Science
A Nigerian Doctor’s Fight for Equitable Access to Vaccines
This interview is a part of our newest Girls and Management particular report, which highlights ladies making vital contributions to the main tales unfolding on this planet immediately. The dialog has been edited and condensed.
Dr. Ayoade Alakija, an infectious illness specialist primarily based in Nigeria, is co-chair of the African Union’s Vaccine Supply Alliance (AVDA). In December 2021, Dr. Alakija, nicknamed Yodi, was put in command of accelerating equitable entry to Covid-19 exams, therapies and vaccines for the World Well being Group’s international initiative often known as the Entry to Covid-19 Instruments Accelerator. She makes use of the time period “international north” to explain high-income nations and “international south” to explain low- and middle-income nations.
All through the pandemic you’ve got been essential about vaccine inequity, particularly in Africa. How did it really feel when the W.H.O. director-general Dr. Tedros Adhanom Ghebreyesus requested you to be particular envoy to the Entry to Covid-19 Instruments (ACT) Accelerator?
I had been one of the crucial essential voices at a number of the outputs of the ACT Accelerator. I had been agitator No. 1 for vaccine inequity. So my first thought was, “Oh my God, they are going to all hate me.”
It was a shake-up of the established order; a fox within the henhouse. When Tedros referred to as me to ask if I might do it, I mentioned, “Have you ever received the correct quantity?” After which I mentioned, “Oh, no, no, no.” So he requested me to consider it, saying, “Your voice is required, your steer is required.”
I spoke to my husband, and he mentioned, “Yodi, you’ve got been on the forefront of claiming these of us from the worldwide south should be heard. They’ve invited you to that desk, you can not say no.”
What does your position entail?
I function 16 to 18 hours a day, advising governments, well being ministers, finance ministers and the ACT Accelerator leads, coordinating with AVDA colleagues on vaccine shipments, deliveries and bottlenecks. There are additionally talking and media engagements I undertake to be able to advocate on the problem of vaccine fairness, and equitable entry to well being care instruments.
How can we obtain vaccine fairness?
Once we ascribe the identical worth to lives within the international south as we do to lives within the international north. We are able to solely obtain it once we don’t assume it’s OK for folks to be dying in Mombasa or in Kibera of illnesses that not exist in London or New York. Once we worth one another the identical. As a result of in the meanwhile there are those that are saying, “Oh, nicely, it’s not so dangerous in Africa. So perhaps we don’t actually need to vaccinate them. We’re not seeing the I.C.U.s being utterly overrun.” Nicely, that’s as a result of there aren’t any I.C.U.s. That’s as a result of there aren’t any well being facilities. That’s as a result of individuals are dying silently.
You started your medical profession working with H.I.V. and AIDS sufferers, then determined to pursue your grasp’s diploma in public well being in your early 20s. Did you face any obstacles early in your profession?
Once I utilized to the London College of Hygiene and Tropical Medication to review public well being, I obtained a rejection letter saying, “This course tends to be for actually senior stage public servants, ministers or everlasting secretaries from totally different nations world wide. You might be very younger so we’re not accepting you on to this course.”
I used to be outraged. My husband and I have been residing in London on the time, so I marched into the college and demanded to see the dean, who on the time was Richard Feachem. I threw the letter on the desk and I mentioned, “What’s the that means of this? That is what I wish to do and I’m not leaving till I’m doing what I utilized to do.” He sat again in his chair and mentioned, “I actually stay up for the day you’re working the world.” He then directed me to somebody in admissions.
You’ve been vocal in regards to the want for extra ladies in positions of energy in relation to the world’s Covid-19 response. How can we obtain that?
It has slapped me within the face a lot throughout this pandemic, the truth that the worldwide well being leaders are males. Lots of ladies are usually No. 2s, so that they don’t fairly have the decision-making energy, the voice.
I used to be at a convention in Rwanda, and there was a bunch of males who had invited themselves into this mentoring session that I used to be doing for younger ladies. They usually have been standing proper in entrance of the one desk within the room. So I tapped every on the shoulder and mentioned, “Excuse me.” They usually type of checked out me and mentioned dismissively, “Oh, yeah, hello.”
So I parted via them and I climbed on a chair, after which on a desk. The convention erupted. I received the mic and I mentioned, “Proper right here, that is what we’re speaking about. That even when you pull up a chair and also you type of get into the dialog politely, they take a look at you want, ‘eh?’”
So in the event that they don’t offer you a seat on the desk, pull up a chair. And in the event that they don’t make area, then get on the desk.
Do you consider that Covid has disproportionately affected the lives of girls and ladies, particularly in Africa?
