BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 11 February 2017)

Research article
Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya
The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. …This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.
Martin Njoroge, Dejan Zurovac, Esther A. A. Ogara, Jane Chuma and Doris Kirigia
BMC Research Notes 2017 10:90
Published on: 10 February 2017

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 11 February 2017]

Research
Global research trends of World Health Organization’s top eight emerging pathogens
Waleed M. Sweileh
Published on: 8 February 2017
Abstract
Background
On December 8th, 2015, World Health Organization published a priority list of eight pathogens expected to cause severe outbreaks in the near future. To better understand global research trends and characteristics of publications on these emerging pathogens, we carried out this bibliometric study hoping to contribute to global awareness and preparedness toward this topic.
Method
Scopus database was searched for the following pathogens/infectious diseases: Ebola, Marburg, Lassa, Rift valley, Crimean-Congo, Nipah, Middle Eastern Respiratory Syndrome (MERS), and Severe Respiratory Acute Syndrome (SARS). Retrieved articles were analyzed to obtain standard bibliometric indicators.
Results
A total of 8619 journal articles were retrieved. Authors from 154 different countries contributed to publishing these articles. Two peaks of publications, an early one for SARS and a late one for Ebola, were observed. Retrieved articles received a total of 221,606 citations with a mean ± standard deviation of 25.7 ± 65.4 citations per article and an h-index of 173. International collaboration was as high as 86.9%. The Centers for Disease Control and Prevention had the highest share (344; 5.0%) followed by the University of Hong Kong with 305 (4.5%). The top leading journal was Journal of Virology with 572 (6.6%) articles while Feldmann, Heinz R. was the most productive researcher with 197 (2.3%) articles. China ranked first on SARS, Turkey ranked first on Crimean-Congo fever, while the United States of America ranked first on the remaining six diseases. Of retrieved articles, 472 (5.5%) were on vaccine – related research with Ebola vaccine being most studied.
Conclusion
Number of publications on studied pathogens showed sudden dramatic rise in the past two decades representing severe global outbreaks. Contribution of a large number of different countries and the relatively high h-index are indicative of how international collaboration can create common health agenda among distant different countries.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 11 February 2017]

Research
The concept of ‘vulnerability’ in research ethics: an in-depth analysis of policies and guidelines
Dearbhail Bracken-Roche, Emily Bell, Mary Ellen Macdonald and Eric Racine
Published on: 7 February 2017
Abstract
Background
The concept of vulnerability has held a central place in research ethics guidance since its introduction in the United States Belmont Report in 1979. It signals mindfulness for researchers and research ethics boards to the possibility that some participants may be at higher risk of harm or wrong. Despite its important intended purpose and widespread use, there is considerable disagreement in the scholarly literature about the meaning and delineation of vulnerability, stemming from a perceived lack of guidance within research ethics standards. The aim of this study was to assess the concept of vulnerability as it is employed in major national and international research ethics policies and guidelines.
Methods
We conducted an in-depth analysis of 11 (five national and six international) research ethics policies and guidelines, exploring their discussions of the definition, application, normative justification and implications of vulnerability.
Results
Few policies and guidelines explicitly defined vulnerability, instead relying on implicit assumptions and the delineation of vulnerable groups and sources of vulnerability. On the whole, we found considerable richness in the content on vulnerability across policies, but note that this relies heavily on the structure imposed on the data through our analysis.
Conclusions
Our results underscore a need for policymakers to revisit the guidance on vulnerability in research ethics, and we propose that a process of stakeholder engagement would well-support this effort.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 11 February 2017]

Research Article
Hepatitis B virus infection in undocumented immigrants and refugees in Southern Italy: demographic, virological, and clinical features
The data on hepatitis b virus (HBV) infection in immigrants population are scanty. The porpoise of this study was to define the demographic, virological, and clinical characteristics of subjects infected with …
Nicola Coppola, Loredana Alessio, Luciano Gualdieri, Mariantonietta Pisaturo, Caterina Sagnelli, Carmine Minichini, Giovanni Di Caprio, Mario Starace, Lorenzo Onorato, Giuseppe Signoriello, Margherita Macera, Italo Francesco Angelillo, Giuseppe Pasquale and Evangelista Sagnelli
Infectious Diseases of Poverty 2017 6:33
Published on: 9 February 2017

JAMA
February 7, 2017, Vol 317, No. 5, Pages 453-546
http://www.jama.jamanetwork.com/issue.aspx

Viewpoint
Population Health Equity: Rate and Burden, Race and Class
David Kindig, MD, PhD
JAMA. 2017;317(5):467-468. doi:10.1001/jama.2016.19435
Although US racial and ethnic minorities have higher rates of poor health because of health care inequities, more low-income white individuals are affected because of greater population numbers. This Viewpoint explains that efforts to improve poor outcomes would be more effective if strategies were not based on proportions of race.

A Global Vaccine Injury Compensation System
Sam F. Halabi, JD, MPhil; Saad B. Omer, MBBS, MPH, PhD
JAMA. 2017;317(5):471-472. doi:10.1001/jama.2016.19492
This Viewpoint discusses the benefits of establishing a global vaccine injury compensation system that is government and manufacturer supported to compensate individuals who experience vaccine injury.

Privatized Pharmaceutical Innovation vs Access to Essential MedicinesA Global Framework for Equitable Sharing of Benefits
Gian Luca Burci; Lawrence O. Gostin, JD
JAMA. 2017;317(5):473-474. doi:10.1001/jama.2016.17994
This Viewpoint proposes a framework for promoting pharmaceutical innovation while ensuring access and affordability of new drugs on a global scale.

Equipoise in ResearchIntegrating Ethics and Science in Human Research
Alex John London, PhD
JAMA. 2017;317(5):525-526. doi:10.1001/jama.2017.0016
This JAMA Guide to Statistics and Methods article reviews the concept of equipoise, which allows for randomization of interventions while also respecting the rights of human subjects in clinical research.

Journal of Immigrant & Refugee Studies
Volume 15, Issue 1, 2017
http://www.tandfonline.com/toc/wimm20/current

Articles
Investigating the Refugee Health Disadvantage Among the U.S. Immigrant Population
Pages 53-70 | Published online: 20 Jun 2016
Holly E. Reed & Guillermo Yrizar Barbosa
ABSTRACT
Much health-disparities research focuses on race and ethnicity, but nativity has proved to be a crucial factor in explaining the immigrant health advantage. Foreign-born subgroups with certain immigration statuses, such as refugees, may have an initial disadvantage. Using nationally representative survey data, we explore differences in health outcomes by analyzing two visa category subgroups in the United States: refugees and nonrefugee immigrants. Our findings show that refugees have a significant disadvantage across multiple health outcomes. This suggests that current refugee health-screening practices should be changed to take into account broader issues, such as chronic disease and functional limitation.

Journal of Medical Internet Research
Vol 19, No 2 (2017): February
http://www.jmir.org/2017/2

Viewpoint
Navigating Ethics in the Digital Age: Introducing Connected and Open Research Ethics (CORE), a Tool for Researchers and Institutional Review Boards
John Torous, Camille Nebeker
ABSTRACT
Research studies that leverage emerging technologies, such as passive sensing devices and mobile apps, have demonstrated encouraging potential with respect to favorably influencing the human condition. As a result, the nascent fields of mHealth and digital medicine have gained traction over the past decade as demonstrated in the United States by increased federal funding for research that cuts across a broad spectrum of health conditions. The existence of mHealth and digital medicine also introduced new ethical and regulatory challenges that both institutional review boards (IRBs) and researchers are struggling to navigate. In response, the Connected and Open Research Ethics (CORE) initiative was launched. The CORE initiative has employed a participatory research approach, whereby researchers and IRB affiliates are involved in identifying the priorities and functionality of a shared resource. The overarching goal of CORE is to develop dynamic and relevant ethical practices to guide mHealth and digital medicine research. In this Viewpoint paper, we describe the CORE initiative and call for readers to join the CORE Network and contribute to the bigger conversation on ethics in the digital age.

The Lancet
Feb 11, 2017 Volume 389 Number 10069 p573-670
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Another kind of Zika public health emergency
The Lancet
Published: 11 February 2017
A year ago, on Feb 1, 2016, WHO declared the Zika virus epidemic a public health emergency. In a brave show of leadership no doubt spurred by the embarrassment of failing to act sooner on the Ebola outbreak threats, Director-General Margaret Chan sounded the alarm about the potential links between Zika virus and rising neurological disorders despite a lack of conclusive data. By doing so she stimulated an international collective effort, scientific research, and funding that helped stabilise the crisis. A year on she has reflected on the rightness of that decision, writing in a commentary on WHO’s website that it strengthened integrated surveillance for mosquito-borne viruses, and accelerated understanding of the modes of transmission and the abnormalities associated with congenital Zika virus syndrome. The coordination that occurred between international and national authorities and health professionals, especially in Latin American countries, to detect, diagnose, and characterise cases of microcephaly is commendable.

But the warm glow of that reflection must be tempered by the challenges ahead. It would be tempting to laud the Zika response as a success and redirect attention to other emergent issues. To do so would ignore the continued spread of Zika virus and its under-appreciated long-term effects. As WHO shifts direction under a new Director-General, we need even bolder Zika leadership that keeps victims and their families firmly on our public health agenda.
As of Feb 1, 2017, the number of countries reporting a Zika virus outbreak since 2015 has grown to 59, 48 of them in North and South America. Seven countries have reported active local transmission of the virus in 2016 or 2017. 13 countries report person-to-person transmission. New affected areas have emerged including Angola, already struggling under yellow fever and cholera epidemics, which reported its first two cases in January.

