Women’s intention to screen and willingness to vaccinate their daughters against cervical cancer – a cross sectional study in eastern Uganda

BMC Public Health
(Accessed 18 March 2017)

Research article
Women’s intention to screen and willingness to vaccinate their daughters against cervical cancer – a cross sectional study in eastern Uganda
Rawlance Ndejjo, Trasias Mukama, Geofrey Musinguzi, Abdullah Ali Halage, John C. Ssempebwa and David Musoke
BMC Public Health 2017 17:255
Published on: 14 March 2017
The World Health Organization recommends cervical cancer screening and vaccination programmes as measures to combat cervical cancer. The uptake of these measures remains low in Uganda, most especially in rural areas. An understanding of the factors that influence women’s decision to attend screening, and willingness to have their daughters vaccinated against cervical cancer is essential for any attempts to increase uptake of these services. This study assessed the factors associated with intention to screen for cervical cancer among women in eastern Uganda, and willingness to have their daughters vaccinated against the disease.
This cross sectional study involved 900 females aged 25 to 49 years in Bugiri and Mayuge districts in eastern Uganda. Data were collected using a pretested semi-structured questionnaire, entered in Epidata version 3.02 and analysed in STATA version 12.0. Unadjusted and adjusted prevalence ratios (PR) were computed using a generalized linear model with Poisson family, and a log link with robust standard errors.
Majority 819 (91.0%) of respondents stated that they intended to go for cervical cancer screening in the subsequent six months. Among them, 603 (73.6%) wanted to know their status, 256 (31.3%) thought it was important, 202 (24.7%) wanted to reduce their chances of getting the disease, and 20 (2.4%) had been told to do so by a health worker. Majority 813 (90.4%) of respondents were willing to vaccinate their daughters against cervical cancer. Higher income (adjusted PR = 1.11, 95% CI: 1.03–1.20), cervical cancer screening status (adjusted PR = 0.81, 95% CI: 0.67–0.99) and knowledge of at least one test for cervical cancer (adjusted PR = 0.92, 95% CI: 0.85–0.98) were significantly associated with intention to screen for cervical cancer. No socio-demographic characteristic was associated with willingness to vaccinate daughters among women.
There is a very high intention to screen and willingness to vaccinate daughters against cervical cancer among women in eastern Uganda. To take advantage of this, there is need to avail opportunities for women to access cervical cancer screening and vaccinations particularly among rural communities.

School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries

BMC Public Health
(Accessed 18 March 2017)

Research article
School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries
Sarah Perman, Simon Turner, Angus I. G. Ramsay, Abigail Baim-Lance, Martin Utley and Naomi J. Fulop
BMC Public Health 2017 17:252
Published on: 14 March 2017
Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes.
We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors.
We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent, and clinic organisation and delivery.
This is the first time that information has been brought together on the organisational factors influencing the delivery of vaccination programmes in school-based settings. An understanding of these factors, underpinned by robust theory-informed research, may help policy-makers and managers design and deliver better programmes. We identified several gaps in the research literature to propose a future research agenda, informed by theories of implementation and organisational change.

Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria

Global Public Health
Volume 12, 2017 Issue 5

Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria
Pages: 601-616
Published online: 24 Feb 2017
Shola Molemodile, Maruchi Wotogbe & Seye Abimbola
Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services.

Migration to middle-income countries and tuberculosis—global policies for global economies

Globalization and Health
[Accessed 18 March 2017]

Migration to middle-income countries and tuberculosis—global policies for global economies
International migration to middle-income countries is increasing and its health consequences, in particular increasing transmission rates of tuberculosis (TB), deserve consideration. Migration and TB are a mat…
Julia Moreira Pescarini, Laura Cunha Rodrigues, M. Gabriela M. Gomes and Eliseu Alves Waldman
Globalization and Health 2017 13:15
Published on: 15 March 2017

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 3, 2017

Product Review
Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era
Pages 579-587 | Received 02 May 2016, Accepted 01 Oct 2016, Accepted author version posted online: 04 Nov 2016, Published online: 04 Nov 2016
Sachin N. Desai, Lorenzo Pezzoli, Kathryn P. Alberti, Stephen Martin, Alejandro Costa, William Perea & show all
Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic setting.

Antibody persistence up to 5 y after vaccination with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine in adolescents

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 3, 2017

Antibody persistence up to 5 y after vaccination with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine in adolescents
Beatriz P. Quiambao, Ashish Bavdekar, Anand Prakash Dubey, Hemant Jain, Devayani Kolhe, Véronique Bianco, Jacqueline M. Miller & Marie Van der Wielen
Pages: 636-644
Published online: 02 Feb 2017

Parents’ confidence in recommended childhood vaccinations: Extending the assessment, expanding the context

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 3, 2017

Parents’ confidence in recommended childhood vaccinations: Extending the assessment, expanding the context
Glen J. Nowak & Michael A. Cacciatore
Pages: 687-700
Published online: 28 Sep 2016

Impact of universal mass vaccination with monovalent inactivated hepatitis A vaccines – A systematic review

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 3, 2017

Impact of universal mass vaccination with monovalent inactivated hepatitis A vaccines – A systematic review
Anke L. Stuurman, Cinzia Marano, Eveline M. Bunge, Laurence De Moerlooze & Daniel Shouval
Pages: 724-736
Published online: 27 Oct 2016
The WHO recommends integration of universal mass vaccination (UMV) against hepatitis A virus (HAV) in national immunization schedules for children aged ≥1 year, if justified on the basis of acute HAV incidence, declining endemicity from high to intermediate and cost-effectiveness. This recommendation has been implemented in several countries. Our aim was to assess the impact of UMV using monovalent inactivated hepatitis A vaccines on incidence and persistence of anti-HAV (IgG) antibodies in pediatric populations. We conducted a systematic review of literature published between 2000 and 2015 in PubMed, Cochrane Library, LILACS, IBECS identifying a total of 27 studies (Argentina, Belgium, China, Greece, Israel, Panama, the United States and Uruguay). All except one study showed a marked decline in the incidence of hepatitis A post introduction of UMV. The incidence in non-vaccinated age groups decreased as well, suggesting herd immunity but also rising susceptibility. Long-term anti-HAV antibody persistence was documented up to 17 y after a 2-dose primary vaccination. In conclusion, introduction of UMV in countries with intermediate endemicity for HAV infection led to a considerable decrease in the incidence of hepatitis A in vaccinated and in non-vaccinated age groups alike.

International Journal of Infectious Diseases

International Journal of Infectious Diseases
March 2017 Volume 56, p1-286
Special Issue: Commemorating World Tuberculosis Day 2017
[40+ articles covering a range of TB thematic areas]

World TB Day 2017: Advances, Challenges and Opportunities in the “End-TB” Era
Eskild Petersen, Markus Maeurer, Ben Marais, Giovanni Battista Migliori, Peter Mwaba, Francine Ntoumi, Cris Vilaplana, Kami Kim, Marco Schito, Alimuddin Zumla
Published online: February 20, 2017


Novel approaches to tuberculosis vaccine development
Stefan H.E. Kaufmann, January Weiner, C. Fordham von Reyn
Published online: November 2, 2016


Experimental animal modelling for TB vaccine development
Pere-Joan Cardona, Ann Williams
Published online: February 3, 2017


Mycobacterium tuberculosis proteins involved in cell wall lipid biosynthesis improve BCG vaccine efficacy in a murine TB model
Martin Rao, Nathalie Cadieux, Megan Fitzpatrick, Steven Reed, Sergei Arsenian, Davide Valentini, Shreemanta Parida, Ernest Dodoo, Alimuddin Zumla, Markus Maeurer
Published online: February 1, 2017

Acknowledging and Overcoming Nonreproducibility in Basic and Preclinical Research

March 14, 2017, Vol 317, No. 10, Pages 987-1090

Acknowledging and Overcoming Nonreproducibility in Basic and Preclinical Research
John P. A. Ioannidis, MD, DSc
JAMA. 2017;317(10):1019-1020. doi:10.1001/jama.2017.0549
In this Viewpoint, Ioannidis discusses the problem of nonreproducibility in biomedical research and proposes implementing reproducibility assessments to improve research practices.
The evidence for nonreproducibility in basic and preclinical biomedical research is compelling. Accumulating data from diverse subdisciplines and types of experimentation suggest numerous problems that can create a fertile ground for nonreproducibility.1 For example, most raw data and protocols are often not available for in-depth scrutiny and use by other scientists. The current incentive system rewards selective reporting of success stories. There is poor use of statistical methods, and study designs are often suboptimal. Simple laboratory flaws—eg, contamination or incorrect identification of widely used cell lines—occur with some frequency.

