A British toddler born deaf has become the first person to have their hearing restored via gene therapy.

The 18-month-year-old Opal Sandy has been reportedly enjoying playing the drums and babbling with her parents after the groundbreaking therapy.  

Opal was born with hearing loss due to a rare genetic mutation in the OTOF gene.

She underwent a 16-minute surgery where a harmless virus called AAV1 was injected into her cochlea. It delivers a working copy of the OTOF gene into the cochlea, restored functionality in her ear.

Opal is the first patient globally to receive the therapy. 

CRISPR gene therapy restores vision

The news comes days after scientists used a gene therapy to restore vision in people with a rare form of inherited or congenital blindness.

Scientists in this separate trial used a different gene editing tool called gene editing tool, CRISPR-Cas9.

The researchers said 11 out of the 14 people in a clinical trial experienced improved vision, without serious adverse side effects.

They said the study was also the first to use gene therapy to treat children who had been born with a form of blindness.

Eric Pierce of Harvard Medical School, who led the study, said participants were "thrilled" to be able to see the food on their plates.

"These were individuals who could not read any lines on an eye chart and who had no treatment options, which is the unfortunate reality for most people with inherited retinal disorders," Pierce said in a statement.

The findings were published in The New England Journal of Medicine on May 6, 2024.

CRISPR gene editing brings 'BRILLIANCE'

The trial was called "BRILLIANCE" and 12 adults and two children, who had a rare form of inherited blindness, known as Leber congenital amaurosis (LCA), participated in it.

LCA affects about one in 40,000 people and causes severe vision loss at an early age.

This blindness is caused by a gene mutation that prevents a protein from functioning properly. That protein — CEP290 — is critical for sight.

Participants in the study received a single dose of a CRISPR gene therapy called EDIT-101.

CRISPR-Cas9 is a precise way of altering DNA. It cuts out specific strands of DNA — the thing that makes us who we are — and replaces them with a new strands.

In the case of EDIT-101, the treatment cuts out the mutation in CEP290 and inserts a healthy strand of DNA back into the gene. This restores normal function of the protein CEP290, allowing the retina to detect light.

In 2020, Emmanuelle Charpentier and Jennifer A. Doudna were awarded the Nobel Prize in chemistry for discovering CRISPR-Cas9.

EDIT-101 gene therapy restores vision

The BRILLIANCE study tested how well participants could see colored lights, navigate a small maze in varying amounts of light, and read from a chart after receiving the treatment.

Almost all of the participants, except three, showed some level of visual improvements. Six participants had major improvements in vision-related quality of life and could identify objects and letters on a chart.

According to the researchers, EDIT-101 caused no serious adverse side effects in participants. Some patients reported mild adverse effects which resolved quickly.

The future of CRISPR gene editing

More than 200 people have been treated with experimental CRISPR technologies. But so far, only one CRISPR treatment has been approved for clinical use — Casgevy, a treatment for sickle-cell disease — which has been available in the US, the UK, and the EU since December 2023. 

Scientists have said they are entering a new phase in genome editing technologies, which they say they can safely help and cure — not just treat — patients with a variety of diseases.

Ongoing clinical trials are testing other CRISPR therapies for HIV/AIDS, diabetes, cancer, cardiovascular diseases, and antibiotic resistance.

Edited by: Zulfikar Abbany

After almost two months of disruptions that have left thousands of patients struggling to access medical care, the government of Kenya announced that it had signed an agreement with  striking doctors on Wednesday.

"After 56 days, KMPDU signs agreement, ending nationwide doctors' strike," the health ministry said on X, formerly Twitter, using the abbreviation for the Kenya Medical Practitioners, Pharmacists and Dentists Union, which launched the action in mid-March to protest wages for its 7,000 members.

"After long and painstaking negotiations that ran into the wee hours of the night for many days ... we have signed a return to work formula and the union has called off the strike," Health Minister Susan Nakhumicha told reporters.

The strike, which was also joined by the Kenya Union of Clinical Officers (KUCO), effectively paralyzed 57 public hospitals in the East African country.

Interns at center of dispute

The full details of the deal were not immediately made public. Davji Atellah, the union secretary general, said the doctors agreed to trust the government to implement an agreement to ensure the labor issues that caused the strike, including poor remuneration and working conditions, are resolved.

Doctors had previously clashed with the authorities over a government decision to cut salaries for medical interns and push back the retirement age. Several rounds of talks have collapsed over the compensation for interns, who make up about 30% of Kenyan doctors.

KMPDU chief Davji Atellah confirmed that the issue of interns' salaries was still "pending," but also said the strike was over.

"Despite having said and stated that we would not go home with promissory notes, we have decided to take the promise for the last time," he said.

Doctors to return to work within 24 hours

KMPDU has also reinforced its demands for a monthly salary of 206,000 Kenyan shillings (€1,450, $1,558) which had been agreed after a previous strike in 2017 which had lasted 100 days.

President William Ruto, however, considered that to be unfeasible. He proposal of a salary of 71,000 shillings (about a third of what was requested) but this was in turn rejected by the KMPDU.

"We cannot continue to spend money we don't have," he declared in early April. "I say to our medical friends that we appreciate the service they perform for our nation but that we have to live according to our means."

The doctors are set to return to work within 24 hours of signing the deal. 

The deal also states that doctors would receive salary arrears amounting to 3.5 billion shillings (about $26 million) over the next five years to make up for unpaid wage hikes stipulated by the 2017 agreement.

Many Kenyan doctors complain about low salaries and poor working conditions which fueled an exodus to other African countries and hospitals outside the continent.

Kenya is still reeling from the flooding that has affected over 235,000 people since the rainy season started in mid-March.

mf/dj (AFP, Reuters)

Health workers are the backbone of a functional health system in any country. However, Kenya's system began to crumble in mid-March when doctors and medical workers began a nationwide strike over pay and working conditions, disrupting services for thousands of patients in the East African nation.

The medical workers, led by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), want the government to fulfill a labor agreement signed in 2017, which promised higher salaries and better working conditions for medical workers, as well as the hiring of intern doctors.

Kenya's government said it would meet some of the medics' demands — including hiring interns on permanent contracts and paying arrears due under a 2017 agreement — but ruled out any further concessions due to a lack of funds.

"We cannot continue to spend the money we do not have," said Kenyan President William Ruto, who has embarked on cost-cutting measures since taking office in 2022.

"I am telling our friends the doctors that ... we value the service they give to our nation but we must live within our means."

The medics rejected the government's offer and insisted that they would not return to work until their demands were met in full.

Dr Davji Atellah, the KMPDU's secretary general, said that, "we cannot speak about universal healthcare while we have no budget for health workforce."

The government should 'stick to its word'

Dr Simon Kigondu, a Kenyan obstetrician, gynecologist, and president of the Kenyan Medical Association, said that setting up a health service commission would perhaps have prevented the current deadlock.

Kigondu told DW that they had proposed a commission to manage the Kenyan health system's human resources. 

"For instance in this scenario where the Ministry of Health claims that it did not budget for medical officer intact, the Health Service Commission would have known that there are these number of medical interns and they budgeted for them," Kigondu said.

Kigondu echoed the demands of the striking workers, calling on Ruto's government to stick to its word.

"The government should actually honor the collective bargaining agreement and then come to the table and try to bargain for the next collective bargaining agreement," he said.

Kigondu added that, "a government cannot sign an agreement, then fail to abide by it and expect the people they govern to abide by other agreements."

Until now, there is no clear sign of how or when Kenya's ongoing protest will end.

Medics flee poor pay in Cameroon

Meanwhile, on the other side of the African continent, Cameroon has a medical crisis of its own.

The National Medical Council said that health care delivery remains very difficult in West African country, where the doctor-to-patient ratio stands at 1 doctor per 50,000 patients — instead of the 1 doctor per 10,000 patients ratio recommended by the World Health Organization.

The council reported that doctors are fleeing to escape hardship, poor pay, difficult working conditions and unemployment.

Cameroon-based DW correspondent Moki Edwin Kindzeka said there is a serious problem of doctors being unable to find work.

"Several thousand of them since they started being trained in 2013, that's about 14 years ago, have not been employed by the government of Cameroon," Kindzeka said, adding that some end up staying home, working for private clinics — or leaving the country.

"You train thousands of doctors who are not recruited, and only 20 are recruited per year in private clinics where they earn less," Kindzeka added. "Those who at home struggle on their own at times sit waiting, applying to be recruited by the government and asking to be recruited by foreign nations."

This dire situation has led doctors to seek jobs in Gabon, Central African Republic, Sudan, and even as far away as Canada and the United States.

According to the National Medical Council in Cameroon, about 6,000 to 7,000 doctors have left the country. But some remain in the country waiting for the opportunity to work.

"So the people are begging to work. They say they want to work. Some of them tell you they don't want to leave the country. They want to stay in their country and work. They want to help the suffering in their country. Yet they're not giving that opportunity to do that."

'No patriotism on empty stomachs'

In his presidential speech, Cameroonian President Paul Biya voiced concern about the youth emigrating. Biya urged Cameroonians to be patriotic and serve their homeland — a sentiment that was not well received by many young people. 

"When I went around doing a report, I discussed with some of the doctors and asked their reaction to the president's call for them to be patriotic," Kindzeka told DW.

"They said they would not be patriotic on an empty stomach. They are going for where duty calls and duty calls, according to them in Canada." 

Moki Edwin Kindzeka in Cameroon contributed to this report

Edited by: Keith Walker

Praful Reddy, 49, an IT professional from the southern Indian state of Andhra Pradesh, has lung cancer and has been undergoing treatment, including targeted therapy, chemotherapy and radiation, to stop its spread since he was diagnosed two years ago. 

Vomiting, headaches and ulcers are a few of the recurring side effects that he faces and he doesn't know whether he will get better, although doctors are holding out hope for his recovery.

"The doctors have been administering drugs to block the growth and spread of cancer cells. If it does not improve, I might have to undergo a lobectomy to remove the entire lobe of one lung," Reddy told DW.

In the city of Bengaluru, in the neighboring state of Karnataka, 12-year-old Dipti is receiving treatment for Wilms tumor, a rare type of cancer that originates in the kidneys and mainly affects children.

"She is undergoing radiation therapy for now, but it has caused side effects such as skin damage and hair loss," her doctor, Charu Sharma, told DW.

These aren't isolated cases and an increasing number of people, especially children, in India are being diagnosed with cancer, marking the fastest rise in cases worldwide.

