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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– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_25 Nov 2017

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

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

Milestones :: Perspectives
 
Editor’s Note
We generally reserve this section of our digest for major strategic announcements and significant milestones in the vaccines/immunization space. We share below the text from a retirement laudation plaque that represents, in our view, such a milestone.

******

In Recognition of Exemplary Leadership in Advancing Immunization Globally,
We Hereby Honor
 
       Dr. Jean M-Marie Okwo-Bele
       Director of Immunization, Vaccines and Biologicals
       World Health Organization
       2004-2017
 
We thank you for your passion, unconditional commitment, and enduring dedicated service to public health.</em
 
Your legacy will live on in the many lives you have touched.
 
Your Friends, Colleagues and Partners Worldwide
November 2017
 
******
 
We understand that Okwo received this laudation during a celebratory event at the close of the SAGE meeting in October. Okwo’s retirement commences following his last day official working day at WHO on 29 November 2017.

We wish him a splendid next adventure…

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IVI   [to 25 November 2017]
http://www.ivi.int/
Commemorating our 20th anniversary, IVI thanks donors, partners for support
IVI expresses our deepest gratitude to all the donors and supporters for your commitment and generosity to the Institute over the past 20 years. In particular, we wish to thank our donors and partners who joined us at our 20th Anniversary Forum held on November 15.
The Forum brought together 170 scientists, partners and friends of IVI from across Korea and around the world, including Dr. Park Neung-hoo, Minister of Health and Welfare of Korea. Present at the Celebration and Dinner were some 120 donors and supporters, including awardees of plaques who were honored for their outstanding commitment and contribution to IVI. As we move into IVI’s third decade, we look forward to the continuing friendship and partnership with our donors and partners to make an even bigger impact in vaccine science and global public health in the years ahead.
We are pleased to share with you images of the commemorative events and greetings on our 20th Anniversary from donors, partners and friends of IVI below.
   Press release: http://www.ivi.int/?mod=document&uid=954&page_id=12463
Photo images of the 20th Anniversary Forum and Celebrations: https://www.flickr.com/photos/internationalvaccineinstitute/albums/72157666609937919

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 22 November 2017 [GPEI]
:: On the 14 November, the 15th IHR Emergency Committee convened to review the risk of international spread of poliovirus. The committee agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months.
:: To mark World Children’s Day, we reported on how the polio eradication programme helps deliver a bright future to children in Nigeria.

:: Summary of newly-reported viruses this week:
…Afghanistan: Four new wild poliovirus type 1 (WPV1) positive environmental samples, three collected from Kandahar province, and one from Kabul province.
…Pakistan: One new WPV1 positive environmental sample, collected from Sindh province.
…Syria: Seven new circulating vaccine derived poliovirus type 2 (cVDPV2) cases reported, all from Deir Ez-Zor governorate.

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Statement of the 15th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement
14 November 2017
[Excerpts; Editor’s text bolding]
The fifteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 November 2017 at WHO headquarters with members, advisers and invited member states attending via teleconference.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 3 August 2017: Afghanistan, the Democratic Republic of Congo (DR Congo), Nigeria, Pakistan and the Syrian Arab Republic.
Wild polio

Overall the Committee was encouraged by continued steady progress in all three WPV1 infected countries, Afghanistan, Nigeria and Pakistan and the fall in the number of cases globally, and that international spread remained limited to between Afghanistan and Pakistan only. While falling transmission in these three countries decreased the risk of international spread, the consequences of any failure to prevent spread would increasingly be a set-back to eradication and a risk to public health, as funding winds down in the coming years.

The Committee commended the high-level commitment seen in both Afghanistan and Pakistan, and the high degree of cooperation and coordination, particularly targeting the high risk mobile populations that cross the international border, such as nomadic groups, local populations straddling the border, seasonal migrant workers and their families, repatriating refugees (official and informal), and guest children (children staying with relatives across the border). Stopping transmission in these populations remains a major challenge that cannot be under-estimated, underlining the critical continuing need for cross border activities in surveillance and vaccination.

The Committee commended the achievements in Pakistan that have resulted in the number of cases falling to just five so far in 2017; achievements included the improved accessibility, improved communication to reduce missed children and better quality supplementary immunization activities (SIA). However, WPV1 transmission continues to be widespread geographically as detected by environmental surveillance and this remains a source of major concern, notwithstanding that the intensity of environmental surveillance is now higher than previously, meaning the probability of environmental detection is now higher.
The Committee was concerned by the ongoing risks to eradication posed by the number of inaccessible and missed children in Afghanistan, particularly in the southern region resulting in ten cases to date in 2017.

The Committee was impressed by the innovations that continue to be made in Nigeria to reach children in Borno, but was very concerned that although the number of inaccessible settlements has fallen, there remains a substantial population in Borno state that is totally inaccessible, including around 160,000 – 200,000 children aged under five. The Committee concluded that there is a substantial risk that polioviruses are still circulating in these inaccessible areas. Nigeria also reported on ongoing efforts to ensure vaccination at international borders (including at airports), other transit points, IDP camps and in other areas where nomadic populations existed, but the Committee felt that efforts to date were inadequate. The Committee also noted that routine immunization, particularly in high risk areas of northern Nigeria, is performing poorly and along with polio eradication has been made a national priority. Although it is over 13 months since the last detection of WPV1 in Nigeria, the recent outbreak response assessment by global polio experts concluded ongoing transmission could not be ruled out.

There was ongoing concern about the Lake Chad basin region, and for all the countries that are affected by the insurgency, with the consequent lack of services and presence of IDPs and refugees. The risk of international spread from Nigeria to the Lake Chad basin countries or further afield in sub-Saharan Africa remains high. The Committee was encouraged that the Lake Chad basin countries including, Cameroon, Chad, the Central African Republic (CAR), Niger and Nigeria continued to be committed to sub-regional coordination of immunization and surveillance activities. However, there is concern about the Lake Chad islands which are currently inaccessible and also about significant gaps in population immunity exist in some areas of these countries in border areas with Borno, and the ongoing population movement in the sub-region was a major challenge.

Vaccine derived poliovirus
The Committee commended the efforts made in some very challenging circumstances in DR Congo and the Syrian Arab Republic. These outbreaks highlighted the presence of vulnerable under-immunized populations in areas with inaccessibility, either due to conflict or geographical remoteness. Furthermore, the delay in detection of these outbreaks illustrated that serious gaps in surveillance exist in many areas of the world, often related to weak health systems or to conflict resulting in disrupted health systems.

In DRC, there has been transmission after the initial SIA’s with geographical spread outside the health zones covered, into Tanganyika, necessitating further rounds with mOPV2. Risks are compounded by poor surveillance in many areas, and widespread gaps in population immunity.

The Committee was very concerned by the size of the outbreak in the Syrian Arab Republic, and the difficulty of reaching target populations because of the conflict. As type 2 population immunity rapidly wanes, the risk of spread within the Syrian Arab Republic and beyond its borders will increase substantially, meaning urgent action is needed to stop transmission. The Committee commended countries surrounding the outbreak zone that are responding to prevent importation, particularly among Syrian refugees in Lebanon, Jordan, and Turkey. The Committee urged any country receiving Syrian refugees, particularly from Deir Ez-Zor and Raqqa, to ensure polio vaccination with IPV.

The Committee noted with concern the recent detection of a single highly diverged VDPV2 in sewage in Mogadishu in Somalia, with genetic evidence of more than three years of replication without detection.

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

• The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
• The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
• The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be grave and a major set-back to achieving eradication.
• The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
• The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears high.
• The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
• The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
• Additionally with respect to cVDPV:

:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, Nigeria, Pakistan and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies
:: The global shortage of IPV which poses an additional risk.

…
Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee strongly encourages all these countries to make further efforts to improve routine immunization, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also strongly encouraged countries newly infected with WPV or cVDPV to act with a great degree of urgency in responding to outbreaks as national public health emergencies, and to ensure emergency operations are used to facilitate this accelerated response…

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 20 November 2017 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV…

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Syria cVDPV2 outbreak situation report 23: 21 November 2017
Situation update 21 November 2017
…Seven (7) new cases of cVDPV2 were reported this week— 4 cases from Mayadeen and 3 from Boukamal district, Deir Ez-Zor governorate. The most recent case (by date of onset) is 9 September 2017 from Mayadeen district.
…The total number of confirmed cVDPV2 cases is 70.
…Outbreak response teams are planning a third mass immunization round to reach children under 5 with mOPV2 in areas where evidence of virus transmission continues.
…A request from the Syrian Ministry of Health for up to one (1) million doses of mOPV2 and 500 000 inactivated polio vaccine doses is being processed to ensure readiness for the second phase of the outbreak response
…Subnational immunization days aiming to reach children under 5 with bOPV started this week in areas of Rural Damascus, districts of Damascus, Homs, Aleppo and accessible areas of Deir Ez-Zor city. Children aged 2-23 months will also be reached with supplementary IPV during the subnational campaign, particularly in areas with large IDP populations.
…A joint supervisory team is monitoring the IPV campaign in all areas of Damascus, with a focus on areas where there are large IDP populations from Deir Ez-Zor to ensure campaign quality.

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WHO Grade 3 Emergencies  [to 25 November 2017]
The Syrian Arab Republic
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syrian Arab Republic
22 November 2017, Damascus, Syrian Arab Republic – Seven people have been killed and 42 people injured in Damascus city and surrounding areas in recent days.
In eastern Ghouta, Rural Damascus, local health authorities report that during a 4-day period alone from 14 to 17 November, 84 people were killed, including 17 children and 6 women; and 659 people were injured, including 127 children and 87 women.
During the same period, more than 200 surgical operations were conducted in eastern Ghouta’s overwhelmed and under-resourced hospitals.
Despite escalating violence and increasing humanitarian needs, life-saving medicines, medical equipment, and surgical supplies are prevented from entering the area…

:: Polio- Situation update 21 November 2017
[See Polio above for detail]

South Sudan
:: WHO in collaboration with the Ministry of Health established water quality control to prevent water-borne diseases in South Sudan
21 November 2017 Juba — The cost of delivering safe water, sanitation and hygiene services is a public health concern in South Sudan. To ensure high quality, sustainable water quality testing, monitoring and surveillance, WHO provided mobile water quality and safety testing kits to the National Public Health Laboratory. The mobile kits are to be used to test and monitor the quality and safety of water in the country.

Yemen
:: Yemen – Cholera Response  W46 2017 [Nov 13-Npv 19]
Highlights
Cumulative figures
-The cumulative total from 27 April 2017 to 19 Nov 2017 is 945,362 suspected cholera cases and 2,211 associated deaths, (CFR 0.23%), 1049 have been confirmed by culture.
-The median age of suspected cases is (20) and the median age of death is (38)
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 18%
– The national attack rate is 343.26 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (801), Al Mahwit (760), Al Dhale’e (641), Abyan (491) and Sana’a (459).
– Children under 5 years old represent 27.8% of total suspected cases.
– In total, 20,884 rapid diagnostic tests (RDT) have been performed which represents 22.1% coverage.
– 2,375 cultures have been performed which represents 22.6% coverage.
– The last positive culture was on 7 Nov 2017 in Al Garahi district
– Among the 305 affected districts, 43 districts in 12 governorates (Abyen, Al Baydha, Al Hudei deh, Al mahrah, Hajjah, Lahj ,Marib, Mokal l a, Sa’dah, Seyoun, Shabwah, Taizz) did not report any suspected case the last three consecutive 3 weeks.
Governorate and District level
– At governorate level, the trend from W43-W45 decrease or was stable in all governorates.
– No district is reporting a CFR higher than 1%.
Trends
– The weekly number of cases is decreasing for the 10th consecutive week.
– The weekly proportion of severe cases has significantly decreased representing now 10% of the admitted cases.
-The use of RDTs has significantly increased since week 40.
Week 46
– 14,955 suspected cases and 6 associated deaths were reported.
– 10 % are severe cases
– 924 RDTs were performed, 176 were positive
– 0 Positive culture

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WHO Grade 2 Emergencies  [to 25 November 2017]
Myanmar
:: Weekly Situation Report 4 – 22 November 2017
Key Highlights
…As of 21 November 2017, the cumulative number of new arrivals in all sites was 622,000. …This number includes over 341,000 arrivals in Kutupalong Balukhali expansion site, 235,000 in other camps and settlements, and 46,000 arrivals in host communities.
…153,765 adolescents and children received measles vaccination
…WHO Mental Health Gap Action Training commenced
Situation Overview
Approximately 170 health care facilities are known to be operating across all camps and settlements. However, many of these facilities provide a basic level of services and referrals for additional services within camps and outside of the camps remains a challenge. Government hospital facilities are overcrowded and do not have the resources to cope with the high volumes of referral patients. Moreover, the services provided are not standardized and the quality of health care services varies considerably.
The latest EWARS data show that fevers of unexplained origin are the most commonly reported disease (29%), followed acute respiratory infections (27%) and acute watery diarrhoea (21%). In view of the low immunization coverage among the Rohingya population, strengthening vaccination programmes is a priority.
Potential outbreaks of diarrhoeal diseases including

