Special Issue:
Challenges and Opportunities in Vaccines
Enrique Chacon-Cruz
Think Vaccines LLC, Houston, Texas, USA.
Erika Zoe Lopatynsky-Reyes
Think Vaccines LLC, Houston, Texas, USA.
Kapil Maithal
Zydus Lifesciences Limited, Ahmedabad, Gujarat, India.
Sabrina Bakeera-Kitaka
Department of Paediatrics, Makerere College of Health Sciences, Kampala, Uganda.
Collins Ankunda
Department of Pharmacology and Therapeutics, Makerere College of Health Sciences, Kampala, Uganda.
Javier Casellas
Allergy, Respiratory, Infectious Diseases and Vaccines Team, IQVIA, Buenos Aires, Argentina.
Malook Vir Singh
IQVIA RDS (India) Private Limited, Noida, India.
Frederic Nikiema
Institut de Recherche en Sciences de la Santè, IRSS, Bobo Dioulasso, Burkina Faso.
Jessabelle E. Basa
Research Institute for Tropical Medicine, Department of Health, Philippines.
Mahmud Sheku
Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
Oscar E. Zazueta
Harvard T.H, Chan School of Public Health. Department of Epidemiology. Boston, MA, USA.
Abstract
Pertussis in a highly infectious respiratory disease, and even though vaccination has been globally implemented since the 1940s, we are far from elimination, and even still suffering from many outbreaks throughout the world.
This comprehensive review is tailored primarily for clinicians and healthcare practitioners, aiming to deepen their insights into the evolving dynamics of Pertussis over time since the first whole-cell Pertussis vaccine was started. It delves into the high reactogenicity and alleged severe neurologic effects, which were later conclusively disproven. The ensuing repercussions of these early challenges manifested in multiple outbreaks, compelling the scientific community to respond proactively. This led to the development and subsequent implementation of acellular Pertussis vaccines, marked by an improved safety profile.
Moreover, the exclusive adoption of acellular Pertussis vaccines for widespread immunization in certain countries resulted in a notable surge in Pertussis cases. Subsequent investigations, conducted through both animal models and epidemiological studies, elucidated that acellular Pertussis vaccines exhibited a considerably diminished mucosal immunity. Consequently, nasopharyngeal carriage showed minimal reduction, leading to a substantial decline in indirect or herd immunity when compared to whole-cell Pertussis vaccines. Conversely, numerous developing countries presently incorporate whole-cell Pertussis vaccines either independently or in conjunction with acellular formulations. In light of this, precise recommendations must be systematically addressed to cultivate a more unified and pragmatic landscape for immunization strategies. These recommendations should be rooted in the latest scientific data and aligned with the guidelines articulated by both the World Health Organization and the Global Pertussis Initiative.
This concerted approach aims to optimize immunization practices on a global scale, fostering a harmonized and evidence-based framework for combating Pertussis. Relevant and updated issues concerning maternal, adolescent and adult vaccination are addressed, as well as the ongoing pipeline of new intramuscular and mucosal vaccines, and finally emphasizing the continuous need for improved surveillance and pharmacovigilance systems.
Ayesha Anwar, MD
Allama Iqbal Medical College
Meryem Malik, MD
Harvard University, Cambridge MA
Vaneeza Raees
Undergraduate Student at University of Washington
Maryem Anwar, MBBS, MRCGP
NHS UK
Anjum Anwar, MD
University of Washington School of Medicine
Abstract
Vaccines offer life-saving protection against diseases and keep us safe from the harmful effects. The speedy development of vaccines during COVID-19 pandemic has reduced the coronavirus’s transmissibility and severity. COVID-19 vaccine development was challenging but the global scientific collaboration and use of resources including extensive funding made it possible. COVID-19 vaccines were deployed in controlled phases for general public use, initially offering them to the first responders and those vulnerable to life threatening effects of virus. However, it was observed that the general population has widespread vaccine hesitancy. Mass media plays a critical role in influencing people’s attitudes and practices. A common man cannot comprehend correlation from causation and jumps to conclusions. Media has the power to unite the world on one platform for a common cause. It is a source for the public to seek information, but like a double ended sword, this platform that provides information, also gives misinformation. On one hand, the public uses the media to seek information for vaccine safety and efficacy and on the other hand, to propagate unverified conspiracies against vaccines. In this review, we analyze the role of mass media and public health communications in COVID-19 vaccination from December 11, 2020, to September 15, 2021, and draw scientific inferences. We have discussed vaccine hesitancy and some prominent reasons that instil fear among the public, including the implausible claims of vaccines being the carriers of Radio Frequency Identification (RFID) microchips, impairing the reproductive systems, converting humans to hybrids, and the misconceptions about herd immunity. A consequential role of media was observed in keeping the world updated and motivated by tracking the vaccine number, distribution and deployment through live dashboards. We saw an upward trend in vaccination numbers with media campaigns, social media vaccination surveys, and socio-medico evidence. Thus, we have proposed a model for developing public awareness and health promotion using media as a tool for better distribution and administration of COVID-19 vaccines. With this, health organizations can gain widespread public trust, manage anti-vaccine movements, overcome threats faced due to vaccine conspiracy theories and eventually overcome the COVID-19 and future pandemics.
