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15.04.21 22:30 [Comment] Bringing equity in access to quality dialysis

An estimated 2–7 million people with kidney failure worldwide die prematurely because they do not have access to kidney replacement therapy (dialysis or transplantation).1 The number of people who were on kidney replacement therapy exceeded 3 million in 2017 and is projected to grow to 5·4 million by 2030.1,2

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15.04.21 22:30 [Comment] Ten scientific reasons in support of airborne transmission of SARS-CoV-2

Heneghan and colleagues' systematic review, funded by WHO, published in March, 2021, as a preprint, states: “The lack of recoverable viral culture samples of SARS-CoV-2 prevents firm conclusions to be drawn about airborne transmission”.1 This conclusion, and the wide circulation of the review's findings, is concerning because of the public health implications.

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14.04.21 22:30 [Clinical Picture] Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination

A 55-year-old woman presented with conjunctival congestion, retro-orbital pain, and diplopia. She had received her first vaccine against SARS-CoV-2—ChAdOx1 nCoV-19—10 days before admission. Both on the night after the vaccination and 7 days later, the patient reported marked flu-like symptoms and a fever. She had no medical history of visual problems, autoimmune disorders, stroke, thrombosis, thrombocytopenia, neurological disorders, or arterial disease risk factors—including hypertension, diabe

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14.04.21 22:30 [Clinical Picture] Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination

A 51-year-old woman attended our emergency department with a 3-day history of dyspnoea, fatigue, and cough; 11 days earlier she had the ChAdOx1 nCoV-19 vaccination. On examination she was afebrile, her peripheral oxygen saturation was 98% (fraction of inspired O2 21%), blood pressure was 150/90 mm Hg, heart rate was 98 beats per min, and body-mass index was 31 kg/m2.

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14.04.21 22:30 [Correspondence] Were pregnant women more affected by COVID-19 in the second wave of the pandemic?

At the emergence of the COVID-19 pandemic in 2020, there was justified concern that this disease might have similar effects on pregnant women as influenza or other coronavirus infections. During the 2009 H1N1 influenza pandemic, influenza mortality in pregnant women in the USA was 4·3%.1 In global analyses,2,3 maternal deaths from severe acute respiratory syndrome or Middle East respiratory syndrome have been reported in 13% (n=24) and 40% (n=10) of published case reports, respectively. Reassuri

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14.04.21 22:30 [Correspondence] Tanzania's position on the COVID-19 pandemic

In a World Report about COVID-19 vaccine use in Tanzania,1 local context was not sufficiently considered to fully understand the country's position on the COVID-19 pandemic and its use of COVID-19 vaccines. We maintain that the late President John Magufuli understood the severity of the COVID-19 pandemic, which merits joint and coordinated global efforts.

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12.04.21 22:30 [Comment] The climate change–homelessness nexus

Climate change affects human health and wellbeing1 with differential impacts on populations and regions. For example, climate change disproportionally affects girls and women and can amplify conflict and violence in resource-deprived environments.2 The way climate change exacerbates economic and social disparities underscores the role of migration in response to climate pressures.3 Movement or staying in place, whether forced or voluntary, have important immediate and downstream implications for

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12.04.21 22:30 [Viewpoint] Problems with traffic light approaches to public health emergencies of international concern

The declaration of a Public Health Emergency of International Concern (PHEIC) is a key mechanism within the 2005 International Health Regulations (IHR) and the governance of global health security. The declaration is made by the Director-General of WHO, upon advice of an expert Emergency Committee and is a global call for governments to prepare for a health emergency.1 Since this mechanism came into existence, PHEICs have been declared six times: for H1N1 influenza (2009), polio (2014), Ebola (w

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10.04.21 22:30 [Seminar] Parkinson's disease

Parkinson's disease is a recognisable clinical syndrome with a range of causes and clinical presentations. Parkinson's disease represents a fast-growing neurodegenerative condition; the rising prevalence worldwide resembles the many characteristics typically observed during a pandemic, except for an infectious cause. In most populations, 3–5% of Parkinson's disease is explained by genetic causes linked to known Parkinson's disease genes, thus representing monogenic Parkinson's disease, whereas 9

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09.04.21 22:30 [Comment] Correlates of protection from SARS-CoV-2 infection

Since the beginning of the COVID-19 pandemic, many scientists and public health officials assumed that infection with SARS-CoV-2 would protect from reinfection and that neutralising antibodies would correlate with protection or would be at least one of the protective immune mechanisms.1 Early on, these assumptions were supported by non-human primate data showing protection from reinfection, a correlation between neutralising antibodies protection, and protection afforded by passive transfer of n

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09.04.21 22:30 [Articles] SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN)

A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals.

