Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures

Value in Health                   
March 2018 Volume 21, Issue 3, p249-372
http://www.valueinhealthjournal.com/current

Articles
Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures
Patricia M. Danzon  danzon@wharton.upenn.edu
p252–257
Abstract
Objectives
To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage “affordability” challenges, defined as drugs that meet cost-effectiveness thresholds but are “unaffordable” within the short-run budget.
Methods
Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, “cures” that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices.
Results
For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation.

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

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

Health Promotion International
Advance articles    Published: 22 March 2018
Using social norms theory for health promotion in low-income countries
Beniamino Cislaghi Lori Heise
Health Promotion International, day017, https://doi.org/10.1093/heapro/day017
Abstract
Social norms can greatly influence people’s health-related choices and behaviours. In the last few years, scholars and practitioners working in low- and mid-income countries (LMIC) have increasingly been trying to harness the influence of social norms to improve people’s health globally. However, the literature informing social norm interventions in LMIC lacks a framework to understand how norms interact with other factors that sustain harmful practices and behaviours. This gap has led to short-sighted interventions that target social norms exclusively without a wider awareness of how other institutional, material, individual and social factors affect the harmful practice. Emphasizing norms to the exclusion of other factors might ultimately discredit norms-based strategies, not because they are flawed but because they alone are not sufficient to shift behaviour. In this paper, we share a framework (already adopted by some practitioners) that locates norm-based strategies within the wider array of factors that must be considered when designing prevention programmes in LMIC.
 
Journal of Community Health
First Online: 21 March 2018
Review
Human Papillomavirus Vaccine Uptake, Knowledge, and Acceptance for Youth: A Systematic Review of Appalachia
C Ryan, KL Duvall, EC Weyant, KR Johnson, D Wood –
Abstract
Though vaccine uptake and public support have risen since the release of the first HPV vaccines, the United States has far lower initiation and completion rates for the HPV vaccine series in comparison to other vaccines indicated for youth. Disparities are even greater in the Appalachian regions. Understanding factors contributing to these discrepancies is vital to improving vaccine rates in Appalachia. A comprehensive literature search identified all articles pertaining to HPV vaccination in children and adolescents living in Appalachia. The final 15 articles were included in a systematic review of the topic.

Media/Policy Watch

Media/Policy Watch

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

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
 
The Atlantic
http://www.theatlantic.com/magazine/
Accessed 24 March 2018
Who Is Robert Redfield, Trump’s Pick for CDC Director? – The Atlantic
On the face of it, veteran virologist Robert Redfield seems like a good pick to lead the agency, but decades-old disputes are shadowing his appointment.

Foreign Policy
http://foreignpolicy.com/
Accessed 24 March 2018
Meet Trump’s New, Homophobic Public Health Quack
Laurie Garrett
March 23, 2018,
The Center for Disease Control will soon be run by a military doctor with a long history of pushing discriminatory AIDS policies.
 
New York Times
http://www.nytimes.com/
Accessed 24 March 2018
AIDS Researcher Robert R. Redfield Named to Lead the C.D.C.
By SHEILA KAPLAN  MARCH 21, 2018
Fake Hepatitis B Vaccines Found at Ugandan Health Facilities
New York Times/AP | 19 March 2018
Official: 2 Polio Workers Killed in Ambush in Tribal Region
New York Times/AP | 17 March 2018
WHO Says Diphtheria Infected Over 1,300 People in Yemen
New York Times/AP | 17 March 2018

Washington Post
http://www.washingtonpost.com/
Accessed 24 March 2018
Polish firm sued over tricking homeless into vaccine test
Associated Press · Mar 21, 2018
Brazil to vaccinate entire country against yellow fever
Associated Press · Foreign · Mar 20, 2018

Vaccines and Global Health: The Week in Review 17 March 2018

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

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

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_17 March 2018

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

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

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

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

Milestones :: Perspectives :: Diphtheria vaccination campaign for 2.7 million children concludes in Yemen

Milestones :: Perspectives

Yemen
 
Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
SANA’A, YEMEN, 16 March 2018 — The World Health Organization (WHO), UNICEF and national health authorities have completed a large-scale vaccination campaign to control the spread of diphtheria in Yemen.

The campaign targeted nearly 2.7 million children aged 6 weeks to 15 years in 11 governorates. It focused on locations reporting suspected cases of diphtheria and areas at high risk of spread of the infectious respiratory disease. More than 6000 health workers were mobilized during the campaign, including for community engagement and the administration of the vaccine.
First reported in October 2017, the outbreak has spread rapidly across the country, infecting more than 1300 people and killing over 70. Almost 80% of the caseload is children and young adults below 25 years of age.

“We are in a race against time to control this outbreak and save lives,” says Dr Nevio Zagaria, WHO Representative to Yemen. “The almost collapsed health system and the conflict has severely hampered the response, but we have managed to deliver urgently needed antibiotics and diphtheria anti-toxins (DAT) to support treatment, and are now scaling up vaccination efforts to stop the outbreak from spreading even further.”

The rapid spread of diphtheria in Yemen highlights major gaps in routine vaccination coverage in recent years and signifies a collapsing health system. Only 50% of all health facilities are partially or fully functioning.

In November and December 2017, WHO and UNICEF vaccinated almost 450,000 children under 7 years of age against diphtheria in Ibb – the worst affected governorate accounting for nearly 35% of all cases reported.

The vaccination campaign is part of a larger response plan to control diphtheria implemented by national health authorities, UNICEF and WHO. Parallel activities include strengthening surveillance and case detection, enhancing laboratory testing capacity, procuring and distributing the DAT to the Diphtheria Isolation Units in health facilities, and training and deploying Rapid Response Teams to trace contacts and provide preventative antibiotics in the community. Health education and awareness campaigns are also being conducted to inform communities on how to protect themselves against diphtheria and other infectious diseases…

Milestones :: Perspectives :: PAHO urges countries to vaccinate against measles to maintain its elimination in the Americas

Milestones :: Perspectives

Measles
 
PAHO urges countries to vaccinate against measles to maintain its elimination in the Americas
Maintaining high and homogeneous immunization coverage, strengthening surveillance and quickly responding to suspected cases are some of the suggested measures to maintain measles elimination in the Americas
Washington, DC, 16 March 2018 (PAHO/WHO)-  The Pan American Health Organization/World Health Organization (PAHO/WHO) warned that in the face of ongoing measles outbreaks in the Americas, countries should redouble efforts to vaccinate their populations, strengthen surveillance to detect possible patients, and implement measures to quickly respond to any suspected cases, according to an epidemiological update released today.
Measles was declared eliminated from the Americas in 2016, following the declaration of rubella and CRS elimination in 2015. The Region was the first in the world to have eliminated all three diseases, culminating a 22-year effort involving mass vaccination against measles, mumps, and rubella throughout the Americas. However, the highly contagious nature of the measles virus and the fact that both it and the rubella virus continue to circulate in the rest of the world mean that the Region is at risk of outbreaks.
In the first months of 2018, there were night countries in the Region reporting confirmed cases: Antigua and Barbuda (1 case), Brazil (14 cases), Canada (4 cases), Guatemala (1 case), Mexico (4 cases), Peru (2 cases), the United States (13 cases), and Venezuela (886 cases in total, 159 cases in 2018), according to the epidemiological update

Milestones :: Perspectives :: Delhi TB Summit: WHO South-East Asia countries commit to intensified efforts, concrete progress to End TB

Milestones :: Perspectives

 
TB
 
Delhi TB Summit: WHO South-East Asia countries commit to intensified efforts, concrete progress to End TB
SEAR/PR/1683
New Delhi, 14 March 2018: Tracking progress to eliminate tuberculosis, Member countries of WHO South-East Asia Region today committed to further intensifying efforts to ensure rapid and concrete progress to End TB by 2030.

In a statement adopted at the Delhi End TB Summit here, member countries unanimously agreed to actualizing and intensifying essential actions agreed to in the Delhi Call to Action which was adopted in March last year to accelerate efforts to End TB in the Region, host to one fourth of the global population but a disproportionate 46% of the global TB burden.

“Progress against TB in this Region will have a major impact on the progress globally,” said Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “Too much is at stake, we cannot afford to fail. We must remember that the war against TB will be won in communities. It will be won by nurses, doctors, community health workers and others at the frontlines. We must give them the resources they need to find every last person with TB, to diagnose them, to treat them, and to cure them,” he said.

Welcoming the statement, Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, said, “it gives shape to our momentum and aspirations, and does so by setting out a series of strategic priorities which include establishing strong leadership of TB programmes at the national level; increasing budgetary and human resource allocations to TB programmes from domestic and global sources; enabling each and every TB patient to access the best possible care available; and supplementing medical care for TB with social and financial protection.”

Reviewing efforts being made to end TB since the adoption of the Delhi Call for Action on 16 March 2017, Member countries noted that though efforts have been strengthened with increased attention, investments and initiatives; the stepped-up response was falling short of what was required to reach the critical thresholds for ending TB.

The Member countries of the Region stressed their firm intent to collectively reach out to 2 million missing TB cases and 150 000 multidrug-resistance cases by 2020 and implement a response that is demonstrably adequate for ending TB.

In the statement, the countries committed to multisectoral and empowered national initiatives, reporting to the highest levels of government, to lead the TB programme…

The Summit sets the stage for the September 2018 United Nations High-Level Meeting on TB. For the first time TB will be discussed in the UN General Assembly at the Heads of State level. The UN high-level meeting is expected to endorse an ambitious set of goals to put the world on course to ending TB.

Perspective: Vaccinating Against Poverty

Perspective

Vaccinating Against Poverty
Project Syndicate | 12 March 2018
By Seth Berkley
A new study shows that developing countries could reduce poverty by targeting higher vaccination rates in poorer and more marginalized communities. Moreover, by making affordable, quality health care available to everyone, regardless of their income, immunization programs are an important step toward universal health-care coverage.
For most people, the choice between a life-threatening disease and a lifetime of crippling debt is no choice at all. Yet every year, hundreds of millions of people around the world are forced to make it, owing to the prohibitive cost of medical treatment. And, paradoxically, the hardest-hit people are not those with the largest medical bills, but rather those living in the poorest parts of the world.
Although countries like the United States have notoriously high treatment costs, with medical debt being one of the leading causes of personal bankruptcy, people living in poor countries actually spend more on health care costs relative to their income. And, because medical insurance is unavailable or too expensive, and because bankruptcy protection is not usually an option, too often they and their families end up being pushed into poverty.
But this tragedy – befalling some of the world’s most vulnerable people – could in many cases be entirely avoided. A new study, published in February in the journal Health Affairs, suggests that there is another option: in many cases, the medical bills can be preempted by prevention, through the widespread and affordable use of vaccines:.

Perspective: The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries

Health Affairs
Vol. 37, No. 2: February 2018

Diffusion Of Innovation
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
PUBLISHED: February 2018
https://doi.org/10.1377/hlthaff.2017.0861
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.

Perspective: Working together for the health and welfare of humankind

Perspective

Working together for the health and welfare of humankind
Joint Statement of INCB, UNODC and WHO in Implementation of the UNGASS 2016 Recommendations
12 March 2018 – 61st session of the Commission on Narcotic Drugs

  1. We, the Heads of the International Narcotics Control Board, the United Nations Office on Drugs and Crime and the World Health Organization are committed to support our Member States to effectively address and counter the world drug problem.

