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

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

Milestones :: Perspectives

Editor’s Note:
We urge readers to invest the time necessary to read and absorb the “Five Most Important Points” below excerpted from this first report of the Transition Independent Monitoring Board (TIMB). We are reflecting on their strategic impact to the poliovirus eradication effort, early planning for GVAP 2.0, and, indeed, the “immunization enterprise” overall.

THE END OF THE BEGINNING – First Report of the Transition Independent Monitoring Board of the Polio Programme
July 2017 :: 35 pages
PDF: http://polioeradication.org/wp-content/uploads/2017/07/TIMB_Report-no1_Jul2017_EN.pdf
This report
The Transition Independent Monitoring Board (TIMB) was created by the Global Polio Eradication Programme (GPEI) to monitor and guide the process of polio transition planning. This is our first report. It provides an initial analysis of the priorities, plans, risks and opportunities as the eradication of polio appears to be drawing closer. In this first report, we have concluded by identifying areas of further work. Our subsequent reports will make recommendations for action.

F I V E  M O S T  I M P O R TA N T  P O I N T S
:: On average, 25% to 50% of staff funded through the Global Polio Eradication Initiative (GPEI) spend time on non-polio activities such as routine immunisation, broader disease surveillance, laboratory support, and responding to public health emergencies; some countries’ health systems have been heavily dependent on polio funding for decades; 95% of the polio asset footprint is concentrated in 16 countries that are the most vulnerable to withdrawal of funding; many of the same countries face simultaneous withdrawal of funding from Gavi and some other sources.

:: If polio eradication succeeds but poorer countries’ public health services collapse in the initiative’s wake, it would be a major failure of global governance and stewardship. The risks to global health and to vulnerable populations are high if the polio transition process is mismanaged. They include: disruption of the path to eradication so that polio resurges; failure to secure and sustain staff, infrastructure and expertise necessary to detect, prevent and control other communicable diseases; direct threats to global biosecurity; rises in death rates from vaccine preventable diseases; humanitarian crises in fragile states; lost opportunities to develop health systems; a drop in resources to respond to public health crises.

:: The transition planning process initiated by the Global Polio Eradication Initiative (GPEI) is predicated on four assumptions: firstly, that to the degree possible, countries will absorb the costs of sustaining polio assets within their public health systems; secondly, that countries will prepare national plans that map out the role polio assets play in their health systems and the deficits that will be created when the GPEI closes; thirdly, that the national plans will align with the targets laid out in the Global Vaccine Action Plan (GVAP) approved and endorsed by all WHO member states; fourthly, that by-and-large donors will be prepared to fill the gap.

:: The GPEI is not a donor. It has been a vehicle for receipt of donations and targeting expenditure for 30 years. As polio eradication nears, the GPEI’s legitimacy to mobilise and oversee resources for the resulting gaps in public health provision is fading. It will not be in a position to receive, coordinate, or allocate donor funding for such purposes; soon it will not exist. Once at the end of polio eradication, funding gaps for routine immunisation and other services will be recurrent and permanent; there will be less donor tolerance towards those countries that they feel should be providing their own resources for non-polio public health services.

:: Beyond the world of polio leaders, academics, donors, and enthusiasts, there is little awareness or understanding of the enormity, complexity, and urgency of the action needed to deal effectively winding down of polio funding begun in 2017; nor is there enough appreciation that the poliovirus will not feel the need to comply with an orderly series of planned measures that will allow itself to be eradicated; polio eradication is progressing alongside polio transition planning and if the latter speeds too far ahead, there is a huge risk that resources will not be available to respond to polio and other disease outbreaks.
 
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Experimental HIV vaccine regimen is well-tolerated, elicits immune responses
NIH   Monday, July 24, 2017
Results from early-stage NIH-funded trial support further development of candidate vaccines.
Results from an early-stage clinical trial called APPROACH show that an investigational HIV vaccine regimen was well-tolerated and generated immune responses against HIV in healthy adults. The APPROACH findings, as well as results expected in late 2017 from another early-stage clinical trial called TRAVERSE, will form the basis of the decision whether to move forward with a larger trial in southern Africa to evaluate vaccine safety and efficacy among women at risk of acquiring HIV.

The APPROACH results will be presented July 24 at the 9th International AIDS Society Conference on HIV Science in Paris.

The experimental vaccine regimens evaluated in APPROACH are based on “mosaic” vaccines designed to induce immunological responses against a wide variety of HIV subtypes responsible for HIV infections globally. Different HIV subtypes, or clades, predominate in various geographic regions around the world. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, funded pre-clinical development of these vaccines. Together with other partners, NIAID supported the APPROACH trial, which is sponsored by Janssen Vaccines & Prevention B.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson. The manufacture and clinical development of the mosaic vaccines are led by Janssen.

“A safe and effective HIV vaccine would be a powerful tool to reduce new HIV infections worldwide and help bring about a durable end to the HIV/AIDS pandemic,” said NIAID Director Anthony S. Fauci, M.D. “By exploring multiple promising avenues of vaccine development research, we expand our opportunities to achieve these goals.”…

Johnson & Johnson Announces Encouraging First-in-Human Clinical Data for Investigational HIV Preventive Vaccine
…In Phase 1/2a APPROACH study, HIV-1 antibody response observed in all healthy volunteers
…Mosaic-based vaccine regimen is designed to elicit an immune response against a wide variety of HIV subtypes prevalent worldwide
…Positive clinical and preclinical results inform selection of lead mosaic HIV vaccine regimen for further evaluation in Phase 2b proof-of-concept study
July 24, 2017
PARIS, France–(BUSINESS WIRE)–Johnson & Johnson today announced encouraging first-in-human clinical data for an investigational HIV-1 vaccine regimen in development at its Janssen Pharmaceutical Companies. In an oral presentation of the early stage Phase 1/2a APPROACH study at the 9th IAS Conference on HIV Science (IAS 2017), the “mosaic”-based vaccine regimen from Janssen Vaccines & Prevention B.V. (Janssen) appeared to be well-tolerated and elicited HIV-1 antibody responses in 100% of healthy volunteers (n=393).

“Finding a preventive vaccine has proven to be one of the biggest scientific challenges in the 35-year quest to end the HIV pandemic. A successful preventive vaccine for HIV will need to provide broad protection against a wide range of viral strains,” said Professor Dan Barouch, Harvard Medical School, Director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and a key collaborator for APPROACH. “These promising, early-stage results suggest that these vaccines utilizing mosaic immunogens should be evaluated further for their potential ability to achieve this historic goal.”

Significant progress has been made in the global battle against HIV/AIDS, including the development of critical antiretroviral treatments and HIV prevention tools, yet the disease remains one of the greatest global health threats of our time. An estimated 37 million people are currently living with HIV-1 globally, and nearly 2 million people become newly infected each year. An effective HIV vaccine is elusive due to the unique properties of the virus – including its genetic diversity and ability to mutate rapidly.

Mosaic-based vaccines contain immunogens created using genes from different HIV subtypes responsible for HIV-1 infections worldwide. These immunogens are delivered through viral vectors, including Janssen’s AdVac® technology based on adenovirus serotype 26 (Ad26). The viral vectors are combined with other components such as soluble proteins to form mosaic-based prime-boost vaccine regimens that first prime and then boost the immune system, with the aim of producing stronger and longer-lasting immunity to HIV.

Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson said, “In recent years, a new optimism has emerged that we will find an effective HIV vaccine in our lifetime. The results from today’s study add to that belief and we look forward to advancing to the next stage of clinical development as quickly as possible.”

In pre-clinical studies, regimens incorporating mosaic vaccines demonstrated protection against infection with an HIV-like virus. The most effective prime-boost regimen in these studies reduced the per-exposure risk of infection by 94 percent and resulted in 66 percent complete protection after six exposures.

Based on immunologic responses observed in APPROACH, as well as protection observed in pre-clinical studies, a lead HIV-1 vaccine regimen comprising Janssen’s Ad26 mosaic candidate and the Clade C gp140 soluble protein has been selected as the basis for further evaluation in a potential Phase 2b proof-of-concept efficacy study. Should this study move forward, Janssen and its global partners anticipate initiating this investigation in southern African countries in late 2017 or early 2018…
 
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Yemen
Statement by UNICEF Executive Director, Anthony Lake, WFP Executive Director, David Beasley and WHO Director-General, Dr Tedros Adhanom Ghebreyesus, following their joint visit to Yemen
Joint WHO/UNICEF/WFP statement
26 JULY 2017 | ADEN/SANA’A – “As the heads of three United Nations agencies – UNICEF, the World Food Programme (WFP) and WHO – we have travelled together to Yemen to see for ourselves the scale of this humanitarian crisis and to step up our combined efforts to help the people of Yemen.

“This is the world’s worst cholera outbreak in the midst of the world’s largest humanitarian crisis. In the last 3 months alone, 400 000 cases of suspected cholera and nearly 1900 associated deaths have been recorded. Vital health, water and sanitation facilities have been crippled by more than 2 years of hostilities, and created the ideal conditions for diseases to spread.

“The country is on the brink of famine, with over 60 per cent of the population not knowing where their next meal will come from. Nearly 2 milllion Yemeni children are acutely malnourished. Malnutrition makes them more susceptible to cholera; diseases create more malnutrition. A vicious combination…

“Amid this chaos, some 16 000 community volunteers go house to house, providing families with information on how to protect themselves from diarrhea and cholera. Doctors, nurses and other essential health staff are working around the clock to save lives.

“More than 30 000 health workers haven’t been paid their salaries in more than 10 months, but many still report for duty. We have asked the Yemeni authorities to pay these health workers urgently because, without them, we fear that people who would otherwise have survived may die. As for our agencies, we will do our best to support these extremely dedicated health workers with incentives and stipends.

“We also saw the vital work being done by local authorities and NGOs, supported by international humanitarian agencies, including our own. We have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. We are working with the World Bank in an innovative partnership that responds to needs on the ground and helps maintain the local health institutions.

“But there is hope. More than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving. And the total number of children who will be afflicted with severe acute malnutrition this year is estimated at 385,000.

“However, the situation remains dire. Thousands are falling sick every day. Sustained efforts are required to stop the spread of disease. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance.

“When we met with Yemeni leaders — in Aden and in Sana’a — we called on them to give humanitarian workers access to areas affected by fighting. And we urged them – more than anything – to find a peaceful political solution to the conflict.

“The Yemeni crisis requires an unprecedented response. Our 3 agencies have teamed up with the Yemeni authorities and other partners to coordinate our activities in new ways of working to save lives and to prepare for future emergencies.

“We now call on the international community to redouble its support for the people of Yemen. If we fail to do so, the catastrophe we have seen unfolding before our eyes will not only continue to claim lives but will scar future generations and the country for years to come.”
 
[See UN OCHA – L3 Emergencies below for Yemen cholera response plan and status of OCV as an intervention]

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 19 July 2017 [GPEI]
:: The first report of the Transition Independent Monitoring Board (TIMB) has now been published, following the group’s first meeting last month.  The TIMB has been established at the request of the Polio Oversight Board (POB) to independently monitor and guide the polio transition process, especially in the 16 countries prioritized for transition planning.  The group’s next meeting will be held in London, United Kingdom, on 2-3 November.  More.

:: Five country-wide vaccination campaigns have been held in Pakistan since October 2016, preparing for the 2017 high season for poliovirus transmission, which runs from June until September. Read more about what the high season means for eradication.

:: Read the latest polio update from WHO Afghanistan to see information on cases, surveillance and vaccination campaigns for the month of June.

:: Summary of newly-reported viruses this week:  Pakistan – six new wild poliovirus type 1 (WPV1)-positive environmental samples

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WHO-UNICEF: Syria cVDPV2 outbreak Situation Report # 6   25 July 2017
Key highlights
:: No new cVDPV2 cases reported this week. The total number of cVDPV2 cases remains 27 (26 cases are from Mayadeen district, Deir Ez-Zor governorate, and 1 case from Tell Abyad district, Raqqa governorate).

:: The first mOPV2 vaccination round in Deir Ez-Zor started on 22 July. A total of 59,051 children under the age of five were vaccinated on the first day of the campaign.

:: Given high temperatures, WHO has arranged for local ice-cream factories to assist in the daily freezing of ice packs.

:: Community mobilization activities continue throughout the campaign. Household visits have focused on addressing vaccine refusal through use of community influencers.

:: In addition to administering mOPV2, vaccination teams are searching for AFP cases during campaign days. An AFP case detected during vaccination visits in Mayadeen district is under investigation.

:: The total number of acute flaccid paralysis (AFP) cases detected in Deir Ez-Zor governorate since the beginning of 2017 is 89 (67 from Mayadeen, 10 from Deir Ez-Zor, and 12 from Boukamal districts). Raqqa governorate has reported 14 AFP cases (6 from Raqqa, 7 from Tell Abyad, and 1 from Thawra districts).

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WHO Grade 3 Emergencies  [to 29 July 2017]
Yemen –
::  The life and death struggle against cholera in Yemen   25 July 2017
Cholera continues to spread in Yemen, causing more than 390 000 suspected cases of the disease and more than 1800 deaths since 27 April.
WHO and its partners are responding to the cholera outbreak in Yemen, working closely with UNICEF, local health authorities and others to treat the sick and stop the spread of the disease…

The Syrian Arab Republic –
:: Read the latest WHO & UNICEF cVDPV2 outbreak situation report  25 July 2017
[See Polio above for more detail]

South Sudan – No new announcements identified.
Iraq  – No new announcements identified.
Nigeria – No new announcements identified.
 
WHO Grade 2 Emergencies  [to 29 July 2017]
Myanmar  – No new announcements identified
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.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified
 
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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 40 (12 to 26 July 2017)
Highlights
:: Almost 1 million people fled from western Mosul and western Ninewa Governorate as of 26 July, surpassing humanitarians’ ‘worst-case’ estimates. Beyond Mosul, sustained efforts are now needed to support more than 700,000 people who lost everything.
:: Protection remains a top priority, especially for minority groups, women and children. The targeting of these groups is a particularly disturbing feature in Ninewa Governorate and in other areas of the country.
:: While the battle for Mosul is declared over, other areas remain under the Islamic State in Iraq and the Levant’s (ISIL) control. This means civilians continue to be in danger as induced displacement, mostly from Ba’aj and Telafar, continues.
:: Outside of camps and in Mosul city water issues remain critical. This is mainly due to the logistical challenges caused by the temporary closure of Qayyarah bridge and lack of funding.

Syrian Arab Republic
:: 28 Jul 2017  2017 Regional Refugee & Resilience Plan – 3RP (all agencies) – Funding snapshot as of 27-Jul-17
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien Statement to the Security Council on the Humanitarian Situation in Syria
New York, 27 July 2017

Yemen
:: Key messages on cholera (23 July 2017)
[No reference to vaccination, immunization, OCV]
:: Joint Cholera Response Plan – Yemen – July 2017
[Excerpts referencing vaccination/OCV]
4) Oral Cholera Vaccine [p.8, 9]
Conduct risk assessment to determine locations and population eligible for vaccination,
explore availability of the vaccine globally, discuss with MoPHP and other stakeholders
the feasibility of a cholera vaccination campaign in high risk areas eligible to receive
the vaccine…

ANNEX 6: Funding Requirements for Health and WASH Response – budget breakdown [p.29]
…Community awareness
Social mobilization and communication for OCV campaign $500,000

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Editor’s Note:
We continue to monitor how OCV is being factored into response strategies in the Yemen context. We note that the Joint Cholera Response Plan document above does not include any reference to the “much larger preventive campaign” noted below from last week’s WHO situation report.
::  [WHO] Yemen cholera situation report no. 4   19 JULY 2017
Highlights [Excerpt]
:: A cholera vaccination campaign originally planned for July 2017 has been postponed at the request of the health authorities, in favour of a much larger preventive campaign next year targeting millions of Yemenis at risk of the disease.

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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.
Ethiopia
:: Ethiopia Weekly Humanitarian Bulletin, 24 July 2017
Key Issues
:: The UN Humanitarian Coordinator allocated US$44.7 million through the OCHA managed Ethiopia Humanitarian Fund (EHF), to address the most life-saving and time critical needs. All eligible partners are encouraged to consult respective clusters and submit their project proposal online on the Grant Management System not later than 8 August 2017.
:: An estimated US$30 million required to assist the most vulnerable Ethiopian returnees from the Kingdom of Saudi Arabia.
:: Ethiopia continues to receive Somali and South Sudanese refugees fleeing conflict and food insecurity.