Immune Responses to Novel Adenovirus Type 26 and Modified Vaccinia Virus Ankara–Vectored Ebola Vaccines at 1 Year

March 14, 2017, Vol 317, No. 10, Pages 987-1090

Research Letter
Immune Responses to Novel Adenovirus Type 26 and Modified Vaccinia Virus Ankara–Vectored Ebola Vaccines at 1 Year
Rebecca L. Winslow, MRCGP; Iain D. Milligan, MRCP; Merryn Voysey, MBiostat; et al.
JAMA. 2017;317(10):1075-1077. doi:10.1001/jama.2016.20644
This study reports 1-year data from a randomized clinical trial testing the safety and immunogenicity of a novel adenovirus type 26 and modified vaccinia virus Ankara-vectored Ebola vaccines.
The Ebola virus vaccine strategies evaluated by the World Health Organization in response to the 2014-2016 outbreak in West Africa included a heterologous primary and booster vaccination schedule of the adenovirus type 26 vector vaccine encoding Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia virus Ankara vector vaccine, encoding glycoproteins from Ebola, Sudan, Marburg, and Tai Forest viruses nucleoprotein (MVA-BN-Filo). This schedule has been shown to induce immune responses that persist for 8 months after primary immunization, with 100% of vaccine recipients retaining Ebola virus glycoprotein-specific antibodies.1

Syria suffers as the world watches

The Lancet
Mar 18, 2017 Volume 389 Number 10074 p1075-1164

Syria suffers as the world watches
The Lancet
March 1 5, 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…
[See Milestones above for full text]

The Lancet Countdown: tracking progress on health and climate change

The Lancet
Mar 18, 2017 Volume 389 Number 10074 p1075-1164

The Lancet Countdown: tracking progress on health and climate change
Nick Watts, W Neil Adger, Sonja Ayeb-Karlsson, Yuqi Bai, Peter Byass, Diarmid Campbell-Lendrum, Tim Colbourn, Peter Cox, Michael Davies, Michael Depledge, Anneliese Depoux, Paula Dominguez-Salas, Paul Drummond, Paul Ekins, Antoine Flahault, Delia Grace, Hilary Graham, Andy Haines, Ian Hamilton, Anne Johnson, Ilan Kelman, Sari Kovats, Lu Liang, Melissa Lott, Robert Lowe, Yong Luo, Georgina Mace, Mark Maslin, Karyn Morrissey, Kris Murray, Tara Neville, Maria Nilsson, Tadj Oreszczyn, Christine Parthemore, David Pencheon, Elizabeth Robinson, Stefanie Schütte, Joy Shumake-Guillemot, Paolo Vineis, Paul Wilkinson, Nicola Wheeler, Bing Xu, Jun Yang, Yongyuan Yin, Chaoqing Yu, Peng Gong, Hugh Montgomery, Anthony Costello
The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process—from November, 2016 to early 2017—to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO’s climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

Status of Breastfeeding and Child Immunization Outcomes in Clients of the Nurse–Family Partnership

Maternal and Child Health Journal
Volume 21, Issue 3, March 2017

From the Field
Status of Breastfeeding and Child Immunization Outcomes in Clients of the Nurse–Family Partnership
William Thorland, Dustin Currie, Emily R. Wiegand…
Background The Nurse–Family Partnership (NFP) is a home visiting program serving first-time, low-income mothers, with an area of focus on healthy early childhood development. Previous foundational trials of program effect on breastfeeding and immunizations have shown a mix of neutral and positive results. The present evaluation investigates these effects following program scale-up, using a large contemporary cohort of clients. Methods Nurse–Family Partnership client breastfeeding and immunization status were compared to National Survey of Children’s Health data and National Immunization Survey data, respectively. Sample differences in demographic covariates were adjusted using logistic regression. Results Nurse–Family Partnership clients were significantly more likely to have ever breastfed (adjusted prevalence ratio [aPR: 1.20 (1.17, 1.23)] and maintain breastfeeding at 6 [aPR: 1.17 (1.10, 1.24)] and 12 [aPR: 1.39 (1.25, 1.53)] months, but less likely to exclusively breastfeed at 6 months [aPR: 0.84 (0.70, 0.95)] NFP clients were significantly more likely to be up-to-date on immunizations at 6 [aPR: 1.23 (1.22, 1.25)], 18 [aPR: 1.33 (1.30,1.35)], and 24 [aPR: 1.15 (1.14, 1.16)] months of age than the reference cohort, with no significant difference at 12 months. Discussion Nurse–Family Partnership clients had more beneficial breastfeeding and immunization outcomes than children of mothers with demographically similar profiles. However, exclusive breastfeeding at 6 months lags behind the reference sample and represents a potential area for further improvement.

Announcement: Transparency upgrade for Nature journals

Volume 543 Number 7645 pp288-458 16 March 2017

Announcement: Transparency upgrade for Nature journals
The Nature journals continue journey towards greater rigour.
15 March 2017
In 2013, this journal and many of the Nature research journals announced initiatives aimed at “reducing our irreproducibility” (Nature 496, 398; 2013). These included a life-sciences checklist for authors and editors intended to improve the transparency of the statistical and methodological aspects of laboratory work, together with abolition of length limits in online methods descriptions and greater attention to statistical evaluation.
At the same time, we encouraged the publishing of step-by-step protocols that are linked to the published papers and made available through the open repository Protocol Exchange. And, complementing our policy of mandated deposition for certain data types, we strongly encouraged or (in some cases) mandated the provision of source data underlying graphical items…

Barriers to dog rabies vaccination during an urban rabies outbreak: Qualitative findings from Arequipa, Peru

PLoS Neglected Tropical Diseases
(Accessed 18 March 2017)

Research Article
Barriers to dog rabies vaccination during an urban rabies outbreak: Qualitative findings from Arequipa, Peru
Ricardo Castillo-Neyra, Joanna Brown, Katty Borrini, Claudia Arevalo, Michael Z. Levy, Alison Buttenheim, Gabrielle C. Hunter, Victor Becerra, Jere Behrman, Valerie A. Paz-Soldan
Research Article | published 17 Mar 2017 PLOS Neglected Tropical Diseases
Canine rabies was reintroduced to the city of Arequipa, Peru in March 2015. The Ministry of Health has conducted a series of mass dog vaccination campaigns to contain the outbreak, but canine rabies virus transmission continues in Arequipa’s complex urban environment, putting the city’s 1 million inhabitants at risk of infection. The proximate driver of canine rabies in Arequipa is low dog vaccination coverage. Our objectives were to qualitatively assess barriers to and facilitators of rabies vaccination during mass campaigns, and to explore strategies to increase participation in future efforts.
Methodology/Principal findings
We conducted 8 focus groups (FG) in urban and peri-urban communities of Mariano Melgar district; each FG included both sexes, and campaign participants and non-participants. All FG were transcribed and then coded independently by two coders. Results were summarized using the Social Ecological Model. At the individual level, participants described not knowing enough about rabies and vaccination campaigns, mistrusting the campaign, and being unable to handle their dogs, particularly in peri-urban vs. urban areas. At the interpersonal level, we detected some social pressure to vaccinate dogs, as well as some disparaging of those who invest time and money in pet dogs. At the organizational level, participants found the campaign information to be insufficient and ill-timed, and campaign locations and personnel inadequate. At the community level, the influence of landscape and topography on accessibility to vaccination points was reported differently between participants from the urban and peri-urban areas. Poor security and impermanent housing materials in the peri-urban areas also drives higher prevalence of guard dog ownership for home protection; these dogs usually roam freely on the streets and are more difficult to handle and bring to the vaccination points.
A well-designed communication campaign could improve knowledge about canine rabies. Timely messages on where and when vaccination is occurring could increase dog owners’ perception of their own ability to bring their dogs to the vaccination points and be part of the campaign. Small changes in the implementation of the campaign at the vaccination points could increase the public’s trust and motivation. Location of vaccination points should take into account landscape and community concerns.
Author summary
Canine rabies was reintroduced in Arequipa, Peru in March 2015, a rare event in an area previously declared free of transmission. In Arequipa, annual mass dog vaccination is practiced as a preventive strategy, with additional campaigns being implemented since the recent detection of the virus. However, these additional efforts have not quelled the outbreak and low dog vaccination coverage is driving ongoing transmission. We conducted focus groups in urban and peri-urban areas of Arequipa to identify barriers to and facilitators of canine vaccination during mass campaigns. Based on our findings, communication campaigns should seek to increase knowledge about canine rabies and the vaccination campaign, and provide timely messages on where and when vaccination is occurring. Small changes at the campaign’s vaccination points could increase public’s trust. Finally, there are differences between urban and peri-urban areas, such as landscape and topography that affect participation in mass vaccination campaigns and that should be considered when selecting locations for vaccination.

“You can save time if…”—A qualitative study on internal factors slowing down clinical trials in Sub-Saharan Africa

PLoS One
[Accessed 18 March 2017]

Research Article
“You can save time if…”—A qualitative study on internal factors slowing down clinical trials in Sub-Saharan Africa
Nerina Vischer, Constanze Pfeiffer, Manuela Limacher, Christian Burri
Research Article | published 16 Mar 2017 PLOS ONE
The costs, complexity, legal requirements and number of amendments associated with clinical trials are rising constantly, which negatively affects the efficient conduct of trials. In Sub-Saharan Africa, this situation is exacerbated by capacity and funding limitations, which further increase the workload of clinical trialists. At the same time, trials are critically important for improving public health in these settings. The aim of this study was to identify the internal factors that slow down clinical trials in Sub-Saharan Africa. Here, factors are limited to those that exclusively relate to clinical trial teams and sponsors. These factors may be influenced independently of external conditions and may significantly increase trial efficiency if addressed by the respective teams.
We conducted sixty key informant interviews with clinical trial staff working in different positions in two clinical research centres in Kenya, Ghana, Burkina Faso and Senegal. The study covered English- and French-speaking, and Eastern and Western parts of Sub-Saharan Africa. We performed thematic analysis of the interview transcripts.
We found various internal factors associated with slowing down clinical trials; these were summarised into two broad themes, “planning” and “site organisation”. These themes were consistently mentioned across positions and countries. “Planning” factors related to budget feasibility, clear project ideas, realistic deadlines, understanding of trial processes, adaptation to the local context and involvement of site staff in planning. “Site organisation” factors covered staff turnover, employment conditions, career paths, workload, delegation and management.
We found that internal factors slowing down clinical trials are of high importance to trial staff. Our data suggest that adequate and coherent planning, careful assessment of the setting, clear task allocation and management capacity strengthening may help to overcome the identified internal factors and allow clinical trials to proceed more efficiently.

