Editor’s Notes:
– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_28 April 2012
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
GAVI said that Ghana has become the first African country to introduce pneumococcal and rotavirus vaccines at the same time. In Ghana, these diseases, together, account for approximately 20% of the country’s under-five child mortality. Ghana’s First Lady H.E. Dr Ernestina Naadu Mills was joined by the country’s Minister of Health Hon. M Alban S. K. Bagbin, GAVI Alliance CEO Dr Seth Berkley, WHO Deputy Director General Dr Anarfi Asamoa-Baah, UNICEF Country Representative Dr Iyabode Olusanmi, and other international guests at a special ceremony in Accra, where the first doses of the vaccines were administered to children. Health Minister Hon. Alban S. K. Bagbin said, “Our children have been dying from these vaccine-preventable diseases for too long, but this moment begins a major fight back. With these vaccines, we want to, and we will, achieve MDG4, the two-thirds reduction of our child mortality by 2015.”
26 April 2012
UNICEF Executive Director Anthony Lake, with partners in the renamed Measles and Rubella Initiative, launched “a new global strategy aimed at reducing measles deaths and congenital rubella syndrome to zero.” The announcement was accompanied by new data showing that accelerated efforts have resulted in a 74 per cent reduction in global measles mortality, from an estimated 535,000 deaths in 2000, to 139,000 in 2010. UNICEF noted that through increased routine immunization coverage and large-scale immunization campaigns, Africa made the most progress with an 85 per cent drop in measles deaths between 2000 and 2010. [see The Lancet – Online First content below in Journal Watch] The new strategy is focused on “…cutting global measles deaths by at least 95 per cent by 2015 compared with 2000 levels, and achieving measles and rubella elimination in at least five World Health Organization (WHO) regions by 2020. The strategy includes: high vaccination coverage; monitoring spread of disease using laboratory-backed surveillance; outbreak preparedness and response and measles case management; communication and community engagement; and research and development.”
UNICEF said that under the new strategy, 63 countries currently not using rubella vaccines are encouraged to use their measles vaccination delivery system to introduce rubella vaccines into their national immunization schedule, protecting children against both diseases with one combined shot. Founded originally as the Measles Initiative in 2001, the new Measles and Rubella Initiative is led by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF and WHO.
25 April 2012
http://www.unicef.org/immunization/index_62289.html
The WHO coverage of this announcement included links to the following content:
News
Measles mortality news release
24 April 2012
European countries must take action now to prevent continued measles outbreaks in 2012
2 December 2011
The Measles Initiative vaccinates one billion children in first decade
4 August 2011
Strategic plan
Global Measles and Rubella Strategic Plan 2012-2020
pdf, 1.39Mb
Press Conference Materials
World Immunization Week was implemented for the first time, involving over 180 countries and running 21-28 April 2012. The theme of the week —
Protect your world: Get vaccinated – “aims to reinforce the importance of immunization and encourage people everywhere to vaccinate themselves and their children against serious diseases. It is also a time to recall that, in this rapidly globalizing world, disease outbreaks can affect communities everywhere.”
Additional coverage:
http://www.who.int/mediacentre/news/notes/2012/immunization_week_20120423/en/index.html
Statement: Director-General commemorates World Malaria Day
Dr Margaret Chan
Director-General of the World Health Organization
Statement on World Malaria Day
Oshakati, Namibia
25 April 2012
http://www.who.int/dg/speeches/2012/malariaday_20120425/en/index.html
Press release: UNICEF marks World Malaria Day
http://www.unicef.org/media/media_62293.html
Statement: NIH – World Malaria Day – April 25, 2012
B. F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases
http://www.nih.gov/news/health/apr2012/niaid-24.htm
Media Release: PATH recognizes World Malaria Day 2012
Events in Seattle and Washington, DC, highlight progress toward ending malaria deaths
http://www.path.org/news/an120420-malaria-day.php
The Global Fund announced that “an innovative initiative…to put affordable and effective anti-malaria medicines in remote communities in Africa, is making rapid progress in Ghana, Kenya, Madagascar, Nigeria, Tanzania and Uganda.” The Affordable Medicines Facility for Malaria (AMFm), which is managed by the Global Fund, “allows people to buy life-saving malaria treatment in private stores and pharmacies for less than one U.S. dollar. Comparable malaria medicines outside the program cost up to ten to twenty times as much.” Dr. Olusoji Adeyi, who heads the AMFm initiative at the Global Fund in Geneva, said, “The innovation is working, bringing relief to millions who need quality anti-malaria medicines at affordable prices. The AMFm is a game-changer in financing access to malaria treatments.” AMFm is “making anti-malaria medicines, called artemisinin-based combination therapies (ACTs), available as widely and inexpensively as possible to those who need them. It allows people to obtain effective drugs without having to travel long distances to reach public health clinics. AMFm is also helping to drive out ineffective medicines off the market, making effective ACT treatment available and accessible to millions of people.”
GAVI said the “under the leadership of its Chair Dagfinn Høybråten, it is strengthening its governance structure by improving its gender balance and streamlining its executive committee composition.” GAVI had earlier announced the appointment of three new independent Board members, all of them women, “achieving the target it set for itself in 2010 of at least 40% representation for both genders. Eleven out of 26 Board members are now female.” In the current announcement, GAVI noted “the restructuring of the Board’s Executive Committee to simplify the process concerning commercially-sensitive decision making.” Mr Høybråten commented, “We believe our governance standards are world class and transparent, and we are always looking to improve and streamline our processes.” The restructuring involves the Board’s 12-member Executive Committee, which “is empowered to make time-sensitive decisions on behalf of the Board between scheduled Board meetings. Since 2008, one of these seats has been assigned to a representative of the vaccine manufacturing industry. Following a decision by vaccine manufacturers not to seek reappointment to the Executive Committee, the Executive Committee will contract to 11 members: the Board Chair, the Vice Chair, eight additional Board members, and the non-voting CEO.” Mr. Høybråten added, “This voluntary move by the Developing Countries Vaccines Manufacturers Network (DCVMN) and the industrialized countries vaccines manufacturers will simplify our discussions and decision making processes even further. Vaccine manufacturers continue to be an important partner in our Alliance and on the Board.” GAVI said that “under existing procedures, conflicted members and members with even a perceived conflict of interest must remove themselves from discussion and voting on sensitive items related to their respective constituencies.”
Twitter Watch [final access 28 April 2012 – 16:42]
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.
Mirta Roses Periago @mirtaroses
We arrived to the end of the 10th Vaccination Week in the Americas, but #health workers will continue to vaccinate every day of the year.
9:53 AM – 28 Apr 12
Sabin Vaccine Inst. @sabinvaccine
It is estimated that a child dies of a vaccine-preventable disease every 20 sec. What are we going to do about that? http://bit.ly/Jqh8Ht
4:02 PM – 27 Apr 12
WHO @WHO
Meet our new super heroes: VacciBoy and ImmuGirl http://goo.gl/VrwX2 #vaccineswork
8:18 AM – 27 Apr 12
Roll Back Malaria @RollBackMalaria
Ban Ki-moon says he has made #malaria “a priority for his second term as a UN Secretary General” in a #WMD video: http://bit.ly/HYUdCX
Retweeted by Malaria Consortium
6:07 PM – 26 Apr 12
UNICEF @UNICEF
Did you know that UNICEF supplies 2.5 billion doses of vaccines to 99 countries? That’s 58 per cent of the world’s children #vaccineswork infographic: http://ow.ly/i/AB1P
9:30 AM – 27 Apr 12
Seth Berkley @GAVISeth
My latest blog: “We have to extend the vaccine revolution to every child in every corner of our world” http://ind.pn/IeROX5 #vaccineswork
4:26 PM – 26 Apr 12
WHO @WHO
Keep your child’s school, kindergarten, caregivers updated on your child’s vaccination status http://goo.gl/pbcp1 #vaccineswork
3:11 PM – 26 Apr 12
Dagfinn Høybråten @Hoybraten
Read my latest blog “Why immunisation is an act of immeasurable love” #vaccineswork http://bit.ly/ziZ1h8
Retweeted by GAVI Alliance
2:26 PM – 26 Apr 12
UNICEF @UNICEF
8 mn ppl are walking today as a result of the effort to eradicate #polio. Most children in the world live in polio-free areas #vaccineswork
12:31 PM – 26 Apr 12
Seth Berkley @GAVISeth
Just honored to be one of 5 vaccinators to give first 5 courses of pneumo and Rota together in Ghana with first lady and MoH. #vaccineswork
9:34 AM – 26 Apr 12
UN Foundation @unfoundation
Let’s get ready to rumble! Today is the national launch of @shotatlife! Join this morning 9-12 to discuss #vaccineswork http://ow.ly/awXaQ
8:38 AM – 26 Apr 12
GAVI Alliance @GAVIAlliance
Today, #Ghana has become the 1st African country 2 introduce #pneumo and #rotavirus #vaccines at the same time! http://ht.ly/awVEg
8:38 AM – 26 Apr 12
Report: Facing the Reality of Drug-Resistant Tuberculosis: Challenges and Potential Solutions in India – Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research
An estimated 8.8 million people fell ill with tuberculosis (TB) in 2010 and 1.4 million died from the disease. Although antibiotics to treat TB were developed in the 1950s and are effective against a large percentage of TB cases, resistance to these antibiotics has emerged over the years, resulting in the growing spread of multi-drug resistant (MDR) TB. The IOM held a workshop April 18-19, 2011, in New Delhi, India, in collaboration with the Indian National Science Academy and the Indian Council of Medical Research, to highlight key challenges to controlling the spread of drug-resistant strains of TB in India and to discuss strategies for advancing and integrating local and international efforts to prevent and treat drug-resistant TB.
