Monthly Archives: November 2019

Achieving health equity: democracy matters

Posted on by

The Lancet
Nov 02, 2019 Volume 394Number 10209p1591-1684, e34
https://www.thelancet.com/journals/lancet/issue/current

 

Comment
Achieving health equity: democracy matters
Johanna Hanefeld, Aaron Reeves, Chris Brown, Piroska Östlin
Progress on health equity in the European region in the past two decades has been slower than expected. Indeed, some countries have even seen health inequalities widen.1 This slow progress is, to some extent, surprising because there is almost unanimous political commitment to addressing health inequities and many countries have made great strides in implementing policies to reduce the health gap.1, 2 Europe, as a region, is on track to achieving the Sustainable Development Goals (SDGs) overall, but countries are not attaining SDG 10 and SDG 3 because ensuring healthy lives for all is impossible without reducing health inequities.

The report of the WHO European Health Equity Status Report Initiative (HESRI), launched on Sept 10, 2019, reviews achievements on the road to health equity to understand how to further accelerate action, and to discuss how to influence decisions related to fiscal policy and industrial strategy in order to deliver healthy, prosperous lives for all.3 The findings of the HESRI report3
show that the evidence on how to best tackle health inequity is clear and overwhelming, even more so in Europe, where we can draw on a wealth of health inequalities research.4 We know the size of the gaps in life expectancy, the social gradients in the burden of disease across the European region, and the root causes of these health inequalities, the social determinants of health.

The root causes of health inequities are driven by policies that structure access to the social determinants of health. Five conditions are necessary to reduce health inequity: good-quality and accessible health services; income security and an appropriate, fair level of social protection; decent living conditions; good social and human capital; and decent work and employment conditions.3 Of these, the two most important determinants are precarious housing and living conditions,5 and low income and weak social protection.6 When people live in unaffordable, cold, and unsafe housing on insecure contracts, their health is worse and they die prematurely.7 When people cannot make ends meet and when social protection systems are stigmatising and inadequate, their health suffers.8 Inadequate access to health services, conditions of employment, and personal and community capabilities are all important too. Health outcomes improve when people can access the care they think they need; when people work in secure employment with a living wage; and when people have someone to turn to for help and feel they have a voice in decision-making processes.9,10

The drivers of health inequity are all too prevalent across the region. This situation is not inevitable. These determinants of health inequalities are all modifiable through policies focused on the five areas identified in the report:3 health services, social protection, decent living conditions, social and human capital, and decent employment. Why, then, has progress been so slow?

Emerging evidence indicates that policies to address health inequalities do not emerge out of thin air, rather they are the result of a country’s or region’s wider political economy.11, 12
Policies are the product of people in particular socioeconomic contexts interacting with political institutions that shape the political process in a given location—be that a community, city, region, or country. Where these institutions are not accountable, transparent, participatory, or coherent, we will be far less likely to see the policy change necessary to deliver health equity. Governments and other stakeholders must actively work to alter how we incorporate the voices, lived experiences, and passions of the child, the young person, or adult who is not able to thrive and prosper because of health inequities. Democratic institutions, such as free and fair elections, are part of establishing the conditions that empower individuals and communities, ensure participation is meaningful, and establish decision-making processes that are accountable. Furthermore, accountable and transparent decision-making processes generate coherent policies by making participation inclusive. Beyond consulting people, participation can only be inclusive where economic barriers to participation are alleviated and where we alter the governance structures of policy processes to ensure the communities affected by policy decisions have a meaningful voice that influences outcomes in these processes.

There are countervailing forces, however. Vested interests, such as commercial actors or those who oppose health-enhancing policies, will seek to subvert efforts to address health equity.13m
Crucially, the influence of these groups depends on how our political systems are organised.14
Addressing health inequity requires a restructuring of our political systems so that we can deepen democracy through making our decision-making processes more inclusive.15, 16

To allow all people in Europe to prosper and flourish in health and in life, we need to recognise both the centrality of equity in health to the sustainable development of Europe and that political institutions are one of the essential conditions that make health equity possible.

Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study

Posted on by

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

 

Articles
Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study
Karin Stenberg, Odd Hanssen, Melanie Bertram, Callum Brindley, Andreia Meshreky, Shannon Barkley, Tessa Tan-Torres Edejer

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis

Posted on by

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

 

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis
Isolde Birdthistle, Clare Tanton, Andrew Tomita, Kristen de Graaf, Susan B Schaffnit, Frank Tanser, Emma Slaymaker

Mortality reduction benefits and intussusception risks of rotavirus vaccination in 135 low-income and middle-income countries: a modelling analysis of current and alternative schedules

Posted on by

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

 

Mortality reduction benefits and intussusception risks of rotavirus vaccination in 135 low-income and middle-income countries: a modelling analysis of current and alternative schedules
Andrew Clark, Jacqueline Tate, Umesh Parashar, Mark Jit, Mateusz Hasso-Agopsowicz, Nicholas Henschke, Benjamin Lopman, Kevin Van Zandvoort, Clint Pecenka, Paul Fine, Colin Sanderson

Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: a systematic review and meta-analysis

Posted on by

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

 

Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: a systematic review and meta-analysis
Laura M Nic Lochlainn, et al

Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis

Posted on by

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

 

Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis
Laura M Nic Lochlainn, et al
Open Access

A governance framework for development and assessment of national action plans on antimicrobial resistance

Posted on by

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

 

Review
A governance framework for development and assessment of national action plans on antimicrobial resistance
Michael Anderson, Kai Schulze, Alessandro Cassini, Diamantis Plachouras, Elias Mossialos

Outbreak response as an essential component of vaccine development

Posted on by

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

 

Personal View
Outbreak response as an essential component of vaccine development
Richard Hatchett, Nicole Lurie
Summary
The Coalition for Epidemic Preparedness Innovations (CEPI) was created as a result of an emerging global consensus that a coordinated, international, and intergovernmental effort was needed to develop and deploy new vaccines to prevent future epidemics. Although some disease outbreaks can be relatively brief, early outbreak response activities can provide important opportunities to make progress on vaccine development. CEPI has identified six such areas and is prepared to work with other organisations in the global community to combat WHO priority pathogens, including the hypothetical Disease X, by supporting early activities in these areas, even when vaccine candidates are not yet available.

Ethical research — the long and bumpy road from shirked to shared

Posted on by

Nature
Volume 574 Issue 7780, 31 October 2019
http://www.nature.com/nature/current_issue.html

 

Comment | 29 October 2019
Ethical research — the long and bumpy road from shirked to shared
From all too scarce, to professionalized, the ethics of research is now everybody’s business, argues Sarah Franklin in the sixth essay in a series on how the past 150 years have shaped science, marking Nature’s anniversary.
Sarah Franklin

Leveraging European infrastructures to access 1 million human genomes by 2022

Posted on by

Nature Reviews Genetics
Volume 20 Issue 11, November 2019
https://www.nature.com/nrg/volumes/20/issues/11

 

Roadmap | 27 August 2019
Leveraging European infrastructures to access 1 million human genomes by 2022
Gary Saunders, Michael Baudis[…] & Serena Scollen
Abstract
Human genomics is undergoing a step change from being a predominantly research-driven activity to one driven through health care as many countries in Europe now have nascent precision medicine programmes. To maximize the value of the genomic data generated, these data will need to be shared between institutions and across countries. In recognition of this challenge, 21 European countries recently signed a declaration to transnationally share data on at least 1 million human genomes by 2022. In this Roadmap, we identify the challenges of data sharing across borders and demonstrate that European research infrastructures are well-positioned to support the rapid implementation of widespread genomic data access.

