Vaccines and Global Health: The Week in Review 19 December 2015

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 with the current issue date

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pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_19 December 2015

blog edition: comprised of the approx. 35+ entries posted below on 6 December 2015.

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

David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

EBOLA/EVD [to 19 December 2015]

EBOLA/EVD [to 19 December 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 16 December 2015
No confirmed cases of Ebola virus disease (EVD) were reported in the week to 13 December. All contacts associated with the cluster of 3 confirmed cases of EVD reported from Liberia in the week to 22 November have now completed 21-day follow-up. The first-reported case in the cluster, a 15-year-old boy, died on 23 November. Two subsequent cases, the boy’s father and younger brother, tested negative twice for Ebola virus on 3 December and were discharged. As of 11 December, 210 eligible recipients associated with the cluster had received the rVSV-ZEBOV Ebola vaccine as part of the Partnership for Research on Ebola Vaccines in Liberia (PREVAIL study), which is administered by the Government of Liberia and the US National Institutes of Health.

Human-to-human transmission linked to the recent cluster of cases in Liberia will end on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. Human-to-human transmission linked to the primary outbreak in Guinea will end on 28 December 2015, 42 days after the country’s most recent case, reported on 29 October, received a second consecutive negative test for Ebola virus. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016…

POLIO [to 19 December 2015]

POLIO [to 19 December 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week as of 15 December 2015

:: The report on the September 2015 meeting of the Strategic Advisory Group of Experts on immunization (SAGE) was published this week, confirming that the globally coordinated withdrawal of the type 2 component in oral polio vaccine (OPV), also referred to as the ‘tOPV to bOPV switch’, should occur in April 2016.

:: Looking back at 2015 and ahead at 2016: a wrap-up of the year shows fewer cases in fewer places than ever before. The report on the status of polio eradication to WHO’s Executive Board also summarizes the progress on the Polio Endgame Plan, and on Resolution WHA68.3, adopted by the World Health Assembly (WHA) in May 2015.
[No new cases identified in Country-level reports in this week’s Update]


Poliomyelitis – Report by the Secretariat
WHO Executive Board 138 Session Provisional Agenda item 8.6
EB138/25 11 December 2015
Excerpts – Editor’s text bolding
1. At the time of writing (November 2015), strong progress continues to be made towards each of the four objectives of the Polio Eradication and Endgame Strategic Plan 2013–2018 (the Endgame Plan). With only Afghanistan and Pakistan remaining endemic for poliomyelitis, wild poliovirus transmission is at the lowest levels in history, with the fewest-ever reported cases from the fewest-ever affected countries. In resolution WHA68.3 on poliomyelitis, adopted in May 2015, the World Health Assembly recognized progress made towards interrupting transmission and towards the phased removal of oral polio vaccines, and urged Member States to fully finance and implement the Endgame Plan.

2. The declaration of international spread of wild poliovirus as a Public Health Emergency of International Concern and the temporary recommendations promulgated under the International Health Regulations (2005) remain in effect. In September 2015, the Polio Oversight Board of the Global Polio Eradication Initiative reviewed progress and concluded that wild poliovirus transmission is more likely to be interrupted in 2016 than in 2015. This delay shifts the target date for certification of global polio eradication to 2019 and increases the cost of completing polio eradication by US$ 1500 million. In October 2015, WHO’s Strategic Advisory Group of Experts on immunization confirmed its recommendation that the withdrawal of oral polio vaccines containing the type 2 component should occur during the period 17 April–1 May 2016 in all countries that are using trivalent oral polio vaccine through a globally-coordinated replacement of this vaccine by the bivalent oral polio vaccine. The Group also reaffirmed that, in preparation for this global event, it is crucial that countries meet established deadlines to identify facilities holding wild or vaccine-derived poliovirus type 2, destroy all type 2 poliovirus materials and, only where necessary, appropriately contain type 2 poliovirus in essential poliovirus facilities…

Strengthening routine immunization
15. The Global Polio Eradication Programme initiated a joint programme of work with the GAVI Alliance and other partners to support efforts to strengthen routine immunization in 10 “focus” countries with significant polio resources. Six of these countries – Chad, Democratic Republic of the Congo, Ethiopia, India, Nigeria and Pakistan – have developed annual national immunization plans that build on polio assets to improve broader immunization goals, resulting in as much as a 22% reduction in unimmunized children in some areas, in 2014 compared to 2013.1 Polio staff in these countries spend as much as 50% of their time on broader immunization and public health issues.

16. In 2015, pursuant to resolution WHA68.3, the Global Commission for the Certification of the Eradication of Poliomyelitis and the Strategic Advisory Group of Experts on immunization urged accelerated implementation of the WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAP III). Specifically, all Member States should complete Phase I (Preparation for containment of poliovirus type 2) which includes establishing an inventory of facilities holding polioviruses, destroying all wild poliovirus materials by the end of 2015 and destroying all Sabin type 2 poliovirus materials by July 2016. Any type 2 poliovirus materials not destroyed should be securely contained in designated “poliovirus essential” facilities. For implementation of Phase II (Poliovirus type 2 containment period) Member States hosting essential poliovirus facilities (vaccine production, research and repositories) should designate a national containment authority, establish biorisk management regulations aligned with GAP III, and certify secure containment of poliovirus materials. The Secretariat is supporting Member States in implementing the global action plan…

Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic
Disease outbreak news
15 December 2015
On 8 December 2015, the National IHR Focal Point of Lao People’s Democratic Republic (PDR) notified WHO of 2 additional VDPV1 cases. These cases are from Xaisomboun, a previously unaffected province. To date, the total number of confirmed cVDPV1 cases in this outbreak is 5…

IS Hinders Polio Eradication Efforts in Afghanistan
Noor Zahid, Zabihullah Ghazi
Voice of America December 11, 2015 4:40 PM
Polio vaccinations for tens of thousands of Afghan children are being delayed because health workers are unable to access remote regions controlled by Islamic militants including the Islamic State group.

Gula Khan Ayub, a Ministry of Public Health official, said around 100,000 children could not get vaccinated in a recent four-day polio vaccination campaign carried out in 14 eastern and southern provinces of Afghanistan due to militants’ threats.

The militants are blocking polio vaccination campaigns, saying the Afghan government and the West are using health workers for intelligence-gathering purposes, VOA correspondent Zabihullah Ghazi reports…

WHO & Regionals [to 19 December 2015]

WHO & Regionals [to 19 December 2015]

Health and human rights
Fact sheet N°323
December 2015
Key facts
:: The WHO Constitution enshrines “…the highest attainable standard of health as a fundamental right of every human being.”
:: The right to health includes access to timely, acceptable, and affordable health care of appropriate quality.
:: Yet, about 100 million people globally are pushed below the poverty line as a result of health care expenditure ever year.
:: Vulnerable and marginalized groups in societies tend to bear an undue proportion of health problems.
:: Universal health coverage is a means to promote the right to health.
Launch of WHO mobile phone application for nutrition
December 2015 — Access the latest WHO nutrition guidelines, recommendations and related information for nutrition interventions, wherever you are, with the eLENA (e-Library of Evidence for Nutrition Actions) mobile phone application.
Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 17 December 2015 Human infection with avian influenza A(H7N9) virus – China
:: 15 December 2015 Circulating vaccine-derived poliovirus – Lao People’s Democratic Republic
:: 15 December 2015 Microcephaly – Brazil
:: 15 December 2015 Cholera – Democratic Republic of the Congo
Weekly Epidemiological Record (WER) 18 December 2015, vol. 90, 51/52 (pp. 701–712)
701 Index of countries/areas
701 Index, Volume 90, 2015, Nos. 1–52
:: 17 December 2015
WHO seeks expression of interest from sub-Saharan African countries for pilot implementation projects of the RTS,S/AS01 malaria vaccine.
Expression of interest – English pdf, 332kb
Expression of Interest – French pdf, 301kb
Deadline for application: 15 January 2016
:: 17 December 2015
Immunization Practices Advisory Committee (IPAC): CALL FOR NOMINATIONS
Information and submission of proposals pdf, 124kb
Closing date: 1 February 2016
:: WHO Regional Offices
WHO African Region AFRO
:: The African Programme for Onchocerciasis Control (APOC) closes and a new body set up to eliminate Neglected Tropical Diseases
KAMPALA, 17 December 2015:- The African Programme for Onchocerciasis Control (APOC) founded in 1995 has been formally closed and a new entity – the Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN), with an expanded mandate, proposed to replace it. ESPEN was formally introduced to delegates at the 21st session of the Joint Action Forum (JAF) of the African Programme for Onchocerciasis Control (APOC) that has concluded in Kampala, Uganda.

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
:: Make focused, accelerated efforts to prevent, reduce newborn deaths: WHO
New Delhi, 14 December 2015: Nearly 7400 new-borns die every day in the WHO South-East Asia Region causing untold misery to mothers and families. Two-thirds of these deaths can be prevented by adopting proven and cost-effective measures, World Health Organization today said seeking focused efforts by governments and partners to prevent newborn deaths with a sense of urgency.
“Scaling up interventions with good quality care around the time of childbirth and during the first days after birth can substantially prevent complications and infections in new-borns, which are the main causes of newborn deaths,” Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia Region, said here as health partners signed a pledge to reduce newborn deaths.
Led by WHO; UNICEF, UNFPA, World Bank, UNAIDS and UNWOMEN pledged to jointly support the countries in the Region to prioritize accelerated reduction in newborn deaths by ensuring equitable access to essential life-saving interventions for mothers and babies across the Region…

WHO European Region EURO
:: Will there be sufficient health professionals to meet future needs? 18-12-2015
:: European health report available in French, German and Russian 16-12-2015

WHO Eastern Mediterranean Region EMRO
:: WHO: Urgent support needed to provide health services for 15 million people in Yemen
Geneva, 15 December 2015 – WHO and health partners are appealing for US$ 31 million to ensure the continuity of health services for nearly 15 million people in Yemen affected by the ongoing conflict. Funding is urgently needed as the Yemeni health system has collapsed, leaving millions of vulnerable people without the care and medications they urgently need. Conflict is making the delivery of health services and supplies extremely challenging, health facilities and ambulances have been damaged, and there is a shortage of health workers, limiting access to health care.

WHO Western Pacific Region
:: Universal Health Coverage – a Foundation for the Sustainable Development Goals
MANILA, 12 December 2015 – Held every year since 2012 on 12 December, Universal Health Coverage (UHC) day gathers partners globally to reaffirm the urgency for greater action and progress towards UHC. WHO Regional Office for the Western Pacific calls for countries to ensure good quality health services are accessible to all as it celebrates UHC Day. Dr. Shin Young-soo, WHO Regional Director for the Western Pacific said, “Every country – no matter how rich or poor – can do something now to improve access to good quality services, to improve financial protection and to improve efficiency.”

UNICEF [to 19 December 2015]

UNICEF [to 19 December 2015]
Selected press releases

On the Day of International Migration, UNICEF says children need urgent solutions, solidarity
GENEVA, 18 December 2015 – “The year, 2015, will be remembered for the heart-breaking image of a lifeless little boy on a beach – one of many who came before him; one of many who came after him. It was a year that saw hundreds of thousands of children and their families on the move leaving behind horrors, on an odyssey of hope through Europe. It was the year of mass displacement. And there is no end in sight.

More than 16 million babies born into conflict this year: UNICEF
NEW YORK, 17 December 2015 – More than 16 million babies were born in conflict zones in 2015 – 1 in 8 of all births worldwide this year – UNICEF said today, a figure that underscores the vulnerability faced by increasing numbers of children.

UNHCR and UNICEF highlight unrelenting children’s crisis
NAIROBI, Kenya, 15 December 2015 – The UN High Commissioner for Refugees (UNHCR) and the UN Children’s Fund (UNICEF) warned today that the children of South Sudan remain some of the most vulnerable in the world. Noting the second anniversary since violence erupted in South Sudan, the two UN agencies called for all parties to uphold their commitments to the Peace Agreement, so as to allow the almost 1.5 million South Sudanese children to return home and receive an education, and child soldiers to be released and reintegrated.

