Milestones :: Perspectives :: Research

Gavi sets ambitious goal to immunise 300 million people by 2025, leaving no one behind 
Yokohama/Geneva, 30 August 2019 – Gavi, the Vaccine Alliance has called on donors to back plans to immunise an additional 300 million children, saving up to eight million lives, in developing countries between 2021 and 2025, launching a fundraising drive of at least US$ 7.4 billion. A total of US$ 3.6 billion will be invested by developing country governments in their own vaccine programmes over the period, up from US$ 1.6 billion in 2016-2020.

The Investment Opportunity sets out how Gavi will provide the most comprehensive and cost-effective preventive health package in history. In Gavi’s first phase, beginning in 2000, it supported six basic vaccines; by 2025 this will rise to 18, including new support for inactivated polio vaccine (IPV), rabies and multivalent meningococcal vaccines, as well as funding for an Ebola vaccine stockpile once it is prequalified by the WHO. In its next phase the Vaccine Alliance will protect children against childhood diseases, adolescents against cervical cancer through the scaling up of human papillomavirus (HPV) vaccine support, and the world against deadly outbreaks of Ebola, cholera, yellow fever and meningitis through support for vaccine stockpiles.

The 2021-25 Investment Opportunity was launched at a special event at the Seventh Tokyo International Conference on African Development (TICAD) in Yokohama co-hosted by the Japanese government, which has supported Gavi with around US$ 150 million since 2011. Access to vaccination was also included in the Osaka G20 Leaders’ Declaration in June. TICAD 7 has brought together representatives of African countries, international organisations, development partners, private companies, civil society and others under the theme of ‘advancing Africa’s development through people, technology and innovation’…

Milestones :: Perspectives :: Research

European Region loses ground in effort to eliminate measles
Press release, WHO Europe
Copenhagen 29 August 2019
Following several years of steady progress toward elimination of measles in the WHO European Region, the number of countries having achieved or sustained elimination of the disease has declined. This was the conclusion of the European Regional Verification Commission for Measles and Rubella Elimination (RVC) based on an assessment of annual status updates for 2018 submitted by the 53 Member States of the Region.

The RVC determined that for the first time since the verification process began in the Region in 2012, 4 countries (Albania, Czechia, Greece and the United Kingdom) lost their measles elimination status.

“Re-establishment of measles transmission is concerning. If high immunization coverage is not achieved and sustained in every community, both children and adults will suffer unnecessarily and some will tragically die,” says Dr Günter Pfaff, Chair of the RVC.

The RVC was, on the other hand, pleased to conclude that Austria and Switzerland attained elimination status, having demonstrated the interruption of endemic transmission for at least 36 months.

For the Region as a whole, as of the end of 2018, 35 countries are considered to have achieved or sustained measles elimination (compared to 37 for 2017), 2 have interrupted the endemic transmission of measles (for 12–35 months), 12 remain endemic for measles and 4 that had previously eliminated the disease have re-established measles transmission.

The surge in cases that began in 2018 has continued into 2019, with approximately 90 000 cases reported for the first half of the year. This is already more than that recorded for the whole of 2018 (84,462)…

Milestones :: Perspectives :: Research

Gavi and Japanese growth equity fund collaborate to support innovative startups for immunisation 
:: Vaccine Alliance launches US$ 7.4 billion fundraising drive to deliver highest return on investment to date offering broad protection against 18 diseases, saving up to eight million lives from 2021-25
:: Developing countries set to make largest investment in their own vaccine programmes in history, more than doubling the amount invested in the 2016-2020 period
:: Sustained investment needed to secure prosperity for the next generation, prevent resurgence of diseases and protect from frequent outbreaks made worse by climate change, urbanisation and conflicts

Yokohama, 28 August 2019 – Gavi, the Vaccine Alliance and Asia Africa Investment and Consulting (AAIC), a Japanese growth equity fund based in Singapore, have agreed to a collaboration that will help companies offering innovations to improve the delivery and availability of vaccines in developing countries. Gavi and AAIC signed the agreement at the Seventh Tokyo International Conference on African Development (TICAD), where Gavi is unveiling its 2021 to 2025 Investment Opportunity.

AAIC will provide funding of up to US$ 3 million for two years to companies that AAIC identifies through Gavi’s accelerator programme, Innovation for Uptake, Scale and Equity in Immunisation, or INFUSE. The funding from AAIC will focus on INFUSE finalists, known as Pacesetters, that are supporting early- and growth-stage health care companies operating in Africa to scale new cost-effective immunisation products and services…

Milestones :: Perspectives :: Research

Opinion
Pinterest takes the right step toward curbing misinformation on vaccines
Washington Post
The Post’s View by Editorial Board
August 30 at 6:04 PM
HOW TO explain that one of the most effective medical innovations of all time is experiencing a crisis of confidence? That’s the situation with vaccines, which save millions of lives every year and especially help children fight disease.

A tide of “vaccine hesitancy,” reluctance to get inoculated because of unfounded fears and misinformation, is rising in the United States and throughout the world. The World Health Organization has identified vaccine hesitancy as one of the 10 most urgent public health challenges of this year.

The WHO director-general, Tedros Adhanom Ghebreyesus, pointed out recently that 20 million children worldwide simply lack access to vaccines because of war, weak primary health-care systems, poverty or unstable governments. But hesitancy among those who do have access is often the result of misinformation on social media, which can spread quickly.

For example, last spring, panic spread among parents in Pakistan because of a scaremongering video on Twitter that showed children seemingly collapsing after getting an expired vaccine. The video was obviously fake, but the panic was not, and it forced the suspension of a national immunization campaign.

Social media has also been responsible for spreading misinformation about vaccines for measles, a highly contagious illness that can have serious complications. So far this year in the United States, there have been 1,215 individual cases of measles, mostly unvaccinated individuals, the highest number of cases since 1992.