Report: The New Global Health Agenda – Universal Health Coverage
Council on Foreign Relations | April 2012
The field of global health is witnessing a shift in focus from disease-driven initiatives to projects aimed at increasing the sustainability and strengthening of health systems. A crucial component to this is universal health coverage (UHC), which seeks to address financing schemes for health, separate from efforts to provide both adequate numbers of health workers and structures for health-care delivery. …In The New Global Health Agenda: Universal Health Coverage, authors Oren Ahoobim, Daniel Altman, Laurie Garrett, Vicky Hausman, and Yanzhong Huang discuss this rise in support for universal health coverage and the financial benefits that may be reaped by implementing such schemes, and provide examples of models used to date by countries in establishing universal health coverage.
http://www.cfr.org/global-health/new-global-health-agenda/p27998
Foreign Affairs
May/June 2012 Volume 91, Number 3
http://www.foreignaffairs.com/
Essay
Developing Symptoms
Thomas J. Bollyky
The main health threat in developing states today is not plagues or parasites but illnesses such as cancer and diabetes, noncommunicable diseases long associated with the rich world. NCDs are striking poorer, younger populations, and this could debilitate states and the global economy. The best way for the West to help is by pushing for governance reform.
Health Policy and Planning
http://heapol.oxfordjournals.org/content/current
Supplement: Policy making for new vaccines in low- and middle-income countries
Volume 27 suppl 2 May 2012
Guest Editors: Sandra Mounier-Jack and Helen Burchett
Commentary
Pauline Paterson and Heidi J Larson
The role of publics in the introduction of new vaccines
Health Policy Plan. (2012) 27(suppl 2): ii77-ii79 doi:10.1093/heapol/czs038
Extract
KEY MESSAGES
– The ‘public’ in public engagement could be a variety of stakeholders.
– Engaging with the public builds trust and helps to identify concerns that need to be addressed.
– There is a need for more research on the impact of different public engagement strategies on vaccination programmes to improve their effectiveness.
– The importance of listening to and engaging publics in the design and implementation of immunization policies and programmes has been well established (Waisbord 2004; Cooper et al. 2008; Obregon 2009; Larson et al. 2010; Larson et al. 2011). There are a number of examples of the costs (financial and social) of not involving publics early, the most acute being the boycott of polio vaccination in five states in Northern Nigeria in 2003 (Yahya 2007).
– Several papers in this special issue highlight potential roles of publics in the introduction of new vaccines, mostly at the level of implementation, but some point to the importance of bringing the role of citizen voices earlier into the decision-making process—i.e. not just as players to implement decisions made by central authorities, but to be a part of decision-making processes (Wonodi et al. 2012).
– The ‘public’ in public engagement could be a variety of stakeholders; such as individuals, parents, policy-makers (Mantel and Wang 2012), researchers and clinicians (Burchett et al. 2012), immunization programme managers (Brooks and Ba-Nguz 2012; Gordon et al. 2012), ‘global/regional bodies’ (Makinen et al. 2012), advocacy groups, or influential individuals (Makinen et al. 2012), such as religious leaders (Wonodi et al. 2012). …
Editorial
Carsten Mantel and Susan A Wang
The privilege and responsibility of having choices: decision-making for new vaccines in developing countries
Health Policy Plan. (2012) 27(suppl 2): ii1-ii4 doi:10.1093/heapol/czs041
Extract
Decisions to introduce new vaccines into national immunization programmes have become a highly complex endeavour. When the Expanded Programme on Immunization (EPI) was established in 1974 through a World Health Assembly resolution to build on the success of the global smallpox eradication programme and to ensure that all children in all countries benefit from life-saving vaccines, the first six diseases targeted by EPI were diphtheria, pertussis, tetanus, polio, measles and tuberculosis (WHO 1974). Today, thanks to scientific advancements and renewed global interest in immunization, more than a dozen1 antigens have been made available through public health services in developing countries, with increasingly reduced time delay compared with introduction in industrialized countries. Country decision-makers can select vaccines from a portfolio of options. This is a privilege and a serious responsibility requiring due consideration, as any decision to select one vaccine will need to be taken in light of the opportunity costs of not investing in another vaccine or another (health) intervention. Moreover, country decision-makers do not form their decisions in a vacuum; the number of immunization stakeholders in both the public and the private sectors has vastly increased and those stakeholders are equipped with varying levels of knowledge and expertise and may have vested interests.
The multitude of factors influencing country decisions to introduce new vaccines, and the process for making these decisions is becoming increasingly important. These factors and processes are briefly outlined and discussed below.
Sources of information and the decision-making process
One of the main and undisputed sources of information for decision making on new vaccine introduction in developing countries is the World Health Organization (WHO) global recommendations and policy guidelines, such as the vaccine position papers. These position papers are based on a thorough and graded review of available evidence by an independent Strategic Advisory Group of Experts in immunization (SAGE) and they
Original articles
H E D Burchett, S Mounier-Jack, U K Griffiths, R Biellik, P Ongolo-Zogo, E Chavez, H Sarma, J Uddin, M Konate, Y Kitaw, M Molla, S Wakasiaka, L Gilson, and A Mills
New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries
Health Policy Plan. (2012) 27(suppl 2): ii5-ii16 doi:10.1093/heapol/czs035
W Scott Gordon, Andrew Jones, and John Wecker
Abstract
As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions.
Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries.
The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics.
Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished.
This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.
Introducing multiple vaccines in low- and lower-middle-income countries: issues, opportunities and challenges
Health Policy Plan. (2012) 27(suppl 2): ii17-ii26 doi:10.1093/heapol/czs040
C B Wonodi, L Privor-Dumm, M Aina, A M Pate, R Reis, P Gadhoke, and O S Levine
Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria
Health Policy Plan. (2012) 27(suppl 2): ii27-ii38 doi:10.1093/heapol/czs037
Marty Makinen, Miloud Kaddar, Vivikka Molldrem, and Lara Wilson
Abstract
Objectives Lower-middle-income countries (LMICs) are lagging behind both high-income and low-income countries in new vaccine adoption. Our study involved the following objectives: (1) understand the decision-making processes of LMICs on new vaccine adoption, (2) identify the factors influencing LMIC decisions, (3) obtain the views of vaccine manufacturers about LMIC markets for new vaccines, and (4) make recommendations concerning how to speed up and improve decision making, including proposing mechanisms for implementation of the recommendations.
Methods Collect and analyse qualitative data from participants in decision making in 15 case study countries [12 LMICs and three upper-middle-income countries (UMICs)] and multinational and developing country vaccine manufacturers.
Findings Interviews of actors in decision making indicate that the aspects deemed most important for adoption are: World Health Organization (WHO) recommendations, the existence of local epidemiological data and a set of factors comprising affordability, cost-effectiveness and overall cost of the new vaccine for the programme. National Immunization Technical Advisory Groups (NITAG) have a key role in advising decision-makers, although their resources and capacity vary. Country decision-makers and manufacturers both see advantages in pooled procurement mechanisms for vaccine purchasing. Recommendations for countries and the international community involve assisting with making epidemiological data and vaccine market information accessible to countries, building and reinforcing related analysis capacity, and assisting with purchasing mechanisms and practices such as pooled procurement.
New vaccine adoption in lower-middle-income countries
Health Policy Plan. (2012) 27(suppl 2): ii39-ii49 doi:10.1093/heapol/czs036
Alan Brooks and Antoinette Ba-Nguz
Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions
Health Policy Plan. (2012) 27(suppl 2): ii50-ii61 doi:10.1093/heapol/czs039
Review
H E D Burchett, S Mounier-Jack, U K Griffiths, and A J Mills
National decision-making on adopting new vaccines: a systematic review
Health Policy Plan. (2012) 27(suppl 2): ii62-ii76 doi:10.1093/heapol/czr049
Abstract
In recent years numerous new vaccines have been developed, offering potential reductions in the morbidity and mortality caused by a range of diseases. This has led to increased interest in decision-making about the adoption of new vaccines into national immunization programmes. This paper aims to systematically review the literature on national decision-making around the adoption of new vaccines.
