Milestones :: Perspectives :: Featured Journal Content

From coast to coast: Africa unites to tackle threat of polio
116 million children to be immunized from coast to coast across the continent, as regional emergency outbreak response intensifies
GENEVA/BRAZZAVILLE/NEW YORK/DAKAR, 24 March 2017 –  More than 190,000 polio vaccinators in 13 countries across west and central Africa will immunize more than 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent.

The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent. All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent. In August 2016, four children were paralysed by the disease in security-compromised areas in Borno state, north-eastern Nigeria, widely considered to be the only place on the continent where the virus maintains its grip.

“Twenty years ago, Nelson Mandela launched the pan-African ‘Kick Polio Out of Africa’ campaign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “At that time, every single country on the continent was endemic to polio, and every year, more than 75,000 children were paralysed for life by this terrible disease. Thanks to the dedication of governments, communities, parents and health workers, this disease is now beaten back to this final reservoir.”

Dr Moeti cautioned, however, that progress was fragile, given the epidemic-prone nature of the virus. Although confined to a comparatively small region of the continent, experts warned that the virus could easily spread to under-protected areas of neighbouring countries. That is why regional public health ministers from five Lake Chad Basin countries – Cameroon, Central African Republic, Chad, Niger, and Nigeria – declared the outbreak a regional public health emergency and have committed to multiple synchronized immunization campaigns…

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New England Journal of Medicine
March 23, 2017  Vol. 376 No. 12
http://www.nejm.org/toc/nejm/medical-journal
Editorial
Rotavirus Vaccines — A New Hope
Mathuram Santosham, M.D., M.P.H., and Duncan Steele, Ph.D.
N Engl J Med 2017; 376:1170-1172 March 23, 2017 DOI: 10.1056/NEJMe1701347

Rotavirus gastroenteritis is the leading cause of diarrhea-associated hospitalization and death in children younger than 5 years of age,1 with more than 85% of the approximately 200,000 annual rotavirus deaths occurring in Africa and Asia.2 Since improvements in water, sanitation, and hygiene do not prevent rotavirus transmission, as they do with the spread of bacterial enteropathogens, the implementation of a rotavirus vaccine is essential to prevent death and complications from childhood diarrhea.

Two rotavirus vaccines — Rotarix (an attenuated G1P8 rotavirus manufactured by GlaxoSmithKline) and RotaTeq (containing five human–bovine reassortant rotaviruses, manufactured by Merck), attained prequalification by the World Health Organization (WHO) in 2008, which paved the way for UNICEF vaccine procurement through the financing mechanisms of the Gavi Alliance. These vaccines, which have been introduced in 42 Gavi-eligible countries and in 6 countries that have been designated as low-income and middle-income, have had a major effect on rotavirus deaths and hospitalizations in all settings.3

However, the uptake of rotavirus vaccines has slowed for various reasons, including supply constraints, high cost, and programmatic concerns for national immunization programs, particularly cold-chain capacity.4 Gavi countries have predominantly selected the attenuated G1P8 rotavirus vaccine,5 which has a smaller vaccine vial size and comes with a vaccine vial monitor for temperature monitoring. The two approved rotavirus vaccines have a liquid ready-to-use formulation. However, issues of cost of the vaccine and vaccine supply remain.
With Gavi support, low-income countries can procure rotavirus vaccines with a minimal copayment of 40 cents (in U.S. currency) per course, and Gavi cofinances the remainder of the UNICEF price (which ranges from $4.50 to $10.50). Low-income and middle-income countries, which are not Gavi-eligible, pay substantially higher costs for rotavirus vaccines.5 Gavi’s principles for vaccine-supply security emphasize the need for multiple manufacturers in the market to drive down prices while establishing sufficient vaccine supply. This protocol will become more critical as countries transition from Gavi support owing to socioeconomic development.

Fortunately, the situation is improving. In 2013, an indigenously developed rotavirus vaccine (ROTAVAC, Bharat Biotech International) was licensed in India and has been introduced in the routine childhood immunization program in four Indian states, with expanded rollout expected this year. This vaccine is under consideration for WHO prequalification, which would make it eligible for UNICEF procurement and Gavi subsidy. Bharat Biotech has committed to a cost of approximately $3.00 per course for global public markets.

In this issue of the Journal, Isanaka and colleagues6 document the safety and efficacy of an oral bovine rotavirus pentavalent vaccine (BRV-PV) developed by Serum Institute of India. The vaccine, which the investigators evaluated in an impoverished setting in Niger, had a reported efficacy of 66.7%,6 which is similar to that of other licensed rotavirus vaccines in similar settings. Efficacy data from an Indian study are pending. Despite this modest efficacy, the absolute public health benefits of vaccination are large, given the tremendous disease burden.

Estimates suggest that rotavirus vaccines have the potential to prevent 2.46 million childhood deaths and 83 million disability-adjusted life-years during the period from 2011 through 2030.7
The authors describe a rotavirus vaccine that is thermostable for 24 months at 37°C and for 6 months at 40°C, which may provide advantages for vaccine delivery in remote areas where cold-chain capacity is limited. However, this vaccine is freeze-dried, and practitioners in many countries may prefer other rotavirus vaccines that have liquid all-in-one formulations to simplify programmatic considerations. The projected cost of this heat-stable vaccine falls between the Gavi prices for the two currently used vaccines. The availability of vaccines from several manufacturers will increase global supply.

During the past three decades, remarkable progress has been made in reducing mortality from diarrheal disease, but the goal of ending such deaths cannot be achieved without aggressive implementation of a comprehensive approach to diarrhea prevention and treatment, including providing access of rotavirus vaccines to every child regardless of economic status. Increased availability of low-cost, programmatically suitable vaccines in abundant supply will be key to achieving this goal.

Original Article
Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger
Sheila Isanaka, Sc.D., Ousmane Guindo, M.D., Celine Langendorf, Pharm.D., M.P.H., Amadou Matar Seck, M.D., Brian D. Plikaytis, M.Sc., Nathan Sayinzoga-Makombe, M.P.H., Monica M. McNeal, M.Sc., Nicole Meyer, M.Sc., Eric Adehossi, M.D., Ali Djibo, M.D., Bruno Jochum, M.S., and Rebecca F. Grais, Ph.D.
N Engl J Med 2017; 376:1121-1130 March 23, 2017 DOI: 10.1056/NEJMoa1609462
Abstract
Background
Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa.
Methods
We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3.
Results
Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception.
Conclusions
Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000.)

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Editor’s Note:
Please note World TB Day announcements across this edition.

Emergencies

WHO Grade 3 Emergencies  [to 25 March 2017]
Iraq  –
WHO scales up disease surveillance reporting in East Mosul and Hamdaniya districts, Iraq
19 March 2017, Erbil, Iraq – The World Health Organization (WHO) and the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) are scaling up disease surveillance activities in newly accessible areas of Ninewa governorate, Iraq, to reduce the risk of disease outbreaks. As a result of acute shortages of safe water, sanitation services, food, and electricity in East Mosul and Hamdaniya districts, current humanitarian conditions pose a high risk of communicable diseases among displaced persons, returnees, and host communities.

Nigeria – No new announcements identified
South Sudan  – No new announcements identified
The Syrian Arab Republic  – No new announcements identified
Yemen – No new announcements identified

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WHO Grade 2 Emergencies  [to 25 March 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.

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 UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 

Iraq
:: UN Expresses Profound Concern about Terrible Loss of Life in Western Mosul
Published on 24 Mar 2017
The United Nations is profoundly concerned by reports yesterday of a high number of civilian casualties in Al Aghawat Al Jadidah, a densely populated neighborhood in Mosul. Initial reports indicate hundreds of causalities.

“We are stunned by this terrible loss of life and wish to express our deepest condolences to the many families who have reportedly been impacted by this tragedy,” said Ms. Lise Grande, the Humanitarian Coordinator for Iraq.

“Nothing in this conflict is more important than protecting civilians,” said Ms. Grande.    “International humanitarian law is clear. Parties to the conflict — all parties – are obliged to do everything possible to protect civilians. This means that combatants cannot use people as human shields and cannot imperil lives through indiscriminate use of fire-power.”

As the fighting to retake Mosul intensifies, civilians are being put at extreme risk. “We fear for the families who are caught in the conflict,” said Ms. Grande. “Everything must be done to avoid civilian casualties.

:: Iraq: Humanitarian Bulletin, February 2017 | Issued on 23 March
:: Iraq: Mosul Humanitarian Response Situation Report No. 25 (13-19 March 2017)

Syria  
:: 24 Mar 2017   Emergency Telecommunications Cluster (ETC) Syria Operation, March 2017

Yemen –
:: 19 Mar 2017  Yemen Humanitarian Bulletin Issue 21 | As of 18 March 2017
HIGHLIGHTS
…Two years of conflict puts future of coming generations at great risk
..First UN cross-line medical aid delivery to Taizz city in months
…117,107 people migrate to Yemen from the Horn of Africa in 2016
…Cholera response gives promising results

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POLIO [to 25 March 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 22 March 2017
:: From 25 to 28 March, synchronised polio campaigns will take place across 13 counties in west and central Africa including Nigeria, Chad, Cameroon, Guinea, Mali and Niger. Over 190 000 vaccinators will immunize more than 116 million children over the course of the campaigns..

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin, Guinea and West Africa, Lao People’s Democratic Republic.
:: No new case activity reported

 [See report on story on polio immunization across Africa in Milestones above]

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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

 Yellow Fever  [to 25 March 2017]
http://www.who.int/emergencies/yellow-fever/en/
Disease outbreak news
20 March 2017
Updates on yellow fever vaccination recommendations for international travellers related to the current situation in Brazil

As of 16 March 2017, yellow fever virus transmission continues to expand towards the Atlantic coast of Brazil in areas not deemed to be at risk for yellow fever transmission prior to the revised risk assessment, supported by the scientific and technical advisory group on geographical yellow fever risk mapping (GRYF), and published by WHO in the Disease Outbreak News of 27 January 2017 and 6 March 2017; as well as on the WHO International Travel and Health website on 31 January 2017,14 February 2017, and 6 March 2017.

As of 16 March 2017, confirmed cases of yellow fever virus infection in humans were reported in Rio de Janeiro State, and epizootics and human cases are under investigation for yellow fever virus infection in São Paulo State. These reports are consistent with the increased yellow fever activity observed in other States (Espírito Santo and Minas Gerais) that share the same ecosystem — tropical and sub-tropical broad leaved forests. As of 16 March 2017, there is no evidence of human cases of yellow fever virus infection transmitted by Aedes aegypti, the vector that could sustain urban transmission of yellow fever.

The WHO Secretariat has determined that the State of Rio de Janeiro, with the exception of the urban areas of Rio de Janeiro City and Niterói, and the State of São Paulo, with the exception of the urban areas of São Paulo City and Campinas, should also be considered at risk for yellow fever transmission.

Consequently, vaccination against yellow fever is recommended for international travellers visiting those areas in the States of Rio de Janeiro and São Paulo. The typology of activities that international travellers anticipate to undertake while visiting areas determined to be at risk for yellow fever transmission should be weighted in the risk-benefit analysis informing the individual decision to be immunized against yellow fever.

There are no other additional changes with respect to other areas of Brazil determined to be at risk for yellow fever transmission in 2013, as published by WHO in the Disease Outbreak News on 31 January 2017 and 6 March 2017…

 EBOLA/EVD  [to 25 March 2017]
http://www.who.int/ebola/en/
No new digest content identified for this edition.

 MERS-CoV [to 25 March 2017]
http://www.who.int/emergencies/mers-cov/en/
No new digest content identified for this edition.

 Zika virus  [to 25 March 2017]
http://www.who.int/emergencies/zika-virus/en/
No new digest content identified for this edition.

WHO & Regional Offices [to 25 March 2017]

Highlights

10th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases
March 2017 – The meeting, taking place on 29–30 March 2017, will cover issues on Global Vector Control Response, examination of dossiers requesting the potential inclusion of diseases as NTDs, gaps in disease elimination, eradication of dracunculiasis, integrated data management, and the 2nd WHO NTD Global Partners’ Meeting.

Global Health Sector Strategy on Viral Hepatitis
March 2017 – Worldwide, approximately 240 million people have chronic hepatitis B infection and 80 million people have chronic hepatitis C infection. A dedicated portal has been developed for the first ever Global Health Sector Strategy on Viral Hepatitis 2016–2021.

Ad-hoc Interagency Coordination Group on antimicrobial resistance
March 2017 – At the UN General Assembly’s high-level meeting on antimicrobial resistance in September 2016, Member States requested the Secretary-General to establish, in consultation with WHO, the Food and Agriculture Organization, and the World Organisation for Animal Health, an ad-hoc interagency coordination group on antimicrobial resistance.

