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The Health Wrap: hundreds of thousands of lives saved, an HIV update, global hunger, and celebrating some wins

In her latest column, Associate Professor Lesley Russell shares some lessons from the United States about preventing COVID deaths, and also looks at what is needed, in Australia and globally, to reduce the toll of HIV/AIDS.

As the UN Food and Agriculture Organization releases its latest report on global food security, The Health Wrap also provides a timely overview of the intersections between climate change and food insecurity.

Russell also addresses some data gaps in Closing the Gap reporting.


Lesley Russell writes:

By the beginning of July, the United States had administered more than 328 million coronavirus vaccine doses, with 67 percent of adults having received at least one dose. The number of cases has fallen from more than 300,000 new infections and over 4,000 deaths per day at the apex of the pandemic in January 2021 to a seven-day average (the daily average measured over a week) of 12,809 infections and 263 deaths.

A study from the Yale School of Public Health and the Commonwealth Fund investigated the impact of vaccination from December 2020 through to July 2021.

It shows that the US COVID-19 vaccination campaign prevented up to 279,000 deaths and 1.25 million hospitalisations. It also blunted the impact of some of the virus variants such as the Alpha or UK strain.

However, as the report notes, millions of Americans remain unvaccinated, paving the way for the Delta variant to trigger a surge of new infections and deaths.

The disparity in vaccination rates pretty much breaks down along political lines. The New York Times found that both willingness to receive a vaccine and actual vaccination rates to date were lower, on average, in those counties where a majority of residents voted to re-elect former President Trump in 2020.

Mississippi has the lowest rate among the states, with 46.3 percent of residents having received at least one vaccine dose and 38.4 percent fully vaccinated.

The state, with a population of about three million (39 percent of whom are African American) has had over 324,000 reported cases of COVID-19, so over 10 percent of the population has antibodies from infection. And while the vaccination rates look bad by American standards, they are well ahead of Australia’s.

In a scary lesson for what could lie ahead unless Australia gets cracking, Mississippi now has 237 patients in hospital with confirmed or suspected COVID-19, 57 of these in ICU and 23 on ventilators.

Unvaccinated Mississippians now account for 96 percent of new infections, 95 percent of hospitalisations and 90 percent of deaths from COVID-19.

Yet the state has returned nearly 900,000 vaccines to the federal government due to low demand.


Birthday parties and other cautionary tales

This could really be headed “more lessons from the US”.

A consistent point the NSW public health officials have been making about the current coronavirus outbreak is that most infections are happening in the home.

A clever piece of analysis recently published in JAMA Internal Medicine and highlighted in The New York Times makes that case, and highlights what NSW has already demonstrated, specifically with the West Hoxton cluster: birthday parties are super spreader virus vectors.

Using health insurance claims data, the researchers looked at the coronavirus infection rates of families in the two weeks after one of them had a birthday. They found that a recent family birthday increased the COVID-19 risk by nearly a third in counties where the virus was widespread. The biggest infection risk was for a child’s birthday.

Their theory is that the increased risk is almost certainly explained by birthday parties – although insurance claims don’t show whether any individual patient had actually had a birthday party.

The study used data from 2020 when COVID-19 was much more common and fewer Americans were vaccinated. But its conclusions are still relevant for those who are unvaccinated today (Americans and Australians), especially with the more contagious Delta variant.

There’s another cautionary tale from the United States about the impact of community gatherings on the spread of coronavirus – this time it’s in-person voting.

Remember how hard Trump and conservative Republicans fought to stop mail-in voting and force people to show up in person often waiting for hours in long lines to vote?

An analysis by The Economist (you have to sign in to access it) shows that places where a high share of votes were cast in person on election day – distinct from both postal ballots and votes submitted in person before the election – also had high COIVID-19 rates in the days after November 3.

As the researchers note, this does not prove that polling sites were to blame. Many places with lots of in-person voting on election day were either in areas of low-socioeconomic status with high numbers of African Americans or areas that supported Trump and were sceptical of masks and social distancing – both aspects putting people at increased risk of infection.


The HIV/AIDS story – 40 years on

I’m a little late with this, but it’s too important to ignore.

Forty years ago this month (on July 3, 1981) a story in The New York Times made the paper’s first mention of a disease baffling doctors.

“Rare cancer seen in 41 homosexuals,” said the headline, atop a story buried on page 20. “The cause of the outbreak is unknown, and there is as yet no evidence of contagion.” (You can see the original story here.)

The story followed the publication on June 5, 1981 by the Centers for Disease Control (CDC) of an MMRW report of Pneumocystis carinii pneumonia in five previously healthy young men in Los Angeles, California, of whom two had already died. This report later was acknowledged as the first published scientific account of what would become known as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).

It was the beginning of a terrible time that for many people who are living with HIV/AIDS continues today – HIV/AIDS is a leading cause of death in Africa.

