Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

UNICEF Watch
http://www.unicef.org/media/media_67204.html

Measles outbreak threatens children’s lives in Guinea
Excerpt
CONAKRY, 21 January 2014 – UNICEF and its partners have begun to organize a campaign to vaccinate over 1.6 million children to stop a measles outbreak in Guinea amid growing number of cases among children especially in the capital Conakry.

Since November last year, 37 cases have been confirmed in the capital–all children under 10 years old. Over the past few weeks, the number of cases of measles has been increasing sharply and led to the death of one child.

This recent spike has prompted the Ministry of Health and Public Hygiene of Guinea to officially declare an outbreak in the Conakry municipalities of Matam, Matoto, and Ratoma. The disease has also been reported in other parts of the country –namely the prefectures of Boké, Coyah, Dubreka, Kissidougou, and Mandiana.

“We are very concerned about this outbreak. Measles is highly contagious and extremely dangerous—especially for young, malnourished children. As we’ve already seen, it can be fatal. In a densely populated city like Conakry, disease spreads quickly,” said UNICEF Representative in Guinea Dr. Mohamed Ayoya.

The Government of Guinea, UNICEF, the World Health Organization (WHO) and Médecins Sans Frontières (MSF) are joining forces to set up coordinated mechanisms to contain the outbreak. For the initial response, UNICEF will provide vaccines, refrigerators, needles, and other medical supplies and logistical support to the Government for the vaccination of children in the Kaloum and Dixinn neighbourhoods of Conakry as well as in the affected areas outside the capital. MSF and WHO will support vaccination efforts in the outbreak-declared areas of Conakry –namely Matam, Matoto, and Ratoma.

The vaccination phase of the national campaign will begin in the coming weeks as soon as vaccines, supplies and funding to ensure a continuous rollout are available…

Update: Polio this week – As of 23 January 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
:: The first four cases wild poliovirus cases type 1 (WPV1) have been reported for 2014. All cases were reported from North Waziristan, FATA, Pakistan. North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world. As long as polio still exists in reservoirs like North Waziristan, the world will always be at risk of outbreaks.
::The Gates Annual Letter for 2014 is now available, and polio eradication is shown as an example of what works in foreign aid.
:: The WHO/UNICEF Strategic Plan for Polio Outbreak Response in the Middle East [pdf] outlines the action plan for Syria and neighbouring countries in response to the circulation of wild poliovirus following importation. The objective is to stop the outbreak in Syria by the end of March 2014 and prevent any further international spread.
:: The WHO Executive Board (EB) is meeting in Geneva on 20-25 January. Ahead of the EB session, the Global Polio Eradication Initiative (GPEI) published the report: “Poliomyelitis: intensification of the global eradication initiative”. The full report is available in English and French here.

Pakistan
:: Four new WPV1 cases were reported in the past week, all from North Waziristan, FATA. The total number for WPV1 cases for Pakistan in 2014 is now 4. The total number of WPV1 cases for Pakistan in 2013 remains 91. The most recent WPV1 case had onset of paralysis on 5 January (from North Waziristan, FATA).

WHO: Humanitarian Health Action
Conflict and humanitarian crisis in Central African Republic
21 January 2014 — The insecurity in the country has limited and delayed delivery of health services. There has been disruptions of services provided by the mobile clinics, vaccination of children and services provided by hospitals on the axel Ouandago – Banforo – Bangui and Bandoro – Mbrès. A measles outbreak has been reported in Bria.
Latest situation Report: 21 January 2014 –
http://www.who.int/entity/hac/crises/caf/sitreps/car_who_sitrep_21january2014.pdf?ua=1

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

:: Human infection with avian influenza A(H7N9) virus – update 23 January 2014
On 22 January 2014, the National Health and Family Planning Commission of China notified WHO of 10 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

:: Human infection with avian influenza A(H7N9) virus – update 22 January 2014
On 20 January 2014, the National Health and Family Planning Commission of China notified WHO of five additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus, including two deaths.

:: Human infection with avian influenza A(H7N9) virus – update 20 January 2014
The National Health and Family Planning Commission of China notified WHO of 16 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

:: Human infection with avian influenza A(H7N9) virus – update 20 January 2014
On 16 January 2014, the National Health and Family Planning Commission of China notified WHO of seven additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus

IVI announced the resignation of Dr. Christian Loucq as IVI Director General due to personal reasons effective February 28, 2014. The IVI Board of Trustees (BOT) has set up a selection committee that will manage the recruitment process and has also appointed Mr. John Morahan, currently Deputy Director General, Finance & Administration and Chief Financial Officer, to serve as Acting Director General during the transition period until the new Director General is in place. The announcement noted that under Dr. Loucq’s leadership, IVI’s “governance, systems and internal control, and management were strengthened.  As a result, organizational transparency to our major donors and stakeholders increased, and IVI’s financial situation and outlook improved significantly. Despite the challenges that occurred during his tenure, research programs continued and he brought to the forefront industrial partners from South Korea that promise to be important players for product development partnerships.  Due to Dr. Loucq’s strong leadership during a critical period of the organization, IVI is more stable and secure, and is well-positioned to embark on the next phase of its growth and evolution. The priorities of the new Director General will include scientific strategy and funding diversification.”

WHO: Executive Board appoints Regional Directors
21 January 2014
The WHO Executive Board, currently holding its 134th session in Geneva, has appointed Dr Poonam Khetrapal Singh as the new WHO Regional Director for South-East Asia and reappointed Dr Shin Young-soo as the WHO Regional Director for the Western Pacific.
Full text:   | GENEVA – The http://www.who.int/mediacentre/news/notes/2014/eb-20140121/en/index.html

Speech: Report by the Director-General to the Executive Board at its 134th Session
WHO Director-General addresses the Executive Board
Dr Margaret Chan
Director-General of the World Health Organization
20 January 2014
Full text: http://www.who.int/dg/speeches/2014/executive-board-opening/en/index.html

WHO: 134th WHO Executive Board session
Date: 20–25 January 2014
Place: Geneva, Switzerland
Selected Documentation
Agenda
pdf, 281kb

Main documents
EB134/13 Global vaccine action plan

EB134/31 Access to essential medicines

EB134/33 Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits – Pandemic Influenza Preparedness Framework

EB134/34 Smallpox eradication: destruction of variola virus stocks

EB134/35 Poliomyelitis: intensification of the global eradication initiative

EB134/54 Contributing to social and economic development: sustainable action across sectors to improve health and health equity (follow up of the 8th Global Conference on Health Promotion)

Conference Papers
EB134/CONF./3 Biological medicines: access to medicines and ensuring safety, quality and efficacy

EB134/CONF./4 Rev.1 Global strategy and targets for tuberculosis prevention, care and control after 2015

EB134/CONF./8 Rev.1 Contributing to social and economic development: sustainable action across sectors to improve health and health equity (follow-up of the 8th Global Conference on Health Promotion)

EB134/CONF./9 Health intervention and technology assessment in support of universal health coverage

EB134/CONF./10 The role of the health system in addressing violence, in particular against women and girls

EB134/CONF./14 Access to essential medicines

The Weekly Epidemiological Record (WER) for  24 January 2014, vol. 89, 4/5 (pp. 37–44) includes:
:: Detection of influenza virus subtype A by polymerase chain reaction: WHO external quality assessment programme summary analysis, 2013
http://www.who.int/entity/wer/2014/wer8904_05.pdf?ua=1

Annals of Internal Medicine
21 January 2014, Vol. 160. No. 2
http://annals.org/issue.aspx

Original Research | 21 January 2014
Cost-Effectiveness of Canine Vaccination to Prevent Human Rabies in Rural Tanzania
Meagan C. Fitzpatrick, MPhil; Katie Hampson, PhD; Sarah Cleaveland, PhD, VetMB; Imam Mzimbiri, BVM; Felix Lankester, DVM; Tiziana Lembo, PhD; Lauren A. Meyers, PhD; A. David Paltiel, PhD; and Alison P. Galvani, PhD
http://annals.org/article.aspx?articleid=1814425

Abstract
Background: The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans.

Objective: To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa.

Design: We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness.

Data Sources: Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns.

Target Population: Two districts of rural Tanzania: Ngorongoro and Serengeti.

Time Horizon: 10 years.

Perspective: Health policymaker.

Intervention: Vaccination coverage ranging from 0% to 95% in increments of 5%.

Outcome Measures: Life-years for health outcomes and 2010 U.S. dollars for economic outcomes.

Results of Base-Case Analysis: Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving.

Results of Sensitivity Analysis: Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and life-saving and therefore preferred.

Limitation: Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro.

Conclusion: Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies.

Primary Funding Source: National Institutes of Health.

BMC Public Health
(Accessed 25 January 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Updating the evidence base on the operational costs of supplementary immunization activities for current and future accelerated disease control, elimination and eradication efforts
Gian Gandhi and Patrick Lydon
http://www.biomedcentral.com/1471-2458/14/67/abstract

Abstract (provisional)
Background
To achieve globally or regionally defined accelerated disease control, elimination and eradication (ADC/E/E) goals against vaccine-preventable diseases requires complementing national routine immunization programs with intensive, time-limited, and targeted Supplementary Immunization Activities (SIAs). Many global and country-level SIA costing efforts have historically relied on what are now outdated benchmark figures. Mobilizing adequate resources for successful implementation of SIAs requires updated estimates of non-vaccine costs per target population.

