The Lancet Series: New Decade of Vaccines
Launched in London on June 9, 2011
Vaccines are undoubtedly one of the best investments in health. Immunisation programmes have contributed enormously to reducing the burden of infectious diseases, and are responsible for much of the falling rates of morbidity and mortality worldwide. In December 2010, global health leaders committed to making the next 10 years the Decade of Vaccines – to ensure discovery, development, and delivery of lifesaving vaccines globally, especially to the poorest countries. This Series looks at every aspect of this medical technology, including the developments expected over the coming decade and what we can expect from translation of the latest vaccine science. Improving vaccine coverage and financing of both existing and newer vaccines together with how we communicate the benefits of vaccines and ensure public trust and confidence, are also examined.

Series Comments
The vaccine paradox
Richard Horton, Pamela Das
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A call to action for the new decade of vaccines
E Richard Moxon, Pamela Das, Brian Greenwood, David L Heymann, Richard Horton, Orin S Levine, Stanley Plotkin, Gus Nossal
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Will the Decade of Vaccines mean business as usual?
Helen Rees, Shabir A Madhi
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Is immunisation child protection?
Adam Finn, Julian Savulescu
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Public–private collaboration in vaccine research
Juhani Eskola, Terhi Kilpi
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The last mile in global poliomyelitis eradication
Zulfiqar A Bhutta
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Series Papers
The next decade of vaccines: societal and scientific challenges
E Richard Moxon, Claire-Anne Siegrist
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Summary
Vaccines against microbial diseases have improved the health of millions of people. In the next decade and beyond, many conceptual and technological scientific advances offer extraordinary opportunities to expand the portfolio of immunisations against viral and bacterial diseases and to pioneer the first vaccines against human parasitic and fungal diseases. Scientists in the public and private sectors are motivated as never before to bring about these innovations in immunisation. Many societal factors threaten to compromise realisation of the public health gains that immunisation can achieve in the next decade and beyond—understanding these factors is imperative. Vaccines are typically given to healthy individuals and safety issues loom high on the list of public concerns. The public needs to regain confidence in immunisation and trust the organisations responsible for the research, development, and implementation of vaccines. In the past, by use of a judicious amalgam of knowledge and empiricism, successful vaccines were largely developed by microbiologists who identified antigens that induced immune responses to conserved pathogen components. In the future, vaccines need to be developed against deadly diseases for which this strategy is often not feasible because of the extensive antigenic variability of relevant pathogens. High microbial diversity means that immunity after natural infection is often ineffective for prevention of disease on subsequent exposure, for example in HIV infection and malaria. Additionally, vaccines need to be generated to protect the people who are most vulnerable because of age or underlying diseases. Thus, in the future, a much deeper understanding of the immunological challenges—including the diversifying role of host genetics and environmental factors, leading perhaps to more personalised approaches—will be the touchstone for rational design and development of adjuvants that result in novel safe and effective vaccines.

Vaccine discovery and translation of new vaccine technology
Rino Rappuoli, Steven Black, Paul Henri Lambert
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Summary
An unprecedented increase in new vaccine development has occurred over the past three decades. This activity has resulted in vaccines that protect against an increased range of vaccine-preventable diseases, vaccines that reduce the number of required injections, and vaccines with improved safety and purity. New methods of discovery, such as reverse vaccinology, structural biology, and systems biology, promise new vaccines for different diseases and efficient development pathways for these vaccines. We expect development of vaccines not only for infectious diseases in children but also for healthy adults, pregnant women, and elderly people, and for new indications such as autoimmune disease and cancer. We have witnessed a concomitant development of new technology for assessment of vaccine safety to rapidly identify potential safety issues. Success of these new approaches will depend on effective implementation of vaccination programmes, creative thinking on the part of manufacturers and regulators as to how best to ensure that safe and effective vaccines are available in a timely manner, and improvement of public awareness about the benefits and risks of new vaccines in a way that encourages confidence in vaccines.

Vaccine production, distribution, access, and uptake
Jon Smith, Marc Lipsitch, Jeffrey W Almond
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Summary
For human vaccines to be available on a global scale, complex production methods, meticulous quality control, and reliable distribution channels are needed to ensure that the products are potent and effective at the point of use. The technologies used to manufacture different types of vaccines can strongly affect vaccine cost, ease of industrial scale-up, stability, and, ultimately, worldwide availability. The complexity of manufacturing is compounded by the need for different formulations in different countries and age-groups. Reliable vaccine production in appropriate quantities and at affordable prices is the cornerstone of developing global vaccination policies. However, to ensure optimum access and uptake, strong partnerships are needed between private manufacturers, regulatory authorities, and national and international public health services. For vaccines whose supply is insufficient to meet demand, prioritisation of target groups can increase the effect of these vaccines. In this report, we draw from our experience of vaccine development and focus on influenza vaccines as an example to consider production, distribution, access, and other factors that affect vaccine uptake and population-level effectiveness.

The future of immunisation policy, implementation, and financing
Orin S Levine, David E Bloom, Thomas Cherian, Ciro de Quadros, Samba Sow, John Wecker, Philippe Duclos, Brian Greenwood
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Summary
Vaccines have already saved many lives and they have the potential to save many more as increasingly elaborate technologies deliver new and effective vaccines against both infectious diseases—for which there are currently no effective licensed vaccines—such as malaria, tuberculosis, and HIV and non-infectious diseases such as hypertension and diabetes. However, these new vaccines are likely to be more complex and expensive than those that have been used so effectively in the past, and they could have a multifaceted effect on the disease that they are designed to prevent, as has already been seen with pneumococcal conjugate vaccines. Deciding which new vaccines a country should invest in requires not only sound advice from international organisations such as WHO but also a well informed national immunisation advisory committee with access to appropriate data for local disease burden. Introduction of vaccines might need modification of immunisation schedules and delivery procedures. Novel methods are needed to finance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to afford them. Here, we discuss some options.

Addressing the vaccine confidence gap
Heidi J Larson, Louis Z Cooper, Juhani Eskola, Samuel L Katz, Scott Ratzan
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Summary
Vaccines—often lauded as one of the greatest public health interventions—are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk—benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.

Related Articles published in The Lancet
Making new vaccines affordable: a comparison of financing processes used to develop and deploy new meningococcal and pneumococcal conjugate vaccines
James R Hargreaves, Brian Greenwood, Charles Clift, Akshay Goel, Anne Roemer-Mahler, Richard Smith, David L Heymann
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Summary
Mechanisms to increase access to health products are varied and controversial. Two innovative mechanisms have been used to accelerate the development of low-price supply lines for conjugate vaccines. The Meningitis Vaccine Project is a so-called push mechanism that facilitated technology transfer to an Indian company to establish capacity to manufacture a vaccine. The Advanced Market Commitment for pneumococcal vaccines is a so-called pull mechanism that guarantees companies a supplement paid in addition to the purchase price for vaccines for a specific period. We compare these approaches, identifying key dimensions of each and considering their potential for replication. We also discuss issues that the Global Alliance for Vaccines and Immunisation (GAVI) face now that these new vaccines are available. Progress towards GAVI’s strategic aims is needed and funding is crucial. Approaches that decrease the financial pressure on GAVI and greatly increase political and financial engagement by low-income countries should also be considered.

Bill Roedy
Priya Shetty
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Helen Rees on the quest for global equity
Pamela Das
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Health Affairs
June 2011; Volume 30, Issue 6
Strategies For The ‘Decade Of Vaccines’
http://content.healthaffairs.org/content/current

From The Editor-in-Chief
Vaccines, Children, And Fulfilling Human Potential
Susan Dentzer
Health Aff June 2011 30:1006; doi:10.1377/hlthaff.2011.0562
Extract

Entry Point
Slow Going For The Global Health Initiative
Nellie Bristol
Health Aff June 2011 30:1007-1009; doi:10.1377/hlthaff.2011.0460
Abstract
The program of US foreign assistance to advance health and health care in developing countries survived the 2011 budget battles, but it continues to face other challenges.

The Priceless Payoff
During The ‘Decade Of Vaccines,’ The Lives Of 6.4 Million Children Valued At $231 Billion Could Be Saved
Sachiko Ozawa, Meghan L. Stack, David M. Bishai, Andrew Mirelman, Ingrid K. Friberg, Louis Niessen, Damian G. Walker, and Orin S. Levine
Health Aff June 2011 30:1010-1020; doi:10.1377/hlthaff.2011.0381
Abstract
Governments constantly face the challenge of determining how much they should spend to prevent premature deaths and suffering in their populations. In this article we explore the benefits of expanding the delivery of life-saving vaccines in seventy-two low- and middle-income countries, which we estimate would prevent the deaths of 6.4 million children between 2011 and 2020. We present the economic benefits of vaccines by using a “value of statistical life” approach, which is based on individuals’ perceptions regarding the trade-off between income and increased risk of mortality. Our analysis shows that the vaccine expansion described above corresponds to $231 billion (uncertainty range: $116–$614 billion) in the value of statistical lives saved. This analysis complements results from analyses based on other techniques and is the first of its kind for immunizations in the world’s poorest countries. It highlights the major economic benefits made possible by improving vaccine coverage.

Estimated Economic Benefits During The ‘Decade Of Vaccines’ Include Treatment Savings, Gains In Labor Productivity
Meghan L. Stack, Sachiko Ozawa, David M. Bishai, Andrew Mirelman, Yvonne Tam, Louis Niessen, Damian G. Walker, and Orin S. Levine
Health Aff June 2011 30:1021-1028; doi:10.1377/hlthaff.2011.0382
Abstract
In 2010 the Bill & Melinda Gates Foundation announced a $10 billion commitment over the next ten years to increase access to childhood vaccines in the world’s poorest countries. The effort was labeled the “Decade of Vaccines.” This study estimates both the short- and long-term economic benefits from the introduction and increased use of six vaccines in seventy-two of the world’s poorest countries from 2011 to 2020. Increased rates of vaccination against pneumococcal and Haemophilus influenzae type b pneumonia and meningitis, rotavirus, pertussis, measles, and malaria over the next ten years would save 6.4 million lives and avert 426 million cases of illness, $6.2 billion in treatment costs, and $145 billion in productivity losses. Monetary estimates based on this type of analysis can be used to determine the return on investment in immunization from both the international community and local governments, and they should be considered in policy making.

