Artículos de revistas sobre el tema "Vaccins à ARN messager"

Le 2 octobre 2023, le prix Nobel de physiologie ou médecine a été décerné à Katalin Karikó et Drew Weissman, tous deux professeurs à l’université de Pennsylvanie, pour leur « découverte concernant les modifications des nucléosides qui ont permis le développement de vaccins ARN efficaces contre le COVID-19 ». Le communiqué du comité Nobel indique que « grâce à leurs découvertes exceptionnelles qui ont changé radicalement notre compréhension des mécanismes par lesquels l’ARN messager interagit avec notre système immunitaire, ces deux lauréats ont contribué au développement, avec une rapidité sans précédent, d’un vaccin contre l’une des plus grandes menaces des temps modernes affectant la santé humaine ».

Poussés par la pandémie, les gouvernements et l’anxiété planétaires, les deux premiers vaccins ARN messager contre la Covid-19 ont été développés dans un délai exceptionnellement court. L’information mondialement diffusée sur leur efficacité à 95 % est valide, mais simpliste, ambiguë et prête à des interprétations erronées. Selon les essais publiés, ces vaccins ont montré qu’ils réduisaient de 95 % un risque de base de Covid-19 symptomatique mesuré à environ 1 % dans le groupe placebo au cours d’un suivi médian de 30 à 64 jours après la seconde injection. Les effets indésirables ont été fréquents et précoces, mais majoritairement bénins, disparaissant en deux à trois jours. Les effets des vaccins ARNm sur la propagation du virus, les hospitalisations, les séjours en soins intensifs et les décès n’ont pas été évalués. Globalement, leur rapport efficacité/effets indésirables est favorable pour la population correspondant à celle qui a été incluse. Cet article didactique propose un regard objectif, détaillé, et plus analytique sur les bénéfices et les risques de chacun des deux vaccins. C’est une approche destinée à favoriser une décision partagée rationnelle prise en connaissance de cause, et tenant compte des préférences et valeurs d’une personne loyalement informée.

Depuis plus de deux siècles, les virus sont utilisés, avec un succès impressionnant, comme outils de prévention des infections virales. Depuis la variole et la rage, l’histoire de la vaccinologie a suivi les pas de l’histoire de la virologie. Après les découvertes empiriques des premiers vaccins, le développement du génie génétique, de la virologie moléculaire, de la génétique inverse, la manipulation des génomes viraux, leur séquençage à haut débit et leur synthèse chimique, la maîtrise de la culture cellulaire et des méthodes de purification, ont considérablement contribué au développement de nouveaux vaccins viraux. Des vaccins à ARN messager ou à vecteur viral ont ainsi vu le jour ces dernières années et, face à la pandémie de Covid-19, ont été développés et distribués à la population en un temps record. Les virus au service de la santé ont un bel avenir devant eux, que cela soit pour prévenir d’autres pandémies, pour traiter le cancer, ou contrôler, enfin, le VIH ou le Plasmodium, l’agent du paludisme.