A thematic framework was developed inductively through analysis of the vaccine adoption decision-making frameworks included in the review. This thematic framework was then applied to the remaining studies included in the review.
In total, 85 articles were included in the review: 39 articles describing examples of vaccine adoption decision-making, 26 presenting vaccine decision-making frameworks, 21 empirical articles of decision-making relating to vaccine adoption and 19 theoretical essays.
An analysis of vaccine adoption decision-making frameworks identified nine broad categories of criteria: the importance of the health problem; vaccine characteristics; immunization programme considerations; acceptability; accessibility, equity and ethics; financial/economic issues; impact; alternative interventions and the decision-making process.
The quality of the empirical studies was varied. Although some of the issues included in the frameworks were similar to those considered in the studies, there were also some notable differences. On the whole, the frameworks were more comprehensive than the studies, including a greater range of criteria.
The existing literature provides a good foundation for further research into vaccine adoption decision-making. The current review, in pulling together what is already known and by identifying strengths, weaknesses and gaps in the existing evidence base, aims to encourage a more focused and rigorous approach to the topic in future. This could help to identify the most appropriate ways to develop vaccine adoption decision-making, so as to improve decisions and, ultimately, health outcomes
International Journal of Infectious Diseases
Volume 16, Issue 6 pp. e413-e468 (June 2012)
http://www.sciencedirect.com/science/journal/12019712
Original Reports
Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India
Original Research Article
Pages e417-e423
Naveen Thacker, Panna Choudhury, Lisa M. Gargano, Paul S. Weiss, Karen Pazol, Sunil Bahl, Hamid S. Jafari, Manisha Arora, A.P. Dubey, Vipin M. Vashishtha, Rohit Agarwal, Amod Kumar, Walter A. Orenstein, Saad B. Omer, James M. Hughes
Summary
Objectives
The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease, immunization, and eradication, and to identify barriers to polio eradication.
Methods
PHC physicians from blocks with at least one confirmed polio case during January 2006 to June 2009 were selected for an in-person survey. Pediatricians were members of the Indian Academy of Pediatrics and were selected from a national directory of members for telephone or mail survey.
Results
A higher percentage of PHC physicians than pediatricians reported that an unvaccinated child was susceptible to polio (82.1% vs. 63.0%, p < 0.0001) and that polio disease was severe in a child aged 1–5 years (77.7% vs. 62.2%, p < 0.0001). PHC physicians and pediatricians expressed confidence in the protectiveness and safety of oral polio vaccine and cited parents’ lack of awareness of the importance of polio eradication as an important barrier to eradication. Strengthening routine immunization efforts was reported as the leading intervention required to eradicate polio.
Conclusions
PHC physicians and pediatricians support and have confidence in the success of polio eradication efforts. These findings will be useful for policy-makers involved in the planning of eradication strategies. Providers and parents need to maintain confidence in polio vaccination if polio is to be eradicated.
JAMA
April 25, 2012, Vol 307, No. 16, pp 1669-1766
http://jama.ama-assn.org/current.dtl
Original Contributions
Effect of a Text Messaging Intervention on Influenza Vaccination in an Urban, Low-Income Pediatric and Adolescent Population: A Randomized Controlled Trial
Melissa S. Stockwell, Elyse Olshen Kharbanda, Raquel Andres Martinez, Celibell Y. Vargas, David K. Vawdrey, Stewin Camargo
JAMA. 2012;307(16):1702-1708.doi:10.1001/jama.2012.502
Abstract
Context Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination.
Objective To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents.
Design, Setting, and Participants Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis.
Intervention Parents of children assigned to the intervention received up to 5 weekly immunization registry–linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites.
Main Outcome Measures Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity.
Results Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the fall review date, 27.1% (n = 1026) of the intervention group compared with 22.8% (n = 864) of the usual care group had received influenza vaccine (difference, 4.3% [95% CI, 2.3%-6.3%]; RRR, 1.19 [95% CI, 1.10-1.28]; P < .001).
Conclusions Among children and adolescents in a low-income, urban population, a text messaging intervention compared with usual care was associated with an increased rate of influenza vaccination. However, the overall influenza vaccination rate remained low.
Trial Registration clinicaltrials.gov Identifier: NCT01146912
JAMA
April 25, 2012, Vol 307, No. 16, pp 1669-1766
http://jama.ama-assn.org/current.dtl
Editorials
Text Messaging: A New Tool for Improving Preventive Services
Peter G. Szilagyi, William G. Adams
JAMA. 2012;307(16):1748-1749.doi:10.1001/jama.2012.524
Extract
Prevention of influenza disease through vaccination is a public health challenge. Influenza disease causes substantial morbidity and mortality in children, adolescents, and adults; vaccination is the best method to prevent this disease. In light of the increasing understanding of the burden of influenza among children and adolescents and its spread from children to adults, the Advisory Committee on Immunization Practices expanded its influenza vaccination recommendations in 2008 to include all children and adolescents between 6 months and 18 years of age.1 More than 65 million children and adolescents should be vaccinated annually, usually within a short timeframe of several months when the vaccine is available. While influenza vaccination coverage nationwide has increased, it remains low—only about half of all children and adolescents are vaccinated.
In the United States, primary care practices bear the major burden of vaccinating children and adolescents, and because most do not have health care visits …
Journal of Infectious Diseases
Volume 205 Issue 10 May 15, 2012
http://www.journals.uchicago.edu/toc/jid/current
Viruses
Nicholas C. Grassly, Hamid Jafari, Sunil Bahl, Raman Sethi, Jagadish M. Deshpande, Chris Wolff, Roland W. Sutter, and R. Bruce Aylward
Waning Intestinal Immunity After Vaccination With Oral Poliovirus Vaccines in India
J Infect Dis. (2012) 205(10): 1554-1561 doi:10.1093/infdis/jis241
Abstract
Background The eradication of wild-type polioviruses in areas with efficient fecal-oral transmission relies on intestinal mucosal immunity induced by oral poliovirus vaccine (OPV). Mucosal immunity is thought to wane over time but the rate of loss of protection has not been examined.
Methods We examined the degree and duration of intestinal mucosal immunity in India by measuring the prevalence of vaccine poliovirus in stool samples collected 4–28 days after a “challenge” dose of OPV among 47 574 children with acute flaccid paralysis reported during 2005–2009.
Results Previous vaccination with OPV was protective against excretion of vaccine poliovirus after challenge, but the odds of excretion increased significantly with the time since the child was last exposed to an immunization activity (odds ratio, 1.39 [95% confidence interval .99–1.97], 2.04 [1.28–3.25], and 1.31 [1.00–1.70] comparing ≥6 months with 1 month ago for serotypes 1, 2, and 3, respectively). Vaccine administered during the high season for enterovirus infections (April–September) was significantly less likely to result in excretion, especially in northern states (odds ratio, 0.57 [95% confidence interval, .50–.65], 0.58 [.41–.81], and 0.48 [.40–.57] for serotypes 1, 2, and 3).
Conclusions Infection with OPV (vaccine “take”) is highly seasonal in India and results in intestinal mucosal immunity that appears to wane significantly within a year of vaccination.
Journal of Infectious Diseases
Volume 205 Issue 10 May 15, 2012
http://www.journals.uchicago.edu/toc/jid/current
Bacteria
Peter C. Wroe, Jonathan A. Finkelstein, G. Thomas Ray, Jeffrey A. Linder, Kristen M. Johnson, Sheryl Rifas-Shiman, Matthew R. Moore, and Susan S. Huang
Aging Population and Future Burden of Pneumococcal Pneumonia in the United States
J Infect Dis. (2012) 205(10): 1589-1592 doi:10.1093/infdis/jis240
Abstract
Pneumococcal pneumonia is concentrated among the elderly. Using a decision analytic model, we projected the future incidence of pneumococcal pneumonia and associated healthcare utilization and costs accounting for an aging US population. Between 2004 and 2040, as the population increases by 38%, pneumococcal pneumonia hospitalizations will increase by 96% (from 401 000 to 790 000), because population growth is fastest in older age groups experiencing the highest rates of pneumococcal disease. Absent intervention, the total cost of pneumococcal pneumonia will increase by $2.5 billion annually, and the demand for healthcare services for pneumococcal pneumonia, especially inpatient capacity, will double in coming decades.
The Lancet
Online First
Comment
Apr 24, 2012
Measles: the burden of preventable deaths
Walter A Orenstein, Alan R Hinman
Preview
Measles has been, and remains, a major killer of children around the world. Despite the introduction of the measles vaccine in 1963, measles caused an estimated 2·6 million deaths in a single year as recently as 1980.1 In The Lancet, Emily Simons and colleagues2 estimate that, after more than 45 years of measles vaccine availability, the disease caused nearly 140 000 deaths in 2010.