ANALYSIS & COMMENTARY: The Moral Case For The Routine Vaccination Of Children In Developed And Developing Countries
Angus Dawson
Health Aff June 2011 30:1029-1033; doi:10.1377/hlthaff.2011.0301
Abstract
In developed countries some parents have decided not to provide routine vaccinations for their children, while in many developing countries there are inadequate rates of vaccination for various reasons. The consequences for children, and members of the community in which they live, can be significant and even tragic. Although some parents may worry that vaccines will harm their child, there is a broader moral case for vaccination that parents and policy makers should consider. This case has four components: benefits and harms, best interests, community benefits, and justice. This moral case should be central to deliberations about vaccination by parents and policy makers.

Challenges For Science & Business
ANALYSIS & COMMENTARY: A Global Road Map Is Needed For Vaccine Research, Development, And Deployment
Adel Mahmoud
Health Aff June 2011 30:1034-1041; doi:10.1377/hlthaff.2011.0391
Abstract
The world is witnessing a tremendous interest in the discovery, development, and use of vaccines as an important contributor to disease prevention and control. However, current global vaccine efforts are not coordinated, and they face many challenges. One is scientific: Most vaccines in use today are based on the scientific knowledge of past centuries. To usher in a new era, there is an urgent need to draw upon new science and scientific disciplines and recruit a new generation of talent trained in the basic and computational sciences of the twenty-first century. In addition, a global road map is urgently needed for making the scientific discoveries necessary to produce new vaccines; developing these into effective vaccines; and drawing up priorities and undertaking the necessary planning for rolling out these vaccines in developing countries. The developing countries themselves must play the lead role in these activities and contribute their own resources as well. This article aims to initiate a wide-ranging debate and discussion that will ultimately result in some agreement on the future of vaccine development and deployment.

ANALYSIS & COMMENTARY: Vaccines As A Global Imperative—A Business Perspective
Jean Stéphenne
Health Aff June 2011 30:1042-1048; doi:10.1377/hlthaff.2011.0338
Abstract
During the past thirty years, vaccines have experienced a renaissance. Advances in science, business, and distribution have transformed the field to the point where vaccines are recognized as a “best buy” in global health, a driver of pharmaceutical industry growth, and a key instrument of international development. With many new vaccines available and others on the horizon, the global community will need to explore new ways of ensuring access to vaccines in developing nations. So-called tiered pricing, which makes vaccines available at different prices for countries at different levels of economic development; innovative financing mechanisms such as advance market commitments or offers of long-term and high-volume contracts to vaccine producers; and technology transfers such as sharing intellectual property and production techniques among companies and countries can all play a part in bringing new life-saving vaccines for pneumonia, rotavirus, malaria, and other diseases to developing countries.

Fighting Critical Diseases
Eliminating Epidemic Group A Meningococcal Meningitis In Africa Through A New Vaccine
F. Marc LaForce and Jean-Marie Okwo-Bele
Health Aff June 2011 30:1049-1057; doi:10.1377/hlthaff.2011.0328
Abstract
A new affordable vaccine against Group A meningococcus, the most common cause of large and often fatal African epidemics of meningitis, was introduced in Burkina Faso, Mali, and Niger in 2010. Widespread use of the vaccine throughout much of Africa may prevent more than a million cases of meningitis over the next decade. The new vaccine is expected to be cost-saving when compared to current expenditures on these epidemics; for example, an analysis shows that introducing it in seven highly endemic countries could save $350 million or more over a decade. International donors have already committed funds to support the new vaccine’s introduction in Burkina Faso, Niger, and Mali, but an estimated US$400 million is needed to fund mass immunization campaigns in people ages 1–29 over six years in all twenty-five countries of the African meningitis belt. The vaccine’s low cost—less than fifty cents per dose—makes it possible for the affected countries themselves to purchase vaccines for future birth cohorts.

ANALYSIS & COMMENTARY: Product Development Partnerships Hit Their Stride: Lessons From Developing A Meningitis Vaccine For Africa
David M. Bishai, Claire Champion, Michael E. Steele, and Lindsay Thompson
Health Aff June 2011 30:1058-1064; doi:10.1377/hlthaff.2011.0295
Abstract
The Meningitis Vaccine Project, a so-called product development partnership, developed a new vaccine against bacterial meningitis, an inflammation of brain tissues that causes an estimated 10,000 deaths among African children and young people each year. The vaccine—known as MenAfriVac and specifically targeted for use in low-income countries in Africa—was designed to be made available to governments at a price of fifty cents per dose. The Meningitis Vaccine Project is an example of how product development partnerships have reinvigorated research on vaccines for neglected diseases. These partnerships disperse the multiple tasks of product development across a network of partners that are best suited for each task. The vaccine was rapidly embraced by African health officials, and in its first few weeks on the market, in late 2010, more than nineteen million people in Burkina Faso, Mali, and Niger were vaccinated.

Producing A Successful Malaria Vaccine: Innovation In The Lab And Beyond
Christian Loucq, Ashley Birkett, David Poland, Carla Botting, Julia Nunes, and Sally Ethelston
Health Aff June 2011 30:1065-1072; doi:10.1377/hlthaff.2011.0356
Abstract
With approximately 225 million new cases and 800,000 deaths annually, malaria exacts a tremendous toll—mostly on African children under the age of five. Late-stage trials of an advanced malaria vaccine candidate—which, if approved, would become the world’s first malaria vaccine—are under way, and it may be ready for use by 2015. This article recounts the pivotal roles in that achievement played by collaborations of nonprofit organizations, pharmaceutical companies, private and public donors, and countries whose citizens would benefit most directly from a vaccine. Just as it takes a village to raise a child, it has taken a huge number of stakeholders around the world to reach this point. Developing even more effective vaccines for malaria and other diseases will require continued hard work and creative thinking from scientists, regulators, and policy makers.

The Challenges Of Developing New Tuberculosis Vaccines
Lewellys F. Barker, Annmarie E. Leadman, and Bartholt Clagett
Health Aff June 2011 30:1073-1079; doi:10.1377/hlthaff.2011.0303
Abstract
The World Health Organization estimates that tuberculosis is causing nearly two million deaths annually, mostly in developing countries. Widespread administration of the current tuberculosis vaccine to newborns is not a reliable route for preventing the disease in adults, the population that drives the epidemic. Several new vaccine candidates are in development, and a few have entered clinical trials. However, the field faces formidable scientific and policy challenges. A collaborative approach to solving scientific, policy, and resource obstacles—as well as new partnerships among emerging economies and vaccine development organizations—will be critical to developing a new tuberculosis vaccine that could achieve its public health potential to save lives and reduce the burden of disease.

A Handful Of ‘Antipoverty’ Vaccines Exist For Neglected Diseases, But The World’s Poorest Billion People Need More
Peter Hotez
Health Aff June 2011 30:1080-1087; doi:10.1377/hlthaff.2011.0317
Abstract
So-called neglected tropical diseases are the most common infections of the world’s poor. Almost all of the “bottom billion”—the 1.4 billion people who live below the poverty level defined by the World Bank—suffer from one or more neglected diseases including hookworm infection, sleeping sickness, or Chagas disease. These diseases are actually a cause of poverty because of their adverse effects on child growth and development and worker productivity. Vaccines to combat such diseases have come to be known as “antipoverty vaccines.” Unfortunately, the recent surge in the development and delivery of vaccines to combat the major childhood killers—such as pneumococcal pneumonia and measles—has bypassed neglected diseases. Nevertheless, some vaccines for these neglected diseases are now entering the clinical pipeline. In this article I describe how some antipoverty vaccine development is proceeding and offer recommendations for stimulating further development such as through pooled funding for innovation, developing-country manufacturers, and public-private partnerships for product development.

Providing Vaccines Against Human Papillomavirus To Adolescent Girls In The Americas: Battling Cervical Cancer, Improving Overall Health
Silvana Luciani, Elisa Prieto-Lara, and Andrea Vicari
Health Aff June 2011 30:1089-1095; doi:10.1377/hlthaff.2011.0315
Abstract
Vaccines against the human papillomavirus (HPV)—the primary cause of cervical cancer—target adolescent girls, many of whom have limited contact with health services. Countries in the Americas are beginning to use HPV vaccines to increase the impact of cervical cancer programs and as an entry point to broader health services for girls. This strategy opens new opportunities to improve lifelong health habits; encourage regular cervical cancer screening and treatment, when necessary; and offer associated services such as reproductive health and nutrition guidance. Some of the early experiences with this strategy illustrate challenges and opportunities that may arise with other new vaccines.

People & Places
Health Aff June 2011 30:1088; doi:10.1377/hlthaff.2011.0513
Abstract
Peter Hotez and his Sabin Vaccine Institute seek to end preventable illness among the world’s impoverished people.

Strengthening Programs
India’s Vaccine Deficit: Why More Than Half Of Indian Children Are Not Fully Immunized, And What Can—And Should—Be Done
Ramanan Laxminarayan and Nirmal Kumar Ganguly
Health Aff June 2011 30:1096-1103; doi:10.1377/hlthaff.2011.0405
Abstract
Although India is a leading producer and exporter of vaccines, the country is home to one-third of the world’s unimmunized children. Fewer than 44 percent of India’s young children receive the full schedule of immunizations. India’s vaccine deficit has several causes: little investment by the government; a focus on polio eradication at the expense of other immunizations; and low demand as a consequence of a poorly educated population and the presence of anti-vaccine advocates. In this article we describe India’s vaccine deficit and recommend that the government move quickly to increase spending on, and otherwise strengthen, national immunization programs.

ANALYSIS & COMMENTARY: Challenges To Building Capacity For Evidence-Based New Vaccine Policy In Developing Countries
Jon Kim Andrus, Barbara Jauregui, Lúcia Helena De Oliveira, and Cuauhtémoc Ruiz Matus
Health Aff June 2011 30:1104-1112; doi:10.1377/hlthaff.2011.0361
Abstract
There are many challenges to ensuring that people in developing countries have equitable access to new vaccines. Two of the most important are having the capacity to make evidence-based new vaccine policy decisions in developing countries, and then when appropriate actually distributing those new vaccines to those who will most benefit from them. Based on our review of the Pan American Health Organization’s ProVac Initiative in the Americas, we found that when national governments in developing countries develop the expertise to make the best technical decisions about immunization programs; take responsibility for helping to pay for and distribute vaccines; and are supported by strong partnerships with international organizations, they succeed in saving more lives more quickly.

