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European Alliance for Personalised Medicine

EAPM update: How to put Europe Beating Cancer Plan into practice

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It is finally with us – the Europe Beating Cancer Plan was formally launched at an EU level last week (4 February), but as the European Alliance for Personalised Medicine (EAPM) has become only too aware in its years of striving for the very best progress in terms of health care and health issues, the question as ever now is how the plan will be implemented in practice, writes EAPM Executive Director Dr. Denis Horgan. 

Factsheets to the rescue

EAPM has, for the past six months, been very hard at work on developing country-oriented factsheets with leading experts in the field and looks to combat lung cancer across key pillars.   Stakeholders' views on national barriers and enablers in tackling lung cancer were obtained via an online survey during seven structured expert panels. Stakeholder groups represented pathologists, lung specialists, the regulatory field, health systems, industry representatives and patient perspectives.

Factsheets covered the following countries and are available here: Slovenia, Greece, Portugal, GermanyDenmark, Italy Belgium, NetherlandsSwitzerland, SwedenPolandBulgariaCroatiaIsrael and Romania. 

As far as the factsheets are concerned, each concentrate on seven core aspects of lung cancer care, which are as follows:

1.     Screening programmes

2.     Access to molecular testing

3.     Personalised treatment decisions

4.     Early and broad access to personalised treatments

5.     Remote monitoring and personalized interventions

6.     Data empowerment and advanced analytics

7.     Prioritization within national health strategy

In addition, each factsheet for each country provides a policy checklist in conclusion. 

Working together

The European Commission will be looking to seek consensus from member states’ health ministers to move the action plan forward, and it will be an interesting challenge to observe the levels of co-operation from member states on health-related matters following on from the coronavirus pandemic. While member states are in control of health policies, there has nevertheless been divergence between them concerning the COVID-19 responses prepared by the Commission. 

Whether member states will align with the ambition as set in cancer plan with the action committee on cancer within the European Commission is unclear but, given that Eurostat's latest data shows that lung cancer is the third leading cause of death in the EU-27, exceeded only by ischaemic heart disease and cerebrovascular disease, one can only hope that the relevant policymakers and institutions will be able to work together.

The toll from lung cancer cannot be underestimated – it kills more than 80 in 100,000 men in Europe and more than 20 per 100,000 women – and for women that figure is rising. It is far more lethal than other cancers, accounting alone for more than a fifth of all cancer deaths, with other leading cancers - colorectal, breast or pancreatic cancer – at half the rate of lung cancer or less.  

This is a major problem for all member states but is particularly acute in some: Hungary recorded the highest standardized death rate from lung cancer in 2017 (89.2 deaths per 100,000 inhabitants), followed by Croatia (68.4 deaths per 100,000 inhabitants), Poland and Denmark (67.0 and 66.8 per 100,000 inhabitants respectively).

The predominant cause of the lethality of lung cancer is late presentation: 70% of lung cancer cases are diagnosed at an advanced and incurable stage, resulting in the deaths of a third of patients within three months. A leading study shows that from 2009 to 2015, 57% of patients had distant metastases at diagnosis, only 16% of patients had localized disease, and the five-year survival rate among all patients with lung cancer was 20.6%. In England, 35% of lung cancers are diagnosed following emergency presentation and of these 90% are at later stages. 

According to EAPM, mechanisms are available to reduce the morbidity and mortality of lung cancer, but health systems are slow to take advantage of them. Europe’s citizens and patients would benefit from wider adoption of risk-based screening, early use of advanced diagnostics, early access to the growing number of personalized treatment options, better patient follow-up and remote monitoring, and systematic exploitation of data. 

With the correct application of new technologies and methods, the principal beneficiaries will be today’s – and still more, tomorrow’s – patients and their carers and entourage. And correctly implemented, these technologies could even allow health-care spending and even national economics to gain from a reduction in the consequences and even in the incidence and mortality of lung cancer.

Hence, member states should engage fully in the action plan and engage in discussions at an early stage. They should represent their views before officials take over the action plan and begin drafting implementation actions with the other institutions.

Conclusion and recommendations

The fight against lung cancer, for many years one of the most intractable healthcare challenges, and still a major killer, is on the threshold of new victories. A combination of  scientific advances, new technology and new practices brings within reach early diagnosis, effective treatment, and more sustainable allocation of healthcare resources.