Methods
This assessment updates the evidence base on the SIA operational costs through a review of literature between 1992 and 2012, and an analysis of actual expenditures from 142 SIAs conducted between 2004 and 2011 and documented in country immunization plans. These are complemented with an analysis of budgets from 31 SIAs conducted between 2006 and 2011 in order to assess the proportion of total SIA costs per person associated with various cost components. All results are presented in 2010 US dollars.

Results
Existing evidence indicate that average SIA operational costs were usually less than US$0.50 per person in 2010 dollars. However, the evidence is sparse, non-standardized, and largely out of date. Average operational costs per person generated from our analysis of country immunization plans are consistently higher than published estimates, approaching US$1.00 for injectable vaccines. The results illustrate that the benchmarks often used to project needs underestimate the true costs of SIAs and the analysis suggests that SIA operational costs have been increasing over time in real terms. Our assessment also illustrates that operational costs vary across several dimensions. Variations in the actual costs of SIAs likely to reflect the extents to which economies of scale associated with campaign-based delivery can be attained, the underlying strength of the immunization program, sensitivities to the relative ease of vaccine administration (i.e. orally, or by injection), and differences in disease-specific programmatic approaches. The assessment of SIA budgets by cost component illustrates that four cost drivers make up the largest proportion of costs across all vaccines: human resources, program management, social mobilization, and vehicles and transportation. These findings suggest that SIAs leverage existing health system infrastructure, reinforcing the fact that strong routine immunization programs are an important pre-requisite for achieving ADC/E/E goals.

Conclusions
The results presented here will be useful for national and global-level actors involved in planning, budgeting, resource mobilization, and financing of SIAs in order to create more realistic assessments of resource requirements for both existing ADC/E/E efforts as well as for new vaccines that may deploy a catch-up campaign-based delivery component. However, limitations of our analysis suggest a need to conduct further research into operational costs of SIAs. Understanding the changing face of delivery costs and cost structures for SIAs will continue to be critical to avoid funding gaps and in order to improve vaccination coverage, reduce health inequities, and achieve the ADC/E/E goals many of which have been endorsed by the World Health Assembly and are included in the Decade of Vaccines Global Vaccine Action Plan.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 25 January 2014]

Research article
Upscaling human papillomavirus vaccination in high-income countries: impact assessment based on transmission model
Iacopo Baussano1*, Joakim Dillner2, Fulvio Lazzarato3, Guglielmo Ronco4 and Silvia Franceschi1
http://www.infectagentscancer.com/content/9/1/4/abstract

Abstract
Background
The decrease in human papillomavirus (HPV) vaccine prices may allow upscale already started vaccination programmes but the advantages of different options are unclear.

Methods
Using a mathematical model of HPV16 and 18 transmission and data on vaccination coverage from Italy, we compared 3 options to upscale an already started programme targeting 11-year old girls (coverage 65%): a) coverage improvement (from 65% to 90%); b) addition of 11-year-old boys (coverage 65%); or c) 1-year catch-up of older girls (coverage 50%).

Results
The reduction of cervical HPV16/18 infection as compared to no vaccination (i.e. effectiveness against HPV16/18) increased from 76% to 98% with coverage improvement in girls and to 90% with the addition of boys. With higher coverage in girls, HPV16/18 infection cumulative probability by age 35 decreased from 25% to 8% with a 38% increase in vaccine number. The addition of boys decreased the cumulative probability to 18% with a 100% increase in the number of vaccinees. For any coverage in girls, the number of vaccinees to prevent 1 woman from being infected by HPV16/18 by age 35 was 1.5, whereas it was 2.7 for the addition of boys. Catch-up of older girls only moved forward the vaccination effectiveness by 2–5 years.

Conclusions
Increasing vaccination coverage among girls is the most effective option for decreasing HPV16/18. If not achievable, vaccinating boys is justifiable if vaccine cost has at least halved, because this option would almost double the number of vaccinees.

The Lancet Global Health
Feb 2014  Volume 2  Number 2  e58 – 116
http://www.thelancet.com/journals/langlo/issue/current

Comment
Persistence of poliomyelitis in Nigeria
Festus D Adu, Itam Hogan Itam
Preview | Full Text | PDF
The World Health Assembly launched the Global Polio Eradication Initiative in 1988 and declared the year 2000 as the target by which to achieve poliomyelitis eradication.1 After aggressive mass immunisation, backed up by effective routine immunisation, cases of poliomyelitis reduced from 350 000 in 165 countries in 1988 to 355 occurring mainly in three countries—Nigeria, Afghanistan, and Pakistan—by 2013.2 Nigeria is the only country in the world where the three poliovirus types are still circulating; as of December, 2013, it had contributed 14·1% of all poliomyelitis cases worldwide.

Key issues in the persistence of poliomyelitis in Nigeria: a case-control study
Dr Tara D Mangal PhD a, R Bruce Aylward MD b, Michael Mwanza BComm c, Alex Gasasira MBChB d, Emmanuel Abanida MBChB e, Prof Muhammed A Pate MD f, Prof Nicholas C Grassly PhD a
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2813%2970168-2/abstract

Summary
Background
The completion of poliomyelitis eradication is a global emergency for public health. In 2012, more than 50% of the world’s cases occurred in Nigeria following an unanticipated surge in incidence. We aimed to quantitatively analyse the key factors sustaining transmission of poliomyelitis in Nigeria and to calculate clinical efficacy estimates for the oral poliovirus vaccines (OPV) currently in use.

Methods
We used acute flaccid paralysis (AFP) surveillance data from Nigeria collected between January, 2001, and December, 2012, to estimate the clinical efficacies of all four OPVs in use and combined this with vaccination coverage to estimate the effect of the introduction of monovalent and bivalent OPV on vaccine-induced serotype-specific population immunity. Vaccine efficacy was determined using a case-control study with CIs based on bootstrap resampling. Vaccine efficacy was also estimated separately for north and south Nigeria, by age of the children, and by year. Detailed 60-day follow-up data were collected from children with confirmed poliomyelitis and were used to assess correlates of vaccine status. We also quantitatively assessed the epidemiology of poliomyelitis and programme performance and considered the reasons for the high vaccine refusal rate along with risk factors for a given local government area reporting a case.

Findings
Against serotype 1, both monovalent OPV (median 32·1%, 95% CI 26·1—38·1) and bivalent OPV (29·5%, 20·1—38·4) had higher clinical efficacy than trivalent OPV (19·4%, 16·1—22·8). Corresponding data for serotype 3 were 43·2% (23·1—61·1) and 23·8% (5·3—44·9) compared with 18·0% (14·1—22·1). Combined with increases in coverage, this factor has boosted population immunity in children younger than age 36 months to a record high (64—69% against serotypes 1 and 3). Vaccine efficacy in northern states was estimated to be significantly lower than in southern states (p≤0·05). The proportion of cases refusing vaccination decreased from 37—72% in 2008 to 21—51% in 2012 for routine and supplementary immunisation, and most caregivers cited ignorance of either vaccine importance or availability as the main reason for missing routine vaccinations (32·1% and 29·6% of cases, respectively). Multiple regression analyses highlighted associations between the age of the mother, availability of OPV at health facilities, and the primary source of health information and the probability of receiving OPV (all p<0·05).

Interpretation
Although high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery.

Funding
Bill & Melinda Gates Foundation Vaccine Modeling Initiative, Royal Society.

The Lancet Global Health
Feb 2014  Volume 2  Number 2  e58 – 116
http://www.thelancet.com/journals/langlo/issue/current

Comment
Rebalancing the global battle against tuberculosis
Mario Raviglione, Mukund Uplekar, Cheri Vincent, Ariel Pablos-Méndez
Preview |
Full Text | PDF

Meetings of health ministers from the five BRICS countries (Brazil, Russia, India, China, and South Africa) have produced two joint statements in less than a year: the Delhi Communiqué1 (Jan 12, 2013) and the Cape Town Communiqué2 (Nov 7, 2013). Both statements bode well for global tuberculosis control. The Delhi Communiqué underscores the principle of equity and focuses on populations who are most affected by the disease. The Cape Town Communiqué emphasises promotion of consortia of researchers to collaborate for clinical trials of drugs and vaccines, strengthening of access to affordable, high-quality, effective, and safe medicines, and delivery of high-quality health care.

The Lancet Global Health
Feb 2014  Volume 2  Number 2  e58 – 116
http://www.thelancet.com/journals/langlo/issue/current

Malaria burden and control in Bangladesh and prospects for elimination: an epidemiological and economic assessment
Ubydul Haque, Hans J Overgaard, Archie C A Clements, Douglas E Norris, Nazrul Islam, Jahirul Karim, Shyamal Roy, Waziul Haque, Moktadir Kabir, David L Smith, Gregory E Glass
Preview | Summary | Full Text | PDF
Malaria elimination is an achievable prospect in Bangladesh and failure to push for elimination nearly ensures a resurgence of disease. Consistent financing is needed to avoid resurgence and maintain elimination goals.

