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

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

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_27 Jan 2018

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Milestones :: Perspectives

 142nd session of the WHO Executive Board
19 January 2018 – Next week the WHO Executive Board will set the agenda for the World Health Assembly, and determine how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on 22–27 January 2018 in Geneva, Switzerland, and will be webcast live.
:: Provisional agenda
:: All documentation
[Selected Documentation]
Decisions [interim report]
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted, edited for the Official Records, will be made available in due course.

EB142(1) – Implementation of International Health Regulations (2005): draft five-year global strategic plan to improve public health preparedness and response, 2018–2023

EB142(2) – Polio transition planning

EB142(3) – Addressing the global shortage of, and access to, medicines and vaccines

EB142(4) – Global strategy and plan of action on public health, innovation and intellectual property

EB142(5) – Health, environment and climate change

EB142(6) – Maternal, infant and young child nutrition

EB142(7) – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits

EB142(8) – Evaluation of the election of the Director-General of the World Health Organization

EB142(9) – Engagement with non-State actors
 
::::::
 
Dr Carissa Etienne elected for a second term as WHO Regional Director for the Americas
WHO | 23 January 2018
The WHO Executive Board, currently holding its 142nd session in Geneva, has appointed Dr Carissa Etienne for a second term as WHO Regional Director for Americas….
“My vision for the Americas is of a society free from inequality where everyone, particularly the most vulnerable and disadvantaged people, can lead healthy, meaningful and productive lives,” said Dr Etienne. “One of my top priorities is ensuring that everyone has access to quality health services without fear of being impoverished.”
Under her leadership, during these past five years PAHO led preparedness and response efforts to the regional Zika and chikungunya epidemics as well as to yellow fever outbreaks in Brazil. The Americas became the first WHO Region to eliminate the endemic transmission of measles, rubella and congenital rubella syndrome…

Dengvaxia Update
We continue to monitor developments associated with Dengvaxia. We did not identify any new press releases or statements on the Sanofi website.
.
Sanofi agrees to pay for proven Dengvaxia adverse events in the Philippines
by Eric Sagonowsky | Fierce Pharma
Jan 23, 2018 11:41am
Sanofi had already agreed to refund the Philippines for unused Dengvaxia shots as part of an ongoing safety controversy there. Now an executive has told legislators the company will “shoulder the cost” of any adverse events that are scientifically linked to vaccination.

Speaking at a Senate hearing on Monday, Sanofi Pasteur Asia-Pacific head Thomas Triomphe said that “should there be any case related to vaccination, death or any other case, we will shoulder the cost, if there is a causality that has been demonstrated through scientific evidence,” according to The Inquirer.

The testimony came as a safety controversy for the vaccine intensified over the last week, with reports that preliminary autopsy results showed a common cause of death among children who died after vaccination, though experts said no causal link was found. At the same hearing, an expert panel from the Philippine General Hospital reported that there was “no evidence linking Dengvaxia to any deaths,” a Sanofi spokesperson told FiercePharma on Monday.

“This finding is consistent with the fact that Sanofi Pasteur has not had any reports of deaths due to vaccination in any of the clinical studies of the vaccine involving over 40,000 people nor in the public or private use of Dengvaxia where over 1 million dose of the vaccine have been administered in several endemic countries,” the spokesperson added…

.

The Lancet Infectious Diseases
February 2018
Editorial
The dengue vaccine dilemma 
Dengue is the most common mosquito-transmitted viral infectious disease. A 2016 study estimated nearly 60 million symptomatic dengue cases worldwide every year (estimates including asymptomatic cases are at least six times higher), resulting in about 10,000 deaths. 4 billion people are at-risk in 128 countries where aedes mosquito vectors are present. Efforts to develop a vaccine against dengue have been ongoing for decades. The first such vaccine to be used routinely is CYD-TDV (marketed as Dengvaxia), a live, attenuated tetravalent product developed by Sanofi Pasteur. Following two phase 3 clinical trials published in 2014, Dengvaxia was licenced in December, 2015, and approved in 19 countries. Subsequently, regional mass vaccination programmes were launched in the Philippines and Brazil, targeting 1 million people.

However, after reassessment of data from the clinical trials, Sanofi warned on Nov 29, 2017, that the vaccine can increase the risk of severe dengue in particular circumstances. The vaccination programme in the Philippines has been suspended, with information released to WHO by Sanofi raising questions about future use of Dengvaxia.

How any vaccine against dengue is used is complicated by the fact that virus occurs in four serotypes, and immunity against any one serotype does not generate lasting immunity against the other three, hence the need for a tetravalent vaccine. Furthermore, being infected with—and developing immunity to—one viral serotype seems to be the trigger that can lead to a patient having more severe disease manifestations when subsequently infected with a different serotype, a phenomenon known as antibody-dependent enhancement. Infections with the third and fourth serotypes, if they occur, usually result in milder disease.

Expert opinion and a position paper on Dengvaxia were issued by WHO in 2016. When licenced, the vaccine was approved for people aged 9–45 years, in which group the phase 3 trials at 2 years of follow-up showed a reduction in severe dengue of 93% and of hospital admissions due to dengue of 82%. The vaccine was not approved in younger children because of less favourable efficacy and safety; in particular, an increase in hospital admissions due to dengue among those aged 2–5 years. This finding, which might have been an effect of age or because of more dengue-unexposed (ie, seronegative) individuals in the younger age group, could not then be explained since serostatus before immunisation was unknown for most trial participants. However, some experts warned in 2016 that the increased risk of hospital admission was a serious safety concern, including Maíra Aguiar and colleagues in this journal, a point emphasised by Aguiar and Nico Stollenwerk in their Correspondence published online on Dec 21, 2017.

Sanofi’s statement in November came about because—prompted by WHO—the company developed an assay to estimate dengue serostatus before vaccination in trial participants. A supplemental statement from WHO on Dec 22, 2017, verifies that overall Dengvaxia reduces the risk of confirmed severe dengue and hospital admissions. Vaccine recipients presumed to be seropositive at immunisation had sustained protection during 5 years’ follow-up. However, among recipients seronegative before immunisation—and regardless of age at vaccination—there was a higher risk of severe dengue disease and hospital admission compared with unvaccinated controls. Thus, in seronegative individuals, the vaccine seems to enhance the severity of subsequent dengue infection.

Where then do these findings leave the status of Dengvaxia and other candidate vaccines against dengue? The Dec 22 WHO statement notes that in settings of high dengue seroprevalence, the vaccine is likely still beneficial at a population level. However, Aguiar and Stollenwerk state that “ethically no one should have been put under risk by receiving this vaccine”. Age was clearly used as a proxy for seropositive status in the original recommendations, a position that is no longer tenable. Indeed, the new WHO recommendation is for vaccination only in individuals with proven past dengue infection. But no point-of-care test for dengue serostatus exists. In a phase 2 trial of the Takeda TDV tetravalent dengue vaccine published in this issue, serostatus at the time of vaccination was measured, but follow-up is too short to detect risks associated with being seronegative. Phase 3 trials of the Takeda vaccine and another from the Instituto Butantan, Brazil, whose primary completion dates are later this year, might provide more answers. A new position paper from WHO is also expected later this year. In the meantime, a rapid assay of dengue serostatus is surely a priority.

Featured Journal Content

PLoS One
http://www.plosone.org/
[Accessed 27 January 2018]

Research Article
The influence of political ideology and trust on willingness to vaccinate
Bert Baumgaertner, Juliet E. Carlisle, Florian Justwan
Research Article | published 25 Jan 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0191728
Abstract
In light of the increasing refusal of some parents to vaccinate children, public health strategies have focused on increasing knowledge and awareness based on a “knowledge-deficit” approach. However, decisions about vaccination are based on more than mere knowledge of risks, costs, and benefits. Individual decision making about vaccinating involves many other factors including those related to emotion, culture, religion, and socio-political context. In this paper, we use a nationally representative internet survey in the U.S. to investigate socio-political characteristics to assess attitudes about vaccination. In particular, we consider how political ideology and trust affect opinions about vaccinations for flu, pertussis, and measles. Our findings demonstrate that ideology has a direct effect on vaccine attitudes. In particular, conservative respondents are less likely to express pro-vaccination beliefs than other individuals. Furthermore, ideology also has an indirect effect on immunization propensity. The ideology variable predicts an indicator capturing trust in government medical experts, which in turn helps to explain individual-level variation with regards to attitudes about vaccine choice.

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 24 January 2018 [GPEI]
:: New on http://polioeradication.org/: In one of the final strongholds of the poliovirus, vaccination coverage is improving thanks to the women working to access children.
:: In Pakistan, we documented some of the high-risk mobile children that must be visited by vaccinators during the low transmission season.
::  By expanding environmental surveillance, Afghanistan hopes to track the movement of poliovirus with more accuracy than ever before.