Weekly Epidemiological Record, 24 March 2017, vol. 92, 12 (pp. 129–144)
Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness

Disease outbreak news

:: Meningococcal disease – Nigeria  24 March 2017
:: Human infection with avian influenza A(H7N9) virus – China  23 March 2017
:: Yellow fever – Brazil  20 March 2017  [See Yellow Fever above]

:: WHO Regional Offices
Selected Press Releases, Announcements

WHO African Region AFRO
:: From coast to coast: Africa unites to tackle threat of polio – 23 March 2017
:: Dr Matshidiso Moeti on an official visit to Republic of Niger – 21 March 2017

WHO Region of the Americas PAHO
:: PAHO/WHO: “Let’s unite to end TB, leaving no one behind” (03/23/2017)

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

WHO European Region EURO
:: World TB Day: leave no one behind 23-03-2017
:: France becomes one of the first countries in Region to recommend colour-coded nutrition labelling system 22-03-2017
:: World Water Day: good health and managing wastewater go hand-in-hand 22-03-2017
:: TB/HIV co-infections up 40% across Europe over the last five years 20-03-2017

WHO Eastern Mediterranean Region EMRO
:: World TB Day: Unite to End TB and alleviate the suffering of millions  22 March 2017
:: WHO reinforces monitoring of health facilities, services and resources in Syria  22 March 2017
:: WHO scales up disease surveillance reporting in East Mosul and Hamdaniya districts, Iraq
19 March 2017

WHO Western Pacific Region
:: Unite to End TB, by properly financing care MANILA, 24 March 2017

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CDC/ACIP [to 25 March 2017]
http://www.cdc.gov/media/index.html

MMWR Weekly March 24, 2017 / No. 11
[Excerpts]
:: World TB Day — March 24, 2017
:: Tuberculosis — United States, 2016
:: Tuberculosis Among Foreign-Born Persons Diagnosed ≥10 Years After Arrival in the United States, 2010–2015
:: Establishing a Timeline to Discontinue Routine Testing of Asymptomatic Pregnant Women for Zika Virus Infection — American Samoa, 2016–2017
:: Notes from the Field: Obstetric Tetanus in an Unvaccinated Woman After a Home Birth Delivery — Kentucky, 2016

Announcements

Gavi [to 25 March 2017]
http://www.gavi.org/library/news/press-releases/
21 March 2017
Gavi ‘effective and fit for purpose’
Network of 19 donor countries assesses Gavi, the Vaccine Alliance’s performance

Gavi is an effective, ‘fit for purpose’ organisation, scoring top ratings in a number key performance areas, according to the Multilateral Organisation Performance Assessment Network (MOPAN).

In its second institutional review of the organisation, MOPAN commends Gavi as being both “strategic and nimble in meeting new vaccine challenges and countries’ evolving needs, while keeping a clear focus on its mission goals.” Gavi is also recognised as being a “strong model for sustainability”.

MOPAN is a network of 19 donor countries, representing 95% of Overseas Development Assistance (ODA), which assesses the effectiveness of the multilateral organisations that receive development and humanitarian funding.

“Gavi has a clear long-term vision based on a distinct business and partnership model” states the report. “It plays a catalytic role in expanding immunisation coverage and shaping the global vaccine market.”

The review, covering the period from 2014 to mid-2016, notes that Gavi demonstrates transparency and accountability in its operations, with strong compliance with fiduciary and social requirements and safeguards. It has recently strengthened its internal audit and risk management functions to meet its increased organisational ambition, complexity and size.
As a performance and results orientated organisation, “Gavi has a clear framework of indicators, targets and metrics at the country level. Results-based management is integral to its planning and grant allocation.”…

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NIH [to 25 March 2017]
http://www.nih.gov/news-events/news-releases
March 24, 2017
NIH Statement on World Tuberculosis Day
— Statement of Christine F. Sizemore, PhD., Richard Hafner, M.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases.
Tuberculosis (TB) is one of the world’s most devastating infectious diseases. March 24th marks the day in 1882 when German microbiologist Robert Koch announced he had discovered Mycobacterium tuberculosis, the bacterium that causes this ancient scourge. Today, in recognition of World TB Day, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), reasserts its commitment to improving our understanding of TB and how to prevent, diagnose and treat it. Around the globe, researchers and the public health community are united in working toward these goals.

TB is the world’s leading cause of death from an infectious disease, especially among women and children. The World Health Organization estimates that more than 1.8 million people worldwide died of TB in 2015. The symptoms of the disease, which is transmitted through the air and primarily affects the lungs, often begin with coughing, shortness of breath or swollen lymph nodes — but can end in death if left untreated. People with HIV are especially vulnerable: of deaths among people co-infected with HIV and TB, about one quarter are due to TB. In addition, the World Health Organization estimates that about one-third of the world’s population is infected with “latent” TB, in which people carry the bacterium while exhibiting no symptoms.  Five to 10 percent of these latent TB carriers risk developing active TB at some point in their lifetimes. For latent TB carriers who are infected with HIV, this risk is approximately 10 percent per year. Finally, it is important to note that smoking substantially increases TB disease occurrence and risk of death due to TB worldwide.

A safe and highly effective vaccine against TB will be a critical tool in ultimately controlling the infection. Currently, the only available vaccine against TB is bacille Calmette-Guerin (BCG), developed in 1921. While this vaccine offers protection against disseminated disease and death in children, it is much less effective against the transmissible pulmonary form of the disease in adults. NIAID supports research across the spectrum of basic, preclinical and clinical development to arrive at innovative new approaches toward the development of vaccines to prevent this disease…

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NIH achieves milestone to accelerate multisite clinical studies
March 23, 2017 — CTSA Program paves way for nationwide single IRB mode
Developing new treatments for diseases often requires large numbers of clinical research participants enrolled in the same study at numerous geographical sites. These multisite clinical trials are well-positioned to discover whether a promising therapeutic is safe and effective, and may provide medical professionals with the information needed for treating their patients. However, the initiation of such studies may be delayed because each site typically relies on its own Institutional Review Boards (IRBs) to provide ethics reviews of the risks and benefits of the proposed research.

The National Institutes of Health is leading policy and programmatic initiatives to streamline this overly cumbersome process. NIH’s National Center for Advancing Translational Sciences (NCATS) announced today that all Clinical and Translational Science Awards (CTSA) Program sites have signed on to the NCATS Streamlined, Multisite, Accelerated Resources for Trials (SMART) IRB authorization agreement. This agreement — which now includes a total of more than 150 top medical research institutions — will enable all participating study sites to rely on the ethics review of one IRB for each study, making it possible to initiate multisite studies within weeks instead of months. For patients waiting to enroll in a study, this could make a life-saving difference.

The SMART IRB authorization agreement serves as a model to help investigators adhere to the NIH’s policy on single IRB use for multisite studies. This policy was designed to improve IRB efficiencies while ensuring the protection of research participants so that research can proceed expeditiously.

The authorization agreement effort was led by Harvard Catalyst, University of Wisconsin-Madison Institute for Clinical and Translational Research, and Dartmouth Synergy. Through these institutions, a team of NCATS-supported SMART IRB ambassadors facilitated and provided critical guidance and support to assist institutions in joining and implementing the SMART IRB authorization agreement.

“This milestone is a giant step toward a nationwide model for greater efficiency in IRB review, which is critical to getting more treatments to more patients more quickly,” said NCATS Director Christopher P. Austin, M.D. “It was made possible by the teamwork of hundreds of experts across the country who worked together to achieve what was thought to be impossible even a few years ago.”…

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Global Fund [to 25 March 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund and Inter-Parliamentary Union Sign MOU
23 March 2017
The Global Fund and the Inter-Parliamentary Union (IPU) have signed a memorandum of understanding to promote mutual advocacy, engage in joint technical work and raise awareness in the fight against AIDS, TB and malaria and building resilient and sustainable systems for health.

News
Senegal and the Global Fund Extend Their Partnership
21 March 2017
The Honorable Macky Sall, President of the Republic of Senegal, today welcomed a delegation from the Global Fund to Fight AIDS, Tuberculosis and Malaria led by Dr. Mark Dybul, Executive Director. The meeting marked the official signing of the Agreement on the Privileges and Immunities of the Global Fund, a symbolic step in strengthening the partnership between the Global Fund and Senegal that has been in place for 15 years. Senegal is now the 15th country to sign the agreement; Côte d’Ivoire, Togo, Burkina Faso, Rwanda as well as some ten European and African states have already done so.

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PATH [to 25 March 2017]
http://www.path.org/news/index.php
Announcement | March 23, 2017
PATH welcomes new promising study results for rotavirus vaccine candidate
A new article published today in the New England Journal of Medicine provides the results of a recent Phase 3 clinical trial conducted in Niger with a rotavirus vaccine candidate from India. The study, conducted by Médecins Sans Frontières (MSF) and Epicentre, evaluated the efficacy and safety of the pentavalent bovine-human reassortant rotavirus vaccine (BRV-PV) manufactured by Serum Institute of India Pvt. Ltd. in infants in Niger. Data from the trial revealed the BRV-PV to be highly efficacious for the prevention of severe rotavirus gastroenteritis and to have an excellent safety profile. In addition, the vaccine was transported and stored at ambient temperature, thus bypassing the typically challenging cold-chain requirements that apply to most other vaccines…

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UNAIDS [to 25 March 2017]
http://www.unaids.org/
Press release
UNAIDS warns that countries will miss the 2020 target of reducing HIV-associated TB deaths by 75% unless urgent action is taken
GENEVA, 24 March 2017—On World Tuberculosis Day, 24 March, UNAIDS is urging countries to do much more to reduce the number of tuberculosis (TB) deaths among people living with HIV. TB is the most common cause of hospital admission and death among people living with HIV. In 2015, 1.1 million people died from an AIDS-related illness—around 400 000 of whom died from TB, including 40 000 children.
“It is unacceptable that so many people living with HIV die from tuberculosis, and that most are undiagnosed or untreated,” said Michel Sidibé, Executive Director of UNAIDS. “Only by stepping up collaboration between HIV and tuberculosis programmes to accelerate joint action can the world reach its critical HIV and tuberculosis targets.”
Eight countries—the Democratic Republic of the Congo, India, Indonesia, Mozambique, Nigeria, South Africa, the United Republic of Tanzania and Zambia—account for around 70% of all TB deaths among people living with HIV. Scaling up action in these eight countries would put the world on track to reach the ambitious target in the 2016 United Nations Political Declaration on Ending AIDS of reducing TB-related deaths among people living with HIV by 75% by 2020…

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Wellcome Trust [to 25 March 2017]
https://wellcome.ac.uk/news
Published: 24 March 2017
Breakthrough in battle against resistant TB
A cutting-edge technique developed by Wellcome-funded researchers in Oxford means that tuberculosis (TB) can now be diagnosed much faster and more accurately.
The researchers’ method uses whole genome sequencing to quickly assess which strains of TB a patient is infected with. Patients will receive their diagnosis in just over a week, rather than waiting up to a month.
This will improve treatments and help reduce the spread of drug-resistant infections.
It will also be possible to improve identification and treatment of other resistant pathogens.
The news comes as World TB Day marks global efforts to eliminate a disease that infects 10 million people and kills 1.5 million each year. The spread of resistant strains of TB are of particular concern. In 2015, an estimated 480,000 people worldwide developed multidrug-resistant TB…

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EDCTP [to 25 March 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
24 March 2017
World TB day 2017: closing the gaps to end tuberculosis
Ending the tuberculosis (TB) epidemic by 2030 is one of the health targets of the Sustainable Development Goals. Although TB incidence has fallen by an average of 1.5% per year since 2000, TB is still one of the top 10 causes of death worldwide. Over 95% of TB deaths occur in low- and middle-income countries. In 2015, an estimated 480,000 people globally developed multidrug-resistant TB (MDR-TB). This ambitious aim to end the TB epidemic by 2030 can only be achieved by uniting efforts to close the research gaps…

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Industry Watch [to 25 March 2017]
:: Pfizer Receives Positive CHMP Opinion for TRUMENBA® for Prevention of Meningococcal Group B Disease
TRUMENBA Has Been Studied in a Global Clinical Development Program Evaluating the Vaccine in Adolescents and Adults1
The Majority of Meningococcal Disease Cases in Europe are Caused by Meningococcal Group B (MenB), with Adolescents and Young Adults at Increased Risk2
March 24, 2017
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) today announced that the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending that TRUMENBA® (Meningococcal Group B Vaccine) be granted marketing authorization in the European Union (EU) for active immunization of individuals 10 years and older to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B (MenB).3 The CHMP’s opinion will now be sent to the European Commission (EC) for final decision.
“This positive opinion by the CHMP to recommend marketing authorization of TRUMENBA in the EU is an additional step toward the fight to help protect individuals over 10 years of age from meningococcal disease caused by serogroup B, an uncommon yet devastating and life-threatening disease,” said Kathrin Jansen, Ph.D., senior vice president and head of Vaccine Research and Development for Pfizer Inc. “This decision further affirms the effectiveness and robust safety profile of TRUMENBA.”…

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AERAS [to 25 March 2017]
http://www.aeras.org/pressreleases
No new digest content identified.