UNICEF: 500 children die every day from lack of safe water, sanitation in sub-Saharan Africa
DAKAR, Senegal, 15 December 2015 – Around 180,000 children under 5 years old die every year – roughly 500 a day – in sub-Saharan Africa due to diarrhoeal diseases linked to inadequate water, sanitation and hygiene (WASH), UNICEF said ahead of a conference in Dakar on financing for the sector.

FDA [to 19 December 2015]

FDA [to 19 December 2015]

Influenza Virus Vaccine for the 2015-2016 Season
Posted: 12/16/2015


December 14, 2015 Approval Letter – GARDASIL 9 (PDF – 35KB)
Posted: 12/15/2015
…approved your request to supplement your biologics license application for Human Papillomavirus 9 – valent Vaccine, Recombinant to extend the indication by including Boys and men 16 through 26 years of age for the prevention of the followingg diseases:
:: Anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58.
:: Genital warts (condyloma acuminata) caused by HPV types 6 and 11. And the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58:
:: Anal intraepithelial neoplasia (AIN) grades 1, 2, and 3…

Industry Watch [to 19 December 2015]

Industry Watch [to 19 December 2015]

:: FDA Approves Expanded Age Indication for GARDASIL® 9 in Males
December 15, 2015
Merck (NYSE:MRK), known as MSD outside the United States and Canada, announced today that the U.S. Food and Drug Administration (FDA) approved an expanded age indication for GARDASIL®9

:: Janssen Announces Collaboration with Bavarian Nordic to Develop Vaccine for Chronic Human Papillomavirus (HPV) Infections
Dec 18, 2015, 16:00 ET
New approach for early treatment and interception of HPV-induced cancers
Janssen Pharmaceuticals, Inc. (Janssen) announced today that the company has entered into a definitive collaboration and license agreement with Bavarian Nordic to leverage their MVA-BN® technology, jointly with Janssen’s own AdVac® technology, in the development and commercialization of a heterologous prime-boost vaccine for the treatment of Human Papillomavirus (HPV) chronic infections which can lead to cancer. Under this agreement, Janssen will conduct all clinical development and, subject to regulatory approval, will be responsible for registration, distribution and commercialization of the potential combination vaccine worldwide…

Global Fund [to 19 December 2015]

Global Fund [to 19 December 2015]

Global Fund Outlines Investment Case to End Epidemics
17 December 2015
TOKYO – The Global Fund today presented its investment case for raising US$13 billion for its next three-year cycle of funding, outlining how partners in global health can contribute to ending HIV, tuberculosis and malaria as epidemics by 2030.

A US$13 billion investment for the 2017-2019 funding cycle would save up to eight million lives, avert up to 300 million infections and new cases of HIV, TB and malaria, and lay the groundwork for potential economic gains of up to US$290 billion in the years ahead. Strong investment in global health can significantly bolster international stability and security, while creating greater opportunity, prosperity, and well-being.

The Investment Case was reviewed and discussed by global health leaders at the Preparatory Meeting of the Global Fund Fifth Replenishment in Tokyo, hosted by the Government of Japan in conjunction with an international conference on universal health coverage…

…Programs supported by the Global Fund saved 17 million lives by the end of 2014. By leveraging advances in science and applying innovative solutions, the partnership is on track to reach 22 million lives saved by the end of 2016, the eve of a new Replenishment period. Every three years, the Global Fund seeks financial support for its mission through a Replenishment pledging conference, to be held in mid-2016…

Fondation Merieux [to 19 December 2015]

Fondation Merieux [to 19 December 2015]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.

Asian Pacific Vaccinology Meeting
18 December 2015, Lyon (France)
Fondation Mérieux organized the 2nd Asian Pacific Vaccinology Meeting on 30 November -3 December in Bangkok, Thailand.

NIH [to 19 December 2015]

NIH [to 19 December 2015]

NIH unveils FY2016–2020 Strategic Plan
December 16, 2015 — Detailed plan sets course for advancing scientific discoveries and human health.

Poverty may slightly increase childhood risk of neurological impairment, NIH study suggests
December 16, 2015 — Children from low income environments appear to have a higher risk of neurological impairment.

Report Finds Gaps in Country’s Ability to Prevent Infectious Disease Outbreaks

Report Finds Gaps in Country’s Ability to Prevent Infectious Disease Outbreaks
Robert Wood Johnson Foundation
Thu Dec 17 10:00:00 EST 2015

Washington, D.C.—A report released today found that more than half (28) of states score a five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. The report, from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea.

Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10…

Right to sanitation, a distinct human right – Over 2.5 billion people lack access to sanitation

Right to sanitation, a distinct human right – Over 2.5 billion people lack access to sanitation
GENEVA (18 December 2015) – The United Nations Special Rapporteur on the human right to water and sanitation, Léo Heller, and the Chair of the UN Committee on Economic, Social and Cultural Rights, Waleed Sadi, today welcomed the explicit recognition of the ‘human right to sanitation’ as a distinct right, together with the ‘human right to safe drinking water’ by the UN General Assembly.

Over 2.5 billion people still lack access to improved sanitation – the sanitation target under Goal 7 has been missed by one of the widest margins of all the 18 targets under the Millennium Development Goals. One billion people practise open defecation, nine out of ten in rural areas across the world.

“The right to sanitation is an essential component of the right to an adequate standard of living, inextricably linked to the highest attainable standard of health, and integrally related to the human right to water,” Mr. Sadi said. “The explicit recognition of the human right to sanitation and the human right to water reaffirms that sanitation has distinct features which warrant its own separate recognition and treatment from water in some respects.”

The experts explained that while sanitation does not necessarily have to be water-borne, Governments tend to focus on this type, rather than on-site sanitation such as pit latrines and septic tanks which are still widely used. As a result, individual households which rely on on-site sanitation often have to operate the entire system themselves, including collection and disposal, without government support. “The right to sanitation also requires privacy and dignity,” the experts stressed.

“Sanitation and water issues need to be approached comprehensively at many levels,” Mr. Heller said. “I strongly believe that the clear definitions of the human right to sanitation and the human right to water provided in the resolution will help focus international attention on sanitation issues in the context of the 2030 Agenda for Sustainable Development.”

In the UN General Assembly resolution, adopted by consensus on 17 December, Member States recognized that ‘the human right to sanitation entitles everyone, without discrimination, to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, socially and culturally acceptable and that provides privacy and ensures dignity.’…

BMC Health Services Research (Accessed 19 December 2015)

BMC Health Services Research
(Accessed 19 December 2015)

Research article
Intellectual capital in the healthcare sector: a systematic review and critique of the literature
Jenna M. Evans, Adalsteinn Brown and G. Ross Baker
BMC Health Services Research 2015 15:556
Published on: 15 December 2015
Variations in the performance of healthcare organizations may be partly explained by differing “stocks” of intellectual capital (IC), and differing approaches and capacities for leveraging IC. This study synthesizes what is currently known about the conceptualization, management and measurement of IC in healthcare through a review of the literature.
Peer-reviewed papers on IC in healthcare published between 1990 and 2014 were identified through searches of five databases using the following key terms: intellectual capital/assets, knowledge capital/assets/resources, and intangible assets/resources. Articles deemed relevant for inclusion underwent systematic data extraction to identify overarching themes and were assessed for their methodological quality.
Thirty-seven papers were included in the review. The primary research method used was cross-sectional questionnaires focused on hospital managers’ perceptions of IC, followed by semi-structured interviews and analysis of administrative data. Empirical studies suggest that IC is linked to subjective process and performance indicators in healthcare organizations. Although the literature on IC in healthcare is growing, it is not advanced. In this paper, we identify and examine the conceptual, theoretical and methodological limitations of the literature.
The concept and framework of IC offer a means to study the value of intangible resources in healthcare organizations, how to manage systematically these resources together, and their mutually enhancing interactions on performance. We offer several recommendations for future research.


Research article
Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: A one-year implementation study
Zikulah Namukwaya, Linda Barlow-Mosha, Peter Mudiope, Adeodata Kekitiinwa, Joyce Namale Matovu, Ezra Musingye, Jane Ntongo Ssebaggala, Teopista Nakyanzi, Jubilee John Abwooli, Dorothy Mirembe, Juliane Etima, Edward Bitarakwate, Mary Glenn Fowler and Philippa Martha Musoke
BMC Health Services Research 2015 15:555
Published on: 15 December 2015

BMC Medicine (Accessed 19 December 2015)

BMC Medicine
(Accessed 19 December 2015)

How should individual participant data (IPD) from publicly funded clinical trials be shared?
Individual participant data (IPD) from completed clinical trials should be responsibly shared to support efficient clinical research, generate new knowledge and bring benefit to patients.
C. Tudur Smith, C. Hopkins, M. R. Sydes, K. Woolfall, M. Clarke, G. Murray and P. Williamson
BMC Medicine 2015 13:298
Published on: 17 December 2015


Subnational benchmarking of health systems performance in Africa using health outcome and coverage indicators
National health systems performance (HSP) assessments and benchmarking are critical to understanding how well the delivery of healthcare meets the needs of citizens.
Abdisalan Mohamed Noor
BMC Medicine 2015 13:299
Published on: 14 December 2015

Innovative approaches for improving maternal and newborn health – A landscape analysis

BMC Pregnancy and Childbirth
(Accessed 19 December 2015)

Research article
Innovative approaches for improving maternal and newborn health – A landscape analysis
Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging.
Karsten Lunze, Ariel Higgins-Steele, Aline Simen-Kapeu, Linda Vesel, Julia Kim and Kim Dickson
BMC Pregnancy and Childbirth 2015 15:337
Published on: 17 December 2015

BMC Public Health (Accessed 19 December 2015)

BMC Public Health
(Accessed 19 December 2015)

Research article
Implementation of a national school-based Human Papillomavirus (HPV) vaccine campaign in Fiji: knowledge, vaccine acceptability and information needs of parents
S. F. La Vincente, D. Mielnik, K. Jenkins, F. Bingwor, L. Volavola, H. Marshall, P. Druavesi, F. M. Russell, K. Lokuge and E. K. Mulholland
BMC Public Health 2015 15:1257
Published on: 18 December 2015
In 2008 Fiji implemented a nationwide Human Papillomavirus (HPV) vaccine campaign targeting all girls aged 9–12 years through the existing school-based immunisation program. Parents of vaccine-eligible girls were asked to provide written consent for vaccination. The purpose of this study was to describe parents’ knowledge, experiences and satisfaction with the campaign, the extent to which information needs for vaccine decision-making were met, and what factors were associated with vaccine consent.
Following vaccine introduction, a cross-sectional telephone survey was conducted with parents of vaccine-eligible girls from randomly selected schools, stratified by educational district. Factors related to vaccine consent were explored using Generalised Estimating Equations.
There were 560 vaccine-eligible girls attending the participating 19 schools at the time of the campaign. Among these, 313 parents could be contacted, with 293 agreeing to participate (93.6 %). Almost 80 % of participants reported having consented to HPV vaccination (230/293, 78.5 %). Reported knowledge of cervical cancer and HPV prior to the campaign was very low. Most respondents reported that they were satisfied with their access to information to make an informed decision about HPV vaccination (196/293, 66.9 %). and this was very strongly associated with provision of consent. Despite their young age, the vaccine-eligible girls were often involved in the discussion and decision-making. Most consenting parents were satisfied with the campaign and their decision to vaccinate, with almost 90 % indicating they would consent to future HPV vaccination. However, negative media reports about the vaccine campaign created confusion and concern. Local health staff were cited as a trusted source of information to guide decision-making. Just over half of the participants who withheld consent cited vaccine safety fears as the primary reason (23/44, 52.3 %).
This is the first reported experience of HPV introduction in a Pacific Island nation. In a challenging environment with limited community knowledge of HPV and cervical cancer, media controversy and a short lead-time for community education, Fiji has implemented an HPV vaccine campaign that was largely acceptable to the community and achieved a high level of participation. Community sensitisation and education is critical and should include a focus on the local health workforce and the vaccine target group.


