Health and Healing

[kmaherali]

Cameroon will be the first country to routinely give children a new malaria vaccine as the shots are rolled out in Africa.

The campaign due to start Monday was described by officials as a milestone in the decades-long effort to curb the mosquito-spread disease on the continent, which accounts for 95% of the world’s malaria deaths.

“The vaccination will save lives. It will provide major relief to families and the country’s health system,” said Aurelia Nguyen, chief program officer at the Gavi vaccines alliance, which is helping Cameroon secure the shots.

The Central Africa nation hopes to vaccinate about 250,000 children this year and next year. Gavi said it is working with 20 other African countries to help them get the vaccine and that those countries will hopefully immunize more than 6 million children through 2025.

In Africa, there are about 250 million cases of the parasitic disease each year, including 600,000 deaths, mostly in young children.

Cameroon will use the first of two recently approved malaria vaccines, known as Mosquirix. The World Health Organization endorsed the vaccine two years ago, acknowledging that that even though it is imperfect, its use would still dramatically reduce severe infections and hospitalizations.

The GlaxoSmithKline-produced shot is only about 30% effective, requires four doses and protection begins to fade after several months. The vaccine was tested in Africa and used in pilot programs in three countries.

GSK has said it can only produce about 15 million doses of Mosquirix a year and some experts believe a second malaria vaccine developed by Oxford University and approved by WHO in October might be a more practical solution. That vaccine is cheaper, requires three doses and India’s Serum Institute said they could make up to 200 million doses a year.

Gavi’s Nguyen said they hoped there might be enough of the Oxford vaccines available to begin immunizing people later this year.

Neither of the malaria vaccines stop transmission, so other tools like bed nets and insecticidal spraying will still be critical. The malaria parasite mostly spreads to people via infected mosquitoes and can cause symptoms including fever, headaches and chills.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

https://apnews.com/article/malaria-vacc ... 778d3e6de3

[kmaherali]

Medical Meditation? Clinical Yoga? Alternative Therapies Go Mainstream.

More than one-third of American adults now supplement or substitute mainstream medical care with treatments long considered alternative.


Therapies such as yoga, long considered alternative, is now practiced by 22 percent of adult pain patients.Credit...Sophie Park for The New York Times

The doctor is in. So is the yogi.

A sharp shift in health care is taking place as more than one-third of American adults now supplement or substitute mainstream medical care with acupuncture, meditation, yoga and other therapies long considered alternative.

In 2022, 37 percent of adult pain patients used nontraditional medical care, a marked rise from 19 percent in 2002, according to research published this week in JAMA. The change has been propelled by growing insurance reimbursement for clinical alternatives, more scientific evidence of their effectiveness and an increasing acceptance among patients.

“It’s become part of the culture of the United States,” said Richard Nahin, the paper’s lead author and an epidemiologist at the National Center of Complementary and Integrative Health, a division of the National Institutes of Health. “We’re talking about the use for general wellness, stress management use, sleep, energy, immune health.”

And for pain management. The use of yoga to manage pain rose to 29 percent in 2022 from 11 percent in 2002, an increase that Dr. Nahin said reflected in part efforts by patients to find alternatives to opiates, and the influence of media and social media.

“It’s in the public domain so much,” he said. “People hear acupuncture, meditation, yoga. They start to learn.”

The change is impacting medical practitioners as well. Dr. Sean Mackey, chief of the pain medicine division at Stanford Medicine, said that a growing number of studies have validated alternative therapies, providing even traditional clinics like Stanford’s with more mind-body therapies and other nonpharmaceutical tools. He said the acceptance of those ideas has grown among younger people in particular, whereas patients of earlier generations may have seen these options as too out there.

“Our parents and our grandparents would look at them and they’re like, What, are you kidding me?”

At the same time, Dr. Mackey said, the growing prominence of the therapies can be a “double-edged sword” because they do not always provide the relief that is marketed.

“My advice to people when they’re pursuing this is to do these things for a trial,” he said. “But if it’s not providing long-term durable benefits, don’t just keep doing it.”

The JAMA article drew its data from the 2002, 2012 and 2022 National Health Interview Survey, which was conducted in person and by telephone. Researchers used the data to evaluate the use of seven complementary health care approaches: acupuncture, chiropractic care, guided imagery, massage therapy, meditation, naturopathy and yoga.

