Public Health Ethics
Volume 6 Issue 1 April 2013
http://phe.oxfordjournals.org/content/current

Human Papilloma Virus, Vaccination and Social Justice: An Analysis of a Canadian School-Based Vaccine Program
Alison Thompson
Public Health Ethics (2013) 6(1): 11-20 doi:10.1093/phe/pht010
http://phe.oxfordjournals.org/content/6/1/11.abstract

Abstract
Social justice has strong historical roots in public health. This does not mean that we always understand what it entails when conducting an ethical analysis of a particular public health program. This article shows that Powers and Faden’s theory of social justice can provide important insights and nuance to such an analysis. The Ontario human papilloma virus vaccination program that is underway in Canada provides an important and timely case where we can surface ethical issues pertaining to social justice that may otherwise remain unarticulated in the context of this program. This analysis focuses on the normative issues raised by the prioritization of a school-based program for girls only. It also examines the relevant domains of well-being identified in Powers and Faden’s theory to see whether the program is likely to enhance the well-being of those for whom it is most important. Finally, the role of vaccines in general in promoting well-being is discussed.

Public Health Ethics
Volume 6 Issue 1 April 2013
http://phe.oxfordjournals.org/content/current

Male Infant Circumcision as a ‘HIV Vaccine’
Barry Lyons
Public Health Ethics (2013) 6(1): 90-103 doi:10.1093/phe/phs039
http://phe.oxfordjournals.org/content/6/1/90.abstract

Abstract
This article deals with the specific claim that prophylactic male infant circumcision should be employed to prevent HIV transmission in countries in which the prevalence of HIV is relatively low. In a recent editorial, Australian researchers sought to promote the procedure as a ‘surgical vaccine’ against HIV in their country. This raises the question whether it would be reasonable for the UK to adopt a policy of mass infant male circumcision in order to protect individuals from heterosexually acquired infection with HIV. A review of the relevant data and associated commentary indicates that the actual benefits of real-world circumcision policies to prevent HIV transmission are disputed and that circumcision, at best, provides partial protection. In addition, it is uncertain whether infant circumcision confers the same benefits that the adult procedure is proposed to provide. Reasons for performing circumcisions on infants include that the procedure is easier, less complicated and cheaper. However, it is not risk free. Despite arguments to the contrary, this article contends that it is morally problematic to operate on thousands of male infants each year for little benefit to children qua children. It is also argued that the use of the term ‘surgical vaccine’ to describe the procedure is both inaccurate and misleading.

Science        
22 March 2013 vol 339, issue 6126, pages 1349-1476
http://www.sciencemag.org/current.dtl

Perspective – Medicine
Spatial Turn in Health Research
Douglas B. Richardson1, Nora D. Volkow2, Mei-Po Kwan3, Robert M. Kaplan4, Michael F. Goodchild5, Robert T. Croyle6
http://www.sciencemag.org/content/339/6126/1390.summary

Summary
Spatial analysis using maps to associate geographic information with disease can be traced as far back as the 17th century. Today, recent developments and the widespread diffusion of geospatial data acquisition technologies are enabling creation of highly accurate spatial (and temporal) data relevant to health research. This has the potential to increase our understanding of the prevalence, etiology, transmission, and treatment of many diseases.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 16, Pages 2009-2108 (12 April 2013)

Editorial
Steps for clinicians and public health officials to take to reach persons of faith, for the sake of protecting all against vaccine-preventable diseases
Pages 2009-2010
Richard K. Zimmerman, Jonathan Raviotta
[No abstract]

What the World’s religions teach, applied to vaccines and immune globulins
Review Article
Pages 2011-2023
John D. Grabenstein

Abstract
For millennia, humans have sought and found purpose, solace, values, understanding, and fellowship in religious practices. Buddhist nuns performed variolation against smallpox over 1000 years ago. Since Jenner developed vaccination against smallpox in 1796, some people have objected to and declined vaccination, citing various religious reasons. This paper reviews the scriptural, canonical basis for such interpretations, as well as passages that support immunization. Populous faith traditions are considered, including Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam. Subjects of concern such as blood components, pharmaceutical excipients of porcine or bovine origin, rubella strain RA 27/3, and cell-culture media with remote fetal origins are evaluated against the religious concerns identified.

The review identified more than 60 reports or evaluations of vaccine-preventable infectious-disease outbreaks that occurred within religious communities or that spread from them to broader communities. In multiple cases, ostensibly religious reasons to decline immunization actually reflected concerns about vaccine safety or personal beliefs among a social network of people organized around a faith community, rather than theologically based objections per se. Themes favoring vaccine acceptance included transformation of vaccine excipients from their starting material, extensive dilution of components of concern, the medicinal purpose of immunization (in contrast to diet), and lack of alternatives. Other important features included imperatives to preserve health and duty to community (e.g., parent to child, among neighbors). Concern that ‘the body is a temple not to be defiled’ is contrasted with other teaching and quality-control requirements in manufacturing vaccines and immune globulins.

Health professionals who counsel hesitant patients or parents can ask about the basis for concern and how the individual applies religious understanding to decision-making about medical products, explain facts about content and processes, and suggest further dialog with informed religious leaders. Key considerations for observant believers for each populous religion are described.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 16, Pages 2009-2108 (12 April 2013)

Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls
Original Research Article
Pages 2028-2034
Jennifer Tsui, Rita Singhal, Hector P. Rodriguez, Gilbert C. Gee, Beth A. Glenn, Roshan Bastani

Abstract
Purpose
Human Papillomavirus (HPV) vaccine uptake remains low. Although publicly funded programs provide free or low cost vaccines to low-income children, barriers aside from cost may prevent disadvantaged girls from getting vaccinated. Prior studies have shown distance to health care as a potential barrier to utilizing pediatric preventive services. This study examines whether HPV vaccines are geographically accessible for low-income girls in Los Angeles County and whether proximity to safety-net clinics is associated with vaccine initiation.

Methods
Interviews were conducted in multiple languages with largely immigrant, low-income mothers of girls ages 9 to 18 via a county health hotline to assess uptake and correlates of uptake. Addresses of respondents and safety-net clinics that provide the HPV vaccine for free or low cost were geo-coded and linked to create measures of geographic proximity. Logistic regression models were estimated for each proximity measure on HPV vaccine initiation while controlling for other factors.

Results
On average, 83% of the 468 girls had at least one clinic within 3-miles of their residence. The average travel time on public transportation to the nearest clinic among all girls was 21 min. Average proximity to clinics differed significantly by race/ethnicity. Latinas had both the shortest travel distances (2.2 miles) and public transportation times (16 min) compared to other racial/ethnic groups. The overall HPV vaccine initiation rate was 25%. Increased proximity to the nearest clinic was not significantly associated with initiation. By contrast, daughter’s age and insurance status were significantly associated with increased uptake.

Conclusions
This study is among the first to examine geographic access to HPV vaccines for underserved girls. Although the majority of girls live in close proximity to safety-net vaccination services, rates of initiation were low. Expanding clinic outreach in this urban area is likely more important than increasing geographic access to the vaccine for this population.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 16, Pages 2009-2108 (12 April 2013)

Parental perspectives of vaccine safety and experience of adverse events following immunisation
Original Research Article
Pages 2067-2074
Adriana Parrella, Michael Gold, Helen Marshall, Annette Braunack-Mayer, Peter Baghurst

Abstract
Introduction
We aimed to determine demographic predictors of parental vaccine safety and risk perceptions, and assess the relationship between the occurrence of children’s perceived adverse events following immunisation (AEFI) on parents’ opinions.

Methods
Computer-assisted telephone interviews (CATI) were conducted in 2011 with a cross-sectional, random general population sample of rural and metropolitan residents in South Australia. Multivariate ordinal logistic regression analyses examined associations between parental vaccine safety attitudes and socio-demographic factors, adjusting for whether children had ever experienced a previous suspected AEFI.

Results
Of 469 parents interviewed, 95% were confident in vaccine safety in general, but almost half expressed concern for pre-licensure testing of vaccines. Of all parents, 41% responded that at least one of their children had experienced an AEFI. Almost one third of the AEFI parent group indicated they reported their children’s symptoms to either a healthcare professional or the Department of Health. Parental acceptability of the risks of febrile convulsion and anaphylaxis were 73% and 76% respectively. Ordinal logistic regression analyses showed parents of children who had experienced a suspected AEFI were associated with greater concern for vaccine safety (OR:0.53, p ≤ 0.01) and more were likely to expect either a mild or a serious AEFI. After adjusting for demographics, parental confidence in vaccine safety was significantly associated with higher levels of education (OR:2.58, p = 0.01) and being born in Australia OR:2.30, p = 0.004. Mothers, when compared with fathers, were less accepting of the two vaccine risks presented: febrile convulsion (OR:0.57, p = 0.04) and anaphylaxis, (OR:0.55, p = 0.04).

Conclusions
Parents commonly perceive and report that their child has experienced an AEFI. In this group of parents the subsequent expectation of an AEFI and vaccine safety concerns may be heightened. Further research should investigate parental understandings of differentiating an expected event from an adverse event as this could inform immunization risk communication and consumer AEFI reporting strategies.