The Lancet Infectious Diseases
Feb 2014  Volume 14  Number 2 p87 – 172
http://www.thelancet.com/journals/laninf/issue/current

Editorial
A conjugate vaccine against typhoid fever
Se Eun Park, Florian Marks
Preview | Full Text | PDF
Zulfiqar Bhutta and colleages’ study1 in The Lancet Infectious Diseases marks an important milestone for the use of typhoid conjugate vaccines. Present Vi polysaccharide vaccines (Vi-PS) are not widely used because they cannot be given to children younger than 2 years and are thus excluded from the Expanded Programme of Immunization (EPI); furthermore, their effectiveness decreases rapidly after 2–3 years.2,3 Expectations of a typhoid conjugate vaccine include safe administration to children younger than 2 years, the induction of protective IgG anti-Vi immune responses, and the development of long-term, and at best lifelong, protection.

Nature   
Volume 505 Number 7484 pp453-580  23 January 2014
http://www.nature.com/nature/current_issue.html

Immunological and virological mechanisms of vaccine-mediated protection against SIV and HIV
Mario Roederer, Brandon F. Keele, Stephen D. Schmidt, Rosemarie D. Mason, Hugh C. Welles, Will Fischer, Celia Labranche, Kathryn E. Foulds, Mark K. Louder, Zhi-Yong Yang, John-Paul M. Todd, Adam P. Buzby, Linh V. Mach, Ling Shen, Kelly E. Seaton, Brandy M. Ward, Robert T. Bailer, Raphael Gottardo, Wenjuan Gu, Guido Ferrari, S. Munir Alam, Thomas N. Denny, David C. Montefiori, Georgia D. Tomaras, Bette T. Korber et al.
http://www.nature.com/nature/journal/v505/n7484/full/nature12893.html

Abstract
A major challenge for the development of a highly effective AIDS vaccine is the identification of mechanisms of protective immunity. To address this question, we used a nonhuman primate challenge model with simian immunodeficiency virus (SIV). We show that antibodies to the SIV envelope are necessary and sufficient to prevent infection. Moreover, sequencing of viruses from breakthrough infections revealed selective pressure against neutralization-sensitive viruses; we identified a two-amino-acid signature that alters antigenicity and confers neutralization resistance. A similar signature confers resistance of human immunodeficiency virus (HIV)-1 to neutralization by monoclonal antibodies against variable regions 1 and 2 (V1V2), suggesting that SIV and HIV share a fundamental mechanism of immune escape from vaccine-elicited or naturally elicited antibodies. These analyses provide insight into the limited efficacy seen in HIV vaccine trials.

PLoS One
[Accessed 25 January 2014]
http://www.plosone.org/

Research Article
Free-Riding Behavior in Vaccination Decisions: An Experimental Study
Yoko Ibuka, Meng Li, Jeffrey Vietri, Gretchen B. Chapman, Alison P. Galvani
Published: January 24, 2014
DOI: 10.1371/journal.pone.0087164
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0087164

Abstract
Individual decision-making regarding vaccination may be affected by the vaccination choices of others. As vaccination produces externalities reducing transmission of a disease, it can provide an incentive for individuals to be free-riders who benefit from the vaccination of others while avoiding the cost of vaccination. This study examined an individual’s decision about vaccination in a group setting for a hypothetical disease that is called “influenza” using a computerized experimental game. In the game, interactions with others are allowed. We found that higher observed vaccination rate within the group during the previous round of the game decreased the likelihood of an individual’s vaccination acceptance, indicating the existence of free-riding behavior. The free-riding behavior was observed regardless of parameter conditions on the characteristics of the influenza and vaccine. We also found that other predictors of vaccination uptake included an individual’s own influenza exposure in previous rounds increasing the likelihood of vaccination acceptance, consistent with existing empirical studies. Influenza prevalence among other group members during the previous round did not have a statistically significant effect on vaccination acceptance

Social Science & Medicine
Volume 104,   In Progress   (March 2014)
http://www.sciencedirect.com/science/journal/02779536/104

Fast, cheap, and out of control? Speculations and ethical concerns in the conduct of outsourced clinical trials in India
Original Research Article
Pages 48-55
Vinay R. Kamat
Abstract
The globalization of biopharmaceutical clinical trials and their offshore outsourcing, from the West to low and middle-income countries, has come under increasing scrutiny from academic scholars, practitioners, regulatory agencies and the media. This article reports the results of a study conducted in Bangalore and Hyderabad between 2007 and 2009, to elicit the perspectives of stakeholders, concerning media representations of their work and the ethical issues that emanate from their engagement in the clinical trials enterprise. In acknowledging the inherently problematic nature of the outsourcing of clinical trials to low income countries, I argue that the practice of not prioritizing research on diseases that are most prevalent among communities, from which subjects are recruited, demands a coordinated and sustained critique. I propose that the critical discourse on the outsourcing of clinical trials should not only emphasize the perils of this practice, but also address some broader issues of equity and distributive justice that determine people’s access to basic health care in low income countries. Close attention to the specific context of clinical trials in an increasingly neoliberal medical and health environment in emerging economies such as India can provide critical insights into the on-the-ground complexities and challenges of outsourced global clinical trials.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 7, Pages 755-896 (7 February 2014)

Economic evaluations of implemented vaccination programmes: key methodological challenges in retrospective analyses
Review Article
Pages 759-765
A.T. Newall, J.F. Reyes, J.G. Wood, P. McIntyre, R. Menzies, P. Beutels

Abstract
Post-implementation evaluation should play an important role in assessing the success of public health programmes; however, the value for money achieved by vaccine programmes after introduction has received relatively little attention to date. In this article we explore the methodological challenges in these analyses and offer direction for future evaluations in the area. We identify alternative approaches to addressing these challenges, which include the estimation of disease changes attributable to vaccination efforts, the hypothetical no vaccination comparator scenario and the full benefit achieved by implemented vaccination programmes. We also outline other important considerations such as the evolution of prices over time. Further work needs to be done to explore these issues and to determine how the application of different approaches may impact on the results of evaluations in various circumstances. As retrospective analyses are likely to become more frequent and influential, it is important that both the benefits and the limitations of post-implementation evaluations are recognised and understood. We argue that it would be useful to establish a methodological framework to provide standards and guidance on how to undertake such analyses in the future.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 7, Pages 755-896 (7 February 2014)
Approved but non-funded vaccines: Accessing individual protection

Review Article
Pages 766-770
David W. Scheifele, Brian J. Ward, Scott A. Halperin, Shelly A. McNeil, Natasha S. Crowcroft, Gordean Bjornson
Abstract
Funded immunization programs are best able to achieve high participation rates, optimal protection of the target population, and indirect protection of others. However, in many countries public funding of approved vaccines can be substantially delayed, limited to a portion of the at-risk population or denied altogether. In these situations, unfunded vaccines are often inaccessible to individuals at risk, allowing potentially avoidable morbidity and mortality to continue to occur. We contend that private access to approved but unfunded vaccines should be reconsidered and encouraged, with recognition that individuals have a prerogative to take advantage of a vaccine of potential benefit to them whether it is publicly funded or not. Moreover, numbers of “approved but unfunded” vaccines are likely to grow because governments will not be able to fund all future vaccines of potential benefit to some citizens. New strategies are needed to better use unfunded vaccines even though the net benefits will fall short of those of funded programs.

Canada, after recent delays funding several new vaccine programs, has developed means to encourage private vaccine use. Physicians are required to inform relevant patients about risks and benefits of all recommended vaccines, publicly funded or not. Likewise, some provincial public health departments now recommend and promote both funded and unfunded vaccines. Pharmacists are key players in making unfunded vaccines locally available. Professional organizations are contributing to public and provider education about unfunded vaccines (e.g. herpes zoster, not funded in any province). Vaccine companies are gaining expertise with direct-to-consumer advertising. However, major challenges remain, such as making unfunded vaccines more available to low-income families and overcoming public expectations that all vaccines will be provided cost-free, when many other recommended personal preventive measures are user-pay. The greatest need is to change the widespread perception that approved vaccines should be publicly funded or ignored.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 7, Pages 755-896 (7 February 2014)

How much does it cost to get a dose of vaccine to the service delivery location? Empirical evidence from Vietnam’s Expanded Program on Immunization
Original Research Article
Pages 834-838
Mercy Mvundura, Vu Duy Kien, Nguyen Tuyet Nga, Joanie Robertson, Nguyen Van Cuong, Ho Thanh Tung, Duong Thi Hong, Carol Levin

Abstract
Few studies document the costs of operating vaccine supply chains, but decision-makers need this information to inform cost projections for investments to accommodate new vaccine introduction. This paper presents empirical estimates of vaccine supply chain costs for Vietnam’s Expanded Program on Immunization (EPI) for routine vaccines at each level of the supply chain, before and after the introduction of the pentavalent vaccine.

We used micro-costing methods to collect resource-use data associated with storage and transportation of vaccines and immunization supplies at the national store, the four regional stores, and a sample of provinces, districts, and commune health centers. We collected stock ledger data on the total number of doses of vaccines handled by each facility during the assessment year.