Meditation as a health therapy jumped sharply, to around 17 percent of American adults in 2022, from around 7.5 percent two decades earlier. Dr. Nihan said that the low cost was a factor: “How much does it cost to do meditation and yoga?” Such activities vary widely in price, depending on whether they are done at home or in classes.

For some people, the alternatives seem to prove superior. Jee Kim started down the traditional-medicine path in 2022 when he was grappling with sleeplessness and anxiety from a separation. His primary care doctor in Boulder, Colo., prescribed medications that Mr. Kim used initially but found to have intolerable side effects.

“I got serious about yoga and meditation,” he said, ultimately finding them a better solution. “I tried the pharmaceutical route, but I wanted tools I could come back to. I knew it wouldn’t be my last hard life transition.”

Mr. Kim, 49, a political consultant and a former college tennis player who still plays avidly, also credits yoga with helping stave off injury, so much so that he has become an occasional yoga instructor himself. “It’s a pillar of my physical and mental health, at work too,” he said.

Dr. Jennifer Rhodes, a psychiatrist in Boulder who specializes in treating women going through hormonal changes, said that a “majority of my patients use supplementary intervention like those for stress management,” referring to the therapies in the survey.

She said that she embraced the concept but cautioned that medications can be crucial, too.

“Do acupuncture and massage,” she said. “But it’s not fair to ask for someone who is severely depressed or anxious and not functioning to employ those until they calm their nervous system down.”

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

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https://www.nytimes.com/2024/02/02/heal ... 778d3e6de3

[kmaherali]

How many STEPS should I walk per day to stay HEALTHY?

How many steps should I walk per day to stay healthy? This video will summarize the major health benefits of daily walking and how many steps you need to maximize those effects. Benefits include improved mortality, decreased cardiovascular risk, improved cognition, better immune response, and stronger mental health.

Video: https://www.youtube.com/watch?v=bs_lVqcWDB4

[kmaherali]

The man continues to improve, doctors said. Organs from genetically engineered pigs one day may make dialysis obsolete.


Surgeons performed the world’s first genetically modified pig kidney transplant into a living human at Massachusetts General Hospital on March 16.Credit...Michelle Rose/Massachusetts General Hospital, via Agence France-Presse — Getty Images

Surgeons in Boston have transplanted a kidney from a genetically engineered pig into an ailing 62-year-old man, the first procedure of its kind. If successful, the breakthrough offers hope to hundreds of thousands of Americans whose kidneys have failed.

So far, the signs are promising.

Kidneys remove waste products and excess fluid from the blood. The new kidney began producing urine shortly after the surgery last weekend and the patient’s condition continues to improve, according to physicians at Massachusetts General Hospital, known as Mass General. He is already walking the halls of the hospital and may be discharged soon.

The patient is a Black man, and the procedure may have special significance for Black patients, who suffer high rates of end-stage kidney disease.

A new source of kidneys “could solve an intractable problem in the field — the inadequate access of minority patients to kidney transplants,” said Dr. Winfred Williams, associate chief of the nephrology division at Mass General and the patient’s primary kidney doctor.

If kidneys from genetically modified animals can be transplanted on a large scale, dialysis “will become obsolete,” said Dr. Leonardo V. Riella, medical director for kidney transplantation at Mass General. The hospital’s parent organization, Mass General Brigham, developed the transplant program.

Over 800,000 Americans have kidney failure and require dialysis, a procedure that filters toxins from the blood. Over 100,000 are on a waiting list to receive a transplanted kidney from a living or dead human donor. End-stage kidney disease is three times more common among Black Americans than among white people.

In addition, tens of millions of Americans have chronic kidney disease, which can lead to organ failure.

More on Organ Transplants
Harvesting Organs: A new method for retrieving hearts from organ donors has ignited a debate over the surprisingly blurry line between life and death in a hospital. https://www.nytimes.com/2023/11/22/nyre ... nks_recirc

‘Morally Inconsistent’: Undocumented immigrants face high hurdles to receiving organ transplants themselves, even though they can donate organs, and more of them are signing up to do so. Some advocates and lawmakers are trying to change things. https://www.nytimes.com/2023/05/16/nyre ... nks_recirc

Solving the Shortage: The use of genetically engineered pigs could help solve the donor-organ shortage. But considerable hurdles remain, including concerns over the potential introduction of animal pathogens into the human population. https://www.nytimes.com/interactive/201 ... nks_recirc

Reversing Death?: A group of researchers was able to revive cells in the organs of dead pigs. They hope their findings will one day help obtain viable human organs for transplants long after death. https://www.nytimes.com/2022/08/03/scie ... nks_recirc

While dialysis keeps people alive, the gold-standard treatment is an organ transplant. Thousands of patients die annually while waiting for a kidney, however, because there is an acute shortage of organs. Just 25,000 kidney transplants are performed each year.

