American Journal of Tropical Medicine and Hygiene
Volume 96, Issue 6, 2017
http://www.ajtmh.org/content/current

Perspective Pieces
The Cuba–United States Thaw: Building Bridges Through Science and Global Health
Authors: Daniel G. Bausch, Vivian Kouri, Sonia Resik, Belsy Acosta, Gerardo Guillen, Karen Goraleski, Marcos Espinal and Maria G. Guzman
https://doi.org/10.4269/ajtmh.17-0136

Articles
High Hepatitis E Seroprevalence Among Displaced Persons in South Sudan
Authors: Andrew S. Azman, Malika Bouhenia, Anita S. Iyer, John Rumunu, Richard Lino Laku, Joseph F. Wamala, Isabel Rodriguez-Barraquer, Justin Lessler, Etienne Gignoux, Francisco J. Luquero, Daniel T. Leung, Emily S. Gurley and Iza Ciglenecki
https://doi.org/10.4269/ajtmh.16-0620

Evaluation of the Field Performance of ImmunoCard STAT!® Rapid Diagnostic Test for Rotavirus in Dadaab Refugee Camp and at the Kenya–Somalia Border
Authors: Maurice Ope, Raymond Nyoka, Ahmed Unshur, Fredrick O. Oyier, Shafe A. Mowlid, Brian Owino, Steve B. Ochieng, Charles I. Okello, Joel M. Montgomery, Burton Wagacha, Aleksandar Galev, Abdikadir Abdow, Mathew D. Esona, Jacqueline Tate, David Fitter, Susan T. Cookson, Balajee Arunmozhi and Nina Marano
https://doi.org/10.4269/ajtmh.16-0885

Phase 1 Randomized Study of a Tetravalent Dengue Purified Inactivated Vaccine in Healthy Adults in the United States
Authors: Alexander C. Schmidt, Leyi Lin, Luis J. Martinez, Richard C. Ruck, Kenneth H. Eckels, Alix Collard, Rafael De La Barrera, Kristopher M. Paolino, Jean-François Toussaint, Edith Lepine, Bruce L. Innis, Richard G. Jarman and Stephen J. Thomas
https://doi.org/10.4269/ajtmh.16-0634

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 10 June 2017)

Research article
Development of a consensus operational definition of child assent for research
Alan R. Tait and Michael E. Geisser
Published on: 9 June 2017
Abstract
Background
There is currently no consensus from the relevant stakeholders regarding the operational and construct definitions of child assent for research. As such, the requirements for assent are often construed in different ways, institutionally disparate, and often conflated with those of parental consent. Development of a standardized operational definition of assent would thus be important to ensure that investigators, institutional review boards, and policy makers consider the assent process in the same way. To this end, we describe a Delphi study that provided consensus from a panel of expert stakeholders regarding the definitions of child assent for research.
Methods
Based on current guidelines, a preliminary definition of assent was generated and sent out for review to a Delphi panel including pediatric bioethicists and researchers, Institutional Review Board members, parents, and individuals with regulatory/legal expertise. For each subsequent review, the process of summarizing and revising responses was repeated until consensus was achieved. Panelists were also required to rank order elements of assent that they believed were most important in defining the underlying constructs of the assent process (e.g., capacity for assent, disclosure). In providing these rankings, panelists were asked to frame their responses in the contexts of younger (≤ 11 yrs) and adolescents/older children (12-17 yrs) in non-therapeutic and therapeutic trials. Summary rankings of the most important identified elements were then used to generate written construct definitions which were sent out for iterative reviews by the expert panel.
Results
Consensus regarding the operational definition was reached by 14/18 (78%) of the panel members. Seventeen (94%) panelists agreed with the definitions of capacity for assent, elements of disclosure for younger children, and the requirements for meaningful assent, respectively. Fifteen (83%) members agreed with the elements of disclosure for adolescents/older children.
Conclusions
It is hoped that this study will positively inform and effect change in the way investigators, regulators, and IRBs operationalize the assent process, respect children’s developing autonomy, and in concert with parental permission, ensure the protection of children who participate in research.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 10 June 2017)

Research article
Assessing the efficiency of catch-up campaigns for the introduction of pneumococcal conjugate vaccine: a modelling study based on data from PCV10 introduction in Kilifi, Kenya
The World Health Organisation recommends the use of catch-up campaigns as part of the introduction of pneumococcal conjugate vaccines (PCVs) to accelerate herd protection and hence PCV impact. The value of a catch-up campaign is a trade-off between the costs of vaccinating additional age groups and the benefit of additional direct and indirect protection. There is a paucity of observational data, particularly from low- and middle-income countries, to quantify the optimal breadth of such catch-up campaigns… We find that catch-up campaigns are a highly dose-efficient way to accelerate population protection against pneumococcal disease.
Stefan Flasche, John Ojal, Olivier Le Polain de Waroux, Mark Otiende, Katherine L. O’Brien, Moses Kiti, D. James Nokes, W John Edmunds and J. Anthony G. Scott
Published on: 7 June 2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 10 June 2017)

Research article
Immunization, urbanization and slums – a systematic review of factors and interventions
Tim Crocker-Buque, Godwin Mindra, Richard Duncan and Sandra Mounier-Jack
BMC Public Health 2017 17:556
Published on: 8 June 2017
Abstract
Background
In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poorer urban dwellers in many contexts. This study aims to identify factors associated with immunization coverage in poor urban areas and slums, and to identify interventions to improve coverage.
Methods
We conducted a systematic review, searching Medline, Embase, Global Health, CINAHL, Web of Science and The Cochrane Database with broad search terms for studies published between 2000 and 2016.
Results
Of 4872 unique articles, 327 abstracts were screened, leading to 63 included studies: 44 considering factors and 20 evaluating interventions (one in both categories) in 16 low or middle-income countries. A wide range of socio-economic characteristics were associated with coverage in different contexts. Recent rural-urban migration had a universally negative effect. Parents commonly reported lack of awareness of immunization importance and difficulty accessing services as reasons for under-immunization of their children. Physical distance to clinics and aspects of service quality also impacted uptake. We found evidence of effectiveness for interventions involving multiple components, especially if they have been designed with community involvement. Outreach programmes were effective where physical distance was identified as a barrier. Some evidence was found for the effective use of SMS (text) messaging services, community-based education programmes and financial incentives, which warrant further evaluation. No interventions were identified that provided services to migrants from rural areas.
Conclusion
Different factors affect immunization coverage in different urban poor and slum contexts. Immunization services should be designed in collaboration with slum-dwelling communities, considering the local context. Interventions should be designed and tested to increase immunization in migrants from rural areas.

BMJ Open
June 2017 – Volume 7 – 6
http://bmjopen.bmj.com/content/current
Health economics
Research
A systematic review of economic evaluations of seasonal influenza vaccination for the elderly population in the European Union
Gemma E Shields, Jamie Elvidge, Linda M Davies

Epidemiology
Research
Timing of two versus three doses of quadrivalent HPV vaccine and associated effectiveness against condyloma in Sweden: a nationwide cohort study
Lamb F, Herweijer E, Ploner A, Uhnoo I, Sundström K, Sparén P, Arnheim-Dahlström L

Emerging Infectious Diseases
Volume 23, Number 6—June 2017
http://wwwnc.cdc.gov/eid/

Research
Stockpiling Ventilators for Influenza Pandemics PDF Version [PDF – 1018 KB – 8 pages
Huang et al.
Abstract
In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

Commentaries
Stockpiling Ventilators for Influenza Pandemics PDF Version [PDF – 1.25 MB – 2 pages]
I. Meltzer and A. Patel

Health Affairs
June 2017; Volume 36, Issue 6
http://content.healthaffairs.org/content/current

Issue Focus: Pursuing Health Equity
From The Editor-in-Chief
Pursuing Health Equity
Alan R. Weil
Extract
If equity is one dimension of what the Institute of Medicine (IOM) defined as health care quality, what are the obligations of the health care sector to achieve health equity? Early evidence of health disparities led to a focus on the health care system—the roles of bias and discrimination, as captured by the title of the 2003 IOM report Unequal Treatment. Yet as Steven Woolf points out in his lead paper, growing understanding of the role of social factors in determining health outcomes makes it clear that achieving equity requires widening the lens. This month’s Health Affairs examines health equity from both perspectives: equity in care, and the relationship between social factors and health equity.

Health and Human Rights
Volume 19, Issue 1, June 2017
http://www.hhrjournal.org/

General Papers
PERSPECTIVE Human Rights in the World Health Organization: Views of the Director-General Candidates
Benjamin Mason Meier
PERSPECTIVE Unstoppable: How Advocates Persevered in the Fight for Justice for Haitian Cholera Victims
Adam Houston

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 10 June 2017]

Research
Health systems research in fragile and conflict affected states: a qualitative study of associated challenges
Tim Martineau, Aniek Woodward, Kate Sheahan and Egbert Sondorp
Published on: 7 June 2017
Abstract
Background
High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges.
Methods
Guided by a purposely-selected steering group, this qualitative study collected respondents’ perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited.
Results
Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results.
Conclusions
This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts.

International Journal of Epidemiology
Volume 46, Issue 2    April 2017
http://ije.oxfordjournals.org/content/current

Miscellaneous
Vaccinations against smallpox and tuberculosis are associated with better long-term survival: a Danish case-cohort study 1971–2010
Andreas Rieckmann; Marie Villumsen; Signe Sørup; Line Klingen Haugaard; Henrik Ravn …

Distance to health services modifies the effect of an 11-valent pneumococcal vaccine on pneumonia risk among children less than 2 years of age in Bohol, Philippines
Elisabeth Dowling Root; Marilla Lucero; Hanna Nohynek; Rebecca Stubbs; Veronica Tallo …

JAMA
June 6, 2017, Vol 317, No. 21, Pages 2145-2248
http://jama.jamanetwork.com/issue.aspx

Progress Toward Achieving UNAIDS 90-90-90 in Rural Communities in East Africa
Carlos del Rio, MD; Wendy S. Armstrong, MD
JAMA. 2017;317(21):2172-2174. doi:10.1001/jama.2017.5704
Preview
In recent years, the results of several studies, including Human Immunodeficiency Virus (HIV) Prevention Trials Network (HPTN) 052,1 Strategic Timing of Antiretroviral Treatment (START),2 and Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa (TEMPRANO),3 have rapidly changed the global approach to HIV treatment and have raised the possibility of ending AIDS by 2030. These 3 studies demonstrated that HIV-infected persons with viral suppression receiving antiretroviral therapy (ART) do not transmit HIV to their uninfected sex partners,1 and that initiating ART resulted in net health benefits to HIV-infected persons in high-income and low-income countries regardless of CD4 lymphocyte count.2,3 In sum, ART has been shown to be beneficial for individual and public health and that “treatment is prevention.”

JAMA
June 6, 2017, Vol 317, No. 21, Pages 2145-2248
http://jama.jamanetwork.com/issue.aspx

Original Investigation
Association of Implementation of a Universal Testing and Treatment Intervention With HIV Diagnosis, Receipt of Antiretroviral Therapy, and Viral Suppression in East Africa
Maya Petersen, MD, PhD; Laura Balzer, PhD; Dalsone Kwarsiima, MBChB, MPH; et al.
JAMA. 2017;317(21):2196-2206. doi:10.1001/jama.2017.5705
This analysis examines intervention communities in rural Uganda and Kenya in an ongoing cluster randomized trial to assess the change in the proportions of HIV-positive residents diagnosed with HIV, treated with ART, and achieving HIV viral suppression.

