Dengvaxia
We continue to monitor developments associated with Dengvaxia, recognizing the continuing and troubling political overlay to the issues in the Philippines such as reported in the Business Mirror article below. We did not identify any new press releases or statements on the Sanofi website.

Pathology group vows help to end vaccine ‘hysteria’
Business Mirror [Philippines] February 15, 2018
ANOTHER group of Filipino doctors have stepped forward to fight what they described as the scare and hysteria stirred by the Dengvaxia controversy, saying there is no medical evidence to show that the anti-dengue vaccine caused the death of some 14 Filipino children.

The Dengvaxia scare, the group said, has also jeopardized the national immunization program, and has threatened to trigger epidemics in the country.

In a news statement, the Philippine Society of Pathologists (PSP), led by its president, Dr. Bernadette R. Espiritu, called for prudence in the dissemination of information about Dengvaxia.

To recall, the expert panel from the University of the Philippines-Philippine General Hospital (UP-PGH) found that none of the 14 children whose deaths they examined could be directly attributable to Dengvaxia.

Such fact is in stark contrast with the supposed findings of the Public Attorney’s Office’s (PAO) forensics team that linked Dengvaxia to the deaths.

“Paramount here is the welfare of our children. This is not a battle of who is the best specialty group,”  Esipiritu said.

The group further said it is committed to support the Philippine Medical Association and the Department of Health in their efforts to reach out to the Dengvaxia vaccine-recipient children and their families, and to help alleviate their plight as a result of the Dengvaxia scare.

“The PSP is always ready, able and willing to serve the Dengvaxia vaccine-recipient children and their families,” the group said.

The group noted that the children who received Dengvaxia vaccination, their families and friends, are now engulfed by the undue scare that death is almost an inevitable consequence of such vaccination.

The scare has been generated by the much-publicized autopsy findings from the supposed forensic consultant of the PAO, unduly and hastily linking Dengvaxia to the death of some 14 children.

“To these helpless Filipino countrymen, their lives have practically come to a halt until they find certain solution or assurance that their Dengvaxia-vaccinated children will not suffer the same fate as those who were autopsied by those who claim to be a forensics expert,” PSP said.

A member of the Philippine Medical Association (PMA), the PSP is the recognized professional medical association that is duly mandated to train and certify physicians in the field of pathology as a medical specialty.

PSP members have undergone residency training in duly accredited hospitals and who successfully hurdled the examinations to qualify as diplomate or fellow  pathologist in either anatomic pathology or clinical pathology, or both.

According to PSP, some of its pathologists further obtain trainings and qualifications in different pathology subspecialties, which include forensic pathology that is now at the core of the dengue vaccine scare.

A forensic pathologist is a medical graduate and licensed physician  who completed the prescribed residency training in anatomic or anatomic and clinical pathology and passed the diplomate board examinations for anatomic or both anatomic and clinical pathology; and successfully completed the prescribed training in forensic  pathology.

At present, the PSP recognizes only two Filipino physicians who have successfully hurdled the stringent trainings and are qualified in the medical subspecialty of forensic pathology and these exclude Dr. Edwin Erfe of PAO.

The group does not discount the capabilities of other physicians conducting autopsies without being trained, qualified and certified as diplomate or  fellow in anatomic or in  anatomic and clinical pathology.

However, it said, the medical profession as a field of science  adheres to certain standards and best practices, which are validated and ensured by medical societies of the PMA in their respective fields of medical specialization.

According to PSP, pathologists are trained to conscientiously handle and process tissue samples as specimens, starting with gross examinations thereof that have to be subsequently correlated with microscopic examinations of specimen slides.

PSP underscored that the most critical in the process is the training of pathologists to adequately sample and properly handle tissues/specimen for histopathologic examination. Any misstep in this process is prone to yield incorrect or misleading diagnosis, which is a mortal mistake especially in diagnosis of a patient, much less in determining the true cause of death.

Erfe, the PAO forensic consultant (and not a pathologist), who, the group said, made sweeping statements linking Dengvaxia to the death of Filipino children, came under fire from medical experts all over the country for allegedly triggering the scare on vaccines.

Dengvaxia

We continue to monitor developments associated with Dengvaxia, recognizing the continuing and troubling political overlay to the issues in the Philippines such as reported in the Business Mirror article below. We did not identify any new press releases or statements on the Sanofi website.
 
The Lancet
Feb 17, 2018 Volume 391 Number 10121 p631-712
http://www.thelancet.com/journals/lancet/issue/current
Correspondence
Dengue vaccination: a more balanced approach is needed
Tikki Pang, Duane Gubler, Daniel Yam Thiam Goh, Zulkifli Ismail on behalf of the Asia Dengue Vaccine Advocacy Group
DOI: https://doi.org/10.1016/S0140-6736(18)30245-9
Media reports have cast doubt on the safety of dengue vaccination, resulting in the suspension of school-based immunisation programmes in the Philippines.1 The main concern about the vaccine is the risk of severe disease in children naive to dengue virus. Although these concerns are justified, it is important to consider this risk in the context of the wider population and to consider the public health value of dengue vaccination for the prevention of a disease that affects 400 million people annually, mostly in developing countries.

In most highly endemic countries, where the use of the dengue vaccine is recommended by WHO, 90% of the population are likely to have been infected with dengue virus by adolescence. These seropositive individuals would clearly benefit from receiving the vaccine. In the remaining 10% of the population who remain unexposed to the virus, the risk of severe disease is relatively small (two cases per 1000 individuals). Moreover, individuals who have become ill after receiving the vaccine had a milder form of dengue, which did not lead to shock, bleeding, or mortality, and were successfully treated.2 Nevertheless, in developing countries with weak health systems and high out-of-pocket health-care costs, the need for hospital admission remains a concern.

The vaccine has been shown to reduce severe disease and hospital admissions by 80–90%.3 The cost savings for health-care systems, and economic benefits more broadly, are of considerable importance. For example, it has been estimated that the annual economic burden of dengue in southeast Asia is US$950 million.4

Without trivialising the risk of severe disease in seronegative individuals receiving the vaccine, we propose two approaches to dengue vaccination. First, the vaccine can be used safely in highly endemic areas when introduced in a controlled fashion with enhanced surveillance and risk management. For example, physicians can have informed discussions with parents to highlight the fact that the potential benefits of vaccination far outweigh the potential risks for their child on the basis of factors such as the endemicity level where they live and the age of the individual. Second, a reliable laboratory testing method to detect previous exposure could be discussed and implemented. Newer, more rapid, affordable, and accurate diagnostic tests must be developed.

Although each country needs to make its own decisions regarding the use of the dengue vaccine, the public health value of the vaccine should not be underestimated. With an overall efficacy of 66%, the vaccine would prevent 66,000 new cases in a country in which 100,000 cases of dengue occur annually. Despite the controversy, some countries have decided to continue using the vaccine against dengue.5

The perfect vaccine does not exist and every new product is likely to have safety risks. Although uncertainties exist, the public health and economic benefits of Dengvaxia (Sanofi Pasteur, Lyon, France) far outweigh the potential risks. As the German theologian Meister Eckhart (1260–1328) is credited with saying, “the cost of inaction is far greater than the cost of making a mistake”.

The Asia Dengue Vaccine Advocacy Group is an independent advocacy group of experts, which has received unrestricted educational grants from Sanofi Pasteur. We declare no competing interests.
References available at title link above

::::::

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 14 February 2018 [GPEI]
:: New on http://polioeradication.org/: Sudan’s surveillance system under the microscope, and a new addition to our ‘Reaching the Hard-to-Reach’ series, on AFP surveillance in challenging areas of Afghanistan, Syria and Nigeria.
:: The 16th International Health Regulations Emergency Committee regarding the international spread of poliovirus recommended that the temporary recommendations to prevent virus spread be extended for a further period of three months.
:: Bill and Melinda Gates released their annual letter, answering the 10 tough questions that they hear most often.

:: Weekly country updates as of 14 February 2018
Afghanistan:  
:: One wild poliovirus type 1 (WPV1) positive environmental sample reported from Hilmand province.
Democratic Republic of the Congo:
:: Three cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, from Tanganyika province. Somalia: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province.
Somalia:
:: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province, Somalia.
 
::::::
 
Statement of the Sixteenth IHR Emergency Committee Regarding the International Spread of Poliovirus
WHO statement  –  14 February 2018
[Editor’s text bolding]
The sixteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 7 February 2018 at WHO headquarters with members, advisers and invited member states attending via teleconference…

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months.

The Committee considered the following factors in reaching this conclusion:
:: The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
:: The risk and consequent costs of failure to eradicate globally a highly debilitating vaccine preventable disease. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be even more grave and a major set-back to achieving eradication.
:: The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
:: The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears considerable.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
 
Additionally with respect to cVDPV:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning in many countries;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies;
:: The global shortage of IPV which poses an additional risk, in that the cohort of children with no type 2 immunity is growing in number in countries affected by the shortage…

Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee also noted that surveillance in these areas may also be sub-optimal, particularly where access is compromised by conflict. The Committee strongly encourages all these countries to make further efforts to improve routine immunization and strengthen surveillance in such areas, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also urged that Nigeria and the Lake Chad countries increase cross border efforts and joint planning and response. Intensified effort is needed to identify and reach vulnerable populations in the sub-region, particularly in the Lake Chad islands. Noting the low number of international travelers being vaccinated in Nigeria, the committee again recommended that the country needs to improve implementation of the Temporary Recommendations regarding traveler vaccination, including reporting of achievements, and requests the secretariat to report back on this aspect of Nigeria’s response to the next Committee meeting. Nigeria should ensure continuing political commitment and take measures to counter fatigue in the fight against polio. Similarly, the DR Congo government needs to regard the current outbreak of cVDPV2 as a public health emergency and pay more attention to prevention of international spread of cVDPV2 from DR Congo, noting that neighboring countries are affected by the global shortage of IPV.

Noting the issues that continue in countries previously subject to Temporary Recommendations such as the Ukraine and Somalia, the Committee requested the secretariat to continue to monitor these and other previously infected countries, and highlight to the Committee issues that pose a risk of international spread. The Committee requested an update on the situation in Somalia at its next meeting.

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 13 February 2018 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 13 February 2018.
 
::::::
 
Global Certification Commission – GPEI
Special Meeting of the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC) on Poliovirus Containment
Geneva, Switzerland, 23 – 25 October 2017
Release date [not identified] :: 15 pages
Summary of recommendations

1. Role of GCC in containment

:: WHO should review GCC’s ToRs at the time of certification of eradication to determine GCC’s role in the post-certification period as the oversight body for containment.

2. Reduction in the number of PEFs

:: WHO should continue to work with Member States so that only those facilities fulfilling critical national or international functions in countries and complying with secondary and tertiary safeguards (as and when required) enter the containment certification process.
:: Member States should coordinate and communicate closely with facilities to make them aware of the implications of becoming and remaining PEFs.
:: WHO should engage the Regional Directors to raise awareness of containment during the Regional Committee Meetings. This could be explored through the Global Policy Group http://www.who.int/dg/global-policy/en/.
:: Countries using PQ polio vaccines are recommended to accept the release certificate issued by the NRA of reference to avoid duplication of testing and use of PV material

3. Completion of Phase I (Preparation for containment of poliovirus type 2) of GAPIII

:: GCC encourages the establishment of a standardized data collection and verification mechanism.
:: NCC/RCC reports need to clearly indicate where and when activities in Phase I have been completed, based on a standardized data collection and verification mechanism, so that, on the basis of equivalent data quality between regions, the GCC can declare global completion of Phase I.
:: The deadline for completion of Phase I for all PV2 is set at one year after the publication of the Guidance for non-poliovirus facilities to minimize risk of sample collections potentially infectious for polioviruses
:: GCC urges countries affected by ongoing transmission of cVDPV2 to repeat their inventories and destroy, transfer or contain PV2 materials after the outbreak is declared closed.
:: GCC requests RCCs to urge countries to complete the identification, destruction, transfer or containment (Phase I) of WPV1 and WPV3 materials by the end of Phase II.
:: GCC urges countries planning to designate facilities for the retention of WPV1 and WPV3 materials to weigh the risks and benefits of having such facilities and the commitments that will be required to comply with the primary (facility), secondary (population immunity) and tertiary (sanitation and hygiene) safeguards.
:: GCC requests a letter be prepared and distributed via Regional Offices formally acknowledging countries for the completion of Phase I of GAPIII.

4. Acceleration of the implementation of the CCS process

:: WHO should consider an EB request for a WHA 2018 resolution urging countries hosting PEFs to accelerate the appointment of a competent NAC as soon as possible and no later than 31 Dec 2018, processing all CP applications as soon as possible and no later than 30 June 2019. After June 2019, new PEF applications will not be considered unless under exceptional circumstances GCC will review these dates in early 2018.
:: WHO should carry out a risk assessment of designated PEFs’ status to ensure that facilities at highest priority are entered into the CCS process as soon as possible.

