Journal Watch

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focu-s on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Health Equity in US Latinx Communities

AMA Journal of Ethics
Volume 24, Number 4: E249-341 Apr 2022
https://journalofethics.ama-assn.org/issue/health-equity-us-latinx-communities

 

Health Equity in US Latinx Communities
Latinx communities in the US include over 60 million people with a plurality of political beliefs, cultural practices, and wealth. This diversity is also expressed in population health data: some health indicators suggest advantages of Latinx community membership while other data demonstrate inequitable disease burden and maldistribution of environmental and occupational risk. Legacies of colonial conquest of the Americas persist in discrimination and marginalization today and are embodied by members of our Latinx communities.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services (2 May, 2022)

BMJ Global Health
May 2022 – Volume 7 – 5
https://gh.bmj.com/content/7/5

 

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services (2 May, 2022)
Agbessi Amouzou, Abdoulaye Maïga, Cheikh Mbacké Faye, Samuel Chakwera, Dessalegn Y Melesse, Martin Kavao Mutua, Sokhna Thiam, Idrissa Boukary Abdoulaye, Seth Kwaku Afagbedzi, Akory Ag Iknane, Odile Sassor Ake-Tano, Joshua O Akinyemi, Victor Alegana, Yakubu Alhassan, Arinaitwe Emma Sam, Dominic Kwabena Atweam, Shraddha Bajaria, Luke Bawo, Mamadou Berthé, Andrea Katryn Blanchard, Hamissou Alaji Bouhari, Ousmane Maimouna Ali Boulhassane, Maio Bulawayo, Ovost Chooye, Amed Coulibaly, Mamatou Diabate, Fatou Diawara, Ousman Esleman, Mulugeta Gajaa, Kamil Halimatou Amadou Garba, Theodros Getachew, Choolwe Jacobs, George P Jacobs, Femi James, Ayodele S Jegede, Catherine Joachim, Rornald Muhumuza Kananura, Janette Karimi, Helen Kiarie, Denise Kpebo, Bruno Lankoandé, Akanni Olayinka Lawanson, Yahaha Mahamadou, Masoud Mahundi, Tewabe Manaye, Honorati Masanja, Modeste Roch Millogo, Abdoul Karim Mohamed, Mwiche Musukuma, Rose Muthee, Douba Nabié, Mukome Nyamhagata, Jimmy Ogwal, Adebola Orimadegun, Ajiwohwodoma Ovuoraye, Adama Sanogo Pongathie, Stéphane Parfait Sable, Geetor S Saydee, Josephine Shabini, Brivine Mukombwe Sikapande, Daudi Simba, Ashenif Tadele, Tefera Tadlle, Alfred K Tarway-Twalla, Mahamadi Tassembedo, Bentoe Zoogley Tehoungue, Ibrahim Terera, Soumaïla Traoré, Musu P Twalla, Peter Waiswa, Naod Wondirad, Ties Boerma

On prioritising global health’s triple crisis of sepsis, COVID-19 and antimicrobial resistance: a mixed-methods study from Malawi

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 07 May 2022)

 

On prioritising global health’s triple crisis of sepsis, COVID-19 and antimicrobial resistance: a mixed-methods study from Malawi
Sepsis causes 20% of global deaths, particularly among children and vulnerable populations living in developing countries. This study investigated how sepsis is prioritised in Malawi’s health system to inform …
Authors: Paul Kawale, Levi Kalitsilo, Jessie Mphande, Bayode Romeo Adegbite, Martin P. Grobusch, Shevin T. Jacob, Jamie Rylance and Nyovani J. Madise
Citation: BMC Health Services Research 2022 22:613
Content type: Research Published on: 7 May 2022

SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 07 May 2022)

 

SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis
The temporal evolution of SARS-CoV-2 vaccine efficacy and effectiveness (VE) against infection, symptomatic, and severe COVID-19 is incompletely defined. The temporal evolution of VE could be dependent on age,…
Authors: Paddy Ssentongo, Anna E. Ssentongo, Navya Voleti, Destin Groff, Ashley Sun, Djibril M. Ba, Jonathan Nunez, Leslie J. Parent, Vernon M. Chinchilli and Catharine I. Paules
Citation: BMC Infectious Diseases 2022 22:439
Content type: Research Published on: 7 May 2022

Measles immunity in medical center staff after changes in national and local hospital vaccination policies

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 07 May 2022)

 

Measles immunity in medical center staff after changes in national and local hospital vaccination policies
Measles vaccination was introduced in Taiwan in 1978, and the disease was declared eliminated in Taiwan in 2007. However, new cases have been reported unpredictably since then. Hospital medical staff are at pa…
Authors: Meng-Yu Lin, Hsin-Hui Shao and Meng-Ting Tsou
Citation: BMC Infectious Diseases 2022 22:427
Content type: Research Published on: 4 May 2022

