Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

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BMGF – Gates Foundation [to 18 February 2017]
http://www.gatesfoundation.org/Media-Center/Press-Releases
February 14, 2017
Our 2017 Annual Letter
By Bill and Melinda Gates
[Excerpt]
The Best Deal Is Vaccines
Melinda: And if you want to know the best deal within the deal—it’s vaccines. Coverage for the basic package of childhood vaccines is now the highest it’s ever been, at 86 percent. And the gap between the richest and the poorest countries is the lowest it’s ever been. Vaccines are the biggest reason for the drop in childhood deaths.

Melinda: They’re an incredible investment. The pentavalent vaccine, which protects against five deadly infections in a single shot, now costs under a dollar.

Bill: And for every dollar spent on childhood immunizations, you get $44 in economic benefits. That includes saving the money that families lose when a child is sick and a parent can’t work.

Melinda: At the start, we just couldn’t understand why vaccines weren’t available to every child who needed them. We were naïve. There were no market incentives to serve people, and we had never seen that before.

Bill: The market wasn’t working for vaccines for poor kids because the families who needed them couldn’t afford them. But this gave us an opening. If we could create a purchasing fund so pharmaceutical companies would have enough customers, they’d have the market incentives to develop and produce vaccines.

Melinda: That’s the magic of philanthropy. It doesn’t need a financial return, so it can do things business can’t. But the limit of philanthropy is that the money runs out before the need is met. That’s why business and government have to play a role if the change is going to last.

Bill: That led us to partner with business and government to set up Gavi, the Vaccine Alliance, with the goal of getting vaccines to every child in the world. Gavi connects companies who develop vaccines with wealthy governments that help with funding and developing countries that get the vaccines to their people. Since 2000, Gavi has helped immunize 580 million children around the world. The United States is a major donor to Gavi—with bipartisan support—along with the UK, Norway, Germany, France, and Canada. It’s one of the great things the rich world does for the rest of the world.

Melinda: But there’s more to do—19 million children, many of them living in conflict zones or remote areas, are still not fully immunized. Their governments have to work harder to reach these kids. It’s crucial to the goal of cutting childhood deaths in half again—down below 3 million by 2030…

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Wellcome Trust [to 18 February 2017]
https://wellcome.ac.uk/news
Explainer Published: 13 February 2017
Preprints: we’re supporting calls for a Central Service
We now allow researchers to cite preprints in their grant applications. And, along with major international research funders, we’re supporting plans to establish a Central Service for Preprints. Robert Kiley, Open Research Development Lead, explains why.

For more than 25 years, researchers in disciplines such as high-energy physics and mathematics have been able to access the very latest research findings in the online repository known as arXiv (pronounced ‘archive’).

Here, researchers deposit their preprints – complete and public drafts of scientific documents, not yet certified by peer review – to:
:: ensure their findings are quickly and widely disseminated
:: establish priority of their discoveries
:: invite feedback and discussion to help improve the work.

Despite these benefits, researchers in the life sciences have been slow to share preprints. While the arXiv holds over 1.2 million articles, the number of preprints shared in the life and biomedical sciences is estimated to be less than 25,000. However, this disguises significant growth over the past two years, which has been aided by the work of ASAPbio (opens in a new tab), a scientist-driven initiative to promote the productive use of preprints in the life sciences…

While it’s positive that preprints are becoming a recognised part of the scholarly communications ecosystem, the downside is that it’s becoming more difficult for researchers to discover relevant content and to know, for example, which preprints have been subject to some initial screening to weed out ethically questionable or unscientific content.

To address these issues, we’re working with an international group of research funders to explore the value and feasibility of establishing a Central Service for Preprints.
The service would seek to aggregate content from multiple sources – such as the preprint servers listed above – and provide new ways for researchers and machines to search, access and reuse this content…

Journal Watch

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa

BMJ Global Health
January 2017; volume 2, issue 1
http://gh.bmj.com/content/2/1?current-issue=y

Article
Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa
Peter Winskill, Patrick GT Walker, Jamie T Griffin, Azra C Ghani
January 24, 2017, 2 (1) e000090; DOI: 10.1136/bmjgh-2016-000090
Abstract
Objectives
To evaluate the relative cost-effectiveness of introducing the RTS,S malaria vaccine in sub-Saharan Africa compared with further scale-up of existing interventions.
Design
A mathematical modelling and cost-effectiveness study.
Setting
Sub-Saharan Africa.
Participants
People of all ages.
Interventions
The analysis considers the introduction and scale-up of the RTS,S malaria vaccine and the scale-up of long-lasting insecticide-treated bed nets (LLINs), indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC).
Main outcome measure The number of Plasmodium falciparum cases averted in all age groups over a 10-year period.
Results
Assuming access to treatment remains constant, increasing coverage of LLINs was consistently the most cost-effective intervention across a range of transmission settings and was found to occur early in the cost-effectiveness scale-up pathway. IRS, RTS,S and SMC entered the cost-effective pathway once LLIN coverage had been maximised. If non-linear production functions are included to capture the cost of reaching very high coverage, the resulting pathways become more complex and result in selection of multiple interventions.
Conclusions
RTS,S was consistently implemented later in the cost-effectiveness pathway than the LLINs, IRS and SMC but was still of value as a fourth intervention in many settings to reduce burden to the levels set out in the international goals.

INTRODUCTION OF A NEW VACCINE INTO NATIONAL IMMUNISATION PROGRAMMES IN AFRICA: THE ROLE OF CAPACITY BUILDING

BMJ Global Health
January 2017; volume 2, issue 1
http://gh.bmj.com/content/2/1?current-issue=y

INTRODUCTION OF A NEW VACCINE INTO NATIONAL IMMUNISATION PROGRAMMES IN AFRICA: THE ROLE OF CAPACITY BUILDING
Carine Dochez, Rosemary Burnett, M. Jeffrey Mphahlele
DOI: 10.1136/bmjgh-2016-000260.141 Published 12 February 2017
Abstract
Background
Members of National Immunisation Technical Advisory Groups, policy-makers, EPI managers and vaccinators are tasked with making evidence-based recommendations and decisions on whether a new vaccine merits introduction into national immunisation programmes; implementation of new vaccine introduction; and efficient management of immunisation programmes. Therefore it is paramount that they are equipped with the latest state-of-the-art information on vaccines and immunisation.
Methods
Capacity building activities – such as high-level in-service vaccinology courses, other interactive courses and workshops (mid-level management training and experience exchange workshops) – address all steps required for decision-making on new vaccine introduction into national immunisation programmes. These include establishing: 1) burden of disease to be prevented; 2) existence of a good intervention (i.e. is the vaccine efficacious, safe and acceptable for the target population); 3) the cost of the new vaccine, its implementation and the comparative effectiveness with other vaccines/interventions in terms of health gains; 4) whether finances to pay for the new vaccine are available; and 5) programmatic implications. Interested parties are trained on this rational decision-making process to be followed before embarking on new vaccine introduction, on key implementation steps, and efficient management of immunisation programmes.
Results
Several inter-country vaccinology courses and interactive workshops, which were organised during the last years in the African region (e.g. Kenya and South Africa), will be presented in detail. These capacity building activities have contributed to successful introduction of new vaccines in the African region, key ones being rotavirus, pneumococcal and currently human papillomavirus vaccines. This concerted effort has contributed for example to the successful introduction of rotavirus vaccine in 29 African countries to date.
Conclusions
Capacity building efforts, like high-level in-service courses and interactive workshops have enabled interested parties to make evidence-based recommendations and decisions on the introduction of any new vaccine, and to successfully implement new vaccine introduction.

Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 18 February 2017)

Research article
Factors associated with the length of delay with tuberculosis diagnosis and treatment among adult tuberculosis patients attending at public health facilities in Gondar town, Northwest, Ethiopia
Early diagnosis and prompt treatment is essential for an effective tuberculosis (TB) control program. However, significant proportion of cases remains undiagnosed and untreated. Delay in diagnosis and treatmen…
Selamsew Bogale, Ermias Diro, Atsede Mazengia Shiferaw and Melaku Kindie Yenit
BMC Infectious Diseases 2017 17:145
Published on: 14 February 2017

“I passed the test!” Evidence of diagnostic misconception in the recruitment of population controls for an H3Africa genomic study in Cape Town, South Africa

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 18 February 2017)

Research article
“I passed the test!” Evidence of diagnostic misconception in the recruitment of population controls for an H3Africa genomic study in Cape Town, South Africa
Francis Masiye, Bongani Mayosi and Jantina de Vries
Published on: 15 February 2017
Abstract
Background
Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease (RHDGen) at the University of Cape Town in South Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study.
Methods
We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases (patients), healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa.
Results
Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease (diagnostic misconception). A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception.
Conclusion
The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases.

Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study

BMC Public Health
http://www.bmcpublichealth.biomedcentral.com/articles
(Accessed 18 February 2017)

Research article
Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study
Afiong Oku, Angela Oyo-Ita, Claire Glenton, Atle Fretheim, Glory Eteng, Heather Ames, Artur Muloliwa, Jessica Kaufman, Sophie Hill, Julie Cliff, Yuri Cartier, Xavier Bosch-Capblanch, Gabriel Rada and Simon Lewin
BMC Public Health 2017 17:200
Published on: 15 February 2017
Abstract
Background
The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria.
Methods
We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis.
Results
We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees.
Conclusions
Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.

Scientific research and the public good

The European Journal of Public Health
Volume 27, Issue 1, 1 February 2017
http://www.academic.oup.com/eurpub/issue/27/1

Editorials
Scientific research and the public good
Diana M.J. Delnoij
Extract
Randomized clinical trials are the state-of-the-art method to study comparative effectiveness of healthcare interventions. However, sometimes a discrepancy is observed between the effects of an intervention in routine clinical practice as compared with the effects that were demonstrated in randomized controlled clinical trials.1 Real-world data, e.g. from registries or claims databases, could help to unravel the effectiveness of interventions in clinical practice. The hope is that the use of these data will allow healthcare decision makers to be more certain when it is (cost-)effective to provide access to new treatments. Real-world data could therefore contribute to the public good…Recently, the Dutch National Health Care Institute hosted an international workshop on the IMI-GetReal project. GetReal is a 3-year project of the Innovative Medicines Initiative (IMI), an EU public-private consortium…

Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006–2014

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 18 February 2017]

Research
Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006–2014
During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodologica…
Ingeborg Jahn, Claudia Börnhorst, Frauke Günther and Tilman Brand
Health Research Policy and Systems 2017 15:11
Published on: 15 February 2017

New “21st Century Cures” Legislation: Speed and Ease vs Science

JAMA
February 14, 2017, Vol 317, No. 6, Pages 555-656
http://www.jama.jamanetwork.com/issue.aspx

Viewpoint
New “21st Century Cures” Legislation: Speed and Ease vs Science
Aaron S. Kesselheim, MD, JD, MPH; Jerry Avorn, MD
JAMA. 2017;317(6):581-582. doi:10.1001/jama.2016.20640
This Viewpoint discusses potential threats to public health that arise from provisions of the 2016 21st Century Cures Act that allow drug manufacturers to use surrogate measures of safety and that encourage the US Food and Drug Administration to emphasize speed over science in the drug approval process.

Yemen’s silent killers

The Lancet
Feb 18, 2017 Volume 389 Number 10070 p671-762
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Yemen’s silent killers
The Lancet
Published: 18 February 2017
DOI: http://dx.doi.org/10.1016/S0140-6736(17)30390-2
Nearly 2 years of war have devastated Yemen. 14·8 million people currently lack access to basic health care, 7 million people are facing food insecurity, and 2·1 million children are acutely malnourished. On Feb 8, WHO and its health partners released their emergency response plan for Yemen’s health sector in 2017, including its funding requirement: US$321·6 million.

Around 75 people are either killed or injured in the conflict every day. But beyond these casualties, Rick Brennan, Director of WHO’s Emergency Operations, notes that “many Yemeni people die in silence” from diseases that are preventable and treatable, but that go unnoticed in reporting of the crisis. The main causes of avoidable deaths are communicable diseases and maternal, perinatal, and nutritional conditions (together responsible for 50% of deaths), and non-communicable diseases (39% of deaths). Lives are being lost because Yemen’s health system is under severe strain; chronic shortages of drugs and other medical supplies exist and less than 45% of health facilities are functioning.

In their response plan for 2017, WHO and its health partners are targeting 10.4 million people, mostly women and children, and others in acute need. Their key strategic objectives include providing integrated primary, secondary, and referral health services, surveillance and response, and medical supplies in priority districts; strengthening reproductive, maternal, newborn, child, and adolescent health interventions; and improving health sector coordination and health information systems.

Amid the dire health and humanitarian data for Yemen, it might be easy for some donors to dismiss the crisis as too difficult and large. But they should not. Last year, WHO and its health partners received financial support that, among its achievements, sustained the functionality of 414 health facilities in 145 districts, delivered 541 child health and nutrition interventions in 323 districts, and provided essential medicine and medical supplies to assist an estimated 3 million people. The 2017 emergency response plan is realistic and targeted, focusing on priority accessible districts and interventions for delivery. It deserves to be fully supported.

Safety, tolerability, and antiviral effect of RG-101 in patients with chronic hepatitis C: a phase 1B, double-blind, randomised controlled trial

The Lancet
Feb 18, 2017 Volume 389 Number 10070 p671-762
http://www.thelancet.com/journals/lancet/issue/current

Articles
Safety, tolerability, and antiviral effect of RG-101 in patients with chronic hepatitis C: a phase 1B, double-blind, randomised controlled trial
Meike H van der Ree, J Marleen de Vree, Femke Stelma, Sophie Willemse, Marc van der Valk, Svend Rietdijk, Richard Molenkamp, Janke Schinkel, Ad C van Nuenen, Ulrich Beuers, Salah Hadi, Marten Harbers, Eva van der Veer, Kai Liu, John Grundy, Amy K Patick, Adam Pavlicek, Jacqueline Blem, Michael Huang, Paul Grint, Steven Neben, Neil W Gibson, Neeltje A Kootstra, Hendrik W Reesink

Reimagining WHO: leadership and action for a new Director-General

The Lancet
Feb 18, 2017 Volume 389 Number 10070 p671-762
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Reimagining WHO: leadership and action for a new Director-General
Prof Lawrence O Gostin, JD, Eric A Friedman, JD
Published: 27 January 2017
Summary
Three candidates to be the next WHO Director-General remain: Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar. The World Health Assembly’s ultimate choice will lead an organisation facing daunting internal and external challenges, from its own funding shortfalls to antimicrobial resistance and immense health inequities. The new Director-General must transform WHO into a 21st century institution guided by the right to health. Topping the incoming Director-General’s agenda will be a host of growing threats—risks to global health security, antimicrobial resistance, non-communicable diseases, and climate change—but also the transformative potential of the Sustainable Development Goals, including their universal health coverage target. Throughout, the next Director-General should emphasise equality, including through national health equity strategies and, more boldly still, advancing the Framework Convention on Global Health. Success in these areas will require a reinvigorated WHO, with sustainable financing, greater multisector engagement, enhanced accountability and transparency, and strengthened normative leadership. WHO must also evolve its governance to become far more welcoming of civil society and communities. To create the foundation for these transformative changes, the Director-General will need to focus first on gaining political support. This entails improving accountability and transparency to gain member state trust, and enabling meaningful civil society participation in WHO’s governance and standing up for the right to health to gain civil society support. Ultimately, in the face of a global environment marked by heightened nationalism and xenophobia, member states must empower the next Director-General to enable WHO to be a bulwark for health and human rights, serving as an inspiring contra-example to today’s destructive politics, demonstrating that the community of nations are indeed stronger together.

New England Journal of Medicine – February 16, 2017 Vol. 376 No. 7

New England Journal of Medicine
February 16, 2017  Vol. 376 No. 7
http://www.nejm.org/toc/nejm/medical-journal

Perspective
New Vaccines against Epidemic Infectious Diseases
John-Arne Røttingen, M.D., Ph.D., Dimitrios Gouglas, M.Sc., Mark Feinberg, M.D., Ph.D., Stanley Plotkin, M.D., Krishnaswamy V. Raghavan, Ph.D., Andrew Witty, B.A., Ruxandra Draghia-Akli, M.D., Ph.D., Paul Stoffels, M.D., and Peter Piot, M.D., Ph.D.
N Engl J Med 2017; 376:610-613 February 16, 2017 DOI: 10.1056/NEJMp1613577
The newly formed international Coalition for Epidemic Preparedness Innovations aims to stimulate, finance, and coordinate the development of vaccines against epidemic infectious diseases, especially in cases in which market incentives alone are insufficient.

Perspective
The Common Rule, Updated
Jerry Menikoff, M.D., J.D., Julie Kaneshiro, M.A., and Ivor Pritchard, Ph.D.
N Engl J Med 2017; 376:613-615 February 16, 2017 DOI: 10.1056/NEJMp1700736
The Common Rule — the set of federal regulations for ethical conduct of human-subjects research — has finally been updated. A long process of deliberation and discussion has resulted in a final rule that differs significantly from what was initially proposed.

Review Article
FDA Regulation of Prescription Drugs
Audrey L. Gassman, M.D., Christine P. Nguyen, M.D., and Hylton V. Joffe, M.D., M.M.Sc.
N Engl J Med 2017; 376:674-682 February 16, 2017 DOI: 10.1056/NEJMra1602972
Share:
Over the past 5 years, the FDA has approved 182 new drugs. This overview explains the FDA’s drug-approval process, including its approach to benefit–risk assessment, drug labeling, risk evaluation and mitigation strategies, and postmarketing surveillance.