Vaccine
Volume 31, Issue 15, Pages 1879-2008 (8 April 2013)

Sustainability of National Immunization Programme (NIP) performance and financing following Global Alliance for Vaccines and Immunization (GAVI) support to the Democratic Republic of the Congo (DRC)
Review Article
Pages 1886-1891
Jean-Bernard Le Gargasson, J. Gabrielle Breugelmans, Benoît Mibulumukini, Alfred Da Silva, Anaïs Colombi

Abstract
Background
The Global Alliance for Vaccines and Immunization (GAVI) is a public–private global health partnership aiming to increase access to immunisation in poor countries. The Democratic Republic of the Congo (DRC) is the third largest recipient of GAVI funds in terms of cumulative disbursed support. We provided a comprehensive assessment of GAVI support and analysed trends in immunisation performance and financing in the DRC from 2002 to 2010.

Methods
The scope of the analysis includes GAVI’s total financial support and the value of vaccines and syringes purchased by GAVI for the DRC from 2002 to 2010. Data were collected through a review of published and grey literature and interviews with key stakeholders in the DRC. We assessed the allocation and use of GAVI funds for each of GAVI’s support areas, as well as trends in immunisation performance and financing.

Findings
DTP3 coverage increased from 2002 (38%) to 2007 (72%) but had decreased to a level below 70% in 2008 (68%) and 2010 (63%). The overall funding for vaccines increased from US$5.4 million in 2006 to US$30.5 million in 2010 (mostly from GAVI support for new vaccines). However, during the same period, the funding from national (government) and international (GAVI and other donors) sources for routine immunisation services (except vaccines) decreased from US$36.4 million to US$24.4 million. This drop in overall funding (33%) primarily affected surveillance, transport, and cold chain equipment.

Interpretation
GAVI support to DRC has enhanced significant progress in routine immunisation performance and financing during 2002–2010. Although progress has been partly sustained, the initial observed increase in DTP3 coverage and available funding for routine immunisation halted towards the end of the analysis period, coinciding with tetravalent and pentavalent vaccine introduction. These findings highlight the need for additional efforts to ensure the sustainability of routine immunization program performance and financing.

Vaccine
Volume 31, Issue 15, Pages 1879-2008 (8 April 2013)

Chlamydia trachomatis control requires a vaccine
Review Article
Pages 1892-1897
Robert C. Brunham, Rino Rappuoli

Abstract
As the most common reported communicable disease in North America and Europe, Chlamydia trachomatis is the focus of concerted public health control efforts based on screening and treatment. Unexpectedly control efforts are accompanied by rising reinfection rates attributed in part to arresting the development of herd immunity. Shortening the duration of infection through the testing and treatment program is the root cause behind the arrested immunity hypothesis and because of this a vaccine will be essential to control efforts. Advances in Chlamydia vaccinomics have revealed the C. trachomatis antigens that can be used to constitute a subunit vaccine and a vaccine solution appears to be scientifically achievable. We propose that an accelerated C. trachomatis vaccine effort requires coordinated partnership among academic, public health and private sector players together with a commitment to C. trachomatis vaccine control as a global public health priority.

Vaccine
Volume 31, Issue 15, Pages 1879-2008 (8 April 2013)

Impact of the introduction of rotavirus vaccine on the timeliness of other scheduled vaccines: The Australian experience
Original Research Article
Pages 1964-1969
Brynley P. Hull, Robert Menzies, Kristine Macartney, Peter B. McIntyre

Abstract
Strict age limits for receipt of rotavirus vaccines and simultaneous use of vaccines requiring two (Rotarix®) and three (RotaTeq®) doses in Australia may impact on coverage and timeliness of other vaccines in the infant schedule. Using data from the Australian Childhood Immunisation Register (ACIR), coverage and timeliness of rotavirus vaccines and changes in timeliness of other infant vaccines following rotavirus vaccine introduction was examined, with particular emphasis on Indigenous infants in whom coverage is less optimal. Final dose rotavirus coverage reached 83% within 21 months of program commencement but remained 7% lower than other vaccines due in infancy. Coverage was 11–17% lower in Indigenous infants. Adherence to the first dose upper age limits for rotavirus vaccine was high with >97% of children vaccinated by the recommended age, but for subsequent rotavirus doses, receipt beyond the upper age limits was more common, especially in Indigenous children. Following rotavirus vaccine introduction, there were improvements in timeliness of receipt of all doses of DTPa-containing and 7-valent pneumococcal conjugate vaccines. High population coverage can be attained with rotavirus vaccines, even with adherence to strict upper age restrictions for vaccine dose administration. Rotavirus vaccine introduction appears to have impacted upon the timeliness of other concomitantly scheduled vaccines. These factors should be considered when rotavirus programs are introduced.

Vaccine: Development and Therapy
(Accessed 23 March 2013)
http://www.dovepress.com/vaccine-development-and-therapy-journal

Key feasibility considerations when conducting vaccine clinical trials in Asia–Pacific countries
Lansang EZ, Tan K, Nayak S, Lee KJ, Wai K
Published Date March 2013 Volume 2013:3 Pages 1 – 9
DOI: http://dx.doi.org/10.2147/VDT.S41903
http://www.dovepress.com/key-feasibility-considerations-when-conducting-vaccine-clinical-trials-peer-reviewed-article-VDT

Introduction: Conducting clinical trial feasibility is an important first step in initiating a clinical trial. A robust feasibility process ensures that a realistic capability assessment is made before conducting a trial. A retrospective analysis of vaccine clinical trials was performed to understand changes which could affect feasibility recommendations.
Methods: Feasibilities conducted by Quintiles between January 2011 and August 2012 were reviewed. Vaccine studies only involving Asia–Pacific countries were selected, and common study parameters were identified. Information from Quintiles’ database was retrieved to examine changes in parameters over time.
Results: A total of six vaccine studies were identified within the 1.7-year period. Two studies were excluded because they did not contain feasibility information or had involved sites that were sponsor selected. Four studies were analyzed. Three cases required healthy volunteers, while one case involved a specific patient population. Age requirement and seasonality of disease mainly influenced recommendations for Study 1. Sponsor’s marketing strategy influenced the recommendations for Study 2. Study 3 showed the effect of a country’s immunization program and reimbursement of vaccines on a study’s success. In contrast to the other studies, Study 4 demonstrated the impact of eligibility criteria in recruitment recommendations for a vaccine trial requiring specific patient pools.
Conclusion: Feasibility recommendations for vaccine trials are largely based on (1) eligibility criteria; (2) cultural beliefs; (3) country’s past recruitment performance; (4) use of advertising; (5) site’s access to subject populations; (6) cooperation with local health professionals and government; (7) sponsor’s marketing strategies; (8) study design concordance with national immunization programs; (9) reimbursement of vaccines; (10) overall benefit of the vaccine to the population; and where applicable, (11) seasonality of the disease under study.

Financial Times
http://www.ft.com
Accessed 23 March 2013
March 21, 2013 8:35 pm

Vaccines: Trial setback fails to damp enthusiasm
By Clive Cookson, Science Editor
http://www.ft.com/cms/s/0/9522528c-870d-11e2-9dd7-00144feabdc0.html#axzz2OQIGNQy2

The Third Global Forum on TB Vaccines will open in Cape Town next week with several hundred researchers and clinicians determined to remain upbeat, despite the setback their field received last month.

The first large clinical trial for 90 years of a new vaccine against tuberculosis, MVA85A, failed to show efficacy when the Lancet published results.

The trial was intended to show MVA85A, developed at Oxford university in a £30m programme over 10 years, would boost the immune response of 2,800 South African babies inoculated with BCG. The Bacille Calmette – Guérin vaccine, introduced in 1921 and based on the bacterium that causes bovine tuberculosis, does not produce a good enough response to stop the TB pandemic.

But Professor McShane insists there is still mileage in MVA85A and says a dozen other vaccine candidates working by different mechanisms are in clinical development globally. “We need new drugs too, but the only way we’re going to tackle this epidemic in the long term is through an effective vaccine,” she says.

The team is not giving up on MVA85A. Samples from the infants in the trial will be analysed for clues about how the immune system reacts to vaccination and infection with the Mycobacterium tuberculosis, the TB germ. Researchers will look to improve the immune response with higher or multiple doses, combining MVA85A with other vaccine, or delivering it into the lungs.

Meanwhile a trial of MVA85A in 1,400 HIV-positive adults, at particular risk of developing TB, is going ahead in South Africa and Senegal with results due in 2015, says Prof McShane. The dozen vaccine candidates at earlier stages of clinical development, and a couple of dozen more in pre-clinical research, span a range of approaches. As with MVA85A, some are based on viruses genetically modified to stimulate the immune system against TB. Some, including BCG, are based on mycobacteria such as the one that causes TB. Some are proteins. For example   GlaxoSmithKline, the UK-based pharmaceutical group, has developed a vaccine, M72/AS01E, based on a combination of proteins and adjuvant (a booster chemical). Crucell of the Netherlands uses Ad35, a harmless adenovirus with antigens from Mycobacterium tuberculosis, to stimulate production of protective antibodies.