5. Coordination and oversight

:: The WHO secretariat needs to ensure coordination of information exchanges between the ECBS, CAG, CWG, SAGE, IHR EC, CMG, SC and the GCC
:: WHO should determine which group is best placed to advise CWG on requirements associated with secondary and tertiary safeguards.
:: A mechanism needs to be established for the CWG to obtain more frequent technical support from CAG for clarifications on the operationalization of GAPIII.

6. GCC-CWG capacity

:: GCC requests WHO to expand the CWG membership.

7. Containment criteria for global certification of eradication

:: The GCC recommends that facilities awarded a CP should begin the CC application process and only if absolutely needed, obtain an ICC for the shortest possible duration.

:: At the time of the declaration of WPV eradication, all facilities retaining WPVs should have a CC, and if not, have a time-limited ICC, with a clear end point for obtaining a CC agreed with the GCC.

8. Containment breaches: public health management of breaches in PV containment

:: WHO should ensure GCC is also informed.

9. Verification of compliance with GAPIII

:: The CWG should establish an agreement with NACs to enable verification of containment under routine working circumstances or when breaches or other exceptional situations arise, and to clarify the possible impact of a containment breach on the potential award/status of a containment certificate.

10. Communication strategy for Certification and Containment

:: GCC encourages WHO to ensure that the new communication officer being recruited by WHO is assigned to cover both areas of Objective 3 of the Polio Eradication and Endgame Strategic Plan (PEESP, Certification and Containment)
:: GCC requests WHO to develop a communication strategy as soon as possible addressing Objective 3 of the PEESP
:: GCC recommends ensuring the containment communication strategy encourages risk elimination by destruction of PV materials. It should also address the long term nature of the commitment to host a PEF, including cost and personnel required.
 
::::::
::::::
 
Syria cVDPV2 outbreak situation report 34, 13 February 2018
Situation update 13 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 and Hasakah governorates, parts of Aleppo governorate and Jurmana district of rural Damascus as part of the second phase of the outbreak response. A total of 233,518 children aged 2-23 months received IPV, representing 71% of the estimated target. Activities are ongoing in accessible areas of Aleppo governorate.
:: A total of 1,456 children under 5 years have received mOPV2 in Hasakah governorate during the IPV vaccination round, as part of special strategies to reach children who were missed by mOPV2 vaccination in January.
:: Independent post campaign monitoring of the IPV campaign is ongoing in all areas that have completed the vaccination round.
:: The Emergency Committee under the International Health Regulations (IHR) was briefed this week on the cVDPV2 outbreak in Syria and the response to date.
   :: An orientation session was held this week with Syrian Arab Red Crescent (SARC) to strengthen the coordination and to refresh training on reporting of vaccine preventable diseases in inaccessible areas. SARC has been supporting the implementation of immunization activities for outbreak response, routine immunization and AFP surveillance. 
::::::
::::::

WHO Grade 3 Emergencies  [to 17 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 34, 13 February 2018
[See Polio above for detail]

Nigeria 
:: WHO moves to contain Nigeria’s Lassa fever outbreak
13 February 2018, ABUJA – The World Health Organization is scaling up its response to an outbreak of Lassa fever in Nigeria, which has spread to 17 states and may have infected up to 450 people in less than five weeks.
From the onset of the outbreak, WHO Nigeria deployed staff from the national and state levels to support the Government of Nigeria’s national Lassa fever Emergency Operations Centre and state surveillance activities. WHO is helping to coordinate health actors and is joining rapid risk assessment teams travelling to hot spots to investigate the outbreak.
Between 1 January and 4 February 2018, nearly 450 suspected cases were reported, of which 132 are laboratory confirmed Lassa fever. Of these, 43 deaths were reported, 37 of which were lab confirmed…
 

::::::
 
WHO Grade 2 Emergencies  [to 17 February 2018]
No new announcements identified

::::::
::::::
 
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq   
:: Iraq: 2018 Humanitarian Response Plan Overview – February 2018 [EN/AR]  Published on 13 Feb 2018
Protection remains the overriding humanitarian priority during 2018

Syrian Arab Republic
:: 16 Feb 2018   Statement attributed to Ali Al-Za’tari, UN Resident and Humanitarian Coordinator in Syria, on the humanitarian situation in Nashabieh, East Ghouta…

Yemen 
:: 12 Feb 2018   Yemen Humanitarian Update Covering 5 – 11 February 2018
 
::::::

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.
Ethiopia  
:: 12 Feb 2018  Ethiopia: Humanitarian Response Situation Report No.17 (January 2018)

ROHINGYA REFUGEE CRISIS 
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar | 11 February 2018
 

WHO & Regional Offices [to 17 February 2018]

Latest news
World leaders join new drive to beat noncommunicable diseases
News release
16 February 2018 | Geneva – WHO is announcing today a new high-level commission, comprised of heads of state and ministers, leaders in health and development and entrepreneurs. The group will propose bold and innovative solutions to accelerate prevention and control of the leading killers on the planet – noncommunicable diseases (NCDs) like heart and lung disease, cancers, and diabetes.

The WHO Independent Global High-level Commission on NCDs is co-chaired by President Tabaré Vázquez of Uruguay; President Maithripala Sirisena of Sri Lanka; President Sauli Niinistö of Finland; Veronika Skvortsova, Minister of Healthcare of the Russian Federation; and Sania Nishtar, former Federal Minister of Pakistan.

Seven in 10 deaths globally every year are from NCDs, the main contributors to which are tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity. More than 15 million people between the ages of 30 and 70 years die from NCDs annually. Low- and lower-middle income countries are increasingly affected, with half of premature deaths from NCDs occurring in those countries. Many lives can be saved from NCDs through early diagnosis and improved access to quality and affordable treatment, as well as a whole-of-government approach to reduce the main risk factors.

“NCDs are the world’s leading avoidable killers but the world is not doing enough to prevent and control them,” says Dr Vázquez. “We have to ask ourselves if we want to condemn future generations from dying too young, and living lives of ill health and lost opportunity. The answer clearly is ‘no.’ But there is so much we can do to safeguard and care for people, from protecting everyone from tobacco, harmful use of alcohol, and unhealthy foods and sugary drinks, to giving people the health services they need to stop NCDs in their tracks.”

Mr Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Commission member, said: “For the first time in history, more people are dying of noncommunicable diseases, such as heart disease and diabetes, than infectious diseases. This loss of human life spares no one — rich or poor, young or old – and it imposes heavy economic costs on nations. The more public support we can build for government policies that are proven to save lives – as this Commission will work to do – the more progress we’ll be able to make around the world.”

The new Commission was established by WHO Director-General Dr Tedros Adhanom Ghebreyesus and runs until October 2019. It will provide actionable recommendations to contribute to the Third United Nations General Assembly High-level Meeting on NCDs scheduled for the second half of 2018. This will include the submission of its first report to Dr Tedros in early June…

::::::
 
Weekly Epidemiological Record, 16 February 2018, vol. 93, 07 (pp. 61–72)
:: Implementation of hepatitis B birth dose vaccination – worldwide, 2016
 
::::::
 
Tenders
:: Medical Writer for the GVAP Assessment Reportpdf, 828kb  Deadline for applications: 6 March 2018
:: Graphic Designer for the GVAP Reports  \pdf, 845kb Deadline for applications: 6 March 2018
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO reaches returnees and displaced families with lifesaving supplies and services in the former Central Equatoria State of South Sudan  16 February 2018
:: WHO promptly responds to the suspected Rift Valley Fever outbreak in Yirol East, Eastern Lakes State, Republic of South Sudan  15 February 2018
:: WHO moves to contain Nigeria’s Lassa fever outbreak  13 February 2018
:: WHO steps up efforts to reach severely malnourished children with life-saving treatment in South Sudan  13 February 2018
 
WHO European Region EURO
::  Improving quality of life and survival for young cancer patients 14-02-2018
:: Summit of Mayors adopts Copenhagen Consensus, committing to build healthier, happier cities 14-02-2018
:: Merging approaches to health systems strengthening and health emergencies response 12-02-2018

CDC/ACIP [to 17 February 2018]

http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Latest News
Is the U.S. Export Economy at Risk from Global Infectious Outbreaks? – Press Release
Tuesday, February 13, 2018
In addition to tragic loss of life, the next global infectious disease outbreak could harm the U.S. export economy and threaten U.S. jobs—even if the disease never reaches our shores. Two Centers for Disease Control and Prevention (CDC) articles published in Health Security analyze the risks and show potential losses to the American export economy from an overseas outbreak.
The two articles underscore the importance of the President’s request this week for $59 million in support of the Global Health Security Agenda (GHSA) in Fiscal Year 2019.
“The President’s Budget request of $59 million for Fiscal Year 2019 for GHSA demonstrates the Administration’s commitment to global health security and provides an important bridge to the extension of the GHSA announced in October 2017 in Uganda,” said Anne Schuchat, M.D., acting Director of CDC. “This new funding continues the U.S. commitment to this multi-national effort and supplements U.S. Government multisector support for this initiative.”

America’s jobs at risk
The first of the two articles, Relevance of Global Health Security to the U.S. Export Economy, the potential disruption to the U.S. export economy if an infectious disease outbreak were to take hold in CDC’s 49 global health security priority countries.
Using 2015 U.S. Department of Commerce data, the article assesses the value of U.S. exports to the 49 countries and the number of jobs supported by those exports, finding that:
:: In 2015 the United States exported over $300 billion in material goods and services to the 49 global health security priority countries.1
:: These exports supported over 1.6 million American jobs across all 50 states, in sectors such as agriculture, manufacturing, and natural resource extraction.1
CDC’s global health security efforts stop outbreaks where they start to protect health worldwide, in turn protecting demand for U.S. exports and the jobs they support in America.
What could happen to the U.S. export economy if an epidemic hits Asia?

The second article, Impact of Hypothetical Infectious Disease Outbreak on U.S. Exports and Export-Based Jobs, examines what could happen to the U.S. economy if an epidemic were to strike a key region, such as Southeast Asia. The article demonstrates how an epidemic spanning nine countries in Asia could cost the U.S. over $40 billion in export revenues and put more than 1 million U.S. jobs at risk.2
Southeast Asia is at greater risk for an emerging infectious disease event due to zoonotic, drug-resistant, and vector-borne diseases. Exports to Asia support the largest number of U.S. export-related jobs, which is why a large-scale infectious disease outbreak in this region could significantly disrupt the U.S. export economy.
The article illustrates the potential impact on the U.S. economy of an outbreak in just one affected country, and then expands the hypothetical scenario to look at what might happen if the outbreak were to spread across the region. Economic models used in the scenario take into account a large number of variables, including the interconnections between sectors of an economy and the trade between countries.
“The results of this hypothetical scenario show that the U.S. economy is better protected when public health threats are quickly identified and contained,” said Rebecca Martin, Ph.D., director, CDC’s Center for Global Health.
These articles offer valuable findings for policymakers and partners to consider when prioritizing programs to improve prevention, detection, and response to outbreaks around the world, and thereby reduce the potential threat to global markets and U.S. jobs.
 
Sources:
Cassell C, Bambery Z, Kakoli R, et al. Relevance of global health security to the US export economy. Health Security. 2017;15(6):563-568.
Bambery Z, Cassell C, Bunnell R, et al. Impact of a hypothetical infectious disease outbeak on US exports and export-based jobs. Health Security. 2018;16(1).

ACIP
February 21-22, 2018 Draft Meeting Agenda[2 pages]
Register for upcoming February ACIP meeting
February 21-22, 2018
Deadline for registration:
Non-US Citizens: January 24, 2018
US Citizens: February 5, 2018
 
MMWR News Synopsis for February 15, 2018 / No. 5
https://www.cdc.gov/mmwr/index2018.html
:: Update: Influenza Activity — United States, October 1, 2017–February 3, 2018
Influenza activity this season has been substantial, with some of the highest levels of influenza-like illness and hospitalization rates recorded in recent years, with elevated activity occurring in most of the country simultaneously.  Elevated influenza activity is expected to continue for several more weeks. Influenza activity in the United States began to increase in early November 2017 and rose sharply from December through February 3, 2018. Influenza A viruses were most commonly identified, with influenza A(H3N2) viruses predominating, but influenza A(H1N1)pdm09 and influenza B viruses also were detected. With several more weeks of elevated influenza activity expected, an increasing proportion of influenza A(H1N1)pmd09 and influenza B viruses, and the potential to prevent significant illness through influenza vaccination, CDC continues to recommend influenza vaccination at this time. During more severe influenza seasons, influenza antiviral medications can be of greater usey as an adjunct to vaccination in the treatment of influenza.  While most people with influenza will experience uncomplicated illness and recover without needing medical care, some people are at high risk of developing serious flu complications. Early treatment with neuraminidase inhibitor antiviral medications is recommended for patients with severe, complicated, or progressive influenza illness and people who are at high risk for influenza complications, including adults aged ≥65 years, who develop influenza symptoms. Everyday preventive measures such as cough and respiratory etiquette, staying home from work or school when sick and frequent hand hygiene, also can help slow the spread of influenza.

:: Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness — United States, February 2018
While flu vaccines vary in how well they work, vaccination can provide important protection against influenza. People age 6 months or older who have not yet been vaccinated this season should be vaccinated. However, some people who get vaccinated will still get sick with influenza. People who are very sick or who are at high risk of serious flu complications should be treated with flu antiviral medications as soon as they develop flu symptoms. Early estimates indicate that influenza vaccines have reduced the risk of medically attended influenza-related illness by about one-third in vaccinated persons so far this season. Vaccination reduced illness caused by the predominant influenza A(H3N2) viruses by 25 percent among patients of all ages, and among vaccinated children 6 months through 8 years of age by more than half (59 percent). Vaccine effectiveness against influenza A(H1N1)pdm09 viruses was 67 percent and against influenza B viruses was 42 percent.  Effectiveness against influenza A(H3N2) viruses is typically lower than against influenza A(H1N1) and influenza B viruses and CDC is actively investigating possible reasons. For these estimates, 4,562 children and adults with acute respiratory illness were enrolled from November 2, 2017 through February 3, 2018, at five study sites with outpatient medical facilities in the United States.

Announcements
 
 
BMGF – Gates Foundation  [to 17 February 2018]
http://www.gatesfoundation.org/Media-Center/Press-Releases
Gates Notes | 13 February 2018
Gates Annual Letter: The 10 Toughest Questions We Get
…We’ve spent $15.3 billion on vaccines over the past 18 years. And it’s been a terrific investment. Better immunization is one reason why the number of children who die has gone down by so much, from almost 10 million in 2000 to 5 million last year…
 

European Vaccine Initiative  [to 17 February 2018]
http://www.euvaccine.eu/news-events
14 February 2018
Sustained support by SAP business ByDesign to EVI’s mission
European Vaccine Initiative (EVI) begins its third decade developing vaccines for diseases against poverty.
 
 
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
[See Milestones/Perspectives above for full text]
 
February 15, 2018 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on advancing the development of novel treatments for neurological conditions; part of broader effort on modernizing FDA’s new drug review programs

February 14, 2018 –
FDA approves new treatment for a certain type of prostate cancer using novel clinical trial endpoint
 
February 13, 2018 –
Statement from FDA Commissioner Scott Gottlieb, M.D., on Administration’s request for new FDA funding to promote innovation and broaden patient access through competition
[Excerpt]
Create a New Medical Data Enterprise: Advance the Use of Real-World Evidence to Improve Human and Animal Health and Support Pre-Market Evaluation and Post-Market Safety
The FDA will advance the use of real-world experience to better inform patient care and provide more efficient, robust and potentially lower-cost ways to develop clinical data that can inform product review and promote innovation. The FDA will establish a new capability, including the development of data and analytical tools, to conduct near-real-time evidence evaluation down to the level of individual electronic health records for at least 10 million individuals in a broad range of U.S. healthcare settings.

Toward these ends, an expanded use of natural language processing for the assessment of information submitted to the agency would be developed in an effort to markedly speed recognition and remediation of emerging safety concerns. The effort would cover a broad range of medical products, including drugs, biologics and medical devices. The healthcare settings would be carefully selected to cover data gaps in the Sentinel and National Evaluation System for health Technology (NEST) systems for FDA-regulated products not currently easily assessed with existing systems.

Expanding the FDA’s capacity to utilize real-world evidence to evaluate the pre- and post-market safety and effectiveness of medical products would generate processes that could improve the efficiency of the regulatory process, better inform patients and providers about pre-and post-market safety, reduce some of the burdens that drive up the time and cost required to bring beneficial innovations to the market and address barriers that can make certain important safety and effectiveness information around the real-world use of products hard to collect and evaluate. The agency has already leveraged the use of real-world data to reduce the time and cost of clinical evidence development resulting in more timely and informative post-market data collection and more timely and efficient approvals of new devices and expanded indications of already marketed drugs and devices, including for drug-eluting stents, pacing leads, companion diagnostics, a spinal cord stimulator and a pediatric ventricular assist device. In the case of transcatheter heart valves, leveraging real-world evidence has already resulted in a greater than 400 percent cost savings for industry, improved post-market surveillance and moved the United States from 42nd to, in some cases, first-in-the-world approvals for life-saving technologies…

Global Fund [to 17 February 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Indonesia and Global Fund Unveil New Grants
13 February 2018
The Global Fund and health partners in Indonesia yesterday launched six new grants aimed at expanding Indonesia’s ambitious goals against HIV, TB and malaria.
 
MSF/Médecins Sans Frontières  [to 17 February 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Promising MSF Research Highlights Immense Benefits, Need for Expanded Use of DR-TB Drug Combination
February 14, 2018
New research published today in The Lancet Infectious Diseases journal by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) provides strong evidence that a combination of two new drugs for tuberculosis (TB)—the world’s leading infectious disease killer—could be used to treat drug-resistant (DR-TB) forms of the disease.

Press release
Iraq: Urgent Needs Must not be Forgotten as International Conference on Reconstruction Begins
February 12, 2018
An international conference on the reconstruction of Iraq is underway in Kuwait this week. Carla Brooijmans, Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission for Iraq, gave the following statement after a meeting in Kuwait today of aid organizations responding to humanitarian needs in Iraq.

 
NIH  [to 17 February 2018]
http://www.nih.gov/news-events/news-releases
February 16, 2018
PHAT Life: Effective HIV intervention for youth in the criminal justice system
Program showed great potential for reducing sexual risk-taking.
 
 
PATH  [to 17 February 2018]
http://www.path.org/news/index.php
Announcement | February 12, 2018
PATH statement on the US Administration’s proposed Fiscal Year 2019 budget
The following is a statement from Carolyn Reynolds, PATH’s Vice President for Policy and Advocacy, on the release of the Administration’s Fiscal Year 2019 Budget Request:
   “For the second year in a row, the Administration’s budget includes extensive cuts to global health and development programs at the US Agency for International Development (USAID) and the State Department. We are deeply concerned that these cuts not only put lives at risk but also reduce America’s own security and standing in the world. Given the extensive threats we face that require international cooperation and investment, gutting US support for global health and development is the wrong choice for America and for the world…”

UNAIDS [to 17 February 2018]
http://www.unaids.org/en
Feature story
Promoting women’s leadership in science and health
11 February 2018
The International Day of Women and Girls in Science is celebrated on 11 February. As part of UNAIDS’ Right to Health campaign last year, UNAIDS Special Ambassador for Adolescents and HIV and champion for young women in science, Quarraisha Abdool Karim, spoke with her daughter about her life’s work and the importance of women’s involvement in science and health.

UNICEF  [to 17 February 2018]
https://www.unicef.org/media/
15 February 2018
Massive data gaps leave refugee, migrant and displaced children in danger and without access to basic services
NEW YORK,– Gaps in data covering refugees, asylum seekers, migrants and internally displaced populations are endangering the lives and wellbeing of millions of children on the move, warned five UN and partner agencies today. In ‘A call to action: Protecting children on the move starts with better data’, UNICEF, UNHCR, IOM, Eurostat and OECD together show how crucial data are to understanding the patterns of global migration and developing policies to support vulnerable groups like children.
PDF: https://www.unicef.org/publications/files/Harrowing_Journeys_Children_and_youth_on_the_move_across_the_Mediterranean.pdf

Vaccine Confidence Project  [to 17 February 2018]
http://www.vaccineconfidence.org/
Perspectives
A global girl gang
Heidi J Larson. 2018. The Lancet 391(10120), p527–528. https://doi.org/10.1016/S0140-6736(18)30193-4
[See Reports, Research, Commentary below for full text]

Wellcome Trust  [to 17 February 2018]
https://wellcome.ac.uk/news
News / Published: 15 February 2018
Huge global survey to gauge public attitudes to science
Wellcome is funding an ambitious new global study designed to understand how people around the world think and feel about science and key health challenges.
Beginning this spring, and throughout 2018, we will survey 140,000 people from 140 countries. The findings will be available in 2019.
The survey will ask about people’s attitudes towards science to gauge their interest in it and how much they trust it. There are also questions about specific areas of science, eg vaccines, that have universal importance and are a priority for Wellcome.
The 30 questions, which take about ten minutes to complete face to face or over the phone, are part of the 2018 Gallup World Poll.

The Wistar Institute   [to 17 February 2018]
https://www.wistar.org/news/press-releases
Press Release 
Wistar Researchers Garnered More Than $6.5M in Funding to Support New Discoveries in Cancer & Infectious Disease
PHILADELPHIA–(Feb. 13, 2018)–Scientists at The Wistar Institute, an international biomedical research leader in cancer, immunology and infectious diseases, received research funds totaling $6.58 million between the end of 2017 and the first months of 2018.

::::::
 
BIO    [to 17 February 2018]
https://www.bio.org/insights/press-release
Feb 12 2018
BIO Expresses Strong Support for TRID Improvement Act
Legislation provides critical regulatory relief to small, pre-revenue emerging companies      
Washington, D.C. (February 12, 2018)— The Biotechnology Innovation Organization (BIO) announced its strong support today for H.R. 3978, the TRID Improvement Act. The bill includes a provision known as the Fostering Innovation Act, which offers much needed regulatory relief to small biotechnology firms..The Fostering Innovation Act extends one vital JOBS Act provision – the temporary exemption from Section 404(b) of Sarbanes-Oxley (SOX) – for an additional five years for pre-revenue small businesses.

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
 

Vaccine Confidence Project  [to 17 February 2018]
http://www.vaccineconfidence.org/
Perspectives
A global girl gang
Heidi J Larson. 2018. The Lancet 391(10120), p527–528. https://doi.org/10.1016/S0140-6736(18)30193-4
If there is one time of life when emotional ups and downs are particularly steep—with roller-coaster highs and lows, risky behaviour, and attention seeking at an all-time high—it’s adolescence. It is an exciting, scary, and vulnerable time. Many cultures around the world recognise this liminal and transformative time with initiation rites to mark the passage from childhood to adulthood. Heads are shaved, genitals cut, tests of courage and strength performed, and ceremonies held to mark sexual maturity, reproduction, and changing roles in family and society. With this transition, is the loss of innocence, of virginity, of purity.

Throughout history, myths have been written and artists have portrayed virgins—as a most precious gift— being sacrificed to the gods, for redemption and protection of whole populations. The notion of sacrificing a virgin for the greater good is the theme of a three-part YouTube series, intended to be woven into a documentary film, called Sacrificial Virgins. In this case, though, filmmaker Joan Shenton challenges the notion that the human papillomavirus (HPV) vaccine is for the greater good, titling part 1 of the series, “Not for the Greater Good”.

The film opens with 16-year-old Ruby—long brown hair, glasses, and wearing a salmon-coloured T-shirt with “Girl Gang” written across the front—capturing well the sentiments of her age. In her gentle voice, she talks about her pain and fatigue; as her mother moves her in a swing, her legs and arms are limp and she’s unable to stand without support. Ruby is convinced that the HPV vaccine caused her situation, and the video series goes on to tell other stories as the filmmaker interviews young girls, their mothers, and scientists who present alternative views and questions around the safety and need for the HPV vaccine. There are no positive voices about the HPV vaccine in this video series. There are no interviews with the Nobel Laureate Harald zur Hausen, who discovered the link between HPV infection and cervical cancer, or with Lasker Award-winning scientists Douglas Lowy and John Schiller for their research on the HPV vaccine, or even with girls or parents who think differently about the positive value of the HPV vaccine and the prevention of cervical cancer.

Documentary films and social media, now enabling the viral spread of photos and videos worldwide, are becoming the media of choice among those most critical of vaccines. Films and social media can channel emotions and provide a platform to share personal testimony as compelling “evidence” that cannot be conveyed in scientific articles and randomised controlled trials.

The HPV vaccine brings out particularly strong emotions. It provokes cultural, religious, and political reactions from the public more than most other vaccines, not in small part because it touches on sensitivities around sexuality and reproduction, as well as the vulnerable emotions and individuation of adolescent girls. Some of these emotions and anxieties have been pointed to by the medical community as contributing to the range of symptoms reported by young girls—dizziness, fainting, eating disorders, and walking difficulties—while those who experience them are convinced they are caused by the HPV vaccine.

Sacrificial Virgins is not a series on its own. It is another film produced on a growing theme of The Vaccinated Girls (De Vaccinerede Piger), as a Danish TV documentary was titled. The documentary was broadcast in Denmark in March, 2015, is still circulating on YouTube, and has prompted other films—in the Netherlands, Ireland, and Colombia—where girls share their personal testimonies, and their symptoms, suspected to be caused by HPV vaccination. Danish HPV vaccine anxieties posted on YouTube or Facebook have influences well beyond Denmark, travelling afar with English or other subtitles. Video clips of Colombian girls telling their stories in Spanish are subtitled in English with voiceover in Japanese. Japanese anti-HPV vaccine sentiments and YouTube images have meaning beyond Japan, shared globally with multilanguage subtitles and images that often speak for themselves. The stories from Japan have travelled particularly widely, and featured in many online discussions, Facebook pages, and YouTube testimonies, including in part 3 of Sacrificial Virgins. The Japanese Government suspended their proactive recommendation of the HPV vaccine in June, 2013, in reaction to reported vaccine reactions and public pressure. Although the independent committee that investigated the cases found no evidence of a link between the vaccine and the reported symptoms, more than 4 years later, the recommendation is yet to be reinstated and HPV acceptance rates have plummeted from over 75% to under 1%. Meanwhile, those around the world who are increasingly anxious, concerned, or convinced they have been injured by the HPV vaccine point to the Japanese Government’s decision as an endorsement of their concerns.

