Bangkok — Millions of lives could be put at risk unless urgent action is taken to curb the spread of drug-resistant malaria in Africa, according to a new paper published in the journal Science.
The paper says the parasite that causes malaria is showing signs of resistance to artemisinin, the main drug used to fight the disease, in several east African countries.
“Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania,” according to the report.
Artemisinin Combination Therapies, or ACTs, have been the cornerstone of malaria treatment in recent years — but there are worrying signs that they are becoming less effective, says report co-author Lorenz von Seidlein of the Mahidol Oxford Tropical Medicine Research Unit in Bangkok.
“We have increasing reports from eastern Africa saying that they have documented resistance against the first line treatments against malaria,” he says. “The first line treatments are artemisinin combination therapy – that has been used for the last 20 years and has worked excellently well. And it’s now not working quite as well as it used to do.”
It’s estimated that over one thousand children die every day from malaria in Africa. The World Health Organization estimates that the global death toll from malaria in 2022 — the most recent figures available — was 608,000.
Past lessons
Before artemisinin therapies were developed, chloroquine was the medicine most used to treat malaria. The report authors say that in the 1990s and early 2000s, signs that the malaria parasite was developing resistance to chloroquine were widely ignored.
“When chloroquine resistance slowly sneaked into Africa there was a whole wave of childhood mortality followed by it. So really, a large number of children — probably in the millions — died because chloroquine didn’t work as well as it used to do. And now we see these first signs that something similar is happening with the ACTs. And that is of course very worrying,” von Seidlein says.
Urgent action
The report authors urge policymakers and global funding bodies to act now to prevent artemisinin resistance taking hold.
Their recommendations include combining artemisinin drugs with other medicines.
“Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies [TACTs] is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance,” the report says.
The authors also call for the rollout of new, more effective insecticides and mosquito nets; better training of community health workers; the rapid deployment of new malaria vaccines; and better monitoring of parasite mutations.
Southeast Asia
Many of these methods were used to halt the spread of artemisinin resistance in south-east Asia since 2014, notes von Seidlein.
“Ultimately, there was an understanding that this could be a major health emergency globally and so there were a lot of investments from funders for the from high-income countries towards these countries in the Greater Mekong sub-region to stop the spread of artemisinin resistant parasites,” he says.
The report says that sense of urgency must now be applied to tackling artemisinin resistance in Africa.
“We ask funders, specifically the Global Fund to Fight AIDS, Tuberculosis and Malaria [GFATM] and the U.S. Government’s President’s Malaria Initiative, to be visionary and to step up funding for malaria control and elimination programs to contain the spread of artemisinin resistance in Africa — as they have done effectively in Southeast Asia since 2014,” says report co-author Ntuli Kapologwe, the director of preventive services at Tanzania’s Ministry of Health.
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The malaria parasite is showing signs of resistance to artemisinin, the main drug used to fight the disease, in parts of Africa. A new report warns of potentially millions more deaths without immediate health policy changes. Henry Ridgwell has more from Bangkok.
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GALAPAGOS ISLANDS, Ecuador — Warm morning light reflects from the remains of a natural rock arch near Darwin Island, one of the most remote islands in the Galapagos. In clear, deep blue water, thousands of creatures — fish, hammerhead sharks, marine iguanas — move in search of food.
The 2021 collapse of Darwin’s Arch, named for the famed British naturalist behind the theory of evolution, came from natural erosion. But its demise underscored the fragility of a far-flung archipelago that’s coming under increased pressure both from climate change and invasive species.
Warming oceans affect the food sources of many of the seagoing animals in the Galapagos. Marine iguanas — one of many species that are endemic, or unique, to the Galapagos — have a harder time finding the red and green algae they prefer. Sea turtles struggle to nest in warmer temperatures. Raising young gets harder as water warms and fewer nutrients are available.
While the Galapagos are known for a great multitude of species, their numbers aren’t unlimited.
“We have something of everything here – that’s why people say the Galapagos is so diverse – but we have a small number of each thing,” said Natasha Cabezas, a naturalist guide.
The Galapagos have always been sensitive to changes in ocean temperature. The archipelago itself is located where major ocean currents converge — cool from the south, warm from the north, and a cold upwelling current from the west. Then there’s El Nino, the periodic and natural Pacific Ocean warming that affects weather worldwide.
While temperatures vary depending on the season and other naturally-occurring climate events, ocean temperatures have been rising because of human-caused climate change as oceans absorb the vast majority of excess heat in the atmosphere. The ocean experienced its warmest decade since at least the 1800s in the last 10 years, and 2023 was the ocean’s warmest year on record.
Early June brings winter in the Southern Hemisphere, and the Cromwell current brings whale sharks, hammerheads, and massive sunfish to the surface. It also provides nutrients for penguins, marine iguanas and sea lions in search of food. As more of those animals make themselves known this season, scientists are tracking how they fared in the warming of the past year’s El Nino.
El Nino can bring food shortages for some species like marine iguanas and sea turtles, as the warmer ocean means dwindling food sources. Scientists observing the species have noted a significant decline in population numbers during El Nino events.
Marine iguanas swim like snakes through the water from rock to rock as waves crash against the shore of Fernandina Island. They latch themselves onto the undersea rocks to feed on algae growing there, while sea lions spin around them like puppies looking for someone to play with.
The iguanas were “one of the most affected species from El Niño last year and right now they are still recovering,” said Galapagos Conservancy Director Jorge Carrión.
As rising ocean temperatures threaten aquatic or seagoing life, on land there’s a different problem. Feral animals — cats, dogs, pigs, goats and cattle, none of them native — are threatening the unique species of the islands.
After the COVID-19 pandemic, many people are abandoning the dogs and cats they wanted to keep them company, Cabezas said.
“If you don’t take care of them they become a problem and now it’s a shame to see dogs everywhere. We have a big problem right now I don’t know what we’re going to do,” she said.
The non-native animals are a special threat to the giant tortoises closely associated with the Galapagos. The tortoises declined dramatically in the 19th century due to hunting and poaching, and authorities have worked to protect them from humans. It’s been illegal to kill a giant tortoise since 1933.
“In one night, a feral pig can destroy all nesting sites in an area,” Carrión said. Park rangers try to visit areas with nesting sites once a day, and kill pigs when they find them. But the pigs are elusive, Carrion said.
