Category: The Conversation

Source: The Conversation – UK – By Philip Broadbent, Wellcome Multimorbidity PhD Fellow & Public Health Registrar, University of Glasgow

Two young people are dead and 20 are receiving treatment after a meningitis outbreak at the University of Kent. The students caught up in it belong to a generation that has never been routinely vaccinated against the strain responsible.

That is not because a vaccine doesn’t exist. It does. Bexsero, which protects against meningococcal group B disease (the strain responsible for the Kent outbreak) has been available since 2013. The UK even became the first country in the world to add it to its national immunisation schedule, in September 2015.

But only for babies.

Every student at university today was born before July 2015, meaning every one of them missed the cut-off. The NHS never offered them the jab and no catch-up programme was ever provided. A decade of students has passed through higher education with no routine protection against the most common form of bacterial meningitis.

The decision not to extend the programme beyond infants reflects a genuine tension at the heart of vaccine policy. The government’s advisory body, the joint committee on vaccination and immunisation (JCVI) concluded that the benefit, real as it was, did not clear the economic threshold required to justify the cost.

With many vaccines, the benefit extends beyond the person vaccinated. Vaccinate enough people and the disease runs out of hosts, protecting even those who never received the jab – this is known as herd immunity. Bexsero does not work that way. It protects the person who receives it, but it does not reduce the amount of bacteria people carry in their throats and pass on to others.

Vaccinating a baby stops that baby getting ill; it does nothing to stop the bacteria circulating in the wider population. With no such ripple effect to factor in, the JCVI judged the benefit too narrow to justify extending the programme.

What that calculation did not fully account for was the particular danger of university life.

Meningococcal bacteria spread through close contact: kissing, sharing drinks, coughing in crowded spaces. Universities, with their halls of residence, freshers’ weeks and nightclubs, are among the most efficient environments imaginable for transmission.

A study tracking students during their first week at a UK university found that the proportion carrying the bacteria in their throats jumped from less than 7% on day one to over 23% by day four. By December of that year, in catered halls, the figure had reached 34%.

In the US, research found that first-year undergraduate students face a risk of meningococcal B disease almost 12 times higher than their non-student peers of the same age. Living in halls of residence amplified that risk further still.

None of this is new. The link between university life and meningococcal risk has been established for decades. The question that the tragic events in Kent force policymakers to consider is whether that increased risk was adequately factored into the original decision.

Parents who wanted to protect their children privately could. Many of them did. A full course of Bexsero requires two doses for anyone over the age of 11. At most UK pharmacies, each dose costs around £110, making the full course £220 or more. Some private clinics charge considerably more.

As one public health expert at the London School of Hygiene and Tropical Medicine put it, the availability of private vaccination creates a situation where access depends on ability to pay. That inequality is now playing out in real time.

Following the Kent outbreak, bookings for private meningitis B vaccinations at Superdrug surged to 65 times their normal level. The families rushing to book appointments are inevitably those who can afford to. Those who cannot are left hoping the outbreak does not reach their child.

Long-term costs

Vaccine policy is genuinely difficult. Every decision involves trade-offs and the resources available to public health are not unlimited. But the economic case for keeping the programme infant-only has grown shakier since 2015.

A re-analysis published in the journal Value in Health in 2021 found that when a fuller picture of the disease’s burden is included (for example, long-term care, loss of earnings, the ripple effects on families) the cost per year of healthy life gained falls below the NHS’s standard threshold for approving treatments. The short-term saving from not vaccinating teenagers may be generating long-term costs the original calculation never captured.

There is also the cost of the outbreak itself. More than 30,000 people in the Canterbury area have been contacted by health authorities. Thousands of doses of antibiotics were distributed. A targeted vaccination campaign has been launched for students in halls of residence. Emergency responses to outbreaks are not without cost, and they cannot undo the harm already done.

