American Journal of Public Health – November 2014

American Journal of Public Health
Volume 104, Issue 11 (November 2014)

Nonmedical Exemptions From School Immunization Requirements: A Systematic Review
Eileen Wang, Jessica Clymer, BA, BSN, Cecilia Davis-Hayes, BA, and Alison Buttenheim, PhD, MBA
We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease.
We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk.
State laws influence exemption rates, but policy implementation, exemptors’ vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions.

Improving Global Access to New Vaccines: Intellectual Property, Technology Transfer, and Regulatory Pathways
Sara Eve Crager, MD
The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

The Convention on the Rights of Persons With Disabilities: A Foundation for Ethical Disability and Health Research in Developing Countries
Jo Durham, PhD, Claire E. Brolan, MA, and Bryan Mukandi, MD
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has foregrounded disability as a human rights and equity issue, elevating it to a priority global research area.
Academics from Western universities are likely to play an increasing role in disability health research in developing countries. In such contexts, there is a need to bridge the gap between procedural ethics and the realities of disability research in cross-cultural contexts.
We provide guidance on engaging in ethical disability health research that intersects with and upholds the CRPD. We highlight challenges and tensions in doing so, underscoring the need to be sensitive to the sociocultural and political context of disability that determines how ethical research should proceed. We conclude with 5 recommendations.

Mandatory Influenza Vaccination for Health Care Workers as the New Standard of Care: A Matter of Patient Safety and Nonmaleficent Practice
Nicolas Cortes-Penfield, MD
A growing body of literature defends the efficacy of seasonal influenza vaccination for health care workers in reducing the mortality of hospitalized patients. I review the evidence concerning influenza vaccination, concluding that universal vaccination of health care workers against influenza should be considered standard patient care and that nonvaccination represents maleficent care. I further argue that the ethical responsibility to ensure universal vaccination of staff against seasonal influenza lies not only with individual health care providers but with each individual health care institution.

The Role of Applied Epidemiology Methods in the Disaster Management Cycle
Josephine Malilay, PhD, MPH, Michael Heumann, MPH, MA, Dennis Perrotta, PhD, Amy F. Wolkin, DrPH, MSPH, Amy H. Schnall, MPH, Michelle N. Podgornik, MPH, Miguel A. Cruz, MPH, Jennifer A. Horney, PhD, MPH, CPH, David Zane, MS, Rachel Roisman, MD, MPH, Joel R. Greenspan, MD, MPH, Doug Thoroughman, PhD, MS, Henry A. Anderson, MD, Eden V. Wells, MD, MPH, and Erin F. Simms, MPH
Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure.