The case for action on childhood pneumonia

The Lancet
Nov 11, 2017 Volume 390 Number 10108 p2121-2214

The case for action on childhood pneumonia
The Lancet
Pneumonia kills almost 1 million children each year, and more than 80% of these deaths are children under 2 years of age. While not solely a disease of developing countries—it is the leading cause of child hospitalisation in the USA—it disproportionately affects children living with poverty or malnourishment who are the most vulnerable to infection. A key defence is immunisation, but over 25 million children under 2 years were not immunised with the pneumococcal conjugate vaccine in 2016. Available vaccines are produced by just two manufacturers and priced out of the reach of many countries, even with assistance from Gavi, which has immunised 109 million children against pneumococcal disease as of last year.

The core of the problem is neglect. Save the Children, in a report released on Nov 2, makes the case that pneumonia is a forgotten killer, and they are right. Despite collective support for Gavi, and WHO and UNICEF’s global plan of action for pneumonia and diarrhoea, no international initiative or campaign has yet spurred attention to the extent required. Pneumonia, despite being the leading cause of death among children, has never appeared on the agendas of the G8 or G20. As a result, the Sustainable Development Goal to eliminate preventable child deaths by 2030 will remain just an aspiration unless childhood pneumonia is vigorously addressed: the report estimates there will be 735 000 children dying from the disease in 2030 if action is not accelerated.

Save the Children’s new global campaign has the backing of former UN Secretary General Kofi Annan, who calls for pharmaceutical companies, donors, and UN agencies to come together and negotiate affordable vaccination. But vaccines are not enough, as the report concedes. Tackling pneumonia is achievable only with strong, efficient, and equitable health systems. This means action to support proper diagnosis and treatment of suspected cases, and to deliver vaccines via skilled health workers, cold storage chains, and well-governed procurement and delivery infrastructure. The case for saving children’s lives from pneumonia is clear—it will be realised only by strenghtening health systems.

Nine-valent human papillomavirus vaccine: great science, but will it save lives?

The Lancet
Nov 11, 2017 Volume 390 Number 10108 p2121-2214

Nine-valent human papillomavirus vaccine: great science, but will it save lives?
Lynette Denny
In The Lancet, Warner K Huh and colleagues1 report their final analysis of a randomised, double-blind trial of 14 215 women, aged 16–26 years, testing the quadrivalent human papillomavirus (qHPV; HPV types 6, 11, 16, and 18) vaccine compared with the nine-valent HPV (9vHPV; HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine. The women were recruited from 105 study sites located in 18 countries and received vaccination on day 1 and months 2 and 6. The 9vHPV vaccine consists of virus-like particles of HPV 6, 11, 16, and 18 (as found in the qHPV vaccine) and an additional five types, HPV 31, 33, 45, 52, and 58, combined with the adjuvant amorphous aluminium hydroxyphosphate sulphate.

Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16–26 years: a randomised, double-blind trial

The Lancet
Nov 11, 2017 Volume 390 Number 10108 p2121-2214

Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16–26 years: a randomised, double-blind trial
Warner K Huh, Elmar A Joura, Anna R Giuliano, Ole-Erik Iversen, Rosires Pereira de Andrade, Kevin A Ault, Deborah Bartholomew, Ramon M Cestero, Edison N Fedrizzi, Angelica L Hirschberg, Marie-Hélène Mayrand, Angela Maria Ruiz-Sternberg, Jack T Stapleton, Dorothy J Wiley, Alex Ferenczy, Robert Kurman, Brigitte M Ronnett, Mark H Stoler, Jack Cuzick, Suzanne M Garland, Susanne K Kjaer, Oliver M Bautista, Richard Haupt, Erin Moeller, Michael Ritter, Christine C Roberts, Christine Shields, Alain Luxembourg
Primary analyses of a study in young women aged 16–26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HPV (qHPV; HPV 6, 11, 16, and 18) vaccine. We aimed to report efficacy of the 9vHPV vaccine for up to 6 years following first administration and antibody responses over 5 years.
We undertook this randomised, double-blind, efficacy, immunogenicity, and safety study of the 9vHPV vaccine study at 105 study sites in 18 countries. Women aged 16–26 years old who were healthy, with no history of abnormal cervical cytology, no previous abnormal cervical biopsy results, and no more than four lifetime sexual partners were randomly assigned (1:1) by central randomisation and block sizes of 2 and 2 to receive three intramuscular injections over 6 months of 9vHPV or qHPV (control) vaccine. All participants, study investigators, and study site personnel, laboratory staff, members of the sponsor’s study team, and members of the adjudication pathology panel were masked to vaccination groups. The primary outcomes were incidence of high-grade cervical disease (cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, invasive cervical carcinoma), vulvar disease (vulvar intraepithelial neoplasia grade 2/3, vulvar cancer), and vaginal disease (vaginal intraepithelial neoplasia grade 2/3, vaginal cancer) related to HPV 31, 33, 45, 52, and 58 and non-inferiority (excluding a decrease of 1·5 times) of anti-HPV 6, 11, 16, and 18 geometric mean titres (GMT). Tissue samples were adjudicated for histopathology diagnosis and tested for HPV DNA. Serum antibody responses were assessed by competitive Luminex immunoassay. The primary evaluation of efficacy was a superiority analysis in the per-protocol efficacy population, supportive efficacy was analysed in the modified intention-to-treat population, and the primary evaluation of immunogenicity was a non-inferiority analysis. The trial is registered with, number NCT00543543.
Between Sept 26, 2007, and Dec 18, 2009, we recruited and randomly assigned 14 215 participants to receive 9vHPV (n=7106) or qHPV (n=7109) vaccine. In the per-protocol population, the incidence of high-grade cervical, vulvar and vaginal disease related to HPV 31, 33, 45, 52, and 58 was 0·5 cases per 10 000 person-years in the 9vHPV and 19·0 cases per 10 000 person-years in the qHPV groups, representing 97·4% efficacy (95% CI 85·0–99·9). HPV 6, 11, 16, and 18 GMTs were non-inferior in the 9vHPV versus qHPV group from month 1 to 3 years after vaccination. No clinically meaningful differences in serious adverse events were noted between the study groups. 11 participants died during the study follow-up period (six in the 9vHPV vaccine group and five in the qHPV vaccine group); none of the deaths were considered vaccine-related.
The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide.
Merck & Co, Inc.

Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals

The Lancet
Nov 11, 2017 Volume 390 Number 10108 p2121-2214

Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals
Nick Golding, Roy Burstein, Joshua Longbottom, Annie J Browne, Nancy Fullman, Aaron Osgood-Zimmerman, Lucas Earl, Samir Bhatt, Ewan Cameron, Daniel C Casey, Laura Dwyer-Lindgren, Tamer H Farag, Abraham D Flaxman, Maya S Fraser, Peter W Gething, Harry S Gibson, Nicholas Graetz, L Kendall Krause, Xie Rachel Kulikoff, Stephen S Lim, Bonnie Mappin, Chloe Morozoff, Robert C Reiner Jr, Amber Sligar, David L Smith, Haidong Wang, Daniel J Weiss, Christopher J L Murray, Catherine L Moyes, Simon I Hay
During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa.
We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels—national, and subnational administrative levels 1 and 2—to provide the full range of geospatial resolution that local, national, and global decision makers might require.
Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030.
In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030.

Build the Ebola database in Africa

Volume 551 Number 7679 pp141-256  9 November 2017

World View
Build the Ebola database in Africa
To build trust, capacity and utility, put local researchers in charge of planned platform, says Brian Conton.

When a weak, feverish person comes into a clinic in Africa, there is no quick, reliable way to know whether the illness is Ebola or one of many other diseases. This is in part why the Ebola epidemic in West Africa between 2014 and 2016 caused more than 11,000 deaths, overwhelmed infrastructure and brought so much loss.

This September, the Infectious Diseases Data Observatory (IDDO), a research network based at the University of Oxford, UK, held a meeting in Guinea to discuss plans for an information platform to share data obtained during the latest outbreaks, in hopes of improving responses in the future. It is now seeking further input on a collaborative research agenda. The team has promised to bring fellows from African institutions to work on the database and is assembling a steering group to set policies on who can access what data. The group will include representatives from countries that endured the outbreak as well as from research networks based in Africa.

The platform has yet to be established, and these preparatory efforts are well-intentioned. But in my opinion, having African scientists work on an information platform in another part of the world and at the behest of and under the jurisdiction of others does not confer the same benefits as working with local researchers to build our own tools on the ground.

As someone who has built one such database, I believe it would be more useful, and more equitable, to base the project in West Africa, at the front line of the battle against the virus. This will build capacity and trust. Once created, the platform should not become ‘helicopter research’, in which phenomena that occur in developing countries are studied for the benefit of foreign academic institutions. That often means that local scientists are not given authorship in publications. And worse, research can become skewed to fit the demands of Western academic careers, rather than solving the problems that the disease causes where it occurs.

During the outbreak, we had to treat people and do research at the same time. We had no vaccine and little to offer beyond rehydration. It took painful soul-searching to engage in studies while watching compatriots die. In my experience, some of the foreign institutions who came here to fight the outbreak had fewer compunctions. Even if they did not arrive with the goal of doing helicopter research, they quickly saw the need and the opportunity to gather data and patient samples. In some cases, this involved actions that would not happen in developed countries, such as unauthorized or poorly authorized taking of samples.
There were genuine reasons for circumventing bureaucracy: stocks of samples were building up that needed to be safely stored or destroyed. The outbreak countries did not have repositories of the right biosafety level to handle these. Nonetheless, many of us who lived through the outbreak feel that data and samples from our people were used with little regard for our countries’ or patients’ sovereignty.

Now that we are between outbreaks, we have a chance to get this right. Those who contribute data and labour must be convinced that the final output will be relevant and usable. No one working in a field hospital in the bush will be consulting a database for help with a diagnosis. The goal of collecting and curating data is to understand incidence, distribution, prevention and control of the disease. We need to know if we will have a sufficiently large population to categorize symptoms and the efficacy of treatments. Finally, African countries should be able to develop and benefit from the bioeconomy. We need a frank conversation about who has what rights to pass results to commercial entities and who will reap any financial benefits. Before a data platform is established and contributors of data are solicited, there must be a collaborative strategy that governs the generation of intellectual property and who will pay for analyses.

Critics of building the Ebola platform in West Africa will counter that the IDDO team, which is also working on platforms for malaria and visceral leishmaniasis, has better technical expertise and know-how. I believe local researchers have earned the right and demonstrated the capacity to lead this. Various teams including my own have already built platforms that track information from samples and medical records.

In my view, it is in the interest of science to build on these kinds of efforts rather than to assemble something new so far away. Our plan would be to function similarly to biobanks in the developed world, including charging fees to support our work. Storing samples and curating data are expensive. The only way to make either sustainable is to carefully integrate all the data with the sample.

Whatever data platform is built, I believe that researchers in Africa can and should be building and curating it. A credible African-led initiative could convince people that the outputs of the data platform would be relevant to and usable by them. This could ease collaborations. No individual source has all the data required — organizations and research institutions from several Western nations erected Ebola Treatment Units, where samples and data were taken. An African-led initiative has a legitimacy that a third party does not, even one as prestigious as Oxford.

It would also give us researchers in Africa a better chance of establishing true collaborations that build on and acknowledge the scientific capacity we have.
doi: 10.1038/d41586-017-05676-4

Defining total-body AIDS-virus burden with implications for curative strategies

Nature Medicine
November 2017, Volume 23 No 11 pp1243-1384

Defining total-body AIDS-virus burden with implications for curative strategies – pp1271 – 1276
Jacob D Estes, Cissy Kityo, Francis Ssali, Louise Swainson, Krystelle Nganou Makamdop, Gregory Q Del Prete, Steven G Deeks, Paul A Luciw, Jeffrey G Chipman, Gregory J Beilman, Torfi Hoskuldsson, Alexander Khoruts, Jodi Anderson, Claire Deleage, Jacob Jasurda, Thomas E Schmidt, Michael Hafertepe, Samuel P Callisto, Hope Pearson, Thomas Reimann, Jared Schuster, Jordan Schoephoerster, Peter Southern, Katherine Perkey, Liang Shang, Stephen W Wietgrefe, Courtney V Fletcher, Jeffrey D Lifson, Daniel C Douek, Joseph M McCune, Ashley T Haase & Timothy W Schacker
Quantifying the total-body virus burden in HIV-infected individuals is necessary to understand viral persistence and guide development of cure strategies. Here, Estes et al. find a high burden of residual virus in tissues of SIV-infected monkeys and HIV-infected humans, and evidence of low-level viral replication, even under antiretroviral therapy.

Pediatrics November 2017, VOLUME 140 / ISSUE 5

November 2017, VOLUME 140 / ISSUE 5

Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period
Grace M. Lee, Ken Kleinman, Stephen Pelton, Marc Lipsitch, Susan S. Huang, Matt Lakoma, Maya Dutta-Linn, Melisa Rett, William P. Hanage, Jonathan A. Finkelstein
Pediatrics Nov 2017, 140 (5) e20170001; DOI: 10.1542/peds.2017-0001
Immunization status and recent antibiotic use may influence individual risk for serotype-specific pneumococcal colonization.

Changes in Influenza Vaccination Rates After Withdrawal of Live Vaccine
Steve G. Robison, Aaron G. Dunn, Deborah L. Richards, Richard F. Leman
Pediatrics Nov 2017, 140 (5) e20170516; DOI: 10.1542/peds.2017-0516
Effects of the US withdrawal of the recommendation for use of LAIVs were assessed in a matched cohort of Oregon children.

Drinking Water to Prevent Postvaccination Presyncope in Adolescents: A Randomized Trial
Alex R. Kemper, Elizabeth D. Barnett, Emmanuel B. Walter, Christoph Hornik, Natalie Pierre-Joseph, Karen R. Broder, Michael Silverstein, Theresa Harrington
Pediatrics Nov 2017, 140 (5) e20170508; DOI: 10.1542/peds.2017-0508
This trial evaluates whether giving water to drink before vaccination decreases the risk of postvaccination presyncope and describes factors associated with postvaccination presyncope.

State-of-the-Art Review Article
Global Health: Preparation for Working in Resource-Limited Settings
Nicole E. St Clair, Michael B. Pitt, Sabrina Bakeera-Kitaka, Natalie McCall, Heather Lukolyo, Linda D. Arnold, Tobey Audcent, Maneesh Batra, Kevin Chan, Gabrielle A. Jacquet, Gordon E. Schutze, Sabrina Butteris, on behalf of the Global Health Task Force of the American Board of Pediatrics
Pediatrics Nov 2017, 140 (5) e20163783; DOI: 10.1542/peds.2016-3783
Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

Enhancing Ebola Virus Disease Surveillance and Prevention in Counties Without Confirmed Cases in Rural Liberia: Experiences from Sinoe County During the Flare-up in Monrovia, April to June, 2016

PLoS Currents: Outbreaks
[Accessed 11 November 2017]

Enhancing Ebola Virus Disease Surveillance and Prevention in Counties Without Confirmed Cases in Rural Liberia: Experiences from Sinoe County During the Flare-up in Monrovia, April to June, 2016

November 9, 2017 · Research Article

Introduction: During the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases. This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended a year ago.

Methods: We conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC).

Results: The attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available. With an additional USD 1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% at the first assessment to 77% (P=0.002). Additionally, personnel/staff training improved from 78% to 89% (P=0.04). The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001).

Discussion: The low attrition of the trained staff and the availability of most supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.

PLoS Medicine (Accessed 11 November 2017)

PLoS Medicine
(Accessed 11 November 2017)

Reaching global HIV/AIDS goals: What got us here, won’t get us there
Wafaa M. El-Sadr, Katherine Harripersaud, Miriam Rabkin
| published 07 Nov 2017 PLOS Medicine

Measuring success: The challenge of social protection in helping eliminate tuberculosis
Priya B. Shete, David W. Dowdy
Perspective | published 07 Nov 2017 PLOS Medicine

Research Article
Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study
William E. Rudgard, Carlton A. Evans, Sedona Sweeney, Tom Wingfield, Knut Lönnroth, Draurio Barreira, Delia Boccia
| published 07 Nov 2017 PLOS Medicine

PLoS One

PLoS One
Research Article

Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea
Louis Samiak, Theophilus I. Emeto
Research Article | published 09 Nov 2017 PLOS ONE

Research Article
Epidemic spreading in multiplex networks influenced by opinion exchanges on vaccination
Lucila G. Alvarez-Zuzek, Cristian E. La Rocca, José R. Iglesias, Lidia A. Braunstein
Research Article | published 09 Nov 2017 PLOS ONE

Research Article
Perceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: A qualitative study
Afiong Oku, Angela Oyo-Ita, Claire Glenton, Atle Fretheim, Heather Ames, Artur Muloliwa, Jessica Kaufman, Sophie Hill, Julie Cliff, Yuri Cartier, Eme Owoaje, Xavier Bosch-Capblanch, Gabriel Rada, Simon Lewin
Research Article | published 08 Nov 2017 PLOS ONE

“My mom said it wasn’t important”: A case for catch-up human papillomavirus vaccination among young adult women in the United States

Preventive Medicine
Volume 105, Pages 1-412 (December 2017)

“My mom said it wasn’t important”: A case for catch-up human papillomavirus vaccination among young adult women in the United States
Pages 1-4
Erika L. Thompson, Alicia L. Best, Cheryl A. Vamos, Ellen M. Daley

Associations between complementary medicine utilization and influenza/pneumococcal vaccination: Results of a national cross-sectional survey of 9151 Australian women

Preventive Medicine
Volume 105, Pages 1-412 (December 2017)

Original Research Article
Associations between complementary medicine utilization and influenza/pneumococcal vaccination: Results of a national cross-sectional survey of 9151 Australian women
Pages 184-189
Jon Wardle, Jane Frawley, Jon Adams, David Sibbritt, Amie Steel, Romy Lauche
Influenza and pneumococcal vaccination is recommended for all adults, with older adults considered a high-risk group for targeted intervention. As such it is important for factors affecting vaccine uptake in this group to be examined. Complementary medicine (CM) use has been suggested as a possible factor associated with lower vaccination uptake. To determine if associations exist between influenza and pneumococcal vaccine uptake in older Australian women and the use of CM, data from women aged 62–67 years surveyed as part of the Australian Longitudinal Study on Women’s Health (ALSWH) were analyzed in 2013 regarding their health and health care utilization. Associations between the uptake of influenza and pneumococcal vaccinations and the use of CM were analyzed in 2016 using chi-squared tests and multiple logistic regression modelling. Of the 9151 women, 65.6% and 17.7% reported that they had influenza and pneumococcal vaccination within the past 3 years respectively. Regression analyses show that women who consulted naturopaths/herbalists (OR = 0.64) and other CM practitioners (OR = 0.64) were less likely to have vaccination (influenza only), as were women who used yoga (OR = 0.77–0.80) and herbal medicines (OR = 0.78–0.83) (influenza and pneumococcal). Conversely, women using vitamin supplements were more likely to receive either vaccination (OR = 1.17–1.24) than those not using vitamin supplements. The interface between CM use and influenza and pneumococcal vaccination uptake in older women appears complex, multi-factorial and often highly individualized and there is a need for further research to provide a rich examination of the decision-making and motivations of stakeholders around this important public health topic.

Association of physicians perceived barriers with human papillomavirus vaccination initiation

Preventive Medicine
Volume 105, Pages 1-412 (December 2017)

Original Research Article
Association of physicians perceived barriers with human papillomavirus vaccination initiation
Original Research Article
Pages 219-225
Albert J. Farias, Lara S. Savas, Maria E. Fernandez, Sharon P. Coan, Ross Shegog, C. Mary Healy, Erica Lipizzi, Sally W. Vernon
Physician recommendation is a strong predictor of vaccine uptake, however their perceived barriers may prevent vaccination. Therefore, we determined the association between physicians’ perceived barriers to HPV vaccination and vaccination initiation.
We surveyed pediatricians in a large network of clinics in Houston, Texas to assess their perceived barriers to vaccinating adolescents. We combined survey data with electronic medical records to determine HPV vaccination initiation over a 12-month study period (July 2014–June 2015). Patients were 11–18 year olds who had not begun the vaccination series, had a physician visit during the study period, and whose physician completed the survey. We conducted a multilevel model clustered by physician controlling for patient and physician demographics to calculate the association between physician-reported barriers and HPV vaccination initiation.
Among 36,827 patients seen by 134 pediatricians, 18.6% initiated HPV vaccination. The relative risk of initiating HPV vaccination were lower for patients whose physician reported concerns about HPV vaccine safety (RR: 0.75, 95% CI: 0.58–0.97), efficacy (RR: 0.73, 95% CI: 0.54–0.99), and the financial burden of the vaccine on patients (RR: 0.72, 95% CI: 0.58–0.88). After controlling for patient and physician characteristics, physician concern about the financial burden on patients was significantly associated with lower relative risk of initiating HPV vaccination (RR: 0.76, 95% CI: 0.64–0.90).
In this large study we observed that physician-reported barriers are associated with HPV vaccination initiation. Interventions should be implemented to educate physicians on vaccine safety, efficacy, and that there is no patient cost for CDC-recommended vaccines.

The Role of Risk Perception in Flu Vaccine Behavior among African-American and White Adults in the United States (pages 2150–2163)

Risk Analysis          
November 2017  Volume 37, Issue 11  Pages 2023–2259

Original Research Articles
The Role of Risk Perception in Flu Vaccine Behavior among African-American and White Adults in the United States (pages 2150–2163)
Vicki S. Freimuth, Amelia Jamison, Gregory Hancock, Donald Musa, Karen Hilyard and Sandra Crouse Quinn
Version of Record online: 17 MAR 2017 | DOI: 10.1111/risa.12790

Genomic history of the seventh pandemic of cholera in Africa

10 November 2017   Vol 358, Issue 6364

Genomic history of the seventh pandemic of cholera in Africa
By François-Xavier Weill, Daryl Domman, Elisabeth Njamkepo, Cheryl Tarr, Jean Rauzier, Nizar Fawal, Karen H. Keddy, Henrik Salje, Sandra Moore, Asish K. Mukhopadhyay, Raymond Bercion, Francisco J. Luquero, Antoinette Ngandjio, Mireille Dosso, Elena Monakhova, Benoit Garin, Christiane Bouchier, Carlo Pazzani, Ankur Mutreja, Roland Grunow, Fati Sidikou, Laurence Bonte, Sébastien Breurec, Maria Damian, Berthe-Marie Njanpop-Lafourcade, Guillaume Sapriel, Anne-Laure Page, Monzer Hamze, Myriam Henkens, Goutam Chowdhury, Martin Mengel, Jean-Louis Koeck, Jean-Michel Fournier, Gordon Dougan, Patrick A. D. Grimont, Julian Parkhill, Kathryn E. Holt, Renaud Piarroux, Thandavarayan Ramamurthy, Marie-Laure Quilici, Nicholas R. Thomson
Science10 Nov 2017 : 785-789 Full Access
Multiple waves of local outbreaks and pandemic cholera indicate independence from climate change and marine reservoirs.
Editor’s Summary
The cholera pathogen, Vibrio cholerae, is considered to be ubiquitous in water systems, making the design of eradication measures apparently fruitless. Nevertheless, local and global Vibrio populations remain distinct. Now, Weill et al. and Domman et al. show that a surprising diversity between continents has been established. Latin America and Africa bear different variants of cholera toxin with different transmission dynamics and ecological niches. The data are not consistent with the establishment of long-term reservoirs of pandemic cholera or with a relationship to climate events
The seventh cholera pandemic has heavily affected Africa, although the origin and continental spread of the disease remain undefined. We used genomic data from 1070 Vibrio cholerae O1 isolates, across 45 African countries and over a 49-year period, to show that past epidemics were attributable to a single expanded lineage. This lineage was introduced at least 11 times since 1970, into two main regions, West Africa and East/Southern Africa, causing epidemics that lasted up to 28 years. The last five introductions into Africa, all from Asia, involved multidrug-resistant sublineages that replaced antibiotic-susceptible sublineages after 2000. This phylogenetic framework describes the periodicity of lineage introduction and the stable routes of cholera spread, which should inform the rational design of control measures for cholera in Africa.