Health Secretary Wes Streeting told parliament this week that he would ask the JCVI to reexamine eligibility for meningitis vaccines in light of the outbreak. That review is welcome, and overdue.

The first cohort of babies vaccinated in 2015 will not reach university age until 2033. Until then, the students arriving at freshers’ week each autumn will do so without routine protection. Unless policy changes.

Philip Broadbent receives funding from the Wellcome Trust Multimorbidity Doctoral Training Programme 223499/Z/21/Z

– ref. Kent’s meningitis outbreak was years in the making – here’s why – https://theconversation.com/kents-meningitis-outbreak-was-years-in-the-making-heres-why-278003

Source: The Conversation – UK – By Barbara Pierscionek, Professor and Deputy Dean, Research and Innovation, Anglia Ruskin University

The phrase “eye stroke” has recently appeared in news reports about a very rare side-effect of weight-loss injections. It’s not a formal medical diagnosis, but a shorthand used to describe a condition in which reduced blood flow damages the optic nerve and causes sudden vision loss.

The phrase might be misleading. Unlike a conventional stroke – which can cause someone to lose the ability to move their limbs or speak – an eye stroke can be harder to recognise at first. Vision can be lost entirely or partially, in one or both eyes, with no numbness or paralysis.

The word “stroke” is used because, as with the more familiar condition, the underlying cause is a loss of blood supply that leads to cell death and tissue damage. The correct medical term for an eye stroke is non-arteritic anterior ischaemic optic neuropathy (Naion).

The recent connection between Naion and weight-loss treatments has made headlines following a large study examining semaglutide, the active ingredient in several popular weight-loss drugs.

Researchers analyse more than 30 million side-effects reported to the US Food and Drug Administration and found that 31,774 involved semaglutide. One drug in particular stood out: Wegovy was found to have a far stronger association with Naion than other semaglutide-based treatments.

The study suggested the risk of eye stroke from Wegovy was almost five times greater than from Ozempic, despite Wegovy being linked to fewer overall reported side-effects.

Understanding why semaglutide might reduce blood flow to the eye requires a little background. Semaglutide is a synthetic version of a naturally occurring hormone called GLP-1, which helps regulate blood sugar. It does this by stimulating insulin production, reducing the release of a sugar-raising hormone called glucagon, and slowing digestion.

Semaglutide has been used to treat type 2 diabetes, heart disease and obesity. Wegovy is administered by injection at a higher maximum dose than Ozempic, another injectable medication. Injected drugs enter the bloodstream faster and in greater concentrations than tablets – and notably, no link was found between Naion and Rybelsus, the tablet form of semaglutide.

The speed at which Wegovy causes weight loss – faster than other treatments – may itself be part of the explanation. The human body is a finely balanced system in which no single organ or process works in isolation. The autonomic nervous system, which controls involuntary functions like heart rate and digestion, relies on a careful balance of hormones to keep things in check. When an external drug significantly alters how those hormones behave, it can affect the rest of the body in unexpected ways.

The relatively high doses used with Wegovy may cause blood pressure to fluctuate beyond normal ranges. A notable drop in blood pressure reduces the rate at which blood flows through the body, and the eye is particularly vulnerable to this. The retina is served by some of the tiniest blood vessels anywhere in the body, and it depends on those small vessels for its oxygen supply. Any significant change in blood pressure can seriously disrupt this delicate circulation.

Men face a much higher risk than women

This does not, however, fully explain why a drug that is broadly beneficial for heart health and blood sugar control might have such a specific harmful effect on eyesight. Nor does it explain another surprising finding from the study: men taking these weight-loss treatments appeared to face three times the risk of vision loss compared to women.

The study did not provide enough detail about the differences between male and female participants. For instance, whether more severely obese men than women were included. In addition, large-scale data of this kind does not always capture the finer details needed to fully understand cause and effect.

It is important to keep all this in perspective: while a link between semaglutide and vision loss has been identified, this side-effect remains rare.

