American Journal of Public Health
107(6), June 2017
http://ajph.aphapublications.org/toc/ajph/current

ZIKA
Zika’s Long Haul: Tackling the Causes of Human Vulnerability to Mosquito-Borne Viruses
Laura C. Rodrigues
107(6), pp. 831–833

INFECTIOUS DISEASES
Public Health Surveillance for Communicable Diseases: From Rigid and Static to Flexible and Innovative
David L. Heymann
107(6), pp. 845–846

GLOBAL SURVEILLANCE
Evolution of Public Health Surveillance: Status and Recommendations
Howard S. Burkom
107(6), pp. 848–850

ZIKA
The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction
Claudia Garcia Serpa Osorio-de-Castro, Elaine Silva Miranda, Carlos Machado de Freitas, Kenneth Rochel de Camargo Jr and Hilarie Hartel Cranmer
107(6), pp. 960–965

Annals of Internal Medicine
16 May 2017 Vol: 166, Issue 10
http://annals.org/aim/issue

Research and Reporting Methods
Clinical Trials of Therapeutics for the Prevention of Congenital Zika Virus Disease: Challenges and Potential Solutions  
Alex P. Salam, MBChB, MSc; Amanda Rojek, MBBS, MSc; Jake Dunning, MBBS, PhD; Peter W. Horby, MBBS PhD
Abstract
Zika virus (ZIKV) infection in pregnancy is associated with adverse fetal outcomes, such as microcephaly and other congenital malformations. No therapeutic options are available to pregnant women with ZIKV infection to prevent these effects. Drug trials in pregnancy raise several scientific, ethical, and logistic challenges, which are compounded further in ZIKV because of limited knowledge of the disease pathophysiology and a product development pipeline in its infancy. We evaluate the major challenges in choosing therapeutics to prevent congenital ZIKV disease and conducting clinical trials of these treatments, with a focus on preventing congenital central nervous system malformations. These challenges must be characterized and planned for now so that clinical trials can progress expediently and effectively in the future.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 20 May 2017)

Research article
Cervical cancer treatment costs and cost-effectiveness analysis of human papillomavirus vaccination in Vietnam: a PRIME modeling study
Hoang Van Minh, Nguyen Thi Tuyet My and Mark Jit
BMC Health Services Research 2017 17:353
Published on: 15 May 2017
Abstract
Background
Cervical cancer is currently the leading cause of cancer mortality among women in South Vietnam and the second leading cause of cancer mortality in North Vietnam. Human papillomavirus (HPV) vaccination has the potential to substantially decrease this burden. The World Health Organization (WHO) recommends that a cost-effectiveness analysis of HPV vaccination is conducted before nationwide introduction.
Methods
The Papillomavirus Rapid Interface for Modeling and Economics (PRIME) model was used to evaluate the cost-effectiveness of HPV vaccine introduction. A costing study based on expert panel discussions, interviews and hospital case note reviews was conducted to explore the cost of cervical cancer care.
Results
The cost of cervical cancer treatment ranged from US$368 – 11400 depending on the type of hospital and treatment involved. Under Gavi-negotiated prices of US$4.55, HPV vaccination is likely to be very cost-effective with an incremental cost per disability-adjusted life year (DALY) averted in the range US$780 – 1120. However, under list prices for Cervarix and Gardasil in Vietnam, the incremental cost per DALY averted for HPV vaccination can exceed US$8000.
Conclusion
HPV vaccine introduction appears to be economically attractive only if Vietnam is able to procure the vaccine at Gavi prices. This highlights the importance of initiating a nationwide vaccination programme while such prices are still available

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 20 May 2017)

Research article
Estimation of the burden of varicella in Europe before the introduction of universal childhood immunization
Varicella is generally considered a mild disease. Disease burden is not well known and country-level estimation is challenging. As varicella disease is not notifiable, notification criteria and rates vary between…
Margarita Riera-Montes, Kaatje Bollaerts, Ulrich Heininger, Niel Hens, Giovanni Gabutti, Angel Gil, Bayad Nozad, Grazina Mirinaviciute, Elmira Flem, Audrey Souverain, Thomas Verstraeten and Susanne Hartwig
BMC Infectious Diseases 2017 17:353
Published on: 18 May 2017

TECHNICAL ADVANCE
A framework for evaluating epidemic forecasts
Over the past few decades, numerous forecasting methods have been proposed in the field of epidemic forecasting. Such methods can be classified into different categories such as deterministic vs. probabilistic…
Farzaneh Sadat Tabataba, Prithwish Chakraborty, Naren Ramakrishnan, Srinivasan Venkatramanan, Jiangzhuo Chen, Bryan Lewis and Madhav Marathe
BMC Infectious Diseases 2017 17:345
Published on: 15 May 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 20 May 2017)
Research article

A qualitative study on acceptable levels of risk for pregnant women in clinical research
Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women.
Indira S. E. van der Zande, Rieke van der Graaf, Martijn A. Oudijk and Johannes J. M. van Delden
Published on: 15 May 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 20 May 2017)

Research article
Avian influenza A/H7N9 risk perception, information trust and adoption of protective behaviours among poultry farmers in Jiangsu Province, China
Poultry farmers are at high-risk from avian influenza A/H7N9 infection due to sustained occupational exposures to live poultry. This study examined factors associated with poultry farmers’ adoption of personal…
Bin Cui, Qiuyan Liao, Wendy Wing Tak Lam, Zong Ping Liu and Richard Fielding
BMC Public Health 2017 17:463
Published on: 18 May 2017

BMJ Open
May 2017 – Volume 7 – 5
http://bmjopen.bmj.com/content/current

Protocol
Post-authorisation passive enhanced safety surveillance of seasonal influenza vaccines: protocol of a pilot study in England
Simon de Lusignan, Gaël Dos Santos, Ana Correa, François Haguinet, Ivelina Yonova, Florence Lair, Rachel Byford, Filipa Ferreira, Karen Stuttard, Tom Chan

Journal of Medical Internet Research
Vol 19, No 5 (2017): May
http://www.jmir.org/2017/5

Editorial
Using mHealth to Predict Noncommunicable Diseases: A Public Health Opportunity for Low- and Middle-Income Countries
Ellen Rosskam, Adnan A Hyder
J Med Internet Res 2017 (May 05); 19(5):e129
Nearly 70% of the 56 million deaths that took place globally in 2012 were due to noncommunicable diseases (NCDs), in particular, cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, and nearly two-thirds of all NCD deaths took place in low- and middle-income countries (LMICs) [1]. If effective steps are not taken to curb the epidemic, deaths due to NCDs are projected to rise exponentially in the coming decade [2]. Key risk factors responsible for a majority of NCDs include tobacco use, unhealthy diet, sedentary lifestyle, and excessive use of alcohol. With targeted action, these behavioral risk factors have demonstrated potential to be modified [3] to reduce NCDs and improve population health. Reducing NCDs, particularly in the world’s poorest countries, can lead to increases in equity and socioeconomic development while reducing poverty due to ill health and promoting sustainable development and social justice.

Key to global efforts to prevent and control NCDs is national surveillance. A promising approach increasingly being explored for public health surveillance involves mobile phones. A nascent yet emergent field, mHealth, describes medical and public health activities that leverage the global proliferation of cellular networks and mobile phone ownership or access to improve population health outcomes. There are nearly 7.5 billion wireless phone subscriptions globally, with the majority (78%) in LMICs [4]. Global connectivity to cellular networks can make large proportions of a population accessible through their mobile phones. In response to the increasing NCD disease burden, the intersecting need for NCD data in LMICs and the near-universal population access to mobile phones in a growing number of countries presents an opportunity for public health.

This special Theme Issue of JMIR offers a step forward in documenting what is known about surveillance of risk factors for NCDs in LMICs using mobile phone surveys (MPS). The evidence illustrates that the state-of-the-art is sufficient to roll out population-level surveys in LMICs using mobile phone platforms while paying careful attention to issues such as ethics, methodology, and turning results into practice. The results offer guidance for policy and practice.

The article, “Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda,” proposes a research and development agenda for NCD risk factors and MPS [5]. The goal of the proposed agenda is to help standardize operating procedures for MPS, which will allow for comparisons of NCD risk factors within and across sites and over time. The potential is explored for MPS to collect such data, review key research issues, and introduce a multicountry effort that seeks to partly respond to this public health challenge. It is hoped that the proposed research agenda will catalyze a global dialogue and action to enhance the use of MPS for NCDs and potentially other public health risk factor surveillance.

Limited evidence exists on the comparative effectiveness of MPS modalities in LMICs although a variety of options are available. “Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review” reviews the current landscape of MPS being used for population-level data collection in LMICs, specifically through the use of short message service, interactive voice response (IVR), and computer-assisted telephone interview survey modalities [6]. From the articles identified of MPS use to collect population estimates across a range of topics, results reveal that the state of MPS to collect population-level estimates of health and other indicators is a nascent field, indicating the need for more research.

The methodological approach used to test the use of MPS for NCDs is described in “Evaluation of Mechanisms to Improve Performance of Mobile Phone Surveys: A Research Protocol” [7]. Using microtrials, a set of future studies that will help enhance the efficiency and technical effectiveness of MPS is proposed for LMICs. The authors assess the effect of factors such as incentive timing and structure, survey introduction characteristics, different sampling frames, and survey modality on key survey metrics such as survey response, completion, and attrition rates.

Further investigating the literature, “Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities” reviews findings that compare a mode of remote data collection to at least one other mode [8]. The synthesis examines MPS mode effects on the reliability and accuracy of results. Findings show, for example, that remote data collection consistently elicited higher reports of socially nondesirable behaviors compared to in-person data collection. The review reveals the need for additional studies that compare reliability and construct validity across survey modalities.

IVR has the potential to expand current surveillance coverage and data collection. Two rounds of IVR pilot testing in Baltimore, Maryland, revealed that most participants felt this type of survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. In the pilot tests, participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Described in “The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing,” the authors conclude that formative research and cognitive testing of the questionnaire are needed for deployment in LMICs [9].

The near-ubiquitous ownership of phones in LMICs, high population mobility, and low cost demand a reexamination of statistical recommendations for MPS, especially when surveys are automated. In “Health surveys using mobile phones in developing countries: automated active strata monitoring and other statistical considerations for improving precision and reducing biases,” methods are proposed to reduce estimate bias and to adjust for selectivity due to mobile ownership [10]. The authors describe using automated active strata monitoring (AASM) to improve representativeness of the sample distribution to that of the source population. They conclude that although some statistical challenges remain, MPS represents a promising emerging means for population-level data collection in LMICs.

The increasing use of MPS in LMICs brings forth a cluster of ethical challenges. The existing literature regarding the ethics of mobile or digital health, however, mainly focuses on the use of technologies in high-income countries and does not consider the specific ethical issues associated with the conduct of MPS for NCD risk factor surveillance in LMICs. In “Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration,” the authors explored central ethics issues in this domain, including identifying the nature of the activity, stakeholder engagement, appropriate design, anticipating and managing potential harms and benefits, consent, reaching intended respondents, data ownership, access and use, and ensuring LMIC sustainability [11]. The authors call for future work to develop a broad conceptual framework for the ethical, legal, and societal issues associated with MPS for NCD risk factors. They further point to the need for guidance documents to identify key issues, outline pros and cons of options available to stakeholders for each issue, review additional points to consider, and provide references to resources relevant to each issue. In order to begin to address the various needs, the researchers hope to establish a global working group inclusive of experts in ethics, mHealth survey implementation, regulatory oversight and policy, public health, social science, and MPS platform development.

