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Gavin: Hello, welcome to Lancet Voice. It's April 2021, and I'm Gary Cleaver. And I'm
Jessamy: Jessamy Bagonal. Later on in today's episode, I'm speaking with Tina Sharazela about Gillian Barr Syndrome, or GBS, an absolutely fascinating condition. First, we wanted to take a look at how the last 12 months have affected some of the most vulnerable people in the world, refugee and migrant populations.
How have border closures, social distancing, and discrimination impacted them? Gavin spoke to Rita Issa of the Lancet Migration Global Collaboration team to find out about the wider issues at play.
Gavin: So I'm joined by Dr. Rita Issa, who's a clinical research fellow at Lancet Migration. Rita, thanks so much for joining us.
Why don't we kick off by talking a little bit about your work at Lancet Migration and also more broadly what Lancet Migration is.
Rita: Yeah, thanks for having me Gavin. So Lancet Migration Global Collaboration to Advance Migration Health. is a collaboration between the Lancet and researchers, implementers and others who are working in the field of migration and health.
And what it does is it aims to address evidence gaps and drive policy change. All of this is building on the recommendations of the UCL Lancet Commission on Migration and Health, which was published in the Lancet in December 2018.
Gavin: Yeah, I wanted to talk to you broadly today about the impact of the last year on refugees and migrating populations across the world, which is no doubt been seismic, but to get into a little bit more detail, for a start, obviously the world has been on hold in terms of international travel over the last year.
How has that impacted refugees and migrant populations?
Rita: Yeah, so exactly as you say, actually all of us have experienced restrictions to our movement in the past year and I guess it's helpful to remember that people move for a myriad of reasons. That ranges from those who migrate primarily for work opportunities to those who are forcibly displaced as a result of conflict, violence, environmental hazards, or economic and political instability.
And today across the world we have over 280 million people who are international migrants, about 26 million refugees, and as of 2020 there were more than 80 million who had been forced to leave their homes as a result of persecution, conflict, or generalized violence. And what we've been doing in Lancet Migration is performing a number of situational briefs this year.
These are case studies from countries and regions across the world, looking at how migrants and refugees have fared in the face of COVID 19. And actually, you can find these on our website, which is migrationandhealth. org. And what these situational briefs have shown us is that Many who need to move are faced with additional challenges as a result of COVID 19.
So these are travel restrictions, which include border closures, suspension of resettlement programs, and last minute deportation that have left many stranded or forced to stay in cramped or makeshift shelters or in detention centers. And within these uncertain and precarious conditions, Many migrants have described to us either a lack of access to healthcare services or a fear of seeking them out even if they're experiencing COVID 19 symptoms.
And I think that's incredibly important to remember. When we have a pandemic and we have a public health strategy that needs people to be coming forward and needs detection of cases and if we don't have that then I don't really understand how we're going to get on top of the pandemic. People who move, whether they're economic migrants or forcibly displaced need to be included in responses to the COVID 19 pandemic, and that's not only from a sort of humanitarian or human rights perspective, but also from a self interest perspective.
So COVID 19 outbreak control measures are only going to be successful if all populations are included in the response.
Gavin: It's been a year, hasn't it, where we've seen countries start to look inwards and focus on themselves and what they consider to be their citizens and their population rather than look more internationally.
This kind of focus on citizens of a country and their health, how badly does this affect migrant populations?
Rita: We're really seeing the impact already. For example, the UK government. is cutting its foreign aid budget by almost three billion pounds as a result of the COVID 19 pandemic. And of course that's going to have impact on migrant populations and actions which can be taken elsewhere to mitigate some of the push factors that we see for migration.
But more broadly Within countries, we're seeing migrants deprioritized and under resourced as a result of the pandemic. And I guess this falls broadly into four areas. So firstly, there's multiple barriers for people accessing health care. These include things like legal status, discrimination and xenophobia, and a lack of migrant and refugee inclusive health systems and health policies.