Continued geographical spread of Zika virus would be a challenge enough were it not for the anticipated long-term effects. Chan’s commentary says WHO “must be ready for the long-haul” but misses the opportunity to urge and specify international attention, research, and resources for the individuals left devastated by Zika virus. It leaves invisible the needs of thousands of children, their families, and future families; and overlooks the responsibility of the world’s community to support them.

Indeed, Zika can only be considered a long-term epidemic. 6 months ago Bruce Aylward, then head of WHO’s outbreaks and health emergencies cluster, told The Lancet that “we don’t know what the full spectrum of the Zika-caused congenital defects will be. Will apparently unaffected children whose mothers had Zika virus infection in pregnancy develop normally? Will they be able to walk and talk normally? Will they be mentally impaired or have other problems that only become evident years later?” We still don’t know. Fully supported research to understand, track, and address the long-term sequelae of congenital, perinatal, and paediatric Zika virus infection on children’s development must be prioritised.

Currently, almost 3000 cases of Zika-related microcephaly or other CNS defects have been recorded in 29 countries. Brazil has been hardest hit: 2366 babies have been born to Zika-infected women and their families, many already vulnerable and lacking the resources to shoulder the burdens of care. Whereas some of these affected children will lead normal lives, many others with congenital Zika virus syndrome will experience severe disability and need long-term medical attention. Medical interventions could involve intensive physical therapy, treatments for neurological impairments, feeding tubes, and others. The US Centers for Disease Control has estimated the costs of treating such children to be tens of millions of dollars. And microcephaly is likely to represent only a portion of those affected. Others will be born blind or deaf, or suffering from seizures, irritability, or swallowing disorders. Even in the absence of microcephaly, congenital brain abnormalities might be present. That Zika virus infection can trigger the autoimmune disorder Guillain-Barré syndrome in adults worsens the long-term effects. A portion of those affected will die without access to respiratory and intensive care; many more will live with disability. Adding to Zika’s economic drain on societies because of lost productivity due to neurological deficits, these medical consequences amount to another kind of Zika public health emergency.

As the world waits for a vaccine, public health efforts will necessarily focus on prevention in the form of mosquito control and travel advisories. But health agencies like WHO, public health researchers, and policy makers must also not forget the individuals affected. They require our unrelenting attention.

The Lancet
Feb 11, 2017 Volume 389 Number 10069 p573-670
http://www.thelancet.com/journals/lancet/issue/current

Articles
Safety and immunogenicity of a recombinant adenovirus type-5 vector-based Ebola vaccine in healthy adults in Sierra Leone: a single-centre, randomised, double-blind, placebo-controlled, phase 2 trial
Feng-Cai Zhu, Alie H Wurie, Li-Hua Hou, Qi Liang, Yu-Hua Li, James B W Russell, Shi-Po Wu, Jing-Xin Li, Yue-Mei Hu, Qiang Guo, Wen-Bo Xu, Abdul R Wurie, Wen-Juan Wang, Zhe Zhang, Wen-Jiao Yin, Manal Ghazzawi, Xu Zhang, Lei Duan, Jun-Zhi Wang, Wei Chen
621
Published: 22 December 2016

Nature Medicine
February 2017, Volume 23 No 2 pp137-264
http://www.nature.com/nm/journal/v23/n2/index.html

Articles
A chikungunya fever vaccine utilizing an insect-specific virus platform – pp192 – 199
Jesse H Erasmus, Albert J Auguste, Jason T Kaelber, Huanle Luo, Shannan L Rossi, Karla Fenton, Grace Leal, Dal Y Kim, Wah Chiu, Tian Wang, Ilya Frolov, Farooq Nasar & Scott C Weaver
doi:10.1038/nm.4253
New vaccine approaches that safely elicit immunity are needed to protect against infectious disease. Erasmus et al. report their development of an insect-virus-based platform that they use to engineer a protective vaccine against chikungunya fever.

New England Journal of Medicine
February 9, 2017  Vol. 376 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Powerful Ideas for Global Access to Medicines
Suerie Moon, M.P.A., Ph.D.
N Engl J Med 2017; 376:505-507 February 9, 2017 DOI: 10.1056/NEJMp1613861

One of the few issues uniting U.S. voters in the 2016 election was outrage over the high prices of medicines. From the quadrupling of EpiPen prices to $1,000-per-pill hepatitis C treatments, from six-digit pricing of cancer drugs to the 55-fold price increase on a 62-year-old toxoplasmosis drug, the scandals keep coming. In Europe, where government involvement in price negotiations means that new drugs, diagnostics, and vaccines (“medicines”) can cost less than half their U.S. prices, there is nevertheless serious concern that yearly price increases will break health system budgets. Worldwide drug spending grew by about 9% in 2014 and 2015, outpacing both overall health expenditures and economic growth.1

But what has recently been headline news in high-income countries has long been a concern everywhere else. Whether low- and middle-income countries (LMICs) are struggling to treat millions of people living with HIV or to immunize refugee children against pneumonia, unaffordable prices mean that many people simply go without. Meanwhile, despite billions of public and private dollars invested in pharmaceutical research and development, urgent needs for new antibiotics and tools for other public health priorities go unmet. Unaffordable medicines and inadequate innovation have become global issues. Like climate change, they require new public policies and international cooperation.

Responding to concerns raised by patients and health advocates worldwide, in 2015 United Nations (UN) Secretary General Ban Ki-Moon convened a High-Level Panel on Access to Medicines led by two former heads of state, Ruth Dreifuss of Switzerland and Festus Mogae of Botswana, together with 13 international experts with wide-ranging perspectives. Even before the report was published in September 2016 (www.unsgaccessmeds.org/final-report), it had attracted an unusual degree of attention — both positive and negative — from governments, the pharmaceutical industry, and civil society. Some of the reaction, epitomized by the U.S. Chamber of Commerce statement “condemn[ing the] U.N. report attacking patents,”2 reflected a decades-old debate over the appropriate relationship between intellectual property monopolies and medicine prices. Yet the report does not generally go beyond preexisting international agreements on patents. Rather, the true source of consternation may be that it reframes the access-to-medicines challenge not only as involving prices in LMICs, but also as requiring systemic changes to the prevailing research-and-development business model for the sake of all countries. The panel then advances some powerful ideas regarding such changes.

One of those ideas is transparency. Reliable, thorough public information is not generally available on the safety, efficacy, prices, patent status, sources of investment, and costs of developing lifesaving medicines. Given its profound implications for the public interest, the drug-development system is shrouded in a disproportionate degree of secrecy. The panel recommended that governments mandate disclosure of information on various aspects of pharmaceutical development, including research-and-development costs. Depending on the information source and the methods used, estimates of the cost of developing a new drug vary by a factor of 40 or more — ranging from $92 million to $4.2 billion.3 Transparency could introduce some measure of reason and evidence into heated pricing debates, which too often deteriorate into hyperbolic claims that any interference with free-market pricing would destroy innovation. A more granular understanding of research and development could also shed light on the efficiency of the processes involved and spark debate about how society ought to appropriately compensate investment, outcomes, and risk and calibrate financial rewards to the degree of therapeutic advance offered.

Transparency is also key to another powerful idea endorsed by the panel: ensuring public return on public investment in medicine development. Drug development is a public–private enterprise, with the public investing in basic research and early-stage discovery through taxpayer funding of academic and public laboratories and then purchasing the medicines that private firms develop through insurance policies or out-of-pocket expenditures. In areas in which the market fails to offer adequate incentives for innovation — such as neglected diseases, emerging infectious diseases, or antimicrobial resistance — public funding and priority setting play an even greater role, subsidizing all stages of product development. For example, the U.S. government’s Biomedical Advanced Research and Development Authority has funded private firms to develop medicines for use in potential outbreaks and has obtained approval from the Food and Drug Administration for 24 products since its founding in 2006.

Transparency regarding public contributions to the research underlying a medicine could provide a foundation for tempering excessive pricing, either in advance through conditions imposed on public financing or after development through government regulation.
The report also calls for testing and implementing new business models of research and development that would build affordability into the product-development process by delinking research financing from end-product prices. Some such models have already been proven to work in not-for-profit drug-development efforts. For example, with $290 million from public funds and philanthropic contributions, the Drugs for Neglected Diseases Initiative (DNDi) put 26 candidate products into the development pipeline and brought 6 to market in 10 years; because the research costs have already been covered, DNDi’s products can be sold for approximately the cost of production.4 Though there are important differences between drug development for neglected diseases and other therapeutic areas, this example offers proof of principle regarding better ways to manage public and private investments to channel research and development in the public interest.

Finally, the panel called for governments and companies to adhere to established agreements to protect access to medicines under international trade rules. For example, governments have the authority to decide when a private patent right can be set aside in the interest of public health — a right that has been reaffirmed in every relevant UN political declaration since 2001. Though the pharmaceutical industry has criticized the report as an attack on patents, the panel in fact recommended only that preexisting agreements be enforced; it did not recommend additional patent flexibilities beyond what has been agreed on for 15 years. Indeed, some panel members and civil-society organizations expressed disappointment that it did not call for a more dramatic overhaul of intellectual-property treaties.

Among the report’s authors is the chief executive officer of GlaxoSmithKline (GSK), Andrew Witty, who has occasionally become a thorn in his industry’s side by taking positions ahead of the curve. For example, he has called the $1 billion research-and-development price tag a myth reflecting inefficiencies rather than required costs; he expanded GSK’s policy of licensing generic versions of patented medicines in some LMICs beyond HIV to include cancer; and he has endorsed new research-and-development models to combat antimicrobial resistance and pathogens of pandemic potential. His peers may wish to reexamine some of the business models advanced in the report, which could continue rewarding innovation while satisfying growing public demands for affordability and needs-driven innovation.

