The Lancet
May 12, 2018 Volume 391 Number 10133 p1865-1964
http://www.thelancet.com/journals/lancet/issue/current

Pathology and laboratory medicine in low-income and middle-income countries
Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action
Susan Horton, Richard Sullivan, John Flanigan, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Sanjay A Pai, Mark Lawler

Nature 
Volume 557 Issue 7704, 10 May 2018
http://www.nature.com/nature/current_issue.html

Comment | 09 May 2018
When will clinical trials finally reflect diversity?
An analysis of drug studies shows that most participants are white, even though trials are being done in more countries, reveal Todd C. Knepper and Howard L. McLeod.
Todd C. Knepper  & Howard L. McLeod

Nature Reviews Immunology
Volume 18 Issue 5, May 2018
https://www.nature.com/nri/journal/v18/n4/index.html

Review Article | 30 January 2018
Passive immunotherapy of viral infections: ‘super-antibodies’ enter the fray
So-called super-antibodies are highly potent, broadly reactive antiviral antibodies that offer promise for the treatment of various chronic and emerging viruses. This Review describes how recent technological advances led to their isolation from rare, infected individuals and their development for the prevention and treatment of various viral infections.
Laura M. Walker  & Dennis R. Burton

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 12 May 2018]

Zika virus outbreak in Suriname, a report based on laboratory surveillance data
May 10, 2018 · Research Article
Introduction : Since the identification of ZIKV in Brazil in May 2015, the virus has spread extensively throughout the Americas. Cases of ZIKV infection have been reported in Suriname since October 2, 2015.  Methods : A laboratory-based surveillance system was quickly implemented according to previous experience with the emergence of chikungunya. General practitioners and public health centers located in different districts of Suriname were asked to send blood samples from suspicious cases to Academic Hospital for molecular diagnosis of Zika virus infection. We investigated Zika-related laboratory data collected during surveillance and response activities to provide the first outbreak report in Suriname in terms of time, location and person. Results : A total of 791 molecularly confirmed cases were reported during a 48-week interval from October 2015 to August 2016. The majority of ZIKV-positive cases involved women between 20 and 39 years of age, reflecting concern about Zika infection during pregnancy. The outbreak peaked in mid-January and gradually spread from the district of Paramaribo to western coastal areas. Discussion : This report provides a simple and comprehensive description of the outbreak in Suriname and demonstrates the utility of laboratory data to highlight the spatiotemporal dynamics of the outbreak in that country.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 12 May 2018)

Editorial
The next forum for unraveling FDA off-label marketing rules: State and federal legislatures
Michael S. Sinha, Aaron S. Kesselheim
Editorial | published 08 May 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002564
…Buoyed by a narrow victory in one appeals court, advocates have turned to state and federal legislatures to unravel current FDA rules relating to off-label promotion. But these rules are essential for the ability of the FDA to fulfill its public health mission by defining what uses of drugs have benefits that outweigh their risks versus those that lack sufficient evidence to warrant such use. These distinctions are crucial for individual physicians—who do not have the time or expertise to perform the same critical data evaluation conducted by the scores of highly trained scientists at the FDA—and for patients, who could be exposed to more non–evidence-based and potentially dangerous off-label uses of high-cost drugs.

PLoS One
http://www.plosone.org/
[Accessed 12 May 2018]

Research Article
Controlling epidemics with transmissible vaccines
Scott L. Nuismer, Ryan May, Andrew Basinski, Christopher H. Remien
| published 10 May 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0196978
Abstract
As the density of human and domestic animal populations increases, the threat of localized epidemics and global pandemics grows. Although effective vaccines have been developed for a number of threatening pathogens, manufacturing and disseminating vaccines in the face of a rapidly spreading epidemic or pandemic remains a formidable challenge. One potentially powerful solution to this problem is the use of transmissible vaccines. Transmissible vaccines are capable of spreading from one individual to another and are currently being developed for a range of infectious diseases. Here we develop and analyze mathematical models that allow us to quantify the benefits of vaccine transmission in the face of an imminent or ongoing epidemic. Our results demonstrate that even a small amount of vaccine transmission can greatly increase the rate at which a naïve host population can be protected against an anticipated epidemic and substantially reduce the size of unanticipated epidemics if vaccination is initiated shortly after pathogen detection. In addition, our results identify key biological properties and implementation practices that maximize the impact of vaccine transmission on infectious disease.

Proceedings of the Royal Society B
16 May 2018; volume 285, issue 1878
http://rspb.royalsocietypublishing.org/content/285/1878?current-issue=y

Editorial
Introduction of the Evidence synthesis: article type
Gary Carvalho
Published 9 May 2018.DOI: 10.1098/rspb.2018.0858

1.Introduction

With over two million scientific publications appearing each year worldwide, there is an escalating need to access evidence and opinion to inform policy. In response, articles encompassing a breadth of policy and practice, from clinical medicine through to conservation science increasingly adopt an Evidence Synthesis framework. These articles access, appraise and synthesize scientific information and makes them readily available to non-specialists. They are rigorous, objective and transparent and driven by stakeholder needs, enabling the reader to make informed decisions. In an exciting new development, Proceedings of the Royal Society B will be extending its publication portfolio by launching a new article type entitled Evidence synthesis in June 2018, as part of a joint programme by the Academy of Medical Sciences and the Royal Society https://royalsociety.org/topics-policy/projects/evidence-synthesis/. Articles can range from brief review-style papers, through to meta-analysis and full systematic reviews of contentious issues. This editorial will serve to explain the appetite for such articles and the benefits for us in publishing them, as well as explain to authors the journal requirements for these pieces…

Vaccine
Volume 36, Issue 22, Pages 3061-3190 (24 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/22

Vaccine Technology VI
Edited by Laura A. Palomares, Tarit K. Mukhopadhay, Yvonne Genzel, Linda L.H. Lua, Manon M.J. Cox
Vaccine Technology VI: Innovative and integrated approaches in vaccine development
Pages 3061-3063
Laura A. Palomares, Tarit K. Mukhopadhyay, Yvonne Genzel, Linda H.L. Lua, Manon M.J. Cox

Value in Health                   

May 2018 Volume 21, Issue 5, p491-630
http://www.valueinhealthjournal.com/current
THEMED SECTION: Rare Diseases
Editorial
Rare Diseases: Addressing the Challenges in Diagnosis, Drug Approval, and Patient Access
Kati Copley-Merriman
p491–492
Published online: April 10, 2018
Rare diseases represent a wide range of disorders and constellations of clinical signs and symptoms. Many rare diseases cause chronic or progressive physical deterioration, disability, or premature death and start in childhood, creating a huge burden on parents and caregivers. Most rare diseases are thought to be genetic and there may be as many as 7000 rare diseases [1]. Although there is no universally accepted terminology or definition as to what constitutes a rare disease, it is typically characterized by its low frequency of occurrence. A global review of rare disease terminology found that 58% of definitions included a prevalence threshold with an average global threshold of 40 cases per 100,000 people [2]. Although the frequency of a single rare disease is low, because of the large number of rare diseases, the total number of people with a rare disease is large.

Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatments. The Orphan Drug Act of 1983 passed by the US Congress created incentives to encourage companies to develop new drugs for rare diseases. There is similar legislation in the European Union. Drugs are granted an orphan designation if they are for the treatment of rare diseases that are life-threatening or seriously debilitating. The definition of “rare disease” varies from jurisdiction to jurisdiction, being a disease or condition affecting fewer than 200,000 patients in the United States (6.4 per 10,000 inhabitants), or a disease with a prevalence of 5 per 10,000 inhabitants or lower in the European Union [3]. In the decade leading up to the passage of the Orphan Drug Act, only 10 industry-supported products for rare diseases were brought to market. Since 1983, more than 600 orphan drug indications were approved from more than 450 distinct drug products, representing a huge increase in rare disease research and clinical development of new technologies [4].

Nevertheless, the development of new rare disease therapies has encountered significant obstacles with respect to understanding the incidence and prevalence (epidemiology), patient-reported burden of disease, economic cost of the disease and treatment, health technology assessment, and patient access. In June 2013, two working groups were established by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) under the ISPOR Rare Disease Special Interest Group. An article by the first working group provided rare disease terms and definitions [2]. The second working group (Challenges in Assessment and Appraisal of Diagnostics and Treatments Working Group) undertook a broad identification of challenges confronting those engaged in rare disease–focused research and development, as well as technology assessment.

Subsequently, Value in Health issued a special Call for Papers to attract submissions for a themed section dedicated to rare diseases. The resulting nine selected articles are published in this issue.

