Seroevidence for H5N1 Influenza Infections in Humans: Meta-Analysis

23 March 2012 vol 335, issue 6075, pages 1397-1532

Seroevidence for H5N1 Influenza Infections in Humans: Meta-Analysis
Taia T. Wang, Michael K. Parides, and Peter Palese
Science 23 March 2012: 1463.
Published online 23 February 2012 [DOI:10.1126/science.1218888]

The prevalence of avian H5N1 influenza A infections in humans has not been definitively determined. Cases of H5N1 infection in humans confirmed by the World Health Organization (WHO) are fewer than 600 in number, with an overall case fatality rate of >50%. We hypothesize that the stringent criteria for confirmation of a human case of H5N1 by WHO do not account for a majority of infections but rather the select few hospitalized cases that are more likely to be severe and result in poor clinical outcome. Meta-analysis shows that 1 to 2% of more than 12,500 study participants from 20 studies had seroevidence for prior H5N1 infection.

Estimating herpes zoster vaccine protection: model choice

Volume 30, Issue 17 pp. 2707-2804 (5 April 2012)

Regular Papers
Estimating the age-specific duration of herpes zoster vaccine protection: A matter of model choice?
Original Research Article
Pages 2795-2800
Joke Bilcke, Benson Ogunjimi, Frank Hulstaert, Pierre Van Damme, Niel Hens, Philippe Beutels

The estimation of herpes zoster (HZ) vaccine efficacy by time since vaccination and age at vaccination is crucial to assess the effectiveness and cost-effectiveness of HZ vaccination. Published estimates for the duration of protection from the vaccine diverge substantially, although based on data from the same trial for a follow-up period of 5 years. Different models were used to obtain these estimates, but it is unclear which of these models is most appropriate (if any). Only one study estimated vaccine efficacy by age at vaccination and time since vaccination combined. Recently, data became available from the same trial for a follow-up period of 7 years.

Aim and methods
We aim to elaborate on estimating HZ vaccine efficacy (1) by estimating it as a function of time since vaccination and age at vaccination, (2) by comparing the fits of a range of models, and (3) by fitting these models on data for a follow-up period of 5 and 7 years.

Although the models’ fit to data are very comparable, they differ substantially in how they estimate vaccine efficacy to change as a function of time since vaccination and age at vaccination.

An accurate estimation of HZ vaccine efficacy by time since vaccination and age at vaccination is hampered by the lack of insight in the biological processes underlying HZ vaccine protection, and by the fact that such data are currently not available in sufficient detail. Uncertainty about the choice of model to estimate this important parameter should be acknowledged in cost-effectiveness analyses.

Prospective Observational Studies to Assess Comparative Effectiveness

Value in Health
March 2012, Vol. 15, No. 2

Featured Article
Prospective Observational Studies to Assess Comparative Effectiveness: The ISPOR Good Research Practices Task Force Report
Marc L. Berger, MD; Nancy Dreyer, PhD, MPH; Fred Anderson, PhD; Adrian Towse, MA; Art Sedrakyan, MD, PhD; Sharon-Lise Normand, PhD

In both the United States and Europe there has been an increased interest in using comparative effectiveness research of interventions to inform health policy decisions. Prospective observational studies will undoubtedly be conducted with increased frequency to assess the comparative effectiveness of different treatments, including as a tool for “coverage with evidence development,” “risk-sharing contracting,” or key element in a “learning health-care system.” The principle alternatives for comparative effectiveness research include retrospective observational studies, prospective observational studies, randomized clinical trials, and naturalistic (“pragmatic”) randomized clinical trials.

This report details the recommendations of a Good Research Practice Task Force on Prospective Observational Studies for comparative effectiveness research. Key issues discussed include how to decide when to do a prospective observational study in light of its advantages and disadvantages with respect to alternatives, and the report summarizes the challenges and approaches to the appropriate design, analysis, and execution of prospective observational studies to make them most valuable and relevant to health-care decision makers.

The task force emphasizes the need for precision and clarity in specifying the key policy questions to be addressed and that studies should be designed with a goal of drawing causal inferences whenever possible. If a study is being performed to support a policy decision, then it should be designed as hypothesis testing—this requires drafting a protocol as if subjects were to be randomized and that investigators clearly state the purpose or main hypotheses, define the treatment groups and outcomes, identify all measured and unmeasured confounders, and specify the primary analyses and required sample size. Separate from analytic and statistical approaches, study design choices may strengthen the ability to address potential biases and confounding in prospective observational studies. The use of inception cohorts, new user designs, multiple comparator groups, matching designs, and assessment of outcomes thought not to be impacted by the therapies being compared are several strategies that should be given strong consideration recognizing that there may be feasibility constraints. The reasoning behind all study design and analytic choices should be transparent and explained in study protocol. Execution of prospective observational studies is as important as their design and analysis in ensuring that results are valuable and relevant, especially capturing the target population of interest, having reasonably complete and nondifferential follow-up. Similar to the concept of the importance of declaring a prespecified hypothesis, we believe that the credibility of many prospective observational studies would be enhanced by their registration on appropriate publicly accessible sites (e.g., and in advance of their execution.

Global Fund announces US$340 million contribution by Japan

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a US$340 million contribution by Japan, noting that it is the “highest amount that Japan has ever made in 10 years of vigorous support for the Global Fund.” Japan is now making its first payment of US$216 million for its 2012 contribution. Gabriel Jaramillo, General Manager of the Global Fund, said, “Japan has always been a leader in the fight against disease, but this is a great vote of confidence in our commitment to saving lives. We recognize Japan’s determination to see real advances in global health, and we are equally determined to deliver.” The announcement said Japan’s leadership in the Global Fund began when a summit of G8 nations called for the creation of such a global financing organization in 2000 in Okinawa, Japan. The contribution received this week raises Japan’s contributions to the Global Fund to more than US$ 1.6 billion since its creation in 2002.

WHO SAGE: Teleconference on Decade of Vaccines 12 March 2012

- Extraordinary Meeting on Decade of Vaccines – 16-17 February 2012

- Teleconference on Decade of Vaccines 12 March 2012
Review by SAGE of how its input from the extraordinary 16-17 February meeting had been addressed


UNICEF, the UN Global Compact and Save the Children announce the Children’s Rights and Business Principles

UNICEF, the UN Global Compact and Save the Children announced the Children’s Rights and Business Principles (the Principles) – “the first comprehensive set of principles to guide companies on the full range of actions they can take in the workplace, marketplace and community to respect and support children’s rights.” The Principles “are built on existing standards, initiatives and best practices related to business and children, and seek to fill gaps to present a coherent vision for business to maximize the positive impacts and minimize negative impacts on children. In doing so, the Principles help to elaborate both expectations of, and opportunities for business, in relation to children; who are often overlooked as stakeholders of business.” The partners “launched an extensive multi-stakeholder consultation process involving business, civil society, governments and children across sectors and geographies” in developing the principles.

