The small community of Arviat, Nvt., has reportedly been selected to host the main campus of Inuit Nunangat University, the first Inuit-led university in Canada. The institution is expected to open in 2030.

Inuit Tapiriit Kanatami (ITK), which represents Canada’s 70,000 Inuit, passed a resolution to develop the university in 2017, “marking a significant step toward self-determination in higher education.”

The vision and plans for the university reflect a common saying among the Indigenous Peoples of the Prairies: “Education is the new buffalo.” It alludes to the importance of buffalo to Indigenous Peoples prior to the animal’s near-extinction in the late 19th century, and the importance placed on education today.

This emphasis on education is partly a response to colonial policies that systematically denied Indigenous Peoples access to quality education for generations.

The consequences of that history are still seen today. While there is a gap in employment rates between Indigenous and non-Indigenous adults overall, the gap essentially disappears for those with a bachelor’s degree or higher.

In this context, the establishment of a university is more than the creation of educational institution. It’s a way to combat the injustices of the past and develop the Indigenous economy, which also helps fund Indigenous self-determination.

Not the first Indigenous university

Inuit Nunangat University will not be the first Indigenous-led university in Canada. That distinction is most often attributed to the First Nations University of Canada in Saskatchewan, which started as the Saskatchewan Indian Federated College in 1976.

The university itself does not appear to claim the distinction on its website, perhaps because of the long history of Indigenous-led post-secondary institutions that predate or parallel it across Canada, from the Wilp Wilxo'oskwhl Nisga'a Institute in Gitwinksihlkw, B.C., which is federated with the University of Northern British Columbia, to Kiuna College in Odanak, Que.

The existence of these institutions reinforces the value Indigenous Peoples see in education — a statement that may surprise those who associate Indigenous education primarily with the residential school system.

Read more: National Day for Truth and Reconciliation: Universities need to revisit their founding stories

Yet, as the Truth and Reconciliation Commission’s final report mdae clear, the schools were incredibly poor at actually educating Indigenous children; those who succeeded academically did so despite the system rather than because of it. The schools were designed primarily around assimilation and labour, not academic learning.

That failure, and the determination to correct it, is one of the reasons why members of Saddle Lake Cree Nation occupied the Blue Quills Indian Residential School in Alberta in 1970 and demanded the right to run it themselves

After a 17-day sit-in, then-minister of Indian Affairs Jean Chrétien transferred operations to the Blue Quills Native Education Council. The council eventually transformed it into the Indigenous-run and operated University nuhelot'įne thaiyot'į nistameyimâkanah Blue Quills.

Education as a form of investment

Many First Nations, Métis nations and Inuit communities fund post-secondary education for their members, often through partnerships with Indigenous Services Canada. There is a broad recognition that investing in education benefits the nation and community, and the number of Indigenous Peoples obtaining a bachelor’s degree or higher has been increasing.

That is one reason for the numerous Indigenous led post-secondary institutions across Canada. Another is that, while Indigenous Peoples are theoretically free to attend any post-secondary institution in the world, many institutions are not located near their communities.

This matters more than it might initially appear. According to the 2021 Census, there is a clear correlation between remoteness and lower levels of post-secondary education. The share of Indigenous adults with a post-secondary qualification was significantly higher in areas closer to economic centres.

Building schools to be closer to home, rather than expecting Indigenous students to travel or move away from home, is the logic behind Inuit Nunangat University.

Designing from the inside out

There are also benefits to having institutions under Indigenous control. Indigenous-led post-secondary institutions can develop curriculum and programs that are directly tailored to the needs and desires of their communities.

They also treat Indigenous knowledge systems as foundational rather than supplementary. For generations, Indigenous ways of knowing were delegitimized. Western disciplines defined what counted as knowledge, and Indigenous Peoples who entered those institutions were expected to set aside their own epistemologies.

Most Canadian universities are attempting to address this through changes grouped under the term “Indigenization,” but questions remain about whether such changes actually address underlying colonial structures or simply work around them.

Indigenous post-secondary institutions are, in principle, better positioned to make more fundamental changes. Nowhere is this better seen than in the six proposed faculties of Inuit Nunangat University, which reflects an Inuit take on programs and courses that differs from the standard structure of Canadian universities. This includes Inuktut language immersion.

Other Indigenous institutions have already led the way on language-based degrees. The Nicola Valley Institute of Technology and the aforementioned Wilp Wilxo'oskwhl Nisga'a Institute have created language-based degrees for Nłe?kepmx and Nisga'a in partnership with the University of British Columbia and University of Northern British Columbia respectively.

A barrier dismantled

Between 1876, when the Indian Act was first passed into law, until its 1920 amendment, status Indians lost their Indian status if they earned a degree and/or worked in certain professions.

For decades after, the most significant barrier to education was the failure of the Indian Residential School system to actually educate Indigenous children. Both forms of exclusion have now been formally dismantled, though their effects persist in the gaps that remain.

More and more Indigenous Peoples are pursuing post-secondary education, and institutions designed specifically to support that pursuit are a central part of how those gaps close. The Inuit Nunangat University, opening in Arviat in 2030, will be part of that process.

Daniel Sims is a member of the Tsay Keh Dene First Nations. Currently he holds an Insight Grant as well as an Explore Grant from the Social Sciences and Humanities Research Council (SSHRC) to research failed economic developments and concepts of wilderness in Tsek'ehne traditional territory (the Finlay-Parsnip watershed).

Health Canada recently warned Canadians not to buy or inject unauthorized peptide drugs sold online, naming products that include BPC-157, CJC-1295, ipamorelin, TB-500 and retatrutide.

The advisory notes these products are being marketed online and on social media for anti-aging, weight loss, injury recovery, sleep, mental focus and general “wellness,” and that Health Canada has already seized several of them.

Peptides, short chains of amino acids (the building blocks of protein), are no longer marketed only to bodybuilders and elite athletes.

A scroll on Instagram and TikTok quickly reveals a broader wellness market in which influencers, including medical doctors, naturopaths and personal trainers, pitch compounds such as BPC-157 and TB-500. The hook? These self-injected compounds are recovery shortcuts, reduce wrinkles, “melt” belly fat and are “anti-aging” with strong and incredible effects.

The problem? Few, if any, of these substances have been tested in human trials.

As a case example, body protective compound 157 (BPC-157) is scientifically interesting. Reviews published in 2025 describe a body of research dominated by animal and cell studies, with signals suggesting effects on angiogenesis (the growth of blood vessels), growth-factor signalling (mainly growth hormone) and musculoskeletal healing.

In one systematic review, 544 papers were screened, 36 met the inclusion criteria, and 35 of those were in rodents or cells; only one involved humans in a musculoskeletal context.