• The first article, written by a group of authors from the ISPOR Rare Disease Special Interest Group, develops a multistakeholder catalogue of the principal difficulties faced in real-life rare disease research [5].

2.The article by Auvin et al. [6] provides a method to estimate the prevalence of rare diseases on the basis of reported incidence, to capture the time it takes for the diagnosis of newly discovered rare diseases to become part of mainstream diagnostic practice.

3.Building on a previously published report in Value in Health titled “Patient-Reported Outcome and Observer-Reported Outcomes Assessment in Rare Disease Clinical Trials: An ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force Report” [7], the article by Phillips [8] in this issue describes rare disease clinical outcome assessments specific to pediatric patients and developmental changes while maturing.

4.The article by Knight et al. [9] describes economic modeling considerations for rare diseases and strategies that manufacturers have used to overcome challenges in submissions to the highly specialized technologies of the National Institute for Health and Care Excellence in England and in ultra-orphan appraisals to the Scottish Medicines Consortium.

5.Schlander et al. [10] conducted a systematic review of the literature-reported expenditures for drugs for rare and ultra-rare diseases in Europe to explore the budget impact of rare diseases.

6.The article by Magalhaes [11] reports a structured deliberation to elicit and describe the values of the general public in Alberta, Canada, regarding whether the severity of a rare condition can achieve priority in funding over common conditions, and what aspects of a condition drive this judgment.

7.The article by Hughes et al. [12] reports a person trade-off and discrete choice experiment among 3950 adults representative of the UK general population to estimate societal preferences for funding of non–cost-effective orphan drug treatments (i.e., Does the UK general public consider rarity in itself as being sufficient to justify special consideration for additional National Health Service funding?).

8.The article by Ollendorf et al. [13] explores the general ethical dilemmas that rare diseases present, the rare disease landscape in health technology assessment and US payer systems, the role of contextual factors in rare diseases (beyond cost effectiveness), and possible ways forward.

9.The final article by Kos et al. [14] investigates patient access to medicines for rare diseases from the Orphanet list in various European countries in the past decade using IMS Health sales data.

Although the international community has taken steps to address the rare disease challenges outlined in these articles, it has done so with a high degree of variation. The ISPOR Rare Disease Special Interest Group plans to continue its multistakeholder efforts toward providing recommendations to address rare disease challenges regarding evidence generation and health technology assessment. This collection of articles should help those attempting to address these challenges

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Journal of Community Health
First Online: 05 May 2018
Assessing and Improving Zoster Vaccine Uptake in a Homeless Population
L Kaplan-Weisman, E Waltermaurer, C Crump
Abstract
The herpes zoster (shingles) vaccine is recommended for all adults aged ≥ 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults. To address these barriers, we developed a new approach of partnering our on-site primary care clinic in a transitional homeless shelter with a local pharmacy and offering vaccination on Shingles Immunization Days with a goal of matching or exceeding the national zoster immunization rate of 30.6%. Over a 3-year period, the live attenuated zoster vaccine was offered to 86% of eligible patients resulting in an immunization rate of 38.1%. This is higher than the estimated national rate but significantly lower than rates of tetanus (80.6%), pneumococcal (76.3%), and influenza (69.6%) vaccination in the same population, highlighting the unique obstacles to zoster immunization. Major reasons that patients were not immunized included lack of insurance coverage and patient refusal of all vaccines. Our findings demonstrate that homeless adults are interested in zoster vaccination and a model of on-site primary care in a shelter partnering with a pharmacy can successfully improve vaccine uptake in this population. Coverage of the new inactivated zoster vaccine under Medicare Part B could increase the national zoster immunization rate.
 
 
System Dynamics Review
Volume 33, Issue 2  Pages: 87-180  April/June 2017
https://onlinelibrary.wiley.com/toc/10991727/current
Early View – Main Article
Using integrated modeling to support the global eradication of vaccine‐preventable diseases
RJ Duintjer Tebbens, KM Thompson – 2018
Abstract
The long‐term management of global disease eradication initiatives involves numerous inherently dynamic processes, health and economic trade‐offs, significant uncertainty and variability, rare events with big consequences, complex and interrelated decisions, and a requirement for cooperation among a large number of stakeholders. Over the course of more than 16 years of collaborative modeling efforts to support the Global Polio Eradication Initiative, we developed increasingly complex integrated system dynamics models that combined numerous analytical approaches, including differential equation‐based modeling, risk and decision analysis, discrete‐event and individual‐based simulation, probabilistic uncertainty and sensitivity analysis, health economics and optimization. We discuss the central role of systems thinking and system dynamics in the overall effort and the value of integrating different modeling approaches to appropriately address the trade‐offs involved in some of the policy questions. We discuss practical challenges of integrating different analytical tools and we provide our perspective on the future of integrated modeling.
 
 
Influenza and other respiratory viruses
Volume 12, Issue 3  Pages: 305-420  May 2018
https://onlinelibrary.wiley.com/toc/17502659/current
Accepted Manuscript
65 Years of influenza surveillance by a WHO‐coordinated global network
T Ziegler, A Mamahit, NJ Cox –
ABSTRACT
The 1918 devastating influenza pandemic left a lasting impact on influenza experts and the public, and the importance of global influenza surveillance was soon recognized. The WHO Global Influenza Surveillance Network (GISN) was founded in 1952 and renamed to Global Influenza Surveillance and Response System in 2011 upon the adoption by the World Health Assembly, of the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits (“PIP Framework”). The importance of influenza surveillance had been recognized and promoted by experts prior to the years leading up to the establishment of WHO. In the 65 years of its existence, the Network has grown to comprise 143 National Influenza Centers recognized by WHO, 6 WHO Collaborating Centers, 4 Essential Regulatory Laboratories, and 13 H5 Reference Laboratories. The Network has proven its excellence throughout these 65 years, providing detailed information on circulating seasonal influenza viruses, as well as immediate response to the influenza pandemics in 1957, 1968, and 2009, and to threats caused by animal influenza viruses and by zoonotic transmission of coronaviruses. For its central role in global public health, the Network has been highly recognized by its many partners and by international bodies. Several generations of world renown influenza scientists have brought the Network to where it is now and they will take it forward to the future, as influenza will remain a pre-eminent threat to humans and to animals.
 
 
Journal of Clinical Epidemiology
March 2018 Volume 95, p1-142
https://www.jclinepi.com/issue/S0895-4356(17)X0016-4
Controversy and Debate on Dengue Vaccine Series
Controversy and debate on dengue vaccine series—paper 1: review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Antonio L. Dans, Leonila F. Dans, Mary Ann D. Lansang, Maria Asuncion A. Silvestre, Gordon H. Guyatt
Published online: November 24, 2017
Highlights
:: The possibility that dengue vaccines can cause severe dengue has led to serious concern regarding the safety of mass vaccination programs.
:: This paper points out problems in the analyses of a published meta-analysis addressing this safety issue for a new vaccine against dengue fever—Dengvaxia.
:: Although the authors of the meta-analysis show a sevenfold rise in hospitalization for dengue fever in children <5 years old, they fail to point out two signals of harm for another outcome—hospitalization for severe dengue fever in children younger than 9 years, the relative risk was 8.5 (95% confidence interval [CI]: 0.5, 146.8), and in the overall study group, the relative risk was 5.5 (95% CI: 0.9, 33).
:: The selective reporting and inappropriate subgroup claims mask the potential harm of dengue mass vaccination programs.
:: Countries planning public use of the vaccine must conduct diligent postmarketing surveillance, secure informed consent from parents of potential recipients, and closely monitor the results of ongoing long-term follow-up of clinical trial participants.
Abstract
Severe life-threatening dengue fever usually occurs when a child is infected by dengue virus a second time. This is caused by a phenomenon called antibody-dependent enhancement (ADE). Since dengue vaccines can mimic a first infection in seronegative children (those with no previous infection), a natural infection later in life could lead to severe disease. The possibility that dengue vaccines can cause severe dengue through ADE has led to serious concern regarding the safety of mass vaccination programs. A published meta-analysis addressed this safety issue for a new vaccine against dengue fever—Dengvaxia. The trials in this meta-analysis have been used to campaign for mass vaccination programs in developing countries. We discuss the results of this paper and point out problems in the analyses. Reporting the findings in an Asian trial (CYD14), the authors show a sevenfold rise in one outcome—hospitalization for dengue fever in children <5 years old. However, they fail to point out two signals of harm for another outcome—hospitalization for severe dengue fever (as confirmed by an independent data monitoring committee): 1. In children younger than 9 years, the relative risk was 8.5 (95% confidence interval [CI]: 0.5, 146.8), and 2. In the overall study group, the relative risk was 5.5 (95% CI: 0.9, 33).