Download the Children’s Rights and Business Principles: لعربية  | 中文 | English | Français | Português | Русский

Press Release: A Call to Business to Respect and Support Children’s Rights

Watch UN Secretary-General Ban Ki-moon’s Message on the Children’s Rights and Business Principles

Watch an introduction video of the Children’s Rights and Business Principles

Key Documents
Background Note (January 2012)

Twitter Watch [accessed 17 March 2012 - 17:45]

Twitter Watch [accessed 17 March 2012 - 17:45]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

Sandra Rotman Centre ‏ @srcglobal
Polio transmission continues on Pakistan-Afghanistan border.
12:45 PM – 16 Mar 12 v

Eurosurveillance ‏ @Eurosurveillanc
Ongoing #measles #outbreak in Elche, Spain:
Retweeted by ECDC
11:27 AM – 16 Mar 1

RIBI ‏ @RotaryRIBI
#primeminster David Cameron awarded #Rotary‘s highest honour for commitment to ending #polio.
Retweeted by EndPolioNow
5:34 AM – 15 Mar 12

IAVI ‏ @AIDSvaccine
New brief details how IAVI works with partners to build scientific capacity: #globalhealth #HIV #vaccine
8:57 AM – 15 Mar 12

Measles Initiative ‏ @MeaslesInit
Warning from the ECDC about Ukraine measles outbreak -5,000+ cases and growing; #Euro 2012
9:51 PM – 14 Mar 12

Rotary International ‏ @rotary
Reflections on #India trip. 172 mil kids get #polio vaccine delivered by 155,000 “vehicles,” including camels.
Retweeted by EndPolioNow
3:48 PM – 14 Mar 12

RWJF PublicHealth ‏ @RWJF_PubHealth
Should flu vaccines be required for hospital workers? #publichealth
4:31 PM – 14 Mar 12

Arthur Caplan ‏ @ArthurCaplan
how to kill lots of people with anti-vaccine b.s.
9:34 AM – 14 Mar 12

The global burden of cholera

Bulletin of the World Health Organization
Volume 90, Number 3, March 2012, 157-244

The global burden of cholera
Mohammad Ali, Anna Lena Lopez, Young Ae You, Young Eun Kim, Binod Sah, Brian Maskery & John Clemens

To estimate the global burden of cholera using population-based incidence data and reports.

Countries with a recent history of cholera were classified as endemic or non-endemic, depending on whether they had reported cholera cases in at least three of the five most recent years. The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera, and incidence rates from published studies were applied to groups of countries to estimate the annual number of cholera cases in endemic countries. The estimates of cholera cases in non-endemic countries were based on the average numbers of cases reported from 2000 to 2008. Literature-based estimates of cholera case-fatality rates (CFRs) were used to compute the variance-weighted average cholera CFRs for estimating the number of cholera deaths.

About 1.4 billion people are at risk for cholera in endemic countries. An estimated 2.8 million cholera cases occur annually in such countries (uncertainty range: 1.4–4.3) and an estimated 87 000 cholera cases occur in non-endemic countries. The incidence is estimated to be greatest in children less than 5 years of age. Every year about 91 000 people (uncertainty range: 28 000 to 142 000) die of cholera in endemic countries and 2500 people die of the disease in non-endemic countries.

The global burden of cholera, as determined through a systematic review with clearly stated assumptions, is high. The findings of this study provide a contemporary basis for planning public health interventions to control cholera.

Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

Globalization and Health
[Accessed 17 March 2012]

Development cooperation for health: reviewing a dynamic concept in a complex global aid environment
Peter S Hill, Rebecca Dodd, Scott Brown and Just Haffeld
Globalization and Health 2012, 8:5 doi:10.1186/1744-8603-8-5
Published: 15 March 2012

Abstract (provisional)
The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a “new consensus on development cooperation” to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant ‘grey’ literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

GIVS: a mid-term analysis of progress in 50 countries

Health Policy and Planning
Volume 27 Issue 2 March 2012

Advance Access
Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries
Lidija Kamara1,*, Patrick Lydon1, Julian Bilous2, Jos Vandelaer3, Rudi Eggers1, Marta Gacic-Dobo1, William Meaney4 and Jean-Marie Okwo-Bele1

Author Affiliations
1Immunization Vaccines and Biologicals Department (IVB), Expanded Program on Immunization (EPI), World Health Organization, Geneva, Switzerland, 2Geneva Switzerland, 3Health Program Division, UNICEF, New York, USA, 4Athlone Institute of Technology, Athlone, Ireland
*Corresponding author. Immunization Vaccines and Biologicals Department (IVB), Expanded Program on Immunization (EPI), World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27 Switzerland. Tel: +41 22 791 2145. Fax: +41 22 791 4384.
Accepted November 29, 2011.

Within the overall framework set out in the Global Immunization Vision and Strategy (GIVS) for the period 2006–2015, over 70 countries had developed comprehensive Multi-Year Plans (cMYPs) by 2008, outlining their plans for implementing the GIVS strategies and for attaining the GIVS Goals at the midpoint in 2010 or earlier. These goals are to: (1) reach ≥90% and ≥80% vaccination coverage at national and district level, respectively; and (2) reduce measles-related mortality by 90% compared with the 2000 level. Fifty cMYPs were analysed along the four strategic areas of the GIVS: (1) protecting more people in a changing world; (2) introducing new vaccines and technologies; (3) integrating immunization, other health interventions and surveillance in the health system context; and (4) immunizing in the context of global interdependence. By 2010, all 50 countries planned to have introduced hepatitis B (HepB) vaccine, 48 the Haemophilus influenzae type B (Hib) vaccine and only a few countries had firm plans to introduce pneumococcal or rotavirus vaccines. Countries seem to be inadequately prepared in terms of cold-chain requirements to deal with the expected increases in storage that will be required for vaccines, and in making provisions to establish a corresponding surveillance system for planned new vaccine introductions. Immunization contacts are used to deliver other health interventions, especially in the countries in the World Health Organization (WHO) Africa Region. The cost for the planned immunization activities will double to U$27 per infant, of which U$5 per infant is the expected shortfall. Global Alliance for Vaccines and Immunization (GAVI) funding is becoming the largest contributor to immunization programmes.

CDC’s Center for Global Health (CGH)

The Lancet  
Mar 17, 2012  Volume 379  Number 9820  p977 – 1074  e36 – 42

The CDC’s Center for Global Health
Thomas R Frieden, Kevin M De Cock

The strategy of the recently established Center for Global Health (CGH) at the US Centers for Disease Control and Prevention (CDC) is to enhance the public health capacity of global partners, increase global health security, and maximise the health impact of specific programmes and interventions through a focus on scientific rigour, scalability, and sustainability. We welcome the opportunity to describe the work of CGH1 and are committed to continuing to increase our impact.

Opportunities and Challenges for the Life Sciences Community

OMICS: A Journal of Integrative Biology
March 2012, 16(3)

Opportunities and Challenges for the Life Sciences Community
Eugene Kolker, Elizabeth Stewart, Vural Ozdemir
OMICS: A Journal of Integrative Biology. March 2012, 16(3): 138-147.

