Monthly Archives: July 2019

Journal Watch

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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 focu-s 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

Assuring Gender Safety and Equity in Health Care: The Time for Action Is Now

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Annals of Internal Medicine
16 July 2019 Vol: 171, Issue 2
http://annals.org/aim/issue

 

Ideas and Opinions
Assuring Gender Safety and Equity in Health Care: The Time for Action Is Now
Lynn E. Fiellin, MD; Darilyn V. Moyer, MD
Issues of sexual and gender harassment and gender inequity have infiltrated all fields and industries, and health care is no exception. Thirty percent to 50% of female physicians or physicians in training report sexual harassment (1, 2). Therefore, on 1 March 2019, TIME’S UP Healthcare (www.timesuphealthcare.org) was established to bring to the medical field the parent organization’s efforts to hasten action and solutions. Herein, we address concerns regarding gender safety and equity in health care and describe the TIME’S UP Healthcare organization, its goals and activities, and its new partnership with the American College of Physicians (ACP).
A 2018 report by the National Academies of Science, Engineering, and Medicine brought the crisis of sexual harassment in health care to the fore (1). The report covers research describing sexual harassment from the perspective of students, trainees, and faculty. Sexual harassment, a form of discrimination, is composed of gender harassment (the most common form), including verbal and nonverbal hostile behaviors based on one’s…

The need for comprehensive and multidisciplinary training in substandard and falsified medicines for pharmacists

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BMJ Global Health
July 2019 – Volume 4 – 4
https://gh.bmj.com/content/4/4

 

Editorial
The need for comprehensive and multidisciplinary training in substandard and falsified medicines for pharmacists (18 July, 2019)
Alessandra Ferrario, Ebiowei Samuel F Orubu, Moji Christianah Adeyeye, Muhammad H Zaman, Veronika J Wirtz

Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa

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BMJ Global Health
July 2019 – Volume 4 – 4
https://gh.bmj.com/content/4/4

 

Analysis
Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa (3 July, 2019)
Ibrahima Socé Fall, Soatiana Rajatonirina, Ali Ahmed Yahaya, Yoti Zabulon, Peter Nsubuga, Miriam Nanyunja, Joseph Wamala, Charles Njuguna, Charles Okot Lukoya, Wondimagegnehu Alemu, Francis Chisaka Kasolo, Ambrose Otau Talisuna

Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review

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BMJ Global Health
July 2019 – Volume 4 – 4
https://gh.bmj.com/content/4/4

 

Practice
Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review (8 July, 2019)
Julie Watson, Lauren D’Mello-Guyett, Erin Flynn, Jane Falconer, Joanna Esteves-Mills, Alain Prual, Paul Hunter, Benedetta Allegranzi, Maggie Montgomery, Oliver Cumming

 

Building the case for actionable ethics in digital health research supported by artificial intelligence

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BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 20 Jul 2019)

 

Opinion
Building the case for actionable ethics in digital health research supported by artificial intelligence
The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies a…
Authors: Camille Nebeker, John Torous and Rebecca J. Bartlett Ellis
Citation: BMC Medicine 2019 17:137
Published on: 17 July 2019

Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys

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BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 20 Jul 2019)

 

Research article
Uptake of maternal care and childhood immunization among ethnic minority and Han populations in Sichuan province: a study based on the 2003, 2008 and 2013 health service surveys
China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, bu…
Authors: Juying Zhang, Yuchan Mou, Jiaqiang Liao, Huaying Xiong, Zhanqi Duan, Yuan Huang and Carine Ronsmans
Citation: BMC Pregnancy and Childbirth 2019 19:250
Published on: 16 July 2019

Establishing a theoretical foundation for measuring global health security: a scoping review

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BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 20 Jul 2019)

 

Research article
Establishing a theoretical foundation for measuring global health security: a scoping review
Since the 2014–2016 West Africa Ebola epidemic, the concept of measuring health security capacity has become increasingly important within the broader context of health systems-strengthening, enhancing responses to public health emergencies, and reducing global catastrophic biological risks. Efforts to regularly and sustainably track the evolution of health security capabilities and capacities over time – while also accounting for political, social, and environmental risks – could help countries progress toward eliminating sources of health insecurity. We sought to aggregate evidence-based principles that capture a country’s baseline public health and healthcare capabilities, its health security system performance before and during infectious disease crises, and its broader social, political, security, and ecological risk environments…. We synthesized four foundational principles for measuring global health security: measurement requires assessment of existing capacities, as well as efforts to build core public health, healthcare, and biosecurity capabilities; assessments of national programs and efforts to mitigate a critical subset of priority threats could inform efforts to generate useful metrics for global health security; there are measurable enabling factors facilitating health security-strengthening efforts; and finally, measurement requires consideration of social, political, and ecological risk environments.
Authors: Sanjana J. Ravi, Diane Meyer, Elizabeth Cameron, Michelle Nalabandian, Beenish Pervaiz and Jennifer B. Nuzzo
Citation: BMC Public Health 2019 19:954
Published on: 17 July 2019

