The WHO continues to issue weekly “updates” and briefing notes on the H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 – update 88
Weekly update
19 February 2010

As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Situation update:
The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.

More at: http://www.who.int/csr/don/2010_02_19/en/index.html

The WHO released “Recommended viruses for influenza vaccines for use in the 2010-2011 northern hemisphere influenza season, February 2010.” WHO noted that it “convenes technical meetings1 in February and September each year to recommend viruses for inclusion in influenza vaccines for the northern and southern hemispheres, respectively. This recommendation relates to the influenza vaccines for the forthcoming influenza season in the northern hemisphere (2010 – 2011). A recommendation will be made in September 2010 relating to vaccines that will be used for the influenza season in the southern hemisphere (2011). For countries in equatorial regions epidemiological considerations will influence which recommendation (February or September) individual national and regional authorities consider more appropriate.”

“…Based on the analyses it is expected that A(H1N1) pandemic 2009, A(H3N2) and B viruses will co-circulate in the northern hemisphere 2010-2011 with the likelihood that the pandemic A(H1N1) 2009 viruses will predominate. Based on recent epidemiological evidence it is anticipated that seasonal A(H1N1) viruses are unlikely to circulate at significant levels during the 2010-2011 northern hemisphere season; hence it has not been recommended for inclusion in the 2010-2011 vaccine. A B/Victoria/2/87 lineage virus, the predominant lineage of type B viruses circulating since September 2009, has been recommended.

“It is recommended that the following viruses be used for influenza vaccines in the 2010- 2011 influenza season (northern hemisphere):

– an A/California/7/2009 (H1N1)-like virus;

– an A/Perth/16/2009 (H3N2)-like virus;#

– a B/Brisbane/60/2008-like virus.

# A/Wisconsin/15/2009 is an A/Perth/16/2009 (H3N2)-like virus and is a 2010 southern hemisphere vaccine virus…

http://www.who.int/csr/disease/influenza/201002_Recommendation.pdf

The Weekly Epidemiological Record (WER) for 12 February 2010, vol. 85, 7 (pp 49–56) includes: Update on human cases of highly pathogenic avian influenza A(H5N1) infection: 2009; Meeting of the International Task Force for Disease Eradication, October 2009
http://www.who.int/wer/2010/wer8507.pdf

The Lancet
Volume 375, Issue 9715, Page 638, 20 February 2010

Correspondence
GAVI’s Advance Market Commitment
Donald W Light

Preview
The World Report on GAVI’s Advance Market Commitment (AMC; Dec 5, p 1879)1 contains irreconcilable claims by GAVI and reveals the inability of the AMC approach to make new vaccines available to low-income countries on a sustainable basis.

GAVI’s Advance Market Commitment
Nina Schwalbe, Ibrahim El-Ziq

Preview
In response to Ann Usher’s World Report,1 it is necessary to clarify how the pilot Advance Market Commitment (AMC) works. The pilot AMC aims to stimulate the manufacture of an adequate supply of affordable pneumococcal vaccines for developing countries. The price of the vaccine is capped at US$3·50 per dose, paid by the GAVI Alliance and countries. Six donors will pay an additional contribution per dose to participating manufacturers in the early years of each contract to offset costs of expanding production.

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138
http://www.thelancet.com/journals/laninf/issue/current

Correspondence

HPV vaccination: waiting for evidence of effectiveness
Eric J Suba, Stephen S Raab, on behalf of the Viet/American Cervical Cancer Prevention Project

Preview
As noted by Gary Clifford (Dec 12, p 1948),1 the greatest source of uncertainty about the potential effectiveness of human papillomavirus (HPV) vaccines remains the duration of the immune response. However, even if the most optimistic scenario of HPV vaccine effectiveness is realised, the introduction of HPV vaccines to populations not yet fully covered by screening services may compete with limited budgets for the build-out of screening services and thereby decelerate global reductions in deaths from cervical cancer by creating populations of women who will not be protected by either screening or vaccination.

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138
http://www.thelancet.com/journals/laninf/issue/current

Review
Biological, clinical, and ethical advances of placebo effects
Damien G Finniss, Ted J Kaptchuk, Franklin Miller, Fabrizio Benedetti

Preview
For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate placebo effects.