Introduction. La pandémie de Covid-19 a émergé en décembre 2019 et, moins d’un an plus tard, de nouveaux vaccins à ARN messager ont été mis sur le marché. La France, connue pour une prévalence importante de l’hésitation vaccinale, a lancé sa campagne de vaccination en janvier 2021, avec priorisation des populations éligibles par âge et comorbidités. Objectifs. Les objectifs principaux de cette étude étaient d’évaluer la perception par les premiers patients vaccinés des débuts de la campagne vaccinale et d’évaluer les motivations à se faire vacciner. Les objectifs secondaires étaient de décrire le profil des premiers patients vaccinés et leur parcours d’accès à la vaccination. Méthode. Étude transversale descriptive menée dans sept centres de vaccinations d’Île-de-France lors de trente et une journées sélectionnées aléatoirement entre le 2 février et le 31 mars 2021, à l’aide d’un questionnaire papier remis par un investigateur et complété par les patients pendant la période de surveillance post-vaccinale. Résultats. Au total, 2 009 personnes ont été incluses (taux de participation : 97,9 %). La population était composée de 1 193 femmes (60,3 %), l’âge médian était de 79 ans (intervalle interquartile : 75-84), 1 229 participants (61,2 %) avaient un niveau d’études baccalauréat ou supérieur. Un total de 1 290 participants (64,2 %) se sont déclarés être « (très) satisfaits » de la campagne de vaccination à l’échelle nationale. Concernant le parcours de soin, 1 144 (56,9 %) avaient pris rendez-vous sans l’aide d’un tiers, dont 684 (34 %) via une plateforme de rendez-vous internet. Entre 41 et 74 % des personnes vaccinées (selon les centres) n’habitaient pas à proximité du centre dans lequel elles se sont fait vacciner. Conclusion. Cette étude sur cette période de vaccination de masse a permis de produire des données utiles pour améliorer de futures campagnes vaccinales. Elle a mis en lumière une satisfaction quant à l’organisation locale, contrairement à une organisation nationale plus souvent critiquée.

Les vaccins vétérinaires représentent en France un quart du marché du médicament vétérinaire. Le taux de pénétration de la vaccination en médecine vétérinaire en France dépend des espèces : très élevé chez les volailles et porcins, élevé chez les chevaux et les chiens, encore modéré ou irrégulier chez les bovins, faible chez le chat et les petits ruminants. Les cibles des vaccins vétérinaires sont essentiellement les virus et bactéries, mais aussi les parasites et les champignons. Les voies d’administration sont très variées, particulièrement chez les volailles. Parmi les technologies vaccinales utilisées en médecine vétérinaire, on peut distinguer les vaccins conventionnels (vivants atténués, inactivés, à base de toxines ou «toxoids ») et les vaccins de nouvelle génération (recombinants, vecteurs, à ADN et à ARN), ainsi que les autovaccins. Un objectif de la vaccination des animaux est de limiter les administrations, sources de stress, à travers des vaccins multivalents à administration unique et longue durée d’immunité. Motivations et freins de la démarche vaccinale varient selon les espèces, notamment entre animaux de rente et de compagnie.

Nombre de maladies ont pour origine une absence d’expression ou une expression défectueuse d’une protéine donnée. Pour certaines d’entre elles, la protéine faisant défaut est circulante et peut être captée par les cellules lorsqu’elle est délivrée de façon exogène. Dans ce cas, les thérapies ont d’abord consisté en l’administration de la protéine thérapeutique extraite de tissus humains. Par la suite, le génie génétique a permis la production des protéines par fermentation de cellules après y avoir introduit le gène correspondant. Pour beaucoup d’autres maladies, la protéine faisant défaut ne peut être délivrée de façon exogène. Une production endogène de la protéine thérapeutique, par les cellules elles-mêmes est donc nécessaire. La technologie de l’ARN messager (ARNm), comme celle la précédant de l’ADN, se propose de supplémenter, au cœur des cellules, l’information génétique nécessaire pour produire elles-mêmes la protéine thérapeutique. Cependant, contrairement aux thérapies utilisant l’ADN, le transfert d’ARNm permet une expression transitoire de la protéine d’intérêt ce qui constitue un avantage dans nombre de maladies. La maîtrise de la quantité, de la qualité et de la régulation spatio-temporelle de la production d’une protéine codée par l’ARNm thérapeutique représente, néanmoins, un défi important pour le développement de cette approche.

