Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.
e.g. Estonia's 17 Feb OIE report
We may have just seen the leap occur from animals to humans here because of the nature of the human/animal interactions in this poultry farm, or there may be something genetically distinct. We need sequencing to know this.
New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.
As SARS-Cov-2 variants of concern to date have shown: these are global issues. There must be urgent multilateral cooperation between countries to:
– build local sequencing capacities
– rapidly share sequence data globally
From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.
There was a huge risk that WHO would be sidelined because states rejected WHO advice (for a range of reasons), but also because it has been woefully underfunded for years.
I disagree with folks dismissing the implications of the UK variant of concern.
While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.
Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
At the population level, this also impacts government responses about control measures, which impacts now & future justifications
Short thread on that here:
Public Health England has just released their updated report on the UK #SARSCoV2 variant
"Investigation of novel SARS-CoV-2 variant: Variant of Concern 202012/01"
I'll do a quick summary thread below & link to report:
A cluster was identified & used to assess increasing incidence of the Variant of Concern (designated as such 18 Dec) in Kent, UK:
- 4% (255/6130) of Kent cases had available genomes
- in Kent: 117 genomically similar cases identified (10-19 Nov)
- in UK: 962 genomes of VoC(8 Dec)
Out of that 962 UK wide, epi data was available for 915 individuals.
As of 20 Dec, VoC present mainly in London, South East & East of England regions.
The report goes into the details of how the VoC testing is carried out.
A lot of good discussion today about what we know and don't know about the new #SARSCoV2 variant in the UK.
But what does this mean (if anything) for government responses & public health law control measures, even if greater transmissibility is confirmed?
Quick notes (1/7)
Firstly, the virus is already sufficiently transmissible to be a concern. As others have noted, already important critical public health measures (avoiding crowds, social distancing, mask wearing, hand washing) will address variants that emerge:
First "but": any potential increase in transmissibility might shift how we weigh the stringency or priority of certain interventions, and how justifications for public health laws determine what is "the least restrictive measure".
The UQ/CSL vaccine (V451) uses a molecular clamp vaccine platform with the COVID-19 spike protein: the clamp "locks" the spike protein to be more stable for purification & manufacture. It contains a small component derived from HIV that cannot infect people & poses no health risk
However, this component resulted in some participants (out of 200 volunteers inc. placebo & vaccine) in Phase 1 trial producing "a partial antibody response" which interfered with HIV screening tests (which detect HIV antibodies, not virus) resulting in false positive HIV tests.
Finding 1: Hubei (Wuhan's province) had 20 times increase in "influenza cases" in Dec. High number of "unknown cause" is flag: flu relatively easy to confirm if tested. Also not clear how many confirmed influenza, & if so, if/what samples or GSD was shared w @WHO GISRS.
Finding 2: signif underreporting of daily new cases & deaths in Feb & Mar. If you recall, this was a live issue at that time w reclassification of case definitions by Chinese health officials, but report indicates deliberate politicization of data to present optimism.
To follow the article, here's a great explainer thread about our piece by @wormmaps about the science of estimating how many uncounted parasites there may be (including the Brothers Grimm & uncountable things):
Failures in US leadership mean Americans face tough decisions with Festive Season. In Jan, China faced similar choices but w more uncertainty).
A short thread comparing & drawing lessons between:
– January China 🧧Lunar New Year🧧
– November United States 🦃Thanksgiving🦃
Starting with some case count comparisons between Lunar New Year in China & now in the US:
– 254.3 cases per day: China (Jan 25)
– 135,714.3 cases per day: US (Nov 12)
Much focus on China's success has been on lockdowns: a time when we didn't know much, didn't have widely available testing & govt support to ensure socio-economic protections. Now, lockdowns can be avoided with strong public health & health systems.
Why did we write this? In light of COVID19, suggestions to reform the mechanism for declaring a public health emergency of international concern (PHEIC) have gained renewed attention & political will. Any substantial reform of PHEICs will likely require amendment to the IHR (2/7)
Already, multiple international and regional processes to review global COVID-19 response, including the operation of the IHR, are underway, including @TheIndPanel, @WHO Health Emergency Program IOAC & the IHR Review Committee.
Dame Barbara Stocking: "What about the next pandemic?"
"We are pressing to have a UN Convention on Pandemics as @WHO does not have the mandate: Member States do not allow it to have an inspector function or doing what is needed to be done" #PandemicRecovery@Cambridge_Uni
Legally, can President Trump withdraw the US from membership of the WHO?
– The WHO Constitution is a treaty.
– Membership of WHO requires signing the WHO Constitution & completing state domestic ratification processes (art 4).
– US has ratified the treaty.
*From WHO side*
WHO Constitution does not set out an express withdrawal process. This is not unusual and it is generally accepted that States are free to withdraw from international treaties & institutions (principle of state sovereignty, enshrined in Vienna Convention)
Legally it's murky if the President can withdraw. While Exec has power to sign treaties, ratification follows advice & consent of Senate.
– Some argue Exec thus retains power to exit treaties
– Others argue it requires Congress consent:
2. When States revised the International Health Regulations after SARS in 2005 they sought to balance sovereignty w public health but there was a "subtle but undeniable dilution of sovereign control" @Gianlucaburci, w WHO able to investigate reports from other states/ngos/media.
3. Another example of this sovereignty dilution: if a State doesn't accept WHO's offer to assist with investigating reports of an outbreak they may have, WHO may share the report with other States if it poses a public health risk (art 10).
2 years ago, I gave a talk @SydneyLawSchool@SydneyHealthLaw@USSC on this issue: rise of populism and impacts on global health (link below). I looked at how Australia & the US were underprepared for the next pandemic.
Last year, we launched the International Law Impact & Infectious Disease Consortium at @georgetown_ghss out of our concerns about the weakening of international laws and its impact on global health pandemic preparedness (but we need funding). (3/4)