It remains for EAPM and lung-cancer stakeholders to continue pushing for political commitments and for structures that provide for evidence based decision-making exploiting the most advanced technologies. The EU Beating Cancer Plan offers scope for tailored interventions to advance the lung cancer agenda.

The overarching key to progress now will be implementation of the action plan, and thankfully, the EAPM factsheets provide a very useful and accessible starting point as to how this can take place. The fact sheets are available here: Slovenia, Greece, Portugal, GermanyDenmarkItaly BelgiumNetherlandsSwitzerland, SwedenPolandBulgariaCroatiaIsrael and Romania. 

Have the best weekend possible, and keep safe.

European Alliance for Personalised Medicine

EAPM: Successful IVDR meeting points the way to future collaborations

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Good afternoon, health colleagues, and welcome to the second European Alliance for Personalised Medicine (EAPM) update of the week, in which we discuss the successful In Vitro Diagnostic Regulation (IVDR) meeting conducted by EAPM yesterday (22 July), and other pressing health issues, writes EAPM Executive Director Dr. Denis Horgan. 

IVDR issues raised

Yesterday, EAPM was pleased to have conducted a successful meeting on In Vitro Diagnostic Regulation (IVDR), with more than 73 representatives from 15 countries participating as well as the European Medicines Agency (EMA) and member states’ representatives. 

The IVDR will come into force on 26 May 2022. There are a number of areas in which there is a lack of awareness or clear guidance to support implementation at member state level. The main areas of concern relate to two issues, namely the limited capacity within Notified Bodies to grant CE marking in a timely manner, with a bottleneck occurring in the approval of some IVDs which are likely to be used for patient selection for use with precision medicines. The Commission’s Medical Device Coordination Group (MDCG) Task Force is reviewing this.

In addition, a significant proportion of predictive testing in Europe to support access to oncology precision medicines is delivered through the use of laboratory developed tests (LDTs), and there will be a new legal requirement for labs to use commercially approved tests (CE-IVD) in place of their current LDTs. If there is no CE-IVD commercial test available, public laboratories may be able to use an LDT, subject to certain provisions in the IVDR. The lab will be required to meet all the relevant requirements for safety and performance, whilst carrying out the manufacture under an appropriate quality management system.

Although health institutions are broadly aware of the IVDR, further guidance for laboratories on compliance with its key provisions would be welcomed, particularly on the exemptions to the Regulation granted under Article 5. An MDCG Task Force has very recently been established to develop such guidance, although there is little time left for laboratories to prepare for the regulation. 

Another key issue was whether member states are expecting cost impacts as a result of the IVDR (incurred through either the switch from LDTs to CE-IVDs or the need to improve their laboratory’s quality and performance processes), and whether they have engaged with their national health authority or other relevant stakeholders on this issue. 

Finally, a key outcome of the meeting was the issue of how the regulation can facilitate some of the solutions that were proposed by member states’ representatives, and a meeting will be organized with the Commission and member states at a later date. 

On to other EU health news...

Making Europe fit for the digital age

The EU continues to lag behind China and the US when it comes to investments into key technologies such as artificial intelligence and quantum computing, the European Commission President Ursula von der Leyen has warned. “Europe is still punching well below its weight. I believe this is because of two main reasons. The first one obvious, a lack of investment,” she said. 

While European companies invest massively in research and development in sectors such as automotive or pharma, “our investment in other fields still lags behind the US and China” she added. “Artificial intelligence and quantum computing are two good examples, and due to this, far too many European startups in the tech world have had to leave the continent in order to scale up.”

Bulgaria creates patients rights’ body

Bulgaria’s council of ministers has given the go-ahead to the creation of a new directorate for patients rights under the health ministry. The new body will aid the health ministry in ensuring that patients rights are protected and work on creating programs and guidelines to improve patient protections. Generally, in Bulgaria the rights envisaged in the European legislative framework have been regulated. 

A person’s rights, including in a situation of illness (when a person is in the position of a “ patient” ) are part of the human rights regulated by the UN convention ratified in Bulgaria in 1992. 

The citizens of the Republic of Bulgaria are entitled to accessible health care and health insurance (Art. 52 ofthe Constitution, Art. 33, 35 of the Health Insurance Act (HIA)), healthy environ-ment and conditions of work, guaranteed food quality and protection against abuse of their personality. Each patient is entitled to obtain the best healthcare in conformity with the legislation. 