Articles
Apr 24, 2012
Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data
Emily Simons, Matthew Ferrari, John Fricks, Kathleen Wannemuehler, Abhijeet Anand, Anthony Burton, Peter Strebel
Summary
Background
In 2008 all WHO member states endorsed a target of 90% reduction in measles mortality by 2010 over 2000 levels. We developed a model to estimate progress made towards this goal.
Methods
We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.
Findings
Estimated global measles mortality decreased 74% from 535 300 deaths (95% CI 347 200—976 400) in 2000 to 139 300 (71 200—447 800) in 2010. Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%.
Interpretation
Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles.
Funding
US Centers for Disease Control and Prevention (PMS 5U66/IP000161).
The Lancet
Apr 28, 2012 Volume 379 Number 9826 p1561 – 1676
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Putting adolescents at the centre of health and development
The Lancet
Preview
Unprecedented momentum is gathering to put adolescents into the centre of global health policies. This opportunity has the potential not only to benefit young people directly but also to have wide-ranging effects on the health of adults and national economic development. The 45th session of the United Nations (UN) Commission on Population and Development, held in New York from April 23 to 26, has chosen Adolescents and Youth as its central theme. In the same week, UNICEF releases its report—Progress for Children: A Report Card on Adolescents—with data from developing countries.
Comment
Seizing the opportunities of adolescent health
Michael D Resnick, Richard F Catalano, Susan M Sawyer, Russell Viner, George C Patton
Preview
Economic and social change have brought great opportunities and threats to adolescent health for rich and poor nations alike. The health transition, together with changes in adolescent social roles, has shifted the burden from childhood infectious diseases towards adolescent injuries and health-jeopardising behaviours in all but the poorest countries. Fortunately, research has clarified many determinants of these behaviours, and wide-ranging prevention approaches to minimise harm and promote health have been identified.
Adolescent health in the 21st century
Robert W Blum, Francisco IPM Bastos, Caroline W Kabiru, Linh C Le
Series
Adolescence: a foundation for future health
Susan M Sawyer, Rima A Afifi, Linda H Bearinger, Sarah-Jayne Blakemore, Bruce Dick, Alex C Ezeh, George C Patton
Preview
Adolescence is a life phase in which the opportunities for health are great and future patterns of adult health are established. Health in adolescence is the result of interactions between prenatal and early childhood development and the specific biological and social-role changes that accompany puberty, shaped by social determinants and risk and protective factors that affect the uptake of health-related behaviours. The shape of adolescence is rapidly changing—the age of onset of puberty is decreasing and the age at which mature social roles are achieved is rising.
Adolescence and the social determinants of health
Russell M Viner, Elizabeth M Ozer, Simon Denny, Michael Marmot, Michael Resnick, Adesegun Fatusi, Candace Currie
Preview
The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours.
Worldwide application of prevention science in adolescent health
Richard F Catalano, Abigail A Fagan, Loretta E Gavin, Mark T Greenberg, Charles E Irwin, David A Ross, Daniel TL Shek
Preview
The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable.
Health of the world’s adolescents: a synthesis of internationally comparable data
George C Patton, Carolyn Coffey, Claudia Cappa, Dorothy Currie, Leanne Riley, Fiona Gore, Louisa Degenhardt, Dominic Richardson, Nan Astone, Adesola O Sangowawa, Ali Mokdad, Jane Ferguson
Preview
Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people.
The Lancet
Apr 28, 2012 Volume 379 Number 9826 p1561 – 1676
http://www.thelancet.com/journals/lancet/issue/current
Correspondence
In support of the US Centers for Disease Control and Prevention
Jeffrey P Koplan, James Curran, Haile Debas, Carlos del Rio, Lawrence O Gostin, Gerald T Keusch, Judith N Wasserheit
Preview
Richard Horton (March 3, p 788)1 harshly criticises the structure and performance of the Center for Global Health (CGH) at the US Centers for Disease Control and Prevention (CDC). He offers no evidence in support of his criticism, but instead uses anonymous statements that are unacceptable in impartial investigative journalism. This particularly concerns us because, as a leading medical journal, The Lancet should publish the most rigorous, evidence-based reports.
In support of the US Centers for Disease Control and Prevention
Tedros Adhanom Ghebreyesus
Preview
I welcome the opportunity to describe our close partnership with the US Centers for Disease Control and Prevention (CDC).1 A paragon of scientific excellence in public health, CDC’s scientific approach to health promotion, disease prevention, and emergency preparedness is a model my Ministry aspires towards. To bolster reform and expansion efforts,2 we continue to look to CDC’s well established institutional organisation and management structure to improve our surveillance and response systems. For decades, CDC has supported our responses to HIV/AIDS, tuberculosis, malaria, meningitis, rabies, dracunculiasis, smallpox, poliomyelitis, and public health emergencies.
In support of the US Centers for Disease Control and Prevention
Mirta Roses Periago
Preview
I am surprised by Richard Horton’s Offline piece,1 which criticises the global health efforts of the US Centers for Disease Control and Prevention (CDC), largely on the basis of anonymous correspondence from disgruntled CDC employees.
In support of the US Centers for Disease Control and Prevention
Marek Ma
The Lancet Infectious Disease
May 2012 Volume 12 Number 5 p355 – 422
http://www.thelancet.com/journals/laninf/issue/current
Newsdesk
Global rabies elimination: are we stepping up to the challenge?
Preview
A 1 year assessment of the Rabies Blueprint website, a detailed online guide developed to support countries aiming to eliminate canine rabies in an effort to prevent human rabies, shows that it has been successful in terms of outreach. “We know that visitors have come from virtually all continents, including 150 countries or territories and 1827 cities”, reports lead author Tiziana Lembo (University of Glasgow, UK, and the Global Alliance for Rabies Control, USA). “We are also aware that this toolkit is being used as a guide for the implementation of canine rabies control programmes in various places, for example the Philippines, Uganda, Benin, Afghanistan, Peru, Bolivia, Haiti, and Indonesia.
Media Watch
Eradication: ridding the world of diseases forever?
Salmaan Keshavjee
Preview
In this well researched and well written book, historian Nancy Leys Stepan uses the diaries and aspirations of Fred Soper—former Director General of the Pan American Health Organization, described in the book as an arch-eradicationist—to recount a social history of public health. In so doing, she critically analyses the very idea of eradication, exposes the weak scientific basis of many of the past century’s greatest battles against disease, and provides lessons for the challenges that lie ahead.
Advances in virus research 79: research advances in rabies
Hildegund CJ Ertl
Preview
Tragically, half of people infected with rabies are children aged younger than 15 years. Most tragic is that all of these deaths could have been prevented by appropriate postexposure prophylaxis consisting of wound cleaning, active immunisation with a safe rabies vaccine, and passive immunisation with a rabies immunoglobulin. The high cost of this prophylaxis prevents its use in low-income countries and, as a result, people die. The 486 page book with its 21 chapters written by experts is thus a welcome reminder that research into rabies has to continue to reduce its deadly toll.
Review
Passive immunity in the prevention of rabies
Leonard Both, Ashley C Banyard, Craig van Dolleweerd, Daniel L Horton, Julian K-C Ma, Anthony R Fooks
Preview
Prevention of clinical disease in those exposed to viral infection is an important goal of human medicine. Using rabies virus infection as an example, we discuss the advances in passive immunoprophylaxis, most notably the shift from the recommended polyclonal human or equine immunoglobulins to monoclonal antibody therapies. The first rabies-specific monoclonal antibodies are undergoing clinical trials, so passive immunisation might finally become an accessible, affordable, and routinely used part of global health practices for rabies.
Nature
Volume 484 Number 7395 pp415-558 26 April 2012
http://www.nature.com/nature/current_issue.html
Specials
Outlook: Malaria
Malaria
Michelle Grayson
The numbers game
Priya Shetty
Drug development: Holding out for reinforcements
Michael Eisenstein
Public health: Death at the doorstep
Amy Maxmen
Perspectives: The missing pieces
Brendan S. Crabb, James G. Beeson, Rogerio Amino, Robert Ménard, Andy Waters, + et al.
Vaccines: The take-home lesson
Sarah DeWeerdt
Vector control: The last bite
Lauren Gravitz
The Pediatric Infectious Disease Journal
May 2012 – Volume 31 – Issue 5
pp: A7-A8,431-537,e73-e77
http://journals.lww.com/pidj/pages/currenttoc.aspx
The Worldwide Impact of the Seven-valent Pneumococcal Conjugate Vaccine
Fitzwater, Sean P.; Chandran, Aruna; Santosham, Mathuram; Johnson, Hope L.
Pediatric Infectious Disease Journal. 31(5):501-508, May 2012.
doi: 10.1097/INF.0b013e31824de9f6
Abstract:
Background: Pneumococcal conjugate vaccines (PCV) are emerging as one of the most promising means to prevent pediatric disease. The 7-valent PCV (PCV-7) has been extensively evaluated in clinical trials, and recent evidence from the introduction of PCV-7 through national immunization programs has demonstrated impact on pneumococcal disease.