Teenage social networks are increasingly created online with intimacies, sensitivities, and experiences shared across the globe in search of like-minded friends. Sometimes these new media offer a space for friendship and sharing, but they have also opened the gates for the viral spread of panic, such as around HPV vaccine risks. These stories are a growing narrative co-created and posted by the girls and circulating globally that fuel a social amplification of risk and anxiety. As with street gangs that create their own brands and loyalty, these girls are creating their own evidence.

The impact of this growing trend of globally shared personal testimonies, risk perceptions, and vaccine critiques is no longer fringe. The impacts are evident in the high level of reported adverse events after HPV vaccination and the less than optimal levels of vaccine acceptance in countries where the vaccine is available and recommended. As poorer countries, with some of the highest cervical cancer burdens, start to introduce the HPV vaccine into their national programmes, anyone with internet and social media access will be exposed to the Babelian mix of trust-building as well as trust-breaking posts about the vaccine. Although most reported adverse events have not been confirmed as being caused by the vaccine, they reflect the heightened perceptions of risk, suspicion, and distrust around HPV vaccination. The trust levels are low.

Building trust among young girls is critical. They are future mothers, and their personal experiences with vaccines will be remembered. Symptoms suspected to be caused by HPV vaccination, such as those portrayed in Sacrificial Virgins, need empathy, counselling, and support. The questions, symptoms, and concerns are real for those who experience them and dismissing them as being unrelated to vaccination will only provoke more distrust and alienation. Disseminating better messages is not the point. These stories are about a broken relationship and need repair. They need listening, not instructing. They need dialogue, not dismissal.

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

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 17 February 2018)

Research
15 February 2018
Cost-effectiveness of antiviral prophylaxis during pregnancy for the prevention of perinatal hepatitis B infection in South Korea
Authors: Donghoon Lee, Hyun-Young Shin and Sang Min Park

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 17 February 2018)

Research article
17 February 2018
Disparate compensation policies for research related injury in an era of multinational trials: a case study of Brazil, Russia, India, China and South Africa
Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa (BRICS).
Authors: George Rugare Chingarande and Keymanthri Moodley

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 17 February 2018)

Research article
The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone
Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effect…
Authors: Grazia Caleo, Jennifer Duncombe, Freya Jephcott, Kamalini Lokuge, Clair Mills, Evita Looijen, Fivi Theoharaki, Ronald Kremer, Karline Kleijer, James Squire, Manjo Lamin, Beverley Stringer, Helen A. Weiss, Daniel Culli, Gian Luca Di Tanna and Jane Greig
Citation: BMC Public Health 2018 18:248
Published on: 13 February 2018

JAMA
February 13, 2018, Vol 319, No. 6, Pages 525-624
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Language, Science, and Politics-The Politicization of Public Health
Lawrence O. Gostin, JD
JAMA. 2018;319(6):541-542. doi:10.1001/jama.2017.21763
This Viewpoint provides historical context for advice given by the US Department of Health and Human Services in 2017 to the CDC to avoid particular words in 2019 budget requests and argues that scientific innovation can flourish only when it is protected from political interference.

The Lancet
Feb 17, 2018 Volume 391 Number 10121 p631-712
http://www.thelancet.com/journals/lancet/issue/current

Review
Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition
Donald A P Bundy, Nilanthi de Silva, Susan Horton, George C Patton, Linda Schultz, Dean T Jamison for the Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group
Summary
The realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5–9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10–14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15–19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.

The Lancet
Feb 17, 2018 Volume 391 Number 10121 p631-712
http://www.thelancet.com/journals/lancet/issue/current

Public Health
Evidence-based guidelines for supportive care of patients with Ebola virus disease
François Lamontagne, Robert A Fowler, Neill K Adhikari, Srinivas Murthy, David M Brett-Major, Michael Jacobs, Timothy M Uyeki, Constanza Vallenas, Susan L Norris, William A Fischer 2nd, Thomas E Fletcher, Adam C Levine, Paul Reed, Daniel G Bausch, Sandy Gove, Andrew Hall, Susan Shepherd, Reed A Siemieniuk, Marie-Claude Lamah, Rashida Kamara, Phiona Nakyeyune, Moses J Soka, Ama Edwin, Afeez A Hazzan, Shevin T Jacob, Mubarak Mustafa Elkarsany, Takuya Adachi, Lynda Benhadj, Christophe Clément, Ian Crozier, Armando Garcia, Steven J Hoffman, Gordon H Guyatt
Summary
The 2013–16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients’ reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief.

Maternal and Child Health Journal
Volume 22, Issue 2, February 2018
https://link.springer.com/journal/10995/22/2/page/1

Original Paper
Pertussis Vaccination Among Childcare Center Staff, Administrators, and Parents: Uptake, Policies, and Beliefs
Little is known about childcare staff’s and parents’ uptake of and attitudes towards pertussis vaccine. Methods Questionnaires were distributed to St. Louis parents and childcare staff in fall, 2014. Parents versus staff and vaccinated versus unvaccinated individuals’ beliefs regarding pertussis vaccine were compared using chi square tests. Multivariate logistic regressions were run to develop predictive models for staff’s and parents’ vaccine uptake. Childcare staff’s and parents’ pertussis vaccine uptake was higher than overall U.S. rates, though significantly lower than the Global Pertussis Initiative target. Implementing an education campaign and providing free vaccine on-site are likely to result in increased vaccine uptake.
Terri Rebmann, Travis M. Loux, Daphne Lew…

Nature 
Volume 554 Number 7692 pp275-392  15 February 2018
http://www.nature.com/nature/current_issue.html

Comment
Find drugs that delay many diseases of old age
Simply extending lifespan is not enough. We need treatments that boost resilience to multiple age-related diseases, argue Ilaria Bellantuono and 12 co-signatories.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 17 February 2018]

Clinical and Laboratory Profile of Zika and Dengue Infected Patients: Lessons Learned From the Co-circulation of Dengue, Zika and Chikungunya in Brazil
February 15, 2018 · Research Article
Background: The current triple epidemic caused by dengue, zika and chikungunya constitutes a serious health problem in Brazil. The aim of this study was to investigate acute samples (up to the 7 days of symptoms) from patients presenting acute fever syndrome suspected as arboviral infection and characterize the clinical and laboratorial profile during the co-circulation of dengue, zika and chikungunya in Campo Grande, Mato Grosso do Sul (MS), midwest region of Brazil. Methods: All suspected cases (n=134) were tested by using serological and molecular diagnostic tests including DENV, ZIKV and CHIKV RT-PCR, Dengue nonstructural protein 1 (NS1) antigen capture ELISA, anti- DENV IgM ELISA and anti-CHIKV IgM ELISA. In addition, clinical, hematological and biochemical parameters of infected patients were analyzed. Results: It was observed that 79.1% of the blood samples were confirmed for ZIKV and/or DENV infection Of those, 38.0% patients were DENV monoinfected, 26.8% were ZIKV monoinfected and 13.4% were DENV/ZIKV co-infected. Seven patients presented Chikungunya IgM antibodies indicating a previous CHIKV infection. Common symptoms included fever, rash, arthralgia, myalgia, prostration, headache and conjunctivitis. Statistical analysis showed that pruritus and edema were associated with ZIKV infection while prostration and vomiting were more associated with dengue. Additionally, total protein and ALT levels were significantly different in DENV patients compared to ZIKV ones. Some DENV infected patients as well as co-infected needed hospitalization and venous hydration. Otherwise, most ZIKV infected patients presented mild clinical course. Among the pregnant women studied (n=11), three were ZIKV monoinfected while four were DENV monoinfected and two were DENV-1/ZIKV coinfected. In general, normal birth outcomes were observed except for the death due to respiratory insufficiency of one baby born to a mother coinfected with DENV-1/ZIKV. Conclusions: Herein, we provide evidence of the co-circulation of DENV, ZIKV and CHIKV infections in the Campo Grande, MS, Brazil, with a high frequency of DENV-1/ZIKV coinfection. Laboratorial diagnosis poses a challenge where those arboviruses are endemic and differential diagnosis proved to imperative for cases characterization. The knowledge about disease severity during arbovirus coinfections is still scarce and there are several issues emphasizing the importance of adequate management of patients at risk areas.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 17 February 2018)

Research Article
Dengue knowledge, attitudes and practices and their impact on community-based vector control in rural Cambodia
Emmanuelle Kumaran, Dyna Doum, Vanney Keo, Ly Sokha, BunLeng Sam, Vibol Chan, Neal Alexander, John Bradley, Marco Liverani, Didot Budi Prasetyo, Agus Rachmat, Sergio Lopes, Jeffrey Hii, Leang Rithea, Muhammad Shafique, John Hustedt
| published 16 Feb 2018 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006268

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 17 February 2018)

Editorial
Modern Sunni-Shia conflicts and their neglected tropical diseases
Peter J. Hotez
| published 15 Feb 2018 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006008
[Excerpt]
…Ultimately, we can look to science and vaccine diplomacy to promote disease control activities across the EMR and to build new interventions for preventing the spread of the new and emerging NTDs [19, 20].
There are several possible approaches to consider on this front. First, greater cooperation between the OIC nations could increase access to essential medicines for mass treatment of the NTDs, including intestinal helminth infections, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma. Today, in some of the African Sahelian OIC nations, only a small percentage of the at-risk populations (including children) benefit from regular and periodic mass drug administration. This problem could be addressed through increased financial support and technical cooperation among OIC nations.
In addition, there is an urgent need to create new vaccines for some of the NTDs and other poverty-related neglected diseases arising out of the conflict nations highlighted above. We need new vaccines for leishmaniasis, coronavirus infections, viral HFs, and other diseases. In terms of nations adjacent to Middle East conflict zones, currently both Saudi Arabia and Iran, as well as other Gulf Cooperation Council (GCC) nations, have substantial capacities for vaccine biotechnology. We need to do better tapping into those strengths. In my role during 2015 and 2016 as United States science envoy for the State Department and White House, I worked to expand collaborations between the US and Saudi Arabia, now leading to joint scientific activities in the area of vaccine development. But such initiatives in the area of vaccine diplomacy need to be expanded. Could US-Saudi vaccine diplomacy extend to other nations? It would be worthwhile to also explore the inclusion of other nations in the Middle East, North Africa, and Central Asia, particularly those that do not have historical connections to Saudi Arabia. In so doing, vaccine diplomacy could become a key 21st-century theme to address regional NTDs arising out of conflict and to promote international cooperation in the region and among the OIC nations.

PLoS One
http://www.plosone.org/
[Accessed 17 February 2018]

Research Article
Parents’ knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand
Maria Grandahl, Seung Chun Paek, Siriwan Grisurapong, Penchan Sherer, Tanja Tydén, Pranee Lundberg
Research Article | published 15 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0193054

Research Article
Occurrence of measles in a country with elimination status: Amplifying measles infection in hospitalized children due to imported virus
HyeEun Eom, YoungJoon Park, JooWhee Kim, Jeong-Sun Yang, HaeJi Kang, Kisoon Kim, Byung Chul Chun, Ok Park, Jeong Ik Hong
Research Article | published 15 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0188957

Research Article
Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada
Sarah E. Wilson, Hannah Chung, Kevin L. Schwartz, Astrid Guttmann, Shelley L. Deeks, Jeffrey C. Kwong, Natasha S. Crowcroft, Laura Wing, Karen Tu
Research Article | published 14 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0192809

Research Article
Increasing influenza vaccination rates via low cost messaging interventions
Ernest Baskin
Research Article | published 14 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0192594

Research Article
Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States
Minesh P. Shah, Rebecca M. Dahl, Umesh D. Parashar, Benjamin A. Lopman
Research Article | published 14 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0191429

Research Article
Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017–2035: Example from Australia
Michaela T. Hall, Kate T. Simms, Jie-Bin Lew, Megan A. Smith, Marion Saville, Karen Canfell
Research Article | published 14 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0185332

Research Article
Choosing important health outcomes for comparative effectiveness research: An updated systematic review and involvement of low and middle income countries
Katherine Davis, Sarah L. Gorst, Nicola Harman, Valerie Smith, Elizabeth Gargon, Douglas G. Altman, Jane M. Blazeby, Mike Clarke, Sean Tunis, Paula R. Williamson
Research Article | published 13 Feb 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0190695

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 17 February 2018]

Contribution of NIH funding to new drug approvals 2010–2016
Ekaterina Galkina Cleary, Jennifer M. Beierlein, Navleen Surjit Khanuja, Laura M. McNamee and Fred D. Ledley
PNAS 2018; published ahead of print February 12, 2018, https://doi.org/10.1073/pnas.1715368115
Significance
This report shows that NIH funding contributed to published research associated with every one of the 210 new drugs approved by the Food and Drug Administration from 2010–2016. Collectively, this research involved >200,000 years of grant funding totaling more than $100 billion. The analysis shows that >90% of this funding represents basic research related to the biological targets for drug action rather than the drugs themselves. The role of NIH funding thus complements industry research and development, which focuses predominantly on applied research. This work underscores the breath and significance of public investment in the development of new therapeutics and the risk that reduced research funding would slow the pipeline for treating morbid disease.
Abstract
This work examines the contribution of NIH funding to published research associated with 210 new molecular entities (NMEs) approved by the Food and Drug Administration from 2010–2016. We identified >2 million publications in PubMed related to the 210 NMEs (n=131,092) or their 151 known biological targets (n=1,966,281). Of these, >600,000 (29%) were associated with NIH-funded projects in RePORTER. This funding included >200,000 fiscal years of NIH project support (1985–2016) and project costs >$100 billion (2000–2016), representing aprox20% of the NIH budget over this period. NIH funding contributed to every one of the NMEs approved from 2010–2016 and was focused primarily on the drug targets rather than on the NMEs themselves. There were 84 first-in-class products approved in this interval, associated with >$64 billion of NIH-funded projects. The percentage of fiscal years of project funding identified through target searches, but not drug searches, was greater for NMEs discovered through targeted screening than through phenotypic methods (95% versus 82%). For targeted NMEs, funding related to targets preceded funding related to the NMEs, consistent with the expectation that basic research provides validated targets for targeted screening. This analysis, which captures basic research on biological targets as well as applied research on NMEs, suggests that the NIH contribution to research associated with new drug approvals is greater than previously appreciated and highlights the risk of reducing federal funding for basic biomedical research.

