Since the start of the CoronaVirus Disease-2019 (CoViD-19) pandemic, which has hitherto killed almost 7 million people worldwide - although the true mortality figures could be much higher -, we have witnessed a progressively expanding number of domestic and wild mammalian species acquiring Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection, both spontaneously and experimentally (Di Guardo, 2022b).
The progressively expanding SARS-CoV-2 host range, hitherto encompassing more than thirty wildlife and domestic species, could be plausibly linked, among others, to the development of new, highly contagious and/or pathogenic variants of concern (VOCs) and variants of interest (VOIs) of this pandemic betacoronavirus.
Over the past three years, in fact, a huge number of mutational events were recorded in the genetic make-up of SARS-CoV-2, with this leading to the global appearance of several VOCs and VOIs (such as those termed "alfa", "beta", "gamma", "delta" and the highly contagious and immune-evasive "omicron", alongside its BA.1-BA.5 subvariants and the more recently identified ones named "Centaurus”, “Chiron”, “Gryphon”, “Cerberus”, followed by the newly emerged and highly transmissible "Kraken"). The progressive acquirement of “non-silent” mutations in the SARS-CoV-2 genome is directly connected to enhanced viral replication and, provided that the virus genetic make-up consists of...
Since the start of the CoronaVirus Disease-2019 (CoViD-19) pandemic, which has hitherto killed almost 7 million people worldwide - although the true mortality figures could be much higher -, we have witnessed a progressively expanding number of domestic and wild mammalian species acquiring Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection, both spontaneously and experimentally (Di Guardo, 2022b).
The progressively expanding SARS-CoV-2 host range, hitherto encompassing more than thirty wildlife and domestic species, could be plausibly linked, among others, to the development of new, highly contagious and/or pathogenic variants of concern (VOCs) and variants of interest (VOIs) of this pandemic betacoronavirus.
Over the past three years, in fact, a huge number of mutational events were recorded in the genetic make-up of SARS-CoV-2, with this leading to the global appearance of several VOCs and VOIs (such as those termed "alfa", "beta", "gamma", "delta" and the highly contagious and immune-evasive "omicron", alongside its BA.1-BA.5 subvariants and the more recently identified ones named "Centaurus”, “Chiron”, “Gryphon”, “Cerberus”, followed by the newly emerged and highly transmissible "Kraken"). The progressive acquirement of “non-silent” mutations in the SARS-CoV-2 genome is directly connected to enhanced viral replication and, provided that the virus genetic make-up consists of approximately 30,000 bases, each replication cycle will imply as an average the occurrence of 1 mutation/10,000 nucleotides (Di Guardo 2022a). Indeed, by progressively undergoing mutational events in both naturally and “artificially” gregarious species like white-tailed deer and mink, respectively, the possibility that new, highly divergent and pathogenic SARS-CoV-2 lineages could emerge from “animal communities” and infect people should be seriously taken into account.
Although the vast majority of SARS-CoV-2 VOCs and VOIs have developed in humans, some of them have also happened to "spill back" from animals to mankind.
This is clearly shown, for example, by the recent case of human infection caused by a highly divergent SARS-CoV-2 lineage (B.1.641) circulating among white-tailed deer (Odocoileus virginianus) from the Canadian region of Ontario, harbouring 76 mutations (37 of which had not been previously detected in human viral isolates) and sharing a quite recent common ancestry with a mink SARS-CoV-2 strain from Michigan (Pickering et al. 2022). Indeed, white-tailed deer have already been shown to be particularly susceptible to SARS-CoV-2 infection on the basis of a high homology degree of their angiotensin-converting enzyme-2 (ACE-2) viral receptor with the human one, thereby supporting in a very efficient way the intraspecies transmission of several VOCs and VOIs infecting people (Palmer et al. 2021; Hale et al. 2022). Furthermore, a vast proportion (40%) of white-tailed deer from North-Eastern USA were proven to harbour anti-SARS-CoV-2 antibodies in their blood serum (Chandler et al. 2021), with the omicron variant having been also identified in deer from New York State and Ohio (Wetzel 2022).
Still noteworthy, during the spring/summer seasons of 2020 the "cluster 5" VOC, characterized by the S:Y453F mutation, emerged from intensely bred mink in Denmark and The Netherlands. Following transmission from infected people (viral spillover), in fact, SARS-CoV-2 was shown to evolve into the aforementioned VOC inside the body of mink, which subsequently “returned” the mutated virus to humans (viral spillback) (Di Guardo 2021a; Lassaunière et al. 2021). This led, in turn, to the "stamping-out" of 17 million mink in Denmark, due to the public health hazard posed by them.