JAMA Pediatrics
June 2017, Vol 171, No. 6, Pages 501-608
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation
Child and Adolescent Health From 1990 to 2015 – Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study
The Global Burden of Disease Child and Adolescent Health Collaboration
JAMA Pediatr. 2017;171(6):573-592. doi:10.1001/jamapediatrics.2017.0250
Key Points
Question
What are the levels and trends of mortality and nonfatal health loss among children and adolescents from 1990 to 2015?
Findings
This study found significant global decreases in all-cause child and adolescent mortality from 1990 to 2015, but with increasing global inequality. In countries with a low Socio-demographic Index (SDI), mortality is the primary driver of health loss in children and adolescents, largely owing to infectious, nutritional, maternal, and neonatal causes, while nonfatal health loss prevails in locations with a higher SDI.
Meaning
Nations should evaluate drivers of disease burden among children and adolescents to aid implementation of appropriate strategies to maximize the health of populations.
Abstract
Importance
Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.
Objective
To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.
Evidence Review
Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.
Findings
Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.
Conclusions and Relevance
Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

Editorial
Importance of Innovations in Neonatal and Adolescent Health in Reaching the Sustainable Development Goals by 2030
Christopher R. Sudfeld, ScD; Wafaie W. Fawzi, DrPH

Journal of Immigrant & Refugee Studies
Volume 15, Issue 2, 2017
http://www.tandfonline.com/toc/wimm20/current
Special Issue: Human Trafficking in Domestic Work: A Special Case or a Learning Ground for the Anti-Trafficking Field?
[Articles focused on Netherlands, Britain, Italy, Greece, France]

Journal of Infectious Diseases
Volume 215, Issue 10  15 May 2017
https://academic.oup.com/jid/issue

Viruses
Continued Transmission of Zika Virus in Humans in West Africa, 1992–2016
Bobby Brooke Herrera; Charlotte A. Chang; Donald J. Hamel; Souleymane Mboup; Daouda Ndiaye …
This study describes Zika virus seroprevalence of 6.2% in Senegal and Nigeria over a 20-year period, demonstrating previously unrecognized persistence in human populations and concurrent infection with HIV/malaria.
 

Journal of Pediatrics
June 2017 Volume 185, p1-258
http://www.jpeds.com/current

Original Articles
Maternal Attitudes and Other Factors Associated with Infant Vaccination Status in the United States, 2011-2014
Cicely W. Fadel, Eve R. Colson, Michael J. Corwin, Denis Rybin, Timothy C. Heeren, Colin Wang, Rachel Y. Moon on behalf of the Study of Attitudes and Factors Effecting Infant Care (SAFE) study
p136–142.e1
Published online: March 4, 2017
Abstract
Objective
To assess the role of maternal attitudes and other factors associated with infant vaccination status.
Study design
Data on reported vaccination status were analyzed from a nationally representative prospective survey of mothers of 2- to 6-month-old infants. Weighted univariate and multiple logistic regression analyses were conducted. Latent profile analysis of mothers reporting nonimmunized infants identified distinct groups,
Results
Of 3268 mothers, 2820 (weighted 86.2%), 311 (9.1%), and 137 (4.7%), respectively, reported their infant had received all, some, or no recommended vaccinations for age. Younger infants and infants with younger mothers were more likely to have received no vaccinations. Mothers with neutral and negative attitudes toward vaccination were >3 (aOR 3.66, 95% CI 1.80-7.46) and 43 times (aOR 43.23, 95% CI 20.28-92.16), respectively, more likely than mothers with positive attitudes to report their infants had received no vaccinations. Two subgroups of mothers reporting that their infants had received no vaccinations were identified: group A (52.5%) had less than positive attitudes and less than positive subjective norms about vaccination (ie, perceived social pressure from others); group B (47.5%) had positive attitudes and positive subjective norms. Group A mothers were more likely to be white (76.1% vs 48.3%, P = .002), more educated (43.5% vs 35.4% college or higher, P = .02), and to exclusively breastfeed (74.9% vs. 27.3%, P < .001).
Conclusions
Although access barriers can result in nonvaccination, less than positive maternal attitude toward vaccination was the strongest predictor. Strategies to improve vaccination rates must focus on both improved access and better understanding of factors underlying maternal attitudes.

The Lancet
Jun 10, 2017 Volume 389 Number 10086 p2263-2348  e12-e14
http://www.thelancet.com/journals/lancet/issue/current

Comment
Data sharing statements for clinical trials: a requirement of the International Committee of Medical Journal Editors
Darren B Taichman, Peush Sahni, Anja Pinborg, Larry Peiperl, Christine Laine, Astrid James, Sung-Tae Hong, Abraham Haileamlak, Laragh Gollogly, Fiona Godlee, Frank A Frizelle, Fernando Florenzano, Jeffrey M Drazen, Howard Bauchner, Christopher Baethge, Joyce Backus
Summary
The International Committee of Medical Journal Editors (ICMJE) believes there is an ethical obligation to responsibly share data generated by interventional clinical trials because trial participants have put themselves at risk. In January, 2016, we published a proposal aimed at helping to create an environment in which the sharing of de-identified individual participant data becomes the norm.1 In response to our request for feedback we received many comments from individuals and groups. Some applauded the proposals, while others expressed disappointment they did not more quickly create a commitment to data sharing.

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
June 2017  Volume 95, Issue 2  Pages 213–446
http://onlinelibrary.wiley.com/doi/10.1111/milq.2017.95.issue-2/issuetoc

Op-Eds
“America First”: Prospects for Global Health (pages 224–228)
LAWRENCE O. GOSTIN
Version of Record online: 6 JUN 2017 | DOI: 10.1111/1468-0009.12254

Original Investigations
Timing and Characteristics of Cumulative Evidence Available on Novel Therapeutic Agents Receiving Food and Drug Administration Accelerated Approval (pages 261–290)
HUSEYIN NACI, OLIVIER J. WOUTERS, RADHIKA GUPTA and JOHN P.A. IOANNIDIS
Version of Record online: 6 JUN 2017 | DOI: 10.1111/1468-0009.12261
Abstract
Policy Points:
:: Randomized trials—the gold standard of evaluating effectiveness—constitute a small minority of existing evidence on agents given accelerated approval. One-third of randomized trials are in therapeutic areas outside of FDA approval and less than half evaluate the therapeutic benefits of these agents but use them instead as common backbone treatments.
:: Agents receiving accelerated approval are often tested concurrently in several therapeutic areas.
:: For most agents, no substantial time lag is apparent between the average start dates of randomized trials evaluating their effectiveness and those using them as part of background therapies.
:: There appears to be a tendency for therapeutic agents receiving accelerated approval to quickly become an integral component of standard treatment, despite potential shortcomings in their evidence base.
Context
Therapeutic agents treating serious conditions are eligible for Food and Drug Administration (FDA) accelerated approval. The clinical evidence accrued on agents receiving accelerated approval has not been systematically evaluated. Our objective was to assess the timing and characteristics of available studies.
Methods
We first identified clinical studies of novel therapeutic agents receiving accelerated approval. We then (1) categorized those studies as randomized or nonrandomized, (2) explored whether they evaluated the FDA-approved indications, and (3) documented the available treatment comparisons. We also meta-analyzed the difference in start times between randomized studies that (1) did or did not evaluate approved indications and (2) were or were not designed to evaluate the agent’s effectiveness.
Findings
In total, 37 novel therapeutic agents received accelerated approval between 2000 and 2013. Our search of ClinicalTrials.gov identified 7,757 studies, which included 1,258,315 participants. Only one-third of identified studies were randomized controlled trials. Of 1,631 randomized trials with advanced recruitment status, 906 were conducted in therapeutic areas for which agents received initial accelerated approval, 202 were in supplemental indications, and 523 were outside approved indications. Only 411 out of 906 (45.4%) trials were designed to test the effectiveness of agents that received accelerated approval (“evaluation” trials); others used these agents as common background treatment in both arms (“background” trials). There was no detectable lag between average start times of trials conducted within and outside initially approved indications. Evaluation trials started on average 1.52 years (95% CI: 0.87 to 2.17) earlier than background trials.
Conclusions
Cumulative evidence on agents with accelerated approvals has major limitations. Most clinical studies including these agents are small and nonrandomized, and about a third are conducted in unapproved areas, typically concurrently with those conducted in approved areas. Most randomized trials including these therapeutic agents are not designed to directly evaluate their clinical benefits but to incorporate them as standard treatment.

New England Journal of Medicine
June 8, 2017  Vol. 376 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Editorials
Data Sharing Statements for Clinical Trials — A Requirement of the International Committee of Medical Journal Editors
D.B. Taichman and Others
The International Committee of Medical Journal Editors (ICMJE) believes there is an ethical obligation to responsibly share data generated by interventional clinical trials because trial participants have put themselves at risk. In January 2016 we published a proposal aimed at helping to create an environment in which the sharing of deidentified individual participant data becomes the norm. In response to our request for feedback we received many comments from individuals and groups.1 Some applauded the proposals while others expressed disappointment they did not more quickly create a commitment to data sharing. Many raised valid concerns regarding the feasibility of the proposed requirements, the necessary resources, the real or perceived risks to trial participants, and the need to protect the interests of patients and researchers.

It is encouraging that data sharing is already occurring in some settings. Over the past year, however, we have learned that the challenges are substantial and the requisite mechanisms are not in place to mandate universal data sharing at this time. Although many issues must be addressed for data sharing to become the norm, we remain committed to this goal.

Therefore, ICMJE will require the following as conditions of consideration for publication of a clinical trial report in our member journals:
1. As of July 1, 2018, manuscripts submitted to ICMJE journals that report the results of clinical trials must contain a data sharing statement as described below.
2. Clinical trials that begin enrolling participants on or after January 1, 2019, must include a data sharing plan in the trial’s registration. The ICMJE’s policy regarding trial registration is explained at www.icmje.org/recommendations/browse/publishing-and-editorial-issues/clinical-trial-registration.html. If the data sharing plan changes after registration this should be reflected in the statement submitted and published with the manuscript, and updated in the registry record…

Pediatrics
June 2017, VOLUME 139 / ISSUE 6
http://pediatrics.aappublications.org/content/139/6?current-issue=y

Articles
Pandemic Influenza Preparedness Among Child Care Center Directors in 2008 and 2016
Timothy R. Shope, Benjamin H. Walker, Laura D. Aird, Linda Southward, John S. McCown, Judith M. Martin
Pediatrics Jun 2017, 139 (6) e20163690; DOI: 10.1542/peds.2016-3690
Abstract
BACKGROUND: Children in child care centers represent an important population to consider in attempts to mitigate the spread of an influenza pandemic. This national survey, conducted in 2008 and 2016, assessed directors’ reports of their child care centers’ pandemic influenza preparation before and after the 2009 H1N1 novel influenza pandemic.
METHODS: This was a telephone-based survey of child care center directors randomly selected from a national database of licensed US child care centers who were queried about their preparedness for pandemic influenza. We grouped conceptually related items in 6 domains into indexes: general infection control, communication, seasonal influenza control, use of health consultants, quality of child care, and perceived barriers. These indexes, along with other center and director characteristics, were used to predict pandemic influenza preparedness.
RESULTS: Among 1500 and 518 child care center directors surveyed in 2008 and 2016, respectively, preparation for pandemic influenza was low and did not improve. Only 7% of directors had taken concrete actions to prepare their centers. Having served as a center director during the 2009 influenza pandemic did not influence preparedness. After adjusting for covariates, child care health consultation and years of director’s experience were positively associated with pandemic influenza preparation, whereas experiencing perceived barriers such as lack of knowing what to do in the event of pandemic influenza, was negatively associated with pandemic influenza preparedness.
CONCLUSIONS: Pandemic influenza preparedness of child care center’s directors needs to improve. Child care health consultants are likely to be important collaborators in addressing this problem.