Lancet published a retraction of Wakefield AJ, Murch SH, Anthony A, et al. “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” Lancet 1998; 351: 637–41:

“Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation.2 In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”
The Editors of The Lancet
Hodgson H. A statement by The Royal Free and University College Medical School and The Royal Free Hampstead NHS Trust. Lancet 2004; 363: 824.
http://download.thelancet.com/flatcontentassets/pdfs/S0140673610601754.pdf

The Philadelphia Inquirer carries an article by Dr. Paul A. Offit which comments on the retraction and the impact of the original Lancet article.  The MMR vaccine scare: How bad science resulted in suffering and death is available at: http://www.philly.com/inquirer/currents/84326297.html. Dr. Offit is chief of the division of infectious diseases at the Children’s Hospital of Philadelphia and provides oversight for the Center for Vaccine Ethics and Policy, which publishes this weekly update.

The WHO continues to issue weekly “updates” and briefing notes on the H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 – update 87
Weekly update
12 February 2010

As of 7 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15292 deaths. More at: http://www.who.int/csr/don/2010_02_12/en/index.html

WHO reported that a meningitis epidemic hit Burkina Faso and Chad, noting that vaccination campaigns are being conducted in both countries and that WHO is working with partners to support the ministries of health in ensuring epidemiological and laboratory surveillance are reinforced and that vaccine is made available.

http://www.who.int/en/

PATH announced that the Global Health Technologies Coalition (GHTC) launched its new website www.ghtcoalition.org, “detailing health technologies and key issues for advancing global health innovations.” The coalition, housed at PATH and funded by the Bill & Melinda Gates Foundation, includes “more than 30 organizations advocating for research and development of tools to prevent, diagnose, and treat global diseases so health solutions are available when populations need them.” The coalition advocates for new vaccines, microbicides, drugs, devices, and diagnostics that will improve health in developing countries.  PATH said the new site offers numerous resources and can serve as a clearinghouse of information about coalition activities and global health research and development. http://www.path.org/news/an100208-ghtc.php

The MMWR for February 12, 2010 / Vol. 59 / No. 5, includes: Update: Mumps Outbreak — New York and New Jersey, June 2009–January 2010

State and local health departments, in collaboration with CDC, continue to investigate a U.S. mumps outbreak that began in June 2009 at a summer camp in New York. As of January 29, 2010, 1,521 cases had been reported, 97% of which have occurred in members of the same tradition-observant religious community. Among patients for whom vaccination status was reported, 88% had received at least 1 dose of mumps-containing vaccine, and 75% had received 2 doses.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5905a1.htm

PLoS Medicine
(Accessed 14 February 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Developing Global Maps of the Dominant Anopheles Vectors of Human Malaria
Simon I. Hay, Marianne E. Sinka, Robi M. Okara, Caroline W. Kabaria, Philip M. Mbithi, Carolynn C. Tago, David Benz, Peter W. Gething, Rosalind E. Howes, Anand P. Patil, William H. Temperley, Michael J. Bangs, Theeraphap Chareonviriyaphap, Iqbal R. F. Elyazar, Ralph E. Harbach, Janet Hemingway, Sylvie Manguin, Charles M. Mbogo, Yasmin Rubio-Palis, H. Charles J Godfray Health in Action, published 09 Feb 2010
doi:10.1371/journal.pmed.1000209

The WHO continues to issue weekly “updates” and briefing notes on the H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 – update 86
Weekly update: 5 February 2010

As of 31 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15174 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Situation update:

In the temperate zone of the northern hemisphere, overall pandemic influenza activity continues to decline or remain low in most regions since peaking during late October and November 2009. Several areas continue to have evidence of active but declining transmission, particularly in North Africa and in limited areas of Eastern Europe and East Asia… More at: http://www.who.int/csr/don/2010_02_5/en/index.html

A new Harvard School of Public Health (HSPH) poll shows that almost half of Americans believe the H1N1 flu outbreak is over (44%), and levels of concern about getting sick with the virus continue to decline. Few (18%) think it is “very likely” there will be another widespread outbreak of the H1N1 virus in the U.S. during the next 12 months, although a larger share of the population (43%) does say such an outbreak is “somewhat likely.” After an initial period of vaccine shortage, 70% of adults said there is now enough vaccine in their community for everyone who wants it. The national poll was conducted January 20-24, 2010.
At this point, the study suggests that more than half of parents (53%) either got the vaccine for their children (40%) or intend to get it before the end of February 2010 (13%). The Centers for Disease Control and Prevention (CDC) had identified children as a priority group for the vaccine.  Among adults, 37% either got the H1N1 vaccine for themselves (21%) or intend to do so before February ends (16%). If perceptions that the outbreak is over spread, those who now say they intend to get the vaccine may ultimately decide not to. The poll also revealed a substantial share of adults who said they have not gotten the vaccine and do not intend to (61%). More at: http://www.hsph.harvard.edu/news/press-releases/2010-releases/poll-half-of-americans-believe-h1n1-outbreak-over.html