First Report of the East-Central South African Genotype of Chikungunya Virus in Rio de Janeiro, Brazil

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 18 February 2017]

Research Article
First Report of the East-Central South African Genotype of Chikungunya Virus in Rio de Janeiro, Brazil
February 14, 2017 ·
Background: Chikungunya virus (CHIKV) is an arbovirus that causes an acute febrile syndrome with a severe and debilitating arthralgia. In Brazil, the Asian and East-Central South African (ECSA) genotypes are circulating in the north and northeast of the country, respectively. In 2015, the first autochthonous cases in Rio de Janeiro, Brazil were reported but until now the circulating strains have not been characterized. Therefore, we aimed here to perform the molecular characterization and phylogenetic analysis of CHIKV strains circulating in the 2016 outbreak occurred in the municipality of Rio de Janeiro.
Methods: The cases analyzed in this study were collected at a private Hospital, from April 2016 to May 2016, during the chikungunya outbreak in Rio de Janeiro, Brazil. All cases were submitted to the Real Time RT-PCR for CHIKV genome detection and to anti-CHIKV IgM ELISA. Chikungunya infection was laboratorially confirmed by at least one diagnostic method and, randomly selected positive cases (n=10), were partially sequenced (CHIKV E1 gene) and analyzed.
Results: The results showed that all the samples grouped in ECSA genotype branch and the molecular characterization of the fragment did not reveal the A226V mutation in the Rio de Janeiro strains analyzed, but a K211T amino acid substitution was observed for the first time in all samples and a V156A substitution in two of ten samples.
Conclusions: Phylogenetic analysis and molecular characterization reveals the circulation of the ECSA genotype of CHIKV in the city of Rio de Janeiro, Brazil and two amino acids substitutions (K211T and V156A) exclusive to the CHIKV strains obtained during the 2016 epidemic, were reported.

Advances in neglected tropical disease vaccines: Developing relative potency and functional assays for the Na-GST-1/Alhydrogel hookworm vaccine

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 18 February 2017)

Research Article
Advances in neglected tropical disease vaccines: Developing relative potency and functional assays for the Na-GST-1/Alhydrogel hookworm vaccine
Jill B. Brelsford, Jordan L. Plieskatt, Anna Yakovleva, Amar Jariwala, Brian P. Keegan, Jin Peng, Pengjun Xia, Guangzhao Li, Doreen Campbell, Maria Victoria Periago, Rodrigo Correa-Oliveira, Maria Elena Bottazzi, Peter J. Hotez, David Diemert, Jeffrey M. Bethony
published 13 Feb 2017 P
http://dx.doi.org/10.1371/journal.pntd.0005385

Systems analysis of protective immune responses to RTS,S malaria vaccination in humans

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
[Accessed 18 February 2017]

Biological Sciences – Systems Biology:
Systems analysis of protective immune responses to RTS,S malaria vaccination in humans
Dmitri Kazmina,1, Helder I. Nakayab,1, Eva K. Leec, Matthew J. Johnsond, Robbert van der Moste, Robert A. van den ergf, W. Ripley Ballouf, Erik Jongerte, Ulrike Wille-Reeceg,
Christian Ockenhouseg, Alan Aderemh, Daniel E. Zakh, Jerald Sadoffi, Jenny Hendriksi, Jens Wrammerta, Rafi Ahmeda,2, and Bali Pulendrana,j,2
Significance
The RTS,S malaria vaccine is the most advanced malaria vaccine candidate to be tested in humans. Despite its promise, there is little understanding of its mechanism of action. In this work, we describe the use of a systems biological approach to identify “molecular signatures” that are induced rapidly after the standard RTS,S vaccination regimen, consisting of three RTS,S immunizations, or with a different regimen consisting of a primary immunization with recombinant adenovirus 35 (Ad35) expressing the circumsporozoite malaria antigen followed by two immunizations with RTS,S. These results reveal important insights about the innate and adaptive responses to vaccination and identify signatures of protective immunity against malaria.
Abstract
RTS,S is an advanced malaria vaccine candidate and confers significant protection against Plasmodium falciparum infection in humans. Little is known about the molecular mechanisms driving vaccine immunity. Here, we applied a systems biology approach to study immune responses in subjects receiving three consecutive immunizations with RTS,S (RRR), or in those receiving two immunizations of RTS,S/AS01 following a primary immunization with adenovirus 35 (Ad35) (ARR) vector expressing circumsporozoite protein. Subsequent controlled human malaria challenge (CHMI) of the vaccinees with Plasmodium-infected mosquitoes, 3 wk after the final immunization, resulted in ∼50% protection in both groups of vaccinees. Circumsporozoite protein (CSP)-specific antibody titers, prechallenge, were associated with protection in the RRR group. In contrast, ARR-induced lower antibody responses, and protection was associated with polyfunctional CD4+ T-cell responses 2 wk after priming with Ad35. Molecular signatures of B and plasma cells detected in PBMCs were highly correlated with antibody titers prechallenge and protection in the RRR cohort. In contrast, early signatures of innate immunity and dendritic cell activation were highly associated with protection in the ARR cohort. For both vaccine regimens, natural killer (NK) cell signatures negatively correlated with and predicted protection. These results suggest that protective immunity against P. falciparum can be achieved via multiple mechanisms and highlight the utility of systems approaches in defining molecular correlates of protection to vaccination.

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 18 February 2017]

Research
Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia
Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for m…
Tamara Fetters, Ghazaleh Samandari, Patrick Djemo, Bellington Vwallika and Stephen Mupeta
Reproductive Health 2017 14:26
Published on: 16 February 2017

Total Economic Consequences of an Influenza Outbreak in the United States (pages 4–19)

Risk Analysis
January 2017 Volume 37, Issue 1 Pages 1–192
http://www.onlinelibrary.wiley.com/doi/10.1111/risa.2017.37.issue-1/issuetoc

Original Research Articles
Total Economic Consequences of an Influenza Outbreak in the United States (pages 4–19)
Fynnwin Prager, Dan Wei and Adam Rose
Version of Record online: 23 MAY 2016 | DOI: 10.1111/risa.12625
Abstract
Pandemic influenza represents a serious threat not only to the population of the United States, but also to its economy. In this study, we analyze the total economic consequences of potential influenza outbreaks in the United States for four cases based on the distinctions between disease severity and the presence/absence of vaccinations. The analysis is based on data and parameters on influenza obtained from the Centers for Disease Control and the general literature. A state-of-the-art economic impact modeling approach, computable general equilibrium, is applied to analyze a wide range of potential impacts stemming from the outbreaks. This study examines the economic impacts from changes in medical expenditures and workforce participation, and also takes into consideration different types of avoidance behavior and resilience actions not previously fully studied. Our results indicate that, in the absence of avoidance and resilience effects, a pandemic influenza outbreak could result in a loss in U.S. GDP of $25.4 billion, but that vaccination could reduce the losses to $19.9 billion. When behavioral and resilience factors are taken into account, a pandemic influenza outbreak could result in GDP losses of $45.3 billion without vaccination and $34.4 billion with vaccination. These results indicate the importance of including a broader set of causal factors to achieve more accurate estimates of the total economic impacts of not just pandemic influenza but biothreats in general. The results also highlight a number of actionable items that government policymakers and public health officials can use to help reduce potential economic losses from the outbreaks.

Risk Analysis – January 2017 Volume 37, Issue 1 Pages 1–192

Risk Analysis
January 2017 Volume 37, Issue 1 Pages 1–192
http://www.onlinelibrary.wiley.com/doi/10.1111/risa.2017.37.issue-1/issuetoc

Determinants of Seeking and Avoiding Risk-Related Information in Times of Crisis (pages 27–39)
Jan M. Gutteling and Peter W. de Vries
Version of Record online: 2 MAY 2016 | DOI: 10.1111/risa.12632

Communicating Uncertain Science to the Public: How Amount and Source of Uncertainty Impact Fatalism, Backlash, and Overload (pages 40–51)
Jakob D. Jensen, Manusheela Pokharel, Courtney L. Scherr, Andy J. King, Natasha Brown and Christina Jones
Version of Record online: 12 MAR 2016 | DOI: 10.1111/risa.12600

Science – 17 February 2017 Vol 355, Issue 6326

Science
17 February 2017 Vol 355, Issue 6326
http://www.sciencemag.org/current.dtl

Editorial
Data in public health
By Jeremy Berg
Science17 Feb 2017 : 669
Summary
In 1854, physician John Snow helped curtail a cholera outbreak in a London neighborhood by mapping cases and identifying a central public water pump as the potential source. This event is considered by many to represent the founding of modern epidemiology. Data and analysis play an increasingly important role in public health today. This can be illustrated by examining the rise in the prevalence of autism spectrum disorders (ASDs), where data from varied sources highlight potential factors while ruling out others, such as childhood vaccines, facilitating wise policy choices.

