WHO & Regional Offices [to 8 April 2017]

Highlights
World Health Day – 7 April 2017
Depression: let’s talk
7 April 2017 – Depression is the leading cause of ill health and disability worldwide. More than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. WHO is leading a global campaign on depression for World Health Day 2017, with the goal of enabling more people with mental disorders to live healthy, productive lives.

World Health Day 2017 – High-level event on mental health and depression in the context of the 2030 Agenda for Sustainable Development
[Event Video: 2:25:58]
Depression affects people of all ages, from all walks of life, in all countries. Untreated depression can prevent people from working and participating in family and community life.
WHO’s “Depression: Let’s Talk” campaign seeks to promote a better understanding of depression, prevention and treatment mechanisms, and the underlying importance of talking about depression as a vital component for reducing stigmas and supporting recovery.

 
Reference Guide: Developing health financing strategy
April 2017 – A new guide published by WHO examines policy development for health financing, expanding on areas including revenue raising, pooling revenues, purchasing services, benefit design, and rationing mechanisms. Health financing is key to improving health system performance and progressing towards universal health coverage (UHC).

WHO alarmed by use of highly toxic chemicals as weapons in Syria
   April 2017 – WHO is alarmed by serious reports of the use of highly toxic chemicals in an attack in Khan Shaykhun, southern rural Idleb, Syria. According to Health Cluster partners on the ground treating the patients, at least 70 people have died and hundreds more have been affected.

Study on the persistence of Zika virus in body fluids
April 2017 – Over the course of 2016, WHO along with the global research community quickly built evidence that Zika virus transmission through sex was not only possible, but more common than previously assumed. But many questions still remain unanswered.

WHO calls for increased support for health aid in Syria and refugee-hosting neighbouring countries
April 2017 – In Syria, limited specialized medical staff, ambulances, equipment and medical supplies have led to growing numbers of deaths which could have been prevented. Large numbers of wounded Syrians continue to die or face permanent disabilities as a result of limited access to medical care

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Weekly Epidemiological Record, 7 April 2017, vol. 92, 14 (pp. 165–180)
Surveillance systems to track progress towards polio eradication worldwide, 2015–2016
Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017
Monthly report on dracunculiasis cases, January– December 2016

GIN March 2017  pdf, 1.77Mb   3 April 2017

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: Ismael Cala joins PAHO’s World Health Day Campaign (04/06/2017)
:: PAHO trains more than 100 journalists from the Americas on responsible coverage of suicide to prevent ‘suicide contagion’ (04/06/2017)

WHO South-East Asia Region SEARO
No new digest content identified.
 
WHO European Region EURO
:: Journalists in Tajikistan expand skills for reporting on tobacco 07-04-2017
:: Policy dialogue proposed during visit of Minister of Health of Latvia to WHO/Europe 07-04-2017
:: Greek Government hosts broad policy dialogue on public health reform 05-04-2017
:: Tackling mild depression: “iCBT was perfect for me.” 04-04-2017
:: Major health gains achieved through working together: 15 years of the South-eastern Europe Health Network and beyond 03-04-2017
: Examples of investing in health from the South-eastern Europe Health Network 03-04-2017

WHO Eastern Mediterranean Region EMRO
:: WHO alarmed by use of highly toxic chemicals as weapons in Syria  5 April 2017
:: WHO releases new guidance on malaria elimination  5 April 2017
:: WHO and Morocco sign Country Cooperation Strategy for 2017–2021  2 April 2017

WHO Western Pacific Region
No new digest content identified.

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CDC/ACIP [to 8 April 2017]
http://www.cdc.gov/media/index.html
Transcript
TUESDAY, APRIL 4, 2017
CDC Telebriefing: New Vital Signs Report – Zika Virus
New Vital Signs Report – Possible Zika virus infections in 44 U.S. states: What can healthcare providers do to help protect pregnant women and their babies?

Press Release
TUESDAY, APRIL 4, 2017
About 1 in 10 U.S. pregnant women with confirmed Zika infection had a fetus or baby with birth defects in 2016
Of the 250 pregnant women who had confirmed Zika infection in 2016, 24 – or about 1 in 10 of them – had a fetus or baby with Zika-related birth…

Press Release
MONDAY, APRIL 3, 2017
CDC Study Finds Flu Vaccine Saves Children’s Lives
   A new CDC study published today in Pediatrics is the first of its kind to show that flu vaccination significantly reduced a child’s risk of dying from influenza.

MMWR: https://www.cdc.gov/mmwr/index2017.html
MMWR Weekly April 7, 2017 / No. 13
[Excerpts]
:: HIV Services Provided by STD Programs in State and Local Health Departments — United States, 2013–2014
:: Surveillance Systems to Track Progress Toward Polio Eradication — Worldwide, 2015–2016
:: Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016
:: Announcement: Sexually Transmitted Diseases Awareness Month — April 2017

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Announcements
 
IVI   [to 8 April 2017]
http://www.ivi.int/
April 3,2017
Korean Ministry of Health and Welfare, International Vaccine Institute (IVI) sign agreement on vaccine development and delivery cooperation
– Agreement to collaborate on vaccine R&D projects, capacity-building, and information-exchange programs between IVI, universities, research institutes and industry
– IVI Director General Jerome Kim thanks Korea for its support of global health R&D and vows to increase IVI’s cooperation with Korea
SEOUL, KOREA – The Ministry of Health & Welfare of the Republic of Korea (MOH) and the International Vaccine Institute (IVI) signed a memorandum of understanding (MOU) on a collaboration to advance global public health, and to develop and deliver vaccines and related technologies for developing countries. Dr. Chung Chin-youb, Minister of Health & Welfare, visited the IVI headquarters at Seoul National University Research Park on April 3rd and exchanged the MOU with IVI Director General Dr. Jerome Kim, and discussed plans on mutual cooperation between Korea and the institute.

Established in 1997, IVI was the first international organization headquartered in Korea.  As IVI’s host country, Korea provides funding through its Official Development Assistance (ODA) to the institute for its vaccine research and operations. Up until recently, the institute was under the Ministry of Education. This MOU is a revision of the MOU signed in 2013 between the Ministry of Education and IVI, and includes newly added areas of support and expanded cooperation between IVI and MOH such as joint vaccine R&D projects and capacity-building initiatives.

Under the purview of MOH, IVI will continue to receive funding from the Korean government to support its operations as per the original host country agreement signed between IVI and Korea. The Ministry will also continue to support IVI’s vaccine research and development activities to help the institute fulfill its mission of making safe, effective and affordable vaccines available for global health.

Finally IVI and the Ministry agreed to actively support exchange and cooperation programs in Korea by collaborating more with Korean universities, research institutes and the life sciences industry.  Notably, IVI and the Korean Centers for Disease Control will partner to develop vaccines against norovirus and hepatitis A…
 
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NIH  [to 8 April 2017]
http://www.nih.gov/news-events/news-releases
April 5, 2017
Monoclonal antibody cures Marburg infection in monkeys
— NIH-funded groups preparing for next filovirus outbreak.
Scientists funded by the National Institutes of Health have found that an experimental treatment cured 100 percent of guinea pigs and rhesus monkeys in late stages of infection with lethal levels of Marburg and Ravn viruses, relatives of the Ebola virus. Although the Marburg and Ravn viruses are less familiar than Ebola virus, both can resemble Ebola in symptoms and outcomes in people, and both lack preventive and therapeutic countermeasures.

NIDA announces recipients of 2017 Avant-Garde Awards for HIV/AIDS research
April 5, 2017 — NIH awards highlight novel approaches to HIV prevention and treatment.
The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, today announced that three scientists have been selected to receive the 2017 Avant-Garde Award for HIV/AIDS Research. The winning proposals focus on a variety of novel approaches, including: improving HIV prevention through effective gene therapies; enhancing innate (natural) immunity against HIV and other related viruses; and developing new small-molecule drugs to treat HIV-1 infection.

The three scientists will each receive $500,000 per year for five years to support their research, subject to the availability of funds. NIDA’s tenth annual Avant-Garde Award competition is intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug users.

“With nearly 37 million people living with HIV worldwide, it is essential that researchers continue to develop effective prevention and treatment strategies for those suffering from this devastating disease, including people with substance use disorders,” said NIDA Director Nora D. Volkow, M.D. “These scientists are pioneering exciting new approaches aimed at preventing and treating new cases of HIV and helping people at risk live longer, healthier lives.”

Awardees are listed below:
Michael Farzan, Ph.D., The Scripps Research Institute
Project: A safety switch for an effective HIV-1 vaccine
Dr. Farzan plans to use preclinical models to explore safe and effective gene therapies for the long-term prevention of HIV infection in high-risk populations, such as injection drug users. He will use an adeno-associated virus to deliver broadly neutralizing antibodies (bNAbs) or eCD4-Ig, proteins that prevent HIV-1 from infecting cells. His group will also explore safety switch mechanisms to control bNAbs and eCD4-Ig, thereby increasing safety during long-term exposure to these molecules.

Eric M. Poeschla, Ph.D., University of Colorado Denver
Project: Novel Approaches to Innate Immunity Against HIV-1 and Other Co-infection Viruses
Dr. Poeschla will use animal and human cells to explore the use of viral RNA-dependent RNA polymerase (RdRP) to enhance broad-spectrum (innate) immunity against various viruses, including HIV-1. Evidence suggests that this stable innate immune system activation does not trigger autoimmunity or inflammatory pathways. This approach may also protect against viruses that infect people with addiction.

Peter S. Kim, Ph.D., Stanford University
Project: Making the HIV-1 gp41 pocket amenable to small-molecule drug discovery
Dr. Kim’s group proposes a strategy that alters the HIV-1 gp41 region, thereby increasing structural rigidity in this region. This will enhance testing of new therapeutics that target the gp41 pocket to prevent HIV infection. Because the pocket is structurally similar across different HIV-1 strains, these therapeutics could treat patients, including people with substance use disorders, who are at higher risk of developing resistance to one or more classes of anti-HIV drugs…

International scientific teams find potential approach against parasites
April 3, 2017 — Research teams from the National Institutes of Health and abroad have identified the first inhibitor of an enzyme long thought to be a potential drug target for fighting disease-causing parasites and bacteria. The teams, led by NIH’s National Center for Advancing Translational Sciences (NCATS) and University of Tokyo scientists, sorted through more than 1 trillion small protein fragments called cyclic peptides to uncover two that could shut down the enzyme. The finding, reported April 3, 2017 in Nature Communications, could set the stage for the potential development of new types of antimicrobial drugs…

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Sabin Vaccine Institute  [to 8 April 2017]
http://www.sabin.org/updates/pressreleases
Tuesday, April 4, 2017
Public Health Experts Discuss Vaccines, Antibiotic Resistance and Surveillance at Conference on Typhoid and Other Invasive Salmonelloses
KAMPALA, UGANDA – April 4, 2017 – Today, the Sabin Vaccine Institute opened the 10th International Conference on Typhoid and Other Invasive Salmonelloses in Kampala, Uganda. Over the course of the three day conference, more than 300 experts from around the world have gathered to discuss new typhoid-related research, as well as how to turn this evidence into action in the fight against typhoid.

Typhoid fever, an illness caused by the bacteria Salmonella Typhi, kills an estimated 220,000 people, primarily children, each year. Currently available typhoid vaccines are underutilized in low- and middle-income countries, including many countries in Africa and Asia. Vaccines for other, nontyphoidal strains of Salmonella bacteria are not available. Typhoid is treated with antibiotics, but the recent rise of antibiotic-resistant typhoid and nontyphoidal Salmonella has increased the burden of treatment on health systems and families. There is an urgent need for new effective vaccines and policies to help prevent the disease and its transmission in communities. Preventing typhoid will minimize the need to treat this serious infection and will also reduce the danger of antibiotic resistance.

