Low+incomeDate accessed: August 4, 2022Google Scholar These facts all make it difficult to comment on what a primary COVID-19 vaccination series should consist of and how we should boost protective immunity in the face of emerging variants in a world with marked inequalities. In The Lancet Infectious Diseases, Karin Hardt and colleagues3Hardt K Vandebosch A Sadoff J et al.Efficacy, safety, and immunogenicity of a booster regimen of Ad26.COV2.S vaccine against COVID-19 (ENSEMBLE2): results of a randomised, double-blind, placebo-controlled, phase 3 trial.Lancet Infect Dis. 2022; (published online Sept 13.)https://doi.org/10.1016/S1473-3099(22)00506-0Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar report on the efficacy, safety, and immunogenicity of a second dose of Ad26.COV2.S vaccine against COVID-19 given as part of the ENSEMBLE2 trial, wherein participants were randomly assigned from the first visit either to get two doses of the vaccine or two doses of placebo 2 months apart. The two-dose regimen provided 75·2% (adjusted 95% CI 54·6–87·3) efficacy against moderate to severe–critical COVID-19 and 100% (32·6–100·0) efficacy against severe–critical COVID-19. Meanwhile, the final analysis of the double-blind phase of the ENSEMBLE vaccine trial showed that primary vaccination with a single dose of Ad26.COV2.S had 56·3% (95% CI 51·3–60·8) efficacy against moderate to severe–critical COVID-19, 74·6% (64·7–82·1) efficacy against severe–critical COVID-19, and 82·8% (40·5–96·8) efficacy against COVID-19 related death.4Sadoff J Gray G Vandebosch A et al.Final analysis of efficacy and safety of single-dose Ad26.COV2.S.N Engl J Med. 2022; 386: 847-860Crossref PubMed Scopus (38) Google Scholar The data collection for the primary analyses of one-dose and two-dose regimens was completed before the global dominance of delta (B.1.617.2) and the emergence of omicron. The follow-on, single-arm, open-label, phase 3b, Sisonke study in health-care workers in South Africa showed that after two doses of Ad26.COV2.S vaccine, effectiveness against severe disease during the omicron surge was equal to that of two doses of BNT162b2.5Gray G Collie S Goga A et al.Effectiveness of Ad26.COV2.S and BNT162b2 vaccines against omicron variant in South Africa.N Engl J Med. 2022; 386: 2243-2245Crossref PubMed Scopus (11) Google Scholar Moreover, a longer interval (4 months) between the two doses of Ad26.COV2.S led to lesser omicron immune escape than other two-dose vaccine regimens (given 3–4 weeks apart).6Bowen JE Addetia A Dang HV et al.Omicron spike function and neutralizing activity elicited by a comprehensive panel of vaccines.Science. 2022; 377: 890-894Crossref PubMed Scopus (23) Google Scholar However, vaccinees receiving two doses of Ad26.COV2.S had greater omicron immune escape than vaccinees receiving three doses of mRNA vaccines or three doses of different heterologous regimens. These findings suggest that a third dose of either Ad26.COV2.S or another vaccine might act as a booster dose for a two-dose regimen of Ad26.COV2.S. Thus, we consider that two doses should be regarded as the primary vaccination series for Ad26.COV2.S in the era of omicron. WHO's updated recommendations also echo this point of view and advise that all efforts should be taken to provide a second dose 2–6 months after the first dose, particularly to the highest-priority and high-priority groups.7WHOInterim recommendations for the use of the Janssen Ad26.COV2.S (COVID-19) vaccine.https://www.who.int/news-room/feature-stories/detail/the-j-j-covid-19-vaccine-what-you-need-to-knowDate accessed: August 4, 2022Google Scholar When a second dose is to be given, WHO supports a flexible approach either to use two doses of Ad26.COV2.S vaccine or a heterologous vaccination schedule. A single-dose regimen is still an acceptable option for countries challenged with supply constraints and vaccine deployment issues. It is clear that there is a constant need to review the available data on vaccine efficacy and generate effectiveness data for the COVID-19 vaccines in the context of emerging variants. The ultimate goal should be to provide the best protection from severe disease, hospitalisation, and death with the lowest number of doses of available COVID-19 vaccines. The best chance to stop this pandemic is to make vaccines available for everyone, everywhere. The efforts to provide booster doses should be balanced with the efforts to attain vaccine equity. We declare no competing interests. Efficacy, safety, and immunogenicity of a booster regimen of Ad26.COV2.S vaccine against COVID-19 (ENSEMBLE2): results of a randomised, double-blind, placebo-controlled, phase 3 trialA homologous Ad26.COV2.S booster administered 2 months after primary single-dose vaccination in adults had an acceptable safety profile and was efficacious against moderate to severe–critical COVID-19. Studies assessing efficacy against newer variants and with longer follow-up are needed. Full-Text PDF

