Nature
Volume 543 Number 7643 pp8-144 2 March 2017
http://www.nature.com/nature/current_issue.html

Editorial
Data on movements of refugees and migrants are flawed
Accurate and timely information on the flow of people is crucial for policymaking and apolitical interpretations.

New England Journal of Medicine
March 2, 2017  Vol. 376 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Review Article
The Changing Face of Clinical Trials: Informed Consent
C. Grady and Others
This multipart review provides an overview of innovative approaches to improving and expanding the informed consent process for researchers and participants, along with short essays covering specific areas of innovation.

New England Journal of Medicine
March 2, 2017  Vol. 376 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Special Report
Conflicts of Interest for Patient-Advocacy Organizations
M.S. McCoy and Others
Share:
In this examination of 104 large patient-advocacy organizations, 83% receive financial support from drug, device, and biotechnology companies, and industry executives often serve on governing boards. The authors recommend more transparency about industry involvement.

Pediatrics
March 2017, VOLUME 139 / ISSUE 3
http://pediatrics.aappublications.org/content/139/3?current-issue=y

Articles
Poverty and Trends in Three Common Chronic Disorders
For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions.
Christian D. Pulcini, Bonnie T. Zima, Kelly J. Kelleher, Amy J. Houtrow
Pediatrics Mar 2017, 139 (3) e20162539; DOI: 10.1542/peds.2016-2539

Pediatrics
March 2017, VOLUME 139 / ISSUE 3
http://pediatrics.aappublications.org/content/139/3?current-issue=y

Articles
Safety of Second-Dose Single-Antigen Varicella Vaccine
We identified no new or unexpected safety concerns for second-dose varicella vaccination. Robust safety monitoring remains an important component of the national varicella vaccination program.
John R. Su, Zanie Leroy, Paige W. Lewis, Penina Haber, Mona Marin, Jessica Leung, Emily Jane Woo, Tom T. Shimabukuro
Pediatrics Mar 2017, 139 (3) e20162536; DOI: 10.1542/peds.2016-2536

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 4 March 2017]

Research Article
Vaccine Hesitancy: In Search of the Risk Communication Comfort Zone
March 3, 2017 ·
Introduction: This paper reports the findings of a national online survey to parents of children aged 5 and younger. The objectives of the study were to assess parental understanding of childhood immunizations, identify sources of information that they trust for vaccine-related content, assess where parents with young children stand on the key issues in the public debate about vaccination, and identify which risk communication messages are most effective for influencing the behaviours of vaccine hesitant parents.
Methods: A total of 1,000 surveys (closed and open-ended questions) were administered in November 2015 using the Angus Reid Forum Panel, a key consumer panel consisting of approximately 150,000 Canadian adults aged 18 and older, spread across all geographic regions of Canada.
Results: Approximately 92% of the Canadian parents surveyed consider vaccines safe and effective, and trust doctors and public health officials to provide timely and credible vaccine-related information. However, a concerning number of them either believe or are uncertain whether there is a link between vaccines and autism (28%), worry that vaccines might seriously harm their children (27%), or believe the pharmaceutical industry is behind the push for mandatory immunization (33%). Moreover, despite the common assumption that social media are becoming the go-to source of health news and information, most parents still rely on traditional media and official government websites for timely and credible information about vaccines and vaccine preventable diseases, particularly during community-based disease outbreaks. Finally, parents reported high levels of support for pro-vaccine messaging that has been demonstrated in previous research to have little to no positive impact on behaviour change, and may even be counterproductive.
Discussion: The study’s results are highly relevant in a context where public health officials are expending significant resources to increase rates of childhood immunization and combat vaccine hesitancy. The data offer insight into where parents stand on the political and public debate about mandatory vaccination, what aspects of vaccine science remain uncertain to them, which media and institutional sources they use and trust to navigate the health information environment, how they look for information and whom they trust during periods of health emergency or crisis, and which communication strategies are considered most effective in persuading vaccine hesitant parents to immunize their children.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 4 March 2017)

Perspective
The potential benefit of scaling up malaria prevention to reduce low birth weight in Africa
James G. Beeson, Julie A. Simpson
Perspective | published 28 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002244

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 4 March 2017)

Perspective
Hope for HIV control in southern Africa: The continued quest for a vaccine
Linda-Gail Bekker, Glenda E. Gray
Perspective | published 28 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002241
… The findings of the HVTN 702 trial have the potential to be a great leap in HIV prevention research, with vaccine efficacy results anticipated in early 2021. But, even if efficacious, a paramount challenge will be getting the vaccine out of the laboratory and to those people who need it most—particularly, difficult-to-reach populations in low- and middle-income countries. Notably, the cost of vaccine manufacturing will play a large role, as developing countries are already having to make tough decisions regarding optimal funding of HIV prevention and treatment programs. If a vaccine is at best only partially efficacious, the correct combination of preventative measures will need to be explored, likely on a population-specific basis, and choices made. From current predictions, however, a safe vaccine of even modest efficacy could be the game changer necessary to close the HIV prevention gap.

PLoS One
http://www.plosone.org/
[Accessed 4 March 2017]

Research Article
Determinants of geographic inequalities in HPV vaccination in the most populated region of France
Delphine Héquet, Roman Rouzier
Research Article | published 03 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172906

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Impact of ten-valent pneumococcal conjugate vaccine on pneumonia in Finnish children in a nation-wide population-based study
Arto A. Palmu, Hanna Rinta-Kokko, Hanna Nohynek, J. Pekka Nuorti, Terhi M. Kilpi, Jukka Jokinen
Research Article | published 01 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172690

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Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis
Marisa Holubar, Maria Christina Stavroulakis, Yvonne Maldonado, John P. A. Ioannidis, Despina Contopoulos-Ioannidis
Research Article | published 01 Mar 2017
http://dx.doi.org/10.1371/journal.pone.0172414

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Assessments of global drivers of vaccine hesitancy in 2014—Looking beyond safety concerns
Melanie Marti, Monica de Cola, Noni E. MacDonald, Laure Dumolard, Philippe Duclos
Research Article | published 01 Mar 2017 P
http://dx.doi.org/10.1371/journal.pone.0172310

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HPV vaccine knowledge and acceptability among Peruvian men who have sex with men and transgender women: A pilot, qualitative study
Jerome T. Galea, Emmi Monsour, César R. Nureña, Magaly M. Blas, Brandon Brown
Research Article | published 28 Feb 2017 P
http://dx.doi.org/10.1371/journal.pone.0172964

Science
03 March 2017 Vol 355, Issue 6328
http://www.sciencemag.org/current.dtl

Editorial
Evolving policy with science
By R. Alta Charo, Richard O. Hynes
Science03 Mar 2017 : 889
Summary
Albert Schweitzer, physician and Nobel laureate, wrote: “The first step in the evolution of ethics is a sense of solidarity with other human beings.” The evolution of U.S. policy governing heritable human germline modification reflects this observation, and a “Human Genome Editing” consensus study committee of the U.S. National Academy of Sciences and National Academy of Medicine (NAM) concluded last month that clinical trials for heritable editing, under strict regulations, may eventually be permissible for parents hoping to prevent serious diseases in their children.

Science
03 March 2017 Vol 355, Issue 6328
http://www.sciencemag.org/current.dtl

Policy Forum
The need for a translational science of democracy
By Michael A. Neblo, William Minozzi, Kevin M. Esterling, Jon Green, Jonathon Kingzette, David M. J. Lazer
Science03 Mar 2017 : 914-915 Restricted Access
The political science community should focus on how to foster the health of democracy
Summary
The bitterly factious 2016 U.S. presidential election campaign was the culmination of several trends that, taken together, constitute a syndrome of chronic ailments in the body politic. Ironically, these destructive trends have accelerated just as science has rapidly improved our understanding of them and their underlying causes. But mere understanding is not sufficient to repair our politics. The challenge is to build a translational science of democracy that maintains scientific rigor while actively promoting the health of the body politic.

