Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 14 Dec 2019
[No new, unique, relevant content]

BBC
http://www.bbc.co.uk/
Accessed 14 Dec 2019
[No new, unique, relevant content]

The Economist
http://www.economist.com/
Accessed 14 Dec 2019
[No new, unique, relevant content]

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

Forbes
http://www.forbes.com/
Accessed 14 Dec 2019
Dec 12, 2019
How Prepared Are We For The Next Pandemic? Not Very, Experts Show
Global leaders in public health, industry, and government faced hard questions in a pandemic preparedness exercise called Event 201.

Dec 10, 2019
Physician Paul Farmer Reflects On Health Solutions Brought To Medical Deserts And The Places Still In Dire Need
At the eighth annual Forbes Healthcare Summit, medical anthropologist Paul Farmer talked about the impact of Partners In Health, the organization he cofounded in 1987.
By Katherine Love Forbes Staff

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 14 Dec 2019
Economic Development   January/February 2020
Comment
How Poverty Ends
In the absence of a magic potion for development, the best way for a country to profoundly transform millions of lives is not to try in vain to boost growth. It is to…
Abhijit V. Banerjee and Esther Duflo

Foreign Policy
http://foreignpolicy.com/
Accessed 14 Dec 2019
[No new, unique, relevant content]

The Guardian
http://www.guardiannews.com/
Accessed 14 Dec 2019
Global health
Spike in Ebola cases alarms health officials in DRC
Peter Beaumont
Fri 13 Dec 2019
Health officials are investigating an alarming spike in Ebola cases in the Democratic Republic of the Congo, with many blamed on a single individual who appears to have contracted the disease for a second time this year.

New Yorker
http://www.newyorker.com/
Accessed 14 Dec 2019
[No new, unique, relevant content]

New York Times
http://www.nytimes.com/
Accessed 14 Dec 2019
Asia Pacific
Samoa Extends Measles State of Emergency, NZ to Fund Pacific Vaccination Campaign
The South Pacific island nation of Samoa on Saturday extended a state of emergency due to a measles outbreak which has killed 72 people, mostly infants, as New Zealand announced NZ$1 million ($640,700) to help combat measles in the Pacific.
By Reuters

Opinion
Terminally Ill at 25 and Fighting Fake News on Vaccines
In 2015, an anti-vaccination campaign in Ireland caused a sudden fall in the uptake of the HPV vaccine. Then Laura Brennan got involved.
Dec. 11 By David Robert Grimes

Health
A Research Nonprofit Shutters TB Vaccine Effort and Lays Off Scientists
A financially troubled Seattle research institute cut back programs, leaving researchers to find new homes for work on infectious diseases like tuberculosis and leprosy.
Dec. 13 By Katie Thomas

U.S.
Doctors End Protest to Demand Flu Vaccines for Migrants
A group of doctors on Wednesday ended a three-day protest against the U.S. government’s refusal to allow the flu vaccine be administered to migrants, following the arrests of six demonstrators outside a Border Patrol regional headquarters in San Diego.
Dec. 11 By The Associated Press

U.S.
Arkansas Judge Denies Students’ Appeal to Vaccination Policy
A judge has denied two University of Arkansas students’ request to block a public health decree that has barred them from attending classes during a mumps outbreak because they don’t have the proper vaccinations.
Dec. 11 By The Associated Press

Asia Pacific
Malaysia Vaccinating for Polio After First Case in 27 Years
Malaysia began a vaccination campaign in a rural town on Borneo island after a 3-month-old boy was confirmed to have polio in the country’s first case of the highly infectious virus in 27 years.
Dec. 8 By The Associated Press

Washington Post
https://www.washingtonpost.com/
Accessed 14 Dec 2019
Doctors protested Border Patrol to offer flu vaccines to detained migrants. They left in handcuffs
Katie Shepherd · Morning Mix · Dec 12, 2019

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 14 Dec 2019
[No new relevant content]

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 14 Dec 2019
Mind the Gaps: Takeaways from Emerging Research and Policy Implications for Aid Transition in Health and Development
Publication 12/10/19
As countries grow economically, governments face rapidly growing demands for quality, affordable, accessible, and equitable healthcare and other social services. At the same time, many middle-income countries face the prospect of transitioning away from donor aid, adding pressure to already-constrained public budgets to fill gaps as donor support ramps down.

CSIS
https://www.csis.org/
Accessed 14 Dec 2019
[No new relevant content]

Council on Foreign Relations
http://www.cfr.org/
Accessed 14 Dec 2019
[No new relevant content]

Kaiser Family Foundation
https://www.kff.org/search/?post_type=pre ss-release
[No new relevant content]

Milestones :: Perspectives :: Research

Typhoid – Pakistan

More than 9.4 million children vaccinated against typhoid fever in Sindh
4 December 2019 – A historical milestone has been successfully achieved in Pakistan with the vaccination in Sindh Province of more than 9.4 million children aged from 9 months to 15 years against typhoid fever, with a coverage rate of 95%. Pakistan is the first country in the world to introduce the World Health Organization (WHO)-recommended typhoid conjugate vaccine (TCV) into its routine immunization programme. This measure will contribute to the control of the extensively drug-resistant (XDR) typhoid fever outbreak in the province, where more than 11,000 cases have been reported since November 2016.

More than 8,000 skilled vaccinators and health workers, along with 20,000 social mobilisers and more than 2000 supervisors and monitors, including international monitors, participated in the campaign from 18 to 30 November 2019.

The dedication of frontline workers and strong commitment from the Federal and Sindh governments underpinned the success of the campaign and the introduction of TCV into the routine immunization schedule. There was effective coordination between different ministries and departments, in particular with the education department to ensure the vaccination of students at more than 18,000 government and private schools and madrasas. The Pakistan Pediatric Association and universities also played a crucial role in mobilizing the community to vaccinate their children…

Milestones :: Perspectives :: Research

Measles

More than 140,000 die from measles as cases surge worldwide
Infants and young children most at risk of fatal complications, health agencies warn
5 December 2019
Joint News Release
Worldwide more than 140,000 people died from measles in 2018, according to new estimates from the World Health Organization (WHO) and the United States Centers for Diseases Control and Prevention (CDC). These deaths occurred as measles cases surged globally, amidst devastating outbreaks in all regions.

Most deaths were among children under 5 years of age. Babies and very young children are at greatest risk from measles infections, with potential complications including pneumonia and encephalitis (a swelling of the brain), as well as lifelong disability – permanent brain damage, blindness or hearing loss.

Recently published evidence shows that contracting the measles virus can have further long-term health impacts, with the virus damaging the immune system’s memory for months or even years following infection. This ‘immune amnesia’ leaves survivors vulnerable to other potentially deadly diseases, like influenza or severe diarrhoea, by harming the body’s immune defenses.
“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr Tedros Adhanom Ghebreysus, Director-General of the World Health Organization. “To save lives, we must ensure everyone can benefit from vaccines – which means investing in immunization and quality health care as a right for all.”

Measles is preventable through vaccination. However, vaccination rates globally have stagnated for almost a decade. WHO and UNICEF estimate that 86% of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70% received the second recommended dose.
Worldwide, coverage with measles vaccine is not adequate to prevent outbreaks. WHO recommends that 95% vaccination coverage with two doses of measles vaccine is needed in each country and all communities to protect populations from the disease…

[in last week’s edition]
Measles – Global situation
Disease outbreak news = WHO
27 November 2019

::::::

Measles vaccination drive launched, North Kivu targets 2.2 million children
Kinshasa, 5 December 2019 – Around 2.2 million children are to be vaccinated against measles in North Kivu, the Democratic Republic of the Congo (DRC), where efforts are underway to curb the world’s second-worst Ebola outbreak amid persistent insecurity.

The DRC is also currently experiencing the world’s largest and most severe measles epidemic, affecting all its 26 provinces. Since the start of 2019, more than 250 000 suspected cases and over 5000 deaths mostly among children under 5 years, have been recorded.

This drive closes the second phase of a preventive vaccination campaign and will be followed by a third and final phase planned in 10 remaining provinces: Bas Uélé, Equateur, Haut Katanga, Haut Lomami, Haut Uélé, Kasai Oriental, Lualaba, Maniema, Mongala and Tshuapa.