Methods: Clinical trials have shown PCV-7 to be effective against the more severe forms of pneumococcal infections: pneumonia and invasive pneumococcal disease (IPD), as well as overall child mortality. A review shows the tremendous impact PCV-7 has had to date, and the potential further benefits of the emerging multi-valent vaccines.
Results: Since its introduction, the PCV-7 has substantially reduced the incidence of IPD, hospital admissions due to pneumonia and acute otitis media in numerous, mostly high income, low-disease burden countries. The reductions in IPD and pneumonia have also been observed among unvaccinated age groups in countries with routine use of PCV-7, demonstrating that PCV-7 provides herd immunity. Some settings observed an increase in rate of Nonvaccine serotype IPD, yet rates of overall and vaccine-serotype IPD show marked reductions post–PCV-7 introduction. Limited data are available on the impact of PCV-7 in lower income countries. The available data from efficacy trials from The Gambia and South Africa suggest that PCV-7 will have substantial impact on reducing pneumococcal disease.
Conclusion: PCV-7 has shown dramatic reduction in disease and mortality rates in the countries in which it has been introduced. The newly introduced 10-valent and 13-valent pneumococcal vaccines are expected to have substantial disease impact, but monitoring is essential to determine their true impact and sustain further introduction of pneumococcal conjugate vaccines.
PLoS One
[Accessed 28 April 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date
Synthetic Biology: Mapping the Scientific Landscape
Paul Oldham, Stephen Hall, Geoff Burton
PLoS ONE: Research Article, published 23 Apr 2012 10.1371/journal.pone.0034368
Abstract
This article uses data from Thomson Reuters Web of Science to map and analyse the scientific landscape for synthetic biology. The article draws on recent advances in data visualisation and analytics with the aim of informing upcoming international policy debates on the governance of synthetic biology by the Subsidiary Body on Scientific, Technical and Technological Advice (SBSTTA) of the United Nations Convention on Biological Diversity. We use mapping techniques to identify how synthetic biology can best be understood and the range of institutions, researchers and funding agencies involved. Debates under the Convention are likely to focus on a possible moratorium on the field release of synthetic organisms, cells or genomes. Based on the empirical evidence we propose that guidance could be provided to funding agencies to respect the letter and spirit of the Convention on Biological Diversity in making research investments. Building on the recommendations of the United States Presidential Commission for the Study of Bioethical Issues we demonstrate that it is possible to promote independent and transparent monitoring of developments in synthetic biology using modern information tools. In particular, public and policy understanding and engagement with synthetic biology can be enhanced through the use of online interactive tools. As a step forward in this process we make existing data on the scientific literature on synthetic biology available in an online interactive workbook so that researchers, policy makers and civil society can explore the data and draw conclusions for themselves.
PLoS Medicine
(Accessed 28 April 2012)
http://www.plosmedicine.org/article/browse.action?field=date
Where There Is No Health Research: What Can Be Done to Fill the Global Gaps in Health Research?
Martin McKee, David Stuckler, Sanjay Basu Essay, published 24 Apr 2012
doi:10.1371/journal.pmed.1001209
Summary Points
– Efforts to strengthen capacity in health research have, so far, concentrated on countries where there is existing capacity rather than those where it is almost completely lacking.
– Judged by absolute numbers of scientific papers, those with the fewest are mainly small islands and a few countries that are politically isolated.
– Judged by papers per capita, the lowest include countries in the former Soviet Union and Africa, both regions experiencing declines in life expectancy in recent years, and states experiencing conflict.
– Although there is a positive association between economic development and research output, some relatively wealthy countries seriously underperform.
– There are many examples of good practice, including regional networks and international partnerships.
– There is a strong argument for donors to look to the long term and consider how best to build health research capacity where it is virtually absent.
Science
27 April 2012 vol 336, issue 6080, pages 381-508
http://www.sciencemag.org/current.dtl
Policy Forum
Public Health
Monitoring EU Emerging Infectious Disease Risk Due to Climate Change
Elisabet Lindgren 1, Yvonne Andersson 2, Jonathan E. Suk 3, Bertrand Sudre 3, Jan C. Semenza 3,*
1 Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
2 Formerly at the Swedish Institute for Communicable Disease Control l, SE-171 82 Solna, Sweden.
3 Office of the Chief Scientist, European Centre for Disease Prevention and Control, SE-171 83 Stockholm, Sweden.
In recent years, we have seen transmission of traditionally “tropical” diseases in continental Europe: chikungunya fever (CF) in Italy in 2007, large outbreaks of West Nile fever in Greece and Romania in 2010, and the first local transmission of dengue fever in France and Croatia in 2010 (1–3). These events support the notion that Europe is a potential “hot spot” for emerging and re-emerging infectious diseases (EIDs) (4). Major EID drivers that could threaten control efforts in Europe include globalization and environmental change (including climate change, travel, migration, and global trade); social and demographic drivers (including population aging, social inequality, and life-styles); and public health system drivers (including antimicrobial resistance, health care capacity, animal health, and food safety) (5, 6). Climate change is expected to aggravate existing local vulnerabilities by interacting with a complex web of these drivers (6). For example, increases in global trade and travel, in combination with climate change, are foreseen to facilitate the arrival, establishment, and dispersal of new pathogens, disease vectors, and reservoir species.
The Sabin Vaccine Institute announced the release of its sponsored special supplement to Vaccine titled “Smallpox Eradication after 30 Years: Lessons, Legacies and Innovations.” Sabin said its President, Dr. Peter Hotez, and Sabin Executive Vice President Dr. Ciro de Quadros, “share their insights on global health innovations and advancements since the eradication of smallpox was certified by the World Health Assembly in 1980.” The issue captures content from a special symposium “which reviewed the major lessons from smallpox eradication and how they could be useful to future health initiatives, and also featured research and discussions regarding issues that require more attention from the global health community such as the need for new vaccines to confront infectious diseases in developing countries.” The symposium, organized by the Fogarty International Center, the Sabin Vaccine Institute and FIOCRUZ took place in Rio de Janeiro, Brazil in August of 2010. Dr. Breman commented, “The symposium went far beyond assembling many giants of smallpox eradication in one place. Scientific and public health leaders addressed the control and eradication of guinea worm, polio, measles, rubella, malaria and neglected tropical diseases. They were able to describe how research, epidemiological surveillance, and good management that contributed to smallpox eradication are being applied to their programs.” The entire special supplement and a summary of the 2010 symposium can be accessed at http://www.sciencedirect.com/science/journal/0264410X/29/supp/S4
24 April 2012
Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Supplement 1, Pages A1-A196 (27 April 2012)
Rotavirus Vaccines for Children in Developing Countries
Edited by A. Duncan Steele, Kathleen M. Neuzil and Umesh D. Parashar
Editorials and Commentaries
Rotavirus vaccines for children in developing countries: Understanding the science, maximizing the impact, and sustaining the effort
Kathleen M. Neuzil, Umesh D. Parashar, A. Duncan Steele
No preview or abstract
Rotavirus vaccines in developing countries: The potential impact, implementation challenges, and remaining questions
Original Research Article
Pages A3-A6
Thomas Cherian, Susan Wang, Carsten Mantel
Abstract
Diarrhoeal disease is one of the commonest causes of death in children, especially in developing countries in Africa and Asia. Rotavirus has been consistently identified as the commonest pathogen associated with severe diarrhoea. Hence, the availability of vaccines against this organism provides the opportunity to reduce child mortality. Data from efficacy trials in developing countries in Africa and Asia showed that the vaccine efficacy was lower than that observed in other countries. Nevertheless, the vaccines are expected to be of significant benefit in high mortality countries in these regions. While the reports published in this supplement add to our understanding about the performance of these vaccines in developing countries in these regions, questions remain over the overall impact of these vaccines when used in national programmes of developing countries in Africa and Asia, the optimal vaccination schedules and the impact of age restrictions for vaccine use on immunization coverage. Additional research is required to improve understanding on the performance of these vaccines in developing countries in Africa and Asia and measures that may improve performance. Data that will assist in the definition of the optimal immunization schedule and possibly allow relaxation of the age restrictions for vaccine use may help in enhancing the impact of the vaccines in these countries. Finally, disease surveillance and studies are required to document the impact of vaccination and monitor changes in disease epidemiology.
Global Perspectives
Projected health and economic impact of rotavirus vaccination in GAVI-eligible countries: 2011–2030
Original Research Article
Pages A7-A14
Deborah E. Atherly, Kristen D.C. Lewis, Jacqueline Tate, Umesh D. Parashar, Richard D. Rheingans
Abstract
Rotavirus is the leading cause of diarrheal disease in children under 5 years of age. It is responsible for more than 450,000 deaths each year, with more than 90% of these deaths occurring in low-resource countries eligible for support by the GAVI Alliance. Significant efforts made by the Alliance and its partners are providing countries with the opportunity to introduce rotavirus vaccines into their national immunization programs, to help prevent childhood illness and death. We projected the cost-effectiveness and health impact of rotavirus vaccines in GAVI-eligible countries, to assist decision makers in prioritizing resources to achieve the greatest health benefits for their populations.
