WeeklySA_AdminDEMAND: Study concludes that inequality in access to the medicines caused by gap between Richer and Poorer Countries
ByHealth Correspondent
New York — Africa experienced the highest demand for vaccines during the Covid-19 pandemic, which was never met, although 50 percent of the continent’s population were willing to take the jab – yet the shots were not available.
This is according to a new study conducted in 17 countries in Africa and Western Pacific which revealed that only 20 percent of the vaccinated in African countries received the booster shot. Overall, the unmet demand for the jab was higher in Africa than in West Pacific countries. Published this month in Health Affairs, the study looks at “vaccine apartheid” — the gap in access to COVID-19 vaccines between high and low-income countries.
Titled “Substantial disparities in Covid-19 vaccine uptake and unmet immunisation demand in low and middle-income countries”, it is co-authored by Ashley Fox, an associate professor in the Department of Public Administration and Policy at University of Albany’s Rockefeller College, along with Yongjin Choi and Leesa Lin, both of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.
While the worst of the COVID-19 pandemic is behind us, research continues on the role of vaccines — and their effectiveness as well as factors that contribute to a resistance to the jab, and the worldwide availability of the vaccine.
Based on surveys conducted between May 2022 and January 2023, at least a year after widespread vaccine rollout, the researchers collected data from 15 696 respondents in 17 Western Pacific and African countries. Unmet vaccine demand was highest in African countries, the study found, and lowest in the Western Pacific region.
In Africa, the surveys were conducted in Cameroon, the Democratic Republic of the Congo, Kenya, Nigeria, Senegal, South Africa and Uganda with support from the Vaccine Confidence Project. And Western Pacific, they focussed on Cambodia, Fiji, Lao People’s Democratic Republic Malaysia, Mongolia, the Philippines, Solomon Islands, Tonga, Vanuatu and Vietnam.
Results indicated that only about 50 percent of individuals in the Africa region had received primary vaccination and only 20 percent a booster shot. Only 22 percent of the entire sample had received an mRNA vaccine. Strikingly, the study found that among unvaccinated respondents, 50 percent were willing to be vaccinated but the shots were unavailable to them.
The highest level of unmet demand was in the Democratic Republic of the Congo, at 43 percent, followed by Nigeria at 39 percent and Cameroon at 36 percent. Uganda and South Africa showed unmet demand of 11 percent in the population. In the Western Pacific countries surveyed, unmet demand was lower than 7 percent.
This correlates with the fact that as of May 2023, African countries had the lowest COVID-19 vaccine uptake, at 60 doses per 100,000 people. In contrast, Australia’s rate was 250 doses per 100 000 — similar to South America and the European Union.
“Vaccine hesitancy and availability are much more interconnected than people often realise,’ Fox said. “Low-income countries, especially in Africa, continue to experience constrained access to vaccines, including the more efficacious mRNA vaccines. People also have concerns about available vaccines. We need more research to understand both the supply and demand side factors that affect people’s willingness to vaccinate against COVID-19, and their continued willingness to vaccinate again.”
The article concludes that countries need targeted efforts to increase vaccination rates.
“Policy efforts should address barriers to vaccine access, ensure accessibility and distribution of mRNA vaccines, and aim to overcome vaccine hesitancy — all critical factors in reducing unmet immunization demand and achieving higher vaccination rates across regions.”
Established in 2010 by Professor Heidi Larson at the London School of Hygiene and Tropical, the Vaccine Confidence Project (VCP) was started “to better understand growing vaccine scepticism around the world medicineIts team has conducted research in over 150 countries – almost 80% of the world.
Cannabis Linked to Unhealthy Pregnancy
EFFECT: Exposure to the weed puts pregnant women at risk of health complications, especially low birth weight…
By Health Correspondent
In the past 10 years, the percentage of Americans who use medical marijuana has more than doubled as state-level legalisation becomes increasingly common. But despite its prevalence as a medication, the full health effects of cannabis remain unknown, especially for specific populations—such as pregnant people—that might be especially at risk of health complications.