The U.S. Food and Drug Administration (FDA) announced a collaboration with PATH to advance development of a vaccine to protect children against diseases caused by Streptococcus pneumoniae (pneumococcus), especially pneumonia. The project is expected to run for two years and is being conducted under the Cooperative Research and Development Agreement (CRADA) program. The program allows federal laboratories and businesses to form partnerships that help expedite research activities. PATH “will help the FDA obtain materials needed for the agency to develop the conjugate vaccine technology, and will also will provide approximately $480,000 to the FDA for the development of both the conjugation technology and tests to determine if the carrier proteins are properly linked to the polysaccharides.” The stated goal of the CRADA is “to evaluate the application of Center for Biologics Evaluation and Research (CBER) conjugation technology to pneumococcal vaccines. If it holds promise for fulfilling the goal of providing safe, effective, and affordable pneumococcal vaccines, the CRADA permits transfer of the technology to the China National Biotec Group’s Chengdu Institute of Biological Products, and eventually to groups in other developing countries as appropriate.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199479.htm

The fifth joint WHO-UNICEF-GAVI Global Immunization Meeting was held in Geneva, 1-3 February 2010, “with the purpose of providing a technical update to WHO and UNICEF Regional and country staff as well as immunization partners…to give all involved in immunization a common understanding of the current status and near future plans in the immunization world, particularly after in the current context of the rapid expansion of available vaccines and the financial crisis the world is facing.” The meeting followed the basic structure in Global Immunization Vision and Strategies (GIVS):

– how to the improve routine vaccination and support to the accelerated disease control initiatives;

– introducing new vaccines, including an update on the Hib Initiative and the status of pneumococcal and rotavirus vaccines;

– experiences in integration of EPI with other programmes (including malaria interventions); and

– issues of global interdependence including vaccine supply and the pandemic influenza vaccines.

More at: http://www.who.int/immunization_delivery/gim/en/index.html

The Weekly Epidemiological Record (WER) for 5 February 2009, vol. 85, 6 (pp 37–48) includes: Update on oseltamivir-resistant pandemic A (H1N1) 2009 influenza virus: January 2010; Human plague: review of regional morbidity and mortality, 2004–2009; http://www.who.int/wer/2010/wer8506.pdf

The Lancet
Feb 06, 2010  Volume 375  Number 9713  Pages 433 – 524
http://www.thelancet.com/journals/lancet/issue/current

Comment
Unlicensed pandemic influenza A H1N1 vaccines
Arthur L Caplan

Preview
When WHO’s Strategic Advisory Group of Experts (SAGE) on immunisation met on July 7, 2009, they recognised that pandemic influenza A H1N1 vaccines, when they become available, are almost entirely committed under contract to a small number of industrialised countries.1 SAGE commended WHO for trying to improve real-time access in poor countries, but these efforts will not have substantial effects in the short term.

Pediatrics
February 2010 / VOLUME 125 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Estimated Burden of Rotavirus-Associated Diarrhea in Ambulatory Settings in the United States
Anthony R. Flores, Peter G. Szilagyi, Peggy Auinger, and Susan G. Fisher

Effectiveness of Pentavalent Rotavirus Vaccine in a Large Urban Population in the United States
Julie A. Boom, Jacqueline E. Tate, Leila C. Sahni, Marcia A. Rench, Jennifer J. Hull, Jon R. Gentsch, Manish M. Patel, Carol J. Baker, and Umesh D. Parashar

Effectiveness of the Pentavalent Rotavirus Vaccine in Preventing Gastroenteritis in the United States
Florence T. Wang, T. Christopher Mast, Roberta J. Glass, Jeanne Loughlin, and John D. Seeger

Sibling Transmission of Vaccine-Derived Rotavirus (RotaTeq) Associated With Rotavirus Gastroenteritis
Daniel C. Payne, Kathryn M. Edwards, Michael D. Bowen, Erin Keckley, Jody Peters, Mathew D. Esona, Elizabeth N. Teel, Diane Kent, Umesh D. Parashar, and Jon R. Gentsch

Vaccine
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)

Letter to the Editor
Polio eradication in India: Have we reached the dead end?
Pages 1661-1662
Yash Paul

Vaccine
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)