Integrated view of Vibrio cholerae in the Americas

10 November 2017   Vol 358, Issue 6364

Integrated view of Vibrio cholerae in the Americas
By Daryl Domman, Marie-Laure Quilici, Matthew J. Dorman, Elisabeth Njamkepo, Ankur Mutreja, Alison E. Mather, Gabriella Delgado, Rosario Morales-Espinosa, Patrick A. D. Grimont, Marcial Leonardo Lizárraga-Partida, Christiane Bouchier, David M. Aanensen, Pablo Kuri-Morales, Cheryl L. Tarr, Gordon Dougan, Julian Parkhill, Josefina Campos, Alejandro Cravioto, François-Xavier Weill, Nicholas R. Thomson
Science10 Nov 2017 : 789-793 Full Access
Multiple waves of local outbreaks and pandemic cholera indicate independence from climate change and marine reservoirs
Latin America has experienced two of the largest cholera epidemics in modern history; one in 1991 and the other in 2010. However, confusion still surrounds the relationships between globally circulating pandemic Vibrio cholerae clones and local bacterial populations. We used whole-genome sequencing to characterize cholera across the Americas over a 40-year time span. We found that both epidemics were the result of intercontinental introductions of seventh pandemic El Tor V. cholerae and that at least seven lineages local to the Americas are associated with disease that differs epidemiologically from epidemic cholera. Our results consolidate historical accounts of pandemic cholera with data to show the importance of local lineages, presenting an integrated view of cholera that is important to the design of future disease control strategies.

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
Accessed 11 November 2017
No Excuses, People: Get the New Shingles Vaccine
Shingrix, which begins shipping this month, is far more effective than the previous shingles shot. Experts recommend it for everyone over age 50.
November 10, 2017 – By PAULA SPAN

Think Tanks et al

Think Tanks et al

Center for Global Development
Accessed 11 November 2017
Six Reasons Why the Global Fund Should Adopt Health Technology Assessment
With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.

Vaccines and Global Health: The Week in Review 4 November 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

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 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_4 Nov 2017

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

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

2017 Assessment Report of the Global Vaccine Action Plan

Milestones :: Perspectives

2017 Assessment Report of the Global Vaccine Action Plan
Strategic Advisory Group of Experts on Immunization
WHO, October 2017 :: 36 pages

EXECUTIVE SUMMARY [text bolding from original]
In 2016, some progress was made towards the goals set out in the Global Vaccine Action Plan (GVAP). The year saw the fewest number of cases of wild poliovirus ever reported, and three more countries were certified as having achieved maternal and neonatal tetanus elimination. Nine additional countries have introduced new vaccines. Overall DTP3 vaccination coverage increased, but by only 1% to 86%. Progress therefore still remains too slow for most goals to be reached by the end of the Decade of Vaccines in 2020.

Furthermore, multiple global, regional and national issues threaten further progress, and have the potential to reverse hard-won gains. Economic uncertainty, conflicts and natural disasters, displacement and migration, and infectious disease outbreaks all pose major challenges to immunization programmes. At the same time, there are concerning signs of complacency and inadequate political commitment to immunization – as well as a global lack of appreciation of its power to achieve wider health and development objectives.

Additional risks include growing levels of vaccine hesitancy and the worrying rise in stockouts disrupting access to vaccines – related primarily to shortcomings in vaccine procurement and distribution but also to some extent to vaccine production. The continued marked underperformance of certain countries relative to others within their region – ‘outlier’ countries – remains of grave concern.

The potential impact of the phase-out of funding for polio eradication is also of concern. It is vital that the polio transition remains sufficiently flexible that it does not jeopardize ongoing outbreak control efforts or critical surveillance activities and post-eradication certification processes. Furthermore, there is a significant risk that wider surveillance activities and routine immunization programmes, and hence global health security, could be compromised during the polio transition. The potentially simultaneous phasing out of polio and Gavi funding and technical support is of further concern.

These risks threaten to slow the extension of vaccines to neglected populations and heighten global inequalities in vaccine access. As the Decade of Vaccines draws to a close, there is a need to intensify global efforts to promote immunization and to address the systemic weaknesses that are limiting equitable access to life-saving and life-changing vaccines, particularly in outlier countries and middle-income countries.

The recommendations made in the Strategic Advisory Group of Experts on Immunization (SAGE) 2016 Assessment Report informed the development of World Health Assembly Resolution WHA70.14, approved in May 2017, and remain a high priority. In light of the risks highlighted, SAGE also calls for a broadening of the dialogue, to align immunization with emerging global health and development agendas, including the sustainable development goals, global health security and International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance. A concerted effort is also required to address outlier countries, through a multidimensional, system-wide approach, recognizing that complex issues require multifaceted solutions and that civil society organizations have important contributions to make.

Through these and other measures, progress can continue to be made towards GVAP goals and the ground laid to exploit the full potential of immunization post-2020.

See page 29 for more detailed versions of these recommendations.
[1] Broadening the dialogue: The immunization community should ensure that immunization is fully aligned and integrated with global health and development agendas, including global health security and International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance

[2] Funding transitions: Until polio eradication is achieved, financial and technical support should be maintained in at least the 16 polio priority countries to ensure the success of eradication efforts and to mitigate the risks to infectious disease surveillance, routine immunization and global health security more generally

[3] Polio and communicable disease surveillance: Countries in all regions should ensure they maintain effective poliovirus surveillance capacities through the polio endgame and beyond, and build on the polio surveillance platform to strengthen communicable disease surveillance systems, especially for measles and rubella, and other vaccine preventable diseases

[4] Outlier countries: WHO regional offices should work with countries experiencing the greatest difficulties in achieving GVAP goals to develop and implement multidimensional remediation plans, integrating existing national improvement plans

[5] Maternal and neonatal tetanus: The immunization community should make concerted efforts to achieve elimination by 2020, in particular by exploiting compact pre-filled auto-disable devices to extend the reach of immunization

[6] Displaced, mobile and neglected populations: WHO should synthesize existing knowledge on reaching displaced and mobile populations – including individuals escaping conflict zones or natural disasters, economic migrants, seasonal migrants, those moving to urban centres, and traditional nomadic communities – and other neglected populations to identify good practice and gaps in knowledge

[7] Acceptance and demand: Each country should develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning

[8] Civil Society Organizations: Countries should broaden and deepen their engagement with CSOs to enhance the performance and reach of their national immunization programmes

[9] Technical capacity-building: WHO regional offices should work with regional and global partners to support national technical capacity-building, adopting a multidimensional approach and leveraging regional and national institutional capacities and expertise as well as global tools and resources

[10] Vaccine access: WHO regional offices and UNICEF should work with countries to identify and systematically address procurement and other programmatic issues affecting vaccine access

[11] Vaccine supply: UNICEF, WHO and global partners should continue and expand efforts to map current and anticipated vaccine supply and demand for routinely used vaccines, with a particular focus on vaccines most at risk of supply shortages

[12] Middle-income countries: WHO regional offices should support middle-income countries in their regions by leveraging all opportunities to promote the exchange of information, the sharing of lessons learned and peer-to-peer support

New assessment report on progress towards global immunization goals

Media Release
New assessment report on progress towards global immunization goals
In the newly published report by the Strategic Advisory Group of Experts (SAGE) on Immunization, it was noted that some progress has been made towards the Global Vaccine Action Plan (GVAP) goals: the year saw the fewest number of cases of wild poliovirus ever reported, and three more countries were certified as having achieved maternal and neonatal tetanus elimination. Nine additional countries have introduced new vaccines.

However, SAGE noted with concerning signs of the complacency and inadequate political commitment to immunization – as well as an insufficient appreciation of the power of vaccines to achieve wider health and development objectives. Overall DTP3 vaccination coverage increased, but by only 1% to 86%. Additional risks identified include: growing levels of vaccine hesitancy; the worrying rise in vaccine stock outs disrupting access to vaccination; and the continued underperformance of certain countries relative to others within their region.

The new report provides a series of key recommendations aimed at accelerating progress and provide solutions to key challenges. When countries follow SAGE recommendations to strengthen routine immunization programmes, the results can go far beyond protecting people from vaccine-preventable diseases – they will build the foundation of resilient health systems for all….

The SAGE October 2017 meeting report will be published in the WHO Weekly Epidemiological Record on 1 December 2017 and related meeting documents — including presentations and background readings — can be found on the SAGE meeting website.
::2017 SAGE Assessment Report of the Global Vaccine Action Plan pdf, 1.45Mb
:: World Health Assembly Resolution WHA70.14: “Strengthening immunization to achieve the goals of the global vaccine action plan resolution”
:: Global Vaccine Action Plan Website
:: SAGE website


WHO Global Leadership Meeting concludes with new commitment to delivering results in countries

WHO Global Leadership Meeting concludes with new commitment to delivering results in countries
WHO statement
2 November 2017
This week more than 260 of WHO’s leaders from headquarters, regional and country offices gathered in Geneva to discuss how to transform WHO into an organization that is better able to deliver meaningful improvements in health to the world’s people.

It was first time that WHO’s new Director-General, Dr Tedros Adhanom Ghebreyesus, had the opportunity to meet face-to-face with all senior leadership in the same room.

They gathered for the ninth bi-annual Global Meeting of heads of WHO country offices, which drove an agenda to return WHO’s focus to strengthen its work at country level.

“This was an unprecedented opportunity to have leadership from all levels, including the most recent senior leaders to join the WHO team, together at one time to chart the future course of our work in countries throughout the world,” said Shambhu Acharya, WHO’s Director of Country Cooperation and Coordination with the United Nations System. “There was a real spirit of energy and appetite for change, you could feel it in in the discussions and working groups throughout the three days.”

The meeting also included contributions from key partners, including the United Nations Development Programme, the International Committee of the Red Cross, GAVI and the Global Fund to Fight AIDS, Tuberculosis and Malaria, who all expressed their renewed commitment to working with WHO to tackle global health challenges.

Director-General Dr Tedros introduced the new senior leadership team, highlighted achievements from his first 120 days in office, and outlined the next steps to gather input from WHO’s country representatives on the draft thirteenth General Programme of Work, and the draft Transformation Plan and Architecture that will guide organizational change over the next years.

Throughout the meeting leaders from headquarters, regional and country offices discussed the specific challenges and solutions to WHOs work at country level. They debated what it will take to deliver on the proposed priorities and direction of the Organization’s work for the next five years.

“I know one thing that impacted and impressed Heads of Country was that Dr Tedros was there throughout the entire meeting. He didn’t just drop in and out at the beginning and end,” said Dr Piedad Huerta, WHO Representative in Honduras. “We had a variety of positions and opinions, regardless of what they were, he was listening.”