We agree that if we are to achieve the 2030 Sustainable Development Goals, including its health targets, we need to vigorously address the world drug problem with a greater focus on the health and well-being of people. We need a balanced, comprehensive and multidisciplinary approach that puts people at the centre of the response and in particular those who are the most vulnerable.

This is in line with the objectives of the three international drug control conventions, to which we are committed. This is also aimed at facilitating implementation of the outcome document of the 30th Special Session of the General Assembly, entitled “Our joint commitment to effectively addressing and countering the world drug problem”. It is also consistent with the aim to achieve universal health coverage, where all people receive the health services they need, including people who use drugs and their families.

Our three entities complement one another, given the different roles they play and the mandates entrusted to them. By working together, we can “deliver as one” to serve people, communities and countries as a whole. We are committed to strengthen this collaboration, to advocate and to promote quality programmes and policies that improve public health and support high-impact actions that leave no one behind, are driven by science, and champion equity and human rights.

We recognize the challenges that lie ahead, but also the opportunities that we should embrace. We reaffirm our support for the full implementation of the outcome document of UNGASS 2016 and we also recognize that the world is a rapidly changing place and that urgent action is required to address emerging threats.

We will focus our joint efforts on addressing the following priorities:
:: improving equitable access to controlled medicines in particular for the management of pain and for palliative care;
:: scaling up effective prevention of non-medical drug use, and treatment services and interventions for drug use disorders;
:: confronting the ‘opioid crisis’ that is devastating so many communities;
:: intensifying delivery to people who use drugs of a comprehensive set of effective and scientific evidence-based measures aimed at minimizing the adverse public health and social consequences of drug abuse laid out in the technical guide issued by WHO, UNODC and UNAIDS 1, towards eliminating AIDS, tuberculosis and viral hepatitis epidemics;

  1. We therefore will work to proactively support countries:

:: to implement public health and social welfare measures as key elements of our response to the world drug problem;
:: to enhance information-sharing and early warning mechanisms in support of a scientific evidence-based review of the most prevalent, persistent and harmful new psychoactive substances and precursors to facilitate informed scheduling decisions by the Commission on Narcotic Drugs;
:: to ensure and improve access to and quality of:
…internationally controlled medicines including to manage pain and for palliative care while preventing their misuse;
…evidence-based prevention of drug use, and treatment services for drug use disorders with special focus on youth, families and communities;
…comprehensive services to prevent, diagnose and treat viral hepatitis, HIV and tuberculosis infections among people who use drugs.
:: to help monitor the progress in addressing the world drug problem and implementation of the UNGASS 2016 operational recommendations.

  1. We stress the importance of Member States taking action to:

:: strengthen their public health systems and their national coordination efforts to address the drug problem and dedicate appropriate resources and capacity for the successful implementation of their comprehensive drug-related policies;
:: advance universal health coverage efforts, by taking action to improve access to controlled medicines and effective and ethical prevention of drug use, and treatment services for people with drug use disorders and associated health conditions, including HIV, viral hepatitis and tuberculosis;
: facilitate information exchange and share the relevant data and information with our three entities to enable us to perform our respective treaty-based core functions; and
:: enhance political support and adequate resources to enable our three entities to deliver on these commitments and advance the achievement of the UN 2030 Agenda for Sustainable Development.

Emergencies

Emergencies

 

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 March 2018 [GPEI]
::  New on www.polioeradication.org: For International Women’s Day, we highlighted the critical role that women play in global polio eradication efforts. Dr Adele Daleke Lisi Aluma works to reach children who have never been vaccinated, whilst in Somalia, women are the face of polio eradication. In Nigeria, dedicated female mobilizers are ending polio, one home at a time.
::  We also launched the Gender and Polio section of our website.
:: The Strategic Advisory Group of Experts on immunization (SAGE) Polio Working Group recently met in Geneva, Switzerland, to review global progress against polio. The group reviewed and endorsed the main elements of the Post-Eradication Strategy (PCS) currently being developed at the request of Member States, aimed at ensuring the availability of core functions to sustain a polio-free world after global certification (such as outbreak response capacity, surveillance, immunization and containment).  The PCS will be presented in April to the full SAGE, and to Member States at the World Health Assembly (WHA) in May. The group also reviewed current outbreak response protocols to vaccine-derived poliovirus, and agreed with a proposed plan to harmonize recommendations on immunization schedules in countries with Polio Essential Facilities (PEFs – facilities that will continue to handle poliovirus stock under appropriate containment).
 
Summary of newly-reported viruses this week:
Afghanistan: Advance notifications have been received of two new cases of wild poliovirus type 1 (WPV1), one occurring in Kunar province, and one in Kandahar province. Three new wild poliovirus type 1 (WPV1) positive environmental samples have been reported in Nangarhar province.
Pakistan: One new WPV1 positive environmental sample has been reported in Balochistan province.
Democratic Republic of the Congo: Two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, one from Tanganyika province, and one from Haut Lomami province.
 
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WHO Grade 3 Emergencies  [to 17 March 2018]
Iraq  
:: Seven years of Syria’s health tragedy
News release       14 March 2018 | Geneva – After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.
Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.
“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”…

Yemen 
:: Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
SANA’A, YEMEN, 16 March 2018
[See Milestones/Perspectives above for more detail]

::::::
 
WHO Grade 2 Emergencies  [to 17 March 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017 
:: Weekly Situation Report #17 – 13 March 2018
…VACCINATION CAMPAIGNS AND ROUTINE IMMUNIZATION
… The third round of 13-day Diptheria campaign has started on 10 March. By day 3, 86 497 (21%) children aged 6 weeks to 15 years have been vaccinated in Ukhiya and Teknaf Upazilas. 1479 humanitarian workers have also received Td vaccine at session sites during campaign days.
… A fixed site at Cox’s Bazar has started vaccinating humanitarian workers and will continue every Saturday henceforth.
… Routine EPI training was conducted in Teknaf and Ukhiya to reorient 270 vaccinators, supervisors, medical officers, and volunteers from Government and various NGOs who would be supporting EPI session sites in camps.
… Microplans for routine EPI in Rohingya refugee settings have been developed and EPI services at fixed sites are ongoing…

::::::
::::::
 
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. 
DRC 
:: UN Humanitarian Chief and Dutch Minister call for urgent international support to meet spiralling humanitarian needs in DR Congo
(Kinshasa, 13 March 2018) UN humanitarian chief Mark Lowcock and Minister for Foreign Trade and Development Cooperation of the Kingdom of the Netherlands, Sigrid Kaag, today called on the international community to urgently address the crisis facing the Democratic Republic of the Congo (DRC) where humanitarian needs have doubled since last year.
More than 13 million people in DRC need humanitarian assistance and 4.5 million have been forced to flee their homes as a result of fighting. More than 4.6 million Congolese children are acutely malnourished, including 2.2 million cases of severe acute malnutrition. Epidemics are spreading, including the worst outbreak of cholera in 15 years.

Syrian Arab Republic
:: 16 Mar 2018   Update on the situation of children in Afrin and Eastern Ghouta

Yemen 
:: 13 Mar 2018  Yemen Humanitarian Update Covering 05 March – 11 March | Issue 6
 
::::::

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 
:: Ethiopia: Government and partners launch the humanitarian and disaster resilience plan (HDRP) for 2018  13 Mar 2018
US$1.66 billion urgently needed to address food and non-food needs for 7.88 million people
(Addis Ababa, 13 March 2018): The Government of Ethiopia and humanitarian partners today launched the Ethiopia Humanitarian and Disaster Resilience Plan (HDRP) for 2018. The HDRP seeks US$1.66 billion to reach 7.88 million people with emergency food or cash and non-food assistance, mainly in the southern and south-eastern parts of the country. “In the last two years, the Government of Ethiopia, with the support of international donors and humanitarian partners, was able to mount a robust drought response operation. Today, we need that partnership once again as continuing drought, flooding and conflict-related displacement has left 7.88 million vulnerable people in need of urgent assistance”, says Mr. Mitiku Kassa, Commissioner of the National Disaster Risk Management Commission (NDRMC). “The Government of Ethiopia has committed $138 million for drought response and rehabilitation of IDPs,” added the Commissioner…
 
Nigeria 
:: UN allocates $9 million to support life-saving aid in north-east Nigeria
(Abuja, 15 March 2018): The United Nations, through the Nigeria Humanitarian Fund, has allocated US$9 million to provide life-saving aid to some 60,000 children, women and men recently displaced by ongoing hostilities in Borno State, including $2 million in support of the UN Humanitarian Air Service for frontline responders in north-east Nigeria.
The humanitarian crisis in the region remains one of the most severe in the world today, with at least 7.7 million people in need of humanitarian assistance in 2018 in the worst-affected states of Borno, Adamawa and Yobe states. About 80 per cent of them, 6.1 million, are targeted for humanitarian assistance…
 
Rohinga Refugee Crisis 
:: Joint Response Plan for the Rohingya crisis requests US$951M to provide life-saving assistance to 1.3M people
16 March 2018
A new Joint Response Plan for the Rohingya humanitarian crisis has been launched today in Geneva. It requests US$951 million to provide life-saving assistance to 1.3 million people, including Rohingya refugees who fled Myanmar to Bangladesh and local host communities.
The priority needs in the plan, which covers the March-December 2018 timeframe, include food, water and sanitation, shelter, and medical care…
:: ISCG Situation Report: Rohingya Refugee Crisis, Cox’s Bazar | 11 March 2018

Somalia
:: Donors agree measures to prevent famine in Somalia in 2018   06 Mar 2018
In support of The Federal Government of Somalia, the United Kingdom and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) convened an event in London on 6 March 2018 to draw urgent attention to the humanitarian crisis in Somalia and the need for a swift and substantial response…The event was attended by 31 Member States, UN Agencies, international organizations and non-governmental organizations committed to ensuring support for the humanitarian situation in Somalia for 2018…
 
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 17 March 2018]
http://www.who.int/emergencies/mers-cov/en/
DONs
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman  15 March 2018
 
Yellow Fever  [to 17 March 2018]
http://www.who.int/csr/disease/yellowfev/en/
DONs
:: Yellow fever – Brazil  9 March 2018
…WHO risk assessment
The exponential increase in human cases and epizootics during January and February 2018, as indicated in Figure 1, is concerning due to the persistence of high viral circulation in at-risk areas and the spread to new areas, particularly near urban areas of large cities, such as São Paulo and Rio de Janeiro, and in municipalities that were previously not considered at-risk for Yellow fever.

The preliminary results of the mass vaccination campaign in São Paulo and Rio de Janeiro states indicate low vaccination coverage which suggests a significant number of persons remain at-risk and the necessity to intensify risk communications among high-risk groups.

Despite the significant efforts made to vaccinate large portion of the population, the increasing number of human cases and the persistence and geographical spread of epizootics among non-human primates illustrate the potential risk of further spread to new areas within Brazil that were not previously considered as at risk and where therefore yellow fever immunization coverage is low. The seasonality need also to be taken in to account as the outbreak is occurring the period of the year the most favourable for sylvatic yellow fever transmission.

The increasing occurrence of confirmed yellow fever infection also shows the potential of international spread. Although to date most imported cases have been reported in countries where the vector is absent (or absent during winter). These reports illustrate the importance of maintaining high levels of awareness especially for international travellers from areas with favourable ecosystem for yellow fever transmission.

