IFPMA calls for “broad-based cooperation to fight online sales of counterfeit medicines around the world”

The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) called for “broad-based cooperation to fight online sales of counterfeit medicines around the world.”  23 July 2012

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Paying the poor (conditional cash transfers)

British Medical Journal
28 July 2012 (Vol 345, Issue 7867)

Global Health
Paying the poor
Using cash incentives to encourage healthy behaviour among poor communities is being hailed as a new silver bullet in global health. Megan Tan and Gavin Yamey investigate why this popular idea went so badly wrong in Guatemala

The Economist calls it “the world’s favourite new anti-poverty device.”1 Global health donors, development agencies, and governments in developing countries praise it as a way of empowering women and investing in community development. A remarkably simple idea that took root in the late 1990s—offering poor mothers cash incentives to enrol their families in health and education programmes—is now being used in over 40 developing countries, from Mexico to Burkina Faso, Cambodia to Yemen.

Although each country’s incentive programme has its own characteristics, the basic idea is the same: impoverished mothers are paid a regular cash stipend in exchange for meeting certain predetermined conditions, or “coresponsibilities” as they are often called in Latin America. Typically, these conditions include attending regular medical check-ups and ensuring that children go to school. In most countries, parents must also attend educational seminars on topics such as nutrition, hygiene, and money management.       Advocates believe that that these cash rewards, known as “conditional cash transfers,” will get transformed over the long run into improved maternal and child health and economic development.

But against this backdrop of intense fervour for cash rewards, a series of missteps and crises led Guatemala to recently suspend its conditional cash transfer programme, called Mi Familia Progresa (My Family Makes Progress) or MIFAPRO. The suspension takes the shine off the reputation of cash transfers as a silver bullet and serves as a cautionary tale for donors and developing countries that are currently planning similar programmes.

High hopes
Although the World Bank classifies Guatemala as a middle income country, over half the population lives in poverty. The country’s …

Planning influenza vaccination programs: a cost benefit model

Cost Effectiveness and Resource Allocation
(Accessed 28 July 2012)

Planning influenza vaccination programs: a cost benefit model
Ian G Duncan, Michael S Taitel, Junjie Zhang and Heather S Kirkham
Cost Effectiveness and Resource Allocation 2012, 10:10 doi:10.1186/1478-7547-10-10
Published: 26 July 2012

Abstract (provisional)
Although annual influenza vaccination could decrease the significant economic and humanistic burden of influenza in the United States, immunization rates are below recommended levels, and concerns remain whether immunization programs can be cost beneficial. The research objective was to compare cost benefit of various immunization strategies from employer, employee, and societal perspectives.

An actuarial model was developed based on the published literature to estimate the costs and benefits of influenza immunization programs. Useful features of the model included customization by population age and risk-level, potential pandemic risk, and projection year. Various immunization strategies were modelled for an average U.S. population of 15,000 persons vaccinated in pharmacies or doctor’s office during the 2011/12 season. The primary outcome measure reported net cost savings per vaccinated (PV) from the perspective of various stakeholders.

Given a typical U.S. population, an influenza immunization program will be cost beneficial for employers when more than 37% of individuals receive vaccine in non-traditional settings such as pharmacies. The baseline scenario, where 50% of persons would be vaccinated in non-traditional settings, estimated net savings of $6 PV. Programs that limited to pharmacy setting ($31 PV) or targeted persons with high-risk comorbidities ($83 PV) or seniors ($107 PV) were found to increase cost benefit. Sensitivity analysis confirmed the scenario-based findings.

Both universal and targeted vaccination programs can be cost beneficial. Proper planning with cost models can help employers and policy makers develop strategies to improve the impact of immunization programs.

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

Vaccination of Health Care Workers to Protect Patients at Increased Risk for Acute Respiratory Disease

Emerging Infectious Diseases
Volume 18, Number 8—August 2012

Vaccination of Health Care Workers to Protect Patients at Increased Risk for Acute Respiratory Disease
PDF Version [PDF – 291 KB – 10 pages]
G. P. Dolan et al.

Evidence is limited but sufficient to sustain current vaccination recommendations.

Avian and pandemic human influenza policy in South-East Asia

Health Policy and Planning
Volume 27 Issue 5  August 2012

Original articles
Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives
Health Policy Plan. (2012) 27(5): 374-383 doi:10.1093/heapol/czr056
Petcharat Pongcharoensuk, Wiku Adisasmito, Le Minh Sat, Pornpit Silkavute, Lilis Muchlisoh, Pham Cong Hoat, and Richard Coker

The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes.

The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand’s poultry industry is large and principally an export economy, Vietnam’s and Indonesia’s are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy.

With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.