Larry L Mweetwa
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Derrick D Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Tumelo Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Kabo Osmas Tshiamo
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Sody Mweetwa Munsaka
University of Zambia, School of Health Sciences, P. O. Box 32379 Lusaka, Africa.
Thatoyaone J Kenaope
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Getrude Mothibe
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Ogorogile Mokate
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Emmanuel T Oluwabusola
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or Coronavirus was initially detected in Wuhan China in December 2019 and has subsequently resulted in the COVID-19 pandemic. The disease presents asymptomatically in some of individuals yet also causes symptoms ranging from those associated with influenza and pneumonia, acute respiratory distress syndrome (ARDS) and even death. The world is currently relying on physical (social) distancing, hygiene and repurposed medicines; however, it was predicted that an effective vaccine will be necessary to ensure comprehensive protection against COVID-19. There was a global effort to develop an effective vaccine against SARS-CoV-2 with approximately 300 vaccines in clinical trials, and over 200 more in different stages of development and anticipated that their success will change research clinical trials processes. Although every one of these vaccines comes with its own particular set of characteristics and difficulties, they were all developed as a direct result of research and development efforts that were carried out on a scale that had never been seen before. It is the first time in the history of vaccination that a worldwide immunization campaign has begun during a time of severe pandemic activity that is defined by high virus transmission. This achievement marks an important milestone in the history of vaccination. More than anything else, the most important aspect of the new game change in drug design is that the traditional drug discovery rules have been rewritten. This is especially significant for the development of vaccines, as it is possible for all clinical trials to be accelerated, which would bring a vaccine or drug molecule to market within a year rather than the traditional fifteen years for each phase of drug clinical trials. This review provides insight in respect to first generation COVID-19 vaccines, which were in clinical use as of December 2020 and focused on the Pfizer/ BioNTech/Fosun, Moderna mRNA-1273, Johnson and Johnson and AstraZeneca/Oxford AZD1222 vaccines.
Larry L Mweetwa
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Derrick D Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Tumelo Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Kabo Osmas Tshiamo
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Sody Mweetwa Munsaka
University of Zambia, School of Health Sciences, P. O. Box 32379 Lusaka, Africa.
Thatoyaone J Kenaope
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Getrude Mothibe
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Ogorogile Mokate
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Emmanuel T Oluwabusola
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or Coronavirus was initially detected in Wuhan China in December 2019 and has subsequently resulted in the COVID-19 pandemic. The disease presents asymptomatically in some of individuals yet also causes symptoms ranging from those associated with influenza and pneumonia, acute respiratory distress syndrome (ARDS) and even death. The world is currently relying on physical (social) distancing, hygiene and repurposed medicines; however, it was predicted that an effective vaccine will be necessary to ensure comprehensive protection against COVID-19. There was a global effort to develop an effective vaccine against SARS-CoV-2 with approximately 300 vaccines in clinical trials, and over 200 more in different stages of development and anticipated that their success will change research clinical trials processes. Although every one of these vaccines comes with its own particular set of characteristics and difficulties, they were all developed as a direct result of research and development efforts that were carried out on a scale that had never been seen before. It is the first time in the history of vaccination that a worldwide immunization campaign has begun during a time of severe pandemic activity that is defined by high virus transmission. This achievement marks an important milestone in the history of vaccination. More than anything else, the most important aspect of the new game change in drug design is that the traditional drug discovery rules have been rewritten. This is especially significant for the development of vaccines, as it is possible for all clinical trials to be accelerated, which would bring a vaccine or drug molecule to market within a year rather than the traditional fifteen years for each phase of drug clinical trials. This review provides insight in respect to first generation COVID-19 vaccines, which were in clinical use as of December 2020 and focused on the Pfizer/ BioNTech/Fosun, Moderna mRNA-1273, Johnson and Johnson and AstraZeneca/Oxford AZD1222 vaccines.