Science Translational Medicine
01 March 2017 Vol 9, Issue 379
http://stm.sciencemag.org/

Editorial
Rx for Innovation: A path forward for us all
By Margaret Anderson
Science Translational Medicine01 Mar 2017 Full Access
The health citizenship movement can provide a platform for citizens—healthy and ill—to engage with researchers, industry, and regulators.

Social Science & Medicine
Volume 174, Pages 1-228 (February 2017)
http://www.sciencedirect.com/science/journal/02779536/173

Original Research Article
Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems
Pages 113-121
Bridget Pratt, Adnan A. Hyder
Abstract
Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder’s policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity.

Social Science & Medicine
Volume 174, Pages 1-228 (February 2017)
http://www.sciencedirect.com/science/journal/02779536/173

Original Research Article
Dynamic axes of informed consent in Japan
Pages 159-168
Laura Specker Sullivan
Abstract
Scholarship in cross-cultural bioethics routinely frames Japanese informed consent in contrast to informed consent in North America. This contrastive analysis foregrounds cancer diagnosis disclosure and physician paternalism as unique aspects of Japanese informed consent that deviate from American practices. Drawing on in-depth interviews with 15 Japanese medical professionals obtained during fieldwork in Japan from 2013 to 15, this article complicates the informed consent discourse beyond East-West comparisons premised on Anglo-American ethical frameworks. It expands professional perspectives to include nurses, medical social workers, clinical psychologists, and ethicists and it addresses informed consent for a broad range of conditions in addition to cancer. The results suggest that division of affective labor is an under-theorized dimension of informed consent that is perceived as at odds with principled demands for universal informed consent. These practical tensions are conceptualized as cultural differences, with Japan identified in terms of omakase as practical and supportive and the United States identified in terms of jiko kettei as principled and self-determining. These results have implications for the methodology of cross-cultural bioethics as well as for theories and practices of informed consent in both Japan and the United States. I conclude that responsible cross-cultural work in bioethics must begin from the ground up, incorporating all relevant stakeholder perspectives, attitudes, and experiences.

Tropical Medicine & International Health
March 2017 Volume 22, Issue 3 Pages 253–369
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2017.22.issue-3/issuetoc

Original Articles
Profile and reintegration experience of Ebola survivors in Guinea: a cross-sectional study (pages 254–260)
Alexandre Delamou, Bienvenu Salim Camara, Jean Pe Kolie, Achille Diona Guemou, Nyankoye Yves Haba, Shannon Marquez, Abdoul Habib Beavogui, Therese Delvaux and Johan van Griensven
Version of Record online: 13 JAN 2017 | DOI: 10.1111/tmi.12825

Vaccine
Available online 23 February 2017

In Press, Corrected Proof
Conference report
Vaccines: Shaping global health
Sonia Pagliusia, Ching-Chia Tinga, Fernando Lobosb, the DCVMN Executive Committee Group
Abstract
The Developing Countries Vaccine Manufacturers’ Network (DCVMN) gathered leaders in immunization programs, vaccine manufacturing, representatives of the Argentinean Health Authorities and Pan American Health Organization, among other global health stakeholders, for its 17th Annual General Meeting in Buenos Aires, to reflect on how vaccines are shaping global health. Polio eradication and elimination of measles and rubella from the Americas is a result of successful collaboration, made possible by timely supply of affordable vaccines. After decades of intense competition for high-value markets, collaboration with developing countries has become critical, and involvement of multiple manufacturers as well as public- and private-sector investments are essential, for developing new vaccines against emerging infectious diseases. The recent Zika virus outbreak and the accelerated Ebola vaccine development exemplify the need for international partnerships to combat infectious diseases. A new player, Coalition for Epidemic Preparedness Innovations (CEPI) has made its entrance in the global health community, aiming to stimulate research preparedness against emerging infections. Face-to-face panel discussions facilitated the dialogue around challenges, such as risks of viability to vaccine development and regulatory convergence, to improve access to sustainable vaccine supply. It was discussed that joint efforts to optimizing regulatory pathways in developing countries, reducing registration time by up to 50%, are required. Outbreaks of emerging infections and the global Polio eradication and containment challenges are reminders of the importance of vaccines’ access, and of the importance of new public-private partnerships.

Vaccine
Volume 35, Issue 10, Pages 1369-1474 (7 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/10

Reviews
Use of m-Health in polio eradication and other immunization activities in developing countries
Review Article
Pages 1373-1379
Sara S. Kim, Manish Patel, Alan Hinman
Abstract
Introduction
Reaching the children that are chronically missed by routine immunization services has been a key pillar of success in achieving progress toward polio eradication. The rapid advancement and accessibility of mobile technology (“mHealth”) in low and lower middle income countries provides an important opportunity to apply novel, innovative approaches to provide vaccine services. We sought to document the use and effectiveness of mHealth in immunization programs in low and lower middle income countries. We particularly focused on mHealth approaches used in polio eradication efforts by the Global Polio Eradication Initiative (GPEI) to leverage the knowledge and lessons learned that may be relevant for enhancing ongoing immunization services.
Methods
In June 2016, the electronic database PubMed was searched for peer reviewed studies that focused on efforts to improve immunization programs (both ongoing immunization services and supplemental immunization activities or campaigns) through mobile technology in low and lower middle income countries.
Results
The search yielded 317 papers of which 25 met the inclusion criteria. One additional article was included from the hand searching process. mHealth was used for reminder and recall, monitoring and surveillance, vaccine acceptance, and campaign strategic planning. Mobile phones were the most common mobile device used. Of the 26 studies, 21 of 26 studies (80.8%) reported that mHealth improved immunization efforts.
Conclusion
mHealth interventions can effectively enhance immunization services in low and lower middle income countries. With the growing capacity and access to mobile technology, mHealth can be a powerful and sustainable tool for enhancing the reach and impact of vaccine programs.

Vaccine
Volume 35, Issue 10, Pages 1369-1474 (7 March 2017)
http://www.sciencedirect.com/science/journal/0264410X/35/10

Review Article
Policy making for vaccine use as a driver of vaccine innovation and development in the developed world
Pages 1380-1389
Katherine Seib, Andrew J. Pollard, Philippe de Wals, Ross M. Andrews, Fangjun Zhou, Richard J. Hatchett, Larry K. Pickering, Walter A. Orenstein
Abstract
In the past 200 years, vaccines have had unmistakable impacts on public health including declines in morbidity and mortality, most markedly in economically-developed countries. Highly engineered vaccines including vaccines for conditions other than infectious diseases are expected to dominate future vaccine development. We examine immunization vaccine policy as a driver of vaccine innovation and development. The pathways to recommendation for use of licensed vaccines in the US, UK, Canada and Australia have been similar, including: expert review of disease epidemiology, disease burden and severity; vaccine immunogenicity, efficacy and safety; programmatic feasibility; public demand; and increasingly cost-effectiveness. Other attributes particularly important in development of future vaccines are likely to include: duration of immunity for improved vaccines such as pertussis; a greater emphasis on optimizing community protection rather than direct protection only; programmatic implementation, feasibility, improvements (as in the case of development of a universal influenza vaccine); public concerns/confidence/fears related to outbreak pathogens like Ebola and Zika virus; and major societal burden for combating hard to treat diseases like HIV and antimicrobial resistant pathogens. Driving innovation and production of future vaccines faces enormous economic hurdles as available approaches, technologies and regulatory pathways become more complex. As such, cost-mitigating strategies and focused, aligned efforts (by governments, private organizations, and private-public partnerships) will likely be needed to continue to spur major advances in vaccine technologies and development.