Rohingya refugees in Bangladesh: Health Sector Bulletin No. 1
Period: 01 October – 15 November 2017
[1] Health Situation
Around 1.2 million people are estimated to be in need of health assistance. This number includes both newly arrived Rohingyas from Myanmar since 25 August, and their host communities. Based on the public health situation analysis published on 10 October 2017, WHO has graded this crisis as a level 3 emergency. the highest possible rating.
…
[5.4] Vaccines and Immunization
Challenges
The baseline coverage for routine immunization is low. This, combined with crowded living conditions, lack of adequate water and sanitation and reported levels of high malnutrition, represents a public health risk to both the new arrivals and the host population.
Health Sector Response
The health sector has conducted several vaccination campaigns. In the first campaign, which ended on 3 October 2017, 135 519 children under 15 years of age were vaccinated against measles and rubella, 72 334 children under 5 years of age were vaccinated against polio and 72 064 children received Vitamin A.
To mitigate the outbreak of cholera, the International Coordinating Group (ICG) on Vaccine Provision mobilized 900,000 doses of oral cholera vaccine (OCV) for a large-scale cholera vaccination campaign among recently arrived Rohingyas and their host communities. The health sector worked with the MOHFW to plan, train volunteers, fund, implement and monitor this campaign. The campaign to administer the first dose (targeting 650 000 individuals over one year of age) was successfully implemented from 10 to 18 October 2017. It reached a total of 712 797 people, 179 848 of whom were children aged from one to five years old. To help improve personal hygiene, vaccinators handed out soap to each person vaccinated.
From 4 to 9 November 2017, the health sector supported the MOHFW in implementing the second phase of a cholera and polio vaccination campaign for children. A total of 199 472 children aged between one and five years received a second dose of oral cholera vaccine for added protection (estimated target population: 180 000), and 236 696 children under five years received oral polio vaccine (estimated target population: 210 000).
In addition, the health sector continues to support the MOHFW’s efforts to strengthen routine vaccination. Approximately 100 vaccinators have been trained on the current routine Expanded Programme on Immunization (EPI) schedule, key EPI messages, the importance of maintaining the cold chain, monitoring vaccine vials, injection safety, registration, reporting and waste management. Polio, measles and tetanus immunization began on 11 November from static sites within the camps. Through these static sites, to date 719 children have been vaccinated against polio, 589 children against measles and 476 pregnant women against tetanus.
Additionally, since 1 November, 970 children (6 months – 15 years) passing through the two transit sites have been vaccinated against measles and rubella (MR) and 1038 children under five years received oral polio vaccine (bOPV).
Establishing the routine Expanded Programme on Immunization (EPI) in camps and settlements and setting up vaccination posts at entry points into Bangladesh are both key to controlling measles and other diseases. However, in response to the significant increase in measles cases, MoHFW and health sector have agreed to rapidly initiate a measles campaign targeting 360 000 children under 15 for MR vaccination. In view of the urgency of the situation, the campaign is planned to start on 18 November and microplanning has begun…

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WHO AFRO – Outbreaks and Emergencies Bulletin, Week 46: 11 – 17 November 2017
The WHO Health Emergencies Programme is currently monitoring 46 events in the region. This week’s edition covers key ongoing events, including:
:: Dengue fever in Burkina Faso,
:: Plague in Madagascar,
:: Lassa fever in Nigeria,
:: Marburg virus disease in Uganda,
:: Humanitarian Crisis in Central African Republic,
:: Humanitarian Crisis in the Democratic Republic of the Congo.

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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. 
Syrian Arab Republic
:: 25 Nov 2017  Urgent Call to Address Gender-based Violence in Syria [EN/AR]

Yemen 
:: 24 Nov 2017 – Yemen: Impact of the closure of seaports and airports on the humanitarian situation – Situation Update 3 | 23 November 2017
:: 24 Nov 2017 – Yemen Humanitarian Bulletin Issue 29 | 20 November 2017
 
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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.
ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 23 November 2017
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
Yellow Fever  [to 25 November 2017]
http://www.who.int/csr/disease/yellowfev/en/
Disease outbreak news
Yellow fever – Brazil – 24 November 2017

WHO & Regional Offices [to 25 November 2017]

Uganda steps up to support women subjected to violence
24 November 2017 – Violence against women is a global public health problem. In Uganda more than half of all women have experienced violence at least once in their life, most likely from an intimate partner.
In response Uganda has developed the National Action Plan on the Elimination of Gender-based Violence. To date more than 400 health workers have been trained, helping to address violence against women….
 
The paradox of migrant women care workers
21 November 2017 – Migrating in the same numbers as men, many migrant women take on personal care work in informal and home-based settings – often without social protection, labour rights, or health care.
A new WHO report shows an emerging paradox: that migrant women carers support health and social systems, while their own health care and other needs may be unfulfilled.
   WHO Report
 
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Weekly Epidemiological Record, 24 November 2017, vol. 92, 47 (pp. 717–728)
:: Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017
:: 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
:: Experts ramp up efforts to leave no one behind  24 November 2017
Brazzaville, 24 November 2017 – With growing momentum to ensure that…
:: Call for behaviour change in antibiotic use and prescription  24 November 2017
:: Making health services a safe place for women: Uganda steps up to support women subjected to violence  24 November 2017
:: Monitoring the efficacy of antimalarial medicines in Tanzania  23 November 2017
:: Promoting Interagency Collaboration to Ensure Pharmaceutical Manufacturing Development in Ethiopia  23 November 2017
:: Political will and evidence-based action to end TB in the African Region a must – WHO Regional Director for Africa  23 November 2017
23 November 2017 – World Health Organization (WHO) Africa…
:: WHO in collaboration with the Ministry of Health established water quality control testing hub within the National Public Health Laboratory to guide water safety management and prevent water-borne diseases in South Sudan  22 November 2017
:: EU commended for renewed commitment to boost Africa’s health development Africa on course to reach health some targets by 2030  21 November 2017
:: World Antibiotics Awareness Week in Tanzania  21 November 2017
:: Tackling antibiotic resistance in Sierra Leone  20 November 2017

WHO European Region EURO
:: Leaving no one behind in eliminating violence against women 24-11-2017
:: WHO/Europe introduces sustainable health workforce toolkit at Dublin Forum 24-11-2017
:: New HEN report reveals gaps in protection of refugees and migrants from vaccine-preventable diseases 21-11-2017
:: University of Pécs designated as WHO Collaborating Centre for migration and health 21-11-2017
:: Health in focus at the UN Climate Change Conference 21-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syria  22 November 2017
:: Islamic Advisory Group launches training manual on polio eradication, mother and child health and immunization  22 November 2017
 

CDC/ACIP [to 25 November 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Wednesday, November 15, 2017

MMWR News Synopsis for November 24, 2017
Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017
CDC Media Relations
404-639-3286
Even a single measles case is expensive and burdensome to public health agencies. Measles can be prevented by a safe and effective vaccine. Measles outbreaks in the United States occur after introduction from international travelers and can be amplified in undervaccinated communities. Effective interruption of transmission requires timely case investigation. The Tri-County Health Department in the metropolitan Denver area assessed the total economic burden of two measles case investigations. Each case exposed hundreds of people, prompting a complex and coordinated response by multiple public health agencies. Public health costs of disease investigation in the first and second case were an estimated $49,769 and $15,573, respectively. Single measles cases prompted extensive public health action and were costly and resource intensive for local public health agencies.

Progress Toward Poliomyelitis Eradication – Pakistan, January 2016-September 2017
Interruption of wild poliovirus (WPV) circulation, and therefore eradication, is within reach in Pakistan. Despite progress made during 2016, virus is still detected in the environment of high-risk areas in the country, and children continue to be missed by vaccination efforts. These factors pose a challenge to the goal of achieving zero cases. To reach this goal, Pakistan must continue heightened polio surveillance, respond aggressively to any new cases, and vaccinate all children. Pakistan is one of three countries – including Afghanistan and Nigeria –where WPV has never stopped circulating. During 2017, Pakistan made significant improvements to its polio eradication program. As a result, the number of reported polio cases decreased by 69 percent, with five WPV cases compared to 16 cases reported during the same period in 2016. Despite the decrease, the virus continues to circulate in certain areas and children continue to be missed by immunization campaigns.

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Africa CDC   [to 25 November 2017]
https://au.int/en/africacdc
No new digest content identified.

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China CDC    [to 25 November 2017]
http://www.chinacdc.cn/en/ne/
No new digest content identified.
 

Announcements

European Medicines Agency  [to 25 November 2017]
http://www.ema.europa.eu/ema/
24/11/2017
New guidelines on good manufacturing practices for advanced therapies
Adaptations ensure a high level of quality for ATMPs and patient protection

European Vaccine Initiative  [to 25 November 2017]
http://www.euvaccine.eu/news-events
20 November 2017
MVVC2 study published
EDCTP funded MVVC2 study published today in Frontiers in Immunology: showing safety and immunogenicity of malaria vectored…
 
 
FDA [to 25 November 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnoncements/default.htm
November 21, 2017 –
FDA approves first two-drug regimen for certain patients with HIV
The U.S. Food and Drug Administration today approved Juluca, the first complete treatment regimen containing only two drugs to treat certain adults with human immunodeficiency virus type 1 (HIV-1) instead of three or more drugs included in standard HIV treatment. Juluca is a fixed-dose tablet containing two previously approved drugs (dolutegravir and rilpivirine) to treat adults with HIV-1 infections whose virus is currently suppressed on a stable regimen for at least six months, with no history of treatment failure and no known substitutions associated with resistance to the individual components of Juluca…
 
 
IAVI  [to 25 November 2017]
https://www.iavi.org/
November 21, 2017
New Findings to Help HIV Scientists Establish ‘Template’ for Potent Antibodies
Natural-infection studies in Africa and India continue to inform HIV vaccine design
New data published today in Immunity further illuminate how some human beings generate powerful, HIV-blocking antibodies. Led by scientists at the International AIDS Vaccine Initiative (IAVI) and The Scripps Research Institute (TSRI), the results offer important insight into a potential AIDS vaccine design.
“Uncovering the process by which neutralizing antibodies develop is critical to HIV vaccine design,” said Elise Landais, Senior Research Scientist with IAVI and lead author of the study. “A small fraction of people living with HIV can naturally produce exceptionally powerful and broad antibodies that could prevent HIV from infecting their immune cells, but not until several years post-infection – long after that protection can help them. But it is of enormous interest to vaccine researchers.”…
 
MSF/Médecins Sans Frontières  [to 25 November 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
MSF: India’s Decision to Give Pfizer Unmerited Patent on Lifesaving Pneumonia Vaccine Limits Access for Children Globally
November 20, 2017
At High Court of Delhi hearing tomorrow, Doctors Without Borders will urge India to remain the “pharmacy of the developing world” and rethink decision that solidifies Pfizer monopoly on critical pneumonia vaccine

Sabin Vaccine Institute  [to 25 November 2017]
http://www.sabin.org/updates/pressreleases
Monday, November 20, 2017
Journalists Gather for Information Session on Vaccines
BUENOS AIRES, ARGENTINA – Today, the Sabin Vaccine Institute (Sabin) convened journalists from across Latin America to contribute to their understanding of the science of vaccines…
During the three-day information session hosted by Sabin, in partnership with the Universidad I Salud and the Centro de Estudos para la Prevención y el Control de Enfermedades Transmisibles, journalists will learn from public health experts about clinical trials, vaccine safety, how to communicate the impact of immunization, and basic epidemiology and immunology of vaccines, among other topics. By bringing together public health experts and 25 journalists from 18 countries, the information session will provide Latin American journalists with a baseline understanding of vaccines, vaccine safety and related global health issues….
 

UNAIDS [to 25 November 2017]
http://www.unaids.org/en
Update
Global ministerial conference ends with adoption of the Moscow Declaration to End TB
23 November 2017
A global ministerial conference held in Moscow, Russian Federation, on 16 and 17 November that united more than 1000 participants, including 75 ministers and 114 country delegations, concluded with the adoption of the Moscow Declaration to End TB.

The Moscow Declaration to End TB is a new commitment to increase multisectoral action and enhance accountability in the global TB response towards ending tuberculosis (TB) by 2030. The declaration will also inform the first United Nations General Assembly High-Level Meeting on TB, in 2018, which will seek to advance commitments to end TB from heads of state and government.

The declaration outlines the importance of international action to address key areas to respond to TB: sustainable financing, pursuing science, research and development and the establishment of a multisectoral accountability framework.

The conference, the First World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: a Multisectoral Response, was opened by the President of the Russian Federation, Vladimir Putin. It was attended by high-level United Nations leaders, including Amina J. Mohammed, the United Nations Deputy Secretary-General, Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, and Michel Sidibé, the UNAIDS Executive Director…
[See last week’s edition for more detail]

UNICEF  [to 25 November 2017]
https://www.unicef.org/media/
Geneva Palais Briefing Note: Urgent measures to improve hygiene practices underway inside Rohingya refugee camps
GENEVA, 21 November 2017 – This is a summary of what was said by Christophe Boulierac, UNICEF Spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

Despite progress, 180 million children face bleaker prospects than their parents – UNICEF
NEW YORK, 20 November 2017 – Despite global progress, 1 in 12 children worldwide live in countries where their prospects today are worse than those of their parents, according to a UNICEF analysis conducted for World Children’s Day.

Wellcome Trust  [to 25 November 2017]
https://wellcome.ac.uk/news
November 21, 2017  STAT
First Opinion
Focused projects can help Tedros restore confidence in the WHO
By Jeremy Farrar
Like many people around the world, I was dismayed last month by the appointment of Robert Mugabe, the embattled president of Zimbabwe, as a World Health Organization goodwill ambassador. While I believe it is important for the WHO to work with political leaders of every variety, Mugabe’s record in Zimbabwe, which has led to incredible pressure for him to step down, made him profoundly unsuitable for such a role. That wasn’t the only reason this decision seemed so extraordinary to me: It stands as an outlier amid many very sound judgments made by Tedros Adhanom Ghebreyesus, WHO’s newly elected director-general.

In his first 100 days in office, Tedros, as he is known, has assembled an able and extremely diverse senior leadership team. He has also engaged meaningfully and constructively with critics — not least by quickly reversing the Mugabe appointment and without equivocation. He acknowledged a misstep and, I believe, deserves our support because his leadership is a critical opportunity to rebuild the WHO into the force it should be in global health.

Tedros’s election has given him a mandate that no other head of a United Nations agency can claim. His election was the first of its kind in terms of transparency and openness, complete with manifestos, an election platform, and a vote among all WHO member states. His legitimacy, coupled with focused minds at WHO after the failures of Ebola, means he can do what the global health community has been asking the WHO director-general to do for decades: lead its member states with an ambitious program of effective and measurable work, rather than simply reacting passively to their diverse wishes…

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

Women on the move: Migration, care work and health
World Health Organization
2017 : 102 pages
ISBN: 978-92-4-151314-2
PDFs:    Women on the move: Full report
Women on the move: Policy brief
Executive Summary [Excerpt; text bolding from original]
Ageing in late industrial and middle-income economies, combined with rising demographic dependency ratios and female labour force participation, has led to emerging care deficits in many developed and developing countries. Around the world, more women are entering the labour force, thus taking them away from traditional unpaid caring roles.

This report focuses largely on one population group: women migrant care workers who provide home-based personal care. However, many of the issues, and the next steps suggested here, also apply to other migrants and refugees – particularly women and girls – as well as to other socially excluded and marginalized groups engaged in paid and unpaid care work across the world.

