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_23 January 2016

– blog edition: comprised of the approx. 35+ entries posted below on 24January 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

EBOLA/EVD [to 23 January 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Report – 20 January 2016
SUMMARY [Excerpts]
:: Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance to ensure the rapid detection of any further cases that might arise as a result a missed transmission chain, reintroduction from an animal reservoir, importation from an area of active transmission, or re-emergence of virus that had persisted in a survivor. On 14 January, 68 days into the 90-day surveillance period, a new confirmed cases of EVD was reported in Sierra Leone after a post-mortem swab collected from a deceased 22-year-old woman tested positive for Ebola virus. The woman died on 12 January at her family home in the town of Magburaka, Tonkolili district, and received an unsafe burial. In the preceding 2 weeks the woman travelled from Port Loko, where she was a student, via the districts of Kambia and Bombali before arriving in Magburaka on 7 January. Reports indicate that her symptoms during travel included vomiting and diarrhoea. The Sierra Leone Ministry of Health and Sanitation (MoHS), with the support of WHO and other partners, responded rapidly to the new case, identifying approximately 150 contacts of whom approximately 50 are deemed to be at high risk. Vaccination of contacts and contacts of contacts is underway under the authority and coordination of the Sierra Leone MoHS. However, the woman’s extensive travel history in the 2 weeks prior to her death, her presentation to and subsequent discharge from a health care facility at which health workers did not use personal protective equipment (PPE), her period of close contact with family whilst ill, and her unsafe burial indicate a significant risk of further transmission. One contact in Tonkolili remains to be traced. The origin of infection is under investigation.

:: Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission on 29 December 2015, and has now entered a 90-day period of enhanced surveillance that is due to end on 27 March 2016.

:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10,000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia had accessed semen screening and counselling services by 17 January 2016…

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Ebola vaccine purchasing commitment from Gavi to prepare for future outbreaks
20 January 2016
Agreement will help push vaccine towards regulatory approval.
Davos, 20 January 2016 – Gavi, the Vaccine Alliance and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. (known as MSD outside the U.S. and Canada) have signed an agreement to support the provision of a vaccine to protect against future deadly Ebola outbreaks. The agreement, announced today at the World Economic Forum in Davos, will help Merck take the vaccine through licensure and WHO prequalification.

Under the Advance Purchase Commitment, Gavi has provided US$ 5 million towards the development of Merck’s rVSV∆G-ZEBOV-GP live attenuated Ebola Zaire vaccine, on the understanding that it will be submitted for licensure by the end of 2017. If approved, it would become one of the world’s first licensed Ebola vaccines and Gavi would be able to begin purchasing the vaccine to create a stockpile for future outbreaks.

Additionally, Merck will ensure that 300,000 doses of the vaccine are available from May 2016 for use in expanded use clinical trials and/or for emergency use as needed while vaccine development continues. Merck has already submitted an application through WHO’s Emergency Use Assessment and Listing (EUAL) procedure. If the EUAL is approved, this will provide an opportunity for the investigational vaccine to be used if another public health emergency with Ebola occurs before the vaccine is licensed.

“The suffering caused by the Ebola crisis was a wake-up call to many in the global health community,” said Gavi CEO Dr Seth Berkley. “New threats require smart solutions and our innovative financing agreement with Merck will ensure that we are ahead of the curve for future Ebola outbreaks.”

“We are very pleased to join with Gavi in announcing this Advance Purchase Commitment agreement to support the provision of MSD’s investigational monovalent Ebola Zaire vaccine – in case of a resurgence of the Ebola outbreak or a new outbreak,” said Dr Julie Gerberding, executive vice president, Strategic Communications, Global Public Policy and Population Health for Merck. “We applaud Gavi for this bold step to be a part of the solution to address a disease that has impacted so many lives.”…

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Guinea Revives Border Health Screening to Mitigate Risk of Spread of Ebola
01/22/16 – IOM / International Organization for Migration
Guinea – Following the confirmation of a new Ebola case in Sierra Leone on January 12 – and confirmation of another case on January 20th – IOM and its partners are reactivating cross-border health screening at Guinea’s borders with Sierra Leone and reinforcing their surveillance capacity in Forecariah Prefecture, the border area closest to the outbreak.

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WHO: Clinical care for survivors of Ebola virus disease
22 January 2016 — Today, there are over 10 000 survivors of Ebola virus disease. A number of medical problems have been reported in survivors, including mental health issues. Ebola virus may persist in some body fluids, including semen. Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission. WHO has developed this document to guide health services on how to provide quality care to survivors of Ebola virus disease.
Read the guidance for survivors

POLIO [to 23 January 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 20 January 2016
:: There are three months to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.
:: A sample from environmental surveillance in Kabul, Afghanistan has tested positive for wild poliovirus type 1. A vaccination response is being planned for the immediate vicinity.

Selected content from country-level reports
Afghanistan
:: Two new WPV1 environmental positive samples were reported in the past week – one in Jalalabad in Nangarhar province, and the second Kabul city. Both samples were collected on 27 December 2015.
:: Subnational Immunization Days (SNIDs) were carried out in the south on 12 to 15 January using bOPV. Further SNIDs are planned from 16 to 19 February, also using bOPV and National Immunization Days (NIDs) are planned from 15 to 18 March using tOPV, prior to the switch. Read more about the switch here.
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 22 December 2015 in Peshawar. The total number of WPV1 cases for 2015 is now 53, compared to 303 reported for 2014 by this time last year. A total of 306 cases occurred in Pakistan in 2014.
:: Two new WPV1 environmental positive samples were detected in Karachi’s Gadap Town in Sindh province and Quetta, Balochistan with collection dates of 11 December 2015 and 14 December 2015 respectively
Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in the past week, in Longxan district of Xaysomboune province with onset of paralysis on 18 November 2015. The total number of cVDPV1 cases in 2015 is now seven.
:: Outbreaks of cVDPVs can arise in areas with low population immunity, emphasizing the importance of maintaining strong vaccination coverage. Learn more about VDPVs.
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces.

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ECHO [to 23 January 2016]
http://ec.europa.eu/echo/en/news
22/01/2016
EU supports vaccination campaign to combat polio in Ukraine
The European Commission is providing €1.2 million to support a third round of polio vaccinations in Ukraine following the start of an outbreak in August last year.

The vaccination campaign is carried out with the cooperation of relevant Ukrainian government ministries, UNICEF and the World Health Organisation (WHO).

Speaking at a press conference in Kiev today launching the latest vaccination drive, Director of Operations of the European Commission’s Humanitarian Aid and Civil Protection department (ECHO), Jean-Louis de Brouwer, stated: “I laud the combined efforts of the Ministries of Health and Education who, together with our partners UNICEF and WHO, have made tremendous strides in vaccinating thousands of children against this dreaded disease”.

The first two rounds of polio vaccinations took place in November 2015, after an outbreak was confirmed by WHO. The third round of vaccinations will target 4.75 million children aged 0-10.
The funding is being made available through the European Commission’s Humanitarian Aid and Civil Protection department (ECHO). The vaccines were flown in the first week of January in preparation for the latest vaccination drive…

WHO & Regionals [to 23 January 2016]

El Niño threatens at least 60 million people
22 January 2016 — WHO and partners predict a major global increase in health-related emergencies this year due to El Niño. According to a new WHO report, severe drought, flooding, rains and temperature rises are all known effects of El Niño that can lead to food insecurity, malnutrition, disease outbreaks, acute water shortages and disruption of health services.
Read the story on El Niño and health

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Weekly Epidemiological Record (WER) 22 January 2016, vol. 91, 3 (pp. 21–32)
Contents
21 Global Advisory Committee on Vaccine Safety, 2–3 December 2015
31 Monthly report on dracunculiasis cases, January– November 2015

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Disease Outbreak News (DONs)
:: 21 January 2016 – Zika virus infection – France – Saint Martin and Guadeloupe
:: 21 January 2016 – Guillain-Barré syndrome – El Salvador
:: 21 January 2016 – Zika virus infection – Haiti
:: 20 January 2016 – Zika virus infection – Bolivia
:: 20 January 2016 – Zika virus infection – Guyana, Barbados and Ecuador
:: 19 January 2016 – Human infection with avian influenza A(H7N9) virus – China
Call for nomination of experts to serve on the Strategic Advisory Group of Experts on immunization (SAGE) Working Group on Typhoid Vaccines
20 January 2016
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:: WHO Regional Offices
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: As the Zika virus spreads, PAHO advises countries to monitor and report birth anomalies and other suspected complications of the virus (01/18/2016)
:: PAHO helps countries in the Americas prepare for spread of Zika (01/16/2016)

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

WHO European Region EURO
:: Collaboration on refugee and migrant health 21-01-2016
Countries in the WHO European Region have agreed to prepare a common framework for coordinated collaboration and action on refugee and migrant health, based on solidarity and mutual assistance and in the spirit of the 2030 Sustainable Development agenda, whereby “no one should be left behind”
…The document states, among other issues:
:: Migrants and refugees do not pose an additional threat to health security in host communities.
:: Screening can be an effective public health instrument but should be non-discriminatory and non-stigmatizing and should benefit both the individual and the public.
:: Special attention should be paid to the most vulnerable groups, such as children, pregnant women, the elderly, people with disabilities and victims of torture.
:: Health records and health cards must be made portable as a priority…

WHO Eastern Mediterranean Region EMRO
:: New delivery rooms in camps for the internally displaced in Iraq save the lives of mothers and babies
20 January 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 23 January 2016]
http://www.cdc.gov/media/index.html

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CDC adds countries to interim travel guidance related to Zika virus
FRIDAY, JANUARY 22, 2016
CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission. Today, CDC added the following destinations to the Zika virus travel alerts: Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa. On January 15, CDC issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing: the Commonwealth of Puerto Rico, a U.S. territory; Brazil; Colombia; El Salvador; French Guiana; Guatemala; Haiti; Honduras; Martinique; Mexico; Panama; Paraguay; Suriname; and Venezuela. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time…

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MMWR Weekly – January 22, 2016 / Vol. 65 / No. 2
http://www.cdc.gov/mmwr/index2015.html
:: Inadequate Diagnosis and Treatment of Malaria Among Travelers Returning from Africa During the Ebola Epidemic — United States, 2014–2015
:: Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016
:: Notes from the Field: Outbreak of Locally Acquired Cases of Dengue Fever — Hawaii, 2015

Gavi [to 23 January 2016]
http://www.gavialliance.org/library/news/press-releases/

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22 January 2016
Gavi launches ‘INFUSE’ initiative to overcome barriers to immunisation
Call to entrepreneurs, corporations and implementers to innovate and improve vaccine delivery.
Davos, 22 January 2016 – Gavi, the Vaccine Alliance today called for proven-concept innovations from entrepreneurs and companies that could drive improvements in immunisation in developing countries. The Geneva-based public-private partnership will identify the most promising concepts and technologies and connect them with influential public and private sector leaders.

At the World Economic Forum’s annual meeting, Gavi hosted global business leaders, government officials and high-tech innovators to introduce Innovation for Uptake, Scale and Equity in immunisation (INFUSE) – an initiative focused on overcoming the obstacles that lead to almost 19 million children per year not receiving a full course of the most basic vaccines. Gavi CEO Dr Seth Berkley highlighted the importance of harnessing new thinking, potentially from innovators outside the immunisation and global health fields, to reach more children with vaccines.

The INFUSE topic for 2016 is immunisation data availability, quality, and use – a fundamental step to building an efficient and sustainable immunisation systems in developing countries. Gavi will welcome data-related proposals of projects that are either already operating or have completed their pilot phase. Gavi will encourage new partnerships to enable a small number of successful projects to help bridge the gap between pilot phase, small-scale implementation and regional or global scale- up.

“I am excited that Gavi is ready to embrace new and diverse thinking to solve the challenges that are preventing us from reaching children with vaccines,” said Dr Berkley. “Data is absolutely critical to health as it enables us to track both people and diseases. We are looking forward to exploring new possibilities for capturing and using data in the countries we work with.”

INFUSE is open to local and global entrepreneurs, corporations, and implementers with a proven-to-work technology or implementation innovation enhancing data availability, quality, or use, that could be adapted to the broad developing country context. These could include solutions ranging from better tools and training resources for local health workers to track vaccinated children at the point of care, to the application of emerging “deep data” concepts to identify resource gaps and areas for improving health and immunisation systems.

By connecting innovators with influential public and private sector figures, Gavi hopes to accelerate the use of proven-concept innovations to modernise immunisation delivery. Those interested in joining INFUSE can apply online at infuse.gavi.org

BMGF – Gates Foundation [to 23 January 2016]
http://www.gatesfoundation.org/Media-Center/Press-Releases

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JANUARY 19, 2016
Nigerian Governors Partner with Dangote Foundation, Gates Foundation, and USAID to Bring Life-saving Vaccines to Children
Four northern Nigerian governors, Alhaji Aliko Dangote, Bill Gates, and U.S. Ambassador James Entwistle agree to Memorandum of Understanding to improve routine immunization and strengthen primary health care.

KADUNA (January 20, 2016) – In a ceremony at the Kaduna State Government House, Alhaji Aliko Dangote, chair of the Dangote Foundation; Bill Gates, co-chair of the Bill & Melinda Gates Foundation; and U.S. Ambassador to Nigeria, James Entwistle, joined governors from Kaduna, Sokoto, Yobe, and Borno to launch an ambitious new partnership committing political and financial resources to strengthen and sustain routine immunization programs that will save more lives and keep Nigeria polio-free.

The witnessing of new Memorandums of Understanding (MOUs) served as an opportunity to review successes and lessons learned from existing programs in Kano and Bauchi states. To extend these efforts, the executive governor of Kano State signed a fourth-year extension to the state’s existing MOU.

Professor I.F Adewole, Nigeria’s health minister, congratulated the states and partners for making a significant investment in immunization. “These are tough financial times in Nigeria, but the health of children cannot wait. The country has an ambitious plan to introduce new life-saving vaccines over the next several years, and today’s commitments will ensure we can get those vaccines to the children who need them most.”

Through the MOUs, the governors commit to effective governance, leadership, and financial accountability to reduce child illness and death from diseases such as measles, pertussis, and hepatitis through increased routine immunization in their respective states. The other partners will bring the financial and technical support needed to operationalize the program. All signatories pledged to improve routine immunization coverage in northern Nigeria systematically and sustainably, where vaccine coverage rates are low.

“These agreements strengthen our partnerships with Nigerian states working to provide health services to all their citizens,” said Dangote. “Building on their recent success in eliminating polio from the region, Nigerian governors have and will continue to play a vital role in establishing a legacy of sustained commitment to routine immunization.”

The objective of the MOUs is to reach 80 percent of the target population in the signing states with the necessary life-saving vaccines by December 2018 to prevent common childhood diseases and ensure a polio-free environment. To achieve this, key components of the program include the operationalization of the ‘Primary Health Care Under One Roof’ policy that will see a single management body oversee the program. The implementation of regular audits and reports will ensure transparent funding and financial discipline is paramount during implementation. Contributions towards the costs of the program by the Bill & Melinda Gates Foundation, Dangote Foundation, and state governments will be staggered across three years: 30 percent in year one, 50 percent in year two, and 70 percent in year three with the states taking progressive responsibility for financing immunization services.

“These commitments will improve immunization coverage and help provide reliable health services in Nigeria. The States will be able to reap the full return on their investment through the number of lives improved and saved, and communities will remain protected from vaccine-preventable diseases for years to come,” said Gates. “Nigeria’s governors have the opportunity to build health systems strong enough to stop future outbreaks.” “These MOUs offer the model platform to capitalize on the prospects of evidence-based approaches. Results will include stronger systems for immunizations, equal access to routine immunization services, and building capacity for Nigerian states to lead in developing solutions for its people,” said Ambassador Entwistle.

Fondation Merieux [to 23 January 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news

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19 January 2016, Lyon (France)
World’s first dengue vaccine authorized for use in 3 endemic countries
A long awaited tool for dengue prevention and control has finally become available in three endemic countries. During the month of December, health authorities in Mexico, the Philippines and Brazil granted marketing authorization for the first dengue vaccine.

The Partnership for Dengue Control (PDC), hosted by Fondation Mérieux, considers a dengue vaccine to be an essential part of the integrated approach needed to lower the burden of dengue fever globally, which the WHO estimates at nearly 400 million infections each year…

IVI [to 23 January 2016]
http://www.ivi.org/web/www/home

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2016.01.21
First Joint Symposium between IVI and Shanghai Public Health Clinical Center, Jan. 22-23, 2016
IVI and Shanghai Public Health Clinical Center (SPCC), an affiliate of Fudan University, are hosting a vaccine symposium that will take place at IVI on Jan. 22-23. The symposium will be the first meeting of its kind between IVI and SPCC. The multidisciplinary symposium will provide a platform for Korean and Chinese scientists to share data and to discuss international research collaborations across cross-cutting themes such as: a) Emerging and re-emerging infectious diseases; b) Viral infection and immunity; and c) Development of vaccines and protective antibodies. The symposium is sponsored by the National Natural Science Foundation of China and the National Research Foundation of Korea.

Global Fund [to 23 January 2016]
http://www.theglobalfund.org/en/news/

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22 January 2016
(RED) Marks 10 Years of Contributions to Fight AIDS
DAVOS, Switzerland – The Global Fund congratulates (RED) on 10 years of spectacular private sector engagement in the fight against AIDS, as (RED) celebrates its anniversary today at the World Economic Forum in Davos and announces that it has generated contributions of more than US$350 million

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Deal on Mosquito Nets to Yield $93 million in Savings
18 January 2016
GENEVA – As part of a new framework for procuring health products in the most cost-effective and sustainable way, the Global Fund has reached an agreement to purchase insecticide-treated mosquito nets that prevent malaria with projected savings of US$93 million over two years.

By achieving sharply lower prices for nets – a 38 percent reduction from 2013 – the agreement serves the Global Fund’s goal of accelerating progress against malaria, a preventable disease that most seriously affects young children and pregnant women. Building on the Global Fund’s large-scale purchasing power, the framework improves the supply of an important tool to fight the epidemic.

The Global Fund projects US$350 million in mosquito net purchases over the next two years through its Pooled Procurement Mechanism. A tender process has selected 10 suppliers and includes volume commitments from the Global Fund and performance contracts from the suppliers.

The agreement creates a level of certainty for suppliers, allowing them greater visibility and planning time to manufacture and deliver nets. That facilitates lower prices, and yields significant savings for the Global Fund partnership. The US$93 million in projected savings is equivalent to about 40 million additional nets…

Preparing for the Next Pandemic: Fear Cannot be our Motivation
46th Annual Meeting of the World Economic Forum to Focus on Fourth Industrial Revolution
· WHO’s Chan: national and local capacity must be built to prevent economic, growth and stability issues that arise from health crises
· William H. Gates III: Surveillance and primary care are critical to building resiliency
· World Economic Forum is launching a two-year initiative to manage the risk and impact of future epidemics through optimized public-private cooperation under its newly formed Global Challenge Initiative on the Future of Health

Davos-Klosters, Switzerland, 22 January 2016 – The recent Ebola epidemic challenged leaders of all nations and sectors and brought to light the need for resiliency and infrastructure to prevent and mitigate risks of future outbreaks.

“Dealing with epidemics presents growth, economic and stability issues,” said Margaret Chan, Director-General, World Health Organization (WHO), Geneva. “The world is ill prepared. We need national and local capacity,” she added.

Strengthening surveillance and primary care are critical to building resiliency, said William H. Gates III, Co-Chair, Bill & Melinda Gates Foundation, USA. He pointed to the insights that technology can provide: “If we are serious about dealing with future epidemics, we must do simulations. Primary healthcare will be digitized in the next 10 years. This will be a huge benefit.”

There is shared recognition that slow action will not be an option moving forward. “The Ebola epidemic was difficult and complicated, but it was slow moving,” said Jim Yong Kim, President of The World Bank, Washington DC. “It is much more difficult to deal with fast-moving epidemics.”

“The motivation of fear that brought us together should not be our motivation in the future,” said Ertharin Cousin, Executive Director, United Nations World Food Programme (WFP), Rome.

Addressing these issues will stretch beyond these discussions at the Annual Meeting 2016. The World Economic Forum is launching a two-year initiative to manage the risk and impact of future epidemics through optimized public-private cooperation under its newly formed Global Challenge Initiative on the Future of Health.

The initiative’s efforts will harness the capabilities of the healthcare, mining, telecommunications and mobility industries, among others, to work with national governments, international organizations and civil society to create solid, preventative action plans for emerging outbreaks.

“The Forum’s new Global Challenge Initiative on the Future of Health seeks to drive forward a critical transformation, putting health at the centre before healthcare is needed, with two pillars focused on health promotion and disease prevention. It’s imperative that across all sectors, stakeholders and nations, we find ways to allow healthy lives and health security for all,” said Arnaud Bernaert, Head of Global Health and Healthcare Industries at the World Economic Forum.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 23 January 2016)

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Research article
Wasted research when systematic reviews fail to provide a complete and up-to-date evidence synthesis: the example of lung cancer
Perrine Créquit, Ludovic Trinquart, Amélie Yavchitz and Philippe Ravaud
Published on: 20 January 2016

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Debate
The need for pragmatic clinical trials in low and middle income settings – taking essential neonatal interventions delivered as part of inpatient care as an illustrative example
Mike English, Jamlick Karumbi, Michuki Maina, Jalemba Aluvaala, Archna Gupta, Merrick Zwarenstein and Newton Opiyo
Published on: 18 January 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 23 January 2016)

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Research article
eRegistries: Electronic registries for maternal and child health
The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health…
J. Frederik Frøen, Sonja L. Myhre, Michael J. Frost, Doris Chou, Garrett Mehl, Lale Say, Socheat Cheng, Ingvild Fjeldheim, Ingrid K. Friberg, Steve French, Jagrati V. Jani, Jane Kaye, John Lewis, Ane Lunde, Kjersti Mørkrid, Victoria Nankabirwa…
BMC Pregnancy and Childbirth 2016 16:11
Published on: 19 January 2016

BMC Public Health
http://bmcpublichealth.biomed

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Research article
Cost- effectiveness of HPV vaccination regime: comparing twice versus thrice vaccinations dose regime among adolescent girls in Malaysia
The HPV vaccine was introduced to Malaysian national immunization programme in 2010.
Syed Aljunid, Namaitijiang Maimaiti, Amrizal M Nur, Mohd Rushdan Md Noor and Sharifa Ezat Wan Puteh

International Health
Volume 8 Issue 1 January 2016
http://inthealth.oxfordjournals.org/content/current

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EDITORIAL
Violence against children and education
Karen Devries
Int. Health (2016) 8 (1): 1-2 doi:10.1093/inthealth/ihv076
Extract
In most countries around the world, children and adolescents spend more time in school than any other single location besides the family home. Whether or not children and adolescents are able to attend school, whether they are safe in school and whether they leave school with necessary learning and skills, are affected by their experiences of violence—at home, at school and in the community.
Before children get to school, they are often exposed to violence at home. Analysis of the Multiple Indicator Cluster Surveys data from 28 countries shows that 43% of children aged 2–14 years in African countries, and 9% in ‘transitional’ states, have experienced severe physical violence from caregivers.1 There are a host of negative health and social consequences associated with exposure to physical violence in childhood, especially during this early period. These include increased risk of depressive disorders and suicide attempts,2 poor educational attainment3 and increased risk of perpetrating or experiencing intimate partner …

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Innovative financing for late-stage global health research and development: the Global Health Investment Fund
Joseph Robert Fitchetta,*, Julia Fan Lib and Rifat Atuna
Author Affiliations
aHarvard School of Public Health, Boston, MA, UK
bSeven Bridges Genomics, London, UK
Abstract
Innovative financing strategies for global health are urgently needed to reinvigorate investment and new tools for impact. Bottleneck areas along the research and development (R&D) pipeline require particular attention, such as the transitions from preclinical discovery to clinical study, and product development to implementation and delivery. Successful organizations mobilizing and disbursing resources through innovating financing mechanisms include UNITAID, the Global Fund, and Gavi, the Vaccine Alliance. Although precise numbers are poorly documented, estimated investment in low-income settings falls seriously short of local need. This commentary discusses the newly established Global Health Investment Fund as a case study to support late-stage global health R&D.