Two non-profit international bodies organise funding and logistical support for TB vaccine development: the Tuberculosis Vaccine Initiative in Europe and Aeras, based in the US. According to Ann Ginsberg, head of science at Aeras, it is too early to talk about which approach is likely to be most promising.

Dr Ginsberg is confident the MVA85A setback will not undermine funding for vaccine research, which will need hundreds of millions of dollars over the next few years: “Our funders, organisations like the Gates Foundation, [US] National Institutes of Health and the [UK] Department for International Development, are realistic about what it takes to develop a TB vaccine.”

But other TB experts say the challenge of developing an effective vaccine is so great that available money should be focused more on diagnostics and drug development. They express their reservations in an article due to appear in a forthcoming issue of The Lancet Infectious Diseases.

“Without a clear scientific basis for protective immunity against the disease and a biological marker for this, which we don’t have, it is difficult to know how to make an effective vaccine,” says one of the group, Richard Anthony of the Royal Tropical Institute, Amsterdam. One fundamental problem, he says, is past tuberculosis infection does not offer protection and patients recently treated for TB can become reinfected.

At next week’s Cape Town congress, however, most delegates will see the scientific challenge as a reason for making more rather than less effort. “I see the meeting as a rallying of the troops,” says Dr Ginsberg. “Now is the time to push forward, not pull back.”

Copyright The Financial Times Limited 2013.

Le Monde
http://www.lemonde.fr/
Accessed 23 March 2013
Revers pour un vaccin contre le paludisme
LE MONDE | 23 mars 2013 | 308 mots

Le vaccin antipaludique RTS, S/AS01E, actuellement le plus avancé de ceux en développement, perd de son efficacité au cours du temps et n’a plus guère d’effet protecteur chez les jeunes enfants au bout de quatre ans, selon les résultats d’un essai.

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_16 March 2013_PDF

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

WHO IVB: Over 700 million children in 49 countries to be protected against measles and rubella.
Rwanda first sub-Saharan African country to introduce measles-rubella vaccine nationwide with GAVI support

Extract
“Kigali, Geneva, New York, Washington: 12 March 2013 – Rwanda’s measles-rubella vaccination campaign, which is being launched today, is the beginning of an effort to vaccinate more than 700 million children under 15 years of age against two disabling and deadly diseases. The combined measles-rubella vaccine will be introduced in 49 countries by 2020 thanks to financial support from the GAVI Alliance. The support builds on the efforts of the Measles & Rubella Initiative (M&RI) that have helped countries to protect 1.1 billion children against measles since 2001. Rwanda, which is already effectively controlling measles, becomes the first sub-Saharan African country to provide measles-rubella vaccine nationwide with GAVI support”…

“…Rwanda has made great strides over the past four years in child survival by introducing vaccines against leading child killers, including pneumonia and diarrhoea,” said Dr Agnes Binagwaho, Rwanda’s Minister of Health. “The introduction of the combined measles-rubella vaccine is one more important step to ensuring that all children in Rwanda receive the full immunization package. In our efforts to eliminate measles, we have raised measles coverage through campaigns and routine immunisation to higher than 95%.” …

http://www.who.int/immunization/newsroom/press/700_million_children_49_countries_protected_measles_rubella/en/index.html

GAVI and the Islamic Development Bank (IDB) signed a Memorandum of Understanding “to help save children’s lives by accelerating the introduction of life-saving vaccines in IDB member countries.” According to the MoU signed between Dr Ahmad Mohamed Ali, Chairman, IDB Group, and Dr Seth Berkley, CEO, GAVI, the IDB “will work closely with GAVI to help secure sufficient funds for immunisation. By 2020, GAVI plans to vaccinate more than 400 million children in at least 29 member countries with the objective of preventing 3.2 million deaths. An estimated US$ 7 billion will be required to reach this target. GAVI CEO Dr Seth Berkley said, “We are joining hands with the IDB to accelerate the introduction of life-saving vaccines in IDB member countries and ensure that children have a healthy start in life. We also aim to increase the uptake of new and underused vaccines in these countries and hopefully generate new sources of funding.”

Dr Ahmad Mohamed Ali stated that “promoting health is among the major strategic thrusts of the Vision 1440H (2020) of the IDB Group and that it was happy to enter into a cooperation agreement with GAVI to save the lives of millions of children in member countries, thereby playing a major role against child mortality. He mentioned that in the initial stage, IDB will try to support the governments of selected member countries to implement the vaccination programme through its “triple win financing model” in which it will seek collaboration with other partners while also providing the recipient countries the opportunity to contribute a portion of the cost along with IDB.”

11 March 2013 – http://www.gavialliance.org/library/news/press-releases/2013/islamic-development-bank-partners-with-gavi-to-save-children-s-lives-with-vaccines/

UNICEF announced that Japan will donate US$189.5 million from its supplementary budget for a wide range of programmes in 35 developing countries and territories. Over 80 per cent of the support will go toward 29 African countries; the remainder is earmarked for Afghanistan and five nations and territories in the Middle East, including Iraq, Jordan and Lebanon affected by the Syrian conflict. UNICEF Executive Director Anthony Lake said, “This extraordinary donation from the Japanese government and the people of Japan is a measure of their deep humanity. Their contribution will help transform the lives of millions of children enduring conflict and hardship. Even when times are tough at home, the generosity of the Japanese is not diminished. US$189.5 million is not only a very large number. It is polio vaccines, seats in classrooms, anti-retroviral drugs, clean water and so much more. The Japanese people should be very proud of making such a difference.”

http://www.unicef.org/media/media_68197.html

Update: Polio this week – As of 12 March 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– Efforts are continuing in DR Congo to further boost immunity levels and fill residual subnational surveillance gaps. Although the country has not reported a WPV case since December 2011, DR Congo was affected by a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak, with 17 cases (the most recent had onset of paralysis on 4 April 2012).
– With Angola successfully coming off the re-established transmission list in July 2012, South Sudan in 2010 and now DR Congo, Chad remains the only country with re-established WPV transmission. Here too, however, strong progress continues to be achieved, and the country is on track to becoming again polio-free in June 2013 (most recent WPV case: 14 June 2012; however, Chad remains affected by a cVDPV2 outbreak, with 12 cases reported in the second half of 2012.

Nigeria
– One new WPV case was reported in the past week (WPV1 from Borno), bringing the total number of WPV cases for 2013 to 4. The total number of WPV cases for 2012 remains 122. The most recent WPV case had onset of paralysis on 31 January 2013 (from Yobe).
– Nationwide Immunization Plus Days (IPDs) were conducted using trivalent OPV on 2-5 March in 30 states, coordinated with activities in neighbouring Republic of Niger. IPDs have been postponed by one week in four southern states and the Federal Capital Territory because of the need for more time to adequately prepare for the round of immunization. IPDs have been postponed in Kano and Borno states due to security concerns. The security situation in the north remains fluid.

Pakistan
– The security situation continues to be monitored closely, in consultation with law enforcement agencies.
– Sub-national Immunization Days were conducted in 34 out of 51 planned districts/towns from 4-6 March. Activities have been delayed in other districts, but campaigns are underway in certain areas as possible.

The Weekly Epidemiological Record (WER) for 15 March 2013, vol. 88, 11 (pp. 117–128) includes:

– Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness
– Fact sheet on pneumonia
– Monthly report on dracunculiasis cases, January 2013 – FIRST MONTH WITH ZERO CASE

http://www.who.int/entity/wer/2013/wer8811.pdf

WHO – Global Alert and Response (GAR)
Disease Outbreak News –
http://www.who.int/csr/don/2013_03_12/en/index.html

12 March 2013  Novel coronavirus infection – update
The Ministry of Health in Saudi Arabia has informed WHO of a new confirmed case of infection with the novel coronavirus (nCoV).

The patient, a 39-year-old male, developed symptoms on 24 February 2013. He was hospitalized on 28 February 2013 and died on 2 March 2013. Preliminary investigation indicated that the patient had no contact with previously reported cases of nCoV infection. Other potential exposures are under investigation.

To date, WHO has been informed of a global total of 15 confirmed cases of human infection with nCoV, including nine deaths.

Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.

All MS are reminded to promptly assess and notify WHO of any new case of infection with nCoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to closely monitor the situation.

Report: IVI Country Investment Case Study on Cholera Vaccination
International Vaccine Institute and funding partners
March 2013; 134 pages

http://www.ivi.int/web/www/04_03?p_p_id=EXT_BBS&p_p_lifecycle=1&p_p_state=exclusive&p_p_mode=view&p_p_col_id=column-1&p_p_col_pos=1&p_p_col_count=2&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fget_file&_EXT_BBS_bbsMessageId=503&_EXT_BBS_extFileId=1295

“As part of its global investment case for oral cholera vaccines, IVI developed a Bangladesh case study providing a local perspective. The report provides an estimate of the disease and economic burden, as well as financing needs, likely challenges, and cost, impact and cost-effectiveness estimates for several cholera vaccination strategies.”

