Saturday, March 19, 2022

Viruses in Outer Space?

This week, I read an article about new discoveries made about viruses in space. In February, a review study came out about the potential risk that viruses might pose to astronauts when they travel to space. The article mentioned how on the Apollo 7 mission one astronaut seemed to have caught a cold and the others soon caught it too. Because there is no gravity in space, the mucus that filled their nose/throats became so uncomfortable that the astronauts refused to wear their helmets when they landed. They were also terrified that the mucus/congestion could be deadly when the pressure changed as they landed. 

While these astronauts came out relatively unscathed, it prompted a new wave of research on viruses in outer space. Recently, the international space station was swabbed for viruses, and it was found that there were lots of viruses such as herpesviruses and papillomaviruses. They also studied a concept called reactivated viruses, whereby viruses that have laid dormant in the body for years can suddenly re-activate, typically due to changes in the environment. When an astronaut goes to space, their external environment changes drastically in terms of temperature, pressure, gravity, etc. Scientists believe that this could cause dormant viruses to begin replicating again. One virus that poses a significant threat is chickenpox, because if someone had chickenpox as a kid and then the chickenpox gets reactivated when they are in space, it can turn into shingles, which is debilitating and very painful. Now, astronauts are required to quarantine several weeks prior to going into space to ensure that they are not sick. 

-Sophia (Week 10)

War in Ukraine, Smallpox/Bioterrorism

 As Russia’s invasion progresses, I was reminded of our conversation in class about the only remaining smallpox vials. We discussed how (to our knowledge) the only remaining vials of the deadly smallpox virus exist in the United States and in Russia. In our homework, we were asked to take a side on the debate as to whether or not these vials should be destroyed. 

It made me think about the possibility of an actual bioterrorist attack. I started listening to the audiobook of Richard Preston’s Demon in the Freezer this past weekend and realized how real and terrifying the anthrax bioterrorism attack of the early 2000s was. I think we take it for granted today that we have not yet had a purposeful, targeted bioterrorist attack in recent years. In some of the other problems from this week’s problem set, there were questions about the ethics of gain-of-function experiments and whether they should be allowed. It made me realize how in science curiosity is often tied with terror. Scientists seek to push the bounds of what we can observe and create something that is stronger or more interesting. They are curious to explore things, especially dangerous things that people don’t know too much about. But with that exploration and experimentation comes a responsibility of ensuring that the knowledge of and access to these dangerous viruses does not get into the wrong hands.

I wonder what the US government’s rationale is for keeping the smallpox vials. Do they really want to do more research on it? Or is it more of a symbol of equal power for destruction against Russia? If Russia does release their smallpox into the population, it’s not like releasing ours will do any good in stopping the bioterrorist attack. So, what is the purpose? Does Russia’s recent invasion of Ukraine change their minds in any way? I have recently started to find biosecurity very interesting and would like to explore this more. 

-Sophia (Week 9)

War in Ukraine, War and Infectious Diseases

 This past week, we learned that Russia had invaded Ukraine. This invasion is an immense tragedy and something that has already cost so many innocent lives in Ukraine. In class this week, we also discussed how war can intersect with pandemics/epidemics and exacerbate the spread of infectious diseases. I remember reading a story about a baby who was born in a bomb shelter in Ukraine because the baby’s family could not get to the hospital. I also remembered this past summer reading about how during violent conflict oftentimes hospitals and health centers become targets for violence, which is a strategy used to further destabilize communities. 

It made me wonder how the conflict in the Ukraine will impact the spread of COVID-19 and other infectious diseases. Particularly as conditions of hygiene may deteriorate during times of war, I wonder if people will become more susceptible to certain diseases, and given the close-quarter living style in bomb shelters, I wonder if diseases will spread more quickly through the population. When people flee into new countries, this also increases the risk of spreading disease across borders. Furthermore, many families are living in bomb shelters, so how will health services reach them, especially if people suffer from medical emergencies or need perscription medications? I wonder if there is anything that the global health community is doing about these concerns. 

-Sophia (Week 8)

Women-Led Teams Vaccinating Families in Pakistan

 This week, I saw an article in NPR Goats and Soda ( about a potential solution for vaccine hesitancy in Pakistan. This article describes how many people are vaccine hesitant simply because they are illiterate and do not know that the vaccine is available or because they have to work all day and it is nearly impossible for them to get the vaccine without skipping work.

The solution that Pakistan has pioneered is to assemble a team of women to go door-to-door in vulnerable communities across the country to offer the vaccine. The team is armed with vaccines from several different countries (the US, China) and explains the importance of the vaccine to each family. 

I think the strategy of choosing a women-only team is a very powerful and important one. It reminds me a bit of the ASHA worker system of female health workers that has been implemented in India. Several years prior to the pandemic, the Indian government decided to tackle the high levels of maternal and newborn mortality. They trained females from rural regions to handle basic maternal/newborn emergencies and helped them educate communities on best practices. The female-led teams made families feel very safe, and women from the communities were also empowered in the process, which I think is very important. In the case of this vaccination strategy in Pakistan, I do wonder if/how people would respond differently to an all-male team or a mixed gender team. I wonder if these female vaccinators face any barriers or sexism as they are going through communities.