Last year, Pinterest, the social media platform, disabled search for terms such as “vaccines” or “cancer cure” because it realized the results were filled with misinformation. The platform says it discovered that, online, “anti-vaccine content is contagious” — it spreads quickly because it is more accessible, more visually compelling and more widely spread than scientific data.

Now, the platform has taken a laudable step toward changing this dynamic. On Aug. 28, Pinterest announced that it will provide information from only leading public health institutions, including the WHO, the Centers for Disease Control and Prevention, the American Academy of Pediatrics and the WHO-established Vaccine Safety Net, “a global network of websites providing reliable vaccine safety information.” Moreover, it won’t show comments, recommendations or ads, so this is not just a case of displaying correct information next to the dodgy, but rather a genuine effort to present authoritative data to its 300 million monthly users.

The principle here is worthy: With free speech comes responsibility, in this case, to not spread misinformation that can lead to illness and death. Other social media platforms are also acting against anti-vaccination information, but Pinterest is bolder and should be emulated.

As both the Ebola and polio inoculation campaigns have shown lately, having an effective vaccine is only part of the battle. Populations must trust the vaccine and those who administer it. Social media should not provide a stage for misguided people to destroy that trust, and digital platforms can do much to help rebuild it.

Milestones :: Perspectives :: Research

News: Global public meeting on draft ICH guideline on clinical trials
News 30/08/2019 European Medicines Agency
The global guidance for the conduct of clinical trials is currently undergoing a major revision. As part of the worldwide consultation process, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) is organising a public meeting to review its draft E8 (R1) Guideline ‘General Considerations for Clinical Trials’. EMA is encouraging its stakeholders to register for this meeting, which will be held on 31 October 2019 at the United States Food and Drug Administration (FDA) headquarters in Silver Spring, Maryland, United States of America. Participants will be able to attend in person or via webcast.

The ICH E8 guideline sets out general scientific principles for the conduct, performance and control of clinical trials. In recent years, clinical trials have undergone a radical transformation with a wider range of both trial designs and data sources being used in drug development. Therefore, ICH initiated a revision of the E8 guideline to address all the aspects that were not covered by the current version of the guidance.

The revision aims to provide up-to-date and flexible guidance on clinical trial designs and data sources that can support regulatory and other health-policy decisions while ensuring that fundamental principles, such as the protection of clinical trial participants and assurance of data quality, are maintained.

This is the first step outlined in the process of renovation of good clinical practice (GCP), described in the ICH reflection paper on GCP “Renovation”. The reflection paper contains the ICH proposal for further modernisation of the ICH guidelines related to clinical trial design, planning, management, and conduct. The scope of the proposed renovation includes the current E8 guideline and further revision to the E6 Guideline for Good Clinical Practice.

The draft revised E8 guideline was released for public consultation in May 2019 and it will remain open until 30 September 2019.

The purpose of the public meeting is to provide information and gather feedback from a broad range of stakeholder groups not represented in ICH. The viewpoints and concerns expressed by external stakeholders will feed into the revision process of this fundamental guideline.

The meeting will be held on 31 October 2019, 8:30 – 18:00, at the FDA headquarters in Silver Spring, Maryland, USA. Participants can register to attend in person or via webcast, on a first-come, first-served basis. More information, including on how to register, is available on the ICH website…

Featured Journal Content

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C
Research article Open access
Real-time predictions of the 2018–2019 Ebola virus disease outbreak in the Democratic Republic of the Congo using Hawkes point process models
J. Daniel Kelly, Junhyung Park, Ryan J. Harrigan, Nicole A. Hoff, … Frederic Paik Schoenberg
Article 100354
Highlights
:: Current 2018–2019 Ebola outbreak in DRC is the second largest ever with over 1600 cases as of 10 May 2019.
:: Evidence of an increase in the estimated transmission rates in health zones with recently reported violence versus those without (p = 0.008) in time series analysis.
:: The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violence.
:: Estimated the increase in R between 0.17 and 0.53.
:: Violence is contributing to the continued transmission and the ongoing nature of this outbreak.

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Disease Outbreak News (DONs)
Ebola virus disease – Democratic Republic of the Congo
29 August 2019
The Ebola virus disease (EVD) outbreak in North Kivu, South Kivu, and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to the previous six weeks, with an average of 77 cases per week…

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Polio :: Democratic Republic of the Congo (DR Congo)
Six cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been reported in the past week: one each from Djalo-Ndjeka, Vanga-Kete, Katako-Kombe, and Bena-Dibele districts from Sankuru State; one from Kilwa district, Katanga State; and, one from Mukanga, Haut Lomami State. The onsets of paralysis were on 10 July, 18 July, 17 July, 9 July, 29 June, and 22 June 2019 respectively. There are 23 cases of cVDPV2 reported in 2019. There were 20 cVDPV2 cases reported in 2018.  DRC is currently affected by nine separate cVDPV2 outbreaks; one each originated in Haut Katanga, Mongala, Sankuru, Tanganika, Tshuapa, Kasai, Kasai Central, and two in Haut Lomami provinces.
Read our Democratic Republic of the Congo country page to see information on surveillance and vaccination campaigns.

Measles control in the Democratic Republic of the Congo [in French] 28 August 2019

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As Ebola cases reach 3000 in the Democratic Republic of the Congo, WHO calls on all partners to fulfill promises to communities
29 August 2019 News release Geneva
As the Ebola outbreak in the Democratic Republic of the Congo reaches 3000 cases, WHO calls for the full force of all partners to respond and increase their presence in the field to stop Ebola and to address one of the largest and most complex humanitarian crises in the world.

“Our commitment to the people of the Democratic Republic of the Congo is that we will work alongside them to stop the Ebola outbreak,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Our commitment also means strengthening health systems to give them all the other things they need. Building strong systems is what will protect people, communities and the world.“

With a population of 80 million, the Democratic Republic of the Congo has more than 4 million displaced and is home to the world’s second largest food crisis with 13 million people food insecure. Since January 2019, there have been outbreaks of cholera (15,331 cases, 287 deaths), measles (161,397 cases, 3,117 deaths) and malaria, the leading cause of death in the DRC, which kills more than 48,000 people every year.