Plausible hypotheses

That is the tension at the heart of the current peptide boom: plausible biology can generate excitement long before it generates reliable clinical evidence. Caution is warranted because animal findings do not reliably map onto what happens in people. Molecular pathway diagrams and rodent healing results are useful for generating scientific hypotheses, but they aren’t evidence that a product improves outcomes in human patients.

Most potential products tested in rodents do not make it to market. The “translational squeeze” — the number of products that begin rodent trials compared to the number that successfully progress from rodent trials to human trials, and from human trials to regulatory approval — is estimated to be greater than 20 to one.

Published human evidence for BPC-157 remains trivial. A retrospective knee-pain report included 16 patients; an interstitial cystitis pilot trial enrolled 12 women; and a recent intravenous safety pilot involved just two healthy adults.

These studies are too small and poorly controlled to establish whether the peptide outperforms natural recovery, the placebo effect or conventional rehabilitation. A randomized, double-blind, placebo-controlled hamstring-strain trial has now been registered, which is exactly the kind of study still missing from the evidence and efficacy base.

Placebo effect and regression to mean

The social power of peptide testimonials is easy to understand. Pain, soreness and recovery are subjective and highly variable outcomes.

The U.S. National Center for Complementary and Integrative Health notes that randomized, placebo-controlled trials are the gold standard because they help determine whether apparent improvement is due to the treatment or to chance. Harvard Health puts the related point bluntly: placebo effects can ease symptoms like pain, fatigue and nausea, but they do not shrink tumours or lower cholesterol.

Symptoms that are severe when people first seek help often improve by the time they are next measured, simply because of natural fluctuation, a phenomenon known as regression to the mean. So when someone injects BPC-157 and feels better two weeks later, several explanations compete: time, rehabilitation, expectation (the person has just spent money on a peptide and perhaps publicly committed to trying it), and regression to the mean. A testimonial saying “it worked,” can generate a hypothesis; it cannot settle causation.

For these reasons, regulatory warnings deserve more attention than influencer enthusiasm. Health Canada states that unauthorized injectable peptides are illegal in Canada, have not been assessed for safety, efficacy or quality, and may contain too much, too little or none of the claimed ingredient.

Notably, labels such as “For Research Use Only, Not for Human Consumption” do not make these products legal for human use.

In the United States, the Food and Drug Administration (FDA) classified BPC-157 as Category 2 for compounding due to adverse immune system reactions, peptide-related impurities and insufficient safety information to determine whether it would cause harm when administered to humans.

Purity certificates and conspiracy theories

A common rejoinder from people buying peptides online is that third-party certificates of analysis show the powder they receive is pure and free of contaminants. That reassurance does not survive scrutiny.

The “third-party” labs that produce these reports are often the vendors themselves and offer assurances of 98 per cent purity, which might seem impressive but would not meet any reasonable drug standards. And what exactly is the other two per cent? The consumer is asked to take the claims of purity as proof, while the peptide-related impurities that concern regulators remain invisible to the end user.

There is a deeper irony embedded in this practice: if buyers believed these products were safe, properly characterized and manufactured to the standards expected of pharmaceutical-grade products, they would not need to commission independent purity tests. The reliance on outside certificates of analysis is itself an admission that the normal guardrails of identity, potency, sterility and quality control are absent.

The conspiracy theory is that useful peptides are ignored by pharma companies because peptide drugs cannot be patented and become real medicines. The facts do not support that.

Semaglutide (used in GLP-1 medications like Ozempic and Wegovy) is a peptide drug, and tesamorelin is an FDA-approved synthetic growth hormone-releasing factor analogue. Peptide therapeutics are not an exotic category that mainstream drug development cannot handle.

What makes BPC-157 different is not that peptide medicine is impossible. But it’s been more than three decades since researchers began studying BPC-157, and public evidence remains dominated by animal- and cell-based papers and small human pilot studies. Journalistic investigation has also noted that much of the BPC-157 literature traces back to a single Croatian research group, another reason to be careful about mistaking repetition for independent confirmation.

Safety concerns

Jurisdictional and approval rules vary across regulators, but a global scan reveals that only a scant few peptides in BPC-157’s broader therapeutic class have achieved any clinically approved use.

A recent FDA 503A update in the U.S. should not be mistaken for a change in that picture. The FDA’s current safety page continues to cite concerns about immunogenicity, peptide impurities and limited safety data, and the agency has stated that a substance may still pose significant safety risks.

BPC-157 or other peptides may yet prove useful for a specific condition, at a specific dose and route of administration. The right response is not to dismiss that possibility, but to insist on the blinded, placebo-controlled human trials that could actually settle the question.

Until then, buying vials of dry powder, reconstituting it in sterile water, and injecting the cocktail with online-purchased needles will not provide proof of anything. It is high-risk, uncontrolled human self-experimentation.

Stuart Phillips owns shares in Exerkine. He receives funding from Nestle, Optimum Nutrition, Danone, and Nutricia. He is affiliated with WndrHlth, Liquid IV, and Myomar.

Over the past 11 years, The Conversation Africa has published 12,961 articles by 8,257 authors, making the expertise of academics and researchers in Africa and other parts of the world accessible to the public, national and global policymakers, and other stakeholders. These articles are also republished by other media, making our work an important pillar of the media ecosystem.

It’s sometimes tough to gauge the true impact of the articles we publish. Replication by other news outlets – and readership on our site – help put numbers on their reach, but not how they might influence policy and opinion.

So it’s very gratifying when authors share stories that illustrate the ripple effect their articles have had. Here are some.

After the publication of her article on the pressures facing families that rely on social grants in South Africa, Nokukhanya Ndhlovu was invited by the country’s Public Protector to consult on hearings about child support and social assistance.

In Kenya, Joseph Ogutu’s analysis of a wildlife conservation policy fed directly into high-level discussions. The author was invited to make a presentation at an annual stakeholder meeting organised by the local governor’s office.

In west Africa, an article by Ifesinachi Okafor-Yarwood and Sayra van den Berg Bhagwandas on the central role women play in informal cross-border trade helped shift thinking among policymakers, helping gain broader recognition of women’s economic contributions. Following the article, the authors were invited to consult with policymakers at the United Nations and the World Trade Organisation.

Other stories demonstrate how impact can unfold through shifts in awareness and accountability. Coverage of issues ranging from social justice to agriculture have triggered consultations between researchers and policymakers, opening pathways for longer-term reform.

The impact of these articles, and thousands of others, is a reminder of why The Conversation Africa exists: to ensure that evidence informs debate, that African expertise shapes decisions, and that knowledge can help build better policy outcomes across the continent.

About 10% of births – that’s about 15 million babies – are born prematurely worldwide each year, making preterm births a major global health concern. The World Health Organization (WHO) defines preterm birth as delivery before 37 completed weeks of gestation.