This mass follow-up campaign will ultimately reach 18.9 million children across the country by the end of the year, particularly targeting those who may have been missed by routine immunization.

“While the Ebola outbreak in the DRC has won the world’s attention and progress is being made in saving lives, we must not forget the other urgent health needs the country faces,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This new vaccination campaign aims to protect children in North Kivu, as well as other parts of the country from a disease that is easily preventable with a vaccine.”…

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Opinion

Wall Street Journal
Review & Outlook
The Backward March of Civilization
A measles outbreak in Samoa kills 60 due to lack of vaccinations.
By The Editorial Board
Dec. 6, 2019
Our age likes to believe in the inevitability of human progress, but for an example of the opposite consider the Pacific island nation of Samoa. A measles outbreak there has already killed more than 60 people, and authorities declared a two-day curfew on Thursday and Friday.

Businesses were obliged to close and vehicles had to stay off the roads from 7 a.m. to 5 p.m. Mike Cherney of The Journal reports that residents were told to fly red banners from their homes if anyone inside needed vaccinations in the country of roughly 200,000 people. Officials were going door-to-door to vaccinate people. Most of the dead were children under 4 years old, and more than 4,300 have been hit with the disease.

The outbreak is especially tragic because measles can be contained with vaccinations. But misinformation from vaccine opponents has spread around the world in recent years, including in supposedly civilized America.

An outbreak hit New York last year among Orthodox Jewish neighborhoods where parents often block vaccinations. New York State banned nonmedical exemptions for school vaccinations as a result. Some 1,200 measles cases have been recorded across the U.S. so far this year, the most since 1992.

Countries like Samoa are more vulnerable because they have less developed health systems and sometimes less efficient governments. Only 31% of Samoans were vaccinated against measles as of 2018.

The outbreak—and death toll—ought to chasten celebrities and others in the U.S. who have spread fears about vaccines, which are remarkably safe and prevent more deaths by far than they cause. It’s also a reminder that the march of civilization isn’t always for the better. Especially in the age of social media and lack of social trust, bad information can drive out good. Avoidable deaths like those in Samoa can be the tragic result.

Milestones :: Perspectives :: Research

Lancet Infectious Diseases
Dec 2019 Volume 19 Number 12 p1265-1380, e404-e451
http://www.thelancet.com/journals/laninf/issue/current
Editorial
Infectious disease crisis in the Philippines
The Lancet Infectious Diseases
The Philippines was among the first countries in the world to introduce the Haemophilus influenzae type b vaccine, and one of the earliest countries in the Western Pacific region to introduce the rotavirus vaccine and the pneumococcal conjugate vaccine. The country achieved the Millennium Development Goal of reducing child mortality by two-thirds in 25 years thanks to Government-declared immunisation months during which millions of children were vaccinated annually. However, vaccine-preventable diseases are again rampant in the Philippines, potentially reversing the positive results of decades of successful immunisation campaigns.

This year the country has reported outbreaks of dengue, diphtheria, measles, and polio. In August, the Department of Health declared a national dengue epidemic. As of Nov 5, 371 717 dengue cases, including 1407 deaths, have been reported in 2019, which is 106% cases more than in 2018. Children aged 5–9 years have been the most affected age group for dengue incidence (23%) and deaths (38%). For diphtheria, the Department of Health has reported 197 cases with 47 deaths through Oct 5, an increase in cases of 47% compared with the same period in 2018. In 2019, health officials have also reported more than 42 200 measles cases up to early October. In addition, measles complications were responsible for 560 deaths. More than eight out of ten people affected by the measles outbreak were children aged 4 years and younger. For polio, four cases caused by infection with vaccine-derived poliovirus have been reported in the country, which had been polio-free for 19 years; these polio cases were due to low population immunity. The Department of Health has now launched campaigns to bolster polio immunisation, planning to inoculate large numbers of children younger than 5 years in several parts of the country.

These outbreaks of vaccine-preventable diseases in the Philippines indicate that vaccination rates are currently insufficient to provide protection. Whereas a reduction in immunisation has been observed in many countries around the world, mistrust in vaccines in the Philippines has been heavily fuelled by the discussion around the use of Dengvaxia, the only dengue vaccine available on the market, and its subsequent ban. Dengue, a viral disease trasmitted by Aedes spp mosquitoes, is endemic in the Philippines. Poverty, geographical remoteness, rapid urbanisation, malnutrition, and poor hygiene and sanitation are all contributing factors in the spread of dengue (and how to address these factors will be a topic in an upcoming Lancet Commission on Aedes-borne viral diseases), and a dengue vaccine is considered an essential tool to control the spread of the disease.

In April, 2016, the Philippines was the first country, alongside Brazil, to introduce a national immunisation campaign for dengue using Dengvaxia. However, as reported in our Editorial in February, 2018, in late 2017, health authorities in the Philippines decided to stop the immunisation campaign after 14 children died out of more than 800 000 inoculated with Dengvaxia in 2016–17. Although no death was directly linked to the vaccine, concerns were further raised by a study funded by Sanofi Pasteur, the producer of the vaccine, that indicated that dengue-seronegative children vaccinated with Dengvaxia had higher chances of subsequent hospitalisation for dengue than seropositive children. This outcome depends on the fact that dengue virus occurs in four serotypes, and immunity against any one serotype does not generate lasting immunity against the other three serotypes. What happens instead is that a new infection with a different serotype might lead to more severe disease manifestations. In individuals not previously exposed to dengue virus, the vaccine simulates a primary infection. On the basis of the new Sanofi data, WHO then recommended the use of Dengvaxia only in children older than 9 years in endemic areas where seropositivity is expected to be high. However, the suspension of Dengvaxia vaccination in the Philippines ultimately resulted in a drop of confidence for parents and caregivers in the safety of immunisation in general.

Although new vaccine candidates are currently under study for dengue, the main issue for the Philippines now is to rebuild the trust of the population in the safety of vaccines for diphtheria, measles, and polio. The current crisis faced by the Philippines should be a warning for other countries where immunisation rates are dropping to invest in public health and information campaigns to promote the use of vaccines. It is unacceptable that a child can die of a disease that is preventable by a readily available vaccine.

Milestones :: Perspectives :: Research

Malaria

World malaria report 2019
WHO Report
4 December 2019 :: 232 pages ISBN: 978-92-4-156572-1
PDF: https://apps.who.int/iris/rest/bitstreams/1262394/retrieve
Overview
The World malaria report 2019 provides a comprehensive update on global and regional malaria data and trends. The report tracks investments in malaria programmes and research as well as progress across all intervention areas: prevention, diagnosis, treatment, elimination and surveillance. It also includes dedicated chapters on the consequences of malaria on maternal, infant and child health, the “High Burden to High Impact” approach as well as biological threats to the fight against malaria.
The 2019 report is based on information received from more than 80 countries and areas with ongoing malaria transmission. This information is supplemented by data from national household surveys and databases held by other organizations.

More pregnant women and children protected from malaria, but accelerated efforts and funding needed to reinvigorate global response, WHO report shows
4 December 2019
News release Geneva, Switzerland
The number of pregnant women and children in sub-Saharan Africa sleeping under insecticide-treated bed nets and benefiting from preventive medicine for malaria has increased significantly in recent years, according to the World Health Organization’s World malaria report 2019.

However, accelerated efforts are needed to reduce infections and deaths in the hardest-hit countries, as progress stalls. Last year, malaria afflicted 228 million people and killed an estimated 405 000, mostly in sub-Saharan Africa.

Pregnancy reduces a woman’s immunity to malaria, making her more susceptible to infection and at greater risk of illness, severe anaemia and death. Maternal malaria also interferes with the growth of the fetus, increasing the risk of premature delivery and low birth weight – a leading cause of child mortality.

“Pregnant women and children are the most vulnerable to malaria, and we cannot make progress without focusing on these two groups,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We’re seeing encouraging signs, but the burden of suffering and death caused by malaria is unacceptable, because it is largely preventable. The lack of improvement in the number of cases and deaths from malaria is deeply troubling.”