Un couple consulte son médecin généraliste. L’entrée en matière est directe : « Docteur, mon épouse ne veut pas se faire vacciner… Moi, je vais me faire vacciner, surtout pour elle, elle est à risque. Dites-lui, docteur… » Cette patiente de 79 ans est traitée par une trithérapie pour une hypertension. Elle a changé ses habitudes de vie depuis plusieurs années afin d’équilibrer son diabète. « Dites-lui, docteur, qu’ils vont l’intuber si elle l’attrape… » Il a douze ans de moins qu’elle et n’a qu’une monothérapie, pour son hypertension… Après avoir rappelé les facteurs associés à la gravité de la COVID-19, le médecin demande à la patiente ce qui la fait hésiter. La patiente répond de manière laconique : « rien en particulier, mais les vaccins… ». Une reformulation simple en écho obtient : « ils ont été développés rapidement… ». Le médecin rappelle brièvement pourquoi et comment la production de ces vaccins a été accélérée1. Le mari demande alors au médecin : « vous les faites, les vaccins ? ». Le médecin explique qu’il disposait jusqu’à présent de dix doses du vaccin ChAdOx1 par semaine. Il explique que d’autres vaccins sont et seront disponibles dans les jours et semaines à venir. Il explique aussi que les pharmaciens vont pouvoir désormais vacciner. Il demande aussi à ce couple ce qu’ils savent de ce vaccin. Le mari explique que ce vaccin est « moins bon » que celui à ARN, et son épouse ose : « il y a beaucoup d’effets indésirables ». Le médecin présente alors la balance bénéfice/risque de ce vaccin de manière complète, en laissant la porte ouverte aux questions2. Il rappelle que, même si la comparaison est tentante, en l’absence de comparaison directe, il n’est pas possible d’affirmer qu’un vaccin est supérieur à l’autre2. La question des variants surgit alors, et cette fois elle est posée par le couple. Le mari : « de toute façon, avec les variants… » ; l’épouse : « les vaccins marchent encore moins ». Le médecin explique alors que pour le moment le variant d’intérêt majoritaire en France est le variant dit anglais. Il explique que des signaux écossais issus d’une étude de cohorte prospective en temps réel portant sur 5,4 millions de personnes laissent à penser que les vaccins sont efficaces sur ce variant3. Lors des consultations conjointes, le médecin généraliste réalise trois consultations : celles de chacun des deux protagonistes et celle du couple. L’approche phénoménologique de Camia et Bénédini permet de comprendre la dynamique des couples4. Ces auteurs nous expliquent que le « je » devient « nous ». La retraite agit comme une rupture d’un habitus social, et cette reconstruction autour de la maladie chronique explique la crainte de la mort de l’autre. L’hésitation vaccinale demande des compétences communicationnelles mais aussi de disposer de données autour de la vaccination. Par exemple, savoir que l’analyse globale de la tolérance du ChAdOx1 est rendue difficile par la multiplicité des placebos (vaccin antiméningococcique, soluté physiologique, ou succession des deux). L’article de Pouchain et al. exprime les résultats en termes de nombre de sujets à vacciner afin d’éviter les présentations réductrices (95 % pour le Cominarty et 60 % pour le ChAdOx1) et une comparaison scientifiquement incorrecte2. La revue exercer permet de comprendre et de répondre aux questions des patients. La rédaction d’exercer remercie tous les auteurs et relecteurs qui nous ont permis de répondre aux questions générées par la COVID-19 depuis une année. Parmi ces auteurs, la rédaction remercie affectueusement Denis Pouchain, ancien rédacteur en chef de la revue.

La poliomyélite est une maladie neurologique qui peut être mortelle, mais qui aboutit dans la majorité des cas à des paralysies et des séquelles permanentes, particulièrement handicapantes et affectant les membres des patients. Cette maladie endémique, connue depuis l’Antiquité, s’est avérée à l’origine de graves épidémies dans les pays développés pendant la première moitié du XX e siècle, jusqu’au développement d’un vaccin inactivé injectable, puis d’un vaccin vivant oral. L’agent pathogène, le poliovirus, est un virus entérique à ARN (genre Enterovirus ) qui comprend trois sérotypes. La surveillance et le contrôle de la maladie se révèlent complexes, en raison de la capacité remarquable du virus à diffuser dans les populations par transmission essentiellement féco-orale, et par le fait qu’un faible pourcentage de personnes infectées développe la maladie. Cependant, un programme mondial visant à éradiquer la maladie grâce à la vaccination a été mis en place en 1988. Ainsi, deux des trois sérotypes de souches endémiques de poliovirus ont disparu et le sérotype restant ne persiste principalement que dans deux pays, le Pakistan et l’Afghanistan. Cette revue présente et discute les principaux aspects, notamment historique, de la maladie, du virus et des vaccins, et fait un état des lieux du programme et des derniers défis pour contrôler/éradiquer la maladie.