DRC
:: United Nations relief chief appeals for urgent funds for people in need in DR Congo
3.8 million people are now displaced within the Democratic Republic of the Congo
(Kinshasa/New York/Geneva, 21 July 2017): The United Nations Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien, today wrapped up a four-day mission to the Democratic Republic of the Congo (DRC) by calling on the world “not to forget the DRC, where millions of girls, boys, women and men are suffering from violence, diseases, and malnutrition.”…

Somalia
:: Trapped in displacement: Lessons and voices from internally displaced   Published on 21 Jul 2017
:: Somalia: Drought Response – Situation Report No. 15  Published on 24 Jul 2017
Highlights
:: While extensive humanitarian operations are ongoing, with over three million people being reached monthly with lifesaving assistance, livelihoods support and protection services, humanitarian needs are expected to persist at current levels through the end of the year. As a result of below average Gu rains, pest infestation and reduced area cultivated, overall cereal production is expected to be 50-60 percent of average, according to the Post Gu Preliminary Assessment Results by Food Security and Nutrition Analysis Unit (FSNAU).
:: Results of nutrition surveys conducted by FSNAU indicate a critical nutrition situation (Global Acute Malnutrition (WHZ) prevalence of 15 per cent or higher) in 9 out of 12 displaced people’s settlements.
::The first ever Somalia Country Humanitarian Forum was held on 19 July, in Mogadishu. The forum will now serve as an information sharing and coordination platform with international humanitarian actors.
:: On 15 July, AMISOM handed over the Somali National University to the Federal Government. The handover of the last civilian learning facility occupied by armed actors comes after over 30 years of occupation and is an important step in expanding opportunities for youth.
 
Nigeria.
:: The Humanitarian Coordinator for Nigeria condemns recent attacks on civilians in camps for internally displaced persons
Abuja, 25 July 2017 – The Humanitarian Coordinator for Nigeria, Edward Kallon, condemns in the strongest terms the deadly suicide attacks that took place in the Dalori I and Dalori II IDP camps in the outskirts of Maiduguri, the capital of Borno State, on 24 July 2017, which resulted in the deaths of several civilians, including women and children, and injured many others.
These suicide attacks are the latest in the recent accelerating trend of attacks against civilians in north-east Nigeria over the past few months…

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Dashboard: International Coordinating Group (ICG) on Vaccine Provision on cholera 
[accessed 29 July 2017]
[No new request activity identified]

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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.

MERS-CoV [to 29 July 2017]
http://www.who.int/emergencies/mers-cov/en/
21 July 2017   WHO/MERS/RA
WHO MERS-CoV Global Summary and Assessment of Risk
Global summary
Between 2012 and 21 July 2017, 2040 laboratory-confirmed cases of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection were reported to WHO, 82% of whom were reported by the Kingdom of Saudi Arabia (Figure 1). In total, cases have been reported from 27 countries in the Middle East, North Africa, Europe, the United States of America, and Asia (Table 1). Males above the age of 60 with underlying conditions, such as diabetes, hypertension and renal failure, are at a higher risk of severe disease, including death. To date, at least 710 individuals have died (crude CFR 34.8%)…

Overall, the epidemiology, transmission patterns, clinical presentation of MERS patients and viral characteristics reported since the last update are consistent with past patterns described in previous WHO risk assessments: MERS-CoV is a zoonotic virus that has repeatedly entered the human population via direct or indirect contact with infected dromedary camels in the Arabian Peninsula. Limited, non-sustained human-to-human transmission in health-care settings continue to occur, primarily in the Kingdom of Saudi Arabia,…

The continued importance of MERS-CoV in health-care settings
Since the last global update of 5 December 2016, approximately 31% of cases reported to WHO were associated with transmission in a health-care facility. These cases included health-care workers (40 cases), patients sharing rooms/wards with MERS patients, or family visitors.

Though not unexpected, these transmission events continue to be deeply concerning, given that MERS-CoV is still a relatively rare disease about which medical personnel in health-care facilities have low awareness. Globally, awareness for MERS-CoV is low and, because symptoms of MERS-CoV infection are non-specific, initial cases are sometimes easily missed. With improved compliance in infection prevention and control, namely adherence to the standard precautions at all times, human-to-human transmission in health-care facilities can be reduced and possibly eliminated with additional use of transmission-based precautions…

WHO & Regional Offices [to 29 July 2017]

Eliminate hepatitis: WHO
News release
27 July 2017 | GENEVA – New WHO data from 28 countries – representing approximately 70% of the global hepatitis burden – indicate that efforts to eliminate hepatitis are gaining momentum. Published to coincide with World Hepatitis Day, the data reveal that nearly all 28 countries have established high-level national hepatitis elimination committees (with plans and targets in place) and more than half have allocated dedicated funding for hepatitis responses.
On World Hepatitis Day, WHO is calling on countries to continue to translate their commitments into increased services to eliminate hepatitis. This week, WHO has also added a new generic treatment to its list of WHO-prequalified hepatitis C medicines to increase access to therapy, and is promoting prevention through injection safety: a key factor in reducing hepatitis B and C transmission.
From commitment to Action
“It is encouraging to see countries turning commitment into action to tackle hepatitis.” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Identifying interventions that have a high impact is a key step towards eliminating this devastating disease. Many countries have succeeded in scaling-up the hepatitis B vaccination. Now we need to push harder to increase access to diagnosis and treatment.”…

Highlights
WHO prequalifies first generic hepatitis C medicine and first HIV self-test
July 2017 – In the lead-up to Paris AIDS conference, WHO today prequalified the first generic version of sofosbuvir, a critical medicine for the treatment of hepatitis C, as well as the OraQuick ® HIV Self-Test.

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Weekly Epidemiological Record, 21 July 2017, vol. 92, 29/30 (pp. 405–416)
:: Progress towards measles elimination in Bangladesh, 2000–2016
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO participates in a forum on effective interventions to reduce harmful use of alcohol 26 July 2017
:: WHO provides lifesaving treatment for severely malnourished children with medical complication in South Sudan  26 July 2017
:: WCO Tanzania takes the Transformation Agenda forwards  26 July 2017

:: Partners agree to harmonise actions to improve the effectiveness of humanitarian efforts
Dakar, 18 July 2017 – Organisations involved in managing health emergencies and disease outbreaks in the African Region have agreed on better ways of coordinating their activities in the event of a crisis so as to save more lives and resources.
With more than 100 public health emergencies occurring each year in the African Region, the need to maximize the efficiency and effectiveness of the preparedness and response to health emergencies to meet the needs of affected communities has become paramount.
At the end of a three – day meeting in Dakar, Senegal, the Organisations agreed to undertake a number of specific joint actions in the next two years aimed at improving the quality and impact of their interventions. Some of the activities include:
…Mapping of partner institutions capacities in African region,
…Mapping of laboratory capacity in the region including diagnostics and vet labs for One Health
…Engaging key partners in the Pandemic Supply Chain Network Lead organizations: WFP
…Harmonize emergency training programs in the African region
…Develop repository of tools and documents for response to public health emergencies.
…Lead organizations: WHO AFRO , GOARN and Africa CDC
The event attracted over 70 representatives and experts from national, regional and international organizations. Among these were UNICEF, FAO, OCHA, WFP, UNHCR, IOM, MSF International, US CDC, AFENET, ALIMA, Nigeria CDC, IFRC, ARC, NICD South Africa, Institut Pasteur de Dakar, Public Health England, UVRI, KEMRI, Africa CDC, GOARN and WHO.

:: The Regional Expert Meeting on Medicine Regulatory Harmonization Initiative is being convened by IGAD  24 July 2017

WHO Region of the Americas PAHO
:: Countries of the Americas take action to eliminate hepatitis (07/28/2017)
…According to a PAHO/WHO survey in May 2017, at least 21 of the 25 countries surveyed in the Region of the Americas have created frameworks within their Ministries of Health that are now addressing and implementing hepatitis response measures.

WHO South-East Asia Region SEARO
::  Enhance awareness, action to eliminate hepatitis in South-East Asia Region 27 July 2017
 
WHO European Region EURO
:: World Hepatitis Day: making hepatitis elimination a reality 27-07-2017

WHO Eastern Mediterranean Region EMRO
:: WHO commemorates World Hepatitis Day in Pakistan  27 July 2017
:: Statement by UNICEF Executive Director, Anthony Lake, WFP Executive Director, David Beasley and WHO Director-General, Dr Tedros Adhanom Ghebreyesus, following their joint visit to Yemen  26 July 2017  [See Milestones/Perspectives above for full text]
:: GoS, WHO, FAO, and OIE fight antimicrobial resistance with new national plan 25 July 2017

CDC/ACIP [to 29 July 2017]
http://www.cdc.gov/media/index.html

Press Release
July 24, 2017
Country with world’s highest HIV prevalence is now controlling its HIV epidemic
New findings from Swaziland, supported by the Swazi Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR), reveal remarkable progress in controlling the country’s HIV epidemic and are the latest to show that global HIV efforts are helping to curb the HIV epidemic and saving lives…
 
MMWR News Synopsis for July 27, 2017
:: Progress Toward Elimination of Hepatitis C Virus Infection — Georgia, 2015–2016
 

Announcements
 
MSF/Médecins Sans Frontières  [to 29 July 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
DRC: Doctors Without Borders Vaccinates More than One Million Children Against Measles
July 28, 2017
As measles sweeps across Democratic Republic of Congo (DRC), more than one million children have been vaccinated against the deadly disease during a nine-month campaign by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

Press release
MSF Sounds Alarm Over High Numbers of People Dying from AIDS in Africa
July 25, 2017
Greater global attention is needed to prevent and treat AIDS, as too many patients are dying despite the availability of antiretroviral treatment.
 
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CEPI – Coalition for Epidemic Preparedness Innovations  [to 29 July 2017]
http://cepi.net/
08 July 2017
CEPI welcomes global leadership shown by government of Norway
Media release, Oslo– CEPI welcomes the vital contribution of additional funding from the government of Norway, which today announced it is increasing its original investment in CEPI by $70m. The government of Norway is a founding investor in CEPI, which will create new vaccines against epidemic threats through an innovative partnership between public, private, philanthropic and civil organizations.
Together with the governments of Germany and Japan, the Bill & Melinda Gates Foundation and Wellcome, the founding investors contributed a total of $540m to launch CEPI in January 2017. CEPI’s mission is to outsmart epidemics by developing safe and effective vaccines against known infectious diseases that can be deployed rapidly to contain outbreaks, before they become global health emergencies…

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NIH  [to 29 July 2017]
http://www.nih.gov/news-events/news-releases
July 20, 2017
Immune system may mount an attack in Parkinson’s disease
July 27, 2017 — NIH-funded study suggests role for specific immune cells in brain disease.

Discovery documentary First in Human gives an up-close look at how advances in medicine are made at the NIH Clinical Center
July 26, 2017 — Three-part series airing in August portrays the hopes and setbacks of patients, doctors, and nurses seeking cures.

In adolescents, oral Truvada and vaginal ring for HIV prevention are safe, acceptable
July 25, 2017 — NIH-funded clinical trials are first of their kind to include younger adolescent girls.

NCI-COG Pediatric MATCH trial to test targeted drugs in childhood cancers
July 24, 2017 — Nationwide trial to explore targeted therapies for children and adolescents with solid tumors.

Drug interaction concerns may negatively affect HIV treatment adherence among transgender women
July 24, 2017 — Participants in NIH-supported study apprehensive about combining HIV medications and hormones.

Experimental HIV vaccine regimen is well-tolerated, elicits immune responses
July 24, 2017 — Results from early-stage NIH-funded trial support further development of candidate vaccines.

Child living with HIV maintains remission without drugs since 2008
July 24, 2017 — Child treated in infancy as part of NIH-funded study.
 
::::::
 
PATH  [to 29 July 2017]
http://www.path.org/news/index.php
Announcement | July 26, 2017
Kenya County Governor Signs Landmark Maternal Child Health and Family Planning Act
The law is the first in the country to allocate county-level resources to support access to critical health services for the most vulnerable mothers, newborns, and children
Kakamega County Governor H.E. Wycliffe Oparanya of Western Kenya signed the Kakamega County Maternal Child Health and Family Planning Bill 2017 into law, guaranteeing pregnant women living on less than one US dollar a day additional support to access essential antenatal and postnatal care for themselves and their babies. PATH Kenya advocates, UNICEF, and other partners played a key role in guiding the overarching strategy for the bill, drafting core language, and securing critical buy-in from high-level leaders and civil society members…

::::::
 
UNAIDS [to 29 July 2017]
http://www.unaids.org/en
Press statement
UNAIDS welcomes the launch of the End AIDS Coalition at the 9th International AIDS Conference on HIV Science in Paris
PARIS/GENEVA, 25 July 2017—UNAIDS has welcomed the launch of the End AIDS Coalition (EAC) during the 9th International AIDS Conference on HIV Science taking place in Paris, France. The EAC brings together a strong collaboration of leading AIDS experts, scientists, clinicians, policy-makers, faith leaders, business leaders and activists determined to end the AIDS epidemic as a public health threat by 2030.
The EAC aims to amplify efforts to end the AIDS epidemic by strengthening linkages across research, resources and implementation, by encouraging the aggregation and analysis of data from the global AIDS response to identify barriers and encourage efficiencies and by inspiring a movement to mobilize and engage the next generation of young leaders in the response to HIV…
 
::::::
 
FDA [to 29 July 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
Influenza Virus Vaccine for the 2017-2018 Season
Updated: 7/27/2017
 
::::::
 
European Medicines Agency  [to 29 July 2017]
http://www.ema.europa.eu/ema/
28/07/2017
Concept paper on development and lifecycle of personalised medicines and companion diagnostics
Public consultation to end on 31 October 2017 …

27/07/2017
EU report: more evidence on link between antibiotic use and antibiotic resistance
The European Food Safety Authority, the European Medicines Agency and the European Centre for Disease Prevention and Control are concerned about the impact of use of antibiotics on the increase in antibiotic-resistant bacteria. …

25/07/2017
Reducing off-label use of antimicrobials in veterinary medicine to reduce risk of resistance
EMA invites comments on a draft reflection paper by 31 January 2018
 
::::::
 
GHIT Fund   [to 29 July 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 ·
2017.07.25      News
New investment opportunity for Hit-to-lead Platform
2017.07.25      News
New investment opportunity for Product Development Platform
2017.07.25      News
New investment opportunity for Target Research Platform in Partnership with Wellcome Trust
 
::::::
 
Wellcome Trust  [to 29 July 2017]
https://wellcome.ac.uk/news
News / Published: 26 July 2017
Mike Ferguson is new Deputy Chair of Governors
Professor Mike Ferguson will become Deputy Chair of our Board of Governors in January 2018. He is taking over from Professor Dame Kay Davies.
Mike, who is Regius Professor of Life Sciences at the University of Dundee, has been on the Board of Governors since January 2012.

Opinion / Published: 26 July 2017
Let’s transform the way research is translated into health benefits
Stephen Caddick, Wellcome’s Director of Innovation, says building a UK environment where research findings are translated into treatments and products is a challenge – but one we must meet.
It’s good to see the launch of Transforming UK translation [PDF 99KB], a set of commitments from the leading science and engineering organisations, including Wellcome, to transform UK research translation.

::::::
 
PhRMA    [to 29 July 2017]
http://www.phrma.org/press-room
July 27, 2017
Biopharmaceutical industry policies aim to increase access to clinical trial data
The biopharmaceutical industry has been at the forefront of initiatives to improve access to clinical trial data.

July 25, 2017
Finding cures for incurable diseases
74 percent of the medicines in the pipeline have the potential to be first-in-class therapies.