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

::::::
 
Syria cVDPV2 outbreak situation report 31, 23 January 2018
Situation update 23 January 2018
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: The first round of the second phase of the outbreak response has been completed in all governorates (Deir Ez-Zor, Homs, Hasakah and Raqqa) with vaccination activities finishing on 21 January.
:: Administrative data has been received from all areas except eastern Deir Ez-Zor.
:: Post-campaign monitoring began 21 January in all governorates.
:: Preparation for the second round (IPV) continues. Global Polio Eradication Initiative (GPEI) partners continue to assist.

::::::
::::::

WHO Grade 3 Emergencies  [to 27 January 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 31, 23 January 2018
[See Polio above for detail]

Yemen
:: WHO airlifts 200 tonnes of health supplies to Yemen
SANA’A, 18 January 2018 — The World Health Organization has delivered 200 tonnes of life-saving medicines and health supplies to Yemen. Four United Nations planes carrying the cargo landed in Sana’a Airport this week.
The shipments include essential medicines, insulin vials, antibiotics, rabies vaccines, intravenous (IV) fluids, and other medical supplies and equipment…

Nigeria 
Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever  24 January 2018
[See Yellow Fever below for more detail]
 
::::::
 
WHO Grade 2 Emergencies  [to 27 January 2018]
Ukraine
:: Ukraine’s efforts to stop measles outbreak continue as case total increases
16 January 2018 — Measles continues to spread in Ukraine, with new cases now being reported in all oblasts and Kyiv. These cases are the latest in an expanding outbreak that affected over 3000 people and claimed the lives of 5 children and adults in 2017, according to preliminary data. The latest information from other countries in the WHO European Region also indicates a rise in cases, including large measles outbreaks affecting Greece, Italy and Romania.

::::::
::::::
 
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: 26 Jan 2018 – Is the world becoming numb to the killing of children? – Statement by Fran Equiza, UNICEF Representative in Syria [EN/AR]

DRC  
:: Deteriorating humanitarian crisis in DR Congo demands largest ever appeal
(Kinshasa, 18 January 2018) The dramatic deterioration of the humanitarian situation in the Democratic Republic of the Congo in 2017 has forced humanitarian actors to launch an appeal for USD 1.68 billion for 2018, the largest ever funding appeal for the country where 13.1 million people require humanitarian assistance.
The funding is required to urgently assist some 10.5 million Congolese people in 2018. Geographical expansion of the humanitarian needs and worsening situations in existing crisis hotspots all require a step change of the response of the international community to address life-threatening humanitarian and protection needs…

Yemen 
:: 20 Jan 2018  US$ 2.96 billion needed to provide life-saving assistance to 13.1 million people in Yemen in 2018 [EN/AR]
 
::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
ROHINGYA REFUGEE CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar | 21 January 2018

Ethiopia  
:: 23 Jan 2018  Ethiopia Humanitarian Bulletin Issue 45 | 08 – 20 January 2018
HIGHLIGHTS
…Opening of Gaaluun bridge at Dawa river improves humanitarian access to Dawa zone.
…As part of the national plan to rehabilitate internally displaced persons in Oromia and Somali regions, the Oromia region is settling some 86,000 IDPs in 12 towns across the region.
…An ‘Alert’ released by Government and humanitarian partners estimated up to 7 million people in need of humanitarian assistance in the first half of 2018, requiring some US$895 milliON
 
::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 27 January 2018]
http://www.who.int/emergencies/mers-cov/en/
DONS
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia  26 January 2018
Between 9 December 2017 and 17 January 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 20 additional cases of Middle East Respiratory Syndrome (MERS), including eight deaths. In addition, one death from a previously reported case was reported to WHO…
 
Yellow Fever  [to 27 January 2018]
http://www.who.int/csr/disease/yellowfev/en/
:: Brazil launches world’s largest campaign with fractional-dose yellow fever vaccine
Brasilia, January 25, 2018 (PAHO) – Brazil today launched a mass immunization campaign that will deliver fractional doses of yellow fever vaccine to residents of 69 municipalities in the states of Rio de Janeiro and São Paulo. The strategic plan for the campaign was developed with support from the Pan American Health Organization (PAHO) and the World Health Organization (WHO). It will be the world’s largest vaccination campaign, to date, using fractional doses of yellow fever vaccine.
Some 23.8 million people are expected to be vaccinated during the campaign, including 10.3 million in the state of São Paulo and 10 million in the state of Rio de Janeiro. The state of Bahia is expected to begin vaccinating on 19 February 2018 with an estimated target population of 3.3 million people to be reached with the vaccine..

:: Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever
24 January 2018, Abuja – The Government of Nigeria will launch a mass vaccination campaign to prevent the spread of yellow fever on Thursday (January 25) with support from the World Health Organization (WHO) and partners. More than 25 million people will be vaccinated throughout 2018, in the largest yellow fever vaccination drive in the country’s history.
The immunization plan is part of efforts to eliminate yellow fever epidemics globally by 2026. The preventive campaign will use vaccines funded by Gavi, the Vaccine Alliance, and will be supported by UNICEF. It will begin on 25 January in Kogi, Kwara and Zamfara states, and then move to Borno state where the campaign will focus on camps for internally displaced persons and surrounding host communities. More than 8.6 million people will be vaccinated in the four states in the coming days.
“The goal of the Yellow Fever Preventive Mass Vaccination Campaign is to reduce yellow fever transmission by achieving 90% coverage in implementing States and Local Government Areas in line with the strategy for the Elimination of Yellow fever Epidemics by 2026,” said Dr Faisal Shuaib, Executive Director of National Primary Healthcare Development Agency…

WHO & Regional Offices [to 27 January 2018]

142nd session of the WHO Executive Board
19 January 2018 – Next week the WHO Executive Board will set the agenda for the World Health Assembly, and determine how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on
22–27 January 2018 in Geneva, Switzerland, and will be webcast live.
:: Provisional agenda
:: All documentation
[See Milestones above for more detail]

World Leprosy Day: ending transmission among children
26 January 2018 – National programmes must boost active case-finding, strengthen surveillance, improve contact-tracing and focus more on early detection of leprosy cases among children to ensure achievement of the global target of zero child infections by 2020. This call comes as the world observers World Leprosy Day on Sunday, 28 January.
 
Weekly Epidemiological Record, 26 January 2018, vol. 93, 04/05 (pp. 33–44)
:: Meeting of the International Task Force for Disease Eradication, October 2017
:: Fact sheet on tuberculosis (updated January 2018)

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO promotes one-health approach to enhance response to zoonoses in South Sudan
25 January 2018
:: Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever – Copy
24 January 2018
:: WHO prioritizes water, sanitation and hygiene (WASH) services in health care facilities to achieve health goals in South Sudan  24 January 2018
:: Government of Uganda confirms outbreak of Crimean-Congo hemorrhagic and Rift Valley fevers  24 January 2018
:: Antimicrobial Consumption Monitoring in Mauritius  23 January 2018
:: Strengthening rational use of Medicines in Tanzania  23 January 2018
:: The United Nations in Zambia, CDC and DFID commend government’s initiative of setting up an efficient cholera treatment hospital and for scaling up preventive interventions in the community 22 January 2018

WHO Region of the Americas PAHO
:: 2017 in review: 10 key public health events in the Americas (12/20/2017)

WHO South-East Asia Region SEARO
:: Nearly half a million children being vaccinated against diphtheria in Cox’s Bazar  14 January 2018
 
WHO European Region EURO
::  Understanding and addressing the mental health needs of adolescents 26-01-2018
:: Cross-sectoral toolkit to guide Member States along SDG roadmap 25-01-2018

WHO Eastern Mediterranean Region EMRO
:: New tool supports systematic use of research evidence for public health decision-making
Cairo, 25 January 2018 – As a result of collaborative work between WHO and several academic institutions, a tool has been developed to streamline use of qualitative research evidence in public health decision-making. A series of academic papers published in the Implementation Science journal this week provides a scientific tool for assessing how much confidence to place in findings from qualitative evidence syntheses. The tool known as CERQual has been designed to help decision-makers use qualitative evidence for decisions and policies about health care and social welfare
:: WHO responds to humanitarian needs in Tripoli with the support of ECHO  22 January 2018

WHO Western Pacific Region
:: Healthy Islands: South Pacific Tourism Organisation and WHO forge new partnership
SUVA, Fiji, 17 January 2018 – The World Health Organization and the South Pacific Tourism Organisation join forces to promote healthy tourism in the Pacific. Through a new partnership, the organizations commit to promoting the health and well-being of tourists and the tourism workforce by establishing smoke-free public places, increasing access to healthy local food options and physical activities and improving accessibility for persons with disabilities in the tourism sector.
 