Parallèlement à son rôle dans le métabolisme énergétique, l’activité mitochondriale intervient également dans l’induction de l’apoptose, ainsi que dans la régulation de la prolifération et de la différenciation cellulaires. Il existe en particulier une véritable régulation de la différenciation des myoblastes par l’activité mitochondriale, indépendante de la production d’ATP. Elle implique notamment le contrôle de l’expression de myogénine et de l’activité des facteurs myogéniques. Dans cette étude, nous démontrons que l’expression du proto-oncogène c-Myc est respectivement stimulée ou diminuée par une inhibition ou une stimulation de l’activité mitochondriale. Cette régulation s’effectue en grande partie au niveau de la stabilité du messager, et au niveau de la localisation cellulaire de la protéine dans les myoblastes aviaires. De plus, la surexpression de c-Myc reproduit très exactement les effets d’une inhibition de l’activité mitochondriale : i) abrogation de la différenciation terminale ; ii) inhibition de l’expression de Myogénine, sans altération de celle de MyoD ; iii) blocage de l’aptitude des facteurs myogéniques à induire la différenciation ; iv) inhibition de la sortie des myoblastes du cycle cellulaire. Ces résultats démontrent que c-Myc est une cible importante de l’activité mitochondriale, impliquée dans l’influence de l’organite sur la différenciation des myoblastes. Nous avons également mis en évidence l’existence d’un autre gène cible de l’organite qui code la phosphatase calcium dépendante Calcineurine. Son expression est respectivement inhibée ou stimulée par l’inhibition ou la stimulation de l’activité mitochondriale. De plus, l’expression d’une forme constitutivement active de Calcineurine stimule la différenciation des myoblastes et l’expression de Myogénine, alors que ces deux événements sont bloqués par l’expression d’un ARN antisens Calcineurine. Enfin, la stimulation de l’activité mitochondriale, comme l’expression d’une forme constitutivement active de Calcineurine stimule spécifiquement l’expression de l’isoforme lente des chaînes lourdes de myosine. Ces données démontrent donc que, notamment via l’expression de Calcineurine, l’activité mitochondriale régule non seulement la différenciation des myoblastes, mais détermine également le type contractile des fibres musculaires