Pediatrics
June 2017, VOLUME 139 / ISSUE 6
http://pediatrics.aappublications.org/content/139/6?current-issue=y

State-of-the-Art Review Articles
Ethical Conduct of Research in Children: Pediatricians and Their IRB (Part 2 of 2)
Carlos D. Rose
Pediatrics Jun 2017, 139 (6) e20163650; DOI: 10.1542/peds.2016-3650
Abstract
In part 1 of this series, we discussed the historical, ethical, and legal background that provides justification for the current system of protection of subjects of human experimentation. We also discussed briefly the implementation of those principles in institutional review board (IRB) operations. In part 2, we focus on legislation dealing with pediatric research, the rules and ethics of assent, and then turn our attention to minimal-risk studies. To that end, we discuss the minimal-risk threshold and the process of balancing benefit and risk in IRB decisions for pediatric studies. We define the notion of consent waiver as well as the procedures for expedited review, management of adverse events, and amendments to approved protocol. Finally, we mention some miscellaneous issues, including central and commercial IRB, reliance agreements, biobanks, and sample shipping regulations.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 10 June 2017)

Research Article
Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage
Lucy A. Parker, John Rumunu, Christine Jamet, Yona Kenyi, Richard Laku Lino, Joseph F. Wamala, Allan M. Mpairwe, Vincent Muller, Augusto E. Llosa, Florent Uzzeni, Francisco J. Luquero, Iza Ciglenecki, Andrew S. Azman
Research Article | published 08 Jun 2017 PLOS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0005652
This is an uncorrected proof.
Abstract
Introduction
In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area.
Methodology/Principal findings
Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign (‘case-triggered’ interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0–73.7) and was highest among children ages 5–14 years (90.0%, 95% CI 85.7–94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68–0.96). In the case-triggered interventions, each lasting 1–2 days, coverage varied (range: 30–87%) with an average of 51.0% (95% CI 41.7–60.3).
Conclusions/Significance
Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.
Author summary
Oral cholera vaccine (OCV) is becoming part of the standard cholera-control toolkit, although experience in deploying OCV is limited. Adapting vaccination strategies to the global availability of vaccines and the local context (i.e., population movement, security constraints, etc.) is key to maximize the impact of OCV as a cholera-control tool. Here we describe the operational details of the first field use of a single-dose of OCV, which was deployed in a targeted manner, both at high-risk neighborhoods and then to neighbors of suspected cases after the main OCV campaign when sporadic cholera case reports continued. We show that it is feasible to conduct micro- and macro-targeted vaccination campaigns in urban areas like Juba with moderate to high coverage and without social unrest due to vaccinating some groups and not others. Flexible and context-adapted OCV dosing regimens and strategies should be considered in future deployments of the vaccine.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 10 June 2017]

Social Sciences – Economic Sciences:
Future of fundamental discovery in US biomedical research
Michael Levitt and Jonathan M. Levitt
PNAS 2017 ; published ahead of print June 5, 2017, doi:10.1073/pnas.1609996114
Significance
Innovative fundamental basic science research is traditionally done by young people. This makes the steady fall in the number of younger US basic scientists a serious concern. Our analysis suggests that this happened mainly due to a bias against younger applicants, with more money going to older principal investigators (PIs). We also find a large number of postdoctoral scholars and research associates, a rapid rise in number of PIs over 71, and a steady shift of NIH funds away from R01 grants. NIH is attempting to deal with some of these issues.
Abstract
Young researchers are crucially important for basic science as they make unexpected, fundamental discoveries. Since 1982, we find a steady drop in the number of grant-eligible basic-science faculty [principal investigators (PIs)] younger than 46. This fall occurred over a 32-y period when inflation-corrected congressional funds for NIH almost tripled. During this time, the PI success ratio (fraction of basic-science PIs who are R01 grantees) dropped for younger PIs (below 46) and increased for older PIs (above 55). This age-related bias seems to have caused the steady drop in the number of young basic-science PIs and could reduce future US discoveries in fundamental biomedical science. The NIH recognized this bias in its 2008 early-stage investigator (ESI) policy to fund young PIs at higher rates. We show this policy is working and recommend that it be enhanced by using better data. Together with the National Institute of General Medical Sciences (NIGMS) Maximizing Investigators’ Research Award (MIRA) program to reward senior PIs with research time in exchange for less funding, this may reverse a decades-long trend of more money going to older PIs. To prepare young scientists for increased demand, additional resources should be devoted to transitional postdoctoral fellowships already offered by NIH.

Science         
09 June 2017  Vol 356, Issue 6342
http://www.sciencemag.org/current.dtl

Special Issue: Repair and Regeneration
Introduction to special issue
Repair and Regeneration
By Beverly A. Purnell, Pamela J. Hines
Science09 Jun 2017 : 1020-1021
Life brings minor ravages in the form of wrinkles and creaky knees, as well as the major sequelae of disease or injury such as blindness, wounds that will not heal, and hearts losing function. The body does its best to deal with each challenge. But unlike the facile reconstruction of missing axolotl and planarian parts, our innate regenerative powers have limits. We are left with scars, diminished mobility, and weakened function. This special issue highlights areas of active research to understand mechanisms of repair and regeneration, with an eye toward therapeutic applications…

Science Translational Medicine
07 June 2017  Vol 9, Issue 393
http://stm.sciencemag.org/

Research Articles
Vaccine priming is restricted to draining lymph nodes and controlled by adjuvant-mediated antigen uptake
By Frank Liang, Gustaf Lindgren, Kerrie J. Sandgren, Elizabeth A. Thompson, Joseph R. Francica, Anja Seubert, Ennio De Gregorio, Susan Barnett, Derek T. O’Hagan, Nancy J. Sullivan, Richard A. Koup, Robert A. Seder, Karin Loré
Science Translational Medicine07 Jun 2017 Restricted Access
Vaccine responses are initiated in vaccine-draining lymph nodes and depend on the efficiency by which adjuvants influence antigen uptake.
Moving beyond mice for vaccine studies
Vaccine enhancement by adjuvants has been known for decades, but the mechanistic differences in how specific adjuvants influence the immune response are just beginning to be elucidated. Liang et al. sought a model that closely mimics humans, so they intramuscularly immunized nonhuman primates with a prototypical HIV antigen in combination with various adjuvants. They then inspected the muscles and lymph nodes to characterize antigen-presenting cells and resulting adaptive immune responses. Their findings should provide valuable information on adjuvant selection for vaccine development in humans.

Vaccine
Volume 35, Issue 29, Pages 3615-3690 (22 June 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/29

Regular papers
Semantic network analysis of vaccine sentiment in online social media
Original Research Article
Pages 3621-3638
Gloria J. Kang, Sinclair R. Ewing-Nelson, Lauren Mackey, James T. Schlitt, Achla Marathe, Kaja M. Abbas, Samarth Swarup
Abstract
Objective
To examine current vaccine sentiment on social media by constructing and analyzing semantic networks of vaccine information from highly shared websites of Twitter users in the United States; and to assist public health communication of vaccines.
Background
Vaccine hesitancy continues to contribute to suboptimal vaccination coverage in the United States, posing significant risk of disease outbreaks, yet remains poorly understood.
Methods
We constructed semantic networks of vaccine information from internet articles shared by Twitter users in the United States. We analyzed resulting network topology, compared semantic differences, and identified the most salient concepts within networks expressing positive, negative, and neutral vaccine sentiment.
Results
The semantic network of positive vaccine sentiment demonstrated greater cohesiveness in discourse compared to the larger, less-connected network of negative vaccine sentiment. The positive sentiment network centered around parents and focused on communicating health risks and benefits, highlighting medical concepts such as measles, autism, HPV vaccine, vaccine-autism link, meningococcal disease, and MMR vaccine. In contrast, the negative network centered around children and focused on organizational bodies such as CDC, vaccine industry, doctors, mainstream media, pharmaceutical companies, and United States. The prevalence of negative vaccine sentiment was demonstrated through diverse messaging, framed around skepticism and distrust of government organizations that communicate scientific evidence supporting positive vaccine benefits.
Conclusion
Semantic network analysis of vaccine sentiment in online social media can enhance understanding of the scope and variability of current attitudes and beliefs toward vaccines. Our study synthesizes quantitative and qualitative evidence from an interdisciplinary approach to better understand complex drivers of vaccine hesitancy for public health communication, to improve vaccine confidence and vaccination coverage in the United States.

Vaccine
Volume 35, Issue 29, Pages 3615-3690 (22 June 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/29

Immunization requirements of the top 200 universities: Implications for vaccine-hesitant families
Original Research Article
Pages 3661-3665
Allison Noesekabel, Ada M. Fenick
Abstract
Background
The majority of pediatricians encounter vaccine hesitancy in their practices. As part of a broad discussion about vaccination, school requirements arise as a topic yet providers may lack information about the effects of immunization on university matriculation.
Methods
We surveyed the top-ranked 200 universities regarding required immunizations, medical, religious, and philosophical exemptions, and noncompliance policies. We examined the legal requirements for involved jurisdictions.
Results
Of 129 responding universities (64%), 94% had ≥1 pre-matriculation immunization requirement (PIR), with a mean of 3.53 (95%CI 3.17–3.89) requirements. In unadjusted analyses, funding, region, jurisdictional requirements, undergraduate size, and tuition were significant predictors of the number of PIRs. In multivariate modeling, jurisdictional requirements outperformed all other university demographics, but excluding these, Northeast and South region and smaller undergraduate size persisted. The most common PIR was measles (93%). 67% of involved jurisdictions have laws mandating ≥1 university PIR, and 45% of universities surpassed their jurisdiction’s law. With respect to medical, religious, and philosophical exemptions, 24%, 40%, and 60% of universities with PIRs had the highest hardship category, and 2%, 2%, and 46% disallowed these outright. Frequent responses to student noncompliance were: hold on classes (89%), additional registration fees (13%), and hold on housing (11%).
Conclusions
Requirements for pre-matriculation immunizations in top universities are common and exemptions are difficult to obtain. Conversations between providers and vaccine-hesitant families may be enriched by discussion of these future effects of their decision on immunization.
 