And these result. in poor health outcomes. We were seeing this already before the COVID 19 pandemic, but actually the last year has really brought these barriers into sharp focus and threatens large numbers of people with avoidable death. The second is that many migrants and refugees have poor access to prevention capacity for COVID 19.
So these are the things, social distancing, hand washing, and for many who are living in high density collective areas, so for example informal settlements, refugee camps, detention centres, they're unable to access things like safe water, sanitation and hygiene facilities. That means that we can really get to the, to the root in preventing the spread of COVID 19.
Thirdly, we've seen increased xenophobia and racism as a result of the pandemic. And in some places, arguably, you could say that this rhetoric has been intentionally politicized to scapegoat refugees and migrants. for the spread of COVID 19. And finally, this has been an incredibly precarious time for all of us, but especially for those who aren't able to access welfare support and compensation programs, for example, the UK furlough scheme.
That causes a lot of problems at a public health level. It may mean that some migrants and refugees have little choice but to continue working despite public health guidance and that potentially increases their exposure and transmission of COVID 19. And I guess while we're talking about work, it's also important to remember that in many countries, migrants make up a disproportionate amount of frontline workers, healthcare workers, and really sadly we've seen a disproportionate amount of the deaths as a result of COVID 19 as well.
And maybe actually just one final thing to say on that is there's a huge concern regarding vaccine nationalism and what that means for everybody being able to access the vaccine.
Gavin: Vaccine nationalism, as you mentioned there, it's obvious from looking at the distribution of vaccines across the world so far that the majority of vaccines are being used in high income nations.
And this is hugely affecting the prospect of low and middle income countries tackling COVID. Where does this leave refugee and migrant populations?
Rita: The WHO, along with other partners, the European Commission, the Bill and Melinda Gates Foundation, has set up the Access to COVID 19 Tools, or ACT.
accelerator. And as part of that, there's this vaccines global access program called COVAX, and that has aimed to create some sort of fair allocation mechanism for COVID 19 vaccines. And unfortunately though, what we're seeing is that most countries have basically remained silent on whether migrants are going to be able to access vaccines introduced.
there. What we've heard from certain countries is that migrants aren't going to be included. So Turkey, which hosts more than 3. 6 million registered Syrian refugees has announced that universal access to its vaccines are going to be restricted just to citizens. And similarly in Colombia, which has just under 2 million displaced Venezuelans has also said that COVID vaccines are only going to be available for Colombian nationals.
And of course, again, from the public health perspective, if we're not vaccinating our refugee and migrant populations, then we're not going to get to the point where we're free of this virus.
Gavin: You mentioned as well, of course, the kind of discrimination and xenophobia that migrant populations face. What more needs to be done post COVID to tackle the kind of surge in discrimination and xenophobia we've seen over the last 12 months?
Rita: So this is one of the key findings actually that we got from the UCL Lancet Commission on Migration and Health and really we need to be tackling racism and xenophobia with a zero tolerance approach and that leadership needs to come from the top. So public leaders, elected officials have a political, social and legal responsibility to oppose xenophobia and racism and Then we also need to see it within our healthcare systems as well.
So health professionals and organizations need to firstly inform their staff of what migrants and refugees are legally entitled to and then work to break down barriers to accessing healthcare because unless we're able to do that, unless we're able to take a joint up approach. then, as I've said before, we're really not going to be able to go on top of this
Gavin: virus.
I wanted to talk about a specific case as well, because our listeners might have seen in the last few weeks that Cox's Bazaar, which is the world's largest refugee camp in Bangladesh, suffered a major fire recently. And I'm interested in finding out what the future looks like for the Rohingya in Cox's Bazaar, because there doesn't seem to be an end to the crisis for them at the moment.
Rita: Yeah, it's such a challenging heartbreak. breaking situation and actually also seeing what's happening in neighbouring Myanmar at the moment as well. Just really trying to envisage what way through. Yeah, it's very tricky. I'm aware that as a result of the fire, through Cox's Bazar, about 40 ish thousand Rohingya refugees have been displaced again.
