Irene Mboyo Mola spent 11 days caring for her husband as he died of Ebola in a hospital where she said nurses were too scared to get close. She helped him to the bathroom, picked up his feverish body when he lost his balance, and reinserted an IV that fell out of his bleeding arm.

“He told me all he could see was death,” recalls Mola, a 30-year-old mother of six, as she sat slumped on the floor in her small hut.

That close contact put Mola at high risk of getting a disease that has no cure and kills about half of those infected. But now, as Congo battles the most serious Ebola outbreak since the devastating 2014 epidemic in West Africa, health workers have something new to offer: a vaccine.

​Promising vaccine

With thousands of doses dispatched to front-line health workers, the world is watching to see if a promising but still experimental vaccine might help stop this terrifying disease faster than traditional measures doctors have tried since Ebola was identified 40 years ago.

Even if the vaccine helps, there are serious hurdles. The shots must be transported deep into forests with few paved roads without it spoiling in the heat. Health workers have to identify and track down anyone who’s had contact with a sick person. Hardest of all, they must persuade a scared and wary population that shots pushed by foreigners could save their lives.

“Communities themselves must be at the center of the response if the activities are going to be effective,” said Jonathan Polonsky of the World Health Organization, a surveillance coordinator in Mbandaka, a city of more than 1 million in northwestern Congo.

Mola’s six children have all been vaccinated. But she refused, telling government social workers and WHO workers that she didn’t believe her husband died from Ebola. She said the hospital never showed her records confirming he’d tested positive for the virus.

​Fear and opportunity

There’s no guarantee the long-sought vaccine will help stop the outbreak. But Congo’s health ministry and the WHO rushed in 7,500 doses, created by the Public Health Agency of Canada and owned by Merck.

It was deemed the best option because the vaccine was found highly promising in testing a few years ago, when the epidemic in West Africa, which killed more than 11,000 people between 2014 and 2016, was starting to wane.

The plan is called “ring vaccination,” to find and vaccinate everyone who’s had direct contact with a sick person — the first “ring” — and then the contacts of those people, too, to break the chain of infection.

Last month, 11-year-old German Umba and her 6-year-old brother lost their father to Ebola. Both were vaccinated. But a shot alone doesn’t end the worry. U.N. workers monitor the children several times a day for fevers, an early symptom, until the incubation period passes.

Standing in the yard outside her classroom at school the young girl suddenly bursts into tears. Surrounded by aid workers, classmates and teachers who are unable to touch and console her, she buries her face in her shirt. 

“I just miss my father,” she said.

​Crucial window

Success with the vaccination strategy hinges on the speed at which health workers can identify people at risk.

“If you detect cases late, you’re missing the opportunity to protect people,” said Dr. Iza Ciglenecki, who is working on the vaccination campaign with Doctors Without Borders.

Congo’s current outbreak has killed 14 people so far, according to the country’s Ministry of Health. There have been 38 confirmed infections.

Friday, WHO emergency response chief Peter Salama said many people vaccinated in Mbandaka received the shots more than 10 days ago, meaning they’re now protected — the vaccine has had time to kick in.

Finding people who need vaccination is much harder in the remote area of Iboko, where a new case was just reported. Shoddy infrastructure adds to the challenge.

“The roads are so bad that even if a person gets vaccinated it can be too late and they can still die,” said Rosy Boyekwa Yamba, a regional representative for the Ministry of Health in Mbandaka.

It can take days to travel just 100 miles (160 kilometers) to reach remote areas where Ebola still is spreading. The vaccine must be kept at a temperature of minus 76 to minus 112 degrees Fahrenheit (minus 60 to minus 80 degrees Celsius), and can only be kept in mobile freezers for up to seven days.

Yamba also worries that potentially infected people aren’t being found. Five such people came forward last week in Mbandaka after he pleaded with community members to “be honest with him” about whether they’d been in contact with someone who had the disease.

So far more than 2,000 people, including front-line health workers, have been vaccinated in Mbandaka and the rural villages of Bikoro and Iboko where confirmed cases have been found, says the Congo’s Ministry of Health.

​Distrust in the community

Mola’s refusal to believe that Ebola killed her husband is a common reaction in the region. While many in Mbandaka have taken to washing hands and avoiding physical contact amid the outbreak, many also remain skeptical. They often don’t trust a government they say is corrupt. Of the dozens of people The Associated Press spoke to on a recent visit, nearly all said they don’t believe Ebola exists and referred to it as witchcraft.

This is Congo’s ninth outbreak, but illnesses are usually in remote areas, not cities.

“Ebola is not here,” said local resident Aziza Monzu. “It’s a disease created by organizations to get money.”

Dr. Pierre Rollin, an Ebola expert with the U.S. Centers for Disease Control and Prevention, understands. 

“People die every day and everywhere but nobody’s interested. Suddenly because of Ebola people are interested and that makes you suspicious,” he said. “Why would they trust us?”

Mola seems to have escaped infection. The incubation period for Ebola is up to 21 days and her husband died three weeks ago. 

“I’m still here,” she said.

Still, WHO officials say three-quarters of those who have been approached have agreed to a shot since the campaign started two weeks ago. 

Once you’ve got people on board “you’ve tackled 90 percent of the problem,” said Dr. Alhassane Touré, the WHO coordinator for ring vaccination in Congo and Guinea.

Does the vaccine work?

Health experts say the next two weeks will be critical in determining whether the outbreak will be brought under control. The WHO is now shifting efforts to more remote areas to contain the outbreak. The organization has predicted there could be up to 300 cases of Ebola in the coming months.

“We could see is another introduction of someone that comes from Itipo (a village in Iboko) or somewhere else to see family (in Mbandaka),” said CDC’s Rollin. In the last few days there’s been a big push in Itipo, the epicenter of the outbreak with 24 confirmed cases, to retrace people and vaccinate contacts as well as health workers, he said.

No matter how the outbreak unfolds, Rollin says it will be nearly impossible to say whether the vaccine worked to stop the disease’s spread.

“We can say the vaccine plus all the other measures work, but you can’t say the vaccine by itself works,” he said. In order to do that a controlled test would have to be run where in one place only the vaccine is being used and in another it’s not being used at all.

Next year, Merck plans to seek approval of the vaccine from the U.S. Food and Drug Administration, based on previous studies of the shots. While the vaccine isn’t being formally studied in the current Congo outbreak, regulatory authorities would want to know if unforeseen side effects crop up.

“If it’s fully approved, then in each outbreak it’ll be the first measure and could be used all over the region,” Dr. Jean-Jacques Muyembe, director general of the National Institute for Biomedical Research in Kinshasa told the AP.

In West Africa, a large study is underway that compares the Merck shot and a second vaccine candidate made by Janssen Pharmaceuticals to determine the best vaccination strategies and track how long protection lasts.

In the meantime, some recipients say the shot provided peace of mind.

Seated in a yard in the center of town, Mbandaka resident Marie Louise proudly slaps her vaccination papers on the table. She had cradled her grandson in her arms as he vomited blood on the hospital floor, and he later died. His case wasn’t officially confirmed as Ebola, but she knew she needed to get vaccinated. Tapping her arm where she was given the needle, the 68-year-old beams. 

“Give me the vaccine,” she said. “I get life with the vaccine.”
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Keeping healthy could become more costly as climate change and water scarcity cause a huge drop in the global production of vegetables and legumes, scientists said Monday.

The amount of vegetables produced could fall by more than a third, especially in hot regions like southern Europe and swaths of Africa and South Asia, said researchers from the London School of Hygiene and Tropical Medicine.

By analyzing studies across 40 countries, with some dating as far back as 1975, they found that hikes in greenhouses gases, water scarcity and global temperatures lowered the amount of vegetables and legumes produced.

Such drastic changes could drive up the prices of vegetables, which would affect poorer communities the most, according to the study, which was published in the Proceedings of the National Academy of Sciences.

“If we take a ‘business as usual’ approach, environmental changes will substantially reduce the global availability of these important foods,” said Alan Dangour, a co-author of the paper, in a statement.

Scientists have warned that world temperatures are likely to rise by 2 degrees to 4.9 degrees Celsius this century compared with pre-industrial times.

This could lead to dangerous weather patterns — including more frequent and powerful droughts, floods and storms — increasing the pressure on agriculture.