Dr Tedros will accompany UN Secretary-General Antonio Guterres on his mission to the country this weekend, along with senior officials, including Dr Matshidiso Moeti, WHO Regional Director for Africa.

“We are working in an incredibly complex environment, but thanks to support from donors and actions taken by the Ministry of Health, WHO and partners, we have saved thousands of lives,” said Dr Moeti. “We strive towards a much more united approach and call on NGOs and UN partners to continue to accelerate all activities. Everyone has a role to play and we each must be accountable for what we signed up to do, only then will we end this outbreak.”…

More than 200,000 people have been vaccinated against Ebola in the Democratic Republic of the Congo, along with health and frontline workers in Uganda, South Sudan, Rwanda and Burundi. Two therapeutic treatments being used in the country as part of a clinical trial have shown to save 9 of 10 lives if used at the right time.

More than 89 million screenings within the country and at international borders have helped control the spread, by identifying and providing care to anyone with symptoms. On 29 August, Ugandan health officials announced confirmation of another case in the country: a child who had crossed over from the Democratic Republic of the Congo. As this alert underlines, regional preparedness will remain key.

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UNICEF – Protecting children and engaging communities key to ending Ebola outbreak in the Democratic Republic of the Congo as deaths pass 2,000
Statement attributable to Edouard Beigbeder, UNICEF Representative in the Democratic Republic of the Congo
KINSHASA, 30 August 2019 – “Almost 600 children have now lost their lives to the Ebola outbreak in the north-east of the Democratic Republic of the Congo (DRC) out of almost 850 who have caught the deadly virus since the epidemic started in August 2018. The news that the total number of deaths has now passed 2,000, out of more than 3,000 cases, should act as a rallying cry for us all to step up our efforts to defeat this terrible disease and end this outbreak.
“As the numbers continue to grow, it is vital to remember that each one of these cases is somebody’s child, a son or daughter; a mother, father, brother or sister. And each of these deaths leaves a family not only in mourning but also scared and worried about their own exposure to the disease.

“That is why supporting, engaging and raising awareness among the affected communities are key in ending this outbreak. The recent breakthrough in finding a successful treatment for this disease, and the continued effectiveness of vaccination efforts to prevent transmission and infection, mean that, for the first time, we now have the means to both prevent and treat Ebola. However, these breakthroughs mean little if individuals are too scared to seek treatment, or too slow to spot symptoms. By ensuring that the local population are informed, engaged and invested in the response, we stand the best chance of defeating the disease.

Preventing infection among children must also be central to the continued response. We know that more children, proportionately, are being affected than in any previous Ebola outbreak, and Ebola ravages children in ways that are very different from adults. What we do to treat and care for them must respond to their unique needs – physical, psychological and social. As such, UNICEF is working with partners, to meet children’s immediate and longer-term needs, accompanying them and their families every step of the way.

“The reality is that we need far more international support now. Ebola outbreaks need an exceptional level of investment compared to other disease outbreaks because they require 100 per cent of cases to be treated, and 100 per cent of contacts to be traced and managed. UNICEF requires US$126 million to meet the needs of children and communities, immediately and over the medium-term.  As of yet, UNICEF has only funded 31 per cent of the appeal.”

###

Notes for editors:
UNICEF works with partners on three broad areas of the response to support the overarching goal of ultimately defeating Ebola and getting to zero cases.

:: Risk communication and community engagement to inform, protect and engage communities. We work with a broad swathe of influential community and religious leaders, Ebola survivors, psychosocial workers, and mass media, to bring crucial knowledge on symptoms, prevention and treatment, to the households and communities most at-risk. We are learning from continuous research and analysis of community feedback to better understand local needs, fears and concerns, and to adapt the response, to one that is socially and culturally acceptable. We have made changes to the burials process; we are conducting decontamination at night; and we are responding with a lighter footprint. We will keep listening and learning.

:: Infection prevention and control to help prevent further spread of the disease. We have installed handwashing units in over 2,500 health facilities, 2,300 schools and over 7,000 critical transit sites. We distribute supplies, including thermometers and chlorine to treat water. And we’ve enabled over 2.1 million people to gain access to safe water.

:: Psychosocial support to assist families, particularly children affected by the disease. UNICEF and its partners have trained more than 918 psychosocial workers to assist children and families directly affected by the disease, and people who are contacts of those who have contracted the disease. We set up childcare centres next to the Ebola treatment centres in Beni and Butembo, where Ebola-survivors look after young children who have been separated from their parents due to Ebola treatment or orphaned.

:: UNICEF has deployed 8 nutritionists to provide specialized care for children (and adults) in the Ebola treatment centres. This is the first time an Ebola outbreak response has included this kind of care, and there is growing recognition among responders that it plays a vital role in the overall health status of patients.

:: We work in over 6,509 schools across the affected and at-risk areas to build a protective environment for children. This includes distributing health and water, sanitation and hygiene supplies, including handwashing units and laser thermometers. Some 32,250 teachers and principals, and 928,500 students have received sensitization or training on Ebola.

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IFRC – Ebola: As death toll approaches 2,000, vaccines, treatment and behaviour change equally important
Nairobi/Geneva 27 August 2019—The availability of an effective vaccine against Ebola and the recent confirmation of two effective treatments do not negate the importance of building trust and understanding in communities affected by the outbreak, warns the International Federation of Red Cross and Red Crescent Societies (IFRC)…

Dr Emanuele Capobianco, IFRC’s Director of Health and Care said:
“The importance of these new treatments – and the continued roll out of vaccines – are not to be underestimated. But alone they are not enough. Now is the time to double down on efforts to engage at-risk communities. For the treatments to work, people need to trust them and the medical staff who administer them. This will take time, resources and a lot of hard work.”