On behalf of the leaders from headquarters, regional and country offices, Dr Maureen Birmingham, WHO Representative in Argentina and Dr Ibrahim El-Ziq, WHO Representative in Saudi Arabia, presented a summary of the key outcomes from the meeting.

“We welcome the vision and strategic priorities and believe that the draft 13th General Programme of Work is aspirational, ambitious, sharp, inspirational and exciting,” said Dr EL-ZIQ. “It captures current issues in the wider health landscape and brings real strategic shifts with impacts and countries at the centre.”

On the Transformation agenda Maureen Birmingham noted that the goal is an Organization that is “flexible, nimble, timely, responsive and proactive.”

“As Heads of Country we embrace the agreed same goal, that of country-level impact as a priority,” she said. “We need to capture what is already working. We have rich experience and knowledge from regional reform processes, good practice and efficiencies. It’s imperative that we don’t throw everything out.”

The 9th Global Meeting culminated in a global all-staff meeting…

“I am proud of everything we have accomplished together in the past four months. And I am excited about everything we can achieve together in the months and years ahead,” said Dr Tedros. “One thing that is clear to me is that you are all proud to work for WHO. So am I. We have a unique mission. I am more determined than ever to work with you all to harness the extraordinary potential of this organization to make meaningful change in our world. Please join me on that mission.”

Partnering to Fight Pneumonia, the “Forgotten Killer” of Children

Partnering to Fight Pneumonia, the “Forgotten Killer” of Children
Huffington Post – 31 October 2017
We have “eradication” targets for polio, “elimination” targets for malaria, and “generation-free” targets for HIV/AIDS, but for a disease that kills more children under five than all three combined, we have…well…very little.

Pneumonia, which has been attracting less than 2 percent of international development assistance for health, and low national health funding, kills nearly 1 million children every year.

But change is brewing, driven by new leaders, new alignments between governments, businesses, United Nations’ agencies and non-governmental organizations (NGOs), and technological innovations with the potential to dramatically improve the cost-effectiveness of care in low and middle income countries.

Thirty organizations are joining forces in a public-private partnership with an ambitious, measurable goal: to end preventable child pneumonia deaths by 2030.

The Every Breath Counts Coalition will be announced at UNICEF headquarters in New York on November 3rd, at a special event co-hosted by the Bill and Melinda Gates Foundation and “la caixa” Foundation in honor of World Pneumonia Day.

We are all deeply concerned about pneumonia’s high death toll – each year 178,000 newborns and 773,000 children under five die according to UNICEF – and the slow rate of decline. Between 2000 and 2015, child pneumonia deaths fell by 47 percent, compared to 85 percent for measles, 61 percent for AIDS, 58 percent for malaria and 57 percent for diarrhea. We need faster progress.

The situation is particularly dire in sub-Saharan Africa. Due to a combination of low vaccine coverage, breastfeeding rates and female literacy, and high malnutrition and solid cooking fuel use, this region is home to the largest populations of children at greatest risk of death from pneumonia.

Most of the child pneumonia deaths happen in just 15 countries. Countries like Chad, Nigeria, Angola, Niger, Somalia, Mali, the Democratic Republic of Congo, Afghanistan, Pakistan and Ethiopia are especially vulnerable. Focused national and international efforts to identify and close gaps in pneumonia prevention, diagnosis and treatment in these countries could prevent more than 250,000 child deaths from pneumonia each year.

Expanding pneumococcal vaccine coverage across countries is an important priority. In addition, improving access to health services and health workers and ensuring that they have the proper diagnostic and treatment tools like pulse oximetry, child-friendly antibiotics and oxygen are key. Working more directly with mothers and families to improve breastfeeding rates, child nutrition and female literacy will also boost progress across all countries. Children who are malnourished are nine times more likely to die from pneumonia.

To stop children dying from pneumonia, the governments most affected will need to lead ambitious national efforts to mobilize attention and resources toward pneumonia prevention, diagnosis and treatment, especially at primary health care level. In addition to enhanced domestic resources, countries will also need to target a greater share of their foreign health aid to fighting pneumonia, especially if they are eligible for Global Financing Facility funding from the World Bank and/or receive support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Efforts to better integrate the management of the “febrile” child will not only impro treatment outcomes, but also the rational use of drugs and combat antimicrobial resistance.

In addition to investing more to help governments with the largest populations of at-risk children fight pneumonia, the Every Breath Counts Coalition will enlist the support of existing child pneumonia initiatives, including the United4Oxygen Alliance, HO2PE, the Pneumonia Innovations Network, Stop Pneumonia/World Pneumonia Day, the ARIDA Project, the Save the Children and GSK partnership, as well as work underway by Results for Development and the Clinton Health Access Initiative. Every Breath Counts will also build bridges between the focus countries and the various innovation pipelines, including Saving Lives at Birth and Grand Challenges Canada and relevant research underway, including the multi-country enhanced community management and clean cooking trials.

Focused efforts in a sub-set of countries where children are most vulnerable are critical, as these countries will not achieve the Sustainable Development Goals relating to child survival nor fulfill their obligations to the Global Strategy for Women’s, Children’s and Adolescents’ Health without a special push to reduce child pneumonia deaths.

It’s time to bring together our collective efforts and support country government efforts to ensure that no child dies of a disease we know how to prevent, diagnose and treat.

We hope you’ll join us,

Carolyn Miles, CEO, Save the Children (US)
Lisa Bonadonna, Global Head, Access to Medicines, GSK
David Fleming, Vice President, PATH
Joe Kiani, CEO, Masimo
Stefan Peterson, Chief of Health, UNICEF
Kate Schroder, Vice President, Clinton Health Access Initiative
Kevin Watkins, CEO, Save the Children (UK)

For more information on Every Breath Counts, please visit

Cholera in Yemen — An Old Foe Rearing Its Ugly Head

[See Second phase of cholera, polio vaccination begins in Cox’s Bazar for vulnerable population [SEAR/PR/1670, Bangladesh, 4 November 2017] in WHO Grade 2 Emergencies
Myanmar below]

Cholera in Yemen — An Old Foe Rearing Its Ugly Head
Firdausi Qadri, Ph.D., M.D., Taufiqul Islam, M.B.B.S., M.P.H., and John D. Clemens, M.D.
New England Journal of Medicine
November 1, 2017  DOI: 10.1056/NEJMp1712099

Yemen, a country with a population of approximately 25 million located at the southern tip of the Arabian Peninsula, is now experiencing one of the largest cholera outbreaks in recent history. The outbreak, which began in late October 2016 and is reportedly due to Vibrio cholerae O1, serotype Ogawa, followed on the heels of civil conflict between Houthi rebels and the internationally recognized Yemeni regime. Beginning in the capital, Sana’a, it spread rapidly, and by December 2016, cases had been reported in 15 of the country’s 22 governorates and municipalities. The outbreak appeared to be in decline by March 2017, when a cold wave hit the country, but it resurged dramatically in April (see map)

Cholera Attack Rate in the Governorates of Yemen, 2017.), coincident with heavy rains that may have contaminated drinking water sources, and was amplified by war-related destruction of municipal water and sewage systems. In September, the World Health Organization (WHO) announced that there have been about 700,000 cases and more than 2000 deaths from cholera (in addition to the 10,000 other deaths caused by the conflict), and the epidemic had spread to all governorates and municipalities except one.1 Although the epidemic seems to be slowing again somewhat, 5000 suspected cholera cases were still being reported every day as of late September.

Even before the conflict, Yemen was among the poorest of the Arab countries, beset by circumstances that made it ripe for cholera, a waterborne disease with fecal–oral transmission. Afflicted by droughts and a lack of water, it was considered among the most water-stressed countries in the world. According to WHO–UNICEF statistics, in 2014 only 53% of the population used improved sanitation facilities and only 55% had access to drinking water from improved water sources.2 Since the onset of the conflict, the situation has worsened markedly. Millions of people have been displaced and now live under conditions with inadequate shelter, water, sanitation, and food. Delivery of health care has been limited by the destruction by air strikes of approximately half the health sector facilities, including hospitals and clinics. In addition, about 30,000 health care workers have not received their salaries during the past year, and many have fled the country.

A naval and air blockade of rebel-controlled areas has contributed to shortages of food, fuel, and medical supplies. Bombing has destroyed water and sanitation infrastructure in some areas, and many sanitation workers have been on strike for several months. A massive fuel shortage has led to the disruption of sewage management and wastewater treatment facilities and a lack of electricity to run water pumps. The WHO has estimated that approximately 15 million people lack access to basic health care and potable water and sanitation. At least 17 million face food insecurity, 7 million are at risk for famine, and 2 million children are malnourished.

Considering the extremely hazardous conditions and other major challenges in this war-ravaged country, the WHO, UNICEF, other international agencies, nongovernmental organizations, and Yemeni health care providers have mounted an extraordinary response and have limited the overall case fatality rate of reported cholera cases to a relatively low 0.5%.3 These organizations have also made efforts to supply chlorinated water, restore the operationalization of water-treatment plants, provide hygiene kits with soap and chlorination tablets, and provide training in water-sanitation–hygiene behaviors to help prevent cholera. Yet, as Tedros Adhanom Ghebreyesus, the WHO director-general, recently emphasized, “Yemen’s health workers are operating in impossible conditions. Thousands of people are sick, but there are not enough hospitals, not enough medicines, not enough clean water. These doctors and nurses are the backbone of the health response — without them we can do nothing in Yemen. They must be paid their wages so that they can continue to save lives.”4

Inactivated vibrio whole-cell oral cholera vaccines (OCVs), given as a two-dose regimen, are now internationally accepted as tools for the control of epidemic and endemic cholera. A global stockpile of these vaccines, managed by the International Societies of the Red Cross and Red Crescent, UNICEF, the WHO, and Doctors without Borders (Médecins sans Frontières), with the WHO as the secretariat, and funded by Gavi, the Vaccine Alliance, has been in operation since 2013. This stockpile has largely been allocated for the control of epidemics and for use in humanitarian crises, and to date it has been deployed in cholera outbreaks in Africa, Asia, Haiti, and the Middle East. In late June 2017, a request was made on behalf of Yemen for 3.4 million doses, and the decision was made to release 1 million doses — at the time the most doses ever to be deployed from the stockpile in its 4-year history. However, several weeks later, a meeting in Sana’a of local ministries as well as United Nations and other aid agencies resulted in retraction of the request for vaccine. Various aid agencies have been quoted by the media explaining that resources would be better spent on existing preventive and therapeutic approaches to the epidemic, that mass immunization would be logistically difficult in this setting, and that the impact of vaccination would be minimal because the epidemic had spread so widely.

No one has a better sense of the challenges in logistics and safety of conducting a mass immunization campaign than workers on the ground. And it is undoubtedly true that the request for vaccination came late; had vaccination been implemented earlier, it might have been helpful in containing the epidemic. It’s possible, however, that it was not too late in the epidemic for vaccination to help: experience has demonstrated that deployment of OCV, reactively, in epidemics can be effective.5 And if the current case count is reliable, we may estimate that roughly 7 million to 14 million people, in a population of 25 million, have been infected. Yet admittedly, a million doses would probably be far too few to have a major impact in controlling the entire countrywide epidemic. Plans are reportedly being discussed for a much more massive allocation of doses for a mass immunization program at a later date.

Though we have not been directly involved in the public health response to this outbreak, we can offer a few general observations. First, Yemen before the epidemic, like Haiti before its ongoing epidemic, had a profile in terms of water, sanitation, and hygiene that made it extremely vulnerable to a cholera epidemic on the heels of a humanitarian emergency. When we think of the geographic reach of cholera, we should recognize not only places that report cases of the disease but also places that are at high risk for it.