::::::
::::::
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 29 July 2017]
http://www.dcvmn.org/
25 September 2017 to 28 September 2017
DCVMN Annual General Meeting
Seoul / Korea
 

Featured Journal Content

JAMA Pediatrics
New Online – July 24, 2017
Original Investigation
Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States
Nathan C. Lo, BS1; Peter J. Hotez, MD, PhD2,3,4,5
doi:10.1001/jamapediatrics.2017.1695
Key Points
Question
How does vaccine hesitancy affect annual measles cases and economic costs in the United States?
Findings
In this modeling study of children (age 2-11 years), a 5% reduction in measles, mumps, and rubella vaccination coverage resulted in a 3-fold increase in annual measles cases with an additional US$2.1 million in public sector costs.
Meaning
Even small declines in vaccination coverage in children owing to vaccine hesitancy may have substantial public health and economic consequences that will be larger when considering unvaccinated infants, adolescents, and adults.
Abstract
Importance
Routine childhood vaccination is declining in some regions of the United States due to vaccine hesitancy, which risks the resurgence of many infectious diseases with public health and economic consequences. There are ongoing policy debates on the state and national level, including legislation around nonmedical (personal-belief) exemptions for childhood vaccination and possibly a special government commission on vaccine safety, which may affect vaccine coverage.
Objective
To estimate the number of measles cases in US children and the associated economic costs under scenarios of different levels of vaccine hesitancy, using the case example of measles, mumps, and rubella (MMR) vaccination and measles.
Design, Setting, and Participants
Publicly available data from the US Centers for Disease Control and Prevention were used to simulate county-level MMR vaccination coverage in children (age 2-11 years) in the United States. A stochastic mathematical model was adapted for infectious disease transmission that estimated a distribution for outbreak size as it relates to vaccine coverage. Economic costs per measles case were obtained from the literature. The predicted effects of increasing the prevalence of vaccine hesitancy as well as the removal of nonmedical exemptions were estimated. The model was calibrated to annual measles cases in US children over recent years, and the model prediction was validated using an independent data set from England and Wales.
Main Outcomes and Measures
Annual measles cases in the United States and the associated public sector costs.
Results
A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year, with an additional $2.1 million in public sector costs. The numbers would be substantially higher if unvaccinated infants, adolescents, and adult populations were also considered. There was variation around these estimates due to the stochastic elements of measles importation and sensitivity of some model inputs, although the trend was robust.
Conclusions and Relevance
This analysis predicts that even minor reductions in childhood vaccination, driven by vaccine hesitancy (nonmedical and personal belief exemptions), will have substantial public health and economic consequences. The results support an urgent need to address vaccine hesitancy in policy dialogues at the state and national level, with consideration of removing personal belief exemptions of childhood vaccination.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 29 July 2017)
Opinion
The public health value of vaccines beyond efficacy: methods, measures and outcomes
Wilder-Smith, I. Longini, P. L. Zuber, T. Bärnighausen, W. J. Edmunds, N. Dean, V. Masserey Spicher, M. R. Benissa and B. D. Gessner

BMC Medicine 2017 15:138
Published on: 26 July 2017
Abstract
Background
Assessments of vaccine efficacy and safety capture only the minimum information needed for regulatory approval, rather than the full public health value of vaccines. Vaccine efficacy provides a measure of proportionate disease reduction, is usually limited to etiologically confirmed disease, and focuses on the direct protection of the vaccinated individual. Herein, we propose a broader scope of methods, measures and outcomes to evaluate the effectiveness and public health impact to be considered for evidence-informed policymaking in both pre- and post-licensure stages.
Discussion
Pre-licensure: Regulatory concerns dictate an individually randomised clinical trial. However, some circumstances (such as the West African Ebola epidemic) may require novel designs that could be considered valid for licensure by regulatory agencies. In addition, protocol-defined analytic plans for these studies should include clinical as well as etiologically confirmed endpoints (e.g. all cause hospitalisations, pneumonias, acute gastroenteritis and others as appropriate to the vaccine target), and should include vaccine-preventable disease incidence and ‘number needed to vaccinate’ as outcomes.
Post-licensure: There is a central role for phase IV cluster randomised clinical trials that allows for estimation of population-level vaccine impact, including indirect, total and overall effects. Dynamic models should be prioritised over static models as the constant force of infection assumed in static models will usually underestimate the effectiveness and cost-effectiveness of the immunisation programme by underestimating indirect effects. The economic impact of vaccinations should incorporate health and non-health benefits of vaccination in both the vaccinated and unvaccinated populations, thus allowing for estimation of the net social value of vaccination.
Conclusions
The full benefits of vaccination reach beyond direct prevention of etiologically confirmed disease and often extend across the life course of a vaccinated person, prevent outcomes in the wider community, stabilise health systems, promote health equity, and benefit local and national economies. The degree to which vaccinations provide broad public health benefits is stronger than for other preventive and curative interventions.

Journal Watch

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

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

American Journal of Preventive Medicine
August 2017 Volume 53, Issue 2, p139-274, e35-e78
http://www.ajpmonline.org/current

Research Articles
Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013–2015
Jasmine L. Jacobs-Wingo, Cheyenne C. Jim, Amy V. Groom
p162–168
Published online: February 28, 2017
Abstract
Introduction
Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare facilities have higher human papillomavirus (HPV) vaccine series initiation and completion rates among adolescent patients aged 13–17 years than the general U.S. population, challenges remain. I/T/U facilities have lower coverage for HPV vaccine first dose compared with coverage for other adolescent vaccines, and HPV vaccine series completion rates are lower than initiation rates. Researchers aimed to assist I/T/U facilities in identifying interventions to increase HPV vaccination series initiation and completion rates.
Study design
Best practice and intervention I/T/U healthcare facilities were identified based on baseline adolescent HPV vaccine coverage data. Healthcare professionals were interviewed about barriers and facilitators to HPV vaccination. Researchers used responses and evidence-based practices to identify and assist facilities in implementing interventions to increase adolescent HPV vaccine series initiation and completion. Coverage and interview data were collected from June 2013 to June 2015; data were analyzed in 2015.
Setting/participants
I/T/U healthcare facilities located within five Indian Health Service regions.
Intervention
Interventions included analyzing and providing feedback on facility vaccine coverage data, educating providers about HPV vaccine, expanding access to HPV vaccine, and establishing or expanding reminder recall and education efforts.
Main outcome measures
Impact of evidence-based strategies and best practices to support HPV vaccination.
Results
Mean baseline first dose coverage with HPV vaccine at best practice facilities was 78% compared with 46% at intervention facilities. Mean third dose coverage was 48% at best practice facilities versus 19% at intervention facilities. Intervention facilities implemented multiple low-cost, evidence-based strategies and best practices to increase vaccine coverage. At baseline, most facilities used electronic provider reminders, had standing orders in place for administering HPV vaccine, and administered tetanus, diphtheria, and acellular pertussis and HPV vaccines during the same visit. At intervention sites, mean coverage for HPV initiation and completion increased by 24% and 22%, respectively.
Conclusions
A tailored multifaceted approach addressing vaccine delivery processes and patient and provider education may increase HPV vaccine coverage.

American Journal of Public Health
August 2017  107(8)
http://ajph.aphapublications.org/toc/ajph/current

AJPH HISTORY
HIV
The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper
Ronald Bayer, Morgan Philbin and Robert H. Remien
107(8), pp. 1259–1265
Abstract
In 2014, only two states in the United States still mandated specific written informed consent for HIV testing and, after years of controversy, New York ended this requirement, leaving only Nebraska. New York’s shift to opt-out testing meant that a singular feature of what had characterized the exceptionalism surrounding HIV testing was eliminated. We trace the history of debates on written informed consent nationally and in New York State. Over the years of dispute from when HIV testing was initiated in 1985 to 2014, the evidence about the benefits and burdens of written informed consent changed. Just as important was the transformation of the political configuration of HIV advocacy and funding, both nationwide and in New York State. What had for years been the subject of furious debate over what a rational and ethical screening policy required came to an end without the slightest public protest. (Am J Public Health. 2017;107:1259–1265. doi:10.2105/AJPH.2017.303819)

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 29 July 2017)

Research article
Knowledge and perceptions about Zika virus in a Middle East country
Zika virus, an emerging serious infectious disease, is a threat to persons living or travelling to regions where it is currently endemic, and also to contacts of infected individuals. The aim of this study was…
Sohaila Cheema, Patrick Maisonneuve, Ingmar Weber, Luis Fernandez-Luque, Amit Abraham, Hekmat Alrouh, Javaid Sheikh, Albert B. Lowenfels and Ravinder Mamtani
BMC Infectious Diseases 2017 17:524
Published on: 26 July 2017

Research article
A cross-sectional sero-survey on preoperative HBV vaccination policy in Poland
A two-dose preoperative vaccination schedule against HBV has been the widely accepted policy in Poland. However, its effectiveness has not yet been assessed.
Maria Ganczak, Marcin Korzen, Alina Jurewicz and Zbigniew Szych
BMC Infectious Diseases 2017 17:515
Published on: 25 July 2017

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 29 July 2017)

Opinion
The public health value of vaccines beyond efficacy: methods, measures and outcomes
Wilder-Smith, I. Longini, P. L. Zuber, T. Bärnighausen, W. J. Edmunds, N. Dean, V. Masserey Spicher, M. R. Benissa and B. D. Gessner
BMC Medicine 2017 15:138
Published on: 26 July 2017
Abstract
Background
Assessments of vaccine efficacy and safety capture only the minimum information needed for regulatory approval, rather than the full public health value of vaccines. Vaccine efficacy provides a measure of proportionate disease reduction, is usually limited to etiologically confirmed disease, and focuses on the direct protection of the vaccinated individual. Herein, we propose a broader scope of methods, measures and outcomes to evaluate the effectiveness and public health impact to be considered for evidence-informed policymaking in both pre- and post-licensure stages.
Discussion
Pre-licensure: Regulatory concerns dictate an individually randomised clinical trial. However, some circumstances (such as the West African Ebola epidemic) may require novel designs that could be considered valid for licensure by regulatory agencies. In addition, protocol-defined analytic plans for these studies should include clinical as well as etiologically confirmed endpoints (e.g. all cause hospitalisations, pneumonias, acute gastroenteritis and others as appropriate to the vaccine target), and should include vaccine-preventable disease incidence and ‘number needed to vaccinate’ as outcomes.
Post-licensure: There is a central role for phase IV cluster randomised clinical trials that allows for estimation of population-level vaccine impact, including indirect, total and overall effects. Dynamic models should be prioritised over static models as the constant force of infection assumed in static models will usually underestimate the effectiveness and cost-effectiveness of the immunisation programme by underestimating indirect effects. The economic impact of vaccinations should incorporate health and non-health benefits of vaccination in both the vaccinated and unvaccinated populations, thus allowing for estimation of the net social value of vaccination.
Conclusions
The full benefits of vaccination reach beyond direct prevention of etiologically confirmed disease and often extend across the life course of a vaccinated person, prevent outcomes in the wider community, stabilise health systems, promote health equity, and benefit local and national economies. The degree to which vaccinations provide broad public health benefits is stronger than for other preventive and curative interventions.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 29 July 2017)

Opinion
Ethics review in compassionate use
Jan Borysowski, Hans-Jörg Ehni and Andrzej Górski
BMC Medicine 2017 15:136
Published on: 24 July 2017
Abstract
Background
Compassionate use is the use of unapproved drugs outside of clinical trials. So far, compassionate use regulations have been introduced in the US, Canada, many European countries, Australia and Brazil, and treatment on a compassionate use basis may be performed in Japan and China. However, there are important differences between relevant regulations in individual countries, particularly that approval by a research ethics committee (institutional review board) is a requirement for compassionate use in some countries (e.g. the US, Spain, and Italy), but not in others (e.g. Canada, the UK, France, and Germany).
Discussion
The main objective of this article is to present aspects of compassionate use that are important for the discussion of the role of research ethics committees in the review of compassionate use. These aspects include the nature of compassionate use, potential risks to patients associated with the use of drugs with unproven safety and efficacy, informed consent, physicians’ qualifications, and patient selection criteria. Our analysis indicates that the arguments for mandatory review substantially outweigh the arguments to the contrary.
Conclusions
Approval by a research ethics committee should be obligatory for compassionate use. The principal argument against mandatory ethical review of compassionate use is that it is primarily a kind of treatment rather than biomedical research. Nonetheless, compassionate use is different from standard clinical care and should be subject to review by research ethics committees. First, in practice, compassionate use often involves significant research aspects. Second, it is based on unapproved drugs with unproven safety and efficacy. Obtaining informed consent from patients seeking access to unapproved drugs on a compassionate use basis may also be difficult. Other important problems include the qualifications of the physician who is to perform treatment, and patient selection criteria.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 29 July 2017)

Research note
Characterizing expanded access and compassionate use programs for experimental drugs
We sought to determine the characteristics of “expanded access” and “compassionate use” programs registered in ClinicalTrials.gov and to determine the percentage of drugs provided through these programs that u…
Jennifer E. Miller, Joseph S. Ross, Kenneth I. Moch and Arthur L. Caplan
BMC Research Notes 2017 10:350
Published on: 28 July 2017

Health Policy and Planning
Volume 32, Issue 7   September 2017
http://heapol.oxfordjournals.org/content/current

Original Articles
Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda
Fiona Samuels; Ana B Amaya; Dina Balabanova
Abstract
There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. To do this, the article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. At the macro level, governance with effective and committed leaders was found to be vital for achieving positive health outcomes. This was underpinned by clear commitment from donors coupled by a significant increase in funding to the health sector. At the meso level, where policies are operationalized, inter-sectoral partnerships as well as decentralization and task-shifting emerged as critical. At micro (service interface) level, community-centred models and accessible and appropriately trained and incentivized local health providers play a central role in all study countries. The key drivers of progress are multiple, interrelated and transversal in terms of their operation; they are also in a constant state of flux as health systems and contexts develop. Without seeking to offer a blueprint, the study demonstrates that a ‘whole-system’ approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 29 July 2017]

Research
Increasing health policy and systems research capacity in low- and middle-income countries: results from a bibliometric analysis
For 20 years, substantial effort has been devoted to catalyse health policy and systems research (HPSR) to support vulnerable populations and resource-constrained regions through increased funding, institutional capacity-building and knowledge production; yet, participation from low- and middle-income countries (LMICs) is underrepresented in HPSR knowledge production… While the absolute number of publications remains low, lead authors from an LMIC have participated exponentially in the life and biomedical sciences (PubMed) since the early 2000s. HPSR publications with a topic relevant to LMICs and an LMIC lead author continue to increase at a greater rate than the life and biomedical science topics in general. This correlation is likely due to increased capacity for research within LMICs and the support for publications surrounding large HPSR initiatives. These findings provide strong evidence that continued support is key to the longevity and enhancement of HPSR toward its mandate.
Krista M. English and Babak Pourbohloul
Health Research Policy and Systems 2017 15:64
Published on: 28 July 2017

JAMA
July 25, 2017, Vol 318, No. 4, Pages 313-400
http://jama.jamanetwork.com/issue.aspx

Research Letter
Association of the Priority Review Voucher With Neglected Tropical Disease Drug and Vaccine Development
Nina Jain, MD, MSc; Thomas Hwang, AB; Jessica M. Franklin, PhD; et al.
JAMA. 2017;318(4):388-389. doi:10.1001/jama.2017.7467
Congress created the priority review voucher in 2007 to incentivize the development of treatments for neglected tropical diseases. Vouchers, which can be transferred or sold, are awarded when a company obtains US Food and Drug Administration (FDA) approval for a drug or vaccine indicated for a neglected tropical disease (Box). They allow sponsors to obtain faster FDA review of a product for any indication, not restricted to neglected tropical diseases, moving the application from the standard 10 months to the priority review timeline of 6 months. This provides valuable earlier access to the US market for those drugs that would have not otherwise qualified for priority review: vouchers have been sold for prices ranging from $67 million to $350 million.2

Journal of Epidemiology & Community Health
AUGUST 2017 – Volume 71 – 8
http://jech.bmj.com/content/current

Reviews
Return on investment of public health interventions: a systematic review
Rebecca Masters, Elspeth Anwar, Brendan Collins, Richard Cookson, Simon Capewell
Abstract
Background Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.
Methods We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.
Results We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.
Conclusions This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

Journal of Pediatrics
August 2017 Volume 187, p1-340
http://www.jpeds.com/current

Original Articles
First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring
Elyse Olshen Kharbanda, Gabriela Vazquez-Benitez, Paul A. Romitti, Allison L. Naleway, T. Craig Cheetham, Heather S. Lipkind, Nicola P. Klein, Grace Lee, Michael L. Jackson, Simon J. Hambidge, Natalie McCarthy, Frank DeStefano, James D. Nordin for the Vaccine Safety Datalink
p234–239.e4
Published online: May 24, 2017
Abstract
Objective
To examine risks for major structural birth defects in infants after first trimester inactivated influenza vaccine (IIV) exposures.
Study design
In this observational study, we used electronic health data from 7 Vaccine Safety Datalink sites to examine risks for selected major structural defects in infants after maternal IIV exposure. Vaccine exposures for women with continuous insurance enrollment through pregnancy who delivered singleton live births between 2004 and 2013 were identified from standardized files. Infants with continuous insurance enrollment were followed to 1 year of age. We excluded mother–infant pairs with other exposures that potentially increased their background risk for birth defects. Selected cardiac, orofacial or respiratory, neurologic, ophthalmologic or otologic, gastrointestinal, genitourinary and muscular or limb defects were identified from diagnostic codes in infant medical records using validated algorithms. Propensity score adjusted generalized estimating equations were used to estimate prevalence ratios (PRs).
Results
We identified 52 856 infants with maternal first trimester IIV exposure and 373 088 infants whose mothers were unexposed to IIV during first trimester. Prevalence (per 100 live births) for selected major structural birth defects was 1.6 among first trimester IIV exposed versus 1.5 among unexposed mothers. The adjusted PR was 1.02 (95% CI 0.94-1.10). Organ system-specific PRs were similar to the overall PR.
Conclusion
First trimester maternal IIV exposure was not associated with an increased risk for selected major structural birth defects in this large cohort of singleton live births.