The article, “Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low- and Middle-Income Countries,” presents the special challenges for policy makers [12]. The article discusses potential benefits of MPS for developing, implementing, and evaluating NCD prevention and control policies. It includes an overview of major global commitments to NCD prevention and control as well as an exploration of how countries can translate these commitments into policy action at the national level. Potential benefits of MPS are discussed, including cost benefits of MPS for informing NCD policy actions compared to using traditional household surveys, timeliness of assessments to feed into policy and planning cycles, tracking progress of interventions, timely course correction for suboptimal or noneffective interventions, and assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage, inter alia. The authors demonstrate how MPS can become a powerful tool for collecting population-based data to inform policies that address key public health challenges such as NCDs. Further research in real-life settings will help to provide additional realistic world experiences.

This special issue of JMIR offers a step forward in benchmarking what is known and what is possible to know using MPS for data collection and surveillance systems. These results offer guidance for research expectations and opportunities to understand and curb the rise of NCDs in LMICs. Additional next steps are foreseen to continue documenting empirical experiences of MPS use in LMICs to collect risk factor data on NCDs, engaging with global bodies toward the development of a research agenda, establishing a global working group of experts to address the ethical issues surrounding MPS use in LMICs, and working with international and national level policy-makers to create a comparative framework for turning results into policy and practice.

Journal of Medical Internet Research
Vol 19, No 5 (2017): May
http://www.jmir.org/2017/5

Guest Editorial

Leveraging Mobile Phones for Monitoring Risks for Noncommunicable Diseases in the Future
Jennifer A Ellis
J Med Internet Res 2017 (May 05); 19(5):e137

Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration
Joseph Ali, Alain B Labrique, Kara Gionfriddo, George Pariyo, Dustin G Gibson, Bridget Pratt, Molly Deutsch-Feldman, Adnan A Hyder
J Med Internet Res 2017 (May 05); 19(5):e110
Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases
Alain Labrique, Emily Blynn, Saifuddin Ahmed, Dustin Gibson, George Pariyo, Adnan A Hyder
J Med Internet Res 2017 (May 05); 19(5):e121

Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review
Dustin G Gibson, Amanda Pereira, Brooke A Farrenkopf, Alain B Labrique, George W Pariyo, Adnan A Hyder
J Med Internet Res 2017 (May 05); 19(5):e139

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol
Claudia Santos-Hövener, Carmen Koschollek, Anna Kuehne, Adama Thorlie, Viviane Bremer
JMIR Res Protoc 2017 (May 02); 6(5):e80

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 6, Issue 2   1 June 2017
http://jpids.oxfordjournals.org/content/current

Editor’s Choice
Evaluation of the Impact of Pneumococcal Conjugate Vaccine on Pediatric Community-Acquired Pneumonia Using an Emergency Database System
Guilhem Noel; Gilles Viudes; Remi Laporte; Philippe Minodier

ORIGINAL ARTICLES AND COMMENTARIES
Tolerability of Japanese Encephalitis Vaccine in Pediatric Patients
Shauna Butler; Deena Sutter; Ashley Maranich

The Lancet
May 20, 2017 Volume 389 Number 10083 p1953-2080
http://www.thelancet.com/journals/lancet/issue/current

Editorial
WHO: Director-General campaign closes amid anxiety and hope
The Lancet
The current race to replace Margaret Chan, outgoing Director-General of WHO, has been a different kind of contest. The unprecedented level of transparency and accountability in the election campaign is to be welcomed—voting by member states and not only by the agency’s executive board, publication and scrutiny of candidate manifestos, and public debates. But will the final decision making, to take place next week at the World Health Assembly in Geneva, also be different? The vote remains a secret ballot, member states can pledge their support to one candidate but vote for another, and, in the end, the choice of WHO’s next leader, still the world’s top international health post, will be as political as ever.

The election comes at a time of unparalleled uncertainty for WHO. Meeting the expectations of the Sustainable Development Goals demands political legitimacy and courageous leadership. Yet the landscape of global health initiatives has never been more complex, narrowing opportunities for WHO to play a decisive part in shaping the future of health. And WHO’s finances are terrifyingly limited. The agency is in an unenviable position: vastly more is expected of WHO while its role is contested and constrained.

A tall order for the remaining candidates, Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar, who have each proved to be strong, credible, and hard working. All have participated in countless discussions and interviews, and travelled around the world competing for country votes, showcasing their particular strengths and priorities. At this juncture in the history of WHO it feels right that there are two candidates from low and middle income countries, and one a woman.

Tedros has been credited with transforming the Ethiopian health system and his country’s population health. He also has deep and valuable experience of several key global health initiatives that sometimes compete with WHO. As potentially the first Director-General from sub-Saharan Africa, his ascent to WHO’s leadership would be a major win for the continent. That said, Tedros has had to contend with considerable political mudslinging. He was Health Minister and Foreign Minister until November, 2016, leading to concerns being raised over his links with an Ethiopian regime guilty of extensive violations of human rights. Some of this criticism has been openly discussed, and also refuted, in social media. Furthermore, Tedros strenuously denies the damaging accusations (made by an adviser to his closest competitor, David Nabarro) that he covered up cholera epidemics in Ethiopia while Health Minister, branding it a smear campaign.

David Nabarro has wide experience on the front lines of global health and in the UN system, where he has spent much of his career. He has strong and proven managerial skills. And he has led and coordinated important global programmes, ranging from nutrition to Ebola. But Nabarro is supported by a present and likely future UK Government sceptical of multilateralism, distracted by Brexit, and lacking the enthusiasm of past administrations for health as an important foreign policy issue. Added to which, some member states may question whether now is the right time to be appointing a UN insider. Does WHO need fresh and more radical thinking, they might ask.

Sania Nishtar has her origins firmly rooted in civil society. A highly successful campaigner to address the abject international neglect of non-communicable diseases, she has also gained experience, albeit briefly, as Pakistan’s Health Minister, among other portfolios. She has successfully chaired important global health working groups, and she has shown an impressive independence of thinking—suggesting, for example, that she might only serve one term as Director-General to free her to take the tough decisions she believes WHO needs to take. But some observers may ask whether her high-level organisational experience is sufficient to lead WHO at such a critical moment in its history.

Each candidate has strengths. And each has weaknesses. The Lancet has, at various times, worked closely with all three. We can attest to their commitment to WHO and its values. But that is not enough. To achieve genuine internal reforms and to restore public confidence might seem to favour Tedros and Nishtar. The complex management and diplomacy requirements could favour Nabarro. The new campaign process has succeeded in enhancing transparency about the qualities and attributes of the candidates. But, as in any election, unpredictability reigns. We encourage member states to vote for the candidate who they believe mixes proven managerial competence with a clear and deliverable vision for WHO’s next 5 years. No empty promises. Just realisable results. And, perhaps most importantly, someone with the skills to handle the unexpected.

The Lancet
May 20, 2017 Volume 389 Number 10083 p1953-2080
http://www.thelancet.com/journals/lancet/issue/current

Articles
Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
Global Burden of Disease Health Financing Collaborator Network
Open Access
Interpretation
Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.

The Lancet
May 20, 2017 Volume 389 Number 10083 p1953-2080
http://www.thelancet.com/journals/lancet/issue/current

Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
Global Burden of Disease Health Financing Collaborator Network
Open Access
Interpretation
Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.

Lancet Global Health
Jun 2017 Volume 5 Number 6 e556-e632
http://www.thelancet.com/journals/langlo/issue/current

Articles
Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial
Muhammad Atif Habib, Sajid Soofi, Simon Cousens, Saeed Anwar, Najib ul Haque, Imran Ahmed, Noshad Ali, Rehman Tahir, Zulfiqar A Bhutta
Summary
Background
Pakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan.
Methods
We did a community-based three-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in three districts of Pakistan at high risk of polio. Clusters were randomly assigned by a computer algorithm using restricted randomisation in blocks of 20 by an external statistician (1:1:1) to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of IPV delivered at the maternal and child health camps (arm C). An independent team conducted surveys at baseline, endline, and after each round of supplementary immunisation activity for acceptability and effect. The primary outcome measures for the study were coverage of OPV, IPV, and routine extended programme on immunisation vaccines and changes in the proportion of unvaccinated and fully vaccinated children. This trial is registered with ClinicalTrials.gov, number NCT01908114.
Findings
Between June 4, 2013, and May 31, 2014, 387 clusters were randomised (131 to arm A, 127 to arm B, and 129 to arm C). At baseline, 28 760 children younger than 5 years were recorded in arm A, 30 098 in arm B, and 29 126 in arm C. 359 clusters remained in the trial until the end (116 in arm A, 120 in arm B, and 123 in arm C; with 23 334 children younger than 5 years in arm A, 26 110 in arm B, and 25 745 in arm C). The estimated OPV coverage was 75% in arm A compared with 82% in arm B (difference vs arm A 6·6%; 95% CI 4·8–8·3) and 84% in arm C (8·5%, 6·8–10·1; overall p<0·0001). The mean proportion of routine vaccine doses received by children younger than 24 months of age was 43% in arm A, 52% in arm B (9%, 7–11) and 54% in arm C (11%, 9–13; overall p<0·0001). No serious adverse events requiring hospitalisation were reported after immunisation.
Interpretation
Despite the challenges associated with the polio end-game in high-risk, conflict-affected areas of Pakistan, a strategy of community mobilisation and targeted community-based health and immunisation camps during polio immunisation campaigns was successful in increasing vaccine coverage, including polio vaccine coverage.
Funding
Bill & Melinda Gates Foundation.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 20 May 2017)

Research Article
Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014–2016: A cross-sectional study
Catherine F. Houlihan, Catherine R. McGowan, Steve Dicks, Marc Baguelin, David A. J. Moore, David Mabey, Chrissy h. Roberts, Alex Kumar, Dhan Samuel, Richard Tedder, Judith R. Glynn
| published 16 May 2017 PLOS Medicine

 PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 20 May 2017)

Viewpoints
NTD policy priorities: Science, values, and agenda setting
Ana S. Ilt s, Kirstin R. W. Matthews
| published 18 May 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005431
…Conclusion
Eliminating NTD epidemics by 2030 requires setting an agenda to meet specific and actionable NTD targets over time. If we focus on all diseases and methods simultaneously, only marginal impact can be attained. Selecting priorities will facilitate more significant achievements. NTD policy aimed at specific targets requires decisions about the balance between funding research, development, treatments, and preventative measures; which diseases to focus on, in what order, how much attention to pay to each; what constraints the agenda must respect; and who will have a voice in agenda setting. Scientists ought to acknowledge the need to set priorities to achieve goals; the importance of collaborating with public health experts, policy makers and communities to make substantial progress toward eliminating NTDs; and the inherently value-laden nature of priority setting. Only through explicitly setting priorities will effective and sustainable policies be achieved over time.

