Milestones :: Perspectives :: Research

Wellcome Trust [to 25 July 2020]
https://wellcome.ac.uk/news
Opinion | 24 July 2020
Our response to COVID-19 will help define the 21st century
Jeremy Farrar, Director Wellcome
The true impact of the COVID-19 pandemic will be felt beyond its immediate effects. Jeremy Farrar explains why the choices leaders make now will help define the 21st century.
[This article was first published in the Financial Times (opens in a new tab).]

It is discomfiting but true that most people still underestimate the true impact of the COVID-19 pandemic. Its immediate effects are so shocking that we are all caught up in them. But the longer-term implications may be more profound still. If we are not careful, they will shake the world order to its foundations.

To understand the crisis fully, imagine the concentric ripples generated by a stone thrown into a pond.

The innermost circle is the immediate impact of the virus: fear, illness and death. The second, larger circle describes COVID-19’s indirect health effects, such as missed cancer screenings. In the 2014 Ebola outbreak, more people died of malaria in west Africa than of the virus itself. It can take years for people to regain trust in healthcare systems.

The third circle, the social and economic impact of rising joblessness and shrinking economies, is larger still. Like every crisis, the pandemic will amplify existing social fractures and inequalities. This will have political consequences. Some governments may fall as a result of COVID-19.

That leads to the fourth and biggest circle: geopolitics. How world powers choose to look after themselves versus the rest of the world will define global politics over the coming decades.

For example, as many governments come to face rising criticism for their perceived or actual failure to protect their citizens, one natural response will be to blame others.

In the UK, there have been increased attacks on minority groups (opens in a new tab). In the US, President Donald Trump has referred to the “China virus” and threatened to withdraw the US from the World Health Organization (WHO).

In stark contrast, China’s President Xi Jinping has sought to position his country (opens in a new tab) as Africa’s friend, promising the continent vaccines as soon as any Chinese citizens get them. Only time will tell if Mr Xi’s promise was true altruism, or merely diplomatic powerplay. But it deliberately differentiated China from Europe and the US. It also underlined the accelerating shift of global power from west to east.

Still, none of the above ripple effects are inevitable.

Of the first two circles, it is not too late to improve disease-surveillance measures, public health and clinical care to reduce the impact of COVID-19’s first wave, and to prepare for potential second waves. We must invest the $31 billion needed in diagnostics, treatments and vaccines (opens in a new tab) to build health systems for all, regardless of ability to pay. This is the only true exit strategy from the pandemic.

The social and political impacts of the third circle can also be mitigated. Among the most vitally needed responses are: debt relief for poorer countries; investment to help the digital transition; support for green technologies to build a carbon neutral world; better education for the young; anti-corruption fighting; and enhanced democratic structures and institutions.

Lastly, there is the fourth circle, where we also face a choice. We can choose nationalistic routes that blame others for our problems. Or we can work together to forge a better, shared future.

There are historical parallels. The international institutions such as the UN, World Bank and WHO that were established after the second world war were born of a moment of enlightened self-interest by leading nations. These institutions have been central to the world’s largely peaceful order of the last 75 years.

Today, they require reform. But they are also needed more than ever. The giant social, scientific and technological advances that humanity saw during the later half of the 20th century grew out of a global commitment to sharing. This did not happen by chance. It happened as a result of choices that were made.

The effects of COVID-19 have been and will continue to be devastating. But infectious disease and pandemics are not the only global challenges that we face. We urgently need to address other issues, including climate change, access to clean water, antimicrobial resistance and mental health.

Like coronavirus, these problems transcend borders. They will not be defeated by insular nationalism, blaming others or drifting into a more polarised world – all this only leaves everyone more vulnerable. Rather, they can be solved by enhancing international cooperation and developing a sense of shared destiny.

It is not inevitable that COVID-19 ripples out these four circles of ruinous effects. But avoiding this outcome requires leaders who lay out honestly the challenges that we face and then, equally honestly, how to deal with them.

The choices we make today will help define the 21st century.

Continue reading →

Milestones :: Perspectives :: Research

A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus
National Academies of Sciences, Engineering, Medicine [U.S.]
An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will develop an overarching framework for vaccine allocation to assist policymakers in the domestic and global health communities in planning for equitable allocation of vaccines against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

The expectation is that such a framework would inform the decisions by health authorities, including the Advisory Committee on Immunization Practices (ACIP), as they create and implement national and/or local guidelines for SARS-CoV-2 vaccine allocation. As part of this effort, the committee will consider the following:
What criteria should be used in setting priorities for equitable allocation of vaccine?
How should the criteria be applied in determining the first tier of vaccine recipients? As more vaccine becomes available, what populations should be added successively to the priority list of recipients? How do we take into account factors such as:
Health disparities and other health access issues
Individuals at higher risk (e.g., elderly, underlying health conditions)
Occupations at higher risk (e.g., health care workers, essential industries, meat packing plants, military)
Populations at higher risk (e.g., racial and ethnic groups, incarcerated individuals, residents of nursing homes, individuals who are homeless)
Geographic distribution of active virus spread
Countries/populations involved in clinical trials
How will the framework apply in various scenarios (e.g., different characteristics of vaccines and differing available doses)?
If multiple vaccine candidates are available, how should we ensure equity?
How can countries ensure equity in allocation of COVID-19 vaccines?
For the US, how can communities of color be assured access to vaccination?
How can we communicate to the American public about vaccine allocation to minimize perceptions of lack of equity?
What steps should be taken to mitigate vaccine hesitancy, especially among high-priority populations?
As part of the overall study, the committee will produce a discussion draft of the framework for public comment, and hold a public workshop to solicit feedback from external stakeholders.
National Academies Launch Study on Equitable Allocation of a COVID-19 Vaccine – First Meeting July 24
Friday, July 24, 4:30 p.m. – 5:30 p.m. EDT
Virtual – Zoom webinar
Agenda

Milestones :: Perspectives :: Research

Confusion spreads over system to determine priority access to Covid-19 vaccines
STAT 22 July 2020
By Helen Branswell @HelenBranswell
As manufacturers around the world race to develop Covid-19 vaccines, a parallel effort has begun to figure out who in the United States should get them first — and how those doses should be distributed.
But already the effort is being complicated by tensions over who gets to make those critical decisions, with some groups feeling sidelined and multiple new actors crowding the stage.
On Tuesday, the National Academy of Medicine, tasked by top U.S. health officials, named an expert panel to develop a framework to determine who should be vaccinated first, when available doses are expected to be scarce. But that panel is ostensibly encroaching on the role of the Advisory Committee on Immunization Practices, a panel that has made recommendations on vaccination policy to the Centers for Disease Control and Prevention for decades, including drawing up the vaccination priority list during the 2009 H1N1 flu pandemic.
There is also the matter of Operation Warp Speed, the government’s vaccine fast-tracking program that has claimed authority over, among other things, distribution decisions when it comes to Covid-19 vaccines.
Amid so many players, public health experts are expressing concern and confusion.
“It seems to me like we’ve just assigned four different air traffic control towers to land the same plane,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “Between ACIP, and this new committee, the group working within Operation Warp Speed and just in terms of input from the general community, it’s not clear to me who will make the final decision and how that process will unfold.”
The health of untold numbers could hang in the balance, given that initial batches of vaccine are likely to be available only for a sliver of the population. Additionally, most vaccines will probably be given in two-dose regimens, meaning any figure of available doses would have to be divided in half to see how many people could be vaccinated.
There is no doubt that health care workers will be offered vaccines first. But after that, tough decisions will have to be made about the order in which other frontline workers — which? how many? — are offered priority access to vaccine and who will follow, in what order.
Normally, such decisions would fall to ACIP, which months ago set up a working group to monitor the evolving science on Covid-19 and the vaccines being developed to protect against it. But it’s not clear what task ACIP will be handed here.
“We haven’t been given a firm answer as to what our role will be. We are continuing with our routine planning and discussion, and we will come up with what we think are appropriate guidelines for prioritization. But that we’ve not been given assurances that we will actually be contributing to that,” said José Romero, the panel’s chairman…

Milestones :: Perspectives :: Research

WFPHA: World Federation of Public Health Associations [to 25 July 2020]
https://www.wfpha.org/
Taskforce on Immunization
Statement on COVID-19 Immunization
Introduction
Immunization is one of the most successful public health measures of modern times. In fact, according to a recent World Health Organization (WHO) report on the prevention of infectious diseases, it is second only to clean water (WHO 2008). Annually immunization prevents an estimated 2.5 million deaths globally and reduces disease-specific treatment costs (WHO 2018).

For all the devastation caused by COVID-19, an important lesson is that the balance needs to shift from treating disease to preventing it. The WHO states that immunization has an important role to play in prevention not only for infants but throughout life as a key component of healthy ageing. Further, investing in vaccines specifically, and immunization generally, saves time, money and lives, and leads to healthier, sustainable healthcare systems and communities (UK Chief Medical Officers’ Guidelines 2011).