Total supply chain costs were estimated at approximately US$65,000 at the national store and an average of US$39,000 per region, US$5800 per province, US$2200 per district, and US$300 per commune health center. Across all levels, cold chain equipment capital costs and labor were the largest drivers of costs. The cost per dose delivered was estimated at US$0.19 before the introduction of pentavalent and US$0.24 cents after introduction. At commune health centers, supply chain costs were 104% of the value of vaccines before introduction of pentavalent vaccine and 24% after introduction, mainly due to the higher price per dose of the pentavalent vaccine.

The aggregated costs at the last tier of the health system can be substantial because of the large number of facilities. Even in countries with high-functioning systems, empirical evidence on current costs from all levels of the system can help estimate resource requirements for expanding and strengthening resources to meet future immunization program needs. Other low- and middle-income countries can benefit from similar studies, in view of new vaccine introductions that will put strains on existing systems.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/6
Volume 32, Issue 6, Pages 639-754 (3 February 2014)

Overcoming barriers to HPV vaccination: Non-inferiority of antibody response to human papillomavirus 16/18 vaccine in adolescents vaccinated with a two-dose vs. a three-dose schedule at 21 months
Original Research Article
Pages 725-732
Eduardo Lazcano-Ponce, Margaret Stanley, Nubia Muñoz, Leticia Torres, Aurelio Cruz-Valdez, Jorge Salmerón, Rosalba Rojas, Rolando Herrero, Mauricio Hernández-Ávila
Abstract
For middle and low-income countries, the cost of HPV vaccines remains challenging. We conducted an open-label nonrandomized clinical trial evaluating immune response to the HPV–16/18 AS04-adjuvanted vaccine administered on a standard (months (M) 0–1–6) versus extended schedule (M 0–6–60) at 7, 21, 60, 72 and 120 months post-vaccination. Participants were females recruited in Morelos, Mexico: 474 girls aged 9–10 years and 500 women aged 18–24 years receiving a standard schedule, and 1026 girls aged 9–10 years receiving an extended schedule (currently the girls in the extended schedule had received only the first 2 doses). This report presents the interim analysis results for non-inferiority between the regimes conducted with the current available data at 21 months after the first dose, with serum antibodies assessed by ELISA. A pre-stated margin of non-inferiority was defined by post-vaccination geometric mean titer (GMT) ratio (upper 95% confidence interval [CI] ≤ 2.0) between the standard and the two-dose schedule in girls at month 21. Immune response to the vaccine was strongest in adolescent girls and in the 3-dose group. Statistical non-inferiority of the two-dose versus three-dose groups was demonstrated. At 21 months, comparing the adolescent 2-dose versus 3-dose groups, the GMT ratio and 95% CI were 1.66 (1.55–1.81) and 1.67 (1.51–1.86) for HPV16 and 18, respectively. The two-dose regimen was non-inferior when compared to the three-dose response in same-age girls and with women aged 18–24 years after 21 months of follow-up. The reduction in the number of doses from the current three-dose schedule may lower overall costs associated with the vaccination and increase accessibility and compliance with the recommended dosing of the HPV vaccine.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 7, Pages 755-896 (7 February 2014)

Estimation of the potential overall impact of human papillomavirus vaccination on cervical cancer cases and deaths
Original Research Article
Pages 733-739
Georges Van Kriekinge, Xavier Castellsagué, David Cibula, Nadia Demarteau
Abstract
Background
Human papillomavirus (HPV) vaccination offers potential for primary prevention of HPV-related pre-cancers and cancers as demonstrated in clinical trials. Mathematical models have estimated the potential real-life impact of vaccination on the burden of cervical cancer (CC). However, these are restricted to evaluations in a limited number of countries.

Methods
Potential decline in CC cases and deaths with the AS04-adjuvanted HPV-16/18 vaccine of young girls naïve to HPV, was estimated at steady-state (vaccine coverage: 0–100%) based on clinical trial and country-specific incidence data. Data on vaccine efficacy were taken from the end of study PATRICIA trial of the AS04-adjuvanted HPV-16/18 vaccine. The numbers of cases and deaths due to HPV-16/18 were estimated and compared with those due to any HPV type to estimate the additional cases prevented. This difference estimates CC cases and deaths avoided due to protection against non-vaccine HPV types. Cost-offsets due to reductions in CC treatment were estimated for five countries (Brazil, Canada, Italy, Malaysia and South African Republic) using country-specific unit cost data. Additionally, cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3)-related burden (cases and treatment costs) prevented by vaccination were estimated for two countries (Italy and Malaysia).

Results
HPV vaccination could prevent a substantial number of CC cases and deaths in countries worldwide, with associated cost-offsets due to reduced CC treatment. Cross-protection increased the estimated potential number of CC cases and deaths prevented by 34 and 18% in Africa and Oceania, respectively. Moreover, vaccination could result in a substantial reduction in the number of CIN2/3 lesions and associated costs.

Conclusion
HPV vaccination could reduce the burden of CC and precancerous lesions in countries worldwide, part of disease burden reduction being related to protection against non HPV-16/18 related types.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

 
Editorial Commentary: Annual Studies of Influenza Vaccine Effectiveness: Evaluating Performance, Informing Policy, and Generating New Questions
KM Neuzil, JC Victor – Clinical Infectious Diseases, 2014
In the United States and other temperate climates in the Northern Hemisphere, we are waiting and preparing for the 2013–2014 influenza epidemic. We know that it will come but, unfortunately, we don’t know when. The epidemic may be upon us by the time this …

Measles Epidemic in a Highly Developed Country: Low Mortality, High Morbidity and Extensive Costs.
A Donas, A Marty-Nussbaumer, HP Roost, TJ Neuhaus – Klinische Padiatrie, 2014
… Vaccination with 2 doses of > 95% of the population is necessary to eliminate measles. In Switzerland and especially in the central part, vaccine coverage is low (2006: 65%). This led 2006-2009 to a measles epidemic with thousands of cases and high costs. …

Considerations for vaccine administration in the emergency department.
MC Thomas, AO Ademolu – American journal of health-system pharmacy: AJHP: …, 2014
Author information: Michael C. Thomas, Pharm.D., BCPS, is Associate Professor, Pharmacy Practice, South University School of Pharmacy, Savannah, GA. Adetola O. Ademolu, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Emergency Medicine, Lyndon B. …

CURRENT OPINION Is there still any hope for amyloid-based immunotherapy for Alzheimer’s disease?
F Panza, G Logroscino, BP Imbimbo, V Solfrizzi – Curr Opin Psychiatry, 2014
… response. Immunization with CAD106 prevented brain senile plaque accumulation in two transgenic Alzheimer’s disease mouse models, with reductions of up to 80% in the senile plaque area compared with controls [53]…

Strength in numbers: comparing vaccine signatures the modular way
WN Haining – Nature Immunology, 2014
Vaccines have improved human health enormously. The trouble is, we are not quite sure how they work. While we know a great deal about some components of the vaccine response, the answers to many important questions remain murky: for example, which features of the …

[HTML] Perceived behavioral control, intention to get vaccinated, and usage of online information about the human papillomavirus vaccine
RK Britt, KN Hatten, SO Chappuis – Health Psychology and Behavioral Medicine: an …, 2014
Objective: Human papillomavirus (HPV) and the HPV vaccine have been examined through multiple lenses over the past several years, though there is little work examining the role of perceived behavioral control (PBC) and its impact on potential recipients retrieving, …

Special Focus Newsletters
RotaFlash
January 23, 2014
Studies confirm importance of rotavirus surveillance in Africa
Special supplement to the Pediatric Infectious Disease Journal describes the critical role of monitoring disease burden and vaccine impact
http://vad.cmail3.com/t/ViewEmail/r/368A047C5C2723DB2540EF23F30FEDED/E38B11B8894CC5F5DBC23BD704D2542D

Council on Foreign Relations
http://www.cfr.org/
Accessed 25 January 2014

New York Review of Books: Syria’s Polio Epidemic: The Suppressed Truth
by Annie Sparrow February 20, 2014
“The UN’s current polio vaccination program—sponsored by UNICEF and delivered in UN-financed convoys and flights—is fully orchestrated by the Syrian government, and in opposition-held areas, it is dependent for administration on volunteers from the government-dominated Syrian Arab Red Crescent (SARC). SARC’s president, Abdul Rahman Attar, is closely tied to the government, and even has his own pharmaceutical company, which has influenced the preference given to regime territory in the administration of polio vaccines during these last three years.”

Forbes
http://www.forbes.com/
Accessed 25 January 2014
Pharma & Healthcare
1/23/2014 @ 12:42AM |15,761 views

Big Data Crushes Anti-Vaccination Movement
For years it’s been relatively easy to ignite medical controversy with emotional (but often anecdotal) evidence. TV is a popular format for doing just that. It’s quick, colorful and dramatic (and increasingly in high-def and big-screen). Add a well known celebrity (or two) and the effects can be powerful, long term and hard to refute.

