How enlightened self-interest guided global vaccine sharing benefits all: A modeling study.

Background: Despite consensus that vaccines play an important role in combatting the global spread of infectious diseases, vaccine inequity is still a prevalent issue due to a deep-seated mentality of self-priority. We aimed to evaluate the existence and possible outcomes of a more equitable global vaccine distribution and explore a concrete incentive mechanism that promotes vaccine equity. Methods: We designed a metapopulation epidemiological model that simultaneously considers global vaccine distribution and human mobility, which we then calibrated by the number of infections and real-world vaccination records during the coronavirus disease 2019 (COVID-19) pandemic from March 2020 to July 2021. We explored the possibility of the enlightened self-interest incentive mechanism, which comprises improving one's own epidemic outcomes by sharing vaccines with other countries, by evaluating the number of infections and deaths under various vaccine sharing strategies using the proposed model. To understand how these strategies affect the national interests, we distinguished imported from local cases for further cost-benefit analyses that rationalise the enlightened self-interest incentive mechanism behind vaccine sharing. Results: The proposed model accurately reproduces the real-world cumulative infections for both global and regional epidemics (R2>0.990), which can support the following evaluations of different vaccine sharing strategies: High-income countries can reduce 16.7 (95% confidence interval (CI) = 8.4-24.9, P < 0.001) million infection cases and 82.0 (95% CI = 76.6-87.4, P < 0.001) thousand deaths on average by more actively sharing vaccines in an enlightened self-interest manner, where the reduced internationally imported cases outweigh the threat from increased local infections. Such vaccine sharing strategies can also reduce 4.3 (95% CI = 1.2-7.5, P < 0.01) million infections and 7.0 (95% CI = 5.7-8.3, P < 0.001) thousand deaths in middle- and low-income countries, effectively benefiting the whole global population. Lastly, the more equitable vaccine distribution could help largely reduce the global mobility reduction needed for pandemic control. Conclusions: The incentive mechanism of enlightened self-interest we explored here could motivate vaccine equity by realigning the national interest to more equitable vaccine distributions. The positive results could promote multilateral collaborations in global vaccine redistribution and reconcile conflicted national interests, which could in turn benefit the global population.

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure.

BACKGROUND: Previous studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality. METHODS: We indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist. RESULTS: The GHS Index was negatively associated with excess COVID-19 CMRs (table 2; ß= -0.21, 95% CI= -0.35 to -0.08). Greater capacities related to prevention (ß= -0.11, 95% CI= -0.22 to -0.00), detection (ß= -0.09, 95% CI= -0.19 to -0.00), response (ß = -0.19, 95% CI= -0.36 to -0.01), international commitments (ß= -0.17, 95% CI= -0.33 to -0.01) and risk environments (ß= -0.30, 95% CI= -0.46 to -0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist). CONCLUSION: The first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available.

Accelerating Action in Global Health Security: Global Biosecurity Dialogue as a Model for Advancing the Global Health Security Agenda.

Biosecurity and biosafety measures are designed to mitigate intentional and accidental biological risks that pose potentially catastrophic consequences to a country's health system, security, and political and economic stability. Unfortunately, biosecurity and biosafety are often under-prioritized nationally, regionally, and globally. Security leaders often deemphasize accidental and deliberate biological threats relative to other challenges to peace and security. Given emerging biological risks, including those associated with rapid technological advances and terrorist and state interest in weapons of mass destruction, biosecurity deserves stronger emphasis in health and security fora. The Global Biosecurity Dialogue (GBD) was initiated to align national and regional donor initiatives toward a common set of measurable targets. The GBD was launched by the Nuclear Threat Initiative (NTI), with support from Global Affairs Canada's Weapons Threat Reduction Program and the Open Philanthropy Project, and in coordination with the government of The Netherlands as the 2018-19 Chair of the Global Health Security Agenda (GHSA) Action Package Prevent-3 (APP3) on Biosafety and Biosecurity. The GBD provides a multisectoral forum for sharing models, enabling new actions to achieve biosecurity-related targets, and promoting biosecurity as an integral component of health security. The GBD has contributed to new national and continent-wide actions, including the African Union and Africa Centres for Disease Control and Prevention's new regional Initiative to Strengthen Biosafety and Biosecurity in Africa. Here we present the GBD as a model for catalyzing action within APP3. We describe how the benefits of this approach could expand to other GHSA Action Packages and international health security initiatives.

Analysis of Raw Biofluids by Mass Spectrometry Using Microfluidic Diffusion-Based Separation.

Elucidation and monitoring of biomarkers continues to expand because of their medical value and potential to reduce healthcare costs. For example, biomarkers are used extensively to track physiology associated with drug addiction, disease progression, aging, and industrial processes. While longitudinal analyses are of great value from a biological or healthcare perspective, the cost associated with replicate analyses is preventing the expansion of frequent routine testing. Frequent testing could deepen our understanding of disease emergence and aid adoption of personalized healthcare. To address this need, we have developed a system for measuring metabolite abundance from raw biofluids. Using a metabolite extraction chip (MEC), based upon diffusive extraction of small molecules and metabolites from biofluids using microfluidics, we show that biologically relevant markers can be measured in blood and urine. Previously it was shown that the MEC could be used to track metabolic changes in real-time. We now demonstrate that the device can be adapted to high-throughput screening using standard liquid chromatography mass spectrometry instrumentation (LCMS). The results provide insight into the sensitivity of the system and its application for the analysis of human biofluids. Quantitative analysis of clinical predictors including nicotine, caffeine, and glutathione are described.