Preserving Civility in Vaccine Policy Discourse – A Way Forward

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JAMA
July 16, 2019, Vol 322, No. 3, Pages 183-282
http://jama.jamanetwork.com/issue.aspx

 

Viewpoint
Preserving Civility in Vaccine Policy Discourse – A Way Forward
Gregory A. Poland, MD; Jon C. Tilburt, MD; Edgar K. Marcuse, MD
free access
JAMA. 2019;322(3):209-210. doi:10.1001/jama.2019.7445
This Viewpoint calls out the threat to vaccine policy posed by a very small number of antivaccine (“antivax”) advocates who disrupt attempts to engage vaccine-hesitant persons in public hearings about risks and benefits of vaccination and, acknowledging the concerns of a skeptical public, calls for a renewed commitment to civility in discussing public health policy.

Safety and Immunogenicity of a 2-Dose Heterologous Vaccination Regimen With Ad26.ZEBOV and MVA-BN-Filo Ebola Vaccines: 12-Month Data From a Phase 1 Randomized Clinical Trial in Uganda and Tanzania

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Journal of Infectious Diseases
Volume 220, Issue 1, 1 July 2019
https://academic.oup.com/jid/issue/220/1

 

MAJOR ARTICLES AND BRIEF REPORTS
Safety and Immunogenicity of a 2-Dose Heterologous Vaccination Regimen With Ad26.ZEBOV and MVA-BN-Filo Ebola Vaccines: 12-Month Data From a Phase 1 Randomized Clinical Trial in Uganda and Tanzania
Zacchaeus Anywaine, Hilary Whitworth, Pontiano Kaleebu, George Praygod, Georgi Shukarev …
The Journal of Infectious Diseases, Volume 220, Issue 1, 1 July 2019, Pages 46–56, https://doi.org/10.1093/infdis/jiz070
This phase 1 study demonstrated that heterologous prime-boost vaccination with Ad26.ZEBOV and MVA-BN-Filo Ebola vaccines at intervals of 28 or 56 days was well tolerated and immunogenic in healthy African adult volunteers.

Safety and Immunogenicity of a 2-Dose Heterologous Vaccine Regimen With Ad26.ZEBOV and MVA-BN-Filo Ebola Vaccines: 12-Month Data From a Phase 1 Randomized Clinical Trial in Nairobi, Kenya

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Journal of Infectious Diseases
Volume 220, Issue 1, 1 July 2019
https://academic.oup.com/jid/issue/220/1

 

Safety and Immunogenicity of a 2-Dose Heterologous Vaccine Regimen With Ad26.ZEBOV and MVA-BN-Filo Ebola Vaccines: 12-Month Data From a Phase 1 Randomized Clinical Trial in Nairobi, Kenya
Gaudensia Mutua, Omu Anzala, Kerstin Luhn, Cynthia Robinson, Viki Bockstal …
The Journal of Infectious Diseases, Volume 220, Issue 1, 1 July 2019, Pages 57–67, https://doi.org/10.1093/infdis/jiz071
This phase 1 study demonstrated that 2-dose vaccination with Ad26.ZEBOV and MVA-BN-Filo vaccines was well tolerated and induced durable immune responses to Ebola virus in healthy African volunteers for up to 360 days after the priming dose.

Diversity and international collaboration should not become casualties of anti-espionage policies

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Nature
Volume 571 Issue 7765, 18 July 2019
http://www.nature.com/nature/current_issue.html

 

Editorial | 09 July 2019
Diversity and international collaboration should not become casualties of anti-espionage policies
US universities have a responsibility to defuse the climate of suspicion hanging over their Chinese and Chinese American communities.

Controlling CRISPR-Cas9 Gene Editing

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New England Journal of Medicine
July 18, 2019 Vol. 381 No. 3
http://www.nejm.org/toc/nejm/medical-journal

 

Clinical Implications of Basic Research
Controlling CRISPR-Cas9 Gene Editing
Steven F. Dowdy, Ph.D.
Off-target DNA editing by the CRISPR-Cas9 ribonucleoprotein nuclease in the experimental treatment of genetic disease is a safety concern. A recent study provides proof of principle of an oligonucleotide-based “quencher” that blocks its activity.

