Tag Archives: population trends

Health

Covid-19 is a leading cause of death for children in the US, despite relatively low mortality rate

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CNN
 — 

Covid-19 has become the eighth most common cause of death among children in the United States, according to a study published Monday.

Children are significantly less likely to die from Covid-19 than any other age group – less than 1% of all deaths since the start of the pandemic have been among those younger than 18, according to federal data. Covid-19 has been the third leading cause of death in the broader population.

But it’s rare for children to die for any reason, the researchers wrote, so the burden of Covid-19 is best understood in the context of other pediatric deaths.

“Pediatric deaths are rare by any measure. It’s something that that we don’t expect to happen and it’s a tragedy in a unique way. It’s a really profound event,” said Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

“Everyone knows that Covid is the most severe in the elderly and immunocompromised and that it’s less severe in children, but that does not mean it’s a benign disease in children. Just because the numbers are so much lower in children doesn’t mean that they’re not impactful.”

In 2019, the last year before the pandemic, the leading causes of death among children and young adults ages 0 to 19 included perinatal conditions, unintentional injuries, congenital malformations or deformations, assault, suicide, malignant neoplasms, diseases of the heart and influenza and pneumonia.

The researchers’ analysis of data from the US Centers for Disease Control and Prevention found that there were 821 Covid-19 deaths in this age group during a 12-month period from August 2021 to July 2022. That death rate – about 1 for every 100,000 children ages 0 to 19 – ranks eighth compared with the 2019 data. It ranks fifth among adolescents ages 15 to 19.

Covid-19 deaths displace influenza and pneumonia, becoming the top cause of death caused by any infectious or respiratory disease. It caused “substantially” more deaths than any vaccine-preventable disease historically, the researchers wrote.

According to CDC data, children are less vaccinated against Covid-19 than any other age group in the US. Less than 10% of eligible children have gotten their updated booster shot, and more than 90% of children under 5 are completely unvaccinated.

“If we looked at all those other leading causes of death – whether you’re talking about motor vehicle accidents or childhood cancer – and we said, ‘Gosh, if we had some simple, safe thing we could do to get rid of one of those, wouldn’t we just jump at it?” And we have that with Covid with vaccines,” said O’Leary, who is also a professor of pediatric infectious disease at the University of Colorado School of Medicine and Children’s Hospital Colorado.

A CDC survey of blood samples suggest that more than 90% of children have already had Covid-19 at least once.

There is uncertainty about exactly how much risk the virus will continue to pose, O’Leary said, but the potential benefits of vaccination clearly outweigh any potential risks.

“Vaccination clearly is our best option right now,” and the benefits clearly outweigh the risks, he said. “Better safe than sorry.”

The findings of the new study, published in JAMA Network Open, may underestimate the mortality burden of Covid-19 because the analysis focuses on deaths where Covid-19 was an underlying cause of death but not those where it may have been a contributing factor, the researchers wrote. Also, other analyses of excess deaths suggest that Covid-19 deaths have been underreported.

As Covid-19 continues to spread in the US, the researchers say that intervention methods such as vaccination and ventilation will “continue to play an important role in limiting transmission of the virus and mitigating severe disease.”

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World

Japan must save its falling birth rate ‘now or never,’ PM Kishida says

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Tokyo
CNN
 — 

Japan’s prime minister issued a dire warning about the country’s population crisis on Monday, saying it was “on the brink of not being able to maintain social functions” due to the falling birth rate.

In a policy address to lawmakers, Fumio Kishida said it was a case of solving the issue “now or never,” and that it “simply cannot wait any longer.”

“In thinking of the sustainability and inclusiveness of our nation’s economy and society, we place child-rearing support as our most important policy,” the prime minister said.

Kishida added that he wants the government to double its spending on child-related programs, and that a new government agency would be set up in April to focus on the issue.

Japan has one of the lowest birth rates in the world, with the Ministry of Health predicting it will record fewer than 800,000 births in 2022 for the first time since records began in 1899.

The country also has one of the highest life expectancies in the world; in 2020, nearly one in 1,500 people in Japan were age 100 or older, according to government data.