Policy Forum
Ensuring scientific integrity in the Age of Trump
By Gretchen T. Goldman, Emily Berman, Michael Halpern, Charise Johnson, Yogin Kothari, Genna Reed, Andrew A. Rosenberg
Science17 Feb 2017 : 696-698 Full Access
Policies to protect government scientists must be defended

Improving the selection and development of influenza vaccine viruses – Report of a WHO informal consultation on improving influenza vaccine virus selection, Hong Kong SAR, China, 18–20 November 2015

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

WHO Report
Improving the selection and development of influenza vaccine viruses – Report of a WHO informal consultation on improving influenza vaccine virus selection, Hong Kong SAR, China, 18–20 November 2015
Pages 1104-1109
Hampson Alan, Barr Ian, Cox Nancy, Donis Ruben O., Hirve Siddhivinayak, Jernigan Daniel, Katz Jacqueline, McCauley John, Motta Fernando, Odagiri Takato, John S. Tam, Waddell Anthony, Webby Richard, Ziegler Thedi, Zhang Wenqing
Abstract
Since 2010 the WHO has held a series of informal consultations to explore ways of improving the currently highly complex and time-pressured influenza vaccine virus selection and development process. In November 2015 experts from around the world met to review the current status of efforts in this field.
Discussion topics included strengthening influenza surveillance activities to increase the availability of candidate vaccine viruses and improve the extent, timeliness and quality of surveillance data. Consideration was also given to the development and potential application of newer laboratory assays to better characterize candidate vaccine viruses, the potential importance of antibodies directed against influenza virus neuraminidase, and the role of vaccine effectiveness studies. Advances in next generation sequencing and whole genome sequencing of influenza viruses were also discussed, along with associated developments in synthetic genomics technologies, evolutionary analysis and predictive mathematical modelling.
Discussions were also held on the late emergence of an antigenic variant influenza A(H3N2) virus in mid-2014 that could not be incorporated in time into the 2014–15 northern hemisphere vaccine. There was broad recognition that given the current highly constrained influenza vaccine development and production timeline it would remain impossible to incorporate any variant virus which emerged significantly long after the relevant WHO biannual influenza vaccine composition meetings. Discussions were also held on the development of pandemic and broadly protective vaccines, and on associated regulatory and manufacturing requirements and constraints.
With increasing awareness of the health and economic burdens caused by seasonal influenza, the ever-present threat posed by zoonotic influenza viruses, and the significant impact of the 2014–15 northern hemisphere seasonal influenza vaccine mismatch, this consultation provided a very timely opportunity to share developments and exchange views. In all areas, a renewed and strengthened emphasis was placed on developing concrete and measurable actions and identifying the key stakeholders responsible for their implementation.

The Advisory Committee on Immunization Practices’ controversial recommendation against the use of live attenuated influenza vaccine is based on a biased study design that ignores secondary protection

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

Commentary
The Advisory Committee on Immunization Practices’ controversial recommendation against the use of live attenuated influenza vaccine is based on a biased study design that ignores secondary protection
Pages 1110-1112
Parker A. Small Jr., Brendan J. Cronin

An expensive adult measles outbreak and response in office buildings during the era of accelerated measles elimination, Beijing, China

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

Regular papers
An expensive adult measles outbreak and response in office buildings during the era of accelerated measles elimination, Beijing, China
Original Research Article
Pages 1117-1123
Rui Ma, Li Lu, Luodan Suo, Xiaomei Li, Fan Yang, Tao Zhou, Lijun Zhai, Hongwei Bai, Xinghuo Pang
Abstract
Background
Few measles outbreaks among adults are reported in China, and outbreak response costs are seldom documented. We report an adult measles outbreak and response in 4 linked office buildings in Beijing and its associated costs.
Method
The World Health Organization measles case definitions were used to determine suspected and confirmed measles cases. Surveillance data were used to describe the outbreak, and records and interviews of response staff were used to describe the response. Costs were determined by use of retrospective surveys of cases, review of records, and interviews of staff.
Results
The outbreak lasted 19 days, and involved 22 cases aged 23–49 years. Nineteen cases had a local household registration. All cases were employed by 8 companies in 4 linked office buildings. Among the 22 cases, 8 had temperature less than 38.5 degree, 18 had no Koplik spots and none had complications or hospitalizations. A total of 7930 contacts were identified, and of these, 6869 were employees in the office buildings. All the child contacts aged 8 months–14 years had been up-to-date for measles-containing vaccine (MCV); no adult could document their vaccination or measles history. Of contacts, about 96% were offered post-exposure vaccination. The total household costs were $13,298, or $605 per case. Control costs were $384,594, or $17,481 per case. Involved companies paid for 90.7% of control costs.
Conclusion
Office buildings provide a mechanism for measles transmission. Timely control activities were challenged by the highly infectious nature of measles and mild presentations of cases. The outbreak response was very costly. Financial support by involved companies can provide needed resources for outbreak management.

Survey of vaccination knowledge and acceptance among adults admitted to an urban emergency department

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

Survey of vaccination knowledge and acceptance among adults admitted to an urban emergency department
Original Research Article
Pages 1148-1151
Kathryn Sutcliffe, Paul E. Kilgore, Kaitlyn DeHoff, Richard Evans, Keith S. Kaye, Ryan E. Malosh, Robert Sherwin, Emily T. Martin
Abstract
Background
Adult vaccination rates in the United States have fallen below national target levels and may be exacerbated by lack of access to a primary care physician. We assessed patient knowledge of and attitudes towards vaccines in an urban emergency department population and analyzed the feasibility of using this setting as a vaccine delivery site from a patient perspective.
Methods
In-person interviewers administered surveys to 250 adult patients presenting to the Detroit Receiving Hospital emergency department in Detroit, Michigan. Respondents were asked about vaccination status, preferences, and willingness to accept vaccination reminders via text messaging. Odds ratios and 95% Wald confidence intervals assessing differences between vaccinated and non-vaccinated individuals were generated with univariate logistic regression.
Results
Vaccinated adults were more likely to have a primary care provider than non-vaccinated adults (OR 1.94, 95% CI: 1.09–3.45). Non-vaccinated adults were significantly more likely to have unvaccinated adult relatives (OR8.64, 95% CI: 4.10–18.22). Nearly all respondents used a cell phone, and 75.8% of unvaccinated adults were willing to receive text messages reminders about vaccines.
Conclusions
Although less likely to have a primary care access point than vaccinated participants, non-vaccinated respondents reported interest in receiving vaccinations. Emergency departments could serve as vaccination hubs for patients and unvaccinated accompanying family members. Text message reminders offer a potential source of additional vaccine prompts and education.

Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults
Original Research Article
Pages 1167-1174
Sandra Crouse Quinn, Amelia Jamison, Vicki S. Freimuth, Ji An, Gregory R. Hancock, Donald Musa
Abstract
Introduction
Racial disparities in adult flu vaccination rates persist with African Americans falling below Whites in vaccine acceptance. Although the literature has examined traditional variables including barriers, access, attitudes, among others, there has been virtually no examination of the extent to which racial factors including racial consciousness, fairness, and discrimination may affect vaccine attitudes and behaviors.
Methods
We contracted with GfK to conduct an online, nationally representative survey with 819 African American and 838 White respondents. Measures included risk perception, trust, vaccine attitudes, hesitancy and confidence, novel measures on racial factors, and vaccine behavior.
Results
There were significant racial differences in vaccine attitudes, risk perception, trust, hesitancy and confidence. For both groups, racial fairness had stronger direct effects on the vaccine-related variables with more positive coefficients associated with more positive vaccine attitudes. Racial consciousness in a health care setting emerged as a more powerful influence on attitudes and beliefs, particularly for African Americans, with higher scores on racial consciousness associated with lower trust in the vaccine and the vaccine process, higher perceived vaccine risk, less knowledge of flu vaccine, greater vaccine hesitancy, and less confidence in the flu vaccine. The effect of racial fairness on vaccine behavior was mediated by trust in the flu vaccine for African Americans only (i.e., higher racial fairness increased trust in the vaccine process and thus the probability of getting a flu vaccine). The effect of racial consciousness and discrimination for African Americans on vaccine uptake was mediated by perceived vaccine risk and flu vaccine knowledge.
Conclusions
Racial factors can be a useful new tool for understanding and addressing attitudes toward the flu vaccine and actual vaccine behavior. These new concepts can facilitate more effective tailored and targeted vaccine communications.