Feral cats feed on marine iguana hatchings, and both pigs and cats compete for food with the tortoises.
If invasive species and warming oceans weren’t enough, there’s the plastic that is a widespread problem in the world’s oceans. One recent study reported microplastics in the bellies of Galapagos penguins.
“There are no animals in the Galapagos that do not have microplastics in their food,” Carrión said.
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Washington — New blood tests could help doctors diagnose Alzheimer’s disease faster and more accurately, researchers reported Sunday – but some appear to work far better than others.
It’s tricky to tell if memory problems are caused by Alzheimer’s. That requires confirming one of the disease’s hallmark signs — buildup of a sticky protein called beta-amyloid — with a hard-to-get brain scan or uncomfortable spinal tap. Many patients instead are diagnosed based on symptoms and cognitive exams.
Labs have begun offering a variety of tests that can detect certain signs of Alzheimer’s in blood. Scientists are excited by their potential, but the tests aren’t widely used yet because there’s little data to guide doctors about which kind to order and when. The U.S. Food and Drug Administration hasn’t formally approved any of them and there’s little insurance coverage.
“What tests can we trust?” asked Dr. Suzanne Schindler, a neurologist at Washington University in St. Louis who’s part of a research project examining that. While some are very accurate, “other tests are not much better than a flip of a coin.”
Demand for earlier Alzheimer’s diagnosis is increasing
More than 6 million people in the United States and millions more around the world
have Alzheimer’s, the most common form of dementia. Its telltale “biomarkers” are brain-clogging amyloid plaques and abnormal tau protein that leads to neuron-killing tangles.
New drugs, Leqembi and Kisunla, can modestly slow worsening symptoms by removing gunky amyloid from the brain. But they only work in the earliest stages of Alzheimer’s and proving patients qualify in time can be difficult. Measuring amyloid in spinal fluid is invasive. A special PET scan to spot plaques is costly and getting an appointment can take months.
Even specialists can struggle to tell if Alzheimer’s or something else is to blame for a patient’s symptoms.
“I have patients not infrequently who I am convinced have Alzheimer’s disease and I do testing and it’s negative,” Schindler said.
New study suggests blood tests for Alzheimer’s can be simpler, faster
Blood tests so far have been used mostly in carefully controlled research settings. But a new study of about 1,200 patients in Sweden shows they also can work in the real-world bustle of doctors’ offices — especially primary care doctors who see far more people with memory problems than specialists but have fewer tools to evaluate them.
In the study, patients who visited either a primary care doctor or a specialist for memory complaints got an initial diagnosis using traditional exams, gave blood for testing and were sent for a confirmatory spinal tap or brain scan.
Blood testing was far more accurate, Lund University researchers reported Sunday at the Alzheimer’s Association International Conference in Philadelphia. The primary care doctors’ initial diagnosis was 61% accurate and the specialists’ 73% — but the blood test was 91% accurate, according to the findings, which also were published in the Journal of the American Medical Association.
Which blood tests for Alzheimer’s work best?
There’s almost “a wild West” in the variety being offered, said Dr. John Hsiao of the National Institute on Aging. They measure different biomarkers, in different ways.
Doctors and researchers should only use blood tests proven to have a greater than 90% accuracy rate, said Alzheimer’s Association chief science officer Maria Carrillo.
Today’s tests most likely to meet that benchmark measure what’s called p-tau217, Carrillo and Hsiao agreed. Schindler helped lead an unusual direct comparison of several kinds of blood tests, funded by the Foundation for the National Institutes of Health, that came to the same conclusion.
That type of test measures a form of tau that correlates with how much plaque buildup someone has, Schindler explained. A high level signals a strong likelihood the person has Alzheimer’s while a low level indicates that’s probably not the cause of memory loss.
Several companies are developing p-tau217 tests including ALZpath Inc., Roche, Eli Lilly and C2N Diagnostics, which supplied the version used in the Swedish study.
Who should use blood tests for Alzheimer’s?
Only doctors can order them from labs. The Alzheimer’s Association is working on guidelines and several companies plan to seek FDA approval, which would clarify proper use.
For now, Carrillo said doctors should use blood testing only in people with memory problems, after checking the accuracy of the type they order.
Especially for primary care physicians, “it really has great potential to help them in sorting out who to give a reassuring message and who to send on to memory specialists,” said Dr. Sebastian Palmqvist of Lund University, who led the Swedish study with Lund’s Dr. Oskar Hansson.
The tests aren’t yet for people who don’t have symptoms but worry about Alzheimer’s in the family — unless it’s part of enrollment in research studies, Schindler stressed.
That’s partly because amyloid buildup can begin two decades before the first sign of memory problems, and so far, there are no preventive steps other than basic advice to eat healthy, exercise and get enough sleep. But there are studies underway testing possible therapies for people at high risk of Alzheimer’s, and some include blood testing.
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KENITRA, Morocco — Golden fields of wheat no longer produce the bounty they once did in Morocco. A six-year drought has imperiled the country’s entire agriculture sector, including farmers who grow cereals and grains used to feed humans and livestock.
The North African nation projects this year’s harvest will be smaller than last year in both volume and acreage, putting farmers out of work and requiring more imports and government subsidies to prevent the price of staples like flour from rising for everyday consumers.
“In the past, we used to have a bounty — a lot of wheat. But during the last seven or eight years, the harvest has been very low because of the drought,” said Al Housni Belhoussni, a small-scale farmer who has long tilled fields outside of the city of Kenitra.
Belhoussni’s plight is familiar to grain farmers throughout the world confronting a hotter and drier future. Climate change is imperiling the food supply and, in regions like North Africa, shrinking the annual yields of cereals that dominate diets around the world — wheat, rice, maize and barley.
The region is one of the most vulnerable in the world to climate change. Delays to annual rains and inconsistent weather patterns have pushed the growing season later in the year and made planning difficult for farmers.
In Morocco, where cereals account for most of the farmed land and agriculture employs the majority of workers in rural regions, the drought is wreaking havoc and touching off major changes that will transform the makeup of the economy. It has forced some to leave their fields fallow. It has also made the areas they do elect to cultivate less productive, producing far fewer sacks of wheat to sell than they once did.
In response, the government has announced restrictions on water use in urban areas — including on public baths and car washes — and in rural ones, where water going to farms has been rationed.