The catalytic role of a research university and international partnerships in building research capacity in Peru: A bibliometric analysis

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PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 20 Jul 2019)

 

Research Article
The catalytic role of a research university and international partnerships in building research capacity in Peru: A bibliometric analysis
Christopher W. Belter, Patricia J. Garcia, Alicia A. Livinski, Fabiola Leon-Velarde, Kristen H. Weymouth, Roger I. Glass
| published 15 Jul 2019 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0007483

Potential use of microarray patches for vaccine delivery in low- and middle- income countries

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

Review article Open access
Potential use of microarray patches for vaccine delivery in low- and middle- income countries
Nicolas Peyraud, Darin Zehrung, Courtney Jarrahian, Collrane Frivold, … Birgitte Giersing
Pages 4427-4434

Differences between coverage of yellow fever vaccine and the first dose of measles-containing vaccine: A desk review of global data sources

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

Research article Abstract only
Differences between coverage of yellow fever vaccine and the first dose of measles-containing vaccine: A desk review of global data sources
Nedghie Adrien, Terri B. Hyde, Marta Gacic-Dobo, Joachim Hombach, … Philipp Lambach
Pages 4511-4517

The privilege paradox: Geographic areas with highest socio-economic advantage have the lowest rates of vaccination

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

Research article Abstract only
The privilege paradox: Geographic areas with highest socio-economic advantage have the lowest rates of vaccination
Gabrielle M. Bryden, Matthew Browne, Matthew Rockloff, Carolyn Unsworth
Pages 4525-4532

Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

Research article Open access
Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning
Jessica A. Fleming, Alister Munthali, Bagrey Ngwira, John Kadzandira, … Niranjan Bhat
Pages 4568-4575

Smartphone app uses loyalty point incentives and push notifications to encourage influenza vaccine uptake

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

Research article Abstract only
Smartphone app uses loyalty point incentives and push notifications to encourage influenza vaccine uptake
Leila Pfaeffli Dale, Lauren White, Marc Mitchell, Guy Faulkner
Pages 4594-4600

Chile’s National Advisory Committee on Immunization (CAVEI): Evidence-based recommendations for public policy decision-making on vaccines and immunization

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Vaccine
Volume 37, Issue 32 Pages 4419-4658 (26 July 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/32

 

History of Vaccinology papers
Research article Open access
Chile’s National Advisory Committee on Immunization (CAVEI): Evidence-based recommendations for public policy decision-making on vaccines and immunization
Jeannette Dabanch, Cecilia González, Jaime Cerda, Johanna Acevedo, … Magdalena Bastías
Pages 4646-4650

Pertussis Vaccination Failure in the New Zealand Pediatric Population: Study Protocol

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Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 20 Jul 2019)

 

Open Access Protocol
Pertussis Vaccination Failure in the New Zealand Pediatric Population: Study Protocol
by Hannah Chisholm, Anna Howe, Emma Best and Helen Petousis-Harris
Vaccines 2019, 7(3), 65; https://doi.org/10.3390/vaccines7030065 – 16 July 2019
Abstract
Pertussis vaccines have been effective at reducing pertussis-associated morbidity and mortality. However, they have a complex array of limitations, particularly associated with the duration of protection against clinical disease and imperfect immunity (carriage and transmission). Little is known about risk factors for pertussis vaccination failure. Understanding pertussis vaccination failure risk is most important in the paediatric population. This study aims to investigate risk factors for pertussis vaccination failure in (1) infants between birth and six weeks of age born to mothers who received pertussis booster vaccinations during pregnancy and (2) infants after the completion of the primary series (approximately five months old) to four years old. This will be achieved in a two-step process for each study group. Pertussis vaccination failure cases will first be described using a case series study design, relevant case characteristics will be sourced from six national administrative datasets. The case series study results will help select candidate risk factors (hypothesis generating step) to be tested in the retrospective cohort study (hypothesis testing step). Pattern analysis will be used to investigate risk factor patterns in the cohort study. The identification of higher risk groups enables targeting strategies, such as additional doses, to better prevent pertussis disease

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

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

The Journal of Law, Medicine & Ethics
First Published July 12, 2019
Research Article
Legal and Policy Responses to Vaccine-Preventable Disease Outbreaks
L Barraza, D Reiss, P Freeman –
Abstract
Laws and policies are vital tools in preventing outbreaks and limiting the further spread of disease, but they can vary in content and implementation. This manuscript provides insight into challenges in responding to recent vaccine-preventable disease outbreaks by examining legislative changes in California, policy changes on certain university campuses, and the laws implicated in a measles outbreak in Minnesota.