Research article
Challenges to the surveillance of non-communicable diseases – a review of selected approaches
The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities var …
Mareike Kroll, Revati K Phalkey and Frauke Kraas
BMC Public Health 2015 15:1243
Published on: 16 December 2015

MERS-CoV geography and ecology in the Middle East: analyses of reported camel exposures and a preliminary risk map

BMC Research Notes
(Accessed 19 December 2015)

Research article
MERS-CoV geography and ecology in the Middle East: analyses of reported camel exposures and a preliminary risk map
Middle Eastern respiratory syndrome coronavirus (MERS-CoV) has spread rapidly across much of the Middle East, but no quantitative mapping of transmission risk has been developed to date.
Tarian Reeves, Abdallah M. Samy and A. Townsend Peterson
BMC Research Notes 2015 8:801
Published on: 18 December 2015

Responding to the needs of refugees

British Medical Journal
19 December 2015 (vol 351, issue 8038)

Editorials Christmas 2015
Responding to the needs of refugees
BMJ 2015; 351 doi: (Published 16 December 2015) Cite this as: BMJ 2015;351:h6731
Frank Arnold, convenor, anti-torture initiative1, Cornelius Katona, lead23, Juliet Cohen, head of doctors4, Lucy Jones, UK programme manager5, David McCoy, director16
Author affiliations
Knowledge of and skills in human rights medicine will be needed
At the time of writing it is unclear how many people will eventually receive refuge in Britain from encampments in countries surrounding Syria through the UN vulnerable persons relocation scheme. The government’s current commitment to receive a maximum of 20 000 over five years, if delivered at a constant rate, would result in 4000 arrivals a year.1 It is also unclear when they will arrive and what financial and other arrangements are being made for local councils to support them. But even if the UK maintains its decision to opt out of the EU refugee sharing scheme, the number of asylum seekers reaching the UK by other routes may increase, given that more than half a million people seeking protection arrived in Europe by sea in 2015.

Whatever the numbers, many will have high levels of complex physical, psychological, social, and legal needs arising from their experiences in their countries of origin or during their often prolonged and dangerous journeys. This is particularly the case for people admitted under the UN relocation scheme, which emphasises vulnerability and damage as primary selection criteria.2

These health needs will interact with each other and with wider social needs (housing, schooling, linguistic, and cultural support) to produce challenges that exceed the experience of most UK clinicians. The issues that the responsible practices and hospitals will need to address are many and complex but largely predictable (box). The current crisis must be met by a plan to train and support clinicians to assist this vulnerable group. Such a plan would also benefit the many traumatised, tortured, and ill refugees, asylum seekers, and undocumented migrants who are already in the country.

Common interacting medical needs of refugees
:: Post-traumatic stress disorder and other mental health problems resulting from trauma
:: Consequences of torture such as damage to feet from repeated blunt trauma or brachial plexus damage after suspension by hyper-extended arms
:: Screening for sexually transmitted diseases (if rape revealed)
:: Traumatic war injuries
Social and legal
:: Adequate interpreting
:: Access to primary and secondary care and difficulties of negotiating exemption from overseas visitors charging regulations
:: Protection from subsequent unsafe repatriation or redress may require careful documentation of medical evidence of human rights abuses, including photographs or clinical notes of physical or psychological damage on arrival

So what needs to happen? Government departments should make use of standard handheld records of medical information gleaned during selection for relocation and ensure that the data follow the patients to their new practitioners. The European Union is developing such a record.3 For people who require secondary care the Home Office should provide immigration status documents and circulate them with advice to relevant officers to prevent inappropriate attempts to charge user fees. The entitlements of migrants to care are complex, but survivors of torture and other human rights abuses do not have to pay under the current regulations.4 And unless a general practice has a policy requiring all new registrants to supply documents, to do so for migrants only would constitute impermissible discrimination.5

As health professionals, we are occupationally and morally required to offer the highest standard of healthcare to all patients, including survivors of human rights abuses who arrive on these shores.6 But clinicians need to be trained and supported to help this vulnerable group. The knowledge and skills in human rights medicine and psychology developed by a relatively small number of specialist health professionals within the NHS and third sector organisations needs to be harnessed and used wisely to enable this to happen. These organisations include Freedom from Torture (, the Helen Bamber Foundation (, and Doctors of the World ( The Royal Society of Medicine is hosting training sessions organised by Medact on clinical aspects of torture and trauma. Public Health England, which has a helpful Migrant Health Guide,7 the royal colleges, the BMA, and other health professional bodies can also facilitate relevant educational initiatives. Close collaboration between the statutory and charity sectors will be crucial.

The voice and mandate of health professionals also needs to be used to prevent xenophobia and tackle the root causes of the refugee crisis. We should make good use of the expressions of goodwill and solidarity from much of the UK population towards those who need help and highlight the past and potential long term economic and social contributions that such refugees have and can make in the UK. We should also seek to educate and engage the UK health community about the need to promote peace and human security, particularly in north Africa and the Middle East. The refugee crisis will not be resolved otherwise.

Clinical Infectious Diseases (CID) – Volume 62 Issue 1 January 1, 2016

Clinical Infectious Diseases (CID)
Volume 62 Issue 1 January 1, 2016

The Use of Ebola Convalescent Plasma to Treat Ebola Virus Disease in Resource-Constrained Settings: A Perspective From the Field
Johan van Griensven, Anja De Weiggheleire, Alexandre Delamou, Peter G. Smith, Tansy Edwards, Philippe Vandekerckhove, Elhadj Ibrahima Bah, Robert Colebunders, Isola Herve, Catherine Lazaygues, Nyankoye Haba, and Lutgarde Lynen
Clin Infect Dis. (2016) 62 (1): 69-74 doi:10.1093/cid/civ680
Clinical evaluation of convalescent plasma (CP) as Ebola treatment in the current outbreak was prioritized by the World Health Organization. Although no efficacy data are available, current field experience supports the safety, acceptability, and feasibility of CP as Ebola treatment.


Prevalence and Persistence of Varicella Antibodies in Previously Immunized Children and Youth With Perinatal HIV-1 Infection
Murli U. Purswani, Brad Karalius, Tzy-Jyun Yao, D. Scott Schmid, Sandra K. Burchett, George K. Siberry, Kunjal Patel, Russell B. Van Dyke, and Ram Yogev for the Pediatric HIV/AIDS Cohort Study (PHACS)
Clin Infect Dis. (2016) 62 (1): 106-114 doi:10.1093/cid/civ734
Long-term persistence of varicella antibodies was strongly associated with administration of 2 varicella vaccines in perinatally human immunodeficiency virus–infected children. Vaccination after ≥3 months of combination antiretroviral therapy and duration of such therapy were also determinants of vaccine immunogenicity

Assessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014

Volume 20, Issue 50, 17 December 2015

Research Articles
Assessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014
by F Vogt, G Fitzpatrick, G Patten, R van den Bergh, K Stinson, L Pandolfi, J Squire, T Decroo, H Declerck, M Van Herp

Global Health: Science and Practice (GHSP) – December 2015

Global Health: Science and Practice (GHSP)
December 2015 | Volume 3 | Issue 4

Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition?
An intensive radio campaign in rural areas of Burkina Faso addressed multiple key behaviors to reduce child mortality, using a randomized cluster design. After 20 months, despite innovative approaches and high reported listenership, only modest reported change in behavior was found, mainly related to care seeking rather than habitual behavior such as hand washing. Various methodologic difficulties may have obscured a true greater impact. Analysis of the intervention after its full 35-month duration may reveal more impact, including on actual child mortality. Improving a number of key behaviors is essential to child survival efforts, and much of it may require strong and sustained efforts.
Glob Health Sci Pract 2015;3(4):521-524. First published online November 3, 2015.


Original Articles
The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.
Joanna Murray, Pieter Remes, Rita Ilboudo, Mireille Belem, Souleymane Salouka, Will Snell,
Cathryn Wood, Matthew Lavoie, Laurent Deboise, Roy Head
Glob Health Sci Pract 2015;3(4):544-556. First published online November 3, 2015.


Monitoring and Evaluating the Transition of Large-Scale Programs in Global Health
Monitoring and evaluating large-scale global health program transitions can strengthen accountability, facilitate stakeholder engagement, and promote learning about the transition process and how best to manage it. We propose a conceptual framework with 4 main domains relevant to transitions—leadership, financing, programming, and service delivery—along with guiding questions and illustrative indicators to guide users through key aspects of monitoring and evaluating transition. We argue that monitoring and evaluating transitions can bring conceptual clarity to the transition process, provide a mechanism for accountability, facilitate engagement with local stakeholders, and inform the management of transition through learning.
James Bao, Daniela C Rodriguez, Ligia Paina, Sachiko Ozawa, Sara Bennett
Glob Health Sci Pract 2015;3(4):591-605.


Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea
An informatics system consisting of a mobile health application and business intelligence software was used for collecting and analyzing Ebola contact tracing data. This system offered potential to improve data access and quality to support evidence-based decision making for the Ebola response in Guinea. Implementation challenges included software limitations, technical literacy of users, coordination among partners, government capacity for data utilization, and data privacy concerns.
Jilian A Sacks, Elizabeth Zehe, Cindil Redick, Alhoussaine Bah, Kai Cowger, Mamady Camara,
Aboubacar Diallo, Abdel Nasser Iro Gigo, Ranu S Dhillon, Anne Liu
Glob Health Sci Pract 2015;3(4):646-659. First published online November 12, 2015.

Conceptualising the agency of highly marginalised women: Intimate partner violence in extreme settings

Global Public Health
Volume 11, Issue 1-2, 2016
Special Issue: Conceptualising the agency of highly marginalised women: Intimate partner violence in extreme settings

Guest Editors’ Introduction
Conceptualising the agency of highly marginalised women: Intimate partner violence in extreme settings
Catherine Campbella* & Jenevieve Mannellb
pages 1-16
DOI: 10.1080/17441692.2015.1109694

How is the agency of women best conceptualised in highly coercive settings? We explore this in the context of international efforts to reduce intimate partner violence (IPV) against women in heterosexual relationships. Articles critique the tendency to think of women’s agency and programme endpoints in terms of individual actions, such as reporting violent men or leaving violent relationships, whilst neglecting the interlocking social, economic and cultural contexts that make such actions unlikely or impossible. Three themes cut across the articles. (1) Unhelpful understandings of gender and power implicit in commonly used ‘men-women’ and ‘victim-agent’ binaries obscure multi-faceted and hidden forms of women’s agency, and the complexity of agency-violence intersections. (2) This neglect of complexity results in a poor fit between policy and interventions to reduce IPV, and women’s lives. (3) Such neglect also obscures the multiplicities of women’s agency, including the competing challenges they juggle alongside IPV, differing levels of response, and the temporality of agency. We outline a notion of ‘distributed agency’ as a multi-level, incremental and non-linear process distributed across time, space and social networks, and across a continuum of action ranging from survival to resistance. This understanding of agency implies a different approach to those currently underpinning policies and interventions.

Globalization and Health [Accessed 19 December 2015]

Globalization and Health
[Accessed 19 December 2015]

Short term global health experiences and local partnership models: a framework
Contemporary interest in in short-term experiences in global health (STEGH) has led to important questions of ethics, responsibility, and potential harms to receiving communities.
Lawrence C. Loh, William Cherniak, Bradley A. Dreifuss, Matthew M. Dacso, Henry C. Lin and Jessica Evert
Globalization and Health 2015 11:50
Published on: 18 December 2015


Towards a simple typology of international health partnerships
International health partnerships are one approach to capacity building in health systems. The evidence base for institutional partnerships for health service development remains weak…
Suzanne Edwards, Dan Ritman, Emily Burn, Natascha Dekkers and Paula Baraitser
Globalization and Health 2015 11:49
Published on: 15 December 2015

The Lancet – Dec 19, 2015

The Lancet
Dec 19, 2015 Volume 386 Number 10012 p2445-2540 e61

Health security: the defining challenge of 2016
The Lancet
This end-of-year double issue of The Lancet is a moment to pause, reflect on the passing year, and consider how the journey through 2015, with its planned milestones and unforeseen global events, might shape the path ahead in 2016. This Year in Medicine crystallises the key moments of 2015: a year that continued to be dominated by the Ebola outbreak; adoption by nations of 17 Sustainable Development Goals, setting the health agenda for the next 15 years; and appalling acts of war and terrorism, which have seen murderous violence in, for example, Syria, Paris, and California.