-Sophia (Week 7)

The Death of Paul Farmer

 This week, I was very sad to hear of the death of Dr. Paul Farmer. I had only recently begun to be deeply inspired by Dr. Farmer and had read his book Fevers, Feuds, and Diamonds towards the end of this past summer. 

I first heard of Dr. Farmer from another doctor who inspired me deeply. She is an infectious diseases doctor in Boston who worked on the front lines of the Ebola epidemic in Sierra Leone, Liberia, and the Democratic Republic of Congo. Dr. Farmer was one of her heroes, and she was (and still is!) one of mine, so naturally I started to learn more about the work that Dr. Farmer was doing. 

In my sophomore year at Stanford, I joined Stanford’s Partners in Health Engage chapter. Each week, we read a news article pertaining to important topics like maternal health in Sierra Leone, the rise of diseases like typhus in Los Angeles’ homeless populations, and the implications of war for global health. We wrote letters to newspapers and spoke with congress members to advocate for health bills that Partners in Health was supporting. I even won a free copy of Mountains Beyond Mountains. We watched the movie Bending the Arc, which tells the story of how Farmer and his colleagues founded Partners in Health and the lives that their work saved. I remember being so excited for the Boston infectious diseases doctor who I mentioned above, because she had been invited to a book club where Dr. Farmer was going to discuss Fevers, Feuds, and Diamonds. 

But it wasn’t until I heard Dr. Farmer speak that I truly understood why he was so important to the field of global health. Stanford’s global health center was hosting a Zoom talk with him one night during winter quarter last year. The interviewer praised Dr. Farmer for several minutes and then asked him a single question. The question was bold, perhaps a bit eerie given Dr. Farmer’s passing this year.

“I know you’re still very young. But, when you do die, what would you like to be on your tombstone? How would you like to be remembered, Dr. Farmer?”

Dr. Farmer was silent for a few seconds and then spoke.  

“Useful,” he said. “I hope my tombstone would say that I was useful. That’s how I hope to be remembered.”

It was such a simple, humble response that moved the audience (and the interviewer) deeply. And when I got the chance to read Fevers, Feuds, and Diamonds, I realized Dr. Farmer was being completely truthful. His book is a reflection of his mindset. In his book, the stories of people whose voices are not usually heard are given the power. His voice, careful and compassionate, lifted theirs up to a place where the rest of the world could hear them. 

I think this humility is especially important in the field of global health, especially when it comes to providing aid during epidemics and pandemics. Understanding that every single patient is a human being deserving of dignity and compassion is crucial. Believing that the doctors who come in to provide help are not saviors but rather partners and co-workers to the nurses and doctors who have been living in these communities for their whole lives is also important. I could say a lot more about the profound impact Dr. Farmer has had on me, but I also think that there is a lot I am excited to discover about his work. I hope to read some of his other books and continue to be involved in Stanford’s Partners in Health Chapter. 

-Sophia (Week 6)

Vaccine Hesitancy in Iraq

 This week, I saw an article in NPR Goats and Soda ( about vaccine hesitancy in Iraq. The article discussed how despite there being enough vaccine doses for everyone, there is a large amount of hesitancy that is impeding vaccination efforts.

In particular, there appears to be a fear of the Pfizer vaccine because it is from the United States. I think this is a good example of how relations and tensions between countries can indirectly impact public health. It reminded me of the polio outbreak in Nigeria in 2003. At the time, polio had been eliminated from Nigeria. However, given that this was soon after 9/11, there were lots of tensions between Christian and Muslim communities globally. This caused some people in Nigeria to say that the polio vaccine contained ingredients that caused infertility and cancer, and that the Americans wanted to deplete the Muslim population. As a result, there was a ban on the vaccine, which resulted in the re-emergence of polio in the country, which ended up spreading into other nearby countries. 

This parallel shows, in my opinion, how important relationships between countries are. Health should technically not be political, but it inevitably does become tied to governments and religions. As a result, it is crucial to ensure that people feel like they can trust the people who are encouraging them to be vaccinated. I don’t have a good answer for how exactly to ensure this, but I do think that country leaders should keep in mind how much public health can be affected by inter-country tensions. 

-Sophia (Week 5)

Tuesday, March 15, 2022

2022–2023 Influenza Vaccine Strains Recommended by FDA

The US Food and Drug Administration's (FDA's) Vaccines and Related Biological Products Advisory Committee has chosen the influenza vaccine strains for the 2022–2023 season in the northern hemisphere, which beginnings in the fall of 2022. The panel voted to include a A/Darwin/9/2021-like strain for the H3N2 component of the vaccine; this is changed from A/Cambodia/e0826360/2020. For the influenza B Victoria lineage component, the committee voted to include a B/Austria/1359417/2021-like virus, a swap from this year's B/Washington/02/2019-like virus. These changes apply to the egg-based, cell-culture, and recombinant vaccines. Both new strains were included in WHO's 2022 influenza vaccine strain recommendations for the southern hemisphere. For the influenza A H1N1 component, the group also agreed to include a A/Victoria/2570/2019 (H1N1) pdm09-like virus for the egg-based vaccine and the A/Wisconsin/588/2019 (H1N1) pdm09-like virus for cell culture or recombinant vaccine.