More research is needed to establish safe dosage levels and to understand whether certain factors – such as sex, age, weight, or existing health conditions – make some people more vulnerable than others. Semaglutide is being prescribed for a growing range of conditions and increasingly to younger patients. To ensure that these treatments do not lead to life-changing sight loss, properly designed clinical trials that assess the level of risk are essential.

A spokesperson for Novo Nordisk told the Guardian: “Patient safety is our top priority, and we take any reports about adverse events from the use of our medicines very seriously. We work closely with authorities and regulatory bodies from around the world to continuously monitor the safety profile of our products.”

The EU patient leaflets for Wegovy, Ozempic and Rybelsus had been updated to include Naion, they added, but “based on the totality of evidence, we concluded that the data did not suggest a reasonable possibility of a causal relationship between semaglutide and Naion and Novo Nordisk believes that the benefit-risk profile of semaglutide remains favourable”.

Barbara Pierscionek does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. What is ‘eye stroke’ and why has it been linked to weight loss injections? – https://theconversation.com/what-is-eye-stroke-and-why-has-it-been-linked-to-weight-loss-injections-278167

Source: The Conversation – UK – By John Strawson, Emeritus Professor of Law, University of East London

Donald Trump told reporters on board Air Force One on March 15 that his relationship with the Israeli prime minister, Benjamin Netanyahu, is “extraordinary”. Netanyahu has been rather less effusive, saying in recent days that their relationship is one of “dialogue, shared concepts, consultation and joint work”.

These comments come as reports are circulating of rifts between the two leaders over the war in Iran, which Trump has rejected as “fake news”. The reported tensions underline not only Trump and Netanyahu’s very different war aims but also the character differences that have shaped their relationship.

Writing in the Sunday Times on March 15, the UK’s former ambassador to Israel, Matthew Gould, pointed out that both men are similar in “some respects”. Like Trump, Netanyahu is a “populist making his country more divided with crude fearmongering; a huge character who sucks oxygen from the entire political scene.”

However, there are some key differences. While Trump had five deferments to avoid serving in the Vietnam war, for example, Netanyahu distinguished himself in the Israeli armed forces. This included serving five years in the elite Sayeret Matkal unit from 1967 to 1972.

Such different backgrounds count especially as Trump and Netanyahu work together in the military confrontation with Iran. Trump has often been cavalier and brags about US military strength, whereas Netanyahu is far more measured. Trump is also regularly talking to journalists, while Netanyahu has been sparing in his interactions with the media.

At the same time, the war with Iran has a very different meaning for Israel and the US. Netanyahu has made the Iranian threat to Israel the most consistent theme of his political career. Since 2019, when it became clear that Iran was enriching uranium over the 3.5% to 5% level needed for peaceful purposes (it now has over 440 tonnes of uranium enriched to over 60%), Netanyahu has seen the threat to Israel as existential.

Trump’s grounds for launching the war have shifted, from wanting to destroy Iran’s military capabilities to toppling the regime in Tehran. But Netanyahu has consistently remained focused on removing what he sees as the threefold threat from Iran: its nuclear weapons programme, ballistic missile capacity and ability to support regional proxy groups like Hamas, Hezbollah and the Houthis.

Trump knows the war is unpopular at home and among his allies and is creating instability in the world economy. Oil prices climbed to over US$100 (£75) a barrel on March 16 after Trump said the US had “totally demolished” most of Kharg Island, Iran’s most vital oil export hub. Facing midterm elections in October, he is likely to want to see the conflict end relatively soon.

Netanyahu, on the other hand, will not want to end the war without imposing a decisive defeat on Iran that ends the country’s nuclear and ballistic missile programmes at the very least. Like Trump, he faces an election in October and will want to present himself not as the leader whose watch saw the October 7 Hamas terrorist attacks in 2023, but as the victor of the war with Iran.

