As the world continues to deal with the devastating effects of COVID-19, the World Bank is today releasing a new report that proposes actionable solutions to end the cycle of devastating pandemics.
The pace of emerging infectious disease (EID) outbreaks has increased at an average annual rate of 6.7 percent from 1980 onwards and the number of outbreaks has grown to several hundred per year since 2000. This is largely due to humans extending their global footprint, altering natural habitats, and accelerating the spillover of animal microbes into human populations.
Seventy-five percent of EIDs and almost all known pandemics result from increased contact between animals and people, causing more than 1 billion human infections and 1 million deaths each year. This, coupled with increasing movement of goods and people around the world, has demonstrated the ease of spread and volatility of EIDs.
In Putting Pandemics Behind Us: Investing in One Health to Reduce Risks of Emerging Infectious Diseases, policymakers, governments, and the international community are urged to invest in pandemic prevention and to move away from the business-as-usual approach based on containment and control after a disease has emerged. The report estimates that prevention costs guided by a One Health approach – which would sustainably balance and optimize the health of people, animals, and ecosystems – would range from $10.3 billion to $11.5 billion per year, compared to the cost of managing pandemics which, according to the recent estimate by the G20 Joint Finance and Health Taskforce, amounts to about $30.1 billion per year.
“Prevention is better than cure. COVID-19 has shown that a pandemic risk anywhere becomes a pandemic risk everywhere. The economic case for One Health is powerful – the cost of prevention is extremely modest compared to the cost of managing and responding to pandemics,” said Mari Pangestu, World Bank Managing Director of Development Policy and Partnerships.
Prevention costs are only about a third of the cost of preparedness, and less than 1 percent of the cost of COVID-19 in 2020 – when the global economy contracted by 4.3% or about $3.6 trillion worth of goods, services and other output lost, and the public health response. Ultimately, prevention is a global public good: no country can be excluded from benefiting and there is no limit to how many countries can benefit. Unfortunately, there is chronic underinvestment in prevention and countries must take action. In addition, when prevention is successful, the benefits are invisible and do not manifest as crises that demand immediate attention. One Health is the global approach required to break this cycle of panic, neglect, and underinvestment.
Successful implementation of One Health will require improved coordination, communication, and collaboration between sectors reinforced by capacity building. It means managing trade-offs between development and holistic health objectives, and sharing costs more equitably through global coordination of policy and financing actions.
Investing in One Health is an investment in humanity’s future. The framework is holistic and helps governments, international organizations, and donors direct financial resources to optimize scarce funding resources and prevent pandemics. One Health actions to prevent disease outbreaks are cost-effective, with an estimated annual rate of return of up to 86 percent. Now is the time to mainstream One-Health, leave the cycle of panic and neglect behind us, and put the notion that prevention is better than the cure into reality.
Psychedelics paired with therapy could treat chronic mental health conditions
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By VITTORIA D’ALESSIO
Mind-bending drugs and psychedelics are generally stigmatised and illegal in EU member states, due to concerns about their possible harmful effects. However, in other parts of the world, some psychedelic compounds are exalted for their healing properties and have been consumed in spiritual and cultural ceremonies for millennia.
Now scientists in Europe and the USA are starting to wake up to what shamans have been saying for years. There is a growing body of evidence to suggest some psychoactive substances have immense therapeutic potential, especially when it comes to tackling serious, hard-to-manage mental health issues such as post-traumatic stress disorder (PTSD), depression, alcoholism and eating disorders.
Mental disorders contribute enormously to the global burden of disease, with huge costs to both society and the economy. Psychedelics (which are generally considered non-addictive) may offer a tantalising form of therapy for difficult-to-treat conditions.
In response to the burgeoning interest from the scientific community, dozens of privately funded American studies, and a handful in Europe too, are attempting to unravel the neuroscience of psychedelic “trips”.
The endgame for many scientists in this area is to decriminalise psychedelics (both synthetic and natural) and establish safe protocols that will allow doctors and psychotherapists to harness the “magic” in these compounds for medical purposes. The goal is to achieve a lasting recovery in patients.
‘Researchers involved in this field picture a world where psychedelics are safely and legally available for beneficial use, and where research is given the opportunity to thoroughly evaluate their risks and benefits,’ said Dr Claudia Schwarz-Plaschg, who recently completed the three-year, Horizon-funded ReMedPsy project, where she examined (among other things) society’s evolving views on psychedelics.
‘Before we can make real progress in the medical use of psychedelics, we need to cultivate mainstream acceptance of these substances,’ said Dr Schwarz-Plaschg, adding, ‘In this sense, America is definitely ahead of Europe.’
While psychedelics are enjoying favourable attention from scientists, this is not the first time research institutions have expressed an interest in these substances. The 1950s and 1960s were a previous age of scientific and cultural exploration of psychedelic substances. However, when the political mood swung against all categories of “recreational” drugs, research was shut down.
