Vaccines – the Key Paradigm for the 21st Century’s Health Care Strategy – 5th Semmering Vaccine Symposium

Vaccine
Volume 30, Issue 29, Pages 4299-4406 (19 June 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/29

Vaccines – the Key Paradigm for the 21st Century’s Health Care Strategy – 5th Semmering Vaccine Symposium
Baden/Vienna
28–30 April 2011
Edited by Sefik S. Alkan, Thomas Decker and Alexander von Gabain

Section headings
– Badly needed novel vaccines
– What vaccinologists expect from immunologists
– About allergies, autoimmunity, microbes and vaccines
– Novel adjuvants – breakthroughs and setbacks, where will we end?
– Improving administration also for vaccines in the less developed world
– Quo vadis flu vaccines – learning from the H1N1 pandemic in the light of new technologies and established paradigms
– Late breakers in vaccine development

UNICEF report: 45% of Pakistanis unaware of polio vaccination

Editor’s Note: The UNICEF Report referenced below did not appear to be posted on the UNICEF website (accessed 9 June 2012 20:35 EDT -UTC/GMT -4). This is an extract selected by the Editor.

The Express Tribune with the International Herald Tribune
By Sehrish Wasif
Published: June 5, 2012

UNICEF report: 45% of Pakistanis unaware of polio vaccination

ISLAMABAD:
More than 45% of Pakistan’s total population is not aware that polio can be prevented through vaccination, a United Nations Children Fund (Unicef) report revealed.

According to the report entitled ‘Pakistan Polio Communications Review’, which was made available with The Express Tribune, only a very small number of parents are aware of the risk that their child may contract polio.

Unicef conducted research in 29 high-risk districts to evaluate key challenges in communications and social mobilisation in order to come up with improved strategies to create awareness about the disease.

The report revealed that 97% of respondents had heard the term ‘polio’; 87% categorised polio as a disease and only 55% were aware of vaccination as a way of preventing the disease.

Only one parent out of three realises their child is at risk of contracting polio this year. According to the report, susceptibility to the virus is highest in Balochistan, where 59% of respondents noted their concern….

http://tribune.com.pk/story/388900/unicef-report-45-of-pakistanis-unaware-of-polio-vaccination/

Researchers at Annual NYC Science Fest Hail Universal Vaccines

Forbes
Pharma & Healthcare
6/05/2012 @ 12:46PM |694 views

Researchers at Annual Science Fest Hail Universal Vaccines
The panel Laurie Garrett, Gary Nabel, Michael Osterholm, Harold Varmus, Richard Besser (Photo by author) was moderated by ABC News’ health and medical editor Richard Besser and was hosted by the New York Historical Society. It was preceded by a screening of the film “Contagion.”

http://www.forbes.com/sites/gerganakoleva/2012/06/05/researchers-at-annual-science-fest-hail-universal-vaccines/

Doctors Without Borders Vaccinates Guineans Against Cholera

Voice of America
June 01, 2012

Doctors Without Borders Vaccinates Guineans Against Cholera
DAKAR, Senegal – The medical aid group, Doctors Without Borders, has vaccinated more than 100,000 people against cholera in Guinea. The group says this is the first intervention of its kind in Africa, where people were vaccinated during a major cholera outbreak. Experts say that while the vaccine is a vital tool, it cannot be seen as a solution in itself…

“…François Verhoustraeten, who is program director with MSF in Geneva and oversees the agency’s work in Guinea, said what’s particular about the Guinea intervention is that MSF introduced the vaccine once cases were already reported. So not only is the group protecting people from the disease, he said, it is also able to see the impact of vaccination on an ongoing epidemic.
“…MSF points out that the cholera vaccine cannot be used alone, but rather is just one tool against this highly contagious yet preventable disease. Verhoustraeten said the agency will not base future cholera prevention efforts on the vaccine. He said proper hygiene and access to clean water remain fundamental measures and that the vaccine can be a significant addition….”