“The late rains during the autumn season affected the agriculture campaign. This year, only the spring rains, especially during the month of March, managed to rescue the crops,” said Abdelkrim Naaman, the chairman of Nalsya. The organization has advised farmers on seeding, irrigation and drought mitigation as less rain falls and less water flows through Morocco’s rivers.
The Agriculture Ministry estimates that this year’s wheat harvest will yield roughly 3.1 billion kilograms, far less than last year’s 5.5 billion kilograms — a yield that was still considered low. The amount of land seeded has dramatically shrunk as well, from 36,700 square kilometers to 9,540 square miles 24,700 square kilometers.
Such a drop constitutes a crisis, said Driss Aissaoui, an analyst and former member of the Moroccan Ministry for Agriculture.
“When we say crisis, this means that you have to import more,” he said. “We are in a country where drought has become a structural issue.”
Leaning more on imports means the government will have to continue subsidizing prices to ensure households and livestock farmers can afford dietary staples for their families and flocks, said Rachid Benali, the chairman of the farming lobby COMADER.
The country imported nearly 2.5 million tons of common wheat between January and June. However, such a solution may have an expiration date, particularly because Morocco’s primary source of wheat, France, is facing shrinking harvests as well.
The United Nations’ Food and Agriculture Organization ranked Morocco as the world’s sixth-largest wheat importer this year, between Turkey and Bangladesh, which both have much bigger populations.
“Morocco has known droughts like this and in some cases known droughts that las longer than 10 years. But the problem, this time especially, is climate change,” Benali said.
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sydney, australia — The world’s largest platypus conservation center has welcomed its first residents as part of a project to protect the semi-aquatic mammal found only in Australia amid threats to its habitat from extreme weather and humans.
The four platypuses — two females and two males — were released over the last two weeks into a custom-built research facility at Taronga Western Plains Zoo in Dubbo, about 400 kilometers (250 miles), northwest of Sydney.
Featuring multi-tiered streams, waterfalls, pools and earth banks for burrowing, the facility will help researchers understand more about the species, Taronga Conservation Society Australia official Phoebe Meagher told Reuters.
“This facility will allow us to not only save the species from the immediate threats of climate change, but also in the long term, be able to repopulate those populations,” she said.
“We would love to see some puggles or baby platypus in the facility and understand what led to that reproductive success.”
The facility was formed as a partnership between the Taronga Conservation Society Australia, San Diego Zoo Wildlife Alliance, the University of New South Wales, the New South Wales state government and wildlife rescue organization WIRES.
Boasting the bill of a duck, webbed feet and a beaver-like tail, the platypus is unique to Australia. The nocturnal mammals lay eggs and live mostly across the eastern seaboard, from the far north of Queensland to the island state of Tasmania, close to rivers and streams whose beds and banks they forage for food.
Platypus numbers may have more than halved over several decades, research models show, but figures are hard to pinpoint. Environment groups estimate the total population between 30,000 and 300,000.
“Sadly, we’re not leaving many places left in the wild for platypus,” Meagher said. “So these platypus that we have here … will really fill those knowledge gaps and allow us to help save this species.”
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HONOLULU — A Hawaii judge has temporarily blocked the state from enforcing a law requiring the licensing of practitioners and teachers of traditional Native Hawaiian midwifery while a lawsuit seeking to overturn the statute wends its way through the courts.
Lawmakers enacted the midwife licensure law, which asserted that the “improper practice of midwifery poses a significant risk of harm to the mother or newborn, and may result in death,” in 2019. Violations are punishable by up to a year in jail, plus thousands of dollars in criminal and civil fines.
The measure requires anyone who provides “assessment, monitoring, and care” during pregnancy, labor, childbirth and the postpartum period to be licensed.
A group of women sued, arguing that a wide range of people, including midwives, doulas, lactation consultants and even family and friends of the new mother would be subject to penalties and criminal liability.
Their complaint also said the law threatens the plaintiffs’ ability to serve women who seek traditional Native Hawaiian births.
Judge Shirley Kawamura issued a ruling late Tuesday afternoon barring the state from “enforcing, threatening to enforce or applying any penalties to those who practice, teach, and learn traditional Native Hawaiian healing practices of prenatal, maternal and child care.”
Plaintiffs testified during a four-day hearing last month that the law forces them to get licensed through costly out-of-state programs that don’t align with Hawaiian culture.
Ki’inaniokalani Kahoʻohanohano testified that a lack of Native Hawaiian midwives when she prepared to give birth for the first time in 2003 inspired her to eventually become one herself. She described how she spent years helping to deliver as many as three babies a month, receiving them in a traditional cloth made of woven bark and uttering sacred chants as she welcomed them into the world.
The law constitutes a deprivation of Native Hawaiian customary rights, which are protected by the Hawaii constitution, Kawamura’s ruling said, and the “public interest weighs heavily towards protecting Native Hawaiian customs and traditions that are at risk of extinction.”
The dispute is the latest in a long debate about how and whether Hawaii should regulate the practice of traditional healing arts that date to well before the islands became the 50th state in 1959. Those healing practices were banished or severely restricted for much of the 20th century, but the Hawaiian Indigenous rights movement of the 1970s renewed interest in them.
The state eventually adopted a system under which councils versed in Native Hawaiian healing certify traditional practitioners, though the plaintiffs in the lawsuit say their efforts to form such a council for midwifery have failed.
The judge also noted in her ruling that the preliminary injunction is granted until there is a council that can recognize traditional Hawaiian birthing practitioners.
“This ruling means that traditional Native Hawaiian midwives can once again care for families, including those who choose home births, who can’t travel long distances, or who don’t feel safe or seen in other medical environments,” plaintiff and midwife trainee Makalani Franco-Francis said in a statement Wednesday. “We are now free to use our own community wisdom to care for one another without fear of prosecution.”
She testified last month how she learned customary practices from Kahoʻohanohano, including cultural protocols for a placenta, such as burying it to connect a newborn to its ancestral lands.
The judge found, however, that the state’s regulation of midwifery more broadly speaking is “reasonably necessary to protect the health, safety, and welfare of mothers and their newborns.”
The ruling doesn’t block the law as it pertains to unlicensed midwives who do not focus on Hawaiian birthing practices, said Hillary Schneller, an attorney with the Center for Reproductive Rights, which represents the women. “That is a gap that this order doesn’t address.”
The case is expected to continue to trial to determine whether the law should be permanently blocked.