Today’s revival of interest seeks to deepen our understanding of the biological mechanisms that give rise to the mind-altering effects of psychedelics, so they can be safely integrated into society.
‘These substances must be used with great care and respect,’ said Dr Schwarz-Plaschg. ‘They can be abused and they can be used to control people, so it’s vital to get both the set and setting right before they are taken.’
The “set” refers to the mindset of the person entering the experience. People need to be relaxed and free of fear, as this will influence the experience they have.
And the “setting” refers to the physical place you are in. ‘You must be comfortable and in good hands, and you must feel safe,’ she said.
So, what is it about these substances that makes them so appealing both on the nightlife scene and in a therapeutic setting?
Psychedelics trigger an altered state of consciousness. They affect all the senses and shift a person’s thought processes, sense of time and emotions. Dr Schwarz-Plaschg says the sensation they elicit is one of ‘opening up’.
She said: ‘Take a substance like MDMA (the active ingredient in the dance party drug Ecstasy). It produces a lot of empathy and strong feelings of bonding with others. Taken in the right setting, a person will also go within, and feel a lot of love and empathy for themselves – and if they’ve been the victim of a traumatic crime, probably for the perpetrator too.’
In this state of emotional expansiveness, patients are sometimes able to revisit traumatic experiences and confront catastrophic memories in a way that would be impossible under normal circumstances.
‘They can feel the same powerful feelings they first experienced at the time of their trauma but with less fear,’ explained Dr Schwarz-Plaschg. ‘And with the help of the psychedelic and their therapist, they can reframe the memory in a new light.
‘This process can help a person release feelings that have been stored in their bodies and give their traumatic experience a fresh, more positive perspective,’ said Dr Schwarz-Plaschg. ‘This perspective seems to stay with them even after the effects of the substance have worn off.’
Dr Schwarz-Plaschg is quick to point out that the work of psychedelics is explained through science, not magic. Their active molecules bind with the body’s receptors for serotonin – the ‘feel good’ neurotransmitter. Established antidepressants work along similar lines. However, psychedelics, when paired with therapy, appear to stave off mental health disorders for longer – for some, perhaps even forever.
A radical approach being proposed by scientists in this field is psychedelic-assisted psychotherapy (PAP). This is the professionally supervised use of psychedelic substances as part of a detailed psychotherapy programme.
‘We picture a world where psychotherapists are trained in the use of psychedelics, so these substances can be offered as part of a package,’ said Dr Schwarz-Plaschg. The programme would involve the pairing of a specific substance with a specific type of therapy. Maybe the patient would have two sessions where the therapist gives them psilocybin (found in “magic mushrooms”) and then two sessions of pure therapy.
In one 2021 trial, run by the Multidisciplinary Association for Psychedelic Studies (MAPS) – an American non-profit to raise awareness and understanding of psychedelics – MDMA-assisted therapy was given to people suffering from chronic post-traumatic stress disorder (PTSD). This condition is profoundly challenging to treat. After just three sessions, 67% no longer met the diagnostic criteria for PTSD while 88% experienced an improvement in symptoms.
‘Once we have more data on the best type of treatment mode to make people better, we are hopeful that the European Medicines Agency will give their approval,’ said Dr Schwarz-Plaschg.
The three substances at the centre of current scientific research are MDMA, psilocybin and ketamine (used as a sedative at higher concentrations and also known for its hallucinogenic effects).
Since 2019, esketamine – a ketamine-based nasal spray – has been allowed in the US and the EU to treat major depressive disorders, but only when other antidepressants have failed and only when administered from a certified clinic.
For many people with depression (but not all), esketamine is proving to be a breakthrough therapy. It acts fast and seems to significantly decrease the likelihood of a relapse into severe depression, when compared to oral antidepressants paired with a placebo nasal spray.
However, as with other psychedelics, more data is needed on the mechanism by which this mind-altering treatment works. More work is also needed to establish how many doses, and at what concentration, patients should take the treatment to achieve optimal results.
The use of MDMA and psilocybin is forbidden in most of Europe (some exceptions are available, with restrictions, in the Netherlands and Austria). However, champions of psychedelics are making good progress in the USA.
Since 2021, magic mushrooms have been legal for mental health treatment in supervised settings in some parts of the USA, and a bill pending in California would go some way to legalising the use of a medley of psychedelics that includes magic mushrooms, MDMA and LSD.
Dr Schwarz-Plaschg is hopeful that MDMA-assisted psychotherapy will be available in Europe within the next two or three years.
Research in this article was funded via the EU’s Marie Skłodowska-Curie Actions (MSCA). The article was originally published in Horizon, the EU Research and Innovation Magazine.
Positive mental wellness benefits society as it reduces pressure on healthcare services, improves the economy, cuts poverty levels, and a whole lot more. The United Nations (UN) reports that almost 1 billion people worldwide have some type of mental disorder. Untreated mental disorders are a big issue for society that costs billions. In the U.S. alone, they cost $300 billion annually. It’s time for governments and leading bodies to tackle this societal issue head-on, but how should they do it?