Journal of Public Health Policy
Volume 37, Issue 1 (February 2016)
http://www.palgrave-journals.com/jphp/journal/v37/n1/index.html

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Original Article
Mass immunization with inactivated polio vaccine in conflict zones – Experience from Borno and Yobe States, North-Eastern Nigeria
A polio eradication team explains how they planned and accomplished success with a mass immunization campaign despite warlike conditions in the two Nigerian states. This example offers important lessons
Faisal M Shuaibu, Gerida Birukila, Samuel Usman, Ado Mohammed, Michael Galway, Melissa Corkum, Eunice Damisa, Pascal Mkanda, Frank Mahoney, Gatei Wa Nganda, John Vertefeuille, Anna Chavez, Sule Meleh, Richard Banda, Almai Some, Hyelni Mshelia, Al-Umra Umar, Ogu Enemaku, and Andrew Etsano
J Public Health Pol 37: 36-50; advance online publication, November 5, 2015; doi:10.1057/jphp.2015.34
Abstract
The use of Inactivated Polio Vaccine (IPV) in routine immunization to replace Oral Polio Vaccine (OPV) is crucial in eradicating polio. In June 2014, Nigeria launched an IPV campaign in the conflict-affected states of Borno and Yobe, the largest ever implemented in Africa. We present the initiatives and lessons learned. The 8-day event involved two parallel campaigns. OPV target age was 0–59 months, while IPV targeted all children aged 14 weeks to 59 months. The Borno state primary health care agency set up temporary health camps for the exercise and treated minor ailments for all. The target population for the OPV campaign was 685 674 children in Borno and 113 774 in Yobe. The IPV target population for Borno was 608 964 and for Yobe 111 570. OPV coverage was 105.1 per cent for Borno and 103.3 per cent for Yobe. IPV coverage was 102.9 per cent for Borno and 99.1 per cent for Yobe. (Where we describe coverage as greater than 100 per cent, this reflects original underestimates of the target populations.) A successful campaign and IPV immunization is viable in conflict areas.

The Lancet
Jan 23, 2016 Volume 387 Number 10016 p311-402 e9-e12
http://www.thelancet.com/journals/lancet/issue/current
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Editorial
Healthy migration needs a long-term plan
The Lancet
Summary
“It occurred to me that no matter where I lived, geography could not save me”, wrote Isabel Wilkerson in The Warmth of Other Suns, recounting stories of black Americans migrating north in the twentieth century. Today, these same words could be used by international migrants who have relocated either by choice or as refugees, many of whom have inadequate access to health care.

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Comment
The future leadership of WHO
Sally C Davies, Somsak Akksilp, Keizo Takemi, Precious Matsoso, Jarbas Barbosa Da Silva Junior
Summary
In about 3 month’s time, the Director-General of WHO will call for nominations from the Executive Board and Member States for her successor. The selection process will then be launched and a new Director-General elected in 2017.

The Lancet
Jan 23, 2016 Volume 387 Number 10016 p311-402 e9-e12
http://www.thelancet.com/journals/lancet/issue/current
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Comment
Implementation of the malaria candidate vaccine RTS,S/AS01
Brian Greenwood, Ogobara K Doumbo
Published Online: 05 November 2015
Summary
As vaccine manufacturers tackle increasingly intractable pathogens, vaccines will be developed that show efficacy, but that are less efficacious than established vaccines. Consequently, regulatory and public health authorities will be faced with difficult decisions about whether such vaccines should be recommended for implementation and, if so, under what circumstances. The RTS,S/AS01 malaria candidate vaccine provides an important example of such a challenge.

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Public health impact and cost-effectiveness of the RTS,S/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models
Melissa A Penny, Robert Verity, Caitlin A Bever, Christophe Sauboin, Katya Galactionova, Stefan Flasche, Michael T White, Edward A Wenger, Nicolas Van de Velde, Peter Pemberton-Ross, Jamie T Griffin, Thomas A Smith, Philip A Eckhoff, Farzana Muhib, Mark Jit, Azra C Ghani
367
Open Access
Summary
Background
The phase 3 trial of the RTS,S/AS01 malaria vaccine candidate showed modest efficacy of the vaccine against Plasmodium falciparum malaria, but was not powered to assess mortality endpoints. Impact projections and cost-effectiveness estimates for longer timeframes than the trial follow-up and across a range of settings are needed to inform policy recommendations. We aimed to assess the public health impact and cost-effectiveness of routine use of the RTS,S/AS01 vaccine in African settings.
Methods
We compared four malaria transmission models and their predictions to assess vaccine cost-effectiveness and impact. We used trial data for follow-up of 32 months or longer to parameterise vaccine protection in the group aged 5–17 months. Estimates of cases, deaths, and disability-adjusted life-years (DALYs) averted were calculated over a 15 year time horizon for a range of levels of Plasmodium falciparum parasite prevalence in 2–10 year olds (PfPR2–10; range 3–65%). We considered two vaccine schedules: three doses at ages 6, 7·5, and 9 months (three-dose schedule, 90% coverage) and including a fourth dose at age 27 months (four-dose schedule, 72% coverage). We estimated cost-effectiveness in the presence of existing malaria interventions for vaccine prices of US$2–10 per dose.
Findings
In regions with a PfPR2–10 of 10–65%, RTS,S/AS01 is predicted to avert a median of 93 940 (range 20 490–126 540) clinical cases and 394 (127–708) deaths for the three-dose schedule, or 116 480 (31 450–160 410) clinical cases and 484 (189–859) deaths for the four-dose schedule, per 100 000 fully vaccinated children. A positive impact is also predicted at a PfPR2–10 of 5–10%, but there is little impact at a prevalence of lower than 3%. At $5 per dose and a PfPR2–10 of 10–65%, we estimated a median incremental cost-effectiveness ratio compared with current interventions of $30 (range 18–211) per clinical case averted and $80 (44–279) per DALY averted for the three-dose schedule, and of $25 (16–222) and $87 (48–244), respectively, for the four-dose schedule. Higher ICERs were estimated at low PfPR2–10 levels.
Interpretation
We predict a significant public health impact and high cost-effectiveness of the RTS,S/AS01 vaccine across a wide range of settings. Decisions about implementation will need to consider levels of malaria burden, the cost-effectiveness and coverage of other malaria interventions, health priorities, financing, and the capacity of the health system to deliver the vaccine.
Funding
PATH Malaria Vaccine Initiative; Bill & Melinda Gates Foundation; Global Good Fund; Medical Research Council; UK Department for International Development; GAVI, the Vaccine Alliance; WHO.

Maternal and Child Health Journal
Volume 20, Issue 1, January 2016
http://link.springer.com/journal/10995/20/1/page/1

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Original Paper
The Influence of Women’s Empowerment on Child Immunization Coverage in Low, Lower-Middle, and Upper-Middle Income Countries: A Systematic Review of the Literature
Sara Thorpe, Kristin VanderEnde, Courtney Peters…
Abstract
Objectives
An estimated 1.5 million children under five die annually from vaccine preventable diseases, and 17% of these deaths can be averted with vaccination. Predictors of immunization coverage, such as maternal schooling, are well documented; yet, preventable under-five mortality persists. To understand these patterns, researchers are exploring the mother–child relationship through an empowerment framework. This systematic review assesses evidence of the relationship between women’s agency as a component of empowerment and vaccine completion among children <5 years in lower-income countries.
Methods
We searched in Socindex, Pubmed, Web of Science and Women’s Studies International for peer-reviewed articles focused on two measures of women’s agency—decision-making and freedom of movement—and child vaccination. Our initial search identified 406 articles and abstracts for screening; 12 studies met the inclusion and exclusion criteria.
Results
A majority (83 %) of studies revealed at least one positive association of measures for women’s agency with immunization coverage. These relationships varied by geographic location, and most studies focused on women’s decision making rather than freedom of movement. No included study came from Latin America or the Middle East.
Conclusions
Overall, women’s agency, typically measured by decision-making, was positively associated with the odds of complete childhood immunizations. Yet, the concept of agency was inconsistently defined and operationalized. Future research should address these inconsistencies and focus on under-represented geographic regions including Latin America and the Middle East.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 23 January 2016)

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Editorial
Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors
Darren B. Taichman, Joyce Backus, Christopher Baethge, Howard Bauchner, Peter W. de Leeuw, Jeffrey M. Drazen, John Fletcher, Frank A. Frizelle, Trish Groves, Abraham Haileamlak, Astrid James, Christine Laine, Larry Peiperl, Anja Pinborg, Peush Sahni, Sinan Wu
| published 20 Jan 2016 | PLOS Medicine
10.1371/journal.pmed.1001950

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Essay
Sharing Individual Participant Data (IPD) within the Context of the Trial Reporting System (TRS)
Deborah A. Zarin, Tony Tse
| published 19 Jan 2016 | PLOS Medicine
10.1371/journal.pmed.1001946

PLoS One
http://www.plosone.org/
[Accessed 23 January 2016]

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Research Article
Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010
David M. Bishai, Robert Cohen, Y. Natalia Alfonso, Taghreed Adam, Shyama Kuruvilla, Julian Schweitzer
| published 19 Jan 2016 | PLOS ONE
Abstract
Introduction
From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change.
Methods
This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data.
Findings
The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector.
Conclusions
Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

Vaccine
Volume 34, Issue 6, Pages 703-874 (3 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/6

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Review Article
A systematic review and meta-analysis on the safety of newly adjuvanted vaccines among children
Pages 714-722
Jorgen Stassijns, Kaatje Bollaerts, Marc Baay, Thomas Verstraeten
Abstract
Introduction
New adjuvants such as the AS- or the MF59-adjuvants improve vaccine efficacy and facilitate dose-sparing. Their use in influenza and malaria vaccines has resulted in a large body of evidence on their clinical safety in children.
Methods
We carried out a systematic search for safety data from published clinical trials on newly adjuvanted vaccines in children ≤10 years of age. Serious adverse events (SAEs), solicited AEs, unsolicited AEs and AEs of special interest were evaluated for four new adjuvants: the immuno-stimulants containing adjuvant systems AS01 and AS02, and the squalene containing oil-in-water emulsions AS03 and MF59. Relative risks (RR) were calculated, comparing children receiving newly adjuvanted vaccines to children receiving other vaccines with a variety of antigens, both adjuvanted and unadjuvanted.
Results
Twenty-nine trials were included in the meta-analysis, encompassing 25,056 children who received at least one dose of the newly adjuvanted vaccines. SAEs did not occur more frequently in adjuvanted groups (RR 0.85, 95%CI 0.75–0.96). Our meta-analyses showed higher reactogenicity following administration of newly adjuvanted vaccines, however, no consistent pattern of solicited AEs was observed across adjuvant systems. Pain was the most prevalent AE, but often mild and of short duration. No increased risks were found for unsolicited AEs, febrile convulsions, potential immune mediated diseases and new onset of chronic diseases.
Conclusions
Our meta-analysis did not show any safety concerns in clinical trials of the newly adjuvanted vaccines in children ≤10 years of age. An unexplained increase of meningitis in one Phase III AS01-adjuvanted malaria trial and the link between narcolepsy and the AS03-adjuvanted pandemic vaccine illustrate that continued safety monitoring is warranted.