PLoS One
http://www.plosone.org/
[Accessed 20 May 2017]

Research Article
Modelling the transmission and control strategies of varicella among school children in Shenzhen, China
Xiujuan Tang, Shi Zhao, Alice P. Y. Chiu, Hanwu Ma, Xu Xie, Shujiang Mei, Dongfeng Kong, Yanmin Qin, Zhigao Chen, Xin Wang, Daihai He
Research Article | published 18 May 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0177514

Research Article
Effect of early measles vaccine on pneumococcal colonization: A randomized trial from Guinea-Bissau
Nadja Skadkær Hansen, Stine Byberg, Lars Hervig Jacobsen, Morten Bjerregaard-Andersen, Aksel Karl Georg Jensen, Cesario Martins, Peter Aaby, Jørgen Skov Jensen, Christine Stabell Benn, Hilton Whittle
Research Article | published 17 May 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0177547

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 20 May 2017]

Biological Sciences – Ecology:
Essential information: Uncertainty and optimal control of Ebola outbreaks
Shou-Li Li, Ottar N. Bjørnstad, Matthew J. Ferrari, Riley Mummah, Michael C. Runge, hristopher J. Fonnesbeck, Michael J. Tildesley, illiam J. M. Probert, and Katriona Shea
PNAS 2017 ; published ahead of print May 15, 2017, doi:10.1073/pnas.1617482114
Significance
The 2014 Ebola outbreak illustrates the complexities of decision making in the face of explosive epidemics; management interventions must be enacted, despite imperfect or missing information. The wide range in projected caseload generated attention as a source of uncertainty, but debate did not address whether uncertainty affected choice of action. By reevaluating 37 published models, we show that most models concur that reducing funeral transmission and reducing community transmission are robust and effective management actions to minimize projected caseload. Although models disagreed about absolute caseload, this measure has little relevance for evaluating candidate interventions. Our study highlights the importance of projecting the impact of interventions and is applicable to management of other epidemic outbreaks where rapid decision making is critical.
Abstract
Early resolution of uncertainty during an epidemic outbreak can lead to rapid and efficient decision making, provided that the uncertainty affects prioritization of actions. The wide range in caseload projections for the 2014 Ebola outbreak caused great concern and debate about the utility of models. By coding and running 37 published Ebola models with five candidate interventions, we found that, despite this large variation in caseload projection, the ranking of management options was relatively consistent. Reducing funeral transmission and reducing community transmission were generally ranked as the two best options. Value of information (VoI) analyses show that caseloads could be reduced by 11% by resolving all model-specific uncertainties, with information about model structure accounting for 82% of this reduction and uncertainty about caseload only accounting for 12%. Our study shows that the uncertainty that is of most interest epidemiologically may not be the same as the uncertainty that is most relevant for management. If the goal is to improve management outcomes, then the focus of study should be to identify and resolve those uncertainties that most hinder the choice of an optimal intervention. Our study further shows that simplifying multiple alternative models into a smaller number of relevant groups (here, with shared structure) could streamline the decision-making process and may allow for a better integration of epidemiological modeling and decision making for policy.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 20 May 2017]

Social Sciences – Economic Sciences – Biological Sciences – Population Biology:
Impact of International Monetary Fund programs on child health
Adel Daoud, Elias Nosrati, Bernhard Reinsberg, Alexander E. Kentikelenis, Thomas H. Stubbs,
and Lawrence P. King
PNAS 2017 ; published ahead of print May 15, 2017, doi:10.1073/pnas.1617353114
Significance
This study adds to the state of the art by analyzing the impact of International Monetary Fund (IMF) programs on children’s health, mediated by their parents’ education. It is the first to combine macrodata and microdata to address this issue systematically across five dimensions of child health: water, malnutrition, shelter, sanitation, and health care access. The sample represents about 2.8 billion (about 50%) of the world’s population in year 2000. Using multilevel models, we find that, although IMF programs do not correlate directly with child health indicators, they reduce the protective effect of parental education on child health, especially in rural areas, and have a mixed impact across the five dimensions of urban child health.
Abstract
Parental education is located at the center of global efforts to improve child health. In a developing-country context, the International Monetary Fund (IMF) plays a crucial role in determining how governments allocate scarce resources to education and public health interventions. Under reforms mandated by IMF structural adjustment programs, it may become harder for parents to reap the benefits of their education due to wage contraction, welfare retrenchment, and generalized social insecurity. This study assesses how the protective effect of education changes under IMF programs, and thus how parents’ ability to guard their children’s health is affected by structural adjustment. We combine cross-sectional stratified data (countries, 67; children, 1,941,734) from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys. The sample represents ∼2.8 billion (about 50%) of the world’s population in year 2000. Based on multilevel models, our findings reveal that programs reduce the protective effect of parental education on child health, especially in rural areas. For instance, in the absence of IMF programs, living in an household with educated parents reduces the odds of child malnourishment by 38% [odds ratio (OR), 0.62; 95% CI, 0.66–0.58]; in the presence of programs, this drops to 21% (OR, 0.79; 95% CI, 0.86–0.74). In other words, the presence of IMF conditionality decreases the protective effect of parents’ education on child malnourishment by no less than 17%. We observe similar adverse effects in sanitation, shelter, and health care access (including immunization), but a beneficial effect in countering water deprivation.

 
Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
http://www.paho.org/journal/index.php?option=com_content&view=featured&Itemid=101
This issue is focused on health reform In Ecuador and its implications.

Editorial
Health systems reform in the quest for universal health [La reforma de los sistemas de salud en la búsqueda de la cobertura universal]
Carissa F. Etienne
Published 15 May

Editorial
La reforma en salud del Ecuador [Health reform in Ecuador]
Verónica Espinosa, Cecilia Acuña , Daniel de la Torre, Gina Tambini
Published 15 May |

Social Science & Medicine
Volume 180, Pages 1-196 (May 2017)
http://www.sciencedirect.com/science/journal/02779536/180

Review article
Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare
Review Article
Pages 62-75
Marij A. Hillen, Caitlin M. Gutheil, Tania D. Strout, Ellen M.A. Smets, Paul K.J. Han
Abstract
Rationale
Uncertainty tolerance (UT) is an important, well-studied phenomenon in health care and many other important domains of life, yet its conceptualization and measurement by researchers in various disciplines have varied substantially and its essential nature remains unclear.
Objective
The objectives of this study were to: 1) analyze the meaning and logical coherence of UT as conceptualized by developers of UT measures, and 2) develop an integrative conceptual model to guide future empirical research regarding the nature, causes, and effects of UT.
Methods
A narrative review and conceptual analysis of 18 existing measures of Uncertainty and Ambiguity Tolerance was conducted, focusing on how measure developers in various fields have defined both the “uncertainty” and “tolerance” components of UT—both explicitly through their writings and implicitly through the items constituting their measures.
Results
Both explicit and implicit conceptual definitions of uncertainty and tolerance vary substantially and are often poorly and inconsistently specified. A logically coherent, unified understanding or theoretical model of UT is lacking. To address these gaps, we propose a new integrative definition and multidimensional conceptual model that construes UT as the set of negative and positive psychological responses—cognitive, emotional, and behavioral—provoked by the conscious awareness of ignorance about particular aspects of the world. This model synthesizes insights from various disciplines and provides an organizing framework for future research. We discuss how this model can facilitate further empirical and theoretical research to better measure and understand the nature, determinants, and outcomes of UT in health care and other domains of life.
Conclusion
Uncertainty tolerance is an important and complex phenomenon requiring more precise and consistent definition. An integrative definition and conceptual model, intended as a tentative and flexible point of departure for future research, adds needed breadth, specificity, and precision to efforts to conceptualize and measure UT.

Social Science & Medicine
Volume 180, Pages 1-196 (May 2017)
http://www.sciencedirect.com/science/journal/02779536/180

Regular articles
The effects of women’s education on maternal health: Evidence from Peru
Original Research Article
Pages 1-9
Abigail Weitzman
Abstract
This article examines the causal effect of women’s education on maternal health in Peru, a country where maternal mortality has declined by more than 70% in the last two and a half decades. To isolate the effects of education, the author employs an instrumented regression discontinuity that takes advantage of an exogenous source of variation—an amendment to compulsory schooling laws in 1993. The results indicate that extending women’s years of schooling reduced the probability of several maternal health complications at last pregnancy/birth, sometimes by as much as 29%. Underlying these effects, increasing women’s education is found to decrease the probability of short birth intervals and unwanted pregnancies (which may result in unsafe abortions) and to increase antenatal healthcare use, potentially owing to changes in women’s cognitive skills, economic resources, and autonomy. These findings underscore the influential role of education in reducing maternal morbidity and highlight the contributions of women’s education to population health and health transitions

Social Science & Medicine
Volume 180, Pages 1-196 (May 2017)
http://www.sciencedirect.com/science/journal/02779536/180

Regular articles
Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis
Original Research Article
Pages 181-192
Arindam Nandi, Itamar Megiddo, Ashvin Ashok, Amit Verma, Ramanan Laxminarayan
Abstract
Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201–44,504) diarrheal episodes and 68 (95% UR 62–74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509–$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603–$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.

Vaccine
Volume 35, Issue 24, Pages 3153-3280 (31 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/24

Reviews
Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review
Review Article
Pages 3153-3161
Carlos K.H. Wong, Qiuyan Liao, Vivian Y.W. Guo, Yiqiao Xin, Cindy L.K. Lam
Abstract
Objectives
To describe and systematically review the modelling and reporting of cost-effectiveness analysis of vaccination in Hong Kong, and to identify areas for quality enhancement in future cost-effectiveness analyses.
Methods
We conducted a comprehensive and systematic review of cost-effectiveness studies related to vaccination and government immunisation programmes in Hong Kong published from 1990 to 2015, through database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of selected studies was assessed using Consolidated Health Economic Evaluation Reporting Standards checklist (CHEERS). Decision making of vaccination was obtained from Scientific Committee on Vaccine Preventable Diseases (SCVPD) and Department of Health in Hong Kong.
Results
Nine eligible studies reporting twelve comparative cost-effectiveness comparisons of vaccination programme for influenza (n = 2), pneumococcal disease (n = 3), influenza plus pneumococcal disease (n = 1), chickenpox (n = 2), Haemophilus influenzae b (n = 1), hepatitis A (n = 1), cervical cancer (n = 1) and rotavirus (n = 1) were identified. Ten comparisons (83.3%) calculated the incremental cost-effectiveness ratio (ICER) of a vaccination strategy versus status quo as outcomes in terms of cost in USD per life-years, cost per quality-adjusted life-years, or cost per disability-adjusted life-years. Among those 10 comparisons in base-case scenario, 4 evaluated interventions were cost-saving relative to status quo while the ICER estimates in 3 of the 6 remaining comparisons were far below commonly accepted threshold and WHO willingness-to-pay threshold, suggestive of very cost-effective. Seven studies were of good quality based on the CHEERS checklist; one was of moderate quality; and one was of excellent quality. The common methodological problems were characterisation of heterogeneity and reporting of study parameters.
Conclusions
There was a paucity of cost-effectiveness models evaluating vaccination targeted to the Hong Kong population. All evaluated vaccinations and immunisation interventions in Hong Kong, except for Haemophilus influenzae b, hepatitis A and HPV vaccinations, were considered either cost-saving or very cost-effective when compared to status quo.