To date, yellow fever transmission by Aedes aegypti has not been documented. The sylvatic yellow fever virus is transmitted to monkeys by forest dwelling mosquitoes such as Haemagogus and Sabethes spp. Humans who are exposed to these mosquitoes can become infected if they are not vaccinated. In entomological studies conducted during the 2016/2017 outbreak in some of the affected states, isolated Haemagogus mosquitoes were found to be positive for yellow fever indicating predominantly sylvatic transmission. More recently, an investigation conducted by the Evandro Chagas Institute reported by the Brazil Ministry of Health revealed the detection of yellow fever virus in Aedes albopictus mosquitoes captured in rural areas of two municipalities in Minas Gerais (Ituêta and Alvarenga) in 2017. The significance of this finding requires further investigation. The last documented outbreak of urban yellow fever in Brazil was recorded in 1942.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information.

WHO advice
WHO encourage Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination, and to inform them of the designated specific yellow fever vaccination centres within their territories, in accordance with Annex 7 of the International Health Regulations (2005). Travellers should also be made aware of yellow fever symptoms and signs and instructed to seek rapidly medical advice when presenting signs. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

Yellow fever can easily be prevented through vaccination. A single dose of WHO approved yellow fever vaccines, administered at least 10 days before travel, is sufficient to confer sustained immunity and life-long protection against the disease, and a booster dose of the vaccine is not needed.

WHO recommends vaccination of international travellers going to Brazil. The updated areas at risk for yellow fever transmission and the related recommendations for vaccination of international travellers were updated by WHO on 16 January 2018; the map of revised areas at risk and yellow fever vaccination recommendations is available on the WHO ITH website: Yellow fever vaccination recommendations in the Americas, 2018

WHO does not recommend that any general travel or trade restriction be applied on Brazil based on the information available for this event.
[See also: CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil – Media Statement
Friday, March 16, 2018]

WHO & Regional Offices [to 17 March 2018]

WHO & Regional Offices [to 17 March 2018]

Latest News
India takes on malaria in its highest burden state
14 March 2018 – India has made major inroads in reducing the toll of malaria. But the path towards elimination has proven a challenge in the eastern state of Odisha, which carries more than 40% of the country’s malaria burden. This photo story illustrates how in recent years, the state government has dramatically scaled up efforts to prevent, diagnose and treat malaria – with impressive results in a short span of time

Highlights
Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
March 2018 – WHO, UNICEF and national health authorities have completed a large-scale vaccination campaign to control the spread of diphtheria in Yemen. The campaign targeted nearly 2.7 million children aged 6 weeks to 15 years in 11 governorates.

Have your say and help give every child the best start in life
March 2018 – The Nurturing Care Framework for early childhood development is now entering its second phase of online consultations. The Framework builds on state-of-the-art evidence of effective interventions and recognises the critical importance of an enabling environment, with policies, information and services in a range of sectors including health, nutrition, education, social protection and child protection. The Framework will be launched at the time of the World Health Assembly in May 2018. The consultation runs until 28 March 2018.

Saving lives by sharing knowledge online
March 2018 – In June 2017, WHO publicly launched its own Massive Open Online Courses platform – OpenWHO – offering online courses specially tailored for health emergency responders.

Pacific leadership in new WHO global commission on noncommunicable diseases
March 2018 – Globally, communities are struggling to cope with the growing burden of noncommunicable diseases (NCDs), such as heart disease, stroke, diabetes, and cancers. In another step forward in combatting this epidemic, WHO has established an Independent Global High-level Commission on Noncommunicable Diseases, where the Tongan Minister of Health and Public Enterprises, Dr Saia Ma’u Piukala, has been appointed as one of the commissioners who will help raise awareness of the issues and experiences of NCDs in the Pacific.

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Weekly Epidemiological Record, 16 March 2018, vol. 93, 11 (pp. 117–132)
:: Vaccine-derived polioviruses outbreaks and events in 3 provinces of Democratic Republic of the Congo, 2017
:: Emergence of monkeypox in West and Central Africa, 1970–2017

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: On the frontlines of the fight against Lassa fever in Nigeria  16 March 2018
:: WHO establishes emergency water, sanitation and hygiene (WASH) services in health facilities to mitigate public health risks in South Sudan  16 March 2018
:: Polio personnel support Lassa fever response in Nigeria for rapid containment of an unprecedented outbreak.  15 March 2018
:: Kenya Certified Free of Guinea worm disease  14 March 2018
:: WHO to roll out integrated disease surveillance training in districts hosting refugees.
13 March 2018
:: WHO supports Nigeria to respond to new cholera outbreak in Borno State  13 March 2018
:: South Sudan declares Rift Valley fever outbreak in parts of Eastern Lakes State  12 March 2018

WHO Region of the Americas PAHO
:: PAHO urges countries to vaccinate against measles to maintain its elimination in the Americas (03/16/2018)
[See Milestones/Perspectives above for more detail]

WHO South-East Asia Region SEARO
:: Delhi TB Summit: WHO South-East Asia countries commit to intensified efforts, concrete progress to End TB 14 March 2018
[See Milestones/Perspectives above for more detail]
 
WHO European Region EURO
:: Seven years of grief: Syrian doctors and psychologists talk about the mental scars of war 16-03-2018
:: Out of conflict, a new life for Syrian health workers in Turkey 15-03-2018
:: Albania mounts rapid and comprehensive response to measles outbreak 14-03-2018
::  Meetings with high-level Finnish delegation focus on emergencies, communicable and noncommunicable diseases 13-03-2018

WHO Eastern Mediterranean Region EMRO
:: Seven years of Syria’s health tragedy   14 March 2018
:: WHO responds to humanitarian needs of people living with HIV in Benghazi  8 March 2018

WHO Western Pacific Region
:: Pacific leadership in new WHO global commission on noncommunicable diseases
SUVA, Fiji, 13 March 2018 – Globally communities are struggling to cope with the growing burden of noncommunicable diseases (NCDs), such as heart disease, stroke, diabetes, and cancers. In another step forward in combatting this epidemic, WHO has established an Independent Global High-level Commission on Noncommunicable Diseases, where the Tongan Minister of Health and Public Enterprises, Dr Saia Ma’u Piukala, has been appointed as one of the commissioners who will help raise awareness of the issues and experiences of NCDs in the Pacific.
:: Emergency health team deployed to earthquake-affected provinces of Papua New Guinea
08 March 2018.

CDC/ACIP [to 17 March 2018]

CDC/ACIP [to 17 March 2018]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Latest News
CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil – Media Statement
Friday, March 16, 2018
In response to a large, ongoing outbreak of yellow fever in multiple states of Brazil, including near large urban areas and popular tourist destinations, CDC is recommending travelers to the country protect themselves from yellow fever by getting the yellow fever vaccine at least 10 days before travel, and taking steps to prevent mosquito bites during their travel.
CDC recommends that people who are unable to get yellow fever vaccine or aren’t recommended to get it should avoid traveling to areas of Brazil where yellow fever vaccination is recommended. Travelers going to areas with ongoing outbreaks may consider getting a booster dose of yellow fever vaccine if it has been 10 or more years since they were vaccinated…

 
MMWR News Synopsis for MARCH 15, 2018
https://www.cdc.gov/mmwr/index2018.html
:: Vaccine-Derived Polioviruses – Three Provinces, Democratic Republic of the Congo, 2017
In 2017 (as of 8 March 2018) the Democratic Republic of Congo (DRC) reported 25 cases of vaccine-derived poliovirus (VDPV). DRC health officials and Global Polio Eradication Initiative (GPEI) partners are collaborating to strengthen population immunity and surveillance with the goal of interrupting virus transmission. The last confirmed wild poliovirus case in the DRC occurred in December 2011; however, the country continues to report cases of vaccine-derived polioviruses (VDPVs). VDPVs can emerge from oral poliovirus vaccine (OPV) and spread within populations with low immunity to the virus. In 2017 (as of 8 March 2018), 25 cases of VDPV were reported in three provinces. In response to these cases, supplementary immunization activities were conducted June – December 2017.  Because of limitations in surveillance and poor immunization activities, VDPV circulation will likely continue in 2018, requiring additional immunization programs. DRC health officials and Global Polio Eradication Initiative (GPEI) partners are increasing human and financial resources to improve all aspects of the response.

Emergence of Monkeypox – West and Central Africa, 1970-2017
Monkeypox has re-emerged in Africa during the past decade, leading to more reports of human monkeypox cases in people. Many of these cases have been reported in countries that have not reported monkeypox in 40 years. During the past decade, cases of human monkeypox have been reported from more countries than in the previous 40 years. Since 2016, confirmed cases have occurred in Central African Republic, the Democratic Republic of the Congo, Liberia, Nigeria, Republic of Congo, and Sierra Leone; and captive chimpanzees were infected in Cameroon. Monkeypox causes significant illness and death in people and other animals; no specific treatment exists. The World Health Organization and CDC are developing updated guidance and regional trainings to improve capacity for laboratory-based surveillance, detection, and prevention of monkeypox as well as improved patient care and outbreak response.

 

ECDC – European Centre for Disease Prevention and Control  [to 17 March 2018]

ECDC – European Centre for Disease Prevention and Control  [to 17 March 2018]
https://ecdc.europa.eu/en/home

16 March 2018
Rapid risk assessment: Outbreak of yellow fever in Brazil, Third update.
In September 2017, the Ministry of Health in Brazil declared the end of the 2016–2017 yellow fever outbreak in the country. The upsurge of human cases since December 2017 and the continuous non-human primate epizootics since September 2017 indicate a continued or resumed increase in yellow fever virus circulation in Brazil. Since January 2018, most of the yellow fever cases have been reported from São Paulo, Rio de Janeiro and Minas Gerais states.

16 March 2018
Communicable disease threats report, 11 – 17 March 2018, Week 11
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 11-17 March 2018 and includes updates on seasonal influenza, dengue, measles, Borna diseas virus, hepatitis A, Lassa fever, yellow fever and malaria.
PDF: Communicable Disease Threats Report, 17 March 2018

Announcements

Announcements

EDCTP    [to 17 March 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
Latest news
15 March 2018
EDCTP contribution to epidemic preparedness: consortia ALERRT and PANDORA-ID-NET
At the 1st International Conference on (Re-)Emerging Infectious Diseases(ICREID) which took place in Addis Ababa on 12-14 March 2018, a symposium was dedicated to two EDCTP-funded epidemic research preparedness consortia: the African coaLition for Epidemic Research, Response and Training (ALERRT), and the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics (PANDORA-ID-NET).