Age-Dependent Effects of Copper Toxicity on Connective Tissue Structural Stability in Wistar Rats Skin.

Over the last three decades, there has been increasing global concern over the public health impacts attributed to direct and indirect environmental pollution, in particular, the global burden of disease. The World Health Organization estimates that, about a quarter of the diseases facing mankind today occur due to prolonged exposure to environmental pollution; the health of 200 million people in lower-income countries is at risk from toxins such as lead and copper or mercury, more than from AIDS, tuberculosis and malaria combined and that, nearly a quarter of deaths in developing countries including Nigeria and Ghana, are linked to pollution. The purpose of the study was to investigate the effects of the ingestion of large dose of copper on the structural stability of collagen molecules, as well as reveal age-dependent differences in the phenomena. The content of de novo synthesized collagen was determined by hydroxyproline concentration using Stegmann-Staeder's method as modified by Utevskaya and Persky; the nature of intra- and inter-molecular covalent cross-links in collagen matrix was estimated by electrophoretic separation of products of partial thermal denaturation of collagen in polyacrylamide gel. There was intensification of synthesis over degradation in young rats, and that administration of copper led to a decrease in collagen solubility. Effects of copper on the structural stability of collagen appeared mostly in young rats.

Editorial

Since the publication of our last issue, which included special sections on The Stakes of Sanctuary and Religion and Refugees, COVID-19 has continued to disrupt peoples’ lives and rhythms in multiple ways around the world. Vaccination programs have enabled many people in Europe and North America to start traveling again for work, to visit family, or for pleasure, yet long-standing global inequalities and inequities have persisted, with deadly effect. At the time of writing (end of February 2022), while 79 percent of the populations of high- and middle-income countries have received at least one vaccine dose, only 13 percent of people in low-income countries have been able to access the vaccine (Holder 2022), reflecting what Tedros Adhanom Ghebreyesu (Director-General of the World Health Organization) calls global “vaccine apartheid.”

Constructing ‘others’ and a wider ‘we’ as emotional processes: A case of South Korea in times of crisis

This article examines how growing fears, insecurities and uncertainties during the COVID-19 pandemic have prompted an emotional distance from others. The aim is to explore how global solidarity and nationalism are challenged and constructed as collective emotional processes concerning ‘others’. Drawing on social theories of emotions during crises and emotions towards others, this study looks at policy decisions around vaccines and health services and their associated emotions in the context of Korea, which has a relatively small migrant population and a short history of supporting people in lower-income countries. The study finds that the COVID-19 pandemic has strengthened nationalism, both ethnic nationalism and cosmopolitan nationalism. This points to the need to highlight global norms such as human rights and justice and cultivate foundational emotions such as empathy and compassion. This article suggests paying attention to the role of emotions in generating othering practices and developing global solidarity.