Public Health Ethics
Volume 11, Issue 1, 1 April 2018
http://phe.oxfordjournals.org/content/current

Editorial
Editorial: Public Health Ethics—10 Years On
Marcel Verweij; Angus Dawson
Public Health Ethics, Volume 11, Issue 1, 1 April 2018, Pages 1–5, https://doi.org/10.1093/phe/phy003
Extract
Public Health Ethics first appeared in April 2008, so with this issue, we celebrate 10 years of publication. The interest in public health ethics as a subfield of bioethics, already beginning to grow before the birth of the journal, has continued to expand steadily throughout this period. The success of Public Health Ethics over these 10 years is a reason for celebration. However, it is good to put this in perspective, in that a significant part of the interest is due to the continuing global need for public health action to address population-level health problems, the ongoing lack of public health infrastructures and poor environmental health in many places in the world, the growing health inequalities between rich and poor and growing health risks due to climate change, population movement, ageing, antimicrobial resistance and overconsumption…

Science         
16 February 2018   Vol 359, Issue 6377
http://www.sciencemag.org/current.dtl

Feature
The data thugs
By Adam Marcus, Ivan Oransky
Science16 Feb 2018 : 730-732 Full Access
Nick Brown and James Heathers have had striking success in catalyzing retractions by publicly calling out questionable data.
Summary
When it comes to correcting problematic data in the scientific literature, styles vary. Some scientists prefer to go through “proper channels,” such as private conversations or letters to the editor. Others leave anonymous comments on online forums, such as PubPeer, for airing concerns about papers. Then there is the more public approach taken by Nick Brown and James Heathers. The two researchers—Heathers has called himself “a data thug”—have been remarkably effective at uncovering problematic data—and publicly airing their concerns on websites and in the media. Their work has led to corrections to dozens of papers, and the full retractions of about 20. But although the duo concedes that their assertive style might rub some scientists the wrong way, they’ve attracted relatively little criticism from academic peers. Indeed, many credit them with addressing an uncomfortable problem in the science world, and even send them tips on suspect papers.

Vaccine
Volume 36, Issue 9  Pages 1133-1242 (21 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/9

Review
Innovation Partnership for a Roadmap on Vaccines in Europe (IPROVE): A vision for the vaccines of tomorrow
Open access – Review article
Pages 1136-1145
Donata Medaglini, Magdalena R. De Azero, Odile Leroy, Florence Bietrix, Philippe Denoel
Abstract
A clear vision for vaccines research and development (R&D) is needed if Europe is to continue to lead the discovery of next generation vaccines. Innovation Partnership for a Roadmap on Vaccines in Europe (IPROVE) is a collaboration between leading vaccine experts to develop a roadmap setting out how Europe can best invest in the science and technology essential for vaccines innovation. This FP7 project, started in December 2013, brought together more than 130 key public and private stakeholders from academia, public health institutes, regulators, industry and small and medium-sized enterprises to determine and prioritise the gaps and challenges to be addressed to bolster innovation in vaccines and vaccination in Europe. The IPROVE consultation process was structured around seven themes: vaccine R&D, manufacturing and quality control, infrastructure, therapeutic vaccines, needs of small and medium-sized enterprises, vaccines acceptance and training needs.
More than 80 recommendations were made by the consultation groups, mainly focused on the need for a multidisciplinary research approach to stimulate innovation, accelerated translation of scientific knowledge into technological innovation, and fostering of real collaboration within the European vaccine ecosystem. The consultation also reinforced the fact that vaccines are only as good as their vaccine implementation programmes, and that more must be done to understand and address vaccination hesitancy of both the general public and healthcare professionals.
Bringing together a wide range of stakeholders to work on the IPROVE roadmap has increased mutual understanding of their different perspectives, needs and priorities. IPROVE is a first attempt to develop such a comprehensive view of the vaccine sector. This prioritisation effort, aims to help policy-makers and funders identify those vaccine-related areas and technologies where key investment is needed for short and medium-long term success.

Vaccine
Volume 36, Issue 9 Pages 1133-1242 (21 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/9

Anti-vaccination and pro-CAM attitudes both reflect magical beliefs about health
Original research article
Pages 1227-1234
Gabrielle M. Bryden, Matthew Browne, Matthew Rockloff, Carolyn Unsworth
Abstract
We examined the relationship between complementary and alternative medicine (CAM) use and vaccination scepticism; and specifically whether a person’s more general health-related worldview might explain this relationship. A cross-sectional online survey of adult Australians (N = 2697) included demographic, CAM, and vaccination measures, as well as the holistic and magical health belief scales (HHB, MHB). HHB emphasises links between mind and body health, and the impact of general ‘wellness’ on specific ailments or resistance to disease, whilst MHB specifically taps ontological confusions and cognitive errors about health. CAM and anti-vaccination were found to be linked primarily at the attitudinal level (r = −0.437). We did not find evidence that this was due to CAM practitioners influencing their clients. Applying a path-analytic approach, we found that individuals’ health worldview (HHB and MHB) accounted for a significant proportion (43.1%) of the covariance between CAM and vaccination attitudes. MHB was by far the strongest predictor of both CAM and vaccination attitudes in regressions including demographic predictors. We conclude that vaccination scepticism reflects part of a broader health worldview that discounts scientific knowledge in favour of magical or superstitious thinking. Therefore, persuasive messages reflecting this worldview may be more effective than fact-based campaigns in influencing vaccine sceptics.

Vaccine
Volume 36, Issue 8  Pages 1027-1132 (14 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/8

Regular papers
Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program
Original research article
Pages 1032-1037
Jacqueline M. Hirth, Denise N. Batuuka, Tyra T. Gross, Leslie Cofie, Abbey B. Berenson
Abstract
Background
Previous interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges.
Methods
We approached students aged 18–26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data.
Results
During interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends’ opinions, but would want to know about side effects that their vaccinated friends experienced.
Conclusions
Successful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness.

Vaccine
Volume 36, Issue 8  Pages 1027-1132 (14 February 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/8

Barriers to immunization among newcomers: A systematic review
Original research article
Pages 1055-1062
Lindsay Wilson, Taylor Rubens-Augustson, Malia Murphy, Cindy Jardine, … Kumanan Wilson
Abstract
Introduction
Currently, there is a lack of comprehensive evidence exploring vaccine decision-making among newcomers. We conducted a systematic review of qualitative studies aimed at identifying factors that influence newcomers’ decision-making with regards to vaccination.
Methods
We conducted a search of MEDLINE, EMBASE, CINAHL and Cochrane Central. To be included, studies needed to employ a qualitative methodology and address newcomer attitudes, beliefs, and/or perceptions regarding vaccination. Two independent reviewers screened the articles for relevant information and applied a content analysis methodology to code the identified barriers.
Results
Twenty-one studies were included in this review, and four types of barriers were identified: cultural factors, knowledge barriers, insufficient access to healthcare, and vaccine hesitancy. Insufficient knowledge about vaccination and the virus being prevented and concerns about safety were the most commonly reported barriers. A sub-analysis of barriers specific to HPV indicated that cultural beliefs about sexuality and incomplete knowledge about the role of HPV in the development of cervical cancer are major barriers to vaccine uptake.
Conclusion
Strategies to improve vaccination uptake in newcomers should consider focusing on the barriers identified in this review while taking into account the unique opportunities for promoting uptake within newcomer populations.
 

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 17 February 2018)

Open Access  Review
Virus-Like-Vaccines against HIV
by Anne-Marie C. Andersson, Melanie Schwerdtfeger and Peter J. Holst
Vaccines 2018, 6(1), 10; doi:10.3390/vaccines6010010 – 11 February 2018
Abstract
Protection against chronic infections has necessitated the development of ever-more potent vaccination tools. HIV seems to be the most challenging foe, with a remarkable, poorly immunogenic and fragile surface glycoprotein and the ability to overpower the cell immune system. Virus-like-particle (VLP) vaccines have emerged as potent inducers of antibody and helper T cell responses, while replication-deficient viral vectors have yielded potent cytotoxic T cell responses. Here, we review the emerging concept of merging these two technologies into virus-like-vaccines (VLVs) for the targeting of HIV. Such vaccines are immunologically perceived as viruses, as they infect cells and produce VLPs in situ, but they only resemble viruses, as the replication defective vectors and VLPs cannot propagate an infection. The inherent safety of such a platform, despite robust particle production, is a distinct advantage over live-attenuated vaccines that must balance safety and immunogenicity. Previous studies have delivered VLVs encoded in modified Vaccinia Ankara vectors and we have developed the concept into a single-reading adenovirus-based technology capable of eliciting robust CD8+ and CD4+ T cells responses and trimer binding antibody responses. Such vaccines offer the potential to display the naturally produced immunogen directly and induce an integrated humoral and cellular immune response.

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 17 February 2018
Should Kids Be Required To Get The HPV Vaccine?
Bruce Y. Lee, Contributor
Florida is considering a bill that would make the human papillomavirus (HPV) vaccine mandatory for public school students. Could this be the cure for the low HPV vaccination rates shown by the Blue Cross Blue Shield Association (BCBSA) Health of America Report?

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 17 February 2018
March/April 2018
Capsule Review
Vaccines: What Everyone Needs to Know
by Kristen A. Feemster
Reviewed by Richard N. Cooper
Life has been made immeasurably better by the sharp decline in the incidence of infectious diseases, an improvement made possible through inoculations, especially of children, which protect people from contracting diseases and have led to the elimination or near elimination of maladies such as smallpox and polio. Yet public wariness of vaccines persists and has even in some cases increased—perhaps, ironically, owing in part to the decline in disease incidence produced by vaccines. This useful, fair-minded, and extremely informative book explains how vaccines are produced and how they work; discusses the diverse reasons behind some parents’ hesitancy to inoculate their children; explores the prospect of employing vaccines for not only preventing but also curing some diseases, including AIDS and even some cancers; and examines the potential for the total elimination of particular diseases, such as measles.

 
New York Times
http://www.nytimes.com/
Accessed 17 February 2018
Health
Lassa Fever Erupts in Nigeria
16 February 2018
The disease, carried by rodents, is sometimes mild but can lead to hemorrhagic fever and death. W.H.O. has sent additional staff to help contain the outbreak.

Americas
Brazil Yellow Fever Vaccine Campaign Struggling to Meet Goal
Brazil’s Health Ministry says a massive yellow fever vaccination campaign has reached less than 20 percent of the targeted population since it began three weeks ago.

Europe
Measles Cases in Europe Tripled Last Year, Officials Say
13 February 2018
The European Centre for Disease Prevention and Control says the number of measles cases across the continent tripled last year and is continuing to cause new outbreaks due to low immunization rates. In an update published this month, the agency said more than 14,400 cases were reported by 30 countries last year — compared with about 4,600 cases the year before. European officials said the spike was due to epidemics in Romania, Italy, Greece and Germany.

Africa
Nigeria Reports 450 Suspected Cases of Lassa Fever; 37 Dead
FEB. 13, 2018
The World Health Organization says as many as 450 people may have been infected with Lassa fever in Nigeria in less than five weeks.