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

Current Opinion in HIV and AIDS
Post Author Corrections: February 21, 2017
Lessons learned from human HIV vaccine trials
Pollara, Justin; Easterhoff, David; Fouda, Genevieve G.
doi: 10.1097/COH.0000000000000362
Abstract
Purpose of review: The ability to induce broadly neutralizing antibody (bNAb) responses is likely essential for development of a globally effective HIV vaccine. Unfortunately, human vaccine trials conducted to date have failed to elicit broad plasma neutralization of primary virus isolates. Despite this limitation, in-depth analysis of the vaccine-induced memory B-cell repertoire can provide valuable insights into the presence and function of subdominant B-cell responses, and identify initiation of antibody lineages that may be on a path towards development of neutralization breadth.
Recent findings: Characterization of the functional capabilities of monoclonal antibodies isolated from a HIV-1 vaccine trial with modest efficacy has revealed mechanisms by which non-neutralizing antibodies are presumed to have mediated protection. In addition, B-cell repertoire analysis has demonstrated that vaccine boosts shifted the HIV-specific B-cell repertoire, expanding pools of cells with long third heavy chain complementarity determining regions – a characteristic of some bNAb lineages.
Summary: Detailed analysis of memory B-cell repertoires and evaluating the effector functions of isolated monoclonal antibodies expands what we can learn from human vaccine trails, and may provide knowledge that can enable rational design of novel approaches to drive maturation of subdominant disfavored bNAb lineages.

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.

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Financial Times
http://www.ft.com/home/uk
Accessed 4 March 2017
GSK ‘real world’ study offers new model for drug trials
26 February 2017
GlaxoSmithKline has conducted the world’s first drug trial under “real world” conditions — closely watched by an industry under greater pressure than ever to prove the value of its medicines to cost-constrained health systems. In a global first for drugmakers, GSK obtained permission to test Relvar, a drug to treat asthma and chronic obstructive pulmonary disease (COPD), before it had received full regulatory approval. It did this by setting in place an electronic patient data-monitoring system that ensured any adverse reactions were immediately communicated to physicians.

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Scientific American
https://www.scientificamerican.com/
Accessed 4 March 2017
Guest Blog
Will an American-Led Anti-Vaccine Movement Subvert Global Health?
We’ve made great gains in fighting infectious diseases in the last 50 years—but those gains are fragile
By Peter J. Hotez on March 3, 2017

Think Tanks et al

CSIS
https://www.csis.org/
Accessed 4 March 2017
Transcript
A Conversation with U.S. Surgeon General Dr. Vivek H. Murthy
March 1, 2017

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Vaccines and Global Health: The Week in Review is a service of the Center for Vaccines Ethics and Policy (CVEP) which is solely responsible for its content, and is an open access publication, subject to the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc/3.0/). Copyright is retained by CVEP.

CVEP is a program of the GE2P2 Global Foundation – whose purpose and mission is to advance ethical and scientific rigor in research and evidence generation for governance, policy and practice in health, human rights action, humanitarian response, heritage stewardship, education and sustainable development – serving governments, international agencies, INGOs, civil society organizations (CSOs), commercial entities, consortia and alliances. CVEP maintains an academic affiliation with the Division of Medical Ethics, NYU School of Medicine, and an operating affiliation with the Vaccine Education Center of Children’s Hospital of Philadelphia [CHOP].

Support for this service is provided by the Bill & Melinda Gates Foundation; Aeras; PATH; the International Vaccine Institute (IVI); and industry resource members Crucell/Janssen/J&J, Pfizer, PRA Health Sciences, Sanofi Pasteur U.S.,Takeda, Valera (list in formation), and the Developing Countries Vaccine Manufacturers Network (DCVMN).

Support is also provided by a growing list of individuals who use this membership service to support their roles in public health, clinical practice, government, NGOs and other international institutions, academia and research organizations, and industry.

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Milestones :: Perspectives

Reaching everyone, everywhere with life-saving vaccines
Commentary
25 February 2017
Dr Margaret Chan, Director-General of WHO,
Chris Elias, President of the Global Development Program at the Bill & Melinda Gates Foundation,
Anthony Fauci, Director of the US National Institute of Allergies and Infectious Diseases,
Anthony Lake, Executive Director of UNICEF,
Seth Berkley, Chief Executive Officer of Gavi, the Vaccine Alliance

In 2015, world leaders agreed to a new development plan—a set of Sustainable Development Goals (SDGs). Expanding access to immunisation is crucial to achieving the SDGs.1, 2 Not only do vaccinations prevent the suffering and death associated with infectious diseases such as pneumonia, diarrhoea, whooping cough, measles, and polio, they also help enable national priorities like education and economic development to take hold.

The unique value of vaccines was the driving force behind the Decade of Vaccines, an effort launched at the 2010 World Economic Forum and supported by many stakeholders to extend the full benefits of immunisation to all by 2020.3 Governments welcomed the initiative, and 194 member states endorsed the Global Vaccine Action Plan (GVAP) at the 65th World Health Assembly.4 The plan is ambitious and aims to ensure that all people everywhere live free from vaccine-preventable diseases.

Since then, WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization has issued annual progress reports. The 2016 GVAP midterm report5 provides a careful analysis of progress and challenges, and indicates that although there are bright spots in global immunisation efforts, the overall picture is sobering.

First, the bright spots. More children are being immunized worldwide than ever before with the highest level of routine coverage in history (as measured by coverage of three doses of the diphtheria-tetanus-pertussis (DTP)-containing vaccine).5 The world is closer than ever to eradicating polio. Since 2010, 99 low-income and middle-income countries have introduced one or more new or underused vaccines—for example, rotavirus and pneumococcal vaccines—exceeding the GVAP target for 2015.5 Indigenous measles and rubella have been eliminated from the Americas, and maternal and neonatal tetanus has been eliminated in southeast Asia.

Important progress has been made in vaccine research and development: a new vaccine against dengue has been licensed in several countries,5 and the first vaccine to protect children against malaria will be piloted in three African countries in 2018.7 In the past 2 years, there has been an increase in the number of vaccines in the clinical development pipeline.

The GVAP midterm report also reveals encouraging national and regional trends in vaccine coverage. For example, since 2010, 16 countries have substantially increased coverage of the third dose of the DTP vaccine, confirming that progress on immunization can be achieved with strong domestic leadership, meaningful investments, and effective accountability mechanisms.
Yet major challenges remain. All of the GVAP targets for disease elimination—including measles, rubella, and maternal and neonatal tetanus—are behind schedule. Although more infants than ever before are receiving the critical third dose of the DTP vaccine, global coverage of these basic vaccines has increased by only 1% since 2010.5 This slow progress puts one of the most important goals in the GVAP seriously off track.

Although inequalities in the implementation of vaccination programmes have narrowed in the past decade as the poorest and least educated people gained more coverage, gaps persist. Only 52 of 112 member states with available and valid district-level data have surpassed the district-level coverage target of 80%. A high priority must be placed on the equitable extension of vaccine coverage to all. Finally, while financial support and commitment from donors and countries has increased, reflecting a global commitment to immunization, this increase is insufficient to meet all the needs to realize the GVAP targets.

In almost every country, some population groups have limited access to vaccines. These groups include people living in poverty, those who live in remote rural locations, segments of the urban poor, and displaced and nomadic people. This problem is compounded by data deficiencies at the national and local levels, which makes it even more challenging to identify where gaps lie and what is causing them—and thus to take corrective action. Several countries also report that vaccine prices are a barrier to the introduction of vaccines into their national programmes.

Many health facilities still have insufficient resources to engage with communities and provide them with the comprehensive public health services they need. Failure to integrate service delivery mechanisms has decreased the opportunities for health workers to improve immunization coverage and other key interventions to improve people’s health. Conflict and public health emergencies, such as the outbreaks of Ebola virus disease and Zika virus, and outbreaks of vaccine-preventable diseases—for example, measles, yellow fever, and cholera—have strained fragile health systems.

