Media/Policy Watch [to 25 July 2015]

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

Center for Global Development
Restructuring US Global Health Programs to Respond to New Challenges and Missed Opportunities
| 20 July 2015
By Amanda Glassman, Rachel Silverman
Policy Recommendations
:: Appoint US global health leadership with the mandate, budget alignment, and political support to enforce interagency collaboration.
:: Harmonize the approach to multilateral organizations to ensure consistency of priorities and objectives.
:: Establish an office of Global Health Trade, Economics, and Knowledge Exchange responsible for sharing US health-care know-how with policymakers and businesses in developing countries.
In the absence of effective international institutions, the United States has become the world’s de facto first responder for global health crises such as HIV/AIDS and new threats like Ebola. The US government has the technical know-how, financial and logistical resources, and unparalleled political support to act quickly and save lives. Initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative are widely considered among the most effective aid programs in the world.
Yet US global health approaches are based on increasingly outdated engagement models, which fail to reflect emerging challenges, threats, and financial constraints. Effective HIV/AIDS control efforts, which already cost US taxpayers many billions of dollars each year, will require more funding as a result of new science and ambitious program coverage goals.[1] At the same time, noncommunicable diseases — such as cancer, diabetes, and cardiovascular disease — have exploded in developing countries. Moreover, the United States and other donor countries historically have spent little on national health systems; in 2011, for example, just 4 percent of development assistance for health went to programs to strengthen health systems.[2] The inability of West African nations to combat the Ebola crisis demonstrates the practical impact of those past spending decisions, with frightening results in the United States and abroad.

The next US president, working closely with Congress, should modernize how US global health programs are organized, deployed, and overseen. By taking three specific steps, the United States can reduce the need for costly first responses and generate more health and economic impact for every US taxpayer dollar spent…

Wall Street Journal,us&_homepage=/home/us
Accessed 25 July 2015
A Win for Vaccines, but Worries Remain
Doctors who offer easy exemptions could undermine efforts to rein in the antivaccine crowd.
By Nina Shapiro
July 23, 2015 7:01 p.m. ET
In a growing number of states, parents can no longer refuse to immunize their children due to conflicting “personal beliefs”—at least not if they want their children to attend school. California recently joined West Virginia and Mississippi in requiring a medical exemption from a physician to permit a child to enter school without being immunized. Gov. Jerry Brown signed the controversial bill, SB277, last month.

Most of us rejoice, yet there is still reason to worry that exemptions will proliferate along with preventable diseases. Particularly if doctors feed their patients’ fears and offer easy exemptions with few questions asked.

The overall immunization rate in California is high, but many schools have dangerously low immunization rates. A Hollywood Reporter story last year highlighted schools in tony areas like Santa Monica with immunization rates near 25%, lower than those in South Sudan.

Vaccines have been a hot topic since 1855, when Massachusetts began requiring them for schoolchildren. England had more stringent laws: The Compulsory Vaccination Act of 1853 required all infants born in England and Wales to be immunized against smallpox, unless they were considered medically “unfit.” This became the first “medical exemption” for vaccines.

Others objected to the mandate itself—and so began the antivaccination movement, long before actress Jenny McCarthy spewed her views on national television. A clause to the Compulsory Vaccination Act, created in 1898, allowed for “conscience” exemptions, eventually leading to the term “conscientious objector” for those abstaining from military service. In 1898 alone, 200,000 conscience (or, shall we say, personal belief) vaccine exemptions were granted in the United Kingdom.

In California exemptions are now up to the doctors, as parents must get approval from their physician. A legitimate medical exemption might be given for a child who has a weakened immune system, either due to a congenital condition or to chemotherapy or long-term steroid use.

A second reason for an exemption might be that the child had a serious allergic or other adverse reaction to an earlier vaccine. But serious, life-threatening reactions, such as seizures or severe rashes, are extremely rare, about one in every 100,000 doses. (The death rate from measles, by the way, is closer to one in 1,000 cases.)

Pockets of California residents are in an uproar over SB277; a few hundred rallied against the bill in San Diego in April. They would prefer to not immunize their children, or to design custom schedules on the medically dubious theory that the recommended schedule is unsafe. There is no evidence for this.

Unvaccinated children are themselves at risk, but they also put other children at risk, too. The more exemptions are given, the larger the gaps in herd immunity, and the more outbreaks of preventable diseases. Children with cancer who cannot be safely given the recommended course of vaccines, for instance, are among the most vulnerable to others’ so-called personal decisions.

Along with these California residents are California doctors who share in their uproar. Dr. Jay Gordon of Santa Monica, for example, testified against the bill; he has called the bill “disgracefully arrogant” and said parents “must participate in all health-care decisions for their children.” He is not alone, and these doctors will certainly stand by their patients.
Who will monitor the high volume of medical exemptions? Will doctors who opposed SB277 be allowed to dole out faux medical exemptions to their patients? In that sense, the California bill is an improvement, but antivaccination fear-mongers will continue to find a workaround.

Dr. Shapiro, director of pediatric ear, nose and throat at Mattel Children’s Hospital, is a professor of head and neck surgery at UCLA.