BIO [to 25 March 2017]
http://www.bio.org/insights
No new digest content identified.

BMGF – Gates Foundation [to 25 March 2017]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

CEPI – Coalition for Epidemic Preparedness Innovations [to 25 March 2017]
http://cepi.net/
No new digest content identified.

DCVMN [to 25 March 2017]
http://www.dcvmn.org/
No new digest content identified.

European Vaccine Initiative [to 25 March 2017]
http://www.euvaccine.eu/news-events
No new digest content identified.

FDA [to 25 March 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
No new digest content identified.

Fondation Merieux [to 25 March 2017]
http://www.fondation-merieux.org/news
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
No new digest content identified.

GHIT Fund [to 25 March 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.
No new digest content identified.

Hilleman Laboratories [to 25 March 2017]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 25 March 2017]
http://www.humanvaccinesproject.org/media/press-releases/
No new digest content identified.

IAVI – International AIDS Vaccine Initiative [to 25 March 2017]
http://www.iavi.org/
No new digest content identified.

IFPMA [to 25 March 2017]
http://www.ifpma.org/resources/news-releases/
No new digest content identified.

IVI [to 25 March 2017]
http://www.ivi.int/
No new digest content identified.

PhRMA [to 25 March 2017]
http://www.phrma.org/press-room
No new digest content identified.

Sabin Vaccine Institute [to 25 March 2017]
http://www.sabin.org/updates/pressreleases
No new digest content identified.

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

WHO issues ethics guidance to protect rights of TB patients
World TB Day 2017 – Unite efforts to leave no one behind
News release
22 March 2017 | GENEVA – New tuberculosis (TB) ethics guidance, launched today by the World Health Organization (WHO), aims to help ensure that countries implementing the End TB Strategy adhere to sound ethical standards to protect the rights of all those affected.

TB, the world’s top infectious disease killer, claims 5 000 lives each day. The heaviest burden is carried by communities which already face socio-economic challenges: migrants, refugees, prisoners, ethnic minorities, miners and others working and living in risk-prone settings, and marginalized women, children and older people.

“TB strikes some of the world’s poorest people hardest,” said Dr Margaret Chan, WHO Director-General. “WHO is determined to overcome the stigma, discrimination, and other barriers that prevent so many of these people from obtaining the services they so badly need.”

Poverty, malnutrition, poor housing and sanitation, compounded by other risk factors such as HIV, tobacco, alcohol use and diabetes, can put people at heightened risk of TB and make it harder for them to access care. More than a third (4.3 million) of people with TB go undiagnosed or unreported, some receive no care at all and others access care of questionable quality.

The new WHO ethics guidance addresses contentious issues such as, the isolation of contagious patients, the rights of TB patients in prison, discriminatory policies against migrants affected by TB, among others. It emphasizes five key ethical obligations for governments, health workers, care providers, nongovernmental organizations, researchers and other stakeholders to:
:: provide patients with the social support they need to fulfil their responsibilities
:: refrain from isolating TB patients before exhausting all options to enable treatment adherence and only under very specific conditions
:: enable “key populations” to access same standard of care offered to other citizens
ensure all health workers operate in a safe environment
:: rapidly share evidence from research to inform national and global TB policy updates…

.

Journal of Global Oncology
DOI: http://dx.doi.org/10.1200/JGO.2016.008151
Special Article
Primary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Guideline
Silvina Arrossi, Instituto Nacional del Cancer, Buenos Aires, Argentina; Sarah Temin, American Society of Clinical Oncology, Alexandria, VA; Suzanne Garland, University of Melbourne, Melbourne, Victoria, Australia; Linda O’Neal Eckert, University of Washington; Vivien Tsu, PATH, Seattle, WA; Neerja Bhatla, All India Institute of Medical Sciences, New Delhi, India; Xavier Castellsagué and Silvia de Sanjosé, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain; Sharifa Ezat Alkaff, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Tamika Felder, Cervivor, Upper Marlboro, MD; Doudja Hammouda, Institut National de Santé Publique, Algiers, Algeria; Ryo Konno, Jichi Medical University, Saitama Medical Center, Saitama, Japan; Gilberto Lopes, Sylvester Comprehensive Cancer Center, Miami, FL; Emmanuel Mugisha, PATH, Kampala, Uganda; Rául Murillo, International Agency for Research on Cancer, Lyon, France; Isabel C. Scarinci, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; Margaret Stanley, University of Cambridge, Cambridge, United Kingdom; Cosette M. Wheeler, University of New Mexico, Albuquerque, NM; and Isaac Folorunso Adewole, Ministry of Health, Abuja, Nigeria
Abstract
Purpose
To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally.
Methods
The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/ biostatistics, health economics, behavioral/ implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group) for one round of formal ratings.
Results E
xisting sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of >= 75%.
Recommendations
In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age >= 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if >= 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus–related cancers and diseases. Basic settings: vaccinating boys is not recommended.

It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.

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

BMC Infectious Diseases

(Accessed 25 March 2017)

Research article
Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis
Efforts to control the global burden of tuberculosis (TB) have been jeopardized by the rapid evolution of multi-drug resistant Mycobacterium tuberculosis (MTB), which is resistant to at least isoniazid and rifamp…
Setegn Eshetie, Mucheye Gizachew, Mulat Dagnew, Gemechu Kumera, Haile Woldie, Fekadu Ambaw, Belay Tessema and Feleke Moges
BMC Infectious Diseases 2017 17:219
Published on: 20 March 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 25 March 2017)

Research article
A qualitative study of participants’ views on re-consent in a longitudinal biobank
Biomedical research increasingly relies on long-term studies involving use and re-use of biological samples and data stored in large repositories or “biobanks” over lengthy periods, often raising questions about whether and when a re-consenting process should be activated. We sought to investigate the views on re-consent of participants in a longitudinal biobank.
Mary Dixon-Woods, David Kocman, Liz Brewster, Janet Willars, Graeme Laurie and Carolyn Tarrant
BMC Medical Ethics 2017 18:22
Published on: 23 March 2017

Epidemiology and Infection
Volume 145 – Issue 5 – April 2017
http://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Research Article
Long-term effectiveness of plasma-derived hepatitis B vaccine 22–28 years after immunization in a hepatitis B virus endemic rural area: is an adult booster dose needed?
Published online: 09 January 2017, pp. 887-894
H. LI, G. J. LI, Q. Y. CHEN, Z. L. FANG, X. Y. WANG, C. TAN, Q. L. YANG, F. Z. WANG, F. WANG, S. ZHANG, S. L. BI, L. P. SHEN
DOI: https://doi.org/10.1017/S0950268816003046

.

Research Article
Maximizing the benefits of ART and PrEP in resource-limited settings
Published online: 29 December 2016, pp. 942-956
G. AKUDIBILLAH, A. PANDEY, J. MEDLOCK
DOI: https://doi.org/10.1017/S0950268816002958
Abstract
Antiretroviral therapy (ART) is increasingly being used as an HIV-prevention tool, administered to uninfected people with ongoing HIV exposure as pre-exposure prophylaxis (PrEP) and to infected people to reduce their infectiousness. We used a modelling approach to determine the optimal population-level combination of ART and PrEP allocations required in South Africa to maximize programme effectiveness for four outcome measures: new infections, infection-years, death and cost. We considered two different strategies for allocating treatment, one that selectively allocates drugs to sex workers and one that does not. We found that for low treatment availability, prevention through PrEP to the general population or PrEP and ART to sex workers is key to maximizing effectiveness, while for higher drug availability, ART to the general population is optimal. At South Africa’s current level of treatment availability, using prevention is most effective at reducing new infections, infection-years, and cost, while using the treatment as ART to the general population best reduces deaths. At treatment levels that meet the UNAIDS’s ambitious new 90–90–90 target, using all or almost all treatment as ART to the general population best reduces all four outcome measures considered.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 March 2017]

Debate
Obstacles and opportunities in Chinese pharmaceutical innovation
Global healthcare innovation networks nowadays have expanded beyond developed countries with many developing countries joining the force and becoming important players. China, in particular, has seen a significant increase in the number of innovative firms and research organizations stepping up to the global network in recent years. Nevertheless, the intense Research and Development input has not brought about the expectable output. While China is ascending at a great speed to a leading position worldwide in terms of Research and Development investment, scientific publications and patents, the innovation capabilities in the pharmaceutical sector remain weak.
Jingyun Ni, Junrui Zhao, Carolina Oi Lam Ung, Yuanjia Hu, Hao Hu and Yitao Wang
Globalization and Health 2017 13:21
Published on: 24 March 2017

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 March 2017]

Research
Operational and implementation research within Global Fund to Fight AIDS, Tuberculosis and Malaria grants: a situation analysis in six countries
Sabine Kiefer, Astrid M. Knoblauch, Peter Steinmann, Tanja Barth-Jaeggi, Mahnaz Vahedi, Dermot Maher, Jürg Utzinger and Kaspar Wyss
Globalization and Health 2017 13:22
Published on: 24 March 2017
Abstract
Background
Operational/implementation research (OR/IR) is a key activity to improve disease control programme performance. We assessed the extent to which malaria and tuberculosis (TB) grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (“Global Fund”) include support for OR/IR, and discuss the implications of the current Global Fund operating mechanisms for OR/IR support.
Methods
The situation analysis focussed on malaria and TB, while HIV was excluded. Stakeholder interviews were conducted at the Global Fund secretariat and in six purposefully selected high disease burden countries, namely the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Myanmar and Zimbabwe. Interviewed in-country stakeholders included the relevant disease control programme managers, project implementation partners, representatives from international organisations with a stake in global health, academic and governmental research institutions, and other relevant individuals such as members of the country coordination mechanism. Additionally, documentation of grants and OR/IR obtained from the Global Fund was reviewed.
Results
The Global Fund provides substantial resources for malaria and TB surveys, and supports OR/IR if such support is requested and the application is well justified. We observed considerable variations from one country to another and between programmes with regards to need, demand, absorption capacity and funding for OR/IR related to malaria and TB. Important determinants for the extent of such funding are the involvement of national research coordination bodies, established research agendas and priorities, human and technical research capacity, and involvement of relevant stakeholders in concept note development. Efforts to disseminate OR/IR findings were generally weak, and the Global Fund does not maintain a central OR/IR database. When faced with a need to choose between procurement of commodities for disease control and supporting research, countries tend to seek research funding from other donors. The Global Fund is expected to issue more specific guidance on the conditions under which it supports OR/IR, and to adapt administrative procedures to facilitate research.
Conclusions
The importance of OR/IR for optimising disease control programmes is generally accepted but countries vary in their capacity to demand and implement studies. Countries expect guidance on OR/IR from the Global Fund. Administrative procedures specifically related to the budget planning should be modified to facilitate ad-hoc OR/IR funding. More generally, several countries expressed a need to strengthen capacity for planning, negotiating and implementing research

Health Policy and Planning
Volume 32 Issue 3 April 2017
http://heapol.oxfordjournals.org/content/current

Editorial
Privilege and inclusivity in shaping Global Health agendas
Health Policy Plan (2017) 32 (3): 303-304.
Kabir Sheikh, Sara C Bennett, Fadi el Jardali, George Gotsadze
DOI: https://doi.org/10.1093/heapol/czw146
Published: 24 October 2016
Initial text
Northern voices dominate Global Health discussions. Of recent Lancet Commissions, excluding representatives from international organizations, 70% of commissioners on the Women and Health commission came from the global North, and likewise, 71% of the Health and Climate Change commission, 72% of the Global Surgery commission and 73% of the Global Health commission (Lancet 2016). Only two out of the 16-member Board of Directors of the Consortium of Universities of Global Health come from the global South (CUGH 2016). No current or past president and only one current member of the World Health Summit’s scientific committee is from the global South (WHS 2016). Only one of the 17 advisory board members of the journal Global Health Governance is based in a low/middle income…

Health Policy and Planning
Volume 32 Issue 3 April 2017
http://heapol.oxfordjournals.org/content/current

Public health expenditure and health system responsiveness for low-income individuals: results from 63 countries
Chetna Malhotra; Young Kyung Do
Abstract
Improvement in overall responsiveness to people’s expectations is an important goal for any health system; socioeconomic equity in responsiveness is equally important. However, it is not known if socioeconomic disparities in responsiveness can be reduced through greater public health expenditures. This article assesses the relationship of the proportion of public health expenditure over total health expenditure (PPHE) with responsiveness for poorest individuals and the difference in responsiveness between the richest and poorest individuals. We used data from six responsiveness dimensions (prompt attention, dignity, choice, clarity of information, confidentiality and quality of basic amenities) of outpatient services from World Health Survey data from 63 countries. Hierarchical Ordered Probit (HOPIT) models assessed the probability of ‘very good’ responsiveness in each domain among the poorest and richest individuals for each country, correcting for reporting heterogeneity through vignettes. Linear regression models were then used to assess the association between predicted probabilities from HOPIT models and PPHE, adjusting for (log) Gross Domestic Product per capita. The study findings showed that higher PPHE was associated with a higher probability of ‘very good’ responsiveness for each domain among the poorest individuals, and with smaller pro-rich disparities in responsiveness between the richest and poorest individuals. In conclusion, increasing PPHE may improve the responsiveness of health services for the poorest individuals and reduce disparities in responsiveness between the richest and poorest individuals.

