A vision of vaccine utopia — minus the cost

Not so long after the miraculously swift development of vaccines against Covid-19, a summit on future vaccines painted a picture of cheap, widely available shots that not only would protect against hospital admission and death, but also keep people from developing infections in the first place. And no more needles: They’ll be delivered via nasal mist or skin patch. Those lofty visions were presented yesterday at the White House with little mention of on-the-ground funding, which could require billions, STAT’s Lev Facher reports, even for projects already in the works, such as a nasally administered booster.

“We need to move quickly to start testing these nasal vaccines, and that requires a significant U.S. government investment, both [financial] resources and help with the manufacturing,” said Yale virologist Akiko Iwasaki, who has co-founded a company to develop one. Read more on the hopes and the realities.

The $100 genome is almost here. Are we ready?

We’re getting to the point where decoding a human genome could cost just $100, or, as STAT’s Jonathan Wosen puts it, about as much as the average American spends on groceries each week. But don’t think you can drop it in your shopping cart (or pull it up on your phone) just yet. There are a raft of unsettled considerations, from the cost of analyzing and interpreting the data to the need to counsel people on what to do with what they learn. Oh, and privacy, too.

Jonathan asked experts for their thoughts. Here are just two:

On accuracy, Shiva Singh of Western University in Ontario warns that few cases are clear-cut, citing one identical twin having schizophrenia and the other not. In 2018 he described the $100 genome as “a health care cart before the genomics horse."
On cost, George Church of Harvard said, “The real price point right now should be zero.” Read why, and more.

What to know about polio, now

Last week STAT’s Helen Branswell brought us news of a a vaccine-derived polio case detected in Rockland County, north of New York City — the first such U.S. case in a decade. And health officials have also reported the discovery of vaccine viruses in London sewage. You have to be close or past retirement age to remember the horror of the virus before vaccines: of iron lungs, of paralyzed children, of summers when fevers struck fear in parents’ hearts. But as Kim Thompson, president of the nonprofit Kid Risk, told Helen last week, “There’s just a lot more polio going around than there should be.”

So Helen has a primer on a virus that continues to evade efforts to stamp it out, including why the biggest challenge is vaccine-derived polio, not wild poliovirus, and where we are now. Read it here.

Closer look: Therapy developed to save soldiers inspires an app to prevent suicide

(MARIA FABRIZIO FOR STAT)

This quote stopped me as I read Mario Aguilar’s story on an app designed to train people at highest risk to defuse their suicidal impulses: “You could argue it's the single biggest gap between the evidence and the outcomes in all of health care,” Seth Feuerstein, co-founder and CEO of the startup developing the app, said about suicide. “We know there are things you can do, and almost no one gets access to those things.”

The company, Oui Therapeutics, draws from in-person therapy methods that reduced suicide attempts by nearly 60% in a randomized trial of soliders at high risk. The startup will have to prove its standalone app can succeed in delivering that approach digitally, a process that could take years before it gains FDA clearance. If it does, it will join the new national suicide prevention hotline number and prevention frameworks like Zero Suicide. Read more about what’s involved.

‘Legacy of discrimination’ has led to a scarcity of midwives of color

STAT’s Usha Lee McFarling brings us this report: Care from midwives, especially those who are the same race as the people they attend, is one way to improve the nation’s growing maternal mortality crisis, which is far worse for Black and Indigenous people. But midwives of color remain scarce: More than 85% of midwives are white, while 6.85% are Black, 4.73% are Hispanic, and 0.58% are Native American/Alaska Native. (These numbers don’t reflect the populations midwives attend; just over half the people giving birth in their care are white.)

A recent study published in the journal Health Services Research found that despite the high motivation of many women of color to become midwives — and the long-standing traditions of midwifery in Black and Indigenous communities — significant structural barriers remain. These include the high cost of midwifery education and the lack of faculty — and those working in the profession — who are people of color.

“Generational harms and a legacy of discrimination have erased Black and Indigenous midwives and healers from their communities, which may have a significant impact on who pursues midwifery education and careers,” wrote the authors, a group led by Renee Mehra of the UCSF School of Nursing.

What could a fall push for Covid boosters mean?

(commonwealth fund)

Here’s a provocative question posed by the Commonwealth Fund: How many lives could a fall Covid-19 booster campaign save in the U.S.? It’s not the science that’s in question, but the current waning pace of vaccination that plants doubt about how effective such a public health push would be. But it’s exactly that lower vaccination rate that makes people vulnerable, the report’s authors say, in the face of a potential fall surge in Covid cases that could mean 1,500 deaths a day, compared to the current average hovering around 400 a day.

So the answer: “A fall Covid-19 booster campaign could prevent as many as 160,000 deaths, more than 1.7 million hospitalizations, and avert $109 billion in direct medical costs," the study concludes. But to get there requires additional funding from Congress and expanded vaccine eligibility from the Biden administration, the authors say.

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.

What to read around the web today

Drugmaker Teva latest to settle opioid lawsuits nationally. Associated Press
‘Critically important work’: Adm. Rachel Levine on efforts to combat gender-based discrimination in health care, STAT
Fentanyl from the government? A Vancouver experiment aims to stop overdoses, New York Times
FDA agrees to review ALS treatment from Biogen, despite inconclusive clinical trial results, STAT
The creature that gave up parasitism for ... wait, what? The Atlantic
Here's why Joni Mitchell's performance at the Newport Folk Festival is so incredible, NPR