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08.04.21 22:30 [Viewpoint] US–China health exchange and collaboration following COVID-19

Strong US–China collaboration on health and medicine is a crucial element of the global effort against COVID-19. We review the history of health collaboration and exchanges between the public and private sectors in the USA and China, including the long-lasting collaboration between governmental public health agencies of the two countries. Academic and scientific exchanges should be reinvigorated and the increasing valuable role of non-profit foundations acknowledged. The shared interests of the

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08.04.21 22:30 [Health Policy] The escalating tuberculosis crisis in central and South American prisons

In the past decade, tuberculosis incidence has declined in much of the world, but has risen in central and South America. It is not yet clear what is driving this reversal of progress in tuberculosis control. Since 2000, the incarcerated population in central and South America has grown by 206%, the greatest increase in the world. Over the same period, notified tuberculosis cases among the incarcerated population (hereinafter termed persons deprived of their liberty [PDL], following the Inter-Am

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07.04.21 22:30 [Correspondence] Ramadan and COVID-19 vaccine hesitancy—a call for action

The Islamic month of fasting, Ramadan, begins around April 12, 2021. In 2020, Ramadan coincided with the beginning of the COVID-19 pandemic, moving what is a month of communal prayers and social gatherings into the era of virtual prayers. 2021 brings further challenges with ongoing virtual prayers and a global vaccination programme. For 1·9 billion Muslims worldwide, Ramadan coinciding with the vaccination programmes crucially means that their vaccinations might be offered during this time. With

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07.04.21 22:30 [Correspondence] Amid political and civil unrest in Myanmar, health services are inaccessible

Myanmar is a democratic country in political crisis, and a suspension of health services is placing millions of patients with chronic illnesses in increasingly difficult situations.1,2 On Feb 1, 2021, the military initiated a coup and committed aggressive repression. In response, Myanmar's citizens engaged in massive protests and a civil disobedience movement in an attempt to end the coup and restore democracy.3 Our colleagues and friends in Myanmar, who ask for anonymity to protect themselves a

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06.04.21 22:30 [Comment] Cardiology and big data: a call for papers

The Lancet and The Lancet Digital Health are seeking research Articles on big data and cardiology. We are interested in research that uses artificial intelligence to analyse data, such as echocardiograms, electrocardiograms, and physiological measurements from wearable devices, to predict risk factors and provide recommendations for early diagnosis and prognosis of cardiovascular diseases. We welcome submissions for consideration to both journals and we will consider high-quality original resear

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06.04.21 22:30 [Comment] From torture to ultraviolence: medical and legal implications

Violent global conflict has forcibly displaced 79·5 million people worldwide, many of whom have experienced torture.1 Although the systematic use of torture is not new, torture as experienced by refugees fleeing war and persecution has become increasingly brutal. Indeed, in many parts of the world, the purpose of torture is no longer to teach a lesson or to extract a confession, but to embody cruelty in its most extreme form.2 When appealing for refuge, asylum seekers describe experiencing viole

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01.04.21 22:30 [Correspondence] Leveraging data and new digital tools to prepare for the next pandemic

The COVID-19 pandemic has accelerated the pace of digital innovation, in part thanks to unprecedented private–public and private–private collaborations. The pandemic has promoted collaboration between inventive and influential companies, universities, and public organisations. These institutions have worked together in vaccine development, in forecasting the spread of infection, and in sharing technology to build public health apps for general use. We must now build on this ability to work acros

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01.04.21 22:30 [Correspondence] COVID-19 vaccines in high-risk ethnic groups

Black, Asian, and minority ethnic communities worldwide have a disproportionate risk of severe COVID-19. In the UK, as of May 19, 2020, 36% of critically ill patients with COVID-19 requiring intensive care were from Black, Asian, or minority ethnic groups.1 According to Public Health England, the mortality risk from COVID-19, after accounting for sex, age, deprivation score, and geographical region, is double in Bangladeshi people and up to 50% higher in Black and south Asian people compared wit

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01.04.21 22:30 [Seminar] Breast cancer

Breast cancer is still the most common cancer worldwide. But the way breast cancer is viewed has changed drastically since its molecular hallmarks were extensively characterised, now including immunohistochemical markers (eg, ER, PR, HER2 [ERBB2], and proliferation marker protein Ki-67 [MKI67]), genomic markers (eg, BRCA1, BRCA2, and PIK3CA), and immunomarkers (eg, tumour-infiltrating lymphocytes and PD-L1). New biomarker combinations are the basis for increasingly complex diagnostic algorithms.