The authors conduct a subgroup analysis to support claims that the vaccine is probably safe among children aged 9 years or more. This subgroup analysis has limited credibility because: (1) it was a post hoc analysis; (2) it was one of a large number of subgroup analyses; (3) the test of interaction was not reported, but was insignificant (P=0.14); and (4) there is no biological basis for a threshold age of 9 years. The more likely explanation for the higher risk in younger children is ADE, that is, more frequent seronegativity, rather than age itself. The selective reporting and inappropriate subgroup claims mask the potential harm of dengue mass vaccination programs. Countries planning public use of the vaccine must conduct diligent postmarketing surveillance, secure informed consent from parents of potential recipients, and closely monitor the results of ongoing long-term follow-up of clinical trial participants.

Controversy and debate on dengue vaccine series—paper 2: response to review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Sri Rezeki S. Hadinegoro, Jose Luis Arredondo-García, Maria Rosario Capeding, Sophie Pallardy, Fernando Noriega, Alain Bouckenooghe
Published online: January 3, 2018

Controversy and debate on dengue vaccine series—paper 3: final response to review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Antonio L. Dans, Leonila F. Dans, Mary Ann D. Lansang, Maria Asuncion A. Silvestre, Gordon H. Guyatt
Published online: January 3, 2018

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 12 May 2018
The New Ebola Outbreak Could Take ‘Three Months’ to Control
Ed Yong   May 11, 2018
The DRC ministry of health is also considering whether to deploy an experimental Ebola vaccine that has proven its effectiveness in clinical .
 

Huffington Post
https://www.huffingtonpost.co.uk/
Accessed 12 May 2018
Why The World Needs Pop-up Vaccine Factories
10 May 2018
Dr Harris Makatsoris, Professor of Manufacturing Operations in the Sustainable Manufacturing Systems Centre at Cranfield University
… The existing model for manufacturing vaccines is geared towards the economies of scale demanded by commerce: huge factories producing a product for a global market. Cranfield is working closely with Imperial on the engineering and manufacturing aspects of the Hub to find workable models of production: novel kinds of processing equipment, strategies for supply chains, storage and distribution linked to the pop-up operations. Once data has been analysed and models tested as digital versions, there are expected to be trials of working operations in the partner countries in 2019.
Ultimately, the work of the Hub is about independence – enabling more countries, and particularly those in the developing world, to access a cost-effective way of meeting their needs for vaccines as they arise rather than being dependent on systems of global business. At the heart of the threat from pandemics is the issue of globalisation, of a world that has been shrinking, where there are very few locations or communities that aren’t inter-linked in some way with every other. Inter-dependencies continue to grow and become more complex, meaning, in many cases including health, we can’t afford to think solely in terms of national interests.
 
 
New York Times
http://www.nytimes.com/
Accessed 12 May 2018
Health
Ebola Erupts Again in Africa, Only Now There’s a Vaccine
12 May 2018

Security Tight as Pakistan Starts 5-Day Anti-Polio Drive
7 May 2018
A Pakistani health official says a five-day anti-polio drive has been launched in the country to vaccinate millions of children under five years of age against the crippling disease. Aimal Khan, a spokesman with the anti-polio drive, says the campaign was launched on Monday amid tight security. He says a total of 23.8 million children are to be vaccinated in the campaign, which involves a total of 161,000 health workers in 109 districts…

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_5 May 2018

– blog edition: comprised of the approx. 35+ entries posted below.

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Milestones :: Perspectives

World Health Assembly
21–26 May 2018
Geneva
Main Documents: http://apps.who.int/gb/e/e_wha71.html
A71/1 – Provisional agenda

Milestones :: Perspectives

Vaccination: Commission calls for stronger EU cooperation against preventable diseases  
European Commission – Press release
Brussels, 26 April 2018
Today, the Commission is issuing a set of recommendations for how the EU can strengthen cooperation in the fight against diseases that can be prevented by vaccines. This follows President Juncker’s call, in his 2017 State of the Union address, for action to increase vaccination coverage and to ensure that everyone in the EU has access to vaccines.

Commissioner for Health and Food Safety, Vytenis Andriukaitis said: ”Vaccination is one of the most powerful and cost-effective public health measures developed in the 20th century. As a medical doctor, I find it disheartening to witness children dying because of low uptake, vaccine hesitancy, or vaccine shortages. Infectious diseases are not confined within national borders. One Member State’s immunisation weakness puts the health and security of citizens at risk across the EU. Cooperating in this area is in all of our interests. Protect our children, vaccinate!”

Vaccination saves between 1 and 3 million lives worldwide every year. According to the World Health Organisation, vaccines will save 25 million more lives in the coming decade. And yet, according to ECDC, several EU countries are facing unprecedented outbreaks of measles and a resurgence of other vaccine-preventable diseases due to insufficient vaccination coverage, and children and adults in the EU are still dying from these diseases.

The Commission’s proposal focuses on 3 main pillars for action: tackling vaccine hesitancy and improving vaccination coverage; sustainable vaccination policies in the EU; and EU coordination and contribution to global health.

The proposal calls for 20 concrete actions by the Commission and Member States, including:
:: Developing and implementing national and/or regional vaccination plans by 2020, including a target of at least 95% vaccination coverage for measles;
:: Introducing routine checks of vaccination status and regular opportunities to vaccinate across different stages of life, for example in schools and workplaces;
:: Presenting options for a common vaccination card that can be shared electronically across borders;
:: Establishing a European vaccination information portal by 2019 to provide online objective, transparent and updated evidence on the benefits and safety of vaccines;
:: Mitigating the risks of shortages by developing a virtual repository EU data warehouse with information on vaccine stocks and needs to facilitate voluntary exchange of information on available supplies and shortages of essential vaccines;
:: Equipping all healthcare workers with the necessary training to confidently deliver vaccinations and address hesitant behaviours;
:: Convening a Coalition for Vaccination to bring together European associations of healthcare workers as well as relevant students’ associations in the field, to commit to delivering accurate information to the public, combating myths and exchanging best practice;
:: Establishing a European Information Sharing System to gather knowledge and develop guidelines for a core EU vaccination schedule by 2020 with doses and ages that EU Member States agree as being common to all countries;
:: Strengthening partnerships and collaboration on vaccination with international partners.

…Next steps
The Commission’s proposal for a Council recommendation will be discussed by the Council, with the aim of seeing it adopted before the end of 2018, with an immediate entry into force. Following this, every 3 years the Commission will report on progress made in the implementation of the recommendation. In addition the Commission will also produce a report on ‘The State of Confidence in Vaccines in the EU’, to monitor attitudes towards vaccination, in the context of the State of Health in the EU process.

Questions & Answers: EU cooperation on vaccine preventable diseases
26/04/2018  –
 

Milestones :: Perspectives

Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12,000 this year
04-05-2018
Over 12 000 people have been infected with measles in Ukraine so far this year. Of those affected, 9158 have required hospitalization and 9 have died, according to information provided by national health authorities as of 27 April 2018. Large-scale outbreak response measures have been undertaken since the start of the outbreak in 2017 to curb further spread of the disease and restore high routine immunization coverage.

“Ukrainian health authorities, with WHO and UNICEF support, have recovered huge ground in the fight against measles. But there are still many vulnerable children and adults in the country; and this highly infectious disease continues to find them,” says Marthe Everard, WHO Representative in Ukraine. “More needs to be done to ensure that everyone is protected.”

Dramatic drop in immunization coverage
In 2008, 95% of eligible children in Ukraine received their second (and final) recommended dose of measles-mumps-rubella vaccine (MMR) on time according to the national routine schedule. By 2016, this rate had fallen to 31%, the lowest coverage in the WHO European Region and among the lowest in the world. In addition, in 2016 only 19% of children received the third recommended vaccine dose of diphtheria-tetanus-pertussis (DTP) and 56% of children received the third recommended dose of oral polio vaccine (OPV).

This tragic nationwide drop in immunization coverage left an increasing number of children in Ukraine susceptible to dangerous, preventable diseases. Among these dangers, it created the ideal setting for the extensive spread of measles, one of the most infectious diseases affecting humans. Measles can affect people of all ages, but infants, young children and older adults are the most at risk of serious measles-related complications and death.

Large-scale outbreak response
Since July 2017, a national Measles Task Force, including the Ministry of Health, key stakeholders and partners such as WHO and the United Nations Children’s Fund (UNICEF), has been working to:
:: vaccinate every eligible child as they reach the appropriate age for MMR vaccination according to the national routine immunization schedule;
:: vaccinate every child who missed routine immunization in the past;
:: train laboratory staff to ensure early detection of all measles (and rubella) cases;
:: inform health-care professionals and parents about the disease and the importance of ensuring that children and their families are fully protected;
:: ensure the availability of vaccines at all vaccination points.