Continued high levels of distrust mean that many Ebola patients are delaying or avoiding going to health facilities. This reluctance significantly decreases their chance of survival, even with access to the newest treatments. It also dramatically increases the risk that the virus will spread to family members and other care givers. More than 42 per cent of alerts that Red Cross receives to bury a loved one are coming from a death at home.

IFRC’s Capobianco said:
“We are asking people to leave the safety of their homes when they fall sick to go to an isolated cell in an Ebola treatment centres where their lives are in the hands of complete strangers. We are asking communities to change the way they care for the sick and the dead in ways that go against their traditions. And we are doing all this in communities that have learned to distrust outsiders following decades of violence and unrest.
“This is our biggest challenge. It is a behavioural challenge, not a medical one. And unfortunately, there is no magic pill to change behaviours.”…

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::::::

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 28 August 2019
:: Technical Advisory Group on Polio Eradication in Afghanistan met on 25-26 August 2019 to discuss and propose recommendations on a range of thematic areas in combatting the ongoing wild poliovirus transmission in the region including: access issues, ban on house-to-house campaigns, optimizing community engagement, and geographic prioritization.

Summary of new viruses this week:
:: Pakistan —  five wild poliovirus type 1 (WPV1) cases;
:: Nigeria — one circulating vaccine-derived poliovirus type 2 (cVDPV2)-positive healthy contact sample;
:: Democratic Republic of the Congo— six cVDPV2 cases;
:: Ghana — one cVDPV2-positive environmental sample.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
WHO Grade 3 Emergencies [to 31 Aug 2019]

Democratic Republic of the Congo
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo
29 August 2019
:: As Ebola cases reach 3000 in the Democratic Republic of the Congo, WHO calls on all partners to fulfill promises to communities 29 August 2019
:: Measles control in the Democratic Republic of the Congo [in French] 28 August 2019
[See DRC Ebola+ above for detail]

Nigeria
:: WHO supports Cross River State in administering polio vaccines to Cameroonian refugees
22 August 2019

Mozambique floods – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 31 Aug 2019]

Cameroon
:: WHO supports Cross River State in administering polio vaccines to Cameroonian refugees
22 August 2019

Libya
:: On the alert: WHO trains Libyans to prevent and control deadly diseases 22 August 2018

MERS-CoV
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia
26 August 2019 From 1 through 31 July 2019, the National IHR Focal Point of Saudi Arabia reported 9 additional laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection and 4 associated deaths.

Measles in Europe
:: European Region loses ground in effort to eliminate measles 29-08-2019
[See Milestones above for detail]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 31 Aug 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Humanitarian Update Syrian Arab Republic – Issue 05 | 29 August 2019

Yemen – No new digest announcements identified

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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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: 22 August 2019 Southern Africa Humanitarian Snapshot (August 2019)

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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WHO & Regional Offices [to 31 Aug 2019]
29 August 2019 News release
WHO revises recommendations on hormonal contraceptive use for women at high HIV risk

29 August 2019 News release
WHO launches global registry on human genome editing

29 August 2019 News release
As Ebola cases reach 3000 in DRC, WHO calls on all partners to fulfill promises to communities

28 August 2019 News release
Weak systems and funding gaps jeopardize drinking-water and sanitation in the world’s poorest countries

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Weekly Epidemiological Record, 30 August 2019, vol. 94, 35/36 (pp. 389–412)
:: Global leprosy update, 2018: moving towards a leprosy-free world

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Protecting the devoted from cholera in pilgrimage sites in Ethiopia 29 August 2019
:: Searching for polio in unusual places in Tanzania 28 August 2019

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
:: Health Ministers of WHO South-East Asia Region to discuss key challenges next week
SEAR/PR/1715 New Delhi, 30 August 2019: Health Ministers of member countries of WHO South-East Asia Region are meeting here next week to discuss ways of addressing health impact of climate change, the high burden of tuberculosis and strengthening capacities for emergency risk management.
Elimination of measles, a childhood killer disease; cervical cancer and other non-communicable diseases; and strengthening health services and workforce for universal health coverage are other key issues that will be taken up at the Seventy-Second Regional Committee Session of WHO South-East Asia from 2 September to 6 September 2019…

WHO European Region EURO
:: European Region loses ground in effort to eliminate measles 29-08-2019
[See Milestones above for detail]

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 31 Aug 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Latest News
Thursday, August 29, 2019
Ebola outbreak in eastern Democratic Republic of Congo reaches 3,000 cases and 2,000 deaths
As the outbreak in the Democratic Republic of the Congo (DRC) continues, the number of Ebola cases has reached 3,000 and more than 2,000 deaths. Cases have recently been reported in previously unaffected areas in DRC and are now in 29 health zones and in a new province, South Kivu, which increases the risk of disease spread both locally within DRC and to neighboring countries. As of August 28, the DRC Ministry of Health has reported 3,004 cases and 2,006 deaths.

“Far too many lives have been lost in this Ebola outbreak. The DRC, U.S. government, and international partners are working hard to overcome the significant challenges to stopping the spread of this disease in DRC,” said CDC Director Robert R. Redfield, M.D. “CDC is prepared for a long-term public health response in DRC and its neighboring countries, and we agree with our World Health Organization colleagues about the need for a change in the response to bring this outbreak to an end.”

CDC has recently doubled the number of outbreak response experts in DRC and will have 30 responders on the ground by September 1 to work on case investigation, contact tracing, disease tracking, safe burials, community engagement and risk communication, laboratory testing, and border health. CDC staff have conducted more than 360 deployments.

CDC’s Emergency Operations Center continues to provide 24/7 technical assistance to the ministries of health of DRC and neighboring countries, in collaboration with international partners, to ensure the response is robust, well-coordinated, and focused on bringing the outbreak to an end.

