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

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– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_24 Feb 2018

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

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

Milestones :: Perspectives

Every Child Alive: The urgent need to end newborn deaths
UNICEF
February 2018 :: 44 pages
https://www.unicef.org/publications/index_102640.html
Overiew
Every year, 2.6 million babies die before turning one month old. One million of them take their first and last breaths on the day they are born. However, millions of these young lives could be saved every year if every mother and every baby had access to affordable, quality health care, good nutrition and clean water. This report addresses the challenges of keeping every child alive, and calls for strong cooperation among governments, businesses, health-care providers, communities and families to give every newborn a fair chance to survive, and to collectively work towards the achievement of universal health coverage, and a world where no newborn dies of a preventable cause.

Excerpts [Editor’s text bolding]
p.19
…After birth, breastmilk is a baby’s first vaccine – the first and best protection against illness and disease. It is critical that health workers provide adequate nutritional counselling to mothers during pregnancy…
 
p.22
The 10 most critical products for newborn survival
:: Ambu-bags, used to manually resuscitate newborns who fail to breathe after birth
:: Antibiotics to treat mothers and newborns who have infections
:: Blankets and cloth to keep the baby warm and support skin-to-skin contact, including during breastfeeding
:: Chlorhexidine, a broad-spectrum antiseptic used to prevent infection of the umbilical cord, which can lead to sepsis
:: Continuous positive airway pressure (CPAP) machines for premature babies whose underdeveloped lungs make it difficult for them to breathe
:: Oxygen concentrator equipment, used to help very low-birthweight babies breathe
:: Phototherapy machines to reduce jaundice in newborns
:: Micronutrient supplements, especially iron and folic acid to prevent iron deficiency anaemia in pregnant women and reduce the risk of low-birthweight babies and complications at birth
:: Tetanus toxoid vaccine to prevent tetanus infection, which can result from unhygienic birth conditions
:: Thermometers, used to closely monitor the temperature of sick newborns

Press Release
World is failing newborn babies, says UNICEF
NEW YORK, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.

“While we have more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old,” said Henrietta H. Fore, UNICEF’s Executive Director. “Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies.”
Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

Unequal shots at life
Highest newborn mortality rates
1. Pakistan: 1 in 22
2. Central African Republic: 1 in 24
3. Afghanistan: 1 in 25
4. Somalia: 1 in 26
5. Lesotho: 1 in 26
6. Guinea-Bissau: 1 in 26
7. South Sudan: 1 in 26
8. Côte d’Ivoire: 1 in 27
9. Mali: 1 in 28
10. Chad: 1 in 28

Lowest newborn mortality rates
1. Japan: 1 in 1,111
2. Iceland: 1 in 1,000
3. Singapore: 1 in 909
4. Finland: 1 in 833
5. Estonia: 1 in 769
5. Slovenia: 1 in 769
7. Cyprus: 1 in 714
8. Belarus: 1 in 667
8. Luxembourg: 1 in 667
8. Norway: 1 in 667
8. Republic of Korea: 1 in 667

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

This month, UNICEF is launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:
:: Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care;
:: Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby;
:: Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life; and
:: Empowering adolescent girls, mothers and families to demand and receive quality care.

“Every year, 2.6 million newborns around the world do not survive their first month of life. One million of them die the day they are born,” said Ms. Fore. “We know we can save the vast majority of these babies with affordable, quality health care solutions for every mother and every newborn. Just a few small steps from all of us can help ensure the first small steps of each of these young lives.”

Milestones :: Perspectives

Urgent need to scale up health services in Cox’s Bazar: WHO
SEAR/PR/1680
Cox’s Bazar, Bangladesh, 20 February 2018: Calling for continued efforts to further scale up health services for nearly 1.3 million people in Cox’s Bazar, Rohingyas and their surrounding host communities, the World Health Organization today said six months after the start of the refugee crisis, the vulnerable populations remain at risk of several diseases and in need of critical services for survival.

“Commendable efforts have been made by the Government of Bangladesh and partner agencies to provide health services; prevent diseases such as cholera; and rapidly control outbreaks of measles and diphtheria. However, the challenges are huge, multiple and evolving. The magnitude of the crisis requires continued efforts and generous contributions by all partners to scale up health services for the vulnerable population,” said Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia.

An estimated 688,000 Rohingyas crossed over to Cox’s Bazar from Myanmar beginning 25 August 2017, joining nearly 212,500 others who had arrived in earlier waves, in one of the largest population movement in the shortest span.

While majority of the refugees are living in Kutapalong and Balukhali mega camps and 11 other clusters of small and big settlements, about 79 000 are living with the host population.
The mega camps are currently one of the world’s biggest refugee settlement areas and also one of the world’s most densely populated areas.

The health needs of this population continue to be immense. Women and young mothers need reproductive health services. An estimated 60 000 children are expected to be born in the camps in the next one year. Besides newborns, pregnant and young mothers; children, adults and the elderly need basic health services and that for injuries, trauma and various non-communicable diseases such as heart disease, diabetes, and importantly, psychosocial support.

“Water and sanitation, and shelter continues to be far from optimum, increasing the risk of rapid spread of several communicable and water borne diseases,” the Regional Director said, stressing the need to accelerate efforts to address the key determinants of health on a priority.
The upcoming rainy season and the risk of cyclone and floods, increase the vulnerability of these people to waterborne diseases such as diarrhea and hepatitis, and vector borne diseases such as malaria, dengue and chikungunya.

For keeping a close watch on the situation, WHO established the Early Warning and Response System (EWARS), early as the crisis started, to rapidly detect and respond to disease outbreak to minimize death and disease. Additionally, WHO has been periodically carrying out risk assessments to enable Ministry of Health and partners take measures to detect potential health risks and take timely and appropriate measures.

The EWARS and risk assessments helped Bangladesh’s decision to carry out large scale vaccination campaigns with cholera, measles and rubella, polio and diphtheria vaccines. WHO has been working with the Ministry of Health and partners to plan, roll out and monitor vaccination campaigns to ensure all children are protected.

WHO continues to lead and coordinate efforts of over 100 partners managing more than 270 health facilities – health posts, hospitals, treatment centers and mobile clinics – while also providing medicines and medical equipment, diagnostics, guidelines and trainings and building laboratory capacity.

Despite efforts by government and partners, challenges are many. The affected population has distinct and unique culture and language, a major barrier in impacting health seeking and hygiene behavior.

But the most impending challenge is finding a safe space to relocate the refugees in case of floods and cyclone during the upcoming rainy season, which may further impact their health.
“The Government of Bangladesh has been extremely generous and forthcoming in hosting and providing for the Rohingyas. However, the health sector is grossly under-funded and grappling to meet the needs of the affected population,” Dr Khetrapal Singh said, appealing to international community to contribute generously and commit to support what clearly is set to be a protracted emergency.

Reiterating WHO’s committed to work with the Ministry of Health and Family Welfare and partners to address health issues of the vulnerable population, the Regional Director said concerted efforts by both national and international community is the need of the hour to strengthen and reinforce health services for both the Rohingyas and the their host population in Cox’s Bazar.

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 21 February 2018 [GPEI]
:: New on http://polioeradication.org/: Ending polio and yellow fever in Nigeria, and why the polio vaccine must be delivered multiple times.
::  Our brand new animation on the two polio vaccines has been released, available in English, French, and Arabic.
:: In response to recent cases, the government of the Democratic Republic of the Congo (DRC) has announced the circulating vaccine-derived poliovirus 2 (cVDPV2) outbreak ongoing in the country as a Public Health Emergency of National Concern. Since the outbreak began, the Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative, has implemented four monovalent oral polio vaccine 2 (mOPV2) supplementary immunization campaigns and one mop-up campaign to prevent virus spread. They have worked hard to strengthen surveillance and routine immunization in the outbreak zones and across the country, and are fully committed to ending the outbreak. The total number of officially reported cVDPV2 cases in the DRC in 2017 is 21. No cases of cVDPV2 with onset in 2018 have so far been reported.
:: Summary of newly-reported viruses this week: No new viruses reported.