Enabling Healthful Aging for All — The National Academy of Medicine Grand Challenge in Healthy Longevity

Posted on by

New England Journal of Medicine
October 31, 2019 Vol. 381 No. 18
http://www.nejm.org/toc/nejm/medical-journal

 

Persepctive
Enabling Healthful Aging for All — The National Academy of Medicine Grand Challenge in Healthy Longevity
Victor J. Dzau, M.D., Sharon K. Inouye, M.D., M.P.H., John W. Rowe, M.D., Elizabeth Finkelman, M.P.P., and Tadataka Yamada, M.D.
Recognizing that aging presents a defining challenge for this century, the National Academy of Medicine is launching a Healthy Longevity Global Grand Challenge, an international effort directed at improving health, productivity, and quality of life for older people.

Early signal detection of adverse events following influenza vaccination using proportional reporting ratio, Victoria, Australia

Posted on by

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 Nov 2019)

Early signal detection of adverse events following influenza vaccination using proportional reporting ratio, Victoria, Australia
Hazel J. Clothier, Jock Lawrie, Melissa A. Russell, Heath Kelly, Jim P. Buttery

 

Research Article | published 01 Nov 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0224702

 

The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers

Posted on by

EPLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 Nov 2019)

 

The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers
Linda Cecilia Karlsson, Stephan Lewandowsky, Jan Antfolk, Paula Salo, Mikael Lindfelt, Tuula Oksanen, Mika Kivimäki, Anna Soveri
Research Article | published 31 Oct 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0224330

Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens

Posted on by

Science
01 November 2019 Vol 366, Issue 6465
http://www.sciencemag.org/current.dtl

 

Research Article
Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens
By Michael J. Mina, Tomasz Kula, Yumei Leng, Mamie Li, Rory D. de Vries, Mikael Knip, Heli Siljander, Marian Rewers, David F. Choy, Mark S. Wilson, H. Benjamin Larman, Ashley N. Nelson, Diane E. Griffin, Rik L. de Swart, Stephen J. Elledge
Science01 Nov 2019 : 599-606 Full Access
The toll of measles on the immune system
Many of the deaths attributable to measles virus are caused by secondary infections because the virus infects and functionally impairs immune cells. Whether measles infection causes long-term damage to immune memory has been unclear. This question has become increasingly important given the resurgence in measles epidemics worldwide. Using a blood test called VirScan, Mina et al. comprehensively analyzed the antibody repertoire in children before and after natural infection with measles virus as well as in children before and after measles vaccination. They found that measles infection can greatly diminish previously acquired immune memory, potentially leaving individuals at risk for infection by other pathogens. These adverse effects on the immune system were not seen in vaccinated children.
Abstract
Measles virus is directly responsible for more than 100,000 deaths yearly. Epidemiological studies have associated measles with increased morbidity and mortality for years after infection, but the reasons why are poorly understood. Measles virus infects immune cells, causing acute immune suppression. To identify and quantify long-term effects of measles on the immune system, we used VirScan, an assay that tracks antibodies to thousands of pathogen epitopes in blood. We studied 77 unvaccinated children before and 2 months after natural measles virus infection. Measles caused elimination of 11 to 73% of the antibody repertoire across individuals. Recovery of antibodies was detected after natural reexposure to pathogens. Notably, these immune system effects were not observed in infants vaccinated against MMR (measles, mumps, and rubella), but were confirmed in measles-infected macaques. The reduction in humoral immune memory after measles infection generates potential vulnerability to future infections, underscoring the need for widespread vaccination.