Specific to COVID-19, almost everyone is at risk and may require vaccination if given the opportunity. Hence, it is likely that demand will surpass supply. The concern of the WFPHA Immunisation Taskforce is the tendency for the rich to acquire and pay for the limited supply of available efficacious vaccines to the detriment of the at-risk populations in low income settings.

Not surprisingly, the race to produce an efficacious and cost-effective vaccine for COVID-19 has been on-going and there are indications that success may not be too far away. There are important lessons, unfortunately, that experience has taught us from previous immunization programs. Even when effective vaccines are available, vulnerable persons in low income settings usually do not have access to these vaccines for some time, if at all. There is a myriad of reasons for this state of affairs. These include (among others) high cost of vaccination programs for countries, health systems, families and individual, individual’s poor geographical access to vaccination centres, and inadequate supply of available vaccines due to competition. To worsen matters, GAVI (The Vaccine Alliance) indicated (prior to COVID-19) its intention to wean itself off such funding support.

Therefore, the WFPHA Immunisation Taskforce recommends
1. The international community should widen the process of coming together to support research and development of cost-effective COVID-19 vaccines from multiple centres.
2. The International community should establish a COVID-19 vaccination fund to support needy but resource-constrained countries
3. Supporting the efforts of the World Health Organization in efforts to coordinate the response to COVID-19 and in particular the coordination of efforts to develop an appropriate vaccine
4. National authorities should financially support the WHO and invest in strengthening national health systems with a particular focus on sustainable immunization programs
5. GAVI should continue to work for equitable distribution of any effective vaccine against COVID-19 and postpone any plans of withdrawing funding support to developing countries.

References
GAVI (2020) COVID-19: massive impact on lower-income countries threatens more disease outbreaks https://www.gavi.org/news/media-room/covid-19-massive-impact-lower-income-countries-threatens-more-disease-outbreaks

WHO (2008) Vaccination greatly reduces disease, disability, death and inequity worldwide. Available at: https://www.who.int/bulletin/volumes/86/2/07-040089/en/ Last accessed: June 2019.

WHO (2018) Vaccines: the powerful innovations bringing WHO’s mission to life every day. Available at: https://www.who.int/news-room/commentaries/detail/vaccines-the-powerful-innovations-bringing-who-s-mission-to-life-every-day Last accessed: May 2019.

UK Chief Medical Officers’ Guidelines (2011) Physical activity benefits for adults and older adults. Available at: https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/physical-activity-info.pdf Last accessed: June 2019.

Milestones :: Perspectives :: Research

WFPHA: World Federation of Public Health Associations [to 25 July 2020]
https://www.wfpha.org/
Taskforce on Immunization
Statement on COVID-19 Immunization
Introduction
Immunization is one of the most successful public health measures of modern times. In fact, according to a recent World Health Organization (WHO) report on the prevention of infectious diseases, it is second only to clean water (WHO 2008). Annually immunization prevents an estimated 2.5 million deaths globally and reduces disease-specific treatment costs (WHO 2018).

For all the devastation caused by COVID-19, an important lesson is that the balance needs to shift from treating disease to preventing it. The WHO states that immunization has an important role to play in prevention not only for infants but throughout life as a key component of healthy ageing. Further, investing in vaccines specifically, and immunization generally, saves time, money and lives, and leads to healthier, sustainable healthcare systems and communities (UK Chief Medical Officers’ Guidelines 2011).

Specific to COVID-19, almost everyone is at risk and may require vaccination if given the opportunity. Hence, it is likely that demand will surpass supply. The concern of the WFPHA Immunisation Taskforce is the tendency for the rich to acquire and pay for the limited supply of available efficacious vaccines to the detriment of the at-risk populations in low income settings.

Not surprisingly, the race to produce an efficacious and cost-effective vaccine for COVID-19 has been on-going and there are indications that success may not be too far away. There are important lessons, unfortunately, that experience has taught us from previous immunization programs. Even when effective vaccines are available, vulnerable persons in low income settings usually do not have access to these vaccines for some time, if at all. There is a myriad of reasons for this state of affairs. These include (among others) high cost of vaccination programs for countries, health systems, families and individual, individual’s poor geographical access to vaccination centres, and inadequate supply of available vaccines due to competition. To worsen matters, GAVI (The Vaccine Alliance) indicated (prior to COVID-19) its intention to wean itself off such funding support.

Therefore, the WFPHA Immunisation Taskforce recommends
1. The international community should widen the process of coming together to support research and development of cost-effective COVID-19 vaccines from multiple centres.
2. The International community should establish a COVID-19 vaccination fund to support needy but resource-constrained countries
3. Supporting the efforts of the World Health Organization in efforts to coordinate the response to COVID-19 and in particular the coordination of efforts to develop an appropriate vaccine
4. National authorities should financially support the WHO and invest in strengthening national health systems with a particular focus on sustainable immunization programs
5. GAVI should continue to work for equitable distribution of any effective vaccine against COVID-19 and postpone any plans of withdrawing funding support to developing countries.

References
GAVI (2020) COVID-19: massive impact on lower-income countries threatens more disease outbreaks https://www.gavi.org/news/media-room/covid-19-massive-impact-lower-income-countries-threatens-more-disease-outbreaks

WHO (2008) Vaccination greatly reduces disease, disability, death and inequity worldwide. Available at: https://www.who.int/bulletin/volumes/86/2/07-040089/en/ Last accessed: June 2019.

WHO (2018) Vaccines: the powerful innovations bringing WHO’s mission to life every day. Available at: https://www.who.int/news-room/commentaries/detail/vaccines-the-powerful-innovations-bringing-who-s-mission-to-life-every-day Last accessed: May 2019.

UK Chief Medical Officers’ Guidelines (2011) Physical activity benefits for adults and older adults. Available at: https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/physical-activity-info.pdf Last accessed: June 2019.

Milestones :: Perspectives :: Research

Coronavirus treatment
Rich country vaccine rush threatens supply security
Spending spree stokes wrangles over pricing and risks leaving behind poorer nations
Financial Times reporters July 23 2020 | Free to read

A multibillion-dollar flurry of coronavirus vaccine dealmaking between rich countries and companies has exposed a lack of international co-ordination and threatens to leave poor nations out.

The resulting patchwork of agreements has raised big questions about global vaccine access and stoked wrangles over pricing, supply security and liability for possible side-effects.

“On the positive side, bilateral deals between countries and companies can drive forward the science and clinical development — and expand the world’s manufacturing capacity,” said Seth Berkley, chief executive of Gavi, a UN-backed alliance that buys and distributes vaccines in more than 50 of the world’s poorest countries.

“But . . . you [also] end up with unnecessary competition, shortages of supplies and a failure to optimise a pipeline that should make the best vaccines available at scale as quickly as possible.”

Every government scrambling to secure inoculations has faced similar difficulties in deciding what to back and how much to pay for products that could prove revolutionary but do not yet exist.

The accords struck range widely in nature. They include commitments to buy specified numbers of doses, production licensing agreements, and the acquisition of direct stakes in manufacturers.

The vaccine rush accelerated this week with the announcement that the UK had agreed to buy 60m doses from Valneva of France and 30m doses over the next two years of a candidate developed by Germany’s BioNTech with the US pharma giant Pfizer.

Two days later, the US unveiled a deal to spend $1.95bn on 100m doses of the same inoculation to distribute free of charge to American citizens. The agreement also included the option for Washington to purchase a further 500m doses, subject to the product receiving regulatory approval

The recent deals add to a growing list being struck for the scores of candidate vaccines being developed worldwide. The US Biomedical Advanced Research and Development Authority has spent billions of dollars securing supplies. The EU has allocated billions of euros and has been in talks with companies including Johnson & Johnson of the US and France’s Sanofi.

Meanwhile, UK-based AstraZeneca has announced agreements to supply Britain, an alliance of four continental European countries, the US, Brazil and low-income nations.

Pricing is a particularly fraught question. People involved on all sides say there are many unknowns, including manufacturing costs, yields of end products and dosage sizes needed. Some companies such as Johnson & Johnson have said they will manufacture on a “not for profit” basis, while others, including Pfizer, have made no such commitment. Latest coronavirus news Follow FT’s live coverage and analysis of the global pandemic and the rapidly evolving economic crisis here.

Many of the agreements do not disclose price, while the variation in those that do is large. The US deal for the BioNTech-Pfizer inoculation works out at $19.50 a dose. This is several times higher than estimates for an AstraZeneca supply agreement with the Netherlands, Germany, France and Italy that the Dutch government described as “at cost”, according to Geoffrey Porges, a pharma and biotech analyst at SVB Leerink.

Without access to full confidential details of agreements, it is hard for outsiders to make firm judgments on pricing. But Peter Pitts, former associate commissioner of the US Food and Drug Administration, said he believed the terms would be such that pharmaceutical companies would benefit one way or another.

“I think at the end of the day what we’ll see is everybody is going to recoup their costs and make some profit,” he said. “I suspect they are all saying different things that mean the same thing.”