Health Policy and Planning
Volume 32 Issue 3 April 2017
http://heapol.oxfordjournals.org/content/current

Editor’s Choice
Government stewardship of the for-profit private health sector in Afghanistan
Harry E. Cross; Omarzaman Sayedi; Laili Irani; Lauren C. Archer; Kathleen Sears …
Abstract
Background: Since 2003, Afghanistan’s largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals.
Aim: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance.
Methods: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives.
Results: The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them.
Conclusions: The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward.

Health Policy and Planning
Volume 32 Issue 3 April 2017
http://heapol.oxfordjournals.org/content/current

The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda
Wenjuan Wang; Gheda Temsah; Lindsay Mallick
Abstract
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.

Health Policy and Planning
Volume 32 Issue 3 April 2017
http://heapol.oxfordjournals.org/content/current

Review
Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods
Ashwin Vasan; David C. Mabey; Simran Chaudhri; Helen-Ann Brown Epstein; Stephen D. Lawn
Abstract
Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 25 March 2017]

Research
International consultation on long-term global health research priorities, research capacity and research uptake in developing countries
David Mc Conalogue, Sue Kinn, Jo-Ann Mulligan and Malcolm McNeil
Health Research Policy and Systems 2017 15:24
Published on: 21 March 2017
Abstract
Background
In recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries.
Methods
An online consultation was used to survey a wide range of participants on global health research priorities. The qualitative data was analysed using a thematic analysis, with frequency of codes in responses tabulated to approximate relative importance of themes and sub-themes.
Results
The public consultation yielded 421 responses. The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership.
Conclusions
The outcomes from this consultation survey provide valuable insights into how DfID stakeholders prioritise research. The outcomes from this survey were reviewed alongside other elements of a wider DfID consultation process to help inform long-term research prioritisation of global health research. There are limitations in this approach; the opportunistic nature of the survey’s dissemination means the findings presented may not be representative of the full range of stakeholders or views.

International Health
Volume 9, Issue 2 March 2017
http://inthealth.oxfordjournals.org/content/current

Editor’s Choice
Strategies for halting the rise of multidrug resistant TB epidemics: assessing the effect of early case detection and isolation
Aquino L. Espindola; Marie Varughese; Marek Laskowski; Affan Shoukat; Jane M. Heffernan …
Abstract
Background
The increasing rates of multidrug resistant TB (MDR-TB) have posed the question of whether control programs under enhanced directly observed treatment, short-course (DOTS-Plus) are sufficient or implemented optimally. Despite enhanced efforts on early case detection and improved treatment regimens, direct transmission of MDR-TB remains a major hurdle for global TB control.
Methods
We developed an agent-based simulation model of TB dynamics to evaluate the effect of transmission reduction measures on the incidence of MDR-TB. We implemented a 15-day isolation period following the start of treatment in active TB cases. The model was parameterized with the latest estimates derived from the published literature.
Results
We found that if high rates (over 90%) of TB case identification are achieved within 4 weeks of developing active TB, then a 15-day patient isolation strategy with 50% effectiveness in interrupting disease transmission leads to 10% reduction in the incidence of MDR-TB over 10 years. If transmission is fully prevented, the rise of MDR-TB can be halted within 10 years, but the temporal reduction of MDR-TB incidence remains below 20% in this period.
Conclusions
The impact of transmission reduction measures on the TB incidence depends critically on the rates and timelines of case identification. The high costs and adverse effects associated with MDR-TB treatment warrant increased efforts and investments on measures that can interrupt direct transmission through early case detection.

International Health
Volume 9, Issue 2 March 2017
http://inthealth.oxfordjournals.org/content/current

The yield and feasibility of integrated screening for TB, diabetes and HIV in four public hospitals in Ethiopia
Degu Jerene; Nebiyu Hiruy; Ilili Jemal; Wondimu Gebrekiros; Tadesse Anteneh …
Abstract
Background
Our objective was to demonstrate the feasibility of integrated care for TB, HIV and diabetes mellitus (DM) in a pilot project in Ethiopia.
Methods
Healthcare workers in four hospitals screened patients with TB for HIV and DM; patients with HIV for DM and TB; and patients with DM for TB. Fasting and random plasma glucose (RPG) tests were used to confirm the diagnosis of DM. We used screening checklists for TB and DM, and additional risk scoring criteria to identify patients at risk of DM.
Results
Of 3439 study participants, 888 were patients with DM, 439 patients with TB and 2112 from HIV clinics. Six of the patients with DM had TB of whom five were already on treatment; and 141 (32.4%) patients with TB had DM, of whom only five were previously diagnosed with DM. Symptomatic patients and those with a risk score of 5 or more were about three times more likely to have abnormal blood glucose level. Of 2075 HIV patients with RPG determined, only 31 (1.5%) had abnormal RPG.
Conclusions
Tri-directional screening was feasible for detecting and managing previously undiagnosed TB and DM. More work is needed to better understand the interaction between HIV and DM.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 6 Issue 1, March 2017
http://jpids.oxfordjournals.org/content/current

ORIGINAL ARTICLES
Reflections of a Vaccinologist: Lessons Learned About What We Can Do to Improve Trust in Vaccines and Vaccine Programs
Neal A. Halsey
Abstract
Public trust can be improved by learning from past mistakes, by establishing a standing forum for review of new concerns as they arise, and by maintaining a robust vaccine safety system. Developing standard guidelines for reporting causality assessment in case reports would help educate physicians and prevent future unnecessary concerns based on false assumptions of causal relationships.

The Lancet
Mar 25, 2017 Volume 389 Number 10075 p1165-1272 e4
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Trauma for migrant children stranded in Greece
The Lancet
A Save the Children report released on March 16 raises alarm about the dire consequences of the deal made between the European Union (EU) and Turkey that limits the number of migrants and refugees entering Europe via Greece. 1 year after the agreement, thousands of people, many escaping Syria or Iraq, are now stranded on Greek islands. They are living in limbo waiting for asylum or passage, prohibited from leaving, and effectively imprisoned. Conditions are said to be appalling with limited infrastructure and facilities. Of the 13 200 migrants and refugees stranded in the Aegean islands, more than 5000 are children, some of whom are unaccompanied or separated from their families. The report calls for the EU and Greece to immediately end the illegal detention of children and to better protect them. But given the extent of the health consequences documented by Save the Children, the medical community also needs to act urgently.

The charity says that children trapped on the Greek islands are showing signs of depression, anxiety, and distress. Bedwetting, nightmares, and aggressive behaviour are increasing. Some children have witnessed deaths, fires, protests, and police violence in the camps. Basic needs for food, water, and sanitation are barely being met, says the report. Shockingly, children as young as 9 years have attempted suicide or self-harm.

Affected children are clearly traumatised. Many will have already fled war, poverty, or persecution. Along the way they may have lost parents or siblings or been separated from them. But instead of treating that trauma, our collective failure has led to their re-traumatisation. At such a crucial time of a child’s development, the physical and mental health effects of this unacceptable detention are devastating. The long-term consequences will be worse. The medical community should act immediately: we must insist on the removal of these children from the camps with their families into safe and humane shelter. We must provide the health care and treatment these children need to recover from their trauma. And we must support all efforts to help them regain their resilience and hope for free and full lives.

The Lancet
Mar 25, 2017 Volume 389 Number 10075 p1165-1272 e4
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Preparing for future global health emergencies
The Lancet
On March 13–14, Chatham House and the Graduate Institute Geneva-Global Health Centre hosted a roundtable meeting on preparedness for global health crises. Representatives from WHO and the UN, including member states, global health and development agencies, foundations, academia, and non-profit initiatives shared their work and experiences on monitoring preparedness for outbreaks and other public health emergencies.

Several themes emerged. Global preparedness for outbreaks is improving in some regions, and changes to the global response architecture are underway. A broad range of sectors must be involved, from animal and livestock to human health and trade. Current monitoring and tracking of preparedness use indicators from the International Health Regulations (IHR) and a joint external evaluation process for IHR requirements has begun. Tracking for Sustainable Development Goals and the Sendai framework for disaster risk reduction is being considered. Reporting on progress is voluntary, non-existent, or overlapping, and tracking of global commitments and responsibilities is largely absent.

Views differed on how to monitor contributions to global, national, and regional preparedness and mutual accountability, but there was consensus that country-level preparedness, financing, and sharing of information, research, and health technologies are vital. Independent accountability is needed to ensure all stakeholders are acting on their commitments to help raise the profile of preparedness politically. This effort will require an ecosystem of multiple stakeholders, a range of expertise, and diverse data sources.

Chatham House and the Graduate Institute will contribute to this ecosystem through a new Monitoring and Accountability for Preparedness initiative (MAP-Global Health Crises). Harvard University and the US National Academy of Sciences have convened a meeting to advance these discussions on April 18, and meetings are planned by others. The Geneva meeting is a good first step towards identifying the stakeholder ecosystem required to ensure that countries and the global community continue to strengthen their collective preparedness for the health crises that will inevitably arise.

The Lancet
Mar 25, 2017 Volume 389 Number 10075 p1165-1272 e4
http://www.thelancet.com/journals/lancet/issue/current

Articles
Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women
Silvia Stringhini, Cristian Carmeli, Markus Jokela, Mauricio Avendaño, Peter Muennig, Florence Guida, Fulvio Ricceri, Angelo d’Errico, Henrique Barros, Murielle Bochud, Marc Chadeau-Hyam, Françoise Clavel-Chapelon, Giuseppe Costa, Cyrille Delpierre, Silvia Fraga, Marcel Goldberg, Graham G Giles, Vittorio Krogh, Michelle Kelly-Irving, Richard Layte, Aurélie M Lasserre, Michael G Marmot, Martin Preisig, Martin J Shipley, Peter Vollenweider, Marie Zins, Ichiro Kawachi, Andrew Steptoe, Johan P Mackenbach, Paolo Vineis, Mika Kivimäki for the LIFEPATH consortium
1229
Open Access
Abstract
Background
In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors.
Methods
We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1,751,479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors.
Findings
During 26.6 million person-years at risk (mean follow-up 13.3 years [SD 6.4 years]), 310,277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1.04 (95% CI 0.98–1.11) for obesity in men and 2.17 (2·06–2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1.42, 95% CI 1.38–1.45 for men; 1.34, 1.28–1.39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1.26, 1·21–1.32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2.1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0.5 years for high alcohol intake, 0.7 years for obesity, 3.9 years for diabetes, 1.6 years for hypertension, 2.4 years for physical inactivity, and 4.8 years for current smoking.
Interpretation
Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality.
Funding
European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.

Lancet Respiratory Medicine
Apr 2017 Volume 5 Number 4 p235-360
http://www.thelancet.com/journals/lanres/issue/current
The Lancet Respiratory Medicine Commission

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis
Keertan Dheda, Tawanda Gumbo, Gary Maartens, Kelly E Dooley, Ruth McNerney, Megan Murray, Jennifer Furin, Edward A Nardell, Leslie London, Erica Lessem, Grant Theron, Paul van Helden, Stefan Niemann, Matthias Merker, David Dowdy, Annelies Van Rie, Gilman K H Siu, Jotam G Pasipanodya, Camilla Rodrigues, Taane G Clark, Frik A Sirgel, Aliasgar Esmail, Hsien-Ho Lin, Sachin R Atre, H Simon Schaaf, Kwok Chiu Chang, Christoph Lange, Payam Nahid, Zarir F Udwadia, C Robert Horsburgh Jr, Gavin J Churchyard, Dick Menzies, Anneke C Hesseling, Eric Nuermberger, Helen McIlleron, Kevin P Fennelly, Eric Goemaere, Ernesto Jaramillo, Marcus Low, Carolina Morán Jara, Nesri Padayatchi, Robin M Warren
291
Summary
Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem.

In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms—including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions—are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.

Nature
Volume 543 Number 7646 pp463-582 23 March 2017
http://www.nature.com/nature/current_issue.html

Editorial
Trump faces backlash on health-agency cuts
Crippling the US National Institutes of Health might increase resistance to other attacks on science.

Editorial
The FDA chief must not be a proxy for industry
Trump’s pick for the US regulatory agency will bring experience and a clear vision — as well as ties to industry.