Without a doubt, women migrant care workers play an increasingly prominent role in securing and protecting the health status of others and are contributing both to health in the broadest sense and to health systems. Yet relatively little is known about their own health status, the health implications to their families of their out-migration, and the extent of their important contributions to health systems. Around the world, care workers are overwhelmingly female, and many are migrants. This report documents how, despite making a large contribution to global public health, they are exposed to many health risks themselves, while enjoying few labour market and health protections. The report also underscores that paid and unpaid care work is central to the broad health and well-being of individuals, their families and communities, as well as society at large.

The care paradox: global public health and the role of migrant women care workers
Increasingly, immigrant women are being imported into receiving country economies to care, often in informal settings, and are frequently engaged by private households, without full access to social protection and labour rights. Yet this group of migrants provides essential care services and, increasingly, health-care services, thus contributing to health systems and to health and well-being worldwide.

As the leading normative agency on health, the World Health Organization (WHO) calls attention to the paradox that migrant women care workers buttress health systems in countries with shortfalls in health-care provision, while their own rights to health may be eroded and their health-care needs are unfulfilled. Migrant women care workers act as a cushion for states that lack adequate public provision for long-term care, child care and care for the sick.
 
Unmet needs and growing demand for care
Home-based personal care – whether for older persons, children, or those with chronic diseases or disabilities – constitutes an important component of modern health systems. This applies to both high-income countries, where formal health-care institutions and services are struggling to meet the growing demand for such care, as well as to middle- and lower-income countries and regions where home-based care relieves the demand for, and expense of, institutional care. In all societies there is a cultural preference for care “in the family” or for “ageing in place”.

One area in which the care deficit in receiving countries is particularly pronounced is long-term care for older persons. Critical shortages of long-term care workers make quality services  unavailable for large parts of the global population aged 65 years and over. The extent of the unmet need varies worldwide, but in Europe alone the shortage is estimated at around 2.3 million formal long-term care workers.

The policy architecture related to care work, migration and women
The unique status of migrant women care workers as both providers and consumers of health and social care requires that both sending and receiving countries reflect on this paradox and work urgently, and much more collaboratively, to overcome challenges, contradictions, gaps and inconsistencies in international, regional, national and subnational policies, laws and programmes across all relevant sectors. This report proposes the integration of policy actions – and of gender, equity and human rights approaches – to mediate concerns about care deficits and decent and safe work in the care sector as a crucial component of maintaining global and national public health.

Why this report?
WHO initiated this report in response to growing global political interest in population health and development, particularly noting discussions at the 42nd G7 meeting in Japan in May 2016 which called for more attention to migrants and their role in paid and unpaid care work. It is hoped that this report, and its reflection on potential next steps, will foster further debate about approaches to ensure that the global community meets its obligations to leave no one behind in securing long-term equitable and sustainable development. The analysis is also shaped by commitments to the principles of human rights, the Tanahashi Framework on health service coverage and evaluation, the United Nations Migration Governance Framework,i the Framework of priorities and guiding principles for a World Health Assembly Resolution on the health of migrants and refugees, the concept of progressive universalism towards achieving universal health coverage (UHC), and the 2030 Agenda for Sustainable Developmentii with its overarching goal of leaving no one behind…

[See also full-text of Lancet editorial “Caring for migrant health-care workers” in Journal Watch below]

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

Annals of Internal Medicine
21 November 2017 Vol: 167, Issue 10
http://annals.org/aim/issue

Ideas and Opinions
Proposed U.S. Funding Cuts Threaten Progress on Antimicrobial Resistance
Antimicrobial resistance (AMR) is an escalating public health crisis that kills patients, threatens national security, and reduces the safety of medical procedures essential to save and enhance lives. Many types of complex medical care can be complicated by serious infections and rely on the availability of safe, effective antimicrobial drugs. In the past 2 years, national and global leaders have united against this threat, making tangible progress. However, budget cuts of a historic magnitude proposed by the Trump administration now threaten to undo this progress, placing patients in grave danger.
The Centers for Disease Control and Prevention (CDC) estimates that at least 2 million persons in the United States acquire antibiotic-resistant infections each year, resulting in at least 23 000 deaths. Antibiotic resistance is estimated to cost our health system more than $20 billion annually (1). Approximately 700 000 deaths are attributable to AMR each year globally. By 2050, a total of 350 million cumulative deaths will likely be attributable to AMR if current trends continue (2), and multidrug-resistant tuberculosis will account for most of these deaths (3).

Annals of Internal Medicine
21 November 2017 Vol: 167, Issue 10
http://annals.org/aim/issue

Editorials
Unraveling the Epidemiology of Oral Human Papillomavirus Infection
The burden of oral cancer in the United States has been evolving for at least 2 decades. Gains in head and neck cancer control afforded by a period effect of reduced tobacco exposure have been displaced by competing cohort effects of increasing sexual exposure to human papillomavirus (HPV) infection and subsequent increases in HPV-associated head and neck cancer, particularly oropharyngeal cancer (1). The male predominance of oropharyngeal cancer in the United States is paralleled by a much higher prevalence of oral HPV infection and a stronger relationship between number of sexual partners and oral HPV prevalence in men than women (2). The reason the risk for oral HPV infection differs between men and women remains unclear, particularly because the prevalence of genital HPV infection is similar in both sexes.
Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 25 November 2017)

Research article
Applying systems biology to biomedical research and health care: a précising definition of systems medicine
Systems medicine has become a key word in biomedical research. Although it is often referred to as P4-(predictive, preventive, personalized and participatory)-medicine, it still lacks a clear definition and is…
Authors: Sebastian Schleidgen, Sandra Fernau, Henrike Fleischer, Christoph Schickhardt, Ann-Kristin Oßa and Eva C. Winkler
Citation: BMC Health Services Research 2017 17:761
Published on: 21 November 2017

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 25 November 2017)

Research article
Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies
Authors: Marie Furuta, Jacqueline Sin, Edmond S. W. Ng and Kay Wang
Citation: BMC Pregnancy and Childbirth 2017 17:390
Published on: 22 November 2017
Abstract
Background
Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection.
Methods
We searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included ‘pertussis’, ‘whooping cough’, ‘pertussis vaccine,’ ‘tetanus, diphtheria and pertussis vaccines’ and ‘pregnancy’ and ‘perinatal’.
Results
We included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19–37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n=48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n=103, RR=0, meaning no case in the vaccine group), or preterm birth (two RCTs, n=151, RR=0.86, 95%CI: 0.14–5.21) related to administration of the vaccine during pregnancy.
Conclusion
Given that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 25 November 2017)

Research article
Estimating disease burden of a potential A(H7N9) pandemic influenza outbreak in the United States
Since spring 2013, periodic emergence of avian influenza A(H7N9) virus in China has heightened the concern for a possible pandemic outbreak among humans, though it is believed that the virus is not yet human-t…
Authors: Walter Silva, Tapas K. Das and Ricardo Izurieta
Citation: BMC Public Health 2017 17:898
Published on: 25 November 2017

Research article
Assessing the impact of the Lebanese National Polio Immunization Campaign using a population-based computational model
After the re-introduction of poliovirus to Syria in 2013, Lebanon was considered at high transmission risk due to its proximity to Syria and the high number of Syrian refugees. However, after a large-scale nat…
Authors: Ali Alawieh, Zahraa Sabra, E. Farris Langley, Abdul Rahman Bizri, Randa Hamadeh and Fadi A. Zaraket
Citation: BMC Public Health 2017 17:902
Published on: 25 November 2017

Clinical Therapeutics
November 2017 Volume 39, Issue 11, p2117-2330
http://www.clinicaltherapeutics.com/current
TECHNOLOGY IN RESEARCH UPDATE: Social Media and Drug Development

Oncology Update: Gastrointestinal Tract Malignancies
#PatientVoiceMatters: How Social Media Is Bringing Patients and Biopharmaceutical Companies Together to Improve Drug Development
Stella Stergiopoulos
p2170–2172
Published online: October 31, 2017

Original Research
Mapping the Landscape of Patient-centric Activities Within Clinical Research
Mary Jo Lamberti, Josephine Awatin
p2196–2202
Published online: October 9, 2017

Original Research
Mapping the Landscape of Patient-centric Activities Within Clinical Research
Mary Jo Lamberti, Josephine Awatin
p2196–2202
Published online: October 9, 2017

Global Public Health
Volume 13, 2017   Issue 1
http://www.tandfonline.com/toc/rgph20/current

Article
Framing post-pandemic preparedness: Comparing eight European plans
Martin Holmberg & Britta Lundgren
Pages: 99-114
Published online: 07 Mar 2016
ABSTRACT
Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics.

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

Research
Map of biomedical research in Cameroon; a documentary review of approved protocols from 1997 to 2012
Over the last decade, there has been a rapid increase in biomedical research in Cameroon. However, the question of whether these research projects target major health priorities, vulnerable populations and geographic locations at risk remains to be answered. The aim of this paper is to describe the state of biomedical research in Cameroon which is a key determinant that would guide future health care policies and promote equitable access to healthcare.
Ebile Akoh Walter, Ateudjieu Jerome, Djuidje Ngounoue Marceline, Martin Ndinakie Yakum and Watcho Pierre
Published on: 21 November 2017

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

Research
Development of a framework to improve the utilisation of malaria research for policy development in Malawi
The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhanc…
Chikondi Mwendera, Christiaan de Jager, Herbert Longwe, Charles Hongoro, Kamija Phiri and Clifford M. Mutero
Health Research Policy and Systems 2017 15:97
Published on: 21 November 2017

Humanitarian Exchange Magazine
http://odihpn.org/magazine/the-humanitarian-consequences-of-violence-in-central-america/
Number 70   October 2017
Special Feature: The Lake Chad Basin: an overlooked crisis?
by Humanitarian Practice Network October 2017
The 70th edition of Humanitarian Exchange, co-edited with Joe Read, focuses on the humanitarian crisis in Nigeria and the Lake Chad Basin. The violence perpetrated by Boko Haram and the counter-insurgency campaign in Nigeria, Cameroon, Chad and Niger has created a humanitarian crisis affecting some 17 million people. Some 2.4 million have been displaced, the vast majority of them in north-eastern Nigeria. Many are living in desperate conditions, without access to sufficient food or clean water. The Nigerian government’s focus on defeating Boko Haram militarily, its reluctance to acknowledge the scale and gravity of the humanitarian crisis and the corresponding reticence of humanitarian leaders to challenge that position have combined to undermine the timeliness and effectiveness of the response…
[Reviewed earlier]

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 6, Issue 4   December 2017
https://academic.oup.com/jpids/issue

ORIGINAL ARTICLES
Sustained High Effectiveness of RotaTeq on Hospitalizations Attributable to Rotavirus-Associated Gastroenteritis During 4 Years in Finland
Maria Hemming-Harlo; Timo Vesikari; Matti Uhari; Marjo Renko; Marjo Salminen …
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 317–323, https://doi.org/10.1093/jpids/piw061

Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population
Claudia M Espinosa; Gary S Marshall; Charles R Woods; Qianli Ma; Derek Ems …
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 360–365, https://doi.org/10.1093/jpids/pix067
In this cohort of nearly 15000 11-year-old girls with insurance (commercial or Medicaid), the human papillomavirus vaccine was administered at only 1 in 4 well-adolescent visits and approximately one-third of vaccine-related visits, which suggests a substantial number of missed opportunities.

LITERATURE REVIEW
Treatment With Quadrivalent Human Papillomavirus Vaccine for Juvenile-Onset Recurrent Respiratory Papillomatosis: Case Report and Review of the Literature
Tomohiro Katsuta; Yusuke Miyaji; Paul A Offit; Kristen A Feemster
Journal of the Pediatric Infectious Diseases Society, Volume 6, Issue 4, 24 November 2017, Pages 380–385, https://doi.org/10.1093/jpids/pix063
Current evidence to support the efficacy of adjuvant therapies, including therapeutic use of the quadrivalent human papillomavirus vaccine, for juvenile-onset recurrent respiratory papillomatosis is inconsistent. Prophylactic use of the currently available human papillomavirus vaccine in adolescents is the most effective strategy for preventing JoRRP among their children in the future.

Nature 
Volume 551 Number 7681 pp413-528  23 November 2017
http://www.nature.com/nature/current_issue.html

Editorials
Research health needs a dedicated group
A US Research Integrity Advisory Board is long overdue. Such a leadership body would mitigate bad practices and strengthen good research.
Research integrity is often taken to mean misconduct and its prevention. But the integrity of research enfolds much broader dimensions that represent the health — technical, ethical, social and psychological — of research activity. Each of these aspects can be too easily undermined, whether at the level of a university or company department, a research group leader, a research group or an institute. Efforts to preserve integrity need more support.

Many officials in universities and funding agencies increasingly acknowledge how the pressures of academic life undermine the capacity of their researchers to provide due diligence, such as checking the validity of results and mentoring younger scientists. This is compounded by the ever more acute pressures on those younger scientists to deliver high levels of achievement. This combination yields a potentially toxic environment for research, all too ripe for shoddiness or even fraud — and one that an increasing proportion of excellent researchers are voting against with their feet. The costs in wasted research funds are substantial. The United States can take a step forward to help redress the situation, a move that is urgently needed and that can also inspire research leaders and communities in other countries.

Committees at the US National Academies of Sciences, Engineering, and Medicine have twice looked at how to support research integrity (in its more conventional, fraud-busting definition). And both times — in 1992 and 2017 — their recommendations included a proposal for a Research Integrity Advisory Board (RIAB). This year’s report, Fostering Integrity in Research, recommends that the RIAB should be independent of government or other institutions, and funded by subscriptions from stakeholder bodies such as universities and funders.

Such a body would indeed be valuable, and even more so if it were to pursue a broader research-health agenda. It could establish best practices and improve research environments, develop new approaches to incentives and to documenting contributions to research, and develop consensus over standards and penalties for various types of misconduct. It could produce training resources on ethics, and other topics that would help new research-group leaders. It might also encourage funders to introduce conditions of compliance on grants. And it could push for more funds to support efforts by research groups to deliver good research and good mentoring. Funders will jib at the challenge of monitoring compliance, but this important work must start somewhere, and they have remarkable leverage. The RIAB would need a small staff, who would work with others in the research system. It would not take on the role of adjudicating particular cases of misconduct.

