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[Correspondence] Reduced neutralisation of SARS-CoV-2 omicron B.1.1.529 variant by post-immunisation serum

Ma, 21/12/2021 - 00:30
According to WHO, SARS-CoV-2 is estimated to have caused 265 million infections and more than 5 million deaths over the past 2 years. Current vaccines are based on the original SARS-CoV-2 strain and are designed primarily to raise an antibody response against the spike protein (S), although elicited T-cell responses can also contribute to protection from severe disease.

[Comment] Managing waning vaccine protection against SARS-CoV-2 variants

Ma, 21/12/2021 - 00:30
Less than 2 years after its emergence, the COVID-19 pandemic has caused more than 5 million deaths worldwide. The expeditious development of safe and effective vaccines against COVID-19 brings hope that the world could soon return to pre-pandemic normality if vaccine uptake is sufficiently high. However, uncertainty about the duration of vaccine protection and the emergence of SARS-CoV-2 variants of concern (VOCs) have added complexities to the path to recovery. The recent emergence of variants such as delta (B.1.617.2) and omicron (B.1.1.529) are particularly worrying because of their higher transmissibility and greater immune escape potential compared with other lineages.

[Articles] Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time: a retrospective, population-based cohort study in Scotland and Brazil

Ma, 21/12/2021 - 00:30
We found waning vaccine protection of ChAdOx1 nCoV-19 against COVID-19 hospital admissions and deaths in both Scotland and Brazil, this becoming evident within three months of the second vaccine dose. Consideration needs to be given to providing booster vaccine doses for people who have received ChAdOx1 nCoV-19.

[Comment] Scale up task-sharing of psychological therapies

Sa, 18/12/2021 - 05:31
The COVID-19 pandemic has fuelled a global crisis of unmet needs for mental health care, particularly for mood and anxiety disorders.1 Recently, the question of what should be the initial treatment choice for these disorders was thoroughly addressed by Furukawa and colleagues in a systematic review.2 Their network meta-analysis of 81 randomised controlled trials, comprising 13 722 adult participants with acute depressive episodes, compared psychotherapy, antidepressant medication, their combination, standard or usual care in primary or secondary settings, or a pill placebo on remission and sustained response and showed combined treatment or psychotherapy alone outperformed all comparators, and was equally effective.

[Editorial] COVID-19: where do we go from here?

Sa, 18/12/2021 - 00:00
The end of 2021 brings a sense of uncertainty. Parts of the world are approaching a transition or a new phase of the COVID-19 pandemic. The window for pursuing the elimination of SARS-CoV-2 has closed. Moving towards a so-called post-pandemic world will be far more complicated than scenarios such as “Zero COVID”. The challenge now is to determine the level of COVID-19 that is acceptable for individual nations in a fundamentally interconnected world. In the first Lancet Editorial of 2021, we noted: “Countries might justifiably start to look inward to repair the damage after COVID-19.

[Comment] COV-BOOST: evidence to support rapid booster deployment

Sa, 18/12/2021 - 00:00
With accruing evidence that the effectiveness of COVID-19 vaccines wanes over time,1–4 and the recent emergence of the omicron (B.1.1.529) variant,5 some countries are rapidly deploying vaccine boosters.6 In the UK, the COVID-19 vaccination campaign launched in December, 2020, and began with prioritised population groups, including people most likely to be at higher risk for severe outcomes or those providing health services or care for these individuals. With emerging evidence from Israel and the UK of vaccine waning, the Joint Committee on Vaccination and Immunisation (JCVI) in September, 2021, recommended boosting individuals in a phased way 6 months after completion of their primary course of COVID-19 immunisation.

[Comment] Winner of the 2021 Wakley Prize: something good enough

Sa, 18/12/2021 - 00:00
Earlier this year, inspired by George Eliot's Middlemarch,1 we invited readers to enter the Wakley Prize, The Lancet's annual essay competition, and tell us about those “unhistoric acts—small incidents of kindness, care, compassion, and conscience” that had made a difference and “can provide a shield against the evils of the world, and be a potent force for good”.2 There were many impressive entries and we were engaged by the wide-ranging topics explored in the submitted essays. We thank all the writers who entered this year's competition.

[Comment] Offline: The origin story—division deepens

Sa, 18/12/2021 - 00:00
After more than a year of contentious debate about the origins of SARS-CoV-2, David Relman and colleagues, including Alina Chan and Michael Worobey, published a letter in Science on May 14, 2021, arguing that a more forensic examination was needed. They noted that an inquiry commissioned by WHO had concluded that a lab leak was “extremely unlikely”. But they criticised WHO for not taking this possibility more seriously. They called for a more transparent, objective, and independent investigation.

