Meningitis in Baby: Symptoms, Causes, Treatment, Vaccine, and More

Cholera Vaccine Shortage Reaches Worst Point Yet, With Experts Fearing Deadly Outbreaks

An unprecedented shortage of cholera vaccine has public health experts fearing that a recent surge of outbreaks across developing countries will only worsen, a situation they argue is as regrettable as it was avoidable.

At least 16 countries in Asia, Africa, and the Caribbean are dealing with cholera outbreaks. According to the latest report from the European Centre for Disease Prevention and Control, between Dec. 23 and Jan. 23, nearly 50,500 people contracted cholera and nearly 500 died. Those numbers will almost certainly rise amid the worst vaccine shortage since an oral vaccine was introduced in the 1990s.

Experts describe the dearth of doses as an unforced error that reflects a lack of interest in a disease that is only deadly for the poorest of the poor. Out of three vaccines qualified for use by the World Health Organization, only one is still being made, and its supplies barely cover a fraction of the global need. Cases continue to grow as climate change worsens weather patterns that are linked with flooding and outbreaks. And without sufficient vaccine supplies, medical personnel on the ground are left with containment strategies that are hardly sufficient during a humanitarian crisis.

"Cholera is a neglected disease. And it is neglected for neglected populations that are poor and do not make a good market," said Abdou Salam Gueye, the regional emergency director of the WHO African Region.

The global stockpile of cholera vaccine, which was established in 2013, is managed by the International Coordinating Group (ICG) on Vaccine Provision with the aim of supporting countries in need. That stockpile is supposed to have 5 million available doses ready to be delivered within a week. At the moment, it's running dry, as only one of the vaccine makers, EuBiologics, is producing doses of its vaccine, Euvichol-Plus. As of 2022, Shantha Biotechnics, an Indian subsidiary of French pharmaceutical company Sanofi, stopped producing its cholera vaccine, ShanChol, which at the time constituted 15% of the global stockpile.

Euvichol-Plus has been approved for people 1 and older and is supposed to be administered in two doses given at least two weeks apart. Yet last year, the ICG changed the administration protocol to one dose rather than two to stretch limited supplies further, even though that compromises the vaccine's effectiveness.

"What we started to do is the second dose within six months. And then we needed to stop the second doses altogether," said Daniela Garone, international medical coordinator at Medécins Sans Frontières and a member of the ICG. "But we don't know how much protection we receive — it is more than a year, but we don't know how long."

A regular protocol would offer protection that starts 10 days after vaccination and is 90% effective against severe diarrhea and dehydration for the first three months, with protection lasting for up to three years. Vaccines are especially important in areas where outbreaks happen in rapid succession and where surges in cases can continue for a year or longer.

Thirty countries experienced cholera outbreaks in 2023, and 14 requested a total of 76 million doses from the ICG, which only had 38 million doses of Euvichol-Plus. This means that current production barely covered half the need for a one-dose protocol, and only a fourth of what would be needed for a two-dose protocol. And EuBiologics is already running at capacity in making its vaccine.

And ideally, said Garone, there would be extra vaccine to set up preventative programs to forestall outbreaks. That would require an estimated minimum 40 million additional doses for 2024.

At the moment, said Garone, 2.4 million doses are being made a week, and all the doses that will be produced in the coming months have already been allocated. Countries that have been approved by the ICG to receive vaccine doses now "will not receive it until the second or third week of March because the vaccine is not produced yet," she said.

The reason behind this shortage is straightforward: At $1.50 a dose, cholera vaccines are unappealing to pharmaceutical companies, and demand is limited to poor countries or emergency situations such as wars or natural disasters. "The only way to maintain a healthy market is to have more than one manufacturer," said Garona. "You need global investment because it's not an attractive market."

With no immediate solution in sight, health workers on the ground have stopped relying much on vaccines as a primary intervention. "Responding in many countries in Africa, we try to intervene without putting cholera vaccine in the center of our strategy," said WHO's Gueye.

Instead, he said, the first goal is to reduce mortality to under 1%. This helps build trust with the affected population, which can otherwise be hesitant to seek care, both because of high mortality rates in health care centers and because of the specific symptoms of cholera, which can quickly impede people's ability to control vomiting and bowel movements. "Cholera [is] a disease that affects the dignity of people," said Gueye.

Only once they've built trust with local communities do health workers take secondary steps to improve water and sanitation, Gueye said, although resources can be scarce.

"If it is very difficult to do the water and sanitation [intervention] and sometimes impossible to do the good clinical care, the vaccine remains the only possibility," he said. "And unfortunately we don't have those vaccines."

In his experience, the one time African countries were able to access extra funding from the WHO to respond to cholera was in 2022, which helped bring an outbreak in Western Africa (Nigeria, Cameroon, and Niger) under control in record time. But recent requests for funding as cases rise have been unsuccessful. "We were able with less than $10 million to really do a good intervention," he said. "But now we have nothing."

Future outbreaks are only likely to intensify because of the effects of climate change, Gueye warns. In particular, in eastern and southern African nations such as Mozambique, Malawi, and Madagascar, flooding that can lead to cholera outbreaks used to be cyclical, but those cycles are now running into one another and prolonging outbreaks.