Un llamado ético a la inclusión de mujeres embarazadas en investigación: Reflexiones del Foro Global de Bioética en Investigación [An ethics call to include pregnant women in research: Reflections from the Global Forum on Bioethics in Research]

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

The Global Forum on Bioethics in Research (GFBR) met on November 3 and 4 in Buenos Aires, Argentina with the purpose of discussing the ethics of research with pregnant women. The GBRF is a global platform that brings together key actors with the purpose of promoting research conducted in an ethical way, strengthening health research ethics–particularly in low- and medium-income countries–and promoting collaboration between the countries in the north and the south.a Some of the participants of the GFBR attending from Latin America include ethicists, researchers, ethics committee members and representatives of health authorities from Argentina, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panama, Peru, Nicaragua and Dominican Republic.

A legitimate concern about the protection of pregnant women and their embryos or fetuses has led most of the countries in the region to restrict studies with pregnant women exclusively to those that are about pregnancy, and to require the systematic exclusion of pregnant women and women who get pregnant from the rest of studies. Certainly, throughout the history of research ethics it has been mistakenly believed that protecting a population is synonymous with excluding that population from studies. It is now known that proceeding in this way implies exposing the very population we want to protect to larger risks.

Pregnancy implies substantial physiological changes that significantly influence the way the body metabolizes medications. However, by avoiding conducting research with pregnant women, the necessary scientific evidence to inform decisions on preventive treatments and interventions with effective and safe dosage for them and their embryos or fetuses has not been produced. As an illustration, in 2001 there were barely a dozen medications approved for use during pregnancy in the United States1, and in 2011 the Food and Drug Administration (FDA) approved, for the first time in 15 years, a medication to be used during pregnancy.2 As a result, pregnant women’s health is jeopardized every time we provide them health care.

Pregnant women get sick and sick women get pregnant, and it is not known if the medications they are prescribed are efficacious or even safe for them and their embryos or fetuses.
Investigators, health professionals, health authorities, members of ethics review committees, ethicists and the scientific community in general have the moral duty to change this situation.

We have the duty to actively promote research with pregnant women, which is not only allowed by international ethical guidelines, but is also a moral imperative. Refusing to conduct research with pregnant women is perpetuating the risk pregnant women are exposed to daily. It is estimated that 94% of pregnant women in the United States use at least one medication that requires a prescription, and close to 50% use four or more medications during pregnancy.3 The responsible inclusion of pregnant women in research is a matter of equity and social justice.4

The authors, therefore, call attention to the importance of research with pregnant women, and call for action to promote this kind of research in the region. We must aim to change the paradigm of researchers, members of ethics review committees, sponsors and health authorities, who systematically exclude pregnant women from research. At the same time, we must strengthen our capacity to conduct a rigorous ethical analysis to determine on a case-by-case basis when is it acceptable to include pregnant women in research studies in a responsible way.

This reflection is appropriate in a context in which many Latin American countries are reviewing their regulatory frameworks for research with human subjects, since the inclusion of pregnant women in research will require a modification of many of the existing frameworks. The Zika virus outbreak has brought to the forefront the moral urgency to promote research with pregnant women.5 The publication in December 2016 of the revision of International Ethical Guidelines for Health-related Research Involving Humans from the Council for International Organizations of Medical Sciences (CIOMS), which provides substantial orientation to include pregnant women in research in an ethical way, establishes this moment as a propitious time for a call to reflection and change in our region….

The cancer epigenome: Concepts, challenges, and therapeutic opportunities

17 March 2017 Vol 355, Issue 6330
Special Issue – Frontiers in Cancer Therapy

The cancer epigenome: Concepts, challenges, and therapeutic opportunities
By Mark A. Dawson
Science17 Mar 2017 : 1147-1152
Cancer biology is profoundly influenced by changes in the epigenome. Because the dynamic plasticity of the epigenome lends itself well to therapeutic manipulation, the past few years have witnessed an unprecedented investment in the development, characterization, and translation of targeted epigenetic therapies. In this review, I provide a broad context for recent developments that offer a greater understanding of how epigenetic regulators facilitate the initiation, maintenance, and evolution of cancer. I discuss newly developed epigenetic therapies and the cellular and molecular mechanisms that may govern sensitivity and resistance to these agents. I also review the rationale for future combination therapies involving existing and emerging epigenetic drugs.

A new cancer ecosystem

17 March 2017 Vol 355, Issue 6330
Special Issue – Frontiers in Cancer Therapy

A new cancer ecosystem
By Sandra J. Horning
Science17 Mar 2017 : 1103
Cancer is increasingly being viewed as an ecosystem, a community in which tumor cells cooperate with other tumor cells and host cells in their microenvironment. As conditions change, the ecosystem evolves and adapts to ensure the survival and growth of cancer. Our understanding of the intricate relationships in this ecosystem has led to revolutionary treatments, including immunotherapy. Successful treatment and prevention of cancer require an ecosystem, too—a coordinated unit of researchers, patients, health care professionals, health care systems, regulatory agencies, government, and industry. How can these partners work together as one interconnected community?

How economics can shape precision medicines

17 March 2017 Vol 355, Issue 6330
Special Issue – Frontiers in Cancer Therapy

Policy Forum
How economics can shape precision medicines
By A. D. Stern, B. M. Alexander, A. Chandra
Science17 Mar 2017 : 1131-1133 Restricted Access
Innovation incentives, pricing, and access are critical
Many public and private efforts in coming years will focus on research in precision medicine, developing biomarkers to indicate which patients are likely to benefit from a certain treatment so that others can be spared the cost—financial and physical—of being treated with unproductive therapies and therapeutic signals can be more easily uncovered. However, such research initiatives alone will not deliver new medicines to patients in the absence of strong incentives to bring new products to market. We examine the unique economics of precision medicines and associated biomarkers, with an emphasis on the factors affecting their development, pricing, and access.

Immunity against vaccine-preventable diseases in Finnish pediatric healthcare workers in 2015

Volume 35, Issue 12, Pages 1579-1662 (14 March 2017)

Regular Papers
Immunity against vaccine-preventable diseases in Finnish pediatric healthcare workers in 2015
Original Research Article
Pages 1608-1614
Karoliina Koivisto, Laura Puhakka, Maija Lappalainen, Soile Blomqvist, Harri Saxén, Tea Nieminen
Healthcare workers (HCWs) pose a risk to themselves and their patients if not protected against vaccine-preventable diseases. Alarmingly, lacking immunity has been reported in several studies. We assessed the immunity against vaccine-preventable diseases in 157 pediatric HCWs in Helsinki Children’s Hospital. The HCWs enrolled answered a questionnaire and gave a serum sample. Antibodies were measured with EIA against MMR-diseases, tetanus and diphtheria toxins, Hepatitis B (HBV), Hepatitis A (HAV), varicella zoster and pertussis toxin. Neutralizing antibodies against poliovirus 1, 2 and 3 were measured. All of the HCWs had antibodies against tetanus and 89.8% against diphtheria. All had measurable levels of polio antibodies to all three polioviruses. 41% had suboptimal levels of antibodies against at least one of the antigens tested: MMR-viruses, diphtheria, HBV or polio. Measles, mumps and rubella antibodies were detectable in 81.5%, 89.2% and 93%, respectively. Only one HCW had no varicella-antibodies. Hepatitis B surface antibodies (HBsAb) were detected in 89.8% of the nurses. 67.5% had HAV-antibodies. A poor correlation between detected antibody levels and reported vaccination history was noticed, indicating a need for a universal record system for registering the vaccines given to each individual.

Rotavirus immunization: Global coverage and local barriers for implementation

Volume 35, Issue 12, Pages 1579-1662 (14 March 2017)

Rotavirus immunization: Global coverage and local barriers for implementation
Original Research Article
Pages 1637-1644
Andrea Lo Vecchio, Ilaria Liguoro, Jorge Amil Dias, James A. Berkley, Chris Boey, Mitchell B. Cohen, Sylvia Cruchet, Eduardo Salazar-Lindo, Samir Podder, Bhupinder Sandhu, Philip M. Sherman, Toshiaki Shimizu, Alfredo Guarino
Rotavirus (RV) is a major agent of gastroenteritis and an important cause of child death worldwide. Immunization (RVI) has been available since 2006, and the Federation of International Societies of Gastroenterology Hepatology and Nutrition (FISPGHAN) identified RVI as a top priority for the control of diarrheal illness. A FISPGHAN working group on acute diarrhea aimed at estimating the current RVI coverage worldwide and identifying barriers to implementation at local level.
A survey was distributed to national experts in infectious diseases and health-care authorities (March 2015–April 2016), collecting information on local recommendations, costs and perception of barriers for implementation.
Forty-nine of the 79 contacted countries (62% response rate) provided a complete analyzable data. RVI was recommended in 27/49 countries (55%). Although five countries have recommended RVI since 2006, a large number (16, 33%) included RVI in a National Immunization Schedule between 2012 and 2014. The costs of vaccination are covered by the government (39%), by the GAVI Alliance (10%) or public and private insurance (8%) in some countries. However, in most cases, immunization is paid by families (43%).
Elevated cost of vaccine (49%) is the main barrier for implementation of RVI. High costs of vaccination (rs = −0.39, p = 0.02) and coverage of expenses by families (rs = 0.5, p = 0.002) significantly correlate with a lower immunization rate. Limited perception of RV illness severity by the families (47%), public-health authorities (37%) or physicians (24%) and the timing of administration (16%) are further major barriers to large- scale RVI programs.
After 10 years since its introduction, the implementation of RVI is still unacceptably low and should remain a major target for global public health. Barriers to implementation vary according to setting. Nevertheless, public health authorities should promote education for caregivers and health-care providers and interact with local health authorities in order to implement RVI.

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial Original Research Article

Volume 35, Issue 12, Pages 1579-1662 (14 March 2017)

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial
Original Research Article
Pages 1645-1651
Aya Saitoh, Akihiko Saitoh, Isamu Sato, Tomohiro Shinozaki, Hajime Kamiya, Satoko Nagata
Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge.
In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention.
Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02).
Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.