::::::
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Syria cVDPV2 outbreak situation report 35, 20 February 2018
Situation update 20 February 2018
[Editor’ text bolding]
:: 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.
:: An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus, Hasakah, parts of Aleppo governorates, and Jurmana district of rural Damascus as part of the second phase of the outbreak response. IPV vaccination is continuing in accessible parts of Aleppo governorate.
:: Reportedly, a total of 233 518 children aged 2–23 months received IPV, representing 71% of the estimated target.
:: Post campaign monitoring of the IPV campaign has concluded in Damascus, Hasakah and parts of Aleppo governorate that completed the implementation. Overall, post campaign monitoring indicates 81% vaccination rates by parental/caregiver recall and 77% by finger marking.
:: Post campaign monitoring particularly focused on the internally displaced persons (IDP) camps; the data indicates 91% vaccination rates by parental/caregiver recall and 89% by finger marking.
:: A nationwide immunization round utilizing bivalent OPV (bOPV) is planned for March. The campaign will target all children aged less than 5 years.

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WHO Grade 3 Emergencies  [to 24 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 35, 20 February 2018
[See Polio above for detail]

Yemen 
Weekly cholera bulletins
:: Weekly epidemiology bulletin, 5–11 February 2018
Cumulative figures
-The cumulative total from 27 April 2017 to 11 Feb 2018 is 1,059,970 suspected cholera cases and 2,258 associated deaths, (CFR 0.21%), 1104 have been confirmed by culture.
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 16%
– The national attack rate is 382.7 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (894), Al Mahwit (857), Al Dhale’e (644), Hajjah (520) and Sana’a (515).
– Children under 5 years old represent 28.8% of total suspected cases.
– In total, 29,629 rapid diagnostic tests (RDT) have been performed which represents 28 % coverage.
– 2,732 cultures have been performed which represents 22.3% coverage.
– The last positive culture was on 4 Feb 2018 in Al Harith district in Amant Al Asimah
– 182 districts are still reporting suspected cholera cases since last 3 weeks
– 123 districts (out of 305 affected districts) did not report any suspected cases for the last three consecutive weeks
Governorate and District level
– At governorate level, the trend from W4 –W6 decrease or was stable in all governorates except (Aden governorate)
(+13%).
Trends
– The weekly number of cases is decreasing for the 22 consecutive weeks.
– The weekly proportion of severe cases has significantly decreased representing now 9% of the admitted cases.
Week 6 2018
– 3,886 suspected cases and 3 associated deaths were reported
– 9 % are severe cases
– 589 RDTs were performed, 131 were positive
– No culture test was performed this week

::::::
 
WHO Grade 2 Emergencies  [to 24 February 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017
[See WHO announcement in Milestones/Perspectives above]

Democratic Republic of the Congo 
:: Read the health situation report in French pdf, 4.28Mb, February 2018

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: 23 Feb 2018   UN chiefs call for stepped-up support for vulnerable Syrians, refugees and host communities, amid escalating violence inside Syria

Yemen 
:: 20 Feb 2018  Yemen Humanitarian Update Covering 12 – 18 February 2018

WHO & Regional Offices [to 24 February 2018]

Latest news
Europe observes a 4-fold increase in measles cases in 2017 compared to previous year
Copenhagen, 19 February 2018
Measles has rebounded in the WHO European Region. The disease affected 21 315 people and caused 35 deaths in 2017, following a record low of 5273 cases in 2016. The WHO Regional Office for Europe has released new data for 2017 one day ahead of a health ministerial meeting on immunization in Montenegro on 20 February 2018.
“Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated. Over 20 000 cases of measles, and 35 lives lost in 2017 alone, are a tragedy we simply cannot accept,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.
“Elimination of both measles and rubella is a priority goal that all European countries have firmly committed to, and a cornerstone for achieving the health-related Sustainable Development Goals,” Dr Jakab continues. “This short-term setback cannot deter us from our commitment to be the generation that frees our children from these diseases once and for all.”..

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Highlights
Recommended composition of influenza virus vaccines for use in the 2018-2019
February 2018- A periodic replacement of viruses contained in influenza vaccines is necessary in order for the vaccines to be effective due to the constant evolving nature of influenza viruses. Twice a year, WHO organizes consultations, and issues recommendations on the composition of the influenza vaccines for the following influenza season.

::::::
 
Weekly Epidemiological Record, 23 February 2018, vol. 93, 08 (pp. 73–96)
:: BCG vaccines: WHO position paper – February 2018
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO strategizes to address the worsening challenge of the malaria burden in South Sudan
24 February 2018
:: Sierra Leone maximizes protection against polio with Inactivated Polio Vaccine launch
23 February 2018
Today Sierra Leone officially introduced injectable polio vaccine (or…
:: WHO and GAVI Alliance Partners along with the Ministry of Health strategizes to vaccinate over 485 000 children under one year of age in 2018  22 February 2018
Despite widespread conflict and insecurity, South Sudan has witnessed…
:: Experts agree on guidelines to boost vaccine uptake through improved communication
20 February 2018  Health experts from over 15 countries have begun a two-day meeting in…

WHO Region of the Americas PAHO
:: PAHO reminds international travelers to get vaccinated before traveling to areas with yellow fever (02/23/2018)
 
WHO European Region EURO
::  12 European countries commit to greater efforts to protect people from vaccine-preventable diseases 23-02-2018
:: European Region countries convene to boost emergency preparedness and response 20-02-2018
:: Portraits from Ukraine’s conflict line, where humanitarian assistance is most needed 20-02-2018
:: South-eastern European countries meet to develop regional action plan 19-02-2018

WHO Western Pacific Region
:: Questions and answers on avian influenza
21 February 2018 — Avian influenza viruses normally spread between birds. However, some viruses have been found to infect humans. The primary risk factor for humans is exposure to infected live or dead poultry or contaminated environments, such as live bird markets. Read our Q&A to learn more.

CDC/ACIP [to 24 February 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

 
MMWR News Synopsis for February 22, 2018 / No. 5
https://www.cdc.gov/mmwr/index2018.html
:: HIV Diagnoses Among Persons Aged 13–29 Years — United States, 2010‒2014
A new analysis provides a clearer picture of the remarkable escalations in HIV diagnosis rates among adolescents as age increases between 13-21 years. Between 2010 and 2014, there were large differences in diagnosis rates among adolescents and young adults as age increased (between 13 and 21 years). An analysis of data from the National HIV Surveillance System revealed large differences in HIV diagnosis rates per 100,000 between adolescents ages 13-15 years (0.7); 16-17 years (4.5); and 18-19 years (16.5). The analysis also found that while diagnosis rates were higher among young adults than adolescents, they were less variable among age groups: 20-21 years (28.6 per 100,000); 22-23 years (34.0); 24-25 years (33.8); 26-27 years (31.3); and 28-29 years (28.7). The findings demonstrate the importance of targeting primary prevention efforts to people younger than 18 years and continuing through the period of elevated risk in the mid-20s.

ECDC – European Centre for Disease Prevention and Control  [to 24 February 2018]

https://ecdc.europa.eu/en/home
19 Feb 2018
Africa CDC Director Dr Nkengasong visits ECDC

Announcements

 
AERAS  [to 24 February 2018]
http://www.aeras.org/pressreleases
February 19, 2018
Results from Innovative Phase 2 Tuberculosis Vaccine Trial Offer Potential for New BCG Revaccination Strategies, Hope For Subunit Vaccines
Study is the First “Prevention of Infection” Trial Conducted for Tuberculosis, the World’s Leading Infectious Disease Killer
Results to Be Presented at the 5th Global Forum on TB Vaccines
NEW DELHI (February 19, 2018) –Aeras, a nonprofit organization dedicated to developing vaccines against tuberculosis (TB), today announced results from an innovative clinical trial that provides encouraging new evidence that TB vaccines could prevent sustained infections in high-risk adolescents. In a prevention-of-infection Phase 2 trial conducted in South Africa, revaccination with the Bacille Calmette-Guerin (BCG) vaccine significantly reduced sustained TB infections in adolescents.  An experimental vaccine candidate, H4:IC31, also reduced sustained infections, although not at statistically significant levels. However, the trend observed for H4:IC31 is the first time a subunit vaccine has shown any indication of ability to protect against TB infection or disease in humans.
TB infections that developed during the study were determined using a QuantiFERON®-TB Gold in Tube (QFT-GIT) test, a commercially available blood test that helps diagnose TB infections. In the trial, individuals who tested negative for QFT-GIT were considered to not have a TB infection. The trial measured the rate by which individuals converted to QFT-GIT positive, implying evidence of TB infection.  Those individuals who tested QFT-GIT positive consecutively over 6 months were considered to have a sustained infection.,,

Aeras Highlights Commitment to Eradicating the World’s Leading Infectious Disease Killer at the 5th Global Forum on Tuberculosis
Aeras will highlight the progress being made in TB vaccine research at the 5th Global Forum on TB Vaccines in New Delhi, India, February 20-23, 2018. Presentations will include new data from Aeras’s advancing portfolio of TB vaccines, including data from four clinical-stage candidates. Keep reading for all presentation details.

European Medicines Agency  [to 24 February 2018]
http://www.ema.europa.eu/ema/
23/02/2018
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 19-22 February 2018
Five medicines recommended for approval, including two orphans
 
 
IFFIm
http://www.iffim.org/library/news/press-releases/
22 February 2018
Financial engineering for global development
New IFFIm Board Chair Cyrus Ardalan reflects on IFFIm’s pioneering role in the growth of socially responsible investing.
Excerpt
…Q. IFFIm has been frequently singled out as an example of a successful socially responsible investment. Indeed, the landmark Third International Conference on Financing for Development, in 2015 in Addis Ababa, Ethiopia, stated that IFFIm should “be replicated to address broader development needs.” What can others in the global development sector learn from IFFIm’s example that they might adopt for their own financing needs?
CA: First, IFFIm Vaccine Bonds are as pure an example of socially responsible financing as you can get.
They have a clear social benefit, the results are measurable, and we can readily see the impact these funds are having. That’s a model that many others can emulate readily, though it may need to be adapted to different development needs.
Second, others might want to look at the institutional structure underpinning IFFIm, not just the bonds it issues. It’s a unique and, we think, replicable form of financial engineering. It enables us to accelerate for the short-term value that donor governments provide over the long run. It also gives Gavi much more flexibility to provide solutions when the need is greatest. That’s why IFFIm-generated funding initially made up more than 50% percent of Gavi’s expenditures.
On a less formal basis, we’re also offering advice and information to leaders in other development sectors who are exploring ways to improve the volume and flow of financing. We’ve done so, for example, with The International Commission on Financing Global Education Opportunity, which is contemplating an International Financing Facility for Education, or IFFEd.    Their goal is to mobilise by 2020 an additional $10 billion annually for investment into education in developing countries.

1. Can you describe potential new strategic initiatives IFFIm is currently exploring?

CA: Over the past couple of years we’ve looked at ways IFFIm can expand its role to help Gavi where there are emerging needs. That would include, first of all, doing more with what IFFIm has traditionally done through Vaccine Bond issuances.
Second, IFFIm could also be called on to more directly support Gavi’s impact on reducing the cost and increasing the availability of vaccines through its market shaping role. Market shaping is really one of Gavi’s core functions and achievements, and it has dramatically increased the supply of vaccines that low income countries can afford.
IFFIm has contributed to market shaping activities in the past by frontloading more than 90% of initial vaccines for Gavi’s pentavalent programme.  Pentavalent vaccine is effective in eradicating five diseases: diphtheria, tetantus, pertussis, hepatitis B and Haemophilus influenzae type b.  This investment encouraged manufacturers to increase vaccine production and decrease the price.  Gavi is now able to procure pentavalent vaccine for as low as $1.68 a dose – a price reduction of more than 50% since 2006.
Additionally, Gavi supported the introduction of pentavalent vaccine in 73 countries., By leveraging IFFIm’s unused capacity, it could play a greater role in supporting Gavi’s market shaping activities.
Third, IFFIm might provide additional financing to help countries install modern cold chain equipment that enables vaccines to be delivered unspoiled to the children whose lives depend on them – especially in remote areas. The goal is to increase access to more children and allow for the wider use of energy efficient, solar-powered equipment, especially in places that don’t have access to electricity.
Finally, we’re also looking into ways in which IFFIm can help with a new mechanism that will allow for the rapid deployment of financing in the event of infectious disease outbreaks, should Gavi decide to play an active role in this area.

IVAC  [to 24 February 2018]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
[Undated]
IVAC Executive Director Dr. Kate O’Brien is featured in the Spring 2018 issue of the Hopkins Bloomberg Public Health magazine
 
Read the latest VIEW-hub report (December 2017)
 
 
MSF/Médecins Sans Frontières  [to 24 February 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Syria: Mass Casualties in Eastern Ghouta as 13 Medical Facilities are Hit and Lifesaving Supplies are Blocked by Siege
February 21, 2018
BRUSSELS/NEW YORK—Thirteen hospitals and clinics that receive support from Doctors Without Borders/Médecins Sans Frontières (MSF) have been damaged or destroyed over the past three days amid an extraordinary increase in bombing and shelling over the Syrian enclave of Eastern Ghouta, MSF said today. Meanwhile, lifesaving medical supplies urgently needed to treat mass casualties are being restricted by the ongoing siege on the area.

 
NIH  [to 24 February 2018]
http://www.nih.gov/news-events/news-releases
February 23, 2018
U.S. hospitals testing experimental therapies to prevent two common bacterial infections
February 23, 2018 — NIH-funded sites join large, international clinical trials.

NIH program to accelerate therapies for arthritis, lupus releases first datasets
February 21, 2018 — Collaborative effort provides important clues about potential research targets.
 

UNAIDS [to 24 February 2018]
http://www.unaids.org/en
23 February 2018
UNAIDS’ Deputy Executive Director, Programme, not to seek renewal of his position
GENEVA, 23 February 2018—UNAIDS’ Deputy Executive Director, Programme, Luiz Loures, has communicated his wish to the UNAIDS Executive Director not to seek the renewal of his position as Assistant Secretary-General of the United Nations and Deputy Executive Director of UNAIDS. Dr Loures will end his term as Deputy Executive Director at the end of March 2018.
The Executive Director of UNAIDS, Michel Sidibé, has accepted the decision and conveyed the decision to the Secretary-General of the United Nations. Mr Sidibé also thanked Dr Loures for his 22 years of dedicated service to UNAIDS…

UNICEF  [to 24 February 2018]
https://www.unicef.org/media/
23 February 2018
Cyclone season and threat of violence loom over 720,000 Rohingya children in Myanmar and Bangladesh – UNICEF
GENEVA/NEW YORK, 23 February 2018 – Urgent efforts are needed to help more than 720,000 Rohingya children who are threatened either by the approaching cyclone season in Bangladesh or by ongoing violence and denial of their basic rights in Myanmar, UNICEF said today.

UNICEF Executive Director Henrietta H. Fore gives remarks at the #EveryChildALIVE launch
NEW YORK, 20 February 2018 – “Thank you for joining us as we launch “Every Child Alive” — our new campaign to end the tragedy of preventable child deaths. Thanks to many of the people in this room, more children are surviving to their fifth birthdays than at any time in history. But as we celebrate the progress achieved for the young citizens of the world, we must do more for the youngest of all: newborns.”

The war on children in Syria: Reports of mass casualties among children in Eastern Ghouta and Damascus
AMMAN, 20 February 2018- “No words will do justice to the children killed, their mothers, their fathers and their loved ones”[1].

World is failing newborn babies, says UNICEF
NEW YORK, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.
[See Reports/Research below for more detail]

Wellcome Trust  [to 24 February 2018]
https://wellcome.ac.uk/news
News / Published: 21 February 2018
Bolster European Research Area to boost science post-Brexit
The European Research Area (ERA) should be strengthened and broadened to increase scientific collaboration between member states and associated countries including the UK, according to a new report from Wellcome.
The Future Partnership Project report, Building a Strong Future for European Science: Brexit and Beyond [PDF 641KB], based on consultations with more than 200 UK and European scientists and policy makers, makes recommendations about how greater scientific collaboration could be achieved after Brexit.

4 projects reveal history of health experiences in LGBTQI+ community
Published: 19 February 2018
To mark this year’s LGBT History Month, Charli Colegate from our Humanities and Social Science team highlights four grants that are exploring the health-related histories of LGBTQI+ people.

