Think Tanks et al
 
 
Council on Foreign Relations
http://www.cfr.org/
Accessed 28 October 2017
Ending Polio in Nigeria Once and for All
Blog Post by Toyin Saraki
October 26, 2017

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_21 October 2017

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

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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.

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

Milestones :: Perspectives
 
Dr Mahmoud Fikri
WHO statement
17 October 2017
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization announces with great sadness the death of Dr Mahmoud M Fikri, WHO Regional Director for the Eastern Mediterranean.

The Organization extends its sincere condolences to Dr Fikri’s family and his colleagues and friends throughout WHO and the Eastern Mediterranean Region.

Dr Fikri assumed his duties as Regional Director on 1 February 2017. He was on his way to attend the WHO Global Conference on NCDs in Montevideo, Uruguay when he died.

Dr Fikri had previously served as Adviser to the Minister of Health of United Arab Emirates, and had been a prominent regional public health figure for many years.

WHO supports the immunization of 874,000 people against yellow fever in Nigeria
News release
16 October 2017 | Geneva – The Government of Nigeria has launched a campaign to immunize 873 837 people against yellow fever in the states of Kwara and Kogi.

The ten-day campaign began on Friday, 13 October 2017, and mobilizes more than 200 health workers and volunteers. It targets residents aged 9 months to 45 years old.

“This campaign aims to ensure that people living in high-risk areas are protected from yellow fever, and to prevent the disease from spreading to other parts of the country,” said Dr. Wondimagegnehu Alemu, WHO Nigeria Representative.

WHO has been working with health authorities on its implementation in nine local government areas in Kwara State and two in Kogi State.

Nigeria has requested support from the International Coordination Group (ICG) on vaccine provision for yellow fever. A global stockpile of 6 million doses of the yellow fever vaccine is available for countries to access, with the support of Gavi, the Vaccine Alliance.

WHO and health partners have been supporting the Government’s response to the outbreak since the first case of yellow fever was confirmed in Oke Owa Community, Ifelodun Local Government Area of Kwara state on 12 September.

WHO has deployed experts to Nigeria to support surveillance and investigation, lab testing, public health measures, and engagement with at-risk communities. An Emergency Operations Centre has been activated in the area to coordinate the response.

WHO – Subnational immunization coverage data
140 member states from all WHO regions have shared 2016 subnational data
17 October 2017
In 2017 and for the first time worldwide, WHO has collected and is publishing subnational immunization coverage data reported by its member states. Member states were asked to report their numerator (number of doses administered), denominator (number of eligible individuals) and coverage data (% of eligible individuals receiving the relevant dose of vaccine) for the first and third dose of DTP-containing vaccines (DTP1, DTP3) and measles containing vaccine (MCV1) from their second administrative level (“admin2” often called districts). The data collection is done through the WHO/UNICEF Joint Reporting Form process.

In 2017, 140 member states have shared their subnational data, either from their first subnational administrative level (“admin1”) or admin2 level for DTP1, DTP3 and/or MCV1. Data has been shared for over 20,000 admin1 and/or admin2, and represents about two-third of the total number of surviving infants worldwide. Among them, 94 member states report coverage for DTP3 at admin2 level (bubble charts from 83 of these countries are accessible at the bottom of this page). Of note is that the size of the target population (in the case of DTP3, the number of infants surviving at 12 months of age) of reporting districts varies significantly from a district to another. Indeed the median number of surviving infants in all reported districts is 400, ranging from a population of surviving infants of 1 in the smallest districts to more than 485,000 in the largest (Karachi, Pakistan).

National coverage data often conceals large inequalities in coverage and access within the country, that can be discovered through subnational monitoring. Targeting specific subnational areas with focused interventions will help countries achieve high and equitable coverage and meet their GVAP targets.

WHO and UNICEF are increasing efforts to gather subnational coverage data and support countries in improving the quality and use of the subnational coverage data to take actions to achieve high and equitable immunization coverage.

Resources
Descriptive analysis of subnational data pptx, 7.66Mb
Limitations related to globally reported subnational immunization data pdf, 341kb
Access 83 country visuals for DTP3 at administrative level (data as of 15 July 2017)

Cholera
 
Over 700 000 people vaccinated against cholera in Cox’s Bazar
SEAR/PR/1669
Cox’s Bazar, Bangladesh, 20 October 2017 – More than 700 000 people over the age of one year have been administered oral cholera vaccine in the first phase of a campaign here to protect the newly arrived Rohingya population and their host communities against the deadly diarrheal disease.

“The coverage is commendable as the oral cholera vaccination campaign was planned and rolled out against very tight timelines. It demonstrates the commitment of the Ministry of Health, Bangladesh, partners on the ground, as well as partners such as GAVI and the International Coordinating Group on vaccine provision, to help secure the health and wellbeing of these immensely vulnerable people,” said Dr N Paranietharan, WHO Representative to Bangladesh.

The first phase of the oral cholera vaccination (OCV) campaign covered 700 487 people aged one year and above, 179 848 of them children aged between one and five years. The campaign was launched on 10 October to cover 650 000 people. The second phase is scheduled for early November to give an additional OCV dose to children aged between one and five years, for added protection.

“The campaign has successfully vaccinated nearly 180,000 children aged one to five years. We will organize another round for these children to provide them with a second dose that will better protect them against this dangerous disease,” said Edouard Beigbeder, UNICEF Representative in Bangladesh…
 
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Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 18 October 2017 [GPEI]
:: On Tuesday [above], Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, announced with great sadness the death of Dr Mahmoud M Fikri, WHO Regional Director for the Eastern Mediterranean (EMRO) Region. His leadership and dedication to public health, and unwavering support for polio eradication in Syria, Afghanistan and Pakistan will be greatly missed. The GPEI extends its sincere condolences to Dr Fikri’s family and his many colleagues and friends throughout WHO and the EMRO Region.

:: Summary of newly-reported viruses this week:
…Afghanistan: one new wild poliovirus type 1 (WPV1) case reported from Nangarhar province. Two new wild poliovirus 1 (WPV1) positive environmental samples reported, one from Hilmand and one from Kandahar provinces.
…Pakistan: three new wild poliovirus 1 (WPV1) positive environmental samples reported, two in Balochistan province and one in Sindh province. See country-specific sections for further details. Syria: four new circulating vaccine derived poliovirus 2 (cVDPV2) cases reported in Deir Ez-Zor governorate, three from Mayadeen district, and one from Boukamal district. One new cVDPV2 positive from a healthy child in Mayadeen district.

::::::

Situation reports on the polio outbreak in Syria
Situation update 17 October 2017
:: Four (4) new cases of cVDPV2 were reported this week— three (3) from Mayadeen district and one (1) from Boukamal district, Deir Ez-Zor governorate.
:: The total number of confirmed cVDPV2 cases is 52.
:: The second immunization round for Raqqa concluded on 13 October. According to administrative data, a total of 144,414 children aged 0-59m were vaccinated with mOPV2. The numbers of children reported vaccinated represented 96% of a revised estimated target calculated according to updated micro-plans.
:: IPV is being administered to children aged between 2-23 months in 2 districts, Raqqa and Thawra. The campaign in Raqqa and Thawra is ongoing.
:: 540,000 Aqua tabs were distributed to families together with vaccination in areas of Rural Raqqa (Salhabiyah, Khilah, Al-Rasheed camp, Hesha, Karama town and camp) during the second Raqqa campaign.
:: New areas were reached this round in the Thawra desert, where 4,550 children (representing 65% of the target) under 5 were vaccinated after a gap of 18 months.

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

WHO Grade 3 Emergencies  [to 21 October 2017]
The Syrian Arab Republic
:: WHO health supplies revive weakened health facilities in besieged Deir-Ez-Zor Governorate in Syria
17 October, 2017, Damascus, Syria – A WHO shipment of health supplies delivered through the Syrian Arab Red Crescent to besieged Deir-Ez-Zor governorate in Syria has helped struggling health facilities deliver life-saving health services to thousands of people.
The 14–ton shipment includes medicines for trauma care, treatment of burns, antibiotics; anti-allergens; cardiovascular medicines; and oral rehydration salts. In total, the supplies are sufficient for almost 1800 trauma cases and 260,000 medical treatments…
:: Situation reports on the polio outbreak in Syria
Situation update 17 October 2017
[See Polio above]

Nigeria
WHO supports the immunization of 874,000 people against yellow fever in Nigeria
News release 16 October 2017
[See Milestones above for more detail]
 
South Sudan
Read the latest health situation report pdf, 2.07Mb  13 October 2017
Republic of South Sudan
CHOLERA SITUATION AND RESPONSE UPDATES
13 OCTOBER 2017
Epidemic trends
:: Cholera transmission has continued to decline countrywide with only three counties [Juba,
Budi, and Fangak] reporting cholera cases in the last four weeks [38-41, 2017].
:: In week 41, four out of 13 samples from Juba tested positive for Vibrio cholerae.

::::::
::::::
 
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. 
Iraq
:: Thousands of Families from Kirkuk Are Returning [EN/AR/KU]
(Baghdad, 17 October 2017): In the past 48 hours, an estimated 61,200 people have been displaced in areas around Kirkuk. Humanitarian partners have dispatched mobile health clinics and are providing hot meals and food parcels to families who have fled. In coming days, partners will be providing 3,000 emergency food rations and hygiene items to families sheltering in public spaces.
“Authorities have confirmed that the majority of displaced families from Kirkuk are already returning to their homes in Kirkuk city,” said Ms. Lise Grande, Humanitarian Coordinator for Iraq. “Most of the families who are still displaced are staying with families and host communities.”…

Syrian Arab Republic
:: 19 Oct 2017  North East Syria Dashboard – September 2017
…Up to 7,000 civilians remain trapped in Ar-Raqqa city and face increasingly deteriorating humanitarian conditions and protection concerns. Despite the risks of exposure to mines, snipers and military operations, some civilians have fled.
…Displacements from and within Deir-ez-Zor Governorate continued due to heavy fighting and airstrikes. An estimated 63,902 people have been displaced from 1 September to 8 October.
…The overall protection situation for civilians remains of high concern across north-eastern Syria, with ISIL reportedly actively preventing civilians attempting to flee the area.
…Large influxes of IDPs from Deir-ez-Zor Governorate are straining existing capacities and services in IDP sites resulting in increased protection needs.

::::::

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.
Ethiopia
:: 20 Oct 2017  Ethiopia HRD 2017: Status Update, 19 October 2017
Since the revision of the Humanitarian Requirements Document (HRD) in August 2017, the humanitarian context in Ethiopia has continued to evolve which has led the Government and humanitarian partners to further adjust the HRD requirements. In the food sector the needs have been revised slightly upwards to accommodate an increase in the number of beneficiaries through the inclusion of 4 million former Productive Safety Net Programme (PSNP) clients in the HRD. In other sectors such as health and nutrition, needs have also continued to increase mainly due to the deteriorating nutrition situation in Somali region, increase in the number of displaced people, as well as the Fall Army Worm (FAW) outbreak that continues to ravage crops throughout the country….
 

WHO & Regional Offices [to 21 October 2017]
 
Latest news
WHO supports containment of rare virus on Uganda-Kenya border
20 October 2017 – WHO is working to contain an outbreak of Marburg virus disease that has appeared in eastern Uganda on the border with Kenya.

Governments commit to reduce suffering and deaths from noncommunicable diseases
18 October 2017 – Heads of State and Government and ministers from around the world today committed to new and bold action to reduce suffering and death from noncommunicable diseases (NCDs), primarily heart and lung diseases, cancers and diabetes, the world’s leading killers.
 
Highlights
Responding to children and adolescents who have been sexually abused
October 2017 – Sexual abuse of children and adolescents is a gross violation of their rights and a global public health problem. It adversely affects the health of children and adolescents. Health care providers are in a unique position to provide an empathetic response to children and adolescents who have been sexually abused.

