Monkeypox vaccination in the global south: Fighting a war without a weapon.

Background: The Mpox outbreak awakened countries worldwide to renew efforts in epidemiological surveillance and vaccination of susceptible populations. In terms of Mpox vaccination, various challenges exist in the global south, which impede adequate vaccine coverage, especially in Africa. This paper reviewed the situation of Mpox vaccination in the global south and potential ameliorative approaches. Methods: A review of online literature from PubMed and Google Scholar concerning Mpox vaccination in countries belonging to the 'global south' category was done between August and September, 2022. The major focus areas included inequity in global vaccine distribution, challenges impeding vaccine coverage in the global south, and potential strategies for bridging the gap in vaccine equity. The papers that met the inclusion criteria were collated and narratively discussed. Results: Our analysis revealed that, while the high-income countries secured large supplies of the Mpox vaccines, the low- and middle-income countries were unable to independently access substantial quantities of the vaccine and had to rely on vaccine donations from high-income countries, as was the case during the COVID-19 pandemic. The challenges in the global south particularly revolved around inadequate vaccine production capacity due to lack of qualified personnel and specialized infrastructure for full vaccine development and manufacturing, limited cold chain equipment for vaccine distribution, and consistent vaccine hesitancy. Conclusion: To tackle the trend of vaccine inequity in the global south, African governments and international stakeholders must invest properly in adequate production and dissemination of Mpox vaccines in low- and middle-income countries.

Monkeypox virus declared as a global health emergency: What next for Africa's preparedness?

The Monkeypox virus, declared a global emergency outbreak, has garnered increasing response globally. The African healthcare community has not translated urgency in its response to the increasing outbreak. The multisectoral influence of COVID-19 has ensured that response patterns to the emerging outbreak must hold ground for proactiveness. The push for stronger health systems reiterated with the COVID-19 pandemic ensures that a successful response requires awareness of knowledge management, multisectoral and international collaboration and strengthening of systems capacity. The intricacies of the infection transmission ensure that interventions must promote equity and justice as well as financial protection of the population.

The emergence of BtSY2 Covid-like virus: A call for global preparedness.

Scientists in China announced on 25th of November with great concern that there is a new Covid-like virus out of the five viruses of concern discovered among bats across Yunnan province. It was reported that this Covid-like virus BtSY2 has high potential of infecting humans as it comprises a receptor binding domain which is a vital part of the spike protein used to lay hold of human cells and subsequently utilize human ACE2 receptor for cell entry similar to the SARS-CoV-2. In a bid to address this global threat in affected countries, it is expedient for authorized health professionals, policy makers and the world to keep an eye on this Covid-like virus capable of spreading from bats to humans because most pandemic outbreaks in recent decades have arisen in such a manner. Strict actions should be implemented in impeding transmission to humans which is paramount to battling viral diseases as learnt from history that viral outbreaks are very impossible to eradicate after global outbreak. Health officials and the World Health Organization should invest urgently in more research to further study this new Covid-like virus with an approach to prepare for a possible viral outbreak, and develop treatment options and possible vaccines to outsmart the danger posed to human health.

The impact of COVID-19 on international development aid and health systems strengthening in low-income countries.

Health systems play a critical role in providing services that aim to improve, promote, restore, or maintain the health of communities. Unfortunately, health systems in low-income countries are fragile, having an adverse effect on the health of the population. Whereas international development aid remains crucial in strengthening health systems in low-income countries (LICs), COVID-19 has induced changes in the dynamics in the availability, provision and access to international development aid. These changes have aggravated the already weak health systems of LICs. Understanding the effects of the COVID-19 pandemic on the distribution of international development aid and how these effects impacted on the quality of the health systems in response to the outbreak is critical to improving the health of populations in LICs. This article discusses the impact of the challenges faced by LICs in the context of international development aid needed for the development of health systems.

Curbing antimicrobial resistance in post-COVID Africa: Challenges, actions and recommendations.

Background: Antimicrobial self-medication and use have significantly increased in the COVID-19 era-increasing antibiotic consumption and resulting in a high prevalence of antimicrobial resistance in Africa (AMR). We conducted a narrative review to investigate challenges associated with curbing AMR in a post-COVID-19 setting in Africa, suggesting practical measures applicable for policy-informed implementation. Method: A narrative review was performed to pinpoint AMR challenges and actions on the African continent. A comprehensive search was conducted in the scientific databases that include PubMed, PubMed Central and Google Scholar using predetermined search terms. Results: The emergence of the COVID-19 outbreak has added to the challenges of tackling AMR on the continent, which has jeopardized AMR interventions' hard-won gains. Identified challenges have been Health systems disruption, Irrational Antimicrobial Use, Weak Antimicrobials Regulatory Ecosystem, Inefficient Population Infection Prevention, and Control Practices, Inadequate access to Health Services and data challenge on AMR surveillance. Conclusion: The COVID-19 pandemic fueled AMR in Africa. There is a need for AMR control post-COVID, such as measures for ongoing antimicrobial stewardship and good infection control practices. Further, curbing AMR requires rigorous regulatory enforcement and efficient AMR Surveillance. There should be a body to raise AMR awareness among the population. Research, Innovation and Technology could play an essential role supported by capacity building and global partnership.

The global response: How cities and provinces around the globe tackled Covid-19 outbreaks in 2021.