In 1981 I was living and working in the United States, initially in the Microbiology Department at Uniformed Services University of the Health Sciences (the Department of Defense Medical School) and then from 1984, as a senior policy advisor in the US Congress. So I was really in the middle of the political history of HIV/AIDS in the United States, as outlined for example in Randy Shilts’ book “And the Band Played On”. It was a very interesting and challenging time.

Many of the people who are leading the way today in the coronavirus pandemic in the United States, Australia and internationally were also involved in the efforts to understand, control and treat HIV/AIDS. There is much that HIV can teach us about the pandemic we face today.

Like coronavirus, AIDS is an “epidemic of inequalities”. Half of the people newly infected with HIV in 2020 were women and girls. Ending AIDS by 2030 is both a prerequisite for — and a result of — implementing the Sustainable Development Goals.

In a declaration passed in June this year the United Nations adopted new targets for ending AIDS as a public health threat by 2030. This is a goal most countries could easily have agreed to, but consensus around a number of issues was elusive. A good summary of the issues and outcomes that led to the final declaration language is here.

The declaration has a new target that looks to have 95 percent of people at risk of HIV use combination HIV prevention services, with a greater emphasis on community-led provision of services.

There is also an important new goal of having nations reform discriminatory laws and measures that unfairly target people at risk of, or living with, HIV. Countries that criminalise same-sex relationships, drug use and sex work have had much less success in tackling HIV, research shows.

But the declaration was not able to deliver changes on patent protections for medications. The United States was among those nations whose delegates significantly watered down language to relax patents to allow for greater access to affordable HIV drugs internationally. This stance is at direct odds with the Biden Administration’s support of patent waivers for COVID-19 vaccines.

I was unable to determine Australia’s position on this, but given that the Morrison Government has so far failed to support moves to waive patents on COVID-19 vaccines, I fear they aligned with the United States.

There is still a long way to go to get HIV/AIDS under control, and the current focus on the coronavirus pandemic is diverting attention from this.

Extract, AFAO report

In 2016 the UN goals were for fewer than 500,000 new HIV infections annually, fewer than 500,000 AIDS-related deaths. The world did not meet those targets: about 1.5 million people became infected with HIV in 2020, and about 690,000 died.

In Australia, research from the Kirby Institute shows that the broad availability of the HIV-prevention drug tenofovir with emtricitabine (known as PrEP) reduced HIV transmissions in New South Wales by 40 percent, to an all-time low, in the period 2016 to 2019.

However, the researchers warned that the elimination of HIV in Australia will require better adherence to PrEP among young people. There were 903 HIV diagnoses in Australia in 2019, representing a decline of 12 percent (over 20 percent in gay and bisexual men) over the past five years.

The Australian Federation of AIDS Organisations has produced a report that says Australia can end HIV transmission in the country by 2025. You can read the “Agenda 2025” report here.

The report, which has been delivered the Health Minister Greg Hunt, shows that a federal government investment of a further $53 million in testing, treatment, prevention and a campaign to reduce stigma would prevent 6000 infections by 2030 and save $1.4 billion in health costs.

So far, not a word on this from Minister Hunt.


Climate change and food shortages – globally and locally

In the previous edition of The Health Wrap, I wrote about how the coronavirus pandemic has increased food insecurity in developed countries like Australia and the consequent links with mental health problems. That alerted me to issues around climate change and food insecurity.

Surging consumer food prices are a growing global problem, making food staples in many countries unaffordable. An Oxfam report just out says that world hunger rose steeply in 2020, with six times more people living in “famine-like conditions” than in 2019. Oxfam calculates that 11 ­people a minute are likely to be dying from acute hunger, compared to seven people a minute from COVID-19.

Last December the head of the World Food Programme told the UN General Assembly that global famine was “knocking on the door”. Thirty-four million people are estimated to be “a step away from famine”.

The UN Food and Agriculture Organization (FAO) says its food price index, which measures the global price of select foods, hit highs in May not seen since 2011. A variety of factors are to blame, but the two global crises – coronavirus and climate change – and driving what will soon be a third crisis.

A new FAO report on global food security has just been released, estimating that between 720 and 811 million people in the world faced hunger in 2020 – as many as 161 million more than in 2019. “The high cost of healthy diets and persistently high levels of poverty and income inequality continue to keep healthy diets out of reach for around three billion people in every region of the world,” it says.

See more on new FAO report at #SOFI2021 on Twitter

A 2019 UN report outlined how extreme weather as a result of climate change, combined with loss of agricultural land and the mismanagement of water resources, will shrink the global food supply. The potential risk of “multi-breadbasket failure” was seen as a particular threat.

The dramatic effects of climate change on the environment and on health have been much in the news lately.

Over past weeks the media has been full of stories about the terrible heatwave that has lingered over Northern America. Record temperatures have been recorded in places like Oregon and British Columbia, with hundreds of deaths and a huge impact on the environment. Even in Death Valley – acknowledged as the hottest place in America – records have been shattered.

An international consortium of scientists has concluded that a robust relationship exists between top-tier heat extremes and human-caused climate change. They state that greenhouse gas emissions made the heat wave at least 150 times more likely to occur.