Vaccine
Volume 35, Issue 24, Pages 3153-3280 (31 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/24

No association between influenza vaccination during pregnancy and adverse birth outcomes
Original Research Article
Pages 3186-3190
Ousseny Zerbo, Sharareh Modaressi, Berwick Chan, Kristin Goddard, Ned Lewis, Karin Bok, Bruce Fireman, Nicola P. Klein, Roger Baxter
Abstract
Background
Pregnant women are recommended to receive inactivated influenza vaccination anytime during pregnancy. Studies have investigated the impact of influenza vaccination during pregnancy on birth outcomes and results on preterm birth have been inconsistent.
Methods
We conducted a retrospective cohort study among children born at a gestational age ≥ 24 weeks from January 1, 2010 to December 31, 2015 at Kaiser Permanente Northern California facilities (KPNC). We evaluated the association between maternal influenza vaccination during pregnancy and risk of preterm birth, small and large for gestational age, admission to the neonatal intensive care unit (NICU), respiratory distress syndrome, low birth weight, and low Apgar score. We ascertained the dates of maternal influenza vaccination, conception, and delivery, as well as birth outcomes from KPNC inpatient and outpatient databases. Conditional multivariate Cox regression and logistic regression analyses were used to determine the association between maternal vaccination during pregnancy and risk of each birth outcome.
Results
The study included 145,869 children. Maternal influenza vaccination during pregnancy was not associated with risk of small or large for gestational age births, preterm birth, need for mechanical ventilation at birth, respiratory distress syndrome, admission to the NICU, low birth weight, or low Apgar score. However, when we did not control for immortal time bias, the risk of preterm birth (odds ratio [OR] = 0.69, 95% confidence interval [CI] 0.66–0.72) was lower among infants of vaccinated mothers.
Conclusion
We found no association between maternal influenza vaccination during pregnancy and adverse birth outcomes. When investigating preterm birth outcome in association with vaccination during pregnancy, immortal time bias should be taken into account in the analysis.

Vaccine
Volume 35, Issue 24, Pages 3153-3280 (31 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/24

Needle adapters for intradermal administration of fractional dose of inactivated poliovirus vaccine: Evaluation of immunogenicity and programmatic feasibility in Pakistan
Original Research Article
Pages 3209-3214
Ali Faisal Saleem, Ondrej Mach, Mohammad T. Yousafzai, Asia Khan, William C. Weldon, M. Steven Oberste, Roland W. Sutter, Anita K.M. Zaidi
Abstract
Administration of 1/5th dose of Inactivated poliovirus vaccine intradermally (fIPV) provides similar immune response as full-dose intramuscular IPV, however, fIPV administration with BCG needle and syringe (BCG NS) is technically difficult. We compared immune response after one fIPV dose administered with BCG NS to administration with intradermal devices, referred to as Device A and B; and assessed feasibility of conducting a door-to-door vaccination campaign with fIPV. In Phase I, 452 children 6–12 months old from Karachi were randomized to receive one fIPV dose either with BCG NS, Device A or Device B in a health facility. Immune response was defined as seroconversion or fourfold rise in polio neutralizing antibody titer 28 days after fIPV among children whose baseline titer ≤362. In Phase II, fIPV was administered during one-day door-to-door campaign to assess programmatic feasibility by evaluating vaccinators’ experience. For all three poliovirus (PV) serotypes, the immune response after BCG NS and Device A was similar, however it was lower with Device B (34/44 (77%), 31/45 (69%), 16/30 (53%) respectively for PV1; 53/78 (68%), 61/83 (74%), 42/80 (53%) for PV2; and; 58/76 (76%), 56/80 (70%), 43/77 (56%) for PV3; p < 0.05 for all three serotypes). Vaccinators reported problems filling Device B in both Phases; no other operational challenges were reported during Phase II. Use of fIPV offers a dose-saving alternative to full-dose IPV.

Vaccine
Volume 35, Issue 24, Pages 3153-3280 (31 May 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/24

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile
Original Research Article
Pages 3215-3221
M.-J.J. Mangen, H. Stibbe, A. Urbanus, E.C. Siedenburg, Q. Waldhober, G.A. de Wit, J.E. van Steenbergen, on behalf of the National Working Group of hepatitis B behavioural risk-groups vaccination program
Abstract
Background
The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007.
Methods
Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002–2006 and 2007–2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections – as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately.
Results
The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY.
Discussion and conclusion
This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per risk-group, increase effects or when to integrate the vaccination in regular healthcare.

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

Pediatric Drugs
First Online: 16 May 2017
Review Article
Immunization During Pregnancy: Impact on the Infant
KP Perrett, TM Nolan –
Abstract
Maternal immunization has undergone a paradigm shift in recent years, as women and healthcare providers accept and recognize the benefits of this strategy not only for the pregnant woman but also for the developing fetus and young infant. This article reviews the evidence for active immunization during pregnancy, with an emphasis on perinatal and infant outcomes. Current recommendations for immunization during pregnancy are presented, with particular focus on the routinely recommended vaccines during pregnancy: influenza and Tdap (tetanus, diphtheria, and pertussis). We discuss future research directions, maternal vaccines in development, and considerations for optimizing and advancing this underutilized strategy.

Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences
Volume 64, August 2017, Pages 11–21
Biotechnology and the transformation of vaccine innovation: The case of the hepatitis B vaccines 1968–2000
F Huzair, S Sturdy
Highlights
:: The recombinant hepatitis B vaccines rehabilitated vaccines as commercially interesting pharmaceutical products.
:: The recombinant hepatitis B vaccines helped substantially to establish the commercial viability of the biotech sector.
:: The commercial success of the recombinant hepatitis B vaccines was largely unanticipated.
:: The recombinant hepatitis vaccines helped establish a two-tier global vaccine innovation system.
Abstract
The approval, from 1986, of a series of recombinant hepatitis B vaccines was a landmark both in the growth of biotechnology and in the development of the vaccine innovation system. In this paper, we show how the early development of the hepatitis B vaccines was shaped by a political and economic context that newly favoured commercialisation of academic research, including the appropriation and management of intellectual property; we elucidate the contingent interests and motivations that led new biotechnology companies and established pharmaceutical businesses to invest in developing recombinant vaccines specifically against hepatitis B; and we show how these and other factors combined to make those vaccines an unexpected commercial success. Broadening the scope of our analysis to include not just North America and Europe but also low- and middle-income countries, we show how the development of the hepatitis B vaccines facilitated the emergence of a two-tier innovation system structured by tensions between the demands for commercial profitability on the one hand, and the expectation of public health benefit for low- and middle-income countries on the other.

American Journal of Epidemiology
2017 May 6. doi: 10.1093/aje/kwx048. [Epub ahead of print]
Imputing direct and indirect vaccine effectiveness of childhood pneumococcal conjugate vaccine against invasive disease by surveying temporal changes in nasopharyngeal pneumococcal colonization
SA Nzenze, SA Madhi, T Shiri, KP Klugman…
Abstract
The limited capabilities in most low-middle income countries to study the bebfit of pneumococcal conjugate vaccine (PCV) against invasive pneumococcal disease (IPD), calls for alternate strategies to assess this. We used a mathematical model, to predict the direct and indirect effectiveness of PCV by analyzing serotype specific colonization prevalence and IPD incidence prior to and following childhood PCV immunization in South Africa. We analyzed IPD incidence from 2005-2012 and colonization studies undertaken in HIV-uninfected and HIV-infected child-mother dyads from 2007-2009 (pre-PCV era), in 2010 (7-valent PCV era) and 2012 (13-valent PCV era). We compared the model-predicted to observed changes in IPD incidence, stratified by HIV-status in children >3 months to 5 years and also in women aged >18-45 years. We observed reductions in vaccine-serotype colonization and IPD due to vaccine serotypes among children and women after PCV introduction. Using the changes in vaccine-serotype colonization data, the model-predicted changes in vaccine-serotype IPD incidence rates were similar to the observed changes in PCV-unvaccinated children and adults, but not among children <24 months. Surveillance of colonization prior and following PCV use can be used to impute PCVs’ indirect associations in unvaccinated age groups, including in high HIV-prevalence settings.

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.

BBC
http://www.bbc.co.uk/
Accessed 20 May 2017
Italy makes 12 vaccinations compulsory for children
19 May 2017
[See Milestones above for more detail]
Forbes
http://www.forbes.com/
Accessed 20 May 2017
The Anti-Vaccine And Anti-GMO Movements Are Inextricably Linked And Cause Preventable Suffering
18 May 2017

Millions Of U.S. Travelers Might Be At Risk For Importing Measles Because They Skipped The Vaccine
May 16, 2017   Rita Rubin, Contributor
In a study of people who visited travel health clinics before departing the United States, more than half of thoe who should have been vaccinated against measles didn’t get immunized, leaing them vulnerable to becoming infected overseas and bringing the disease back home.

The Guardian
http://www.guardiannews.com/
Accessed 20 May 2017
Vaccination in adults – a change in attitude could help prevent serious disease
Kim Thomas  Thursday 18 May 2017 1
Many of us take a lot of care over our diet and make sure we take regular exercise – yet we neglect to get ourselves vaccinated. Experts say this needs to change …

New York Times
http://www.nytimes.com/
Accessed 20 May 2017
The Opinion Pages | Op-Ed Contributor
Seth Berkley: The Looming Threat of Yellow Fever
14 May 2017
Three years ago, the West African Ebola epidemic set off a worldwide panic and the biggest global-health security crisis in years. Then Zika struck and the reality of those transmittable disease threats was brought even closer to home in the United States, with more than 5,000 cases reported and America still on high alert. Yet today, an even greater potential threat to the world is sweeping across Brazil.

The disease, yellow fever, is a deadly virus that spreads as rapidly as Zika, with symptoms that can be as horrific as Ebola. It is transmitted by certain species of mosquito, including the same Aedes aegypti that carries Zika. Up to 15 percent of those bitten become severely ill, with symptoms that include black vomit and bleeding from the nose, mouth and eyes. For up to half of those who develop severe symptoms, yellow fever ends in a painful death.

Until about a century ago, the disease regularly caused urban epidemics in the United States, including one in Philadelphia that killed 10 percent of the population in 1793, forcing President George Washington and others in his administration to flee what was then the nation’s capital.
Now, with Brazil facing an unusually large outbreak of yellow fever — there are 715 confirmed cases, more than 820 suspected cases and 240 confirmed deaths — another global health crisis looms. So far, the outbreaks have largely been confined to sparsely populated jungle areas. There is serious concern, however, that if the virus starts spreading in a major city, health authorities will be ill equipped to contain it. Rio de Janeiro, for one, is aggressively vaccinating its citizens in hopes of inoculating 12 million by the end of the year.

Yellow fever already kills upward of 30,000 people a year worldwide, though in 2013 as many as 60,000 might have died from the disease. With the threat of yellow fever returning to regions where it was once expunged, that number could rise significantly. What is particularly worrying is the possibility of yellow fever taking hold in previously unaffected parts of the world like Asia. The combination of Aedes aegypti being prevalent there and about 1.8 billion unvaccinated people living in densely populated parts of that continent makes for a potential disaster.

While there is no cure for yellow fever, a licensed vaccine has long been available that is safe, affordable and highly effective, providing lifetime protection with just one dose.

Last year, Angola’s capital, Luanda, endured the world’s largest outbreak of yellow fever in three decades. A surge in demand resulted in vaccine shortages, particularly when the disease spread to the neighboring Democratic Republic of Congo and farther afield to Kenya. With a large Chinese work force in Angola, many whom were unvaccinated, 11 cases reached China. Miraculously those were contained without further spread.

The shortages made the situation so desperate that the World Health Organization and Unicef had to resort to fractional dosing in Kinshasa, capital of the Democratic Republic of Congo, administrating one-fifth of a normal dose. We got lucky: The Brazilian manufacturer made available up to 2.5 million doses of the vaccine, and the outbreak was curbed.