They've also lost their 24 hour health centre which served They have a 55, 000 people in the last year, which is obviously going to complicate how we are able to respond to COVID 19 there. And I think actually, bringing it back to COVID 19 in this situation, even before the fire, we have to remember that preventative measures like physical distancing like hand hygiene are incredibly difficult in crowded temporary settlements and places of detention.
I'm aware that the WHO had set up various early detection and surveillance systems in Cox's Bazaar and had also trained up people on the ground to work in contact tracing and to keep track of positive cases. But all of this is on a background and a backdrop of a huge population that's been displaced, that's already going to be suffering from a myriad of health problems.
And actually, I think what's interesting about what we've seen in Bangladesh, what we've seen with Rohingya, is that cases have been far lower than expected and transmission has been far lower than expected and one of the hypotheses put forward is that this is because of the sort of on average younger age of people who are in refugee camps such as Cox's Bazar.
Gavin: I also wanted to talk about, over the last 12 months, we've we've seen a huge amount of money thrown by governments at this problem. Generally, not always particularly well targeted, but undoubtedly a gigantic amount of money. Is there a chance that the kind of huge amounts of money thrown at health, thrown at healthcare, thrown at vaccines will at least provide some positive benefits to, to refugee and migrant populations?
Rita: I mean I think that's a noble hope but unfortunately I think what we've really seen through the pandemic is the amplification of existing social dynamics, racial inequality and that's not only been because of structural social and political determinants which are shaping who is going to be at higher risk of infection but also the fact that many migrant workers are frontline workers.
and they're the ones who've been disproportionately represented in COVID 19 mortality statistics. So I guess maybe the other thing to say on that is that while there has been more money pumped into healthcare, a lot of the focus has gone into COVID 19 and the focus has moved away from for example, routine surgery or chronic disease management.
And those are going to be ongoing health issues that are going to be affecting both sort of host and migrant populations. And I guess it's just a question to see how with time, we'll see what the overall impact is going to be on health more broadly. But I can't really say with, with any certainty that despite there being more money going towards, you know, being pumped into the pandemic that migrants and refugees are going to be seeing much of it.
Gavin: It's important to to make that point about the kind of lack of prospects and, cause I think it's easy to think, isn't that, that with all this money going towards vaccines and healthcare, that, it might show some advantage, but actually I think you're exactly right. That the kind of.
gaps in in treatment could actually be massively exacerbated by it. So we talked as well about the kind of proper allocation of vaccines worldwide, but I'm sure that there are a lot of additional barriers that need to be overcome to ensure equitable vaccination for refugees and for migrant people.
So what are some of those?
Rita: Yeah, so this is something that Plancet Migration and Our colleagues and partners from across the sort of migrant and health world have been calling for. I think as we're all increasingly aware, there's a social, a political, an environmental and an economic dimension to the COVID 19 pandemic.
And though the vaccine does offer us hope and the sort of light at the end of the tunnel, in order for us to be able to come through this pandemic. learn from it and minimise the risk of future pandemics and other major health crises. I think there has to be a much broader public health response. And what we've been calling for at Lancet Migration is a number of factors to facilitate this.
So firstly, access to healthcare needs to include migrants and refugees. And that needs to come about through a number of ways. So we're calling to immediately suspend the laws that limit access to healthcare and economic support programmes. And we also need to remove the barriers to people accessing care.
And quite importantly, that's the removal of data sharing between health services and immigration enforcement, which acts as a huge deterrent to people approaching healthcare services in the first place. Secondly, migrants need to be thought of and included in COVID planning and preparedness. Thank you.
And this includes the current practice that we're seeing of transferring migrants and refugees into overcrowded reception, transit and detention facilities. And really we think that migrants and refugees need to be able to live in safer living conditions. We're also calling for the suspension of deportations.
and forced return processes. While this is all going ahead, we think it's important that we continue having ongoing asylum procedures in accordance with the 1951 Refugee Convention. And third, last but not least, clear and transparent public communication is really important in pandemic response. And obviously this needs to include migrant populations.
