In 2001, Uzbekistan was far from a model of public health. The country was grappling with high hepatitis B infection rates and a fragmented healthcare system, few would have predicted that it would one day be celebrated for near elimination of the disease in children.

Yet today, reports Gavi, The Vaccine Alliance, the country stands among just nine in the World Health Organization (WHO) European region to meet hepatitis B control targets. A recent nationwide survey revealed that only 0.2% of Uzbek children carry the hepatitis B surface antigen (HBsAg)—well below WHO’s 0.5% threshold.

What is Hepatitis B and Why It’s Dangerous

Hepatitis B is a viral infection that affects the liver. While some infections are brief and symptom-free, others can become chronic, quietly progressing over years to cause liver failure or cancer. The risk of chronic infection is especially high in infants whose immune systems are still developing.

Fortunately, the hepatitis B vaccine is highly effective, offering 98–100% protection after a full three-dose series. WHO recommends that all infants receive the first dose within 24 hours of birth, followed by two or more doses at spaced intervals.

Also Read: National Doctors' Day, July 1, 2025: Theme – "Who Heals the Healer?" Know more about Its History and Significance.

What Are Gavi Countries?

Gavi supports lower-income and transitioning middle-income countries to strengthen immunisation systems and increase vaccine access. Countries that receive support are commonly referred to as “Gavi countries.”

Uzbekistan introduced universal hepatitis B vaccination in October 2001, supported by US$4.5 million in funding from Gavi, the Vaccine Alliance.

From 2001 to 2008, Uzbekistan provided the hepatitis B birth dose followed by two additional doses.

In 2009, the country upgraded to the pentavalent vaccine—offering protection against hepatitis B, diphtheria, tetanus, pertussis, and Haemophilus influenzae type B—while still delivering a standalone birth dose. Gavi extended further funding of US$32 million for the next decade.

Also Read: Healers, But Human Too: The Quiet Burdens Our Doctors Carry

Vaccination coverage has remained impressively high—above 95% since 2002. However, until recently, the real-world impact of the programme on hepatitis B infection rates had not been comprehensively measured.

Proof of Progress In Uzbekistan’s Healthcare

In 2022, a team led by Dr Nino Khetsuriani from the U.S. Centers for Disease Control and Prevention (CDC), along with local researchers, conducted a nationwide survey.

They tested blood samples from 3,753 children in grades one to three and reviewed their immunisation records. Their findings, published in Vaccine, showed that just 0.2% of the children tested positive for HBsAg—proof of the vaccine’s long-term effectiveness.

With consistently high coverage, experts expect the burden of hepatitis B in Uzbekistan to decline further as vaccinated children grow into adulthood, replacing older, unvaccinated cohorts.

Uzbekistan graduated from Gavi’s financial support in 2022. Today, its national immunization programme is fully self-funded and regarded as one of the most efficient in the region.

“Uzbekistan stands as a model of excellence in immunization,” said Jan-Christopher Castilhos França, Gavi’s Senior Country Manager for Middle-Income Countries.

With rates of esophageal cancer having quadrupled since the 1970s and fewer than 20% of patients surviving five years post-diagnosis, early detection is more critical than ever. The capsule sponge test offers a powerful tool for risk stratification, ensuring that high-risk individuals continue receiving endoscopy while sparing low-risk patients from unnecessary invasive procedures.

The gold standard for monitoring patients at risk of esophageal (throat) cancer has been the endoscopy—a procedure that, while effective, is invasive, uncomfortable, and resource-intensive. Now, a simple device known as the “pill-on-a-string” or capsule sponge test is emerging as a transformative alternative, promising to make screening and surveillance for throat cancer faster, less invasive, and more accessible for millions worldwide.

The concept is ingeniously simple: patients swallow a small capsule attached to a string. Once in the stomach, the capsule dissolves, releasing a sponge that expands to about the size of a coin. Healthcare professionals then gently pull the sponge back up by the string, allowing it to collect cells from the lining of the esophagus as it travels upward. The entire procedure takes about ten minutes and can be performed by a nurse in a clinic or even a mobile screening van.

Barrett’s esophagus is a chronic condition in which prolonged acid reflux damages the lining of the esophagus. Over time, the damaged cells can become precancerous, forming dysplasia, and potentially progressing into esophageal adenocarcinoma—a type of throat cancer with notoriously poor survival rates. Despite the relatively low annual conversion rate from Barrett’s to cancer (approximately 0.5%), regular monitoring is essential.