Report: The European health report 2012 – charting the way to well-being
WHO Europe
March 2013
http://www.euro.who.int/en/what-we-do/data-and-evidence/european-health-report-2012

“Like its predecessors, the 2012 European health report describes both the overall improvements in health in the WHO European Region and their uneven distribution within and between countries. It breaks new ground, however, by helping both to define well-being, a goal of Europe’s new health policy, Health 2020, and to map the way towards achieving it.

“By describing health in Europe, this report provides policy-makers and public health professionals with the epidemiological evidence base that underpins Health 2020 and its six overarching targets. In addition, it sets out the agreed approach to monitoring progress towards Health 2020, outlines the collaborative agenda to address the challenges ahead and makes the case for measuring well-being as a marker of progress in health.”

Full report: The European health report 2012: charting the way to well-being

Report: The 2013 Human Development Report – The Rise of the South: Human Progress in a Diverse World
United Nations Development Programme (UNDP)
14 March 2013; 216 pages
http://hdr.undp.org/en/media/HDR_2013_EN_complete.pdf

Excerpt
“The 2013 Human Development Report examines the profound shift in global dynamics driven by the fast-rising new powers of the developing world and its long-term implications for human development.

“China has already overtaken Japan as the world’s second biggest economy while lifting hundreds of millions of its people out of poverty. India is reshaping its future with new entrepreneurial creativity and social policy innovation. Brazil is lifting its living standards through expanding international relationships and antipoverty programs that are emulated worldwide.

“But the “Rise of the South” analyzed in the Report is a much larger phenomenon: Turkey, Mexico, Thailand, South Africa, Indonesia and many other developing nations are also becoming leading actors on the world stage.

“The 2013 Human Development Report identifies more than 40 countries in the developing world that have done better than had been expected in human development terms in recent decades, with their progress accelerating markedly over the past ten years. The Report analyzes the causes and consequences of these countries achievements and the challenges that they face today and in the coming decades.

“Each of these countries has its own unique history and has chosen its own distinct development pathway. Yet they share important characteristics and face many of the same challenges. They are also increasingly interconnected and interdependent. And people throughout the developing world are increasingly demanding to be heard, as they share ideas through new communications channels and seek greater accountability from governments and international institutions.

“The 2013 Human Development Report identifies policies rooted in this new global reality that could promote greater progress throughout the world for decades to come. The Report calls for far better representation of the South in global governance systems and points to potential new sources of financing within the South for essential public goods. With fresh analytical insights and clear proposals for policy reforms, the Report helps chart a course for people in all regions to face shared human development challenges together, fairly and effectively…”

http://hdr.undp.org/en/mediacentre/humandevelopmentreportpresskits/2013report/

Report: Public-Private Partnerships for Global Health: How PATH Advances Technologies Through Cross-Sector Collaboration
PATH
March 2013; 8 pages
This policy report highlights the essential role that public-private partnerships play in driving global health product development and offers insights into the key components of successful multi-sector partnerships led by PATH.
http://www.path.org/publications/files/ER_app_ppp_policy_rpt.pdf

Excerpt
RECOMMENDATIONS
Adequately fund public-private partnerships to maximize global health impact
Public-private partnerships are an efficient and sustainable model for conducting global health research and development throughout the product lifecycle. They leverage the resources and expertise of different stakeholders to accelerate the development and delivery of high-impact, cost-effective products to improve public health. As the lead funder of global health research and development, the public sector should ensure that its investments support the critical work of public-private partnerships in accelerating the availability, accessibility, and affordability of global health technologies.

Provide support throughout the product lifecycle to accelerate innovation, introduction, and integration of global health technologies
To maximize impact, the public and private sectors and NGOs must begin with the end in mind. Support by the public sector for technology development alone does not guarantee that a product will reach those most in need. To ensure that innovative ideas become products that efficiently advance from development through wide-scale adoption for sustained public health impact, the public sector must support the products throughout their lifecycle. Thus, investment in market development from the very beginning is essential to build the foundation for supply, create demand, and provide an incentive for private-sector partners to sustain their investments.

Create incentives for private-sector engagement to advance health products for low-resource settings
Public-sector investment—through funding, capacity strengthening, or providing incentives—helps to create an enabling environment that encourages commercialinvestment in global health. Incentives such as accelerated regulatory reviews and pooled funding mechanisms enable commercial partners to meet the needs of the public and the private sectors. Such incentives need to be offered in combination with other innovative mechanisms—such as milestone prizes that provide rewards for incremental achievements along the product lifecycle—to ensure mutual benefits for the public and private sectors, as well as for the global health missions of NGOs like PATH.

Video Report: Now is the time
http://www.path.org/news/an130313-video-optimize.php

New video highlights importance of strengthening vaccine supply and logistics systems
“Recent advances in vaccine science have enabled more countries to provide newer, lifesaving vaccines to more people. However, the impact of these vaccines is often constrained by delays and vaccine waste due to stressed and aging vaccine supply and logistics systems. To harness the power of new vaccines, a new video from Optimize argues, it is critical to upgrade and strengthen vaccine supply and logistics systems throughout the world.

“Optimize, a collaboration between PATH and the World Health Organization with support from many other partners, has begun to demonstrate and document the impact of new technologies, systems, and approaches on supply system efficiency. These partners have agreed on a global vision to improve vaccine supply and logistics by 2020.

“Titled Now Is the Time, the video illustrates the immediate need for all immunization partners to support countries as they embark on meaningful changes in their vaccine supply systems and prepare for the introduction of new and lifesaving vaccines.”

WHO IVB: Request For Proposals – Systematic review of missed opportunities for vaccination
Application deadline: 15 April 2013
– Introduction and Background

Excerpt
Introduction
This request for proposals (RFP) is made by the WHO Department of Immunization Vaccines and Biologicals (IVB). IVB seeks proposals for the rigorous systematic review and meta-analysis of all available data from published and unpublished studies relevant to missed opportunities for vaccination. IVB encourages proposals that include collaboration between institutions/groups in industrialized countries and institutions/groups in low and middle income countries.

Background
As early as 1983, the Expanded Programme on Immunization (EPI) has recommended using every opportunity to immunize all eligible people as a direct strategy to increase vaccination coverage. Protocols for the assessment of “missed opportunities” (defined as any contact with a health service that did not result in an eligible child or woman receiving the needed vaccines) were developed in 1984 and 1988 and widely distributed.

Missed opportunities for vaccination occur in two major settings:
– during visits for immunization and other preventive services (e.g. growth monitoring, nutrition assessments and oral rehydration training sessions, etc.).
– during visits for curative services.

In both settings, eliminating missed opportunities has the potential to raise immunization coverage in a population, particularly when the availability and use of health services is high. When the availability and use of health services is low, immunizing at health care contact is extremely important because the risk for vaccine-preventable diseases is likely to be high in these areas…
– Research objectives
– Proposal Submission/Research Plan
– Deliverables
– Eligibility and How to Apply

More at: http://www.who.int/immunization/rfp_review_missed_opportunities_vaccination/en/index.html

British Medical Journal
16 March 2013 (Vol 346, Issue 7899)
http://www.bmj.com/content/346/7899

Research
Comparative effect sizes in randomised trials from less developed and more developed countries: meta-epidemiological assessment
Orestis A Panagiotou, research associate1, Despina G Contopoulos-Ioannidis, clinical associate professor23, John P A Ioannidis, director4, C F Rehnborg professor in disease prevention, professor of medicine, and professor of health research and policy5
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f707 (Published 12 February 2013)
Cite this as: BMJ 2013;346:f707

Abstract
Objective  To compare treatment effects from randomised trials conducted in more developed versus less developed countries.

Design  Meta-epidemiological study.

Data sources C Cochrane Database of Systematic Reviews (August 2012).

Data extraction  Meta-analyses with mortality outcomes including data from at least one randomised trial conducted in a less developed country and one in a more developed country. Relative risk estimates of more versus less developed countries were compared by calculating the relative relative risks for each topic and the summary relative risks across all topics. Similar analyses were performed for the primary binary outcome of each topic.

Results  139 meta-analyses with mortality outcomes were eligible. No nominally significant differences between more developed and less developed countries were found for 128 (92%) meta-analyses. However, differences were beyond chance in 11 (8%) cases, always showing more favourable treatment effects in trials from less developed countries. The summary relative risk was 1.12 (95% confidence interval 1.06 to 1.18; P<0.001; I2=0%), suggesting significantly more favourable mortality effects in trials from less developed countries. Results were similar for meta-analyses with nominally significant treatment effects for mortality (1.15), meta-analyses with recent trials (1.14), and when excluding trials from less developed countries that subsequently became more developed (1.12). For the primary binary outcomes (127 meta-analyses), 20 topics had differences in treatment effects beyond chance (more favourable in less developed countries in 15/20 cases).

Conclusions  Trials from less developed countries in a few cases show significantly more favourable treatment effects than trials in more developed countries and, on average, treatment effects are more favourable in less developed countries. These discrepancies may reflect biases in reporting or study design as well as genuine differences in baseline risk or treatment implementation and should be considers when generalising evidence across different settings.

