Medical Journal News

The Californian wildfires have captured global attention. The Golden State is once again engulfed in flames, with neighbourhoods decimated and more than 40 000 acres of land reduced to ash and rubble. Lives have been lost, people are missing, communities displaced, and ecosystems devastated in one of the worst natural disasters in US history. The road to recovery and reconstruction will be long. The fires have occurred well outside the usual wildfire season, fuelled by a combination of extreme weather conditions, the Santa Ana winds, and prolonged drought, exacerbated by climate change.

Juvenile idiopathic arthritis is the most common chronic systemic disease associated with uveitis in childhood. Uveitis occurs in 11–22% of children with juvenile idiopathic arthritis.1 Due to the chronic course of intraocular inflammation, there is a high risk of secondary vision-threatening complications. Juvenile idiopathic arthritis-associated uveitis is often asymptomatic, leading to a delay in diagnosis and therapy.2 In the past few years, treatment has substantially improved due to earlier recognition of the disease3 and the use of additional disease-modifying anti-rheumatic drugs (DMARDs),4 particularly those that allow corticosteroid sparing.

The development of adaptive immunity to SARS-CoV-2 (in the shape of antibody, B, and T cells) is associated with protection against infection and severe disease, regardless of whether this is induced by infection, vaccination, or a combination of both.1 It is also established that immunocompromised people have a greater risk than others of SARS-CoV-2 infection and severe disease2,3 and exhibit attenuated responses to SARS-CoV-2 vaccines.4 Evidence is less clear on whether a weakened immune response independently predicts risk of infection, as immunocompromised participants were excluded from vaccine efficacy trials and population studies generally do not contain individual data on immune responses.

Contemporary guidelines for the evaluation of patients with stable chest pain recommend coronary CT angiography (CCTA) as the preferred first-line test in most patients who do not have previously established coronary artery disease.1,2 These recommendations are based, in part, on results from studies such as the pivotal SCOT-HEART study, a large-scale, prospective, randomised, parallel-group trial which demonstrated that CCTA significantly improved diagnostic certainty regarding coronary artery disease as the cause for patient symptoms at 6 weeks compared with standard care among 4146 Scottish patients with stable chest pain.

“None of us were entirely right, none of us were entirely wrong.” That was Francesco Rubino's wry comment on his Commission, published by The Lancet Diabetes and Endocrinology on Jan 14, 2025, and launched at the Royal College of Physicians in London. The scope of the project was narrow—the definition of obesity—but the implications were colossal. The Commission identified a major and, in truth, surprising gap: the absence of a clinical definition of obesity. It is worth pausing for a moment and reflecting on the scale of the clinical challenge and why this omission matters so much.

Bangladesh's Anti-Corruption Commission has accused Saima Wazed of securing her position thanks to her mother, Bangladesh's former Prime Minister. Samaan Lateef reports.

Women and girls will lose access to essential health services should the incoming US President cut funding. By Udani Samarasekera.

As elections approach, doctors have described increasingly draconian crackdowns that are driving many to emigrate. Ed Holt reports.

When I spoke to researcher Catherine Draper, she was about to travel to work in a rural area of South Africa. Draper is Associate Professor in the MRC/Wits Developmental Pathways for Health Research Unit at the University of the Witwatersrand, South Africa. Her research interest is early childhood development, with a current focus on social emotional development and mental health of children aged 3–5 years. “I have a real passion for early childhood development, and have worked a lot with organisations working on the ground including in rural areas”, she says.

In 2015 this journal published a report by the Lancet Commission on Health and Climate Change, making the case that the climate crisis could have catastrophic effects on human health. Abnormally high temperatures, extreme weather events, degradation of and changes to ecosystems, and the spread of infectious and parasite-borne diseases could have drastic consequences for populations worldwide, not to mention the deleterious effects of climate change on infrastructure, national and international stability, livestock, fisheries, and agriculture.

Foreign-born practitioners in the health professions are critical to the health-care labour force in many high-income countries. In addition, both immigrant and non-immigrant health professionals have a stake in protecting the rights of their patients and communities whose health and wellbeing are threatened by labour exploitation and threats of mass deportation. In the context of political attacks on immigration in many countries, it is constructive to consider the contributions of immigrants to health care and how doctors and nurses have served immigrant communities and promoted the human right to health irrespective of citizenship status.