ANALYSIS & COMMENTARY: Vaccine Supply Chains Need To Be Better Funded And Strengthened, Or Lives Will Be At Risk
Judith R. Kaufmann, Roger Miller, and James Cheyne
Health Aff June 2011 30:1113-1121; doi:10.1377/hlthaff.2011.0368
Abstract
In the next decade, at least twelve additional vaccines that target such diseases as typhoid, malaria, and dengue will become available to lower- and middle-income countries. These vaccines must travel along what are called supply chains, which include all personnel, systems, equipment, and activities involved in ensuring that vaccines are effectively delivered from the point of production to the people who need them. But for various reasons, supply chains are already strained in many developing countries, and the potential inability to distribute new vaccines will place lives at risk. Among the many steps needed to strengthen the global vaccine supply chain, we suggest that the international community pursue improved coordination between organizations that donate and ship vaccines and the host-country officials who receive and distribute the vaccines, as well as better training for supply-chain managers.

Financing
An Analysis Of How The GAVI Alliance And Low- And Middle-Income Countries Can Share Costs Of New Vaccines
Helen Saxenian, Santiago Cornejo, Kira Thorien, Robert Hecht, and Nina Schwalbe
Health Aff June 2011 30:1122-1133; doi:10.1377/hlthaff.2011.0332
Abstract
Immunization is one of the “best buys” in global health. However, for the poorest countries, even modest expenditures may be out of reach. The GAVI Alliance is a public-private partnership created to help the poorest countries introduce new vaccines. Since 2008 GAVI has required that countries cover a share of the cost of vaccines introduced with GAVI support. To determine how much countries can contribute to the cost of vaccines—without displacing spending on other essential programs—we analyzed their fiscal capacity to contribute to the purchase of vaccines over the coming decade. For low-income countries, external financing will be required to purchase vaccines supported by GAVI, so co-financing needs to be modest. Relatively better-off “intermediate” countries could support initially modest but gradually increasing co-financing levels. The countries soon to graduate from GAVI can generally afford to follow a rapid path to self-sufficiency. Co-financing for these countries needs to ramp up so that national budgets fully cover the costs of the new generation of vaccines once GAVI support ends.

Creating Sustainable Financing And Support For Immunization Programs In Fifteen Developing Countries
Michael McQuestion, Devendra Gnawali, Clifford Kamara, Helene Mambu-Ma-Disu, Jonas Mbwangue, and Ciro de Quadros
Health Aff June 2011 30:1134-1140; doi:10.1377/hlthaff.2011.0265
Abstract
Immunization programs are important tools for reducing child mortality, and they need to be in place for each new generation. However, most national immunization programs in developing countries are financially and organizationally weak, in part because they depend heavily on funding from foreign sources. Through its Sustainable Immunization Financing Program, launched in 2007, the Sabin Vaccine Institute is working with fifteen African and Asian countries to establish stable internal funding for their immunization programs. The Sabin program advocates strengthening immunization programs through budget reforms, decentralization, and legislation. Six of the fifteen countries have increased their national immunization budgets, and nine are preparing legislation to finance immunization sustainably. Lessons from this work with immunization programs may be applicable in other countries as well as to other health programs.

Issues For The United States
The Benefits To All Of Ensuring Equal And Timely Access To Influenza Vaccines In Poor Communities
Bruce Y. Lee, Shawn T. Brown, Rachel R. Bailey, Richard K. Zimmerman, Margaret A. Potter, Sarah M. McGlone, Philip C. Cooley, John J. Grefenstette, Shanta M. Zimmer,
William D. Wheaton, Sandra Crouse Quinn, Ronald E. Voorhees, and Donald S. Burke
Health Aff June 2011 30:1141-1150; doi:10.1377/hlthaff.2010.0778
Abstract
When influenza vaccines are in short supply, allocating vaccines equitably among different jurisdictions can be challenging. But justice is not the only reason to ensure that poorer counties have the same access to influenza vaccines as do wealthier ones. Using a detailed computer simulation model of the Washington, D.C., metropolitan region, we found that limiting or delaying vaccination of residents of poorer counties could raise the total number of influenza infections and the number of new infections per day at the peak of an epidemic throughout the region—even in the wealthier counties that had received more timely and abundant vaccine access. Among other underlying reasons, poorer counties tend to have high-density populations and more children and other higher-risk people per household, resulting in more interactions and both increased transmission of influenza and greater risk for worse influenza outcomes. Thus, policy makers across the country, in poor and wealthy areas alike, have an incentive to ensure that poorer residents have equal access to vaccines.

Confidence About Vaccines In The United States: Understanding Parents’ Perceptions
Allison Kennedy, Katherine LaVail, Glen Nowak, Michelle Basket, and Sarah Landry
Health Aff June 2011 30:1151-1159; doi:10.1377/hlthaff.2011.0396
Abstract
The United States has made tremendous progress in using vaccines to prevent serious, often infectious, diseases. But concerns about such issues as vaccines’ safety and the increasing complexity of immunization schedules have fostered doubts about the necessity of vaccinations. We investigated parents’ confidence in childhood vaccines by reviewing recent survey data. We found that most parents—even those whose children receive all of the recommended vaccines—have questions, concerns, or misperceptions about them. We suggest ways to give parents the information they need and to keep the US national vaccination program a success.

   The 2011 United Nations High Level Meeting on AIDS, held in New York, “launched a Global Plan that will make significant strides towards eliminating new HIV infections among children by 2015 and keeping their mothers alive.” Michel Sidibé. Executive Director of UNAIDS, said, “We believe that by 2015 children everywhere can be born free of HIV and that their mothers can remain healthy. This new global plan is realistic, it is achievable and it is driven by the most affected countries.” The United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced an additional US$75 million to preventing mother-to-child transmission of HIV (PMTCT) efforts. This funding will be on top of the approximately US$300 million that PEPFAR already provides annually for PMTCT. The Bill & Melinda Gates Foundation pledged US$40 million, Chevron committed to US$20 million and Johnson & Johnson pledged US$15 million.

http://www.unicef.org/media/media_58834.html

    The Sabin Vaccine Institute, Baylor College of Medicine, and Texas Children’s Hospital today announced an agreement “to move Sabin’s vaccine development program to Texas Children’s and BCM as part of the recruitment of world renowned neglected diseases expert Dr. Peter Hotez.” The action includes “establishment of the first national school of tropical medicine in the United States at BCM.” Dr. Hotez will serve as the founding dean and “the entire Sabin Vaccine Institute vaccine development program will relocate to Texas Children’s and BCM, while the Sabin Vaccine Institute’s advocacy and education programs will remain at the institute’s headquarters in Washington, D.C.” Dr. Hotez will continue to serve as president. The institutions noted that the collaborative program “represents a significant expansion of efforts to develop and test vaccines for a range of diseases affecting low-income populations in the United States and worldwide.” Representatives of BCM and Texas Children’s will be joining the Board of the Sabin Vaccine Institute.

http://sabin.org/news-resources/releases/2011/06/08/bcm-texas-children%E2%80%99s-announce-recruitment-dr-peter-hotez-and-team

The Foundation for Vaccine Research was launched by “fourteen leading scientists and advocacy experts in vaccines and infectious diseases…to advance and accelerate vaccine research and development against infectious diseases.” The new foundation will be headquartered in Washington, DC. With the mission to “raise global awareness of the need for increased, long-term, flexible funding for vaccine research against HIV/AIDS, tuberculosis, malaria, and other infectious diseases, including neglected tropical diseases, as well as universal vaccines for influenza and a vaccine to avert pandemic influenza.”

The Foundation’s activities “will focus on persuading opinion leaders, policymakers inside and outside government, and other decision makers of the benefits and safety of vaccines and the merits of increased investment in vaccine research. The Foundation will seek to mobilize resources internationally and on a large scale to finance vaccine research globally, with a special focus on securing new assets and the development of innovative financing mechanisms. The Foundation will also conduct televised fundraising events and benefit concerts, with 100 percent of publicly donated funds going directly to teams of scientists and their institutions. The Foundation will also engage with the anti-vaccine movement to persuade them of the benefits of vaccines.”

The leadership of the new Foundation includes:

– Galit Alter, PhD, Assistant Professor in Medicine, Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University; Director, Ragon Institute Imaging Core; Director, Harvard Center for AIDS Research (CFAR) Immunology Core, Boston, USA

– Patrice Debre, MD, PhD, Professor of Immunology, University of Pierre and Marie Curie, Pitie-Salpetriere Hospital, Paris, France

– Jose M. Gatell MD, PhD, Professor of Medicine, Senior Consultant & Head, Infectious Diseases & AIDS Units, Clinical Institute of Medicine & Dermatology, Founder and Co-Director of the Catalan HIV Vaccine Project (HIVACAT), Hospital Clinic de Barcelona, University of Barcelona, Spain

– Peter Hale, Founder, The It’s Time Campaign, Washington, DC, USA

– Sylvie Le Gall, PhD, Assistant Professor of Medicine, Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University; Director, Ragon Institute Education and Training Platform, Boston, USA

– Ronald C. Desrosiers, PhD, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, New England Primate Research Center, Boston, USA

– Willem Hanekom, Professor of Immunology; Co-Director, South African TB Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa

– Professor Gregory Hussey, Deputy Dean: Research, Faculty of Health Sciences; Founder and Director, Vaccines for Africa, University of Cape Town, South Africa

– Paul A. Offit, MD, Chief, Division of Infectious Diseases, Maurice R. Hilleman Professor of Vaccinology, Children’s Hospital of Philadelphia, Philadelphia, USA

– Gregory A. Poland, MD, MACP, FIDSA, Mary Lowell Leary Professor of Medicine, Infectious Diseases, Molecular Pharmacology and Experimental Therapeutics; Director, Mayo Vaccine Research Group; Director, Translational Immunovirology and Biodefense; Editor-in-Chief, VACCINE; Mayo Clinic, Rochester, MN, USA

– Mauro Schechter, MD, PhD, Professor of Infectious Diseases, Head, Projeto Praca Onze, Hospital Escola Sao Francisco de Assis, Federal University of Rio de Janeiro, Brazil

Guillaume Stewart-Jones, PhD, Principal Investigator, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK

– Professor Simon Wain-Hobson, PhD, Chief, Molecular Retrovirology, Institut Pasteur, Paris, France

– Robin A. Weiss, PhD, Professor of Viral Oncology, Division of Infection and Immunity, University College London, UK