Short Communications
Understanding adolescents’ intentions to have the HPV vaccine
Pages 1673-1676
Alice S. Forster, Laura A.V. Marlow, Jane Wardle, Judith Stephenson, Jo Waller

Abstract
From September 2008, older adolescent girls in the UK are eligible to have the HPV vaccine as part of the HPV vaccination ‘catch-up’ programme. Six months before they were due to be offered the vaccine 16–18 year old girls (N = 617) from eight further education/sixth-form colleges reported their intentions to have the HPV vaccine and reasons for this decision. Most intended to have the vaccine (around 70%). Some intentions were influenced by perceptions of risk. Many participants wanted more information and a small minority were scared of needles. Some ‘non-intenders’ were opposed to vaccinations altogether. The HPV vaccine is likely to be popular but non-intenders’ views may be difficult to change.

Vaccine
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)

Regular Papers
Mothers’ preferences and willingness to pay for vaccinating daughters against human papillomavirus
Pages 1702-1708
Derek S. Brown, F. Reed Johnson, Christine Poulos, Mark L. Messonnier

Abstract
A choice-format, conjoint-analysis survey was developed and fielded to estimate how features of human papillomavirus (HPV) vaccines affect mothers’ perceived benefit and stated vaccine uptake for daughters. Data were collected from a national sample of 307 U.S. mothers of girls aged 13–17 years who had not yet received an HPV vaccine. Preferences for four features of HPV vaccines were evaluated: protection against cervical cancer, protection against genital warts, duration of protection, and cost. We estimate that mean maximum willingness-to-pay (WTP)—an economic measure of the total benefits to consumers—for current HPV vaccine technology ranges between $560 and $660. All vaccine features were statistically significant determinants of WTP and uptake. Mothers were willing to pay $238 more for a vaccine that provides 90% protection for genital warts relative to a vaccine that provides no protection against warts. WTP for lifetime protection vs. 10 years protection was $245. Mothers strongly valued greater cervical cancer efficacy, with 100% protection against cervical cancers the most desired feature overall. Adding a second HPV vaccine choice to U.S. consumers’ alternatives is predicted to increase stated uptake by 16%. Several features were significantly associated with stated choices and uptake: age of mother, race/ethnicity, household income, and concern about HPV risks. These findings provide new data on how HPV vaccines are viewed and valued by mothers, and how uptake may change in the context of evolving vaccine technology and as new data are reported on duration and efficacy.

Vaccine
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)

A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet
Pages 1709-1716
Anna Kata

Abstract
The Internet plays a large role in disseminating anti-vaccination information. This paper builds upon previous research by analyzing the arguments proffered on anti-vaccination websites, determining the extent of misinformation present, and examining discourses used to support vaccine objections. Arguments around the themes of safety and effectiveness, alternative medicine, civil liberties, conspiracy theories, and morality were found on the majority of websites analyzed; misinformation was also prevalent. The most commonly proposed method of combating this misinformation is through better education, although this has proven ineffective. Education does not consider the discourses supporting vaccine rejection, such as those involving alternative explanatory models of health, interpretations of parental responsibility, and distrust of expertise. Anti-vaccination protestors make postmodern arguments that reject biomedical and scientific “facts” in favour of their own interpretations. Pro-vaccination advocates who focus on correcting misinformation reduce the controversy to merely an “educational” problem; rather, these postmodern discourses must be acknowledged in order to begin a dialogue.

Vaccine
Volume 28, Issue 6, Pages 1437-1660 (10 February 2010)
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28

Editorial
VACCINE in the 21st century: What’s next?
Page 1437
Gregory A. Poland, Mary Lowell Leary

Vaccine
Volume 28, Issue 6, Pages 1437-1660 (10 February 2010)
http://www.sciencedirect.com/science?_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2&jchunk=28#28

Regular Papers
An analysis of the Human Papilloma Virus vaccine debate on MySpace blogs
Pages 1535-1540
Jennifer Keelan, Vera Pavri, Ravin Balakrishnan, Kumanan Wilson

Abstract
Background
The roll out of HPV immunization programs across the United States was hindered by controversy. We tracked the debate in the United States through MySpace, then the most popular social networking site, in order to better understand the public’s reaction to the vaccine.

Methods
We searched MySpace for all blog discourse related to HPV immunization. We analyzed each blog according to the overall portrayal of HPV immunization, identified the characteristics of the bloggers, and developed a content analysis to categorize the types of supporting arguments made.