Cancer capital of the world?

A report released by the Indian multinational health care group, Apollo Hospitals, last month labeled the South Asian nation as "the cancer capital of the world."

The study revealed an alarming picture of declining overall health across India, pointing to soaring cases of cancer and other non-communicable diseases.

It found that at present, one in three Indians is pre-diabetic, two in three are pre-hypertensive and one in 10 struggles with depression. Chronic conditions like cancer, diabetes, hypertension, cardiovascular diseases and mental health disorders are now so prevalent that they have reached "critical levels," it added. 

The study projected the number of annual cancer cases would rise to 1.57 million by 2025, from almost 1.4 million in 2020.

Breast, cervical and ovarian cancer are the most common forms affecting women, while cancer of the lung, the mouth and the prostate are those most affecting men.

"Cancer cases and deaths are rising and are expected to rise further over the next two decades," said K. Srinath Reddy, the former president of the Public Health Foundation of India.

"Contributory factors to rising incidence are advancing age, unhealthy diets with ultra-processed foods stoking inflammation, exposure to air pollution laden with carcinogens and climate change with increased exposure to ultraviolet radiation," he explained.

Children increasingly affected by cancer

The Apollo Hospitals report also detailed how certain cancers were affecting people in India at an earlier age than in certain other  countries. The median age for lung cancer is 59 in India, but 68 in China, 70 in the United States and 75 in the United Kingdom.

Around a million new cases of cancer are detected in India every year, 4% of which are in children. Doctors and other health professionals have deplored the shortage of pediatric oncology facilities.

"Most private hospitals have trained pediatric oncologists, but this may not be the case in medical colleges or government hospitals," said Ruchira Misra, pediatric oncologist and senior consultant at Mumbai's MRR Children's Hospital.

"Only 41% of public hospitals have dedicated pediatric oncology departments," she added.

A lack of funds and access to care, as well as social stigma, were big hurdles for many affected families, she continued.

"Diagnosis, access to care and medications and follow-up are difficult and there is a lot of abandonment of treatment as the parents cannot afford treatment," she said.

Regular screenings needed

Experts say low health screening rates in the country pose a significant challenge for the fight against cancer, and stress the importance of preventive health care measures.

"There is no doubt that cancer is growing and there needs to be prioritized action by everyone. The government should incentivize screening as a first measure," said Nitesh Rohatgi, a senior director of medical oncology at the Fortis Memorial Research Institute.

"There is also a need for policies to impart financial protection and expand the screening and curative services for cancer," he added.

India has a screening program in place for oral, breast and cervical cancer, but screening rates are below  1%, according to national data, despite the WHO's recommendation that at least 70% of women should be tested.

"I would not want to call it an epidemic but we will see cancer cases double by 2040 compared to 2020. A lot of them can be prevented at the individual, societal and governmental levels," said Asit Arora, director of cancer care at the Max Super Speciality Hospital in the Indian capital, Delhi.

"If we don't do anything we, as a society, will be paying a heavy price."

Before you leave: Every Friday, the DW Asia newsletter delivers compelling articles and videos from around the continent right to your inbox. Subscribe below.

Edited by: Srinivas Mazumdaru

The world seems to have largely got over COVID-19 — and is now making preparations for how to cope with any future pandemic. A global agreement on pandemics is designed to improve communication between countries. Members of the World Health Organization (WHO) are currently negotiating the draft accord.

Many scientists are convinced that there will be another pandemic. Flu, a new coronavirus or a pox virus are among the potential candidates.

"Bird flu would be uncomfortable," said Emanuel Wyler, a molecular biologist from Berlin's Max Delbrück Center. "Pox would be a small nightmare. "

But measles or multi-resistant bacteria are also possible — the list is long.

Our increasingly connected world and climate change mean that infectious diseases can spread increasingly quickly and easily. Intensive livestock farming and the encroachment of people into wildlife habitats make zoonoses more likely. That is when a disease jumps from animals to people.

Germany is also considering whether it has learned the right lessons from COVID-19. Is the country prepared to face another pandemic?

Hospitals will play a critical role

Images of packed intensive care wards and overworked staff have seared themselves into our brains. In any future pandemic it'll be crucial how well Germany's hospitals are armed to cope with a sudden influx of patients.

"Health care provision in times of crisis will only work well if hospitals run well in normal times," said Christian Karagiannidis, a critical care doctor at Cologne-Merheim Hospital in western Germany. "That doesn't currently exist in the form we need."

There is no contingent of spare beds for unforeseen eventualities. There are almost 1,700 hospitals in Germany, but only a quarter treated COVID-19 patients during the pandemic. 

Germany's health ministry is now working on transforming the hospital sector so that the load is distributed more evenly. Karagiannidis is part of the government commission involved in the hospital reform. He thinks it is crucial to expand the number of clinics that have at least ten intensive care beds with intubation facilities, plus special features, like a heart catheter and a helipad. But that would mean smaller hospitals would have to close.

Germany needs more health care workers

Another problem is aging health care workers. In the western German state of North Rhine-Westphalia (NRW), one in three are over the age of 55, according to the NRW Pflegekammer. The organization, which represents health care workers in Germany's biggest state, says only 15% are younger than 30. The health insurance company DAK says it is impossible to replace those retiring.

The fact that hospitals learned to work together rather than as rivals gives cause for hope, says Karagiannidis. And the lesson has been learned that it's a good idea to have a stock of masks and medication.

While stockpiling might be working at the hospital level, there is an implementation problem at the national level. At the start of the coronavirus pandemic in 2020, the German government decided to set up a national reserve of protective clothing and medical products. The idea was to stockpile centrally and supplement the stock with medication and medical products made in Germany in an attempt to avert supply chain problems.

Four years later, however, the project has not made much progress. Masks that are past their best by date are being destroyed.

"That could backfire on us again next time," says Philipp Wiesener, who is responsible for national crisis management and public health protection for the German Red Cross.

On the plus side: during the coronavirus pandemic, we learned how to set up vaccination centers and vaccinate large numbers within a short space of time, says Wiesener. That's something that could be drawn on next time.

A starting point: The vaccines

The rapid development of effective vaccines averted a worse health care crisis. The mRNA technology had been the focus of research as a way to help cure cancer.

"It was indeed fortunate that the development of mRNA technology had progressed so far," said Emanuel Wyler. 

During the pandemic, mRNA vaccines proved to be a flexible tool. However, they only work if it is clear exactly which pathogen structures they should target. The vaccines would be useful if the next pandemic were again to involve a new coronavirus, molecular biologist Wyler says, warning that they may be less useful in the fight against some other viruses such as smallpox, for which the world's population is not sufficiently vaccinated against.

But the question is also whether Germans will get vaccinated at all next time.

German society is more skeptical

Shortly before the WHO declared the end of COVID-19 as a public health emergency in May 2023, more than 20% of the population in Germany had not gotten vaccinated. And quite a lot of people say they lack confidence in government measures. In a survey conducted by psychologist Cornelia Betsch from the University of Erfurt in late 2022 and early 2023, a third of those questioned said they would not take protective measures in the next pandemic. And almost a third even said they would like to see the government punished for the way it handled the pandemic.

The COVID-19 outbreak exposed numerous shortcomings. It was hard for health care officials to reach less educated people and those with lower incomes. Digitalization in the health care system and schools was again shown to be way behind in Germany. Many children and young people are still suffering from the effects of COVID school shutdowns. Scientists have criticized the lack of systematic data collection to evaluate the measures.

Doctors in intensive care units, however, are clear on what needs to be done. 

"We need to run through what would happen if the next pandemic were to break out now," says Karagiannidis. 

How do we react? What will happen to children? What will happen to schools?

"We need to develop a scenario so we can see where the weak spots are," he says.

That has still not happened.

This article was originally written in German. 

Editor's note: The previous version of this article has been modified to remove a factual inaccuracy. 

While you're here: Each Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

The nationwide doctors' strike in Kenya began on March 12, with at least 4,000 medics demanding higher salaries as part of a 2017 collective bargaining agreement, better working conditions and the employment of intern doctors. Five weeks later, there is no sign of a compromise as the government claims it cannot allocate the necessary funds. DW has put together a timeline of the row so far.

Week 1: Demand for higher wages

Led by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), 1,210 intern doctors, medical doctors, pharmacists and dentists laid out their demands. These included a salary increase of up to 206,000 Kenyan shillings ($1,548, €1,451) per month.

The doctors also called on President William Ruto's government to fulfill its 2017 promise to increase their salaries. The government rejected the doctors' demands and made a counteroffer which was rejected by the doctors' union. 

Week 2: Health sector paralysis

In its second week, the strike caused widespread disruptions in healthcare services. With medical professionals absent from their posts, hospitals, and clinics, many patients were left unattended and desperate for medical assistance.

A 12-year-old boy taken to the hospital by his mother due to a broken leg wa s turned away from a hospital in Kakamega county in western Kenya because there were no doctors to assist.

Another patient affected by the ongoing doctors' strike told DW that he needed to raise money for an urgent spinal surgery.

Week 3: First casualty as doctors dig in

Kenyan doctors stopped offering emergency medical services at public hospitals as the strike entered its third week.

According to local media reports, a young man died from what first appeared to be a toothache but then advanced to a blood infection and malaria. He had been moved between several hospitals, seeking medical attention to no avail. 

Many patients began turning to private clinics, which are costlier than public hospitals, to receive medical attention.

Week 4: Catholic bishops urge government to take action

Bishops under the Kenya Conference of Catholic Bishops (KCCB) call on President Ruto to "speedily" resolve the concerns of the striking doctors.

Meanwhile, Kenyatta National Hospital, the country's largest referral hospital, laid off 100 of its striking doctors and announced it had hired new staff as replacement.

Week 5: President Ruto lashes out at strike supporters

President William Ruto has expressed dismay at leaders endorsing the strike: "If you support them [the doctors], pay the money they are asking for," the president said.

Ruto insists that the government's offer is final — a position the KMPDU firmly rejects. A Kenyan court has given the government and the medical union 48 hours to agree on a deal.

Edited by: Chrispin Mwakideu

More than 1,000 people have succumbed to cholera, while tens of thousands across Africa have been infected in a series of deadly cholera outbreaks since the beginning of 2024.

The hardest hit nations are the Democratic Republic of the Congo, Mozambique, Zimbabwe , Zambia in southern Africa, and Ethiopia further north.

