Health Brief, powered by European Diabetes Forum: Time to de-liver

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When you think of the leading causes of death and disease in the EU, you would likely think of cancer or something affecting the heart or lungs.

You might not think of the liver, the silent hero pumping away all the excesses of our lives (which seems appropriate as we reach the holiday season).

But, according to the World Health Organisation (WHO), liver disease is now the second leading cause of years of working life lost in Europe – and it shows no signs of slowing down any time soon. 

As it stands, some 300,000 people in Europe die prematurely each year due to liver problems.

Of these, non-alcoholic fatty liver disease (NAFLD) is now the fastest-growing liver disease in Europe, with one in four people living with the condition, which is also on track to become the number one cause of liver cancer. 

Of course, when you think of the liver, you think of alcohol – and while it’s true alcohol causes about 40% of premature liver-related deaths in Europe every year, the key driving factor of NAFLD is actually obesity. 

It is also worth mentioning that, unlike smoking-related and other obesity-related illnesses, this is a disease of the (relatively) young, with the peak age of death for chronic liver diseases occurring in the late 40s and early 50s. 

Put simply – like many cancers, liver disease is a ticking time bomb. 

But, unlike cancer, liver disease does not seem to be high on the priority list, even though liver health is inextricably linked to a whole heap of other health and societal issues. 

So much so that Professor Thomas Berg, secretary-general of the European Association for the Study of the Liver (EASL), has described liver health as a “window to the general health challenges of Europe in the 21st century”.

Speaking during the launch event of a new joint 3-year study, conducted by the EASL together with the Lancet, Berg explained that this is because common risk factors for liver disease “reflect behaviours and conditions that are the consequence of both unhealthy environments and social inequities”.

As such, we are “at the precipice of failure or opportunity,” he stressed.

Berg, alongside other experts, is now calling for a fundamental shift in how liver disease is dealt with, pointing out that, in many cases, liver disease is avoidable. 

“The prevention and treatment of most liver diseases are now possible thanks to significant achievements in modern medicine,” said Michael Manns, a co-chair of the EASL-Lancet commission and president of Hannover Medical School in Germany, while fellow co-chair Professor Patrizia Burra said that “therapeutic nihilism” for liver diseases belongs to the past.

So everyone is making the right noises – the question now is how this can be achieved?

Besides calling for better integration and coordination of Europe’s fragmented health systems, the EASL-Lancet commission also calls for a somewhat radical proposition – a complete online and digital ban on marketing and advertising of alcohol and ultra-high-processed, high-fat and high-sugar foods.

According to Richard Horton, editor-in-chief of The Lancet, addressing the causes of liver disease (and by de facto many other diseases) requires “bold and extensive public health responses”, such as digital marketing regulations for children.

But he pointed out that these measures are often opposed by commercial interests that “prioritise the financial health of their shareholders over the health of the European population”.

This is not the first time that there have been calls for an EU-wide ban or tightening of rules on unhealthy food marketing, which is predictably met with staunch opposition.

Although the EU’s flagship food and farming policy, the Farm to Fork strategy, highlights the need to adapt marketing and advertising strategies, taking into account “the needs of the most vulnerable”, more often than not, the conversation has found itself (endlessly) stuck on labelling and information rather than advertising. 

While there has been discussion on restricting the promotion of foods linked with cancer risks in the EU’s promotional policy, which is currently under review, this has been centred more on the question of meat rather than ultra-processed food per se.

Meanwhile, the EU chose to go easy on alcohol in its flagship beating cancer plan.

Elsewhere in the world, governments are stepping up their game on advertising, especially in the wake of the COVID-19 pandemic.

For example, Chile has banned cartoon mascots on processed food and, after Mexico’s government saw that so many of their overweight young people were contracting and dying from COVID, some states banned selling junk food to children.

If that seems a little extreme, keep in mind that it was perfectly legal for children to buy cigarettes not so long ago.

Meanwhile, closer to home, Spain, where 41% of children aged 6-9 are now obese or overweight, has also moved to ban junk food ads for children as of 2022 in a bid to fight obesity.

While opinions may differ on whether this is the way forward, one thing is clear – it’s time to de-liver on the burgeoning problem of liver disease.

(N.F.)