Evaluation of the election of the Director-General of WHO
October 2017 – The Sixty-fifth World Health Assembly decided, in resolution WHA65.15 (2012), that an evaluation, open to all Member States, will be conducted by the Executive Board within one year from the appointment of the next Director-General of WHO, to assess the efficacy of the revised process and methods for the election of the Director-General, in order to discuss any need for further enhancing fairness, transparency and equity among the Member States of the six regions of WHO.

WHO delivers lifesaving trauma medicines and supplies for victims of Mogadishu blasts
October 2017 – WHO has delivered lifesaving blood supplies and trauma care medicines as part of its emergency response to the bombings in Mogadishu, Somalia on 14 October, in which more than 275 people were killed and more than 300 people severely injured.

Handwashing an affordable way to prevent diseases and save lives
October 2017 – Global Handwashing Day is an opportunity to design, test, and replicate creative ways to encourage people to wash their hands with soap at critical times.

::::::

Weekly Epidemiological Record, 20 October 2017, vol. 92, 42 (pp. 625–648)
:: Recommended composition of influenza virus vaccines for use in the 2018 southern hemisphere influenza season
:: Zoonotic influenza viruses: antigenic and genetic characteristics and development of candidate vaccine viruses for pandemic preparedness
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: South Sudan conducts Joint External Evaluation of Core capacities for International Health Regulation (2005) 20 October 2017
:: WHO supports containment of rare virus on Uganda-Kenya border20 October 2017
:: WHO supports Bayelsa state to rapidly contain outbreak of Monkeypox virus. 20 October 2017
:: WHO facilitates training on contact tracing for health professionals and volunteers on Plague
:: Namibia Continues to invest in Polio Eradication  19 October 2017
:: Monkey pox virus-Sultan dispels rumours linking outbreak to vaccine safety. 18 October 2017
:: Suspected cases from Seychelles test negative for plague  18 October 2017
:: Supporting the mental health needs of frontline responders 18 October 2017
:: WHO supports the immunization of 874 000 people against yellow fever in Nigeria 16 October 2017

WHO Region of the Americas PAHO
:: Governments commit to reduce suffering and deaths from noncommunicable diseases (10/19/2017)

WHO South-East Asia Region SEARO
:: Over 700 000 people vaccinated against cholera in Cox’s Bazar  20 October 2017
[See Cholera above for more detail]

WHO European Region EURO
:: European Region makes huge gains in NCD response, but needs faster progress 19-10-2017
:: Obituary: Dr Mahmoud M. Fikri, WHO Regional Director for the Eastern Mediterranean Region 18-10-2017
:: Using taxes to beat NCDs: success story in Hungary 17-10-2017
:: Giving influenza vaccination a boost among older people 16-10-2017
:: Nurse Gladis leads the way on influenza vaccination in Jönköping, Sweden 16-10-2017

WHO Eastern Mediterranean Region EMRO
:: WHO delivers additional trauma care supplies to patients injured in Mogadishu attacks, Somalia  19 October 2017
:: Tenfold increase in childhood and adolescent obesity in four decades  11 October 2017

CDC/ACIP [to 21 October 2017]
http://www.cdc.gov/media/index.html
Press Release
Thursday, October 19, 2017
CDC updates guidance for infants born to mothers with possible Zika virus infection during pregnancy – Press Release
This update includes information that has become available since the August 2016 release of the previous guidance.

MMWR News Synopsis for October 19, 2017
:: Update: Interim Guidance for the Diagnosis, Evaluation and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017
CDC’s updated interim clinical guidance for infants born to mothers with possible Zika virus infection during pregnancy will provide helpful, interpretable information for families and their healthcare providers. The Centers for Disease Control and Prevention (CDC) issued updated interim clinical guidance for health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy. This update includes information that has become available since the August 2016 release of the previous guidance. Zika virus continues to be a public health threat to pregnant women and their infants, although at lower levels than during the recent epidemic in the Americas. The updated guidance is intended to provide helpful, interpretable information for families and their healthcare providers.

HIV Testing, Linkage to HIV Medical Care, and Interviews for Partner Services Among Women — 61 Health Department Jurisdictions, United States, Puerto Rico, and the U.S. Virgin Islands, 2015
To reduce and eventually eliminate HIV infection among women in the United States, HIV testing programs need to improve early linkage to HIV medical care among HIV-positive women who are not in care – even if it is not the first time they are diagnosed with HIV infection. A new analysis showed that six in 10 women who tested positive for HIV infection via CDC-funded HIV tests had already been diagnosed with HIV infection through a previous test. The vast majority (87 percent) of women who were previously diagnosed were not in HIV medical care at the time of testing, suggesting they were never linked to care or had fallen out of care. Black women were significantly less likely than white women to be linked to HIV medical care within 90 days of the current test. HIV testing is essential – not only to identify new infections, but also to link people with new or previous diagnoses to medical care to achieve viral suppression. To reduce and eventually eliminate HIV infection among women in the United States, HIV testing programs need to improve early linkage to HIV medical care among HIV-positive women who are not in care – even if it is not the first time they are diagnosed with HIV infection.

Tdap Vaccination Coverage During Pregnancy — Selected Sites, United States, 2006–2015
Gina DiGravio
Boston University School of Medicine
Tdap vaccination during pregnancy has increased between 2006 and 2017, from <1% in the years before the recommendation to 53% in 2015. However, this coverage is far short of the ACIP recommendation that every woman receive Tdap vaccine during each pregnancy. Since 2012 the Advisory Committee on Immunization Practices has recommended Tdap vaccination during each pregnancy. From 2006 through 2015, Tdap vaccination coverage in pregnant women participating  in the Birth Defects Study of the Slone Epidemiology Center at Boston University increased from <1% before 2010 to 28% in 2013 and reached 53% in 2015. Although Tdap coverage has increased in recent years, Tdap vaccine coverage remains far below the recommendation that every woman be vaccinated during each pregnancy. Increasing vaccination coverage during pregnancy could help reduce the impact of pertussis on infant morbidity and mortality.

Knowledge, Attitudes, and Practices Related to Ebola Virus Disease at the End of a National Epidemic — Guinea, August 2015
Regional variations in Ebola-related KAP in Guinea, after more than one year of a massive epidemic, reinforce the need for targeted health communication strategies during epidemic response. The findings also highlight the importance of health promotion efforts to prevent sporadic transmission or future outbreaks of Ebola, including messages that aim to address misconceptions about transmission and prevention and to address stigma that survivors might face as they recover from a devastating disease, rebuild their lives, and reintegrate into communities. Efforts to improve the public’s knowledge, attitudes, and practices (KAP) about Ebola Virus Disease (Ebola) were important in controlling the 2014–2016 Ebola epidemic in Guinea, Sierra Leone, and Liberia. A national survey conducted in Guinea in August 2015 found regional variations in Ebola-related KAP.  Results suggest that tailoring health communication by region might be more effective than a uniform, national approach. Most participants understood key aspects of Ebola transmission and prevention and intended to use safer burial practices for relatives with suspected Ebola. However, misconceptions about Ebola transmission were widespread, and many participants expressed concern about being near Ebola survivors.

Reporting Deaths Among Children Aged <5 Years After the Ebola Virus Disease Epidemic — Bombali District, Sierra Leone, 2015–2016
Child mortality surveillance in settings with limited vital registration can be strengthened by using multiple data sources, which together capture community and facility deaths. Mortality surveillance and national death reporting are limited in Sierra Leone, a country with one of the highest mortality rates in the world among children ages <5 years. To inform efforts to strengthen surveillance of stillbirths and deaths in children ages <5 years, multiple surveillance streams in Bombali Sebora chiefdom were retrospectively reviewed. Analysis of multiple death reporting streams, including the 1-1-7 phone alert system established during the Ebola virus disease outbreak, improved collection of data about deaths among children ages <5 years and stillbirths. Community-based reporting strategies, such as phone alerts, can be implemented in countries with incomplete death registration to supplement vital events records and strengthen child mortality surveillance.
 

Announcements
 
 
BMGF – Gates Foundation  [to 21 October 2017]
http://www.gatesfoundation.org/Media-Center/Press-Releases
OCTOBER 16, 2017
Bill & Melinda Gates Foundation Releases Open-Source Software to Support Efforts that Expand Access to Financial Services in Developing Countries
New code reduces complexity and cost of building payment platforms that connect poor customers to merchants, banks, mobile money providers, governments

EDCTP    [to 21 October 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
18 October 2017
EDCTP requests proposals for conference management services
EDCTP is soliciting proposals from conference management companies for the provision of services for the Ninth EDCTP Forum…

European Medicines Agency  [to 21 October 2017]
http://www.ema.europa.eu/ema/
20/10/2017
Unparalleled access to clinical data – one year on
Over 3,000 clinical documents published, 3,600 registered users and positive stakeholder feedback …

20/10/2017
New action plan to foster development of advanced therapies
Actions address specific challenges identified by stakeholders
… ATMPs are medicines for human use that are based on genes or cells. These therapies offer ground-breaking new opportunities for the treatment of disease and injury. They are particularly important for severe, untreatable or chronic diseases for which conventional approaches have proven to be inadequate.
ATMPs can be classified into four main groups: gene therapy medicinal products, somatic cell therapy medicinal products, tissue engineered medicinal products and combined ATMPs. EMA has received 18 marketing authorisation applications since the ATMP regulation came into force in 2009. Nine products have been approved.
The Agency’s Committee for Advanced Therapies (CAT) plays a central role in the scientific assessment of ATMPs, as it provides the expertise needed to evaluate these medicines. Other initiatives include European Commission research programmes, the innovation offices in the national competent authorities and EMA’s PRIME scheme…

17/10/2017
EMA’s procedural handling of safety review was complete and independent
EMA’s procedural handling of safety review was complete and independent
European Ombudsman concludes her inquiry into the HPV vaccines referral
The European Medicines Agency (EMA) has welcomed the decision from the European Ombudsman which concludes that there was no maladministration by the Agency in the handling of its safety review of human papillomavirus (HPV) vaccines.
The conclusions of this review were that the available evidence does not support that two specific syndromes, complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS) in young women and girls are caused by HPV vaccines. These vaccines are given to prevent infections with the most common types of HPV which can cause cervical cancer, other HPV-related cancers and pre-cancerous conditions.
The procedure was conducted by EMA’s Pharmacovigilance Risk Assessment Committee’s (PRAC) in 2015.
The Ombudsman’s review followed a complaint which expressed concerns about aspects of the PRAC’s handling of the referral procedure.
Following her inquiry into the procedural aspects complained about, the Ombudsman concluded that her inquiry did not identify any procedural issues that could have negatively affected the work and conclusions of the PRAC referral procedure. The examination of scientific evidence was complete and it was independent.
The Ombudsman also considered that EMA’s conflicts of interest policy was fully complied with during the referral procedure on HPV vaccines and that no conflicts of interest were detected.
The Agency welcomes two suggestions made by the Ombudsman to further improve the information on its scientific assessments that it provides to the public and will now explore ways to address these.