Twenty-first century life sciences have transformed into data-enabled (also called data-intensive, data-driven, or big data) sciences. They principally depend on data-, computation-, and instrumentation-intensive approaches to seek comprehensive understanding of complex biological processes and systems (e.g., ecosystems, complex diseases, environmental, and health challenges). Federal agencies including the National Science Foundation (NSF) have played and continue to play an exceptional leadership role by innovatively addressing the challenges of data-enabled life sciences. Yet even more is required not only to keep up with the current developments, but also to pro-actively enable future research needs. Straightforward access to data, computing, and analysis resources will enable true democratization of research competitions; thus investigators will compete based on the merits and broader impact of their ideas and approaches rather than on the scale of their institutional resources. This is the Final Report for Data-Intensive Science Workshops DISW1 and DISW2. The first NSF-funded Data Intensive Science Workshop (DISW1, Seattle, WA, September 19–20, 2010) overviewed the status of the data-enabled life sciences and identified their challenges and opportunities. This served as a baseline for the second NSF-funded DIS workshop (DISW2, Washington, DC, May 16–17, 2011). Based on the findings of DISW2 the following overarching recommendation to the NSF was proposed: establish a community alliance to be the voice and framework of the data-enabled life sciences. After this Final Report was finished, Data-Enabled Life Sciences Alliance (DELSA, was formed to become a Digital Commons for the life sciences community.

Mix of Prevention Strategies against Cervical Cancer for Maximum Efficiency

April 1, 2012 – Volume 30 – Issue 4  pp: 257-353

Original Research Articles
Selecting a Mix of Prevention Strategies against Cervical Cancer for Maximum Efficiency with an Optimization Program
Demarteau, Nadia; Breuer, Thomas; Standaert, Baudouin
Pharmacoeconomics. 30(4):337-353, April 1, 2012.
doi: 10.2165/11591560-000000000-00000

Background: Screening and vaccination against human papillomavirus (HPV) can protect against cervical cancer. Neither alone can provide 100% protection. Consequently it raises the important question about the most efficient combination of screening at specified time intervals and vaccination to prevent cervical cancer.

Objective: Our objective was to identify the mix of cervical cancer prevention strategies (screening and/or vaccination against HPV) that achieves maximum reduction in cancer cases within a fixed budget.

Methods: We assessed the optimal mix of strategies for the prevention of cervical cancer using an optimization program. The evaluation used two models. One was a Markov cohort model used as the evaluation model to estimate the costs and outcomes of 52 different prevention strategies. The other was an optimization model in which the results of each prevention strategy of the previous model were entered as input data. The latter model determined the combination of the different prevention options to minimize cervical cancer under budget, screening coverage and vaccination coverage constraints.

We applied the model in two countries with different healthcare organizations, epidemiology, screening practices, resource settings and treatment costs: the UK and Brazil. 100 000 women aged 12 years and above across the whole population over a 1-year period at steady state were included.

The intervention was papanicolaou (Pap) smear screening programmes and/or vaccination against HPV with the bivalent HPV 16/18 vaccine (Cervarix® [Cervarix is a registered trademark of the GlaxoSmithKline group of companies]). The main outcome measures were optimal distribution of the population between different interventions (screening, vaccination, screening plus vaccination and no screening or vaccination) with the resulting number of cervical cancer and associated costs.

Results: In the base-case analysis (= same budget as today), the optimal prevention strategy would be, after introducing vaccination with a coverage rate of 80% in girls aged 12 years and retaining screening coverage at pre-vaccination levels (65% in the UK, 50% in Brazil), to increase the screening interval to 6 years (from 3) in the UK and to 5 years (from 3) in Brazil. This would result in a reduction of cervical cancer by 41% in the UK and by 54% in Brazil from pre-vaccination levels with no budget increase. Sensitivity analysis shows that vaccination alone at 80% coverage with no screening would achieve a cervical cancer reduction rate of 20% in the UK and 43% in Brazil compared with the pre-vaccination situation with a budget reduction of 30% and 14%, respectively. In both countries, the sharp reduction in cervical cancer is seen when the vaccine coverage rate exceeds the maximum screening coverage rate, or when screening coverage rate exceeds the maximum vaccine coverage rate, while maintaining the budget. As with any model, there are limitations to the value of predictions depending upon the assumptions made in each model.

Conclusions: Spending the same budget that was used for screening and treatment of cervical cancer in the pre-vaccination era, results of the optimization program show that it would be possible to substantially reduce the number of cases by implementing an optimal combination of HPV vaccination (80% coverage) and screening at pre-vaccination coverage (65% UK, 50% Brazil) while extending the screening interval to every 6 years in the UK and 5 years in Brazil.

Health Equity and Conclusions of Systematic Reviews

PLoS One
[Accessed 17 March 2012];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Does Consideration and Assessment of Effects on Health Equity Affect the Conclusions of Systematic Reviews? A Methodology Study
Vivian Welch, Mark Petticrew, Erin Ueffing, Maria Benkhalti Jandu, Kevin Brand, Bharbhoor Dhaliwal, Elizabeth Kristjansson, Janet Smylie, George Anthony Wells, Peter Tugwell
PLoS ONE: Research Article, published 13 Mar 2012 10.1371/journal.pone.0031360

Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research.

We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion.

Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity.

The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.

HPV Vaccine Efficacy in France and Policy Improvements

PLoS One
[Accessed 17 March 2012];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Efficacy of Vaccination against HPV Infections to Prevent Cervical Cancer in France: Present Assessment and Pathways to Improve Vaccination Policies
Laureen Ribassin-Majed, Rachid Lounes, Stephan Clémençon
PLoS ONE: Research Article, published 12 Mar 2012 10.1371/journal.pone.0032251

Seventy percent of sexually active individuals will be infected with Human Papillomavirus (HPV) during their lifetime. These infections are incriminated for almost all cervical cancers. In France, 3,068 new cases of cervical cancer and 1,067 deaths from cervical cancer occurred in 2005. Two vaccines against HPV infections are currently available and vaccination policies aim to decrease the incidence of HPV infections and of cervical cancers. In France, vaccine coverage has been reported to be low.

We developed a dynamic model for the heterosexual transmission of Human Papillomavirus types 16 and 18, which are covered by available vaccines. A deterministic model was used with stratification on gender, age and sexual behavior. Immunity obtained from vaccination was taken into account. The model was calibrated using French data of cervical cancer incidence.

In view of current vaccine coverage and screening, we expected a 32% and 83% reduction in the incidence of cervical cancers due to HPV 16/18, after 20 years and 50 years of vaccine introduction respectively. Vaccine coverage and screening rates were assumed to be constant. However, increasing vaccine coverage in women or vaccinating girls before 14 showed a better impact on cervical cancer incidence. On the other hand, performing vaccination in men improves the effect on cervical cancer incidence only moderately, compared to strategies in females only.

While current vaccination policies may significantly decrease cervical cancer incidence, other supplementary strategies in females could be considered in order to improve vaccination efficacy.

Guidance for Evidence-Informed Policies about Health Systems [2.0]

PLoS Medicine
(Accessed 17 March 2012)

Guidance for Evidence-Informed Policies about Health Systems: Linking Guidance Development to Policy Development
John N. Lavis, John-Arne Røttingen, Xavier Bosch-Capblanch, Rifat Atun, Fadi El-Jardali, Lucy Gilson, Simon Lewin, Sandy Oliver, Pierre Ongolo-Zogo, Andy Haines Policy Forum, published 13 Mar 2012

Summary Points
- Contextual factors are extremely important in shaping decisions about health systems, and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance.