“…Claire-Lise Chaignat is a cholera expert at the World Health Organization in Geneva. She said WHO is closely watching the campaign in Guinea. “Vaccines have certainly a role to play in cholera control, but it’s not a panacea. We’re very keen on seeing how this intervention of MSF in West Africa is going to be effective,” said Chaignat. She said vaccination is becoming increasingly prominent in cholera prevention, pointing to a project in Zanzibar, in eastern Africa, where broad vaccination campaigns are planned.
“Now the recommendation is to use cholera vaccines to eliminate cholera in Zanzibar by having three vaccination rounds over a period of 10 years, along with improved water and sanitation. So you see the vaccine is really coming to the forefront, but again not as a sole measure; it has to be part of an intervention package,” said Chaignat.
Voice of America: http://www.voanews.com/content/doctors_without_borders_completes_cholera_campaign_guinea/1146248.html

Vaccines: The Week in Review 2 June 2012

Editor’s Notes:

Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_2 June 2012

Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

William Foege, MD, MPH awarded Presidential Medal of Freedom

   William Foege, MD, MPH awarded Presidential Medal of Freedom Award. In a White House ceremony May 29th, 2012, President Barack Obama honored 13 recipients of the Presidential Medal of Freedom Award, including William Foege, MD, MPH, professor emeritus in Emory University’s Rollins School of Public Health and a member of the Emory Global Health Institute advisory board. Dr. Foege was recognized for his role in smallpox eradication.

http://www.youtube.com/watch?v=HAog_BstxrQ&list=UUPTZWC3WPdtBbKk1_qlXcUw&feature=plcp

65th WHA closes with new global health measures

WHO Media Release: 65th World Health Assembly closes with new global health measures
26 May 2012

Excerpted
The Sixty-fifth World Health Assembly concluded Saturday after adopting 21 resolutions and three decisions on a broad range of health issues. The six days of discussions involved nearly 3000 delegates, including health ministers and senior health officials from amongst the 194 WHO Member States, as well as representatives from civil society and other stakeholders.

The agenda covered some of the biggest challenges and opportunities facing public health today.

“As challenges, let me mention noncommunicable diseases and ageing, maternal and child health, under- and over- nutrition, the eradication of polio and health demands during humanitarian emergencies,” said Dr Margaret Chan, WHO Director-General. “As opportunities, let me mention immunization, and the decade of vaccines, and the new multisectoral strategies made possible when we take a social determinants approach.”…

The resolutions and decisions adopted by the Member States include:

– Humanitarian emergencies: The World Health Assembly adopted a resolution reaffirming the central role of health in humanitarian response and strongly endorsing WHO’s role as Health Cluster Lead Agency. It calls on Member States and donors to allocate sufficient resources for health sector activities during humanitarian emergencies and for strengthening WHO’s capacity to exercise its role as Lead Agency both at global and country levels. The resolution also calls on WHO to provide Member States and humanitarian partners with predictable support during emergencies, by coordinating rapid assessments, the development of strategies and action plans, and monitoring the health situation.

– Mass gatherings: The Health Assembly received the report by the Secretariat on “Global mass gatherings: implications and opportunities for global health security”. The discussions were led by delegates from areas which have hosted mass gatherings recently or on a regular basis. Delegates expressed the need to exchange lessons learned on preparedness and management and Member States also stressed the need for efficient preventive measures and interventions.

– Millennium Development Goals: Member States endorsed the report on the progress and achievements of the health-related Millennium Development Goals and health goals after 2015. While the pace of progress has accelerated in many Member States, it was also acknowledged that more still needs to be done in the remaining three years to achieve the goals.

– A second report on The Commission on Information and Accountability for Women’s and Children’s Health, established at the request of the United Nations Secretary-General’s in the context of the Global Strategy for Women’s and Children’s Health, presented 10 recommendations to improve accountability in countries and globally. The focus is on the 75 countries which together account for more than 95% of all maternal and child deaths in the world. Many countries and global partners have made specific commitments to accelerate action towards the achievement of MDG 4 (reduce child mortality) and 5 (improve maternal health).