Now, the situation has reversed. Having already distributed 15 million vaccine doses since the outbreak began in December, Brazil has been forced to request 3.5 million doses from the International Coordinating Group on Vaccine Provision, which oversees emergency stocks financed by Gavi, the Vaccine Alliance, the nonprofit group I manage. With a global emergency stockpile of six million doses and about 12 million people living in and around Rio, it is easy to see why public health experts are worried. If Rio and one other major city experience an outbreak, it is doubtful whether stocks could be replenished fast enough to keep up with demand.

The proportion of people living in urban areas, where diseases can spread far more rapidly than in rural areas with scattered populations, is forecast to rise from one-third of the planet’s population in 1950 to two-thirds by 2050. Clearly, we need to revise our risk assessments for infectious diseases to reflect this trend. But just how large should vaccine stockpiles be? And for how many cities should we prepare?

And while these emergency stockpiles are essential, if we have to call upon them we have in some way already failed. They should be our last line of defense. Instead, if we want to avoid a return of the kind of urban epidemic that killed 5,000 people in Philadelphia two centuries ago, we need to prevent outbreaks from occurring in the first place. That means improving mosquito control and simultaneously increasing immunity against yellow fever through routine immunization and pre-emptive vaccination campaigns.

With winter arriving next month in South America, the outbreak will most likely be brought to heel. But as mosquito season approaches in the north, control measures will be essential if we want to avoid yellow fever following Zika’s path, making its way north through Latin America to southern states in the United States like Florida.

And if, or when, it arrives, awareness will also be critical to prevent its spread, especially because very few doctors in the United States have ever seen a case and hardly anyone is vaccinated. As things stand, shortages are already affecting the availability of yellow fever travel vaccines in the United States.

History has shown that preventive approaches can be highly effective at controlling yellow fever, but if they are to work we first need to recognize there is a problem. To quote a long-ago Philadelphian, Benjamin Franklin, “an ounce of prevention is worth a pound of cure.”

Washington Post
http://www.washingtonpost.com/
Accessed 20 May 2017
Health & Science
Doctors worry as Texas lawmakers OK vaccine restrictions
By Paul J. Weber | AP May 19
AUSTIN, Texas — Texas moved closer Friday to restricting emergency immunizations given to children removed from troubled homes, worrying doctors and handing a political victory for vaccination opponents in a state where the number of families forgoing shots is soaring.
Vaccination critics are trying to build a foothold in Texas, and the state’s Republican-controlled House has now signed off on prohibiting doctors from administering any immediate immunizations— other than for tetanus — for children newly taken into state custody.
Doctors argue there are real implications…

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_13 May 2017

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– 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.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and PolicyVaccines and Global Health_The Week in Review_6 May 2017

Milestones :: Perspectives

World Health Assembly
22–31 May 2017, Geneva
WHA70 – Main documents
:: A70/1 – Provisional agenda

::::::

EBOLA/EVD  [to 13 May 2017]
http://www.who.int/ebola/en/
12 May 2017
Statement on Ebola in the Democratic Republic of the Congo
WHO Statement
On 9 May, WHO was informed of a cluster of undiagnosed illness and deaths including haemorrhagic symptoms in Likati Health Zone, Bas Uele Province in the north of the Democratic Republic of the Congo (DRC), bordering Central African Republic.
On 11 May, the Ministry of Health of the Democratic Republic of Congo informed WHO that of 5 laboratory samples tested, 1 tested positive for Ebola virus at the Institut National de Recherche Biomédicale (INRB) laboratory in Kinshasa. Additional laboratory samples are currently being tested.
Since 22 April, nine suspected cases including 3 deaths have been reported. Six cases are currently hospitalized.
“An investigation team led by the Ministry of Health and supported by WHO and partners has deployed and is expected to reach the affected area in the coming days”, says Dr Peter Salama, WHO Executive Director for Emergencies.
WHO and partners are supporting the Ministry of Health in all aspects of the response, including epidemiological investigation, surveillance, logistics and supplies, communications and community engagement.

Dr Oly Ilunga Kalenga, Minister of Public Health, announces an outbreak of Ebola Virus Disease in Likati district, Bas-Uélé Province (northern DRC) following confirmation by the National Biomedical Research Institute.
KINSHASA, 12 May 2017
The Minister of Public Health of the Democratic Republic of the Congo (DRC), Dr Oly Ilunga Kalenga, has informed the World Health Organization (WHO) of “an outbreak of Ebola Virus Disease (EVD)” in Likati health district (Aketi, Bas-Uélé province), more than 1300 kilometres from Kinshasa in the northern DRC, following confirmation of the disease by the National Biomedical Research Institute (INRB), the national reference laboratory. ‘‘Of the five blood specimens taken from suspected cases and analysed at INRB, one has tested positive for Ebola virus (Zaïre serotype) using real-time polymerase chain reaction,’’ the Minister of Public Health indicated in a letter to the WHO representative in the DRC, and requested ‘‘support from WHO to strengthen the response to this outbreak’’. Since 22 April 2017, 9 suspected EVD cases have been reported including 3 deaths in Likati health district, i.e. a case-fatality rate of 33.3%, according to an official assessment on 11 May 2017.

‘‘The WHO Country Office in the DRC is working closely with the national and provincial authorities and with the WHO Regional Office for Africa, WHO headquarters in Geneva and all other partners to facilitate deployment of health workers and protective kits in the field  to strengthen epidemiological surveillance and rapidly control the outbreak’’, says Dr Yokouidé Allarangar, WHO representative in the DRC.  Dr Allarangar also announced that Dr Matshidiso Moeti, WHO Regional Director for Africa, would arrive in Kinshasa this weekend to attend a coordination meeting of the national committee at the Ministry of Health to deal with this emergency and ensure that WHO provides all necessary assistance to the DRC.

WHO has also drawn up a comprehensive logistics plan to meet  urgent requirements. ‘‘The first teams of epidemiologists, biologists, and experts in the areas of social mobilization, risk communication and community engagement, and also personnel specializing in water, hygiene and sanitation, are scheduled to reach the affected area today or tomorrow via Kisangani’’, the administrative centre of Tshopo (350 kilometres from Buta), Dr Allarangar added.  ‘‘The Likati health district is in a remote area, but contact tracing is essential to contain the outbreak in its focus; the DRC can rely on very experienced health workers for this purpose.’’ Dr Allarangar also appealed to other partners to work with the country to put in place an appropriately coordinated multisectoral approach. Médecins Sans Frontières, the NGO ALIMA, the United Nations Children’s Fund (UNICEF), the Gavi Alliance, the World Food Programme/United Nations Humanitarian Air Service (WFP-UNHAS), and the United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) are now standing ready to lend their support to the authorities in the DRC.

This confirmed outbreak is centred on the Nambwa health area approximately 130 kilometres from Buta, the administrative centre of Bas-Uélé province, which shares a border with the Central African Republic; it is the eighth EVD outbreak in the DRC since 1976. The most recent recorded outbreak was in August 2014 in Boende region, where the disease was brought under control where it started in Lokolia, now in Tshuapa province.

WHO Fact sheets
Ebola virus disease  Updated May 2017

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Emergencies
 

Public Health Emergencies of International Concern (PHEIC)  [to 13 May 2017]

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 10 May 2017
:: A major global polio event will be held this June at the Rotary Convention in Atlanta. Find out more.
:: Pakistan’s polio surveillance network provides a silent force behind eradication efforts. Read more.
:: New animations from the WHO highlight the global scope of the polio surveillance system, how they respond to a polio outbreak and efforts to reach every last child with vaccines.
Summary of newly-reported viruses this week:  Pakistan – two new wild poliovirus type 1 (WPV1) environmental samples.

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin. Guinea and West Africa, and Lao People’s Democratic Republic have been removed from the monitored geographies list.
Pakistan
:: Two new WPV1 positive environmental samples were reported in the past week, from Sindh (Khi Gadap and Khi Landhi, in greater Karachi), collected on 10 and 12 April, respectively.

::::::

WHO Grade 3 Emergencies  [to 13 May 2017]
Iraq 
:: Separated by conflict but reunited: health care in action
7 May 2017 – Thousands of people have been seriously wounded as a result of the conflict in Mosul, with many patients facing permanent disability as a result of their injuries. To date, more than 8000 people, many of them civilians including women and children, have received treatment in hospitals for trauma injuries since west Mosul operations began. For some, these injuries are life-changing.
:: Special health situation report from Mosul  7 May 2017
 
South Sudan 
:: Read the latest cholera situation report pdf, 674kb  5 May 2017
[Excerpts]
…Working with Health and Wash cluster partners, WHO has completed a rational plan for deploying 9 million doses of oral cholera vaccines alongside WASH interventions over the next two years targeting at least 4.5 million people aged one year and above in cholera transmission hotspots. The plan has been submitted to the Global Taskforce for cholera control for approval…

Planned Activities/recommendations

1. The next weekly EPR/cholera taskforce meeting is scheduled for 10 May 2017 starting 2:00pm in the WHO Conference Hall.
2. Roll out a comprehensive integrated response including oral cholera vaccination in response to the cholera outbreak in Mingkaman IDPs, Bentiu PoC, and Bor PoC.
3. Continue with the ongoing response to the outbreaks in Mingkaman, Yirol East, Yirol West, Northern Liech, and Pigi/Malakal Town in Central Upper Nile states.
4. Deploy additional WASH partners to support the cholera response in Yirol East and Yirol West.
5. Develop tailored strategies for cholera prevention and response in affected and at-risk cattle camps.
6. Enhance cholera preparedness, investigation and response activities in Kapoeta North and Kapoeta East as well as Torit county.
7. Identify areas with active transmission that should be prioritized

Yemen
:: WHO responds to resurgent cholera in Yemen
11 May 2017, Sana’a, Yemen — The World Health Organization (WHO) and partners are responding to an upsurge in cholera transmission in several parts of Yemen that has claimed 51 lives and caused around 2752 suspected cases since 27 April 2017. [No OCV mention]
 
Nigeria – No new announcements identified
The Syrian Arab Republic  – No new announcements identified
 

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WHO Grade 2 Emergencies  [to 13 May 2017]
Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified.

::::::

 
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq
:: Mosul Humanitarian Crisis, 9 May 2017
..616,264 People displaced, cumulatively, from Mosul city as of 9 May 409,604 people currently displaced from western Mosul city as of 9 May
…6,612 family plots immediately available to shelter displaced people in 9 priority sites and 10 other sites as of 9 May
…3,100 m³ water trucked every day to eastern Mosul by humanitarian partners
…12,081 people have been referred from frontline areas to hospitals to receive treatment for trauma injuries as of 7 May
OVERVIEW
…Re-intensification of hostilities on 4 May between the Iraqi Security Forces (ISF) and the Islamic State in Iraq and the Levant (ISIL) has significantly impacted the humanitarian situation. Many families have been arriving at the newly established Badoush mustering point, northeast of Mosul city, where humanitarian partners are providing emergency relief assistance…
:: Iraq: Humanitarian Bulletin, April 2017 | Issued on 10 May
:: Iraq: Mosul Humanitarian Response Situation Report No. 32 (1 May to 7 May 2017) [EN/KU]

Syrian Arab Republic
:: Syria Crisis: Menbij and Ar-Raqqa Situation Report No. 4 (as of 1 May 2017)
:: Syrian Arab Republic: Whole of Syria CCCM Cluster response snapshot for 2017 (as of end March) 13 May 2017

Yemen
:: Yemen Humanitarian Response Plan – Funding Status (As of 09 May 2017) [EN/AR]
:: Yemen Humanitarian Bulletin Issue 23 | 9 May 2017
:: Statement on behalf of the humanitarian coordinator, Jamie McGoldrick on the need to ensure funding and humanitarian access into and throughout Yemen [EN/AR] 7 May 2017

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia
:: Somalia: Drought Response – Situation Report No. 7 (as of 9 May 2017)

Ethiopia
:: 9 May 2017  Ethiopia Weekly Humanitarian Bulletin, 08 May 2017

Nigeria
:: Press Statement by Peter Lundberg, Deputy Humanitarian Coordinator/Humanitarian Coordinator A.I on the Release of 82 Chibok Girls
(Abuja, 8 May 2017): The United Nations welcomes the release of the 82 Chibok girls in northeastern Nigeria and appeals to all Nigerians, including the families and communities of the liberated girls, to fully embrace them and provide all necessary support to ensure their reintegration into society.
Over 100 of these school girls are still unaccounted for, and the United Nations urges the international community to continue supporting the Government of Nigeria in its efforts to ensure the release, rehabilitation and reintegration of all the children, women and men who are victims of Boko Haram.
Despite this encouraging news, insecurity continues to affect millions of people living in six states in north-eastern Nigeria amid a deepening humanitarian crisis. Borno, Adamawa and Yobe States, where 8.5 million people are in need of life-saving humanitarian assistance and protection, are the most directly affected by conflict and mass forced displacement. The United Nations and partners are committed to supporting the Government of Nigeria to providing much needed relief to these vulnerable people.