During European Immunization Week (23–29 April 2018) stakeholders were sensitized to the importance of immunization. Kicking off with a press conference on 23 April, events involving the Ministry of Health, WHO, UNICEF, Rotary International and national Rotary clubs, a parents group (Parents for Immunization), bloggers and even participants dressed as super heroes, included a national conferences with opinion leaders, a flash mob at schools in Kyiv, a webinar on vaccination and a roundtable discussion with paediatricians.

Routine immunization coverage back on track and pool of vulnerable people shrinking
By the end of 2017, routine vaccination coverage had drastically improved compared to previous years: 93% of 1-year-olds received the first dose of MMR on time in 2017 and 91% of 6-year-olds received their second dose as recommended. Figures for January and February 2018 indicate that the country is on track to reach at least 95% routine coverage with both doses of MMR vaccine by the end of the year.

If Ukraine can reach and sustain this target, it will prevent the renewed accumulation of susceptible individuals and ultimately protect the population from future outbreaks of measles…

Milestones :: Perspectives

NFID Recognizes Infectious Disease Heroes and Calls for 2019 Awards Nominations
BETHESDA, Md., May 1, 2018 /PRNewswire-USNewswire/ — To mark its 45th anniversary, the National Foundation for Infectious Diseases (NFID) will celebrate three infectious disease heroes during the 2018 annual awards dinner on the evening of May 10, at the historic Willard InterContinental Washington, D.C.

The 2018 NFID awardees are:
   Roger I. Glass, M.D., Ph.D., Director of the Fogarty International Center at the National Institutes of Health, is the recipient of the 2018 Jimmy and Rosalynn Carter Humanitarian Award in recognition of his lasting contributions to improving children’s health worldwide, including novel scientific research for the prevention of gastroenteritis from rotaviruses and noroviruses.
   Kathryn M. Edwards, M.D., Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt University School of Medicine, is the recipient of the 2018 Maxwell Finland Award for Scientific Achievement as one of the world’s authorities on vaccinology, pediatric respiratory infections and pneumococcal disease, who has conducted pivotal studies on vaccine-preventable diseases and vaccine safety that have transformed the field and driven policy change.
   Anne Schuchat, M.D., (Rear Adm., U.S. Public Health Service), Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), is the recipient of the 2018 John P. Utz Leadership Award in recognition of her outstanding leadership throughout her long-standing tenure at CDC, her ongoing dedication to mentoring future generations of infectious disease professionals and her continued support of NFID.

“As NFID celebrates 45 successful years of providing education about the causes, prevention and treatment of infectious diseases, we are proud to honor these three outstanding infectious disease heroes,” said Marla Dalton, CAE, Executive Director and Chief Executive Officer of NFID. “Drs. Glass, Edwards and Schuchat have saved countless lives through their collective work on serious infectious diseases and public policy.”…

Featured Journal Content
 
The Lancet
May 05, 2018 Volume 391 Number 10132 p1749-1864
http://www.thelancet.com/journals/lancet/issue/current

Perspectives
Roger Glass: celebrating the Fogarty at 50
Marianne Guenot
Published: 05 May 2018
At the Fogarty International Center, “we’re small, but we’re catalytic”, says Roger Glass, the centre’s Director and Associate Director for International Research at the US National Institutes of Health (NIH). The Fogarty celebrates its 50th anniversary this month and has been under Glass’s leadership since 2006. By training scientists, supporting research, and building partnerships, the Fogarty serves a bridge between the NIH and the global health community. Since its creation in 1968, about 6000 scientists have received research training through its programmes and the centre funds about 500 projects. “We really invest in capacity building of young people interested in research in biomedical and health sciences”, says Glass. “I visit institutes and attend meetings in Africa, Asia, and Latin America and people come up to me and say ‘I was a Fogarty trainee and that experience transformed my career!’ It brings a smile to my face.” Many Fogarty trainees and grantees become leaders in health, politics, and other fields.

It was his work with diarrhoeal diseases that brought Glass into global health. After medical and public health studies at Harvard, he did research on cholera at the then International Centre for Diarrheal Disease Research in Bangladesh in 1979 for the US Centers for Disease Control and Prevention (CDC). He joined the NIH’s Laboratory of Infectious Diseases in 1984 and 2 years later became Chief of the CDC’s Viral Gastroenteritis Unit, a role he held until 2006. His work focused on rotavirus research. “Because new diagnostics were available, we developed epidemiologic and laboratory methods…we trained people from probably 50 countries around the world to conduct surveillance of rotavirus and participate in a global surveillance network now run by WHO. That surveillance system is ongoing today in over 60 countries, now managed by WHO and PAHO”, he explains.

The development of a rotavirus vaccine took another 30 years; the Indian Neonatal Rotavirus Vaccine Project, begun in 1985 as a collaboration with Maharaj Krishan Bhan and other colleagues, led to the licensure of the oral rotavirus vaccine, Rotavac. “Earlier vaccines from the multinational manufacturers worked well but were too costly for low-income countries”, he says. Glass and coworkers set out to develop a more affordable vaccine through a public–private partnership. “Through this extraordinary partnership, this vaccine probably cost less than US$80 million to develop compared with Big pharma that claims that a new vaccine would cost half a billion or more to produce”, he says. In 2016, the Indian Government introduced the vaccine into its national immunisation programme and on Jan 24, 2018, Rotavac was prequalified by WHO for distribution by UNICEF and Gavi, the Vaccine Alliance.

Glass’s work on enteric and diarrhoeal diseases has taken him to many countries and he is fluent in five languages, in which he often lectures and engages with researchers. “I learned from the experience that if you get people involved in research on an important problem early on in their career, many will end up pursuing this for their career, a great return on investment”, he says. Glass is proud of the Fogarty’s ability to accelerate globalisation of health research and training because he “feels strongly that we must take science where the problems are and where we can most rapidly seek their solutions”. Fogarty programmes have facilitated research and training collaborations between academic institutions in the USA and in low-income and middle-income countries. “We have no monopoly on knowledge in the USA, good ideas come from all over…We only have to listen, and maybe help them or bring something else to the table.”

A recent turning point, says Michele Barry, Senior Associate Dean for Global Health and Director of the Center for Innovation in Global Health at Stanford University, was when the Trump administration “tried to zero out the budget at Fogarty” in 2017. “Roger had so many supporters around the world that we all came together to stage a campaign. This was really because of Roger’s leadership”, says Barry, who has served on Fogarty’s advisory board. The centre’s budget for this year was not reduced.

Looking to the future, Glass thinks that while infectious diseases and pandemic control remain important, non-communicable diseases (NCDs) and environmental health will increasingly shape global health research. “There is an explosion of new research tools—in point-of-care diagnostics, genomics, mHealth, imaging—that will change our ability to work in the global space”, he says. Glass points out that “solutions will depend upon other partners—in business to consider supply chain logistics to deliver services, drugs, and vaccines; bioengineering to develop low-cost technologies and devices; law to write documents like the Framework Convention on Tobacco Control or laws to instate taxes to reduce the sugar content of beverages or the salt content of foods”.

Glass will be presented with the National Foundation for Infectious Diseases’ Jimmy and Rosalynn Carter Humanitarian Award on May 10. He is “optimistic about the future of the Fogarty International Center”, he says. “Our trainees and grantees have been on the cutting edge of research to make HIV/AIDS a chronic, treatable disease, of combating Ebola and Zika outbreaks, and of establishing research platforms in low- and middle-income countries. Fogarty trainees and grantees today will be on the cutting edge of research and leadership into the critical health problems of the NCDs, as well as the next pandemics of tomorrow.”

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1 May 2018 [GPEI]
:: In Iraq, polio vaccinators work to protect conflict-affected children.
:: In preparation for the Seventy-first World Health Assembly, taking place on 21-26 May, the Director-General’s office has finalized the Strategic Action Plan on Polio Transition. The Plan has three strategic objectives, which are highly interlinked:

1. a) Sustaining a polio-free world after eradication (with the Post-Certification Strategy as its main pillar);
2. b) Strengthening immunization systems;
3. c) Strengthening emergency preparedness, detection and response capacity.

The Plan aims at aligning these objectives with the overall vision of the 13th General Programme of Work and WHO’s support at the country level, with the eventual phasing out of resources from the Global Polio Eradication Initiative. The action plan in all official UN languages may be found here.

Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1)  positive environmental sample has been reported, in Kandahar province.
Pakistan: Five new wild poliovirus type 1 (WPV1)  positive environmental samples have been reported, one in Balochistan province, two in Khyber Pakhtunkhwa province, and two in Sindh province.
Nigeria: Three circulating vaccine-derived poliovirus type 2 (cVDPV2)  positive environmental samples have been confirmed, one in Gombe province, and two in Jigawa province.

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WHO Grade 3 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

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WHO Grade 2 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

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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. 

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia
:: Humanitarian Bulletin Somalia, 5 April – 2 May 2018
:: OCHA Somalia Flash Update #3 – Humanitarian impact of heavy rains | 2 May 2018
 

WHO & Regional Offices [to 5 May 2018]

UN’s Health and Development Agencies Join Forces for Good Health
4 May 2018
London
While real progress has been made on a number of serious health issues, half of the world’s citizens lack access to essential health services.
Today, the United Nations Development Programme (UNDP) and WHO signed a five year Memorandum of Understanding (MoU) to help support countries to achieve the health-related targets across the 2030 Agenda for Sustainable Development and the agenda’s commitment to leave no-one behind.
“Universal health coverage is a powerful tool not only for better health, but for reducing poverty, creating jobs, fueling inclusive economic growth and promoting gender equality,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “But achieving a healthier world is not a job for the health sector alone. By working with partners like UNDP, we can better address the social, economic and environmental determinants of health and make progress towards a fairer, safer and more prosperous future for everyone.”…

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GIN April 2018  pdf, 1.15Mb
2 May 2018

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Weekly Epidemiological Record, 4 May 2018, vol. 93, 18 (pp. 229–240)
:: Progress towards measles elimination, Western Pacific Region, 2013–2017
:: Monthly report on dracunculiasis cases, January-March 2018

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Wellbeing Foundation Africa seeks WHO’s support in major nationwide campaign to curb disease outbreaks.  04 May 2018
:: Uganda vaccinates more than 360,000 people against cholera  03 May 2018
:: Celebrating African Vaccination Week in Sierra Leone: “Vaccines work, do your part!”  29 April 2018

WHO Region of the Americas PAHO
:: PAHO/WHO calls for grant applications to support health policy, programs and systems on projects related to the SDGs (05/03/2018)
:: Bahamian pioneer in disease elimination is named a PAHO Health Hero of the Americas (05/03/2018)

WHO South-East Asia Region SEARO
:: Fast-track efforts to eliminate rabies: WHO
SEAR/PR/1688
Kathmandu, 3 May 2018: The World Health Organization today called upon Member States and partners to accelerate efforts to end rabies which causes 59 000 agonizing and painful deaths globally every year, one person every nine minute, mostly children and the poor.
Eight of the 11 Member countries of WHO South-East Asia Region account for nearly 26 000 rabies deaths, 45% of the global rabies toll, as over 1.5 million people in the Region remain at risk of rabies.
“Human rabies is caused mostly by dogs and can be eliminated by increasing awareness about the disease, vaccinating dogs and most importantly by making the already available life-saving rabies vaccines, medicines, tools and technologies affordable and available to all. We can, and must break the disease cycle and save lives,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, told the global meeting ‘Driving progress towards rabies elimination’ here.
At the meeting, the global rabies partners comprising of WHO, OIE, FAO and UNICEF and rabies endemic countries from Asia-Pacific and Africa, shared and deliberated on measures to fast-track elimination of dog transmitted rabies by 2030.
Countries from Africa and Asia, including Bangladesh, Bhutan, Cambodia, India, Kenya, Nepal, Sri Lanka and Vietnam, who have assessed access, delivery and distribution of rabies post-exposure prophylaxis, shared outcomes of their studies. These studies were conducted with WHO support to enable GAVI take an informed decision to support rabies vaccines. The rabies endemic countries are seeking GAVI support to improve affordability and access to rabies vaccines for vulnerable populations, of which many are children…
 
WHO European Region EURO
:: Celebrating nurses’ and midwives’ role in bringing health services to everyone, everywhere 04-05-2018
:: Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12 000 this year 04-05-2018
:: Hand Hygiene Day: It’s in your hands – prevent sepsis in health care 03-05-2018
:: Over half a million premature deaths annually in the European Region attributable to household and ambient air pollution 02-05-2018
:: New law on cigarettes and tobacco coming into effect in Georgia 01-05-2018

WHO Eastern Mediterranean Region EMRO
:: Statement on the death of a WHO team member in Somalia  2 May 2018
WHO Director-General visits Saudi Arabia  30 April 2018

WHO Western Pacific Region
:: One third of global air pollution deaths in Asia Pacific
MANILA, 2 MAY 2018 – Air pollution levels remain dangerously high in many parts of Asia according to new data from the World Health Organization (WHO). Around one third, or 2.2 million of the world’s 7 million premature deaths each year from household (indoor) and ambient (outdoor) air pollution are in the WHO Western Pacific Region—home to one quarter of the world’s population.

CDC/ACIP [to 5 May 2018]

http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for May 3, 2018
Progress Toward Measles Elimination – Western Pacific Region, 2013-2017
2017 saw the lowest rate of new measles cases ever recorded in the WHO Western Pacific Region, 5.2 per million population. However, outbreaks in several countries and an overall increase in cases between 2013 and 2016 indicate countries must continue to strengthen immunization systems, maintain high-quality surveillance, and improve outbreak response in order to achieve regional measles elimination. In 2017, rates of new measles cases in the WHO Western Pacific Region were lower than they have ever been, but recent outbreaks and a rise in cases shows more work needs to be done to completely eliminate the disease from the region. Measles cases decreased substantially in the WHO Western Pacific Region to a low of 5.9 per million population in 2012. During 2013–2016, however, measles cases rose sharply due to large-scale outbreaks in Mongolia, the Philippines, and Vietnam. There was also increased measles transmission in China. Cases rose from 19.2 cases per million population in 2013 to 68.9 in 2014. After controlling the outbreaks, cases in the region decreased to 5.2 per million in 2017, a new historic low. The recent measles resurgence demonstrates a need for collective efforts by countries to achieve high population immunity, strengthen immunization systems, maintain high-quality surveillance, and improve outbreak preparedness and response, so that measles can be eliminated from the region.

Register for upcoming June ACIP meeting
June 20-21, 2018
Deadline for registration:
Non-US Citizens: May 16, 2018
US Citizens: June 11, 2018
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
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ECDC – European Centre for Disease Prevention and Control  [to 5 May 2018]
https://ecdc.europa.eu/en/home
27 Apr 2018
Communicable disease threats report, 29 April – 5 May 2018, Week 18
Publication series: Communicable Disease Threats Report (CDTR)
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 22-5 May 2018 and includes updates on dengue, chikungunya, seasonal influenza, yellow fever, gonorrhoea and cholera.

Announcements

European Medicines Agency  [to 5 May 2018]
http://www.ema.europa.eu/ema/
02/05/2018
EMA 2017 annual report published
Report highlights major achievements and includes key figures …

30/04/2018
Update of EU recommendations for 2018/2019 seasonal flu vaccine composition
Update to recommendations issued in March 2018 …

 
European Vaccine Initiative  [to 5 May 2018]
http://www.euvaccine.eu/news-events
04 May 2018
EVI 20th Anniversary Symposium
EVI 20th Anniversary Symposium in Heidelberg, Germany, 20-21 November 2018
 
Gavi [to 5 May 2018]
http://www.gavi.org/library/news/press-releases/
02 May 2018
Cervical cancer vaccine introduced in Zimbabwe
800,000 girls to be protected against disease following introduction of HPV vaccine.
Geneva, 2 May 2018 – Girls across Zimbabwe will be protected against one of the country’s most deadly diseases following the introduction of Human Papillomavirus (HPV) vaccine into the country’s routine immunisation programme, First Lady of Zimbabwe Auxillia C. Mnangagwa announced today at a launch ceremony in Harare.
The vaccines, which will be funded by Gavi, the Vaccine Alliance and the Government of Zimbabwe, will reach over 800,000 girls aged between 10-14 years old across the country. UNICEF, WHO and partners will work alongside the Zimbabwe Ministry of Health on implementation…
 
 
IAVI  [to 5 May 2018]
https://www.iavi.org/
No new digest content identified
CSIS – Pursuing a Vaccine for HIV
May 3, 2018 | By Sara M. Allinder Podcast Episode
Despite substantial progress made in expanding access to HIV/AIDS treatment and prevention options, a vaccine for HIV—even an imperfect one—is likely needed to put a durable end to the epidemic. In this episode of Take as Directed, Dr. Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI) discusses the landscape of HIV vaccine development and why he thinks a vaccine remains a necessary pursuit. Dr. Feinberg also discusses the facilitating role that IAVI plays in the HIV vaccine development process.
 
 
MSF/Médecins Sans Frontières  [to 5 May 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Libya: Time Running Out For Hundreds of Migrants and Refugees in Dangerously Overcrowded Detention Center
May 03, 2018
Hundreds of migrants and refugees are being held in a dangerously overcrowded detention center in Libya, without adequate food or water and in inhumane conditions, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned today.

Press release
Greece: As Prime Minister Visits Lesvos, Moria Camp is Overcrowded, Dangerous and Without Adequate Health Care
May 03, 2018
As the Greek Prime Minister, Alexis Tsipras, visits Lesvos for a regional conference, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warns that thousands of men, women, and children in Lesvos are living in squalid, overcrowded conditions in Moria camp, with insufficient access to health care.

Press release
Preventive Oral Cholera Vaccination Campaign Underway in Juba, South Sudan
May 01, 2018
Working with the health authorities and partners, Doctors Without Borders/Médecins Sans Frontières (MSF) is carrying out a four-week preventive oral cholera vaccination campaign in Juba, to increase the immunity of people at risk of this deadly disease.

 
NIH  [to 5 May 2018]
http://www.nih.gov/news-events/news-releases
May 4, 2018
NIAID-Sponsored Trial of a Universal Influenza Vaccine Begins
— Phase 2 clinical trial of investigational universal influenza vaccines has begun in the U.S.

Essential malaria parasite genes revealed
May 3, 2018 — NIAID-funded research could aid antimalarial drug development
 
 
PATH  [to 5 May 2018]
http://www.path.org/news/index.php
Announcement | May 04, 2018
PATH names Michael Fahey as Chief Information Officer
 

UNAIDS [to 5 May 2018]
http://www.unaids.org/en
04 May 2018
Update
Metrics matter in identifying gaps and key populations to find solutions in each country
The International Association of Providers of AIDS Care (IAPAC) hosted its 2018 Controlling the HIV Epidemic Summit in Geneva, Switzerland, on 3 and 4 May. Speakers at the summit discussed new metrics for assessing progress in national and subnational HIV responses as well as scaling up HIV services to include other health conditions, such as tuberculosis…

Feature story
South Africa tests ATMs for medicine
03 May 2018
People living with HIV and other chronic illnesses are getting faster, simpler access to essential medicines thanks to new medicine dispensing machines being piloted in Johannesburg, South Africa.
The non-profit organization Right to Care is testing three pharmacy dispensing units at a shopping mall and two hospitals. Most of the people using the new machines are accessing repeat prescriptions for HIV medicines…

UNICEF  [to 5 May 2018]
https://www.unicef.org/media/
Selected Press Releases
UN urges the world to act now to save lives in West Africa’s Sahel
DAKAR, 3 May 2018 – Drought, high food prices and conflict are set to drive millions of people into acute hunger and malnutrition in parts of West Africa’s Sahel, if the global community does not act now, three United Nations agencies warned today.

Over 140 million children at greater risk of illness as they miss life-saving vitamin A supplements
NEW YORK, 2 May 2018  – Over 140 million children are at greater risk of illness, hearing loss, blindness and even death if urgent action is not taken to provide them with life-saving vitamin A supplements, warns UNICEF in a new report released today. Two doses of vitamin A every year can save thousands of children’s lives, yet as the report finds, the coverage of this low-cost intervention fell alarmingly in 2016.

Geneva Palais briefing note: 55,000 Rohingya refugee children at risk due to floods and landslides as pre-monsoon rains start in Bangladesh
GENEVA, 1 May 2018 – This is a summary of what was said by Christophe Boulierac, UNICEF spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

Wellcome Trust  [to 5 May 2018]
https://wellcome.ac.uk/news
Published: 3 May 2018
Policies to promote positive research cultures
Alyson Fox, our Director of Grants, explains how Wellcome’s grant conditions and policies help great ideas to thrive.
Today, Wellcome is introducing a new policy that clarifies our responsibilities as a funder in relation to bullying and harassment. In it, we set out what we expect from researchers we fund and the organisations that employ them, to ensure that people involved in Wellcome-funded activities are treated with dignity and respect.
This complements our guidelines on good research practice, updated in April, and other policies currently under review, including those on clinical trials and intellectual property…

Lassa fever: what Wellcome is doing to support Nigerian research
Explainer / Published: 1 May 2018
In mid-February, the World Health Organisation (WHO) announced a scaled-up response to the outbreak of Lassa fever in Nigeria. Josie Golding explains what Wellcome is doing to help. 

Can AI improve health for everyone? We want to fund research to find out
News / Published: 30 April 2018
Wellcome has commissioned a new report that focuses on the ethical, social and political challenges of using artificial intelligence (AI) in health. And to respond to the issues this raises, we’re launching AI-themed Seed Awards. Dan O’Connor, head of Wellcome’s Humanities and Social Science team, explains…
Wellcome has partnered with think-tank Future Advocacy (opens in a new tab) to produce a report: Ethical, social and political challenges of artificial intelligence in health [PDF 5MB].

Eight cutting-edge immunology projects we fund
Published: 29 April 2018
29 April is World Immunology Day 2018. Divya Shah and Pete Gardner, from our Science team, highlight some of the researchers we fund who are exploring different aspects of immunology and the immune system.

Industry Watch    [to 5 May 2018]
:: FDA Grants PaxVax Fast Track Designation for its Chikungunya Vaccine
May 4, 2018 /PRNewswire/ — PaxVax, a leading independent specialty vaccine company, announced today that it has received Fast Track designation from the U.S. Food and Drug Administration (FDA) for its vaccine for the prevention of disease caused by the chikungunya virus.

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org
 
 
A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region
WHO Health Evidence Network Synthesis Reports 53.  – 55 pages
Editors – De Vito E, Parente P, de Waure C, Poscia A, Ricciardi W.
Source – Copenhagen: WHO Regional Office for Europe; 2017.
PDF: https://www.ncbi.nlm.nih.gov/books/n/whohen53/pdf/
Excerpt
This review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services. Evidence was obtained by a scoping review of academic and grey literature in English and a further 11 languages and included official documents available from the websites of ministries of health and national health institutes of the WHO European Region Member States. The review highlights that vaccination policies tailored to migrants and refugees are very heterogeneous among WHO European Region Member States. By comparison, common barriers for the implementation and utilization of immunization services can be identified across countries. Outlined policy options are intended to strengthen information about immunization for migrants and refugees, support future evidence-informed policy-making, enable the achievement of national vaccination coverage goals and improve the eligibility of migrants and refugees to access culturally competent immunization services.
 
SUMMARY
The issue
Providing equitable access to safe and cost-effective vaccines is vital to protect vulnerable groups in any country and to reduce morbidity and mortality from vaccine-preventable diseases (VPDs), particularly among children. Migrants and refugees in the WHO European Region may be particularly vulnerable to VPDs. Children, who constitute approximately 25% of the total migrant population, are considered at greatest risk of VPDs because they may not have yet been vaccinated or may not have completed the schedule for all vaccines. In November 2015, WHO, the United Nations High Commissioner for Refugees and the United Nations Childrens Fund made a joint recommendation that migrants and refugees in the WHO European Region should be vaccinated without unnecessary delay according to the immunization schedule of the host countries. The WHO European Region’s Strategy action plan and resolution on refugee and migrant health, adopted in September 2016, addresses the issue of immunization among migrants and refugees.

The synthesis question
The objective of the review is to address the following question: “What is the evidence on equitable delivery, access and utilization of immunization services for migrants and refugees within WHO European Region?” The review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services.

Types of evidence
Evidence was obtained by a scoping review of academic and grey literature, in English and Russian, including official documents available from the websites of ministries of health and national health institutes in the Region. A total of 56 articles/papers/documents published between 2007 and July 2017 were considered for this review.

Results
Immunization policies, vaccine delivery practices and barriers to access and utilization of immunization services by migrants and refugees vary widely in WHO European Region:
:: national immunization programmes seldom include specific recommendations for immunization for migrants and refugees;
:: fewer than one third of the countries have specific directives on immunization focusing on migrants and refugees, including children and pregnant women;
:: undocumented migrants receive immunization services in very few countries because of inbuilt administrative barriers in the host countries related to their entitlement to free health services, including immunization;
:: in most of the countries of the Region, the delivery of immunization services is primarily carried out by the public health care systems, but international organizations and nongovernmental organizations are also involved in a few;
:: lack of financial and human resources, in particular cultural mediators and/or interpreters, is seen as a barrier to the effective implementation of national immunization policies and to the systematic collection and evaluation of data for corrective actions;
:: socioeconomic, sociocultural and educational issues remain important obstacles for migrants and refugees in accessing the available immunization services in the host countries; and
:: targeted interventions have been shown to be successful in improving the uptake of immunization programmes among migrants and refugees, for example door-to-door vaccination initiatives, media campaigns, thematic lectures, peer-to-peer interactions and health promotion days.