MMWR News Synopsis for Friday, August 30, 2019
Notes From the Field:
Mumps in Detention Facilities that House Detained Migrants — United States, September 2018–July 2019
The first known outbreaks of mumps in detention facilities have resulted in the spread of mumps to over 50 detention facilities in 19 states since September 2018. From September 1, 2018 to August 22, 2019, a total of 898 mumps cases in adult migrants in 57 detention facilities were reported in 19 states, with another 33 cases among detention facility staff. While more than 150 outbreaks have been reported in the U.S. since 2015 – most often in close-contact settings such as universities – this is the first time mumps outbreaks have been reported in detention facilities. CDC was first notified about the outbreaks by the Texas Department of State Health Services (TDSHS) in December last year. Since that time, CDC has been working with state and local health departments, the Immigration and Customs Enforcement Health Service Corps (IHSC), and other federal agencies to assist detention facility health administrators to develop and implement mumps outbreak control measures.

Africa CDC [to 31 Aug 2019]
http://www.africacdc.org/
News
No new digest content identified.

China CDC
http://www.chinacdc.cn/en/
No new digest content identified.

National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/
Selected Updates and Press Releases
China vows continued aid to Africa for Ebola
2019-08-26
China will continue to provide aid to African countries to battle Ebola, and hopes the international community will take more effective measures to help these countries overcome the epidemic.

Announcements

Paul G. Allen Frontiers Group [to 31 Aug 2019]
https://alleninstitute.org/what-we-do/frontiers-group/news-press/
News
No new digest content identified.

BMGF – Gates Foundation [to 31 Aug 2019]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

Bill & Melinda Gates Medical Research Institute [to 31 Aug 2019]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.

CARB-X [to 31 Aug 2019]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.

CEPI – Coalition for Epidemic Preparedness Innovations [to 31 Aug 2019]
http://cepi.net/
No new digest content identified.

Clinton Health Access Initiative, Inc. (CHAI) [to 31 Aug 2019]
https://clintonhealthaccess.org/about/
News & Press Releases
No new digest content identified.

EDCTP [to 31 Aug 2019]
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
No new digest content identified.

Emory Vaccine Center [to 31 Aug 2019]
http://www.vaccines.emory.edu/
No new digest content identified.

European Medicines Agency [to 31 Aug 2019]
http://www.ema.europa.eu/ema/
News and press releases
News: Global public meeting on draft ICH guideline on clinical trials
Last updated: 30/08/2019
[See Milestones above for detail]

European Vaccine Initiative [to 31 Aug 2019]
http://www.euvaccine.eu/news-events
No new digest content identified.

FDA [to 31 Aug 2019]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
No new digest content identified.

Fondation Merieux [to 31 Aug 2019]
http://www.fondation-merieux.org/
No new digest content identified.

Gavi [to 31 Aug 2019]
https://www.gavi.org/
Latest news
Gavi sets ambitious goal to immunise 300 million people by 2025, leaving no one behind 
30 August 2019
[See Milestones above for detail]

New Gavi impact figures released: 66 million immunised and 1.7 million deaths averted in 2018 
28 August 2019

Gavi and Japanese growth equity fund collaborate to support innovative startups for immunisation 
28 August 2019
[See Milestones above for detail]

GHIT Fund [to 31 Aug 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical
No new digest content identified.

Global Fund [to 31 Aug 2019]
https://www.theglobalfund.org/en/news/
News
News
TICAD Pledges to Spur More Investments in Global Health
30 August 2019
Sourcing & Management of Health Products

Global Fund Finalizes Procurement Service Agent Fees
28 August 2019
Voices

TICAD is a Great Path to Sustainable Global Prosperity
28 August 2019
Updates

5 days, 5 pledges
28 August 2019
News

Republic of Korea Reaffirms Its Commitment to the Fight Against TB and Malaria
27 August 2019
Sourcing & Management of Health Products

Opportunity for Evaluation of Selected Medicines
26 August 2019
News

Global Fund Applauds Germany’s Major Pledge Increase
25 August 2019
News

Global Fund Welcomes Italy’s Increased Contribution
25 August 2019
News

Hilleman Laboratories [to 31 Aug 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 31 Aug 2019]
http://www.humanvaccinesproject.org/media/press-releases/
Press Releases
No new digest content identified.

IAVI [to 31 Aug 2019]
https://www.iavi.org/newsroom
No new digest content identified.

International Coalition of Medicines Regulatory Authorities (ICMRA)
http://www.icmra.info/drupal/en/news
Statements and Press Releases
No new digest content identified.

IFFIm
http://www.iffim.org/library/news/press-releases/
29 August 2019
How Japanese investors primed a global market for vaccine bonds
From an acclaimed debut Uridashi to the latest investment by Dai-ichi Life, Japanese investors set a trend for socially responsible investing.
Leaders from the global health community are convening this week at the Seventh Tokyo International Conference on African Development (TICAD), where Gavi, the Vaccine Alliance is unveiling its Investment Opportunity detailing the plans for the 2021 to 2025 strategic period…

Immunisation is the world’s most universal, cost-effective health intervention, but there are still diseases for which there is no effective vaccine. Now, with the help of institutional investors like Dai-ichi Life, work to develop those vaccines is underway.

IFFIm’s latest Vaccine Bond issuance in July 2019 raised NOK600 million in immediate funding for the Coalition of Epidemic Preparedness Innovations (CEPI), a public private initiative that accelerates development of vaccines against emerging infectious diseases and enables equitable access to these vaccines during outbreaks. Dai-ichi Life purchased 73% of the issue, becoming its biggest investor and the first institutional investor in vaccine bonds from Japan.
Looking to the future, IFFIm’s support for CEPI will yield dividends in the form of new vaccines for deadly epidemics and diseases…

IFRC [to 31 Aug 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
Democratic Republic of the Congo
Ebola: As death toll approaches 2,000, vaccines, treatment and behaviour change equally important
Nairobi/Geneva 27 August 2019—The availability of an effective vaccine against Ebola and the recent confirmation of two effective treatments do not negate the importance of building trust and understanding in communities affected by the outbreak, warns …
[See Ebola above for detail]

IVAC [to 31 Aug 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
No new digest content identified.