Zambia is being battered by its worst outbreak ever, with more than 740 cholera deaths recorded since the onset of seasonal rains in October 2023.

The highly contagious bacterial disease can cause severe diarrhea and dehydration within hours of infection. When people are quickly treated, less than 1% die. But the death rate in Zambia, one of the world's poorest countries, is more than 3%.

How does cholera spread?

Cholera outbreaks often occur in disaster-hit areas or poorer communities lacking safe drinking water and proper sanitation. Those who depend on untreated water from rivers and ponds or live in slums and refugee camps are at particular risk.

This is because the Vibrio cholerae bacteria that causes cholera is shed in the feces of the infected host, with the bacteria spreading rapidly if it gets into food or water supplies.

"Just imagine one household where the toilet is pretty close to the place where people fetch their water, so there is a transmission of contamination between the toilets and the water that people drink," explained epidemiologist Yap Boum, the head of the Pasteur Institute of Bangui, a non-profit research foundation in the Central African Republic.

"And then in settings like refugee camps, where you have a concentration of people, the water that is being used is highly contaminated."

What is fueling Africa's current cholera outbreaks?

There are a host of reasons for the rash of simultaneous cholera outbreaks across so many southern African countries, said epidemiologist Boum.

"Cholera is a marker of inequality, mostly affecting countries that are exposed to conflict, insecurity and poverty," he said. Those factors are all present in each of the African nations currently battling cholera outbreaks.

Another factor is climate change.

"Increasingly frequent and more severe flooding linked to climate change has an impact [on cholera outbreaks] too," wrote water management expert Anja du Plessis, an associate professor at the University of South Africa, in response to DW questions. "Cholera occurs more in the rainy season, which the region is currently experiencing."

"Flooding results in more run-off containing more pathogens, increasing the risk of contamination."

What about the cholera vaccine?

To make matters worse, stockpiles of the only available cholera vaccine are empty as demand soars.

Only one manufacturer, based in South Korea, currently makes an oral cholera vaccine. It is churning out 700,000 doses a week, but demand is four times greater than it can supply, according to Doctors Without Borders (MSF).

This despite an October 2022 International Coordinating Group (ICG) on Vaccine Provision recommendation to replace the long-standing two-dose regimen with a single dose of the cholera vaccine in an effort to preserve stocks.

Unlike routine childhood vaccinations, cholera vaccines are produced on a "needs basis," said Edina Amponsah-Dacosta, a vaccine expert with the Vaccines for Africa Initiative based at the University of Cape Town in South Africa.

"We tend to use cholera vaccines for mass vaccination programs whenever we have outbreaks — to control the outbreak of the disease. That means we tend to produce a limited amount for a limited number of countries."

Are vaccines the solution to cholera containment?

The past decade has seen a massive increase in cholera vaccines produced, jumping from roughly 2 million doses in 2013 — when the cholera stockpile was set up — to 36 million in 2022.

But that still isn't enough to keep up with the current unprecedented surge in global cholera cases.

"If cholera were similarly affecting Western countries, I believe we would have the highest amount of vaccine available, but that is not the case," said Boum, who previously headed MSF's research arm, Epicentre.

At the same time, every expert interviewed for this article warned that vaccines would never be the silver bullet that will stem the spread of cholera in southern Africa.

Rather, a vaccine is just one of many tools to help fight disease. Others include improving community health messaging about boiling water and good hygiene practices, like washing one's hands, providing safe and reliable water sources, and increasing water quality testing and monitoring.

Why isn't Africa producing its own cholera vaccine?

In 2022, the South African-based company Biovac signed a licensing contract to manufacture oral cholera vaccines in a deal heralded by international health experts. But Biovac's vaccines can't be used to curb current outbreaks because production isn't slated to start until 2026.

Having a regional manufacturer is an important step in the right direction though, say both Yap Boum and Edina Amponsah-Dacosta.

"Diseases are not prioritized the same way in all parts of the world," vaccinologist Amponsah-Dacosta told DW. "With cholera, we have just one manufacturer with limited global interest in a disease such as this one. It creates the situation that we're seeing now in terms of the dwindling stockpile."

"If you increase manufacturing capacity in parts of the world that experience the disease the worst, it just means that they are able to take ownership and rely on their own resources and better support their health programs. "That is critical."

Edited by: Chrispin Mwakideu

Nigeria has become the first country in Africa's "meningitis belt" to introduce the new Men5CV or 'MenFive' meningitis vaccine. It is the world's first vaccine to provide protection against all five strains of the meningococcal bacteria that cause meningitis.

Around half of meningitis cases and deaths occur in children under 5 years old, according to the World Health Organization (WHO). 

Since 2010, Africa, which sees the highest burden of meningitis infection in the world, has been fighting outbreaks using the MenAfriVac vaccine. Although it has successfully eradicated about 80% of meningitis infections across the continent, the vaccine only protects against a single strain of the meningococcal bacteria, serogroup A.

That means Africans haven't had protection against the four other strains of the bacteria (C, W, Y and X), all of which cause the disease. Cases of meningitis have continued to rise in meningitis-prone areas, and have been attributed to the C, W, Y, and X strains, but not the A strain. 

Last year, reported meningitis cases jumped 50% across Africa, according to the WHO.

"According to any standards, it's unbearable to keep this disease burden," Marie-Pierre Preziosi, an expert on meningitis at the WHO, told DW.

Between October 2023 and mid-March of this year, Nigeria experienced an outbreak of the C strain, which led to around 1,700 suspected meningitis cases and some 150 deaths across the country, the WHO reports. The vaccine was rolled out to address that epidemic.

Other countries, such as Togo, have seen similar outbreaks in past years. 

Meningitis belt

Africans located in the 26 countries considered part of the continent's meningitis belt are more susceptible than anyone in the world to meningitis. Preziosi said that is because of the area's climate.

At any given time, around 10% of the global population is carrying the bacteria that causes meningitis in the back of their throat or nose. The bacteria normally sits in mucus membranes, which protects against the spread of bacterial infection. Trouble only comes when the membrane is breached, allowing the bacteria to enter the bloodstream.

Preziosi said that when the dry season arrives in Africa's "meningitis belt" — generally between December and June — dry, dusty winds blow from east to west. When inhaled, the material that these winds carry can breach mucus membranes. Many studies have shown that meningitis outbreaks can be clearly tracked to dry season. 

Before the rollout of the MenAfriVac shot, countries in the belt saw major outbreaks of meningitis every five to 12 years, according to Gavi, the Vaccine Alliance, an international health organization that will help distribute the shot. During the worst of these outbreaks, up to one-in-100 people were infected. 

Africa's 1996-97 meningitis outbreak, which caused at least 25,000 deaths and 250,000 infections, remains one of the continent's worst. 

Meningitis causes serious long-term health issues

Even with early diagnosis and antibiotics, meningitis is deadly in about 10% of cases, and about 20% of those infected experience long-term health issues. 

"For those who survive, one-in-five can develop long-lasting disabilities — that can be neurological disabilities, loss of hearing, deafness, also losing limbs," said Preziosi. "So it's quite dramatic, and it can drive a whole community into poverty."

Meningitis is most commonly spread through droplets from coughing, sneezing or kissing. The incubation period is generally between three and four days.

Initial symptoms are usually non-specific and can look like the flu. If untreated, the carrier can develop high fever, light sensitivity, neck stiffness, bleeding in the skin and, in the worst cases, blood poisoning that can lead to sepsis. Infection leads to the inflammation of membranes surrounding and protecting the brain and spinal cord. 

By protecting people from all five strains of meningitis, experts hope the new Men5CV vaccine will prevent the burden of the disease initially in the African meningitis belt, but eventually in other meningitis-prone regions. 

Men5CV vaccine rollout

The Men5CV vaccine rolled out in Nigeria has been in the works for 13 years,, and uses the same infection fighting mechanism as the MenAfriVac. 

"When you get the vaccine … your body will react by creating antibodies, these are the defense mechanisms to protect from infectious diseases," said Preziosi. "Those antibodies could also generate some specific mucus antibodies at the surface of your nose or throat," she said, which prevent the bacteria from latching on.

At this point, the new Men5CV vaccine will only be used to address outbreaks. The WHO says it hopes countries can begin using it as preventative protection for all children two and older by 2025.

At $3 (€2.80) per shot, this vaccine is slightly more expensive than the MedAfriVac, which is less than $1 (€0.94). But Preziosi says that if there is broad uptake, the price could go down. 

Preziosi hopes the new five-strain vaccine will be as successful in eradicating all strains of meningitis as the A vaccine was in nearly ridding the meningitis belt of that particular type.

Edited by: Fred Schwaller

Sierra Leone's President Julius Maada Bio said Thursday that the West African nation was facing "an existential threat due to the devastating impact of drugs and drug addiction — in particular the devastating synthetic drug kush."

Scores of young Sierra Leoneans have become addicted to kush, a drug that threatens the lives of its users and others in their communities.

"It is my solemn duty as president ... to declare a national emergency on drug abuse," Bio said in an address to the nation.

A task force would be responsible for prevention, treatment, social services support, law enforcement and community engagement in Sierra Leone, reported AFP news agency.

Bio also said his government was working to take down drug trafficking networks.

The growing problem of kush

At the beachfront on the peninsula west of Freetown, DW was able to speak to some kush users. One of them identified herself as Mosquito Rambo.

"I'm a prostitute. After going out with different men, any money I make, I purchase a couple of kush, smoke it for the day so that I can be joyful and feel fine," she told DW.

Escapism from unemployment, poverty or other traumas is a big draw for the drug. 

Its users are well aware of its dangers. Estimates vary, but thousands have been hospitalized, and kush-related causes kill scores of people every week in Sierra Leone.

"Kush puts our lives backwards; young men are always behind," said Abass Kamara, who added that he used to smoke two joints a day. "Now it's one a day, so I will be able to abandon it. But you cannot just do so from one moment to another."

Common among kush users are the aches and pains that follow the high. Another young woman, who calls herself Sarah, said she would be happy if kush were to disappear.

"That the government plans to eliminate kush, we are happy, because sore feet, swollen feet and robbery would stop. So we would go back to normal life," Sarah told DW.

What is kush?

The exact ingredients that go into kush are not always the same, or even known. It is a synthetic drug, or polydrug, that combines several elements. Similar types of highly-addictive drugs known as nyoape and mandrax are found in southern Africa.

