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Poorer nations face vaccine wait as West locks down supply

Published

4 years ago

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by Patrick Galey

Hailed this week as a pandemic game-changer, the new Covid-19 vaccine offered countries that had pre-ordered doses a potential escape from a cycle of lockdowns and new waves of sickness and death.

But while richer nations plan their vaccination programmes through the end of 2021, experts warn that poorer and developing countries face hurdles that could deny billions the first proven protection against the coronavirus.

Vaccine developers Pfizer and BioNTech plan to roll out the first doses within weeks, once they receive emergency use permissions from drug agencies. They expect to have 1.3 billion doses ready next year.

The results of phase 3 clinical trials showed their mRNA vaccine was 90 percent effective in preventing Covid-19 symptoms and did not produce adverse side effects among thousands of volunteers.

At the cost of $40 per treatment, which consists of two separate shots, richer nations have rushed to order tens of millions of doses. But it is less clear what poorer nations can expect.

“If we only have the Pfizer vaccine and everyone needs two doses, clearly that’s a difficult ethical dilemma,” Trudie Lang, director of The Global Health Network at the University of Oxford’s Nuffield Department of Medicine, told AFP.

Anticipating the outsize demand for any approved vaccine, the World Health Organization formed the COVAX facility in April to ensure equitable distribution.

COVAX brought together governments, scientists, civil society and the private sector — though Pfizer is not currently part of the facility.

A company spokesperson told AFP it had “provided an expression of interest for possible supply” to COVAX.

Rachel Silverman, a policy fellow at the Center for Global Development, said it was unlikely that much of the first vaccine batch would end up in poorer nations.

Based on advance purchase agreements signed with Pfizer, she calculated that 1.1 billion doses had been snapped up entirely by wealthy nations.

“There’s not much left for everyone else,” she told AFP.

Some countries that pre-ordered, such as Japan and Britain, are part of COVAX, so some doses are likely to reach less developed nations through their purchase agreements.

Conversely, the United States, which has 600 million doses on order, is not a COVAX member, though this may change under a Joe Biden administration.

Fair share

Benjamin Schreiber, Covid-19 vaccine coordinator at the UN’s children’s fund UNICEF, said it was vital that all nations had fair access to the new vaccine.

“We really need to avoid a situation of rich nations gobbling up all the vaccines and then there’s not enough doses for the poorest nations,” he said.

Ethics aside, epidemiological data underscores the need for equitable vaccine distribution.

This month researchers at America’s Northeastern University published research examining the link between vaccine reach and Covid-19 mortality.

They modelled two scenarios. The first, the “uncooperative allocation” scenario, hypothesised what would happen if 50 rich nations monopolised the first 2 billion doses of a vaccine.

The second saw the vaccine distributed based on a country’s population rather than its ability to pay for it.

The researchers found that the rich nation stockpiling scenario reduced Covid-19 deaths by 33 percent globally. The fair-share approach prevented 61 percent.

Commenting on the study, the Gavi vaccine alliance, which co-leads COVAX, said “the modest gain for high-income countries in monopolising vaccines was far less than the devastating losses for low-income countries if countries don’t cooperate”.

‘Enormous challenge’

Even if finance for poorer nations materialises, the logistics of getting the new vaccine to everyone remains dizzying.

Pfizer’s vaccine is based on mRNA, which tricks the immune system to produce viral proteins itself that are then neutralised.

It appears to be effective at bestowing protection against Covid-19, yet is extremely fragile: it must be stored at -80 degrees Celsius (-112 degrees Fahrenheit) or else it falls apart.

“Most freezers in most hospitals anywhere in the world are -20C,” said Lang. “This is four times colder.”

Silverman said maintaining the vaccine’s “ultra-cold chain” from factory to patients’ arms constituted “an enormous logistical challenge even in the West”.

Although Pfizer and some governments have been preparing delivery protocols for months in anticipation of trial results, “none of that has taken place in low- and middle-income countries”, she said.

Pfizer has designed its own “thermal shipper”, a briefcase-sized container that can keep the vaccine supercool for up to 10 days.

For others, there may be ways around the problem. Food storage containers, for example, are regularly cooled to close to the temperature required by the vaccine before being shipped long distances.

And the Ebola vaccine, which like those in trial for Covid-19 was developed and delivered at warp speed following a string of deadly outbreaks, has a similar temperature profile to Pfizer’s.

“We have experience in rolling out the Ebola vaccine in some countries,” Schreiber told AFP.

He said it was “more difficult but not impossible” to safely store and administer the Covid-19 vaccine across the global south, but this would require significant investment and training.

Gaining trust ‘tall order’

There are currently more than three dozen other Covid-19 vaccine candidates in development, 11 of which are in or have completed phase 3 trials.