- A division of labour between global guidance developers, global policy developers, national guidance developers, and national policy developers is needed to support evidence-informed policy-making about health systems.

- A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level.

- Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development.

- Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses.

This is the second paper in a three-part series in PLoS Medicine on health systems guidance.

Intent to receive HPV vaccine: 2006–2008 National Survey of Family Growth

Volume 30, Issue 16 pp. 2605-2706 (30 March 2012)

Regular papers
Intent to receive HPV vaccine and reasons for not vaccinating among unvaccinated adolescent and young women: Findings from the 2006–2008 National Survey of Family Growth
Original Research Article
Pages 2676-2682
Nicole C. Liddon, Julia E. Hood, Jami S. Leichliter

Background and purpose
HPV vaccine coverage for females has increased in the U.S., although challenges to achieving high coverage remain. HPV vaccine coverage continues to lag behind that of other routinely recommended adolescent vaccines and these gaps in coverage are widening. To inform strategies to improve uptake, we explore correlates of vaccine intention and describe reasons for refusing HPV vaccination among unvaccinated females in a nationally representative sample of adolescents and young adults during early stages of HPV vaccine availability.

In 2007–2008, 1243 females aged 15–24 years were asked about HPV vaccination in the National Survey of Family Growth (NSFG). For unvaccinated women (n = 955), we evaluated demographic and sexual behavior correlates of likelihood to receive the vaccine in the next 12 months in bivariate and multivariable analyses by age. Correlates to the main reasons for foregoing vaccination are described.

A minority (42.5%) of unvaccinated respondents said they intended to receive HPV vaccine in the next 12 months: 37.6% of adolescents (15–19 years) and 42.0% of young adults (20–24 years). Sexually experienced women were more than twice as likely as non-sexually experienced women to intend to receive HPV vaccine (15–19 years: aOR = 2.39, 95% CI = 1.15, 4.94; 20–24 years: aOR = 2.17, 95% CI = 1.08, 4.33). Having health insurance was associated with being likely to receive HPV vaccine among adolescents. Hispanic young adults were more likely than non-Hispanic Whites to be likely to receive HPV vaccine. The belief of not being at risk for HPV and institutional barriers were the two most commonly cited reasons for foregoing vaccination. Among unvaccinated women who did not intend to get vaccinated, respondents who never had sex were more likely to report not being at risk as the main reason for not needing the vaccine compared to women with sexual experience (44.5 vs. 24.4%) but this finding was only marginally significant in our limited sample.

In the first years immediately post-licensure of an HPV vaccine, the majority of unvaccinated women indicated that they were unlikely to seek vaccination. Intent to receive the HPV vaccine is tied to sexual experience and most women who do not intend to get vaccinated and have never had sex believe they are not at risk of HPV or do not need an HPV vaccine. These findings highlight the need to better communicate information regarding lifetime risk for HPV and the importance of receiving HPV vaccine prior to sexual initiation. These findings should inform strategies to increase vaccine uptake.

Contribution of Immunization Week: childhood vaccinations in Assam, India

Volume 30, Issue 15 pp. 2499-2604 (28 March 2012)

Regular papers
Contribution of Immunization Weeks toward improving coverage, access to services, and completion of recommended childhood vaccinations in Assam, India
Original Research Article
Pages 2551-2555
Tove K. Ryman, Ajay Trakroo, J.B. Ekka, Margaret Watkins

Recommended childhood vaccines have typically been provided through routine immunization programs. Recently, implementation of strategies that use campaign-like features for providing all the recommended childhood immunizations have been utilized to increase vaccination coverage. Between January 2006 and January 2008, Assam, India, conducted Immunization Weeks (IWs), a periodic campaign-like approach for providing the recommended childhood vaccines generally administered through the routine Universal Immunization Program (UIP). Using data from a household vaccination coverage survey conducted in 5 districts of Assam in late-2007/early-2008 among children 12–28 months of age, a secondary analysis was conducted for a subset of children with vaccination cards to assess the impacts of implementing the IW-strategy. Sixty-five percent of the 3310 surveyed children received at least one vaccine dose through an IW. Without IWs, coverage would likely have been lower for all vaccines (e.g., 75% measles vaccine coverage including IWs doses and an estimated 61% without IWs). The proportion of children receiving at least one IW dose was significantly different depending on the child’s residence; 72% in hard-to-reach char areas, 66% in rural areas and 53% in urban areas (p = 0.01). Overall, 2085 (63%) of children were fully vaccinated; of these 60% received a combination of IW and UIP doses, 35% received doses only through the UIP, and 5% received doses only through IWs. A delay in administration later than the recommended ages was found for both UIP doses and for IW doses (e.g., for measles vaccine, UIP doses were 6.9 weeks delayed and IW doses 13.6 weeks delayed). Among this sample of vaccinated children, IWs appeared to increase vaccination coverage and improve access to services in hard-to-reach areas. However, the UIP appeared to be a better system for ensuring that children received all doses in the recommended vaccination series.

Cost-effectiveness: live oral pentavalent reassortant rotavirus vaccine in Ghana

Volume 30, Issue 15 pp. 2499-2604 (28 March 2012)

Regular papers
Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Ghana
Original Research Article
Pages 2582-2587
Collette Abbott, Benjamin Tiede, George Armah, Adel Mahmoud

Globally, rotavirus gastroenteritis is the most common identifiable cause of severe diarrhea in children under 5. Recently introduced rotavirus vaccines from Merck & Co. and GlaxoSmithKline have the potential to save hundreds of thousands of lives. Efficacy results in Ghana suggest Merck & Co.’s live oral pentavalent rotavirus vaccine (RotaTeq®) prevents 65.0% of severe gastroenteritis due to rotavirus infection in children under 5. The announcement by Merck and GSK to make their rotavirus vaccines available for developing nations at reduced prices provides Ghana with the opportunity to introduce rotavirus vaccines into the national immunization program after investigation of the medical, economic and political implications.

We estimated the average costs of treating children with diarrhea in the Ashanti region of Ghana as inpatients and outpatients. Using these results, data from rotavirus surveillance studies, and recent rotavirus vaccine efficacy evaluation, we estimated the cost-effectiveness of introducing RotaTeq in Ghana.

Based on our prospective calculations, we estimated an average inpatient and outpatient costs of $233.97 and $17.09, respectively, for treating childhood diarrhea. Using the 2003 birth cohort, RotaTeq introduction could save 1554 lives and avert 93,109 disability-adjusted life-years (DALYs) annually. At a market price of $5 per dose, introducing RotaTeq would have a base-case cost of $62.26 per DALY averted, at a market price of $3.50 per dose, a base-case cost of $39.59 per DALY averted and at market cost of $1 per dose, a base-case cost of $1.81 per DALY averted. All three values are below the 2009 Ghana per capita GDP. Thus, RotaTeq introduction into Ghana will be very cost-effective. Sensitivity analyses suggest these results are robust.

RotaTeq vaccination for children under five in Ghana would be a highly cost-effective public health intervention. Ghanaian health officials should seek GAVI funding and evaluate how to maximize RotaTeq access.