Addressing malnutrition and food insecurity with breadfruit in a rural, developing country: a case study and lessons learned in Thomassique, Haiti

Haiti’s Central Plateau region suffers from significant malnutrition, economic hardship, and a crisis level of food insecurity. Already the poorest country in the Western Hemisphere in terms of gross domestic product (GDP) per capita, Haiti has pervasively high malnutrition rates, but the Central Plateau is among the most severely affected areas. One in five children of the Central Plateau suffers from malnutrition, and the region exhibits a devastating 30% rate of child stunting. Our US-based team affiliated with Klinik Sen Jozèf, a community-respected medical clinic in the Central Plateau city of Thomassique. We partnered with local Haitian leadership, a local agronomist, and Trees That Feed Foundation to introduce breadfruit (Artocarpus altilis) and an innovative development model to combat local malnutrition. Five years into the program, we have partnered with 152 farmers, and we have enhanced our malnutrition program with breadfruit derivatives. This report addresses the lessons we learned to assist others looking to introduce models or crops in a similar manner. Our experience is particularly significant in light of the COVID-19 pandemic, as supply chain disruptions have worsened food insecurity for more than 800 million people in low-income countries.

DNA vaccines join the fight against COVID-19

As of March, 2022, just over 1 year has passed since the authorisation of first-generation vaccines against COVID-19. Since then, almost 10 billion doses of COVID-19 vaccines have been administered globally.1Our World in DataCoronavirus (COVID-19) vaccinations.https://ourworldindata.org/covid-vaccinations?country=OWID_WRLDate: 2022Date accessed: January 18, 2022Google Scholar Although the delivery of this number of vaccines is a remarkable achievement, there is still a disparity in vaccine equity, access, and affordability between high-income and low-income countries. According to the Global Dashboard for Vaccine Equity (established by the UN Development Programme, WHO, and the University of Oxford), as of Jan 18, 2022, approximately 67·6% of people in high-income countries have had at least one dose, compared with only approximately 11·36% of people in low-income countries.2UN Development ProgrammeVaccine access.https://data.undp.org/vaccine-equity/accessibility/Date accessed: January 18, 2022Google Scholar This inequity has major negative implications for global pandemic control; thus, there is an imperative to develop more affordable, scalable, and easily distributable vaccines. In the current landscape of mRNA, viral vector, and inactivated COVID-19 vaccines, one modality that has been largely under-represented is DNA vaccines. In The Lancet, Akash Khobragade and colleagues3Khobragade A Bhate S Ramaiah V et al.Efficacy, safety, and immunogenicity of the DNA SARS-CoV-2 vaccine (ZyCoV-D): the interim efficacy results of a phase 3, randomised, double-blind, placebo-controlled study in India.Lancet. 2022; 399: 1313-1321Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar report an interim analysis of a phase 3, randomised, double-blind, placebo-controlled study of a DNA vaccine, ZyCoV-D, against COVID-19. The vaccine contains a 2 mg dose of a DNA plasmid (pVAX-1) expressing the Wuhan Hu-1 spike antigen of SARS-CoV-2 and an IgE signal peptide, which is delivered intradermally using a needle-free injection system. Participants received three doses of vaccine or placebo at 28-day intervals. The primary outcome of this study was the number of participants with first occurrence of symptomatic COVID-19, as determined by a symptomatic RT-PCR test 28 days after the third dose, until the targeted number of 158 cases was achieved. Between Jan 16 and June 23, 2021, 27 703 participants (aged >12 years) were randomly assigned (1:1) to receive ZyCoV-D (n=13 851) or placebo (n=13 852), and 81 cases were eligible for the interim primary efficacy endpoint as per protocol, which yielded a vaccine efficacy of 66·6% (20 cases in the ZyCoV-D group and 61 in the placebo group). There was full protection against more severe disease and death. It is important to keep in mind that this study was done during a surge of the B.1.617.2 (delta) variant in India, and the study population was predominantly male (18 592 [67·11%] male and 9111 [32·89%] female), with no ethnicity data reported. Furthermore, the efficacy analysis was not stratified for age. Age is a known determinant of both COVID-19 outcomes and vaccine effectiveness. Finally, the efficacy analysis was only performed after the third dose, limiting insight into the effect of the first and second doses—this is useful information where incomplete vaccination could occur. The vaccine was found to be safe, with approximately equivalent prevalence of solicited adverse events between the ZyCoV-D (n=623) and placebo (n=620) groups. The authors state that the safety profile of ZyCoV-D is comparable to another DNA-based vaccine in development.4Tebas P Yang S Boyer JD et al.Safety and immunogenicity of INO-4800 DNA vaccine against SARS-CoV-2: a preliminary report of an open-label, phase 1 clinical trial.EClinicalMedicine. 