Traditionally, endoscopy has been the go-to method for this surveillance. However, it is not without drawbacks: sedation, fasting, potential complications, and significant cost. This is where the pill-on-a-string method is poised to transform care—making monitoring more accessible, efficient, and patient-friendly.

What Is the Pill-on-a-String Test?

The new test involves swallowing a capsule containing a compressed sponge. Once it reaches the stomach, the capsule dissolves, allowing the sponge to expand. Attached to a string, the sponge is gently pulled back up through the esophagus, collecting cells from the lining along the way. These cells are then analyzed in a lab for red-flag changes indicative of dysplasia or early cancer.

Though the idea may initially sound uncomfortable, the experience has proven to be far more tolerable than an endoscopy. For Duncan Cook, a 57-year-old heating engineer from Cambridge, who has endured nearly two decades of endoscopic monitoring, the change was welcome.

“The first time I had the sponge, I was a bit nervous,” Cook shared in a news release. “It’s quite a big pill to swallow, but it’s much better than going for endoscopies... I was able to have the test done and go right back to work after.”

A major challenge is that symptoms often overlap with benign conditions like heartburn, leading to late diagnoses when treatment options are limited. Early detection is critical: when caught at stage 1, five-year survival rates can reach 63%. This is why regular surveillance of high-risk individuals—particularly those with Barrett’s esophagus—is so important.

In a large multi-center trial involving 910 patients across 13 hospitals in the U.K., researchers from the University of Cambridge and Queen Mary University of London evaluated the effectiveness of the capsule sponge test. Participants—all of whom were already being monitored for Barrett’s esophagus—underwent both the new test and a standard endoscopy for comparison. Findings from the study, recently published in The Lancet, are compelling:

• 54% of patients were classified as low-risk after the sponge test, showing no cellular changes that could indicate progression to cancer.
• Only 0.4% of the low-risk group were later found via endoscopy to have high-risk cell changes.
• No cancers were detected in those flagged as low-risk by the sponge test.

These results suggest that more than half of the patients undergoing routine endoscopies could safely switch to the capsule test without compromising diagnostic accuracy.

“Our findings suggest that the capsule sponge could help stratify patients with Barrett’s esophagus by risk,” said Dr. Peter Sasieni, director of the Cancer Research UK Cancer Prevention Trials Unit. “Given the low risk of progression in these individuals, it should be safe to replace their usual endoscopy with the capsule sponge.”

The research team isn’t stopping here. Scientists are now working to refine the sponge test further by enhancing laboratory analysis of the collected cell samples. Artificial intelligence (AI) is being evaluated to assist in identifying early signs of dysplasia, potentially boosting accuracy and reducing human error.

Professor Rebecca Fitzgerald, director of the Early Cancer Institute at Cambridge, noted, “We need an alternative surveillance method that’s less invasive, easier to administer and more reliable… Endoscopies aren’t always a reliable way of spotting early cancers, and they depend on the skill of the person doing it."

Food Standards Australia New Zealand is urging people to not consume two peanut butter products by Coles. These two varieties are Coles Smooth peanut butter and Coles Crunchy peanut butter, which have been found to contain mycotoxin and aflatoxin. Coles has also recalled these two products. The question is raised for products with the batch marked best before February 5, 2027.

Coles' recalling means that people can return these products for a full refund.

The toxins found in these products are said to increase the risk of liver cancer. An alert has been issued, which reads: “Coles Online customers can receive a refund or credit by contacting Coles Online Customer Care on 1800 455 400. Any consumers concerned about their health should seek medical advice.”

What Are These Toxins, How Does It Impact Our Health?

Mycotoxins

As per the World Health Organization (WHO), mycotoxins are toxic substances produced naturally by certain types of mould (fungi). These moulds can grow on a wide variety of foods—such as grains, dried fruits, nuts, and spices—especially in warm, damp, and humid environments. The contamination can occur either before harvest or after, during storage or even on the food itself. Alarmingly, most mycotoxins are highly stable and can survive food processing methods.

There are hundreds of known mycotoxins, but a few pose significant health risks to both humans and animals. These include aflatoxins, ochratoxin A, patulin, fumonisins, zearalenone, and nivalenol/deoxynivalenol. Mycotoxins enter the food chain when crops are infected with mould. People can be exposed either by consuming contaminated food directly or indirectly—most commonly through animal products like milk, when livestock are fed mould-contaminated feed.

Where Are They Found?