These trends have driven a growing demographic crisis, with a rapidly aging society, a shrinking workforce and not enough young people to fill the gaps in the stagnating economy.

Experts point to several factors behind the low birth rate. The country’s high cost of living, limited space and lack of child care support in cities make it difficult to raise children, meaning fewer couples are having kids. Urban couples are also often far from extended family who could help provide support.

Attitudes toward marriage and starting families have also shifted in recent years, with more couples putting off both during the pandemic.

Some point to the pessimism young people in Japan hold toward the future, many frustrated with work pressure and economic stagnation.

Japan’s economy has stalled since its asset bubble burst in the early 1990s. The country’s GDP growth slowed from 4.9% in 1990 to 0.3% in 2019, according to the World Bank. Meanwhile, the average real annual household income declined from 6.59 million yen ($50,600) in 1995 to 5.64 million yen ($43,300) in 2020, according to 2021 data from the country’s Ministry of Health, Labor and Welfare.

The government has launched various initiatives to address the population decline over the past few decades, including new policies to enhance child care services and improve housing facilities for families with children. Some rural towns have even begun paying couples who live there to have children.

Shifting demographics are a concern across other parts of East Asia, too.

South Korea recently broke its own record for the world’s lowest fertility rate, with data from November 2022 showing a South Korean woman will have an average of 0.79 children in her lifetime – far below the 2.1 needed to maintain a stable population. Japan’s fertility rate stands at 1.3, while the United States is at 1.6.

Meanwhile, China’s population shrank in 2022 for the first time since the 1960s, adding to its woes as it struggles to recover from the pandemic. The last time its population fell was in 1961, during a famine that killed tens of millions of people across the country.

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Health

US cancer death rate drops 33% since 1991, partly due to advances in treatment, early detection and less smoking, new report says

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CNN
 — 

The rate of people dying from cancer in the United States has continuously declined over the past three decades, according to a new report from the American Cancer Society.

The US cancer death rate has fallen 33% since 1991, which corresponds to an estimated 3.8 million deaths averted, according to the report, published Thursday in CA: A Cancer Journal for Clinicians. The rate of lives lost to cancer continued to shrink in the most recent year for which data is available, between 2019 and 2020, by 1.5%.

The 33% decline in cancer mortality is “truly formidable,” said Karen Knudsen, chief executive officer of the American Cancer Society.

The report attributes this steady progress to improvements in cancer treatment, drops in smoking and increases in early detection.

“New revelations for prevention, for early detection and for treatment have resulted in true, meaningful gains in many of the 200 diseases that we call cancer,” Knudsen said.

In their report, researchers from the American Cancer Society also pointed to HPV vaccinations as connected to reductions in cancer deaths. HPV, or human papillomavirus, infections can cause cervical cancer and other cancer types, and vaccination has been linked with a decrease in new cervical cancer cases.

Among women in their early 20s, there was a 65% drop in cervical cancer rates from 2012 through 2019, “which totally follows the time when HPV vaccines were put into use,” said Dr. William Dahut, the society’s chief scientific officer.

“There are other cancers that are HPV-related – whether that’s head and neck cancers or anal cancers – so there’s optimism this will have importance beyond this,” he said.

The lifetime probability of being diagnosed with any invasive cancer is estimated to be 40.9% for men and 39.1% for women in the US, according to the new report.

The report also includes projections for 2023, estimating that there could be nearly 2 million new cancer cases – the equivalent of about 5,000 cases a day – and more than 600,000 cancer deaths in the United States this year.

During the early days of the Covid-19 pandemic, many people skipped regular medical exams, and some doctors have seen a rise in advanced cancer cases in the wake of pandemic-delayed screenings and treatment.

The American Cancer Society researchers were not able to track “that reduction in screening that we know we all observed across the country during the pandemic,” Knudsen said. “This time next year, I believe our report will give some initial insight into what the impact was in the pandemic of cancer incidence and cancer mortality.”

The new report includes data from national programs and registries, including those at the National Cancer Institute, the US Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.

