Media/Policy Watch

BBC
http://www.bbc.co.uk/
Accessed 15 November 2014
14 November 2014
Polio eradication programme reaches ‘major milestone’
By James Gallagher Health editor, BBC News website
A “major milestone” in the battle to eliminate polio globally has been reached, the US Centres for Disease Control (CDC) has said.
Its experts think a second of the three forms of poliovirus has been eliminated after mass vaccination campaigns.
Wild poliovirus type 3 has not been detected for more than two years. Type 2 was eradicated in 1999…
…Prof Walt Orenstein, from the vaccine centre at Emory University in the US, told the BBC: “Type 3 appears to be gone – I think it is overwhelmingly likely that we are there, but it’s too soon to say we’re definitely there.
“So it’s not a total victory, but it is very promising.”
But he warned: “Pakistan is a major concern, about 85% of wild type 1 poliovirus this year has been in Pakistan, but in Nigeria there is real hope we can get rid of type 1 even by the end of this year.”…

Brookings
http://www.brookings.edu/
Accessed 15 November 2014
November 13, 2014 4:17pm
USAID Administrator Rajiv Shah: Ebola “One of the Toughest Challenges We Face”
Yesterday, Brookings hosted a discussion on the current state of the Ebola crisis, with USAID Administrator Rajiv Shah; Eric Postel, assistant to the USAID administrator for Africa; and a panel of Brookings experts plus Oscar Bloh, the chairperson of the Civil Society Organization Ebola Response Taskforce, Liberia and also country director, Search for Common Ground Liberia. Listen to the complete audio here. The administrator’s opening remarks are presented below (edit some for clarity).
The Ebola Crisis: U.S. Leadership and International Response Listen to Audio play

Council on Foreign Relations
http://www.cfr.org/
Accessed 15 November 2014
Transcript
Ebola Update
with Helene D. Gayle, Stephen S. Morse, Jordan S. Kassalow November 10, 2014
Experts discuss international efforts to combat the Ebola outbreak in West Africa.

DEVEX
https://www.devex.com/en/
Global Views – Inside Development
Moving beyond access to development — immunization reframed
By Robert Steinglass12 November 2014
…In the immunization field, there is growing recognition that in addition to vaccine accessibility there are serious challenges such as availability of vaccination services; awareness of when and where to get vaccinated; acceptability of vaccination and understanding its benefits; affability of services; agency of women to leave home and seek services; affordability for parents to use services and for the health system to provide them; and accountability of the program to community, government and funding agencies….

The Economist
http://www.economist.com/
Accessed 15 November 2014
15 November 2014
Treating Ebola – Unchained malady
What is the best way to test drugs and vaccines for Ebola fever?
EVERY year, in early November, researchers gather at a conference called TropMed to discuss tropical diseases. This year it was New Orleans’s turn to host them, and, not surprisingly, the meeting was dominated by Ebola—specifically, how to develop and test treatments for it in a timely and ethical manner.
American and European Ebola patients have been treated with experimental drugs that include an antiviral agent called brincidofovir; a mixture of synthetic antibodies called ZMapp; extracts of serum from recovered patients; and a medicine called TKM-Ebola which interferes with viral replication. Yet without some kind of trial it is impossible to say that any of these worked. Survival rates have been higher than in Africa, but no one knows whether this is the result of the treatment or of better supportive care.
Such trials are now planned. On November 12th Médicins sans Frontières (MSF), a charity at the forefront of dealing with Ebola, announced it was hosting three—of brincidofovir, of serum, and of another drug, favipiravir—in its treatment facilities in Liberia and Guinea. But supportive care clearly matters, too. Billy Fischer, of the University of North Carolina School of Medicine, told TropMed that providing intravenous hydration to every patient at the centre in Guinea at which he worked reduced mortality rates from 74% to less than 50%. Dr Fischer thinks that, with the proper resources, it would be possible to get the rate down to 20%.
One aspect of trials that particularly concerned TropMed was what are known as control arms. These are the parts of a trial that set the benchmark a drug or vaccine must beat to prove that it is effective. One way to create a control arm is to pick some of the volunteers at random and give them not the new treatment, but the best existing one. For a disease as lethal and lacking in existing treatments as Ebola, though, that is regarded by many as unethical, since it denies some participants a possibly life-saving medicine.
One way to ameliorate that problem is to design a trial to be “adaptive”, meaning data from it are assessed as they accumulate. If a drug seems effective early on in a trial, those in the control group can then be offered it immediately. In the case of Ebola, however, Edward Cox, director of the office of microbial products at America’s Food and Drug Administration has proposed another modification to normal procedure. He told TropMed that his organisation, in collaboration with the National Institutes of Health (NIH), has devised a way to compare several drugs at once against a single control group, greatly reducing the number of patients needed to act as controls.
Sometimes, nature herself provides a control arm. In the serum trial announced by MSF, immune-system compatibility problems mean not everyone can be injected with a given serum. The trial’s organisers, the Antwerp Institute of Tropical Medicine, therefore hope (with the permission of those involved) to use people who cannot be injected as their controls.
In the case of the other two trials, though, this approach is not possible. Instead, they will do what Dr Fischer did and compare the efficacy of their treatments with mortality rates at the clinics concerned before the trials started.
At least one other approach is possible, too. This is called a “step-wedge” design and will be used by another American government organisation, the Centres for Disease Control and Prevention (CDC), in a vaccine trial being run in Sierra Leone. A lack of people and equipment in west Africa means it is not possible to vaccinate everyone at once. The CDC’s researchers hope to make a virtue of this unfortunate fact, and assess the vaccine’s efficacy by comparing infection rates in groups vaccinated at different times.
Which approach will work best remains to be seen. But there may be a moral dilemma for ethicists if trials whose control arms put volunteers at risk turn out to be the quicker way to an answer. For every day that passes without decent drugs and a vaccine means Ebola kills more people.