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

Academic Pediatrics
Article in Press
Financing of Vaccine Delivery in Primary Care Practices
MA Allison, ST O’Leary, MC Lindley, LA Crane…
Abstract
Objectives
Vaccines represent a significant portion of primary care practices’ expenses. Our objectives were to determine among Pediatric (Ped) and Family Medicine (FM): 1) relative payment for vaccine purchase and administration and estimated profit margin by payer type, 2) strategies used to reduce vaccine purchase costs and increase payment, and 3) whether practices have stopped providing vaccines due to finances.
Methods
A national survey conducted April—September 2011 among Ped and FM in private, single-specialty practices.
Results
The response rate was 51% (221/430). Depending on payer type, 61%–79% of practices reported that payment for vaccine purchase was at least 100% of purchase price and 34%–74% reported that payment for vaccine administration was at least $11. Reported strategies to reduce vaccine purchase cost were online purchasing (81% Ped, 36% FM), prompt pay (78% Ped, 49% FM) and bulk order (65% Ped, 49% FM) discounts. Fewer than half of practices used strategies to increase payment; in a multivariable analysis, practices with > 5 providers were more likely to use strategies compared to practices with fewer providers (adjusted odds ratio 2.65, 95% confidence interval 1.51-4.62). When asked if they had stopped purchasing vaccines due to financial concerns, 12% of Ped and 23% of FM responded ‘yes’, and 24% of Ped and 26% of FM responded ‘no, but have seriously considered’.
Conclusions
Practices report variable payment for vaccination services from different payer types. Practices may benefit from increased use of strategies to reduce vaccine purchase costs and increase payment for vaccine delivery.

Public Health Reports
First Published June 6, 2017
Brief Report
Longitudinal Trends in Vaccine Hesitancy in a Cohort of Mothers Surveyed in Washington State, 2013-2015
NB Henrikson, ML Anderson, DJ Opel, J Dunn… –
Abstract
Parents who refuse or delay vaccines because of vaccine hesitancy place children at increased risk for vaccine-preventable disease. How parental vaccine hesitancy changes as their children age is not known. In 2015, we conducted a follow-up survey of 237 mothers enrolled in a 2-arm clinic-level cluster randomized trial (n = 488) in Washington State that was completed in 2013. We surveyed mothers at their baby’s birth, age 6 months, and age 24 months using a validated measure of vaccine hesitancy. Both mean hesitancy scores (mean 4.1-point reduction; 95% CI, 2.5-5.6; P = .01) and the proportion of mothers who were vaccine hesitant (9.7% at baseline vs 5.9% at 24 months; P = .01) decreased significantly from child’s birth to age 24 months. Changes from baseline were similar for first-time mothers and experienced mothers. Individual item analysis suggested that the decrease may have been driven by increases in maternal confidence about the safety and efficacy of vaccines. Our results suggest that hesitancy is a dynamic measure that may peak around childbirth and may remit as experience with vaccines accumulates.

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.
 
 
BBC
http://www.bbc.co.uk/
Accessed 10 June 2017
Parents eye Austrian asylum in Italy vaccination dispute
9 June 2017
A group of German-speaking parents in northern Italy are so angry about a new requirement to get their children vaccinated that they plan to seek asylum in nearby Austria…
The leader of the South Tyrol protest, Reinhold Holzer, said the group had sent protest messages to Italian President Sergio Mattarella, Austrian President Alexander Van der Bellen, and the UN Human Rights Council in Geneva.
“We won’t allow our children to be poisoned. Asylum is claimed not just by people fleeing war, but also by people whose rights are being violated,” said Mr Holzer, quoted by Austria’s Der Standard daily…

New York Times
http://www.nytimes.com/
Accessed 10 June 2017
Polio Outbreak in Syria Poses Vaccination Dilemma for WHO
June 09, 2017 – By REUTERS
GENEVA — Vaccinating too few children in Syria against polio because the six-year-old war there makes it difficult to reach them risks causing more cases in the future, the World Health Organization (WHO) said on Friday, posing a dilemma after a recent outbreak.
Two children have been paralyzed in the last few months in Islamic State-held Deir al-Zor in the first polio cases in Syria since 2014 and in the same eastern province bordering Iraq where a different strain caused 36 cases in 2013-2014.
Vaccinating even 50 percent of the estimated 90,000 children aged under 5 in the Mayadin area of Deir al-Zor would probably not be enough to stop the outbreak and might actually sow the seeds for the next outbreak, WHO’s Oliver Rosenbauer said.
Immunisation rates need to be closer to 80 percent to have maximum effect and protect a population, he told a briefing.
“Are we concerned that we’re in fact going to be seeding further future polio vaccine-derived outbreaks? … Absolutely, that is a concern. And that is why this vaccine must be used judiciously and to try to ensure the highest level of coverage,” Rosenbauer said…

Puerto Rico Declares Zika Outbreak Over, CDC Maintains Travel Warning
June 06, 2017 – (Reuters) – Puerto Rico on Monday declared that the 2016 Zika epidemic is over, saying transmission of the virus that can cause birth defects when pregnant women are exposed has fallen significantly.
About 10 cases of the mosquito-borne disease have been reported in each four-week period since April 2017, down from more than 8,000 cases reported in a four-week period at the peak of the epidemic in August 2016, the Puerto Rico Health Department said in a statement.
The U.S. Centers for Disease Control and Prevention, however, has not changed its travel advice, noting that pregnant women should not travel to Puerto Rico.
The CDC said its travel notice for Puerto Rico remains in place and that it expects the virus will continue to “circulate indefinitely” in most regions where it has been introduced.

Dr. Babatunde Osotimehin, Global Advocate for Women’s Health, Dies at 68
6 June 2017
Dr. Babatunde Osotimehin, who as head of the United Nations Population Fund promoted public health, especially sexual and reproductive health for women and girls, died on Sunday night at his home in West Harrison, N.Y. He was 68.
The population agency confirmed his death, saying it was sudden, but did not give a cause.
Dr. Osotimehin, a Nigerian, had been the executive director of the agency, the world’s leading provider of family planning services, including contraception, since 2011. He led efforts to advance a 1994 action plan adopted by 179 countries that recognized for the first time that women have the right to control their reproductive and sexual health and to choose whether to become pregnant.

He also advocated family planning services, championed methods to prevent maternal deaths in childbirth and sought to eliminate genital cutting of women and girls.

Think Tanks et al

CSIS
https://www.csis.org/
Accessed 10 June 2017
GPEI’s Funding Decline Among Tedros’ Top Challenges as WHO Director-General
June 9, 2017
Nellie Bristol, Senior Fellow, Global Health Policy Center
Among the pressing issues facing incoming World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus when he begins his term July 1 is the winding down of the Global Polio Eradication Initiative (GPEI). The polio program comprises 27 percent of total WHO expenditures and provides support for disease surveillance, immunization delivery, and laboratory capacity along with data collection and analysis not only for polio, but other diseases as well. WHO still is analyzing what the reductions will mean specifically for the organization’s activities, but it notes, “the current downscaling of the polio infrastructure, together with that planned for the future, will cause WHO to lose its field presence, coordinating role, and technical leadership in some countries in greatest need.”
Among those is Tedros’ home country, Ethiopia, which receives the fifth highest amount of external polio-related funding of any country at $40 million in 2016. That amount currently is slated to decline to $4.6 million by 2019, an 88.5 percent decrease. Polio-funded NGOs provide immunization and other health services to Ethiopia’s hard to reach border areas where government services are scarce…

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_3 June 2017

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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.

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

Milestones :: Perspectives

::::::

World Health Assembly
WHA70
22–31 May 2017, Geneva

World Health Assembly endorsed resolution to strengthen immunization
29 May 2017
:: Resolution full text:
Strengthening immunization to achieve the goals of the global vaccine action plan resolution
:: Report by the Secretariat on GVAP [WHA]

29 May 2017, GENEVA – Ministers of Health from 194 countries at the 70th World Health Assembly endorsed a resolution on strengthening immunization to achieve the goals of the Global Vaccine Action Plan (GVAP). In 2012, the Health Assembly endorsed GVAP, a commitment to ensure that no one misses out on vital immunization by 2020. To date, progress towards the GVAP targets is off track. In 2015, more than 19 million children missed out the basic immunization and overall global immunization coverage has stagnated.

The resolution urges Member States to strengthen the governance and leadership of national immunization programmes, and improve monitoring and surveillance systems to ensure up-to-date data guides policy and programmatic decisions to optimize performance and impact. It also calls on countries to expand immunization services beyond infancy, mobilize domestic financing, and strengthen international cooperation to achieve GVAP goals.

It requests the WHO Secretariat to continue supporting countries to achieve regional and global vaccination goals. It recommends scaling up advocacy efforts to improve understanding of the value of vaccines and urgency of meeting the GVAP goals. The Secretariat will report back in 2020 and 2022 on the achievements against the 2020 GVAP goals and targets.

60 speakers including 51 delegates from Member States[i] and 9 non-state actors[ii] took the floor during the GVAP session. The delegates commended the WHO Strategic Advisory Group of Experts (SAGE) on immunization for their recommendations that contributed to the Secretariat’s report on progress towards the GVAP goals.

Delegates also acknowledged WHO’s fundamental role in facilitating the GVAP implementation, stressing that WHO should continue to play an important and leading role in:
:: Polio end game and effectively manage the critical transition period including the transfer of tangible polio assets to routine immunization programmes and sustaining the immunization gains achieved through the support from the Global Polio Eradication Initiative and the GAVI Alliance;
: Supporting middle-income countries to access affordable vaccines of assured quality in adequate supply and mobilizing resources for countries facing transition from Gavi support to ensure sustainability of their immunization programmes;
:: Addressing vaccine resistance and provision of tailored evidence-based strategies and tools to address the root causes of vaccine hesitancy to sustain immunization programmes around the world and prevent outbreaks of vaccine-preventable diseases;
:: Supporting countries to make evidence-based decisions on new vaccines introductions which is critical to ensure the efficient use of resources, sustainability and affordability of immunization programmes with high impact vaccines;
: Supporting developing countries’ capacity to develop and produce vaccines to achieve affordable pricing;
:: Inclusion of an immunization indicator aligned with GVAP targets in the Sustainable Development Goals (SDG’s);
:: Support countries in reporting sub-national coverage data to identify and address the pockets of unvaccinated and under vaccinated populations.

A technical briefing on immunization – Reaching Everyone, Everywhere with Life-Saving Vaccines – was held on 24 May. The briefing provided an opportunity for delegates to share experiences to better understand some of the challenges and bottlenecks to achieving the GVAP goals, learn lessons from the successes seen in some regions and countries and see how we can build on these successes to get back on track.

Note: List of WHO Member States and non-state actors that made interventions
i Afghanistan, Algeria, Angola, Australia, Bahrain, Bahamas, Bangladesh, Bolivia (Plurinational States of), Botswana, Brazil, Canada, Chile, Colombia, China, Ecuador, Ethiopia, Georgia, Ghana, India, Indonesia, Iraq, Jamaica, Japan, Malaysia, Republic of Korea, Lebanon, Mexico, Myanmar, Niger, Norway, Pakistan, Panama, Paraguay, Philippines, Qatar, Russian Federation, Senegal, Somalia, South Africa, Sri Lanka, Suriname, Turkey, United States of America, United Republic of Tanzania, Thailand, Tunisia, United Kingdom, Venezuela (Bolivarian Republic of), Viet Nam, Zambia, Zimbabwe.
ii The Bill and Melinda Gates Foundation, Gavi, the Vaccine Alliance, Global Health Council, Knowledge Ecology International, International Counsel of Nurses, The International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières, Save the Children, World Medical Association.

::::::

Seventieth World Health Assembly update
29 May 2017 | GENEVA – Delegates at the World Health Assembly have reached new agreements on dementia; immunization; refugee and migrant health; substandard and falsified medical products, and the world drug problem.

