January 22, 2021

Pfizer vaccine appears effective against coronavirus variant found in Britain: Study

Vials with a sticker reading, "COVID-19 / Coronavirus vaccine / Injection only" and a medical

syringe are seen in front of a displayed Pfizer logo in this illustration taken on October 31,

2020. Reuters file photo

The COVID-19 vaccine developed by Pfizer and BioNTech is likely to protect against a more

infectious variant of the virus discovered in Britain which has spread around the world,

according to results of further lab tests released on Wednesday.

The encouraging results from an analysis of blood of participants in trials are based on more

extensive analysis than those released by the U.S. drugmaker last week.

Last week, Pfizer said a similar laboratory study showed the vaccine was effective against one

key mutation, called N501Y, found in two highly transmissible new variants spreading in

Britain and South Africa.

The latest study, posted on bioRxiv.org but not yet peer-reviewed, was conducted on a synthetic

virus with 10mutations that are characteristic of the variant known as B117 identified in Britain

Among the 11 authors of the study are Ugur Sahin and Oezlem Tuereci, co-founders of

BioNTech. Sahin is chief executive and his wife Tuereci is chief medical officer.

It provides further hope as record numbers of daily deaths from COVID-19 are reported in

Britain, which is believed to be driven by the more transmissible variant. It also means vaccine

development would for now not have to start all over again.

But the virus needs to be continuously monitored to check that changes maintain protection by

vaccines, the study said.

For the test, blood samples drawn from 16 vaccinated participants in prior clinical trials were

exposed to a synthetic virus called pseudovirus which was engineered to have the same surface

proteins as B117, as characterised by 10 hallmark mutations.

The antibodies in the blood of the volunteers given the vaccine, known as Comirnaty, or

BNT162b2, neutralised the pseudovirus as effectively as the older coronavirus version that the

product was initially designed for.

Experts said the findings were reassuring and not surprising and results from similar studies on

the South African variant would be keenly watched.

"This makes it very unlikely that the UK variant will escape from the protection provided by

the vaccine," said Jonathan Stoye, a specialist in virus science at Britain's Francis Crick

Institute. "It will be interesting to carry out the same experiments with the South African

variant." BioNTech has said it plans to publish a more detailed analysis of the likely effect of

its vaccine on the South African variant within a few days.

The world is pinning its hopes on vaccines to rein in the coronavirus, first detected in the central

Chinese city of Wuhan at the end of 2019, as many countries impose tighter and longer

lockdowns to try to bring the pandemic under control.

Variants and vaccines

The variants are said by scientists to be more transmissible than previously dominant ones, but

they are not thought to cause more serious illness.

"The South African strain has been detected in the UK - albeit currently in small numbers - but

does seem to be increasing in recent weeks," said Paul Hunter, a professor in medicine at

Britain's University of East Anglia.

"Variants with this mutation could reduce vaccine efficacy, though most likely all current

vaccines would still be highly effective."

Experts have called for continued testing to establish whether vaccines will protect people as

the virus mutates.

COVID-19 has killed more than 2 million people worldwide.

Preparation for potential COVID-19 vaccine strain changes would be "prudent", the study said

on Wednesday.

The Pfizer/BioNTech COVID-19 vaccine and the one from Moderna Inc, which both use

synthetic messenger RNA technology, or mRNA, can be quickly adapted to address new

mutations in the coronavirus if necessary. Scientists have suggested the changes could be made

in as little as six weeks.

AstraZeneca, Moderna and CureVac are also testing whether their respective shots will protect

against the fast-spreading variants. They have not released the results of those tests.



Antidepressants ineffectual for back pain and osteoarthritis

Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain

and hip and knee osteoarthritis

Antidepressants ineffectual for back pain and osteoarthritis

Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain

and hip and knee osteoarthritis

A study published by the British Medical Journal (BMJ) provides evidence that stimulant

medications are generally inadequate for back and osteoarthritis pain, despite being broadly

utilized for these conditions.

The findings, based on moderate certainty evidence, show that for people with back pain the

effects were too small to be worthwhile, but for osteoarthritis, a small beneficial effect cannot

be ruled out.

Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain

and hip and knee osteoarthritis, yet evidence supporting their use is uncertain.