The Lancet
Jul 29, 2017 Volume 390 Number 10093 p429-530
http://www.thelancet.com/journals/lancet/issue/current

Series
Evolutionary public health
Evolutionary public health: introducing the concept
Jonathan C K Wells, Randolph M Nesse, Rebecca Sear, Rufus A Johnstone, Stephen C Stearns
Summary
The emerging discipline of evolutionary medicine is breaking new ground in understanding why people become ill. However, the value of evolutionary analyses of human physiology and behaviour is only beginning to be recognised in the field of public health. Core principles come from life history theory, which analyses the allocation of finite amounts of energy between four competing functions—maintenance, growth, reproduction, and defence. A central tenet of evolutionary theory is that organisms are selected to allocate energy and time to maximise reproductive success, rather than health or longevity. Ecological interactions that influence mortality risk, nutrient availability, and pathogen burden shape energy allocation strategies throughout the life course, thereby affecting diverse health outcomes. Public health interventions could improve their own effectiveness by incorporating an evolutionary perspective. In particular, evolutionary approaches offer new opportunities to address the complex challenges of global health, in which populations are differentially exposed to the metabolic consequences of poverty, high fertility, infectious diseases, and rapid changes in nutrition and lifestyle. The effect of specific interventions is predicted to depend on broader factors shaping life expectancy. Among the important tools in this approach are mathematical models, which can explore probable benefits and limitations of interventions in silico, before their implementation in human populations.

Lancet Global Health
Aug 2017 Volume 5 Number 8 e727-e837
http://www.thelancet.com/journals/langlo/issue/current

Editorial
Collaborating to ease Africa’s data drought
The Lancet Global Health
At the High-Level Political Forum on Sustainable Development in New York this week, UN Member States have been taking a detailed look at progress on a selection of the Sustainable Development Goals (SDGs), including goal 3 on ensuring healthy lives. As part of this process, 44 countries from across the wealth spectrum have provided voluntary national reviews, including seven from Africa. These African reviews reveal a dedication to the SDG process, with incorporation of targets into national plans and efforts to engage all stakeholders via consultations and awareness campaigns. However, there is a recurring theme when it comes to challenges. Aside from the obvious financial limitations, almost all countries cite a dearth of reliable disaggregated data on which to base intervention programmes….

Lancet Global Health
Aug 2017 Volume 5 Number 8 e727-e837
http://www.thelancet.com/journals/langlo/issue/current

Articles
Global funding trends for malaria research in sub-Saharan Africa: a systematic analysis
Michael G Head, Sian Goss, Yann Gelister, Victor Alegana, Rebecca J Brown, Stuart C Clarke, Joseph R A Fitchett, Rifat Atun, J Anthony G Scott, Marie-Louise Newell, Sabu S Padmadas, Andrew J Tatem
Summary
Background
Total domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. We describe the trends of investments in malaria-related research in sub-Saharan Africa and compare investment with national disease burden to identify areas of funding strength and potentially neglected populations. We also considered funding for malaria control.
Methods
Research funding data related to malaria for 1997–2013 were sourced from existing datasets, from 13 major public and philanthropic global health funders, and from funding databases. Investments (reported in US$) were considered by geographical area and compared with data on parasite prevalence and populations at risk in sub-Saharan Africa. 45 sub-Saharan African countries were ranked by amount of research funding received.
Findings
We found 333 research awards totalling US$814·4 million. Public health research covered $308·1 million (37·8%) and clinical trials covered $275·2 million (33·8%). Tanzania ($107·8 million [13·2%]), Uganda ($97·9 million [12·0%]), and Kenya ($92·9 million [11·4%]) received the highest sum of research investment and the most research awards. Malawi, Tanzania, and Uganda remained highly ranked after adjusting for national gross domestic product. Countries with a reasonably high malaria burden that received little research investment or funding for malaria control included Central African Republic (ranked 40th) and Sierra Leone (ranked 35th). Congo (Brazzaville) and Guinea had reasonably high malaria mortality, yet Congo (Brazzaville) ranked 38th and Guinea ranked 25th, thus receiving little investment.
Interpretation
Some countries receive reasonably large investments in malaria-related research (Tanzania, Kenya, Uganda), whereas others receive little or no investments (Sierra Leone, Central African Republic). Research investments are typically highest in countries where funding for malaria control is also high. Investment strategies should consider more equitable research and operational investments across countries to include currently neglected and susceptible populations.
Funding
Royal Society of Tropical Medicine and Hygiene and Bill & Melinda Gates Foundation.

Lancet Infectious Diseases
Aug 2017 Volume 17 Number 8 p781-882 e235-e279
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Cholera in Yemen: war, hunger, disease…and heroics
The Lancet Infectious Diseases
Summary
The harms done by war are many and complex. Death, injury, and displacement are the most obvious, but infection is also closely intertwined with conflict. Across the Middle East and Africa, outbreaks of infection have occurred as a direct effect of war, compounded by food and water shortages, displacement, and damage to infrastructure and health services. Nowhere is this web of interconnections more clear than in the cholera epidemic in Yemen.

Lancet Infectious Diseases
Aug 2017 Volume 17 Number 8 p781-882 e235-e279
http://www.thelancet.com/journals/laninf/issue/current

Comment
Advances in Ebola virus vaccination
Elizabeth C Clarke, Steven B Bradfute

The Ebola virus outbreak in western Africa between 2013 and 2016 was the largest and deadliest since the discovery of the virus in 1976. The epidemic provided the impetus to fast-track several promising vaccines into clinical trials during the tail-end of the outbreak, including the rVSVΔG-ZEBOV-GP viral vector vaccine, which was used in ring vaccination trials in Guinea.

In The Lancet Infectious Diseases, D Gray Heppner and colleagues2 report on the safety and immunogenicity of the rVSVΔG-ZEBOV-GP vaccine over a 6 log10 dose range. This study shows vaccine dose-dependent total and neutralising antibody titres among study participants, which persisted for up to 360 days. The rVSVΔG-ZEBOV-GP vaccine used in the study is a recombinant, replication-competent vaccine based on vesicular stomatitis virus in which the vesicular stomatitis virus glycoprotein (G) has been replaced with the Zaire Ebola virus surface glycoprotein (GP). The Ebola virus surface glycoprotein is the main antigen used in Ebola vaccine development, with the chimpanzee adenovirus (ChAd3)-based vaccine also expressing Ebola virus glycoprotein.3

The strength of this study lies in its demonstration of the longevity of neutralising antibody responses after vaccination. Previous studies with this vaccine showed sharp drop-offs in antibody titres after several months,4, 5 but in this study Ebola virus glycoprotein-specific antibodies were maintained for up to 360 days. Good longevity of immune responses is particularly positive for future development of Ebola virus vaccines, since it could increase the utility of the vaccine for health-care workers and people in endemic regions who are most likely to be exposed to the virus over a prolonged period.

This study examined a range of vaccine doses for immunogenicity. Although lower doses of the vaccine did develop neutralising antibody titres, the authors show that these responses were lower and emerged more slowly than with higher doses of the vaccine. These data are important because the rapidity of the development of immunity could have important repercussions on the value of the vaccine in an outbreak setting, where exposure to the virus is high and decreased time to onset of protection is essential.

Concerns have been raised previously regarding the safety profile of the rVSVΔG-ZEBOV-GP vaccine, particularly the high rates of post-vaccination arthralgia, which were reported in the phase 1 VSV-Ebola CONsortium (VEBCON) network vaccine study in Geneva, Switzerland.6 As with other live attenuated vector-based vaccines, adverse events in this study were more common at higher vaccine doses than at lower doses. This study also addresses many safety concerns, showing that the vaccine was well tolerated and that adverse events of transient arthritis were observed at a much lower rate than in some previous Ebola vaccine studies.

The correlates of protection for Ebola virus are currently unclear. Historically, different vaccine studies have shown that either robust virus-specific CD8+ T-cell responses, high antibody titres, or both are necessary for protection.7, 8, 9, 10 It is possible that correlates of protection for Ebola virus are different for each vaccine,11 or that variations in methodology for complex assays produce different outcomes.

The authors used IgG ELISA and neutralising antibody titres to assess the relevant immunogenicity of the vaccine. Antibodies are thought to be the necessary correlate of protection for the rVSVΔG-ZEBOV-GP vaccine, on the basis of results in non-human primate studies.8 However, it is unknown how well correlates of protection in non-human primates apply to human beings. Additionally, multiple methods can be used for assessment of antibody neutralisation and titre, and the absence of standard assays introduces uncertainty into comparisons of different vaccine platforms and clinical trials.

The prolonged antibody responses and increased understanding of the optimal vaccine doses shown in this study are important steps towards creating a safe and efficacious vaccine against Ebola virus disease. Future work should further describe the onset of protection after Ebola virus vaccination and characterise antibody isotype make-up and T-cell responses. We believe that efforts should be made to standardise the T-cell and antibody assays used in Ebola vaccine trials so that comparisons can be made between vaccines and the vaccines themselves can be improved upon.

Lancet Infectious Diseases
Aug 2017 Volume 17 Number 8 p781-882 e235-e279
http://www.thelancet.com/journals/laninf/issue/current

Articles
Safety and immunogenicity of a live attenuated influenza H5 candidate vaccine strain A/17/turkey/Turkey/05/133 H5N2 and its priming effects for potential pre-pandemic use: a randomised, double-blind, placebo-controlled trial
Punnee Pitisuttithum, Kobporn Boonnak, Supat Chamnanchanunt, Pilaipan Puthavathana, Viravarn Luvira, Hatairat Lerdsamran, Jaranit Kaewkungwal, Saranath Lawpoolsri, Vipa Thanachartwet, Udomsak Silachamroon, Wanibtisam Masamae, Alexandra Schuetz, Ponthip Wirachwong, Sit Thirapakpoomanunt, Larisa Rudenko, Erin Sparrow, Martin Friede, Marie-Paule Kieny

Safety and immunogenicity of a parenteral P2-VP8-P[8] subunit rotavirus vaccine in toddlers and infants in South Africa: a randomised, double-blind, placebo-controlled trial
Michelle J Groome, Anthonet Koen, Alan Fix, Nicola Page, Lisa Jose, Shabir A Madhi, Monica McNeal, Len Dally, Iksung Cho, Maureen Power, Jorge Flores, Stanley Cryz

Safety and immunogenicity of the rVSV∆G-ZEBOV-GP Ebola virus vaccine candidate in healthy adults: a phase 1b randomised, multicentre, double-blind, placebo-controlled, dose-response study
D Gray Heppner Jr, Tracy L Kemp, Brian K Martin, William J Ramsey, Richard Nichols, Emily J Dasen, Charles J Link, Rituparna Das, Zhi Jin Xu, Eric A Sheldon, Teresa A Nowak, Thomas P Monath for the V920-004 study team

Impact of MenAfriVac in nine countries of the African meningitis belt, 2010–15: an analysis of surveillance data
Caroline L Trotter, Clément Lingani, Katya Fernandez, Laura V Cooper, André Bita, Carol Tevi-Benissan, Olivier Ronveaux, Marie-Pierre Préziosi, James M Stuart

Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis
Radha Rajasingham, Rachel M Smith, Benjamin J Park, Joseph N Jarvis, Nelesh P Govender, Tom M Chiller, David W Denning, Angela Loyse, David R Boulware

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 29 July 2017)

Research Article
Participation of women and children in hunting activities in Sierra Leone and implications for control of zoonotic infections
Jesse Bonwitt, Martin Kandeh, Michael Dawson, Rashid Ansumana, Foday Sahr, Ann H. Kelly, Hannah Brown
| published 27 Jul 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005699
Abstract
The emergence of infectious diseases of zoonotic origin highlights the need to understand social practices at the animal-human interface. This study provides a qualitative account of interactions between humans and wild animals in predominantly Mende villages of southern Sierra Leone. We conducted fieldwork over 4 months including participant and direct observations, semi-structured interviews (n=47), spontaneously occurring focus group discussions (n=12), school essays and informal interviews to describe behaviours that may serve as pathways for zoonotic infection. In this region, hunting is the primary form of contact with wild animals. We describe how these interactions are shaped by socio-cultural contexts, including opportunities to access economic resources and by social obligations and constraints. Our research suggests that the potential for exposure to zoonotic pathogens is more widely distributed across different age, gender and social groups than previously appreciated. We highlight the role of children in hunting, an age group that has previously not been discussed in the context of hunting. The breadth of the “at risk” population forces reconsideration of how we conceptualize, trace and monitor pathogen exposure.
Author summary
Studying how and why humans interact with animals is important to understand the transmission of zoonotic diseases (infectious diseases transmitted from animals to humans) and how to prevent and control them. We conducted a qualitative study to understand how and why people come into contact with wild animals in the Southern province of Sierra Leone, a region with numerous wildlife species known to carry zoonotic diseases. Previous studies on hunting in sub-Saharan Africa principally describe adult men as hunters and adult women as retailers of meat from wild animals. Based on our results, we seek to broaden the category of people deemed “at risk” of zoonotic diseases through hunting by including women and children. In particular, because of their limited physical abilities and social position, children hunt under different circumstances than those of adults. Our results have implications for zoonotic disease research and prevention, for example by ensuring children are integrated in health interventions and that their unique reasons to hunt are taken into account during such processes.

PLoS One
http://www.plosone.org/
[Accessed 29 July 2017]

Research Article
Using actor-partner interdependence modeling to understand HPV vaccine acceptance
Laura E. VanderDrift, Peter A. Vanable, Katherine E. Bonafide, Jennifer L. Brown, Rebecca A. Bostwick, Michael P. Carey
| published 27 Jul 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0181662

Coverage and factors associated with influenza vaccination among kindergarten children 2-7 years old in a low-income city of north-western China (2014-2016)
Lili Xu, Ying Qin, Juan Yang, Wei Han, Youju Lei, Huaxiang Feng, Xiaoyun Zhu, Yanming Li, Hongjie Yu, Luzhao Feng, Yan Shi
Research Article | published 27 Jul 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0181539

Adolescent values for immunisation programs in Australia: A discrete choice experiment
Bing Wang, Gang Chen, Julie Ratcliffe, Hossein Haji Ali Afzali, Lynne Giles, Helen Marshall
Research Article | published 26 Jul 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0181073

Science        
28 July 2017   Vol 357, Issue 6349
http://www.sciencemag.org/current.dtl

Editorial
We still need to beat HIV
By François Dabis, Linda-Gail Bekker
Science28 Jul 2017 : 33
Summary
Despite remarkable advances in HIV treatment and prevention, the limited political will and leadership in many countries—particularly in West and Central Africa and Eastern Europe—have fallen short of translating these gains into action. As a result, nearly 2 million infections occurred in 2016, creating a situation that is challenging to counter. This week in Paris, the International AIDS Society (IAS) convened researchers, health experts, and policy-makers to discuss the global state of this epidemic. It has been more than three decades since AIDS was clinically observed and associated with HIV infection. Since then, HIV has accounted for 35 million deaths worldwide. Today, about 37 million people are infected. IAS and the French Research Agency on HIV and Viral Hepatitis (ANRS) have now released the Paris Statement (www.ias2017.org/The-Paris-Statement-HIV-Science-Matters) to remind world leaders why HIV science matters, how it should be strengthened, and why it should be funded globally and durably so that new evidence can be translated into policy.

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.
 
Forbes
http://www.forbes.com/
Accessed 29 July 2017
The HPV Vaccine Saves Lives, So Why Aren’t More Kids Getting It?
David DiSalvo, Contributor
24 July 2017
The HPV vaccine is safe, effective, and it saves lives—so why are so few children getting vaccinated?