The complexity of the dealmaking has been increased by the variety of different vaccine types that are in development.

Kate Bingham, head of the UK’s vaccines taskforce, said London was hoping to expand its three deals to give it a “broad and diverse portfolio”. The aim is to have two agreements in place for each of the four main vaccine technologies — mRNA, viral vectors, inactivated whole virus and adjuvanted proteins.

The terms of agreements also vary depending on the size and type of company. “Smaller companies need a lot more funding upfront than larger companies, [such as] contributions to scale up manufacturing and help to fund clinical trials,” Ms Bingham said.

While any new pharmaceutical product poses potential safety risks, the hazards may be higher with Covid-19 because of the gaps in scientific knowledge of the disease and the accelerated development of candidate vaccines.

“[Liability] is an issue that comes up all the time and with Covid-19 the risk is unknown,” said Melanie Saville, head of vaccines at the Coalition for Epidemic Preparedness Innovations (Cepi), a partnership of governments, industry and charities.

“The usual types of insurance policies that companies take out just aren’t available. It will have to be sorted out and we’re looking at how to do it.”

Cepi is one of the organisations leading efforts to secure supplies for poorer countries by funding nine Covid-19 vaccine projects. A condition of the financing is that recipients participate in the joint Cepi, Gavi and World Health Organization Covax programme, which aims to enable equitable access to a inoculation for all countries, rich and poor.

But efforts to ensure equitable worldwide distribution of any successful vaccine are the exception to the wider deal-making free-for-all.

As rich countries pour rising sums into ad-hoc bets on products they hope will provide an escape hatch out of the pandemic, an official at one vaccine manufacturer observed: “In the future, we need a better system.”

Reporting by Michael Peel in Brussels, Clive Cookson in London, Hannah Kuchler in New York, Joe Miller in Frankfurt and Donato Paolo Mancini in Rome

EMERGENCIES

Coronavirus [COVID-19]
Public Health Emergency of International Concern (PHEIC)

Situation report – 187
Coronavirus disease 2019 (COVID-19)
25 July 2020

Confirmed cases :: 15 581 009 [week ago: 13 876 441]
Confirmed deaths :: 635 173 [week ago: 593 087]

Highlights [selected]
:: The COVID-19 pandemic has affected older people disproportionately, especially those living in long-term care facilities. WHO has published a policy brief on preventing and managing COVID-19 across long-term care services.

:: WHO has released a set of practical steps for implementing the prescriptions of the WHO Manifesto for a healthy recovery from COVID-19. These prescriptions aim to create a healthier, fairer and greener world while investing to maintain and resuscitate the economy hit by the effects of the pandemic.

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New COVID-19 Law Lab to provide vital legal information and support for the global COVID-19 response
22 July 2020 News release New York/Geneva
Launching today, the COVID-19 Law Lab initiative gathers and shares legal documents from over 190 countries across the world to help states establish and implement strong legal frameworks to manage the pandemic. The goal is to ensure that laws protect the health and wellbeing of individuals and communities and that they adhere to international human rights standards.
The new Lab (at www.COVIDLawLab.org) is a joint project of United Nations Development Programme (UNDP), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the O’Neill Institute for National and Global Health Law at Georgetown University.
Well-designed laws can help build strong health systems; evaluate and approve safe and effective drugs and vaccines; and enforce actions to create healthier and safer public spaces and workplaces. Critically, they are key to effective implementation of the WHO International Health Regulations: surveillance; infection prevention and control; management of travel and trade; and implementation of measures to maintain essential health services.
“Laws and policies that are grounded in science, evidence and human rights can enable people to access health services, protect themselves from COVID-19 and live free from stigma, discrimination and violence,” says Achim Steiner, UNDP Administrator. “The COVID-19 Law Lab is an important tool for sharing good practices on laws and policies.”…

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Pfizer and BioNTech Announce an Agreement with U.S. Government for up to 600 Million Doses of mRNA-based Vaccine Candidate Against SARS-CoV-2
July 22, 2020
:: U.S. government placed an initial order of 100 million doses for $1.95 billion and can acquire up to 500 million additional doses
:: Americans to receive the vaccine for free consistent with U.S. government’s commitment for free access for COVID-19 vaccines
:: Pfizer and BioNTech remain on track to begin an anticipated Phase 2b/3 safety and efficacy trial later this month, seek regulatory review as early as October 2020, and manufacture globally up to 100 million doses by the end of 2020 and potentially more than 1.3 billion doses by the end of 2021

Pfizer and BioNTech Announce Early Positive Update from German Phase 1/2 COVID-19 Vaccine Study, Including First T Cell Response Data
July 20, 2020
:: The data further demonstrated the ability of BNT162b1 to elicit high SARS-CoV-2 neutralizing titers
:: BNT162b1 elicited strong CD4+ and CD8+ T cell responses against SARS-CoV-2- receptor binding domain (RBD), compared to baseline
:: The RBD-specific, interferon-γ+, IL-2+, CD8+ T cells elicited by BNT162b1 in immunized participants indicate a strong potential for cell mediated anti-viral activity
:: T cell cytokine profile shows vaccine elicited T cells exhibit a Th1 phenotype, which is associated with antiviral properties
:: BNT162b1 induced antibodies had broadly neutralizing activity in pseudovirus neutralization assays across a panel of sixteen SARS-CoV-2 RBD variants identified in published SARS-CoV-2 sequences and against the newly dominant D614G strain
:: Robust specific antibody and T cell responses, (both of which are considered by experts as key to a vaccine ensuring protection against disease) elicited by the BNT162b1 mRNA vaccine against RBD suggest a potential for multiple beneficial protective mechanisms against COVID-19
:: Local reactions and systemic events after immunization with BNT162b1 were dose-dependent, generally mild to moderate and transient, with occasional severe adverse events (Grade 3, e.g. flu-like symptoms and injection site reactions) that resolved spontaneously or could be managed with simple measures – no serious adverse events were reported

Pfizer and BioNTech Announce Agreement with the United Kingdom for 30 Million Doses of mRNA-based Vaccine Candidate against SARS-CoV-2
July 19, 2020
:: Thirty million doses expected to be delivered in 2020 and 2021, subject to regulatory approval or authorization
:: Pfizer and BioNTech remain on track to begin an anticipated Phase 2b/3 safety and efficacy trial later this month, seek regulatory review as early as October 2020 and manufacture globally up to 100 million doses by the end of 2020 and more than 1.3 billion doses by the end of 2021
:: Agreement is part of Pfizer’s and BioNTech’s global commitment to help address the pandemic

Novavax and FUJIFILM Diosynth Biotechnologies Initiate Large Scale Manufacturing of COVID-19 Vaccine Candidate
Jul 23, 2020

COVID-19 Vaccines Test Safe & Effective by China & UK teams: the Lancet
Jul 23, 2020,

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Emergencies

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

Last WHO Situation Report published 23 June 2020

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Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 21 July 2020
:: In response to donor and stakeholder feedback, as well as the programme’s evolving needs and challenges, in December 2019, GPEI launched an internal governance review process to evaluate how to improve the partnership’s operations and structures at the leadership level (Polio Oversight Board, Finance & Accountability Committee and Strategy Committee). The result of a series of surveys, workshops, interviews and stakeholder consultations conducted over a six-month period, this report outlines key issues with recommendations aimed at strengthening the programme’s governance [see below].

Summary of new WPV and cVDPV viruses this week (AFP cases and environmental samples):
:: Afghanistan: five WPV1 cases and five WPV1 positive environmental samples
:: Pakistan: two WPV1 cases and eight WPV1 positive environmental samples
:: Cameroon: one cVDPV2 positive environmental sample
:: Chad: three cVDPV2 cases

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GPEI – Governance Review Final Report
July 2020 :: 25 pages
EXECUTIVE SUMMARY
In response to donor and stakeholder feedback, as well as the programme’s evolving needs
and challenges, the Global Polio Eradication Initiative (GPEI) undertook an internal review process to evaluate how to improve the partnership’s operations, structures and culture in order to more efficiently and effectively progress towards the endgame strategy’s goals and objectives. The result of a series of surveys, workshops, interviews and stakeholder consultations, this report sets forth key issues and recommendations aimed at strengthening
the programme’s structure and operations.

Stakeholders also emphasized the importance of integration activities and – while not a primary focus of this report – we acknowledge that work remains to be done to strengthen efforts toward GPEI’s integration goal. Incorporating these recommendations through deliberate and concerted actions – while simultaneously strengthening efforts towards integration and fostering a culture of change – GPEI can achieve greater accountability for decisions and
implementation, increase transparency around its decision-making and financial processes,
enhance country engagement and ownership, and reinforce continuous improvement. These outcomes will help GPEI reach its goals: eradication, integration, containment and certification.

GPEI has achieved significant and important successes. There are, however, obstacles that GPEI must address in order to realize its goals. The programme must rise to meet significant
challenges, including GPEI’s work in the remaining endemic countries, contending with
circulating vaccine-derived polioviruses, vaccine supply issues and the impact of COVID-19 on
GPEI operations and vaccination efforts.