In 2018, an estimated 11 million pregnant women were infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa.  As a result, nearly 900 000 children were born with a low birthweight.

Despite the encouraging signs seen in the use of preventive tools in pregnant women and children, there was no improvement in the global rate of malaria infections in the period 2014 to 2018.

Inadequate funding remains a major barrier to future progress. In 2018, total funding for malaria control and elimination reached an estimated US$ 2.7 billion, falling far short of the US$ 5 billion funding target of the global strategy…

Milestones :: Perspectives :: Research

Governance

Reform of the International Coordinating Group for Vaccine Provision: a new framework for coordination, accountability and transparency
Weekly Epidemiological Record, 6 December 2019, vol. 94, 49 (pp. 581–600)
Introduction
The International Coordinating Group (ICG) for Vaccine Provision is a mechanism for allocation of vaccines from global stockpiles to respond to emergency requests in major infectious disease outbreaks and humanitarian emergencies.1, 2 There are currently 3 functionally separate ICG decision-making groups, for meningitis, yellow fever (YF) and cholera vaccine allocation, which comprise representatives from its 4 founding partners, the International Federation of Red Cross and Red Cres-cent Societies, Médecins Sans Frontières, the United Nations Children’s Fund (UNICEF) and WHO. The ICG’s guiding principles are to ensure equitable and timely access to essential vaccines while maintaining independent decision-making.1 It has evolved in the face of an ever-changing policy environment and new challenges in infectious disease control.
This paper outlines the timeline of the changes to the ICG mechanism to date, which gives the context for a discussion of current reforms, including changes to its governance structure and measures to ensure account-ability to stakeholders. The implications of these changes for future development of the ICG are then discussed…

…Discussion
The new oversight mechanism preserves the ICG’s flexibility and decision-making independence, while facilitating a new level of coordination between the ICG, its partners and wider disease control initiatives, including the newly established “Defeating Meningitis by 2030” strategy.31, 32 The Accountability Framework, in conjunction with the GOC oversight mechanism, has the potential to enhance stakeholder trust, drive improvements in the effectiveness of the ICG process and respond to new challenges.

In addition to market-shaping and coordination among partners, another area for improvement is the timeliness of vaccine delivery to affected countries. The requirement for licensing and customs authorization for vaccine shipments by national authorities remains a major cause of delays in vaccine deployment. While ICG decision-making groups have a strong record of meeting their time performance targets for circulating requests and reaching decisions on approval or rejection,33 vaccines arrived in affected countries within 7 days for only 18% of approved requests during 2016–2018. Inability to achieve this target is considered to be outside the control of ICG decision-making groups,22, 31 as recognized in the Accountability Framework, which defines the areas of responsibility in vaccine delivery for UNICEF SD, manufacturers and national governments.

Following efforts to fast-track vaccine development in the wake of the 2014–2015 Ebola virus epidemic in West Africa and the recent outbreak in DRC,34 several promising vaccine candidates have been identified.35 The first commercially available Ebola virus vaccine has been licensed and prequalified in November 2019.36 Given the probable need for a coordinated mechanism to ensure effective, equitable allocation of limited vaccine in the event of another large-scale outbreak, proposals for establishment of an ICG-like stockpile mechanism for Ebola virus disease are under discussion. The mechanism would have to be adapted to Ebola virus disease response,18, 36 with a holistic approach including potential prophylactic vaccine use alongside emergency response.

The ICG has pursued its mandate for over 20 years, responded in time to crises, controlled outbreaks, ensured equitable access to vaccines and essential medicines and protected millions of lives.31 Between 2006 and 2018, the ICG decision-making groups handled 291 emergency vaccine requests and approved the release of over 125 million doses of stockpiled meningitis, YF and cholera vaccines.13, 22 In 2018 alone, the 3 ICG groups received 25 requests, of which 21 were approved for over 16.5 million vaccine doses. Its role has been extended to cover new infectious diseases with epidemic potential and its mechanism refined as it has adapted to the persistent challenges inherent in managing vaccine stockpiles, their global allocation and the changing needs and demands of a range of partners and stake-holders. The reform of the ICG not only gives new focus to its work and reaffirms its continuing role in the global response to pandemic-prone diseases but also lays the foundation for further expansion and improvements towards achieving its core objectives.

Featured Journal Content

Bulletin of the World Health Organization
Volume 97, Number 12, December 2019, 789-856
https://www.who.int/bulletin/volumes/97/12/en/
PERSPECTIVES
Ensuring access to affordable, timely vaccines in emergencies
— Kate Elder, Barbara Saitta, Tanja Ducomble, Miriam Alia, Ryan Close, Suzanne Scheele, Elise Erickson, Rosalind Scourse, Patricia Kahn & Greg Elder
http://dx.doi.org/10.2471/BLT.18.228585
Vaccination is an effective intervention to reduce disease, disability, death and health inequities worldwide. Over the last two decades, vaccines have become more accessible in low-income countries; however, significant gaps remain, particularly in humanitarian emergencies, where populations face increased risks of many diseases. In 2013, the World Health Organization (WHO) published Vaccination in acute humanitarian emergencies: a framework for decision-making, to provide guidance on which vaccines to prioritize during emergencies.¹ However, substantial obstacles, especially high prices for new vaccines, hinder implementation of this framework and of critical vaccination activities in emergency settings.
In response to these challenges, global health stakeholders held a series of consultations in 2016 and proposed a WHO-based mechanism, the Humanitarian Mechanism, for the rapid procurement of affordable vaccines during emergencies, to be used by nongovernmental organizations (NGOs), civil society organizations, United Nations (UN) agencies and governments.
Here we present the background of the creation of the mechanism from the perspective of Médecins Sans Frontières (MSF), including a description of our past challenges in accessing affordable pneumococcal conjugate vaccine (PCV; Box 1), a critical vaccine during many emergencies. We then describe how the mechanism has so far facilitated access to more affordable PCV and outline steps that could increase its potential for saving lives…
…The Humanitarian Mechanism
In May 2017, the Humanitarian Mechanism was jointly launched by WHO, the United Nations Children’s Fund (UNICEF), Save the Children and MSF.⁸ The mechanism aims to address the high prices of new vaccines and to facilitate rapid access to vaccines for children in emergencies who missed doses or who live in countries where a given vaccine is not yet in the national immunization calendar, but where there is a high risk of exposure. Under the mechanism’s terms of reference, manufacturers commit to supplying a particular vaccine (currently only PCV10 and PCV13) at a set price. UNICEF, through its supply division, and other organizations with their own supply chain capacity, negotiate contracts bilaterally with manufacturers, specifying ordering and delivery terms as well as protocols. When an emergency need for a vaccine is identified, the implementing organization makes a request to WHO, specifying the context, number of doses needed and other relevant details; within two days WHO verifies the emergency context and appropriateness of the request. Upon verification, the order can be placed and the vaccine supplied.⁸ WHO manages the administrative aspects of the mechanism; once contracts between the implementing organization and manufacturer are in place, the administrative aspects, and the verification process require minimal overhead cost…

Next steps
Building on these initial successes, we see three critical elements of the mechanism, which if fully implemented, could greatly enhance its impact. First, the mechanism needs to be better known among global health actors, including UN agencies and NGOs, who should be encouraged to use it under appropriate circumstances. Second, while the mechanism’s terms of reference includes use by governments responding to emergencies,⁸ conditions attached to the PCV pledges discussed here (the only pledges to the mechanism so far) exclude governmental use. Manufacturers should allow governments to access the mechanism during emergencies to procure critical vaccines needed to protect their populations. Many middle-income countries already grapple with high vaccine prices for routine immunization programmes and may find the cost of extending vaccination to influxes of displaced people during emergencies prohibitive. While Gavi adopted a fragility, emergencies and refugees policy in June 2017 to allow more flexible use of Gavi-supported vaccine doses in specific contexts, strict criteria exist for how and where this flexibility can be applied, and it can only cover Gavi-eligible countries.¹²
Finally, the types of vaccines pledged to the mechanism by manufacturers should be expanded: the only commitments to date are for pneumococcal conjugate vaccines. Current and future manufacturers should commit other vaccines with affordability and accessibility challenges to the mechanism, so they can be procured rapidly at the lowest global price

Conclusion
The mechanism is a significant step forward in delivering life-saving vaccines to populations caught in emergencies and conflict. The mechanism’s mandate is strengthened by multiple organizations recognizing the gap between existing technical guidelines and constraints on their implementation, that is, the lack of rapidly available, affordable vaccines. While the mechanism does not address the broader systemic failures of the vaccine market, it was created to specifically address the failure of the global vaccine market to meet relatively small, urgent vaccine procurement needs efficiently and affordably. Further steps are needed for the mechanism to reach its full potential; however, it already provides a critical platform during humanitarian crises for expanding the number of people who can receive life-saving vaccines.

Emergencies

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

Ebola Outbreak in DRC 70: 03 December 2019
Situation Update
In the week of 25 November to 1 December 2019, 10 new confirmed EVD cases were reported from two health zones in two affected provinces in the Democratic Republic of the Congo. The confirmed cases in this week came from Mabalako (50%, n=5) and Mandima (50%, n=5) Health Zones.
In the past week, violence, widespread civil unrest, and targeted attacks have severely disrupted the Ebola response and restricted access to affected communities in multiple locations.
On the night of 27 November 2019, an attack on the Ebola response camp in Biakato Mines resulted in the death of three responders and the injury of seven others. Response personnel in Biakato were relocated to Goma, and the majority of response activities in the area have been suspended. On the same night, a separate attack on the Ebola coordination office in Mangina resulted in one death. Most response personnel in Mangina have also been relocated. As of 2 December 2019, North Kivu Province has declared ‘ville morte’ and many response activities have been suspended across the province.
As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they may result in increased transmission…

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WHO Director-General praises bravery of health workers during visit to eastern Democratic Republic of Congo following fatal attacks on Ebola responders
1 December 2019 News release

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Democratic Republic of Congo
As security situation deteriorates, MSF withdraws staff from Biakato
Statement 6 Dec 2019
On 4 December 2019, Medecins Sans Frontières (MSF) took the painful decision to temporarily withdraw our staff from the Biakato region of Ituri province, Democratic Republic of Congo. After months of working extremely closely with the community to address the health needs in the region, MSF is saddened to have made this decision….

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Gavi Board approves new Ebola vaccine programme
New Delhi, 5 December 2019 – A global emergency stockpile of Ebola vaccines will be available to countries for outbreak response and prevention following the approval of a new Ebola vaccine programme by the Board of Gavi, the Vaccine Alliance, which met this week in New Delhi, India.

Gavi will open a new funding window, with estimated investment of US$ 178 million between now and 2025 for the new Ebola vaccine programme. Gavi-supported low- and middle-income countries will be able to access the stockpile free of charge and will receive support for the operational costs of vaccination campaigns. Wealthier countries will be able to access vaccines but will be expected to self-finance.

As well as creating the emergency stockpile, Gavi will also support targeted preventative vaccination outside of an outbreak in high-risk populations, such as health workers, in countries at risk. The target populations and scope of countries will be based on future recommendations by the WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE).

“Today, I think about Ebola victim Dr Ameyo Adadevoh, a true vaccine hero who died stopping the Ebola virus from spreading in Nigeria and we should all be excited by the Alliance decision,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “This is a historic milestone in humanity’s fight against this horrific disease. Just five years ago we faced an Ebola outbreak in West Africa with no vaccine and no way to treat the disease. Today, thanks to the heroic efforts of countless patients, health workers, scientists, manufacturers, donors, partners as well as the leadership of African countries, we now have one vaccine approved for use and more on their way, as well as rapid diagnostics and several promising treatments. With these tools at our disposal, the battle against Ebola can be won, and I’m proud of the role Gavi has played in this.”
The W
HO’s SAGE Working Group on Ebola Vaccines and Vaccination has provided guidance that the global emergency stockpile should be maintained at 500,000 licensed doses of vaccines. The price of Ebola vaccines funded by Gavi will be defined as part of a tender process managed by UNICEF, as Gavi’s partner and procurement agency.

There are currently eight candidate Zaire Ebolavirus vaccines at different phases of development. This includes Merck’s vaccine currently being used under compassionate use as part of the response to the ongoing DRC outbreak, which has recently received conditional marketing approval from the European Commission and prequalification from the WHO. More than 250,000 people have received it since the outbreak started in August last year. Moreover, close to a thousand people have received a second candidate vaccine manufactured by Johnson & Johnson as part of a study in North Kivu, DRC.

“The Ebola vaccine has shown extraordinary efficacy in tackling the outbreak in the DRC,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This achievement demonstrates the Alliance at its best. Now that funding has been approved, we will get to work with manufacturers and our Alliance partners to build the stockpile. It will be critical for Gavi to secure enough funding for the 2021-2025 period to maintain this Ebola vaccine programme in order to protect people, health systems and economies that may be threatened by this devastating disease in the future.”

A coordinating mechanism to decide how and when the vaccine stockpile will be deployed will be established with partner organisations.

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 04 December 2019
:: To provide an insight on the status of polio eradication efforts as at September 2019, the WHO Director-General’s report on polio eradication to the upcoming Executive Board (EB) meeting has been published here. Available in six languages, the report summarizes the programmatic, epidemiological and financial challenges to securing a lasting polio-free world.

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan — one WPV1 case and one WPV1 positive environmental sample;
:: Pakistan — 25 WPV1 positive environmental samples;
:: Angola — 16 cVDPV2 cases and four cVDPV2 positive environmental samples.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 7 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 70: 03 December 2019

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

::::::

WHO Grade 2 Emergencies [to 7 Dec 2019]

Angola
:: WHO supports Angola’s Government efforts to end polio outbreak 02 December 2019

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

::::::

WHO Grade 1 Emergencies [to 7 Dec 2019]

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

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

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

::::::

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: 06 December 2019 Southern Africa: Humanitarian Key Messages, December 2019

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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

WHO & Regional Offices [to 7 Dec 2019]
28 November 2019
News release
4 December 2019
News release
More pregnant women and children protected from malaria, but accelerated efforts and funding needed to reinvigorate global response, WHO report shows

3 December 2019
News release
Pollution Pods at COP25 show climate change and air pollution are two sides of the same coin

3 December 2019
News release
Climate risks to health are growing but prioritized funding lacking to safeguard human health from climate change

1 December 2019
News release
WHO Director-General praises bravery of health workers during visit to eastern Democratic Republic of Congo following fatal attacks on Ebola responders

::::::

Weekly Epidemiological Record, 6 December 2019, vol. 94, 49 (pp. 581–600)
:: Progress towards regional measles elimination – worldwide, 2000–2018

:: Reform of the International Coordinating Group for Vaccine Provision: a new framework for coordination, accountability and transparency
Introduction
The International Coordinating Group (ICG) for Vaccine Provision is a mechanism for allocation of vaccines from global stockpiles to respond to emergency requests in major infectious disease outbreaks and humanitarian emergencies.1, 2 There are currently 3 functionally sepa-rate ICG decision-making groups, for meningitis, yellow fever (YF) and cholera vaccine allocation, which comprise representatives from its 4 founding partners, the International Federation of Red Cross and Red Cres-cent Societies, Médecins Sans Frontières, the United Nations Children’s Fund (UNICEF) and WHO. The ICG’s guiding principles are to ensure equitable and timely access to essential vaccines while maintaining indepen-dent decision-making.1 It has evolved in the face of an ever-changing policy environment and new challenges in infectious disease control.
This paper outlines the timeline of the changes to the ICG mechanism to date, which gives the context for a discussion of current reforms, including changes to its governance structure and measures to ensure account-ability to stakeholders. The implications of these changes for future development of the ICG are then discussed.