As far as concerns SARS-CoV-2 transmission from people to animals, cases of infection caused by the “alfa” variant were described in two cats and in one dog from France with suspect myocarditis, whose owners had shown CoViD-19-associated respiratory symptoms three to six weeks before
(Ferasin et al. 2021). It has also been claimed that pet hamsters transferred the highly pathogenic "delta" VOC to pet shop workers and visitors in Hong Kong (Mesa 2022), while the Omicron BA.2 subvariant could have been passed to people in China by a dog acting as a passive SARS-CoV-2 mechanical carrier (Zhou et al. 2022).
Among the wild animal species hitherto deemed susceptible to SARS-CoV-2 infection, a number of them appear to be increasingly threatened by extinction in terrestrial as well as in marine ecosystems.
While being of great concern, this simultaneously provides a strong argument for advocating the opportunity, if not the need, of immunizing the aforementioned species against SARS-CoV-2 (Di Guardo 2022b), although we don't know yet "how" and "to which extent" SARS-CoV-2 infection could impact their health and conservation status. By doing so, in fact, we would correctly apply the so-called "principle of precaution", thus aiming at protecting the increasingly threatened animal biodiversity by conferring an adequate antiviral population immunity to those SARS-CoV-2-susceptible wildlife species facing an increased extinction risk (e.g. lions, tigers, snow leopards, gorillas, etc.) (Delahay et al. 2021). At the same time, we would likely contribute to reducing SARS-CoV-2 circulation and, consequently, the appearance of new, highly transmissible and/or pathogenic VOCs.
To this aim, the tremendous progress gained in the production of the currently available vaccines through the messenger RNA (mRNA) technology should be viewed as a great advantage and scientific achievement.
Within this framework, the SARS-CoV-2 vaccination programmes should also include animals either living in close contact with people or intensely bred (i.e. mink and pigs), as well as wildlife species with a marked social ecology that have been shown to enhance intra-species transmission of SARS-CoV-2 (i.e. white-tailed deer) (Chandler et al. 2021; Hale et al. 2022).
The first key lesson we have learned (once again!) from the dramatic SARS-CoV-2 pandemic is that human, animal and environmental health are mutually and inextricably linked to each other.
This is the reason why, in order to be better prepared for future pandemics, we urgently need to adopt a scientific evidence-based, “holistic”, multidisciplinary and "One Health-based" approach.
In this respect, let me end this commentary by affirming it is very surprising, if not almost unbelievable, that in the far too brief two years of its life, the "Italian CoViD-19 Scientific Committee" (popularly known by the acronym "CTS") has never appointed any veterinarians as members of the committee (Di Guardo 2021b), thereby completely forgetting that at least 70% of the pathogens responsible for emerging infectious diseases (including also SARS-CoV-2 and its two betacoronavirus "predecessors", SARS-CoV and MERS-CoV) have either a proven or suspect origin from one or more animal reservoirs (Casalone and Di Guardo 2020).
Errare Humanum est Perseverare Autem Diabolicum!
2) Chandler JC, Bevins SN, Ellis JW, Linder TJ, Tell RM, Jenkins-Moore M, Root JJ, Lenoch JB, Robbe-Austerman S, DeLiberto TJ, Gidlewski T, Kim Torchetti M, Shriner SA (2021) SARS-CoV-2 exposure in wild white-tailed deer (Odocoileus virginianus). Proc Natl Acad Sci USA 118(47):e2114828118. doi: 10.1073/pnas.2114828118.
3) Delahay RJ, de la Fuente J, Smith GC, Sharun K, Snary EL, Flores Girón L, Nziza J, Fooks AR, Brookes SM, Lean FZX, Breed AC, Gortazar C (2021) Assessing the risks of SARS-CoV-2 in wildlife. One Health Outlook 3:7. doi: 10.1186/s42522-021-00039-6.
5) Di Guardo G (2021a) Future trajectories of SARS-CoV-2 in animals. Vet Rec 188:475. doi: 10.1002/vetr.663.
6) Di Guardo G (2021b) No Veterinarians (yet) on the Italian COVID-19 Scientific Committee. BMJ 374:n1719.
7) Di Guardo G (2022a) Is gain of function a reliable tool for establishing SARS-CoV-2 origin?. Adv Microbiol 12:103-108. doi:10.4236/aim.2022.123009.