A decision-analytic model was used to project the health outcomes and direct costs of a birth cohort in the target population, with and without a rotavirus vaccine. Current data on disease burden, vaccine efficacy, immunization rates, and costs were used in the model.
Vaccination in GAVI-eligible countries would prevent 2.46 million childhood deaths and 83 million disability-adjusted life years (DALYs) from 2011 to 2030, with annual reductions of 180,000 childhood deaths at peak vaccine uptake. The cost per DALY averted is $42 for all GAVI countries combined, over the entire period. Rotavirus vaccination would be considered very cost-effective for the entire cohort of GAVI countries, and in each country individually, as cost-effectiveness ratios are less than the gross domestic product (GDP) per capita. Vaccination is most cost-effective and has the greatest impact in regions with high rotavirus mortality.
Rotavirus vaccination in GAVI-eligible countries is very cost-effective and is projected to substantially reduce childhood mortality in this population.
Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness
Original Research Article
Pages A15-A23
Richard Rheingans, Deborah Atherly, John Anderson
Abstract
Background
Other studies have demonstrated that the impact and cost effectiveness of rotavirus vaccination differs among countries, with greater mortality reduction benefits and lower cost-effectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance.
Methods
For each country we estimate the benefits and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile’s coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects.
Results
In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2–10 times higher). In all countries, the greatest potential benefit of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected benefits for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall.
Conclusions
Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health benefits for the poorest children and value for money require increased attention to these distributional effects.
Additional articles in this Supplement are organized under the following headings:
– Rotavirus Vaccines in Africa
– Rotavirus Vaccines in Asia
– Rotavirus Strain Studies
– Clinical Studies
– Intussusception
Editor’s Notes:
– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_21 April 2012
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
The Executive Directors of the World Bank Group selected Dr. Jim Yong Kim as President for a five-year term beginning on July 1, 2012. The President is Chair of the Boards of Directors of the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA). The President is also ex officio Chair of the Boards of Directors of the International Finance Corporation (IFC), the Multilateral Investment Guarantee Agency (MIGA), and the Administrative Council of the International Centre for Settlement of Investment Disputes (ICSID). In a statement,
the Executive Directors said “We, the Executive Directors, wish to express our deep appreciation to all the nominees, Jim Yong Kim, José Antonio Ocampo and Ngozi Okonjo-Iweala. Their candidacies enriched the discussion of the role of the President and of the World Bank Group’s future direction. The final nominees received support from different member countries, which reflected the high caliber of the candidates. We all look forward to working with Dr. Kim when he assumes his responsibilities.”
Dr. Jim Yong Kim is currently President of Dartmouth College. A U.S. national, Dr. Kim is a co-founder of Partners in Health (PIH) and a former director of the Department of HIV/AIDS at the World Health Organization (WHO). Before assuming the Dartmouth presidency, Dr. Kim held professorships at Harvard Medical School and the Harvard School of Public Health. He also served as chair of the Department of Global Health and Social Medicine at Harvard Medical School, chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and director of the François Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health.
Dr. Jim Yong Kim released a statement in response to his selection by the World Bank’s Executive Directors as 12th President of the World Bank:
“I am honored to accept the Executive Directors’ decision to select me as the next President of the World Bank Group. I am delighted to succeed Robert Zoellick, who has served with excellence and distinction during the last five years, and I am grateful to the Bank’s member countries for the broad support I have received….
I have spoken with Minister Okonjo-Iweala and Professor Ocampo. They have both made important contributions to economic development, and I look forward to drawing on their expertise in the years to come.
It is befitting that I conclude my global listening tour in Peru. It was here in the shantytowns of Lima that I learned how injustice and indignity may conspire to destroy the lives and hopes of the poor. It was here that I saw how communities struggle to prosper because of a lack of infrastructure and basic services. It was here that I learned that we must raise our sights to match the aspirations of those most excluded. And it was here that I learned that we can triumph over adversity by empowering the poor and focusing on results.
As President, I will seek a new alignment of the World Bank Group with a rapidly changing world. Together, with partners old and new, we will foster an institution that responds effectively to the needs of its diverse clients and donors; delivers more powerful results to support sustained growth; prioritizes evidence-based solutions over ideology; amplifies the voices of developing countries; and draws on the expertise and experience of the people we serve.
My discussions with the Board and member countries point to a global consensus around the importance of inclusive growth. We are closer than ever to achieving the mission inscribed at the entrance of the World Bank – “Our Dream is a World Free of Poverty.” The power of this mission is matched by the talent of the World Bank Group staff. May this shared mission embolden our efforts to end the disparities which too often diminish our shared humanity. Let us work together to provide every woman and man with the opportunity to determine their own future.”
The World Bank Board of Executive Directors said it approved in principle the creation of a Global Partnership for Social Accountability (GPSA). The GPSA is described as “a new mechanism to scale up and support social accountability by beneficiary groups and civil society organizations (CSOs) in developing countries.” The Bank’s Board will review operational details of the proposed Partnership in June. World Bank Group President Robert B. Zoellick commented, “The Bank understands now more than ever that citizen voice and the engagement of project beneficiaries are crucial for lasting development results. This new dedicated partnership will support critical work on social accountability, including beneficiary monitoring and oversight of projects and programs. I hope this new Partnership can become an integral part of the Bank Group’s work going forward.” The Bank said it plans to invest US$20 million in seed money to create the Partnership and will work with others to raise additional funds. The GSPA will focus on exchanging knowledge of best practice, as well as investing in projects to boost social accountability. The scope of the GPSA is global, and over 20 potential partners—including foundations, think tanks, governments and bilateral organizations – “have provided input to its design, along with more than 1,300 representatives of civil society organizations from 60 countries, who have participated in consultations on the proposed Partnership.” http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23175490~pagePK:64257043~piPK:437376~theSitePK:4607,00.html?cid=EXT_TWBN_D_EXT
Meeting Documentation: SAGE meeting of April 2012
Geneva, 10-12 April 2012
The report of this meeting will be made available in French and English in the Weekly Epidemiological Record (WER) on 25 May 2012.
Background documents
Session: Report from Director, IVB
– SAGE report of November 2011 meeting
pdf, 870kb
– SAGE report from the DoV meeting of February 2012
pdf, 299kb
– SAGE tracking record of recommendations and action points
pdf, 481kb
– Draft Global Vaccins Action Plan, 19 March 2012
pdf, 923kb
– Immunization and Vaccines related Implementation Research Advisory Committee (IVIR-AC) – Terms of reference
pdf, 254kb
– TFI members’ meeting, Summary report, Windhoek, Namibia, 2-3 December 2011
pdf, 660kb
Session: Reports from other advisory committees on immunization
– GACVS report
pdf, 1.10Mb
Documentation for the sessions below are available here:
http://www.who.int/immunization/sage/meetings/2012/april/presentations_background_docs/en/index.html
Session: Polio eradication
Session: Seasonal influenza vaccine
Session: Impact of introduction of new vaccines on the strengthening of immunization and health systems
Session: Vaccination in humanitarian emergencies
Session: Rotavirus vaccine schedules
Session: Use of hepatitis A vaccines
Session: Report from the GAVI Alliance Secretariat
Session: Information on vaccines for an Intergovernmental Negotiating Committee on Mercury
WHO Strategic Advisory Group of Experts (SAGE) on immunization: Request for nominations
WHO is soliciting proposals for nominations for current vacancies on its Strategic Advisory Group of Experts (SAGE) on immunization. Nominations should be submitted no later than 29 June 2012. In view of the current SAGE membership, nominations are solicited for experts from the African, American, Eastern Mediterranean, and Western Pacific regions. Nominations will then be carefully reviewed by the SAGE membership selection panel, which will propose the selection of nominees to the WHO Director-General for appointment. Please see this link for further information:
The Board of Directors of the Global Health Council (GHC) announced “with deep regret” that the Council will close operations within the coming months following “serious deliberations about the state of global health issues, the role of the Council as a convenor, and the Council’s current operating model.” GHC “is the world’s largest membership alliance dedicated to saving lives by improving health throughout the world, and worked to ensure that all who strive for improvement and equity in global health have the information and resources they need to succeed.” But the GHC Board said that “the compelling needs that gave rise to the Global Health Council’s mission have shifted. Funding that once existed to promote a broad-based health agenda is now focused on specific health issues. The fundamental shifts in the health landscape have led the Board to revisit the relevance of the organization and determine that the Council’s current operating model is no longer sustainable…We wish to thank our staff, leadership past and present and our members of the international community who have supported the Global Health Council for the last 40 years. We have accomplished much together, but despite the progress we have made, millions of people, many of them children, remain without access to basic health care. Our commitment to them must not waver. Although The Global Health Council will no longer play the same role, we will continue to fight for the goals that first inspired us to action.”