Le 28 février dernier se tenait la Journée internationale des maladies rares. Alors que 6 à 8% de la population belge serait atteinte d’une maladie rare, on estime que 94% de ces maladies rares n’ont pas de traitement. Pour la petite proportion de maladies rares pour lesquelles un traitement est disponible, le processus allant de la découverte d’une molécule à sa commercialisation prend en moyenne 10 ans. Devant de tels longs délais, le développement des vaccins contre la Covid-19 en une petite dizaine de mois est une prouesse, et pousse à s’interroger sur les raisons de cette rapidité sans précédent. La recherche médicale, pour un traitement, se décompose typiquement en trois grandes étapes : la «recherche pré-clinique» en laboratoire, la «recherche clinique» où le traitement est expérimenté sur des êtres humains et l’autorisation et mise sur le marché du traitement. Dans le cas de vaccins, la recherche peut avoir trois objectifs : (1) une amélioration de vaccins existants – meilleure efficacité, moins d’effets secondaires, conditions de conservation ou d’administration plus simples, etc.; (2) une actualisation des vaccins existants – comme c’est le cas des vaccins contre la grippe, qui sont différents chaque année en fonction des souches en circulation; (3) le développement d’un nouveau vaccin. La recherche médicale est un processus long, coûteux et incertain. La durée des différentes étapes dépend de nombreux facteurs, dont les principaux sont la difficulté de la question de recherche, les connaissances déjà acquises et également les aspects administratifs, logistiques, et financiers. La recherche dans le contexte des vaccins anti-Covid a suivi globalement la même démarche que les autres vaccins. Elle s’est cependant distinguée par le fait qu’il a été possible de gagner du temps à plusieurs niveaux dans ce processus. Tout d’abord, le vaccin anti-Covid a bénéficié de recherches qui étaient déjà dynamiques et avancées sur les vaccins à ARN messager et à vecteur adénovirus notamment pour d’autres virus tels que Ebola ou Zika. Ensuite, le recrutement de personnes pour les essais cliniques a pu se faire en quelques semaines puisqu’il s’agissait de recruter des personnes saines et qu’un suivi de quelques mois à un an était suffisant pour établir le rapport risque-bénéfice du vaccin. Enfin, l’urgence mondiale de la situation a poussé les instances réglementaires à réduire au maximum les délais induits par les procédures administratives et logistiques. De plus, une autre particularité du développement du vaccin anti-Covid a eu trait aux aspects financiers. Des scientifiques dans les domaines publics et privés ont collaboré et leur recherche s’est appuyée sur un investissement financier important des phases de recherche et de développement par les contributeurs habituels mais aussi des contributeurs privés et philanthropiques. De plus, l’achat en avance de doses de vaccins par plusieurs Etats a permis de partager le risque financier dans le processus de financement du vaccin. De cette situation sans précédent, nous tirons plusieurs enseignements. Premièrement, cette prouesse montre que la recherche médicale pourrait être menée plus rapidement. La question du financement semble clef dans ce contexte, mais d’autres aspects comme encourager plus de collaborations entre les différents acteurs privés et/ou publics et dégager un nouveau modèle de recherche pourraient permettre de raccourcir la recherche pré-clinique et clinique. Néanmoins, le temps de développement de traitements concernant des pathologies avec un mécanisme d’action complexe et encore peu connues, nécessitant un recrutement de patients plus complexes, et un suivi à long terme comme c’est souvent le cas d’une maladie rare, aura moins de chances de pouvoir être raccourci. En second lieu, on se doit de constater que la rapidité du développement de vaccins anti-Covid-19 a accru la méfiance ou peur de la population vis-à-vis de la vaccination. La crise sanitaire a donc révélé qu’une plus grande «culture médicale» pourrait être nécessaire au sein de la population afin d’amenuiser les possibles incompréhensions, mauvaises interprétations et finalement, frustrations que cela a engendré. Enfin, il est à craindre que cette prouesse médicale a été obtenue au prix d’une priorisation des ressources, tant humaines que logistiques et financières au profit de projets de vaccins anti-Covid-19. Ainsi, le recrutement et la participation des patients dans des essais cliniques autres que ceux dédiés à la Covid-19 durant ces deux dernières années ont vraisemblablement été ralentis voire arrêtés. Les conséquences négatives sur les autres patients que les patients Covid-19 sont difficilement quantifiables mais certainement non négligeables.

Les vaccins vétérinaires représentent en France un quart du marché du médicament vétérinaire. Le taux de pénétration de la vaccination en médecine vétérinaire en France dépend des espèces : très élevé chez les volailles et porcins, élevé chez les chevaux et les chiens, encore modéré ou irrégulier chez les bovins, faible chez le chat et les petits ruminants. Les cibles des vaccins vétérinaires sont essentiellement les virus et bactéries, mais aussi les parasites et les champignons. Les voies d’administration sont très variées, particulièrement chez les volailles. Parmi les technologies vaccinales utilisées en médecine vétérinaire, on peut distinguer les vaccins conventionnels (vivants atténués, inactivés, à base de toxines ou « toxoids ») et les vaccins de nouvelle génération (recombinants, vecteurs, à ADN et à ARN), ainsi que les autovaccins. Un objectif de la vaccination des animaux est de limiter les administrations, sources de stress, à travers des vaccins multivalents à administration unique et longue durée d’immunité. Motivations et freins de la démarche vaccinale varie selon les espèces, notamment entre animaux de rente et de compagnie. Mots-clés : vaccins, vétérinaire, prévalence, cibles, technologies, voies d’administration, protocoles vaccinaux, pharmacovigilance, motivations, freins.