NITAG in Côte d’Ivoire: Process and lessons learned

Volume 30, Issue 15 pp. 2499-2604 (28 March 2012)

Regular papers
Establishment of a National Immunization Technical Advisory Group in Côte d’Ivoire: Process and lessons learned
Original Research Article
Pages 2588-2593
Julia Blau, Papa Coumba Faye, Kamel Senouci, Simplice Ncho Dagnan, Alfred Douba, Jeanine Tagliante Saracino, Bradford D. Gessn

In January 2010, Côte d’Ivoire became the first GAVI-eligible country in sub-Saharan Africa to establish a National Immunization Technical Advisory Group (NITAG). The Côte d’Ivoire “National Committee of Independent Experts for Vaccination and Vaccines” (CNEIV-CI) was created to strengthen national capacity for evidence-based policy decisions with regard to immunization and vaccines. The primary reasons for success in Côte d’Ivoire were a strong political will, the availability of sufficient national expertise, a step-by-step country-driven process, and the provision of technical assistance to the Ministry of Health. The challenges included operating within the socio-political crisis, and initial reluctance from some stakeholders due to the potential overlap with other existing committees. The latter rapidly dissolved over the course of numerous meetings held with the SIVAC Initiative to clarify the mandate of a NITAG.

Barriers to and facilitators of child influenza vaccine

Volume 30, Issue 14 pp. 2397-2498 (23 March 2012)

Regular Papers
Barriers to and facilitators of child influenza vaccine – Perspectives from parents, teens, marketing and healthcare professionals
Original Research Article
Pages 2448-2452
Kavitha Bhat-Schelbert, Chyongchiou Jeng Lin, Annamore Matambanadzo, Kristin Hannibal, Mary Patricia Nowalk, Richard K. Zimmerma

The CDC recommends annual influenza vaccination for all children age 6 months and older, yet vaccination rates remain modest. Effective strategies to improve influenza vaccination for children are needed.

Eight focus groups with 91 parents, teens, pediatric healthcare staff and providers, and immunization and marketing experts were conducted, audiotaped, transcribed verbatim, and coded based on grounded theory.

Three themes emerged: barriers, facilitators, and strategies. Barriers included fear, misinformation, and mistrust, with exacerbation of these barriers attributed to media messages. Many considered influenza vaccination unnecessary and inconvenient, but would accept vaccination if recipients or other family members were considered high risk, if recommended by their doctor or another trusted person, or if offered or mandated by the school. Access to better information regarding influenza disease burden and vaccine safety and efficacy were notable facilitators, as were prevention of the inconvenience of missing work or important events, and if the child requests to receive the vaccine. Marketing strategies included incentives, jingles, videos, wearable items, strategically-located information sheets or posters, and promotion by informed counselors. Practice-based strategies included staff buy-in, standing orders protocols, vaccination clinics, and educational videos. Teen-specific strategies included message delivery through schools, texting, internet, and social networking sites.

To improve influenza vaccination rates for children using practice-based interventions, participants suggested campaigns that provide better information regarding the vaccine, the disease and its implications, and convenient access to vaccination. Strategies targeting adolescents should use web-based social marketing technologies and campaigns based in schools.

Is the AMC motivating innovation and increasing manufacturing capacity?

Volume 30, Issue 14 pp. 2397-2498 (23 March 2012)

Regular Papers
Is the pneumococcal vaccine Advance Market Commitment motivating innovation and increasing manufacturing capacity? Some preliminary answers
Original Research Article
Pages 2462-2466
Jens Plahte

This paper seeks to give some preliminary evidence on the potential outcome of the pneumococcal vaccine Advance Market Commitment (AMC), with a focus on its impact on innovation in ‘emerging’ vaccine manufacturers in developing countries.

The evidence is derived from a series of interviews with executives at industrial vaccine developing organizations with pneumococcal vaccines in their R&D portfolio, including both multinational pharmaceutical companies and ‘emerging’ manufacturers.

The main findings are that so far there is no evidence to support any claim that the AMC is speeding innovation of pneumococcal vaccines, or that it is contributing to productive capacity expansion. Representatives of emerging manufacturers consistently state that the AMC is either irrelevant or inappropriate for supporting their innovative activities on pneumococcal vaccines.

Acceptability and uptake of HPV vaccine in Argentina

Volume 30, Issue 14 pp. 2397-2498 (23 March 2012)
Regular Papers
Acceptability and uptake of HPV vaccine in Argentina before its inclusion in the immunization program: A population-based survey

Original Research Article
Pages 2467-2474
Silvina Arrossi, Veronica Maceira, Melisa Paolino, Rengaswamy Sankaranarayanan

In Argentina, human papillomavirus (HPV) vaccination was approved in 2006, but not included in the National Immunization Program. In 2008 a mass media campaign was carried out by a cancer Non-Governmental Organization (NGO), but it was stopped due to criticisms about the publicity. In October 2011 the Ministry of Health (MoH) has introduced HPV vaccination in the National Immunization Program. In this context, to assure high HPV vaccine coverage, evidence is needed on factors both associated to vaccine acceptability and uptake. In 2009–2010 we carried out a population-based survey among a representative sample of 1200 women aged 18–49 years from the Metropolitan Area of Buenos Aires. The objective was twofold: first to analyze socio-demographic determinants of women’s knowledge on HPV vaccine and secondly, determinants of actual HPV vaccine uptake and acceptability in Argentina after the above-mentioned vaccine advertising shown in mass media in the year 2008.

We analyzed vaccine uptake/acceptability separately for women and for their daughters aged 9–15, and willingness to vaccinate one’s daughter younger than 9 to receive future HPV vaccination.

Results of the 1200 women interviewed, 438 women (36.5%) knew the HPV vaccine and 303 (25%) remembered the mass media advertisement about HPV vaccination. When asked whether she would get vaccinated after having seen/heard the advertisement, around 75% (n = 226) of women answered surely/probably yes. No significant differences in socio-demographic characteristics were found among women who would or not get vaccinated. When surveyed, 6 women had been vaccinated. Main reasons for non-vaccination were: “Doctor did not mention/recommend it” (34.1%) and “Vaccine is too expensive” (15.7%). No woman had had their 9–15 year-old daughter vaccinated. Among women who only had at least one daughter under 9 (n = 278), 74% answered that they would get their daughter vaccinated if they were pre-adolescents.

The conclusion is that, in Argentina, the potential acceptability of the vaccine is high, given that there is acceptance among the professional community, physicians recommend it, and vaccine is affordable.