Cyber concerns on health 

Plans to set up an EU rapid-response cyber unit that could quickly respond to attacks like the recent ransomware hack of Ireland’s Health Service Executive (HSE) have been unveiled. Across Europe, cyberattacks rose 75% last year, with 756 such incidents logged, including an increasing number of attacks on health-care systems, representing a growing risk to society with critical infrastructure at stake, according to the European Commission. “We have a lot of cyber enemies around us,” 

European Commissioner Thierry Breton said. “Ireland’s public healthcare system suffered a pretty strong ransomware attack. I believe it affected a system with more than 80,000 computers, so that was something which was pretty, pretty strong. It could have been a very important plus, if we could have sent dedicated experts very quickly to react even faster, because we know that, of course, the longer you wait the worse it is.” 

The HSE expects it will take as long as six months to recover from the attack, with many hospital and patient data systems still affected. The cyberattack was part of a growing trend of attacks on critical systems, including on the Colonial Pipeline in the US.

Spain offers to test-run the EU's AI regulation

Spain has pitched itself to the European Commission as a laboratory to test the Artificial Intelligence Act - with more 117 AI ethics initiatives springing up around the world, initiatives to regulate artificial intelligence (AI) have sprung up around the world, spearheaded by the likes of Spain, OECD and UNESCO. It‘s time to harmonize and consolidate, a conference on AI ethics held under the auspices of Slovenia’s presidency of the EU Council heard this week. “We are clearly at a developmental point where you’ve got a lot of actors right now contributing to this movement from principles to practice, and we simply need to work together in a multistakeholder way to harmonize these approaches,” said David Leslie, of the Council of Europe’s Ad hoc Committee on Artificial Intelligence (CAHAI). 

WTO and WHO demand more vaccines

The World Trade Organization (WTO) and the World Health Organization (WHO) The World Trade Organization (WTO) have mapped critical inputs for the production of COVID-19 vaccines, in a bid to clarify complex supply chains for sourcing raw materials and components. The organizations this week published an indicative list of 83 inputs, most of which cover the manufacturing of coronavirus jabs, but also those relevant to storage, distribution and administration. It covers the vaccines produced by AstraZeneca, Janssen, Moderna and Pfizer-BioNTech, including product details and their likely HS codes when exported. The list was jointly produced with the Asian Development Bank, the OECD and the World Customs Organization, as well as representatives from the pharmaceutical industry, academia and logistics. It is subject to further modification and improvement depending on expert advice, the WTO says. The exercise was carried out amid concerns over the rate of vaccine production.

MEPs call for mutual recognition of intensivists

While Europe is getting ready to spend a second summer under the shadow of COVID-19, European decision-makers are pushing forward an ambitious agenda and preparing to deliver a more resilient and sustainable European Health Union. To make the best use of the hard-learned lessons from the pandemic, policymakers are now joining the call of the heroes of this unprecedented health crisis: the health-care workers in Intensive Care Units (intensivists) who came under enormous pressure and outdid themselves constantly to save lives. Pandemics don’t stop at our borders and Members of the European Parliament (MEPs) acknowledge the need for European solutions to a European problem. In a letter addressed to European Commission President Ursula von der Leyen, MEPs urge for intensive care medicine to be recognized as a main pillar of the new European Health Union. According to the MEPs, there is a lack of mutual recognition for intensive care medicine training among many EU countries, which prevents a fast and efficient European response in times of pandemics and other cross-border health threats.

Good news to end: EU countries double vaccine-sharing promise to 200M doses

EU countries have committed to sharing 200 million doses of coronavirus vaccines to low- and middle-income countries by the end of 2021, doubling a previous commitment.

The Commission has also pointed today to its other efforts to increase access to vaccines in Africa in particular, however the EU remains firmly opposed to a waiver of intellectual property rights for coronavirus vaccines.

That is all from EAPM for now – make sure you stay safe and well and have an excellent weekend, see you next week.

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European Alliance for Personalised Medicine

EAPM: Truly active summer ahead for EU health policy

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Good afternoon, health colleagues, and welcome to the first European Alliance for Personalised Medicine (EAPM) update of the week, in which we discuss the range of items ahead for the summer months as far as EU health policy is concerned, so it’s a busy time ahead for EAPM, writes EAPM Executive Director Dr. Denis Horgan. 

