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Fight against tuberculosis set back 12 years by Covid pandemic, report finds | Global development

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Twelve months of Covid-19 has reversed 12 years of global progress against tuberculosis, worse than previously estimated.

The pandemic has resulted in nearly a 25% decrease in diagnosis and treatment around the world, according to research published on Thursday by a coalition working to end TB.

Due to the impact of the Covid pandemic on services, the number of people diagnosed and treated for TB in the worst-affected countries has dropped back to 2008 levels, said Stop TB Partnership’s executive director, Lucica Ditiu. A modelling study published last year estimated a setback of five to eight years.

“Twelve years of impressive gains in the fight against TB – including in reducing the number of people who were missing from TB care – have been tragically reversed by another virulent respiratory infection,” said Ditiu.

“I hope that in 2021, we buckle up and smartly address, at the same time, TB and Covid-19 as two airborne diseases with similar symptoms.”

The effect on countries has depended on their existing disease burden. Data from India and South Africa showed people infected with both TB and Covid-19 are three times more likely to die than those infected with TB alone, meaning preventive steps such as contact tracing and testing are essential in keeping rates low.

Heath officials in Johannesburg prepare to check for HIV and tuberculosis while carrying out Covid-19 tests
Heath officials in Johannesburg, South Africa, prepare to check for HIV and tuberculosis while carrying out Covid-19 tests. Photograph: Jérôme Delay/AP

“After less than a year, a vaccine was developed and is now being deployed to help contain, and hopefully end, the Covid-19 pandemic,” said Thokozile Phiri Nkhoma, a Stop TB Partnership board member.

“But although TB has been around since the time of the pharaohs, the only approved vaccine is 100 years old and doesn’t fully work, especially in adults. First-line treatment for TB is several decades old, and drug resistance is on the rise, while the millions of people with TB who are not found and treated remain at risk of spreading the disease.”

Every year TB infects 10 million people and kills 1.5 million, more than any other infectious disease. Although Covid-19 overtook TB in 2020 as the most common cause of death from an infectious disease, TB still kills more people than Covid in low- and middle-income countries.

Some countries have fought hard to reverse the setbacks. India’s health ministry, after seeing a 70% drop in TB notifications in the first four months of 2020, integrated TB outreach into Covid-19 programming.

“TB didn’t go anywhere when the Covid-19 pandemic hit,” said India’s minister of health, Harsh Vardhan. “People just got distracted, health workers were redirected and health systems became overwhelmed.

Rural children in Bangladesh are vaccinated
Rural children in Bangladesh are vaccinated against tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. Photograph: Anadolu Agency/Getty

“Recovery efforts succeed with political leadership and substantial resources, along with an insistence that Covid-19 outreach and prevention efforts include TB work, instead of replacing it.”

Last week the US administration approved $3.5bn (£2.5bn) in emergency funding for low- and middle-income countries to fight Covid-19 and help mitigate the impact of the pandemic on efforts to tackle TB, malaria and HIV, all of which have been severely affected by resources being redirected.

Peter Sands, executive director of the Global Fund, said that while it feels there may be light at the end of the tunnel as far as Covid goes, “for the communities we’re talking about here, those most at risk of TB, we’re right at the darkest point”.



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Malaria kills 180,000 more people annually than previously thought, says WHO | Global development

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The World Health Organization has called for a “massive, urgent” effort to get the new malaria vaccine into the arms of African children, as it warned that about 180,000 more people were dying annually from the disease than had previously been thought.

Dr Pedro Alonso, director of the WHO’s global malaria programme, said the RTS,S vaccine, recommended for widespread rollout in October, represented a historic opportunity to save tens of thousands of lives, mostly those of under-fives in sub-Saharan Africa.

But he warned that the global community risked “massive failure” if funding commitments aimed at boosting production and helping deployment of the vaccine were not rapidly made.

“What I think is the real barrier [is] international solidarity,” he said. “Is the world going to allow that there is a first malaria vaccine that can save the lives of tens of thousands of African children every year and they’re going to let it sit on a shelf? Or are they going to step up?”

The British pharmaceutical company GlaxoSmithKlein, which developed the RTS,S vaccine, has committed to donate up to 10m doses for use in the pilot programmes already under way, and to supply up to 15m doses annually.

However, with more than 240m cases globally last year, the potential demand could reach 80 to 100m doses annually, Alonso warned. “Therefore, this is a prime example of where international mechanisms will need to come into play,” he said.

“A vaccine that could save somewhere between 40 and 70-80,000 lives every year, of African children, is something that needs to be treated with the utmost ambition and sense of urgency. And therefore, a slow, gradual scale-up, if you ask me, would not be acceptable. This needs to be a massive, urgent operation to ensure that we can reach as many children as possible and as soon as possible.”

He added: “If the global health community does not respond to this challenge, it will represent a massive failure. I cannot imagine how different leaders, leaders of philanthropy or of financing institutions, are going to go to Africa and advocate for efforts to prevent childhood deaths if they don’t, first and foremost, support the deployment of this vaccine.”

Last week, the global vaccine alliance, Gavi, said its board had approved an initial $155.7m (£117m) for the rollout of RTS,S. The funding would help the introduction, procurement and delivery of the vaccine for eligible countries in sub-Saharan Africa from 2022 until 2025, it said.

Dr Abdourahmane Diallo, CEO of the RBM Partnership to End Malaria, said the announcement would give the private sector “a crucial motive to scale up” the rollout.

“We now call on leaders to step up investment to accelerate the development and delivery of more effective, transformative tools to combat the ever-evolving malaria parasite,” he said.

New figures released by the WHO on Monday underlined the scale of the problem, with a new, “more precise” method of counting estimating that 627,000 people died of malaria last year, 180,000 more than the total would have been according to the old methodology.