There has been significant progress in typhoid vaccine development. New typhoid conjugate vaccines offer important advantages over prior vaccines, including longer duration of protection, the ability to protect young children, and the potential for delivery with other vaccines in routine immunization of infants. Conjugate vaccines have the potential to dramatically reduce the burden of typhoid around the world and, consequently, help to prevent the occurrence of antibiotic resistance. The research shared at Sabin’s conference – the world’s only such meeting devoted to typhoid and other invasive salmonelloses – will inform discussions at the World Health Organization later this month, when experts gather to review recommendations on the use of typhoid vaccines…

“This conference comes at a pivotal moment for global action on typhoid,” said Bruce Gellin, president of Global Immunization at the Sabin Vaccine Institute. “…To have the greatest impact, we need to review the evidence for these vaccines and consider the vaccination programs in which they will be delivered. The discussions and debates over the next three days at this conference will help the researchers, policy makers and advocates meet the urgent need for prevention and control.”…

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AERAS  [to 8 April 2017]
http://www.aeras.org/pressreleases
Aeras Updates – Quarterly Newsletter
5 April 2017
:: Aeras celebrates World TB Day 2017
:: World TB Day Europe: Personal Stories and Focusing on AMR
:: Aeras Asia: Leveraging Social Media to Promote World TB Day Messages
:: Aeras Africa: Using World TB Day to Spark Discussion About TB R&D

 
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Global Fund [to 8 April 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=

News
Global Fund Welcomes Italy’s €140 million Contribution
07 April 2017
The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomed a contribution of €140 million from the government of Italy for the three-year period beginning in 2017, a strong demonstration of Italy’s leadership in global health.

News
The Global Fund and Pink Ribbon Red Ribbon Partner to Prevent and Control Cervical Cancer
06 April 2017
Today, leaders of the Global Fund to Fight AIDS, Tuberculosis and Malaria and Pink Ribbon Red Ribbon signed an agreement to collaborate on programming to prevent cervical cancer. HIV positive women are up to five times more likely to develop cervical cancer, so routine screening and treatment is essential for this population. Screening and treatment for cervical pre-cancer is a cost-effective intervention, costing less than $25 per woman. Pink Ribbon Red Ribbon will work with countries to integrate cervical cancer programming into their HIV/AIDS grants from the Global Fund, building on efforts by national governments and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

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FDA [to 8 April 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
April 07, 2017
FDA approves two hepatitis C drugs for pediatric patients

 What’s New for Biologics
:: February 8, 2017 Transcript – Identification and Characterization of the Infectious Disease Risks of Human Cells, Tissues, and Cellular and Tissue-based Products (PDF – 2.7MB)
Posted: 4/4/2017
:: February 9, 2017 Transcript – Identification and Characterization of the Infectious Disease Risks of Human Cells, Tissues, and Cellular and Tissue-based Products (PDF – 1.4MB)
Posted: 4/4/2017
 

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Wellcome Trust  [to 8 April 2017]
https://wellcome.ac.uk/news
News / Published: 7 April 2017
Public invited to help tackle antibiotic resistance
A new citizen science project, BashTheBug (opens in a new tab), has been launched to study antibiotic resistance in tuberculosis (TB).
On the Zooniverse website (opens in a new tab), volunteers are shown a series of small, circular wells each containing Mycobacterium tuberculosis, which causes TB, and a different dose of an antibiotic.
They are then asked to identify wells in which the bacteria have grown, helping the researchers to determine which antibiotics are effective at killing each specific strain of TB.
“Antibiotic resistance is a global threat, and accurately and rapidly diagnosing drug-resistant disease places a huge strain on hospital laboratories,” says Dr Philip Fowler, lead researcher on the BashTheBug project.
“Knowing which antibiotics are effective against a particular bacterial infection is crucial for effectively treating a patient, while also limiting the opportunity for the bug to develop antibiotic-resistance and then be passed onto other people.”
“Cultivating and examining TB plates is a time-consuming process, but by enlisting extra help online we hope to examine over 40 million images, something we could never do on our own…

 
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Industry Watch  [to 8 April 2017]
:: Takeda Completes Enrollment of More Than 20,000 Children and Adolescents in Global Phase 3 Trial of Dengue Vaccine Candidate
   Tetravalent Immunization against Dengue Efficacy Study (TIDES) trial evaluates the efficacy of two doses of vaccine candidate TAK-003, administered three months apart, to protect against all four strains of dengue virus, regardless of previous dengue exposure
   Study includes children and adolescents ages 4 through 16 years in eight dengue-endemic countries across Latin America and Asia
   Achieving enrollment demonstrates Takeda’s commitment to advancing global vaccine business and addressing unmet needs in dengue prevention
April 05, 2017 08:00 AM Eastern Daylight Time
OSAKA, Japan–(BUSINESS WIRE)–Takeda Pharmaceutical Company Limited today announced that it has completed enrollment of 20,100 children and adolescents ages 4 through 16 in its global, pivotal Phase 3 Tetravalent Immunization against Dengue Efficacy Study (TIDES) trial, a double-blind, randomized and placebo-controlled study designed to evaluate the efficacy, safety and immunogenicity of its live-attenuated tetravalent dengue vaccine candidate (TAK-003).1 Takeda initiated the TIDES trial, the largest vaccine clinical trial for Takeda to date, in September 2016 and completed enrollment in less than seven months.1 …
“The successful enrollment of more than 20,000 children and adolescents in this Phase 3 trial, across several continents, and on an ambitious timeline, while maintaining a clear focus on quality and subject safety, reflects Takeda’s prioritization of dengue and the substantial capabilities of our global organization,” said Rajeev Venkayya, MD, President of the Global Vaccine Business Unit at Takeda…

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

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

American Journal of Tropical Medicine and Hygiene
Volume 96, Issue 4, 2017
http://www.ajtmh.org/content/current

Perspective Pieces
Impacts on Global Health from Nursing Research
Authors: Kimberly Baltzell, Monica McLemore, Mona Shattell and Sally Rankin
https://doi.org/10.4269/ajtmh.16-0918
Infectious disease continues to adversely affect populations in low- and middle-income countries. Investments in solutions often focus on technology, yet health-care workers remain in short supply. Nurses are the largest cadre of health-care workers and are largely responsible for patient care around the world. In fact, it is estimated that nurses care for nine out of every 10 patients seen. Importantly, sound nursing science contributes to solutions that directly impact patient care, especially those that pertain to infectious disease. Here we share several examples of nursing science that are improving care delivery in three global health areas: human immunodeficiency virus testing and prevention strategies in Malawi, family planning in Kenya, and response to Ebola virus disease.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 8 April 2017)

Research article
A systematic review of strategies to increase access to health services among children in low and middle income countries
Tess Bright, Lambert Felix, Hannah Kuper and Sarah Polack
BMC Health Services Research 2017 17:252
Published on: 5 April 2017
Abstract
Background
Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.
Methods
We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation -uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.
Results
Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.
Conclusions
This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 8 April 2017)

Research article
Modelling the therapeutic dose range of single low dose primaquine to reduce malaria transmission through age-based dosing
Low-dose primaquine is a key candidate for use in malaria transmission reduction and elimination campaigns such as mass drug administration (MDA). Uncertainty about the therapeutic dose range (TDR) required fo…
Daniel Joseph Hayes, Clifford George Banda, Alexandra Chipasula-Teleka and Dianne Janette Terlouw
BMC Infectious Diseases 2017 17:254
Published on: 8 April 2017

Research article
Decline in hospitalization for genital warts in the Veneto region after an HPV vaccination program: an observational study
Human papillomavirus (HPV) is one of the most common sexually transmitted pathogens. This observational study was conducted to estimate the trend of hospitalization for genital warts (GWs) in the Veneto region…
Silvia Cocchio, Tatjana Baldovin, Chiara Bertoncello, Alessandra Buja, Patrizia Furlan, Mario Saia and Vincenzo Baldo
BMC Infectious Diseases 2017 17:249
Published on: 5 April 2017

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 8 April 2017)

Debate
A critique of the regulation of data science in healthcare research in the European Union
John M. M. Rumbold and Barbara K. Pierscionek
BMC Medical Ethics 2017 18:27
Published on: 8 April 2017
Abstract
The EU offers a suitable milieu for the comparison and harmonisation of healthcare across different languages, cultures, and jurisdictions (albeit with a supranational legal framework), which could provide improvements in healthcare standards across the bloc. There are specific ethico-legal issues with the use of data in healthcare research that mandate a different approach from other forms of research. The use of healthcare data over a long period of time is similar to the use of tissue in biobanks. There is a low risk to subjects but it is impossible to gain specific informed consent given the future possibilities for research. Large amounts of data on a subject present a finite risk of re-identification. Consequently, there is a balancing act between this risk and retaining sufficient utility of the data. Anonymising methods need to take into account the circumstances of data sharing to enable an appropriate balance in all cases. There are ethical and policy advantages to exceeding the legal requirements and thereby securing the social licence for research. This process would require the examination and comparison of data protection laws across the trading bloc to produce an ethico-legal framework compatible with the requirements of all member states. Seven EU jurisdictions are given consideration in this critique.

BMC Medical Ethics

(Accessed 8 April 2017)

Research article
The ECOUTER methodology for stakeholder engagement in translational research
Madeleine J. Murtagh, Joel T. Minion, Andrew Turner, Rebecca C. Wilson, Mwenza Blell, Cynthia Ochieng, Barnaby Murtagh, Stephanie Roberts, Oliver W. Butters and Paul R Burton
BMC Medical Ethics 2017 18:24
Published on: 4 April 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 8 April 2017)

Research article
Ethical issues in public health surveillance: a systematic qualitative review
Corinna Klingler, Diego Steven Silva, Christopher Schuermann, Andreas Alois Reis, Abha Saxena and Daniel Strech
BMC Public Health 2017 17:295
Published on: 4 April 2017
Abstract
Background
Public health surveillance is not ethically neutral and yet, ethics guidance and training for surveillance programmes is sparse. Development of ethics guidance should be based on comprehensive and transparently derived overviews of ethical issues and arguments. However, existing overviews on surveillance ethics are limited in scope and in how transparently they derived their results. Our objective was accordingly to provide an overview of ethical issues in public health surveillance; in addition, to list the arguments put forward with regards to arguably the most contested issue in surveillance, that is whether to obtain informed consent.

Methods

Ethical issues were defined based on principlism. We assumed an ethical issue to arise in surveillance when a relevant normative principle is not adequately considered or two principles come into conflict. We searched Pubmed and Google Books for relevant publications. We analysed and synthesized the data using qualitative content analysis.

Results

Our search strategy retrieved 525 references of which 83 were included in the analysis. We identified 86 distinct ethical issues arising in the different phases of the surveillance life-cycle. We further identified 20 distinct conditions that make it more or less justifiable to forego informed consent procedures.

Conclusions

This is the first systematic qualitative review of ethical issues in public health surveillance resulting in a comprehensive ethics matrix that can inform guidelines, reports, strategy papers, and educational material and raise awareness among practitioners.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 8 April 2017)

Research article
Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage
Raveesha R. Mugali, Farooq Mansoor, Sardar Parwiz, Fazil Ahmad, Najibullah Safi, Ariel Higgins-Steele and Sherin Varkey
BMC Public Health 2017 17:290
Published on: 4 April 2017
Abstract
Background
Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births.

Methods

The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12–23 months.

Results

Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%).

Conclusion

The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Clinical Therapeutics
March 2017 Volume 39, Issue 3, p451-664
http://www.clinicaltherapeutics.com/issue/S0149-2918(17)X0003-9

Editorial
Current Insights in the Placebo and Nocebo Phenomena
Seetal Dodd, PhD
We have arranged a series of review and original research reports that are both up-to-date and timely. The articles are from leading researchers in different countries, and they provide insight into the range of ongoing research investigating the placebo and nocebo phenomena.

The word placebo has a Latin origin and a long history of use; however, the context in which the word is used has changed over time. Nocebo is a modern word that has been made up from the word placebo. In common usage, a placebo or nocebo effect occurs when an inert substance creates a beneficial or harmful effect in a person who takes it. The concept is also extended beyond the administration of inert substances.1 In a research setting, active placebos are pharmacologically active controls that are not considered to be effective for the index symptoms being treated. Active placebos have also been used in clinical settings, where an active agent has been given to a patient even though the pharmacologic action of the active agent is not known to be beneficial for treating the patient’s diagnosed condition, typically to meet a patient’s expectation that he or she will receive a treatment. Similarly, a nocebo response can occur with an inert or noninert substance as a worsening of the diagnosed condition or as treatment-emergent adverse effects. Moreover, when indication-appropriate active treatment is administered, the therapeutic effect may be a combination of the pharmacologic activity of the treating agent and a placebo effect, as demonstrated in an experiment of open and hidden analgesic administration using an infusion pump where pain relief was significantly reduced when the patients were unaware that an analgesic was being administered.2

It is also common usage to refer to all improvement in a placebo arm of a randomized clinical trial (RCT) as a placebo response and all worsening and adverse events as a nocebo response, even though fluctuation of symptoms occurs with the natural progression of many illnesses. It is often impossible to discern between a genuine placebo response and fluctuation in symptom severity that may have occurred without administering a placebo or between a nocebo response and highly prevalent physical ailments, such as headache or nausea. Consequently, the terms placebo and nocebo are used differently by different authors or even by the same authors when reporting different studies.