Determinants of associated events following AZD1222 (Covishield) vaccination in a high-risk population in Nepal

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 07 May 2022)

 

Determinants of associated events following AZD1222 (Covishield) vaccination in a high-risk population in Nepal
Vaccination is the most effective method to prevent the spread of infectious diseases and helps reduce mortality rate and economic costs associated with the pandemic. Despite these advantages, misinformation o…
Authors: Kapil Madi Poudel, Neha Shah, Manab Prakash, Santosh Kumar Deo, Sunita Bhandari and Tika Ram Poudel
Citation: BMC Infectious Diseases 2022 22:422
Content type: Research Published on: 3 May 2022

The COVID-19 pandemic in the African continent

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 07 May 2022)

 

The COVID-19 pandemic in the African continent
In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly…
Authors: Godfrey Bwire, Alex Riolexus Ario, Patricia Eyu, Felix Ocom, Joseph F. Wamala, Kwadwo A. Kusi, Latif Ndeketa, Kondwani C. Jambo, Rhoda K. Wanyenze and Ambrose O. Talisuna
Citation: BMC Medicine 2022 20:167
Content type: Forum Published on: 2 May 2022

Correlates of influenza vaccination among underserved Latinx middle-aged and older adults: a cross-sectional survey

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 07 May 2022)

 

Correlates of influenza vaccination among underserved Latinx middle-aged and older adults: a cross-sectional survey
Vaccination is a powerful tool in the fight against seasonal influenza, among underserved, middle-age and older, Latinx adults. Yet, vaccine hesitancy and inconsistent uptake in this population continues to re…
Authors: Mohsen Bazargan, Adrienne Martinez-Hollingsworth, Sharon Cobb and Lucy W. Kibe
Citation: BMC Public Health 2022 22:907
Content type: Research Published on: 6 May 2022

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 07 May 2022)

 

Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study
Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as wel…
Authors: Rania Itani, Samar Karout, Hani M. J. Khojah, Makram Rabah, Mohamad B. Kassab, Francine K. Welty, Mazen AlBaghdadi, Haitham Khraishah, Faris El-Dahiyat, Salman Alzayani, Yousef S. Khader, Mohammad S. Alyahya, Danah Alsane, Rana Abu-Farha, Tareq L. Mukattash, Tarek Soukarieh…
Citation: BMC Public Health 2022 22:893
Content type: Research Published on: 5 May 2022

COVAX and equitable access to COVID-19 vaccines

Bulletin of the World Health Organization
Volume 100(5);  2022 May 1
https://www.ncbi.nlm.nih.gov/pmc/issues/406286/

 

Research
COVAX and equitable access to COVID-19 vaccines
Katelyn J Yoo, Akriti Mehta, Joshua Mak, David Bishai, Collins Chansa, Bryan Patenaude
Bull World Health Organ. 2022 May 1; 100(5): 315–328. Published online 2022 Mar 25. doi: 10.2471/BLT.21.287516
PMCID: PMC9047429
To evaluate equity in the allocation and distribution of vaccines for coronavirus disease 2019 (COVID-19) to countries and territories participating in the COVID-19 Vaccines Global Access (COVAX) Facility.

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

Bulletin of the World Health Organization
Volume 100(5);  2022 May 1
https://www.ncbi.nlm.nih.gov/pmc/issues/406286/

 

Systematic Reviews
Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis
Paul Eze, Lucky Osaheni Lawani, Ujunwa Justina Agu, Yubraj Acharya
Bull World Health Organ. 2022 May 1; 100(5): 337–351J. Published online 2022 Apr 4. doi: 10.2471/BLT.21.287673
PMCID: PMC9047424

The Impact of COVID-19 on the Initiation of Clinical Trials in Europe and the United States

Clinical Pharmacology & Therapeutics
Volume 111, Issue 5 Pages: 973-1174 May 2022
https://ascpt.onlinelibrary.wiley.com/toc/15326535/current

 

Articles
The Impact of COVID-19 on the Initiation of Clinical Trials in Europe and the United States
Florian Lasch, Eftychia-Eirini Psarelli, Ralf Herold, Andrea Mattsson, Lorenzo Guizzaro, Frank Pétavy, Anja Schiel
Pages: 1093-1102
First Published:28 January 2022

Conducting public health surveillance in areas of armed conflict and restricted population access: a qualitative case study of polio surveillance in conflict-affected areas of Borno State, Nigeria

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 07 May 2022]

 