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30.03.21 22:30 [Comment] Pandemic moves and countermoves: vaccines and viral variants

In the past few months, the results of several phase 3 studies showing high vaccine efficacy against SARS-CoV-2 and the subsequent rapid regulatory approval and roll-out of several vaccines have ignited much optimism. However, this optimism has been dampened by the emergence of several new virus variants that are more transmissible and less sensitive to vaccine-induced antibodies.1–6 The extent to which emerging variants affect the efficacy of vaccines appears to vary considerably between vaccin

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30.03.21 22:30 [Correspondence] Thromboembolism and the Oxford–AstraZeneca COVID-19 vaccine: side-effect or coincidence?

By mid March, 2021, vaccination against COVID-19 using the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford–AstraZeneca1,2 was paused in a number of European countries due to reports of thromboembolic events in vaccinated individuals.3 According to the European Medicines Agency (EMA), 30 cases of thromboembolic events (predominantly venous) had been reported by March 10, 2021, among the approximately 5 million recipients of the Oxford–AstraZeneca COVID-19 vaccine in the European Economic Area.3 The

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30.03.21 22:30 [Comment] Build back fairer: achieving health equity in the Eastern Mediterranean region of WHO

The Eastern Mediterranean region of WHO stretches from Morocco in the west to Pakistan in the east. This region's 22 countries and territories contain great contrasts. Life expectancy in Kuwait—84 years for women, 79 years for men—is 25 years longer than in Somalia.1 The region contains among the richest countries in the world, measured by income per person (Kuwait, Qatar, and United Arab Emirates), and among the poorest (Afghanistan, Djibouti, and Yemen).2 Similar to other regions, non-communic

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30.03.21 22:30 [Seminar] Gout

Gout is a common and treatable disease caused by the deposition of monosodium urate crystals in articular and non-articular structures. Increased concentration of serum urate (hyperuricaemia) is the most important risk factor for the development of gout. Serum urate is regulated by urate transporters in the kidney and gut, particularly GLUT9 (SLC2A9), URAT1 (SLC22A12), and ABCG2. Activation of the NLRP3 inflammasome by monosodium urate crystals with release of IL-1β plays a major role in the ini

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30.03.21 22:30 [Articles] Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trial

ChAdOx1 nCoV-19 showed reduced neutralisation activity against the B.1.1.7 variant compared with a non-B.1.1.7 variant in vitro, but the vaccine showed efficacy against the B.1.1.7 variant of SARS-CoV-2.

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25.03.21 23:30 [Comment] COVID-19 vaccines for the European region: an unprecedented challenge

Almost 4 months have passed since the first COVID-19 vaccines became available in the European region of WHO. As vaccination programmes roll-out across the region, at a time when COVID-19 cases are increasing in some European countries,1 it is a good time to consider the challenges ahead and what can be done to address them. There have been questions about the speed with which COVID-19 vaccines were authorised for use in Europe, about the timetable for supplying vaccines to some countries in the

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25.03.21 23:30 [Series] Migraine: integrated approaches to clinical management and emerging treatments

Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed cli

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25.03.21 23:30 [Correspondence] New COVID-19 resurgence in the WHO Eastern Mediterranean region

After 7 weeks of falling numbers of COVID-19 cases, a global upsurge was reported during the week of Feb 22, 2021. This case resurgence was observed earlier in the WHO Eastern Mediterranean region, where, between Jan 30 and Feb 26, 2021, the number of weekly cases increased from 158 004 to 207 424 (31%; appendix).

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25.03.21 23:30 [Series] Migraine: disease characterisation, biomarkers, and precision medicine

Migraine is a disabling neurological disorder, diagnosis of which is based on clinical criteria. A shortcoming of these criteria is that they do not fully capture the heterogeneity of migraine, including the underlying genetic and neurobiological factors. This complexity has generated momentum for biomarker research to improve disease characterisation and identify novel drug targets. In this Series paper, we present the progress that has been made in the search for biomarkers of migraine within

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25.03.21 23:30 [Series] Migraine: epidemiology and systems of care

Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epide

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24.03.21 23:30 [Articles] The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study

Our analysis showed that the African continent had a more severe second wave of the COVID-19 pandemic than the first, and highlights the importance of examining multiple epidemiological variables down to the regional and country levels over time. These country-specific and regional results informed the implementation of continent-wide initiatives and supported equitable distribution of supplies and technical assistance. Monitoring and analysis of these data over time are essential for continued

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24.03.21 23:30 [Correspondence] Considering gender-based violence in vaccine prioritisation strategies

We are delighted to see Sophie Harman and colleagues1 advocating the clinical and logistical considerations for the equitable and safe development, delivery, and administration of the COVID-19 vaccine to women. Additionally, there exists an area of gendered vaccine inequality, concerningly neglected to date, relating to the prioritisation of vaccines for survivors of gender-based violence (GBV).