Malireddy S. Reddy, BVSC (DVM)., MS., Ph.D.
International Media And Cultures, INC. (IMAC) American Dairy Food And Consulting Labs, INC. (ADFAC Labs, Inc.) Denver, CO., USA.
Abstract
The US patent 11,077,052 B1, issued in August of the year 2021, has been granted relying on the research conducted until September 2020, using the multiple mixed strain probiotics and their immunomodulins to prevent or treat COVID-19 due to SARS-CoV-2 and its limited variants. Since then the SARS-CoV-
2 virus continuously generated multiple variants with different genomic configurations, almost to the point of overriding the vaccines and medications. The objective of this research article is to evaluate the effectiveness of the invention outlined in the U.S. patent 11,077,052 B1 on the variants of SARS- CoV-2 evolved in the later years of 2020, 2021 and 2022. This research has great significance because vaccines are not totally effective because of the high rate of mutations of SARS-CoV-2 virus resulting in antigenically different variants, which are overriding the immunity conferred by vaccines. Thus, there is a definite need for a reliable alternative or adjuvant therapy, which can be used either by itself or used as adjuvant therapy along with vaccines to combat COVID-19 infection due to SAR-CoV-2 virus and its continuously mutating variants of different antigenicity. The results of this investigation proved that the use of multiple mixed strain probiotics along with their immunomodulins are effective not only on novel SARS-CoV-2 coronavirus evolved in late 2019 and mid 2020 but also the mutated variants in the later part of the years 2020, 2021, and 2022. The COVID-19 pandemic is not yet contained as of August 2022. The SARS-CoV- 2 virus has been continuously mutating generating variants which are resisting vaccines and the treatments. The death’s due to SARS -COV- 2 viral infections are attributed predominantly to cytokine storm and thrombosis resulting in ARDS (Acute Respiratory Disease Syndrome} and multi organ failure. The earlier published article thoroughly discussed about the genesis and control of cytokine storm to protect the victims. This article mainly emphasizes the Pathophysiology of thrombosis, due to SARS-CoV-2 virus and its recent multiple variants, and the ways and means of controlling it to prevent or cure COVID-19, using the multiple mixed strain probiotics and their Immunomodulins. The hormonal and enzymatic system variations causing the disturbance in homeostasis of the vascular system resulting in thrombosis, due to SARS-CoV-2 virus and its continuously evolving variants is thoroughly discussed. In addition, the infection pattern and progression of the SARS-CoV-2 virus causing endothelial cell lysis of the vascular system resulting in thrombosis has been elucidated with molecular details. The specific role of immunomodulins of the multiple mixed strain probiotics to prevent or treat COVID-19 disease induced thrombosis has also been presented. The physiological functions of individual components of the probiotics and the immunomodulins produced by the multiple mixed strain probiotics, is presented for the first time with explicitly proven molecular details, showing how they contribute individually and cumulatively to prevent or treat COVID-19 infection, due to SARS-CoV-2 virus and its multiple variants, generated during the years 2020 through 2022, to induce thrombosis.
Oscar Cobar
School of Health Sciences, University of Isthmus, Guatemala; Pharmacogenomics and Nutrigenomics Research Group, School of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
Stella Cobar
School of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
Abstract
Background: The World Health Organization -WHO- declares the end of COVID-19 pandemic on May 5, 2023, and the contagious and pathogenic XBB.2.3 “Acrux” begins to spread worldwide. XBB.2.3 has a higher transmission rate and greater evasive capacity of immune-generated antibodies and vaccines than the XBB.1.16 strain, the potential to evade all forms of immunity, including those conferred by current booster vaccination or by previous infections, besides that current virus vaccines and their boosters may provide little or no protection against XBB.2.3*. Those infected with XBB.2.3*, are expected to acquire more opportunistic secondary infections that contribute to the severity of the disease and more long-term problems (Post-COVID Syndrome) and a possible increase in the mortality rate.