The Wistar Institute   [to 24 February 2018]
https://www.wistar.org/news/press-releases
Press Release 
Variant of the p53 Gene Increased Tumor Cell Metabolism
PHILADELPHIA — (Feb. 22, 2018) — Scientists at The Wistar Institute have found a novel mechanism through which mutant p53 enhances metastasis by controlling tumor metabolism.

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Industry Watch   [to 24 February 2018]
:: GSK presents new efficacy data for FLUARIX® QUADRIVALENT (Influenza Vaccine) in children 6 months through 35 months of age
PHILADELPHIA, Feb. 21, 2018 /PRNewswire/ — GSK presented today at the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices meeting that FLUARIX® QUADRIVALENT demonstrated 63.2% efficacy against moderate to severe influenza and 49.8% efficacy against influenza of any severity in children 6 months through 35 months of age.
These results are based on a randomized, observer-blind, non-influenza vaccine-controlled trial that enrolled 12,018 children in five independent cohorts in 13 countries in Asia, Europe, and Central America from 2011 through the end of 2014.
“Children 6 months through 35 months of age are particularly vulnerable to the flu, and the efficacy results from this trial are promising,” said Dr. Leonard Friedland, Vice President, Scientific Affairs and Public Health, GSK Vaccines, who presented the data to the ACIP.    “FLUARIX® QUADRIVALENT can help ensure health care provider and parents have the ability to help protect young children against the flu.”…

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 Public Health
March 2018  108(3)
http://ajph.aphapublications.org/toc/ajph/current

AJPH PERSPECTIVES
OUTBREAKS
Delays in Global Disease Outbreak Responses: Lessons from H1N1, Ebola, and Zika
Steven J. Hoffman and Sarah L. Silverberg
108(3), pp. 329–333
Abstract
In global disease outbreaks, there are significant time delays between the source of an outbreak and collective action. Some delay is necessary, but recent delays have been extended by insufficient surveillance capacity and time-consuming efforts to mobilize action.
Three public health emergencies of international concern (PHEICs)—H1N1, Ebola, and Zika—allow us to identify and compare sources of delays and consider seven hypotheses about what influences the length of delays. These hypotheses can then motivate further research that empirically tests them. The three PHEICs suggest that deferred global mobilization is a greater source of delay than is poor surveillance capacity. These case study outbreaks support hypotheses that we see quicker responses for novel diseases when outbreaks do not coincide with holidays and when US citizens are infected. They do not support hypotheses that we see quicker responses for more severe outbreaks or those that threaten larger numbers of people.
Better understanding the reason for delays can help target policy interventions and identify the kind of global institutional changes needed to reduce the spread and severity of future PHEICs.

American Journal of Public Health
March 2018  108(3)
http://ajph.aphapublications.org/toc/ajph/current

AJPH PRACTICE
VACCINES
Fostering Interprofessional Education Through a Multidisciplinary, Community-Based Pandemic Mass Vaccination Exercise
Annette Hays, Christopher Schriever, John Rudzinski, Janet L. Lynch, Ellen Genrich and Allison Schriever
108(3), pp. 358–360
Abstract
We expanded health care services to economically disadvantaged individuals in an interprofessional, student-driven vaccination effort that also served as a pandemic planning drill. Health care professional students from colleges in and around Rockford, Illinois participated in implementing a mass vaccination event from 2011 to 2014 that targeted the underserved population. There was a 459% increase in total vaccinations administered to at-risk patients from year 1 to year 4. This interprofessional health care student–driven effort expanded medical service to disadvantaged individuals.

Annals of Internal Medicine
20 February 2018 Vol: 168, Issue 4
http://annals.org/aim/issue

Original Research
Low Prevalence of Hepatitis B Vaccination Among Patients Receiving Medical Care for HIV Infection in the United States, 2009 to 2012
John Weiser, MD, MPH; Alejandro Perez, MPH; Heather Bradley, PhD; Hope King, PhD, MSPH; R. Luke Shouse, MD, MPH
Abstract
Background: Persons with HIV infection are at increased risk for hepatitis B virus infection. In 2016, the World Health Organization resolved to eliminate hepatitis B as a public health threat by 2030.
Objective: To estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection (“HIV patients”).
Design: Nationally representative cross-sectional survey.
Setting: United States.
Participants: 18 089 adults receiving HIV medical care who participated in the Medical Monitoring Project during 2009 to 2012.
Measurements: Primary outcomes were prevalence of 1) no documentation of hepatitis B vaccination or laboratory evidence of immunity or infection (candidates to initiate vaccination), and 2) initiation of vaccination among candidates, defined as documentation of at least 1 vaccine dose in a 1-year surveillance period during which patients received ongoing HIV medical care.
Results: At the beginning of the surveillance period, 44.2% (95% CI, 42.2% to 46.2%) of U.S. HIV patients were candidates to initiate vaccination. By the end of the surveillance period, 9.6% (CI, 8.4% to 10.8%) of candidates were vaccinated, 7.5% (CI, 6.4% to 8.6%) had no documented vaccination but had documented infection or immunity, and 82.9% (CI, 81.1% to 84.7%) remained candidates. Among patients at facilities funded by the Ryan White HIV/AIDS Program (RWHAP), 12.5% (CI, 11.1% to 13.9%) were vaccinated during the surveillance period versus 3.7% (CI, 2.6% to 4.7%) at facilities not funded by RWHAP. At the end of surveillance, 36.7% (CI, 34.4% to 38.9%) of HIV patients were candidates to initiate vaccination.
Limitation: The study was not designed to describe vaccine series completion or actual prevalence of immunity.
Conclusion: More than one third of U.S. HIV patients had missed opportunities to initiate hepatitis B vaccination. Meeting goals for hepatitis B elimination will require increased vaccination of HIV patients in all practice settings, particularly at facilities not funded by RWHAP.
Primary Funding Source: Centers for Disease Control and Prevention.

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 24 February 2018)

Methodology
20 February 2018
Incorporating economies of scale in the cost estimation in economic evaluation of PCV and HPV vaccination programmes in the Philippines: a game changer?
Authors: Thanthima Suwanthawornkul, Naiyana Praditsitthikorn, Wantanee Kulpeng, Manuel Alexander Haasis, Anna Melissa Guerrero and Yot Teerawattananon
Abstract
Background
Many economic evaluations ignore economies of scale in their cost estimation, which means that cost parameters are assumed to have a linear relationship with the level of production. Economies of scale is the situation when the average total cost of producing a product decreases with increasing volume caused by reducing the variable costs due to more efficient operation. This study investigates the significance of applying the economies of scale concept: the saving in costs gained by an increased level of production in economic evaluation of pneumococcal conjugate vaccines (PCV) and human papillomavirus (HPV) vaccinations.
Methods
The fixed and variable costs of providing partial (20% coverage) and universal (100% coverage) vaccination programs in the Philippines were estimated using various methods, including costs of conducting questionnaire survey, focus-group discussion, and analysis of secondary data. Costing parameters were utilised as inputs for the two economic evaluation models for PCV and HPV. Incremental cost-effectiveness ratios (ICERs) and 5-year budget impacts with and without applying economies of scale to the costing parameters for partial and universal coverage were compared in order to determine the effect of these different costing approaches.
Results
The program costs of the partial coverage for the two immunisation programs were not very different when applying and not applying the economies of scale concept. Nevertheless, the program costs for universal coverage were 0.26 and 0.32 times lower when applying economies of scale compared to not applying economies of scale for the pneumococcal and human papillomavirus vaccinations, respectively. ICERs varied by up to 98% for pneumococcal vaccinations, whereas the change in ICERs in the human papillomavirus vaccination depended on both the costs of cervical cancer screening and the vaccination program. This results in a significant difference in the 5-year budget impact, accounting for 30 and 40% of reduction in the 5-year budget impact for the pneumococcal and human papillomavirus vaccination programs.
Conclusions
This study demonstrated the feasibility and importance of applying economies of scale in the cost estimation in economic evaluation, which would lead to different conclusions in terms of value for money regarding the interventions, particularly with population-wide interventions such as vaccination programs. The economies of scale approach to costing is recommended for the creation of methodological guidelines for conducting economic evaluations.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 24 February 2018)

Research article
Efficacy of a bivalent killed whole-cell cholera vaccine over five years: a re-analysis of a cluster-randomized trial
Oral cholera vaccine (OCV) is a feasible tool to prevent or mitigate cholera outbreaks. A better understanding of the vaccine’s efficacy among different age groups and how rapidly its protection wanes could he…
Authors: Youyi Fong, M. Elizabeth Halloran, Jin Kyung Park, Florian Marks, John D. Clemens and Dennis L. Chao
Citation: BMC Infectious Diseases 2018 18:84
Published on: 20 February 2018

Global Public Health
Volume 13, 2017   Issue 4
http://www.tandfonline.com/toc/rgph20/current

Article
Geneva–Seattle collaboration in support of developing country vaccine manufacturing
Michael A. Stevenson
Pages: 426-441
Published online: 19 Oct 2016
ABSTRACT
Vaccines were once produced almost exclusively by state-supported entities. While they remain essential tools for public health protection, the majority of the world’s governments have allowed industry to assume responsibility for this function. This is significant because while the international harmonisation of quality assurance standards have effectively increased vaccine safety, they have also reduced the number of developing country vaccine producers, and Northern multinational pharmaceutical companies have shown little interest in offering the range of low-priced products needed in low and middle-income-country contexts. This article examines how public–private collaboration is relevant to contemporary efforts aimed at strengthening developing country manufacturers’ capacity to produce high-quality, low-priced vaccines. Specifically, it casts light on the important and largely complimentary roles of the World Health Organization, The Bill and Melinda Gates Foundation, and the Seattle-based non-profit PATH, in this process. The take away message is that external support remains critical to ensuring that developing country vaccine manufacturers have the tools needed to produce for both domestic and global markets, and the United Nations supply chain, and collaboration at the public–private interface is driving organisational innovation focused on meeting these goals.

International Health
Volume 10, Issue suppl_1, 1 March 2018
http://inthealth.oxfordjournals.org/content/current
Special Issue: Onchocerciasis: The Beginning of the End

INTRODUCTION
Onchocerciasis: the beginning of the end
Joni Lawrence; Yao K Sodahlon
International Health, Volume 10, Issue suppl_1, 1 March 2018, Pages i1–i2, https://doi.org/10.1093/inthealth/ihx070
Extract
Thirty years ago, the concept that onchocerciasis could be eliminated worldwide was unthinkable. Today, we’re on the road to seeing the end of this debilitating disease. Thanks to the efforts of a global partnership consisting of MSD, also known as Merck & Co., Inc., Kenilworth, NJ USA, the Mectizan Donation Program (MDP), endemic countries, bilateral funding agencies and the donor community, the World Health Organization (WHO), non-governmental organizations (NGOs) and researchers, the disease is on the decline. In areas that have been under treatment the longest, the blindness, visual impairment, skin disease and itching caused by onchocerciasis is now increasingly rare.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 7, Issue 1, 19 February 2018
https://academic.oup.com/jpids/issue
SPECIAL ARTICLE

A Time to Save
Carol J Baker
Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, 19 February 2018, Pages 1–5, https://doi.org/10.1093/jpids/piw080
Abstract
Group B Streptococcus (GBS), characterized by Lancefield in 1933, was not recognized as a human pathogen until the early 1970s when it emerged and replaced Escherichia coli as the most common cause of sepsis and meningitis among neonates and young infants. This article briefly gives a personnel account of the discovery of clinical syndromes of GBS distinguished by age at onset, vertical mode of transmission for early-onset disease, meningeal tropism for GBS capsular (CPS) type III strains, and protective CPS epitopes. It also reviews the difficult evolution of the now routine program for antenatal GBS culture screening and intrapartum antibiotic prophylaxis, development of the first GBS candidate vaccines, clinical trials documenting the immunogenicity and safety of CPS tetanus toxoid conjugate vaccines, ongoing need to prevent morbidity and mortality in neonates and young infants, and critical need for commercial vaccines for routine use in pregnant women.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 7, Issue 1, 19 February 2018
https://academic.oup.com/jpids/issue
SPECIAL ARTICLE

Editor’s Choice
Rapid Decrease in Rates of Hospitalization Resulting From Invasive Pneumococcal Disease and Community-Acquired Pneumonia in Children Aged <60 Months After 13-Valent Pneumococcal Conjugate Vaccine Introduction in Argentina
Eduardo L López; Eduardo Glatstein; Gustavo C Ezcurra; Marisa Iacono; Eduardo Teplitz …
Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, 19 February 2018, Pages 30–35, https://doi.org/10.1093/jpids/piw089

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 7, Issue 1, 19 February 2018
https://academic.oup.com/jpids/issue
SPECIAL ARTICLE

Use of Internet Search Data to Monitor Rotavirus Vaccine Impact in the United States, United Kingdom, and Mexico
Minesh P Shah; Benjamin A Lopman; Jacqueline E Tate; John Harris; Marcelino Esparza-Aguilar
Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, 19 February 2018, Pages 56–63, https://doi.org/10.1093/jpids/pix004
Internet searches for “rotavirus,” as measured by Google Trends, correlated well with laboratory-confirmed rotavirus disease and hospitalizations for acute gastroenteritis in the United States, United Kingdom, and Mexico. Internet searches declined after the introduction of national rotavirus vaccination programs, mirroring rotavirus disease activity.

Lancet Global Health
Mar 2018 Volume 6 Number 3 e229-e350
http://www.thelancet.com/journals/langlo/issue/current

Editorial
Local research in Africa: a glimpse at possibilities in Niger
The Lancet Global Health
At the core of the conclusions reached by the Lancet Commission on the future of health in sub-Saharan Africa published last September is a sense of possibility for what Africans can and must accomplish to level their populations’ health with the rest of the world’s by 2030. Among the key requirements are the home-bred, tailored solutions that a greater local research capacity and leadership would produce to respond to the challenges ahead. At the first Epicentre Niger Scientific Day held in Niamey on January 25, there were signs that the message is on point and the optimism justified.

Epicentre, an offshoot of Médecins Sans Frontières (MSF) created in 1988, conducts field epidemiology, research, and training activities that encompass the span of MSF’s areas of intervention. This connection to the medical humanitarian organisation makes it a unique research institution, with solid operational know-how, deep roots in the field, and strong ties to local communities. While its nerve centre is located in Paris, France, its heart clearly beats to the rhythm of two research facilities located in Maradi, Niger, and Mbarara, Uganda. Both are the scene for locally-led innovative research on issues ranging from infectious diseases and malnutrition to antimicrobial resistance, mental health, and child development. In Niger, the local staff of around 250 researchers, communicators, laboratory technicians, and administrators, run projects under the careful mentorship of international experts with knowledge of the realities of the field and a keen understanding of the importance of local knowledge and talent development.

Scientific days showcasing Epicentre’s research have been held in Paris for the last 27 years and for the first time in Kampala in 2017. But the day in Niamey, organised with the support of the Elsevier Foundation, carries some particular significance. A vast, landlocked country mostly covered by desert, Niger is by traditional indicators one of the poorest and least developed countries in the world. It is prone to chronic food insecurity, natural disasters, and infectious disease outbreaks, which included hepatitis E and meningitis in 2017. Diarrhoea is still a leading cause of death in children, as is malaria. Against such a backdrop, the research presented during the conference stands out: studies on malaria treatments highlighting the challenges of seasonal malaria chemoprevention, nutritional interventions underlining the difficulties in preventing severe acute malnutrition, and work around the heat stable and therefore highly adapted Rotasiil rotavirus vaccine, with impact beyond Niger, to only name a few. A francophone forum for these presentations is to be valued. As for many French-speaking countries, Niger faces challenges of another order that need to be acknowledged: the predominance of English as the language of communication in science undeniably represents a limiting factor for many francophone African researchers, adding significant hurdles to the exchange of knowledge and dissemination of research generated locally, as well as hindering the rise of local talent able to champion the country on the international scene.