Donors have questioned whether GPEI’s structure and governance remain fit for purpose to eradicate polio. This report outlines proposed changes that stakeholders feel will reinforce the partnership’s fitness moving forward. These recommendations do not address questions of
programme strategy and are not intended to be the sum total of the governance review process. They are, however, important steps in GPEI’s ongoing improvement to ensure the partnership is fit for purpose and provide important substrate for the larger revision of the endgame strategy. The GPEI Strategy Committee should actively manage and monitor implementation of the recommendations and any required follow-ups.

While the need for this review was identified and the exercise itself began before the onset of COVID-19, the challenges confronting GPEI as a result of the pandemic have reinforced
…
CONCLUSION AND NEXT STEPS
The donor community is supportive of GPEI and its work. Though this review explored the possibility, no one suggested that GPEI should be dismantled and rebuilt from the ground up. The history, momentum, institutional knowledge and capabilities of the partnership are unparalleled, and stakeholders are eager to see the partnership succeed. However, stakeholders want substantive changes within the partnership related to role clarity, accountability, and considering new perspectives.

This review emphasizes stakeholders’ concerns with some of GPEI’s operations and structures across all levels of the programme and presents some ways forward to address them. GPEI must commit to a strong culture of change to implement these recommendations and improve the programme’s accountability, transparency, country engagement and ownership, as well as the ability to continuously improve. GPEI must also refocus its integration efforts, which will allow GPEI to support immunization, health systems and emergency response in the near term, particularly in the wake of COVID-19, as well as in the long-term, cementing its legacy in a post-polio world.

GPEI’s donors, stakeholders and partners are rooting for its success, and seeing demonstrable progress on these recommendations will strengthen their commitment and resolve to achieve a polio-free world.

As immediate next steps, the Strategy Committee needs to:
reflect on recommendations and determine how to move forward;
consult with the POB on its conclusions and course of action;
develop an implementation workplan;
follow up (as soon as possible) with donors and other stakeholders, outlining which steps are to be taken and what the implementation workplan (and timeline) looks like; and
provide regular updates to the programme and stakeholders on the progress of the implementation workplan.

It is critical that GPEI leadership follow through on the steps listed above to ensure that this is
a substantial, serious effort – and demonstrate that change is welcome within the partnership
because eradication goals may be at risk with the partnership’s current structure and practices

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WHO Grade 3 Emergencies [to 25 July 2020]

Democratic Republic of the Congo – No new digest announcements identified
Mozambique floods – No new digest announcements identified
Nigeria – 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 25 July 2020]
Burkina Faso [in French]
:: Combattre la peur et la stigmatisation liées à la COVID-19
23 juillet 2020
Hésitation à se faire dépister, éviter les personnes chargées de la recherche des contacts ou se méfier de ce que diront les voisins : la pandémie de COVID-19 a déclenché chez certains habitants de Ouagadougou des réactions diverses qui ont rendu la riposte plus difficile.

Iraq
:: WHO mobile clinics serving the vulnerable in Mosul amid COVID-19 outbreak 20 July 2020

Niger
:: Continuité des services de santé en contexte de COVID19 : l’OMS accompagne le Gouver… 19 juillet 2020
Le Niger a lancé officiellement le 13 juillet l’édition 2020 de la campagne de chimio prévention du paludisme saisonnier. Cette campagne couplée au dépistage de la malnutrition, entre dans le cadre de la lutte contre le paludisme au Niger qui reste une des principales préoccupations de santé pour le pays. La cérémonie de lancement a eu lieu à Niamey dans la salle de conférence de l’hôtel Bravia sous le patronage du Ministre de la Santé Publique, Dr Idi Illiassou Mainassara en présence de la Représentante de l’OMS au Niger Dr Anya Blanche, et des autres partenaires du Programme.

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Libya – No new digest announcements identified
Malawi – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::

WHO Grade 1 Emergencies [to 25 July 2020]

Chad – No new digest announcements identified
Djibouti – Page not responding at inquiry
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
:: 23 Jul 2020 Daily Noon Briefing Highlights: Nigeria – Syria

Yemen
:: 22 Jul 2020 UN report: Yemen sees return to alarming levels of food insecurity
:: 20 Jul 2020 Daily Noon Briefing Highlights: India – Nepal – Sudan – Yemen

::::::

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.
East Africa Locust Infestation
:: Desert Locust situation update – 21 July 2020

COVID-19
:: Coronavirus disease 2019 (COVID-19) Situation Report 37: occupied Palestinian territory, issued 16 July 2020, information for period: 5 March – 23 July 2020

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

WHO & Regional Offices [to 25 July 2020]

New COVID-19 Law Lab to provide vital legal information and support for the global COVID-19 response
22 July 2020 News release New York/Geneva
[See COVID-19 above for detail]
::::::

Weekly Epidemiological Record, 24 July 2020, vol. 95, 30 (pp. 349–360)
WHO Alliance for the Global Elimination of Trachoma by 2020: progress report, 2019

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Over 10 000 health workers in Africa infected with COVID-19 23 July 2020
The World Health Organization (WHO) today warned of the threat posed by COVID-19 to health workers across Africa. More than 10 000 health workers in the 40 countries which have reported on such infections have been infected with COVID-19 so far, a sign of the challenges medical staff on the frontlines of the outbreak face.
:: WHO, Africa CDC in joint push for COVID-19 traditional medicine research in Africa
22 July 2020

WHO Region of the Americas PAHO
No new digest content identified

WHO South-East Asia Region SEARO
No new digest content identified

WHO European Region EURO
:: Prison nurse Deanna Mezen guarantees continuity of care for detainees 24-07-2020
:: Countries commit to meeting SDGs in face of pandemic 23-07-2020
:: WHO Regional Director for Europe signs agreement for new centre of excellence and visits Gaziantep, marking 60 years of cooperation with Turkey 22-07-2020
:: Altynai Karakhoishiyeva: helping women give birth during the COVID-19 pandemic 21-07-2020

WHO Eastern Mediterranean Region EMRO
:: Confronting outbreaks in Somalia 22 July 2020
:: WHO delivers 16 CT scan machines to Islamic Republic of Iran 21 July 2020
:: Essential polio vaccination campaigns resume  20 July 2020

WHO Western Pacific Region
No new digest content identified

CDC/ACIP [to 25 July 2020]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Latest News Releases
Transcript for CDC Telebriefing on New Resources and Tools to Support Opening Schools Friday, July 24, 2020

CDC releases new resources and tools to support opening schools Thursday, July 23, 2020

Dr. Robert R. Redfield Statement on SARS-CoV-2 infections Wednesday, July 22, 2020

MMWR News Synopsis Friday, July 24, 2020
Estimated County-Level Prevalence of Select Underlying Medical Conditions Associated with Increased Risk of Severe COVID-19 Illness: United States 2018

Evaluation of an Online Risk Assessment To Identify Rabies Exposures Among Health Care Workers — Utah, 2019

Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample — Indiana, April 25–29, 2020 (Early release July 21, 2020)

Estimated Community Seroprevalence of SARS-CoV-2 Antibodies — Two Georgia Counties, April 28–May 3, 2020 (Early release, July 21, 2020)

Africa CDC [to 25 July 2020]
http://www.africacdc.org/
News
WHO, Africa CDC in joint push for COVID-19 traditional medicine research in Africa
Addis Ababa/Brazzaville, 22 July 2020 – In a joint effort to enhance research and development of traditional medicines for COVID-19 in Africa, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) today launched an expert advisory committee/panel to provide independent scientific advice and support to countries on the safety, efficacy and quality of traditional medicine therapies.
The 25-member Regional Expert Committee on Traditional Medicine for COVID-19 will support countries in collaborative efforts to conduct clinical trials of traditional medicines in compliance with international standards…

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/
News
July 25: Daily briefing on novel coronavirus cases in China
On July 24, 31 provincial-level regions and the Xinjiang Production and Construction Corps on the Chinese mainland reported 34 new cases of confirmed infections.

China to intensify infectious disease prevention in H2: document
2020-07-24
BEIJING — China will give priority to the prevention of COVID-19 while deepening healthcare reform in the second half of this year, according to a document issued on July 23.
Released by the General Office of the State Council, the document clarifies the key tasks for deepening reform of medical and health systems.
It calls for strengthening the public health system, improving the monitoring and early warning system for infectious diseases, and preparing for COVID-19 prevention in autumn and winter.
Public hospitals should strengthen the ability to treat infectious diseases, the document says, adding efforts should be made to improve the containment of infectious diseases at border ports.
The mechanism for monitoring diseases of unknown causes and abnormal health events should be improved, according to the document, which also urges the military and civilian authorities to strengthen information sharing about infectious diseases.
The document demands the enhancement of the country’s nucleic acid detection capability, as well as more investment in developing vaccines, drugs and rapid-detection technologies.
In preparation for a possible COVID-19 outbreak during the autumn and winter, the document requires local authorities to strengthen personnel training to guard against the epidemic and conduct emergency drills.
The document also seeks to deepen reform of public hospitals, promote the prevention and treatment of chronic diseases, improve basic medical insurance, and complete the medicine supply system.