 
Foreign Policy
http://foreignpolicy.com/
Accessed 29 July 2017
The Next AIDS Pandemic
Laurie Garrett | July 26, 2017
Funding cuts to key U.S. programs that support medicine and treatment are coming. And with a booming African population and drug-resistant strains on the rise, the future is grim.
 

New York Times
http://www.nytimes.com/
Italy Approves Hotly Contested Mandatory Vaccine Program
Italy’s parliament on Friday gave final approval to making a slate of childhood vaccinations mandatory for school children up to age 16, a move aimed at countering an anti-vaccine trend that officials have attributed to misinformation.
July 28, 2017 – By THE ASSOCIATED PRESS

Whooping Cough Cases Double in Indiana in a Year, Prompting a Call to Vaccinate
There were 136 confirmed cases of whooping cough in the state in the first half of 2017, compared with 66 in the first half of 2016, but an expert was not alarmed.
July 27, 2017 – By MAGGIE ASTOR

Romania to Pass Vaccination Law to Deal With Immunisation Gaps
Romania needs to pass a vaccination law and overhaul medical services to prevent the spread of a measles outbreak that has already claimed 32 deaths, the most of any European country, the health ministry said late on Wednesday.
July 27, 2017 – By REUTERS –

Yemen Cholera Epidemic Slowing After Infecting 400,000
Yemen’s cholera outbreak is set to hit 400,000 cases on Tuesday but there are signs the three-month-old epidemic is slowing, according to World Health Organization data analyzed by Reuters.
July 25, 2017 – By REUTERS –

The Drug Maker Sanofi’s New Dengue Vaccine
Sanofi takes issue with a claim that Big Pharma ignores sickness in developing countries.
July 24, 2017 – – Opinion

‘No Jab, No Play’: How Australia Is Handling the Vaccination Debate
States are moving to punish child care centers that enroll the unvaccinated, dismissing the objections of those who resist immunization without a valid medical reason.
July 24, 2017 – By ADAM BAIDAWI

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 29 July 2017
TechTank
How the Trump budget harms global health and weakens international stability
Jake Schneider and Darrell M. West
Thursday, July 27, 2017

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

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

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_22 July 2017

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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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.

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

Milestones :: Perspectives
 

Editor’s Note:
We lead this “Milestones” section with the overview and commentary from most recent WHO and UNICEF immunization estimates. In the context of the aspirations of GVAP now past mid-point – and in principle – the numbers of un-vaccinated and under-vaccinated children should alarm us all.

 
1 in 10 infants worldwide did not receive any vaccinations in 2016
Joint news release UNICEF/WHO
GENEVA/NEW YORK, 17 JULY 2017  ─ Worldwide, 12.9 million infants, nearly 1 in 10, did not receive any vaccinations in 2016, according to the most recent WHO and UNICEF immunization estimates. This means, critically, that these infants missed the first dose of diphtheria-tetanus-pertussis (DTP)-containing vaccine, putting them at serious risk of these potentially fatal diseases.

Additionally, an estimated 6.6 million infants who did receive their first dose of DTP-containing vaccine did not complete the full, three dose DTP immunization series in 2016. Since 2010, the percentage of children who received their full course of routine immunizations has stalled at 86% (116.5 million infants), with no significant changes in any countries or regions during the past year. This falls short of the global immunization coverage target of 90%.

“Most of the children that remain un-immunized are the same ones missed by health systems,” says Dr Jean-Marie Okwo-Bele, Director of Immunization, Vaccines and Biologicals at WHO. “These children most likely have also not received any of the other basic health services. If we are to raise the bar on global immunization coverage, health services must reach the unreached. Every contact with the health system must be seen as an opportunity to immunize.”

Immunization currently prevents between 2-3 million deaths every year, from diphtheria, tetanus, whooping cough and measles. It is one of the most successful and cost-effective public health interventions.

Global immunization coverage levels
According to the new data, 130 of the 194 WHO Member States have achieved and sustained at least 90% coverage for DTP3 at the national level – one of the targets set out in the Global Vaccine Action Plan. However, an estimated 10 million additional infants need to be vaccinated in 64 countries, if all countries are to achieve at least 90% coverage. Of these children, 7.3 million live in fragile or humanitarian settings, including countries affected by conflict. 4 million of them also live in just three countries – Afghanistan, Nigeria and Pakistan – where access to routine immunization services is critical to achieving and sustaining polio eradication.

In 2016, eight countries had less than 50% coverage with DTP3 in 2016, including Central African Republic, Chad, Equatorial Guinea, Nigeria, Somalia, South Sudan, Syrian Arab Republic and Ukraine.

Globally, 85% of children have been vaccinated with the first dose of measles vaccine by their first birthday through routine health services, and 64% with a second dose. Nevertheless, coverage levels remain well short of those required to prevent outbreaks, avert preventable deaths and achieve regional measles elimination goals…

152 countries now use rubella vaccines and global coverage increased from 35% in 2010 to 47% in 2016. This is a big step towards reducing the occurrence of congenital rubella syndrome, a devastating condition that results in hearing impairment, congenital heart defects and blindness, among other life-long disabilities.

Global coverage of more recently-recommended vaccines are yet to reach 50%. These vaccines include vaccines against major killers of children such as rotavirus, a disease that causes severe childhood diarrhoea, and pneumonia. Vaccination against both these diseases has the potential to substantially reduce deaths of children under 5 years of age, a target of the Sustainable Development Goals.
Many middle-income countries are lagging behind in the introduction of these newer and more expensive vaccines. These countries often do not receive external support and their health budgets are often insufficient to cover the costs of procuring these vaccines.

Inequities in immunization coverage
National coverage estimates often mask large inequities in coverage within countries. The WHO report, State of inequality: Childhood immunization, highlights inequalities in childhood immunization coverage in low- and middle-income countries over the past 10 years. The report shows that global improvements have been realized with variable patterns of change across countries and that there is generally less inequality now than 10 years ago.

These findings were reinforced by a recent UNICEF study, which emphasized the cost effectiveness of investing in the poorest, most marginalized communities.

“Immunization is one of the most pro-equity interventions around,” says Dr Robin Nandy, Chief of Immunizations at UNICEF. “Bringing life-saving vaccines to the poorest communities, women and children must be considered a top priority in all contexts.”

Efforts to reduce inequalities related to household economic status and mother’s education are needed in many countries if immunization coverage is to be improved. Additionally, more than half of the global population resides in urban areas, including in rapidly growing slums in Africa and Asia. The urban poor is a group at high risk of being un- or under-immunized.

For the first time, WHO and UNICEF have collected disaggregated data on immunization coverage at the subnational level. Of 194 reporting countries, 125 reported on subnational coverage, covering nearly 20 000 districts and roughly two–thirds of the global infant population. These data will help shed more light on geographical disparities in access to vaccines.
 
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Gavi [to 22 July 2017]
http://www.gavi.org/library/news/press-releases/
Vaccine progress in developing countries ‘in danger of stalling’
New figures show an increase in measles, pneumococcal and rotavirus vaccine coverage in developing countries, but basic vaccine coverage remains unchanged at 80%

Geneva, 20 July 2017 – “The extraordinary improvement in immunisation coverage made since 2000 is in danger of stalling, with conflict, human and animal migration, urbanisation and vaccine hesitancy adding new barriers to global vaccination efforts,” Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said today.

New WHO/UNICEF figures released this week show that in 68 of the world’s poorest countries, while close to a million more children received the basic diphtheria-tetanus-pertussis vaccine in 2016 compared to 2015, the coverage rate has remained at 80% for the past three years. Millions of children remain under-vaccinated in countries torn apart by conflict, from Syria to South Sudan.

“Since 2000 an unprecedented international effort to improve immunisation in the world’s poorest countries has helped to save millions of children from killer diseases like measles, tetanus and whooping cough,” said Dr Berkley. “Thanks to vaccines more children are now living to see their fifth birthday than at any point in history.”

“However, while these figures need to verified by detailed country surveys, they appear to show that this extraordinary progress is in danger of stalling,” he said. “Growing trends like human and animal migration, urbanisation and vaccine hesitancy, as well as conflict, are combining to make the challenge of reaching every child even tougher. The fact that Nigeria has overtaken India as the country with the greatest number of under-vaccinated children, despite having less than a seventh of the population, is particularly concerning. We now need to work twice as hard to meet these challenges and ensure no child goes without lifesaving vaccines.”

“There are positives we can take from this data,” said Dr Berkley. “Newer vaccines protecting against the leading causes of pneumonia and diarrhoea are reaching millions more children across Africa. Liberia’s health system is recovering after the damage wrought by Ebola and India’s commitment to routine immunisation is also continuing to pay dividends.”

In the 68 countries supported by Gavi an additional 5.4 million infants received their second dose of measles vaccine in 2016, 4.8 million more children were vaccinated against the leading cause of pneumonia and 2.3 million more were vaccinated against rotavirus, the leading cause of severe diarrhoea.

The WHO and UNICEF Estimates of National Immunisation Coverage 2016 (WUENIC 2016) figures show that:
:: 19.5 million infants globally did not receive all three doses of diphtheria-tetanus-pertussis (DTP3) vaccine.
:: DTP3 coverage in Liberia increased to 79% from just 52% in 2015, while coverage in India edged up to 88% from 58% in 2000.
:: Nigeria has overtaken India as the country with the greatest number of under-vaccinated children, with 3.4 million children missing out on DTP3 compared to 2.9 million in India.
:: In 2016 coverage of Haemophilus influenzae type b (Hib), pneumococcal and measles vaccines for the 68 countries in which Gavi works increased markedly. Coverage of children receiving three doses of Hib rose from 67% to 78%, pneumococcal from 35% to 41%, and the second dose of measles vaccine from 43% to 50%.
:: One-quarter of infants in Gavi-supported countries are now protected against rotavirus, one of the leading causes of diarrhoea, with supported vaccines.
:: The difference in DTP3 coverage between Gavi-supported and high-income countries is now half of what it was in 2000 (2000: 33%, 2016: 16%)…
 
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IMPUNITY MUST END: Attacks on Health in 23 Countries in Conflict in 2016
SAFEGUARDING HEALTH IN CONFLICT COALITION
July 2017 :: 84 pages
PDF: https://www.safeguardinghealth.org/sites/shcc/files/SHCC2017final.pdf
This report should once again serve as an alarm about the scale and scope of attacks on health
care. In many cases, these violations amount to war crimes and crimes against humanity, and
collectively they threaten the health, well-being, and the lives of people who may number in the
millions. In 2016, these attacks continue to occur with impunity.

Excerpt from Introduction
This is the fourth annual report by the Safeguarding Health in Conflict Coalition documenting attacks on, interference with, and obstruction of health workers, patients, facilities, and transports during periods of armed conflict and political violence across the world. The Safeguarding Health in Conflict Coalition is a group of more than 30 civil society, health provider, and human rights organizations working to protect health workers and services  threatened by war or civil unrest. We have raised awareness of global attacks on health and pressed United Nations agencies for greater global action to protect the security of healthcare. We monitor attacks, strengthen universal norms of respect for the right to health, and demand accountability for perpetrators.
In this report, we review events in 23 countries affected by conflict or political volatility in 2016, compared to 19 countries in 2015. The countries we are reporting for the first time are Armenia, Egypt, Ethiopia, Jammu and Kashmir (India), Mozambique, and Niger. Two countries that were included in our 2015 report—Colombia and Thailand—are not included in this report because either there were no reported attacks or sound data were not available.

Excerpt from Executive Summary [p.10]
KILLING AND ABDUCTION OF VACCINATORS AND THE SECURITY FORCES PROTECTING THEM
Community health workers often work tirelessly to deliver medications and vaccinations to ensure equitable access to health care and to protect groups from communicable diseases, especially polio. Their provision of services in communities often places them at high risk and they have been subject to targeted killings and abductions in Afghanistan, Nigeria, and Nigeria.  In recent years, under pressure to eradicate polio, Pakistan has increased police protection for vaccinators. The increased security has saved the lives of many vaccinators and has enabled children to receive the vaccinations they need, but it has also resulted in the targeting and killing of police and armed forces charged with providing security for vaccinators.

In Afghanistan, in 13 recorded attacks, 16 vaccinators were abducted and ten killed. Some armed opposition groups have reached agreements with the government to allow vaccination efforts to continue. However, other groups have demanded a halt to vaccination campaigns, abducted and killed vaccinators, and destroyed stores of vaccines.

In Pakistan, attacks on polio workers and police took place in January, March, April, May, September, and October. In the January attack, 15 people were killed at a vaccination center; in April, seven police providing security for vaccinators were killed. Physicians supervising the vaccine campaigns and police protecting community health workers were shot and killed.

In Nigeria, four polio workers were kidnapped and held for ransom, jeopardizing the progress made towards polio eradication. This type of intimidation represents one of the factors that contributed to an outbreak of the disease in the country for the first time in more than two years.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 19 July 2017 [GPEI]
:: The Polio Research Committee (PRC) issued a call for research proposals, to support the implementation of the Polio Eradication & Endgame Strategic Plan, with particular focus on:  vaccine schedule immunogenicity; surveillance; product development on innovative IPV formulations or administration techniques; epidemiology/virology; monitoring and evaluation; and, basic immunology.  The deadline for submission of proposals is 6 October 2017.  Submission guidelines and procedures are available here.

:: Animations from WHO on the Polio Surveillance System, Reaching Every last Child and Responding to a Polio Outbreak have won the Innovation (Screen) category of the EVCOM Clarion Awards, for offering a fresh and unique way of engaging audiences in projects concerning the environment, health, education, social welfare and sustainability.

:: Summary of newly-reported viruses this week:  Afghanistan – one new wild poliovirus type 1 (WPV1) isolated from an acute flaccid paralysis (AFP) case and one new WPV1-positive environmental sample; Syria – four new circulating vaccine-derived poliovirus type 2 (cVDPV2) isolated from AFP cases.

Ambassador Yousef Al Otaiba Joins Global Leaders in Pledging Additional Support for Fight to Eradicate Polio
— Embassy of the United Arab Emirates says since 2013, UAE Committed $150 Million to Deliver Vaccines in Afghanistan, Pakistan and Syria —
WASHINGTON, July 18, 2017 /PRNewswire-USNewswire/ — United Arab Emirates (UAE) Ambassador to the US Yousef Al Otaiba joined Gates Foundation Co-Chairman Bill Gates and other members of the Global Polio Eradication Initiative in Atlanta, Georgia to announce a $30 million gift from the Government of the UAE that will help drop the level of global polio infections down to zero. The gift was announced at the Rotary International Convention, along with representatives from other donor nations, such as Canada, Germany, Japan, and the European Commission…

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WHO Grade 3 Emergencies  [to 22 July 2017]
Yemen –
:: Yemen cholera situation report no. 4   19 JULY 2017
Highlights
:: National Emergency Operations Centres (EOCs) in Aden and Sana’a have now been redesigned and strengthened to harness the full capacity of United Nations agencies and partners to support the cholera response.
:: The national Case Fatality Ratio (CFR) has been reduced to 0.5%, with 99.5% of people with suspected cholera surviving.
:: Surveillance confirms a decline in suspected cases over the past two weeks in some of the most affected governorates (e.g. Amanat al-Asimah, Amran and Sana’a). This data should be interpreted with caution, however, given a backlog in the analysis of suspected cases. Even if the outbreak is beginning to slow in some areas, thousands are falling sick every day. Sustained efforts are required to stop the spread of this disease.
:: The World Health Organization (WHO) has successfully established 47 diarrhoea treatment centres of the 50 centres in the original plan.
  :: A cholera vaccination campaign originally planned for July 2017 has been postponed at the request of the health authorities, in favour of a much larger preventive campaign next year targeting millions of Yemenis at risk of the disease.
:: WHO and UNICEF are supporting a door to door awareness campaign at the end of July to help people understand how they can keep their families safe from cholera.

South Sudan
:: WHO scales up cholera response with 500 000 doses of oral cholera vaccine for vaccination campaign in South Sudan
Juba, South Sudan, 19 July 2017: The World Health Organization (WHO) received 500 000 doses of oral cholera vaccine (OCV) on 17 July 2017. WHO is working with the Republic of South Sudan’s Ministry of Health and partners to scale up cholera vaccination campaign from 28 July to 3 August 2017.

Cumulatively, a total of 17 785 cholera cases including 320 (CFR 1.8%) deaths have been reported from 24 counties in South Sudan since the outbreak in June 2106.