European Vaccine Initiative  [to 21 October 2017]
http://www.euvaccine.eu/news-events
19 October 2017
EDUFLUVAC Final Meeting
After four years of collaborative research activities towards the development of a broadly reactive influenza vaccine, the European Commission-funded project EDUFLUVAC will be concluded by the end of October 2017. The EDUFLUVAC partners met for the final project meeting on 09-10 October in Brussels, Belgium to review the results generated and plan for future activities.
Promising pre-clinical results in different animal models have been obtained, but more research is needed to optimise the strategy undertaken by the consortium, which is based on the Epitope Dilution Phenomenon and the use of baculovirus-derived virus-like particles…

16 October 2017
TRANSVAC: European Vaccine Research and Development Infrastructure
Open Call for Vaccine Development Services
 
 
FDA [to 21 October 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
October 18, 2017 –
FDA approves CAR-T cell therapy to treat adults with certain types of large B-cell lymphoma
The U.S. Food and Drug Administration today approved Yescarta (axicabtagene ciloleucel), a cell-based gene therapy, to treat adult patients with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment. Yescarta, a chimeric antigen receptor (CAR) T cell therapy, is the second gene therapy approved by the FDA and the first for certain types of non-Hodgkin lymphoma (NHL).
“Today marks another milestone in the development of a whole new scientific paradigm for the treatment of serious diseases. In just several decades, gene therapy has gone from being a promising concept to a practical solution to deadly and largely untreatable forms of cancer,” said FDA Commissioner Scott Gottlieb, M.D. “This approval demonstrates the continued momentum of this promising new area of medicine and we’re committed to supporting and helping expedite the development of these products. We will soon release a comprehensive policy to address how we plan to support the development of cell-based regenerative medicine. That policy will also clarify how we will apply our expedited programs to breakthrough products that use CAR-T cells and other gene therapies. We remain committed to supporting the efficient development of safe and effective treatments that leverage these new scientific platforms…
 
 
Gavi [to 21 October 2017]
http://www.gavi.org/library/news/press-releases/
16 October 2017
Attack on health facilities puts all Syrian children at risk
Gavi CEO urges all parties in Syria to stop attacks against health facilities following destruction of vaccine stocks and equipment.
 
 
GHIT Fund   [to 21 October 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical ·
2017.10.18      
Upcoming Event: GHIT R&D Forum on December 8th
… The 200-person R&D Forum on December 8th will create opportunities for GHIT’s development partners to share project overviews, R&D progress to date, and lessons learned over the past five years. The event offers unique opportunities to engage with scientists and experts across a multitude of organizations, as well as develop new partnerships to further build our community and accelerate global health R&D…
 
 
MSF/Médecins Sans Frontières  [to 21 October 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Doctors Without Borders Challenges Pfizer’s Unmerited Patent for Pneumonia Vaccine in Delhi High Court
NEW YORK/NEW DELHI, OCTOBER 13, 2017—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières(MSF) filed a petition before the High Court of Delhi today to overturn a patent granted to Pfizer pharmaceutical corporation on the pneumococcal conjugate vaccine (PCV).
 
 
NIH  [to 21 October 2017]
http://www.nih.gov/news-events/news-releases
October 18, 2017
Norman Sharpless sworn in as director of the National Cancer Institute
— Succeeds Harold Varmus, M.D., who stepped down in March 2015.

Experts Outline Pathway to a Universal Influenza Vaccine
October 17, 2017 — NIH-Led meeting identifies knowledge gaps, development goals.
Scientists and clinicians from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the California Institute of Technology discuss key considerations for developing a universal influenza vaccine in a meeting report appearing in the October 17 issue of Immunity. The report summarizes discussions from a workshop NIAID held June 28-29, 2017, in Rockville, Maryland, entitled, “Pathway to a Universal Influenza Vaccine.” The workshop brought together U.S. and international experts from academia, industry and government to identify knowledge gaps in influenza research and to set goals to fill these knowledge gaps. NIAID will use the report to develop a strategic plan and research agenda aimed at the development of a universal influenza vaccine.
 
 
PATH  [to 21 October 2017]
http://www.path.org/news/index.php
Announcement | October 18, 2017
Join PATH at the 66th American Society of Tropical Medicine and Hygiene Annual Meeting
PATH experts to share latest research and innovations to tackle malaria and other Neglected Tropical Diseases, underscore critical role of US in global health

UNAIDS [to 21 October 2017]
http://www.unaids.org/en
Update
20 October 2017
Civil society and WFP increasing food security in Ukraine
 
19 October 2017
UNAIDS urges United Republic of Tanzania to implement HIV Prevention 2020 Road Map
 
19 October 2017
Republic of Moldova to fund HIV prevention services for key populations
 
18 October 2017
Parliamentarians call for firm action towards ending the AIDS epidemic
 
17 October 2017
ILO’S VCT@WORK has reached 6 million workers

UNICEF  [to 21 October 2017]
https://www.unicef.org/media/
20 October, 2017
Violence in Myanmar driving up to 12,000 Rohingya refugee children into Bangladesh every week – UNICEF
DHAKA, BANGLADESH/GENEVA, 20 October 2017 – Desperate living conditions and waterborne diseases are threatening more than 320,000 Rohingya refugee children who have fled to southern Bangladesh since late August, including some 10,000 who crossed from Myanmar over the past few days, UNICEF said today.

7,000 newborns die every day, despite steady decrease in under-five mortality, new report says
NEW YORK/GENEVA/WASHINGTON, 19 October 2017 – Every day in 2016, 15,000 children died before their fifth birthday, 46 per cent of them – or 7,000 babies – died in the first 28 days of life, according to a new UN report.
 
 
Wellcome Trust  [to 21 October 2017]
https://wellcome.ac.uk/news
News / Published: 19 October 2017
First international awards in new Engagement Fellowships
Wellcome’s Engagement Fellowships for 2017 have been awarded to Sara Kenney, Alok Jha, Anita Shervington and our first international fellows, Elizabeth Kimani and Nabeel Peterson. 
Over the next three years the fellows will explore the topics of comic creation, science journalism, child nutrition, inclusion and equity in science.

::::::
 
 
Industry Watch  [to 21 October 2017]
:: FDA Approves GSK’s Shingles Vaccine with Agenus’ QS-21 Stimulon® Adjuvant
– SHINGRIX containing QS-21 Stimulon® demonstrates remarkable efficacy of greater than 90% in pooled studies against shingles
– Shingles is a major public health issue in the US, impacting as many as 1 in 3 adults over the age of 50 years
LEXINGTON, Mass., Oct. 20, 2017 /PRNewswire/ — Agenus Inc. (NASDAQ: AGEN), an immuno-oncology company with a pipeline of immune checkpoint antibodies and cancer vaccines, announced today that the US Food and Drug Administration (FDA) granted marketing authorization to GlaxoSmithKline’s (GSK) herpes zoster vaccine, SHINGRIX, containing Agenus’ proprietary immune adjuvant QS-21 Stimulon®. SHINGRIX is indicated for prevention of herpes zoster (also known as shingles) in adults aged 50 years and older. The addition of QS-21 Stimulon helps improve the vaccine’s effectiveness by boosting immune response in older adults who often experience age-related decline in immunity…

:: Lilly and CureVac Announce Global Collaboration to Develop mRNA Cancer Vaccines
– Immuno-oncology collaboration aims to develop up to five cancer vaccines that target neoantigens across multiple tumor types
– CureVac to receive an upfront payment of $50 million and an equity investment of €45 million
INDIANAPOLIS and TÜBINGEN, Germany, Oct. 18, 2017 /PRNewswire/ — Eli Lilly and Company and CureVac AG have announced a global immuno-oncology collaboration focused on the development and commercialization of up to five potential cancer vaccine products based on CureVac’s proprietary RNActive® technology. The companies will use messenger RNA (mRNA) technology that targets tumor neoantigens for a more robust anti-cancer immune response…
Under the terms of the agreement, CureVac will receive an upfront payment of $50 million and an equity investment of €45 million. CureVac is also eligible to receive more than $1.7 billion in development and commercialization milestones if all five vaccines are successfully developed, plus tiered royalties on product sales. Lilly is responsible for target identification, clinical development and commercialization. CureVac will be responsible for mRNA design, formulation and manufacturing of clinical supply and retains the option to co-promote the vaccine products in Germany.
CureVac’s proprietary RNActive technology will be used to deliver mRNA that ultimately directs the human immune system to target the encoded neoantigens. These tumor-specific neoantigens instruct the patient’s existing immune system to mount a selective and potent response to eradicate the cancer.

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

7,000 newborns die every day, despite steady decrease in under-five mortality, new report says
At current trends, 30 million newborns will die within first 28 days of life between 2017 and 2030
News release
19 October 2017 | NEW YORK/GENEVA/WASHINGTON DC – Every day in 2016, 15,000 children died before their fifth birthday, 46% of them – or 7 000 babies – died in the first 28 days of life, according to a new UN report.

Levels and Trends in Child Mortality 2017, reveals that although the number of children dying before the age of five is at a new low– 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41% to 46% during the same period.

“The lives of 50 million children under-five have been saved since 2000, a testament to the serious commitment by governments and development partners to tackle preventable child deaths,” said UNICEF Chief of Health, Stefan Swartling Peterson. “But unless we do more to stop babies from dying the day they are born, or days after their birth, this progress will remain incomplete. We have the knowledge and technologies that are required – we just need to take them where they are most needed.”

At current trends, 60 million children will die before their fifth birthday between 2017 and 2030, half of them newborns, according to the report released by UNICEF, the World Health Organization, the World Bank and the Population Division of UNDESA which make up the Inter-agency Group for Child Mortality Estimation (IGME)…
 
 
Levels & Trends in Child Mortality – Report 2017
Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation
PDF:
http://www.childmortality.org/files_v21/download/IGME%20report%202017%20child%20mortality%20final.pdf
CHILD SURVIVAL: KEY FACTS AND FIGURES
:: The world has made substantial progress in reducing child mortality in the past several decades. The total number of under-five deaths dropped to 5.6 (5.4, 6.0)1 million in 2016 from
12.6 (12.4, 12.8) million in 1990 – 15,000 every day compared with 35,000 in 1990.

:: Globally, the under-five mortality rate dropped to 41 (39, 44) deaths per 1,000 live births in 2016 from 93 (92, 95) in 1990 – a 56 (53, 58) per cent decline.

:: Globally, 2.6 (2.5, 2.8) million newborns died in 2016 – or 7,000 every day. Neonatal deaths
accounted for 46 per cent of all under-five deaths, increasing from 41 per cent in 2000.

:: The largest number of newborn deaths occurred in Southern Asia (39 per cent), followed by sub-Saharan Africa (38 per cent). Five countries accounted for half of all newborn deaths: India, Pakistan, Nigeria, the Democratic Republic of the Congo and Ethiopia.

:: The neonatal mortality rate fell by 49 per cent from 37 (36, 38) deaths per 1,000 live births in
1990 to 19 (18, 20) in 2016.

:: Children face the highest risk of dying in their first month of life, at a rate of 19 deaths per
1,000 live births. By comparison, the probability of dying after the first month but before reaching age 1 is 12 and after age 1 but before turning 5 is 11.

:: Progress is slower in reducing neonatal mortality rates than in reducing mortality rates in childrenaged 1–59 months. While neonatal mortality declined by 49 per cent, the mortality in children aged 1–59 months declined by 62 per cent from 1990 to 2016.

:: Disparities in child survival exist across regions and countries: in sub-Saharan Africa, approximately 1 child in 13 dies before his or her fifth birthday, while in the world’s high-income
countries the ratio is 1 in 189. Among newborns in sub-Saharan Africa, about 1 child in 36 dies inthe first month, while in the world’s high-income countries the ratio is 1 in 333.

:: Many lives can be saved if the gaps acrosscountries are closed. If all countries had reached
an under-five mortality rate at or below theaverage rate of high-income countries – 5.3 deaths per 1,000 live births – 87 percent of under-five deaths could have been averted, and almost 5 million children’s lives could have been saved in 2016.

:: If current trends continue with more than 50 countries falling short of the Sustainable Development Goal (SDG) target on child survival,some 60 million children under age 5 will die
between 2017 and 2030 – and half of them will be newborns.

:: If every country achieves the SDG target on child survival by 2030, an additional 10 million lives of children under age 5 will be saved throughout the period 2017–2030 – about half of them will be newborns.

:: Most under-five deaths are caused by diseases that are readily preventable or treatable with
proven, cost-effective interventions. Infectious diseases and neonatal complications are
responsible for the vast majority of under-five deaths globally.