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO unveils plan to tackle rising HIV drug resistance in Africa 06 December 2019
:: Measles vaccination drive launched, North Kivu targets 2.2 million children 05 December 2019
:: Seventeen African Countries Conducting Exercise to Test Readiness of Public Health E…
04 December 2019

WHO Region of the Americas PAHO
:: Climate risks to health are growing but prioritized funding lacking to safeguard human health from climate change (12/05/2019)

WHO South-East Asia Region SEARO
:: 4 December 2019 News release
Malaria on the decline in WHO South-East Asia Region; efforts must continue as risks persist: WHO

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: More than 9.4 million children vaccinated against typhoid fever in Sindh 4 December 2019
:: WHO supports Sudan to enhance cholera diagnosis at its laboratories 2 December 2019

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 7 Dec 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Tuesday, December 3, 2019
Transcript of CDC Telebriefing – Vital Signs HIV

Tuesday, December 3, 2019
HIV Testing, Treatment, Prevention Not Reaching Enough Americans

MMWR News Synopsis for Friday, December 6, 2019
Progress Toward Regional Measles Elimination — Worldwide, 2000–2018
Despite global improvements during 2000-2018, including a 66% decrease in reported measles incidence and an estimated 23.2 million lives saved because of measles vaccination, reported measles incidence has increased in five of the six World Health Organization (WHO) regions since 2016, and estimated global measles mortality has increased since 2017. During 2000–2018, increased coverage with measles vaccines, supplemental immunization activities, and other elimination efforts contributed to a 66% decrease in reported measles incidence, a 73% reduction in estimated measles mortality, and a reduction in the number of circulating wild measles genotypes worldwide. Measles vaccination prevented an estimated 23.2 million deaths during this period. Despite this progress, global measles control milestones have not been achieved, reported measles incidence has increased in five of the six World Health Organization regions since 2016, and estimated global measles deaths have increased since 2017. Large measles outbreaks in countries with weak immunization systems accounted for most reported measles cases. Outbreaks should serve as opportunities to investigate underlying causes for under-vaccination and to design and implement specific routine immunization strengthening activities to prevent future outbreaks.

Progress Toward Measles Elimination — China, January 2013–June 2019
China made considerable progress towards measles elimination during January 2013-June 2019. Measles cases, incidence, and outbreaks were all at historic low levels in 2017 and 2018, and they have continued to decrease through June 2019. China’s measles incidence per million population decreased from 20.4 in 2013 to 2.8 in 2018. Measles cases, incidence, and outbreaks were all at historic low levels in 2017 and 2018. Reported measles-related deaths decreased from 32 in 2015 to one in 2018, and to zero through June, 2019. Measles elimination in China can be achieved through strengthening the immunization program’s existing strategies: Ensuring sufficient vaccine supply, continuing to improve laboratory-supported surveillance and outbreak investigation and response, strengthening school entry vaccination checks, and vaccinating students without documentation of two doses of measles-rubella vaccine.

Africa CDC [to 7 Dec 2019]
http://www.africacdc.org/
News
No new digest content identified.

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

National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/
No new digest content identified.

Announcements
December 5, 2019 –
FDA launches app for health care professionals to report novel uses of existing medicines for patients with difficult-to-treat infectious diseases
The U.S. Food and Drug Administration today announced the global launch of CURE ID, an internet-based repository that will allow the clinical community to report their experiences treating difficult-to-treat infectious diseases with novel uses of existing FDA-approved drugs through a website, a smartphone or other mobile device. The platform enables the crowdsourcing of medical information from health care providers to guide potentially life-saving interventions and facilitate the development of new drugs for neglected diseases. The repository is a collaboration between the FDA and the National Center for Advancing Translational Sciences (NCATS), which is part of the National Institutes of Health (NIH)…

Fondation Merieux [to 7 Dec 2019]
http://www.fondation-merieux.org/
News, Events
20 – 22 Jan 2020
Mérieux Foundation co-organized event
Dengue pre-vaccination screening strategies workshop
Les Pensières Center for Global Health, Veyrier-du-Lac (France)

Gavi [to 7 Dec 2019]
https://www.gavi.org/
5 December 2019
Gavi Board approves new Ebola vaccine programme
[See Ebola above for detail]

5 December 2019
Gavi Board appoints Sarah Goulding as Vice Chair
New Delhi, 5 December 2019 – Sarah Goulding, Assistant Secretary, Education, Social Protection and Human Development Finance at the Australian Department of Foreign Affairs and Trade (DFAT), was appointed by the Gavi Board as its new Vice Chair effective as of 1st January 2020.
“It is an honour to be appointed Vice Chair of the Gavi Board, at a time when Gavi is embarking on its new strategy for 2021-2025”, said Sarah Goulding. “I look forward to supporting the Board Chair at this critical time for the Vaccine Alliance, focusing on leaving no one without immunisation. Gavi’s mission to protect millions against life-threatening diseases is critically important for the most vulnerable children in the world’s poorest countries. This year, outbreaks of vaccine-preventable diseases including measles in places as diverse as DRC, Pakistan and Samoa shows the ongoing importance of vaccination globally.”
Sarah Goulding is currently the Gavi Board member for the United States, Australia, Japan and Republic of Korea constituency…

GHIT Fund [to 7 Dec 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that No new digest content identified.

Global Fund [to 7 Dec 2019]
https://www.theglobalfund.org/en/news/
News & Stories
Sourcing & Management of Health Products
Withdrawal of the Quality Assurance Information Notice 2018-02 Regarding Dolutegravir
06 December 2019

Updates
42nd Board Meeting Documents
05 December 2019

Updates
Data Service: Performance Framework Data
03 December 2019
Performance framework data from Global Fund grants are now available for download from the Global Fund Data Service.
The new data set lists indicator targets and results for grant implementation periods from the 2017-2019 allocation period and going forward. A number of grants from the previous allocation period are also included…

Hilleman Laboratories [to 7 Dec 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 7 Dec 2019]
http://www.humanvaccinesproject.org/media/press-releases/
Press Releases
No new digest content identified.

IAVI [to 7 Dec 2019]
https://www.iavi.org/newsroom
No new digest content identified.

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

International Generic and Biosimilar Medicines Association [IGBA]
https://www.igbamedicines.org/
05 December 2019
IGBA applauds long-awaited scientific harmonization process of bioequivalence studies
The International Generic and Biosimilar Medicines Association (IGBA) welcomes the adoption by the International Council for Harmonization (ICH) of a new topic proposal on Bioequivalence for ImmediateRelease Solid Oral Dosage Forms (M13)i . The ICH Assembly approved the Concept Paper Outline in their November Singapore meeting with the establishment without delay of a new Working Group to initiate work on finalizing the concept paper and business plan for this new topic…bioequivalence studies establish the efficacy and safety of most generic medicines and are an essential part of their development. Scientific harmonization of the study design of bioequivalence studies will allow the streamlining of some important aspects of the conduct of these trials and optimize product development…

IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.

IFRC [to 7 Dec 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
No new digest content identified.

IVAC [to 7 Dec 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
No new digest content identified.

IVI [to 7 Dec 2019]
http://www.ivi.int/
Selected IVI News & Announcements
No new digest content identified.

JEE Alliance [to 7 Dec 2019]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 7 Dec 2019]
http://www.msf.org/
Latest [Selected Announcements]
Democratic Republic of Congo
As security situation deteriorates, MSF withdraws staff from Biakato
Statement 6 Dec 2019
On 4 December 2019, Medecins Sans Frontières (MSF) took the painful decision to temporarily withdraw our staff from the Biakato region of Ituri province, Democratic Republic of Congo. After months of working extremely closely with the community to address the health needs in the region, MSF is saddened to have made this decision….

DRC Ebola outbreaks
Crisis update – December 2019
Crisis Update 6 Dec 2019

Access to medicines
Pharma giants shouldn’t receive multi-million dollar pneumonia vaccine subsidy
Press Release 3 Dec 2019
:: MSF is urging Gavi to stop paying pharma giants Pfizer and GSK subsidies for their pneumonia vaccines.
:: The vaccines protect against pneumonia, which kills nearly 1 million children each year.
:: The pharma giants earn billions off their vaccines and have been receiving subsidies as an ‘incentive’ to introduce them in developing countries.
:: The vaccines nevertheless remain too expensive for many countries to introduce, thanks to high prices – leaving young lives unprotected against the disease.
:: MSF urges Gavi to instead support the introduction of a more affordable pneumonia vaccine, coming to market soon.