Currently, kush usage has been mostly recorded in the West African nations of Sierra Leone, Liberia and Guinea. 

By most accounts, it is a marijuana-based conconction which may include anything from fentanyl, tramadol or formalin, a substanstance used to embalm corpses, which seem to make kush extremely addictive. Most users smoke the drug, and joints can be shared.

What is known, however, is that drug is extremely cheap — even in areas where there is little disposable income. For the price of a pack of chewing gum, users can get a short high.

But mental health experts say kush intake can lead to permanent brain damage and suicidal actions. One mental health expert, Dr Abdul Jalloh of the Sierra Leone Medical and Dental Association, said that in 2023 that cases of drug abuse rose from 2% to 40% over a two-year period.

Graves robbed to add embalmed bones to the drug mix

Sierra Leone's Minister of Planning and Economic Development, Kenyeh Barlay, told DW that local investigations have found that kush is the "cheapest drug on the market."

The formalin found in the drug is rumored in local media to have been obtained from exhuming bodies from graveyards and crushing the bones into a powder, though this has not been scientifically proven.

Freetown's municipal authorities earlier this month said they would deploy overnight police patrols to protect cemeteries following a spate of grave robberies involving the removal of bones from dead bodies.

This is one of the reasons why Solomon Moses Sogbandi, director of Amnesty International in Sierra Leone, wants the drug kingpins to be stopped.

"Not much is done about the drug barons, who are financiers of those bringing the drugs or those manufacturing the drugs within the country," Sogbandi told DW.

"If the government should target the drug barons, to ensure that they cut off the supply route, I think the issue of intake will be really reduced, and we can see how we can manage those that are already affected."

Calls for stronger government response in Sierra Leone

In response to the growing kush problem — which is especially prevalent in urban areas — Sierra Leone's government in February established a rehabilitation center for victims of drug abuse and set up a ministerial task force. 

The vice chairman of Sierra Leone's Human Rights Commission, Victor Idrissa Lansana, told DW that the government should have declared an emergency at the same time.  

"With the public emergency in place, we would have increased awareness, get young people to understand the dangers of kush and how they could avoid it," Lansana told DW.

"We don't have to wait until many more lives are lost to kush. As we have said, it's about the right to life, the right to health and the right to education. We have to intervene as a country, co-ordinately, so as to address this issue of kush once and for all."

Lansana was also not the only voice calling for this measure.

Crushing the kush addiction across western Africa

Religious leaders like Father Peter Conteh, who heads the humanitarian aid organization Caritas Freetown, suggested that the same approach used during the COVID and Ebola health crises could be transferred to the fight against kush. 

"Collaboration between religious leaders and the health sector was instrumental in managing the spread of COVID-19," Conteh told DW. "This same collaboration can be applied in the fight against kush, with the religious leaders working hand-in-hand with the health professionals to provide education, intervention and support to those struggling with substance abuse."

Sierra Leone's neighbors, Guinea and Liberia, are also fighting to contain an increase in kush consumption.

Guinean authorities said that more than 10 young men have died after taking the substance. Many others are undergoing medical treatments due to kush side effects.

In Liberia, President Joseph Boakai declared drug abuse a public health emergency and announced a steering committee to tackle the "existential threat" during his first state of the nation address in January.

This article was adapted by Cai Nebe from a radio report that was broadcast on DW's daily podcast AfricaLink. It has been updated to reflect the latest news about Sierra Leone's president declaring drug abuse a "national emergency."

Edited by: Keith Walker

"Somebody tells you 'God, you look terrible, are you going to be sick?' and then suddenly you are," said Charlotte Blease, recalling a recent bus trip in Ireland, from Belfast to Dublin. "You have this expectancy and it ramps up the symptoms."

Blease ― a health researcher at Uppsala University, Sweden, and one of the authors of "The Nocebo Effect: When Words Make You Sick" ― was feeling nauseous with motion sickness. 

She was trying to distract herself with any other thought, and knew that if someone interrupted her, it would trigger the nocebo effect. 

"The nocebo effect [is] negative health outcomes that arise from negative expectations," Blease told DW. It can exacerbate feelings of pain, anxiety, nausea and fatigue.

Nocebo: Not placebo

The nocebo effect is the negative mirror image of the placebo effect.

Imagine a medical trial. One group is given a real medication to treat headaches. The other group gets sugar pills, without an active ingredient.

When patients in this second group report an alleviation of their headaches, doctors say the patients are experiencing a placebo effect ― because they thought they were taking painkillers, like the patients in group one, positive thinking led to a positive outcome in their treatment.

It's a medically recognized phenomenon. And the nocebo effect is slowly gaining a similar recognition by health professionals, except it's the exact opposite: it's when negative thinking influences your outcomes, negatively.

Nocebo effect, COVID and vaccine hesitancy

During the coronavirus pandemic, researchers found that people's expectations before a COVID-19 vaccination could be linked to how they felt afterwards.

A team of scientists from Israel and the UK looked at a group of 756 Israeli adults over the age of 60 years. Each had received a booster shot ― a third vaccine against COVID-19.

"We measured both vaccine hesitancy ― one's negative attitude or expectations towards the vaccine ― and the number of subjectively reported side effects," said Yaakov Hoffman, lead author of the study and a professor in the Department of Social and Health Sciences at Bar-Ilan University, Israel.

Published in the journal Scientific Reports in December 2022, their results indicated that people who had negative expectations before their second shot were more likely to experience side effects after their third.

"The more anxiety about the vaccine, its safety and its side effects [one felt], the greater one would actually experience side effects," Hoffman told DW. 

And when the nocebo effect and vaccine hesitancy were combined, he said, it had the potential to become a vicious circle: A person who was hesitant to get vaccinated, perhaps because they had read about side effects online, would be more likely to experience side effects. Those side effects would then be recorded and reported by their doctor. That, in turn, would contribute to more media coverage about side effects, and more people feeling hesitant about vaccines… and so on, and so on.

How doctors deal with the nocebo effect

Talking to patients without triggering the nocebo effect can be a challenge.

"Doctors are obligated not to harm the patient, or to mitigate harm where possible, but they also have an obligation to tell the truth," said Blease.

In the case of a vaccine with relatively minor side effects, said Hoffman, addressing the nocebo effect head-on could make sense.

"Perhaps it's better to call a spade a spade and say, 'There's a certain percent of side effects which you are experiencing that are nocebo effects. Which means you are really experiencing them, but it doesn't necessarily signify danger,'" he said.

Hoffman stressed, however, that this was only speculation and that further research was needed to provide firm evidence.

Importance of framing health information

Other experts in the field agree the way that doctors communicate with patients can help prevent nocebo effects.

"How doctors talk to patients can influence therapy outcomes," said Ulrike Bingel, a clinical neurosciences professor who heads a pain research unit at University Hospital Essen, Germany.

"So far, communication has been mostly viewed as a feel-good issue. We need a higher awareness of how crucial it is," Bingel said.

When it comes to vaccines, for example, doctors are required to disclose any possible side effects.

But instead of rattling off a list of side effects that might scare a patient, Bingel said doctors should frame side effects as a sign that the immune system is working well.

This way, the patient might have fewer negative expectations and experience fewer or less-pronounced side effects.

Nocebo effect may be evolutionary

But how can negative ideas in our mind affect what's going on in our body?

First, it's important to understand that the nocebo effect is real. It's not a figment of a patient's ― pessimistic — imagination. 

"The nocebo and placebo effects involve complex neuroscientific processes," Bingel told DW. "When you're experiencing a nocebo effect, your body stops pumping its pain brakes. Your brain receives more brain impulses and you feel more pain."

The problem is, researchers can't explain why this happens. Not yet. But they do believe it may have something to do with our evolution.

"It was important that our ancestors learned from coming into contact with a wild animal or a poisonous plant," said Bingel. "The body [got] prepared for next time."

In other words, an early human's negative expectations would have prepared them, just in case they had to run for their lives.

"The nocebo effect could be a hangover from the past," said Blease, [but] that's a mismatch for today's modern medical environment."

Edited by: Zulfikar Abbany

Sources:

The Nocebo Effect: When Words Make You Sick by Michael Bernstein, Charlotte Blease, Cosima Locher, Walter Brown. Mayo Clinic Press, March 19, 2024.

Vaccine hesitancy prospectively predicts nocebo side-effects following COVID-19 vaccination by Y.S.G. Hoffman, Y. Levin, Y. Palgi et al. Scientific Reports, 2022: https://doi.org/10.1038/s41598-022-21434-7

Protein is essential for a healthy diet. And you can get your protein from plants and animals — beans, peas, nuts and wholegrain seeds, and fish, poultry and other livestock.

Nutrition experts at the Harvard School of Public Health advise you take most of your proteins from plant-based sources. Red meats, such as beef, they say, "should be consumed on a more limited basis."

Meat production is, for one, considered environmentally unsustainable. But too much meat can also lead to health problems, including bowel cancer. Often, it's more a case of the way the meat is cooked than the meat itself, but still it is worth bearing in mind: You are what you eat, as the saying goes.

But many people enjoy eating meat. So the idea of lacing rice — a plant-based protein — with sustainable, lab-grown beef should be welcome news. That's what scientists in South Korea say they have created, and they are calling it "beef rice".

What is beef rice?

Researchers in Seoul, South Korea, took meat and fat cells from cows, coated with fish gelatin, and inserted them into rice grains, where they grew. 

The gelatin coating helped nutrients from the animal material — beef muscle and fat stem cells — to grow and enrich the rice.

It was grown in a culture for around 10 days, allowing the protein and fat from the animal cells to develop. And what resulted was a pink-white grain.

But does it taste good?

"The initial flavor is predominantly that of rice. However, there are multiple complex flavors intertwined. It had a somewhat chalky but nutty protein flavor, followed by a slightly creamy, buttery aftertaste," said Jinkee Hong, a lead author of the study into beef rice at Yonsei University.

How nutritious is beef rice?

Hong said his beef rice contained 8% more protein and 7% more fat than conventional rice. That would make it a rich source of essential amino acids, which produce proteins.

"Th[is] demonstrate[s] its potential as a future superfood but also offer[s] ideas for the development of new forms of hybrid food products," said Hong.

But some food experts have questioned the nutritional value of Hong's beef rice.