::::::

UNICEF  [to 13 May 2017]
https://www.unicef.org/media/media_94367.html
12 May 2017
Statement attributable to UNICEF’s Regional Office for Latin America and the Caribbean on health data in Venezuela
PANAMA CITY, 12 May 2017 – “Data on infant and maternal deaths released last week by the Ministry of Health in Venezuela provides stark evidence of the impact of the prolonged crisis on women and children in the country.
“Despite the efforts of the Government and other stakeholders, the data indicates that 30 per cent more children died before their first birthday and 64 per cent more women died during pregnancy or within 42 days after giving birth in 2016 compared to 2015. More than 240,000 people were infected with malaria in 2016, up 76 per cent from 2015. Cases of diarrhea, pertussis, pneumonia, HIV, and measles –all potentially deadly for children– also show marked increases.
“The publication of the data by the Ministry of Health is a crucial step in addressing health challenges in Venezuela. UNICEF is deeply concerned about the situation and stands ready to strengthen its ongoing support to partners in government and civil society, which has included the provision of medicine for the treatment of malaria, diphtheria and other diseases, within the framework of agreed cooperation priorities.”

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 13 May 2017
World
Venezuela’s Maduro Replaces Top Health Official After Data Released
By Kejal Vyas
May 12, 2017 12:40 am ET
Move comes days after publication of figures showing sharp declines in public health
Venezuela President Nicolás Maduro replaced his top health official just days after her ministry reported a severe worsening in public health in a rare release of government statistics.
After withholding data since 2015, the Health Ministry in Venezuela this week published an epidemiological bulletin showing a 30% increase in infant mortality…

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::::::

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
EBOLA/EVD  [to 13 May 2017]
http://www.who.int/ebola/en/
12 May 2017
WHO: Statement on Ebola in the Democratic Republic of the Congo
[See Milestones section above for detail]

MERS-CoV [to 13 May 2017]
http://www.who.int/emergencies/mers-cov/en/
[No new digest content identified]
 
Yellow Fever  [to 13 May 2017]
http://www.who.int/emergencies/yellow-fever/en/
[No new digest content identified]
 
Zika virus  [to 13 May 2017]
http://www.who.int/emergencies/zika-virus/en/
[No new digest content identified]
 
::::::
::::::

WHO & Regional Offices [to 13 May 2017]

WHO: Access to medicines: making market forces serve the poor
11 May 2017
Nearly 2 billion people have no access to basic medicines, causing a cascade of preventable misery and suffering. Since the landmark agreement on the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, WHO and its partners have launched a number of initiatives that are making market forces serve the poor. The WHO prequalification programme is now firmly established as a mechanism for improving access to safe, effective and quality-assured products.
Access to medicines
WHO has struggled to improve access to medicines throughout its nearly 70-year history, and rightly so. Good health is impossible without access to pharmaceutical products. Universal health coverage depends on the availability of quality-assured affordable health technologies in sufficient quantities.
Lack of access to medicines causes a cascade of misery and suffering, from no relief for the excruciating pain of a child’s earache, to women who bleed to death during childbirth, to deaths from diseases that are easily and inexpensively prevented or cured. Lack of access to medicines is one inequality that can be measured by a starkly visible yardstick: numbers of preventable deaths.
Efforts to improve access to medicines are driven by a compelling ethical imperative. People should not be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic or social causes.
Millions of yearly childhood deaths from diseases that could have been prevented or cured by existing medical products would be unthinkable in a fair and just world.
The world is neither. An estimated two billion people have no access to essential medicines, effectively shutting them off from the benefits of advances in modern science and medicine.

WHO improves transparency of financial data
12 May 2017 – WHO is improving transparency and accountability with the launch of a redesigned Programme Budget Web Portal that makes budget and spending information easier to access, use and understand. The redesigned portal provides timely and detailed budget, financing and expenditure data on WHO activities and how they are funded in countries, regions and internationally.

WHO calls for immediate action in Somalia
11 May 2017 – WHO is concerned by the shortage of funding for life-saving work in Somalia in response to the ongoing drought that has plunged the country further towards famine, disease, and health insecurity. Drought in Somalia led to the destruction of crops and livestock, leaving more than 3.3 million people hungry. If this continues, famine could soon be a reality, creating a devastating cycle of hunger and disease.

Highlights
WHO list of priority medical devices for cancer management
May 2017 – From kick buckets to MRI units, medical devices are an indispensable part of preventing, diagnosing and treating cancer, as well as for palliative care for cancer patients. WHO’s new List of priority medical devices for cancer management describes hundreds of devices that are needed for six types of cancer: breast, cervical, colorectal, leukemia, lung and prostate.

WHO responds to resurgent cholera in Yemen
May 2017 – WHO and partners are responding to an upsurge in cholera transmission in several parts of Yemen that has claimed 51 lives and caused around 2752 suspected cases since 27 April 2017. WHO has rapidly distributed medicines and medical supplies, including cholera kits, oral rehydration solutions and intravenous (IV) fluids as well as medical furniture and equipment for diarrhoea treatment centres.

Preparing for the next influenza pandemic
May 2017 – This year the World Health Assembly will receive the first review of the Pandemic Influenza Preparedness (PIP) Framework – an agreement helping to prepare the world for the next influenza pandemic by ensuring that all countries, whether rich or poor, have access to influenza vaccines.
::::::

Weekly Epidemiological Record, 12 May 2017, vol. 92, 19 (pp. 241–268)
Human papillomavirus vaccines: WHO position paper, May 2017

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Ebola virus disease – Democratic Republic of the Congo 13 May 2017 [See  Milestones above for more detail]
:: Dr Oly Ilunga Kalenga, Minister of Public Health, announces an outbreak of Ebola Virus Disease in Likati district, Bas-Uélé Province (northern DRC) following confirmation by the National Biomedical Research Institute. – 12 May 2017
:: Ebola vaccines for Guinea and the world – 08 May 2017

WHO Region of the Americas PAHO
No new announcements identified.

WHO South-East Asia Region SEARO
:: Amitabh Bachchan appointed WHO Goodwill Ambassador for Hepatitis in South-East Asia Region  SEAR/PR/1649
Mumbai, 12 May 2017 – World Health Organization today appointed legendary Indian movie star Mr Amitabh Bachchan as its Goodwill Ambassador for Hepatitis in South-East Asia Region to boost awareness and intensify action to arrest the hepatitis epidemic.
 
WHO European Region EURO
:: Reviewing the health impact and effectiveness of urban green space interventions 11-05-2017
:: Reducing the SDG reporting burden: WHO/Europe’s initiative presented at the Regional Forum on Sustainable Development 09-05-2017

WHO Eastern Mediterranean Region EMRO
:: WHO support gives new life to Syrian refugees in Egypt requiring emergency medical care
7 May 2017

WHO Western Pacific Region
:: DOH, WHO Launch Cooperation Strategies Toward a Healthy Philippines
DAVAO CITY, 11 May 2017 – Health statistics over the years indicate that more Filipinos live longer now as a result of collaborative efforts of the government, various development partners and stakeholders. Several health sector reforms have been made to expand the breadth and depth of health service delivery and coverage. The World Health Organization has been a staunch partner of the Government in developing strategies to improve the health of the people.

CDC/ACIP [to 13 May 2017]
http://www.cdc.gov/media/index.html

Press Release
Thursday, May 11, 2017
New Hepatitis C Infections Nearly Tripled over Five Years
Deadly virus concentrated among baby boomers and increasing rapidly among new generations of Americans
Over just five years, the number of new hepatitis C virus infections reported to CDC has nearly tripled, reaching a 15-year high, according to new preliminary surveillance data released today by the Centers for Disease Control and Prevention (CDC).

Because hepatitis C has few symptoms, nearly half of people living with the virus don’t know they are infected and most new infections go undiagnosed. Further, limited surveillance resources have led to underreporting, meaning the annual number of hepatitis C virus cases reported to CDC (850 cases in 2010 and 2,436 cases in 2015) does not reflect the true scale of the epidemic. CDC estimates about 34,000 new hepatitis C infections actually occurred in the U.S. in 2015.

Hepatitis C kills more Americans than any other infectious disease reported to CDC. The data released today indicate that nearly 20,000 Americans died from hepatitis C-related causes in 2015, and the majority of deaths were people ages 55 and older.

“By testing, curing, and preventing hepatitis C, we can protect generations of Americans from needless suffering and death,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “We must reach the hardest-hit communities with a range of prevention and treatment services that can diagnose people with hepatitis C and link them to treatment. This wide range of services can also prevent the misuse of prescription drugs and ultimately stop drug use – which can also prevent others from getting hepatitis C in the first place.”…

Announcements
 

Human Vaccines Project   [to 13 May 2017]
http://www.humanvaccinesproject.org/media/press-releases/
08 May, 2017
New Study Aims to Explain the Rules of How The Immune System Works
Findings from this research will inform how to generate long-lasting immunity against diseases
NEW YORK, May 8, 2017 /PRNewswire-USNewswire/ — The Human Vaccines Project, a nonprofit public-private partnership focused on decoding the immune system to improve human health, announced today the initial enrollment of its first clinical trial in a new program aimed at dramatically increasing knowledge of how the immune system works. The study is the first step in a series of trials, with the goal of engineering the human immune system to confer lifelong protection from infectious and non-communicable diseases across global populations.

“While vaccines are among the greatest successes in the history of public health, we do not fully understand how most vaccines work and why some are less effective in certain populations,” said Wayne C. Koff, Ph.D., president and CEO of the Human Vaccines Project. “Determining the core principles of how the human immune system recognizes pathogens and fights diseases will enable a more precise approach for developing vaccines and immunotherapies for a wide range of diseases such as AIDS, tuberculosis, diabetes, multiple sclerosis and cancer.”

The initial study will assess immune responses of 10 healthy adults (ages 40-80) to a licensed hepatitis B vaccine. It will feature one of the most comprehensive analyses of how people respond to vaccinations to learn why some individuals are protected from a single dose, while others are not. The study will expand to include several hundred people – from neonates to the elderly in middle and low-income countries.