Much of that power, however, is changing and will continue to change with large datasets that are freely available online – or soon will be. When we talk about the science of “Big Data” as a new discipline, it’s often the datasets that we’re referencing – and the visualization of those datasets can be equally powerful and dramatic.
http://www.forbes.com/sites/danmunro/2014/01/23/big-data-crushes-anti-vaccination-movement/

Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
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– Email Summary: Vaccines and Global health : The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
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– pdf version: A pdf of the current issues is available here: Vaccines and Global Health_The Week in Review_18 Jan 2014
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

GAVI said the United States committed an additional US$175 million toward funding global vaccine programmes, “the largest amount that the U.S. has ever appropriated to GAVI.” The funds, part of the fiscal year 2014 U.S. budget, will be used to purchase and deliver life-saving vaccines in the world’s poorest countries. GAVI CEO Dr Seth Berkley said, “In these difficult budgetary times, we are deeply appreciative of the Obama Administration and leaders in Congress for continuing their generous support of our mission to save children’s lives in the world’s poorest countries…”

http://www.gavialliance.org/library/news/press-releases/2014/u-s–commits-us$-175-million-to-the-gavi-alliance/

   The International Vaccine Institute and Intravacc (the Institute for Translational Vaccinology) in The Netherlands “agreed to collaborate on vaccine research and development (R&D) and to promote capacity building in developing nations.” IVI said the collaboration will focus on improving available technologies for vaccine development and in addition on the clinical evaluation and the regulatory process, and that the two parties will work together to create a joint application for funding of a collaborative project. They will also join forces on further development and complement training initiatives in vaccinology for developing countries, including a possible laboratory-oriented course. IVI Director General Dr. Christian Loucq said, “As a signatory country of IVI, the Netherlands has been an important supporter of the organization. This partnership will benefit both Intravacc and IVI in that it furthers our mutual aim to ensure that vaccines are developed and made available to the poor, and in how it deepens our relationship with the Netherlands, a key IVI partner.”

http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=585

WHO Announcement: India three years polio-free
Excerpt
Wild poliovirus has not been found in India since 13 January 2011 meaning that, from that date, India is no longer a country where polio is endemic. Three years of being polio free is a notable milestone for the country as a whole, but the success of the immunization and awareness campaign has had a wider impact – with this achievement, it is hoped that soon the entire South-East Asia Region can be considered certifiably free from polio. A commission of experts will meet at the World Health Organization offices at the end of March to analyze the data and determine the polio status for the Region.

Historically, India has been the largest endemic reservoir of polio in the world with between 50,000 to 100,000 paralytic polio cases occurring each year between 1978 and 1995. It has also been one of the main sources of polio importation for other countries. This achievement has been driven by the partnership between the Government of India, international organizations, local NGOs and other institutions. An extraordinary mobilization of health workers was necessary to reach this point, particularly in the Uttar Pradesh and Bihar states. The outcome of this has been an improved vaccine delivery system, better trained health staff and high quality surveillance, monitoring and research mechanisms…
http://www.searo.who.int/mediacentre/features/2014/sea-polio/en/index.html

Commentary: Standing tall against polio– by Seth Berkley
The Hindustan Times | 12 January 2014
Today marks a major global public health milestone and a huge success as India celebrates the third anniversary of its last reported case of wild polio virus and counts down to when the World Health Organization (WHO) is due to declare India as officially polio-free. But with nearly seven million children still not receiving basic immunisation, there is still so much more to be done, and if India were to build on this success then in a few years it could have so much more to celebrate.

Commentary: Gates Foundation Reflections on a Polio-Free India – Impatient Optimists

IVAC Blog: From India, Achievement, Lessons Learned, and Hope
By Dr. Kate O’Brien, Executive Director, IVAC
http://www.jhsph.edu/research/centers-and-institutes/ivac/IVACBlog/From_India_Achievement_Lessons_Learned_and_Hope

Update: Polio this week – As of 9 January 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
::  In Syria, polio vaccination campaigns continue despite challenges. According to preliminary results more than 2 million children were immunized against polio across Syria last week during a third round of vaccination in response to a polio outbreak in the country. For more, please click here.
:: India celebrates three years since its last case of polio, despite once being considered the most challenging place to end the disease. Pending final clearance of December and January laboratory samples, the Regional Certification Commission is expected to certify the South-East Asia Region of the World Health Organization as polio-free in March. For more, please click here.

Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week. The total number of WPV1 cases for 2013 is now 13. The most recent WPV1 case had onset of paralysis on 20 December from Watapur, Kunar province. All but one of the WPV1 cases 2013 in Afghanistan are reported from Eastern Region, close to the Pakistan border.

Nigeria
:: Two new WPV cases were reported this week – one from Damboa, Borno and one from Kura, Kano. The total number of WPV cases for Nigeria 2013 is now 53 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on 15 December from Damboa, Borno.
:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 is now 3. The most recent cVDPV case had onset of paralysis on 6 November (from Konduga, Borno).

Pakistan
:: Six new WPV1 cases were reported in the past week. Four from North Waziristan, FATA; one from Khyber, FATA; and one from Karachi Baldia, Sindh. The total number of WPV1 cases for Pakistan in 2013 is now 91. The most recent WPV1 case had onset of paralysis on 28 December (from Khyber, FATA).

Horn of Africa
:: In Ethiopia, two new WPV1 cases were reported in the past week. Both cases had onset of paralysis on 21 October and were reported from Warder district, Somali region.
:: In Somalia, two new WPV1 cases were reported in the past week. One from Bossaso district, Bari region and one from Bardera district, Gedo region.
:: The total number of WPV1 cases in the Horn of Africa is now 207 (185 from Somalia, 14 from Kenya and eight from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 26 November (from Bardera, Gedo region in Somalia).
:: Outbreak response across the Horn of Africa is on-going. The impact of concerted response efforts is continued to be seen, as no new cases have been reported since July from the epicentre of the outbreak – Banadir, Somalia. All efforts continue to be made to reach all children across the region.

Speech: Opening remarks at the Fourth stakeholder meeting: Accountability for women’s and children’s health – now and in the post-2015 agenda
Dr Margaret Chan, WHO Director-General
14 January 2014

Excerpt
Colleagues in public health, development partners, representatives of sister agencies and civil society organizations, ladies and gentlemen,

Welcome to this fourth meeting of stakeholders as we continue our efforts to improve accountability for women’s and children’s health. I thank all of you for coming to Geneva. We have a good mix of perspectives, experiences, and contributions at many levels represented in this room.

We are at the midpoint in a time-bound process of improving accountability. This is a good time to take stock of where we stand, the lessons we have learned, and how we can institutionalize these lessons as the international community moves into the post-2015 era.

When I was asked to serve as a vice-chair for the Commission on Information and Accountability for Women’s and Children’s Health, I knew we were embarking on a journey into largely uncharted territory.

Accountability for resources and results has long been deeply desired, but rarely tackled in a rigorous and systematic way. I also knew that establishing an accountability framework specifically for women’s and children’s health would be an especially hard test case, perhaps even the hardest test case imaginable.

As we all know, maternal and child mortality cannot be brought down without addressing fundamental weaknesses in health systems that have been neglected for decades. Addressing accountability for women’s and children’s health means addressing long-standing problems with health infrastructures and services, inadequate numbers of appropriately trained and motivated staff, and the absence in most countries of reliable systems for civil registration and vital statistics.

Accountability means counting. Transparency is impossible in the absence of reliable data. It means improving the way donors and recipient countries work together, the way information is collected and used, and the capacity to track resource flows throughout the health sector.

It means ensuring equitable access to services, fair financing for care, and, as the independent Expert Review Group so clearly reminds us, high quality care that is person-centred, not intervention-centred…

http://www.who.int/dg/speeches/2014/accountability-women-children/en/index.html

The Weekly Epidemiological Record (WER) for 17 January 2014, vol. 89, 3 (pp. 29–36) includes:
:: Consultation on global influenza surveillance, Geneva, 10–12 July 2013
:: Monthly report on dracunculiasis cases, January– November 2013
http://www.who.int/entity/wer/2014/wer8903.pdf

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Human infection with avian influenza A(H7N9) virus – update 17 January 2014
On 15 January 2014, the National Health and Family Planning Commission of China notified WHO of four additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus…The source of infection is still under investigation. So far, there is no evidence of sustained human-to-human transmission.
The Chinese government continues to take the following measures:
–       strengthen surveillance and situation analysis;
–       reinforce case management and treatment;
–       conduct risk communication with the public and release information;
–       strengthen international collaboration and communication; and conduct scientific studies.
WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions…

:: Human infection with avian influenza A(H7N9) virus – update 16 January 2014

:: Human infection with avian influenza A(H7N9) virus – update 15 January 2014

:: Human infection with avian influenza A(H7N9) virus – update 14 January 2014

IOM Report: The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities – Summary of a Joint Workshop
Although antibiotics to treat tuberculosis (TB) were developed in the 1950s and are effective against a majority of TB cases, resistance to these antibiotics has emerged over the years, resulting in the growing spread of drug-resistant TB. Since 2008, the IOM Forum on Drug Discovery, Development, and Translation has hosted or co-hosted six domestic and international workshops to address the global crisis of drug-resistant TB. On January 16-18, 2013, the IOM along with the Institute of Microbiology of the Chinese Academy of Sciences held a workshop to address the current status of drug-resistant TB globally and in China as well as identify opportunities for Brazil, Russia, India, China, and South Africa (the BRICS countries) to lead efforts in TB control.
Read the Report >>

Announcement: Consensus Framework for Ethical Collaboration between Patients’ Organizations, Healthcare Professionals and the Pharmaceutical Industry
13 January 2014
Framework: http://www.ifpma.org/fileadmin/content/Publication/2014/Consensus_Framework-vF.pdf].