CDC/ACIP [to 27 January 2018]

http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Friday, January 26, 2018
CDC Update on Widespread Flu Activity – Transcript
… . It has been a tough flu season so far this year. And while flu activity is beginning to go down in parts of the country, it remains high for most the U.S., with some areas still rising. Most people with influenza are being infected with the H3N2 influenza virus. And in seasons where H3N2 is the main cause of influenza, we see more cases, more visits to the doctor, more hospitalizations, and more deaths, especially among older people. This season now looking like the 2014-15 season where H3N2 predominated. In that season, was categorized as a high severity season..

Thursday, January 25, 2018
More birth defects seen in parts of U.S. with local Zika spread – Press Release
Birth defects most strongly linked to Zika virus infection during pregnancy have increased in parts of the United States that have had local Zika virus transmission, according to a report in CDC’s Morbidity and Mortality Weekly Report (MMWR). Areas with local transmission of Zika – southern Florida, a portion of south Texas, and Puerto Rico – saw a 21 percent increase in births with outcomes most strongly linked to Zika virus in the last half of 2016 compared with births in the first half of that year…
 
MMWR News Synopsis for January 25, 2018
Population-Based Surveillance of Birth Defects Potentially Related to Zika Virus Infection – 15 States and U.S. Territories
Zika remains a threat to mothers and babies in the United States. Though the relationship between the increase in birth defects in certain areas and local Zika virus transmission has not been confirmed, this increase highlights the critical need for strong and rapid public health surveillance systems to identify babies with birth defects. About 3 out of every 1,000 babies born in 15 U.S. states and territories in 2016 had a birth defect meeting the case definition for birth defects potentially related to Zika virus infection during pregnancy. Areas with local Zika virus transmission in the U.S. had a 21 percent increase in the birth defects most strongly linked to Zika virus infection during pregnancy in the last half of 2016 compared with the first half. It is not known if this increase is due to local transmission of Zika virus alone, or if there are other contributing factors. These findings underscore the importance of surveillance for early identification of birth defects potentially related to Zika virus infection and the need for continued monitoring in areas at risk for Zika.

Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
Vaccination is our best tool to prevent shingles, and Shingrix® is now the preferred shingles vaccine. Every year in the U.S., about 1 million people get shingles – and the vast majority are older than 50. On October 25, 2017, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted that the Shingrix® vaccine is the preferred vaccine to prevent shingles. This new vaccine is more than 90 percent effective, even among the elderly, and maintained high protection during the four years of clinical trials. Previously, Zostavax® had been the only vaccine for seniors to prevent shingles. For adults 60 years and older, Zostavax is about 51 percent effective in preventing shingles. Zostavax is less protective in the elderly and protection wanes over time. Shingrix is now recommended as the preferred vaccine to prevent shingles for adults 50 and older. Eligible adults should get Shingrix even if they previously received Zostavax.

Announcements
 
BMGF – Gates Foundation  [to 27 January 2018]
http://www.gatesfoundation.org/Media-Center/Press-Releases
JANUARY 26, 2018
Investing in Africa: the EU and Bill & Melinda Gates Foundation commit a further €100 million
BRUSSELS (25 January 2018) – The Bill & Melinda Gates Foundation today announced their commitment to contribute to the EU’s External Investment Plan.
The Gates Foundation will contribute $50 million (€40.9 million) in financing, as well as an additional $12.5 million (€10.2 million) in technical assistance, to investment projects in the health sector in Africa through the EU’s framework to improve sustainable investments in Africa.       This pooling of resources is designed to encourage additional private investment towards achieving the Sustainable Development Goals, and will allow successful projects to be scaled up more rapidly. The European Commission welcomes this strong support to its efforts towards sustainable development in Africa, and will match this contribution with another €50 million…

JANUARY 26, 2018
Initiative Announced to End Malaria in Central America and the Dominican Republic
Inter-American Development Bank, Bill & Melinda Gates Foundation and Carlos Slim Foundation to endorse five-year initiative
DAVOS, Switzerland – The Inter-American Development Bank (IDB), the Bill & Melinda Gates Foundation and the Carlos Slim Foundation today announced an initiative to support seven Central American countries and the Dominican Republic in taking the final steps necessary to eliminate malaria in their territories. The Regional Malaria Elimination Initiative (RMEI) will bring $83.6 million in new funds, and is expected to leverage over $100 million in domestic financing and $39 million of existing donor resources across the region by 2022 to ensure malaria remains a top health and development priority despite dwindling numbers of cases. The funding will serve to close the technical and financing gaps to support and execute country elimination plans in Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua and Panama…

European Medicines Agency  [to 27 January 2018]
http://www.ema.europa.eu/ema/
26/01/2018
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 22-25 January 2018
…The Committee recommended granting a marketing authorisation for Shingrix (recombinant, adjuvanted Herpes zoster vaccine), a vaccine for the prevention of herpes zoster and post-herpetic neuralgia in adults 50 years of age or older….

23/01/2018
Human medicines: highlights of 2017
92 medicines recommended for approval, including 35 with a new active substance …
 
Gavi [to 27 January 2018]
http://www.gavi.org/library/news/press-releases/
25 January 2018
Orange, Gavi and Côte d’Ivoire Ministry of Health join forces to boost child immunisation
The mobile phone project “M-Vaccin Côte d’ Ivoire” will raise awareness of immunisation among parents and communities to increase vaccine coverage in regions with the lowest coverage.
Davos, 25 January 2018 – Orange SA and Gavi, the Vaccine Alliance, will enter into a partnership with the Côte d’Ivoire Ministry of Health to increase immunisation rates in the regions and districts with the lowest vaccine coverage, it was announced at the World Economic Forum today.
The “M-Vaccin Côte d’Ivoire” project uses Orange mobile technology to inform parents about the importance of vaccination by sending text and voice messages in the local language. Targeted messages will also help ensure parents don’t miss immunisation sessions by reminding them of their children’s schedule and dates.
“This new partnership is truly innovative and important for the children of Côte d’Ivoire,” explained Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Parents often do not receive enough information about the importance of immunisation because they live a long way from health centres or in hard-to-reach places. These voice and text messages should therefore have a significant impact and lead to an increase in vaccine coverage.”…

Global Fund [to 27 January 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Lombard Odier and the Global Fund Join Forces to Expand Private Investment In Global Health
26 January 2018
Lombard Odier and the Global Fund are pleased to announce a strategic partnership to rethink traditional approaches to investment and philanthropy to make it easier for more people to contribute to the fight against some of the world’s most pressing health challenges. Together they will create innovative solutions that allow investors to meet both their goals of doing well financially and doing good socially…
Lombard Odier and the Global Fund have come together in their belief that private sector investment is a vital resource that needs to be better employed to support the sustainable development agenda – particularly ending HIV, TB and malaria as epidemics, and building strong, resilient systems for health. The demand for capital is high. A funding gap of US$20 billion was identified for 2017-2019 to implement approved strategies to fight the three diseases in countries where the Global Fund invests, so every extra dollar can help to maximize the positive impact of the Global Fund partnership. Increased funding can also support innovative, evidence-based approaches that generate greater impact for communities affected by the diseases…

News
Global Fund and Partners Launch HER
24 January 2018
The Global Fund to Fight AIDS, Tuberculosis and Malaria and partners pledged support for HER – HIV Epidemic Response – an initiative to build private sector support for programs that address HIV in 13 African countries where adolescent girls and young women face disproportionate risk.
 
JEE Alliance  [to 27 January 2018]
https://www.jeealliance.org/
24.1.2018
Alliance successes in 2017 and an update on 2018
The year 2017 was the first full year of the work of the JEE Alliance. During the year, 15 new members joined the Alliance, contributing the wealth of expertise and experience. There are now 68 members…
 
NIH  [to 27 January 2018]
http://www.nih.gov/news-events/news-releases
January 24, 2018
15 years later, PEPFAR continues to save lives
— NIAID experts highlight federal program’s unprecedented impact on HIV pandemic.

Study links gut-homing protein levels with HIV infection risk, disease progression
January 24, 2018 — NIH clinical trial is testing antibody against the protein in people with HIV.

NIH begins large HIV treatment study in pregnant women
January 24, 2018 — Clinical trial will compare three antiretroviral drug regimens.

NIH to launch genome editing research program
January 23, 2018 — Somatic Cell Genome Editing aims to develop tools for safe and effective genome editing in humans.

Flu infection study increases understanding of natural immunity
January 23, 2018 — Findings illustrate role of specific antibodies.
 