Dementia
Delegates at the World Health Assembly today endorsed a global action plan on the public health response to dementia 2017-2025 and committed to developing ambitious national strategies and implementation plans. The global plan aims to improve the lives of people with dementia, their families and the people who care for them, while decreasing the impact of dementia on communities and countries. Areas for action include: reducing the risk of dementia; diagnosis, treatment and care; research and innovative technologies; and development of supportive environments for carers.

They called on the WHO Secretariat to offer technical support, tools and guidance to Member States as they develop national and subnational plans and to draw up a global research agenda for dementia. Delegates recognized the importance of WHO’s Global Dementia Observatory as a system for monitoring progress both within countries and at the global level.

Delegates emphasized the need to integrate health and social care approaches, and to align actions to tackle dementia with those for other aspects of mental health, as well as noncommunicable diseases and ageing. They also highlighted the importance of ensuring respect for the human rights of people living with dementia, both when developing plans and when implementing them.

Worldwide, around 47 million people have dementia, with nearly 9.9 million new cases each year. Nearly 60% of people with dementia live in low- and middle-income countries.

Immunization
Delegates agreed to strengthen immunization to achieve the goals of the Global Vaccine Action Plan (GVAP). In 2012, the Health Assembly endorsed GVAP, a commitment to ensure that no one misses out on vital immunization by 2020. However, progress towards the targets laid out in that plan is off track. Halfway through the decade covered by the plan, more than 19 million children were still missing out on basic immunizations.

Today’s resolution urges Member States to strengthen the governance and leadership of national immunization programmes. It also calls on them to improve monitoring and surveillance systems to ensure that up-to-date data guides policy and programmatic decisions to optimize performance and impact. It calls on countries to expand immunization services beyond infancy; mobilize domestic financing, and strengthen international cooperation to achieve GVAP goals. It requests the WHO Secretariat to continue supporting countries to achieve regional and global vaccination goals. It recommends scaling up advocacy efforts to improve understanding of the value of vaccines and of the urgent need to meet the GVAP goals. The Secretariat will report back in 2020 and 2022 on achievements against the 2020 goals and targets.

Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. An additional 1.5 million deaths could be avoided if global vaccination coverage were improved.

Refugee and migrant health
Delegates asked the Director-General to provide advice to countries in order to promote the health of refugees and migrants, and to gather evidence that will contribute to a draft global action to be considered at the 72nd World Health Assembly in 2019. They also encouraged Member States to use the framework of priorities and guiding principles to promote the health of refugees and migrants developed by WHO, in collaboration with IOM and UNHCR, to inform discussions among Member States and partners engaged in the development of the UN global compact on refugees and the UN global compact for safe, orderly and regular migration.

There are an estimated 1 billion migrants in the world – one in seven of the world’s population. This rapid increase of population movement has important public health implications, and requires an adequate response from the health sector. International human rights standards and conventions exist to protect the rights of migrants and refugees, including their right to health. But many refugees and migrants often lack access to health services and financial protection for health.

Health problems faced by newly-arrived refuges and migrants can include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications. Women and girls frequently face specific challenges, particularly in maternal, newborn and child health, sexual and reproductive health, and violence. Children are prone to acute infections such as respiratory infections and diarrhoea because of poor living conditions and deprivation during migration and forced displacement. Lack of hygiene can lead to skin infections.

Refugees and migrants are also at risk of psychosocial disorders, drug abuse, nutrition disorders, alcoholism and exposure to violence. Those with noncommunicable diseases (NCDs) can also suffer interruption of care, due either to lack of access or to the decimation of health care systems and providers.

Substandard and falsified medical products
“Substandard” medical products (also called “out of specification”) are authorized by national regulatory authorities, but fail to meet either national or international quality standards or specifications – or in some cases, both. “Falsified” medical products deliberately or fraudulently misrepresent their identity, composition or source.

The Assembly also agreed a definition of “unregistered or unlicensed medical products”. These have not been assessed or approved by the relevant national or regional regulatory authority for the market in which they are marketed, distributed or used.

The new terminology aims to establish a common understanding of what is meant by substandard and falsified medical products and to facilitate a more thorough and accurate comparison and analysis of data. It focuses solely on the public health implications of substandard and falsified products, and does not cover the protection of intellectual property rights.

Substandard and falsified medical products can harm patients and fail to treat the diseases for which they were intended. They lead to loss of confidence in medicines, healthcare providers and health systems, and affect every region of the world. Anti-malarials and antibiotics are amongst the most commonly reported substandard and falsified medical products, but all types of medicines can be substandard and falsified. They can be found in illegal street markets, via unregulated websites, and in pharmacies, clinics and hospitals.

Delegates agreed to adopt the new name of “substandard and falsified” (SF) medical products for what have until now been known as “substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC)” medical products.

The world drug problem and public health
Delegates agreed on the need for intensified efforts to help Member States address the world drug problem. They asked the WHO Secretariat to strengthen its collaboration with the United Nations Office on Drugs and Crime and the International Narcotics Control Board to implement the health-related recommendations of in the outcome document of the 2016 Special Session of the United Nations General Assembly on the world drug problem (UNGASS).

It has been 26 years since the Health Assembly made a decision on this topic. The Secretariat is asked to report back on progress in 2018, 2020 and 2022.

According to WHO’s latest estimates, psychoactive drug use is responsible for more than 450 000 deaths each year. The drug-attributable disease burden accounts for about 1.5% of the global burden of disease. Furthermore, injecting drug use accounts for an estimated 30% of new HIV infections outside sub-Saharan Africa and contributes significantly to hepatitis B and C epidemics in all regions.

Weekly Epidemiological Record, 2 June 2017, vol. 92, 22 (pp. 301–320)
Meeting of the Strategic Advisory Group of Experts on immunization, April 2017 – conclusions and recommendations
Report Sections
Report from the WHO Department of Immunization, Vaccines and Biologicals
Report from GAVI, the Vaccine Alliance
Report from the Global Advisory Committee on Vaccine Safety (GACVS)
Report from the Expert Committee on Biological Standardization (ECBS)
Report of the Immunization Practices Advisory Committee (IPAC)
Report from the Implementation Research Advisory Committee (IVIR-AC)
Polio eradication
Cholera vaccination
Ebola vaccines
National immunization programme management: functions and competencies
National Immunization Technical Advisory Groups (NITAGs)
Private sector engagement with national immunization programmes
Diphtheria

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 31 May 2017
:: Delegates to the World Health Assembly discussed how to finish the job and address the challenges of the post-polio world last week in Geneva.
:: After a polio outbreak, how do experts make sure that the virus is gone for good? Find out more about finding that needle in the haystack.
:: In May, the Emergency Committee of the International Health Regulations removed Lao People’s Democratic Republic from the list of polio-infected countries after a comprehensive outbreak response.
:: Summary of newly-reported viruses this week: one new environmental sample positive for wild porelates to response to the situation in Soth Sudan.
Poliovirus type 1 (WPV1) from Pakistan.

::::::

Editor’s Note:
We include below a joint statement from WHO and UNICEF, and additional New York Times coverage, as part of coverage of the health emergency in South Sudan.

Statement regarding findings of joint investigation of 15 deaths of children in Nachodokopele village, Kapoeta East County in South Sudan
1 June 2017
An investigation into the cause of the death of 15 children in rural and remote Nachodokopele village, Kauto County in South Sudan by the National Adverse Events Following Immunization (AEFI) Committee, supported by WHO and UNICEF Vaccine safety experts has concluded that severe sepsis / toxicity resulting from the administration of a contaminated vaccine caused the event.

Ministry of Health, WHO and UNICEF express our deep regret and sadness at the passing of the children. This tragic event could have been prevented by adhering to WHO immunization safety standards.

The report presented to the Minister of Health by the AEFI committee stated that the team that vaccinated the children in this tragic event were neither qualified nor trained for the immunization campaign.

Evidence gathered by the investigators indicates that the vaccination team did not adhere to the WHO-approved immunization safety standards. A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use. The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children.

The report also stated that the vaccination team did not follow the cold chain protocols as specified in the Measles Supplementary Immunization Activities guidelines. The vaccines were stored in a building with no cold chain facilities for four days. This means that the vaccines were not maintained at the recommended temperature ranges to preserve their quality.

About 300 people were vaccinated against Measles in Nachodokopele Village during the campaign. Thirty-two other children suffered similar symptoms of fever, vomiting and diarrhoea but recovered.

The Ministry of Health has commissioned a multiagency administrative committee to review the AEFI report and give appropriate recommendations for further actions to improve immunization service delivery.

Vaccination is one of the most basic and critical health needs in emergencies to protect populations from the risk of contracting deadly but preventable diseases.
The risk of measles and other Vaccine Preventable Diseases in South Sudan remains extremely high because of the challenges being faced by the health system. The country has experienced significant measles outbreaks among unprotected population caused by a backlog of unvaccinated children in areas of insecurity.

The measles vaccine has been used all over the world to protect more than 2 billion children against measles. When used according to WHO-approved immunization safety standards, the measles vaccine is safe and effective.  In South Sudan, this is the fifth follow up vaccination campaign. The past campaigns were successfully implemented and the safety of the vaccine was assured.

Mishandled Measles Vaccine Kills 15 Children in South Sudan
New York Times   June 02, 2017 – By JACEY FORTIN
Contaminated vaccines in a rural village in South Sudan killed 15 children last month and endangered dozens more, according to a statement [above] from the World Health Organization, Unicef and the health ministry of South Sudan…
…And children were recruited to help organize the efforts; one even administered injections, the W.H.O. representative to South Sudan, Dr. Abdulmumini Usman, said in a phone interview.
The vaccination campaign, which was officially run by South Sudan’s government and supported by the W.H.O. and Unicef, lasted for four days, and about 300 people in the village were inoculated. The children who died were all injected on the same day and from the same vial, Dr. Usman said…

::::::

WHO Grade 3 Emergencies  [to 3 June 2017]
South Sudan
:: Read the latest cholera situation report pdf, 315kb  30 May 2017
[Excerpt]
…Oral cholera vaccination
As part of the ongoing cholera response, cholera vaccines have been deployed in Leer, Bor
PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, and Aburoc IDPs. All these sites
are not reporting cholera cases with the exception of Aburoc. In 2017, a total of 228,551 doses
of the vaccine have been deployed targeting individuals aged one year and above. WHO has
secured a total of 544,140 doses of oral cholera vaccines in 2017 and the current balance in
the National Vaccine store stands at 78,684 doses….

