The Lancet
May 21, 2016 Volume 387 Number 10033 p2063-2162 e26-e27
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
No health workforce, no global health security
The Lancet
Summary
Since the recent epidemics of Ebola, MERS, and Zika viruses, the ever-present threat of pandemic influenza, and now the menace of a yellow fever crisis, the notion of global health security has risen to the top of concerns facing the 194 member states attending next week’s 69th World Health Assembly (WHA) in Geneva, Switzerland. Without global health security, the common goal of a more sustainable and resilient society for human health and wellbeing will be unattainable.

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Articles
Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study
Simon Cauchemez, Marianne Besnard, Priscillia Bompard, Timothée Dub, Prisca Guillemette-Artur, Dominique Eyrolle-Guignot, Henrik Salje, Maria D Van Kerkhove, Véronique Abadie, Catherine Garel, Arnaud Fontanet, Henri-Pierre Mallet
Summary
Background
The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified.
Methods
We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk.
Findings
The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62–70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0–8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34–191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data.
Interpretation
Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus.
Funding
Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.

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Review
Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition
Hellen Gelband, Rengaswamy Sankaranarayanan, Cindy L Gauvreau, Susan Horton, Benjamin O Anderson, Freddie Bray, James Cleary, Anna J Dare, Lynette Denny, Mary K Gospodarowicz, Sumit Gupta, Scott C Howard, David A Jaffray, Felicia Knaul, Carol Levin, Linda Rabeneck, Preetha Rajaraman, Terrence Sullivan, Edward L Trimble, Prabhat Jha, Disease Control Priorities-3 Cancer Author Group
Summary
Investments in cancer control—prevention, detection, diagnosis, surgery, other treatment, and palliative care—are increasingly needed in low-income and particularly in middle-income countries, where most of the world’s cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities, 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.

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Health Policy
The World report on ageing and health: a policy framework for healthy ageing
John R Beard, Alana Officer, Islene Araujo de Carvalho, Ritu Sadana, Anne Margriet Pot, Jean-Pierre Michel, Peter Lloyd-Sherlock, JoAnne E Epping-Jordan, G M E E (Geeske) Peeters, Wahyu Retno Mahanani, Jotheeswaran Amuthavalli Thiyagarajan, Somnath Chatterji
Summary
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

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Health Policy
Protecting human security: proposals for the G7 Ise-Shima Summit in Japan
Japan Global Health Working Group
2155
Summary
In today’s highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.