Results
303 blogs met our inclusion criteria. 157 (52%) of the blogs were classified as positive, 129 (43%) as negative, and 17 (6%) were ambivalent toward HPV immunization. Positive blogs generally argued that HPV infection was effective and there were no reasonable alternatives to immunizing. Negative blogs focused on the risks of immunizing and relied heavily on vaccine-critical publications to support their viewpoint. Of the blogs where gender could be identified, 75 (25%) were posted by men and 214 (71%) by women. 60% of blogs posted by men were explicitly critical about HPV immunization versus 36% of women’s blogs. Male bloggers also had larger networks of friends.

Conclusions
We describe a novel and promising approach to the surveillance of public opinions and attitudes toward immunization. In our analysis, men were far more likely to hold negative views about HPV immunization than women and disseminate negative messages through larger social networks. Blog analysis is a useful tool for Public health officials to profile vaccine criticism and to design appropriate educational information tailored to respond to alternative media/alternative information actively disseminated via social media tools. Public health officials should examine mechanisms by which to leverage this media to better communicate their message through existing networks and to engage in on-going dialogue with the public.

Bill and Melinda Gates, speaking at the World Economic Forum’s Annual Meeting in Davos, announced that their foundation will commit $10 billion over the next 10 years “to help research, develop and deliver vaccines for the world’s poorest countries, noting that “increased investment in vaccines by governments and the private sector could help developing countries dramatically reduce child mortality by the end of the decade, and they called for others to help fill critical financing gaps in both research funding and childhood immunization programs.”

Bill Gates said, “We must make this the decade of vaccines. Vaccines already save and improve millions of lives in developing countries. Innovation will make it possible to save more children than ever before.” Melinda Gates said, “Vaccines are a miracle—with just a few doses, they can prevent deadly diseases for a lifetime,” said. “We’ve made vaccines our number-one priority at the Gates Foundation because we’ve seen firsthand their incredible impact on children’s lives.”

The Gates Foundation said it used a model developed by a consortium led by the Institute of International Programs at the Johns Hopkins Bloomberg School of Public Health to project the potential impact of vaccines on childhood deaths over the next 10 years.

By significantly scaling up the delivery of life-saving vaccines in developing countries to 90 percent coverage—including new vaccines to prevent severe diarrhea and pneumonia—the model suggests that we could prevent the deaths of some 7.6 million children under 5 from 2010-2019. The foundation also estimates that an additional 1.1 million children could be saved with the rapid introduction of a malaria vaccine beginning in 2014, bringing the total number of potential lives saved to 8.7 million.

If additional vaccines are developed and introduced in this decade—such as for tuberculosis—even more lives could be saved. The new funding announced today is in addition to the $4.5 billion that the Gates Foundation has already committed to vaccine research, development and delivery to date across its entire disease portfolio since its inception.

The announcement noted that “many of the recent advances in vaccine development and delivery have been driven by public-private partnerships such as the GAVI Alliance and the Rotavirus Vaccine Program at PATH, which coordinate the resources and expertise of vaccine companies, donors, UNICEF, WHO, the World Bank, and developing countries.” Mr. Gates said these partnerships are “transforming the business of vaccines.”

Commenting on the announcement, WHO Director-General Margaret Chan said, “The Gates Foundation’s commitment to vaccines is unprecedented, but just a small part of what is needed. It’s absolutely crucial that both governments and the private sector step up efforts to provide life-saving vaccines to children who need them most.”

http://www.gatesfoundation.org/press-releases/Pages/decade-of-vaccines-wec-announcement-100129.aspx

PATH and GAVI, in a joint media release, discuss studies in Mexico and Africa which, “for the first time ever, demonstrate a reduction in diarrheal disease deaths following rotavirus vaccine introduction in Mexico and vaccine efficacy among impoverished populations in Malawi and South Africa.” The research is published in the New England Journal of Medicine [see Journal Watch below for citation and free full text access] Both studies “underscore the importance of vaccination in achieving significant reduction of severe rotavirus infections among children in the developing world, where disease impact is greatest.”

In an editorial accompanying the studies’ results, Mathuram Santosham, Professor of International Health and Pediatrics at Johns Hopkins University, Baltimore, welcomed these studies for supporting the use of rotavirus vaccines in the poorest countries of the world: “We now have another powerful weapon to add to our armamentarium to combat diarrheal deaths – rotavirus vaccines…Rotavirus vaccine should be introduced immediately in high mortality areas and it should be used as a trigger to energize diarrhea control programs and improve coverage for all the proven interventions for diarrhea.”