To address this knowledge gap, researchers led by Giovanni Ferreira at the University of

Sydney set out to investigate the effectiveness and safety of antidepressants for back and

osteoarthritis pain compared with placebo.

Their findings are based on analysis of published data from 33 randomised controlled trials

involving more than 5,000 adults with low back or neck pain, sciatica, or hip or knee


The trials were designed differently and were of varying quality, but the researchers were able

to allow for this in their analysis. Most of the data came from industry-sponsored trials.

The researchers set a difference of 10 points on a 0 to 100 point scale for pain or disability as

the smallest worthwhile difference between groups - a threshold commonly used in other

studies of chronic pain.



South African coronavirus variant may escape antibodies, cause reinfection, say scientists

Scientists believe the findings underscore the prospect of reinfection with such distinct variants

of the virus carrying these mutations, and ‘may foreshadow reduced efficacy of current spikebased


South African coronavirus variant may escape antibodies, cause reinfection, say scientists

A lineage of the novel coronavirus, first reported to have emerged in South Africa, escapes

neutralisation by antibodies from recovered COVID-19 patients, says a new study which raises

questions on the possibility of reinfection by this strain.

According to the yet-to-be peer reviewed study, published in the preprint platform bioRxiv, the

novel lineage of the coronavirus—501Y.V2—has mutations in nine parts of its spike protein,

which enables it to infect human cells.

In the research, the scientists, including those from the University of the Witwatersrand in

South Africa, tested the neutralisation activity of plasma from patients who recovered from

prior infection with other strains of the coronavirus against the 501Y.V2 variant.

They found that nearly half—21 of 44—of the samples had no detectable neutralising activity

against this variant.

According to the scientists, 501Y.V2 shows “substantial or complete escape from neutralising

antibodies in COVID-19 convalescent plasma”.

“Here we show that the 501Y.V2 lineage, that contains nine spike mutations, and rapidly

emerged in South Africa during the second half of 2020, is largely resistant to neutralising

antibodies elicited by infection with previously circulating lineages,” the researchers wrote in

the study.

They believe the findings underscore the prospect of reinfection with such distinct variants of

the virus carrying these mutations, and “may foreshadow reduced efficacy of current spikebased


Commenting on the study, clinical virologist Julian Tang from the University of Leicester in

the UK, said this variant could escape neutralising antibody responses largely due to the

presence of two mutations in the spike (S) region — one in the 484th amino acid position and

the other in the 417th molecule of the protein.

“This may reduce some efficacy from S-protein-based vaccine-induced antibodies in some

people,” Tang said.

However, he added that the study also noted considerable binding to the 501Y.V2 virus by

other non-neutralising antibodies, which the virologist believes could still offer some

significant protection against this variant.

“The study also acknowledges that it could not assess the impact of this virus variant on T-cell

responses so some additional defence will arise from this, as well as other naturally existing

innate components of the immune system in those infected in addition to any residual vaccine

protection,” Tang said.

“Further real life studies will be needed to assess the true impact of this South African 501Y.V2

variant on the vaccinated South African population outside of a laboratory context and in the

presence of other natural human immune responses,” he added.

Calling the findings “potentially concerning”, Liam Smeeth, Professor of Clinical

Epidemiology at the London School of Hygiene and Tropical Medicine, however, said these

were laboratory findings, adding that “it would be unwise to extrapolate to clinical effects in

humans at this stage”.

Smeeth said the study did, however, raise the possibility that immunity gained from past

COVID-19 infection may be lower for re-infection with the South African variant.

Lawrence Young, virologist and professor of molecular oncology, Warwick Medical School,




January 21, 2021

Don’t doubt Indian vaccines

Covaxin vaccine being administrated at Rajiv Gandhi Govt. General Hospital on Sunday.

Vaccination is important to prevent a second wave 

Several people have questioned the emergency approval given to the indigenously developed COVID-19 vaccine. They have demanded efficacy data and cast aspersions on the regulatory machinery. Such views will only increase vaccine hesitancy.