One might argue that it is the job of heads of universities and their departments and institutes to develop standards. But the realities of economic and other pressures on institutional leaders divert attention that many would wish to devote to this challenge. Indeed, a functioning RIAB would help to provide university leaders with the clout needed to develop positive changes in culture and practice that are too often resisted by researchers.

The bad news is that, despite the consistent and strong recommendations and the evident need for such a body, there is no discernible gathering of momentum that would help the research community to create one. And the political environment hardly suggests that the federal government will take the lead.

But there are ways forward, nevertheless. By focusing on the broadest agendas, which include support for good research ‘health’ and leadership, alongside measures against bad conduct, the emphasis can be placed where it should be: on a significantly better return in robust research results per dollar of research investment, with researchers better trained to meet today’s demands.

The US National Academies should take the lead. They should propose a working group to develop the agenda and practicalities of an RIAB. The necessary funds should be solicited from federal funders, including the National Institutes of Health and the National Science Foundation, and from private foundations. The group’s deliverables would include a set of priorities, evidence of buy-in from stakeholders, and a timeline for achievements over five- and ten-year timescales. The RIAB is a necessary step towards a culture of research health that can counteract the adverse pressures that so many researchers currently face. We all need it to happen.
doi: 10.1038/d41586-017-07330-5

Nature 
Volume 551 Number 7681 pp413-528  23 November 2017
http://www.nature.com/nature/current_issue.html

Editorials
Rewarding negative results keeps science on track
Creating a culture of replication takes prizes, grants and magnanimity — as well as publications.

New England Journal of Medicine
November 23, 2017  Vol. 377 No. 21
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Cholera in Yemen — An Old Foe Rearing Its Ugly Head
Qadri, T. Islam, and J.D. Clemens

Free Full Text
 

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 25 November 2017]

Detecting Local Zika Virus Transmission in the Continental United States: A Comparison of Surveillance Strategies
November 22, 2017 · Research Article
Introduction: The 2015-2017 Zika virus (ZIKV) epidemic in the Americas has driven efforts to strengthen surveillance systems and to develop interventions, testing, and travel recommendations. In the continental U.S. and Hawaii, where limited transmission has been observed, detecting local transmission is a key public health objective. We assessed the effectiveness of three general surveillance strategies for this situation: testing all pregnant women twice during pregnancy, testing blood donations, and testing symptomatic people who seek medical care in an emergency department (ED).
Methods: We developed a simulation model for each surveillance strategy and simulated different transmission scenarios with varying population sizes and infection rates. We then calculated the probability of detecting transmission, the number of tests needed, and the number of false positive test results.
Results: The probability of detecting ZIKV transmission was highest for testing ED patients with Zika symptoms, followed by pregnant women and blood donors, in that order. The magnitude of the difference in probability of detection between strategies depended on the incidence of infection. Testing ED patients required fewer tests and resulted in fewer false positives than surveillance among pregnant women. The optimal strategy identified was to test ED patients with at least two Zika virus disease symptoms. This case definition resulted in a high probability of detection with relatively few tests and false positives.
Discussion: In the continental U.S. and Hawaii, where local ZIKV transmission is rare, optimizing the probability of detecting infections while minimizing resource usage is particularly important. Local surveillance strategies will be influenced by existing public health system infrastructure, but should also consider the effectiveness of different approaches. This analysis demonstrated differences across strategies and indicated that testing symptomatic ED patients is generally a more efficient strategy for detecting transmission than routine testing of pregnant women or blood donors.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 November 2017)

Research Article
The US President’s Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study
Peter Winskill, Hannah C. Slater, Jamie T. Griffin, Azra C. Ghani, Patrick G. T. Walker
| published 21 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002448
Abstract
Background
Although significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and hence the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur.
Methods and findings
We combined an established mathematical model of Plasmodium falciparum transmission dynamics with epidemiological, intervention, and PMI-financing data to estimate the contribution PMI has made to malaria control via funding for long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), and artemisinin combination therapies (ACTs). We estimate that PMI has prevented 185 million (95% CrI: 138 million, 230 million) malaria cases and saved 940,049 (95% CrI: 545,228, 1.4 million) lives since 2005. If funding is maintained, PMI-funded interventions are estimated to avert a further 162 million (95% CrI: 116 million, 194 million) cases, saving a further 692,589 (95% CrI: 392,694, 955,653) lives between 2017 and 2020. With an estimate of US$94 (95% CrI: US$51, US$166) per Disability Adjusted Life Year (DALY) averted, PMI-funded interventions are highly cost-effective. We also demonstrate the further impact of this investment by reducing caseloads on health systems. If a 44% reduction in PMI funding were to occur, we predict that this loss of direct aid could result in an additional 67 million (95% CrI: 49 million, 82 million) cases and 290,649 (95% CrI: 167,208, 395,263) deaths between 2017 and 2020. We have not modelled indirect impacts of PMI funding (such as health systems strengthening) in this analysis.
Conclusions
Our model estimates that PMI has played a significant role in reducing malaria cases and deaths since its inception. Reductions in funding to PMI could lead to large increases in the number of malaria cases and deaths, damaging global goals of malaria control and eliminatio

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 November 2017)

Perspective
Closing the gaps in the HIV care continuum
Ruanne V. Barnabas, Connie Celum
| published 21 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002443
[No abstract]

Science         
24 November 2017  Vol 358, Issue 6366
http://www.sciencemag.org/current.dtl

Editorial
Blurring disciplinary boundaries
By Gordon McBean, Alberto Martinelli
Science24 Nov 2017 : 975
Summary
The ambitious and integrated framework of the United Nations (UN) Sustainable Development Goals (SDGs) demonstrates that complex global problems span the natural and social sciences and that solutions to such problems demand a joint approach of the two. Despite decades of efforts toward better integration, much of society still presumes a stark divide between the disciplines, and most scientists continue to be trained, evaluated, and rewarded in disciplinary silos. The recent merger of the International Council for Science (ICSU) and the International Social Science Council (ISSC)—leading international councils of the natural and social sciences, respectively—sends a powerful message that the future of science depends on collapsing the walls between academic disciplines.

Science Translational Medicine
22 November 2017  Vol 9, Issue 417
http://stm.sciencemag.org/

Perspective
What evidence do we need for biomarker qualification?
By Chris Leptak, Joseph P. Menetski, John A. Wagner, Jiri Aubrecht, Linda Brady, Martha Brumfield, William W. Chin, Steve Hoffmann, Gary Kelloff, Gabriela Lavezzari, Rajesh Ranganathan, John-Michael Sauer, Frank D. Sistare, Tanja Zabka, David Wholley
Science Translational Medicine22 Nov 2017 Restricted Access
Predictable steps are needed to determine the evidence required for confident use of a biomarker in drug development.
Abstract
Biomarkers can facilitate all aspects of the drug development process. However, biomarker qualification—the use of a biomarker that is accepted by the U.S. Food and Drug Administration—needs a clear, predictable process. We describe a multistakeholder effort including government, industry, and academia that proposes a framework for defining the amount of evidence needed for biomarker qualification. This framework is intended for broad applications across multiple biomarker categories and uses.

Travel Medicine and Infectious Diseases
September 2017   Volume 19
http://www.travelmedicinejournal.com/

Editorial
The Hajj and Umrah: Health protection matters
Dipti Patel
Vol. 19, p1
Published online: October 23, 2017

Travel Medicine and Infectious Diseases
September 2017   Volume 19
http://www.travelmedicinejournal.com/

Review
Expected immunizations and health protection for Hajj and Umrah 2018 —An overview
Jaffar A. Al-Tawfiq, Philippe Gautret, Ziad A. Memish
Vol. 19, p2–7
Published online: October 13, 2017
Abstract
Background
The annual Hajj and Umrah are one of the largest recurring religious mass gatherings across the globe drawing pilgrims from more than 185 countries. The living circumstances and activities of the pilgrims may create an environment for the occurrence and spread of communicable diseases. Each year, the Health authority of the Kingdom of Saudi Arabia, in coordination with international health authorities, updates health requirements for pilgrims. The Hajj for 2017 took place from August 24 to September 5, 2017. Here, we review the expected obligations for immunizations for the 2018 Hajj and Umrah.
Results
The Hajj and Umrah vaccine requirements include mandatory vaccinations against yellow fever, quadrivalent meningococcal polysaccharide (every 3 years) or conjugated (every 5 years) vaccines and poliomyelitis vaccine. Influenza vaccine utilizing the 2016 (Southern Hemisphere vaccine to all pilgrims) was recommended but was not obligatory for pilgrims. Ciprofloxacin is required for individuals >12 years excluding pregnant women as chemoprophylaxis to be given at the port of entry for Pilgrims coming from the meningitis belt. With the ongoing outbreaks of measles in Europe, it is recommended that all pilgrims have an updated immunization against vaccine-preventable diseases (diphtheria, tetanus, pertussis, polio, measles and mumps).
Conclusion
The mandatory vaccines remain the same with continued vigilance for the development of any new or emerging infectious diseases. Continuing surveillance for Zika virus, cholera and MERS-CoV are ongoing.

Vaccine
Volume 35, Issue 48, Part B  Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB

European Court of Justice ruling on vaccine liability and its implications for the United States
Pages 6583–6584
Tony Yang
[No abstract]

Vaccine
Volume 35, Issue 48, Part B  Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB

Short communications
Enhancing the role of vaccines in combatting antimicrobial resistance
Open access
Pages 6591–6593
Charles Clift, David M. Salisbury
Abstract
Interest in addressing antimicrobial resistance (AMR) has grown recently but little effort has been made to consider how existing and new vaccines could impact on AMR. A 2017 Chatham House meeting considered the role of vaccines and how to demonstrate their value through their impact on AMR. Ways existing vaccines have reduced antibiotic prescribing and the prevalence of some resistant organisms were reviewed. Other new vaccines could have a similar impact. In gonorrhoea, where complete resistance has developed, vaccine may be the best option. Valuing the impact of vaccines on AMR was challenging: there were difficult methodological issues and a lack of data for modelling. A participant poll suggested priorities for accelerated vaccine development were tuberculosis, typhoid, influenza, RSV and gonorrhoea. More evidence is needed to convince policymakers but that vaccine development projects should be considered by funders on the same basis as those for new antibiotics or diagnostics.

Vaccine
Volume 35, Issue 48, Part B  Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB

Review
Recruitment barriers for prophylactic vaccine trials: A study in Belgium
Review article
Pages 6598–6603
Lauriane Harrington, Pierre Van Damme, Corinne Vandermeulen, Stéphanie Mali
Abstract
Recruitment of volunteers is one of the main challenges in clinical trial management, and there is little information about recruitment barriers for preventative vaccine trials. We investigated both the recruitment barriers and recruitment strategies for preventive vaccine trials in Belgium. A 10 min survey was used as well as interviews of staff at all clinical trial sites in Belgium that regularly perform vaccine trials. We observed that there are successful recruitment strategies and few recruitment issues for trials involving healthy adults and those over 65 years old. However, challenges face the recruitment of paediatric populations, pregnant women, patients and the very elderly (over 85 years old). From these results, we identified three priority areas to increase recruitment for prophylactic vaccine trials in Belgium. These are: the lack of public knowledge about infectious diseases; the lack of resources of healthcare professionals to take part in clinical trials; and the burden to potential volunteers to take part in a trial. These were discussed with stakeholders and solutions were proposed.

Vaccine
Volume 35, Issue 48, Part B  Pages 6583–6774 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PB
Original research article

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices
Pages 6751–6758
Aaron S. Wallace, Fred Willis, Eric Nwaze, Boubacar Dieng, … Tove K. Ryman
Abstract
Introduction
The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted.
Methods
We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns.
Results
Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose.
Discussion
Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

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

Clinical Infectious Diseases
21 November 2017  Accepted Manuscript
Immunogenicity and protection from a single dose of internationally available killed oral cholera vaccine: a systematic review and meta-analysis 
Anna Lena Lopez Jacqueline Deen Andrew S Azman Francisco J Luquero Suman Kanungo Shanta Dutta Lorenz von Seidlein David A Sack
Abstract
In addition to improved water supply and sanitation, the two-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The meta-analysis showed an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggests otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.

 
Nature Scientific Reports
Published online: 22 November 2017
Article
Early vaccination protects against childhood leukemia: A systematic review and meta-analysis
Mostafa Ebraheem Morra, Nguyen Dang Kien […] Nguyen Tien Huy
Abstract
Leukemia is the most commonly diagnosed childhood cancer, although its etiology is still largely unknown. Growing evidence supports a role for infection in the etiology of acute lymphocytic leukemia (ALL), and the involvement of the immune system suggests that vaccination may also play a role. However, the findings presented in the published literature are inconsistent. Therefore, we conducted a PRISMA systematic review and meta-analysis. 14 studies were identified and meta-analyzed. Vaccinations studied comprised Bacillus Calmette-Guérin (BCG) vaccine, Triple vaccine, Hepatitis B vaccine (HBV), Polio, Measles, Rubella, Mumps, trivalent MMR vaccine and Haemophilus influenza type B (HiB) vaccine. We observed a protective association between any vaccination in the first year of life and risk of childhood leukemia (summary odds ratio (OR) 0.58 [95% confidence interval (CI) 0.36–0.91]). When individual vaccines were analysed, some evidence of an association was seen only for BCG (summary OR 0.73 [95% CI 0.50–1.08]). In conclusion, early vaccination appears to be associated with a reduced risk of childhood leukemia. This finding may be underpinned by the association observed for BCG. Given the relatively imprecise nature of the results of this meta-analysis, our findings should be interpreted cautiously and replicated in future studies.