Time to eliminate rabies
The Lancet
On Dec 10, WHO and the World Organisation for Animal Health, in collaboration with the UN Food and Agriculture Organization and the Global Alliance for the Control of Rabies, launched a global framework to eliminate rabies by 2030. This initiative marks the first time that the human and animal health sectors have come together to adopt a common strategy to tackle this devastating, but massively neglected, disease.


This Year in Medicine
2015: review of the year
Farhat Yaqub
The year, progress was made for Ebola virus disease, genetic disorders, and the health of the planet and its population, with two new global agendas agreed. Farhat Yaqub reports


The medical response to multisite terrorist attacks in Paris
Martin Hirsch, Pierre Carli, Rémy Nizard, Bruno Riou, Barouyr Baroudjian, Thierry Baubet, Vibol Chhor, Charlotte Chollet-Xemard, Nicolas Dantchev, Nadia Fleury, Jean-Paul Fontaine, Youri Yordanov, Maurice Raphael, Catherine Paugam Burtz, Antoine Lafont, health professionals of Assistance Publique-Hôpitaux de Paris (APHP)

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries

Medical Decision Making (MDM)
January 2016; 36 (1)

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries
Christian E. H. Boehler, PhD, Joanne Lord, PhD
Institute for Prospective Technological Studies, Joint Research Centre–European Commission, Seville, Spain (CEHB)
Health Economics Research Group, Brunel University, Uxbridge, UK (JL)
Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations.
Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation.
Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature.
Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks.
Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical.

PLoS Currents: Outbreaks
(Accessed 19 December 2015)

Validating the Use of Google Trends to Enhance Pertussis Surveillance in California
October 19, 2015 · Research Article
Introduction and Methods: Pertussis has recently re-emerged in the United States. Timely surveillance is vital to estimate the burden of this disease accurately and to guide public health response. However, the surveillance of pertussis is limited by delays in reporting, consolidation and dissemination of data to relevant stakeholders. We fit and assessed a real-time predictive Google model for pertussis in California using weekly incidence data from 2009-2014.
Results and Discussion: The linear model was moderately accurate (r = 0.88). Our findings cautiously offer a complementary, real-time signal to enhance pertussis surveillance in California and help to further define the limitations and potential of Google-based epidemic prediction in the rapidly evolving field of digital disease detection.

Earth Observation, Spatial Data Quality, and Neglected Tropical Diseases

PLoS Neglected Tropical Diseases
(Accessed 19 December 2015)

Earth Observation, Spatial Data Quality, and Neglected Tropical Diseases
Nicholas A. S. Hamm, Ricardo J. Soares Magalhães, Archie C. A. Clements
Published: December 17, 2015
DOI: 10.1371/journal.pntd.0004164
Earth observation (EO) is the use of remote sensing and in situ observations to gather data on the environment. It finds increasing application in the study of environmentally modulated neglected tropical diseases (NTDs). Obtaining and assuring the quality of the relevant spatially and temporally indexed EO data remain challenges. Our objective was to review the Earth observation products currently used in studies of NTD epidemiology and to discuss fundamental issues relating to spatial data quality (SDQ), which limit the utilization of EO and pose challenges for its more effective use. We searched Web of Science and PubMed for studies related to EO and echinococossis, leptospirosis, schistosomiasis, and soil-transmitted helminth infections. Relevant literature was also identified from the bibliographies of those papers. We found that extensive use is made of EO products in the study of NTD epidemiology; however, the quality of these products is usually given little explicit attention. We review key issues in SDQ concerning spatial and temporal scale, uncertainty, and the documentation and use of quality information. We give examples of how these issues may interact with uncertainty in NTD data to affect the output of an epidemiological analysis. We conclude that researchers should give careful attention to SDQ when designing NTD spatial-epidemiological studies. This should be used to inform uncertainty analysis in the epidemiological study. SDQ should be documented and made available to other researchers.

PLoS One [Accessed 19 December 2015]

PLoS One
[Accessed 19 December 2015]


Differential Globalization of Industry- and Non-Industry–Sponsored Clinical Trials
Ignacio Atal, Ludovic Trinquart, Raphaël Porcher, Philippe Ravaud
Published: December 14, 2015
DOI: 10.1371/journal.pone.0145122
Mapping the international landscape of clinical trials may inform global health research governance, but no large-scale data are available. Industry or non-industry sponsorship may have a major influence in this mapping. We aimed to map the global landscape of industry- and non-industry–sponsored clinical trials and its evolution over time.
We analyzed clinical trials initiated between 2006 and 2013 and registered in the WHO International Clinical Trials Registry Platform (ICTRP). We mapped single-country and international trials by World Bank’s income groups and by sponsorship (industry- vs. non- industry), including its evolution over time from 2006 to 2012. We identified clusters of countries that collaborated significantly more than expected in industry- and non-industry–sponsored international trials.
119,679 clinical trials conducted in 177 countries were analysed. The median number of trials per million inhabitants in high-income countries was 100 times that in low-income countries (116.0 vs. 1.1). Industry sponsors were involved in three times more trials per million inhabitants than non-industry sponsors in high-income countries (75.0 vs. 24.5) and in ten times fewer trials in low- income countries (0.08 vs. 1.08). Among industry- and non-industry–sponsored trials, 30.3% and 3.2% were international, respectively. In the industry-sponsored network of collaboration, Eastern European and South American countries collaborated more than expected; in the non-industry–sponsored network, collaboration among Scandinavian countries was overrepresented. Industry-sponsored international trials became more inter-continental with time between 2006 and 2012 (from 54.8% to 67.3%) as compared with non-industry–sponsored trials (from 42.4% to 37.2%).
Based on trials registered in the WHO ICTRP we documented a substantial gap between the globalization of industry- and non-industry–sponsored clinical research. Only 3% of academic trials but 30% of industry trials are international. The latter appeared to be conducted in preferentially selected countries.


Research Article
People at Risk of Influenza Pandemics: The Evolution of Perception and Behavior
Jianhua Xu, Zongchao Peng
Published: December 14, 2015
DOI: 10.1371/journal.pone.0144868
Influenza pandemics can severely impact human health and society. Understanding public perception and behavior toward influenza pandemics is important for minimizing the effects of such events. Public perception and behavior are expected to change over the course of an influenza pandemic, but this idea has received little attention in previous studies. Our study aimed to understand the dynamics of public perception and behavior over the course of the 2009 H1N1 influenza pandemic. Three consecutive cross-sectional surveys were administered among Beijing residents with random-digit dialing techniques in March 2008 and August and November 2009. Effective samples of 507, 508 and 1006 respondents were interviewed in each of the three surveys, respectively. The mean scores of risk perception were low to moderate across the three surveys. The perceived risk of infection of self was significantly lower than that of the community, revealing an optimistic bias. Longitudinally, the perceived risk of contracting H1N1 increased, whereas the perceived risk of being unable to obtain medicine and medical care once influenza permeated the community first increased and then decreased. Responsive actions toward influenza varied. Most respondents took actions that required little extra effort, such as ventilating rooms; these actions did not change over time. Comparatively, a smaller number of respondents took actions for coping with influenza, such as vaccination; however, these actions were taken by an increasing number of respondents over time. The association between risk perception and behavior was unstable. Positive, insignificant, and negative associations were obtained in the three surveys. In conclusion, the evolving patterns of risk perception and responsive behavior over the course of an influenza pandemic are sensitive to how risk and behavior are defined and scoped.

Stock-outs, uncertainty and improvisation in access to healthcare in war-torn Northern Uganda

Social Science & Medicine
Volume 146, Pages 1-348 (December 2015)
Special issue section Violence, Health and South-North Collaboration: Furthering an Interdisciplinary Agenda


Stock-outs, uncertainty and improvisation in access to healthcare in war-torn Northern Uganda
Original Research Article
Pages 316-323
Herbert Muyinda, James Mugisha
Stock-outs, also known as shortages or complete absence of a particular inventory, in public health facilities have become a hallmark in Uganda’s health system making the notions of persistent doubt in access to healthcare – uncertainty, and doing more with less – ‘improvisation’, very pronounced. The situation becomes more critical in post-conflict areas with an over whelming burden of preexisting and conflict-related ailments amidst weak health systems. Particularly in the war-torn Northern Uganda, the intersection between the effects of violent conflict and shortage of medications is striking. There are problems getting the right type of medications to the right people at the right time, causing persistent shortages and uncertainty in access to healthcare. With reference to patients on Antiretroviral Therapy (ART), we present temporal trends in access to healthcare in the context of medication shortages in conflict-affected areas. We examine uncertainties in access to care, and how patients, medical practitioners, and the state – the key actors in the domain of supplying and utilizing medicines, respond. Our observation is that, while improvisation is a feature of biomedicine and facilitates problem solving in daily life, it is largely contextual. Given the rapidly evolving contexts and social and professional sensitivities that characterize war affected areas, there is a need for deliberate healthcare programs tailored to the unique needs of people and to the shaping of appropriate policies in post-conflict settings, which call for more North-South collaboration on equal terms.

Arguments and sources on Italian online forums on childhood vaccinations: Results of a content analysis

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


Arguments and sources on Italian online forums on childhood vaccinations: Results of a content analysis
Original Research Article
Pages 7152-7159
Marta Fadda, Ahmed Allam, Peter J. Schulz
Despite being committed to the immunization agenda set by the WHO, Italy is currently experiencing decreasing vaccination rates and increasing incidence of vaccine-preventable diseases. Our aim is to analyze Italian online debates on pediatric immunizations through a content analytic approach in order to quantitatively evaluate and summarize users’ arguments and information sources.
Threads were extracted from 3 Italian forums. Threads had to include the keyword Vaccin* in the title, focus on childhood vaccination, and include at least 10 posts. They had to have been started between 2008 and June 2014. High inter-coder reliability was achieved. Exploratory analysis using k-means clustering was performed to identify users’ posting patterns for arguments about vaccines and sources.
The analysis included 6544 posts mentioning 6223 arguments about pediatric vaccinations and citing 4067 sources. The analysis of argument posting patterns included users who published a sufficient number of posts; they generated 85% of all arguments on the forum. Dominating patterns of three groups were identified: (1) an anti-vaccination group (n = 280) posted arguments against vaccinations, (2) a general pro-vaccination group (n = 222) posted substantially diverse arguments supporting vaccination and (3) a safety-focused pro-vaccination group (n = 158) mainly forwarded arguments that questioned the negative side effects of vaccination. The anti-vaccination group was shown to be more active than the others. They use multiple sources, own experience and media as their cited sources of information. Medical professionals were among the cited sources of all three groups, suggesting that vaccination-adverse professionals are gaining attention.
Knowing which information is shared online on the topic of pediatric vaccinations could shed light on why immunization rates have been decreasing and what strategies would be best suited to address parental concerns. This suggests there is a high need for developing automated approaches to detect misleading or false information on the Internet.

Factors affecting the causality assessment of adverse events following immunisation in paediatric clinical trials: An online survey

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


Factors affecting the causality assessment of adverse events following immunisation in paediatric clinical trials: An online survey
Original Research Article
Pages 7203-7210
Merryn Voysey, Rahele Tavana, Yama Farooq, Paul T. Heath, Jan Bonhoeffer, Matthew D. Snape
Serious adverse events (SAEs) in clinical trials require reporting within 24 h, including a judgment of whether the SAE was related to the investigational product(s). Such assessments are an important component of pharmacovigilance, however classification systems for assigning relatedness vary across study protocols. This on-line survey evaluated the consistency of SAE causality assessment among professionals with vaccine clinical trial experience.
Members of the clinical advisory forum of experts (CAFÉ), a Brighton Collaboration online-forum, were emailed a survey containing SAEs from hypothetical vaccine trials which they were asked to classify. Participants were randomised to either two classification options (related/not related to study immunisation) or three options (possibly/probably/unrelated). The clinical scenarios, were (i) leukaemia diagnosed 5 months post-immunisation with a live RSV vaccine, (ii) juvenile idiopathic arthritis (JIA) 3 months post-immunisation with a group A streptococcal vaccine, (iii) developmental delay diagnosed at age 10 months after infant capsular group B meningococcal vaccine, (iv) developmental delay diagnosed at age 10 months after maternal immunisation with a group B streptococcal vaccine.
There were 140 respondents (72 two options, 68 three options). Across all respondents, SAEs were considered related to study immunisation by 28% (leukaemia), 74% (JIA), 29% (developmental delay after infant immunisation) and 42% (developmental delay after maternal immunisation). Having only two options made respondents significantly less likely to classify the SAE as immunisation-related for two scenarios (JIA p = 0.0075; and maternal immunisation p = 0.045). Amongst study investigators (n = 43) this phenomenon was observed for three of the four scenarios: (JIA p = 0.0236; developmental delay following infant immunisation p = 0.0266; and developmental delay after maternal immunisation p = 0.0495).
SAE causality assessment is inconsistent amongst study investigators and can be influenced by the classification systems available to them. There is a pressing need for SAE classification systems to be standardised across study protocols.