It is not the case that the vaccine developed indigenously is being pushed by vested interests, while the international vaccines are great. Questions have been raised about the Moderna and Pfizer vaccines too, which have reported more than 90% efficacy. As Peter Doshi wrote in The BMJ, questions have been raised about the exclusion of individuals from the efficacy analysis for ‘important protocol deviations’; the higher rate of medication in the vaccine arm to prevent side-effects due to reactogenicity; the processes of the primary event adjudication committees, comprising the companies’ own employees; vaccine efficacy in those who already had COVID-19; the non-availability of raw trial data; and so on.

Efficacy assessment 

Efficacy would actually mean testing, say, 10,000 individuals who have been given the vaccine versus an equivalent number not given the vaccine in terms of the number who get the infection. Can these vaccines prevent transmission? We may have to wait at least six months to get meaningful results. Efficacy would reflect in the rate of hospitalisation, ICU cases and deaths. With a declining level of infection, perhaps the virus is weakening in India on its own, as is the case with most pathogens. This makes efficacy assessment of a vaccine very difficult. 

The question of antibody-dependent enhancement, a phenomenon in which virus-specific antibodies enhance the severity of the virus, and in some cases the replication of the virus, has been put on the back burner with experts suggesting it may not be a major issue. It depends on vaccine design and it is not known whether all the candidate vaccines have been tested for this phenomenon. 

In the case of the rabies vaccine, efficacy assessment is based on the virus neutralisation capacity of the serum from the vaccinated individual, assessed in terms of international units. It is a surrogate marker for efficacy, since the candidate vaccine cannot be tested in an experimental population that is administered the virus or bitten by rabid dogs, for validation. At this stage, no one can predict whether the COVID-19 vaccine candidates can protect against the circulating mutants. The SARS-CoV-2 virus is both intellectually and medically challenging. But there has been no prevention strategy in history other than vaccination to save lives. Therefore, vaccination of the population is very important for protection against fresh infections and a second wave, although the duration of protection is not known for any vaccine candidate. It is well known that some people take the flu vaccine every year. 

The SARS-CoV-2 pandemic has been extraordinary, both in terms of positive and negative developments. The cooperation among the scientific community, industry and regulatory agencies has been truly remarkable in making vaccine development and deployment possible in less than two years, a process that would otherwise take 10-15 years. The future timelines for research and development, product development and expectations will be very different. On the negative side, we have tall claims by political leaders in the West on vaccines, major scientific journals coming under pressure to publish data with poor peer review, vaccine nationalism, etc. 

Moving ahead 

Given the context of the pandemic, it would be prudent for India to go by safety studies (Phase I and II) and assessment of virus neutralisation assays with the serum. It is also not appropriate to doubt the integrity of the expert committee advising the Drugs Controller General of India (DCGI). The DCGI is not just an individual to be pressured; it follows due process for making an informed decision regarding emergency use, or, as is called in India, approval for restricted use. 

It is understandable that limited approval has been given in clinical trial mode, where individuals vaccinated will be monitored regularly. Though no particular vaccine candidate should be favoured, candidates with proven safety studies and efficacy, as assessed based on the virus neutralisation potency of the sera, should be allowed to go ahead. One or two more months into the trial could have given partial data to satisfy interim efficacy assessment, but we will get real data on efficacy only after vaccinating the masses. Eventually, affordability could become an issue. Selective criticism of indigenous efforts will only jeopardise such efforts. India has a huge population to be vaccinated and we need to move ahead. 


January 20, 2021

India's vaccine diplomacy



Vaccine hesitancy



January 13, 2021

All set for vaccine rollout amid probing questions



January 06, 2021

Air pollution raises risk of pregnancy loss in India, south Asia: Lancet study

An estimated 349,681 pregnancy losses per year in south Asia were associated with exposure

to PM2.5 concentrations, accounting for 7% of annual pregnancy loss in the region from


Poor air quality is associated with a considerable proportion of pregnancy loss in India,

Pakistan, and Bangladesh, according to a modelling study published in The Lancet Planetary

Health journal, which says such losses are more common in north India and Pakistan.

An estimated 349,681 pregnancy losses per year in south Asia were associated with exposure

to PM2.5 concentrations that exceeded India’s air quality standard (more than 40 μg/m³),

accounting for 7% of annual pregnancy loss in the region from 2000-2016, the study says.