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24.03.21 23:30 [Correspondence] Gender, race, and health workers in the COVID-19 pandemic

The Editors1 correctly highlighted the situation the health workforce is in, and how it is facing “serious harms to their physical and mental wellbeing while trying to deliver quality care” during the COVID-19 pandemic. Considering the health workforce as a homogeneous group misses the reality of who is affected within this group and the necessary solutions.

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24.03.21 23:30 [Comment] Africa needs local solutions to face the COVID-19 pandemic

In The Lancet, Stephanie Salyer and colleagues' comprehensive and elegant cross-sectional analysis of COVID-19 case counts, response measures, and mortality rates highlights the diversity of the COVID-19 burden and response across Africa.1 Between Feb 14 and Dec 31, 2020, 2 763 421 COVID-19 cases and 65 602 deaths were reported in African countries, accounting for 3·4% of the 82 312 150 cases and 3·6% of the 1 798 994 deaths reported globally. Their Article shows the variable effects of COVID-19

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24.03.21 23:30 [Comment] Human rights and fair access to COVID-19 vaccines: the International AIDS Society–Lancet Commission on Health and Human Rights

The rapid development of safe and effective COVID-19 vaccines has been an unprecedented scientific achievement and offers a promise for a healthy post-pandemic future. However, inequitable vaccine access has jeopardised that vision, and our global governance institutions have failed to anticipate, prevent, or redress this inequality. As of March 21, 2021, 78% of 447 million deployed doses of COVID-19 vaccines were in only ten countries.1,2 Nearly a quarter of the world's population might not hav

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24.03.21 23:30 [Correspondence] The medical right to repair: the right to save lives

Throughout the COVID-19 pandemic, hospitals worldwide have reported inadequate supplies of crucial equipment1 such as ventilators, haemodialysis machines, personal protective equipment, and decontamination equipment. Having functional crucial equipment is essential for hospitals to meet patient care needs, especially now, when there is a demand for nearly every ventilator to be called into near constant service in COVID-19 hotspots worldwide.

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23.03.21 23:30 [Correspondence] WHO International Standard for anti-SARS-CoV-2 immunoglobulin

The development timeline of COVID-19 vaccines is unprecedented, with more than 300 vaccine developers active worldwide.1 Vaccine candidates developed with various technology platforms targeting different epitopes of SARS-CoV-2 are in the pipeline. Vaccine developers are using a range of immunoassays with different readouts to measure immune responses after vaccination, making comparisons of the immunogenicity of different COVID-19 vaccine candidates challenging.

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23.03.21 23:30 [Correspondence] The unsung virtue of thermostability

The current vaccination campaign against SARS-CoV-2 has many challenging aspects, one of which is maintaining the cold chain for the distribution, delivery, and storage of available vaccines and guaranteeing that their full titre is retained for administration. Although outstanding technology for vaccine development has enabled products to be put on the market in 1 year, it is difficult to understand why approximately the same length of time is taken to roll out their administration, thus jeopar

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22.03.21 23:30 [Correspondence] Vaccines and SARS-CoV-2 variants: the urgent need for a correlate of protection

Immune-escape variants have raised concerns about the effectiveness of vaccines as the world scales up SARS-CoV-2 immunisation. COVID-19 vaccines have shown up to 95% efficacy1 in preventing clinical cases and up to 100% efficacy2 in preventing severe disease or admission to hospital in settings with pre-existing variants. New variants, especially 501Y.V2 (B.1.351), which escape natural-induced and vaccine-induced immunity, have created uncertainty on whether the vaccines are effective in preven

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22.03.21 23:30 [Comment] The need to prioritise childhood tuberculosis case detection

With 10 years left to the WHO End TB Strategy's interim milestones of 80% reduction in new tuberculosis cases and 90% reduction in tuberculosis deaths by 2030 compared with 2015,1 little progress has been made. The COVID-19 pandemic has worsened the situation because of its negative impact on tuberculosis case detection and reduced access to tuberculosis treatment and prevention services globally.2 In a worst-case scenario, COVID-19 might have resulted in up to 400 000 excess tuberculosis deaths

