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.
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BMC Health Services Research
(Accessed 29 April 2017)
Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework
Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents.
Yasmin Khan, Sarah Sanford, Doug Sider, Kieran Moore, Gary Garber, Eileen de Villa and Brian Schwartz
BMC Health Services Research 2017 17:312
Published on: 28 April 2017
BMC Infectious Diseases
(Accessed 29 April 2017)
Direct and indirect effects of influenza vaccination
Martin Eichner, Markus Schwehm, Linda Eichner and Laetitia Gerlier
BMC Infectious Diseases 2017 17:308
Published on: 26 April 2017
After vaccination, vaccinees acquire some protection against infection and/or disease. Vaccination, therefore, reduces the number of infections in the population. Due to this herd protection, not everybody needs to be vaccinated to prevent infections from spreading.
We quantify direct and indirect effects of influenza vaccination examining the standard Susceptible-Infected-Recovered (SIR) and Susceptible-Infected-Recovered-Susceptible (SIRS) model as well as simulation results of a sophisticated simulation tool which allows for seasonal transmission of four influenza strains in a population with realistic demography and age-dependent contact patterns.
As shown analytically for the simple SIR and SIRS transmission models, indirect vaccination effects are bigger than direct ones if the effective reproduction number of disease transmission is close to the critical value of 1. Simulation results for 20–60% vaccination with live influenza vaccine of 2–17 year old children in Germany, averaged over 10 years (2017–26), confirm this result: four to seven times as many influenza cases are prevented among non-vaccinated individuals as among vaccinees. For complications like death due to influenza which occur much more frequently in the unvaccinated elderly than in the vaccination target group of children, indirect benefits can surpass direct ones by a factor of 20 or even more than 30.
The true effect of vaccination can be much bigger than what would be expected by only looking at vaccination coverage and vaccine efficacy.
BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles (Accessed 29 April 2017)
Impact of the Ebola outbreak on routine immunization in western area, Sierra Leone – a field survey from an Ebola epidemic area
Since March 2014, the Ebola Virus Disease (EVD) outbreak in West Africa disrupted health care systems – especially in Guinea, Liberia and Sierra Leone – with a consequential stress on the area’s routine immunization programs. To address perceived decreased vaccination coverage, Sierra Leone conducted a catch-up vaccination campaign during 24–27 April 2015. We conducted a vaccination coverage survey and report coverage estimates surrounding the time of the EVD outbreak and the catch-up campaign… Coverage levels of MV and Pentavalent3 were low before the EVD outbreak and decreased further during the outbreak. Although the MCHW catch-up campaign increased coverage levels, coverage remained below pre-outbreak levels. High-quality supplementary immunization activities should be conducted and routine immunization should be strengthened to address gaps in immunity among children in this EVD-affected area.
Xiaojin Sun, T. T. Samba, Jianyi Yao, Wenwu Yin, Lin Xiao, Fuqiang Liu, Xiaoqiang Liu, Jikun Zhou, Zengqiang Kou, Hongwei Fan, Hao Zhang, Aqnes Williams, Paul M. Lansana and Zundong Yin
BMC Public Health 2017 17:363
Published on: 26 April 2017
April 2017 Volume 39, Issue 4, p665-872
Postmarketing Surveillance Studies—An Industry Perspective on Changing Global Requirements and Implications
Arshadul Haque, Sajjan Daniel, Tricia Maxwell, Mariette Boerstoel
Published online: April 7, 2017
This article describes postmarketing surveillance (PMS) study regulations and expectations of the regulatory agencies in 5 countries. With a focus on postapproval drug safety, there is a continuous need for understanding the benefit–risk profile of an approved drug. In addition to spontaneous adverse-event reporting, regulatory agencies seem to be more reliant on PMS studies. The opportunity to systematically monitor use in special populations, such as elderly patients and those with comorbid conditions, also presents itself during postmarketing use. Regulatory agencies in Japan, the Republic of Korea, and Mexico are requiring such studies as standards or conditions of drug approvals and license renewals. These studies are meant to be observational and noninterventional, over specified time periods. Studies are required specifically for following up treated patients in clinical practice, with the main objective of collecting safety data to further characterize the benefit–risk profile that was established during clinical trials and particularly in the country-specific population.
We reviewed and compared the published PMS guidelines and requirements in Japan, the Republic of Korea, the People’s Republic of China, India, and Mexico. Interpretations of the guidelines and requirements are included and are based on direct interactions with the different regulatory agencies.
We note that the different country PMS guidelines are at varying points in development. While some countries have more comprehensive guidelines, in others, the guidelines are still evolving. The similarities among guidelines include the requirements of the content and format of protocols, periodic reports, and interim reports of PMS studies. The differences in the requirements of PMS studies, such as sample size and study duration, are noticeable. These protocols are to be submitted, together with the respective risk-management plans, for approval by the regulatory authority prior to implementation of the study.
Conventional drug discovery and approval processes are well understood, and there are ample regulatory guidelines and International Conference of Harmonisation–based reference documents for understanding the path of the drug-approval process. Limited information is currently available with regard to the regulations and how PMS studies should be developed and evaluated. Some of the country-specific elements included can inform readers while they prepare to develop and implement PMS study protocols.
Global Public Health
Volume 12, 2017 Issue 6
Special Issue: Maternal and Child Health in Africa for Sustainable Development Goals (SDGs) Beyond 2015
Maternal and child health in Africa for sustainable development goals beyond 2015
Published online: 25 Apr 2017
Ezekiel Kalipeni, Juliet Iwelunmor & Diana Grigsby-Toussaint
Health Research Policy and Systems
[Accessed 29 April 2017]
Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?
Paul Cairney and Kathryn Oliver
Published on: 26 April 2017
There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.
We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.
We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.
We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.