Eurosurveillance
Volume 18, Issue 11, 14 March 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Review articles
Outbreaks associated to large open air festivals, including music festivals, 1980 to 2012
by E Botelho-Nevers, P Gautret

Abstract
In the minds of many, large scale open air festivals have become associated with spring and summer, attracting many people, and in the case of music festivals, thousands of music fans. These festivals share the usual health risks associated with large mass gatherings, including transmission of communicable diseases and risk of outbreaks. Large scale open air festivals have however specific characteristics, including outdoor settings, on-site housing and food supply and the generally young age of the participants. Outbreaks at large scale open air festivals have been caused by Cryptosporium parvum, Campylobacter spp., Escherichia coli, Salmonella enterica, Shigella sonnei, Staphylococcus aureus, hepatitis A virus, influenza virus, measles virus, mumps virus and norovirus. Faecal-oral and respiratory transmissions of pathogens result from non-compliance with hygiene rules, inadequate sanitation and insufficient vaccination coverage. Sexual transmission of infectious diseases may also occur and is likely to be underestimated and underreported. Enhanced surveillance during and after festivals is essential. Preventive measures such as immunisations of participants and advice on-site and via social networks should be considered to reduce outbreaks at these large scale open air festivals.

Journal of Medical Microbiology
April 2013; 62 (Pt 4)
http://jmm.sgmjournals.org/content/current

Review
Global spread of antibiotic resistance: the example of New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance
Alan P. Johnson and Neil Woodford
J Med Microbiol April 2013 62:499-513; published ahead of print January 17, 2013, doi:10.1099/jmm.0.052555-0
[Open Access] http://jmm.sgmjournals.org/content/62/Pt_4/499.abstract

Abstract 
The rapidity with which new types of antibiotic resistance can disseminate globally following their initial emergence or recognition is exemplified by the novel carbapenemase New Delhi metallo-β-lactamase (NDM). The first documented case of infection caused by bacteria producing NDM occurred in 2008, although retrospective analyses of stored cultures have identified the gene encoding this enzyme (blaNDM) in Enterobacteriaceae isolated in 2006. Since its first description, NDM carbapenemase has been reported from 40 countries worldwide, encompassing all continents except South America and Antarctica. The spread of NDM has a complex epidemiology involving the spread of a variety of species of NDM-positive bacteria and the inter-strain, inter-species and inter-genus transmission of diverse plasmids containing blaNDM, with the latter mechanism having played a more prominent role to date. The spread of NDM illustrates that antibiotic resistance is a public health problem that transcends national borders and will require international cooperation between health authorities if it is to be controlled.

Journal of Medical Microbiology
April 2013; 62 (Pt 4)
http://jmm.sgmjournals.org/content/current

Clinical microbiology and virology
Hand contamination during routine care in medical wards: the role of hand hygiene compliance
J Med Microbiol April 2013 62:623-629; published ahead of print January 17, 2013, doi:10.1099/jmm.0.050328-0
Olga Monistrol, M. Liboria López, Montserrat Riera, Roser Font, Carme Nicolás, Miguel Angel Escobar, Núria Freixas, Javier Garau, and Esther Calbo
http://jmm.sgmjournals.org/content/62/Pt_4/623.abstract

Abstract
The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before–after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log10 c.f.u. ml−1 and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (P<0.001). Enterobacteriaceae, Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (P<0.001). The meticillin-resistant coagulase-negative staphylococci log10 c.f.u. count ml−1 decreased from 1.96±1.2 to 0.89±1.2 (mean±sd; P<0.001), and the global flora count decreased from 2.77±1.1 to 1.56±1.4 (P<0.001). In the POST period, the wearing of fewer rings (P<0.001), shorter fingernail length (P = 0.008), a shorter time since recent hand hygiene (HH) (P = 0.007) and an increased use of alcohol-based hand rub instead of soap (P<0.001) were documented.   The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.

The Lancet  
Mar 16, 2013  Volume 381  Number 9870  p875 – 962
http://www.thelancet.com/journals/lancet/issue/current
[No relevant content]

Early Online Publication, 13 March 2013
Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis
Dr Daniel A Salmon PhD Michael Proschan PhD d, Richard Forshee PhD e, Paul Gargiullo PhD f, William Bleser MSPH a, Dale R Burwen MD e, Francesca Cunningham PharmD g, Patrick Garman PhD h, Sharon K Greene PhD i, Grace M Lee MD i, Claudia Vellozzi MD f, W Katherine Yih PhD i, Bruce Gellin MD a, Nicole Lurie MD b, the H1N1 GBS Meta-Analysis Working Group†
doi:10.1016/S0140-6736(12)62189-8

Summary
Background
The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the vaccination programme, a project to monitor vaccine adverse events was undertaken, the most comprehensive safety surveillance agenda in the USA to date. The adverse event monitoring project identified an increased risk of Guillain-Barré syndrome after vaccination; however, some individual variability in results was noted. Guillain-Barré syndrome is a rare but serious health disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness, sometimes paralysis, and infrequently death. We did a meta-analysis of data from the adverse event monitoring project to ascertain whether influenza A (H1N1) 2009 monovalent inactivated vaccines used in the USA increased the risk of Guillain-Barré syndrome.

Methods
Data were obtained from six adverse event monitoring systems. About 23 million vaccinated people were included in the analysis. The primary analysis entailed calculation of incidence rate ratios and attributable risks of excess cases of Guillain-Barré syndrome per million vaccinations. We used a self-controlled risk-interval design.

Findings
Influenza A (H1N1) 2009 monovalent inactivated vaccines were associated with a small increased risk of Guillain-Barré syndrome (incidence rate ratio 2·35, 95% CI 1·42—4·01, p=0·0003). This finding translated to about 1·6 excess cases of Guillain-Barré syndrome per million people vaccinated.

Interpretation
The modest risk of Guillain-Barré syndrome attributed to vaccination is consistent with previous estimates of the disorder after seasonal influenza vaccination. A risk of this small magnitude would be difficult to capture during routine seasonal influenza vaccine programmes, which have extensive, but comparatively less, safety monitoring. In view of the morbidity and mortality caused by 2009 H1N1 influenza and the effectiveness of the vaccine, clinicians, policy makers, and those eligible for vaccination should be assured that the benefits of inactivated pandemic vaccines greatly outweigh the risks.

Funding
US Federal Government.

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2013  Volume 91, Issue 1  Pages 1–218
http://onlinelibrary.wiley.com/doi/10.1111/milq.2013.91.issue-1/issuetoc

Summarizing Social Disparities in Health (pages 5–36)
YUKIKO ASADA, YOKO YOSHIDA and ALYCE M. WHIPP
Article first published online: 14 MAR 2013 | DOI: 10.1111/milq.12001
[Open Access: http://onlinelibrary.wiley.com/doi/10.1111/milq.12001/full ]

Abstract
Context
Reporting on health disparities is fundamental for meeting the goal of reducing health disparities. One often overlooked challenge is determining the best way to report those disparities associated with multiple attributes such as income, education, sex, and race/ethnicity. This article proposes an analytical approach to summarizing social disparities in health, and we demonstrate its empirical application by comparing the degrees and patterns of health disparities in all fifty states and the District of Columbia (DC).

Methods
We used the 2009 American Community Survey, and our measure of health was functional limitation. For each state and DC, we calculated the overall disparity and attribute-specific disparities for income, education, sex, and race/ethnicity in functional limitation. Along with the state rankings of these health disparities, we developed health disparity profiles according to the attribute making the largest contribution to overall disparity in each state.

Findings
Our results show a general lack of consistency in the rankings of overall and attribute-specific disparities in functional limitation across the states. Wyoming has the smallest overall disparity and West Virginia the largest. In each of the four attribute-specific health disparity rankings, however, most of the best- and worst-performing states in regard to overall health disparity are not consistently good or bad. Our analysis suggests the following three disparity profiles across states: (1) the largest contribution from race/ethnicity (thirty-four states), (2) roughly equal contributions of race/ethnicity and socioeconomic factor(s) (ten states), and (3) the largest contribution from socioeconomic factor(s) (seven states).

Conclusions
Our proposed approach offers policy-relevant health disparity information in a comparable and interpretable manner, and currently publicly available data support its application. We hope this approach will spark discussion regarding how best to systematically track health disparities across communities or within a community over time in relation to the health disparity goal of Healthy People 2020.

PLoS Medicine
(Accessed 16 March 2013)
http://www.plosmedicine.org/

Policy Forum
Adapting Standards: Ethical Oversight of Participant-Led Health Research
Effy Vayenal, John Tasioulas

Summary Points
– Online social media and digital technologies have facilitated formation of communities of individuals engaged in establishing and conducting health research projects. The results of such participant-led research (PLR) have already appeared in leading biomedical journals.

– These projects involve research with human participants. Hence, what are the requirements for ethical oversight? To what extent is standard ethics review also suitable for PLR?

– A comparison of PLR with standard research reveals six areas that are of potential relevance to ethical oversight: institutionalization, state recognition and support, incentive structures, openness, bottom-up approach, and self-experimentation.

– The distinctive nature of PLR requires adaptation of ethical oversight standards to the character of such research. These should strike a balance between protecting interests of research participants and achieving promised benefits of PLR.