Global Fund: Germany contribution “a clear endorsement”

The Global Fund said an announcement by Germany of a EUR50 million contribution “was a clear endorsement of new measures to improve financial oversight and management.” Last year, Germany suspended contributions to the Global Fund, but now has made the first quarterly payment of a EUR200 million contribution this year and “was confident that (it) would make all its payments this year if the pace of reform is maintained.” Global Fund General Manager Gabriel Jaramillo commented, “We are committed to do even better what we already do best, which is to save lives. We want to assure…that German taxpayer money is being handled effectively to achieve the best possible results.” Germany is described as the fourth largest donor to the Global Fund, having pledged over EUR1.5 billion since 2002. This includes EUR 600 million for the period 2011-13, in yearly installments of EUR 200 million each. The Global Fund media release noted that “In his first month at the Global Fund, Mr. Jaramillo has streamlined its organizational structure and sharpened the focus on grant management in countries with the highest burden of disease…”

IVI receives two patents on shigellosis

The International Vaccine Institute (IVI) said it was recently issued two patents on shigellosis by the United States Patent and Trademark Office marking “a milestone in its aim to prevent and control dysentery (also commonly called shigellosis or bloody diarrhea), a deadly disease that affects several million people worldwide.” The two patents “will accelerate the Institute’s current efforts in developing an effective and low-cost vaccine for use among impoverished communities afflicted by dysentery.” IVI noted that the disease, caused by the bacterial pathogen Shigella, is a major health problem in developing countries, as young children are particularly vulnerable to the disease.  Dr. Cecil Czerkinsky, IVI’s Deputy Director-General of Laboratory Sciences, and Dr. Dong Wook Kim, Associate Professor at Hanyang University and former IVI scientist, reported the original discovery of the Shigella common protein antigens in a provisional patent application filed in October 2008. Dr. Czerkinsky commented, “We are extremely excited about the issuance of the Shigella vaccine patents. It further reinforces our belief that these common proteins, through their immunological properties, may be highly effective in preventing shigellosis, a diarrheal disease that claims countless lives of children every year, mainly in developing countries.” Dr. Christian Loucq, IVIs Director-General, commented, “This patent issuance is an important milestone on IVI’s path of delivering a new vaccine against another killer infectious disease. Furthermore, it underlies the dynamism and productivity of IVI scientists.”

GSK and Daiichi Sankyo form joint venture – largest vaccines company in Japan

GSK announced a joint venture (JV with Daiichi Sankyo Co., Ltd. to form the largest vaccines company in Japan. The JV “will hold the development and commercial rights for already existing preventative vaccines from both parent companies (and) supply globally recommended vaccines to help protect people of all ages in Japan including Human Papillomavirus (HPV) vaccine, Rotavirus vaccine, Seasonal flu vaccine, Mumps vaccine, Diphtheria Pertussis (DTP) vaccine, and Measles Rubella (MR) vaccine.” Both companies will sell their respective vaccines into the JV at agreed upon prices and will have an equal stake in the joint venture. Christophe Weber, President Designate of GlaxoSmithKline Vaccines, commented, “This collaboration marks another step in our strategy to build our presence in key growth markets and will create the first and largest company dedicated solely to vaccines in Japan. We are very pleased to be partnering with Daiichi Sankyo, a highly regarded company and an established leader in Japan.  Both companies have strong track records in commercialisation and, in combination, will create further significant economies of scale in the development and distribution of vaccines in the Japanese market.”

Twitter Watch [accessed 10 March 2012 15:05]

Twitter Watch  [accessed 10 March 2012 15:05]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

PAHO/WHO Equity ‏ @eqpaho
Inside the black box: modelling health care financing reform in data-poor contexts
Retweeted by Amanda Glassman
8:06 PM – 9 Mar 12

Measles Initiative ‏ @MeaslesInit
Nepal’s women health volunteers spread the word to every mountain
5:11 AM – 9 Mar 12

UN Foundation ‏ @unfoundation
RT @un_women: “I urge gov’ts, civil society & private sector to commit to empowerment of #women as fundamental #humanright“- #UN Sec-Gen #IWD
5:01 PM – 8 Mar 12

History of Vaccines ‏ @historyvaccines
An Anti-Vaccination Hymn? From the Anti-Vaccination Society of America, ca 1900 #vaxfax #vaccine #smallpox
10:59 AM – 8 Mar 12

PATH MVI ‏ @MalariaVaccine
More information about the Vaccine Formulation Center that opened in Pune, India:
3:05 PM – 7 Mar 12

Doctors w/o Borders ‏ @MSF_USA
Measles Takes its Toll in #Somalia MSF awaiting permission from authorities to conduct vaccination campaigns.
2:08 PM – 7 Mar 12

The Lancet ‏ @TheLancet
Recently established @CDCGlobal plans to build on @CDCgov 60-year history of evidence-based global health programmes
1:31 PM – 7 Mar 12

Seth Berkley ‏ @GAVISeth
GAVI’s HPV Vaccine program for LDCs was selected as one of the “Women Deliver 50” in Technologies and Innovations
10:22 AM – 7 Mar 12

Mapping for economic evaluation

British Medical Bulletin
Volume 101 Issue 1 March 2012

Mapping for economic evaluation
Ling-Hsiang Chuang and Sarah J. Whitehead
Br Med Bull (2012) 101(1): 1-15 doi:10.1093/bmb/ldr049

Introduction/background Mapping provides a statistical algorithm that allows the estimation of utilities and consequently calculation of QALYs in clinical studies where preference-based measures are not implemented.

Sources of data Reviews of the mapping literature were utilized.

Areas of agreement Mapping requires similar populations between the estimation and study data sets, with a high degree of overlap between the target and base measures being desirable. The National Institute for Health and Clinical Excellence recognizes mapping as a method to provide utility information.

Areas of controversy Issues surrounding mapping include the descriptive system of the measure, the appropriate econometric method and model specification.

Growing points There is a need for further research into the issue of over-prediction for severe health states and uncertainty around the estimated utility scores.

Areas timely for developing research Mapping continues to be an important area of research for economic evaluation, in particular validation of mapping functions.

Is the QALY blind, deaf and dumb to equity? NICE’s considerations over equity

British Medical Bulletin
Volume 101 Issue 1 March 2012

Is the QALY blind, deaf and dumb to equity? NICE’s considerations over equity
M. O. Soares
Br Med Bull (2012) 101(1): 17-31 doi:10.1093/bmb/lds003

The quality-adjusted life year (QALY) is the preferred measure of health outcome used to inform decisions over the use of health care interventions in the UK NHS. This measure considers the overall impact of alternative interventions on both the quantity and quality of life.

Sources of data
Review of the relevant literature.

Areas of agreement
The QALY assumes that health improvement is equally valued between individuals.

Areas of controversy
Some can perceive as equitable, that is fair, the assumption that health improvement is equally valued between individuals in the QALY. However, others may believe that this assumption leaves no space for alternative views over equity to be explicitly considered in societal decision making.

Growing points
The role of equity in decision making in the UK has been subject of intense debate, and controversy, and to-date there is no consensus on whether, or how, should NICE should change their general process.

Areas timely for developing research
Further examination of the issues needs to be debated and researched.

Money or Die: A Watershed Moment for Global Public Health

Foreign Affairs

Money or Die: A Watershed Moment for Global Public Health
Laurie Garrett
March 6, 2012

Extract (first paragraphs)
Over the last three decades, public funding for global health organizations has dried up. Private companies are writing checks to fill the gap, and, accordingly, they are bending the agenda toward their interests. Realigning priorities, however, will mean getting more private firms involved, not less.

In relative terms, the funds required are not large. Combined charitable giving for all causes by individuals in the United States and the United Kingdom hit $300 billion in 2011, but the bulk of this giving goes to domestic issues, and what goes to foreign causes is often dominated by surges of support for relief efforts for shocking natural disasters. Total estimated expenditures worldwide on health care in 2010, meanwhile, hit $5.3 trillion, with U.S. domestic spending accounting for nearly half of that. Even at its recent peak, the amount of money spent on the health of the world’s poorest people, who suffer most of humanity’s infectious and preventable diseases, represented merely .0005 percent of worldwide health spending.