8) Di Guardo G (2022b) SARS-CoV-2 Susceptibility of Domestic Animals and Wildlife in the Media Narrative. Pathogens 11:1356. https://doi.org/10.3390/pathogens11111356.
9) Ferasin L, Fritz M, Ferasin H, Becquart P, Corbet S, Ar Gouilh M, Legros V, Leroy EM (2021) Infection with SARS-CoV-2 variant B.1.1.7 detected in a group of dogs and cats with suspected myocarditis. Vet Rec 189(9):e944. doi: 10.1002/vetr.944.
10) Hale VL, Dennis PM, McBride DS, Nolting JM, Madden C, Huey D, Ehrlich M, Grieser J, Winston J, Lombardi D, Gibson S, Saif L, Killian ML, Lantz K, Tell RM, Torchetti M, Robbe-Austerman S, Nelson MI, Faith SA, Bowman AS (2022) SARS-CoV-2 infection in free-ranging white-tailed deer. Nature 602:481-486. doi: 10.1038/s41586-021-04353-x.
11) Lassaunière R, Fonager J, Rasmussen M, Frische A, Polacek C, Rasmussen TB, Lohse L, Belsham GJ, Underwood A, Winckelmann AA, Bollerup S, Bukh J, Weis N, Sækmose SG, Aagaard B, Alfaro-Núñez A, Mølbak K, Bøtner A, Fomsgaard A (2021) In vitro Characterization of Fitness and Convalescent Antibody Neutralization of SARS-CoV-2 Cluster 5 Variant Emerging in Mink at Danish Farms. Front Microbiol 12:698944. doi: 10.3389/fmicb.2021.
13) Palmer MV, Martins M, Falkenberg S, Buckley A, Caserta LC, Mitchell PK, Cassmann ED, Rollins A, Zylich NC, Renshaw RW, Guarino C, Wagner B, Lager K, Diel DG (2021) Susceptibility of white-tailed deer (Odocoileus virginianus) to SARS-CoV-2. J Virol 95(11):e00083-21. doi: 10.1128/JVI.00083-21.
14) Pickering B, Lung O, Maguire F, Kruczkiewicz P, Kotwa JD, Buchanan T, Gagnier M, Guthrie JL, Jardine CM, Marchand-Austin A, Massé A, McClinchey H, Nirmalarajah K, Aftanas P, Blais-Savoie J, Chee HY, Chien E, Yim W, Banete A, Griffin BD, Yip L, Goolia M, Suderman M, Pinette M, Smith G, Sullivan D, Rudar J, Vernygora O, Adey E, Nebroski M, Goyette G, Finzi A, Laroche G, Ariana A, Vahkal B, Côté M, McGeer AJ, Nituch L, Mubareka S, Bowman J (2022) Divergent SARS-CoV-2 variant emerges in white-tailed deer with deer-to-human transmission. Nat Microbiol 7(12):2011-2024. doi: 10.1038/s41564-022-01268-9.
16) Zhou C, Wu A, Ye S, Zhou Z, Zhang H, Zhao X, Wang Y, Wu H, Ruan D, Chen S, Tang W, Xu S, Li Q, Su K (2022) Possible transmission of COVID-19 epidemic by a dog as a passive mechanical carrier of SARS-CoV-2, Chongqing, China, 2022. J Med Virol. doi: 10.1002/jmv.28408. Epub ahead of print.
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, patients who are deaf or hard of hearing face prolonged wait times and are often unable to fully express their medical needs and fully comprehend what is happening with their medical care. When patients cannot adequately communicate their health needs, they are unable to get the care they need, exacerbating existing inequities.
When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.4
As the prevalence of unsafe listening practices in adolescents and young adults continues to grow5, we need to continue our advocacy efforts to optimize the health care environment so that persons who are deaf or hard of hearing can get the best medical care possible.
This includes not only access to timely and appropriate sign language interpretation but also captioning options, American Sign Language-translated videos, assistive devices that facilitate appointment scheduling and quiet environments that allow patients to better communicate with the providers.6
We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard of hearing patients. These steps are useful not only in the medical setting but in all social settings so that the deaf and hard of hearing can be fully integrated in our society.
1. Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol. 2020 Oct 28:1-7. doi: 10.1080/17483107.2020.1822449. Epub ahead of print. PMID: 33112178.
