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Category: policy – Page 45

To determine the long-term cost-benefit of intravenous immunoglobulin (IVIG) treatment in Children with Kawasaki Disease (KD), a model was made to compare the total cost for management of these children with and without the use of IVIG. Long-term (10−21 years) follow-up of 594 KD patients treated in the pre-IVIG era reported by Kato, et al. was used to calculate cost using previous cost studies from Chulalongkorn Hospital. Reduction of CAA from 25 per cent to 4 per cent with IVIG treatment was assumed based on previous published data. Total cost was slightly lower for the non-IVIG treatment group compared to the IVIG treatment group (33,451,129 baht vs 35,001,195 baht) for the duration of follow-up in Kato’s model. Cost per effectiveness analysis showed more effectiveness in the IVIG treatment group (359,576 baht vs 383,614 baht). Net cost analysis similarly demonstrated lower costs in the IVIG treatment group (25,365,215 baht vs 33,451,129 baht). Incremental cost-effectiveness analysis demonstrated supplementary costs of 13,663 baht for one case in the reduction of coronary involvement and 387,517 baht for one life saved in the IVIG-treated group. Estimation of total costs for follow-up and treatment for healthy life (until 60 years old) was more expensive in the non-IVIG treatment than the IVIG treated group (75,482,803 baht vs 29,883,833 baht). The authors conclude that treatment of all KD cases in Thailand with IVIG is likely to result in lower cost and better outcome when compared to no treatment with the IVIG policy.

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The debate is focused on a subset of gain-of-function studies that manipulate deadly viruses to increase their transmissibility or virulence. “This is what happens to viruses in the wild”, explains Carrie Wolinetz, head of the NIH Office of Science Policy. “Gain-of-function experiments allow us to understand how pandemic viruses evolve, so that we can make predictions, develop countermeasures, and do disease surveillance”. Although none of the widely publicised mishaps of 2014 involved such work, the NIH decided to suspend funding for gain-of-function studies involving influenza, MERS-CoV, and SARS-CoV.

The US moratorium on gain-of-function experiments has been rescinded, but scientists are split over the benefits—and risks—of such studies. Talha Burki reports.

On Dec 19, 2017, the US National Institutes of Health (NIH) announced that they would resume funding gain-of-function experiments involving influenza, Middle East respiratory syndrome coronavirus, and severe acute respiratory syndrome coronavirus. A moratorium had been in place since October, 2014. At the time, the NIH had stated that the moratorium “will be effective until a robust and broad deliberative process is completed that results in the adoption of a new US Government gain-of-function research policy”. This process has now concluded. It was spearheaded by the National Science Advisory Board for Biosecurity (NSABB) and led to the development of a new framework for assessing funding decisions for research involving pathogens with enhanced pandemic potential. The release of the framework by the Department of Health and Human Services (HHS), of which NIH is part, signalled the end of the funding pause.

The situation has its roots in 2011, when the NSABB suppressed two studies involving H5N1 viruses that had been modified to allow airborne transmission from ferret to ferret. They worried that malign actors could replicate the work to deliberately cause an outbreak in human beings. After much debate, the studies were published in full in 2012. HHS subsequently issued guidelines for funding decisions on experiments likely to result in highly pathogenic H5N1 viruses transmissible from mammal to mammal via respiratory droplets. The guidelines were later expanded to include H7N9 viruses.

Continue reading “Ban on gain-of-function studies ends” | >

Over at the always interesting Small Wars Journal, Tony Corn has a stimulating piece on the implications of the European crisis for world politics. He sees a clueless German policy establishment recklessly moving toward an unsustainable quest for power reminiscent in too many ways of problems Germany has had in its past.

Germany, warns Corn, is planning to use its financial domination of Europe to remake the EU into an extension of German power — more or less the way that Prussia used the Zollverein to bring northern Germany under its control and then dominated the Bismarckian Reich through a rigged constitutional system. Once that is in place, he writes, the Germans will continue their policy of deepening relations with Russia at the expense of NATO and transatlantic ties, and end Europe’s embargo on arms sales to China.

As an analyst, Corn sometimes goes to what we more placid types at VM consider overexcited conclusions about Eurasian power realignments. Safely ensconced among the storied oaks and elms, gazebos, pergolas, ha-has, follies and deer parks surrounding the stately Mead manor in glamorous Queens, we tend to take a wait-and-see attitude toward organizations like the Shanghai Cooperation Organization which Russia and China have sometimes posited as a kind of embryonic counter-NATO. Corn, in our perhaps excessively complacent view, can be too quick to take vague Eurasian fantasies and aspirations about diplomatic revolutions as accomplished facts; it is easier to dream about firm Russian and Chinese anti-US cooperation than for those two countries to make it work. But that said, there is no doubt that Corn’s industry, historical grounding and sensitive, even over-sensitive nerve endings give him the ability to produce original and striking ideas.

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The path forward begins with admitting the nation has a bomber shortfall. Retiring more aircraft exacerbates the problem. Nor is this just an Air Force problem. Bombers are national assets essential to our security strategy and must be prioritized accordingly. If other services have excess funds to invest in ideas like a 1,000-mile-range cannon when thousands of strike aircraft, various munitions and remotely piloted aircraft can fill the exact same mission requirements, it is time for a roles and missions review to direct funding toward the most effective, efficient options. Bombers would compete well in such an assessment. Ultimately, the solution demands doubling down on the B-21 program.