Conducting public health surveillance in areas of armed conflict and restricted population access: a qualitative case study of polio surveillance in conflict-affected areas of Borno State, Nigeria
This study examined the impact of armed conflict on public health surveillance systems, the limitations of traditional surveillance in this context, and innovative strategies to overcome these limitations. A q…
Authors: Eric Wiesen, Raymond Dankoli, Melton Musa, Jeff Higgins, Joseph Forbi, Jibrin Idris, Ndadilnasiya Waziri, Oladapo Ogunbodede, Kabiru Mohammed, Omotayo Bolu, Gatei WaNganda, Usman Adamu and Eve Pinsker
Citation: Conflict and Health 2022 16:20
Content type: Research in practice Published on: 7 May 2022

Initiation of three complementary international studies investigating prevalence of oral HPV infection, burden of HPV-related head and neck disease, and efficacy of 9-valent HPV vaccination against oral HPV persistent infection

Contemporary Clinical Trials
Volume 115 April 2022
https://www.sciencedirect.com/journal/contemporary-clinical-trials/vol/115/suppl/C

 

Short communication No access
Initiation of three complementary international studies investigating prevalence of oral HPV infection, burden of HPV-related head and neck disease, and efficacy of 9-valent HPV vaccination against oral HPV persistent infection
Anna R. Giuliano
Article 106629

Design of a phase III efficacy, immunogenicity, and safety study of 9-valent human papillomavirus vaccine in prevention of oral persistent infection in men

Contemporary Clinical Trials
Volume 115 April 2022
https://www.sciencedirect.com/journal/contemporary-clinical-trials/vol/115/suppl/C

 

Research article Abstract only
Design of a phase III efficacy, immunogenicity, and safety study of 9-valent human papillomavirus vaccine in prevention of oral persistent infection in men
Anna R. Giuliano, Timothy Wilkin, Oliver M. Bautista, Kyeongmi Cheon, … Yingmei Tu
Article 106592

Ethical and epistemic issues in the design and conduct of pragmatic stepped-wedge cluster randomized clinical trials

Contemporary Clinical Trials
Volume 115 April 2022
https://www.sciencedirect.com/journal/contemporary-clinical-trials/vol/115/suppl/C

 

Research article Abstract only
Ethical and epistemic issues in the design and conduct of pragmatic stepped-wedge cluster randomized clinical trials
Carole A. Federico, Patrick J. Heagerty, John Lantos, Pearl O’Rourke, … David Magnus
Article 106703

COVID-19 interventional trials: Analysis of data sharing intentions during a time of pandemic

Contemporary Clinical Trials
Volume 115 April 2022
https://www.sciencedirect.com/journal/contemporary-clinical-trials/vol/115/suppl/C

 

Research article Open access
COVID-19 interventional trials: Analysis of data sharing intentions during a time of pandemic
Kristina Larson, Ida Sim, Megan von Isenburg, Marcia Levenstein, … Rebecca Li
Article 106709

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 07 May 2022]

 

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries
Evidence briefs for policy (EBPs) represent a potentially powerful tool for supporting evidence-informed policy-making. Since 2012, WHO Evidence-Informed Policy Network (EVIPNet) Europe has been supporting Mem…
Authors: Adrianna Murphy, Maja Šubelj, Balázs Babarczy, Kristina Köhler, Evelina Chapman, Polonca Truden-Dobrin, Kathryn Oliver, Saskia Nahrgang, Marge Reinap and Tanja Kuchenmüller
Citation: Health Research Policy and Systems 2022 20:54
Content type: Research Published on: 7 May 2022

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 07 May 2022]

 

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries
Evidence briefs for policy (EBPs) represent a potentially powerful tool for supporting evidence-informed policy-making. Since 2012, WHO Evidence-Informed Policy Network (EVIPNet) Europe has been supporting Mem…
Authors: Adrianna Murphy, Maja Šubelj, Balázs Babarczy, Kristina Köhler, Evelina Chapman, Polonca Truden-Dobrin, Kathryn Oliver, Saskia Nahrgang, Marge Reinap and Tanja Kuchenmüller
Citation: Health Research Policy and Systems 2022 20:54
Content type: Research Published on: 7 May 2022

Tracking immunization coverage, dropout and equity gaps among children ages 12–23 months in Malawi – bottleneck analysis of the Malawi Demographic and Health Survey

International Health
Volume 14, Issue 3, May 2022
https://academic.oup.com/inthealth/issue/14/3

 

ORIGINAL ARTICLES
Tracking immunization coverage, dropout and equity gaps among children ages 12–23 months in Malawi – bottleneck analysis of the Malawi Demographic and Health Survey
Kondwani Mmanga, Tisungane E Mwenyenkulu, Owen Nkoka, Peter A M Ntenda
International Health, Volume 14, Issue 3, May 2022, Pages 250–259, https://doi.org/10.1093/inthealth/ihab038