Aim: The purpose of the manuscript is to present a systematic review on the prevalence, structural, genomic, and pathogenic characteristics of XBB.2.3 and its descendants as of May 31, 2023, emphasizing the symptoms generated in children, adults, and the elderly.
Material and methods: Original scientific articles published in Medline, Pubmed, Science Direct, Web of Science, Scopus, EBSCO and BioMed Central databases, official health organizations (WHO, CDC, ECDEC, DOH Philippines) electronic publications, and specialized media in the subject, were electronically searched to accomplish the aim of the study. Articles published in any language were included from 2020 to present using a variety of keywords in combination. The studies relevant to our review were analysed and compared.
Results and discussion: XBB.2.3 probably originated in India, but is expanding, being detected as early as Europe in mid-January 2023 and as of May 31, 2023, in more than 47 countries, including the United States, India, Philippines and Thailand. XBB.2.3* has five defining mutations; S:D253G (previously found in Lambda and Iota variants), S:P521S (new since XBB family), S:S486P and the unprecedented ORF1a:G2091S, and ORF7a:A13V. S:S486P is probably the responsible of the superior transmissibility of XBB.2.3*, appears to have a 37% rate of infection and hospitalisation, which is 3-8% higher than other sub-variants.
Conclusions: XBB.2.3* SARS-CoV-2 strain has a higher transmission rate than XBB.1.16*, exhibits a greater evasive capacity of immune-generated antibodies and vaccines than XBB.1.16*, and even has the potential to evade all forms of immunity, including those conferred by current booster vaccination or by previous infections. Those infected with XBB.2.3*, are expected to acquire more opportunistic secondary infections that contribute to the severity of the disease and more long-term problems (Post-COVID Syndrome) and a possible increase in the mortality rate. Preliminary data from the study suggest that current virus vaccines and their current boosters may provide little or no protection against XBB.2.3*. The potential consequences of XBB.2.3* underscore the importance of coordinated, proactive and productive efforts to contain its spread.
Mairi C. Noverr
Department of Microbiology and Immunology, Tulane University School of Medicine
Junko Yano
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Michael E. Hagensee
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Hui-Yi Lin
Biostatistics Program, LSU Health School of Public Health
Mary C. Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Erin Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Jennifer Cameron
Department of Microbiology, Immunology, and Parasitology, LSU Health New Orleans
Judd Shellito
Section of Pulmonary Medicine, Department of Medicine, LSU Health New Orleans
Amber Trauth
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Paul L. Fidel, Jr.
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Abstract
Mortality in COVID-19 cases was strongly associated with progressive lung inflammation and eventual sepsis. There is mounting evidence that live attenuated vaccines commonly administered during childhood, also provide beneficial non-specific immune effects, including reduced mortality and hospitalization due to unrelated infections. It has been proposed that live attenuated vaccine-associated non-specific effects are a result of inducing trained innate immunity to function more effectively against broader infections. In support of this, our laboratory has reported that immunization with a live attenuated fungal strain induces a novel form of trained innate immunity which provides protection against various inducers of sepsis in mice via myeloid-derived suppressor cells. Accordingly, we initiated a randomized control clinical trial with the live attenuated Measles, Mumps, Rubella (MMR) vaccine in healthcare workers in the greater New Orleans area aimed at preventing/reducing severe lung inflammation/sepsis associated with COVID-19 (ClinicalTrials.gov Identifier: NCT04475081). Included was an outcome to evaluate the myeloid-derived suppressor cell populations in blood between those administered the MMR vaccine vs placebo. The unanticipated emergency approval of several COVID-19 vaccines in the midst of the MMR clinical trials eliminated the ability to examine effects of the MMR vaccine on COVID-19-related health status. Unfortunately, we were also unable to show any impact of the MMR vaccine on peripheral blood myeloid-derived suppressor cells due to several inherent limitations (low percentages of blood leukocytes, small sample size), that also included a collaboration with a similar trial (CROWN CORONATION; ClinicalTrials.gov Identifier: NCT04333732) in St. Louis, MO. In contrast, monitoring the COVID-19 vaccine response in trial participants revealed that high COVID-19 antibody titers occurred more often in those who received the MMR vaccine vs placebo. While the trial was largely inconclusive, lessons learned from addressing several trial-associated challenges may aid future studies that test the non-specific beneficial immune effects of live attenuated vaccines.