The vast majority of all malaria deaths – 96% – were in sub-Saharan Africa.

In its annual malaria report, the WHO said the “doomsday scenario” some had predicted at the beginning of the Covid-19 pandemic – that deaths from malaria would double as a result of disruption to treatment and services – had not materialised.

Nonetheless, it said, deaths had risen by nearly 70,000 last year, an increase of 12%, of which nearly 50,000 were attributable to disruptions during the pandemic. One main cause of disruption was that more than a quarter of insecticide-treated bed nets – the backbone of WHO efforts to combat malaria – were not distributed in 2020.

Faced with a slowing of progress in the fight against malaria, the WHO believes the vaccine could be a crucial new weapon, even though questions have been raised over its limited efficacy. Over four years of trials, RTS,S was found to prevent 39% of malaria cases and 29% of severe malaria cases.

But Alonso rejected concerns. “A reduction of 30% [in] severe cases of malaria means a massive public health impact, larger probably than any other vaccine against any other disease being used right now,” he said.

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Fresh violence at anti-vax protests in Brussels

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Belgian police fired water cannon at violent anti-vaccination protesters outside EU buildings in Brussels for the second weekend in a row on Sunday. More than 40,000 people also protested against lockdowns in Vienna Saturday. Several thousand people also protested in Utrecht, in The Netherlands, as well as in Berlin and Frankfurt, where German police used batons and pepper spray after being attacked by a radical minority in the demonstration.

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‘They see it in corridors, in bathrooms, on the bus’: UK schools’ porn crisis | Pornography

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Barnardo’s works directly with children who are victims of abuse or display signs of harmful or risky sexual behaviour. In 2020-21, they worked with 382,872 children, young people, parents and carers.

In a recent survey of their frontline workers across England and Wales, staff reported a rise in the number of children participating in acts they have seen in pornographic videos, despite feeling uncomfortable or scared. They describe porn as having a “corrosive” effect on child wellbeing.

Child sexual abuse expert Sarah works with children who are displaying signs of inappropriate sexual behaviour. She also trains other professionals who work with children

“I started out as a primary school teacher eight years ago, and I’ve been worried about children seeing porn ever since. Children don’t have to be able to type to see porn – it can be sent to them or shown to them on someone else’s phone. They see it at school, in the corridors, in the bathrooms, on the bus. There is just no censor on any of it – one video leads to another. If you can imagine it, it exists as porn, and children are seeing it.

“I am working with a teenager who was sexually abused by a family member. This young person had been exposed to porn and it was perpetuating what the abuser told them – that this is normal, that it’s not abuse.”

She is particularly concerned, as are her colleagues, about the increasingly extreme nature of the porn freely available on mainstream sites.

“A common role play theme on porn sites is intra-familial abuse – on mainstream sites you will see fetishisation of grandad and granddaughter sex, or stepfathers and stepdaughters. This may lead to a young person not disclosing or getting the support they need. From both angles it is dangerous; it puts the child at risk and encourages the perpetrator.

“The impact of porn shows in children harming others or themselves because they either don’t understand or are so ashamed of sexual urges. Shame is very prevalent and is often hidden.

“We are working with a seven-year-old who has been exposed to porn and is now displaying sexualised behaviour. They had free rein on a device, and someone hadn’t deleted a browser history. Once a young person sees porn, they may feel a need to come back again and again – porn is designed to meet a need. That is a form of sexual abuse against that child.”

Brian* is a senior social worker who has worked with children for over 30 years

“Unfortunately, porn is a feature for the majority of the children who come into our service. The children we support are very damaged. They would be likely to have experienced multiple forms of abuse – sexual, physical and domestic. Porn in and of itself is not the cause of their behaviour but it becomes a compounding factor when it hits that history of vulnerability.

Adult sex offenders can give children a distorted rationalisation for their behaviour, and the messages that are given through porn then fit with that distortion.

Lucy* has worked within the field of child sexual abuse for 16 years.

“We know children find porn distressing – they are telling us that themselves. We have done research with children in schools so that we have a cohort to compare our vulnerable children to, and they are saying the same thing.

“This is not what could be described as erotic or soft porn. They may start on porn sites and quickly begin to see very hardcore material. Or [extreme material] lands in their social media feeds, and they can then feel compelled to go back and look again.

“Children are less able to manage sexual arousal, and this material is designed to be arousing. Lots of children can feel guilty and distressed by what they see. We have 14-year-olds telling us they have to watch it as soon as they wake up. They describe being preoccupied with accessing porn to an extent that impacts upon their day-to-day life.

“We also regularly work with children with learning disabilities, another group vulnerable to the harm of porn. They may be shielded from sexual information and then reach 13 or 14 and take away the wrong learning from porn. They may learn that no means yes, that if you persist, women will enjoy forced sex. These messages are harmful for any child but for children with learning needs or who have developed unhealthy beliefs around sex as a result of abuse, it’s particularly bad.

“After lockdown, we began to get more calls from parents where there is no other obvious trauma, just the exposure to porn. I’ve been doing this 16 years, and children have far more access to porn now.”

* Names and some details have been changed to protect identities

In the UK, the NSPCC offers support to children on 0800 1111, and adults concerned about a child on 0808 800 5000. The National Association for People Abused in Childhood (Napac) offers support for adult survivors on 0808 801 0331. In the US, call or text the Childhelp abuse hotline on 800-422-4453. In Australia, children, young adults, parents and teachers can contact the Kids Helpline on 1800 55 1800, or Bravehearts on 1800 272 831, and adult survivors can contact Blue Knot Foundation on 1300 657 380. Other sources of help can be found at Child Helplines International

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