There may be one other silent pandemic happening right here with baby marriage — folks promoting off their daughters due to the financial influence of Covid. Folks can’t afford to feed their households, subsequently, it’s the ladies who must go.
Even for vaccines, the prioritization in communities signifies that if there are a couple of vaccines accessible within the nation, and individuals are prepared to go and get it, the person will go and get it. However the lady received’t.
How can we get extra vaccines in arms?
It isn’t so simple as hesitancy. Hesitancy is a operate of belief — belief in programs, belief in governments. There must be a extra common, extra constant, predictable provide of vaccines.
We have now to additionally take a look at the broader strengthening of the well being programs. It must be a part of our supply of vaccines and our preparation for the following outbreak or the following pandemic or simply preparation for all times, actually.
Science
Despite warnings from bird flu experts, it's business as usual in California dairy country
TIPTON, Calif. — It was a late fall morning and hundreds of cows — black and white splattered Holsteins and cappuccino-colored Jerseys — milled about a San Joaquin Valley dairy farm in the largest milk-producing state in the nation.
Nearby, workers herded some of the animals onto a rotating platform within the farm’s milking parlor and quickly attached pumping equipment. The machines buzzed and whirred as the cows were carried in a lazy arc to the parlor’s exit, where they were detached from milk hoses and sent on their way.
The scene seemed utterly unremarkable — except for the fact that five days earlier, the H5N1 bird flu virus that has ravaged California’s dairy herds for the last three months, had been confirmed on the farm. Although dozens of cows were sick, and their owner expected that number to climb, none of the farm’s workers wore personal protective equipment and vehicles from off site were let in and out with nary a hint of concern.
The farm was just one of more than 400 California operations that have been confirmed to have suffered outbreaks of H5N1, but interviews with Central Valley dairy farmers, dairy workers and a recent study by the U.S. Centers for Disease Control and Prevention suggests the virus may be more widespread in people than the CDC’s official numbers suggest. Although authorities have been urging dairy farms and workers to take precautions against spreading infection, there is little evidence their cautions are being heeded.
No expert will say that H5N1 bird flu is going to become the next global pandemic, and government health officers say the virus poses a low risk to the public. However, some experts warn that nearly all the conditions needed for the virus to develop a threatening mutation are now present in many dairy farms: Lax testing protocols; close, unprotected contact between humans and animals; a general failure to take the threat seriously enough; and the approach of human flu season.
Since this particular clade of H5N1 virus (2.3.4.4b) first appeared in North America at the end of 2021, it has infected more than 600 dairy herds across 15 states, hundreds of millions of wild and domesticated birds, and at least 48 mammal species — such as dolphins, seals, cats and dogs.
“We are in a soup of virus. I mean, there’s virus everywhere around us at this point,” said Dr. Marcela Uhart, a wildlife veterinarian with UC Davis’ One Health institute, who is based in Argentina, speaking at symposium held by the O’Neill Institute at Georgetown Law recently. (11/15) “This virus is circulating left and right in mammals and in birds, as far as we can tell, some of them are not showing any signs of disease.”
In October, The Times visited Tipton, a dairy town in Tulare County, and spoke with several residents, including Elodia Ibañez, who said the number of reported human cases in California — which in mid-October was 16, and is now 23 — sounded too low. She said her husband, a dairy worker, told her that two of his co-workers had red, swollen eyes, but they had continued working despite displaying bird flu symptoms.
“It’s an illness that they know the cows have, and many cows have died. But the boss cared about the cows, not the workers,” Ibañez told The Times. “They never told them they have to go to the doctor to get a check-up.”
People often continue to work because they feel they have no other choice, she said. “Even though they say there are laws that protect them, there are still a lot of people who are fearful … They’re scared of losing their jobs.”
Anthony, also a Tipton resident, said he would talk, but did not want to share his last name; he has family members who work in dairies, and he feared impacting their employment by speaking out.
“My dad and uncle have told me there’s a bunch of dairies that have had outbreaks,” Anthony said. He said his dad and uncle take steps to stay safe, but many workers likely are not reporting getting sick because they don’t want to get in trouble.
“Some of them are here not legally. They’re relying on that job, they don’t want to jeopardize that,” he said.
In early November, the CDC published a study that looked for H5N1 antibodies in the blood of dairy workers in Michigan and Colorado. The agency sampled blood from 115 people; eight — or 7% — had antibodies. Only three dairy workers in those two states — one in Colorado, two in Michigan — have been positively identified as having the disease.
It’s this blindness to — and ignorance of — the virus’ reach that has infectious disease and health experts concerned.
