It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Wednesday, September 14, 2022
Kebnekaise’s southern peak once again lower than the northern peak
IMAGE: MEASUREMENT OF THE HEIGHT OF KEBNEKAISE’S SOUTHERN PEAK ON SEPTEMBER 9, 2022. PHOTO: TARFALA RESEARCH STATIONview more
CREDIT: TARFALA RESEARCH STATION
This year’s measurement confirms that the summit of Kebnekaise’s southern peak continues to be lower than that of the northern peak. However, in contrast to reports on extreme glacier mass loss in the Alps, glacier mass loss in Sweden was moderate during the summer of 2022, according to researchers at Tarfala Research Station.
Since September 2019, Sweden has had a new official highest point. Researchers at Stockholm University’s research station in Tarfala established that the southern peak of the Kebnekaise mountain, at 2095.6 metres, was now lower than the northern peak, with a height of 2096.8 metres. Scientists had long predicted that the south peak, consisting of a snow-covered glacier, would shrink due to the warmer climate, and thus fall below the height of the north peak, the summit of which consists of rock, which does not change in elevation.
The annual measurement of the height of Kebnekaise’s southern peak was carried out on September 9, 2022. The elevation was measured as 2094.6 metres above sea level, the same height as measured at the end of the summer 2021.
“In contrast to reports on extreme glacier mass loss in the Alps, glacier mass loss in Sweden was moderate during the summer of 2022, and Kebnekaise’s southern peak was able to maintain its elevation”, says Nina Kirchner, director of Tarfala Research Station (TRS) at Stockholm University.
The annual measurement of the southern peak is carried out by staff from TRS, who this year climbed the southern peak instead of visiting it by helicopter. “Species found here in the Arctic are already living in difficult conditions and climate change adds extra pressure on them. The climate crisis can be seen as an evolutionary process, created by humans, and we do our best to avoid escalating it”, explains Annika Granebeck, operative station manager at TRS.
TRS is also responsible for reporting mass balance data from Swedish glaciers to the World Glacier Monitoring Service in Switzerland, where information about the state of glaciers worldwide is gathered.
“While 2022 again saw a continued trend of negative mass balance among the glaciers studied by TRS, mass losses were subdued compared to recent years. We thus hoped to find little change at the southern peak, too, and are happy to confirm this with our measurement”, adds Jamie Barnett, research engineer at TRS.
* Mass balance calculations for a glacier can be compared to a bank account where income (here: snow that accumulates on the glacier during the winter and eventually turns into glacial ice) and losses (here: snow and glacier ice that melts during the summer) are added together to either give a positive balance (the glacier is growing because income is greater than losses) or a negative balance (the glacier is shrinking because income is less than losses).
Background information Kebnekaise is the highest mountain in Sweden. The Kebnekaise massif has two peaks; a northern ice-free peak with exposed bedrock at an elevation of 2096.8 meters above sea level and a southern ice-covered peak known as Sydtoppen (which means the southern peak in Swedish). Because of its ice-cover, Sydtoppen has a variable elevation — higher in winter as a consequence of snowfall, and lower in summer because of snow melt.
Reoccurring measurements of the elevation of Sydtoppen have been part of the measuring programme at the nearby Tarfala Research Station since the late 1940s. The elevation is measured at the end of every summer, aiming to capture the peak’s lowest elevation each year. Until 2019, Sydtoppen remained higher than the northern peak, but continued ice melt, driven by climate warming has resulted in the fact that Sydtoppen is now lower than the than the northern peak. In the two last decades, the elevation of Sydtoppen has decreased by approximately 0.7 m/year (7.3 m between 2002 and 2011, and 7.2 m between 2012 and 2021). The remaining ice thickness at the southern peak is currently amounting to about 35 m.
Doctors experiencing burnout are twice as likely to be involved in patient safety incidents and four times more likely to be dissatisfied with their job, suggests research published today by The BMJ.
The scale of burnout amongst clinicians and the serious impact it can have on patient safety and staff turnover has been revealed in the largest and most comprehensive systematic review and analysis of studies on the subject to date.
Previous studies have highlighted concerns that burnout – defined as emotional exhaustion, cynicism and detachment from the job, and a feeling of reduced personal accomplishment – is reaching global epidemic levels among physicians. Their representatives have warned that spare capacity in the field of medicine is nearing what they call crisis point.
In the UK, a third of trainee doctors report that they experience burnout to a high or very high degree, while in the US, four in 10 physicians report at least one symptom of burnout. And in a recent review of low and middle income countries the overall single-point prevalence of burnout ranged from 2.5% to 87.9% among 43 studies.