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

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

Cold Spring Harbor Perspectives in Biology
Early Release Articles – Last updated March 13, 2017
Immune Memory and Vaccines: Great Debates What Is Wrong with Pertussis Vaccine Immunity?: Inducing and Recalling Vaccine-Specific Immunity
Christiane S. Eberhardt and Claire-Anne Siegrist
Cold Spring Harb Perspect Biol doi:10.1101/cshperspect.a029629
Acellular pertussis vaccines exhibit only short-term effectiveness. This may be due to (1) vaccine-specific (not pathogen-specific) immunity and (2) the failure of memory B and T cells to reactivate upon pathogen exposure.

Immune Memory and Vaccines: Great Debates What Is Wrong with Pertussis Vaccine Immunity?: Why Immunological Memory to Pertussis Is Failing
Dimitri A. Diavatopoulos and Kathryn Margaret Edwards
Cold Spring Harb Perspect Biol doi:10.1101/cshperspect.a029553
Children primed with acellular pertussis vaccines exhibit a Th2-dominant immune response and possess higher levels of antigen-specific IgG4, which leads to a suboptimal immune response and the progressive loss of protection.

Immune Memory and Vaccines: Great Debates What Is Wrong with Pertussis Vaccine Immunity?: The Problem of Waning Effectiveness of Pertussis Vaccines
Nicolas Burdin, L.K. Handy, and S.A. Plotkin
Cold Spring Harb Perspect Biol doi:10.1101/cshperspect.a029454
Acellular pertussis vaccines provide protection during the first years of life, but their effectiveness wanes a few years post-boosters. This may be because these vaccines tend to produce Th1/Th2 responses (instead of Th1/Th17).


Academic Pediatrics
Available online 9 March 2017 In Press, Accepted Manuscript
Impact of Non-Medical Vaccine Exemption Policies on the Health and Economic Burden of Measles
MD Whittington, A Kempe, A Dempsey, R Herlihy… – Academic Pediatrics, 2017
Despite relatively high national vaccination coverage for measles, geographic vaccination variation exists resulting in clusters of susceptibility. A portion of this geographic variation can be explained by differences in state policies related to non-medical vaccine exemptions. The objective of this analysis was to determine the magnitude, likelihood, and cost of a measles outbreak under different non-medical vaccine exemption policies.
An agent-based transmission model simulated the likelihood and magnitude of a measles outbreak under different non-medical vaccine exemption policies, previously categorized as easy, medium, or difficult. The model accounted for measles herd immunity, infectiousness of the pathogen, vaccine efficacy, duration of incubation and communicable periods, acquired natural immunity, and the rate of recovery. Public health contact tracing was also modeled. Model outcomes, including the number of secondary cases, hospitalizations, and deaths, were monetized to determine the economic burden of the simulated outbreaks.
A state with easy non-medical vaccine exemption policies is 140% and 190% more likely to experience a measles outbreak compared to states with medium or difficult policies, respectively. The magnitude of these outbreaks can be reduced by half by strengthening exemption policies. These declines are associated with significant cost reductions to public health, the healthcare system, and the individual.
Strengthening non-medical vaccine exemption policies is one mechanism to increase vaccination coverage to reduce the health and economic impact of a measles outbreak. States exploring options for decreasing their vulnerability to outbreaks of vaccine preventable diseases should consider more stringent requirements for non-medical vaccine exemptions.


Computational Biology and Chemistry
Available online 10 March 2017 In Press, Accepted Manuscript
A Bioinformatics approach to designing a Zika virus vaccine
S Dey, A Nandy, SC Basak, P Nandy, S Das
:: Zika virus envelope gene and protein sequences analysed.
:: Based on maximum sequences available, identified peptide segments with minimum variability and maximum surface accessibility using alignment-free numerical characterization techniques.
:: Checked identified regions on 3D crystal structures to ensure solvent accessibility.
:: Confirmed linear and conformational epitope potential of identified segments using web based servers.
:: Confirmed no auto-immune threats from the segments that passed all the above tests.
:: These peptide regions are suggested as starting points for rational design of peptide vaccines subject to wet lab verification.
The Zika virus infections have reached epidemic proportions in the Latin American countries causing severe birth defects and neurological disorders. While several organizations have begun research into design of prophylactic vaccines and therapeutic drugs, computer assisted methods with adequate data resources can be expected to assist in these measures to reduce lead times through bioinformatics approaches. Using 60 sequences of the Zika virus envelope protein available in the GenBank database, our analysis with numerical characterization techniques and several web based bioinformatics servers identified four peptide stretches on the Zika virus envelope protein that are well conserved and surface exposed and are predicted to have reasonable epitope binding efficiency. These peptides can be expected to form the basis for a nascent peptide vaccine which, enhanced by incorporation of suitable adjuvants, can elicit immune response against the Zika virus infections.

Media/Policy Watch

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

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

Accessed 18 March 2017
How Does Trump’s Plan To Gut Health And Medical Research Make America Great?
Judy Stone, Contributor
17 March 2017
Trump’s budget proposal would decimate NIH, biomedical research and emergency preparedness, hurt the economy, and destroy our innovation and research. How does this MAGA?


Foreign Affairs
Accessed 18 March 2017
Mar 13, 2017
Making Insulin AffordableIts Cost Is Creating a Crisis
Fran Quigley


New York Times
Accessed 18 March 2017
Trump Plan Eliminates a Global Sentinel Against Disease, Experts Warn
By DONALD G. McNEIL Jr. MARCH 17, 2017
Nobody in the United States has ever died from an intercontinental missile strike. Over the past 50 years, hundreds of billions of dollars have been spent on silos, submarines, bombers and satellites to ensure that does not happen.
During the same period, about 1.3 million Americans have died from intercontinental virus strikes. The toll includes one American dead of Ebola, 2,000 dead of West Nile virus, 700,000 dead of AIDS, and 1.2 million dead of flu — a virus that returns from abroad each winter.
The federal budget to stop these threats is infinitely smaller than the Pentagon’s, and the Trump administration’s proposed cuts to the National Institutes of Health, and particularly its plan to eliminate the Fogarty International Center at the N.I.H., would, global health experts say, make America vulnerable again.
The Fogarty center, based in Bethesda, Md., was one of the few specific trims in President Trump’s “skinny budget.” It is an odd target: Eliminating it would save only $69 million. The administration did not explain why it was picked, leaving scientists to surmise that it was because the center’s grants pay American doctors to train foreign ones. Mr. Trump has a well-known “America First” bent.
But most of those trainees focus on diseases that circle the globe, researchers point out, including flu, mosquito-borne viruses, vaccine-preventable diseases and bioterrorism agents.
The idea of eliminating the center “is just atrocious,” said Dr. Daniel G. Bausch, a Tulane University virologist and the scientific program director at the American Society of Tropical Medicine and Hygiene. “It would have a severe impact not just on global health but on American health.”…


Washington Post
Accessed 18 March 2017
Small Brazil city on edge after man dies from yellow fever
.. The vaccinations come as cases In the city center and rural areas of Casimiro de Abreu, about 93 miles (150 kilometers) from Rio de Janeiro, a large tent has been set up to vaccinate people. Authorities say around 30,000 of the city’s 42,000 people have been vaccinated in recent days..
.Yesica Fisch | AP · Foreign · Mar 18, 2017

Why mandatory vaccinations are critical, visualized
Philip Bump · Politics · Mar 17, 2017

Brazil yellow fever cases pass 400; more than 130 dead
SAO PAULO — Brazil’s Health Ministry says 424 people have been infected with yellow fever in the largest outbreak the country has seen in years. Of those, 137 have died.
An update published Thursday said that more than 900 other cases are under investigation. During the current outbreak in the Southern Hemisphere’s summer rainy season, the vast majority of the confirmed cases have been in the southeastern state of Minas Gerais.
Much of Brazil is considered at risk for yellow fever, and people in those areas are supposed to be vaccinated. But this outbreak struck some areas not previously considered at risk, and Brazil is rushing vaccines to those areas…
Associated Press · Foreign · Mar 16, 2017

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

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_11 March 2017

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

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

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

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

Milestones :: Perspectives :: Featured Articles

Milestones :: Perspectives :: Featured Articles

Access to Vaccines Index: 2017
How vaccine companies are responding to calls for greater immunisation coverage
Access to Medicine Foundation
2017 :: 102 pages
PDF: https://accesstovaccinesindex.org/media/atvi/2017-Access-to-Vaccines-Index.pdf
The 2017 Access to Vaccines Index provides an initial baseline of industry activity to improve access to vaccines. It examines where and how companies are already taking action to improve immunization coverage, and brings good practices to the attention of other companies and stakeholders working in the vaccines space. These organisations will be able to use the Index to inform priorities and strategies, and to clarify where new incentives are needed to spur greater positive change. The methodology for the Index has been developed with reference to experts working in the field and industry. The research was reviewed prior to publication by a group of Expert Advisors: including from Clinton Health Access Initiative (CHAI) and Gavi the Vaccine Alliance.
The Access to Vaccines Index has been developed by the Access to Medicine Foundation, an independent non-profit organisation based in the Netherlands. The Access to Vaccines Index is funded by the Dutch National Postcode Lottery.

Foreword [Excerpt]
Vaccines are a cornerstone of modern health systems. A few shots can protect a child for life
against diseases such as diphtheria and cholera. While many of us take vaccines for granted, every year, 1.5 million children under five die from vaccine-preventable diseases. Most unvaccinated children live in low- and middle-income countries, where health systems are often under pressure.

Many parties share responsibility for ensuring everyone can benefit from vaccines. Governments
and many others are dedicated to boosting immunisation coverage or reshaping vaccine markets, to ensure safe and effective vaccines can be made available and affordable everywhere.