Food production itself is a major contributor to climate change.

Agriculture, forestry and changes in land use together produce nearly a quarter of global greenhouse gas emissions, making them the second-largest emitter after the energy sector, said the United Nations Food and Agriculture Organization.

The volume of food transported around the world also is exacerbating global warming.

The global demand for food is expected to soar as the world’s population is projected to grow to 9.8 billion people by 2050, up from 7.6 billion today, according to the U.N.

Crops now take up 11 percent of the world’s land surface, and livestock grazing covers 26 percent of ice-free land, according to the Organization for Economic Cooperation and Development (OECD).

Farming accounts for about 70 percent of all water used globally, said the OECD.

Water scarcity already affects more than 40 percent of the world’s population, according to the U.N.

That number is expected to rise due to global warming, with one in four people projected to face chronic or recurring shortages by 2050, the U.N. said.

“Urgent action needs to be taken, including working to support the agriculture sector to increase its resilience to environmental changes,” said Dangour. “And this must be a priority for governments across the world.”
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A vaccine against bacterial pneumonia and another against meningitis have saved 1.45 million children’s lives this century, according to a new study.

The diseases the vaccines prevent are now concentrated in a handful of countries where the medications are not yet widely available or were only recently introduced, the research says.

Pneumonia is the leading cause of death among children worldwide. The bacteria targeted by the shots, Haemophilus influenzae type b (known as Hib) and Streptococcus pneumoniae (pneumococcus), are major causes of pneumonia and also cause meningitis. Together, the two bacteria claimed nearly 1.1 million lives in 2000, before the vaccines were widely available, according to the World Health Organization.

Vaccines against the bacteria are not new, but funding to provide them in low-income countries only became available recently.

To estimate their impact, the researchers started with country-by-country data from the WHO on pneumonia and meningitis cases and deaths, as well as vaccine coverage estimates. They factored in data from dozens of clinical studies on infections caused by the two bacteria to create estimates of illness and death from the diseases in 2000 and 2015.

They found deaths from Hib fell by 90 percent in 2015, saving an estimated 1.2 million lives since 2000. Pneumococcus deaths fell by just over half, accounting for approximately 250,000 lives saved.

The research appears in the journal The Lancet Global Health. 

“What was interesting was to see the rate at which some of these deaths have been prevented in the last several years,” said lead author Brian Wahl at Johns Hopkins University, “largely due to the availability of funding for these vaccines in countries with some of the highest burdens [of disease].”

The study estimates that 95 percent of the reduction in pneumococcal deaths occurred after 2010, when 52 low- and middle-income countries began receiving funding from Gavi, The Vaccine Alliance, to introduce the vaccine into their national immunization programs.

“The good news is that the numbers are moving in the right direction,” wrote Cynthia Whitney at the U.S. Centers for Disease Control and Prevention in an accompanying editorial.

However, Whitney added, “far too many deaths — about 900 every day — are still being caused by these two infections.”

She notes that more than 40 percent of the world’s children live in countries where pneumococcal vaccine is not a routine childhood immunization.

Many of the countries with the largest number of deaths from these two bacteria have recently introduced the vaccines, but coverage is uneven.

India, Nigeria, China and South Sudan had the highest rates of death from Hib, the study says. All but China have introduced the vaccine in the past few years.

Half of the world’s pneumococcal deaths occurred in just four countries: India, Nigeria, the Democratic Republic of the Congo and Pakistan. All have recently introduced the vaccine, though in India it is a routine immunization in only three states.

Lowering the global burden of these diseases will depend on improving coverage in these countries, the study says.
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Paraguay is officially free of malaria, the World Health Organization (WHO) said on Monday, making it the first country in the Americas in 45 years to have wiped out the deadly disease which is back on the rise globally.

Nearly half a million people — most of them babies and children in Africa —  died in 2016 from mosquito-borne malaria, while at least 216 million were infected, an increase of five percent over 2015, WHO said.

With no recorded cases of malaria in five years, Paraguay became the first country in the region to have eliminated malaria since Cuba in 1973, the WHO said. It was the first country to be declared malaria free since Sri Lanka in 2016.