:: The probability of dying among children aged 5–14 was 7.5 (7.2, 8.3) deaths per 1,000 children aged 5 in 2016 – substantially lower than among younger children. Still 1 (0.9, 1.1) million children aged 5–14 died in 2016. This is equivalent to 3,000 children in this age group dying every day. Among children aged 5–14, communicable diseases are a less prominent cause of death than among younger children, while other causes including injuries and
non-communicable diseases become important.

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

Clinical Therapeutics
October 2017  Volume 39, Issue 10
http://www.clinicaltherapeutics.com/current

Commentaries
Enhancing the Pediatric Drug Development Framework to Deliver Better Pediatric Therapies Tomorrow
Christina Bucci-Rechtweg
p1920–1932
Published online: August 14, 2017

International Children’s Advisory Network: A Multifaceted Approach to Patient Engagement in Pediatric Clinical Research
Meghan Gwara, Sharon Smith, Christine Woods, Elizabeth Sheeren, Hampton Woods
p1933–1938
Published online: September 21, 2017

Reviews
Roles of Clinical Research Networks in Pediatric Drug Development
Mark A. Turner, Sabah Attar, Saskia N. de Wildt, Gilles Vassal, Laura Mangiarini, Carlo Giaquinto
p1939–1948
Published online: September 21, 2017

Frameworks for Evaluating Medicines in Children
Mark A. Turner, Steven Hirschfeld
p1949–1958
Published online: September 26, 2017

JBI Database of Systematic Review and Implementation Reports
October 2017 – Volume 15 – Issue 10
http://journals.lww.com/jbisrir/Pages/currenttoc.aspx

Systematic Review Protocols
Information overload in consumers of health-related information: a scoping review protocol
Lee, Kenneth; Roehrer, Erin; Cummings, Elizabeth
JBI Database of Systematic Reviews and Implementation Reports. 15(10):2457-2463, October 2017.

New England Journal of Medicine
October 19, 2017  Vol. 377 No. 16
http://www.nejm.org/toc/nejm/medical-journal

Perspective
A Devastating Delay — Zika and the Implementation Gap
Stephanie R. Morain, Ph.D., M.P.H., Susan H. Wootton, M.D., and Catherine Eppes, M.D., M.P.H.
N Engl J Med 2017; 377:1505-1507 October 19, 2017 DOI: 10.1056/NEJMp1707273
[Initial text]
The epidemic of Zika in the Americas and the virus’s effects on fetal development have jolted the U.S. medical community and the broader public. Zika’s relatively recent emergence has necessitated rapid research on its virology and pathogenesis, transmission, clinical manifestations, and diagnosis. The medical community has risen to this challenge admirably. Though a PubMed search for articles about Zika published before the 2015 outbreak in Brazil yielded fewer than 110 results, a similar search in July 2017 yielded more than 3000. The National Institutes of Health has identified several high-priority areas of Zika research, and at least 15 related trials are actively enrolling participants, including several vaccine clinical trials.
Developing knowledge to guide prevention and clinical management of Zika virus disease is critical, and these efforts should continue. However, this focus on knowledge acquisition has overshadowed another critical need — namely, ensuring that new knowledge is disseminated to frontline providers and used to improve care…

PLoS One
http://www.plosone.org/

Research Article
Economic benefits of sharing and redistributing influenza vaccines when shortages occurred
Recurrent influenza outbreak has been a concern for government health institutions in Taiwan. Over 10% of the population is infected by influenza viruses every year, and the infection has caused losses to both health and the economy. Approximately three million free vaccine doses are ordered and administered to high-risk populations at the beginning of flu season to control the disease. The government recommends sharing and redistributing vaccine inventories when shortages occur. While this policy intends to increase inventory flexibility, and has been proven as widely valuable, its impact on vaccine availability has not been previously reported.
Sheng-I Chen
Research Article | published 17 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0186418

Vaccine
Volume 35, Issue 45, Pages 6041-6254 (27 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/45?sdc=1

Biosecurity
Reviews
A systematic review of factors affecting vaccine uptake in young children
Review Article
Pages 6059-6069
Louise E. Smith, Richard Amlôt, John Weinman, Jenny Yiend, G. James Rubin
Abstract
Background
Many parents make a conscious decision not to vaccinate their child. Multiple beliefs and perceptions surround this choice. If uptake of routine child vaccination is to increase, public health communications about vaccines must be informed by evidence on the factors affecting uptake.
Method
We conducted a systematic review to investigate psychological, social and contextual factors associated with uptake of routine vaccines in young children. Studies were included if they reported analyses of the association between psychological factors and uptake or included parents’ self-reported reasons for or against vaccination.
Results
Our search identified 9110 citations after deduplication. Sixty-eight citations describing sixty-four studies were included in the review. The quality of the studies was mixed. There is strong evidence for an association between vaccination uptake and: not perceiving vaccines to cause adverse effects; general positive attitudes towards vaccination; positive vaccine recommendations; and perceiving fewer practical difficulties of vaccination. While there was good evidence for an association between vaccination and perceived susceptibility to the illness, evidence for an association between perceived severity of an illness and vaccination was weak. Other factors associated with vaccination include knowledge about the vaccine, social influences and trust in the healthcare profession. Having increased information about the vaccine was associated with vaccination, but the influence of different sources of information needs more research.
Conclusion
Understanding which factors are consistently associated with the decision to vaccinate one’s child is important to identify messages which should be targeted by public health communications about routine child vaccinations.

Vaccine
Volume 35, Issue 45, Pages 6041-6254 (27 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/45?sdc=1

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children
Original Research Article
Pages 6122-6128
Lila J. Finney Rutten, Jennifer L. St. Sauver, Timothy J. Beebe, Patrick M. Wilson, Debra J. Jacobson, Chun Fan, Carmen Radecki Breitkopf, Susan T. Vadaparampil, Kathy L. MacLaughlin, Robert M. Jacobson
Abstract
Purpose
We tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates.
Methods
From October 2015 through January 2016, we conducted a survey of primary care clinicians (n = 227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11–12 years (n = 14,406) with site-level vaccination rates.
Results
The majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR) = 1.05; 95% CI (1.01–1.09)] and completion (3 doses) [IRR = 1.08; 95% CI (1.02–1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR = 1.03; 95% CI (1.00–1.06)] and completion [IRR = 1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR = 1.05; CI (1.02,1.08)] and completion [IRR = 1.05; 95% CI (1.01, 1.09)].
Conclusions
Consistency and strength of HPV vaccination recommendation was associated with higher vaccination rates.

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 21 October 2017
Will the World’s Most Worrying Flu Virus Go Pandemic?
There’s good news and bad news.
Ed Yong
Oct 19, 2017

Foreign Policy
http://foreignpolicy.com/
Accessed 21 October 2017
Essay
Yemen’s Humanitarian Nightmare — The Real Roots of the Conflict
November/December 2017
Asher Orkaby
 

New York Times
http://www.nytimes.com/
Accessed 21 October 2017
The Long War on Polio, as Recalled by Its Generals
“Coffee With Polio Experts” videos may be amateurish, but they are full of insights explaining why polio eradication has been such a struggle.
October 20, 2017 – By DONALD G. McNEIL Jr – Health – Print Headline: “”

Marburg Hemorrhagic Fever Kills 1 Person in Uganda
One Ugandan has died of Marburg, a highly infectious disease that, like Ebola, manifests as a viral hemorrhagic fever, Uganda’s health minister said Thursday.
October 19, 2017 – By THE ASSOCIATED PRESS – World – Print Headline: “Marburg Hemorrhagic Fever Kills 1 Person in Uganda”

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_14 October 2017

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– 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.

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

Milestones :: Perspectives
 
Meeting: SAGE Strategic Advisory Group of Experts on Immunization (SAGE)
17 – 19 October 2017
Executive Board Room, WHO Headquarters, Geneva, Switzerland
:: Draft agenda pdf, 110kb  As of 27 September 2017
:: Background documents
 
::::::
::::::
 
Attack on vaccines sets back immunization efforts in eastern Syrian Arab Republic
13 October 2017 | GENEVA – The World Health Organization has received reports of an attack on medical facilities in eastern Syrian Arab Republic that has destroyed the only vaccines cold room in al-Mayadeen district, Deir Ezzor Governorate.

More than 100,000 doses of measles vaccines and 35,000 doses of polio vaccines were stored in these facilities, alongside equipment, syringes, and stocks for all vaccine-preventable childhood diseases.

If confirmed, this would set back the efforts of WHO and health partners to protect the children of Deir Ezzor from preventable childhood diseases, including polio. WHO and local partners have intensified efforts to respond to an outbreak of polio that has affected 48 children in the Syrian Arab Republic since March this year.

“WHO has made strenuous efforts in cooperation with health authorities to deliver vaccines to protect the children living in these areas from disease,” said Elizabeth Hoff, WHO Representative in the Syrian Arab Republic. “We unequivocally condemn these actions. Vaccines are not a legitimate target of war.”

“Until a new cold room is built and the required cold chain equipment — including solar fridges, cold boxes and vaccine carriers — are delivered, this will delay the implementation of routine immunization for vulnerable children in the area,” Hoff added.

WHO has supported 23 polio campaigns since the first outbreak in 2013 and helped to establish 1,148 sentinel sites across the country, of which more than 35% are in hard-to-reach and besieged areas, including al-Mayadeen in Deir Ezzor Govenorate.

The last polio vaccination campaign in Deir Ezzor reached 252,768 children aged 0-59 months.
 
::::::
::::::
 
Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 —
NIH reports final data from large clinical trial in West Africa.
Results from a large randomized, placebo-controlled clinical trial in Liberia show that two candidate Ebola vaccines pose no major safety concerns and can elicit immune responses by one month after initial vaccination that last for at least one year. The findings, published in the October 12 issue of the New England Journal of Medicine, are based on a study of 1,500 adults that began during the West Africa Ebola outbreak. The trial is being conducted by a U.S.-Liberia clinical research collaboration known as the Partnership for Research on Ebola Virus in Liberia (PREVAIL), established in 2014 in response to the request from the Liberian Minister of Health to the U.S. Secretary of Health and Human Services. The trial is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) and involves scientists and clinicians from Liberia and the United States.

“This clinical trial has yielded valuable information that is essential for the continued development of these two Ebola vaccine candidates and also demonstrates that well-designed, ethically sound clinical research can be conducted during an epidemic,” said NIAID Director Anthony S. Fauci, M.D. “A safe and effective vaccine would be a critically important addition to classical public health measures in controlling inevitable future Ebola outbreaks.”

PREVAIL conducts collaborative biomedical research in accordance with best practices, to advance science, strengthen health policy and practice, and improve the health of people in Liberia and around the world. The partnership launched this first study, PREVAIL 1, in February 2015.  Originally designed to enroll 28,000 volunteers, the trial was scaled back to a Phase 2 study when the decline in new Ebola cases made it impossible to conduct a large efficacy study.
“In Liberia, we have demonstrated to the global community that rigorous scientific research can take place in a developing sub-Saharan African country when a mutually beneficial partnership is developed,” noted Dr. Bernice T. Dahn, Liberia’s Minister of Health. “The work of PREVAIL, ranging from the Ebola vaccine to the Ebola survivor studies, clearly manifest the prospects of such a sustainable partnership and clinical research platform.”