New England Journal of Medicine
March 23, 2017  Vol. 376 No. 12
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families
K.R. Page and S. Polk
Excerpt
…Today, the ACA’s fate is unclear, with implications for millions of Americans.5 We cannot predict how health care access will be reshaped, yet it’s all but certain that undocumented immigrants who were never eligible for ACA benefits will not have better access to care. Access may be significantly reduced if financial penalties are applied to states or cities that refuse to cooperate with ICE. Overt restrictions on basic public services, such as schools or public health clinics, are unlikely, given that such measures were ruled unconstitutional in the 1990s (California Proposition 187), but access could be restricted by requiring government-issued identification cards or Social Security numbers at federally qualified health centers or health department clinics. In addition, as our pregnant patient showed us, a climate of deportation may dampen the use of existing resources, even among eligible people.5

To reduce barriers to care for immigrant families, the medical and public health community can engage in local and national politics and promote a welcoming, inclusive environment in our practices. Clinicians have access to powerful stories of human suffering and strength. The current climate presents a renewed opportunity to partner with advocacy groups and media to share stories of human experience that counter the Trump administration’s negative narrative about immigrants. The sharing of personal stories about the impact of the temporary immigrant ban through social and mainstream media has energized millions of people to express opposition to the ban. Portraits of scientists and doctors affected by the ban highlighted its unintended consequences for science and health care. Telling human stories is an effective rapid-response tool that we can use to advocate for our patients.

Clinicians and public health practitioners can also join forces to harness the power of data. We can monitor and measure health care utilization and health outcomes. Clinicians can pay attention to patterns in health care utilization among their immigrant patients and communicate worrisome trends to public health professionals. Some markers of child well-being — such as Medicaid enrollment rates among eligible children of foreign-born parents, teen pregnancy rates, uptake of supplemental nutrition assistance programs, school attendance, and bullying reports — are already monitored, allowing comparison of the pre- and post-election periods.

The election’s implications for undocumented adults may be more complicated to evaluate, since these adults are often invisible in conventional databases because of barriers to care and insufficient collection of relevant sociodemographic data (i.e., ethnic background, country of origin, and language preference). It’s important to develop inclusive methods that account for the unique needs of hidden populations. Some existing measures, however, can provide indications of a chilling effect, including utilization of safety-net clinics for sexual and reproductive health care, timeliness of prenatal care, domestic violence reports, and hate crimes (especially assaults resulting in emergency department visits)…

There are many reasons to support equitable access to care for all, regardless of nationality. Objective and scientifically rigorous data analysis will be essential in elucidating the interconnection between immigrants’ health and the public health and health care costs of the United States.

.

Editorial
Rotavirus Vaccines — A New Hope
Mathuram Santosham, M.D., M.P.H., and Duncan Steele, Ph.D.
N Engl J Med 2017; 376:1170-1172 March 23, 2017 DOI: 10.1056/NEJMe1701347
[See full text in Milestones section above]

.

Original Article
Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger
Sheila Isanaka, Sc.D., Ousmane Guindo, M.D., Celine Langendorf, Pharm.D., M.P.H., Amadou Matar Seck, M.D., Brian D. Plikaytis, M.Sc., Nathan Sayinzoga-Makombe, M.P.H., Monica M. McNeal, M.Sc., Nicole Meyer, M.Sc., Eric Adehossi, M.D., Ali Djibo, M.D., Bruno Jochum, M.S., and Rebecca F. Grais, Ph.D.
N Engl J Med 2017; 376:1121-1130 March 23, 2017 DOI: 10.1056/NEJMoa1609462
Abstract
[See full abstract in Milestones section above]

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 25 March 2017]

Brief Report
The Development of a Veterans Health Administration Emergency Management Research Agenda
March 23, 2017 ·
Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices.
Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA.
Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities.
Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 25 March 2017)

Editorial
Will a new 2017 global leadership commit to NTDs?
Peter J. Hotez, Serap Aksoy
| published 23 Mar 2017 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005309
Initial text
[In] 2017 we will experience a nearly wholesale shift in global governance as it relates to the world’s neglected tropical diseases (NTDs). A new United Nations (UN) Secretary General, Antonio Guterres from Portugal, was just appointed and we’ll soon have in place a new World Health Organization (WHO) Director General. In addition, the United States Government has so far been the largest financier of NTD mass drug administration (MDA), as well as research and development (R&D) for NTDs. A new US President, President Donald Trump, is now in the White House, while Prime Minister Theresa May has been appointed as the new British Prime Minister. The United Kingdom is probably the second largest global supporter of NTDs.
How shall we advocate? What does our community of NTD scientists, public health experts, and health care providers want this new global leadership to know about our diseases? What should they prioritize? Clearly, consensus on this front is problematic, but based on your submissions, emails, and letters, here are some early thoughts…

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 25 March 2017)

Research Article
Using simulation to aid trial design: Ring-vaccination trials
Matt David Thomas Hitchings, Rebecca Freeman Grais, Marc Lipsitch
| published 22 Mar 2017 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005470
[uncorrected proof]
Abstract
Background
The 2014–6 West African Ebola epidemic highlights the need for rigorous, rapid clinical trial methods for vaccines. A challenge for trial design is making sample size calculations based on incidence within the trial, total vaccine effect, and intracluster correlation, when these parameters are uncertain in the presence of indirect effects of vaccination.
Methods and findings
We present a stochastic, compartmental model for a ring vaccination trial. After identification of an index case, a ring of contacts is recruited and either vaccinated immediately or after 21 days. The primary outcome of the trial is total vaccine effect, counting cases only from a pre-specified window in which the immediate arm is assumed to be fully protected and the delayed arm is not protected. Simulation results are used to calculate necessary sample size and estimated vaccine effect. Under baseline assumptions about vaccine properties, monthly incidence in unvaccinated rings and trial design, a standard sample-size calculation neglecting dynamic effects estimated that 7,100 participants would be needed to achieve 80% power to detect a difference in attack rate between arms, while incorporating dynamic considerations in the model increased the estimate to 8,900. This approach replaces assumptions about parameters at the ring level with assumptions about disease dynamics and vaccine characteristics at the individual level, so within this framework we were able to describe the sensitivity of the trial power and estimated effect to various parameters. We found that both of these quantities are sensitive to properties of the vaccine, to setting-specific parameters over which investigators have little control, and to parameters that are determined by the study design.
Conclusions
Incorporating simulation into the trial design process can improve robustness of sample size calculations. For this specific trial design, vaccine effectiveness depends on properties of the ring vaccination design and on the measurement window, as well as the epidemiologic setting.
Author summary
The urgency, as well as the logistical and sometimes ethical challenges of clinical trials for interventions during epidemics of emerging diseases prompts the need for novel designs and analytic strategies. The successful use of a novel cluster-randomized ring-vaccination trial to test an Ebola vaccine in Guinea raises the general question of what circumstances would favour the use of trials of similar design and how the properties of the population, the vaccine and the trial would influence the necessary sample size and the expected results. We present a generalized transmission dynamic model for a ring vaccination trial to address these questions. This work is an example of the general phenomenon that mechanistic, transmission-dynamic simulations can aid in the design and interpretation of intervention trials for infectious diseases, when the trial itself can have non-obvious effects on transmission dynamics that may not be fully captured by effect- and sample-size calculations for noncommunicable diseases.

PLoS One
http://www.plosone.org/
[Accessed 25 March 2017]

Research Article
The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review
Benjamin M. Hunter, Sean Harrison, Anayda Portela, Debra Bick
| published 22 Mar 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0173068
Abstract
Background
Cash transfers and vouchers are forms of ‘demand-side financing’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.
Methods
This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637).
Results
Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.
Conclusion
Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

PLoS Pathogens
http://journals.plos.org/plospathogens/
[Accessed 25 March 2017]

Research Article
The blood DNA virome in 8,000 humans
Ahmed Moustafa, Chao Xie, Ewen Kirkness, William Biggs, Emily Wong, Yaron Turpaz, Kenneth Bloom, Eric Delwart, Karen E. Nelson, J. Craig Venter, Amalio Telenti
| published 22 Mar 2017 PLOS Pathogens
http://dx.doi.org/10.1371/journal.ppat.1006292
[uncorrected proof]
Abstract
The characterization of the blood virome is important for the safety of blood-derived transfusion products, and for the identification of emerging pathogens. We explored non-human sequence data from whole-genome sequencing of blood from 8,240 individuals, none of whom were ascertained for any infectious disease. Viral sequences were extracted from the pool of sequence reads that did not map to the human reference genome. Analyses sifted through close to 1 Petabyte of sequence data and performed 0.5 trillion similarity searches. With a lower bound for identification of 2 viral genomes/100,000 cells, we mapped sequences to 94 different viruses, including sequences from 19 human DNA viruses, proviruses and RNA viruses (herpesviruses, anelloviruses, papillomaviruses, three polyomaviruses, adenovirus, HIV, HTLV, hepatitis B, hepatitis C, parvovirus B19, and influenza virus) in 42% of the study participants. Of possible relevance to transfusion medicine, we identified Merkel cell polyomavirus in 49 individuals, papillomavirus in blood of 13 individuals, parvovirus B19 in 6 individuals, and the presence of herpesvirus 8 in 3 individuals. The presence of DNA sequences from two RNA viruses was unexpected: Hepatitis C virus is revealing of an integration event, while the influenza virus sequence resulted from immunization with a DNA vaccine. Age, sex and ancestry contributed significantly to the prevalence of infection. The remaining 75 viruses mostly reflect extensive contamination of commercial reagents and from the environment. These technical problems represent a major challenge for the identification of novel human pathogens. Increasing availability of human whole-genome sequences will contribute substantial amounts of data on the composition of the normal and pathogenic human blood virome. Distinguishing contaminants from real human viruses is challenging.
Author summary
Novel sequencing technologies offer insight into the virome in human samples. Here, we identify the viral DNA sequences in blood of over 8,000 individuals undergoing whole genome sequencing. This approach serves to identify 94 viruses; however, many are shown to reflect widespread DNA contamination of commercial reagents or of environmental origin. While this represents a significant limitation to reliably identify novel viruses infecting humans, we could confidently detect sequences and quantify abundance of 19 human viruses in 42% of individuals. Ancestry, sex, and age were important determinants of viral prevalence. This large study calls attention on the challenge of interpreting next generation sequencing data for the identification of novel viruses. However, it serves to categorize the abundance of human DNA viruses using an unbiased technique.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 25 March 2017]

Biological Sciences – Population Biology:
Effectiveness of UNAIDS targets and HIV vaccination across 127 countries
Jan Medlock, Abhishek Pandey, Alyssa S. Parpia, Amber Tang, Laura A. Skrip, and Alison P. Galvani
PNAS 2017 ; published ahead of print March 20, 2017, doi:10.1073/pnas.1620788114
Significance
Despite extraordinary advances in the treatment of HIV, the global pandemic has yet to be reversed. We developed a mathematical model for 127 countries to evaluate Joint United Nations Program on HIV/AIDS (UNAIDS) targets for expanding diagnosis and treatment of the infected, and partially efficacious HIV vaccination. Under the current levels of diagnosis and treatment, we estimated 49 million new HIV cases globally from 2015 to 2035. Achieving the ambitious UNAIDS target is predicted to avert 25 million of these new infections, with an additional 6.3 million averted by the 2020 introduction of a 50%-efficacy vaccine. Our study provides country-specific impacts of a partially effective HIV vaccine and demonstrates its importance to the elimination of HIV transmission globally.
Abstract
The HIV pandemic continues to impose enormous morbidity, mortality, and economic burdens across the globe. Simultaneously, innovations in antiretroviral therapy, diagnostic approaches, and vaccine development are providing novel tools for treatment-as-prevention and prophylaxis. We developed a mathematical model to evaluate the added benefit of an HIV vaccine in the context of goals to increase rates of diagnosis, treatment, and viral suppression in 127 countries. Under status quo interventions, we predict a median of 49 million [first and third quartiles 44M, 58M] incident cases globally from 2015 to 2035. Achieving the Joint United Nations Program on HIV/AIDS 95–95–95 target was estimated to avert 25 million [20M, 33M] of these new infections, and an additional 6.3 million [4.8M, 8.7M] reduction was projected with the 2020 introduction of a 50%-efficacy vaccine gradually scaled up to 70% coverage. This added benefit of prevention through vaccination motivates imminent and ongoing clinical trials of viable candidates to realize the goal of HIV control.

Risk Analysis
February 2017 Volume 37, Issue 2 Pages 193–397
http://onlinelibrary.wiley.com/doi/10.1111/risa.2017.37.issue-2/issuetoc

Early View First published: 17 March 2017
The Role of Risk Perception in Flu Vaccine Behavior among African‐American and White Adults in the United States
VS Freimuth, A Jamison, G Hancock, D Musa, K Hilyard… –
Abstract
Seasonal flu vaccination rates are low for U.S. adults, with significant disparities between African and white Americans. Risk perception is a significant predictor of vaccine behavior but the research on this construct has been flawed. This study addressed critical research questions to understand the differences between African and white Americans in the role of risk perception in flu vaccine behavior: (1) What is the dimensionality of risk perception and does it differ between the two races?  (2) Were risk perceptions of white and African-American populations different and how were sociodemographic characteristics related to risk for each group? (3) What is the relation between risk perception and flu vaccine behaviors for African Americans and whites? The sample, drawn from GfK’s Knowledge Panel, consisted of 838 whites and 819 African Americans. The survey instrument was developed from qualitative research. Measures of risk perception included cognitive and emotional measures of disease risk and risk of side effects from the vaccine. The online survey was conducted in March 2015. Results showed the importance of risk perception in the vaccine decision-making process for both racial groups. As expected, those who got the vaccine reported higher disease risk than those who did not. Separate cognitive and emotional factors did not materialize in this study but strong evidence was found to support the importance of considering disease risk as well as risk of the vaccine. There were significant racial differences in the way risk perception predicted behavior.