Given the charged politics of debates over access to medicines, I believe Secretary General Ban was courageous to convene this panel — though the report’s fate in the UN system is uncertain, given that there is a new secretary general, a new U.S. president, and a new director general of the World Health Organization in 2017. Nevertheless, the panel’s greatest impact may be realized not through intergovernmental talks, but by stimulating public debate over ways of reforming the research-and-development system to better serve the global public interest. The Netherlands’ trade and health ministers recently echoed three panel recommendations, calling for transparency of pharmaceutical research-and-development costs, adequate public return on public investment, and testing of new business models.5

This report comes at a time when the public appetite for change is growing, the pharmaceutical industry’s reputation is in the doldrums, and demand for a more equitable global trade system is building. It puts forth ideas that deserve a fair hearing in countries struggling to provide access to medicines for their people and in the boardrooms of companies with the vision to try new ways of delivering innovation. Business as usual is no longer an option.

New England Journal of Medicine
February 9, 2017  Vol. 376 No. 6
http://www.nejm.org/toc/nejm/medical-journal

Special Report
Middle East Respiratory Syndrome
Yaseen M. Arabi, M.D., Hanan H. Balkhy, M.D., Frederick G. Hayden, M.D., Abderrezak Bouchama, M.D., Thomas Luke, M.D., J. Kenneth Baillie, M.D., Ph.D., Awad Al-Omari, M.D., Ali H. Hajeer, Ph.D., Mikiko Senga, Ph.D., Mark R. Denison, M.D., Jonathan S. Nguyen-Van-Tam, D.M., Nahoko Shindo, M.D., Ph.D., Alison Bermingham, Ph.D., James D. Chappell, M.D., Ph.D., Maria D. Van Kerkhove, Ph.D., and Robert A. Fowler, M.D., C.M., M.S. (Epi)
N Engl J Med 2017; 376:584-594 February 9, 2017 DOI: 10.1056/NEJMsr1408795
The Middle East respiratory syndrome is caused by a coronavirus that was first identified in Saudi Arabia in 2012. Periodic outbreaks continue to occur in the Middle East and elsewhere. This report provides the latest information on MERS.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 11 February 2017]

Brief Report
Health Consequences of Typhoon Haiyan in the Eastern Visayas Region Using a Syndromic Surveillance Database
February 6, 2017 ·
Introduction: Typhoon Haiyan was the strongest storm recorded in Philippine history. Surveillance in Post Extreme Emergencies and Disasters (SPEED) was activated during the typhoon response. This study analyzes the health impact of different diseases during different timeframes post-disaster during Typhoon Haiyan in 2013 using a syndromic surveillance database.
Methods: SPEED reports medical consultations based on 21 syndromes covering a range of conditions from three syndrome groups: communicable diseases, injuries, and non-communicable diseases (NCDs). We analyzed consultation rates for 150 days post-disaster by syndrome, syndrome group, time period, and health facility type for adults as well as for children under the age of five.
Results: Communicable diseases had the highest consultation rates followed by similar rates for both injuries and NCDs. While communicable diseases were the predominant syndrome group for children, wounds and hypertension were common syndromes observed in adults. Village health centers had the most consultations amongst health facilities, but also showed the highest variability.
Discussion: Children were more vulnerable to communicable diseases compared to adults. Community health centers showing consistently high consultation rates point out a need for their prioritization. The predominance of primary care conditions requires disaster managers to focus on basic health care and public health measures in community health centers that target the young, elderly and impoverished appropriate to the time period.

PLoS Neglected Tropical Diseases
http://www.plosntds.org
(Accessed 11 February 2017)

Review
Environmental and Social Change Drive the Explosive Emergence of Zika Virus in the Americas
Sofia Ali, Olivia Gugliemini, Serena Harber, Alexandra Harrison, Lauren Houle, Javarcia Ivory, Sierra Kersten, Rebia Khan, Jenny Kim, Chris LeBoa, Emery Nez-Whitfield, Jamieson O’Marr, Emma Rothenberg, R. Max Segnitz, Stephanie Sila, Anna Verwillow, Miranda Vogt, Adrienne Yang, Erin A. Mordecai
published 09 Feb 2017 P
http://dx.doi.org/10.1371/journal.pntd.0005135
Abstract
Since Zika virus (ZIKV) was detected in Brazil in 2015, it has spread explosively across the Americas and has been linked to increased incidence of microcephaly and Guillain-Barré syndrome (GBS). In one year, it has infected over 500,000 people (suspected and confirmed cases) in 40 countries and territories in the Americas. Along with recent epidemics of dengue (DENV) and chikungunya virus (CHIKV), which are also transmitted by Aedes aegypti and Ae. albopictus mosquitoes, the emergence of ZIKV suggests an ongoing intensification of environmental and social factors that have given rise to a new regime of arbovirus transmission. Here, we review hypotheses and preliminary evidence for the environmental and social changes that have fueled the ZIKV epidemic. Potential drivers include climate variation, land use change, poverty, and human movement. Beyond the direct impact of microcephaly and GBS, the ZIKV epidemic will likely have social ramifications for women’s health and economic consequences for tourism and beyond.

PLoS One
http://www.plosone.org/
[Accessed 11 February 2017]

Research Article
Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain
Àngela Domínguez, Núria Soldevila, Diana Toledo, Núria Torner, Luis Force, María José Pérez, Vicente Martín, Lourdes Rodríguez-Rojas, Jenaro Astray, Mikel Egurrola, Francisco Sanz, Jesús Castilla, Working Group of the Project PI12/02079
Research Article | published 10 Feb 2017 P
http://dx.doi.org/10.1371/journal.pone.0171943

Research Article
Cost-effectiveness of maternal influenza immunization in Bamako, Mali: A decision analysis
Evan W. Orenstein, Lauren A. V. Orenstein, Kounandji Diarra, Mahamane Djiteye, Diakaridia Sidibé, Fadima C. Haidara, Moussa F. Doumbia, Fatoumata Diallo, Flanon Coulibaly, Adama M. Keita, Uma Onwuchekwa, Ibrahima Teguete, Milagritos D. Tapia, Samba O. Sow, Myron M. Levine, Richard Rheingans
| published 07 Feb 2017 P
http://dx.doi.org/10.1371/journal.pone.0171499

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 11 February 2017]

Study protocol
A study protocol for facility assessment and follow-up evaluations of the barriers to access, availability, utilization and readiness of contraception, abortion and postabortion services in Zika affected areas
The Zika virus epidemic in Latin America has elicited official recommendations for women to delay or avoid pregnancy in affected countries, which has increased demand for family planning services. It is likely…
Moazzam Ali, Rachel Folz, Kelsey Miller, Brooke Ronald Johnson and James Kiarie
Reproductive Health 2017 14:18
Published on: 2 February 2017

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
Recently Published Articles –
http://www.paho.org/journal/index.php?option=com_content&view=featured&Itemid=101

Special Report
Promoting and regulating generic medicines: Brazil in comparative perspective
[La promoción y la regulación de los medicamentos genéricos: el caso del Brasil desde una perspectiva comparativa]
Elize Massard da Fonseca and Kenneth C. Shadlen
Published 8 February

Letter to the editor
Un llamado ético a la inclusión de mujeres embarazadas en investigación: Reflexiones del Foro Global de Bioética en Investigación [An ethics call to include pregnant women in research: Reflections from the Global Forum on Bioethics in Research]
Carla Saenz, Jackeline Alger, Juan Pablo Beca, José M. Belizán, Maria Luisa Cafferata, Julio Arturo Canario Guzmán, Jesica E. Candanedo P., Lissette Duque, Lester Figueroa, Ana Garcés, Lionel Gresh, Ida Cristina Gubert, Dirce Guilhem, Gabriela Guz, Gustavo Kaltwasser, A. Roxana Lescano, Florencia Luna, Alexandrina A. M. Cardelli, Ignacio Mastroleo, Irene N. Melamed, Agueda Muñoz del Carpio Toia, Ricardo Palacios, Gloria I. Palma, Sofía P. Salas, Xochitl Sandoval, Sergio Surugi de Siqueira, Hans Vásquez, y Bertha Ma. Villela de Vega
Published 8 February |

Science
10 February 2017 Vol 355, Issue 6325
http://www.sciencemag.org/current.dtl

Editorial
Act for science
Rush Holt
Summary
This year’s American Association for the Advancement of Science (AAAS, the publisher of Science) Annual Meeting in Boston (16 to 20 February) promises again to be one of the world’s most recognized forums for communicating the excitement, beauty, power, and relevance of science. Attendees from dozens of countries, from nearly every field of study, and from all sectors will share ideas and build collaborations. Attendees share a cherished understanding that science practiced with diligence and reverence for evidence illuminates the human condition, leads to measurable progress, and provides the best insurance against error and deception. These amazing benefits depend on open communication as a fundamental ingredient of science. This is why President Trump’s recent immigration ban has been a jolt across the global scientific enterprise.

Social Science & Medicine
Volume 172, Pages 1-162, e1-e2 (January 2017)
http://www.sciencedirect.com/science/journal/02779536/172

Original Research Article
Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia
Pages 89-97
Robert A. Blair, Benjamin S. Morse, Lily L. Tsai
Abstract
Trust in government has long been viewed as an important determinant of citizens’ compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014–15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as “safe burial” of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD’s symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD’s spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.