European Medicines Agency  [to 17 March 2018]
http://www.ema.europa.eu/ema/
16/03/2018
EMA Management Board: highlights of March 2018 meeting
Board adopts 2017 report on veterinary medicines for minor use minor species and hears update on clinical trial portal and database
…Review of clinical trial portal and database
The Board received an update on progress with the development of the European Union (EU) portal and database. Based on the experience with this complex development so far, the developer has submitted a revised project plan with improved project management, development and testing processes and resources. It also contains increased contingency…
Advanced therapies: achievements and challenges
Dr Martina Schüssler-Lenz, chair of EMA’s Committee for Advanced Therapies (CAT), also deputy head of advanced therapy medicinal products at the Paul-Ehrlich Institute (PEI) in Germany, presented the achievements and ongoing challenges in the area of advanced therapies, i.e. medicines that are based either on cells, genes or tissues. These medicines offer new treatment options for rare diseases and patients with high unmet medical need.
Ten advanced therapies have been granted an EU-wide marketing authorisation since the creation of the CAT in 2009. Four advanced therapies are currently under evaluation, including one cell-based and three gene-based therapies. In 2018, the CAT expects to start evaluating four additional medicines.
“We are observing rapidly evolving scientific and technical innovation entering the field of advanced therapies,” explained Dr Schüssler-Lenz, “but the Committee is well set up to cope with the scientific and regulatory challenges ahead due to its expertise and the way members interact and learn from each other.”
Dr Schüssler-Lenz also noted that requests for scientific advice for advanced therapies have increased significantly between 2012 and 2017 and that the CAT is now routinely involved in all scientific advice procedures for these medicines.
 
FDA [to 17 March 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
March 14, 2018 Approval Letter – Trumenba (PDF – 96KB)
Posted: 3/15/2018
 
 
Fondation Merieux  [to 17 March 2018]
http://www.fondation-merieux.org/
March 14, 2018  Bamako, Mali
A new mobile laboratrory to combat epidemics more efficiently I the G5 Sahel
A second mobile laboratory was inaugurated on March 1, 2018 at the Charles Mérieux Center for Infectious Disease. It joins a first mobile laboratory that was provided to Malian authorities in 2014. It will benefit all G5 Sahel member countries: Burkina Faso, Chad, Mali, Mauritania and Niger. The lab will enable health professionals in these countries to rapidly diagnose outbreaks of highly pathogenic diseases with potentially serious consequences for the health and safety of the local communities.
 
JEE Alliance  [to 17 March 2018]
https://www.jeealliance.org/
16.3.2018
Meeting of the Alliance Advisory Group on 27 February 2018
On 27 February, the Advisory Group of the Alliance met at the OIE Headquarters in Paris. The aim of the meeting was to discuss the role of the Alliance in the changing health security landscape, the strategic targets for health security capacity building, and the programme and working methods in 2018…

 
NIH  [to 17 March 2018]
http://www.nih.gov/news-events/news-releases
March 15, 2018
H7N9 influenza vaccine clinical trials begin
Two new clinical trials testing an experimental vaccine to prevent influenza caused by an H7N9 influenza virus are now enrolling volunteers at sites across the United States. The Phase 2 studies, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), will test different dosages of the inactivated influenza vaccine candidate (called 2017 H7N9 IIV) as well as different vaccination schedules. The studies also will evaluate whether an adjuvant boosts the immune responses of people receiving the vaccine…

NIDA’s 2018 Avant-Garde awards highlight immune response and killer cells
March 13, 2018 — NIH’s awards support groundbreaking approaches to HIV prevention and treatment.
With diverse proposals focused on everything from natural killer cells to therapeutic vaccines to treat HIV, three recipients have been selected for the 2018 Avant-Garde Award for HIV/AIDS Research from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The awards will each provide $500,000 per year for up to five years (subject to the availability of funds) to support the research of three scientists, Drs. Catherine Blish, Nathaniel Landau, and Sara Sawyer. NIDA’s annual Avant-Garde Award competition, now in its 11th year, is intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug users…

 NIH scientists describe potential antibody approach for treating multidrug-resistant Klebsiella pneumoniae
March 13, 2018 — Promising concept may lead to an alternative to antibiotics.

NIH experts call for transformative research approach to end tuberculosis
March 9, 2018 — A more intensive biomedical research approach is necessary to control and ultimately eliminate tuberculosis (TB), according to a perspective published in the March 2018 issue of The American Journal of Tropical Medicine and Hygiene. In the article, authors Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and Robert W. Eisinger, Ph.D., special assistant for scientific projects at NIAID, discuss the need to modernize TB research by applying new diagnostic, therapeutic, and vaccine approaches. The perspective is based on a lecture delivered by Dr. Fauci on Nov. 17, 2017 in Moscow at the first World Health Organization Global Ministerial Conference, “Ending TB in the Sustainable Development Era: A Multisectoral Response.”…
 

UNAIDS [to 17 March 2018]
http://www.unaids.org/en
14 March 2018
Feature story
Improving data on key populations
14 March 2018
UNAIDS has relaunched its Key Populations Atlas. The online tool that provides a range of information about members of key populations worldwide—sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people and prisoners—now includes new and updated information in a number of areas. And in addition to data on the five key populations, there are now data on people living with HIV.
Chief among the new data is information on punitive laws, such as denial of the registration of nongovernmental organizations, and on laws that recognize the rights of transgender people. The overhaul of the site was undertaken in consultation with representatives of civil society organizations, including the International Lesbian, Gay, Bisexual, Trans and Intersex Association, which supplied some of the new data on punitive laws…

UNICEF  [to 17 March 2018]
https://www.unicef.org/media/
Selected Press Releaases
Geneva Palais briefing note on UNICEF Rohingya Joint Response Plan
GENEVA, 16 March 2018 – This is a summary of what was said by Marixie Mercado, UNICEF spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

Briefing note on the situation of children in Afrin and Eastern Ghouta, Syria
GENEVA, 16 March 2018 – This is a summary of what was said by Marixie Mercado, UNICEF spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

No end in sight to seven years of war in Syria: children with disabilities at risk of exclusion
BEIRUT/AMMAN/DAMASCUS, 12 March 2018 – With no end in sight to the war in Syria, children with disabilities risk being excluded and forgotten.

Wellcome Trust  [to 17 March 2018]
https://wellcome.ac.uk/news
News / Published: 13 March 2018
Wellcome’s goals: support global research to tackle global challenges
News / Published: 13 March 2018
Cell and developmental biology
Genetics, genomics and molecular biology
Infectious disease and the immune system
Influencing policy
Population health
In March 2017, Wellcome announced five ambitious goals to support research globally. Today we look at what we have achieved so far and what we are working towards in 2018.
Throughout 2017 we have worked towards these goals by working with colleagues from across the world.
Collaboration brings fresh ideas and new perspectives. Bringing people together from diverse backgrounds, often across borders, leads to new ways of thinking, better solutions and faster progress.
In 2016/17, Wellcome made 939 awards worth £1.1 billion, more than ever before and double what we supported a decade ago. We currently fund research activity in more than 100 countries and our non-UK funding continues to increase, largely driven by our commitment to major initiatives such as CEPI (opens in a new tab), CARB-X (opens in a new tab), GARD-P (opens in a new tab), DELTAS and H3Africa (opens in a new tab), and by increased investments in our Africa and Asia Programmes
 
News / Published: 9 March 2018
Sir Damon Buffini to stand down from our Board of Governors
News / Published: 13 March 2018
After six years as a Wellcome Governor, Sir Damon Buffini will step down later this year.
Sir Damon joined Wellcome in September 2012. He was awarded a knighthood in the Queen’s Birthday Honours 2016 for voluntary and charitable services.
He is a founding partner of Permira, a private equity firm with global reach. He was managing partner from 1997 to 2007 and Chair from 2007 to 2010…

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BIO    [to 17 March 2018]
https://www.bio.org/insights/press-release
Mar 12 2018
International Council of Biotech Associations Launches New Website
Washington, D.C. (March 12, 2018) – The International Council of Biotech Associations (ICBA) today announced the launch of internationalbiotech.org, a new website to support the organization’s mission of growing and connecting the innovative biotechnology industry worldwide.
The website unites publicly available resources of ICBA members, providing a virtual library of materials ranging from economic and employment data to issue specific whitepapers. The site’s interactive map demonstrates the distribution of the biotechnology industry around the world, enabling users to easily contrast key economic data markers, including the percent of GDP spent by businesses and governments on research and development.
“The increasingly global biotechnology industry provides breakthrough products and technologies that combat debilitating and rare diseases, reduce our environmental footprint, feed the hungry, use less and cleaner energy, and have safer, cleaner and more efficient industrial manufacturing processes,” said Andrew Casey, Chair of the ICBA and President & CEO, BIOTECanada. “The challenges and opportunities faced by the biotechnology industry cross borders. This website demonstrates the steps our industry is taking to better coordinate, organize and face these issues around the world together.”

DCVMN – Developing Country Vaccine Manufacturers Network  [to 17 March 2018]
http://www.dcvmn.org/
5 April 2018
Webinar: The new Future Vaccine Manufacturing Hub, collaborating with DCVMN
Prof Robin Shattock, Professor of Mucosal Infection and Immunity, Imperial College, London
Thursday, April 5, 2018 9:00 am
Europe Summer Time (Paris, GMT+02:00)

Journal Watch

Journal Watch

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

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

The impact of a human papillomavirus (HPV) vaccination campaign on routine primary health service provision and health workers in Tanzania: a controlled before and after study

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 17 March 2018)

Research article
The impact of a human papillomavirus (HPV) vaccination campaign on routine primary health service provision and health workers in Tanzania: a controlled before and after study
The burden of cervical cancer and shortage of screening services in Tanzania confers an urgent need for human papillomavirus (HPV) vaccination. However, the sustainability and impact of another new vaccine cam…
Authors: Katherine E. Gallagher, Tusajigwe Erio, Kathy Baisley, Shelley Lees and Deborah Watson-Jones
Citation: BMC Health Services Research 2018 18:173
Published on: 12 March 2018

High vaccination coverage is associated with low epidemic level of seasonal influenza in elementary schools: an observational study in Matsumoto City, Japan

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 17 March 2018)

Research article
High vaccination coverage is associated with low epidemic level of seasonal influenza in elementary schools: an observational study in Matsumoto City, Japan
Influenza virus transmission may be prevented by infection control measures, including vaccination, wearing a mask, gargling with water, and hand washing. It is unclear, however, whether these measures affect …
Authors: Mitsuo Uchida, Minoru Kaneko, Yoshihiko Hidaka, Hiroshi Yamamoto, Takayuki Honda, Shouhei Takeuchi, Masaya Saito and Shigeyuki Kawa
Citation: BMC Infectious Diseases 2018 18:128
Published on: 13 March 2018

Ethical principles and placebo-controlled trials – interpretation and implementation of the Declaration of Helsinki’s placebo paragraph in medical research

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

Research article
15 March 2018
Ethical principles and placebo-controlled trials – interpretation and implementation of the Declaration of Helsinki’s placebo paragraph in medical research
In October 2013, the Declaration of Helsinki was revised a seventh time in its 50 year history. While it is the most widely accepted set of ethical principles for the protection of patients participating in medical research, the Declaration of Helsinki has also been subject of constant controversy. In particular, its paragraph on the use of placebo controls in clinical trials divides the research community into active-control and placebo orthodox proponents, both continuously demanding revisions of the Declaration of Helsinki in favour of their position. The goal of the present project is to compare the mainly theoretical controversy with regulatory implementation.
Authors: Antonia-Sophie Skierka and Karin B. Michels

Future-proofing global health: Governance of priorities

Global Public Health
Volume 13, 2017   Issue 5
http://www.tandfonline.com/toc/rgph20/current

Article
Future-proofing global health: Governance of priorities
Belinda Bennett, I. Glenn Cohen, Sara E. Davies, Lawrence O. Gostin, Peter S. Hill, Aditi Mankad & Alexandra L. Phelan
Pages: 519-527
Published online: 08 Mar 2017
ABSTRACT
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of ‘global’ health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.

Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world

Global Public Health
Volume 13, 2017   Issue 5
http://www.tandfonline.com/toc/rgph20/current

Article
Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world
Kylea Laina Liese & Angela B. Maeder
Pages: 567-581
Published online: 20 Sep 2017
ABSTRACT
The greatest variation in maternal mortality is among poor countries and wealthy countries that rely on emergency obstetric technology to save a woman’s life during childbirth. However, substantial variation in maternal mortality ratios (MMRs) exists within and among poor countries with uneven access to advanced obstetric services. This article examines MMRs across the Muslim world and compares the impact of national wealth, female education, and skilled birth attendants on maternal mortality. Understanding how poor countries have lowered MMRs without access to expensive obstetric technologies suggests that certain social variables may act protectively to reduce the maternal risk for life-threatening obstetric complications that would require emergency obstetric care.

Measuring research impact in medical research institutes: a qualitative study of the attitudes and opinions of Australian medical research institutes towards research impact assessment frameworks

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 17 March 2018]

Research
Measuring research impact in medical research institutes: a qualitative study of the attitudes and opinions of Australian medical research institutes towards research impact assessment frameworks
The question of how to measure, assess and optimise the returns from investment in health and medical research (HMR) is a highly policy-relevant issue. Research Impact Assessment Frameworks (RIAFs) provide a c…
Authors: Simon Deeming, Penny Reeves, Shanthi Ramanathan, John Attia, Michael Nilsson and Andrew Searles
Citation: Health Research Policy and Systems 2018 16:28
Published on: 16 March 2018

Health Care Spending in the United States and Other High-Income Countries

JAMA
March 13, 2018, Vol 319, No. 10, Pages 957-1058
http://jama.jamanetwork.com/issue.aspx

Special Communication
Health Care Spending in the United States and Other High-Income Countries
Irene Papanicolas, PhD; Liana R. Woskie, MSc; Ashish K. Jha, MD, MPH
free accesshas active quizhas multimediahas audio
JAMA.2018;319(10):1024-1039. doi:10.1001/jama.2018.1150
This Special Communication analyzes data primarily from 2013-2016 to compare potential drivers of health care spending in the United States with those of 10 other high-income countries.
   Audio Interview: Health Care Spending in the United States and Other High-Income Countries
Editorial
   Factors Contributing to Higher Health Care Spending in the United States Compared With Other High-Income Countries
Stephen T. Parente, PhD
   The Real Cost of the US Health Care System
Ezekiel J. Emanuel, MD, PhD
   Challenges in Understanding Differences in Health Care Spending Between the United States and Other High-Income Countries
Katherine Baicker, PhD; Amitabh Chandra, PhD
   Health Care Spending in the United States Compared With 10 Other High-Income CountriesWhat Uwe Reinhardt Might Have Said
Howard Bauchner, MD; Phil B. Fontanarosa, MD, MBA
 

Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis

Journal of Pharmaceutical Policy and Practice
https://joppp.biomedcentral.com/
[Accessed 17 March 2018]

Research
13 March 2018
Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis
Competing claims are made about the amount of money that pharmaceutical companies spend on research and development (R&D) versus promotion. This study investigates this question in the Canadian context.
Authors: Joel Lexchin

Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries

The Lancet
Mar 17, 2018 Volume 391 Number 10125 p999-1120  e9-e14
http://www.thelancet.com/journals/lancet/issue/current

Articles
Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries
The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer.
Claudia Allemani, Tomohiro Matsuda, Veronica Di Carlo, Rhea Harewood, Melissa Matz, Maja Nikšić, Audrey Bonaventure, Mikhail Valkov, Christopher J Johnson, Jacques Estève, Olufemi J Ogunbiyi, Gulnar Azevedo e Silva, Wan-Qing Chen, Sultan Eser, Gerda Engholm, Charles A Stiller, Alain Monnereau, Ryan R Woods, Otto Visser, Gek Hsiang Lim, Joanne Aitken, Hannah K Weir, Michel P Coleman, CONCORD Working Group

 

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

The Lancet
Mar 17, 2018 Volume 391 Number 10125 p999-1120  e9-e14
http://www.thelancet.com/journals/lancet/issue/current

Review
Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition
Dean T Jamison, Ala Alwan, Charles N Mock, Rachel Nugent, David Watkins, Olusoji Adeyi, Shuchi Anand, Rifat Atun, Stefano Bertozzi, Zulfiqar Bhutta, Agnes Binagwaho, Robert Black, Mark Blecher, Barry R Bloom, Elizabeth Brouwer, Donald A P Bundy, Dan Chisholm, Alarcos Cieza, Mark Cullen, Kristen Danforth, Nilanthi de Silva, Haile T Debas, Peter Donkor, Tarun Dua, Kenneth A Fleming, Mark Gallivan, Patricia J Garcia, Atul Gawande, Thomas Gaziano, Hellen Gelband, Roger Glass, Amanda Glassman, Glenda Gray, Demissie Habte, King K Holmes, Susan Horton, Guy Hutton, Prabhat Jha, Felicia M Knaul, Olive Kobusingye, Eric L Krakauer, Margaret E Kruk, Peter Lachmann, Ramanan Laxminarayan, Carol Levin, Lai Meng Looi, Nita Madhav, Adel Mahmoud, Jean Claude Mbanya, Anthony Measham, María Elena Medina-Mora, Carol Medlin, Anne Mills, Jody-Anne Mills, Jaime Montoya, Ole Norheim, Zachary Olson, Folashade Omokhodion, Ben Oppenheim, Toby Ord, Vikram Patel, George C Patton, John Peabody, Dorairaj Prabhakaran, Jinyuan Qi, Teri Reynolds, Sevket Ruacan, Rengaswamy Sankaranarayanan, Jaime Sepúlveda, Richard Skolnik, Kirk R Smith, Marleen Temmerman, Stephen Tollman, Stéphane Verguet, Damian G Walker, Neff Walker, Yangfeng Wu, Kun Zhao
Summary
The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

The landscape of genomic alterations across childhood cancers

Nature 
Volume 555 Issue 7696, 15 March 2018
http://www.nature.com/nature/current_issue.html

Article | 28 February 2018 | open
The landscape of genomic alterations across childhood cancers
Analyses of genomes from 914 children, adolescents, and young adults provide a comprehensive resource of genomic alterations across a spectrum of common childhood cancers.
Susanne N. Gröbner, Barbara C. Worst… & Stefan M. Pfister
Abstract
Pan-cancer analyses that examine commonalities and differences among various cancer types have emerged as a powerful way to obtain novel insights into cancer biology. Here we present a comprehensive analysis of genetic alterations in a pan-cancer cohort including 961 tumours from children, adolescents, and young adults, comprising 24 distinct molecular types of cancer. Using a standardized workflow, we identified marked differences in terms of mutation frequency and significantly mutated genes in comparison to previously analysed adult cancers. Genetic alterations in 149 putative cancer driver genes separate the tumours into two classes: small mutation and structural/copy-number variant (correlating with germline variants). Structural variants, hyperdiploidy, and chromothripsis are linked to TP53 mutation status and mutational signatures. Our data suggest that 7–8% of the children in this cohort carry an unambiguous predisposing germline variant and that nearly 50% of paediatric neoplasms harbour a potentially druggable event, which is highly relevant for the design of future clinical trials.

Pan-cancer genome and transcriptome analyses of 1,699 paediatric leukaemias and solid tumours

Nature 
Volume 555 Issue 7696, 15 March 2018
http://www.nature.com/nature/current_issue.html

Letter | 28 February 2018 | open
Pan-cancer genome and transcriptome analyses of 1,699 paediatric leukaemias and solid tumours
Analysis of the genomes, exomes and transcriptomes of 1,699 childhood cancers identifies 142 driver genes.
Xiaotu Ma, Yu Liu… & Jinghui Zhang
Abstract
Analysis of molecular aberrations across multiple cancer types, known as pan-cancer analysis, identifies commonalities and differences in key biological processes that are dysregulated in cancer cells from diverse lineages. Pan-cancer analyses have been performed for adult1,2,3,4 but not paediatric cancers, which commonly occur in developing mesodermic rather than adult epithelial tissues5. Here we present a pan-cancer study of somatic alterations, including single nucleotide variants, small insertions or deletions, structural variations, copy number alterations, gene fusions and internal tandem duplications in 1,699 paediatric leukaemias and solid tumours across six histotypes, with whole-genome, whole-exome and transcriptome sequencing data processed under a uniform analytical framework. We report 142 driver genes in paediatric cancers, of which only 45% match those found in adult pan-cancer studies; copy number alterations and structural variants constituted the majority (62%) of events. Eleven genome-wide mutational signatures were identified, including one attributed to ultraviolet-light exposure in eight aneuploid leukaemias…

Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa

New England Journal of Medicine
March 15, 2018   Vol. 378 No. 11
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa
Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)–related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy.
Síle F. Molloy, Ph.D., Cecilia Kanyama, M.D., Robert S. Heyderman, Ph.D., Angela Loyse, M.D.(Res.), Charles Kouanfack, Ph.D., Duncan Chanda, M.B., Ch.B., Sayoki Mfinanga, M.D., Elvis Temfack, M.D., Shabir Lakhi, M.D., Sokoine Lesikari, M.D., Adrienne K. Chan, M.D., Neil Stone, M.B., B.S., Newton Kalata, M.D., Natasha Karunaharan, M.B., B.S., Kate Gaskell, M.B., Ch.B., Mary Peirse, M.B., Ch.B., Jayne Ellis, M.B., B.S., Chimwemwe Chawinga, B.A., Sandrine Lontsi, M.D., Jean-Gilbert Ndong, M.D., Philip Bright, F.R.C.Path., Duncan Lupiya, C.O., Tao Chen, Ph.D., John Bradley, Ph.D., Jack Adams, B.Sc., Charles van der Horst, M.D., Joep J. van Oosterhout, Ph.D., Victor Sini, M.D., Yacouba N. Mapoure, M.D., Peter Mwaba, Ph.D., Tihana Bicanic, M.D.(Res.), David G. Lalloo, M.D., Duolao Wang, Ph.D., Mina C. Hosseinipour, M.D., Olivier Lortholary, M.D., Shabbar Jaffar, Ph.D., and Thomas S. Harrison, M.D. for the ACTA Trial Study Team

Pharmacokinetics and Drug Metabolism in Canada: The Current Landscape—A Summary of This Indispensable Special Issue

Pharmaceutics
Volume 10, Issue 1 (March 2018)
http://www.mdpi.com/1999-4923/10/1

Open Access   Editorial
Pharmacokinetics and Drug Metabolism in Canada: The Current Landscape—A Summary of This Indispensable Special Issue
by Neal M. Davies and Kishor M. Wasan
Pharmaceutics 2018, 10(1), 13; doi:10.3390/pharmaceutics10010013
Received: 15 January 2018 / Revised: 15 January 2018 / Accepted: 15 January 2018 / Published: 16 January 2018
Abstract
Canadian Pharmaceutical Scientists have a rich history of groundbreaking research in pharmacokinetics and drug metabolism undertaken primarily throughout its Pharmacy Faculties and within the Pharmaceutical and Biotechnology industry. The principles of drug absorption, distribution, metabolism, and excretion (ADME) is the foundational basis of rationale drug-design, and principled pharmacotherapy. The study of ADME and its descriptive quantitative analysis is the basis of pharmacokinetics. Pharmacokinetics is fundamental in the development of a new chemical entity into a marketable product and is essential in understanding the bioavailability, bioequivalence, and biosimilarities of drugs. Pharmacokinetics and drug metabolism and development studies facilitate an understanding of organ-based functionality.     Population pharmacokinetic variability and the modeling of drug concentrations has significant utility in translating individual response in a target patient population underlying advances in precision health.
This special issue serves to highlight and capture the contemporary progress and current landscape of pharmacokinetics and drug metabolism within the prevailing Canadian context and the impact this pharmaceutical sciences research has had on an international scientific community…