Most experts agree that the best route out of the pandemic would be to have several safe and effective vaccines that work in different ways, giving varying levels of protection.

Pfizer has yet to release its full results so it is not clear if its vaccine stops Covid-19 transmission — meaning it would be suitable for mass administration — or if it only prevents severe illness, in which case it would be prioritised for elderly and at-risk populations.

But even if several vaccines come online in the coming months, there is no guarantee everyone who should get one will agree to it.

The WHO in 2019 said “vaccine hesitancy” was one of the top 10 global health threats, and last month The Lancet medical journal warned that growing anti-vaccine movements could hamper the Covid-19 inoculation rollout.

Although the Ebola vaccination programme has all but eradicated the virus, several studies showed how progress was slowed by mistrust and misinformation circulating both online and within communities.

Lang said there were also lessons to learn from the polio response in Africa.

“Africa is now clear of polio, which is amazing,” she said. “But the things we had to get over in order to do that.

“Mothers would often say: ‘If I go to the hospital with my son I can’t get medicines or treatment, but you’re going over to my house with this foreign vaccine. What’s that about?’

“It’s a tall order to gain trust.”

– AFP

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Health

Survey reveals one-third of Singaporean youth struggle with severe mental health issues

A national study by the Institute of Mental Health reveals that 30.6% of Singaporean youth suffer from severe symptoms of depression, anxiety, or stress, driven by factors like excessive social media use, body image concerns, and cyberbullying. The findings emphasize the need for early intervention and targeted mental health strategies.

Published

2 weeks ago

on

23 September 2024

By

A significant portion of Singapore’s youth are experiencing severe mental health challenges, according to a comprehensive national survey conducted by the Institute of Mental Health (IMH).

The National Youth Mental Health Study (NYMHS), released on 19 September 2023, found that 30.6% of individuals aged 15 to 35 reported severe or extremely severe symptoms of depression, anxiety, or stress, with key risk factors including excessive social media use, body shape concerns, and experiences of cyberbullying.

The study, which surveyed 2,600 Singaporean citizens and permanent residents, highlights the growing mental health concerns among Singaporean youth and suggests the need for more targeted interventions and support systems.

Mental Health Issues Prevalent Among Youth

Anxiety was the most common mental health issue, with 27% of respondents reporting severe or extremely severe symptoms, followed by depression (14.9%) and stress (12.9%).

These findings underscore the high prevalence of mental health issues among young people, particularly in those aged 15 to 24, who were more likely to report severe symptoms compared to older participants.

According to the IMH, young people who were female, single, unemployed, or had lower levels of education or household income were more prone to severe mental health symptoms.

For example, youth with monthly household incomes below S$5,000 were more likely to experience severe anxiety​.

Key Risk Factors: Social Media, Body Image, and Cyberbullying

The study identified three major factors linked to severe mental health symptoms:

  1. Excessive Social Media Use: Around 27% of respondents reported using social media for more than three hours daily, which was associated with a significantly higher likelihood of severe mental health issues. Youth with excessive social media use were 1.5 to 1.6 times more likely to experience severe symptoms of depression, anxiety, or stress​.
  2. Body Shape Concerns: About 20.2% of youth had moderate to severe concerns about their body image. These individuals were 4.9 times more likely to experience severe depression, 4.3 times more likely to experience severe anxiety, and 4.5 times more likely to suffer from severe stress​. Such concerns were often linked to social media exposure, which can perpetuate unrealistic beauty standards and increase dissatisfaction with one’s body.
  3. Cyberbullying: One in five youth (21%) reported being victims of cyberbullying. These individuals were approximately twice as likely to report severe mental health symptoms compared to those who had not experienced such harassment​. The anonymity and pervasive nature of online bullying exacerbates the mental health toll on young people, according to the study.

Demographics at Higher Risk

The study found that specific demographics were more vulnerable to mental health issues. Young people aged 15 to 24 were more likely to experience anxiety, depression, and stress, particularly females, those who were single, and those with lower levels of education, such as junior college or vocational qualifications​.

The Malay ethnic group was also found to have a higher prevalence of severe mental health symptoms compared to other ethnic groups​.

Barriers to Seeking Help and Sources of Support

Although about 69.1% of those with severe mental health symptoms sought help—primarily from family and friends—a significant portion of young people hesitated to seek professional support.

The top reasons included concerns about privacy, fear of judgment, and doubts about the effectiveness of professional services​.

Among those who sought help, family and friends were the most common sources of support (57.9%), followed by self-help measures (31.1%) and medical services (20.1%)​.

However, the reluctance to seek professional help highlights the need for continued efforts to destigmatize mental health treatment and increase awareness of available services.