2021; 31100689Summary Full Text Full Text PDF PubMed Scopus (104) Google Scholar Notably, ZyCoV-D was found to be stable at room temperature (25°C) for 2 months in initial studies, although it was stored at 2–8°C for this study. Based on the safety, immunogenicity, and efficacy findings from the phase 3 trial, ZyCoV-D has been granted Emergency Use Authorisation in India: a landmark milestone for DNA vaccines with potential to further contribute to the COVID-19 vaccine diversity and worldwide supply. Despite decades of research and development of DNA vaccines, including at least eight candidates currently in clinical trials for COVID-19,5Sheridan C First COVID-19 DNA vaccine approved, others in hot pursuit.Nat Biotechnol. 2021; 39: 1479-1482Crossref PubMed Scopus (5) Google Scholar they have had limited success. One of the main challenges for DNA vaccines is the delivery: mRNA vaccines need to cross only one membrane to reach their site of action (cytoplasm), whereas DNA vaccines need to cross the cytoplasm and the nuclear membrane. Because of this difference, the lipid nanoparticles that effectively deliver mRNA do not work as well for DNA. Historically, DNA vaccines have required a physical method of delivery such as electroporation, or the needle-free injection system used in this study.6Lee J Arun Kumar S Jhan YY Bishop CJ Engineering DNA vaccines against infectious diseases.Acta Biomaterialia. 2018; 80: 31-47Crossref PubMed Scopus (59) Google Scholar, 7Modjarrad K Roberts CC Mills KT et al.Safety and immunogenicity of an anti-Middle East respiratory syndrome coronavirus DNA vaccine: a phase 1, open-label, single-arm, dose-escalation trial.Lancet Infect Dis. 2019; 19: 1013-1022Summary Full Text Full Text PDF PubMed Scopus (161) Google Scholar, 8Gaudinski MR Houser KV Morabito KM et al.Safety, tolerability, and immunogenicity of two Zika virus DNA vaccine candidates in healthy adults: randomised, open-label, phase 1 clinical trials.Lancet. 2018; 391: 552-562Summary Full Text Full Text PDF PubMed Scopus (177) Google Scholar Although these physical devices appear to be effective—as shown in this study—they pose a potential challenge for widespread use and scale-up. The device used in Khobragade and colleagues’ study3Khobragade A Bhate S Ramaiah V et al.Efficacy, safety, and immunogenicity of the DNA SARS-CoV-2 vaccine (ZyCoV-D): the interim efficacy results of a phase 3, randomised, double-blind, placebo-controlled study in India.Lancet. 2022; 399: 1313-1321Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar is small and portable (<50 g) and consists of an injector, syringe, and filling adapter. However, widespread administration of ZyCoV-D will be limited not only by production and availability of the DNA, but also the injection device, which is vulnerable to global manufacturing disruptions. If these delivery system challenges can be overcome then the amenable storage conditions, efficacy against COVID-19 (including the delta strain), and low cost (<US$10) have poised ZyCoV-D to be another global solution in our fight against SARS-CoV-2, and might act as a catalyst for DNA-based vaccines against other diseases, such as tuberculosis and HIV-1, especially in areas that have restricted access and affordability. AKB is a co-founder and reports holding shares in VaxEquity, a for-profit company that aims to develop self-amplifying RNA vaccines for infectious diseases, but is not currently actively involved in the company. VaxEquity does not produce DNA vaccines. L-GB has received honoraria from Gilead Sciences and Merck for advisory work in HIV prevention. Efficacy, safety, and immunogenicity of the DNA SARS-CoV-2 vaccine (ZyCoV-D): the interim efficacy results of a phase 3, randomised, double-blind, placebo-controlled study in IndiaIn this interim analysis, ZyCoV-D vaccine was found to be efficacious, safe, and immunogenic in a phase 3 trial. Full-Text PDF