“Cholera is endemic in South Sudan and historically, outbreaks have occurred along major commercial routes and rivers in the dry season as well as during the rainy season,” said Dr Joseph Wamala, WHO Epidemiologist. “South Sudan has suffered from several major cholera outbreaks in the last four years. Following other successful oral cholera vaccine campaigns, WHO and partners can make a real difference in controlling the outbreak in Tonj and Kapoeta states and in other parts of the country.”

The use of the OCV is one of the strategies available to prevent and combat outbreaks. At the same time, South Sudan is implementing the integrated approach for cholera control. The strategy harnesses strategies for improving access to patient care, surveillance, social mobilisation, water, sanitation and hygiene, and use of oral cholera vaccines.

South Sudan recently requested OCV to complement the current response in areas with active cholera transmission. The country has developed extensive experience in deploying OCV to prevent cholera in endemic areas and to interrupt transmission for ongoing outbreaks. As a result of these integrated and comprehensive strategies, especially with deployment of OCV, cholera transmission in Bor, Mingkaman, Duk, Ayod, Bentiu, Leer, Aburoc, Malakal Town, and several other areas has been controlled.

A planned OCV campaign is scheduled to take place 28 July to 3 August, 2017 in four selected counties with high active transmission. These include Tonj East, Kapoeta South, Kapoeta North and Kapoeta East counties. In Tonj East, the surrounding payams will be targeted to limit further spread of the outbreak. WHO jointly with the Health Cluster, UNICEF and MSF-CH facilitated a training of over 26 supervisors drawn from the Ministry of Health and partners to oversee the OCV campaign in the above mentioned counties. County level cascade trainings are slated for 25-26 July 2017.

With some 6 million people in South Sudan facing starvation, WHO and partners have been responding across the country, particularly in places facing famine, food insecurity and disease outbreaks.

Furthermore, food insecurity is putting people at increased risk of starvation and malnutrition, which will further contribute to the risk of spread of the cholera outbreak in South Sudan. Drought has also led to the drying of water points in some regions leading to the population using contaminated water from the remaining few unprotected points leading to repeated outbreaks of water-borne diseases including cholera.

Many countries and partners have introduced OCVs as part of their cholera control programs in endemic and epidemic settings. Currently, the International Coordinating Group manages the global stockpile for emergency use of OCV.

Iraq  – No new announcements identified.
Nigeria – No new announcements identified.
The Syrian Arab Republic – No new announcements identified.
 
 
WHO Grade 2 Emergencies  [to 22 July 2017]
Myanmar
:: WHO and Health Cluster partners support rapid health assessments and response in flood-affected areas, Rakhine State
Since the beginning of July 2016 heavy monsoonal rains have hit several areas of Myanmar, resulting in floods in five townships of Rakhine State and putting other States and Regions of the country (Sagaing and Magway regions, Chin state) on high alert for flooding risk. Around 27,000 people have been affected by flooding according to Government and UN estimates, and many remain displaced due to high water levels in their townships…

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.
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. 
Syrian Arab Republic
:: 21 Jul 2017 Syria: EWARS Weekly Bulletin, Week No. 23 (4 Jun– 10 Jun 2017)
Highlights:
(4) AFP cases were reported during this week, (3) cases from Al-Mayadin in Deir-ez-Zor, (1) case from Rural Damascus. v A notable decrease in SM cases reported for three consecutive weeks.
(58) Suspected Measles cases were reported during this week: from Ar-Raqqa (17), Damascus (17), Deirez-Zor (14), and Dar’a (6)
:: 15 Jul 2017 Millions of Syrians benefit from cross-border operations
Three years after the adoption of a Security Council resolution on relief delivery across border lines in Syria, cross-border operations continue to play a pivotal role in the delivery of life-saving assistance to millions of Syrians.

Yemen
:: Yemen Humanitarian Bulletin Issue 25 | 16 July 2017
HIGHLIGHTS
:: 332,658 suspected cholera cases and over 1,759 cholera deaths reported between 27 April and 13 July.
:: Two million people more need assistance, bringing the number of people in need to 20.7 million from 18.8 million in January.
:: From January to April 2017, 4.3 million people were assisted across Yemen out of the total target population of 11.9 million.
:: 22 civilians were killed or injured in an air attack on a market in Sa’ada near the border with Saudi Arabia.
Worst cholera outbreak in the world
More than 330,000 suspected cases with 1,759 associated deaths reported in less than three months
The cholera epidemic sweeping across Yemen is currently the worst such outbreak in the world. At the end of June, suspected cases exceeded 200,000 people, increasing at an average of 5,000 every day, with one person dying nearly every hour. Children and the elderly are the most affected; children under the age of 15 account for 40 per cent of suspected cases and a quarter of the deaths while those aged over 60 represent 30 per cent of fatalities. The governorates most affected by cholera are Amanat Al Asimah, Al Hudaydah, Hajjah and Amran. The situation is particularly worrying in ‘’hot spots’ like Ibb, Raymah, Dhamar, Hajjah and Al Mahwit, where case fatality ratios, a reference to the proportion of deaths within a designated population, have exceeded the one per cent emergency threshold established by the World Health Organisation (WHO).

Cholera is endemic to Yemen, but the current outbreak is the direct consequence of more than two years of heavy conflict that has moved an already weak and impoverished country towards social, economic and institutional collapse. The war has decimated Yemen’s health system, damaged key infrastructure and cut off 15.7 million people from access to adequate clean water and sanitation. In the last 10 months, about 30,000 health and sanitation workers have not received their salaries; only a third of critical medical supplies have entered the country compared to the period before March 2015; and garbage has piled up in the cities. Indeed, the current numbers of cholera cases are likely to be an underrepresentation of the magnitude of the epidemic since only 45 per cent of health facilities are effectively functioning and surveillance systems are weak.
Data collection and verification is a major challenge throughout the country. Between 27 April and 13 July 2017, a total of 332, 658 suspected cholera cases and 1,759 deaths were reported in all governorates except the island of Socotra.

Response ramped up but the magnitude of the outbreak is outstripping capacity to respond
Humanitarian partners have ramped up efforts to contain the outbreak. However, the magnitude of the outbreak is beyond the capacity, presence and reach of humanitarian organisations who have had to reprogramme meagre resources available to tackle widespread food insecurity for the cholera response. Displacement and high levels of food insecurity compound the cholera crisis.

The current cholera outbreak has overwhelmed what remains of Yemen’s conflictbattered health system. Hospitals and treatment centres are struggling to cope with large numbers of patients and medicines and intravenous fluids are quickly running out. Various partners are racing to stop the acceleration of the cholera outbreak, working around the clock to detect and track the spread of disease and to reach people with clean water, adequate sanitation and medical treatment. Rapid response teams are going house-to-house to reach families with information about how to protect themselves by cleaning and storing drinking water. Medical supplies such intravenous fluids, and Oral Rehydration Salts and water chlorination tablets have been shipped in and plans are underway for a nationwide anti-cholera campaign from 15 July in priority districts. Despite these efforts, the response continues to lag behind. Some 5,006 Cholera Treatment Centre beds are needed but only 2,351 are currently available, along with 2,003 Oral Rehydration Points, of which only 624 are currently available. On 4 July, WHO reported that out of 309 districts with reported cholera cases, cholera partners are only present in 121 districts.

Even then, the risk of the epidemic affecting thousands more people is real as the health, water, sanitation and hygiene systems are unable to cope and humanitarian funding remains low. As of 16 July, the 2017 Yemen Humanitarian Response Fund is 40 per cent funded. Additionally, humanitarian organizations continue to face restrictions on movements of supplies and people to and from Yemen. Al Hudaydah port, which is the main entry point for humanitarian supplies, is operating at limited capacity due to damage sustained from attacks. In Sana’a, the main airport is closed to commercial traffic, thus preventing people seeking medical assistance not available in Yemen to travel abroad for treatment.

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.
Ethiopia
:: Ethiopia Weekly Humanitarian Bulletin, 17 July 2017

DRC
:: Note d’informations humanitaires, 19 juillet 2017 : Mission du chef des affaires humanitaires des Nations Unies en République Démocratique du Congo
 
Somalia
:: Horn of Africa: Humanitarian Impacts of Drought – Issue 8 (18 July 2017)

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::::::
 
Dashboard: International Coordinating Group (ICG) on Vaccine Provision on cholera  [accessed 22 July 2017]
Country: Yemen
ICG request receive date: 14 Jun 2017
Status: Partially-approved
Context: Outbreak response
Doses shipped: 500,000
Confirmed delivery dates: Vaccine scheduled to arrive in Saana on 6 July before the request was cancelled by requestor
Vaccination implementation: Vaccine redirected to another country

The Lancet Infectious Diseases
Published: 17 July 2017
Comment
Oral cholera vaccines: exploring the farrago of evidence
The development of a cheap and effective oral cholera vaccine (OCV) is a remarkable achievement in the field of cholera prevention. A meta-analysis on the efficacy and effectiveness of OCVs by Qifang Bi and colleagues1 updates the estimates of the 2011 Cochrane review.2 Their analysis includes additional studies published since 2011, yet provides estimates that are almost the same.

The debate about the low efficacy of OCVs in children aged younger than 5 years has continued to dominate the policy discourse in endemic countries such as India, where children are the main target of immunisation programmes. Older estimates identified children younger than 5 years to be at a disproportionately higher risk of cholera than other age groups;3 however, updated estimates have shown that making robust assertions in the absence of accurate age-specific morbidity and mortality data is difficult.4 This uncertainty has further contributed to a policy-level hesitancy in adopting OCVs for widespread use in endemic countries. Crucially, more accurate estimates of cholera burden should be established to enable programmatic implementation of OCVs, and the reasons for poor immune responses to OCVs in children need to be understood. Furthermore, we propose that the extent of herd protection offered by OCVs should be established, especially in children, if a targeted vaccination policy covering all age groups is endorsed for highly endemic hotspots.5

Water, sanitation, and hygiene (WaSH) interventions are considered to be the best method of cholera control, but gaps have been shown in the knowledge about which interventions work best.6 In our experience, in-house contamination of water remains a major problem, which sometimes persists despite efficient programmatic implementation of WaSH strategies.7 Trials in India have shown similar problems, and a rural sanitation programme failed to show evidence of prevention of diarrhoea and soil-transmitted helminth infections or reduction in faecal contamination of water sources.8, 9, 10

Modelling studies have suggested that in areas with poor sanitation, isolated efforts for water quality improvement are likely to be met with low success.11 Further, considering the high endemicity of cholera in low-income and middle-income countries (LMICs), single-pathway interventions are likely to be inadequate in the control of diarrhoeal diseases, and cholera in particular because of environmental persistence of vibrios, which might not be eradicated even with stringent implementation of such interventions.11 Besides, deploying adequate WaSH interventions takes time because it involves significant investment in infrastructural improvements and behavioural changes. Keeping these issues in mind, cheap and effective OCVs emerge as a viable option to keep cholera at bay, reducing morbidity and mortality, while the definitive WaSH interventions are identified and rolled out. The successful expansion of the Swachh Bharat (Clean India) mission in India provides a governance-driven model of sanitation and hygiene promotion that can be replicated in other LMICs; however, its effectiveness in reducing numbers of cases and deaths from cholera or diarrhoeal diseases needs to be systematically studied.

Although cholera outbreaks in areas of political and civil unrest are a major concern, strategies to mitigate the risks have been poorly studied. Mortality and morbidity from cholera in complex emergencies remains high. A systematic review showed that the evidence on the effectiveness of WaSH interventions in times of humanitarian crises is scarce and of poor quality.12 Only point-of-use interventions and safe water storage were effective measures in reducing diarrhoea incidence.12 By contrast, a single-dose regimen was an effective strategy to combat a cholera outbreak in South Sudan and an endemic focus in Bangladesh.13, 14

The creation of an OCV stockpile, and the commitment of Gavi, the Vaccine Alliance, to support vaccination of emergency and endemic areas of cholera activity, provides a cost-effective method by which countries can access vaccines as they work towards universal deployment of adequate WaSH facilities. In our opinion, a balanced public health policy needs to be in place, in which OCVs are used as a synergistic tool for cholera control, while the most efficient, cost-effective, and locally feasible, acceptable, and relevant WaSH interventions are identified and deployed. Given that even in endemic countries, cholera is a public health menace only in specific regions, with multiple local factors contributing to disease epidemiology, health policies need to be customised to fit the local contexts, eschewing one-size-fits all approaches

WHO & Regional Offices [to 22 July 2017]

Discovering who misses out on health: the example of Indonesia
21 July 2017 – While many countries have improved the overall health of their populations, national averages don’t tell the whole story: groups of people can miss out on health services for a variety of reasons. WHO has developed a set of resources to monitor health inequalities – one of which, the Health Equity Assessment Toolkit (HEAT), was recently tested in Indonesia, allowing the country to analyse and interpret inequalities in health.

WHO urges action against HIV drug resistance threat
News release
20 July 2017 | GENEVA – WHO alerts countries to the increasing trend of resistance to HIV drugs detailed in a report based on national surveys conducted in several countries. The Organization warns that this growing threat could undermine global progress in treating and preventing HIV infection if early and effective action is not taken.
The WHO HIV drug resistance report 2017 shows that in 6 of the 11 countries surveyed in Africa, Asia and Latin America, over 10% of people starting antiretroviral therapy had a strain of HIV that was resistant to some of the most widely used HIV medicines. Once the threshold of 10% has been reached, WHO recommends those countries urgently review their HIV treatment programmes.
:: HIV drug resistance report 2017
“Antimicrobial drug resistance is a growing challenge to global health and sustainable development,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We need to proactively address the rising levels of resistance to HIV drugs if we are to achieve the global target of ending AIDS by 2030.”…

Highlights
Training on refugee and migrant health for policy-makers and aid workers
July 2017 – Over 1.3 million refugees and migrants have arrived to Europe since 2015. To help aid workers and policy-makers better manage the health aspects of this mass influx of people WHO has launched the first Summer School on Refugee and Migrant Health.

New International Food Safety Standards protecting consumer health and ensuring fair practices in trade
July 2017 – Members of the international food standards-setting body, the Codex Alimentarius Commission, are considering today the adoption of international standards and code of practices.