But there was no shortage of talent present in Niamey, both on stage and in the audience. It is fair to say that the rigour of the research, clarity of the presentations, and depth of the discussions on topics of direct importance to the local context made an impression. Familiar difficulties were evoked during a plenary session expanding beyond Epicentre’s work, on the priorities for research in Niger: the pressing need for locally-adapted tools, the shortage of researchers, and the obstacles encountered in research activities—including accessing information—because of infrastructural limitations. Participants to a round table on how to move from research to policy also identified the misalignment of the donor-researcher-policymaker triad and the need for a stronger link between the protagonists of research and policy. These are all quasi-universal issues and they must be addressed. Yet opportunities seem to exist, many driven by the researcher’s knowledge and membership of the local context: the proximity to the Ministry of Health as a natural and close partner, the understanding of the local oral tradition to overcome research dissemination barriers, or even the inherent trust of the local population in the conduct of research. A sense of possibility was definitely glimpsed at in Niger, and with collaborations between Epicentre, local universities and research institutes such as CERMES, NGOs and other partners, Nigeriens involved in local research can play their part in leading Africa towards her health goals.

Lancet Global Health
Mar 2018 Volume 6 Number 3 e229-e350
http://www.thelancet.com/journals/langlo/issue/current

Articles
Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years
Christopher Troeger, Danny V Colombara, Puja C Rao, Ibrahim A Khalil, Alexandria Brown, Thomas G Brewer, Richard L Guerrant, Eric R Houpt, Karen L Kotloff, Kavita Misra, William A Petri Jr, James Platts-Mills, Mark S Riddle, Scott J Swartz, Mohammad H Forouzanfar, Robert C Reiner Jr, Simon I Hay, Ali H Mokdad

Lancet Global Health
Mar 2018 Volume 6 Number 3 e229-e350
http://www.thelancet.com/journals/langlo/issue/current

Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis
Freya M Shearer, Joshua Longbottom, Annie J Browne, David M Pigott, Oliver J Brady, Moritz U G Kraemer, Fatima Marinho, Sergio Yactayo, Valdelaine E M de Araújo, Aglaêr A da Nóbrega, Nancy Fullman, Sarah E Ray, Jonathan F Mosser, Jeffrey D Stanaway, Stephen S Lim, Robert C Reiner Jr, Catherine L Moyes, Simon I Hay, Nick Golding

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

Comment
Tuberculosis eradication: renewed commitment and global investment required
Helen Cox, Mark P Nicol

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

Correspondence
Dengvaxia: age as surrogate for serostatus
Maíra Aguiar [Centre for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon, 2829-516 Caparica, Portugal mafsantos@fc.ul.pt ]
Nico Stollenwerk [Centro de Matemática, Aplicações Fundamentais e Investigação Operacional, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal]
Published: 21 December 2017
DOI: https://doi.org/10.1016/S1473-3099(17)30752-1

Since April, 2016, Dengvaxia—a dengue vaccine produced by Sanofi Pasteur (Lyon, France)—has been licensed for use in 19 countries. Dengvaxia was recommended by the WHO Strategic Advisory Group of Experts (SAGE) on immunisation to be used in regions with high endemicity, as defined by a prevalence of dengue antibodies of more than 50% in the targeted age group of people aged 9–45 years.1 We have previously discussed the risks behind this vaccine recommendation,2, 3 and by analysing an age-structured model4 using the available vaccine trial data1 predicted a significant reduction in dengue virus infection-related hospital admissions if Dengvaxia is given only to individuals who are seropositive for dengue antibodies. We also predicted a significant increase in the number of dengue-related admissions, over 5 years, if the vaccine is administered without previous population screening for serostatus.4 More recently, our analysis of trial data has indicated that serostatus (and not age) is statistically discriminative with regard to the relative risk (RR) of hospital admission after vaccination, and of efficacy5—ie, the RR is similar across age classes but significantly different across serostatus groups.5

After rigorous statistical analysis of study data (taken from Martínez-Vega and colleagues’ analysis6), here we present further evidence showing that serostatus (and not age) is statistically discriminative with regard to the RR of hospital admission after Dengvaxia vaccination, and efficacy. By using the risk of dengue-related admission to hospital estimated from dengue antibody-seronegative children aged 2–8 years and infectivity measured from control groups of seropositive children younger than 9 years or seronegative individuals aged 9–16 years,6 we calculated the probability of specific numbers of individuals requiring dengue-related hospital admission in either seropositive children aged 2–8 years or seronegative children aged 9–16 years. The distribution of the number of expected admissions to hospital for younger seropositive children and older seronegative children and adolescents, and the actual number of hospital admissions for each group as reported in Martínez-Vega and colleagues’ analysis6 are shown in the appendix, showing the differences in the risk of hospital admissions between seronegative and seropositive individuals in the same age group.

The relative risk measured from seronegative individuals aged 2–8 years—the group for which Dengvaxia is not recommended—can explain and correctly estimate the observed increase of dengue-related admissions to hospital for all seronegative children enrolled during the vaccine trials, independent of age (appendix). However, it cannot explain statistically the observed number of seropositive individuals admitted to hospital of the same age (appendix).

Despite all our efforts in communicating the risks behind the Dengvaxia recommendation and its implementation without serostatus testing before vaccination,2, 3, 4, 5 an individual’s age, as a risk factor, was (until November) the only restriction for vaccine recommendation in countries with high endemicity. More than 800,000 children in the Philippines and around 300,000 individuals in Brazil were vaccinated against dengue virus in mass vaccination programmes, and many of those were possibly seronegative individuals. Communications from Sanofi in November,7 stating that vaccinated seronegative individuals are at risk of a vaccine-induced increase in the severity of a subsequent dengue virus infection, and by WHO advising that Dengvaxia be used only in people previously infected with dengue,8 are inexcusably late, since the vaccine-induced risk in seronegative individuals was already observed in the phase 3 trial data, published more than a year ago.1 Even with controversial modelling results indicating that the use of Dengvaxia in highly endemic settings could be beneficial at the population level,9 ethically no one should have been put under risk by receiving this vaccine.
We declare no competing interests.

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

Articles
The global burden of tuberculosis: results from the Global Burden of Disease Study 2015
GBD Tuberculosis Collaborators

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis
Evelina Tacconelli, Elena Carrara, Alessia Savoldi, Stephan Harbarth, Marc Mendelson, Dominique L Monnet, Céline Pulcini, Gunnar Kahlmeter, Jan Kluytmans, Yehuda Carmeli, Marc Ouellette, Kevin Outterson, Jean Patel, Marco Cavaleri, Edward M Cox, Chris R Houchens, M Lindsay Grayson, Paul Hansen, Nalini Singh, Ursula Theuretzbacher, Nicola Magrini and the WHO Pathogens Priority List Working Group

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

Review
Genetics of human susceptibility to active and latent tuberculosis: present knowledge and future perspectives
Laurent Abel, Jacques Fellay, David W Haas, Erwin Schurr, Geetha Srikrishna, Michael Urbanowski, Nimisha Chaturvedi, Sudha Srinivasan, Daniel H Johnson, William R Bishai

Lancet Infectious Diseases
Mar 2018 Volume 18 Number 3 p227-356  e64-e106
http://www.thelancet.com/journals/laninf/issue/current

The WHO public health approach to HIV treatment and care: looking back and looking ahead
Nathan Ford, Andrew Ball, Rachel Baggaley, Marco Vitoria, Daniel Low-Beer, Martina Penazzato, Lara Vojnov, Silvia Bertagnolio, Vincent Habiyambere, Meg Doherty, Gottfried Hirnschall

Nature 
Volume 554 Number 7693 pp403-554  22 February 2018
http://www.nature.com/nature/current_issue.html

Editorials
Adolescence research must grow up
Young people get a raw deal from society. Targeted study and approaches as part of a new global effort are urgently needed to help them.

Nature 
Volume 554 Number 7693 pp403-554  22 February 2018
http://www.nature.com/nature/current_issue.html

Perspectives
Importance of investing in adolescence from a developmental science perspective
Ronald E. Dahl, Nicholas B. Allen, Linda Wilbrecht & Ahna Ballonoff Suleiman
Insights into windows of opportunity that will have strong positive impacts on the trajectories of health, education, social and economic success of adolescents are reviewed.

Nature 
Volume 554 Number 7693 pp403-554  22 February 2018
http://www.nature.com/nature/current_issue.html

Analysis
Adolescence and the next generation
Open
George C. Patton, Craig A. Olsson, Vegard Skirbekk, Richard Saffery, Mary E. Wlodek+ et al.
Investing in adolescents as the parents of the next generation is important for the wellbeing of current and future generations.

