Dear readers,

COVID has now reached a state of “endemicity” with the WHO declaring the end of the pandemic stage in May 2023. this does not mean that COVID-19 is gone and doesn’t need ongoing management- it does with selected boosters and treatments for those at high risk of severe disease. The US has approved new COVID-19 boosters directed against XBB1.5 – a subvariant of Omicron which is no longer dominant. However, good laboratory -based data show that the XBB1.5 will generate antibodies that work well against the currently circulating strains (e.g. EG.5).  Of note, BA.2.86 is not very prevalent but the XBB1.5 antibodies generated by the booster work well against this subvariant as well. Most countries, including the WHO Sage vaccination committee, recommend boosters for older people (those 65 and older) as well as those who are on immunosuppressants and those with multiple comorbidities. Lancet Infectious Diseases reviewed the book I wrote on the pandemic (“Endemic”) citing that HIV could help inform our responses to new pathogens.

In the meantime, as we enter the usual respiratory pathogen season, we have a new RSV vaccine for older people (those 60 and older) and for pregnant women between 32-36 weeks of pregnancy to protect the neonate, approved now for this fall.

We also have to pay attention to chronic endemic diseases that can vary by region, such as coccidioidomycosis or Valley Fever. We are approaching a very important time where there will likely be a vaccine available for cocci using novel technology.

Finally, I wrote a piece with Dr. Eric Goosby on the reauthorization of PEPFAR by Congress in JAMA this month.  PEPFAR is a bipartisan program started by President GW Bush in 2003 to provide life-saving treatment to people with HIV around the globe.  PEPFAR is responsible for saving at least 25 million lives in the first 20 years of its programming, with countless other benefits including helping the US maintain global health diplomacy.  We urge Congress to re-authorize PEPFAR this month as certain funding streams will continue through the State Department but Congress reauthorization will provide even more needed funding for this vital global health program.

Thank you,

Monica