Vaccine
Volume 34, Issue 6, Pages 703-874 (3 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/6

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General practitioners’ attitudes and behaviors toward HPV vaccination: A French national survey
Original Research Article
Pages 762-768
Fanny Collange, Lisa Fressard, Céline Pulcini, Rémy Sebbah, Patrick Peretti-Watel, Pierre Verger
Abstract
Objective
General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.
Methods
Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.
Results
Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R2 = 0.10), a decision not to vaccinate one’s own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R2 = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R2 = 0.03).
Conclusion
Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician’s hesitancy about this vaccine.

Vaccine
Volume 34, Issue 6, Pages 703-874 (3 February 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/6

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Future pandemics and vaccination: Public opinion and attitudes across three European countries
Original Research Article
Pages 803-808
Domino Determann, Esther W. de Bekker-Grob, Jeff French, Helene A. Voeten, Jan Hendrik Richardus, Enny Das, Ida J. Korfage
Abstract
Background
Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level.
Methods
We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models.
Results
Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland.
Conclusions
Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 23 January 2016)

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Review: Current Advances in Virus-Like Particles as a Vaccination Approach against HIV Infection
by Chongbo Zhao, Zhujun Ao and Xiaojian Yao
Vaccines 2016, 4(1), 2; doi:10.3390/vaccines4010002 (registering DOI) – published 22 January 2016
Abstract:
HIV-1 virus-like particles (VLPs) are promising vaccine candidates against HIV-1 infection. They are capable of preserving the native conformation of HIV-1 antigens and priming CD4+ and CD8+ T cell responses efficiently via cross presentation by both major histocompatibility complex (MHC) class I and II molecules. Progress has been achieved in the preclinical research of HIV-1 VLPs as prophylactic vaccines that induce broadly neutralizing antibodies and potent T cell responses. Moreover, the progress in HIV-1 dendritic cells (DC)-based immunotherapy provides us with a new vision for HIV-1 vaccine development. In this review, we describe updates from the past 5 years on the development of HIV-1 VLPs as a vaccine candidate and on the combined use of HIV particles with HIV-1 DC-based immunotherapy as efficient prophylactic and therapeutic vaccination strategies.

Value in Health
January 2016 Volume 19, Issue 1, p1-122
http://www.valueinhealthjournal.com/current

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Systematic Reviews
Assessing Patient-Reported Outcomes in Pediatric Populations With Vaccine-Preventable Infectious Diseases: A Systematic Review of the Literature (the PROCHID Study)
Michael Herdman, Christopher K. Hoyle, Victoria Coles, Stuart Carroll, Nancy Devlin
p109–119
Abstract
Objective
To investigate the use of patient-reported outcomes (PROs) in pediatric populations with vaccine-preventable infectious diseases in high-income Western countries.
Methods
Systematic review of PRO use in populations younger than 18 years with any of 17 infectious diseases for which vaccines are available or in development. The search was limited to studies performed in Europe, North America, Australia, and New Zealand and published between January 1, 1990, and July 31, 2013. Searches were conducted in Scopus and PsycINFO, and reference lists were manually searched. Results are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Of 6410 titles and abstracts and 174 full-text articles reviewed, 17 full-text articles were included for data extraction. The largest number of PRO studies was carried out in patients with anogenital warts and rotavirus gastroenteritis. No PRO studies were identified for nine conditions. A total of 24 PRO measures (12 generic and 12 disease-specific) were used in the studies reviewed. Most of the instruments used were of high quality. Proxy responses were occasionally obtained when self-report would have been feasible. No validated disease-specific instruments for children with any of the conditions studied were found.
Conclusions
The paucity of studies and PRO instruments to assess pediatric health status in vaccine-preventable infectious diseases, and the lack of a standardized approach to measurement, makes it difficult to capture the impact of disease and the benefit of vaccination and could potentially hinder decision making. Guidelines from relevant bodies to steer research in this area would be useful.

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.

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New York Times
http://www.nytimes.com/
Accessed 23 January 2016
Mosquito-Borne Zika Virus Found in 3 New York State Patients
January 23, 2016 – By RICK ROJAS – State health officials said on Friday that three people in New York State, including one from Queens, tested positive for Zika, a mosquito-borne virus that has prompted concern as it has spread rapidly, mostly in Latin America and the Caribbean.
All three had traveled to places outside the United States where the virus had been spreading. Besides the person from New York City, the patients were from Nassau and Orange Counties. One person has fully recovered, and the two others are recovering without complications, according to a statement the State Health Department issued on Friday…

In Pakistan, a Final Push to Wipe Out Polio
January 21, 2016 – By BINA SHAH –
…One effort to resolve that problem was the introduction in Punjab last year of a smartphone app on which the region’s 3,700 vaccinators could keep track of their work. Now, instead of going household to household, they go to a center where children have been assembled for vaccination. The vaccinators then send the data via phone to a central office. Using this approach, vaccinators’ attendance rates, which at times had been as low as 21 percent, have risen to 95 percent to 100 percent.

Officials also have analyzed satellite images to target population clusters, and have produced a color-coded map showing where vaccinations have and haven’t reached children in need.
By now, the rates of vaccination with the two types of antigens have risen beyond 70 percent, a critical threshold toward the goal of eradication.

Encouraged by those results, the Punjab government and the World Bank plan to invest in 10,000 more vaccinator smartphones, which will also capture a child’s photo and the mother’s cellphone number, enabling automatic reminders to a mother that a child is due for a vaccine scheduled near home.

The Punjab government is eager to share its technological know-how with the rest of the nation. One target area this year is remote Khyber Pakhtunkhwa.
And if Sindh and Baluchistan follow suit, there’s every chance that Pakistan can catch up quickly to the rest of the world. A polio-free Pakistan — and globe — may be coming sooner than you think.

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 23 January 2016
Gates Foundation Sees Possible End to Polio Soon
By Khadeeja Safdar, Rebecca Blumenstein
Jan. 22, 2016 1:35 pm ET

World
Health Threats Spur Vaccine Hunt
Ebola and Zika virus have catapulted the threat of infectious-disease epidemics to a top spot at Davos
By Betsy McKay
Updated Jan. 21, 2016 3:35 a.m. ET

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Washington Post
http://www.washingtonpost.com/
Accessed 23 January 2016
As Zika virus spreads, El Salvador asks women not to get pregnant until 2018
Several Latin American countries are urging a pause in having babies.
Joshua Partlow | Foreign | Jan 22, 2016

More pandemics are inevitable, and the U.S. is grossly underprepared
Just as nations invest in military preparedness, a panel says, so should they confront disease.
Editorial Board | Editorial-Opinion | Jan 21, 2016
WHILE IT has not gained much attention in the United States, Brazil has been struck in recent months with an outbreak of Zika virus that has infected hundreds of thousands of people. Most of the time the symptoms are mild and flu-like, but in some cases health officials say the virus has led to birth defects in babies born to women who were infected in pregnancy. The virus is spread by small insects such as mosquitoes or fleas, and there is no known vaccine to prevent infection.

The Zika story might seem easy to dismiss if one is not living in Brazil. Is this just another unpleasant headline about misery far away?

Not quite. In the aftermath of the mishandled and tardy reaction to the Ebola epidemic in West Africa in which more than 11,000 people died, an independent and authoritative commission was set up in the United States to look ahead and draw lessons from this and other recent waves of infectious disease. The 17-member Commission on a Global Health Risk Framework for the Future issued its final report on Jan. 13, and the panel’s conclusions are a wake-up call about the threat of pandemic disease that could originate almost anywhere and spread everywhere. Despite all the advances of science, “the global community has massively underestimated the risks that pandemics present to human life and livelihoods,” the group declared. “There are very few risks facing humankind that threaten loss of life on the scale of pandemics.”

The 1918 influenza pandemic killed anywhere from 50 million to 100 million people; in catastrophic mortality events since 1900, only World War II caused more deaths. Since it first appeared, HIV/AIDS has killed more than 35 million. Although the tolls have been far lower, five outbreaks in the past 15 years have been worrying: severe acute respiratory syndrome, or SARS; two influenza waves, H5N1 and H1N1; Ebola; and Middle East respiratory syndrome, or MERS.

As the world becomes more globalized with the movement of goods and people, as climate change disrupts the environment, and as pathogens move between humans and animals, cocktails of infectious disease will form, spread and sicken. Already a dozen cases of Zika virus have been reported in the United States, so far only among people who had traveled outside the country. “The threat from infectious diseases is growing,” the panel warns, adding that “the conditions for infectious disease emergence and contagion are more dangerous than ever.” Moreover, “further outbreaks of new, dormant, or even well-known diseases are a certainty.”

The commission insists that pandemic risks must be treated not as distant, unavoidable possibilities but as real national security threats. Just as nations invest in military preparedness, the panel says, so should they confront disease. In fact, this has been long neglected in many places. The panel calls for measures to bolster public health systems in individual countries; creating a rapid-response capability; strengthening the World Health Organization; and funding research and development of new therapies, all for about $4.5 billion a year. That’s the equivalent of three Powerball drawings like the one on the day of the panel’s report.

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 david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_16 January 2016

– blog edition: comprised of the approx. 35+ entries posted below on 17 January 2016.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

EBOLA/EVD [to 16 January 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO
Editor’s Note:
The regular, weekly Ebola Situation Report was not posted on the WHO website.

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Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur
WHO News release
14 January 2016 | Liberia – Today, WHO declares the end of the most recent outbreak of Ebola virus disease in Liberia and says all known chains of transmission have been stopped in West Africa. But the Organization says the job is not over, more flare-ups are expected and that strong surveillance and response systems will be critical in the months to come….

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New Ebola case in Sierra Leone. WHO continues to stress risk of more flare-ups
WHO statement
15 January 2016
A new case of Ebola has been confirmed in Sierra Leone, reflecting the ongoing risk of new flare-ups of the virus in the Ebola-affected countries.

The Sierra Leone government acted rapidly to respond to this new case. Through the country’s new emergency operations centre, a joint team of local authorities, WHO and partners are investigating the origin of the case, identifying contacts and initiating control measures to prevent further transmission.
WHO stressed in a statement yesterday (14 January), that Guinea, Liberia and Sierra Leone remain at high risk of additional small outbreaks of Ebola in the coming months due to the virus persisting in survivors after recovery.