There has been reported vaccine hesitancy within certain groups. And I think it's important that we work to tackle that. And part of the way that we do that is with linguistically and culturally appropriate information. And as I mentioned before, governments also need to be actively countering racism, xenophobia and discrimination, which is fueling prejudice and exclusion of migrant and refugee populations.
And I think it's just really important for all of us to remember that we are interlinked, our systems are interlinked, and my health is directly linked to your health, Gavin, or somebody's health across the world, and the pandemic has brought that into really sharp focus. And unless we take this joined up approach and realize that we're only as strong as our weakest link, Then we're not going to get to a point where we're able to move through this pandemic or any future pandemics that we're going to be up against.
So I think that there's a real opportunity here for us to rethink what it means to be caring, active citizens in a society, whether it's, for purely selfish reasons or whether it's for more communal reasons, it's, it's highly important that we take migrants and refugees into account in policies at all levels.
Gavin: Yeah, I couldn't agree more on the interlinking of health worldwide. It's been a really sobering lesson, hasn't it? Dr. Rita Issa, thank you so much for joining me today. It's been a real pleasure talking to you.
Rita: Great. Thanks for having me. Guillain
Jessamy: Barre syndrome is a rare disorder in which your body's immune system starts to attack your nerves and it can lead to paralysis. It's very rare and we don't really understand what causes it except that we know that, some patients have some history of infection, either gastric or respiratory infection in the six weeks preceding.
It's also been linked to Zika. And we don't really have any specific treatments for it other than supportive. And we know that it normally just resolves. So I've always been quite fascinated by this disease. It's something you learn at medical school. And we just know so little about it. So I was excited to talk to Tina Sherazela about her most recent seminar in the Lancet.
Thanks, Tina, for joining us. Do you think you could tell us a little bit about yourself and how you became interested in Guillain Barré syndrome?
Tina: All right. Hi, Jasmy. Thank you so much, again, for, inviting me to talk about this very interesting topic. I'm a neurologist, and I'm based at University of Malaya Medical Centre in Kuala Lumpur, Malaysia.
And I hold a dual position. I'm also a professor of neurology at the University of Malaya as well. So many neurological conditions leave patients with, significant and most of the time permanent disability as you probably know. And it's really quite disheartening, for patients and also for clinicians, because, we're always wanting to look up, to give them the best, to give them good news.
With Guillain Barré syndrome, It's very different. This is one disease where it is a monophasic condition. So in the majority of cases, with very rare exceptions, they do not get it again and they can get better and they can actually get better and go back to normal. So that is one of the things that really, as a neurologist, it's really nice to have a condition that you can look after that the patients actually get better.
And it's so important that you diagnose the condition to start with and make sure that, you institute whatever treatment as early as possible because you really want to get them early so that you optimize. There are chances of really making that complete recovery and that is really what attracted me to really focus, not just my clinical interest, but also research in GBS.
And then once you understand the pathophysiology, which is quite fascinating, and I'm sure we'll talk about it later, then it just makes it, all
Jessamy: very interesting. It is a fascinating disease. I've always found it very captivating. Might you be able to tell us a bit about the history of the disease?
Tina: So I think you can't get away from that landmark description, by Guillen, Berry and Stroll. We were just discussing about how we pronounce their names and I think we've got it right here. So basically this was back in 1916. So we're talking about more than a century ago. And these were, they were French Clinicians and they described two French soldiers with this ascending paralysis back in 1916 and reported these cases, these two cases.
And interestingly, in those two cases, there wasn't an antecedent illness, which is something that we see much more now. And that was perhaps What we recognize as the official first description of GBS, although if you went back through the history, it probably dates back as far back as 1859, and another French person, Landry, actually reported a case of acute ascending paralysis.
And if you read that report, you'll find that it's also a very similar presentation where the patients present with an acute ascending paralysis very quickly on. reaches a plateau, and he describes it as an asphyxia, which is respiratory involvement. And then the patient starts to get better even without any treatment.
That is really going back to, like a century ago. And then for a very long time, you'll have all of these different descriptions, similar people recognizing that this is a post infectious event. So it's not an infectious event. So it's actually an autoimmune condition here we're talking about.