Yet there is a lack of evidence about the association of burnout with how engaged a physician is with their job (career engagement) and how that potentially impacts on the quality of patient care.
To address this, a team of researchers based in the UK and Greece set out to examine the association of burnout with the career engagement of physicians and the quality of patient care globally.
To do this, they selected and analysed the results of 170 observational studies on the subject involving 239,246 physicians.
Their analysis showed that physicians with burnout were up to four times more likely to be dissatisfied with their job and more than three times as likely to have thoughts or intentions to leave their job (turnover) or to regret their career choice.
Equally worrying was the finding that physicians with burnout were twice as likely to be involved in patient safety incidents and show low professionalism, and over twice as likely to receive low satisfaction ratings from patients.
The analysis also found that burnout and poorer job satisfaction was greatest in hospital settings, physicians aged 31-50 years, and those working in emergency medicine and intensive care, while burnout was lowest in general practitioners.
The association between burnout and patient safety incidents was greatest in physicians aged 20-30 years, and people working in emergency medicine.
The study authors acknowledge some limitations in their research including the fact that precise definitions of terms, such as patient safety, professionalism, and job satisfaction, varied between the studies analysed so may have led to some overestimation of their association with burnout.
Also, the tools or questionnaires used to assess outcomes varied considerably between the 170 studies, and the design of the original studies imposed limits on their ability to establish causal links between physician burnout and patient care or career engagement.
Nevertheless, the authors conclude: “Burnout is a strong predictor for career disengagement in physicians as well as for patient care. Moving forward, investment strategies to monitor and improve physician burnout are needed as a means of retaining the healthcare workforce and improving the quality of patient care.”
“Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency,” they add.
This research adds to growing evidence that the poor mental health of healthcare providers jeopardises the quality and the safety of patient care, says Matthias Weigl, Professor of Patient Safety at Bonn University, in a linked editorial.
“The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector,” he warns.
“Urgent action is imperative for the safety of physicians, patients, and health systems, including interventions that are evidence based and system oriented, to design working environments that promote staff engagement and prevent burnout,” he concludes.
Research: Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis Editorial: Physician burnout undermines safe healthcare
ARTICLE PUBLICATION DATE
14-Sep-2022
UCLA study links length of REM sleep to animals’ body temperature
Study challenges notion that REM sleep aids learning
UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES
Warm-blooded animal groups with higher body temperatures have lower amounts of rapid eye movement (REM) sleep, while those with lower body temperatures have more REM sleep, according to new research from UCLA professor Jerome Siegel, who said his study suggests that REM sleep acts like a “thermostatically controlled brain heater.”
The study in Lancet Neurologysuggests a previously unobserved relationship between body temperature and REM sleep, a period of sleep when the brain is highly active, said Siegel, who directs the Center for Sleep Research at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.
Birds have the highest body temperature of any warm-blooded, or homeotherm, animal group at 41 degrees while getting the least REM sleep at 0.7 hours per day. That’s followed by humans and other placental mammals (37 degrees, 2 hours of REM sleep), marsupials (35 degrees, 4.4 hours of REM sleep), and monotremes (31 degrees, 7.5 hours of REM sleep).
Brain temperature falls in non-REM sleep and then rises in REM sleep that typically follows. This pattern “allows homeotherm mammals to save energy in non-REM sleep without the brain getting so cold that it is unresponsive to threat,” Siegel said.
The amount of humans’ REM sleep is neither high nor low compared to other homeotherm animals, “undermining some popular views suggesting a role for REM sleep in learning or emotional regulation,” he said.
Siegel’s research is supported by National Institutes of Health grants (HLB148574 and DA034748) and the Medical Research Service of the Department of Veterans Affairs. He declared no competing interests.
JOURNAL
The Lancet Neurology
SUBJECT OF RESEARCH
Animals
ARTICLE TITLE
Sleep function: an evolutionary perspective
ARTICLE PUBLICATION DATE
14-Sep-2022
First UK study of synthetic chemicals found in food
The first comprehensive assessment of common synthetic chemicals found in UK foods has been completed by researchers at the University of Birmingham.
In the study, nearly 400 food samples were tested for evidence of organophosphate esters (OPEs) – chemicals used as flame retardants in furnishings and textiles, building, food packaging materials and decorating materials, as well in various other consumer products.
While the levels found in all the samples were below those currently deemed to be a risk to health, the researchers say this baseline survey should be a wake-up call to industrial users of OPEs to check their use of these chemicals and start exploring alternatives. Food producers should also investigate supply chains to better understand where contaminants might be introduced.
“Organophosphates are toxic to human health at high levels, or with long term exposure, and their use is increasing worldwide,” says lead author Muideen Gbadamosi. “Although we found that current levels in food products are not dangerous, these chemicals build up in the body’s fatty tissues over time and we need to have a clearer picture of the different sources of contaminants.