Public opinion on childhood immunisations in Iceland

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


Public opinion on childhood immunisations in Iceland
Original Research Article
Pages 7211-7216
Ýmir Óskarsson, Þórólfur Guðnason, Guðbjörg A. Jónsdóttir, Karl G. Kristinsson, Haraldur Briem, Ásgeir Haraldsson
In recent years, vaccine preventable diseases such as measles and pertussis have been re-emerging in Western countries, maybe because of decreasing participation in childhood vaccination programs in some countries. There is clear evidence for vaccine efficacy and the risk of adverse effects is low. This needs to be communicated to the general public. The aim of the study was to evaluate the public opinion on childhood vaccinations in Iceland.
Materials and methods
An internet based study was used to evaluate the opinion on childhood immunisations in Iceland. The cohort was divided in three groups: (a) general public (b) employees of the University Hospital Iceland and (c) employees (teachers and staff) of the University of Iceland. The cohorts could be stratified according to age, gender, education, household income, parenthood and residency.
Responses were received from 5584 individuals (53% response rate). When asked about childhood vaccinations in the first and second year of life, approximately 95% of participants were “positive” or “very positive”, approximately 1% were “negative” or “very negative”. When participants were asked whether they would have their child immunized according to the Icelandic childhood vaccination schedule, 96% were “positive” or “very positive”, 1.2% were “negative” or “very negative”. Similarly, 92% trust Icelandic Health authorities to decide on childhood vaccination schedule, 2.3% did not. In total, 9.3% “rather” or “strongly” agreed to the statement “I fear that vaccinations can cause severe adverse effects”, 17.5% were undecided and 66.9% “disagreed” or “strongly disagreed”. Individuals with higher education were more likely to disagree with this statement (OR = 1.45, CI95 = 1.29–1.64, p < 0.001) as did males (OR = 1.22, CI95 = 1.087–1.379, p = 0.001).
This study shows a very positive attitude towards vaccinations raising expectations for an ongoing success in preventing preventable communicable diseases in childhood in Iceland.

Increasing postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis vaccine by incorporating pertussis cocooning information into prenatal education for group B streptococcus prevention

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


Increasing postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis vaccine by incorporating pertussis cocooning information into prenatal education for group B streptococcus prevention
Original Research Article
Pages 7225-7231
Po-Jen Cheng, Shang-Yu Huang, Sheng-Yuan Su, Hsiu-Huei Peng, Chia-Lin Chang
To evaluate whether incorporating pertussis cocooning information into prenatal education for group B streptococcus (GBS) prevention increased postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
We performed a retrospective pre-intervention/post-intervention study of postpartum women at a teaching hospital in Taiwan. We compared the frequency of Tdap vaccination during the pre-intervention (May 1, 2009 to December 31, 2010) and post-intervention (March 1, 2011–March 31, 2012) time periods. The clinical intervention was incorporation of pertussis cocooning information into prenatal education for GBS prevention to pregnant women presented during a prenatal visit at 35–37 weeks of gestation. Postpartum Tdap vaccination rate during the pre-intervention and post-intervention periods was compared. We also specifically examined group differences in the percentage of women who received postpartum Tdap vaccination to explore factors that influenced their decision regarding Tdap vaccine.
Tdap vaccination was more likely during the post-intervention period compared with the pre-intervention period (2268 of 3186 [71.2%] compared with 2556 of 5030 [55.6%]; p < .001). Comparisons between each subgroup of pre-intervention and post-intervention women showed that incorporating pertussis information into prenatal education for GBS prevention was beneficial except for women of maternal age 30–34 years and women living in rural areas.
Prenatal GBS screening activities represent an opportunity for healthcare providers to offer pertussis cocooning information to eligible pregnant women to improve rates of postpartum Tdap vaccination.

From current vaccine recommendations to everyday practices: An analysis in five sub-Saharan African countries

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


From current vaccine recommendations to everyday practices: An analysis in five sub-Saharan African countries
Original Research Article
Pages 7290-7298
Isabelle Delrieu, Bradford D. Gessner, Laurence Baril, Edith Roset Bahmanyar
Estimates of WHO and UNICEF vaccination coverage may provide little insight into the extent to which vaccinations are administered on time. Yet, lack of adherence to the recommended age to receive a specific vaccination may have detrimental health consequences. For example, delays in receiving vaccination will prolong the risk of lack of protection, often when disease risk is highest, such as during early infancy. We estimated the reported age at vaccination, and vaccine coverage at different ages in children from five sub-Saharan African countries.
We analyzed data from the latest Demographic and Health Programme databases available for Burkina Faso 2010 (n = 15,044 observations), Ghana 2008 (n = 2992), Kenya 2008–9 (n = 6079), Senegal 2010–11 (n = 12,326), and Tanzania 2010 (n = 8023). We assessed, amongst vaccinees, the exact age when vaccine was administered for the three infant doses of pentavalent vaccine (DTP) and the first dose of measles-containing-vaccine (MCV), as well as the proportion of children immunized with these antigens by a certain age. Vitamin A supplementation (VAS) coverage was evaluated as a potential contact visit for vaccine introduction.
For all DTP doses, the median intervals between recommended and actual ages of receiving vaccination ranged from 12, 17 and 23 days in Kenya, to 22, 33 and 45 days in Senegal. MCV was mostly given during the recommended age of 9 months. In each country, there was a large discrepancy in the median age at DTP vaccination between regions. VAS coverage in young children ranged from 30.3% in Kenya to 78.4% in Senegal, with large variations observed between areas within each study country.
In the context of new vaccine introduction, age of children at vaccination should be monitored to interpret data on vaccine-preventable disease burden, vaccine effectiveness, and vaccine safety, and to adapt targeted interventions and messages.

A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda

Volume 33, Issue 51 pp. 7141-7422 (16 December 2015)


A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda
Original Research Article
Pages 7357-7363
Fidèle Ngabo, Ann Levin, Susan A. Wang, Maurice Gatera, Celse Rugambwa, Celestin Kayonga, Philippe Donnen, Philippe Lepage, Raymond Hutubessy
Detailed cost evaluations of delivery of new vaccines such as pneumococcal conjugate, human papillomavirus (HPV), and rotavirus vaccines in low and middle-income countries are scarce. This paper differs from others by comparing the costs of introducing multiple vaccines in a single country and then assessing the financial and economic impact at the time and implications for the future. The objective of the analysis was to understand the introduction and delivery cost per dose or per child of the three new vaccines in Rwanda to inform domestic and external financial resource mobilization.
Start-up, recurrent, and capital costs from a government perspective were collected in 2012. Since pneumococcal conjugate and HPV vaccines had already been introduced, cost data for those vaccines were collected retrospectively while prospective (projected) costing was done for rotavirus vaccine.
The financial unit cost per fully immunized child (or girl for HPV vaccine) of delivering 3 doses of each vaccine (without costs related to vaccine procurement) was $0.37 for rotavirus (RotaTeq®) vaccine, $0.54 for pneumococcal (Prevnar®) vaccine in pre-filled syringes, and $10.23 for HPV (Gardasil ®) vaccine. The financial delivery costs of Prevnar® and RotaTeq® were similar since both were delivered using existing health system infrastructure to deliver infant vaccines at health centers. The total financial cost of delivering Gardasil® was higher than those of the two infant vaccines due to greater resource requirements associated with creating a new vaccine delivery system in for a new target population of 12-year-old girls who have not previously been served by the existing routine infant immunization program.
The analysis indicates that service delivery strategies have an important influence on costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy. Documented information on financial commitments for new vaccines, particularly from government sources, is a useful input into country policy dialogue on sustainable financing and co-financing of new vaccines, as well as for policy decisions by donors such as Gavi, the Vaccine Alliance.

Next generation dengue vaccines: A review of the preclinical development pipeline

Volume 33, Issue 50 pp. 7049-7140 (10 December 2015)

Dengue Vaccines Issue

Next generation dengue vaccines: A review of the preclinical development pipeline
Original Research Article
Pages 7091-7099
Kirsten S. Vannice, John T. Roehrig, Joachim Hombach
Dengue represents a significant and growing public health problem across the globe, with approximately half of the world’s population at risk. The increasing and expanding burden of dengue has highlighted the need for new tools to prevent dengue, including development of dengue vaccines. Recently, the first dengue vaccine candidate was evaluated in Phase 3 clinical trials, and other vaccine candidates are under clinical evaluation. There are also a number of candidates in preclinical development, based on diverse technologies, with promising results in animal models and likely to move into clinical trials and could eventually be next-generation dengue vaccines. This review provides an overview of the various technological approaches to dengue vaccine development with specific focus on candidates in preclinical development and with evaluation in non-human primates.


Development of the Sanofi Pasteur tetravalent dengue vaccine: One more step forward

Volume 33, Issue 50 pp. 7049-7140 (10 December 2015)

Dengue Vaccines Issue

Development of the Sanofi Pasteur tetravalent dengue vaccine: One more step forward
Original Research Article
Pages 7100-7111
Bruno Guy, Olivier Briand, Jean Lang, Melanie Saville, Nicholas Jackson
Sanofi Pasteur has developed a recombinant, live-attenuated, tetravalent dengue vaccine (CYD-TDV) that is in late-stage development. The present review summarizes the different steps in the development of this dengue vaccine, with a particular focus on the clinical data from three efficacy trials, which includes one proof-of-concept phase IIb (NCT00842530) and two pivotal phase III efficacy trials (NCT01373281 and NCT01374516). Earlier studies showed that the CYD-TDV candidate had a satisfactory safety profile and was immunogenic across the four vaccine serotypes in both in vitro and in vivo preclinical tests, as well as in initial phase I to phase II clinical trials in both flavivirus-naïve and seropositive individuals. Data from the 25 months (after the first injection) active phase of the two pivotal phase III efficacy studies shows that CYD-TDV (administered at 0, 6, and 12 months) is efficacious against virologically-confirmed disease (primary endpoint) and has a good safety profile. Secondary analyses also showed efficacy against all four dengue serotypes and protection against severe disease and hospitalization. The end of the active phases in these studies completes more than a decade of development of CYD-TDV, but considerable activities and efforts remain to address outstanding scientific, clinical, and immunological questions, while preparing for the introduction and use of CYD-TDV. Additional safety observations were recently reported from the first complete year of hospital phase longer term surveillance for two phase 3 studies and the first and second completed years for one phase 2b study, demonstrating the optimal age for intervention from 9 years. Dengue is a complex disease, and both short-term and long-term safety and efficacy will continue to be addressed by ongoing long-term follow-up and future post-licensure studies.

Media/Policy Watch [to 19 December 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.


The Huffington Post
Accessed 19 December 2015
It’s Time for Action on Universal Health Coverage
Huffington Post | 16 December 2015
By Jim Yong Kim, President, World Bank Group

TOKYO, Japan — In 1961, Japan established universal health coverage, a remarkable achievement for a post-conflict country. Broadly accessible, affordable, quality health care has helped the residents of Japan live healthier, longer and more prosperous lives than people almost anywhere else in the world.

Yet for billions of others — and especially for those in the developing world — even basic health care remains out of reach. Estimates suggest that only 65 percent of the global population had access to basic health services in 2013.