IVI [to 31 Aug 2019]
http://www.ivi.int/
Selected IVI News & Announcements
IVI acquires supplemental funding for Severe Typhoid in Africa Program (SETA Plus)
August 28, 2019 – SEOUL, South Korea – The International Vaccine Institute (IVI) has received additional funds of $4.33 million from the Bill & Melinda Gates Foundation to expand Severe Typhoid in Africa (SETA) Program activities in close alignment with the “Effect of a novel typhoid conjugate vaccine in Africa: a multicenter study in Ghana and the Democratic Republic of the Congo (THECA)” program coordinated by the University of Cambridge. With this SETA Plus supplement, IVI can continue with and strengthen its research on the epidemiological and economic impact of typhoid in Africa to pave the way for future Gavi-supported introductions.
With this supplemental funding, the SETA Program transitions to SETA Plus. In total, the Gates Foundation has invested $13.86M in the SETA program at IVI. “This additional funding highlights both the Gates Foundation’s interest in typhoid control and the critical value of information on typhoid and other Salmonella-related diseases that SETA and the Typhoid Fever Surveillance in Africa Program (TSAP) that preceded it have generated,” says Dr. Jerome Kim, Director General of IVI…

JEE Alliance [to 31 Aug 2019]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 31 Aug 2019]
http://www.msf.org/
Selected News; Project Updates, Reports
DRC Ebola outbreaks
Crisis update – August 2019

Yemen
Chaos and fighting in Aden as over 50 wounded admitted in just a few hours
Press Release 29 Aug 2019

Yemen
A population on the frontline, indiscriminate attacks on civilians, and still no sign of…
Voices from the Field 27 Aug 2019

Access to medicines
Gavi should stop awarding special funds to Pfizer and GSK for pneumonia vaccine
Press Release 26 Aug 2019
:: Millions of children around the world remain vulnerable to pneumonia – the leading cause of childhood death – because of exploitative pricing by Pfizer and GSK
:: Nearly one-third of the world’s countries have been unable to introduce the vaccine, largely due to its high price
:: More children could be protected if Gavi reserved its special funding for a new manufacturer offering a more affordable version of the pneumonia vaccine

Palestine
Mental healthcare in translation
Project Update 25 Aug 2019

NIH [to 31 Aug 2019]
http://www.nih.gov/news-events/news-releases
Selected News Releases
NIH announces six inaugural Genomic Innovator Awards
August 27, 2019 — Supporting early career investigators at the cutting edge of genomics.

PATH [to 31 Aug 2019]
https://www.path.org/media-center/
No new digest content identified.

ProMED [Program for Monitoring Emerging Diseases] [to 31 Aug 2019]
International Society for Infectious Diseases
https://www.promedmail.org/announcements/
Selected Announcements/Posts
No new digest content identified.

Sabin Vaccine Institute [to 31 Aug 2019]
http://www.sabin.org/updates/pressreleases
No new digest content identified.

UNAIDS [to 31 Aug 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
No new digest content identified.

UNICEF [to 31 Aug 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Statement
Protecting children and engaging communities key to ending Ebola outbreak in the Democratic Republic of the Congo as deaths pass 2,000
Statement attributable to Edouard Beigbeder, UNICEF Representative in the Democratic Republic of the Congo
30/08/2019
[See Ebola above for detail]

Press release
More than 1,100 unaccompanied refugee and migrant children in Greece need urgent shelter and protection
European Member States urged to increase relocation pledges and fast-track family reunifications
29/08/201

Vaccination Acceptance Research Network (VARN) [to 31 Aug 2019]
https://vaccineacceptance.org/news.html#header1-2r
No new digest content identified.

Vaccine Confidence Project [to 31 Aug 2019]
http://www.vaccineconfidence.org/
Posted on 26 Aug, 2019
Article of the week
David Grimes presents an excellent discussion on the imbalance of “balanced”  reporting of evidence and perceptions of evidence – HL A dangerous balancing act:  On matters of science, a well-meaning desire to present all views equally can be an Trojan…

Vaccine Education Center – Children’s Hospital of Philadelphia [to 31 Aug 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.

Wellcome Trust [to 31 Aug 2019]
https://wellcome.ac.uk/news
News | 30 August 2019
Paul Schreier is new Chief Operating Officer at Wellcome
Paul Schreier has been appointed as Wellcome’s Chief Operating Officer (COO), responsible for the effective and efficient delivery of our operations.

The Wistar Institute [to 31 Aug 2019]
https://www.wistar.org/news/press-releases
Press Release
No new digest content identified.

World Organisation for Animal Health (OIE) [to 31 Aug 2019]
http://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

::::::

BIO [to 31 Aug 2019]
https://www.bio.org/insights/press-release
No new digest content identified.

DCVMN – Developing Country Vaccine Manufacturers Network [to 31 Aug 2019]
http://www.dcvmn.org/
Events
DCVMN 20th Annual General Meeting
21 October 2019 to 23 October 2019
Rio de Janeiro / Brazil

IFPMA [to 31 Aug 2019]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
29 July 2019 – Publication
The Complex Journey of a Vaccine – The Steps Behind Developing a New Vaccine

PhRMA [to 31 Aug 2019]
http://www.phrma.org/press-room
Selected Press Releases, Statements
No new digest content identified.