Data showed that the US cancer death rate rose during most of the 20th century, largely due to an increase in lung cancer deaths related to smoking. Then, as smoking rates fell and improvements in early detection and treatments for some cancers increased, there was a decline in the cancer death rate from its peak in 1991.

Since then, the pace of the decline has slowly accelerated.

The new report found that the five-year relative survival rate for all cancers combined has increased from 49% for diagnoses in the mid-1970s to 68% for diagnoses during 2012-18.

The cancer types that now have the highest survival rates are thyroid at 98%, prostate at 97%, testis at 95% and melanoma at 94%, according to the report.

Current survival rates are lowest for cancers of the pancreas, at 12%.

The finding about a decreasing cancer death rate shows “the continuation of good news,” said Dr. Otis Brawley, an oncology professor at Johns Hopkins University who was not involved in the research.

“The biggest reason for the decline that started in 1991 was the prevalence of smoking in the United States started going down in 1965,” said Brawley, a former chief medical officer of the American Cancer Society.

“That’s the reason why we started having a decline in 1991, and that decline has continued because the prevalence of people smoking in the United States has continued to go down,” he said. “Now, in certain diseases, our ability to treat has improved, and there are some people who are not dying because of treatment.”

Although the death rate for cancer has been on a steady decline, the new report also highlights that new cases of breast, uterine and prostate cancer have been “of concern” and rising in the United States.

Incidence rates of breast cancer in women have been increasing by about 0.5% per year since the mid-2000s, according to the report.

Uterine corpus cancer incidence has gone up about 1% per year since the mid-2000s among women 50 and older and nearly 2% per year since at least the mid-1990s in younger women.

The prostate cancer incidence rate rose 3% per year from 2014 through 2019, after two decades of decline.

Knudsen called prostate cancer “an outlier” since its previous decline in incidence has reversed, appearing to be driven by diagnoses of advanced disease.

On Thursday, the American Cancer Society announced the launch of the Impact initiative, geared toward improving prostate cancer incidence and death rates by funding new research programs and expanding support for patients, among other efforts.

“Unfortunately, prostate cancer remains the number one most frequently diagnosed malignancy amongst men in this country, with almost 290,000 men expected to be diagnosed with prostate cancer this year,” Knudsen said. Cancer diagnosed when it is confined to the prostate has a five-year survival rate of “upwards of 99%,” she said, but for metastatic prostate cancer, there is no durable cure.

“Prostate cancer is the second leading cause of cancer death for men in this country,” she said. “What we’re reporting is not only an increase in the incidence of prostate cancer across all demographics but a 5% year-over-year increase in diagnosis of men with more advanced disease. So we are not catching these cancers early when we have an opportunity to cure men of prostate cancer.”

Breast, uterine and prostate cancers also have a wide racial disparity, in which communities of color have higher death rates and lower survival rates.

In 2020, the risk of overall cancer death was 12% higher in Black people compared with White people, according to the new report.

“Not every individual or every family is affected equally,” Knudsen said.

For instance, “Black men unfortunately have a 70% increase in incidence of prostate cancer compared to White men and a two- to four-fold increase in prostate cancer mortality as related to any other ethnic and racial group in the United States,” she said.

The data in the new report demonstrates “important and consistent” advances against cancer, Dr. Ernest Hawk, vice president of cancer prevention and population sciences at the University of Texas MD Anderson Cancer Center, said in an email.

“Cancer is preventable in many instances and detectable at an early stage with better outcomes in many others. When necessary, treatments are improving in both their efficacy and safety. That’s all great news,” Hawk wrote.

“However, it’s well past time for us to take health inequities seriously and make them a much greater national priority. Inequities in cancer risks, cancer care and cancer outcomes are intolerable, and we should not be complacent with these regular reminders of avoidable inequities,” he said. “With deliberate and devoted effort, I believe we can eliminate these disparities and make even greater progress to end cancer.”

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World

Taiwan’s military has a problem: As China fears grow, recruitment pool shrinks

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Taipei, Taiwan
CNN
 — 

Taiwan has noticed a hole in its defense plans that is steadily getting bigger. And it’s not one easily plugged by boosting the budget or buying more weapons.