Finally, inadequate domestic investments and continued donor dependency in many low-income and middle-income countries are raising concerns about the long-term global sustainability of immunization programmes, especially as funding for the polio programme slows down and countries transition away from the support they receive from Gavi, the Vaccine Alliance.
Where do we go from here? First, the global health community must continue working to provide all vaccines recommended by WHO to each and every child by ramping up efforts to extend full immunization to the about 19 million children who are still not fully protected against a core set of vaccine-preventable diseases. Efforts to build strong routine immunization systems, which balance supply and demand, must be intensified.

Routine immunization is a building block of strong primary health care and universal health coverage—it provides a point of contact for health care at the beginning of life and offers every child the chance of a healthy life from the start. Immunization is a cornerstone of global health security in an interconnected world where diseases do not respect national borders. Vaccines also serve as a frontline defense against antimicrobial resistance. Furthermore, a 2016 study showed that for every US dollar spent on childhood vaccinations, the return on investment is US$44 when the full range of economic benefits are considered—making immunization one of the most cost-effective health interventions.

In addition to implementation challenges, we still face substantial research challenges. Vaccines are lacking or sub-optimal for many serious infectious diseases that exact an enormous toll worldwide. To address this problem, it will be crucial to ensure that vaccine markets provide the right incentives to invest in research and development for these vaccines and to expand research and development capacity in low-income and middle-income countries.

The global health community must work together to advance progress. Although governments are the main providers of immunization, the GVAP’s success depends upon many stakeholders—families, communities, health professionals, civil society, development partners, global agencies, manufacturers, media, and the private sector. It is essential that governments show strong leadership and good governance of national immunization programmes, which involves prioritizing system strengthening, securing investments, and improving surveillance capacity and data quality and use. Organisations that deliver immunization programmes, research and development partners, as well as global agencies can help improve GVAP accountability, work to overcome barriers to the timely delivery of vaccines in humanitarian crisis, and support vaccine research and development in low-income and middle-income countries.

Delivering on the goals and the promise of the GVAP is an urgent and essential priority. It will improve the health and wellbeing of people everywhere and help us achieve the SDGs, and ultimately a world in which no one—no child, no adolescent, no adult—is left behind. In 2017, we challenge countries and our own organisations to do more.

[Link to The Lancet version: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30554-8/fulltext?rss=yes ]

Emergencies

WHO Grade 3 Emergencies [to 25 February 2017]
Iraq –
Read the health situation report from Mosul pdf, 521kb 18 February 2016

Nigeria –
Statement on Nigeria and the Lake Chad Region in Oslo Humanitarian Conference
24 February 2017 Oslo, Norway
As several speakers have noted today, while there are enormous food security, nutrition and protection dimensions to the crisis in the Lake Chad Region, this is also a public health crisis, with rates of death, malnutrition and disease rarely seen over the past 20 years.
In Nigeria and the Lake Chad Region, lack of qualified health workers, essential medicines and the destruction of medical facilities hamper the delivery of lifesaving health care. Widespread food insecurity and malnutrition are associated with severe health consequences. As you know, malnutrition lowers the body’s capacity to fight infection – a malnourished child is far more prone to contract an infectious disease such as pneumonia, diarrhoea and measles – and then to die from that disease. As one of our local staff in Niger said to me once – between malnutrition and death, there is always disease.
All four countries in the Lake Chad Region have similar health priorities: rapidly expanding access to a package of essential health care – including child and reproductive health; boosting immunization rates; preventing, detecting and responding to disease outbreaks; effectively treating malnutrition and its consequences. We also must address psychosocial problems, sexual and gender-based violence, and violent trauma leading to physical injuries. Together, health sector partners seek to help 8.2 million people this year…

South Sudan –
South Sudan: Amidst insecurity, WHO in collaboration with the Ministry of Health and partners intensifies the health response to the cholera outbreak
14 February 2017, Juba, South Sudan – Despite the ongoing complex humanitarian crises in South Sudan, the World Health Organization (WHO) in partnership with the Ministry of Health and partners are responding to the latest cholera outbreak in the former Jonglei and Lakes States. The outbreak of cholera was first detected in June 2016 and since then 5 006 cholera cases and 99 deaths (CFR 1.98%) have been reported from 12 Counties in nine states countrywide.

Yemen –
Yemeni health system crumbles as millions risk malnutrition and diseases
23 February 2017, Al-Hudaydah, Yemen – “Hospital staff have not received their salaries for the past 5 months. There are acute shortages of certain medicines and we need more fuel to ensure the hospital has electricity,” says Dr Khaled Suhail, Director of Al-Tharwa Hospital in Yemen’s third largest city, Al-Hudaydah. With more than 1200 employees and 320 beds, Al-Thawra Hospital is the main functioning health facility in Al-Hudaydah and neighbouring governorates.

The Syrian Arab Republic – No new announcements identified

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WHO Grade 2 Emergencies [to 25 February 2017]
Cameroon – No new announcements identified.
Central African Republic – No new announcements identified.
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.

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 

Iraq
:: Iraq: Mosul Humanitarian Response Situation Report No. 21 (13 February – 19 February 2017)

Syria
:: Statement to the Security Council on Syria 22 Feb 2017
:: 24 Feb 2017
Health Resources Availability Mapping System (HeRAMS) Report – Turkey Hub Health Cluster for Syria, 2016

Yemen
:: Escalating Conflict on Yemen’s Western Coast – Flash Update # 2 | 25 February 2017
:: 21 Feb 2017
Statement by the Humanitarian Coordinator in Yemen, Jamie McGoldrick, on the Impact of the Conflict and Ongoing Food Crisis [EN/AR]

::::::

UNICEF [to 25 February 2017]
https://www.unicef.org/media/media_94367.html
21 February 2017
Nearly 1.4 million children at imminent risk of death as famine looms in Nigeria, Somalia, South Sudan and Yemen – UNICEF
NEW YORK/DAKAR/NAIROBI/AMMAN,– Almost 1.4 million children are at imminent risk of death from severe acute malnutrition this year, as famine looms in Nigeria, Somalia, South Sudan and Yemen, UNICEF said today.

WHO: Rapid response teams and medicines deployed to cholera outbreak in South Sudan
February 2017 – Essential medicines and supplies have been delivered to communities in South Sudan affected by the cholera outbreak. The supplies were deployed along with rapid response teams that are currently working alongside local teams to control the outbreaks.
[No mention of OCV use]

WHO: About 17 million people are affected by crisis in the Lake Chad Basin
23 February 2017 – Years of violent conflict have deprived millions of people in north-eastern Nigeria, northern Cameroon, western Chad and south-east Niger of even the most basic health care services. Malnutrition is widespread and in the 3 worst-affected states of Nigeria nearly 6 million men, women, children and infants urgently need health assistance. WHO is working with the Nigerian Ministry of Health and partners to reach those in need with lifesaving health care.
…Millions of people in Borno State have had limited or no access to regular health services over a number of years, leading to very low vaccination rates. The ongoing movement of internally displaced people also makes it difficult to track those who have or have not been immunized. WHO supported a measles vaccination campaign in January 2017 which reached nearly 3 million children. Polio is still endemic in Nigeria, but WHO and its partners have vaccinated over 1.8 million children under five against the disease in a continued effort to eradicate it…

PAHO -Epidemiological Alerts and Updates
:: 24 February 2017: Cholera – Epidemiological Update
Between epidemiological week (EW) 1 and 5 of 2017, a total of 1,897 cholera cases were reported in Haiti, including 28 deaths. In the Dominican Republic, from the beginning of the year to EW 2 of 2017, there were 7 suspected cholera cases and 2 confirmed cases reported, including one death.

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

POLIO [to 25 February 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 15 February 2017
Country Updates [Selected Excerpts]
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week from Nahr-e-Saraj district, Helmand province, with onset of paralysis on 21 January. The total number of WPV1 cases for 2016 remains 13, and two for 2017.
:: One new environmental WPV1 positive sample was reported in the past week from Jalalabad, Nangarhar, collected on 24 January
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week from Lodhran district, Punjab province, with onset of paralysis on 28 January 2017. This is the first case in Punjab since December 2015, and an immunization response is already being implemented.
:: One new environmental WPV1 positive sample was reported in the past week, from Quetta, Balochistan, collected on 20 January.