The Foundation said it will incorporate the “It’s Time Campaign,” an advocacy and campaign organization based in Washington, which will become a program of the new Foundation and its main fundraising arm. The Foundation said it will also finance vaccine research directly. Funding sources will include the It’s Time Campaign’s internet-based campaign, televised fundraising events, benefit concerts, and other initiatives undertaken by the Foundation.

http://www.prnewswire.com/news-releases/scientists-launch-vaccine-research-foundation-123459359.html

The MMWR Weekly for June 10, 2011 / Vol. 60 / No. 22 includes:
– Interim Results: State-Specific Influenza Vaccination Coverage — United States, August 2010–February 2011
http://www.cdc.gov/mmwr/pdf/wk/mm6022.pdf

The Weekly Epidemiological Record (WER) for 10 June 2011, vol. 86, 24 (pp 241–256) includes: 241 Vaccines against tick-borne encephalitis: WHO position paper
http://www.who.int/entity/wer/2011/wer8624.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

GAVIAlliance GAVI Alliance
GAVI’s Pledging Conference gets off to a flying start http://ht.ly/5g1c7 #4mlives #vaccines

GAVIAlliance GAVI Alliance
“Melinda and I very committed to vaccines. It is as much fun as writing code” @billgates #4mlives

PATHtweets PATH
Tackling chronic disease—our work on cervical cancer will be spotlighted at Global Health Council conference. http://ow.ly/5fgVE #ghc2011

sabinvaccine Sabin Vaccine Inst.
In advance of @GAVIAlliance pledging mtg Dr Ciro de Quadros offers support with “A Lesson from Smallpox Eradication”: http://bit.ly/iYOMbL

ECDevelopment EC Development
by GAVIAlliance
Piebalgs will announce an extra €10 million to provide life-saving vaccines @GAVIAlliance in London #4mlives http://bit.ly/9JMs9e

AIDSvaccine IAVI
@IAVISeth on strengthening continuum from R&D to eradication to deliver on #vaccines‘ promise http://bit.ly/kWQ12H #globalhealth #AIDS2011

TheLancet The Lancet
New Decade of Vaccines Series launched in London today. Read the papers here bit.ly/jj239B

PublicHealth APHA
Though child vaccination rates are high, parents need more education about vaccines, says new study: http://goo.gl/8MjxO

GAVIAlliance GAVI Alliance

#FACT: Every 20 seconds, a child dies of a vaccine-preventable disease. #infographic: http://on.fb.me/klwV1i #health #GAVI

USAID USAID
“The most transformative new breakthroughs we have at our disposal are vaccines,ʺ says USAID’s @RajShah #FrontLines http://1.usa.gov/m5nIn7

MalariaVaccine PATH MVI
GSK, J&J to trial next-generation malaria vaccine | @Reuters reut.rs/mNMyFe #malaria #vaccine

Annals of Internal Medicine
June 7, 2011; 154 (11)
http://www.annals.org/content/current

National Clinical Guideline Centre Cost-Effectiveness Assessment for the National Institute for Health and Clinical Excellence
David Wonderling, Laura Sawyer, Elisabetta Fenu, Kate Lovibond, and Philippe Laramée
Ann Intern Med June 7, 2011 154:758-765;

Abstract
The National Clinical Guideline Centre (NCGC) develops evidence-based clinical guidelines on behalf of the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom. The U.K. Department of Health has commissioned NICE to make recommendations on the basis of both clinical effectiveness and cost-effectiveness. This article describes how cost-effectiveness is evaluated and accounted for in NCGC guidelines. Six recent case studies are presented, in which consideration of cost-effectiveness has informed recommendations in various ways for clinical guidelines on alcohol use disorders, chronic obstructive pulmonary disease, glaucoma, lower urinary tract symptoms, non–ST-segment elevation myocardial infarction and unstable angina, and venous thromboembolism prophylaxis. Some of the challenges faced in trying to account for cost-effectiveness in clinical guidelines are outlined, as well as some of the difficulties in adapting cost-effectiveness guidelines for other settings.

Clinical Infectious Diseases
Volume 53 Issue 1 July 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

ARTICLES AND COMMENTARIES
Sucheta J. Doshi, Hardeep S. Sandhu, Linda V. Venczel, Karen J. Hymbaugh, Jagadish M. Deshpande, Mark A. Pallansch, Sunil Bahl, Jay D. Wenger, and Steve L. Cochi
Poliomyelitis-Related Case-Fatality Ratio in India, 2002–2006
Clin Infect Dis. (2011) 53(1): 13-19 doi:10.1093/cid/cir332

Abstract
Background. On the basis of studies from developed countries, the case-fatality ratio (CFR) of poliomyelitis generally ranges from 2%–5% among children <5 years of age to 10%–30% among adults. However, little information is available for poliomyelitis-related CFR in developing countries. We conducted a study to determine the CFR in India, 1 of the 4 remaining countries with endemic wild poliovirus (WPV) circulation, during outbreaks of WPV infection during 2002 and 2006 and during the inter-epidemic years of 2003–2005.

Methods. We conducted a descriptive analysis with use of data from the acute flaccid paralysis surveillance system in India. Variables analyzed included age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification, and survival outcome. Our analysis also accounted for surveillance changes that occurred in 2005, impacting case definitions and final classification.

Results. In 2006, 45 deaths occurred among 676 WPV cases in India, yielding a CFR of 6.7%. By comparison, in 2002, there were 66 deaths among 1600 reported WPV cases (CFR, 4.2%) and during 2002–2005, CFR was 1.5%–5.2%. All 45 deaths were among 644 (95%) WPV cases in children aged <5 years (CFR, 7.0%). Among those who died, 33 (73%) were children aged <2 years (CFR, 7.1%).

Conclusions. The CFR among children aged <2 years in India is high compared with previously published Cars for young children, in part because of improved case finding through enhanced surveillance techniques. Fatal cases emphasize the lethal nature of the disease and the importance of achieving polio eradication in India.

The Lancet  
Jun 11, 2011  Volume 377  Number 9782  Pages 1977 – 2054
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Towards an improved investment approach for an effective response to HIV/AIDS
Bernhard Schwartländer, John Stover, Timothy Hallett, Rifat Atun, Carlos Avila, Eleanor Gouws, Michael Bartos, Peter D Ghys, Marjorie Opuni, David Barr, Ramzi Alsallaq, Lori Bollinger, Marcelo de Freitas, Geoffrey Garnett, Charles Holmes, Ken Legins, Yogan Pillay, Anderson Eduardo Stanciole, Craig McClure, Gottfried Hirnschall, Marie Laga, Nancy Padian, on behalf of the Investment Framework Study Group

Preview
Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system.

Nature  
Volume 474 Number 7350 pp127-246  9 June 2011
http://www.nature.com/nature/current_issue.html

World View
Beware of gifts that come at too great a cost
Danger lurks for state universities when philanthropy encroaches on academic independence, warns Sheldon Krimsky.

Sheldon Krimsky

Nature  
Volume 474 Number 7350 pp127-246  9 June 2011
http://www.nature.com/nature/current_issue.html

Specials
Outlook: Hepatitis C
Vaccines: A moving target
Michael Eisenstein

Nature Medicine
June 2011, Volume 17 No 6
http://www.nature.com/nm/index.html

Book Review: Vaccine politics – p656
Arthur Allen reviews Three Shots at Prevention: the HPV Vaccine and the Politics of Medicine’s Simple Solutions by Keith Wailoo,  Julie Livingston,  Steven Epstein  and Robert Aronowitz
doi:10.1038/nm0611-656

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issues 29-30  pp. 4647-4874 (24 June 2011)

Regular papers
Student utilization of a university 2009 H1N1 vaccination clinic
Pages 4687-4689
T.S. Sunil, Lisa K. Zottarelli

Abstract
The 2009 H1N1 influenza resulted in widespread outbreaks on college campuses. Once sufficient quantity of vaccine became available, many universities held vaccination clinics for students. We sought to examine factors associated with participation in an on-campus vaccination effort. A self-administered questionnaire was completed by students in January 2010. Our results suggest a high degree of awareness of the 2009 H1N1 virus among students. The odds of being vaccinated were higher for students who believed the H1N1 virus was a greater public health threat and for students who had friends and family that were vaccinated after controlling for sex, ethnicity, age, and living conditions.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 28  pp. 4535-4646 (20 June 2011)

Editorial
Sophiology, vaccinology, and the healing professions – A warning from ancient Greece?
Pages 4535-4536
Gregory A. Poland

[No abstract or preview]

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 28  pp. 4535-4646 (20 June 2011)

Challenges and opportunities of a new HPV immunization program: Perceptions among Swedish school nurses
Pages 4576-4583
Maria Gottvall, Tanja Tydén, Margareta Larsson, Christina Stenhammar, Anna T. Höglund

Abstract
Aim
To investigate school nurses’ perceptions of HPV immunization, and their task of administering the vaccine in a planned school-based program in Sweden. Method: Data were collected through five focus group interviews with school nurses (n = 30). The interviews were recorded, transcribed verbatim and analyzed using content analysis.

Findings
The theme Positive attitude to HPV immunization despite many identified problems and challenges summarizes the results. The school nurses saw the program as a benefit in that the free school-based HPV immunization program could balance out social inequalities. However, they questioned whether this new immunization program should be given priority given their already tight schedule. Some also expressed doubts regarding the effect of the vaccine. It was seen as challenging to obtain informed consent as well as to provide information regarding the vaccine. The nurses were unsure of whether boys and their parents should also be informed about the immunization.

Conclusion
Although some positive aspects of the new HPV immunization program were mentioned, the school nurses primarily identified problems and challenges; e.g. regarding priority setting, informed consent, culture and gender. In order to achieve a good work environment for the school nurses, and obtain a high coverage rate for the HPV immunization, these issues need to be taken seriously, be discussed and acted upon.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 28  pp. 4535-4646 (20 June 2011)

Willingness of pregnant women to vaccinate themselves and their newborns with the HPV vaccine
Pages 4618-4622
Katherine P. Heyman, Michael J. Worley Jr, Melissa K. Frey, Robin T. Kessler, Diane C. Bodurka, Brian M. Slomovitz

Abstract
Objective
To evaluate the willingness of pregnant women to accept the HPV vaccine for their newborns as well as themselves.

Methods
An 18-item questionnaire was distributed to antepartum women. Demographic data about the respondent’s current pregnancy and her knowledge of HPV and the HPV vaccine was collected. Information about the respondent’s HPV and HPV vaccine status as well as her acceptance of the vaccine for herself during pregnancy and her newborn son and/or daughter after delivery was also collected.