Predictors of durable immune responses six months after the last vaccination in preventive HIV vaccine trials

Vaccine
Volume 35, Issue 8, Pages 1101-1194 (22 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/8

Predictors of durable immune responses six months after the last vaccination in preventive HIV vaccine trials
Original Research Article
Pages 1184-1193
Yunda Huang, Lily Zhang, Holly Janes, Nicole Frahm, Abby Isaacs, Jerome H. Kim, David Montefiori, M. Julie McElrath, Georgia D. Tomaras, Peter B. Gilbert
Abstract
Background
The evaluation of durable immune responses is important in HIV vaccine research and development. The efficiency of such evaluation could be increased by incorporating predictors of the responses in the statistical analysis. In this paper, we investigated whether and how baseline demographic variables and immune responses measured two weeks after vaccination predicted durable immune responses measured six months later.
Methods
We included data from seven preventive HIV vaccine regimens evaluated in three clinical trials: a Phase 1 study of four DNA, NYVAC and/or AIDSVAX vaccine regimens (HVTN096), a Phase 2 study of two DNA and/or MVA vaccine regimens (HVTN205), and a Phase 3 study of a single ALVAC/AIDSVAX regimen (RV144). Regularized random forests and linear regression models were used to identify and evaluate predictors of the positivity and magnitude of durable immune responses.
Results
We analyzed 201 vaccine recipients with data from 10 to 127 immune response biomarkers, and 3–5 demographic variables. The best prediction of participants’ durable response positivity based on two-week responses rendered up to close-to-perfect accuracy; the best prediction of participants’ durable response magnitude rendered correlation coefficients between the observed and predicted responses ranging up to 0.91. Though prediction performances differed among biomarkers, durable immune responses were best predicted by the two-week response level of the same biomarker. Adding demographic information and two-week response levels of different biomarkers provided little or no improvement in the predictions.
Conclusions
For some biomarkers and for the vaccines we studied, two-week post-vaccination responses can well predict durable responses six months later. Therefore, if immune response durability is only assessed in a sub-sample of vaccine recipients, statistical analyses of durable responses will have increased efficiency by incorporating two-week response data. Further research is needed to generalize the findings to other vaccine regimens and biomarkers.
Clinicaltrials.gov identifiers: NCT01799954, NCT00820846, NCT00223080.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Cochrane Library
First published: 7 February 2017
Qualitative Review
Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence
Heather MR Ames1,2,*, Claire Glenton1, Simon Lewin3,4
Editorial Group: Cochrane Consumers and Communication Group
DOI: 10.1002/14651858.CD011787.pub2
Abstract
Background
Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.
Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate.
Objectives
The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents’ and informal caregivers’ views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents’ and informal caregivers’ decisions regarding childhood vaccination.
Search methods
We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search.
Selection criteria
We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed.
Data collection and analysis
We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents’ knowledge, attitudes and behaviour about childhood vaccination.
Main results
We included 38 studies, mostly from high-income countries, many of which explored mothers’ perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.
In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).
Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).
Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).
Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).
The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).
Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents’ needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives.
Authors’ conclusions
We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents’ perceptions of health workers and the information provided.

Media/Policy Watch

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

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

The Economist
http://www.economist.com/
Accessed 18 February 2017
International
Feb 16th 2017
Has philanthropy reached its limits? Podcast: The Economist asks Bill Gates
The Bill & Melinda Gates Foundation has given away grants of over $36 billion in the past decade. But under a new presidency, philanthropist and Microsoft co-founder Bill Gates faces stiff challenges on vaccine programmes, promised clampdowns on federal aid and a mood of distrust toward technocrats. He tells host Anne McElvoy why he still believes in engaging with Donald Trump

The Guardian
http://www.guardiannews.com/
Accessed 18 February 2017
Bill Gates warns tens of millions could be killed by bio-terrorism
Ewen MacAskill Defence correspondent in Munich
Saturday 18 February 2017 09.00 EST
Microsoft founder and philanthropist tells Munich security conference genetic engineering could be terrorist weapon

Scientific American
http://www.scientificamerican.com/
Accessed 18 February 2017
Guest Blog
Biting Back: Developing a Dengue Vaccine
We’ve been working on it for more than 70 years; here’s how we’re finally getting there, and what still needs to be done
By John Boslego on February 15, 2017
..The development of a safe and effective dengue vaccine candidate has faced many hurdles. An important challenge lies in the virus’s biological makeup. The dengue virus exists in four different forms, called serotypes. Each serotype can be transmitted from mosquito to human, and each can lead to dengue fever. The quest to develop a vaccine that protects against all four serotypes has proved challenging, compounded by the fact that infection by one serotype can lead to a more severe form of dengue fever upon re-infection by a different serotype (an effect called antibody-dependent enhancement). Moreover, multiple serotypes are present in many of the 128 countries where dengue is endemic. This means we must ensure that vaccination is protective against all four serotypes.
New dengue vaccine candidates, including the one I oversee at Takeda’s global vaccine unit, are now in late-stage, Phase 3 clinical trials. The TIDES Phase 3 trial is evaluating safety of the vaccine candidate, as well as efficacy in protecting study subjects against dengue caused by any of the four virus serotypes. If successful, it will be another victory in the collective effort against mosquito-borne diseases…
John Boslego is Senior Vice President and Head of Development for Takeda Pharmaceuticals Global Vaccine Business Unit

Wall Street Journal
http://www.online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 18 February 2017
Italy’s Vaccination Rates Raise Government’s Concern
Measles inoculations have dipped below level of India amid stubborn antivaccine sentiment
13 February 2017
By Pietro Lombardi
Italy is the latest front in Europe’s growing antivaccine trend, fueled in part by groups that oppose mandatory injections and raise doubts over their safety. The share of Italian 1-year-olds immunized against measles has dropped by at least 5 percentage points since 2012, according to the World Health Organization, slipping below the comparable rate for India. The country’s 2015 immunization rates were the lowest in Western Europe, WHO figures show, roughly on par with those in Serbia and Romania…

Washington Post
http://www.washingtonpost.com/
Accessed 18 February 2017
Fact Checker
Analysis
Trump’s claim that there’s ‘tremendous amount of increase’ in autism cases
By Michelle Ye Hee Lee February 16, 2017

Vaccines and Global Health: The Week in Review 11 February 2017

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_11-february-2017

– blog edition: comprised of the approx. 35+ entries posted below.

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

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Milestones :: Perspectives

Milestones :: Perspectives

In India, 410 million children to be vaccinated against measles-rubella
7 February 2017 – India has launched one of the world’s largest vaccination campaigns against measles and rubella. The campaign to vaccinate more than 410 million children aged 9 months to 15 years over the next 2 years is a big step towards improving child survival and preventing birth defects.

India’s measles-rubella vaccination campaign a big step towards reducing childhood mortality, addressing birth defects
By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
World Health Organization congratulates India for launching one of the world’s largest vaccination campaign against measles, a major childhood killer disease, and congenital rubella syndrome (CRS), responsible for irreversible birth defects.
The campaign launched today to vaccinate more than 35 million children in the age group of nine months to 15 years with MR (measles and rubella) vaccine, once again demonstrates India’s commitment to improve health and well-being of its people by protecting children against vaccine preventable diseases.
The first phase of the campaign is significant as it is expected to accelerate the country’s efforts to eliminate measles which affects an estimated 2.5 million children every year, killing nearly 49 000 of them. The campaign also marks the introduction of rubella vaccine in India’s childhood immunization programme to address CRS which causes birth defects such as irreversible deafness and blindness in nearly 40 000 children every year.
India has made important efforts and gains against measles in recent years. Measles deaths have declined by 51% from an estimated 100 000 in the year 2000 to 49 000 in 2015. This has been possible by significantly increasing the reach of the first dose of measles vaccine, given at the age of nine months under routine immunization programme, from 56% in 2000 to 87% in 2015. In 2010 India introduced the second dose of measles-containing vaccine in routine immunization programme to close the immunity gap and accelerate measles elimination. Nearly 118 million children aged nine months to 10 years were vaccinated during mass measles vaccination campaigns between 2010 and 2013 in select states of India.
Today’s campaign, the first in the series to cover a total of 410 million children across the country over the next 2 years, is a truly remarkable, world-beating effort. Apart from improving the life-chances of millions of children in India, the campaign is expected to have a substantial effect on global measles mortality and rubella control target as India accounts for 37% of global measles deaths…

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New York Times
February 8, 2017Op-Ed Contributor
How the Anti-Vaxxers Are Winning
Peter J. Hotez, a pediatrician at Baylor College of Medicine, is director of the Texas Children’s Hospital Center for Vaccine Development.
HOUSTON — It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America.
Measles is one of the most contagious and most lethal of all human diseases. A single person infected with the virus can infect more than a dozen unvaccinated people, typically infants too young to have received their first measles shot. Such high levels of transmissibility mean that when the percentage of children in a community who have received the measles vaccine falls below 90 percent to 95 percent, we can start to see major outbreaks, as in the 1950s when four million Americans a year were infected and 450 died. Worldwide, measles still kills around 100,000 children each year.