Caregiver COVID-19 Vaccination Status in Pediatric Hospitals—Ethics of Exclusion

JAMA Pediatrics
May 2022, Vol 176, No. 5, Pages 434-532
https://jamanetwork.com/journals/jamapediatrics/currentissue

 

Viewpoint
Caregiver COVID-19 Vaccination Status in Pediatric Hospitals—Ethics of Exclusion
Andrew J. Helmers, MDCM, MHSc, MSc; James A. Anderson, PhD; Roxanne E. Kirsch, MD, MBE
free access
JAMA Pediatr. 2022;176(5):441-442. doi:10.1001/jamapediatrics.2021.6582
This Viewpoint discusses the benefits and harms of restrictions excluding caregivers who are not vaccinated for COVID-19 from pediatric hospitals.

Hypersensitivity Reactions to COVID-19 Vaccines—Identify High-risk Children and Vaccinate the Rest

JAMA Pediatrics
May 2022, Vol 176, No. 5, Pages 434-532
https://jamanetwork.com/journals/jamapediatrics/currentissue

 

Hypersensitivity Reactions to COVID-19 Vaccines—Identify High-risk Children and Vaccinate the Rest
Natalia Fernandez-Davila, MD; Margaret G. Taylor, MD; Sara Anvari, MD, MS
free access
JAMA Pediatr. 2022;176(5):443-444. doi:10.1001/jamapediatrics.2022.0088
This Viewpoint discusses recommendations for COVID-19 vaccination in children with hypersensitivity to the vaccine and its excipients.

Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes

JAMA Pediatrics
May 2022, Vol 176, No. 5, Pages 434-532
https://jamanetwork.com/journals/jamapediatrics/currentissue

 

Original Investigation
Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Neonatal and Early Infant Outcomes
Inbal Goldshtein, PhD; David M. Steinberg, PhD; Jacob Kuint, MD; et al.
free access has active quiz has audio
JAMA Pediatr. 2022;176(5):470-477. doi:10.1001/jamapediatrics.2022.0001
This cohort study examines the association between maternal immunization with the BNT162b2 COVID-19 vaccine during pregnancy and neonatal and early infant outcomes.
Audio Editors’ Summary: Early Intervention Services and Standardized Tests Among Children Exposed to Lead; Association of BNT162b2 COVID-19 Vaccination During Pregnancy With Infant Outcomes

Differences in State COVID-19 Vaccine Mandates for Schoolteachers and Childcare Professionals

JAMA Pediatrics
May 2022, Vol 176, No. 5, Pages 434-532
https://jamanetwork.com/journals/jamapediatrics/currentissue

 

Research Letter
Differences in State COVID-19 Vaccine Mandates for Schoolteachers and Childcare Professionals
Kavin M. Patel, MD; Saad B. Omer, MBBS, MPH, PhD; Walter S. Gilliam, PhD
free access has active quiz
JAMA Pediatr. 2022;176(5):522-525. doi:10.1001/jamapediatrics.2021.6572
This case series examines the differences in COVID-19 vaccine mandates for schoolteachers vs childcare professionals from US states that have implemented them.

Antigen vs RT-PCR Tests for Screening Quarantined Students in Florida During the COVID-19 Pandemic SARS-CoV-2 Delta Variant Surge

JAMA Pediatrics
May 2022, Vol 176, No. 5, Pages 434-532
https://jamanetwork.com/journals/jamapediatrics/currentissue

 

Antigen vs RT-PCR Tests for Screening Quarantined Students in Florida During the COVID-19 Pandemic SARS-CoV-2 Delta Variant Surge
Eric J. Nelson, MD, PhD, MS; Sarah Lindley McKune, PhD, MPH; Kathleen A. Ryan, MD; et al.
open access has active quiz
JAMA Pediatr. 2022;176(5):525-526. doi:10.1001/jamapediatrics.2022.0080
This diagnostic/prognostic study compares the results of antigen vs real-time reverse transcription–polymerase chain reaction tests among quarantined students 5 days after exposure to SARS-CoV-2 during the surge of Delta variant cases in the COVID-19 pandemic.