“We can also ingest OPEs from dust, or just from the air we breathe. There are data on these sources of contamination, but not yet on food products, so our research fills a really important gap in our knowledge.”
In the study, published in Science of the Total Environment, the team divided sample products into 15 food groups, that were either animal-derived products or plant-derived products and tested for eight different OPEs. They found concentrations were highest in milk and milk products, followed by those in cereal and cereal products. Concentrations were lowest in chickens’ eggs.
The chemicals triphenyl phosphate (TPHP) and 2-ethylhexyl diphenyl phosphate (EHDPP) were most common, being found in all food samples except egg and egg products.
Levels of the chemicals varied across the different samples, but overall, the concentrations in animal-derived foods were statistically indistinguishable from those in plant-derived.
The team also estimated daily dietary intakes across four age groups: toddlers; children; elderly people; and adults. Baby food contributed 39 per cent of OPE intake for toddlers, while non-alcoholic beverages were the main contributor for children (27 per cent). In adults and the elderly, cereal products (25 per cent) and fruit (22 per cent) were the main contributors.
Overall, the study found that the levels of these contaminants in UK foods was broadly similar to those reported in other countries.
Finally, the researchers also combined their data on dietary exposure with available data on the same chemicals ingested via indoor dust in UK. They found that, for adults, exposure to OPEs remained well below levels considered dangerous to health in comparison to the health-based limit values (HBLVs) for individual OPEs.
For children and toddlers, however, the safety margins were much narrower under high-end exposure scenarios for some OPEs, specifically: EHDPP, tris(2-butoxyethyl) phosphate (TBOEP, tris(2-chloroisopropyl) phosphate (TCIPP) and tris(1,3-dichloro-2-propyl) phosphate (TDCIPP).
For EHDPP, TBOEP, TCIPP and TDCIPP the high-end exposure data was about 56%, 52%, 37% and 10% of the health-based limit value – the guideline value for evaluating risk to health – for toddlers and 88%, 30%, 22% and 14% of the health-based limit value for children respectively.
Mr Gbadamosi said: “It’s clear that food is a significant source of human exposure to OPEs in the UK and that more work is urgently needed to fully understand the risks of continuing to increase our use of OPEs.”
JOURNAL
Science of The Total Environment
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Organophosphate Esters in UK Diet; Exposure and Risk Assessment.
Our Synthetic Environment. Murray Bookchin. 1962. Table of contents. Chapter 1: THE PROBLEM. Chapter 2: AGRICULTURE AND HEALTH.
Sharing a laugh: Scientists teach a robot when to have a sense of humor
Researchers at Kyoto University designed a shared-laughter AI system that appropriately responds to human laughter in order to build a sense of empathy into dialogue
IMAGE: AN EXAMPLE OF CONVERSATION BETWEEN THE RESEARCHERS AND ERICA.view more
CREDIT: IMAGE: INOUE ET AL
Since at least the time of inquiring minds like Plato, philosophers and scientists have puzzled over the question, “What’s so funny?” The Greeks attributed the source of humor to feeling superior at the expense of others. German psychoanalyst Sigmund Freud believed humor was a way to release pent-up energy. US comedian Robin Williams tapped his anger at the absurd to make people laugh.
It seems no one can really agree on the question of “What’s so funny?” So imagine trying to teach a robot how to laugh. But that’s exactly what a team of researchers at Kyoto University in Japan are trying to do by designing an AI that takes its cues through a shared laughter system. The scientists describe their innovative approach to building a funny bone for the Japanese android ‘Erica’ in the latest issue of the journal Frontiers in Robotics and AI.
It’s not as if robots can’t detect laughter or even emit a chuckle at a bad dad joke. Rather, the challenge is to create the human nuances of humor for an AI system to improve natural conversations between robots and people.
“We think that one of the important functions of conversational AI is empathy,” explained lead author Dr Koji Inoue, an assistant professor at Kyoto University in the Department of Intelligence Science and Technology within the Graduate School of Informatics. “Conversation is, of course, multimodal, not just responding correctly. So we decided that one way a robot can empathize with users is to share their laughter, which you cannot do with a text-based chatbot.”
A funny thing happened
In the shared-laughter model, a human initially laughs and the AI system responds with laughter as an empathetic response. This approach required designing three subsystems – one to detect laughter, a second to decide whether to laugh, and a third to choose the type of appropriate laughter.
The scientists gathered training data by annotating more than 80 dialogues from speed dating, a social scenario where large groups of people mingle, or interact, with each other one-on-one for a brief period of time. In this case, the matchmaking marathon involved students from Kyoto University and Erica, teleoperated by several amateur actresses.