::::::

Weekly Epidemiological Record, 21 July 2017, vol. 92, 29/30 (pp. 405–416)

:: Progress towards measles elimination in Bangladesh, 2000–2016 :: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017

::::::
 
Disease outbreak news
:: Cholera – Kenya  21 July 2017
:: Dengue fever – Sri Lanka  19 July 2017
:: Human infection with avian influenza A(H7N9) virus – China  19 July 2017

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: The HIV Self-Testing Africa (STAR) project in Zambia shows potential for increasing uptake and coverage of HIV testing  21 July 2017 [Lusaka]
:: WHO establishes an Emergency Hub in Nairobi  21 July 2017
:: Progress towards Malaria Elimination in The Gambia  21 July 2017
:: WHO’s support to the response of the acute watery diarrhoea outbreak in Ethiopia’s Somali Region  20 July 2017
:: Gambia launches National Tobacco Control Act 2016 whilst WHO honours national tobacco control champions for 2017  20 July 2017
:: WHO scales up cholera response with 500 000 doses of oral cholera vaccine for vaccination campaign in South Sudan  19 July 2017

 
WHO European Region EURO
:: European Union presidency discussions consider policy options for alcohol labelling 21-07-2017
:: Summer School sets course for intercountry collaboration and capacity-building on refugee and migrant health 19-07-2017
:: Rescue in the Mediterranean: learning from the Italian experience 18-07-2017
:: WHO to improve health care in northern Syria with integrated network 18-07-2017

CDC/ACIP [to 22 July 2017]
http://www.cdc.gov/media/index.html
Press Release

Wednesday, July 19, 2017
CDC reminds travelers to Europe: Protect against measles
With the peak summer travel season under way, the Centers for Disease Control and Prevention (CDC) is reminding travelers …
 
Press Release
Tuesday, July 18, 2017
New CDC report: More than 100 million Americans have diabetes or prediabetes
Press Release
Monday, July 17, 2017
CDC awards $12 million to help states fight opioid overdose epidemic

MMWR News Synopsis for July 20, 2017
Progress Toward Measles Elimination — Bangladesh, 2000–2016
To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services in order to increase two-dose measles vaccine coverage to ≥95% in all districts. There is also a need to enhance the sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and enhancing capacity for epidemiological investigation and outbreak preparedness and response to rapidly identify and contain outbreaks. In 2014 Bangladesh adopted a goal for national measles elimination by 2018. This report summarizes progress toward measles elimination in Bangladesh during 2000–2016. During 2000–2016, estimated coverage with the first dose of measles-containing vaccine (MCV1) increased from 74 percent to 94 percent. Supplementary immunization activities vaccinated approximately 36 million children in 2005-06, 18.1 million children in 2010, and 53.6 million children in 2014. Reported suspected measles incidence declined by 82 percent during 2000–2016, from 34.2 to 6.1 cases per million population.
Notes from the Field:
Cluster of Acute Flaccid Myelitis in Pediatric Patients — Maricopa County, Arizona, October 2016
Hospital Contact Investigation for a Patient Who Developed a Zoster Vaccine–Related Rash — Maryland, February 2015
 

Announcements
 

PATH [to 22 July 2017]
http://www.path.org/news/index.php
Announcement | July 21, 2017
Zambia and the BID Initiative celebrate commitment to close the immunization gap with better data
Today the BID Initiative is celebrating its partnership with the Ministry of Health (MOH) in Zambia to create a culture of data use in a showcase event. It will also mark the launch of Zambia’s electronic immunization registry (ZEIR). The celebration, which will include Zambia’s First Lady Esther Lungu, among other special guests, symbolizes both parties’ commitments to closing the immunization gap with timely, high-quality data.
Immunization is one of the best investments to improving health around the globe. Yet inaccurate or incomplete data about vaccine coverage rates, difficulties tracking patients who have missed a recent vaccine, labor-intensive reporting protocols, and poor visibility into vaccine stocks all make it difficult for health workers and health systems, particularly in low-resource settings, to protect their target population against life-threatening childhood diseases.
The BID Initiative, led by PATH, helps ensure that accurate data are both available and utilized, allowing health workers to make better decisions on how best to deliver care. Designed and implemented in partnership with the governments of Tanzania and Zambia, the BID Initiative enhances immunization and overall health service delivery by improving data collection, quality, and use. It holistically addresses immunization data challenges and strengthens evidence-based decisions through a package of interventions that build a culture of data use, including electronic immunization registries (EIR), barcodes or QR codes on child health cards, stock management tools, and peer support networks, among other data use tools. With better data, facilities can avoid stock-outs, identify defaulting patients, and better measure their performance against neighboring facilities…

Announcement | July 19, 2017
PATH welcomes $8.2 million grant from the Conrad N. Hilton Foundation to improve early childhood development in Mozambique, Kenya, and Zambia
PATH welcomes a four-year, $8.2 million grant from the Conrad N. Hilton Foundation to help thousands more children in Kenya, Mozambique, and Zambia develop to their full physical, cognitive, and social potential.
Children whose caregivers play and talk with them and are responsive to their needs show better education, health, social, and economic outcomes as adults. Yet globally, these activities, formally referred to as “nurturing care,” are often absent from children’s lives, especially during the critical window from birth until age three, when these activities have the greatest impact.
The investment builds on other PATH early childhood development (ECD) programs in sub-Saharan Africa, including the Hilton Foundation–supported Scaling Up Early Child Development project in Kenya and Mozambique, the Window of Opportunity project in South Africa and Mozambique (supported by BHP Billiton Sustainable Communities), and a US Agency for International Development-funded Public Private Partnership project in Mozambique.
PATH’s innovative approach integrates ECD services into the work of existing government health facilities and community-level health providers at a very low cost. The approach is particularly effective at reaching children younger than age three, who can benefit the most from ECD but are often missed by programs designed to reach children in school…

::::::
 
European Vaccine Initiative [to 22 July 2017]
http://www.euvaccine.eu/news-events
20 July 2017
Role of vaccines in combatting anti-microbial resistance
 
19 July 2017
Current efforts in the development of effective Zika vaccines presented at the Zika Virus and other Mosquito-borne Viruses conference
 
::::::
 
FDA [to 22 July 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
July 18, 2017 –
FDA approves Vosevi for Hepatitis C
The U.S. Food and Drug Administration today approved Vosevi to treat adults with chronic hepatitis C virus (HCV) genotypes 1-6 without cirrhosis (liver disease) or with mild cirrhosis. Vosevi is a fixed-dose, combination tablet containing two previously approved drugs – sofosbuvir and velpatasvir – and a new drug, voxilaprevir. Vosevi is the first treatment approved for patients who have been previously treated with the direct-acting antiviral drug sofosbuvir or other drugs for HCV that inhibit a protein called NS5A.
“Direct-acting antiviral drugs prevent the virus from multiplying and often cure HCV. Vosevi provides a treatment option for some patients who were not successfully treated with other HCV drugs in the past,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research…

What’s New for Biologics
Influenza Virus Vaccine for the 2017-2018 Season Updated: 7/20/2017
Recall of MENVEO [Meningococcal (Groups A, C, Y and W-135) Oligosaccharide Diphtheria CRM197 Conjugate Vaccine] Solution for intramuscular injection Posted: 7/18/2017
July 14, 2017 Approval Letter – Afluria and Afluria Quadrivalent (PDF – 32KB) Posted: 7/17/2017

::::::
 
European Medicines Agency [to 22 July 2017]
http://www.ema.europa.eu/ema/
21/07/2017
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 17-20 July 2017
Eleven medicines recommended for approval, including five orphans
 
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EDCTP    [to 22 July 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
21 July 2017
EC Call for Tender: burden of diseases preventable by maternal immunisation in sub-Saharan Africa
The European Commission Directorate-General for Research and Innovation issued a call for tender on 14 July 2017 on the topic…
 
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Wellcome Trust [to 22 July 2017]
https://wellcome.ac.uk/news
News / Published: 19 July 2017
Fiona Powrie joins our Board of Governors
Fiona Powrie, Director of the Kennedy Institute of Rheumatology at the University of Oxford, is joining Wellcome as a new Governor.
 
::::::
 
Industry Watch
:: Jul 17, 2017 Sanofi Pasteur Ships First of its U.S. Influenza Vaccine Doses for 2017-2018 Season
:: Jul 14, 2017, 16:56 ETGSK ships 2017-18 seasonal influenza vaccines for US market

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PhRMA   [to 22 July 2017]
http://www.phrma.org/press-room
July 18, 2017
New Report Shows 74 Percent of Medicines in Development have Potential to be First-in-Class Treatments
Seventy-four percent of medicines in clinical development around the world are potentially first-in-class medicines, meaning they use a completely new approach to fighting a disease, according to a new report:
The Biopharmaceutical Pipeline: Innovative Therapies in Clinical Development
The biopharmaceutical pipeline contains thousands of significant and innovative new treatments with the potential to address unmet medical needs, save lives and improve patients’ health. A new report by the Analysis Group, “The Biopharmaceutical Pipeline: Innovative Therapies in Clinical Development,” examines the state of the drug development pipeline and provides insights into new approaches researchers are pursuing.
Key findings:
:: 74 percent of medicines in clinical development are potentially first-in-class medicines, meaning they represent a possible new pharmacological class for treating a medical condition.
:: 822 projects – defined as unique molecule-indication combinations – are designated by the U.S. Food and Drug Administration (FDA) as orphan drugs, which is critically important given only 5 percent of rare diseases have an approved medicine.
:: A range of novel scientific approaches are being pursued, including cell and gene therapies, DNA and RNA therapeutics and conjugated monoclonal antibodies.
PDF: http://phrmasubscribers.com/2017-pipeline-report?__hstc=99188225.961cb2d611680f482141e3df7aaa21f9.1487423286359.1500115909916.1500732104978.23&__hssc=99188225.3.1500732104978&__hsfp=1851132392

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

Ending AIDS: progress towards the 90–90–90 targets – Global AIDS Update 2017
Joint United Nations Programme on HIV/AIDS (UNAIDS)
July 2017 :: 198 pages
PDF: http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf

Overview
Ending AIDS: progress towards the 90–90–90 targets, gives a detailed analysis of progress and challenges towards achieving the 90–90–90 targets. The report shows that for the first time the scales have tipped: more than half of all people living with HIV (53%) now have access to HIV treatment and AIDS-related deaths have almost halved since 2005. In 2016, 19.5 million of the 36.7 million people living with HIV had access to treatment, and AIDS-related deaths have fallen from 1.9 million in 2005 to 1 million in 2016. Provided that scale-up continues, this progress puts the world on track to reach the global target of 30 million people on treatment by 2020.

Foreward
When I launched the 90–90–90 targets three years ago, many people thought they were
impossible to reach. Today, the story is very different. Families, communities, cities and
countries have witnessed a transformation, with access to HIV treatment accelerating in
the past three years. A record 19.5 million people are accessing antiretroviral therapy,
and for the first time more than half of all people living with HIV are on treatment. More
countries are paying for HIV treatment themselves. More people living with HIV are
employed, more girls are in school, there are fewer orphans, there is less ill health and less
poverty. Families and communities are feeling more secure.

With science showing that starting treatment as early as possible has the dual benefit of
keeping people living with HIV healthy and preventing HIV transmission, many countries
have now adopted the gold-standard policy of treat all. Our efforts are bringing a strong
return on investment. AIDS-related deaths have been cut by nearly half from the 2005
peak. We are seeing a downward trend in new HIV infections, especially in eastern and
southern Africa, where new HIV infections have declined by a third in just six years. This
good news is a result of the combined effect of a rapid scale-up of treatment and existing
HIV prevention interventions. Moving forward, every additional dollar invested in AIDS will
deliver a US$ 8 return.

But our quest to end AIDS has only just begun. We live in fragile times, where gains can
be easily reversed. The biggest challenge to moving forward is complacency.

Global solidarity and shared responsibility has driven the success we have achieved so
far. This must be sustained. But for several years now, resources for AIDS have remained
stagnant, and we are not on track to reach the US$ 26 billion of investment we need by
Without more domestic investments and international assistance, we cannot push

faster on the Fast-Track. More people will become infected with HIV and lives will be lost.
Without more community health workers, health systems will remain stretched. Without
changing laws, key populations will be left behind.

We must not fail children, women and girls, young people and key populations. We must
engage with men differently. Men are being left behind in the push to 90–90–90, in turn
affecting the lives of women and children.

I remain optimistic. This report clearly demonstrates the power of the 90–90–90 targets
and what can be achieved in a short time. It shows that innovations are possible at every
level—from communities to research laboratories, from villages to cities. It illustrates the
power of political leadership to make the impossible possible.
Michel Sidibé
UNAIDS Executive Director

Press Release
The scales have tipped—UNAIDS announces 19.5 million people on life-saving treatment and AIDS-related deaths halved since 2005
The 90–90–90 targets are galvanizing global action and saving lives. Eastern and southern Africa leading the way in reducing new HIV infections by nearly 30% since 2010—Malawi, Mozambique, Uganda and Zimbabwe have reduced new HIV infection by nearly 40% or more since 2010. Concerted efforts still needed for children, adolescents, men and key populations, and in certain regions.

GENEVA/PARIS, 20 July 2017—UNAIDS has released a new report showing that for the first time the scales have tipped: more than half of all people living with HIV (53%) now have access to HIV treatment and AIDS-related deaths have almost halved since 2005. In 2016, 19.5 million of the 36.7 million people living with HIV had access to treatment, and AIDS-related deaths have fallen from 1.9 million in 2005 to 1 million in 2016. Provided that scale-up continues, this progress puts the world on track to reach the global target of 30 million people on treatment by 2020.

“We met the 2015 target of 15 million people on treatment and we are on track to double that number to 30 million and meet the 2020 target,” said Michel Sidibé, Executive Director of UNAIDS. “We will continue to scale up to reach everyone in need and honour our commitment of leaving no one behind.”

The region showing the most progress is eastern and southern Africa, which has been most affected by HIV and which accounts for more than half of all people living with HIV. Since 2010, AIDS-related deaths have declined by 42%. New HIV infections have declined by 29%, including a 56% drop in new HIV infections among children over the same period, a remarkable achievement resulting from HIV treatment and prevention efforts that is putting eastern and southern Africa on track towards ending its AIDS epidemic.

WHAT’S ON TRACK
90–90–90 progress
The report, Ending AIDS: progress towards the 90–90–90 targets, gives a detailed analysis of progress and challenges towards achieving the 90–90–90 targets. The targets were launched in 2014 to accelerate progress so that, by 2020, 90% of all people living with HIV know their HIV status, 90% of all people with diagnosed HIV are accessing sustained antiretroviral therapy and 90% of all people accessing antiretroviral therapy are virally suppressed.

The report shows that in 2016 more than two thirds (70%) of people living with HIV now know their HIV status. Of the people who know their status, 77% were accessing treatment, and of the people accessing treatment, 82% were virally supressed, protecting their health and helping to prevent transmission of the virus.

Eastern and southern Africa, western and central Europe and North America and Latin America are on track to reach the 90–90–90 targets by 2020. In eastern and southern Africa, 76% of people living with HIV know their HIV status, 79% of people who know their HIV-positive status have access to antiretroviral therapy and 83% of people who are on treatment have undetectable levels of HIV—this equates to 50% of all people living with HIV in eastern and southern Africa with viral suppression. The Caribbean and Asia and the Pacific can also reach the 90–90–90 targets if programmes are further accelerated.

Seven countries have already achieved the 90–90–90 targets—Botswana, Cambodia, Denmark, Iceland, Singapore, Sweden and the United Kingdom of Great Britain and Northern Ireland—and many more are close to achieving it.

“Ending AIDS is possible – it is a shared engagement and aspiration. One that cities can lead while promoting inclusive societies for all,” said Anne Hidalgo, Mayor of Paris…

In 2016 an estimated:
:: 19.5 million people were accessing antiretroviral therapy
:: 36.7 million [30.8 million–42.9 million] people globally were living with HIV
:: 1.8 million [1.6 million–2.1 million] people became newly infected with HIV
:: 1.0 million [830 000–1.2 million] people died from AIDS-related illnesses

WHAT’S OFF TRACK?
Treatment for children living with HIV
Only 43% of children living with HIV have access to antiretroviral therapy, compared to 54% of adults. Ending AIDS also reveals that as many as two thirds of children under two years old are diagnosed late and start treatment with advanced immunodeficiency, resulting in a high mortality rate for children of this age group. More action is needed to diagnose and treat children living with HIV.

Young people are lagging behind
Young people (15–24 years) are lagging behind on multiple fronts—knowledge of HIV, HIV testing, treatment and prevention. Young people continue to be at great risk of HIV infection, especially young women in sub-Saharan Africa. New HIV infections among young women in sub-Saharan Africa are 44% higher than among young men of their age in the region. Around 610 000 new HIV infections occurred among young people aged 15–24 years; 59% of those new infections occurred among young women age 15–24 years.
In Malawi, Zambia and Zimbabwe, half of young people do not know their status and more than half do not have access to HIV treatment. Only 36% of young men and 30% of young women in sub-Saharan Africa had a basic knowledge of how to protect themselves from HIV. Population-based HIV Impact Assessments (PHIAs) conducted in Malawi, Zambia and Zimbabwe, and supported by the United States President’s Emergency Plan for AIDS Relief, found that less than 50% of young people living with HIV were aware of their HIV status, compared to 78% of adults aged 35–59 years.

Men not being reached
The report reveals that less than 50% of young men know how to protect themselves from HIV infection, that men are much less likely to know their HIV status or start treatment than women and that less than 50% of men living with HIV are accessing antiretroviral therapy. Many men who are diagnosed with HIV are diagnosed late and start treatment only when they fall ill, making them much more likely to die of AIDS-related illnesses than women. Deaths from AIDS-related illnesses were 27% lower among women than among men…

MSF/Médecins Sans Frontières [to 22 July 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Doctors Without Borders Statement on New UNAIDS Report
July 20, 2017
UNAIDS released a report today that shows a reduction in AIDS-related deaths and states that more than half of all people living with HIV have access to treatment. Unfortunately, this report fails to recognize that sustained support is critical and that many people living with HIV/AIDS—like those in West and Central Africa—remain neglected and continue to suffer needlessly and die silently from AIDS-related diseases and infections. Today’s report finds that there were 1 million AIDS-related deaths last year, compared to 1.9 million in 2005.