In-vitro diagnostic expert panel

And it is a busy week for EAPM, with an in-vitro diagnostic expert panel on Thursday (22 July). This deals with legislation that is due to come into force next year on 26 May, 2022 - the question will be how will this legislation have an impact on bringing innovation into health-care systems and being able to diagnose patients earlier? 

At present a significant proportion of predictive testing in Europe to support access to oncology precision medicines is delivered through the use of laboratory developed tests (LDTs), with the following implications under the IVDR, and there will be a new legal requirement for labs to use commercially approved tests (CE-IVD) in place of their current LDTs. If there is no CE-IVD commercial test available, public laboratories may be able to use an LDT, subject to certain provisions in the IVDR. 

The lab will be required to meet all the relevant requirements for safety and performance, whilst carrying out the manufacture under an appropriate quality management system. As a consequence, many laboratories may face additional procurement costs for commercially approved tests and/or the need to improve their safety and performance requirements for any LDT offerings.

All these issues will be discussed in the expert panel this Thursday through various case studies. A policy paper will be the outcome of this meeting so more on this in the months ahead. 

EU Health Union 

As discussed in the previous updates, the European Health Union package includes proposals to strengthen the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC), and a regulation on cross-border health threats. 

Slovenia, who holds the EU Presidency now and its predecessors at the helm of the EU, Portugal and Germany, are working to finalize negotiations on three draft regulations that form the basis of the EU Health Union, Slovenian Health Minister Janez Poklukar has said. 

The desire is to co-ordinate the regulations in trialogue with other EU institutions as soon as possible, the minister added in a statement. The comments came after a high-level conference on implementing innovative solutions for resilient health systems that also featured the health ministers of Portugal and Germany, Marta Temida and Jens Spahn. Spahn said the shared objective of all three countries was to establish a trialogue with the European Parliament and the Commission. 

“We want actual results in practice,” Spahn added. Temida said it was essential that the work done by the German and Portuguese presidencies continues to produce good results and that the transition was smooth. 

She said adoption of the legislative package would mark “a significant milestone in Europe’s preparedness for extraordinary health events”. The Health Union package includes proposals to strengthen the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC), and a regulation on cross-border health threats.

Research and innovation 

The Commission has adopted its proposal for a Council Recommendation on ‘A Pact for Research and Innovation in Europe' to support the implementation of national European Research Area (ERA) policies.

This is an issue that the EAPM has followed closely. 

The Pact proposal defines shared priority areas for joint action in support of the ERA, sets out the ambition for investments and reforms, and constitutes the basis for a simplified policy coordination and monitoring process at EU and member states' level through an ERA platform where member states can share their reform and investment approaches to enhance exchanges of best practices. Importantly, to ensure an impactful ERA, the Pact foresees the engagement with research and innovation stakeholders. 

A Europe fit for the Digital Age Executive Vice President Margrethe Vestager said: “The pandemic has shown us the importance of uniting research and innovation efforts that swiftly bring results to the market. It has shown us the importance of investment in jointly agreed strategic priorities between Member States and the EU. 

"The Pact for Research and Innovation we propose today, will facilitate better collaboration and join our efforts to tackle research and innovation objectives that matter the most for Europe. And it will allow all of us to learn from each other.” 

New rules on open data and reuse of public sector information start to apply 

17 July marked the deadline for member states to transpose the revised Directive on open data and reuse of public sector information into national law. The updated rules will stimulate the development of innovative solutions such as mobility apps, increase transparency by opening the access to publicly funded research data, and support new technologies, including artificial intelligence. 

A Europe Fit for the Digital Age Executive Vice President Margrethe Vestager said: “With our Data Strategy, we are defining a European approach to unlock the benefits of data. The new directive is key to make the vast and valuable pool of resources produced by public bodies available for reuse. Resources that have already been paid by the taxpayer. So the society and the economy can benefit from more transparency in the public sector and innovative products.” 

Internal Market Commissioner Thierry Breton said: “These rules on open data and reuse of public sector information will enable us to overcome the barriers that prevent the full re-use of public sector data, in particular for SMEs. The total direct economic value of these data is expected to quadruple from €52 billion in 2018 for the EU member states and the UK to €194bn in 2030. Increased business opportunities will benefit all EU citizens thanks to new services.” 