“Our biggest challenge in this work was identifying the actual cases of shared laughter, which isn’t easy, because as you know, most laughter is actually not shared at all,” Inoue said. “We had to carefully categorize exactly which laughs we could use for our analysis and not just assume that any laugh can be responded to.”
The type of laughter is also important, because in some cases a polite chuckle may be more appropriate than a loud snort of laughter. The experiment was limited to social versus mirthful laughs.
The robot gets it
The team eventually tested Erica’s new sense of humor by creating four short two- to three-minute dialogues between a person and Erica with her new shared-laughter system. In the first scenario, she only uttered social laughter, followed only by mirthful laughs in the second and third exchanges, with both types of laughter combined in the last dialogue. The team also created two other sets of similar dialogues as baseline models. In the first one, Erica never laughs. In the second, Erica utters a social laugh every time she detects a human laugh without using the other two subsystems to filter the context and response.
The researchers crowdsourced more than 130 people in total to listen to each scenario within the three different conditions – shared-laughter system, no laughter, all laughter – and evaluated the interactions based on empathy, naturalness, human-likeness and understanding. The shared-laughter system performed better than either baseline.
“The most significant result of this paper is that we have shown how we can combine all three of these tasks into one robot. We believe that this type of combined system is necessary for proper laughing behavior, not simply just detecting a laugh and responding to it,” Inoue said.
Like old friends
There are still plenty of other laughing styles to model and train Erica on before she is ready to hit the stand-up circuit. “There are many other laughing functions and types which need to be considered, and this is not an easy task. We haven’t even attempted to model unshared laughs even though they are the most common,” Inoue noted.
Of course, laughter is just one aspect of having a natural human-like conversation with a robot.
“Robots should actually have a distinct character, and we think that they can show this through their conversational behaviors, such as laughing, eye gaze, gestures and speaking style,” Inoue added. “We do not think this is an easy problem at all, and it may well take more than 10 to 20 years before we can finally have a casual chat with a robot like we would with a friend.”
ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL
Arlington, Va., September 15, 2022 – Findings from a pilot study published today in the American Journal of Infection Control (AJIC) suggest that portable thermal imaging cameras might provide a new approach to assessing and improving hand-hygiene practices among healthcare professionals (HCPs).
“Effective hand hygiene is recognized as the single most important act to prevent the transmission of potentially pathogenic microbes in the healthcare setting, but there is no widely adopted method for assessing the effectiveness of healthcare professionals’ hand hygiene technique,” said John Boyce, MD, a private consultant at J.M. Boyce Consulting, LLC, and a study author. “Our study shows that thermal imaging shows promise as an approach that warrants additional research to determine if it can be used for routine monitoring of hand hygiene technique to improve patient care.”
The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) both recommend the use of alcohol-based hand sanitizer (ABHS) in their hand-hygiene guidelines. ABHS application technique, including the quantity of liquid used and length of hand rubbing, has a substantial impact on antimicrobial effectiveness. Several studies have documented that HCPs often fail to apply ABHS to their thumb and fingertips.
Based on a previous study demonstrating that transient reductions in skin temperature occur following topical application of ABHS, Dr. Boyce and his colleague, Richard A. Martinello, MD, sought to determine whether thermal imaging with a portable infrared thermal camera could reveal whether ABHS had been appropriately applied by HCPs, including to their fingertips and thumbs. Using an infrared camera attached to an iPhone, they obtained thermal images of 12 HCPs’ dominant hands, recording baseline readings of the mid-palm area, the tips of the third finger and thumb before and then at multiple time points after the study participants performed hand hygiene with ABHS (immediately after hands felt dry, and at 1 minute and 2 minutes later).
The images revealed significant decreases in mid-palm, finger and thumb temperatures after the participants performed hand hygiene (p < 0.01 for all sites), confirming that the infrared camera was capable of detecting color changes that reflected drops in temperature. The researchers also found that when participants performed ABHS without including their thumbs, a lack of colorimetric change in the thumbs was visible in the resulting thermal images.
One volunteer with large hands did not have decreased temperatures at the palm, finger, or thumb after applying ABHS, suggesting that thermal imaging could also help measure the amount of ABHS needed based on HCP’s individual hand surface area.
“The findings from this pilot study are exciting, because they are the first to evaluate a new tool that might help infection preventionists assess the quality of hand hygiene technique during educational sessions, periodic competency evaluations, and routine patient care,” said Linda Dickey, RN, MPH, CIC, FAPIC, 2022 APIC president.
# # #
About APIC
Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.
About AJIC
As the official peer-reviewed journal of APIC, The American Journal of Infection Control(AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.