The role for companies
Vaccine manufacturers, the innovators and producers of vaccines, stand early in the vaccine value chain. The decisions they make to improve access to vaccines can help safeguard the health, wellbeing and economic potential of many millions of people. Take the decisions to develop pneumococcal, malaria, dengue and HIV vaccines. In all three cases, the technical hurdles have been immense. The benefits, when such projects prove successful, are profound. The Access to Vaccines Index has now mapped, for the first time, what vaccine companies
are doing to improve access to vaccines, and what prompts them to take action.

The drivers behind company action
The Index finds that companies are responding to global calls to increase immunisation coverage, and to mechanisms put in place to ensure vaccine markets are viable long-term. We found a high level of diversity in how companies approach access. Yet overall, their actions and strategies are largely driven by the reliability and sustainability of vaccine markets, and by political will. At least in part, this is because vaccines development and production are lengthy, complex and expensive…

…Vaccine companies need to be at the table as governments and others work to build resilient health systems. Several companies are already in the right conversations and poised to do something about investing in remaining vaccine R&D gaps, addressing affordability, and ensuring supply meets increasing global supply of vaccines. The map will help define next steps and chart progress. For those looking to deepen company engagement in vaccines access, the Index shows that the formula of commitment-making, market-shaping and incentivizing collaborative action really works, especially as the world faces challenges to global health security.
Jayasree K. Iyer
Executive Director
Access to Medicine Foundation

Media Release
New Access to Vaccines Index reveals first landscape of vaccine company actions to improve immunisation coverage
Amsterdam, the Netherlands, 6 March, 2017 – The 2017 Access to Vaccines Index reveals the first landscape of industry activity to improve immunisation coverage. It finds a high level of diversity in how vaccine companies are improving access to vaccines for people living in poorer countries. This diversity is generally linked to the size of their portfolios and pipelines.
Vaccines are one of the most powerful and cost-effective health interventions available. Yet WHO states that an estimated 19.4 million infants worldwide are still missing out on basic vaccines.
The independent Index, published Monday, analysed companies’ R&D pipelines, identifying nearly 90 vaccine projects for high-priority diseases. This includes dozens of first-ever vaccines, for diseases such as Ebola and a range of deadly bacterial infections. If successful, such vaccines could prove critical for tackling anti-microbial resistance (AMR). The Index also finds that companies are taking steps to prevent vaccine shortages and that, when setting prices, most take affordability into account to a degree. All companies consider a country’s eligibility for support from Gavi, a public-private partnership that funds vaccine purchases for lower-income countries.
Portfolios and pipelines follow the markets
In their vaccine portfolios and pipelines, the eight companies in scope concentrate on diseases with larger global markets: for example, the diseases with the most vaccines on the market are meningococcal disease, polio, seasonal influenza and hepatitis (A and B); the top five diseases targeted by R&D projects are pneumococcal disease, seasonal influenza, meningococcal disease, respiratory syncytial virus and human papillomavirus, which causes cervical cancer…

[See Lancet editorial below in Journal Watch]


Featured Article[s]

Economic Papers
Études et Documents, n7, No 201707, Working Papers from CERDI
Post-neonatal Mortality Impacts Following Grants from the Gavi Vaccine Alliance: An Econometric Analysis from 2000 to 2014
Robert John Kolesar Martine Audibert
We completed a retrospective multivariate panel and longitudinal trend study to evaluate the effect of Gavi Vaccine Alliance grants on vaccine-preventable disease (VPD) post-neonatal mortality. Feasible Generalized Least Squares (fGLS) regression analysis was used to examine the association between VPD post-neonatal mortality rates and Gavi funding. We also applied segmented regression analysis to assess the structural trend in VPD post-neonatal mortality rates, the impact of Gavi funding, and trend changes following Gavi support. We separately tested a composite VPD mortality rate and five vaccine-preventable mortality rates: pertussis, meningitis, measles, diarrhea, and pneumonia (lower-respiratory infection) as dependent variables. All 77 countries eligible for Gavi assistance from 2000 to 2014 were included in the study. To isolate the effect of Gavi funding in our primary model, we controlled for known and likely predictors of child mortality. Among other factors, Gavi investment and corruption control/system efficiency are important elements to reduce vaccine-preventable mortality rates. For every $1 per capita invested by the Gavi Vaccine Alliance, there are highly statistically significant effects- decreasing the vaccine-preventable disease post-neonatal mortality rate by 2.535 per 1,000 live births. We also found Gavi investments to be significantly associated with reductions in four vaccine preventable disease-specific rates: pertussis, meningitis, diarrhea, and pneumonia. Furthermore, we found Gavi support to be significantly associated with both immediate impacts and trend changes on vaccine-preventable mortality rates. We conclude that Gavi investments in developing country immunization programs have measurably contributed to reductions in post-neonatal VPD mortality rates. Furthermore, we found evidence of a longer term catalytic effect of Gavi funding with accelerated reductions in the trend for post-neonatal meningitis, diarrhea, and pneumonia mortality rates.



WHO Grade 3 Emergencies [to 11 March 2017]
South SudanNo new announcements identified
:: Japan and WHO donate essential equipment to South Sudan’s National Blood Transfusion Services 6 March 2017
:: South Sudan: Amid multiple health challenges and famine, WHO and partners strive to immunize over 3 million children against polio
3 March 2017 — Despite multiple humanitarian crises, including famine, the first round of the National Immunization Days of 2017 is underway throughout South Sudan aiming to reach over three million children under 5 with two drops of polio vaccine…

The Syrian Arab Republic
:: WHO support saves lives of malnourished children in Syria
8 March 2017 — Six years into the Syria crisis, malnutrition rates have increased, especially among children under 5 years of age. Almost 4.3 million boys and girls under the age of 5 are in need of nutrition services, including 73 000 children who are acutely malnourished. WHO is working to ensure that children suffering from malnutrition are diagnosed and treated before their condition leads to serious and long-term medical complications.

:: Kidney patients struggle as Yemeni health crisis worsens
9 March 2017 – “I feel anxious every time I come here as I don’t know if I will able to get my treatment,” says 37-year-old Salim Ali, a renal failure patient who for the last 17 years has come to Al Hudaydah Renal Dialysis Centre in Yemen for bi-weekly haemodialysis sessions.
Haemodialysis is a treatment for patients with severe kidney failure using a dialysis machine to clean the blood. In general, haemodialysis takes between 3 and 5 hours and is done 3 times a week.
In recent months, with internally displaced people flooding into Al-Hudaydah governorate, the number of patients receiving haemodialysis treatment in the centre has risen to over 600, despite the fact that the centre’s capacity is 400. Day and night dozens of patients are crowded in the corridors of the centre, waiting for their turn…

IraqNo new announcements identified
NigeriaNo new announcements identified


WHO Grade 2 Emergencies [to 11 March 2017]
CameroonNo new announcements identified.
Central African RepublicNo new announcements identified.
Democratic Republic of the CongoNo new announcements identified.
EthiopiaNo new announcements identified.
LibyaNo new announcements identified.
Myanmar No new announcements identified.
NigerNo new announcements identified.
UkraineNo new announcements identified.


UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
:: Iraq: Mosul Humanitarian Response Situation Report No. 23 (27 February – 5 March 2017) [EN/KU]
:: Statement by the Humanitarian Coordinator for Iraq, Lise Grande, on the alleged use of chemical weapons in Mosul, Iraq [EN/AR/KU]
(Baghdad, 4 March 2017): The Humanitarian Coordinator in Iraq, Lise Grande, expressed shock at reports of alleged use today of chemical weapons in Iraq’s Mosul neighbourhoods.
“This is horrible. If the alleged use of chemical weapons is confirmed, this is a serious violation of international humanitarian law and a war crime, regardless of who the targets or the victims of the attacks are. There is never justification–none whatsoever–for the use of chemical weapons,” said Ms Grande.
“We call on everyone to act responsibly and to grant and ensure immediate access for appropriate parties to investigate the circumstances of the alleged attack,” she said.
Ms. Grande reiterated that the use of chemical weapons by any side under any circumstances would violate international law, and reaffirmed the need for a thorough investigation of the alleged incidents.

:: Scarred but not broken by six years of conflict in Syria 9 Mar 2017
:: Turkey | Syria: Eastern Countryside of Aleppo Flash Update (as of 5 March 2017) [EN/AR]

:: USG/ERC Stephen O’Brien Statement to the Security Council on Missions to Yemen, South Sudan, Somalia and Kenya and an Update on the Oslo Conference on Nigeria and the Lake Chad Region
Published on 10 Mar 2017


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

Polio this week as of 8 March 2017
:: Coffee with Polio Experts: A short video-chat with Senator Ayesha Raza Farooq, Prime Minister’s Focal Person on Polio Eradication in Pakistan, on the prospects of eradicating polio in the country.
: Afghan women leading the battle against polio – a photo essay marking International Women’s Day, 8 March 2017.
:: Polio Research Committee (PRC) call for research proposals: the PRC is soliciting research proposals to support the implementation of the Polio Eradication & Endgame Strategic Plan. The deadline for submissions of proposals is 24 March 2017. Submission guidelines and procedures are available here.

Country Updates [Selected Excerpts]
No 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.