Second, although prior to this epidemic Yemen had not reported cholera since the 1980s, the magnitude of this epidemic and the evisceration of the country’s infrastructure by the war place Yemen at high risk for continued endemic cholera in the future, much as appears to have happened in Haiti, where a massive cholera epidemic occurred in 2010 after approximately 100 years without cholera.

Finally, despite important efforts by the WHO and other international organizations to create and deploy the OCV global stockpile, that stockpile is currently inadequate. Moreover, we lack validated predictive tools to identify humanitarian emergencies posing so high a risk of cholera that the doses of OCV should be deployed preemptively, as well as tools to flag incipient outbreaks that are destined to become so large that doses should be deployed early. Greater funding for the stockpile and more work on the development of both improved predictive tools and improved water and sanitation are important priorities.

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

Featured Journal Content

Bulletin of the World Health Organization
Published online: 19 October 2017)
Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia
Marc Poncin,a Gideon Zulu,b Caroline Voute,a Eva Ferreras,c Clara
Mbwili Muleya,b Kennedy Malama,b Lorenzo Pezzoli,d Jacob Mufunda,e
Hugues Robert,a Florent Uzzeni,a Francisco J Luquero,c Elizabeth
Chizemab & Iza Cigleneckia
This online first version has been peer-reviewed, accepted and edited, but not formatted and finalized with corrections from authors and proofreaders
To describe the implementation and feasibility of an innovative mass vaccination strategy – based on single-dose oral cholera vaccine – to curb a cholera epidemic in a large urban setting.
In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.
Overall, vaccination teams administered 424_100 doses of vaccine to an estimated target population of 578_043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign – 2.31 United States dollars (US$) per dose – included the relatively low cost of local delivery – US$_0.41 per dose.
We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccinees in response to a cholera epidemic, by the use of just one dose per member of an at-risk ommunity, should be considered.


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1November 2017 [GPEI]
:: This month Harvard University and National Public Radio (NPR) hosted an online forum to discuss how social data shines a global spotlight on polio’s last challenges.

:: Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1) case, reported in Shahwalikot district in Kandahar province. Three new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Kandahar and two from Hilmand provinces.
Pakistan: Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Sindh and one from Khyber Pakhtunkhwa provinces. Democratic Republic of the Congo (DRC): One new circulating vaccine derived poliovirus type 2 (cVDPV2) case reported, in Tanganika province.
Syria:  One new circulating vaccine derived poliovirus type 2 (cVDPV2) case reported, in Deir Ez-Zor governorate.

:: Additionally, an advance notification was received this week of a new WPV1 case in Afghanistan from Batikot district in Nangarhar province, onset 11 October.  The case will be officially reflected in next week’s global data reporting.


Syria cVDPV2 outbreak situation report 20: 31 October 2017
:: One (1) new case of cVDPV2 was reported this week from Mayadeen, Deir Ez-Zor governorate. The date of onset of the case was 18 August 2017. The most recent case (by date of onset) remains 25 August.
:: The total number of cVDPV2 cases is 53.
:: Third party independent monitoring results for the second outbreak response round for Raqqa governorate have been received. Reported coverage of targeted children is 69% (measured by parental recall through a house to house survey). Market surveys reported much higher coverage of 84%.
:: Sixteen (16) new refrigerator trucks have been provided by UNICEF to transport vaccine and maintain cold chain for ongoing response activities and outreach.
:: WHO is supporting the upgrade of laboratory facilities to enable more sophisticated techniques to be conducted in country for the detection of poliovirus. WHO is also supporting the establishment of environmental surveillance in country by end of 2017.


WHO Grade 3 Emergencies  [to 4 November 2017]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 20, 31 October 2017
 [See Polio above]

:: Daily epidemiology bulletin, 30 October 2017
887, 440 – Suspected cases
2,184 – Associated deaths
0.25%  – Case Fatality Rate
96%  – Governorates affected   ( 22 / 23 governorates )
92%  – Districts affected   ( 305 / 333 districts )

WHO Grade 2 Emergencies  [to 4 November 2017]
::  Second phase of cholera, polio vaccination begins in Cox’s Bazar for vulnerable population
Cox’s Bazar, Bangladesh, 4 November 2017 – The second phase of the oral cholera vaccination drive began today to provide an additional dose of the vaccine to children of newly arrived Rohingya population against the deadly diarrheal disease. The children are also being administered oral polio vaccine.

Nearly 180,000 children aged between one and five years are expected to receive the second dose of oral cholera vaccine (OCV), while around 210,000 children up to the age of five years will be vaccinated against polio in a six-day immunization campaign in Ukhia and Teknaf sub-districts of Cox’s Bazar and Naikhanchari in Bandarban district.

The campaign is being conducted by The Ministry of Health and Family Welfare (MoHFW) with support from WHO, UNICEF, International Centre for Diarrhoeal Disease Research, Bangladesh, IOM, UNHCR and local and international NGO’s.

“These large scale immunization drives against cholera and polio reflect the commitment of the health sector to take all possible measures to protect the health of these vulnerable population,” Dr. N. Paranietharan, WHO Representative to Bangladesh, said. “Children being among the most vulnerable, the vaccination campaign is an important and commendable effort of the Ministry of Health and Family Welfare and health partners”, he added.

The previous oral cholera vaccine campaign, launched on 10 October, covered 700 487 people aged one year and above, 176 482 of them children aged one to five years. 900 000 doses of oral cholera vaccine were mobilized following a risk assessment conducted by MoHFW, with the support from WHO, UNICEF, IOM and Médecins Sans Frontières (MSF), in late September. The International Coordinating Group (ICG) on vaccine provision released OCV within a day of the Bangladesh government’s request, while GAVI, the Vaccine Alliance, provided financial support.

Earlier, in a rapidly organized vaccination campaign for measles, rubella and polio, 72 334 children up to five years of age were administered oral polio vaccine between 16 September to 4 October…


Outbreaks and Emergencies Bulletin, Week 43: 21 – 27 October 2017
The WHO Health Emergencies Programme is currently monitoring 44 events in the region. This week’s edition covers key ongoing events, including:
:: Marburg virus disease in Uganda
:: Plague in Madagascar
:: Malaria in Cabo Verde
:: Dengue fever in Côte d’Ivoire
:: Cholera in Zambia
:: Cholera in north-east Nigeria.
Week 43: 21 – 27 October 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. 
:: Iraq: Humanitarian Bulletin, October 2017 | Issued on 2 November
…Military operations to retake the last major territory held by ISIL begin in western Anbar.
184,000 people are currently displaced by recent unrest in northern governorates.
…Almost 62,000 people return to Hawiga a month after it is retaken, to a lack of services and explosive hazard contamination.
…Heaters, fuel and sanitation upgrades are urgently needed in camps across Iraq as winter approaches.
…IHF launches $14 million reserve allocation for Hawiga.

Syrian Arab Republic
:: 1 Nov 2017  Turkey | Syria: Border Crossings Status 1 November 2017 [EN/AR/TR]
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock: Statement to the Security Council on the humanitarian situation in Syria, 30 October 2017 [EN/AR]


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.
:: 30 Oct 2017   Ethiopia Humanitarian Bulletin Issue 39 | 16 – 29 October 2017
…Ethiopia begins civil registration of refugees for the first time in history as the number of refugees in country nears the one million mark….

:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 2 November 2017
607,000 new arrivals are reported as of 31 October, according to IOM Needs and Population Monitoring, UNHCR and other field reports. The dataset and full report is available online.
Partners reported today that an estimated 3,000 arrivals have crossed Naf river and are currently staying in no man’s land near Anjumapara border (Palongkhali union). They are expected to continue into Bangladesh. NPM is keeping track of them and verifying the information.
…607,000 Cumulative arrivals since 25 Aug
…329,000 Arrivals in Kutupalong Expansion Site
…46,000 Arrivals in host communities

:: Horn of Africa: Humanitarian Impacts of Drought – Issue 11 (3 November 2017)
Measles cases rise in Somalia and Ethiopia, while number of AWD and/or Cholera cases declines. In Somalia, more than 18,000 cases of measles were recorded between January and September 2017; four times the number of cases reported during the same period in 2015 and 2016. Most recently, 12 suspected cases were reported at an IDP settlement in Waajid district, Bakool region. A nationwide campaign to vaccinate 4.2 million children is planned for November-December. Meanwhile, there has been a significant reduction in new AWD/cholera cases in Somalia over the past three months, with no deaths reported during this period. To date, 77,783 cholera cases and 1,159 deaths have been reported in 2017. In Ethiopia, 3,151 measles cases have been reported and four districts in the Oromia (Babile and Jima Spe town, East Hararge zone) and Somali (Afder and Warder) regions reached the measles outbreak threshold in September…
:: Humanitarian Bulletin Somalia, 01 – 30 October 2017
…Measles cases remain at epidemic levels as new AWD/cholera cases reduce…

WHO & Regional Offices [to 4 November 2017]

WHO & Regional Offices [to 4 November 2017]
Latest news
WHO meeting concludes with commitment to delivering results in countries
2 November 2017 – This week more than 260 of the WHO’s leaders from headquarters, regional and country offices gathered in Geneva to discuss how to transform WHO into an organization that is better able to deliver meaningful improvements in health to the world’s people. It was first time that WHO’s new Director-General, Dr Tedros Adhanom Ghebreyesus, has had the opportunity to meet face-to-face with all senior leadership in the same room.
[See Milestones above for full Statement]

Madagascar plague: preventing regional spread
2 November 2017 – More than 1800 suspected, probable, or confirmed plague cases were reported in Madagascar from August to late October 2017, resulting in 127 deaths. WHO has moved quickly in response to this unusually severe outbreak by supporting the Government of Madagascar, while at the same time working with nearby countries and territories to prevent regional spread.
Plague – Madagascar
2 November 2017

Close to 3 million people access hepatitis C cure
31 October 2017 – On the eve of the World Hepatitis Summit in Brazil, WHO reports increasing global momentum in the response to viral hepatitis. A record 3 million people were able to obtain treatment for hepatitis C over the past two years, and 2.8 million more people embarked on lifelong treatment for hepatitis B in 2016.

WHO report signals urgent need for greater political commitment to end tuberculosis
30 October 2017 – Global efforts to combat tuberculosis (TB) have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%, according to the Global TB Report 2017, released by WHO today.

WHO helps Kenya guard against Marburg Virus Disease
November 2017 – WHO is helping the Kenyan Ministry of Health guard against the spread of Marburg Virus Disease from neighbouring Uganda. Health authorities are strengthening preparedness measures in Trans Nzoia and West Pokot counties along the border with Uganda, where an outbreak was officially declared on 19 October.

Global Nutrition Summit 2017: Milan
November 2017 – Building upon the spirit and outcomes of the L’Aquila Food Security Initiative, the Milan Expo 2015, the 2nd International Conference on Nutrition (ICN2) and the G7 Summit in Taormina, the Nutrition for Growth Stakeholder Group will organize a day-long, high-level summit on nutrition and food for a healthier future which is co-facilitated and co-hosted by the Italian G7 Presidency, the City of Milan and Ministry of Health: the Milan Global Nutrition Summit.

Video: The eHealth journey in Latvia
October 2017 – The Ministry of Health of Latvia has created a national programme of electronic health (eHealth). As part of an ambitious, long-term national health reform agenda, the eHealth programme has been a key element of ensuring that Latvian people receive the right care in the right place and at the right time.

Using digital technology to strengthen public health services in Africa
October 2017 – With Africa currently undergoing a digital revolution, WHO and the International Telecommunications Union (ITU) signed a Cooperation Agreement, on using digital services to save lives and improve people’s health.