 
PATH  [to 27 January 2018]
http://www.path.org/news/index.php
Press release | January 24, 2018
India-made rotavirus vaccine achieves World Health Organization prequalification
ROTAVAC® will now be available for procurement by United Nations agencies and Gavi, the Vaccine Alliance, for use in low-resource countries
New Delhi, January 24, 2018—PATH applauds Indian vaccine manufacturer Bharat Biotech for receiving prequalification from the World Health Organization (WHO) for their oral rotavirus vaccine, ROTAVAC. As a partner in the development of ROTAVAC, PATH worked with the Indian Department of Biotechnology, the Society for Applied Studies, and Bharat Biotech on the clinical trials that demonstrated the safety and efficacy of the vaccine…

UNAIDS [to 27 January 2018]
http://www.unaids.org/en
22 January 2018
Update
How do investment vehicles and innovations work together to deliver better health care?
UNAIDS, ICV, Johnson & Johnson, BD and the Center for Global Health and Diplomacy are hosting a forum entitled Transformational Aid for Development in order to create connections for scaling up innovations and investments for health and to reach vulnerable populations…

UNICEF  [to 27 January 2018]
https://www.unicef.org/media/
24 January 2018
More action needed to improve security and humanitarian access in Myanmar if Rohingya children are to return safely – UNICEF
COX’S BAZAR, Bangladesh, 24 January 2018 –  Improved security and unimpeded humanitarian access in Myanmar are essential before Rohingya children can be returned from Bangladesh, UNICEF Deputy Executive Director Justin Forsyth said today.

Statement by Geert Cappelaere, UNICEF Regional Director for the Middle East and North Africa, on Syrian children freezing to death while crossing from Syria to Lebanon
AMMAN, 20 January 2018- “It is tragic that at least 12 Syrians including two children died in Eastern Lebanon near the Masna’ border crossing with Syria.”

At least one in four children in Iraq impacted by conflict and poverty
BAGHDAD/AMMAN, 19 January 2018 – “Iraq today hosts one of UNICEF’s largest operations in the world, responding with humanitarian and development assistance to the needs of the most vulnerable girls and boys across the country.

Wellcome Trust  [to 27 January 2018]
https://wellcome.ac.uk/news
News / Published: 25 January 2018
What our new strategy means for the Public Engagement Fund
We’ve developed an ambitious new strategy for our public engagement work and, as a result, we are making some changes to the Public Engagement Fund.
When we launched the Public Engagement Fund in January 2017 we said that the fund would evolve – as we learned from its implementation, and to reflect Wellcome’s changing vision.
After the changes, funding will still be open to anyone with a great project for engaging the public in Wellcome’s mission of improving health…

News / Published: 22 January 2018
New Wellcome office in Berlin will bolster global partnerships
News / Published: 22 January 2018
Wellcome is planning to open a small office in the German capital later this year so that we can work more closely with our international partners on shared priorities…

The Wistar Institute   [to 27 January 2018]
https://www.wistar.org/news/press-releases
Press Releases
Wistar’s David Weiner, Ph.D., Named President of the International Society for Vaccines
PHILADELPHIA—(Jan. 25, 2018)—The Wistar Institute is pleased to announce David B. Weiner, Ph.D., executive vice president, director of the Vaccine & Immunotherapy Center at The Wistar Institute, and the W.W. Smith Charitable Trust Professor in Cancer Research, has been appointed President of the International Society for Vaccines (ISV), an organization that engages, supports, and sustains the professional goals of a diverse membership in all areas relevant to vaccines.
“As I begin my service as ISV President, it is important to keep in mind that our overarching goals and focus remains the same: serve all of our members and continue to build the society and ‘lift all boats’ in vaccine research around the globe,” Weiner said. “In this regard, we extend our hand and encourage all members to be engaged and energized, and to take an active role in this society-your society.”…

::::::
 
IFPMA   [to 27 January 2018]
http://www.ifpma.org/resources/news-releases/
24 January 2018
The African Global Health Leaders Fellowship launched to support the future of health in Africa
Geneva, 24 January 2018│ The Centre on Global Health Security at Chatham House, the Global Health Centre at the Graduate Institute and the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) announced yesterday the establishment of the 2018-2019 African Global Health Leaders Fellowship.
Sub-Saharan African countries have undergone unprecedented transformation and change in the last decade, including constant economic growth, a growing middle class, a healthier, more productive and increasingly more educated and skilled workforce and increased political stability. Although many challenges remain, recognition must be given to the huge advances that have been made.
To mark the occasion, the three signing partners invited emerging leaders and fellows of the West African Global Health Leaders Fellowship ─ the predecessor of the new fellowship, to discuss the achievements and challenges across the continent, including the most promising approaches for improving healthcare systems and the realisation of Universal Health Coverage (UHC).
The fellowship supports the development of the next generation of public health leaders in Africa. The objective is to help fellows from Africa develop the knowledge, insight and skills to work within their own countries to formulate and implement evidence-based policy and to serve as the next generation of leaders. It builds skills in leadership, policy analysis and formulation, as well as global health diplomacy…

Industry Watch   [to 27 January 2018]
:: World Health Organization Grants Prequalification to Bharat Biotech’s Rotavirus Vaccine, ROTAVAC®
NEW DELHI–(BUSINESS WIRE)–Bharat Biotech today announced that the World Health Organization (WHO Geneva) has awarded prequalification to the developing world’s first rotavirus vaccine, ROTAVAC®…

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
 
2018 Antimicrobial Resistance Benchmark
Access to Medicine Foundation
January 2018 :: 185 pages
PDF: https://amrbenchmark.org/wp-content/uploads/2018/01/Antimicrobial-Resistance-Benchmark-2018.pdf
The Antimicrobial Resistance Benchmark provides the first independent assessment of how pharmaceutical companies are responding to AMR. The 30 companies in scope include those
with the largest R&D divisions, the largest market presence, and specific expertise in developing critically needed medicines and vaccines. The goal of the Antimicrobial Resistance Benchmark is
to guide and incentivise such companies to adopt and implement effective actions for tackling AMR. It highlights where good ideas for limiting AMR are being implemented and where action
is still required. The AMR Benchmark is independently funded by UK AID and the Dutch Ministry of Health, Welfare and Sport.

Key Findings
:: There are 28 antibiotics for high-priority pathogens in late stages of development. However, only two of these are supported by plans to ensure the successful candidate can be made accessible and used wisely once it reaches the market.

:: Nearly half of companies evaluated are involved in efforts to track patterns in antibiotic drug resistance, with AMR surveillance programmes running in 147 countries. Pneumonia is the most widely-tracked infection.

:: Eight companies are setting limits on the levels of antibiotics that can be released into the environment in wastewaters at their antibiotic manufacturing facilities. Yet no company publishes what is released in practice.
:: Four companies are taking steps to separate sales agents’ bonuses from the volume of antibiotics they sell. GSK and Shionogi have fully separated the two globally, Pfizer is piloting that approach in certain territories, and Novartis is taking steps toward adjusting its sales teams incentives.

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
February 2018 Volume 46, Issue 2, p123-244
http://www.ajicjournal.org/current

Major Articles
Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings
Pinyo Rattanaumpawan, Adhiratha Boonyasiri, Sirenda Vong, Visanu Thamlikitkul
p139–146
Published online: October 10, 2017
Abstract
Background
Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings.
Methods
We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians.
Results
A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection.
Conclusions
This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases.

American Journal of Infection Control
February 2018 Volume 46, Issue 2, p123-244
http://www.ajicjournal.org/current

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control
Sarah H. Alfaraj, Jaffar A. Al-Tawfiq, Talal A. Altuwaijri, Marzouqa Alanazi, Nojoom Alzahrani, Ziad A. Memish
p165–168
Published online: September 25, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Research Articles
Immunization Practices of U.S. Obstetrician/Gynecologists for Pregnant Patients
Sean T. O’Leary, Laura E. Riley, Megan C. Lindley, Mandy A. Allison, Lori A. Crane, Laura P. Hurley, Brenda L. Beaty, Michaela Brtnikova, Margaret Collins, Alison P. Albert, Allison K. Fisher, Angela J. Jiles, Allison Kempe
p205–213
Published online: December 12, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Nativity Disparities in Human Papillomavirus Vaccination Among U.S. Adults
…few studies have explored whether vaccination differences exist by nativity status. Vaccination disparities have the potential to exacerbate HPV-related cancer disparities in the long term if left unaddressed. Therefore, the authors investigated whether there were significant differences in HPV vaccination initiation (one or more doses) and completion (three or more doses) between U.S.-born and foreign-born men and women.
Ashley E. Pérez, Madina Agénor, Kristi E. Gamarel, Don Operario
p248–258
Published online: December 11, 2017

