December 26, 2018
While it may seem that 2018 was filled with surprising disease outbreaks — from measles to a polio-like virus, it was actually fairly mild compared to the Zika and H1N1 outbreaks of years past.
STAT News has made some predictions about some of the global health issues that we can expect to grow or unfold in 2018. Check out their top three predictions below.
Dengvaxia hit the world market in 2016 as the first dengue vaccine. Needless to say, the development of this vaccine was a big deal because, according to the Centers for Disease Control and Prevention, more than one-third of the world’s population is living in areas at risk for infection. The dengue virus, which is caused by any one of four related viruses transmitted by mosquitoes, is a leading cause of illness and death in the tropics and subtropics.
In 2016, the company discovered a slight hiccup in the vaccine: while it lowered the risk of hospitalization for severe dengue in kids who battled the disease at least one, it elevated the risk for children who were vaccinated before ever having dengue. “Experts who advise the World Health Organization recommended the vaccine be given only to children who have been previously infected with dengue. But there isn’t currently a point-of-care rapid test available for prior infection and having to test before vaccination really complicates mass vaccination efforts,” STAT News states.
Sanofi, the company that created Dengvaxia, has applied to the Food and Drug Administration (FDA) for a license to sell the vaccine in the United States, which is a little odd since a very small percentage of Americans have been infected with dengue. But apparently, dengue is on a list of neglected diseases that the FDA encourages pharmaceutical companies to work on. Companies that bring to market a new drug targeting these diseases earn a priority review voucher, which entitles a company to expedited FDA review of a future submission. Such vouchers have been sold in the past for $80 million to $125 million.
The FDA is giving Dengvaxia an expedited review, meaning a decision must be made by the end of April.
Ebola, which is a deadly disease generally contained to sub-Saharan Africa, can be contracted via direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with the virus, according to the CDC. Symptoms include flu-like signs like fever and weakness as well as unexplained bruising or bleeding and more.
Conflict-torn North Kivu, in northeastern Democratic Republic of the Congo, is in the midst of the second-worst Ebola outbreak on record. This year, 574 cases have been recorded, and 347 of those people have died, STAT News reports. Containing Ebola in this war zone has taxed the skills of the world’s best Ebola fighters, namely because the people don’t trust their government. Also because some parts of the region are too dangerous for Ebola response workers to operate in.
Many locals who have had risky contact with cases have refused the recommended vaccine and generally avoid the Ebola response team’s efforts to monitor their health. Instead of staying in the specialized Ebola treatment centers, some people who have been diagnosed have fled, exposing the people who care for them during their illness to the dreadful disease, while spreading the virus to new locations.
In December, it became apparent that transmission was moving southward towards Butembo — a city of more than a million people — and Goma, a major transportation hub for East Africa, STAT News reports. Needless to say, the prospect of an outbreak in a major city is quite daunting and calls into question the availability of the experimental vaccine used to combat the Ebola outbreak. Merck, which makes the vaccine, maintains a stockpile of 300,000 doses, but that is thought not to be enough for an urban outbreak.
While the vaccine is still unlicensed, it’s now an accepted tool in the fight against outbreaks caused by the Zaire species — but not other strains — of Ebola viruses. Ebola is also on FDA’s neglected diseases list and the agency would likely also grant it an expedited review.
There have been more cases of polio in 2018 — 29 total — than there were in 2017, when 22 children were paralyzed by the disease. All of the cases were in Afghanistan and Pakistan, two countries that have never managed to arrest circulation of the virus. Individuals running the effort to eradicate polio worry this is a sign of further erosion to come.
2018 marked the 30th anniversary of the launch of the polio eradication effort. For some perspective, it took 13 years to eradicate smallpox after the world got serious about the effort. Interestingly, smallpox is the only human disease that’s ever been completely eradicated to this date.
Now the polio program is faced with drawing up another five-year budget. Initial estimates suggest another $4.2 billion — $3.27 billion of which remains to be raised — will be needed, said Michel Zaffran, head of WHO’s polio department. And it’s not expected to come easily.