Xenotransplantation — the implantation of an animal’s organ into a human — has for decades been proposed as a potential solution that could make kidneys much more widely available. But the human immune system rejects foreign tissue, causing life-threatening complications, and experts note that long-term rejection can occur even when donors are well matched.

In recent years, scientific advances including gene editing and cloning have edged xenotransplants closer to reality, making it possible to modify animal genes to make the organs more compatible and less likely to be rejected by the immune system.

The kidney came from a pig engineered by the biotech company eGenesis, which removed three genes involved in potential rejection of the organ. In addition, seven human genes were inserted to enhance human compatibility. Pigs carry retroviruses that may infect humans, and the company also inactivated the pathogens.

In September 2021, surgeons at NYU Langone Health in New York attached a kidney from a genetically modified pig to a brain-dead man and watched as it began to function and make urine. Shortly afterward, scientists at the University of Alabama at Birmingham announced they had performed a similar procedure with similar results.

Surgeons at the University of Maryland have twice transplanted hearts from genetically modified pigs into patients with heart disease. While the organs functioned and the first did not appear to be rejected, both of the patients, who had advanced disease, died shortly afterward.

(Patients who agree to these cutting-edge experimental treatments are usually extremely ill and have few options available; often they are too sick to qualify for the waiting list for a precious human organ or are not eligible for other reasons.)

The transplant patient in Boston, Richard “Rick” Slayman, a state transportation department supervisor, had suffered from diabetes and hypertension for many years, and had been under treatment at Mass General for over a decade.

After his kidneys failed, Mr. Slayman was on dialysis for seven years, eventually receiving a human kidney in 2018. But the donated organ failed within five years, and he developed other complications, including congestive heart failure, Dr. Williams said.

When Mr. Slayman resumed dialysis in 2023, he experienced severe vascular complications — his blood vessels were clotting and failing — and he needed recurrent hospitalization, Dr. Williams said.

Mr. Slayman, who kept working despite his health problems, faced a long wait for another human kidney, and “he was growing despondent,” Dr. Williams said. “He said, ‘I just can’t go on like this. I can’t keep doing this.’ I started to think about extraordinary measures we could take.”

“He would have had to wait five to six years for a human kidney. He would not have been able to survive it,” Dr. Williams added.

When Dr. Williams asked Mr. Slayman about receiving a pig’s kidney, Mr. Slayman had many questions but eventually decided to proceed.

“I saw it not only as a way to help me, but a way to provide hope for thousands of people who need a transplant to survive,” he said in a statement provided by Mass General.

Mr. Slayman’s new kidney seems to be functional, so far, and he has been able to stop dialysis. The new pig kidney is making urine and filtering out creatinine, a waste product.

Other measures are also improving daily, his doctors said. Doctors will continue to monitor Mr. Slayman for signs of organ rejection.

“He looks like his own self. It’s remarkable,” Dr. Williams said.

The surgery was not without critics. Xenotransplantation raises the prospect of still greater exploitation of animals and may introduce new pathogens into human populations, said Kathy Guillermo, senior vice president at People for the Ethical Treatment of Animals.

“Using pigs as a source of spare parts is dangerous to the human patients, deadly for the animals and may bring about the next pandemic,” she said. “It’s impossible to eliminate, or even identify, all the viruses that pigs carry. Researchers need to focus on cleaning up the organ donation system and leave the animals alone.”

The four-hour operation was carried out by a team of surgeons, including Dr. Tatsuo Kawai, director of the Legorreta Center for Clinical Transplant Tolerance at Mass General, and Dr. Nahel Elias.

The procedure was performed under a Food and Drug Administration protocol known as a compassionate use provision, which is granted to patients with life-threatening illness who might benefit from an unapproved treatment. New drugs to suppress the immune system and prevent rejection of the organ were also used under the protocol.