Rethinking Fairness: An Interdisciplinary Survey of Critiques of Hegemonic ML Fairness Approaches

Journal of Artificial Intelligence Research
Vol. 74 (2022)
https://www.jair.org/index.php/j air

 

Rethinking Fairness: An Interdisciplinary Survey of Critiques of Hegemonic ML Fairness Approaches
Lindsay Weinberg
Abstract
This survey article assesses and compares existing critiques of current fairness-enhancing technical interventions in machine learning (ML) that draw from a range of non-computing disciplines, including philosophy, feminist studies, critical race and ethnic studies, legal studies, anthropology, and science and technology studies. It bridges epistemic divides in order to offer an interdisciplinary understanding of the possibilities and limits of hegemonic computational approaches to ML fairness for producing just outcomes for society’s most marginalized.

SARS-CoV-2 Infection During Pregnancy and Associated Perinatal Health Outcomes: A National US Cohort Study

Journal of Infectious Diseases
Volume 225, Issue 5, 1 March 2022
https://academic.oup.com/jid/issue/225/5

 

MAJOR ARTICLES AND BRIEF REPORTS
COVID-2019
SARS-CoV-2 Infection During Pregnancy and Associated Perinatal Health Outcomes: A National US Cohort Study
Annette K Regan, Onyebuchi A Arah, Deshayne B Fell, Sheena G Sullivan
The Journal of Infectious Diseases, Volume 225, Issue 5, 1 March 2022, Pages 759–767, https://doi.org/10.1093/infdis/jiab626
Based a national claims-based cohort study of 78 283 pregnancies, prenatal SARS-CoV-2 infection was associated with increased risk of preterm birth, fetal growth restriction, and delivery complications. Prevention of infection through immunization and other preventive measures could have fetal health benefits.

Immune Responses to the ChAdOx1 nCoV-19 and BNT162b2 Vaccines and to Natural Coronavirus Disease 2019 Infections Over a 3-Month Period

Journal of Infectious Diseases
Volume 225, Issue 5, 1 March 2022
https://academic.oup.com/jid/issue/225/5

 

Immune Responses to the ChAdOx1 nCoV-19 and BNT162b2 Vaccines and to Natural Coronavirus Disease 2019 Infections Over a 3-Month Period
Ji Yeun Kim, So Yun Lim, Soonju Park, Ji-Soo Kwon, Seongman Bae
The Journal of Infectious Diseases, Volume 225, Issue 5, 1 March 2022, Pages 777–784, https://doi.org/10.1093/infdis/jiab579
The antibody responses induced by BNT162b2 vaccine were much higher than those induced by ChAdOx1 vaccine and similar to responses to natural infections. T-cell responses were maintained in BNT162b2 vaccinees but not in ChAdOx1 vaccinees after 3 months.

Early Immunogenicity and Safety of the Third Dose of BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccine Among Adults Older Than 60 Years: Real-World Experience

Journal of Infectious Diseases
Volume 225, Issue 5, 1 March 2022
https://academic.oup.com/jid/issue/225/5

 

Early Immunogenicity and Safety of the Third Dose of BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccine Among Adults Older Than 60 Years: Real-World Experience
Mayan Gilboa, Michal Mandelboim, Victoria Indenbaum, Yaniv Lustig, Carmit Cohen
The Journal of Infectious Diseases, Volume 225, Issue 5, 1 March 2022, Pages 785–792, https://doi.org/10.1093/infdis/jiab584
A rapid and broad immune response to the third BNT162b2 dose in 208 individuals aged >60 years is reported (33-fold and 51-fold increase in IgG and neutralizing antibody, respectively). Levels post–third dose were significantly higher than post–second dose.

Reappraising the Value of HIV-1 Vaccine Correlates of Protection Analyses

Journal of Virology
Volume 96 • Number 8 • April 2022
http://jvi.asm.org/content/current

 

Virology Minireview 06 April 2022
Reappraising the Value of HIV-1 Vaccine Correlates of Protection Analyses
P. J. Klasse, John P. Moore
https://doi.org/10.1128/jvi.00034-22
With the much-debated exception of the modestly reduced acquisition reported for the RV144 efficacy trial, HIV-1 vaccines have not protected humans against infection, and a vaccine of similar design to that tested in RV144 was not protective in a later …

COVID-19: the next phase and beyond

The Lancet
May 07, 2022 Volume 399 Number 10337 p1753-1844
https://www.thelancet.com/journals/lancet/issue/current

 

Editorial
COVID-19: the next phase and beyond
The Lancet
After living for more than 2 years with COVID-19—with over 6·2 million confirmed deaths (but probably many more, with an estimated 20 million excess deaths) and over 510 million confirmed cases—the world is at a critical point. The omicron wave, with its high transmissibility and milder course than previous variants, especially for people who are fully vaccinated and without comorbidities, is abating in many countries. Restrictions are being relaxed, and people are slowly returning to pre-pandemic activities, including gatherings, office-based working, and cultural events. Mask mandates are being lifted in many countries. Testing and surveillance have decreased and travelling is recommencing widely. People are understandably exhausted and want to forget about the pandemic. This would be a grave mistake.