– The appropriate form of ethical oversight for PLR projects depends on which of three categories they fall into. If they meet the “institution-plus” criterion, standard ethics review applies. If not, then the appropriate form of oversight depends on the application of a minimal risk criterion.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 14, Pages 1765-1878 (3 April 2013)

Legal considerations surrounding mandatory influenza vaccination for healthcare workers in the United States
Review Article
Pages 1771-1776
Lisa H. Randall, Eileen A. Curran, Saad B. Omer

Abstract
Recent years have brought increased focus on the desirability of vaccinating more healthcare workers against influenza. The concern that novel 2009 H1N1 influenza A would spark a particularly severe influenza season in 2009–2010 spurred several institutions and one state to institute mandatory vaccination policies for healthcare workers, and several new mandates have been introduced since then. Some healthcare workers, however, have voiced objections in the media and in legal proceedings. This paper reviews the characteristics of influenza and how it is transmitted in the healthcare setting; surveys possible constitutional, administrative, and common law arguments against mandates; assesses the viability of those arguments; and identifies potential new legal strategies to support influenza vaccine mandates. It is intended to assist those involved in the regulation and administration of public and private healthcare institutions who may be considering approaches to mandates but have concerns about legal challenges.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Active immunotherapy for chronic diseases
Review Article
Pages 1777-1784
Martin F. Bachmann, Piers Whitehead

Abstract
With the effective control of infectious diseases in many parts of the world, chronic, non-communicable diseases have become the major cause of death and disability. Monoclonal antibodies (mAbs) have become an important class of drugs for the treatment of such diseases. Nevertheless, mAbs suffer from major shortcomings in a chronic setting: most notably, generation of anti-antibodies and high cost of goods. Here, we discuss a novel approach to treat chronic diseases based on active rather than passive immunization and contrast the 2 treatment modalities to highlight their respective advantages and disadvantages.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 14, Pages 1765-1878 (3 April 2013)

Adverse events following yellow fever preventive vaccination campaigns in eight African countries from 2007 to 2010
Original Research Article
Pages 1819-1829
J.G. Breugelmans, R.F. Lewis, E. Agbenu, O. Veit, D. Jackson, C. Domingo, M. Böthe, W. Perea, M. Niedrig, B.D. Gessner, S. Yactayo, on behalf of the YF AEFI group

Abstract
Background
Serious, but rare adverse events following immunization (AEFI) have been reported with yellow fever (YF) 17D vaccine, including severe allergic reactions, YF vaccine-associated neurologic disease (YEL-AND) and YF vaccine-associated viscerotropic disease (YEL-AVD). The frequency with which YEL-AND and YEL-AVD occur in YF endemic countries is mostly unknown.

Methods
From 2007 to 2010, eight African countries – Benin, Cameroon, Guinea, Liberia, Mali, Senegal, Sierra Leone, and Togo- implemented large-scale YF preventive vaccination campaigns. Each country established vaccine pharmacovigilance systems that included standard case definitions, procedures to collect and transport biological specimens, and National Expert Committees to review data and classify cases. Staff in all countries received training and laboratory capacity expanded.

Results
In total, just over 38 million people were vaccinated against YF and 3116 AEFIs were reported of which 164 (5%) were classified as serious. Of these, 22 (13%) were classified as YF vaccine reactions, including 11 (50%) hypersensitivity reactions, six (27%) suspected YEL-AND, and five (23%) suspected YEL-AVD. The incidence per 100,000 vaccine doses administered was 8.2 for all reported AEFIs, 0.43 for any serious AEFI, 0.058 for YF vaccine related AEFIs, 0.029 for hypersensitivity reactions, 0.016 for YEL-AND, and 0.013 for YEL-AVD. Our findings were limited by operational challenges, including difficulties in obtaining recommended biological specimens leading to incomplete laboratory evaluation, unknown case ascertainment, and variable levels of staff training and experience.

Conclusions
Despite limitations, active case-finding in the eight different countries did not find an incidence of YF vaccine associated AEFIs that was higher than previous reports. These data reinforce the safety profile of YF vaccine and support the continued use of attenuated YF vaccine during preventive mass vaccination campaigns in YF endemic areas.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 14, Pages 1765-1878 (3 April 2013)

Economic evaluation of universal newborn hepatitis B vaccination in China
Original Research Article
Pages 1864-1869
Sandy Qiuying Lu, Sarah M. McGhee, Xu Xie, Jinquan Cheng, Richard Fielding

Abstract
Objective
To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity.

Method
A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty.

Results
Over the cohort’s lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided.

Conclusion
The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue.

Vaccine
Volume 31, Issue 13, Pages 1651-1764 (25 March 2013)

Systematic review of economic evaluation studies: Are vaccination programs efficient in Spain?
Review Article
Pages 1656-1665
Anna García-Altés

Abstract
Introduction
During the twentieth century, vaccination has been one of the measures of greatest public health impact. Vaccine administration has helped reduce the burden of disease and mortality from infectious diseases. At present, there is increasing concern about infectious diseases and the ability of health systems to control them, highlighting the need for evaluation of vaccination programs. The aim of this study was to conduct a systematic review of economic evaluation studies carried out regarding Spain on vaccines.

Methods
Systematic review. Search of articles in major bibliographic databases available online from January 1983 to June 2011. References identified were limited to full economic evaluations carried out regarding Spain that evaluated vaccination programs. For each of the selected papers, a set of predefined variables were extracted.

Results
A total of 46 studies met inclusion criteria. The topics studied were pneumococcal vaccination, influenza vaccination, Hepatitis B vaccination and varicella vaccination. Cost-minimization analysis, perspective of society, long time horizon, use of modeling techniques, and the inclusion of direct and indirect costs were the most common methodological characteristics. The results of the studies reviewed showed, in most cases, net savings or cost-effectiveness ratios below €30,000/QALY.

Conclusions
Although there has been an improvement in the methodological quality of studies, they still show shortcomings that should be addressed. From a public health perspective, it would be relevant to evaluate vaccines targeted to major health problems in Spain, including all relevant costs and benefits. In order to obtain a more efficient use of health resources, economic evaluation methods should be applied more rigorously and results should be used consistently in decision-making processes.

Vaccine
Volume 31, Issue 13, Pages 1651-1764 (25 March 2013)

Female human papillomavirus (HPV) vaccination: Global uptake and the impact of attitudes
Review Article
Pages 1673-1679
Tom Glass Hopkins, Nick Wood
Abstract
Human papillomavirus (HPV) is the causative agent in cervical cancer and has been implicated in a range of other malignancies. Preventative vaccines are now internationally available and provide high levels of protection from common viral strains. The introduction of a comprehensive vaccination programme (except ‘program’ in computers) could prevent over 60% of current cervical cancer cases, but this is dependent on such programmes achieving a high level of coverage. In this review, we summarise the current trends in female HPV vaccination coverage throughout the world, and place it in the context of available research on attitudes towards vaccination amongst the public and health professionals.

Where countries have the resources for mass vaccination programmes, uptake has varied. School-based opt-out programmes consistently achieve highest coverage, whilst countries and regions without systematic vaccination schemes have low coverage. In all countries, the success of vaccination programmes is dependent on the support of the public and healthcare professionals. Whilst public acceptance is dependent on multiple factors, it has repeatedly been shown that recommendation by a health professional, particularly clinicians, is key to vaccine uptake. Worryingly, it appears that a proportion of clinicians still have significant reservations about promoting vaccination, particularly for younger age groups. A commitment now, to fully educating both the public and clinicians, has the potential to make a dramatic future impact.

Vaccine
Volume 31, Issue 13, Pages 1651-1764 (25 March 2013)

Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data
Review Article
Pages 1680-1694
G.S. Goldman, P.G. King

Abstract
In a cooperative agreement starting January 1995, prior to the FDA’s licensure of the varicella vaccine on March 17, the Centers for Disease Control and Prevention (CDC) funded the Los Angeles Department of Health Services’ Antelope Valley Varicella Active Surveillance Project (AV-VASP). Since only varicella case reports were gathered, baseline incidence data for herpes zoster (HZ) or shingles was lacking. Varicella case reports decreased 72%, from 2834 in 1995 to 836 in 2000 at which time approximately 50% of children under 10 years of age had been vaccinated. Starting in 2000, HZ surveillance was added to the project. By 2002, notable increases in HZ incidence rates were reported among both children and adults with a prior history of natural varicella. However, CDC authorities still claimed that no increase in HZ had occurred in any US surveillance site. The basic assumptions inherent to the varicella cost–benefit analysis ignored the significance of exogenous boosting caused by those shedding wild-type VZV. Also ignored was the morbidity associated with even rare serious events following varicella vaccination as well as the morbidity from increasing cases of HZ among adults. Vaccine efficacy declined below 80% in 2001. By 2006, because 20% of vaccinees were experiencing breakthrough varicella and vaccine-induced protection was waning, the CDC recommended a booster dose for children and, in 2007, a shingles vaccination was approved for adults aged 60 years and older. In the prelicensure era, 95% of adults experienced natural chickenpox (usually as children)—these cases were usually benign and resulted in long-term immunity. Varicella vaccination is less effective than the natural immunity that existed in prevaccine communities. Universal varicella vaccination has not proven to be cost-effective as increased HZ morbidity has disproportionately offset cost savings associated with reductions in varicella disease. Universal varicella vaccination has failed to provide long-term protection from VZV disease.