Estimates suggest that the preterm figure is much higher in low-income countries. Preterm births are a danger to the infant’s survival and long-term health. And according to the WHO, the level of socioeconomic development in the country where a preterm baby is born often plays a crucial role in their survival.

In high-income countries, over 90% of extremely preterm newborns survive. In low-income countries, survival rates can be as low as 10%.

The survival rates of preterm babies depend heavily on healthcare accessibility and socioeconomic factors. Those include organisational support like maternity leave and consideration for the needs of working mothers. Even in high-income countries with advanced healthcare services, racial and socioeconomic disparities lead to disproportionate rates of preterm birth and adverse maternal outcomes.

While attention is rightly placed on the survival and long-term health of the babies, a silent crisis often unfolds alongside it: the mental health of mothers.

Preterm birth is frequently sudden and unexpected, bringing intense stress and psychological trauma, uncertainty, and emotional disruption for mothers. For many women, the experience is not only medical but also deeply psychological. Also, mothers’ mental health challenges not only affect maternal well-being but can also influence bonding, caregiving practices, and long-term child development.

Read more: 80% of premature baby deaths happen in poorer countries. Five simple measures that can help save them

Our work sits at the intersection of maternal mental health, public health systems, and research translation. We conducted a study which highlights how preterm birth can trigger profound psychological distress in mothers. We explored the complex intersections of preterm motherhood and maternal mental health in a low-resource context, in this case Ghana. The study used a qualitative approach and centred on understanding mothers’ personal experiences.

Our findings reveal the complex experiences mothers of preterm children go through, such as shielding themselves from negative comments until their babies gained weight. The findings further revealed the complex interplay between mothers’ subjective experiences and their perceptions during their premature infants’ conception, birth and care-giving journey.

These are not isolated experiences. For example, a study found that 17.2% of the world’s population suffers from postpartum depression and the highest prevalence rate is in southern Africa – 39.96%.

But the findings underscore the importance of addressing both personal and systemic issues when providing support to mothers of preterm babies. They also highlight how stigma adds to the emotional challenges mothers with preterm babies experience.

Read more: Young mothers in Kenya face a higher risk of giving birth early: study explores why

Giving birth too soon

We conducted in-depth interviews with 22 mothers of preterm infants in the eastern region of Ghana. Few studies have observed the interplay of preterm birth, sociocultural issues and psychological outcomes among mothers in this country.

Our analytical approach aimed to capture the sense that participants made of their experiences – to explore the complex emotional, psychological and social realities surrounding preterm birth from the mothers’ perspectives. The method allowed us to understand how mothers interpret, cope with and are affected by their experiences.

One of the women told us:

I was like, is all my struggle going to be wasted? I was extremely sad throughout the period … I didn’t expect him to be small like that at seven months. I was scared about his size.

Another shared her experience:

I was always indoors with the baby when he was small. Even if I’m going out, say to the hospital, I will wrap the baby in a cloth so that no one sees the child for them to make bad comments about him.

A third woman said:

It was so stressful because you will be sleeping somewhere while your baby too will be staying somewhere (else). I was always thinking about my baby and asking myself what was wrong with him at every point.

Challenges like these can be compounded by limited access to mental health services, especially in resource-constrained settings. The implications are far-reaching. For example, poor maternal mental health can affect infant development, breastfeeding and caregiving practices, mother-child bonding, and overall family well-being.

Supporting maternal mental health is essential to improving outcomes for both mother and child.

Read more: Every 2 seconds in the world a baby is born prematurely – report identifies biggest challenges for their survival

What should be done?

Mental health must be integrated into maternal and neonatal care.

Mental health screening should be a routine part of care for mothers, especially those with preterm infants.

There is a need to expand access to support services through community-based counselling, peer support networks, and affordable psychological care.

Public and private health institutions, academics and communities need to address obstetric violence and stigma through public education and further research. Obstetric violence is violence experienced by women during facility-based childbirth.

Interventions and policies should be developed to help normalise maternal mental health challenges and encourage women to seek help without fear.

Healthcare providers should be trained to recognise and respond to maternal mental health needs, particularly in neonatal care settings.

It’s also important to invest in context-specific research to quantify the burden and to design effective interventions.

Puleng Segalo receives funding from the University of South Africa.

Jacob Owusu Sarfo receives funding from the University of South Africa, University of Cape Coast, and Grand Challenges Canada.

In Nepal’s remote mountain district of Jumla, preparation for a family meal begins long before food reaches the cooking pot. It starts in terraced fields of beans, buckwheat, apples and pumpkins that must be ploughed, planted, tended and harvested before a family can eat.

But other workers often go unseen: the pollinating insects. By moving pollen between flowers, pollinators ensure that crops bear healthy, nutritious fruit to eat and sell.

Most people don’t think about insects when they eat. But in farming systems like this one, the link is direct and stark. If pollinators decline, crop harvests decline. That can mean less food on the plate, fewer nutrients in people’s diets, and less income for the household.

In our new study, published in the journal Nature, we set out to trace that chain of connections directly: from pollinating insects to crops to human diets and livelihoods.

Working in ten smallholder farming villages in Jumla, our team recorded the diets of 776 women, men and children over a full year. We measured where key nutrients came from, and how this changed through the seasons. At the same time, we surveyed the insects visiting crops and analysed the pollen they carried, to identify which species were helping produce the foods people rely on.

The first thing that stood out was just how local these diets were. More than 80% of people’s intake of many key micronutrients – including vitamin A, folate, vitamin C, calcium and vitamin B12 – came from foods grown or raised in nearby villages. This shows just how closely people’s health is tied to their surrounding landscape.

Most people’s diets were dominated by staple cereals like rice and wheat, which do not depend on insect pollination. But pollinator-dependent crops – including fruits, vegetables and beans – punched far above their weight nutritionally and economically. These foods provided more than 60% of people’s vitamin A, folate and vitamin E intake, and up to 90% of farming income.

In places like Jumla, pollinators are not simply supporting production – they are helping keep families fed and providing crucial cash to meet basic needs. Given the high levels of poverty and malnutrition that already exist, families simply cannot afford to lose them.

When pollinators decline

Pollinator decline is no longer a distant threat. Local beekeepers in Jumla have reported sharp drops in honey production in recent years, with some hives dying out completely. They point to changing weather, fewer wildflowers due to heavy grazing, and increasing pesticide use as the problems. Wild pollinators such as bumblebees, butterflies and hoverflies are likely to be under similar pressure.

If current trends continue, farming income could fall by around 15% by 2030, with vitamin A and folate intake dropping by almost 10%. And if local pollinators disappeared entirely, families could lose nearly half of their farming income and more than 20% of their vitamin A and folate intake.