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_10 Feb 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

WHO Special Intervention Teams Vaccinate Nearly 400,000 children at transit points – Nigeria
08 February 2018
…Presently, WHO has engaged 400 Special Intervention Teams in Borno state who operate quasi-fixed vaccination posts at transit points, motor parks, markets and along nomadic grazing routes, host communities and internally displaced people (IDP) camps. Their job is to intercept, assess, profile and vaccinate all children on transit with the appropriate vaccines including polio, measles and yellow fever.
In 2017, more than 2.4 million doses of oral polio vaccines were administered to eligible children and nearly 400 000 children profiled by the Special Interventions Teams, including 18 000 children from Marte and Abadam,” said Dr Mohammed Tahir Bolori, WHO focal person for internally displaced persons in Borno.
Out of the nearly 400,000 children,  the teams tracked and profiled by the team , more than 375,000 were from populations trapped in inaccessible and partially accessible wards and settlements with no healthcare facilities, while another 21,664 children reached at transit points came from neighboring countries and other States in Nigeria.
Violence in the north-east Nigeria has caused widespread devastation, that affects the health of more than 6.9 million people in Adamawa, Borno and Yobe States with massive displacements of people. There are 1.7 million IDPs in the three states and more than 200,000 refugees from Niger, Chad and Cameroon.
In Borno state, two-thirds of health facilities in the conflict-affected areas have been completely or partially damaged leaving them incapable of providing urgently needed healthcare services. According to WHO’s latest Health Resources Availability Monitoring System report (known as HeRAMS), one- third of more than 700 health facilities in the state have been completely destroyed. Millions of people are unable to access even the most basic services such as vaccinations, treatment for minor ailments including malaria, diarrhea, and upper respiratory tract infections.
The “Special Intervention Teams” are helping to fill the gap in healthcare due to the humanitarian crisis by providing children who are often extremely vulnerable protection from some of childhood’s most virulent diseases…

Milestones :: Perspectives

Bill & Melinda Gates Medical Research Institute   [to 10 February 2018]

https://www.linkedin.com/company/bill-melinda-gates-medical-research-institute/  [LinkedIn site]
February 6, 2018
Gates MRI Leadership Update
by Penny Heaton, Chief Executive Officer
The Gates MRI is taking an exciting step in its journey to solve some of the world’s toughest and most persistent global health challenges. I’m pleased to introduce the inaugural members of our leadership team.

Each of the individuals joining the leadership team brings a unique background and perspective to the Gates MRI, and each shares a commitment to helping accelerate progress in translational science for global health.

Here are the new members of the Gates MRI leadership team:
   David Kaufman serves as Chief Medical Officer. Previously, he led Translational Oncology at Merck Research Laboratories, where he oversaw immuno-oncology translational research and biomarker development, as well as global translational research partnering. Prior to Merck, he was a faculty member at Beth Israel Deaconess Medical Center and Harvard Medical School, where his research focused on HIV vaccine immunology. David holds a Bachelor of Arts degree in biology, sociology, and anthropology from Swarthmore College, a PhD in Molecular Virology & Immunology from Rockefeller University, and an MD from Weill Medical College of Cornell University. He trained in internal medicine at the University of California, San Francisco, and in infectious diseases at Massachusetts General Hospital and Brigham and Women’s Hospital. David is a member of the Board of Directors of the Society for the Immunotherapy of Cancer.

Jared Silverman serves as Head of Translational Discovery. He was previously Senior Vice President at Kaleido Biosciences, developing a drug discovery research platform for the microbiome. Prior to Kaleido, he spent 18 years at Cubist Pharmaceuticals, where he contributed to the discovery of three novel antibiotics. Jared trained as a microbiologist, focusing on a variety of problems in microbial pathogenesis. He holds a Bachelor of Arts degree in Molecular Biology from Princeton University and a PhD in Microbiology and Molecular Genetics from Harvard University. Jared is a member of the Board of Directors of Auspherix and on the editorial board of Antimicrobial Agents and Chemotherapy.

Debra Weiss serves as Head of Quality Assurance. Before joining the Gates MRI, Debra was Group Vice President and Head of R&D Quality Assurance at Shire Pharmaceuticals. Prior to Shire, she was a leader in R&D Quality Assurance at Merck & Co. Inc. She earned her Bachelor of Science degree in nursing from Hahnemann University and her Master of Science degree in the same field from the University of Pennsylvania. Debra is also an adjunct professor at Temple University, teaching a graduate course on good clinical practices.

John Boama-Sefah serves as the Chief Human Resources Officer. Previously, John was the Vice President of Human Resources at Baxalta, where he collaborated with business and HR leaders in multiple markets around the world. He also spent 14 years at Sanofi in New Jersey where he held HR leadership roles of increasing responsibility within the Research & Development function. John has expertise leading HR strategy and implementation across multiple geographies and during significant times of change and transformation. He received his Bachelor of Science degree in business administration from the University of Ghana and his Master of Business Administration degree in human resources and marketing management from Vanderbilt University.
   Dina Berdieva serves as Head of Project Management & Clinical Operations. Prior to joining the Gates MRI, she was the Executive Director of Clinical Operations for Boston Pharmaceuticals, and spent nine years at Novartis Vaccines prior to that. Dina holds a Bachelor of Arts degree from Clark University and a Master of Public Health degree from Boston University with a focus on International Health & Epidemiology and Biostatistics.

Mary Thistle serves as the Gates MRI’s Chief of Staff. Mary is a biopharmaceutical leader with more than 20 years of expertise in driving accelerated growth, and leading organizational strategy, operations, and business development. Before joining the Gates MRI, she was the COO for Dimension Therapeutics, a gene therapy company focused on rare diseases of the liver. Prior to Dimension, Mary was the Senior Vice President of Business Development at Cubist Pharmaceuticals. She holds a Bachelor of Science degree in Accounting and Business/Management from the University of Massachusetts. Mary serves on the Board of Directors for Enterome Biosciences.

In the coming months and years, the Gates MRI will continue to build a strong, talented team dedicated to our mission of eradicating malaria, accelerating the end of the tuberculosis epidemic, and ending diarrheal deaths in children.

This team will work to create a place where experts in translational science and medicine can come together, apply transformational science, and improve the lives of millions of people in the world’s poorest countries. I’m excited to welcome each of these individuals, and I look forward to the work ahead!

Featured Journal Content

Health Affairs
February 2018.  Vol. 37, No. 2
https://www.healthaffairs.org/toc/hlthaff/current
Diffusion Of Innovation
Research Article   Global Health Policy
The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries
Angela Y. Chang1, Carlos Riumallo-Herl2, Nicole A. Perales3, Samantha Clark4, Andrew Clark5,
Dagna Constenla6, Tini Garske7, Michael L. Jackson8, Kévin Jean9, Mark Jit10, Edward O. Jones11, Xi Li12, Chutima Suraratdecha13, Olivia Bullock14, Hope Johnson15, Logan Brenzel16, and Stéphane Verguet17
Open Access
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs’ total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 07 February 2018 [GPEI]
:: New on http://polioeradication.org/: protecting children on the move in Pakistan; and, following the workday of female polio vaccinators in Afghanistan.
:: Watch long-time polio eradicators Hans Everts and Mohammed Mohammedi share their experiences from the frontline of outbreak response and describe the remaining challenges to reaching a polio-free world, in the latest ‘Coffee with Polio Experts’ videos.

:: Weekly country updates as of 07 February 2018
Afghanistan:  
:: Two new cases of wild poliovirus type 1 (WPV1) have been confirmed in Kandahar province, following advance notification last week. One new WPV1 positive environmental sample collected from Kandahar province
Pakistan:
:: Two new WPV1 positive environmental samples collected, from Islamabad and Punjab provinces.
Democratic Republic of the Congo:
:: One new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been confirmed in Tanganyika province

::::::
 
Syria cVDPV2 outbreak situation report 33, 6 February 2018
Situation update 6 February 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.
:: An IPV vaccination round is currently in progress as part of the second phase of the outbreak response, in Damascus, Hasakah, Aleppo governorates and Jurmana district of rural Damascus. IPV is being delivered through fixed centres.
:: Teams delivering IPV are comprised of two vaccinators and one social mobiliser. In selected fixed sites with a higher proportion of displaced populations from Deir Ez-Zor, social mobilisers have been recruited from the local community to ensure high participation.
:: Children in Hasakah governorate who were missed by mOPV2 vaccination in first round will receive mOPV2 alongside IPV in the second round taking place this week.

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

WHO Grade 3 Emergencies  [to 10 February 2018]
The Syrian Arab Republic
:: WHO delivers life-saving health supplies to Deir-ez-Zor governorate
7 February 2018 –  The World Health Organization (WHO) dispatched 14 tons of life-saving medicines, anesthetics, antibiotics, emergency medical kits and other treatments to Deir-ez-Zor governorate this week to urgently respond to the critical health needs of people in north-east Syria. The shipment contains more than 303 000 treatments for ill and wounded children, women and men.
:: Syria cVDPV2 outbreak situation report 33, 6 February 2018
[See Polio above for detail]

Yemen 
:: Cancer patients in Yemen face slow death as treatment options diminish  4 February 2018
:: Weekly epidemiology bulletin, 22–28 January 2018 [Cholera]

::::::
 
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
:: 9 Feb 2018  Syrian Arab Republic (Northern Governorates): Displacements to northwest Syria as of February 3, 2018
:: Statement by the UN Resident and Humanitarian Coordinator and UN Representatives in Syria on the impact of the compounded humanitarian crisis in Syria [EN/AR]    Damascus, 6 February 2018

Yemen 
:: 6 Feb 2018   Yemen Humanitarian Update Issue No. 1 | 6 February 2018
 
::::::

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.
Ethiopia  
:: 6 Feb 2018   Ethiopia Humanitarian Bulletin Issue 46 | 22 January – 4 February 2018
 
::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
::::::
::::::
 
WHO & Regional Offices [to 10 February 2018]
Latest news
Displaced people in Ibb devastated by hunger and disease
6 February 2018 – The number of people in need for humanitarian aid in Yemen has increased dramatically. Around 22.2 million people need some kind of humanitarian assistance. Currently, more than 2 million people are still displaced in Yemen, with women and children representing three quarters of internally displaced persons.
 
Highlights
Global summit highlights solutions to end violence against children, calls for accelerated action
February 2018 – Globally, up to 1 billion children aged 2-17 years – or one in two children – have suffered physical, sexual or emotional violence or neglect in the past year. WHO will be joining global efforts next week aimed at promoting solutions, and reinforcing global commitments, to end all forms of violence against children.

South Sudan declares the end of its longest cholera outbreak
   February 2018 – South Sudan declared the end of its longest and largest cholera outbreak, with no new cases of cholera reported in over seven weeks. The fight against cholera in South Sudan has involved a range of partners working together to enhance surveillance, deploy rapid response teams to investigate and respond to cases, provide clean water, promote good hygiene practices and treat cholera patients.

Low uptake of seasonal influenza vaccination in Europe may jeopardise capacity to protect people
February 2018 – Influenza vaccination coverage among high-risk groups has dropped in the European Region over the last seven years, and half the countries report a decrease in the number of vaccine doses available. Low uptake of seasonal influenza vaccination in Europe jeopardizes the capacity to protect people during annual epidemics and the next pandemic

::::::
 
Weekly Epidemiological Record, 9 February 2018, vol. 93, 06 (pp. 45–60)
:: Creating new solutions to tackle old problems: the first ever evidence-based guidance on emergency risk communication policy and practice
:: The role of extended and whole genome sequencing for tracking transmission of measles and rubella viruses: report from the Global Measles and Rubella Laboratory Network meeting, 2017
:: Monthly report on dracunculiasis cases, January-December 2017
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: South Sudan declares the end of its longest cholera outbreak  09 February 2018
:: Tanzania signs a joint health data collaborative communiqué   08 February 2018
:: WHO Special Intervention Teams Vaccinate Nearly 400 000 children at transit points  08 February 2018
:: South Sudan declares the end of its longest cholera outbreak  07 February 2018
:: Federal Government of Nigeria to vaccinate 1.2 million Internally Displaced Persons (IDPs) against yellow fever in Borno State with support from WHO and UNICEF  07 February 2018

WHO Region of the Americas PAHO
:: PAHO launches new study on migration of health workers in the Caribbean (02/08/2018)
As health care workers continue to leave the Caribbean, the study’s findings will help countries address future health systems needs in human resources for health.
WHO European Region EURO
::  WHO provides health advice for travellers to 2018 Winter Olympics 08-02-2018
:: Sixty five cities commit to health and well-being as drivers of urban development: two out of three people in the WHO European Region live in urban environments 08-02-2018
:: WHO Europe/ECDC joint statement: Low uptake of seasonal influenza vaccination in Europe may jeopardize capacity to protect people in next pandemic 07-02-2018

WHO Eastern Mediterranean Region EMRO
:: Sudan’s surveillance system for polio put under the microscope  8 February 2018
:: WHO calls for sustainable solution to health sector power shortages in Gaza  8 February, 2018
:: WHO delivers life-saving health supplies to Deir-ez-Zor governorate, Syrian Arab Republic
7 February 2018
UN releases US$ 9.1 million to support urgent health needs in Yemen  6 February, 2018

WHO Western Pacific Region
:: Health Advice for Travellers to the 2018 Olympic and Paralympic Winter Games in the Republic of Korea  7 February 2018

CDC/ACIP [to 10 February 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Friday, February 9, 2018
CDC update on widespread flu activity – Transcript
[Excerpt]
ANNE SCHUCHAT: Good morning – and thank you for joining us. We were hoping to have better news to share today, but unfortunately, it looks like this flu season continues to be particularly challenging. Our latest tracking data indicate that influenza activity is still on the rise overall. In fact, we may be on track to beat some recent records. Before getting into the specifics, I just want to recognize that we know this issue is personal to so many Americans, and that there is a lot of fear and alarm about this flu season. There have been far too many heart-wrenching stories in recent weeks about families who have lost loved ones to influenza.