2. Oyler AL. Untreated hearing loss in adults. Accessed from https://www.asha.org/Articles/Untreated-Hearing-Loss-in-Adults/#:~:text=... on December 1, 2022.
3. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol. 2015 Mar;36(3):545-50. doi: 10.1097/MAO.0000000000000562. PMID: 25158616; PMCID: PMC4466103.
4. Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging. 2012;7:159-63. doi: 10.2147/CIA.S26059. Epub 2012 Jun 15. PMID: 22791988; PMCID: PMC3393360.
5. Dillard LK, Arunda MO, Lopez-Perez L, et al. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health 2022;7:e010501.
6. Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA. 2022;327(12):1129–1130. doi:10.1001/jama.2022.3026
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Approximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, patients who are deaf or hard of hearing face prolonged wait times and are often unable to fully express their medical needs and fully comprehend what is happening with their medical care. When patients cannot adequately communicate their health needs, they are unable to get the care they need, exacerbating existing inequities.
When health systems and society do not accommodate individuals with hearing loss, they contribute to social isolation. This isolation can manifest in poorer long-term health outcomes such as dementia and premature mortality.4
As the prevalence of unsafe listening practices in adolescents and young adults continues to grow5, we need to continue our advocacy efforts to optimize the health care environment so that persons who are deaf or hard of hearing can get the best medical care possible.
This includes not only access to timely and appropriate sign language interpretation but also captioning options, American Sign Language-translated videos, assistive devices that facilitate appointment scheduling and quiet environments that allow patients to better communicate with the providers.6
We also need better training for all members of the healthcare team to understand the nuances involved in caring for deaf and hard of hearing patients. These steps are useful not only in the medical setting but in all social settings so that the deaf and hard of hearing can be fully integrated in our society.
1. Jilla AM, Johnson CE, Huntington-Klein N. Hearing aid affordability in the United States. Disabil Rehabil Assist Technol. 2020 Oct 28:1-7. doi: 10.1080/17483107.2020.1822449. Epub ahead of print. PMID: 33112178.
2. Oyler AL. Untreated hearing loss in adults. Accessed from https://www.asha.org/Articles/Untreated-Hearing-Loss-in-Adults/#:~:text=... on December 1, 2022.
3. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol. 2015 Mar;36(3):545-50. doi: 10.1097/MAO.0000000000000562. PMID: 25158616; PMCID: PMC4466103.
4. Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging. 2012;7:159-63. doi: 10.2147/CIA.S26059. Epub 2012 Jun 15. PMID: 22791988; PMCID: PMC3393360.
5. Dillard LK, Arunda MO, Lopez-Perez L, et al. Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis. BMJ Global Health 2022;7:e010501.
6. Tonelli M, Warick R. Focusing on the Needs of People With Hearing Loss During the COVID-19 Pandemic and Beyond. JAMA. 2022;327(12):1129–1130. doi:10.1001/jama.2022.3026
Sir ,Voluntary noise exposure can be avoided. Every country has laws for noise pollution but the ground reality? Just by one act of "Abolishing Horn facility in vehicles" can have unimaginable health benefits to humans and animals in the whole world. I even wrote to Shri Modiji,my beloved PM but I wonder if it reached his ears since he too must be a victim of noise pollution(on a lighter note ). Can Bmj reach out to tall leaders of all countries through this Rapid Response????
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine...
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine (drug given in complicated Falciparum malaria) and rifampicin (1st line drug for Tuberculosis).
Adverse drug reactions under- reporting is very high in India.4 Doctors, Health Care Workers (HCWs) treating malaria patients, including peripheral areas must be encouraged to report ADRs and should be trained for drug reactions management. They should also provide data on adverse drug effects of antimalarial when given during pregnancy and lactation, fetal toxicity i.e. effect of cardiac malformation and skeletal defects due to some of anti-malarial drugs and lastly G-6 PD Deficiency and use of primaquine where a significant proportion of population has high prevalence of G6PD
deficiency. Drug efficacy is also affected by may complains and ADR reporting as time may help in proper m/m at local level and incorporation of important new points in malaria treatment guidelines. For malaria elimination, thus sharing of data demonstrating or exhibiting (a) Drug efficacy and bioavailability of drugs (b) Real time reporting of ADR of individual drugs (c) Drug interactions (d) Information regarding radical cure given to patients (especially in P vivax endemic regions) and compliance of primaquine, in digital dashboard will strengthen the system and definitely a country with highest P. vivax cases (India accounts for nearly 50% cases of Plasmodium vivax cases) should think about alternative to primaquine 5 .