[Edited by Alice Taylor]

 

 


A message from the European Diabetes Forum

EUDF has been created to bring together multiple stakeholders from across the diabetes landscape in Europe. The mission of EUDF is to ensure that policy action can be directed towards driving better diabetes care at national and European level. Continue Reading >>


 

 

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Pandemic treaty

World Health Organization (WHO) member states decided to pursue an agreement ON PANDEMIC TREATY ON Wednesday (1 December). The diplomatic breakthrough came amid growing international concern over the Omicron coronavirus variant.

A global agreement to strengthen pandemic prevention and responses, expected to be ready in May 2024, would cover issues such as sharing of data and genome sequences of emerging viruses, and of any potential vaccines and drugs derived from research. “The adoption of this decision is cause for celebration, and cause for hope, which we will need,” said  Tedros Adhanom Ghebreyesus, WHO Director-General, at the Special Session of the World Health Assembly

COVID-19

EU agencies endorse mix & match: EMA and ECDC on Tuesday (7 December) published recommendations on heterologous vaccination courses against COVID-19. Evidence from studies on heterologous vaccination (‘mix and match’) suggests that the combination of viral vector vaccines and mRNA vaccines produces good levels of antibodies against the COVID-19 virus and a higher T-cell response than using the same vaccine whether in a primary or booster regimen. The use of a viral vector vaccine as second dose in primary vaccination schemes, or the use of two different mRNA vaccines, is less well studied. 

Research conducted by WHO Europe and ECDC has found that from December 2020 to November 2021, at least 470,000 lives were directly saved through COVID-19 vaccination, WHO tweeted on Tuesday (7 December). 

‘Hope for the best, be prepared for the worst’: Although more research is needed into the COVID-19 Omicron variant, Europe knows “enough to be concerned,” said European Commission President Ursula von der Leyen on Wednesday (1 December). Health commissioner Stella Kyriakides said that “we are once more facing a very worrying epidemiological situation” in regards to omicron spread. 

Omicron variant: In the latest updated threat assessment brief on Omicron, published on Thursday (2 December) European Centre for Disease Prevention and Control (ECDC)  noted that there are a number of uncertainties around Omicron in terms of transmissibility, severity, and immune escape potential, though preliminary data suggest a substantial advantage over the Delta variant. 

As of Monday (6 December), Omicron variant of concern (VOC) cases have been reported by 18 countries in the European Union and European Economic Area (EU/EEA), contributing to an overall total of 212 confirmed cases to date.  All cases for which there is available information on severity were either asymptomatic or mild. No deaths have been reported among these cases so far. These figures should be assessed with caution as the number of confirmed cases is too low to understand if the disease clinical spectrum of Omicron differs from that of previously detected variants.

Compulsory vaccination? It is time for the European Union to “think about mandatory vaccination” against COVID-19, European Commission chief Ursula von der Leyen said Wednesday (1 December). “How can we encourage and potentially think about mandatory vaccination within the European Union? This needs discussion. This needs a common approach. But it is a discussion that I think has to be led,” she said.

Boosters: Six different COVID-19 boosters are safe and increase immunity when given after two doses of AstraZeneca or Pfizer-BioNTech, with large variations in immune responses, a UK trial, published in The Lancet on Friday (3 December) showed. 

Convalescent plasma: On Tuesday (7 December) WHO advised against the use of convalescent plasma for COVID-19. Despite its initial promise, current evidence shows that convalescent plasma, a transfusion of blood plasma from someone who has recovered from COVID-19 does not improve survival nor reduce the need for mechanical ventilation, and it is costly and time-consuming to administer.

Dementia

“I will eventually have the luxury of forgetting, all those around me won’t have that luxury, they will never forget what dementia has done to us,” Chris Roberts, who has dementia, told EURACTIV.com in an interview, emphasising the need for increased awareness over a devastating disease is present in all corners of the world.

AIDS

The world is off-track from delivering on the shared commitment to end AIDS by 2030, WHO announced on World AIDS Day, on Wednesday (1 December). In 2020 there were 37.7 million people living with HIV, 1.5 million new HIV infections and 680 000 AIDS-related deaths. Around 65% of HIV infections globally were among key populations, including sex workers and their clients, gay men and other men who have sex with men, people who inject drugs and transgender people, and their sexual partners.

