Childhood vaccinations backslide around the world to historic lows

Childhood vaccinations around the world have dropped to their lowest levels in 30 years, new data from WHO and UNICEF say, a historic backslide dimming hopes for improvement after the Covid pandemic’s first year. Looking at children who received three doses of the DTP vaccine against diphtheria, tetanus, and pertussis as a signal of immunization in general, the analysis says coverage fell to 81%, a 5 percentage point drop between 2019 and 2021. That means 25 million children missed DTP doses in 2021 — 6 million more than in 2019. Covid disrupted vaccination efforts, but the report also cites regional conflicts as well as misinformation.

“This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF executive director, in a statement. “Covid-19 is not an excuse.”

Diagnosing HIV in children dropped in Covid's early days, PEPFAR data say

Here’s another way the Covid-19 pandemic has affected children’s medical care around the world. A new CDC report tells us that in the 22 countries where the U.S. President’s Emergency Plan for AIDS Relief, better known as PEPFAR, works, testing and diagnosing children with HIV have taken a hit during Covid. In the first three months of the pandemic, HIV testing dropped by 40% and case identification fell 29%. For some context, an estimated 150,000 children around the world from birth to age 14 acquired HIV in 2020.

The analysis does note that while outpatient testing went down, it did go up in other settings, including mobile testing, when testing was offered to partners and biological children of HIV-positive individuals, and when children were being tested because they had signs of malnutrition.

Disparities mark cancer care during Covid

Name a metric and Black and Latino adults with cancer fared worse than white people in the pandemic’s first year. A national survey of 1,240 U.S. adults with cancer from September 2020 through January 2021 found that compared with white patients, Black and Latino patients had three times the odds of having their cancer care modified and involuntarily delayed by more than four weeks. Wider concerns about Covid’s impact were also more pronounced among Black and Latino people, including more fears about losing jobs, child care, housing, and affordable cancer care.

The study in JAMA Network Open was undertaken against a background of known disparities in timely cancer care and higher premature deaths rates among Black and Latino people than other racial and ethnic groups. “Urgent efforts are needed to address these disparities,” the authors write.

Closer look: Wilderness therapy is polarizing. Courts weigh whether insurers should pay for it

(RHONA WISE/AFP via Getty Images)

Wilderness therapy has a checkered past. Programs employ a team of guides and therapists who take adolescents with severe behavioral health issues like suicidal ideation and substance misuse into the woods for weeks or months at a time — often against their will. Far from phones, friends, and regular lives, they get a mix of traditional psychotherapy and outdoor skills training. That’s the ideal, but there’s a troubling history from decades ago, when at least 10 kids died from preventable ailments like dehydration and heat stroke under the care of unscrupulous programs.

STAT’s Tara Bannow brings us a story of insurers balking at paying for the pricey programs, and parents fighting to get coverage comparable to what’s offered for residential mental health programs. Read more about the coverage fights and the polarizing therapy behind them.

What keeps 'healthy underweight' people that way

BMI may not be a perfect measure of health, but it’s a factor routinely used when researching overweight and obesity. A small new study posted in Cell Metabolism looked in the other direction, at “healthy underweight” people whose BMI was below 18.5, but not because illness put them below the “normal” range of 21.5 to 25. For two weeks the researchers compared 150 healthy underweight people to 163 normal BMI participants, monitoring the food they ate, the energy they expended, and how active they were.

The healthy underweight people ate 12% less food, but they were also 23% less active. They had higher resting metabolic rates, including higher resting energy expenditure and elevated thyroid activity, as well as lower triglycerides and “bad” cholesterol. “This suggests low body weight/fat is a more potent driver of metabolic health than higher physical activity,” the authors write.

Opinion: Don’t let hospital care at home end with the public health emergency

Some changes spurred by Covid-19 — telehealth among them — are worth keeping, most people would agree. Hospital-level care in the home is another alternative that emerged when only the sickest people were admitted to short-staffed hospitals. Policymakers granted Medicare and Medicaid flexibility to connect vulnerable patients with care this way, but that waiver is set to expire when the public health emergency eventually ends, Stephen Parodi of the Permanente Federation and Ceci Connolly of the Alliance of Community Health Plans warn in a STAT First Opinion, urging an extension.

“Clinical care teams know that patients, even those with complex conditions, benefit and thrive from receiving care at home. This type of care can also increase access for patients experiencing social barriers, such as transportation and food insecurity,” they write. “Home is where patients and their families want to be.” Read more.

What to read around the web today

Story of 10-year-old girl who had to travel out of state for abortion underscores impact of bans on adolescents, Boston Globe
IVF patients started moving their embryos out of states with abortion bans when Roe fell, The 19th
OB-GYN board moves exam online to avoid Texas travel post-Roe, Bloomberg
A Supreme Court review of a contentious patent issue would change the way pharma claims discoveries, STAT
The BA.5 wave is what Covid normal looks like, The Atlantic
Opinion: New competencies on diversity, equity, and inclusion for medical education across the continuum, STAT