“He’s remarkably courageous to step forward,” Dr. Williams said of Mr. Slayman. “Hats off to him. He’s making a huge contribution with this.”

A correction was made on March 21, 2024: An earlier version of this article misstated the kidney’s function regarding creatinine. The kidney removes the substance from the blood; the organ does not create creatinine.

https://www.nytimes.com/2024/03/21/heal ... 778d3e6de3

[swamidada]

Autism and SDGs
Rukhsana Shah Published April 2, 2024 Updated about 23 hours ago
The writer, a former federal secretary, is CEO, ASD Welfare Trust

THE 2024 observance of World Autism Day is aligned with the implementation status and progress on the Sustainable Development Goals. Autism is a neurodevelopmental condition representing human evolution and neurodiversity among all world populations. The SDGs are universally agreed goals adopted in 2015 by the UN to bridge economic disparities in 17 overlapping areas including access to quality health, education and safety. They promote gender equality and inclusive economic growth and employment for all.

The Sustainable Development Agenda was to be fulfilled by 2030. However, the SDG report of 2023 shows that progress on more than 50 per cent of targets is inadequate while in 30pc, it has reversed. The most important reason cited is the neoliberal fiscal and monetary policy environm­ent created by the “outdated, dysfunctional and unfair international financial architecture” of the 1940s’ Bretton Woods institutions. Inequalities within rich and poor countries are increasing, and the North-South divide is deepening. According to the report, the SDGs are in peril; their failure would sound the death knell for the planet.

Centuries of colonisation and exploitation have left developing countries with the poorest, most vulnerable people. Continu­ing injustices through institutional monetary and political instruments play a major role in the lack of progress on SDGs. The promise of increasing official development assistance by developed countries towards achieving the SDGs hasn’t been kept, and targets on climate change haven’t met with success, not least because the financial co­­m­­­­­mitment of $100 billion per year was ignored.

Poor progress on SDGs is bad news for the marginalised.

At the same time, the developing countries’ governments cannot be absolved of their responsibility of eradicating poverty and providing education, health, access and employment opportunities to their people. In the 2023 Human Development Ind­ex, Pakistan ranks below Togo and Rwanda, with only 4.4 average years of education (SDG-4), while India and Bangladesh (se­ven years) are in the Medium Development Index, and Iran and Sri Lanka (11 years) in the High Development Index. The SDG Status Report issued by the Planning Com­mission in 2021 admits Pakistan’s progress has been dismal in education and poor on economic growth and employment.

Pakistan has failed to provide literacy to 60pc of its population in the last 77 years; its primary and secondary healthcare systems are deteriorating due to low budgetary allocations and unbridled population growth; poverty is rising; its infrastructure of roads, railways and air travel is collapsing; business growth is restricted by high interest rates, chronic energy deficit, rentier capitalism and elite capture; and its position on world indices of poverty alleviation, economic opportunities, per capita productivity, human rights, safety, gender equality, inclusion of persons with disabilities and almost everything else has remained at shamefully low levels.

A critical component of development in general and achieving SDGs in particular, is good governance, oversight and accountability of governments and public institutions. Governance in Pakistan has deteriorated alarmingly, with the bureaucracy and state institutions becoming partisan, self-serving and rapacious. Two political dynasties have ruled in the name of democracy for more than 40 years, evading public accountability, weakening domestic institutions, and compromising national interest with ad hoc policy decisions. The SDGs have thus been sidelined.

The options of economic recovery are fast disappearing for Pakistan and other countries on the radar of the US and EU agenda in their war for capitalist hegemony. The re­­cent failure of UN agencies, int­ernational hum­an rights groups and Western media to stop genocide in Palestine has ex­­posed the hollowness of many slogans fed to the world in the last 80 years. This debacle has undermined the credibility of international institutions and also called into question developed countries’ respect for international law.

In 2019, Pakistan ranked 67th on the World Happiness Index, faring better than many developing countries. Cynics said it was due to our low self-esteem and lack of awareness.

In 2023, this ranking fell by 41 positions to 108 mainly because of a public awakening as to what could have been. There is widespread anger, frustration, and bitterness. People with a formal education or a degree are migrating abroad, triggering Pakistan’s biggest brain drain.