Mycotoxins can contaminate food before harvest (in the field) or afterward during storage and processing. Since most mycotoxins are chemically stable, they can survive food manufacturing and cooking processes, making them hard to eliminate completely.

Mycotoxins can pose serious health risks to both humans and animals. Their effects can range from sudden poisoning to long-term health issues such as:

• Suppressed immune response
• Liver damage
• Increased cancer risk

Livestock can also be exposed through contaminated feed, and humans may indirectly consume these toxins through animal products like milk.

Common Mycotoxins to Watch For

Though hundreds of mycotoxins have been identified, a few are especially harmful and frequently found in food:

• Aflatoxins (among the most toxic, produced by Aspergillus moulds found in soil and stored grains)
• Ochratoxin A
• Patulin
• Fumonisins
• Zearalenone
• Nivalenol/Deoxynivalenol (DON)

What Are Aflatoxins?

As per the National Cancer Institute, US, aflatoxins are a group of toxic compounds produced by specific types of fungi, primarily Aspergillus flavus and Aspergillus parasiticus. These fungi thrive in warm, humid climates and commonly infect crops like maize (corn), peanuts, cottonseed, and various tree nuts. Contamination can occur at multiple stages—while the crops are growing in the field, during harvest, or later in storage.

The National Cancer Institute also notes that exposure to aflatoxins is associated with an increased risk of liver cancer.

Another 2013 study published in World Journal of Gastroenterology notes that while Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths worldwide, it is caused by aflatoxin. The study notes that aflatoxin is a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus, is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of HCC. In fact, Aflatoxin B1 has been classified by the WHO as a “group A” carcinogen because of it’s proven contribution to the pathogenesis of HCC.

On June 30, the U.S. Supreme Court declined to hear a lawsuit filed by Children’s Health Defense (CHD), an anti-vaccine group founded by Robert F. Kennedy Jr., now the Secretary of Health and Human Services under the Trump administration.

The group alleged that its First and Fifth Amendment rights were violated when Meta Platforms—parent company of Facebook and Instagram—restricted its content related to vaccine misinformation during the COVID-19 pandemic.

Without providing comment, the Supreme Court left in place a series of lower court rulings that dismissed CHD’s claims. These rulings found that Meta acted independently and could not be treated as a government actor bound by constitutional free speech protections.

Lawsuit Stemmed From Facebook’s 2022 Removal of CHD’s Page

The legal dispute centered around Facebook’s removal of CHD’s page in 2022, amid efforts to combat vaccine misinformation during the pandemic. CHD claimed Meta’s actions were a result of coordination with the federal government as part of the CDC’s “Vaccinate with Confidence” campaign—an initiative encouraging platforms to promote accurate health information.

The group’s lawsuit was filed under the First and Fifth Amendments and other laws, arguing that Meta effectively carried out government censorship by restricting CHD’s content. However, courts repeatedly found no substantial evidence of collusion between Meta and the federal government.

Lower Courts: Meta Is Not a State Actor

The San Francisco-based 9th U.S. Circuit Court of Appeals, among others, ruled that Meta, as a private company, is not a "state actor" and is therefore free to determine what content appears on its platforms. The court also observed that Meta and the federal government were not always aligned in their objectives or actions.

While the CDC encouraged accurate vaccine messaging, the 9th Circuit noted there was no direct government control or coercion over Meta’s decisions. This distinction was critical in rejecting CHD’s claim that Meta was acting as an agent of the state.

Dissent Raises Concern Over Platform Power

Despite the unanimous rulings, one appeals judge issued a dissent, suggesting that Meta may still warrant First Amendment scrutiny due to the sweeping influence it holds over public discourse. The judge argued that when a platform controls speech at such a vast scale, its role begins to resemble that of a government actor—especially when supported by government policy, even if not outright directed by it.

Part of a Broader Pattern

The rejection follows a similar 2024 Supreme Court ruling, in which justices said Louisiana, Missouri, and other Republican-led states lacked legal standing to sue the Biden administration over alleged censorship of conservative content on social media. These decisions reflect a cautious judicial stance on intervening in disputes over online content moderation, especially in the absence of clear evidence of government overreach.

A Continuing Free Speech Debate in the Digital Age

While Meta has prevailed legally, the case leaves unresolved broader questions about the relationship between government agencies and tech companies—and how far platforms can or should go in moderating content related to public health or politics.

As misinformation continues to be a major concern and social media remains central to public discourse, the debate over where free speech ends and platform responsibility begins is far from over.