The co-leaders of the trial are Stephen B. Kennedy, M.D., M.P.H., senior research scientist at the University of Liberia-Pacific Institute for Research and Evaluation (UL-PIRE) Africa Center, an infectious disease research center; Fatorma Bolay, Ph.D., director, Public Health and Medical Research at the National Public Health Institute of Liberia; and H. Clifford Lane, M.D., NIAID’s clinical director…
 

JAMA
New Online – Published October 9, 2017. doi:10.1001/jama.2017.13505
Viewpoint
An HIV Vaccine is Essential for Ending the HIV/AIDS Pandemic
Anthony S. Fauci, MD1
Today, highly effective modalities of HIV treatment and prevention are available, and these essential tools, if properly implemented, could end the current HIV/AIDS pandemic. Yet, the pandemic continues.1

Most of the major infectious diseases affecting humans, such as smallpox, polio, and yellow fever, have required effective vaccines for their control and in some cases elimination, and so the question arises whether the HIV/AIDS pandemic can be effectively addressed without an HIV vaccine. The answer to that question is not straightforward, but needs to be addressed from both a theoretical and a practical standpoint. Theoretically, the HIV pandemic can be ended without an HIV vaccine. More than 30 highly effective anti-HIV drugs are currently available. When given in combinations of 3 or more, these medications can durably suppress the virus such that patients who are treated soon after infection and continue therapy throughout their lifetime can expect to have an almost-normal life expectancy.

Importantly, effective treatment can reduce the level of virus in a person with HIV so low that it is extremely unlikely that this person will transmit the virus to his or her uninfected sexual partner. This concept is referred to as “treatment as prevention.” Therefore, theoretically, if most or all of the people living with HIV in the world could be identified, accessed, and treated, it would be possible to stop all infections and end the epidemic. People who are uninfected, but whose behavior or life situation puts them at high risk of HIV infection, can take a single pill containing 2 anti-HIV drugs and decrease the likelihood of acquiring HIV infection. This approach—“preexposure prophylaxis” or PrEP—can lower the risk of acquiring HIV through sexual activity by more than 90%, or from injection drug use by more than 70% if the medications are taken consistently.2 Accordingly, if both of these treatment and prevention modalities were effectively implemented throughout the world, the HIV/AIDS pandemic would end.

However, from a practical standpoint, ending the HIV/AIDS pandemic without a vaccine is possible, although it is unlikely. Although an estimated 19.5 million of the estimated 36.7 million HIV-infected people globally are receiving anti-HIV therapy (an extraordinary accomplishment), more than 17 million people are not receiving therapy.1 This leaves a substantial treatment gap. These 17 million people can continue to infect others, allowing the pandemic to be sustained. In addition, although PrEP is highly effective in preventing acquisition of HIV among people at high risk of infection, only a very small percentage of these individuals are actually taking these medications. In the United States, it is estimated that only approximately 10% of people who could benefit from PrEP are actually receiving it,3 and this proportion is much smaller elsewhere in the world.1

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set an ambitious target to help end the HIV pandemic.1 Called “90-90-90,” the goal for 2020 is to have 90% of HIV-infected people throughout the world know their HIV status, 90% of people diagnosed with HIV receiving anti-HIV treatment, and 90% of people who receive treatment having their virus suppressed to undetectable levels. If successful, the result would be that an estimated 73% of all people in the world with HIV would have undetectable viral levels. Since suppressed viral levels result in a marked reduction in the risk of HIV transmission to other individuals, mathematical models suggest that achieving the 90-90-90 goal would reverse the kinetics and trajectory of global HIV disease such that it would no longer be of pandemic proportions. A recent study in rural Kenya and Uganda demonstrated that implementation of community-based testing and treatment resulted in increased HIV diagnosis, initiation of antiretroviral therapy and viral suppression, and the study communities reached the UNAIDS target within 2 years.4 In addition, some entire countries have been successful in reaching the goal of 73%, largely through the efforts of the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. However, the global figure for achieving this goal in all countries is just 44%.1 Also, modeling studies have suggested that in certain high-prevalence regions of the world, the geographic dispersion of the infected population, would make it extremely difficult to reach them effectively with HIV treatment.5

The question also arises whether it is economically feasible to end the HIV pandemic in the absence of a vaccine. In this regard, the resource requirements to achieve such a goal are continually increasing. The 19.5 million people currently receiving anti-HIV drugs must be maintained on these medications for the rest of their lives; at the same time, anti-HIV drugs need to be provided to the 17.2 million infected, but untreated people. Furthermore, the estimated 1.8 million people who are newly infected with HIV each year1 also need to be treated. In addition, the cost of providing PrEP and other prevention services to the millions of people who are at risk for HIV infection is substantial. In 2016, UNAIDS estimated that the total investments needed for an adequate treatment and prevention response for HIV in low- and middle-income countries between 2016 and 2030 would amount to approximately $350 billion.6 Against this backdrop, a recent Kaiser Family Foundation and UNAIDS study found that donor-government funding for HIV decreased by 7% in 2016, which represents the lowest funding level since 2010.7

Despite the remarkable gains in the treatment and prevention of HIV infection, development of an effective HIV vaccine will likely be necessary to achieve a durable end to the HIV pandemic. An important question is how effective that vaccine must be. One vaccine tested in a large vaccine trial8 in Thailand reduced the risk of infection by 31%, a figure inadequate to justify licensure of the vaccine. In contrast, other vaccines used in controlling or ending global outbreaks have been much more effective. For example, the measles, polio, and yellow fever vaccines are nearly 100% effective. Given the difficulty for the human immune system to mount a protective response against HIV, it is extremely unlikely that an HIV vaccine will be as effective as those other proven vaccines.

In fact, modeling studies have suggested that if current treatment and prevention efforts are continued and an HIV vaccine that is about 50% effective is developed and deployed, millions of additional new HIV infections could be averted, and the pandemic could slow substantially.9

Despite extraordinary advances in the treatment and prevention of HIV infection, it is theoretically possible to end the HIV epidemic by aggressively and effectively implementing these interventions, although from a practical standpoint this goal would be difficult to achieve. Therefore, development of a moderately effective vaccine together with optimal implementation of existing treatment and prevention modalities could end the current HIV pandemic. Recent advances in HIV vaccine research provide hope that at least a moderately effective vaccine can be developed. It is critical to continue to accelerate a robust research effort in that direction while aggressively scaling-up the implementation of current treatment and prevention tools. To do anything less would lead to failure, which for HIV is not an option.

Reference at title link above

Cholera
 
World’s second largest oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
COX’S BAZAR, Bangladesh, 10 October 2017 – A massive cholera immunization campaign started today near Cox’s Bazar, Bangladesh, to protect newly arrived Rohingya and host communities from the life-threatening diarrheal disease. 900 000 doses of the vaccine have been mobilized and are being delivered by more than 200 mobile vaccination teams, making it the second largest oral cholera vaccination campaign ever.

The campaign, which is led by the Ministry of Health and supported by the World Health Organization (WHO) and UNICEF, is being held in Ukhiya and Teknaf, where more than half a million people have arrived from across the border since August, joining vast numbers already residing in a series of settlements and camps.

The first round of the campaign will cover 650,000 people aged one year and older. The second round will commence on 31 October and will target 250,000 children between one and five years with an additional dose of the vaccine for added protection.

“This is the second largest oral vaccination campaign in the world after Haiti in 2016,” says Edouard Beigbeder, UNICEF Representative in Bangladesh. “Cholera is a dangerous disease, especially among children living in cramped, unhygienic conditions. Prevention is essential.”

In the last week, at least 10,292 cases of diarrhoea have been reported and treated from across the settlements and camps. WHO has warned of the potential for an outbreak of cholera.

UNICEF and WHO are supporting the Ministry of Health with planning, distribution, volunteer orientation, operational costs and monitoring.

“Emergency vaccination saves lives. The risk of cholera is clear and present, and the need for decisive action apparent,” says Dr. N Paranietharan, WHO Representative to Bangladesh. “WHO is committed to mobilizing its full technical and operational capacity to support the Ministry and our partners to protect, promote and secure the health of this immensely vulnerable population.”

In Ukhiya 150 teams have been deployed to vaccinate the target population, while 55 teams have been deployed in Teknaf. Each team is comprised of five members.  Though vaccination can provide life-saving protection against cholera, it supplements but does not replace other traditional cholera control measures such as access to clean water, adequate sanitation and good hygiene.

To help meet present water, sanitation and hygiene needs, UNICEF is working to scale up its interventions and communication on safe practices, and is prepositioning critical supplies for case management. WHO is monitoring water quality and working with the Department of Public Health Engineering to increase local laboratory capacity, has raised an early warning, alert and response emergency surveillance system, and has prepositioned life-saving supplies to ensure a rapid response if and when an outbreak occurs. In addition, the WHO-led Health Sector has supported the Ministry set up diarrhea treatment centres among other response-oriented interventions.

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 4 October 2017 [GPEI]
:: Summary of newly-reported viruses this week:
…Syria: one new circulating vaccine derived poliovirus 2 (cVDPV2) case reported, from Mayadeen district, Deir Ez-Zor governorate.  Two new cVDPV2 positives from healthy children, both from Mayadeen district. Afghanistan: two new wild poliovirus 1 (WPV1) positive environmental samples reported in Nangarhar province.
…Pakistan: three new wild poliovirus 1 (WPV1) positive environmental samples reported in

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

WHO Grade 3 Emergencies  [to 14 October 2017]
The Syrian Arab Republic
:: WHO responds to critical health needs of displaced populations in Al-Tabqa city, Ar-Raqqa Governorate  18 October 2017
:: Syria cVDPV2 outbreak situation report 17, 10 October 2017
 
::::::
 
WHO Grade 2 Emergencies  [to 14 October 2017]
Myanmar
:: Situation Report 5 – 5 October 2017
 KEY HIGHLIGHTS
:: As of 5 October 2017, cumulative new arrivals in all sites of Ukiah, Tekna, Cox’s Bazar and Ramu was 515,000, of which 198 000 are in makeshift settlements, 225,000 in new spontaneous sites and 92,000 in host communities.
:: At the weekly health sector coordination meeting, the revised humanitarian response plan was shared, targeting 1.2 million people in need and the present requirement across sectors totalling USD 434 million. The health sector is targeting to reach these 1.2 million people in need with USD 48 million.
:: An oral cholera vaccine (OCV) campaign will be rolled out in two phases. 1st dose of OCV vaccination campaign is scheduled for 10-16 October, targeting 650 000 people (new arrival population and host communities) aged 1 year and above including pregnant women. 2 weeks after the first dose, the 2nd dose would be given to children under 5 years of age to be given.
:: Oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
 [See Cholera above for more detail]

::::::
::::::
 
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. 
Iraq
:: One year on from the start of the battle for Mosul, hundreds of thousands of civilians need…
(Baghdad, 12 October 2017) One year after the start of the military campaign to retake Mosul from the Islamic State of Iraq and the Levant (ISIL), 673,000 Muslawis are still displaced from their homes; 274,000 are living in 18 camps and emergency sites surrounding the city; 400,000 are staying with family, friends or in rented accommodation.

Syrian Arab Republic
:: 13 Oct 2017  Growing concerns for Syrian civilians amid intense fighting in Al Raqqa and Deir ez-Zor

::::::

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.
Ethiopia
:: 13 Oct 2017  Ethiopia: Humanitarian Response Situation Report No.14 (August – September 2017)

::::::
::::::
 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD  [to 14 October 2017]
http://www.who.int/ebola/en/
Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 — NIH reports final data from large clinical trial in West Africa.
[See Milestones/Perspectives above for more detail]

MERS-CoV [to 14 October 2017]
http://www.who.int/emergencies/mers-cov/en/
DONs
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
9 October 2017
Between 31 August and 26 September 2017, the national IHR focal point of Saudi Arabia reported nine additional cases of Middle East Respiratory Syndrome (MERS), including four deaths. In addition, four deaths from previously reported cases were reported…
 

WHO & Regional Offices [to 14 October 2017]
 
WHO to establish commission on noncommunicable diseases
10 October 2017 – Dr Tedros Adhanom Ghebreyesus, the WHO’s Director-General, today announced the establishment of a new High-level global Commission on Noncommunicable Diseases (NCDs). The announcement came at the 64th Session of WHO’s Regional Committee for the Eastern Mediterranean being held in Islamabad, 9-12 October. The commission’s aim is to identify innovative ways to curb the world’s biggest causes of death and extend life expectancy for millions of people.
Read the statement

Sixty-eighth session of the Regional Committee for the Western Pacific
10 October 2017 — The WHO Regional Committee for the Western Pacific today opened its 68th session in Brisbane, Australia. The annual meeting brings together ministers of health and senior officials from 37 countries and areas to decide on issues that affect the health and well-being of the Region’s peoples.