In our bleak environment of economic, sociocultural and political insolvency, achieving the SDGs seems impossible in the next seven years, particularly those relating to access, education, vocational training, employment and inclusion of persons with autism, physical dis-abilities, women, and all marginalised communities.

The writer, a former federal secretary, is CEO, ASD Welfare Trust.

Published in Dawn, April 2nd, 2024

https://www.dawn.com/news/1825180/autism-and-sdgs

[kmaherali]

Cracking the Chronic Illness Code: Ticks, Toxins & Mold



Hi Karim,

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- What role does the nervous system play in healing from chronic illness?
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[swamidada]

Fox News
Having trouble sleeping? It could be for this surprising reason, experts say
Melissa Rudy
Thu, April 18, 2024 at 3:40 AM CDT·

Having trouble sleeping? It could be for this surprising reason, experts say
When creating an ideal sleeping environment, you might think of lighting, temperature and sound — but what about food?

What you eat during the day can have a surprising impact on how well you sleep at night, according to experts.

"Food choice is an essential consideration for ensuring good sleep quality. Some types of food promote sleep while others may cause sleep disruption," Dr. Chelsie Rohrscheib, head sleep expert at Wesper, a sleep analysis company in New York, told Fox News Digital.

Here's what to know.

If after eating you’re struggling to fall asleep, waking up often during the night or experiencing heartburn, acid reflux or indigestion, your food choices could be the culprit, according to Dr. Raj Dasgupta, chief medical adviser at Sleepopolis in California.

What you eat can have an impact on how well you sleep at night, experts say.
Other warning signs include experiencing restlessness or stomach discomfort, needing more frequent bathroom breaks at night, or waking up feeling groggy or unrested.

"Having intense dreams or nightmares or noticing changes in your usual sleep routine" are other indications that food could be interfering with sleep, Dasgupta said.

"Paying attention to these cues can help you figure out if certain foods or drinks are messing with your sleep quality, so you can make adjustments as needed for better rest," he said.

Foods that encourage better sleep include meals with a good amount of lean protein, meals that are high in fiber, and meals that are rich in complex carbohydrates, according to Rohrscheib.

"This food combination keeps us feeling full and satisfied throughout the night and prevents us from waking up from hunger," she said.

"Having intense dreams or nightmares or noticing changes in your usual sleep routine" are other indications that food choices could be interfering with sleep, an expert said.
"It also reduces the risk of indigestion and heartburn."

Foods containing dairy are especially beneficial, she said, because they contain tryptophan, an amino acid that is essential for the production of serotonin and melatonin, two chemicals needed for sleep.

Bananas can also help promote sleep, according to Dasgupta.

"They contain magnesium and tryptophan, which can help you relax and boost production of sleep-inducing hormones," he told Fox News Digital.

Almonds provide magnesium for muscle relaxation and also contain protein and healthy fats to keep blood sugar levels stable, said an expert.
Almonds also provide magnesium for muscle relaxation; they contain protein and healthy fats to keep blood sugar levels stable, he said.

"Cherries contain natural melatonin, potentially helping to regulate your sleep-wake cycles," Dasgupta said.

Oatmeal is also a sleep-friendly food.

"Its complex carbohydrates increase serotonin levels, while its melatonin content helps to regulate sleep," said Dasgupta.

Bananas can help with quality sleep because they contain magnesium and tryptophan, which can promote relaxation, an expert said.
"Kiwi is loaded with antioxidants, vitamins and serotonin, all of which support sleep pattern regulation," he said.

Dasgupta also recommends eating Greek yogurt to promote improved sleep, as its calcium content assists in the body's use of tryptophan for melatonin production, while its protein helps maintain blood sugar levels.

"Finally, warm milk, with its tryptophan content and comforting warmth, can help you relax" for a good night's sleep, he said.

Those who are lactose-intolerant can opt for warm almond milk.

Some foods are more likely to cause indigestion and heartburn, which makes it difficult to fall asleep and maintain sleep, according to Rohrscheib.

"This includes foods with high fat or acid content, foods containing caffeine, or spicy foods," she said.

Dasgupta agreed that eating heavy or spicy foods ahead of bedtime can cause stomach discomfort, heartburn and acid reflux, which can make it harder to settle down comfortably.

Eating heavy or spicy foods can cause stomach discomfort, heartburn and acid reflux, which can make it harder to settle down comfortably for the night, an expert said.
"Greasy or heavy meals take longer to digest, which can leave you feeling uncomfortable and disrupt your sleep," he advised.

