Epidemiology and Infection Volume 145 – Issue 15 – November 2017

Epidemiology and Infection
Volume 145 – Issue 15 – November 2017
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Mumps
Original Papers
An outbreak of mumps with genetic strain variation in a highly vaccinated student population in Scotland
J. WILLOCKS, D. GUERENDIAIN, H. I. AUSTIN, K. E. MORRISON, R. L. CAMERON, K. E. TEMPLETON, V. R. F. DE LIMA, R. EWING, W. DONOVAN, K. G. J. POLLOCK
https://doi.org/10.1017/S0950268817002102
Published online: 14 September 2017, pp. 3219-3225

Respiratory infections
Influenza vaccination status and outcomes among influenza-associated hospitalizations in Columbus, Ohio (2012–2015)
N. ZIVICH, L. TATHAM, K. LUNG, J. TIEN, C. E. BOLLINGER, J. K. BOWER

https://doi.org/10.1017/S0950268817002163

Published online: 16 October 2017, pp. 3284-3293

Globalization and Health [Accessed 18 November 2017]

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 18 November 2017]

Research
Challenges to implementing Gavi’s health system strengthening support in Chad and Cameroon: results from a mixed-methods evaluation
Since 2005, Gavi has provided health system strengthening (HSS) grants to address bottlenecks affecting immunization services. This study is the first to evaluate the Gavi HSS implementation process in either Chad or Cameroon…
Conclusions
Though Chad and Cameroon both critically needed support to strengthen their weak health systems, serious challenges drastically limited implementation of their Gavi HSS programs. Implementation of future HSS programs in these and similar settings can be improved by transparent and reliable procedures and communication from Gavi, proposals that account for countries’ programmatic capacity and the potential for delayed disbursements, implementation practices that foster learning and adaptation, and an early emphasis on developing managerial and other human resources.
Emily Dansereau, Yodé Miangotar, Ellen Squires, Honoré Mimche and Charbel El Bcheraoui
Globalization and Health 2017 13:83
Published on: 16 November 2017

Commentary
Patent landscape of neglected tropical diseases: an analysis of worldwide patent families
“Neglected Tropical Diseases” (NTDs) affect millions of people in Africa, Asia and South America. The two primary ways of strategic interventions are “preventive chemotherapy and transmission control” (PCT), a…
Folahanmi Tomiwa Akinsolu, Vitor Nobre de Paiva, Samuel Santos Souza and Orsolya Varga
Globalization and Health 2017 13:82
Published on: 14 November 2017

Towards fair and effective North–South collaboration: realising a programme for demand-driven and locally led research

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 18 November 2017]

Research
Towards fair and effective North–South collaboration: realising a programme for demand-driven and locally led research
At the turn of the 90s, studies showed that health research contributed little to health and development in low- and middle-income countries because it was oriented towards international priorities and dominated by researchers from the North. A new approach to North–South collaboration was required that would support demand-driven and locally led research in the South. The aim of this study was to analyse the development and functioning of a programme for demand-driven and locally led research in Ghana that was supported by a North–South collaboration.
Maarten Olivier Kok, John Owusu Gyapong, Ivan Wolffers, David Ofori-Adjei and Elis Joost Ruitenberg
Published on: 13 November 2017

The Critical Role of Biomedical Research in Pandemic Preparedness

JAMA
November 14, 2017, Vol 318, No. 18, Pages 1731-1840
http://jama.jamanetwork.com/issue.aspx

Viewpoint
The Critical Role of Biomedical Research in Pandemic Preparedness
Hilary D. Marston, MD, MPH; Catharine I. Paules, MD; Anthony S. Fauci, MD
JAMA. 2017;318(18):1757-1758. doi:10.1001/jama.2017.15033
In this Viewpoint, Anthony Fauci and colleagues review rapid research responses to recent infectious disease outbreaks as a way of emphasizing the strategies and collaborations necessary to prepare for a next unknown pandemic.

Opportunities and challenges in a world of data abundance

JBI Database of Systematic Review and Implementation Reports
November 2017 – Volume 15 – Issue 11
http://journals.lww.com/jbisrir/Pages/currenttoc.aspx

Editorial
Opportunities and challenges in a world of data abundance
Holly, Cheryl
JBI Database of Systematic Reviews and Implementation Reports. 15(11):2597-2598, November 2017.
Since their debut in the 1980s, the publication rate of systematic reviews has rapidly accelerated. In 2014, more than 8000 systematic reviews were indexed on MEDLINE, a three-fold increase over the last decade.1 Systematic reviews organize the discrete pieces of information contained in primary studies and other reports into a coherent body of evidence for use to inform healthcare decisions and policy in support of patient care and to engage stakeholders. Currently, much of the work in systematic review methodology is focused on developing guidance for reliable approaches to scoping, searching, appraising, synthesizing and grading evidence.1,2 Accordingly, there are now widely disseminated standards on how to complete a systematic review, which has increased interest in the conduct of systematic reviews and allowed this proliferation in publication. The challenge and opportunity in this proliferation is how to engage in this new world of data abundance, keeping in mind expediency, efficiency and complexity.
Expediency
While systematic reviews are considered to be the gold standard in evidence synthesis, they are not without their limitations. Despite the need for systematic review evidence to inform clinical practice and policy, the best evidence is not always used due to lack of knowledge, time, skills and/or resources to translate knowledge into meaningful and useful informaton.2 For example, a systematic review can require between six months to twoyears to complete, whereas decision makers, whose needs are generally time-sensitive and emergent, often require up-to-date evidence more quickly than this. The rapid review is a new methodology that has emerged to address this need. Although the definition of a rapid review varies, typically it is characterized by a strong focus on the specific needs of a particular decision maker and by methodological shortcuts.3,4 Results of rapid reviews have been characterized by a reduced scope, omission of dual data abstraction and critical appraisal, and conduct by only one reviewer. While there is no evidence to suggest that rapid reviews are misleading, there is a need to ensure credibility and technical quality.2 The opportunity lies in developing a standardized approach to rapid reviews that does not sacrifice validity for expediency.
Efficiency
Umbrella or overviews of systematic reviews, which involve the synthesis of results from multiple systematic reviews, has emerged as an organized means to address an abundance of data. These reviews take advantage of previous research syntheses, bringing an efficiency that enables a broad understanding of a wide-scope topic in a shorter timeframe.5 An umbrella review can be conducted to identify factors that may influence the treatment-outcome effect in the same or different populations, map evidence and identify gaps for primary researchers, or examine discordance or similarity in findings and conclusions across reviews.6 This information is important to clinicians and patients as it aids in understanding what patients will benefit most, who is least likely to benefit, and who is at greatest risk of experiencing adverse outcomes. There are, however, unique issues to the conduct of an umbrella review that differ from a traditional review. Chief among these are how to handle overlapping primary studies, i.e. when one primary study appears in one or more systematic review.5 The challenge is how to handle the overlap of primary studies when they are included in more than one review so that their results are not being used multiple times, violating the principles of independence of data.
Complexity
While methods for conducting systematic reviews on distinct treatments, such as medication regimens, are well-defined, these methods may be inadequate for systematic reviews of the complex interventions often encountered in health care. Complex interventions are those in which a number of elements must work together to achieve the best outcomes, such as chronic disease management or smoking cessation programs.7 Such complexity is influenced by multiple factors, including patient characteristics and behavior, social determinants of health, differing contexts as well as the interventions themselves.7 They need to be tailored to be effective. The challenge and opportunity here is to determine what methods can best elucidate recommendations that work best, under what circumstances and for what subgroup, given the interactions in the dual challenge of intervention complexity (multiple components) and pathway complexity (multiple causal pathways, feedback loops, synergies, and/or moderators of effect).8 Consideration needs to be given to qualitative and mixed method reviews to overcome the limits of measurement-based research, which often focus on the easily observed and easily measured effects, rather than the context and acceptability of an intervention.4,5

Drugs Delivery by Charities: A Possible Epidemiologic Indicator in Children of Undocumented Migrants

Journal of Immigrant and Minority Health
Volume 19, Issue 6, December 2017
https://link.springer.com/journal/10903/19/6/page/1

Original Paper
Drugs Delivery by Charities: A Possible Epidemiologic Indicator in Children of Undocumented Migrants
S Bini, A Clavenna, AE Rigamonti, A Sartorio
Abstract
Describing the health status of a population is difficult, especially in the case of irregular migrants who are now a growing population in western Countries. Data for children of these families are almost inexistent. In the absence of databases on this peculiar pediatric population, we analyzed drugs dispensation by a major Charity to have an insight into their health needs. This observational retrospective study was carried out during the entire 2015 and enrolled 628 undocumented children. A cohort of 8438 adult patients belonging to the same ethnic groups was used for comparison. Respiratory drugs were those most commonly prescribed, followed by those for skin and ocular diseases and by those for gastrointestinal disorders. Also in adults respiratory medications were the most dispensed, but almost in equal measure than cardiovascular drugs.To our knowledge this is the first study on the health needs of undocumented children residing in a western Country. The method we used seems to be a useful method for epidemiological analysis. As could be expected, respiratory and skin diseases ranked first, possibly owing to environmental factors.

Human Papillomavirus (HPV) Prevalence in Male Adolescents 4 Years After HPV-16/18 Vaccination

Journal of Infectious Diseases
Volume 216, Issue 8, 15 November 2017
https://academic.oup.com/jid/issue

MAJOR ARTICLES AND BRIEF REPORTS
VIRUSES
Human Papillomavirus (HPV) Prevalence in Male Adolescents 4 Years After HPV-16/18 Vaccination
Tuomas Lehtinen; Anna Söderlund-Strand; Tiina Petäjä; Tiina Eriksson; Sakari Jokiranta
The Journal of Infectious Diseases, Volume 216, Issue 8, 15 November 2017, Pages 966–968, https://doi.org/10.1093/infdis/jix415
Although the quadrivalent human papillomavirus (HPV) vaccine is known to reduce HPV infection in men, this is the first report that HPV prevalence rates are also reduced among men given the bivalent HPV vaccine.

The Lancet Nov 18, 2017 Volume 390 Number 10109 p2215-2324 e39-e40

The Lancet
Nov 18, 2017 Volume 390 Number 10109 p2215-2324   e39-e40
http://www.thelancet.com/journals/lancet/issue/current

Comment
Where is the science in humanitarian health?
Ronald J Waldman, Michael J Toole

Humanitarian medicine is more than a technical exercise
Vickie Hawkins, André Heller Pérache

Research ethics and evidence for humanitarian health
Dónal O’Mathúna, Chesmal Siriwardhana

Attacks against health care in Syria, 2015–16: results from a real-time reporting tool

The Lancet
Nov 18, 2017 Volume 390 Number 10109 p2215-2324   e39-e40
http://www.thelancet.com/journals/lancet/issue/current

Articles
Attacks against health care in Syria, 2015–16: results from a real-time reporting tool
Mohamed Elamein, Hilary Bower, Camilo Valderrama, Daher Zedan, Hazem Rihawi, Khaled Almilaji, Mohammed Abdelhafeez, Nabil Tabbal, Naser Almhawish, Sophie Maes, Alaa AbouZeid
Summary
Background
Collecting credible data on violence against health services, health workers, and patients in war zones is a massive challenge, but crucial to understanding the extent to which international humanitarian law is being breached. We describe a new system used mainly in areas of Syria with a substantial presence of armed opposition groups since November, 2015, to detect and verify attacks on health-care services and describe their effect.
Methods
All Turkey health cluster organisations with a physical presence in Syria, either through deployed and locally employed staff, were asked to participate in the Monitoring Violence against Health Care (MVH) alert network. The Turkey hub of the health cluster, a UN-activated humanitarian health coordination body, received alerts from health cluster partners via WhatsApp and an anonymised online data-entry tool. Field staff were asked to seek further information by interviewing victims and other witnesses when possible. The MVH data team triangulated alerts to identify individual events and distributed a preliminary flash update of key information (location, type of service, modality of attack, deaths, and casualties) to partners, WHO, United Nations Office for the Coordination of Humanitarian Affairs, and donors. The team also received and entered alerts from several large non-health cluster organisations (known as external partners, who do their own information-gathering and verification processes before sharing their information). Each incident was then assessed in a stringent process of information-matching. Attacks were deemed to be verified if they were reported by a minimum of one health cluster partner and one external partner, and the majority of the key datapoints matched. Alerts that did not meet this standard were deemed to be unverified. Results were tabulated to describe attack occurrence and impact, disaggregated where possible by age, sex, and location.
Findings
Between early November, 2015, and Dec 31 2016, 938 people were directly harmed in 402 incidents of violence against health care: 677 (72%) were wounded and 261 (28%) were killed. Most of the dead were adult males (68%), but the highest case fatality (39%) was seen in children aged younger than 5 years. 24% of attack victims were health workers. Around 44% of hospitals and 5% of all primary care clinics in mainly areas with a substantial presence of armed opposition groups experienced attacks. Aerial bombardment was the main form of attack. A third of health-care services were hit more than once. Services providing trauma care were attacked more than other services.
Interpretation
The data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators.
Funding
None.

Evidence on public health interventions in humanitarian crises

The Lancet
Nov 18, 2017 Volume 390 Number 10109 p2215-2324   e39-e40
http://www.thelancet.com/journals/lancet/issue/current

Series
Health in humanitarian crises
Evidence on public health interventions in humanitarian crises
Karl Blanchet, Anita Ramesh, Severine Frison, Emily Warren, Mazeda Hossain, James Smith, Abigail Knight, Nathan Post, Christopher Lewis, Aniek Woodward, Maysoon Dahab, Alexander Ruby, Vera Sistenich, Sara Pantuliano, Bayard Roberts
Summary
Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research.

Public health information in crisis-affected populations: a review of methods and their use for advocacy and action

The Lancet
Nov 18, 2017 Volume 390 Number 10109 p2215-2324   e39-e40
http://www.thelancet.com/journals/lancet/issue/current

Health in humanitarian crises
Public health information in crisis-affected populations: a review of methods and their use for advocacy and action
Francesco Checchi, Abdihamid Warsame, Victoria Treacy-Wong, Jonathan Polonsky, Mark van Ommeren, Claudine Prudhon
Summary
Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. The paper also quantifies the availability of a minimal essential set of information in large armed conflict and natural disaster crises since 2010: we show that information was available and timely only in a small minority of cases. On the basis of this observation, we propose an agenda for methodological research and steps required to improve on the current use of available methods. This proposition includes setting up a dedicated interagency service for public health information and epidemiology in crises.

Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?

The Lancet
Nov 18, 2017 Volume 390 Number 10109 p2215-2324   e39-e40
http://www.thelancet.com/journals/lancet/issue/current

Health in humanitarian crises
Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?
Sandro Colombo, Enrico Pavignani
Summary
Humanitarian health workers operate in dangerous and uncertain contexts, in which mistakes and failures are common, often have severe consequences, and are regularly repeated, despite being documented by many reviews. This Series paper aims to discuss the failures of medical humanitarianism. We describe why some of these recurrent failings, which are often not identified until much later, seem intractable: they are so entrenched in humanitarian action that they cannot be addressed by simple technical fixes. We argue that relief health-care interventions should be contextualised. Perhaps medical humanitarianism deserves a better reputation than the one at times tarnished by unfair criticism, resulting from inapplicable guiding principles and unrealistic expectations. The present situation is not conducive to radical reforms of humanitarian medicine; complex crises multiply and no political, diplomatic, or military solutions are in sight. Relief agencies have to compete for financial resources that do not increase at the same pace as health needs. Avoiding the repetition of failures requires recognising previous mistakes and addressing them through different policies by donors, stronger documentation and analysis of humanitarian programmes and interventions, increased professionalisation, improved, opportunistic relationships with the media, and better ways of working together with local health stakeholders and through indigenous institutions.

 

 

Data Sharing from Clinical Trials — A Research Funder’s Perspective

New England Journal of Medicine
November 16, 2017  Vol. 377 No. 20
http://www.nejm.org/toc/nejm/medical-journal

Sounding Board
Data Sharing from Clinical Trials — A Research Funder’s Perspective
Robert Kiley, Tony Peatfield, Jennifer Hansen, and Fiona Reddington
N Engl J Med 2017; 377:1990-1992 November 16, 2017 DOI: 10.1056/NEJMsb1708278

The Wellcome Trust, the Medical Research Council, Cancer Research UK, and the Bill and Melinda Gates Foundation share a common vision for maximizing the value of data that are generated through the trials we fund. We are committed to ensuring that the data from published clinical trials can be accessed by researchers so they can validate key findings, stimulate further inquiry, and ultimately deliver lifesaving results.

The sharing of data during the outbreak of Ebola virus disease in West Africa that began in 2014 helped researchers to trace the origins of the final few cases and bring the epidemic under control.1 And the challenge organized by the Journal to encourage researchers to use data from the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated the vast potential for those data to be reused to develop new applications and uncover new knowledge.2

The recent announcement by the International Committee of Medical Journal Editors (ICMJE) on data-sharing statements for clinical trials3 is a step in the right direction but falls short of realizing our vision. The ICMJE has not mandated data sharing as a requirement for publication, and we find the example statements it provides to be vague and open to interpretation. Crucially, the requirements do not recognize that some research funders already have mandates for data sharing.

Policy
As funders of medical research, we recognize the importance of the appropriate sharing of clinical-trial data for reasons of transparency, good practice, and accelerated dissemination of results to the broader community. There is now a clear consensus that the results of all clinical trials must be reported in a timely manner, as set out in a joint statement by the World Health Organization regarding public disclosure of results from clinical trials.4 In addition, all our organizations have implemented data-sharing policies requiring that the data from studies we have funded will be made available to other researchers at the time of publication. This requirement applies equally to clinical trials.

These policies, however, do not mean that such data have to be openly available for anyone to access on the Web. We fully recognize that some data — and especially clinical-trial data — may contain sensitive, personal information about research participants, and these data need to be shared in a manner that protects participants’ privacy and confidentiality and respects the terms under which they consented to take part in the study. Such an approach might include the use of managed-access procedures, whereby requests to access data are reviewed by an independent committee, and of data-access agreements that place appropriate restrictions on how the data may be used.

As funders, we also recognize the many challenges to data sharing5 — most notably, those related to resources, equity, and incentives.

Resources
Sharing data is not a cost-free activity. Data need to be collected, preserved, curated, and stored in standardized formats in order to be useful to the scientific community. We need to support technical solutions that enable researchers to easily discover, access, and reuse the data in order to reap the benefits of accelerating discovery, enabling research reproducibility, and preventing redundancy. In addition, funding bodies are increasingly requiring that researchers develop data-management plans as part of research proposals, and we support the justified costs of delivering these plans as an integral part of funding the research. We anticipate that the data-sharing statements required by the ICMJE can, in part, be derived from researchers’ data-management-and-sharing plans.

Funders are actively working in partnership to support the development of community resources that facilitate access to clinical-trial data and reduce the burden on trialists. In particular, our organizations are planning to participate in the ClinicalStudyDataRequest.com platform,6 which currently includes trial data from 13 pharmaceutical companies, as a mechanism for listing and providing managed access to data from clinical trials that we have funded.

Equity
Particular concerns have been raised over the effect of more stringent requirements for sharing data from clinical trials that are conducted in low-income and middle-income countries — specifically, that requiring researchers in such countries to share data with better-resourced groups elsewhere may put them at an unfair disadvantage and that benefits will not necessarily be shared with the communities that participated in the research.

Our organizations are strongly committed to establishing trusted and equitable systems for data-access governance in these settings, which may include terms that require users to contribute to training and capacity development or to share the resulting outcomes. However, the fundamental requirement to ensure that data are accessible at the time of publication still holds firm.

Incentives
Arguably, the biggest challenge to data sharing is the sense that researchers are not given incentives to share data — and worse, many researchers believe they are disadvantaging themselves by doing so. A recent survey of Wellcome Trust–funded researchers showed that the potential loss of publication opportunities — along with the belief that publishing is the only currency for successful grant funding and academic advancement — was a key factor in the inhibition of data sharing.7

As funders, we need to tackle this issue head-on and demonstrate that we value the sharing of data — as well as other outputs, such as software and materials (e.g., antibodies, cell lines, and reagents) — and will take these outputs into account when reviewing grant and job applications. In parallel, we will make it clear that we focus on the scientific content of an article, rather than its publication metrics or the name of the journal in which it was published.
We commit to clearly communicating these values to the members of our grant-reviewing panels.

But we need to do more. The Wellcome Trust is reexamining its grant-application process to see how it can shift the emphasis from publications to a wider set of outputs. The Wellcome Innovator Awards program invites applicants to describe their key achievements and the significance in their field. These statements can be supported with reference to peer-reviewed articles, but also with other research outputs, such as patents, data sets, software, and materials.8 Such a model could be applied more broadly. Asking applicants to explain how they support the values of open research — transparency, reproducibility, and early access to results — is also worthy of consideration.9

More broadly, there is a need to support and foster community-wide efforts in this realm. Such efforts include accelerating the uptake of consistent approaches for data citation that allow the use of data to be acknowledged and tracked. The recently announced initiative exploring the value of awarding “data authorship” to researchers whose data are used or reused is also one we are following with interest.10

Conclusions
Medical research saves lives, and as the challenges in our world continue to outweigh the resources, collaboration and cooperation among members of the global research community will be essential in maximizing the effect of funded research. It is simply unacceptable that the data from published clinical trials are not made available to researchers and used to their fullest potential to improve health.

Excess Mortality Related to Chikungunya Epidemics in the Context of Co-circulation of Other Arboviruses in Brazil

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 18 November 2017]

Excess Mortality Related to Chikungunya Epidemics in the Context of Co-circulation of Other Arboviruses in Brazil
November 13, 2017 · Research Article
Introduction: Chikungunya is an emerging arbovirus that reached the Western Hemisphere at the end of 2013. Studies in the Indian Ocean and India suggest that passive surveillance systems cannot recognize many of deaths associated with chikungunya, which can be inferred by an increase in the overall mortality observed during chikungunya epidemics.
Objective: We assess the mortality associated with chikungunya epidemics in the most affected states in Brazil, from 2015 and 2016.
Methods: We studied the monthly mortality by age group, comparing a period without epidemics to a chikungunya epidemic period, which we defined arbitrarily as consecutive months with incidences of more than 50 cases/100,000 persons.
Results: We obtained official data from the National System of Reported Diseases (SINAN) and the Mortality Information System (SIM), both maintained by the Ministry of Health. We identified a significant increase in the all-cause mortality rate during chikungunya epidemics, while there was no similar mortality in the previous years, even during dengue epidemics. We estimated an excess of 4,505 deaths in Pernambuco during the chikungunya epidemics (47.9 per 100,000 persons).The most affected age groups were the elderly and those under 1 year of age, and the same pattern occurred in all the states.
Discussion: Further studies at other sites are needed to confirm the association between increased mortality and chikungunya epidemics indifferent age groups. If these findings are confirmed, it will be necessary to revise the guidelines to recognize the actual mortality associated with chikungunya and to improve therapeutic approaches and protective measures in the most vulnerable groups.

Evidence-based restructuring of health and social care

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 18 November 2017)

Perspective
Evidence-based restructuring of health and social care
Aziz Sheikh
Perspective | published 14 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002426
Governments around the world are grappling with how to respond to the challenges resulting from the epidemiological transition. Of particular concern is the increasing number of people living—for several decades—with 1 or more non-communicable disorders. The policy focus is centred on moving care away from the expensive specialist-dominated hospital sector to more community-based longitudinal care. The United Kingdom’s 2012 Health and Social Care Act, which gave control in England for the commissioning of care to clinicians working through Clinical Commissioning Groups (CCGs), represents one of the most ambitious and costly policy experiments to date [1]. This had the aims of supporting local decision-making, promoting innovation, and focusing attention on public health measures which, it was anticipated, would result in reductions in the need for specialist outpatient appointments and hospitalisations. In this issue of PLOS Medicine, however, James Lopez Bernal and colleagues report the results of their study finding that these benefits were not realised and that the intervention may have been associated with increased referrals to specialists [2].

The need to restructure care
There is now across the world increasing policy interest in the need to restructure health and social care such that it is better suited to the needs of people living with long-term conditions. Although the emergence of the specialist hospital sector was an appropriate response to cater to the large numbers of people affected by life-threatening infectious disease epidemics, the burden of disease now predominantly arises from noncommunicable disorders. The use of hospitals as the mainstay of care for people living with long-term conditions is inconvenient for patients and an inefficient use of public resources.

The policy focus is therefore on seeing whether patients can be better managed in community care contexts where they can receive longitudinal care in close proximity to where they live, with an emphasis on supported self-management and coordination of care, and with a greater focus on population-based preventive care than is possible in hospital-dominated health systems [3].

Integrating health and social care
Bradley and Taylor’s investigations in The American Health Care Paradox threw into sharp relief the need to consider expenditure on both health and social care in order to understand the relationship between expenditure and health outcomes [4]. This analysis, which has been widely debated in health policy circles, has underscored the need to integrate health and social care budgets in order to maximise the potential for health gains; for example, modest investments in home adaptations and mobility aids may be the difference between an individual’s ability to manage independently and a prolonged hospital admission.

Although the need to integrate health and social care policy is now widely appreciated, achieving this has proven challenging. The United Kingdom’s 2012 Health and Social Care Act represents one of the most important policy experiments in this respect [1]. In essence, this has involved passing financial control of local National Health Service (NHS) budgets to general practitioners through CCGs who were charged with procuring services on behalf of their patients. The underpinning assumption was that needs assessment and provision of care are best managed by those who are locally grounded. The Act thus resulted in a major shift of control and resources from the hospital sector to those providing front-line care, but as demonstrated by Lopez Bernal et al., this did not translate into a reduction of hospitalisations and was associated with an increased number of specialist outpatient referrals [2].

Challenges to and opportunities for evidence-based policymaking
Health is largely won or lost on the basis of major health policy decisions, but these are seldom evaluated [5]. The reasons are complex, including the time and costs of undertaking such evaluations and the distinct possibility that they may reveal inconvenient truths. Politicians, especially those operating in liberal democracies such as the United Kingdom, are vulnerable to the effects of adverse publicity associated with what are often perceived as ‘failed’ government initiatives. These political challenges are real and not easily overcome until such time as there is a cross-party, longer-term approach to restructuring care.

More promising is that in many contexts it is now possible to exploit routinely collected data, thereby greatly reducing the time and costs of evaluating major policy initiatives on the restructuring of health and social care. This is well illustrated by the Lopez Bernal et al. study, which will have been undertaken much more rapidly and at a fraction of the cost of generating primary data [2]. As the United Kingdom’s data assets continue to mature, in addition to major recent government investments to make routine data more liquid—by improving access to and the ability to link data—and developing data science capacity, it will become possible to answer an increasing array of health policy questions within rapid timeframes at minimal costs. There is thus now, at least in the United Kingdom, the opportunity for a step-change in our ability to move towards evidence-based policymaking. What remains is the political maturity to see the value in such evaluations and, where necessary, iterate the policy approach in the light of their findings.
[References at title link above]
 
 

Vaccine effectiveness against laboratory-confirmed influenza hospitalizations among young children during the 2010-11 to 2013-14 influenza seasons in Ontario, Canada

PLoS One
http://www.plosone.org/
Research Article

Vaccine effectiveness against laboratory-confirmed influenza hospitalizations among young children during the 2010-11 to 2013-14 influenza seasons in Ontario, Canada
Sarah A. Buchan, Hannah Chung, Michael A. Campitelli, Natasha S. Crowcroft, Jonathan B. Gubbay, Timothy Karnauchow, Kevin Katz, Allison J. McGeer, J. Dayre McNally, David Richardson, Susan E. Richardson, Laura C. Rosella, Andrew Simor, Marek Smieja, Dat Tran, George Zahariadis, Jeffrey C. Kwong
Research Article | published 17 Nov 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0187834

Public Health Reports Volume 132, Issue 6, November/December 2017

Public Health Reports
Volume 132, Issue 6, November/December 2017
http://phr.sagepub.com/content/current

Surgeon General’s Perspective
Charting the Course to End HIV Transmission in the United States
Sylvia Trent-Adams, PhD, RN, FAAN
RADM, US Public Health Service
Deputy Surgeon General
First Published September 21, 2017; pp. 603–605

Research
Ranking States on Coverage of Cancer-Preventing Vaccines Among Adolescents: The Influence of Imprecision
Anne R. Waldrop, MD, Jennifer L. Moss, PhD, Benmei Liu, PhD, Li Zhu, PhD
First Published August 30, 2017; pp. 627–636
Abstract
Objectives:
Identifying the best and worst states for coverage of cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision of coverage and ranks is important for avoiding overinterpretation. The objective of this study was to examine states’ vaccination coverage and ranks, as well as the imprecision of these estimates, to inform public health decision making.
Methods:
We used data on coverage of HepB and HPV vaccines among adolescents aged 13-17 from the 2011-2015 National Immunization Survey-Teen (n = 103 729 from 50 US states and Washington, DC). We calculated coverage, 95% confidence intervals (CIs), and ranks for vaccination coverage in each state, and we generated simultaneous 95% CIs for ranks using a Monte Carlo method with 100 000 simulations.
Results:
Across years, HepB vaccination coverage was 92.2% (95% CI, 91.8%-92.5%; states’ range, 84.3% in West Virginia to 97.0% in Connecticut). HPV vaccination coverage was 57.4% (95% CI, 56.6%-58.2%; range, 41.8% in Kansas to 78.0% in Rhode Island) for girls and 31.0% (95% CI, 30.3%-31.8%; range, 19.0% in Utah to 59.3% in Rhode Island) for boys. States with the highest and lowest ranks generally had narrow 95% CIs; for example, Rhode Island was ranked first (95% CI, 1-1) and Kansas was ranked 51st (95% CI, 49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise 95% CIs; for example, New York was 26th for girls’ HPV vaccination coverage, but its 95% CI included ranks 18-35.
Conclusions:
States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be overinterpreted. However, ranks can highlight high-performing and low-performing states to target for further research and vaccination promotion programming.

Racing for academic glory and patents: Lessons from CRISPR

Science         
17 November 2017   Vol 358, Issue 6365
http://www.sciencemag.org/current.dtl

Policy Forum
Racing for academic glory and patents: Lessons from CRISPR
By Arti K. Rai, Robert Cook-Deegan
Science17 Nov 2017 : 874-876 Restricted Access
Overly broad patents must be reined in
Summary
The much-publicized dispute over patent rights to CRISPR-Cas9 gene-editing technology highlights tensions that have been percolating for almost four decades, since the U.S. Bayh-Dole Act of 1980 invoked patents as a mechanism for promoting commercialization of federally funded research. With the encouragement provided by Bayh-Dole, academic scientists and their research institutions now race in dual competitive domains: the quest for glory in academic research and in the patent sphere. Yet, a robust economic literature (1, 2) argues that races are often socially wasteful; the racing parties expend duplicative resources, in terms of both the research itself and the legal fees spent attempting to acquire patents, all in the pursuit of what may be a modest acceleration of invention. For CRISPR, and future races involving broadly useful technologies for which it may set a precedent, the relationship between these competitive domains needs to be parsed carefully. On the basis of legal maneuvers thus far, it appears that the litigants will try for broad rights; public benefit will depend on courts reining them in and, when broad patents slip through, on updating Bayh-Dole’s pro-commercialization safeguards with underused features of the Act.

Advancing dengue vaccine development

Science         
17 November 2017   Vol 358, Issue 6365
http://www.sciencemag.org/current.dtl

Perspectives
Advancing dengue vaccine development
By Mark B. Feinberg, Rafi Ahmed
Science17 Nov 2017 : 865-866 Restricted Access
Insights into the natural history of dengue virus infection guide vaccine development
Summary
Dengue virus (DENV) is a member of the viral genus Flavivirus, which also includes yellow fever virus (YFV) and Zika virus (ZIKV). DENV infection is a major and growing global health threat: There are ∼400 million cases of infection, ∼500,000 hospitalizations, and ∼12,500 deaths now estimated to occur each year (1). Dengue represents the most common mosquito-borne disease in humans (1). A remarkable 50% of the world’s population now lives in regions where DENV transmission is manifest. Dengue is associated with a wide spectrum of clinical outcomes, ranging from mild febrile illnesses to dengue hemorrhagic fever to the most severe clinical presentation of dengue shock syndrome, which is characterized by profound systemic cytokine activation, vascular leakage, and shock—this carries a high risk of death. On page 929 of this issue, Katzelnick et al. (2) analyzed DENV infection outcome data gleaned from the long-term followup of a cohort of Nicaraguan children (2). They found that the risk of severe dengue disease upon subsequent DENV infection correlated with baseline DENV antibody concentrations (titers), which has implications for DENV vaccination approaches.

Antibody-dependent enhancement of severe dengue disease in humans

Science         
17 November 2017   Vol 358, Issue 6365
http://www.sciencemag.org/current.dtl

Reports
Antibody-dependent enhancement of severe dengue disease in humans
By Leah C. Katzelnick, Lionel Gresh, M. Elizabeth Halloran, Juan Carlos Mercado, Guillermina Kuan, Aubree Gordon, Angel Balmaseda, Eva Harris
Science17 Nov 2017 : 929-932 Full Access
A long-term Nicaraguan pediatric cohort reveals that a narrow range of preexisting antibody titers increases the risk of severe dengue disease.
Editor’s Summary
Too much or too little—better than some
Dengue fever is caused by a mosquito-transmitted flavivirus resembling Zika virus. Both viruses can cause severe diseases in humans with catastrophic sequelae. It has been suspected in humans, and shown in animal models, that the host’s immune responses can make disease worse. Katzelnick et al. examined data from a long-term study of Nicaraguan children exposed to dengue virus (see the Perspective by Feinberg and Ahmed). They confirmed that antibody-dependent enhancement of disease occurs at a specific range of antibody concentrations. Low levels of antibody did not enhance disease, intermediate levels exacerbated disease, and high antibody titers protected against severe disease. These findings have major implications for vaccines against flaviviruses. Indeed, recent vaccine trials have shown evidence of severe disease in some recipients who were previously exposed to virus.
Science, this issue p. 929; see also p. 865
Abstract
For dengue viruses 1 to 4 (DENV1-4), a specific range of antibody titer has been shown to enhance viral replication in vitro and severe disease in animal models. Although suspected, such antibody-dependent enhancement of severe disease has not been shown to occur in humans. Using multiple statistical approaches to study a long-term pediatric cohort in Nicaragua, we show that risk of severe dengue disease is highest within a narrow range of preexisting anti-DENV antibody titers. By contrast, we observe protection from all symptomatic dengue disease at high antibody titers. Thus, immune correlates of severe dengue must be evaluated separately from correlates of protection against symptomatic disease. These results have implications for studies of dengue pathogenesis and for vaccine development, because enhancement, not just lack of protection, is of concern.

Safety assessment of immunization in pregnancy

Vaccine
Volume 35, Issue 48, Part A Pages 6469–6582 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PA
Harmonising Immunisation Safety Assessment in Pregnancy – Part II

Safety assessment of immunization in pregnancy
Open access
Pages 6469–6471
Sonali Kochhar, Jorgen Bauwens, Jan Bonhoeffer, GAIA Project Participants
In pregnancy, immunological and physiological changes may increase a woman’s risk of infections and their sequelae. The immature immune system of the fetus and neonate pose an additional risk of infection and associated complications for the developing infant, including preterm birth [1,2]. In 2016, it was estimated that neonatal death accounted for approximately 45 percent of mortality among children less than five years of age [3]. Immunization in pregnancy has emerged as an important and successful public health intervention globally to reduce mortality and morbidity among pregnant women, their developing fetuses and neonates, and infants [4]. It may become a key strategy to address neonatal mortality in particular. This is particularly true in low and middle-income countries (LMIC) where the burden of vaccine-preventable diseases is the greatest and access to basic health services is limited.

An important aim of vaccinating pregnant women is to increase pathogen-specific antibodies in the mother to protect against some of the leading causes of morbidity in pregnant women [5]. Also, high and protective levels of immunoglobulin G may be transferred across the placenta from the vaccinated mother to the fetus [6]. This may reduce risk of transmitting infections to the infant and may also directly provide passive immunity early in life, which is a period of vulnerability for the infant [6]. The success of maternal tetanus vaccination demonstrates this principle and is part of routine care in many countries: 41 out of 59 countries achieved Maternal and Neonatal Tetanus (MNT) elimination as a result of the MNT Elimination programme in conjunction with the World Health Organization (WHO) and UNICEF [7]. Influenza and pertussis vaccines are being increasingly recommended as an integral part of immunization in pregnancy programs. These programs have demonstrated the feasibility and effectiveness of immunization in pregnancy programs in high, middle and low-income countries. New vaccines are being developed to prevent infections in pregnant women and infants, including against Group B streptococcus, respiratory syncytial virus, and cytomegalovirus [4].

Immunization in pregnancy is currently an underutilized strategy and public awareness and acceptance could be improved. Despite evidence for their safety and effectiveness in both mothers and their infants, vaccine uptake in pregnancy remains low for influenza and moderate for pertussis vaccine. The uptake of the influenza vaccine in pregnancy rarely exceeds 50 percent in developed countries, even in countries with national vaccination strategies in place. For example, 50 percent of women in the US were vaccinated against influenza just before or during pregnancy in the 2015–16 influenza season [8]. Influenza and pertussis vaccine uptake in pregnancy in England was around 42 percent and 60 percent, respectively in 2015–2016. The UK has among the highest coverage rates globally, indicating the scale of potential improvement [9]. The coverage of seasonal influenza vaccination in the 2014–15 influenza season in pregnant women in five EU Member States was between 0.3% and 56.1% (median 23.6%). No country achieved the EU target of 75 percent coverage among the risk groups) [10]. In LMIC, influenza vaccine coverage amongst pregnant women is negligible in 35 of the 64 tropical countries that recommend seasonal influenza vaccination for pregnant women [11].

Barriers to vaccination in pregnancy are complex and vary depending on the country and population. The safety of vaccines administered during pregnancy is a key consideration for pregnant women, healthcare providers, vaccine manufacturers, investigators, regulators, ethics committees and communities [4]. There is a need for a globally harmonised approach to actively monitor the safety of vaccines used in immunization programs for pregnant women [12].

Historically, there was little standardization of case definitions for adverse events following immunization (AEFI) [13]. This resulted in limited comparisons of safety data across vaccine trials and studies in pre- and post-licensure settings. The Brighton Collaboration (BC) was formed in 2000 to help to overcome this shortcoming [14]. Today, BC case definitions are used and recommended for use by normative bodies such as the World Health Organization (WHO), the US FDA, the European Medicines Agency, the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC) [15].

The GAIA (Global Alignment of Immunization Safety Assessment in Pregnancy) project (http://gaia-consortium.net), coordinated by the Brighton Collaboration Foundation (BCF) and funded by the Bill and Melinda Gates Foundation, was initiated in 2015 for an initial period of two years (2015–2016). This was a response to the World Health Organization’s call for a globally harmonised approach to actively monitor the safety of vaccines and immunization in pregnancy programs with a specific focus on LMIC needs and requirements [12]. In the GAIA project, experts from 13 organisations (BCF, US National Institute of Health, WHO, Global Healthcare Consulting, University of Washington, Baylor College of Medicine, Monash Institute of Medical Research, St. George’s University of London, Erasmus University Medical Center, Cincinnati Children’s Hospital, Public Health Agency Canada, Synapse Research Management Partners and International Alliance for Biological Standardization) collaborated with over 200 volunteers worldwide who participated in 25 specific working groups [16].

During the GAIA project, a global functional network of experts was created, bringing together experts in vaccinology, maternal health, and neonatology from academia, public health institutes, regulatory agencies, investigators and vaccine manufacturers from LMIC and high-income countries. GAIA outputs include a landscape analysis of available standards and guidance documents, comprising regulatory guidance pertinent to immunization in pregnancy from the Food and Drug Administration (FDA), the European Medicines Agency (EMA) and the International Conference on Harmonisation [4].

Further, GAIA has developed two guideline documents for a harmonised conduct of clinical trials of vaccines in pregnant women [17,18]. This includes recommendations for harmonised collection, analysis and presentation of safety data, provides guidance on the prioritisation and classification of data to be collected, as well as guidance on study design, applicable in various settings, including LMICs. The WHO Global Advisory Committee on Vaccine Safety (GACVS) provided a highly supportive assessment of the GAIA guidelines for clinical trials and considered them to be timely and useful [19]. These guidelines may also inform safety monitoring of vaccines already recommended for pregnant women (tetanus, influenza and pertussis).

The GAIA partners developed the first set of over 21 standardized case definitions of prioritized obstetric and neonatal outcomes based on the standard Brighton Collaboration process [20]. The first 10 definitions were published in a special issue of the journal Vaccine in December 2016. They comprise five obstetric (hypertensive disorders of pregnancy, maternal death, non-reassuring foetal status, pathways to preterm birth and postpartum haemorrhage) and five neonatal outcomes (congenital anomalies, neonatal death, neonatal infections, preterm birth and stillbirth) [21]. These were complemnted with definitions and assessment algorithms of enabling terms (e.g., gestational age).

Moreover, a searchable database of terms (glossary), concept definitions and ontology of over 3000 terms related to key events for monitoring immunization in pregnancy was developed (https://evs.nci.nih.gov/ftp1/GAIA/About.html). A map of disease codes across coding terminologies, including MedDRA and ICD, was created to enable pooling of data from various sources. An online tool for automated case classification (single case or batch classification) of events according to the standardized case definitions has also been developed [12].

An investigator workshop assessing the usefulness and applicability of GAIA guidelines and case definitions in clinical trials and observational studies in LMIC, and an internatonal consensus conference were held at the National Institute of Health (NIH) [22].

In this special issue, the next set of 11 case definitions including five obstetric outcomes (abortion, antenatal bleeding, gestational diabetes, dysfunctional labour, foetal growth retardation) and six neonatal outcomes (low birth weight, small for gestational age, neonatal encephalopathy, respiratory distress, failure to thrive and microcephaly) are published. In the light of the important public health benefit of immunization in pregnancy in particularly LMIC and the significant challenges of conducting research in low resource settings especially with pregnant women, the paper by Kochhar et al. highlights pertinent aspects of study design, regulatory and safety monitoring considerations in these settings.

The GAIA outputs are already being increasingly utilized in the field of immunization in pregnancy and maternal and child health by key stakeholders such as clinical trialists, investigators, regulators, and industry. Useful next steps would be monitoring the implementation of GAIA outputs and a structured assessment of their current field use in addition to systematic evaluation of GAIA output performance and the impact on data quality. This could guide refinement of tools, and updates of guidelines and case definitions in cyclical revision periods. A second way to stimulate scientific progress could be by developing additional guidelines and tools requested by investigators and key stakeholders, and establishing a central resource that may provide investigators and stakeholders with the standards and tools they need.

The GAIA guidelines, definitions and tools will be applicable in immunization in pregnancy pre-and post-licensure safety and pharmacovigilance surveillance systems and may help supporting enhanced surveillance and collection of safety data that can be consolidated and compared across sites, countries, and programs worldwide. A standardized approach to safety data collection and reporting is likely to improve the acceptability and implementation of immunizations in pregnancy and subsequently help reduce illness and death among pregnant women and infants globally.

Immunization in pregnancy clinical research in low- and middle-income countries – Study design, regulatory and safety considerations

Vaccine
Volume 35, Issue 48, Part A Pages 6469–6582 (4 December 2017)
http://www.sciencedirect.com/journal/vaccine/vol/35/issue/48/part/PA
Harmonising Immunisation Safety Assessment in Pregnancy – Part II

Research considerations
Immunization in pregnancy clinical research in low- and middle-income countries – Study design, regulatory and safety considerations
Open access
Pages 6575–6581
Sonali Kochhar, Jan Bonhoeffer, Christine E. Jones, Flor M. Muñoz, … Steven Hirschfeld
Abstract
Immunization of pregnant women is a promising public health strategy to reduce morbidity and mortality among both the mothers and their infants. Establishing safety and efficacy of vaccines generally uses a hybrid design between a conventional interventional study and an observational study that requires enrolling thousands of study participants to detect an unknown number of uncommon events. Historically, enrollment of pregnant women in clinical research studies encountered many barriers based on risk aversion, lack of knowledge, and regulatory ambiguity. Conducting research enrolling pregnant women in low- and middle-income countries can have additional factors to address such as limited availability of baseline epidemiologic data on disease burden and maternal and neonatal outcomes during and after pregnancy; challenges in recruiting and retaining pregnant women in research studies, variability in applying and interpreting assessment methods, and variability in locally acceptable and available infrastructure. Some measures to address these challenges include adjustment of study design, tailoring recruitment, consent process, retention strategies, operational and logistical processes, and the use of definitions and data collection methods that will align with efforts globally
 

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

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

EID Journal
Volume 23, Supplement—December 2017
Research
Centers for Disease Control and Prevention Public Health Response to Humanitarian Emergencies, 2007–2016
Andrew T. Boyd  , Susan T. Cookson, Mark Anderson, Oleg O. Bilukha, Muireann Brennan, Thomas Handzel, Colleen Hardy, Farah Husain, Barbara Lopes Cardozo, Carlos Navarro Colorado, Cyrus Shahpar, Leisel Talley, Michael Toole, and Michael Gerber
Author affiliations: Centers for Disease Control and Prevention Epidemic Intelligence Service, Atlanta, Georgia, USA (A.T. Boyd); Centers for Disease Control and Prevention, Atlanta (S.T. Cookson, M. Anderson, O.O. Bilukha, M. Brennan, T. Handzel, C. Hardy, F. Husain, B.L. Cardozo, C.N. Colorado, C. Shahpar, L. Talley, M. Gerber); Burnet Institute, Melbourne, Victoria, Australia (M. Toole)
Abstract
Humanitarian emergencies, including complex emergencies associated with fragile states or areas of conflict, affect millions of persons worldwide. Such emergencies threaten global health security and have complicated but predictable effects on public health. The Centers for Disease Control and Prevention (CDC) Emergency Response and Recovery Branch (ERRB) contributes to public health emergency responses by providing epidemiologic support for humanitarian health interventions. To capture the extent of this emergency response work for the past decade, we conducted a retrospective review of ERRB’s responses during 2007–2016. Responses were conducted across the world and in collaboration with national and international partners. Lessons from this work include the need to develop epidemiologic tools for use in resource-limited contexts, build local capacity for response and health systems recovery, and adapt responses to changing public health threats in fragile states. Through ERRB’s multisector expertise and ability to respond quickly, CDC guides humanitarian response to protect emergency-affected populations.

Media/Policy Watch

Media/Policy Watch

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

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

New York Times
http://www.nytimes.com/
Accessed 18 November 2017
U.N. Pleads for End of Yemen Blockade or ‘Untold Thousands’ Will Die
The heads of three U.N. agencies urged the Saudi-led military coalition on Thursday to lift its blockade of Yemen, warning that “untold thousands” would die if it stayed in place.
November 17, 2017 – By REUTERS –
 
Washington Post
http://www.washingtonpost.com/
Accessed 18 November 2017
Vaccine Shortage Complicates Efforts To Quell Hepatitis A Outbreaks
Stephanie O’Neill | Kaiser Health News · National · Nov 14, 2017

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

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

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

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_11 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 – National Foundation for Infectious Diseases Announces Prestigious 2018 Award Recipients

National Foundation for Infectious Diseases Announces Prestigious 2018 Award Recipients

BETHESDA, Md., Nov. 9, 2017 /PRNewswire-USNewswire/ — The National Foundation for Infectious Diseases (NFID) has selected Roger I. Glass, M.D., Ph.D., as recipient of the 2018 Jimmy and Rosalynn Carter Humanitarian Award, Kathryn M. Edwards, M.D., as recipient of the 2018 Maxwell Finland Award for Scientific Achievement and Anne Schuchat, M.D. (Rear Adm., U.S. Public Health Service), as recipient of the 2018 John P. Utz Leadership Award.

In recognition of his extraordinary contributions to public health over several decades and his outstanding leadership in research and vaccine policy which have helped to improve the health of children worldwide in the prevention of rotavirus, through the use of vaccines, NFID has selected Roger I. Glass, M.D., Ph.D., to receive the 2018 Jimmy and Rosalynn Carter Humanitarian Award.

“For three decades, Dr. Glass has been a global champion for research on rotavirus, the development of safe, effective and affordable rotavirus vaccines and for their inclusion in national programs for childhood immunization. Dr. Glass is not only an outstanding internationally recognized scientist but also a tireless advocate for health equity and delivery of the most effective vaccines to children throughout the world. Beyond these scientific and policy contributions, Dr. Glass has trained and mentored countless young investigators, many of whom are now in leadership positions worldwide. He has instilled in trainees a love for science, academic rigor and integrity, and a commitment to the public good,” said Mathuram Santosham, M.D., M.P.H., professor in the Department on International Health and Pediatrics at Johns Hopkins University.

In presenting the 2018 Maxwell Finland Award for Scientific Achievement, NFID recognizes Kathryn M. Edwards, M.D., as one of the world’s authorities on vaccinology, pediatric respiratory infections and pneumococcal disease. A member of the National Academy of Medicine, Dr. Edwards has made seminal discoveries in pediatric infectious diseases with work ranging from basic discovery, translational research, clinical trials and implementation. “Based on the myriad contributions to science that Dr. Edwards has made over her illustrious career, the tangible ways in which she has trained new generations of physicians and scientists, and the lasting impact her work will have, as well as her tireless dedication to the field, demonstrate how deeply deserving of this award she truly is. All who know her would echo my sentiment that she is one of the giants of pediatric infectious diseases,” said C. Buddy Creech, M.D., M.P.H., associate professor of Pediatrics in the Division of Pediatric Infectious Diseases at Vanderbilt University School of Medicine.

Anne Schuchat, M.D. (Rear Adm., U.S. Public Health Service), has been selected to receive the 2018 John P. Utz Leadership Award in recognition of her demonstrated skillful, unselfish leadership in trying times, including long-standing service to the Centers for Disease Control and Prevention and support to NFID. The award was established in honor of the late John P. Utz, M.D., one of the original founders of NFID.

The 2018 awards will be presented during the 45th anniversary of NFID, at the 2018 NFID Annual Awards Dinner on May 10, 2018 in Washington, D.C.

 

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Milestones :: Perspectives – G7 Milan Health Ministers’ Communiqué – 5-6 November, 2017

Milestones :: Perspectives

Editor’s Note:

We recognize the inherent limitations of high-level communiques from multilateral meetings such at the G7, etc. But we present excerpts from the communique issued at last week’s G7 Health Ministers meeting in Milan which represent, in our view, constructive recognition of some key issues. Full test of the communique available at title link.