For air pollution above WHO air quality guideline, exposure may have contributed to 29% of

pregnancy losses. Although WHO’s guidelines aim for a safer level of air pollution, the

authors note that India’s standard is a more realistic target level, given the high average levels

of air pollution in the region and the need to balance practical governance and public health.

Considered the first such study to estimate the effect of air pollution on pregnancy loss across

the region, it says limitations in the survey data mean that it was unable to distinguish

between natural pregnancy loss and abortions, which may have led to an underestimation of

the effect of air pollution on natural pregnancy loss.

The researchers included 34,197 women who had lost a pregnancy, including 27,480

miscarriages and 6,717 stillbirths, which were compared to live birth controls. Of the

pregnancy loss cases, 77% were from India, 12% from Pakistan, and 11% from Bangladesh.

The authors combined data from household surveys on health from 1998-2016 (from women

who reported at least one pregnancy loss and one or more live births) and estimated exposure

to PM2.5 during pregnancy through combining satellite with atmospheric modelling outputs.

They created a model to examine how exposure to PM2.5 increased women’s risk of

pregnancy loss, calculating risk for each 10 μg/m³ increased in PM2.5 after adjusting for

maternal age, temperature and humidity, seasonal variation, and long-term trends in

pregnancy loss.

Using this association, they calculated the number of pregnancy losses that may have been

caused by PM2.5 in the whole region for the period 2000–16 and looked at how many

pregnancy losses might have been prevented under India’s and WHO’s air quality standard

(40 μg/m³ and 10 μg/m³, respectively).

Gestational exposure to PM2.5 was associated with an increased likelihood of pregnancy

loss, and this remained significant after adjusting for other factors. Each increase in 10 μg/m³

was estimated to increase a mother’s risk of pregnancy loss by 3%, the study says.

Lead study author Tao Xue of Peking University says: “South Asia has the highest burden of

pregnancy loss globally and is one of the most PM2.5 polluted regions in the world. Our

findings suggest that poor air quality could be responsible for a considerable burden of

pregnancy loss in the region, providing further justification for urgent action to tackle

dangerous levels of pollution.”



NFHS data shows several maternal and child health interventions have led to improved outcomes

Though overall trends do suggest an improvement in population control, use of modern

contraception, reproductive and child health, immunisation and social determinants of health,

a complete overhaul is needed to identify and address the multidimensional aspects of child


While states have shown an increase in exclusive breastfeeding and adequacy of diets, about

half of them have shown an increase in rates of malnutrition, wasting and underweight


Population-based surveys form the bedrock of the country’s health information systems. Use

of accurate and nationally representative data can be instrumental in policy planning,

programme design, health system monitoring and management of financial and human

resources. Hence, the release of the National Family Health Survey-round 5 (NFHS-5), which

covers about 6.1 lakh sample households to provide estimates for 707 districts, serves as a

litmus test to evaluate India’s prospects for achieving improved health and well-being for its

population. In the first phase, data from 22 states and UTs has been released from the latest

survey conducted in 2019-2020.

The biggest highlight comes from the data on Total Fertility Rate (TFR), which has come

down to 2.1 or below (replacement level) in all states and UTs, except Bihar (3), Meghalaya

(2.9) and Manipur (2.2). This finding is substantial given India’s longstanding investment in

population control, which has also been instrumental in our poverty alleviation efforts. This

correlates with the data on the overall use of modern methods of contraception, which has

increased in 20 out of 22 states, though female sterilisation continues to be the most dominant

method. Since universal uptake of contraception in developing countries may take more time,

other socio-demographic variables like age at marriage play an equally important role in

reducing fertility rates. The data show that the number of women marrying before the legal

age has fallen in 17 out of 22 states and UTs, with Nagaland, Maharashtra, Jammu &

Kashmir and Sikkim as the top performers. Also, indicators on teenage marriage and

childbearing have improved in 17 states/UTs.