First Published July 12, 2019
Research Article
Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency
G Sunshine, N Barrera, AJ Corcoran, M Penn
Abstract
Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.

 

Cancer
First published: 10 July 2019
https://doi.org/10.1002/cncr.32379
Original Article
Intent and subsequent initiation of human papillomavirus vaccine among young cancer survivors
B Cherven, SM Castellino, Y Chen, FL Wong, JM York… –
Background
Despite an increased risk of subsequent human papillomavirus (HPV)–related malignancies, HPV vaccine initiation rates among cancer survivors remain critically low. The purpose of this study was to determine the relationship between HPV vaccine intent and subsequent vaccine initiation among cancer survivors by linking data from a cross‐sectional survey with state‐based immunization registry records.

 

Frontiers in Public Health
Received: 08 Jan 2019; Accepted: 16 Jul 2019.
Methods ARTICLE
Assessing vaccine herd protection by killed whole-cell oral cholera vaccines using different study designs
M Ali, JD Clemens –
Abstract
The population level effectiveness of a vaccine may arise as the result of direct protection of vaccinees and vaccine herd protection, which may protect non-vaccinees, vaccinees, or both. Indirect, total, enhanced and overall vaccine protection are measures of vaccine herd protection. The level of population level effectiveness induced by a vaccine depends on many factors, including the level of vaccine protective efficacy, the magnitude and distribution of vaccine coverage at a point in time and the extent to which different groups mix with one another in the community. Data on vaccine herd protection are important in the assessment of the public health importance and cost-effectiveness of many vaccines. Killed whole-cell (WC) oral cholera vaccines (OCVs) have been evaluated for herd protection in various study settings, leveraging geographic information system (GIS) tools for the analyses. This article provides a brief description of the herd protective effects of killed WC OCVs measured using various study deigns that include a) individually randomized, controlled clinical trials, b) cluster randomized clinical trials, c) observational cohort studies, and d) observational case-control studies. In all of the study designs, significant herd protection was observed in unvaccinated persons as well as in the community as a whole. The findings of these studies suggest that using killed WC OCV as a public health tool for controlling cholera is impactful and cost-effective.

Media/Policy Watch

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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 20 Jul 2019
[No new, unique, relevant content]

 

BBC
http://www.bbc.co.uk/
Accessed 20 Jul 2019
[No new, unique, relevant content]

 

The Economist
http://www.economist.com/
Accessed 20 Jul 2019
[No new, unique, relevant content]

 

Financial Times
http://www.ft.com/home/uk
Accessed 20 Jul 2019
July 15, 2019
Tedros Adhanom Ghebreyesus
Anti-vaxxers distract from a more serious threat

 

Forbes
http://www.forbes.com/
Accessed 20 Jul 2019
[No new, unique, relevant content]

 

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 20 Jul 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 20 Jul 2019
[No new, unique, relevant content]

 

The Guardian
http://www.guardiannews.com/
Accessed 20 Jul 2019
Opinion
Ebola
The Guardian view on Ebola in the DRC: help needed – and dialogue too
Editorial
The second largest outbreak of the disease has already sickened thousands. WHO’s declaration of an emergency of international concern should prompt more and better support
Thu 18 Jul 2019 13.27 EDT Last modified on Fri 19 Jul 2019 05.48 EDT

 

New Yorker
http://www.newyorker.com/
Accessed 20 Jul 2019
[No new, unique, relevant content]

 

New York Times
http://www.nytimes.com/
Accessed 20 Jul 2019
Africa
Congo Soldiers, Police to Enforce Ebola Emergency Measures
Congolese soldiers and police will enforce hand-washing and fever checks now that the deadly Ebola outbreak has been declared an international health emergency , authorities said Thursday.
July 18 By The Associated Press

Europe
Britain Tells Canada and France to Pull Their Weight on Ebola
Britain’s international development minister Rory Stewart called on France and Canada on Monday to offer more help in tackling the Ebola outbreak in Democratic Republic of Congo.
By Reuters
July 15

Health
Polio Cases Surge in Pakistan and Afghanistan
False rumors that children are fainting or dying have led parents to turn away vaccinators, threatening the campaign to eradicate the disease.
By Donald G. McNeil Jr.