Like it or not, the burden of reducing suffering and increasing the health of the world’s poor now falls largely on the backs of the two Washingtons. The Gates Foundation is doing extraordinary work, but it operates without accountability or transparency and needs competition. Bill Gates has admitted as much himself in multiple interviews, acknowledging that his efforts wield an uncomfortably large amount of unchallenged power over global health. So far, Congress has spared global health drastic budget cuts, but the White House 2013 budget request signals that pressure for reductions is building. It would be a catastrophe were the “age of generosity” to end so soon after it began, leaving millions without life-sparing medicines and tools they have come to rely upon….

Book Review: History of Vaccine Development

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 8, Issue 3  March 2012

Book Review
History of Vaccine Development by Stanley A. Plotkin (Editor)
Volume 8, Issue 3   March 2012
Jose Esparza

This book (History of Vaccine Development, edited by Stanley Plotkin, Springer, 2011, 349 pages) collects the personal perspectives of selected scientists who were instrumental in the development of a number of current vaccines. The editor of this book, Stanley Plotkin, is an emeritus professor of the University of Pennsylvania and at the Wistar Institute. He developed the rubella vaccine and has worked extensively in the development and application of many other vaccines. The book originates from information discussed at a meeting convened by Dr. Plotkin in Paris in 1995 which, unfortunately, has not been widely disseminated until now. Some of the participants have passed away since the meeting was held and, as Dr. Plotkin indicates, that makes their account even more important for future generation of vaccinologists. There are so many lessons to be learned from those individuals who actually developed vaccines. As the Spanish-born philosopher, novelist, and poet George Santayana said, “Those who cannot remember the past are condemned to repeat it.” But, perhaps more importantly, this book should also provide guidance and inspiration to future vaccinologists so that they can build on the successes of the past.

Social determinant impacts on immunization programs

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 8, Issue 3  March 2012

The effect of social determinants on immunization programs
Volume 8, Issue 3   March 2012
Aharona Glatman-Freedman and Katherine Nichols

Vaccine preventable diseases have been responsible for a significant portion of childhood mortality in low-income countries, and have been re-emerging in medium- and high-income countries. The effectiveness of routine childhood immunization programs relies on multiple factors. Social determinants have the potential to affect immunization programs around the world, with globalization and ease of communication facilitating their effect. Exploring the types of social determinants affecting immunization efforts in various countries is of great importance to the ability of nations to address them, prevent the spread of disease and lower mortality rates. The social determinants affecting vaccination programs can vary among countries of different income levels, with some social determinants overlapping among these country groups. In this article we explore the various social determinants affecting routine immunization programs in low-, middle- and high-income countries and possible interventions to address them.

Public health and economic benefits: new pediatric influenza vaccination programs – Argentina

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 8, Issue 3  March 2012

Research Paper
Public health and economic benefits of new pediatric influenza vaccination programs in Argentina
Volume 8, Issue 3   March 2012
Norberto Giglio, Angela Gentile, Lydia Lees, Paula Micone, Judith Armoni, Camille Reygrobellet and Pascal Crepey

Argentina’s population was heavily affected by the 2009 influenza pandemic, particularly children, in whom incidence of seasonal influenza is consistently high. Following the pandemic, Argentinean national recommendations for pediatric vaccination against A/H1N1 influenza were defined for all children aged up to five years, in line with programs implemented by national authorities elsewhere. Economic evaluations have found that vaccination programs for this population against seasonal influenza are cost-effective, if not cost-saving in many countries. Recently, Argentina decided to routinely vaccinate against influenza children aged 6–23 mo-old. But, the economic value of such strategies for the country has never been assessed.

A model was developed to assess the value of four different vaccination strategies: (1) no pediatric vaccination; (2) vaccination of 6–23 mo-old children; (3) vaccination of 6–36 mo-old children; (4) vaccination of 6 mo−5 y-old children. We first estimate community health benefits of vaccination then we evaluate the economic and quality-of-life impact of these strategies on the population. Data used in the model come from surveillance networks, published literature, national databases, and retrospective hospital-based data.

Pediatric influenza vaccination benefited not only children but also the overall community, due to decreased disease transmission. Our results showed that the recent decision by Argentina to vaccinate 6–23 mo-old children is cost-effective as would be the incremental vaccination of broader age groups.

Results from this study are consistent with previous analyses in other countries confirming that implementing influenza pediatric vaccination programs can be highly cost-effective through individual- and community protection against the disease.

Plant-derived vaccines against cervical cancer

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 8, Issue 3  March 2012

Plant-derived vaccines: An approach for affordable vaccines against cervical cancer
Volume 8, Issue 3   March 2012
Mohammad Tahir Waheed, Johanna Gottschamel, Syed Waqas Hassan and Andreas Günter Lössl

Several types of human papillomavirus (HPV) are causatively associated with cervical cancer, which is the second most common cancer in women worldwide. HPV-16 and 18 are among the high risk types and responsible for HPV infection in more than 70% of the cases. The majority of cervical cancer cases occur in developing countries. Currently available HPV vaccines are expensive and probably unaffordable for most women in low and middle income countries. Therefore, there is a need to develop cost-effective vaccines for these countries. Due to many advantages, plants offer an attractive platform for the development of affordable vaccines. These include low cost of production, scalability, low health risks and the potential ability to be used as unprocessed or partially processed material. Among several techniques, chloroplast transformation is of eminent interest for the production of vaccines because of high yield of foreign protein and lack of transgene transmission through pollen. In this commentary, we focus on the most relevant aspects of plant-derived vaccines that are decisive for the future development of cost-effective HPV vaccines.

A Human Challenge Model for Mycobacterium tuberculosis

Journal of Infectious Diseases
Volume 205 Issue 7 April 1, 2012

Hazel M. Dockrell
Editor’s Choice: A New Challenge for the Tuberculosis Vaccine Community?
J Infect Dis. (2012) 205(7): 1029-1031 doi:10.1093/infdis/jis016

The tuberculosis vaccine community has much to occupy it at this time. Two recombinant BCG vaccines currently in clinical trials are designed to improve the protection given by Mycobacterium bovis bacille Calmette-Guérin (BCG) and hoped to be safer in human immunodeficiency virus (HIV)–infected infants as are a number of novel vaccines designed to boost the immunity given by BCG (or an improved priming vaccine), including viral vectors expressing key antigens of M. tuberculosis and fusion proteins in adjuvant [1]. The pipeline of vaccines in phase I and phase II trials is supported by a number of promising vaccines in early-stage development. However, even in settings with the highest incidence of tuberculosis, large-scale and very costly trials will be needed to determine the efficacy of a new tuberculosis vaccine. The development of these vaccines is hampered by our current inability to identify biosignatures or correlates of protection that would be induced by a protective tuberculosis vaccine. This limitation has been identified as a roadblock by many in the field, including in the new Integrated Roadmap for Tuberculosis Research published by the Stop TB Partnership and the World Health Organization in November 2011 [2]. Minassian et al [3], in this issue of the Journal, reports a new approach that could lead to new insights, in which BCG vaccination has been used as a challenge.