Iraq
:: Iraq: WHO and UNFPA scale up trauma and emergency obstetric response capacity to safeguard lives of newly displaced families from west Mosul
Baghdad, 31 May 2017 – The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) are extremely concerned about the health conditions of about 180 000 men, women and children who are reportedly still trapped inside west Mosul’s old city where access to health care services has been limited.
:: Special health situation report from Mosul  27 May 2017
[Excerpt]
Under the leadership of the Ministry of Health Iraq and in collaboration with Ninawa, Erbil and Duhok Directorates of Health (DOHs), more than 60 700 children aged 0-59 months living in selected districts and internally displaced persons camps in the three governorates were vaccinated against polio…

Yemen
:: Yemen: Jumbo jet lands in war-torn Yemen carrying 67 tons of cholera response supplies
25 May 2017 – A World Health Organization-chartered aircraft carrying intravenous fluids and cholera kits has successfully landed at Sana’a airport in Yemen. At 67 tons, it constitutes the largest planeload of medical goods WHO has brought into the country since the escalation of the conflict in March 2015.
[see UNICEF reports below]

Nigeria – No new announcements identified
The Syrian Arab Republic  – No new announcements identified
 

WHO Grade 2 Emergencies  [to 3 June 2017]
Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.  [see UNICEF reports below]
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified
 
::::::
 
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq
:: Mosul Humanitarian Crisis, 01 June 2017
…790,674 People cumulatively displaced since 16 October 2016 from Mosul city as of 1 June
…572,278 people remain displaced from western Mosul city as of 1 June – 42,246 people have returned to western Mosul city as of 30 May
…40,913 people remain displaced from eastern Mosul city as of 1 June – 135,237 people have returned to eastern Mosul city as of 30 May
…7,382 fully-serviced family plots available to shelter Mosul displaced people at 19 sites as of 1 …   6,400m³ of water trucked and distributed daily to Mosul city by humanitarian partners as of …   13,039 people transferred from frontline areas to hospitals for trauma injuries treatment as of 28 May
:: Iraq: Mosul Humanitarian Response Situation Report No. 35 (22 May to 28 May 2017) [EN/KU]

Syrian Arab Republic
:: Syria: Flash update on recent events – 1 June 2017
KEY DISPLACEMENT STATISTICS (AS OF 16 MAY 2017)
…898,374 displacements recorded by the CCCM Cluster in the last 12 months from affected areas of northern and southern Syria:
…..871,978 displacements from affected areas of northern Syria, including Aleppo (385,004), Ar-Raqqa (205,503), Hama (144,780), Idleb (101,634), Homs (21,005), Al-Hassakeh (5,294), Deir-Ez-Zor (7,717), Lattakia (1,041) governorates, northern Syria. This includes around 136,926 new displacements recorded in May 2017 alone, with the large majority from Ar-Raqqa Governorate (94,362).
….26,396 displacements from affected areas of Damascus, Rural Damascus, Sweida and Dar’a, southwestern Syria. This includes around 9,094 new displacements recorded in May 2017 alone.

Yemen
:: Key messages on cholera (29 May 2017)  [No OCV mention]
[see UNICEF reports below]

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Somalia
:: Humanitarian Bulletin Somalia May 2017 | Issued on 2 June 2017
:: Somalia: Drought Response – Situation Report No. 10 (as of 31 May 2017)

Ethiopia
:: 31 May 2017  Ethiopia Weekly Humanitarian Bulletin, 29 May 2017

Nigeria – No new announcements identified

::::::
::::::
 
UNICEF  [to 3 June 2017]
https://www.unicef.org/media/media_94367.html
2 June, 2017
Unprecedented spread of cholera in Yemen as health workers race against time to save children
SANAA/DJIBOUTI/AMMAN,– “I have just concluded a trip to Yemen to oversee UNICEF’s response to the unprecedented cholera outbreak that is gripping the country.

1.3 million children urgently need humanitarian assistance after storms batter Bay of Bengal
NEW YORK/BANGKOK/KATHMANDU, 1 June 2017 – At least 1.3 million children are in urgent need of humanitarian assistance across the Bay of Bengal region following severe weather over the past six days, UNICEF has warned. Devastation wrought by Cyclone Mora in Myanmar and Bangladesh, and torrential monsoon rains across Sri Lanka have left children homeless and in need of protection, nutrition and health services.

UNICEF reaches children fleeing to Angola from violence in the Democratic Republic of the Congo
LUANDA, Angola 1 June 2017 – More than 9,000 children who have arrived at two temporary reception centres in Dundo, northern Angola, from the Democratic Republic of Congo (DRC) need urgent support, UNICEF said today. To date, more than 25,000 people have arrived in Angola, having fled violence in the Kasai province of the Democratic Republic of the Congo.

Central African Republic: Thousands of children and families in desperate need of humanitarian assistance as violence escalates
BANGUI/DAKAR/NEW YORK, 1 June 2017 – Two planes carrying vital supplies for thousands of families displaced by violence in the Central African Republic were finally able to land earlier today in Bangassou, UNICEF said, after weeks of intensified conflict had blocked the delivery of humanitarian assistance to the southeast.

Over 1,000 children seek treatment for watery diarrhoea daily as number of suspected cholera cases in Yemen soars – UNICEF
NEW YORK/SANA’A, 31 May 2017 – In the past 72 hours, the number of suspected cholera cases in Yemen has risen by 10,000 to a total of 65,300. Over 1,000 children suffering from acute watery diarrhoea have been reporting to health facilities every day. In just one month, cholera has claimed at least the lives of 532 people, including 109 children. These numbers represent only verified cases and actual figures are expected to be much higher.

Statement attributable to Geert Cappelaere UNICEF Regional Director on the spread of cholera in Yemen
AMMAN, 30 May 2017- “As the UN Security Council yet again holds consultations on the situation in Yemen, UNICEF is reporting an unprecedented increase in the number of suspected cholera cases across the country, many of those affected are children.
 
::::::
 
MSF/Médecins Sans Frontières  [to 3 June 2017]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
South Sudan: Thousands at Risk of Cholera and Malnutrition After Fleeing Attacks in Yuai and Waat
JUBA, SOUTH SUDAN, JUNE 2, 2017—Malnutrition and suspected cases of cholera are e   scalating among people sheltering in the bush near Pieri, in northeastern South Sudan, putting the health of thousands of people at risk, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

Press release
Yemen: Cholera Outbreak Threatens to Spiral Out of Control
June 01, 2017
As cases of cholera and acute watery diarrhea rise across Yemen, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warns that the outbreak is threatening to spiral out of control and calls for an urgent and appropriate response.

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

EBOLA/EVD  [to 3 June 2017]
http://www.who.int/ebola/en/

Ebola Situation report: 02 June 2017
Situation update
[Excerpt]
WHO, UN Agencies, international organizations, non-governmental organizations (NGOs) and partners con­tinue to support the Ministry of Health (MoH) in the Democratic Republic of the Congo to rapidly investigate and respond to the outbreak of Ebola virus disease (EVD) in Likati Health Zone, Bas Uele Province in the north-east of the country.
On 01 June 2017, no new confirmed, probable or suspected EVD cases were reported. The last confirmed case was reported on 11 May 2017. There are currently a total of two confirmed, three probable and 8 sus­pected cases…
…Vaccination

• :: The protocol for a possible ring vaccination has been formally approved by the national regulatory author­ity and Ethics Review Board of the Democratic Republic of the Congo Vaccine.
• :: International vaccine deployment and cold chain shipment to DRC is not advised at this point. Planning and arrangements should be in place for immediate deployment if necessary.
• :: The government of the Democratic Republic of the Congo and MSF with support of WHO and other part­ners are working on detailed planning and readiness to offer access to the rVSV ZEBOV experimental/investigational vaccine, within the Expanded Access framework, with informed consent and in compliance with good clinical practice.
• :: Planning and readiness should be completed urgently to be able to rapidly initiate ring vaccination should an EVD laboratory confirmed case be identified outside already defined chains of transmission. The vac­cine would be offered to contacts and contacts of contacts of a confirmed EVD case, including health care workers and field laboratory workers.
• :: MOH, with support from WHO and partners continue active surveillance and response activities, including completing the contact follow-up period for already identified contacts, and conducting rapid laboratory evaluation of suspected cases as per WHO guidelines.

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

Zika virus  [to 3 June 2017]
http://www.who.int/emergencies/zika-virus/en/
[No new digest content identified]

MERS-CoV [to 3 June 2017]
http://www.who.int/emergencies/mers-cov/en/
[No new digest content identified]
 
Yellow Fever  [to 3 June 2017]
http://www.who.int/emergencies/yellow-fever/en/
[No new digest content identified]

WHO & Regional Offices [to 3 June 2017]

New vector control response a game-changer
1 June 2017 – Today more than 80% of the world’s population is at risk of vector-borne disease, with half at risk of two or more diseases. Mosquitoes, flies and bugs such as ticks can transmit diseases such as malaria, lymphatic filariasis, leishmaniasis, Chagas disease, Lyme disease and encephalitis. Over the past year, WHO has spearheaded a reprioritization of vector control, resulting in the Global Vector Control Response (GVCR) 2017–2030.
:: Global Vector Control Response 2017–2030

Highlights
Huge bed net campaign kicks off in Sierra Leone
June 2017 – Sierra Leone kicked off bed net distribution campaign to help protect its population against malaria, which remains as one of the most deadly diseases in the country. In total, 4.3 million insecticide treated bed nets will be distributed through the landmark nationwide campaign. Sierra Leone is one of the most severely malaria-burdened nations in Africa, with its entire population of 7 million people at risk of the disease.

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
;; Accelerating the AIDS response in western and central Africa
31 May 2017 – Only 1.8 million people of the 6.5 million people living with HIV in western and central Africa were on antiretroviral therapy at the end of 2015. This 28% treatment coverage of people living with HIV in the region contrasts with the 54% coverage in eastern and southern Africa in the same year.
:: New technology allows for rapid diagnosis of Ebola in Democratic Republic of the Congo – 29 May 2017

WHO Region of the Americas PAHO
:: World No Tobacco Day 2017: Tobacco threatens development, strong control measures needed (05/30/2017)
:: Colombia, Ecuador and Peru to receive WHO World No Tobacco Day Award (05/30/2017)

WHO South-East Asia Region SEARO
:: India’s Health Minister gets WHO’s special recognition for tobacco control; Maldives, Bhutan Ministers conferred World No-Tobacco Day Award  30 May 2017
 
WHO European Region EURO
:: World No Tobacco Day: tobacco threatens us all 30-05-2017

WHO Eastern Mediterranean Region EMRO
:: WHO and UNFPA scale up trauma and emergency obstetric response capacity to safeguard lives of newly displaced families from west Mosul   Baghdad, 31 May 2017 –
:: Japan’s support to WHO boosts lifesaving health interventions for IDPs and refugees in Ninewa, Erbil and Duhok  29 May 2017

WHO Western Pacific Region
:: World No Tobacco Day 2017: Tobacco is a threat to development  MANILA, 31 May 2017
 
::::::

CDC/ACIP [to 3 June 2017]
http://www.cdc.gov/media/index.html
Media Statement
Friday, June 02, 2017
CDC updates Zika guidance for Miami-Dade County, Florida
The Centers for Disease Control and Prevention (CDC) has updated guidance for people who travel to or live in Miami-Dade County to lift the Zika cautionary (yellow) area designation. There have been no new cases of local Zika virus transmission identified and no cases under investigation in Miami-Dade County for more than 45 days. Lifting the yellow area designation means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida…

MMWR News Synopsis for June 1, 2017
Strategies for Preventing HIV Infection Among HIV-Uninfected Women Attempting Conception with HIV-Infected Men — United States
While insemination with HIV-uninfected donor sperm remains an option for achieving conception among couples in which the male partner is HIV-infected and the female partner is uninfected, couples who want to conceive a biologic child together can consider using HAART, PrEP, and “sperm washing” in combination with timed intercourse, insemination, or IVF. In a comprehensive scientific update, CDC outlines the best strategies for preventing transmission from an HIV-infected male partner to his uninfected female partner while attempting conception. This new resource can help providers improve counseling for assisting conception among HIV-discordant couples. Based on available science, for discordant couples in which the male partner is HIV-infected and the female partner is uninfected, insemination with HIV-uninfected donor sperm remains an option for achieving conception. However, for couples who want to conceive a biologic child together, several risk-reduction strategies are available. One strategy is viral suppression with HIV medications for the male partner (highly-active antiretroviral therapy, or HAART), with condomless sex around the time of ovulation, while the female partner takes daily oral HIV medication to prevent infection (pre-exposure prophylaxis, or PrEP). Alternatively, combining HAART and PrEP use among the male and female partner, respectively, with “sperm washing” and subsequent intrauterine insemination or in vitro fertilization can further reduce risk. Because each method carries a unique risk profile and degree of effectiveness, which may be affected by underlying fertility factors, patients should discuss all options with a medical provider who can help them select a treatment plan.