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

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 31 Aug 2019)

Editorial
Editorial: the airborne microbiome – implications for aerosol transmission and infection control – special issue
Although the title of the Special Issue is ‘Airborne Microbiome’ the manuscripts received have highlighted a variety of peripheral, yet related aspects of this. The contributions are a mixture of primary resea…
Authors: Julian W. Tang and Yuguo Li
Citation: BMC Infectious Diseases 2019 19:755
Published on: 29 August 2019

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 31 Aug 2019)

Research article
Systematic review of dengue vaccine efficacy
Authors: Lucia Teresa Côrtes da Silveira, Bernardo Tura and Marisa Santos
Citation: BMC Infectious Diseases 2019 19:750
Published on: 28 August 2019

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 31 Aug 2019)

Research article
Systematic review of dengue vaccine efficacy
Authors: Lucia Teresa Côrtes da Silveira, Bernardo Tura and Marisa Santos
Citation: BMC Infectious Diseases 2019 19:750
Published on: 28 August 2019

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 31 Aug 2019)

Debate
|   23 August 2019
Umbrella and basket trials in oncology: ethical challenges
Authors: Karolina Strzebonska and Marcin Waligora

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 31 Aug 2019)

Research article
A novel sub-epidemic modeling framework for short-term forecasting epidemic waves
Simple phenomenological growth models can be useful for estimating transmission parameters and forecasting epidemic trajectories. However, most existing phenomenological growth models only support single-peak …
Authors: Gerardo Chowell, Amna Tariq and James M. Hyman
Citation: BMC Medicine 2019 17:164
Published on: 22 August 2019

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 31 Aug 2019)

Research article
Geographical variation and associated factors of childhood measles vaccination in Ethiopia: a spatial and multilevel analysis
In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is c…
Authors: Tesfahun Taddege Geremew, Lemma Derseh Gezie and Ayenew Negesse Abejie
Citation: BMC Public Health 2019 19:1194
Published on: 30 August 2019

Clinical Therapeutics
August 2019 Volume 41, Issue 8, p1401-1642
http://www.clinicaltherapeutics.com/current

Drugs and Biologics Update: Artificial Intelligence and Patient-centric Approaches to Advance Pharmaceutical Innovation
Editorial
Artificial Intelligence and Patient-centric Approaches to Advance Pharmaceutical Innovation
Kenneth I. Kaitin
p1406–1407
Published online: July 25, 2019

Clinical Therapeutics
August 2019 Volume 41, Issue 8, p1401-1642
http://www.clinicaltherapeutics.com/current

Commentary
Using Patient Advisory Boards to Solicit Input Into Clinical Trial Design and Execution
Annick Anderson, Jasmine Benger, Ken Getz
p1408–1413
Published online: July 12, 2019
Abstract
Academic institutions, pharmaceutical and biotechnology companies, foundations, and associations are routinely implementing patient advisory boards (PABs) to solicit patients’ voices and perspectives on a variety of clinical research–related areas, including protocol design, clinical trial execution, informed-consent form design, clinical trial medicine kit design, wearable devices and mobile technologies, and patient-communication materials. Based on experience conducting >50 PABs during the past several years, the authors provide insights into how to best plan and execute PABs and their value in informing improvement in patient engagement.

Clinical Therapeutics
August 2019 Volume 41, Issue 8, p1401-1642
http://www.clinicaltherapeutics.com/current

Original Research
A Study on the Application and Use of Artificial Intelligence to Support Drug Development
Mary Jo Lamberti, Michael Wilkinson, Bruce A. Donzanti, G. Erich Wohlhieter, Sudip Parikh, Robert G. Wilkins, Ken Getz
p1414–1426
Published online: June 24, 2019

Clinical Therapeutics
August 2019 Volume 41, Issue 8, p1401-1642
http://www.clinicaltherapeutics.com/current

Original Research
Assessing Biopharmaceutical Company Experience with Patient-centric Initiatives
Debra L. Michaels, Mary Jo Lamberti, Yaritza Peña, Barbara Lopez Kunz, Kenneth Getz
p1427–1438
Published online: August 20, 2019

Developing World Bioethics
Volume 19, Issue 2 Pages: 61-122 June 2019
https://onlinelibrary.wiley.com/toc/14718847/current

COUNTRY REPORT
How do Chinese universities address research integrity and misconduct? A review of university documents
Nannan Yi, Benoit Nemery, Kris Dierickx
Pages: 64-75
First Published: 15 May 2019

Developing World Bioethics
Volume 19, Issue 2 Pages: 61-122 June 2019
https://onlinelibrary.wiley.com/toc/14718847/current

ARTICLES
Considerations for community engagement when conducting clinical trials during infectious disease emergencies in West Africa
Morenike Oluwatoyin Folayan, Dan Allman, Bridget Haire, Aminu Yakubu, Muhammed O. Afolabi, Joseph Cooper
Pages: 96-105
First Published: 15 November 2018

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C

Research article Open access
Phylogeography of rubella virus in Asia: Vaccination and demography shape synchronous outbreaks
Brooke A. Bozick, Colin J. Worby, C. Jessica E. Metcalf
Article 100346

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C

Research article Open access
Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018–2019
S. Rae Wannier, Lee Worden, Nicole A. Hoff, Eduardo Amezcua, … J. Daniel Kelly
Article 100353

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C

Research article Open access
Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018–2019
S. Rae Wannier, Lee Worden, Nicole A. Hoff, Eduardo Amezcua, … J. Daniel Kelly
Article 100353

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C

Research article Open access
Real-time predictions of the 2018–2019 Ebola virus disease outbreak in the Democratic Republic of the Congo using Hawkes point process models
J. Daniel Kelly, Junhyung Park, Ryan J. Harrigan, Nicole A. Hoff, … Frederic Paik Schoenberg
Article 100354

Epidemics
Volume 28 September 2019
https://www.sciencedirect.com/journal/epidemics/vol/28/suppl/C

Research article Open access
School dismissal as a pandemic influenza response: When, where and for how long?
Timothy C. Germann, Hongjiang Gao, Manoj Gambhir, Andrew Plummer, … Amra Uzicanin
Article 100348

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Genome editing, Goldilocks and polygenic risk scores (26 July, 2019)
Christopher Gyngell, Hilary Bowman-Smart, Julian Savulescu