Tropical Medicine & International Health
February 2017 Volume 22, Issue 2 Pages 123–251
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2017.22.issue-2/issuetoc

Original Articles
Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger (pages 196–204)
Halima Boubacar Maïnassara, Garba Idé Oumarou, Bassira Issaka, Ali Sidiki, Issa Idi, Jean-Paul Moulia Pelat, Arnaud Fontanet and Judith E. Mueller
Version of Record online: 7 DEC 2016 | DOI: 10.1111/tmi.12815
Abstract
Objective
To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger.
Methods
We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal.
Results
A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination.
Conclusion
In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.

Vaccine
Volume 35, Issue 7, Pages 993-1100 (15 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/7

Short communication
Impact of universal infant hepatitis B vaccination in the US-affiliated Pacific Islands, 1985–2015
Pages 997-1000
W.E. Abara, M.G. Collier, E.H. Teshale
Abstract
The US-affiliated Pacific Island countries (USAPI) is an endemic region for hepatitis B virus (HBV) infection. Universal infant hepatitis B vaccination was introduced in the USAPI in the mid-1980s to mitigate the HBV burden. We assessed the impact of universal infant vaccination on the HBV infection prevalence over time among children born in the 1980s, 1990s, and 2000s in the USAPI. Demographic and serologic data from serial sero-surveys conducted between 1985 and 2015 were obtained. Descriptive statistics and analysis of variance were performed. From data obtained from 4827 children (2–11 years), HBV prevalence decreased markedly: 8.4% in the 1980s; 2.5% in the 1990s; and 0.2% in the 2000s (P<0.0001) as vaccination coverage increased: 76.4% in the 1980s; 87.3% in the 1990s; and 97.5% in the 2000s (P<0.0001). These findings underscore the protective effect of universal infant hepatitis B vaccination over time on the HBV burden in an HBV endemic region.

Vaccine
Volume 35, Issue 7, Pages 993-1100 (15 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/7

Vaccine shot-limiting: Estimating the prevalence, indicators, and impact on vaccination status — Michigan, 2012
Original Research Article
Pages 1018-1023
Meghan Weinberg, Stephanie Dietz, Rachel Potter, Robert Swanson, Corinne Miller, Jevon McFadden
Abstract
Background
Concerns regarding vaccine safety and pain have prompted certain parents to limit the number of shots their child receives per visit. We estimated the prevalence of shot-limited children in Michigan, described their characteristics, assessed whether shot-limited children were up-to-date on recommended vaccinations, and investigated possible intervention points for vaccination education.
Methods
We analyzed vaccination registry and birth record data of children born in Michigan during 2012 who had ⩾2 vaccination visits, with ⩾1 visits after age 5 months. Shot-limited was defined as receiving ⩽2 shots at all visits through age 24 months. Nonlimited children received >2 shots at ⩾1 visits. Up-to-date vaccination was based on receipt of a seven-vaccine series and was determined at ages 24 months and 35 months. Risk ratios (RR) were calculated using risk regression.
Results
Of 101,443 children, a total of 2,967 (3%) children were shot-limited. Mothers of shot-limited children were more likely to be white (RR: 1.2; 95% confidence interval [CI]: 1.2–1.2), college graduate (RR: 1.9; 95% CI: 1.9–2.0), and married (RR: 1.5; 95% CI: 1.5–1.5). Compared with nonlimited children, shot-limited children were more likely to be born in a nonhospital setting (RR: 11.7; 95% CI: 9.4–14.6) and have a midwife attendant (RR: 1.9; 95% CI: 1.7–2.1). Shot-limited children were less likely to be up-to-date on recommended vaccinations (RR: 0.2; 95% CI: 0.2–0.3); this association was stronger for those with a midwife birth attendant (RR: 0.1; 95% CI: 0.1–0.2) rather than a medical doctor (RR: 0.3; 95% CI: 0.2–0.3).
Conclusions
Shot-limited children are less likely to be up-to-date on vaccinations, possibly leading to increased risk for vaccine-preventable diseases. This association was stronger for those with a midwife birth attendant. This analysis should prompt targeted education, such as to midwives, concerning risks associated with shot-limiting behavior.

Vaccine
Volume 35, Issue 7, Pages 993-1100 (15 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/7

Timeliness and risk factors associated with delay for pneumococcal conjugate 10-valent routine immunization in Brazilian children
Original Research Article
Pages 1030-1036
Ana Lucia Sartori, Ruth Minamisava, Eliane Terezinha Afonso, Gabriela Moreira Policena, Grécia Carolina Pessoni, Ana Luiza Bierrenbach, Ana Lucia Andrade
Abstract
Background
Vaccination coverage is the usual metrics to evaluate the immunization programs performance. For the 10-valent pneumococcal conjugate (PCV10) vaccine, measuring the delay of vaccination is also important, particularly as younger children are at increased risk of disease. Routinely collected administrative data was used to assess the timeliness of PCV10 vaccination, and the factors associated with delay to receive the first and second doses, and the completion of the PCV10 3 + 1 schedule.
Methods
A population-based retrospective cohort study was conducted with children born in 2012 in Central Brazil. Children who received the PCV10 first dose in public health services were followed-up until 23 months of age. Timeliness of receiving each PCV10 dose at any given age was defined as receiving the dose within 28 days grace period from the recommended age by the National Immunization Program. Log-binomial regression models were used to examine risk factors for delays of the first dose and the completion PCV10 3 + 1 schedule.
Results
In total, 14,282 children were included in the cohort of study. Delayed vaccination occurred in 9.4%, 23.8%, 36.8% and 39.9% children for the first, second, third and the booster doses, respectively. A total of 1912 children (12.8% of the cohort) were not adequately vaccinated at the 6 months of life; 1,071 (7%) received the second dose after 6 months of age, 784 (5.4%) did not receive the second dose, and 57 (0.4%) received the first dose after six months of life.
Conclusion
A considerable delay was found in PCV10 third and booster doses. Almost 2 thousand children had not received the recommended PCV10 doses at 6 months of age. Timeliness of vaccination is an issue in Brazil although high vaccination coverages.

Vaccine
Volume 35, Issue 7, Pages 993-1100 (15 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/7

Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia
Original Research Article
Pages 1055-1063
Neisha Sundaram, Cynthia Chen, Joanne Yoong, Munkh-Erdene Luvsan, Kimberley Fox, Amarzaya Sarankhuu, Sophie La Vincente, Mark Jit
Abstract
Objective
The Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.
Methods
The incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price.
Results
The ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.
Conclusion
Introducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.

Vaccine
Volume 35, Issue 7, Pages 993-1100 (15 February 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/7

Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India
Original Research Article
Pages 1087-1093
Arpita Ghosh, Ramanan Laxminarayan
Abstract
Background
Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette–Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3.
Methods
We analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007–08).
Results
Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres.
Conclusions
Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals’ background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.

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

Clinical and Experimental Vaccine Research
2017 Jan;6(1):31-37. English.
Published online Jan 25, 2017.
Psychogenic illness following vaccination: exploratory study of mass vaccination against pandemic influenza A (H1N1) in 2009 in South Korea
TU Yang, HJ Kim, YK Lee, YJ Park
Abstract
Purpose
Adverse events during mass vaccination campaigns have had a profoundly negative impact on vaccine coverage rates. The objective of the study was to identify the characteristics of reported psychogenic illness cases following mass vaccination that needed further interventions of the national immunization program.
Materials and Methods
We collected documents that were submitted to the Korea Centers for Disease Control and Prevention for vaccine injury compensation, and analyzed cases of psychogenic illness following pandemic influenza A (H1N1) vaccination in 2009 which were confirmed by the Korean Advisory Committee on Vaccine Injury Compensation.
Results
During the 2009-2010 influenza season, 13 million Koreans were vaccinated against pandemic influenza. Of 28 reported psychogenic illness cases following immunization, 25 were vaccinated through school-located mass immunization. Significant numbers of them were female adolescents (68%) or had underlying vulnerable conditions or emotional life stressors (36%). They required lengthy hospitalization (median, 7 days) and high medical costs (median, US $1,582 per case).
Conclusion
Health authorities and organizers of future mass vaccinations should be well aware of the possible occurrence of psychogenic illness, acknowledge their detailed characteristics, and take its economic burden into account to mitigate the risk of transmission of infectious diseases efficiently.

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.

New Yorker
http://www.newyorker.com/
Accessed 11 February 2017
February 3, 2017
The Deep Denialism of Donald Trump
By Michael Specter
This White House, unlike any other, has already crossed the threshold into a space where facts appear to mean nothing.

New York Times
http://www.nytimes.com/
Accessed 11 February 2017
Venezuelan Girl’s Diphtheria Death Highlights Country’s Health Crisis
February 10, 2017
…Her death and a wider Venezuelan outbreak of diphtheria, once a major global cause of child death but increasingly rare due to immunizations, shows how vulnerable the country is to health risks amid a major economic crisis that has sparked shortages of basic medicines and vaccines….
– By REUTERS –

Turning the Tide Against Cholera
6 February 2017
…Just as important, after 35 years of work, researchers in Bangladesh and elsewhere have developed an effective cholera vaccine. It has been accepted by the W.H.O. and stockpiled for epidemics like the one that struck Haiti in 2010. Soon, there may be enough to begin routine vaccination in countries where the disease has a permanent foothold.
Merely creating that stockpile — even of a few million doses — profoundly improved the way the world fought cholera, Dr. Margaret Chan, secretary general of the W.H.O., said last year. Ready access to the vaccine has made countries less tempted to cover up outbreaks to protect tourism, she said.
That has sped up emergency responses and attracted more vaccine makers, lowering costs. “More cholera vaccines have been deployed over the last two years than in the previous 15 years combined,” Dr. Chan said…

Washington Post
http://www.washingtonpost.com/
Accessed 11 February 2017
More than 350 organizations write Trump to endorse current vaccines’ safety
The letter reflects growing concern over Trump’s embrace of discredited claims about vaccine safety.
Lena H. Sun | National/health-science | Feb 8, 2017
[See Milestones above for more detail]

Milestones :: Perspectives

Editor’s Note:
We include the full text of the extraordinary and precedent-setting declaration and commitments taken by African states at Addis Ababa below, and an associated commentary by the WHO Regional Director for Africa.