“It gives me great pleasure today to certify that Paraguay is officially free of malaria,” Tedros Adhanom Ghebreyesus, head of WHO, said in a statement.

“Success stories like Paraguay’s show what is possible. If malaria can be eliminated in one country, it can be eliminated in all countries.”

While significant progress has been made over the past 20 years in reducing malaria cases and deaths, in 2016, for the first time in a decade, the number of malaria cases rose and in some areas there was a resurgence, the WHO said.

Health experts say this was partly to blame on a growing resistance to the sprays and drugs used to attack the mosquito that transmits the disease and the parasite that causes it.

They also say it is partly due to stagnant global funding for malaria since 2010. Climate change and conflict can also exacerbate malaria outbreaks.

“This is a powerful reminder for the region of what can be achieved when countries are focused on an important goal,” said Carissa Etienne, director of the Pan American Health Organization (PAHO), the WHO’s regional office.

“We are hopeful that other countries will soon join Paraguay in eliminating malaria,” she said in a statement.

In 2016 the WHO identified Paraguay as one of 21 countries with the potential to eliminate malaria by 2020.

The WHO said Algeria, Argentina and Uzbekistan are on track to be declared free from malaria later this year.
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Tropical Storm Bud intensified late Sunday afternoon into a Category 1 hurricane some 254 miles (410 km) west of the Pacific coast of Mexico, the country’s weather service said.

With maximum sustained winds of 75 miles (121 km) per hour and gusts of 93 miles (150 km) per hour, Bud was moving northwest at 9.3 miles (15 km) per hour.

The storm is the second of the 2018 Pacific hurricane season after Tropical Storm Aletta, which is moving west away from land. On the Atlantic side, Subtropical Storm Alberto slammed into the Mexican Caribbean in late May, forcing the evacuation of oil workers in the Gulf of Mexico and killing almost 10 people in Cuba and in the U.S. Southeast.

Within hours, Bud was due to generate intense storms in the Mexican states that border the Pacific Ocean, such as Jalisco, Colima and Guerrero.

The Miami-based U.S. National Hurricane Center said Bud would start to weaken by late Tuesday or early Wednesday.

There are no oil installations on the Pacific side of Mexico.

Although authorities established a surveillance zone to follow the trajectory of the hurricane northward along Mexico’s western coast, there were no evacuations of tourist spots like Acapulco, Puerto Vallarta and Cabo San Lucas.

“People in the zones of the states with forecast of rains, wind and waves, including maritime navigation, are recommended to take extreme precautions and to comply with the recommendations issued by the authorities,” Mexico’s meteorological service said in a statement.
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After years of research and 400 million dollars from investors, Impossible Foods has produced the hottest new item on the vegan market, meat-free burgers. The goal of the California-based start-up is to make an all-natural organic product that could deliver the pleasure people get from eating meat, but with no cholesterol, antibiotics, hormones, harmful bacteria… or meat. Faiza Elmasry has the story. Faith Lapidus narrates.
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The University of Hawaii Cancer Center is the leader in a groundbreaking national study that found that early-stage breast cancer patients with the most common form of the disease do not benefit from chemotherapy.

The center helped develop the largest breast cancer study, enrolling 172 Hawaii patients onto the TailorX clinical trial, which found that hormone therapy alone produced results as good as both chemotherapy and hormone treatment for 70 percent of women post-surgery, the Honolulu Star-Advertiser reported.

“We’re able now to spare a large group of women side effects of chemotherapy,” said Dr. Randall Holcombe, director of the University of Hawaii Cancer Center. “We now know with this study that women in this intermediate group will have the same chance of a cure by treating with a hormone pill alone. There are some side effects to hormone pills but a lot less than chemotherapy.”

It could significantly change the standard of care, he added.

The five-year survival rate was 98 percent for women who received hormone pills alone and 98.1 percent for those who received both therapies. At nine years, the rates were 93.9 percent and 93.8 percent, respectively.

The findings were based on 10,273 women who participated in the study from 2006 to 2010.

ECOG-ACRIN Cancer Research Group based in Philadelphia conducted the clinical trial, supported by the National Cancer Institute, a number of foundations and sales of the breast cancer research postage stamp, which provided more than $5 million.
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