The state attorney general’s office said in an email Wednesday that it was still reviewing the decision.
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washington — NASA’s rover Perseverance on Mars has made what could be its most astonishing discovery to date: possible signs of ancient life on the Red Planet.
The six-wheeled robotic explorer came across an intriguing, arrow-shaped rock dubbed “Cheyava Falls” that may harbor fossilized microbes from billions of years ago, when Mars was a watery world.
Perseverance drilled into the enigmatic rock to collect a core sample on July 21, as it traversed Neretva Vallis, an ancient river valley.
The samples carefully stowed beneath the rover’s belly are destined to eventually return to Earth, where they will undergo more comprehensive analysis.
“Cheyava Falls is the most puzzling, complex, and potentially important rock yet investigated by Perseverance,” project scientist Ken Farley of Caltech said Thursday.
Three compelling clues have scientists buzzing.
White calcium sulfate veins run the length of the rock, a telltale sign that water once flowed through it.
Between these veins is a reddish middle area, teeming with organic compounds, as detected by the rover’s SHERLOC (Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals) instrument.
Finally, tiny off-white splotches ringed with black, reminiscent of leopard spots, contain chemicals that suggest energy sources for ancient microbes, according to scans by the PIXL (Planetary Instrument for X-ray Lithochemistry) instrument.
“On Earth, these types of features in rocks are often associated with the fossilized record of microbes living in the subsurface,” said David Flannery, an astrobiologist and member of the Perseverance science team from the Queensland University of Technology in Australia.
The quest to confirm ancient Martian life is far from over, however.
The real test will come when Perseverance’s precious rock samples are returned to Earth as part of the Mars Sample Return Program, a collaboration between NASA and the European Space Agency slated for the 2030s.
While there are alternative explanations for these findings that do not involve microbes, there is a tantalizing chance that Perseverance’s core sample might contain actual fossilized microbes — potentially making history as the first proof of life beyond Earth.
“We have zapped that rock with lasers and X-rays and imaged it literally day and night from just about every angle imaginable,” said Farley.
“Scientifically, Perseverance has nothing more to give. To fully understand what really happened in that Martian river valley at Jezero Crater billions of years ago, we’d want to bring the Cheyava Falls sample back to Earth, so it can be studied with the powerful instruments available in laboratories,” he explained.
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washington — Thousands of policymakers, health care professionals and advocates gathered this week in Munich, Germany, to take stock of the global fight against HIV as they try to meet the 2030 deadline set by world leaders for eliminating AIDS as a public health threat.
Advocates hailed sub-Saharan Africa’s progress in the global HIV response, with tens of millions of people now on lifesaving drugs.
A new UNAIDS survey released during the conference reported that “approximately 30.7 million of the estimated 39.9 million people living with HIV globally were receiving antiretroviral therapy in 2023.”
The report called that result a “landmark public health achievement,” and health officials at the conference said it would not be possible without the “immense political will” of regional leaders and NGOs.
Anne Githuku-Shongwe, the UNAIDS regional director for eastern and southern Africa, told VOA from Johannesburg that recently there has been a “huge focus” on ensuring that anyone living with HIV in sub-Saharan Africa gets access to testing and treatment to ensure virus suppression, so the virus becomes untransmissible.
“The data is telling us that 84% of people living with HIV in our region have access to treatment. And 94% of those on treatment have been able to keep [the virus] suppressed so it is untransmissible,” she said.
However, Githuku-Shongwe pointed out that despite the progress that has been made, some countries in Africa are lagging behind in the battle against HIV/AIDS, partly because of civil wars, humanitarian setbacks and sheer negligence. She mentioned South Sudan, Angola, Madagascar, Mauritius, Seychelles and the Comoros as examples.
“[Countries] like Mauritius are barely at 50% of the treatment target,” she said, adding that another critical challenge being faced is the lack of attention to children living with the virus.
The report said children aged 0-14 years are still contracting HIV. An estimated 120,000 children got the virus in 2023, bringing the number of children living with HIV globally to 1.4 million, 86% of whom are in sub-Saharan Africa, according to the UNAIDS report.
Worries about donor funding
Githuku-Shongwe said there have been major investments from partners – particularly from PEPFAR, a U.S.-funded initiative to tackle the HIV/AIDS crisis, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. She noted that in some countries, up to 99% of the HIV response is externally funded.
“But with time we are seeing that dwindling,” she said.
Nearly $19.8 billion was available in 2023 for HIV programs in low- and middle-income countries, almost $9.5 billion short of the amount needed by 2025, the report said.
Catherine Connor, vice president in charge of public policy and advocacy at the Elizabeth Glaser Pediatric AIDS Foundation, a Washington nonprofit, told VOA from Munich that the data on infections in children were “troubling” and pointed to a lackadaisical approach toward pediatric HIV.
“The report clearly shows that children are one out of every 10 new infections, which is really high,” she said. “But there’s also an outsized mortality issue around children. Children make up 3% of the HIV-infected population, but they represent 12% of deaths.”
Connor said there’s inequity in treatment, particularly for children living with HIV.
“Children can’t take themselves to clinics. They often don’t even know they’ve been exposed to HIV,” she said. “So they really rely on caregivers, the community around them, to ensure not just that they can be identified as being HIV-exposed or potentially HIV-positive, but also get the needed support to maintain their health, even if they are on treatment.”
Connor concluded that world leaders and policymakers should be made aware how significant it is to act on HIV prevention, because if the world fails to take steps to curtail the virus, then “we will not end AIDS.”
“It’s almost like having a dam holding back a river of water,” she said.
“HIV is preventable and treatable, but it is not curable. And so, if we let cracks in that dam get so bad, it’s going to break, and we are going to see a reemergence of the HIV/AIDS pandemic in ways we have never seen,” Connor said.
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United Nations — The U.N. Secretary-General warned Thursday that the Earth is becoming hotter and more dangerous for everyone, killing nearly a half-million people annually, and he blamed fossil fuels for driving global warming.
“Billions of people are facing an extreme heat epidemic — wilting under increasingly deadly heat waves, with temperatures topping 50 degrees Celsius around the world. That’s 122 degrees Fahrenheit. And halfway to boiling,” Antonio Guterres told reporters.
Sunday was the Earth’s hottest day on record, only to have the record broken the following day. Temperatures have been rising steadily, with scientists declaring the last 13 consecutive months all heat record-breakers. Urban areas are heating up at twice the global average.