::::::

Japan gives US$ 33.3 million in emergency polio funding
17/02/2017
New funding will contribute to emergency efforts in Nigeria and Lake Chad Region to prevent further spread of polio and stop the outbreak for good
US$ 33.3 million grant from the Government of Japan in humanitarian emergency funding to UNICEF was announced this week and will help to protect millions of children from polio in Nigeria and the Lake Chad region.
In response to the urgent need to rapidly raise immunity to polio virus in the region, Japan has generously provided exceptional funding from their supplementary budget envelope to purchase polio vaccines, conduct house-to-house polio campaigns and support communication efforts to mobilize communities for vaccination in Nigeria, Chad, Niger, Cameroon and the Central African Republic…

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

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 25 February 2017]
http://www.who.int/emergencies/zika-virus/en/
Latest Report [apparently no longer bi-weekly]:
Zika situation report – 2 February 2017
Full report: http://apps.who.int/iris/bitstream/10665/254507/1/zikasitrep2Feb17-eng.pdf?ua=1
Analysis
Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.
[See PAHO announcements below]

Yellow Fever [to 25 February 2017]
http://www.who.int/emergencies/yellow-fever/en/
Disease Outbreak News (DONs)
:: Yellow fever – Brazil 24 February 2017 –
From 1 December 2016 to 22 February 2017, a total of 1336 cases of yellow fever infection (292 confirmed, 920 suspected, and 124 discarded), including 215 deaths (101 confirmed, 109 suspected, 5 discarded), have been detected in six states (Bahia, Espírito Santo, Minas Gerais, Rio Grande do Norte, São Paulo, and Tocantins). The estimated case fatality rate is 35% for confirmed cases and 12% for suspected cases. To date, the majority (86%) of the confirmed cases are men and of which, approximately 81% are aged between 21 and 60 years.

EBOLA/EVD [to 25 February 2017]
http://www.who.int/ebola/en/
No new digest content identified for this edition.

MERS-CoV [to 25 February 2017]
http://www.who.int/emergencies/mers-cov/en/
No new digest content identified for this edition.

WHO: Disease Outbreak News (DONs)
:: 24 February 2017 – Yellow fever – Brazil
:: 23 February 2017 – Meningococcal disease – Togo
:: 22 February 2017 – Human infection with avian influenza A(H7N9) virus – China
:: 20 February 2017 – Seoul virus – United States of America and Canada
:: 20 February 2017 – Human infection with avian influenza A(H7N9) virus – China

WHO & Regional Offices [to 25 February 2017]

Reducing maternal and newborn deaths by half
14 February 2017 – Today, 9 countries – Bangladesh, Cote d’Ivoire, Ethiopia, Ghana, India, Malawi, Nigeria, Tanzania and Uganda – committed to halving preventable deaths of pregnant women and newborns in their health facilities within the next 5 years. Through a new network supported by WHO, UNICEF, and other partners, these countries will improve the quality of care mothers and babies receive.

Highlights
Rapid response teams and medicines deployed to cholera outbreak in South Sudan
February 2017 – Essential medicines and supplies have been delivered to communities in South Sudan affected by the cholera outbreak. The supplies were deployed along with rapid response teams that are currently working alongside local teams to control the outbreaks.

WHO issues first viral hepatitis testing guidelines
February 2017 – WHO issued its first-ever global guidance on testing for chronic viral hepatitis B and C on 16 February 2017. Viral hepatitis causes an estimated 1.4 million deaths worldwide each year. he guidelines were released in a special session at the 26th Conference of the Asian Pacific Association for the Study of the Liver (APASL), held in Shanghai, China.

South African government commits to implement sugary drinks tax to tackle diabetes and obesity
February 2017 – WHO strongly supports announcement by the Government of South Africa to implement a tax on sugary beverages as part of the country’s campaign to promote the health of its citizens and combat the increasing challenges of diabetes and obesity.

Sri Lanka gears up to host Global Consultation on Migrant Health
February 2017 – Health leaders will gather in Colombo, from 21 to 23 February 2017, for a landmark consultation on migrant health. The 2nd Global Consultation on Migrant Health, jointly organized by the Government of Sri Lanka, IOM and WHO, strives to build international solidarity to enhance the health and well-being of migrants and their families.

Weekly Epidemiological Record, 24 February 2017, vol. 92, 8 (pp. 89–96)
Continued endemic wild poliovirus transmission in security-compromised areas – Nigeria, 2016

::::::

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: About 17 million people are affected by crisis in the Lake Chad Basin 23 February 2017
:: WHO and the African Union Commission map the way forward for stronger partnership – 18 February 2017
:: Gavi, the Vaccine Alliance visits the WHO Regional Office for Africa – 18 February 2017

WHO Region of the Americas PAHO
:: WHO and PAHO Initiative to Support 17 New Research Proposals on Zika in Seven Countries in Latin America and the Caribbean (02/23/2017)
:: Early cancer diagnosis saves lives, cuts treatment costs (02/03/2017)
:: The Zika Virus outbreak continues one year after the global emergency (02/02/2017)
:: Overweight affects almost half the population of all countries in Latin America and the Caribbean except for Haiti (01/18/2017)

WHO South-East Asia Region SEARO
:: Migrant Health: Resetting the agenda
21 February 2017 – The health problems of refugees and migrants are similar to those of the rest of the population. The most frequent health problems of newly arrived refugees and migrants include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications, diabetes, and hypertension. Key stakeholders are discussing improving the health aspects of refugees and migrants, in the 2nd Global Consultation on Migrant Health, on 21–23 February 2017, in Colombo, Sri Lanka.

WHO European Region EURO
:: The Crown Princess of Denmark, WHO/Europe Patron, receives WHO Medal for commendable contributions to global health 24-02-2017
:: Tobacco control activities in Turkey enter a new phase, with leaders looking to ensure sustainability 24-02-2017
:: Slovenian National Assembly passes strong tobacco control law 20-02-2017

WHO Eastern Mediterranean Region EMRO
:: Tracing every last virus:  Afghanistan steps up surveillance to accelerate polio eradication
Kabul 23 February 2017 – Afghanistan’s strong surveillance system is the backbone of the country’s polio eradication effort. It ensures that every single poliovirus is detected and analysed, enabling a quick and effective response to stop every strain of the debilitating virus. Afghanistan is closer than ever to stopping polio. Together with partners of the Global Polio Eradication Initiative, WHO is further strengthening Afghanistan’s surveillance system to accelerate progress towards a polio-free Afghanistan.

WHO Western Pacific Region
:: A new vision for WHO–Lao People’s Democratic Republic partnership
VIENTIANE CAPITAL, 21 February 2017 – Over the past decade, the Lao People’s Democratic Republic has observed significant improvements in the health status of the population. People are living longer, maternal mortality and deaths from malaria have been drastically reduced, and the number of tuberculosis cases is in decline. However, these impressive improvements in the country’s health are at risk from a new set of challenges, including rapidly increasing rates of noncommunicable disease and injury.