The risks to health are clear. Vitamin A deficiency can damage eyesight and weaken the immune system. Low folate intake increases the risk of serious complications in pregnancy, including birth defects in babies. In communities already facing high levels of malnutrition, pollinator decline would add yet another strain.

The situation in Jumla is not unique. Smallholder farms make up 84% of all farms worldwide and feed 2 billion people. These farms are highly exposed to environmental change and the families that depend on them already struggle with poor diets and poverty. Even when our food comes from supermarkets and long supply chains, much of it still begins with pollination by insects. The link between biodiversity and human health is still there – it is just less visible.

However, there are signs that this pollinator-nutrition link can be strengthened. In Jumla, farmers are already testing pollinator-friendly practices such as planting flowers around fields, protecting nesting habitats, reducing pesticide use and keeping native honeybees. Our results show promising signs of change. When pollinator numbers increase, so does the production of nutritious food to eat and sell.

The lesson from Jumla is clear. Biodiversity loss is not just an environmental issue, it is a growing threat to human health. At a time when governments like the UK are warning that biodiversity loss poses serious risks to national security, the story in Jumla helps explain what that means in practical, human terms. But it also shows that by supporting the ecosystems around us, we can help secure healthier diets and more resilient livelihoods for the future.

This work was funded by the Natural Environment Research Council (NERC) coordinated through the Belmont Forum

Jane Memmott receives funding from NERC, BBSRC & The Belmont Forum.

Immigration is receiving much attention in the run-up to the Welsh election. This might seem odd at first because the Welsh parliament (the Senedd) has no power over immigration. It can’t make laws on who enters the country, how asylum claims are handled or who gets citizenship. All of that is controlled by the UK government in Westminster.

But since 2019, Wales has considered itself a “nation of sanctuary”. This means the Welsh government can support refugees and asylum seekers through the services it controls, such as health, education and housing.

Read more: Voters in Wales face Senedd election amid confusion over who holds power over what

A YouGov poll from April 2026 shows that immigration is a priority for 25% of Welsh voters, tied with the economy. Health (46%) and the cost of living (51%) are ranked higher. Among intended Reform UK voters, immigration is ranked as the highest priority (55%).

In December 2025, there were 3,353 asylum seekers in Wales, most of whom were in Cardiff. Of the £64 million spent on the nation of sanctuary since 2019, 91% has been to support refugees from Ukraine.

Data from the Welsh Election Study shows that 53.8% of respondents agreed or strongly agreed with the statement “people from different backgrounds get on together” in their local area, compared with 14.4% who disagree or strongly disagree. Only a small minority feel that there are tensions in their areas.

Yet, Wales has not been exempt from the wider tensions around immigration in the UK. There have been several protests against housing asylum seekers in Penally in 2020, Llanelli in 2023 and Mold in 2025.

It is, therefore, unsurprising that some political parties have highlighted this as an electoral issue. Reform UK and the Welsh Conservatives have pledged in their manifestos to scrap the nation of sanctuary policies.

The nation of sanctuary policy is a vision that connects the Welsh government with global issues. Academics have described it as an example of “moral” or “progressive” nationalism.

It was introduced largely in response to the UK government’s “hostile environment” approach on immigration. The hostile environment was a series of policies put in place by Theresa May during her time as home secretary to make life harder for people who overstayed their visa to continue working and accessing public services, such as the NHS. For example, it required employers, landlords and service workers to check immigration status.

Alongside putting clear water between Cardiff and Whitehall, the nation of sanctuary also took inspiration from Holyrood’s New Scots strategy in creating a more welcoming environment for immigrants in Scotland.

Read more: How immigration is playing a role in the Scottish election, even though policy is set in Westminster

The UK government is responsible for who is granted asylum and the housing of asylum seekers. The Welsh government can – and does – make policy in devolved fields such as health and education, for all residents in Wales, including people seeking sanctuary.

The nation of sanctuary built on existing Welsh policies. For example, giving rejected asylum seekers access to specialised medical care, and creating routes for refugees to work as doctors and dentists in the UK.

However, Wales is not exempt from UK-wide immigration policies. Welsh employers and landlords must continue to verify their employees’ and tenants’ immigration status, and Cardiff airport can be used for deportation flights. Nor does it mean that people seeking sanctuary are diverted to Wales from elsewhere in the UK. In this sense, Wales is less of a sanctuary than many north American cities, which can pass ordinances prohibiting deportations or inquiries about immigration status.

Nation without sanctuary

What could happen should the next Welsh government decide to revoke its nation of sanctuary vision?

Election polls have constantly shown Plaid Cymru and Reform UK in the lead. Plaid Cymru have committed to protecting the nation of sanctuary, and called for the devolution of some immigration powers to Wales. Reform UK has committed to scrapping it, and changing planning regulations to limit hotels being used to house asylum seekers. However, given Wales’ new electoral system, any party would probably need support from another to govern.

Should a future Welsh government decide to abandon the nation of sanctuary, this alone is unlikely to lead to significant changes in practice. The activism and networks that support it would continue, as would the housing of asylum seekers in Wales. These are matters for the UK government. Other policies around health and education that existed before the Nation of Sanctuary was declared would also continue.

Other specific issues relating to refugee status are subject to international agreements, such as the 1951 refugee convention. So, while immigration is a priority for some voters, no election result is likely to see immediate radical policy changes in Wales.

However, it could have a radical impact on the lives of migrants and others already affected by harsh immigration policies and rhetoric. It should be remembered that hate crimes increased during the 2016 Brexit referendum campaign and its aftermath, leading to many people feeling that they no longer belonged in the UK.

The current heated political discourse dehumanises migrants, whose experiences of fleeing conflict and persecution are largely missing from discussions. Election coverage and campaigns would benefit from bringing calm, nuance and sensitivity into its approach on immigration.

Rhys Dafydd Jones receieves and has received funding from The Economic and Social Research Council (ESRC) and the Leverhulme Trust.

A recent trip to Haworth, in West Yorkshire, got me thinking about Anne Brontë, who died 177 years ago this month. Stepping into St Michael and All Angels’ Church, a carved stone pillar prominently declares the location of the Brontë family vault. All members of the Brontë family – parents Patrick and Maria, sisters Elizabeth and Maria who died young, the rebellious brother Branwell, and Emily and Charlotte – are all listed. Yet, not mentioned is Anne Brontë, who is buried in Scarborough, almost 100 miles away.

Charlotte Brontë’s Jane Eyre and Emily Brontë’s Wuthering Heights are repeatedly included on lists of Britain’s favourite novels and are firmly ensconced in the popular literary canon.