Epidemiology of the Zika Virus Outbreak in the Cabo Verde Islands, West Africa

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

Epidemiology of the Zika Virus Outbreak in the Cabo Verde Islands, West Africa
March 15, 2018 · Research Article
Introduction: The Zika virus (ZIKV) outbreak in the island nation of Cabo Verde was of unprecedented magnitude in Africa and the first to be associated with microcephaly in the continent.
Methods: Using a simple mathematical framework we present a first epidemiological assessment of attack and observation rates from 7,580 ZIKV notified cases and 18 microcephaly reports between July 2015 and May 2016.
Results: In line with observations from the Americas and elsewhere, the single-wave Cabo Verdean ZIKV epidemic was characterized by a basic reproductive number of 1.85 (95% CI, 1.5 – 2.2), with overall the attack rate of 51.1% (range 42.1 – 61.1) and observation rate of 2.7% (range 2.29 – 3.33).
Conclusion: Current herd-immunity may not be sufficient to prevent future small-to-medium epidemics in Cabo Verde. Together with a small observation rate, these results highlight the need for rapid and integrated epidemiological, molecular and genomic surveillance to tackle forthcoming outbreaks of ZIKV and other arboviruses.

Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013

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

Research Article
Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013
Etienne Gignoux, Jonathan Polonsky, Iza Ciglenecki, Mathieu Bichet, Matthew Coldiron, Enoch Thuambe Lwiyo, Innocent Akonda, Micaela Serafini, Klaudia Porten
Research Article | published 14 Mar 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0194276

Concern as HIV prevention strategy languishes

Science         
16 March 2018  Vol 359, Issue 6381
http://www.sciencemag.org/current.dtl

In Depth
Concern as HIV prevention strategy languishes
By Jon Cohen
Science16 Mar 2018 : 1205 Restricted Access
Few countries promote prophylactic drug regimen, and many people shun it.
Summary
Some 200,000 people uninfected with HIV now take antiretroviral drugs as preventive medicine—but 75% of them are in the United States. Called pre-exposure prophylaxis, or PrEP, this daily pill has proved its worth in several clinical trials and was approved by the U.S. Food and Drug Administration in 2012. Other countries have been slow to adopt PrEP even though the World Health Organization recommended it for everyone at “substantial risk” of becoming infected. At the Conference on Retroviruses and Opportunistic Infections held in Boston last week, there was a growing clamor about the underuse of PrEP. In hard hit sub-Saharan Africa, only Kenya aggressively promotes the use of PrEP. Evidence from San Francisco, California, and the state of New South Wales in Australia, which both have prominent PrEP campaigns, shows that it has helped reduce new infection rates. Several presenters at the meeting discussed why PrEP has been slow to catch on both at the government level and with people who are at high risk of becoming infected. In 2016, nearly 2 million more people became infected with the AIDS virus, bringing the global total to 37 million.

Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis

Systematic Reviews
https://systematicreviewsjournal.biomedcentral.com/articles
[Accessed 17 March 2018]

Protocol
Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis
Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit ac…
Authors: Kednapa Thavorn, Howsikan Kugathasan, Darrell H. S. Tan, Nasheed Moqueet, Stefan D. Baral, Becky Skidmore, Derek MacFadden, Anna Simkin and Sharmistha Mishra
Citation: Systematic Reviews 2018 7:47
Published on: 15 March 2018

New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data

Vaccine
Volume 36, Issue 13  Pages 1711-1800 (20 March 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/13

Review
New insights into physiopathology of immunodeficiency-associated vaccine-derived poliovirus infection; systematic review of over 5 decades of data
Review article
Pages 1711-1719
Mohammadreza Shaghaghi, Saeed Soleyman-jahi, Hassan Abolhassani, Reza Yazdani, … Asghar Aghamohammadi
Abstract
Widespread administration of oral poliovirus vaccine (OPV) has decreased global incidence of poliomyelitis by ≈99.9%. However, the emergence of vaccine-derived polioviruses (VDPVs) is threatening polio-eradication program. Primary immunodeficiency (PID) patients are at higher risks of vaccine-associated paralytic poliomyelitis (VAPP) and prolonged excretion of immunodeficiency-associated VDPV (iVDPV).

Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps – National Immunization Survey-Teen, 2012–2014

Vaccine
Volume 36, Issue 13  Pages 1711-1800 (20 March 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/13

Original research article
Vaccination coverage among foreign-born and U.S.-born adolescents in the United States: Successes and gaps – National Immunization Survey-Teen, 2012–2014
Pages 1743-1750
Jessica Healy, Alfonso Rodriguez-Lainz, Laurie D. Elam-Evans, Holly A. Hill, … David Yankey
 

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option

Vaccine
Volume 36, Issue 13  Pages 1711-1800 (20 March 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/13

Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option
Open access – Original research article
Pages 1757-1765
Kinley Dorji, Sonam Phuntsho, Pempa, Suthasinee Kumluang, … Yot Teerawattananon

Evaluation of vaccine derived poliovirus type 2 outbreak response options: A randomized controlled trial, Karachi, Pakistan

Vaccine
Volume 36, Issue 13  Pages 1711-1800 (20 March 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/13

Evaluation of vaccine derived poliovirus type 2 outbreak response options: A randomized controlled trial, Karachi, Pakistan
Open access – Original research article
Pages 1766-1771
Ali Faisal Saleem, Mohammad Tahir Yousafzai, Ondrej Mach, Asia Khan, … Anita K.M. Zaidi
 

Strategies to implement maternal vaccination: A comparison between standing orders for midwife delivery, a hospital based maternal immunisation service and primary care

Vaccine
Volume 36, Issue 13  Pages 1711-1800 (20 March 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/13

Strategies to implement maternal vaccination: A comparison between standing orders for midwife delivery, a hospital based maternal immunisation service and primary care
Original research article
Pages 1796-1800
Sushena Krishnaswamy, Euan M Wallace, Jim Buttery, Michelle L Giles

Hepatitis B At-Birth Dose Vaccine: An Urgent Call for Implementation in Ghana

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

Open Access  Letter
Hepatitis B At-Birth Dose Vaccine: An Urgent Call for Implementation in Ghana
by Yaw Asante Awuku and Mary Yeboah-Afihene
Vaccines 2018, 6(1), 15; doi:10.3390/vaccines6010015 – 12 March 2018
Abstract
Globally, approximately two billion people are infected with the Hepatitis B virus with attributable death estimated at about half a million people annually across the globe. Chronic hepatitis B infection is also an important public health problem in Ghana. The main mode of transmission in endemic regions is the perinatal route. Mother-to-child transmission can be reduced by antiviral therapy especially in the last trimester and adherence to the national immunization schedule. The World Health Organization recommends to add the birth dose vaccine to the current expanded program on immunization (EPI) in all countries but especially for endemic regions. The evidence for the efficacy of the birth dose HBV vaccine is overwhelming and there is an urgent need for its introduction into the current EPI schedule in Ghana

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

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

Trends in microbiology
http://www.cell.com/trends/microbiology/current
Online Now Articles
Review
Call to Arms: Quest for a Cryptococcal Vaccine
C Marley, C Van Dyke, L Floyd

Highlights
Cryptococcosis remains a significant cause of morbidity and mortality world-wide, particularly among AIDS patients. Yet, to date, there are no licensed vaccines clinically available to treat or prevent cryptococcosis. In this review, we provide a rationale to support continued investment in Cryptococcus vaccine research, potential challenges that must be overcome along the way, and a literature review of the current progress underway towards developing a vaccine to prevent cryptococcosis
:: Expansion of Cryptococcus in unique patient populations and environmental niches highlights the need for a prophylactic vaccine to prevent cryptococcosis caused by virulent C. neoformans and C. gattii.
:: Vaccination with heat-killed Cryptococcus mutants containing cell-wall modifications appears to induce protective immune responses against cryptococcosis in mice.
:: Experimental studies show potential for eliciting long-lasting protective immunity against cryptococcosis in CD4+ T cell-deficient hosts.
:: Administration of fungal glycolipids, such as glucosylceramide, demonstrates significant protection against subsequent Cryptococcus infection in mice.
:: Mice vaccinated with an innovative β-glucan antigen-delivery platform containing immune stimulatory Cryptococcus fractions have protective anticryptococcal immune responses against virulent strains of C. neoformans and C. gattii.

Media/Policy Watch

Media/Policy Watch

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

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

BBC
http://www.bbc.co.uk/
Accessed 17 March 2018
14 Mar 2018
First steps taken for vaccine pills
…UK scientists have taken the first steps towards creating new vaccine… treatments in pill form
 
The Economist
http://www.economist.com/
Accessed 17 March 2018
Shooting up
Britain is slowly acquiring a pro-vax movement
Chickenpox parties could soon be a thing of the past
Mar 15th 2018
MANY parents may have fond-and-itchy memories of chickenpox parties. At these events infected children played with healthy ones, helping to strengthen immune systems. Now such shindigs face dwindling guest lists as more people pay to be vaccinated against chickenpox and other diseases.
Children are entitled to free vaccinations on the National Health Service for some diseases, like polio. For high-risk groups, such as those with long-term conditions, the list is extended. But where jabs are not covered, parents must pay…
 
The Guardian
http://www.guardiannews.com/
Accessed 17 March 2018
Global Health
‘There are a lot of unknowns’: British scientists set to work on Zika vaccine
9 March 2018
Research begins on £4.7m project with scientific community still puzzled by concentrated but intense spate of birth defects in Brazil
Scientists in the UK have started work on developing a vaccine to protect women against the Zika virus. The £4.7m project, involving the universities of Manchester and Liverpool, and Public Health England, aims to have trials on humans up and running within the next three years. The news comes two and a half years after the Zika virus, which can lead to foetal abnormalities, began to appear in Brazil…
 
New York Times
http://www.nytimes.com/
Accessed 17 March 2018
Rumours, mistrust hinder Brazil yellow fever vaccine campaign
12 March 2018
…The vaccine is free at public health posts around the country, but Santos’ suspicion that someone must be profiting somewhere is typical of the current high levels of mistrust Brazilians hold for officialdom. Flagging faith in Brazil’s institutions amid a series of corruption scandals, a chaotic communications campaign promoting the vaccine, and the country’s decision to give partial doses to stretch supplies are contributing to rumors that the vaccine is a scam, weak or even dangerous.
That misinformation is scaring people away from the campaign that is trying to vaccinate more than 23 million people in areas of Rio de Janeiro, Sao Paulo and Bahia states that until recently were not considered at risk for yellow fever. Nearly six weeks into the campaign, the Health Ministry says 76 percent of the target population has been vaccinated — far off its goal of 95 percent.
The current atmosphere of uncertainty and rumors around the vaccine is likely to make the last 20 percent very difficult to reach, hampering the efforts of Latin America’s biggest nation to contain its largest yellow fever outbreak in more than three decades…
 