And as time went by, it was. largely a demyelinating illness. So the myelin, the lining of the sheath that's being involved. And all of that changed in 1991. So about 30 years ago, when there was that summer epidemic in Northern China and that had patients presenting similarly with an ascending paralysis, but the difference here was that if you did the neurophysiology, the sensory potentials were not involved.
It was a very motor. And it was exonal neuropathy. And they had an antecedent illness, in this case it was a diarrheal illness and it was campylobacter jejuni. And that was when it became clear that this is not just a demyelinating polyneuropathy, it's actually a radiculopolyneuropathy. And you, and depending on where the target antigen is, where your autoimmune is attacking your, where your autoantibodies are being attacking, whether it's the myelin targets or whether it's the axonal targets, that then describes what type of GBS that you had.
So if you can
Jessamy: just take us through in plain language, what's the sort of classic presentation of patients? What do they come complaining of and how does the, that presentation progress?
Tina: The ones that tend to present to hospital typically would describe having perhaps a little bit of tingling sensation in the peripheries and fairly quickly they might then develop weakness.
And we talk, this is, I'm talking about the classical presentation. They may have weakness, for instance, they find it difficult to walk upstairs. And then over a period of between one to two days, that then rapidly ascends. And they then start having problems with the hands. And by the time they come to us, sometimes over a very short period, it might then evolve to, involve the respiratory muscles, also the vulva muscles.
So we do have quite a number of patients that do end up on ICU due to this fairly rapid ascending paralysis. So that's what patients may describe at the start. And this is where history is incredibly important, particularly when you have somebody presenting with an acute or subacute evolution of this weakness.
You want to go back. to ask, was there some sort of trigger because we now know that in a majority of cases there is a trigger and it's usually some kind of infective symptoms. It doesn't have to be a full blown infection. Sometimes we have patients that just say they have a bit of, a little bit of sore throat, a little bit of a cough, and that can be up to about four weeks even before they present to you.
So I think having that that history is really quite crucial and I think if you were in a general practice setting, I think it's really important to identify that and just make sure that these patients are really sent, sent to hospital because once they start evolving, it does evolve very quickly.
But we should say this is a rare condition that,
Jessamy: Listeners should not be thinking they're going to have a cold.
Tina: Oh no, yes, absolutely. It is a rare condition. That is, it all has to be taken into context. If you do develop the neurological symptoms then of course that's the sort of thing that you need to be thinking of if you have a neurological symptom that develops that, that quickly.
I'm describing here the classical, and I think I should just mention here, this is the classical presentation. And one of the things that I alluded to in the seminar that, that my authors and I discussing is that we now recognize that There are variants, there are different presentations of GBS, it's a big umbrella, and patients can present not with the ascending paralysis, they could present with variants where they might have abnormal eye movements, so they get double vision, they might have swallowing problems instead, And certainly that's what we're seeing in Asia, for instance.
We see a larger proportion compared to the Western countries of patients with a variant of GBS called Miller Fisher syndrome, for instance.
Jessamy: And how are they classically managed? These symptoms tend to Get better and patients make a full recovery. What's that process? What's that process
Tina: like?
We now know that Yes, you know it is self limiting in that patients do Progressively get worse and then they plateau and that plateau is typically reached Within two weeks in the majority of patients But it can be up to four weeks and officially we would say up to eight weeks because they can sometimes have fluctuations in the symptoms.
But the idea is that we now know that, if you left it untreated with immunotherapy, because this is an autoimmune condition. So we're talking about patients having an autoimmune response and their, their antibodies attacking the nerves. And what you don't want to happen is for it to then cause secondary axonal injury.
So the idea is to try and first diagnose the patients. and institute immunotherapy as soon as possible. And that is either with plasma exchange or with intravenous immunoglobulin, both of which are equally efficacious. And with very close monitoring, because patients can also get autonomic involvement, in which case they could get cardiac arrhythmia.