Influential specialist in intensive care medicine. Born on Jan 12, 1945, in Milan, Italy, he died on Dec 2, 2024, in Göttingen, Germany, aged 79 years.

Public health emergencies demand decisive leadership, proactive capacities, and swift, coordinated responses to mitigate their impacts on lives, livelihoods, and economies, particularly in Africa, where health systems have little resilience to public health emergencies.1 The declaration of mpox as a Public Health Emergency of Continental Security was made following strategic engagements and consultations with high-level political leaders and scientific advisory committees.2 This declaration was crucial in making quick decisions and was followed by the establishment of a Continental Incident Management Support Team to streamline and accelerate response efforts through a unified approach that emphasised collaboration across multiple stakeholders.

Polio is a highly viral infectious disease that poses a life-threating risk to young children, often leading to paralysis and death, and children who are not fully immunised are especially vulnerable. Since the initiation of the Global Polio Eradication Initiative (GPEI) in 1988, substantial global efforts have been made to eradicate polio.1 However, polio remains a concern, with 25 confirmed cases in Afghanistan and 70 in Pakistan in 2024.2 In 2023, the WHO Eastern Mediterranean region reported 12 cases of polio, five times higher than in the previous year, highlighting the immunity gaps among young children.

The 2024 WHO disease outbreak news report1 on malaria underscores the challenges posed in DR Congo and neighbouring regions.2 The update identifies acute respiratory infections complicated by malaria, with 891 infections and 48 deaths reported in children younger than 5 years (hereafter referred to as under-5 mortality).1 These infections, driven by respiratory viruses, Plasmodium falciparum, and malnutrition, emphasise the urgent need to improve health-care access and tackle food insecurity in vulnerable populations.

Madhukar Pai and colleagues1 highlight the need for Global North institutions to assume an allyship position in the decolonisation of global health. Pai and colleagues’ vision, anchored in principles of equity and justice, presents an ideal of what global health could become. However, expecting authentic allyship from Global North institutions that stand to lose their control of resources and influence in the wake of true decolonisation, is akin to asking the coloniser to become an ally in the struggle for the freedom of the colonised.

Adam Strobeyko and colleagues1 propose strengthening WHO's capacity to address pandemic product inequities through amendments to the International Health Regulations and establishing the Global Supply Chain and Logistics Network as a successor to the Access to COVID-19 Tools Accelerator and the interim Medical Countermeasures Network (i-MCM-Net).1 Although necessary, a WHO-led initiative risks replicating systemic limitations that favour high-income countries, as seen during the COVID-19 pandemic.

I am writing to voice concerns over the findings of the phase 3 trial of the R21/Matrix-M malaria vaccine by Mehreen Datoo and colleagues.1 The study indicates that the vaccine's efficacy appears to decline over time, from an initial 79% in months 1–3 to 63% in months 10–12 at standard sites. This observed decrease raises substantial questions regarding the long-term effectiveness of the vaccine. Ensuring sustained protection is pivotal for a vaccine's success, particularly in the face of ongoing and future disease transmission.

The R21/Matrix-M malaria vaccine offers the highest efficacy in the history of malaria vaccine development as reported by Mehreen Datoo and colleagues.1 The potential for saving the lives of African children must be harnessed immediately but cautiously, for several reasons.

Several studies have found non-live vaccines, including the RTS,S malaria vaccine, to be associated with increased female mortality.1 It is therefore unfortunate that the recent paper by Mehreen Datoo and colleagues2 on the phase 3 trial of the new R21 malaria vaccine does not report the mortality data by randomisation group and sex. The paper reports 19 deaths, “with 11 deaths reported in male participants and eight in female participants”. However, supplementary table 23 in the appendix, which is said to show no significant difference in the number of deaths between the malaria vaccine and control group, has only 18 deaths—15 in the experimental group and three in the control group (relative risk 2·50, 95% CI 0·72–8·62; Fisher exact test, p=0·21).