First, the pandemic situation is not the same everywhere in the world. China, for example, continues to employ its so-called dynamic zero COVID strategy of mass testing, quarantining of those testing positive, and lockdown of districts or even whole cities (most recently Shanghai). Chinese authorities have been harshly and ruthlessly implementing these measures, without much consideration for human costs. The goal is, according to Chinese officials, to avoid further spread, to protect the health system, and to avert deaths. The problem is that older and vulnerable people are often not fully vaccinated, and the efficacy of the licensed vaccines is suboptimal. For China, the top priority must be to accelerate an effective vaccination strategy. The current approach is not a long-term solution for Chinese people.

Second, the global vaccination strategy is far from on track. Unacceptable vaccine inequity persists. WHO’s goal of complete vaccination in at least 70% of people in every country by June, 2022, is way out of reach. Although 59·7% of people globally have received two vaccine doses, in more than 40 countries fewer than 20% are completely vaccinated. Even in high-income countries, a sizeable proportion of the population continue to refuse vaccination. The emergence of a new SARS-CoV-2 variant is almost inevitable with continuous high transmission rates. The BA.4 and BA.5 omicron subvariants first seen in South Africa are being monitored closely. Continuing vigilance is needed everywhere.

Third, vaccine inequity is mirrored by slow and delayed access to one of the few effective oral treatments for COVID-19—paxlovid. When taken early, paxlovid reduces the risk of hospitalisation and death by 89%. Although high-income countries are ordering millions of doses from the manufacturer, Pfizer, mechanisms to make paxlovid available in low-income and middle-income countries via the Medicines Patent Pool are slow. An agreement has been reached with 35 generic manufacturers in 12 countries, but is not expected to deliver the drug before 2023.

Finally, now is the time to plan, learn from mistakes, and create strong resilient health systems, as well as national and international preparedness strategies with lasting funding. Capacities of health systems need to be strengthened, not only to be ready for future pandemics, but immediately to deal with the delays in treatment, diagnosis, and care for other diseases after the disruption of the past 2 years. Catch-up vaccine campaigns for diseases such as measles are urgently needed. Preparedness plans, both nationally and internationally, must have a strong emphasis on early data sharing and transparent surveillance. One Health should be the underlying principle, with simultaneous consideration of both human and animal health. At the 75th World Health Assembly (May 22–29, 2022), there is an opportunity to examine progress in revising the International Health Regulations and to discuss further a pandemic treaty—the process for a treaty has been far too slow. The Intergovernmental Negotiating Body’s progress report is not expected until 2023.

Nationally, countries need independent inquiries into their responses to COVID-19. Learning from mistakes is never easy and governments can be reluctant to even accept that they have been made. When the UK High Court ruled last week that it was unlawful to discharge hospital patients to care homes without COVID-19 testing, the UK Government claimed to have acted on the best evidence available at the time. This is a blatant lie. The evidence for asymptomatic transmission was clearly available by late January, 2020.

Now is not the time to turn away from COVID-19 or rewrite history. It is time to vigorously engage, redouble efforts to end the acute phase of the pandemic in 2022 for all, and lay strong sustainable foundations for a better future with clear accountabilities and honest acceptance of uncomfortable truths.

What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years

The Lancet
May 07, 2022 Volume 399 Number 10337 p1753-1844
https://www.thelancet.com/journals/lancet/issue/current

 

Series
Optimising Child and Adolescent Health and Development
What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years
Tyler Vaivada, et al.
Summary
Progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. We review the current evidence base on the effectiveness of a variety of essential and emerging interventions that can be delivered from before conception until age 20 years to help children and adolescents not only survive into adulthood, but also to grow and develop optimally, support their wellbeing, and help them reach their full developmental potential. Although scaling up evidence-based interventions in children younger than 5 years might have the greatest effect on reducing child mortality rates, we highlight interventions and evidence gaps for school-age children (5–9 years) and the transition from childhood to adolescence (10–19 years), including interventions to support mental health and positive development, and address unintentional injuries, neglected tropical diseases, and non-communicable diseases.

Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services

The Lancet
May 07, 2022 Volume 399 Number 10337 p1753-1844
https://www.thelancet.com/journals/lancet/issue/current

 

Optimising Child and Adolescent Health and Development
Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services
Margaret E Kruk, et al.
Summary
Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

Paediatric hospitalisations due to COVID-19 during the first SARS-CoV-2 omicron (B.1.1.529) variant wave in South Africa: a multicentre observational study

The Lancet Child & Adolescent Health
May 2022 Volume 6 Number 5 p279-352, e16-e19
https://www.thelancet.com/journals/lanchi/issue/current

 

Articles
Paediatric hospitalisations due to COVID-19 during the first SARS-CoV-2 omicron (B.1.1.529) variant wave in South Africa: a multicentre observational study
Jeané Cloete, et al.