Announcements

Paul G. Allen Frontiers Group [to 25 July 2020]
https://alleninstitute.org/what-we-do/frontiers-group/news-press/
News
No new digest content identified.

BARDA – U.S. Department of HHS [to 25 July 2020]
https://www.phe.gov/about/barda/Pages/default.aspx
BARDA News
July 22, 2020: U.S. Government Engages Pfizer to Produce Millions of Doses of COVID-19 Vaccine
The U.S. Department of Health and Human Services and the Department of Defense (DoD) today announced an agreement with U.S.-based Pfizer Inc. for large-scale production and nationwide delivery of 100 million doses of a COVID-19 vaccine in the United States following the vaccine’s successful manufacture and approval. The agreement also allows the U.S. government to acquire an additional 500 million doses.
The federal government will own the 100 million doses of vaccine initially produced as a result of this agreement, and Pfizer will deliver the doses in the United States if the product receives Emergency Use Authorization (EUA) or licensure from the U.S. Food and Drug Administration (FDA), as outlined in FDA guidance, after completing demonstration of safety and efficacy in a large Phase 3 clinical trial.
By entering into this agreement now, a safe and effective vaccine can be shipped quickly if FDA grants EUA or licensure. This approach helps meet the U.S. government’s Operation Warp Speed goal to begin delivering 300 million of doses of safe and effective vaccine to the American people by
the end of the year…

BMGF – Gates Foundation [to 25 July 2020]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

Bill & Melinda Gates Medical Research Institute [to 25 July 2020]
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 25 July 2020]
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 25 July 2020]
http://cepi.net/
Latest News
CEPI extends funding call to accelerate development and global manufacture of COVID-19 vaccines
21 Jul 2020 By Jodie Rogers
CEPI has extended its Call for Proposals to advance development and manufacture of COVID-19 vaccine candidates
Vaccine developers with end-to-end experience and capability for the global supply of COVID-19 vaccine doses in 12-18 months are encouraged to apply
The new call will look more favourably on vaccine candidates that, based on field experience to date, have indications that their candidate vaccine is able to offer measurable protection after one dose.

EDCTP [to 25 July 2020]
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 25 July 2020]
http://www.vaccines.emory.edu/
Vaccine Center News
No new digest content identified.

European Medicines Agency [to 25 July 2020]
http://www.ema.europa.eu/ema/
News & Press Releases
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 20-23 July 2020
News 24/07/2020
Eleven new medicines recommended for approval
EMA’s human medicines committee (CHMP) recommended eleven medicines for approval at its July 2020 meeting, including a medicine for use in countries outside the European Union.
The CHMP adopted a positive opinion for Dapivirine Vaginal Ring (dapivirine) used to reduce the risk of infection with the human immunodeficiency virus type 1 (HIV-1), in combination with safer sex practices when oral pre-exposure prophylaxis is not used, cannot be used or is not available. Placed in the vagina, the ring slowly releases the antiretroviral medicine dapivirine over a period of 28 days.
This is the eleventh medicine recommended by EMA under EU Medicines for all (EU-M4All), a mechanism that allows the CHMP to assess and give opinions on medicines that are intended for use in countries outside the EU under Article 58 of Regulation (EC) No 726/2004…

News: EMA starts review of dexamethasone for treating adults with COVID-19 requiring respiratory support
CHMP, Last updated: 24/07/2020

News: COVID-19: EMA sets up infrastructure for real-world monitoring of treatments and vaccines
Last updated: 21/07/2020
EMA has now set up an infrastructure to support the monitoring of the efficacy and safety of COVID-19 treatments and vaccines when used in day-to-day clinical practice. This is underpinned by three contracts for observational research that EMA has signed with academic and private partners over recent months, to be ready to effectively monitor vaccines in the real world as soon as they are authorised, and support the safe and effective use of COVID-19 vaccines and medicines.
The latest contract was finalised in mid-July with Utrecht University and the University Medical Center Utrecht as coordinators of the CONSIGN project (‘COVID-19 infectiOn aNd medicineS In preGNancy’). This project will collect data on the impact of COVID-19 in pregnancy in order to guide decision-making about vaccine indications, vaccination policies and treatment options for COVID-19 in pregnant women. CONSIGN will analyse existing data sources (e.g. electronic health records, hospital data) and cohorts of pregnant women to provide information on the effect of infection and its treatments in different trimesters of pregnancy and on neonates. The project will be carried out in collaboration with the ConcePTION consortium, which was established under the EU’s Innovative Medicines Initiative, the COVI-PREG project and the International Network of Obstetric Survey Systems (INOSS) network.
In June, EMA contracted the company IQVIA with a project to build a framework for the conduct of multicentre cohort studies on the use of medicines in COVID-19 patients. This project will include the identification of large national cohorts of COVID-19 patients and appropriate comparator groups, the development of a study protocol template for multinational studies as well as the establishment of a collaborative framework for researchers. The project will be carried out in collaboration with the European Health Data & Evidence Network (EHDEN) consortium, which was established under the Innovative Medicines Initiative and includes the Erasmus Medical Centre in Rotterdam and the University of Oxford as project lead and research coordinator, respectively.*
In May, EMA commissioned the ACCESS project (‘vACcine Covid-19 monitoring readinESS’) for preparatory research into data sources and methods that can be used to monitor the safety, effectiveness and coverage of COVID-19 vaccines in clinical practice, once authorised…

European Vaccine Initiative [to 25 July 2020]
http://www.euvaccine.eu/
Latest News
No new digest content identified.

FDA [to 25 July 2020]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
Press Announcements
July 24, 2020 – Coronavirus (COVID-19) Update: FDA Authorizes First Diagnostic Test for Screening of People Without Known or Suspected COVID-19 Infection

July 24, 2020 – Coronavirus (COVID-19) Update: Daily Roundup July 24, 2020

July 23, 2020 – Coronavirus (COVID-19) Update: Daily Roundup July 23, 2020

July 22, 2020 – Coronavirus (COVID-19) Update: Daily Roundup July 22, 2020

July 21, 2020 – Coronavirus (COVID-19) Update: Daily Roundup July 21, 2020

July 20, 2020 – Coronavirus (COVID-19) Update: Daily Roundup July 20, 2020

Fondation Merieux [to 25 July 2020]
http://www.fondation-merieux.org/
News, Events
Project
The Mérieux Foundation, FIND, ASLM and LSHTM are launching a MOOC on COVID-19 Diagnostics and Testing
July 21, 2020 – Lyon, France
This online course, available in English and French as of July 20, is open for registration. It is designed for professionals involved in the diagnostics and testing of COVID-19, with a focus on low- and middle-income settings.

Gavi [to 25 July 2020]
https://www.gavi.org/
News releases
24 July 2020
Why the UK wants to recruit half a million people in a COVID-19 vaccine trial

²3 July 2020
Delivering life-saving vaccines during the COVID-19 pandemic

22 July 2020
What happens if COVID-19 mutates?

GHIT Fund [to 25 July 2020]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that No new digest content identified.

Global Fund [to 25 July 2020]
https://www.theglobalfund.org/en/news/
No new digest content identified.

Hilleman Laboratories [to 25 July 2020]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 25 July 2020]
http://www.humanvaccinesproject.org/media/press-releases/
No new digest content identified.

IAVI [to 25 July 2020]
https://www.iavi.org/newsroom
Features
July 21, 2020
Surveying the HIV Vaccine and Cure Landscape at AIDS 2020 Virtual
Thumbi Ndung’u, Ph.D., provides a view of current strategies for HIV vaccine and cure design

International Coalition of Medicines Regulatory Authorities [ICMRA]
http://www.icmra.info/drupal/en/news
Selected Statements, Press Releases, Research
No new digest content identified.

International Generic and Biosimilar Medicines Association [IGBA]
https://www.igbamedicines.org/
News
No new digest content identified.

IFFIm
http://www.iffim.org/
Announcements
No new digest content identified.

IFRC [to 25 July 2020]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
Americas
Red Cross on the ground bracing for tropical storm Gonzalo in the Caribbean
Panama/Port of Spain, 23 July 2020 — The International Federation of Red Cross and Red Crescent Societies (IFRC) is preparing a humanitarian response as the Caribbean braces for their first tropical storm of 2020. A hurricane watch is in effect for Bar …
24 July 2020

Asia Pacific, Indonesia
Red Cross urges Indonesians to change behavior to slow COVID-19
Jakarta/Kuala Lumpur, 24 July 2020 –  Indonesian Red Cross is calling on Indonesians to continue practising physical distancing and to exercise greater caution to prevent COVID-19 infections from spiralling out of control as the country adapts to a `ne …
24 July 2020

Asia Pacific, Bangladesh, India, Nepal
South Asia floods: 9.6 million people swamped as humanitarian crisis deepens
Kuala Lumpur/Delhi/Dhaka/Kathmandu/Geneva, 22 July 2020 – A humanitarian crisis is deepening in South Asia as new figures reveal that more than 9.6 million people have been affected by monsoon floods, devastating large areas of India, Bangladesh and Ne …
22 July 2020

IVAC [to 25 July 2020]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
Q&A: Enhancing Public Trust and Health with COVID-19 Vaccination
July 2020
IVAC experts contribute to the Center for Health Security report on Enhancing Public Trust and Health With COVID-19 Vaccination.