Weekly Epidemiological Record, 3 November 2017, vol. 92, 44 (pp. 661–680)
:: Update on vaccine-derived polioviruses worldwide, January 2016–June 2017
:: Progress with the implementation of rotavirus surveillance and vaccines in countries of the WHO African Region, 2007–2016
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Health Workers urged to Work with Communities to Stop Marburg  04 November 2017
:: WHO helps Kenya guard against Marburg Virus Disease  03 November 2017
:: Strengthening Medicines Quality Control in Tanzania  03 November 2017
:: Fostering partnerships for health: WHO and partners conduct a joint field visit  02 November 2017
:: Madagascar plague: mitigating the risk of regional spread  02 November 2017
:: Bringing the human and animal health sectors closer: The National Bridging Workshop
02 November 2017
:: Integrated campaign tackles malaria and polio in north-eastern Nigeria  01 November 2017
:: Experts begin second wave of polio outbreak response assessment in Nigeria.  31 October 2017
:: Routine immunization in Nigeria gets a bolster from the European Union  29 October 2017

WHO Region of the Americas PAHO
:: PAHO/WHO Malaria Champion awards go to Brazil, Haiti, and Dominican Republic (11/03/2017)

WHO South-East Asia Region SEARO
::  Second phase of cholera, polio vaccination begins in Cox’s Bazar  4 November 2017

WHO European Region EURO
:: The eHealth journey in Latvia 02-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO-supported field hospitals in Iraq respond to injured patients as danger for war-related trauma remains  29 October 2017

CDC/ACIP [to 4 November 2017]

CDC/ACIP [to 4 November 2017]

MMWR News Synopsis for November 2, 2017
Vaccination Coverage Among Children Aged 19–35 Months — United States, 2016
CDC encourages parents to protect their children from vaccine-preventable diseases by ensuring their children receive all recommended vaccines on schedule. Vaccination is the best way to reduce illness and death from vaccine-preventable diseases in young children. Data from the 2016 National Immunization Survey-Child (NIS-Child) were used to assess vaccination coverage with recommended vaccines among children aged 19–35 months in the United States. Based on the data, coverage with recommended vaccines for children aged 19–35 months continues to be high and stable, but remains below 90 percent for vaccines that require booster doses during the second year of life and for more recently recommended vaccines. Differences in coverage by race/ethnicity, poverty status, and insurance status indicate that improvements are needed in the immunization safety net (that is, access to and delivery of age-appropriate immunization to all children, regardless of insurance or financial status).

Progress in Childhood Vaccination Data in Immunization Information Systems — United States, 2013–2016
Incremental progress in four Immunization Information System (IIS) priority areas was noted since 2013, but continued effort is needed to implement these critical functionalities among all IISs. IISs are computerized, population-based systems that consolidate vaccination data from providers for clinical and public health use. Data from 2013–2016 were analyzed to assess progress made in four priority areas: 1) pediatric data completeness, 2) bidirectional data exchange with electronic health records, 3) pediatric clinical decision support for immunizations, and 4) ability to generate jurisdictional and provider-level vaccination coverage estimates. Progress was noted since 2013, but continued effort is needed to implement these functionalities among all IISs. Success in these priority areas bolsters public health practitioners’ ability to attain high childhood vaccination coverage and prepares IISs to develop more advanced functionalities. Success also supports the achievement of federal immunization objectives, including using IISs as supplemental sampling frames for vaccination coverage surveys.

Update on Vaccine-Derived Polioviruses — Worldwide, January 2016–June 2017
Vaccine-derived polioviruses will continue to cause rare outbreaks and infect individuals with immune deficiencies until all use of oral poliovirus vaccine can cease after wild poliovirus transmission is eradicated. Vaccine-derived polioviruses (VDPVs) are strains genetically divergent from the oral poliovirus vaccine (OPV) that fall into three categories: 1) circulating VDPVs (cVDPVs) from outbreaks, 2) immunodeficiency-associated VDPVs (iVDPVs) from patients with primary immunodeficiencies, and 3) ambiguous VDPVs (aVDPVs) that cannot be more definitively identified. During January 2016–June 2017, new cVDPV outbreaks were identified in the Democratic Republic of the Congo and Syria, and residual cVDPV2 circulation was detected in Nigeria and Pakistan. Fourteen newly identified persons in 10 countries were found to excrete iVDPVs. Because >94 percent of cVDPVs since 2006 and 69 percent of iVDPVs since OPV introduction are type 2, WHO coordinated worldwide replacement of trivalent OPV with bivalent OPV (types 1 and 3) in April 2016.

Implementation of Rotavirus Surveillance and Vaccine Introduction — World Health Organization African Region Countries, 2007–2016
Rotavirus vaccines have been rapidly implemented in the majority of countries in the WHO African region and their use has resulted in substantial declines in the burden of severe rotavirus disease. Rotavirus is a leading cause of severe childhood diarrhea globally, estimated to have caused 120,000 deaths among children ages <5 years in sub-Saharan Africa in 2013. In 2009, the World Health Organization (WHO) recommended routine rotavirus vaccination of all children worldwide. As of December 2016, 31 of 47 (66 percent) countries in the WHO African Region had introduced rotavirus vaccination into their national schedules, with an overall coverage of 77 percent for a full vaccine series. In 12 countries with available data before and after rotavirus vaccine introduction, the proportion of childhood diarrhea hospitalizations that were rotavirus-positive declined 33 percent, from 39 percent to 26 percent. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.


CEPI – Coalition for Epidemic Preparedness Innovations  [to 4 November 2017]
Latest News  [Undated]
IT platform vendor
CEPI seeks a vendor for new IT platform

Chikungunya Workshop
The Department of Biotechnology, India (DBT) and Coalition for Epidemic Preparedness Innovations (CEPI) are organising a workshop “Chikungunya vaccines- challenges, opportunities and possibilities” on 5th and 6th February 2018 in Delhi, India. This workshop will bring together international delegates for two days of intense dialogue on ideas, data, challenges and opportunities related to Chikungunya vaccine development
To ensure we have good mix of participants and allow for vivid discussions, participation in the workshop is invitation only. All speakers and participants will be invited to the workshop in the next couple of weeks…

EDCTP    [to 4 November 2017]
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
3 November 2017
GSK and EDCTP launch joint call for Senior Fellowship proposals
In response to the growing challenge of non-communicable diseases (NCDs) in Africa, GSK and EDCTP will launch a joint call…

1 November 2017
Vacancy: Project Officer for The Hague Office
We are looking for a Project Officer to be based at the EDCTP office in The Hague. The Project Officer…

European Medicines Agency  [to 4 November 2017]
EU-US mutual recognition of inspections of medicines manufacturers enters operational phase
Major milestone is a testimony to mutual trust …

How to develop vaccines and medicines that prevent and treat respiratory syncytial virus (RSV) infection
New guideline to facilitate development of vaccines and treatments out for consultation until April 2018…

European Vaccine Initiative  [to 4 November 2017]
01 November 2017
New funding to support novel DNA vaccine for therapy of leishmaniasis
Fresh funding has been awarded by the GHIT Fund to EVI and its partners from Nagasaki University, German biopharmaceutical firm Mologen AG, Charité – Universitätsmedizin Berlin and the London School of Hygiene and Tropical Medicine (LSHTM) to support the completion of the preclinical development of a novel leishmaniasis vaccine candidate and for preparing the conduct of a future Phase I clinical trial.

31 October 2017
EVI Annual Report 2016 now available
The EVI 2016 Annual Report provides an overview of all the activities EVI was involved in during 2016.
FDA [to 4 November 2017]
October 31, 2017 –
FDA takes unprecedented step toward more efficient global pharmaceutical manufacturing inspections
The U.S. Food and Drug Administration has determined the agency will recognize eight European drug regulatory authorities as capable of conducting inspections of manufacturing facilities that meet FDA requirements. The eight regulatory authorities found to be capable are those located in: Austria, Croatia, France, Italy, Malta, Spain, Sweden and the United Kingdom.
This achievement marks an important milestone to successful implementation and operationalization of the amended Pharmaceutical Annex to the 1998 U.S.-European Union (EU) Mutual Recognition Agreement (MRA) that enables U.S. and EU regulators to utilize each other’s good manufacturing practice inspections of pharmaceutical manufacturing facilities.
“At a time in which medical product manufacturing is truly a global enterprise, there is much to be gained by partnering with regulatory counterparts to reduce duplicative efforts and maximize global resources while realizing the greatest bang for our collective inspectional buck,” said FDA Commissioner Scott Gottlieb, M.D. “By partnering with these countries we can create greater efficiencies and better fulfill our public health goals, relying on the expertise of our colleagues and refocusing our resources on inspections in higher risk countries.”…
GHIT Fund   [to 4 November 2017]
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical ·
2017.10.31      Press Room
GHIT Fund Accelerates Promising Efforts to Find New Treatments, Vaccines and Diagnostics for Malaria, Tuberculosis, Leishmaniasis and Mycetoma
The Global Health Innovative Technology (GHIT) Fund, a unique Japanese public-private partnership formed to battle infectious diseases around the globe, today announced US$16.7 million to support development of new compounds for fighting malaria and tuberculosis, a leishmaniasis vaccine and drug, and a treatment for a long-ignored flesh-eating infection. The new investments also will allow scientists to pursue a critically needed diagnostic tool for detecting a relapsing form of malaria when it is hiding in the liver during its dormant phase.
Among new support for malaria drug development is US$ 1.59M to Medicines for Malaria Venture (MMV) and Takeda Pharmaceuticals to develop an antimalarial drug candidate DSM265. DSM265 targets an essential enzyme, dihydroorotate dehydrogenase (DHODH), which is a critical part of the parasite making its own DNA. This completely new mode of action for an antimalarial drug will be critical in the face of resistance to both the artemisinin and partner-drug components of the current gold standard artemisinin combination treatments (ACTs) for malaria. In early-stage human testing, DSM265 has exhibited an exciting potential to both cure and prevent malaria caused by the deadly Plasmodium falciparum malaria parasite. It has already been tested in patients, where, in a study last year, 12 out of 13 patients with P. falciparum malaria were cured with a single dose of 400-milligrams. The final medicine would be a combination of DSM265 with another active compound, and so we expect even better results with a combination medicine…

IVAC  [to 4 November 2017]
Latest IVAC News  [Undated]
IVAC Progress Report finds stubborn gap in reaching intervention targets among countries heavily burdened by childhood pneumonia and diarrhea 
Why are pneumonia and diarrhea still responsible for 1 of every 4 deaths in children under 5? Released today, IVAC’s 2017 Pneumonia and Diarrhea Progress Report: Driving Progress through Equitable Investment and Action (PDPR) explores factors slowing progress in the most impacted countries against the world’s two biggest killers of young children…
IVAC’s Progress Report, issued annually since the Johns Hopkins Center helped establish World Pneumonia Day in 2009, also delves for the first time into the economic cost of the illnesses and sheds light on the complex relationship between childhood illnesses and poverty. Children in low-resource settings are at higher risk for illness; at the same time, pneumonia and diarrhea can contribute to the cycle of poverty.
Read the full report here.

