Lancet

During the COVID-19 pandemic, many states failed to meet their human rights obligations and commitments to equity, as Lawrence O Gostin and colleagues elaborate.1 Surprisingly, the authors omit rights violations related to border closures. One of the clearest cases is that of Australia.

We thank Diego S Silva and Oliver Razum and for the thoughtful and thorough analysis arguing that Australia's border closing to its own citizens during much of the COVID-19 pandemic was indeed a violation of their right to enter their own country.1 Given our focus on inequality and discrimination,2 we appreciate the emphasis on the unequal impact of Australia's border closing and mention of Australia's policy on asylum seekers, which pre-dated COVID-19. We would add that border closures to asylum seekers during COVID-19 (as in many high-income countries, such as the USA)3 were violations of the rights of some of the world's most vulnerable people—violations that should never be repeated in future health emergencies, or ever.

José Manuel Pérez-García and colleagues reported updated results from PHERGain, a randomised, phase 2 trial in patients with HER2-positive breast cancer.1 This trial investigated a chemotherapy-free treatment approach based on a dual HER2 blockade with trastuzumab and pertuzumab, with treatment decisions made based on early response on 18fluorine-fluorodeoxyglucose (18F-FDG)-PET during neoadjuvant therapy, then further adapted treatment according to pathology findings at surgery. With this strategy, the 3-year invasive disease-free survival was 94·8%, and about a third of patients could avoid chemotherapy.

We appreciate the Correspondence from Elif Hindié and David Groheux highlighting two important points from our PET-based, pathological complete response-adapted PHERGain strategy.1 This study met its two primary endpoints: the proportion of PET responders in group B with a pathological complete response (37·9%), and the 3-year invasive disease-free survival rate for the entire adaptive group (94·8%), which was similar to standard neoadjuvant treatment with chemotherapy, trastuzumab, and pertuzumab (HP), despite around 30% of patients completely omitting chemotherapy and a delay in chemotherapy administration for the remaining patients.

The Lancet. Cancer registries: the bedrock of global cancer care. Lancet 2025; 405: 353—In this Editorial, the spelling of Michel P Coleman's name has been corrected. This change has been made to the online version as of March 27, 2025.

Bowman SJ, Fox R, Dörner T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren's syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet 2022; 399: 161–71—In figure 2E of this Article, the least-squares mean change from baseline in ESSPRI scores of the placebo group and the ianalumab 300 mg group were plotted incorrectly. In figure 2F, the percentages for ianalumab 50 mg at baseline, ianalumab 50 mg at week 24, and ianalumab 300 mg at week 24 were incorrect.

Ageing is a scientifically fascinating and complex biological occurrence characterised by morphological and functional changes due to accumulated molecular and cellular damage impairing tissue and organ function. Ageing is often accompanied by cognitive decline but is also the biggest known risk factor for Alzheimer's disease, the most common form of dementia. Emerging evidence suggests that sedentary and unhealthy lifestyles accelerate brain ageing, while regular physical activity, high cardiorespiratory fitness (CRF), or a combination of both, can mitigate cognitive impairment and reduce dementia risk.

Participation in screening was higher among individuals invited to faecal immunochemical test screening than colonoscopy screening. On the basis of participation observed in this study, a faecal immunochemical test-based programme was non-inferior to a colonoscopy-based programme for colorectal cancer-related mortality.

Cancer screening tests can be divided into early detection and preventive tests.1 Early-detection tests (eg, mammography for breast cancer and prostate-specific antigen testing for prostate cancer) detect cancer early with the aim of reducing cancer mortality. These tests cannot reduce the risk of individuals developing cancer. Preventive screening tests (eg, colonoscopy for colorectal cancer and Papanicolaou-smear cytology for cervical cancer) aim to prevent cancer through the identification of benign cancer precursors for removal.

For nearly 2 years, Sudan has been engulfed in a devastating war that has crippled its health system and displaced millions. The conflict that erupted in April, 2023, between the Sudanese Armed Forces and the paramilitary Rapid Support Forces has led to widespread violence, including sexual violence, displacement, and the collapse of essential health services.1 The humanitarian crisis is worsening daily with reports of rising infectious diseases, including HIV—an often overlooked consequence of war.

On Oct 12, 2023, merely a few days after the sudden brutal attack of Hamas on Israel, The Lancet published a Correspondence by three Israeli doctors calling for the immediate release of Israeli hostages.1 Using the same moral compass, we—three Israeli doctors, one of whom was also an author on the previous Correspondence—now call for the immediate end of Israeli bombardments in the Gaza Strip and for the immediate return to negotiations towards the cessation of war.