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Commentary on ‘Moral reasons to edit the human genome’: this is not the moral imperative we are looking for (27 August, 2019)
Sarah Chan

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

The moral argument for heritable genome editing requires an inappropriately deterministic view of genetics (12 March, 2019)
Rachel Horton, Anneke M Lucassen

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Goldilocks and the two principles. A response to Gyngell et al (28 February, 2019)
Peter Mills

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Feature article
Moral reasons to edit the human genome: picking up from the Nuffield report (24 January, 2019)
Christopher Gyngell, Hilary Bowman-Smart, Julian Savulescu

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Current controversy
The ‘serious’ factor in germline modification
Erika Kleiderman¹, Vardit Ravitsky², Bartha Maria Knoppers³
Abstract
Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of ‘serious’ as a core criterion in determining what genetic diseases should be targeted by these technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to ‘health’ and ‘disease’: objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a ‘serious’ disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of ‘serious’. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies.

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Original research
Practical allocation system for the distribution of specialised care during cellular therapy access scarcity (19 June, 2019)
Andrew Hantel, Gregory A Abel, Mark Siegler

Journal of Medical Ethics
August 2019 – Volume 45 – 8
http://jme.bmj.com/content/current

Student essay
Ethical position of medical practitioners who refuse to treat unvaccinated children (27 June, 2019)
Melanie Forster

Journal of the Royal Society – Interface
7 August 2019 Volume 16Issue 157
https://royalsocietypublishing.org/toc/rsif/current

Review articles
Growth and remodelling of living tissues: perspectives, challenges and opportunities
Davide Ambrosi, Martine Ben Amar, Christian J. Cyron, Antonio DeSimone, Alain Goriely, Jay D. Humphrey and Ellen Kuhl
Published:21 August 2019Article ID:20190233

Journal of the Royal Society – Interface
7 August 2019 Volume 16Issue 157
https://royalsocietypublishing.org/toc/rsif/current

Review articles
Mathematical modelling to study the horizontal transfer of antimicrobial resistance genes in bacteria: current state of the field and recommendations
Quentin J. Leclerc, Jodi A. Lindsay and Gwenan M. Knight
Published:14 August 2019Article ID:20190260

Journal of the Royal Society – Interface
7 August 2019 Volume 16Issue 157
https://royalsocietypublishing.org/toc/rsif/current

Report
Serostatus testing and dengue vaccine cost–benefit thresholds
Carl A. B. Pearson, Kaja M. Abbas, Samuel Clifford, Stefan Flasche and Thomas J. Hladish
Published:21 August 2019Article ID:20190234
https://doi.org/10.1098/rsif.2019.0234
Abstract
The World Health Organization (WHO) currently recommends pre-screening for past infection prior to administration of the only licensed dengue vaccine, CYD-TDV. Using a threshold modelling analysis, we identify settings where this guidance prohibits positive net-benefits, and are thus unfavourable. Generally, however, our model shows test-then-vaccinate strategies can improve CYD-TDV economic viability: effective testing reduces unnecessary vaccination costs while increasing health benefits. With sufficiently low testing cost, those trends outweigh additional screening costs, expanding the range of settings with positive net-benefits. This work highlights two aspects for further analysis of test-then-vaccinate strategies. We found that starting routine testing at younger ages could increase benefits; if real tests are shown to sufficiently address safety concerns, the manufacturer, regulators and WHO should revisit guidance restricting use to 9-years-and-older recipients. We also found that repeat testing could improve return-on-investment (ROI), despite increasing intervention costs. Thus, more detailed analyses should address questions on repeat testing and testing periodicity, in addition to real test sensitivity and specificity. Our results follow from a mathematical model relating ROI to epidemiology, intervention strategy, and costs for testing, vaccination and dengue infections. We applied this model to a range of strategies, costs and epidemiological settings pertinent to CYD-TDV. However, general trends may not apply locally, so we provide our model and analyses as an R package available via CRAN, denvax. To apply to their setting, decision-makers need only local estimates of age-specific seroprevalence and costs for secondary infections.

Lancet Global Health
Sep 2019 Volume 7Number 9e1147-e1286
http://www.thelancet.com/journals/langlo/issue/current

Article
Effect of voluntary licences for hepatitis C medicines on access to treatment: a difference-in-differences analysis
Voluntary licences are increasingly being used to expand access to patented essential medicines in low-income and middle-income countries (LMICs). Since 2014, non-exclusive voluntary licences have been issued by Gilead and Bristol-Myers Squibb for key drugs for hepatitis C virus (HCV) infection. We aimed to evaluate the effect of these licences on access to HCV treatment…Voluntary licensing initiatives appear to substantially improve HCV treatment uptake in eligible countries. This evidence supports the expansion of licensing strategies to include more countries and more treatments.
Bryony Simmons, Graham S Cooke, Marisa Miraldo

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Comment
The unanticipated benefits of protecting young children from malaria
Lauren M Cohee, Miriam K Laufer

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

First clinical trial of a MERS coronavirus DNA vaccine
In-Kyu Yoon, Jerome H Kim

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Use of reverse genetics to inform Ebola outbreak responses
Robert W Cross, Thomas W Geisbert

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Articles
Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study
William L Hamilton, et al
Open Access

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Safety and immunogenicity of an anti-Middle East respiratory syndrome coronavirus DNA vaccine: a phase 1, open-label, single-arm, dose-escalation trial
Kayvon Modjarrad, et al

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Characterisation of infectious Ebola virus from the ongoing outbreak to guide response activities in the Democratic Republic of the Congo: a phylogenetic and in vitro analysis

Lancet Infectious Diseases
Sep 2019 Volume 19Number 9p915-1034, e301-e336
http://www.thelancet.com/journals/laninf/issue/current

Review
The effect of global change on mosquito-borne disease
Lydia H V Franklinos, Kate E Jones, David W Redding, Ibrahim Abubakar