MSF/Médecins Sans Frontières  [to 4 November 2017]
Press release
MSF Secures Generic Hepatitis C Treatment at $120 Compared to $147,000 Launch Price Tag
October 31, 2017
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) announced today it can now purchase generic hepatitis C medicines for as low as $1.40 per day, or $120 per 12-week treatment course, for two key medicines used to treat and cure this disease, sofosbuvir and daclatasvir. This dramatic price reduction—which will benefit patients in countries where MSF can supply generic versions—illustrates the importance of generic options, which could, if expanded, help countries provide treatment for millions of people and improve public health by preventing the spread of this disease.
NIH  [to 4 November 2017]
October 31, 2017
NIH establishes new research in social epigenomics to address health disparities
— Grant program to break new ground in genomics and health disparities research.
The National Institutes of Health will award 10 grants to support social epigenomics research in health disparities. This investigator-initiated research is being funded as part of the Social Epigenomics Research Focused on Minority Health and Health Disparities research program, which seeks to support research to better understand the drivers of health disparities. The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, will commit $26.2 million over five years, subject to available funds, for nine awards. An additional award under this initiative will be funded by the National Cancer Institute (NCI) – also part of NIH…

UNAIDS [to 4 November 2017]
Feature story
Living with HIV but dying from tuberculosis
03 November 2017
Global progress to End TB not fast enough to reach global TB and HIV targets
Tuberculosis (TB) retains its undesirable status as the leading infectious cause of death globally. According to the latest WHO Global Tuberculosis Report 2017 launched this week, global progress in reducing new tuberculosis (TB) cases and deaths is insufficient to meet the global targets for TB and HIV, despite most deaths being preventable with early diagnosis and appropriate treatment of tuberculosis and HIV.
As part of global efforts to advance the response to TB is now being pushed higher up the global development agenda with hundreds of global leaders attending the first WHO Global Ministerial Conference on Ending TB in Moscow from 14-17 November and a dedicated United Nations General Assembly High-Level Meeting on TB in 2018…

New app helps treatment adherence for people living with HIV
30 October 2017
A new mobile app for people living with HIV, Life4me+, is now available for free in 156 countries and in six languages—Armenian, English, Estonian, German, Russian and Ukrainian. The app was created by a German–Russian activist living with HIV and his team and aims to simplify medical information and treatment for people living with HIV in eastern Europe and central Asia and beyond.
The app was developed based on the experiences of its developers and HIV activists. For people living with HIV, the app works like a personal electronic patient card. It allows users to stay in touch with doctors online, saving and displaying test results, a calendar of blood tests and a prescription history, and sets up reminders about when to take medication and schedule appointments. There are also functions for recording weight, chest volume, blood pressure, disease history, HIV drug resistance, etc…

UNICEF  [to 4 November 2017]
02 November 2017
9,500 children dying from diarrhoea each year in Afghanistan – UNICEF
KABUL, NILI, Afghanistan, 02 November 2017 – Although the number of children under five years dying from diarrhoea each year in Afghanistan has dropped below 10,000 for the first time, the disease still claims the lives of 26 children each day across the country, UNICEF said today.
Wellcome Trust  [to 4 November 2017]
News / Published: 1 November 2017
New group to advise Wellcome on diversity and inclusion
The first meeting of Wellcome’s new steering group for Diversity & Inclusion (D&I) takes place this week.
It’s the next step in our commitment to increase the diversity of the people we fund, engage with and employ, and create a research culture in which everyone feels able to contribute their ideas…
Who’s who in the D&I steering group
The group has 12 external members – Catherine Brown, Andrea Callender, Prof Jane Clarke, Lenna Cumberbatch, Dr Robbie Dushinsky, Liz Ellis, Patrick Johnson, Elizabeth Lynch, Katherine Rake, Dr Nicola Rollock, David Ruebain and Adrian Shooter. Together, they have extensive experience of leading on D&I initiatives in a broad mix of settings, from corporate, healthcare and higher education to research environments and public engagement.

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:

Global tuberculosis report 2017
WHO – November 2017 :: 262 pages
WHO has published a global TB report every year since 1997. The main aim of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels. This is done in the context of recommended global TB strategies and targets endorsed by WHO’s Member States and broader development goals set by the United Nations.
PDF: Full report

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:

Workplace interventions associated with influenza vaccination coverage among health care personnel in ambulatory care settings during the 2013-2014 and 2014-2015 influenza seasons

American Journal of Infection Control
November 01, 2017 Volume 45, Issue 11, p1175-1296, e119-e148

Major Articles
Workplace interventions associated with influenza vaccination coverage among health care personnel in ambulatory care settings during the 2013-2014 and 2014-2015 influenza seasons
Xin Yue, Carla Black, Sarah Ball, Sara Donahue, Marie A. De Perio, A. Scott Laney, Stacie Greby
Published online: July 3, 2017

Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions

BMC Cost Effectiveness and Resource Allocation
(Accessed 4 November 2017)

Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions
Estimating health care costs, either in the context of understanding resource utilization in the implementation of a health plan, or in the context of economic evaluation, has become a common activity of healt…
Melanie Y. Bertram, Karin Stenberg, Callum Brindley, Jina Li, Juliana Serje, Rory Watts and Tessa Tan-Torres Edejer
Cost Effectiveness and Resource Allocation 2017 15:21
Published on: 26 October 2017

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

BMC Infectious Diseases
(Accessed 4 November 2017)

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries
There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatit…
Azumi Ishizaki, Julie Bouscaillou, Niklas Luhmann, Stephanie Liu, Raissa Chua, Nick Walsh, Sarah Hess, Elena Ivanova, Teri Roberts and Philippa Easterbrook
BMC Infectious Diseases 2017 17(Suppl 1):696
Published on: 1 November 2017

Values, preferences and current hepatitis B and C testing practices in low- and middle-income countries: results of a survey of end users and implementers

BMC Infectious Diseases
(Accessed 4 November 2017)

Values, preferences and current hepatitis B and C testing practices in low- and middle-income countries: results of a survey of end users and implementers
Access to hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnostics remains a key bottleneck in scale-up of access to HBV and HCV treatment, particularly in low- and middle-income countries (LMICs) that …
Elena Ivanova Reipold, Alessandra Trianni, Douglas Krakower, Stefano Ongarello, Teri Roberts, Philippa Easterbrook and Claudia Denkinger
BMC Infectious Diseases 2017 17(Suppl 1):702
Published on: 1 November 2017

Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children

BMC Research Notes
(Accessed 4 November 2017)

Research article
Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children
Poliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly…
Joanne Hassan, Laura Wangai, Peter Borus, Christopher Khayeka–Wandabwa, Lucy Wanja Karani, Mercy Kithinji and Michael Kiptoo
BMC Research Notes 2017 10:555
Published on: 3 November 2017

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania

Bulletin of the World Health Organization
Volume 95, Number 11, November 2017, 729-792

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania
Riaz Aziz, Robert N Peck, Samuel Kalluvya, Bernard Kenemo, Alphonce Chandika & Jennifer A Downs

The Council of Europe should not reaffirm the ban on germline genome editing in humans

EMBO Reports
01 November 2017; volume 18, issue 11
The Council of Europe should not reaffirm the ban on germline genome editing in humans
The Council of Europe plans to urge member states to sign and ratify the Oviedo Convention that would ban all inheritable modifications of the human germline. Such a policy would prevent research to develop new therapeutic options for inheritable diseases in Europe and is in sharp contrast to international developments.
Peter Sykora, Arthur Caplan

Humanitarian Exchange Magazine

Humanitarian Exchange Magazine
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…


International Journal of Community Medicine and Public Health Vol 4, No 11 (2017)

International Journal of Community Medicine and Public Health
Vol 4, No 11 (2017)

Original Research Articles
Immunization coverage in an urban resettlement colony of district Gautam-Budh Nagar, Uttar Pradesh, India using WHO 30×7 cluster sampling technique
Harsh Mahaja n, Shalini Srivastava, S. Nagesh
DOI: 10.18203/2394-6040.ijcmph20174660

A study on immunization coverage of 12-23 months children in urban areas of Kanchipuram district, Tamil Nadu
Duraimurugan Murugesan, Ramasubramanian R.
DOI: 10.18203/2394-6040.ijcmph20174486

Assessment of knowledge and attitude of medical and nursing students towards screening for cervical carcinoma and HPV vaccination in a tertiary care teaching hospital
Sunite A. Ganju, Neha Gautam, Vijay Barwal, Sohini Walia, Shriya Ganju
DOI: 10.18203/2394-6040.ijcmph20174826

International Journal of Infectious Diseases November 2017 Volume 64, p1-106

International Journal of Infectious Diseases
November 2017 Volume 64, p1-106

A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa
Natalie Schellack, Deon Benjamin, Adrian Brink, Adriano Duse, Kim Faure, Debra Goff, Marc Mendelson, Johanna Meyer, Jacqui Miot, Olga Perovic, Troy Pople, Fatima Suleman, Moritz van Vuuren, Sabiha Essack
Published online: September 8, 2017

Knowledge and practices related to plague in an endemic area of Uganda
Kiersten J. Kugeler, Titus Apangu, Joseph D. Forrester, Kevin S. Griffith, Gordian Candini, Janet Abaru, Jimmy F. Okoth, Harriet Apio, Geoffrey Ezama, Robert Okello, Meghan Brett, Paul Mead
Published online: September 18, 2017

Factors Associated with HPV Vaccination in Young Males

Journal of Community Health
Volume 42, Issue 6, December 2017

Original Paper
Factors Associated with HPV Vaccination in Young Males
Kelli M. Fuller, Leslie Hinyard
Human papilloma virus (HPV) affects both men and women; however, recommendations for HPV vaccination among men were not issued in the United States until 2011. The purpose of this study was to describe and compare characteristics of men who did and did not report receiving at least one dose of the HPV vaccine. Data from the ten states that completed the HPV vaccination module in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) were included in the study. Young men ages 18–26 were included (N = 1624). Categorical variables were compared between those who did and did not receive the HPV vaccine using Chi square. Logistic regression was used to examine the odds of HPV vaccination by the above factors. Only 16.5% of men reported at least one dose of HPV vaccine. Having health insurance, having a primary doctor, and receiving an HIV test were predictive of HPV vaccination. Men in Texas were more likely to report HPV vaccination than all other states. Overall, HPV vaccination is low in men. Targeted interventions for improving HPV vaccination rates in men are warranted, especially for those without health insurance or a routine source of care


Getting to Zero New Tuberculosis Infections: Insights From the National Institutes of Health/US Centers for Disease Control and Prevention/Bill & Melinda Gates Foundation Workshop on Research Needs for Halting Tuberculosis Transmission

Journal of Infectious Diseases
Volume 216, Issue suppl_6  1 October 2017
Towards Zero New TB Infections: Research Needs for Halting TB Transmission

Getting to Zero New Tuberculosis Infections: Insights From the National Institutes of Health/US Centers for Disease Control and Prevention/Bill & Melinda Gates Foundation Workshop on Research Needs for Halting Tuberculosis Transmission
N Sarita Shah; Peter Kim; Bavesh Davandra Kana; Roxana Rustomjee
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S627–S628,
Tuberculosis caused an estimated 1.4 million deaths in 2015 and now ranks as the leading infectious disease cause of mortality in the world [1]. An additional 1.7 billion people are currently infected with Mycobacterium tuberculosis and are at risk of developing active tuberculosis disease. The challenge to eliminate tuberculosis has never been more relevant and urgent. Unfortunately, efforts to bring this global epidemic under control have been hampered by inadequate understanding of the epidemiology, biology, and effective interventions that directly address tuberculosis transmission. Identifying the key drivers of transmission and…

Journal of Infectious Diseases Volume 216, Issue suppl_6  1 October 2017

Journal of Infectious Diseases
Volume 216, Issue suppl_6  1 October 2017

Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis
David W Dowdy; Alison D Grant; Keertan Dheda; Edward Nardell; Katherine Fielding
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S654–S661,

Research Roadmap for Tuberculosis Transmission Science: Where Do We Go From Here and How Will We Know When We’re There?
Sara C Auld; Anne G Kasmar; David W Dowdy; Barun Mathema; Neel R Gandhi
The Journal of Infectious Diseases, Volume 216, Issue suppl_6, 3 November 2017, Pages S662–S668,

Paper: The case against libertarian arguments for compulsory vaccination

Journal of Medical Ethics
November 2017 – Volume 43 – 11
Political philosophy & medical ethics

Paper: The case against libertarian arguments for compulsory vaccination
Justin Bernstein
In a recent paper in this journal, Jason Brennan correctly notes that libertarians struggle to justify a policy of compulsory vaccination. The most straightforward argument that justifies compulsory vaccination is that such a policy promotes welfare. But libertarians cannot make this argument because they claim that the state is justified only in protecting negative rights, not in promoting welfare. I consider two representative libertarian attempts to justify compulsory vaccination, and I argue that such arguments are unsuccessful. They either fail to show that the state is justified in implementing the policy or overgeneralise. I suggest that Brennan’s solution is especially well motivated insofar as it addresses the shortcomings of these arguments. Brennan argues that we violate the rights of others by participating in an activity that imposes an unacceptable collective risk of harm. Going unvaccinated is an activity that imposes an unacceptable collective risk of harm, and thus amounts to a rights violation. So, the state can implement a policy of compulsory vaccination I object, however, that Brennan’s delineation of acceptable and unacceptable risk implicitly rests on classical liberal rather than libertarian principles; he justifies compulsory vaccination on the grounds that it promotes welfare. I also object that Brennan’s argument would entail significant departures from libertarian institutional arrangements. This leaves libertarians with a choice: they can develop new arguments to demonstrate that their position is compatible with compulsory vaccination, or they can accept that their view entails the impermissibility of compulsory vaccination, and argue that this is not an unpalatable implication of their view.