In terms of antenatal care, 17 of 22 states/UTs saw an increase in ANC visits during the first

trimester with Nagaland, Bihar and West Bengal demonstrating the highest increase. But

when we look at the data on interventions for anaemia reduction in mothers, consumption of

IFA tablets by pregnant women for 180 days or more has increased in almost all states/UTs

(except Karnataka), though this has not resulted in a parallel reduction in anaemia levels

among pregnant women. These findings do reflect the need to consider complementing IFA

tablets with the provision of more natural sources of iron, folic acid and other micronutrients

in the diet.

A case where maternal and child health interventions have translated into improved health

outcomes is the uptake of institutional deliveries. According to the WHO, nearly 3/4th of the

neonatal deaths are attributable to preterm births, intrapartum complications and sepsis —

most of which can be addressed through appropriate medical care at the time of delivery. In

this regard, there has been a consistent increase in institutional delivery, with 14 out of 22

states and UTs having more than 90 per cent of newborns being delivered in institutional

facilities. Similarly, 14 out of 22 states/UTs have seen a decline in neonatal mortality.

While women’s empowerment is a wide construct, indicators like household decision

making, control over personal hygiene choices and assets like bank accounts and mobile

phones are good proxies for evaluation. As per the NFHS-5 data, majority of women (80 per

cent) participated in at least three household decisions. More than 64 per cent of younger

women in each of the 22 states/UTs, except Bihar at 59 per cent, are now using hygienic

methods of protection during menstruation. More women now own a personal mobile phone

and the percentage of women with bank accounts has jumped to over 70 per cent across each

of the 22 states/UTs of India (except Nagaland) in 2019-2020.

It is heartening to see almost all states and UTs report a drastic increase in the number of

households with a constructed toilet, improved drinking water as well as clean cooking fuel.

All three indicators are critical in improving public health in India, especially for women.

While indoor air pollution has been linked with major respiratory disorders with women

being disproportionately affected, population-level coverage of sanitation facilities has been

associated with a reduction of infectious disease like diarrhoea, which can take a substantial

toll on child mortality. Additionally, women are spending more time in school with the

percentage of women who completed at least 10 years of schooling jumping by at least 6 per

cent points in the past five years across states and UTs, except Daman & Diu and Tripura.

While states have shown an increase in exclusive breastfeeding and adequacy of diets, about

half of them have shown an increase in rates of malnutrition, wasting and underweight

children. To act upon the underlying determinants, we have to understand that indicators like

stunting, for example, can be multifactorial. Stunting can be affected by variables like

indicators of the mother a child is born to, economic situation of the household, adequacy of

diets, water and sanitation facilities, as well as interventions for nutrition promotion and

health. An encouraging example is from Bihar, which has shown a decline of stunting rates

by about 5.4 per cent points over the past five years.

At the same time, NFHS-5 data also show an increase in the rates of obesity in children and

risk factors for chronic diseases in adults like hypertension and blood glucose, which

represent the flip slide of the malnutrition problem.

In conclusion, we should fall short of generalising these results for the country both because

data from phase 2 is yet to come and summary figures may overlook how contextual health

and nutritional outcomes of the population can be. Though overall trends do suggest an

improvement in population control, use of modern contraception, reproductive and child

health, immunisation and social determinants of health, a complete overhaul is needed to

identify and address the multidimensional aspects of child malnutrition.



Study suggests gut microbe may promote breast cancers

A microbe found in the colon and commonly associated with the development of colitis and

colon cancer also may play a role in the development of some breast cancers, according to

new research.

The research was led by investigators with the Johns Hopkins Kimmel Cancer Center and its

Bloomberg~Kimmel Institute for Cancer Immunotherapy. Breast tissue cells exposed to this

toxin retain a long-term memory, increasing the risk for disease.

In a series of laboratory experiments, researchers discovered that when enterotoxigenic

Bacteroides fragilis (ETBF) was introduced to the guts or breast ducts of mice, it always

induced growth and metastatic progression of tumour cells. A description of the work is

published in the January 6 issue of the journal Cancer Discovery.

While microbes are known to be present in body sites such as the gastrointestinal tract, nasal

passages and skin, breast tissue was considered sterile until recently, says senior study author

Dipali Sharma, Ph.D., a professor of oncology at Johns Hopkins Medicine.