DECLARATION ON “Universal Access to Immunization as a Cornerstone for Health and Development in Africa”
English | French | Portuguese | Arabic
[text bolding from original text]
We, African Ministers of Health, Finance, Education, Social Affairs, Local Governments attending the Ministerial Conference on Immunization in Africa, which took place from 24 to 25 February 2016 in Addis Ababa, Ethiopia, and convened by the World Health Organization in collaboration with the African Union Commission, are committed to continued investment in immunization programs and a healthy future for all people of the African continent.

Recognizing the tremendous advances that are improving the health of Africa’s citizens, including:
:: A 50% decline in child death rates, and ever-growing numbers of children attending school;
:: Widespread access to vaccines that were not available to African children and adults just a decade ago;
:: Higher vaccine coverage rates across the continent in each five-year periods between 1999-2014;
:: The remarkable achievement of the Africa continent for interrupting wild poliovirus transmission for more than one year; achieving near elimination of Meningococcal meningitis A epidemics, and the significant reduction in disease burden and mortality due to measles.

Bearing in mind the recently ratified Sustainable Development Goal target of Universal Health Coverage which calls for access to immunisation for all (New York, September 2015); and that health is fundamental to social and economic development;

Acknowledging that, broad-based, inclusive growth in Africa is dependent on a healthy population; and that strong immunization programs are a cornerstone of robust systems that help achieving universal health coverage, which is critical to helping national leaders achieve their economic and development goals;

Reaffirming the economic imperative and benefits of reducing vaccine-preventable diseases and consequential deaths, which will improve overall health, empower our future generations and allow every person to achieve his or her full potential;

Recalling the Heads of State Declaration on Polio Eradication in Africa: “Our Historic Legacy to Future Generations” (Johannesburg, June 2015); the World Health Assembly resolution (WHA68.6) on the Global Vaccine Action Plan (Geneva, May 2015), the commitment made by African Ministers of Health on Universal Health Coverage in Africa (Luanda, April 2014); the Immunize Africa 2020 Declaration (Abuja, May 2014) endorsed by African Heads of State; the World Health Assembly resolution that commits all 194 Member States to apply the vision and strategies of the Global Vaccine Action Plan (GVAP) (Geneva, May 2012), and the African Heads of State endorsement of the Pharmaceutical Manufacturing Plan in 2012 as the framework for African people to have access to essential, quality, safe and effective medical products and technologies.

Recognizing that despite progress, universal access to immunisation by 2020, as endorsed under the GVAP, is largely off track in Africa as indicated by the 2014 GVAP report; but that with resolve we can still achieve the GVAP target of at least 90% coverage in our countries and at least 80% coverage in every district for all nationally available vaccines;

Admitting that to sustain the progress made in vaccine introduction and coverage – and achieve the full potential to save children’s and adult’s lives – current national budgetary allocations to vaccination programmes within the context of national health systems financing will need to be further increased;

We hereby collectively and individually commit ourselves to:
:: Keeping universal access to immunisation at the forefront of our efforts to reduce child mortality, morbidity and disability, and in doing so help our countries achieve their long-term health, economic and development goals;

:: Increasing and sustaining our domestic investments and funding allocations, including innovative financing mechanisms, to meet the cost of traditional vaccines, fulfil our new vaccine financing requirements, and providing financial support for the operational implementation of immunization activities by EPI programs;

:: Addressing the persistent barriers in our vaccine and healthcare delivery systems, especially in the poorest, vulnerable and most marginalized communities, including the strengthening of data collection, reporting and use at all levels as well as building effective and efficient supply chains and integrated procurement systems;

:: Increasing the effectiveness and efficiency, as well as changing the approaches as needed, of our immunization delivery systems as an integrated part of strong and sustainable primary health care systems;

:: Attaining and maintaining high quality surveillance for targeted vaccine preventable diseases;

:: Monitoring progress towards achieving the goals of the global and regional immunization plans;

::Ensuring polio legacy transition plans are in place by end-2016 that will allow future health programs to benefit from the knowledge and expertise the polio program has generated through the eradication initiative;

:: Developing a capacitated African research sector to enhance immunization implementation and uptake;

:: Building broad political will, working with communities, civil society organizations,  traditional and religious leaders, health professional associations and parliamentarians, for the right of every child and every community to have universal access to life-saving vaccines, and by extension the best possible chance for a healthy future;

:: Promoting and investing in regional capacity for the development and production of vaccines in line with the African Union Pharmaceutical Manufacturing Plan including the strengthening of national regulatory authorities.

We call upon:
:: Member states and partners, including African development banks and African regional economic communities, to support the implementation of this Declaration, and to increase their efforts to mobilize resources and secure new investments to strengthen national immunization programmes to achieve the GVAP goals and overall health care delivery systems in the Member States;

:: Member states and partners, to negotiate with vaccine manufacturers to facilitate access to available vaccines at affordable prices, and in increasing price transparency as well as developing price databases in line with resolution WHA68.6;

:: Gavi, the vaccine alliance to consider refugees and internally displaced populations as eligible recipients of Gavi support for vaccines and operational costs;

:: The World Health Organization and the African Union Commission to support member states to share experiences, strengthen capacity, and establish mechanisms for monitoring progress towards the fulfilment of these commitments.

We thank his Excellency Hailemariam Desalegn, Prime Minister of the Federal Democratic Republic of Ethiopia, and host country for this Ministerial Conference on Immunization in Africa, for agreeing to champion this declaration and further request him to present it to the African Heads of States at the 26th Summit of the African Union, to be held in June 2016.
Done at Addis Ababa on 25 February 2016

::::::

Statement by the WHO Regional Director for Africa Following Historic Commitment to Immunization at 28th African Union Summit
31 January 2017, Addis Ababa, Ethiopia
Today, at the 28th African Union Summit, heads of state from across Africa adopted a Declaration on Universal Access to Immunization in Africa, in which they endorsed the Addis Declaration on Immunization, a historic and timely pledge to ensure that everyone in Africa – no matter who they are or where they live – has access to the vaccines they need to survive and thrive. The WHO Regional Office for Africa applauds this landmark commitment to immunization.

The theme of this year’s African Union Summit is “Harnessing the Demographic Dividend through Investments in Youth” – and there is no better way to invest in young people and in our continent’s future than prioritizing universal access to vaccines. Vaccines are among the most effective and cost-effective public health tools available, saving between two and three million lives every year and yielding economic benefits 44 times greater than initial investments. The economic case is simple: When children are given a healthy start, they can stay in school and grow into healthy, productive adults. At the same time, their families, communities and governments can save and reinvest the time and money previously spent caring for sick children.

A healthy generation of young people in Africa will have tremendous ripple effects. Today, Africa’s youth population is growing faster than that of any other region in the world. Between now and 2050, the working age population in sub-Saharan Africa is projected to more than double. This surge in young working-age adults could catapult many African nations into periods of rapid economic growth and stability – the “demographic dividend” – but only if every young person is equipped to thrive. That starts with ensuring children have access to life-saving vaccines.

Political will at the highest levels is an essential precursor for success toward achieving universal access, and today’s commitment couldn’t have come at a better time. While Africa has made impressive gains over the last 15 years toward increasing access to immunization, progress has stagnated, and the continent is falling behind on meeting global immunization targets.

The stakes have never been higher for African nations to make immunization an urgent priority. International funding for immunization is expected to decline in the coming years. More countries are approaching middle-income status, which will make them ineligible for donor funding through Gavi. Domestic funding – both through government budgets and innovative financing mechanisms – is needed to ensure immunization efforts are uninterrupted, particularly during upcoming transition periods.

Today’s commitment to the ADI – at the highest levels of government – demonstrates that Africa’s leaders are ready and prepared to tackle the challenges ahead. WHO and its partners are committed to supporting Member States’ efforts to ensure that life-saving vaccines reach every child, and, ultimately, improve child health and drive sustainable development across the continent.

We are grateful to Heads of State and to the line ministers who have championed the ADI over the past year for their unwavering dedication to immunization. We leave this historic African Union Summit filled with optimism and ready to work. With the right mix of political will, financial resources and technical know-how – we can ensure that no child in Africa dies of a vaccine-preventable disease.

:::::::
:::::::

Editor’s Note:
The WHO Executive Board concluded its meetings earlier this week. While we have not identified a summary or digest of main outcomes posted on the ED meeting site, working versions of Resolutions and Decisions have been posted with the caveats on “definitive versions” as below.

140th session of the Executive Board
23 January–1 February 2017, Geneva

Resolutions
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted by EB140, edited for the Official Records, will be made available in due course.

