(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)
We could start with the NEET mess again, and there is indeed much to report since our last health newsletter. However, we have decided to press on with some good news and come back to the sordid mess that NEET 2024 has caused in this country. The government, back in power a third time, sure has baggage that sits upon it like an albatross around the sailor’s neck. Baggage of its own making, though.
But all in good time, let’s power on to some positive news in the area of health care- achievements that took a long time to come, and yet when the arrived, the horizon suddenly brightened up with the possibilities of what technology can achieve to ameliorate human suffering. Primary on that list would probably be the progress towards the HIV vaccine - research has been ongoing for a long while, and yet a preventative vaccine has remained largely a pipe dream. No longer, though. The pot of gold at the end of the rainbow is nigh, perhaps. Arun Panchapakesan writes that four new studies report progress towards long-awaited HIV vaccine.
Now if you wondered why it has been really difficult to build a vaccine for HIV, given that recent human history has been marked by remarkable advancements in the field of medical care, and therapy, not to mention vaccinations - here’s why. He writes: This anomaly in humanity’s otherwise remarkable track record in tackling major infectious diseases is a result of several factors. Chief among them is that the replication of the human immunodeficiency virus (HIV), which causes AIDS, is an incredibly error-prone process that results in multiple variants of the virus circulating.The sheer number of all the different strains circulating in the world is in fact the biggest challenge to an HIV vaccine today. HIV has more variants circulating in a single patient at any given point of time than influenza cumulatively generates in one year in all influenza patients around the world combined.
When the immune system encounters a virus, one of its responses is to produce antibodies highly specific to proteins on the virions’ surface. Each antibody is unique to a small piece of a given protein, and the immune system can generate antibodies against any given fragment of any protein. In the early 1990s, scientists noticed that in a small subset of HIV-infected individuals, a new kind of antibody was being produced that could neutralise a large number of circulating viral strains. These broadly neutralising antibodies (bNAb) worked by targeting areas of the viral proteins that the virus couldn’t afford to change, since doing so would make it lose infectivity. Some of these bNAbs can effectively neutralise more than 90% of circulating strains.
There is a catch, he explains: a body usually takes years to make bNAbs, and by then, the virus has already evolved to escape them. It takes years because the parental B-cell that makes the bNAbs is incredibly rare in the starting pool. The challenge, therefore, has been to make the immune system produce these bNAbs in large numbers in response to a vaccine. The route to doing this, called germline targeting. After years of failures, researchers have established a possible roadmap for the first two steps of germline targeting for two groups of bNAbs. Four papers recently published in Science journals outlined two promising nanoparticle-based vaccine candidates: N332-GT5 and eOD-GT8. The teams showed that using these novel vaccines, it may be possible to engage B-cells to make two different classes of bNAbs. Clearly for it to be efficacious and safe as a vaccine for humans, much work remains, but sometimes it’s that suddenly opening up with a streak of bright light in a room that has been dark for years that brings hope.
This has been a week of such hopeful news though, as we said before. Do read Abdul Ghafur’s article on the winner of the £8million Longitude Prize on Antimicrobial resistance (AMR) - a Rapid, diagnostic test for UTI that may help stem super bug crisis. The PA-100 AST System from Sysmex Astrego is a high-tech, transformative, rapid, point-of-care test for UTIs (Urinary Tract Infection). Why is this important? Because, the crisis is imminent: Antibiotic-resistant infections killed nearly 1.3 million people globally in 2019 and are on course to cause 10 million deaths a year by 2050, outstripping deaths caused by cancer. The global economy may lose up to 4 trillions by 2030 and up to 100 trillions by 2050 due to the AMR crisis.
This prize-winning test identifies bacteria causing the urinary tract infection and performs antibiotic susceptibility testing (AST) to determine the effective antibiotic for the specific patient in under 45 minutes. The test uses a single-use cartridge, the size of a smart phone. Less than half a millilitre of the urine is added to this cartridge. Bacteria in the urine is trapped in over 10,000 microfluidic traps in parallel arrays and exposed to five different antibiotics at five different concentrations. The cartridge is inserted into a reader instrument, the size of a shoe box, where bacterial growth is monitored by phase-contrast imaging. It provides a report, “sensitive” or “resistant” for each antibiotic in 30-45 minutes. This supports doctors and health workers in their clinical decision making at the point of care, and opens up the significant possibility of previously “retired” first-line antibiotics coming back into use for the majority of patients.
Earlier, during its World Health Assembly, the World Health Organisation commended India-made TB diagnostics tech. The Truenat platform, a rapid molecular test for the diagnosis of pulmonary, extrapulmonary, and rifampicin-resistant tuberculosis, that was developed in India, has been hailed for its role in combating TB and as a possible component of global healthcare solutions at the recently-held 77th World Health Assembly in Geneva. Developed by Goa-based Molbio, a point-of-care molecular diagnostics company, Truenat was actually first launched in 2017 and is a real-time quantitative micro-PCR system that has been deployed in several States in the country. It is a portable, battery-operated machine that can be deployed at labs, health centres, and in the field. Truenat delivers results from samples in less than an hour and can test for over 40 diseases.