Reported cases of multisystem inflammatory syndrome in children aged 12–20 years in the USA who received a COVID-19 vaccine, December, 2020, through August, 2021: a surveillance investigation

The Lancet Child & Adolescent Health
May 2022 Volume 6 Number 5 p279-352, e16-e19
https://www.thelancet.com/journals/lanchi/issue/current

 

Reported cases of multisystem inflammatory syndrome in children aged 12–20 years in the USA who received a COVID-19 vaccine, December, 2020, through August, 2021: a surveillance investigation
Anna R Yousaf, et al. and the MIS-C Investigation Authorship Group

Measuring and monitoring child health and wellbeing: recommendations for tracking progress with a core set of indicators in the Sustainable Development Goals era

The Lancet Child & Adolescent Health
May 2022 Volume 6 Number 5 p279-352, e16-e19
https://www.thelancet.com/journals/lanchi/issue/current

 

Health Policy
Measuring and monitoring child health and wellbeing: recommendations for tracking progress with a core set of indicators in the Sustainable Development Goals era
Jennifer Requejo, et al.

Holding artificial intelligence to account

Lancet Digital Health
May 2022 Volume 4 Number 5 e290-e397
https://www.thelancet.com/journals/landig/issue/current

 

Editorial
Holding artificial intelligence to account
The Lancet Digital Health
In this issue of The Lancet Digital Health, Xiaoxuan Liu and colleagues give their perspective on global auditing of medical artificial intelligence (AI). They call for the focus to shift from demonstrating the strengths of AI in health care to proactively discovering its weaknesses.

Machines make unpredictable mistakes in medicine, which differ significantly from those made by humans. Liu and colleagues state that errors made by AI tools can have far-reaching consequences because of the complex and opaque relationships between the analysis and the clinical output. Given that there is little human control over how an AI generates results and that clinical knowledge is not a prerequisite in AI development, there is a risk of an AI learning spurious correlations that seem valid during training but are unreliable when applied to real-world situations.

Lauren Oakden-Rayner and colleagues analysed the performance of an AI across a range of relevant features for hip fracture detection. This preclinical algorithmic audit identified barriers to clinical use, including a decrease in sensitivity at the prespecified operating point. This study highlighted several “failure modes”, which is the propensity of an AI to fail recurrently in certain conditions. Oakden-Rayner told The Lancet Digital Health that their study showed that “the failure modes of AI systems can look bizarre from a human perspective. Take, for example, in the hip fracture audit (figure 5), the recognition that the AI missed an extremely displaced fracture … the sort of image even a lay person would recognise as completely abnormal.” These errors can drastically affect clinician and patient trust in AI. Another example demonstrating the need for auditing was highlighted last month in an investigation by STAT and the Massachusetts Institute of Technology, which found that an EPIC health algorithm used to predict sepsis risk in the USA deteriorated sharply in performance, from 0·73 AUC to 0·53 AUC, over 10 years. This deterioration over time was caused by changes in the hospital coding system, increased diversity and volume of patient data, and changes in operational behaviours of caregivers. There was little to no oversight of the AI tool once it hit the market, potentially causing harm to patients in hospital. Liu commented, “without the ability to observe and learn from algorithmic errors, the risk is that it will continue to happen and there’s no accountability for any harm that results.”

Auditing medical AI is essential; but whose responsibility is it to ensure that AI is safe to use? Some experts think that AI developers are responsible for providing guidance on managing their tools, including how and when to check the system’s performance, and identifying vulnerabilities that might emerge after they are put into practice. Others argue that not all the responsibility lies with AI developers, and health providers must test AI models on other data to verify their utility and assess potential vulnerabilities. Liu says, “we need clinical teams to start playing an active role in algorithmic safety oversight. They are best placed to define what success and failure looks like for their health institution and their patient cohort.”

There are three challenges to overcome to ensure AI auditing is successfully implemented.

First, in practice, auditing will require professionals with clinical and technical expertise to investigate and prevent AI errors and to thoughtfully interrogate errors before and during real-world deployment. However, experts with computational and clinical skill sets are not yet commonplace. Health-care institutes, AI companies, and governments must invest in upskilling health-care workers so that these experts can become an integral part of the medical AI development process.