Malawi
New model of care aims to reduce deaths among advanced HIV patients
Project Update 1 Dec 2019

HIV/AIDS
AIDS death toll stagnating due to lack of testing at community l…
Press Release 1 Dec 2019

National Vaccine Program Office – U.S. HHS [to 7 Dec 2019]
https://www.hhs.gov/vaccines/about/index.html
NVAC 2020 Meetings
February 13-14, 2020 NVAC Meeting
June 9-10, 2020 NVAC Meeting
September 23-24, 2020 Meeting (Virtual)

NIH [to 7 Dec 2019]
http://www.nih.gov/news-events/news-releases
Selected News Releases
No new digest content identified.

PATH [to 7 Dec 2019]
https://www.path.org/media-center/
Selected Announcements
PATH statement on the World Health Organization’s World Malaria Report, 2019
Focusing care on pregnant women and children will help accelerate progress toward malaria elimination; A statement from PATH’s Director of Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, Kammerle Schneider
December 4, 2019

PATH names Mr. Nikolaj Gilbert as President and CEO
The team of innovators, headquartered in Seattle, welcomes global development expert to lead ambitious efforts to improve health outcomes for more than 1.4 billion people by 2030
December 4, 2019

Sabin Vaccine Institute [to 7 Dec 2019]
http://www.sabin.org/updates/pressreleases
Statements and Press Releases
No new digest content identified.

UNAIDS [to 7 Dec 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
5 December 2019
Desert AIDS Project delegation visits health-care centre on the sidelines of ICASA

Communities hailed during South Africa’s World AIDS Day commemoration

Commemorating World AIDS Day in Belgium

4 December 2019
Ending stigma and discrimination is critical to expanding HIV services in Jamaica

3 December 2019
Remembering the leadership of Charlot Jeudy

UNAIDS staff member breaks gruelling world record

ICASA conference opens in Rwanda with an emphasis on African leadership

2 December 2019
Ending AIDS is everyone’s business

HIV treatment numbers continue to rise

UN Cares: putting people first in Jamaica’s HIV response

1 December 2019
World AIDS Day 2019: Speech by UNAIDS Executive Director Winnie Byanyima

UNICEF [to 7 Dec 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Press release
Measles outbreaks continue unabated : Five countries accounted for nearly half of all measles cases in 2018
Children in Samoa are latest victims of 2019 outbreaks
05/12/2019

Press release
More than 140,000 die from measles as cases surge worldwide
Infants and young children most at risk of fatal complications, health agencies warn
05/12/2019

Vaccination Acceptance Research Network (VARN) [to 7 Dec 2019]
https://vaccineacceptance.org/news.html#header1-2r
No new digest content identified.

Vaccine Confidence Project [to 7 Dec 2019]
http://www.vaccineconfidence.org/
No new digest content identified.

Vaccine Education Center – Children’s Hospital of Philadelphia [to 7 Dec 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.

Wellcome Trust [to 7 Dec 2019]
https://wellcome.ac.uk/news
News | 3 December 2019
Mosaic to close after five years of award-winning long-form journalism

The Wistar Institute [to 7 Dec 2019]
https://www.wistar.org/news/press-releases
No new digest content identified.

World Organisation for Animal Health (OIE) [to 7 Dec 2019]
https://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

::::::

ARM [Alliance for Regenerative Medicine] [to 7 Dec 2019]
https://alliancerm.org/press-releases/
No new digest content identified.

BIO [to 7 Dec 2019]
https://www.bio.org/press-releases
Press Release
More than 135 Emerging Biotech Leaders Urge Congress to Reject H.R. 3 
“Our continued success depends on maintaining an environment that supports investment in tomorrow’s discoveries.”
December 5, 2019

DCVMN – Developing Country Vaccine Manufacturers Network [to 7 Dec 2019]
http://www.dcvmn.org/
News
No new digest content identified.

IFPMA [to 7 Dec 2019]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
No new digest content identified.

PhRMA [to 7 Dec 2019]
http://www.phrma.org/
Selected Press Releases, Statements
Press Release
PhRMA Names Anne Esposito Senior Vice President of Federal Advocacy
Esposito to Lead Association’s Federal Advocacy Team
Washington, D.C. (December 5, 2019) — Today, the Pharmaceutical Research and Manufacturers of America (PhRMA) named Anne Esposito as senior vice president of federal advocacy, effective January 2020. Esposito will oversee the association’s federal government affairs and succeeds Scott Olsen, who is retiring.
“Anne’s extensive experience provides her with the strategic leadership needed to build upon our successful advocacy to advance public policy reforms that address patient affordability challenges and foster innovation,” said PhRMA president and CEO Stephen J. Ubl. “Her ability to work on a bipartisan basis with stakeholders across the health care system is a vital addition to the association.”…

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focu-s on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

American Journal of Preventive Medicine
December 2019 Volume 57, Issue 6, p733-874
http://www.ajpmonline.org/current

Current Issues
U.S. Immigration Law Enforcement Practices and Health Inequities
Immigration policies and law enforcement practices in the U.S. have the power to create a climate of fear for undocumented individuals, their families, and their communities, which can impact health outcomes.1–3 This paper examines how these policies and practices (henceforth referred to as “immigration enforcement”) affect health.
Paul J. Fleming, Nicole L. Novak, William D. Lopez
p858–861
Published in issue: December 2019

American Journal of Public Health
January 2020 110(1)
http://ajph.aphapublications.org/toc/ajph/current

THE PLAN
The Time Is Now to End the HIV Epidemic
HIV/AIDS
Brett P. Giroir
110(1), pp. 22–24

American Journal of Public Health
January 2020 110(1)
http://ajph.aphapublications.org/toc/ajph/current

AJPH EDITORIALS
ENDING THE HIV EPIDEMIC
Ending the HIV Epidemic: Getting to Zero AND Staying at Zero
HIV/AIDS, Prevention, Epidemiology, Health Policy
Farzana Kapadia and Stewart Landers
110(1), pp. 15–16

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 6, 2019
http://www.ajtmh.org/content/journals/14761645/101/6

Perspective Piece
Simplification of Rabies Postexposure Prophylaxis: A New 2-Visit Intradermal Vaccine Regimen
Mary J. Warrell
https://doi.org/10.4269/ajtmh.19-0252
THE CURRENT SITUATION
Rabies encephalitis following a rabid dog bite is always fatal in unvaccinated patients, yet correct preventive vaccination has proved 100% effective. Rabies vaccine is frequently unavailable or unaffordable in rural areas of Asia and Africa, where up to 90% of rabies deaths occur.¹ Gavi, the Vaccine Alliance, recently approved support for human rabies vaccine for postexposure prophylaxis (PEP), beginning in 2021. The success of this endeavor will depend on whether the expensive vaccines can be provided economically. Using small doses of vaccine intradermally (ID) is highly immunogenic and economical.²
The WHO has recently recommended the new IPC (Institut Pasteur du Cambodge) postexposure vaccine regimen consisting of 0.1 mL ID injection at 2 sites on days 0, 3, and 7.³ This is the same as the method recommended for 20 years, the Thai Red Cross (TRC) 2-site ID regimen, but without the day 28 dose (Table 1). The WHO decision to accept this regimen was based on preliminary serological data from some of the patients in a clinical trial.⁴ (The study used vaccine containing 0.5 mL/vial.) The full data remain unavailable a year later.² Rabies vaccines do not contain preservatives and their use ID is off-label but is sanctioned by the WHO, provided that an opened vial is used within 8 hours. Attempts to use the TRC regimen in rural clinics where only a few dog bite patients are treated each month have failed, mainly because of vaccine wastage. This regimen has proved economical only in urban clinics seeing several patients a week. It seems unlikely that the new 1-week IPC method will solve that problem. Rabies immunoglobulin, officially recommended for all but the most trivial bites,³ is not expected to be available.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 7 Dec 2019)