Commission to make HERA proposal on 14 September

The European Commission will present its European Health Emergency Preparedness and Response Authority (HERA) package on 14 September. The COVID-19 pandemic demonstrated the need for co-ordinated EU level action to respond to health emergencies. It revealed gaps in foresight, including demand/supply dimensions, preparedness and response tools. 

A European HERA is a central element for strengthening the European Health Union with better EU preparedness and response to serious cross-border health threats, by enabling rapid availability, access and distribution of needed countermeasures. Last year, the Commission proposed changing the mandates for both the EU’s infectious disease agency and medicines agency, and made a proposal for a regulation on serious cross-border health threats.

Some good news to end: COVID-19 antibodies persist 'at least nine months after infection', study finds 

Antibodies in COVID-19 patients remain high even nine months after infection, according to a landmark study which tested almost the entirety of a small Italian town. The study, published in the journal Nature Communications, focused on the town of Vo which became the centre of the country's coronavirus pandemic in February 2020 when it recorded Italy's first death. 

Now, researchers from the University of Padua and Imperial College London have tested more than 85% of the town's 3,000 residents for antibodies against COVID-19. 

The researchers found that 98.8% of people who had been infected in the first wave of the pandemic were still showing detectable levels of antibodies nine months later, regardless of whether their infection had been symptomatic or not. Residents' antibody levels were tracked using three different "assays", or tests that detected separate kinds of antibodies which respond to different parts of the virus.

That is all from EAPM for now  - make sure you stay safe and well and have an excellent week, see you on Friday.

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European Alliance for Personalised Medicine

EAPM: Conference Presidency report now available, digital updates, Delta bringing new spikes

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Good afternoon, health colleagues, and welcome to the first European Alliance for Personalised Medicine (EAPM) update of the week, writes EAPM Executive Director Dr. Denis Horgan. 

Innovation, Public Trust and Evidence: EU Presidency Conference report 

On 1 July, EAPM held a virtual online bridging conference to inaugurate the shift leadership of the EU Council of Minister to the new Slovenian EU Presidency  – in line with what is now an established EAPM tradition, the conference provided a necessary bridge to ensure smooth continuation of reflections on its priority health issues across the shifts in leadership of the EU Council of Ministers. Coming immediately after the eventful Portuguese Presidency, and right at the start of the Slovenian Presidency, the meeting reviewed recent advances in personalised health-care innovation, in prostate and lung cancer and in securing patient access to advanced molecular diagnostics. 

Its title of ‘Innovation, Public Trust and Evidence: Generating Alignment to facilitate personalized Innovation in Health Care Systems’ also indicated EAPM’s other role as a bridge – in bringing together stakeholders from across the widest spectrum of health care, to seek common ground and consensus, and to candidly identify persisting divergences and challenges still to be overcome in implementing personalised care in Europe and beyond. 

Consequently, its panel of distinguished speakers from the research community, regulatory agencies, public health decision makers, clinicians, patients and industry attracted 164 delegates from an even wider range of disciplines. 

The link to the report is available here, and provides a detailed overview of the insights of each speaker as well as the recommendations. 

ENVI to vote on final HTA agreement 

Today (13 July), the Environment, Public Health and Food Safety (ENVI) Committee will cast final votes on the Health Technology Assessment (HTA) provisional agreement, following Slovenian Health Minister Janez Poklukar addressing ENVI on Monday to present the Presidency’s work programme in the health field. Poklukar reiterated the country’s health priorities. 

Chief among them is resilience against outside threats, which includes both “pandemic and large scale cyber attacks”. As MEP Veronique Trillet-Lenoir noted, the European Medicines Agency has been the target of hackers in the context of its vaccine approval process. The presidency will also focus on “the added value of EU level collaboration in developing and implementing innovative solutions for resilient health systems,” said Poklukar. HERA — the planned European Health Emergency Preparedness and Response Authority (HERA) — will also be a priority. 

Digital Markets Act

“The Slovenian presidency will aim for a targeted Digital Market Act, that is also quickly implementable,” said Slovenia’s Economic Development and Technology Minister Zdravko Počivalšek. He added that Slovenia aimed to achieve a general approach by November for a Competitiveness Council. On the regulatory side, the minister also pointed to the Digital Services Package as the main focus of the next Presidency. 

For both the Digital Services Act (DSA) and the Digital Markets Act (DMA), the Slovenian government has the ambition to broker a general approach at the Competitiveness Council that will take place in November. 