Highlights
Investing in disaster prevention for a healthier world
October 2017 – The International Day for Disaster Reduction (IDDR) reminds us of the importance of putting health at the centre of action to prevent, prepare for, respond to and recover from emergencies and disasters. Millions of people are killed, injured or made sick each year by natural and manmade disasters.

Nepal tackles diabetic retinopathy
October 2017 – Diabetic retinopathy, which contributes to 2.6% of blindness in the world, can be a challenging disease for many countries to manage, because doing so involves two different parts of the health system, that which cares for patients with diabetes and that which cares for patients with vision loss. A lack of coordination can lead to people missing out on essential services, enduring long waits or traveling far from home to receive care.

Progressing the Sustainable Development Goals through Health in All Policies
October 2017 – WHO and the Government of South Australia have published the case study book on Health in All Policies (HiAP), which describes experiences from around the world in the context of the 2030 Sustainable Development Agenda.

WHO scales up response to plague in Madagascar
October 2017 – WHO is rapidly scaling up its response to an outbreak of plague that has spread to the capital and port towns, infecting more than 100 people in just a few weeks.

::::::

Weekly Epidemiological Record, 13 October 2017, vol. 92, 41 (pp. 609–624)
:: Executive summary of the 9th meeting of the WHO working group RT-PCR for the detection and subtyping of influenza viruses
:: Executive summary of the 6th meeting of the WHO Expert Working Group of the GISRS for Surveillance of Antiviral Susceptibility
:: Continuing risk of meningitis due to Neisseria meningitidis serogroup C in Africa: revised recommendations from a WHO expert consultation
:: Progress towards eliminating onchocerciasis in the WHO Region of the Americas: elimination of transmission in the north-east focus of the Bolivarian Republic of Venezuela
 
::::::
 
5 October 2017
GIN September 2017 pdf, 2.74Mb
 
::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: With USAID’s support, WHO strengthens integrated diseases surveillance and response for timely and effective public health action in South Sudan  13 October 2017
:: WHO Regional Director for Africa begins official visit to Nigeria  11 October 2017
:: The World Mental Health Day commemorated in South Sudan  11 October 2017

WHO Region of the Americas PAHO
:: Eradicating hunger in Latin America and the Caribbean by 2030 is becoming increasingly unlikely (10/10/2017)

WHO South-East Asia Region SEARO
:: WHO, partners implement 900 000 dose oral cholera vaccination campaign in Cox’s Bazaar  10 Oct 2017

WHO European Region EURO
:: World Obesity Day: Understanding the social consequences of obesity 10-10-2017
:: “We’re doctors but we’re also human”: helping Syrian health workers handle severe stress 09-10-2017

WHO Eastern Mediterranean Region EMRO
:: 64th session of the Regional Committee for the Eastern Mediterranean concludes in Pakistan
12 October 2017, Islamabad, Pakistan – Members of WHO’s Regional Committee for the Eastern Mediterranean today concluded their 64th Session, endorsing a number of resolutions that will have a positive impact on the health of populations in countries of the Eastern Mediterranean Region.
Among the topics discussed were cancer, climate change, the health of adolescents and antimicrobial resistance…

WHO Western Pacific Region
:: Countries pledge to fund priority public health services; make medicines, the health workforce and food safer
BRISBANE, Australia, 12 October 2017 – Governments from across the Region today pledged to take action to ensure the safety of medicines and competence of health workers. They also agreed on frameworks for the financing of priority health services and for making food safer. Ministers and senior officials at the 68th session of the World Health Organization (WHO) Regional Committee for the Western Pacific also noted progress in areas of public health including: noncommunicable diseases, tobacco control, mental health, tuberculosis (TB), hepatitis, traditional medicine, and gender and health…
:: World Health Organization Director-General Dr Tedros appoints Cook Islands’ Elizabeth Iro as WHO’s Chief Nursing Officer
BRISBANE, Australia, 12 October 2017 – Director-General Dr Tedros Adhanom Ghebreyesus today appointed Ms Elizabeth Iro as the Chief Nursing Officer at the World Health Organization (WHO). Ms Iro is a registered nurse, and the Cook Islands’ current Secretary of Health. With this announcement, Dr Tedros fulfils a commitment he made during his transition to the Director-General role to appoint a nurse to his senior team. “I am thrilled to welcome Ms Iro to our team as WHO’s Chief Nursing Officer,” said Dr Tedros.
 

CDC/ACIP [to 14 October 2017]
http://www.cdc.gov/media/index.html

MMWR News Synopsis for October 12, 2017
:: Vaccination Coverage Among Children in Kindergarten — United States, 2016–2017 School Year
Getting vaccines at the recommended ages protects children from serious vaccine-preventable diseases before they start school. For the 2016-2017 school year, vaccination coverage among kindergartners remained high. Immunization programs conduct annual kindergarten vaccination assessments to monitor school entry vaccination coverage. For the 2016-17 school year, vaccination coverage among kindergartners remained high and exemptions remained low. Based on the data:
:: Median vaccination coverage was 94.0 percent for two doses of measles, mumps, and rubella vaccine; 94.5 percent for the state-required number of doses of diphtheria, tetanus, and acellular pertussis vaccine; and 93.8 percent for two doses of varicella vaccine.
:: Median exemption level was 2.0 percent.
:: Median proportion of kindergartners under a grace period or provisional enrollment was 2.0 percent, the same as in 2015–16.
School assessment allows immunization programs to focus on schools with lower vaccination coverage and higher exemption levels, and encourages follow up with undervaccinated students to ensure kindergartners are protected from vaccine-preventable diseases.

Announcements

 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 14 October 2017]
http://cepi.net/
[Undated]
CEPI vaccine R&D pipeline and cost tracking survey
CEPI is inviting you to participate in a survey that is mapping vaccine research and development pipelines and associated costs for emerging infectious diseases.
The survey is open until 10 November 2017.
To achieve its strategic objectives, and to make efficient use of its financial resources, CEPI needs to draw on a variety of vaccine candidates and leverage diversity of product development partners. CEPI is currently building up a comprehensive knowledge base on available vaccine candidates and their current status, in order to serve vaccine preparedness needs against non-commercial epidemic disease threats…

EDCTP    [to 14 October 2017]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
9 October 2017
EDCTP joins forces with WHO AFRO and TDR to fund implementation research
A new partnership has been formed between EDCTP, TDR (the Special Programme for Research and Training in Tropical Diseases), and the World Health Organization’s Regional Office for Africa (WHO AFRO) in recognition of a mutual interest in strengthening the capacity for health research in African countries. Collaboration between these three partners has been realised through a recently launched call “Joint WHO-AFRO/TDR/EDCTP Small Grants Scheme for implementation research on infectious diseases of poverty”, which will close on 30 November 2017…

European Medicines Agency  [to 14 October 2017]
http://www.ema.europa.eu/ema/
13/10/2017
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 9-12 October 2017
One generic medicine recommended for approval …
 
 
FDA [to 14 October 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
October 11, 2017 –
Statement by FDA Commissioner Scott Gottlieb, M.D. on new steps by FDA to advance patient engagement in the agency’s regulatory work
The Food and Drug Administration is hosting a pioneering event today: the first meeting of the Patient Engagement Advisory Committee or PEAC. It’s a significant step forward in the FDA’s efforts to broaden its engagement with patients – and to deepen the involvement of patients in our regulatory activities.
This is the agency’s first advisory committee that’s comprised solely of patients, care-partners, and those who represent their needs. Founded by the FDA’s Center for Devices and Radiological Health (CDRH), it reflects CDRH’s commitment to keep patients at the center of their work.
The FDA’s work requires us to establish objective, consistent criteria on which we base our decisions. But ultimately, the criteria we use to judge benefit and risk turn on the parameters that matter to patients.
Involving the end-user – the patient – in identifying health priorities and outcomes desired from health interventions is critically important…
 
 
Global Fund [to 14 October 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund and The Union Deepen Partnership to Fight TB
11 October 2017
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the International Union against Tuberculosis and Lung Disease, also known as The Union, announced a partnership agreement to deepen their shared commitment to end tuberculosis as an epidemic.
News
Partners Launch Global Effort to Find Missing Cases of TB
09 October 2017
Global health partners and implementers from 13 countries with a high burden of tuberculosis launched an ambitious program to find and treat an additional 1.5 million missing cases of TB by the end of 2019. The new initiative is critically important to stopping the spread of TB and to reaching the global goal of ending TB as an epidemic by 2030.
 
 
Hilleman Laboratories   [to 14 October 2017]
http://www.hillemanlabs.org/
12/10/2017
Hilleman Labs achieves successful outcome of Phase I/II Clinical Trial of its Oral Cholera Vaccine Hillchol
New Delhi: Delivering on its mission to develop affordable vaccines for global health, Hilleman Laboratories today announced that it has successfully completed the Phase I/II Clinical Trials of its novel Oral Cholera Vaccine HillcholTM to address growing need to stop Cholera in the developing world.
The Phase I/II clinical study was conducted in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Results of the clinical trials were announced at the Vaccines for Enteric Diseases Conference 2017 recently held in Albufeira, Portugal…

Hilleman Labs successfully completes Phase I/II Clinical Trial of its Heat Stable Rotavirus Vaccine (HSRV)
12th October 2017, New Delhi: Making headway towards providing the developing nations an affordable and easy-to-use Heat Stable Rotavirus Vaccine (HSRV), Hilleman Laboratories, a joint-venture between Merck Sharp & Dohme (MSD) and the Wellcome Trust, today announced the successful completion of Phase I/II clinical trial of its oral vaccine against the deadly Rotavirus disease.
The study was conducted in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)…
 
IAVI  [to 14 October 2017]
https://www.iavi.org/
October 2017
IAVI REPORT – VOL. 21, NO. 3, 2017
:: Decisive Moments in Wake of Paris
:: Stumbling on Greatness
:: PrEParing to Prevent HIV
:: In Brief
 
MSF/Médecins Sans Frontières  [to 14 October 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Governments Must Step Up the Use of Newer Drugs to Fight Multidrug-Resistant TB
Guadalajara, Mexico, October 13, 2017—People with drug-resistant tuberculosis (DR-TB) are still not receiving two newer tuberculosis (TB) drugs, bedaquiline and delamanid, which have shown improved cure rates for the disease, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) at the 48th Union World Conference on Lung Health in Guadalajara, Mexico, where the global TB community is meeting.
 
 
NIH  [to 14 October 2017]
http://www.nih.gov/news-events/news-releases
October 12, 2017
NIH partners with 11 leading biopharmaceutical companies to accelerate the development of new cancer immunotherapy strategies for more patients
October 12, 2017 — Supports Cancer Moonshot goal to bring immunotherapy success to more patients in half the time.

Experimental Ebola vaccines elicit year-long immune response
October 11, 2017 — NIH reports final data from large clinical trial in West Africa.
[See Milestones/Perspectives above for more detail]

NIH completes atlas of human DNA differences that influence gene expression
October 11, 2017 — This atlas will be a critical resource for the scientific community.

