Tuberculosis Kills As Many People Each Year As COVID-19. It’s Time We Found a Better Vaccine

A TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By External Source
Jan 15 2021 – In July 1921, a French infant became the first person to receive an experimental vaccine against tuberculosis (TB), after the mother had died from the disease. The vaccine, known as Bacille Calmette-Guérin (BCG), is the same one still used today.

This first dose of BCG was the culmination of 13 years of research and development.

BCG remains the only licensed vaccine against TB and 2021 marks its 100th anniversary.

Today, all eyes are on the rollout of the COVID-19 vaccine. But while the number of people who died from COVID-19 in the last year is shocking, TB kills about the same number of people — about 1.5-2 million — each year, and has done so for many decades.

In fact, it’s estimated that over the last 200 years, more than 1 billion people have died from TB, far more than from any other infectious disease.

 

If we have a vaccine, why do so many people still die from TB?

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It’s transmitted when a person with active TB coughs up aerosol droplets, which are then inhaled by someone else.

There are about 10 million cases of active TB annually, and it’s estimated up to 2 billion people are what’s known as “latently infected”. That means they are not sick and do not transmit the disease, but in about 10% of these people the disease reactivates.

In most TB endemic regions of the world, BCG is given to infants shortly after birth. The vaccination prevents childhood versions of TB and saves thousands of children’s lives annually.

However, the efficacy of BCG wanes over time. In other words, it stops working. Protection against TB is often lost by adolescence or early adulthood.

Importantly, BCG doesn’t prevent active lung TB in adults, the most important driver of ongoing transmission and cause of death.

The World Health Organization has a goal of TB elimination. To do that, we need to find a TB vaccine that also works in adults.

 

Why hasn’t BCG been replaced with a more effective TB vaccine?

Over the last decades only about 15 new TB vaccine candidates have entered clinical trials (versus 63 for COVID-19 in one year).

Worryingly, many of the most advanced TB vaccine candidates work no better than BCG.

Because the current TB vaccine candidate pipeline is relatively small, these setbacks and trial “failures” mean BCG may remain the gold standard for many years to come.

Despite being 100 years old, exactly how BCG vaccine works is largely unknown. It’s unclear why BCG usually only confers protection against childhood versions of TB or why protection wanes in adolescence.

Given those uncertainties, we can count ourselves lucky the bureaucratic hurdles for vaccine development were significantly lower in the 1920s.

If BCG were developed today, it would probably never be used; the current complex regulatory framework for vaccine development and licensing would likely not allow the use of a vaccine for which nothing or little is known about how it works.

The reasons BCG hasn’t been replaced with a more effective TB vaccine include:

  • the decline of TB in many Western countries in the 20th century
  • limited interest from pharmaceutical companies to invest in TB vaccine development
  • the fact TB research and pre-clinical vaccine development is logistically challenging and requires special biological containment facilities
  • the short-term and fiercely competitive environment for government and philanthropic research funding makes it difficult for academics to commit to TB vaccine research as a career path.

 

Where there’s a will, there’s a way

The pace of COVID-19 vaccine development shows what’s possible when the political will, pharmaceutical interest and funding is there.

While TB is no longer widespread in Australia, it is an issue in remote Indigenous communities.

Papua New Guinea, Australia’s closest neighbour, has high rates of multi-drug resistant TB and low BCG coverage rates. TB has been introduced into Australia via the Torres Strait, with a high proportion of cross-border diagnoses in North Queensland and over-representation of Indigenous children.

Resistance to current TB treatments increases steadily. Treatment of multi drug-resistant TB is hugely expensive and can take up to two years, requiring multiple antibiotics and close monitoring.

Now is the time to put financial and political will into finding a more effective TB vaccine.

2020 taught us pathogens can cause enormous harm to societies and economies. Investment into infectious disease research and vaccine development represents a fraction of the economic cost of a pandemic.

Tuberculosis is a global threat and a public health concern on a scale similar to COVID-19. The development of a new and effective TB vaccine is crucial if TB is to be significantly reduced, let alone eradicated.

Although the anniversary of BCG is cause for celebration, it should also serve as a reminder more needs to be done to combat this deadly disease.
The Conversation

Andreas Kupz, Senior Research Fellow, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Legally Speaking, Is Digital Money Really Money?