Tachi Yamada, president of the Global Health Program at the Bill & Melinda Gates Foundation, commented, “Diarrhea is rarely a life-threatening problem in rich countries, but in the developing world it is a leading cause of death in children. The world now has an effective vaccine against rotavirus, with the potential to save hundreds of thousands of lives every year. The next challenge is to ensure that rotavirus vaccines reach all those in need.”

The GAVI Alliance said it has launched efforts to support the introduction of rotavirus vaccines in at least 44 low-income countries by 2015. Global health organizations have issued a call to action on diarrheal disease to advocate for adequate funding for rotavirus vaccines to prevent and treat this major cause of severe diarrheal disease. The vaccine is an important part of a coordinated approach that combines proven strategies for prevention and treatment of diarrhea, such as oral rehydration therapy, exclusive breastfeeding, zinc supplementation, and improved sanitation to achieve the greatest impact on diarrheal disease morbidity and mortality.

http://www.path.org/news/an100129-davos.php

The WHO continues to issue weekly “updates” and briefing notes on the H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 85
Weekly update
29 January 2010

As of 24 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 14711 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Situation update:
Although much of the temperate northern hemisphere passed a peak of fall and wintertime pandemic influenza activity between late October and late November 2009, virus transmission remain active in several later affected areas, particularly in North Africa, limited areas of eastern and southeastern Europe, and in parts of South and East Asia… More at: http://www.who.int/csr/don/2010_01_29/en/index.html

[Editor’s Note: As the title of its statement just below describes, WHO continues to respond to various “allegations” around management of the H1N1 pandemic]

22 January 2010
WHO Statement of the World Health Organization on allegations of conflict of interest and ‘fake’ pandemic

Providing independent advice to Member States is a very important function of the World Health Organization (WHO). We take this work seriously and guard against the influence of any improper interests. The WHO influenza pandemic policies and response have not been improperly influenced by the pharmaceutical industry.

WHO recognizes that global cooperation with a range of partners, including the private sector, is essential to pursue public health objectives today and in the future. Numerous safeguards are in place to manage conflicts of interest or perceived conflicts of interest among members of WHO advisory groups and expert committees. Expert advisers provide a signed declaration of interests to WHO detailing any professional or financial interest that could affect the impartiality of their advice. WHO takes allegations of conflict of interest seriously and is confident of its decision-making independence regarding the pandemic influenza.

Additional allegations that WHO created a ‘fake’ pandemic to bring economic benefit to industry are scientifically wrong and historically incorrect.

Lab analyses showed that this influenza virus was genetically and antigenically very different from other influenza viruses circulating among people

Epidemiological information provided by Mexico, the US and Canada demonstrated person-to-person transmission.

Clinical information, especially from Mexico, indicated this virus also could cause severe disease and death. At the time, those reports did not indicate a pandemic situation, but taken together sent a very strong warning to WHO and other public health authorities to be ready for one.

As the pandemic evolved, clinicians identified a very severe form of primary viral pneumonia, which was rapidly progressive and frequently fatal, that is not part of the disease pattern seen during seasonal influenza. While these cases were relatively rare, they imposed a heavy burden on intensive care units.

Geographical spread was exceptionally rapid.

On 29 April 2009, WHO reported lab confirmed cases in 9 countries.

About 6 weeks later, on 11 June, WHO reported cases in 74 countries and territories in more than two WHO regions. It is this global spread which led WHO to call for increasing phases and finally, to announce that a pandemic was underway.

By 1 July, infections had been confirmed in 120 countries and territories.

The world is going through a real pandemic. The description of it as a fake is wrong and irresponsible. We welcome any legitimate review process that can improve our work.

An explanation of how WHO uses advisory bodies in responding to the influenza pandemic was made publicly available on the WHO web site on 3 December 2009

http://www.who.int/mediacentre/news/statements/2010/h1n1_pandemic_20100122/en/index.html

26 January 2010
Statement by Dr Keiji Fukuda on behalf of WHO at the Council of Europe hearing on pandemic (H1N1) 2009
[Initial paragraph and closing paragraphs. Full text available at the link below]

WHO is pleased to take part in this hearing, and thanks the Council of Europe for taking this initiative. The H1N1 influenza pandemic has created immensely complicated challenges for countries as well as the global community. At the same time, rising to this challenge has created an unprecedented level of global cooperation and coordination among countries in confronting a fast-moving threat in this increasingly linked and globalized world. There is much to learn about how the world can improve its handling of such events and a need to separate fact from rhetoric. Again, we welcome this opportunity….