Global Fund [to 22 July 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
New Global Fund Results Show Accelerated HIV Treatment Progress
20 July 2017
GENEVA – Ahead of next week’s International AIDS Society Conference on HIV Science in Paris, France, the Global Fund to Fight AIDS, Tuberculosis and Malaria today announced new results that highlight accelerating progress in providing HIV prevention, treatment and care services.
The results show that 11 million people are receiving antiretroviral therapy for HIV through Global Fund-supported programs, an increase of 19 percent from a year before.
“Our partnership is achieving results on a scale that few of us thought was possible,” said Marijke Wijnroks, Interim Executive Director of the Global Fund. “But we need to do even more. The number of new infections is still too high and, as we continue to expand lifesaving HIV treatments we need a stronger focus on prevention, human rights and gender. Reaching key and vulnerable populations, youth, and adolescent girls and young women is absolutely essential.”
The results, based on data from the end of 2016, also show that programs supported by the Global Fund partnership provided 4.3 million pregnant women with antiretroviral medicines to prevent the transmission of HIV to their unborn children.
This incredible progress is due to the global partnership and commitment of governments, civil society groups, health workers and local and international organizations, along with support from major donors and organizations including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS and WHO…

NIH  [to 22 July 2017]
http://www.nih.gov/news-events/news-releases
July 20, 2017
NIH-supported scientists elicit broadly neutralizing antibodies to HIV in calves
Unique structure of bovine bNAbs may inform HIV vaccine, therapeutics design.

Featured Journal Content

The Lancet
Jul 22, 2017 Volume 390 Number 10092 p333-428
http://www.thelancet.com/journals/lancet/issue/current
Editorial
The global HIV/AIDS epidemic—progress and challenges
The Lancet
On July 20, UNAIDS released their annual report on the status of the global HIV/AIDS epidemic, which also includes a comprehensive analysis of progress towards ending AIDS as a public health threat. The latest epidemiological estimates and programmatic data from 168 countries in all regions were reviewed. Worldwide, AIDS-related deaths have declined from a peak of about 1·9 million in 2005 to around 1·0 million in 2016, largely due to treatment scale-up—for the first time more than half of people with HIV are estimated to be on treatment. Since 2010, the annual number of new infections in all age groups has decreased by 16% to around 1·8 million in 2016. However, progress is variable, and despite a global downward trend in the epidemic, several regions are experiencing sharp increases in new infections and struggling to expand treatment.

In 2014, to accelerate progress towards ending AIDS as a public health threat by 2030, UNAIDS launched the 90-90-90 goals. The goals are that by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 90% of people receiving ART will achieve viral suppression. The report states that considerable progress has been made towards the 90-90-90 targets, but there are gaps along the continuum that vary across regions. Globally, more than two-thirds of people living with HIV knew their status in 2016. Around 77% of them were on treatment, and 82% of those on treatment had suppressed viral loads. In 2016, around 19·5 million people with HIV (53%) were on treatment, up from 17·1 million in 2015.

If reached, the 90-90-90 targets translate into 73% of all people living with HIV being virally suppressed. Botswana, Cambodia, Denmark, Iceland, Singapore, Sweden, and the UK already achieve or exceed this target, and 11 other countries are moving closer. However, the report notes that globally when the gaps along the cascade are combined, only 43% of all people living with HIV were virally suppressed in 2016, which is far lower than the final target, which means many regions are not on track to meet the 2020 target.

Progress in the world’s most affected areas, eastern and southern Africa, has been striking. With rapid scaling up of treatment in combination with existing prevention interventions, AIDS-related deaths have nearly halved in the past 6 years. New infections have declined from around 1·1 million to about 790 000, a 29% reduction. The region’s progress across the three 90s is comparable with that in Latin America, and if progress is sustained both are likely to achieve the targets alongside western and central Europe and North America, which have already met the 2020 goal.

Progress is less positive elsewhere. In the Middle East and north Africa, trends vary, and although numbers of new infections seem stable since 2010, AIDS-related mortality has increased in the past decade. In the same period in eastern Europe and central Asia, the number of new infections has risen to 190 000 in 2016, a 60% increase. The region’s HIV epidemic is mainly within two countries: Russia and Ukraine. People who inject drugs accounted for 42% of new HIV infections in the region in 2015. In both countries, there are large gaps across the 90-90-90 continuum. HIV testing and treatment coverage are low. Key populations in these regions are unable to access services and linkage to care is weak. These regions are unlikely to meet the 90-90-90 target.

The report points out challenges across all regions. Late diagnosis in key populations counteracts the potential effects of treatment as prevention in the general population. Gaps in the 90–90–90 continuum are greater for men, young people, and key populations. Women continue to be disproportionately affected by the epidemic. Criminalisation, stigma, and discrimination act as barriers to key populations entering care programmes. Funding too is a concern with resources falling short of global commitments.

The report emphasises that there is no room for complacency. Indeed, 53% of all people living with HIV being on ART means that another 17 million people with HIV are not. Indeed, in a letter in this week’s Lancet, Brian Williams and Reuben Granich call for an urgent review of the assumptions used to calculate the effect of ART on rates of new infections and AIDS-related mortality. Current approaches need to be more efficient, and innovations around diagnosis, treatment, service delivery, and surveillance and monitoring need to be brought to bear.
The UNAIDS annual report is a vital benchmark for identifying progress, successes, shortfalls, and gaps in tackling the global HIV epidemic. The use of the 90-90-90 goals provides a useful framework that can help countries prioritise their paths and actions toward an AIDS-free world. But what actions will now follow?

Journal Watch

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

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

American Journal of Tropical Medicine and Hygiene
Volume 97, Issue 1, 2017
http://www.ajtmh.org/content/current

Perspective Pieces
Precisely Tracking Childhood Death
Authors: Tamer H. Farag, Jeffrey P. Koplan, Robert F. Breiman, Shabir A. Madhi, Penny M. Heaton, Trevor Mundel, Jaume Ordi, Quique Bassat, Clara Menendez and Scott F. Dowell
https://doi.org/10.4269/ajtmh.16-0302
Abstract
Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12–15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.

American Journal of Tropical Medicine and Hygiene
Volume 97, Issue 1, 2017
http://www.ajtmh.org/content/current

Bidirectional Exchange in Global Health: Moving Toward True Global Health Partnership
Authors: Gitanjli Arora, Christiana Russ, Maneesh Batra, Sabrina M. Butteris, Jennifer Watts and Michael B. Pitt
https://doi.org/10.4269/ajtmh.16-0982
Abstract
Although there has been rapid growth in global health educational experiences over the last two decades, the flow of learners remains overwhelmingly one directional; providers from high-resourced settings travel to limited-resourced environments to participate in clinical care, education, and/or research. Increasingly, there has been a call to promote parity in partnerships, including the development of bidirectional exchanges, where trainees from each institution travel to the partner’s setting to learn from and teach each other. As global health educators and steering committee members of the Association of Pediatric Program Directors Global Health Pediatric Education Group, we endorse the belief that we must move away from merely sending learners to international partner sites and instead become true global health partners offering equitable educational experiences. In this article, we summarize the benefits, review common challenges, and highlight solutions to hosting and providing meaningful global health experiences for learners from limited-resourced partner institutions to academic health centers in the United States.

American Journal of Tropical Medicine and Hygiene
Volume 97, Issue 1, 2017
http://www.ajtmh.org/content/current

Conventional Wisdom versus Actual Outcomes: Challenges in the Conduct of an Ebola Vaccine Trial in Liberia during the International Public Health Emergency
Authors: Gregg S. Larson, Beth R. Baseler, Marie L. Hoover, Jerome F. Pierson, Jemee K. Tegli, Melvin P. Johnson, Mark W. S. Kieh, Laura A. McNay and Wissedi Sio Njoh
https://doi.org/10.4269/ajtmh.16-1015
Abstract
Clinical trials are challenging endeavors. Planning and implementing an investigational vaccine trial in Liberia, in the midst of an Ebola virus disease (EVD) epidemic that World Health Organization classified a public health emergency of international concern, presented extraordinary challenges. Normally, years of preparation and a litany of tasks lay the groundwork for a successful, randomized, blinded, placebo-controlled trial focused on safety and efficacy. Difficult research settings, unpredictable events, and other unique circumstances can add complexity. The setting in Liberia was especially problematic due to an infrastructure still badly damaged following a lengthy civil war and a very fragile health-care system that was further devastated by the EVD outbreak. The Partnership for Research on Vaccines in Liberia I EVD vaccine trial was planned and implemented in less than 3 months by a Liberian and U.S. research partnership, and its Phase II substudy was fully enrolled 3 months later. Contrasting conventional wisdom with trial outcomes offers an opportunity to compare early assumptions, barriers encountered, and adaptive strategies used, with end results. Understanding what was learned can inform future trial responses when disease outbreaks, especially in resource-poor locations with minimal infrastructure, pose a significant threat to public health.

Annals of Internal Medicine
18 July 2017 Vol: 167, Issue 2
http://annals.org/aim/issue

Original Research
Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations
Emily P. Hyle, MD, MSc; Sowmya R. Rao, PhD; Emily S. Jentes, PhD, MPH; Amy Parker Fiebelkorn, MSN, MPH; Stefan H.F. Hagmann, MD, MSc; Allison Taylor Walker, PhD, MPH; Rochelle P. Walensky, MD, MPH; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH
Abstract
Background:
Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers.
Objective:
To describe how providers assessed the measles immunity status of departing U.S. adult travelers seeking pretravel consultation and to assess reasons given for nonvaccination among those considered eligible to receive the measles, mumps, rubella (MMR) vaccine.
Design:
Observational study in U.S. pretravel clinics.
Setting:
24 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention–funded consortium.
Patients:
Adults (born in or after 1957) attending pretravel consultations at GTEN sites (2009 to 2014).
Measurements:
Structured questionnaire completed by traveler and provider during pretravel consultation.
Results:
40 810 adult travelers were included; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]).
Limitation:
These estimates could underrepresent the opportunities for MMR vaccination because providers accepted verbal histories of disease and vaccination as evidence of immunity.
Conclusion:
Of U.S. adult travelers who presented for pretravel consultation at GTEN sites, 16% met criteria for MMR vaccination according to the provider’s assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of importation and transmission of measles virus.
Primary Funding Source:
Centers for Disease Control and Prevention, National Institutes of Health, and the Steve and Deborah Gorlin MGH Research Scholars Award.

Annals of Internal Medicine
18 July 2017 Vol: 167, Issue 2
http://annals.org/aim/issue

Editorials
Why Aren’t International Travelers Vaccinated for Measles?
Lori K. Handy, MD, MSCE; Paul A. Offit, MD
Before a vaccine against measles was introduced, 500 000 cases occurred each year in the United States, resulting in 500 deaths, 48 000 hospitalizations, and 1000 cases of permanent brain damage from encephalitis (1). Endemic measles was eliminated from the United States in 2000 (2), but sporadic outbreaks have occurred since then because of importation of the virus from other countries. These cases occur in travelers as well as their contacts in the United States, many of whom are unvaccinated themselves (3). In 2014, the United States had the largest single outbreak of measles (667 cases) in more than 20 years because of infected travelers returning from abroad combined with the low vaccination rate of certain U.S. populations (4). This outbreak was linked to travel to the Philippines, which was in the midst of a measles epidemic. In 2015, a multistate outbreak associated with Disneyland likely was the result of a park visitor who had traveled overseas; 188 cases were reported that year (5). Importations remain the source of measles transmission in the United States, and persons visiting travel clinics present an opportunity to reduce or eliminate these cases.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 22 July 2017)

Research article
“We and the nurses are now working with one voice”: How community leaders and health committee members describe their role in Sierra Leone’s Ebola response
Across low-income settings, community volunteers and health committee members support the formal health system – both routinely and amid emergencies – by engaging in health services such as referrals and healt…
Shannon A. McMahon, Lara S. Ho, Kerry Scott, Hannah Brown, Laura Miller, Ruwan Ratnayake and Rashid Ansumana
BMC Health Services Research 2017 17:495
Published on: 18 July 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 22 July 2017)

Research article
Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China
China has a high prevalence of human papillomavirus (HPV) and a consequently high burden of disease with respect to cervical cancer. The HPV vaccine has proved to be effective in preventing cervical cancer and…
Xiuting Mo, Ruoyan Gai Tobe, Lijie Wang, Xianchen Liu, Bin Wu, Huiwen Luo, Chie Nagata, Rintaro Mori and Takeo Nakayama
BMC Infectious Diseases 2017 17:502
Published on: 18 July 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 22 July 2017)

Research article
Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence
Critical health literacy enables older adults to make informed health decisions and take actions for the health and wellbeing of themselves and their community, within their own social and cultural context. A …
Liesbeth de Wit, Christine Fenenga, Cinzia Giammarchi, Lucia di Furia, Inge Hutter, Andrea de Winter and Louise Meijering
BMC Public Health 2017 18:40
Published on: 20 July 2017

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 22 July 2017)

Short report
Sero-prevalence and vaccination status of hepatitis A and hepatitis B among adults with cirrhosis in Sri Lanka: a hospital based cohort study
As acute viral hepatitis can be fatal in patients with cirrhosis, vaccination against hepatitis A (HAV) and hepatitis B (HBV) is recommended for non-immune patients. With increasing affluence the incidence of …
Madunil Anuk Niriella, Vipuli Jayendra Kobbegala, Hasnatha Nuwan Karalliyadda, Chamila Kumara Ranawaka, Arjuna Priyadarshin de Silva, Anuradha Supun Dassanayake and Hithanadura Janaka de Silva

Published on: 21 July 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 7, 2017
http://www.tandfonline.com/toc/khvi20/current

Article
Herpes zoster vaccine: A health economic evaluation for Switzerland
Patricia R. Blank, Zanfina Ademi, Xiaoyan Lu, Thomas D. Szucs & Matthias Schwenkglenks
Pages: 1495-1504
Published online: 08 May 2017

brief report
Measles cases among adolescents in southern Pakistan 2012–2015: The case for revisiting vaccination strategies
Sadia Shakoor, Erum Khan, Muhammad Imran Rajput & Wali Muhammad Rahimoon
Pages: 1544-1547
Published online: 25 Apr 2017
ABSTRACT
Aims: Surveillance of adult measles in Pakistan is a challenge as it does not enjoy the status of a reportable disease unlike childhood cases and therefore cases remain undetected and unreported or misdiagnosed. Consequently no data or estimates of young adult cases, seroprevalence, or estimates of susceptible preadolescent or young adult population exist. We have presented both laboratory conformed and clinically suspected cases of measles occurring in adolescents and adults in the southern province of Sindh in Pakistan. Methods: Through an examination of 2 independent databases, i.e. a laboratory database of measles IgM positive cases and clinically detected cases on surveillance performed by the Disease Early Warning System, we have analyzed and reported age-specific positivity rates from 2012 to 2015 in Sindh, Pakistan. Results: High rates of laboratory confirmed measles were observed in those aged 9 y and younger. Among adolescents and adults, significantly higher positivity rates were observed among those aged 10–19 y. Clinically detected cases from Sindh showed similar distribution of cases. Conclusions: High burden of cases among children <9 y of age confirm that supplementary immunization activities (SIAs) among this age group are inadequate and need to be strengthened. Cases among those 10–19 y further demonstrate the need for consolidating SIAs with an additional strategy to vaccinate those who remain non-immune at college entry and in institutions where outbreaks can be prevented. Such measures are essential to achieving the goal of measles elimination in the country and region.

review
A review of the value of quadrivalent influenza vaccines and their potential contribution to influenza control
Riju Ray, Gaël Dos Santos, Philip O. Buck, Carine Claeys, Gonçalo Matias, Bruce L. Innis & Rafik Bekkat-Berkani
Pages: 1640-1652
Published online: 22 May 2017

case report
Vaccination campaign at a temporary camp for victims of the earthquake in Lorca (Spain)
Jaime Jesús Pérez-Martín, Francisco José Romera Guirado, Yolanda Molina-Salas, Pedro José Bernal-González & José Antonio Navarro-Alonso
Pages: 1714-1721
Published online: 31 Mar 2017

International Journal of Infectious Diseases
July 2017 Volume 60, p1-102
http://www.ijidonline.com/issue/S1201-9712(17)X0007-6

Editorials
Yellow Fever importation to China – a failure of pre- and post-travel control systems?
Patricia Schlagenhauf, Lin H. Chen
p91–92
Published online: June 6, 2017

A new paradigm in pneumococcal conjugate vaccination: moving from individual to herd protection
Gail L. Rodgers, Keith P. Klugman
p96–97
Published online: April 24, 2017

Perspective
From individual to herd protection with pneumococcal vaccines: the contribution of the Cuban pneumococcal conjugate vaccine implementation strategy
Nivaldo Linares-Pérez, María E. Toledo-Romaní, Darielys Santana-Mederos, Anaí García-Fariñas, Dagmar García-Rivera, Yury Valdés-Balbín, Vicente Vérez-Bencomo
p98–102