"The end product contains 4.8 grams (0.17 ounces) of cultivated bovine cells per 1 kg (35 oz) of rice. This means that 0.5% of the end product is cultivated meat and 99.5% is rice. For replacing meat, the percentage of the protein in the final product would need to be higher," said Hannah Tuomisto, a professor of sustainable food systems at the University of Helsinki in Finland.

Beef rice is only one of several experiments to modify rice with the goal of getting more nutrients into people's staple diets.

Golden rice, for example, is genetically engineered to contain a form of vitamin A, which was found to be lacking in some people's diets in parts of Asia and Africa.

How 'green' is beef rice?

Hong and his team said that cultivating their hybrid rice would produce fewer greenhouse gases than producing conventional beef protein. 

They say 100g of beef protein production releases about 50kg of carbon dioxide (a number substantiated by previous studies), while producing 100g of protein from hybrid rice would release less than 6.27kg of carbon dioxide.

"Cultivated meat is an extremely promising field due to its potential benefits for the environment, food security, sustainability and animal ethics," said Hong.

The team are not the first to work on lab-grown meat products, either. The first lab-grown meat burger was unveiled in 2013 by Dutch scientist Mark Post.

Less than a decade later, the lab-meat industry had grown to more than 150 companies worldwide. Most companies have focused on producing alternatives for common meats, such as pork, beef, and chicken.

Why is it so hard to buy lab-grown meat?

Hong said lab-grown meat is still too expensive for mass production and that means it's been tough to get it onto supermarket shelves.  

One of the main challenges is that lab-grown meat relies on animal products to grow the cells. In Hong's study, the researchers obtained their initial batches of muscle and fat cells from cattle slaughtered at a local abattoir.

"All lab-based meats rely on bovine serum, the blood of a cow, as a growth supplement. It's the best way we have to grow such a quantity of cells that you can make something with. But it brings in ecological arguments, issues of animal cruelty, and it's expensive," said Alfredo Franco-Obregon at the National University of Singapore. Franco-Obregon has also worked on lab-grown meat.

But producers also have some way to go to convince people to eat lab-grown, cultivated meats.

A UK-based survey by the Food Standards Agency found only a third of participants were willing to try lab-grown meat.

Almost half the participants reported that nothing could encourage them to try lab grown meat, but more than a quarter said they could be persuaded if they knew it was safe to eat.

Edited by: Zulfikar Abbany

Sources:

Rice grains integrated with animal cells: A shortcut to a sustainable food system. Published in the journal Matter by Sohyeon Park, Jinkee Hong, et al., 2024: https://doi.org/10.1016/j.matt.2024.01.015

Protein in The Nutrition Source by Harvard School of Public Health: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/

Greenhouse gas emissions per 100 grams of protein, Our World in Data: https://ourworldindata.org/grapher/ghg-per-protein-poore

People are facing famine and starvation on the Gaza Strip, a Palestinian territory, which has been the focus of the Israel-Hama war.

Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, has described "severe levels of malnutrition" which have led to the deaths of at least 10 children. The Palestinian Health Ministry, which is run by Hamas, said meanwhile that 15 children had died of malnutrition and dehydration.

In northern Gaza, an estimated 300,000 people are living with food and clean water shortages.

Prolonged hunger is an extreme burden for the body. But our evolution has trained the human body to survive without food for weeks if necessary.

It doesn't work for everyone, and when there are other factors, such as disease, that weaken the immune system even more than the lack of food, a person's chances of survival are poor.

Below, we look at how the body tries to survive hunger and starvation.

The body is programmed to survive

There's a "hunger center" in the brain's hypothalamus, a region that plays a central role when a person starves. It gets active as soon as blood sugar levels drop.

First, the hypothalamus instructs the kidney's adrenal glands to release the stress hormone adrenaline. This gives us strength to search for food.

But if we fail to find food, the brain resorts to Plan B: It scrounges around the rest of the body for glucose.

The brain needs glucose, a form of sugar — also known as blood sugar — to function. Glucose accounts for only 2% of a person's body mass, but the brain consumes about half of that.

In order to obtain this essential sugar, the brain tricks the body: It sends a signal to stop insulin secretion. That stops the body's muscles from getting glucose and allows the brain to get it instead.

During severe hunger, each organ shrinks to about half its original weight until the point that they fail and the person dies. The brain is the only exception: It decreases by a maximum of 4% due to its ability to store glucose.

The rest of the body turns to protein for energy production. This also comes at the expense of the muscles, which consist largely of protein. The body converts amino acids — which are proteins — into glucose.

Can you smell extreme hunger?

After eight to ten days, the body switches its metabolism to an energy-saving program.

Like an animal in hibernation, essential activities, such as heart rate, blood pressure and body temperature drop to run at a minimum. When food is limited, it's the best thing the body can do.

The body starts tapping into its fat reserves by converting fatty acids into so-called ketone bodies.

Ketone bodies are an extremely important source of energy. They are the only compounds the brain can use alongside glucose.

But when converts those fatty acids into ketone bodies, it can emit the distinct smell of nail polish. That's because acetone is among the ketone bodies excreted through the kidneys and breath.

The longer hunger lasts, the worse things become: The skin's barrier function decreases, the immune system weakens and inflammation spreads.

Why organs fail because of starvation

Gradually, the body converts all its vital organs into brain food. After a while, the person becomes nothing but skin and bones, and the organs start to fail. The heart often gives up first.

A person can only survive hunger for an extended period if the metabolism reprograms itself, as described above, to allow the brain to survive on less glucose. That makes it possible to maintain protein reserves in the vital organs.

In order for all of this to function smoothly, the body must give that initial hunger signal — the one that stops insulin secretion. But it doesn't always work.

For example, people with malaria, HIV/AIDS or other diseases have so many inflammatory substances in their blood that the pancreas will continue releasing insulin, blocking the so-called starvation metabolism.

Long-term physical impact of starvation

People do recover from starvation. But some face long-term physical and psychological effects. These can include irreversible organ damage or dysfunction, impaired immune function and a loss of bone density.

Starvation can affect hormones, including insulin, cortisol and thyroid.

People who have experienced starvation are often also more likely to develop gastrointestinal problems.

Starvation weakens the immune system, making the body more susceptible to infectious diseases, such as cholera, measles and malaria.

Starvation passes from mother to child

Malnourished pregnant mothers can pass on the negative effects of starvation to their babies.

In a 2022 study, researchers at Pennsylvania State University in the US examined individuals who had been exposed to the Dutch Hunger Winter, a famine at the end of World War II, to study the long-term effects of starvation on children.

Out of all the age groups studied, researchers found that malnutrition in utero caused the most severe negative long-term health effects.

Babies born under those circumstances had faced an increased risk of diabetes, cardiovascular disease and obesity later in life, as well as muscular-skeletal deficiencies and auditory impairment.

Starvation's psychological effect

In the mid-1940s, researchers set out to understand the physiology of starvation via an experiment would be inconceivable today.

Facilitated by American scientist Ancel Keys, the study tracked 36 study participants fed half the calories required for normal survival for three months.

The psychological effects of constant hunger became particularly clear. Many participants withdrew and became apathetic.

Hunger overshadowed everything. They were only interested in things related to food. Some even dreamed of cannibalism. Meanwhile, their senses sharpened: the subjects could smell and hear much better than before.

This article was originally published in German.

All around the world, more and more people are taking dietary supplements that promise better skin and hair, a strengthened immune system or improved performance. Magnesium, vitamin C and others are part of a market worth billions of euros.

Angela Clausen from the consumer advice center in North Rhine-Westphalia has been dealing with this topic for years.

"The problem is that a great many people see dietary supplements as a kind of natural medication, so they use them accordingly: for therapy, and to relieve or heal diseases," she said. "But dietary supplements are only really intended to supplement essential components that we don't get enough of from our diet."

In the best-case scenario, when consumers buy dietary supplements that don't offer any benefits, they're just wasting their money. However, some substances, such as vitamin D, iodine or selenium can be harmful if too much is consumed.

Food supplements are also subject to far fewer controls, precisely because they are not medications. They can be marketed without having been tested for safety, quality, or effectiveness. Consequently, dietary supplements don't always contain the ingredients indicated on the packet, or may not do so in the quantities stated. Sometimes they even contain substances that are dangerous or banned.

On social media, there is even less monitoring of these claims. False promises about the healthy properties of dietary supplements are found everywhere, as demonstrated by a random investigation of hundreds of posts and stories conducted in 2021.

DW Fact Check did its own search for claims about dietary supplements on social media, then took three examples and analyzed them.

Supplements to make you smarter?

Claim: In this TikTok video, which has been viewed around 1.7 million times, a user claims: "You're not stupid, you just don't have enough circulation going to your brain, which is preventing you from focusing, concentrating effectively and it's leading to really poor memory."

Her top four recommended supplements to help with this are ginkgo biloba, bacopa monnieri, L-theanine and magnesium L-threonate.

DW fact check: False

Better cognitive performance and concentration thanks to these dietary supplements — unfortunately, it's too good to be true. Nutritionist Friederike Schmidt from the University of Lübeck analyzed the video for DW.

"The TikToker talks about very specific metabolic mechanisms, and she does initially appear competent," said Schmidt. However, she pointed out that, with regard to many aspects of the preparations the woman mentions, "we actually have no idea what they do and whether they help at all."

For example, one of the claims made in the video is that the plant extract bacopa monnieri raises the level of the neurotransmitter acetylcholine in the brain, which improves memory.

"This is very far-fetched," said Schmidt. "As yet, there has been not one methodologically sound study, let alone several, in which people have been given this plant extract, had more acetylcholine in their brains, and were then better able to remember things."

Angela Clausen from the consumer advice center knows all too well that citing studies of little or no relevance or significance is a common tactic when advertising dietary supplements. "The studies presented are usually a disaster as far as the actual product is concerned," she said.

Overall, the TikToker's claims are not at all scientifically sound. There is no proof that her "top four supplement recommendations" improve cognitive performance in the way she describes.

Turmeric: A miracle cure?

Claim: According to this Spanish-language video, which has had more than 1.5 million views, powdered turmeric dissolved in water can help against eczema. It is also alleged to detoxify the body, prevent arthritis and reduce the risk of cancer. Similar claims can be found here and here, as well as elsewhere.

DW fact check: False

Used as a spice, turmeric has long been held to be good for the digestion. However, according to Clausen, "all these claims are inadmissible; there are no existing studies to support them."