Risk Analysis
February 2017 Volume 37, Issue 2 Pages 193–397
http://onlinelibrary.wiley.com/doi/10.1111/risa.2017.37.issue-2/issuetoc

Original Research Articles
The Value of Information in Decision-Analytic Modeling for Malaria Vector Control in East Africa (pages 231–244)
Dohyeong Kim, Zachary Brown, Richard Anderson, Clifford Mutero, Marie Lynn Miranda, Jonathan Wiener and Randall Kramer
Version of Record online: 23 MAR 2016 | DOI: 10.1111/risa.12606
Abstract
Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced-based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5–21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria-transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs.

Social Science & Medicine
Volume 176, Pages 1-182 (March 2017)
http://www.sciencedirect.com/science/journal/02779536/176

Review articles
Trade liberalization and social determinants of health: A state of the literature review
Review Article
Pages 1-13
Courtney McNamara
Abstract
The health impacts of trade liberalization are often described in relation to access to medicines, changing dietary patterns, tobacco use and alcohol consumption. The impacts of trade liberalization on the social determinants of health (SDH), are by contrast, less well known. Missing is an account of how liberalizing processes identified across different research areas relate to each other and how the association between trade liberalization and health is conceptualized within each of them, especially with reference to SDH. This paper presents a systematic review which provides a more complete picture of the pathways between trade liberalization and health, with special attention to SDH pathways. This picture captures the interrelationships between different areas of investigation, along with current limitations of our understanding and recommendations for future research.

Social Science & Medicine
Volume 176, Pages 1-182 (March 2017)
http://www.sciencedirect.com/science/journal/02779536/176

Original Research Article
The productive techniques and constitutive effects of ‘evidence-based policy’ and ‘consumer participation’ discourses in health policy processes
Pages 60-68
K. Lancaster, K. Seear, C. Treloar, A. Ritter
Abstract
For over twenty years there have been calls for greater ‘consumer’ participation in health decision-making. While it is recognised by governments and other stakeholders that ‘consumer’ participation is desirable, barriers to meaningful involvement nonetheless remain. It has been suggested that the reifying of ‘evidence-based policy’ may be limiting opportunities for participation, through the way this discourse legitimates particular voices to the exclusion of others. Others have suggested that assumptions underpinning the very notion of the ‘affected community’ or ‘consumers’ as fixed and bounded ‘policy publics’ need to be problematised. In this paper, drawing on interviews (n=41) with individuals closely involved in Australian drug policy discussions, we critically interrogate the productive techniques and constitutive effects of ‘evidence-based policy’ and ‘consumer participation’ discourses in the context of drug policy processes. To inform our analysis, we draw on and combine a number of critical perspectives including Foucault’s concept of subjugated knowledges, the work of feminist theorists, as well as recent work regarding conceptualisations of emergent policy publics. First, we explore how the subject position of ‘consumer’ might be seen as enacted in the material-discursive practices of ‘evidence-based policy’ and ‘consumer participation’ in drug policy processes. Secondly, we consider the centralising power-effects of the dominant ‘evidence-based policy’ paradigm, and how resistance may be thought about in this context. We suggest that such interrogation has potential to recast the call for ‘consumer’ participation in health policy decision-making and drug policy processes.

Vaccine
Volume 35, Issue 14, Pages 1735-1816 (27 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/14
[Includes: Special Section: Skin Vaccination Summit 2015 (Guest Editors: Yotam Levin and Sachin Mani)

Original Research Article
Vaccination of active component US military personnel against Salmonella Typhi
Pages 1742-1748
Chad K. Porter, Tia Sorrell, Indrani Mitra, Mark S. Riddle
Abstract
Introduction
Vaccination against Salmonella Typhi is one of the leading public health interventions reducing the risk of typhoid fever. There are two available licensed vaccines, Vivotif, oral live-attenuated, and Typhim Vi, intramuscular Vi capsular polysaccharide. The US military is a high risk travel population commonly vaccinated for S. Typhi. We describe the use of S. Typhi vaccination in this population and the acute reactogenicity profile of these vaccines.
Methods
Data were obtained from the Defense Medical Surveillance System and vaccination identified between 1998 and 2011 from vaccination codes. Clinical outcomes were assessed for four weeks post vaccination. Adverse event rates and odds ratios were estimated across the two vaccine types.
Results
A total of 1.9 million predominately male military personnel received 3.6 million S. Typhi vaccinations with 94.3% of vaccinees receiving the Vi capsule vaccine though variability in the vaccine administered was observed. Receipt of other vaccinations in the 6 months surrounding the S. Typhi vaccine was common. Rates of nausea (195 per 100,000 vaccinations), headache (13 per 100,000 vaccinations) and fever (40 per 100,000 vaccinations) were significantly higher following Vi capsule vaccination compared to receipt of Vivotif (130, 2, 10 per 100,000 vaccinations, respectively). In contrast the rates of rash and non-infectious diarrhea (186 and 426 per 100,000 vaccinations, respectively) were increased in those receiving Vivotif compared to the Vi capsule vaccine.
Discussion
The US military is a major consumer of S. Typhi vaccines. The parenterally administered vaccine appears to be more amenable, though we were limited in our ability to assess the reasons for its higher usage. While we observed a higher rate of several adverse events in subjects receiving the intramuscular vaccination, the overall rate of these events was low. Future studies assessing more long-term health outcomes are warranted.

Vaccine
Volume 35, Issue 13, Pages 1663-1734 (23 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/13

Conference report
Feasibility of using regional sentinel surveillance to monitor the rotavirus vaccine impact, effectiveness and intussusception incidence in the African Region
Pages 1663-1667
Inácio Mandomando, Goitom Weldegebriel, Nilsa de Deus, Jason M. Mwenda
Abstract
The 9th African rotavirus symposium was held in Maputo, Mozambique from the 8th to 10th of December 2015, including a total of 101 delegates from 17 countries, 15 of which were African countries. This forum brought together participants with various expertise including scientists, clinicians, immunization program managers, public health officials and policymakers. By the time of the symposium, 29/47 (61%) of countries in the World Health Organization (WHO) African Region had introduced rotavirus vaccine into their routine immunization program. Countries that had started monitoring impact and effectiveness of the rotavirus vaccines as well as potential adverse events following immunization (AEFI) including intussusception) also participated. Seven Rotarix® vaccine-using countries and another four countries that are using the Rotateq® vaccine are conducting systematic surveillance on intussusception and report data to the WHO and partners. The symposium concluded that the regional rotavirus surveillance network has played a crucial role in pre-vaccine data through documenting burden and epidemiology of rotavirus diarrhea in Africa, seasonal trends and identifying common rotavirus genotypes. The sentinel surveillance platform is now being used to assess the impact of the vaccines and monitoring adverse events with a focus on intussusception.

Vaccine
Volume 35, Issue 13, Pages 1663-1734 (23 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/13

Review
Rationale and support for a One Health program for canine vaccination as the most cost-effective means of controlling zoonotic rabies in endemic settings
Review Article
Pages 1668-1674
Robert P. Lavan, Alasdair I. MacG. King, David J. Sutton, Kaan Tunceli
Abstract
Although dog vaccination has been demonstrated to reduce and eliminate rabies in humans, during meetings there are often calls for further pilot studies. The assembled data proves that a widespread approach is now required. While zoonotic rabies has a minimal presence in developed nations, it is endemic throughout most of Asia and Africa, where it is considered to be a neglected tropical disease. In these areas, rabies causes an estimated annual mortality of at least 55,000 human deaths. Worldwide rabid dogs are the source of the vast majority of human rabies exposures. The World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations and the World Organization for Animal Health (OIE) advocate a collaborative One Health approach involving human public health and veterinary agencies, with mass canine vaccination programs in endemic areas being the mainstay of strategies to eliminate dog-mediated human rabies. While post-exposure prophylaxis (PEP) is effective in preventing deaths in people exposed to rabies, it is comparatively expensive and has little impact on the canine reservoir that is the primary source of zoonotic rabies. Indiscriminate culling of the dog population is expensive and there is little evidence that it is effective in controlling rabies in non-island locations. Mass canine vaccination programs using a One Health framework that achieves a minimum 70% vaccination coverage during annual campaigns have proven to be cost-effective in controlling zoonotic rabies in endemic, resource-poor regions. Case studies, such as in Tanzania and Bhutan, illustrate how an approach based on mass canine rabies vaccination has effectively reduced both canine and human rabies to minimal levels. The multiple benefits of mass canine rabies vaccination in these cases included eliminating rabies in the domestic dog reservoirs, eliminating human rabies cases, and decreasing the rabies economic burden by reducing expenditures on PEP.

Vaccine
Volume 35, Issue 13, Pages 1663-1734 (23 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/13

Original Research Article
Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies
Pages 1721-1728
Daniele Rocha Queiroz Lemos, Aidée Ramirez Franco, Maria Lúcia Feitosa de Sá Roriz, Ana Karine Borges Carneiro, Márcio Henrique de Oliveira Garcia, Fábia Lidiana de Souza, Regina Duron Andino, Luciano Pamplona de Góes Cavalcanti
Abstract
The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This article describes the strategies adopted and the effectiveness of surveillance and control measures implemented during a measles epidemic in the post-elimination period. The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response.

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

Wellcome Open Research
2017, 2:12
Research Article
Crude childhood vaccination coverage in West Africa: Trends and predictors of completeness
JS Kazungu, IMO Adetifa –
Abstract
Background: Africa has the lowest childhood vaccination coverage worldwide. If the full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan Africa, all countries need to improve on vaccine delivery to achieve and sustain high coverage. In this paper, we review trends in vaccination coverage, dropouts between vaccine doses and explored the country-specific predictors of complete vaccination in West Africa.
Methods: We utilized datasets from the Demographic and Health Surveys Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d’Ivoire, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT) vaccines in children aged 12 – 23 months. We also calculated the DPT1-to-DPT3 and DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors predictive of FIC were explored using Chi-squared tests and multivariable logistic regression.
Results: Overall, there was a trend of increasing vaccination coverage. The proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles dropout exceeded 10% in all but four countries. Although no single risk factor was consistently associated with FIC across these countries, maternal education, delivery in a health facility, possessing a vaccine card and a recent post delivery visit to a health facility were the key predictors of complete vaccination.
Conclusions: The low numbers of fully immunised children and high dropout between vaccine doses highlights weaknesses and the need to strengthen the healthcare and routine immunization delivery systems in this region. Country-specific correlates of complete vaccination should be explored further to identify interventions required to increase vaccination coverage. Despite the promise of an increasing trend in vaccination coverage in West African countries, more effort is required to attain and maintain global vaccination coverage targets.

Health Systems and Policy Research
Vol. 4 No. 1: 42 2017
Setting the Scene for Post-Ebola Health System Recovery and Resilience in Liberia: Lessons Learned and the Way Forward
B Harris, MZ Gebrekidan, H Karamagi, P Tumusiime… –
Abstract
Following the devastation caused by the 2014 Ebola outbreak in Liberia there remains much to be done for the health system to fully recover and become resilient against any future public health threat. Liberia is a post-conflict setting having experienced prolonged years of civil conflict that weakened the health system. With the decline in the incidence of new Ebola cases in late 2014 and the progressive draw down of the emergency and humanitarian response resources from early 2015, the government of Liberia moved to set the scene for the health system’s recovery and resilience through the development of a comprehensive seven-year Investment Plan for building a resilient health system (2015-2021). The Plan aims to ensure universal health coverage, guarantee health security and
improve health outcomes for the population of Liberia, while complementing the National Health Policy and Plan (2011-2021). The plan requires the investment of 1.7 billion US dollars over a period of seven years and realignments that the Government of Liberia alone does not currently have the capacity to undertake without long term external support. This paper describes the experience of Liberia in the development of the Investment Plan for building a resilient health system following the 2014-15 Ebola crisis, the approaches, process and realignments that were undertaken, lessons learned, and the way forward. It aims to provide lessons for countries recovering from crises, on how to manage their system recovery efforts.