Durable end to the HIV/AIDS pandemic likely will require an HIV vaccine
October 10, 2017 — From a practical standpoint, ending the HIV/AIDS pandemic without a vaccine is unlikely.
   AS Fauci. An HIV vaccine is essential for ending the HIV/AIDS pandemic. Journal of the American Medical Association DOI: 10.1001/jama.2017.13505 (2017) (link is external).
[See Milestones/Perspectives above for more detail]

UNAIDS [to 14 October 2017]
http://www.unaids.org/en
Update
International Day of the Girl Child: empowering girls before, during and after crises
11 October 2017
The International Day of the Girl Child, marked every year on 11 October, highlights and addresses the needs and challenges that girls face, while promoting their empowerment and human rights.
In many parts of the world, one of the key challenges that adolescent girls face is HIV. Globally, every week 6900 adolescent girls and young women aged 15–24 years are newly infected with HIV, yet only one in three adolescent girls and young women have comprehensive and correct knowledge of how to prevent HIV. In sub-Saharan Africa, three in four new HIV infections among 15–19-year-olds are among girls.
The theme of the International Day of the Girl Child 2017 is “EmPOWER girls: before, during and after crises”. War and conflict exacerbate the vulnerability of girls to child marriage, intensify inequality and make women and girls susceptible to both household and intimate partner violence, all of which increase the vulnerability of women and girls to HIV…

Press statement
UNAIDS and UNFPA launch road map to stop new HIV infections
Global HIV Prevention Coalition holds first meeting in Geneva, Switzerland, to find ways to strengthen and sustain political commitment for HIV prevention
GENEVA, 10 October 2017—As part of global efforts to end AIDS as a public health threat, UNAIDS, the United Nations Population Fund (UNFPA) and partners have launched a new road map to reduce new HIV infections. The HIV prevention 2020 road map was launched at the first meeting of the Global HIV Prevention Coalition. The coalition is chaired by the Executive Directors of UNAIDS and UNFPA and brings together United Nations Member States, civil society, international organizations and other partners as part of efforts to reduce new HIV infections by 75% by 2020…

Update
New fund for key populations in eastern Europe and central Asia
10 October 2017
The Elton John AIDS Foundation announced on 10 October a new funding initiative for key populations in eastern Europe and central Asia.
The Key Populations Fund for Eastern Europe and Central Asia will focus on prevention and treatment of both HIV and hepatitis C for the people in the region most vulnerable to HIV—people who inject drugs, gay men and other men who have sex with men and sex workers. Over the next three years, the fund will aim to reach 20 000 people in the region with prevention, testing and treatment services…

UNICEF  [to 14 October 2017]
https://www.unicef.org/media/
12 October, 2017
Violence in al-Mayadin district, Deir ez-Zor, reportedly destroys cold room and vaccines
AMMAN/DAMASCUS,– “UNICEF has received reports that ongoing violence in Deir ez-Zor in eastern Syria has destroyed a UNICEF-supported vaccine cold room in al-Mayadin district, with at least 140,000 doses of vaccines lost, including some planned for use in tackling vaccine-preventable childhood diseases in the area. UNICEF is currently verifying this alarming report.

UNICEF emergency supplies for Rohingya children en route to Cox’s Bazar
COX’S BAZAR, 14 September 2017 – UNICEF trucks filled with emergency water, sanitation and hygiene supplies for thousands of Rohingya children are headed to Cox’s Bazar, with a steady stream of supplies in the pipeline for the coming days and weeks.

World’s second largest oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh
COX’S BAZAR, Bangladesh, 10 October 2017 – A massive cholera immunization campaign started today near Cox’s Bazar, Bangladesh, to protect newly arrived Rohingya and host communities from the life-threatening diarrheal disease. 900,000 doses of the vaccine have been mobilized and are being delivered by more than 200 mobile vaccination teams, making it the second largest oral cholera vaccination campaign ever.
 
Wellcome Trust  [to 14 October 2017]
https://wellcome.ac.uk/news
News / Published: 13 October 2017
Global pledges to speed up action on superbugs
Wellcome is investing £2.4 million in a new project to track the global impact of superbugs as part of our ongoing efforts to help address this urgent global health threat.
The Global Burden of Disease AMR project will be launched today at our international Call to Action conference.

News / Published: 10 October 2017
Findings from new malaria database are ‘wake-up call’
Researchers have compiled and analysed 115 years of malaria data in Africa, providing the most detailed picture yet of where efforts to control malaria infection are being won and lost across the continent.
The largest data repository of any parasitic disease in the world, it includes 7.8 million blood samples from more than 30,000 locations in 43 countries.
The open access dataset (opens in a new tab) was collected and analysed by KEMRI-Wellcome Trust (opens in a new tab) researchers Professor Bob Snow, Abdisalan Noor and colleagues based in Kenya, and is the result of over 20 years of research funded by Wellcome.

::::::
 
PhRMA    [to 14 October 2017]
http://www.phrma.org/press-room
October 12, 2017
PhRMA, member companies and NIH create public-private partnership for immuno-oncology
A new public-private partnership will help build upon a new era in cancer treatment.

October 11, 2017
Amgen Chairman and CEO Robert A. Bradway Elected PhRMA Board Chairman-Elect
The Pharmaceutical Research and Manufacturers of America elected new officers to its board of directors.

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 14 October 2017)

Research article
Spatial model for risk prediction and sub-national prioritization to aid poliovirus eradication in Pakistan
Laina D. Mercer, Rana M. Safdar, Jamal Ahmed, Abdirahman Mahamud, M. Muzaffar Khan, Sue Gerber, Aiden O’Leary, Mike Ryan, Frank Salet, Steve J. Kroiss, Hil Lyons, Alexander Upfill-Brown and Guillaume Chabot-Couture
Published on: 11 October 2017
Abstract
Background
Pakistan is one of only three countries where poliovirus circulation remains endemic. For the Pakistan Polio Eradication Program, identifying high risk districts is essential to target interventions and allocate limited resources.
Methods
Using a hierarchical Bayesian framework we developed a spatial Poisson hurdle model to jointly model the probability of one or more paralytic polio cases, and the number of cases that would be detected in the event of an outbreak. Rates of underimmunization, routine immunization, and population immunity, as well as seasonality and a history of cases were used to project future risk of cases.
Results
The expected number of cases in each district in a 6-month period was predicted using indicators from the previous 6-months and the estimated coefficients from the model. The model achieves an average of 90% predictive accuracy as measured by area under the receiver operating characteristic (ROC) curve, for the past 3 years of cases.
Conclusions
The risk of poliovirus has decreased dramatically in many of the key reservoir areas in Pakistan. The results of this model have been used to prioritize sub-national areas in Pakistan to receive additional immunization activities, additional monitoring, or other special interventions.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 14 October 2017)

Research article
Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014
Cholera remains an important public health challenge globally. Several pandemics have occurred in different parts of the world and have been epidemiologically linked by different researchers to illustrate how …
Kennedy Ohene-Adjei, Ernest Kenu, Delia Akosua Bandoh, Prince Nii Ossah Addo, Charles Lwanga Noora, Priscillia Nortey and Edwin Andrew Afari
BMC Public Health 2017 17:801
Published on: 11 October 2017

EMBO Reports
01 October 2017; volume 18, issue 10
http://embor.embopress.org/content/18/10?current-issue=y

Science & Society
Viral taxonomyThe effect of metagenomics on understanding the diversity and evolution of viruses
The advent of next‐generation sequencing and metagenomics is challenging viral taxonomy to define and characterize viruses along with providing novel insights into the vast diversity of viruses and their evolution.
Philip Hunter

The European Journal of Public Health
Volume 27, Issue 5, October 2017
https://academic.oup.com/eurpub/issue/27/5

Editorials
Resilience and 21st century public health
Erio Ziglio; Natasha Azzopardi-Muscat; Lino Briguglio
European Journal of Public Health, Volume 27, Issue 5, 1 October 2017, Pages 789–790, https://doi.org/10.1093/eurpub/ckx116
Extract
The concept of ‘resilience’ is recently being increasingly used in academia, professional bodies, business, human rights and civil society organizations and in a wide-range of policy sectors. Its use in the field of public health has long been part and parcel of preventive policies designed to promote a long-term, holistic and socio-economic developmental approach to individual, community health and wellbeing. With today’s protracted economic crisis, it is more vital than ever to be clear about its particular significance if we are to foster lasting and meaningful action to strengthen resilience to improve health and well-being.
Resilience can be strengthened at individual, community and system levels. There are at least four types of resilience capacity that can be applied to these levels, usually referred to as absorptive, adaptive, anticipatory and transformative…

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 14 October 2017]

Scoping Review
The perspective of gender on the Ebola virus using a risk management and population health framework: a scoping review
In the three decades since the first reported case of Ebola virus, most known index cases have been consistently traced to the hunting of “bush meat”, and women have consistently recorded relatively high fatal…
Miriam N. Nkangu, Oluwasayo A. Olatunde and Sanni Yaya
Infectious Diseases of Poverty 2017 6:135
Published on: 11 October 2017

The Lancet
Oct 14, 2017 Volume 390 Number 10104 p1715-1810   e25-e26
http://www.thelancet.com/journals/lancet/issue/current

WHO launches new leadership, new priorities
The Lancet
Published: 14 October 2017
WHO’s Director-General, Dr Tedros, last week launched his new cabinet to widespread acclaim. His mix of deputy and assistant director-generals is made up of nine women (two-thirds of his leadership team) with a geographical spread across 14 countries. India, Brazil, Saudi Arabia, South Africa, and Barbados are all newly represented. The announcement also translated Tedros’s verbal promises into structural commitments. New priorities include Universal Health Coverage, climate change, and access to medicines. His cabinet is diverse, talented, and experienced. Now it’s all about WHO’s actions. A special session of the Executive Board will be convened in November to agree a future global programme of work for the agency.

There are important questions to resolve. How will the new team in Geneva work with regional directors and regional offices? Will the expanded number of priorities and larger executive team create more silos within an organisation that is already partly paralysed by inefficiency? Will the optimism engendered by Dr Tedros’s election be backed by donor investment to a chronically impoverished WHO? Internally, the director-general has signalled to staff that he wants urgent and profound organisational change. Reports suggest that he is likely to appoint a transformation czar and hire McKinsey consultants to manage the change.

Dr Tedros is said to be obsessed by impact, which is welcome. WHO is at its best when it amplifies its voice and reach by establishing radical and innovative initiatives led by internationally recognised technical or political leaders. This was the lesson of Gro Harlem Brundtland’s term as director-general. The goal of transformational change is good. But it might be more practical for WHO to deliver on a limited number of tangible and feasible objectives rather than speaking in terms of broad generalities and aspirations. Dr Tedros and his team will be judged on specific and measurable successes—such as pandemic protection and stronger health systems.

The announcement last week has brought additional and valuable momentum to the renewal of WHO. The agency must now raise its political game.