Background: Tackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19. Methods: In the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021- Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo. Findings: Based on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation. Interpretation: How an individual city or province handled the pandemic profoundly affected and determined how the entire country handled the pandemic since the chain of transmission needs to be broken at the very grassroot level to achieve nationwide control. Funding: The present study did not receive any external funding.

Gender dimensions of COVID-19 preventive policies: a global perspective.

The COVID-19 pandemic has had an impact on the global population not just from morbidity and mortality associated with SARS-CoV-2 infection, but also due to measures imposed upon populations to slow the transmission and prevent infections. Measures introduced by policymakers have included self-isolation of infective or potentially infective individuals, social distancing, travel bans, school closures, and mandatory face coverings. Most recently, the introduction of vaccination has been a key preventative measure encouraged by many governments. Considering gender differences in adherence to these measures is important to help guide future policymaking and targeting of advice. Differences also arise in how the preventative measures impact different genders. Some policies have caused greater harm to women, compounding existing problems such as inequality in the paid workforce, sexual- and gender-based violence, and inadequate maternal healthcare. Policymakers must consider the gender differences in response to preventive measures and creating effective and equitable policy.

COVID-19 Vaccines: Ensuring Social Justice and Health Equity among Refugees in Africa.

COVID-19 poses a particular threat to refugees in Africa. Overcrowded living conditions and lack of effective sanitation make refugees highly vulnerable to infection. Furthermore, migration has the potential to undermine measures to control viral spread. As a result, vaccination of the refugee community in Africa must be considered key in the vaccination plan to end the worldwide COVID-19 pandemic. Although the WHO has approved vaccines for emergency use worldwide in vulnerable groups through the COVID-19 Vaccines Global Access (COVAX) program, there is a lack of a strategy for achieving vaccination in the African refugee population. A specific strategy for refugee vaccination must be among the top priorities at national, regional, and global levels to ensure all refugees and asylum seekers in African countries have equitable and quality vaccine assistance regardless of displacement, statelessness, and financial hardship. We call on leaders in Africa and worldwide to ensure that refugee vaccination is a priority to protect this highly at-risk population and achieve an end to the current pandemic.

COVID-19 and its threat to refugees in Africa.

Although it is widely accepted that coronavirus disease 2019 (COVID-19) has adversely affected the Global South's most vulnerable refugee communities, they have received little attention. There have been gaps in testing, which is fundamental to treat and isolate patients and make data-driven decisions to protect the refugee community. Therefore, it is imperative to holistically implement policies to curtail COVID-19 in refugee camps to ensure that refugees are safe and protected from the pandemic. Processes for timely diagnosis and treatment, quick isolation and contact tracing are essential to keep refugees safe. Furthermore, it is crucial to encourage protective behaviours and raise awareness about hygiene and social prevention to dampen disease transmission. Refugees in the Global South have been disproportionately affected by the consequences of the COVID-19 pandemic, facing financial hardship and social injustice throughout. Refugees in Africa have also faced threats to their security, being subjected to torture, disappearance, or even killings in their host countries. The pandemic has exposed gender inequalities, with females being the most affected, and health inequities in the refugee community in Africa. There is a need for international organizations like the African Union, United Nations (UN) agencies, non-governmental organizations (NGOs), and other stakeholders to take serious action regarding the refugee situation in Africa. Food aid for refugees in Africa should be increased as quickly as possible and refugees' security must be guaranteed. Of equal importance, there must be justice for the death or disappearance of refugees. It is imperative to end discrimination against refugees and support the promotion of gender equity.

Impact of the COVID-19 pandemic on the food rations of refugees in Rwanda.

The coronavirus disease (COVID-19) has significantly impacted the global economy, by forcing people to stay indoors and creating a 'new normal' of living. Rwanda has made notable efforts to fight the pandemic. However, the impacts of the COVID-19 pandemic on the country's economy are numerous and the refugees residing in Rwanda are not spared these effects. As of December 2020, 164,000 people were granted refugee status in Rwanda according to the United Nations High Commissioner for Refugees (UNHCR). The majority were from neighbouring countries in the Great Lakes regions, including DRC (Democratic Republic of Congo) and Burundi. The impact the COVID-19 pandemic on the global economy has led to a decline in donations to the United Nations World Food Programme (WFP), which in turn has significantly reduced the food rations of refugees. Such paucity will no doubt cause unprecedented impacts on the people residing in refugee camps, who completely depend on humanitarian aid to meet their basic food requirements. This lack of access to adequate and affordable food will expose refugees to extreme hunger and starvation, putting their lives in danger by triggering forced returns, infections, social conflicts and thus higher morbidity and mortality.Furthermore, such stressful environments would no doubt put the mental health of these already vulnerable communities at risk. It is unsurprising that refugees are more likely to experience poor mental health compared to local population, including higher rates of depression and anxiety disorders including Post-Traumatic Stress Disorder (PTSD). This is an issue as they are also less likely to receive support than the general population. Refugees in Rwanda are under the responsibility of UNHCR and WFP, who should ensure adequate food assistance is provided to refugees and therefore ameliorate the risks to health that result from food shortages, safeguarding these vulnerable communities.

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review.

OBJECTIVES: To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. DESIGN: Systematic review. METHODS: Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. OUTCOME MEASURES: Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. RESULTS: A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). CONCLUSIONS: COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.