NOTES FOR EDITORS
“Pilot Study of Using Thermal Imaging to Assess Hand Hygiene Technique,” by John M. Boyce, MD, and Richard A. Martinello, MD, was published online in AJIC on September 15, 2022. The article may be found online at: https://doi.org/10.1016/j.ajic.2022.07.015
AUTHORS
John M. Boyce, MD (corresponding author: jmboyce69@gmail.com)
Pilot Study of Using Thermal Imaging to Assess Hand Hygiene Technique
ARTICLE PUBLICATION DATE
15-Sep-2022
COI STATEMENT
Conflicts of interest: JMB is a consultant to, has presented at conferences supported by, and has received travel support from GOJO Industries, and is a consultant to Diversey.
COVID-19 mutations accelerated by virus-fighting enzyme in human cells, according to new research The findings by a team of USC researchers could help scientists predict new coronavirus variants and subvariants and give them a leg up on producing effective vaccines
Researchers have found the first experimental evidence explaining why the COVID-19 virus produces variants, such as delta and omicron, so quickly.
The findings, published Sept. 13 in the journal Scientific Reports, could help scientists predict the emergence of new coronavirus strains and possibly even produce vaccines before those strains arrive.
The relatively rapid emergence of multiple COVID-19 virus variants has baffled researchers because most coronaviruses don’t mutate and evolve so quickly. That’s because they possess a built-in “proofreading” mechanism to prevent mutations as they make copies of themselves while growing and multiplying in our cells.
But scientists at USC figured out the COVID-19 virus’ strategy for bypassing the proofreading: It hijacks enzymes within human cells that normally defend against viral infections, using those enzymes to alter its genome and make variants.
According to lead researcher Xiaojiang Chen, professor of biological sciences and chemistry at the USC Dornsife College of Letters, Arts and Sciences, the findings could prove vital to curbing the pandemic by helping to prevent new surges in infection caused by new variants.
“New strains can become increasingly more contagious and evade the existing vaccine’s protection,” Chen said. “Predicting new variants and preparing effective vaccines ahead of time could stop new variants before they spread.”
The best offense is a good defense
Chen and the USC team infected human cells with the coronavirus in the lab and then studied changes to the virus’ genome as it multiplied, making copies of itself, within the cells.
The genetic code sequence of the virus, which is composed of DNA’s close cousin RNA, uses four letters to identify component nucleotides: A, C, G, U. During their analysis, Chen and the team noticed an interesting pattern: Many mutations that arose as the virus replicated itself were caused by changing one particular nucleotide in the code to another — the letter “C” changed to “U.”
The high frequency of C-to-U mutations pointed them toward a group of enzymes that cells often use to defend against viruses. Called APOBEC, the enzymes convert Cs in the virus’ genome to Us with the aim of causing fatal mutations.
But Chen and the team found that for the COVID-19 virus growing in the human cells, not only are the C-to-U mutations not fatal, they actually benefit the virus by providing a way for the virus to mutate, evolve and develop new strains faster than expected.
“We have provided the first experimental evidence that our own enzymes can help the COVID-19 virus to mutate quickly,” Chen said. “Somehow the virus learned to turn the tables on these host APOBEC enzymes for its evolution and fitness.”
Turning the tables back around
Fortunately for researchers looking to overcome COVID-19, every good offense has its weakness. In this case, the mutations created by APOBEC enzymes are not random — they convert C to U in specific places in the genetic sequence where a U or A is just ahead of the C (like UC or AC).
With this insight, scientists can look for every UC and AC in the COVID-19 virus genome and, using powerful computational and experimental methods, predict and test what will happen if any of them change to a U. This can help them predict what new COVID-19 variants might emerge and suggest how to update vaccines so they protect against any new variants that are likely to spread.
Chen and the team aim to do just that, studying what potential effects C-to-U mutations caused by APOBEC enzymes might have on the COVID-19 virus’ life cycle and its ability to spread and cause disease. Over time, this information can help scientists produce new drugs and vaccines to defeat drug-resistant and vaccine-evading COVID-19 virus strains.
About the study
In addition to Chen, authors on the study include, from USC Dornsife, PhD students Kyumin Kim (first author on the study) and Shanshan Wang, and Associate Professor (Teaching) of Quantitative and Computational Biology Peter Calabrese; and from Herman Ostrow School of Dentistry of USC, Professor and Section Chair of Infection and Immunity Pinghui Feng, Research Associate Chao Qin and researcher Youliang Rao.
The study was supported by National Institutes of Health grant number AI150524.