The Guardian
http://www.guardiannews.com/
Accessed 15 November 2014
14 November 2014
David Cameron presses for indemnities to speed Ebola vaccinations
Global response to crisis criticised by Britain at G20 summit as it calls for more funding and faster licensing of medicines
…The indemnity fund would protect pharmaceutical companies developing new drugs that might subsequently turn out to have side-effects, but need to be licensed urgently.
GlaxoSmithKline’s chief executive, Andrew Witty, said an indemnity system was required because companies were being urged by the World Health Organisation to fast-track novel vaccines in months rather than years.
There is currently no proven vaccine against Ebola and drug companies have been wary of investing in the area since the commercial opportunity is small. Potential losses or claims arising from the use of new vaccines would represent an additional hurdle.
Many drug companies are now discussing ways to help with production, including some such as Pfizer that are not directly involved in Ebola vaccine development but believe they could provide technical expertise.
It has been argued that, out of necessity, some drugs are being developed in five months that would traditionally undergo five years of checks.
The companies have been lobbying Downing Street to give them financial protection so some of the drawn out licensing programme can be short-circuited. Different trials are due to start next year in Liberia, Sierra Leone and Guinea.
Speaking in Brisbane before the G20 summit began, Jim Yong Kim, the World Bank president, said the global response to Ebola in Africa was still not enough as the crisis was still not under control in Sierra Leone and Guinea.
“I’m encouraged especially by the tremendous response of both the United States and the UK. But I would still say that despite the pledges and the goodwill that has been expressed, we still need much, much more commitment,” he said.
To offer protection against the threat posed by future pandemics to the global economy, the World Bank has proposed setting up a fund that could disburse millions and possibly billions of dollars in aid.
“What we’re talking about is almost like an insurance policy that when the World Health Organisation declared a global health emergency, when they invoked what’s called the International Health Regulations, then and only then would this fund disburse,” Kim said.
“The idea is that we have funds to protect from other kinds of downside risks to the global economy. I just want to stress that pandemics, epidemics, are in fact very real downside risks to the global economy.
“If we had a flu pandemic that would move very quickly and potentially kill millions, we would need many billions disbursed right away.”

New York Times
http://www.nytimes.com/
Accessed 15 November 2014
Researchers to Test New Treatments in Countries Hit Hardest by ...
Nov. 12, 2014 – By ANDREW POLLACK
Although there are currently no drugs or vaccines approved in the United States to treat or prevent Ebola, health officials have used several …

Reuters
http://www.reuters.com/
Exclusive: MSF should have called for Ebola vaccine earlier, says aid group veteran
By Daniel Flynn and Robert-Jan Bartunek
DAKAR/BRUSSELS Fri Nov 14, 2014 1:10am EST
(Reuters) – Medecins Sans Frontiers “wasted time” by waiting too long to call for vaccines to fight an unprecedented outbreak of Ebola in West Africa, a veteran of the medical charity told Reuters.
The group’s response to the epidemic which has so far killed more than 5,000 people has been widely praised by governments and the World Health Organization. While Western donors dithered and other aid groups pulled out, MSF deployed hundreds to the Ebola “hot zones” and treated more than 3,000 patients.
But the emergency group relied too much on strategies it developed during smaller previous eruptions of the virus, leading it to make mistakes as this year’s rampant multi-country epidemic pushed it to its limits, said Jean-Herve Bradol, a member of MSF’s internal think-tank.
“Our response was too orientated toward the management of previous outbreaks,” Bradol, of the Paris-based Centre For Reflection on Humanitarian Action (CRASH), told Reuters, adding that MSF’s public appeal for vaccine development in September came months too late.
“We wasted time before speaking about a vaccine and treatments… It’s very hard to imagine controlling this epidemic now without a vaccine.”…

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 15 November 2014
Dengue Fever Researchers in Military Weigh Infecting Volunteers
11/13/14
U.S. military scientists are considering resurrecting a research program that would infect healthy people with dengue fever, the potentially deadly mosquito-borne disease that has no known drug treatment.
Ebola workers ask Congress for help
11/12/14
WASHINGTON — A top U.S. official outlined plans Wednesday for clinical trials of a possible Ebola vaccine in West Africa, as the global response to the outbreak took on added urgency with the disclosure of a new cluster of cases in Mali and reports that the death toll had surpassed 5,000.
Federal Goal Is to Vaccinate 80% of Boys and Girls Against HPV by 2020
11/10/14
With oral-cancer rates climbing for men, federal health authorities are looking to overcome parental qualms and achieve 80% HPV vaccination rates of boys and girls by 2020.