Oscar Cobar
Pharmacogenomics and Nutrigenomics Research Group, School of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala; Biomedical Sciences Ph.D. Program, School of Medical Sciences, University of San Carlos, Guatemala.
Stella Co
Shool of Chemical Sciences and Pharmacy, University of San Carlos, Guatemala.
Abstract
Background: JN.1 (BA.2.86.1.1) has become the dominant strain in the U.S. at the end of 2023 according to the U.S. Centers for Disease Control and Prevention. The strain is a descendant of EG.5 family that was identified in China in February 2023 and was first detected in the United States in April 2023. JN.1* SARSCoV2 lineages: JN.1 (BA.2.86.1.1), JN.1.1, JN.1.1.1, JN.1.2, JN.1.3 and recombinants XDD (EG.5.1.1/JN.1), XDK (XBB*/JN.1.1.1). There is only a single change between JN.1 and BA.2.86 in the spike protein. JN.1 has inherited more than 30 mutations in its spike protein. It also acquired a new mutation,L455S, which further decreases the ability of antibodies to bind to the virus and prevent infection. A nonspike protein that is heavily mutated in JN.1 is the NSP3 protein. There are six mutations in NSP3 protein, namely T24I, V238L, G489S, K1155R, N1708S, and A1892T. NSP3 is one of the most active proteins in the virus, playing roles in viral RNA binding, polyprotein processing, and other functions. While the exact function of these mutations is unknown, they are likely to increase the efficiency of many of these mechanisms, creating a more functional and pathogenetic virus.The N protein is heavily mutated, R203K and G204R have been mutated in most virus variants throughout the pandemic and likely improve viral replication rate. The other mutations in N may also work to improve viral replication. While the Orf8 protein is truncated in the widespread XBB.1.5 variant, it is fully present in JN.1.
The symptoms of JN.1 appear to be similar to those caused by other strains, which include sore throat, congestion, runny nose, cough, fatigue, headache, muscle aches, fever or chills, loss of sense of taste or smell, shortness of breath or difficulty breathing, nausea or vomiting and diarrhea.
Some doctors have reported that upper respiratory symptoms seem to follow a pattern of starting with a sore throat, followed by congestion and a cough.
Aim: The purpose of the manuscript is to present a systematic review on the prevalence, structural, genomic, and pathogenic characteristics of JN.1 from January 1 to February 29, 2024, emphasizing on the variant genetic characteristics, contagiousness, and potential pathogenicity.
Material and Methods: Original scientific articles published in Medline, Pubmed, Science Direct, Web of Science, Scopus, EBSCO and BioMed Central databases, official health organizations (World Health Organization, U.S. Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control) electronic publications, and specialized media in the subject, were electronically searched to accomplish the aim of the study. Articles published in any language were included from January 2024 to present using a variety of keywords in combination. The studies relevant to our review were analysed and compared.
Results and Discussion: The step-change evolution of BA.2.86, combined with the immune-evading features in JN.1, has given the virus a global growth advantage well beyond the XBB.1-based lineages the world faced in 2023. Evidence suggests the human adaptive immune system could still recognise and respond to BA.286 and JN.1 effectively. Updated monovalent vaccines, tests and treatments remain effective against JN.1. There are two elements to “severity”: first if it is more ‘intrinsically’ severe (worse illness with an infection in the absence of any immunity) and second if the virus has greater transmission, causing greater illness and deaths, simply because it infects more people. The latter is certainly the case with JN.1.
Conclusions: The latest data from US-CDC shows JN.1 as the prevalent SARS-CoV-2 variant in the United States. JN.1 in January 2024, quickly increase its prevalence and surpassed other variants, including HV.1 to become the most prevalent strain in The United States of América. JN.1 has a similar transmission rate, exhibits a greater evasive capacity of immune-generated antibodies than HV.1 family of SARS-CoV-2, produce similar symptoms that of other Omicron variants, are expected not to produce an increase in hospitalizations and mortality rate and the SARS-CoV-2 vaccines recently developed by Pfizer and Moderna, must be effective against this Omicron subvariant. For now, the dominant variant JN.1 does not seem harmful in terms of creating a deadly disease but is still contagious enough to not be ignored.
Chester Spatt, Ph.D.
Tepper School of Business, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA.
Abstract
Several fundamental principles in economics help enhance our understanding of COVID-19, including opacity and externalities. COVID-19 is a contagious disease whose spread has been difficult to manage due to opacity, as the disease is contagious prior to the presence of symptoms and in some instances testing results for the disease require a considerable time lag before they become available. This highlights the importance of alternative testing strategies to limit the extent of opacity and to manage the costs associated with accurate testing. In addition to individual tests, such strategies would include testing employees in small groups and testing for concentration of the disease in wastewater. Diminishing returns to scale, depreciation, and shocks to the underlying disease also all play an important role in understanding the effectiveness of vaccines. Externalities are central to the mechanism for transmitting contagious diseases. The strength of the externality can be reduced potentially by various preventive measures such as social distancing and masking, though quantitative studies of the efficacy of such measures can be enhanced. Further, efforts to undertake randomized trial studies of various questions related to vaccines and prevention would be helpful, especially in light of the magnitude of economic costs that have been imposed by contagious disease, such as COVID-19.
COVID-19 and other contagious diseases also have had considerable effects on the structure of the economy. This has resulted in great development of technologies to support online meetings and work and the ability to work remotely, which in turn highlights dramatic challenges to the five-day work week, the potential for stay-at-home work, the relationship between residential and office real estate and the value of contractual flexibility in the face of dramatic shocks. Some of the effects arise during the period of acute societal disease, while other aspects reflect long-term learning. The nature of societal shocks to work and income generation also has led to important questions regarding the use of societal resources and potential shocks to the overall macroeconomy.
Babalola O.E.
Department of Surgery, Bingham University, New Karu, Nigeria
Ajayi A.A ., MD, PhD
Adjunct Professor, Keck Department of Medicine, Division of Hypertension and Clinical pharmacology, Baylor College, Houston TX 77030.
Abstract
Background and aims
The covid 19 pandemic necessitated the use of old, repurposed, and new drugs, in addition to vaccines and public health measures. There are still many controversies about the efficacy and impact of some of the medications used, which need further elucidation.
We review the pharmacological properties and the place of the repurposed drug, Ivermectin (IVM) in the prophylaxis and treatment of SARS – CoV- 2 (severe acute respiratory syndrome coronavirus 2.) infection or Covid 19 disease.
Major findings: in-vitro, in-vivo, and human studies
In vitro studies in Vero/hSlam cells caused a 99.98 % inhibition of SARS – Cov-2 (5000-fold) within 48 hours. The IC50 (half maximal inhibitory concentration) for this virucidal action was 2.8μM, which was thought unattainable in humans in-vivo. Thus, there was initial skepticism on pharmacokinetic grounds as to possible efficacy of IVM in humans with Covid 19. There are, however, a multiplicity of anti-covid 19 mechanisms, beyond mere anti-viral effects, such as blockade of ACE2 receptor viral entry, and the anti-cytokine and anti-inflammatory effects of IVM. IVM has a long half-life of 18 – 24 hours, Mean Residence Time (MRT) of 3.4 days and a preferential site of lung accumulation.
In-vivo studies in Syrian Golden hamsters confirmed the symptomatic, anti-inflammatory, anti-cytokine, histopathological and survival benefit of IVM, which was more manifest in female animals.
In a January 2023 meta-analysis of studies (s) in total number of patients (n) for various parameters (p), the reduction in risk relative to placebo or controls were as follows:
- Overall improvement (s= 95) (n= 134,554) was 62% [95%CI 54-69].
- Mortality (s=48) (n=120,000) there was 51% reduction [95%CI 37-62].
- Hospitalization (s=29) (n = 44, 784), there was 34% reduction [ 95% CI 20-45].
- Viral clearance (s=20) (n= 3945) there was 45% reduction [95%CI 31-55].
- Prophylaxis (s=17) (n=19,764) showed 82% reduction [95%CI 73-88]
6 Randomised Control Trial (RCT) studies (s= 45) (n=2173) showed a 54 % mortality reduction [95% CI 39-65]
In addition, IVM has been shown in studies to cause a rapid reversal of hypoxemia (SPO2 < 94%) and a rapid increase in SPO2, an effect exhibiting a gender dichotomy. (SPO2 is the percentage of the maximum carrying capacity of the blood). This effect on SPO2 has been attributed to IVM’s reversal and prevention of SARS-CoV-2 virus induced hemagglutination. The dosage used for treatment of covid 19 varied widely within studies, but doses of 200-400 μg/kg twice weekly or daily for 5 consecutive days, caused significant viral clearance and clinical improvement, with minimal safety concerns. For prophylaxis, a dose of 200μg/kg for two consecutive days every 15 days was found effective in studies.