Anne Brontë’s The Tenant of Wildfell Hall and Agnes Grey occasionally receive an honourable mention, but are often nowhere in sight. Like their author, they have been too frequently overlooked. Googling for articles on Anne Brontë brings up very few hits. I began to wonder: why is that?

Finding Anne

Agnes Grey, A Novel was the name of Anne’s first book, published in December 1847. She had been working on the text for many months before sending it off to the publisher Thomas Cautley Newby in July of that year. Emily’s Wuthering Heights was also accepted by Newby at the same time. It was a painful two months later that Charlotte finally found a publisher for her book, Jane Eyre.

Unluckily for her sisters, Charlotte’s publisher was more proactive than their own, and Jane Eyre became a sensation. Newby then decided to print Agnes Grey and Wuthering Heights, riding on the coattails of Charlotte’s success. More naturalistic than Charlotte’s Jane Eyre, but similarly focused on the life of a poor governess, Anne’s novel had been upstaged and was received, as the author Samantha Ellis notes, as a “pale imitation of Jane Eyre”.

Even worse, the gender-neutral pseudonyms the sisters had chosen to hide their identities (Currer, Ellis and Acton Bell), had ensured that the three books were thought to have been by only one author. Anne was not disheartened by Charlotte’s success or these authorship disputes however, and soon embarked on her second literary project.

Appallingly, many editions of Anne second and most famous work, The Tenant of Wildfell Hall, have been abridged. In 1854, overzealous publisher Thomas Hodgson slashed huge chunks of text which featured controversial subject matter detailing the protagonist’s concerns about her husband’s depraved behaviour, so that the novel would fit neatly into a single volume.

Brontë scholars declare this to be a “corrupt text”, which cuts four pages of the novel’s opening, all expletives (filler words), 25 additional paragraphs and most of chapter 28. While more recent editions of the novel have reprinted the original 1848 text, many of us, without knowing, have read the potted version.

This censorship of Anne’s text is frankly unacceptable, as poor editing aside, much contextual information which she included for a reason has been removed. Charlotte’s opinion of her sister’s book, writing in a letter in 1850 that it “hardly appears desirable to preserve”, also damaged Anne Brontë’s reputation further.

Far from Haworth

Another factor in her neglect is that Anne’s grave is miles away from the rest of her family’s. She travelled to Scarborough in 1849 in an attempt to ease the symptoms of the tuberculosis that killed her only three days after her arrival.

Only a very dedicated Brontë fan would follow in her footsteps and make the pilgrimage to Scarborough in addition to Haworth. This Yorkshire town will always be the main site of the Brontë sisters fandom as long as their home, now the Brontë Parsonage Museum, remains. Anne Brontë does not have a formal memorial in Haworth, while the rest of her family is buried there. This sets her apart even more.

Perhaps it is simply that Anne was the youngest in a remarkable family, and so in death is overlooked as she may have been in life. Or her stories are not the gothic fantasies featuring troubled and problematic literary heroes like Rochester and Heathcliff we immediately associate with the Brontë name.

Instead, Anne Brontë’s works are visceral and real, commenting unflinchingly on the dark sides of human nature: cruelty and violence to children and women, adultery, alcoholism, and coercive control being just some of the topics she covers. Contemporary reviewers called the novel “brutal” and “coarse”.

Utterly shocking at the time, with its descriptions of alcohol abuse and a female protagonist leaving her unhappy marriage, The Tenant of Wildfell Hall is often hailed as a feminist masterpiece. Yet, this does not tie into the romantic ideal readers expect. Wuthering Heights grapples with many of the same themes, but while that novel is viewed as a gothic romance, Anne Brontë’s The Tenant of Wildfell Hall is considered by many as a social-realist text.

This enduring oversight could be for all of these reasons or a combination of some. Still, I resent the descriptions of Anne by journalists such as Charlotte Cory as the “runt of the literary litter”, and urge readers and Brontë fans to give her work a chance in its own right.

The 1996 mini-series of The Tenant of Wildfell Hall is available to watch online. To me it is a travesty that it is 30 years since there was an adaptation of this novel. And there has never been a big-screen treatment of Agnes Grey, while Jane Eyre and Wuthering Heights have seen myriad film versions. A fine writer and one who is equal to her sisters, Anne Brontë deserves better.

This article features references to books that have been included for editorial reasons, and may contain links to bookshop.org; if you click on one of the links and go on to buy something, The Conversation UK may earn a commission.

Amy Wilcockson 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.

Donald Trump has paused “Project Freedom”, the US operation aimed at restoring commercial shipping through the Strait of Hormuz. In a post on social media just days after the operation was first announced, Trump said he had made the decision to give US negotiators time to reach an agreement with Iran to end the war.

Iranian state media has framed the suspension as a US failure. Iran had warned that it would target vessels attempting to enter the waterway and subsequently launched missiles and drones at civilian ships and the United Arab Emirates. It is unclear where the conflict will go from here. But whatever happens next, the role of China will be crucial.

China has kept Iran’s economy afloat in the first two months of the war. Before the war, China accounted for up to 90% of Iran’s oil exports, importing over 1 million barrels each day. Iran continued to send large amounts of crude to China during the war’s early stages, with CNBC reporting that at least 11.7 million barrels were shipped between February 28 and March 10.

Payments for Iranian oil have been processed by institutions such as China’s Bank of Kunlun and the Cross-border Interbank Payment System. These are alternatives to the US-dominated Swift global payment system that enable oil trades to be settled in yuan. This has helped Iran bypass western sanctions by putting oil revenues out of the reach of the US Treasury.

The flow of oil from Iran to China has dropped since mid-April, when the US imposed a naval blockade of Iranian ports. But China remains able to provide Iran with a revenue lifeline – albeit a more limited one – moving forward.

On May 2, China’s Ministry of Commerce ordered firms not to comply with US sanctions on five Chinese refiners linked to the Iranian oil trade. This enables the refiners to continue processing Iranian crude that arrives by train or is already outside the blockade area. Roughly 160 million barrels of Iranian crude were in transit or in floating storage at sea as of April 21.

China’s economic support for Iran is emerging as a source of friction between Washington and Beijing ahead of Trump’s upcoming summit with Chinese leader Xi Jinping. In an interview with Fox News on May 4, the US treasury secretary, Scott Bessent, said China’s continued purchases of Iranian oil amounted to funding global terrorism.

However, the influence of China over Iran’s economy gives it leverage over Tehran. And it does appear to be in the interests of China for the war to end. Rising prices are beginning to affect the Chinese economy, and helping the conflict come to an end would also assist the Chinese government in its push to present itself as the responsible global power.

China has already played an important diplomatic role in the conflict. While Pakistan has served as one of the key mediators between the US and Iran, many analysts have credited China as being the key driving force behind the April ceasefire. At that time, Iranian officials said China had asked them to show flexibility and defuse tensions.