Heat waves have killed scores of people this year in India and in Africa’s Sahel region. Last month, extreme heat killed 1,300 Muslim pilgrims in Saudi Arabia. This month, Europe, the United States and Asia have also seen exceptional heat.
He said that the World Health Organization and World Meteorological Organization estimate that improvements to heat health warning systems in 57 countries could save nearly 100,000 lives a year.
Fossil fuels
Guterres has repeatedly called on greenhouse gas emitters to meet the 2015 Paris Climate Accord’s target of limiting global temperature rise to 1.5 degrees Celsius — a goal that many worry is slipping away. He said that fossil fuel expansion and new coal plants are obstacles to meeting that target.
“I must call out the flood of fossil fuel expansion we are seeing in some of the world’s wealthiest countries,” he said. “In signing such a surge of new oil and gas licenses, they are signing away our future.”
He urged leaders to quickly and fairly phase out fossil fuels and end new coal projects.
“The G20 must shift fossil fuel subsidies to renewables and support vulnerable countries and communities,” he said of the world’s largest economies.
And he urged more climate adaptation and mitigation financing from the richest countries — which are the biggest emitters — to help the poorest, most vulnerable nations that have contributed the least to global warming.
Guterres said he is launching a global call to action focused on caring for the most vulnerable, including protecting workers who are exposed to extreme heat.
“A new report from the International Labor Organization — being released today — warns that over 70% of the global workforce — 2.4 billion people — are now at high risk of extreme heat,” he said.
In addition to the rights and health of individual workers, there are economic impacts of extreme heat too.
“Heat stress at work is projected to cost the global economy $2.4 trillion by 2030. Up from $280 billion in the mid-1990s,” Guterres said, adding measures need to be taken to “heat proof” critical sectors of the global economy, like farming and construction work.
The U.N. chief warned that extreme heat widens social inequality, undermines development, furthers food insecurity, and pushes people deeper into poverty.
“Leaders across the board must wake up and step up,” he said.
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CAPE CANAVERAL, Florida — A super Jupiter has been spotted around a neighboring star by the Webb Space Telescope — and it has a super orbit.
The planet is roughly the same diameter as Jupiter, but with six times the mass. Its atmosphere is also rich in hydrogen like Jupiter’s.
One big difference: It takes this planet more than a century, possibly as long as 250 years, to go around its star. It’s 15 times the distance from its star than Earth is to the sun.
Scientists had long suspected a big planet circled this star 12 light-years away, but not this massive or far from its star. A light-year is 5.8 trillion miles. These new observations show the planet orbits the star Epsilon Indi A, part of a three-star system.
An international team led by Max Planck Institute for Astronomy’s Elisabeth Matthews in Germany collected the images last year and published the findings Wednesday in the journal Nature.
Astronomers directly observed the incredibly old and cold gas giant — a rare and tricky feat — by masking the star through use of a special shading device on Webb. By blocking the starlight, the planet stood out as a pinpoint of infrared light.
The planet and star clock in at 3.5 billion years old, 1 billion years younger than our own solar system, but still considered old and brighter than expected, according to Matthews.
The star is so close and bright to our own solar system that it’s visible with the naked eye in the Southern Hemisphere.
Don’t bet on life, though.
“This is a gas giant with no hard surface or liquid water oceans,” Matthews said in an email.
It’s unlikely this solar system sports more gas giants, she said, but small rocky worlds could be lurking there.
Worlds similar to Jupiter can help scientists understand “how these planets evolve over giga-year timescales,” she said.
The first planets outside our solar system — dubbed exoplanets — were confirmed in the early 1990s. NASA’s tally now stands at 5,690 as of mid-July. The vast majority were detected via the transit method, in which a fleeting dip in starlight, repeated at regular intervals, indicates an orbiting planet.
Telescopes in space and also on the ground are on the hunt for even more, especially planets that might be similar to Earth.
Launched in 2021, NASA and the European Space Agency’s Webb telescope is the biggest and most powerful astronomical observatory ever placed in space.
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A group of young African students is shooting for the stars thanks to a program called ‘Pathways to Space.’ Aerospace company Boeing and a South African science organization backed an education program that just celebrated its first batch of graduates. Vicky Stark reports from Cape Town.
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Geneva — A senior World Health Organization official expressed alarm Tuesday at the high risk of polio spreading within the Gaza Strip because of dire sanitary conditions in the war-wracked enclave, and that the paralytic disease it causes could spill across borders without prompt action to stem the outbreak.
“I am, like, super worried,” Dr. Avadil Saparbekov, team lead for health emergencies at the WHO in the occupied Palestinian territory, told journalists from Jerusalem. “I am extremely worried about an outbreak happening in Gaza … and that it may spill over internationally at a very high point.”
Saparbekov, who recently returned from a weeklong visit to Gaza, confirmed that “circulating vaccine-derived poliovirus type 2” has been identified in samples of Gazan sewage assessed by researchers and that an epidemiological probe “to identify the potential source of this importation” is underway.
“Based on the results of the assessment, WHO and the GPEI (Global Polio Eradication Initiative) partners will consolidate a set of recommendations, including the need for a mass vaccination campaign,” he said.
On July 16, the Global Polio Laboratory Network isolated the virus in six environmental surveillance samples collected from sewage on June 23 in Khan Younis and Deir al Balah in Gaza.
The WHO reports that further genomic sequencing of the samples by the U.S. Centers for Disease Control and Prevention indicates that they are related to environmental samples that were circulating in Egypt during the second half of last year.
“It is important to note that poliovirus has been isolated from environmental samples only at this time; no associated paralytic cases have been detected,” Saparbekov stressed.
Circulating vaccine-derived poliovirus is transmitted from person to person mainly through the fecal-oral route. It can invade a person’s nervous system and cause paralysis and death.
“We have not yet collected the human samples to identify any viruses because of the lack of equipment to collect those and lack of capacity to test those samples,” Saparbekov said, noting that WHO and UNICEF teams entering Gaza on Thursday will bring up to 50 sample collection kits “so we will be able to collect human samples, stool samples from humans.”
The samples, he said, will be sent to a lab in Jordan to confirm any cases of infection.
“Until that is done, I cannot say that there are any humans that are affected with this circulating vaccine-derived poliovirus,” he said.