Otolaryngology–Head and Neck Surgery
First Published March 21, 2017 research-article
A Survey of Wisconsin Pediatricians’ Knowledge and Practices Regarding the Human Papillomavirus Vaccine
MR Rohrbach, AM Wieland
Abstract
Objective
The human papillomavirus (HPV) is common and carries a significant burden of disease. This is increasingly apparent in males with the rising incidence of HPV-related oropharyngeal cancer. Unfortunately, vaccination rates remain poor and are lowest in males. It is unclear if pediatricians are aware of the alarming rise of HPV-mediated head and neck cancers and the disproportionate effect on males.
Study Design
This investigation used a cross-sectional descriptive survey research design.
Setting
The survey was developed by investigators in the University of Wisconsin Division of Otolaryngology.
Subjects and Methods
The survey was distributed to 831 members of the Wisconsin Chapter of the American Academy of Pediatrics.
Results
A total response rate of 49.6% was achieved. Most supported routine vaccination in both sexes. Females are regarded as being at higher risk of an HPV-related cancer and are more often recommended vaccination. Most providers are unaware of the magnitude of HPV-related oropharyngeal cancer and the greater affliction in males.
Conclusions
Male vaccination is overwhelmingly supported by Wisconsin pediatricians, yet there is a preponderance toward vaccinating females, who are perceived as having greater risk for HPV-associated disease. This is likely because providers are unaware of the magnitude of HPV-driven oropharyngeal cancer and its predilection for males. A lack of provider awareness, in combination with out-of-date education material for parents, likely contributes to poor vaccination rates in males.

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 York Times
http://www.nytimes.com/
Accessed 25 March 2017

The Opinion Pages | Op-Ed Contributors
The Real Threat to National Security: Deadly Disease
By MICHAEL T. OSTERHOLM and MARK OLSHAKER
MARCH 24, 2017
While the Trump administration is proposing significantly increased military spending to enhance our national security, it seems to have lost sight of the greatest national security threat of all: our fight against infectious disease…

The Opinion Pages | Editorial
U.N. Accepts Blame but Dodges the Bill in Haiti
By THE EDITORIAL BOARD
MARCH 21, 2017
Today’s lesson in evading moral responsibility comes to us from the United Nations. The organization says it is terribly concerned about the cholera epidemic in Haiti and wishes to eliminate it. But it has not figured out when and how this is going to happen, and with what money.

The “who” and “why” are well known. The United Nations has the duty to end the cholera crisis because the United Nations caused it. The disease was unknown in modern Haiti until peacekeepers, from Nepal, introduced it. They let their raw sewage flow into a river that people use for drinking water. That was in 2010. Cholera has since killed more than 9,000 Haitians and sickened 800,000 others.

The United Nations has spent nearly all that time trying to avoid blame. Only last December did it apologize and promise to make things right. The secretary-general at the time, Ban Ki-moon, promised strenuous efforts, called the “New Approach,” to eradicate cholera from the country.

That unfinished job has fallen to Mr. Ban’s successor, António Guterres. The New Approach envisions spending $400 million, but has raised only about $2 million. (Thank you, South Korea, France, Chile, India and Liechtenstein.) The United States, perhaps unsurprisingly, has contributed zero dollars to this effort. Our president is trying to gut international aid, including famine relief, as he lectures other nations about their failures to meet shared obligations.

Haiti, meanwhile, suffers. It lacks clean water and sanitation. The natural and human-caused disasters that beset Haiti throughout the last century have continued into the current one: the ruinous cycles of outside intervention and neglect; the lingering effects of underdevelopment, political instability and institutions; the 2010 earthquake; and last year, the catastrophic Hurricane Matthew.

What Haiti has in abundance, thanks especially to United Nations, is white papers and policy proposals and fresh commitments from well-meaning outsiders to do better this time. It has powerful friends, like Bill and Hillary Clinton, though their ministrations have not, in the minds of many Haitians, had a lasting imprint on Haiti’s stability and prosperity. The Clintons came and went, but the United Nations is still at it. It declared the “end in sight” for cholera — in 2013 — and is now hoping, under a new leader, to overcome the donor fatigue, inattention and neglect that have robbed Haitians of their right to healthy lives.

The latest United Nations plan seeks a “two track” cholera solution. Track 1 is divided into Track 1a and Track 1b, and Track 1a into Axis 1, Axis 2 and Axis 3. The trouble is all the money that is supposed to flow down these tracks and axes, for treating the sick and giving the country clean water and sanitation systems. It’s missing.

Mr. Guterres needs to use every bit of skill and good will to compel and cajole member nations and philanthropies to make the cholera campaign succeed — and with it, to settle the United Nations’ moral debt to Haiti. (Maybe you can help. The website of the United Nations Foundation is asking for credit-card donations, from $25 to $5,000.)

Think Tanks et al

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 25 March 2017
Blog Post
3/22/17
Health Technology Assessment: Global Advocacy and Local Realities
Kalipso Chalkidou, Ryan Li, Anthony Culyer, Amanda Glassman, Karen Hofman and Yot Teerawattananon
Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities.

Milestones :: Perspectives :: Featured Journal Content

WHO: 6 years into the conflict, hero vaccinators in northern Syria brave danger to protect children from disease
15-03-2017
This month marks a tragic milestone: 6 years since the conflict began in the Syrian Arab Republic. This ongoing crisis has led to 5 million refugees, more than 6 million internally displaced people and 13.5 million people in need within the country.

A number of WHO partners in the north of the country collectively form what is known as the Syria Immunization Group (SIG), an immunization cluster coordinated by WHO staff in the field office in Gaziantep, Turkey. The work of this group is carried out under what is known as the “whole-of-Syria” approach, which brings together humanitarian actors both within the country and from neighbouring countries to provide access to health services across lines and borders.

The SIG is made up of individuals who often put their own lives at risk to bring vaccines to children in hard-to-reach and besieged areas. These courageous health workers take boats when bridges are destroyed. They walk through farmland carrying coolers of vaccines. They provide vaccinations to communities while bombs fall nearby. They brave tremendous danger to protect children from deadly diseases.

Read the stories representing just a few of the many hero vaccinators working in partnership with WHO to keep children in northern Syria safe from vaccine-preventable diseases…

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The Lancet
Mar 18, 2017 Volume 389 Number 10074 p1075-1164
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Syria suffers as the world watches
The Lancet
March 15, 2017, marks the sixth anniversary of the civil war in Syria, a conflict perhaps unprecedented in its apparently shameless disregard for international law. The world has stood by in horror, watching the death toll rise and the humanitarian and refugee crises spread their indelible stain on the world map and human history. The Syrian conflict has been marked on the one hand by immense suffering and on the other by a stunning lack of adequate condemnation or action from governments, international agencies, or the medical community.

The first output from the Syria Commission launched jointly by The Lancet and the American University in Beirut (AUB) shows the credibility, urgency, and importance of the Commission’s work. Detailing events in both government-controlled and non-government-controlled areas, the article strengthens the concept of the weaponisation of health: the targeting of health workers and facilities as a weapon of war. The strongest independent analysis of the Syrian health worker crisis published so far, it collates data from multiple sources in a compelling four-part analytical approach, analysing the formidable challenges health-care workers in Syria face now and in the future, and carefully offering policy options and lessons for public debate.

2 weeks ago, the UN published its Inquiry on the Syrian Arab Republic, finding that multiple war crimes had been committed by both sides. Powerful in its concentrated nature, the report dispassionately describes deliberate attacks on schools, hospitals, markets, water supplies, humanitarian relief personnel, and civilians; use of civilians as human shields; arbitrary arrests, forced conscription, reprisal executions, and forced displacement; withholding of humanitarian aid; use of chemical weapons including probable chlorine attacks; and intentional targeting of medical workers, facilities, and transport, including double tap attacks—deliberate targeting of those already harmed. The UN also calls for action, and although some conclusions might not seem feasible, its recommendations to the international community are irrefutable.

Together, these reports highlight grievous failings by the global health community and international governance. Although many medics have shown extraordinary bravery and solidarity in the face of this war, the 6-year conflict has been marked by insufficient cooperation among health professionals and, as the war has raged, fatigue. Journals too have been guilty of turning away from the conflict to focus on more immediate wins.

This is a moment to think carefully about how we renew our solidarity, particularly as the tectonic plates shift elsewhere in politics. The efforts of the Obama administration to seek a ceasefire and a political process might have been incomplete, but the USA was there. Donald Trump’s speeches so far do not instill confidence in the USA’s ongoing commitment to resolving the Syrian conflict. The proposed USAID budget cuts will have a more serious impact for Syrians in future development and humanitarian assistance.

At WHO, the focus for the past 12 months has been on the elections, rather than the world’s health crises. By their own definition, WHO’s commitment to meeting the health needs of Syrians has been inadequate. The summits and intergovernmental meetings organised in the face of Ebola have not been matched by a response to this very different human catastrophe. If the USA is withdrawing from its role as a champion for a peaceful and democratic Syria, it is even more important that multi-lateral organisations step in to fill the vacuum and show leadership. WHO must now focus every effort on supporting the health structure and health workers in Syria, raising the finances needed to meet this challenge, and mobilising international support to resolve the humanitarian crisis in Syria, as they acknowledge in a Comment.

On March 30, the World Bank will host a meeting in Marseille, France, to discuss the integration of Syrian health-care workers into OECD countries. This is also an opportunity for the international community to face up to the situation in Syria and shoulder responsibility. The Syrian civil war, which started as a popular uprising and became a battleground for the great world powers, is not just a Syrian crisis but a global crisis. An entire region and its people have been decimated while the world has watched. For Syria and its neighbouring countries the effects will last lifetimes. Health and development will take decades to catch up with themselves, and it will take generations to survive the loss of lives and livelihoods, structures and infrastructure. The Lancet-AUB Commission is ongoing and is much needed, but it is only a tiny part of the commitment that Syria needs.

Emergencies

WHO Grade 3 Emergencies [to 18 March 2017]
South Sudan – No new announcements identified
The Syrian Arab Republic – No new announcements identified
Yemen – No new announcements identified
Iraq – No new announcements identified
Nigeria – No new announcements identified

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WHO Grade 2 Emergencies [to 18 March 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.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 24 (6 March – 12 March 2017) [EN/KU/AR]

Syria
:: Syria Operation Overview (February 2017) 18 Mar 2017
:: Message on Syria 15 Mar 2017 UN Humanitarian Chief
:: Syrian Arab Republic: Aleppo Situation Report No. 16 (13 March 2017)

Yemen – No new announcements identified.

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Editor’s Note:
We present two versions of the important announcement of a new OCV campaign in Somalia – because each presents some unique details and for comparative purposes.

WHO: Oral cholera vaccination campaign launched in Somalia
15 March 2017 – The Government of Somalia has launched an oral cholera vaccination (OCV) campaign today with the support of WHO, targeting over 450 000 people in 7 high-risk areas around the country. It is the first OCV campaign to be conducted in the country, and comes at a critical time after Somalia announced the ongoing drought as a national disaster and faces the possibility of another famine.

The campaign is being held in select communities in Mogadishu, Kismayo and Beledweyne through a combination of fixed and mobile sites for maximum accessibility by the communities. The vaccines, which will be administered to at-risk persons aged one year or older, are being delivered in 2 rounds. The first round of the campaign has commenced today and will continue until 19 March, and the second round of the campaign will be held from 18 to 22 April.

“This is one of the largest oral cholera vaccination campaigns conducted in Africa,” said Dr Ghulam Popal, WHO Representative in Somalia. “This vaccination campaign will contribute to the reduction in the number of new cholera cases, interrupt transmission and limit the spread of cholera,” he said.

Somalia is currently experiencing a large-scale outbreak of cholera with over 11,000 cases of cholera and 268 deaths (case–fatality rate 2.4%) reported in 11 regions since the beginning of 2017. This is more than half the number of cases reported in total for 2016. The response efforts by the Ministry of Health, WHO, UNICEF and health partners have included active case search, effective case management, intensive household chlorination campaign, and community awareness.

The oral vaccination campaign was preceded by extensive social mobilization efforts to inform the community of the benefits, availability and necessity of the vaccine. Vaccination is a preventive measure against cholera that supplements, but does not replace, other traditional cholera control measures such as improving access to safe water and sanitation and hygiene measures/interventions.

Somalia has long experienced a humanitarian emergency due to conflict, insecurity, displacement of people and limited access to health system. This situation is further compounded by drought, malnutrition and lack of access to clean water and sanitation facilities. If the current drought and food insecurity continue, the number of cholera cases is likely to increase. Preventative measures such as oral cholera vaccine can mitigate these numbers, and save lives.

The vaccination campaign is supported by the Global Task Force on Cholera Control, Gavi the Vaccine Alliance, UNICEF and health partners in its various stages of planning and implementation. WHO is also providing support for the campaign in the areas of planning, organization and monitoring.