…Pharmaceutical industry
“Recently, accusations have been made that policies and recommendations of WHO were influenced by the pharmaceutical industry. Providing independent advice to Member States is a very important function of the WHO that is taken seriously. WHO guards against the influence of any improper interests.

Let me state clearly for the record. The influenza pandemic policies and responses recommended and taken by WHO were not improperly influenced by the pharmaceutical industry.

WHO recognizes that global cooperation with a range of partners, including the private sector, is essential for optimally addressing the public health challenges of today and tomorrow. Numerous safeguards are in place to manage conflicts of interest or perceived conflicts of interest among members of WHO advisory groups and expert committees. Expert advisers provide a signed declaration of interests to WHO detailing any professional or financial matters that could affect the impartiality of their advice.     WHO takes allegations of conflicts of interest seriously and is confident of the integrity and scientific validity of its decision-making during this influenza pandemic. An explanation of how WHO uses advisory bodies in responding to the influenza pandemic was made publicly available on the WHO web site on 3 December 2009.

Closing remarks
In closing, I would like to reiterate the most basic point. This current influenza pandemic is a scientifically well-documented event in which the emergence and spread of a new influenza virus has caused an unusual epidemiological pattern of disease throughout the world. This is not an arbitrary matter of word-smithing, definitions or polemics. The labelling of the pandemic as “fake” is to ignore recent history and science and to trivialize the deaths of over 14 000 people and the many additional serious illnesses experienced by others.

As we go forward, the world will continue to face many difficult health challenges. The resources to face them are limited, especially among developing countries, and finding ways to do this better is the shared responsibility of Member States and organizations, such as the Parliamentary Assembly of the Council of Europe, as well as WHO. Thank you.

http://www.who.int/csr/disease/swineflu/coe_hearing/en/index.html

The Weekly Epidemiological Record (WER) for 29 January 2009, vol. 85, 5 (pp 29–36) includes Yellow fever fact sheet (revised in December 2009), and Global Advisory Committee on Vaccine Safety (GACVS) , 3–4 December 2009:

“GACVS held its twenty-first meeting in Geneva, Switzerland, during 3–4 December 2009.2 The committee reviewed the safety of pandemic A (H1N1) influenza vaccines and the safety profile of a meningococcus A conjugate vaccine that will soon be deployed in sub-Saharan Africa. The committee also discussed the use of bacille Calmette–Guérin (BCG) vaccine in areas with a high prevalence of infection with human immunodeficiency virus (HIV) and reviewed progress with global monitoring of adverse events following immunization (AEFI)…”

http://www.who.int/wer/2010/wer8505.pdf

The Lancet
Jan 30, 2010 Volume 375  Number 9712  Pages 347 – 432
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Financing of health systems to achieve the health Millennium Development Goals in low-income countries
Robert Fryatt, Anne Mills, Anders Nordstrom

Preview
Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health.

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138
http://www.thelancet.com/journals/laninf/issue/current

Review
Serogroup B meningococcal vaccines—an unfinished story
Manish Sadarangani, Andrew J Pollard

Summary
Most invasive meningococcal disease in developed countries is caused by Neisseria meningitidis with a serogroup B capsule. However, despite availability of vaccines for other serogroups since the 1960s, no serogroup B vaccine exists. In this Review we look at the development of serogroup B vaccines over the past 40 years. Outer membrane vesicle vaccines have been successfully used to control geographically isolated epidemics, but most have not been highly immunogenic in young children or provided broad cross-protection from infections with other strains. Vaccines based on subcapsular antigens have recently produced promising results in early clinical trials, and the disease burden might be substantially reduced over the next few years.

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138
http://www.thelancet.com/journals/laninf/issue/current

Book Review
The elusive malaria vaccine: miracle or mirage?
Vasee S Moorthy

The author of The Elusive Malaria Vaccine: Miracle or Mirage? has spent several decades engaged in malaria research. Given the start in May, 2009, of the Phase 3 trial of RTS,S/AS01, the first malaria vaccine that might be registered and that could potentially be available for use in sub-Saharan Africa, this book is timely and provides a very good overview of the prehistory and history of microbiology, parasitology, and vaccinology. Its strengths include illuminating details into the life of figures such as Robert Koch and Louis Pasteur, the seminal malaria work of some of the doyens of the 1960s, 1970s, and 1980s, and outlining preclinical research on the blood stages of non-human plasmodia.