The myth that vaccines like the one that prevents measles are connected to autism has persisted despite rock-solid proof to the contrary. Donald Trump has given credence to such views in tweets and during a Republican debate, but as president he has said nothing to support vaccination opponents, so there is reason to hope that his views are changing.

However, a leading proponent of the link between vaccines and autism said he recently met with the president to discuss the creation of a presidential commission to investigate vaccine safety. Such a commission would be a throwback to the 2000s, when Representative Dan Burton of Indiana held fruitless hearings and conducted investigations on this topic. And a documentary alleging a conspiracy at the Centers for Disease Control and Prevention, “Vaxxed: From Cover-Up to Catastrophe,” has recently been shown around the country.

As a scientist leading global efforts to develop vaccines for neglected poverty-related diseases like schistosomiasis and Chagas’ disease, and as the dad of an adult daughter with autism and other disabilities, I’m worried that our nation’s health will soon be threatened because we have not stood up to the pseudoscience and fake conspiracy claims of this movement.

Texas, where I live and work, may be the first state to once again experience serious measles outbreaks. As of last fall, more than 45,000 children here had received nonmedical exemptions for their school vaccinations. A political action committee is raising money to protect this “conscientious exemption” loophole and to instruct parents on how to file for it. As a result, some public school systems in the state are coming dangerously close to the threshold when measles outbreaks can be expected, and a third of students at some private schools are unvaccinated.

The American Academy of Pediatrics has produced a 21-page document listing all of the studies clearly showing there is no link between vaccines and autism, in addition to more recent epidemiological studies involving hundreds of thousands of children or pregnant women that also refute any association. A study of infant rhesus monkeys also shows that vaccination does not produce neurobiological changes in the brain.

Vaccines are clearly not the reason children develop autism. So what is? There is strong evidence that genetics play a role, and that defects in the brain of children on the autism spectrum occur during pregnancy. Exposure during early pregnancy to particular chemicals in the environment or infections could be involved. Researchers have suggested that damage could be done by the drugs thalidomide, misoprostol and valproic acid; by exposure to the insecticide chlorpyrifos; and by infection of the mother with the rubella virus.

This is what we need to be focusing on, not the myth that vaccines cause autism. Yet I fear that such myths will be used to justify new rounds of hearings or unwarranted investigations of federal agencies, including the C.D.C. This would only distract attention from these agencies’ crucial work, and the real needs of families with children on the autism spectrum, such as mental health services, work-entry programs for adults and support for the research being done by the National Institutes of Health.

Today, parents in Texas have to live in fear that something as simple as a trip to the mall or the library could expose their babies to measles and that a broader outbreak could occur. Perpetuating phony theories about vaccines and autism isn’t going to help them — and it’s not going to help children on the autism spectrum, either.

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Washington Post
February 8, 2017
More than 350 organizations write Trump to endorse current vaccines’ safety
By Lena H. Sun
More than 350 organizations, including leading U.S. medical, advocacy and professional organizations, have sent a letter to President Trump expressing their “unequivocal support for the safety of vaccines.”

The effort, organized by the American Academy of Pediatrics, reflects the growing alarm among a wide array of groups over Trump’s embrace of discredited claims about vaccine safety. After a meeting in January with Robert F. Kennedy Jr., a proponent of the debunked theory that vaccines cause autism, a Trump spokeswoman said he was considering creation of a commission on autism.

“Vaccines protect the health of children and adults and save lives,” the letter opens. “Vaccines have been part of the fabric of our society for decades and are one of the most significant medical innovations of our time.”

It continues: “Claims that vaccines are unsafe when administered according to expert recommendations have been disproven by a robust body of medical literature.”

The letter was sent to Trump on Tuesday. Organizations that signed on represent families, providers, researchers, patients and consumers. They include the American Medical Association, the advocacy group Autism Speaks and major children’s and disability groups such as the Children’s Defense Fund, Easter Seals and the March of Dimes.

Following their meeting last month, Kennedy said that he and Trump had discussed creation of a vaccine commission, which he would chair. The Centers for Disease Control and Prevention already has a well-established expert panel, the Advisory Committee on Immunization Practices, which follows a scientifically rigorous and open process to evaluate all aspects of vaccine safety.

The letter calls vaccines the safest and most cost-effective way of preventing disease, disability and death. It notes that the United States is still experiencing outbreaks of vaccine-preventable illness, disability and death, such as the 2014-2015 measles outbreak that began at Disneyland and the sharp spike of pertussis, or whooping cough, in 2012.

The organizations wrote that they would welcome a meeting with Trump “to share the robust, extensive, scientific evidence” supporting vaccine safety and effectiveness. After just over a page of text, the letter continues for 26 additional pages to list all the national and state-based groups that signed as well as a summary of more than 40 studies on vaccine safety.
Here is the letter in full

Emergencies

Emergencies

WHO Grade 3 Emergencies [to 11 February 2017]
IraqNo new announcements identified.
The Syrian Arab RepublicNo new announcements identified.
NigeriaSee measles immunization campaign announcement above.

South Sudan
:: WHO partners with South Sudan’s Government to strengthen disease surveillance and outbreak response to save lives
03 February 2017, Juba, South Sudan – The deteriorating security situation in South Sudan, along with disruption of health services, increased population displacement, overcrowding and poor environmental conditions, led to more frequent disease outbreaks.
:: Read the latest cholera situation report pdf, 994kb 3 February 2017

Yemen
WHO: Urgent health needs in Yemen
8 February 2017 – WHO has deployed medical teams to provide urgently needed health services for internally displaced persons in Yemen. Roughly 22,000 people are affected by intense fighting in Al-Mokha city. More than 8000 people have fled to neighbouring regions to escape, while thousands more remain trapped and caught in the crossfire.
:: Yemen Emergency Response Plan 2017
:: Launch of UN appeal ‘Life-saving assistance needed in Yemen’
: Q&A: Malnutrition and emergencies

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WHO Grade 2 Emergencies [to 11 February 2017]
Cameroon No new announcements identified.
Central African Republic No new announcements identified.
Democratic Republic of the Congo No new announcements identified.
Ethiopia No new announcements identified.
Libya – No new announcements identified.
Myanmar No new announcements identified.
Niger – No new announcements identified.

Ukraine
Ukraine: Health needs soar as fighting flares in eastern Ukraine
3 February 2017 — A large shipment of WHO interagency emergency health kits is on its way to help meet immediate health needs in response to the recent intensification of fighting and shelling in the eastern part of Ukraine. Thousands of civilians are living in subzero temperatures and many others are injured and urgently in need of life-saving medical care. The emergency health kits will address the health needs of over 300 000 patients for 3 months in Ukraine. Further suffering and loss of life can be expected if preventive and emergency response measures are not taken immediately.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 19 (30 January – 5 February 2017) [EN/KU]

Syria
:: Statement by UNICEF Regional Director Geert Cappelaere on reports of children killed and injured in Syria 10 Feb 2017
:: Syrian Arab Republic: Aleppo Situation Report No. 15 (4 February 2017) [EN/AR]

Yemen
:: Yemen Humanitarian Bulletin Issue 20 | As of 31 January 2016
:: 2017 Yemen Humanitarian Response Plan (YHRP)
:: Yemen: UN and Partners Appeal for $2.1 BLN to Provide Life-saving Assistance to 12 million People in 2017 [EN/AR]
:: Yemen: Escalating Conflict – Yemen’s Western Coast Flash Update | 07 February 2017
:: Statement by the Humanitarian Coordinator in Yemen, Jamie McGoldrick, on the Situation in DHUBAB and MOKHA Areas 

POLIO [to 11 February 2017]

POLIO [to 11 February 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 8 February 2017
:: As the low season for poliovirus transmission continues, the first wild poliovirus case from acute flaccid paralysis (AFP) in the calendar year 2017 is reported from Afghanistan. Wild poliovirus type 1 positive samples from 2017 had previously been reported from environmental samples in Pakistan. Both countries continue to intensify their eradication efforts to urgently interrupt any residual virus transmission.

Country Updates [Selected Excerpts]
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 13 January, from Kandahar. It is the first reported case for calendar year 2017. The total number of WPV1 cases for 2016 remains 13. More than half of the 2016 cases are from Bermal district, Paktika.
:: This latest case is linked to the cross-border transmission corridor, affecting both southern Afghanistan and Quetta block, Balochistan, Pakistan. Both countries share common epidemiological reservoirs, and close coordination is ongoing between the country teams to further strengthen immunization and surveillance operations in a joint manner.
Pakistan
:: Three new environmental WPV1 positive samples were reported in the past week, from Quetta, Balochistan; Rawalpindi and Multan, Punjab; all collected in January 2017.