Second, industry-wide standards for monitoring medical AI tools over time must be enforced by key regulatory bodies. Tools to identify when an algorithm becomes miscalibrated because of changes in data or environment are being developed by researchers, but these tools must be endorsed in a sustained and standardised way, led by regulators, health systems, and AI developers.

Third, the main issue that can exacerbate errors in AI is the lack of transparency of the data, code, and parameters due to intellectual property concerns. Liu and colleagues emphasise that much of the benefit that software and data access would provide can be instead obtained through a web portal with the ability to test the model on new data and receive model outputs. Oakden-Rayner said, “AI developers have a responsibility to make auditing easier for clinicians, especially by providing clear details of how their system works and how it was built.”

The performance of wearable sensors in the detection of SARS-CoV-2 infection: a systematic review

Lancet Digital Health
May 2022 Volume 4 Number 5 e290-e397
https://www.thelancet.com/journals/landig/issue/current

Review
The performance of wearable sensors in the detection of SARS-CoV-2 infection: a systematic review
Marianna Mitratza, et al.
Summary
Containing the COVID-19 pandemic requires rapidly identifying infected individuals. Subtle changes in physiological parameters (such as heart rate, respiratory rate, and skin temperature), discernible by wearable devices, could act as early digital biomarkers of infections. Our primary objective was to assess the performance of statistical and algorithmic models using data from wearable devices to detect deviations compatible with a SARS-CoV-2 infection. We searched MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (known as CENTRAL), International Clinical Trials Registry Platform, and ClinicalTrials.gov on July 27, 2021 for publications, preprints, and study protocols describing the use of wearable devices to identify a SARS-CoV-2 infection. Of 3196 records identified and screened, 12 articles and 12 study protocols were analysed. Most included articles had a moderate risk of bias, as per the National Institute of Health Quality Assessment Tool for Observational and Cross-Sectional Studies. The accuracy of algorithmic models to detect SARS-CoV-2 infection varied greatly (area under the curve 0·52–0·92). An algorithm’s ability to detect presymptomatic infection varied greatly (from 20% to 88% of cases), from 14 days to 1 day before symptom onset. Increased heart rate was most frequently associated with SARS-CoV-2 infection, along with increased skin temperature and respiratory rate. All 12 protocols described prospective studies that had yet to be completed or to publish their results, including two randomised controlled trials. The evidence surrounding wearable devices in the early detection of SARS-CoV-2 infection is still in an early stage, with a limited overall number of studies identified. However, these studies show promise for the early detection of SARS-CoV-2 infection. Large prospective, and preferably controlled, studies recruiting and retaining larger and more diverse populations are needed to provide further evidence.

The medical algorithmic audit

Lancet Digital Health
May 2022 Volume 4 Number 5 e290-e397
https://www.thelancet.com/journals/landig/issue/current

Viewpoint
The medical algorithmic audit
Xiaoxuan Liu, Ben Glocker, Melissa M McCradden, Marzyeh Ghassemi, Alastair K Denniston, Lauren Oakden-Rayner
Summary
Artificial intelligence systems for health care, like any other medical device, have the potential to fail. However, specific qualities of artificial intelligence systems, such as the tendency to learn spurious correlates in training data, poor generalisability to new deployment settings, and a paucity of reliable explainability mechanisms, mean they can yield unpredictable errors that might be entirely missed without proactive investigation. We propose a medical algorithmic audit framework that guides the auditor through a process of considering potential algorithmic errors in the context of a clinical task, mapping the components that might contribute to the occurrence of errors, and anticipating their potential consequences. We suggest several approaches for testing algorithmic errors, including exploratory error analysis, subgroup testing, and adversarial testing, and provide examples from our own work and previous studies. The medical algorithmic audit is a tool that can be used to better understand the weaknesses of an artificial intelligence system and put in place mechanisms to mitigate their impact. We propose that safety monitoring and medical algorithmic auditing should be a joint responsibility between users and developers, and encourage the use of feedback mechanisms between these groups to promote learning and maintain safe deployment of artificial intelligence systems.

National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010–19: a data envelopment and stochastic frontier analysis

Lancet Global Health
Apr 2022 Volume 10 Number 4 e448-e584
https://www.thelancet.com/journals/langlo/issue/current

 

Articles
National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010–19: a data envelopment and stochastic frontier analysis
Gerard Joseph Abou Jaoude, et al.

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Lancet Global Health
Apr 2022 Volume 10 Number 4 e448-e584
https://www.thelancet.com/journals/langlo/issue/current

 

The Lancet Global Health Commissions
The Lancet Global Health Commission on financing primary health care: putting people at the centre
Kara Hanson, et al
The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective management of non-communicable diseases) and essential public health functions. PHC is widely recognised as a key component of all high-performing health systems and is an essential foundation of universal health coverage