Japan’s upcoming G7 presidency presents a golden opportunity to remedy this shortcoming by making progress toward universal health coverage, or UHC, in every country. Since Japan established universal health coverage, it has helped take this concept global, sharing knowledge and resources, and rallying political will…

…At the request of the G7 and G20, the World Bank Group is working with the World Health Organization and other partners to build a comprehensive response to pandemics. A critical part of the framework that we are developing is called the Pandemic Emergency Financing Facility. The facility aims to eliminate financial constraints to a swift and effective response to an outbreak, using pre-arranged public and private financing, including leveraging resources from insurance and capital markets. It should save lives and protect economies.

A strong and well-funded WHO must be our next step. The reforms underway to strengthen the WHO’s emergency response capacity are a good start. We must fully fund its Contingency Fund for Emergencies.

We also need a new international mechanism designed to hold accountable the pandemic risk management community. This body must be apolitical, technical and independent of countries, institutions or funders. It should have the mandate, funding and authority to evaluate the preparedness and response plans of governments, international institutions, the private sector, civil society, and communities. By telling the truth to the highest levels of the global system, this group of trusted experts would prompt action from the entire pandemic response community.

Japan’s G7 Presidency in May is our moment for action. At the Isay-Shima summit, we have the opportunity to finally act on the unfulfilled promise of Alma Ata, and move rapidly toward universal health coverage. It also is our opportunity to prepare ourselves before the next pandemic hits. Accomplishing these goals will represent a quantum leap forward in people’s health and economic well-being.


New York Times
Accessed 19 December 2015
Flu Season Off to Slower Start This Year; Might Be Milder
The CDC’s Brammer said so far this year there’s a mix of flu viruses making people sick. In bad seasons, one nasty strain dominates…
December 18, 2015 – By THE ASSOCIATED PRESS – Health – Print Headline: “Flu Season Off to Slower Start This Year; Might Be Milder”

New York City’s Flu Shot Mandate for Young Children Is Struck Down
December 18, 2015 – By MARC SANTORA – N.Y. / Region – Print Headline: “Judge Halts City’s Flu-Shot Mandate for Children, Saying It Bypassed Albany”


Wall Street Journal,us&_homepage=/home/us
Accessed 19 December 2015
Fresh Ebola Cases Damp Liberia Hopes of Eliminating Deadly Disease
New cases serve notice that the fight against the disease will take months, even years
By Drew Hinshaw in Monrovia, Liberia, and Betsy McKay in Atlanta
Updated Dec. 10, 2015


Center for Global Development
Aligning Incentives, Accelerating Impact: Next Generation Financing Models for Global Health
Next Generation Financing Models in Global Health Working Group
Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3–$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses—and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death.

Vaccines and Global Health: The Week in Review 12 December 2015

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 with the current issue date

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_12 December 2015

blog edition: comprised of the approx. 35+ entries posted below on 6 December 2015.

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

David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Commentary – Isolated gains in immunization need to become the norm

Commentary – Isolated gains in immunization need to become the norm
Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals, WHO

11 December 2015
Ten days and more than 11 million children vaccinated against measles and rubella – that’s 764 children reached every minute. These numbers continue to impress me when I think about last year’s game-changing immunization programmes that reached children often missed due to humanitarian emergencies.

In Yemen, for example, despite the ongoing conflict, fuel shortages and block roads, the country’s 2014 immunization campaign was able to reach 91% of children aged nine months to 15 years. Remarkably, parents brought their children to the clinics and more than 24 000 health workers were mobilized across the country to administer a newly introduced measles-rubella vaccine.

With strong government commitment, adequate funding and flawless coordination among a wide-range of partners, Yemen achieved the target set out in the Global Vaccine Action Plan (GVAP) to reach 90% of children with the measles-rubella vaccine.

Problem is campaigns like this are an example of isolated improvements in reaching the nearly 1 in 5 children missing out on life-saving immunizations. Many countries are still way off-track. In order to reach every child by 2020, isolated improvements, including those to strengthen routine immunization, need to become the norm.

So, how do we get back on track?

Reducing missed opportunities, increasing coverage
WHO’s Strategic Advisory Group of Experts on immunizations (SAGE) met in October to review progress on achieving the GVAP targets, and reported most countries are still missing countless opportunities to protect children.

While substantial progress has been made in vaccinating 90% of children with the first dose of diphtheria-tetanus-pertussis (DTP) containing vaccine globally, many children do not come back for their second and third doses. Drop-out will need to be reduced if we are to achieve 90% coverage in 194 countries by 2015. In 2014, only 129 countries had reached this target.

One way of reducing drop-out is ensuring health workers always check vaccination cards when children are seen for well-child care or sick visits. Exit interviews conducted at health facilities in Chad and Malawi this year found 75% of children did not receive the vaccines for which they were eligible. Checking vaccination cards at every visit is an easy way of improving global vaccination coverage. We already have the child and his or her caregiver’s attention, so let’s make sure children have all of their vaccinations before they leave the clinic.

Most unvaccinated infants in the world remain located in a few large under-performing countries. With better data at national and especially at the subnational levels countries could assess pockets of under-immunization, identify exactly where missed opportunities exist and target these populations with localized solutions.

Common factors for success
Although opportunities were missed to reach every child last year, many countries had great success.

India, the second largest country in the world, was validated as having eliminated maternal and neonatal tetanus because it committed to improving access to immunization, antenatal care services and skilled birth attendance in the most vulnerable populations. It also improved coverage of the diphtheria-tetanus-pertussis-containing vaccines (DTP3) to 83%.

The Americas became the first region to eliminate rubella and congenital rubella syndrome, a major achievement.

Nigeria was removed from the list of polio-endemic countries in September, leaving the African Region one-step closer to being certified polio-free.

The key to success in all 3 of these examples was leadership and accountability at all 3 levels – national, regional and global. When countries and partners establish and enforce clear accountability systems, measure results, and take action when results are not being achieved, amazing progress will be made.

SAGE also identified an additional 5 factors to achieving significant results: quality and use of data; community involvement; better access to immunization services for marginalized and displaced populations; strong health systems and access to vaccines in all places at all times. While there is no one-size-fits-all solution to reach every child, we need to work with countries to understand how each of these success factors can help achieve a world free of vaccine-preventable diseases.

Reaching everyone throughout life
Going forward, countries should have annual plans for immunization that are consistent with the GVAP and relevant regional vaccine action plans. SAGE says it is not enough to just have a plan, countries need to strengthen the quality of their data, be accountable to their targets, and be monitored through an independent body.

Development partners, both global and national, cannot continue to be fragmented. We need to improve coordination and confirm our actions follow country and regional action plans. Vaccine stockpiles for humanitarian emergencies also need to continue to be replenished so that the second they are needed, they are available.

There is demand for immunization across the world. Now, we need to continue to meet the demand and reach every person with live-saving immunizations.

As we launch “Close the Immunization Gap”, the theme for next year’s World Immunization Week, let’s guarantee impressive gains achieved in some countries become the norm in all countries, and provide immunization for all throughout life.

EBOLA/EVD [to 12 December 2015]

EBOLA/EVD [to 12 December 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 9 December 2015
No confirmed cases of Ebola virus disease (EVD) were reported in the week to 6 December. Investigations into the origin of infection of the cluster of 3 confirmed cases of EVD reported from Liberia in the week to 22 November are continuing, with a working assumption that the cluster arose as a result of a rare re-emergence of persistent virus from a survivor….

POLIO [to 12 December 2015]

POLIO [to 12 December 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week as of 9 December 2015

:: Two cases of circulating vaccine-derived poliovirus were confirmed in Myanmar this week. The Ministry of Health is implementing an urgent outbreak response with the support of the partners of GPEI.

:: Around the world, thousands of polio workers have selflessly dedicated their lives to stopping polio in their communities. Five people have been honoured with Heroes of Polio Eradication (HOPE) Awards, presented by Bill Gates and His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi. Read more.

:: In 2015, wild poliovirus transmission is at the lowest levels ever, with fewer cases reported from fewer areas of fewer countries than ever before. In 2015 so far, 66 wild poliovirus cases have been reported from two countries (Pakistan and Afghanistan), compared to 324 cases from nine countries during the same period in 2014.

[Selected elements from Country-level reports]
:: One new WPV1 environmental positive sample was reported in the past week, collected on 24 November from Kabul province. – See more at:
:: Efforts are underway to strengthen the implementation of the national emergency action plan in the country. Focus is on:
– Consolidating the National and Provincial Emergency Operations Centres
– Improving SIA quality by focusing resources on low-performing districts, and clearly identifying and targeting persistently missed children
– Maximising the impact of front-line health workers through more systematic vaccinator selection, training and supervision
– Ensuring closer cross-border coordination in border areas with Pakistan
– Further strengthening surveillance, including by expanding environmental surveillance activities
:: A mop-up campaign was carried out from 2 to 4 December in the West of the country using bivalent OPV. Subnational immunization days (SNIDs) are planned for 20 to 22 December, 10 to 12 January and 14 to 16 February, all using bivalent oral polio vaccine (bOPV.

:: Six new wild poliovirus type 1 (WPV1) cases were reported in the past week: four in Sindh province, one in Balochistan province, and one in the Federally Administered Tribal Area (FATA). The total number of WPV1 cases for 2015 is now 49, compared to 275 by this time in 2014.
:: Two new environmental samples positive for WPV1 were reported in the last week, both from Gadap Town, Sindh province, with collection dates of 12 and 17 November.

Lao People’s Democratic Republic
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces. The first Subnational Immunization Days (SNIDs) using trivalent oral polio vaccine (OPV) targeted an expanded age group of children under the age of fifteen in the three most high risk districts, and children under the age of ten elsewhere. According to independent monitoring conducted in the high-risk areas, coverage of 85-95% was achieved, with 5-15% of children missed (primarily due to children not being present at the time of the vaccination teams’ visit).

:: An outbreak of type 2 circulating vaccine-derived poliovirus (cVDPV) has been confirmed in Myanmar, with two new cases confirmed in the past week. The most recent reported case was isolated from a 15-month old child in Rakhine, with onset of paralysis on 15 October. The case is genetically linked to a VDPV isolated in the same village earlier in the year, which has now been reclassified as a cVDPV type 2.
:: The re-classified strain had been originally isolated from a 28-month old child, with onset of paralysis on 16 April. The genetic changes of the isolate detected in April suggest that the cVDPV2 had already been circulating for more than one year.
:: The Ministry of Health of Myanmar is being supported by WHO and partners of the GPEI in planning and implementing an urgent outbreak response. Large-scale supplementary immunization activities (SIAs) using trivalent oral polio vaccine (OPV) has already been conducted from 5 to 7 December 2015, and a further three large-scale SIAs are planned in ‘high risk’ areas between now and the end of February 2016.
:: Significant immunization gaps remain in Myanmar, with an estimated 24% of children un- or under-immunized. Vaccination coverage remains particularly low among special at-risk populations. National surveillance rates are strong yet subnational gaps persist.
:: While WHO assesses the risk of international spread to be low, surveillance and immunization activities are being strengthened in neighbouring countries.

HOPE Awards – United Arab Emirates and Bill Gates Honor those Working to Stop Polio
Thursday, December 10, 2015
…To recognize the invaluable contributions of polio workers everywhere, this year His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the United Arab Emirates (UAE) Armed Forces, and the Bill & Melinda Gates Foundation partnered to create the first-ever Heroes of Polio Eradication (HOPE) Awards. On Sunday December 6, His Highness and Bill Gates personally honored five of these extraordinary individuals at the HOPE Awards ceremony in Abu Dhabi.

The award winners include:
:: HOPE Humanitarian Award: Mr. Constant Dedo from Ghana received the award for more than a decade of commitment to and perseverance in stopping polio in South Sudan, Pakistan, Nigeria and Afghanistan. Mr. Dedo was shot while working on an immunization campaign and, despite this, continued his work to support polio.

:: HOPE Education Award: Mr. Atta Ullah from Pakistan received the award for his innovative approach to educating communities in Pakistan about the importance of vaccinating children against polio.

:: HOPE Advocacy Award: Bibi Malika from Afghanistan received this award for her instrumental work on polio eradication in hard-to-reach areas, and has served as a community leader, a source of medical wisdom and a female role model in her community.