New England Journal of Medicine
February 22, 2018  Vol. 378 No. 8
http://www.nejm.org/toc/nejm/medical-journal

Human Neonatal Rotavirus Vaccine (RV3-BB) to Target Rotavirus from Birth
Julie E. Bines, M.D., Jarir At Thobari, Ph.D., Cahya Dewi Satria, M.D., Amanda Handley, M.P.H.,
Emma Watts, B.Sci., Daniel Cowley, Ph.D., Hera Nirwati, M.D., Ph.D., James Ackland, B.Sci.,
Jane Standish, M.B., B.S., Frances Justice, B.Sci., Gabrielle Byars, M.Bio.Med.Sci., Katherine J. Lee, Ph.D., Graeme L. Barnes, M.D., Novilia S. Bachtiar, Dr.M.Kes., Ajeng Viska Icanervilia, .D.,
Karen Boniface, B.Sci., Nada Bogdanovic-Sakran, B.Sci., Daniel Pavlic, B.Sci., Ruth F. Bishop, A.O., D.Sc., Carl D. Kirkwood, Ph.D., Jim P. Buttery, M.D., and Yati Soenarto, M.D., Ph.D.
Conclusions
RV3-BB was efficacious in preventing severe rotavirus gastroenteritis when administered according to a neonatal or an infant schedule in Indonesia. (Funded by the Bill and Melinda Gates Foundation and others; Australian New Zealand Clinical Trials Registry number, ACTRN12612001282875.)

New England Journal of Medicine
February 22, 2018  Vol. 378 No. 8
http://www.nejm.org/toc/nejm/medical-journal

Sounding Board
A Framework for Ethical Payment to Research Participants
Luke Gelinas, Ph.D., Emily A. Largent, J.D., Ph.D., R.N., I. Glenn Cohen, J.D., Susan Kornetsky, M.P.H., Barbara E. Bierer, M.D., and Holly Fernandez Lynch, J.D.
The authors propose a framework for evaluating the appropriateness of payments to research participants. They distinguish three acceptable rationales for payment: out-of-pocket expenses, time and burdens of participation, and incentive to participate.

PLoS One
http://www.plosone.org/
[Accessed 24 February 2018]

Research Article
Cross-sectional associations between psychological traits, and HPV vaccine uptake and intentions in young adults from the United States
Aaron M. Scherer, Heather Schacht Reisinger, Marin L. Schweizer, Natoshia M. Askelson, Angela Fagerlin, Charles F. Lynch
Research Article | published 23 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0193363

PLoS One
http://www.plosone.org/
[Accessed 24 February 2018]

Development of improved therapeutic mesothelin-based vaccines for pancreatic cancer
Michael White, Andrew Freistaedter, Gwendolyn J. B. Jones, Emmanuel Zervos, Rachel L. Roper
Research Article | published 23 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0193131

PLoS One
http://www.plosone.org/
[Accessed 24 February 2018]

Global influenza seasonality to inform country-level vaccine programs: An analysis of WHO FluNet influenza surveillance data between 2011 and 2016
Laura P. Newman, Niranjan Bhat, Jessica A. Fleming, Kathleen M. Neuzil
Research Article | published 21 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0193263

Science         
23 February 2018  Vol 359, Issue 6378
http://www.sciencemag.org/current.dtl

Policy Forum
The Global Virome Project
By Dennis Carroll, Peter Daszak, Nathan D. Wolfe, George F. Gao, Carlos M. Morel, Subhash Morzaria, Ariel Pablos-Méndez, Oyewale Tomori, Jonna A. K. Mazet
Science23 Feb 2018 : 872-874 Restricted Access
Summary
Outbreaks of novel and deadly viruses highlight global vulnerability to emerging diseases, with many having massive health and economic impacts. Our adaptive toolkit—based largely on vaccines and therapeutics—is often ineffective because countermeasure development can be outpaced by the speed of novel viral emergence and spread. Following each outbreak, the public health community bemoans a lack of prescience, but after decades of reacting to each event with little focus on mitigation, we remain only marginally better protected against the next epidemic. Our ability to mitigate disease emergence is undermined by our poor understanding of the diversity and ecology of viral threats, and of the drivers of their emergence. We describe a Global Virome Project (GVP) aimed to launch in 2018 that will help identify the bulk of this viral threat and provide timely data for public health interventions against future pandemics.

Social Science & Medicine
Volume 198  In progress (February 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/198/suppl/C

Regular articles
Do we consider paid sick leave when deciding to get vaccinated?
Original research article
Pages 1-6
Namhoon Kim, Travis P. Mountain
Abstract
This study investigated the effect of paid sick leave on workers’ decisions to obtain vaccinations for the seasonal flu. Our vaccination decision model suggested that the marginal effect of paid sick leave depended on the reduced cost of obtaining a vaccination now and the expected income benefit from claiming paid sick leave after flu infection. Our hypothesis was that these effects vary according to workers’ income levels. To confirm this hypothesis, we examined 11,702 participants in the National H1N1 Flu Survey (NHFS) conducted in late 2009 to early 2010 and measured the marginal effect using a Bayesian endogenous covariates regression model. The results of our estimation indicate that having paid sick leave did affect workers’ vaccination decisions differently based on their income levels. Low-income workers were willing to be vaccinated because of the positive expected income benefit. High-income workers were willing to be vaccinated because the positive cost effect dominated the negative expected income benefit.

Social Science & Medicine
Volume 198  In progress (February 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/198/suppl/C

Integrating social justice concerns into economic evaluation for healthcare and public health: A systematic review
Original research article
Pages 27-35
Vadim Dukhanin, Alexandra Searle, Alice Zwerling, David W. Dowdy, … Maria W. Merritt

Social Science & Medicine
Volume 198  In progress (February 2018)
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/198/suppl/C

Health equity monitoring for healthcare quality assurance
Open access – Original research article
Pages 148-156
Cookson, M. Asaria, S. Ali, R. Shaw, … P. Goldblatt

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

Short communication
Disparities in parental human papillomavirus (HPV) vaccine awareness and uptake among adolescents
Pages 1243-1247
Narissa J. Nonzee, Susie B. Baldwin, Yan Cui, Rita Singhal
Abstract
Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13–17) and HPV vaccine uptake (≥1 dose) among girls (ages 13–17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware. HPV vaccine initiation among daughters nearly doubled from 25% in 2007 to 48% in 2011, and girls who were older, uninsured, and had access-related barriers showed the largest improvements. In 2011, daughters who were younger and who had older and African American parents were at risk for low uptake. Thus, initiatives targeting male and younger adolescents, culturally-relevant information, and access to vaccination may help to reduce identified disparities.

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

Regular Papers
The role of timeliness in the cost-effectiveness of older adult vaccination: A case study of pneumococcal conjugate vaccine in Australia
Original research article
Pages 1265-1271
Chen, J.G. Wood, P. Beutels, R. Menzies, … A.T. Newall

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

The impact of expanded program on immunization with live attenuated and inactivated Hepatitis A vaccines in China, 2004–2016
Original research article
Pages 1279-1284
Xiaojin Sun, Fuzhen Wang, Hui Zheng, Ning Miao, … Hagai Levine

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France
Original research article
Pages 1285-1296
D.S. N’Diaye, O. Launay, O. Picone, V. Tsatsaris, … Y. Yazdanpanah

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

Impact of introduction of the 9-valent human papillomavirus vaccine on vaccination coverage of youth in North Carolina
Original research article
Pages 1304-1309
Justin G. Trogdon, Paul Shafer, Brianna Lindsay, Tamera Coyne-Beasley

Vaccine
Volume 36, Issue 10  Pages 1243-1322 (28 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/10

Impact of introduction of the 9-valent human papillomavirus vaccine on vaccination coverage of youth in North Carolina
Original research article
Pages 1304-1309
Justin G. Trogdon, Paul Shafer, Brianna Lindsay, Tamera Coyne-Beasley

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 24 February 2018
Japan’s New Drug: One Pill May Stop The Flu in Just One Day
Bruce Y. Lee, Contributor
On Friday, Japanese pharmaceutical company Shionogi announced that Xofluza has been approved to be manufactured and sold in Japan. How does it work and when will it be available in the U.S.
 