The island democracy of 23.5 million is facing an increasing challenge in recruiting enough young men to meet its military targets and its Interior Ministry has suggested the problem is – at least in part – due to its stubbornly low birth rate.

Taiwan’s population fell for the first time in 2020, according to the ministry, which warned earlier this year that the 2022 military intake would be the lowest in a decade and that a continued drop in the youth population would pose a “huge challenge” for the future.

That’s bad news at a time when Taiwan is trying to bolster its forces to deter any potential invasion by China, whose ruling Communist Party has been making increasingly belligerent noises about its determination to “reunify” with the self-governed island – which it has never controlled – by force if necessary.

And the outlook has darkened further with the release of a new report by Taiwan’s National Development Council projecting that by 2035 the island can expect roughly 20,000 fewer births per year than the 153,820 it recorded in 2021. By 2035, Taiwan will also overtake South Korea as the jurisdiction with the world’s lowest birth rate, the report added.

Such projections are feeding into a debate over whether the government should increase the period of mandatory military service that eligible young men must serve. Currently, the island has a professional military force made up of 162,000 (as of June this year) – 7,000 fewer than the target, according to a report by the Legislative Yuan. In addition to that number, all eligible men must serve four months of training as reservists.

Changing the mandatory service requirement would be a major U-turn for Taiwan, which had previously been trying to cut down on conscription and shortened the mandatory service from 12 months as recently as 2018. But on Wednesday, Taiwan’s Minister of National Defence Chiu Kuo-cheng said such plans would be made public before the end of the year.

That news has met with opposition among some young students in Taiwan, who have voiced their frustrations on PTT, Taiwan’s version of Reddit, even if there is support for the move among the wider public.

A poll by the Taiwanese Public Opinion Foundation in March this year found that most Taiwanese agreed with a proposal to lengthen the service period. It found that 75.9% of respondents thought it reasonable to extend it to a year; only 17.8% were opposed.

Many experts argue there is simply no other option.

Su Tzu-yun, a director of Taiwan’s Institute for National Defense and Security Research, said that before 2016, the pool of men eligible to join the military – either as career soldiers or as reservists – was about 110,000. Since then, he said, the number had declined every year and the pool would likely be as low as 74,000 by 2025.

And within the next decade, Su said, the number of young adults available for recruitment by the Taiwanese military could drop by as much as a third.

“This is a national security issue for us,” he said. “The population pool is decreasing, so we are actively considering whether to resume conscription to meet our military needs.

“We are now facing an increasing threat (from China), and we need to have more firepower and manpower.”

Taiwan’s low birth rate – 0.98 – is far below the 2.1 needed to maintain a stable population, but it is no outlier in East Asia.

In November, South Korea broke its own world record when its birth rate dropped to 0.79, while Japan’s fell to 1.3 and mainland China hit 1.15.

Even so, experts say the trend poses a unique problem for Taiwan’s military, given the relative size of the island and the threats it faces.

China has been making increasingly aggressive noises toward the island since August, when then-US House Speaker Nancy Pelosi controversially visited Taipei. Not long after she landed in Taiwan, Beijing also launched a series of unprecedented military exercises around the island.

Since then, the temperature has remained high – particularly as Chinese leader Xi Jinping told a key Communist Party meeting in October that “reunification” was inevitable and that he reserves the option of taking “all measures necessary.”

Chang Yan-ting, a former deputy commander of Taiwan’s air force, said that while low birth rates were common across East Asia, “the situation in Taiwan is very different” as the island was facing “more and more pressure (from China) and the situation will become more acute.”

“The United States has military bases in Japan and South Korea, while Singapore does not face an acute military threat from its neighbors. Taiwan faces the greatest threat and declining birth rate will make the situation even more serious,” he added.

Roy Lee, a deputy executive director at Taiwan’s Chung-hua Institution for Economic Research, agreed that the security threats facing Taiwan were greater than those in the rest of the region.

“The situation is more challenging for Taiwan, because our population base is smaller than other countries facing similar problems,” he added.