“Developing a better understanding of why some groups of people are protected from disease is a goal that simply must be achieved,” said Co-Principal Investigator Tobias Kollmann, M.D., Ph.D., professor of pediatrics at the University of British Columbia (UBC) and an investigator at the Vaccine Evaluation Center in Vancouver, Canada. “The licensed hepatitis B vaccine, which only works in about 30 percent of people on the first shot, is an ideal model vaccine to study general principles of human immunological protection because it is one of the few vaccines for which we know how it protects.”

The study will take place at the at the Vaccine Evaluation Center, in Vancouver, Canada, and will be augmented by extensive immunological and bioinformatic analyses at the Project’s San Diego Mesa Consortium, which includes the J. Craig Venter Institute, the La Jolla Institute, The Scripps Research Institute, and UC San Diego, with clinical coordination by the Vanderbilt Institute for Clinical and Translational Research.

“With technological advances in biomedical, computational and engineering sciences, we have an unprecedented opportunity to decipher the immune system’s components and core principles required to generate long-lasting immunity against disease, and usher in a new era of global health,” added Stanley Plotkin, M.D., Chairman of the Human Vaccines Project’s Board of Directors.

 
::::::
 

Gavi [to 13 May 2017]
http://www.gavi.org/library/news/press-releases/
08 May 2017
U.S. approves US$ 275 million for Gavi in fiscal year 2017 budget
Funding to provide life-saving vaccines to children.
Washington, DC, 8 May 2017– Gavi, the Vaccine Alliance welcomed final approval of the U.S. fiscal year 2017 appropriations bill that includes US$ 275 million for Gavi, funding that will greatly enhance Gavi’s capacity to purchase and deliver life-saving vaccines for children in the world’s poorest countries. This will help immunise millions of children in developing countries against vaccine-preventable diseases, which claim 1.5 million lives every year.
The contribution to Gavi is part of the US$ 814.5 million approved for USAID’s Maternal and Child Health programs for 2017. This funding not only supports the introduction of new vaccines, innovative approaches and tools to expand equitable access to vaccines, but a range of other life-saving interventions.
“We are extremely grateful for the continued strong bipartisan support for Gavi’s role in expanding global immunisation programs, especially in a particularly challenging budget environment. Vaccines are one of the best buys in global health and healthy families contribute to healthy economies,” said Gavi CEO Dr. Seth Berkley…

 
::::::
 

CEPI – Coalition for Epidemic Preparedness Innovations  [to 13 May 2017]
http://cepi.net/
Newsletter 12 May 2017
[Excerpt]
Address from CEO
Last week I had the pleasure of attending the World Economic Forum – Africa meeting in Durban, South Africa, which began with a session on “Leadership in an Era of Disruption” that probed the question of how Africa’s leaders can better respond to the many challenges they face. At the end of the session, the moderator asked the audience to remain seated for a memorial video honoring Ahmed Kathrada, one of the last surviving and youngest of the Rivonia Trialists who had been imprisoned with Nelson Mandela on Robben Island, who passed away in March. It was an inspiring session, honoring the sacrifices of the past and looking with hope toward the future.
In Durban, I met many inspiring individuals: Victor Ochen, the Director of AYINET, an organization that addresses the needs of children displaced by conflict, who in 2015 became the youngest African ever to be nominated for a Nobel prize; Keller Rinaudo, an entrepreneur who founded Zipline, which has established the world’s first commercial drone delivery system — in Rwanda, delivering blood products to remote hospitals in as little as 30 minutes; and John Nkengasong, the first director of the recently established Africa CDC – to name just a few. Each has an incredible story to tell, and each is making the continent – and the world – a better place.
CEPI is part of this unfolding story. African scientists still command too small a share of Africa’s GDP but increasingly are asserting their right to set the science agenda for the continent. CEPI, for its part, is committed to working closely with African scientists and institutions to develop products and design clinical trials that serve the needs of their communities. While the World Economic Forum was convening in South Africa, a meeting on Ebola, hosted by President Condé of Guinea, took place in Conakry.  In her opening remarks at that meeting, Margaret Chan, the Director-General of the World Health Organization, said “A safe and efficacious Ebola vaccine was the world’s best gift during 2016” and highlighted the contributions of scientists from Guinea, the Guinea national medicine and regulatory agency, and the national ethics committee who worked with the international team to complete the ring vaccination study there. She also highlighted the role of CEPI in contributing to global preparedness for such threats in the future.
This week, in London, CEPI’s Scientific Advisory Committee reviewed the white papers submitted in response to CEPI’s first call for proposals. The best of these will now be developed into full proposals.  CEPI is taking its first definitive steps toward fulfilling its promise.

 
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IAVI – International AIDS Vaccine Initiative   [to 13 May 2017]
https://www.iavi.org/
[Undated]
HIV VACCINE AWARENESS DAY – HVAD 2017 Campaign Toolkit
On May 18, join IAVI in recognizing the thousands of trial volunteers, clinicians, scientists, advocates, and communities leading the global search for a vaccine.

 
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UNAIDS  [to 13 May 2017]
http://www.unaids.org/
Selected Press Releases & Updates
Update
UNAIDS and Xinhua partnership brings the common goal of ending AIDS closer
News agency is a key partner through its efforts of reaching billions of people with life-saving…

Feature Story
Germany—ending AIDS by 2020
Deutsche AIDS-Hilfe has launched a new campaign to end AIDS in Germany by 2020. The campaign features Maik, who nine years ago was fighting for his life.

Feature Story
Interviews with the candidates for WHO Director-General
David Nabarro, Sania Nishtar and Tedros Adhanom Ghebreyesus talk to unaids.org about the AIDS epidemic and global health.

 
::::::
 
NIH  [to 13 May 2017]
http://www.nih.gov/news-events/news-releases
May 10, 2017
Cell particles may help spread HIV infection, NIH study suggests
HIV appears to enlist the aid of nano-sized structures released by infected cells to infect new cells, according to a study by researchers at the National Institutes of Health. Known as extracellular vesicles (EVs), these bubble-like structures are made by many kinds of cells and, under most circumstances, are thought to ferry molecules from one cell to another, providing a means of communication. NIH scientists discovered that cells infected with HIV appear to produce EVs that manipulate prospective host cells to pass infection to other cells. The study appears in Scientific Reports…

::::::
 

FDA [to 13 May 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
:: May 2, 2017 Approval Letter – ACAM2000 (PDF – 33KB)  Posted: 5/9/2017
:: Complete List of Currently Approved Premarket Approvals (PMAs) (PDF – 16KB)
Posted: 5/9/2017; Updated as of 5/4/2017
:: Complete List of Currently Approved NDA and ANDA Application Submissions (PDF – 17KB)
Posted: 5/9/2017; Updated as of 5/4/2017

 
::::::
 

Wellcome Trust  [to 13 May 2017]
https://wellcome.ac.uk/news
11 May 2017
Largest UK resource of human stem cells created
Scientists have created the UK’s largest resource of human stem cells from healthy people. This is a powerful research tool for studying human development and disease.
Researchers generated human induced pluripotent stem cells (iPSCs) on a large scale to study cell differences between individuals…
9 May 2017
International Research Scholars announced
Wellcome has teamed up with the Howard Hughes Medical Institute (HHMI), the Bill & Melinda Gates Foundation, and the Calouste Gulbenkian Foundation for a new research award that will develop scientific talent around the world.
Today the first 41 early-career scientists to receive the International Research Scholars awards (opens in a new tab) were announced.
This group of scholars will receive a total of nearly $26.7 million, with each researcher receiving $650,000 over five years…
8 May 2017
23 researchers given prestigious fellowships
Members of the Wellcome community have been elected fellows of two prestigious organisations.
Fourteen have been elected Fellows of the Academy of Medical Sciences, and nine have been elected Fellows of the Royal Society.

 
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European Medicines Agency  [to 13 May 2017]
http://www.ema.europa.eu/ema/
08/05/2017
Involving patients in discussions on benefits and risks of medicines
EMA publishes report on CHMP pilot project
The European Medicines Agency (EMA) has published a final report on the experience gained during its pilot project to involve patients directly in the assessment of the benefits and risks of medicines in its Committee for Medicinal Products for Human Use (CHMP).
The report concludes that patients should continue to be invited to oral explanations when their input could be valuable to the assessment of a medicine. This could be the case, for example, when the Committee is considering whether to recommend the authorisation of a new medicine or the maintenance, suspension or revocation of an existing authorisation, or a restriction of indication of an authorised medicine…

::::::
GHIT Fund   [to 13 May 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.
2017.05.10      News
New interview articles posted on our 5th Anniversary website:
– Dr. Hannah Kettler Senior Program Officer, Life Science Partnerships, Global Health Program, Office of the President, Bill & Melinda Gates Foundation
– Mr. George Nakayama, Representative Director, Chairman and CEO, Daiichi Sankyo Company, Limited
– Mr. Yoshihiko Hatanaka, Representative Director, President and CEO, Astellas Pharma Inc.
– Mr. Gen Miyazawa, Executive Corporate Officer EVP, President of Media Group, Yahoo Japan Corporation

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

Report Launch: “Global Health and the Future Role of the United States”
May 15, 2017 (11:00 AM Eastern)  Register here (Webcast Available)
National Academy of Sciences Building (Rm. 125) • 2101 Constitution Avenue, NW, Washington, DC 20418
The report “Global Health and the Future Role of the United States” examines the changing landscape of global health and opportunities for the U.S. government, as well as nongovernmental organizations and the private sector, to improve responsiveness, coordination, and efficiency.

Journal Watch

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

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

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 13 May 2017)

Research article
Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare
The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.
Linda Richter Sundberg, Rickard Garvare and Monica Elisabeth Nyström
BMC Health Services Research 2017 17:344
Published on: 11 May 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 13 May 2017)

Research article
The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries
Joseph L. Ward and Russell M. Viner
BMC Public Health 2017 17:429
Published on: 11 May 2017
Abstract
Background
Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world.
Methods
We performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1–4, 5–9, 10–14, 15–19 and 20–24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP.
Results
Data were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20–24 year olds, and increased non-communicable disease mortality amongst 20–24 year old females. The strength of these associations tended to increase during adolescence.
Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15–19 year old females, and 15–24 year old males. GDP became a weaker predictor of mortality during adolescence.
Conclusion
Policies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.