Countries are moving fast toward creating digital currencies. Or, so we hear from various surveys showing an increasing number of central banks making substantial progress towards having an official digital currency. But, in fact, close to 80% of the world’s central banks are either not allowed to issue a digital currency under their existing laws, or the legal framework is not clear

Can mobile money be categorized as digital money? IOM helped Mohammed Ahmed to set up a shop in Omduram market, near Khartoum, Sudan. The initiative involves the use of mobile money to buy goods. Credit: International Organization for Migration / Yasir Elbakri

By Catalina Margulis and Arthur Rossi
WASHINGTON DC, Jan 15 2021 – Countries are moving fast toward creating digital currencies. Or, so we hear from various surveys showing an increasing number of central banks making substantial progress towards having an official digital currency.

But, in fact, close to 80 percent of the world’s central banks are either not allowed to issue a digital currency under their existing laws, or the legal framework is not clear.

To help countries make this assessment, we reviewed the central bank laws of 174 IMF members in a new IMF staff paper, and found out that only about 40 are legally allowed to issue digital currencies.

Not just a legal technicality

Any money issuance is a form of debt for the central bank, so it must have a solid basis to avoid legal, financial and reputational risks for the institutions. Ultimately, it is about ensuring that a significant and potentially contentious innovation is in line with a central bank’s mandate. Otherwise, the door is opened to potential political and legal challenges.

Now, readers may be asking themselves: if issuing money is the most basic function for any central bank, why then is a digital form of money so different? The answer requires a detailed analysis of the functions and powers of each central bank, as well as the implications of different designs of digital instruments.

Building a case for digital currencies

To legally qualify as currency, a means of payment must be considered as such by the country’s laws and be denominated in its official monetary unit. A currency typically enjoys legal tender status, meaning debtors can pay their obligations by transferring it to creditors.

Therefore, legal tender status is usually only given to means of payment that can be easily received and used by the majority of the population. That is why banknotes and coins are the most common form of currency.

To use digital currencies, digital infrastructure—laptops, smartphones, connectivity—must first be in place. But governments cannot impose on their citizens to have it, so granting legal tender status to a central bank digital instrument might be challenging. Without the legal tender designation, achieving full currency status could be equally challenging. Still, many means of payments widely used in advanced economies are neither legal tender nor currency (e.g. commercial book money).

Uncharted waters?

Digital currencies can take different forms. Our analysis focuses on the legal implications of the main concepts being considered by various central banks. For instance, where it would be “account-based” or “token-based”. The first means digitalizing the balances currently held on accounts in a central banks’ books; while the second refers to designing a new digital token not connected to the existing accounts that commercial banks hold with a central bank.

From a legal perspective, the difference is between centuries-old traditions and uncharted waters. The first model is as old as central banking itself, having been developed in the early 17th century by the Exchange Bank of Amsterdam, considered the precursor of modern central banks. Its legal status under public and private law in most countries is well developed and understood.

Digital tokens, in contrast, have a very short history and unclear legal status. Some central banks are allowed to issue any type of currency (which could include digital forms), while most (61 percent) are limited to only banknotes and coins.

Another important design feature is whether the digital currency is to be used only at the “wholesale” level, by financial institutions, or could be accessible to the general public (“retail”). Commercial banks hold accounts with their central bank, being therefore their traditional “clients.”

Allowing private citizens’ accounts, as in retail banking, would be a tectonic shift to how central banks are organized and would require significant legal changes. Only 10 central banks in our sample would currently be allowed to do so.

A challenging endeavor

The overlapping of these and other design features can create very complex legal challenges—and could well influence the decisions made by each monetary authority.

The creation of central bank digital currencies will also raise legal issues in many other areas, including tax, property, contracts, and insolvency laws; payments systems; privacy and data protection; most fundamentally, preventing money laundering and terrorism financing.

If they are to be “the next milestone in the evolution of money,” central bank digital currencies need robust legal foundations that ensure smooth integration to the financial system, credibility and broad acceptance by countries’ citizens and economic agents.