Caffeine is also a common culprit in sleep disruption — experts recommend avoiding it in the hours leading up to bedtime.

"Any food containing caffeine, even small amounts, should be avoided to prevent sleep disruption," Rohrscheib said. "This includes coffee, some teas, sodas, energy drinks and some chocolates."

It’s best to abstain from alcohol as well, Dasgupta said. "While it might seem like a nightcap, it messes with your sleep cycles, leading to worse sleep quality."

Caffeine is also a common culprit in sleep disruption — experts recommend avoiding it in the hours leading up to bedtime.
Highly processed foods and foods containing high amounts of sugar cause a quick spike in glucose levels and increase the risk of a "blood sugar crash," also known as hypoglycemia, Rohrscheib warned.

"When we're hypoglycemic, our brain will attempt to wake us up to eat more food to normalize our blood glucose levels," she said. "Thus, these foods should be avoided before bedtime."

"Lastly, processed or junk foods, loaded with additives and unhealthy fats, can throw off your sleep patterns," Dasgupta added.

"Regardless of the type of meal you eat, consuming too much and making yourself over-full is likely to make you uncomfortable and cause poor sleep quality," Rohrscheib said.

https://currently.att.yahoo.com/att/cm/ ... 21622.html

[kmaherali]

Millions of Girls in Africa Will Miss HPV Shots After Merck Production Problem

The company has told countries that it can supply only 18.8 million of the 29.6 million doses it was contracted to deliver this year.



On the way to class in Freetown, Sierra Leone. The delayed vaccines means that girls in countries such as Sierra Leone, Burkina Faso and Mozambique who are now 14 will no longer be eligible for vaccination when these campaigns finally start.Credit...John Wessels/Agence France-Presse — Getty Images

Nearly 1.5 million teenage girls in some of the world’s poorest countries will miss the chance to be protected from cervical cancer because the drugmaker Merck has said it will not be able to deliver millions of promised doses of the HPV vaccine this year.

Merck has notified Gavi, the international organization that helps low- and middle-income countries deliver lifesaving immunizations, and UNICEF, which procures the vaccines, that it will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in 2024, Gavi said.

That means that more than 10 million girls will not receive their expected HPV shots this year — and 1.5 million of them most likely will never get them because they will be too old to qualify for the vaccine in subsequent years.

Patrick Ryan, a spokesman for Merck, said the company “experienced a manufacturing disruption” that required it to hold and reinspect many doses by hand. He declined to give further details about the cause of the delay.

“We are acting with urgency and rigor to deploy additional personnel and resources to resolve this matter as soon as possible,” he said.

Mr. Ryan said that Merck would deliver the delayed doses in 2025.

He also said the company would ship 30 million doses of the vaccine to Gavi-supported countries this year. However, about a third of these are doses that were supposed to have been sent in 2023, leaving Gavi with the 10.7 million dose shortfall.

The delay is a big setback for countries that had already waited years to begin vaccinating girls against HPV, the human papillomavirus, which causes an estimated 90 percent of cervical cancers.

About 350,000 women die from cervical cancer annually, according the World Health Organization. Ninety percent of them are in low-income countries, where routine screening for the disease is rare. The vaccine offers near-total protection against HPV infection, making it the lone vaccine against cancer.

“HPV is the highest impact vaccine Gavi has: If you vaccinate 1,000 girls, you prevent 17.4 future deaths,” said Dr. Aurélia Nguyen, Gavi’s chief program officer. “If there is one vaccine that you want to get out and do well on, this is it.”

The W.H.O. recommends the vaccine for girls up to age 14. The delay means that girls in countries including Sierra Leone, Burkina Faso and Mozambique who are now 14 will no longer be eligible for vaccination when these campaigns finally start.

The HPV vaccine is a complex one to deliver, since it is associated with sexual activity, a taboo topic for teenagers in many of the cultures affected by the delay, and because it is given to children who are outside the usual age for routine immunization. Both girls and their parents must be amenable to vaccination, and that requires crafting distinct messages, delivered on different media, to drum up demand. The vaccine has to be given before girls are sexually active to be effective.

Image
A close-up view of a vial of HPV vaccine.