  G7 Milan Health Ministers’ Communiqué  – 5-6 November, 2017

“United towards Global Health: common strategies for common challenges”

[9 pages; Editor’s excerpts/text bolding]

PREAMBLE

  1. We recognize the importance of improving emergency preparedness, as well as crisis management and response, in cases of weather-related, and other disasters, epidemics and other health emergencies. In this respect, we welcome the consultation, led by the Italian Presidency and with international experts, providing science-based considerations to support informed decisions. We are determined to coordinate efforts, foster innovation, and share knowledge, information, and monitoring and foresight tools, to support the resilience of health systems and to protect the health of our populations. We underline the need to safeguard the protection of health workers and facilities during emergencies and in conflict-affected areas as provided by international humanitarian law.

 

  1. In line with previous G7 and G20 commitments and the objectives set by the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs), we reiterate the importance of strengthening health systems through each country’s path towards Universal Health Coverage (UHC), leaving no one behind, and of preventing health systems from collapsing during humanitarian and public health emergencies and effectively mitigating health crises. We will work together to implement the Sendai Framework for Disaster Risk Reduction. We seek to reduce global inequalities; to protect and improve the health of all individuals throughout their life course through inclusive health services; to tackle non-communicable diseases (NCDs); to sustain our commitments to eradicate polio through support to the Global Polio Eradication Initiative, and to end the epidemics of HIV/AIDS, malaria and tuberculosis by 2030 through the support to the Joint UN Programme on HIV/AIDS (UNAIDS), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNITAID; to support key global initiatives such as Gavi the Vaccine Alliance; and to invest in research and innovation important to global health.

 

  1. As the world gets closer to achieving global polio eradication, we also recognize the importance of continuing our efforts to succeed and keep the world sustainably polio‐free, and, of the opportunity to leverage and transition polio assets and resources that have generated major and broader health benefits, including strengthened health systems.

 

  1. We acknowledge the central leadership and coordinating role of WHO in country capacity building in preparing for and responding to public health emergencies, building resilient health systems, and the new strategic priority of WHO leadership to address the health impacts of climate and environmental factors. We acknowledge that WHO’s financial and human resource capacities have to be strengthened, including through adequate and sustainable funding of the WHO Emergency Programme and the Contingency Fund for Emergencies (CFE). We will explore supporting the World Bank’s Pandemic Emergency Financing Facility (PEF) and the WHO programme on environmental degradation and other determinants of health.

IMPACTS OF ENVIRONMENTAL FACTORS ON HEALTH

  1. We welcome and support the provision of health services, particularly including immunization programs for migrants and refugees, including in situations of forced displacement and protracted crises, as well as the improvement of health services in transit and destination countries. This includes making immunization programs and clinical services available and accessible to everyone, while increasing the surveillance of infectious diseases and the monitoring of NCDs and their risk factors.

 

  1. We will seek to improve access to physical and mental health services and assistance to migrants, refugees and crisis affected populations as appropriate. We will promote the identification, sharing, and adoption of good practices to address psychosocial needs of refugees and migrants. Following the adoption of the New York Declaration for Refugees and Migrants in September 2016, and the Resolution WHA 70.15 in May 2017, the support for migrants and refugees should consider their specific needs, leaving no one behind, in line with the 2030 Agenda for Sustainable Development.

GENDER PERSPECTIVE IN HEALTH POLICIES AND RIGHTS FOR WOMEN, CHILDREN AND ADOLESCENTS

  1. We invite the OECD to benchmark mental health performance focusing specifically on adolescents. We condemn sexual and gender-based violence that impacts women and girls across the globe. We need to demonstrate our commitment and our leadership in addressing sexual and gender‐based violence, including harmful practices such as child, early and forced marriage, and female genital mutilation, in line with SDG 5.2 and 5.3, and human trafficking, including for the purpose of sexual exploitation.

 

  1. We will support and empower women’s, children’s and adolescents’ voices, and meaningful participation through our policy, advocacy and programmatic engagement on health and nutrition and actively involve also men and boys as agents of change.

 

  1. We will seek to invest in their education, improving their health literacy, skills, and capacities, including children and adolescents’ gender and diversity-sensitive sexuality education, programmes, and tools.

ANTIMICROBIAL RESISTANCE

  1. We will promote R&D for new antimicrobials, alternative therapies, vaccines and rapid-point-of care diagnostics, in particular for WHO-defined priority pathogens and tuberculosis. We endeavor to preserve the existing therapeutic options. We see at this as a first step towards the acceleration of political commitments and urgent coordination, we look forward to the report to the United Nations General Assembly on AMR and the High Level Meeting on Tuberculosis in 2018.

CONCLUSIONS

  1. We recognize the urgent need to build political momentum on the importance of addressing the impacts of environmental degradation and other factors on health and coordinated action for strengthening health systems, in line with aid effectiveness principles. This includes addressing health workforce shortages and poor health financing by countries to achieve their goals of increasing access to health care. We welcome WHO, World Bank, UNICEF, and relevant partners, including OECD, joint action for supporting countries to achieve SDG 3.8, and look forward to the progress reported at the UHC Forum 2017 next month in Tokyo.

 

  1. We acknowledge the particular challenges of delivering health services in fragile states and conflict‐affected areas, where health systems are often compromised and ill-equipped to respond. Moreover, medical personnel and facilities in areas of conflict are increasingly under attack. Highlighting UN Security Council Resolution 2286 (2016) and UN General Assembly Resolution A RES/69/132 and UNGA 71/129, we strongly condemn violence, attacks, and threats directed against medical personnel and facilities, which have long term consequences for the civilian population and the healthcare systems of the countries concerned, as well as for the neighbouring regions. We therefore commit to improving their safety and security by upholding International Humanitarian Law.

 

  1. We reiterate our commitment to build our International Health Regulations (IHR) core capacities and to assist 76 partner countries and regions to do the same. We also recognize the importance of developing national plans to address critical health security gaps as notably identified using the WHO’s Joint External Evaluation tool. We call on all countries to make specific commitments to support full implementation of the IHR and recognize their compliance with IHR as essential for efficient global health crisis prevention and management. We encourage other countries and development partners to join these collective efforts.

 

Yemen

Yemen

Geneva Palais Briefing Note: The impact of the closure of all air, land and sea ports of Yemen on children
This is a summary of what was said by Meritxell Relano, UNICEF Representative in Yemen – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.
[Editor’s text bolding]
GENEVA, 10 November 2017 – Yemen is facing the largest humanitarian crisis and the worst food crisis in the world. Nearly 7 million people do not know where their next meal will come from and the survival of millions of people depends on humanitarian assistance operations.  You have all seen the statements from the humanitarian community in Yemen and from the Emergency Relief Coordinator based on his last visit on the ground. Fuel, medicines and food are essential in this context. And in order to get them in, we need access.

ACCESS
The recent closure of the Yemen’s airspace, sea and land ports has worsened the already shrinking space for the lifesaving humanitarian work. It is blocking the delivery of vital humanitarian assistance to children in desperate need in Yemen. And it is making a catastrophic situation for children far worse. The port of Hodeida is where most of the humanitarian supplies enter and it is essential that the port resumes its activity.

Also, because missions on the ground are not possible, blocking the movement of humanitarian workers and supplies, this means that millions of children will be deprived of lifesaving humanitarian assistance.

IMPACT
Let me give you some examples of the impact of the closure of the entry points to the country:
The current stocks of fuel will only last until the end of November. We need fuel to maintain health centers open and water systems functioning (both for distributing water and for treating used water). The price of existing fuel has increased by 60%.
If fuel stocks are not replenished:
:: UNICEF’s ongoing WASH response to respond to the cholera outbreak is likely to be affected. This could impact nearly 6 million people living in cholera high-risk districts.
:: The operating water supply systems and waste water treatment plants will stop functioning, causing unimaginable risks.
:: The functionality and mobility of the Rapid Response Teams, serving nearly half a million every week, will be hindered.
:: Due to shortage of fuel supply, 22 Governorates/District cold rooms/district vaccine stores are at a major risk of being shut down. Vaccines for thousands of children could be damaged.
If vaccines are blocked from reaching Yemen, at least 1 million children under the age of one will be at risk of diseases including polio and measles:

…The current stock of vaccines in the country will last 1 month
…Shortage of medical supplies will only worsen the Diphtheria outbreak recently reported in five districts of Ibb. About 87 suspected cases were reported with nine associated deaths.
With more than 60 per cent of population food insecure, the closure of the Yemen’s airspace, sea and land ports will lead to more deterioration in food security level which will worsen malnutrition rates.
Children are suffering from severe malnutrition and diseases that could be easily prevented. Children need urgent care and any disruption in bringing in therapeutic nutrition supplies will only mean that more children in Yemen will die.
UNICEF calls on all parties to the conflict in Yemen to allow and facilitate safe, sustainable, rapid and unhindered humanitarian access to all children and families in need, through land, air and sea.
 
::::::
 
WHO warns that more people will die if ports in Yemen do not reopen to humanitarian aid
Statement
9 November 2017 | GENEVA – For the fourth consecutive day, WHO’s operations in Yemen have been severely hampered due to the closure of all land, sea and air ports.

“WHO and the other humanitarian agencies need immediate and unhindered humanitarian access to Yemen”, said WHO Executive Director for Emergencies Dr Peter Salama. “The country is still facing the world’s largest cholera outbreak and 7 million people are on the brink of famine, including some two million severely malnourished children. If we can’t bring food and medical supplies into Yemen we will not be able to save people’s lives.”

WHO’s supplies are critically low. On Wednesday, WHO was prevented from delivering 250 tonnes of medical supplies via sea. The supply ship could not leave Djibouti as previously planned because of the closure of Yemen’s Al-Hudaydah’s port. The ship was carrying surgical kits, anaesthesia machines, infant incubator sets, water purification tablets and other essential supplies.

“We are particularly worried with the low stock of trauma kits”, said WHO representative in Yemen, Dr Nevio Zagaria. “We have enough for 2,000 surgeries but because of the escalating conflict we have treated hundreds of trauma patients in the last few weeks alone. If the hostilities continue and the ports remain closed, we will not be able to perform life-saving surgeries or provide basic health care.”

The closure of the ports will also affect the response to the cholera outbreak. As of 5 November, a total of 908,400 suspected cases and 2192 deaths have been reported since 27 April 2017 in 22 of 23 governorates. “We have made progress and there have been fewer deaths from cholera but we will suffer a major setback if we don’t have full access to all affected areas”, said Dr Zagaria.

Providing emergency health services and supporting partners in Yemen is a top priority for WHO. So far in 2017, WHO has provided 1500 tonnes of medicines and supplies. WHO-supported mobile medical teams have provided 21,443 consultations. WHO-supported surgical teams have conducted 9300 surgical interventions.
 

  Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

Bangladesh – Measles Immunization
 
Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

Joint press release

COX’S BAZAR, Bangladesh, 10 November 2017 – An increase in the number of suspected measles cases among the newly arrived Rohingya and their host communities in southern Bangladesh has prompted the Government and UN partners to step up immunization efforts in overcrowded camps and makeshift shelters close to the border with Myanmar.

Nearly 360 000 people in the age group of six months to 15 years among the new Rohingya arrivals in Cox’s Bazar and their host communities, irrespective of their immunization status, would be administered measles and rubella vaccine through fixed health facilities, outreach vaccination teams, and at entry points into Bangladesh.

Measles, a childhood killer disease which can be particularly dangerous among unimmunized and malnourished children, is one of the major health risks among the over 611,000 people who have crossed over to Bangladesh from Myanmar since late August and are now living in cramped and insanitary conditions in Cox’s Bazar district.

As of 4 November, one death and 412 suspected cases of measles have been reported among the vulnerable populations living in camps, settlements, and among the host communities in Cox’s Bazar. Of them, 352 cases are from Ukhia and 46 from Teknaf sub-districts, and 11 have been reported from the district hospital. Majority of cases – 398 – are among the new arrivals and 14 among the host communities. As many as 82% cases are among children under five years of age.

“Children are especially at risk from outbreaks of measles and other communicable diseases that result from the crowded living conditions, malnutrition and severe lack of water and sanitation in the camps and other sites,” said Edouard Beigbeder, UNICEF Bangladesh Representative. “To halt any wider outbreak, it’s essential that coordinated efforts begin immediately to protect as many children as possible.”

With the risk of measles being high during such health emergencies, Ministry of Health and Family Welfare (MoHFW), with support of WHO, UNICEF and other local partners, was quick to roll out a measles and rubella (MR) vaccination campaign, between 16 September and 4 October, within weeks of the start of the recent influx of Rohingyas from Myanmar. Nearly 136,000 children between six months and 15 years were administered MR vaccine. Additionally, around 72,000 children up to five years of age were given bivalent oral polio vaccine (bOPV) and a dose of Vitamin A to help prevent measles related complication. The number of new arrivals has increased since the MR campaign, which also had challenges reaching out to all children in view of movement of people within the camps and settlements.

“As part of stepped up vaccination efforts, 43 fixed health facility sites, 56 outreach vaccination teams and vaccination teams at main border entry points will administer MR vaccine to population aged six months to 15 years, along with oral polio vaccine to children under five years and TT vaccine to pregnant women. These efforts are aimed at protecting and preventing the spread of measles among the vulnerable population,” WHO Representative to Bangladesh, Dr N Paranietharan, said.

More than 70 vaccinators from government and partners have been trained to deliver routine vaccination though fixed sites and outreach teams beginning tomorrow, while vaccination at entry points at Subrang, Teknaf, is ongoing since 1 November.

The fixed sites and outreach teams will also cover under two year olds with vaccines available in Bangladesh EPI schedule, such as BCG, pentavalent vaccine, oral polio vaccine, pneumococcal vaccine and two doses of MR vaccine.

As an additional measure, resources to treat measles cases are being reinforced with the distribution of vitamin A supplements, antibiotics for pneumonia and Oral Rehydration Salt (ORS) for diarrhoea related to measles. To improve hygiene conditions among the refugee population, 3.2 million water purification tablets and a total of 18,418 hygiene kits have been distributed benefitting 92,090 people.

The current initiative is yet another massive vaccination drive being rolled out for the new arrivals from Myanmar and their host communities in Cox’s Bazar since 25 August this year.  After covering 136 000 people in the September- October MR campaign, MoHFW and partners administered 900 000 doses of oral cholera vaccine to these vulnerable populations in two phases. The first phase that started 10 October covered over 700 000 people aged one year and above – both the new arrivals and their host communities, while the second phase from 4 – 9 November provided an addition dose of OCV to 199,472 children between one and five years, for added protection and bOPV to 236,696 children under 5 years of age

Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1 November 2017 [GPEI]
:: Health Ministers at the G7 summit in Milan this week reaffirmed their commitment to polio eradication, recognising “the importance of continuing our efforts to succeed and keep the world sustainably polio-free”.
[See Milestones above for polio eradication reference]

:: Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1) case, reported in Batikot district in Nangarhar province.
Syria:  Ten new circulating vaccine derived poliovirus type 2 (cVDPV2) cases reported, eight in Mayadeen district, and two in Boukamal district, Deir Ez-Zor governorate. Four new cVDPV2 positive contacts reported, three in Mayadeen district, and one in Boukamal district, Deir Ez-Zor governorate.

::::::

Syria cVDPV2 outbreak situation report 21: 7 November 2017
Situation update 7 November 2017
:: Ten (10) new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week from Mayadeen and Boukamal districts, Deir Ez-Zor governorate. Isolates from some cases had been laboratory pending for some time. The most recent case (by date of onset) remains 25 August.
:: The total number of cVDPV2 cases is 63.
:: Inactivated polio vaccine (IPV) will be offered to children 2-23 months in areas of Damascus and Rural Damascus with large internally displaced populations in the upcoming subnational immunization days (SNIDs) targeting children under 5 with bivalent oral polio vaccine. The campaign is planned for 19 November.
:: 250,000 doses of IPV have arrived in Damascus, which will ensure a continuous supply of vaccine for routine immunization activities in coming months. Syria is finalizing planning for targeted vaccination with IPV and is finalizing a request for additional IPV vaccine for additional campaign activities in Hasakah, Aleppo, Damascus and Rural Damascus governorates.
:: The International Monitoring Board (the polio programmes highest independent review mechanism) met last week in London to assess progress towards global interruption of all poliovirus circulation. The IMB reviewed the quality of the Syrian outbreak response to date and will provide recommendations through its report on how Syria can strengthen its outbreak response activities in coming months.

::::::

Polio Eradication Hopes and Fears: What Next?
4 Nov, 201:
On the occasion of World Polio Day  
Heidi Larson, Ph.D. & Will Schulz, MSc,
[See Research/Commentary below for full text]
 
::::::
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WHO Grade 3 Emergencies  [to 11 November 2017]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 21: 7 November 2017
 [See Polio above]

Yemen
[See UNICEF and WHO statements above in Milestones]

::::::
 
WHO Grade 2 Emergencies  [to 11 November 2017]
Myanmar
::  Mortality and Morbidity Weekly Bulletin(MMWB) Cox’s Bazar, Bangladesh Volume No 4: 05
November 2017

::::::
::::::
 
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
:: 8 Nov 2017  Syria: Flash update on recent events – 8 November 2017

Yemen 
:: 6 Nov 2017  Yemen Humanitarian Bulletin Issue 28 | 29 October 2017
:: Statement by the Humanitarian Coordinator for Yemen, Jamie Mcgoldrick, on Continued Violence Affecting Civilians in Yemen [EN/AR] Sana’a, 5 November 2017
 
::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 9 November 2017
613,000 new arrivals are reported as of 7 November, according to IOM Needs and Population Monitoring.
A note on methodology: The official situation report figures are tabulated using the IOM Needs and Population Monitoring Emergency Tracking. This exercise takes place each day by estimating new arrivals at the point of transit in and around different settlements. NPM reports figures three times a week to update the international community on influx.

::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 11 November 2017]
http://www.who.int/emergencies/mers-cov/en/
DONs
Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman
10 November 2017
 
Yellow Fever  [to 11 November 2017]
http://www.who.int/csr/disease/yellowfev/en/
[See Milestone above]
 
::::::
::::::
 
WHO & Regional Offices [to 11 November 2017]
Stop using antibiotics in healthy animals
7 November 2017 – To prevent the spread of antibiotic resistance, farmers and the food industry should stop using antibiotics to promote growth and prevent disease in healthy animals. Over-use and misuse of antibiotics contributes to the threat of antibiotic resistance. Sustained action across all sectors, including agriculture, is key to preventing the spread of antibiotic resistance.

Highlights
Facilitating access to paediatric treatment of Chagas disease
November 2017 – WHO and partners are working to make an essential antiparasitic medicine for treatment of Chagas disease widely accessible to children. Treatment with this medicine in the early stages of infection can cure the Chagas disease, but currently very few people are able to access diagnosis and treatment services.

WHO’s work on air pollution
November 2017 – From smog hanging over cities to smoke inside the home, air pollution poses a major threat to health and climate. The combined effects of ambient (outdoor) and household air pollution cause about 6.5 million premature deaths every year.

Triple drug therapy to accelerate elimination of lymphatic filariasis
November 2017 – WHO is recommending an alternative three-drug treatment to accelerate the global elimination of lymphatic filariasis, a disabling and disfiguring neglected tropical disease. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate, and albendazole.
 
Evaluation of the election of the Director-General of WHO
November 2017 – The Sixty-fifth World Health Assembly decided, in resolution WHA65.15 (2012), that an evaluation, open to all Member States, will be conducted by the Executive Board within one year from the appointment of the next Director-General of WHO, to assess the efficacy of the revised process and methods for the election of the Director-General, in order to discuss any need for further enhancing fairness, transparency and equity among the Member States of the six regions of WHO.

::::::

GIN October 2017 pdf, 2.23Mb 10 November 2017

::::::

Weekly Epidemiological Record, 10 November 2017, vol. 92, 45 (pp. 681–700)
:: Progress report on the elimination of human onchocerciasis, 2016–2017
:: Country Immunization Information System Assessments (IISAs), in Kenya (2015) and Ghana (2016)

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: 10 November 2017  Botswana successfully concludes the IDSR national Training of Trainers (TOT) Workshop
:: Uganda and Kenya Hold Cross Border Meeting on Marburg Virus Disease 10 November 2017
:: Ghana celebrates World Mental Health Day
:: As Nigerian government Flags-off 2017/2018 Measles Vaccination Campaign, Kaduna state Governor’s children get vaccinated against measles disease.  09 November 2017
:: Mental health in the workplace: Commemoration of the World Mental Health Day in Swaziland
09 November 2017
:: Local Communities in Kween District Embrace Marburg Virus Disease Control Interventions
08 November 2017
:: Namibia’s ban on antibiotics in healthy animals drives meat exports  08 November 2017
:: Building capacity for reducing health inequalities: The Regional GER & SD Workshop kicks off in Tanzania  07 November 2017
:: South Sudan kick starts implementation of the 3rd Malaria Indicator Survey to assess progress in tackling the disease  07 November 2017
:: New Strategy Launched to Help Tackle Maternal, Child Deaths in Sierra Leone 06 November 2017

WHO Region of the Americas PAHO
:: Obesity, a key driver of diabetes (11/10/2017)

WHO South-East Asia Region SEARO
::  Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise  10 November 2017
[See Bangladesh in Emergencies above]

WHO European Region EURO
:: Meeting of European immunization programme managers offers innovative forum for exchange of ideas and experiences 09-11-2017
Over 170 immunization programme managers from 43 Member States of the WHO European Region came together on 24–27 October 2017 in Budva, Montenegro, for the biannual Immunization Programme Managers’ Meeting (PMM), organized by WHO/Europe. They focused on maintaining momentum towards the goals of the European Vaccine Action Plan (EVAP).
Participants received updates on the work of WHO and partners, informed WHO and each other about progress in their countries, and learned about innovative WHO projects to address ongoing challenges. The PMM covered many immunization-related topics using a variety of formats to ensure maximum information sharing and discussion…

:: New procedure to accredit regional non-State actors not in official relations with WHO to the WHO Regional Committee for Europe 08-11-2017
:: Ioannina becomes the first city in Greece to pilot integrated health and social services 08-11-2017
:: New studies of street food in Kyrgyzstan and Tajikistan show alarming levels of trans fat and salt 08-11-2017
:: Training supports Republic of Moldova and Ukraine in increasing access to lower-priced medicines 06-11-2017

WHO Western Pacific Region
:: Stop overuse and misuse of antibiotics: combat resistance  MANILA, 10 November 2017
 

CDC/ACIP [to 11 November 2017]

CDC/ACIP [to 11 November 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for November 9, 2017
Country Immunization Information System Assessments — Kenya, 2015 and Ghana, 2016
Countries wanting to strengthen their national immunization programs by creating data quality improvement plans now have a model, due to the new WHO and CDC method for immunization information system assessments (IISAs) which was recently used for assessments in Kenya and Ghana. The availability, quality, and use of immunization data are widely considered to be cornerstones of successful national immunization programs. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment method designed to identify the root causes of immunization data quality problems and assist in the development of improvement plans. In Kenya, this resulted in national and county target-setting workshops, with goals of strengthening support for 17 targeted counties. In Ghana, public health officials are piloting changes to improve the managerial and supervision skills of sub-district staff. They are also incorporating data quality content into pre-professional coursework for health students and continuing education for facility staff.

Announcements

Announcements

European Medicines Agency  [to 11 November 2017]
http://www.ema.europa.eu/ema/
10/11/2017
Committee for Medicinal Products for Veterinary Use (CVMP) meeting of 7–9 November 2017

10/11/2017
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 6-9 November 2017
Ten medicines recommended for approval, including two orphans ..
 
 
FDA [to 11 November 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
November 08, 2017 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on new steps to improve FDA review of shared Risk Evaluation and Mitigation Strategies to improve generic drug access

November 06, 2017 –
Statement from FDA Commissioner Scott Gottlieb, M.D., on implementation of agency’s streamlined development and review pathway for consumer tests that evaluate genetic health risks
 
 
Global Fund [to 11 November 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Malawi Accelerating Progress against HIV, TB and Malaria
09 November 2017
Malawi and the Global Fund strengthened their partnership by signing four grants today worth a total of US$460 million. The funds seek to expand interventions for HIV, tuberculosis and malaria, including efforts to reach more than 800,000 people in Malawi with treatment for HIV by 2020.

IFFIm
http://www.iffim.org/library/news/press-releases/
10 November 2017
IFFIm issues US$ 300 million in 3-year floating rate Vaccine Bonds
Funding to support immunisation of children in the poorest countries
London, 9 November 2017 – The International Finance Facility for Immunisation Company (IFFIm) today priced a US dollar floating rate benchmark bond issuance. The US$ 300 million, 3-year Vaccine Bonds provide investors an opportunity to fund immunisation programmes by Gavi, the Vaccine Alliance (Gavi), helping protect millions of children in the world’s poorest countries against preventable diseases.
This marks IFFIm’s first visit to the international US dollar benchmark market this year, and it re-establishes IFFIm as regular borrower in the market, following its US$ 500 million 3-year floating rate note issued in October 2016. Today’s issuance was lead managed by Citi, Crédit Agricole and Goldman Sachs International. The issue maturing on 16 November 2020 has a re-offer of 100% and carries a quarterly coupon of +13 basis points over the 3-month USD Libor rate.
IFFIm funds – approximately US$ 2.6 billion to-date — have accelerated delivery of vaccines, helping vaccinate 640 million children and saving more than nine million lives in communities across Africa and Asia. Gavi uses economies of scale to drive down the prices of vaccines for the world’s poorest countries. Gavi-supported countries pay less than US$ 40 for the full recommended course of 11 vaccines, compared with the U.S. market price of more than US$ 900.
“This transaction is yet another opportunity in IFFIm’s 11-year history for investors to put their money to work in support of Gavi’s efforts to increase access to life-saving vaccines in developing countries,” said IFFIm Board Chair René Karsenti. “IFFIm’s Vaccine Bonds are the consummate example of how investors can do good for the world, even as they do well with a solid investment.”…

 
MSF/Médecins Sans Frontières  [to 11 November 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Yemen: Saudi-Led Coalition Must Allow Access for Humanitarian Organizations
SANA’A, YEMEN/NEW YORK, NOVEMBER 8, 2017—The Saudi-led coalition has not allowed Doctors Without Borders/Médecins Sans Frontières (MSF) flights into Yemen for the past three days, directly hindering the organization’s ability to provide life-saving medical and humanitarian assistance to a population already in dire need.
MSF is calling on the Saudi-led coalition to immediately allow unhindered access so that humanitarian assistance can reach those most in need in Yemen.