CDC/ACIP [to 25 February 2017]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/

MMWR Weekly February 24, 2017 / No. 7
[Excerpts]
:: Near Real-Time Surveillance of U.S. Norovirus Outbreaks by the Norovirus Sentinel Testing and Tracking Network — United States, August 2009–July 2015
:: Continued Endemic Wild Poliovirus Transmission in Security-Compromised Areas — Nigeria, 2016

Gavi [to 25 February 2017]
http://www.gavi.org/library/news/press-releases/
23 February 2017

Gavi seeks to support innovative solutions to improve vaccine delivery
To propose cutting edge technology that could save lives, apply to INFUSE 2017
Geneva, 23 February 2017 – To ensure vaccines reach all the world’s children, Gavi is inviting entrepreneurs and businesses to identify innovations in vaccine delivery by applying to its INFUSE initiative.
With global immunisation coverage stalled at around 80% for several years and 19 million children missing out on a full course of basic vaccines, Gavi launched INFUSE – Innovation for Uptake, Scale and Equity in Immunisation – in 2016. This aims to find new thinking and technology that will help modernise often outdated vaccine delivery systems and then accelerate the expansion of these solutions.
“The speed with which the disease outbreaks disrupt the lives of children in the world’s poorest countries is only getting faster. We need to keep up and find new innovative solutions to evolving challenges and gaps in immunisation coverage which affect the most vulnerable children”, said Managing Director of resource mobilisation and private sector partnerships Marie-Ange Saraka-Yao.
“To create these solutions, we started INFUSE. This platform brings together global problem solvers who can find new ways to accelerate immunisation coverage and reduce inequities in access to vaccination for the world’s poorest children.”
Following last year’s launch at the World Economic Forum Annual Meeting in Davos, Gavi has already helped one of INFUSE’s initial pacesetters, Nexleaf Analytics, forge a partnership with Google.org. Together these two companies are working to provide real-time data solutions to keep vaccines cold and safe in developing countries…

NIH [to 25 February 2017]
http://www.nih.gov/news-events/news-releases
February 22, 2017

Respiratory syncytial virus vaccine enters clinical testing
NIH-led trial to evaluate RSV vaccine’s safety in healthy adults.
A Phase 1 clinical trial to test the safety and tolerability of an investigational vaccine against respiratory syncytial virus (RSV) has begun at the National Institutes of Health Clinical Center in Bethesda, Maryland. The trial also will assess the vaccine’s ability to prompt an immune response in healthy adult participants. The investigational vaccine was developed by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH…

.

Rare Disease Day at NIH event features advances in rare diseases research
February 22, 2017 — Rare diseases affect an estimated 25 million Americans.

.

NIH begins study of vaccine to protect against mosquito-borne diseases
February 21, 2017 — Experimental vaccine targets mosquito saliva.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has launched a Phase 1 clinical trial to test an investigational vaccine intended to provide broad protection against a range of mosquito-transmitted diseases, such as Zika, malaria, West Nile fever and dengue fever, and to hinder the ability of mosquitoes to transmit such infections. The study, which is being conducted at the NIH Clinical Center in Bethesda, Maryland, will examine the experimental vaccine’s safety and ability to generate an immune response.
The investigational vaccine, called AGS-v, was developed by the London-based pharmaceutical company SEEK, which has since formed a joint venture with hVIVO in London. The consulting group Halloran has provided regulatory advice to both companies.
Unlike other vaccines targeting specific mosquito-borne diseases, the AGS-v candidate is designed to trigger an immune response to mosquito saliva rather than to a specific virus or parasite carried by mosquitoes. The test vaccine contains four synthetic proteins from mosquito salivary glands. The proteins are designed to induce antibodies in a vaccinated individual and to cause a modified allergic response that can prevent infection when a person is bitten by a disease-carrying mosquito…

.

Experimental PfSPZ malaria vaccine provides durable protection against multiple strains in NIH clinical trial
February 21, 2017 — An investigational malaria vaccine has protected a small number of healthy U.S. adults from infection with a malaria strain different from that contained in the vaccine, according to a study published today in the Proceedings of the National Academy of Sciences (PNAS). The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, sponsored and co-conducted the Phase 1 clinical trial.
… The PfSPZ Vaccine used in this study was developed by Sanaria Inc., of Rockville, Maryland. The vaccine contains weakened P. falciparum sporozoites that do not cause infection but are able to generate a protective immune response against live malaria infection. Earlier research at the NIH Clinical Center with the PfSPZ Vaccine found it to be safe, well-tolerated and protective for more than a year when tested in healthy U.S. adults against a single Africa-derived malaria strain matched to the PfSPZ Vaccine.
“An effective malaria vaccine will need to protect people living in endemic areas against multiple strains of the mosquito-borne disease,” said NIAID Director Anthony S. Fauci, M.D. “These new findings showing cross-protection with the PfSPZ Vaccine suggest that it may be able to accomplish this goal.”…

FDA [to 25 February 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm

What’s New for Biologics
February 17, 2017 Approval Letter – Varivax (PDF – 36KB)
Posted: 2/23/2017 [Merck, varicella]

UNAIDS [to 25 February 2017]
http://www.unaids.org/

Update
Italy invests half a million euros to support UNAIDS’ work in Ethiopia
21 February 2017
The Italian Government signed on 21 February a financing agreement for €500 000 to support UNAIDS’ efforts to end the AIDS epidemic in Ethiopia. The funds will be invested in a special project to bolster UNAIDS’ work in improving community health education and capacity- and knowledge-building. The project will be implemented across 10 areas of the Southern Nations, Nationalities and Peoples’ Region of the country over a 12-month period…

Update
CROI shows the importance of 90–90–90
21 February 2017
A number of important updates were announced at the annual Conference on Retroviruses and Opportunistic Infections (CROI) that have shown the importance of, and ways to achieve, the 90–90–90 targets, whereby, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.
Held in Seattle, United States of America, from 13 to 16 February, CROI, the foremost annual scientific research conference on HIV, brought together around 4000 scientists, researchers, clinicians, students and others working in the response to HIV and related diseases…

Industry Watch

:: In First Phase 3 Trial, Merck’s Investigational Inactivated Varicella Zoster Virus Vaccine (V212) Reduced the Incidence of Confirmed Herpes Zoster Cases by an Estimated 64 Percent in Immunocompromised Subjects
February 24, 2017 04:00 PM Eastern Standard Time
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced the first Phase 3 study results for V212, the company’s investigational inactivated varicella zoster virus vaccine (VZV) for the prevention of herpes zoster or HZ, also known as shingles, in immunocompromised patients. This was a double-blind, randomized, placebo-controlled, multi-center trial to study safety, tolerability, efficacy and immunogenicity of inactivated VZV Vaccine in Recipients of Autologous Hematopoietic Stem Cell Transplants (auto-HSCT). In the trial, V212 met its primary endpoint and reduced the incidence of confirmed HZ cases by an estimated 64 percent (95% CI, 0.48, 0.75) in recipients of auto-HSCT. These results were presented today, as an oral presentation, at the combined annual meetings of the Center for International Blood & Marrow Transplant Research (CIBMTR) and the American Society for Blood and Marrow Transplantation (ASBMT) during a “Best Abstracts” session in Orlando, Florida…

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Immunization Financing: A Resource Guide for Advocates, Policymakers, and Program Managers
Results for Development, Washington, DC
2017 :: 128 pages
PDF: http://immunizationfinancing.org/home/Immunization_Financing_Resource_Guide_2017_FULL.pdf
Preface
This resource guide collects 26 brief documents on topics related to the cost and financing of national immunization programs in low- and middle-income countries. Some of the briefs explore possible financing sources. Others examine the components and drivers of immunization costs, planning and decision-making processes related to immunization programs and budgets, and the relationship between immunization and broader health system financing. The resource guide concludes with a set of country case studies that illustrate particular approaches or important challenges.

This volume is intended for immunization advocates, program managers, decision-makers, and planners in ministries of health and finance. The information is relevant to countries that are eligible for support from Gavi, the Vaccine Alliance, as well as to countries that are transitioning out of Gavi support and middle-income countries that have never received Gavi support.

The briefs can be read in sequential order or individually. Each begins with a summary of key
points. Some of the briefs are more technical than others, due to their subject matter, but they are all meant to convey practical information to readers who do not have specific technical expertise. Many of the briefs recommend other resources that offer more in-depth information.