There has indeed been research done into the active ingredient in turmeric, curcumin — but there are no "gold standard studies" relating to the imprecisely defined extracts used in the products. This would mean studies conducted in humans, in which neither the researchers nor the subjects knew who had received the placebo and who the active ingredient, and which have ideally been corroborated by at least one other study conducted by a different working group.

Studies have only shown that a specific turmeric extract, at a specific dosage, has an anti-inflammatory effect in laboratory tests, in a test tube. But these effects can only be attributed to precisely this extract, in precisely this dosage, not simply to turmeric. The effect in humans can be completely different to the effect in a test tube.

"We are very far from being able to say that turmeric definitely helps," said Schmidt. The nutritionist explained that a particular problem with curcumin is that it is very reactive, meaning that in the laboratory it interacts with many other substances — which is presumably also why it is said to be effective against so many different diseases and problems. But this doesn't necessarily mean it will be effective in people.

Better skin, hair, nails and joints with collagen?

Claim: Posts on social media also ascribe many positive attributes to collagen. This viral video claims it will give you firmer skin, stronger nails and shinier, stronger hair, while this TikTok clip asserts that it will also support your joints.

DW fact check: False

Collagen is a protein naturally produced by the body, and it's important for bones, joints, muscles and tendons. Dietary supplements containing collagen are therefore derived from animals, usually slaughterhouse waste.

It's not clear how well the body is able to process collagen received from external sources. Even the best-known supposed effect of collagen — a rejuvenating effect on the skin — is still in need of further research, according to a meta-study conducted in 2023.

"None of these advertising promises are approved for use in the EU, certainly not the one about joint health," said consumer adviser Clausen. There is no conclusive evidence it has this effect, she added. The consumer advice center even successfully sued the manufacturer of Glow25 Collagen Powder in 2022 for using the slogan "Healthy bones and joints."

The suppliers acknowledged that their promises with regard to its effects on skin, hair and nails were inadmissible. Nonetheless, many posts online still make these claims.

Conclusion: Consumers are being misled

With dietary supplements, it's not easy to separate the truth from the hype. Generally speaking, the claims made on social media are often exaggerated, unscientific or have even been prohibited.

"In many cases, we see that people are just spending money on things they don't need," said Schmidt. She described it as "a very tempting idea: that you can do something for your health with a few capsules or powders."

Additional reporting by Julia Vergin.

This article was originally written in German.

It's a common assumption that processed foods are unhealthy and a cause of overweight and obesity. And it is sometimes true: Processed foods can, for instance, contain four times more calories than unprocessed foods.

A meta-study published in the British Medical Journal on February 28, 2024, concluded that "greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes."  

Processed foods can be any kind of food that has been altered in production. It can be food that's had vitamins or coloring added, or food that's been made safe for human consumption, such as pasteurized milk.

Strictly speaking, a freshly-baked loaf of organic whole grain bread is processed, because the individual ingredients have been altered in the baking process. But we still tend to say that "processed foods" are bad for us, when in fact it depends on the extent to which the foods have been processed.

But the results of a study published in January 2024 aimed to show why processed foods, and even ultra-processed foods aren't unhealthy per se — but that they are far more likely to contain more calories and lack nutrients and vitamins. 

Processed foods: More calories on average

Published in the British Journal of Nutrition, the study from January found that ultra-processed foods in the UK contained more food energy than mildly processed foods.

On average, ultra-processed foods contained four times more calories than minimally processed foods — the ultra-processed foods contained on average 378 calories per 100g compared to 94 calories per 100g of minimally processed food.

Not all ultra-processed foods in the study contained high amounts of energy, however; a number of the products had similar nutritional values as mildly processed foods.

"[It's not] clear whether the effects can be attributed to the ultra-processing per se, or whether the effects of processing can be attributed to the nutrient profiles of the foods which tend to be ultra-processed [such as] ready-meals, pre-packaged cakes, crisps, biscuits, cookies, sweets chocolate," said Nerys Astbury, a nutrition scientist at the University of Oxford, in a statement.

Astbury was not directly involved in the study.

Are processed foods bad for my health? 

Previous research suggests there is no evidence that processing food has an adverse impact on health.

But it may affect what the food is made of and, possibly, its texture. And food texture has been shown to affect the rate at which people eat food. This can result in overeating, and overeating can be bad for your health.

The most common processed foods with healthier profiles in the study included packet sandwiches, plant-based milk alternatives and high-fiber breakfast cereals.

But the study was limited, said Thomas Sanders, a professor of nutrition sciences at King's College London, in a statement. It did not look at the nutritional value of processed foods.

"It does not show the contribution made by the different processed food categories to key nutrients, such as protein, calcium, iron, vitamins and fiber," said Sanders.

That means it's hard to know whether the calorific content of different foods can be linked to their nutritional value.

Sanders was not directly involved in the study.

What is ultra-processed food?

Ultra-processed food is an industrially created food, derived from natural and/or synthesized foods. Most ultra-processed foods contain a lot of calories but very little nutritional value.

Think frozen pizzas, donuts and chips — they are far from their raw ingredients: wheat, tomatoes, dairy and potatoes.

Processed foods often contain high levels of chemical additives and can be addictive as well. 

In a study published in 2021, scientists linked the consumption of high levels of ultra-processed foods to deficiencies in nutrients , such as potassium, zinc, and magnesium, and vitamins such as:

• Vitamin A: important for defense against colds and for good eyesight 
• Vitamin C: important for skin and bones
• Vitamin D: important for bones, teeth and muscles
• Vitamin E: important for the immune system
• Vitamin B12: important for red blood cells and the nervous system

Foods that are high in fat, sugar and salt — whether they are ultra-processed or not — have been linked to many illnesses, from obesity to cardiovascular disease, cancer, a decline in cognitive health and increased all-cause mortality. About 40% of the global population is overweight or obese, and experts say that processed foods are largely to blame. 

But the causes of obesity are complex: "Consuming a diet containing lots of ultra-processed foods can also be a sign of other unhealthy dietary patterns and lifestyle behaviors," Astbury said.

Sources:

Nutrients or processing? An analysis of food and drink items, British Journal of Nutrition, 2024

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, British Medical Journal, 2024

Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples, Nutrients, 2021

Edited by: Zulfikar Abbany

Andrea, a woman living in Berlin, was dating a supportive, kind and creative guy named Ben. She felt they were intellectually compatible and communicated well. But there was a problem from the very start: he wanted less sex than she did.

At first, she thought this just meant he wasn't interested in her. But he insisted he was — sex was just lower on his list of priorities.

"In terms of our connection as humans, there was not much to work on," she said. But she still felt lonely in the relationship, like something was missing.

DW has changed their names to protect the couple's privacy, but their story is real — and more common than you might think. Here's why sex drive mismatch happens and how you and your partner can handle it for a happy relationship. 

Sexual desire is not a fixed 'trait'

Sex drive mismatch is "pretty inevitable in long-term relationships," said Kristen Mark, a sex and relationships researcher and professor of family medicine and community health at the University of Minnesota Medical School.

To understand the factors underpinning mismatched sex drive in relationships, such as in the case of Andrea and Ben, the researcher said it was important to understand that sexual desire is not fixed.

"We used to think about sexual desire as this trait, this thing that's stable over time, like an 'I'm just a low sex drive person' sort of thing," said Mark. "That's not really the case."

Instead, she said, sex drive shifts over time.

"If you have two people whose sex drives are fluctuating over their lifetime … there are going to be moments ... sometimes longer periods of time, where you may have a mismatch," said Mark.

Factors that influence sex drive fluctuation

Mark groups the things that influence libido into three categories: individual, interpersonal and societal factors.

Individual factors are things like stress, health or lack of sleep.

"For some people, stress really dampens their desire. For other people, stress actually increases [it]," said Mark.

Interpersonal factors relate to the relationship itself — whether you are happy in your relationship or your level of attraction. This can be basic, Mark said. "We hear from lots of people who think they have low desire, but really, it's just like, 'No, I just don't really like my partner that much.'"

But these factors can also include issues with communication around sex within an otherwise happy relationship, said the researcher.

"In long-term relationships especially, some couples get into [a] pattern of how to initiate sex that can become a pretty sensitive dance. If you get rejected a few times, for example, that can have a really negative impact on your sexual desire. Because you just don't really want to approach anymore."

Andrea mentioned experiencing this in her relationship with Ben. She abstained from initiating sex with him out of fear of appearing pushy, she said, or getting rejected.

Societal factors, such as gender inequality, can also influence sex drive, said Mark.

Women who take on the bulk of household duties may feel less inclined to have sex with partners they feel are not doing their fair share around the home — or that their partners are actively contributing to their feelings of stress.

Sexual desire isn't always spontaneous

Mark said it was also important for couples to understand that sexual desire is often not what we think it is: A spontaneous drive to have sex out of the blue. This exists, said Mark, but it's less common than responsive desire: A desire in response to stimuli.

"You may not feel like having sex before you start having sex, but then once you start having sex, it feels great, and you're really rewarded, and then the cycle begins where it's, like, quite beneficial," she said.

Ways to bridge the libido gap

While the partner with a higher sex drive can end up feeling lonely in a mismatched sex drive dynamic, the other partner may "end up being sort of pathologized or thought of as the one having a problem," said Mark.

This results in a lot of pressure on the partner with the lower sex drive to bring their desire up, while little or no pressure is placed on the other to bring theirs down, she explained.

"For couples who navigate this well, what they do is they meet in the middle," said Mark.

Couples experiencing a mismatched sex drive, one that is causing problems in the relationship, should have a "really frank conversation about sexual needs," said Mark: You should try to figure out how your individual needs can be met in ways that work for both of you.

For many people, Mark said, the desire for sex is really about a desire for closeness and intimacy. Good sex in a relationship can serve as confirmation of being wanted.

Verbal reassurances and touching that doesn't lead to sex, like hugging, holding hands, kissing, or showing affection in public, are ways some couples are able to bridge this gap, she said.

Andrea's relationship with Ben wasn't the first time she had experienced sexual mismatch. Years earlier, Andrea dated a man who could not have penetrative sex for health reasons. But with him, said Andrea, she never saw the mismatch as a problem.

"He made me feel very wanted. He complimented me a lot. And I knew he was attracted to me. I knew he thought I was a beautiful woman. And there were ways in which he was flirting with me or trying to satisfy me with any kind of alternative to conventional penetration," said Andrea.

There is no 'normal' sex drive

Mark said there was no "normal" amount of times to be having sex with your partner per week. 