Press release
DRC: Aid Urgently Needed in Rural Areas of Kasai
November 07, 2017
KINSHASA, DEMOCRATIC REPUBLIC OF CONGO—More aid is urgently needed in rural areas of Kasai province, Democratic Republic of Congo (DRC), as people come out of hiding a year after conflict flared in the region, according to the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).
Alarming levels of malnutrition among young children indicate the severity of this neglected crisis.
 
 
NIH  [to 11 November 2017]
http://www.nih.gov/news-events/news-releases
November 6, 2017
NIH awards to test ways to store, access, share, and compute on biomedical data in the cloud
— NIH Data Commons Pilot Phase to seek best practices for developing and managing a data commons.
 
 
PATH  [to 11 November 2017]
http://www.path.org/news/index.php
Announcement | November 06, 2017
PATH convenes global partners to improve access to safe oxygen delivery
Government delegations from nine countries will join industry leaders, financiers, and global health partners in Dubai from November 7-9

UNAIDS [to 11 November 2017]
http://www.unaids.org/en
Press release
UNAIDS launches 2017 World AIDS Day campaign—My Health, My Right
GENEVA, 6 November 2017—In the lead-up to World AIDS Day on 1 December, UNAIDS has launched this year’s World AIDS Day campaign. The campaign, My Health, My Right, focuses on the right to health and explores the challenges people around the world face in exercising their rights…

UNICEF  [to 11 November 2017]
https://www.unicef.org/media/
10 November 2017
Geneva Palais Briefing Note: The impact of the closure of all air, land and sea ports of Yemen on children
This is a summary of what was said by Meritxell Relano, UNICEF Representative in Yemen  – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.
[See Emergencies above for more detail]
 
Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise
COX’S BAZAR, Bangladesh, 10 November 2017 – An increase in the number of suspected measles cases among the newly arrived Rohingya and their host communities in southern Bangladesh has prompted the Government and UN partners to step up immunization efforts in overcrowded camps and makeshift shelters close to the border with Myanmar.
[See Emergencies above for more detail]

Wellcome Trust  [to 11 November 2017]
https://wellcome.ac.uk/news
News / Published: 8 November 2017
WHO changes guidance on averting maternal deaths after WOMAN trial results
The WHO has published new guidance strongly recommending that intravenous tranexamic acid (TXA) is given to women diagnosed with severe bleeding within three hours of them giving birth.
Bethan Hughes, from our Innovations team, explains how the WOMAN trial, which was co-funded by Wellcome, has prompted the new WHO guidelines.

::::::
 
November 9, 2017
New report and event examine the new era of vaccines
Vaccines play a vital role in protecting public health and preventing deadly disease.
For decades, vaccines and immunizations have played a critical role in protecting public health. A new report released today examines the integral value of vaccines in preventing the spread of illness and, in many places around the world, eliminating deadly infectious diseases. Smallpox has been eliminated and 16 diseases are now preventable in the United States as a result of childhood vaccines.
In order to develop vaccines, researchers must work together with stakeholders to overcome unique scientific, clinical and logistical challenges. America’s biopharmaceutical companies are committed to advancing a new era of both preventative and therapeutic vaccines for patients.      Our 2017 Medicines in Development: Vaccines update, released today, highlights the more than 260 vaccines in development to treat and prevent disease. These groundbreaking discoveries could alleviate the suffering of millions of people around the world…
Report: VACCINES: HARNESSING SCIENCE TO DRIVE INNOVATION FOR PATIENTS. 2017: 18 pages
PDF:  http://phrma-docs.phrma.org/files/dmfile/Vaccines_ReportLong_2017.pdf

 
Industry Watch  [to 11 November 2017]
:: One Year Later: Pfizer Update On Progress Of Humanitarian Assistance Program
6 November 2017

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

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

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

Vaccines: Accelerating Innovation and Access
Global Challenges Report – WIPO
Author(s): Hilde Stevens, Isabelle Huys, Koenraad Debackere, Michel Goldman, Philip Stevens, Richard T. Mahoney |
Publication year: 2017 : 32 pages
PDF: http://www.wipo.int/edocs/pubdocs/en/wipo_pub_gc_16.pdf
Abstract
This Global Challenges Report describes the innovation process for vaccines. It explains how the restricted availability of vaccines is due to impediments at every stage of the process. Most of these obstacles are manageable, and intellectual property (IP) rights are associated with only some of them. The analysis aims to put into perspective debates around health innovation and the availability of health technologies in developing countries, especially with respect to the role of IP. In particular, it provides an overview of how IP has been used to meet global health challenges in the vaccines field, and considers whether lessons can be drawn to inform other important health technologies.

The report proceeds as follows: Section 2, following the introduction, outlines the basic principles of vaccination, while also giving an overview of the history of vaccine research. Section 3 presents the social, economic, and health benefits of vaccines. Section 4 describes the research and development (R&D) process, identifying opportunities to accelerate progress. Section 5 examines the relevant regulatory pathway. Section 6 provides information about the challenges of vaccine manufacturing. Section 7 looks at national and international health systems for vaccine delivery. Section 8 examines how IP contributes to advances in vaccines and the availability of existing and future vaccines. Section 9 offers concluding remarks.

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Polio Eradication Hopes and Fears: What Next?
Confidence Commentary: The Vaccine Confidence Project 
4 Nov, 201:
Heidi Larson, Ph.D. & Will Schulz, MSc
On the occasion of World Polio Day  
In August 1980, just three months after the World Health Assembly declared smallpox to be officially eradicated, D.A. Henderson stood up to address a gathering at the Fogarty Center in Washington D.C. His audience, flushed with the successful defeat of smallpox, had one question at the forefront of their minds: What next? Which disease, after smallpox, shall we eliminate utterly from the earth? His answer, tempered by 15 years in the difficult struggle that had just been won: There is none.

According to D.A., who passed away last year at the age of 87, smallpox was uniquely suited to eradication, since it had no animal reservoir, its vaccine was heat-stable, and its cases were detectable at a glance. Even so, he said, they had succeeded only by virtue of extraordinary performances by field staff, and a considerable amount of luck. There was no other disease currently within reach, he told his audience.

Of course, the idea of eradication lived on, and poliomyelitis was soon chosen as the next target. And, with phenomenal effort and a little bit of luck, we may finally be close to achieving it. We cannot be certain how soon – the legacy of missed deadlines creates doubt, as does the vexing problem of outright violence against vaccinators by the likes of Boko Haram and the Pakistani Taliban – but with case counts lower than ever before, and breakthroughs in the last holdouts of the virus, there is a palpable sense of anticipation in the air. The time has come, therefore, to begin planning our answer when the question is asked again, as it surely will be: What next?

We hope that when the global health community answers this question again, we will draw on the experience we have accrued over the decades of the polio programme. Most of all, we hope that we will be honest with ourselves as to the challenges – including the practical as well as political hurdles we will encounter. It is this clear-eyed ambition, not vapid optimism, that makes eradication unique and audacious. Eradication is inspiring precisely because we go into it with full knowledge of its difficulties, and acceptance – not denial – of its inherent uncertainties.

Only by heeding the hard lessons of the past can we avoid repeating old mistakes. D.A. knew, for example, that polio eradication would encounter its greatest challenges “in those areas of Africa and south Asia which all but thwarted global smallpox eradication.” (Henderson 1999, p. 21) Perhaps if his insights had been embraced early, rather than dismissed, polio would already be gone from the planet.

And yet, later in life, D.A. came to embrace polio eradication. He gave several reasons – Bill Gates’ financial commitment to the effort, for example, and the appointment of PAHO’s famed epidemiological miracle-worker, Dr. Ciro de Quadros, to lead it. However, there is also a deeper lesson we can learn from D.A.’s change of heart: The fact that a person so critical of eradication lent his support to it, in the end, should inspire us to always put forward our most constructive critiques, if we feel critiques are needed. Even the most sceptical people can contribute to the eradication effort, not dampening others’ hope, but enriching it with our accrued wisdom and knowledge of past pitfalls.

We hope that we will remember not only the problems polio has presented, but also the solutions it spurred us to invent, notably the unprecedented advances in: disease surveillance, mapping of remote settlements, tracking technologies for managing vaccination teams, and adaptive models for delivering vaccines in difficult political environments. Although technological advances may render some of these outmoded in time, the deeper insights – that recruiting local vaccinators increases public trust, for example – can be expected to endure.

Finally, we also hope that we will not forget the sacrifices made by health workers and volunteers, especially those who gave their lives to deliver vaccines to children in the most dangerous corners of the world. The success of eradication depends on a highly choreographed coalition of national and local government, non-government organizations, international agencies, pharmaceutical companies and research institutions, and perhaps most importantly, the commitment of local vaccinators and social mobilizers working long days, weeks, months and years in difficult situations. Success depends not on a single leader, but on a chorus of local, national and global leaders – from houses of worship to the halls of power, and many others in between. When polio is defeated and laurels are bestowed in Geneva, let us not forget the real heroes. When we plan the eradication of the next disease, we must make their safety and welfare an inviolable priority.

Eradication is, by its very nature, an uncertain enterprise. If for some reason polio eradication fails, this does not necessarily mean we should abandon it as a strategy for fighting infectious disease. Yet by the same token, if polio eradication succeeds, it is no guarantee that we will find success eradicating the next disease, which is sure to have new characteristics and present new obstacles. What we can take with us, though, are the lessons we have learned from polio. We have a duty, whether or not we intend to participate in the next eradication effort, to catalogue our experiences for the benefit of posterity. If the next eradication programme comes along in ten years or a hundred, we will give it the best possible chance of success by being clear and honest about the challenges we’ve faced.

Journal Watch

Journal Watch

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

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

Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid

Annals of Internal Medicine
7 November 2017 Vol: 167, Issue 9
http://annals.org/aim/issue

Do Less Harm: Evaluating HIV Programmatic Alternatives in Response to Cutbacks in Foreign Aid
Rochelle P. Walensky, MD, MPH; Ethan D. Borre, BA; Linda-Gail Bekker, MD, PhD; Emily P. Hyle, MD, MSc; Gregg S. Gonsalves, PhD; Robin Wood, MMed, DSc (Med); Serge P. Eholié, MD, MSc; Milton C. Weinstein, PhD; Xavier Anglaret, MD, PhD; Kenneth A. Freedberg, MD, MSc; A. David Paltiel, PhD, MBA
Abstract
Background:
Resource-limited nations must consider their response to potential contractions in international support for HIV programs.
Objective:
To evaluate the clinical, epidemiologic, and budgetary consequences of alternative HIV program scale-back strategies in 2 recipient nations, the Republic of South Africa (RSA) and Côte d’Ivoire (CI).
Design:
Model-based comparison between current standard (CD4 count at presentation of 0.260 × 109 cells/L, universal antiretroviral therapy [ART] eligibility, and 5-year retention rate of 84%) and scale-back alternatives, including reduced HIV detection, no ART or delayed initiation (when CD4 count is <0.350 × 109 cells/L), reduced investment in retention, and no viral load monitoring or second-line ART.
Data Sources:
Published RSA- and CI-specific estimates of the HIV care continuum, ART efficacy, and HIV-related costs.
Target Population:
HIV-infected persons, including future incident cases.
Time Horizon:
5 and 10 years.
Perspective:
Modified societal perspective, excluding time and productivity costs.
Outcome Measures:
HIV transmissions and deaths, years of life, and budgetary outlays (2015 U.S. dollars).
Results of Base-Case Analysis:
At 10 years, scale-back strategies increase projected HIV transmissions by 0.5% to 19.4% and deaths by 0.6% to 39.1%. Strategies can produce budgetary savings of up to 30% but no more. Compared with the current standard, nearly every scale-back strategy produces proportionally more HIV deaths (and transmissions, in RSA) than savings. When the least harmful and most efficient alternatives for achieving budget cuts of 10% to 20% are applied, every year of life lost will save roughly $900 in HIV-related outlays in RSA and $600 to $900 in CI.
Results of Sensitivity Analysis:
Scale-back programs, when combined, may result in clinical and budgetary synergies and offsets.
Limitation:
The magnitude and details of budget cuts are not yet known, nor is the degree to which other international partners might step in to restore budget shortfalls.
Conclusion:
Scaling back international aid to HIV programs will have severe adverse clinical consequences; for similar economic savings, certain programmatic scale-back choices result in less harm than others.
Primary Funding Source:
National Institutes of Health and Steve and Deborah Gorlin MGH Research Scholars Award.