In placebo-controlled RCTs, a mean change in the primary outcome from baseline to treatment end point is commonly described as the placebo response. For researchers whose objectives is to demonstrate efficacy of treatment in the active arm of the RCT, it does not matter whether the change from baseline for individuals in the placebo arm of an RCT is a genuine placebo response driven by expectancy and the treatment environment or is attributable to fluctuations in illness severity that may occur during the illness. What matters to these researchers is that there is a statistically significant difference in outcome between participants in the placebo and active arms of the RCT. Alternatively, for researchers investigating the placebo phenomenon itself, experiments are tightly controlled to measure only the response to the placebo itself, typically, in healthy participants.

There is a need for considerable further research investigating the placebo and nocebo phenomena that will increase our scientific and theoretical knowledge about these phenomena and broaden our understanding of their clinical relevance. This requires researchers working in a broad range of fields.

In this issue of Clinical Therapeutics, experts in nocebo and placebo research contribute new insights into the mechanisms and characteristics of the phenomena. The article by Weimer et al3 reports an experiment on the placebo effects for treating nausea, investigating whether altering the levels of expectation of receiving an active agent when actually receiving a placebo can influence treatment outcomes. The article by by Bartels et al4 reports an experiment in which cognitive schemas with regard to memory and expectations are assessed as moderators of placebo and nocebo responses.

Also in this issue, Enck et al5 contribute a review article that describes a wealth of recent research into placebo and nocebo effects but highlights the gaps in current research. Two other review articles are contributed by researchers in Australia, Spain, and Portugal, one reviewing current knowledge regarding the scientific and theoretical basis of the nocebo and placebo phenomena6 and the other investigating the importance and effect of the nocebo and placebo phenomena in clinical research and clinical practice.7

This issue accurately represents the current understanding of the nocebo and placebo phenomena and the limitation in the current knowledge. Gaps still exist in the way placebo and nocebo are conceptualized. As suggested by Enck et al,5 gaps exist in our understanding of the basic science of the placebo response, especially outside placebo analgesia research. In addition, within clinical populations, identifying placebo and nocebo responders remains problematic. I hope that readers enjoy this issue and find it informative.

Clinical Therapeutics
March 2017 Volume 39, Issue 3, p451-664
http://www.clinicaltherapeutics.com/issue/S0149-2918(17)X0003-9

Reviews
Unsolved, Forgotten, and Ignored Features of the Placebo Response in Medicine
Paul Enck, Sibylle Klosterhalfen, Katja Weimer
p458–468
Published online: December 2, 2016

A Review of the Theoretical and Biological Understanding of the Nocebo and Placebo Phenomena
Seetal Dodd, Olivia M. Dean, João Vian, Michael Berk
p469–476
Published online: February 1, 2017

The Placebo and Nocebo Phenomena: Their Clinical Management and Impact on Treatment Outcomes
Victor Chavarria, João Vian, Círia Pereira, João Data-Franco, Brisa S. Fernandes, Michael Berk, Seetal Dodd
p477–486
Published online: February 22, 2017

Global Health Action
Volume 10, 2017 – Issue 1
http://www.tandfonline.com/toc/zgha20/10/1?nav=tocList

Review
The impact of the worldwide Millennium Development Goals campaign on maternal and under-five child mortality reduction: ‘Where did the worldwide campaign work most effectively?’
Seungman Cha
Article: 1267961
Published online: 07 Feb 2017

Rapid communication
The real-life number of neonatal doses of Bacille Calmette-Guérin vaccine in a 20-dose vial
Frederik Schaltz-Buchholzer, Hannah Nørtoft Frankel & Christine Stabell Benn
Article: 1267964
Published online: 27 Jan 2017

Review article
Who is a community health worker? – a systematic review of definitions
Abimbola Olaniran, Helen Smith, Regine Unkels, Sarah Bar-Zeev & Nynke van den Broek
Article: 1272223
Published online: 27 Jan 2017

Health Affairs
April 2017; Volume 36, Issue 4
http://content.healthaffairs.org/content/current
Issue Focus: Maternity Coverage, Children, Disability & More
Maternity & Children’s Coverage

State And Federal Coverage For Pregnant Immigrants: Prenatal Care Increased, No Change Detected For Infant Health
Laura R. Wherry, Rachel Fabi, Adam Schickedanz, and Brendan Saloner
Health Aff April 2017 36:607-615; doi:10.1377/hlthaff.2016.1198

Low-Income Children With Chronic Conditions Face Increased Costs If Shifted From CHIP To Marketplace Plans
Alon Peltz, Amy J. Davidoff, Cary P. Gross, and Marjorie S. Rosenthal
Health Aff April 2017 36:616-625; doi:10.1377/hlthaff.2016.1280

Global Health
Industry-Led Access-To-Medicines Initiatives In Low- And Middle-Income Countries: Strategies And Evidence
Peter C. Rockers, Veronika J. Wirtz, Chukwuemeka A. Umeh, Preethi M. Swamy, and Richard O. Laing
Health Aff April 2017 36:706-713; doi:10.1377/hlthaff.2016.1213
Abstract
Global biopharmaceutical companies are increasingly establishing access-to-medicines (AtM) initiatives in low- and middle-income countries. We reviewed the initiatives of twenty-one research-based global biopharmaceutical companies to assess their strategies for improving access and the quality of evidence on the impact of their initiatives. The number of operating initiatives increased from 17 in 2000 to 102 in 2015. Of the 120 different AtM initiatives identified, 48 percent used a medicine donation strategy, and 44 percent used a price reduction strategy. While companies have frequently claimed that their initiatives have had positive impacts, we found published evaluations for only seven initiatives, and nearly all of the evaluations were of low (62 percent) or very low (32 percent) quality. It is clear that the biopharmaceutical industry has increased its commitment to improving access to medicines in low- and middle-income countries. However, companies should do more to generate high-quality evidence on their initiatives, and the global health community should do more to assist the developing of evidence about the initiatives.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 8 April 2017]

Scoping Review
The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals
Mathieu Bangert, David H. Molyneux, Steve W. Lindsay, Christopher Fitzpatrick and Dirk Engels
Infectious Diseases of Poverty 2017 6:73
Published on: 4 April 2017
Abstract
The Sustainable Development Goals (SDGs) call for an integrated response, the kind that has defined Neglected Tropical Diseases (NTDs) efforts in the past decade.

NTD interventions have the greatest relevance for SDG3, the health goal, where the focus on equity, and its commitment to reaching people in need of health services, wherever they may live and whatever their circumstances, is fundamentally aligned with the target of Universal Health Coverage. NTD interventions, however, also affect and are affected by many of the other development areas covered under the 2030 Agenda. Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities (SDG6) are driven by effective global partnerships (SDG17). Intervention against the NTDs can also have an impact on poverty (SDG1) and hunger (SDG2), can improve education (SDG4), work and economic growth (SDG8), thereby reducing inequalities (SDG10). The community-led distribution of donated medicines to more than 1 billion people reinforces women’s empowerment (SDG5), logistics infrastructure (SDG9) and non-discrimination against disability (SDG16). Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability (SDG11) and resilience to climate change (SDG13), while the safe use of insecticides supports the goal of sustainable ecosystems (SDG15). Although indirectly, interventions to control water- and animal-related NTDs can facilitate the goals of small-scale fishing (SDG14) and sustainable hydroelectricity and biofuels (SDG7).

NTDs proliferate in less developed areas in countries across the income spectrum, areas where large numbers of people have little or no access to adequate health care, clean water, sanitation, housing, education, transport and information. This scoping review assesses how in this context, ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs.

JAMA
April 4, 2017, Vol 317, No. 13, Pages 1291-1388
http://jama.jamanetwork.com/issue.aspx

The JAMA Forum
April 4, 2017
Vaccines and the Trump Administration
Joshua M. Sharfstein, MD1
JAMA. 2017;317(13):1305-1306. doi:10.1001/jama.2017.2311
Initial Text
Writing recently in the New York Times, infectious disease physician Peter Hotez warned: “It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America.”

These fears have everything to do with the new administration in Washington, DC. During the campaign, Donald Trump met with discredited British physician Andrew Wakefield, who first alleged a connection between the measles, mumps, and rubella (MMR) vaccine and autism in a now-retracted Lancet article. Then, in a September 2015 primary debate, Trump himself suggested that vaccines cause autism. In January, Robert F. Kennedy Jr, known for his engagement with vaccine conspiracies, emerged from a meeting with the President-elect to claim that he will lead a new vaccine safety commission…

JAMA Pediatrics
April 1, 2017, Vol 171, No. 4, Pages 313-404
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint
Implementing Public Health Goals for Human Immunodeficiency Virus Infection Through Law
Rhonda Gay Hartman, JD JAMA Pediatr. 2017;171(4):315-316. doi:10.1001/jamapediatrics.2016.4366
This Viewpoint discusses laws that favor confidential access to HIV testing and treatment for adolescents, as a way of achieving public health goals for HIV infection.

Viewpoint
Social Justice and the Provision of Health Care for Poor Children
Andrew D. Racine, MD, PhD
JAMA Pediatr. 2017;171(4):316-317. doi:10.1001/jamapediatrics.2016.4567
This Viewpoint asks whether the provision of health care to underserved children is an act of social justice.

Journal of Infectious Diseases
Volume 215, Issue 5  1 March 2017
http://jid.oxfordjournals.org/content/current

OBITUARY
Donald Ainslie (D. A.) Henderson, MD, MPH (1928–2016) Smallpox Eradication: Leadership and Legacy

Viruses
Development of a Global Respiratory Severity Score for Respiratory Syncytial Virus Infection in Infants
Mary T. Caserta; Xing Qiu; Brenda Tesini; Lu Wang; Amy Murphy

Effectiveness of Human Papillomavirus Vaccination on Prevalence of Vaccine Genotypes in Young Sexually Active Women in France
Isabelle Heard; Laura Tondeur; Laurence Arowas; Marie Demazoin; Michaël Falguières …

Journal of the Royal Society – Interface
01 April 2017; volume 14, issue 129
http://rsif.royalsocietypublishing.org/content/current
Life Sciences–Mathematics interface
Research article:

Exploring the high-resolution mapping of gender-disaggregated development indicators
C. Bosco, V. Alegana, T. Bird, C. Pezzulo, L. Bengtsson, A. Sorichetta, J. Steele, G. Hornby, C. Ruktanonchai, N. Ruktanonchai, E. Wetter, A. J. Tatem
J.R. Soc. Interface 2017 14 20160825; DOI: 10.1098/rsif.2016.0825. Published 5 April 2017
Open Access
Abstract
Improved understanding of geographical variation and inequity in health status, wealth and access to resources within countries is increasingly being recognized as central to meeting development goals. Development and health indicators assessed at national or subnational scale can often conceal important inequities, with the rural poor often least well represented. The ability to target limited resources is fundamental, especially in an international context where funding for health and development comes under pressure. This has recently prompted the exploration of the potential of spatial interpolation methods based on geolocated clusters from national household survey data for the high-resolution mapping of features such as population age structures, vaccination coverage and access to sanitation. It remains unclear, however, how predictable these different factors are across different settings, variables and between demographic groups. Here we test the accuracy of spatial interpolation methods in producing gender-disaggregated high-resolution maps of the rates of literacy, stunting and the use of modern contraceptive methods from a combination of geolocated demographic and health surveys cluster data and geospatial covariates. Bayesian geostatistical and machine learning modelling methods were tested across four low-income countries and varying gridded environmental and socio-economic covariate datasets to build 1×1 km spatial resolution maps with uncertainty estimates. Results show the potential of the approach in producing high-resolution maps of key gender-disaggregated socio-economic indicators, with explained variance through cross-validation being as high as 74–75% for female literacy in Nigeria and Kenya, and in the 50–70% range for many other variables. However, substantial variations by both country and variable were seen, with many variables showing poor mapping accuracies in the range of 2–30% explained variance using both geostatistical and machine learning approaches. The analyses offer a robust basis for the construction of timely maps with levels of detail that support geographically stratified decision-making and the monitoring of progress towards development goals. However, the great variability in results between countries and variables highlights the challenges in applying these interpolation methods universally across multiple countries, and the importance of validation and quantifying uncertainty if this is undertaken.