Now, in a large study of more than 9 000 pregnant people from across the US, researchers at University of Utah Health have found that cannabis exposure during pregnancy is associated with a composite measure of unhealthy pregnancy outcomes, especially low birth weight, and that higher exposure is associated with higher risks.
Compared to most prior studies, this study was larger and measured cannabis exposure more accurately, which allowed researchers to distinguish the effects of cannabis itself from those caused by other correlated health conditions. The research publishes online on December 12 in JAMA. “Cannabis use is not safe,” says Robert Silver, M.D., professor of obstetrics and gynecology at U of U Health and last author on the study. “It increases the risk of pregnancy complications. If possible, you shouldn’t use cannabis during pregnancy.”
The researchers were driven to answer this question in part by the contradictory answers that many people encounter when trying to learn about the health impacts of cannabis use. “There’s so much information out there—discussion and social media channels and on the Internet—about cannabis use and pregnancy,” explains Torri Metz, M.D., vice chair of research of obstetrics and gynecology at U of U Health and lead author on the study. “I think it’s hard for patients to understand what they should be worried about, if anything.”
Indeed, some previous studies on the topic found no association between cannabis use and pregnancy complications. One hurdle facing such research, Metz says, is that there are “so many differences between baseline characteristics of people who use and don’t use cannabis during pregnancy. There’s different rates of anxiety and depression.” These differences can also impact pregnancy risks, which makes it challenging to figure out the consequences related specifically to cannabis use.
The large study population, including participants from eight medical centers across the U.S., allowed the researchers to address this issue. Being able to compare pregnancy outcomes for so many participants, 610 of which had detectable levels of cannabis exposure, meant that the researchers could statistically untangle the impacts of cannabis use from many other factors, including pre-existing health conditions, nicotine exposure, and socioeconomic status.
The scientists found that cannabis exposure was associated with a 1.5-fold increase in risk: 26% of cannabis-exposed pregnant people experienced an unhealthy pregnancy outcome, versus 17% of non-exposed pregnant people. Higher levels of cannabis exposure over the course of pregnancy were associated with higher risks.
A distinguishing feature of the study was how the researchers measured cannabis exposure. While other studies had asked participants to report their own cannabis use (which has been shown to underestimate the actual rate of use by two or three times), the scientists measured the levels of a metabolic byproduct of cannabis in participants’ urine samples, which gave more accurate measurements of cannabis exposure.
To gauge impacts on pregnancy, the researchers looked at an aggregate measure of negative health outcomes, including low birth weight, pregnancy-related high blood pressure, stillbirth, and medically indicated preterm birth. Of these, the association between cannabis use and low birth weight was the strongest. All of these conditions have been linked to reduced function of the placenta, which supplies the growing baby with oxygen and nutrients.
While this type of study can’t determine why cannabis is associated with negative pregnancy outcomes, previous studies in non-human primates have found that long-term cannabis exposure can interfere with blood supply to the placenta. The correlation Metz and her colleagues observed suggests that cannabis may disrupt the human placenta in a similar way.
Silver adds that the greater risk seen at higher levels of exposure is especially concerning given the high amount of THC found in newer cannabis products—products that were barely starting to become available from 2010 to 2014, when the study data was collected. The health impacts of these more concentrated products remain largely unknown.
The researchers urge people who are considering using cannabis while pregnant to have an open conversation with their doctor. While pregnant people may turn to cannabis to alleviate nausea or anxiety, other remedies have been proven to be safe. “There are many, many reasons people use cannabis,” Silver says. “But there may be alternative therapies that can help mitigate the symptoms.”
Silver emphasizes that continued research on the health impacts of cannabis is urgently needed so that patients can make informed decisions about their health.
“As long as humans are interested in using this product,” he says, “we ought to assess health effects both good and bad, as accurately as we can, and provide that information for folks.”