The Lancet Infectious Disease
Feb 2010  Volume 10  Number 2  Pages 67 – 138
http://www.thelancet.com/journals/laninf/issue/current

Personal View
Adherence to cervical screening in the era of human papillomavirus vaccination: how low is too low?
Chris T Bauch, Meng Li, Gretchen Chapman, Alison P Galvani

Human papillomavirus vaccine prevents infection by two major oncogenic types of the virus. Continued screening is needed in vaccinated women to prevent cancers caused by high-risk types not included in the vaccine. An exaggerated sense of protection from the vaccine could lead to a decline in the rate of screening among vaccinated women, which in principle could lead to an increase in the incidence of cervical cancer. We present a simple mathematical model of vaccination, screening, and disease incidence, including an analysis of the effect of data uncertainties.

Nature
Volume 463 Number 7280 pp401-578  28 January 2010
http://www.nature.com/nature/journal/v463/n7280/

Editorial
Learning to share

Abstract [initial paragraphs]
By opening up its database of potential malaria drugs, GlaxoSmithKline has blazed a path that other pharmaceutical companies should follow.

It was heartening to learn last week that British pharmaceutical company GlaxoSmithKline (GSK) is to make publicly available a database containing the structures and pharmacological data for 13,500 possible drugs against malaria. The database, obtained by screening two million compounds in GSK’s library, promises to be a windfall for malaria drug development.

More broadly, the move highlights ongoing efforts by GSK and many other drug companies to re-engage with the ‘neglected’ diseases that predominantly affect poor countries, reversing decades of indifference. Some firms are already making their libraries available to public–private partnerships such as the Medicines for Malaria Venture (MMV) and the Global Alliance for TB Drug Development. This month’s announcement, however, marks the first time that any drug-maker has made public domain a substantial database of possible drug leads.

The move advances the pharmaceutical industry’s slow but steady shift towards more open sharing of data. At least for early-stage, precompetitive research, drug companies are finding it useful to lower the firewalls around their intellectual property and pool their resources. Making data public brings fresh eyes and minds to the problem, and has the potential to accelerate the discovery process….

http://www.nature.com/nature/journal/v463/n7280/full/463401a.html

New England Journal of Medicine
Volume 362 — January 28, 2010 — Number 4
http://content.nejm.org/current.shtml

[Editor’s Note: Please see the joint GAVI/PATH media release on this material above. NEJM is providing the first three articles below as free full text]

Editorial
Rotavirus Vaccine — A Powerful Tool to Combat Deaths from Diarrhea
M. Santosham

Original Articles
Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants
S. A. Madhi and Others

Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico
V. Richardson and Others

Brief Report: Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency
N. C. Patel and Others

PLoS Medicine
(Accessed 24 January 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies
Margaret Chan, Michel Kazatchkine, Julian Lob-Levyt, Thoraya Obaid, Julian Schweizer, Michel Sidibe, Ann Veneman, Tadataka Yamada Essay, published 26 Jan 2010
doi:10.1371/journal.pmed.1000223

[Initial paragraph and selected text]
“Recent substantial increases in international attention to health have been accompanied by demands for statistics that accurately track health progress and performance, evaluate the impact of health programs and policies, and increase accountability at country and global levels. The use of results-based financing mechanisms by major global donors has created further demand for timely and reliable data for decision-making. In addition, there is increasing country demand for data in the context of health sector strategic plans, including in countries that have established International Health Partnership (IHP+) compacts. In spite of recognized efforts by programs and countries, the ability to respond to this demand is constrained by limited data availability, quality, and use. Many developing countries have limitations that hamper the production of data of sufficient quality and timeliness to permit regular tracking of progress made in scaling up and strengthening health systems. Data gaps span across the range of input, output, outcome, and impact indicators. New ways of working and a more systematic approach by all partners are needed to better monitor and evaluate progress and performance. We believe that this global public good is a necessary foundation to improve health investments and programs and accelerate progress towards the Millennium Development Goals (MDGs) and other major international health goals…”

Eight agencies working in global health – Bill & Melinda Gates Foundation; GAVI; Global Fund to Fight AIDS, Tuberculosis & Malaria; UNAIDS; UNFPA; UNICEF; World Bank, and the World Health Organization – “…agree that it is critical to strengthen the five key data sources and capacity for analysis, synthesis, validation, and use of health data in countries. This should enable countries to better monitor and evaluate their own progress and performance and, secondarily, allow them to respond to the increased emphasis on results and accountability. The eight agencies propose four global actions to support these country goals:”

– Increase Levels and Efficiency of Investments in Health Information
– Develop a Common Data Architecture
– Strengthen Performance Monitoring and Evaluation
– Increase Data Access and Use