[World Report] Russia–Ukraine tensions hampering health-care access

Sa, 18/12/2021 - 00:00
Humanitarian groups warn that medical care for civilians is being jeopardised amid a military standoff. Sharmila Devi reports

[World Report] WHO and World Bank urge spending for UHC

Sa, 18/12/2021 - 00:00
Governments have been urged to strengthen public spending on health as COVID-19 stalls progress towards universal health coverage. John Zarocostas reports from Geneva.

[World Report] 2021: a year in review

Sa, 18/12/2021 - 00:00
COVID-19, climate, conflict, and good news for malaria. Farhat Yaqub looks back at the major stories in health and medicine in 2021.

[Perspectives] Highlights 2021: line of sight

Sa, 18/12/2021 - 00:00
Earlier this year The Lancet invited readers to submit arresting images that illuminate health stories for our annual photography competition, Highlights. We wanted to see what was in your line of sight and we were delighted by the rich variety of images submitted. 17 winning images are published in this issue.

[Correspondence] Another public health catastrophe

Sa, 18/12/2021 - 00:00
The UK Medicines and Healthcare products Regulatory Agency is considering prescription of e-cigarettes on the National Health Service.1 This consideration heralds the next big revenue stream for big tobacco, whose lobbyists have campaigned for the prescription of e-cigarettes as UK smoking rates dwindle. We absolutely disagree that “doctors, medical leaders and health campaigners welcomed the move”.2

[Correspondence] Mental and physical exhaustion of health-care practitioners

Sa, 18/12/2021 - 00:00
Health-care workers are experiencing mental and physical exhaustion after coping with 18 months of the COVID-19 pandemic. Many dedicated staff members are retiring from the field and leaving their jobs. This occurrence is now widespread. A recent study by The Physicians Foundation found that doctors were heavily affected by the COVID-19 pandemic: 61% reported often experiencing feelings of burnout; 57% had experienced inappropriate feelings of anger, tearfulness, or anxiety; 46% had isolated themselves from others; and more than 55% know of a physician who has either considered, attempted, or died by suicide.

[Correspondence] The global oral health workforce

Sa, 18/12/2021 - 00:00
Habib Benzian and colleagues1 aptly put forth the six key recommendations for the new WHO global strategy for oral health. We take this opportunity to address some key issues that can affect the action plan.

[Correspondence] The global oral health workforce

Sa, 18/12/2021 - 00:00
Medicine and dentistry have always been, and continue to be, worlds apart. Unfortunately, this separation has exacerbated the poor oral health of many people, especially among vulnerable sections of the population, which, in turn, has led to oral health inequities across the globe.1 Notably, oral diseases have increasingly been associated with some of the most prevalent non-communicable diseases, namely cardiovascular diseases, diabetes, and cancers; they share common risks, including social determinants (eg, low income and low level of education) and associated risk behaviours (eg, frequent smoking and high amounts of sugar consumption).

[Correspondence] The global oral health workforce – Authors' reply

Sa, 18/12/2021 - 00:00
In response to our Comment,1 Gargi Sarode and Sachin Sarode point out the crucial role of human resources for oral health as well as the predominance of the private practitioner model to deliver oral health care. Frank Lobbezoo and Ghizlane Aarab suggest strengthening dental–medical integration as an additional strategy to address oral diseases. These are notable aspects to consider in the context of a future WHO global oral health strategy and country-level reforms of health-care systems towards universal oral health coverage.

[Department of Error] Department of Error

Sa, 18/12/2021 - 00:00
Munro APS, Janani L, Cornelius V, et al. Safety and immunogenicity of seven COVID-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST): a blinded, multicentre, randomised, controlled, phase 2 trial. Lancet 2021; 398: 2258–76—In this Article, Prof Teresa Lambe should have been included in the author list, and her affiliations should have been Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK and NIHR Oxford Biomedical Research Centre, Oxford, UK.

[Clinical Picture] Late presentation of hepatocellular carcinoma highlights the need for a public health programme to eliminate hepatitis B

Sa, 18/12/2021 - 00:00
A 34-year-old man presented to our department with a 4-month history of constant, progressive epigastric abdominal pain. He also reported that he had lost a substantial amount of weight and that his clothes no longer fitted him. The patient had recently been given a course of Helicobacter pylori eradication therapy with no improvement in his symptoms. Additionally, he had sought help from traditional healers who superficially cut the skin over his abdomen with a sharp blade—a process known as scarification—with the aim of relieving the pain.

[Wakley Prize Essay] Something good enough

Sa, 18/12/2021 - 00:00
Our middle child was 72 minutes old when the midwife listened for his heartbeat and heard no sound. His peaceful death was the long-anticipated conclusion of a pregnancy fraught with inconclusive scans and tests, and eventually a diagnosis of anhydramnios that put all ambiguity to an end. With no more amniotic fluid to help his lungs grow strong enough to breathe, we knew that his birth would be the death of him.