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 Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 25 February 2017)

Research article
Hepatitis C virus and HIV co-infection among pregnant women in Rwanda
Hepatitis C virus (HCV) infection is a pandemic causing disease; more than 185 million people are infected worldwide. An HCV antibody (Ab) prevalence of 6.0% was estimated in Central African countries. The study aimed at providing HCV prevalence estimates among pregnant women in Rwanda.
Mwumvaneza Mutagoma, Helene Balisanga, Dieudonné Sebuhoro, Aimable Mbituyumuremyi, Eric Remera, Samuel S. Malamba, David J. Riedel and Sabin Nsanzimana
BMC Infectious Diseases 2017 17:167
Published on: 22 February 2017
2017

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 25 February 2017)

Research article
A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands
Human papillomavirus (HPV) vaccination coverage in the Netherlands is low (~60%) compared to other childhood vaccinations (>90%), and even lower among ethnic minorities. The aim of this study was to explore th…
Catharina J. Alberts, Maarten F. Schim van der Loeff, Yvonne Hazeveld, Hester E. de Melker, Marcel F. van der Wal, Astrid Nielen, Fatima El Fakiri, Maria Prins and Theo G. W. M. Paulussen
BMC Public Health 2017 17:220
Published on: 21 February 2017

Clinical Therapeutics
February 2017 Volume 39, Issue 2, p231-450
http://www.clinicaltherapeutics.com/issue/S0149-2918(17)X0002-7

Editor-in-Chief’s Note
Informed Consent and Assent in Pediatric Oncology Trials
Richard I. Shader, MD (Editor-in-Chief), Cynthia H. Livingston, ALM, MAT
[Free full text]

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 25 February 2017]

Short report
Challenges to conducting epidemiology research in chronic conflict areas: examples from PURE- Palestine
Little has been written on the challenges of conducting research in regions or countries with chronic conflict and strife. In this paper we share our experiences in conducting a population based study of chron…
Rasha Khatib, Rita Giacaman, Umaiyeh Khammash and Salim Yusuf
Conflict and Health 2017 10:33
Published on: 22 February 2017

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 February 2017]

Research
Corporate social responsibility to improve access to medicines: the case of Brazil
Halla Thorsteinsdóttir, Natasha Ovtcharenko and Jillian Clare Kohler
Published on: 21 February 2017
Abstract
Background
Access to medicines and the development of a strong national pharmaceutical industry are two longstanding pillars of health policy in Brazil. This is reflected in a clear emphasis by Brazil’s Federal Government on improving access to medicine in national health plans and industrial policies aimed at promoting domestic pharmaceutical development. This research proposes that such policies may act as incentives for companies to pursue a strategic Corporate Social Responsibility (CSR) agenda. CSR that supports Governmental priorities could help companies to benefit significantly from the Governmental industrial policy. We sought to determine whether CSR activities of Brazilian pharmaceutical firms are currently aligned with the Federal Government’s health prioritization. To do so we examined key Brazilian health related policies since 2004, including the specific priorities of Brazil’s 2012–2015 Health Plan, and compared these with CSR initiatives that are reported on the websites of select pharmaceutical firms in Brazil.
Results
Brazil’s national health plans and industrial policies demonstrated that the Federal Government has followed diverse approaches for improving access to medicines, including strengthening health care infrastructure, increasing transparency, and supporting product development partnerships. Case studies of six pharmaceutical firms, representing both public and private companies of varying size, support the perspective that CSR is a priority for firms. However, while many programs target issues such as health infrastructure, health care training, and drug donation, more programs focus on areas other than health and do not seem to be connected to Governmental prioritization.
Conclusion
This research suggests that there are loose connections between Governmental priorities and pharmaceutical firm CSR. However, there remains a significant opportunity for greater alignment, which could improve access to medicines in the country and foster a stronger relationship between the Government and industry.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 13, Issue 2, 2017
http://www.tandfonline.com/toc/khvi20/current

Review article
Meningococcal serogroup B vaccines: Estimating breadth of coverage
Pages: 255-265
Published online: 14 Dec 2016
Robert G. K. Donald, Julio Cesar Hawkins, Li Hao, Paul Liberator, Thomas R. Jones, Shannon L. Harris, John L. Perez, Joseph J. Eiden, Kathrin U. Jansen & Annaliesa S. Anderson

Article
Why, when and for what diseases pregnant and new mothers “should” be vaccinated
Pages: 283-290
Published online: 08 Dec 2016
Giovanni Gabutti, Giorgio Conforti, Alberto Tomasi, Parvanè Kuhdari, Paolo Castiglia, Rosa Prato, Silvia Memmini, Chiara Azzari, Giovanni Vitali Rosati & Paolo Bonanni

Article
Preclinical study and clinical trial of a novel therapeutic vaccine against multi-drug resistant tuberculosis
Pages: 298-305
Published online: 14 Dec 2016
Masaji Okada, Yoko Kita, Satomi Hashimoto, Hitoshi Nakatani, Shiho Nishimastu, Yumiko Kioka & Yasuko Takami

Review article
Recommended vaccinations for asplenic and hyposplenic adult patients
Pages: 359-368
Published online: 08 Dec 2016
Paolo Bonanni, Maddalena Grazzini, Giuditta Niccolai, Diana Paolini, Ornella Varone, Alessandro Bartoloni, Filippo Bartalesi, Maria Grazia Santini, Simonetta Baretti, Carlo Bonito, Paola Zini, Maria Teresa Mechi, Fabrizio Niccolini, Lea Magistri, Maria Beatrice Pulci, Sara Boccalini & Angela Bechini

Article
Strategies and actions of multi-purpose health communication on vaccine preventable infectious diseases in order to increase vaccination coverage in the population: The ESCULAPIO project
Pages: 369-375
Published online: 19 Feb 2017
Angela Bechini, Paolo Bonanni, Sara Lauri, Emilia Tiscione, Miriam Levi, Rosa Prato, Francesca Fortunato, Domenico Martinelli, Roberto Gasparini, Donatella Panatto, Daniela Amicizia, Rosa Cristina Coppola, Barbara Pellizzari, Garden Tabacchi, Claudio Costantino, Francesco Vitale, Stefania Iannazzo & Sara Boccalini

Article
Clinical and economic impact of herpes zoster vaccination in elderly in Italy
Pages: 405-411
Published online: 07 Dec 2016
Sara Boccalini, Cristiano Alicino, Domenico Martinelli, Angela Bechini, Emilia Tiscione, Barbara Pellizzari, Rosa Prato, Giancarlo Icardi, Stefania Iannazzo & Paolo Bonanni

Article
How often people google for vaccination: Qualitative and quantitative insights from a systematic search of the web-based activities using Google Trends
Pages: 464-469
Published online: 16 Dec 2016
Nicola Luigi Bragazzi, Ilaria Barberis, Roberto Rosselli, Vincenza Gianfredi, Daniele Nucci, Massimo Moretti, Tania Salvatori, Gianfranco Martucci & Mariano Martini

JAMA
February 21, 2017, Vol 317, No. 7, Pages 663-780
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Emerging and Reemerging Infectious Diseases – The Dichotomy Between Acute Outbreaks and Chronic Endemicity
Catharine I. Paules, MD; Anthony S. Fauci, MD
JAMA. 2017;317(7):691-692. doi:10.1001/jama.2016.21079
This Viewpoint discusses the importance of continuing infectious diseases research, even after outbreaks subside and disease progression becomes endemic.