Policy considerations
A systemic and tailored approach to the management of immunization among migrants and refugees is critical. Adequate protection of migrants and refugees from VPDs may require long-term strategies by national health systems. This review suggests the following policy options to be considered by policy-makers in strengthening immunization for migrants and refugees in the WHO European Region.

:: Ensure national policies are in place for provision of equitable and high-quality
immunization services tailored to migrant and refugee populations:
– national immunization programmes should ensure that migrants and refugees benefit from easy access to the vaccines offered free of charge under the national vaccination schedule; and
– appropriate strategies, such as outreach activities, and existing initiatives, such as tailored immunization programmes, should be considered to improve the delivery and uptake of vaccines.

:: Provide appropriate administrative mechanisms and ensure political commitment to address the existing barriers to vaccination service delivery and utilization; useful interventions include:
– interpreters and cultural mediators to support interactions;
– provision of information in the languages of the migrants;
– models for collection of relevant data on migrants and refugees that avoid issues of stigma and discrimination;
– effective collaboration on service delivery between national health services, existing social services networks and local service providers in the country;
– provision of adequate training and culturally relevant information for health care professionals to ensure that they understand the specific needs of the migrants and refugees they link with and can avoid detrimental inappropriate behaviours and/or stereotypical attitudes; and
– inclusive decision-making that involves migrants and refugees during planning and implementation of vaccination programmes.

:: Promote strategies to address wider issues such as marginalization, health literacy and other social determinants of health that contribute to low vaccination coverage among migrants and refugees.

:: Develop realistic implementation plans together with a robust monitoring and evaluation framework to review existing policies periodically in light of population movement and VPD epidemiology in the host countries.

:: Foster research to further understand and address the barriers related to immunization service delivery and utilization in these groups.

:: Devise appropriate mechanisms to promote cross-border collaboration and sharing of good practices among countries in the Region.

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 focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 5 May 2018)

Research article
|   2 May 2018
Clinical trial registration and reporting: a survey of academic organizations in the United States
Many clinical trials conducted by academic organizations are not published, or are not published completely. Following the US Food and Drug Administration Amendments Act of 2007, “The Final Rule” (compliance date April 18, 2017) and a National Institutes of Health policy clarified and expanded trial registration and results reporting requirements. We sought to identify policies, procedures, and resources to support trial registration and reporting at academic organizations.
Authors: Evan Mayo-Wilson, James Heyward, Anthony Keyes, Jesse Reynolds, Sarah White, Nidhi Atri, G. Caleb Alexander, Audrey Omar and Daniel E. Ford

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Patients’ understanding of telemedicine terms required for informed consent when translated into Kiswahili
In Africa, where access to specialist medical services is often limited, telemedicine, the use of information and communication technologies for the provision of healthcare at a distance, can contribute towards enhancing access to healthcare. Informed consent is considered the cornerstone of ethical practice, especially when technology and techniques are considered new and or unproven. It is advised that informed consent should be gained in the patient’s mother tongue. However, many African languages have not kept pace with technology and lack the words and terms needed to describe computing and technical terms. Additionally, even when present, patients may not understand these words and terms. This affects the validity of informed consent given.
Authors: Rachael Odhiambo and Maurice Mars
Citation: BMC Public Health 2018 18:588
Published on: 3 May 2018

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Vaccination hesitancy in the antenatal period: a cross-sectional survey
Recent reports of childhood vaccination coverage in Australia have shown steadily improving vaccination coverage and narrowing differences between highest and lowest coverage regions, yet the NSW North Coast c…
Authors: Paul Corben and Julie Leask
Citation: BMC Public Health 2018 18:566
Published on: 2 May 2018

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture – a qualitative survey
Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes…
Authors: Pierre Verger, Aurélie Bocquier, Chantal Vergélys, Jeremy Ward and Patrick Peretti-Watel
Citation: BMC Public Health 2018 18:569
Published on: 2 May 2018

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Debate
The value of program science to optimize knowledge brokering on infectious diseases for public health
Knowledge translation (KT) and related terms have variously been defined as process and as products. In this paper we contribute to debates on effective KT, specifically knowledge brokering, by describing an a…
Authors: Marissa Becker, Margaret Haworth-Brockman and Yoav Keynan
Citation: BMC Public Health 2018 18:567
Published on: 2 May 2018

Bulletin of the World Health Organization
Volume 96, Number 5, May 2018, 297-368
http://www.who.int/bulletin/volumes/96/5/en/

EDITORIALS
Potential yellow fever epidemics in unexposed populations
Duane J Gubler
http://dx.doi.org/10.2471/BLT.18.213298

Bulletin of the World Health Organization
Volume 96, Number 5, May 2018, 297-368
http://www.who.int/bulletin/volumes/96/5/en/

Research
Evaluation of the EpiCore outbreak verification system
Taryn Silver Lorthe, Marjorie P Pollack, Britta Lassmann, John S Brownstein, Emily Cohn, Nomita Divi, Dionisio Jose Herrera-Guibert, Jennifer Olsen, Mark S Smolinski & Lawrence C Madoff
Abstract
Objective
To describe a crowdsourced disease surveillance project (EpiCore) and evaluate its usefulness in obtaining information regarding potential disease outbreaks.
Methods
Volunteer human, animal and environmental health professionals from around the world were recruited to EpiCore and trained to provide early verification of health threat alerts in their geographical region via a secure, easy-to-use, online platform. Experts in the area of emerging infectious diseases sent requests for information on unverified health threats to these volunteers, who used local knowledge and expertise to respond to requests. Experts reviewed and summarized the responses and rapidly disseminated important information to the global health community through the existing event-based disease surveillance network, ProMED.
Findings
From March 2016 to September 2017, 2068 EpiCore volunteers from 142 countries were trained in methods of informal disease surveillance and use of the EpiCore online platform. These volunteers provided 790 individual responses to 759 requests for information addressing unverified health threats in 112 countries; 361 (45%) responses were considered to be useful. Most responses were received within hours of the requests. The responses led to 194 ProMED posts, of which 99 (51%) supported verification of an outbreak, were published on ProMED and sent to over 87 000 subscribers.
Conclusion
There is widespread willingness among health professionals around the world to voluntarily assist efforts to verify and provide supporting information on unconfirmed health threats in their region. By linking this member network of health experts through a secure online reporting platform, EpiCore enables faster global outbreak detection and reporting.

Bulletin of the World Health Organization
Volume 96, Number 5, May 2018, 297-368
http://www.who.int/bulletin/volumes/96/5/en/

International travel between global urban centres vulnerable to yellow fever transmission
Shannon E Brent, Alexander Watts, Martin Cetron, Matthew German, Moritz UG Kraemer, Isaac I Bogoch, Oliver J Brady, Simon I Hay, Maria I Creatore & Kamran Khan
http://dx.doi.org/10.2471/BLT.17.205658

Emerging Infectious Diseases
Volume 24, Number 5—May 2018
http://wwwnc.cdc.gov/eid/

Perspective
History of Mosquitoborne Diseases in the United States and Implications for New Pathogens PDF Version [PDF – 1.32 MB – 6 pages]
J. Moreno-Madriñán and M. Turell
Abstract
The introduction and spread of West Nile virus and the recent introduction of chikungunya and Zika viruses into the Americas have raised concern about the potential for various tropical pathogens to become established in North America. A historical analysis of yellow fever and malaria incidences in the United States suggests that it is not merely a temperate climate that keeps these pathogens from becoming established. Instead, socioeconomic changes are the most likely explanation for why these pathogens essentially disappeared from the United States yet remain a problem in tropical areas. In contrast to these anthroponotic pathogens that require humans in their transmission cycle, zoonotic pathogens are only slightly affected by socioeconomic factors, which is why West Nile virus became established in North America. In light of increasing globalization, we need to be concerned about the introduction of pathogens such as Rift Valley fever, Japanese encephalitis, and Venezuelan equine encephalitis viruses.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 5 May 2018]

Study Protocol
3 May 2018
How can the use of data within the immunisation programme be increased in order to improve data quality and ensure greater accountability in the health system? A protocol for implementation science study
Authors: Binyam Tilahun, Alemayehu Teklu, Arielle Mancuso, Zeleke Abebaw, Kassahun Dessie and Desalegn Zegey