EB140.R1 – Appointment of the Regional Director for the Eastern Mediterranean
EB140.R2 – Appreciation of the outgoing Regional Director for the Eastern Mediterranean
EB140.R3 – Nomination for the post of Director-General
EB140.R4 – Post of Director-General: draft contract
EB140.R5 – Improving the prevention, diagnosis and management of sepsis
EB140.R6 – Scale of assessments for 2018–2019
EB140.R7 – Preparation for the third High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, to be held in 2018
EB140.R8 – Confirmation of amendments to the Staff Rules: revised compensation package, related entitlements and salaries for staff
EB140.R9 – Salaries of staff in ungraded positions and of the Director-General

Decisions
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted by EB140, edited for the Official Records, will be made available in due course.

EB140(1) – Post of Director-General: options for the conduct of the election at the Executive Board on the basis of paper-based voting

EB140(2) – Post of Director-General: options for the conduct of the election at the Health Assembly on the basis of paper-based voting

EB140(3) – Human resources for health and implementation of the outcomes of the United Nations’ High-Level Commission on Health Employment and Economic Growth

EB140(4) – Poliomyelitis [see text below in “Polio”]

EB140(5) – Decision concerning the Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits

EB140(6) – Member State mechanism on substandard/ spurious/falsely-labelled/falsified/ counterfeit medical products

EB140(7) – Draft global action plan on the public health response to dementia

EB140(8) – Overall programme review of the global strategy and plan of action on public health, innovation and intellectual property

EB140(9) – Promoting the health of refugees and migrants

EB140(10) – Engagement with non-State actors

EB140(11) – Award of the Dr A.T. Shousha Foundation Prize
EB140(12) – Award of the Sasakawa Health Prize
EB140(13) – Award of the United Arab Emirates Health Foundation Prize
EB140(14) – Award of the Dr LEE Jong-wook Memorial Prize for Public Health
EB140(15) – Provisional agenda of the Seventieth World Health Assembly
EB140(16) – Date and place of the 141st session of the Executive Board

Emergencies

WHO Grade 3 Emergencies [to 4 February 2017]
Iraq –
:: WHO scales up response to critical trauma needs as plans for west Mosul operations intensify
30 January 2017 – The Government of France, through the European Union Civil Protection Mechanism, has swiftly responded to an appeal by WHO and the Ministry of Health, Iraq for urgent medicines and medical supplies to manage the overwhelming number of casualty caseloads coming from east Mosul.

South Sudan – No new announcements identified.
The Syrian Arab Republic – No new announcements identified.
Yemen – No new announcements identified.
Nigeria – See measles immunization campaign announcement above.
.

WHO Grade 2 Emergencies [to 4 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 – No new announcements identified.
.

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. 18 (23 January – 29 January 2017)

Syria
:: Syrian Arab Republic: Wadi Barada Flash Update No. 2 (30 January 2017) [EN/AR]

Yemen
:: 31 Jan 2017 Humanitarian Coordinator in Yemen, Jamie McGoldrick, Statement on the Situation in the Dhubab and Al Mokha Areas [EN/AR]
:: Yemen Humanitarian Bulletin Issue 19 | As of 31 January 2017
.

Corporate Emergencies
Haiti
:: Haiti: Hurricane Matthew – Situation Report No. 34 (2 February 2017)

Zika virus [to 4 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
Key updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past two weeks: None
:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past two weeks: None
:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past two weeks: None
The next situation report will be published on Friday, 17 February and will include a new country classification scheme.

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.

Commentary – Zika: We must be ready for the long haul
Dr Margaret Chan, Director-General of WHO
1 February 2017
…In November 2016, I lifted the declaration of Zika as a public health emergency of international concern, again on the advice of the expert committee. That, too, was the right call. By then, research had addressed many of the questions that made the disease so “extraordinary” nine months earlier. Some uncertainties remain, but many fundamental questions have been answered.
In large parts of the world, the virus is now firmly entrenched. WHO and affected countries need to manage Zika not on an emergency footing, but in the same sustained way we respond to other established epidemic-prone pathogens, like dengue and chikungunya, that ebb and flow in recurring waves of infection. That is why WHO is creating a cross-Organizational mechanism to provide sustained guidance for effective interventions and support for families, communities, and countries experiencing Zika virus. For the research community, WHO has identified priority areas where more knowledge is urgently needed.
We are now in the long haul and we are all in this together. WHO’s strategic planning and commitment to work with partners for sustained interventions and research should go a long way towards bracing the world for this challenging – and still heart-breaking – effort.

POLIO [to 4 February 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 1 February 2017
:: The Executive Board of the World Health Organization at its meeting in Geneva last week noted that the world is closer than ever to being polio-free, and urged for increased support to the remaining endemic countries. At the same time, ministries commended efforts made on containment and to manage an ongoing global inactivated polio vaccine (IPV) supply constraint. The Board also encouraged plans to transition the polio infrastructure for the long-term, to ensure it continues to benefit broader public health efforts even after the disease is gone. To this effect, the Board adopted a ‘decision’, requesting the GPEI to present a strategic roadmap towards polio transition and the development of a post-certification strategy at the May World Health Assembly. Closing the discussion, Rotary International addressed the ministries with a clear call to action: “We must protect the gains. An additional US$1.3 billion is needed through 2019. Together, we can end polio and forever build a better future for all children.”

Country Updates [Selected Excerpts]
Pakistan
:: Five new environmental WPV1 positive samples were reported in the past week, from Balochistan (Quetta and Pishin), Sindh (Karachi-Gadap and Jacobabad) and Khyber Pakhtunkhwa (Peshawar), collected between 1 and 10 January 2017.
.

WHO Executive Board
140th session EB140(4)
27 January 2017
Poliomyelitis
The Executive Board, having considered the reports on poliomyelitis1 and human resources: update;2
(1) recalled resolution WHA68.3 (2015) on poliomyelitis and encouraged Member States to ensure its full implementation;
(2) recalled previous discussions on the human resources aspects of the Global Polio Eradication Initiative at the Executive Board and the World Health Assembly, in particular on the issue of potential indemnities resulting from the termination of staff contracts;
(3) underlined the need for continued emphasis on an effective endgame effort to eradicate polio and the importance of ensuring that the Global Polio Eradication Initiative is fit for purpose, with adequate levels of qualified staff;
(4) emphasized the urgent need for effective transition planning, in line with the three main aims outlined in paragraph 19 of document EB140/13;
(5) further emphasized the need to continue to provide the appropriate, situation-specific and focused interventions, in particular in relation to human resources and budgetary requirements, to the regions and countries where transmission has not been interrupted;
(6) recognized the major and systemic challenges facing WHO that will result from the current winding-down of the Global Polio Eradication Initiative;
(7) called for appropriate prioritization of opportunities for internal reassignment so as to reduce potential liabilities and indemnities, in particular to strengthen the WHO Health Emergencies Programme and the Expanded Programme on Immunization, with emphasis given to retaining the highest-performing staff;
(8) emphasized the need to accelerate opportunities to shift or reprofile the 43% of staff funded by the Global Polio Eradication Initiative who work in polio-free countries, while ensuring that appropriate resources remain in place for surveillance;
(9) reiterated its expectation that recruitment of staff for the Global Polio Eradication Initiative should be carried out without incurring any avoidable costs resulting from the foreseeable future termination of contracts, including by synchronizing contract end dates, and requested WHO to ensure that standard contracts that meet this requirement are available and are used;
(10) decided to request the Director-General:
(a) to present to the Seventieth World Health Assembly a report that outlines the programmatic, financial, and human-resource-related risks resulting from the current winding-down and eventual discontinuation of the Global Polio Eradication Initiative, as well as an update on actions taken and planned to mitigate those risks while ensuring that essential polio-related functions are maintained, and to present a first draft of that report to a meeting of Member States before the end of April 2017;
(b) to continue reporting regularly to the Health Assembly, through the Executive Board, on the planning and implementation of the transition process.
(Tenth meeting, 27 January 2017)

WHO & Regional Offices [to 4 February 2017]

Yearly, 8.8 million people die from cancer
3 February 2017 – Launched ahead of the World Cancer Day (4 February), the new WHO guidance 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. Strategies to improve early diagnosis can be built into health systems at a low cost. In turn, effective early diagnosis can help detect cancer in patients at an earlier stage, enabling treatment that is generally more effective, less complex, and less expensive.

Weekly Epidemiological Record, 3 February 2017, vol. 92, 5 (pp. 45–52)
:: Early warning, alert and response system in emergencies: a field experience of a novel WHO project in north-east Nigeria
:: Fact sheet on Guillain-Barré syndrome (updated October 2016)

WHO Immunization, Vaccines and Biologicals
:: GIN January 2017pdf, 1.68Mb 2 February 2017
.

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO and partners step up action to improve access to and uptake of family planning services in four African countries – 01 February 2017
:: Statement by the WHO Regional Director for Africa Following Historic Commitment to Immunization at 28th African Union Summit – 31 January 2017

WHO Region of the Americas PAHO
:: Early cancer diagnosis saves lives, cuts treatment costs (02/03/2017)
:: The Zika Virus outbreak continues one year after the global emergency (02/02/2017)

WHO South-East Asia Region SEARO
:: Diagnose, treat cancer early to save lives 3 February 2017

WHO European Region EURO
:: Health needs soar as fighting flares in eastern Ukraine 03-02-2017
:: World Cancer Day 2017: focus on early diagnosis 03-02-2017
:: Zika: Then, now, and tomorrow 03-02-2017
:: Migration-themed edition of Public Health Panorama out now 01-02-2017
:: Closing in on measles and rubella in Europe 30-01-2017

WHO Eastern Mediterranean Region EMRO
:: Mahmoud Fikri appointed as Regional Director for the WHO Eastern Mediterranean Region
24 January 2017
:: Trauma care now available in Bartalla 23 January 2017
:: Leishmaniasis continues to affect the lives of tens of thousands of Afghans 22 January 2017

CDC/ACIP [to 4 February 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/

MMWR Weekly February 3, 2017 / No. 4
[Excerpts]
:: National Black HIV/AIDS Awareness Day — February 7, 2017
:: HIV Care Outcomes Among Blacks with Diagnosed HIV — United States, 2014
:: Changes in the Disparity of HIV Diagnosis Rates Among Black Women — United States, 2010–2014
:: Notes from the Field: Knowledge, Attitudes, and Practices Regarding Yellow Fever Vaccination Among Men During an Outbreak — Luanda, Angola, 2016

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 4 February 2017]
https://www.iavi.org/
February 2, 2017

IAVI Sponsors Phase I Clinical Trial of a Broadly Neutralizing HIV Antibody
The International AIDS Vaccine Initiative (IAVI) is sponsoring a Phase 1 clinical trial (T001) led by the Beth Israel Deaconess Medical Center (BIDMC) to investigate the safety and tolerability of a broadly neutralizing antibody infusion (bNAb) to prevent HIV infection.