IVI [to 25 July 2020]
http://www.ivi.int/
Selected IVI News & Announcements
No new digest content identified.

JEE Alliance [to 25 July 2020]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 25 July 2020]
http://www.msf.org/
Latest [Selected Announcements]
Nigeria
MSF condemns the killing of five aid workers in northeast Nigeria
Statement 23 Jul 2020

Kyrgyzstan
In remote Kyrgyzstan, COVID-19 puts a strain on the health system
Project Update 22 Jul 2020

Syria
COVID-19 provokes fears over further health system decline in northwestern Sy…
Project Update 21 Jul 2020

National Vaccine Program Office – U.S. HHS [to 25 July 2020]
https://www.hhs.gov/vaccines/about/index.html
NVAC Meetings
September 23-24, 2020 Meeting (Virtual)
February 4-5, 2021 NVAC Meeting
June 16-17, 2021 NVAC Meeting

NIH [to 25 July 2020]
http://www.nih.gov/news-events/news-releases
Selected News Releases
Vaginal ring for HIV prevention receives positive opinion from European regulator
July 24, 2020 — NIAID celebrates pivotal step toward expanding HIV prevention choices for women.

NIH leadership details unprecedented initiative to ramp up testing technologies for COVID-19
July 22, 2020 — RADx efforts seek to create capacity for 6 million daily tests by the end of 2020, address underserved populations.
In a paper in the New England Journal of Medicine(link is external), scientific leaders from the National Institutes of Health set forth a framework to increase significantly the number, quality and type of daily tests for detecting SARS-CoV-2, the virus that causes COVID-19, and help reduce inequities for underserved populations that have been disproportionally affected by the disease. The authors describe the current testing landscape and explain the urgent need for nationwide deployment of low-complexity, point-of-care molecular diagnostics with rapid results. To fill this urgent need, the Rapid Acceleration of Diagnostics (RADx) program was established in just five days following the announcement of $1.5 billion in federal stimulus funding in April 2020. RADx covers the entire life cycle of the target testing technologies,..

PATH [to 25 July 2020]
https://www.path.org/media-center/
Selected Announcements
Milestone study identifies immune markers that may help predict success of vaccination with RTS,S/AS01 malaria vaccine
July 22, 2020 by PATH
Results of partnership between the Ragon Institute, GSK Vaccines, and PATH is key step in understanding human protection against Plasmodium falciparum infection; could help accelerate clinical trials of future malaria vaccines

Sabin Vaccine Institute [to 25 July 2020]
http://www.sabin.org/updates/pressreleases
Statements and Press Releases
No new digest content identified.

UNAIDS [to 25 July 2020]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
23 July 2020
Phenomenal Positive Youths lead the way during COVID-19 pandemic in Zambia

21 July 2020
UNAIDS celebrates the life of Mozambican AIDS activist Tauzene Murgo

21 July 2020
A safe space for key populations in Armenia

UNICEF [to 25 July 2020]
https://www.unicef.org/media/press-releases
Selected Press releases/Announcements
Press release
07/23/2020
Millions of children affected by devastating flooding in South Asia, with many more at risk as COVID-19 brings further challenges

Press release
07/23/2020
UNICEF and partners respond to the triple threat of floods, locusts and COVID-19 in Somalia
Over 3 million Somali children in need of humanitarian assistance

Press release
07/23/2020
Number of separated children rising fast as Ebola spreads in Equateur Province of DRC

Press release
07/21/2020
40 million children miss out on early education in critical pre-school year due to COVID-19

Statement
07/21/2020
Joint Call to Action: Reimagining the World We Need
by Henrietta Fore, Executive Director of UNICEF, and John W.H. Denton, AO Secretary General of the International Chamber of Commerce
[See Milestones above for detail]

Unitaid [to 25 July 2020]
https://unitaid.org/
Featured News
No new digest content identified.

Vaccination Acceptance Research Network (VARN) [to 25 July 2020]
https://vaccineacceptance.org/news.html#header1-2r
Announcements
No new digest content identified.

Vaccine Confidence Project [to 25 July 2020]
http://www.vaccineconfidence.org/
Latest News & Archive
Confusion spreads over system to determine priority access to Covid-19 vaccines
23 July 2020
[See Milestones above for detail]

Vaccine Education Center – Children’s Hospital of Philadelphia [to 25 July 2020]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.

Wellcome Trust [to 25 July 2020]
https://wellcome.ac.uk/news
Opinion | 24 July 2020
Our response to COVID-19 will help define the 21st century
Jeremy Farrar, Director Wellcome
The true impact of the COVID-19 pandemic will be felt beyond its immediate effects. Jeremy Farrar explains why the choices leaders make now will help define the 21st century.
[See Milestones above for detail]

The Wistar Institute [to 25 July 2020]
https://www.wistar.org/news/press-releases
Press Released
No new digest content identified.

WFPHA: World Federation of Public Health Associations [to 25 July 2020]
https://www.wfpha.org/
Latest News
WFPHA Statement on COVID-19 Immunization
Friday, 24 July 2020
Immunization is one of the most successful public health measures of modern times. Annually immunization prevents an estimated 2.5 million deaths globally and reduces disease-specific treatment costs (WHO 2018). For all the devastation caused by COVID-19, an important lesson is that the balance needs to shift from treating disease to preventing it. Specific to COVID-19, almost everyone is at risk and may require vaccination if given the opportunity. Hence, it is likely that demand will surpass supply. The concern of the WFPHA Immunisation Taskforce is the tendency for the rich to acquire and pay for the limited supply of available efficacious vaccines to the detriment of the at-risk populations in low income settings. Therefore, the WFPHA Immunisation Taskforce provides some recommendations. Read the recommendations and statement here.
[See Milestones above for detail]

World Organisation for Animal Health (OIE) [to 25 July 2020]
https://www.oie.int/en/for-the-media/press-releases/2020/
Press Releases
Global action needed now to halt spread of deadly pig disease
The escalation of the spread of African swine fever (ASF) has placed most of the world’s domestic and wild pig populations under direct threat. To support countries’ efforts to protect economies and food security, the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) today launch a joint initiative for the Global Control of ASF.
Paris | Rome, 20 July 2020 – Pork is the most consumed meat in the world, representing 35.6 percent of global meat consumption. In recent years, ASF – which may cause up to 100 percent mortality in pigs – has become a major crisis for the pork industry, causing massive losses in pig populations and generating drastic economic consequences. Currently affecting several countries of Africa, Asia and the Pacific, and Europe, and with no effective vaccine, the disease is not only impeding animal health and welfare but has detrimental impacts on the livelihoods of farmers.

“Today, 51 countries are affected by African swine fever. Amid the difficult situation posed by COVID-19, ASF continues to spread, intensifying the current health and socioeconomic crises,” said Dr Matthew Stone, OIE Deputy Director General for International Standards and Science.
Many countries that are affected by ASF lack sufficient human, financial or technical resources to rapidly detect, respond and contain animal diseases.

“In this globalised world, where diseases can spread rapidly across borders, timely sharing of latest scientific information, international collaboration and notification of ASF are needed to prevent transboundary spread and minimise impact,” said FAO Deputy Director-General, Maria Helena Semedo…

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ARM [Alliance for Regenerative Medicine] [to 25 July 2020]
https://alliancerm.org/press-releases/
Press Releases
No new digest content identified.

BIO [to 25 July 2020]
https://www.bio.org/press-releases
Press Releases
BIO’s Dr. McMurry-Heath Warns Executive Order to “Cripple Small, Innovative Companies” Working to Eradicate COVID-19
July 24, 2020
[See PhRMA below]

DCVMN – Developing Country Vaccine Manufacturers Network [to 25 July 2020]
http://www.dcvmn.org/
News; Upcoming events
No new digest content identified.

IFPMA [to 25 July 2020]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
No new digest content identified.

ICBA – International Council of Biotechnology Associations [to 25 July 2020]
https://internationalbiotech.org/
News
No new digest content identified.