Protective Factors: Resilience, Social Support, and Self-Esteem

The study also identified factors that helped mitigate mental health challenges. Youth who reported higher levels of resilience, perceived social support, and self-esteem were significantly less likely to experience severe symptoms of depression, anxiety, or stress.

This suggests that fostering strong support networks and building resilience in youth could play a critical role in improving their mental well-being​.

Government Response and Preventive Measures

The findings of the NYMHS support Singapore’s broader National Mental Health and Well-Being Strategy, launched in October 2023, which adopts a whole-of-government and whole-of-society approach to addressing mental health concerns. Schools have already begun integrating mental health education into their curricula, equipping students with the knowledge and skills to manage their well-being.

Additionally, the government introduced the Parenting for Wellness toolbox in September 2023 to help parents manage their children’s screen time and promote healthy social media usage.

A guide on responsible social media use, expected to be released by mid-2025, will offer further strategies to mitigate the negative impacts of excessive screen time and online harassment​.

Future Implications and Policy Development

Associate Professor Swapna Verma, chairman of IMH’s medical board and co-principal investigator of the study, emphasized the importance of early intervention.

“Not all individuals with severe or extremely severe symptoms of depression or anxiety have a clinical condition, but being in such states for a prolonged period of time can be detrimental to their well-being,” she said​.

The study’s data will help policymakers and healthcare providers develop more targeted approaches to address the mental health needs of Singapore’s youth, especially those most at risk.

Associate Professor Mythily Subramaniam, IMH’s assistant chairman of medical board (research), stressed the need to pay attention to issues like excessive social media use and cyberbullying, noting their “tremendous impact on youth mental health” and the importance of preventive measures​.

Support for Youth Facing Mental Health Challenges

Young people dealing with mental health challenges in Singapore have access to various resources:

  • CHAT (Centre of Excellence for Youth Mental Health): CHAT offers a safe and confidential space for youth to seek help through online and face-to-face mental health assessments and support.
  • Institute of Mental Health (IMH): IMH provides a comprehensive range of mental health services, including outpatient consultations and inpatient care. Youth in crisis can also seek immediate assistance from the 24-hour Mental Health Helpline at 6389 2222.
  • Samaritans of Singapore (SOS): SOS offers emotional support for those feeling distressed or experiencing suicidal thoughts. Their 24-hour hotline is 1767.
  • Health Promotion Board’s National Care Hotline: This hotline provides immediate emotional support for those in need and can be reached at 1800-202-6868.
  • Counselling Services: School-based counsellors, as well as community-based services such as TOUCH Youth, provide further avenues of support for young people grappling with mental health issues.
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Health

Malaysia reports new mpox case in man without recent international travel

Malaysia has confirmed its first mpox case of 2024 in a male patient, the Health Ministry reported. The patient is in isolation and stable, with authorities monitoring his contacts. This brings the total confirmed cases since July 2023 to ten, all from clade II.

Published

3 weeks ago

on

17 September 2024

By

MALAYSIA: The Malaysian Health Ministry confirmed a new case of monkeypox (mpox) in a male citizen, marking the country’s first confirmed case of 2024.

The patient, who began showing symptoms on 11 September, is currently in isolation and in stable condition.

The ministry, in a statement issued Tuesday (17 September), revealed that the patient first experienced fever, sore throat, and cough, followed by the appearance of rashes on 12 September.

He has no recent history of international travel within the past 21 days, and authorities are in the process of identifying and monitoring his close contacts, following strict standard operating procedures (SOPs).

“Out of the 58 suspected mpox cases referred to the ministry this year, one case has been confirmed positive for mpox clade II as of 16 September,” the ministry stated.

“All 10 cases reported in Malaysia since July 2023 have been from clade II.”

The Health Ministry had earlier reported that Malaysia recorded a total of nine mpox cases since the first detection on 26 July 2023, with the most recent case reported in November 2023.

All previous cases had links to high-risk activities, but no deaths were reported.

Global Context and National Preparedness

Mpox was declared a Public Health Emergency of International Concern (PHEIC) for the second time on 14 August this year, due to the rapid spread of the clade Ib variant, particularly from the Democratic Republic of Congo (DRC) and neighboring African nations.

In response, Malaysia’s Health Ministry activated its national crisis response centre on 16 August to enhance readiness and coordinate preventive measures.

The ministry advised the public to take precautions, including maintaining personal hygiene and avoiding direct contact with individuals suspected or confirmed to be infected with mpox.

High-risk individuals experiencing symptoms such as fever, swollen lymph nodes, and rashes are urged to seek immediate medical attention.

Mpox is caused by the monkeypox virus (MPVX) and spreads through close contact with symptomatic individuals.

The incubation period is typically between 5 and 21 days, and patients remain contagious until all lesions have dried up and fallen off.

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