The roles of APOBEC-mediated RNA editing in SARS-CoV-2 mutations, replication and fitness
ARTICLE PUBLICATION DATE
13-Sep-2022
The Lancet: New report details “massive global failures” of COVID-19 response, calls for improved multilateral cooperation to end pandemic and effectively manage future global health threats
IMAGE: WIDESPREAD FAILURES AT MULTIPLE LEVELS WORLDWIDE HAVE LED TO MILLIONS OF PREVENTABLE DEATHS AND A REVERSAL IN PROGRESS TOWARDS SUSTAINABLE DEVELOPMENT FOR MANY COUNTRIES.view more
CREDIT: THE LANCET
Peer-reviewed/ Review, Opinion and Analysis/ People
New Lancet Commission critically considers the global response to the first two years of the COVID-19 pandemic, citing widespread failures of prevention, transparency, rationality, basic public health practice, and operational cooperation and international solidarity that resulted in an estimated 17.7 million deaths (including those not reported).
The report also finds that most national governments were unprepared and too slow in their response, paid too little attention to the most vulnerable groups in their societies, and were hampered by a lack of international cooperation and an epidemic of misinformation.
World-renowned expert authors provide practical steps to ensure COVID-19 is no longer a pandemic threat through a vaccination-plus strategy and call for actions to strengthen multilateralism, alongside actions to strengthen national health systems and preparedness plans to defend against future global health threats and achieve sustainable development.
Widespread, global failures at multiple levels in the COVID-19 response led to millions of preventable deaths and reversed progress made towards the UN Sustainable Development Goals (SDGs) in many countries, according to a new Lancet COVID-19 Commission report.
The Lancet Commission on lessons for the future from the COVID-19 pandemic synthesises evidence from the first two years of the pandemic with new epidemiological and financial analyses to outline recommendations that will help hasten the end of the ongoing COVID-19 pandemic emergency, lessen the impact of future health threats, and achieve long-term sustainable development.
The report warns that achieving these goals hinges upon a strengthened multilateralism that must centre around a reformed and bolstered World Health Organisation (WHO), as well as investments and refined planning for national pandemic preparedness and health system strengthening, with special attention to populations experiencing vulnerability. Crucial investments also include improved technology and knowledge transfers for health commodities and improved international health financing for resource limited countries and regions.
The Commission is the result of two years of work from 28 of the world’s leading experts in public policy, international governance, epidemiology, vaccinology, economics, international finance, sustainability, and mental health, and consultations with over 100 other contributors to 11 global task forces.
"The staggering human toll of the first two years of the COVID-19 pandemic is a profound tragedy and a massive societal failure at multiple levels”, says Professor Jeffrey Sachs, Chair of the Commission, University Professor at Columbia University (USA), and President of the Sustainable Development Solutions Network. “We must face hard truths—too many governments have failed to adhere to basic norms of institutional rationality and transparency; too many people have protested basic public health precautions, often influenced by misinformation; and too many nations have failed to promote global collaboration to control the pandemic.” [1]
He continues, “Now is the time to take collective action that promotes public health and sustainable development to bring an end to the pandemic, addresses global health inequities, protects the world against future pandemics, identifies the origins of this pandemic, and builds resilience for communities around the world. We have the scientific capabilities and economic resources to do this, but a resilient and sustainable recovery depends on strengthened multilateral cooperation, financing, biosafety, and international solidarity with the most vulnerable countries and people.” [1]
Failures of global cooperation and inequality between countries
The COVID-19 response has shown several aspects of international cooperation at its best: public-private partnerships to develop multiple vaccines in record time; actions of high-income countries to financially support households and businesses; and emergency financing from the International Monetary Fund (IMF) and World Bank.
But the events of the past two years have also exposed multiple failures of global cooperation. Costly delays by WHO to declare a “public health emergency of international concern” and to recognise the airborne transmission of SARS-CoV-2 coincided with national governments’ failure to cooperate and coordinate on travel protocols, testing strategies, commodity supply chains, data reporting systems, and other vital international policies to suppress the pandemic. The lack of cooperation among governments for the financing and distribution of key health commodities—including vaccines, personal protective equipment, and resources for vaccine development and production in low-income countries—has come at dire costs.
Pre-COVID-19 rankings of country preparedness for pandemics, such as the 2019 Global Health Security Index, ranking the USA and many European countries among the strongest for their epidemic response capabilities, turned out to be poor predictors of the actual outcomes of the pandemic. The Commission found that the Western Pacific region, including East Asia and Oceania, primed by previous experience with the SARS epidemic of 2002, adopted relatively successful suppression strategies resulting in cumulative deaths per million around 300, much lower than in other parts of the world. Disjointed public health systems and poor-quality public policy response to COVID-19 in Europe and the Americas resulted in cumulative deaths around 4,000 deaths per million, the highest of all WHO regions.