Results
Three hundred surveys were completed and available for review. Only 6 respondents (2%) had received the HPV vaccine. Despite the small group of patients who had previously been vaccinated, 112 respondents (37.3%) stated that they would receive the HPV vaccine during pregnancy if recommended by an obstetrician. 99 respondents (33%) stated that they would vaccinate their newborn female infant and 83 (27.7%) stated would vaccinate their male infants.

Conclusion
Providing the HPV vaccine to pregnant women as well as newborns could be an important way to increase the patient population who is protected against HPV. A percentage of pregnant women are willing to accept the vaccine for themselves and their newborns.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 27 pp. 4431-4534 (15 June 2011)

Reviews
Influenza vaccine for pregnant women in resource-constrained countries: A review of the evidence to inform policy decisions
Pages 4439-4452
Justin R. Ortiz, Janet A. Englund, Kathleen M. Neuzil

Abstract
Seasonal influenza is responsible for three to five million severe cases of disease annually, and up to 500,000 deaths worldwide. Pregnant women and infants suffer disproportionately from severe outcomes of influenza. The excellent safety profile and reliable immunogenicity of inactivated influenza vaccine support WHO recommendations that pregnant women be vaccinated to decrease complications of influenza disease during pregnancy. Nevertheless, influenza vaccine is not routinely used in most low-and middle-income countries and is not widely used in pregnant women worldwide.

Two recent prospective, controlled trials of maternal influenza vaccination in Bangladesh and US Native American reservations demonstrated that inactivated influenza vaccine given to pregnant women can decrease laboratory-confirmed influenza virus infection in their newborn children. These studies support consideration of the feasibility of targeted influenza vaccine programs in resource-constrained countries.

Platforms exist for the delivery of influenza vaccine to pregnant women worldwide. Even in the least developed countries, an estimated 70% of women receive antenatal care, providing an opportunity for targeted influenza vaccination. Challenges to the introduction of maternal influenza vaccination in resource-constrained countries exist, including issues regarding vaccine formulation, availability, and cost. Nonetheless, maternal influenza vaccination remains an important and potentially cost-effective approach to decrease influenza morbidity in two high-risk groups – pregnant women and young infants.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 27 pp. 4431-4534 (15 June 2011)

Regular Papers
The effects of vaccine characteristics on adult women’s attitudes about vaccination: A conjoint analysis study
Pages 4507-4511
Melissa S. Stockwell, Susan L. Rosenthal, Lynne A. Sturm, Rose M. Mays, Rita M. Bair, Gregory D. Zimet

Abstract
The number of current and future vaccines for adults has been steadily increasing. Yet, vaccine coverage rates for adult vaccinations have historically been low, and less is known about how adults in the mid-adult age range make vaccine decisions for themselves. The purpose of this study was to assess which vaccine characteristics affect vaccine decision-making among mid-adult women. Adult women, aged 27–55 (n = 258) rated 9 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: mode of transmission (STI or non-STI), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Ratings ranged from 0 to 100. Conjoint analysis was used to assess the effect of relative preferences for the vaccine scenario characteristics on participant ratings of scenarios. The mean vaccine scenario rating was 78.2. Nearly half (40%, n = 104) of participants rated all nine scenarios the same, with the majority of those (84%) holding strongly positive views. Conjoint analysis of the other 154 participants who discriminated between scenarios indicated that the main drivers for vaccine acceptability were severity of the disease and the efficacy of the vaccine to prevent the disease. Mode of transmission and availability of a preventative behavioral measure did not play a significant role. Future studies should further assess how women’s understanding of severity of the disease and efficacy of the vaccine to prevent disease may be useful for increasing vaccine acceptability.

This is a pdf version of Vacines: The Week in Review  6 JUne 2011 comprising all posts below dated 5 June:

Vaccines_The Week in Review_6 June 2011

    UNICEF said it is improving transparency around vaccine supply by making vaccine prices available on its website. As the largest buyer of children’s vaccines, UNICEF noted that the action is in line with its “commitment to ensure that vaccine supply is sustainable and affordable.” Information on market dynamics that influence vaccine uptake “will be more publicly available, starting with prices at which companies sell vaccines to UNICEF.” Shanelle Hall, Director of Supply Division, UNICEF, said, “Transparency is a core principle in itself and will support governments and partners in making more informed decisions. Transparency will also help foster a competitive, diverse supplier base for global public goods.”

UNICEF said it “undertook a consultation with all suppliers to ensure understanding and acceptance of the new policy prior to publishing vaccine prices online.  All recent and future tenders include a clause that enables UNICEF to make awarded vaccine prices publicly available, in addition to pricing and contracting information already in the public domain on UNICEF’s website.” The procurement of vaccines is UNICEF’s largest procurement activity, worth US$757 million in 2010. Last year, UNICEF provided 2.5 billion doses of vaccines to 99 countries, reaching an estimated 58 per cent of the world’s children.

http://www.unicef.org/media/media_58692.html

UNICEF Vaccine Price Data [full text]

UNICEF has a significant role within vaccine procurement for children. In recognition of this and in an attempt to be fully transparent UNICEF is now publishing a retrospective of vaccine prices.
This overview has been prepared following consultations with vaccine suppliers to UNICEF on making pricing information more transparent. A few suppliers are at this stage not able to share their price information but we hope to add this information in the future.
The vaccine prices received by UNICEF from industry are based on the UNICEF mandate, UNICEF aggregated quantities, commercial terms, reliability of forecasts, timelines of payment, and long standing relationship with industry.

Awarded Prices
The below links provide an overview of prices contracted with suppliers by UNICEF per vaccine.

http://www.unicef.org/supply/index_57476.html

UNICEF said Executive Director Anthony Lake joined world leaders at a meeting hosted by the Government of Japan “to discuss how focusing investment on the most vulnerable can improve human security and accelerate global progress toward meeting the Millennium Development Goals.” A Plenary session of the meeting “discussed the disturbing evidence that disparities between the richest and poorest children have widened, even as the world has made progress since the 2000 Millennium Declaration.”  Director Lake said, “Progress, measured by national averages, can conceal huge local disparities, and statistical success can mask moral failure. We need to come together as a global community and fully commit ourselves to reaching the hardest to reach…With the 2015 deadline for achieving the MDGs fast approaching, we must find new ways to do more with the resources we have, achieving not only more money for development, but also more development for the money.”

http://www.unicef.org/media/media_58756.html

The MMWR Weekly for June 3, 2011 / Vol. 60 / No. 21 includes:
– Vaccination Coverage Among Children in Kindergarten — United States, 2009–10 School Year

– Update: Influenza Activity — United States, 2010–11 Season, and Composition of the 2011–12 Influenza Vaccine

http://www.cdc.gov/mmwr/pdf/wk/mm6021.pdf

The Weekly Epidemiological Record (WER) for 3 June 2011, vol. 86, 23 (pp 233–240) includes: Targeting influenza in Africa: strategic actions for assessing the impact of the disease and for developing control measures; Surveillance of drug resistance in leprosy: 2010 http://www.who.int/entity/wer/2011/wer8623.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

PIH Partners In Health
“Health care programs can and should be made w/ the system as a whole in mind” http://ow.ly/58MKg #HIV #AIDS #Haiti

PATHtweets PATH

Read our China program leader Jack Zhang’s comments on China’s emerging role in #globalhealth and vaccine production. http://ow.ly/577IJ

GAVIAlliance GAVI Alliance
Vaccine alliance seeks $3.7 bln from London meeting http://ht.ly/56wlL

Clinical Infectious Diseases
Volume 52 Issue 12 June 15, 2011
http://www.journals.uchicago.edu/toc/cid/current

ARTICLES AND COMMENTARIES
Pieter Uys, Ben J. Marais, Simon Johnstone-Robertson, John Hargrove, and Robin Wood
Transmission Elasticity in Communities Hyperendemic for Tuberculosis
Clin Infect Dis. (2011) 52(12): 1399-1404 doi:10.1093/cid/cir229

Abstract
Backround. Despite consistently meeting international performance targets for tuberculosis case detection and treatment success, areas where tuberculosis is hyperendemic fail to achieve the predicted epidemiological impact. In this article, we explore the anomalous relationship between defined performance targets and actual reduction in tuberculosis transmission.

Methods. In areas where tuberculosis is endemic, poorly ventilated social gathering places such as shebeens (informal alcohol drinking places), minibus taxis, and clinic waiting rooms are all potential transmission hot spots. We modeled the transmission reduction achieved by removal of infectious persons in settings with different tuberculosis prevalence rates to demonstrate the concept of transmission elasticity. We then applied this concept to real-life data from a hyperendemic community in Cape Town, South Africa.

Results. In a hyperendemic area, reducing the number of infectious people by a given percentage results in a smaller percentage decrease in the annual risk of infection (ARI) compared with a nonendemic area; for example, removing 10% of infectious persons could result in as little as a 5% reduction in the ARI. With use of real-life data and removal of 60% of infectious individuals with tuberculosis, as would be achieved by meeting current performance targets of 70% case detection and 85% cure, the estimated ARI reduction is 50%.

Conclusions. The relationship between the number of infectious people removed and the decrease in ARI is nonlinear. The concept of transmission elasticity has important implications for the formulation of universal performance targets, since hyperendemic areas would require more stringent targets to achieve comparable transmission reduction.

Human Vaccines
Volume 7, Issue 6  June 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/5/

Parents’ vaccination concerns are about more than risk and benefit
Open Access Article
Anna K. Mikulak

[No abstract]

Human Vaccines
Volume 7, Issue 6  June 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/5/

Meeting Report
How will diagnostics create new opportunities for prophylactic and therapeutic vaccines?
Niranjan Y. Sardesai

The Phacilitate Vaccine Forum in Washington DC (Jan 24-26, 2011) brought together vaccine stakeholders from industry, government and non-government organizations to discuss broad current issues covering the spectrum of vaccine policy, funding, research and clinical development, manufacturing, regulatory, and post marketing safety and surveillance. While the conference is held annually and the topics generally discussed reflect the emerging trends, case studies, and best practices of current interest to the vaccine industry, this year’s meeting had a new plenary session focusing on the intersection of diagnostics and vaccine development. The session was chaired by Dr. Una Ryan (President and CEO, Diagnostics for All) with the provocative title “How will diagnostics create new opportunitites for prophylactic and therapeutic vaccines?” and was followed by a panel discussion amongst industry leaders discussing the key diagnostic applications gaining interest in the vaccine industry. A common theme running through the session was the increasingly significant role of companion diagnostics and immune monitoring to facilitate and accelerate vaccine development. Indeed the recent examples from pneumococcal and meningococcal vaccine development where the developers and regulatory agencies have considered the use of diagnostic assays and immune markers to assess efficacy of the candidate vaccines in regards to licensure strategies for expanding the serotypes covered, can be considered as breakthrough events for the diagnostics developers. As such the meeting and the session was timely in presenting current progress and for soliciting a convergence of opinions amongst the vaccine industry and the regulatory agencies.

