Lancet

Science editor, journalist, author, and mentor. Born on Oct 9, 1940, in Rawene, New Zealand, he died in Eastbourne, UK, on Feb 10, 2025, aged 84 years.

Africa accounts for only 3% of all medicine production globally, and more than 90% of drugs and 99% of vaccines consumed are imported.1 The continent has not been well positioned to address these gaps due to capacity challenges related to limited research and development (R&D) infrastructure and skilled researchers, the absence of a well defined continental health research governance framework, and scarcity of sustainable financing for R&D.2 Moreover, there is inadequate local funding, and most research conducted on the continent is donor-driven and often not informed by national or regional priorities, underscoring the urgent need for research prioritisation, coordination, and governance.

Canada has joined the world's largest research and innovation programme (Horizon Europe), with its strong life science and technology focus and the launch of a policy dialogue to advance health priorities. Canada and the EU have taken steps towards transnational collaboration, which is paramount to successfully take on global challenges, such as cancer, antimicrobial resistance, health security, rare diseases, and non-communicable diseases.1,2 However, the proposed dialogue does not directly reference the crucial importance of health data access and exchange.

In an Offline piece,1 Richard Horton commented on several issues regarding human rights and remembrance in Argentina.

We enjoyed the Viewpoint by Jeremy W Jacobs and colleagues and agree with their major observations.1 Defining the true need for blood is an essential challenge. The authors rightly noted that the annual blood donation to population ratio threshold cannot define true blood need. This definition should be specific to geographical scale and depend on disease burden, geographical heterogeneity and the isolation of communities in resource and disease distributions, and access to blood and blood products within the context of health-care access, among other factors.

In their open-label, multicentre, randomised, non-inferiority trial of home-based ovulation monitoring in the management of frozen-thawed embryo transfers (FETs), Tjitske Zaat and colleagues showed their ability to organise national collaborative research efforts involving multiple fertility centres.1 In the accompanying Comment,2 Shari Mackens and Christophe Blockeel state that there is little in Zaat and colleagues’ study that warrants the consideration of home-based ovulation monitoring as a new gold standard.

In Tjitske Zaat and colleagues’ study,1 fewer than 3% of patients in natural menstrual cycles were administered exogenous progesterone for luteal phase support. In their Comment,2 Shari Mackens and Christophe Blockeel suggest that, with more evidence, progesterone supplementation could become part of the prescribed natural cycle frozen-thawed embryo transfer (FET) protocol. This change could simplify monitoring and reduce the number of hospital visits.

In the CASTING study,1 the TRiP(cast) score was utilised to identify patients at low risk of venous thromboembolism. The cumulative incidence of venous thromboembolism was estimated to be 2·0%, indicating that most patients, approximately 98%, were at low risk and did not require anticoagulation. Therefore, it was inappropriate to identify low-risk subgroups from a population already consisting mostly of individuals at low risk of developing the condition. In contrast, there was no significant difference in the incidence of venous thromboembolism (1·1% vs 1·0%) between the intervention phase, guided by the TRiP(cast), and the control phase, during which 16% of patients would be classified as high risk but did not receive anticoagulation.

We would like to congratulate Douillet and colleagues1 on their CASTING study, which showed a relevant reduction in prophylactic anticoagulation by using the TRIP(cast) score without an increase in the risk of venous thromboembolism. However, we were surprised by the inclusion of male sex as a risk factor in the TRIP(cast) score. The TRIP(cast) score was developed on the basis of two prior scores. One score was based on expert consensus (TIP score) that did not include male sex as a risk factor.

I read with great interest the CASTING study by Douillet and colleagues.1 I appreciate the authors’ contribution; however, there are several issues I would like to discuss.

We thank Liang V Tang and colleagues, Perrine Truong and Francois-Xavier Ageron, and Wei Xiong for their interest in our CASTING study and their comments.

Veltkamp R, Korompoki E, Harvey KH, et al. Direct oral anticoagulants versus no anticoagulation for the prevention of stroke in survivors of intracerebral haemorrhage with atrial fibrillation (PRESTIGE-AF): a multicentre, open-label, randomised, phase 3 trial. Lancet 2025; 405: 927–36—In this Article, the final sentence of the Findings in the Summary was incorrect and has been deleted. This correction has been made to the online version as of March 13, 2025, and the printed version is correct.

Human African trypanosomiasis or sleeping sickness is caused by infection with Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense parasites, which are transmitted by tsetse flies in sub-Saharan Africa. Control of human African trypanosomiasis is based on case detection, treatment, and vector control. In the past decade, simple rapid diagnostic tests were introduced for gambiense human African trypanosomiasis, facilitating screening in primary health-care facilities. A new oral drug, fexinidazole, became the first-line treatment for gambiense human African trypanosomiasis without severe meningo-encephalitic disease, as well as for rhodesiense human African trypanosomiasis.