Research article
Determinants of high residual post-PCV13 pneumococcal vaccine-type carriage in Blantyre, Malawi: a modelling study
In November 2011, Malawi introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant schedule. Four to 7 years after introduction (2015–2018), rolling prospective nasopharyngeal car…
Authors: J. Lourenço, U. Obolski, T. D. Swarthout, A. Gori, N. Bar-Zeev, D. Everett, A. W. Kamng’ona, T. S. Mwalukomo, A. A. Mataya, C. Mwansambo, M. Banda, S. Gupta, N. French and R. S. Heyderman
Citation: BMC Medicine 2019 17:219
Published on: 5 December 2019

Bulletin of the World Health Organization
Volume 97, Number 12, December 2019, 789-856
https://www.who.int/bulletin/volumes/97/12/en/

PERSPECTIVES
Ensuring access to affordable, timely vaccines in emergencies
— Kate Elder, Barbara Saitta, Tanja Ducomble, Miriam Alia, Ryan Close, Suzanne Scheele, Elise Erickson, Rosalind Scourse, Patricia Kahn & Greg Elder
http://dx.doi.org/10.2471/BLT.18.228585
[See Milestones above for detail]

Emerging Infectious Diseases
Volume 25, Number 12—December 2019
http://wwwnc.cdc.gov/eid/

Research
Cost-effectiveness of Prophylactic Zika Virus Vaccine in the Americas [PDF – 1.03 MB – 6 pages]
A. Shoukat et al.

The European Journal of Public Health
Volume 29, Issue 6, December 2019
https://academic.oup.com/eurpub/issue/29/6

Editorials
The social responsibility of public health: Italy’s lesson on vaccine hesitancy
C Signorelli, A Odone, W Ricciardi, B Lorenzin
Eur J Public Health, Volume 29, Issue 6, December 2019, Pages 1003–1004, https://doi.org/10.1093/eurpub/ckz135

JAMA Pediatrics
December 2019, Vol 173, No. 12, Pages 1119-1216
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint
Adolescent Consent to Vaccination in the Age of Vaccine-Hesitant Parents
Y. Tony Yang, ScD, LLM, MPH; Robert S. Olick, JD, PhD; Jana Shaw, MD, MPH
JAMA Pediatr. 2019;173(12):1123-1124. doi:10.1001/jamapediatrics.2019.3330
Abstract
As children of vaccine-hesitant parents become adolescents, they develop their individual perspectives on vaccination. One of these adolescents, Ethan Lindenberger, researched vaccines, discussed them with trusted adults, and ultimately got vaccinated.¹ His testimony to the Senate Committee on Health, Education, Labor and Pensions made national headlines.¹ Many other adolescents are similarly seeking advice on how to get vaccinated. While vaccination against measles and other conditions occurs in early childhood, vaccine-hesitant parents have also refused human papillomavirus vaccination, routinely provided for adolescents beginning at age 11 or 12 years. And they have refused to let their children catch up on any missed early childhood vaccinations. Prior research has shown that adolescents feel generally marginalized in the decision-making process, yet they desire to participate in decisions.² Their main obstacle to vaccination is that most states require an individual to be 18 years or older to consent to medical procedures.³ We argue for expansion of the rights of adolescents to make their own decisions to be vaccinated against serious and potentially life-threatening diseases without requiring parental consent and involvement.

Journal of Adolescent Health
December 2019 Volume 65, Issue 6, p709-824
https://www.jahonline.org/issue/S1054-139X(18)X0014-7

Editorials
Human Papillomavirus Vaccination Expected to Reduce Human Papillomavirus–Associated Cancers and May Lessen Racial/Ethnic Disparities of Cancer Incidence
Joan R. Cates
p709–710
Published in issue: December 2019

Journal of Adolescent Health
December 2019 Volume 65, Issue 6, p709-824
https://www.jahonline.org/issue/S1054-139X(18)X0014-7

Original Articles
Declines in Vaccine-Type Human Papillomavirus Prevalence in Females Across Racial/Ethnic Groups: Data From a National Survey
Nancy M. McClung, Rayleen M. Lewis, Julia W. Gargano, Troy Querec, Elizabeth R. Unger, Lauri E. Markowitz
p715–722
Published online: September 9, 2019

Journal of Public Health Policy
Volume 40, Issue 4, December 2019
https://link.springer.com/journal/41271/40/4

Original Article
Nigerian rural mothers’ knowledge of routine childhood immunizations and attitudes about use of reminder text messages for promoting timely completion
Oladimeji Oladepo, Isaac Oluwafemi Dipeolu…`

The Lancet
Dec 07, 2019 Volume 394 Number 10214 p2039-2124, e39-e42
https://www.thelancet.com/journals/lancet/issue/current

Lecture
Corruption in global health: the open secret
Patricia J García
Summary
Corruption is embedded in health systems. Throughout my life—as a researcher, public health worker, and a Minister of Health—I have been able to see entrenched dishonesty and fraud. But despite being one of the most important barriers to implementing universal health coverage around the world, corruption is rarely openly discussed. In this Lecture, I outline the magnitude of the problem of corruption, how it started, and what is happening now. I also outline people’s fears around the topic, what is needed to address corruption, and the responsibilities of the academic and research communities in all countries, irrespective of their level of economic development. Policy makers, researchers, and funders need to think about corruption as an important area of research in the same way we think about diseases. If we are really aiming to achieve the Sustainable Development Goals and ensure healthy lives for all, corruption in global health must no longer be an open secret.

Lancet Global Health
Dec 2019 Volume 7 Number 12 e1584-e1735
http://www.thelancet.com/journals/langlo/issue/current

Comment
Integrated vaccine economics for countries transitioning from Gavi support
Maarten van Wijhe,Lone Simonsen

Lancet Global Health
Dec 2019 Volume 7 Number 12 e1584-e1735
http://www.thelancet.com/journals/langlo/issue/current

Global access to quality-assured medical products: the Oxford Statement and call to action
Paul N Newton,Katherine C Bond on behalf of the Oxford Statement signatories
…In September, 2018, the first international Medicine Quality and Public Health Conference was held at Oxford University, UK, to discuss opportunities and solutions to ensure that all people have access to affordable and quality-assured medical products. Delegates developed the short Oxford Statement, calling for investment, policy change, and action to eliminate substandard and falsified medical products. The statement was born out of discussion between governments, national and international agencies, non-governmental organisations, professional associations, and academic institutions who together examined the latest evidence on the epidemiology and public health implications of substandard and falsified medical products. Here, we expand this statement with a call to action (panel) and research agenda (appendix 2)…

Lancet Global Health
Dec 2019 Volume 7 Number 12 e1584-e1735
http://www.thelancet.com/journals/langlo/issue/current

Articles
Potential effect of age of BCG vaccination on global paediatric tuberculosis mortality: a modelling study
Partho Roy, Johan Vekemans, Andrew Clark, Colin Sanderson, Rebecca C Harris, Richard G White

Lancet Infectious Diseases
Dec 2019 Volume 19 Number 12 p1265-1380, e404-e451
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Infectious disease crisis in the Philippines
The Lancet Infectious Diseases
[See Milestones above for detail]

Lancet Infectious Diseases
Dec 2019 Volume 19 Number 12 p1265-1380, e404-e451
http://www.thelancet.com/journals/laninf/issue/current

Articles
Long-term immunity against yellow fever in children vaccinated during infancy: a longitudinal cohort study
A single dose of vaccine against yellow fever is routinely administered to infants aged 9–12 months under the Expanded Programme on Immunization, but the long-term outcome of vaccination in this age group is unknown. We aimed to evaluate the long-term persistence of neutralising antibodies to yellow fever virus following routine vaccination in infancy.
Cristina Domingo, Juliane Fraissinet, Patrick O Ansah, Corey Kelly, Niranjan Bhat, Samba O Sow,
José E Mejía

Nature
Volume 576 Issue 7785, 5 December 2019
http://www.nature.com/nature/current_issue.html

Genomes from Asia
To date, human genetic studies have focused largely on Europeans, which has limited the diversity of individuals represented in the genetic data sets. With a plan to sequence and analyse the genomes of 100,000 Asian individuals, the GenomeAsia 100K project aims to play a major part in plugging that gap. In this week’s issue, the consortium presents the data from the pilot phase of the project: a whole-genome reference data set from 1,739 individuals of 219 population groups and 64 countries across Asia. The researchers use the data to catalogue genetic variation, population structure and disease associations. They also find that Asia has sizeable founder populations, where groups have broken away from the original population to form a new one, and suggest further study of these could help identify genes associated with rare diseases.