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015
While people with HIV in multiple low- and middle-income countries are increasingly starting treatment earlier, many still do not begin treatment until their disease has reached an advanced stage. This puts their health at risk and greatly increases their chances of transmitting HIV to others. A CDC study of 10 countries in Africa, Asia, and the Caribbean suggests that in most of them, more people with HIV are starting treatment before they reach advanced stages of infection. From 2004-2015, the percentage of people who started HIV treatment at later stages decreased significantly in Mozambique, Namibia, and Haiti. Five other countries also experienced declines. However, at least a third of people with HIV in these 10 countries still began treatment too late in 2015. The research sheds light on approaches countries can take to ensure more people with HIV begin treatment sooner, including earlier testing and connecting people to care. Research shows that early and effective HIV treatment improves the health of people living with HIV and reduces transmission of the disease.

::::::

Announcements
 
GHIT Fund   [to 3 June 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 ·  2017.06.01      Press Room
GHIT Fund Secures Commitments of Over US$200 Million to its Replenishment for the Acceleration of Japanese Innovation for Infectious Diseases of the Developing World
This announcement demonstrates the continued leadership and commitment of the Government of Japan, leading life sciences companies, international foundations and other partners to combat neglected diseases; with this replenishment, which marks a doubling of previous commitments, GHIT will accelerate and expand its development of new tools while ensuring they are accessible and delivered to the world’s most vulnerable
TOKYO, JAPAN (June 1, 2017)—The Global Health Innovative Technology Fund (GHIT Fund), which has been dedicated to leveraging Japanese expertise and capacity for health innovations to save lives in the world’s poorest countries, announced today that it has secured commitments of over US$200 million* to its replenishment for its next phase of work, allowing it to move the most advanced tools out of the lab, and into the hands of those who need them most.
GHIT’s funding partners, including the Government of Japan (GOJ), private companies, the Bill & Melinda Gates Foundation, and the Wellcome Trust have committed over US$200 million in a significant vote of confidence in the institution’s work. The new commitment for GHIT’s second phase is double the initial US$100 million investment GHIT received when it was created in 2013. The GOJ will contribute roughly half of the replenishment, with other partners splitting the remaining half…

::::::
 
PATH  [to 3 June 2017]
http://www.path.org/news/index.php
Announcement | May 30, 2017
Radboud University Medical Center, the Instituto de Medicina Molecular, and PATH’s Malaria Vaccine Initiative will collaborate on first-in-human study of a novel malaria vaccine approach
This early-stage study will test a new vaccine concept using a genetically modified parasite to induce protection
… The concept being tested is similar to that used by Edward Jenner to develop a vaccine against smallpox, the only disease affecting humans that has ever been eradicated. Jenner used cowpox—a similar but much less dangerous bovine version of the disease—to inoculate people against smallpox. In this clinical trial, based on data from earlier animal studies conducted by iMM Lisboa, the researchers will use a rodent version of the malaria-causing parasite (known as Plasmodium berghei) to determine if it can induce protection against infection by Plasmodium falciparum, the deadliest version of the parasite that infects humans.
In the study, a specific gene from P. falciparum known as the circumsporozoite protein (CS), will be inserted into the rodent parasite, resulting in a genetically modified version known as Pb(PfCS@UIS4). By inserting the gene for CS, the researchers hope to improve the potential of the modified rodent parasite to induce a protective response in healthy human volunteers.
“Bringing together the concept underlying the first vaccine ever developed, when Edward Jenner used the cowpox virus to immunize people against smallpox, with modern genetic manipulation tools, has resulted in a truly innovative approach to malaria vaccination,” said Miguel Prudêncio, who is leading the research team at iMM Lisboa…

2017.06.01   Report
GHIT’s 2016 Annual Report Published
 
::::::
 
Global Fund [to 3 June 2017]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
31 May 2017  News
UNHCR and Global Fund Strengthen Partnership to Expand Health Services to Refugees
GENEVA – UNHCR, the UN Refugee Agency, and the Global Fund to Fight AIDS, Tuberculosis and Malaria today signed an agreement intended to improve health services for refugees and other displaced communities. This new agreement will strengthen UNHCR’s humanitarian response – focusing on public health and education as well as emergency care.
“Our focus remains on working together to provide specialized health care for refugees and communities hosting them,” said Filippo Grandi, the UN High Commissioner for Refugees. “Our partnership ensures refugees have access to treatments for HIV, tuberculosis and malaria.”
Both agencies are already working together in Rwanda, where UNHCR is implementing a grant of US$2.09 million from the Global Fund to address health needs for Burundian refugees. Further discussions are also underway to expand joint activities in the Middle East and East Africa.
“We need to better connect pieces of the humanitarian response within the larger development continuum,” said Mark Dybul, Executive Director of the Global Fund. “This framework promotes innovation and advancing efforts that make sense and that work.”
 
::::::
 
EDCTP    [to 3 June 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
29 May 2017
Leprosy Research Initiative and EDCTP in partnership to boost leprosy research
The Leprosy Research Initiative (LRI) and EDCTP created a partnership to boost leprosy-related research. They aim to leverage resources and pool funds to support clinical and implementation research in sub-Saharan Africa, particularly in relation to leprosy and neglected infectious diseases (NIDs) that are co-endemic with leprosy.
 
::::::
 
Wellcome Trust  [to 3 June 2017]
https://wellcome.ac.uk/news
1 June 2017
Renewed commitment to Japanese global health fund
… Wellcome first supported GHIT in 2015 with a £3m grant for two research projects that aimed to find new treatments for malaria and tuberculosis. The new joint commitment for GHIT’s second phase is double the initial US$100m investment it received when it was created in 2013….

New insights into how Zika causes microcephaly
1 June 2017
… In a study, published in Science (opens in a new tab), the team showed that the Zika virus hijacks a human protein called Musashi-1 (MSI1), which is present in large amounts in neural stem cells. MSI1 allows Zika virus to replicate inside these cells and kill them. Neural stem cells eventually develop into a baby’s brain, so any loss of these cells can prevent a normal-sized brain from growing.

UK-EU research partnerships benefit patients across Europe
31 May 2017
A report commissioned by eight leading UK medical organisations highlights how partnerships between UK and EU medical researchers have increased the value of research, benefiting patients across Europe. This new research shows how the UK’s contribution to research throughout the EU has fostered and strengthened scientific cooperation in the following areas.

New genetic cause of childhood cancer found
29 May 2017
Scientists have identified a genetic mutation that causes a childhood kidney cancer called Wilms’ tumour. The research revealed how loss of control over the number of chromosomes in a cell can lead to cancer.

::::::
 
NIH  [to 3 June 2017]
http://www.nih.gov/news-events/news-releases
June 2, 2017
Details of Lassa virus structure could inform development of vaccines, therapies
— Lassa virus can cause a hemorrhagic disease called Lassa fever and is endemic to western Africa.

May 30, 2017
NIH Scientists Find Real-Time Imaging in Mice a Promising Influenza Study Tool
— A non-invasive method to track and monitor viruses, bacteria, and various types of cells and genes.
 
::::::
 
PhRMA    [to 3 June 2017]
http://www.phrma.org/press-room
June 1, 2017
More than 240 immuno-oncology treatments in development to fight cancer
PhRMA, in partnership with the American Cancer Society Cancer Action Network (ACS CAN), announced today in a new report that there are more than 240 immuno-oncology medicines and vaccines in development to treat cancer.
 
::::::
 
UNAIDS  [to 3 June 2017]
http://www.unaids.org/
Selected Press Releases & Updates
Update
Report of the United Nations Secretary-General
The report of the United Nations Secretary-General on HIV is being presented in New York on 1 June 2017.
 
::::::
 
European Medicines Agency  [to 3 June 2017]
http://www.ema.europa.eu/ema/
31/05/2017
New action plan to support SMEs as drivers of pharmaceutical innovation
16 actions identified for implementation in 2017-2020
The European Medicines Agency (EMA) has published today an action plan for small and medium-sized enterprises (SMEs), which aims to foster innovation and support SMEs in the development of novel human and veterinary medicines.
SMEs are the backbone of Europe’s economy. They represent 99% of all businesses in the European Union (EU) and provide two-thirds of total private sector employment. In the pharmaceutical sector SMEs are a motor of innovation and play a major role in the development of new medicines…

::::::

IVI   [to 3 June 2017]
http://www.ivi.int/
[Undated]
IVI co-hosts first Global Health Youth Leadership Forum at the Korean National Assembly
IVI and Representative Jeon Hye-sook, a member of the parliamentary Health and Welfare Committee, co-hosted the First Global Health Youth Leadership Forum at the National Assembly in Seoul on May 13. The forum, designed to inspire Korean youth to consider global health career paths, gathered about 150  college and middle- and high-school students. IVI Director General Dr. Jerome Kim and Rep. Jeon gave welcome speeches, and four experts including Prof. Kim Sun-young of Seoul National University School of Public Health; Dr. Beck Nam Seon, Director of Delivery at IVI; Ms. Choi Soon-young from World Vision; and Prof. Lee Byung-joo of Global Jobs, a private consulting firm, delivered lectures on topics that included the ‘Importance of health and development,’ ‘Cooperation and partnership in international health,’ and ‘Employment at international organizations.’…

::::::

Industry Watch
:: European Commission Approves Pfizer’s TRUMENBA® to Help Prevent Meningococcal Group B Disease in Adolescents and Adults
   Meningococcal Group B (MenB) is Responsible for 60 Percent of Meningococcal Disease Cases in Adolescents and Young Adults in Europe1
   TRUMENBA Approved in Europe with Option for a Two- or Three-Dose Schedule
May 30, 2017
:: NovaDigm Therapeutics Awarded $6 Million by U.S. Department of Defense to Conduct a Phase 2a Staphylococcus aureus Vaccine Trial
Assessing the Impact of NDV-3A Vaccine on S. aureus Colonization in a High Risk Population of Military Trainees
June 02, 2017
 
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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 3 June 2017)

Editorial
Spotlight on landmark oncology trials: the latest evidence and novel trial designs
Helena Earl, Stefano Molica and Piotr Rutkowski
BMC Medicine 2017 15:111
Published on: 2 June 2017
Abstract
The era of precision oncology is marked with prominent successes in the therapy of advanced soft tissue sarcomas, breast cancer, ovarian cancer and haematological neoplasms, among others. Moreover, recent trials of immune checkpoint inhibitors in melanoma, non-small cell lung carcinoma, and head and neck cancers have significantly influenced the therapeutic landscape by providing promising evidence for immunotherapy efficacy in the adjuvant setting in high-risk locoregional disease. To speed up the introduction of targeted therapy for cancer patients, novel phase II trials are being designed, and may likely form the basis for the ‘landmark trials’ of the future. A special article collection in BMC Medicine, “Spotlight on landmark oncology trials”, features articles from invited experts on recent clinical practice-changing trials.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 3 June 2017)