UNICEF [to 11 March 2017]
08 March 2017
National polio immunization campaign reaches five million children in Yemen as conflict intensifies
SANA’A – Amid escalating violence, UNICEF and partners have completed the first round of a nationwide door-to-door vaccination campaign reaching 5 million children under the age of five with oral polio vaccine and vitamin A supplementation.
In the first campaign of its kind this year, 40,000 vaccinators spread across Yemen to provide children with polio vaccine and vitamin A supplements. Mobile health teams have reached children wherever they are, including in places where access to health services has been cut off by the fighting. Health workers have shown heroic resolve in crossing frontlines, mountains and valleys to vaccinate children.
“In the last two years, more children have died from preventable diseases than those killed in the violence. This is why vaccination campaigns are so crucial to save the lives of Yemen’s children and to secure their future,” said Dr Meritxell Relaño, UNICEF Representative in Yemen…

WHO: South Sudan: Amid multiple health challenges and famine, WHO and partners strive to immunize over 3 million children against polio
03 March 2017, Juba, South Sudan – Despite multiple humanitarian crises, including famine, the first round of the National Immunization Days of 2017 is underway throughout South Sudan aiming to reach over three million children under 5 with two drops of polio vaccine.
The four-day campaign, undertaken by the Ministry of Health with support from WHO and other partners, are part of efforts to ensure that the country remains polio-free and immunization stays in the forefront of primary health care activities. More than 18 000 trained vaccinators will carry out the campaign using both house-to-house and facility-based services to reach all eligible children nationwide.
South Sudan has remained polio-free for the last seven years, but recent cases in Nigeria and the disruption in routine health services, coupled with low coverage of routine immunization, places the country at risk for importation of the virus.
Insecurity, accessibility and logistical challenges continue in many areas, including in Panyinjar, Leer and Mayendit Counties, where famine was recently declared. For the campaign to be effective in these areas, it will be implemented over 10 days to allow for overcoming security and access challenges. To further improve vaccination coverage, special strategies, such as evening vaccination and working with security and rapid response teams with access to insecure, remote areas, will be used…


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 11 March 2017]
No new digest content identified for this edition.


Zika virus [to 11 March 2017]
Situation Report
Zika virus, Microcephaly and Guillain-Barré syndrome
10 March 2017
Key updates
:” Countries, territories and subnational areas reporting vector-borne Zika virus (ZIKV) infections for the first time since 1 February:
:: Countries and territories reporting microcephaly and other central nervous system malformations potentially associated with ZIKV infection for the first time since 1 February:
Mexico, Saint Martin
:: Countries and territories reporting Guillain-Barré syndrome cases associated with ZIKV infection for the first time since 1 February:
Curaçao, Trinidad and Tobago

:: WHO, the United States Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control have developed a new Zika virus classification scheme. The classification serves to categorize the presence of and potential for vector-borne ZIKV transmission and to inform public health recommendations. Based on the defined criteria and expert review, some countries, territories and subnational areas were reclassified and some were classified for the first time.

:: In line with WHO’s transition to a sustained programme to address the long-term nature of the disease and its consequences, this is the final WHO Zika situation report. WHO will continue to publish the Zika classification table (Table 1) on a regular basis as well as periodic situation analysis.

[See new CDC guidance below]


Yellow Fever [to 11 March 2017]
Disease outbreak news
:: Yellow fever – Brazil 16 March 2017
Updates on yellow fever vaccination recommendations for international travellers related to the current situation in Brazil
As of 3 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 on the WHO International Travel and Health website on 31 January 2017 and 14 February 2017.
Taking into account the speed of spread observed in Espírito Santo State, the proximity to the urban area of Vitoria of epizootics and human cases under investigation for yellow fever infection, as well as the implementation of yellow fever vaccination campaign in the State of Espírito Santo as a whole, the WHO Secretariat has determined that the State of Espírito Santo in its entirety should be considered at risk for yellow fever transmission.
Therefore, vaccination against yellow fever is recommended for international travellers visiting any area in Espírito Santo State.
There are no additional changes with respect to other areas of Brazil determined to be at risk for yellow fever transmission in 2013 and as published by WHO in the Disease Outbreak News of 27 January 2017…


MERS-CoV [to 11 March 2017]
Disease outbreak news
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 10 March 2017
Between 6 and 21 February 2017 the National International Health Regulations (IHR) Focal Point of Saudi Arabia reported twelve (12) additional cases of Middle East Respiratory Syndrome (MERS) including three (3) fatal cases. Four (4) deaths among previously reported MERS cases were also reported (case numbers 1, 2, 4 and 6 in the Disease Outbreak News published on 10 February 2017).
Detailed information concerning these cases can be found in a separate document (see link below). Most of these cases are primary cases with exposure to infected dromedary camels or consumption or their raw milk, which is the most likely source of their infection.
Globally, since September 2012, 1917 laboratory-confirmed cases of infection with MERS-CoV including at least 684 related deaths have been reported to WHO…
MERS-CoV cases reported between 6 February and 21 February 2017
xlsx, 19kb

WHO & Regional Offices [to 11 March 2017]

WHO & Regional Offices [to 11 March 2017]

The cost of a polluted environment: 1.7 million child deaths a year, says WHO
News release
6 March 2017 | GENEVA – More than 1 in 4 deaths of children under 5 years of age are attributable to unhealthy environments. Every year, environmental risks – such as indoor and outdoor air pollution, second-hand smoke, unsafe water, lack of sanitation, and inadequate hygiene – take the lives of 1.7 million children under 5 years, say two new WHO reports.
The first report, Inheriting a Sustainable World: Atlas on Children’s Health and the Environment reveals that a large portion of the most common causes of death among children aged 1 month to 5 years – diarrhoea, malaria and pneumonia – are preventable by interventions known to reduce environmental risks, such as access to safe water and clean cooking fuels.

“A polluted environment is a deadly one – particularly for young children,” says Dr Margaret Chan, WHO Director-General. “Their developing organs and immune systems, and smaller bodies and airways, make them especially vulnerable to dirty air and water.”…

Harmful exposures can start in the mother’s womb and increase the risk of premature birth. Additionally, when infants and pre-schoolers are exposed to indoor and outdoor air pollution and second-hand smoke they have an increased risk of pneumonia in childhood, and a lifelong increased risk of chronic respiratory diseases, such as asthma. Exposure to air pollution may also increase their lifelong risk of heart disease, stroke and cancer.

Top 5 causes of death in children under 5 years linked to the environment
A companion report, Don’t pollute my future! The impact of the environment on children’s health, provides a comprehensive overview of the environment’s impact on children’s health, illustrating the scale of the challenge.
Every year:
:: 570,000 children under 5 years die from respiratory infections, such as pneumonia, attributable to indoor and outdoor air pollution, and second-hand smoke.
:: 361,000 children under 5 years die due to diarrhoea, as a result of poor access to clean water, sanitation, and hygiene.
: 270,000 children die during their first month of life from conditions, including prematurity, which could be prevented through access to clean water, sanitation, and hygiene in health facilities as well as reducing air pollution.
:: 200,000 deaths of children under 5 years from malaria could be prevented through environmental actions, such as reducing breeding sites of mosquitoes or covering drinking-water storage.
:: 200,000 children under 5 years die from unintentional injuries attributable to the environment, such as poisoning, falls, and drowning…


Women who decide on their health have brighter futures
Dr Flavia Bustreo,
Assistant Director-General of the World Health Organization and Vice-Chair of GAVI, the Vaccine Alliance
8 March 2017
Access to contraception can allow adolescent girls and women to stay in school longer, opening up better economic opportunities and more independent, fulfilling futures. Every additional year of schooling for a girl increases her future earnings by 10% to 20%. On International Women’s Day, WHO calls for unequivocal commitment to gender equality and women’s and girls’ fundamental rights…


Disease outbreak news
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 10 March 2017
:: Lassa Fever – Benin, Togo and Burkina Faso 10 March 2017
:: Yellow fever – Brazil 6 March 2017


:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified for this edition.

WHO Region of the Americas PAHO
:: WHO publishes list of bacteria for which new antibiotics are urgently needed (02/27/2017)

WHO South-East Asia Region SEARO
:: Empower women in the workplace, advance health and development across South-East Asia
8 March 2017 – Workforce participation and economic empowerment is a powerful tool for women to achieve greater control of their health and wellbeing.
Women that work and are economically empowered tend to be better placed to make critical life choices, including on reproduction. They are also more likely to be able to seek out and access health care for themselves and their families.
On International Women’s Day, let’s commit to a brighter, healthier future for girls and women. Let’s commit to empowering women in the workplace and advancing health and development across the South-East Asia Region.

WHO European Region EURO
:: International Women’s Day: unlocking the full potential of women at work in the European Region 08-03-2017
:: Danish parliamentarians go to work with a hearing impairment on World Hearing Day 2017 07-03-2017
:: Regional Director outlines links between WHO/Europe’s work to address NCDs and JA-CHRODIS 07-03-2017

WHO Eastern Mediterranean Region EMRO
:: Kidney patients struggle as Yemeni health crisis worsens 9 March 2017.
:: The UN system in the Arab/MENA Region kicks off International Women’s Day with an eye on Planet 50-50 by 2030 8 March 2017
:: WHO support saves lives of malnourished children in Syria 8 March 2017

WHO Western Pacific Region
:: Gender equality makes everyone healthier: WHO
MANILA, 6 March 2017 – On International Women’s Day (8 March), the World Health Organization (WHO) will focus on the powerful link between gender equality and health and well-being. Public health efforts for women used to focus mainly on pregnancy and childbirth. Now gender, equity and human rights concerns are woven into every aspect of WHO’s work in the Western Pacific Region. “International Women’s Day is a great opportunity to challenge the unequal systems and practices that perpetuate health inequalities,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.


