Lancet

Low-income and middle-income countries (LMICs) host nearly 85% of the world's population and bear a disproportionate burden of critical illness. Yet, knowledge generation and dissemination in critical care remain dominated by academics from high-income countries (HICs). A key tool of this dominance is medical journals. The structural biases within the current publishing system prioritise the visibility of work from HIC-based academics, marginalising contributions from LMICs.1 This academic divide has historical roots in colonialism.

We read with interest the study by Peter A Campochiaro and colleagues on RGX-314 for neovascular age-related macular degeneration (AMD),1 which suggests that gene therapy could reduce the need for frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. However, some methodological concerns warrant further attention.

We thank Huixun Jia and Xiaodong Sun for their perspective on our study.1 The goals of this first-in-human trial were to identify safe doses of RGX-314 and an optimised protocol for advanced studies. Doses in cohorts 1 and 2 were very low, resulting in little expression of anti-vascular endothelial growth factor (VEGF) protein, and, reassuringly, supplemental anti-VEGF injections were needed (these cohorts were vector-treated controls). In cohorts 3–5, there was good expression of anti-VEGF protein: most participants had good control of exudation and many of those with persistent exudation did not improve with monthly supplemental injections.

We read with great interest the Article by Victor Tumukunde and colleagues on kangaroo mother care (KMC).1 The authors conducted a meta-analysis pooling the results from the OMWaNA trial with the WHO iKMC trial2 and eKMC trial in The Gambia. We strongly believe this pooling is unjustified because the OMWaNA study is not comparable with the iKMC trial in terms of participants, intervention, comparisons, and outcomes.

We read with considerable interest the Article by Victor Tumukunde and colleagues1 on the effectiveness of kangaroo mother care (KMC) before clinical stabilisation in sub-Saharan Africa. Although we commend the authors for their extensive research, we believe that their findings necessitate a deeper examination of the practicality and universal applicability of KMC in resource-constrained settings.2

We thank these colleagues for their letters regarding our OMWaNA trial.1 First, in response to Harish Chellani and colleagues from WHO's Immediate Kangaroo Mother Care (iKMC) trial,2 we welcome their insights on our meta-analysis pooling neonatal mortality effects of the OMWaNA trial with similar trials in sub-Saharan Africa, where neonatal mortality is highest. This meta-analysis was important in showing a significant relative reduction in 28-day mortality of 14% across the African sites of all three trials to date, with consistency across five of the six sites,1 all lower than the effect at the iKMC Indian site.

Ivonescimab significantly improved PFS compared with pembrolizumab in previously untreated patients with advanced PD-L1 positive non-small cell lung cancer. Therefore, ivonescimab might represent another treatment option in the first-line setting for PD-L1-positive advanced non-small cell lung cancer.

Tuberculosis is a leading cause of death globally. Given the airborne transmission of tuberculosis, anybody can be infected, but people in high-incidence settings are more exposed. Risk of progression to disease is higher in the first years after infection, and in people with undernourishment, immunosuppression, or who smoke, drink alcohol, or have diabetes. Although cough, fever, and weight loss are hallmark symptoms, people with tuberculosis can be asymptomatic, so a high index of suspicion is required.

Dengue virus, a WHO grade 3 emergency, infected over 10 million individuals in 2024. With no population-effective prophylaxis or direct treatment, there is an urgent need for immediate vector control to protect the 3·9 billion individuals at risk globally.1,2

Humanitarian assistance has saved millions of lives, improved public health outcomes, and strengthened communities in crisis.1 From responding to armed conflicts and natural disasters to advancing disease control and poverty reduction, the humanitarian and development sectors have played an indispensable role in reducing suffering worldwide. However, despite these successes, the existing humanitarian system is not fit for purpose in today's rapidly evolving geopolitical landscape of conflict and displacement.

The ceasefire in Gaza presents an opportunity to rebuild and redesign its health system to include long-term sustainability and autonomy. In Gaza, over 90% of homes and schools have been destroyed; hospitals have been reduced to rubble; and medical personnel have been displaced, arrested, and killed. Temporary emergency aid cannot compensate for the structural weaknesses that have long defined Gaza's health sector. The focus must be on creating a system that is more resilient, equitable, and independent of external factors.