Nature
Volume 576 Issue 7785, 5 December 2019
http://www.nature.com/nature/current_issue.html

Editorial | 04 December 2019
Expensive treatments for genetic disorders are arriving. But who should foot the bill?
The majority of people with sickle-cell disease are live in the world’s poorest communities and cannot afford the eye-watering costs of treatments.

Nature
Volume 576 Issue 7785, 5 December 2019
http://www.nature.com/nature/current_issue.html

News Feature | 04 December 2019
Gene therapy is facing its biggest challenge yet
After finally gaining traction as a potential treatment for certain genetic disorders, gene therapy tackles the challenge of sickle-cell disease.
Heidi Ledford

Nature
Volume 576 Issue 7785, 5 December 2019
http://www.nature.com/nature/current_issue.html

Comment | 03 December 2019
Crack down on genomic surveillance
Corporations selling DNA-profiling technology are aiding human-rights abuses. Governments, legislators, researchers, reviewers and publishers must act.
Yves Moreau

Nature
Volume 576 Issue 7785, 5 December 2019
http://www.nature.com/nature/current_issue.html

Article | 04 December 2019 | Open Access
The GenomeAsia 100K Project enables genetic discoveries across Asia
Using whole-genome sequencing data from 1,739 individuals, the GenomeAsia 100K Project catalogues genetic variation, population structure and disease associations to facilitate genetic studies in Asian populations and increase representation in genetics studies worldwide.
Jeffrey D. Wall
, Eric W. Stawiski[…] & Andrew S. Peterson

Nature Biotechnology
Volume 37 Issue 12, December 2019
https://www.nature.com/nbt/volumes/37/issues/12

Patents | 03 December 2019
Access and openness in biotechnology research collaborations between universities and industry
An empirical study of publicly funded collaborative research projects in biotechnology identifies contractual provisions that govern the extent of access to and openness of research results.
Knut Jørgen Egelie, Haakon Thue Lie[…] & Roger Sørheim

Nature Biotechnology
Volume 37 Issue 12, December 2019
https://www.nature.com/nbt/volumes/37/issues/12

Review Article | 03 June 2019
Gene editing for immune cell therapies
Bailey and Maus discuss cutting-edge developments in engineering immune cells towards expanding the reach and efficacy of adoptive cell therapies in cancer and beyond.
Stefanie R. Bailey  & Marcela V. Maus

Nature Genetics
Volume 51 Issue 12, December 2019
https://www.nature.com/ng/volumes/51/issues/12

Mapping the regulatory wiring of the genome
The human genome encodes millions of enhancers (tangled balls) that quantitatively tune the expression of 21,000 genes (arrows). The regulatory wiring connecting enhancers to their target genes has remained elusive. In this issue, Fulco, Nasser and colleagues develop new experimental and computational approaches to map this complex wiring, and demonstrate their utility in interpreting the functions of genetic variants associated with human diseases.

Nature Genetics
Volume 51 Issue 12, December 2019
https://www.nature.com/ng/volumes/51/issues/12

Editorial | 29 November 2019
A year in genetics
As the year comes to a close and we start to look ahead to 2020, we thought that we would highlight some of our favorite Nature Genetics papers from 2019. This snapshot also captures some of the topics and themes in genetics that we are most excited to see develop in the near future.

Nature Medicine
Volume 25 Issue 12, December 2019
https://www.nature.com/nm/volumes/25/issues/12

Turning Points | 05 December 2019
Finding a cure for sickle cell disease
Julie Makani is an associate professor in the Department of Haematology and Blood Transfusion at Muhimbili University of Health and Allied Sciences in Dar es Salaam, where she helped Tanzania establish one of the world’s largest single-center study cohorts for sickle cell disease. She received the 2011 Royal Society Africa Award on the translation of genomics to health benefits.
Julie Makani

Nature Medicine
Volume 25 Issue 12, December 2019
https://www.nature.com/nm/volumes/25/issues/12

Comment | 25 November 2019
Benefit Corporation: a path to affordable gene therapies?
With the growing number of efficient gene therapies on the market, now is the time to take actions to ensure reasonable pricing of gene therapy products. Among these, we propose to incentivize gene therapy companies to adopt a status that translates their corporate social responsibility into concrete commitments.
Alain Fischer, Mathias Dewatripont  & Michel Goldman

New England Journal of Medicine
December 5, 2019 Vol. 381 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Preparing for the Next Pandemic — The WHO’s Global Influenza Strategy
Mark Eccleston-Turner, Ph.D., Alexandra Phelan, S.J.D., and Rebecca Katz, Ph.D., M.P.H.
Given the ongoing threat posed by influenza, the WHO earlier this year released its Global Influenza Strategy 2019–2030. Although the strategy is a welcome step, additional challenges will test its effectiveness unless efforts are made to ensure that they are addressed.

New England Journal of Medicine
December 5, 2019 Vol. 381 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Original Articles
Phase 3 Efficacy Analysis of a Typhoid Conjugate Vaccine Trial in Nepal
Mila Shakya, M.P.H., and others for the TyVAC Nepal Study Team*
Salmonella Typhi is a major cause of fever in children in low- and middle-income countries. A typhoid conjugate vaccine (TCV) that was recently prequalified by the World Health Organization was shown to be efficacious in a human challenge model, but data from efficacy trials in areas where typhoid is endemic are lacking.

New England Journal of Medicine
December 5, 2019 Vol. 381 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Editorials
Parting the Clouds over Typhoid with a New Conjugate Vaccine
Florian Marks, Ph.D., and Jerome H. Kim, M.D.
Typhoid fever is caused by fecal–oral transmission of Salmonella enterica serovar Typhi (S. Typhi). It has been a deadly companion to mankind for centuries, affecting 10.9 million persons and resulting in an estimated 116,800 deaths per year.1 Although vaccines against typhoid have been available for more than a century and have been shown to be protective,2,3 the approved vaccines (injectable Vi polysaccharide and oral, live-attenuated Ty21a typhoid vaccines) have not been useful in populations with a high typhoid burden, particularly in young children.4 To address this shortfall, the Bill and Melinda Gates Foundation, as well as other donors, has supported . . .

PharmacoEconomics
Volume 37, Issue 12, December 2019
https://link.springer.com/journal/40273/37/12

Systematic Review
The Use of Risk-Sharing Contracts in Healthcare: Theoretical and Empirical Assessments
Over 20 studies proposed different taxonomies of risk-sharing contracts, which can be summarised as financial and paying-for-performance agreements. Theoretical studies modelling the incentives to implement risk-sharing agreements are scarce; they addressed different types of contracts and regulatory contexts, characterizing the drug prices and the optimal strategies of the involved agents. Empirical studies describing specific agreements are abundant and referred to different geographical contexts; however, few articles showed the economic results and assessed the value of such contracts. Stakeholders’ perceptions of risk-sharing contracting were favourable, but little is known about the economic and clinical advantages of specific agreements. Whether risk-sharing contracts have yielded the desired results for healthcare systems remains uncertain.. Risk-sharing contracts are increasingly used, although the lack of transparency and aggregated registries makes it difficult to learn from these experiences and assess their impact on healthcare systems.
Fernando Antonanzas, Carmelo Juárez-Castelló, Reyes Lorente…

PLoS One
http://www.plosone.org/
[Accessed 7 Dec 2019]

Research Article
Factors that enable effective One Health collaborations – A scoping review of the literature
Kaylee Myhre Errecaborde, Katelyn Wuebbolt Macy, Amy Pekol, Sol Perez, Mary Katherine O’Brien, Ian Allen, Francesca Contadini, Julia Yeri Lee, Elizabeth Mumford, Jeff B. Bender, Katharine Pelican
Research Article | published 04 Dec 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0224660