Improve mental health services
Worldwide, there is a huge demand for mental health services. This has resulted in a global shortage of mental health care workers. In some countries, up to 85% of people are unable to access mental health care. Earlier this year, the WHO Europe program was announced. It aims to improve mental health services for children and teenagers. But, a wider approach needs to be taken to ensure that all members of society get the right support. Ultimately, governments need to provide more funding for mental health research and care. They also need to ensure that the right measures are being implemented when the results of crucial research are published.
Change the working week
Around 15% of workers develop poor mental health at work, according to Mental Health. Poor mental health may occur following an accident at work. Being in pain, losing earnings, and not being able to work can cause issues such as depression, anxiety, and PTSD. Others may experience poor mental health at work due to long working hours. Some governments have recognized the need to change working hours to improve people’s work-life balance and mental wellness. Belgium is set to introduce a 4-day working week in 2023, but a uniform approach needs to be taken across the world. Many countries have trialed a 4-day working week with great success. Iceland’s trial concluded that employees experienced less stress, fewer episodes of burnout, and a better work-life balance when they dropped a working day.
Speak openly about mental illness
Mental illness, no matter how minor or severe, carries a negative stigma. Often, people with poor mental health are viewed as weak, unpredictable, and dangerous. People experiencing poor mental health even feel ashamed of who they are. These stigmas can lead to discriminatory behavior which can stop people from functioning fully in society. It’s time for governments to clamp down on these stigmas and for mental disorders to be normalized. There are sure to be plenty of government officials that have had or currently have a mental illness, but it’s rarely – if ever – spoken about publicly. Doing so would help society see that mental disorders are normal and that you can succeed with them.
Provide free help & support
Someone with mental illness can experience a much happier life with the right mental health support. This could be in the form of medication, psychotherapy, or support groups, among others. DW reports that in at least nine EU countries, patients have to pay towards the cost of a psychologist. Meanwhile, more than one-half of Americans say the cost of mental health care puts them off getting help. The current economic climate means that many people don’t have the cash to spend on their mental health. The impact of this on society will be huge, so governments need to seriously consider making mental health services free to everyone. The sooner someone has their mental health condition under control, the better their health will be, and the more society will benefit.
Everyone strives for their mental wellness to be the best that it can be. But, substantial support is needed from the government and official bodies to keep people’s mental health in the place it should be. In doing so, society as a whole will reap the advantages.
Today, the Council has adopted the final building blocks of the European Health Union: the Regulation on Serious cross-border health threats, the Regulation on the extended mandate of the European Centre for Disease Prevention and Control (ECDC) and the Emergency Framework Regulation to provide extra powers to the European Health Emergency Preparedness and Response Authority (HERA). These new rules complete the European Health Union, building a powerful legal framework to improve the EU’s capacity in the vital areas of prevention, preparedness, surveillance, risk assessment, early warning, and response.
Welcoming the adoption, Vice-President for Promoting our European Way of Life, Margaritis Schinas, said: “Today’s adoption by the Council of the three Regulations is a major achievement, and strengthens the EU Health Security Framework. With these new regulations, we have shown that we can move forward together, decisively, and fast. This legislation will work hand in hand with the financial support provided through the EU4Health Programme and the Recovery and Resilience Facility to ensure more resilient health systems across the EU. Collaboration and solidarity are key for the challenges ahead of us.”
Commissioner for Health and Food Safety, Stella Kyriakides, said: “The central pillars of our European Health Union are now in place. The pandemic has shown the need for more Europe in public health, and a stronger capacity to protect citizens from health threats. With a stronger ECDC, an empowered HERA and a reinforced role for the EU in preventing, preparing for, and managing cross-border health threats, we now have additional tools to quickly react and respond to emerging health crises, decisively and with unity”.
With the adoption of the Serious cross-border threats to health Regulation, the EU will have:
A stronger ECDC will not only issue recommendations to Member States regarding health threats preparedness, but also host a new excellence network of EU reference laboratories and establish an EU Health Task Force for rapid health interventions in the event of a major outbreak.
To be effective and operational in times of public health emergencies, the Emergency Framework Regulation will allow the establishment within HERA of a Health Crisis Board. This Board will rapidly coordinate at EU level the supply of and access to medical countermeasures. The Regulation also enables the activation of the EU fab facilities, emergency research and innovation plans and access to emergency funding.
Following today’s adoption of the three Regulations, they will be published in the Official Journal and will enter into force in November 2022.
The European Health Union package is a key part of the Commission’s response to the COVID-19 pandemic and future public health emergencies. In addition to the three Regulations adopted today, the Regulation on the extended mandate of the European Medicines Agency (EMA) is already in the implementation phase since 1 March 2022.
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