The WHO said that wild poliovirus was eliminated more than 25 years ago in the Palestinian territories. Before the start of the war in Gaza, following a vicious attack on Israel by Hamas militants on October 7, the U.N. health agency says 89% of the population was vaccinated against polio, primarily conducted through routine immunization.
Last Sunday, Israel’s military said it would offer polio vaccinations to soldiers serving in Gaza to protect against the paralytic disease.
Saparbekov said the WHO will be reaching out to COGAT, the Israeli authority responsible for the coordination of government activities in the Palestinian territories, “to see how they can facilitate” the response to the outbreak. One way to do that, he added, is to have vaccines available for Gazans in case “there is a decision to conduct a mass campaign.”
“We have so far received assurances that this will be done,” he said.
The WHO official expressed hope that the epidemiological investigation and risk assessment would be completed by the end of the week, such that his team “will have a joint recommendation from the GPEI network about what to do with this particular outbreak” by Sunday.
In the meantime, he said, aid workers are doing their best to inform the population as to health measures they must take to prevent a polio outbreak.
“Given the water and sanitation limitations in Gaza, it will be very difficult for the population to follow the advice to wash their hands, to drink safe water,” he said.
“Unfortunately, the majority that live in shelters with one toilet for 600 people and maybe 1.5 liters of water per person, will definitely not be able to follow the recommendations that we are providing,” he said.
While reiterating concerns about polio spreading in the Palestinian enclave, WHO health emergency chief Saparbekov said he also is very worried about the possible outbreak of other communicable diseases.
“We had Hepatitis A confirmed last year and now we may have a polio outbreak,” he said. “So, with the crippled health system, lack of water and sanitation, as well as lack of access of the population to health services, specifically primary health services, this is going to be a very bad situation that will happen in Gaza.
“We may have more people dying from communicable diseases than from injuries and related conditions,” he warned.
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Some people who have lost the ability to speak can still move their vocal cords. California researchers are working to transform those muscle movements into audible speech. Genia Dulot reports from Los Angeles in this week’s edition of LogOn.
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United Nations — Nearly 40 million people were living with the HIV virus that causes AIDS last year, over 9 million weren’t getting any treatment, and the result was that every minute someone died of AIDS-related causes, the U.N. said in a new report launched Monday.
While advances are being made to end the global AIDS pandemic, the report said progress has slowed, funding is shrinking, and new infections are rising in three regions: the Middle East and North Africa, Eastern Europe and Central Asia, and Latin America.
In 2023, around 630,000 people died from AIDS-related illnesses, a significant decline from the 2.1 million deaths in 2004. But the latest figure is more than double the target for 2025 of fewer than 250,000 deaths, according to the report by UNAIDS, the U.N. agency leading the global effort to end the pandemic.
Gender inequality is exacerbating the risks for girls and women, the report said, citing the extraordinarily high incidence of HIV among adolescents and young women in parts of Africa.
The proportion of new infections globally among marginalized communities that face stigma and discrimination – sex workers, men who have sex with men, and people who inject drugs also increased to 55% in 2023 from 45% in 2010, it said.
UNAIDS Executive Director Winnie Byanyima said: “World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs, and that the human rights of everyone are protected.”
As part of that pledge, leaders vowed to reduce annual new HIV infections to below 370,000 by 2025, but the report said in 2023 new infections were more than three times higher at 1.3 million.
Last year, among the 39.9 million people globally living with HIV, 86% knew they were infected, 77% were accessing treatment, and for 72% the virus was suppressed, the report said
Cesar Nunez, director of the UNAIDS New York office, told a news conference there has been progress in HIV treatments — injections that can stay in the body for six months, but the two doses cost $40,000 yearly, out of reach for all but the richest people with the virus.
He said UNAIDS has been asking the manufacturer to make it available at lower cost to low and middle-income countries.
Nunez said there have also been seven cases where people with HIV who were treated for leukemia emerged with no sign of the HIV virus in their system.
He said injections and the seven cases will be discussed at the 25th International AIDS Conference which began Monday in Munich.
At present, he said, daily treatment with pills costs about $75 per person per year. It has allowed many countries to increase the number of people with HIV to receive treatment.
Nunez said UNAIDS will continue advocating for a vaccine to prevent AIDS.
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BENGALURU, India — At a Coca-Cola factory on the outskirts of Chennai in southern India, a giant battery powers machinery day and night, replacing a diesel-spewing generator. It’s one of just a handful of sites in India powered by electricity stored in batteries, a key component to fast-tracking India’s energy transition away from dirty fuels.
The country’s lithium ion battery storage industry — which can store electricity generated by wind turbines or solar panels for when the sun isn’t shining or the wind isn’t blowing — makes up just 0.1% of global battery storage systems. But battery storage is growing fast, with around a third of India’s total battery infrastructure coming online just this year.
“Our orders are growing exponentially,” said Ayush Misra, CEO of Amperehour Energy, the company that installed the batteries at the Chennai factory. “It’s a really exciting time to be a battery storage provider.”
Businesses invest in industry
India currently has around 100 megawatts of storage capacity from batteries, with another 3.3 gigawatts of clean energy storage coming from hydropower. The Indian government estimates that the country will need about 74 gigawatts of energy storage from batteries, hydropower and nuclear energy by 2032, but experts think the country actually needs closer to double that amount to meet the country’s energy needs.
Some customers are still wary of using battery technology for storage, and the storage systems can be seen as more expensive than the more commonly used coal. The supply chain of batteries is also concentrated in China, meaning the sector is vulnerable to geopolitical volatility.
But markets don’t think customers will be hesitant about batteries for long, with major Indian businesses announcing significant investments in the industry.
In January this year, energy giant Reliance Industries said it will build a 5,000-acre factory in Jamnagar, Gujarat. And in March, Goodenough Energy said it will spend $53 million by 2027 to set up a 20 million kilowatt-hour battery factory in the northern region of Jammu and Kashmir.
Alexander Hogeveen Rutter, an independent energy analyst based in Bengaluru, said upping storage capacity should be done alongside ramping up renewables.
“Clean energy combined with adequate storage can be an alternative to coal. Not in the future but right now,” he said. He added that it’s a “myth” that clean energy is more expensive than coal, as current prices of renewable energy combined with storage is cheaper than new coal.