Data Governance Act 

In EU rules to bolster the data economy, the big data era has created valuable resources for public interest outcomes, like health care. In the past 18 months, the speed with which scientists were able to respond to the covid-19 pandemic—faster than any other disease in history—demonstrated the benefits of gathering, sharing, and extracting value from data for a wider good. 

Access to data from 56 million National Health Service (NHS) patients’ medical records enabled public health researchers in the UK to provide some of the strongest data on risk factors for covid mortality and features of long covid, while access to health records sped up the development of lifesaving medical treatments like the messenger-RNA vaccines produced by Moderna and Pfizer. But balancing the benefits of data sharing with the protection of individual and organizational privacy is a delicate process—and rightly so. 

Governments and businesses are increasingly collecting vast amounts of data, prompting investigations, concerns around privacy, and calls for stricter regulation. In a letter to TranspariMED dated 8 July, the Heads of Medicines Agencies (HMA), a network of the head of regulators in the European Economic Area, said it would be initiating joint action with the European Medicines Agency and the Commission to improve compliance. 

The letter comes just days after a report indicated that medicines regulators in 14 European countries are failing to ensure that data on new medicines is rapidly publicly available as required under EU rules. Explaining the reason for the non-compliance, the HMA said that it’s “a lack of knowledge of the European rules itself on the part of the sponsors that constitute the root cause.” The HMA’s management board is preparing an overview of actions that member countries are taking to improve compliance, to be circulated as a best practice document. 

WHO urges regulation on ethical genome editing 

On Monday (12 July), a World Health Organization (WHO) advisory committee called on the world’s largest public health authority to stand by the 2019 statement of its director-general urging a halt to any experiments that might lead to the births of more gene-edited humans. The committee — established in December 2018, weeks after news broke of the birth of twin girls whose genomes were edited by Chinese scientist He Jiankui — said in a pair of long-awaited reports that the germline editing technology that led to the ‘CRISPR babies’ scandal is still too scientifically and ethically fraught for use. But for other, less controversial forms of gene-editing, the reports offer a path to how governments might establish the technology as a tool for improving public health.

 “The framework recognizes that policies governing the technology will likely vary from country to country,” committee co-chair and former U.S. Food and Drug Administration commissioner Margaret Hamburg said at a virtual press conference. “Nonetheless the framework calls on all countries to incorporate key values and principles into their policies, such as inclusiveness, equal moral worth, social justice, responsible stewardship of science, solidarity, and global health justice.” 

Dealing with Delta - new EU spikes

The delta variant is the fourth variant of concern identified by the World Health Organization (WHO), first identified in India (April 2021) and it's quickly becoming the dominant variant across the world. It has now overwhelmed the medical ecosystem globally. Since then it has made its way to many countries in Europe. As per research, the Delta variant is the most transmissible form of the virus and mostly deadlier too. 

What makes Delta variant different and more dangerous from the other mutations is that it has many spike proteins that enable it to bind to our body cells more rapidly and efficiently. People infected with this mutation tend to transmit more of this virus around, and as a result of which it affects about 60% plus efficiently more than previous variants. 

Factually, all the coronavirus variants share many similarities, however, recent findings show that the delta variant causes more headache to start with, along with sore throat, runny nose, and fever. It was striking to notice that the traditional early symptoms of COVID-19 were observed lesser in this new variant, such as cough and loss of smell. People infected with this new variant have higher chances of being hospitalized as compared to the alpha variant. This can be easily understood considering the alarming death tolls all over the world. 

COVID still ‘troubling and dangerous’ WHO warns 

Dr David Nabarro of the World Health Organization (WHO) has told the UK’s Radio 4's Today programme the virus is "troubling and dangerous", that the "pandemic is advancing ferociously around the world" and that "I don't think we've anywhere near got through the worst of it". Asked about the government's switch to personal responsibility, as of 19 July, he said: "All this doesn't quite fit with the position that was taken by Britain, along with other nations, some months ago when there was a real effort to try to prevent large numbers of people getting the disease, partly because of the risk of death and partly because of the recognition of the risk of long COVID. 

"Yes, relax, but don't have these mixed messages about what's going on. This dangerous virus hasn't gone away, it's variants are coming back and are threatening those who have already been vaccinated - we have to take it seriously."

That is all from EAPM for now – don’t forget to check out our report on our latest virtual conference available here, and make sure you stay safe and well and have an excellent week, see you soon.

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