Less international attention has been paid to heatwaves of similar magnitude in Middle East, the Arabian peninsula, and the Indian sub-continent.

Similarly, the final report of the Earth Systems and Climate Change Hub highlights how climate change is affecting Australia’s weather, with marine and land heatwaves becoming become more frequent and intense, and thunderstorms causing more flooding. dumping more will dump more rain and worsen floods as the globe heats up.

A study published last month in Nature Climate Change finds than a third of all heat-related deaths around the world between 1991 and 2018 can be attributed to human-induced global warming.

There’s a raft of reports that highlight what climate change means for food production, availability and prices in Australia. In addition, as noted in a 2015 report from the Climate Council,  Australia’s food supply chains are vulnerable to extreme weather events.

A 2018 report from the Senate Standing Committees on Foreign Affairs, Defence and Trade that looked at the implications of climate change for Australia’s national security found that climate change “threatens the security and quality of water sources and the productivity of major agricultural regions in Australia, with implications for ensuring food and water security for a growing population”.

It recommended that the Commonwealth Government develop a National Climate, Health and Wellbeing Plan. This is an issue the Climate and Health Alliance has actively promoted.

There have been three parliamentary inquiries into the price and quality of food in stores in remote communities (with a special focus on Indigenous communities) in the past 11 years. In an article in Croakey Health Media last year, Professors Bronwyn Fredericks and Odette Best called for sustained solutions to these problems.

This week, public health researchers have underscored the urgency of addressing food security issues for children, warning food insecurity should be understood as a form of trauma.

It’s disappointing that the Morrison Government is so reluctant to address these issues – or even acknowledge them (climate change was virtually ignored in the most recent Intergenerational Report).

The Australian Institute of Family Studies (a federal government agency whose work the government consistently ignores) has some excellent information about food insecurity in Australia and, importantly, how to address this.

One issue highlighted is that food security is not measured regularly or consistently at a population level. Estimates suggest that between 4 percent and 13 percent of the general population and 22 percent to 32 percent of the Indigenous population are food insecure.

There’s not much good news in this area, but I recently came across this encouraging story about the work of Food Ladder in Indigenous communities. Food Ladder runs projects in Katherine and Tennant Creek and now children in the West Australian outback town of Leonora are about to learn how to grow their own produce.

This links in with this story, published last year in Croakey Health Media, about what VicHealth is doing to help grow a more resilient food system.

Croakey Health Media has a wealth of resources on global health and climate change and heatwave health.


The data gap on Closing the Gap reporting

The Productivity Commission has launched the Closing the Gap Information Repository to inform and improve reporting around the priority reforms and socioeconomic outcome areas outlined in the National Agreement on Closing the Gap which was launched last year.

For the four priority reform areas (formal partnerships and shared decision-making; building the community-controlled sector; transforming government organisations; shared access to data and information at a regional level  – areas that primarily relate to a better partnership between government and Indigenous leaders and communities), only the targets and supporting indicators are available, with no data to populate these. The dashboard says “reporting for this priority reform is yet to be developed”.

Of the 17 socioeconomic outcomes, three are new so there are only baseline data. Of the remainder, only three areas are on track to meet the set targets, four are not on track given current trends, and – shockingly and frustratingly – seven areas have no up-to-date data to inform them. In some cases the most recent data are from 2016.

The National Indigenous Times, makes the point that only 60 percent of Closing the Gap targets have data. Until up-to-date data are available and acted upon, it’s hard to see how programs and initiatives can be effectively resourced and targeted and outcomes accurately assessed.

As stated by ProBono Australia, this means: “Our ability to effect real change is not being met. The right to self-determination by Indigenous communities through the delivery of high-quality, culturally safe, and responsive programs and services that meet the needs of Aboriginal and Torres Strait Islander people across the country is not being delivered.”

While funds have been provided to the Productivity Commission for this reporting ($10.1 million over four years in the 2020-21 Budget), this is clearly not enough to enable the missing data gaps to be filled.


The best of Croakey

Don’t miss these two articles:

Return to country endangered by failure to invest – by Aboriginal and Torres Strait Islander Social Justice Commissioner June Oscar.

Heal Country – a timely call for action and justice – by Dr Janine Mohamed and Nicole Bowman, of the Lowitja Institute.

 


The good news story

How could I go past the victories of two Aussie tennis legends this past weekend?

Like many, I stayed up late to watch the matches, to celebrate the amazing wins of Ashleigh Barty and Dylan Alcott and to join the Barty Party. We all needed those feel-good moments, a welcome break from the endless coronavirus updates here in Sydney.

Ash Barty’s win and her homage to Evonne Goolagong Cawley was a glorious way to cap off NAIDOC week.

I am amazed at the athletic prowess and speed of Dylan Alcott. I once tried to play tennis in a wheelchair and I had more spills than hits (true, I am a terrible tennis player even on two feet). But even Novak Djokovic found it impossibly hard.


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.


See Croakey’s archive of stories on healthcare and health reform.

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