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

Comment
Eliminating maternal and neonatal tetanus and closing the immunity gap
Craig Burgess, Francois Gasse, Robert Steinglass, Ahmadu Yakubu, Azhar Abid Raza, Kari Johansen
Summary
Although progress has been made in achieving maternal and neonatal tetanus elimination (MNTE), WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) noted at its October, 2016, meeting that the 2015 goal for MNTE had been missed. Maternal and neonatal tetanus is still to be eliminated in 18 countries (Afghanistan, Angola, Central African Republic, Chad, DR Congo, Ethiopia, Guinea, Haiti, Kenya, Mali, Nigeria, Pakistan, Papua New Guinea, Philippines, Somalia, Sudan, South Sudan, and Yemen).

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

Series
America: Equity and Equality in Health
Mass incarceration, public health, and widening inequality in the USA
Christopher Wildeman, Emily A Wang
Summary
In this Series paper, we examine how mass incarceration shapes inequality in health. The USA is the world leader in incarceration, which disproportionately affects black populations. Nearly one in three black men will ever be imprisoned, and nearly half of black women currently have a family member or extended family member who is in prison. However, until recently the public health implications of mass incarceration were unclear. Most research in this area has focused on the health of current and former inmates, with findings suggesting that incarceration could produce some short-term improvements in physical health during imprisonment but has profoundly harmful effects on physical and mental health after release. The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs.

The Lancet
Apr 08, 2017 Volume 389 Number 10077 p1369-1490 e5
http://www.thelancet.com/journals/lancet/issue/current

America: Equity and Equality in Health
Population health in an era of rising income inequality: USA, 1980–2015
Jacob Bor, Gregory H Cohen, Sandro Galea
Summary
Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution—ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 8 April 2017)

Research Article
Demographic transition and the dynamics of measles in six provinces in China: A modeling study
Sheng Li, Chao Ma, Lixin Hao, Qiru Su, Zhijie An, Fubao Ma, Shuyun Xie, Aiqiang Xu, Yanyang Zhang, Zhengrong Ding, Hui Li, Lisa Cairns, Huaqing Wang, Huiming Luo, Ning Wang, Li Li, Matthew J. Ferrari
| published 04 Apr 2017 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002255

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 8 April 2017)

Research Article
Development of a glycoconjugate vaccine to prevent invasive Salmonella Typhimurium infections in sub-Saharan Africa
Scott M. Baliban, Mingjun Yang, Girish Ramachandran, Brittany Curtis, Surekha Shridhar, Rachel S. Laufer, Jin Y. Wang, John Van Druff, Ellen E. Higginson, Nicolas Hegerle, Kristen M. Varney, James E. Galen, Sharon M. Tennant, Andrew Lees, Alexander D. MacKerell Jr., Myron M. Levine, Raphael Simon
| published 07 Apr 2017 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005493

PLoS One
http://www.plosone.org/
[Accessed 8 April 2017]

Research Article
Universal vaccine against respiratory syncytial virus A and B subtypes
Jeong-Yoon Lee, Jun Chang
Research Article | published 06 Apr 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0175384

Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain
Jordi Càmara, José María Marimón, Emilia Cercenado, Nieves Larrosa, María Dolores Quesada, Dionísia Fontanals, Meritxell Cubero, Emilio Pérez-Trallero, Asunción Fenoll, Josefina Liñares, Carmen Ardanuy
Research Article | published 06 Apr 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0175224

Cost-effectiveness of dengue vaccination in Yucatán, Mexico using a dynamic dengue transmission model
Eunha Shim
Research Article | published 05 Apr 2017 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0175020

Public Health Ethics
Volume 10, Issue 1   April 2017
http://phe.oxfordjournals.org/content/current

Original Articles
Research Ethics Governance in Times of Ebola
Doris Schopper; Raffaella Ravinetto; Lisa Schwartz; Eunice Kamaara; Sunita Sheel …
Abstract
The Médecins Sans Frontières (MSF) ethics review board (ERB) has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.

Science         
07 April 2017  Vol 356, Issue 6333
http://www.sciencemag.org/current.dtl

Books et al. – Reproducibility
On rigor and replication
Leonard P. Freedman
Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hopes, and Wastes Billions Richard Harris Basic Books, 2017. 288 pp.
Summary
In Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hopes, and Wastes Billions, a sensationalistic title belies a carefully crafted book about data reproducibility and scientific rigor in biomedical research. Although the book breaks no new ground, at a time when the so-called “irreproducibility crisis” has stoked passionate debate among scientists, bewil­dered the public, and even launched new disciplines (e.g., metaresearch), an accessible overview of the problem is most welcome.

Science
07 April 2017 Vol 356, Issue 6333
http://www.sciencemag.org/current.dtl

Policy Forum
Global Fund lessons for Sustainable Development Goals
By Jeffrey D. Sachs, Guido Schmidt-Traub
Science07 Apr 2017 : 32-33 Restricted Access
Summary
The Global Fund to Fight AIDS, Tuberculosis (TB), and Malaria (GF) was launched in 2001 in the context of the AIDS pandemic and the Millennium Development Goals (MDGs). Thanks in large part to key design principles (DPs), the GF public-private partnership has played a major role in advancing public health science and in scaling up and strengthening evidence-based public health efforts in developing countries. As world leaders prepare to advance international development finance at the July 2017 Group of 20 (G20) Summit, we suggest the GF as a template for funding research, development, and scale-up of interventions in both health and non-health areas of the Sustainable Development Goals (SDGs), which replaced MDGs in 2016.

Science
07 April 2017 Vol 356, Issue 6333
http://www.sciencemag.org/current.dtl

The applied value of public investments in biomedical research
By Danielle Li, Pierre Azoulay, Bhaven N. Sampat
Science07 Apr 2017 : 78-81 Full Access
For biomedical patents, basic research is just as valuable as applied research.
Patents from papers both basic and applied
Public funding for research depends on the idea that the resulting knowledge translates into socially valuable outcomes, such as medicines. Such linkages are easier to assert than to prove. Li et al. studied 27 years of grant-level funding by the U.S. National Institutes of Health. About 10% of grants are directly cited by patents, suggesting some technological application, and 30% of grants are cited in research articles that are then cited in patents. Five percent of grants result in papers cited by patents for successfully approved drugs, compared with less than 1% that are cited directly by such patents. These patterns hold regardless of whether the research is more basic or applied.
Abstract
Scientists and policy-makers have long argued that public investments in science have practical applications. Using data on patents linked to U.S. National Institutes of Health (NIH) grants over a 27-year period, we provide a large-scale accounting of linkages between public research investments and subsequent patenting. We find that about 10% of NIH grants generate a patent directly but 30% generate articles that are subsequently cited by patents. Although policy-makers often focus on direct patenting by academic scientists, the bulk of the effect of NIH research on patenting appears to be indirect. We also find no systematic relationship between the “basic” versus “applied” research focus of a grant and its propensity to be cited by a patent.

Social Science & Medicine
Volume 177, Pages 1-288 (March 2017)
http://www.sciencedirect.com/science/journal/02779536/177

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review
Original Research Article
Pages 1-8
Elina Miteniece, Milena Pavlova, Bernd Rechel, Wim Groot
Abstract
Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care.
This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists.
Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it.
Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.

Social Science & Medicine
Volume 177, Pages 1-288 (March 2017)
http://www.sciencedirect.com/science/journal/02779536/177

Adapting public policy theory for public health research: A framework to understand the development of national policies on global health
Original Research Article
Pages 69-77
Catherine M. Jones, Carole Clavier, Louise Potvin
Abstract
National policies on global health appear as one way that actors from health, development and foreign affairs sectors in a country coordinate state action on global health. Next to a burgeoning literature in which international relations and global governance theories are employed to understand global health policy and global health diplomacy at the international level, little is known about policy processes for global health at the national scale. We propose a framework of the policy process to understand how such policies are developed, and we identify challenges for public health researchers integrating conceptual tools from political science. We developed the framework using a two-step process: 1) reviewing literature to establish criteria for selecting a theoretical framework fit for this purpose, and 2) adapting Real-Dato’s synthesis framework to integrate a cognitive approach to public policy within a constructivist perspective. Our framework identifies multiple contexts as part of the policy process, focuses on situations where actors work together to make national policy on global health, considers these interactive situations as spaces for observing external influences on policy change and proposes policy design as the output of the process. We suggest that this framework makes three contributions to the conceptualisation of national policy on global health as a research object. First, it emphasizes collective action over decisions of individual policy actors. Second, it conceptualises the policy process as organised interactive spaces for collaboration rather than as stages of a policy cycle. Third, national decision-making spaces are opportunities for transferring ideas and knowledge from different sectors and settings, and represent opportunities to identify international influences on a country’s global health policy. We discuss two sets of challenges for public health researchers using interdisciplinary approaches in policy research.

Social Science & Medicine
Volume 177, Pages 1-288 (March 2017)
http://www.sciencedirect.com/science/journal/02779536/177

Impact of health financing policies in Cambodia: A 20 year experience
Original Research Article
Pages 118-126
Tim Ensor, Chhim Chhun, Ton Kimsun, Barbara McPake, Ijeoma Edoka
Abstract
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting.
Multiple rounds of the Cambodia Socio-Economic Survey are used to investigate the impact of financing policies on health service utilisation and out of pocket payments both over time using commune panel data from 1997 to 2011 and across groups using individual data from 2004 and 2009. Policy combinations including areas with multiple interventions were examined against controls using difference-in-difference and panel estimation.
Widespread roll-out of financing policies combined with user charge formalisation has led to a general reduction in health spending by the poor. Equity funds are associated with a reduction in out of pocket payments although the effect of donor schemes is larger than those financed by government. Vouchers, which are aimed only at reproductive health services, has a more modest impact that is enhanced when combined with other schemes. At the aggregate level changes are less pronounced although there is evidence that policies take a number of years to have substantial effect.
Health financing policies and the supportive systems that they require provide a foundation for more radical extension of coverage already envisaged by a proposed social insurance system. A policy challenge is how disparate mechanisms can be integrated to ensure that vulnerable groups remain protected.

Tropical Medicine & International Health
April 2017 Volume 22, Issue 4 Pages 371–512
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2017.22.issue-4/issuetoc

Original Research Papers
Determining the effective coverage of maternal and child health services in Kenya, using demographic and health survey data sets: tracking progress towards universal health coverage (pages 442–453)
Peter K. Nguhiu, Edwine W. Barasa and Jane Chuma
Version of Record online: 7 FEB 2017 | DOI: 10.1111/tmi.12841

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Conference report
Report of the WHO technical consultation on the effect of maternal influenza and influenza vaccination on the developing fetus: Montreal, Canada, September 30–October 1, 2015
Pages 2279-2287
Deshayne B. Fell, Zulfiqar A. Bhutta, Jennifer A. Hutcheon, Ruth A. Karron, Marian Knight, Michael S. Kramer, Arnold S. Monto, Geeta K. Swamy, Justin R. Ortiz, David A. Savitz
Abstract
In 2012, the World Health Organization (WHO) released a position paper on influenza vaccination recommending that pregnant women have the highest priority for seasonal vaccination in countries where the initiation or expansion of influenza immunization programs is under consideration. Although the primary goal of the WHO recommendation is to prevent influenza illness in pregnant women, the potential benefits of maternal immunization in protecting young infants are also recognized. The extent to which maternal influenza vaccination may prevent adverse birth outcomes such as preterm birth or small-for-gestational-age birth, however, is unclear as available studies are in disagreement.
To inform WHO about the empirical evidence relating to possible benefits of influenza vaccination on birth outcomes, a consultation of experts was held in Montreal, Canada, September 30–October 1, 2015. Presentations and discussions covered a broad range of issues, including influenza virus infection during pregnancy and its effect on the health of the mother and the fetus, possible biological mechanisms for adverse birth outcomes following maternal influenza illness, evidence on birth outcomes following influenza illness during pregnancy, evidence from both observational studies and randomized controlled trials on birth outcomes following influenza vaccination of pregnant women, and methodological issues. This report provides an overview of the presentations, discussions and conclusions.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Commentaries
Informing pneumococcal conjugate vaccine policy in middle-income countries: The case of Malaysia
Pages 2288-2290
Serena Tricarico, Hannah C. McNeil, Michael G. Head, David W. Cleary, Stuart C. Clarke, on behalf of MYCarriage