:: HOPE Innovation Award: Mr. Lawan Didi Misbahu from Nigeria, a polio survivor himself, and Chairman of The Association of Polio Survivors of Nigeria and President of the Para-Soccer Federation of Nigeria, received the award for the innovative program focused on engaging and rehabilitating 3000 paraplegics, who are mostly polio survivors in Nigeria. The Polio Survivors has had a core role in Nigeria’s polio program, mobilizing nearly 1300 polio survivors.

:: HOPE Achievement Award: Mrs. Freeda, a Lady Health Worker from Pakistan, received this award for efforts to stop polio over the last 15 years, even after a loved one was killed and she was injured in an attack during a vaccination drive.

WHO & Regionals [to 12 December 2015]

WHO & Regionals [to 12 December 2015]

New global framework to eliminate rabies
News release
10 DECEMBER 2015 | GENEVA – A new framework to eliminate human rabies and save tens of thousands of lives each year has been launched today by WHO, the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for the Control of Rabies (GARC).

The framework calls for 3 key actions – making human vaccines and antibodies affordable, ensuring people who get bitten receive prompt treatment, and mass dog vaccinations to tackle the disease at its source.

“Rabies is 100% preventable through vaccination and timely immunization after exposure, but access to post-bite treatment is expensive and is not affordable in many Asian and African countries. If we follow this more comprehensive approach, we can consign rabies to the history books,” says WHO Director-General Dr Margaret Chan…

Global elimination of human rabies – The time is now!
On 10 and 11 December 2015, experts, donors, and veterinary and public health officials will adopt a plan of action that is expected to deliver prompt post-exposure prophylaxis for all in rabies endemic areas as well as a framework for scaling up sustained, large-scale dog vaccination. This milestone international conference will also discuss a push for coordinated activities targeting dog and human populations by adapting proven control strategies.

Another important component is harnessing support for community awareness and engagement to facilitate and strengthen data collection, bite incidence reporting and demand for post-exposure prophylaxis. Educating children on how to avoid being bitten is also vital.

The conference “Global elimination of dog-mediated human rabies – The time is now” is jointly organized by WHO and the OIE, in collaboration with FAO with the support of GARC.


Weekly Epidemiological Record (WER) 11 December 2015, vol. 90, 50 (pp. 681–700)
681 Meeting of the Strategic Advisory Group of Experts on immunization, October 2015 – conclusions and recommendations

:: Request for proposals: Joomla website administrator/developer for the TechNet website and e-forum
9 December 2015
Information and submission of proposals pdf, 234kb
Deadline for application: 3 January 2016

:: WHO Regional Offices
WHO African Region AFRO
:: The road to universal health coverage: a case study on Gabon
11 December 2015 — Mobile phones are becoming one of the world’s most important health tools, used in many countries to track exercise, ensure medicines are genuine, and even to read blood glucose levels. In Gabon, they’re being used to raise revenue for the national health system. A 10% levy on the revenues of mobile phone companies and on mobile phone usage, introduced by Gabon’s government in 2008, has helped to more than double the funds for a health insurance programme that now covers 99% of the equatorial nation’s poor, giving them access to critical health services such as care…

WHO Region of the Americas PAHO
:: Experts seek ways to boost public spending on health in Latin America and the Caribbean to achieve and sustain universal health (12/07/2015)

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: A strong agreement from COP21 matters to health – and to the European Region 11-12-2015

WHO Eastern Mediterranean Region EMRO
:: WHO condemns attack on Al Houban clinic in Taiz, Yemen run by MSF, wounding 9 people
7 December 2015

WHO Western Pacific Region
:: Malaysia and WHO tackle the marketing of unhealthy food and beverages to children
KUALA LUMPUR, 7 December 2015 – Recognizing the need to protect children from unhealthy diet, the Malaysian Ministry of Health and the World Health Organization (WHO) regional offices for South-East Asia and the Western Pacific convened a bi-regional workshop to guide Member States in restricting the marketing of foods and non-alcoholic beverages to children.

Dengvaxia, World’s First Dengue Vaccine, Approved in Mexico

Dengvaxia, World’s First Dengue Vaccine, Approved in Mexico
December 9, 2015
– First marketing authorization of Dengvaxia® is a historic milestone paving the way to significantly impact dengue burden in endemic countries –

Lyon, France – December 9, 2015 – Sanofi Pasteur, the vaccines division of Sanofi, announced today that the Mexican authorities have granted marketing authorization to Dengvaxia®, making it the first vaccine to be licensed in the world for the prevention of dengue.

The Federal Commission for the Protection against Sanitary Risks (COFEPRIS) has approved Dengvaxia®, tetravalent dengue vaccine, for the prevention of disease caused by all four dengue virus serotypes in preadolescents, adolescents and adults, 9 to 45 years of age living in endemicareas.

“When Sanofi set out to develop a dengue vaccine 20 years ago together with local and global public health and scientific communities, it was with the intention of developing an innovative vaccine to tackle this global public health need,” said Olivier Brandicourt, MD, Chief Executive Officer, Sanofi. “Today, with this first marketing authorization of Dengvaxia®, we have achieved our goal of making dengue the next vaccine-preventable disease. This is a historic milestone for our company, for the global public health community and, most importantly, for half the world’s population who lives at risk of dengue.”

The COFEPRIS approval of Dengvaxia® is based on results from an extensive clinical development program involving over 40,000 people of different ages, geographic and epidemiological settings, and ethnic and socio-economic backgrounds living in 15 countries. Dengue-endemic regions of Mexico participated in all three phases of the clinical development program for the vaccine.

“Dengue is a growing health threat in Mexico and many other tropical and subtropical countries in Latin America and Asia. The first vaccine approved to prevent dengue fever is a major innovation and a public health breakthrough. Dengvaxia® will be a critical addition to the integrated dengue prevention and control efforts. It will be an essential tool to boost on-going community efforts to relieve the long-standing suffering that this disease continues to bring to people in endemic countries like ours,” asserts José Luis Arredondo García, Associate Director of Clinical Research in the National Institute of Pediatrics*.

Regulatory review processes for Dengvaxia® are continuing in other endemic countries. Manufacturing of Dengvaxia® has already started at vaccine facilities in France and first doses are already produced. Sanofi Pasteur remains committed to introducing Dengvaxia® first in countries where dengue is a major public health priority.

The World Health Organization (WHO) has called for development of a dengue vaccine as an essential part of the integrated dengue prevention effort needed to significantly lower the dengue burden globally. The WHO has called on endemic countries to reduce dengue mortality by 50% and morbidity by 25% by 2020. Disease impact modelling results indicate if you vaccinate 20% of the population in the 10 endemic countries that participated in the Phase III efficacy studies for Dengvaxia, in the ages 9 and above indication, you could potentially reduce your dengue burden by 50% in five years.1 Such a significant disease reduction in this large at-risk population would result in a smaller pool of infected individuals in a given country and, therefore, fewer mosquitoes capable of transmitting the disease, potentially leading to an overall lowering of transmission risk for all…

About Sanofi Pasteur’s dengue vaccine
Sanofi Pasteur’s vaccine is the culmination of over two decades of scientific innovation and collaboration, as well as 25 clinical studies in 15 countries around the world. Over 40,000 volunteers participated in the Sanofi Pasteur dengue vaccine clinical study program (phase I, II and III), of whom, 29,000 volunteers received the vaccine. Dengvaxia® successfully completed phase III clinical studies in 2014 to evaluate the primary objective of vaccine efficacy.7, 8

Long-term follow-up studies of the vaccine, recommended by WHO for all dengue vaccines in development, are currently ongoing. Additional pooled efficacy and integrated safety analyses from the 25-month Phase III efficacy studies and the ongoing long-term studies, respectively, were recently published in The New England Journal of Medicine reconfirming the vaccine’s consistent efficacy and longer-term safety profile in populations 9 years of age and older. In a pooled efficacy analysis in volunteers aged 9-16 who participated in the two Phase III 25-month efficacy studies, Dengvaxia® was shown to reduce dengue due to all four serotypes in two-thirds of the participants. Furthermore, this pooled efficacy analysis showed that Dengvaxia® prevented 9 out of 10 cases of severe dengue and 8 out 10 hospitalizations due to dengue in this age group.9
Dengvaxia® is the first vaccine licensed for the prevention of dengue in the world. First doses of the vaccine have been produced and full scale production capacity will be reaching 100 million vaccine doses annually.
Additional information about Sanofi Pasteur’s dengue vaccine is available on the web at

Statement by the Dengue Vaccine Initiative on Mexico’s Regulatory Approval of Sanofi Pasteur’s Dengue Vaccine, Dengvaxia
Cross-posted by Sabin Vaccine Institute and International Vaccine Access Center
On December 9 2015, Mexico approved Sanofi Pasteur’s dengue vaccine marking the first time a dengue vaccine has been licensed for use in a country. Called Dengvaxia® and developed by the French pharmaceutical company, Sanofi Pasteur, the vaccine was approved for people aged 9 to 45 years in areas that are highly endemic, with a dengue seroprevalence of more than 60 percent.

The Dengue Vaccine Initiative (DVI) views Mexico’s licensure of Dengvaxia® as an important milestone in the fight against dengue. Recent studies have demonstrated that in children and adolescents aged 9 years and above, Dengvaxia® reduces dengue cases overall by approximately 65 percent; dengue cases requiring hospitalization by 81 percent; and severe dengue cases by 93 percent. The vaccine’s efficacy was most apparent in individuals with evidence of prior dengue virus exposure. In children below the age of 9 years and in those with no evidence of prior dengue, the vaccine’s efficacy was substantially lower. There was also an increased risk of cases requiring hospitalization during the third year after vaccine initiation in children under 9.
These results suggest that Dengvaxia® may have significant public health impact in reducing dengue disease burden for people 9 years of age and older, especially in areas with existing high infection rates of dengue. Questions remain regarding Dengvaxia®, including duration of protection, price, and impact on overall dengue virus transmission given that the youngest age groups will not be vaccinated. These and other issues will have to be closely followed in order to ascertain the ultimate impact of this vaccine.

Dengue, also known as “breakbone fever,” is caused by a virus transmitted by Aedes mosquitoes, the same mosquitoes that can transmit chikungunya and Zika virus. Dengue virus causes approximately 400 million infections globally each year. In the Americas alone, dengue’s economic burden has been estimated to cost $2.1 billion dollars a year.

DVI believes that this first vaccine licensure in a dengue-endemic country may pave the way for other countries considering new technologies to fight dengue, but stresses that the decision to introduce a dengue vaccine should follow scientific evidence. Following registration, ministries of health will still face important decisions about whether and how to introduce the vaccine into national programs. These decisions may vary according to the specific demographic characteristics, dengue epidemiology and the capacity of public health systems of each country. Therefore, DVI continues to strongly support increasing efforts to improve endemic countries’ access to the evidence needed to inform vaccine introduction decisions.

DVI also welcomes the decision by Mexico as an opportunity to increase our understanding of the questions raised above, as well as the effectiveness of the vaccine in field conditions. DVI recognizes the importance of effective integration of dengue prevention and control strategies, notably vaccination and vector-control approaches, to comprehensively reduce dengue. DVI also encourages the global health community to facilitate and support mechanisms for regional knowledge transfers and information sharing among endemic countries to collectively fight dengue and other vector-borne diseases that are also on the rise. We hope this development spurs other vaccine candidates currently in clinical development to continue to progress in the pipeline.

About the Dengue Vaccine Initiative
The Dengue Vaccine Initiative is an international consortium of the International Vaccine Institute, the World Health Organization Initiative for Vaccine Research, the International Vaccine Access Center at the Johns Hopkins University Bloomberg School of Public Health and the Sabin Vaccine Institute that specializes in research, health economics, policy and advocacy to equip countries with objective information and scientific evidence to fight dengue fever. The Initiative is supported by the Bill & Melinda Gates Foundation.

Secretary-General Ban Ki-moon Issues Call for New Deal on Medicines

Secretary-General Ban Ki-moon Issues Call for New Deal on Medicines
Dec 11, 2015
United Nations Development Programme/UNDP
NEW YORK -The United Nations Secretary-General’s High-Level Panel on Access to Medicines held its first meeting today. The panel committed itself to finding solutions that will increase access to medicines, while continuing to promote investment in new treatments to save the lives of millions.