China seems to have continued pressing Iran to negotiate with the US since then. Hours after Trump announced he was pausing the US effort to guide vessels out of the Strait of Hormuz, Iran’s foreign minister, Abbas Araghchi, met with his Chinese counterpart, Wang Yi, in Beijing. This is the first time Araghchi has travelled to China since the war broke out.

In a statement released after the meeting, the Chinese foreign ministry said: “China considers that a complete cessation of fighting must be achieved without delay … and that continuing to negotiate remains essential.” Also after the meeting Araghchi said Iran would protect its “legitimate rights and interests in the negotiations”, but will “accept a fair and comprehensive agreement”.

Chinese military support

At the same time, there are some signs that China is hedging its bets. A protracted war involving the US in the Middle East has advantages for China too, primarily because it would divert US attention from the Asia-Pacific region. Reports suggest that China is considering taking steps that would help Iran militarily if a full-blown conflict returns.

According to US intelligence, Beijing has weighed transferring air defence systems to Iran, possibly routing the shipments through other countries to mask its involvement. CNN reported in April that the defence systems in question were shoulder-fired anti-air missiles known as Manpads. China responded by saying it “has never provided weapons to any party to the conflict”.

Chinese technical assistance also enhanced the effectiveness of Iran’s military earlier in the war. Since 2021, Iran has been implementing BeiDou, a Chinese satellite navigation system. As an alternative to the US-run Global Positioning System (GPS), BeiDou has helped guide Iranian missile strikes in the conflict and has enabled more effective monitoring of US military deployments.

China has played a key role in how the conflict has played out so far. And given its position of influence over Iran, it will be a leading factor in whether the war reaches a negotiated end or spills back into open conflict.

Tom Harper 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.

The standoff in the Strait of Hormuz has already made fuel and energy noticeably more expensive. But energy prices are only part of the story.

While tensions continue between Iran and the US over that vital stretch of water, another, more subtle economic effect could come into play. “Skimpflation” is the name for a phenomenon that involves a gradual decline in the quality, quantity or service associated with everyday goods.

Unlike shrinkflation, where the size or weight of a product is reduced, skimpflation affects the value that consumers receive. It happens when companies attempt to keep prices the same while quietly reducing quality, ingredients or service levels.

So instead of raising the price of a ready meal, for example, a manufacturer may replace or reduce some of the key ingredients with cheaper substitutes. The price and packaging remain the same, but there may be less pork in your sausages, or less beef in your lasagne.

Similar adjustments can also occur in service industries. Restaurants may keep menu prices stable but switch to cheaper ingredients.

Hotels might choose to subtly cut service levels, such as housekeeping, to reduce costs (as some did during the pandemic). Airlines – already worried about jet fuel supplies – could adopt cost-saving strategies, such as reducing complimentary food or baggage allowances.

In each case, the price paid by consumers may appear unchanged, but the quality or level of service gradually declines, meaning customers effectively receive less value for the same money.

These kinds of adjustments are carefully designed to be barely noticeable. Businesses hope that consumers will continue to buy their products and use their services without being aware of the changes.

But they could become more widespread if economic circumstances mean that organisations need to make more savings. And they represent yet another economic ripple effect that comes from effectively shutting down a major oil and gas shipping corridor.

Energy levels

The world has already seen how quickly oil prices and energy markets react to the possibility of supply shortages. For countries (like the UK) which depend heavily on imported energy, these shocks function like an economic tax, raising fuel costs and inflation.

And energy costs affect nearly every stage of modern production and distribution. When fuel becomes more expensive, so does transport, running factories and producing food. A rise in oil prices can quickly evolve into a broader inflationary shock affecting shipping, logistics and industrial production.

These pressures ultimately reach consumers, but often indirectly. And businesses facing rising costs must decide how to respond. Raising prices is the most obvious option, but after several years of high inflation, many firms worry that consumers are already highly sensitive to price increases.

Eventually though, these costs must be absorbed somewhere in the system, either through higher prices or changes in quality and service.

This is why geopolitical energy shocks are often described as “inflationary events”, even if consumer price indices do not immediately capture their full impact. The real cost of living may rise not only through higher prices, but also through a decline in what those prices buy.

Economists might describe this process as a form of “hidden inflation”, where businesses respond to rising costs by quietly altering product composition or reducing service levels rather than raising prices outright. Analysis of recent cost pressures suggests that recipe reformulation, ingredient substitution and service reductions have become common strategies for firms attempting to manage higher input costs in sectors such as food manufacturing, retail and hospitality.

If instability in the Middle East continues to disrupt shipping routes and energy markets, the UK could face renewed inflationary pressures. But for households, the effects may not always appear in official statistics.

Instead, they may appear in smaller portions at restaurants, reduced service levels in hospitality, or supermarket products that look familiar but contain slightly cheaper ingredients. These incremental adjustments are harder to measure than price changes, but shape everyday consumer experiences through a gradual erosion of value.

Erhan Kilincarslan 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.

The Promoter

The promoter of this competition is The Conversation Trust (UK), a non-profit company limited by guarantee (number 08158264), with its registered office at Shropshire House (4th Floor), 11-20 Capper Street, London, WC1E 6JA. For queries about this competition, please contact climatepoetry@theconversation.com.

1. How to enter

1.1. The competition will close on September 1 at 11.59pm BST (the “Closing Date”).

1.2. All submissions to be made via the entry form and must be received no later than the Closing Date. All competition entries received after the Closing Date are automatically disqualified. No changes can be made to poems once they have been submitted.

1.3. We will not accept (a) responsibility for competition entries that are lost, mislaid, damaged or delayed in transit, regardless of cause, including, for example, as a result of any equipment failure, technical malfunction, systems, satellite, network, server, computer hardware or software failure of any kind; or (b) proof of transmission as proof of receipt of entry to the competition; or (c) entries in any language other than English or translations (d) entries that have previously been submitted to any other competition.

1.4. Poems must be a minimum of three lines and maximum of 40 lines and can follow any form. They don’t need to address a specific theme, but should be focused on communicating climate research.

1.5 By submitting a competition entry, you are agreeing to be bound by these terms and conditions.

1.6 The competition entries will be reviewed by the judging panel who will draw up a longlist based on the best entries. Winners will be selected by Helen Mort from a shortlist drawn up by the rest of the panel. The full names and credentials of all judging panel members will be made available on request after the Closing Date. The decision of the panel of judges will be final and no correspondence will be entered into regarding judging decisions

2. Eligibility

2.1 The competition is only open to researchers or academics employed by or affiliated to a university or approved research institution (IRO) in the UK, including PhD candidates under supervision by an academic.

2.2 The competition is not open to Masters students or to employees of The Conversation, their immediate families, nor any other person connected with the competition.

2.3 In entering the competition, you confirm that you are eligible to do so and eligible to claim the prize you may win. The winner must pay costs of travel to the prize themselves. You may be required to provide proof that you are eligible to enter the competition.

2.4 We will not accept competition entries that are: (a) automatically generated by computer or created by artificial intelligence (including but not limited to chatbots such as ChatGPT or similar software applications); (b) completed by third parties or in bulk; (c) illegible, have been altered, reconstructed, forged or tampered with; (d) incomplete; (e) already published or in the public domain.

2.5 There is no limit on entries, but each poem must be submitted individually. Entries on behalf of another person will not be accepted and joint submissions are not allowed.

3. The prize

3.1 The prize is as follows: five days and four nights (arrival 2pm or later on day one, departure by noon on day five) on dates to be mutually agreed, within 12 months of announcement of winner at the Little Goat Barn Writing Retreat, in the Vale of Conwy in North Wales. You’ll be welcomed and fully catered for by husband and-wife Dr Emma Claire Sweeney, author and creative writing lecturer, and Jonathan Ruppin, former literary agent and bookseller. The retreat offered is untaught. All food, non-alcoholic drink, bedding, towels and basic toiletries supplied. The retreat will likely be attended by up to four other writers of the retreat’s choosing.

3.2 There is no cash alternative for the prize and the prize is not negotiable or transferable. Winner must organise and pay for their own travel, though if travelling by rail, free collection and return by car from Chester or Chirk stations will be provided.

3.3 The retreat is provided by the owners of Little Goat Barn Writing Retreat, who hold appropriate public liability insurance and are solely responsible for the day-to-day delivery of the retreat experience. The Conversation will use reasonable endeavours to ensure the prize is awarded as described but accepts no liability for matters outside its reasonable control once the winner has been confirmed and the retreat arrangements have been communicated to the retreat owners

4. The winner

4.1 The decision of the judges is final and no correspondence or discussion will be entered into. The winner will be announced in November 2026.

4.2 We will contact the winner personally as soon as practicable after the judges have reached their decision, using the telephone number or email address provided with the competition entry.

4.3 The winner consents to their story being published on The Conversation as per its publishing terms & conditions, including a profile being created on The Conversation to accompany the work, including their first name, surname, institution and country. By winning, the winner grants The Conversation a non-exclusive licence to publish their poem under the terms described. The competition organisers must provide the surname and country of the winner to the Advertising Standards Authority on request.

5. Claiming the prize

5.1 The prize may not be claimed by a third party on your behalf.

5.2 We will make all reasonable efforts to contact the winner. If the winner cannot be contacted or is not available or has not claimed their prize within 30 of days of the Announcement Date, we reserve the right to offer the prize to the next eligible entrant selected from the shortlisted entries that were received before the Closing Date.

5.3 We do not accept any responsibility if you are not able to take up the prize.

6. Ownership of competition entries and intellectual property rights

6.1 All competition entries and any accompanying material submitted remain the property of the entrant. The winning entry will be published under the general terms and conditions of The Conversation, including under a creative commons licence. The Conversation reserves the right to make additions or deletions to the text or graphics prior to publication, or to refuse publication.

6.2 Non-winning competition entries will not be published or used by The Conversation without the express written consent of the entrant. All non-winning entries and associated personal data will be deleted within 90 days of the Announcement Date. The Conversation reserves the right to use anonymized, non-attributable excerpts or statistics about entries received (e.g. “We received over 200 entries from 50 institutions”) for promotional purposes relating to future competitions.

7. Data protection and publicity

7.1 The Promoter will process your personal data (name, email address, telephone number, and institutional affiliation) solely for the purposes of administering this competition, selecting winners, and publishing the winning entry as described in these terms and conditions. Your data will be retained until the prize has been claimed and delivered. Under UK GDPR, you have the right to access, rectify, erase, or restrict processing of your personal data. To exercise these rights or for data protection queries, please contact uk-privacy@theconversation.com. We will not use your data for marketing purposes without your separate consent

8. General

8.1 If there is any reason to believe that there has been a breach of these terms and conditions, the Promoter may, at its sole discretion, reserve the right to exclude you from participating in the competition.

8.2 We reserve the right to hold void, suspend, cancel, or amend the prize competition where it becomes necessary to do so.

8.3 These terms and conditions are governed by English law.

We’re launching a new poetry award to bring science and creativity closer together. Too often, research can stay locked in academic language – but poetry offers a powerful way to make ideas felt, not just understood. This prize is for UK-based researchers who want to explore the climate crisis through a different lens, blending insight with imagination to reach wider audiences and spark new conversations.

For this competition – the first of its kind for The Conversation – we are inviting academics to write a poem inspired by climate change research.

The climate crisis is also a communications challenge: how do we tell stories that move people, not just to fear the future, but to imagine and build a better one? That question sits at the heart of our climate storytelling series, and it’s what we want you to consider when writing your poem. The Conversation UK’s climate poetry award 2026 is all about bringing research to life in a different way.

Whether you’re an experienced poet or completely new to writing poetry, we want to hear your perspective on climate change. Your poem can draw on your own research, the work of others or your general field of expertise. Entrants to this competition must be enrolled in a research position at a university in the UK. Poems must be minimum of three lines, maximum of 40 lines. No prior poetry experience is required.

The competition will kick off with a free introductory climate poetry workshop led by poet Professor Sam Illingworth of Edinburgh Napier University on May 13. Entries close on September 1 2026 (11.59pm BST).

The poems will be reviewed by a panel of judges: Senior Environment Editor Anna Turns, Senior Arts and Culture Editor Anna Walker and Professor Sam Illingworth. The winner will be selected from a shortlist by award-winning poet Professor Helen Mort, of Manchester Metropolitan University. Judges will be looking for creativity, a point of view and clarity of research communication.

Who can enter: UK-based academics currently enrolled in a research position (including PhD candidates, postdoctoral scholars and lecturers).

What to submit: A climate-themed poem (3–40 lines) and a supporting statement of up to 250 words on the research that inspired it.

Entry window: Open for entries now until September 1 2026 (11.59pm BST).

How to enter: Via the official submission form.

Workshop: Free online climate poetry workshop on May 13 2026

Prizes: First prize: five-day stay at The Little Goat Barn Writing Retreat (North Wales). Shortlisted poems published in a The Conversation ebook anthology.

Judges: Anna Turns, Anna Walker, Professor Sam Illingworth

Final winner selected by: Professor Helen Mort

In need of inspiration? Check out some of our favourite climate poems.

The prizes

Shortlisted entries will be published in an ebook by The Conversation UK in the autumn.