PhRMA [to 25 July 2020]
http://www.phrma.org/
Selected Press Releases, Statements
PhRMA Statement on Drug Pricing Executive Orders
July 24, 2020
WASHINGTON, D.C. (July 24, 2020) – Pharmaceutical Research and Manufacturers of America President and CEO Stephen J. Ubl made the following statement:
“In his 2020 State of the Union Address, President Trump declared that ‘we will never let socialism destroy American health care.’
“Yet, in the middle of a global pandemic, when nearly 145,000 Americans have lost their lives and millions of others have suffered untold economic hardships, this administration has decided to pursue a radical and dangerous policy to set prices based on rates paid in countries that he has labeled as socialist, which will harm patients today and into the future.
“The research-based biopharmaceutical industry has been working around the clock to develop therapeutics and vaccines to treat and prevent COVID-19. The administration’s proposal today is a reckless distraction that impedes our ability to respond to the current pandemic – and those we could face in the future. It jeopardizes American leadership that rewards risk-taking and innovation and threatens the hope of patients who need better treatments and cures.
“The president’s attempt to open our country up to socialized health care sets America, our economic recovery and scientific progress back at a time when we need them most.”

Executive Order on Increasing Drug Importation to Lower Prices for American Patients
Issued on: July 24, 2020
Section 1.  Purpose.  Americans spend more per capita on pharmaceutical drugs than residents of any other developed country.  Americans often pay more for the exact same drugs, even when they are produced and shipped from the exact same facilities.

One way to minimize international disparities in price is to increase the trade of prescription drugs between nations with lower prices and those with persistently higher ones.  Over time, reducing trade barriers and increasing the exchange of drugs will likely result in lower prices for the country that is paying more for drugs.

Sec. 2.  Permitting the Importation of Safe Prescription Drugs from Other Countries.  The Secretary of Health and Human Services shall, as appropriate and consistent with applicable law, take action to expand safe access to lower-cost imported prescription drugs by:
(a)  facilitating grants to individuals of waivers of the prohibition of importation of prescription drugs, provided such importation poses no additional risk to public safety and results in lower costs to American patients, pursuant to section 804(j)(2) of the Federal Food, Drug, and Cosmetic Act (FDCA), 21 U.S.C. 384(j)(2);…

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

Artificial Intelligence – An International Journal
Volume 285 August 2020
https://www.sciencedirect.com/journal/artificial-intelligence/vol/285/suppl/C

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 25 July 2020)
Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation
Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally…
Authors: Solomon Tessema Memirie, Hailemichael Desalegn, Mulugeta Naizgi, Mulat Nigus, Lisanu Taddesse, Yared Tadesse, Fasil Tessema, Meseret Zelalem and Tsinuel Girma
Citation: Cost Effectiveness and Resource Allocation 2020 18:23
Content type: Research
Published on: 22 July 2020

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 25 July 2020)

Normalizing inconvenience to promote childhood vaccination: a qualitative implementation evaluation of a novel Michigan program
In 2015, Michigan implemented a rule requiring parents to attend an education session at a local health department (LHD) prior to waiving mandatory child vaccinations. This study utilizes Normalization Process…
Authors: Denise F. Lillvis, Charley Willison and Katia Noyes
Citation: BMC Health Services Research 2020 20:683
Content type: Research article
Published on: 23 July 2020

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 25 July 2020)

The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach
The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB inf…
Authors: Sandip Mandal, Vineet Bhatia, Mukta Sharma, Partha Pratim Mandal and Nimalan Arinaminpathy
Citation: BMC Medicine 2020 18:163
Content type: Research article
Published on: 20 July 2020

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 25 July 2020)

The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach
The prevention of tuberculosis (TB) is key for accelerating current, slow declines in TB burden. The 2018 World Health Organization (WHO) guidelines on eligibility for preventive therapy to treat latent TB inf…
Authors: Sandip Mandal, Vineet Bhatia, Mukta Sharma, Partha Pratim Mandal and Nimalan Arinaminpathy
Citation: BMC Medicine 2020 18:163
Content type: Research article
Published on: 20 July 2020

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 25 July 2020)

Vaccine uptake and associated factors in an irregular urban settlement in northeastern Brazil: a cross-sectional study
Globally, childhood immunization saves the lives of 2–3 million children annually by protecting them against vaccine-preventable diseases. In 2017, 116.2 million children were vaccinated worldwide according to…
Authors: Ana Amélia Corrêa de Araújo Veras, Eduardo Jorge da Fonseca Lima, Maria de Fátima Costa Caminha, Suzana Lins da Silva, Amanda Alves Moreira de Castro, Andressa Lílian Bezerra Bernardo, Maria Lídia Amaral Barbosa Ventura, Pedro Israel Cabral de Lira and Malaquias Batista Filho
Citation: BMC Public Health 2020 20:1152
Content type: Research article
Published on: 22 July 2020

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 25 July 2020)

Immunization coverage in Ethiopia among 12–23 month old children: systematic review and meta-analysis
Immunization is a cost-effective public health strategy. Immunization averts nearly three million deaths annually but immunization coverage is low in some countries and some regions within countries. The aim o…
Authors: Tahir Yousuf Nour, Alinoor Mohamed Farah, Omer Moeline Ali and Kalkidan Hassen Abate
Citation: BMC Public Health 2020 20:1134
Content type: Research article
Published on: 20 July 2020

Global Public Health
Volume 15, 2020 Issue 8
http://www.tandfonline.com/toc/rgph20/current

Article
The ghost in the data: Evidence gaps and the problem of fake drugs in global health research
Sarah Hodges & Emma Garnett
Pages: 1103-1118
Published online: 31 Mar 2020

Global Public Health
Volume 15, 2020 Issue 8
http://www.tandfonline.com/toc/rgph20/current

Article
Is expanding service through an outreach programme enough to improve immunisation uptake? A qualitative study in Indonesia
Anna Wahyuni Widayanti , Pauline Norris , James A. Green & Susan Heydon
Pages: 1168-1181
Published online: 14 Apr 2020

JAMA Network
COVID-19 Update July 25, 2020

These articles on COVID-19 were published across the JAMA Network in the last week.

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

Viewpoint
The Moral Determinants of Health
Donald M. Berwick, MD, MPP
free access has active quiz
JAMA. 2020;324(3):225-226. doi:10.1001/jama.2020.11129
In this Viewpoint, Berwick emphasizes that moral commitment to others, expressed through working for universal health coverage, criminal justice, and housing policy reform, climate change intervention, and more, is necessary if society is to meaningfully address adverse social determinants of health and reduce health inequalities.

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

Editorial
COVID-19 and Health Equity—A New Kind of “Herd Immunity”
David R. Williams, PhD, MPH; Lisa A. Cooper, MD, MPH

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

2020—A Year That Will Be Remembered
Howard Bauchner, MD

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

COVID-19 Pandemic, Unemployment, and Civil UnrestUnderlying Deep Racial and Socioeconomic Divides
Sandro Galea, MD, DrPH; Salma M. Abdalla, MBBS, MPH
free access has active quiz
JAMA. 2020;324(3):227-228. doi:10.1001/jama.2020.11132
This Viewpoint discusses the inequalities underlying the preferential spread of COVID-19 and of economic hardship in lower-income communities of color in the US, and sees the national protests in support of the Black Lives Matter movement as a natural consequence of those inequities and an opportunity to change the systems that create them.

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

COVID-19: Beyond Tomorrow
Health Care Policy After the COVID-19 Pandemic
Victor R. Fuchs, PhD
free access has active quiz
JAMA. 2020;324(3):233-234. doi:10.1001/jama.2020.10777
This Viewpoint discusses the necessity and prospects for health care reform in the wake of the coronavirus disease 2019 (COVID-19) pandemic, reviewing policy options to fund universal coverage, incentivize efficiencies, and reduce political opposition to change.

JAMA
July 21, 2020, Vol 324, No. 3, Pages 209-310
https://jamanetwork.com/journals/jama/currentissue

Research Letter
Use of Risk Evaluation and Mitigation Strategies by the US Food and Drug Administration, 2008-2019
Jenny S. Guadamuz, PhD; Dima M. Qato, PharmD, MPH, PhD; G. Caleb Alexander, MD, MS
JAMA. 2020;324(3):299-301. doi:10.1001/jama.2020.6611
This study uses publicly available FDA.gov data to characterize trends in the US Food and Drug Administration’s use of Risk Evaluation and Mitigation Strategy (REMS) programs between 2008 and 2019 and to describe the number and classes of medications included, the strategies deployed, and the risks the program was intended to mitigate.

JBI Database of Systematic Review and Implementation Reports
July 2020 – Volume 18 – Issue 7
https://journals.lww.com/jbisrir/Pages/currenttoc.aspx

SYSTEMATIC REVIEW PROTOCOLS
Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: a scoping review protocol
Edge, Rhiannon; Isba, Rachel
JBI Evidence Synthesis. 18(7):1566-1572, July 2020.