A maximum of 93 volunteers will receive one-time infusions of the bNAb PGT121 at varying dosages with six months of follow-up as part of T001, which will include HIV-uninfected adults, HIV-infected adults on anti-retroviral therapy (ART) with suppressed viral loads and HIV-infected adults not on ART. Results are expected in 2018.

Preclinical data suggests that bNAbs, which have neutralized a broad spectrum of HIV-1 variants in laboratory tests, can protect people from HIV infection. bNAbs can either be administered passively through infusion or generated actively by the immune system through vaccination.

PGT121 was isolated by scientists from IAVI’s Neutralizing Antibody Consortium at The Scripps Research Institute. This antibody comes out of the landmark Protocol G, a global search for bNAbs in blood samples from people living with HIV, supported by the United States Agency for International Development (USAID).

PGT121 is being developed and tested for HIV prevention by BIDMC, supported by the Bill & Melinda Gates Foundation through a Collaboration for AIDS Vaccine Development (CAVD) grant to the BIDMC. IAVI is sponsoring the study through its Vaccine Product Development Center (VxPDC), which provides CAVD grantees with the required expertise and support to advance promising approaches to HIV prevention more rapidly from early stages of development to clinical trials.

IVI [to 4 February 2017]
http://www.ivi.int/
[Undated]

IVI Strengthens Ties with India
IVI is pleased to announce that India will become a financially contributing member state, providing USD 500,000 per year to IVI. The Indian Cabinet, chaired by Prime Minister Shri Narendra Modi, recently approved the proposal. India will be the third member state to provide annual funding to the Institute, in addition to Korea and Sweden. The Indian funding will support IVI operations, vaccine R&D and capacity-building projects in India.

IVI and India have a long history of collaboration. In 2007, India became a signatory to IVI’s treaty that comprises of 35 signatory countries and the World Health Organization (WHO). For many years, IVI has been partnering with various Indian vaccine manufacturers, research institutes, government, and public health agencies such as Shantha Biotechnics, National Institute of Cholera and Enteric Diseases (NICED), and the Indian Council for Medical Research (ICMR) on product development partnership, research, and training. One of the most successful collaborations was the development and WHO prequalification of the inactivated oral cholera vaccine, Shanchol, in 2011, the world’s first affordable oral cholera vaccine for global public health.

The new development will strengthen already close ties by promoting further synergies between IVI and India on vaccine development and public health research. The partnership will enable IVI to exert a greater impact in vaccine development and delivery, particularly in India. An official signing ceremony between the two parties is being planned. More information about the ceremony and agreement will follow soon.

Wellcome Trust [to 4 February 2017]
https://wellcome.ac.uk/news
News / Published: 3 February 2017

Drug-resistant bugs threaten global malaria control
A new strain of multidrug-resistant malaria parasites has spread across parts of South-east Asia, according to a study published this week.
Wellcome researchers reporting in The Lancet found a strain of the malaria type called Plasmodium falciparum that is resistant to the most effective treatment drugs. This has spread widely through parts of Thailand, Laos and Cambodia…

PATH [to 4 February 2017]
http://www.path.org/news/index.php

Announcement | February 02, 2017
PATH’s Uganda country director receives presidential award for pioneering work in HPV vaccination and cervical cancer screening
Dr. Emmanuel Mugisha, PATH’s Uganda country director, has received the prestigious Golden Medal Award for his work pioneering the campaign against cervical cancer through human papillomavirus (HPV) vaccination in Uganda.

The award—representing the highest civilian distinction in Uganda—was delivered to Dr. Mugisha on January 26 by Uganda’s president, His Excellency Yoweri Museveni, at the country’s 31st Liberation Day celebrations.

Dr. Mugisha has pioneered HPV vaccine demonstration programs in Africa, starting in Uganda and later expanding to Eastern and Southern Africa. Through his tireless and forward-looking efforts, Uganda became the first country to transition from an HPV demonstration program to a full national rollout of the HPV vaccine. The Golden Medal Award also recognizes Dr. Mugisha’s leadership in promoting cervical cancer screening in Uganda…

Press release | February 01, 2017
EXASOL and PATH Announce Partnership to Help Eliminate Malaria in Zambia
EXASOL, a high-performance in-memory analytic database developer, and PATH, an international nonprofit organization and global leader in health and innovation, today announced a partnership to support the Zambian government’s ambitious campaign to eliminate malaria by 2020.

“Much is made of the ability to use data analytics to increase profits, save costs, and streamline business operations,” said Aaron Auld, CEO, EXASOL. “But it’s not always about money. It’s also about saving lives. If we can help an organization do great things for the greater good of humanity, that’s a great thing to do.”

EXASOL joins a transformative partnership—Visualize No Malaria—between the Zambian Ministry of Health, PATH, Tableau, and technical partners including Alteryx, Mapbox, DataBlick, Twilio, DigitalGlobe, and Slalom.
EXASOL’s contribution—access to the EXASOL database in the cloud on Amazon Web Services—enables the Visualize No Malaria team to perform highly complex queries of not just “big data” but truly “massive data” with speed that enables almost instant rendering, allowing for real-time analysis…

Press release | January 31, 2017
PATH, Clarus, and the Global Health Investment Fund Announce an Innovative $25 Million Financing Arrangement to Improve Treatment of Intestinal Worms, Affecting More Than 1 Billion People Worldwide
PATH will lead a consortium of partners toward US FDA approval for tribendimidine and its inclusion in mass deworming campaigns

Press release | January 30, 2017
Wipro and PATH Announce Partnership to Improve Health in Developing Countries
… PATH and Wipro will co-create a platform for PATH’s global health programs that makes more effective and efficient use of data from internal and external sources, spurring insights to accelerate ongoing global health efforts. The collaboration will strengthen PATH’s ability to harness entrepreneurial ingenuity, scientific expertise, and community knowledge to disrupt the cycle of poor health and tackle global health problems such as malaria…

NIH [to 4 February 2017]
http://www.nih.gov/news-events/news-releases
February 2, 2017
NIH to expand critical catalog for genomics research
The National Institutes of Health plans to expand its Encyclopedia of DNA Elements (ENCODE) Project, a genomics resource used by many scientists to study human health and disease. Funded by the National Human Genome Research Institute (NHGRI), part of NIH, the ENCODE Project is generating a catalog of all the genes and regulatory elements — the parts of the genome that control whether genes are active or not — in humans and select model organisms. With four years of additional support, NHGRI builds on a long-standing commitment to developing freely available genomics resources for use by the scientific community…

Industry Watch [to 4 February 2017]
:: Milestone: 250 Million Pneumococcal Conjugate Vaccine Doses Delivered in Gavi Countries
Pfizer | 24 January 2017
We have delivered 250M doses of pneumococcal conjugate vaccine – protecting more than 20 million babies in Gavi countries. Using new technology, education, and sustainable investments, we are helping to support Gavi’s goal of immunizing an additional 300 million of the world’s poorest children against life-threatening diseases by 2020.

:: Sanofi Pasteur Announces the Availability of Quadracel DTaP-IPV Vaccine for Children 4 Through 6 Years of Age in the U.S.
SWIFTWATER, Pa., Jan. 31, 2017 /PRNewswire/ — Sanofi Pasteur, the vaccines division of Sanofi announced today the availability of Quadracel™ (Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus; DTaP-IPV) vaccine in the United States. Quadracel is approved by the U.S. Food and Drug Administration (FDA) for active immunization against diphtheria, tetanus, pertussis and poliomyelitis in children 4 through 6 years of age…

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

Survey/Analysis: Vast Majority of Americans Say Benefits of Childhood Vaccines Outweigh Risks
Parents of young children support measles, mumps and rubella vaccine requirements but rate the risks higher, the benefits lower. There are not major partisan divisions on these issues, though.
Pew Research Center :: February 2, 2017 :: 104 pages
PDF: http://assets.pewresearch.org/wp-content/uploads/sites/14/2017/02/01172718/PS_2017.02.02_Vaccines_FINAL.pdf
Excerpt from Overview
Most Americans support requiring the measles, mumps and rubella vaccine for public school children in order to protect public health. They see high preventive health benefits of such vaccines, and low risk of side effects, and they consider the benefits of the vaccine to outweigh the risks.