“We are now at a critical period in the Ebola epidemic as we move from managing cases and patients to managing the residual risk of new infections,” said Dr Bruce Aylward, WHO’s Special Representative for the Ebola Response, yesterday. “We still anticipate more flare-ups and must be prepared for them.”
Sierra Leone is still in a 90-day period of enhanced surveillance following the declaration on 7 November 2015 of the end of Ebola transmission in the country. This period is designed to ensure no hidden chains of transmission have been missed and to detect any new flare-ups of the disease.

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WHO – Press Conference: Update on Ebola situation (Geneva, 14 January 2016)
14 Jan 2016 [Video: 40:45]
– Subject: Liberia 42-day announcement – Update on Ebola situation in West Africa
Speaker: Dr Rick Brennan, Director, Emergency Risk Management and Humanitarian Response, WHO
[Q&A on ebola vaccines and status begins at about 00:24]

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United Nations
Briefing on progress of the Ebola outbreak response and recovery efforts and to discuss priorities going forward – General Assembly
13 Jan 2016 [Video: 1:58]

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WHO Director-General briefs UN General Assembly on Ebola
Dr Margaret Chan
Director-General of the World Health Organization
Briefing to the United Nations General Assembly, New York, United States of America
13 January 2016
[Excerpt, closing comments]
…Since March of last year, WHO has documented ten flare-ups of infection that were not part of the original outbreak. These very small incidents followed the reintroduction of virus persisting in survivors.

The good news is that countries immediately and rapidly stopped each of these flares. Equally reassuring, research shows that casual contact with survivors poses no risk to their families.
Vigilance and response capacity must be maintained throughout 2016. By the end of this year, we expect that all survivors will have cleared the virus.

The next three months are the most critical, as national emergency response mechanisms and partners scale down or close their operations. Responsibility for managing survivor care, surveillance, and the response to further possible flares will shift back to ministries of health.

While the risk of new flares is rapidly declining, these countries continue to need international solidarity to ensure a safe transition and sufficient national response capacity. National leadership is outstanding.

The period of intense vigilance will continue as recovery proceeds. Strong recovery plans, developed by each of the three governments, will make their health systems more resilient, leaving them better prepared to prevent, detect, and respond to future outbreaks.

We are grateful to participants at last July’s International Recovery Conference in New York for their generous support. Ebola delivered an extremely severe and shattering blow to societies and economies.
Recovery will take some time. While the job is by no means finished, no one anticipates that the situation will return to what we were seeing 15 months ago.

The determination is fierce. The many steps taken at national and international levels have had a decisive impact. No one will let this virus take off and run away again…

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Welcoming End of Ebola Flare-Up in Liberia, Secretary-General Calls upon Global Community to Continue Supporting Affected Countries
14 January 2016
SG/SM/17456-AFR/3302

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World Bank [to 16 January 2016]
http://www.worldbank.org/en/news/all
January 14, 2016
Statement by World Bank Group President on the Declaration of the End of Latest Ebola Outbreak in Liberia
West Africa Now Has No Known Ebola Cases
WASHINGTON,—World Bank Group President Jim Yong Kim issued the following statement on today’s announcement declaring the end of Ebola transmission…
Date: January 14, 2016 Type: Press Release

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MSF/Médecins Sans Frontières [to 16 January 2016]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
End of Ebola Outbreak in West Africa: World Must Learn Lesson for Future Outbreaks, Says MSF
January 14, 2016
BRUSSELS/NEW YORK—As Liberia today celebrates 42 days without any new Ebola infections—effectively marking the end of the Ebola outbreak in West Africa—the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) calls on the global health community to draw on lessons learned during the epidemic to be better prepared for future similar outbreaks.

“Today is a day of celebration and relief that this outbreak is finally over,” said Joanne Liu, MSF’s international president. “We must all learn from this experience to improve how we respond to future epidemics and to neglected diseases. This Ebola response was not limited by lack of international means but by a lack of political will to rapidly deploy assistance to help communities. The needs of patients and affected communities must remain at the heart of any response and outweigh political interests.”

From the very beginning of the epidemic, MSF responded in the worst affected countries—Guinea, Liberia, and Sierra Leone—by setting up Ebola treatment centers and providing psychological support and conducting health promotion activities, surveillance, and contact tracing. At its peak, MSF employed nearly 4,000 national staff and over 325 international staff to combat the epidemic across the three countries. MSF admitted a total of 10,376 patients to its Ebola treatment centers, of which 5,226 turned out to be confirmed Ebola cases. MSF continues to run support clinics for Ebola survivors in Liberia, Sierra Leone, and Guinea.

“We should congratulate all the people who tirelessly contributed to putting an end to this devastating and unprecedented epidemic, while we should also remember the many health professionals who tragically lost their lives on the Ebola frontline,” said Brice de le Vingne, MSF’s director of operations. “This devastating epidemic hit nearly 40 years after the first discovery of Ebola in 1976, yet the lack of research and development on Ebola meant that even today after the medical trials and at the end of the epidemic, there is no effective treatment. There is also a need to obtain licensure for a new vaccine that has been developed.”
With such an unpredictable disease, it is crucial that vigilance and the capacity to respond to new cases be maintained in the region as well as a well-functioning surveillance and rapid response system.

Ebola survivors are particularly vulnerable, and they face continuing health challenges such as joint pain, chronic fatigue, and hearing and vision problems. They also suffer from stigma in their communities and need specific and tailored care. MSF has invested in setting up Ebola survivor clinics in Liberia, Sierra Leone, and Guinea, providing a comprehensive care package, including medical and psychosocial care and protection against stigma.

“Throughout the epidemic, I witnessed how communities were ripped apart,” said Hilde de Clerck, an MSF epidemiologist who worked in Liberia, Guinea, and Sierra Leone. “Initially, the response from the global health community was really paralyzed by fear. It was a horrible experience being left on our own and constantly running behind the wave of the epidemic. But it was very empowering to see how extremely dedicated all the national staff were, and fortunately other international actors eventually got involved. For the next epidemic, the world should stand ready to intervene much faster and more efficiently.”

MSF responded to the Ebola epidemic in the three worst affected countries—Guinea, Sierra Leone and Liberia—and also responded to cases in Nigeria, Senegal, and Mali, as well as a separate epidemic in Democratic Republic of Congo in 2014. In total, the organization has spent over 96 million euros on tackling the epidemic.

Already-weak public health systems have been seriously damaged by the epidemic, so MSF has also decided to invest efforts in their recovery. New projects on maternal and child health should open soon in different towns of Sierra Leone (Kabala, Magburaka, Kenema), and a new pediatric hospital has already opened in Monrovia (Liberia). MSF continues to run an HIV project in Conakry, Guinea, in collaboration with health authorities.

POLIO [to 16 January 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 13 January 2016
:: This week India marks five years without reporting a single case of wild polio, a remarkable achievement. Today, lessons learned in India and Nigeria are being used to drive progress in the last two polio-endemic countries: Pakistan and Afghanistan. Read more here.
:: There are three months to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine. This will be an important milestone in achieving a polio-free world. Read more here.

Selected content from country-level reports
Afghanistan
:: Subnational Immunization Days (SNIDs) were carried out in the south on 10 to 12 January using bOPV. Further SNIDs are planned from 14 to 16 February, also using bOPV and National Immunization Days (NIDs) are planned from 13 to 15 March using tOPV, prior to the switch. Read more about the switch here.
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 2 December 2015 in Punjab province. The total number of WPV1 cases for 2015 is now 52, compared to 296 reported for 2014 by this time last year. A total of 306 cases occurred in Pakistan in 2014.
:: One new WPV1 environmental positive was detected in Peshawar district in Khyber Pakhtunkhwa. The sample was collected on 11 December 2015.
Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in the past week, in Longxan district of Xaysomboune province with onset of paralysis on 18 December 2015. The total number of cVDPV1 cases in 2015 is now six.
:: An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces.
Myanmar
:: 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. AFP surveillance quality indicators are acceptable at the national level, but subnational gaps persist.
:: While WHO assesses the risk of international spread from Myanmar to be low, surveillance and immunization activities are being strengthened in neighbouring countries.

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New York Times
http://www.nytimes.com/
Accessed 16 January 2016
Suicide Bomb Near Polio Center in Pakistan Kills at Least 16
By IHSANULLAH TIPU MEHSUDJAN. 13, 2016
ISLAMABAD, Pakistan — At least 16 people were killed on Wednesday in a suicide bombing outside a polio vaccination center in the southwestern Pakistani city of Quetta, officials and witnesses said.

Thirteen of the victims were police officers, said Syed Imtiaz Shah, a senior official with the Quetta police. He said the officers were there to guard polio workers, who are often targeted by Islamist militants in Pakistan.

The attack came on the third day of a vaccination campaign in the province of Baluchistan, of which Quetta is the capital. The bomber, who was also killed, walked up to police officers and detonated what Mr. Shah said amounted to more than 20 pounds of explosives.

A spokesman for the Pakistani Taliban, Muhammad Khurrasani, claimed responsibility for the attack on the militants’ behalf. Two civilians and a paramilitary police officer were also killed, and 10 police officers and nine civilians were wounded…

WHO & Regionals [to 16 January 2016]

Syrian Arab Republic: Crossing borders with life-saving support
12 January 2016 — Almost 6.5 million Syrians remain displaced within the country and more than 4 million are living in Egypt, Iraq, Jordan, Lebanon and Turkey. WHO’s Emergency Support Team, based in Amman, coordinates the distribution of medical supplies and equipment to Syrian Arab Republic and neighbouring countries dealing with the crisis…

.Appeal for communities under siege in Syria
January 2016 — WHO and UNICEF delivered urgently-needed humanitarian supplies to the besieged communities of Madaya, Foua’a and Kafraya in Syria. Much of the community in Madaya is severely malnourished with only 2 doctors for a town of 40,000.

Zika virus infection: Frequently asked questions
January 2016 — Zika fever is a mosquito-borne viral disease caused by Zika virus, consisting of mild fever, rash, headaches, arthralgia, myalgia, asthenia, and non-purulent conjunctivitis, occurring about 3 to 12 days after the mosquito bite.

Weekly Epidemiological Record (WER) 15 January 2016, vol. 91, 2 (pp. 1¬¬3–20)
Contents:
13 Human rabies transmitted by dogs: current status of global data, 2015

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:: WHO Regional Offices
WHO African Region AFRO
:: New Ebola Case in Sierra Leone; WHO continues to stress risk of more flare-ups
WHO statement – 15 January 2016

WHO Region of the Americas PAHO
:: PAHO helps countries in the Americas prepare for spread of Zika (01/16/2016)

WHO South-East Asia Region SEARO
:: Five polio-free years; efforts must continue
By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
On 13 January, WHO South-East Asia Region completes five years without any case of wild poliovirus. This is a remarkable achievement in view of the continued threat of poliovirus importation from the remaining polio-endemic countries.
Countries in the Region have been making commendable efforts, stepping up vigilance against polio and continuing to protect children against the crippling virus. WHO South-East Asia Region reported its last case of wild poliovirus in West Bengal, India, in 2011, which facilitated polio-free certification of the Region on 27 March 2014…

WHO European Region EURO
:: What can countries expect during this year’s influenza season? 13-01-2016

WHO Eastern Mediterranean Region EMRO
:: WHO Regional Director’s statement on urgent and immediate access into Taiz City for delivery of health supplies
14 January 2016
:: WHO’s Regional Director and Minister of Health of Yemen discuss Yemen’s critical health needs
13 January 2016

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 16 January 2016]
http://www.cdc.gov/media/index.html

Transcript for CDC Telebriefing: Zika Virus Travel Alert
SATURDAY, JANUARY 16, 2016

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CDC issues interim travel guidance related to Zika virus for 14 Countries and Territories in Central and South America and the Caribbean
FRIDAY, JANUARY 15, 2016
Regions and certain countries where Zika virus transmission is ongoing: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy…

NIH [to 16 January 2016]
http://www.nih.gov/news/releases.htm

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January 14, 2016
Dengue vaccine enters phase 3 trial in Brazil
— Investigational vaccine to prevent ‘breakbone fever’ developed at NIH.
A large-scale clinical trial to evaluate whether a candidate vaccine can prevent the mosquito-borne illness dengue fever has been launched in Brazil. The vaccine, TV003, was developed by scientists in the laboratory of Stephen Whitehead, Ph.D., at NIH’s National Institute of Allergy and Infectious Diseases (NIAID). The Butantan Institute, a non-profit producer of immunobiologic products for Brazil, licensed the NIAID dengue vaccine technology and is sponsoring the placebo-controlled, multi-center Phase 3 trial using test vaccine produced in Sao Paulo…

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January 12, 2016
New NIH awards will support development of therapeutic alternatives to traditional antibiotics
— NIAID has awarded approximately $5 million in funding for 24 research projects seeking to develop non-traditional therapeutics for bacterial infections.