Taiwan’s population is 23.5 million, compared to South Korea’s 52 million, Japan’s 126 million and China’s 1.4 billion.

Besides the shrinking recruitment pool, the decline in the youth population could also threaten the long-term performance of Taiwan’s economy – which is itself a pillar of the island’s defense.

Taiwan is the world’s 21st largest economy, according to the London-based Centre for Economics and Business Research, and had a GDP of $668.51 billion last year.

Much of its economic heft comes from its leading role in the supply of semiconductor chips, which play an indispensable role in everything from smartphones to computers.

Taiwan’s homegrown semiconductor giant TSMC is perceived as being so valuable to the global economy – as well as to China – that it is sometimes referred to as forming part of a “silicon shield” against a potential military invasion by Beijing, as its presence would give a strong incentive to the West to intervene.

Lee noted that population levels are closely intertwined with gross domestic product, a broad measure of economic activity. A population decline of 200,000 people could result in a 0.4% decline in GDP, all else being equal, he said.

“It is very difficult to increase GDP by 0.4%, and would require a lot of effort. So the fact that a declining population can take away that much growth is big,” he said.

Taiwan’s government has brought in a series of measures aimed at encouraging people to have babies, but with limited success.

It pays parents a monthly stipend of 5,000 Taiwan dollars (US$161) for their first baby, and a higher amount for each additional one.

Since last year, pregnant women have been eligible for seven days of leave for obstetrics checks prior to giving birth.

Outside the military, in the wider economy, the island has been encouraging migrant workers to fill job vacancies.

Statistics from the National Development Council showed that about 670,000 migrant workers were in Taiwan at the end of last year – comprising about 3% of the population.

Most of the migrant workers are employed in the manufacturing sector, the council said, the vast majority of them from Vietnam, Indonesia, Thailand and the Philippines.

Lee said in the long term the Taiwanese government would likely have to reform its immigration policies to bring in more migrant workers.

Still, there are those who say Taiwan’s low birth rate is no reason to panic, just yet.

Alice Cheng, an associate professor in sociology at Taiwan’s Academia Sinica, cautioned against reading too much into population trends as they were affected by so many factors.

She pointed out that just a few decades ago, many demographers were warning of food shortages caused by a population explosion.

And even if the low birth rate endured, that might be no bad thing if it were a reflection of an improvement in women’s rights, she said.

“The educational expansion that took place in the 70s and 80s in East Asia dramatically changed women’s status. It really pushed women out of their homes because they had knowledge, education and career prospects,” she said.

“The next thing you see globally is that once women’s education level improved, fertility rates started declining.”

“All these East Asian countries are really scratching their head and trying to think about policies and interventions to boost fertility rates,” she added.

“But if that’s something that really, (women) don’t want, can you push them to do that?”

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Health

Dr. Sanjay Gupta: After two years of Covid-19 vaccines, here’s why they’re still vital

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CNN
 — 

In the United States, approximately 658 million Covid-19 vaccine doses have been administered since they were first distributed exactly two years ago Wednesday.

Framing the significance of preventive measures like vaccines can be challenging, which is why a new report from the Commonwealth Fund and Yale School of Public Health made headlines: According to their modeling of disease transmission across all age demographics and taking into account the existing health conditions in so many Americans, Covid vaccines prevented an estimated 3.2 million deaths and 18.5 million hospitalizations from their introduction in December 2020 to November 30, 2022.

That is why it is surprising to hear, according to a Kaiser Family Foundation analysis of data from the US Centers for Disease Control and Prevention, that from April through August – the last month included in the analysis – there were more vaccinated than unvaccinated people dying of Covid. The vaccinated categories include people who were vaccinated with the primary series and people who had been vaccinated and received at least one non-bivalent booster.

According to a CNN analysis of additional CDC data for September, 12,593 people died of Covid. A CDC sample of the deaths found 39% were unvaccinated, and 61% were vaccinated.

This phenomenon has many people – especially vaccine skeptics, but even stalwart vaccine supporters – confused and wondering if Covid vaccines and boosters are still effective and warranted.