Research article
Incidence of influenza virus infection among pregnant women: a systematic review
The World Health Organization (WHO) considers pregnant women to be a risk group for severe influenza disease. We conducted a systematic review to evaluate influenza disease incidence in pregnant women in order…
Mark A. Katz, Bradford D. Gessner, Jeanene Johnson, Becky Skidmore, Marian Knight, Niranjan Bhat, Helen Marshall, David J. Horne, Justin R. Ortiz and Deshayne B. Fell
BMC Pregnancy and Childbirth 2017 17:155
Published on: 30 May 2017

Bulletin of the World Health Organization
Volume 95, Number 6, June 2017, 389-480
http://www.who.int/bulletin/volumes/95/6/en/
Special theme: measuring quality of care

EDITORIALS
Measuring quality of health-care services: what is known and where are the gaps?
Margaret E Kruk, Edward Kelley, Shamsuzzoha B Syed, Finn Tarp, Tony Addison & Yoko Akachi
http://dx.doi.org/10.2471/BLT.17.195099

RESEARCH
Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan
Marzia Lazzerini, Venera Shukurova, Marina Davletbaeva, Kubanychbek Monolbaev, Tatiana Kulichenko, Yuri Akoev, Maya Bakradze, Tea Margieva, Ilya Mityushino, Leyla Namazova-Baranova, Elnura Boronbayeva, Aigul Kuttumuratova, Martin Willy Weber & Giorgio Tamburlini
http://dx.doi.org/10.2471/BLT.16.176982

Variation in quality of primary-care services in Kenya, Malawi, Namibia, Rwanda, Senegal, Uganda and the United Republic of Tanzania
Margaret E Kruk, Adanna Chukwuma, Godfrey Mbaruku & Hannah H Leslie
http://dx.doi.org/10.2471/BLT.16.175869

Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India
Gaurav Sharma, Timothy Powell-Jackson, Kaveri Haldar, John Bradley & Véronique Filippi
http://dx.doi.org/10.2471/BLT.16.179291

Developing global indicators for quality of maternal and newborn care: a feasibility assessment
Barbara Madaj, Helen Smith, Matthews Mathai, Nathalie Roos & Nynke van den Broek
http://dx.doi.org/10.2471/BLT.16.179531

Community-based approaches for neonatal survival: meta-analyses of randomized trial data
Claudia Hanson, Sanni Kujala, Peter Waiswa, Tanya Marchant & Joanna Schellenberg
http://dx.doi.org/10.2471/BLT.16.175844

POLICY & PRACTICE
Quality of care: measuring a neglected driver of improved health
Yoko Akachi & Margaret E Kruk
http://dx.doi.org/10.2471/BLT.16.180190

LESSONS FROM THE FIELD
Maternal and neonatal services in Ethiopia: measuring and improving quality
Maureen E Canavan, Marie A Brault, Dawit Tatek, Daniel Burssa, Ayele Teshome, Erika Linnander & Elizabeth H Bradley
http://dx.doi.org/10.2471/BLT.16.178806

Child Care, Health and Development
July 2017   Volume 43, Issue 4  Pages 463–625
http://onlinelibrary.wiley.com/doi/10.1111/cch.v43.4/issuetoc

Review Articles
Immunization of looked-after children and young people: a review of the literature (pages 463–480)
Walton and H. Bedford
Version of Record online: 19 MAR 2017 | DOI: 10.1111/cch.12452

Original Articles
What do popular YouTubeTM videos say about vaccines? (pages 499–503)
H. Basch, P. Zybert, R. Reeves and C. E. Basch
Version of Record online: 19 JAN 2017 | DOI: 10.1111/cch.12442

Child Care, Health and Development
July 2017   Volume 43, Issue 4  Pages 463–625
http://onlinelibrary.wiley.com/doi/10.1111/cch.v43.4/issuetoc

Original Articles
Factors influencing uptake of measles, mumps and rubella (MMR) immunization in site-dwelling Gypsy, Roma and Traveller (G&T) communities: a qualitative study of G&T parents’ beliefs and experiences (pages 504–510)
Newton and D. M. Smith

Version of Record online: 7 MAR 2017 | DOI: 10.1111/cch.12453
Abstract
Background
Increasing immunization in the Gypsy, Roma and Traveller (G&T) community is a key priority for improving health outcomes in this community. This study aimed to explore G&T parents: (1) beliefs about childhood immunization; (2) beliefs about the risks of immunization and non-immunization; (3) perceived obstacles to, and facilitators of, immunization and (4) views on increasing immunization levels.
Method
A cross-sectional, qualitative study was conducted comprising of five focus groups with 16 site-dwelling G&T women with pre-school aged children. Data were transcribed verbatim and analysed thematically.
Results
Five main themes were identified:
…Lay understandings of causation and risk;
…Timing of immunization;
…Children being perceived as vulnerable;
…The fit between lifestyle and healthcare provision;
…The impact of living with a high burden of disease.
Conclusion
Understanding of the risks and benefits of measles, mumps and rubella immunization did not differ significantly from the wider population or those promoted by the health service. The majority of barriers stemmed from living with the effects of long-standing health inequalities, which posed further barriers to accessing immunization, and shaped beliefs about immunization. Factors facilitating uptake occurred where access to immunization services was made flexible, e.g. immunization on traveller sites.

Emerging Infectious Diseases
Volume 23, Number 6—June 2017
http://wwwnc.cdc.gov/eid/

Research
Stockpiling Ventilators for Influenza Pandemics PDF Version [PDF – 1018 KB – 8 pages]
Huang et al.
Abstract
In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

Commentaries
Stockpiling Ventilators for Influenza Pandemics PDF Version [PDF – 1.25 MB – 2 pages]
I. Meltzer and A. Patel

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 3 June 2017]

Research
Perceived reciprocal value of health professionals’ participation in global child health-related work
Sarah Carbone, Jannah Wigle, Nadia Akseer, Raluca Barac, Melanie Barwick and Stanley Zlotkin
Globalization and Health 2017 13:27
Published on: 22 May 2017
Abstract
Background
Leading children’s hospitals in high-income settings have become heavily engaged in international child health research and educational activities. These programs aim to provide benefit to the institutions, children and families in the overseas locations where they are implemented. Few studies have measured the actual reciprocal value of this work for the home institutions and for individual staff who participate in these overseas activities. Our objective was to estimate the perceived reciprocal value of health professionals’ participation in global child health-related work. Benefits were measured in the form of skills, knowledge and attitude strengthening as estimated by an adapted Global Health Competency Model.
Methods
A survey questionnaire was developed following a comprehensive review of literature and key competency models. It was distributed to all health professionals at the Hospital for Sick Children with prior international work experience (n = 478).
Results
One hundred fifty six health professionals completed the survey (34%). A score of 0 represented negligible value gained and a score of 100 indicated significant capacity improvement. The mean respondent improvement score was 57 (95% CI 53–62) suggesting improved overall competency resulting from their international experiences. Mean scores were >50% in 8 of 10 domains. Overall scores suggest that international work brought value to the hospital and over half responded that their international experience would influence their decision to stay on at the hospital.
Conclusions
The findings offer tangible examples of how global child health work conducted outside of one’s home institution impacts staff and health systems locally.

Health Economics, Policy and Law 
Volume 12 – Issue 3 – July 2017
https://www.cambridge.org/core/journals/health-economics-policy-and-law/latest-issue

Perspectives
Democratic transitions, health institutions, and financial protection in the emerging economies: insights from Asia
Eduardo J. Gómez
DOI: https://doi.org/10.1017/S1744133116000293
Published online: 14 November 2016, pp. 309-323
Abstract
In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees’ choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417). Results showed 37.4% of respondents willing to choose a restrictive health plan in exchange for a lower premium. This fell to 22% when the restrictive health plan also included a longer travelling time. Enrolees who choose a restrictive health plan are younger and healthier, or on lower incomes, than those preferring a non-restrictive one. This means that enrolees who use care will be unlikely to choose a restrictive health plan and, therefore, health insurers will not be able to channel them to contracted care providers. This undermines the goals of the health care system based on managed competition.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 3 June 2017]

Research
Towards understanding the drivers of policy change: a case study of infection control policies for multi-drug resistant tuberculosis in South Africa
Explaining policy change is one of the central tasks of contemporary policy analysis. In this article, we examine the changes in infection control policies for multi-drug resistant tuberculosis (MDR-TB) in South Africa from the time the country made the transition to democracy in 1994, until 2015. We focus on MDR-TB infection control and refer to decentralised management as a form of infection control. Using Kingdon’s theoretical framework of policy streams, we explore the temporal ordering of policy framework changes. We also consider the role of research in motivating policy changes.
Trust Saidi, Faatiema Salie and Tania S. Douglas
Published on: 30 May 201

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 3 June 2017]

Research Article
The impact of poverty on dog ownership and access to canine rabies vaccination: results from a knowledge, attitudes and practices survey, Uganda 2013
Rabies is a neglected disease despite being responsible for more human deaths than any other zoonosis…This study is the first to comprehensively evaluate the effect of poverty on dog ownership in Africa. These results indicate that describing a dog population may not be as simple as applying a human: dog ratio, and factors such as poverty are likely to heavily influence dog ownership and vaccination coverage. These modelled estimates should be confirmed through further field studies, however, if validated, canine rabies elimination through mass vaccination may not be as difficult as previously considered in Uganda. Data derived from this study should be considered to improve models for estimating the in-country and regional rabies burden.
Ryan MacLaren Wallace, Jason Mehal, Yoshinori Nakazawa, Sergio Recuenco, Barnabas Bakamutumaho, Modupe Osinubi, Victor Tugumizemu, Jesse D. Blanton, Amy Gilbert and Joseph Wamala
Infectious Diseases of Poverty 2017 6:97
Published on: 1 June 2017

International Health
Volume 9, Issue 3  May 2017
http://inthealth.oxfordjournals.org/content/current

EDITORIALS
Global infectious disease surveillance: getting back to basics
N. Durrheim

EDITORIALS
Why transition matters as much as eradication: lessons from global polio surveillance
Joseph R. A. Fitchett
… There is, however, a threat to global investment in surveillance if polio eradication effort is not coupled with an excellent transition plan. This challenge is particularly evident when attempting to raise donor funding from a limited pool of contributors, and to raise domestic funding following successful polio control efforts when so few cases remain visible in comparison to significant other societal challenges. Furthermore, polio eradication alone represents 20% of the current WHO budget.7 Although, in practice, polio systems have major benefits across health issues and to health systems more broadly, the case to transition valuable polio assets in support of global health governance is critical.
Going forward, the need for polio surveillance will diminish but the need for infectious disease surveillance will increase. The value of surveillance to societies, countries and global partnership must be better communicated. Global health, development and surveillance needs good news that transcends scientific, political and geographic boundaries. In the current socio-political and economic climate that is challenging the rationale of official development assistance (ODA), and where contributions to development assistance for health (DAH) are plateauing,8 successful surveillance and polio eradication couldn’t come at a better time.