Zika virus [to 11 February 2017]

Zika virus [to 11 February 2017]
http://www.who.int/emergencies/zika-virus/en/

Latest Report [now bi-weekly]:
Zika situation report – 2 February 2017
Full report: http://apps.who.int/iris/bitstream/10665/254507/1/zikasitrep2Feb17-eng.pdf?ua=1
Analysis
Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.

Please see Lancet editorial in Journal Watch below.

MERS-CoV [to 11 February 2017]

MERS-CoV [to 11 February 2017]
http://www.who.int/emergencies/mers-cov/en/

Disease outbreak news
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
10 February 2017
Between 10 January and 3 February 2017 the National International Health Regulations Focal Point of Saudi Arabia reported seventeen (17) additional cases of Middle East Respiratory Syndrome (MERS) including four (4) fatal cases. Three (3) deaths among previously reported MERS cases (case no. 1 and 2 in DON published on 26 January 2017 and case no. 6 in DON published on 17 January 2017) were also reported…
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

WHO & Regional Offices [to 11 February 2017]

WHO & Regional Offices [to 11 February 2017]

WHO issues updated tetanus vaccines position paper
10 February 2017
In a revised position paper on tetanus toxoid (TT) vaccines published in today’s edition of the Weekly Epidemiological Record, WHO provided updated guidance on vaccination schedules for primary and booster vaccine doses, according to age and population group.
All children worldwide should be immunized against tetanus. Every country should seek to achieve early and timely infant vaccination. Other tetanus prevention efforts are also needed including individual and community education on clean wound care and the importance of following standard surgical protocols in accordance with WHO guidelines.
Weekly Epidemiological Record,10 February 2017, vol. 92, 6 (pp. 53–76)
Tetanus vaccines: WHO position paper – February 2017

Highlights
Strengthening resilience of hospitals during and after emergencies
February 2017 – 18 hospitals in 7 countries in the WHO European Region were assessed using the WHO Hospital Safety Index tool in 2015–2016. The Hospital Safety Index is a rapid, reliable way of assessing risk in the health sector.

Rehabilitation 2030: A Call for Action
February 2017 – There is a substantial and ever-increasing unmet need for rehabilitation worldwide, which is particularly profound in low- and middle-income countries. The availability of accessible and affordable rehabilitation is necessary for many people with health conditions to remain as independent as possible, to participate in education, to be economically productive, and fulfil meaningful life roles.

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO South-East Asia Region SEARO
:: India’s measles-rubella vaccination campaign a big step towards reducing childhood mortality, addressing birth defects 5 February 2017

WHO European Region EURO
:: Member States invited to propose candidates for the WHO Independent Expert Oversight Advisory Committee 10-02-2017
:: WHO/Europe strengthens resilience of hospitals during and after emergencies 06-02-2017

WHO Eastern Mediterranean Region EMRO
:: Prevention is crucial in tackling Afghanistan’s cancer burden
Kabul 5 February 2017 – New guidance from WHO aims to improve the chances of survival for people living with cancer by ensuring that health services can focus on diagnosing and treating the disease earlier. WHO figures indicate that each year 8.8 million people die from cancer, mostly in low- and middle-income countries. In Afghanistan, according to WHO estimates, there are around 15 000 new cancer cases every year.

CDC/ACIP [to 11 February 2017]

CDC/ACIP [to 11 February 2017]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/

MMWR Weekly February 10, 2017 / No. 4
[Excerpts]
:: Prevalence and Clinical Attributes of Congenital Microcephaly — New York, 2013–2015
:: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2017
:: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2017
: Announcement: Release of National Association of State Public Health Veterinarians’ 2016 Compendium of Animal Rabies Prevention and Control

Register for upcoming February ACIP meeting
February 22-23, 2017
Deadline for registration:
:: Non-US Citizens: February 1, 2017; US Citizens: February 13, 2017
Registration is NOT required to watch the live meeting webcast or to listen via telephone.

IAVI – International AIDS Vaccine Initiative [to 11 February 2017]

Announcements
IAVI – International AIDS Vaccine Initiative [to 11 February 2017]
https://www.iavi.org/

February 8, 2017
IAVI and Oxford University Initiate Africa-Europe Partnership to Develop an AIDS Vaccine
The International AIDS Vaccine Initiative (IAVI) announces an expanded partnership with Oxford University to develop a broadly effective AIDS vaccine candidate.
Led by Tomas Hanke at the Jenner Institute at Oxford University, the Globally Relevant AIDS Vaccine Europe-Africa Trials Partnership (GREAT) is a collaboration with Oxford University, IAVI, Imperial College London, the Kenya AIDS Vaccine Initiative Institute for Clinical Research (KAVI-ICR) at the University of Nairobi, the Uganda Virus Research Institute-IAVI HIV Vaccine Program (UVRI-IAVI), the Medical Research Council/UVRI Uganda Research Unit on AIDS, the Kenya Medical Research Institute-Wellcome Trust Research Programme (KWTRP) and the Zambia Emory HIV Research Program (ZEHRP).
GREAT includes a series of clinical trials to evaluate a promising vaccine candidate called tHIVconsvX. This candidate is designed to address one of AIDS vaccine science’s primary challenges: HIV’s frequent mutations. Targeting highly “conserved” or less-variable regions of the virus, tHIVconsvX triggers production of specialized immune cells called killer T cells that can destroy HIV-infected cells in the body. A previous Phase I clinical study by Oxford University with support from IAVI at KAVI-ICR in Kenya found an earlier-generation candidate to be safe and immunogenic, and researchers have subsequently adapted it with the aim to expand its breadth of protection.
The GREAT program will evaluate the candidate vaccine in both Europe and Africa. In Africa, the trials will evaluate safety and immunogenicity in young men and women, who account for more than a third of new HIV infections globally, as well as residents of fishing communities along the shores of Lake Victoria in Uganda, where HIV prevalence can be more than four times higher than in the general population. About two-thirds of all new HIV infections occur in sub-Saharan Africa.
GREAT is supported by the European and Developing Countries Clinical Trials Partnership (EDCTP), with co-funding from IAVI and Oxford University, and builds on extensive research expertise and infrastructure, as well as successful community engagement programs, at KAVI, KWTRP, UVRI and ZEHRP. In parallel to the trials, GREAT will support a range of projects at IAVI-partner clinical research centers to prepare them for participation in future large-scale vaccine efficacy trials.

IVI [to 11 February 2017]

IVI [to 11 February 2017]
http://www.ivi.int/

[Undated]
International Scientific Conference to Focus on Emerging Infectious Diseases and Antimicrobial Resistance in Asia
:: S.-Japan Cooperative Medical Sciences Program’s (USJCMSP) 19th International Conference on Emerging Infectious Diseases (EID) in the Pacific Rim runs from Feb. 7 to 10
:: First time conference held in South Korea; the International Vaccine Institute is the local host
…Since 1996, the United States-Japan Cooperative Medical Sciences Program has been convening the EID conference annually in alternating countries. It serves as a venue for panel meetings and discussion of cross-cutting topics related to infectious disease research to promote international cooperation in research efforts in response to new, emerging infectious disease challenges of Asia and the greater Pacific region…

Global Fund [to 11 February 2017]

Global Fund [to 11 February 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
07 February 2017

Catholic Relief Services Accelerates Fight Against Malaria in Niger
NIAMEY, Niger – CRuSh Malaria, a campaign to expand access to antimalarial medication for children in Niger, was launched today by Catholic Relief Services, a key partner in global health.
CRuSh Malaria aims to reduce the number of malaria cases among children under five by 60 percent by 2020. It aims to raise US$5 million from individuals, Catholic youth communities and parishes to support efforts by the Global Fund to end malaria…

UNAIDS [to 11 February 2017]

UNAIDS [to 11 February 2017]
http://www.unaids.org/
09 February 2017

Update
Faith leaders mobilize to end AIDS in the Caribbean
Caribbean faith leaders met in Port of Spain, Trinidad and Tobago, on 1 and 2 February to determine how they can support the Sustainable Development Goal agenda to end AIDS. The 55 faith leaders from 14 Caribbean countries representing the Bahá’í, Christian, Hindu, Muslim and Voodoo faiths were joined by regional and international development partners, including UNAIDS Deputy Executive Director Luiz Loures.
The faith leaders agreed on a set of recommendations, including offering leadership in support of achieving the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—and addressing violence against women and girls. Other recommendations include engagement between representatives of religious organizations and key populations, including men who have sex with men, sex workers and people who use drugs.
While religious organizations have long contributed to the Caribbean AIDS response, the consultation aimed to increase knowledge and coordination, while rallying the region around the goal of ending the AIDS epidemic. However, the meeting heard that challenges surrounding stigma, discrimination, prevention and access to services remain.
The consultation, which was organized by a regional Faith Leader Planning Committee with support from the Pan Caribbean Partnership against HIV and AIDS, culminated with an endorsement of the United Nations Political Declaration on Ending AIDS and a road map to deepen their partnerships and capacity.

