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[Editorial] Malaria vaccine approval: a step change for global health

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On Oct 6, WHO announced that it will be recommending widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine for children in sub-Saharan Africa and in other regions with moderate-to-high Plasmodium falciparum transmission. Malaria has ravaged people's lives for centuries; today the burden falls disproportionately on children in tropical regions. 229 million cases were recorded in 2019, and 409 000 people lost their lives, two-thirds of whom were younger than 5 years and living in sub-Saharan Africa.

[Comment] Developing COVID-19 vaccine policy in increments

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Over the past several months, there has been fierce debate in the public domain as to whether booster vaccinations are needed to sustain vaccine-induced immunological protection against SARS-CoV-2 infection.1 Discussions in medical journals, news outlets, social media, and among the wider public have been robust but limited owing to the paucity of data for the breadth and durability of existing vaccines.

[Comment] Offline: The generation of ghosts

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What happened to our ambition for a different, better world? One has to go back to World War 2 to find a time when our species faced a catastrophe on the scale of this COVID-19 pandemic. In the early 1940s, there were some observers of the mounting global chaos who recognised a need to create a new world order. In England, two writers stood out, and their far-reaching visions contrast sharply with the surprising lack of aspiration shown by my generation today.

[World Report] An interview with the Nobel Prize 2021 winners

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Talha Burki speaks with Ardem Patapoutian and David Julius, winners of the 2021 Nobel Prize in Physiology or Medicine for their discoveries of the receptors for temperature and touch.

[World Report] Cautious optimism for malaria vaccine roll-out

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The approval of a vaccine for malaria is a milestone in global health, but challenges remain. Udani Samarasekera reports.

[World Report] Syria and Iraq facing severe drought

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Climate change and conflict are driving a humanitarian emergency that threatens 12 million people. Sharmila Devi reports.

[Perspectives] How imperialism, slavery, and war shaped epidemiology

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In recent decades, historians have become increasingly attuned to the ways in which empire and imperialism transformed modern conceptions of disease, medicine, and the body. Such scholarship argues that European medical theories were not simply disseminated in imperial territories and that science and medicine should not only be seen as scientific and cultural projects that consolidated imperialism. Instead, the thrust has been to understand how the development of modern ideas of hygiene, sanitation, public health, and disease were themselves produced out of an encounter with empire and subjugated populations.

[Perspectives] Superhuman, but never enough: Black women in medicine

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Historically, Black women have long been disregarded in the USA. The Three-Fifths Compromise of the US Constitution discounted Black women as only “part” of a human being, to be counted for congressional representation and direct taxation but nothing more. Even in prominent social justice movements, Black women have been excluded. Racism and elitism were embedded within the 19th-century and early 20th-century US women's suffrage movement, which prioritised white women over voting rights for all women.

[Obituary] Gino Strada

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Surgeon and founder of the non-governmental organisation Emergency. He was born in Sesto San Giovanni, Italy, on April 21, 1948, and died of heart disease in Honfleur, France, on Aug 3, 2021, aged 73 years.

[Correspondence] Telehealth use in antenatal care? Not without women's voices

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Kirsten R Palmer and colleagues1 assessed integrated telehealth for antenatal care in Australia during the early COVID-19 pandemic. However, the estimated 50% reduction of in-person consultations does not represent the proportion of telehealth consultations received by women. Women included in the intervention gave birth between March 23 and July 26, 2020, which is equivalent to, at most, 4 months of a telehealth-integrated antenatal care schedule. Although not presented, the average duration of antenatal follow-up was probably 2 weeks (implementation period) and 6 weeks (integrated care period), allowing for a maximum of two telehealth visits with three face-to-face consultations.

[Correspondence] Telehealth use in antenatal care? Not without women's voices – Authors' reply

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We thank Anna Galle and colleagues for progressing the conversation about quality and equity in antenatal care. Although our analysis of telehealth integrated care addressed the initial 4 months following widespread telehealth integration and analysed data following birth only,1 this means that women included in the analysis were predominately in the third trimester of pregnancy, a time when most pregnancy complications arise. The fact that women in their final stages of pregnancy received, on average, 40% of consultations via telehealth without an impact on the quality of their pregnancy outcomes remains heartening.