Journal of Pharmaceutical Policy and Practice
https://joppp.biomedcentral.com/
[Accessed 25 July 2020]

COVID-19 therapeutics: how to sow confusion and break public trust during international public health emergencies
Since SARS-CoV2 was declared a Public Health Emergency of International Concern, those tasked with the stewardship of public health at a global, regional, and local level—policymakers, politicians, scientists, drug regulators, health officials, professional associations, journal editors, publishers, and clinicians—have displayed rushed decisions and lapses in judgment in their handling of chloroquine and hydroxychloroquine as potential COVID-19 therapeutics and prophylactics. These lapses merit noting as they hold lessons for how the guardians of medicines regulation and public health can inadvertently sow confusion and damage public trust.
Authors: Jerome Amir Singh and Rafaella Ravinetto
Content type: Commentary
24 July 2020

The Lancet
Jul 25, 2020 Volume 396 Number 10246 p213-290, e6-e11
https://www.thelancet.com/journals/lancet/issue/current

Editorial
COVID-19 and China: lessons and the way forward
The Lancet
… China is facing legitimate questions in many areas of its domestic and foreign policy, but when it comes to COVID-19, scapegoating China for the pandemic is not a constructive response. “Now is the time for global leaders to decide: will we succumb to chaos, division and inequality? Or will we right the wrongs of the past and move forward together, for the good of all?”, as UN Secretary-General António Guterres asked in his 2020 Nelson Mandela Annual Lecture. Tackling a global health emergency like a pandemic requires open collaboration. The lack of global solidarity to address COVID-19 amid geopolitical instability is a threat to us all.

The Lancet
Jul 25, 2020 Volume 396 Number 10246 p213-290, e6-e11
https://www.thelancet.com/journals/lancet/issue/current

Comment
Offline: Preparing for a vaccine against COVID-19
Richard Horton
The results of two randomised trials reported this week in The Lancet give great encouragement to the view that a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be produced within the next 18 months. There are no guarantees. But the evidence is hopeful. Pedro Folegatti and colleagues from The Jenner Institute at the University of Oxford used a chimpanzee adenovirus viral vector expressing SARS-CoV-2 spike protein to create a vaccine given by a single intramuscular injection. The ChAdOx1 nCoV-19 vaccine, tested in five trial sites in the UK, was safe and well tolerated, and led to striking findings of both humoral and cellular immune responses. This candidate vaccine is now undergoing phase 3 trials in Brazil, South Africa, and the UK. Feng-Cai Zhu and colleagues completed a single-centre phase 2 randomised trial in Wuhan, China, using a recombinant adenovirus type-5-vectored COVID-19 vaccine. They found rapid onset of an immune response within 14 days, with evidence of humoral and cellular immune responses by day 28. This vaccine was also safe and well tolerated. There were signs that it produced a poorer immune response in older recipients. As the vaccine enters phase 3 trials, a second dose will be considered for this group to boost their immunity. These results are unquestionable breakthroughs in the global response to the COVID-19 pandemic.

The Lancet
Jul 25, 2020 Volume 396 Number 10246 p213-290, e6-e11
https://www.thelancet.com/journals/lancet/issue/current

Articles
Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial
Kenneth H Mayer,et al

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/

Opinion: It’s ethical to test promising coronavirus vaccines against less-promising ones
Front Matter
Nir Eyal and Marc Lipsitch
PNAS first published July 22, 2020. https://doi.org/10.1073/pnas.2014154117

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/

News Feature: Finding a vaccine for misinformation
Front Matter
Gayathri Vaidyanathan
PNAS first published July 22, 2020. https://doi.org/10.1073/pnas.2013249117

Science
24 July 2020 Vol 369, Issue 6502
http://www.sciencemag.org/current.dtl

In Depth
Polio vaccinators are back after pandemic pause
By Leslie Roberts
Science24 Jul 2020 : 360 Full Access
Mass campaigns resume after modelers warn about risk of “explosive” outbreaks.
Summary
In March, the Global Polio Eradication Initiative (GPEI) abruptly halted all mass vaccination campaigns, worried they could inadvertently spread the novel coronavirus. The move further imperiled the troubled 3-decade drive to wipe out polio. But now, armed with new data and perspective, GPEI and the countries it supports are resuming vaccination campaigns. Burkina Faso was first in early July; Pakistan followed this week. Polio cases are surging in many countries, and models suggested there might be “explosive” outbreaks if campaigns don’t restart soon. To reduce the risk of spreading the coronavirus, vaccinators will be screened, wear masks, use hand sanitizer, and practice physical distancing as much as possible.

Science
24 July 2020 Vol 369, Issue 6502
http://www.sciencemag.org/current.dtl

Policy Forum
Ecology and economics for pandemic prevention
By Andrew P. Dobson, Stuart L. Pimm, Lee Hannah, Les Kaufman, Jorge A. Ahumada, Amy W. Ando, Aaron Bernstein, Jonah Busch, Peter Daszak, Jens Engelmann, Margaret F. Kinnaird, Binbin V. Li, Ted Loch-Temzelides, Thomas Lovejoy, Katarzyna Nowak, Patrick R. Roehrdanz, Mariana M. Vale
Science24 Jul 2020 : 379-381 Full Access
Investments to prevent tropical deforestation and to limit wildlife trade will protect against future zoonosis outbreaks

Science
24 July 2020 Vol 369, Issue 6502
http://www.sciencemag.org/current.dtl

The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries
By Patrick G. T. Walker, Charles Whittaker, Oliver J. Watson, Marc Baguelin, Peter Winskill, Arran Hamlet, Bimandra A. Djafaara, Zulma Cucunubá, Daniela Olivera Mesa, Will Green, Hayley Thompson, Shevanthi Nayagam, Kylie E. C. Ainslie, Sangeeta Bhatia, Samir Bhatt, Adhiratha Boonyasiri, Olivia Boyd, Nicholas F. Brazeau, Lorenzo Cattarino, Gina Cuomo-Dannenburg, Amy Dighe, Christl A. Donnelly, Ilaria Dorigatti, Sabine L. van Elsland, Rich FitzJohn, Han Fu, Katy A. M. Gaythorpe, Lily Geidelberg, Nicholas Grassly, David Haw, Sarah Hayes, Wes Hinsley, Natsuko Imai, David Jorgensen, Edward Knock, Daniel Laydon, Swapnil Mishra, Gemma Nedjati-Gilani, Lucy C. Okell, H. Juliette Unwin, Robert Verity, Michaela Vollmer, Caroline E. Walters, Haowei Wang, Yuanrong Wang, Xiaoyue Xi, David G. Lalloo, Neil M. Ferguson, Azra C. Ghani

Global prospects for COVID-19 control
Lower-income countries have recognized the potential impact of coronavirus disease 2019 (COVID-19) from observing ongoing epidemics. Many have intervened quickly and early with measures to slow viral transmission, which may partly explain the low rates observed so far in these countries. Walker et al. calibrated a global model with country-specific data (see the Perspective by Metcalf et al.). Despite the potentially protective effects of younger demographics, the closer intergenerational contact, limitations on health care facilities, and frequency of comorbidities in lower-income countries require sustained nonpharmaceutical interventions (NPIs) to avoid overwhelming health care capacity. As a result of strict NPIs, the protective effects of immunity will be reduced, and it will be important to improve testing capacity. Ensuring equitable provision of oxygen and—when they are ready—pharmaceutical interventions should be a global priority.
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Conference info Open access
Human monkeypox – After 40 years, an unintended consequence of smallpox eradication
Karl Simpson, David Heymann, Colin S. Brown, W. John Edmunds, … Andy Wapling
Pages 5077-5081

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Discussion Full text access
COVID-19 vaccine development: Time to consider SARS-CoV-2 challenge studies?
G. Owen Schaefer, Clarence C. Tam, Julian Savulescu, Teck Chuan Voo
Pages 5085-5088

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Discussion Full text access
COVID-19 vaccine development: Time to consider SARS-CoV-2 challenge studies?
G. Owen Schaefer, Clarence C. Tam, Julian Savulescu, Teck Chuan Voo
Pages 5085-5088

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Vaccination against coronaviruses in domestic animals
Ian R. Tizard
Pages 5123-5130

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Review article Abstract only
Vaccine hesitancy and perceived behavioral control: A meta-analysis
Xizhu Xiao, Rachel Min Wong

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Research article Open access
The impact of maternal RSV vaccine to protect infants in Gavi-supported countries: Estimates from two models
Ranju Baral, Xiao Li, Lander Willem, Marina Antillon, … Clint Pecenka
Pages 5139-5147

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Research article Abstract only
Economic evaluation and budget impact analysis of dengue vaccination following pre-vaccination serological screening in India
Yuvaraj Krishnamoorthy, Marie Gilbert Majella
Pages 5154-5162

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Research article Open access
Assessment of risk of intussusception after pilot rollout of rotavirus vaccine in the Indian public health system
Nita Bhandari, Kalpana Antony, Vinohar Balraj, Temsunaro Rongsen-Chandola, … Madhulika Kabra
Pages 5241-5248

Vaccine
Volume 38, Issue 33 Pages 5077-5388 (14 July 2020)
https://www.sciencedirect.com/journal/vaccine/vol/38/issue/32

Research article Open access
Keep calm and carry on vaccinating: Is anti-vaccination sentiment contributing to declining vaccine coverage in England?
Michael Edelstein, Martin Müller, Shamez Ladhani, Joanne Yarwood, … Mary Ramsay
Pages 5297-5304