IVI [to 16 January 2016]
http://www.ivi.org/web/www/home

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[Undated]
New affordable oral cholera vaccine receives prequalification by the World Health Organization
– Oral cholera vaccine manufactured by Korean company EuBiologics following technology transfer from the International Vaccine Institute (IVI)
– Vaccine developed through international public-private partnership involving IVI and EuBiologics
– Euvichol will be used to protect the world’s underprivileged populations from cholera

SEOUL, KOREA – EuBiologics Co., Ltd. (EuBiologics) and the International Vaccine Institute (IVI) announced today that Euvichol®, an inactivated oral cholera vaccine (OCV), recently received prequalification from the World Health Organization (WHO). Developed to protect against epidemic and endemic cholera, the two-dose oral vaccine is low-cost and ready to use in a single-dose vial, facilitating its use in mass immunization programs in low-income countries.

“I am very pleased that Euvichol®, a vaccine whose development was enabled by IVI, was prequalified by WHO,” said Dr. Jerome Kim, IVI’s Director General. “This milestone shows that public-private partnerships – such as that between IVI and EuBiologics – are effective in developing vaccines against diseases of the poor like cholera.”…

…“The prequalification of Euvichol® demonstrates the power of partnerships to successfully develop vaccines,” said Dr. Anita Zaidi, Head of Enteric and Diarrheal Diseases at the Bill & Melinda Gates Foundation. “We are pleased to be a part of this effort and congratulate IVI and Eubiologics for this major milestone. Euvichol®will go a long way in easing global cholera vaccine supply constraints at the global level, however a lot remains to be done to make sure the cholera vaccine will be used in populations and countries where cholera is a problem.”

IAVI International AIDS Vaccine Initiative [to 16 January 2016]
http://www.iavi.org/press-releases/2016

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January 15, 2016
Study Provides Additional Insights for AIDS Vaccine Design
A new study helps AIDS vaccine researchers further understand how HIV interacts with its host, and how some people naturally produce antibodies against the virus’ many variants. The study, authored by researchers from the International AIDS Vaccine Initiative (IAVI) and partners, was published 14 January in PLOS Pathogens…

The new study suggests that both viral and host factors may be critical for the development of such broadly neutralizing antibodies (bNAbs), and that one “supersite” on HIV’s envelope protein may be a particularly favorable target for vaccine design. This research utilized samples from 439 newly infected volunteers in Protocol C, a large observational study by IAVI and partners in Eastern and South Africa supported by the United States Agency for International Development (USAID). About 15 percent developed bNAb responses, on average three years after infection. Gender, age and geographical origin appeared to have no influence on the development of bNAbs. However, the study showed that broad neutralization was associated with high viral load, low levels of particular immune cells, infection with one particular HIV subtype, and the presence of a particular gene in the host.

“These findings add to the important lessons that AIDS vaccine science continues to learn from large observational studies like Protocol C,” said Mark Feinberg, IAVI President and CEO. “The volunteers who participate in these studies are critical and valued partners in the effort to design a safe and effective AIDS vaccine.”

“Broadly Neutralizing Antibody Responses in a Large Longitudinal Sub-Saharan HIV Primary Infection Cohort,” by Elise Landais, Pascal Poignard, et al.

Sabin Vaccine Institute [to 16 January 2016]
http://www.sabin.org/updates/pressreleases

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January 13, 2016
Kenneth Kelley and Jordan Orange Join Sabin Vaccine Institute Board of Trustees
WASHINGTON, D.C. —— The Sabin Vaccine Institute (Sabin) is pleased to announce the election of Kenneth Kelley, M.B.A., and Jordan Orange, M.D., Ph.D., to its Board of Trustees. Mr. Kelley is a Harvard Senior Advanced Leadership Fellow, focusing on global health, biosecurity and the market inefficiency leading to a lack of vaccines against neglected tropical diseases (NTDs) and emerging pandemic threats. Dr. Orange is chief of Immunology, Allergy and Rheumatology, and professor and section head for Immunology, Allergy and Rheumatology in the pediatrics department at Baylor College of Medicine.

Global Fund [to 16 January 2016]
http://www.theglobalfund.org/en/news/

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12 January 2016
Challenges and Opportunities in 2016: Mark Dybul Looks Ahead
It is an exciting time in global health, and an extremely challenging one. Mark Dybul, Executive Director of the Global Fund spoke about current trends.

:: What are the greatest challenges and opportunities in 2016?
The road ahead calls for new thinking, for practical solutions that serve people who are being left behind. In global health, we have to think about our work beyond the disease or development paradigms, and focus on the person. How do we find innovative ways to empower individuals? Connecting education and health, especially where it enables girls to become women with opportunity, is an area that needs more work.

Building resilient and sustainable systems for health is another. Making a health clinic accessible may mean hiring more health workers, or an innovative health insurance scheme, but it also can mean lifting stigma and discrimination. Whatever helps an individual remove barriers to health, especially for key populations.

We face very serious challenges. Achieving impact in the last decade was relatively easy because the need was so great – almost anything you did had impact. However, the next stage of ending the epidemics involves confronting social and cultural issues. Our investments have to be more focused, nuanced and interwoven. And we have to put human beings at the center of our response

Climate change and the refugee crisis are big challenges for the world to deal with. By building lasting health programs and systems that boost the capacity and resilience of a country’s health system and its people, the Global Fund mission can play its part in improving humanity in a way that is connected with other challenges.

:: What do you mean when you speak of the need to put human beings at the center of our response?
If a scientific or medical response to the three epidemics was enough to end them, our mission would be complete. We already have the tools to defeat HIV, TB and malaria, but the diseases are still with us. Putting human beings at the center of our response means going beyond the work we have already done. We have to work hard to reach key populations, expanding programs we have and finding new ways, too. We have to think about stigma and poverty, and how they are connected with epidemics.

Overall, we have to expand access to health care and education and economic empowerment – powerful tools for the prevention and treatment of HIV, TB and malaria.

Whether it’s a 14 year old girl in Lesotho or a migrant forestry worker in Myanmar, every human being should be empowered to make smart decisions about their health, not subjected to the lottery of infectious disease. Education is one avenue toward progress, and linking education, especially for girls, must be a priority.

The Global Fund has a strong record of putting human beings at the center of its approach, inspired by solidarity and compassion. Today, we can point to great results: the partnership has saved more than 17 million lives, through the end of 2014. Each life saved represents expanded opportunity and greater social justice for families and communities worldwide – it inspires even greater belief in the power of the human spirit and what we can achieve by working together.

:: What gives you hope about ending the epidemics?
Every time a health program assists a girl to make powerful, positive decision about her health, or prevents a mother from transmitting HIV to her baby, or protects a young child from malaria or a grown man from tuberculosis, we are adding to the momentum of human opportunity and progress. When girls are given the opportunity to stay in school, and make informed choices that allow them to grow into empowered women, it breeds human progress. Wherever I see that, it contributes to my hope and my confidence that we can get there. But there still is a tremendous amount of work to do, and it is going to take more commitment, and a commitment to news ways of thinking, to get us there.

European Medicines Agency [to 16 January 2016]
http://www.ema.europa.eu/

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15/01/2016
Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 11-14 January 2016
Measuring the impact of pharmacovigilance activities – PRAC adopts new strategy
The Pharmacovigilance Risk Assessment Committee (PRAC), at its January meeting, adopted a ‘Strategy on measuring the impact of pharmacovigilance activities’. The new strategy details how to gather data and knowledge on the concrete effect of measures and processes meant to ensure the safe use of medicines for patients in the European Union (EU)…

Measuring the impact of such activities is crucial in order to know whether the measures taken to minimise the risks of a medicine have been effective. Measuring the impact of pharmacovigilance activities also allows regulators to determine which activities are most successful and so helps to promote best practice and improve pharmacovigilance.

The new strategy adopted by the PRAC builds on existing activities in the Member States and the Agency and relies on a collaborative approach with stakeholders. The strategy will focus on four areas: measuring the effectiveness of risk-minimisation measures on specific products; measuring the effect of specific pharmacovigilance processes (e.g. spontaneous reporting of suspected adverse reactions, signal management); investigating how to ensure engagement of key stakeholders (e.g. patients, healthcare professionals); and further improving methodologies to determine the effect of pharmacovigilance activities on public health…

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12/01/2016
Human medicines: highlights of 2015
93 medicines recommended for approval – 39 new active substances
The European Medicines Agency (EMA) has released an overview of its 2015 key recommendations in relation to the marketing authorisations of new medicines and the safety monitoring of authorised medicines…

WIPO World Intellectual Property Organization [to 16 January 2016]
http://www.wipo.int/pressroom/en/

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Jan 14, 2016 PR/2016/787
WIPO Re:Search Welcomes Institut Pasteur as Consortium Surpasses 100 Members
WIPO Re:Search has now surpassed 100 members and is just shy of 100 agreements to share intellectual property in the fight against neglected tropical diseases, tuberculosis and malaria – both significant milestones for the consortium as it heads into its fifth full year of operation.

The storied French research foundation Institut Pasteur became the 101st member of WIPO Re:Search last month as the consortium also signed its 99th collaboration to bring together research bodies aiming to promote new diagnostics, vaccines and treatments for diseases that afflict more than one billion people worldwide, largely in poorer regions.

“WIPO Re:Search continues to expand its network across the globe, bringing together leading research organizations from developing and developed countries to share intellectual property and scientific data in order to accelerate drug discovery to fight against diseases that affect the world’s most-vulnerable populations,” said WIPO Director General Francis Gurry. “Institut Pasteur now brings more than a century of pioneering research in medicine and vaccines to that effort, further strengthening the work of this unique collaboration.”

WIPO Re:Search allows organizations to share their intellectual property, compounds, expertise, facilities and know-how royalty-free with qualified researchers worldwide working on new solutions for the maladies, which affect more than one billion people across the globe…

“By joining the WIPO Re:Search consortium, Institut Pasteur looks forward to furthering its longstanding commitment to combating infectious diseases and its mission together with the Institut Pasteur International Network in 33 countries to contribute solving global health issues, in particular through technology transfer and partnerships”, said Christian Bréchot, President of the Institut Pasteur…

GHIT Fund [to 16 January 2016]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.