Humanitarian Exchange Magazine
Number 71  March 2018
https://odihpn.org/magazine/humanitarian-response-urban-areas/

Humanitarian response in urban areas
Humanitarian crises are increasingly affecting urban areas either directly, through civil conflict, hazards such as flooding or earthquakes, urban violence or outbreaks of disease, or indirectly, through hosting people fleeing these threats. The humanitarian sector has been slow to understand how the challenges and opportunities of working in urban spaces necessitate changes in how they operate. For agencies used to working in rural contexts, the dynamism of the city, with its reliance on markets, complex systems and intricate logistics, can be a daunting challenge. Huge, diverse and mobile populations complicate needs assessments, and close coordination with other, often unfamiliar, actors is necessary.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Delayed measles vaccination of toddlers in Canada: Associated socio-demographic factors and parental knowledge, attitudes and beliefs
Simone Périnet, Marilou Kiely, Gaston De Serres & Nicolas L. Gilbert
Pages: 868-874
Published online: 16 Jan 2018

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Evaluation of potentially achievable vaccination coverage of the second dose of measles containing vaccine with simultaneous administration and risk factors for missed opportunities among children in Zhejiang province, east China
Yu Hu, Yaping Chen, Ying Wang & Hui Liang
Pages: 875-880
Published online: 23 Jan 2018

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Revisiting knowledge, attitudes and practice (KAP) on human papillomavirus (HPV) vaccination among female university students in Hong Kong
Jonathan Tin Chi Leung & Chi-kin Law
Pages: 924-930
Published online: 18 Jan 2018

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Parents’ attitude, awareness and behaviour towards influenza vaccination in Pakistan
Allah Bukhsh, Habib Rehman, Tauqeer Hussain Mallhi, Humera Ata, Inayat Ur Rehman, Learn-Han Lee, Bey-Hing Goh & Tahir Mehmood Khan
Pages: 952-957
Published online: 25 Jan 2018

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Impact of a website based educational program for increasing vaccination coverage among adolescents
Susanna Esposito, Sonia Bianchini, Claudia Tagliabue, Giulia Umbrello, Barbara Madini, Giada Di Pietro & Nicola Principi
Pages: 961-968
Published online: 22 Feb 2018

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Article
Timeliness of vaccination in infants followed by primary-care pediatricians in France
Anne-Charlotte Bailly, Pauline Gras, Jean-François Lienhardt, Jean-Christophe Requillart, François Vié-le-Sage, Alain Martinot & François Dubos
Pages: 1018-1023
Published online: 21 Dec 2017

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 14, Issue 4 2018
http://www.tandfonline.com/toc/khvi20/current

Meeting report
Report of the 5th European expert meeting on rotavirus vaccination (EEROVAC)
Marieke L. A. de Hoog, Timo Vesikari, Carlo Giaquinto, Hans-Iko Huppertz, Federico Martinon-Torres & Patricia Bruijning-Verhagen
Pages: 1027-1034
Published online: 18 Jan 2018

Infectious Agents and Cancer
http://www.infectagentscancer.com/content
[Accessed 5 May 2018]

Research Article
|   2 May 2018
Epidemiologic and economic burden of HPV diseases in Spain: implication of additional 5 types from the 9-valent vaccine
Authors: Noelia López, Aureli Torné, Agustín Franco, María San-Martin, Elisabet Viayna, Carmen Barrull and Nuria Perulero

Journal of Immigrant and Minority Health
Volume 20, Issue 3, June 2018
https://link.springer.com/journal/10903/20/3/page/1

Original Paper
Medical Care, Screening and Regularization of Sub-Saharan Irregular Migrants Affected by Hepatitis B in France and Italy
Cecilia Santilli

Journal of Infectious Diseases
Volume 217, Issue 11, 5 May 2018
https://academic.oup.com/jid/issue/217/1

Editor’s Choice
Relative Vaccine Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among Veterans Health Administration Patients
Yinong Young-Xu; Robertus Van Aalst; Salaheddin M Mahmud; Kenneth J Rothman; Julia Thornton Snider …
Using the prior event rate ratio approach, which controls for confounding from unmeasured variables, we found that, in protecting senior Veterans Health Administration patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine was more effective than a standard-dose vaccine.

Journal of Travel Medicine
Volume 25, Issue suppl_1, 1 May 2018
https://academic.oup.com/jtm/issue/25/suppl_1

Asian travel: from the rare to the difficult
Reviews
Cholera: under diagnosis and differentiation from other diarrhoeal diseases
Tristan P Learoyd, PhD; Rupert M Gaut, MSc
Journal of Travel Medicine, Volume 25, Issue suppl_1, 1 May 2018, Pages S46–S51, https://doi.org/10.1093/jtm/tay017
Abstract
Background
Globally 1.4 billion people are at risk from cholera in countries where the disease is endemic, with an estimated 2.8 million cases annually. The disease is significantly under reported due to economic, social and political disincentives as well as poor laboratory resources and epidemiological surveillance in those regions. In addition, identification of cholera from other diarrhoeal causes is often difficult due to shared pathology and symptoms with few reported cases in travellers from Northern Europe.
Methods
A search of PubMed and Ovid Medline for publications on cholera diagnosis from 2010 through 2017 was conducted. Search terms included were cholera, Rapid Diagnostic Test (RDT), multiplex PCR and diagnosis of diarrhoea. Studies were included if they are published in English, French or Spanish.
Results
An increase of RDT study publications for diarrhoeal disease and attempted test validations were seen over the publication period. RDTs were noted as having varied selectivity and specificity, as well as associated costs and local resource requirements that can prohibit their use.
Conclusions
Despite opportunities to employ RDTs with high selectivity and specificity in epidemic areas, or in remote locations without access to health services, such tests are limited to surveillance use. This may represent a missed opportunity to discover the true global presence of Vibrio cholerae and its role in all cause diarrhoeal disease in underdeveloped countries and in travellers to those areas. The wider applicability of RDTs may also represent an opportunity in the wider management of traveller’s diarrhoea.

The Lancet
May 05, 2018 Volume 391 Number 10132 p1749-1864
http://www.thelancet.com/journals/lancet/issue/current

Comment
Who is responsible for the vaccination of migrants in Europe?
Sally Hargreaves, Laura B Nellums, Mary Ramsay, Vanessa Saliba, Azeem Majeed, Sandra Mounier-Jack, Jon S Friedland
[See Research/Reports above for more detail]

The Lancet
May 05, 2018 Volume 391 Number 10132 p1749-1864
http://www.thelancet.com/journals/lancet/issue/current

Articles
Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40
Global Burden of Disease Health Financing Collaborator Network
Open Access
Background
Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.

The Lancet
May 05, 2018 Volume 391 Number 10132 p1749-1864
http://www.thelancet.com/journals/lancet/issue/current

Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015
Global Burden of Disease Health Financing Collaborator Network
Open Access
Background
Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries.

Pediatrics
May 2018, VOLUME 141 / ISSUE 5
http://pediatrics.aappublications.org/content/141/5?current-issue=y

Articles
Safety and Immunogenicity of a Recombinant Influenza Vaccine: A Randomized Trial
Lisa M. Dunkle, Ruvim Izikson, Peter A. Patriarca, Karen L. Goldenthal, Manon Cox, John J. Treanor
Pediatrics May 2018, 141 (5) e20173021; DOI: 10.1542/peds.2017-3021
Recombinant HA provided better protection than the inactivated influenza vaccine in adults ≥50 years old but lower immunogenicity in children <5 years old. In subjects 6 to 17 years old, immunogenicity was comparable.

PharmacoEconomics
Volume 36, Issue 5, May 2018
https://link.springer.com/journal/40273/36/5/page/1

Leading Article
Cost-Effectiveness Thresholds: the Past, the Present and the Future
Praveen Thokala, Jessica Ochalek, Ashley A. Leech, Thaison Tong
Abstract
Cost-effectiveness (CE) thresholds are being discussed more frequently and there have been many new developments in this area; however, there is a lack of understanding about what thresholds mean and their implications. This paper provides an overview of the CE threshold literature. First, the meaning of a CE threshold and the key assumptions involved (perfect divisibility, marginal increments in budget, etc.) are highlighted using a hypothetical example, and the use of historic/heuristic estimates of the threshold is noted along with their limitations. Recent endeavours to estimate the empirical value of the thresholds, both from the supply side and the demand side, are then presented. The impact on CE thresholds of future directions for the field, such as thresholds across sectors and the incorporation of multiple criteria beyond quality-adjusted life-years as a measure of ‘value’, are highlighted. Finally, a number of common issues and misconceptions associated with CE thresholds are addressed.