Reference:
1. Rahi M, Sharma A. For malaria elimination India needs a platform for data integration BMJ Global Health 2020;5:e004198.
2. Shrivastva, S., Chakma, T., Das, A. and Verma, A.K. (2021), Digitisation and realtime sharing of unified surveillance tool and clinicopathological data for efficient management of disease outbreaks. Int J Health Plann Mgmt, 36: 1352-1354. https://doi.org/10.1002/hpm.3163
3. Sim IK, Davis TM, Ilett KF. Effects of a high-fat meal on the relative oral bioavailability of piperaquine. Antimicrob Agents Chemother. 2005 Jun;49(6):2407-11. doi: 10.1128/AAC.49.6.2407-2411.2005. PMID: 15917540; PMCID: PMC1140540.
4. Tandon, V. R., Mahajan, V., Khajuria, V., &Gillani, Z. (2015). Under-reporting of adverse drug reactions: a challenge for pharmacovigilance in India. Indian journal of pharmacology, 47(1), 65–71. https://doi.org/10.4103/0253-7613.150344
5. Wells, T. N., Alonso, P. L., &Gutteridge, W. E. (2009). New medicines to improve control and contribute to the eradication of malaria. Nature reviews. Drug discovery, 8(11), 879–891. https://doi.org/10.1038/nrd2972.
To,
The Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical....
To,
The Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical. This advocacy has worked and is exemplified by greater decrease in neonatal mortality. .
We declare no conflict of interest.
Phadke M. A1*, Nair R2*, Menon P3*, Jotkar R4*.
1*Sr. Adv Govt,UNICEF,Mumbai, India
2*Nutrition Specialist,UNICEF,Mumbai, Maharashtra, India
3*Asso. Prof, Pediatrics, MEDD, DY P. Med College, Pune, India
4*Sr. Consultant R.Jijau mission, DWCD,Govt of Mah Mumbai,India
References:
1.Deliberation-based learning: strengthening neonatal care in China http://orcid.org/0000-0001-5158-3267Yue Xiao1,
Yingpeng Qiu1, Lewis Husain2,Gerald Bloom2,
Liwei Shi1Correspondence to Dr. Yue Xiao; moonxy@126.com
Pardon my literary brevity, but this article does little in the way of actually helping poor communities . All you are
doing is changing words around to sugar coat widespread healthcare inequalities ( disparities ) in this country. Why not just call it what it is and do something about it, ipso facto ? It is dissapointing to read an article where the primary debate centers on linguistics or terminology and not practical solutions to real life health problems. So what if a country is 'developing', we used to call them "third world " what the hell is the difference? My bigger point is should we not concentrate on helping each other instead of finding different ways to be woke .
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely to be in global north institutions that can afford it. I believe this is one of the most important reasons why equity of access for authors and others involved in journal publication has not progressed more than it has, as shown in the current article.
A quick look through the first editions of RHM shows that we had a very international group of board members, authors and peer reviewers from a wide range of countries, including the global south (or what the authors of this article call LMIC countries). But like other journals, we did not have a policy to that effect at the beginning, only the politics of international feminism and women’s rights. This changed when one of the trustees put this subject on the agenda of an annual meeting, around 1997, and proposed that we develop written policy on equity, which we did. Its first and most important point was that any paper published about a specific country had to be by at least some authors from that country, not just as an afterthought at the end of the list or as people who were thanked for “helping with the research”. Together we enforced this policy throughout my editorship, which lasted 23 years. With each edition, I would do a count of how many authors and peer reviewers and countries were represented by the articles and from which parts of the world. I reported this to the annual meetings as well, though I can’t recall for how long.
We were very aware that few if any other journals did the same at the time, including the most important health-related journals, whose tables of contents I scoured regularly for news and partly with checking equity of authorship in mind.
When I left RHM in May 2015, its name, editorship, staff, boards, and publisher all changed. I don’t know if this policy has continued. I do know that real open access in most journals is far less available than we may be led to believe.
This is a thought-provoking article and I can see similar tensions and themes in my own collaborative relationships. I would have liked to see more discussion of how the funding opportunity shaped and contributed to these tensions and what the role of the funder is in contributing to healthy equitable collaborations. Many of the decisions were driven by how to meet the expectations of the funder. It would also be interesting to examine these tensions in long-term collaborations that exist outside of any one specific funding opportunity.