“Over a year and a half since the first COVID-19 vaccine was administered, global vaccine equity has not been achieved. In high-income countries, three in four people have been fully vaccinated, but in low-income countries, only one in seven,” says Commission co-author, Maria Fernanda Espinosa, former President of the UN General Assembly and former Minister of Foreign Affairs and Defence, Ecuador. “All countries remain increasingly vulnerable to new COVID-19 outbreaks and future pandemics if we do not share vaccine patents and technology with vaccine manufacturers in less wealthy countries and strengthen multilateral initiatives that aim to boost global vaccine equity.” [1]
Isolated and unequal national responses, with devastating socioeconomic and health effects
The report is also critical of national responses to COVID-19, which often featured inconsistent public health advice and poor implementation of public health and social measures, such as wearing face masks and vaccination. Many public policies did not properly address the profoundly inequitable impacts of the pandemic on vulnerable communities, including women, children, and workers in low- and middle-income countries. These inequities were exacerbated by extensive misinformation campaigns on social media, low social trust, and a failure to draw on the behavioural and social sciences to encourage behaviour change and counter the significant public opposition to routine public health measures seen in many countries.
“National pandemic preparedness plans must include the protection of vulnerable groups, including women, older people, children, disadvantaged communities, refugees, Indigenous Peoples, people with disabilities, and people with comorbid medical conditions. Loss of employment and school closures due to the pandemic have devastated progress made on gender equality, education and nutrition and it is critical to prevent this from happening again. We ask governments, private sector, civil society, and international organisations to build social protection systems and guarantee universal health coverage,” says Commissioner, Gabriela Cuevas Barron, Co-Chair of UHC2030 (Geneva, Switzerland), Honorary President of the Inter-Parliamentary Union and former Senator in the Mexican Congress, Mexico.
Ending the pandemic emergency requires a comprehensive vaccination-plus strategy
The deepening of socioeconomic inequities, coupled with economic and public health setbacks and growing social and political tensions, has jeopardised the 2030 SDG agenda. Two clear timelines have been set for pandemic response and preparedness: immediate actions in the short-term to end the COVID-19 emergency, and longer-term policy recommendations for a new era of multilateral cooperation to achieve long-term sustainable development (see panel on pages 3-4).
To finally control the pandemic, the Commission proposes that all countries adopt a vaccination-plus strategy, combining widespread vaccination with appropriate public health precautions and financial measures.
“A global vaccine-plus strategy of high vaccine coverage plus a combination of effective public health measures will slow the emergence of new variants and reduce the risk of new waves of infection while allowing everyone (including those clinically vulnerable) to go about their lives more freely. The faster the world can act to vaccinate everybody, and provide social and economic support, the better the prospects for exiting the pandemic emergency and achieving long-lasting economic recovery,” says Commission co-author Prof. Salim S. Abdool Karim of the Mailman School of Public Health, Columbia University, USA. [1]
To prepare for future pandemic health threats, the Commission recommends strengthening national health systems and the adoption of national pandemic preparedness plans, with actions to improve coordinated surveillance and monitoring for new variants, protect groups experiencing vulnerability, and create safer school and workplace environments by investing in ventilation and filtration.
Promoting multilateralism to build a more resilient future, and unlock a new approach to global health funding
To improve the world’s ability to respond to pandemics, the Commission calls for WHO to be transformed and bolstered by a substantial increase in funding and greater involvement from heads of state representing each region to better support decision-making and actions, especially on urgent and controversial matters. The Commission supports calls from other panels for a new global pandemic agreement and an update of the International Health Regulations.
With the support of WHO, the G20, and major financial institutions such as the World Bank, the Commission recommends increased and more effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care, achieving universal health coverage, and disease control more generally.
To achieve this goal, the Commission estimates that around $US60 billion would be required yearly, equivalent to 0.1% of the gross domestic product of high-income countries. Consolidation and expansion of several existing health funds should be closely aligned with the work of WHO, and the Commission emphasises that health-system strengthening must be implemented at the local level, reflecting regional needs and priorities, rather than from the top-down by a few donor countries.
Alongside this long-term funding commitment, the Commission recommends a 10-year effort by G20 countries to bolster research and development and investments in infrastructure and manufacturing capacity for all critical pandemic control tools including testing, diagnostics, vaccines, treatments, and PPE, alongside support and training for health workers in low- and middle-income countries.
These investments and the restructuring of multilateral global health efforts are essential to achieve the 2030 SDG Agenda. In 2019, the IMF estimated that LMICs face a financing gap of $300-500 billion a year to achieve SDGs, and this gap has increased as a result of the pandemic. Global recovery plans from the pandemic are not aligned with the SDGs and do not do enough to counter climate change.