Human Vaccines
Volume 7, Issue 6  June 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/5/

Commentary
Synthetic biology: Impact on the design of innovative vaccines
Kathrin Kindsmüller and Ralf Wagner

Conventional vaccine design strategies mainly focus on live-attenuated vaccines, inactivated microorganisms, and subunits thereof comprising purified components or recombinantly expressed proteins, mostly formulated with adjuvants. Although generally very efficient, these approaches are suboptimal or unfeasible for some infectious diseases. Over the past years new technologies to vaccine development have evolved, often utilizing design principles and construction technologies of synthetic biology. The contribution of synthetic biology to vaccine development comprises algorithms for accelerated in silico identification of relevant protein candidates, in silico design of novel immunogens with improved expression, safety and immunogenicity profiles as well as in silico design of (1) nucleic acid based, (2) vectored and (3) live-attenuated vaccines. Furthermore, synthetic biology enables economic and rapid chemical synthesis of DNA encoding the immunogens designed in silico, and their efficient assembly with delivery systems to obtain vectored vaccines. Altogether, synthetic biology can help to develop improved vaccine candidates in considerably less time compared to conventional approaches.

JAMA   
June 8, 2011, Vol 305, No. 22, pp 2257-2368
http://jama.ama-assn.org/current.dtl

Commentaries
A Strategic Approach to Therapeutic Cancer Vaccines in the 21st Century
Matthew M. Davis, Elias J. Dayoub
JAMA. 2011;305(22):2343-2344.doi:10.1001/jama.2011.814

Extract: First 150 words
Prophylactic vaccines have forever reduced the burden of disease in the United States and around the world. 1 One of the critical keys to success for prophylactic vaccines was that scientists set their sights on high-burden infectious diseases—frequently with high incidence, and often with high rates of mortality and morbidity and minimally effective therapeutic options at the time vaccines were developed.

Now, in the midst of a golden era of continuing prophylactic vaccine successes, 2 therapeutic vaccines for cancer are being developed. Currently available treatments with surgery, chemotherapy, and radiation therapy help about 2 of every 3 patients diagnosed with cancer survive for at least 5 years in the United States, 3 but many of those patients experience treatment complications and morbidities that reduce their quality of life. Therapeutic vaccines that trigger individuals’ targeted immune response against tumor-specific antigens and tumor-associated antigens may offer patients with cancer dual benefits of …

Journal of Infectious Diseases
Volume 204 Issue 1   July 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

MAJOR ARTICLES AND BRIEF REPORTS: PARASITES
Philip Bejon, Jackie Cook, Elke Bergmann-Leitner, Ally Olotu, John Lusingu, Jedidah Mwacharo, Johan Vekemans, Patricia Njuguna, Amanda Leach, Marc Lievens, Sheetij Dutta, Lorenz von Seidlein, Barbara Savarese, Tonya Villafana, Martha M. Lemnge, Joe Cohen, Kevin Marsh, Patrick H. Corran, Evelina Angov, Eleanor M. Riley, and Chris J. Drakeley

Effect of the Pre-erythrocytic Candidate Malaria Vaccine RTS,S/AS01E on Blood Stage Immunity in Young Children
J Infect Dis. (2011) 204(1): 9-18 doi:10.1093/infdis/jir222

Abstract [Free full text]
Background. RTS,S/AS01E is the lead candidate malaria vaccine and confers pre-erythrocytic immunity. Vaccination may therefore impact acquired immunity to blood-stage malaria parasites after natural infection.

Methods. We measured, by enzyme-linked immunosorbent assay, antibodies to 4  Plasmodium falciparum merozoite antigens (AMA-1, MSP-142, EBA-175, and MSP-3) and by growth inhibitory activity (GIA) using 2 parasite clones (FV0 and 3D7) at 4 times on 860 children who were randomized to receive with RTS,S/AS01E or a control vaccine.

Results. Antibody concentrations to AMA-1, EBA-175, and MSP-1 42 decreased with age during the first year of life, then increased to 32 months of age. Anti–MSP-3 antibody concentrations gradually increased, and GIA gradually decreased up to 32 months. Vaccination with RTS,S/AS01E resulted in modest reductions in AMA-1, EBA-175, MSP-142, and MSP-3 antibody concentrations and no significant change in GIA. Increasing anti-merozoite antibody concentrations and GIA were prospectively associated with increased risk of clinical malaria.

Conclusions. Vaccination with RTS,S/AS01E reduces exposure to blood-stage parasites and, thus, reduces anti-merozoite antigen antibody concentrations. However, in this study, these antibodies were not correlates of clinical immunity to malaria. Instead, heterogeneous exposure led to confounded, positive associations between increasing antibody concentration and increasing risk of clinical malaria.

The Pediatric Infectious Disease Journal
June 2011 – Volume 30 – Issue 6  pp: A9-A10,451-542,e88-e108
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Early Estimate of the Effectiveness of Quadrivalent Meningococcal Conjugate Vaccine
MacNeil, Jessica R.; Cohn, Amanda C.; Zell, Elizabeth R.; Schmink, Susanna; Miller, Elaine; Clark, Thomas; Messonnier, Nancy E.; for the Active Bacterial Core surveillance (ABCs) Team and MeningNet Surveillance Partners
Pediatric Infectious Disease Journal. 30(6):451-455, June 2011.
doi: 10.1097/INF.0b013e31820a8b3c

Abstract:
Background: In January 2005, a quadrivalent meningococcal conjugate vaccine (MenACWYD) was licensed for use in the United States. The Advisory Committee on Immunization Practices recommends MenACWYD for all adolescents 11 to 18 years of age and others at increased risk for meningococcal disease.

Methods: Reports of breakthrough meningococcal disease after vaccination with MenACWYD were collected. A simulation approach was used to estimate the expected number of cases in vaccinated persons.

Results: Between 2005 and 2008, 14 breakthrough cases, including 3 deaths occurred. At a vaccine effectiveness (VE) of 90%, 7 breakthrough cases would be expected (range, 1–17); at VE of 85%, 11 cases (range, 2–30); at VE of 80%, 15 cases (range, 5–28); and at VE of 75%, 18 cases (range, 7–32) would be expected. The probability of the ≥14 observed cases occurring was 2.9% at VE of 90%, 29.3% at VE of 85%, 66.1% at VE of 80%, and 83.0% at VE of 75%.

Conclusions: This report provides an early estimate of MenACWYD effectiveness within 3 to 4 years after vaccination, and suggests that MenACWYD effectiveness is 80% to 85%, similar to the VE reported for meningococcal polysaccharide vaccine.

The Pediatric Infectious Disease Journal
June 2011 – Volume 30 – Issue 6  pp: A9-A10,451-542,e88-e108
http://journals.lww.com/pidj/pages/currenttoc.aspx

Current Abstracts
Implementation of Cocooning Against Pertussis in a High-risk Population
Pediatric Infectious Disease Journal. 30(6):500, June 2011.
doi: 10.1097/INF.0b013e318218ef05

Pediatrics
June 2011, VOLUME 127 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Immunogenicity and Safety of H influenzae Type b–N meningitidis C/Y Conjugate Vaccine in Infants
Kristina A. Bryant, Gary S. Marshall, Colin D. Marchant, Noris Pavia-Ruiz, Terry Nolan, Stephen Rinderknecht, Mark Blatter, Emmanuel Aris, Pascal Lestrate, Dominique Boutriau, Leonard R. Friedland, and Jacqueline M. Miller
Pediatrics 2011; 127:e1375-e1385

Abstract
BACKGROUND: Meningococcal disease incidence is highest in children younger than 2 years of age, yet there is no US-licensed vaccine for this age group. A phase III study evaluated the immunogenicity and safety of an investigational Haemophilus influenzae type b (Hib)–Neisseria meningitidis serogroups C and Y-tetanus toxoid conjugate vaccine (HibMenCY).

MATERIALS AND METHODS: A total of 4180 infants were randomly assigned to receive the HibMenCY at the ages of 2, 4, 6, and 12 to 15 months or the licensed Hib tetanus toxoid conjugate vaccine (ActHIB) at 2, 4, and 6 months and Hib conjugated to N meningitidis outer membrane protein (PedvaxHIB) at 12 to 15 months. Routinely scheduled vaccines were coadministered. Serum bactericidal activity using human complement and anti–polyribosylribitol phosphate antibodies were assessed in 991 subjects. Local and systemic adverse reactions were recorded for 4 days after each dose.

RESULTS: The percentage of HibMenCY recipients with serum bactericidal assay using human complement titers of 1:8 or higher after dose 3 was 98.8% for N meningitidis serogroup C (MenC) and 95.8% for N meningitidis serogroup Y (MenY). After dose 4, the percentages were 98.5% and 98.8%, respectively. The percentage of HibMenCY recipients with postdose 3 anti-polyribosylribitol phosphate antibody levels of ≥1.0 μg/mL was noninferior to that of control (96.3% vs 91.2%). After dose 4, MenC and MenY serum bactericidal assay using human complement antibody titers increased 12-fold over pre–dose 4 levels. Incidence of pain, redness, and swelling at the HibMenCY injection sites tended to be lower than with Hib type b after the first 3 doses and after the fourth dose. Rates of systemic symptoms were similar across groups.

CONCLUSIONS: The HibMenCY was immunogenic against MenC and MenY and induced anti–polyribosylribitol phosphate antibody levels noninferior to those of licensed Hib conjugate vaccine. The safety profile of the HibMenCY was clinically acceptable and comparable to Hib conjugate vaccine.