I would like to thank the authors for their analysis of the structural imbalances of power that exist in global health. I particularly agree with their argument that diversity, equity and inclusion initiatives work only to strengthen existing structures rather than to dismantle them.
However, I would like to problematise the framing of the power relation in this article and suggest an alternative.
To describe the contemporary problems with the “structural imbalance of power” in global health as feudal perhaps implies that they are somehow historic or located in the past, when they are operating and located within modern political economy. Feudalism, as a system of production, is predominantly associated with medieval Europe. Therefore there is a danger, in this piece, that the solution gestured towards is one of modernisation, to develop the relations from these feudal ones. However, from feudalism developed capitalism, both in Europe (Marx et al., 1981; Robinson, 2000) and also, as Alavi (1980) argues, in the colonial Indian context the authors explore in detail in their article.
Colonisation is inseparable from the rise of capitalism as a means of production (Vergès, 2021), of which developing healthcare infrastructure to support the colonisers was an integral part, as the authors identify. Colonial expansions were not primarily a thirst for adventure but a thirst for profits, for resources, for land and for new people to exploit (Blaut, 1989; Bryan...
I would like to thank the authors for their analysis of the structural imbalances of power that exist in global health. I particularly agree with their argument that diversity, equity and inclusion initiatives work only to strengthen existing structures rather than to dismantle them.
However, I would like to problematise the framing of the power relation in this article and suggest an alternative.
To describe the contemporary problems with the “structural imbalance of power” in global health as feudal perhaps implies that they are somehow historic or located in the past, when they are operating and located within modern political economy. Feudalism, as a system of production, is predominantly associated with medieval Europe. Therefore there is a danger, in this piece, that the solution gestured towards is one of modernisation, to develop the relations from these feudal ones. However, from feudalism developed capitalism, both in Europe (Marx et al., 1981; Robinson, 2000) and also, as Alavi (1980) argues, in the colonial Indian context the authors explore in detail in their article.
Colonisation is inseparable from the rise of capitalism as a means of production (Vergès, 2021), of which developing healthcare infrastructure to support the colonisers was an integral part, as the authors identify. Colonial expansions were not primarily a thirst for adventure but a thirst for profits, for resources, for land and for new people to exploit (Blaut, 1989; Bryan et al., 2018). As Walter Rodney demonstrates (Rodney and Recorded Books, 2012), the profits from British colonial endeavours were directed back to Britain, developing British society and infrastructure at the cost of underdeveloping colonial countries. The global North, built as it is on theft of the world’s wealth, is a creation of the global South (Fanon, 1963; Vergès, 2021). Therefore, to be anti-colonial one must be anti-capitalist.
The alternative I would suggest in this article is to name these relations as capitalism, not feudalism. To understand the persistence of colonial and neo-colonial relationships in global health, it’s necessary to understand how these relationships are related to our current system of production, oppression and exploitation: capitalism. For example, the well-documented phenomenon of “brain drain” where doctors are being lost to their global South contexts can be understood, in part, as an expression of the contradictions of capitalism. The structures that enable imperialist exploitation of the global South for the benefit of the global North, including through the global health ecosystem are capitalist, not feudal.
Imperialism, to which the authors allude, is not called the highest stage of capitalism for nothing (Lenin, 1916). The financial leverage that imperial countries hold over colonial and neo-colonial countries cannot be broken only by considering the positionality of individual actors but rather by dismantling and reforming the existing relations of production, returning genuine autonomy to the global South. I hope that through this, global health is truly transformed.
Bibliography
Alavi, H. (1980) India: Transition from feudalism to colonial capitalism. Journal of Contemporary Asia 10, (4) 359–399. https://doi.org/10.1080/00472338085390251
Blaut, J. M. (1989) Colonialism and the Rise of Capitalism. Science & Society 53, (3) 260–296
Bryan, B., Dadzie, S., Scafe, S., and Okolosie, L. (2018) The heart of the race: Black women’s lives in Britain. London ; New York: Verso
Fanon, F. (1963) The wretched of the earth. New York: Grove
Lenin, V. (1916) Imperialism, the Highest Stage of Capitalism. https://www.marxists.org/archive/lenin/works/1916/imp-hsc/
Marx, K., Fowkes, B., and Fernbach, D. (1981) Capital: a critique of political economy. London ; New York, N.Y: Penguin Books in association with New Left Review
Robinson, C. J. (2000) Black marxism: The making of the Black radical tradition. Chapel Hill, N.C: University of North Carolina Press
Rodney, W., and Recorded Books, I. (2012) How Europe Underdeveloped Africa. Baltimore, MD: Black Classic Press
Vergès, F. (2021) A decolonial feminism. Trans. by Bohrer, A. J. London: Pluto Press
Since the start of the CoronaVirus Disease-2019 (CoViD-19) pandemic, which has hitherto killed almost 7 million people worldwide - although the true mortality figures could be much higher -, we have witnessed a progressively expanding number of domestic and wild mammalian species acquiring Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection, both spontaneously and experimentally (Di Guardo, 2022b).