 


!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?’http’:’https’;if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+’://platform.twitter.com/widgets.js’;fjs.parentNode.insertBefore(js,fjs);}}(document, ‘script’, ‘twitter-wjs’);  

Advisors Propose New System To Regulate China’s Overseas Investments

High-level advisors, including former UNEP chief Erik Solheim and green finance heavyweight Ma Jun, propose a system to categorise China's overseas investments based on their polluting, climate and biodiversity impacts.

A Chinese backed solar plant in Cafayate, northern Argentina. Such projects would be given the green light by regulators under new proposals for Chinese overseas investment Credit: Alamy/ChineseDialogue

By Ma Tianjie
BEIJING, Jan 15 2021 – A government-backed coalition of international advisors to the Belt and Road Initiative (BRI) has recommended that China apply more stringent environmental controls over its overseas investments. If adopted, this would be a major departure from China’s usual approach of deferring to host country rules, many of them inadequate, for regulating its overseas investments.

High-level advisors, including former UNEP chief Erik Solheim and green finance heavyweight Ma Jun, propose a system to categorise Chinese overseas investments based on their polluting, climate and biodiversity impacts.

The classification methodology was published on 1 December at a press conference organised by the BRI International Green Development Coalition (BRIGC) in Beijing. It would see coal-fired power plants given a firm red light, while other types of Chinese overseas investments, such as hydropower and railways would need to implement internationally recognised mitigation measures to earn “green” status. On the other hand, solar and wind power are considered green projects that advance the climate goals of the Paris Agreement.

 

Higher standards in China’s overseas investments

Christoph Nedopil Wang, founding director of the Green BRI Center at the Central University of Finance and Economics and one of the lead authors of the classification methodology, told China Dialogue that the system combines multiple international approaches to green finance.

The categorisation system and an ensuing taxonomy of green, yellow and red projects take inspiration from international standards such as the EU Sustainable Finance Taxonomy, the Equator Principles and performance standards issued by the International Finance Corporation (IFC) of the World Bank Group. It also uses China’s own guidelines for green credit and green bond issuance as references.

For years Chinese companies and financial institutions working abroad have primarily adhered to the “host country principle” which emphasises compliance with host countries’ environmental and social regulations. The inadequacy of the safeguards in many Global South countries, which make up the majority of BRI participant countries, means that the principle is often used as an excuse to lower standards for China’s overseas investments.

This creates a stark contrast between China’s domestic green transition and its footprints across the rest of the world. While clean energy is growing at a breathtaking speed inside China, a large portion of the energy infrastructure Chinese companies are building overseas is coal-based. Many such projects are of the low-efficiency type that China itself has gradually phased out.

Biodiversity threats are also a main concern of many of the BRI’s linear infrastructure projects such as railways and roads that intersect with key protection areas. Domestically, China has implemented an ecological redlining system hailed as a model for reconciling development with the conservation of nature.

There are calls on Chinese actors to follow higher standards in their overseas investments, but so far the response has been limited. None of the major Chinese financial institutions involved in overseas lending, for example, has signed on to the Equator Principles, which requires international standards (such as the IFC’s performance standards) to be applied in low-income countries with underdeveloped safeguards.

In 2019, major Chinese banks such as China Development Bank and ICBC signed on to the Green Investment Principles (GIP) which call for “acute awareness of potential impacts of investments and operations on climate, environment and society in the Belt and Road region”. But mechanisms to translate such awareness into action are yet to be developed.

“The GIP is more market driven”, comments Nedopil Wang, “while our [proposed system] is much more targeted at the regulators.”

How the ratings system works

Red projects require stricter supervision and regulation.These are regarded as creating “significant and irreversible environmental harm” in at least one of the areas of climate change, pollution and biodiversity, or the risk of such harm.

Yellow projects are environmental neutral with moderate impacts. These cause no significant harm, and remaining harms can be mitigated by affordable and practical measures, on a reasonable scale, within the project itself.

Green projects are encouraged. These have no significant negative impact on pollution, climate change or biodiversity, and contribute positively to at least one of these, particularly if they benefit the aims of international environmental treaties and conventions.

