Why is the Aids conference still held in the Global North? – Mail and Guardian
The world’s largest Aids gathering, the International Aids Society’s bi-annual International Aids conference, should never be held in Europe or the United States again, says Ayoade Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance, an organisation set up during the Covid-19 pandemic that works towards the equitable delivery of immunisations.
Alakija was speaking in an interview on the first episode of Bhekisisa’s new television show Health Beat.
Most people with HIV live in the Global South, so that’s where the gathering of the most important new HIV research should be held, she says. The Global South is a catch-all term for low- or middle-income nations, usually in Africa, Asia, Oceania, Latin America and the Caribbean.
Researchers, who reviewed more than 20 years of global health conferences, found that 96% of such events happened in high- or middle-income countries. Fewer than four out of every 10 delegates come from poorer nations — despite the fact that the diseases discussed at such conferences are far more common in Global South countries.
This year, the Aids conference was held in Montreal, Canada, but African delegates struggled to get visas to enter the country — so much so that most of the speakers for the closing session of the conference had to participate virtually.
Even those who had the right documents battled to get to the conference.
Winnie Byanyima, who heads up the Joint United Nations Programme on HIV/Aids (UNAids), was only allowed to board her plane to Canada after airport officials made several calls and “scrutinised [her visa documents] over and over again”.
And the South African activist, Tian Johnson, spent more than R330 000 on visa applications and flights, but only got as far as the United States border before flying back home after he was blocked from boarding a plane to Montreal.
The next gathering will be held in Brisbane, Australia.
The drama is the latest in a slew of slights African researchers have faced during the Covid-19 pandemic. In 2021, for instance, South African researchers who identified the Omicron Covid-19 variant were shocked that their transparency was met swiftly with travel bans on South Africa and other African countries, but not on other nations in the Global North where the variant was already circulating.
Alakija spoke to Bhekisisa about what she sees as a dangerous double standard in the world of public health.
- Pharmaceutical company ViiV healthcare has issued a voluntary licence (so that cheaper, generic versions of the product can be made) for their two-monthly HIV prevention injection cabotegravir. It will take years for generics to be made but in the meantime they’ll sell the branded jab to 90 countries at a lower price. But history tells us that pharmaceutical companies aren’t transparent about money. What happens now?
We welcome the fact that they have caved into pressure, because really that’s what it is. It’s a caving in to pressure that reminds us why we put pressure on the health injustices of this world. But it’s also very blurry, [ViiV healthcare] said they will provide it at a [lower] price. But how affordable is that price? They’ve given a list of 90 countries that they will make the patent available to through the Medicines Patent Pool, an organisation that works with drug companies to make medicines more affordable. It’s a step in the right direction, but the basic issues around the inequities and the fact that we have to beg, scream and shout, for the right to basic healthcare is something we still need to interrogate.
- Drug companies have priced low-income countries (where they trial their medications), out before when antiretrovirals first became available. Do you think African governments should do more to negotiate with pharmaceutical companies?
I absolutely do. It’s not just about negotiating with pharmaceutical companies. I’ve called for this before when high-income countries like the UK and others shut South Africa and others out when [the] Omicron [variant] was first detected.
African governments need to understand that our lives are at stake. And it is not just about negotiating with pharmaceutical companies, but it is about using our geopolitical power in a way that we become reckoned with. At the moment the world doesn’t [take us seriously] because we’re not standing up to them. I would say that our leaders need to recognise how important they are, in terms of the wider global quality of nations. We have President [Emmanuel] Macron of France, visiting African countries, because there’s this competition for who Africa is going to lean towards.
- You speak about international relations and Africa’s bargaining power and it seems that you think fixing this inequality needs more than just negotiating with Big Pharma. What needs to change now?
It is about our wider health security, it is about our wider peace and security. It is about our wider food security. We have a problem of leadership which is why the world is taking us as people for granted. It is making it look like a life in Abuja is worth less than a life in Alberta, Canada. That shouldn’t be the case. A life in Cape Town should be worth the same as a life in Connecticut. But at the moment what the world is telling us with these drugs and the withholding of access to medicines is that our lives are not worth the same. And that is not just on pharma, that is on us. It is on our leadership. Activism will go so far but what we need is political change.
- If an African president came to you today and said, “I’m meeting a certain big pharmaceutical company.” How would you advise the president on standing up to the company?
If an African president came to me, I would say, “Mr President, I would advise you to tell these people who are refusing to purchase or refusing to support our own homegrown pharmaceutical industries that until they do that, we no longer want what you are giving to us, we will find our own procurement mechanisms”.
It is not so much what I say, it is what I do. I think our leadership needs to begin to put their foot down in those geopolitical spaces, be it at the United Nations or the various assemblies that they attend. They make a speeches, but they need to start making demands,
The charity model [of international relations] no longer works. We need global multilateral partnerships, not global charities that are mostly controlled by men from the high-income countries of the world, who tell us who must live and who must die. It is wrong.