Show MoreThe progressively expanding SARS-CoV-2 host range, hitherto encompassing more than thirty wildlife and domestic species, could be plausibly linked, among others, to the development of new, highly contagious and/or pathogenic variants of concern (VOCs) and variants of interest (VOIs) of this pandemic betacoronavirus.
Over the past three years, in fact, a huge number of mutational events were recorded in the genetic make-up of SARS-CoV-2, with this leading to the global appearance of several VOCs and VOIs (such as those termed "alfa", "beta", "gamma", "delta" and the highly contagious and immune-evasive "omicron", alongside its BA.1-BA.5 subvariants and the more recently identified ones named "Centaurus”, “Chiron”, “Gryphon”, “Cerberus”, followed by the newly emerged and highly transmissible "Kraken"). The progressive acquirement of “non-silent” mutations in the SARS-CoV-2 genome is directly connected to enhanced viral replication and, provided that the virus genetic make-up consists of...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Show MoreApproximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
During the Covid-19 pandemic, I became acutely aware of my own worsening hearing issues. As I struggled to hear what my colleagues, patients and friends were saying muffled behind masks, I realized that I needed hearing aids. Even though I work closely with deaf and hard of hearing patients, I was shocked by the expense. The average cost of a pair of prescription hearing aids is $2500 US.1 As a physician, I could pay out of pocket, but most of my own patients can’t afford this luxury.
Show MoreApproximately 17% of American adults have some hearing loss, with over 28 million potentially benefiting from hearing aids.2 However, many insurances, including traditional Medicare plans, currently do not cover this benefit. Paying for hearing aids out of pocket is unrealistic, as on average, individuals who are hard of hearing more likely to be unemployed or underemployed and have lower incomes compared to those who are not.3
We now have lowered the costs for hearing aids and made them more easily accessible, but for those who need assistance, over the counter hearing aids may not be enough. We need to ensure access to the latest technology and the proper tools to use hearing aids effectively.
We also must remember that individuals who are deaf or hard of hearing continue to face significant barriers to accessibility, especially in the healthcare system. Video technologies used in lieu of in person interpreters, may be unreliable and difficult to operate. As a result, p...
Sir ,Voluntary noise exposure can be avoided. Every country has laws for noise pollution but the ground reality? Just by one act of "Abolishing Horn facility in vehicles" can have unimaginable health benefits to humans and animals in the whole world. I even wrote to Shri Modiji,my beloved PM but I wonder if it reached his ears since he too must be a victim of noise pollution(on a lighter note ). Can Bmj reach out to tall leaders of all countries through this Rapid Response????
Dear Editor,
The article by Rahi et al1 Digitization of malaria surveillance tools is very informative, and it may raise malaria elimination activities in India. It would be a key step towards malaria elimination in India and if we need a strong malaria health information system we have to switch from aggregated data to near real time case based surveillance. We also agree that digitisation and real-time sharing of surveillance result and sharing of clinic pathological data is very essential for efficient management of disease outbreaks2 which may include Malaria outbreak by new species of Plasmodium; To their proposed platform (which may provide real time epidemiological, entomological and community surveillance data), there is a need of emphasis on drug efficacy determining factors and reporting of Adverse Drug Reactions (ADR) from each and every region and each and every case detected even in primary or community health centres of country. Drug treatment for malaria is far away from simple. Drug efficacy of anti-malarial drug depends upon various factors like a) Pharmacokinetics and pharmacodynamics of drugs commonly used and including effect of high fat meal on relative bioavailability of lumefantrines and piperaquine3 b) Severe side effects of some drugs like life threatening ADRs from quinine, possibility of delayed haemolytic anemia in cases treated with Artemether- lumefantrine (c) Drug interactions between anti-malarial drugs and other drugs i.e. Quinine...