The system considers three dimensions of a project’s potential environmental footprint: pollution, climate change and biodiversity. Projects that are contrary to the Paris Agreement objectives, such as those which increase emissions or undermine climate mitigation measures, are considered to cause “significant harm”. Similarly, projects that encroach on key biodiversity areas are given a red rating.

The system has some flexibility built in to allow contextual considerations of a project’s environmental merits. Some projects types, such as railways, may initially raise a red flag for their potential high risks to biodiversity.

But if developers can credibly demonstrate that mitigation measures are taken to prevent or reduce environmental harms, following international standards, they may get a green classification. However, the original red rating will remain as a reminder of the project’s intrinsic high risk.

The creators believe the two-step classification will better equip the system to respond to complex situations on the ground in most countries along the Belt and Road. “The idea is to make the system adaptive,” says Nedopil Wang, who believes that a black-and-white taxonomy may be too rigid in some circumstances. Therefore, “process standards” which detail how a risk should be managed, are also included.

 

Risky projects

According to the system, the construction and operation of coal-fired power plants will be given a red rating with no mitigation or compensation measures available to upgrade it. The same applies to the retrofit of coal-fired power plants designed to extend their operating life.

On the other hand, a hydropower station will be given an initial red rating but could earn a green rating if it applies “internationally relevant” hydropower standards for mitigating environmental damage, such as the IFC’s 2015 Hydroelectric Power Standard.

The research team provided an initial classification of 38 project types under 20 sectors, ranging from renewable energy to passenger transport and livestock farming. The grouping of the project types into positive (green), neutral (yellow) and negative (red) lists for the first time creates a simple taxonomy for BRI projects based on their environmental impacts.

“I can see the value of a taxonomy [for BRI projects] which raises environmental awareness for investors,” a Chinese expert familiar with international green finance safeguards, who is not authorised to take interviews, told China Dialogue. “At the very early stage of a project, when you have a project concept note in front of you, a taxonomy may help you make a snap judgment about whether a sector is in line with your strategy or should be excluded in the first place.”

But she cautioned that Chinese overseas projects are often large-scale and such a taxonomy may be too simplistic to capture their complex impacts, particularly social impacts.

Architects of the new system respond that the taxonomy is for demonstration purposes at this stage, created to illustrate how the classification system can be run. They are planning to refine the list with more technical details and application guidelines as a next step. One key recommendation from the advisors is to link the system with more comprehensive environmental impact assessments for red and yellow projects.

 

Adoption is key

The international team proposing the system also recommends it be embedded into China’s decision-making processes on Belt and Road projects. According to their analysis, China’s central government agencies such as the National Development and Reform Commission (NDRC) and Ministry of Commerce (MOFCOM) all have power to regulate overseas investment, but currently environmental considerations are not reflected in their approval processes.

“The positive and negative list will provide a foundation for governmental bodies to make sure overseas investment is in line with climate and environmental goals,” says Wang Ye, a green finance analyst with the World Resources Institute (WRI), who co-created the system. One key recommendation from the team is to develop an “exclusion list” of projects irreversibly harming the environment.

Yuan Feng, deputy director general of the NDRC’s Department for Regional Openness, which oversees the development of the BRI, offered his blessing at the press conference where the system was presented.

But Nedopil Wang admits that the appetite of regulators to adopt such a system is hard to gauge. It is noteworthy that the Ministry of Ecology and Environment (MEE) which hosts the BRIGC, does not have formal regulatory power over project development outside China’s borders.

Experts have also opined that green catalogues, which encourage certain types of investments, are easier for regulators to consider than exclusion lists, which often go beyond their legal authority. China’s own environmental laws have yet to regulate greenhouse gas emissions with binding force, they noted. Positive lists such as the green bond catalogue have so far been the mainstay of domestic actions to steer finance toward greener projects.

There are signs that some regulators might be more receptive of the recommendations. On 25 October, five central government agencies, including the central bank, the MEE and the banking regulator, issued a joint guidance for the country’s financing system to better serve China’s 2060 carbon neutrality goal. It specifically encourages financial institutions to support low-carbon development along the Belt and Road.

There is hope that China’s financial sector may adopt the classification system and apply differential treatment to overseas projects: favourable financing conditions for “good practice” projects and stringent conditions for risky ones.