Conclusion: This review provides powerful evidence that IVM is efficacious singly or as a part of a regimen for covid 19. IVM could potentially be combined with newer oral anti-covid 19 agents, such as Paxlovid, for effective and life-saving regimen in patients infected with covid-19. The anti-viral properties of these drugs can synergize with the anti-inflammatory and anti-cytokine properties of Ivermectin. Ivermectin is also useful prophylactically, especially where vaccines are unavailable or undesirable.
Daniel R. Lucey, MD, MPH
Professor of Medicine Geisel School of Medicine at Dartmouth and the Dartmouth Institute for Healthcare Policy and Clinical Research, Hanover, New Hampshire, USA
Abstract
Nipah virus is a bat-borne zoonotic RNA virus discovered in Malaysia during an 1998-1999 outbreak that involved pigs, fruit bats, and humans in Malaysia (1). Clinical manifestations are primarily encephalitis and pneumonia. The case fatality rate of symptomatic cases is 40%-70%. Survivors can have severe neurologic sequelae (2-5). There are no licensed vaccines, antiviral drugs, monoclonal antibodies, or point-of-care rapid diagnostic tests, although extensive work on vaccines and monoclonal antibodies is underway (6). Person-to-person transmission, including a small number of superspreading events, has occurred in Bangladesh and India (7-9).
From 1998-2023 all reported outbreaks have been in either southeast (SE) Asia (Malaysia, Singapore, the Philippines), or south Asia (Bangladesh, India) (2, 7-10). It is likely that a future Nipah outbreak, and possibly widespread epidemic, will occur outside south/SE Asia, whether elsewhere in Asia such as China, or on another continent. When it does, then as with the COVID-19 pandemic, multiple questions will be raised regarding the origin of the epidemic. Each of the following four (4) main scenarios could be anticipated to account for the origin of such a geographically-unprecedented Nipah epidemic during analysis on Day 1 of the event by national and international organizations.
Marco Villanueva Reza
Infectious Disease Physician, Instituto Nacional Enfermedades Respiratorias
Sebastián Rodríguez-Llamazares
Division of Respirology and Sleep Medicine, Queen’s University Department of Medicine
Alvaro López Iñiguez
HIV and Infectious Disease Physician, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Santiago Montiel Romero
Infectious Disease Physician, Centro Medico ABC (American British Cowdray Hospital)
Arturo Galindo Fraga
Deputy Director of Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Abstract
In Latin America, the COVID-19 pandemic, which initially surged and is now a constant presence, has brought about significant health challenges due to disparities and differences in regional responses. Vaccination is not only a necessity but also a responsibility as the primary tool for prevention. However, its implementation has not been consistent across countries, leading to various challenges such as global demand, initial high costs, infrastructure limitations for distribution, public hesitance, and misinformation. Other issues, like vaccine efficacy in immunocompromised patients and the use of different vaccines, were initially questioned but are now regarded as strategies to protect patients. This region, with its unique traditions, also faces several risk factors including vaccine supply shortages, lack of vaccine manufacturing, overcrowded cities, and an increasing migrant population that adds to the vulnerability of the people, challenging countries to strive for equity in prevention strategies. It is important to address individual strategies in communities to increase vaccine uptake as part of public health policy, and collaboration between countries should be encouraged to reach more people. This review will provide information about the COVID-19 vaccines available in the region, their characteristics and composition, their use across countries, and the reported effectiveness in the general population and among those with weakened immune systems.
Maia G Campbell
Ball State University Honors College
Dr. Jayanthi Kandiah
Ball State University College of Health
Dr. James Jones
Ball State University
Abstract
Background. The global spread of COVID-19 prompted a need for widespread vaccination to slow the transmission of the virus. Despite global, national, and local efforts, many people in various nations hesitated to receive a COVID-19 vaccine.
Aims. The objective of this systematic review was to synthesize the existing literature addressing factors influencing COVID-19 vaccine acceptance and hesitancy.