Show MoreTo,
Show MoreThe Editor,
We read with interest the article on ‘Deliberation-based learning: strengthening neonatal care in China’ by Yingpeng et.al. that has appeared in the September 2022 issue of BMJ Global health. The strategies evolved by the Govt. seem to have worked. They held detailed deliberations with staff and patients that helped in better neonatal care. On this backdrop, we submit observations from India to accentuate their study.
The Sample Registration System of India released its data on 22nd September 20222, which has shown some promising figures.SRS data shows that U5MR( Under 5 mortality rate) to be 32 per thousand live births, IMR(Infant mortality rate) to be 28(87.5%) and NMR(Neonatal mortality rate) to be 22 (68.75% of total and 78.5 % of the IMR). This more than amply describes divergent age pattern in mortality statistics of India in 2020.
In 2014 U5MR was 45, IMR 39(86.6%) and NMR 26(57.7of total and 66.6% of the IMR).It is thus clear that neonatal mortality as a subcomponent of IMR has declined more in terms of percentage. This probably is the result of many policy changes in national programs started by the Govt. of India like HBNC3(home based new born care), HBYC( Home based young child care), exclusive breast feeding , MAA( mother’s absolute affection)and KMC( Kangaroo mother care) . All these programs involve health professional staff to advocate and parents (caregivers) to participate. Empowerment of the mother is critical....
Pardon my literary brevity, but this article does little in the way of actually helping poor communities . All you are
doing is changing words around to sugar coat widespread healthcare inequalities ( disparities ) in this country. Why not just call it what it is and do something about it, ipso facto ? It is dissapointing to read an article where the primary debate centers on linguistics or terminology and not practical solutions to real life health problems. So what if a country is 'developing', we used to call them "third world " what the hell is the difference? My bigger point is should we not concentrate on helping each other instead of finding different ways to be woke .
I am very glad to see this article and the research that went into it. Although the findings are disappointing on their own, an historical perspective would show they are certainly a sign of some progress compared to the days when no journal at all considered the issue of equity in authorship, let alone in peer review or subject matter. In 1992, Sundari Ravindran and I founded the journal Reproductive Health Matters (RHM). We published an issue twice a year with an editorial and 20-25 articles that included features, original research, commentaries and news summaries. We formed an Editorial Advisory Board and a Board of Trustees so as to become a charity early on, and began listing their names in the journal in 1997. One of the most important policy decisions our joint board meetings made, also around 1997, was related to equity of authorship and equity in other forms of participation, e.g. in peer reviewing. We also began to publish shorter editions of the journal with some the papers, which were translated into Spanish, French, Arabic, Chinese, and Hindi by editors from the countries/regions represented by those languages.
The journal, published by Elsevier Science, was open access throughout the time RHM existed, because we raised donor funds to pay them for this. In my opinion, if a journal is not open access, then ensuring equity of access to publication is not possible, because the authors most likely to be given grants to pay for open access are more likely...
Show MoreThis is a thought-provoking article and I can see similar tensions and themes in my own collaborative relationships. I would have liked to see more discussion of how the funding opportunity shaped and contributed to these tensions and what the role of the funder is in contributing to healthy equitable collaborations. Many of the decisions were driven by how to meet the expectations of the funder. It would also be interesting to examine these tensions in long-term collaborations that exist outside of any one specific funding opportunity.
I would like to thank the authors for their analysis of the structural imbalances of power that exist in global health. I particularly agree with their argument that diversity, equity and inclusion initiatives work only to strengthen existing structures rather than to dismantle them.
However, I would like to problematise the framing of the power relation in this article and suggest an alternative.
To describe the contemporary problems with the “structural imbalance of power” in global health as feudal perhaps implies that they are somehow historic or located in the past, when they are operating and located within modern political economy. Feudalism, as a system of production, is predominantly associated with medieval Europe. Therefore there is a danger, in this piece, that the solution gestured towards is one of modernisation, to develop the relations from these feudal ones. However, from feudalism developed capitalism, both in Europe (Marx et al., 1981; Robinson, 2000) and also, as Alavi (1980) argues, in the colonial Indian context the authors explore in detail in their article.
Colonisation is inseparable from the rise of capitalism as a means of production (Vergès, 2021), of which developing healthcare infrastructure to support the colonisers was an integral part, as the authors identify. Colonial expansions were not primarily a thirst for adventure but a thirst for profits, for resources, for land and for new people to exploit (Blaut, 1989; Bryan...
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