Consensus statement from 17 relevant Japanese academic societies on the promotion of the human papillomavirus vaccine
Pages 2291-2292
Satoshi Iwata, Kenji Okada, Kei Kawana, Expert Council on Promotion of Vaccination

Rabies: Still a silent killer targeting the poor
Pages 2293-2294
Henry Wilde, Siriporn Ghai, Thiravat Hemachudha

Short communications
Cognitive testing to evaluate revisions to the Vaccine Adverse Event Reporting System (VAERS) reporting form
Pages 2295-2297
Tiffany A. Suragh, Elaine R. Miller, Beth F. Hibbs, Scott K. Winiecki, Craig Zinderman, Tom T. Shimabukuro

Measuring maternal Tdap and influenza vaccination rates: Comparison of two population-based methods
Pages 2298-2302
Ruth Koepke, Stephanie L. Schauer, Jeffrey P. Davis

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Reviews
Lower vaccine uptake amongst older individuals living alone: A systematic review and meta-analysis of social determinants of vaccine uptake
Review Article
Pages 2315-2328
Anu Jain, A.J. van Hoek, Delia Boccia, Sara L. Thomas
Abstract
Introduction
Vaccination is a key intervention to reduce infectious disease mortality and morbidity amongst older individuals. Identifying social factors for vaccine uptake enables targeted interventions to reduce health inequalities.
Objective
To systematically appraise and quantify social factors associated with vaccine uptake amongst individuals aged ≥60 years from Europe.
Methods
We searched Medline and Embase from inception to 24/02/2016. The association of vaccine uptake was examined for social factors relevant at an individual level, to provide insight into individuals’ environment and enable development of targeted interventions by healthcare providers to deliver equitable healthcare. Factors included: living alone, marital status, education, income, vaccination costs, area-level deprivation, social class, urban versus rural residence, immigration status and religion. Between-study heterogeneity for each factor was identified using I2-statistics and Q-statistics, and investigated by stratification and meta-regression analysis. Meta-analysis was conducted, when appropriate, using fixed- or random-effects models.
Results
From 11,754 titles, 35 eligible studies were identified (uptake of: seasonal influenza vaccine (SIV) only (n = 27) or including pneumococcal vaccine (PV) (n = 5); herpes zoster vaccine (n = 1); pandemic influenza vaccine (n = 1); PV only (n = 1)). Higher SIV uptake was reported for individuals not living alone (summary odds ratios (OR) = 1.39 (95% confidence interval (CI): 1.16–1.68). Lower SIV uptake was observed in immigrants and in more deprived areas: summary OR = 0.57 (95%CI: 0.47–0.68) and risk ratio = 0.93 (95%CI: 0.92–0.94) respectively. Higher SIV uptake was associated with higher income (OR = 1.26 (95%CI: 1.08–1.47)) and higher education (OR = 1.05 (95%CI: 1–1.11)) in adequately adjusted studies. Between-study heterogeneity did not appear to result from variation in categorisation of social factors, but for education was partly explained by varying vaccination costs (meta-regression analysis p = <0.0001); individuals with higher education had higher vaccine uptake in countries without free vaccination.
Conclusions
Quantification of associations between social factors and lower vaccine uptake, and notably living alone (an overlooked factor in vaccination programmes), should enable health professionals target specific social groups to tackle vaccine-related inequalities.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Off-label use of vaccines
Review Article
Pages 2329-2337
Pieter Neels, James Southern, Jon Abramson, Philippe Duclos, Joachim Hombach, Melanie Marti, Alanna Fitzgerald-Husek, Jacqueline Fournier-Caruana, Germaine Hanquet
Abstract
This article reviews the off-label recommendations and use of vaccines, and focuses on the differences between the labelled instructions on how to use the vaccine as approved by the regulatory authorities (or “label”1), and the recommendations for use issued by public health advisory bodies at national and international levels. Differences between public health recommendations and the product label regarding the vaccine use can lead to confusion at the level of vaccinators and vaccinees and possibly result in lower compliance with national vaccination schedules. In particular, in many countries, the label may contain regulatory restrictions and warnings against vaccination of specific population groups (e.g. pregnant women) due to a lack of evidence of safety from controlled trials at the time of initial licensure of the vaccine, while public health authorities may recommend the same vaccine for that group, based on additional post-marketing data and benefit risk analyses.
We provide an overview of the different responsibilities between regulatory authorities and public health advisory bodies, and the rationale for off-label use2 of vaccines, the challenges involved based on the impact of off-label use in real-life. We propose to reduce off-label use of vaccines by requiring the manufacturer to regularly adapt the label as much as possible to the public health needs as supported by new evidence. This would require manufacturers to collect and report post-marketing data, communicate them to all stakeholders and regulators to extrapolate existing evidence (when acceptable) to other groups or to other brands of a vaccine (class effect3). Regulatory authorities have a key role to play by requesting additional post-marketing data, e.g. in specific target groups. When public health recommendations for vaccine use that are outside labelled indications are considered necessary, good communication between regulatory bodies, public health authorities, companies and health care providers or vaccinators is crucial. Recommendations as well as labels and label changes should be evidence-based. The rationale for the discrepancy and the recommended off-label use of a vaccine should be communicated to providers.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Regular papers
Predictors of influenza vaccination in the U.S. among children 9–13 years of age
Original Research Article
Pages 2338-2342
Teresa M. Imburgia, Kristin S. Hendrix, Kelly L. Donahue, Lynne A. Sturm, Gregory D. Zimet
Abstract
Background and objectives
U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014–2015 were 62% for 5–12 year olds, dropping to 47% for 13–17 year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9–13 year old children.
Methods
An online U.S. survey of mothers of children aged 9–13 assessed children’s influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status.
Results
There were 2363 respondents (Mean age = 38 years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6 years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p = n.s.).
Conclusions
This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Moving the needle on nursing staff influenza vaccination in long-term care: Results of an evidence-based intervention
Original Research Article
Pages 2390-2395
Cori L. Ofstead, Miriam R. Amelang, Harry P. Wetzler, Litjen Tan
Abstract
Purpose
Influenza vaccination rates among healthcare providers (HCPs) in long-term care facilities (LTCFs) are commonly below the Healthy People 2020 goal of 90%. This study was conducted to develop and evaluate an intervention program designed to increase influenza uptake among HCPs in LTCFs.
Methods
This study was conducted in four Midwestern LTCFs. Baseline interviews, surveys, and administrative data analysis were performed following the 2013–2014 influenza season. Interventions implemented during the 2014–2015 season were based on the health belief and ecological models and included goal-setting worksheets, policy development, educational programs, kick-off events, incentives, a vaccination tracking roster, and facility-wide communication about vaccine uptake among HCPs. Outcomes were evaluated in 2015.
Results
At baseline, 50% of 726 nursing staff employed during the 2013–2014 influenza season had documented receipt of influenza vaccine (Site A: 34%; Site B: 5%; Site C: 75%; Site D: 62%), and 31% of 347 survey respondents reported absenteeism due to respiratory illness. At follow-up, 85% of HCPs had documented receipt of influenza vaccine (p < 0.01) and 19% of 323 survey respondents reported absenteeism due to respiratory illness (p < 0.01). Vaccination rates among respondents’ family members increased from 31% at baseline to 44% post-intervention (p < 0.01). Reasons for declining vaccination did not change following exposure to educational programs, but HCPs were more likely to recommend vaccination to others after program implementation.
Conclusions
Vaccination rates among long-term care HCPs and their family members increased significantly and HCP absenteeism decreased after the implementation of multifaceted interventions based on an ecological model. The findings suggest that major increases in HCP vaccination can be achieved in LTCFs. More research is needed to evaluate the impact of increased HCP vaccination on the health and productivity of LTCF employees, their family members, and residents.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries
Original Research Article
Pages 2479-2488
Catherine Arsenault, Mira Johri, Arijit Nandi, José M. Mendoza Rodríguez, Peter M. Hansen, Sam Harper
Abstract
Background
Important inequalities in childhood vaccination coverage persist between countries and population groups. Understanding why some countries achieve higher and more equitable levels of coverage is crucial to redress these inequalities. In this study, we explored the country-level determinants of (1) coverage of the third dose of diphtheria-tetanus-pertussis- (DTP3) containing vaccine and (2) within-country inequalities in DTP3 coverage in 45 countries supported by Gavi, the Vaccine Alliance.
Methods
We used data from the most recent Demographic and Health Surveys (DHS) conducted between 2005 and 2014. We measured national DTP3 coverage and the slope index of inequality in DTP3 coverage with respect to household wealth, maternal education, and multidimensional poverty. We collated data on country health systems, health financing, governance and geographic and sociocultural contexts from published sources. We used meta-regressions to assess the relationship between these country-level factors and variations in DTP3 coverage and inequalities. To validate our findings, we repeated these analyses for coverage with measles-containing vaccine (MCV).
Results
We found considerable heterogeneity in DTP3 coverage and in the magnitude of inequalities across countries. Results for MCV were consistent with those from DTP3. Political stability, gender equality and smaller land surface were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities in DTP3 coverage were also lower in countries receiving more external resources for health, with lower rates of out-of-pocket spending and with higher national coverage. Greater government spending on heath and lower linguistic fractionalization were also consistent with better vaccination outcomes.
Conclusion
Improving vaccination coverage and reducing inequalities requires that policies and programs address critical social determinants of health including geographic and social exclusion, gender inequality and the availability of financial protection for health. Further research should investigate the mechanisms contributing to these associations.

Vaccine
Volume 35, Issue 18, Pages 2279-2530 (25 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/18

Knowledge, attitudes, beliefs, and behaviors of university students, faculty, and staff during a meningococcal serogroup B outbreak vaccination program
Original Research Article
Pages 2520-2530
D.M. MacDougall, J.M. Langley, L. Li, L. Ye, D. MacKinnon-Cameron, K.A. Top, S.A. McNeil, B.A. Halperin, A. Swain, J.A. Bettinger, E. Dubé, G. De Serres, S.A. Halperin, for the Canadian Immunization Research Network
Abstract
Objectives
During an outbreak of invasive meningococcal B disease on a university campus, we explored the knowledge, attitudes, beliefs, and behaviors of members of the university community in relation to the disease, the vaccine, and the vaccination program.
Design
All students, faculty and staff were invited by email to participate in a 71-item online survey, which was administered after completion of the mass clinics for the first and second doses of a meningococcal B vaccination program.
Results
A total of 404 individuals responded to the survey; 75.7% were students. Knowledge about meningococcal disease and vaccine was generally high; more than 70% correct responses were received on each knowledge question except for one question about the different meningococcal serogroups. Gender (female) and higher knowledge scores were significantly associated with either being immunized or intending to be immunized (p < 0.05). Positive attitudes about immunization, concern about meningococccal infection, a sense of community responsibility, and trust in public health advice also correlated with being vaccinated or intending to be vaccinated (p < 0.05).

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

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

BBC
http://www.bbc.co.uk/
Accessed 8 April 2017
Vaccine credited with HPV virus reduction in Scotland
Published Date 5 Apr 2017

Nigeria meningitis: Vaccine cost cripples response to outbreak
3 April 2017
Nigeria does not have enough vaccine doses to deal with a deadly meningitis outbreak because they are too expensive, a senior official has said.
Each vaccine dose costs $50, and only 500,000 doses are currently available, Dr Chikuwe Ihekuwazu, head of Nigeria’s Centre for Disease Control said.
The outbreak which is said to be spreading rapidly has already killed more than 300 people.
It is the worst to hit Nigeria since 2009 when it killed 156 people…

Forbes
http://www.forbes.com/
Accessed 8 April 2017
UNICEF USA How To Close The Immunization Gap? Summon The Spirit Of Jim Grant
Adam Fifield, UNICEF USA
6 April 2017
How can we close the immunization gap? Two decades after the death of UNICEF’s visionary leader, the solution may be: “What would Jim Grant do?”

Doctors Should Be Talking To Teens And Parents About MenB Vaccination
Tara Haelle, Contributor
6 April 2017
A group of mothers whose teens died from meningococcal disease want other parents to know how to prevent it.