The International Journal of Tuberculosis and Lung Disease
Volume 21, Number 12, 1 December 2017, pp. 1288-1293(6)
Knowledge of tuberculosis and vaccine trial preparedness in Lima, Peru
E Shu, ME Sobieszczyk, VG Sal y Rosas, P Segura…
Abstract
SETTING: A safe, effective vaccine would improve tuberculosis (TB) control worldwide. Extensive community engagement will be essential to ensure the interest and participation of populations at highest risk.
OBJECTIVE/METHOD: To inform the potential implementation of efficacy studies, we assessed TB knowledge, attitudes towards licensed vaccines and willingness to participate in future TB vaccine efficacy trials among 262 household contacts of 79 recently diagnosed pulmonary TB cases in Lima, Peru.
RESULTS: Overall knowledge of TB was low. Only 41.6% of household contacts perceived themselves as being at high risk of acquiring TB. Slightly above half (54.2%) indicated willingness to participate in a TB vaccine trial. After clustered analysis adjusting for homogeneity among families, willingness to enroll was associated with belief that receiving all recommended vaccinations is important (adjusted OR [aOR] 3.28, P = 0.016), desire to know more about TB risk factors and clinical trials (aOR 2.60, P = 0.004), older age (aOR 1.02, P = 0.027) and TB knowledge (aOR 0.05, P = 0.039).
CONCLUSION: Barriers to participation in TB vaccine trials exist among individuals at high risk for TB. Targeted education about TB risk factors, TB transmission and education about the clinical trial process will be critical for laying the groundwork for future vaccine trials.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 

BBC
http://www.bbc.co.uk/
Accessed 25 November 2017
Yemen war: First aid flights arrive since blockade
Nov 25, 2017
The first aid flights since the Saudi-led coalition imposed a blockade on rebel-held areas three weeks ago have landed in Yemen’s capital, Sanaa.
They include a UN flight carrying 1.9m doses of vaccines, Meritxell Relano, Unicef representative in Yemen tweeted…

Forbes
http://www.forbes.com/
Accessed 25 November 2017
Just Two Measles Cases Cost Taxpayers $68,192 In Colorado
Tara Haelle, Contributor
25 November 2017
The cost of the public health response to a single measles case can exceed $100,000 depending on circumstances.

HPV Vaccination Immunity Remains Strong 10 Years Later, Especially For Preteens
Tara Haelle, Contributor
22 November 2017
The vaccine against human papilloma virus (HPV) is safe and effective at preventing infection, according to new findings from one of the longest follow-up industry-funded studies of the four-strain HPV vaccine to date.
The study, published in Pediatrics, also revealed data supporting the rationale behind recommending the vaccine to boys and girls at 9-12 years old. Not only are these ages long before most kids become sexually active, but those who received the vaccine at these younger ages had stronger immunity against HPV than those who received the vaccine more than two years later…

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 25 November 2017
Health   Snapshot
Ready for a Global Pandemic?
The Trump Administration May Be Woefully Underprepared
Nov 21, 2017
Tom Inglesby and Benjamin Haas
 
Huffington Post
https://www.huffingtonpost.com/
Accessed 25 November 2017
Measles: eliminated, but not out of the game
| 16 November 2017
By Orin Levine

Washington Post
http://www.washingtonpost.com/
Accessed 25 November 2017
States prepare to shut down children’s health programs if Congress doesn’t act
Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year…
Longtime physician William Rees remembers the years before CHIP’s safety net, when families without coverage would put off bringing a sick child to the doctor until symptoms were so severe they would end up in a hospital emergency room.
“Pediatrics is mostly preventive medicine, it’s so important what we do,” said Rees, who has practiced in Northern Virginia since 1975. “It’s about trying to keep up with routine visits. If [children] don’t have insurance, that often doesn’t happen, so CHIP keeps them in the system and they get their vaccines when they’re due.”…
Colby Itkowitz and Sandhya Somashekhar · Health-Environment-Science · Nov 23, 201

Think Tanks et al
 
Brookings
http://www.brookings.edu/
Accessed 25 November 2017
Future Development
State fragility is key to reaching the last mile in ending poverty
George Ingram and Jonathan Papoulidis
Tuesday, November 21, 2017
Fragile states are at the center of today’s global development crisis. By 2030, an estimated 80 percent of the world’s extreme poor will live in these perilous places. While international actors have broadened their focus to cover fragility, conflict, and violence, this has not come with high-level political calls to recognize “fragility as the new development frontier.” Fragility merits top billing and should encompass security reform, peace building, poverty reduction, environment, humanitarian assistance, and equity…

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_18 Nov 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.

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

Milestones :: Perspectives

New global commitment to end tuberculosis
News release
17 November 2017 | MOSCOW/GENEVA – Today 75 ministers agreed to take urgent action to end tuberculosis (TB) by 2030. The announcement came at the first WHO Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response, which brought together delegates from 114 countries in Moscow. President Vladimir Putin of the Russian Federation opened the Conference, together with Amina J Mohammed, UN Deputy Secretary General, and Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Today marks a critical landmark in the fight to end TB,” said Dr Tedros. “It signals a long overdue global commitment to stop the death and suffering caused by this ancient killer.”
The Moscow Declaration to End TB is a promise to increase multisectoral action as well as track progress, and build accountability. It will also inform the first UN General Assembly High-Level Meeting on TB in 2018, which will seek further commitments from heads of state.

Global efforts to combat TB have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%. However, progress in many countries has stalled, global targets are off-track, and persistent gaps remain in TB care and prevention.

As a result, TB still kills more people than any other infectious disease. There are major problems associated with antimicrobial resistance, and it is the leading killer of people with HIV.

“One of the main problems has been a lack of political will and inadequate investment in fighting TB,” added Dr Tedros. “Today’s declaration must go hand-in-hand with increased investment.”

The meeting was attended by ministers and country delegations, as well as representatives of civil society and international organizations, scientists, and researchers. More than 1000 participants took part in the two-day conference which resulted in collective commitment to ramp up action on four fronts:
[1] Move rapidly to achieve universal health coverage by strengthening health systems and improving access to people-centered TB prevention and care, ensuring no one is left behind.

[2] Mobilize sufficient and sustainable financing through increased domestic and international investments to close gaps in implementation and research.

[3] Advance research and development of new tools to diagnose, treat, and prevent TB.

[4] Build accountability through a framework to track and review progress on ending TB, including multisectoral approaches.

Ministers also promised to minimize the risk and spread of drug resistance and do more to engage people and communities affected by, and at risk of, TB.

The Russian Federation, host of the first Ministerial Conference to End TB, welcomed the Moscow Declaration. “Tuberculosis is a complex, multi-sectoral problem that requires a systemic and highly coordinated response to address the conditions which drive the disease,” said Professor Veronika Skvortsova, Minister of Health, Russian Federation. “The accountability framework we have agreed to develop marks a new beginning, and, with WHO’s support to coordinate and track progress, we expect the Moscow Declaration to lead us forward to the high-level meeting of the UN General Assembly in 2018.”
 
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Ending TB means investing in R&D
Joint statement from Aeras, FIND, and TB Alliance
November 17, 2017
This week, as health ministers, diplomats and other representatives meet to discuss tuberculosis (TB) at the World Health Organization (WHO) Ministerial Conference in Moscow, millions of people are suffering from the disease. The governments around the world can and must end this suffering through a major and sustained investment in TB research and development (R&D).
There were 10.4 million new cases of active TB in 2016—of which only 6 million were diagnosed and notified. Drug-resistant infections are on the rise. There remains a dire need for better, faster-acting drugs, a new vaccine, and technologies that quickly diagnose TB and determine the degree of drug-resistance.
Science is not holding us back, funding and political will to implement is.
The WHO estimates that R&D budgets need more than US$1 billion annually to turn around the odds of patients potentially losing years of their lives to a toxic treatment course, missing the opportunity for treatment due to poor diagnostics, or contracting TB in the first place because of an ineffective vaccine.
The WHO also reports that despite accounting for about 2 percent of deaths globally, TB receives only 0.25 percent of the estimated US$265 billion spent worldwide on medical research each year.

Simply put, TB science is woefully underfunded. Governments must work together to dramatically reshape the investment landscape.

Today, the time needed to treat drug-resistant TB ranges from nine months to two years or more—and yet in common practice the success rate is only about 50 percent. The majority of drugs that these patients are given are probably not helping at all—but they are producing side effects, everything from nausea and dizziness to deafness and kidney failure. For some, the treatment can be worse than the disease itself.

A true point of care test is needed to find the 4 million missing patients every year, where and when they first seek care. New diagnostic technology is critical to ensure that the right treatment regimens are used—right from the start—to prevent the lengthy and arduous road to diagnosis and cure faced by many patients.

Making matters worse, there is no vaccine that can effectively play a major role in eliminating this disease. Today, the Bacillus Calmette–Guérin vaccine is the only TB vaccine available. It is nearly a century old, only moderately effective in preventing severe TB in infants and young children, and it doesn’t adequately protect teens and adults, who are most at risk for developing and spreading TB.

Progress has been made but we need a greater commitment. There are 12 different TB vaccine candidates in clinical trials today, a significant increase from 2000—when there were zero. Data from multiple mid- and late-stage efficacy trials will become available over the next 3 years, providing data that will help optimize and accelerate TB vaccine development. But it will take a significant increase in resources to achieve critical breakthroughs—and to reach success quickly
Similarly, only a handful of drug candidates were being tested in clinical trials. Today there are more than 30. Two new experimental treatments show promise—one that might be able to cure all forms of TB except for the most drug-resistant strains (known as extensively drug-resistant TB or XDR-TB), and another that might be able to cure XDR-TB. Both could take substantially less time and money than current treatments.

At first glance, the TB diagnostics pipeline looks healthy. However, emerging game-changers are at risk due to underfunding at the clinical trial stage. In addition, very few diagnostic candidates would address the most critical need—a point of care test for primary care facilities. Diversification of the point of care pipeline, and identification of new biomarkers are urgently needed.

While the meeting in Moscow will inform future discourse on TB, it must also serve as a springboard toward decisive action against the disease. TB is the world’s deadliest infectious disease and efforts to curb it remain underfunded. We are calling on governments to make major commitments to fund the R&D that will end TB once and for all.
Catharina Boehme, CEO, FIND
Jacqueline Shea, CEO, AERAS
Mel Spigelman, President and CEO, TB Alliance
 
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Global Fund Appoints Peter Sands as Executive Director
14 November 2017  News Release
GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria today appointed a new Executive Director: Peter Sands, a former chief executive of Standard Chartered Bank who after a distinguished career in banking immersed himself in a range of global public health projects.

Sands, who is currently Chairman of the World Bank’s International Working Group on Financing Pandemic Preparedness, is also a research fellow at the Harvard Global Health Institute and the Mossavar Rahmani Center for Business and Government at Harvard’s Kennedy School, where he works on research projects in global health and financial regulation.

“Peter Sands brings exceptional management and finance experience, and a heart for global health,” said Aida Kurtović, Board Chair of the Global Fund. “At a time when we face complex challenges, his ability to mobilize resources while managing transformational change is exactly what we need. We expect him to take the Global Fund to the next level.”

Sands served as Chief Executive Officer of Standard Chartered PLC from 2006 to 2015, having joined the bank in 2002 as Group Finance Director. Under his leadership, Standard Chartered successfully navigated the turbulence of the global financial crisis in 2007-2009, continuing to support clients and counterparties throughout the worst of the financial stresses and without drawing on government support of any kind…

After stepping down from the bank in 2015, Sands deployed his skills and experience in international finance on global health. Sands served as Chairman of the U.S. National Academy of Medicine’s Commission on a Global Health Risk Framework for the Future, which published the influential report on pandemics entitled The Neglected Dimension of Global Security: a Framework to Counter Infectious Disease Outbreaks. Sands is also serving on the U.S. National Academy of Science’s Forum on Microbial Threats and Committee on Ensuring Access to Affordable Drugs. Sands has published articles on global health and epidemics in various peer-reviewed journals.

“I am deeply honored to join this extraordinary partnership,” Sands said. “Infectious diseases today represent one of the most serious risks facing humankind. If we work together to mobilize funds, build strong health systems and establish effective community responses we will be able to end epidemics, promote prosperity and increase our global health security.”…

As new Executive Director, Sands will oversee and guide the implementation of the Global Fund’s 2017-2022 strategy, designed to maximize impact against HIV, TB and malaria and build resilient and sustainable systems for health.

The Global Fund is a 21st-century partnership organization designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by the diseases.

The Global Fund raises and invests nearly US$4 billion a year to support programs run by local experts in countries and communities most in need. The Global Fund has been consistently rated as one of the most effective and transparent organizations in the development sector.

::::::
 
WHO welcomes appointment of new Executive Director of the Global Fund
14 November, 2017 – WHO welcomes the appointment of Peter Sands as the new Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Gavi welcomes new Global Fund Executive Director
12 November 2017 – Gavi collaborates with the Global Fund in the vast majority of Gavi-supported countries.
 
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FDA announces comprehensive regenerative medicine policy framework
Comprehensive regenerative medicine policy framework to spur innovation, efficient access to potentially transformative products, while ensuring safety & efficacy
November 16, 2017 –
Today the U.S. Food and Drug Administration announced a comprehensive policy framework for the development and oversight of regenerative medicine products, including novel cellular therapies.

The framework – outlined in a suite of four guidance documents – builds upon the FDA’s existing risk-based regulatory approach to more clearly describe what products are regulated as drugs, devices, and/or biological products. Further, two of the guidance documents propose an efficient, science-based process for helping to ensure the safety and effectiveness of these therapies, while supporting development in this area. The suite of guidance documents also defines a risk-based framework for how the FDA intends to focus its enforcement actions against those products that raise potential significant safety concerns. This modern framework is intended to balance the agency’s commitment to safety with mechanisms to drive further advances in regenerative medicine so innovators can bring new, effective therapies to patients as quickly and safely as possible. The policy also delivers on important provisions of the 21st Century Cures Act.

“We’re at the beginning of a paradigm change in medicine with the promise of being able to facilitate regeneration of parts of the human body, where cells and tissues can be engineered to grow healthy, functional organs to replace diseased ones; new genes can be introduced into the body to combat disease; and adult stem cells can generate replacements for cells that are lost to injury or disease. This is no longer the stuff of science fiction. This is the practical promise of modern applications of regenerative medicine,” said FDA Commissioner Scott Gottlieb, M.D. “But this field is dynamic and complex. As such, it has presented unique challenges to researchers, health care providers, and the FDA as we seek to provide a clear pathway for those developing new therapies in this promising field, while making sure that the FDA meets its obligation to ensure the safety and efficacy of the medical products that patients rely upon. Alongside all the promise, we’ve also seen products marketed that are dangerous and have harmed people. With the policy framework the FDA is announcing today, we’re adopting a risk-based and science-based approach that builds upon existing regulations to support innovative product development while clarifying the FDA’s authorities and enforcement priorities. This will protect patients from products that pose potential significant risks, while accelerating access to safe and effective new therapies.”