Autism

A new, comprehensive model of autism care and treatment that prioritises personalised, stepped care approaches is urgently needed, according to a new international report published in The Lancet on Tuesday (7 December).  Autism affects 78 million people and families worldwide. The authors of the report call for global coordination between governments, health care providers, education, financial institutions, and social sectors to reform research, care, and treatment for autism that will include individualised treatments throughout a person’s life with active participation from patients and their families.

Plasma

With the ban on collecting UK-sourced plasma lifted in February 2021, the Uk is bracing to face up to another harsh challenge in the coming months: building an entire plasma supply chain from the scratch.

BUCHAREST

Omicron variant brings new restrictions in Romania. The first cases of Omicron infection were confirmed in Romania, prompting the government to adopt new measures for travellers. By  Bogdan Neagu |  EURACTIV.ro

PRAGUE

Czech caretaker and future government clash over mandatory vaccination. The future government said it will immediately cancel the current health ministry’s measures for mandatory COVID-19 vaccination from March 2022 for people over 60 and doctors, nurses and police officers as soon as it assumes power. It said it would do so immediately after it assumes power. By  Aneta Zachová |  EURACTIV.cz

BERLIN

Germany’s next chancellor backs mandatory vaccination for all from February or March. With Germany in the midst of the fourth pandemic wave, Olaf Scholz, who is set to take over as chancellor next week, has made a case for making the COVID-19 jab mandatory for everyone. By  Nikolaus J. Kurmayer |  EURACTIV.de

MADRID

Eight Spanish regions implement mandatory use of COVID-19 pass. In a last-minute effort to “save Christmas” amid rising COVID-19 cases, eight Spanish regions have made COVID digital certificates mandatory. EURACTIV’s partner EFE reported. By  Fernando Heller |  EuroEFE.EURACTIV.es

ROME

Minister: compulsory vaccination not necessary in Italy. It is unnecessary to make  COVID-19 vaccine mandatory in Italy, Public Administration Minister Renato Brunetta said on Sunday (5th December), adding that the current measures have led to increased vaccination rates. He added that the spread of the virus is being managed better than in some other European countries. By  Eleonora Vasques |  EURACTIV.com

​​Italian region of Veneto stops tests for the unvaccinated. Veneto has decided to suspend tests for unvaccinated people to privilege those with symptoms and vulnerable cases, the regional health authorities announced on Thursday (2nd December). By  Eleonora Vasques |  EURACTIV.it

ATHENS 

Greece to fine non-vaccinated over-60-year-olds €100 per month. People who do not schedule a vaccination appointment by 16 January will pay an administrative fine of €100 each month. The announcement has already resulted in an increase in appointments for the first dose among citizens over 60.By  Matthaios Tsimitakis |  EURACTIV.gr

VIENNA

Austria considers €7,200 fine for unvaccinated. Austrian residents who refuse to get their COVID-19 jab from February when they will be mandatory will face fines of up to €7,200, a draft of Austria’s COVID-19 vaccination law reveals. By  Oliver Noyan |  EURACTIV.de

BRATISLAVA

Slovakia incentivises elderly to get vaccinated. Unlike Austria and Greece, which decided to punish unvaccinated citizens with heavy fines, Slovakia seems to be exploring another way: incentivising people over-60-years-old with €500 if they get the COVID-19 jab. Meanwhile, EU sources explained to EURACTIV the logic behind Commission President’s surprising statement that it’s time to think about mandatory vaccination in the EU. By  Michal Hudec and Sarantis Michalopoulos |  EURACTIV.com and EURACTIV.sk 

SOFIA

Large-scale police operation unveils 250 fake Green passes in Bulgaria. In a major operation that resulted in the raid of two vaccination centres, the arrest of three doctors, and a dentist, the police found 250 people who had been issued a Green COVID-19 pass despite not being vaccinated. By  Krassen Nikolov |  EURACTIV.bg

7-8 December | Nutrition for Growth Summit

8 December | French President Emmanuel Macron holds a press conference on the forthcoming French EU presidency’s priorities

9 December | 8th ACT-Accelerator Facilitation Council meeting 

9 December | A new report from WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria, will be released

9 December | European Parliament’s special committee on Beating Cancer (BECA) votes on its final report

10 December | On the Human Rights Day and the last day of the 16 Days of Activism against Gender-Based Violence, WHO will launch a new report, documenting the extent to which countries’ policies are addressing violence against women and girls

12 December | Universal Health Coverage Day

13-16 December | European Parliament’s plenary session

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