April 20, 2012
The Global Fund reported that United Kingdom International Development Secretary, Andrew Mitchell, told a parliamentary hearing that “the speed and effectiveness of reforms underway at the Global Fund to Fight AIDS, Tuberculosis and Malaria are on target.” Mr. Mitchell told a select committee for international development on Tuesday that he “thought the new leadership at the Global Fund warranted renewed confidence, and he singled out the Global Fund’s new General Manager, Gabriel Jaramillo, for bringing in improved management and financial supervision.” Mr. Mitchell told the hearing that the UK was already committed to giving the Global Fund 128 million pounds (204 million US dollars) “this year, next year and the year after,” and that the UK could significantly increase its annual contribution from 2013 to 2015 if reforms currently underway are successful.
Statement: NSABB Review of Revised H5N1 Manuscripts
NIH Director Francis Collins, M.D., Ph.D.
April 20, 2012
Extract
“On March 29 and 30, the National Science Advisory Board for Biosecurity (NSABB), an independent expert committee that advises the National Institutes of Health (NIH), the Department of Health and Human Services (HHS) and other Federal departments and agencies on matters of biosecurity, convened to review unpublished revised manuscripts describing NIH-funded research on the transmissibility of H5N1 influenza virus—the strain commonly referred to as “bird flu.”…The NSABB reviewed the revised manuscripts to make recommendations as to whether, and if so how, they should be communicated…
“…During its March meeting, the NSABB took into account the new and clarified information in the manuscripts, additional perspectives provided by influenza biology experts, highly pertinent but as yet unpublished epidemiologic data, and relevant security information.
“After careful deliberation, the NSABB unanimously recommended the revised manuscript by Dr. Yoshihiro Kawaoka be communicated in full. The NSABB also recommended, in a 12-to-6 decision, that the data, methods, and conclusions presented in the revised manuscript by Dr. Ron Fouchier be communicated fully after a number of further scientific clarifications are made in the manuscript. The recommendation to communicate the research was based on the observation that the information in the revised manuscripts has direct applicability to ongoing and future influenza surveillance efforts and does not appear to enable direct misuse of the research in ways that would endanger public health or national security.
“The HHS Secretary and I concur with the NSABB’s recommendation that the information in the two manuscripts should be communicated fully and we have conveyed our concurrence to the journals considering publication of the manuscripts. This information has clear value to national and international public health preparedness efforts and must be shared with those who are poised to realize the benefits of this research….”
Global Initiative: World Malaria Day, 25 April 2012
“In 2010, about 3.3 billion people – almost half of the world’s population – were at risk of malaria. Every year, this leads to about 216 million malaria cases and an estimated 655 000 deaths. People living in the poorest countries are the most vulnerable. World Malaria Day – which was instituted by the World Health Assembly at its 60th session in May 2007 – is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:
– for countries in the affected regions to learn from each other’s experiences and support each other’s efforts;
– for new donors to join a global partnership against malaria;
– for research and academic institutions to flag their scientific advances to both experts and general public; and
– for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.
Related links
http://www.who.int/mediacentre/events/annual/malaria/en/index.html
Global Initiative: World Meningitis Day, 24 April 2012
The Confederation of Meningitis Organisations (CoMO) “is urging people all over the world to ‘Join Hands Against Meningitis’ in an effort to reduce the global impact of the disease. The call-to-action encourages individuals, families and communities to learn the signs and symptoms of meningitis, the importance of urgent treatment of the disease, and that prevention is available through vaccination against some forms of meningitis.
http://www.multivu.com/mnr/55808-world-meningitis-day-join-the-fight-to-stop-meningitis
The MMWR Weekly for April 20, 2012 / Vol. 61 / No. 15 includes”
– Measles — United States, 2011
– Human Papillomavirus–Associated Cancers — United States, 2004–2008
– Tracking Progress Toward Global Polio Eradication, 2010–2011
– Announcements: World Malaria Day — April 25, 2012
– Announcements: National Infant Immunization Week — April 21–28, 2012
The Weekly Epidemiological Record (WER) for 20 April 2012, vol. 87, 16 (pp 153–160) includes: Tracking progress towards global polio eradication, 2010–2011
Twitter Watch [accessed 21 April 2012 – 15:20]
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.
Orin Levine @OrinLevine
This@GAVIAlliance video is why i’m going 2 Ghana next week, & why we do the work we do @IVACtweets http://vimeo.com/38946570
Retweeted by GAVI Alliance
11:48 AM – 20 Apr 12
Dagfinn Høybråten @Hoybraten
Celebrating 1st World Immunisation Week in Haiti and 10 years of Vaccination Week in the Americas @pahowho http://pic.twitter.com/jNIvClD9
Retweeted by GAVI Alliance
1:50 PM – 21 Apr 12
PATH MVI @MalariaVaccine
T-4 days to #WorldMalariaDay | #Malaria accounts for up to 40% of Africa’s public health expenditures. http://bit.ly/MVIwmd
2:00 PM – 21 Apr 12
UNICEF @UNICEF
Join the first ever World #Immunization Week, 21-28 April. Vaccines save lives, protect kids against deadly diseases http://goo.gl/M37Yb
10:25 AM – 21 Apr 12
RWJF PublicHealth @RWJF_PubHealth
2011 was the worst year for #measles in 15 years: http://bit.ly/IW2XW6 #publichealth
9:35 AM – 20 Apr 12
GHS @GHS
Why is it important to engage the public ahead of #vaccine introductions? Check out LSHTM’s reasons here: http://bit.ly/IXULtH
Retweeted by Sabin Vaccine Inst.
5:45 PM – 19 Apr 12
DoV Collaboration @DofVC
Decade of Vaccines Collaboration – April 2012 News Report – http://eepurl.com/k7XwX
5:10 AM – 20 Apr 12
IHME at UW @IHME_UW
Close
Jimmy Carter: Key to changing health outcomes is reaching journalists in countries afflicted by hard-to-eradicate diseases. #AHCJ12
6:19 PM – 19 Apr 12
WHO @WHO
Close
Over 19 million infants did not receive the basic vaccine against diphtheria-tetanus-pertussis in 2010 http://goo.gl/tCakV #vaccineswork
5:10 PM – 19 Apr 12
GAVI Alliance @GAVIAlliance
DTP3 coverage in low-income countries has increased from 66% in 2000 to 82% in 2011 – highest level ever! http://ht.ly/aoCeb #vaccineswork
5:07 PM – 19 Apr 12
WHO @WHO
Ten years of vaccination weeks in the Americas, 365m people have been vaccinated since http://goo.gl/fUicI #vaccineswork
12:04 PM – 19 Apr 12
Partners In Health @PIH
VIDEO: In #Haiti, health workers deliver the first of two doses of #cholera vaccine: http://ow.ly/ao6c4
11:29 AM – 19 Apr 12
Partners In Health @PIH
Dr. Jim Yong Kim ( @PIH co-founder) named @WorldBank president! http://ow.ly/ajyMP via @washingtonpost
Retweeted by USAID Global Health
1:42 PM – 16 Apr 12
The Pharmaceutical Research and Manufacturers of America (PhRMA) released Report (2012): Medicines in Development for Vaccines, profiling “nearly 300 vaccines for the prevention and treatment of a wide variety of diseases in development by America’s biopharmaceutical research companies.” The vaccines – all either currently tested in clinical trials or under review by the Food and Drug Administration – include 170 for infectious diseases, 102 for cancers and eight for neurological disorders. PhRMA noted that the report includes discussion of vaccines currently in development including:
– A genetically-modified vaccine for the treatment of pancreatic cancer.
– A therapeutic vaccine that increases the immune response against the HIV virus.
– A vaccine that protects infants against meningococcal disease, a leading cause of meningitis.
– An immunotherapeutic vaccine for the treatment of Alzheimer’s disease.
– A recombinant vaccine to prevent malaria.
REPORT: Report (2012): Medicines in Development for Vaccines
April 20, 2012
http://www.phrma.org/media/releases/nearly-300-vaccines-development-prevention-treatment-disease
The World Bank released the 2012 edition of World Development Indicators (WDI), providing “updated data on global development, the quality of people’s lives, the environment, the economy, the functioning of states and markets, and global links – how actions in one part of the world affect people elsewhere.” WDI 2012 “includes data for the first ten years of the Millennium Development Goals (MDGs), providing an important data resource for the Global Monitoring Report (GMR)…Measured against 1990 benchmarks, progress accelerated in the past decade, lifting millions out of poverty, enrolling millions of children in school, and sharply reducing the loss of life due to preventable causes.”