The Guardian
http://www.guardiannews.com/
Accessed 8 April 2017
Unvaccinated children would be barred from childcare in NSW under new proposals
Labor opposition leader Luke Foley says legislation intends to stop specialist anti-vaccination childcare centres being set up
Australian Associated Press
Saturday 1 April 2017 22.19 EDT Last modified on Sunday 2 April 2017 00.27 EDT
Parents who oppose vaccinations on conscientious grounds won’t allowed to enrol their children at New South Wales childcare centres under legislation to be introduced by the state opposition.
The state’s Labor leader, Luke Foley, announced the policy on Sunday and said the legislation, set to be introduced this week, would plug the loophole which had allowed specialist anti-vaccination childcare centres to be set up.
The changes won’t affect children who can’t be vaccinated for medical reasons, such as a specialised cancer treatment.
“We need to be encouraging vaccinations not discouraging them,” Foley said in a statement. “Vaccinations are the only way to protect against serious diseases like polio, mumps, whooping cough, meningococcal, diphtheria and tetanus.”…

New York Times
http://www.nytimes.com/
Accessed 8 April 2017
Meningitis Epidemic Kills 336 Children in Nigeria
A statement Tuesday says most victims are between 5 and 14. Some 500,000 doses of vaccine have arrived in Zamfara, where the disease surfaced. But officials say 2 million doses are needed and
April 04, 2017

DOJ: For Decade, Sanofi Vaccine Unit Overcharged VA on Meds
The vaccines unit of French pharmaceutical company Sanofi SA will pay a $19.9 million fine for overcharging the U.S. Department of Veterans Affairs for two products between 2002 and 2011.
By law, drug manufacturers cannot charge the VA more than a maximum level called the Federal Ceiling Price for drugs.
The Justice Department said Monday that Sanofi Pasteur notified the VA that it had incorrectly calculated the price for some medicines from 2007 to 2011, and thereby overcharged the VA.
An investigation by the VA’s Office of Inspector General then determined the overcharges dated back to 2002.
Sanofi Pasteur, based in Swiftwater, Pennsylvania, also agreed not to seek reimbursement for sales where it undercharged the VA.
The government did not identify the products involved.
April 03, 2017 – By THE ASSOCIATED PRESS

Washington Post
http://www.washingtonpost.com/
Accessed 8 April 2017
Africa
Massive measles vaccination campaign launches in Guinea
By Associated Press April 7
DAKAR, Senegal — Doctors Without Borders says it is launching a massive measles vaccination campaign with Guinea’s government after at least 14 deaths and more than 3,400 cases were confirmed so far this year.
The aid group said Friday that thousands of people were left unprotected in 2014 and 2015 when the Ebola outbreak swept through the West African nation. Vaccination activities were reduced because of infection risks, and frightened families stayed away from health facilities.
A measles epidemic was declared in February despite a vaccination campaign a year ago…

Milestones :: Perspectives :: Featured Journal Content

2017 CANADA GAIRDNER AWARDS RECOGNIZE BASIC AND TRANSFORMATIVE RESEARCH IN CANADA AND INTERNATIONALLY
TORONTO, ON (March 28, 2017) – The Gairdner Foundation is pleased to announce the 2017 Canada Gairdner Award laureates, recognizing some of the most significant medical discoveries from around the world. The Awards carry an honorarium of $100,000 for each of the seven awards and will be presented at a Gala in Toronto on October 26, 2017.
[Among the laureates:]
Dr. Rino Rappuoli
Chief Scientist and Head External R&D at GSK Vaccines, Siena, Italy
Awarded “For pioneering the genomic approach, known as reverse vaccinology, used to develop a vaccine against meningococcus B which has saved many lives worldwide”
The work:
Dr. Rappuoli is a pioneer in the world of vaccines and has introduced several novel scientific
concepts. First, he introduced the concept that bacterial toxins can be detoxified by manipulation of their genes (genetic detoxification, 1987). Next, the concept that microbes are better studied in the context of the cells they interact with (cellular microbiology, 1996), and then the use of genomes to develop new vaccines (reverse vaccinology, 2000). In the process of reverse vaccinology, the entire genomic sequence of a pathogen is screened using
bioinformatics tools to help determine which genes code for which proteins, against which vaccines can be developed.
The impact:
Dr. Rappuoli also worked on several molecules which became part of licensed vaccines. He characterized a molecule, CRM197, that today is the most widely used carrier for vaccines against Haemophilus influenzae, meningococcus and pneumococcus. Later he developed a vaccine against pertussis containing genetically detoxified pertussis toxin and the first conjugate vaccine against meningococcus C that eliminated the disease in the United Kingdom in 2000. His work on reverse vaccinology led to the licensure of the first meningococcus B vaccine approved in Europe and Canada in 2013 and USA in 2015.

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NFID Honors Three Infectious Disease Heroes and Issues Call for 2018 Nominations
Bethesda, MD (March 30, 2017) – The National Foundation for Infectious Diseases (NFID) will celebrate three infectious disease heroes during the 2017 annual awards dinner on the evening of May 18 and is calling for nominations for 2018 awards – a landmark year that commemorates the 45th year anniversary of NFID.
This year, NFID will honor:
:: Peter Piot, MD, PhD, as recipient of the 2017 Jimmy and Rosalynn Carter Humanitarian Award in recognition of his lifetime public health contributions and leadership, including his role in the first isolation of the Ebola virus and outbreak investigation, his early AIDS research in Africa, his leadership of the global AIDS response and his service as head of the London School of Hygiene & Tropical Medicine.
:: Myron M. Levine, MD, who will receive the 2017 Maxwell Finland Award for Scientific Achievement for his unparalleled accomplishments in public health to identify solutions to major sources of disease in the developing world including cholera, typhoid and Shigella dysentery.
:: Thomas M. File, Jr., MD, who will receive the 2017 John P. Utz Leadership Award in recognition of his commitment as a national leader in infectious diseases and an exceptional teacher, clinician, scientist and prolific contributor to the infectious disease literature, including his work on the diagnosis, prevention and treatment of pneumonia…

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Featured Journal Content

Vaccine
Volume 35, Issue 17, Pages 2101-2278 (19 April 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/17
Building Next Generation Immunization Supply Chains
Edited by Bruce Y. Lee, Benjamin Schreiber and Raja Rao
Twenty-nine articles organized under thematic areas:
:: Making the Case: how immunization supply chains impact vaccine coverage
:: Challenges
:: Toward next generation supply chains: Successful pilots
:: Toward next generation supply chains: Promising ideas and innovations
:: Toward next generation supply chains: Upstream solutions

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Global Immunization Impact Constrained by Outdated Vaccine Delivery Systems, Researchers Say
Press release | March 30, 2017 [Issued by PATH and WHO]
New research finds persistent stockouts and exposure to freezing are among problems in vaccine supply chains designed during an era with fewer childhood immunizations

SEATTLE, 30 March 2017—Outdated vaccine supply and distribution systems are delaying and limiting the impact that vaccines have on safeguarding people’s health, according to the editors of a collection of new articles published today in Vaccine journal. Among the challenges of ensuring a consistent supply of potent vaccines identified by researchers: one in every three countries in the world experiences at least one stockout of at least one vaccine for at least one month; and 19 to 38 percent of vaccines worldwide are accidentally exposed to freezing temperatures, potentially compromising the potency of those vaccines.

Some countries are implementing changes and adopting new technologies like solar “direct drive” refrigerators and redesigning delivery systems. These changes are helping increase vaccine availability and coverage, even in more remote areas, according to the editors.

The 29 articles are part of a special supplement to Vaccine coordinated by the global health nonprofit, PATH—with guest editors from the Bill & Melinda Gates Foundation, UNICEF, and the Johns Hopkins Bloomberg School of Public Health—that identify challenges and point to solutions that countries can employ to modernize their immunization supply chains.

need them most,” says Steve Davis, president and CEO of PATH. “We need to apply the same ambitious investments to vaccine delivery as we apply to vaccine development.”

According to the World Health Organization (WHO), vaccines prevent an estimated 2 to 3 million deaths every year, but an additional 1.5 million deaths could be avoided if global immunization coverage improves. In 2015, an estimated 19.4 million infants worldwide did not receive routine immunizations.

“We must act to close the global immunization gap,” says Dr. Matshidiso Moeti, WHO regional director for Africa. “Achieving the Global Vaccine Action Plan goal of universal access to immunization by 2020 would benefit the health of millions of Africans.”
Immunization supply chains—the network of staff, equipment, vehicles, and data needed to get vaccines safely from the manufacturer to the people who need them—were first developed in the late 1970s with the establishment of the Expanded Program on Immunization.

Since 2010, however, immunization services have expanded with additional vaccines. Immunization programs are storing and transporting four times the volume of vaccines, according to WHO, and health care workers are administering up to six times as many doses per person, including to older children, adolescents, and adults.

“Too many children still lack access to lifesaving vaccines because of outdated and inefficient supply chains.” says Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Unless we drive change and deliver comprehensive improvements now, countries won’t have the systems in place to protect the next generation of children, particularly the most vulnerable.”…

Emergencies

WHO Grade 3 Emergencies [to 1 April 2017]
Iraq –
Iraq: Within hours of opening its doors, Athbah trauma field hospital treats casualties from west Mosul
29 March 2017 – Mosul, Iraq — With medical capacities to treat severely wounded people significantly reduced due to conflict and coupled with the increased trend of traumatic injuries among civilians, the World Health Organization, the Federal Ministry of Health and Ninewa Department of Health has opened a trauma field hospital in Athba.

South Sudan –
WHO’s famine response plan in South Sudan focuses on working with partners to prevent spread of diseases amongst people weakened by food insecurity
Juba, 30 March 2017 – The World Health Organization (WHO) continues to scale up its response to reduce preventable deaths and diseases, and provide health services in famine-affected areas of South Sudan. In February 2017, famine was declared in the former Unity State, where 100 000 people face starvation and another 1 million are on the brink of famine.

WHO joins partners at South Sudan’s National Health Summit to build a resilient health system and attain greater access to health services
Juba, 27 March 2017— The third National Health Summit for South Sudan opened today with some 500 participants coming together to consider the challenges and opportunities of delivering health in South Sudan, and to establish a clear vision for health in the years ahead.

The Syrian Arab Republic –
Addressing the silent impact of war: WHO expands mental health care services across Syria 27 March 2017

Nigeria – No new announcements identified
Yemen – No new announcements identified

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WHO Grade 2 Emergencies [to 1 April 2017]
Central African Republic  – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises.
Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 26 (20-26 March 2017) [EN/AR/KU]

Syria
:: 31 Mar 2017 Syria: US $3.4 billion needed to provide life-saving assistance for 13 million people
:: 30 Mar 2017 Statement to the Security Council on the humanitarian situation in Syria

Yemen –
:: Humanitarian coordinator in Yemen, Jamie McGoldrick, statement on the humanitarian situation in Yemen two years into the escalation of the conflict [EN/AR]
Sana’a, 28 March 2017
Two years of relentless conflict in Yemen have devastated the lives of millions of people. An alarming 18.8 million of them- almost two thirds of the population- need some kind of humanitarian or protection support. This man-made disaster has been brutal on civilians. Some seven million women, children, and men could risk famine in 2017.
:: Under-Secretary General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien – Statement on Yemen 26 Mar 2017

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POLIO [to 1 April 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 29 March 2017
:: This week, synchronized polio campaigns were conducted across 13 countries in west and central Africa including Nigeria, Chad, Cameroon, Guinea, Mali, and Niger. Over 190 000 vaccinators aimed to immunize more than 116 million children over the course of the campaign.

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin. Guinea and West Africa, and Lao People’s Democratic Republic have been removed from the monitored geographies list.
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, from Kunduz province, with onset of paralysis on 21 February. It is the most recent case in the country, and brings the total number of WPV1 cases for 2017 to three. For 2016, the case count remains 13.
:: One new WPV1 environmental positive sample was reported in the past week, from Kandahar, collected on 26 January.
Pakistan
:: Two new WPV1 positive environmental samples were reported in the past week, from Killa Abdullah and Pishin, Balochistan, collected on 1 and 2 March, respectively.

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

Zika virus [to 1 April 2017]
http://www.who.int/emergencies/zika-virus/en/
WHO podcast episodes 2017
Zika virus has been reported in dozens of countries around the world from 2015 onwards. WHO’s experience over 2016 has shown that Zika virus and the associated neurological complications represent a long-term public health challenge.
In a series of 5 podcasts on Zika, we bring you stories of Evidence in action.