The International Alliance of Patients’ Organizations (IAPO), International Council of Nurses (ICN), International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), International Pharmaceutical Federation (FIP), and the World Medical Association (WMA) announced that they established a Consensus Framework for Ethical Collaboration “to support partnerships that will aim to deliver greater patient benefits and support high quality patient care. Derived from the individual codes of ethical practice and health policy positions of the five supporting organizations, this framework is based on four overarching principles:
:: putting patients first;
:: supporting ethical research and innovation;
:: ensuring independence and ethical conduct; and
:: promoting transparency and accountability.
…“Marie-Paule Kieny, Assistant Director-General for Health Systems and Innovation at WHO, said “Ensuring ethical conduct, transparency and accountability are key in the development and testing of medicines and other health technologies.  We encourage all organizations involved to examine ways to develop monitoring mechanisms that can support these principles.”
http://www.ifpma.org/news/news-releases/news-details/article/putting-patients-first-five-global-healthcare-org.html

American Journal of Preventive Medicine
Vol 46 | No. 2 | February 2014 | Pages 103-218
http://www.ajpmonline.org/current

Vaccinations Given During Pregnancy, 2002–2009: A Descriptive Study
Allison L. Naleway, PhD, Samantha Kurosky, MS, Michelle L. Henninger, PhD, Rachel Gold, PhD, PH, James D. Nordin, MD, MPH, Elyse O. Kharbanda, MD, MPH, Stephanie Irving, MHS, T. Craig Cheetham, PharmD, MS, Cynthia Nakasato, MD, Jason M. Glanz, PhD, Simon J. Hambidge, MD, PhD, Robert L. Davis, MD, MPH, Nicola P. Klein, MD, PhD, Natalie L. McCarthy, MPH, Eric Weintraub, MPH
http://www.ajpmonline.org/article/S0749-3797%2813%2900583-7/abstract

Abstract
Background
A number of studies have described influenza vaccination coverage during pregnancy but few publications have described rates of other vaccinations.

Purpose
To describe vaccination rates during pregnancy in the Vaccine Safety Datalink (VSD), with particular focus on vaccinations contraindicated during pregnancy.

Methods
Pregnancies ending in 2002 through 2009 and vaccinations administered during these pregnancies were identified in the VSD. Vaccination rates per 1000 pregnancies during the study period were calculated by vaccine type, recommendation category, pregnancy year, maternal age, and trimester. Analyses were conducted in 2012–2013.

Results
In the VSD, 669,695 pregnancies and 141,389 vaccinations were identified. Trivalent inactivated influenza (TIV) was the most commonly administered vaccination (174.1 doses per 1000 pregnancies) and was most often administered during the 2nd and 3rd trimesters. The most common vaccines in the “consider if indicated” category were tetanus–diphtheria (6.1 per 1000) and hepatitis B (3.7 per 1000). Contraindicated vaccination was infrequent, and the majority of these were measles–mumps–rubella (MMR) (1.2 per 1000); varicella (1.0 per 1000); and live-attenuated influenza vaccine (LAIV) (0.3 per 1000). Both “consider if indicated” and contraindicated vaccines were more frequently administered during early pregnancy.

Conclusions
TIV was the most commonly administered vaccine. With the exception of TIV, other vaccines were most frequently administered during early pregnancy and among younger women, suggesting that vaccination may occur when the woman and/or provider are unaware of the pregnancy. Contraindicated vaccines were infrequently administered during pregnancy; however, given that some women received contraindicated vaccines later in pregnancy, clearer recommendations and improved provider education may be needed.

BMC Public Health
(Accessed 18 January 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Influenza vaccines and influenza antiviral drugs in Africa: are they available and do guidelines for their use exist?
Jazmin Duque, Meredith L McMorrow and Adam L Cohen
http://www.biomedcentral.com/1471-2458/14/41/abstract
Abstract (provisional)
Background
Influenza viruses cause significant morbidity and mortality in Africa, particularly among high-risk groups, but influenza vaccines and antiviral drugs may not be commonly available and used. The main aim of this study was to determine the availability and use of influenza vaccines and antiviral drugs as well as to describe existing related guidelines and policies in Africa.

Methods
A self-administered survey was distributed among key influenza experts in 40 African countries.

Results
Of the 40 countries surveyed, 31 (78%) responded; 14/31 (45%) reported availability of seasonal influenza vaccine, and 19/31 (65%) reported availability of antiviral drugs for the treatment of influenza. Vaccine coverage data were only available for 4/14 (29%) countries that reported availability of seasonal influenza vaccine and ranged from <0.5% to 2% of the population.

Conclusions
Influenza vaccines and antiviral drugs are available in many countries in Africa but coverage estimates are low and remain largely unknown. Describing the local burden of disease and identifying funding are essential to encourage countries to use influenza vaccine more widely

British Medical Journal
18 January 2014 (Vol 348, Issue 7941)
http://www.bmj.com/content/348/7941

Editorial
Improving, and auditing, access to clinical trial results
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g213 (Published 15 January 2014)
http://www.bmj.com/content/348/bmj.g213

Excerpt
All trials should be registered, with their full methods and results reported, and routine audit on the extent of information withheld

The House of Commons Public Accounts Committee delivered a remarkable report on 3 January. Its initial remit was the United Kingdom’s £424m (€510m; $697m) stockpile of oseltamivir (Tamiflu), but the committee soon broadened out—with evident surprise—into the ongoing problem of clinical trial results being routinely and legally withheld from doctors, researchers, and patients.

This situation has persisted for too long. The first quantitative evidence on publication bias was published in 1986.1 Iain Chalmers described in 2006 how progress in the 1990s soon deteriorated into broken promises.2 Recent years have seen extensive denial. The Association of the British Pharmaceutical Industry (ABPI) has claimed that these problems are historic, and that results are now posted on clinicaltrials.gov. The recently defunct Ethical Standards in Health and Life Sciences Group,3 which most UK medical and academic professional bodies signed up to, falsely claimed that a “robust regulatory framework” ensures access to trial results.4 US legislation requiring all results to be posted on clinicaltrials.gov within 12 months of completion has been widely ignored,5 with no enforcement. There has also been covert activity from industry—a leaked memo on its “advocacy” strategy included “mobilising patient groups” to campaign…

Clinical Therapeutics
Vol 36 | No. 1 | 01 January 2014 | Pages 1-150
http://www.clinicaltherapeutics.com/current

Safety and Success of the Human Papillomavirus Vaccine: Time for a Robust Vaccination Program in the United States and Worldwide
Linda R. Duska, MD
http://www.clinicaltherapeutics.com/article/S0149-2918%2813%2901102-8/fulltext
Excerpt
…Education, then, is key. Education of health care professionals, particularly pediatricians, and parents about the tolerability and efficacy of this vaccine is crucial to increasing uptake. Vaccination of both boys and girls before the initiation of sexual activity is critical to optimal protection against HPV infection and its sequelae. Perhaps most importantly, we must educate those people in power who influence health policy decisions and may erroneously believe that the HPV vaccine will somehow condone sexually activity in our children.

Update on Vaccination Clinical Trials for HPV-Related Disease  
Britt K. Erickson, Emily E. Landers, Warner K. Huh
Abstract

The Australian Experience With the Human Papillomavirus Vaccine  
Suzanne M. Garland
Abstract

Race, Ethnicity, and Income Factors Impacting Human Papillomavirus Vaccination rates  

Patricia Jeudin, Elizabeth Liveright, Marcela G. del Carmen, Rebecca B. Perkins
Abstract

Cost Effectiveness and Resource Allocation
(Accessed 18 January 2014)
http://www.resource-allocation.com/

Research
Lifetime QALY prioritarianism in priority setting: quantification of the inherent trade-off
Trygve Ottersen1*, Ottar Mæstad2 and Ole Frithjof Norheim1
http://www.resource-allocation.com/content/12/1/2

Abstract
Background
Multiple principles are relevant in priority setting, two of which are often considered particularly important. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. This principle is intimately linked to the goal of health maximization and standard cost-effectiveness analysis (CEA). According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. This principle is often linked to an idea of equity. Together, the two principles accord with prioritarianism; a view which can motivate non-standard CEA. Crucial for the actual application of prioritarianism is the trade-off between the two principles, and this trade-off has received scant attention when the worse off are specified in terms of lifetime health. This paper sheds light on that specific trade-off and on the public support for prioritarianism by providing fresh empirical evidence and by clarifying the close links between the findings and normative theory.

Methods
A new, self-administered, computer-based questionnaire was used, to which 96 students in Norway responded. How respondents wanted to balance quality-adjusted life years (QALYs) gained against benefiting those with few lifetime QALYs was quantified for a range of different cases.