Yet, public concerns about childhood vaccines linger in the public discourse, often linked to a now discredited and retracted research study published nearly two decades ago that raised questions about a possible link between the measles, mumps and rubella vaccine and autism. Despite assurances of vaccine safety from the Centers for Disease Control and Prevention, the American Academy of Pediatrics and a host of other scientific bodies that the measles, mumps and rubella (MMR) vaccine does not cause autism, a number of prominent figures have expressed concerns about the safety of childhood vaccines. President Donald Trump raised questions about the safety of childhood vaccines on the campaign trail and during the transition period met with Robert Kennedy Jr. reportedly about the possibility of leading a commission on vaccine safety and scientific integrity. Kennedy edited a book that argues that a preservative used in some vaccines causes neurological disorders, including autism.1

A new Pew Research Center survey conducted prior to the election finds the “vaccine hesitant” views expressed by Trump and other public figures to be at odds with most Americans’ views. An overwhelming majority of Americans (82%) support requiring all healthy schoolchildren to be vaccinated for measles, mumps and rubella. Some 73% of Americans see high preventive health benefits from use of the MMR vaccine, and 66% believe there is a low risk of side effects from the vaccine. Overall, 88% believe that the benefits of these inoculations outweigh the risks.

But there are several groups with comparatively more concern about the safety of the measles, mumps and rubella vaccine. Foremost among them are parents of children ages 0 to 4 who have recently faced or will soon face a decision about whether to follow the recommended immunization schedule for measles, mumps and rubella starting when their children are between 12 and 15 months old. Six-in-ten (60%) parents with children ages 0 to 4 see the preventive health benefits of the MMR vaccine as high, compared with 75% of parents with school-age children (ages 5-17) and 76% of people with no children under age 18. About half (52%) of parents with children ages 0 to 4 say the risk of side effects from the MMR vaccine is low, 43% of this group says the risk is medium or high. By comparison, 70% of those with no minor age children say the risk of side effects is low, and 29% say the risk is medium or worse.

In addition, blacks consider the risk of side effects from the MMR vaccine to be higher and the benefits lower than other Americans. There are also generational differences with adults under age 30 less convinced that the MMR vaccine brings high preventive health benefits. People’s use of alternative and conventional medicine is linked with their beliefs about the MMR vaccine; those who report never taking over-the-counter cold or flu medication and those who have used alternative medicine instead of conventional medicine see higher risk from the MMR vaccine.

People with low knowledge about science are also less likely to see high preventive health benefits from vaccines (55% compared with 91% of those high in science knowledge).2 In addition, they are more likely to consider the risk of side effects to be at least “medium” or worse (47% vs. 19% of those with high science knowledge.) Similarly, the 68% majority of Americans who do not correctly recognize the definition for “herd immunity” are less likely to rate the benefits of the MMR vaccine as high and comparatively more likely to see the risk of side effects as at least medium. (Herd immunity refers to the health benefits that occur when most people in a population have been vaccinated.) This group is equally likely as those who correctly recognize the term “herd immunity” to support a requirement for all children in public schools to be vaccinated.

Nonetheless, public views of medical scientists and their research related to childhood vaccines are broadly positive regardless of parent status, race, ethnicity and experience using alternative medicine. Fully 73% of U.S. adults believe that medical scientists should have a major role in policy decisions related to childhood vaccines. In addition, a 55% majority say they trust information from medical scientists a lot to give a full and accurate picture of the health effects of vaccines. At the same time people are less trusting of other groups about this issue. For example, just 13% trust information from pharmaceutical industry leaders about the health effects of the MMR vaccine a lot. People with high science knowledge are especially positive in their views of medical scientists and research on childhood vaccines. Younger adults, ages 18 to 29, are a bit more skeptical than older age groups about medical scientists and their work on childhood vaccines.

The new Pew Research Center survey finds Republicans (including independents who lean Republican) hold roughly the same views as Democrats (including leaning Democrats) about the benefits and risks of the MMR vaccine, consistent with a 2015 Pew Research Center survey on this topic. Republicans and Democrats (including those who lean to either party) are about equally likely to support a school-based vaccine requirement. However, political conservatives are slightly more likely than either moderates or liberals to say that parents should be able to decide not to have their children vaccinated, though majorities of all ideology groups support requiring the measles, mumps and rubella vaccine for all children in public schools because of the potential health risk to others.

These are some of the findings from a Pew Research Center survey conducted among a nationally representative sample of 1,549 adults, ages 18 or older from May 10-June 6, 2016. This is the third in a series of reports on public views about science-related issues and public trust in scientists working on these issues. The margin of sampling error based on the full sample is plus or minus 4.0 percentage points…

[U.S.] National Vaccine Advisory Committee (NVAC) Meeting
February 7-8, 2017
Washington, DC.
The meeting AGENDA will include updates on:
:: Vaccines and the 21st Century Cures Act
:: Recent mumps outbreaks in the United States
:: Zika virus and vaccine development
:: Vaccine safety science and personalized vaccinology
:: NVAC’s Mid-course Review Working Group will also present its findings and draft recommendations for the Mid-Course Review of the National Vaccine Plan.
The February meeting is open to the public and attendees can join the meeting in-person or by livestream.
Find out more and register for the meeting
REMOTE ACCESS: U.S.) 1-888-603-7096 , (International) 1-630-395-0214
Participant Passcode:  2108114 Webcast Link

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

American Journal of Preventive Medicine
February 2017 Volume 52, Issue 2, p135-262, e33-e66
http://www.ajpmonline.org/current

Research Articles
Use of Immunization Information Systems in Primary Care
Allison Kempe, Laura P. Hurley, Cristina V. Cardemil, Mandy A. Allison, Lori A. Crane, Michaela Brtnikova, Brenda L. Beaty, Laura J. Pabst, Megan C. Lindley
p173–182
Published online: September 16, 2016
Immunization information systems (IISs) are highly effective for increasing vaccination rates but information about how primary care physicians use them is limited.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 4 February 2017)

Research article
Association between caregivers’ knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries
Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only …
Aaltje Camielle Noordam, Alyssa B. Sharkey, Paddy Hinssen, GeertJan Dinant and Jochen W. L. Cals
BMC Health Services Research 2017 17:107
Published on: 2 February 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 4 February 2017)

Research article
Regulation of genomic and biobanking research in Africa: a content analysis of ethics guidelines, policies and procedures from 22 African countries
Jantina de Vries, Syntia Nchangwi Munung, Alice Matimba, Sheryl McCurdy, Odile Ouwe Missi Oukem-Boyer, Ciara Staunton, Aminu Yakubu and Paulina Tindana
Published on: 2 February 2017
Abstract
Background
The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research based on sharing, causing confusion about what is allowed, where and when.

Methods
In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents.

Results
Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines.

Conclusions
There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers.

[Article excerpt]
Conclusion
Overall, in the rapidly changing landscape of science—epitomised in the fields of genomic research and biobanking—ethics guidelines need to be broad and flexible enough to accommodate changes, whilst also offering guidance on the principles that should be applied to foster ethically sound health research. Key principles that ought to be incorporated into African guidance for genomic research and biobanking relate to promoting African leadership and ownership of genomics and biobanking science and capacity strengthening as an essential feature of international collaboration. In terms of specific guidance supporting ethics committee decision-making, we think that what is required are guidelines that address issues relating to sample and data sharing and the requirements of governance frameworks supporting these. What is also required is a clear statement, by African governments, national health ethics councils or other authorities charged with developing the ethical frameworks for research, about the appropriateness of using broad consent in the context of African genomics and biobanking research.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 4 February 2017)

Research article
Pragmatic trial of an intervention to increase human papillomavirus vaccination in safety-net clinics
Human papillomavirus (HPV) infection has been causally linked to six cancers, and many disproportionately affect minorties. This study reports on the development and effectiveness of an intervention aimed at i…
Maureen Sanderson, Juan R. Canedo, Dineo Khabele, Mary K. Fadden, Cynthia Harris, Katina Beard, Marilyn Burress, Helen Pinkerton, Cynthia Jackson, Tilicia Mayo-Gamble, Margaret K. Hargreaves and Pamela C. Hull
BMC Public Health 2017 17:158
Published on: 2 February 2017

Research article
Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model
Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, agai…
Ariel Esteban Bardach, Osvaldo Ulises Garay, María Calderón, Andrés Pichón-Riviére, Federico Augustovski, Sebastián García Martí, Paula Cortiñas, Marino Gonzalez, Laura T. Naranjo, Jorge Alberto Gomez and Joaquín Enzo Caporale
BMC Public Health 2017 17:152
Published on: 2 February 2017

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 4 February 2017)

Research article
Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state
Florence T. Sibeudu, Benjamin S. C. Uzochukwu and Obinna E. Onwujekwe
BMC Research Notes 2017 10:78
Published on: 1 February 2017
Abstract
Background
Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis.

Result
Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X2=9.97, p<0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility.

Conclusion
Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.

BMJ Open
January 2017 – Volume 7 – 2
http://bmjopen.bmj.com/content/current
Genetics and genomics
Research
Approaching confidentiality at a familial level in genomic medicine: a focus group study with healthcare professionals
Sandi Dheensa, Angela Fenwick, Anneke Lucassen

Bulletin of the World Health Organization
Volume 95, Number 2, February 2017, 85-164
http://www.who.int/bulletin/volumes/95/2/en/
Special theme: vulnerable populations

POLICY & PRACTICE
An equity dashboard to monitor vaccination coverage
Catherine Arsenault, Sam Harper, Arijit Nandi, José M Mendoza Rodríguez, Peter M Hansen & Mira Johri
http://dx.doi.org/10.2471/BLT.16.178079
Abstract
Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda.

In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time.

Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti.

Bulletin of the World Health Organization
Volume 95, Number 2, February 2017, 85-164
http://www.who.int/bulletin/volumes/95/2/en/
Special theme: vulnerable populations

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