In other fields, an infectious challenge has been used to test new vaccines, bypassing the need for correlates of protection (eg, for malaria using bites from infected mosquitoes [4], influenza [attempted as far back as 1918 and successful in 1936] [5], diarrhea-inducing enterotoxigenic Escherichia coli [6], dengue [7], Campylobacter jejuni [8 …

Angela M. Minassian, Iman Satti, Ian D. Poulton, Joel Meyer, Adrian V. S. Hill, and Helen McShane
Editor’s Choice: A Human Challenge Model for Mycobacterium tuberculosis Using Mycobacterium bovis Bacille Calmette-Guérin
J Infect Dis. (2012) 205(7): 1035-1042 doi:10.1093/infdis/jis012

(See the editorial commentary by Dockrell)

There is currently no safe human challenge model of  Mycobacterium tuberculosis infection to enable proof-of-concept efficacy evaluation of candidate vaccines against tuberculosis. In vivo antimycobacterial immunity could be assessed using intradermal Mycobacterium bovis bacille Calmette-Guérin (BCG) vaccination as a surrogate for M. tuberculosis infection.

Healthy BCG-naive and BCG-vaccinated volunteers were challenged with intradermal BCG. BCG load was quantified from skin biopsy specimens by polymerase chain reaction (PCR) and culture colony-forming units. Cellular infiltrate was isolated by suction blisters and examined by flow cytometry. Prechallenge immune readouts were correlated with BCG load after challenge.

In BCG-naive volunteers, live BCG was detected at the challenge site for up to 4 weeks and peaked at 2 weeks. Infiltration  of mainly CD15+ neutrophils was observed in blister fluid. In previously BCG-vaccinated individuals, PCR analysis of skin biopsy specimens reflected a degree of mycobacterial immunity. There was no significant correlation between BCG load after challenge and mycobacterial-specific memory T cells measured before challenge by cultured enzyme-linked immunospot assay.

This novel experimental human challenge model provides a platform for the identification of correlates of antimycobacterial immunity and will greatly facilitate the rational down-selection of candidate tuberculosis vaccines. Further evaluation of this model with BCG and new vaccine candidates is warranted.

Public-private partnerships need honest brokering

Nature Medicine
March 2012, Volume 18 No 3 pp323-467

Public-private partnerships need honest brokering
Michel Goldman

Given the current challenges in research and development, it’s increasingly apparent that collaboration between large pharmaceutical companies, academic teams and biotechnology enterprises is essential for converting basic biomedical discoveries into lifesaving medicines. But these partnerships work best when a neutral third party helps foster them.

US Public Support for 2009 H1N1 Vaccine Donation to Poorer Countries

PLoS One
[Accessed 10 March 2012];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

US Public Support for Vaccine Donation to Poorer Countries in the 2009 H1N1 Pandemic
Supriya Kumar, Sandra Crouse Quinn, Kevin H. Kim, Karen M. Hilyard
Research Article, published 06 Mar 2012 10.1371/journal.pone.0033025

During the 2009 H1N1 pandemic, the global health community sought to make vaccine available “in developing nations in the same timeframe as developed nations.” However, richer nations placed advance orders with manufacturers, leaving poorer nations dependent on the quantity and timing of vaccine donations by manufacturers and rich nations. Knowledge of public support for timely donations could be important to policy makers during the next pandemic. We explored what the United States (US) public believes about vaccine donation by its country to poorer countries.

Methods and Findings
We surveyed 2079 US adults between January 22nd and February 1st 2010 about their beliefs regarding vaccine donation to poorer countries. Income (p = 0.014), objective priority status (p = 0.005), nativity, party affiliation, and political ideology (p<0.001) were significantly related to views on the amount of vaccine to be donated. Though party affiliation and political ideology were related to willingness to donate vaccine (p<0.001), there was bipartisan support for timely donations of 10% of the US vaccine supply so that those “at risk in poorer countries can get the vaccine at the same time” as those at risk in the US.

We suggest that the US and other developed nations would do well to bolster support with education and public discussion on this issue prior to an emerging pandemic when emotional reactions could potentially influence support for donation. We conclude that given our evidence for bipartisan support for timely donations, it may be necessary to design multiple arguments, from utilitarian to moral, to strengthen public and policy makers’ support for donations.

Workforce Shift and School Closure for Mitigating the Spread of Influenza

PLoS One
[Accessed 10 March 2012];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Evaluating Temporal Factors in Combined Interventions of Workforce Shift and School Closure for Mitigating the Spread of Influenza
Tianyou Zhang, Xiuju Fu, Stefan Ma, Gaoxi Xiao, Limsoon Wong, Chee Keong Kwoh, Michael Lees, Gary Kee Khoon Lee, Terence Hung
PLoS ONE: Research Article, published 05 Mar 2012 10.1371/journal.pone.0032203

It is believed that combined interventions may be more effective than individual interventions in mitigating epidemic. However there is a lack of quantitative studies on performance of the combination of individual interventions under different temporal settings.

Methodology/Principal Findings
To better understand the problem, we develop an individual-based simulation model running on top of contact networks based on real-life contact data in Singapore. We model and evaluate the spread of influenza epidemic with intervention strategies of workforce shift and its combination with school closure, and examine the impacts of temporal factors, namely the trigger threshold and the duration of an intervention. By comparing simulation results for intervention scenarios with different temporal factors, we find that combined interventions do not always outperform individual interventions and are more effective only when the duration is longer than 6 weeks or school closure is triggered at the 5% threshold; combined interventions may be more effective if school closure starts first when the duration is less than 4 weeks or workforce shift starts first when the duration is longer than 4 weeks.

We therefore conclude that identifying the appropriate timing configuration is crucial for achieving optimal or near optimal performance in mitigating the spread of influenza epidemic. The results of this study are useful to policy makers in deliberating and planning individual and combined interventions.

Guidance for Evidence-Informed Policies about Health Systems

PLoS Medicine
(Accessed 10 March 2012)

Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development
Xavier Bosch-Capblanch, John N. Lavis, Simon Lewin, Rifat Atun, John-Arne Røttingen, Daniel Dröschel, Lise Beck, Edgardo Abalos, Fadi El-Jardali, Lucy Gilson, Sandy Oliver, Kaspar Wyss, Peter Tugwell, Regina Kulier, Tikki Pang, Andy Haines Policy Forum, published 06 Mar 2012

Summary Points
- Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence.

- Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes, but health systems guidance is poorly developed at present.

- The translation of research on problems, interventions, and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance.

- The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges.

- Further research is needed to adapt existing approaches (e.g., those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts.

This is the first paper in a three-part series in PLoS Medicine on health systems guidance.

Public Health and Public Goods

Public Health Ethics
Volume 4 Issue 3 November 2011

Original Articles
Public Health and Public Goods
Jonny Anomaly
Public Health Ethics (2011) 4(3): 251-259 doi:10.1093/phe/phr027

It has become increasingly difficult to distinguish public health (and public health ethics) from tangentially related fields like social work. I argue that we should reclaim the more traditional conception of public health as the provision of health-related public goods. The public goods account has the advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they disagree about precisely why they are desirable.