Pediatrics
June 2011, VOLUME 127 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Commentaries
Bruesewitz v Wyeth: Ensuring the Availability of Children’s Vaccines
Gary N. McAbee, William M. McDonnell, and Steven M. Donn
Pediatrics 2011; 127:1180-1181

Pediatrics
June 2011, VOLUME 127 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care
Steering Committee on Quality Improvement and Management and Committee on Hospital Care
Pediatrics 2011; 127:1199-1210

Abstract
Pediatricians are rendering care in an environment that is increasingly complex, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown in the 10 years since the Institute of Medicine published its report To Err Is Human, and patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to uncover a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification. Pediatricians in all venues must have a working knowledge of patient-safety language, advocate for best practices that attend to risks that are unique to children, identify and support a culture of safety, and lead efforts to eliminate avoidable harm in any setting in which medical care is rendered to children.

Vaccine
Volume 29, Issue 26 pp. 4299-4430 (10 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
A survey of children’s preferences for influenza vaccine attributes
Pages 4334-4340
Emuella M. Flood, Kellie J. Ryan, Matthew D. Rousculp, Kathleen M. Beusterien, Stan L. Block, Matthew C. Hall, Parthiv J. Mahadevia

Abstract
Background
While annual influenza vaccination is recommended by the CDC for children 6 months and older, vaccination rates remain suboptimal. For healthy, US children 2 years of age and older, influenza vaccine is available as an intramuscular injection (TIV) or an intranasal spray (LAIV), respectively. Little is known about children’s experiences and preferences for influenza vaccine attributes.

Objective
To examine preferences for influenza vaccine attributes and their relative importance among children.

Methods
A quantitative web-survey was administered to children aged 8–12 years sampled from a standing online panel representative of the US population. Children were stratified by age, gender and parent’s influenza vaccination behavior. The survey included questions to ascertain children’s preferences for influenza vaccine attributes, including efficacy, chance of common side effects, and mode of administration. It included conjoint (trade-off) questions in which children traded-off different attributes in their choice between two influenza vaccines with differing features. We also surveyed children’s comprehension of and ability to complete the conjoint questions.

Results
544 children completed the survey (response rate 37%). Children most frequently selected efficacy as the most important vaccine attribute followed by mode of administration (45% and 31%, respectively). When asked for their preference to receive influenza vaccine as a “shot” or a “nose spray”, the majority (69%) preferred the nose spray. An evaluation of children’s ability to complete the conjoint survey demonstrated that 85% of the sample was able to complete the conjoint tasks. Analysis of the conjoint responses demonstrated that mode of administration and efficacy had the greatest impact on preferences, with a relative importance of 40.5% and 30.6%, respectively. In a direct comparison of vaccine profiles representing the efficacy, side effects, and other characteristics of LAIV and TIV, 79% of children preferred the LAIV-like profile.

Conclusion
Children in the sample had consistent opinions regarding influenza vaccine attributes and consider vaccine efficacy and mode of administration to be important. Children can be informed participants in influenza prevention and can be included in discussions regarding influenza vaccination.

Vaccine
Volume 29, Issue 26 pp. 4299-4430 (10 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
A method for estimating vaccine-preventable pediatric influenza pneumonia hospitalizations in developing countries: Thailand as a case study
Pages 4416-4421
Fatimah S. Dawood, Alicia M. Fry, Charung Muangchana, Wiwan Sanasuttipun, Henry C. Baggett, Supamit Chunsuttiwat, Susan A. Maloney, James Mark Simmerman

Abstract
The burden of influenza in children is increasingly appreciated; some middle-income countries are considering support for influenza vaccine programs. To support decision-making, methods to estimate the potential impact of proposed programs are needed. Using Thailand as a case-study, we present a model that uses surveillance data, published vaccine effectiveness estimates, and vaccination coverage assumptions to estimate the impact of influenza vaccination on pediatric influenza pneumonia hospitalizations. Approximately 56,000 influenza pneumonia hospitalizations occur annually among children aged <18 years in Thailand; 23,700 (41%) may be vaccine-preventable. Vaccination of 85% of Thai children aged 7 months–4 years might prevent 30% of all pediatric influenza pneumonia hospitalizations in Thailand.

A pdf version of Vaccines: The Week in Review  30 May 2011, comprising all the posts for this date as below:

Vaccines_The Week in Review_30 May 2011

The Sixty-fourth World Health Assembly (16–24 May 2011) concluded in Geneva. Member States adopted 28 resolutions and three decisions during the Assembly, summarized here: http://www.who.int/mediacentre/news/releases/2011/world_health_assembly_20110524/en/index.html

We excerpt selection sections from the summary below [full text]:

Improving global preparedness for future pandemics
In another agenda item aimed to improve global preparedness for future pandemics, delegates approved a framework for pandemic influenza preparedness, the culmination of four years of negotiation between WHO’s Member States. The framework will improve influenza virus sharing and access to vaccines and other benefits. Member States agreed the framework lays the groundwork for better preparedness and better access to tools and knowledge. The next phase is to ensure the implementation of the agreement.

Resolutions and reports support health-related MDGs
Health-related MDGs received support with resolutions and reports on immunization strategy, infant and young child nutrition, child injury prevention, youth health risks, malaria, and the presentation of the final report of the Commission on Information and Accountability for Women’s and Children’s Health.

The progress report on the global immunization vision and strategy was widely supported. Delegates highlighted their country’s achievements in increasing immunization coverage, reducing vaccine-preventable deaths and implementing advocacy events such as the regional immunization weeks. But they also recognized that several challenges remain, including mobilizing more resources to strengthen national immunization programmes; ensuring a balanced approach in strengthening immunization systems; introducing new vaccines; preventing a resurgence of measles through high vaccination coverage; and facilitating vaccine technology transfer to developing countries. The work outlined in the strategy will contribute to overcoming these challenges.
Member States commend WHO’s leadership and collaboration with UNICEF, the Bill & Melinda Gates Foundation, and other partners on the Decade of Vaccines — a vision for using the next 10 years to achieve immunization goals and reach important milestones in vaccine research, development, financing and public support…

…The Health Assembly adopted a resolution on malaria calling on Member States to keep malaria high on the political and development agendas in order to sustain the tremendous gains made during the past decade, and calling on international partners to ensure adequate and predictable funding so that global malaria targets for 2015 can be met. The resolution highlighted the need for continued universal coverage with malaria vector control for at-risk persons, expanded access to diagnostic testing for suspected malaria and treatment for confirmed cases, and strengthened malaria surveillance systems. The need to implement the WHO Global Plan for Artemisinin Resistance Containment, and to develop a global plan for insecticide resistance management in malaria vectors, were also emphasized.

Reaffirmed that the remaining stock of smallpox virus should be destroyed
The Health Assembly strongly reaffirmed the decision of previous Assemblies that the remaining stock of smallpox (variola) virus should be destroyed when crucial research based on the virus has been completed. The state of variola virus research will be reviewed at the 67th World Health Assembly in 2014 and in light of that, determining a date for destruction of the remaining virus stocks will be discussed.

Annual report on the eradication guinea-worm disease
The delegates adopted a resolution paving the way for an annual report on the eradication of dracunculiasis (more commonly known as guinea-worm disease) to be presented every year beginning with the next Health Assembly. Dracunculiasis is the second disease which is approaching eradication (the first being smallpox) and it occurs only after people drink contaminated water. Previously it was responsible for millions of infections across Africa and Asia. The disease mainly occurs in remote poverty-stricken areas, with limited or no access to safe drinking water.

Strong commitment to polio eradication
The global health community sent a sign of strong commitment to polio eradication with discussion focusing on the ‘significant advances’ since the launch of a new strategic plan and new, bivalent oral poliovirus vaccine in 2010. In India and Nigeria — the source of all importations of wild poliovirus into previously polio-free countries in recent years — polio cases declined by 95% between 2009 and 2010; during the same period polio cases due to the type 3 virus declined by 92% globally. Delegates called for strong national and subnational leadership by political authorities for the implementation of polio eradication strategies and highlighted the need for countries to significantly strengthen routine immunization. Delegates expressed particular concern over the funding gap of US$ 665 million to fully carry out polio eradication activities in 2011 and 2012. Delegates requested WHO to provide additional technical support to countries with ongoing, re-established polio transmission (Angola, Chad, Democratic Republic of the Congo), to continue to pursue research for post-eradication risk management and to help countries maintain high-quality surveillance and population immunity until eradication is complete globally.

WHO Media Center documentation on the overall WHA available here: http://www.who.int/mediacentre/events/2011/wha64/en/index.html

    WHO Director-General Dr Margaret Chan, in closing remarks at the Sixty-fourth World Health Assembly, discussed historic agreements reached by Member States. Full text here: http://www.who.int/dg/speeches/2011/wha_20110524/en/index.html

The following excerpts are relevant to vaccines, immunization an related themes:

“…Mr. Bill Gates reminded us that we in public health have one of the hardest jobs in the world, but also one of the most rewarding jobs. He also reminded us that work done by these Health Assemblies is having a tremendous impact on the health of this world.

Having seen his teenage dream of putting a computer in every home well under way, he is now committed to devoting his time, talent, and wealth to getting vaccines in every child.

Through the Decade of Vaccines, launched with a $10 billion pledge, he is using his wealth to spur innovation and to work with industry to get the prices of existing vaccines down.

His devotion to polio eradication is unwavering, and public health in many other areas has benefitted greatly from the generosity of the Bill and Melinda Gates Foundation. He reminded us of the absolutely critical importance of leadership and accountability in getting things done…”

.
“…Committee A experienced true euphoria when the item on pandemic influenza preparedness was discussed, based on the framework agreed in April.

I can summarize the significance of this agreed framework by quoting the words used by delegates during their interventions: a milestone, an historical agreement, a landmark, a momentous and remarkable achievement, and a proof of the democratic decision-making dynamics we see at WHO. Many delegates commended the strong collaboration of the pharmaceutical industry and the very useful perspectives provided by civil society organizations.

I will add my own comment. This agreed framework is a triumph for health diplomacy, under the superb leadership of chairs and co-chairs, as well as a triumph for public health. It is a tribute to the principles of equity, fairness, and solidarity that underpin everything we try to do at WHO.

The resolution on this matter was adopted, as amended, by consensus. As you know, this was the culmination of four years of very hard work which at times faced issues that appeared hopelessly deadlocked.

This was a high point for all of us, and especially, for the health security of the world. It vastly improves the world’s capacity to prepare for the next influenza pandemic through better surveillance and risk assessment, and to distribute the benefits of vaccines, antiviral medicines, and diagnostic tests more equitably.

With consensus now reached, delegates asked me to maintain close oversight of the framework’s implementation, working hand-in-hand with the Advisory Group, and to give particular attention to building the requisite capacities, skills, and know-how, including through technology transfer….”