Further recommendations are made, such as the call for an expansion of the WHO Science Council to apply urgent scientific evidence for global health priorities, including future emerging infectious diseases; strengthening of WHO through the establishment of a WHO Global Health Board with representation of all six WHO regions; and strengthening of national health systems on the foundations of public health and universal health coverage, grounded in human rights and gender equality. The Commission also recognises the need for an independent, transparent investigation into the origins of SARS-CoV-2, alongside robust regulations, to help prevent future pandemics that may result from both natural and research-related activities, and to strengthen public trust in science and public authorities.
A linked Editorial published in TheLancet says, “…as the Commission demonstrates, reassessing and strengthening global institutions and multilateralism will not only benefit the response to COVID-19 and future infectious diseases but to also to any crisis that has global ramifications. The release of The Lancet COVID-19 Commission offers another opportunity to insist that the failures and lessons from the last three years are not laid to waste but are constructively used to build more resilient health systems and stronger political systems that support the health and wellbeing of people and planet during the 21st century.”
NOTES TO EDITORS
The Commission received funding from the Rockefeller Foundation, the Nizami Ganjavi International Center, and the Germany Federal Ministry for Economic Cooperation and Development (BMZ). A full list of authors and their institutions is available in the report.
[1] Quote direct from author and cannot be found in the text of the Article.
IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: www.thelancet.com/commissions/covid19
JOURNAL
The Lancet
METHOD OF RESEARCH
Systematic review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
The Lancet Commission on lessons for the future from the COVID-19 pandemic
ARTICLE PUBLICATION DATE
14-Sep-2022
COI STATEMENT
SSAK declares grants paid to the Centre for the AIDS Programme of Research in South Africa from the National Institutes of Health (National Institute of Allergy and Infectious Diseases), the South African Medical Research Council, the National Research Foundation, and the European and Developing Countries Clinical Trials Partnership. He is a vicepresident of the International Science Council; a commissioner of the African Commission on COVID-19; and a member of the WHO Science Council, the Advisory Council of the Physicians for Human Rights, the Global Medical Advisory Board on COVID-19 for Sanofi Pasteur, and the Scientific Advisory Committee of the Bill & Melinda Gates Foundation. CBa declares consulting fees from and is a member of the advisory board of the Sustainable Development Solutions Network. MEB and PJH are co-directors of a team of scientists at Texas Children’s Hospital Center for Vaccine Development, who are co-inventors of a COVID-19 recombinant protein vaccine technology owned by Baylor College of Medicine (BCM) that was licensed by BCM, non-exclusively and with no patent restrictions, to several companies committed to advancing vaccines for low-income and middle-income countries. The co-inventors have no involvement in license negotiations conducted by BCM. Similar to other research universities, a long-standing BCM policy provides its faculty and staff, who make discoveries that result in a commercial license, a share of any royalty income. To date, BCM has not distributed any royalty income to the co-inventors of the COVID-19 recombinant protein vaccine technology. Any such distribution will be undertaken in accordance with BCM policy. CBu declares grants from the Health Research Council of New Zealand, the New Zealand Ministry of Health, and the New Zealand Ministry of Foreign Affairs and Trade; consulting fees from Johnson & Johnson Japan; payment from University of Malaya; and is the president of the Society for Research on Nicotine and Tobacco—Oceania. GCB is co-chair of the UHC2030 International Alliance. AH declares grants and consulting fees from the Wellcome Trust and the Oak Foundation. NJ declares support from the UN Sustainable Development Solutions Network and consulting fees from the University of California, San Francisco Department of Humanities and Social Sciences and the Foundation for Global Governance and Sustainability. ET declares consulting fees from the United Nations Development Programme. VV-F and IS are co-chairs of the Nizami Ganjavi International Centre. MAP declares grants from the Rockefeller Foundation to his institution and is a member of the Board of Directors for Management Sciences for Health, and non-executive Governing Board member of Sidra Medicine. JT declares funds from the Victorian Government to BehaviourWorks Australia for surveys and research on COVID-19 related behaviours, from Monash University and from Melbourne Water. AG was a member of the Open Society Global Drug Policy Program until February, 2022. MH declares funds from the Victorian Government, the New South Wales Government, the Australian Government, and the Macquarie Foundation to the Burnet Institute, Melbourne, VIC, Australia for research and modelling work related to COVID-19, and grants from AbbVie and Gilead Sciences that are unrelated to this work. JVL declares grants from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics, and consulting fees from NovVax, all unrelated to this work. All other authors declare no conflicts of interest. This report does not represent the institutions nor the organisations for which the authors work.