Scientific American
https://www.scientificamerican.com/
Accessed 17 March 2018
Pakistan Is Racing to Combat the World’s First Extensively Drug-Resistant Typhoid Outbreak
Rumors about poisoned vaccines are making this bacterial infection hard to control
14 March 2018
…Mariam’s doctors, it turned out, had reason to be concerned: A blood test revealed the typhoid strain Mariam carried was resistant to five classes of antibiotics typically used to treat the infection. Although resistance to three classes of typhoid medication—formally known as “multidrug-resistant” typhoid—had become common in Pakistan in recent decades, this extreme level of resistance was much worse. Mariam’s infection was designated “extensively drug resistant,” or XDR—meaning it would only respond to one powerful, broad-spectrum class of antibiotics: azithromycin, which is considered the last line of defense against typhoid…
 
Washington Post
http://www.washingtonpost.com/
Accessed 17 March 2018
Participants In Rogue Herpes Vaccine Research Take Legal Action
Marisa Taylor, Kaiser Health News   Mar 13, 2018

Think Tanks et al

Think Tanks et al
 
CSIS
https://www.csis.org/
Accessed 17 March 2018
Report
A Ripe Moment for Reducing Vaccine-Preventable Disease
March 13, 2018 | By Nellie Bristol
…Over the next several years, three global health activities growing out of programs championed by the U.S. government will come together in a way that could catalyze immunization system improvements in the most disease-prone countries. These include immunization and disease surveillance goals outlined in the Global Health Security Agenda (GHSA) and two activities related to global polio eradication: the need for worldwide delivery of the inactivated polio vaccine; and the repurposing of the polio infrastructure for immunization and other health activities, a process known as polio transition. All three activities create concerted attention to immunization systems that could result in sustained increases in global vaccination rates and amplify U.S. investments in vaccine promotion mechanisms, such as Gavi, the Vaccine Alliance.
Yet an uncertain budget future for each of the activities threatens not only the potential expansion of this global public good but could cause regression in successful vaccine delivery and related coverage rates. Although both polio eradication and the GHSA enjoy strong bipartisan support, including under the current administration, the potential for decreases in U.S. foreign assistance endangers the future of these activities. In fact, the U.S. Centers for Disease Control and Prevention is already developing staff reduction plans for the GHSA in the face of possible budget cuts…

Vaccines and Global Health: The Week in Review 10 March 2018

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

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

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_10 March 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

CEPI Partners with Themis Bioscience to Advance Vaccines Against Lassa Fever and MERS

Milestones :: Perspectives

CEPI Partners with Themis Bioscience to Advance Vaccines Against Lassa Fever and MERS
First major investment by Coalition for Epidemic Preparedness Innovations (CEPI) to advance vaccine development and manufacturing on two of CEPI’s highest priority infectious diseases —

Vienna, Austria and Oslo, Norway, March 7, 2018 – Today Themis Bioscience and CEPI – the Coalition for Epidemic Preparedness Innovations – announce a partnership under which Themis will provide advanced vaccine development and manufacturing for Lassa fever and MERS.

This is the first company agreement that CEPI has signed since it was established in 2017 as a coalition to finance and coordinate the development of new vaccines to prevent and contain infectious disease epidemics.

The investment of up to $37,500,000 represents an innovative approach to funding vaccine development, unlocking research and development potential so that vaccines are ready for efficacy studies during an outbreak. The agreement will enable funding for Themis’ development efforts over a five-year period. Additional financial details were not disclosed.

Lassa fever is a disease endemic in West Africa associated with annual outbreaks. An ongoing outbreak in Nigeria is believed to have infected nearly a thousand people and caused 90 deaths this year alone. MERS, first identified in 2012, causes a severe respiratory illness and has been associated with a number of outbreaks in Saudi Arabia and neighboring countries.

Individuals acquiring these diseases in the regions of origin occasionally travel to other locations, becoming ill in areas outside the endemic regions. In 2015, for example, an individual returning to South Korea from the Middle East caused a large outbreak there that resulted in 186 cases and 36 deaths. The outbreak affected 24 hospitals, led to the temporary closure of more than 2000 schools, and had a significant impact on the South Korean economy.

Dr Richard Hatchett CEO of CEPI said:
“Establishing our partnership with Themis represents not only an important step in our journey towards tackling these diseases, but also a breakthrough in how we can partner and work with vaccine developers when traditional market incentives for development have failed.”

“As we can see with the current outbreak of Lassa fever in Nigeria, these diseases devastate lives and have far reaching economic consequences. Vaccines are a vital part of our fight against them but their development is costly, complex and challenging.”

Themis has established a versatile technology platform for the discovery, development and production of vaccines as well as other immune system activation approaches. The company will apply its platform technology to discoveries made by Institut Pasteur and the Paul Ehrlich Institut on Lassa fever and MERS, respectively, and will advance those vaccine candidates up to human proof-of-concept and safety studies…

The investment with Themis is the first in CEPI’s planned portfolio programme. CEPI’s investments will support development up to the end of Phase II, providing clinical safety and immunological data, and the establishment of investigational stockpiles that will be ready for clinical efficacy trial testing during outbreaks. CEPI’s investments will also provide additional benefits to the wider vaccine community through the development of assays, reference standards and associated knowledge that may accelerate the development of other vaccines and medical counter measures against Lassa fever and MERS.

Themis’ most advanced proprietary development program is a vaccine against chikungunya virus, a mosquito-transmitted disease that can have serious debilitating long-term effects. The disease causes fever, joint pain and muscle pain, among other symptoms, and has no current treatment or prevention options. Themis’ chikungunya vaccine is in Phase 2 clinical studies in 600 patients across the US, EU and South and Central America. With its broadly applicable technology platform, Themis is also developing vaccines against Zika virus, Respiratory Syncytial Virus (RSV), norovirus and Cytomegalovirus (CMV), as well as other applications of harnessing the immune system to treat disease.

About Themis Bioscience
“Themis is developing urgently needed vaccines to prevent death and disability around the world. We lead in the development of a vaccine against chikungunya, a serious debilitating disease with global outbreak potential. Our innovation in vaccine and immune activation technology has created a powerful platform and a growing pipeline addressing a broad range of infectious diseases. Together with industrial and academic leaders we work to prevent illness across the globe. For more information, visit http://www.themisbio.com

Global Health 50/50 Report (2018)

Global Health 50/50 Report (2018)
How gender-responsive are the world’s most influential global health organisations?
First report 2018
The Global Health 50/50 initiative is housed by the University College London Centre for Gender and Global Health.
March 2018 :: 56 pages
PDF: https://globalhealth5050.org/wp-content/uploads/2018/03/GH5050-Report-2018_Final.pdf

This report was supported by a grant from Wellcome Trust, Grant reference number: 210398/Z/18/Z
The Global Health 50/50 Report, the first of its kind, provides a comprehensive review of the gender-related policies of more than 140 major organisations working in and/or influencing the field of global health. The initiative is focused at the intersection of several Sustainable Development Goals (SDGs), including on health (3), gender equality (5), inequalities (10) and inclusive societies and institutions (16).

Gender equality has seemingly been embraced as a priority in global health. The report is inspired, however, by a growing concern that too few global health organisations walk the talk by defining, programming, resourcing or monitoring gender, either as a determinant of health, or as a driver of career equality in their own workplaces.
The Global Health 50/50 Report provides a benchmark across the sector to catalyse shifts in organisational and management culture and practice, the adoption of gender-responsive policies, and ensuring adequate resources for programmes focusing on the gendered dynamics of global health. It seeks to provide evidence of where the gaps lie, while shining a light on ways forward.

Excerpt
GH50/50 High Scorers – 2018
Based on the findings across the seven domains explored above, GH5050 identified nine very high-scoring organisations and a further ten high-scoring organisations (some of which missed out on a top ’score’ since they provide little or no information for one key variable, such as gender composition of Board).

Highest scorers: BRAC; Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ); Gavi; Global Fund to Fight AIDS, TB and Malaria; Population Reference Bureau; Save the Children International; Sida; Joint United Nations Programme on HIV/AIDS (UNAIDS); UNICEF.

High scorers: CARE; European Commission; FHI360; Food and Agriculture Organization of the UN (FAO); Jhpiego; Partnership for Maternal, Newborn and Child Health (PMNCH); Stop TB; UNFPA; UN Women; WHO.

Organisations have been scored based on whether they have gender-responsive policies in place, and some indicators of practice—namely sex-disaggregation of data and parity among senior management and boards. Such a review provides a critical initial understanding of whether an organisation has an adequate policy foundation in place to guide gender-responsive programming and foster a gender-equitable workplace. Looking forward, however, a much better understanding of the extent to which effective policies and accountability mechanisms to promote gender equality are implemented is urgently needed.

JAMA: Retreat From Human Rights and Adverse Consequences for Health

Featured Journal Content
 
JAMA
March 6, 2018, Vol 319, No. 9, Pages 843-943
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Retreat From Human Rights and Adverse Consequences for Health
Diederik Lohman, MA
JAMA. 2018;319(9):861-862. doi:10.1001/jama.2018.0271
Abstract
The international environment for human rights has rapidly deteriorated in recent years. Populist leaders have come to power in an increasing number of countries, often on political platforms that are explicitly hostile to human rights. These leaders tend to portray respect for human rights as an inconvenient obstacle to their agendas rather than as an essential limit on their power. Meanwhile, many governments that have traditionally been proponents of human rights, although often with records that do not entirely reflect human rights, have encountered internal challenges from authoritarian populists or far-right political parties that have turned their focus inward and weakened their willingness to stand up for human rights internationally.

This development has serious consequences. As the Human Rights Watch 2018 World Report, released on January 18, notes, this trend has left an “open field for murderous leaders and their enablers.”1 The report details mass atrocities carried out with near impunity in Yemen, Syria, Burma, South Sudan, and elsewhere. It also provides ample examples of rapidly decreasing political space in many countries as governments seize the opportunity to eliminate free speech, the political opposition, and nongovernmental groups as a fragmented international community stands by paralyzed.

Populist and authoritarian leaders have had civil and political rights, first and foremost, as their focus, rather than economic and social rights, including the right to health. In some cases, populists have exploited public frustration about health care and other social policies to gain electoral support for their anti-rights agendas. However, the retreat from human rights is also a threat to health because it inevitably undermines key building blocks for good public health policy such as the ability to have robust public discussion on complex health issues and to critique government policies that affect public health.

Effects on Health During Conflict
Perhaps the most glaring example of the effect of this retreat from human rights on health globally is the failure of countries and multilateral organizations to effectively counteract the rapid increase in recent years in attacks on health care facilities during conflict. Although international humanitarian law explicitly grants health care facilities protected status, reports of attacks on these facilities and on health care workers during conflict have become so common that many incidents do not even attract media attention.