“The China Banking and Insurance Regulatory Commission (CBIRC) has been involved in designing the system, so that’s a good sign,” Nedopil Wang told China Dialogue. “The de facto application [of the system] really depends on the specific champions within the different regulators.”

“Incorporating environmental risks into policy and finance practices requires these champions to push it relentlessly inside the system, like woodpeckers that always hit the same spot without getting a headache,” he said. “[Adopting the classification system] makes reputational sense and environmental sense for China today. But it requires a really different approach to some of the decision making.”

This article was originally published by ChinaDialogue

Twitter, Donald Trump, and Incitement to Violence

The @realDonaldTrump account on Twitter, the outgoing president of the United States’ preferred platform for communication, and which was permanently suspended by the company on January 8, as was the official account as president, @POTUS. Image: Twitter

By Andrés Cañizález
CARACAS, Jan 15 2021 – Over the last four years, United States President Donald Trump has had in Twitter his main political communication tool. On this technological platform, he spread messages that were not entirely true, insulted and disqualified people, fired, or mocked his collaborators. Twitter was a stage for his sort of presidential reality show.

Twitter’s business decisions, initially to temporarily suspend Trump’s account, and then permanently, have ignited a heated debate, which like all those involving the United States (US), in these days of January, seems to be wrapped around extreme positions. It would be a good idea for another piece to look into how Trump precisely fueled polarization, the fruits of which are now for all to see, and how Twitter was his tool in such a strategy.

Trump and Twitter already had a love-hate relationship before the events of January 6, with the assault on the Capitol in Washington. With almost 89 million followers, Trump is the most influential head of state or government in office on this social media worldwide. Barack Obama, US president for two terms (2009-2016), is the person with the greatest number of followers worldwide, over 127 million.

Remarkably, Trump favored to communicate through Twitter. With succinct publications and by smartly using the impact of his messages among his many followers, the outgoing president not only skipped over engaging with mainstream media, but he himself had a far greater impact on Twitter than any press or TV company could have. From Twitter, he denigrated American journalism.

Andrés Cañizález

For Twitter, it was also a good business to be used intensively for four years by the most powerful man in the world, who sent out tweets at any time of the day or night, messages that were not filtered by the White House communications team. His Twitter account was a way of finding out what Trump was concerned about or up to, and thousands of news stories ended up being written based on the president’s tweets, not from the official president’s office account but from his personal account.

It should not be overlooked that this corporate decision, unprecedented in the case of a political figure with such a large following, was preceded by “misleading content” labels that Twitter decided to place on some of Trump’s messages in November 2020, in the heat of the election and counting of votes.

On claims that Trump was generating false content, which was subsequently proven to be the case, Twitter not only labeled but also even removed some tweets from the president. In my view, that seemed to be a mistake.

Then I argued that 1) a company should not restrict a discussion that was purely political; 2) politicians in the midst of a debate are not under the obligation to tell only truths; 3) without being media outlets themselves, social media are today a substantial part of the public forum; and 4) if Trump or any politician told lies, journalism was obliged to fact-check or prove it.

After the disgraceful and unfortunate events that took place in Washington on January 6, Twitter decided to suppress Trump’s account because with his messages the president would have “incited violence”.

 

Donald Trump’s last two tweets before his Twitter account was permanently suspended, after more than 57,000 tweets generated by the outgoing US president, who had about 89 million followers. Photo: Twitter

 

It is quite accepted that limits can be placed on freedom of expression when messages go from being, for example, a mere insult, to proposing actions that end up unleashing violence. It was only when the crisis became a major scandal and the possibility of an impeachment on grounds of these events began to be floated that Trump finally condemned violence.

It was not the messages of just a random agitated person with a few tens or hundreds of followers. We are dealing with messages from someone who has held the main office in the world’s leading power – and will continue to do so for a few more days, with millions of followers on Twitter. This left the door open for his followers to sabotage the legislative ratification act on Democrat candidate Joe Biden’s victory, scheduled for January 6.

While some of Trump’s messages – or even silence at crucial moments – could be considered an implicit incitement or blessing of violence, the next question is whether a company alone can establish this.