 

Washington Post
http://www.washingtonpost.com/
Accessed 20 Jul 2019
Editorial Board · Editorial-Opinion ·
The vaccine challenge isn’t just about getting shots
Jul 19, 2019

Foreign
Germany introducing mandatory measles vaccination for kids
Associated Press · · Jul 17, 2019

Think Tanks et al

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Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 20 Jul 2019
[No new relevant content]

 

Center for Global Development
http://www.cgdev.org/page/press-center
[No new relevant content]

 

CSIS
https://www.csis.org/
Accessed 20 Jul 2019
[No new relevant content]

 

Council on Foreign Relations
http://www.cfr.org/
Accessed 20 Jul 2019
July 18, 2019
Democratic Republic of Congo
Ebola Reaches DRC Border City of Two Million, WHO Responds
The recent designation of Ebola as a “public health emergency of international concern” by the World Health Organization (WHO) is a positive development in efforts to contain the disease. The decision highlights the importance of containing the disease to an international audience; the WHO’s designation is being widely carried by the international media.
Blog Post by John Campbell Africa in Transition

 

Kaiser Family Foundation
https://www.kff.org/search/?post_type=press-release
Accessed 20 Jul 2019
[No new relevant content]

Vaccines and Global Health: The Week in Review :: 13 July 2019

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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_13 Jul 2019

– 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

DRC – Ebola/Cholera/Polio/Measles

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Milestones :: Perspectives :: Research

 

DRC – Ebola/Cholera/Polio/Measles

Disease Outbreak News (DONs}
Ebola virus disease – Democratic Republic of the Congo
11 July 2019
The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. While the number of new cases continues to ease in former hotspots, such as Butembo, Katwa and Mandima health zones, there has been an increase in cases in Beni, and a high incidence of cases continues in parts of Mabalako Health Zone. In addition to these re-emerging hotspots, there are a large number of people with confirmed and probable infections moving to other health zones, with the greatest number coming from Beni Health Zone. The movement of cases causes the outbreak to spread to new health zones and re-emerge in health zones with previously controlled infections. Overall, this underscores the importance of robust mechanisms for listing and following up contacts and understanding the motivations for peoples’ decisions to move…

 

::::::

CDC Lab Research Shows Two Treatments Effective Against DRC Ebola Strain
Tuesday, July 9, 2019
New research by the Centers for Disease Control and Prevention (CDC) shows two investigational Ebola treatments being used in the ongoing outbreak in eastern Democratic Republic of the Congo (DRC) are effective in laboratory studies.

The treatments – the antiviral remdesivir and antibodies in the ZMapp treatment – blocked growth of the virus strain causing the outbreak in human cells in the laboratory. The research suggests these treatments hold promise for allowing patients to recover from the deadly illness. The research will be published Tuesday, July 9, in Lancet Infectious Diseases.

Importantly, the study also shows that the lab test most often used in DRC and neighboring countries to diagnose Ebola – which was developed during the 2014-2016 West Africa outbreak for use against a different strain of Ebola virus – appears to be accurate for the outbreak strain now circulating in DRC, which researchers are calling the Ituri strain. The Ituri strain and the strain that caused the West Africa outbreak are both strains of Ebola virus (formerly called Ebola Zaire).

“All of the treatments being tested in the current DRC outbreak were developed to fight Ebola viruses from previous outbreaks,” said Laura McMullan, Ph.D., CDC microbiologist and the paper’s lead author. “RNA viruses are always mutating – and because Ebola is an RNA virus it’s vitally important to make sure existing treatments work against the virus that’s making people sick now.”

How and Why This Research Was Done
Lacking samples from patients infected with the Ebola virus strain causing the current outbreak, CDC laboratory scientists reconstructed the Ituri strain of Ebola virus using reverse genetics in the CDC Biosafety Level 4 laboratory, under the highest level of biosecurity and safety. They based this work on virus sequence data generated from recent patient samples by the DRC National Institute of Biomedical Research (INRB) and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and published in GenBank, an open-access database for pathogen sequences.

By having access to the virus strain, CDC laboratory experts can learn more about the Ituri strain and how it fits into the Ebola virus family tree, which may provide clues to finding additional promising treatments. The scientists will also be able to test new therapies as they are developed to see if they can effectively fight against the actual virus making people sick. They will also be able to compare it to future Ebola strains to explore how the virus changes over time.