Vaccine
Volume 31, Issue 13, Pages 1651-1764 (25 March 2013)

The impact of differential uptake of HPV vaccine by sexual risks on health inequalities: A model-based analysis
Original Research Article
Pages 1740-1747
Talía Malagón, Véronique Joumier, Marie-Claude Boily, Nicolas Van de Velde, Mélanie Drolet, Marc Brisson

Abstract
Background
Differences in sexual behaviour are partly responsible for significant inequalities in human papillomavirus (HPV)-related diseases between sub-populations. Our aim was to illustrate how differential HPV vaccine uptake by sexual behaviour can impact population-level vaccination effectiveness and inequalities in HPV prevalence.

Methods
We used a multi-type individual-based transmission-dynamic model of HPV infection. The modelled population is stratified into 4 sexual activity levels (low = L0, high = L3). The model was calibrated to Canadian epidemiological data, including the proportion of sexually active individuals by gender and type-specific HPV prevalence by level of sexual activity. Vaccine uptake by sexual activity level was varied in one-way sensitivity analyses. Uncertainty in model predictions is presented using the median [10-90th percentiles] of simulations.

Results
In our pre-vaccination calibrated modelled population, the most sexually active risk groups (L2–L3) account for 43% of prevalent HPV-16/18 infections while only representing 20% of the population. Under base case assumptions (age at vaccination = 12 years, vaccine efficacy = 100%, average duration of protection = 20 years, overall coverage = 50%), vaccinating girls is predicted to reduce HPV-16/18 prevalence by 56% [46–69] at equilibrium (70 years post-vaccination) when uptake is uniform across sexual activity levels, and by 35% [28–40] when uptake is maldistributed (L0: 100%, L1: 55%, L2: 0%, L3: 0%). At uniform 50% vaccination coverage across risk groups, HPV-16/18 prevalence is predicted to be reduced by 62% [52–73], 74% [57–82], 40% [24–60], and 28% [7–54] at equilibrium among women in levels of sexual activity L0, L1, L2 and L3, respectively.

Conclusions
A low vaccine uptake in girls at highest risk of future HPV acquisition may substantially limit population effectiveness of vaccination. Vaccination effectiveness is lower in more sexually active groups due to smaller herd effects. Uniform vaccination coverage across sub-populations may not be able to decrease existing inequalities in HPV infection and disease unless coverage is high enough to produce herd effects in higher risk groups.

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses
Vaccine design: emerging concepts and renewed optimism

SK Grimm, ME Ackerman – Current Opinion in Biotechnology, 2013
Arguably, vaccination represents the single most effective medical intervention ever developed. Yet, vaccines have failed to provide any or adequate protection against some of the most significant global diseases. The pathogens responsible for these vaccine- …

A Survey of US Travelers to Asia to Assess Compliance With Recommendations for the Use of Japanese Encephalitis Vaccine
MR Duffy, C Reed, PJ Edelson, S Blumensaadt… – Journal of Travel Medicine, 2013
Background Japanese encephalitis (JE) vaccine is recommended for travelers to Asia whose itineraries increase their risk of exposure to JE virus. The numbers of travelers with such itineraries and the proportion of those who receive JE vaccine are unknown. We …

Niccine®, a Nicotine Vaccine, for Relapse Prevention: A Phase II, Randomized, Placebo-Controlled, Multicenter Clinical Trial
S Tonstad, E Heggen, H Giljam, PÅ Lagerbäck… – Nicotine & Tobacco …, 2013
Abstract Introduction: A nicotine vaccine could prevent relapse to smoking by hindering blood nicotine from reaching the brain. Niccine® is a nicotine hapten tetanus-toxoid conjugate vaccine. The present study evaluated the clinical efficacy of Niccine for tobacco …

Pharmaceutics
Volume 5, Issue 1 (March 2013)
http://www.mdpi.com/1999-4923/5/1

Commentary
Vaccine Safety Surveillance Systems: Critical Elements and Lessons Learned in the Development of the US Vaccine Safety Datalink’s Rapid Cycle Analysis Capabilities
Robert L. Davis, Director of Research, Center for Health Research Southeast
Received: 31 December 2012; in revised form: 16 February 2013 / Accepted: 18 February 2013 / Published: 12 March 2013
doi:10.3390/pharmaceutics5010168

Abstract:
Since the late 1990s, there have been tremendous strides made in improving the capacity for carrying out routine active surveillance of new vaccines in the United States. These strides have led to new surveillance systems that are now in place. Some of the critical elements that are part of successful vaccine or drug safety surveillance systems include their use of (i) longitudinal data from a discrete enumerated population base, (ii) frequent, routine transfers of small amounts of data that are easy to collect and collate, (iii) avoidance of mission creep, (iv) statistical capabilities, (v) creation of an “industrialized process” approach and (vi) political safe harbor.

Risk Analysis
March 2013   Volume 33, Issue 3  Pages 349–504
http://onlinelibrary.wiley.com/doi/10.1111/risa.2013.33.issue-3/issuetoc
[No relevant content]

Article first published online: 7 MAR 2013
Oral Poliovirus Vaccine Evolution and Insights Relevant to Modeling the Risks of Circulating Vaccine-Derived Polioviruses (cVDPVs)
Radboud J. Duintjer Tebbens1,*, Mark A. Pallansch2, Jong-Hoon Kim1, Cara C. Burns2, Olen M. Kew2, M. Steven Oberste2, Ousmane M. Diop3, Steven G.F. Wassilak4, Stephen L. Cochi4, Kimberly M. Thompson1,5
DOI: 10.1111/risa.12022
http://onlinelibrary.wiley.com/doi/10.1111/risa.12022/abstract;jsessionid=DAC134E9BF5C939730C31626BAB31558.d01t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Abstract
The live, attenuated oral poliovirus vaccine (OPV) provides a powerful tool for controlling and stopping the transmission of wild polioviruses (WPVs), although the risks of vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived poliovirus (cVDPV) outbreaks exist as long as OPV remains in use. Understanding the dynamics of cVDPV emergence and outbreaks as a function of population immunity and other risk factors may help to improve risk management and the development of strategies to respond to possible outbreaks. We performed a comprehensive review of the literature related to the process of OPV evolution and information available from actual experiences with cVDPV outbreaks. Only a relatively small fraction of poliovirus infections cause symptoms, which makes direct observation of the trajectory of OPV evolution within a population impractical and leads to significant uncertainty. Despite a large global surveillance system, the existing genetic sequence data largely provide information about transmitted virulent polioviruses that caused acute flaccid paralysis, and essentially no data track the changes that occur in OPV sequences as the viruses transmit largely asymptomatically through real populations with suboptimal immunity. We updated estimates of cVDPV risks based on actual experiences and identified the many limitations in the existing data on poliovirus transmission and immunity and OPV virus evolution that complicate modeling. Modelers should explore the space of potential model formulations and inputs consistent with the available evidence and future studies should seek to improve our understanding of the OPV virus evolution process to provide better information for policymakers working to manage cVDPV risks. The live, attenuated oral poliovirus vaccine (OPV) provides a powerful tool for controlling and stopping the transmission of wild polioviruses (WPVs), although the risks of
vaccine associated paralytic polio (VAPP) and circulating vaccine-derived poliovirus ( …

Social Science & Medicine
Volume 82, Pages 1-164 (April 2013)
http://www.sciencedirect.com/science/journal/02779536/82
Aprrl 2013;82:115-25. doi: 10.1016/j.socscimed.2012.12.020. Epub 2012 Dec 27.

Social inequalities in adolescent human papillomavirus (HPV) vaccination: A test of fundamental cause theory.
Polonijo AN, Carpiano RM.

Abstract
A unique contribution of the fundamental cause theory of health disparities is its ability to account for the persistence of disparities in health and mortality, despite changes in the mechanisms that are relevant at any given time. Few studies, however, have investigated how such mechanisms are created or operate. Examining the introduction of the human papillomavirus (HPV) vaccine for adolescents-a treatment aimed at preventing cervical and other cancers that typically emerge in mid- to late-adulthood-we empirically trace such a disparity-generating mechanism that is in the process of being latently created, testing whether socioeconomic status (SES) and racial/ethnic disparities exist for several facets of vaccination receipt: knowledge about the vaccine, receipt of a health professional recommendation to vaccinate, and initiation and completion of the three-shot vaccination series. Analyses of 2008, 2009, and 2010 United States National Immunization Survey-Teen data (n = 41,358) reveal disparities consistent with fundamental cause theory, particularly for vaccine knowledge and receipt of a health professional recommendation. While parental knowledge is a prerequisite to adolescent vaccine uptake, low SES and racial/ethnic minority parents have significantly lower odds of knowing about the vaccine. Receipt of a health professional’s recommendation to vaccinate is strongly associated with vaccine uptake, however the odds of receiving a recommendation are negatively associated with low SES and black racial/ethnic status. Our findings inform fundamental cause theory by illustrating how disparities in distinct stages of the uptake of new treatments may contribute to reproducing existing health disparities-and, in this case of adolescent HPV vaccination, may maintain future disparities in cervical cancer among adult populations.

http://www.ncbi.nlm.nih.gov/pubmed/23337830

MSMR
February 2013  Volume 20 Number 2
http://www.afhsc.mil/viewMSMR?file=2013/v20_n02.pdf#Page=01

Incidence of genital warts among U.S. service members before and after the introduction of the quadrivalent human papillomavirus vaccine.
Nsouli-Maktabi H, Ludwig SL, Yerubandi UD, Gaydos JC.

Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection among U.S. military members. The most frequent clinical manifestation of HPV is genital warts (GW). This investigation examined the annual incidence of diagnoses of GW among U.S. service members before and after the availability of the quadrivalent HPV (HPV4) vaccine in 2006. Incidence rates of GW diagnoses markedly declined among female service members in the HPV4 vaccine-eligible age range from 2007 (following introduction of the HPV4 vaccine) through 2010. In contrast, among women 25 years and older and men of all age groups, annual rates of GW diagnoses remained relatively low and stable from 2000 through 2010. The higher rates of diagnoses of GWs among female than male service members reflect the effects of routine periodic gynecologic screening. Slight increases in the incidence of GW diagnoses among men between 2010 and 2012 may in part reflect the repeal of the U.S. military’s “Don’t Ask Don’t Tell” policy.

Free full text http://www.ncbi.nlm.nih.gov/pubmed/23461306

Cancer Epidemiology, Biomarkers & Prevention
March 2013; 22 (3)
http://cebp.aacrjournals.org/content/current

Human Papillomavirus Vaccine Knowledge and Uptake among Adolescent Boys and Girls in an Appalachian Ohio County
Bhatta MP, Phillips L, Frew S, Burns J, and Cascarelli N

Abstract
Background: Population-based studies of human papillomavirus (HPV) vaccine uptake among both adolescent boys and girls are limited. The purpose of this study was to examine middle and high school student knowledge and behaviors surrounding the HPV vaccine in a rural Appalachian Ohio county. Methods: Five questions regarding the HPV vaccine were added to 2012 Youth Risk Behavior Survey (YRBS) administered in an Ohio Appalachian county. The participants were asked whether or not they had heard of the HPV vaccine; been given the vaccine and, if yes, the number of shots received; and whether their health care provider and/or their parents had discussed the vaccine with them. The voluntary and anonymous survey was completed by a total of 1,300 adolescent boys and girls. Results: Of the 596 and 704 high school students who completed the survey, 51.9% were male and 48.1% were female, and 95% were white. Regarding whether they had ever heard of the HPV vaccine, 49.1%, 29.6%, 21.2% respectively reported ‘yes’, ‘no’, and ‘don’t know/not sure’. Girls were more likely to report having heard of the HPV vaccine than boys (56.7% vs. 42.19%; p < 0.001). In all, 19.5% and 24.5% of the participants indicated having their parents and a health care provider respectively having discussed the HPV vaccine with them. Girls were two times as likely to report having a parent discuss the HPV vaccine with them than boys (P < 0.01). They were also almost three times as likely than boys to report a health care provider having discussed the vaccine with them (p < 0.01). Overall, 11.4% boys and 21.3% girls reported having received at least one dose of the vaccine (p < 0.001). The HPV uptake rates among middle and high school boys and girls respectively were 9.2%, 13.2%, 14.4%, and 27.4%. Conclusion: The HPV vaccine knowledge, as well as parental and health care provider communication regarding the HPV vaccine, particularly with the boys, remains low among these rural Appalachian adolescents. The role of these two factors on the HPV vaccine uptake among this adolescent population needs to be further explored.

The Guardian
http://www.guardiannews.com/
Accessed 16 March 2013

Taliban stopping polio vaccinations, says Afghan governor
Immunisation programme halted in Nuristan province, raising fears that opposition has spread from Pakistan
Emma Graham-Harrison in Kabul
Tuesday 12 March 2013 12.31 EDT
http://www.guardian.co.uk/world/2013/mar/12/taliban-stopping-polio-vaccinations-afghanistan?INTCMP=SRCH

Excerpt
The Taliban have halted an annual polio vaccination campaign in a remote part of Afghanistan, according to a senior official, raising concerns that opposition to the critical immunisation drive could be spilling across from insurgent groups in neighbouring Pakistan.

The Taliban have controlled parts of poor, isolated and mountainous Nuristan province for several years, but they have never before prevented medical workers reaching children in their strongholds, said the governor Tamim Nuristani.

“For the past three years Waygal district has been under the Taliban, they are very strong there. For the last two years the vaccine process went on in the district, but this year they stopped it,” he told the Guardian by phone from the provincial capital, an island of government control in the restive area.

“They are saying in terms of religion it is a problem and we have to stop it. In Kamdesh district we also have problems, they have stopped the programme,” he added…

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_9 March 2013

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

Report: Pneumococcal AMC process & design evaluation
GAVI
March 2013
http://www.gavialliance.org/results/evaluations/pneumococcal-amc-process—design-evaluation/

Editor’s Excerpt from GAVI Announcement

Overview
This report presents the findings of the Process and Design Evaluation for the Pilot Advance Market Commitment (AMC) for Pneumococcal Vaccines.
This evaluation was conducted in 2012 by Dalberg Global Development Advisors.

The pilot AMC is an innovative funding mechanism with the overarching goal to reduce morbidity and mortality from pneumococcal diseases. In June 2009, the governments of Italy, the United Kingdom, Canada, the Russian Federation, Norway and the Bill & Melinda Gates Foundation launched the pilot AMC with a collective US$1.5 billion commitment.

The pneumococcal AMC is designed to:
– accelerate the development of vaccines that meet developing country needs;
– bring forward the availability of effective pneumococcal vaccines – through scaling up of production capacity to meet developing country vaccine demand;
– accelerate vaccine uptake – through predictable vaccine pricing for countries and manufacturers;
– test the AMC concept for potential future applications.

Objectives
This evaluation is a process and design evaluation intended to offer insights and lessons to the international development community by appraising the design process, design decisions, and implementation of the pilot Pneumococcal AMC to date. The Terms of Reference (TOR) for this evaluation were developed in collaboration with AMC stakeholders.

The purpose of the evaluation was to assess the design process, design elements and implementation to date.

It is important to note that this evaluation forms part of the broader Monitoring and Evaluation (M&E) framework for this pilot AMC. This framework is based around four key components:
– a Baseline Study (completed in 2010 );
– a title=”an annual monitoring report” href=”http://www.gavialliance.org/funding/pneumococcal-amc/”>an annual monitoring report published on the GAVI website each year from 2010 ;
– an independent Process and Design Evaluation;
– independent Impact Evaluations to be undertaken every four years starting from 2014.

Findings and recommendations
Overall, the evaluators conclude that the pilot AMC has been implemented as designed and has demonstrated the ability of the international development community to design, establish and administer an AMC.

The evaluation assesses key design elements of the AMC such as the Pilot’s pricing structure, its legally binding commitments on donor pledges, its limited purchase guarantees on long-term procurement contracts, and its target product profile.

The evaluators found that while there are some areas for improvement and key lessons to be learnt for the development of any future AMCs, this Pilot is on track for progressing towards its overarching objective and that the design process and design elements have contributed, at least in part, to increasing the supply and uptake of PCV. In addition to a small number of recommendations for improving the pneumococcal AMC, the report also provides some recommendations based on lessons learned for future AMCs or market shaping initiatives .

The Secretariat’s responses to a number of the key findings are outlined in the Management Response.

Documents:
– Pneumococcal AMC process & design evaluation: full report [89 pages] http://www.gavialliance.org/library/documents/gavi-documents/evaluations/amc-process-and-design-evaluation-full-report/
– Pneumococcal AMC process & design evaluation: appendix
http://www.gavialliance.org/library/documents/gavi-documents/evaluations/amc-process-and-design-evaluation-appendix-feb-2013/
Pneumococcal AMC process & design evaluation: management response
http://www.gavialliance.org/library/documents/gavi-documents/evaluations/amc-process-and-design-evaluation-mgt-response/

   Moody’s Investors Service has downgraded the International Finance Facility for Immunisation (IFFIm) by one notch from Aaa to Aa1 and is maintaining a negative outlook. The short-term issuer rating of IFFIm remains unchanged at Prime-1.  Moody’s decision to downgrade IFFIm follows the recent downgrade by Moody’s of the United Kingdom, a donor to IFFIm, to Aa1 from Aaa. In its analysis of IFFIm’s rating, Moody’s considers IFFIm’s credit rating to be closely associated with the rating of the UK. The UK is IFFIm’s largest grantor, representing approximately half of the outstanding present value of IFFIm’s total grants. IFFIm currently is rated AAA by Fitch Ratings with a negative outlook, Aa1 by Moody’s with a negative outlook and AA+ with a negative outlook by Standard & Poor’s.

Moody’s rating action does not affect IFFIm’s ability to approve new programme funding for GAVI.

6 March 2013 – http://www.iffim.org/library/news/press-releases/2013/iffim-rating-action-by-moodys-follows-uk-downgrade/