Abstract Background In the United States, human papillomavirus (HPV) vaccination rates remain low. The President’s Cancer Panel suggests that effective messaging about the HPV vaccination focus on the vaccine’s safety, efficacy, ability to prevent cancer, and recommendation at ages 11- to 12-years. We aimed to develop messages about HPV vaccine that include the President Cancer Panel’s suggestions and were acceptable to caregivers of adolescents. Methods From August to October 2020, we conducted one-hour, Zoom videoconference focus groups with caregivers who lived in Florida, had an 11- to 12-year-old child, and had not had any of their children receive the HPV vaccine. Focus group moderators asked caregivers to react to three videos of clinician (i.e., MD, DO, APRN, PA) recommendations and three text message reminders. Thematic analysis was conducted using the constant comparative method and led by one author with qualitative analysis expertise. Two additional authors validated findings. Results Caregivers (n = 25 in six groups) were primarily non-Hispanic white (84%) and educated (64% had at least an Associate’s degree). Approximately a third of caregivers had delayed (44%) or decided against a vaccine for their child (36%). Caregivers described six preferred message approaches: recognize caregivers’ autonomy, balanced benefits and risks, trustworthy sources, increased feasibility of appointment scheduling, information prior to decision point, and preferred personalized information. Caregivers expressed a desire to have the follow-up doses mentioned in the introduction. Conclusions HPV vaccine messages, whether delivered by a clinician or via text message, will be more acceptable to caregivers if they approach HPV vaccination as the caregivers’ decision, and include information from trusted sources to help caregivers make an informed choice.

Abstract Objective There is no European Union (EU) health system but there is an EU health policy and this health policy is rapidly changing due to the COVID-19 responses of the EU and Member States. The aim of this panel discussion is to analyze and put into context the rapid evolvement of EU health policy during the pandemic. This panel discussion will therefore focus on 1) EU public health policy 2) EU action for health 3) the EU Market shaping health 4) the fiscal governance 5) the institutions, processes and powers. Background EU health policy has often been overlooked and was never on the political agenda. COVID-19 and the pandemic response, however, changed this dramatically. EU-health policy has become centre stage followed by bold investments and new regulatory initiatives. Obvious examples are the EU4Heatlth programme, the Recovery and Resilience fund, the new agency HERA, the new remit for the European Medicines Agency and the European Center for Disease Control. There are also new European Commission mechanisms with regards to the purchase of personal protective equipment, supplies, medicines including vaccines and medical technologies. But will the new EU health policy strengthen health systems of Member States or just focus on stronger emergency responses? Will the constitutional asymmetry between health and internal market be addressed? Will EU-health policy remain after the crisis a centre-piece of European Integration? This panel is based on the COVID-19 update of the EU-health policy handbook ‘Everything you always wanted to know about European Union health policies but were afraid to ask' Interactivity There will be a high level of interactivity. After an introductory presentation, attendees can use the chat-box to choose specific topics from the aforementioned five themes. These topics will be presented in a table. The chair will then pass the questions and topics to the panelists. Speakers/Panelists Sarah Rozenblum University of Michigan, Ann Arbor, USA Holly Jarman University of Michigan, Ann Arbor, USA Nick Fahy University of Oxford, Oxford, UK Anniek de Ruijter University of Amsterdam, Amsterdam, Netherlands Eleanore Brooks University of Edinburgh, Edinburgh, UK Key messages The European Health Union will be one of the most important constitutional and policy outcomes of the pandemic. It is essential that the European Health Union is not only strengthening emergency planning and response but also accessibility, equity and resilience of health systems.

Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. 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