And unfortunately, this week’s report reveals more somber news, with an additional 10 flu-related pediatric deaths for this season. That means we have now received reports for 63 children who have died of the flu so far this season. I also know many of you are asking how this season compares to previous ones and how much longer it will go on. But flu is incredibly difficult to predict, and we don’t know if we’ve hit the peak yet. In the past five seasons, influenza-like Illness has been elevated for between 11 and 20 weeks, and we’re only at week 11 now, so we could potentially see several more weeks of activity.

Here’s what we can tell you, based on the latest data. Levels of influenza-like-illness across the country are now as high as we observed at the peak of the 2009 H1N1 pandemic. This doesn’t mean that we are having a pandemic, just that levels of influenza-like-illness are as high as what we saw during the peak of H1N1. That’s a signal of how very intense this flu season has been. And let me remind you that the influenza like illness measure is based on outpatient visits and emergency department visits. In addition, overall hospitalizations are now significantly higher than what we’ve seen for this time of year since our current tracking system began almost a decade ago in 2010 and the rate is approaching the final rate of hospitalizations that we observed at the end of the active 2014-2015 flu season…

ACIP
February 21-22, 2018 Draft Meeting Agenda[2 pages]
Register for upcoming February ACIP meeting
February 21-22, 2018
Deadline for registration:
Non-US Citizens: January 24, 2018
US Citizens: February 5, 2018
 
MMWR News Synopsis for February 8, 2018 / No. 4
https://www.cdc.gov/mmwr/index2018.html
:: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2018
::  Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2018

Announcements

EDCTP    [to 10 February 2018]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
9 February 2018
Co-infections and co-morbidities: stakeholder meeting report published
Co-infections and co-morbidities in low- and middle-income countries are an important public health problem. These conditions decrease chances of recovery or cure and ultimately result in increased morbidity and mortality. Co-infections present unique challenges in diagnosis, treatment and prevention. Non-communicable diseases (NCDs) have become a fast-growing burden of disease in sub-Saharan Africa. There is a clear need for long-term, more integrated management of poverty-related infectious diseases and NCDs. Therefore, co-infections and co-morbidities are among the priority topics for EDCTP to be addressed in 2018.
 
Fondation Merieux  [to 10 February 2018]
http://www.fondation-merieux.org/
February 8, 2018
Trainings for doctors and laboratory technicians as part of the LABOMEDCAMP project in Mali
 
February 8, 2018
Congo Republic’s Prime Minister Clément Mouamba visits the Mérieux Foundation to discuss the challenges of infectious diseases in Africa
 
 
Gavi [to 10 February 2018]
http://www.gavi.org/library/news/press-releases/
05 February 2018
Study: vaccines prevent not just disease, but also poverty
New study shows that immunisation in world’s poorest countries is set to save millions from one of the primary causes of extreme poverty: health expenses.
Geneva, 5 February 2018 – In addition to saving millions of lives, vaccines will help prevent 24 million people in some of the world’s poorest countries from slipping into poverty by 2030, according to a study published today in Health Affairs.
The Harvard study, co-authored by Gavi, the Vaccine Alliance and a wide range of partners, modelled the health and economic impact of vaccines for ten diseases in 41 developing countries. As well as the economic impact, the study also estimated that vaccines administered between 2016 and 2030 would prevent 36 million deaths.
“Vaccines don’t just save lives, they also have a huge economic impact on families, communities and economies,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “A healthy child is more likely to go to school and become a more productive member of society in later life, while their families can avoid the often crippling healthcare costs that diseases can bring. As this important study shows, this is enough to save millions of people from the misery of extreme poverty. To realise these figures we now need to redouble our efforts to ensure every child, no matter where they’re born, has access to lifesaving vaccines.”…

Global Fund [to 10 February 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Mozambique and Global Fund Launch New Grants
08 February 2018
The Global Fund and health partners in Mozambique today launched the implementation of six grants aimed at accelerating the end of HIV, tuberculosis and malaria as epidemics.
 
MSF/Médecins Sans Frontières  [to 10 February 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Yemen: Conflict Puts Renal Failure Patients’ Lives at Risk
February 08, 2018
The lives of thousands of renal failure patients are in danger as kidney treatment centers in war-ravaged Yemen close or struggle to function, said the international medical humanitarian organization Doctors Without Borders/Medecins Sans Frontieres (MSF) Thursday.

Press release
Zambia: MSF Data Published in New England Journal of Medicine Stresses Effectiveness of Single-Dose Oral Cholera Vaccine
February 07, 2018
data from Zambia’s 2016 cholera epidemic found that giving people just one of the currently-recommended two doses of the oral cholera vaccine was nearly 90 percent effective for adequate short-term protection during this outbreak.

Press release
MSF Challenges Pfizer’s Monopoly on Lifesaving Pneumonia Vaccine in South Korea
February 06, 2018
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has filed a legal petition to the Supreme Court of South Korea requesting that the court review Pfizer’s patent to for its pneumococcal conjugate vaccine (PCV). On November 29, 2017, the Patent Court of Korea upheld the patent granted to Pfizer for its PCV13 product, marketed as Prevnar13. Unmerited patents like this are a barrier for people, governments, and treatment providers, such as MSF, trying to protect children against pneumonia—a disease that kills almost one million kids every year, or 2,500 per day.

 
NIH  [to 10 February 2018]
http://www.nih.gov/news-events/news-releases
February 8, 2018
Ebola virus infects reproductive organs in monkeys
— Additional research is needed to determine if drugs and vaccines can cure or prevent such infections, and to understand the mechanisms of sexual transmission.
 
 
PATH  [to 10 February 2018]
http://www.path.org/news/index.php
Press release | February 07, 2018
First vaccine carrier approved by World Health Organization to prevent vaccine freezing during transport commercially available
PATH’s Freeze-Safe innovation sets a new benchmark, helping protect vaccine potency, reducing health worker burden, and providing cost savings to health systems

Announcement | February 06, 2018
Cara Bradley named Chief Corporate Engagement Officer for PATH; Kathryn Kennedy joins as Head of Media

Press release | February 05, 2018
Tackling a silent killer: information and testing for hepatitis C becomes more available in Ho Chi Minh City thanks to integration into community-led services
Ho Chi Minh City, February 5, 2018—People most at risk of contracting hepatitis C virus (HCV), an infectious disease that can result in serious liver damage and death, will soon be able to access more convenient testing options and information about the disease through a new initiative launched today by the Ho Chi Minh City Provincial AIDS Center (HCMC PAC); international non-profit organization, PATH; Gilead Sciences and private clinics in Ho Chi Minh City…

UNAIDS [to 10 February 2018]
http://www.unaids.org/en
Update
Time to act in South Sudan
09 February 2018
A United Nations interagency task team has called for partners, donors, national authorities and others to act in South Sudan.

South Sudan has been ripped apart by civil war for the past two years. Tens of thousands of people have been killed and many others have fled their homes. Widespread reports have detailed looting, rape, enslavement and the use of children in armed conflict.

Two million people are internally displaced in the country and more than 1.95 million people have migrated to neighbouring countries. Food has become scarce and famine has followed.
The task team gives 16 recommendations in a new report, Time to act! Conflict, displacement, famine and the HIV response. Among these are that when targeting food assistance, people living with chronic illnesses, including HIV, should be included, in order to help them to adhere to their treatment. The report also urges the continuing distribution of medicines to treat HIV, sexually transmitted infections and tuberculosis and for condoms to be available through the country and in neighbouring countries.

South Sudan is one of the 38 countries that account for 90% of all new infections, and only 10% of people living with HIV in the country are on life-saving antiretroviral therapy. The conflict has weakened HIV services and host countries often cannot provide for the influx of refugees…

06 February 2018
Update
African first ladies and the African Union launch Free to Shine
First ladies across Africa are spearheading a campaign to stop children acquiring HIV, prevent AIDS-related deaths and keep mothers healthy across Africa.
The Free to Shine campaign was launched by the Organisation of African First Ladies Against HIV/AIDS (OAFLA) and the African Union on the sidelines of the 30th Ordinary Session of the African Union in Addis Ababa, Ethiopia. It was launched during OAFLA’s annual General Assembly, which this year included 20 first ladies from across Africa, joining under the theme of “Transforming Africa through prioritizing children, adolescents and mothers in the fight against HIV”…

UNICEF  [to 10 February 2018]
https://www.unicef.org/media/
7 February 2018
Violence leaves 750,000 children in Mosul struggling to access basic health services
MOSUL, Iraq, 7 February 2018 – As many as 750,000 children in Mosul and surrounding areas are struggling to access basic health services, UNICEF warned today. While violence has subsided, less than 10 per cent of health facilities in Ninewa governorate are functioning at full capacity, with those that are operational stretched to breaking point.
Three years of intense violence have devastated health facilities in Iraq. Over 60 health facilities have repeatedly come under attack since the escalation of violence in 2014, severely disrupting access to basic health services for children and families.
“The state of Iraq’s healthcare system is alarming. For pregnant women, newborn babies, and children, preventable and treatable conditions can quickly escalate into a matter of life and death,” said Peter Hawkins, UNICEF Representative in Iraq, who has just completed a visit to Al Khansa hospital in Mosul, the largest in the city. “Medical facilities are strained beyond capacity and there are critical shortages of life-saving medicines.”
UNICEF has stepped up its support to primary healthcare facilities to help the Government of Iraq provide critical health services so that children and families affected by violence and displacement can resume their lives.
In Mosul, UNICEF has rehabilitated the pediatric and nutritional wards of two hospital centres, provided refrigerators to store vaccines for up to 250,000 children, and supported vaccination campaigns to immunize all children under five years old. Most health centres in the governorate have also restarted vaccination services for children.

“As people start to return to their homes, it is essential that basic services like health, education, and specialized support for children impacted by violence are available,” said Hawkins…

Vaccine Education Center – Children’s Hospital of Philadelphia  [to 10 February 2018]
http://www.chop.edu/centers-programs/vaccine-education-center
Published on Feb 07, 2018
New Shingles Vaccine Changes Recommendations for Adults
In this video, Dr. Offit discusses the differences between the two shingles vaccines and updated recommendations for adults. These include getting the vaccine at 50 years of age instead of 60 and being revaccinated if you’ve previously received the older version (Zostavax).

Wellcome Trust  [to 10 February 2018]
https://wellcome.ac.uk/news
News / Published: 6 February 2018
£10 million to fund new urban health project in ten cities
Wellcome is launching a £10 million research partnership across four continents to help improve understanding of how countries can create healthier cities and protect the planet.
The partnership is a network of experts from science and other disciplines working closely with ten cities around the world. It will be led by Mike Davies, Professor of Building Physics and Environment at University College London, and Majid Ezzati, Professor of Global Environmental Health at Imperial College London.
The aim is to provide evidence to help policy makers and governments act to improve population health and protect the planet in a way that minimises health inequality.
The cities involved are: London (UK), Rennes (France), Beijing and Ningbo (China), Nairobi and Kisumu (Kenya), Dhaka (Bangladesh), Vancouver (Canada), and Accra and Tamale (Ghana)…

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…

::::::
 
BIO    [to 10 February 2018]
https://www.bio.org/insights/press-release
Feb 9 2018
BIO Applauds Introduction of the Vaccine Access Improvement Act
Washington, DC (February 9, 2018) – – The Biotechnology Innovation Organization (BIO) applauds Reps. Mike Kelly (R-PA) and Brian Higgins (D-NY) for introducing H.R. 4993, the Vaccine Access Improvement Act, which would promote timely access to new first-in-class childhood and maternal vaccines. The legislation would update the tax code to ensure new first-in-class vaccines are promptly covered under the National Vaccine Injury Compensation Program (VICP).
The VICP was created by the National Childhood Vaccine Injury Act (NCVIA) of 1986 and serves as a no-fault alternative to the traditional legal system for resolving vaccine injury petitions.  The program is funded by an excise tax paid by manufacturers on each vaccine. Under current law, new first-in-class vaccines may only be added to the program by changing the underlying tax statute to include the disease that the vaccine protects against. The Vaccine Access Improvement Act would streamline this process by giving the Secretary of Health and Human Services regulatory authority to add new eligible vaccines to the program once they have been approved by the FDA and recommended by the CDC.
“Updating the Vaccine Injury Compensation Program to allow for the prompt inclusion of new childhood and maternal vaccines is crucial to ensuring timely access to these life-saving preventative medicines,” said BIO President and CEO Jim Greenwood. “I commend Reps. Kelly and Higgins for their efforts to protect  our nation’s mothers and children.”…

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
 

WHO-WIPO-WTO Technical Symposium on Sustainable Development Goals: Innovative technologies to promote healthy lives and well-being*
Date of the event: 26 February 2018 (09:00 to 17:15)
Location: Geneva, Switzerland (WHO Headquarters, Executive Board Room)
The event is open to Geneva-based delegations to WHO, WIPO and WTO, representatives of international and philanthropic organizations, experts on intellectual property and trade, civil society organizations and interested individuals and organizations.
The provisional programme of the event is available here.
Further details about the Symposium can be accessed here.
Background
The post-2015 Agenda for Sustainable Development sets out an ambitious plan for action: to reach and empower the most vulnerable and take action in areas of critical importance for humanity and the planet. The Sustainable Development Goals usher in a new era of global development that seeks to leave no one behind. Achievement of the SDGs will require a delicate choreography of interplay between all stakeholders.