American Journal of Preventive Medicine
February 2018 Volume 54, Issue 2, p157-324
http://www.ajpmonline.org/current

Review Articles
The Cost of Interventions to Increase Influenza Vaccination: A Systematic Review
Laura J. Anderson, Paul Shekelle, Emmett Keeler, Lori Uscher-Pines, Roberta Shanman, Sally Morton, Gursel Aliyev, Teryl K. Nuckols
p299–315
Published in issue: February 2018

American Journal of Public Health
February 2018   108(2)
http://ajph.aphapublications.org/toc/ajph/current

SOCIAL IMPACT BONDS
Social Impact Bonds as a Funding Method for Health and Social Programs: Potential Areas of Concern
Amy S. Katz, Benjamin Brisbois, Suzanne Zerger and Stephen W. Hwang
108(2), pp. 210–215
Abstract
Social Impact Bonds (SIBs) represent a new way to finance social service and health promotion programs whereby different types of investors provide an upfront investment of capital. If a given program meets predetermined criteria for a successful outcome, the government pays back investors with interest. Introduced in the United Kingdom in 2010, SIBs have since been implemented in the United States and across Europe, with some uptake in other jurisdictions.
We identify and explore selected areas of concern related to SIBs, drawing from literature examining market-based reforms to health and social services and the evolution of the SIB funding mechanism. These areas of concern include increased costs to governments, restricted program scope, fragmented policymaking, undermining of public-sector service provision, mischaracterization of the root causes of social problems, and entrenchment of systemically produced vulnerabilities.
We argue that it is essential to consider the long-term, aggregate, and contextualized effects of SIBs in order to evaluate their potential to contribute to public health. We conclude that such evaluations must explore the assumptions underlying the “common sense” arguments often used in support of SIBs.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 27 January 2018)

Research article
General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh
Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) rea…
Authors: Md. Shajedur Rahman Shawon, Gourab Adhikary, Md. Wazed Ali, Md. Shamsuzzaman, Shahabuddin Ahmed, Nurul Alam, Katya A. Shackelford, Alexander Woldeab, Stephen S. Lim, Aubrey Levine, Emmanuela Gakidou and Md. Jasim Uddin
Citation: BMC Health Services Research 2018 18:39
Published on: 25 January 2018

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 27 January 2018)

Research article
Cost-effectiveness of increasing vaccination in high-risk adults aged 18–64 Years: a model-based decision analysis
Adults aged 18–64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation…
Authors: Angela R. Wateska, Mary Patricia Nowalk, Richard K. Zimmerman, Kenneth J. Smith and Chyongchiou J. Lin
Citation: BMC Infectious Diseases 2018 18:52
Published on: 25 January 2018

 
BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 27 January 2018)

Research article
Evaluation of two health education interventions to improve the varicella vaccination: a randomized controlled trial from a province in the east China
We evaluated the effect of two Elaboration Likelihood Model (ELM)-based health educational interventions on varicella vaccine (VarV) vaccination among pregnant women in a province in the east China.
Authors: Yu Hu, Qian Li and Yaping Chen
Citation: BMC Public Health 2018 18:144
Published on: 16 January 2018

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

JAMA
January 23/30, 2018, Vol 319, No. 4, Pages 319-418
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Improving Public Health Requires Inclusion of Underrepresented Populations in Research
Catherine Y. Spong, MD; Diana W. Bianchi, MD
JAMA. 2018;319(4):337-338. doi:10.1001/jama.2017.19138
Advances in genomics have ushered in promising therapies tailored to the individual. Personalized medicine is promoted and has begun to positively influence care. For example, medications such as trastuzumab for the 30% of breast cancers that overexpress ERBB2 and vemurafenib for patients with late-stage melanoma who carry the V600E variant have been beneficial.1 Despite these advances, for many sectors of the population—children, older adults, pregnant and lactating women, and individuals with physical and intellectual disabilities—limited evidence-based therapies optimized to their specific medical needs exist. Combined, these groups comprise as much as 58% of the US population (eTable in the Supplement). Research focusing on or at the very least includes members of these groups is critically needed.

Journal of Pediatrics
February 2018 Volume 193, p1-280
http://www.jpeds.com/current

Editor’s Choice
Smart use of vaccines
Sarah S. Long
Published in issue: February 2018
Abstract
The increasing complexities of the recommended immunization schedule and vaccine products available make it almost impossible for even the best informed and intentioned practitioners and staff to get it perfect. Mistakes are “costly,” leaving some children sub-optimally protected from vaccine-targeted diseases (and in some scenarios requiring extra doses), while other children may be over-immunized. In this volume of The Journal, Rodgers et al report a study of the frequency and cost of vaccinations administered outside minimum and maximum recommended ages despite using what currently is likely to be one of the “smartest” electronic systems that aims to prevent these errors. Data included examination and analysis of de-identified information throughout 2014 from 6 Centers for Disease Control and Prevention Sentinel Sites of Immunization Information Systems in 6 states, representing approximately 10% of the US population <19 years of age. The system possesses advanced functionality available at the point of clinical care.
In most regards, the findings are reassuring. Among roughly 3.4 million doses of vaccines with maximum age recommendations, only 0.3% of doses were given after the maximum age. Among roughly 7.5 million doses of vaccines with minimum age recommendations, only 0.1% of doses were administered before the minimum age. Monetary costs could accrue when an unnecessary dose was given after a maximum age (eg, Prevnar given after the fifth birthday) or an inadequate dose given required re-vaccination (eg, a 0.25 mL dose of Fluzone Quadrivalent given after the third birthday when a dose of 0.5 mL is recommended). The most costly errors of administration before a minimum recommended age are those requiring re-vaccination. This report identified approximately $291 000 in direct and indirect re-vaccination costs that would have been incurred in 1 year in this sample population if each error identified was corrected. An estimated annual cost on a national level would be 10-fold, ie, almost 3 million dollars.
Immunizations are a critical pillar of our children’s health, and a precious resource. Until an impossibly smart computer program can be brought to bear at the point of care to integrate each patient’s unique immunization record and need, and to preclude misuse, we will have to strive to be advocates for as well as best protectors of the precious resource.

Journal of Pediatrics
February 2018 Volume 193, p1-280
http://www.jpeds.com/current

Editorials
How to Make Pediatric Trials Better: Transparency and Accountability of Trial Registration and Reporting
Ana Marušić, Shelly M. Pranić
Published online: November 22, 2017

Journal of Pediatrics
February 2018 Volume 193, p1-280
http://www.jpeds.com/current

Original Articles
Frequency and Cost of Vaccinations Administered Outside Minimum and Maximum Recommended Ages—2014 Data From 6 Sentinel Sites of Immunization Information Systems
Loren Rodgers, Lauren Shaw, Raymond Strikas, Beth Hibbs, JoEllen Wolicki, Cristina V. Cardemil, Cindy Weinbaum
p164–171
Published online: December 14, 2017

Journal of Pediatrics
February 2018 Volume 193, p1-280
http://www.jpeds.com/current

The Conduct and Reporting of Child Health Research: An Analysis of Randomized Controlled Trials Published in 2012 and Evaluation of Change over 5 Years
Allison Gates, Lisa Hartling, Ben Vandermeer, Patrina Caldwell, Despina G. Contopoulos-Ioannidis, Sarah Curtis, Ricardo M. Fernandes, Terry P. Klassen, Katrina Williams, Michele P. Dyson
p237–244.e37
Published online: November 21, 2017

Nature 
Volume 553 Number 7689 pp380-530  25 January 2018
http://www.nature.com/nature/current_issue.html

Science after a year of President Trump
After 12 months in office, Trump’s effects on science have been as bad as feared.

Nature 
Volume 553 Number 7689 pp380-530  25 January 2018
http://www.nature.com/nature/current_issue.html

Science must get ready for the next global flu crisis
A universal flu vaccine is the only serious defence against a future flu pandemic.