I wonder if it should be Twitter, with a decision based on its corporate policies, that effectively closed Trump’s account or was this a decision that, as it was regarding freedom of expression, had to be settled in the US justice system.

I am afraid that we are facing a case in which we have irresponsible positions both from Trump, with his virulent or deceitful messages, and from Twitter by taking for itself the role of arbiter of what US and global society should read or not.

It is possible that this case will end up spurring a debate that should be urgent, but which has unfortunately been postponed given the immense economic power and political influence that such social media as Twitter and Facebook have gained.

The public defense of these platforms, in order to avoid any public debate or possibility of legislation, was precisely to hide behind the premise that their role was technological. They defined themselves as providers of technological applications to connect people, with no intervention on content. The case of Twitter and Trump proves the opposite.

Dengue—an Epidemic Within a Pandemic in Peru

International Year of Volunteers: A volunteer ombudsman in Peru helps a local woman with her problem, 2001. Credit: UN Photo

By Carmen Arroyo
UNITED NATIONS, Jan 15 2021 – While the world is grappling with the third wave of the COVID-19 pandemic, Peru is still dealing with an epidemic that it has not been able to control—the mosquito-borne viral disease known as dengue.

With almost 56,400 confirmed cases as of December, Peru is suffering the worst dengue epidemic since 2017, when the virus infected over 68,000 people. The illness, coupled with the novel coronavirus crisis, has left thousands of people exposed to malnutrition and water-borne diseases.

Although mortality rates are low for dengue cases, nutritious diets and immediate sanitary responses are needed to battle the condition. And, above all, prevention is key to handling future epidemics, given that the mosquito responsible for dengue, Aedes aegypti, is expanding to new territories in Peru. As informal settlements and urbanization increase, so do Aedes larvae, which grow in stagnant water accumulated in cans or pots.

“Dengue has become endemic to many regions in Peru whereas before it was mostly found in the tropical ecosystem areas,” says a researcher for the Pan American Health Organization (PAHO) in Washington DC, pointing at the regions of Madre de Dios, Loreto, Ucayali, and San Martin, among others. “It’s normal to find dengue near the Amazon, but now we can find it in desert-type areas. It should be easier to control dengue, but it’s difficult to control urbanization.”

The epidemic

The Peru dengue crisis began in October of 2019 when the cases increased in the Madre de Dios region in the country’s southeast. The government soon sent the armed forces to fumigate people’s houses and kill the larvae while issuing recommendations to avoid the virus.

As a result, the spread of the virus slowed down in November, with the Minister of Health Elizabeth Hinostroza saying that dengue cases in Madre de Dios had decreased by 30%, as reported by local outlets.

But the respite was short-lived. In February, the government declared dengue a health emergency, ramping up the resources dedicated to fighting off the virus. By the time the coronavirus pandemic hit Peru, dengue had spread to 17 regions, including Junin and Ica.

Still, the country lacked the resources to face a pandemic and an epidemic simultaneously.

Protests broke out in early March in the region of Loreto, northeast Peru, due to a lack of medical attention to those infected. With air-borne COVID-19 assailing the country and mandatory lockdowns in place, fumigations became difficult if not impossible to conduct. Besides, some of the coronavirus symptoms, like headaches, were similar to those generated by dengue.

In October of 2020, Peru raised the alarm again by “reinforcing the sanitary response to dengue’s control and prevention […].” By the end of the year, the COVID-19 pandemic had left almost 38,400 casualties, high unemployment levels, and a growing informal economy. (The underground economy may have increased from 70% to 80% or 90% since the pandemic hit Peru, say local outlets.)

In the background, dengue kept spreading.

On December 9, The National Center of Epidemiology, Prevention, and Disease Control, tied to the Ministry of Health, sent out an alert, warning that Peru was the third country in the Americas region with the highest mortality rate due to dengue. The Dominican Republic and Venezuela came in first.

But what does dengue do?

Dengue is a mosquito-borne viral disease, widespread through the tropics as it is “influenced by rainfall, temperature, relative humidity, and unplanned rapid urbanization,” explains the World Health Organization (WHO). The species Aedes aegypti is also the vector for other viruses such as chikungunya, yellow fever, and Zika.