Access to, and innovation in, health technologies is a requisite element for ensuring progress toward universal health coverage and achievement of the SDGs, namely SDG 3 Ensure healthy lives and promote well-being for all at all ages. Scientific progress, advances in health technologies and improved trade have contributed to unprecedented improvements in health outcomes. However, gains in life expectancy and quality of life are unequally distributed between low-, middle-, and high-income countries. Troubling inequalities in the burden of disease are, in part, attributed to the disparate access to health technologies. As a fundamental human right, the right of everyone to enjoy the highest attainable standard of physical and mental health obliges governments to ensure appropriate access to essential medicines.

The seventh technical symposium organized by WHO, WIPO, WTO will discuss challenges and opportunities for the international community to ensure that innovative technologies are developed and reach patients in order to realize the right to health and the health-related SDGs. The Symposium will offer a forum for an evidence-based exchange of views and experiences of the various stakeholders and representatives of the relevant sectors. Innovative, inclusive, and multi-stakeholder initiatives and partnerships that research, develop and facilitate access to novel, needs-based health technologies will be highlighted. The exchange will provide the basis for discussion and allow participants to achieve a better understanding of the benefits, drawbacks, and impact of the various available options.

The joint technical symposia convened by WHO, WIPO and WTO build on the collaborative work undertaken by the three agencies to enhance capacity, including the trilateral study “Promoting Access to Medical Technologies and Innovation.”

Journal Watch

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

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

American Journal of Tropical Medicine and Hygiene
Volume 98, Issue 2, 2018
http://www.ajtmh.org/content/journals/14761645/98/2

Perspective Piece
Rotavirus Vaccine will Improve Child Survival by More than Just Preventing Diarrhea: Evidence from Bangladesh
Authors: Senjuti Saha, Mathuram Santosham, Manzoor Hussain, Robert E. Black and Samir K. Saha
https://doi.org/10.4269/ajtmh.17-0586
Abstract
Despite the high burden of rotavirus diarrhea, uptake of rotavirus vaccines in Asia remains low. This primarily stems from a perception of rotavirus as a non-life-threatening pathogen amidst a background of competing health priorities and limited resources. In the largest pediatric hospital of Bangladesh, where there is a fierce competition for beds, we found that between November 2015 and October 2016, 12% of 23,064 admissions were due to gastrointestinal infections, 54% of which were caused by rotavirus. One in four cases requiring hospitalization, or 5,879 cases, was refused because of unavailability of beds. Most refused cases were of pneumonia (22%), severe perinatal asphyxia (17%), preterm birth complications (7%), and meningitis (2%), all of which bear high risks of death or disability, if not treated timely. When determining vaccine policies and conducting vaccine impact studies, it would be shortsighted to not consider the impact on morbidity and mortality of cases that are refused admission because of the hospitalization of children with a preventable disease as rotavirus diarrhea. In our hospital, routine use of a rotavirus vaccine with 41% efficacy will release 629 beds per year to accommodate previously refused cases. Based on evidence, we make the case that introduction of this vaccine in Bangladesh and the surrounding region will prevent morbidity and mortality, both directly and indirectly, and help us ensure survival and well-being of all children.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 10 February 2018)

Research article
8 February 2018
Elucidating the impact of the pneumococcal conjugate vaccine programme on pneumonia, sepsis and otitis media hospital admissions in England using a composite control
Authors: Dominic Thorrington, Nick Andrews, Julia Stowe, Elizabeth Miller and Albert Jan van Hoek

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 10 February 2018)

Research article
Attitude and subjective wellbeing of non-compliant mothers to childhood oral polio vaccine supplemental immunization in Northern Nigeria
Attitude and subjective well-being are important factors in mothers accepting or rejecting Oral Polio Vaccine (OPV) supplemental immunization. The purpose of the study was to determine the role of mothers’ att…
Authors: Gregory C. Umeh, Terna Ignatius Nomhwange, Anthony F. Shamang, Furera Zakari, Audu I. Musa, Paul M. Dogo, Victor Gugong and Neyu Iliyasu
Citation: BMC Public Health 2018 18:231
Published on: 8 February 2018

Contemporary Clinical Trials
Volume 65   Pages 1-166 (February 2018)
https://www.sciencedirect.com/journal/contemporary-clinical-trials/vol/65/suppl/C

Clinical Trial Management and Optimization
Agreement in reporting between trial publications and current clinical trial registry in high impact journals: A methodological review
Original research article
Pages 144-150
Sarah Daisy Kosa, Lawrence Mbuagbaw, Victoria Borg Debono, Mohit Bhandari, … Lehana Thabane
Abstract
Objectives
The primary objective of this systematic survey was to examine the percentage of studies in which there was agreement in the reporting of the primary outcome between the currently updated version of the clinical trial registry and the published paper. We also investigated the factors associated with agreement in reporting of the primary outcome.
Methods
We searched PubMed for all randomized control trials (RCT)s published in 2012–2015 in the top five general medicine journals (based on the 2014 impact factor). Two hundred abstracts (50 from each year) were randomly selected for data extraction. Agreement in reporting of 11 key study conduct items (e.g., sample size) and study characteristics (e.g., funding, number of sites) were extracted by two independent reviewers.
Analysis
Descriptive analyses were conducted to determine the proportion of studies on which there was agreement in reporting of key study conduct items. Generalized estimating equations were used to explore factors associated with agreement in reporting of the primary outcome.
Results
Of the 200 included studies, 87% had agreement in reporting of the primary outcome. After adjusting for other covariates, having greater than 50 sites was associated with an increased likelihood of agreement in reporting of the primary outcome (odds ratio=7.1, 95% confidence interval=1.39, 36.27, p=0.018).
Conclusions
We identified substantive disagreement in reporting between publications and current clinical trial registry, which were associated with several study characteristics. Further measures are needed to improve reporting given the potential threats to the quality and integrity of scientific research.

Epidemiology and Infection
Volume 146 – Issue 3 – February 2018
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Measles
Public health response to a measles outbreak on a university campus in Australia, 2015 
Smith, S. Banu, M. Young, D. Francis, K. Langfeldt, K. Jarvinen
https://doi.org/10.1017/S0950268817003089
Published online: 17 January 2018, pp. 314-318

Epidemiology and Infection
Volume 146 – Issue 3 – February 2018
https://www.cambridge.org/core/journals/epidemiology-and-infection/latest-issue

Article
Molecular characterisation of measles virus strains among refugees from Central African Republic in Cameroon in 2014
a href=”https://www.cambridge.org/core/search?filters%5BauthorTerms%5D=P.%20K.%20Ndombo&eventCode=SE-AU”> K. Ndombo, V. N. Ndze, F. D. Mbarga, R. Anderson, A. Acho, J. Ebua Chia, A. K. Njamnshi, P. A. Rota, D. Waku-Kouomou
https://doi.org/10.1017/S0950268817002990
Published online: 09 January 2018, pp. 319-323

Health Affairs
February 2018. Vol. 37, No. 2
https://www.healthaffairs.org/toc/hlthaff/current
Diffusion Of Innovation

Research Article   Global Health Policy
The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries
Angela Y. Chang1, Carlos Riumallo-Herl2, Nicole A. Perales3, Samantha Clark4, Andrew Clark5,
Dagna Constenla6, Tini Garske7, Michael L. Jackson8, Kévin Jean9, Mark Jit10, Edward O. Jones11, Xi Li12, Chutima Suraratdecha13, Olivia Bullock14, Hope Johnson15, Logan Brenzel16, and Stéphane Verguet17
Open Access
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs’ total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.

Health Policy and Planning
Volume 33, Issue suppl_1   February 2018
http://heapol.oxfordjournals.org/content/current
Beyond Gross National Income: Innovative methods for global health aid allocation

Global health aid allocation in the 21st century
Jesse B Bump
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i1–i3, https://doi.org/10.1093/heapol/czx193
Extract
The ways multilateral agencies allocate support are idiosyncratic, include opaque judgments made with undisclosed criteria, and lead to results that are not widely disclosed. This presents deep challenges for accountability and legitimacy, and raises serious questions about how well the needs of recipient countries are assessed and addressed. The stakes are very high, and the underlying issues are very important. These include how agencies define need, determine eligibility, and decide what support to provide to whom. The governance of these processes is also crucial. However, allocation has attracted very little scrutiny.

Health Policy and Planning
Volume 33, Issue suppl_1   February 2018
http://heapol.oxfordjournals.org/content/current
Beyond Gross National Income: Innovative methods for global health aid allocation

Original Articles
Resource allocation processes at multilateral organizations working in global health
Y-Ling Chi; Jesse B Bump
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i4–i13, https://doi.org/10.1093/heapol/czx140

Allocation of development assistance for health: is the predominance of national income justified?
Olivier Sterck; Max Roser; Mthuli Ncube; Stefan Thewissen
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i14–i23, https://doi.org/10.1093/heapol/czw173

Allocating external financing for health: a discrete choice experiment of stakeholder preferences
Karen A Grépin; Crossley B Pinkstaff; Arne Risa Hole; Klara Henderson; Ole Frithjof Norheim …
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i24–i30, https://doi.org/10.1093/heapol/czx017

New approaches to ranking countries for the allocation of development assistance for health: choices, indicators and implications
Trygve Ottersen; Karen A Grépin; Klara Henderson; Crossley Beth Pinkstaff; Ole Frithjof Norheim …
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i31–i46, https://doi.org/10.1093/heapol/czx027

The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health
Annie Haakenstad; Tara Templin; Stephen Lim; Jesse B Bump; Joseph Dieleman
Health Policy and Planning, Volume 33, Issue suppl_1, 1 February 2018, Pages i47–i55, https://doi.org/10.1093/heapol/czx165

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 10 February 2018]

Opinion
A research utilisation framework for informing global health and development policies and programmes
A shift in the culture and practice of health and development research is required to maximise the real-world use of evidence by non-academic or non-research-oriented audiences. Many frameworks have been devel…
Authors: Christine Kim, Rose Wilcher, Tricia Petruney, Kirsten Krueger, Leigh Wynne and Trinity Zan
Citation: Health Research Policy and Systems 2018 16:9
Published on: 9 February 2018

ISRIA statement: ten-point guidelines for an effective process of research impact assessment
As governments, funding agencies and research organisations worldwide seek to maximise both the financial and non-financial returns on investment in research, the way the research process is organised and fund…
Authors: Paula Adam, Pavel V. Ovseiko, Jonathan Grant, Kathryn E. A. Graham, Omar F. Boukhris, Anne-Maree Dowd, Gert V. Balling, Rikke N. Christensen, Alexandra Pollitt, Mark Taylor, Omar Sued, Saba Hinrichs-Krapels, Maite Solans‐Domènech and Heidi Chorzempa
Citation: Health Research Policy and Systems 2018 16:8
Published on: 8 February 2018

Review
What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal
Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how res…
Authors: Joanna Raven, Sushil Baral, Haja Wurie, Sophie Witter, Mohamed Samai, Pravin Paudel, Hom Nath Subedi, Tim Martineau, Helen Elsey and Sally Theobald
Citation: Health Research Policy and Systems 2018 16:6
Published on: 7 February 2018

Patient engagement in Canada: a scoping review of the ‘how’ and ‘what’ of patient engagement in health research
Over the last 10 years, patient engagement in health research has emerged as the next evolution in healthcare research. However, limited evidence about the clear role and scope of patient engagement in health …
Authors: Elizabeth Manafo, Lisa Petermann, Ping Mason-Lai and Virgnia Vandall-Walker
Citation: Health Research Policy and Systems 2018 16:5
Published on: 7 February 2018

Common issues raised during the quality assurance process of WHO guidelines: a cross-sectional study
In 2007, WHO established the Guidelines Review Committee (GRC) to ensure that WHO guidelines adhere to the highest international standards. The GRC reviews guideline proposals and final guidelines. The objecti…
Authors: Teegwendé V. Porgo, Mauricio Ferri and Susan L. Norris
Citation: Health Research Policy and Systems 2018 16:7
Published on: 7 February 2018

Identifying priority technical and context-specific issues in improving the conduct, reporting and use of health economic evaluation in low- and middle-income countries
The use of economic evaluation in healthcare policies and decision-making, which is limited in low- and middle-income countries (LMICs), might be promoted through the improvement of the conduct and reporting o…
Authors: Alia Luz, Benjarin Santatiwongchai, Juntana Pattanaphesaj and Yot Teerawattananon
Citation: Health Research Policy and Systems 2018 16:4
Published on: 5 February 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]

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 2 2018
http://www.tandfonline.com/toc/khvi20/current

Profile Asia-Pacific Alliance for the Control of Influenza (APACI)
Kim Sampson
Pages: 248-249
Published online: 06 Dec 2017