Results
Respondents supported both principles and were willing to make trade-offs in a particular way. In the baseline case, the median response valued a QALY 3.3 and 2.5 times more when benefiting someone with lifetime QALYs of 10 and 25 rather than 70. Average responses harbored fundamental disagreements and varied modestly across distributional settings.

Conclusion
In the specific context of lifetime health, the findings underscore the insufficiency of pure QALY maximization and explicate how people make trade-offs in a way that can help operationalize lifetime prioritarianism and non-standard CEA. Seen through the lens of normative theory, the findings highlight key challenges for prioritarianism applied to priority setting.

Eurosurveillance
Volume 19, Issue 2, 16 January 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
Coverage of the English National human papillomavirus (HPV) Immunisation Programme among 12 to 17 year-old females by area-level deprivation score, England, 2008 to 2011
A Hughes1, D Mesher1, J White2, K Soldan1
Public Health England, HIV and STI Department, London, United Kingdom
Public Health England, Immunisation, Hepatitis and Blood Safety Department, London, United Kingdom

Abstract
The English national human papillomavirus (HPV) immunisation programme has offered vaccination to girls aged 12 years at the start of each school year since September 2008. A catch-up programme has offered vaccination to girls up to 18 years. Delivery is predominantly school-based, with some general practitioner (GP)-based immunisation. The relationship between HPV immunisation coverage and deprivation (index of multiple deprivation, IMD) was assessed by geographical area (N=151) for each school year offered the HPV vaccine between 2008 to 2011 using the Spearman’s rank correlation coefficient, and compared to that for adequate cervical screening of women aged 25 to 49 years. Coverage at age 12 showed no significant association with IMD at the area-level (p=0.12). Within the catch-up years, there was some suggestion of higher deprivation being associated with lower coverage. This was not significant for girls offered immunisation under 16 years (in compulsory education) (p=0.09), but was more marked and statistically significant for older girls (p<0.0001). The proportion of women aged 25 to 49 years with an adequate cervical screen was negatively associated with deprivation (p<0.0001). School-based HPV immunisation delivery appears to be successfully reducing inequalities in cervical cancer control at area-level. However, the catch-up cohorts above the age of compulsory education may face increased inequality. Further investigation is needed into individual-level factors associated with coverage.

The Lancet  
Jan 18, 2014  Volume 383  Number 9913   p187 – 280
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Grand convergence: a future sustainable development goal?
The Lancet
Preview |
On Jan 16, in the North Lawn Building of the United Nations in New York, Norway’s Permanent Representative to the UN, Mr Geir Pedersen, is hosting an event that just might change the course of negotiations on the future of sustainable development. The meeting is based on the findings of the Lancet Commission on Investing in Health, “Global Health 2035: a world converging within a generation”. Margaret Kruk, one of the commissioners on the Global Health 2035 report, will chair a discussion that includes the Rwandan Minister of Health, Agnes Binagwaho, the President of the Public Health Foundation of India, Srinath Reddy, the US Assistant Administrator for Global Health, Ariel Pablos-Méndez, and Gavin Yamey from the University of California, San Francisco (who led the writing of the report).

The Lancet  
Jan 18, 2014  Volume 383  Number 9913   p187 – 280
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
What does universal health coverage mean?
Thomas O’Connell, Kumanan Rasanathan, Mickey Chopra
Preview |
The recent UN General Assembly resolution calling for universal health coverage (UHC) was testimony to the continuing high-level political commitment to achievement of global health goals—an achievement that has the potential to transform health systems, especially for the poorest people.1 Fulfilment of this potential, however, requires a clear definition of the term UHC otherwise it could suffer the same fate of the refrain of Health for All, which received high-level political support but failed to produce sufficiently widespread policy and budgeting changes to realise its aims.

PLoS One
[Accessed 18 January 2014]
http://www.plosone.org/

Research Article
Potential Cost-Effectiveness of a New Infant Tuberculosis Vaccine in South Africa – Implications for Clinical Trials: A Decision Analysis
Jared B. Ditkowsky, Kevin Schwartzman mail
Published: January 15, 2014
DOI: 10.1371/journal.pone.0083526 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083526

Abstract
Novel tuberculosis vaccines are in varying stages of pre-clinical and clinical development. This study seeks to estimate the potential cost-effectiveness of a BCG booster vaccine, while accounting for costs of large-scale clinical trials, using the MVA85A vaccine as a case study for estimating potential costs. We conducted a decision analysis from the societal perspective, using a 10-year time frame and a 3% discount rate. We predicted active tuberculosis cases and tuberculosis-related costs for a hypothetical cohort of 960,763 South African newborns (total born in 2009). We compared neonatal vaccination with bacille Calmette-Guérin alone to vaccination with bacille Calmette-Guérin plus a booster vaccine at 4 months. We considered booster efficacy estimates ranging from 40% to 70%, relative to bacille Calmette-Guérin alone. We accounted for the costs of Phase III clinical trials. The booster vaccine was assumed to prevent progression to active tuberculosis after childhood infection, with protection decreasing linearly over 10 years. Trial costs were prorated to South Africa’s global share of bacille Calmette-Guérin vaccination. Vaccination with bacille Calmette-Guérin alone resulted in estimated tuberculosis-related costs of $89.91 million 2012 USD, and 13,610 tuberculosis cases in the birth cohort, over the 10 years. Addition of the booster resulted in estimated cost savings of $7.69–$16.68 million USD, and 2,800–4,160 cases averted, for assumed efficacy values ranging from 40%–70%. A booster tuberculosis vaccine in infancy may result in net societal cost savings as well as fewer active tuberculosis cases, even if efficacy is relatively modest and large scale Phase III studies are required.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Development and Initial Feedback About a Human Papillomavirus (HPV) Vaccine Comic Book for Adolescents
ML Katz, BR Oldach, J Goodwin, PL Reiter… – Journal of Cancer Education, 2014
Abstract Human papillomavirus (HPV) vaccination rates do not meet the Healthy People 2020 objective of 80 % coverage among adolescent females. We describe the development and initial feedback about an HPV vaccine comic book for young adolescents. The comic book is …

Print News Coverage of School‐Based Human Papillomavirus Vaccine Mandates
DM Casciotti, KC Smith, L Andon, J Vernick, A Tsui… – Journal of School Health, 2014
BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events …

Predictors of IV behaviors during and after the 2009 influenza pandemic in France
CB Anne-Laure, R Jocelyn, L Nathanaël, X De-Lambal… – Vaccine, 2014
Background Controversies about the 2009 H1N1 pandemic influenza vaccination might have impacted the motivational processes that underlie individual immunization against seasonal influenza. The purpose of this article is to investigate correlates of vaccine …

[HTML] Immunogenicity of Influenza Vaccine in Colorectal Cancer Patients
DH Kim, YY Lee, US Shin, SM Moon – Cancer Research and Treatment, 2013
Purpose Although influenza is regarded as a major cause of morbidity and mortality in immunocompromised patients, vaccine coverage remains poor. We evaluated the immunogenicity of influenza vaccines in colorectal cancer patients. Materials and Methods …

Therapeutic Cancer Vaccines: An Emerging Approach to Cancer Treatment
RA Madan, TA Ferrara, JL Gulley – Handbook of Anticancer Pharmacokinetics and …, 2014
… Cancer Immun 7:11; Chakraborty M, Abrams SI, Coleman CN, Camphausen K, Schlom
J, Hodge JW (2004) External beam radiation of tumors alters phenotype of tumor cells to render them susceptible to vaccine-mediated T-cell killing. …

Systematic review of human papillomavirus vaccine coadministration
AS Noronha, LE Markowitz, EF Dunne – Vaccine, 2014
Abstract Human papillomavirus (HPV) vaccination is recommended in early adolescence, at an age when other vaccines are also recommended. Administration of multiple vaccines during one visit is an opportunity to improve uptake of adolescent vaccines. We conducted …

Safety and Reactogenicity of the Inactivated Poliomyelitis Vaccine (Poliorix (TM)) in Korea (2006-2012)
JB Sin, MS Park, SH Ma, YY Choi, SM Shin, WD Kim… – Korean Journal of Pediatric …, 2013
OBJECTIVE: As per the requirement of Korean Food and Drug Administration, this post-marketing surveillance was conducted in Korea to evaluate the safety and reactogenicity of Poliorix (TM) following its introduction in 2006. METHODS: In this open, multicenter study, .