In her work, Mark encourages couples to relieve themselves of the pressure that their sex life is "abnormal" or worse than that of the couple next door.

Some research indicates that sex once per week is the sweet spot, said Mark, but "it's really individual."

Edited by: Zulfikar Abbany

The pharmaceutical giant AstraZeneca has reportedly withdrawn its COVID-19 vaccine Vaxzevria, also known as Covishield, worldwide, citing commercial reasons for the decision.

"As multiple, variant COVID-19 vaccines have since been developed, there is a surplus of available updated vaccines. This has led to a decline in demand for Vaxzevria, which is no longer being manufactured or supplied," various media outlets quoted the company was quoted as saying.

A document hosted by the EU's European Medicines Agency website confirmed that Vaxzevria was no longer authorized in the region.

In an email to DW, virologist Wolfgang Preiser said "the demand for SARS-CoV-2 vaccines is very low and unlikely to pick up significantly in the foreseeable future, so I understand the reasoning."

Vaxzevria saved millions of lives 

AstraZeneca, who developed the vaccine with Oxford University, said it was "incredibly proud of the role Vaxzevria played in ending the global pandemic."

More than three billion doses were supplied globally. Independent studies estimate that more than 6.5 million lives were saved in the first year that it was used.

The Oxford-AstraZeneca vaccine was developed within the first months of the pandemic in 2020. It was first approved in the UK on December 30, 2020, with other countries granting the vaccine conditional marketing authorization later in 2020 due to the urgency of the pandemic.

Vaxzevria was effective against initial ancestral variants of COVID-19 virus — the alpha variant — but was less effective against newer variants of COVID-19, such as the omicron variant. 

Many governments, including in the UK, Germany and Australia, had stopped using the Oxford-AstraZeneca vaccine before its withdrawal from the market.

"We are still distributing COVID-19 vaccines, but none of them are AstraZeneca any more. They were the first manufacturer with which we concluded our arrangement in 2022," Olly Cann, director of communications at the international organization Gavi, the Vaccine Alliance, told DW.

The latest COVID-19 vaccine advice issued by the World Health Organisation in April advised that COVID-19 vaccines should target the JN.1 lineage of the virus, which is now the most dominant variant.

However, at the time of writing, Preiser said relatively few severe infections were being observed "due to a high level of population immunity stemming from past vaccination, and often also past infection."

Was the vaccine withdrawn due to side effects?

Although the vaccine was found to be safe and effective overall, it carried a very small risk of developing blood clots as a side effect. The condition is known as "thrombosis with thrombocytopenia syndrome (TTS)."

The rare syndrome occurred in two to three people per 100,000 who were vaccinated with the Vaxzevria vaccine.

While studies found the vaccine did not increase the risk of heart attacks or strokes, it has been under intense scrutiny due to TTS.

"The side effects are real and may have serious consequences for those affected, but as with all interventions, a careful risk-benefit analysis [was] needed. During the pandemic, the balance was definitely in favor of using the vaccine," said Preiser, who is based at Stellenbosch University in South Africa.

In a UK High Court case, AstraZeneca is being sued by more than 50 people, who claim to have been affected by side effects.

The British Telegraph newspaper, quoted as the first to break the news of Vaxzevria's withdrawal from the market, reported that AstraZeneca had admitted in the court case in February 2024 that the vaccine "can, in very rare cases, cause TTS."

AstraZeneca said the decision to withdraw the vaccine was not linked to the court case or any risks associated with TTS. 

Edited by: Zulfikar Abbany

Ulrike Holzgrabe believes China wouldn't need an atomic bomb to deal a fatal blow to Europe. Just stopping its supplies of antibiotics would also do the trick, the professor for pharmaceutical and medicinal chemistry at Würzburg University in southern Germany told DW.

Europe's huge shortage of medical masks during the coronavirus pandemic has laid bare the continent's vulnerability to ensuring a steady supply of basic medicinal products. In 2020, the European Parliament stated in a report that public health could be a "geopolitical weapon that can bring down an entire continent."

The European Union has since attempted to identify the types of medicines it can only source from outside the bloc, notably from China. Holzgrabe said this effort needs to be intensified with a database on which company produces what and who provides the precursor chemicals for drug production.

Cut-throat competition and trade secrets

Establishing a precise pharmaceutical database is where the problem already begins, says Jasmina Kirchhoff from the German Economic Institute (IW) in Cologne, Germany. Information on the manufacturers of chemicals and other downstream ingredients are "well-kept trade secrets," the pharma business expert told DW.

It's critical for manufacturers to keep market advantages secret from competitors, especially in the generics sector. Generics are pharmaceutical drugs that contain the same chemical substance as a drug that was formerly protected by chemical patents.

The success of generic drugmakers depends on low prices, which means that supply chains are often "very complex, and making it unclear how many companies in which countries are involved," Kirchhoff said.

Regarding antibiotics, the IW researcher noted that China recognized "as early as the 1980s" how important it is to have its own antibiotic production. "There was massive investment in those factories that could produce at the lowest costs — first for the domestic market, and then the surplus output was exported," Kirchhoff added.

In addition to China, which has also become the largest producer of chemical precursor products for the global pharmaceutical market, India has emerged as a major supplier of pharmaceutical products.

National Pharma Strategy: Germany's reshoring initiative

As part of efforts to boost the domestic pharmaceutical industry, the German government adopted a strategy paper in December 2023 identifying three key areas to be strengthened. The goals include, first of all, unbureaucratic approvals for clinical trials with medicinal products. Secondly, easier access to health data for research purposes. And finally, incentives for setting up more manufacturing sites in the country.

Germany is still a major player in the global pharma market and home to leading companies such as Bayer, Boehringer Ingelheim and Merck Group. However, they are strong in the market for innovative, patented medications but weak in the generics market, said Holzgrabe, adding that generics production in Europe is hardly profitable due to low profit margins. 

But generics are crucial for public health care in general, as they cover about 80% of basic medication needs, including many antibiotics.

Bork Bretthauer criticizes the government's strategy to boost domestic investments with subsidies. The CEO of Pro Generika — a German nonprofit that regularly commissions scientific studies into health policy and the pharma sector — told DW that Germany needs "a different pricing system" for drugs.

"We don't need zombie factories in Europe that need to be permanently subsidized," he said, adding that Europeans must be willing to pay higher drug prices.

Big Pharma needs big incentives

In the summer of last year, the German parliament adopted legislation aimed at incentivizing the German pharma industry to reshore production or at least stop relocating abroad, with higher drug prices. The law was also a result of drug shortages and supply bottlenecks that had emerged during the global pandemic and the Russian invasion of Ukraine.

It is a major healthcare policy change because Germany had sought to keep public health costs as low as possible until last year.

Previously, drugmakers were forced to offer statutory health insurance companies their medications at capped prices. So prices were fixed for about 80% of medications, including generic drugs, meaning that only the most cost-effective drug firms could make a profit.

Under the new legislation, insurance companies' drug tenders for specific active ingredients and off-patent medications must also award contracts to a European company.

Ulrike Holzgrabe believes the legislation is a step in the right direction, but fears it will come to nothing because there is "simply no European production left," especially in the generics sector. Jasmina Kirchhoff says the law has at least helped prevent more production from moving abroad.

China's unassailable dominance

Wolfgang Große Entrup, managing director of the Association of the German Chemical Industry (VCI), thinks higher drug prices are inevitable if Europe wants more security. But production in Europe will never be as cheap as in Asia, he said in April. The German pharma industry, in particular, would suffer from "excessive bureaucracy, skilled labor shortages, high energy costs, and crumbling infrastructure."

Holzgrabe shares this view, adding that Chinese drugmakers, by contrast, benefit from lower labor and energy costs and cost-free land allowances from the government when they establish production facilities. Moreover, they don't have to comply with environmental regulations as strict as those in Europe.

All of this, she said, would make it difficult to bring pharmaceutical production back to Europe so that "independence from China won't be achieved."

This article was originally written in German.

The world seems to have largely got over COVID-19 — and is now making preparations for how to cope with any future pandemic. A global agreement on pandemics is designed to improve communication between countries. Members of the World Health Organization (WHO) are currently negotiating the draft accord.

Many scientists are convinced that there will be another pandemic. Flu, a new coronavirus or a pox virus are among the potential candidates.

"Bird flu would be uncomfortable," said Emanuel Wyler, a molecular biologist from Berlin's Max Delbrück Center. "Pox would be a small nightmare. "

But measles or multi-resistant bacteria are also possible — the list is long.

Our increasingly connected world and climate change mean that infectious diseases can spread increasingly quickly and easily. Intensive livestock farming and the encroachment of people into wildlife habitats make zoonoses more likely. That is when a disease jumps from animals to people.

Germany is also considering whether it has learned the right lessons from COVID-19. Is the country prepared to face another pandemic?

Hospitals will play a critical role

Images of packed intensive care wards and overworked staff have seared themselves into our brains. In any future pandemic it'll be crucial how well Germany's hospitals are armed to cope with a sudden influx of patients.

"Health care provision in times of crisis will only work well if hospitals run well in normal times," said Christian Karagiannidis, a critical care doctor at Cologne-Merheim Hospital in western Germany. "That doesn't currently exist in the form we need."

There is no contingent of spare beds for unforeseen eventualities. There are almost 1,700 hospitals in Germany, but only a quarter treated COVID-19 patients during the pandemic. 

Germany's health ministry is now working on transforming the hospital sector so that the load is distributed more evenly. Karagiannidis is part of the government commission involved in the hospital reform. He thinks it is crucial to expand the number of clinics that have at least ten intensive care beds with intubation facilities, plus special features, like a heart catheter and a helipad. But that would mean smaller hospitals would have to close.

Germany needs more health care workers

Another problem is aging health care workers. In the western German state of North Rhine-Westphalia (NRW), one in three are over the age of 55, according to the NRW Pflegekammer. The organization, which represents health care workers in Germany's biggest state, says only 15% are younger than 30. The health insurance company DAK says it is impossible to replace those retiring.

The fact that hospitals learned to work together rather than as rivals gives cause for hope, says Karagiannidis. And the lesson has been learned that it's a good idea to have a stock of masks and medication.

While stockpiling might be working at the hospital level, there is an implementation problem at the national level. At the start of the coronavirus pandemic in 2020, the German government decided to set up a national reserve of protective clothing and medical products. The idea was to stockpile centrally and supplement the stock with medication and medical products made in Germany in an attempt to avert supply chain problems.