The Guardian
http://www.guardiannews.com/
Accessed 24 February 2018
Opinion
I understand the fears. But vaccinating children should be compulsory
22 February 2018
Engaging the emotional intelligence of the public is the way to sell the scientific fact that immunisation prevents deaths

Trump appears to abandon vaccine sceptic group denounced by scientists
21 February 2018
Robert F Kennedy Jr claimed to be leading a review of links to autism – a widely debunked claim – but now says he hasn’t heard from the White House in months.
 
New York Times
http://www.nytimes.com/
Accessed 24 February 2018
Business Day
U.S. Health Officials Reverse Stance on AstraZeneca’s Flu Vaccine
AstraZeneca Plc said on Wednesday an advisory committee of the U.S. Centers for Disease Control and Prevention recommended the use of its FluMist Quadrivalent vaccine in the upcoming flu season, reversing its earlier position.
Feb 21, 2018

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 24 February 2018
The Numbers
The Math Behind Flu Season
By Jo Craven McGinty
Feb. 23, 2018 8:00 am ET
The U.S. relies on a network of hospitals,​laboratories and outpatient facilities to track the flu each year, but the effort captures only a fraction of the cases.

Washington Post
http://www.washingtonpost.com/
Accessed 24 February 2018
Brazil battles yellow fever — and a ‘dangerous’ anti-vaccination campaign
18 Feb 2018.

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_17 Feb 2018

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

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

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

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

Milestones :: Perspectives

 
Top epidemic-prone diseases without sufficient counter measures – WHO
12 February 2018 – WHO releases its 2018 list of priority pathogens that have the potential to cause a public health emergency and which have no, or insufficient, countermeasures. WHO calls on the medical community to unite in greater R&D efforts for these 8 diseases to develop treatments and vaccines to help control outbreaks.
List of Blueprint priority diseases
2018 annual review of the Blueprint list of priority diseases
For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic.

The first list of prioritized diseases was released in December 2015. Using a published prioritization methodology, the list was first reviewed in January 2017.

The second annual review occurred 6-7 February 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

:: Crimean-Congo haemorrhagic fever (CCHF)
:: Ebola virus disease and Marburg virus disease
:: Lassa fever
:: Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute   
  Respiratory Syndrome (SARS)
:: Nipah and henipaviral diseases
:: Rift Valley fever (RVF)
:: Zika
:: Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged…
 
::::::
::::::       
 
One year on, Global Observatory on Health R&amp;D identifies striking gaps and inequalities – WHO
February 2018
Each year, hundreds of billions of dollars are spent on research and development (R&D) into new or improved health products and processes, ranging from medicines to vaccines to diagnostics. But the way these funds are distributed and spent is often poorly aligned with global public health needs.

One year ago, the World Health Organization launched a new initiative to gather information and provide an accurate picture of where and how R&D monies are being spent, helping governments, funders and researchers to make better decisions on investment and policy making priorities.

Ensuring that decision-making about which diseases, countries and products receive investment funds is not entirely reliant on market forces is critical. The 2014 outbreak of Ebola virus disease in West Africa, which left more than 11,000 dead, dramatically exposed the lack of investments in products and approaches to prevent and minimize the impact of pathogens with epidemic potential. And gaps in R&D investments in the pipeline for antimicrobial medicines are a cause of global concern in the context of rapidly increasing antimicrobial resistance.

The Global Observatory on Health R&D has identified striking gaps and inequalities in investment both between countries and between health issues, with frequent disconnects between burden of disease and level of research activity.

:: High income countries have an average of 40 times more health researchers than low income countries. Based on data from 60 countries:
…The disparity in investment means the number of health research workers per million inhabitants in countries ranges from 1140 in Singapore to 0.2 in Zimbabwe.
…Women health researchers are underrepresented in low income countries. While the average number of female researchers in high income countries is approximately 51%, this drops to just 27% in low income countries.

Explore health researchers by country income group and by WHO Regions:
Health researchers data
:: Serious imbalances in funding flows mean countries with comparable levels of poverty and health needs receive strikingly different levels of Official development assistance (ODA) for medical research and basic health sectors (health ODA).
…In 2016, among low income countries, Liberia received the highest health ODA per capita – 3 times more than the weighted average amount received by other low income countries and 3.5 times more than Madagascar, which suffered from a serious outbreak of pneumonic plague this year.
…In 2016, Tuvalu, an upper middle income country, received the highest health ODA per capita (60.03 US$) anywhere in the world, 286 times more than the weighted average for the upper middle income group it belongs to, 39 times more than South Africa and 95 times more than Albania.
….Amongst countries in Africa, the Seychelles, a high income country, received the highest amount of health ODA per capita in 2016. At 34.17 US$ per capita, the country received almost 8 times more per capita than the weighted average for this region.

Explore ODA for medical research and basic health sciences per capita, by recipient country:
ODA data
:: As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, despite these diseases accounting for more than 12.5% of the global burden of disease.
…Public sector governments contributed almost two thirds of investments on product-related health R&D for neglected diseases, followed by philanthropies.
….The United States of America continues to be the lead country in investments on neglected diseases from public and philanthropic sources. Over 10 years of investments, USA has contributed almost two thirds of the total investments, followed by the United Kingdom of Great Britain and Northern Ireland and the European Union.
…Investments by the private sector in neglected diseases have increased since 2012, mostly due to investments in HIV/AIDS and malaria.

Explore the distribution of R&D funding flows for neglected diseases by country, funder and recipient organizations:
R&D funding flows by country, funder, and recipient organizations and R&D funding flows by source and type of funding
Investing in R&D to discover and develop medicines and vaccines is key to improving access to medicines and quality health care for people across the world and to achieving universal health coverage. The Global Health Observatory on Health R&D builds on existing data and reports from a wide range of sources as well as newly gathered information to provide an accurate picture of the current investment situation and enable informed decision making on priorities.

FDA [to 17 February 2018]

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
February 15, 2018 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on the efficacy of the 2017-2018 influenza vaccine
Seasonal flu has been widespread this year, impacting millions of people across the country. It has been an especially challenging season, with high rates of hospitalization for both influenza and its complications, which include pneumonia and the exacerbation of chronic conditions such as asthma and congestive heart failure. Many schools have closed in an attempt to control the spread of the illness and doctors’ offices are packed with patients seeking diagnosis and antiviral treatment.

This year much of the illness has been caused by one strain of influenza A called H3N2, with another strain of influenza A called H1N1 and strains of influenza B contributing to lesser extents. The flu is a respiratory illness caused by several types and strains of influenza virus that infect the respiratory tract in humans, which includes the nose, throat and lungs.
Vaccination is one of the best ways known to protect against the flu. However, because of the severity of this season, there have been questions raised about how well this year’s flu vaccine worked. Although the initial report of 36 percent overall efficacy for this year’s vaccine in the United States that has been reported by our colleagues at the U.S. Centers for Disease Control and Prevention (CDC) is better than some might have predicted, there is still clearly significant room for improvement. The FDA is committed to working together with the scientific and medical communities to better protect the public against the flu and apply lessons learned to next season’s flu vaccines.

Because influenza viruses can change their genetic make-up rapidly during the course of a single year, seasonal influenza vaccines are unlike most other preventative vaccines, in that the strains contained in the vaccine constantly need to be adjusted based on the viruses that are expected to be in circulation. Public health experts do their best each year to select the influenza viruses against which the vaccine should provide protection. In fact, in just two weeks, the FDA will be convening an advisory panel of experts to help us select strains for next season’s flu vaccines. It takes several months for influenza vaccines to be produced so flu strains for the next season need to be selected even before the current flu season ends. The majority of vaccine doses are made using chicken eggs, which adds time to the production process, but some doses are made in mammalian cells or by recombinant DNA technology.
Although some factors are beyond our control, such as the ability of flu virus to change rapidly as it circulates, there are steps that we can take to ensure that the seasonal influenza vaccine protects as many individuals as possible. The FDA is collaborating with CDC, the National Institutes of Health (NIH), and other federal partners to address the full spectrum of measures that need to be taken to ensure optimal protection against the flu. These measures include working to select the most appropriate flu strains for inclusion in seasonal influenza vaccines, providing seed viruses and quality control reagents to manufacturers, and ensuring the overall quality of the manufacturing process…