From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

BMJ Global Health
October 2017; volume 2, issue 4
http://gh.bmj.com/content/2/4?current-issue=y

Analysis
From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?
Brian M Till, Alexander W Peters, Salim Afshar, John Meara
November 10, 2017, 2 (4) e000570; DOI: 10.1136/bmjgh-2017-000570
Abstract
Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

Monitoring Sustainable Development Goal 3: how ready are the health information systems in low-income and middle-income countries?

BMJ Global Health
October 2017; volume 2, issue 4
http://gh.bmj.com/content/2/4?current-issue=y

Monitoring Sustainable Development Goal 3: how ready are the health information systems in low-income and middle-income countries?
Juliet Nabyonga-Orem
October 25, 2017, 2 (4) e000433; DOI: 10.1136/bmjgh-2017-000433
Abstract
Sustainable Development Goals (SDGs) present a broader scope and take a holistic multisectoral approach to development as opposed to the Millennium Development Goals (MDGs). While keeping the health MDG agenda, SDG3 embraces the growing challenge of non-communicable diseases and their risk factors. The broader scope of the SDG agenda, the need for a multisectoral approach and the emphasis on equity present monitoring challenges to health information systems of low-income and middle-income countries. The narrow scope and weaknesses in existing information systems, a multiplicity of data collection systems designed along disease programme and the lack of capacity for data analysis are among the limitations to be addressed. On the other hand, strong leadership and a comprehensive and longer-term approach to strengthening a unified health information system are beneficial. Strengthening country capacity to monitor SDGs will involve several actions: domestication of the SDG agenda through country-level planning and monitoring frameworks, prioritisation of interventions, indicators and setting country-specific targets. Equity stratifiers should be country specific in addressing policy concerns. The scope of existing information systems should be broadened in line with the SDG agenda monitoring requirements and strengthened to produce reliable data in a timely manner and capacity for data analysis and use of data built. Harnessing all available opportunities, emphasis should be on strengthening health sector as opposed to SDG3 monitoring. In this regard, information systems in related sectors and the private sector should be strengthened and data sharing institutionalised. Data are primarily needed to inform planning and decision-making beyond SGD3 reporting requirements.

Is governance, gross domestic product, inequality, population size or country surface area associated with coverage and equity of health interventions? Ecological analyses of cross-sectional surveys from 80 countries

BMJ Global Health
October 2017; volume 2, issue 4
http://gh.bmj.com/content/2/4?current-issue=y

Is governance, gross domestic product, inequality, population size or country surface area associated with coverage and equity of health interventions? Ecological analyses of cross-sectional surveys from 80 countries
To assess associations between national characteristics, including governance indicators, with a proxy for universal health coverage in reproductive, maternal, newborn and child health (RMNCH).
Fernando C Wehrmeister, Inácio Crochemore M da Silva, Aluisio J D Barros, Cesar G Victora
October 31, 2017, 2 (4) e000437; DOI: 10.1136/bmjgh-2017-000437

Role of mHealth applications for improving antenatal and postnatal care in low and middle income countries: a systematic review

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 11 November 2017)

Research article
Role of mHealth applications for improving antenatal and postnatal care in low and middle income countries: a systematic review
From 1990 to 2015, the number of maternal deaths globally has dropped by 43%. Despite this, progress in attaining MDG 5 is not remarkable in LMICs. Only 52% of pregnant women in LMICs obtain WHO recommended minimum of four antenatal consultations and the coverage of postnatal care is relatively poor. In recent years, the increased cellphone penetration has brought the potential for mHealth to improve preventive maternal healthcare services. The objective of this review is to assess the effectiveness of mHealth solutions on a range of maternal health outcomes by categorizing the interventions according to the types of mHealth applications.Authors: Anam Feroz, Shagufta Perveen and Wafa Aftab
Citation: BMC Health Services Research 2017 17:704
Published on: 7 November 2017

No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013–2015

 BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 11 November 2017)

Research article
No MERS-CoV but positive influenza viruses in returning Hajj pilgrims, China, 2013–2015
Authors: Xuezheng Ma, Fang Liu, Lijuan Liu, Liping Zhang, Mingzhu Lu, Abuduzhayier Abudukadeer, Lingbing Wang, Feng Tian, Wei Zhen, Pengfei Yang and Kongxin Hu
10 November 2017

BMC Public Health (Accessed 11 November 2017)

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 11 November 2017)

Introduction
Introduction: reporting on updates in the scientific basis for the Lives Saved Tool (LiST)
Authors: Neff Walker and Ingrid K. Friberg
Citation: BMC Public Health 2017 17(Suppl 4):774
Published on: 7 November 2017

Research
Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the Lives Saved Tool
In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, …
Authors: Nazia Darvesh, Jai K. Das, Tyler Vaivada, Michelle F. Gaffey, Kumanan Rasanathan and Zulfiqar A. Bhutta
Citation: BMC Public Health 2017 17(Suppl 4):776
Published on: 7 November 2017

Research
How is the Lives Saved Tool (LiST) used in the global health community? Results of a mixed-methods LiST user study
The Lives Saved Tool (LiST) is a computer-based model that estimates the impact of scaling up key interventions to improve maternal, newborn and child health. Initially developed to inform the Lancet Child Surviv…
Authors: Angela R. Stegmuller, Andrew Self, Kate Litvin and Timothy Roberton
Citation: BMC Public Health 2017 17(Suppl 4):773
Published on: 7 November 2017

Research article
To vaccinate or not to vaccinate? Perspectives on HPV vaccination among girls, boys, and parents in the Netherlands: a Q-methodological study
Despite the introduction of Human papillomavirus (HPV) vaccination in national immunization programs (NIPs), vaccination rates in most countries remain relatively low. An understanding of the reasons underlyin…
Authors: Nathalie J. S. Patty, Hanna Maria van Dijk, Iris Wallenburg, Roland Bal, Theo J. M. Helmerhorst, Job van Exel and Jane Murray Cramm
Citation: BMC Public Health 2017 17:872
Published on: 7 November 2017

Research
A method for estimating maternal and newborn lives saved from health-related investments funded by the UK government Department for International Development using the Lives Saved Tool
In 2010, the UK Government Department for International Development (DFID) committed through its ‘Framework for results for reproductive, maternal and newborn health (RMNH)’ to save 50,000 maternal lives and 2…
Authors: Ingrid K. Friberg, Angela Baschieri and Jo Abbotts
Citation: BMC Public Health 2017 17(Suppl 4):779
Published on: 7 November 2017

Health Affairs November 2017; Vol. 36, No. 11

Health Affairs
November 2017; Vol. 36, No. 11
http://content.healthaffairs.org/content/current

Issue Focus: Global Health Policy
Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared
Thomas J. Bollyky, Tara Templin, Matthew Cohen, and Joseph L. Dieleman

Research Article  Global Health Policy
Trends In The Alignment And Harmonization Of Reproductive, Maternal, Newborn, And Child Health Funding, 2008–13
Melisa Martinez-Alvarez, Arnab Acharya, Leonardo Arregoces, Lara Brearley,

Research Article  Global Health Policy
Nationwide Mortality Studies To Quantify Causes Of Death: Relevant Lessons From India’s Million Death Study
Mireille Gomes, Rehana Begum, Prabha Sati, Rajesh Dikshit, Prakash C. Gupta,

Research Article  Global Health Policy
Measuring The Impact Of Cash Transfers And Behavioral ‘Nudges’ On Maternity Care In Nairobi, Kenya
Jessica Cohen, Claire Rothschild, Ginger Golub, George N. Omondi, Margaret E. Kruk

Research Article  Global Health Policy
Accountable Care Reforms Improve Women’s And Children’s Health In Nepal
Duncan Maru, Sheela Maru, Isha Nirola, Jonathan Gonzalez-Smith, Andrea Thoumi,

The many meanings of evidence: a comparative analysis of the forms and roles of evidence within three health policy processes in Cambodia

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 11 November 2017]

Research
The many meanings of evidence: a comparative analysis of the forms and roles of evidence within three health policy processes in Cambodia
Helen Walls, Marco Liverani, Kannarath Chheng and Justin Parkhurst
Health Research Policy and Systems 2017 15:95
Published on: 10 November 2017
Abstract
Background
Discussions within the health community routinely emphasise the importance of evidence in informing policy formulation and implementation. Much of the support for the evidence-based policy movement draws from concern that policy decisions are often based on inadequate engagement with high-quality evidence. In many such discussions, evidence is treated as differing only in quality, and assumed to improve decisions if it can only be used more. In contrast, political science scholars have described this as an overly simplistic view of the policy-making process, noting that research ‘use’ can mean a variety of things and relies on nuanced aspects of political systems. An approach more in recognition of how policy-making systems operate in practice can be to consider how institutions and ideas influence which pieces of evidence appear to be relevant for, and are used within, different policy processes.
Methods
Drawing on in-depth interviews undertaken in 2015–2016 with key health sector stakeholders in Cambodia, we investigate the evidence perceived to be relevant to policy decisions for three contrasting health policy examples, namely tobacco control, HIV/AIDS and performance-based salary incentives. These cases allow us to examine the ways that policy-relevant evidence may differ given the framing of the issue and the broader institutional context in which evidence is considered.
Results
The three health issues show few similarities in how pieces of evidence were used in various aspects of policy-making, despite all being discussed within a broad policy environment in which evidence-based policy-making is rhetorically championed. Instead, we find that evidence use can be better understood by mapping how these health policy issues differ in terms of the issue characteristics, and also in terms of the stakeholders structurally established as having a dominant influence for each issue. Both of these have important implications for evidence use. Contrasting concerns of key stakeholders meant that evidence related to differing issues could be understood in terms of how it was relevant to policy. The stakeholders involved, however, could further be seen to possess differing logics about how to go about achieving their various outcomes – logics that could further help explain the differences seen in evidence utilisation.
Conclusion
A comparative approach reiterates that evidence is not a uniform concept for which more is obviously better, but rather illustrates how different constructions and pieces of evidence become relevant in relation to the features of specific health policy decisions. An institutional approach that considers the structural position of stakeholders with differing core goals or objectives, as well as their logics related to evidence utilisation, can further help to understand some of the complexities of evidence use in health policy-making.

Institutional capacity to generate and use evidence in LMICs: current state and opportunities for HPSR

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 11 November 2017]

Research
Institutional capacity to generate and use evidence in LMICs: current state and opportunities for HPSR
Evidence-informed decision-making for health is far from the norm, particularly in many low- and middle-income countries (LMICs). Health policy and systems research (HPSR) has an important role in providing the context-sensitive and -relevant evidence that is needed. However, there remain significant challenges both on the supply side, in terms of capacity for generation of policy-relevant knowledge such as HPSR, and on the demand side in terms of the demand for and use of evidence for policy decisions. This paper brings together elements from both sides to analyse institutional capacity for the generation of HPSR and the use of evidence (including HPSR) more broadly in LMICs.Zubin Cyrus Shroff, Dena Javadi, Lucy Gilson, Rockie Kang and Abdul Ghaffar
Health Research Policy and Systems 2017 15:94
Published on: 9 November 2017

Humanitarian Exchange Magazine Number 70 October 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]

JAMA November 7, 2017, Vol 318, No. 17, Pages 1625-1728

JAMA
November 7, 2017, Vol 318, No. 17, Pages 1625-1728
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Targeting Immune Checkpoints in Cancer Therapy
Suzanne L. Topalian, MD
JAMA. 2017;318(17):1647-1648. doi:10.1001/jama.2017.14155
This Viewpoint reviews the development of immune checkpoint inhibitors as a new drug class for treating cancer, and discusses future directions including development of commercial assays for identifying response-to-treatment biomarkers and the use of combination regimens to improve response.

Viewpoint
Vaccination Challenges in Confronting the Resurgent Threat From Yellow Fever
Lin H. Chen, MD; Davidson H. Hamer, MD
JAMA. 2017;318(17):1651-1652. doi:10.1001/jama.2017.14258
This Viewpoint examines strategies for vaccinating travelers against yellow fever given recent vaccine shortages and global yellow fever outbreaks.

Pertussis-associated persistent cough in previously vaccinated children

Journal of Medical Microbiology
Volume 66, Issue 11, November 2017
http://jmm.microbiologyresearch.org/content/journal/jmm/66/11

Prevention and Therapy
Pertussis-associated persistent cough in previously vaccinated children
Nicola Principi, David Litt, Leonardo Terranova, Marina Picca, Concetta Malvaso, Cettina Vitale, Norman K. Fry, Susanna Esposito, the Italian Pertussis Group for Persistent Cough in Children
First Published Online: 06 October 2017, Journal of Medical Microbiology 66: 1699-1702, doi: 10.1099/jmm.0.000607