- As you have pointed out, inequality plays out in many ways. Just last week at the Aids conference in Canada, many people from Africa couldn’t attend because of high travel costs or visas being rejected. How does that influence who the world takes seriously when it comes to global pandemics such as HIV or Covid-19?
I myself have been unable to attend that conference because of the prohibitive cost. I have friends who were denied boarding [after] having paid over $20 000 to get visas and buy tickets so that their voices could be heard. Winnie Byanyima, the executive director of UNAids, who’s from Uganda, was almost denied boarding to attend a conference, which basically is her core business in Canada, because she’s a black woman. Institutional racism is the problem.
One day we’ll have the conversation about why we are still in a pandemic, because institutional racism meant that when the director general of the World Health Organisation, who was a man from Ethiopia named Tedros Adhanom Ghebreyesus, declared that we, the world, had a problem and presidents of high-income countries refused to believe him. Therefore, the rest of the world did not take this seriously. What would’ve happened if Tedros from Ethiopia, was Ted from Colorado, would they have taken Covid-19 more seriously?
- At the 2022 Aids conference we saw a situation where people from the Global South can be locked out of conversations which are about solutions to the problems they face. How do we avoid a repeat of this?
What I am calling for is for people to stop hosting these conferences in these places. You cannot talk about us behind our backs. The majority of the burden of the disease is in our countries — largely, because you refuse to provide us access to drugs; refuse to provide us access to testing for HIV. There is no point in having these conversations behind closed doors with people from high-income countries who will again decide for us what we must do in our own countries.
It’s time that our leadership says “we are not having the conference for Aids in Canada; we’ll have these conferences in the Global South so that we can make decisions together”. It is only when this world acts together as one that we’re going to have equity and justice and true health security for the entire planet.
- Researchers from lower-income countries often help peers from richer countries to do studies on things like new medications, for example. But they don’t get the same recognition as their Global North counterparts. How do we change that?
We have to shake up this world. It’s not about being upset, because then they will call me an angry black woman. We cannot leave this world to our children. I’m the mother of a girl child who I want to not have to fight the [same battles] that I have fought as a woman. And I don’t want to have to walk into the spaces and have to keep my voice down just so that they will let me stay in the room because they must not feel threatened.
It is those institutions that have power, who will say to the likes of me, “what do you think about this?” over a phone call, when they have ten research assistants writing everything that I’ve said down, and then help them to l publish it as their own. People are still doing that, because I don’t have the time or resources.
We’re dealing with power cuts, we’re dealing with security issues, so we don’t have the time and space to reimagine this world. What we need is to reimagine the world of global health and the world of global development. We need to think about what equity looks like and have a conversation about institutional racism that says your voice has more value because you’re a man or because you’re caucasian.
Questions and answers have been edited for length and clarity.
Watch the full interview on Health Beat with Ayoade Alakija
New stroke treatment helps more Canadian patients return home to their normal lives – CBC.ca
The Current19:05Calls for greater access to life-saving treatment for stroke
When Marleen Conacher was taken to a hospital for major stroke treatment for the second time in a week in 2021, she wasn’t treated with a clot-busting drug like she was previously given at North Battleford Hospital in Saskatchewan.
Instead, she was transported directly to Royal University Hospital in Saskatoon, where a stroke team performed an endovascular thrombectomy (EVT).
The procedure involved passing small devices through one of the arteries in her groin, and then using suction, or tubes called stents to pull the stroke-causing blood clot out.
“I don’t recall when they, they put the little claw-like thing up through my groin and it went up through the artery and, and into my brain,” she said. “But I do remember feeling when they had got to it and were pulling it out.”
“It was a great deal of pressure. It did not hurt, but it was a great deal of pressure,” she told The Current‘s Matt Galloway.
Within a few days of the stroke, Conacher was out of the hospital, walking on her own and ready to go shopping.
She said she doesn’t think about the stroke much these days.
“I don’t spend a lot of time, you know, thinking about having a stroke or whatever or that time,” she said. “I just thank the good Lord that I am here.”
EVT procedures are a relatively new option in the field of ischemic stroke treatment. In 2015, a study known as the escape stroke trial led by the University of Calgary’s Hotchkiss Brain Institute found that, overall, positive outcomes for stroke patients increased from 20 per cent to 55 per cent thanks to EVTs.
Today, EVTs are used in about 25 to 30 major hospitals across Canada — and according to the senior study author and stroke specialist Dr. Michael Hill, it’s had a “massive treatment effect.”
“People would come in and they were paralyzed on one side, they couldn’t speak or they were severely affected, and they were leaving the hospital in two or three days,” he told Galloway.
“That was a visible change … whereas [before] people would have stayed many days and weeks for their recovery and rehab, if they survived at all.”
Speed is critical
Hill said the key to this procedure’s success is speed, as “10 or 15 minutes makes a difference.”
That’s why a patient is often greeted at the door by a team of emergency department nurses, physicians and the stroke specialist.
“When we’re alerted to a stroke or suspected stroke syndrome and we’re meeting somebody in the emergency room, we’re hustling to get there and be there before the patient or just after the patient arrives,” said Hill, who is a neurologist at the Foothills Medical Centre in Calgary.