Merck notified Gavi that it will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in sub-Saharan Africa in 2024.Credit...Joe Raedle/Getty Images

The countries affected have some of the lowest-resource health systems in the world, Dr. Nguyen said. They have invested in planning for the scrapped HPV campaign, while juggling other urgent vaccination needs such as measles or cholera, and can ill-afford the disruption, she said.

The delay will disrupt carefully laid plans to catch up on vaccinations — most of the delayed doses were bound for what’s called “multi-age cohorts,” when countries try to reach all unvaccinated girls between 9 and 14, alongside a standard immunization program for 9-year-olds, usually run in schools.

Most high-income countries routinely vaccinate both girls and boys against HPV, but the global coverage rate for the vaccine is only 20 percent.

Gavi has been trying to expand HPV vaccination for more than a decade. Many low-income countries had designed programs to begin in 2018, but Gavi could not get shots then either because it and UNICEF were competing with a global market and suppliers did not increase production to meet Gavi’s predicted demand.

The version of the Merck HPV vaccine used in the United States costs about $285. UNICEF, which typically negotiates big discounts from pharmaceutical companies, pays $3 to $5 per shot for the large volumes of vaccine it sought to procure.

“UNICEF and Gavi have struggled for years to get sufficient supply, and that was finally starting to change,” said Andrew Jones, UNICEF’s deputy director, immunization supplies.

UNICEF has contracts with other suppliers, but because the Merck product is in high demand from countries, the Gavi program is dependent on the company’s supply. That means this delay disrupts vaccination campaigns in a half-dozen countries, many of which have already had to postpone repeatedly.

“It affects countries’ confidence because for years they were told there wasn’t sufficient supply, but when finally supply opened up, they campaigned, got political buy-in, and now delivery is delayed by six or eight months,” Mr. Jones said.

Mr. Ryan of Merck said the company was committed to supporting the drive to vaccinate millions of girls in developing countries against HPV and had invested more than $2 billion in that effort.

Though Mr. Ryan said the company will deliver the delayed doses next year, Merck has yet to notify Gavi when countries can expect those deliveries, which means they cannot yet begin to plan new campaigns.

The countries that won’t get doses this year include Mozambique, Sierra Leone, Ivory Coast and Burkina Faso. They were going to do the multi-age blitz campaigns aimed at catching as many girls as possible, in addition to the routine vaccination of 9-year-olds. The routine program will continue using doses Merck has delivered.

Image
An exterior view of a Merck facility in New Jersey, with its logo and name large on a brick wall at the entrance.

A Merck campus in Rahway, N.J. A spokesman for the company said it had “experienced a manufacturing disruption” that required it to hold and reinspect many doses by hand.Credit...Brendan Mcdermid/Reuters

In addition, Burundi, and, in Asia, Tajikistan, were supposed to get supplies at the end of this year to start doing both multi-age and routine vaccinations, while Cameroon and Liberia were to take delivery of shots so they could start doing multi-age vaccination early in the new year. All of those campaigns will be postponed.

The girls who won’t get vaccinated this year are some of the least likely in the world to be screened or treated for cervical cancer, said Dr. Cathy Ndiaye, the Dakar-based director of the HPV vaccine program for the health-focused nonprofit organization PATH.

“In some countries you can say, ‘OK, you weren’t vaccinated but if you have anything later on in life you can go and get treated’, but not for these girls,” Dr. Ndiaye said.

The delay also complicates the challenge of maintaining political and community support for the HPV shot, she said.

“When you have momentum you want to take advantage of that: When you manage to create demand from the community, you want to deliver, to give them what they need,” she said. “Even at the national level you have to convince them this is important, that it should be a priority because they don’t see cervical cancer, they don’t see the disease now, they say, ‘No let’s deal with polio, let’s deal with measles, that is urgent now.’”

In Mozambique, the plan was to begin the multi-age campaign in June. “There is huge demand, people are asking for it,,” said Dr. Betuel Sigaúque, who works to support routine immunization in Mozambique through JSI, a global nonprofit focused on health and education.

Merck also failed to deliver 7.7 million doses of vaccine to Ethiopia that were scheduled to arrive late last year, and now says they will arrive in June. The country had to scrap a planned school campaign set for spring. Instead, that campaign will take place later this year and will miss girls who have aged out.

https://www.nytimes.com/2024/04/18/heal ... 778d3e6de3