“It is a basic fundamental right that everyone should be able to access medicines, vaccines and diagnostics they need in order to ensure healthy lives and promote the well-being of people of all ages, as set out in Sustainable Development Goal 3,” said President Mogae, co-chair of the High Level Panel.

Festus Mogae, former President of Botswana and Ruth Dreifuss, former President of Switzerland are co-chairing the panel. The work of the High-Level and its Expert Advisory Group is being supported by a Secretariat at UNDP in collaboration with UNAIDS. The panel was established by the Secretary-General to find solutions to increase access to medicines, while continuing to promote investment in developing new medicines.

Panelists noted that despite progress made in many areas, millions of people are still left behind. Many are dying because they cannot access life-saving medicines. This includes:
:: 1.2 million people died from AIDS in 2014.
:: 9.6 million people infected with TB and 1.5 people died because of TB.
:: Over 400 million people have hepatitis B and C and 1.4 million people have died from Hepatitis B and C.
:: 38 million people have died from non-communicable diseases such as cardiovascular diseases (17.5 million deaths), diabetes (1.5 million deaths), cancer (8.2 million deaths) and respiratory diseases (4 million deaths)…

…Following the meeting, the High-Level Panel will issue a call for proposals from experts, individuals and organizations to recommend solutions that promote the rights of inventors, international human rights law, trade rules, and public health in the context of health technologies. Proposals submitted will be reviewed, shortlisted and invited to present at public hearings where stakeholders from governments, the industry, patient groups and others will be able to provide their thoughts and views on the proposals. The High-Level Panel’s findings and recommendations will be compiled in a report, which will be presented to the Secretary-General in June 2016.

The Secretary-Generals High Level Panel on Access to Medicines comprises of 16 eminent, well-respected individuals with a deep knowledge and understanding of the broad range of legal, trade, public health and human rights issues associated with access to medicines and health technologies. Biographies and additional information on the High-Level Panel can be accessed from

Global Fund [to 12 December 2015]

Global Fund [to 12 December 2015]

Global Fund Encourages People to Speak Out against Fraud and Corruption
08 December 2015
GENEVA – On International Anti-Corruption day, 9 December, the Global Fund’s Office of the Inspector General is launching a campaign to raise awareness about fraud and abuse. Called ‘I Speak Out Now!’, the campaign is designed to encourage people to denounce any wrongdoing that prevents the medicines, health products and services from reaching those who need them.

By the end of 2015, the Office of the Inspector General, the Global Fund’s independent assurance structure, estimates it will have received around 200 allegations of fraud and abuse. This represents an increase of 30 percent compared to last year, largely attributable to better visibility of its whistle-blowing channels. On average, over a third of allegations become investigations, which result in recommendations to recover misspent funds and actions to strengthen the Global Fund’s impact in the fight against AIDS, tuberculosis and malaria.

The objective of the campaign is to improve the quality and timeliness of allegations that the Office of the Inspector General receives so that the Global Fund can intervene earlier to prevent small scale irregularities from becoming systemic cases of wrongdoing. Targeted audiences include Global Fund staff and grant implementers. Anti-fraud and corruption materials will also be piloted in three countries representative of the Global Fund portfolio: Ukraine, Côte d’Ivoire and Malawi. The Office of the Inspector General plans to extend the campaign to other countries in 2016…

PATH [to 12 December 2015]

PATH [to 12 December 2015]

Press release
Leading global health innovator celebrates 35 years in Vietnam
US Deputy Chief of Mission attends PATH anniversary event
Hanoi, December 8, 2015—A leading US-based global health organization, PATH, celebrated 35 years of partnership and innovation in Vietnam. US Deputy Chief of Mission Susan Sutton joined the anniversary event to celebrate the milestone and highlight achievements of PATH partnerships. The event follows the recent 20th anniversary of US-Vietnam health cooperation and normalized bilateral relations.

“PATH’s work in Vietnam continues to represent the best in global health innovation. Our collaboration with the government and many development and private-sector partners has saved and protected many lives,” said PATH president and CEO Steve Davis. “Moving into a new era of health and development goals, PATH is committed to continue working with current and new partners to accelerate health innovation in Vietnam.”…

European Medicines Agency [to 12 December 2015]

European Medicines Agency [to 12 December 2015]

“EMA ready to address challenges ahead”
Support to innovative medicines, transparency and patient involvement will be among the priorities of new EMA Executive Director Guido Rasi

Executive Director Guido Rasi outlined his vision for his five-year mandate at the helm of the European Medicines Agency (EMA), at a press briefing today.

Among the current shifts in medicines development, Professor Rasi mentioned the vast progress made in the understanding of the human body and the underlying science, the increased globalisation of medicines development and manufacturing, as well as the current pressure on healthcare systems. “I am confident that EMA, working closely with the national competent authorities in Member States, is ready to successfully address these new challenges,” said Guido Rasi.

Professor Rasi highlighted five building blocks on which EMA’s response to these shifts is built:
:: Focusing on research and development for medicines that address public health needs: “We want to focus our efforts on those medicines which have the potential to really improve patients’ lives – so that innovation clearly translates into public health benefits.”
:: Commitment to transparency: “We have a pioneering approach to transparency. We are the first regulator in the world to allow researchers and academics, and the public as a whole, access to the clinical data on which marketing authorisations are based.”
:: Patient involvement: “All that we do must ultimately benefit patients. This is why we involve them more and more in our work, to ensure their views and needs are taken into account at every step of the process.”
:: Best use of all available evidence: “In Europe, with a population of over 500 million citizens, the opportunities to study the impact of medicines in real life and monitor their safety and efficacy are enormous. Integrating all available data enables real-time monitoring of the safety and efficacy of medicines.”
:: Global reference authority for the regulation of medicines: “Development and manufacturing of medicines is now global and regulatory authorities cannot work in isolation. We are reinforcing our role as a global reference authority, to provide the regulatory oversight that our citizens expect.”

To address these challenges, Professor Rasi noted the importance to strengthen the cooperation with Member States, the European Commission and other European and international partners, and to bring communities and stakeholders involved closer together for a more holistic approach to medicines evaluation and surveillance across the whole lifespan of a medicine.

Guido Rasi took office as Executive Director of EMA on 16 November 2015. Professor Rasi was nominated as Executive Director for a five-year mandate by the Management Board of the Agency on 1 October 2015.

Health in 2015: from MDGs to SDGs

Health in 2015: from MDGs to SDGs
December 2015 :: 204 pages
ISBN 978 92 4 156511 0
Pdf of full report:

This report aims to describe global health in 2015, looking back 15 years at the trends and positive forces during the Millennium Development Goal (MDG) era and assessing the main challenges for the coming 15 years.

The 2030 Sustainable Development Agenda is of unprecedented scope and ambition, applicable to all countries, and goes well beyond the MDGs. While poverty eradication, health, education, and food security and nutrition remain priorities, the Sustainable Development Goals (SDGs) comprise a broad range of economic, social and environmental objectives, and offer the prospect of more peaceful and inclusive societies.

Progress towards the MDGs, on the whole, has been remarkable, including, for instance, poverty reduction, education improvements and increased access to safe drinking-water. Progress on the three health goals and targets has also been considerable. Globally, the HIV, tuberculosis (TB) and malaria epidemics were “turned around”, child mortality and maternal mortality decreased greatly (53% and 44%, respectively, since 1990), despite falling short of the MDG targets.

During the MDG era, many global progress records were set. The MDGs have gone a long way to changing the way we think and talk about the world, shaping the international discourse and debate on development, and have also contributed to major increases in development assistance. However, several limitations of the MDGs have also become apparent, including a limited focus, resulting in verticalization of health and disease programmes in countries, a lack of attention to strengthening health systems, the emphasis on a “one-size-fits-all” development planning approach, and a focus on aggregate targets rather than equity.

The 17 goals and 169 targets, including one specific goal for health with 13 targets, of the new development agenda integrate the three dimensions of sustainable development around people, planet, prosperity, peace and partnership. The health goal is broad: “Ensure healthy lives and promote well-being for all at all ages”. Health has a central place as a major contributor to and beneficiary of sustainable development policies. There are many linkages between the health goal and other goals and targets, reflecting the integrated approach that is underpinning the SDGs. Universal health coverage (UHC), one of the 13 health goal targets, provides an overall framework for the implementation of a broad and ambitious health agenda in all countries.

Monitoring and review of progress will be a critical element of the SDGs. An indicator framework is still being developed and is scheduled to be adopted in 2016.

700+ Organizations in 116 Countries Say Universal Health Coverage is Right, Smart, and Overdue

700+ Organizations in 116 Countries Say Universal Health Coverage is Right, Smart, and Overdue
December 11, 2015
Global leaders urged to ensure all people can access essential health services without facing financial hardship
NEW YORK – On the second annual Universal Health Coverage Day on 12 December 2015, a coalition of more than 700 organizations in 116 countries will come together to say that universal health coverage is right, smart, and overdue. The coalition will urge world leaders to deliver on promises to achieve universal health coverage because health is a human right that reduces poverty, fuels economic growth, and builds resilience to threats from disease outbreaks to climate change.

On Universal Health Coverage Day 2015, hundreds of millions of people worldwide are still waiting for access to lifesaving health services or fall into poverty paying for needed health care. To address these inequities, more than 100 countries across the income spectrum have begun working toward universal health coverage, increasingly demonstrating its feasibility.
“When The Rockefeller Foundation first began its work to advance universal health coverage, it seemed to many to be a pipedream. Today, we are truly inspired to see how rapidly support for universal health coverage has grown, including its recent recognition in the Sustainable Development Goals,” said Judith Rodin, President of The Rockefeller Foundation. “Universal health coverage is key to building resilient health systems that make both people and planet healthier in the face the increasingly common shocks and stresses posed by climate change, urbanization, and globalization.”

Universal Health Coverage Day, inaugurated by The Rockefeller Foundation, marks the anniversary of the United Nations’ unanimous 2012 resolution urging governments to ensure universal access to quality health care without financial hardship.

“Universal health coverage is one of the most powerful social equalizers among all policy options,” said Dr. Margaret Chan, Director-General of the World Health Organization. “The global community has recognized this approach as a pro-poor pillar of sustainable development that builds social cohesion and stability – valued assets for every country.”

“Governments have everything to gain when they prioritize human health – it is an investment. I am hopeful for global progress because universal health coverage has been included in the Sustainable Development Goals,” said Dr. Agnes Binagwaho, Minister of Health, Rwanda.

Progress toward Health for All
New events and initiatives show growing global momentum to deliver universal health coverage and offer an opportunity to further accelerate progress:

:: High-Level Panel on Access to Medicines: To address serious gaps in access to lifesaving health interventions, UN Secretary General Ban Ki-moon has established a new High-Level Panel tasked with ensuring access to medicines is improved around the world. The panel, which convenes for the first time on 11 and 12 December, demonstrates commitment to improve health access at the highest level of the United Nations.

:: International Conference on Universal Health Coverage in the New Development Era: Next week in Japan, Bill Gates, Margaret Chan, Jim Yong Kim, and other global health leaders will gather for a major conference on the role of universal health coverage in realizing the Sustainable Development Goals. Co-hosted by The Global Fund to Fight AIDS, Tuberculosis and Malaria in conjunction with its replenishment meeting, the conference will examine the critical link between building strong health systems and stopping the world’s deadliest infectious diseases.

:: Sustainable Development Goals: The Sustainable Development Goals officially launch on 1 January 2016, and include achieving universal health coverage among their many targets. Coalition members are urging world leaders to prioritize universal health coverage as a foundational investment that can drive progress on all health objectives and advance the overarching goal of ending extreme poverty.

There is increasing evidence that universal health coverage is a smart investment. Earlier this year, The Rockefeller Foundation convened the Economists’ Declaration on Universal Health Coverage, a landmark statement outlining the economic benefits of universal health coverage and calling on policymakers to prioritize it as an essential pillar of sustainable development. More than 300 economists from 44 countries have added their names to the Declaration, including the current and former World Bank chief economists and five Nobel Laureates.

The WHO and World Bank’s first global monitoring report on universal health coverage released in June 2015 found that despite significant worldwide progress on health, 400 million people still lack access to essential health services and 17% of people in low- and middle-income countries are pushed or further pushed into poverty (US$2/day) because of health spending…