WATCH: Dr. Michael Mayich explains how clots that cause strokes can be removed
From there, medical personnel conduct a clinical and imaging assessment to confirm if a patient has a blood clot and where it may be.
If the clot is in a location that is “amenable to a vascular treatment,” then an EVT will be offered.
Sedation can be approached in two ways, he said.
“Sometimes, patients are completely co-operative and we can do it completely awake. Sometimes they require some degree of sedation to keep them still.”
“You can imagine it’s important to do this procedure with your head relatively still. You can’t have them thrashing around.”
Hill said EVTs have a lot of potential in improving stroke treatment, as positive outcomes are a lot more frequent.
“So it’s terrific, right? We get people back to their lives,” he said.
In an ideal world, of course it’s available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?-Dr. Michael Hill, stroke physician
At the moment, EVTs aren’t available for all Canadians. Hill said the procedure is usually reserved for patients with the most severe forms of ischemic stroke, which occurs when the blood supply to part of the brain is interrupted or reduced.
“It’s a tertiary-level procedure. You’re not going to see it in a small, rural hospital,” he said.
But part of that has to do with the volume of cases needed in order to develop expertise in this field, and it’s big hospitals in major cities that tend to see the most patients.
“So if you’re just doing one a year, you’re more likely to have complications than you are to be successful,” he said. “Whereas if you’re doing 150 a year … everyone’s ready for these things to occur because you’re doing it so frequently.”
Still, it’s important to balance that expertise with availability.
“In an ideal world, of course [EVT is] available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?” He said.
For the time being, Conacher is content with how the procedure turned out — it’s been nearly two years and the only major impact the stroke has had is a bit of memory loss.
Furthermore, as someone who saw her dad suffer paralysis in his left side due to stroke, she’s pleased with the way stroke treatment is evolving.
“If they had things like this, I think he would have been just as fine as I was,” she said.
Produced by Ines Colabrese.
Study shows well-established protective gene for Alzheimer's only safeguards against cognitive decline in men – Sunnybrook Research Institute – Sunnybrook Hospital
The gene variant is one of three that can affect the chances of a person developing Alzheimer’s disease.
A new study led by Sunnybrook researchers has found that APOE ε2, a gene variant known to be protective against Alzheimer’s disease, is only protective in men and not women. The research was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association today.
“Previous research has shown that women have an increased risk of developing Alzheimer’s disease,” says Dr. Jennifer Rabin, senior author of the study and a scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute. “Although factors such as longer survival may contribute to why women are more likely to develop the disease, recent research suggests biological mechanisms may also impact sex differences in Alzheimer’s risk and progression.”
APOE ε2 is one of three inherited gene variants that can affect the chances of a person developing Alzheimer’s disease. Having the APOE ε2 variant decreases risk, whereas having the APOE ε4 variant increases risk. APOE ε3, the most common variant, is believed to have a neutral effect on the disease.
The collaborative study team, which included researchers from Canada and the United States, looked at whether sex modifies the association between the protective APOE ε2 gene variant and cognitive decline, using publicly available data from cognitively unimpaired adults that were part of four observational research sources.
The authors found that across two independent samples of participants, men with APOE ε2 were more protected against cognitive decline compared to women with the same APOE ε2 variant. In addition, men with APOE ε2 were more protected compared to men with the neutral gene variant (APOE ε3/ε3). However, this was not the case in women. In women, those with APOE ε2 were no more protected than those with the neutral gene variant (APOE ε3/ε3). The reasons for these sex-specific effects remain unclear. However, one possibility is that declining estrogen levels that occur with menopause may be a contributing factor given that estrogen has neuroprotective effects.
“These results suggest that the longstanding view that APOE ε2 provides protection against Alzheimer’s disease may require reevaluation,” says Madeline Wood, a graduate student at Sunnybrook and lead author of the study. “Our findings have important implications for developing sex-specific strategies to prevent and treat Alzheimer’s disease, particularly given that women are at a higher risk than men.”
The authors say the next step in their research is to continue to replicate the findings in large and diverse samples and to further investigate the sex-specific effects of APOE ε2 on Alzheimer’s disease biomarkers.
Funding for this study was supported by The Harquail Centre for Neuromodulation, the Dr. Sandra Black Centre for Brain Resilience & Recovery, Canadian Institutes of Health Research, and the Alzheimer’s Society of Canada.
Communications Manager, Sunnybrook Research Institute
WHO says medium-risk adults do not need extra COVID jabs – The Jakarta Post – The Jakarta Post
The World Health Organization said on Tuesday it is no longer recommending additional COVID-19 vaccine booster doses for regular, medium-risk adults as the benefit was marginal.
For such people who have received their primary vaccination course and one booster dose, there is no risk in having further jabs but the returns are slight, WHO’s vaccine experts said.
The United Nations health agency’s Strategic Advisory Group of Experts on Immunization (SAGE) issued updated recommendations after its regular biannual meeting.
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