The short answer is yes – but understanding why requires a crash course in statistics. We enlisted the help of Jeffrey Morris, a professor and the director of the Division of Biostatistics at the Perelman School of Medicine at the University of Pennsylvania, who helped us define three key reasons more vaccinated than unvaccinated people are dying of Covid.

One of the main reasons we see more vaccinated than unvaccinated people dying of Covid is a basic one. At this point in time, there are simply many more people who are vaccinated.

Think of it like this: If we round the September deaths to 13,000 and use the CDC sampling percentages, approximately 7,800 were vaccinated and approximately 5,200 were unvaccinated. The conclusion might be that you are far more likely to die if you are vaccinated. And, mathematically that would be true based on the raw numbers alone. If you stopped your analysis at this point, you will have committed a statistical error known as a base rate fallacy.

If instead, you take the extra step of accounting for the total number of fully vaccinated adults 18 and older in the United States (around 203 million) versus the total number of unvaccinated adults (around 55 million), a very different picture emerges.

Among the vaccinated population, 7,800/203 million died in September, which equals a rate of 38 deaths for every 1 million people. For the unvaccinated population, 5,200/55 million died, which equals a rate of 95 deaths for every 1 million people. That means an adult who is unvaccinated is roughly 2.5 times more likely to die than one who is vaccinated.

“You have to take into account the size of those groups,” explained Morris, who also publishes a blog, COVID-19 Data Science, to “just communicate what the emerging data suggest.”

There is another important difference when looking at the vaccinated versus unvaccinated populations in the United States. The vaccinated population skews older and has more health conditions. These are the same groups that are much more likely to have worse outcomes, like hospitalization and death, when infected with SARS-CoV-2, the virus that causes Covid-19. For example, CDC data show more than 90% of deaths through mid-November have been in those 65 or older.

“So those things lead to a higher risk of death and also a higher probability of being vaccinated,” Morris said. “That’s the key: if the vaccine uptake of those high-risk groups is high enough, then we can have a majority of the hospitalized or fatal cases be higher in the vaccinated population.”

You are more likely to die if you are older, and also more likely to be vaccinated if you are older. It does not mean vaccination is more likely to lead to death.

So if age isn’t taken into account when assessing vaccine efficacy, it can lead to something known as Simpson’s paradox, where a trend can appear to be the opposite of reality.

Morris said those kinds of errors not only result in a serious underestimation of the benefit of vaccines but also to downright wrong conclusions, even flipping the results – in this case, making it appear that vaccines increase the risk of death.

This happened in August 2021, with a study out of Israel – a highly vaccinated country – showed 60% of those hospitalized with severe Covid were fully vaccinated, causing misinterpretation and raising questions about the continued value of vaccination.

Morris said he has also seen Simpson’s paradox when people look at the rate of Covid deaths before vaccines were rolled out in 2020 versus since then, or comparing countries with higher vaccination rates to countries with lower vaccination rates.

“It’s a lot more subtle, but the pandemic has provided a number of pure examples of it. So the bottom line with all of that is, we can’t accurately assess the effects of vaccines from simple summaries,” Morris said, however “seemingly intuitive” they may appear.

A more telling and accurate comparison is between the death rate per 100,000 among unvaccinated people compared to the death rate of vaccinated people, adjusted for age.

CDC data show that for the week of September 25, people age 12 and older who were unvaccinated had a death rate of 1.32 per 100,000. Those who were vaccinated (but without an updated, bivalent booster) had a death rate of 0.26 per 100,000. And those who were vaccinated and boosted had a death rate of 0.07 per 100,000.

Broken down further by age, the numbers are even starker: The death rate during that week for those in the oldest age group, 80 and above, was 14.16 per 100,000 for the unvaccinated, 3.69 for those who were vaccinated but had not received the bivalent booster, and 0.0 for those who were vaccinated and boosted.

Overall, the CDC estimates that for the whole month of September, among those 12 and older, there was an almost 15 times lower risk of dying from Covid-19 for the vaccinated and boosted compared to the unvaccinated.