The study is a first step to show the involvement of ETBF in breast cancer development,

Sharma says. Additional studies are needed to clarify how ETBF moves throughout the body,

whether ETBF can be a sole driver to directly trigger the transformation of breast cells in

humans, and/or if other microbiota also have cancer-causing activity for breast tissue.

“Despite multiple established risk factors for breast cancer, such as age, genetic changes,

radiation therapy and family history, a large number of breast cancers arise in women

harbouring none of these, indicating the need to look beyond,” Sharma says.

“Our study suggests another risk factor, which is the microbiome. If your microbiome is

perturbed, or if you harbour toxigenic microbes with oncogenic function, that could be

considered an additional risk factor for breast cancer.”

Sharma and colleagues performed several experiments to study the role of ETBF. First, they

performed a meta-analysis of clinical data looking at published studies comparing microbial

composition among benign and malignant breast tumours and nipple aspirate fluids of breast 

cancer survivors and healthy volunteers. B. fragilis was consistently detected in all breast

tissue samples as well as the nipple fluids of cancer survivors.

In the lab, the team gave the ETBF bacteria by mouth to a group of mice. First, it colonized

the gut. Then, within three weeks, the mouse mammary tissue had observable changes

usually present in ductal hyperplasia, a precancerous condition.

In additional tests, investigators found that hyperplasia-like symptoms also appeared within

two to three weeks of injecting ETBF bacteria directly to the teats of mice and that cells

exposed to the toxin always exhibited more rapid tumour progression and developed more

aggressive tumours than cells not exposed to the toxin.

Breast cells exposed to the toxin for 72 hours retained a memory of the toxin and were able to

start cancer development and form metastatic lesions in different mouse models. Investigators

also found the Notch1 and beta-catenin cell signalling pathways to be involved in promoting

EBFT’s role in breast tissue.

In clinical studies, the investigators have started looking for microbiome changes among

breast cancer patients to see how this impacts tumour progression and response to therapy.

Meanwhile, Sharma says, “we definitely should try to maintain a healthy microbiome,

including eating a healthy diet and exercising, and maintaining the correct body mass index.”

Down the road, screening for microbiome changes could be as simple as stool sample tests,

said lead author Sheetal Parida, a postdoctoral fellow at Johns Hopkins Medicine. “This is

just one indicator, and we think there will be multiple,” she said.

“If we find additional bacteria responsible for cancer development, we can easily look at the

stool and check for those. Women at high risk of developing breast cancer might have a high

population of some of these.”



January 05, 2021

Govt should next focus on well-being of the child from womb to first five years

India continues to be successful in preventing child deaths, but the health and nutrition of the
surviving, living child has deteriorated, somewhat worryingly.

The NFHS has 42 indicators related to child’s health and nutrition (there is one indicator on
school enrolment which falls outside the scope of this analysis).

The recently released fifth round of the National Family Health Survey (NFHS-5) provides
new and reliable evidence to assess some dimensions of micro-development performance
before COVID struck. The survey covers health, nutrition (of mother and child) and the overall
quality of lives.

In a recent piece on these pages (‘New welfarism of India’s Right’, IE, December 22) we had
argued that the data illustrated significant gains achieved by the government in respect to its
distinctive approach to redistribution and inclusion that we called New Welfarism. This
involved the subsidised public provision of essential goods and services, normally provided by
the private sector. Access to banks accounts (especially for women), clean fuel for cooking,
toilets and power had increased and at a significantly faster pace since 2015 than before.
Here, we provide preliminary evidence on the health and nutrition of the child in India. Since
the latest round only has data for 17 states and five Union territories, our findings cover only
54 per cent of India’s population. Madhya Pradesh, Uttar Pradesh, Punjab, Rajasthan and Tamil
Nadu are notable exclusions. Another point to emphasise is this: The New Welfarism was
consciously driven by the Centre and it could, therefore, reasonably claim credit for its success.
In contrast, many of the child-related outcomes are also determined by state-level
implementation, therefore neither success nor failure can be attributed to one source. With
those caveats, we explain the data and then present our results.