CDC/ACIP [to 11 March 2017]
Media Statement
FRIDAY, MARCH 10, 2017
CDC updates Zika travel guidance for pregnant women to not travel to any area with Zika risk
CDC has updated its Zika travel guidance and now recommends that pregnant women not travel to any area where there is a risk of Zika virus infection, including areas where the virus has been newly introduced or reintroduced and local mosquito-borne transmission is ongoing; areas where the virus was present before 2015 (endemic) and there is no evidence transmission has stopped; and areas where the virus is likely to be circulating but has not been documented.
To help pregnant women and others identify areas of Zika risk, CDC published a new interactive World Map of Areas with Zika Risk …

Media Statement
FRIDAY, MARCH 10, 2017
CDC adds 4 countries to interim travel guidance related to Zika virus
CDC is working with other public health officials to monitor for ongoing spread of Zika virus?. Today, CDC posted a Zika virus travel notice for Angola, Guinea-Bissau, Maldives and Solomon Islands…

Media Statement
CDC: Outbreak of North American avian influenza A(H7N9) in poultry poses low risk to people
CDC is working closely with USDA APHIS and the Tennessee Department of Health to minimize any human health risk posed by the avian influenza outbreak in Lincoln County, Tennessee.


MMWR Weekly March 10, 2017 / No. 7
:: Confidentiality Issues and Use of Sexually Transmitted Disease Services Among Sexually Experienced Persons Aged 15–25 Years — United States, 2013–2015
:: Increase in Human Infections with Avian Influenza A(H7N9) Virus During the Fifth Epidemic — China, October 2016–February 2017



New York Times
F.D.A. Official Under Bush Is Trump’s Choice to Lead Agency
MARCH 10, 2017
President Trump said Friday that he intended to nominate Scott Gottlieb, a partner at a venture capital fund with longstanding ties to the pharmaceutical and biotech industries, to lead the Food and Drug Administration…


CEPI – Coalition for Epidemic Preparedness Innovations [to 11 March 2017]
10 March 2017
CEPI Newsletter
More than 30 applications for CEPI’s first call
CEPI received more than 30 applications for our first call for development of vaccines against Lassa, MERS-COV and Nipah, which had deadline 8 March. The applications will now be evaluated, and shortlisted applicants will be invited to submit full proposals in April 2017.
The partner organizations represented among the applicants are from North America, Europe, Africa, the Middle East, South-East Asia and Australia, representing academic institutions, biotechs, large pharmaceutical companies and Product Development Partnerships. There was also a broad diversity displayed in the vaccine platform technologies being used, including novel concepts.


UNAIDS [to 11 March 2017]
Press release
On International Women’s Day UNAIDS is urging countries to stop 1 million women and girls from becoming infected with HIV every year
Nearly 1 million women are becoming infected with HIV every year and only half of all women living with HIV have access to lifesaving treatment—making AIDS now the leading cause of death worldwide among women between the ages of 30 and 49.

GENEVA, 8 March 2017—On International Women’s Day UNAIDS has released a new report which shows that there is an urgent need to scale up HIV prevention and treatment services for women and girls. The report, When women lead, change happens, shows that globally in 2015, there were 18.6 million women and girls living with HIV, 1 million women and girls became newly infected with HIV and 470 000 women and girls died of AIDS-related illnesses.

“Women are leading change in increasing demand for and access to HIV and health services. This movement needs to grow to allow families to thrive, societies to flourish and economies to progress,” said Michel Sidibé, Executive Director of UNAIDS. “Women’s rights are human rights—no exceptions.”

The report shows that women are more vulnerable to HIV than men. Domestic violence and sexual abuse have been shown to increase the risk of HIV among women. Data show that in high HIV prevalence settings women who experience intimate partner violence are up to 50% more likely to acquire HIV.

A lack of access to education and health services and a lack of decision-making power are also contributing factors to women’s vulnerability to HIV. In only 30% of countries worldwide do equal numbers of girls and boys attend upper secondary school and in western and central Africa only a third of young women between the ages of 15 and 24 report having the final say in their own health care. In Botswana, every additional year of school has been shown to reduce the risk of HIV infection by 11.6% among girls.

“Structural, behavioural and biological factors are compounding the risk of HIV infection among women,” said Mr Sidibé. “Every girl should have the opportunity to stay in school, every young woman should have the decision-making power over her own sexual and reproductive health and all women and girls should be able to protect themselves against HIV.”…


EDCTP [to 11 March 2017]
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.
9 March 2017
PanACEA kicks off new clinical trials programme for TB-drug evaluation
The EDCTP-funded PanACEA consortium (Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics) who were recently awarded their second EDCTP grant worth almost € 11.4 million (PanACEA2), held a kick-off meeting in Cape Town, South Africa from 7-8 March 2017. The German and Swiss governments will contribute direct co-funding to PanACEA2 to the amounts of almost 3 million euro and 336.000 euro, respectively. The meeting gathered 80 delegates from all beneficiaries of the grant to go over what will be tackled during the next 5 years. Senior Project Officer Dr Monique Surette attended the meeting on behalf of EDCTP.
The PanACEA2 programme aims to develop at least two promising TB-treatment regimens with sound prediction data for a successful phase III evaluation, and advance one new agent into phase IIB. It will take full advantage of state of the art technologies, including innovative trial designs, new microbiological markers of treatment response, pharmacokinetic-pharmacodynamic analyses and modelling techniques. As a result, drug development processes could be accelerated by several years. PanACEA2 trial activities will be conducted at 11 research sites in six countries (Gabon, Malawi, Mozambique, South Africa, Tanzania, and Uganda) in sub-Saharan Africa with integrated research capacity development…


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

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

Missing the signals:  India’s anti-vaccination social media campaign
Confidence Commentary
Heidi Larson
7 Mar, 2017
The Vaccine Confidence Project http://www.vaccineconfidence.org

It is not just in the US and Europe where wealthier populations are among the most vaccine questioning.  India recently launched a one-month campaign to vaccinate over 35 million 9-month to 15-year old children with a measles-rubella vaccine across five states.  The campaign marked the start of a two-year initiative aiming to vaccinate over 400 million children across India – part of a larger global effort to eliminate measles and rubella.

By the end of the first month of the campaign, it became clear that it was struggling to meet its goal. A different kind of campaign was circulating on WhatsApp and Facebook – fuelling a mix of conspiracy theories, safety concerns, and questioning around why the vaccine and the campaign were needed.  What’s more, the rumours were taking hold in the wealthier southern states with generally the best education and health indicators in the country.

Last year, though, there were already signals of waning confidence reported in the newly launched National Family Health Survey (NFHS 2015-2016). While showing progress in immunization uptake in the poorer states, where an extra effort had been made, wealthier states were reported to have declining coverage. The most dramatic drop in immunization coverage was in Tamil Nadu – a decline of 10% over the past decade.

Perhaps it should have been no surprise that Tamil Nadu has struggled the most in the current measles-rubella vaccination campaign. The signals were there.

One official from the Ministry of Health and Family Welfare commented on the situation, noting that while Goa managed 90% vaccine coverage and Karnataka reached above 85%, Tamil Nadu only reached 50% of the children they were aiming to vaccinate, with considerably higher rates of non-acceptance in urban Chennai than in less social media-saturated rural areas. Private schools in Chennai posed a particular challenge, with parents there reporting anxieties about the safety of and need for the vaccine.

Every year in India, measles kills nearly 49,000 children, and approximately 40,000 children become deaf or blind because of rubella-related birth defects. The public health rationale for introducing the measles-rubella vaccine seemed clear. And, for those who don’t trust interventions coming from afar, this vaccine was made in India.

Nonetheless, the rumours and misinformation went viral, provoking fears of sterilization and side effects as well as distrust of the motives of the campaign. Reflecting her uncertainty, one mother in Bengaluru was quoted in The Hindu expressing her concern that “It is worrying as to why the government is pushing vaccination on such a large scale.” Although not specific to the vaccination campaign, coinciding widespread media coverage about Union Minister Kirin Rijiju’s tweets saying that the Hindu population was getting smaller, added fuel to Muslim communities’ suspicions about the motives of the MR vaccination campaign. Other concerns ranged from autism anxieties, to perceptions that the vaccine had been banned in the US and sent instead to India.

With such clear evidence of waning vaccine confidence reported in the recent National Family Health Survey, an extra effort to dialogue with already known-to-be-hesitant communities before the campaign was launched, may have helped to build trust and allow for higher rates of vaccine acceptance.


Journal Watch

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

An Investment Case to Prevent the Reintroduction of Malaria in Sri Lanka

American Journal of Tropical Medicine and Hygiene
Volume 96, Issue 3, 2017

An Investment Case to Prevent the Reintroduction of Malaria in Sri Lanka
Rima Shretta, Ranju Baral, Anton L. V. Avanceña, Katie Fox, Asoka Premasiri Dannoruwa, Ravindra Jayanetti, Arumainayagam Jeyakumaran, Rasike Hasantha, Lalanthika Peris and Risintha Premaratne
Sri Lanka has made remarkable gains in reducing the burden of malaria, recording no locally transmitted malaria cases since November 2012 and zero deaths since 2007. The country was recently certified as malaria free by World Health Organization in September 2016. Sri Lanka, however, continues to face a risk of resurgence due to persistent receptivity and vulnerability to malaria transmission. Maintaining the gains will require continued financing to the malaria program to maintain the activities aimed at preventing reintroduction. This article presents an investment case for malaria in Sri Lanka by estimating the costs and benefits of sustaining investments to prevent the reintroduction of the disease. An ingredient-based approach was used to estimate the cost of the existing program. The cost of potential resurgence was estimated using a hypothetical scenario in which resurgence assumed to occur, if all prevention of reintroduction activities were halted. These estimates were used to compute a benefit–cost ratio and a return on investment. The total economic cost of the malaria program in 2014 was estimated at U.S. dollars (USD) 0.57 per capita per year with a financial cost of USD0.37 per capita. The cost of potential malaria resurgence was, however, much higher estimated at 13 times the cost of maintaining existing activities or 21 times based on financial costs alone. This evidence suggests a substantial return on investment providing a compelling argument for advocacy for continued prioritization of funding for the prevention of reintroduction of malaria in Sri Lanka.