New England Journal of Medicine
January 25, 2018   Vol. 378 No. 4
http://www.nejm.org/toc/nejm/medical-journal

Perspective
History of Medicine: PEPFAR — 15 Years and Counting the Lives Saved
Anthony S. Fauci, M.D., and Robert W. Eisinger, Ph.D.
In the long history of successful public health initiatives, such as those leading to the eradication of smallpox, the elimination of polio throughout most of the world, and the marked reduction globally in vaccine-preventable childhood diseases, few programs have matched the impact of one that began in 2003, the President’s Emergency Plan for AIDS Relief, or PEPFAR. This innovative program has had an unprecedented impact on the pandemic of HIV and AIDS…

New England Journal of Medicine
January 25, 2018   Vol. 378 No. 4
http://www.nejm.org/toc/nejm/medical-journal

Treating and Preventing HIV with Generic Drugs — Barriers in the United States
Erika G. Martin, Ph.D., M.P.H., and Bruce R. Schackman, Ph.D.
Combination antiretroviral therapy (ART) has dramatically improved survival rates among people with HIV and is a mainstay of HIV prevention; evidence shows that durable viral suppression prevents the transmission of infection. In addition, preexposure prophylaxis (PrEP) is an emerging approach to preventing HIV acquisition for certain high-risk groups. Generic ART medications offer the potential for treating and preventing HIV with fewer resources. Generic versions of lamivudine, abacavir, and efavirenz became available in the United States within the past 6 years at prices lower than their brand-name counterparts, a generic version of PrEP (emtricitabine and tenofovir disoproxil fumarate) was approved in 2016, and generic versions of tenofovir disoproxil are expected later in 2018. Yet most of the discussion about the availability of generic HIV drugs focuses on low- and middle-income countries…

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 27 January 2018)

Research Article
The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study
The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso. The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso.
Reza Yaesoubi, Caroline Trotter, Caroline Colijn, Maziar Yaesoubi, Anaïs Colombini, Stephen Resch, Paul A. Kristiansen, F. Marc LaForce, Ted Cohen
| published 24 Jan 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002495

PLoS One
http://www.plosone.org/
[Accessed 27 January 2018]

Research Article
The influence of political ideology and trust on willingness to vaccinate
Bert Baumgaertner, Juliet E. Carlisle, Florian Justwan
Research Article | published 25 Jan 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0191728
Abstract
In light of the increasing refusal of some parents to vaccinate children, public health strategies have focused on increasing knowledge and awareness based on a “knowledge-deficit” approach. However, decisions about vaccination are based on more than mere knowledge of risks, costs, and benefits. Individual decision making about vaccinating involves many other factors including those related to emotion, culture, religion, and socio-political context. In this paper, we use a nationally representative internet survey in the U.S. to investigate socio-political characteristics to assess attitudes about vaccination. In particular, we consider how political ideology and trust affect opinions about vaccinations for flu, pertussis, and measles. Our findings demonstrate that ideology has a direct effect on vaccine attitudes. In particular, conservative respondents are less likely to express pro-vaccination beliefs than other individuals. Furthermore, ideology also has an indirect effect on immunization propensity. The ideology variable predicts an indicator capturing trust in government medical experts, which in turn helps to explain individual-level variation with regards to attitudes about vaccine choice.

Qualitative Health Research
Volume 28, Issue 3, February 2018
http://qhr.sagepub.com/content/current
Special Issue: Methods

A Guide to Field Notes for Qualitative Research: Context and Conversation
Julia Phillippi, Jana Lauderdale
First Published April 5, 2017; pp. 381–388
Abstract
Field notes are widely recommended in qualitative research as a means of documenting needed contextual information. With growing use of data sharing, secondary analysis, and metasynthesis, field notes ensure rich context persists beyond the original research team. However, while widely regarded as essential, there is not a guide to field note collection within the literature to guide researchers. Using the qualitative literature and previous research experience, we provide a concise guide to collection, incorporation, and dissemination of field notes. We provide a description of field note content for contextualization of an entire study as well as individual interviews and focus groups. In addition, we provide two “sketch note” guides, one for study context and one for individual interviews or focus groups for use in the field. Our guides are congruent with many qualitative and mixed methodologies and ensure contextual information is collected, stored, and disseminated as an essential component of ethical, rigorous qualitative research.

Science         
26 January 2018  Vol 359, Issue 6374
http://www.sciencemag.org/current.dtl

In Depth
Critics see only risks, no benefits in horsepox paper
By Kai Kupferschmidt
Science26 Jan 2018 : 375-376 Restricted Access
Scientists say their labmade virus could make a new smallpox vaccine. Others call it a “mistake” and a “stunt.”
Summary
A highly controversial study in which researchers synthesized the horsepox virus from scratch was finally published in PLOS ONE on 19 January. The study stirred alarm when Science first reported about it in July 2017 because it might give would-be terrorists a recipe to construct smallpox virus, a major human scourge vanquished in 1980. And now that the paper is out, many scientists say it doesn’t answer the most pressing question: Why did they do it? The team claims its work, funded by Tonix, a pharmaceutical company headquartered in New York City, could lead to a safer, more effective vaccine against smallpox. But safe smallpox vaccines already exist, and critics say there is no market for a horsepox-based replacement.
 

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Regular papers
How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes, 2008/2009 to 2014/2015
Open access – Original research article
Pages 442-452
Pernille Jorgensen, Jolita Mereckiene, Suzanne Cotter, Kari Johansen, … Caroline Brown

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Parent perceptions of dentists’ role in HPV vaccination
Original research article
Pages 461-466
Gabriela E. Lazalde, Melissa B. Gilkey, Melanie L. Kornides, Annie-Laurie McRee
Offering HPV vaccine in settings beyond the traditional medical home holds promise for increasing the currently low levels of coverage. As adolescents frequently visit dentists, dental practices may be one such alternative vaccination setting. This study assessed parent attitudes about the roles dental providers could play in HPV prevention, including vaccine provision.

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Willingness to accept a future influenza A(H7N9) vaccine in Beijing, China
Original research article
Pages 491-497
Shuangsheng Wu, Jianting Su, Peng Yang, Haiyan Zhang, … Quanyi Wang

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Bacillus Calmette-Guérin (BCG) vaccine: A global assessment of demand and supply balance
Open access – Original research article
Pages 498-506
Tania Cernuschi, Stefano Malvolti, Emily Nickels, Martin Friede

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

HIV population-level adaptation can rapidly diminish the impact of a partially effective vaccine
Open access – Original research article
Pages 514-520
Joshua T. Herbeck, Kathryn Peebles, Paul T. Edlefsen, Morgane Rolland, … Steven M. Goodreau
Development of an HIV vaccine might be essential to ending the HIV/AIDS pandemic. However, vaccines can result in the emergence and spread of vaccine-resistant strains. Indeed, analyses of breakthrough infections in the HIV phase 3 vaccine trial RV144 identified HIV genotypes with differential rates of transmission in vaccine and placebo recipients. We hypothesized that, for HIV vaccination programs based on partially effective vaccines similar to RV144, HIV adaptation will rapidly diminish the expected vaccine impact.

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Healthcare worker’s attitude to seasonal influenza vaccination in the South Tyrolean province of Italy: barriers and facilitators
Original research article
Pages 535-544
Andrea Rabensteiner, Alessandra Buja, Dagmar Regele, Martin Fischer, Vincenzo Baldo

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network
Original research article
Pages 545-552
Eve Dubé, Dominique Gagnon, Manale Ouakki, Julie A. Bettinger, … Devon Greyson

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Safety of vaccines that have been kept outside of recommended temperatures: Reports to the Vaccine Adverse Event Reporting System (VAERS), 2008–2012
Original research article
Pages 553-558
Beth F. Hibbs, Elaine Miller, Jing Shi, Kamesha Smith, … Tom T. Shimabukuro

Vaccine
Volume 36, Issue 4   Pages 427-594 (25 January 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/4

Predictors of measles vaccination coverage among children 6–59  months of age in the Democratic Republic of the Congo
Open access – Original research article
Pages 587-593
Hayley R. Ashbaugh, Nicole A. Hoff, Reena H. Doshi, Vivian H. Alfonso, … Anne W. Rimoin
Highlights
:: DRC’s overall measles vaccination coverage level of 70% is too low to halt the spread of measles.
:: Socioeconomic variables and residence are associated with vaccination coverage disparities.
:: Vaccination coverage and data quality are linked, and as such, dated records must be increased.