The winner will be hosted for five days at the Little Goat Barn Writing Retreat, in the peaceful and beautiful countryside of the Vale of Conwy in North Wales courtesy of The Ruppin Agency. They’ll be welcomed and fully catered for by husband and wife Dr Emma Claire Sweeney, author and creative writing lecturer, and Jonathan Ruppin, former literary agent and bookseller.

While there, they will have access to the 5,000-volume library, full of places to read, write and relax, and housed in a 400-year-old converted barn vaulted with the timbers of an ancient ship – as well as space to write in their room if they prefer. As well as socialising with a small group of other writers, other activities such as hill walks, wild swimming and a film night will be on offer. See terms and conditions for full details.

The judges

Sam Illingworth is a full professor at Edinburgh Napier University, where his research and practise involve using poetry and generative AI to explore connections between science and society.

“This competition is a great way of exploring the different ways in which scientists can communicate their work outside of traditional academic publishing,” says Illingworth. “Poetry is, in my opinion, an extremely effective way of developing empathy for a subject. I hope that in writing and reading poems about the climate crisis, researchers can better understand the impact that their work is having on different audiences.”

Helen Mort is a professor of creative writing at Manchester Metropolitan University and a fellow of the Royal Society of Literature. She has published four poetry collections with Chatto & Windus and her work has won awards in the UK and Canada.

In 2024, she wrote a poetry collection called Field Notes during a research expedition to Greenland with climate scientists from Manchester Met University. These poems explored the emotional and sensory effects of the changing landscape they experienced while investigating climate change.

Enter your poem here

Terms & Conditions 2026 – please read carefully.

Many thanks to our sponsor for this competition, Little Goat Barn Writing Retreat.

Whooping cough, medically known as pertussis, is a highly contagious bacterial infection that affects the airways. It gets its common name from the “whoop” sound that some infected children make when they take a deep, gasping breath after a severe coughing fit.

The infection is caused by the bacterium bordetella pertussis, with research suggesting that as few as 140 bacterial cells may be enough to cause infection. The bacterium spreads through infected droplets, which are released when an infected person coughs or sneezes. These droplets can then settle on the lining of another person’s nose, throat or airways.

Doctors usually describe whooping cough in three stages. The first is the catarrhal phase, when symptoms resemble a cold. In this stage, many of the symptoms are similar to other respiratory infections. A person may have a stuffy or runny nose, a low-grade fever and a mild, occasional cough that gradually becomes more severe. This phase typically lasts one to two weeks.

The second stage is the paroxysmal (sudden and intense) phase. During this stage, people experience repeated bouts of uncontrolled coughing. The classic whooping sound is common in infants, but it is often absent in adults. This may be partly because adults have more control over their cough reflex and partly because a child’s larynx, or voice box, is shaped differently from an adult’s. A child’s larynx sits higher in the neck, is funnel-shaped rather than cylindrical and narrower, and has softer cartilage.

The cough can last so long that pertussis is sometimes called the “100-day cough”. It can also cause exhaustion and vomiting, which is one of the most common symptoms reported in adults. One study found that the average duration of coughing was 54 days. The final stage is convalescence, when coughing episodes become less frequent and less severe.

Because pertussis is caused by bacteria, antibiotics can be helpful, especially in the early stages of infection. They can reduce how long a person remains infectious and may reduce the severity of illness if given early enough. The infectious period usually ends 48 hours after starting appropriate antibiotics, or 21 days after the onset of coughing if treatment is not given.

Vaccination remains important because it reduces the risk of severe disease. However, vaccination does not always prevent infection, and protection can weaken over time. This means vaccinated people can still catch pertussis, although symptoms are often milder.

Pertussis cases tend to rise and fall in three to five-year cycles, with increases reported in England and other countries. Possible factors include pandemic disruption to vaccination, mutations in bordetella pertussis, waning immunity and vaccine differences.

Many countries have moved from whole-cell pertussis vaccines to acellular vaccines. A whole-cell vaccine contains killed bacterial cells, while an acellular vaccine contains selected proteins from the bacterium rather than the whole organism. Many countries have shifted to acellular vaccines because they tend to cause fewer side effects. However, they may also provide a shorter period of effective immune protection.

For many adults, whooping cough is unpleasant but manageable. For others, it can be serious. Secondary complications occur in nearly 30% of infected adults. One of the most common is pneumonia, an infection that inflames the air sacs in the lungs.

Pneumonia can develop because bordetella pertussis can directly damage the airway lining, partly by paralysing the cilia, tiny hair-like structures that clear mucus, dust and germs. Damaged cilia make the lungs less able to clear harmful bacteria, including those that cause pneumonia.

The repeated force of coughing can also damage the body. Severe coughing may cause vomiting, exhaustion, disturbed sleep and urinary incontinence. Nearly one-third of women over the age of 50 report urinary incontinence associated with pertussis infection.

Severe coughing can also lead to rib fractures, especially in older people or those with weaker bones. Repeated strain usually affects the fifth to tenth ribs. In rare cases, lung tissue can tear, causing a pneumothorax: air escapes between the lung and chest wall, causing part or all of the lung to collapse. The larynx and vocal cords can also become damaged or dysfunctional from repeated coughing.

Very rarely, severe coughing has been linked to spinal fractures, damage to the discs between vertebrae, organ herniation between the ribs and under the skin, and arterial tears that may interrupt blood supply and lead to stroke.

Some people are at higher risk of secondary complications, including those with respiratory conditions, obesity or weakened immune systems. People who smoke or have asthma may have a longer cough, a higher risk of sinus infection and more disturbed sleep.

Delayed diagnosis can be a problem because early whooping cough overlaps with many other respiratory infections, including respiratory syncytial virus, or RSV, flu and COVID. RSV is a common virus that usually causes cold-like symptoms, but it can be more serious in babies, older adults and people with underlying health conditions. One study has estimated that the misdiagnosis rate may be as high as 95% in some cases.

Although early symptoms can look similar, there are clues that may help distinguish whooping cough from other infections. Once the cough develops, whooping cough is often worse at night and can be severe enough to cause vomiting. RSV more commonly causes shortness of breath and wheezing rather than prolonged coughing bouts. Whooping cough also usually causes a low-grade fever or no fever, while RSV, particularly in high-risk adults, can cause a high fever. Timing can help too. RSV is most prevalent from late autumn to early spring, peaking in December and January.

Vaccines are available for both conditions. But antibiotics only work for whooping cough because it is bacterial rather than viral, and they are most useful when given early enough.

The main warning sign is a cough that comes in severe bouts, lasts for weeks, gets worse at night or causes vomiting. Anyone with these symptoms should seek medical advice, especially if they live with or care for babies, pregnant women, older adults or people with weakened immune systems.

Adam Taylor 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.