.
“…The item on the Global immunization and vision strategy deserves special mention as an exciting contribution to the achievement of the MDG set for reducing child mortality. Well over 50 delegates and representatives of civil society organizations took the floor.

As we enter this Decade of Vaccines, we heard high praise for support from WHO and UNICEF, but especially for the GAVI Alliance. With GAVI support, vaccines that prevent pneumonia and diarrhoea, the two biggest childhood killers, are now being rolled out in a number of countries.

We heard first-hand accounts of what the new meningitis vaccine means for Africa and its people. Many countries have also added yellow fever and hepatitis B vaccines to routine immunization programmes.

I hardly need to remind you of what these efforts contribute to the attainment of MDG 4. But as I have said, and you agree, achievement of this goal also depends on some very basic and cost-effective measures best delivered through primary health care.

You gave us an extremely clear message. The achievement of ambitious, yet fully agreed goals, such as expanded immunization coverage, the introduction of new vaccines, polio eradication, and measles elimination is directly tied to funds.

We heard compelling pleas to fully replenish GAVI funds so that this spectacular recent progress, supported by strong country ownership, does not lose its momentum.

As I have heard on many occasions, a vaccine that is too expensive for the developing world is worse than no vaccine at all.

Many asked the international community to seek ways to reduce the costs of vaccines, especially the newer ones. Let me assure you. WHO, UNICEF, several other partners and, of course, the Bill and Melinda Gates Foundation are working on this right now.

You will see the results you so greatly need to maintain the current momentum. And I know you want this to happen. You strongly endorsed WHO plans for the development of a global vaccine action plan.

You referred to the need for technology transfer and skills training to enable local manufacturing of vaccines, especially in Africa. Some of you described WHO’s key role in achieving exactly this objective for the local manufacturing of pandemic influenza vaccines.

This is a decade with a vision, and vision always feeds that perennial optimism of public health that keeps us going despite the many obstacles and setbacks thrown our way by policies and events beyond our control.

This decade will help realize the full power of immunization to prevent morbidity and mortality, and the young lives saved from death or life-long disability will be numbered in the millions.

Several delegates mentioned the need for communication strategies that address public fears about the safety of vaccines, especially as these fears are responsible for several recent outbreaks that really should not have happened.

WHO was not proactive on social media during the influenza pandemic, and I believe that this allowed some unfounded criticisms to flourish and contributed to the decision of some groups, including members of the medical profession, to refuse vaccination as unsafe and unnecessary.

But we did use Twitter extensively during this Assembly, and our tweets about events over the past several days, on topics ranging from the reform agenda for WHO to pandemic influenza preparedness, reached more than three million people…”

http://www.who.int/dg/speeches/2011/wha_20110524/en/index.html

 The G2—G8 Summit of Deauville, held 26-27 May 2011, included the following summary declaration: G8 DECLARATION: RENEWED COMMITMENT FOR FREEDOM AND DEMOCRACY http://ht.ly/54nvv The excerpts below reference vaccines, immunization and related themes:

57. We remain strongly committed to meeting our commitments and to tracking their implementation in a fully transparent and consistent manner. We endorse the Deauville Accountability Report: “G8 Commitments on Health and Food Security: State of Delivery and Results” which documents G8 action on health and food security, and mobilisation of financial resources including 85% of all commitments to the L’Aquila Food Security Initiative, 78% of the overall resources of the Global Fund to fight AIDS, Tuberculosis and Malaria, 44% of funding for the Global Polio Eradication Initiative, and $1.8 billion to the GAVI Alliance through direct contributions and innovative financing mechanisms. We will continue to improve the rigour of G8 accounting for progress in meeting its non-financial commitments and will follow-up on the report’s recommendations.

60. The G8 has catalysed significant action on health and food security and we are ready to further work with other stakeholders. In this regard:
a. We will continue to support the Global Fund to Fight AIDS, Tuberculosis and Malaria. We welcome the commitment of the Global Fund Board to implement a reform agenda to improve oversight, accountability and effectiveness in using its resources. Based on these reforms, traditional donors will be enabled to meet their respective pledges to the Global Fund. We encourage non-traditional donors and the private sector to provide resources to the Global Fund.

b. We reaffirm our commitment to improving maternal health and reducing child mortality, most notably through the Muskoka Initiative for Maternal, Newborn and Child Health launched in 2010. We are delivering our Muskoka commitments. We will continue to monitor their implementation in coordination with all partners, including stakeholders in the Global Strategy for Women’s and Children’s Health. We support the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health established by the WHO at the request of the UN Secretary General. We will implement them, and urge others to do so.

c. We recognise the impact of the GAVI Alliance and strongly welcome its efforts to expand access to new and under-used life-saving vaccines in the poorest countries including through tiered pricing and innovative mechanisms such as the International Finance Facility for Immunisation. We call for a successful completion of the first pledging conference of GAVI in June in London, involving all relevant actors. We also welcome the development of the Advanced Market Commitments and notably the pilot project on pneumococcal vaccines.

d. We stress our continuing commitment to the eradication of polio which is a reachable objective. Our past support has contributed to the 99% decrease of polio cases in the developing countries. We flag the need for a special focus on this issue and renewed momentum. To this end, we will continue to support the Global Polio Eradication Initiative.

e. We will work, together with major bilateral donors, global health programmes and country coordination initiatives, to improve these funds’ implementation of aid effectiveness. http://ht.ly/54nvv

Presidents Obama and Medvedev, speaking at the G20-G8 Summit in Deauville, “recognized the collaborative efforts already underway between the United States and Russia to eradicate polio globally, and pledged to continue that cooperative until the eradication objective is finally achieved.” USAID noted that in January, 2011, the U.S. government and the government of the Russian Federation, through the U.S. Agency for International Development (USAID), the U.S. Department of Health and Human Services (HHS), and the Ministry of Health and Social Development of the Russian Federation (MOHSD), signed a Protocol of Intent on Cooperation for the Global Eradication of Polio.

Areas of collaboration include “providing technical assistance for polio surveillance; participating in and monitoring of polio immunization campaigns; providing technical assistance on polio clinical diagnoses, case management and rehabilitation; and advocacy and resource mobilization.”  The U.S. noted that it is the largest bilateral donor to the Global Polio Eradication Initiative. Polio eradication “is part of USAID’s more comprehensive effort to reduce morbidity, mortality and disability due to vaccine-preventable diseases.”

http://www.usaid.gov/press/releases/2011/pr110526_1.html?utm_source=twitterfeed&utm_medium=twitter

GAVI reported that Germany will contribute €30 million to the GAVI Alliance in 2012, up from €20 million in 2011. The announcement from Germany’s Ministry of Economic Cooperation and Development (BMZ) was made ahead of the G8 summit and is part of a plan to implement last year’s G8 commitment to the Muskoka initiative for maternal and child health. In a media release, Gudrun Kopp, Parliamentary Secretary to the Minister of Economic Cooperation and Development, said, “An important part of the G8 Muskoka implementation is to work more closely with the Global Alliance for Vaccines and Immunisation, GAVI…GAVI is doing an excellent job and has financed the immunisation of more than 280 million children in the last decade. We have therefore increased our contributions to €20 million in 2011, a fivefold increase compared with previous years. I am happy to announce that we are planning another increase to €30 million in 2012.”

The Bill & Melinda Gates Foundation has offered to match the 2011 and 2012 increases with a €24 million contribution of its own.

http://www.gavialliance.org/media_centre/press_releases/germany_funding.php

GAVI released its 2010 Progress Report, marking its first decade of operation. GAVI’s summary of the report notes: “By the end of 2010, over 5 million future deaths had been prevented and over 288 million additional children had been immunised with support from GAVI and its partners. With sufficient funding GAVI can address the main childhood killers, pneumonia and diarrhoea, as well as other diseases that place a huge burden on developing countries, and prevent another 3.9 million future deaths by 2015.” The report includes “a summary of GAVI’s new strategy and business plan, success stories, facts and figures, country information and an overview of how the GAVI Alliance is governed.” download the full report (PDF – 4.7MB).

The MMWR Weekly for May 27, 2011 / Vol. 60 / No. 20 includes:

– Recommendations for Use of a Booster Dose of Inactivated Vero Cell Culture-Derived Japanese Encephalitis Vaccine — Advisory Committee on Immunization Practices, 2011

– Update on Japanese Encephalitis Vaccine for Children — United States, May 2011

– Measles — United States, January–May 20, 2011

http://www.cdc.gov/mmwr/pdf/wk/mm6020.pdf

The Weekly Epidemiological Record (WER) for 27 May 2011, vol. 86, 22 (pp 221–232) includes: Outbreak news – Ebola, Uganda; Review of the 2010–2011 winter influenza season, northern hemisphere; Meeting of the WHO Human Papillomavirus Vaccine Advisory Committee, April 2010.
http://www.who.int/entity/wer/2011/wer8622.pdf

WHO released the latest issue of Global Immunization News 27 May 2011:

http://www.who.int/entity/immunization/GIN_May_2011.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

globalfundnews The Global Fund
WSJ.com – AIDS Fight Hits Hurdle Over Funding on.wsj.com/mDiZi4

globalfundnews The Global Fund
Joint Letter to Heads of State at the G8 Deauville Summit http://bit.ly/jWFWU1

MalariaVaccine PATH MVI
Plasmodium vivax: The other malaria | The Economist economist.com/node/18741412?… via @theeconomist

GAVIAlliance GAVI Alliance
Great #GAVI mention in the #G8 declaration! http://ht.ly/54nvv

GAVIAlliance GAVI Alliance
Thank you Germany! Germany increases funding for GAVI to €30 million @GatesFoundation will match last 2 increases http://ht.ly/53nc0

UN_Spokesperson UN Spokesperson
Secretary-General’s remarks at launch of Global Partnership for Girls’ and Women’s #Education, #GenderEquality http://bit.ly/d03VI0

sabinvaccine Sabin Vaccine Inst.
Proceedings from the 9th Intl #Rotavirus Symposium now available online: http://bit.ly/m3Qh2A

GAVIAlliance GAVI Alliance
Really exciting news! Former CEO of MTV Bill Roedy takes up fight against childhood disease & becomes GAVI’s 1st envoy http://ht.ly/52rwp

IAVISeth Seth Berkley
At Gates Foundation for Product Development Partnership meeting and to hear BMGF perspectives on GAVI–like drinking from a fire hose.