And as human flu season approaches, and infected wild birds continue their southward migration down the North American flyways — stopping to rest in lakes, ponds, farms and backyards throughout the United States — experts worry conditions are becomingly increasingly ripe for a large “spillover” event.
If a virus — whether it’s a bird flu, a human influenza virus or a coronavirus — is given the opportunity to spread within and between organisms, the virus will evolve, adapt and mutate. Sometimes these mutations have little effect on its ability to transmit between organisms or cause severe disease. But sometimes, they do.
Then there’s the concern that the bird flu virus will find another flu virus that’s circulating — a human, swine or even other bird flu — and swap genetic material with it, potentially creating a new “super flu” that can spread easily between people, make its hosts very sick, or carry immunity to the antiviral medications used to treat infected patients.
In the 1970s, when the understanding of flu viruses was still being developed, Robert Webster, a researcher at St. Jude’s Hospital in Memphis, Tenn., conducted an experiment at the U.S. Department of Agriculture’s Plum Island Research Station, off the coast of Long Island.
He put a human flu virus — H3N2 — into one pig, and a swine flu virus — H1N1 — into another. He then put the two pigs in a pen with four other pigs. Seven days later, he and his team detected reassorted viruses — H3N1 and H1N2 — in one of the other pigs.
The viruses had swapped genes and created new combinations.
The work of Webster and others led to the discovery that several of the nastier historical flu pandemics have been the result of this kind of reassortment. For instance, the 1918 flu outbreak — which killed approximately 50 million people worldwide — is believed to have been a recombined version of a bird and human flu.
It happened again in 2009, when a human and swine flu switched genes, unleashing the H1N1 swine flu outbreak that killed roughly 500,000 people.
Already there is evidence this virus is swapping genes. The birds currently traveling south from the Arctic are carrying a slightly different variant of H5N1 — called D1.1 or D1.2 — that has an altered take on the several of the flu’s viral segments.
It’s this strain that has put a Canadian teenager into critical condition at a British Columbia hospital. Health authorities don’t know where or how the child picked it up, except to note it wasn’t from cows or poultry. And they don’t know yet whether it has acquired the ability to move easily between people — although early and initial testing suggests it may have acquired some new and ominous traits, including changes that would make it easier to infect people.
Even so, as of this moment, there is no evidence that the H5N1 bird flu circulating among dairy cows and workers — known as B3.13 — has achieved the ability to move efficiently from human to human, or to cause severe illness. But with human flu season approaching — and the possibility that retail customers were drinking infected raw milk — the chances increase.
In an effort to spread awareness among dairy farms and potentially lure workers in for testing and decrease the chances for this virus to acquire mutations that could make it widespread and deadly in people, state health, agriculture and workers safety experts held a workshop at the Tulare Expo Center in late October, with help from the dairy trade group, Western United Dairies.
About 20 dairy workers and farmers sat through the two-hour session, which included English and Spanish presentations from the different state agenciess and dozens of slides
Dr. Erica Pan, California’s State Epidemiologist, told the audience her agency recommended personal protective equipment at work, and urged people to protect their eyes. She also told the audience to stay up to date on their recommended vaccines and refrain from consuming raw milk and undercooked beef, “especially ground beef.”
Eric Berg, Deputy Chief of Health and Research and Standards at CalOSHA said that farms under quarantine needed to establish restricted areas for infected animals. Workers, he said, should wear protective clothing, including coveralls, gloves and “and very important … eye protection and also respirators indoors.”
Eduardo Mondragon sat near the front of a conference room, nodding along as experts discussed safety protocols for dairy workers. As a manager of multiple dairy farms, Mondragon had watched the bird flu rip through the farms he oversaw in Tulare County and the cows he and his colleagues were tasked with caring for as they became sick.
Milk production fell as hundreds of cows became sick and about a dozen died, he said, but the dairy’s owner provided protective gear, including gloves and goggles, which workers were used to wearing daily.
At the dairy farm, Mondragon said they worked quickly when cows started getting sick over the summer to try and stop the spread. His boss sent him to the seminar in Tulare to learn more about the bird flu.
“For weeks, we never stopped,” he said, with many workers working weekend shifts to care for the cows. “We had a good handle on the flu, and because of that we didn’t suffer that many losses. Milk production yes, but animals, no.”
Mondragon knows that while his dairy farm saw the worst of the bird flu hit over the summer, none of the workers reported getting sick. He said friends in the industry in other countries were not yet affected like dairies in Tulare County.
After the seminar, Mondragon loaded up his white pickup truck with boxes of N95 masks, face shields and goggles to take back to his job site and share with the other workers.
Science
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
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