For most of us, gene therapy is the Holy Grail, we believe that it contains in itself immense possibilities that would prolong life and reduce suffering. We only know that we have merely scratched the surface, and that the still waters of gene therapy run deep and silent. Brining us the latest news, Rahul Bhoyar and Vinod Scaria write that Gene therapy offers hope for patients with hearing loss. Hearing loss is one of the most prevalent disorders and it is estimated that over one billion people suffer from hearing loss and approximately one-two children in every 1,000 births are born with congenital hearing loss. It is widely estimated that a significant majority, amounting to approximately 50-60% of congenital hearing loss cases, are attributed to genetic causes. Among the various populations, genetic variants play a significant role. Researchers at the Fudan University, China, in collaboration with a number of research and clinical centres in China, proposed that gene therapy could effectively treat a form of genetic deafness involving the OTOF gene, known as hereditary deafness 9. Mutations in the OTOF gene account for approximately 2-8% of all genetic hearing loss cases. In this clinical trial, researchers employed Adeno-associated virus vectors with the intention of inserting a healthy OTOF gene into patients’ ears using a harmless virus. All patients experienced improved hearing in both ears. Initially performed on one ear, the study was expanded to test bilateral (both ears) therapy in five paediatric patients. Hearing tests showed significant improvement in all patients reported and all patients regained the ability to understand speech and locate sound sources, and the side effects were minor.
It’s time to dig deep into the NEET imbroglio, that has dominated headlines and discussions online. We might have over done it, admittedly, but there was much to report, nearly everyday.
Last week, we told you that cases had been filed in the Supreme Court by disgruntled candidates. This week, literally began with the Supreme Court’s order, which Krishnadas Rajagopal reported: NEET-UG 2024 results: NTA cancels scorecards of 1,563 NEET candidates. The government told the court that it intended to conduct a retest for these candidates, admitting that there might have irregularities in the awarding of grace marks for these students, on the basis that they did not have enough time to finish the test. Meanwhile, there were more problems to NEET UG 2024 than just a bunch of grace marks that went wrong: Congress says ‘grace marks not the only problem’, calls for removal of NTA chief; and Tamil Nadu Chief Minister M. K. Stalin, who has been opposing the conduct of NEET right from the beginning said: Centre’s submission to SC on NEET is another admission of its ineptitude. Meanwhile officials clarified that while there were 63 cases of use of unfair means, they insisted there had been no paper leak in NEET-UG, as alleged by students.
For more indepth information as to the context, and ramifications of the NEET 2024 confusion, do look at our explainers tab.
As we often do, we turn on our gender lens this week again. While immunisation for children is only opposed by deluded anti-vax groups, adult immunisation is hardly even discussed. And vaccination for adult women, even less if it is at all. But thanks to the Federation of Obstetric and Gynaecologists of India’s new project, a comprehensive immunisation schedule for adult women is now ready. It provides a list of essential vaccines that adult women should receive, and the recommended frequency of each vaccine. A recent report highlighted that women spend 25% more time in poor health compared to men. Vaccination can help change this and safeguard women from vaccine-preventable diseases, contributing to an improved quality of life. As Jaydeep Tank, the president of FOGSI, said: This resource will provide a clear actionable roadmap for both women and doctors, resulting in an increased awareness about vaccination. Immunisation is critical in protecting women against vaccine-preventable diseases and thereby helping reduce its burden in India. I firmly believe that this schedule will make a substantial contribution to the overall health and well-being of women in India and benefit society as a whole.”
Sharath Srivasta reports on consultations on providing menstrual leave getting under way in Karnataka. The Karnataka High Court also deliberated over the doctor-patient relationship ruling that sexual exploitation of vulnerable patients will erode that relationship. It refused to quash investigation into a criminal case registered against a 33-year-old city-based doctor for allegedly making sexual overtures to a 28-year-old woman patient.
Getting back to one of our constants: TB, Bindu Shajan Perappadan reports on the study that finds alarming financial hardships resulting from TB, marring the treatment programme. A collaborative survey 1,482 TB patients across four States conducted by the George Institute for Global Health, New Delhi, along with the Indira Gandhi Government Medical College (Nagpur), and the London School of Hygiene and Tropical Medicine, U.K., highlighted the severe financial strain faced by TB patients in India. The survey has recommended intensifying private sector engagement, improving rapid diagnosis, implementing community awareness campaigns, expanding health insurance coverage for pre-treatment expenses, and safeguarding TB patients from loss of income.
Meanwhile, three months after Karnataka’s request to Centre for regular supply of drug-sensitive TB drugs, the requirement has not yet been met. The constant and sometimes repetitive shortages of TB drugs that this country has been reporting is definitely another millstone that will weigh this country down, if not addressed forthwith.
The tailpiece for this week, comes all the way from outer space: Data from all-civilian crew details health effects of space travel. When paediatric cancer survivor Hayley Arceneaux and a trio of crewmates spent three days in space in 2021 as part of SpaceX’s Inspiration4 mission, they made history not only as the first all-civilian team to orbit Earth. They also provided the most in-depth data on record regarding the effects of space travel on the human body. New research based on this data details changes in the brain, heart, muscles, kidneys and skin, immune regulation and stress levels and a breakdown in the activity of subcellular structures called mitochondria amid the microgravity environment, increased radiation and other factors in space. Do hit the link for more information on this.
This week’s explainers bring the context you needed for the major health stories and developing news:
Maitri Porecha writes on the students affected by NEET: The NEET sheeters
G Sampath in the In Focus podcast, looks at What’s behind the calls for an independent probe into conduct of NEET 2024?
I write on the allegations and what led to the Supreme Court judgement: The allegations over NEET-UG 2024 | Explained
Do listen to Zubeda Hamid chat up with experts on the avian flu outbreak: Does India need to be concerned?
If you have a few extra moments, here’s our recommended catch up for you:V. Geetanath writes: CSIR-IICT scientists identify microalgae as a potential protein supplement
Medical lasers market has grown rapidly in India as access increases
Nepal seeks help from India to set up Jan Aushadhi Kendra
WHO confirms human case of bird flu in India; four-year-old infected in West Bengal
For many more health stories, head to our health page, and subscribe to the health newsletter, here.