Four years later, however, the project has not made much progress. Masks that are past their best by date are being destroyed.

"That could backfire on us again next time," says Philipp Wiesener, who is responsible for national crisis management and public health protection for the German Red Cross.

On the plus side: during the coronavirus pandemic, we learned how to set up vaccination centers and vaccinate large numbers within a short space of time, says Wiesener. That's something that could be drawn on next time.

A starting point: The vaccines

The rapid development of effective vaccines averted a worse health care crisis. The mRNA technology had been the focus of research as a way to help cure cancer.

"It was indeed fortunate that the development of mRNA technology had progressed so far," said Emanuel Wyler. 

During the pandemic, mRNA vaccines proved to be a flexible tool. However, they only work if it is clear exactly which pathogen structures they should target. The vaccines would be useful if the next pandemic were again to involve a new coronavirus, molecular biologist Wyler says, warning that they may be less useful in the fight against some other viruses such as smallpox, for which the world's population is not sufficiently vaccinated against.

But the question is also whether Germans will get vaccinated at all next time.

German society is more skeptical

Shortly before the WHO declared the end of COVID-19 as a public health emergency in May 2023, more than 20% of the population in Germany had not gotten vaccinated. And quite a lot of people say they lack confidence in government measures. In a survey conducted by psychologist Cornelia Betsch from the University of Erfurt in late 2022 and early 2023, a third of those questioned said they would not take protective measures in the next pandemic. And almost a third even said they would like to see the government punished for the way it handled the pandemic.

The COVID-19 outbreak exposed numerous shortcomings. It was hard for health care officials to reach less educated people and those with lower incomes. Digitalization in the health care system and schools was again shown to be way behind in Germany. Many children and young people are still suffering from the effects of COVID school shutdowns. Scientists have criticized the lack of systematic data collection to evaluate the measures.

Doctors in intensive care units, however, are clear on what needs to be done. 

"We need to run through what would happen if the next pandemic were to break out now," says Karagiannidis. 

How do we react? What will happen to children? What will happen to schools?

"We need to develop a scenario so we can see where the weak spots are," he says.

That has still not happened.

This article was originally written in German. 

Editor's note: The previous version of this article has been modified to remove a factual inaccuracy. 

While you're here: Each Tuesday, DW editors round up what is happening in German politics and society. You can sign up here for the weekly email newsletter Berlin Briefing.

Durga was devastated last year when she learned that she had developed a tuberculosis (TB) infection for the third time.

Now, almost four months after completing another course of anti-TB treatment, the 28-year-old was still short of breath when we spoke.

"The doctors say I am cured, but I don't feel like I am the same person anymore," said Durga, who requested we protect her identity by not using her full name.

Beating a tuberculosis infection is only the first milestone in a long journey of recovery for many patients.

Emerging data shows that TB survivors often go on to develop long-term breathing difficulties — a result of lasting damage that the respiratory disease does to the lungs.

Even household tasks leave Durga breathless: "When I lie down, my breathing gets wheezy. I am unable to feel hunger and haven't regained the weight I lost during the infection."

How common is tuberculosis globally?

Every year, more than 10 million people get tuberculosis — that makes it the second most common cause of death in the world. TB infection rates rose to a 30-year high at the end of 2023.  

A majority of TB cases are reported in India, China and Indonesia. India alone accounts for more than a quarter of the global TB health burden.

A large number of TB patients continue to feel its effects long after their treatment is completed.

The effects can range from minor breathing difficulties to a patient developing Chronic Obstructive Pulmonary Disorder, a persistent lung condition, also known as emphysema or chronic bronchitis.

How does TB affect the lungs?

A TB infection is caused by a bacteria, Mycobacterium tuberculosis.

"The bacteria first infects the airway. If the infection is severe, it moves into the lungs," said Vijil Rahulan, a pulmonologist based in India. 

Shortly after the initial infection, the human immune system attacks the bacteria, which causes inflammation.

Sometimes the reaction is so severe that it damages parts of the lungs, leaving cavities which can fill with fluids or dead cells.

The inflammation can also trigger a thickening of the walls of some lung cells, which is what causes poor breathing.

"Medically, the end point of the treatment is when the patient's sputum tests negative for tuberculosis bacteria. It is not defined by the disappearance of symptoms. This seems to be the gap in the system," said Ramya Ananthakrishnan, director of REACH, a non-profit organization in India that aims to eliminate tuberculosis in local communities.

Post-TB lung damage can leave patients with lasting chest pain, coughs, shortness of breath, and a reduced capacity to do sport and other exercise, or even basic, everyday activities and errands.

Poor lung function can deprive the body of vital oxygen, leading to fatigue in other organs and poor health overall.

The rise of drug-resistant TB is affecting treatment

As tuberculosis is caused by a bacteria, it can be treated with antibiotics. But antibiotics are losing their potency against many bacterial infections, and as Durga's case shows, it is important that patients complete the course of tablets they are prescribed. 

Durga first developed TB when she was 22 years old. "I was asked to take four tablets each day. I took the prescribed tablets for two months and felt better. So I discontinued the treatment without finishing the full course," she said.

Two years later, she fell ill with TB again. 

"I was diagnosed with drug-resistant TB. The doctors were baffled by how rapidly it was damaging my lungs. This time I had to take nine tablets a day," Durga said. 

Ananthakrishnan said Durga's case was common among TB patients.

"But I'm having difficulty understanding how badly new drug-resistant strains of TB are affected the lungs," said Ananthakrishnan. "The way different strains of tuberculosis affect the lungs has to be studied to mitigate the long-term impact."

Having recently lost a family member to TB, Durga said she would now like to see government-run health programs that provide long-term support and monitoring of symptoms for patients.

Edited by: Zulfikar Abbany

Sources

The WHO Global Tuberculosis Report 2023 (World Health Organization, 2023): https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023

Tuberculosis and lung damage: from epidemiology to pathophysiology, published in European Respiratory Review by Shruthi Ravimohan, Hardy Kornfeld, Drew Weissman, Gregory P. Bisson (2018): https://err.ersjournals.com/content/27/147/170077

You may know the feeling. Your days are characterized by a dull haze of sameness. You want to connect with people, but even when you get the chance, you don't feel happy enough to get out and meet them. You don't want to bother friends with your issues — you don't even think there is anyone you could turn to.

Everyone else seems to be normal. You are convinced you are different. You feel lonely, and you feel it written in your face.

But we all have lonely moments or periods and health experts know it, too.

Health bodies in the UK, US and Japan have been warning of the risk of a loneliness crisis since before the COVID-19 pandemic — a time when many people said they felt an increased sense of loneliness and other mental health issues.  

But why? And how widespread is loneliness? Some researchers say loneliness could be connected to pressures we feel in our everyday lives.

Loneliness and the pressures of success in the city

Kamna Chhibber, a psychologist based in India, said loneliness was a byproduct of globalization, industrialization and a rapid spread of technology.

Data on loneliness in India is sparse, but some surveys have indicated that up to 40% of adults in the country say they feel lonely.

The country is undergoing significant migration, particularly among young people, from smaller towns and cities to larger urban centers, Chhibber said. This migration has weakened a sense of support that people traditionally got from their families.

"Elders, or even your neighbors, community elders, providing you with some guidance, helping you solve problems, mak[ing] decisions … that has completely gone away," the psychologist told DW.

Chhibber explained that as with other large cities of the world, life in urban India was rife with competition, long working hours and anonymity — like not knowing your neighbors — and these are all factors that can contribute to loneliness.

Social media doesn't help, either, said Chhibber — for many people, an endless scrolling through posts prevents them from getting out into the world and making real personal connections with people, in person.

But research published in 2021 indicated that even in tight-knit, rural villages, people were feeling loneliness. Despite being surrounded by people, you can still feel loneliness when you feel misunderstood by family or other people in the community. 

A lack of historical data on loneliness in poorer regions

Experts say it's hard to understand the global spread of loneliness because they lack the data, especially in low and middle-income countries.

"There are marked differences in the data [we have from] high-income countries and low and middle-income countries," said Andre Hajek, a professor at Hamburg University's Center for Health Economics. "We lack valid, population-based studies on loneliness in low and middle-income countries."

While there is anecdotal evidence, some experts say they need more empirical data to understand how loneliness affects broader populations, in sub-Saharan Africa, for example. 

"There is a lack of comprehensive empirical data on loneliness in sub-Saharan Africa," wrote Razak Gyasi, a member of the WHO's Commission on Social Connection, in an email to DW.

"However, anecdotal evidence suggests that loneliness is a widespread psychosocial phenomenon in sub-Saharan Africa, even more than in the Western world, and particularly among older people and women," Gyasi said. "Approximately 30-40% of adults in sub-Saharan Africa [reported] transient and chronic loneliness."

This was largely due to a perceived lack of close relationships, bereavement, and young people moving away. Gyasi said the Commission would address the problem by developing practical interventions for psychosocial conditions, including loneliness and feelings of isolation.

Tackle loneliness by prioritizing relationships

We may not have the best data on loneliness, but we do know how it feels, and over time, we can learn to recognize the symptoms. And we can learn how to deal with it.

Chhibber said young people should try to handle their loneliness by looking within. In the pursuit of success and achievement, Chhibber said many young people forget to pause and think about what's important to them.

You should ask yourself: "Do I need to pause and stop for a little bit and just try and understand for myself [what I want]?" said Chhibber.

When we neglect what's important to us, we often forget to focus on personal relationships with family and friends, or potential friends.

"[Young people] are just constantly moving from one thing to the next to the next" at the expense of their relationships, said Chhibber. "It almost feels like everyone's in some sort of a race — towards what, we have no idea."

Hajek, whose research generally focuses on older people, said it was also important for aging adults to try to maintain their skills, such as doing their own finances and using the phone for as long as possible to counteract loneliness.

But some things are out of our control. The death of a spouse, for example, can have a "tremendous" effect and contribute to loneliness, said Hajek. That's when "safety nets," such as family and friends and pets, or "looking after grandchildren" will help you feel connected through share experiences. 

Edited by: Zulfikar Abbany

Primary source:

Loneliness across cultures with different levels of social embeddedness: A qualitative study. Published in the journal Personal Relationships by Luzia C. Heu et al., February 2, 2021 https://onlinelibrary.wiley.com/doi/10.1111/pere.12367

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