The Lancet
Oct 14, 2017 Volume 390 Number 10104 p1715-1810   e25-e26
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents
Peter Sheehan, Kim Sweeny, Bruce Rasmussen, Annababette Wils, Howard S Friedman, Jacqueline Mahon, George C Patton, Susan M Sawyer, Eric Howard, John Symons, Karin Stenberg, Satvika Chalasani, Neelam Maharaj, Nicola Reavley, Hui Shi, Masha Fridman, Alison Welsh, Emeka Nsofor, Laura Laski
Summary
Investment in the capabilities of the world’s 1.2 billion adolescents is vital to the UN’s Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Misdirections in Informed Consent — Impediments to Health Care Innovation
David A. Asch, M.D., M.B.A., Tracy A. Ziolek, M.S., and Shivan J. Mehta, M.D., M.B.A., M.S.H.P.
N Engl J Med 2017; 377:1412-1414 October 12, 2017 DOI: 10.1056/NEJMp1707991

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Voluntary Site Accreditation — Improving the Execution of Multicenter Clinical Trials
S.C. Johnston, C.P. Austin, and F. Lewis-Hall

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Original Articles
Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors — Final Report
G.F. Deen and Others

New England Journal of Medicine
October 12, 2017  Vol. 377 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Phase 2 Placebo-Controlled Trial of Two Vaccines to Prevent Ebola in Liberia
Stephen B. Kennedy, M.D., Fatorma Bolay, Ph.D., Mark Kieh, M.D., Greg Grandits, M.S., Moses Badio, M.Sc., Ripley Ballou, M.D., Risa Eckes, B.S.N., Mark Feinberg, M.D., Ph.D., Dean Follmann, Ph.D., Birgit Grund, Ph.D., Swati Gupta, Dr.P.H., Lisa Hensley, Ph.D., Elizabeth Higgs, M.D., Krisztina Janosko, B.S., Melvin Johnson, B.Sc., Francis Kateh, M.D., James Logue, M.S., Jonathan Marchand, M.S., Thomas Monath, M.D., Martha Nason, Ph.D., Tolbert Nyenswah, M.P.H., François Roman, Ph.D., Eric Stavale, M.S., Julian Wolfson, Ph.D., James D. Neaton, Ph.D., and H. Clifford Lane, M.D., for the PREVAIL I Study Group*
N Engl J Med 2017; 377:1438-1447 October 12, 2017 DOI: 10.1056/NEJMoa1614067
Abstract
Background
The safety and efficacy of vaccines to prevent Ebola virus disease (EVD) were unknown when the incidence of EVD was peaking in Liberia.
Full Text of Background…
Methods
We initiated a randomized, placebo-controlled, phase 3 trial of the chimpanzee adenovirus 3 vaccine (ChAd3-EBO-Z) and the recombinant vesicular stomatitis virus vaccine (rVSV∆G-ZEBOV-GP) in Liberia. A phase 2 subtrial was embedded to evaluate safety and immunogenicity. Because the incidence of EVD declined in Liberia, the phase 2 component was expanded and the phase 3 component was eliminated.
Full Text of Methods…
Results
A total of 1500 adults underwent randomization and were followed for 12 months. The median age of the participants was 30 years; 36.6% of the participants were women. During the week after the administration of vaccine or placebo, adverse events occurred significantly more often with the active vaccines than with placebo; these events included injection-site reactions (in 28.5% of the patients in the ChAd3-EBO-Z group and 30.9% of those in the rVSV∆G-ZEBOV-GP group, as compared with 6.8% of those in the placebo group), headache (in 25.1% and 31.9%, vs. 16.9%), muscle pain (in 22.3% and 26.9%, vs. 13.3%), feverishness (in 23.9% and 30.5%, vs. 9.0%), and fatigue (in 14.0% and 15.4%, vs. 8.8%) (P<0.001 for all comparisons); these differences were not seen at 1 month. Serious adverse events within 12 months after injection were seen in 40 participants (8.0%) in the ChAd3-EBO-Z group, in 47 (9.4%) in the rVSV∆G-ZEBOV-GP group, and in 59 (11.8%) in the placebo group. By 1 month, an antibody response developed in 70.8% of the participants in the ChAd3-EBO-Z group and in 83.7% of those in the rVSV∆G-ZEBOV-GP group, as compared with 2.8% of those in the placebo group (P<0.001 for both comparisons). At 12 months, antibody responses in participants in the ChAd3-EBO-Z group (63.5%) and in those in the rVSV∆G-ZEBOV-GP group (79.5%) remained significantly greater than in those in the placebo group (6.8%, P<0.001 for both comparisons).
Full Text of Results…
Conclusions
A randomized, placebo-controlled phase 2 trial of two vaccines that was rapidly initiated and completed in Liberia showed the capability of conducting rigorous research during an outbreak. By 1 month after vaccination, the vaccines had elicited immune responses that were largely maintained through 12 months. (Funded by the National Institutes of Allergy and Infectious Diseases and the Liberian Ministry of Health; PREVAIL I ClinicalTrials.gov number, NCT02344407.)

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 14 October 2017]

First Wave of the 2016-17 Cholera Outbreak in Hodeidah City, Yemen – Acf Experience and Lessons Learned
October 13, 2017 · Research Article
Introduction: Although cases were reported only in 2010 and 2011, cholera is probably endemic in Yemen. In the context of a civil war, a cholera outbreak was declared in different parts of the country October 6th, 2016. This paper describes the ACF outbreak response in Hodeidah city from October 28th, 2016 to February 28th, 2017 in order to add knowledge to this large outbreak.
Methods: The ACF outbreak response in Hodeidah city included a case management component and prevention measures in the community. In partnership with the Ministry of Public Health and Population of Yemen (MoPHP), the case management component included a Cholera Treatment Center (CTC) implemented in the Al Thoraw hospital, 11 Oral Rehydration Therapy Corners (ORTCs) and an active case finding system. In partnership with other stakeholders, prevention measures in the community, including access to safe water and hygiene promotion, were implemented in the most affected communities of the city.
Results: From October 28th, 2016 until February 28th, 2017, ACF provided care to 8,270 Acute Watery Diarrhea (AWD) cases, of which 5,210 (63%) were suspected cholera cases, in the CTC and the 11 ORTCs implemented in Hodeidah city. The attack rate was higher among people living in Al Hali district, with a peak in November 2016. At the CTC, 8% of children under 5 years-old also presented with Severe Acute Malnutrition (SAM). The Case-Fatality Rate (CFR) was low (0.07%) but 15% of admitted cases defaulted for cultural and security reasons. Environmental management lacked the information to appropriately target affected areas. Financial resources did not allow complete coverage of the city.
Conclusion: Response to the first wave of a large cholera outbreak in Hodeidah city was successful in maintaining a CFR <1% in the CTC. However, considering the actual context of Yemen and its water infrastructure, much more efforts are needed to control the current outbreak resurgence.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 14 October 2017)

Research Article
Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control
Ian T. Kracalik, Ernest Kenu, Evans Nsoh Ayamdooh, Emmanuel Allegye-Cudjoe, Paul Nokuma Polkuu, Joseph Asamoah Frimpong, Kofi Mensah Nyarko, William A. Bower, Rita Traxler, Jason K. Blackburn
| published 13 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005885

Is mass drug administration against lymphatic filariasis required in urban settings? The experience in Kano, Nigeria
Dung D. Pam, Dziedzom K. de Souza, Susan Walker, Millicent Opoku, Safiya Sanda, Ibrahim Nazaradeen, Ifeoma N. Anagbogu, Chukwu Okoronkwo, Emmanuel Davies, Elisabeth Elhassan, David Molyneux, Moses J. Bockarie, Benjamin G. Koudou
Research Article | published 11 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006004

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district
Carolyn Patricia Mulipukwa, Boyd Mudenda, Allan Rabson Mbewe
Research Article | published 09 Oct 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005946

PLoS One
http://www.plosone.org/

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia
Paul R. Ward, Katie Attwell, Samantha B. Meyer, Philippa Rokkas, Julie Leask
Research Article | published 12 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185955

PLoS One
http://www.plosone.org/

Assessing the individual risk of fecal poliovirus shedding among vaccinated and non-vaccinated subjects following national health weeks in Mexico
Leticia Ferreyra-Reyes, Luis Pablo Cruz-Hervert, Stephanie B. Troy, ChunHong Huang, Clea Sarnquist, Guadalupe Delgado-Sánchez, Sergio Canizales-Quintero, Marisa Holubar, Elizabeth Ferreira-Guerrero, Rogelio Montero-Campos, Mauricio Rodríguez-Álvarez, Norma Mongua-Rodriguez, Yvonne Maldonado, Lourdes García-García
Research Article | published 12 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185594

PLoS One
http://www.plosone.org/

Violence, insecurity, and the risk of polio: A systematic analysis
Kia Guarino, Arend Voorman, Maxime Gasteen, Donte Stewart, Jay Wenger
Research Article | published 11 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0185577
Conclusion
National virologic and immunologic indicators understate the risk of poliovirus spread in areas with violence and insecurity, and the inclusion of such factors improves precision. In addition, the link between violence and incidence of disease highlights the broader challenge of implementing health interventions in conflict areas. We discuss practical implications of this work in understanding and measuring the risks to polio eradication and other global health initiatives, and the policy implications of the need to reach vulnerable populations in conflict zones.

PLoS One
http://www.plosone.org/

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects
Siobhan Botwright, Taylor Holroyd, Shreya Nanda, Paul Bloem, Ulla K. Griffiths, Anissa Sidibe, Raymond C. W. Hutubessy
Research Article | published 10 Oct 2017 PLOS ONE
https://doi.org/10.1371/journal.pone.0182663
Abstract
From 2012 to 2016, Gavi, the Vaccine Alliance, provided support for countries to conduct small-scale demonstration projects for the introduction of the human papillomavirus vaccine, with the aim of determining which human papillomavirus vaccine delivery strategies might be effective and sustainable upon national scale-up. This study reports on the operational costs and cost determinants of different vaccination delivery strategies within these projects across twelve countries using a standardized micro-costing tool. The World Health Organization Cervical Cancer Prevention and Control Costing Tool was used to collect costing data, which were then aggregated and analyzed to assess the costs and cost determinants of vaccination. Across the one-year demonstration projects, the average economic and financial costs per dose amounted to US$19.98 (standard deviation ±12.5) and US$8.74 (standard deviation ±5.8), respectively. The greatest activities representing the greatest share of financial costs were social mobilization at approximately 30% (range, 6–67%) and service delivery at about 25% (range, 3–46%). Districts implemented varying combinations of school-based, facility-based, or outreach delivery strategies and experienced wide variation in vaccine coverage, drop-out rates, and service delivery costs, including transportation costs and per diems. Size of target population, number of students per school, and average length of time to reach an outreach post influenced cost per dose. Although the operational costs from demonstration projects are much higher than those of other routine vaccine immunization programs, findings from our analysis suggest that HPV vaccination operational costs will decrease substantially for national introduction. Vaccination costs may be decreased further by annual vaccination, high initial investment in social mobilization, or introducing/strengthening school health programs. Our analysis shows that drivers of cost are dependent on country and district characteristics. We therefore recommend that countries carry out detailed planning at the national and district levels to define a sustainable strategy for national HPV vaccine roll-out, in order to achieve the optimal balance between coverage and cost.

Preventive Medicine
Volume 102, Pages 1-126 (September 2017)
http://www.sciencedirect.com/science/journal/00917435/102?sdc=1

Original Research Article
Determinants of human papillomavirus vaccination uptake among adolescent girls: A theory-based longitudinal study among Hong Kong Chinese parents
Pages 24-30
Linda Dong-Ling Wang, Wendy Wing Tak Lam, Richard Fielding

Science         
13 October 2017   Vol 358, Issue 6360
http://www.sciencemag.org/current.dtl
Special Issue: Remote sensing

In Depth
Drug-resistant malaria advances in Mekong
By Leslie Roberts
Science13 Oct 2017 : 155-156 Restricted Access
Dangerous strain has spread to Vietnam, but experts sharply dispute its risk to the world.

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

The value of multi-country joint regulatory reviews: The experience of a WHO joint technical consultation on the CYD-TDV (Dengvaxia®) dossier
Pages 5731-5733
Kirsten Vannice, Liliana Chocarro, Michael Pfleiderer, Ahmed Bellah, Michael Ward, In-Kyu Yoon, Joachim Hombach

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

Data and product needs for influenza immunization programs in low- and middle-income countries: Rationale and main conclusions of the WHO preferred product characteristics for next-generation influenza vaccines
Pages 5734-5737
Kathleen M. Neuzil, Joseph S. Bresee, Fernando de la Hoz, Kari Johansen, Ruth A. Karron, Anand Krishnan, Shabir A. Madhi, Punam Mangtani, David J. Spiro, Justin R. Ortiz, On behalf of the WHO Preferred Product Characteristics for Next-Generation Influenza Vaccines Advisory Group

Vaccine
Volume 35, Issue 43, Pages 5731-5946 (13 October 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/43?sdc=1

WHO position on the use of fractional doses – June 2017, addendum to vaccines and vaccination against yellow fever WHO: Position paper – June 2013
Pages 5751-5752
World Health Organization