“This work has benefits beyond the current study. Having access to this virus will allow us to explore whether other compounds or potential therapies affect the virus in the lab,” said Inger Damon, M.D., PhD, chief strategy officer for the CDC’s 2018 Ebola response and director of CDC’s Division of High-Consequence Pathogens and Pathology. “We hope the knowledge gained from this work can be translated into safe and effective therapies to help cure Ebola patients.”

Laboratory experts within CDC’s Viral Special Pathogens Branch have been testing compounds and antivirals since 2007 to look for potential treatments for viral hemorrhagic fevers – some of the world’s deadliest diseases, including Ebola and Marburg. In addition to assessing the effectiveness of remdesivir and the antibodies in the ZMapp cocktail against the Ituri strain, CDC researchers also encourage the future testing of the investigational vaccine being used in DRC and of other investigational therapies – such as mAb114 and Regeneron’s REGN-3EB against the current Ebola Ituri virus.

The current DRC outbreak is the second-largest ever recorded and DRC’s tenth Ebola outbreak since 1976. To date, more than 2,400 people have become infected and more than 1,600 have died. Uganda also has reported three travel-associated deaths tied to a DRC Ebola patient. Armed conflicts and public mistrust in the area have complicated public health response efforts. Despite efforts from the DRC Ministry of Health and international health partners, including CDC, the current outbreak has continued for 10 months.

The research will be available on the Lancet Infectious Diseases websiteexternal icon at 6:30 p.m. EST Tuesday, July 9. For more information on Ebola and the current DRC outbreak, please visit www.cdc.gov/ebola.

 

::::::

Press release
Vaccination to contain severe measles outbreak underway in the Democratic Republic of the Congo amidst Ebola and mass displacement
Campaign led by the Ministry of Health with support from UNICEF and MSF

ITURI, Democratic Republic of the Congo/DAKAR/GENEVA/NEW YORK, 11 July 2019 – Health workers are urgently rolling out a complex measles vaccination campaign targeting 67,000 children in Ituri, northeast Democratic Republic of the Congo (DRC), a region ravaged by armed conflict that is now also the hub of the second-deadliest Ebola outbreak on record.

At least 1,981 deaths due to measles have been reported across the DRC this year, over two-thirds of them among children below 5 years old. As of 23 June, nearly 115,000 cases of suspected measles had been reported, far more than the 65,000 recorded in all of 2018.
Ituri, one of the two provinces (the other is North Kivu) struck by Ebola since the outbreak began nearly a year ago, has recorded over 5,400 cases and 50 deaths.

“The combined threat of Ebola and measles for the thousands of families living in overcrowded and unsanitary displacement camps is unprecedented,” said UNICEF DRC Representative Edouard Beigbeder. “We have a small window to prevent a potentially massive loss of life.”

The first sites targeted for measles vaccinations are four displacement camps in Bunia, Ituri, that have seen a huge influx of families forcibly uprooted by fighting in recent weeks. The boundary of one camp, located alongside Bunia’s General Hospital, is less than 100 metres away from an Ebola treatment center. It is also less than 3 kilometres away from parts of Bunia that have seen 5 Ebola cases since the start of the outbreak, 2 of them in the past three weeks.

The Ebola outbreak means the measles vaccination campaign must incorporate extra measures to protect against infection and meticulous triage. Health workers will need to wear gowns to prevent contact with blood or other body fluids. Teams will include an additional health worker who will evaluate and refer suspected Ebola cases, check temperatures and oversee handwashing and other safety measures.

An additional layer of complexity is that some of the early symptoms of Ebola – fever, redness around the eyes, diarrhoea – are virtually indistinguishable from those of measles, malaria or cholera – all of which are prevalent, especially in severely congested displacement sites.

Up to 400,000 people are thought to be internally displaced across Ituri, the vast majority of them women and children. Many live in about 35 camps scattered throughout the province, in territory that is virtually inaccessible due to insecurity. Fighting among various armed groups has damaged or destroyed up to half the health facilities and schools in the province.

“The northeastern part of DRC is home to one of the worst humanitarian crises today. Whether it is from measles, Ebola, or the reality of living in a displacement camp, children are at grave risk. We must do everything we can to protect them,” Beigbeder said.

Measles campaigns are also being planned for Tchomia and Nyankunde health zones.

As of 8 July, there were 2,428 cases of Ebola, with 1,641 deaths. Almost 30 per cent of cases are among children.