They can very quickly develop respiratory involvement if you are not keeping it an eye on that because, patients are paralyzed, so they're not exerting themselves so much. So that side of things may not be so evident. So where it's possible you do a spirometry, but sometimes because they can also get facial weakness, doing a spirometry may not give you a marker that is reliable, in which case you want to be looking for the impending type two respiratory failure, a rise in the CO2, suggesting that these patients have got a respiratory muscle weakness and going into impending failure.
So that's the supportive treatment on top of the immunotherapy. And then there are other things like, making sure that you've covered them for DBT prophylaxis, because with them being in bed the whole time, they're The chances of developing thromboembolic events obviously goes up.
Jessamy: Obviously post infectious, is there any link
Tina: with COVID 19 do we think?
Oh gosh, you've obviously not read all the hundreds of case reports. So COVID 19, yes of course even before COVID 19 we had Zika and there, there is actually a clear association with Zika virus, we know that. And one of the things that is clear with Zika that is now that we don't see in COVID 19 is that with Zika, there was a clear rise, there was a surge in GBS cases.
So it was, in case control studies have seen since already associated the two links between Zika and GBS, but with COVID 19, yes, we have seen reports of GBS, but to say there was a search. There really hasn't been a search in GBS cases. And since we wrote the seminar, there has actually been some studies that have given us some clarity in that there is at the moment.
No good evidence or robust evidence to suggest a causal link between the two, okay? But what was interesting is that, and this is actually from a UK study by the UK authors who found that the number of GBS cases was less During the pandemic and that probably has a lot to do To some extent with the fact that it was social distancings people wearing masks So they were not getting those other infections that we know are associated with gps you can pilot back to judge any some of those viruses so whatever you do find in terms of patients who do have gbs when they did compare patients who had covid19 with gbs with those who had gbs not associated with COVID 19.
The presentation was very similar. The only difference was maybe patients with the COVID 19 had a higher rate of intubation, but that could actually just be because of the COVID 19 rather than the actual GBS. So I would say that. There isn't a causal association here, there may well be in future.
I think this is something that we need to continue to monitor and certainly whenever there's any pandemic, the GBS community is on alert and there are measures in place for looking into this further and hopefully we'll know in the next. year or two.
Jessamy: Such a complex disease and fascinating.
What is it that we know and what don't we know? And what are you most excited about on the horizon for GBS?
Tina: Okay, so what do we know? I think, ironically, we know more about the Campylobacter jejuni GBS. I think a lot of what we know about GBS has actually arisen for that, even though that something that we, in the context of historical aspect of GBS, that's only something we know a lot of since 1991 really.
One of the things that we know in terms of pathophysiology is this concept of molecular mimicry. And that basically is the fact that we know that, patients who have GBS, there is definitely an epidemiology. association with campylobacter jejuni to start with and we now also know that patients have certain antibodies so these are antibodies against the glycolipids so these are like structures on the peripheral nerves and we know that patients the coating of the campylobacter jejuni the structural component that surrounds the campylobacter has got similarities to, your peripheral nerve glycolipids.
And as a result, you can just imagine, so in layperson's term, here you are mounting a defense to fight this, this bug. And, your body gets confused and starts attacking the nerve. To put it simply, of course, it's not that simple so that we have shown, there is robust evidence to support that.
And there's also animal models to also support that. And it is, it is largely believed that a lot of other infections that are associated with GBS probably is, has a similar sort of pathophysiology in terms of molecular mimicry. It's just that we have yet. to really show definitive evidence for this.
So that's, I think, very exciting because that really helps in terms of, how you want to develop treatment. So that's what we do know that I find really fascinating. So that's one of the things that really attracted me into GBS research and being involved in GBS. To try and discover whether the infections have got this similar pathology.
What we don't know that, that list is very long. Because, interestingly, like you said, yes, don't go to the GP with cough and cold and expect to be referred for, with GBS. Out of a thousand patients who've got campylobacter jejuni, maybe one might get GBS.
Why is it that 999 don't develop GBS, so there's obviously something that's inherent in the person that made them more susceptible. So that, that obviously is something that we are still, still trying to figure out. And also, we talked about, Zika and other viruses that have triggered GBS.