The NFHS has 42 indicators related to child’s health and nutrition (there is one indicator on
school enrolment which falls outside the scope of this analysis). Indicators fall into nine
categories and each of these can be divided into outcomes and inputs as the table shows. For
example, neonatal, infant and under-5 mortality rates can be thought of as outcomes. Similarly,
all the nutrition indicators —stunting, wastage, excess wastage, underweight and overweight
—as well as the prevalence of diarrhoea, acute respiratory illness (ARI) and anaemia can also
be classified as outcomes. In contrast, the post-natal care indicators relating to visits made by
health workers, the provision of vaccinations and Vitamin A, and the extent and nature of
feeding for the child can be classified as inputs (details of the NFHS questions are available
The input indicators are not easy to aggregate in easy or obvious ways, so we leave that as
material for future research. Instead, we present some findings on the 11 child outcomes below.
First, though, some nuances. We score wasting (weight for height of children) as an
improvement because even though the gains were marginal, they reversed a negative trend
between 2005 and 2015. However, the wasting outcome must be treated with caution because
trends on wasting move contrary to those of “severe wasting” even from 2005. There is also
one indicator we have ignored, since it is difficult to classify: Underweight, where there were
marginal gains, but a slowdown relative to the past.
Now, for the results, which can be summarised as: India continues to be successful in
preventing child deaths, but the health and nutrition of the surviving, living child has
deteriorated, somewhat worryingly.

Of the 10 outcomes, there have been improvements in four (Figure 1). It is readily apparent
that India continued to make progress in preventing child-related deaths (neonatal, infants and
under-5). That said, the pace of improvement in child mortality slowed down relative to the
previous 10 years. For example, between 2005 and 2015, the infant mortality rate came down
by nearly 2 percentage points per year while between 2015 and 2019 that pace halved to 1
percentage point per year (post-2015, the mortality lines are flatter than before in Figure 1).
Whether some slowing should be expected because India is now close enough to the desirable
benchmark is an open question.

Figure 2 shows the six indicators where outcomes have deteriorated. These all relate to what
happens after survival: The health (anaemia, diarrhoea, and acute respiratory illness (ARI)) and
nutrition (stunting, and overweight) of the child deteriorated between 2015 and 2019. In none
of these cases is the aggregate deterioration driven by outliers, that is, by one or two states.
Moreover, the absolute deterioration in health and nutrition indicators must be seen against the
fact that they reversed the historic trends of steady improvements. That is particularly true of
the prevalence of diarrhoea and anaemia and to a lesser extent of stunting and acute respiratory
illness (post-2015, the lines slope downwards whereas they sloped upwards from 2005-2015).
Several factors probably play a role in explaining these outcomes. As already noted,
implementation capacity of individual states probably played an important role. Sector-specific
factors such as changing diets are also implicated. But the fact of a broader deterioration in
outcomes hints at the likelihood of a common factor, namely the macro-economic growth
environment, which determines employment, incomes and opportunities. At the least, it is safe
to conjecture that some of these outcomes are inconsistent with the narrative of a rapidly
growing economy.

We mentioned earlier that the NFHS provides data on child-related inputs. These need to be
examined too. Suppose it turns out that the Centre and the states have done a good job in
improving the quality and quantity of inputs that go into the child, then there would be a real
puzzle: Why do outcomes and inputs diverge? Indeed, as we showed in our earlier piece, the
government has made great strides in providing a number of basic needs to households such as
toilets, clean cooking fuel, power and bank accounts. Those developments would also serve to
aggravate the puzzle of why the health and nutrition of the child in India has deteriorated.
As discussed in Chapter 5 of the Economic Survey of 2015-16, perhaps the next big welfare
initiative of the government, building on the considerable success of its NewWelfarism, should
be a mission-mode focus on the well-being of the early child (and of course the mother), from
the womb to the first five years, which research shows is critical for realising its long run
potential as an individual.


Brain cancer linked to tissue healing

Researchers have found that the healing process that follows a brain injury -- from trauma to

infection and stroke -- could spur tumour growth.

"Our data suggest that the right mutational change in particular cells in the brain could be

modified by injury to give rise to a tumour," said Peter Dirks, Professor at the University of


The finding, published in the journal Nature Cancer, could lead to a new therapy for

glioblastoma patients who currently have limited treatment options with an average lifespan of

15 months after diagnosis, the researchers said.