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

 
Frontiers in Public Health
Received: 11 Nov 2017; Accepted: 16 Jan 2018. doi: 10.3389/fpubh.2018.00013
Original Research Aerticle
National immunisation campaigns with oral polio vaccine reduce all-cause mortality: A natural experiment within seven randomised trials
Andreas Andersen1, Ane B. Fisker1, Amabelia Rodrigues1, Cesario Martins1, Henrik Ravn1, Najaaraq Lund1, Sofie Biering-Sørensen1, Christine S. Benn1 and Peter Aaby1*
Abstract
Background
A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate it would suggest beneficial NSEs.
Setting
Between 2002 and 2014 Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV and H1N1 vaccine. In this period, we conducted seven randomised controlled trials (RCTs) with mortality as main outcome.
Methods
Within these RCTs we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign versus before-campaign.
Results
The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI=0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR=0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p=0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children.
Conclusions
Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively

Journal of Pediatric Infectious Diseases
DOI: 10.1055/s-0037-1620266
Original Article
Development of Vaccine Preferences among Parents of Newborns
JN Yarnall, J Knowles, JA Lohr -, 2018
Abstract
Objective
Vaccine hesitancy and refusal and the resulting outbreaks of vaccine-preventable diseases continue to be an issue today. Most of contemporary research on these issues has focused on underlying characteristics of non-vaccinators and ambivalent parents; however, few studies have looked into how or when vaccine preferences develop. In this study, we sought to explore when parental preferences for vaccines develop in relation to a pregnancy. We also examined self-reported influences on vaccine decision making.
Methods
We recruited and administered a short survey to parents at the North Carolina Women’s Hospital in Chapel Hill, NC, following the birth of their child from February to April 2015.
Results
A total of 166 parents (55%) completed the entire survey. Seventy-two percent of surveyed parents reported deciding on their vaccine preferences for their newborn before conception. Parents who were older, Caucasian, married, and had attained higher levels of education were significantly more likely to develop preconception vaccine preferences. The presence of partner conversations in the past and the desire for more information on vaccines were also significant predictors of preconception vaccine preference development. After logistic regression adjustment, only education level and past vaccine conversations remained significant. The most common influences for vaccine decision making were family, friends, and medical staff and organizations.
Conclusion
Our study documents that a majority of parents establish vaccine decision making and preferences before conception. Notable influences from friends, family, and medical sources are part of the process. These findings suggest that vaccine information and interventions currently are given too late in the vaccine preference decision-making process.

Media/Policy Watch

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

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

Forbes
http://www.forbes.com/
Accessed 27 January 2018
Here Are 2 Possible Steps Toward A Universal Flu Vaccine
24 Jan 2018
Bruce Y. Lee, Contributor
This year’s harsher flu season is a not-so-gentle reminder that we really, really need a universal flu vaccine, a vaccine that works against all influenza viruses. Are newly published studies in the journal Science and in the journal Nature Communications significant steps?
 
The Guardian
http://www.guardiannews.com/
Accessed 27 January 2018
Brazil yellow fever crisis: dozens dead as São Paulo closes city …
24 Jan 2018
… São Paulo closed its zoo and botanical gardens Tuesday as a yellow fever outbreak that has led to 70 deaths is picking up steam. The big Inhotim art park, which attracts visitors from all over the world, also announced that all visitors would have to show proof of vaccination to be allowed in…
 
The anti-vaxxers have a new target in their sights – pets | Life and …
24 Jan 2018
… A growing movement of animal anti-vaccine advocates claim that immunising cats and dogs can cause a range of diseases and disorders – including autism.
 
New York Times
http://www.nytimes.com/
Accessed 27 January 2018
Killing of Mother-Daughter Team Shakes Polio Fighters in Pakistan
The country had just eight polio cases last year. The murder of a 38-year-old woman and her 16-year-old daughter won’t derail vaccinations, a leader says.
January 22, 2018 – By DONALD G. McNEIL Jr –

New UNICEF Chief to Engage Private Sector to Help Children
19 January 2018  By THE ASSOCIATED PRESS

The new leader of UNICEF says the children’s agency is taking a new approach in 2018 by engaging with private companies to help prepare young people for productive lives.
In an interview with The Associated Press, executive director Henrietta Holsman Fore said she plans to draw on her experience in the business and development worlds. The American was the first woman to lead the U.S. Agency for International Development and was CEO of Holsman International, an investment and management firm….
 
Times of India
https://timesofindia.indiatimes.com/
Accessed 27 January 2018
India: Vaccines from Chengalpet complex will meet three-fourths of country’s requirements, minister says
25 January 2018
Work on the Integrated Vaccine Complex — a nodal centre for manufacture and research of vaccines — in Chengalpet is complete and it will be dedicated to the nation soon, Tamil Nadu health minister C Vijaya Baskar said on Thursday. The complex will supply vaccines at affordable prices for the centre’s Universal Immunisation Programme (UIP). The vaccines manufactured from here would meet three-fourths of the country’s requirements, particularly for infants and women, the minister said. The centre will produce over 500 million doses of pentavalent combination (DPT plus Hep B plus Hib), BCG and other vaccines, the minister said.
 
Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 27 January 2018
U.S.–Schools Close as Flu Epidemic Spreads
1/27/2018
By Sarah Toy, Tawnell D. Hobbs
Schools in at least 11 states have closed as the worst flu epidemic in nearly a decade intensifies

Think Tanks et al

Center for Global Development  
http://www.cgdev.org/page/press-center
Accessed 27 January 2018
Blog Post
Measuring the Reproductive Ecosystem: Modern Contraception and Women’s Empowerment in the Developing World
1/24/18
Nancy Birdsall
Modern contraception may be the single most important technology for development—it liberates women to think ahead, as men have always been able to do. Last month, CGD hosted the Third Annual Birdsall House Conference on Women: “Reproductive Choices to Life Chances: New and Existing Evidence on the Impact of Contraception on Women’s Empowerment.” The conference featured presentations from some of the world’s top scholars.

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

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

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_20 Jan 2018

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Milestones :: Perspectives

142nd session of the WHO Executive Board
19 January 2018 – Next week the WHO Executive Board will set the agenda for the World Health Assembly, and determine how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on
22–27 January 2018 in Geneva, Switzerland, and will be webcast live.
:: Provisional agenda
:: All documentation
[Selected Documentation]
EB142/10 – Public health preparedness and response
Implementation of the International Health Regulations (2005)
 
EB142/11 – Polio transition planning
 
EB142/13 – Addressing the global shortage of, and access to, medicines and vaccines

EB142/16 – Preparation for a high-level meeting of the General Assembly on ending tuberculosis
 
EB142/24 – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits
 
EB142/35 – Global vaccine action plan
 
EB142/37 – Eradication of poliomyelitis

CDC to Scale Back Work in Dozens of Foreign Countries Amid Funding Worries

Efforts to prevent infectious-disease epidemics and other health threats were funded mostly through a five-year supplemental package
By  Betsy McKay
Wall Street Journal, Jan. 19, 2018 4:51 p.m. ET
The Centers for Disease Control and Prevention plans to scale back or discontinue its work to prevent infectious-disease epidemics and other health threats in 39 foreign countries because it expects funding for the work to end, the agency told employees.

The CDC currently works in 49 countries as part of an initiative called the global health security agenda, to prevent, detect and respond to dangerous infectious disease threats. It helps expand surveillance for new viruses and​ ​drug-resistant bacteria, modernize laboratories to detect dangerous pathogens​and train workers who respond to epidemics.

The activities are funded mostly through a five-year supplemental package that was awarded to the CDC and other government agencies in fiscal 2015 to respond to the Ebola epidemic in West Africa.

The package included $582 million in funds to work with countries around the world after the Ebola crisis in 2014 and 2015. But that funding runs out at the end of fiscal 2019.

Public health leaders had said they hoped dollars for the work would eventually be added into the CDC’s core budget, after the epidemic delivered a wake-up call about the world’s lack of preparedness for deadly epidemics. More than 11,300 people died in the Ebola epidemic, mainly in Africa.

In an email to U.S. and overseas leaders in its global health center, the CDC said it anticipates that if its funding situation remains the same, it will have to narrow activities to 10 “priority countries” starting in October 2019. The email was reviewed by The Wall Street Journal.

The Division of Global Health Protection “will have to scale its global health security portfolio to focus efforts based on existing resources,” wrote Rebecca Martin, director of the CDC’s Center for Global Health. “Faced with this anticipated fiscal reality, we have had to make some very difficult decisions.”

The 10 countries where global health security activities will remain are India, Thailand, Vietnam, Kenya, Uganda, Liberia, Nigeria, Senegal, Jordan and Guatemala, according to the email—countries of strategic or regional importance for the CDC.

Other countries where the agency currently conducts global health security agenda activities include Democratic Republic of the Congo, one of the world’s main hot spots for emerging infectious diseases and the site of the first Ebola outbreak in history; Pakistan; Indonesia; Haiti; and China, where CDC provides technical assistance to the country, which is devoting increasing resources to global health needs. In these 39 countries, the CDC “will plan for the completion of its country-based programs,” transitioning them to other possible funders by October 2020, according to the email.

But if more funding becomes available in fiscal 2019, work in the 10 priority countries could be enhanced and could continue in some of the other countries, according to the email.

Those countries next on the priority list, after the top 10, are China, the DRC, Ethiopia, Indonesia and Sierra Leone, according to another CDC document reviewed by the Journal.

The CDC said in a statement that it is taking these steps now because “we recognize the need for forward planning, and are confident that by planning now we will successfully achieve smooth transitions.”

The CDC is carrying out the work as part of a global health security agenda launched in 2014. Professionals trained in the initiative have helped quickly contain an anthrax outbreak in Kenya and yellow fever in Uganda and identify over 4,000 cases of measles in Sierra Leone.