WDI and Regional Highlights: http://data.worldbank.org/data-catalog/world-development-indicators
April 19, 2012
Annals of Internal Medicine
April 17, 2012; 156 (8)
http://www.annals.org/content/current
Original Research
The Cost-Effectiveness of Preexposure Prophylaxis for HIV Prevention in the United States in Men Who Have Sex With Men
Jessie L. Juusola, Margaret L. Brandeau, Douglas K. Owens, and Eran Bendavid
Ann Intern Med April 17, 2012 156:541-550;
Abstract
Preexposure chemoprophylaxis (PrEP) with antiretroviral drugs significantly reduces the risk for HIV infection in HIV-negative men who have sex with men (MSM), but its cost-effectiveness is uncertain. In a dynamic model of HIV transmission and progression, a strategy that targeted PrEP to the 20% of MSM considered to be at highest risk for HIV prevented twice as many infections over the long term, and at better economic value, than one that provided PrEP to 20% of all HIV-negative MSM. Targeted PreP could have a substantial impact on the U.S. HIV epidemic at an acceptable cost.
British Medical Journal
21 April 2012 (Vol 344, Issue 7853)
http://www.bmj.com/content/344/7853
Editorial
Reducing neonatal mortality in resource poor settings
BMJ 2012; 344 doi: 10.1136/bmj.e2197 (Published 21 March 2012)
Cite this as: BMJ 2012;344:e2197
Kim Eva Dickson, Mickey Chopra
Extract
What works is now clearer but implementation is a challenge
Since the announcement in 2000 of the millennium development goals (MDGs), progress towards achieving these goals has resulted in considerable reductions in deaths from communicable diseases such as HIV, tuberculosis, and malaria (MDG 6); maternal mortality (MDG 5); and child deaths (MDG 4). Child deaths for instance have declined from more than 12 million in 1990 to 7.6 million in 2010.1 However, progress in reducing neonatal deaths—deaths within the first month of life—has lagged behind. Neonatal deaths now account for a greater proportion of global child deaths than ever before—nearly 41% of all deaths in children under 5 years occur during the neonatal period.2
In this context, the results of the linked trial by Bhandari and colleagues (doi:10.1136/bmj.e1634) are of particular interest and importance.3 It is the first study to evaluate India’s large and complex Integrated Management of Neonatal and Childhood Illness (IMNCI) programme, which is an approach to neonatal and child care that is being implemented across
Emerging Infectious Diseases
Volume 18, Number 5—May 201
http://www.cdc.gov/ncidod/EID/index.htm
Transmission Dynamics, Border Entry Screening, and School Holidays during the 2009 Influenza A (H1N1) Pandemic, China
H. Yu et al.
Abstract
Pandemic influenza A (H1N1) 2009 virus spread rapidly around the world in 2009. We used multiple data sources from surveillance systems and specific investigations to characterize the transmission patterns of this virus in China during May–November 2009 and analyze the effectiveness of border entry screening and holiday-related school closures on transmission. In China, age distribution and transmission dynamic characteristics were similar to those in Northern Hemisphere temperate countries. The epidemic was focused in children, with an effective reproduction number of ≈1.2–1.3. The 8 days of national holidays in October reduced the effective reproduction number by 37% (95% credible interval 28%–45%) and increased underreporting by ≈20%–30%. Border entry screening detected at most 37% of international travel–related cases, with most (89%) persons identified as having fever at time of entry. These findings suggest that border entry screening was unlikely to have delayed spread in China by >4 days.
Health Policy and Planning
Volume 27 Issue 3 May 2012
http://heapol.oxfordjournals.org/content/current
Original articles
Influencing policy change: the experience of health think tanks in low- and middle-income countries
Sara Bennett, Adrijana Corluka, Jane Doherty, Viroj Tangcharoensathien, Walaiporn Patcharanarumol, Amar Jesani, Joseph Kyabaggu, Grace Namaganda, A M Zakir Hussain, and Ama de-Graft Aikins
Health Policy Plan. (2012) 27(3): 194-203 doi:10.1093/heapol/czr035
[Open access]
Abstract
In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.
Health Policy and Planning
Volume 27 Issue 3 May 2012
http://heapol.oxfordjournals.org/content/current
Editor’s Choice: 10 best resources on … the current effects of global health initiatives on country health systems
Neil Spicer and Aisling Walsh
Health Policy Plan. (2012) 27(3): 265-269 doi:10.1093/heapol/czr034
Extract
The last decade has seen momentous shifts in the global development assistance architecture for health. Actors at global level are changing. In addition to the WHO, UNICEF, the World Bank and donor governments, new actors including philanthropic trusts and other civil society organizations, private-for-profit organizations, global health initiatives (GHIs) and partnerships are becoming increasingly significant (Brugha 2008; Walt et al. 2009). GHIs are mobilizing substantial new resources for disease control programmes in low- and middle- income countries (LMICs) leading to dramatic scaling up of services, especially for HIV and AIDS. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Emergency Plan For AIDS Relief (PEPFAR) and the World Bank’s HIV and AIDS programmes including the Multi-Country AIDS Program (MAP) collectively contribute more than two-thirds of all external funding for HIV and AIDS-related programmes in LMICs (Global Fund 2007; Oomman et al. 2007).1 They have also introduced new forms of governance, engaged non-traditional actors—private-for-profit actors and civil society—and promoted increased political support around focal diseases and public health issues.
Due to the magnitude of funding there is a growing interest in the effects of these and other major GHIs, including the GAVI Alliance (Global Alliance for Vaccines and Immunisations).2 Among the concerns expressed about GHIs are the unintended negative effects of disease-specific programmes (often perceived as ‘vertical’ programmes) including whether they undermine efforts to improve donor harmonization (co-ordination between donors) and alignment (co-ordination between donors and recipient government policies and programmes),3 place increased burdens on already weak health systems and unintentionally weaken the delivery of services for non-focal diseases (Brugha 2008; WHO Maximizing Positive Synergies Academic Consortium 2009).
Evidence is beginning to emerge from empirical studies conducted in several countries on GHI effects on country health systems. Much of …
JAMA
April 18, 2012, Vol 307, No. 15, pp 1555-1657
http://jama.ama-assn.org/current.dtl
Theme Issue: Comparative Effectiveness Research
Viewpoints
The Patient-Centered Outcomes Research Institute (PCORI) National Priorities for Research and Initial Research Agenda
Joe V. Selby, Anne C. Beal, Lori Frank
JAMA. 2012;307(15):1583-1584.doi:10.1001/jama.2012.500
Extract
The Patient Protection and Affordable Care Act of 2010 created the Patient-Centered Outcomes Research Institute (PCORI) to fund and promote comparative clinical effectiveness research (CER) that will “assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis.”1 CER is not a new concept,2,3 but appreciation of its potential for providing patients and their clinicians with uniquely valuable information on what works, tailored to the clinical situation and to patient priorities, has increased rapidly in recent years.
The research institute founded by this legislation was named to emphasize the critical importance of a patient-centered perspective in conducting this research.4 The PCORI Board of Governors determined early on that taking this …
Special Communication
Methodological Standards and Patient-Centeredness in Comparative Effectiveness Research: The PCORI Perspective
Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI)
JAMA. 2012;307(15):1636-1640.doi:10.1001/jama.2012.466
Abstract
Rigorous methodological standards help to ensure that medical research produces information that is valid and generalizable, and are essential in patient-centered outcomes research (PCOR). Patient-centeredness refers to the extent to which the preferences, decision-making needs, and characteristics of patients are addressed, and is the key characteristic differentiating PCOR from comparative effectiveness research. The Patient Protection and Affordable Care Act signed into law in 2010 created the Patient-Centered Outcomes Research Institute (PCORI), which includes an independent, federally appointed Methodology Committee. The Methodology Committee is charged to develop methodological standards for PCOR. The 4 general areas identified by the committee in which standards will be developed are (1) prioritizing research questions, (2) using appropriate study designs and analyses, (3) incorporating patient perspectives throughout the research continuum, and (4) fostering efficient dissemination and implementation of results. A Congressionally mandated PCORI methodology report (to be issued in its first iteration in May 2012) will begin to provide standards in each of these areas, and will inform future PCORI funding announcements and review criteria. The work of the Methodology Committee is intended to enable generation of information that is relevant and trustworthy for patients, and to enable decisions that improve patient-centered outcomes.
Editorials
Is It Time for Medicine-Based Evidence?
John Concato
Comparative Effectiveness Research: Relative Successes
Robert M. Golub, Phil B. Fontanarosa
The Lancet
Apr 21, 2012 Volume 379 Number 9825 p1461 – 1560
http://www.thelancet.com/journals/lancet/issue/current
Series
The importance of quantitative systemic thinking in medicine
Geoffrey B West
Preview
The study and practice of medicine could benefit from an enhanced engagement with the new perspectives provided by the emerging areas of complexity science and systems biology. A more integrated, systemic approach is needed to fully understand the processes of health, disease, and dysfunction, and the many challenges in medical research and education. Integral to this approach is the search for a quantitative, predictive, multilevel, theoretical conceptual framework that both complements the present approaches and stimulates a more integrated research agenda that will lead to novel questions and experimental programmes.
vaccines and global health :: ethics and policy 