Time to vaccinate against hesitancy

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Nature Medicine
Volume 25 Issue 7, July 2019
https://www.nature.com/nm/volumes/25/issues/7
Editorial | 03 July 2019
Time to vaccinate against hesitancy
Recent measles outbreaks worldwide highlight the urgency of tracking and countering vaccine hesitancy to ensure the continued success of immunization programs.

In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan, whose goals included eliminating measles in at least five out of the six World Health Organization (WHO) regions by 2020. This goal seemed attainable, given the gains in measles vaccine coverage in low-income countries during the previous decade. And yet, in 2019, measles has surged worldwide. According to the World Health Organization (WHO), three times as many cases were reported in January through March of 2019 than during the same period in 2018. The United States, which had declared that locally transmitted measles was eliminated within its borders in 2000, has already reported the largest number of cases in any year since 1992 (https://www.cdc.gov/measles/cases-outbreaks.html).

Vaccine hesitancy, defined as a delay in vaccination or a refusal to vaccinate in spite of vaccine availability, has played a major role in driving outbreaks in all regions. At the beginning of 2019, the WHO declared vaccine hesitancy one of the top ten threats to global health. Routine and supplemental immunizations are a cornerstone of preventive health and wellness, but are threatened by gaps in coverage. The ongoing measles outbreaks, although tragic, provide an opportunity for health authorities to rebuild and preserve trust in immunization programs by promoting the uptake of tools to measure vaccine hesitancy, thus better supporting health care providers as they engage with patients and field-test new messaging approaches in communities that have different reasons for delaying or refusing vaccines.

Measles vaccines are the poster child for successful vaccine design and potential disease control, but a mix of complacency, fear and challenges to vaccine access have stymied vaccine coverage efforts. Although there are now a number of published tools to measure attitudes toward vaccination, in an analysis of data collected from 2014 to 2016, only 30% of WHO member countries reported performing assessments of vaccine hesitancy in the previous 5 years (S. Lane, N. E. MacDonald, M. Marti and L. Dumolard, Vaccine 36, 3861–3867; 2018). In the future, it will be important for more countries to routinely measure vaccine hesitancy and dissect which distinct factors are contributing on per-country and even more localized bases, a strategy that might help better anticipate gaps in vaccine coverage.

In the same analysis, one of the top three cited reasons for vaccine hesitancy was concerns related to the safety and side effects of vaccines. The detrimental effects of anti-vaccine messaging have thus far proven challenging to overcome. Primary health care providers already have an important influence in the decision to vaccinate and are therefore well placed to discuss the monitoring systems that ensure vaccine safety. However, to communicate this message even more effectively, providers themselves must have a strong grasp of the principles underpinning vaccine development, scheduling and surveillance, because such an understanding has been shown to increase providers’ confidence in promoting immunization (Paterson, P. et al., Vaccine 34, 6700–6706; 2016). In addition, some public health researchers feel that if vaccine counseling were better reimbursed by insurance companies, more health care providers in countries with healthcare systems such as that in the United States might be motivated to take on the time commitment of having these dialogues.

More information is still needed about which approaches best convey the benefits of immunization and address the concerns of parents who delay or refuse vaccines. One study has found that common fear-based messages might actually backfire (B. Nyhan, J. Reifler, S. Richey and G. L. Freed, Pediatrics 133, e835–e842; 2014). In that study, parents randomly received one of four interventions designed to provide information about the safety of the measles–mumps–rubella vaccine or the risks of contracting these diseases. Those who were given images of children sick with measles, mumps or rubella were actually more likely to believe in the discredited link between vaccines and autism. New studies are needed to test the efficacy of more refined motivational or empathetic communication, with the caveat that there will be no one-size-fits-all strategy in light of the varied contextual factors that contribute to the lack of vaccine confidence. In addition to addressing the needs of caregivers, approaches designed to enhance preventive-care education of young adults, including those in college, could mitigate gaps in vaccine knowledge and confidence later in life. Social media has been rightly lambasted for its role in perpetuating irresponsible and dangerous beliefs about vaccine safety and efficacy, but attention has mostly focused on how to block the spread of spurious misinformation on online platforms. Immunization programs should also better leverage social media to respond to determinants of vaccine hesitancy in different communities.

If measles continues to circulate in the United States through the fall, the country is at danger of losing its elimination status. Importantly, the effects of vaccine hesitancy extend beyond measles vaccines. If elimination of measles, a relatively simple disease to control, cannot be achieved, the possibility of elimination of other vaccine-preventable diseases with more complex dynamics and variable vaccine efficacy seems less likely. Restricting allowable exemptions from vaccination for school-age children, although a welcome development in response to the outbreaks in regions of the United States, would provide only part of the solution. To be truly effective, immunization programs must improve both education and outreach by incorporating strategies to measure and respond to vaccine hesitancy. Unless this epidemic is used to galvanize these changes, the United States will be no better prepared to prevent the next outbreak.