So we don't have a great understanding of what's truly going on there. And then we talked about, knowing. some of the targets for the GBS, which is targets on the axon. The inner part of the nerve but we still don't know what the targets are on the sheath, the myelin sheath as yet.
And of course, if you look at The map. I do love the maps in the Lancet publication. There are lots of areas, regions, especially other low middle income countries where we just don't know what's going on there. We don't know what the epidemiology is like there.
And that is You know, most of Africa, a lot of we don't know very much in the Middle East and a lot of areas in Asia as well. And, one of the reasons we know a lot about what's happening in Latin America is really because of Zika. And that's only been, in the last kind of five, five or six years.
So I think that is. A lot of things I think that we still don't know and something that we really need to improve on. And I am optimistic and I refer to the international collaboration. That in the paper, we did refer to the IGOR study, which is the International GBS Outcome Study. So that's one component.
They do still have the majority of patients arising from the high income countries, but it's a start, it's a start to try and include other countries and really it's that shared collaboration, shared minds and understanding what is going on elsewhere. I think That's how we move forward and move the needle in terms of, how we truly manage those patients.
There are about 20 percent of patients left with significant disability, 5 percent of patients even with treatment that are still, that still do die. So that should not really be happening in a neurological condition that technically should be completely treatable. Are
Jessamy: there other clear sort of translatable implications for other neurological conditions that a greater understanding of GBS might be able to shine a light on
Tina: almost?
Oh yeah, no, absolutely. And I think this is where the new, the more novel treatments have come through. So we are learning, actually we are learning a lot from the other autoimmune conditions. You've got now certainly there's been a recent trial of monoclonal antibodies that's shown some promise.
The eculizumab, for instance. So that's something that's been used in other autoimmune conditions. So I think whatever we learn from here, the basic principles of autoimmunity can certainly be applied across the board. And so it's not just, even though GBS in itself is quite rare, for sure. But I think, whatever we learn from here can certainly be applied across the board in terms of other autoimmune conditions.
Jessamy: That's great Tina. Thank you so much. Is there anything else that you want to touch on? I think that was great. I
Tina: think the only other thing I think your listeners would be very interested in is, of course, the vaccine. Vaccination. With it rolling out, right? So I think, I certainly have a lot of questions on this for my patients.
So back in, back in 1976, I think it was when we had the flu vaccine that came out in the U. S. And that was associated with an increased risk of GBS. So as a result, there's always been this, yeah, so for a very long time, ever since that happened, there was always concern that one might develop GBS following vaccination.
And whilst that might be the case way back when, we now know that's certainly not the case. With the newer H1N1, pandemic, the 2009 vaccination and certainly all the other vaccines that's come. That's come through. There's not been a significant risk in developing GBS. And I think that's really important to reiterate here.
And it's really important because with the vaccination rollout for COVID 19, there has not been, and there's been, millions around the world have rolled this out. And as far as I'm aware, there's not been any reported incidents of GBS. So I think that's really important to just highlight to everyone to not just leap.
Into 1976 because obviously the risk of develop, the morbidity and mortality associated with COVID 19 is far worse than any potential risk that one could get with vaccination. So I think that's something that we ought to just reiterate here.
Jessamy: All right. That's great. Thank you, Tina.
Great. Thank you very much.
Gavin: Okay, so we should probably speak of course, Jessamy, about the kind of purported link to COVID. And as you and Tina chatted about that, there's no established link. But it was really interesting to hear the Zika link, I thought, in comparison to the COVID stuff.
Jessamy: Yeah, it is interesting. It's just one of these diseases.
Because it does tend to incur with infections and it's a sort of very globally diverse problem. Some people who get it don't have the facilities. So I think there was a real concern when COVID, when the pandemic started, that this might be something that we would see. And so it's encouraging and a relief that there doesn't appear to be any link.
Gavin: Thanks so much for listening to this episode of The Lancet Voice. You can subscribe to us by searching The Lancet Voice on your usual podcast subscription platform, and we'll see you again very soon.