Unfortunately, uptake of the booster is low: Only 13.5% of the US population 5 and older is vaccinated and has gotten the new updated (bivalent) booster. Among those 65 and older, that percentage is 34.2%.

It’s not to say that vaccines are entirely risk free. For example, in people – especially males – between the ages of 5 and 39, there were 224 verified cases of myocarditis or pericarditis, inflammation of the heart and lining, reported to the CDC after vaccination with an mRNA vaccine between December 14, 2020, and May 31, 2022. But that was out of almost 7 million vaccine doses administered.

A study examining those figures found myocarditis/pericarditis occurred within seven days approximately 0.0005% of the time after the first dose, 0.0033% of the time after the second dose of the primary series, and 0.002% after the first booster – but it varied by age and sex, and was much more common among 16- to-17-year-old males after a second shot or a booster.

According to a separate analysis of nearly 43 million people in England, the researchers found that for younger men, the Moderna vaccine in particular had the highest rates of post vaccine myocarditis – although this number was still very low, 97 per million people exposed (0.0097%) – leading some to suggest a different vaccine for that age group or a longer interval between vaccine doses.

Statistical optical illusions aside, the fact is, there are more so-called breakthrough cases among the vaccinated. They have always existed. Since December 2020, we have known these vaccines are not 100% effective at preventing severe illness and death, let alone infection. When vaccines were first introduced, their efficacy was estimated to be an astonishing 95% against severe illness and death. They even protected people at a very high rate against infection.

But the efficacy keeps ticking downward. Part of it is waning immunity: Over the course of several months, antibody levels fade away – that’s just how the body works – even though there is still some protection, thanks to B cells and T cells. Getting boosted – or catching Covid – can help increase antibody levels for a few months at least. Between those two options, it’s far safer and less disruptive to get a booster than to risk illness.

Meanwhile, new variants keep cropping up, and they are increasingly able to evade our immune system. Unlike earlier variants, including the highly transmissible Delta variant, descendants of the Omicron lineage are escape artists.

“The emergence of Omicron at the end of 2021 was a game changer, as Omicron and its subsequent subvariants demonstrated strong immune evasion properties, with mutations in the spike protein and especially the [receptor binding domain] that reduced the neutralizing ability of the vaccine-induced antibodies,” Morris noted. The result is a great reduction in vaccine efficacy against infection, as well as against severe and fatal disease.

This actually means it’s more important to get boosted, especially if you are in a high-risk category, and as the weather gets colder and we gather indoors to spend time together.

The newest booster – the bivalent booster – is designed to protect against the original SARS-CoV-2 virus and against the more recent Omicron subvariants, although how much and for how long is still unknown.

Covid cases, and deaths have slowed down in recent months, but those numbers are trending up like they’ve done during the holidays in previous pandemic years. For the week of December 7, weekly new cases topped 65,000 and Covid claimed the lives of almost 3,000 people. Both represent an increase of around 50% from the week before, according to CDC data.

All of this is happening at a time when hospitals are already full of patients sick with the flu and RSV.

I know we’re all tired of hearing that we need to roll up our sleeves and get yet another Covid-19 booster.

But remember, many of us get the flu shot every year: We don’t assume we are protected from a flu vaccine a year ago. We get the shot even in seasons when the flu vaccine is much less effective than the Covid vaccine (the latest one appears to be a good match). We don’t call it a booster – it’s just the annual flu vaccine. And we don’t track the rate of so-called breakthrough flu infections; unlike Covid, we don’t routinely test people for flu unless they are demonstrably sick, so we have no way of knowing how many people, vaccinated or not, are infected and asymptomatic or mildly ill.

For some diseases, like measles, a single vaccine or a previous infection provides us with a near lifetime of protection. Even though we hoped for a one-and-done scenario when the Covid vaccines rolled out two years ago, the virus didn’t lend itself to that. Newer vaccines are being studied that could offer far more durable protection.

Analyzing all of this data without falling into the trap of a base rate fallacy or Simpson’s paradox isn’t easy, as you can see. And it is also clear the overall effectiveness of the vaccines have waned over time and with new variants.

However, two years later, a more thorough statistical analysis of vaccine effectiveness shows they are still cause for celebration.