Methods. A literature search was conducted between November 2021 and March 2022. Inclusion criteria were studies identifying causations of COVID-19 vaccine acceptance and/or hesitancy since March 2020 in six developed/developing countries, Australia, Brazil, India, Nigeria, Russia, and the United States. Studies that were not originally published in English were excluded.
Results. Patterns in the factors influencing both acceptance and hesitancy toward the COVID-19 vaccines emerged. Vaccination acceptance was largely related to individuals’ personal preferences and beliefs regarding immunity, while vaccination hesitancy was attributed to fears and distrust of vaccine safety, side effects, and efficacy.
Limitations. Lack of consistency in methodical procedures and text availability by country may limit the generalizability of the findings.
Conclusion. In developed/developing nations, emerging data suggest that skepticism surrounding COVID-19 vaccines was the most prevalent factor leading to vaccination hesitancy, while factors including personal protection were largely associated with higher acceptance rates of the COVID-19 vaccine. Because widespread immunization is necessary to slow the transmission of COVID-19, it is important that factors leading to hesitation are addressed in order to increase vaccination rates and achieve herd immunity.
Ronald Cárdenas Krenz
Universidad de Lima. Universidad Pública de Navarra
Abstract
What has been experienced during the COVID-19 pandemic, especially in the most vulnerable populations, has revealed the need for a new health model, much more fair, efficient and inclusive; However, defining and applying it is particularly a complex task.
When the pandemic arrived, health systems in different parts of the world revealed their precariousness and inequality, exacerbating the vulnerability of some groups. To make matters worse, the international response once the crisis arrived revealed limited solidarity in the most difficult moments of the crisis.
Although the arrival of vaccines months later offered hope, demonstrating the importance of collective work and not the fate of nations, many people, for reasons of the most diverse nature, were reluctant to get vaccinated. So, governments, faced with the urgency of confronting the virus in the most massive and rapid way, dictated different measures, sometimes correct, sometimes controversial, with the purpose of promoting vaccination.
This intervention, beyond its results, should raise questions about the scope and limits of state intervention in health, what are the terms that the relationship between the individual and the State should have, the need for subtle measures to motivate vaccination and the possibility of applying nudges as a strategy for the effect.
The experience of the pandemic, with its millions of victims, raises the need for a global and autonomous model, taking advantage of globalization to access knowledge, produce medicines and vaccines, as well as distribute them in the most efficient way.
In this purpose, science plays a crucial role, even when its postulates are provisional. States must rebuild lost trust in their governments, and know how to balance health and the economy. The pandemic has highlighted the importance of global public goods and the need to reconcile personal and collective interests instead of opposing them.
Lessons include the need for universal health systems, balanced measures by the State and the promotion of both a culture of responsibility and an ethic of care, with persuasion preferable to imposition.
This article certainly does not seek to propose what this system should be, which requires deeper and more interdisciplinary work, but it does seek to propose some guidelines that serve as guidance in this task, based on reflection on the experiences lived in the fateful days of the pandemic.
Eliana Zeballos
USDA Economic Research Service, Food Economic Division, Washington, D.C., USA
Wilson Sinclaira
USDA Economic Research Service, Food Economic Division, Washington, D.C., USA
Keenan Marchesia
USDA Economic Research Service, Food Economic Division, Washington, D.C., USA
Abstract
The U.S. government’s efforts in response to the pandemic included the development, manufacturing, and distribution of safe and effective COVID-19 vaccines. By the end of 2020, the Food and Drug Administration issued Emergency Use Authorizations for the Pfizer-BioNTech COVID-19 and the Moderna COVID-19 vaccine. Following this authorization, on December 14, 2020, each State received allocations of vaccines and devised individual distribution plans. This study investigates the impact of COVID-19 vaccination on U.S. food spending at home and away from home in 2021 employing fixed-effects regression analysis on quarterly State-level data. The results reveal that higher vaccination rates—measured by the share of the population that is fully vaccinated—are associated with a decrease in food-at-home sales and an increase in food-away-from-home sales. Further analysis reveals nuanced shifts between full-service and limited-service restaurants, indicating increased sales at full-service establishments and decreased sales at limited-service ones, suggesting a trade-off effect between the two restaurant types. The results of this study provide valuable insights for policymakers and industry stakeholders seeking to understand the heterogenous impacts of vaccinations on food spending.