Reductions now would halt critical work midstream and result in a loss of newly trained local experts, said Tom Frieden, the former CDC director who led the effort until a year ago and is now president and chief executive of Resolve to Save Lives, an initiative working on strengthening epidemic preparedness.

“They’re more likely to have outbreaks and less likely to be able to stop them themselves,” he said of countries that will be affected. “We’ll have to respond instead of having them respond.”
The global health security agenda is “the most important international intervention for emerging infectious disease infrastructure in many years,” said Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. He added that U.S. leadership has helped persuade other nations to help fund the effort.

The CDC will continue to help respond to emerging disease threats and conduct work that had already been under way to improve detection of emerging infectious diseases globally. It will also continue programs combating HIV, tuberculosis, malaria, flu, and conducting immunization programs, Dr. Martin wrote.

Inoculate against a global vaccine crisis

By Laurie Garrett
Foreign Policy – 16 January 2018
On Feb. 27, 2017, the World Health Organization (WHO) named a dozen bacteria as major global health threats, underscoring the surge in antibiotic resistance and paucity of vaccines that, combined, now render incurable the infections caused by those germs.

There is plenty to fret about on the microbial front at the moment: Several scary strains of flu are circulating, and Australia’s winter 2017 flu season was one of the country’s deadliest in recent years. Any hope of protecting the world, generally, against the resurgence of old microbes, as well as the emergence of new ones — man-made biological menaces, for example — hinges on resolving the breakdown in the manufacturing of vaccines and moving the best, most applicable pharmaceutical innovations into the commercial pipeline for affordable access.

Ever since the 2014 Ebola epidemic in West Africa claimed 11,000 lives, global health experts, including those at Doctors Without Borders, have insisted on WHO reforms and an overhaul of the ways governments respond to outbreaks. But topping the list of needed changes is the speed with which the pharmaceutical industry develops new vaccines to guard against everything from Zika virus and tuberculosis to Ebola and drug-resistant bacteria.

But the reality is that … the world faces an even bigger problem: shortages and completely diminished stores of older but highly effective vaccines and a shrinking pool of manufacturers that can produce them.

This search for new protections against infection captured attention at the World Economic Forum in Davos, Switzerland, in January 2017 and at the G-20 summit later in July. It’s certainly appealing to imagine that pharmaceutical innovation fueled by Wall Street investments could lead to the quick creation of technological solutions to ward off outbreaks. But the reality is that, as 2018 begins, the world faces an even bigger problem: shortages and completely diminished stores of older but highly effective vaccines and a shrinking pool of manufacturers that can produce them.

In an average year between 2011 and 2015, data submitted to WHO and UNICEF showed that one-third of 194 countries ran out of a vaccine for a month or longer. Nearly 13 million infants received no vaccines at all in 2016, and by 2017 supplies of vaccines that target yellow fever, hepatitis B, cholera, meningitis C, diphtheria, whooping cough, tetanus, hepatitis A, and tuberculosis were critically low. And these shortages are acute in both poor and rich countries, with 77 percent of European nations telling WHO in 2015 that they had depleted supplies. By September 2017, Switzerland was experiencing shortages of 16 essential vaccines, prompting Daniel Desgrandchamps, an infectious diseases expert at the University of Geneva, to say, “This isn’t a Swiss problem — it’s an international problem.… I can’t remember a situation like this in my 30 years of professional life as a vaccination expert.”

The global pharmaceutical market is worth more than $1 trillion a year, but the vaccines portion of it is trivial, amounting to merely $24 billion — or about 2.4 percent. Yet the tried-and-true ways of targeting viruses and bacteria to prevent infection garner less industry interest. Though low profit margins, despite high demand, have long blocked the vaccine pipeline, the situation is worsening and now has impact on new product development. Few solutions have been suggested, but one country — Brazil — was able to handle a potentially catastrophic shortage better than any other because it manufactures its own vaccines in a unique public-private arrangement that fulfills the country’s constitutional requirement of providing health care for all of its citizens. The government sets production priorities and purchases from local pharmaceutical manufacturers, avoiding the unreliable international market.

In 2016, outbreaks of two mosquito-spread viruses — yellow fever and Zika — exploded in Angola and Brazil, respectively. The yellow fever outbreak spread to nearby Democratic Republic of the Congo as the entire world supply of yellow fever vaccine dwindled dangerously toward zero.

The irony is that the vaccine is almost 100 percent effective and a full dose protects patients for life. But the drug had become so cheap — by 2008, it cost a mere 60 cents for each vaccine — that few companies were interested in making it. With tens of millions of African lives at stake, WHO took a big gamble, diluting donated vaccines from countries such as Brazil — which donated 18 million doses — by 5 to 1 and hoping they would still work. Briefly, by January 2017, the epidemic seemed to be under control. But then it began to sweep across Brazil and the region, with cases popping up in the states of São Paulo and Rio de Janeiro. As the disease continued to spread, placing the global supply under further strain, stockpiles at the U.S. Centers for Disease Control and Prevention (CDC) disappeared. The CDC now estimates that its supplies won’t be replenished until the end of 2018, perhaps not until 2019.

The Zika epidemic and vaccine invention offer a cautionary tale of how these contradicting interests culminate in a less-than-desirable scenario. Before Zika first surfaced in Brazil in 2015 and then spread across the Americas, it had been too obscure to draw pharmaceutical industry interest. But once it hit Puerto Rico and Florida, the industry raced to create a vaccine, and the manufacturer Sanofi developed one that seemed safe and almost completely effective. Officials sighed in relief. But in 2017, when an epidemic in the wealthy United States failed to materialize, Sanofi shut down its Zika vaccine program. And as the year closed, another manufacturer, Merck, failed to apply to the U.S. Food and Drug Administration for approval of its Ebola vaccine — a product supported by strong clinical data — even after signing a $5 million advance purchase commitment with Gavi, the global vaccine alliance.

The challenge for 2018 will be finding a way to keep the pharmaceutical pipeline flowing, both for vaccines against 20th-century threats such as measles and cholera and for 21st-century challenges including SARS, MERS, new forms of deadly influenza, and the unknown microbes lurking out there. Many things have been tried: creating pots of gold for guaranteed bulk purchases, improving global shipping and delivery systems to better target limited supplies, and promoting the entry of vaccine manufacturers from emerging economies. These measures have acted like fingers in a dike, holding back a flood of further market failures. But Doctors Without Borders and many global health leaders fear that nothing less than a change to the capitalist underpinnings of the pharmaceutical industry will resolve the vaccine crisis — a step so extreme that only Brazil and a handful of left-leaning nations have dared put in practice.
     Garrett is a Pulitzer Prize-winning writer and global health policy analyst.

Featured Journal Content

Science

18 January 2018
Letter
Vaccine mandates in France will save lives
by Stanley A. Plotkin, Paul Offit, Pierre Bégué
In their Letter “France’s risky vaccine mandates” (27 October 2017, p. 458), J. K. Ward et al. question the adoption of mandatory vaccination in France. Their prediction that such a step will encourage resistance to vaccination is unsupported by the facts and could prolong a dangerous situation in which French citizens have the right to allow their children to catch and transmit potentially fatal infections.
The French recommendation—which has now gone into effect (1)—was the product of two juries composed of both medical professionals and lay citizens (2), suggesting that Ward et al.’s concerns about acceptance by doctors and the public are unfounded. Moreover, evidence shows that mandates are effective. In California, immunization rates increased after so-called “philosophical exemptions” were eliminated (3).
Vaccine-hesitancy in French physicians has been found to be only moderate in prevalence (4). Even one vaccine-hesitant doctor is too many, but Ward et al. do not offer a solution to the problem, such as better education by medical schools. Furthermore, a reference cited by Ward et al. does not, as they claim, show that mandating vaccines increases antivaccinationism, but rather that citing dangers of diseases is more effective than arguing for safety of vaccination (5).
Ward et al.’s reasoning could be extrapolated to argue against mandating car seats for young    children. Like car seats, vaccination mandates will likely save lives.

References
.1. Association Française de Pédiatrie Ambulatoire, Obligation Vaccinale: Ce Qu’il Faut Savoir (2018); https://afpa.org/obligation-vaccinale/ [in French].
.2. Concertation Citoyenne sur la Vaccination, “Rapport sur la Vaccination” (2016); http://concertationvaccination.fr/la-restitution/.
.3. L. Sun, “California vaccination rate hits new high after tougher immunization law,” Washington Post (2017).
.4. P. Verger et al., Euro Surveill. 27, 30406 (2016).
.5. Z. Horne et al, ., Proc. Natl. Acad. Sci. U.S.A. 112, 10321 (2015).