Ending the war

How Trump and Netanyahu manage these differences will determine both the course of the war and its duration. We do know that while the two leaders frequently pay effusive compliments to each other in public, they have a rather more fractious personal relationship.

Six months ago, Trump strong-armed Netanyahu to accept his 20-point plan for a Gaza ceasefire. This involved Netanyahu making a humiliating phone call to the Qataris to apologise for an Israeli attack on Hamas leadership in Doha. The White House even published a picture of the US president and the Israeli prime minister making the call.

And while routinely praising Trump for his support for Israel, Netanyahu appears to be wary of their relationship. In his 2022 autobiography, Bibi: My Story, Netanyahu complained that Trump was slow to act on the Israeli government’s agenda in his first term as US president. He also described his relationship with Trump as “bumpy”.

Trump’s second term has been a rather mixed experience for Netanyahu. On the one hand, he convinced the US to bomb the Iranian nuclear sites in June 2025 and since February 2026 to collaborate in a major war against Iran. But on the other hand, he (like everyone else) is having to deal Trump’s capricious and unpredictable behaviour.

The war in Iran is now in a difficult phase. Israel and the US have an overwhelming firepower advantage over Iran and have eliminated numerous high-ranking Iranian leadership figures, most recently killing security chief and de facto leader of the country Ali Larijani. Despite these serious blows, the regime is still functioning and maintains significant military capacity.

For Israel, a new development in the war is coordinated Iranian-Hezbollah missile attacks. This demonstrates the very different pressures that the US and Israeli leaderships are under. Israelis are now in their third year of war. The US will be feeling the effects of the war in terms of higher gas prices and a spike in inflation, but the lives of Americans are not punctuated by air raid sirens and military service.

These differences will play out as Trump and Netanyahu envisage the war’s end. There are reports that the US administration is talking to Iran already about ending the conflict as the war enters its third week. Netanyahu will worry where these diplomatic moves might lead.

Trump and Netanyahu may have started a war together, but they are going to have difficulty ending it together.

John Strawson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Trump and Netanyahu may have jointly started the war in Iran, but ending it together will be difficult – https://theconversation.com/trump-and-netanyahu-may-have-jointly-started-the-war-in-iran-but-ending-it-together-will-be-difficult-278483

Source: The Conversation – UK – By Adrian R Bell, Chair in the History of Finance and Associate Pro-Vice-Chancellor Research, Prosperity and Resilience, Henley Business School, University of Reading

The Peasants’ Revolt of 1381 was one of the largest and most dramatic popular uprisings in medieval Europe. But what do we really know about this celebrated event in English history?

The rising was the culmination of a wide range of popular grievances against the government of the young King Richard II and his uncle John of Gaunt. The trigger was the levy of a third poll tax in four years to fund the hundred years war.

To understand the depth of the rebellion and its impact on society today, we created the People of 1381, a database of events, places and people comprising around 28,000 records. It challenges the established narrative that the revolt was focused on a handful of counties in England and restricted to certain levels of society.

The term “Peasants’ Revolt” was not popularised until 1874 by John Richard Green’s Short History of the English People. The legal records generated by the prosecution of the rebels reveal that they were not just peasants but drawn from every level of medieval society beneath the aristocracy.

Read more:
We built a database of 290,000 English medieval soldiers – here’s what it reveals

Our database shows how widespread the depth of feeling was against the government. The revolt wasn’t just a march on London – it involved people in over half the counties of England. In the west, there were riots in Bridgwater and Gloucester, while the disturbances spread as far north as Yorkshire and Chester.

The medieval records that make up the database uncover the participation of social groups whose role in the revolt has been underexplored, including household servants, soldiers and women.

It also includes details of those who didn’t partake directly but were affected in some way, from victims of the rising to jurors and lawyers who prosecuted the rebels. In doing so, the database sheds new light on the rebels of 1381. They are revealed as once living people, rather than the faceless mob described in contemporary chronicles.

So who was involved and where?