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22.03.21 23:30 [Correspondence] Assessing government responsibility for COVID-19 deaths

Pedro Hallal1 describes how Brazil's President Bolsonaro has ridiculed the COVID-19 pandemic, hindered scientists, and implemented unreasonable policies. One point, holding the president's policies accountable for the death of 156 582 people, warrants a closer look. The estimate is based on the premise that Brazil should have COVID-19 death rates equal to the world average. However, there are substantial limitations to that assumption. Many of the countries reporting death rates that are less th

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22.03.21 23:30 [Correspondence] Rapid identification and tracking of SARS-CoV-2 variants of concern

In the past few months, we have seen emergence of clinically important mutations that alter infectivity, severity, or immune susceptibility of SARS-CoV-2.1 Prominent examples include Asn501Tyr, His69_Val70del, and Glu484Lys mutations in the spike protein that have emerged independently in many global strains, such as those from the UK, South Africa, and Brazil, possibly driving resurgence of the pandemic when it appeared to be coming under control.2 Some of these variants are likely to be resist

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22.03.21 23:30 [Correspondence] Guidelines should not pool evidence from uncomplicated and severe COVID-19

The WHO Global Development Group guidelines on COVID-19 therapeutics are meant to provide evidence-based advice to all countries on the medical management of patients with COVID-19.1,2 The only small-molecule drug to show unequivocal benefit to date is dexamethasone. In the largest randomised controlled trial in patients who were admitted to hospital with COVID-19 (ie, the RECOVERY trial), dexamethasone at a low dose reduced mortality in the prospectively defined subgroups of patients requiring

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19.03.21 23:30 [World Report] Researchers slam UK cuts to global health research

A £120 million cut by UK Research and Innovation has led to an outcry from experts who say health projects across the world will be affected. Jacqui Thornton reports.

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18.03.21 23:30 [Correspondence] Free licensing of vaccines to end the COVID-19 crisis

The pace of COVID-19 vaccine development, authorisation, and production is unprecedented. Yet all three approved vaccines by Pfizer–BioNTech, Moderna, and AstraZeneca are already facing manufacturing delays. These delays are creating chaos for many national vaccination programmes, leading to calls for coordinated efforts by governments and manufacturers to increase production.1

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18.03.21 23:30 [Perspectives] Nicole Salazar-Austin: emerging tuberculosis–HIV research leader

“I love clinical work in the US, but my heart is in tuberculosis research in sub-Saharan Africa”, says Nicole Salazar-Austin, Assistant Professor of Pediatrics at the Johns Hopkins University School of Medicine, Baltimore, MD, USA. It is the quality and originality of her research that saw Salazar-Austin become the 2020 winner of the annual Stephen Lawn TB–HIV Research Leadership Prize for promising work in reducing the disease burden of tuberculosis and AIDS in sub-Saharan Africa. She is also a

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18.03.21 05:00 [Comment] Ageism: a social determinant of health that has come of age

On March 18, 2021, the Global Report on Ageism1 was launched by WHO, the Office of the UN High Commissioner for Human Rights, the UN Department of Economic and Social Affairs, and the UN Population Fund. Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021–2030).2 Changing how we think, feel, and act towards age and ageing is a prerequisite for successful action on healthy ageing and for progress on the three other action areas of the Decade of Healthy Ageing: d

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17.03.21 23:30 [Comment] Risk of SARS-CoV-2 reinfection after natural infection

Since the start of the COVID-19 pandemic, the question of potential reinfection has been ever present. Although there has been much debate about potential reliance on herd immunity through natural infection, human coronaviruses are well adapted to subvert immunity1 and reinfection occurs for seasonal coronaviruses (229E, OC43, NL63, and HKU1) that cause the common cold due to ephemeral immunity that is poorly protective between infections.2 Furthermore, detailed mapping of immune parameters in c

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17.03.21 23:30 [Articles] Assessment of protection against reinfection with SARS-CoV-2 among 4 million PCR-tested individuals in Denmark in 2020: a population-level observational study

Our findings could inform decisions on which groups should be vaccinated and advocate for vaccination of previously infected individuals because natural protection, especially among older people, cannot be relied on.

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17.03.21 23:30 [Correspondence] The UK Health and Care Bill: failure to address fundamental issues of coverage and funding

The UK Government has outlined its legislative proposals for a new Health and Care Bill.1 The objectives, heavily aligned with the National Health Service (NHS) England Long Term Plan, include strengthening integration, reducing bureaucracy, and improving accountability. Although the timing is questionable, to the extent that these proposals aim to promote integration and cooperation, they should be welcomed.

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