IFPMA [to 11 February 2017]

IFPMA [to 11 February 2017]
http://www.ifpma.org/resources/news-releases/
09 February 2017

Leadership rotation at Fight the Fakes, the worldwide campaign to protect people from fake medicines
Today the International Federation of Pharmaceutical Wholesalers (IFPW) begins its role as secretariat of Fight the Fakes, the global campaign to raise awareness of the threat fake medicines pose to people and public health.
Launched in November 2013, Fight the Fakes has grown into a coalition of over 30 organizations, including healthcare professionals, academia, NGOs, the generic and research-based pharmaceutical industry, healthcare distributers, and consumer protection organizations.
As the Fight the Fakes secretariat, IFPW will continue to coordinate and amplify campaign partners’ activities in combatting fake medicines, and leverage their supply chain expertise and membership base to strengthen the campaign’s network…

Thomas Cueni takes helm of IFPMA as Director General
07 February 2017
Thomas B. Cueni has taken up office as Director General of IFPMA on February 1, representing the interests of the research-based biopharmaceutical industry at a global level.
Thomas Cueni is highly respected across the biopharmaceutical sector, having served for many years as Secretary General of Interpharma, the association of pharmaceutical research companies in Switzerland. He has been closely associated with IFPMA throughout his tenure at Interpharma as a member of the Council of the IFPMA. He has also been instrumental in shaping policy and advocating with European Institutions on behalf of the European Federation of Pharmaceutical Industries and Associations (EFPIA)…

Journal Watch

Journal Watch
Vaccines and Global Health: The Week in Review
continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Noma: Time to Address a Collective Moral Failure

American Journal of Tropical Medicine and Hygiene
February 2017; 96 (2)
http://www.ajtmh.org/content/current

Editorial
Noma: Time to Address a Collective Moral Failure
Raffaella Ravinetto1,*
Author Affiliations
1Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Author Notes
Author’s address: Raffaella Ravinetto, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium, E-mail: rravinetto@itg.be.
* Address correspondence to Raffaella Ravinetto, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. E-mail: rravinetto@itg.be
In this issue of the journal, Srour and others1 give a comprehensive overview of the history, epidemiology, etiology, pathogenesis, microbiology, prevention, diagnosis, and treatment of noma, a devastating orofacial gangrene that affects malnourished children in tropical regions. Even if exclusively present in tropical regions, noma is better described as a “poverty disease” rather than as a “tropical disease,” because it has accompanied extreme poverty and poor nutrition for centuries.2,3 With the exception of cases occurred in concentration camps during World War II,2,4 noma disappeared from Europe and North America by the end of the nineteenth century, thanks to the economic development and improved access to nutrition and health care.1,3 Today, it is particularly present in the sub-Saharan Africa “noma belt,” stretching from Senegal to Ethiopia.
The victims of noma are so neglected that their deaths are not included in mortality statistics5 or in the Global Burden of Diseases.6 Noma incidence is estimated to 30,000–140,000 cases, and its mortality at 85%. In addition, the disease, which is named after a Greek word (νoμη) meaning “devour” and indicating a process that develops very rapidly,2,3 leaves survivors with devastating sequelae: severe facial disfigurement and functional impairment hinder interpersonal relationships and trigger stigma and rejection from societal life.1,3,4,7 The pharmacological treatment is empirical and has not been tested in clinical trials.5 The surgical treatment of sequelae requires tertiary health care that is often unavailable, and it is estimated that at least 770,000 noma survivors remain in need of reconstructive surgery.2

Noma: Overview of a Neglected Disease and Human Rights Violation

American Journal of Tropical Medicine and Hygiene
February 2017; 96 (2)
http://www.ajtmh.org/content/current

Articles
Noma: Overview of a Neglected Disease and Human Rights Violation
Am J Trop Med Hyg 2017 96:268-274; Published online January 16, 2017, doi:10.4269/ajtmh.16-0718
M. Leila Srour, Klaas Marck, and Denise Baratti-Mayer
Abstract
Noma is an orofacial gangrene affecting malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa. Epidemiological data on noma are scarce, but a current estimate of the global incidence is 30,000–40,000 cases per year, with a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1–10 million disability-adjusted life years. The etiology of noma is multifactorial with malnutrition as an ever present factor, often in combination with concomitant diseases, such as measles, malaria, and human immunodeficiency virus (HIV), and poor oral hygiene. The pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis. Rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms. Prevention lies in food security, measles vaccination, prevention of malaria and HIV, including the early detection and treatment of necrotizing gingivitis and stomatitis. Early treatment with antibiotics may prevent gangrene or reduce its extent. Late treatment consists of surgical rehabilitation, which is often complex. However, access to medical care is very limited for noma patients due to the extremely poor conditions in which they live that are frequently located in remote rural areas. The authors support the United Nations Human Rights Council Resolution 19/7 adopted on March 22, 2012 “The right to food,” and advocate for the inclusion of noma on the list of neglected tropical diseases to encourage more medical and institutional attention for this often lethal or very mutilating infectious gangrene.

Interagency and Commercial Collaboration During an Investigation of Chikungunya and Dengue Among Returning Travelers to the United States

American Journal of Tropical Medicine and Hygiene
February 2017; 96 (2)
http://www.ajtmh.org/content/current

Perspective Piece
Interagency and Commercial Collaboration During an Investigation of Chikungunya and Dengue Among Returning Travelers to the United States
Am J Trop Med Hyg 2017 96:265-267; Published online September 6, 2016, doi:10.4269/ajtmh.16-0298
Emily S. Jentes, Alexander J. Millman, Michelle Decenteceo, Andrew Klevos, Holly M. Biggs, Douglas H. Esposito, Heidi McPherson, Carmen Sullivan, Dayton Voorhees, Jim Watkins, Fanancy L. Anzalone, Linda Gaul, Sal Flores, Gary W. Brunette, and Mark J. Sotir
Abstract
Public health investigations can require intensive collaboration between numerous governmental and nongovernmental organizations. We describe an investigation involving several governmental and nongovernmental partners that was successfully planned and performed in an organized, comprehensive, and timely manner with several governmental and nongovernmental partners.

International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines

BMC Cost Effectiveness and Resource Allocation
http://www.resource-allocation.biomedcentral.com/
(Accessed 11 February 2017)

Review
International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines
Kathryn M. Antioch, Michael F. Drummond, Louis W. Niessen and Hindrik Vondeling
Published on: 10 February 2017
Abstract
Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by ‘checklists’ to establish the best evidence for decision making given methodological rigor. New economic evaluation checklists, Multi-Criteria Decision Analyses (MCDA) and other decision criteria enable health economists to impact on decision making world-wide. We analyse the methodologies for integrating economic evidence into CPG agencies globally, including the Agency of Health Research and Quality (AHRQ) in the USA, National Health and Medical Research Council (NHMRC) and Australian political reforms. The Guidelines and Economists Network International (GENI) Board members from Australia, UK, Canada and Denmark presented the findings at the conference of the International Health Economists Association (IHEA) and we report conclusions and developments since. The Consolidated Guidelines for the Reporting of Economic Evaluations (CHEERS) 24 item check list can be used by AHRQ, NHMRC, other CPG and health organisations, in conjunction with the Drummond ten-point check list and a questionnaire that scores that checklist for grading studies, when assessing economic evidence. Cost-effectiveness Analysis (CEA) thresholds, opportunity cost and willingness-to-pay (WTP) are crucial issues for decision rules in CEA generally, including end-of-life therapies. Limitations of inter-rater reliability in checklists can be addressed by including more than one assessor to reach a consensus, especially when impacting on treatment decisions. We identify priority areas to generate economic evidence for CPGs by NHMRC, AHRQ, and other agencies. The evidence may cover demand for care issues such as involved time, logistics, innovation price, price sensitivity, substitutes and complements, WTP, absenteeism and presentism. Supply issues may include economies of scale, efficiency changes, and return on investment. Involved equity and efficiency measures may include cost-of-illness, disease burden, quality-of-life, budget impact, cost-effective ratios, net benefits and disparities in access and outcomes. Priority setting remains essential and trade-off decisions between policy criteria can be based on MCDA, both in evidence based clinical medicine and in health planning.

Active surveillance study of adverse events following immunisation of children in the Czech Republic

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 11 February 2017)

Research article
Active surveillance study of adverse events following immunisation of children in the Czech Republic
Despite the undisputed public health benefits of routine vaccination, adverse events following immunisation (AEFI) remain a concern… The rate of AEFI identified in this study was considerably higher than the officially reported rate. Although the vast majority of AEFI were non-serious, health care providers and the public should be educated and encouraged to report AEFI to address the issue of underreporting, to increase the safety profile of vaccines, and to improve public confidence in immunisation programmes.
Jana Danova, Aneta Kocourkova and Alexander M. Celko
BMC Public Health 2017 17:167
Published on: 6 February 2017