There comes a point where you cannot do more with less. Given the importance of bombers to the nation, rebuilding the bomber force is not an option — it is an imperative.

Retired U.S. Air Force Maj. Gen. Larry Stutzriem served as a fighter pilot and held various command positions. He concluded his service as the director of plans, policy and strategy at North American Aerospace Defense Command and U.S. Northern Command. He is currently the director of studies at the Mitchell Institute for Aerospace Studies, where Douglas Birkey is the executive director. Birkey researches issues relating to the future of aerospace and national security, and he previously served as the Air Force Association’s director of government relations.

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Talk being ahead of the curve;

Event 201 was a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic. 15 global business, government, and public health leaders were players in the simulation exercise that highlighted unresolved real-world policy and economic issues that could be solved with sufficient political will, financial investment, and attention now and in the future.

The exercise consisted of pre-recorded news broadcasts, live “staff” briefings, and moderated discussions on specific topics. These issues were carefully designed in a compelling narrative that educated the participants and the audience.

The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose these recommendations.

Continue reading “About the Event 201 exercise” | >

Of the spread of COVID-19 aboard the aircraft carrier USS Theodore Roosevelt and the subsequent relief of its Commanding Officer has highlighted the tension that exists between maintaining military readiness and the need to safeguard the health of members of the armed forces in the face of a pandemic.

The disease has been a feature of war for the vast majority of human history – from the plague that ravaged Athens early in the Peloponnesian War, killing the Athenian strategos Pericles; to the diseases that European settlers brought with them to the New World, devastating local populations; to the host of tropical diseases that caused appalling casualties in the China-Burma-India and Southwest Pacific theaters in World War II. The fact that we were surprised by the emergence, growth, and spread of COVID-19 reflects the false conceit of 21st century life that we have “conquered” disease.

In fact, pandemics are but one class of low-probability but high-impact contingencies that we could face in the coming years, including an earthquake or other natural disaster in a major urban area, regime change in an important state, and the collapse of financial markets leading to a global depression. When I served as Deputy Assistant Secretary of Defense for Policy Planning between 2006 and 2009, we explored a series of such “shocks” as well as the role the Defense Department could play in responding to them as a way of helping the Department’s leaders address such contingencies. During my time in the Pentagon, we also held a series of wargames with members of Congress and their staff, governors of several states and their cabinets, and the government of Mexico, to explore in depth the consequences of a pandemic. Much of what we found then resonates with what we are experiencing now.

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The widespread perception that it was once official British policy to let the novel coronavirus spread until the population reached herd immunity is false; the government was just overly optimistic about how easy flattening the curve would be. But the idea has gained so much traction in some circles, fueled by speculation that we might already be much closer to it than we think, that it’s worth understanding why it’s not a viable policy according to the evidence to date.

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Interventions that may slow ageing include drugs (e.g., rapamycin, metformin), supplements (e.g., nicotinamide riboside, nicotinamide mononucleotide), lifestyle interventions (e.g., exercise) and diets (e.g., fasting)

Thanks to advances in modern medicine over the past century, the world’s population has experienced a marked increase in longevity. However, disparities exist that lead to groups with both shorter lifespan and significantly diminished health, especially in the aged. Unequal access to proper nutrition, healthcare services, and information to make informed health and nutrition decisions all contribute to these concerns. This in turn has hastened the ageing process in some and adversely affected others’ ability to age healthfully. Many in developing as well as developed societies are plagued with the dichotomy of simultaneous calorie excess and nutrient inadequacy. This has resulted in mental and physical deterioration, increased non-communicable disease rates, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental to good health, it remains unclear what impact various dietary interventions may have on improving healthspan and quality of life with age. With a rapidly ageing global population, there is an urgent need for innovative approaches to health promotion as individual’s age. Successful research, education, and interventions should include the development of both qualitative and quantitative biomarkers and other tools which can measure improvements in physiological integrity throughout life. Data-driven health policy shifts should be aimed at reducing the socio-economic inequalities that lead to premature ageing. A framework for progress has been proposed and published by the World Health Organization in its Global Strategy and Action Plan on Ageing and Health. This symposium focused on the impact of nutrition on this framework, stressing the need to better understand an individual’s balance of intrinsic capacity and functional abilities at various life stages, and the impact this balance has on their mental and physical health in the environments they inhabit.

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As China begins to reopen its factories and return back to work, what they are returning to will not be the same…

Despite China being the worlds economic darling for the last 40 years, the balance of the worlds economic power has begun to shift to some places that you might not expect.

In fact, we are already starting to see some signs of other nations around the world, rising up in order to take away some of China’s manufacturing prowess away from them.

And who knows, we might be witnessing the creation of the next generation of economic superpowers, right infront of our very eyes.

Continue reading “There’s A Crisis That Is Quietly Creating New Economic Superpowers…” | >

👏Europe’s largest economy is looking to make its post-virus recovery compatible with its ambition of becoming carbon-neutral by 2050.

The EU has similarly pledged to make its stimulus plan aligned with its climate commitments.

Germany’s green energy shift may get a financial shot in the arm when the impact of the coronavirus ebbs, according to a senior member of Chancellor Angela Merkel’s cabinet.

When the virus’ acute phase is over, the government plans a stimulus package that advances the nation technologically and helps the economy’s move toward climate neutrality, Finance Minister Olaf Scholz said in an interview with Funke Mediengruppe. Such a package “makes sense,” said the Social Democrat without adding details.

Continue reading “Germany Touts Green Stimulus in Post Covid-19 Policy Push” | >