[Clinical Picture] Lumbar sediment sign seen in an unusual presentation of meningitis

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A 39-year-old woman was transferred to our neurosurgical service following a fall and development of a progressive quadriparesis over the previous 24 h.

[Editorial] Sexual abuse and exploitation at WHO: an erosion of trust

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The final report of an Independent Commission investigating accusations of sexual exploitation and abuse arising from WHO's response to the tenth Ebola outbreak in the Democratic Republic of the Congo (DRC) was issued on Sept 28. The report describes dozens of appalling allegations made by vulnerable women and girls, including demands for sex in return for jobs and resources and nine rapes, which resulted in many pregnancies (one in a girl aged 13 years), forced abortions, and 22 children being born.

[Comment] Retraction—Hidden harm

Sa, 09/10/2021 - 00:00
On March 5, 2011, The Lancet published a Case Report by Masahiro Suzuki, Chisato Konno, Sakae Takahashi, and Makoto Uchiyama on pheochromocytoma.1 The Case Report was accepted after we had been informed in writing by the authors that it had not been submitted for publication elsewhere. However, the same case had already been reported by the same authors and published in Seishinka, a Japanese journal of psychiatry.2 The Lancet was alerted to this fact on Aug 2, 2021. Since the Case Report in The Lancet is a duplicate publication, we retract this Case Report.

[Comment] Offline: How others see us

Sa, 09/10/2021 - 00:00
“A victory for science!” Who could possibly disagree with Christel van Geet, Vice-Rector of Biomedical Sciences at the University of Leuven? She was opening a symposium about the defence of rationality during the COVID-19 pandemic, held at the University of Sorbonne, Paris, last week. Jean-François Delfraissy, President of France's COVID-19 Scientific Council, called COVID-19 vaccines a “miracle”. The Rector of the University of Geneva, Yves Flückiger, described the contribution of science to the pandemic as “spectacular”.

[World Report] Experts criticise WHO response to sex abuse allegations

Sa, 09/10/2021 - 00:00
An independent report has documented allegations of sexual exploitation and abuse, but commentators have called for stronger outcomes. Udani Samarasekera reports.

[World Report] England gets new body for health improvement

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A new body to tackle health disparities in England has been launched, with a busy agenda for its joint leaders. Jacqui Thornton reports.

[Perspectives] Dévora Kestel: global leader in mental health policy

Sa, 09/10/2021 - 00:00
“I never had any ambitions to become director within a large international agency”, says Dévora Kestel, Director of Mental Health and Substance Use at WHO. Yet her formative experiences as a mental health adviser at country level and her commitment to advancing the rights of people with mental illness have equipped her well for this global leadership position. At WHO's Geneva headquarters, Kestel directs teams of technical and policy experts across a range of mental health and related specialties, including child and adolescent mental health, suicide prevention, mental health policy relating to humanitarian crises, brain health, and substance use.

[Perspectives] Digitising the vision test

Sa, 09/10/2021 - 00:00
The Dutch ophthalmologist Herman Snellen invented his visual chart in 1862 and it has remained the basis for assessing visual acuity since then. The Snellen chart relies on assessing the ability to discriminate high contrast symbols (optotypes) by asking a person to identify rows of letters at a fixed distance, showing them increasingly smaller sizes. Yet quantifying how well an individual can distinguish visual information in a fast and reliable way is a surprisingly difficult task. Despite the ubiquity of chart-based visual acuity assessments, these tests suffer from some shortcomings.

[Perspectives] Rebuilding happiness

Sa, 09/10/2021 - 00:00
It may seem courageous, even foolhardy, for a scientific and cultural institution to put on exhibitions dedicated to joy and tranquillity. Foolhardy because a joyful experience in western culture might well have been underpinned by someone else's labour in the Global South. And in the COVID-19 pandemic, joy and tranquillity, for many, have been hard to come by. The Joy and Tranquillity exhibitions at the Wellcome Collection, London, UK, are part of the On Happiness season, which aims to “celebrate the complexity of positive emotions”.