By combining judicial and manorial (administrative records generated by a manor) documents with records generated by central and local government, poll tax and military service, we can build a picture of the people involved in the revolt.

John Peper of Linton is one example: he owned land, granted charters, engaged in lawsuits and could afford lawyers – a far cry from the profile of a peasant. He was also one of the many rebels who had social aspirations and apparently resented the legal and fiscal checks on their ambition.

Peper highlights the important leadership role of soldiers in spreading the revolt. Having just returned from campaigning in France in May, he immediately joined the revolt and led groups attacking people and property around Cambridgeshire. He survived the government reaction and was ultimately pardoned.

There were also many poorer rural rebels and it was the way people of many social ranks joined the rising that made it so potent.

Manorial records are fascinating because they enable us to reconstruct the lives of very humble people. For example, Walter Spittebotter of Blackmore near Chelmsford was admitted to land previously held by his father in 1354-55. He found farming a struggle and was fined for the poor condition of his land and not clearing ditches. In 1381, he was among those who attacked the manor of Joan of Kent at North Weald Bassett in Essex. On his death in 1404, he held a cottage and six acres of land. His best animal, forfeited to the lord of the manor, was a pig.

In Wix (Essex), Joanna Welbetyn, Joanna Alfred and the wife of Thomas Ilsent joined in the burning of the manor’s records during the revolt. Our database suggests that sometimes women joined the rising as part of a family group. Joan Pode of Charlton joined one of the most spectacular events of the rising – the destruction of John of Gaunt’s luxurious Savoy Palace (on the present site of the Savoy Hotel). Joan was accompanied by her husband and another relative, suggesting that the whole Pode family joined the rising.

Unlike contemporary chronicles, the legal records show how women intervened at key moments in the revolt, most dramatically when Katherine Gamen was accused of pushing a boat out across the River Little Ouse in Suffolk. The chief justice could not escape and was killed.

The tantalising nature of much of the source material regarding women in 1381 is illustrated through the example of an unnamed woman who joined the attack. We know nothing about her except that she was “lately the wife of William Dekne” and was “led by Nicholas Carter”. They were part of a band which travelled from South Benfleet near the Thames Estuary up to Cressing Temple (a distance of over 30 miles, covered in a couple of days).

It is frustrating that we don’t know more about this unnamed woman. Why was she led by Nicholas Carter, and what was their relationship? But she demonstrates that some women did take part in the movement of rebel bands over long distances, even if they were in the minority.

The People of 1381 database is a versatile tool which enables us to develop many new perspectives on the revolt of 1381. We can reconstruct the background of the rebels, find connections between them, identify rebel bands, trace their movements and explore the spatial structure of the revolt.

However, we believe the ability of the database to reconstruct the human stories connected with the revolt, restoring humanity to the people caught up in the rising who have otherwise only been described in the most generic terms, is its most beguiling feature.

Adrian R Bell receives funding from UKRI via AHRC. He’d like to acknowledge the full team effort in driving the project, as well as the authors: Professor Anne Curry and Ian Waldock, University of Southampton; Dr Herbert Eiden, Victoria County History; and Dr Helen Lacey, University of Oxford.

Andrew Prescott receives funding from Arts and Humanities Research Council.

Helen Killick receives funding from UKRI via AHRC.

Jason Sadler receives funding from from UKRI via AHRC.

– ref. Who were the ‘peasants’ of the 1381 Peasants’ Revolt? New database has answers – https://theconversation.com/who-were-the-peasants-of-the-1381-peasants-revolt-new-database-has-answers-278011

Source: The Conversation – UK – By Vikram Niranjan, Assistant Professor in Public Health, School of Medicine, Health Research Institute, University of Limerick

A hotter world is quietly changing one of the simplest things we do for our health – moving our bodies. For many people, a walk in the park, a jog around the neighbourhood or a cycle to work is becoming harder, and sometimes unsafe, as temperatures rise.