It's a situation he says underscores how global crises affect the poorest nations. "In my opinion cholera is not a public health problem. It's a development problem with public health consequences. If you support a country to have human development that is appropriate, the problem will disappear by itself," he said.

This has become harder because, in many cases, economic growth in the Global South has fostered more economic inequality, with the poor sinking deeper into poverty even as countries become richer overall. The good news is that a little funding would go a long way, such as increased support for climate change remediation. For instance, cholera prevention and treatment programs should qualify to receive at least a small portion of the $13 billion United Nations Green Climate Fund, he said.

"You don't need rocket science to know that cholera is a consequence of climate change," Gueye said. "We asked last year for around $31 million; we got less than 4 million. And that $13 billion that is available for climate change — why is it not oriented toward the cholera funding gap?"

Switching Arms For The Second Dose Of A Vaccine Significantly Enhances Its Effectiveness

New research has revealed a significant boost in immune response when individuals switch arms for the administration of a multi-dose vaccine. This simple act could quadruple the vaccine's effects.

The laboratory study, led by researchers from the Oregon Health & Science University (OHSU), measured the antibody response in the blood of 947 individuals who received two-dose vaccinations against COVID-19 at the onset of the pandemic. The participants included OHSU employees who agreed to enroll in the research while being vaccinated against the SARS-CoV-2 virus and were randomized to receive the second dose in the same arm as the first dose or in the opposite arm.

Historically, clinicians believed that the choice of arm did not matter. However, the new study, recently published in The Journal of Clinical Investigation, tested serum samples collected at different times after vaccination. They found a substantial increase in the magnitude and scope of the antibody response in individuals who received a "contralateral" vaccination - an injection in each arm - compared to those who had injections in the same arm.

The improvement in immune response was clearly evident three weeks after the second booster and persisted beyond 13 months post-boost. The researchers found increased immunity against the original strain of SARS-CoV-2 and an even stronger immune response to the omicron variant that appeared about a year after switching arms.

The researchers are uncertain about why this occurs but speculate that administering an injection in each arm activates new immune responses in different lymph nodes of each arm. "By switching from one arm to the other, you essentially have memory training in two places instead of one," stated lead author Marcel Curlin, an associate professor of medicine (infectious diseases) at the OHSU School of Medicine and medical director of OHSU Occupational Health.

The study has generated significant interest as it offers perspectives for enhancing the effectiveness of two-dose vaccines, not only against COVID-19 but potentially for other multiple-dose vaccinations. Although this research focused on COVID-19 vaccination, the researchers indeed assume that the results could be similar for other multi-dose vaccines. They call for further research to determine if contralateral vaccination improves immune response for other vaccines, especially in children.

It is important to note that this study raises promising questions, but it is too early to make clinical recommendations based on its findings. However, this discovery could significantly impact how vaccinations are administered in the future, potentially offering a valuable boost in immunity for vaccinated individuals.

Myocarditis, Other Rare COVID-19 Vaccine Risks Confirmed By Study

People who received the Moderna and Pfizer vaccines for COVID-19 were more likely to come down with myocarditis or pericarditis, which are heart-related inflammations, according to a study involving 99 million people who received vaccine.

For example, people were 6.1 times more likely to come down with myocarditis following their second dose of Moderna vaccine. Higher than expected rates of myocarditis also occurred among people who received the Pfizer vaccine, according to the study which can be read in full in the journal Vaccine.

The study, which also looked at side effects among people who received the AstraZeneca vaccine, further found elevated risks of side effects including Guillain-Barre syndrome, a disease of the immune system, and blood clots in the brain.

Dr. Marc Siegel of NYU Langone Medical Center told Fox News, "This study does not really change anything; it just provides much further evidence of what we already know."

Siegel and other experts further said the risks of those conditions and others including death are still far higher following an actual COVID-19 infection. Seigel, who is a regular Fox News contributor, called the side effects "rare" and said "other studies show that the vaccine decreases the risk of myocarditis from COVID itself dramatically."

Forbes quoted biotech CEO Jacob Glanville as saying, "The odds of all of these adverse events is still much, much higher when infected with SARS-CoV-2 (COVID-19), so getting vaccinated is still by far the safer choice."

The study, which was funded in part by the U.S. Centers for Disease Control and Prevention, looked at people in eight countries including Canada, but not the United States.

Previous studies have found the same side effects, and experts have noted that nearly everyone who experiences conditions such as myocarditis recovers quickly.

The new study, done by the Global Vaccine Network, which is part of the World Health Organization, focused on side effects that showed up within about two months of a vaccine dose. It contained no information regarding severity of illness, recovery time or deaths.

Doctors and the U.S. Government have long cited a slight risk of myocarditis following COVID-19 vaccination, with the risk highest among young men.

One study involved members of the U.S. Military who received a total of 2.8 million doses. Twenty-three men came down with myocarditis, with most coming after their second dose. In most cases symptoms went away within a week; none died.

All told, 13.53 billion doses of COVID-19 vaccine have been given around the world, with about 70% of people having received at least one. That includes 677 million doses in the United States as of May 2023, and 28 million in Pennsylvania.

If you purchase a product or register for an account through a link on our site, we may receive compensation. By using this site, you consent to our User Agreement and agree that your clicks, interactions, and personal information may be collected, recorded, and/or stored by us and social media and other third-party partners in accordance with our Privacy Policy.

---