Medical Journal News

Like political leaders throughout Europe, US President Donald Trump pledged if elected to detain and deport millions of migrants without legal documentation or with temporary protected status.1 Since Jan 20, 2025, he has moved swiftly to achieve these aims. His administration rescinded guidance that restricted immigration enforce­ment in health-care facilities, religious institutions, and schools.2–4 Military resources have been diverted for deportations, with wrenching images of shackled people directed into military planes, detained at Guantánamo Bay military base, and crowded into militarised camps in Panama.

New England Journal of Medicine, Volume 392, Issue 11, Page 1089-1099, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1143-1144, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1140-1143, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1136-1137, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1120-1120, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1121-1132, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 11, Page 1111-1119, March 13/20, 2025.

New England Journal of Medicine, Volume 392, Issue 13, April 3, 2025.

In 2020, WHO published guidance on the use of multiple micronutrient supplements (MMS) for pregnant women, which usually provide up to 15 vitamins and minerals in tablet or capsule form.1 In the 2020 update to the 2016 guidance,2 WHO issued a context-specific recommendation: “Antenatal multiple micronutrient supplements that include iron and folic acid are recommended in the context of rigorous research.”2 The evidence that informed this recommendation indicated that, compared with standard of care (iron and folic acid [IFA] supplementation), MMS reduced the prevalence of low birthweight but had little to no impact on other maternal and neonatal outcomes.

When compared with a licensed, quadrivalent meningococcal conjugate vaccine, and given alongside other routine vaccines, a single dose of NmCV-5 was safe and elicited a non-inferior immune response in infants aged 9 months and young children aged 15 months.

Since the introduction of the MenA conjugate vaccine in the African meningitis belt through mass vaccination campaigns and its inclusion in the Essential Program on Immunization (EPI), cases of serogroup A meningococcal meningitis have disappeared. This success has provided hope of eliminating serogroup A meningococcal disease and certainly epidemics in the African meningitis belt. The novel MenACWYX conjugate vaccine (NmCV-5), which contains four additional polysaccharides, is now expected to do the same for the remaining epidemic-causing serogroups in the region.

Digital adherence technologies did not reduce poor treatment outcomes in the four countries investigated. The use of digital adherence technologies should be based on careful review of additional data on economic evaluation, patient and stakeholder preferences, and the effect on other important patient outcomes beyond programmatic treatment outcomes.

Poor treatment adherence remains a major obstacle in national tuberculosis programmes globally. Digital adherence technologies offer novel opportunities to monitor and address poor adherence. Research shows that adherence challenges are common under programmatic conditions, vary among patient subgroups, and worsen over the course of treatment.1,2 Patterns of poor adherence range from missed doses and irregular treatment to discontinuation of treatment.2 Although digital adherence technologies can improve adherence through patient reminders and better monitoring, assessing their impact is challenging due to the Hawthorne effect3 and difficulties in measuring adherence in control groups without digital adherence technologies.

Pre-exposure prophylaxis (PrEP) is the advent of antiretroviral treatment use for people at increased risk of acquiring HIV-1. With access to PrEP in key risk groups and consistent use, HIV-1 incidence can decrease substantially.1–3 Initially, only oral PrEP options were available with tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine. Long-acting PrEP with cabotegravir became available in the early 2020s in some settings, but is still not widely implemented.4 Long-acting PrEP alternatives, including a dapivirine vaginal ring, are available in some African countries, but are associated with lower efficacy.

Following administration of once-yearly intramuscular lenacapavir, median plasma concentrations exceeded those associated with efficacy in phase 3 studies of twice-yearly subcutaneous lenacapavir for PrEP for at least 56 weeks. Both formulations were safe and well tolerated. These data show the potential for biomedical HIV prevention with a once-yearly dosing interval.

by Sara Ahmadi-Abhari, Piotr Bandosz, Martin J. Shipley, Joni V. Lindbohm, Abbas Dehghan, Paul Elliott, Mika Kivimaki

Background

The direct and indirect impacts of the COVID-19 pandemic on life expectancy (LE) and years of life lost with and without disability remain unclear. Accounting for pre-pandemic trends in morbidity and mortality, we assessed these impacts in 18 European countries, for the years 2020–2022.

Methods and Findings

We used multi-state Markov modeling based on several data sources to track transitions of the population aged 35 or older between eight health states from disease-free, combinations of cardiovascular disease, cognitive impairment, dementia, and disability, through to death. We quantified separately numbers and rates of deaths attributable to COVID-19 from those related to mortality from other causes during 2020–2022, and estimated the proportion of loss of life expectancy and years of life with and without disability that could have been avoided if the pandemic had not occurred. Estimates were disaggregated by COVID-19 versus non-COVID causes of deaths, calendar year, age, sex, disability status, and country. We generated the 95% uncertainty intervals (UIs) using Monte Carlo simulations with 500 iterations. Among the 289 million adult population in the 18 countries, person-years of life lost (PYLL) in millions were 4.7 (95% UI 3.4–6.0) in 2020, 7.1 (95% UI 6.6–7.9) in 2021, and 5.0 (95% UI 4.1–6.2) in 2022, totaling 16.8 (95% UI 12.0–21.8) million. PYLL per capita varied considerably between the 18 countries ranging between 20 and 109 per 1,000 population. About 60% of the total PYLL occurred among persons aged over 80, and 30% in those aged 65–80. If the pandemic were avoided, over half (9.8 million (95% UI 4.7–15.1)) of the 16.8 million PYLL were estimated to have been lived without disability. Of the total PYLL, 11.6–13.2 million were due to registered COVID-19 deaths and 3.6–5.3 million due to non-COVID mortality. Despite a decrease in PYLL attributable to COVID-19 after 2021, PYLL associated with other causes of death continued to increase from 2020 to 2022 in most countries. Lower income countries had higher PYLL per capita as well as a greater proportion of disability-free PYLL during 2020–2022. Similar patterns were observed for life expectancy. In 2021, LE at age 35 (LE-35) declined by up to 2.8 (95% UI 2.3–3.3) years, with over two-thirds being disability-free. With the exception of Sweden, LE-35 in the studied countries did not recover to 2019 levels by 2022.

Conclusions

The considerable loss of life without disability and the rise in premature mortality not directly linked to COVID-19 deaths during 2020–2022 suggest a potential broader, longer-term and partially indirect impact of the pandemic, possibly resulting from disruptions in healthcare delivery and services for non-COVID conditions and unintended consequences of COVID-19 containment measures. These findings highlight a need for better pandemic preparedness in Europe, ideally, as part of a more comprehensive global public health agenda.