Special Focus Newsletters
RotalFlash/ January 15, 2014
PATH
Mali puts children first in the fight against rotavirus
From clinical trial to GEMS study site to vaccine introduction
http://vad.cmail3.com/t/ViewEmail/r/DEE77DE43B2037EB2540EF23F30FEDED/E38B11B8894CC5F5DBC23BD704D2542D

Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
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– Email Summary: Vaccines and Global health : The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
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– pdf version: A pdf of the current issues is available here: Vaccines and Global Health_The Week in Review_11 Jan 2014
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

   UNICEF undated the status of an emergency vaccination campaign to reach over 210,000 children displaced by violence in Bangui CAR, noting that it is now underway at major displacement sites in the capital. At least seven cases of measles have been confirmed, three of them at a site by Bangui airport where about 100,000 people fleeing the violence are staying. The integrated vaccination campaign includes immunization against measles and polio, with the addition of vitamin A   UNICEF undated the status of an emergency vaccination campaign to reach over 210,000 children displaced by violence in Bangui CAR, noting that it is now underway at major displacement sites in the capital. At least seven cases of measles have been confirmed, three of them at a site by Bangui airport where about 100,000 people fleeing the violence are staying. The integrated vaccination campaign includes immunization against measles and polio, with the addition of vitamin A supplementation, deworming medication, and screening for malnutrition. UNICEF noted that up to two-thirds of Bangui’s residents have been displaced by violence since early December. Over 935,000 have been displaced across the country over the past year. They seek shelter in a variety of locations which are not formal settlements and are often called displacement sites. UNICEF said it is providing most of the vaccines, injection material, and operational costs, and will monitor the campaign as it unfolds over several days in dozens of sites across the city. Campaign partners supporting the Ministry of Health include the ICRC, WHO, MSF, the CAR Red Cross, Merlin/Save the Children, International Medical Corps and Médecins du Monde…
UNICEF Media Release: BANGUI, Central African Republic / DAKAR, Senegal / GENEVA, 8 January 2014  http://www.unicef.org/media/media_71726.html

Report: Poliomyelitis: intensification of the global eradication initiative
Secretariat/GPEI
EXECUTIVE BOARD EB134/35, 134th session 13 December 2013, Provisional agenda item 10.4
http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_35-en.pdf

Excerpts
1.The Polio Eradication and Endgame Strategic Plan 2013–20181 was prepared in response to a request by the Health Assembly in resolution WHA65.5 on poliomyelitis: intensification of the global eradication initiative. In May 2013, the Plan was presented to the Sixty-sixth World Health Assembly. The present report summarizes the status of each of the four objectives of the Endgame Strategic Plan, the impediments to achieving the milestones in a timely manner, the current financing situation, and the programme priorities for 2014:
:: OBJECTIVE 1: POLIOVIRUS DETECTION AND INTERRUPTION
:: OBJECTIVE 2: STRENGTHENING IMMUNIZATION SYSTEMS AND WITHDRAWAL OF ORAL POLIO VACCINE
:: OBJECTIVE 3: CONTAINMENT AND CERTIFICATION
:: OBJECTIVE 4: LEGACY PLANNING

2. As of 10 December 2013, the number of cases of disease due to wild poliovirus had increased by 68% compared to the same time in 2012 (359 cases compared with 213 cases), with eight countries reporting cases of poliomyelitis compared to four at this point in 2012. This increase is driven by disease outbreaks due to new international spread of polioviruses from Nigeria into the Horn of Africa (183 cases in Somalia, 14 in Kenya, 6 in Ethiopia) and from Pakistan into the Middle East (17 cases in the Syrian Arab Republic). Four cases due to an imported poliovirus have also been detected in Cameroon. To date, cases of endemic poliomyelitis increased by 32% in Pakistan (to 74) compared with the same time in 2012. In the other two countries where the virus is endemic, Nigeria and Afghanistan, cases declined by 58% and 68%, respectively. In 2013, all cases detected in Afghanistan occurred in the Eastern Region and were due to polioviruses that originated in Pakistan. Wild poliovirus of Pakistani origin was also detected in environmental samples collected in Israel and the occupied Palestinian territory.

3. For the first time in the history of the eradication initiative, in 2013 all cases of poliomyelitis caused by a wild virus were due to a single serotype, type 1; the most recent case due to wild poliovirus type 3 occurred on 10 November 2012 in Nigeria. Cases due to circulating vaccine-derived poliovirus type 2 (57 cases in seven countries) declined by 16% compared to 2012, with most cases being either in Pakistan or the border area of Cameroon, Chad, Niger and Nigeria…

MAJOR RISKS AND PROGRAMME PRIORITIES FOR 2014
16. As of 25 November 2013, the major risks to attaining the 2014 eradication target of the Endgame Plan were: the bans on immunization campaigns in the North Waziristan agency in Pakistan and parts of southern and central Somalia; the continued targeting of vaccinators in Khyber Pakhtunkhwa province in Pakistan; ongoing military operations in Khyber Agency (within the Federally Administered Tribal Areas region) of Pakistan; insecurity in Eastern Region, Afghanistan and Borno, Nigeria; active conflict in the Syrian Arab Republic and chronic gaps in programme performance in Kano state, Nigeria. These risks to the vaccination of children in known polio-affected areas are compounded by gaps in polio surveillance and the continued threat of new international spread of wild poliovirus into highly vulnerable areas and populations.

17. Management of these risks requires full national ownership of the eradication programme in all infected countries, with deep engagement of all relevant line ministries and departments, and the holding of local authorities fully accountable for the quality of activities, particularly in accessible areas such as Kano. Accessing and vaccinating children in insecure and conflict-affected areas will in addition require the full engagement of relevant international bodies, religious leaders and other actors with influence in such settings. Collaboration with broader humanitarian efforts must be enhanced to develop and implement area-specific operational plans, generate greater community demand and participation, and adapt or modify eradication approaches in line with local contexts. In order to minimize the risks and consequences of international spread of poliovirus, Member States are urged to enhance surveillance, strengthen routine immunization coverage, and, where appropriate, implement supplementary immunization activities. The Secretariat will convene an expert group in 2014 to advise on further measures to vaccinate travellers from areas where there is active poliovirus transmission.

18. In order to facilitate the withdrawal of the type 2 component of oral polio vaccine in 2016, and further reduce global vulnerability to the remaining wild poliovirus serotypes, Member States are encouraged to establish plans for the introduction of at least one dose of the inactivated poliovirus vaccine into their routine immunization programmes. Recognizing the complex financing arrangements and tight supply timelines for introduction of this vaccine globally, the Strategic Advisory Group of Experts on immunization recommended that countries endemic and at high risk of polio develop by mid-2014 a plan for inactivated polio vaccine introduction, and that all countries develop such plans by the end of 2014.1

19.  In order to further strengthen governance and oversight of the eradication initiative, the Polio Oversight Board, comprised of the heads of the five core partners, initiated in-person meetings on a six-monthly basis, is adopting a systematic risk review process, and is introducing a decision-making process that facilitates more systematic input by donors and stakeholders. Within WHO, the Director-General established a cross-cluster Polio Endgame Management Team to enhance organizational support for programme management, strategy implementation, and resource mobilization and management.

Update: Polio this week – As of 9 January 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: India will reach a great milestone in polio eradication on 13 January – three years since its last case of wild poliovirus! India was once thought to be the most difficult country in which to achieve polio eradication.
:: The Executive Board (EB) will meet in Geneva on 20-25 January. Ahead of the EB 134th session, the Global Polio Eradication Initiative (GPEI) published the report: “Poliomyelitis: intensification of the global eradication initiative”. The full report is available in English and French here. [excerpts above]
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week. The total number of WPV1 cases for 2013 is now 12. The most recent WPV1 case had onset of paralysis on 11 December from Nad-e-Ali, Hilmand province. This is the first case reported from the southern part of the country in 2013. All other WPV1 cases are reported from Eastern Region, close to the Pakistan border.
Nigeria
:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 is now 2. The most recent cVDPV case had onset of paralysis on 6 November (from Konduga, Borno)
Pakistan
:: Two new WPV1 cases were reported in the past week. One from South Waziristan, FATA and one from Gulshan Iqbal Karachi, Sindh. The total number of WPV1 cases for Pakistan in 2013 is now 85. The most recent WPV1 case had onset of paralysis on 16 December (from South Waziristan, FATA)

    Rotary said its members worldwide are “celebrating a major milestone in the global effort to eradicate polio: India, until recently an epicenter of the wild poliovirus, will mark the third anniversary of its last recorded case of the paralyzing infectious disease on 13 January.”
…In celebration of the decades-long battle and ultimate victory over this disabling disease in India, Rotary clubs throughout the country will illuminate landmarks and iconic structures on Jan. 13.  India Gate in Delhi and Red Fort in Delhi and Agra are among the structures that will carry Rotary’s dramatic message – ‘India is Polio Free’. Rotary said the three-year achievement also sets the stage for the polio-free certification of the entire South East Asia Region of the World Health Organization in the first quarter of 2014 by the Regional Certification Committee. The Indian government also plans to convene a polio summit in February to mark the occasion. Rotary said the challenge now is to replicate India’s success in neighboring Pakistan (in a different WHO region), one of three remaining polio-endemic countries including Afghanistan and Nigeria…
Media Release: EVANSTON, Ill., Jan. 10, 2014 /PRNewswire-USNewswire/ —
http://www.prnewswire.com/news-releases/rotary-celebrates-indias-third-straight-polio-free-year-239615751.html

WHO: Liberia begins protecting its children against pneumococcal disease
9 January 2014
Excerpt
Children across Liberia are now receiving protection against one of the leading vaccine-preventable killers of children as the country today celebrates the introduction of pneumococcal vaccine (PCV)… Liberian President Ellen Johnson Sirleaf was joined at the launch event, held at the JFK Medical Center in Monrovia, by representatives of the GAVI Alliance, cabinet ministers and senior politicians, representatives of the diplomatic corps, UNICEF, WHO, health workers, parents and babies…
News release on pneumococcal vaccine rollout in Liberia