Editorial
Using Design Thinking to Differentiate Useful From Misleading Evidence in Observational Research
Steven N. Goodman, MD, MHS, PhD; Sebastian Schneeweiss, MD, ScD; Michael Baiocchi, PhD
JAMA. 2017;317(7):705-707. doi:10.1001/jama.2016.19970

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 28, Number 1, February 2017
https://muse.jhu.edu/issue/35850

Reports from the Field
Academic-Community Partnership for Medical Missions: Lessons Learned and Practical Guidance for Global Health Service-Learning Experiences
pp. 8-13
Yen H. Dang, Frank J. Nice, Hoai-An Truong

Journal of Public Health Policy
Volume 37, Issue 4, December 2016
http://link.springer.com/journal/41271/37/4/page/1

Original Article
Public health aspects of the world’s largest mass gathering: The 2013 Kumbh Mela in Allahabad, India
Satchit Balsari, P. Gregg Greenough, Dhruv Kazi, Aaron Heerboth, Shraddha Dwivedi, Jennifer Leaning
Abstract
India’s Kumbh Mela remains the world’s largest and longest mass gathering. The 2013 event, where participants undertook a ritual bath, hosted over 70 million Hindu pilgrims during 55 days on a 1936 hectare flood plain at the confluence of the Yamuna and Ganga Rivers. On the holiest bathing days, the population surged. Unlike other religious, cultural, and sports mass gatherings, the Kumbh Mela’s administration cannot estimate or limit the participant number. The event created serious and uncommon public health challenges: initiating crowd safety measures where population density and mobility directly contact flowing bodies of water; providing water, sanitation, and hygiene to a population that frequently defecates in the open; and establishing disease surveillance and resource use measures within a temporary health delivery system. We review the world’s largest gathering by observing first-hand the public health challenges, plus the preparations for and responses to them. We recommend ways to improve preparedness.

The Lancet
Feb 25, 2017 Volume 389 Number 10071 p763-880
http://www.thelancet.com/journals/lancet/issue/current

Series
Health, equity, and women’s cancers
The global burden of women’s cancers: a grand challenge in global health
Ophira Ginsburg, Freddie Bray, Michel P Coleman, Verna Vanderpuye, Alexandru Eniu, S Rani Kotha, Malabika Sarker, Tran Thanh Huong, Claudia Allemani, Allison Dvaladze, Julie Gralow, Karen Yeates, Carolyn Taylor, Nandini Oomman, Suneeta Krishnan, Richard Sullivan, Dominista Kombe, Magaly M Blas, Groesbeck Parham, Natasha Kassami, Lesong Conteh

Health, equity, and women’s cancers
Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries
Lynette Denny, Silvia de Sanjose, Miriam Mutebi, Benjamin O Anderson, Jane Kim, Jose Jeronimo, Rolando Herrero, Karen Yeates, Ophira Ginsburg, Rengaswamy Sankaranarayanan

Health, equity, and women’s cancers
Changing global policy to deliver safe, equitable, and affordable care for women’s cancers
Ophira Ginsburg, Rajan Badwe, Peter Boyle, Gemma Derricks, Anna Dare, Tim Evans, Alexandru Eniu, Jorge Jimenez, Tezer Kutluk, Gilberto Lopes, Sulma I Mohammed, You-Lin Qiao, Sabina Faiz Rashid, Diane Summers, Diana Sarfati, Marleen Temmerman, Edward L Trimble, Aasim I Padela, Ajay Aggarwal, Richard Sullivan

Nature
Volume 542 Number 7642 pp392-512 23 February 2017
http://www.nature.com/nature/current_issue.html

Comment
No publication without confirmation
Jeffrey S. Mogil and Malcolm R. Macleod propose a new kind of paper that combines the flexibility of basic research with the rigour of clinical trials.
Concern over the reliability of published biomedical results grows unabated. Frustration with this ‘reproducibility crisis’ is felt by everyone pursuing new disease treatments: from clinicians and would-be drug developers who want solid foundations for the preclinical research they build on, to basic scientists who are forced to devote more time and resources to newly imposed requirements for rigour, reporting and statistics. Tightening rigour across all experiments will decrease the number of false positive findings, but comes with the risk of reducing experimental efficiency and creativity.

Bolder ideas are needed. What we propose here is a compromise between the need to trust conclusions in published papers and the freedom for basic scientists to explore and innovate1. Our proposal is a new type of paper for animal studies of disease therapies or preventions: one that incorporates an independent, statistically rigorous confirmation of a researcher’s central hypothesis. We call this large confirmatory study a preclinical trial. These would be more formal and rigorous than the typical preclinical testing conducted in academic labs, and would adopt many practices of a clinical trial.

We believe that this requirement would push researchers to be more sceptical of their own work. Instead of striving to convince reviewers and editors to publish a paper in prestigious outlets, they would be questioning whether their hypotheses could stand up in a large, confirmatory animal study. Such a trial would allow much more flexibility in earlier hypothesis-generating experiments, which would be published in the same paper as the confirmatory study. If the idea catches on, there will be fewer high-profile papers hailing new therapeutic strategies, but much more confidence in their conclusions…

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 25 February 2017]

Research Article
Does Zika Virus Cause Microcephaly – Applying the Bradford Hill Viewpoints
February 22, 2017 · Research Article
Introduction: Zika virus has been documented since 1952, but been associated with mild, self-limiting disease. Zika virus is classified as an arbovirus from a family of Flaviviridae and primarily spread by Aedes Aegypti mosquitos. However, in a large outbreak in Brazil in 2015, Zika virus has been associated with microcephaly.
Methods: In this review we applied the Bradford-Hill viewpoints  to investigate the association between Zika virus and microcephaly. We examined historical studies, available data and also compared historical rates of microcephaly prior to the Zika virus outbreak. The available evidence was reviewed against the Bradford Hill viewpoints.
Results: All  the nine criteria were met to varying degrees: strength of association, consistency of the association, specificity, temporality, plausibility, coherence, experimental evidence, biological gradient and analogy.
Conclusion: Using the Bradford Hill Viewpoints as an evaluation framework for causation is highly suggestive that the association between Zika virus and microcephaly is causal. Further studies using animal models on the viewpoints which were not as strongly fulfilled would be helpful.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 February 2017)

Perspective
Precision oncology: Charting a path forward to broader deployment of genomic profiling
Alison M. Schram, Michael F. Berger, David M. Hyman
| published 21 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002242

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 February 2017)

Essay
Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints
Evelinn Mikkelsen, Jan A. C. Hontelez, Maarten P. M. Jansen, Till Bärnighausen, Katharina Hauck, Kjell A. Johansson, Gesine Meyer-Rath, Mead Over, Sake J. de Vlas, Gert J. van der Wilt, Noor Tromp, Leon Bijlmakers, Rob M. P. M. Baltussen
| published 21 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002240

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 February 2017)

Research Article
Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data
Improvements to housing may contribute to malaria control and elimination by reducing house entry by malaria vectors and thus exposure to biting. We tested the hypothesis that the odds of malaria infection are lower in modern, improved housing compared to traditional housing in sub-Saharan Africa (SSA).
Lucy S. Tusting, Christian Bottomley, Harry Gibson, Immo Kleinschmidt, Andrew J. Tatem, Steve W. Lindsay, Peter W. Gething
| published 21 Feb 2017 P
http://dx.doi.org/10.1371/journal.pmed.1002234

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 25 February 2017)

Editorial
Global urbanization and the neglected tropical diseases
Peter J. Hotez
| published 23 Feb 2017 P
http://dx.doi.org/10.1371/journal.pntd.0005308
Increasing urbanization in both developing and developed countries could promote the emergence of a new set of neglected tropical diseases (NTDs)
…Overall, there is a dearth of information about the urban transmission of NTDs and very few disease burden estimates that distinguish urban versus rural modes of transmission. As global urbanization continues to increase, there is going to be an urgent need for such studies. By 2050, with most of the global population living in cities, we will need to better understand how NTDs and other poverty-related neglected diseases flourish in urban environments.
The UN is beginning to shape new public policies for global urbanization, which include programs for balanced urban growth and spatial distribution, sustainability, and timely collection of data required for urban planning [1]. The findings of significant and serious NTDs in urban areas mean that these diseases will also need to be considered as urban areas and megacities strive to meet their SDGs. Arbovirus infections, leptospirosis, cholera, and typhoid fever, vector-borne parasitic infections such as schistosomiasis, Chagas disease, leishmaniasis, and vivax malaria, and NTD–NCD comorbidities each represent the product of urban planning breakdowns and unchecked growth. Without adequate public health measures and research and development for new drugs, diagnostics, and vaccines, we can expect that these diseases will continue to thwart sustainable urban growth in the coming decades.