Gavi: Cholera vaccination campaign begins in Somalia
Mass vaccination campaign will target over 450,000 people to halt cholera outbreak.
Geneva, 15 March 2017 – A major vaccination campaign to halt the spread of cholera begins in three drought-ravaged regions of Somalia today.
Gavi, the Vaccine Alliance, has delivered 953,000 doses of Oral Cholera Vaccine to the country to protect over 450,000 people from the disease. The campaign will take place in three of the worst-hit regions, Banadir, Kismayo and Beledweyne, with the vaccination being given in two doses to everyone over the age of one. The first round runs from 15-19 March and the second from 18-22 April.
The vaccines were procured, transported and stored at the appropriate temperature by UNICEF. They will be administered by the Government of Somalia with the support of World Health Organisation (WHO) and UNICEF; while UNICEF and others continue to improve water and sanitation infrastructure and promote behaviour change. As well as providing the vaccines, Gavi has provided US$550,000 to support the campaign.
Seth Berkley, CEO of Gavi, the Vaccine Alliance, said:
“The people of Somalia are going through unimaginable suffering. After years of conflict, a severe drought has brought the country to the brink of famine and now a suspected cholera outbreak threatens to become a nationwide epidemic. These lifesaving vaccines will play a vital role in slowing the spread of the disease, buying valuable time to put the right water, sanitation and hygiene infrastructure in place to stop the root causes of this outbreak.”…
…A vaccination campaign also begins this week in South Sudan. Gavi is delivering 475,000 doses to the country to help halt a cholera outbreak that has reached over 5,500 cases nationwide and claimed over 100 lives. The vaccines will be administered and distributed by MedAir and the World Food Programme (WFP), working with the WHO.

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UNICEF [to 18 March 2017]
https://www.unicef.org/media/media_94367.html
17 March 2017
One year on after EU-Turkey statement the human cost to refugee and migrant children mounts up
GENEVA, 17 March 2017 – One year after the Balkan border closures and the EU-Turkey Statement which were aimed at stopping mass migration flows, refugee and migrant children face greater risks of deportation, detention, exploitation and deprivation, says UNICEF.

Yemen needs urgent assistance to prevent famine – FAO, WFP, UNICEF
15 March 2017, Sana’a/Amman -Severe food insecurity threatens more than 17 million people in conflict-ridden Yemen, according to the latest Integrated Food Security Phase Classification (IPC) analysis released by the United Nations and humanitarian partners today.

Hitting rock bottom: Children’s suffering in Syria at its worst – UNICEF
DAMASCUS/AMMAN, 13 March 2017 – Grave violations against children in Syria were the highest on record in 2016, said UNICEF in a grim assessment of the conflict’s impact on children, as the war reaches six years.

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::::::

POLIO [to 18 March 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 15 March 2017
:: Summary of newly-reported viruses this week (see country-specific sections below for further details):  Pakistan – one WPV1 case, six WPV1 positive environmental samples.
:: Yemen and Syria have both carried out polio immunization campaigns as part of ongoing efforts to protect children affected by conflict.

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afganistan, Pakistan, Nigeria, Lake Chad Basin, Guinea and West Africa, Lao People’s Democratic Republic.

Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week from Diamir district, Gilgit Baltistan province, with onset of paralysis on 13 February.  The total number of WPV1 cases for 2017 is two, and for 2016 remains 20.
:: Six new WPV1 positive environmental samples were reported in the past week, ranging from Punjab to Sindh and from Islamabad to Khyber Pakhtunkhwa. The most recent is from Killa Adbullah district, Balochistan, with a collection date of 15 February.

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::::::

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD [to 18 March 2017]
http://www.who.int/ebola/en/
No new digest content identified for this edition.

Zika virus [to 18 March 2017]
http://www.who.int/emergencies/zika-virus/en/
No new digest content identified for this edition.

Yellow Fever [to 18 March 2017]
http://www.who.int/emergencies/yellow-fever/en/
No new digest content identified for this edition.

MERS-CoV [to 18 March 2017]
http://www.who.int/emergencies/mers-cov/en/
No new digest content identified for this edition.

WHO & Regional Offices [to 18 March 2017]

The road to universal health coverage in the Solomon Islands
16 March 2017 – In a nation of 620 000 people dispersed over more than 600 islands, patients travel for days by truck and boat to receive medical care. A bold new plan is restructuring available health resources, setting out the Pacific nation’s roadmap towards universal health coverage while ensuring efficient use of resources at strategic locations.

Health care a casualty of 6 years of war in the Syrian Arab Republic
15 March 2017 –This week the conflict in the Syrian Arab Republic enters its seventh year. Over the past 6 years access to health services for the civilian population in the country has seriously deteriorated.

.

Highlights
WHO and partners re-open Qayyara Hospital in Mosul with support from ECHO
March 2017 – Five months after Al-Qayyara Hospital was closed due to extensive damage, the facility has been re-opened to provide trauma care and obstetric services to peoples affected by the ongoing conflict.

WHO responds to reported use of chemical weapons agents in East Mosul, Iraq
March 2017 – Following the reported use of chemical weapons agents in East Mosul, Iraq, WHO, partners and local health authorities have activated an emergency response plan to safely treat men, women and children who may be exposed to the highly toxic chemical.

Borno State Reports First Lassa Fever Outbreak in 48 Years
March 2017 – Borno state in northeast Nigeria has recorded its first Lassa fever outbreak in almost five decades. The last confirmed outbreak of the deadly disease was in 1969. WHO is supporting the government to contain the outbreak in an area of the country which is already coping with a humanitarian crisis resulting from years of conflict.

Weekly Epidemiological Record, 17 March 2017, vol. 92, 11 (pp. 117–128)
:: Recommended composition of influenza virus vaccines for use in the 2017–2018 northern hemisphere influenza season

Disease outbreak news
:: Human infection with avian influenza A(H7N9) virus – China 16 March 2017
:: Human infection with avian influenza A(H7N9) virus – China 15 March 2017

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Building the legacy of Ebola: Survivors, health systems, and a blueprint for research and development
This report describes the work done by WHO from January 2015 up to the end of December 2016 to address the long-term issues of survivor care, health-systems strengthening and research. This work would not otherwise have been possible without the foresight and commitment of donors  who, having contributed generously to the WHO-led response to the outbreak, recognised the importance of dealing with its consequences.
Ebola Response Report 2016 (2.1 MB)

WHO Region of the Americas PAHO
– No new announcements identified.

WHO South-East Asia Region SEARO
:: South-East Asia countries adopt Call for Action to accelerate efforts to End TB
SEAR/PR/1644
New Delhi, 16 March 2017 – Health Ministers from countries in WHO South-East Asia Region which bear half the global TB burden, and WHO today signed a Call for Action for Ending TB, pledging to scale-up efforts and implement adequately funded, innovative, multisectoral and comprehensive measures to achieve the global target to end the disease by 2030.
“We need to make ending TB our central priority. The disease continues to be a leading cause of death and lost productive years in the crucial age group of 15-49 years causing catastrophic expenses, financial losses, outright impoverishment of individuals and households and massive aggregate costs to national economies. Ending TB is paramount for health and development across the Region,” Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, told the Ministerial Meeting Towards Ending TB in the South-East Asia Region, here…

WHO European Region EURO
:: Strengthening countries’ pharmaceutical systems: a year in review 17-03-2017
:: 6 years into the conflict, hero vaccinators in northern Syria brave danger to protect children from disease 15-03-2017
:: WHO European Healthy Cities Network adopts the Pécs Declaration 14-03-2017
:: Regional Director visits Israel to further strengthen collaboration 14-03-2017

WHO Eastern Mediterranean Region EMRO
:: Health care a casualty of 6 years of war in the Syrian Arab Republic 16 March 2016
:: Oral cholera vaccination campaign launched in Somalia 15 March 2017
:: First Joint Ministerial Meeting of the Arab Councils of the Health and the Environment Ministers 12 March 2017

WHO Western Pacific Region
:: The road to universal health coverage in the Solomon Islands 16 March 2017

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CDC/ACIP [to 18 March 2017]
http://www.cdc.gov/media/index.html
Media Statement
MONDAY, MARCH 13, 2017
CDC identifies potential risk of Zika virus transmission since June 15, 2016, in Miami-Dade, Broward, and Palm Beach counties
CDC has identified a potential risk of Zika virus transmission starting on June, 15, 2016, to present in Miami-Dade County, Florida, that also could affect risk for residents of Broward and Palm Beach counties.

MMWR Weekly March 17, 2017 / No. 10
[Excerpts]
:: Notes from the Field: Investigation of Patients Testing Positive for Yellow Fever Viral RNA After Vaccination During a Mass Yellow Fever Vaccination Campaign — Angola, 2016

Announcements

Gavi [to 18 March 2017]
http://www.gavi.org/library/news/press-releases/
15 March 2017
Cholera vaccination campaign begins in Somalia
Mass vaccination campaign will target over 450,000 people to halt cholera outbreak.
[See Emergencies above for more detail]

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Global Fund [to 18 March 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
15 March 2017
Global Fund Receives Top Marks in Performance Review
GENEVA – The Global Fund is an effective multilateral organization that provides strong global leadership for the response to HIV, TB and malaria, a group of leading donor countries said in a review that gave the Global Fund top marks in performance.
The evaluation by the Multilateral Organisation Performance Assessment Network (MOPAN), which monitors the performance of multilateral organizations, gave the Global Fund top ratings in organizational architecture, operating model and financial transparency and accountability.
The assessment is here.
Published today, the assessment noted an overall strong performance by the Global Fund in all 12 of its criteria. Key strengths identified point to the Global Fund’s commitment to delivering impact and value for money: clear strategic direction and a proactive approach to innovation and change; results-based budgeting well aligned to strategy within a low operational budget; early identification of operational and financial risks; and vibrant and effective partnerships, particularly those that work with civil society and leverage private sector skills to address operational gaps…

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PATH [to 18 March 2017]
http://www.path.org/news/index.php
Announcement | March 17, 2017
PATH welcomes grant for the collaborative development of solutions for achieving universal health coverage
Award will strengthen and expand the work of the Joint Learning Network for Universal Health Coverage
PATH was awarded $4M to support the Joint Learning Network for Universal Health Coverage (JLN)—a global community of health policymakers and practitioners working to address barriers to achieving universal health coverage in their countries. This investment by the Bill & Melinda Gates Foundation will revitalize and expand the technical work of the network, allowing for continued peer-to-peer learning and co-development of solutions that contribute to the goal of extending effective health insurance coverage to more than 3 billion people…

Announcement | March 16, 2017
PATH Statement on the US President’s Proposed Federal Budget
Proposed Cuts to Global Health Programs and Research Would Stifle Innovation and Make the World—and America—Less Healthy and Less Secure
March 16, 2017—Today the US Administration sent its proposed budget for fiscal year 2018 to Congress. The budget includes extensive cuts to global health and development programs, including approximately a one-third cut to the Department of State and the US Agency for International Development, as well as cuts to vital research programs funded through the National Institutes of Health and the Centers for Disease Control and Prevention. PATH opposes these cuts and believes they will make the world—and America—less healthy and less secure, while also stifling innovation. A statement from PATH’s President and CEO Steve Davis follows:

“Global health and development programs save lives, foster healthier, more prosperous communities, and create a safer, more secure world. The cuts proposed to these programs represent a threat to the health of millions of people around the world—including Americans. At the same time, proposed cuts to scientific research threaten to stifle innovation, which has driven so much of the progress we have seen in the past two decades.

Recent outbreaks of Ebola and Zika made painfully clear that no one is immune to disease outbreaks, and that the world is unprepared for the next threat. It is not a question of if, but when another outbreak will occur, and US government leadership has been instrumental to global efforts to better prevent outbreaks from becoming widespread epidemics. Now is not the time to pull back. Epidemics not only threaten lives, but also cost billions of dollars and disrupt entire economies, when they could be prevented at just a fraction of the cost.

The budget also proposes deep cuts to scientific research, which would not only risk health and safety, but also dampen innovation. Robust research and development efforts are critical to ensure we have tools to tackle the health challenges we face today, and that we are able to quickly respond as new threats emerge. These innovations pay dividends not only in health outcomes, but also as drivers of economic growth. Further, relatively small public-sector investments have the power of catalyzing private-sector engagement, which we have seen at unprecedented levels in recent years. Harnessing the capacity and eagerness of private-sector companies to solve global challenges is essential to tackling complex challenges around the world. These budget cuts will stymie our ability to do so.

Global health and scientific research have historically earned bipartisan support, and we urge Congress to protect these vital programs. There is too much at risk if they do not.”

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FDA [to 18 March 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
:: March 15, 2017 Approval Letter – Zostavax (PDF – 43KB) Posted: 3/17/2017
:: March 15, 2017 Approval Letter – PROQUAD (PDF – 34KB) Posted: 3/17/2017
:: CBER Expanded Access Submission Receipt Reports FY 2016 (October 1, 2015 – September 30, 2016); Updated: 3/7/2017
:: Complete List of Currently Approved NDA and ANDA Application Submissions (PDF – 17KB)
:: Complete List of Currently Approved Premarket Approvals (PMAs) (PDF – 16KB)
Posted: 3/16/2017; Updated as of 3/15/2017
:: Complete List of Substantially Equivalent 510(k) Device Applications (PDF – 409KB)
Posted: 3/16/2017; Updated as of 3/15/2017
:: Complete List of Licensed Products and Establishments Posted: 3/16/2017; Updated as of 2/28/2017

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