Engaging patients in health research: identifying research priorities through community town halls

BMC Health Services Research
(Accessed 11 March 2017)

Research article
Engaging patients in health research: identifying research priorities through community town halls
The vision of Canada’s Strategy for Patient-Oriented Research is that patients be actively engaged as partners in health research. Support units have been created across Canada to build capacity in patient-ori…
Holly Etchegary, Lisa Bishop, Catherine Street, Kris Aubrey-Bassler, Dale Humphries, Lidewij Eva Vat and Brendan Barrett
BMC Health Services Research 2017 17:192
Published on: 11 March 2017

Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison

BMC Health Services Research
(Accessed 11 March 2017)

Research article
Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison
Despite Nigeria’s high HIV prevalence, voluntary testing and counselling rates remain low. UNAIDS/WHO/CDC recommends provider-initiated testing and counselling (PITC) for HIV in settings with high HIV prevalen…
Felix A. Ogbo, Andrew Mogaji, Pascal Ogeleka, Kingsley E. Agho, John Idoko, Terver Zua Tule and Andrew Page
BMC Health Services Research 2017 17:188
Published on: 9 March 2017

Lack of immunity against rubella among Italian young adults

BMC Infectious Diseases
(Accessed 11 March 2017)

Research article
Lack of immunity against rubella among Italian young adults
To support the evaluation of the 2010-15 National Plan for Measles and Congenital Rubella Elimination, the authors designed and performed a serosurveillance survey to verify the immunity/susceptibility rate ag…
Gallone Maria Serena, Gallone Maria Filomena, Larocca Angela Maria Vittoria, Germinario Cinzia and Tafuri Silvio
BMC Infectious Diseases 2017 17:199
Published on: 7 March 2017

Which recommendations are considered essential for outbreak preparedness by first responders?

BMC Infectious Diseases
(Accessed 11 March 2017)

Research article
Which recommendations are considered essential for outbreak preparedness by first responders?
Preparedness is considered essential for healthcare organizations to respond effectively to outbreaks. In the current study we aim to capture the views of first responders on what they consider key recommendat…
Evelien Belfroid, Aura Timen, Jim E. van Steenbergen, Anita Huis and Marlies E. J. L. Hulscher
BMC Infectious Diseases 2017 17:195
Published on: 7 March 2017

Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors

BMC Infectious Diseases
(Accessed 11 March 2017)

Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors
Sulaimon T. Adedokun, Olalekan A. Uthman, Victor T. Adekanmbi and Charles S. Wiysonge
BMC Public Health 2017 17:236
Published on: 8 March 2017
Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live.
The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12–23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3).
More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15–24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39–0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51–0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50–0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02–1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60–4.71) and states (aOR = 2.69; 955 CrI =1.37–4.73) were more likely to be incompletely immunized.
This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.

Reconsidering counselling and consent (pages 4–10)

BMC Infectious Diseases
(Accessed 11 March 2017)

Reconsidering counselling and consent (pages 4–10)
David R. Hall and Anton A. van Niekerk
Version of Record online: 1 DEC 2015 | DOI: 10.1111/dewb.12100
In the current era patient autonomy is enormously important. However, recently there has also been some movement back to ensure that trust in the doctor’s skill, knowledge and virtue is not excluded in the process. These new nuances of informed consent have been referred to by terms such as beneficent paternalism, experience-based paternalism and we would add virtuous paternalism. The purpose of this paper is to consider the history and current problematic nature of counselling and consent. Starting with the tradition founded by Hippocrates we trace and seek to understand how relevant aspects of the patient-doctor relationship have evolved under the influences of subsequent moral theories. Finally we tentatively endorse certain modes of counselling in the current era in order to promote morally sound, good clinical practice.

Raising the Barriers to Access to Medicines in the Developing World – The Relentless Push for Data Exclusivity (pages 11–21)

BMC Infectious Diseases
(Accessed 11 March 2017)

Raising the Barriers to Access to Medicines in the Developing World – The Relentless Push for Data Exclusivity (pages 11–21)
Lisa Diependaele, Julian Cockbain and Sigrid Sterckx
Version of Record online: 27 JAN 2016 | DOI: 10.1111/dewb.12105
Since the adoption of the WTO-TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity.
Data exclusivity limits the use of clinical trial data that need to be submitted to the regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator’s data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs.
This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry’s arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry’s appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free-riding’ encounters some important problems: Neither legitimize excluding all others.

Factors Affecting Women’s Autonomous Decision Making In Research Participation Amongst Yoruba Women Of Western Nigeria (pages 40–49)

BMC Infectious Diseases
(Accessed 11 March 2017)

Factors Affecting Women’s Autonomous Decision Making In Research Participation Amongst Yoruba Women Of Western Nigeria (pages 40–49)
Chitu Womehoma Princewill, Ayodele S. Jegede, Karin Nordström, Bolatito Lanre-Abass and Bernice Simone Elger
Version of Record online: 12 FEB 2016 | DOI: 10.1111/dewb.12112
Research is a global enterprise requiring participation of both genders for generalizable knowledge; advancement of science and evidence based medical treatment. Participation of women in research is necessary to reduce the current bias that most empirical evidence is obtained from studies with men to inform health care and related policy interventions. Various factors are assumed to limit autonomy amongst the Yoruba women of western Nigeria. This paper seeks to explore the experience and understanding of autonomy by the Yoruba women in relation to research participation. Focus is on factors that affect women’s autonomous decision making in research participation.
An exploratory qualitative approach comprising four focus group discussions, 42 in-depth interviews and 14 key informant interviews was used. The study permits a significant amount of triangulation, as opinions of husbands and religious leaders are also explored. Interviews and discussions were audiotaped and transcribed verbatim. Content analysis was employed for data analysis.
Findings show that concepts of autonomy varied amongst the Yoruba women. Patriarchy, religion and culture are conceived to have negative impact on the autonomy of women in respect to research participation. Among the important findings are: 1) male dominance is strongly emphasized by religious leaders who should teach equality, 2) while men feel that by making decisions for women, they are protecting them, the women on the other hand see this protection as a way of limiting their autonomy. We recommend further studies to develop culturally appropriate and workable recruitment methods to increase women’s participation in research.

Improving research misconduct policiesEvidence from social psychology could inform better policies to prevent misconduct in research

EMBO Reports
Volume 18, Issue 3, 2017
Science & Society

Improving research misconduct policiesEvidence from social psychology could inform better policies to prevent misconduct in research
Current policies for dealing with research misconduct emphasize the role and responsibility of individuals. Evidence from social psychology, however, shows that the environment determines personal conduct. Research misconduct policies should address these institutional factors.
Barbara K Redman, Arthur L Caplan
Published online 10.03.2017

Learning from multi-model comparisons: Collaboration leads to insights, but limitations remain

Volume 18, Pages 1-112 (March 2017)
Multi-model comparisons for neglected tropical diseases – validation and projection
Edited by Déirdre Hollingsworth and Graham Medley

Learning from multi-model comparisons: Collaboration leads to insights, but limitations remain
Original Research Article
Pages 1-3
T.D. Hollingsworth, G.F. Medley
[Initial text]
Neglected tropical diseases (known as NTDs) are a group of diseases predominantly affecting the poorest populations of the globe (sometimes called the ‘bottom billion’). The risk of disease is related to poor housing, poor sanitation and poor health systems as well as the environmental suitability of tropical areas. The NTDs are not a well-defined group, and comprise a variety of pathogens with different transmission routes, life cycles and behavioural risk factors, although they are similar in that they are currently relatively hard to diagnose. The host population factors and relatively poor surveillance data present particular challenges for providing transmission dynamics models. This collection reflects the current state-of-the-art for modelling NTDs, as well as judging on the suitability of models to provide quantitative policy advice

Controlling corporate influence in health policy making? An assessment of the implementation of article 5.3 of the World Health Organization framework convention on tobacco control

Globalization and Health
[Accessed 11 March 2017]

Controlling corporate influence in health policy making? An assessment of the implementation of article 5.3 of the World Health Organization framework convention on tobacco control
Gary Jonas Fooks, Julia Smith, Kelley Lee and Chris Holden
Published on: 8 March 2017

Primary Health Care That Works: The Costa Rican Experience

Health Affairs
February 2017; Volume 36, Issue 2
Issue Focus: Delivery System Innovation

Global Health Innovation
Primary Health Care That Works: The Costa Rican Experience
Madeline Pesec, Hannah L. Ratcliffe, Ami Karlage, Lisa R. Hirschhorn, Atul Gawande, and Asaf Bitton
Health Aff March 2017 36:531-538; doi:10.1377/hlthaff.2016.1319
Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica’s innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica’s experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Designating The Health Workforce As A Global Good

Health Affairs
February 2017; Volume 36, Issue 2
Issue Focus: Delivery System Innovation

From the Publisher
Designating The Health Workforce As A Global Good
Tom Kenyon
Health Aff March 2017 36:584; doi:10.1377/hlthaff.2016.1676
The United Nations has registered a milestone: declaring that within thirteen years, everyone, wherever they live in the world, should have access to health care regardless of their financial situation. This aspiration, contained in the Sustainable Development Goals (SDGs) calling for universal health coverage by 2030 (UHC 2030), was agreed upon at the United Nations (UN) General Assembly in 2015 and is a significant one—yet it brings with it another challenge: the sustained shortage of health workers…

Initiating community engagement in an ecohealth research project in Southern Africa

Infectious Diseases of Poverty
[Accessed 11 March 2017]

Research Article
Initiating community engagement in an ecohealth research project in Southern Africa
Community Engagement (CE) in health research ensures that research is consistent with the socio-cultural, political and economic contexts where the research is conducted. The greatest challenges for researcher…
Rosemary Musesengwa, Moses J. Chimbari and Samson Mukaratirwa
Infectious Diseases of Poverty 2017 6:22
Published on: 7 March 2017