Global battery costs are declining faster than expected, and experts say that if costs continue to plummet, energy storage systems can better compete with both coal and clean energy sources like hydropower and nuclear energy that can also control their supply to meet demand.
“Battery storage is now the largest resource to meet California’s evening peak electricity requirements. It’s more than gas, nuclear or coal,” he said. This is being replicated in the U.K., China and even smaller nations like Tonga. “There’s no reason why this can’t happen in India too,” he said.
India’s energy needs grow
One of India’s unique challenges is that energy needs are growing more rapidly than most nations: the population is increasing and extreme heat fueled by climate change means more and more people are using energy-guzzling air conditioning. India’s electricity demand grew by 7% last year and is expected to grow by at least 6% every year for the next three years, according to the International Energy Agency.
“The country needs to quadruple its renewable energy deployment just to meet demand growth,” said Hogeveen Rutter.
Ankit Mittal, co-founder of Sheru, a software company that offers energy storage and management solutions, said that making battery storage sites more flexible can help the industry ramp up quickly.
Mittal said battery storage sites should be more accessible to the national energy grid, so they can provide electricity to whichever regions need the extra boost of energy most. Currently, battery storage sites in India only power up more local sites.
To encourage further growth of the battery sector, the Indian government announced last year a $452 million effort to support an additional four gigawatts of battery storage by 2031. But the government also provides subsidies for coal plants, making the electricity generated there a cheaper bet for some utility companies.
Future government policy could level the playing field. The country is set to announce a new national budget later in July that industry leaders hope will contain incentives for clean energy storage.
Akshat Singhal, co-founder of the Bengaluru-based battery tech startup Log 9 Materials, thinks that better government support can help the country meet growing energy demands “the right way,” with clean energy.
“One significant policy change can kickstart the entire ecosystem,” he said.
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new york — As U.S. health officials investigate a fatal outbreak of listeria food poisoning, they’re advising people who are pregnant, elderly or have compromised immune systems to avoid eating sliced deli meat unless it’s recooked at home to be steaming hot.
The U.S. Centers for Disease Control and Prevention didn’t mandate a food recall as of early Saturday, because it remains unclear what specific products have been contaminated with the bacteria now blamed for two deaths and 28 hospitalizations across 12 states. This means the contaminated food may still be in circulation, and consumers should consider their personal risk level when consuming deli meats.
Federal health officials warned Friday that the number of illnesses is likely an undercount, because people who recover at home aren’t likely to be tested. For the same reason, the outbreak may have spread wider than the states where listeria infections have been reported, mostly in the Midwest and along the U.S. eastern coast.
The largest number known to get sick — seven — were in New York, according to the CDC. The people who died were from Illinois and New Jersey.
What investigators have learned
Of the people investigators have been able to interview, “89% reported eating meats sliced at a deli, most commonly deli-sliced turkey, liverwurst and ham. Meats were sliced at a variety of supermarket and grocery store delis,” the CDC said.
And samples collected from victims from May 29 to July 5 show the bacteria is closely related genetically.
“This information suggests that meats sliced at the deli are a likely source of this outbreak. However, at this time CDC doesn’t have enough information to say which deli meats are the source of this outbreak,” the agency said in a statement published on its website Friday.
What to expect if you’re infected
Listeria infections typically cause fever, muscle aches and tiredness and may cause stiff neck, confusion, loss of balance and convulsions. Symptoms can occur quickly or to up to 10 weeks after eating contaminated food.
It can be diagnosed by testing bodily fluids, usually blood, and sometimes urine or spinal fluid, according to the Mayo Clinic.
Listeria infections are especially dangerous for people older than 65 and those with weakened immune systems, according to the CDC. Victims of this outbreak ranged in age from 32 to 94, with a median age of 75.
For pregnant people, listeria can increase the risk of miscarriages. One of the victims of the current outbreak was pregnant, but did not have a miscarriage, officials said.
Infections confined to the gut — intestinal listeriosis — can often be treated without antibiotics according to the CDC. For example, people might need extra fluids while experiencing diarrhea.
But when the infection spreads beyond the gut — invasive listeriosis — it’s extremely dangerous and is often treated with antibiotics to mitigate the risk of blood infections and brain inflammation, according to the Mayo Clinic.
What about the meat in your fridge
So far there’s no sign that people are getting sick from prepackaged deli meats. And for at-risk people who already have deli slices in their refrigerator, they can be sanitized by being recooked.
“Refrigeration does not kill Listeria, but reheating before eating will kill any germs that may be on these meats,” the CDC says.
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After the Apollo program ended, the US took a long hiatus from lunar exploration. What happened during this time, and what has NASA been doing? This documentary by the Voice of America’s Russian service focuses on the details of the NASA’s Artemis program and plans to further explore the Moon and Mars.
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Washington — Russia and China are edging ever closer to unleashing space-based weapons, a decision that could have far-reaching implications for America’s ability to defend itself, U.S. military and intelligence agencies warn.
Adding to the concern, they say, is what appears to be a growing willingness by both countries to set aside long-running suspicions and animosity in order to gain an edge over the United States.
“I would highlight … the increasing amount in intent to use counterspace capabilities,” said Lieutenant General Jeff Kruse, director of the Defense Intelligence Agency.
“Both Russia and China view the use of space early on, even ahead of conflict, as important capabilities to deter or to compel behaviors,” Kruse told the annual Aspen Security Forum on Wednesday. “We just need to be ready.”
Concerns about the safety of space surged earlier this year when House Intelligence Committee Chairman Mike Turner called for the declassification of “all information” related to what was described as a new Russian anti-satellite capability involving nuclear weapons.
More recently, Turner has warned that the U.S. is “sleepwalking” into a disaster, saying that Russia is on the verge of being able to detonate a nuclear weapon in space, which would impose high costs on the U.S. military and economy.
The White House has responded repeatedly that U.S. officials have been aware of the Russian plans, and that Moscow has not yet deployed a space-based nuclear capability.
It is a stance that Kruse reaffirmed Wednesday, with added caution.
“We have been tracking for almost a decade Russia’s intent to design the ability to put a nuclear weapon in space,” he said. “They have progressed down to a point where we think they’re getting close.”
The Russians “don’t intend to slow down, and until there’s repercussions, will not slow down,” he said.
Russian and Chinese officials have yet to respond to VOA’s requests for reaction to the latest U.S. accusations, but both countries have repeatedly denied U.S. criticisms of their space policies.