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Health

Cancer death rates fall steadily in the US, with more survivors than ever

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CNN
 — 

More people are surviving cancer than ever before in the United States, according to a new report from the American Association for Cancer Research.

In the past three years, the number of cancer survivors in the US – defined as living people who have had a cancer diagnosis – increased by more than a million. There are 18 million survivors in the US as of January, with that number expected to increase to 26 million by 2040, the association said. The report notes that there were only 3 million US cancer survivors in 1971.

For all cancers combined, the five-year overall survival rate has increased from 49% in the mid-1970s to nearly 70% from 2011 to 2017, the most recent years for which data is available.

The overall cancer death rate, adjusted for age, continues to drop, with reductions between 1991 and 2019 translating into nearly 3.5 million deaths avoided, the association said.

Declines in smoking and improvements in catching and treating cancer early are driving the change, according to the AACR Cancer Progress Report 2022, released Wednesday.

Dr. Lisa Coussens, president of the association, said in a statement that part of the credit goes to an investment in research – both for treatments and for understanding the disease.

“Targeted therapies, immunotherapy, and other new therapeutic approaches being applied clinically all stem from fundamental discoveries in basic science,” she said. “Investment in cancer science, as well as support for science education at all levels, is absolutely essential to drive the next wave of discoveries and accelerate progress.”

For example, between August 1 and July 31, the US Food and Drug Administration approved eight anticancer therapeutics, expanded the use of 10 previously approved medications to treat new cancer types, and approved two diagnostic imaging agents, Coussens said at a news conference Wednesday.

Increased funding for cancer research is a cornerstone of President Joe Biden’s relaunched Cancer Moonshot initiative.

Biden – who lost a son to brain cancer – said this month that his goal is to cut cancer death rates in the United States by at least half in the next 25 years.

“Cancer does not discriminate red and blue. It doesn’t care if you’re Republican or Democrat. Beating cancer is something we can do together,” said Biden, who initially helmed the initiative when he was vice president under Obama.

The new report urges Congress to fully fund and support Biden’s goal to “end cancer as we know it.”

“The reignited Cancer Moonshot will provide an important framework to improve cancer prevention strategies; increase cancer screenings and early detection; reduce cancer disparities; and propel new lifesaving cures for patients with cancer,” the report says, adding that the “actions will transform cancer care, increase survivorship, and bring lifesaving cures to the millions of people whose lives are touched by cancer.”

Although nearly 3.5 million cancer deaths were avoided between 1991 and 2019, more than 600,000 people in the US are still expected to die from cancer this year, according to the association.

“In the United States alone, the number of new cancer cases diagnosed each year is expected to reach nearly 2.3 million by 2040,” the report says.

About 40% of cancer cases in the US are attributable to preventable risk factors, such as smoking, drinking too much alcohol, eating a poor diet, not exercising enough and being obese, according to the report.

But there are also ongoing challenges such as health disparities that affect racial and ethnic minorities and barriers to health care such as limited health insurance coverage and living in rural areas.

In a recorded statement played at the news conference, US Rep. Nikema Williams said she learned after her mother died of cancer that “health care in America is not a human right yet.”

“We have two health care systems in this country: one for people who can afford preventative services and quality treatment and one for everyone else,” said Williams, a Democrat from Georgia.

The reversal of Roe v. Wade is also expected to affect cancer care by limiting health care options for pregnant women with cancer, the report said.

“With the recent Supreme Court decision to overturn Roe v. Wade, which ends the constitutional right to an abortion, there is uncertainty surrounding how a particular cancer treatment may lead to the termination of a pregnancy. Such uncertainty may prohibit some physicians from prescribing a drug or performing other health services in a timely manner due to the potential legal consequences for both physician and mother,” according to the report.

The Covid-19 pandemic had an effect on cancer in the US, with nearly 10 million breast, colorectal and prostate cancer screenings missed in 2020.

The report offers recommendations to build on the progress and regain momentum.

“Making progress to end cancer means more birthdays, more Christmases, more graduations and everyday moments for families everywhere,” Williams said.

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