"Glioblastoma can be thought of as a wound that never stops healing," Dirks said.

"We're excited about what this tells us about how cancer originates and grows, and it opens up

entirely new ideas about treatment by focusing on the injury and inflammation response," he


The researchers applied the latest single-cell RNA sequencing and Machine Learning (ML)

technologies to map the molecular make-up of the glioblastoma stem cells (GSCs), which

Dirks' team previously showed are responsible for tumour initiation and recurrence after


They found new sub-populations of GSCs that bear the molecular hallmarks of inflammation

and which are commingled with other cancer stem cells inside patients' tumours.

It suggests that some glioblastomas start to form when the normal tissue healing process, which

generates new cells to replace those lost to injury, gets derailed by mutations -- possibly many

years before patients become symptomatic, Dirks said.

Once a mutant cell becomes engaged in wound healing, it cannot stop multiplying because the

normal controls are broken and this spurs tumour growth, according to the study.

The team collected GSCs from 26 patients' tumours and expanded them in the lab to obtain

sufficient numbers of the rare cells for analysis. Almost 70,000 cells were analyzed by singlecell

RNA sequencing, which detects what genes are switched on in individual cells -- an effort

led by Laura Richards, a graduate student in Pugh's lab.

The data confirmed extensive disease heterogeneity, meaning that each tumour contains

multiple sub-populations of molecularly distinct cancer stem cells, making recurrence likely as

existing therapy is unable to wipe out all the different sub-clones.

A closer look revealed that each tumour has either of the two distinct molecular states - termed

"Developmental" and "Injury Response" - or a gradient between the two.

According to the researchers, the developmental state is a hallmark of the glioblastoma stem

cells and resembles that of the rapidly dividing stem cells in the brain before birth.

But the second state came as a surprise. The researchers termed it "Injury Response" because

it showed an upregulation of immune pathways and inflammation markers such as interferon

and TNFalpha, which are indicative of wound healing processes.


Brown fat may protect against cardiac, metabolic conditions

Brown fat may protect against cardiac, metabolic conditions

People with detectable brown fat are less likely to suffer cardiac and metabolic conditions

ranging from Type-2 diabetes to coronary artery disease, a new study suggests.

Brown fat, also called brown adipose tissue, helps maintain your body temperature when you

get too cold. Unlike white fat, which stores calories, brown fat burns energy and scientists hope

it may hold the key to new obesity treatments.

"For the first time, it reveals a link to lower risk of certain conditions. These findings make us

more confident about the potential of targeting brown fat for therapeutic benefit," said Paul

Cohen, Assistant Professor at The Rockefeller University Hospital in the US.

The study, published in the journal Nature Medicine, confirms and expands the health benefits

of brown fat suggested by previous studies.

For the study, the researchers reviewed 130,000 PET scans from more than 52,000 patients and

found the presence of brown fat in nearly 10 per cent of individuals.

Several common and chronic diseases were less prevalent among people with detectable brown

fat. For example, only 4.6 per cent had Type-2 diabetes, compared with 9.5 per cent of people

who did not have detectable brown fat. Similarly, 18.9 per cent had abnormal cholesterol,

compared to 22.2 per cent in those without brown fat.

Moreover, the study revealed three more conditions for which people with brown fat have

lower risk: hypertension, congestive heart failure, and coronary artery disease -- links that had

not been observed in previous studies.

Another surprising finding was that brown fat may mitigate the negative health effects of

obesity. In general, obese people have increased risk of heart and metabolic conditions; but the

researchers found that among obese people who have brown fat, the prevalence of these

conditions was similar to that of non-obese people.

"It almost seems like they are protected from the harmful effects of white fat," said Cohen.

The role of brown fat is more mysterious in other conditions like hypertension, which is tightly

connected to the hormonal system.

"We are considering the possibility that brown fat tissue does more than consume glucose and

burn calories, and perhaps actually participates in hormonal signalling to other organs," the

researcher said.

The team plans to further study the biology of brown fat, including by looking for genetic

variants that may explain why some people have more of it than others -- potential first steps

toward developing pharmacological ways to stimulate brown fat activity to treat obesity and

related conditions..



December 29, 2020

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