Vaccination remains the most cost-effective public health intervention, preventing millions of deaths and reducing disease burden worldwide.1 However, their impact is rendered meaningless if vaccines are not epidemiologically relevant to the populations they serve, are not accepted by communities, or are not effectively delivered through routine or mass immunisation programmes. As history has shown, immunisation programmes have always faced threats—from political instability to misinformation—and these challenges are growing more severe in today's global landscape.

There is a growing opportunity to expand clinical research capacity in Africa, and numerous organisations are contributing to this effort. To name a few: the African Medicines Agency provides leadership for creating an enabling regulatory environment for pharmaceutical sector development in Africa;1 WHO's Clinical Trials Forum calls for an “always on, always busy, always ready” approach to clinical trials;2 and the Africa Centres for Disease Control and Prevention have developed a roadmap for optimising efficiency and impact in the African clinical trials ecosystem.

On March 13, 2025, the UK Government announced that it was disbanding NHS England, the arm's length government body overseeing health-care delivery in England. This was a shock to many people. But there is public support for change in the NHS. Using a sample of 2088 people in the UK, a UCL Policy Labs and More in Common polling report from March, 2025, indicated 72% of people think things in the UK are getting worse and 61% think the NHS needs radical change.1 However, the British public generally do not want the careless and irresponsible actions of US President Donald Trump's executive orders, leading the report to conclude the “British people are looking for change, but not chaos, radicalism, but not recklessness”.

Population-based analyses of new vaccination programmes provide robust real-world evidence for post-licensure vaccine evaluation. A 2023–24 vaccine effectiveness analysis of immunocompetent adults aged 60 years or older in the USA showed 80% (95% CI 71–85) protection against respiratory syncytial virus (RSV)-associated hospital admissions.1 In England, the UK Joint Committee on Vaccination and Immunisation advised an initial programme for those turning 75 years old, with a catch-up to age 79 years, pending further data on protection of those who are older.

Overactive bladder is a chronic condition that affects 10–45% of women worldwide;1 however, more than half of women discontinue conservative and medical treatment.2,3 Predicting which women are better served by more invasive, third-line treatments, such as intradetrusor botulinum toxin A (BoNT-A) or sacral neuromodulation, has been elusive. Urodynamic studies have been used to better assess the cause of lower urinary tract symptoms. Expert societies, such as the European Association of Urology and the Canadian Urology Association, recommend conducting urodynamic studies in the event of treatments that did not work, when the diagnosis of overactive bladder is unclear, or if the choice of invasive treatments might change.

In women with refractory overactive bladder or urgency predominant mixed urinary incontinence, the participant-reported success in the urodynamics plus CCA group was not superior to the CCA-only group, and urodynamics was not cost-effective at the £20 000 per QALY gained threshold.

The US Agency for International Development (USAID) is no more. Marco Rubio, the US Secretary of State, has announced that 83% of programmes funded by USAID are to be ended, with the remainder to be absorbed by the State Department. Notwithstanding legal challenges, these decisions signal the end of an organisation that has brought crucial aid to millions globally. The move confirms the worst fears of the international community, coming 6 weeks after a pause on USAID's work that saw 5200 contracts cancelled, classified documents shredded, and life-saving aid halted.

A 2022 review evaluating the global magnitude of encephalitis burden concluded that low-income and middle-income countries (LMICs) had the highest age-standardised incidence rate worldwide (31·63 per 100 000 compared with 6·17 per 100 000 in high-income countries).1 Reported case fatality rates for Neisseria meningitidis were sometimes 3·5 times higher than in high-income countries.2 Accordingly, the Article in The Lancet by Bhagteshwar Singh and colleagues, reporting simple, context-informed interventions to improve the diagnosis and management of brain infections in Brazil, India, and Malawi, addresses a major public health issue.

We would like to express our sincere gratitude to the many dedicated peer reviewers who provided insightful and thoughtful comments on manuscripts submitted to The Lancet in 2024. With the rise in misinformation, together with the challenges posed by paper mills and other research integrity issues,1,2 we depend more than ever on peer reviewers to help uphold the standards of academic research and facilitate The Lancet's goal to publish the best science for better lives. In 2024, more than 1700 peer reviewers from 76 countries volunteered their time to critically assess submissions to the journal.