WHO updates global guidance on medicines and diagnostic tests to address health challenges, prioritize highly effective therapeutics, and improve affordable access

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World Health Organization model list of essential medicines: 21st list – 2019
WHO/MVP/EMP/IAU/2019.06 : 60 pages
PDF: WHO-MVP-EMP-IAU-2019.06-eng.pdf (‎951.1Kb)‎
19.3 Vaccines [p.44]

News release
WHO updates global guidance on medicines and diagnostic tests to address health challenges, prioritize highly effective therapeutics, and improve affordable access
New essential medicines and diagnostics lists published today
9 July 2019 Geneva
WHO’s Essential Medicines List and List of Essential Diagnostics are core guidance documents that help countries prioritize critical health products that should be widely available and affordable throughout health systems.

Published today, the two lists focus on cancer and other global health challenges, with an emphasis on effective solutions, smart prioritization, and optimal access for patients.

“Around the world, more than 150 countries use WHO’s Essential Medicines List to guide decisions about which medicines represent the best value for money, based on evidence and health impact,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The inclusion in this list of some of the newest and most advanced cancer drugs is a strong statement that everyone deserves access to these life-saving medicines, not just those who can afford them.”

 

The Essential Medicines List (2019)
Cancer treatments: While several new cancer treatments have been marketed in recent years, only a few deliver sufficient therapeutic benefits to be considered essential. The 12 medicines WHO added to the new Medicines List for five cancer therapies are regarded as the best in terms of survival rates to treat melanoma, lung, prostate, multiple myeloma and leukemias cancers.

For example, two recently developed immunotherapies (nivolumab and pembrolizumab) have delivered up to 50% survival rates for advanced melanoma, a cancer that until recently was incurable.

Antibiotics: The Essential Medicines Committee strengthened advice on antibiotic use by updating the AWARE categories, which indicate which antibiotics to use for the most common and serious infections to achieve better treatment outcomes and reduce the risk of antimicrobial resistance.  The committee recommended that three new antibiotics for the treatment of multi-drug resistant infections be added as essential…

Bioethics International’s Good Pharma Scorecard Improved the Data-Sharing Practices of Large Pharmaceutical Companies

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Bioethics International’s Good Pharma Scorecard Improved the Data-Sharing Practices of Large Pharmaceutical Companies
NEW HAVEN, Conn., July 10, 2019 /PRNewswire/ — Bioethics International (BEI), a not-for-profit organization dedicated to raising the bar on ethics, trustworthiness and patient-centricity in the pharmaceutical industry, today announced the third publication of its Good Pharma Scorecard (GPS) in The BMJ. The GPS is an annual ranking of new drugs and the associated pharmaceutical companies on their ethics performance. This year’s rankings focus on clinical transparency and data-sharing practices in large pharmaceutical companies, specifically on trial registration, results reporting, publication and data-sharing practices.  BEI, in collaboration with Yale School of Medicine and Stanford Law School, developed new data sharing measures, which were informed by a multi-stakeholder advisory team.

Two companies, Novo Nordisk and Roche, tied for the top rank in overall trial transparency, each with scores of 100%. Novo Nordisk, Roche, Novartis and Janssen/Johnson & Johnson all achieved scores of 100% on the data-sharing measure.

In addition to measuring companies’ data-sharing practices, the study tested whether the GPS ranking tool could improve companies’ practices. BEI provided companies a 30-day window to amend their policies to meet the new data-sharing measure. At the end of the window, three companies improved their policies.  Additionally, since the first GPS published rankings in 2015, the industry’s overall median transparency scores have gone up year after year.

“A goal of the GPS is to help set ethics and social responsibility measures in the pharma industry and provide an independent tracking tool to both recognize best practices and catalyze reform, where needed, in companies,” said Jennifer E. Miller, Ph.D., founder of Bioethics International, assistant professor at the Yale School of Medicine and lead author on the paper.

“We are encouraged by the efforts of some large companies to share patient-level trial data and a willingness to improve policies and practices, where needed. However, there is substantial room for improvement. Providing companies with a consistent, fair and achievable set of measures is important to encouraging and tracking further progress toward routine data sharing.”…