Six-Year Experience of Influenza Vaccination as a Condition of Employment for a Large Regional Health Care System

Journal of Patient-Centered Research and Reviews
Volume 4, Issue 4 (2017)
Health Disparities and Inequities: Part I

Six-Year Experience of Influenza Vaccination as a Condition of Employment for a Large Regional Health Care System
John R. Brill, Mark Hermanoff, Angela Tonozzi, Mary Jo Capodice, Jennifer Farrar, and Zarina Dawoodbhai
Conclusion: An influenza program as a condition of employment leads to high levels of immunization of HCW, with minimal impact on HCW retention and satisfactory satisfaction among HCW.

The imperative of vaccination

Lancet Infectious Diseases
Nov 2017 Volume 17 Number 11 p1099-1218   e334-e382

The imperative of vaccination
The Lancet Infectious Diseases
Vaccination is one of the most effective public health interventions and it has been instrumental in saving lives and greatly changing the burden of many infectious diseases over the past 100 years. However, the very effectiveness of vaccines has made some diseases rare, and most of us are less likely to witness first hand the devastating consequences of vaccine-preventable diseases. This fact, combined with misinformation, suspicion about vaccines, and mistrust of governments and health authorities, have prompted many parents to override concerns about the diseases themselves and oppose the vaccination of their children.

Although vaccination is usually recommended by local health authorities, in many countries immunisation rates for diseases such as measles have dropped well below the 95% threshold set by WHO. This threshold is deemed necessary to maintain the herd immunity that guarantees protection for babies too young to be vaccinated, elderly people, immunosuppressed individuals, and those who cannot be vaccinated for other medical reasons. In the past year, low immunisation rates have caused a surge in the number of cases of measles and related deaths in several countries, such as Romania, Italy, and France. Similarly, the drop in vaccination is the cause of two cases of tetanus reported in Italy in recent months, after the disease had not been seen in the country for more than 30 years. The rise in cases of vaccine-preventable diseases secondary to lower immunisation rates is becoming a serious public health problem and as François Chast, head of pharmacology at Paris hospitals (Paris, France), said, “It is urgent to fight the speeches of anti-science and anti-vaccination lobbies that play on fear, they show nothing and rely on a few, very rare side effects to discredit vaccines that save millions of lives.”

To tackle this worrying and unjustified drop in vaccination rates, some countries are considering, or have already implemented, the introduction of mandatory vaccination for children. Following the example of the state of California, USA, and Australia, the Italian Government passed in June, without prior public consultation, a law that made vaccination for ten diseases (polio, diphtheria, tetanus, hepatitis B, pertussis, Haemophilus influenzae type B, measles, varicella, mumps, and rubella) mandatory for children aged between 1 and 16 years. In 2020, after collection of new data on vaccination rates, the government will re-evaluate whether or not vaccination for measles, rubella, varicella, and mumps should still be mandatory. Unvaccinated children are not allowed to attend kindergardens and must be vaccinated before starting primary school, or their parents will incur heavy financial penalties. France will adopt a similar policy by making vaccination mandatory for 11 diseases (including also meningitis C) from 2018 onwards. Australia has gone even further with its so-called no jab-no play (banning the enrolment of unvaccinated children in preschool and childcare centres) and so-called no jab-no pay (under which parents of unvaccinated children lose government benefits and welfare rebates) policies.

The introduction of mandatory vaccination has sparked controversy among parents who feel deprived of their freedom to make decisions about the health of their children. A concern raised by such vaccine-hesitant parents is the chance of adverse events, such as neurodevelopmental problems, potentially linked to vaccination. In reality, although vaccines, like any medical intervention, can have adverse events, these outcomes are so rare that they are, by far, outweighed by the benefits of vaccination. As Michael Gannon, the president of the Australian Medical Association (Barton, Australia), said, “You are 10 000 times more likely to be brain damaged by measles than you are by its vaccination.” Unfortunately, the anti-vaccine movement seems to prefer to ignore the bulk of scientific evidence in support of the safety of vaccines.

Public health problems such as the surge in cases of vaccine-preventable diseases need to be addressed with strong interventions that maximise societal benefits; making vaccination mandatory, albeit temporarily, should not be seen as an infringement of personal rights. Nobody would rationally advocate for vaccination if there were alternatives or if scientific evidence showed that the risk of adverse events outweighed the protection against infectious diseases. But the reality is that vaccines are still one of the safest options to prevent infectious diseases and judgement should be based on facts, not unfounded fears.

Lancet Infectious Diseases – Nov 2017 Volume 17 Number 11 p1099-1218 e334-e382

Lancet Infectious Diseases
Nov 2017 Volume 17 Number 11 p1099-1218   e334-e382

Understanding commitment to polio vaccination
Kathleen M O’Reilly

Yellow fever vaccination: estimating coverage
Annelies Wilder-Smith

Understanding threats to polio vaccine commitment among caregivers in high-priority areas of Afghanistan: a polling study
Gillian K SteelFisher, Robert J Blendon, Sherine Guirguis, William Lodge II, Hannah Caporello, Vincent Petit, Michael Coleman, Matthew R Williams, Sardar Mohammad Parwiz, Melissa Corkum, Scott Gardner, Eran N Ben-Porath

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis
Freya M Shearer, Catherine L Moyes, David M Pigott, Oliver J Brady, Fatima Marinho, Aniruddha Deshpande, Joshua Longbottom, Annie J Browne, Moritz U G Kraemer, Kathleen M O’Reilly, Joachim Hombach, Sergio Yactayo, Valdelaine E M de Araújo, Aglaêr A da Nóbrega, Jonathan F Mosser, Jeffrey D Stanaway, Stephen S Lim, Simon I Hay, Nick Golding, Robert C Reiner Jr

Where are the innovations in tuberculosis drug discovery?

Lancet Respiratory Medicine
Nov 2017 Volume 5 Number 11 p835-908   e31-e34

Where are the innovations in tuberculosis drug discovery?
The Lancet Respiratory Medicine
WHO has released a report that highlights a serious lack of antibiotics in clinical development; a worrying finding in an era of antimicrobial resistance. The report identifies a particular shortage of antibiotics under development for multidrug-resistant tuberculosis, which is a disease that kills a quarter of a million people every year.

The WHO analysis aimed to identify products that were in clinical development up to May, 2017, for the treatment of tuberculosis, Clostridium difficile, and diseases caused by pathogens on the WHO priority pathogen list. WHO also assessed whether these products were innovative. Their definition of innovative was based on whether they were a new chemical class, had a new target or binding site, had a new mode of action, or had no cross resistance to other antibiotic classes. For tuberculosis, they found that only seven products are currently in clinical development. Five of these products are categorised as innovative, but only one—pretomanid—is in phase 3 clinical development. These figures are an improvement on 2000, when no tuberculosis drugs were in clinical development and the TB Alliance was formed to address the issue. However, the figures are still well short of the targets set out by the Stop TB Partnership Global Plan 2011–2105. Additionally, only two new antibiotics for tuberculosis have reached the market in over 70 years—delamanid and bedaquiline—but limited access to these newly licensed drugs has been highlighted, with fewer than 5% of people in need being treated with them according to Medecins Sans Frontieres. Reasons for the restricted access include their high price, and the drugs not being registered in many high-burden countries.

The limited drug pipeline for tuberculosis can be attributed to a substantial lack of funding. According to the US-based Treatment Action Group, global funding for all tuberculosis research and development almost doubled between 2005 and 2011; however, funding has plateaued since 2009. In 2015, total global funding was US$620 million, which is far from the 2011–2015 Global Plan’s target of $2·2 billion. Treatment Action Group notes that the reduced funding in 2015 was due to the payment cycles of major funders, and declining investment from the largest pharmaceutical funder, Otsuka, whose new drug delamanid is in the final stages of phase 3 clinical trials.

In this context, it is welcome news that the Global Antibiotic Research and Development Partnership (GARDP) announced more than €56 million has been raised to fund an initiative to fight antibiotic resistance. The partnership was launched in May, 2016, by WHO and the Drugs for Neglected Diseases initiative, with the aim of developing and delivering new treatments for bacterial infections for which drug resistance is present or emerging, or for which current treatments are inadequate. GARDP will target products that the pharmaceutical industry will likely not develop due to lack of profitability or other reasons, and will pilot the use of alternative incentive models, removing the link between the cost of research and development and the sales of antibiotics. GARDP has four main focus areas: sexually transmitted infections, a programme to revive abandoned antibiotic development projects, neonatal sepsis, and paediatric antibiotics. However, it has no specific programme to tackle multidrug-resistant tuberculosis.

Despite poor funding for tuberculosis research and development, the latest analyses of the Global Burden of Disease study show that deaths caused by tuberculosis in 2016 were down by nearly 21% since 2006, and the incidence of tuberculosis was down by 1·7%. However, this rate of decline is not sufficient to meet the UN Sustainable Development Goal to end the epidemic of tuberculosis by 2030, with not a single country projected to achieve this goal. The identification of new drugs is not the only strategy for tackling tuberculosis; efforts are also being made to improve diagnosis, infection prevention and control, and to ensure appropriate use of existing and future antibiotics in the human, animal, and agricultural sectors. But without innovations in the market to help develop new treatments for multidrug-resistant tuberculosis, the UN Sustainable Development Goal will remain out of reach.

Medical Decision Making (MDM) Volume 37, Issue 8, November 2017

Medical Decision Making (MDM)
Volume 37, Issue 8, November 2017

Original Articles
From Data to Improved Decisions: Operations Research in Healthcare Delivery
Muge Capan, PhD, Anahita Khojandi, PhD, Brian T. Denton, PhD, Kimberly D. Williams, MPH, Turgay Ayer, PhD, Jagpreet Chhatwal, PhD, Murat Kurt, PhD, Jennifer Mason Lobo, PhD, Mark S. Roberts, MD, Greg Zaric, PhD, Shengfan Zhang, PhD, J. Sanford Schwartz, MD
First Published April 19, 2017; pp. 849–859

Effects of Anti- Versus Pro-Vaccine Narratives on Responses by Recipients Varying in Numeracy: A Cross-sectional Survey-Based Experiment
Wändi Bruine de Bruin, PhD, Annika Wallin, PhD, Andrew M. Parker, PhD, JoNell Strough, PhD, Janel Hanmer, MD PhD
First Published May 5, 2017; pp. 860–870