In May, Russian Deputy Foreign Minister Sergei Ryabkov dismissed U.S. concerns about Moscow trying to put nuclear weapons in space as “fake news.”
But the Chinese Embassy in Washington, while admitting there are some “difficulties” when it comes to China-U.S. relations in space, rejected any suggestion Beijing is acting belligerently in space.
“China always advocates the peaceful use of outer space, opposes weaponizing space or an arms race in space and works actively toward the vision of building a community with a shared future for mankind in space,” spokesperson Liu Pengyu told VOA in an email.
“The U.S. has been weaving a narrative about the so-called threat posed by China in outer space in an attempt to justify its own military buildup to seek space hegemony,” Liu said. “It is just another illustration of how the U.S. clings on to the Cold War mentality and deflects responsibility.”
Despite Beijing’s public posture, the Defense Intelligence Agency’s Kruse suggested Wednesday that China’s rapid expansion into the space domain is just as worrisome.
“They’re in multiple orbits that they did not used to be before,” he told the audience in Aspen, Colorado, warning that Beijing has already invested heavily in directed energy weapons, electronic warfare capabilities and anti-satellite technology.
“China is the one country that more so even than the United States has a space doctrine, a space strategy, and they train and exercise the use of space and counterspace capabilities in a way that we just don’t see elsewhere,” he said.
The general in charge of U.S. Space Command described the Chinese threat in even starker terms.
“China is building a kill web, if you will, in space,” said General Stephen Whiting, speaking alongside Kruse at the Aspen conference.
“In the last six years, they’ve tripled the number of intelligence, surveillance and reconnaissance satellites they have on orbit — hundreds and hundreds of satellites, again, purpose built and designed to find, fix, track target and, yes, potentially engage U.S. and allied forces across the Indo-Pacific,” he said.
Whiting also raised concerns about the lack of clear military communication with China about space.
“We want to have a way to talk to them about space safety as they put more satellites on orbit,” he said, “so that we can operate effectively and don’t have any miscommunication or unintended actions that cause a misunderstanding.”
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Blantyre, Malawi — Malawi has declared the end of the country’s worst cholera outbreak, which began in March 2022 and killed nearly 2,000 people.
In a statement Monday, the Ministry of Health said the country had registered no cases or deaths from cholera in 26 of Malawi’s 29 health districts in the past four weeks. Some health experts, however, said the outbreak could resurface if the country failed to address sanitation problems that caused it.
Malawi President Lazarus Chakwera launched a national campaign to end the cholera outbreak in February 2023. The “Tithetse Kolera” or “Let’s End Cholera” campaign came three months after he declared the disease to be a public health emergency in Malawi.
The campaign aimed to interrupt cholera transmission in all districts and reduce the fatality rate from 3.2% to below 1%, which the World Health Organization considers a controlled cholera outbreak.
Dr. Wilfred Chalamira Nkhoma, co-chairperson for the presidential task force on COVID-19 and cholera in Malawi, told VOA the disease had now been defeated largely because of the campaign.
“By WHO definition, a country stands to end the transmission of cholera when they have gone at least four weeks without reporting a laboratory confirmed case of cholera,” he said. “So that is the case with Malawi right now. We haven’t had a confirmed case since 6th of June.”
Successful steps
Nkhoma attributed the development to several interventions Malawi conducted over the past two years. He said they involved educating people about transmission, prevention and control of cholera; increasing surveillance; and properly managing cholera cases.
“The key one — and that must remain the key one — is to increase access to safe water and also improve adequate sanitation,” he said. “The Ministry of Water and Sanitation was taking the lead in this, but they were supported very well by nongovernmental organizations that are working in the water and sanitation sector.”
Nkhoma said another measure was the oral cholera vaccination campaign, which began in December 2022.
“We were able as a country to access some doses from WHO,” he said. “We were able to administer not less than about 6 million doses of cholera vaccine focusing first and foremost in priority areas.”
The Ministry of Health said in its Monday statement that Malawi had registered 56,376 cases of cholera, with 1,772 deaths since March 2022.
Maziko Matemba, a national community health ambassador in Malawi, told VOA that Malawi seemed to have managed the cholera outbreak at the treatment and case-management levels, but added that sanitation problems remained a challenge.
“Because at the moment, if you go to villages, if you go to public places, people are not doing the sanitation issues properly,” Matemba said. “Even if you check in public toilets, even if you check how people are preparing food, you will find that we still have challenges as a country to contain disease like cholera.”
Nkhoma said the government would continue its effort to educate people about how cholera is transmitted, prevented and controlled to try to avoid further outbreaks.
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LONDON — The world’s second vaccine against malaria was launched on Monday as Ivory Coast began a routine vaccine program using shots developed by the University of Oxford and the Serum Institute of India.
The introduction of the World Health Organization (WHO)-approved R21 vaccine comes six months after the first malaria vaccine, called RTS,S and developed by British drugmaker GSK, began being administered in a routine program in Cameroon.
Some 15 African countries plan to introduce one of the two malaria vaccines this year with support from the Gavi global vaccine alliance.
Ivory Coast has received a total of 656,600 doses of the Oxford and Serum shot, which will initially vaccinate 250,000 children aged between 0 and 23 months across the West African country. The vaccine has also been approved by Ghana, Nigeria, Burkina Faso and the Central African Republic.
The rollout of a second vaccine is the latest milestone in the global fight against malaria and should help address a problem that emerged well before either of the two shots was launched: demand for them is likely to far outstrip supply for several years.
Experts say having safe and effective malaria vaccines is important to meet demand. The shot is meant to work alongside existing tools — such as bed nets — to combat malaria, which in Africa kills nearly half a million children under the age of five each year.
The Serum Institute of India, which manufactures the vaccine, has produced 25 million doses for the initial rollout of the shot and “is committed to scaling up to 100 million doses annually,” the company said on Monday about the launch in Ivory Coast.
Serum said it is offering the vaccine for less than $4 per dose, in keeping with its aim to deliver low-cost vaccines at scale.
Results from a large trial in February showed the vaccine prevented around three-quarters of symptomatic malaria cases in young children the first year after they got the shots.
Experts told Reuters at that time that comparing the two malaria vaccines head-to-head was difficult because of the many variables involved in the trials, but overall their performance was similar — a conclusion endorsed by WHO.
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