Yellow Fever [to 1 April 2017]
http://www.who.int/emergencies/yellow-fever/en/
March 28, 2017
Brazil Works to Control Yellow Fever Outbreak, with PAHO/WHO support
Washington, D.C., (PAHO/WHO)—Brazil is carrying out mass vaccination campaigns for yellow fever in the states of Minas Gerais, Espirito Santo, Sao Paulo, Rio de Janeiro and Bahia, while strengthening surveillance and case management throughout the country since an outbreak of sylvatic yellow fever began in January. More than 18.8 million doses of vaccine have been distributed, in addition to routine immunization efforts.
The Pan American Health Organization/World Health Organization (PAHO/WHO) is providing specialized technical cooperation to the federal authorities managing the outbreak and has mobilized more than 15 experts, including experts from the Global Outbreak Alert and Response Network (GOARN), in disease control, surveillance, virology, immunization and other fields to collaborate with health officials in the affected states. These experts have been operating with field teams in surveillance, response, and control operations in Minas Gerais, Espirito Santo and Rio de Janeiro States…

Disease outbreak news
Yellow fever – Suriname
28 March 2017
On 9 March 2017, the National Institute for Public Health and the Environment (RIVM) in the Netherlands reported a case of yellow fever to WHO. The patient is a Dutch adult female traveller who visited Suriname from the middle of February until early March 2017. She was not vaccinated against yellow fever…

EBOLA/EVD [to 1 April 2017]
http://www.who.int/ebola/en/
No new digest content identified for this edition.

MERS-CoV [to 1 April 2017]
http://www.who.int/emergencies/mers-cov/en/
No new digest content identified for this edition.

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Meningococcal disease – Nigeria
Disease outbreak news – 24 March 2017
As of 19 March 2017 (epidemiological week 11), a total of 1407 suspected cases of meningitis and 211 deaths (case fatality rate: 15%) have been reported from 40 local government areas (LGAs) in five states of Nigeria since December 2016. Zamfara, Katsina and Sokoto account for 89% of these cases. Twenty-six LGAs from all five states reported 361 cases in epidemiological week 11 alone. Twenty-two wards in 15 LGAs have crossed the epidemic threshold. Three of these LGAs share borders with Niger. NmC is the predominant serotype in this outbreak.

The most affected age group is 5 to 14 year olds and they are responsible for about half of reported cases. Both sexes are almost equally affected.

Public health response
WHO and partners including National Primary Health Care Development Authority, UNICEF, Nigeria Field Epidemiology and Laboratory Training Program, eHealth Africa, Médecins Sans Frontières, Rotary International, Nigeria Centre for Disease Control, and Gavi, the Vaccine Alliance (Gavi) are providing support to this outbreak.*

The following measures are being implemented:
:: Nigeria Centre for Disease Control, with support from the WHO, is taking the overall lead in coordinating the response at the national level.
:: Daily coordination meetings are being held at the state and LGA levels.
:: The rapid response teams are conducting active case finding, performing lumbar puncture of suspect cases and training local staff on case management.
:: Case management is being carried out at the public health centres at the LGA level.
:: 19,600 persons were vaccinated with the meningococcal ACWY vaccine in Gora ward in Zamfara state.
:: 500,000 doses of Gavi-supported meningococcal AC PS vaccines and injection supplies were approved by the International Coordination Group (ICG) for use in Zamfara State and arrived on 27 March 2017.**
;; Katsina state is preparing an ICG request for submission.

WHO risk assessment
The successful roll-out of MenA conjugate vaccine has resulted to the decreasing trend of meningitis A, however, other meningococcal serogroups are still causing epidemics. The most recent outbreak that has been reported was in Togo due to Neisseria meningitidis serogroup W (see Disease Outbreak News as published by WHO on 23 February 2017).

WHO advice
The outbreak response consists of appropriate case management with reactive mass vaccination of populations. Promptness of the reactive campaign is essential, ideally within four weeks of crossing the epidemic threshold.
WHO does not recommend any travel or trade restriction to Nigeria based on the current information available on this outbreak.

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WHO & Regional Offices [to 1 April 2017]

WHO launches global effort to halve medication-related errors in 5 years
29 March 2017 – WHO today launched a global initiative to reduce severe, avoidable medication-associated harm in all countries by 50% over the next 5 years.

Marshall Islands triumphs against lymphatic filariasis
1 April 2017 – The country is the latest to join six others in WHO’s Western Pacific Region: Cambodia, China, Cook Islands, Niue, the Republic of Korea and Vanuatu are already validated for eliminating the disease as a public health problem. In 2016, WHO validated the Maldives and Sri Lanka – both from the South East-Asia Region – for having achieved elimination. Lymphatic filariasis is a mosquito-borne disease that damages the lymphatic system, leading to severe disfigurement, pain and disability.

Depression tops list of causes of ill health
31 March 2017 – WHO’s World Health Day campaign, the high point of which is 7 April, is themed “Depression: let’s talk”. The campaign’s aim is to have more people with depression, in all countries, both seek and get help. According to the latest WHO estimates, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015.

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Highlights
WHO’s famine response in South Sudan focuses on working with partners to prevent spread of diseases
April 2017 – WHO continues to scale up its response to reduce preventable deaths and diseases, and provide health services in famine-affected areas of South Sudan. Currently 100,000 people in the region face starvation and another 1 million are on the brink of famine.

France to recommend colour-coded nutrition labelling system
March 2017 – France has decided to recommend an easy to read labelling system that uses colour codes to guide consumers on the nutritional value of food products. The Nutri-Score system can help limit the consumption of foods high in energy, saturated fats, sugar or salt.

10th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases
March 2017 – The meeting, taking place on 29–30 March 2017, will cover issues on Global Vector Control Response, examination of dossiers requesting the potential inclusion of diseases as NTDs, gaps in disease elimination, eradication of dracunculiasis, integrated data management, and the 2nd WHO NTD Global Partners’ Meeting.

Global Health Sector Strategy on Viral Hepatitis
March 2017 – Worldwide, approximately 240 million people have chronic hepatitis B infection and 80 million people have chronic hepatitis C infection. A dedicated portal has been developed for the first ever Global Health Sector Strategy on Viral Hepatitis 2016–2021.

Weekly Epidemiological Record, 31 March 2017, vol. 92, 13 (pp. 145–164)
:: Epidemic meningitis control in countries of the African meningitis belt, 2016
:: Ensuring the timely supply and management of medicines for preventive chemotherapy against neglected tropical diseases

IVB Announcements
:: STI vaccine consultant pdf, 224kb 28 March 2017
Deadline for application: 21 April 2017

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: Brazil Works to Control Yellow Fever Outbreak, with PAHO/WHO support (03/28/2017)

WHO South-East Asia Region SEARO
:: Saima Wazed Hossain is WHO Champion for Autism in South-East Asia Region 1 April 2017

WHO European Region EURO
:: Helping Syrians cope with depression 30-03-2017
:: Feeling low in adolescence 29-03-2017
:: New report offers in-depth analysis of health situation in Republic of Moldova 27-03-2017
:: Measles outbreaks across Europe threaten progress towards elimination
Copenhagen, 28 March 2017
Over 500 measles cases were reported for January 2017 in the WHO European Region. Measles continues to spread within and among European countries, with the potential to cause large outbreaks wherever immunization coverage has dropped below the necessary threshold of 95%.
“With steady progress towards elimination over the past 2 years, it is of particular concern that measles cases are climbing in Europe,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “Today’s travel patterns put no person or country beyond the reach of the measles virus. Outbreaks will continue in Europe, as elsewhere, until every country reaches the level of immunization needed to fully protect their populations.”
Two-thirds of the Region’s 53 countries have interrupted endemic transmission of measles; however, 14 remain endemic, according to the Regional Verification Commission for Measles and Rubella Elimination (RVC)…
“I urge all endemic countries to take urgent measures to stop transmission of measles within their borders, and all countries that have already achieved this to keep up their guard and sustain high immunization coverage. Together we must make sure that the hard-earned progress made towards regional elimination is not lost,” continues Dr Jakab…

WHO Eastern Mediterranean Region EMRO
:: Within hours of opening, Athbah trauma field hospital treats casualties from west Mosul
Mosul, Iraq 29 March 2017

WHO Western Pacific Region
:: Republic of the Marshall Islands eliminates lymphatic filariasis as a public health problem
MANILA, 30 March 2017

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CDC/ACIP [to 1 April 2017]
http://www.cdc.gov/media/index.html

MMWR Weekly March 31, 2017 / No. 12
[Excerpts]
:: Zika Virus Transmission — Region of the Americas, May 15, 2015–December 15, 2016
:: Yellow Fever Outbreak — Kongo Central Province, Democratic Republic of the Congo, August 2016
:: Evaluation of Automated Molecular Testing Rollout for Tuberculosis Diagnosis Using Routinely Collected Surveillance Data — Uganda, 2012–2015
:: Notes from the Field: Adverse Events Following a Mass Yellow Fever Immunization Campaign — Kongo Central Province, Democratic Republic of the Congo, September 2016

Announcements

NIH [to 1 April 2017]
http://www.nih.gov/news-events/news-releases
March 31, 2017
Phase 2 Zika vaccine trial begins in U.S., Central and South America
— Study will evaluate NIH’s experimental DNA vaccine.
Vaccinations have begun in a multi-site Phase 2/2b clinical trial testing an experimental DNA vaccine designed to protect against disease caused by Zika infection. The vaccine was developed by government scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). NIAID is leading the trial, which aims to enroll at least 2,490 healthy participants in areas of confirmed or potential active mosquito-transmitted Zika infection, including the continental United States and Puerto Rico, Brazil, Peru, Costa Rica, Panama and Mexico. The two-part trial, called VRC 705, further evaluates the vaccine’s safety and ability to stimulate an immune response in participants, and assesses the optimal dose for administration. It also will attempt to determine if the vaccine can effectively prevent disease caused by Zika infection…
“We are pleased to have advanced rapidly one of NIAID’s experimental Zika vaccines into this next stage of testing in volunteers. We expect this study will yield valuable insight into the vaccine’s safety and ability to prevent disease caused by Zika infection,” said NIAID Director Anthony S. Fauci, M.D. “A safe and effective Zika vaccine is urgently needed to prevent the often-devastating birth defects that can result from Zika virus infection during pregnancy. Evidence also is accumulating that Zika can cause a variety of health problems in adults as well. This trial marks a significant milestone in our efforts to develop countermeasures for a pandemic in progress.”…

Antimicrobial Resistance Diagnostic Challenge selects 10 semifinalists in first phase of competition
March 27, 2017 — Each will receive $50,000 to develop prototypes of diagnostics to improve detection of drug resistant bacteria.

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GHIT Fund [to 1 April 2017]
http://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.
Press Room
GHIT Fund Invests in Late-stage Trial for Child-friendly “Snail Fever” Medicines—One of the Most Debilitating and Widespread Parasitic Diseases in Africa
2017.03.30
Completion of Phase 3 trial for treatment of “Snail Fever” (aka schistosomiasis) is final step before regulatory and WHO submission; GHIT also announces new investment in novel malaria vaccine and therapeutic for dengue, continued support for innovative tools to tackle malaria and neglected tropical diseases
TOKYO, JAPAN (March 30, 2017)—The Global Health Innovative Technology Fund (GHIT Fund), a unique Japanese public-private partnership formed to battle infectious diseases around the globe, today announced 11 new investments totaling US$23 million* that could help deliver a range of new innovative therapies for a host of debilitating conditions.
This latest round of targeted support includes funding for a Phase 3 clinical trial testing a pediatric formulation of a drug considered the gold standard for treating schistosomiasis, a water-borne parasitic disease linked to an assortment of acute and chronic health problems. Young children are most at risk, but the existing drug is so bitter and hard to swallow that kids often go untreated, leading to serious lifelong health and learning problems.
This clinical trial is one of the most advanced partnerships invested by the GHIT Fund, an organization that combines Japan’s historic leadership in global health and innovation with groundbreaking research from across the globe. The GHIT Fund also is making new investments in two malaria vaccine candidates, while accelerating work to find new drug treatments for malaria, dengue, Chagas disease, cryptosporidiosis and leishmaniasis.
“We’re reaching an exciting phase where GHIT’s approach to partnerships and drug and vaccine development is starting to produce tangible progress towards product deployment that could eventually lead to revolutionary breakthroughs,” said BT Slingsby, MD, PhD, MPH, who is CEO of the GHIT Fund. “We knew that combining Japan’s wealth of biomedical research talent and pharmaceutical capabilities with leading infectious disease experts near and far was likely to be a winning combination, and that’s been validated by the progress we are seeing across a rich diversity of projects.”…