The framework includes two final guidance documents and two draft guidance documents.

New Final Guidance Documents
The two final guidance documents clarify the FDA’s interpretation of the risk-based criteria manufacturers use to determine whether a product is subject to the FDA’s premarket review.
The first guidance provides greater clarity around when cell and tissue-based products would be excepted from the established regulations if they are removed from and implanted into the same individual within the same surgical procedure and remain in their original form. The second final guidance helps stakeholders better understand how existing regulatory criteria apply to their products by clarifying how the agency interprets the existing regulatory definitions “minimal manipulation” and “homologous use.” As this field advances, the FDA has noted that there are a growing number of regenerative medicine products subject to FDA premarket authorization. These guidance documents will help explain how the FDA will provide a risk-based framework for its oversight. The policy framework defines how we intend to take action against unsafe products while facilitating continued innovation of promising technologies…
 
New Draft Guidance Documents
The two draft guidances provide important information to help spur development and access to innovative regenerative therapies. The first draft guidance, which builds off the regenerative medicine provisions in the 21st Century Cures Act, addresses how the FDA intends to simplify and streamline its application of the regulatory requirements for devices used in the recovery, isolation, and delivery of regenerative medicine advanced therapies (RMATs), including combination products. The guidance specifies that devices intended for use with a specific RMAT may, together with the RMAT, be considered to comprise a combination product.

The second draft guidance describes the expedited programs that may be available to sponsors of regenerative medicine therapies, including the new Regenerative Medicine Advanced Therapy (RMAT) designation created by the 21st Century Cures Act, Priority Review, and Accelerated Approval. In addition, the guidance describes the regenerative medicine therapies that may be eligible for RMAT designation – including cell therapies, therapeutic tissue engineering products, human cell and tissue products, and combination products using any such therapies or products, as well as gene therapies that lead to a durable modification of cells or tissues (including genetically modified cells)…
 
Statement from FDA Commissioner Scott Gottlieb, M.D. on FDA’s comprehensive new policy approach to facilitating the development of innovative regenerative medicine products to improve human health
November 16, 2017 –
One of the most promising fields of science is the area of cell-based therapies and their use in regenerative medicine. These new technologies, most of which are in early stages of development, hold transformative promise for patients.

Given this area’s rapid growth, dynamism and complexity, this field has also presented unique challenges to researchers, health care providers and the FDA. We need to provide a clear, efficient pathway for product developers, while making sure that we meet our obligation to help ensure the safety and efficacy of these medical products so that patients can benefit from these novel therapies.

To achieve these goals, today we’re taking steps to advance an innovative framework for how we intend to apply the existing laws and regulations that govern these products. Our aim is to make sure we’re being nimble and creative when it comes to fostering innovation, while taking steps to protect the safety of patients.

The FDA originally established a regulatory framework for these products that went into effect in 2005. But in the last decade, we’ve seen improbable advances that hold out great hope for patients. I believe that with the ability to facilitate the regeneration of parts of the human body, we’re bearing witness to the beginning of a paradigm shift in the practice of medicine.

These concepts are no longer the stuff of science fiction, but rather real-life science where cells and tissues can be engineered to grow healthy, functional organs to replace diseased ones; where new genes can be introduced into the body to combat disease; and where adult stem cells can generate replacements for cells that are lost to injury or illness. The promise of this technology is why the FDA is so committed to encouraging and supporting innovation in this field.

But the rapid growth and promise of this field has increasingly sowed the ground for the entry of some unscrupulous actors, who have opportunistically seized on the clinical potential of regenerative medicine to make deceptive claims to patients about unproven and, in some cases, dangerous products. By exploiting the lack of consumer understanding of this area, as well as the fear and uncertainties posed by the diseases these bad actors claim to treat, they’re jeopardizing the legitimacy and advancement of the entire field. This underscores the importance of having a clear regulatory framework for developers, and ensuring that those who skirt these regulations are held accountable.

To realize the full potential of regenerative medicine, we need to support the innovation pursued by responsible product developers – who represent the vast majority of the field – to help ensure that they clearly understand where the regulatory lines are drawn. We must advance a modern, efficient and least burdensome framework that recognizes the breakneck speed of advancement in the products we’re being asked to evaluate, while ensuring patient safety. That is the goal of the policy we’re announcing today.

To achieve this balance, embedded in our comprehensive framework are many proposed novel and modern approaches to regulation, where we intend to adapt our regulatory model to meet the revolutionary nature of the products we’re being asked to evaluate.

One example is how we’re considering innovative trial designs whereby individual academic investigators would follow the same manufacturing protocols and share combined clinical trial data in support of approval from the FDA. This is an innovative way of making sure that small investigators who are working with cells that are being manufactured in ways that render them subject to our current laws and regulations — because the cells are, for example, more than “minimally manipulated” — can nonetheless seek the FDA’s approval through a less burdensome process.

There are other similarly proposed novel approaches embedded in our broad policy framework. Our goal is to achieve a risk-based and science-based approach to support innovative product development, while clarifying the FDA’s authorities and enforcement priorities and making sure we are protecting patients.

The suite of four guidance documents we are making public today also delivers on important provisions of the 21st Century Cures Act, including our continued promise to fully implement the Regenerative Medicine Advanced Therapy (RMAT) designation program, which is designed to expedite the development and review of regenerative medicine advanced therapies.

We understand that there will be questions and it will take time for product developers to determine whether their products require FDA approval. Our policy will allow product manufacturers that time to engage with the FDA to determine if they need to submit a marketing authorization application and, if so, seek guidance on how to submit their application to the FDA for approval.

To be clear, we remain committed to ensuring that patients have access to safe and effective regenerative medicine products as efficiently as possible. We are also committed to making sure we take action against products being unlawfully marketed that pose a potential significant risk to their safety. The framework we’re announcing today gives us the solid platform we need to continue to take enforcement action against a small number of clearly unscrupulous actors.
With this balanced approach, we’re well positioned to support and help advance breakthrough science, like regenerative medicine, and promote responsible and flexible regulation that leverages science to advance public health…
 
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Editor’s Note:
We are pleased to begin regular coverage of news and announcements from the Africa CDC…overdue…
 
Africa CDC   [to 18 November 2017]
https://au.int/en/africacdc
November 07, 2017
Africa Partnership and Coordination Forum agree on joint priorities to fast track implementation of the Catalytic Framework to end AIDS, TB and eliminate Malaria in Africa by 2030
Johannesburg, 07 November 2017- The African Union Commission (AUC) convened regional and continental partners last week to discuss joint priorities to support countries end AIDS, TB and Malaria by 2030. In attendance were: African Union Organs, Regional Economic Communities, Regional Health Organisations, development partners, civil society the private sector and invited guests.

“We have the science and tools to end AIDS, TB and Malaria by 2030. The continental targets set for the three diseases can be achieved with sustained leadership, ownership, sustained financing, effective partnerships and accountability,” said Dr. Richard Kamwi, former health minister of Namibia who is the current Goodwill Ambassador of Elimination 8 and Africa CDC Champion.

The Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030 is a continental framework that enunciates key policy issues, strategic priorities, targets and accountability mechanisms…

07 November 2017
African countries launch framework to tackle the threat of antibiotic resistant infections
Annecy, France – Africa CDC launched its framework to fight antibiotic resistant infections during the eighth edition of the Advanced Courses on Diagnostics convened by the Fondation Mérieux. Antibiotic resistant infections occur when bacteria, viruses, and other microorganisms change in ways that make medications ineffective against them. In Africa, antibiotic resistance is already a major problem for malaria, tuberculosis, typhoid, meningitis, gonorrhea, and dysentery. Recognising the urgent need for action, the World Health Assembly adopted the Global Action Plan to address the challenge in May 2015. The Africa CDC Framework describes priorities for African Union Member States to improve diagnosis and treatment of, collect more accurate data about, and strengthen policies to address antibiotic resistance.

‘Africa CDC developed a remarkably comprehensive framework, fully aligned with the Global Action Plan and the Global Antimicrobial Resistance Surveillance System which if fully implemented will address the growing threat of antibiotic resistant infections’, said Dr Marc Sprenger, Director of the Antimicrobial Resistance Secretariat at the World Health Organisation who chaired the launch.

“Antimicrobial resistance is a major threat to Africa’s economic growth and structural transformation goals. We need to urgently strengthen partnerships and leverage our existing assets across Africa to fully implement the Africa CDC Framework for Antimicrobial Resistance,” said Dr. John Nkengasong, the Director of the Africa Centres for Disease Control and Prevention…
 

Featured Journal Content
 
Nature 
Volume 551 Number 7680 pp271-398   16 November 2017
http://www.nature.com/nature/current_issue.html
World View
Immunization needs a technology boost
Tracking who receives vaccines is essential, but will be impossible without innovations in digital technologies, says Seth Berkley.
Today, about 80% of infants living in the world’s 73 poorest countries receive routine immunizations, a measure currently assessed by whether they have been given a full course of a vaccine regime to prevent diphtheria, pertussis and tetanus. In 2000, only about 60% received such protection. That progress is great, but achieving 100% coverage will require better insight into which children are missing out.

For that, we need a new approach: the global health community must move to digital systems. My organization, Gavi, the Vaccine Alliance, spends an average of nearly US$2 billion a year on getting vaccines to children in the poorest countries. It has also invested tens of millions of dollars in innovations to monitor immunization.

Current methods for measuring immunization coverage are based on how many vaccine doses are distributed — not how many children are fully immunized. Doses delivered are much easier to count, but knowing which children are covered is much more important. That picture is vague. Surveys done to plug this knowledge gap are rare, costly and — to be reliable — require mothers to have retained paper-based child health cards.

Putting the child at the centre of tracking efforts is not as simple as it sounds. Tens of millions of children have no formal record of their existence — especially those living in remote, impoverished or vulnerable communities. This global identity crisis is so important that it has its own indicator (number 16.9) under the United Nations’ Sustainable Development Goals (SDGs) intended to ensure that everyone has a legal identity by 2030. Right now, unregistered births are one of the biggest barriers to achieving another SDG, which aims to end preventable deaths of children under five and achieve universal health coverage, with access to affordable essential vaccines for all, by 2030.

Digital technology and social media offer an opportunity. The technology sector is on a mission to equip everyone on the planet with a digital and online presence. And the innovations that will help to achieve that goal are exactly those that could aid the global public-health community in vaccinating every child.

Many relevant technologies are largely in place already. Big data, for example, can help public-health officials to anticipate the spread of disease and hone vaccination campaigns. Geospatial mapping and drones are already being used in Nigeria to identify communities that have not received polio vaccines, and in Rwanda to deliver blood needed for transfusions for mothers who haemorrhage after giving birth.

One of the biggest needs is for affordable, secure digital identification systems that can store a child’s medical history, and that can be accessed even in places without reliable electricity. That might seem a tall order, but it is both achievable and necessary. Technology is already intertwined with vaccine delivery. For example, Google.org — the charitable arm of Google — and Gavi are working together to scale-up wireless temperature monitoring to provide real-time data on refrigerators used to store medications. This will notify workers when the refrigerators are starting to fail, and generally ensure that vaccines are kept at safe temperatures. We are also supporting the use of cloud-based databases to track vaccines along the supply chain.

Other projects help to inform us of who receives vaccines. We are working with a company in India called Khushi Baby, which creates off-grid digital health records. A necklace worn by infants contains a unique identification number on a short-range communication chip. Community health workers can scan the chip using a mobile phone, enabling them to update a child’s digital record even in remote areas with little phone coverage. In the Indian state of Rajasthan, Khushi Baby has tracked more than 15,000 vaccination events of thousands of children across 100 villages.

We still have a long way to go. We should be more ambitious in defining what 100% vaccination coverage means. Although the common measure of routine immunization coverage suggests that only one in five children misses out, the reality is much bleaker. The current measurement leaves out at least 8 of the 11 antigens that the World Health Organization (WHO) recommends be included in vaccines given to all infants. Among the missing ones are the highly contagious measles. Also missing are antigens for pneumococcus, which causes pneumonia, and rotavirus, which causes severe diarrhoea — the two biggest killers globally of children under five.

Our analysis suggests that just 7% of infants in the 73 poorest countries — those that most need our attention — are fully immunized. That means that more than nine of every ten children in these countries are not getting the minimum recommended protection against infectious diseases.

A UN expert group is meeting this week in Bahrain to review indicators for the SDGs. Expanding indicators to include all the WHO-recommended antigens will help. And in theory, governments have already signed up to finding a solution to the problem of birth registration. Both moves are essential to improve understanding of how many children are fully immunized. A third essential ingredient is information technologies targeted at helping the developing world. If we want to make sure that preventable childhood deaths are actually prevented, we need to go digital.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 November 2017 [GPEI]
:: Underlining their commitment to a polio-free world for all future generations, Italy has provided €4.5 million to deliver polio vaccines in Afghanistan and Pakistan.
[In Afghanistan, the contribution will be used to support and train vaccinators and social mobilizers in generating demand for vaccination, the delivery of vaccines and monitoring whether vaccination activities are well-implemented. In Pakistan, the contribution will support vaccination campaigns in the most challenging areas of the country, as well as the immunization of communities that are at particularly high risk due to their mobility, through tactics such as giving vaccine established transit points. The Bill & Melinda Gates Foundation have matched Italy’s contribution, doubling its impact to €9 million…]

Summary of newly-reported viruses this week:
…Afghanistan:  One new wild poliovirus type 1 (WPV1) case, reported in Kandahar province. One new WPV1 positive environmental sample, collected from Kandahar province.
… Pakistan: Six new  WPV1 positive environmental samples, one collected from Punjab province, two collected from Sindh province, and three collected from Balochistan province.

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Syria cVDPV2 outbreak situation report 22: 14 November 2017
Situation update 14 November 2017
14 November 2017 [Editor’s text bolding]
:: No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. The total number of cVDPV2 cases remains 63. All confirmed cases to date have had onset of paralysis before 25 August 2017.