Research article
The comprehensive ‘Communicate to Vaccinate’ taxonomy of communication interventions for childhood vaccination in routine and campaign contexts
Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways.
Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice.
In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions.
Jessica Kaufman, Heather Ames, Xavier Bosch-Capblanch, Yuri Cartier, Julie Cliff, Claire Glenton, Simon Lewin, Artur Manuel Muloliwa, Afiong Oku, Angela Oyo-Ita, Gabriel Rada and Sophie Hill
BMC Public Health 2017 17:423
Published on: 10 May 2017

Research article
Comparing national infectious disease surveillance systems: China and the Netherlands
Risk assessment and early warning (RAEW) are essential components of any infectious disease surveillance system. In light of the International Health Regulations (IHR)(2005), this study compares the organisati…
Willemijn L. Vlieg, Ewout B. Fanoy, Liselotte van Asten, Xiaobo Liu, Jun Yang, Eva Pilot, Paul Bijkerk, Wim van der Hoek, Thomas Krafft, Marianne A. van der Sande and Qi-Yong Liu
BMC Public Health 2017 17:415
Published on: 8 May 2017

Emerging Infectious Diseases
Volume 23, Number 5—May 2017
http://wwwnc.cdc.gov/eid/

Research
Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China PDF Version [PDF – 1.62 MB – 8 pages]
Cui et al.
Abstract
China’s hepatitis B virus (HBV) prevention policy has been evaluated through nationally representative serologic surveys conducted in 1992 and 2006. We report results of a 2014 serologic survey and reanalysis of the 1992 and 2006 surveys in the context of program policy. The 2014 survey used a 2-stage sample strategy in which townships were selected from 160 longstanding, nationally representative, county-level disease surveillance points, and persons 1–29 years of age were invited to participate. The 2014 sample size was 31,713; the response rate was 83.3%. Compared with the 1992 pre–recombinant vaccine survey, HBV surface antigen prevalence declined 46% by 2006 and by 52% by 2014. Among children <5 years of age, the decline was 97%. China’s HBV prevention program, targeted toward interrupting perinatal transmission, has been highly successful and increasingly effective. However, this progress must be sustained for decades to come, and elimination of HBV transmission will require augmented strategies.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 13 May 2017]

Research
Gender blind? An analysis of global public-private partnerships for health
Sarah Hawkes, Kent Buse and Anuj Kapilashrami
Published on: 12 May 2017
Abstract
Background
The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system.
We identified 18 GPPPH – defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors – and conducted a gender analysis of each.
Results
Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women – up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases – none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens.
Conclusions
We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

Health Affairs
May 2017; Volume 36, Issue 5
http://content.healthaffairs.org/content/current
Issue Focus: ACA Coverage, Access, Medicaid & More

Global Health
Mongolia’s Public Spending On Noncommunicable Diseases Is Similar To The Spending Of Higher-Income Countries
Otgontuya Dugee, Enkhtuya Munaa, Ariuntuya Sakhiya, and Ajay Mahal
Health Aff May 2017 36:918-925; doi:10.1377/hlthaff.2016.0711
Abstract
Although there is increased recognition of the global challenge posed by noncommunicable diseases (NCDs), translating that awareness into resources for action requires better data than typically available in low- and middle-income countries. One middle-income country that does have good-quality information is Mongolia. Using detailed administrative data from Mongolia and supplementary survey-based information, we estimated public spending on four NCDs in Mongolia and reached four main conclusions. First, Mongolia’s public spending patterns on NCDs are similar to NCD spending observed in countries with much higher per capita incomes. Second, public spending for NCDs is low relative to the NCD disease burden in Mongolia. Third, public-sector NCD spending is dominated by inpatient care and hospital-based specialist outpatient services, which suggests inefficiency in resource use. Finally, while public spending on cardiovascular disease is evenly distributed across regions, for cancers it is heavily concentrated in the nation’s capital.

Health Affairs
May 2017; Volume 36, Issue 5
http://content.healthaffairs.org/content/current
Issue Focus: ACA Coverage, Access, Medicaid & More

DATAWATCH: Vast Majority Of Development Assistance For Health Funds Target Those Below Age Sixty
Vegard Skirbekk, Trygve Ottersen, Hannah Hamavid, Nafis Sadat, and Joseph L. Dieleman
Health Aff May 2017 36:926-930; doi:10.1377/hlthaff.2016.1370
Abstract
Development assistance for health targets younger more than older age groups, relative to their disease burden. This disparity increased between 1990 and 2013. There are several potential causes for the disparity increase.

Health Affairs
May 2017; Volume 36, Issue 5
http://content.healthaffairs.org/content/current
Issue Focus: ACA Coverage, Access, Medicaid & More

Improving Allocation And Management Of The Health Workforce In Zambia
Fiona J. Walsh, Mutinta Musonda, Jere Mwila, Margaret Lippitt Prust, Kathryn Bradford Vosburg,
Günther Fink, Peter Berman, and Peter C. Rockers
Health Aff May 2017 36:931-937; doi:10.1377/hlthaff.2016.0679
Abstract
Building a health workforce in low-income countries requires a focused investment of time and resources, and ministries of health need tools to create staffing plans and prioritize spending on staff for overburdened health facilities. In Zambia a demand-based workload model was developed to calculate the number of health workers required to meet demands for essential health services and inform a rational and optimized strategy for deploying new public-sector staff members to the country’s health facilities. Between 2009 and 2011 Zambia applied this optimized deployment policy, allocating new health workers to areas with the greatest demand for services. The country increased its health worker staffing in districts with fewer than one health worker per 1,000 people by 25.2 percent, adding 949 health workers to facilities that faced severe staffing shortages. At facilities that had had low staffing levels, adding a skilled provider was associated with an additional 103 outpatient consultations per quarter. Policy makers in resource-limited countries should consider using strategic approaches to identifying and deploying a rational distribution of health workers to provide the greatest coverage of health services to their populations.

Health Policy and Planning
Volume 32, Issue 5  June 2017
http://heapol.oxfordjournals.org/content/current

Original Articles
Improving access to child health services at the community level in Zambia: a country case study on progress in child survival, 2000–2013
Aaron M Kipp; Margaret Maimbolwa; Marie A Brault; Penelope Kalesha-Masumbu; Mary Katepa-Bwalya …
Abstract
Reductions in under-five mortality in Africa have not been sufficient to meet the Millennium Development Goal #4 (MDG#4) of reducing under-five mortality by two-thirds by 2015. Nevertheless, 12 African countries have met MDG#4. We undertook a four country study to examine barriers and facilitators of child survival prior to 2015, seeking to better understand variability in success across countries. The current analysis presents indicator, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve MDG#4. Results identified a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health. Zambia has also focused on bringing health services as close to the family as possible through specific community health strategies. This includes actively involving community health workers to provide health education, basic MNCH services, and linking women to health facilities, while supplementing community and health facility work with twice-yearly Child Health Weeks. External partners have contributed greatly to Zambia’s MNCH services, and their relationships with the government are generally positive. As government funding increases to sustain MNCH services, national health strategies/plans are being used to specify how partners can fill gaps in resources. Zambia’s continuing MNCH challenges include basic transportation, access-to-care, workforce shortages, and financing limitations. We highlight policies, programs, and implementation that facilitated reductions in under-five mortality in Zambia. These findings may inform how other countries in the African Region can increase progress in child survival in the post-MDG period

Health Policy and Planning
Volume 32, Issue 5  June 2017
http://heapol.oxfordjournals.org/content/current

Editor’s Choice
Civil war, contested sovereignty and the limits of global health partnerships: A case study of the Syrian polio outbreak in 2013
Jonathan Kennedy; Domna Michailidou
Abstract
States and the World Health Organization (WHO), an international organization that is mandated to respect the sovereignty of its member states, are still the leading actors in global health. This paper explores how this discrepancy inhibits the ability of global health partnerships to implement programmes in conflict-affected areas that are under the de facto control of rebel organizations. We concentrate on a single crucial case, the polio outbreak in Syria in 2013, analysing a variety of qualitative data—twenty semi-structured interviews with key actors, official documents, and media reports—in order to investigate the events that preceded and followed this event. The WHO’s mandate to respect the Syrian government’s sovereignty inhibited its ability to prevent, identify and contain the outbreak because the Assad regime refused it permission to operate in rebel-controlled areas. The polio outbreak was identified and contained by organizations operating outside the United Nations (UN) system that disregarded the Syrian government’s sovereignty claims and cooperated with the militants. Thus, we identify a serious problem with so-called global health partnerships in which nation states and international organizations remain key actors. Such initiatives function well in situations where there is a capable state that is concerned with the welfare of its citizens and has exclusivity of jurisdiction over its territory. But they can encounter difficulties in areas where rebels challenge the state’s sovereignty. Although the response to the Syrian polio outbreak was ultimately effective, it was reactive, ad hoc, slow and relied on personnel who had little experience. Global health partnerships would be more effective in conflict-affected areas if they put in place proactive and institutionalized plans to implement their programmes in regions outside government control.

Health Policy and Planning
Volume 32, Issue 5  June 2017
http://heapol.oxfordjournals.org/content/current

Frameworks to assess health systems governance: a systematic review
Thidar Pyone; Helen Smith; Nynke van den Broek
Abstract
Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal–agent theory, theory of common pool resources, North’s institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified as well as replicate and scale-up examples of good practice.

Health Policy and Planning
Volume 32, Issue 5  June 2017
http://heapol.oxfordjournals.org/content/current

Evaluating the effect of integrated microfinance and health interventions: an updated review of the evidence
Lara M J Lorenzetti; Sheila Leatherman; Valerie L Flax
Abstract
Background: Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor populations. Integrated microfinance and health interventions leverage networks of women to promote financial inclusion, build livelihoods, and safeguard against high cost illnesses. Our understanding of the effect of integrated interventions has been limited by variability in intervention, outcome, design, and methodological rigour. This systematic review synthesises the literature through 2015 to understand the effect of integrated microfinance and health programs.
Methods: We searched PubMed, Scopus, Embase, EconLit, and Global Health databases and sourced bibliographies, identifying 964 articles exclusive of duplicates. Title, abstract, and full text review yielded 35 articles. Articles evaluated the effect of intentionally integrated microfinance and health programs on client outcomes. We rated the quality of evidence for each article.
Results: Most interventions combined microfinance with health education, which demonstrated positive effects on health knowledge and behaviours, though not health status. Among programs that integrated microfinance with other health components (i.e. health micro-insurance, linkages to health providers, and access to health products), results were generally positive but mixed due to the smaller number and quality of studies. Interventions combining multiple health components in a given study demonstrated positive effects, though it was unclear which component was driving the effect. Most articles (57%) were moderate in quality.
Discussion: Integrated microfinance and health education programs were effective, though longer intervention periods are necessary to measure more complex pathways to health status. The effect of microfinance combined with other health components was less clear. Stronger randomized research designs with multiple study arms are required to improve evidence and disentangle the effects of multiple component microfinance and health interventions. Few studies attempted to understand changes in economic outcomes, limiting our understanding of the relationship between health and income effects.

Health Policy and Planning
Volume 32, Issue 5  June 2017
http://heapol.oxfordjournals.org/content/current

Commentary
Redefining public health leadership in the sustainable development goal era
K Srinath Reddy; Manu Raj Mathur; Sagri Negi; Bhargav Krishna
Abstract
Adoption of the Sustainable Development Goals (SDGs) by member states of the United Nations (UN) has set a new agenda for public health action at national and global levels. The changed context calls for a reframing of what constitutes effective leadership in public health, through a construct that reflects the interdependence of leadership at multiple levels across the health system and its partners in other sectors. This is especially important in the context of Low and Middle Income Countries (LMICs) that are facing complex demographic and epidemiological transitions. The health system needs to exercise leadership that effectively mobilises all its resources for maximising health impact, and channels trans-disciplinary learning into well-coordinated multi-sectoral action on the wider determinants of health. Leadership is essential not only at the level of inspirational individuals who can create collective vision and commitment but also at the level of supportive institutions situated in or aligned to the health system. In turn, the health system as a whole has to exercise leadership that advances public health in the framework of sustainable development. This commentary examines the desirable attributes of effective leadership at each of these levels and explores the nature of their inter-dependence.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 13 May 2017]

Letter to the Editor
Open Access
Rebuilding transformation strategies in post-Ebola epidemics in Africa
Ernest Tambo, Chryseis F. Chengho, Chidiebere E. Ugwu, Isatta Wurie, Jeannetta K. Jonhson and Jeanne Y. Ngogang
Infectious Diseases of Poverty20176:71
DOI: 10.1186/s40249-017-0278-2
Published: 10 May 2017
Abstract
Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national ‘One Health’ approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.