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2015.12.17
Event Report: International Conference on Universal Health Coverage in the New Development Era
The Government of Japan, Japan International Cooperation Agency (JICA) and Japan Center for International Exchange (JCIE) co-hosted the International Conference on Universal Health Coverage (UHC) in the New Development Era: Toward Building Resilient and Sustainable Health Systems on December 16, 2015 in Tokyo, Japan. The conference explored the role of the UHC in the transition from the Millennium Development Goals (MDGs) to the 2030 Agenda for Sustainable Development and in enhancing preparedness and responses to health crises based on lessons learned from the recent Ebola crisis. Experts in global health, such as leaders from the Bill & Melinda Gates Foundation, Global Fund, World Bank Group, and World Health Organization participated…

£3bn a year needed to prepare the world for future pandemics
13 January 2016
An investment of less than 50p per year for every person on the planet (£3bn/$4.5bn total) would make the world significantly more resilient to the threat of infectious disease, according to a group of international experts convened in the wake of the Ebola crisis.

The report of the Commission on Creating a Global Health Risk Framework for the Future, published today, highlights infectious diseases as one of the biggest risks facing humankind. It estimates that pandemics cost the world more than £40bn ($60bn) each year, and match wars and natural disasters in their capacity to endanger human life and health and disrupt societies.

Yet compared with other high-profile threats to human and economic security – such as war, terrorism, nuclear disasters, natural catastrophes and financial crises – preparation for pandemics has received chronic under-investment.

The Commission recommends that urgent action be taken during 2016 to increase private, philanthropic and government spending on pandemic preparedness. It lays out comprehensive recommendations for bolstering the world’s ability to prevent and prepare for future disease outbreaks, including:
:: Reinforcing national public health capabilities and infrastructure as the first line of defence against potential pandemics, especially in low-income countries.

:: Establishing a permanent WHO Center for Health Emergency Preparedness and Response, with sustainable funding and operational independence, which would lead and co-ordinate defences and action against pandemic threats.

:: Accelerating research and development in the infectious disease arena, through annual global investment of at least £686m ($1bn) a year in prevention and treatment of threats, and a co-ordinating body to prioritise and oversee this.

The Wellcome Trust sponsored the creation of the Commission and the report, in partnership with seven other philanthropic and government organisations including the Bill and Melinda Gates Foundation and the Rockefeller Foundation, in response to the Ebola outbreak that began in 2014. It was coordinated by the US National Academy of Medicine.

Dr Jeremy Farrar, Director of the Wellcome Trust and a member of the Commission’s International Oversight Group, said:
“Few global events match epidemics and pandemics in potential to disrupt human security and inflict loss of life and economic and social damage. Yet for many decades, the world has invested far less in preventing, preparing for and responding to these threats than in comparable risks to international and financial security.

“Today’s report shows that by spending the equivalent of around 40p a year for every person on the planet, we could make our world much safer against the threat of infectious disease outbreaks.
“The cornerstones of the proposed framework must be the creation of a strong, independent WHO Center to lead outbreak preparedness and response, and an expert body to galvanise the research and development of vaccines, therapies, diagnostics and other tools.

“While the WHO has already taken welcome steps to improve co-ordination of health emergency preparedness and response, the report rightly recommends further change, with a central body that is a permanent part of the WHO system and that has considerable operational independence and a sustainable budget.

“The report is also right to recommend the creation of a WHO expert committee to inspire, support and oversee research and development into vaccines, drugs and other countermeasures. This would allow this essential field to benefit from the legitimacy and authority of the WHO, while ensuring that investment decisions are made by people with the expertise to judge health need and scientific merit. This panel could act as a convening and co-ordinating body that linked parallel efforts to finance and prioritise research and development in specialised fields such as vaccines, drug-resistant infections and personal protective equipment.

“The Commission should be congratulated on an excellent report, with recommendations that are clear, necessary and achievable. What we need to see now is action. The WHO’s leadership and its member states must make 2016 the year in which we learn the lessons of past epidemics and pandemics and implement these valuable measures, to build a more resilient global health system.”

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 16 January 2016)

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Research article
Postal recruitment and consent obtainment from index cases of narcolepsy
Access to research volunteers may be hampered by low numbers of cases and few eligible participants for rare diseases in clinical settings.
Gambo Aliyu and Salah M. Mahmud
BMC Medical Ethics 2016 17:6
Published on: 16 January 2016

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Debate
Developing a new justification for assent
Amanda Sibley, Andrew J. Pollard, Raymond Fitzpatrick and Mark Sheehan
BMC Medical Ethics 2016 17:2
Published on: 12 January 2016
Abstract
Background
Current guidelines do not clearly outline when assent should be attained from paediatric research participants, nor do they detail the necessary elements of the assent process. This stems from the fact that the fundamental justification behind the concept of assent is misunderstood. In this paper, we critically assess three widespread ethical arguments used for assent: children’s rights, the best interests of the child, and respect for a child’s developing autonomy. We then outline a newly-developed two-fold justification for the assent process: respect for the parent’s pedagogical role in teaching their child to become an autonomous being and respect for the child’s moral worth.
Discussion
We argue that the ethical grounding for the involvement of young children in medical decision-making does not stem from children’s rights, the principle of best interests, or respect for developing autonomy. An alternative strategy is to examine the original motivation to engage with the child. In paediatric settings there are two obligations on the researcher: an obligation to the parents who are responsible for determining when and under what circumstances the child develops his capacity for autonomy and reasoning, and an obligation to the child himself. There is an important distinction between respecting a decision and encouraging a decision. This paper illustrates that the process of assent is an important way in which respect for the child as an individual can be demonstrated, however, the value lies not in the child’s response but the fact that his views were solicited in the first place.
Summary
This paper demonstrates that the common justifications for the process of assent are incomplete. Assent should be understood as playing a pedagogical role for the child, helping to teach him how specific decisions are made and therefore helping him to become a better decision-maker. How the researcher engages with the child supports his obligation to the child’s parents, yet why the researcher engages with the child stems from the child’s moral worth. Treating a child as having moral worth need not mean doing what they say but it may mean listening, considering, engaging or involving them in the decision.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 16 January 2016)

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Research article
Comparing the quality of pro- and anti-vaccination online information: a content analysis of vaccination-related webpages
Gabriele Sak, Nicola Diviani, Ahmed Allam and Peter J. Schulz
BMC Public Health 2016 16:38
Published on: 15 January 2016

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Research article
Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach
Neisha Sundaram, Christian Schaetti, Sonja Merten, Christian Schindler, Said M. Ali, Erick O. Nyambedha, Bruno Lapika, Claire-Lise Chaignat, Raymond Hutubessy and Mitchell G. Weiss
BMC Public Health 2016 16:36
Published on: 14 January 2016
Abstract
Background
Controlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar.
Methods
Cross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings.
Results
Anticipated OCV acceptance was high in all settings. More than 93 % of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar.
Conclusions
These cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination.

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Research article
Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study
The prevention of child mortality through immunization is one of the most cost-effective and widely applied public health interventions. In Ethiopia, the Expanded Program on Immunization (EPI) schedule is rare…
Abel Negussie, Wondewosen Kassahun, Sahilu Assegid and Ada K. Hagan
BMC Public Health 2016 16:27
Published on: 12 January 2016

British Medical Journal
14 January 2016 (vol 352, issue 8040)
http://www.bmj.com/content/352/8040

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Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study
BMJ 2015; 351 :h6291 (Published 08 December 2015)
Paul J Turner, clinician scientist and clinical senior lecturer1, honorary consultant2, Jo Southern, clinical research lead2, Nick J Andrews, senior statistician2, Elizabeth Miller, consultant epidemiologist2, Michel Erlewyn-Lajeunesse, consultant paediatric allergist3 on behalf of the SNIFFLE-2 Study
Abstract
Study question
How safe is live attenuated influenza vaccine (LAIV), which contains egg protein, in young people with egg allergy?
Methods
In this open label, phase IV intervention study, 779 young people (2-18 years) with egg allergy were recruited from 30 UK allergy centres and immunised with LAIV. The cohort included 270 (34.7%) young people with previous anaphylaxis to egg, of whom 157 (20.1%) had experienced respiratory and/or cardiovascular symptoms. 445 (57.1%) had doctor diagnosed asthma or recurrent wheeze. Participants were observed for at least 30 minutes after vaccination and followed-up by telephone 72 hours later. Participants with a history of recurrent wheeze or asthma underwent further follow-up four weeks later. The main outcome measure was incidence of an adverse event within two hours of vaccination in young people with egg allergy.
Study answer and limitations
No systemic allergic reactions occurred (upper 95% confidence interval for population 0.47% and in participants with anaphylaxis to egg 1.36%). Nine participants (1.2%, 95% CI 0.5% to 2.2%) experienced mild symptoms, potentially consistent with a local, IgE mediated allergic reaction. Delayed events potentially related to the vaccine were reported in 221 participants. 62 participants (8.1%, 95% CI for population 6.3% to 10.3%) experienced lower respiratory tract symptoms within 72 hours, including 29 with parent reported wheeze. No participants were admitted to hospital. No increase in lower respiratory tract symptoms occurred in the four weeks after vaccination (assessed with asthma control test). The study cohort may represent young people with more severe allergy requiring specialist input, since they were recruited from secondary and tertiary allergy centres.
What this study adds
LAIV is associated with a low risk of systemic allergic reactions in young people with egg allergy. The vaccine seems to be well tolerated in those with well controlled asthma or recurrent wheeze.
Funding, competing interests, data sharing
This report is independent research commissioned and funded by a Department of Health policy research programme grant to the National Vaccine Evaluation Consortium. Additional funding was provided by the NIHR Clinical Research Networks, Health Protection Scotland (Edinburgh site), and Health & Social Care Services in Northern Ireland (Belfast site). PJT and MEL had support from the Department of Health for the submitted work; PJT has received research grants from the Medical Research Council and NIHR. No additional data available.
Study registration
ClinicalTrials.gov (NCT02111512) and the EU Clinical Trials Register EudraCT (2014-001537-92).

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Editorials
Live attenuated influenza vaccine for children with egg allergy
BMJ 2015; 351 :h6656 (Published 09 December 2015)
Policies should change to allow vaccination, after compelling new evidence of safety.