As climate changes and urbanization increases, the mosquito is finding new places to hatch. “If new areas get warmer, the vector Aedes will expand,” explains the PAHO researcher to IPS. “We can now find it in higher altitudes than before.”

The consequences of the disease vary, notes the WHO in a note on June 23, 2020. The symptoms may range from those similar to the flu to “severe bleedings, organ impairment and/or plasma leakage.” In either case, the virus can also affect women and anemics disproportionately.

“Dengue impacts on an individual’s platelet count, which can be especially crucial for pregnant women,” says Angel Muñoz, climate variability researcher at the International Research Institute, which is part of the Earth Institute at Columbia University. “Anemics are more likely to get the disease.”

Malnutrition

Dengue patients usually experience high levels of dehydration and lack of nutrients, so the intake of water and nutrients is essential.

Recommended diets are rich in vegetables with vitamin A, C, and K, such as spinach and beetroot, fruits with the latter two vitamins, such as citrus, and nuts with proteins.

However, in Peru access to clean water can be tricky in certain regions and marginal areas, where stagnant water abounds. For instance, in the region of Loreto, only 45.4% of the population consumed drinking water through the public infrastructure in 2019, notes the country’s National Institute of Statistics and Informatics (INEI) in a 2020 report.

This lack of access to drinking water heightens the impact of dengue and results in other malnutrition problems. The Food Sustainability Index, developed by the Barilla Center for Food & Nutrition and the Economist Intelligence Unit, notes “poor sanitation and a lack of clean water contribute to malnutrition resulting from diarrhea.” In contrast, the index says that “improved sanitation and better water services also help tackle world hunger.”

On top of these infrastructural problems, the Food and Agriculture Organization (FAO) warns in its latest report that malnutrition increased in 2020 due to the COVID-19 pandemic, deepening the pervasiveness of dengue. “During the last five years, the situation has worsened with an increase of 13.2 million people with undernutrition,” says the FAO.

How to prevent dengue

Prevention is essential to control dengue, both through forecasts and awareness campaigns conducted by public institutions.

Research has shown a relationship between climate patterns and the mosquito’s life cycle, as explained in the paper AeDES: a next-generation monitoring and forecasting system for environmental suitability of Aedes-borne disease transmission, authored by Muñoz and other researchers.

“There’s a relationship between environmental conditions such as temperature, rainfall and humidity, and the mosquito’s life cycle,” he explains to IPS. “It is possible to do reliable climate forecasts and predict the likelihood of the disease spreading.”

As a result of the paper, the team at IRI has designed a tool to monitor and forecast Aedes-borne environmental suitability, which could be used by policymakers to predict the potential impact of dengue.

However, predicting dengue’s probability is not enough, as the information must reach the population. Muñoz notes that awareness campaigns are essential to ensuring the public knows how the disease spreads. “Recipients with stagnant water or large landfills create the perfect habitat for the mosquito.”

Through the Ministry of Health, the Peruvian government has launched awareness campaigns in the past, its latest being “Dengue kills. Kill the mosquito!”

This campaign emphasized getting rid of breeding grounds for the species, both through preventive measures and fumigation. Some of its recommendations include:

    ● “If you have flowerpots or aquatic plants, clean the recipients every two days […].” every day you water the plants.”
    ● “Tightly close the recipients where you store water […].”

But fumigations and awareness campaigns require vast amounts of resources. While the regions have exclusive budgets to fight mosquito-borne diseases, in the past months a portion of that money has been used to face the pandemic, report Jorge Carrillo and Alicia Tovar for Peru’s investigative outlet Ojo Público.

As a result, populations with less access to information, healthcare, and lower socioeconomic conditions remain more at risk because they are more likely to preserve cans or planters to conserve water.

“We need tools to understand the impact of environmental factors on dengue’s seasonality. If we have a detailed system of who could be more at risk and where and when dengue could spread, we could reinforce prevention strategies,” concludes Muñoz.

 


!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?’http’:’https’;if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+’://platform.twitter.com/widgets.js’;fjs.parentNode.insertBefore(js,fjs);}}(document, ‘script’, ‘twitter-wjs’);