Scientists are beginning to understand how heat affects physical activity and why this matters for long-term health. A new modelling study in The Lancet Global Health suggests that if rising temperatures lead to sustained reductions in activity, the knock-on effects could contribute to hundreds of thousands of premature deaths each year by the middle of this century.

The underlying behaviour is familiar. As temperatures climb, many people cut back on outdoor exercise. There is no single threshold, but activity often becomes noticeably less comfortable somewhere in the high 20s celsius, especially in humid conditions. Running, cycling or even brisk walking can feel more strenuous.

This is because the body has to work harder to stay cool. More blood is diverted to the skin and sweating increases, which can lead to earlier fatigue, dizziness and dehydration. Faced with this, people may slow down, shorten their exercise or avoid it altogether. Across large populations, this can translate into less movement, more time spent sitting and higher risks of chronic disease.

Some groups are more affected than others. Older adults tend to regulate temperature less efficiently. Women may experience different responses depending on physiology and hormonal factors. People with respiratory conditions such as chronic obstructive pulmonary disease can find breathing more difficult in hot and humid conditions, especially during exertion.

Over time, even small reductions in activity matter. Regular movement helps protect against heart disease, stroke, diabetes and other chronic illnesses. When activity levels fall, those protective effects diminish.

The modelling study estimates that, if warming continues and outdoor activity declines without compensation elsewhere, the resulting increase in inactivity could contribute to a substantial number of additional deaths by 2050. These would not be caused directly by heat itself, but by the gradual development of diseases linked to inactivity. The scale of the estimate depends heavily on how people adapt – for example, whether they move exercise indoors or shift it to cooler times of day.

The poor bear the brunt

The effects of heat are not evenly distributed. In wealthier settings, people are more likely to have access to air-conditioned gyms, indoor sports facilities or shaded green spaces. When it becomes too hot outside, they may have alternatives.

In many low- and middle-income countries, those options are more limited. People may live in densely built areas with little green space or cooling. Outdoor work is also more common, meaning higher overall heat exposure alongside fewer safe opportunities for recreation.

Research from Rio de Janeiro, Brazil, illustrates this imbalance. Heatwaves there are associated with increased deaths from cardiovascular and respiratory disease, particularly among older adults and women. Many deaths occur at home, pointing to gaps in cooling, information and access to care.

At the same time, physical activity remains part of the wider public health response. Evidence suggests that encouraging walking, cycling and public transport can reduce emissions while improving health. A framework in the journal Nature Health highlights how designing cities for active travel can support both cleaner air and more consistent physical activity.

There is also growing recognition that climate change may disrupt sport and recreation directly. The UK body Sport England has warned that heat, flooding and drought could damage facilities and reduce participation unless infrastructure adapts.

Some responses are already being tested. Tree-lined streets and shaded paths can lower urban temperatures. Parks with water features and dense planting offer cooler spaces for activity. Guidance increasingly recommends exercising in the early morning or evening, when conditions are milder, and research supports these adjustments as practical ways to maintain activity safely.

Technology may also play a role. During the COVID pandemic, many people turned to home-based exercise, online classes and simple equipment such as resistance bands. A study I conducted found that even housebound patients with serious lung disease could improve fitness, mood and quality of life through structured virtual programmes.

Similar approaches could help during periods of extreme heat. Online sessions, community “cool hubs” in air-conditioned buildings and guided indoor exercise can provide alternatives when outdoor conditions are unsuitable.

Exercise is not just a lifestyle choice but a core component of health. As the climate warms, the challenge will be to ensure people can remain active in ways that are safe and accessible. That is likely to involve a mix of individual adaptation and changes to the environments in which people live.

Vikram Niranjan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Extreme heat may keep millions from exercising, linked to 500,000 early deaths yearly – https://theconversation.com/extreme-heat-may-keep-millions-from-exercising-linked-to-500-000-early-deaths-yearly-278330