:: Inactivated polio vaccine activities aimed at reaching children aged 2–23 months are ongoing. IPV will be offered alongside bOPV as part of the subnational immunization days in 6 districts of Damascus and 200 hotels in the city, 3 areas of Rural Damascus, 2 districts of Homs and 1 district of Aleppo with large internally displaced populations from Deir Ez-Zor.

:: Almost 3000 children under 5 have received all routine immunization antigens in newly accessible areas of Deir Ez-Zor city between 7 and 10 November in opportunistic vaccination activities.

:: A joint mission between the World Health Organization and the local health authority to visit newly accessible areas of Aleppo was conducted this week. The mission also met with the Aleppo University Hospital and Aleppo Pediatric Association to advocate for acute flaccid paralysis surveillance and to support ongoing immunization activities to reach IDPs from infected areas.

:: The advisory group on mOPV2 vaccine provision met this week to review the revised risk assessment for Syria cVDPV2 outbreak and discuss contingency plans for outbreak response. The group endorsed, in principle, the proposal to preposition approximately 1 million doses mOPV2 in Damascus (pending receipt of formal vaccine request from the Ministry of Health) to enable rapid response in the event of any ongoing outbreak response activities

::::::

Devex: Exclusive: The Gates Foundation picks a partner to share lessons learned from polio eradication
By Catherine Cheney
16 November 2017
SAN FRANCISCO — The Johns Hopkins Bloomberg School of Public Health has received a new grant to translate the lessons learned from polio eradication to other global health initiatives, the Bill & Melinda Gates Foundation told Devex.

Polio is one of the top priorities of the largest foundation in the world, and in their 2017 annual letter, Bill and Melinda Gates said they think it is possible that polio could be eliminated this year. At the Reaching the Last Mile summit in Abu Dhabi this week, panelists talked about the near eradication of both polio and Guinea worm disease, and what lessons smallpox — the only infectious disease to be wiped off the face of the planet — might offer. But as the Gates Foundation funds this effort to get to zero case of polio, its program staff wants to make sure to improve upon one of the failures of the smallpox eradication effort by documenting the lessons learned.

Dr. Olakunle Alonge, assistant professor at JHSPH, will lead this new grant, $3.7 million over five years, resulting from a request for proposals called “Applying the Lessons Learned from Polio Eradication to Global Health.” Working with the Global Polio Eradication Initiative, Alonge and a team of partners from seven countries — Nigeria, India, Afghanistan, Ethiopia, the Democratic Republic of Congo, Bangladesh, and Indonesia — will develop courses and clinics that capture the best practices of the polio eradication effort. The goal, said Alonge, is to capture the lessons learned and prevent this knowledge from being lost so that systems and strategies can be repurposed, not recreated….

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WHO Grade 3 Emergencies  [to 18 November 2017]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 22: 14 November 2017
 [See Polio above]

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WHO Grade 2 Emergencies  [to 18 November 2017]
Myanmar
::  Mortality and Morbidity Weekly Bulletin – Volume No 5: 12 November 2017
…4.1 Second round of Oral Cholera Vaccination Campaign
…From 4-9 November 2017, the second round of OCV was conducted targeting 182,317 FDMNs between 1 and 5 years. As of 9 November 2017, a total of 199,472 persons were reported to have been vaccinated, representing 109% (199,472/182,317) of the target population (table 2). Oral cholera vaccines represent a tool to fight cholera and are licensed as two-dose regimens with 2-4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera….

Niger
:: Rift Valley fever in Niger
November 2016 — Rift Valley Fever (RVF) is caused by a virus transmitted by mosquitoes and blood feeding flies that usually affects animals (commonly cattle and sheep) but can also involve humans. In humans the disease ranges from a mild flu-like illness to severe haemorrhagic fever that can be lethal. When livestock are infected the disease can cause significant economic losses due to high mortality rate in young animals and waves of abortions in pregnant females

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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. 
Syrian Arab Republic
:: 16 Nov 2017  WFP Condemns Destruction of Humanitarian Food Supplies in Eastern Ghouta Area of Syria

Yemen 
:: Statement by the Humanitarian Community on the Blockade in Yemen | 16 November 2017
:: Yemen: Impact of the closure of seaports and airports on the humanitarian situation – Situation Update 2 | 15 November 2017
:: Ensuring Yemen’s lifeline: the criticality of all Yemeni ports
:: Yemen: Key messages on the continued closure of Yemen’s ports – 13 November 2017

DRC 
:: Democratic Republic of the Congo Overview (November 2017)   16 Nov 2017
The humanitarian situation in the Democratic Republic of the Congo (DRC) has deteriorated dramatically over the past year. The crisis has deepened and spread, affecting people in areas previously considered stable and stretching the coping mechanisms of people in areas already impacted. A surge in violent conflict and intercommunal tensions has forced more than 1.7 million people to flee their homes in 2017 – an average of more than 5,500 people per day. Today, the total number of internally displaced people in the DRC has reached 4.1 million, which is the highest number of any country on the African continent. Insecurity has had a devastating impact on people’s ability to access food, and 7.7 million people across the DRC are facing severe food insecurity – a 30 per cent increase from the same time last year. The situation is further complicated by political uncertainty and economic downturn.

:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock – Remarks at the Member States briefing on the Democratic Republic of the Congo – 16 November 2017
 
Iraq
:: Earthquake in northeast Iraq 14 November 2017 – 12:30, Flash Update #3 [EN/AR/KU]
:: Humanitarian partners are rushing to help the victims of the earthquake [EN/AR/KU]  13 Nov 2017
 
WHO airlifts medical supplies to treat wounded in Islamic Republic of Iran-Iraq earthquake
16 November 2017, Cairo, Egypt – WHO has airlifted trauma kits and medical supplies to the Islamic Republic of Iran to support the treatment of thousands people injured as a result of the recent earthquake in the  Islamic Republic of Iran-Iraq border region…
 
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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.
ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 16 November 2017

Ethiopia
:: 15 Nov 2017  Ethiopia: Humanitarian Response Situation Report No.15 (October 2017)
 
Nigeria 
:: Fact Sheet NE Nigeria: Pulka, Gwoza LGA (November 2017)
:: Fact Sheet NE Nigeria: Rann, Kala/Balge LGA (November 2017)

WHO & Regional Offices [to 18 November 2017]

Highlights
Preterm birth
November 2017 – Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015.

Nutrition Report highlights an increase in malnutrition in Africa
November 2017 – A newly released nutrition report by WHO has revealed that undernutrition is still persistent in the region and the number of stunted children has increased. The Report also a growing number of children under five years old are overweight.

River blindness: shifting to surveillance and elimination
November 2017 – After years of painstaking control and prevention activities, the world is finally edging to eliminate river blindness. Latest data show globally almost 133 million people received treatment in 2016, compared with 46 million in 2005.

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Progress towards rubella and congenital rubella syndrome control and elimination
17 November 2017
A new report published in todays’ edition of the WHO Weekly Epidemiological Record shows that 53 more countries introduced rubella vaccine into their national immunization schedules since 2000. This led to a decline in cases by 97% from 2000-2016. But, improved disease surveillance and stronger country commitment are still needed to reach elimination goals.
WHO recommends that all countries that have not yet introduced rubella vaccine should consider doing so using existing, well-established measles immunization programmes.

Weekly Epidemiological Record, 17 November 2017, vol. 92, 46 (pp. 701–716)
:: Global routine vaccination coverage, 2016
::Progress in rubella and congenital rubella syndrome control and elimination – worldwide, 2000–2016

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Ghanaians urged to seek advice from qualified health practitioners before taking antibiotics
17 November 2017
:: Women and Girls should be empowered to strengthen their capacity to prevent Type 2 Diabetes  17 November 2017
:: WHO’s Africa Nutrition Report highlights an increase in malnutrition in Africa. 16 November 2017
:: International Health Emergency Response plan on Marburg virus disease  15 November 2017
:: Plague in Madagascar – Disease Outbreak News Update  15 November 2017
:: WHO implements Emergency Response Plan  15 November 2017
:: WHO strengthening the capacity of frontline healthcare workers in Yei River State, Central Equatoria hub to improve the management of cases of priority diseases in South Sudan
14 November 2017
:: South Sudan conducts Polio Outbreak Simulation Exercise to strengthen Polio outbreak preparedness and response  14 November 2017

WHO European Region EURO
:: Tuberculosis (TB) research and innovation among key priorities at global conference to end TB 17-11-2017
:: Planning cities to boost physical activity 14-11-2017
:: Turkey takes strong action to reduce antibiotic consumption and resistance 13-11-2017
::  Every infection prevented is an antibiotic treatment avoided 13-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO airlifts medical supplies to treat wounded in Islamic Republic of Iran-Iraq earthquake
16 November 2017
:: WHO delivers urgent health assistance for earthquake trauma patients  15 November 2017
:: Government of Italy boosts efforts to eradicate polio and improve child nutrition in Afghanistan  14 November 2017

CDC/ACIP [to 18 November 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Wednesday, November 15, 2017

CDC Encourages Safe Antibiotic Prescribing and Use – Press Release
November 13, 2017, kicked off U.S. Antibiotic Awareness Week and World Antibiotic Awareness Week. The Centers for Disease Control and Prevention (CDC) recognizes this week with an updated educational effort, Be Antibiotics Aware: Smart Use, Best Care, to support the nation’s efforts to combat antibiotic resistance through improved use of these life-saving medications…

MMWR News Synopsis for November 16, 2017
Global Routine Vaccination Coverage, 2016
In recent years, vaccination coverage rates have remained the same. This suggests the need to improve access to and completion of vaccinations for hard-to-reach populations in order to reduce global morbidity and mortality from vaccine-preventable diseases.
Substantial progress in global routine vaccination coverage has been made in the past 40 years since the establishment of the World Health Organization (WHO) Expanded Program on Immunization (EPI). In 2016, the global vaccination coverage rate with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, polio, and measles was ≥85 percent. However, 33 percent of countries still are not meeting the target requirements needed to reach and sustain high vaccination coverage. Targeted strategies are needed to improve access to vaccination and to increase the number of children who are fully protected from vaccine-preventable diseases.

Rubella and Congenital Rubella Syndrome Control and Elimination — Global Progress, 2000–2016
The accelerated introduction of rubella-containing vaccine (RCV) into national immunization schedules is a significant step toward. rubella elimination. For regions to achieve rubella elimination, as has been achieved in the Americas, a strong commitment is required in all countries to introduce rubella-containing vaccine and increase the quality of rubella routine and campaign immunization activities. Countries and international partners should take advantage of opportunities provided by existing measles-elimination activities.
Rubella is the leading vaccine-preventable cause of birth defects in the world. Rubella during pregnancy can cause miscarriage, fetal death, stillbirth, and congenital malformations known as congenital rubella syndrome (CRS). During 2000-2016, 53 countries introduced RCV into their national immunization schedules. By the end of 2016, 152 (78 percent) of 194 countries were using rubella vaccine. Reported rubella cases declined 97 percent, from 670,894 cases in 102 countries in 2000 to 22,361 cases in 165 countries in 2016. The WHO Americas region achieved rubella and CRS elimination in 2015, and 33 of 53 countries in the European region have eliminated endemic rubella and CRS. The Western Pacific Region also has a rubella elimination goal (no countries verified).

Announcements

EDCTP    [to 18 November 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
Latest news
15 November 2017
EU action against antimicrobial resistance: EDCTP’s contribution
Antimicrobial resistance and improper use of antibiotics are a potential global threat to healthcare. During the European Antibiotic Awareness Week…

.
European Medicines Agency  [to 18 November 2017]
http://www.ema.europa.eu/ema/
17/11/2017
Towards a single development programme for new antibiotics in EU, Japan and US
EMA, PMDA and FDA to further align data requirements and explore options to streamline paediatric development …

16/11/2017
Improving the availability of vaccines for animals within the EU
CVMP agrees proposals to increase clarity for when field efficacy trials are needed in the development of veterinary vaccines
The Committee for Veterinary Medicinal Products (CVMP), at its November meeting, accepted recommendations to clarify the need for conducting field efficacy trials, i.e. trials in animals under real-life conditions in the field, to support the authorisation of veterinary vaccines. Improving clarity on this topic will facilitate the availability of veterinary vaccines in the European Union (EU).

These recommendations were made by the joint European Medicines Agency (EMA) and Heads of Medicines Agencies (HMA) Steering Group on veterinary vaccine availability on the basis of the outcome of a joint EMA/HMA stakeholder focus group meeting held in June 2017, which brought together regulators, industry and academic experts.

According to EU legislation, the efficacy and safety of veterinary vaccines should be demonstrated in laboratory trials, and then supplemented by data from field trials, unless an acceptable justification can be provided for not providing this data. The role of veterinary field trials is primarily to confirm that the performance of the product observed under controlled experimental conditions is verified under actual conditions of use.

According to veterinary vaccine developers, field trials can be challenging to carry out because of practical matters and due to issues related to trial design whilst adding only limited value to an authorisation dossier. A common issue encountered is connected to trials where animals are not exposed to the disease under real-life conditions, leading to inconclusive outcomes, while conducting these trials can be very costly…

15/11/2017
EMA to work with stakeholders to improve the product information for EU medicines
Stakeholder feedback sought on ongoing electronic initiatives …
.
 
FDA [to 18 November 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
November 16, 2017 –
FDA announces comprehensive regenerative medicine policy framework
[See Milestones above for more detail]
 
November 16, 2017 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on FDA’s comprehensive new policy approach to facilitating the development of innovative regenerative medicine products to improve human health
[See Milestones above for more detail]
.
 
Fondation Merieux  [to 18 November 2017]
http://www.fondation-merieux.org/
November 13, 2017
African countries launch framework to tackle the threat of antibiotic resistant infections
Annecy, 07 November 2017- Africa CDC launched its framework to fight antibiotic resistant infections during the eighth edition of the Advanced Courses on Diagnostics convened by the Fondation Mérieux.
The Advanced Course on Diagnostics (ACDx) was organized October 29-November 3 at Les Pensières Center for Global Health by the Mérieux Foundation and the London School of Hygiene & Tropical Medicine (LSHTM). This eighth edition trained more than 38 scientists and decision-makers from 20 countries…
.

 .
Gavi [to 18 November 2017]
http://www.gavi.org/library/news/press-releases/
12 November 2017
Pneumonia vaccine saves 500,000 lives in world’s poorest countries
Over 109 million children in the developing world have now received pneumococcal conjugate vaccine (PCV).
Geneva – The rollout of pneumonia vaccine has prevented the deaths of over half a million children in developing countries over the past decade, Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said today.