Eurosurveillance
Volume 21, Issue 2, 14 January 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Rapid Communications
Zika virus infection in a traveller returning from the Maldives, June 2015
by E Korhonen, E Huhtamo, T Smura, H Kallio-Kokko, M Raassina, O Vapalahti

Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015
by U Heudorf, B Krackhardt, M Karathana, N Kleinkauf, C Zinn

Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June-December 2015
by C Reinheimer, V Kempf, S Göttig, M Hogardt, T Wichelhaus, F O’Rourke, C Brandt

Respiratory diphtheria in an asylum seeker from Afghanistan arriving to Finland via Sweden, December 2015
by J Sane, T Sorvari, M Wideström, H Kauma, U Kaukoniemi, E Tarkka, T Puumalainen, M Kuusi, M Salminen, O Lyytikäinen

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 16 January 2016]

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Research
The development of ORACLe: a measure of an organisation’s capacity to engage in evidence-informed health policy
Steve R Makkar, Tari Turner, Anna Williamson, Jordan Louviere, Sally Redman, Abby Haynes, Sally Green, Sue Brennan Health Research Policy and Systems 2016, 14:4 (14 January 2016)
Abstract
Background
Evidence-informed policymaking is more likely if organisations have cultures that promote research use and invest in resources that facilitate staff engagement with research. Measures of organisations’ research use culture and capacity are needed to assess current capacity, identify opportunities for improvement, and examine the impact of capacity-building interventions. The aim of the current study was to develop a comprehensive system to measure and score organisations’ capacity to engage with and use research in policymaking, which we entitled ORACLe (Organisational Research Access, Culture, and Leadership).
Method
We used a multifaceted approach to develop ORACLe. Firstly, we reviewed the available literature to identify key domains of organisational tools and systems that may facilitate research use by staff. We interviewed senior health policymakers to verify the relevance and applicability of these domains. This information was used to generate an interview schedule that focused on seven key domains of organisational capacity. The interview was pilot-tested within four Australian policy agencies. A discrete choice experiment (DCE) was then undertaken using an expert sample to establish the relative importance of these domains. This data was used to produce a scoring system for ORACLe.
Results
The ORACLe interview was developed, comprised of 23 questions addressing seven domains of organisational capacity and tools that support research use, including (1) documented processes for policymaking; (2) leadership training; (3) staff training; (4) research resources (e.g. database access); and systems to (5) generate new research, (6) undertake evaluations, and (7) strengthen relationships with researchers. From the DCE data, a conditional logit model was estimated to calculate total scores that took into account the relative importance of the seven domains. The model indicated that our expert sample placed the greatest importance on domains (2), (3) and (4).
Conclusion
We utilised qualitative and quantitative methods to develop a system to assess and score organisations’ capacity to engage with and apply research to policy. Our measure assesses a broad range of capacity domains and identifies the relative importance of these capacities. ORACLe data can be used by organisations keen to increase their use of evidence to identify areas for further development.

International Journal of Infectious Diseases
January 2016 Volume 42, p1-74
http://www.ijidonline.com/issue/S1201-9712%2815%29X0012-9

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Editorial
Why is Pakistan a threat to “The Polio Eradication and Endgame Strategic Plan 2013–2018”? A look into the past decade
Tariq Khan, Bilal Haider Abbasi, Mubarak Ali Khan, Akhtar Nadhman
p4–6
Published online: November 16 2015
Abstract
The fight against endemic polio transmission is restricted to three countries: Pakistan, Afghanistan, and Nigeria. In 2012, when the world saw the lowest numbers of cases from polio-reporting countries, the World Health Organization (WHO) initiated a comprehensive strategy, “The Polio Eradication and Endgame Strategic Plan 2013–2018”.1 The plan (as it will be called from this point onwards) aims at: (1) wild polio virus (WPV) interruption by the end of 2014, (2) a strengthened immunization system and cessation of oral polio vaccine (OPV), (3) containment and certification, and (4) the quest for maintenance of a polio-free world by 2018.

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Perspective
Impacts of neglected tropical disease on incidence and progression of HIV/AIDS, tuberculosis, and malaria: scientific links
G.G. Simon
Management Sciences for Health, Arlington VA, USA
DOI: http://dx.doi.org/10.1016/j.ijid.2015.11.006
Highlights
:: The neglected tropical diseases (NTDs) share a high degree of geographic overlap with malaria and HIV.
:: Research suggests that NTDs can impact HIV, tuberculosis, and malaria disease progression.
:: Immunological, epidemiological, and social cofactors contribute to disease impact.
Summary
The neglected tropical diseases (NTDs) are the most common infections of humans in Sub-Saharan Africa. Virtually all of the population living below the World Bank poverty figure is affected by one or more NTDs. New evidence indicates a high degree of geographic overlap between the highest-prevalence NTDs (soil-transmitted helminths, schistosomiasis, onchocerciasis, lymphatic filariasis, and trachoma) and malaria and HIV, exhibiting a high degree of co-infection. Recent research suggests that NTDs can affect HIV and AIDS, tuberculosis (TB), and malaria disease progression. A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria. Together these results point to the impacts of the highest-prevalence NTDs on the health outcomes of malaria, HIV/AIDS, and TB and present new opportunities to design innovative public health interventions and strategies for these ‘big three’ diseases. This analysis describes the current findings of research and what research is still needed to strengthen the knowledge base of the impacts NTDs have on the big three.

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Reviews
Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making
Gwenan M. Knight, Nila J. Dharan, Gregory J. Fox, Natalie Stennis, Alice Zwerling, Renuka Khurana, David W. Dowdy
p17–23
Published online: November 3 2015
Highlights
:: Mathematical models are under-utilized in public health.
:: We discuss the current use of infectious disease modelling with a case study.
:: We lay out the methods and limitations of modelling infectious diseases.
:: We present a framework for improved interaction between public health and modellers.
:: This could lead to more transparent and evidence-driven policy decisions.
Summary
The dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy), the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively re-evaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions.

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Original Reports
Age and Ebola viral load correlate with mortality and survival time in 288 Ebola virus disease patients
Jin Li, Hui-Juan Duan, Hao-Yang Chen, Ying-Jie Ji, Xin Zhang, Yi-Hui Rong, Zhe Xu, Li-Jian Sun, Ji-Yuan Zhang, Li-Ming Liu, Bo Jin, Jian Zhang, Ning Du, Hai-Bin Su, Guang-Ju Teng, Yue Yuan, En-Qiang Qin, Hong-Jun Jia, Shu Wang, Tong-Sheng Guo, Ye Wang, Jin-Song Mu, Tao Yan, Zhi-Wei Li, Zheng Dong, Wei-Min Nie, Tian-Jun Jiang, Chen Li, Xu-Dong Gao, Dong Ji, Ying-Jie Zhuang, Lei Li, Li-Fu Wang, Wen-Gang Li, Xue-Zhang Duan, Yin-Ying Lu, Zhi-Qiang Sun, Alex B.J. Kanu, Sheku M. Koroma, Min Zhao, Jun-Sheng Ji, Fu-Sheng Wang
p34–39
Published online: October 30 2015

Journal of Medical Ethics
January 2016, Volume 42, Issue 1
http://jme.bmj.com/content/current

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Viewpoint
To research (or not) that is the question: ethical issues in research when medical care is disrupted by political action: a case study from Eldoret, Kenya
Darlene R House1,2, Irene Marete2,3, Eric M Meslin2,3,4
Author Affiliations
1Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
2Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
3Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
4Center for Bioethics, Indiana University, Indianapolis, Indiana, USA
Correspondence to Dr Darlene R House, Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; dhouse@iupui.edu
Abstract
While considerable attention has been focused on understanding the myriad of ethical analysis in international research in low and middle income countries, new issues always arise that have not been anticipated in guidelines or studied extensively. The disruption of medical care arising as a direct result of political actions, including strikes, postelection violence and related activities, is one such issue that leaves physician-researchers struggling to manage often conflicting professional responsibilities. This paper discusses the ethical conflicts that arise for physician-researchers, particularly when disruption threatens the completion of a study or completion is possible but at the expense of not addressing unmet medical needs of patients. We review three pragmatic strategies and the ethical issues arising from each: not starting research, stopping research that has already started, and continuing research already initiated. We argue that during episodes of medical care disruption, research that has been started can be continued only if the ethical standards imposed at the beginning of the study can continue to be met; however, studies that have been approved but not yet started should not begin until the disruption has ended and ethical standards can again be assured.

The Lancet
Jan 16, 2016 Volume 387 Number 10015 p199-310
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China
Yanping Wang, Xiaohong Li, Maigeng Zhou, Shusheng Luo, Juan Liang, Chelsea A Liddell, Matthew M Coates, Yanqiu Gao, Linhong Wang, Chunhua He, Chuyun Kang, Shiwei Liu, Li Dai, Austin E Schumacher, Maya S Fraser, Timothy M Wolock, Amanda Pain, Carly E Levitz, Lavanya Singh, Megan Coggeshall, Margaret Lind, Yichong Li, Qi Li, Kui Deng, Yi Mu, Changfei Deng, Ling Yi, Zheng Liu, Xia Ma, Hongtian Li, Dezhi Mu, Jun Zhu, Christopher J L Murray, Haidong Wang
Summary
Background
In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012.
Methods
We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties.
Findings
In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%.
Interpretation
The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates.
Funding
National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation.

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Series
Antimicrobials: access and sustainable effectiveness
Exploring the evidence base for national and regional policy interventions to combat resistance
Osman A Dar, Rumina Hasan, Jørgen Schlundt, Stephan Harbarth, Grazia Caleo, Fazal K Dar, Jasper Littmann, Mark Rweyemamu, Emmeline J Buckley, Mohammed Shahid, Richard Kock, Henry Lishi Li, Haydar Giha, Mishal Khan, Anthony D So, Khalid M Bindayna, Anthony Kessel, Hanne Bak Pedersen, Govin Permanand, Alimuddin Zumla, John-Arne Røttingen, David L Heymann

Antimicrobials: access and sustainable effectiveness
International cooperation to improve access to and sustain effectiveness of antimicrobials
Christine Årdal, Kevin Outterson, Steven J Hoffman, Abdul Ghafur, Mike Sharland, Nisha Ranganathan, Richard Smith, Anna Zorzet, Jennifer Cohn, Didier Pittet, Nils Daulaire, Chantal Morel, Zain Rizvi, Manica Balasegaram, Osman A Dar, David L Heymann, Alison H Holmes, Luke S P Moore, Ramanan Laxminarayan, Marc Mendelson, John-Arne Røttingen

PLoS One
http://www.plosone.org/
[Accessed 16 January 2016]

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Spatiotemporal Evolution of Ebola Virus Disease at Sub-National Level during the 2014 West Africa Epidemic: Model Scrutiny and Data Meagreness
Eva Santermans, Emmanuel Robesyn, Tapiwa Ganyani, Bertrand Sudre, Christel Faes, Chantal Quinten, Wim Van Bortel, Tom Haber, Thomas Kovac, Frank Van Reeth, Marco Testa, Niel Hens, Diamantis Plachouras
Research Article | published 15 Jan 2016 | PLOS ONE
10.1371/journal.pone.0147172

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Research Article
Quantifying Access Disparities in Response Plans
Saratchandra Indrakanti ,
Armin R. Mikler, Martin O’Neill II, Chetan Tiwari
Published: January 15, 2016
DOI: 10.1371/journal.pone.0146350
Abstract
Effective response planning and preparedness are critical to the health and well-being of communities in the face of biological emergencies. Response plans involving mass prophylaxis may seem feasible when considering the choice of dispensing points within a region, overall population density, and estimated traffic demands. However, the plan may fail to serve particular vulnerable subpopulations, resulting in access disparities during emergency response. For a response plan to be effective, sufficient mitigation resources must be made accessible to target populations within short, federally-mandated time frames. A major challenge in response plan design is to establish a balance between the allocation of available resources and the provision of equal access to PODs for all individuals in a given geographic region. Limitations on the availability, granularity, and currency of data to identify vulnerable populations further complicate the planning process. To address these challenges and limitations, data driven methods to quantify vulnerabilities in the context of response plans have been developed and are explored in this article.

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Research Article
Human Papillomavirus Infection and Vaccination: Awareness and Knowledge of HPV and Acceptability of HPV Vaccine among Mothers of Teenage Daughters in Weihai, Shandong, China
Yang Yu, Minglei Xu, Jiandong Sun, Ruiying Li, Meilan Li, Jianguang Wang, Dongfeng Zhang, Aiqiang Xu
Research Article | published 14 Jan 2016 | PLOS ONE
10.1371/journal.pone.0146741

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Research Article
Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk – A Systematic Review and Meta-Analysis
Julia Schiffner-Rohe, Annika Witt, Jana Hemmerling, Christof von Eiff, Friedrich-Wilhelm Leverkus
Research Article | published 13 Jan 2016 | PLOS ONE
10.1371/journal.pone.0146338