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Hilleman Laboratories [to 1 April 2017]
http://www.hillemanlabs.org/
29/03/2017
Hilleman Laboratories signs MoU with NICED, ICMR to develop Shigella Vaccine
March 29th, 2017, New Delhi: Hilleman Laboratories, a joint-venture partnership between MSD and Wellcome Trust, today, signed a Memorandum of Understanding (MoU) with National Institute of Cholera and Enteric Diseases (NICED), an ICMR organization for further development and commercialization of the Shigella vaccines and other enteric vaccines for diarrheal diseases. This agreement was signed as an effort of Hilleman’s mission to make affordable vaccines for the developing world population…
Addressing the press conference at the signing-in, Dr. Davinder Gill said, “Shigella is the second most fatal organism after Rotavirus that causes severe diarrhea in children with no approved vaccine available at this time. We are pleased at this opportunity to collaborate with NICED and jointly develop Shigella vaccine for a disease whose basic pathology is not yet properly understood. NICED comes with a variety of strengths in research and developing strategies for treatment, prevention and control of enteric infections. This will also be a strategic shift for Hilleman, since till now, our focus has been to optimise existing vaccines and address the gaps in low resource settings. We will now endeavour to develop an entirely new line of treatment and we look forward to jointly abating this fatal disease which threatens the Nation’s health”.
Dr. Soumya Swaminathan added by saying, “This is a step in a new direction. India has immense potential in clinical research, drug and device manufacturing and we would like to see more of these types of partnerships to happen within the country to realize the ‘Make in India’ dream. We are keen that ICMR becomes more collaborative and partners with organizations in this direction and mutually expand capacities through cross-functional partnerships”…

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Wellcome Trust [to 1 April 2017]
https://wellcome.ac.uk/news
Published: 30 March 2017
We are pledging £125m to tackle drug-resistant infections
Wellcome is committing £125 million over five years to tackle drug-resistant infections through a transatlantic partnership, CARB-X  
CARB-X, which stands for Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, has named its first projects to receive funding – three in the UK and eight in the US.
Drug-resistant infections kill 700,000 people a year globally. Within a generation, the death toll could be 10 million. The last new antibiotic class to be approved was discovered in 1984.
Tim Jinks, Wellcome’s Head of Drug Resistant Infections, said: “Antibiotic discovery is absolutely vital if we are to tackle drug-resistant infections, but it has been long neglected.
“New medicines and diagnosistic tools are needed so patients get better treatment. Through CARB-X, we’re filling the current void of support for early research.”
The CARB-X projects
UK biotech’s Oppilotech (opens in a new tab) and Redx (opens in a new tab) are among three projects working on potential new classes of antibiotics.
The funded projects also include four products offering new approaches to targeting and killing bacteria.
And University of Edinburgh is leading the Proteus (opens in a new tab) project to develop a new imaging tool that can rapidly diagnose bacterial lung infections and help prevent unnecessary use of antibiotics in intensive care units.
All 11 projects are targeting the most resistant and deadly Gram-negative bacteria.
Kevin Outterson, Executive Director of CARB-X, said: “The projects in the new CARB-X portfolio are in the early stages of research, and there is always a high risk of failure. But if successful, these projects hold exciting potential in the fight against the deadliest antibiotic-resistant bacteria.”
The aim is that over five years CARB-X funding will result in 20 new antibiotic products, and that at least two will progress to clinical trials for a medicine safe for human use.
Wellcome is calling on other governments and organisations to support CARB-X…

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Global Fund [to 1 April 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund Names Sylvie Billion Interim Chief Financial Officer
31 March 2017
The Global Fund to Fight Aids, Tuberculosis and Malaria today announced that Sylvie Billion, Deputy CFO and Treasurer, will become Interim Chief Financial Officer.

News
Japan Secures US$313 million Contribution to the Global Fund
27 March 2017
The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomes the Japanese Diet’s passage of the fiscal 2016 supplementary budget and the fiscal 2017 budget, which includes Japan’s contribution of US$313 million to the Global Fund.

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UNAIDS [to 1 April 2017]
http://www.unaids.org/
Press release
UNAIDS welcomes David Beasley as new Executive Director of the World Food Programme
GENEVA, 31 March 2017—UNAIDS welcomes the appointment of David Beasley as the Executive Director of the World Food Programme (WFP).
“The appointment of David Beasley comes at a critical moment,” said UNAIDS Executive Director Michel Sidibé. “WFP’s work to achieve food security is at the heart of global efforts to break the cycle of hunger and poverty and essential to achieving the Sustainable Development Goals which include ending the AIDS epidemic.”…

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PATH [to 1 April 2017]
http://www.path.org/news/index.php
Press release | March 28, 2017
Carla Sandine to oversee PATH’s cross-cutting communications efforts on global health innovation and impact
Seattle-born entrepreneur sells Phoenix marketing agency to lead communications for PATH

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FDA [to 1 April 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
:: March 24, 2017 Approval Letter – Prevnar 13 (PDF – 32KB)
Posted: 3/27/2017

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Industry Watch [to 1 April 2017]
:: Takeda’s Dengue Vaccine Candidate Elicited Broad Immune Responses in Children and Adolescents Living in Dengue-Endemic Areas; Interim Phase 2 Analysis Published in The Lancet Infectious Diseases
– Analysis showed two doses of the vaccine candidate induced antibody responses against all four types of dengue virus in a large population of participants ages two through 17
– No safety concerns were observed, further supporting the vaccine candidate’s safety profile
March 29, 2017

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

Equitable Access Initiative – 2016
42 pages :: PDF – https://www.theglobalfund.org/media/1322/eai_equitableaccessinitiative_report_en.pdf
The convening partners of the Equitable Access Initiative include: the World Health Organization; the World Bank; Gavi, The Vaccine Alliance; UNAIDS; UNICEF; UNDP; UNFPA; UNITAID; and the Global Fund, with support from the Bill & Melinda Gates Foundation and the Wellcome Trust.

Executive Summary [Excerpts]
Key Findings
The analyses find that policymaking should not rely on a single variable to inform complex health financing polices on the eligibility for and the prioritisation of investments. It is proposed that policymakers consider a more comprehensive framework for decision making that accounts for countries’ position on a health development continuum, based on the analysis of countries’ needs, fiscal capacity and policies. 5

For instance, eligibility policies should not only consider the level of wealth in a society, as measured by GNI per capita, but account for health need relative to income as well as mitigate the effects of discrete thresholds that render a country ineligible for support once it passes a certain GNI per capita level. Further, in order to prioritize investments, a government’s resources and policies to meet this health need should be taken into account. Finally, the analyses highlight the need to account for equity considerations, particularly within country inequity, suggesting that context-specific analyses are relevant when assessing the level and type of support to be provided.

Based on the analyses and findings of the EAI analytical work, a conceptual framework to guide policymaking in external financing for health is proposed that accounts for the following considerations:

Recommendations
:: To inform complex external health financing decisions such as eligibility and the prioritisation of investments with a multi-criteria framework that takes into account income levels and health needs, in addition to domestic capacity and policies, where relevant.
:: To inform eligibility policies by health need relative to income, and to design complimentary policies that allow for a planned gradual transition, in order to mitigate the risk of a country losing gains in health when external financing decreases rapidly in spite of significant health needs and/or limited fiscal space.2
:: To consider domestic fiscal capacity characteristics when prioritising investments and to develop policies that favour improved health outcomes and increased domestic finance.

Long-term actions
:: To consider greater investments in data collection systems towards developing a more nuanced, comprehensive framework that captures sub-national equity considerations, including the needs of key populations and vulnerable groups, through better quality and more reliable data that support the inclusion of relevant indicators.

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Health Governance Capacity: Enhancing Private Sector Investment in Global Health
The Brookings Private Sector Global Health R&D Project
Darrell M. West, John Villasenor, and Jake Schneider
March 2017 :: 28 pages
PDF: https://www.brookings.edu/wp-content/uploads/2017/03/cti_20170329_health_governance_capacity.pdf

Executive Summary [Excerpt]
…In this report, we examine the quality of healthcare governance in a set of low- and middle-income countries. In particular, we look at management capacity, regulatory processes, health infrastructure, and policy conditions in sub-Saharan Africa and Asia. We argue that good governance is a foundational condition for global health investment and that it conditions the
overall environment in which both public and private sector health investment takes place. This report is the first in a series of planned publications under the Brookings Private Sector Global Health R&D Project, which was launched in fall 2016. Subsequent reports will examine funding levels, rate of return on investment, and the financial benefits of global health R&D.

To explore governance, we compile data on 25 aspects of health governance in 18 different countries. As we explain later in this report, we chose these indicators based on the research literature that outlines the measures associated with investment decisions. In particular, we focus on measures that reflect key aspects related to health management, policies, regulations,
infrastructure and financing, and health systems. The countries assessed are Bangladesh, China, Democratic Republic of Congo, Ethiopia, Ghana, India, Indonesia, Kenya, Liberia, Mozambique, Nigeria, Pakistan, Philippines, Sierra Leone, South Africa, Tanzania, Uganda, and Vietnam. These places were chosen based on geographic diversity, opportunities to improve health outcomes, and having a large population.

Among the important findings of our analysis are the following:
1. Factors which can help low- and middle-income countries attract greater private investment in healthcare R&D are improving transparency, strengthening management capacity, lowering
tariffs on incoming medical products to the extent that is fiscally possible, expediting regulatory
reviews of new drugs, building effective health infrastructure, and increasing appropriately-targeted and efficient public spending on healthcare.

2. Of the countries in the study, Vietnam, South Africa, China, and Ghana rank the highest on
aspects of overall health governance that we believe have the greatest potential to help attract
private sector investment in health R&D.

3. Several countries have components of good governance that show promise in creating an
attractive investment environment. For example, South Africa and Uganda have a notably effective approach to health regulations, while South Africa and China have invested significantly in health infrastructure and Vietnam has worked hard to build its health system.

4. Ghana and Liberia do well on health leadership and management capacity, while Tanzania does well on several of its health policies.

5. Nigeria, Pakistan, the Democratic Republic of Congo, and Bangladesh perform less well on key health governance metrics.

More broadly, countries require enabling policy, regulatory, and administrative mechanisms in order to encourage positive health outcomes in general and global health R&D investments in particular. If there is a strengthened capacity to make effective use of resources, governments, businesses, and non-governmental organizations will be better able to absorb new investments relevant to global health goals. Private investors will be more likely to make global health R&D investments if it is clear that the resulting vaccines, drugs, and diagnostics will pass regulatory, policy, and legal muster, and produce positive health outcomes…

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

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

American Journal of Infection Control
April 01, 2017 Volume 45, Issue 4, p341-46
http://www.ajicjournal.org/current

Major Articles
Antibiotic knowledge and self-medication practices in a developing country: A cross-sectional study
Antoun Jamhour, Ammar El-Kheir, Pascale Salameh, Pierre Abi Hanna, Hanine Mansour
p384–388
Published online: January 12, 2017

Influenza vaccination among workers—21 U.S. states, 2013
Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups.
Alissa C. O’Halloran, Peng-jun Lu, Walter W. Williams, Pamela Schumacher, Aaron Sussell, Jan Birdsey, Winifred L. Boal, Marie Haring Sweeney, Sara E. Luckhaupt, Carla L. Black, Tammy A. Santibanez
p410–416
Published in issue: April 01, 2017

American Journal of Infection Control
April 01, 2017 Volume 45, Issue 4, p341-46
http://www.ajicjournal.org/current

Brief Reports
Despite awareness of recommendations, why do health care workers not immunize pregnant women?
Anat Gesser-Edelsburg, Yaffa Shir-Raz, Samah Hayek, Sharon Aassaraf, Lior Lowenstein
p436–439
Published online: January 4, 2017
Highlights
:: Uncertainty about vaccination safety and efficacy for pregnant women is a health issue.
:: Gap between physicians’ knowledge about recommendations and implementation.
:: Some health care workers have fears and concerns about vaccine efficacy and safety.
Studies indicate uncertainty surrounding vaccination safety and efficacy for pregnant women, causing a central problem for health authorities. In this study, approximately 26% of participants do not recommend the tetanus, diphtheria, and acellular pertussis and influenza vaccines to their patients, although being aware of the health ministry recommendations. We found significant statistical discrepancies between the knowledge about the recommendations and their actual implementation, revealing the concerns of health care workers regarding vaccine safety