Since 2007, 109 million children have received pneumococcal conjugate vaccine (PCV), which protects against the leading cause of pneumonia, with the support of Gavi. Vaccination coverage in Gavi-supported countries has now reached 41%, up from 35% in 2015 and almost equaling the global average of 42%.

“Hundreds of thousands of children in the world’s poorest countries are alive today thanks to pneumococcal vaccine,” said Dr Berkley. “I’m immensely proud of the role Gavi has played in expanding access to this lifesaver over the past ten years, but millions of children remain unprotected. This is an entirely preventable, treatable disease that still takes the lives of more children than any other illness, causing untold needless suffering. We cannot afford to lose focus in the fight against pneumonia.”

This year marks the tenth anniversary of the launch of the Advance Market Commitment (AMC). Children in the poorest countries typically received newly developed vaccines more than a decade later than children in the richest countries. With help from the AMC developing countries began to introduce the latest formulations of PCV as soon as a year after they were first made available.

Funded by Italy, UK, Canada, Russia, Norway and the Bill and Melinda Gates Foundation, this unique financing mechanism has allowed eligible countries to access affordable PCV vaccines at a cost of less than 10% of the US market price. Gavi has now helped 58 countries across Africa and Asia to introduce the vaccine into their routine immunisation programmes…
.
 
Global Fund [to 18 November 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund Appoints Peter Sands as Executive Director
14 November 2017
The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria today appointed a new Executive Director: Peter Sands, a former chief executive of Standard Chartered Bank who after a distinguished career in banking immersed himself in a range of global public health projects.
[See Milestones above for more detail]
.
 
IAVI  [to 18 November 2017]
https://www.iavi.org/
November 13, 2017
IAVI’s Fran Priddy Talks Scientific Challenges at AtlanticLIVE’s Vaccines + Immunity
What’s missing in HIV vaccine development? If you guessed political will or buy-in from pharmaceutical companies, you’d be wrong.
According to Fran Priddy, IAVI’s Chief Medical Officer, it’s actually the virus itself, she explained at AtlanticLIVE’s Vaccines + Immunity event on November 9 in Philadelphia. The event convened top health officials and vaccine experts from both the private and public sectors.
That’s not to say that HIV vaccine research efforts are deficient, however. Priddy’s point is that HIV is an extraordinarily challenging and elusive virus and why, 30 years later, scientists are still trying to understand how the body produces HIV antibodies and how to harness that knowledge in a vaccine.
“The science is really key for HIV,” she said. “That’s really why it’s been such a long road.”
Priddy joined Leonard Friedland of GSK and David B. Weiner of the Wistar Institute for a panel on the latest science, which includes a roster of 260 new vaccines in development by America’s biopharmaceutical companies. She highlighted the last decade’s HIV vaccine progress, such as the discovery of broadly neutralizing antibodies, which has led to a renaissance in the field. As important, she discussed the hurdles facing vaccine product development in light of these successes…

.
IVAC  [to 18 November 2017]
http://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Latest IVAC News  [Undated]
Mathu Santosham, MD, MPH, wins the 2017 Prince Mahidol Award
IVAC’s Senior Advisor recognized for landmark scientific contribution to controlling Hib, pneumococcal disease
Mathu Santosham, MD, MPH, has received the Prince Mahidol Award 2017 in the field of Public Health, which recognizes “outstanding contribution in the field of public health for the sake of the well-being of the peoples.”
Santosham, who serves as Director Emeritus of the Johns Hopkins Center for American Indian Health and Special Advisor in the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, has been recognized for his landmark scientific contribution to the control of Hib and pneumococcal disease around the world.
The Prince Mahidol Award was established in 1992 to honor the late Prince Mahidol of Songka, the Royal Father of His Majesty the King of Thailand. Prince Mahidol modernized medical services and education in Thailand and is known to the country as the “Father of Modern Medicine and Public Health.” Dr. Santosham will jointly receive the award with Professor Porter Warren Anderson Jr., Dr. Rachel Schneerson, and Dr. John B. Robbins…
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MSF/Médecins Sans Frontières  [to 18 November 2017]
http://www.doctorswithoutborders.org/news stories/press/press-releases
Press release
Yemen: Blockade by Saudi-Led Coalition Hindering Medical Aid
SANA’A, YEMEN/NEW YORK, NOVEMBER 17, 2017—The Saudi-led coalition’s continuing blockade of Yemen’s ports and airports is significantly hindering the efforts of Doctors Without Borders/Médecins Sans Frontières (MSF) and other humanitarian organizations to provide lifesaving assistance to people in the war-torn country.
For the past 12 days, MSF has not received authorization from the Saudi-led coalition to fly into Yemen’s capital, Sana’a, which is essential to bring medical supplies and staff to patients in need.

Press release
Doctors Without Borders Brings Interactive Exhibition on Refugee Crisis to the Santa Monica Pier
November 15, 2017
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières brings its exhibition on the plight of more than 65 million refugees and internally displaced people to Santa Monica this week. Forced From Home illustrates individual stories of the world’s displaced people, and helps visitors better understand the medical humanitarian consequences of the global refugee crisis.

Press release
MSF Welcomes Suspension of Harmful Intellectual Property Measures in New TPP Trade Deal
November 14, 2017
Ministers from the eleven countries assessing the Trans-Pacific Partnership (TPP) trade deal have suspended many of the damaging provisions that would have restricted access to medicines and vaccines, a victory for millions of people who rely on affordable medicines worldwide.
 
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NIH  [to 18 November 2017]
http://www.nih.gov/news-events/news-releases
November 16, 2017
National organizations support outreach efforts for NIH’s All of Us Research Program
— Groups will help raise awareness about the initiative to engage 1 million or more volunteers in health research.

November 14, 2017
Three decades of responding to infectious disease outbreaks
— NIAID director Anthony S. Fauci, M.D., highlights lessons from AIDS to Zika.
Article : CI Paules, et al. What recent history has taught us about responding to emerging infectious disease threats. Annals of Internal Medicine DOI: 10.7326/M17-2496 (2017).

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PATH  [to 18 November 2017]
http://www.path.org/news/index.php
Press release | November 15, 2017
A Structural Clue to Attacking Malaria’s ‘Achilles Heel’
TSRI and PATH collaboration provides blueprint for design of a next-generation vaccine
Washington DC, and La Jolla California, November 15, 2017—Researchers from The Scripps Research Institute (TSRI) and PATH’s Malaria Vaccine Initiative (MVI) have shed light on how the human immune system recognizes the malaria parasite through investigation of antibodies generated from the RTS,S malaria vaccine—work that could boost the development of a more potent vaccine against the global killer.
In a study published this week in the journal Proceedings of the National Academy of Sciences, the researchers provide an atomic-level view of how human antibodies bind to an important malarial surface protein, the circumsporozoite protein [CSP], to protect against the malaria parasite. These new structures could potentially help scientists enhance the efficacy and duration of RTS,S, the world’s most advanced malaria vaccine to date, which has shown partial protection against the disease in a large-scale Phase 3 clinical trial.
The RTS,S vaccine was the outcome of a long-standing collaboration between PATH and GSK that began in 2001 and involved research institutions in Africa and around the world. RTS,S is the first and, to date, the only vaccine to show a protective effect against malaria among young children in Phase 3 clinical trials.
Efforts continue to enhance the vaccine’s efficacy and duration of protection against malaria, a major public health problem that infects millions of people each year. An estimated 429,000 people died from the mosquito-borne illness in 2015 and 212 million people were infected…

Press release | November 14, 2017
Multi-sector partnership supports detection and treatment of childhood tuberculosis in Vietnam
Nghe An, Vietnam, November 14, 2017—Increasing numbers of children in four districts of Vietnam’s Nghe An province are being protected against tuberculosis (TB) through a partnership focused on strengthening detection, treatment, and management of the deadly disease.
The Breath for Life project, a partnership between PATH, the Nghe An Tuberculosis and Lung Disease Hospital, and Johnson & Johnson, has supported public and private health care workers and facilities to increase the detection and early treatment of children with TB, and to increase the number of children taking preventive treatment due to being in close contact with people who have contracted the illness.
Through the Breath for Life project’s focus on improved detection, 148 children were diagnosed with TB in the districts of Dien Chau, Quynh Luu, Nam Dan, and Yen Thanh in 2016, double the 74 diagnosed in these districts in 2015. In the first nine months of 2017, an additional 87 children were diagnosed with TB. The increased number of diagnoses means that more children with previously undetected TB are now being treated…

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UNAIDS [to 18 November 2017]
http://www.unaids.org/en
Update
China focuses on strengthening HIV prevention
16 November 2017
The International Symposium on the Prevention and Control of HIV in China was held in Beijing, China, on 13 and 14 November to discuss China’s evolving HIV epidemic. The symposium was sponsored by China’s National Health and Family Planning Commission and the Ministry of Science and Technology, with the support of UNAIDS, the World Health Organization and the United States Centers for Disease Control and Prevention.
The meeting aimed to put forward new strategies for preventing HIV through sexual transmission…

Update
United Nations Deputy Secretary-General and Geneva-based leaders discuss the future of global health in 2030 Agenda
15 November 2017

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UNICEF  [to 18 November 2017]
https://www.unicef.org/media/
16 November 2017
   UN Leaders appeal for immediate lifting of humanitarian blockade in Yemen – Millions of lives at imminent risk
NEW YORK/GENEVA, 16 November 2017 – “While the Saudi-led military coalition has partially lifted the recent blockade of Yemen, closure of much of the country’s air, sea and land ports is making an already catastrophic situation far worse. The space and access we need to deliver humanitarian assistance is being choked off, threatening the lives of millions of vulnerable children and families.

Statement by UNICEF South Asia Regional Director, Jean Gough, from Afghanistan and Pakistan border
SPIN BOLDAK, Afghanistan, 11 November 2017 – “The town of Spin Boldak on Afghanistan’s southern border with Pakistan is at the epicentre of the global effort to eradicate polio.
[See Polio above for more detail]

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Wellcome Trust  [to 18 November 2017]
https://wellcome.ac.uk/news
News / Published: 16 November 2017
Ayurvedic Man: our new exhibition exploring ‘the knowledge of long life’
‘Ayurvedic Man: Encounters with Indian medicine’, Wellcome Collection’s latest exhibition, shines a light on some of the treasures in our archives, from intricate anatomical diagrams and surgical tools, to erotic manuals and spiritual manuscripts

Journal Watch

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

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

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 18 November 2017)

Research article
Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence
Results
Twenty-five studies were included in the review. HCWs may be motivated to accept vaccination to protect themselves and their patients against infection. However, a range of beliefs may act as barriers to vaccine uptake, including concerns about side-effects, scepticism about vaccine effectiveness, and the belief that influenza is not a serious illness. HCWs value their autonomy and professional responsibility in making decisions about vaccination. The implementation of interventions to promote vaccination uptake may face barriers both from HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations.
Conclusions
HCWs’ vaccination behaviour needs to be understood in the context of HCWs’ relationships with each other, with management and with patients. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCWs and the organisational context within which they are implemented.
Authors: Theo Lorenc, David Marshall, Kath Wright, Katy Sutcliffe and Amanda Sowden
Citation: BMC Health Services Research 2017 17:732
Published on: 15 November 2017

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 18 November 2017)

Research article
Varicella zoster virus-associated morbidity and mortality in Africa – a systematic review
Varicella zoster virus (VZV) causes varicella and herpes zoster. These vaccine preventable diseases are common globally. Most available data on VZV epidemiology are from industrialised temperate countries and …
Authors: Hannah Hussey, Leila Abdullahi, Jamie Collins, Rudzani Muloiwa, Gregory Hussey and Benjamin Kagina
Citation: BMC Infectious Diseases 2017 17:717
Published on: 14 November 2017

Developing World Bioethics
December 2017  Volume 17, Issue 3  Pages 141–216
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2017.17.issue-3/issuetoc

GENERAL EDITORIAL
Research ethics and the Zika legacy in Brazil (pages 142–143)
Debora Diniz and Ilana Ambrogi
Version of Record online: 12 NOV 2017 | DOI: 10.1111/dewb.12175
[No abstract]

ARTICLES
Social Responsibility and the State’s Duty to provide Healthcare: An Islamic Ethico-Legal Perspective (pages 205–214)
Aasim I. Padela
Version of Record online: 30 DEC 2016 | DOI: 10.1111/dewb.12140
Abstract
The United Nations Educational, Scientific and Cultural Organization’s (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state’s moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico-legal conceptual analogues for human rights and communal responsibility, ḥuqūq al-’ibād and farḍ al-kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico-legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico-legal values might inform the discursive outputs of Muslim organizations.

Disaster Medicine and Public Health Preparedness
Volume 11 – Issue 5 – October 2017
https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/latest-issue

Original Research
Evaluating the Impact of Pharmacies on Pandemic Influenza Vaccine Administration
Joy Schwerzmann, Samuel B. Graitcer, Barbara Jester, David Krahl, Daniel Jernigan, Carolyn B. Bridges, Joseph Miller
https://doi.org/10.1017/dmp.2017.1
Published online: 21 February 2017, pp. 587-593
Abstract
The objective of this study was to quantify the potential retail pharmacy vaccine administration capacity and its possible impact on pandemic influenza vaccine uptake.
We developed a discrete event simulation model by use of ExtendSim software (Imagine That Inc, San Jose, CA) to forecast the potential effect of retail pharmacy vaccine administration on total weekly vaccine administration and the time needed to reach 80% vaccination coverage with a single dose of vaccine per person.
Results showed that weekly national vaccine administration capacity increased to 25 million doses per week when retail pharmacist vaccination capacity was included in the model. In addition, the time to achieve 80% vaccination coverage nationally was reduced by 7 weeks, assuming high public demand for vaccination. The results for individual states varied considerably, but in 48 states the inclusion of pharmacies improved time to 80% coverage.
Pharmacists can increase the numbers of pandemic influenza vaccine doses administered and reduce the time to achieve 80% single-dose coverage. These results support efforts to ensure pharmacist vaccinators are integrated into pandemic vaccine response planning. (Disaster Med Public Health Preparedness. 2017;11:587–593)