Last year, a report from the Safeguarding Health in Conflict Coalition documented attacks on health care facilities and workers in 23 countries across 3 continents.2 The report indicated that hospitals and clinics had been bombed or shelled in 10 countries, health care workers had been killed or abducted in 15, and military or police forces had occupied health care facilities in 7. The report documented 108 attacks on health care facilities in Syria, identified the Syrian and Russian governments as the worst offenders, and noted that the level of violence inflicted on health care facilities and health care workers was “remarkably high” as well in Afghanistan, Iraq, South Sudan, and Yemen.2

Due to a lack of data, it is impossible to quantify the full effects of these attacks on the health of the population of these countries. However, those effects are sure to be substantial. Many attacks described in the coalition report led to the suspension of essential health programs, destruction of health care infrastructure, flight of health care workers, and disruptions in deliveries of essential medicines and supplies. In Pakistan, one of the last remaining countries where polio is endemic, attacks by militants on individuals who provide vaccinations for polio led to a temporary suspension of the vaccination program in 2016, although enhanced security measures allowed the program to resume in 2017 without further incident.2

A Human Rights Watch review of 25 attacks on hospitals and health care workers in 10 countries between 2013 and 2016 documented that the attacks resulted in the deaths of more than 230 people, injuries to 180 more, and the closure or destruction of 6 hospitals.3 Yet the review found that no individuals faced criminal charges for their role in the attacks and most of the attacks were not investigated, even though at least 16 of the attacks may have constituted war crimes.3 The attacks involved military forces or armed groups from Afghanistan, Central African Republic, Iraq, Israel, Libya, Russia, Saudi Arabia, South Sudan, Sudan, Syria, Ukraine, and the United States.3 Even though the adverse effects of these attacks on a population can be enormous, most governments showed no greater willingness to investigate alleged attacks on health care facilities than they have with other potentially unlawful attacks in which their forces were involved, and instead apparently ignored, denied, or even justified them.3

The United Nations, which has been weakened by divisions and a retreat from rights norms (moral principles), has responded to these attacks with rhetoric but almost no action. In 2016, the UN Security Council adopted a strong resolution condemning attacks on health care facilities, and former UN Secretary-General Ban Ki-moon made 13 recommendations for preventing attacks on medical personnel, as requested by the Security Council.4 The World Health Organization will begin systematic data collection on these incidents (albeit without identification of those responsible). The UN Security Council held a follow-up meeting in May 2017 devoted to protecting civilians, with a special focus on attacks on health care facilities. However, attacks on health care facilities in conflict have continued.

Health Rights Under Authoritarian Regimes
The anti-rights zeal of populist and authoritarian leaders may not specifically target the right to health—and some such leaders have been credited with significant advances in the health of their countries—but good health policy withers without space for robust discussion on policy issues and government accountability. While populist and authoritarian leaders usually first seek to restrict the voice of political opponents or the media, it rarely stops there. Government restrictions intended to hamper the work of civil rights groups also tend to adversely affect groups working on health and other social and economic issues. While international resolve to protect rights has at times been a restraint on the behavior of authoritarian leaders, the global retreat from human rights has given them a freer hand.

A 2017 analysis by Human Rights Watch involving several countries has demonstrated how a lack of public domestic and international accountability can have major negative consequences for health. For example, in the early years of the rule of Hugo Chavez in Venezuela, primarily between 2003 and 2006, the country made significant progress in improving health. However, it also gradually restricted political freedoms, becoming increasingly intolerant of criticism. Since 2015, Venezuela’s health care system has slid into crisis as a result of government mismanagement and dwindling oil revenues, and intolerance of criticism now extends to physicians who publicly discuss the state of the health care system.4 For instance, several Venezuelan physicians reported that government officials had threatened reprisals, including dismissal, after they raised concerns about the scarcity of medicines and medical supplies.4

According to official statistics from Venezuela, in 2016 infant mortality increased 30% (from 8812 to 11 446 infant deaths) and maternal mortality increased 65% (from 457 to 756 deaths).5,6 Human Rights Watch analyses suggest that these increases were related to the severe shortages of basic medicines and medical supplies.4 Yet the government insists that Venezuela is not facing a humanitarian crisis.7

In Equatorial Guinea, with the world’s longest surviving president (since 1979), a lack of political freedoms and accountability has allowed the ruling elite to realize billions of dollars in oil revenues while largely ignoring the dire state of public health. Equatorial Guinea was one of the poorest countries in Africa when large oil reserves were discovered in the early 1990s, but its per capita income increased from US $330 in 1991 to a peak of US $24 304 in 2012.

Yet in 2017, an analysis by Human Rights Watch found that 20 years of oil wealth had done little to improve the country’s health indicators.8 Life expectancy has increased and was 57.5 years in 2015, the latest year for which data are available, but merely kept pace with that of other, much poorer, sub-Saharan African countries. Access to safe drinking water remains the same as in 1995 while it has improved in many other countries in the region. Vaccination rates for children have actually declined since the late 1990s and are among the worst in the world, with only 35% estimated to have received the first dose of the diphtheria, tetanus, and pertussis vaccine in 2016, the second lowest vaccination rate in the world for that year.9 Meanwhile, research by Human Rights Watch shows that the president and his inner circle have accumulated incredible wealth while the government frequently harasses members of civil society and political opposition groups.8

Today’s often hostile climate for human rights threatens to undermine health gains the world has achieved in recent decades. Governments and civil society groups concerned with global health should push back against the populist tide and advocate for a firm commitment to human rights and accountability as an integral part of their agendas.
Corresponding Author: Diederik Lohman, MA, Human Rights Watch, Health and Human Rights, 350 Fifth Ave, 34th Floor, New York, NY 10118 (lohmand@hrw.org).
Published Online: January 18, 2018. doi:10.1001/jama.2018.0271

Emergencies

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 06 March 2018 [GPEI]
::  New on http://polioeradication.org/: Japan has provided additional funding to support the Regional Reference Laboratory in Pakistan, whilst we looked at how one family in Afghanistan is helping to vaccinate every child in their community.
:: The Global Commission for Certification of Poliomyelitis Eradication met in Geneva, reviewing the criteria that will need to be met in order to achieve global certification of wild poliovirus (WPV) eradication.
:: On International Women’s Day, we highlighted some of the incredible women working to reach every last child.
:: We are pleased to announce the launch of the Gender and Polio section on our website.
:: Minda Dentler, a champion triathlete, advocate for polio eradication, and polio survivor, spoke at TEDWomen about conquering the world’s toughest triathlon, and what it inspired her to do next.
:: Also released this week are new translations of our animation on the two polio vaccines, now available in Dari and Pashto, and Urdu
 
Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1) positive environmental sample has been reported in Nangarhar province.
Pakistan: Two new WPV1 positive environmental samples have been reported, one collected in Sindh province, and one in Punjab province.
Democratic Republic of the Congo: One case of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, from Tanganyika province.

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Global Commission for Certification of Poliomyelitis Eradication (GCC) reviewed criteria for certification [page link not loading content]
   March 2018 – With fewer cases of WPV reported from fewer countries than ever before, the GCC is accelerating its work to prepare for the eventual certification that WPVs have been eradicated from the world.
 
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WHO Grade 3 Emergencies  [to 10 March 2018]
Nigeria 
:: Lassa Fever – Nigeria  Disease outbreak news   1 March 2018
From 1 January through 25 February 2018, 1081 suspected cases and 90 deaths have been reported from 18 states (Anambra, Bauchi, Benue, Delta, Ebonyi, Edo, Ekite, Federal Capital Territory, Gombe, Imo, Kogi, Lagos, Nasarawa, Ondo, Osun, Plateau, Rivers, and Taraba).      During this period, 317 cases have been classified as confirmed and eight as probable, including 72 deaths (case fatality rate for confirmed and probable cases=22%). A total of 2845 contacts have been identified in 18 states.
Fourteen health care workers have been affected in six states (Benue, Ebonyi, Edo, Kogi, Nasarawa, and Ondo), with four deaths (case fatality rate= 29%). As of 18 February, four out of the 14 health care workers were confirmed positive for Lassa fever…

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WHO Grade 2 Emergencies  [to 10 March 2018]
Central African Republic 
:: Central African Republic: Rapid health assessment
March 2017 — The purpose of this report is to analyze the capacity of the health systems and minimum health needs of the population on the way to early recovery.
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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: 9 Mar 2018  UNHCR’s Grandi appalled at suffering of civilians in Syria
:: The UN and partners plan to deliver humanitarian assistance to eastern Ghouta [EN/AR]  Damascus, 4 March 2018

Yemen 
:: 8 Mar 2018  Yemen Humanitarian Update Covering 26 February – 04 March 2018 | Issue: 05

DRC 
:: Media Advisory: Humanitarian Chief to visit the Democratic Republic of the Congo 11-13 March 2018
 
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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.
Somalia
:: Humanitarian Bulletin Somalia, February 2018  Published on 05 Mar 2018
HIGHLIGHTS
Localized drought conditions worsen as hotspot areas bear the brunt.
Over 1.2 million children will be malnourished in 2018.
London conference draws attention to Somalia crisis.
Somalia Humanitarian Fund supports early action, but more is urgently needed.

  WHO & Regional Offices [to 10 March 2018]

WHO & Regional Offices [to 10 March 2018]
Latest News
WHO issues new guidance on tobacco product regulation
9 March 2018 – Many countries have developed advanced policies to reduce the demand for tobacco, which kills over 7 million people annually, but governments can do much more to implement regulations to control tobacco use, especially by exploiting tobacco product regulation. WHO has launched new guidance on the role tobacco product regulation can play to reduce tobacco demand, save lives and raise revenues for health services to treat tobacco-related disease, in the context of comprehensive tobacco control.
 
Gender equality must be at the core of ‘Health for All’
8 March 2018 – Today, for International Women’s Day, we imagine a world where every woman and girl has access to quality and affordable health care, a world in which women and girls can freely exercise their sexual and reproductive health rights, and one where all women and girls are treated and respected as equals. At WHO, we’re speaking up for women and girls’ right to health.
Statement by Director-General
 
Highlights
Global Commission for Certification of Poliomyelitis Eradication (GCC) reviewed criteria for certification [page link not loading content]
   March 2018 – With fewer cases of WPV reported from fewer countries than ever before, the GCC is accelerating its work to prepare for the eventual certification that WPVs have been eradicated from the world.

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Weekly Epidemiological Record, 9 March 2018, vol. 93, 10 (pp. 105–116)
:: Delivering at the country level: the International Coordinating Group on Vaccine Provision and its impact in 2016 and 2017
 
 
GIN February 2018 pdf, 1.75Mb
5 March 2018

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Kenya Eliminates Maternal and Neonatal Tetanus  10 March 2018
:: Federal Government of Nigeria repositions Polio Committees towards meeting eradication certification standards  09 March 2018
:: Filling the gaps in healthcare services in conflict-affected North-east Nigeria  07 March 2018
:: Dr Moeti Matshidiso awarded the Honorary Fellowship of the London School of Hygiene and Tropical Medicine  06 March 2018
:: WHO convenes a three-day meeting to review the National response to the recent Marburg Virus disease outbreak in Uganda  05 March 2018
:: WHO convenes a three-day meeting to review the National response to the recent Marburg Virus disease outbreak in Uganda  05 March 2018

WHO European Region EURO
:: Call for more women in public health leadership roles 07-03-2018
:: WHO calls on partners to respond to the health and humanitarian needs of Ukrainians 05-03-2018

WHO Eastern Mediterranean Region EMRO
:: WHO responds to humanitarian needs of people living with HIV in Benghazi  8 March 2018
:: Japan to provide substantial support to regional polio laboratory  04 March 2018