Vaccine Technology VII: Beyond the “decade of vaccines”

Posted on by

Vaccine
Volume 37, Issue 47, Pages 6931-7122 (8 November 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/47

 

Vaccine Technology VII: Promises and achievements of the Decade of Vaccines
Edited by Amine A. Kamen, Linda H.L. Lua, Tarit K. Mukhopadhyay
Editorial Open access
Vaccine Technology VII: Beyond the “decade of vaccines”
Amine A. Kamen, Linda H.L. Lua, Tarit K. Mukhopadhyay
Pages 6931-6932

Media/Policy Watch

Posted on by

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 2 Nov 2019
[No new, unique, relevant content]

 

BBC
http://www.bbc.co.uk/
Accessed 2 Nov 2019
[No new, unique, relevant content]

 

The Economist
http://www.economist.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

 

Financial Times
http://www.ft.com/home/uk
Accessed 2 Nov 2019
[No new, unique, relevant content]

 

Forbes
http://www.forbes.com/
Accessed 2 Nov 2019
The Political Battlefield Of Infections And Migrant Children’s Bodies
Deaths from influenza have occurred among migrant children in detention. Yet the US government is denying them flu vaccination, and recently went to court arguing that children are not entitled to basic sanitation, clean clothes, bathing, and toothbrushes.
By Judy Stone Senior Contributor

 

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

 

The Guardian
http://www.guardiannews.com/
Accessed 2 Nov 2019
Release of Vaxxed sequel prompts fears dangerous propaganda will spread again
Anti-vaccination film to premiere in theatres as several states have been battling against localised outbreaks of measles
31 Oct 2019
Anti-vaccination campaigners are preparing to release the sequel to Vaxxed, the highly contentious film that has been used to spread the unfounded claim that vaccines cause autism and other developmental problems.
Vaxxed II: The People’s Truth will be premiered on 6 November in 50 venues across America. Its producers, led by Robert F Kennedy Jr, are keeping locations secret with tickets sold quietly in advance in the hope of foiling efforts to block the movie.
From 7 November, the film will be taken on the road in the same “Vaxxed” bus that was deployed in 2016 to disseminate the original film, traveling more than 50,000 miles from coast to coast of the US. The movie was a powerful propaganda tool for the anti-vaccination movement, which has seen a surge in recent years within certain religious communities and among parents worried about scientifically unproven so-called “vaccine injuries”.’’

 

New Yorker
http://www.newyorker.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

 

New York Times
http://www.nytimes.com/
Accessed 2 Nov 2019
Africa
Exclusive: WHO, Congo Eye Tighter Rules for Ebola Care Over Immunity Concerns
The World Health Organization and Congolese authorities are proposing changes to how some Ebola patients are cared for, new guidelines show, after a patient’s death challenged the accepted medical theory that survivors are immune to reinfection.
By Reuters Oct 31

Business
Merck to Ramp Up Gardasil Vaccine Production, Flags ‘Tempered’ Sales Growth in 2020
Merck & Co Inc said on Tuesday it intends to ramp up production of its top-selling vaccine Gardasil in 2023 and warned of a slowdown in revenue growth next year as demand for the therapy outpaces supply.
By Reuters Oct 29

Global health
New TB Vaccine Could Save Millions of Lives, Study Suggests
There are 10 million new cases each year of tuberculosis, now the leading infectious cause of death worldwide. Even a partly effective vaccine could help turn the tide.
Oct. 29, 2019
… The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa and Zambia. All of them already had latent tuberculosis — a silent infection that might or might not progress to active tuberculosis.
Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis…

 

Washington Post
https://www.washingtonpost.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

Think Tanks et al

Posted on by

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 2 Nov 2019
[No new relevant content]

 

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 2 Nov 2019
[No new relevant content]

 

CSIS
https://www.csis.org/
Accessed 2 Nov 2019
[No new relevant content]

 

Council on Foreign Relations
http://www.cfr.org/
Accessed 2 Nov 2019
[No new relevant content]

 

Kaiser Family Foundation
https://www.kff.org/search/?post_type=pre ss-release
November 1, 2019 Fact Sheet
The U.S. Government and Global Polio Efforts
This fact sheet provides a snapshot of global polio eradication efforts and examines the U.S. government’s role in addressing polio worldwide.

October 29, 2019 Issue Brief
Data Note: Donor Funding for the Current Ebola Response in the DRC
This data note provides the first comprehensive summary of donor funding for the Ebola response in the DRC.