– Pandemic influenza preparedness: Member States acknowledged that the pandemic influenza preparedness (PIP) framework is a crucial development for global health security, based on the lessons from the 2009 influenza pandemic. Delegates recognized that industry and other partners play important roles in the development of vaccines to counter outbreaks.

Delegates agreed on a 70% and 30% share of resources between preparedness and response respectively, but that this would be regularly reviewed. They welcomed the role of the framework’s advisory group, but stressed the need for extra resources – both human and financial – to support WHO capacity and leadership.

– Intensification of the global polio eradication initiative: The delegates acknowledged that polio eradication is at a tipping point between success and failure and necessary funding is essential to ensure success. In this regard, Member States declared the completion of polio eradication a programmatic emergency for global health.

– Research and development: The Health Assembly welcomed the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination containing recommendations for securing new funds for health research and development on diseases that affect people in developing countries. It adopted a resolution to hold Member States’ consultations at national, regional and global levels to analyze the report and the feasibility of the recommendations.

http://www.who.int/mediacentre/news/releases/2012/wha65_closes_20120526/en/index.html

WHA: GVAP (Global Vaccine Action Plan)

WHO Media Release: World Health Assembly endorses the Global Vaccine Action Plan and World Immunization Week
28 May 2012
Ministers of Health from 194 countries at the 65th World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a roadmap to prevent millions of deaths by 2020 through more equitable access to vaccines for people in all communities. In addition, Member States also designate the last week of April as World Immunization Week.
http://www.who.int/immunization/newsroom/press/wha_endorses_gvap/en/index.html

 IFPMA Statement under WHA 65 agenda item 13.12 on Draft global vaccine action plan
Extract
“…As a key partner in immunization, global health, and research and development, the IFPMA, welcomes the vision of the Decade of Vaccines, and lauds the Global Vaccine Action Plan (GVAP), as it outlines an ambitious strategy to achieve immunization goals, including sustained funding, higher national prioritization, enhanced awareness of the value of vaccination, the production of high-quality vaccines, and the adoption of a holistic approach to immunization practices.

“In order to fully achieve the vision of the Decade of Vaccines, further efforts should be undertaken to refine the plan. This requires clarifying interaction vis-à-vis other global vaccine programs and partnerships; prioritizing objectives and identifying opportunities for synergies amongst them; and defining human and financial resource needs and funding sources. In addition, further dialogue is needed to develop an accountability framework which would define stakeholders’ roles and responsibilities, targeted indicators and a monitoring process.

“Equitable and sustained access to and use of high quality, safe and effective vaccines can be enhanced through well-functioning competitive market dynamics that reward innovation and strive for sustainable investments and collaboration. For example through recognition of current pricing and procurement mechanisms that have contributed significantly to progress in access of affordable vaccines.

“We recognize the potential value of facilitating access to vaccine technology and know-how through voluntary technology transfers, while preserving an environment that supports future immunization research and development through protection of intellectual property rights.

“The Decade of Vaccines’ objectives cannot be achieved by countries acting alone. We stand ready to contribute to a country-led, broad-based and collective approach, and work with mutually accountable partners to achieve the GVAP goals. The decisions we make this year, this decade, will have repercussions on future generations – we cannot and we will not fail them.”

http://www.ifpma.org/fileadmin/content/Events/Statements/IFPMA_WHA65_Statement_on_global_vaccine_action_plan__13.12_.pdf

DoVC Blog: World Health Assembly: WHO Carves Out Leadership Role In “Vaccine Decade”
Posted: 31 May 2012 09:23 AM PDT
In this piece, journalist Rachel Marusak Hermann reports from the Sixty-fifth World Health Assembly on the endorsement of the Global Vaccine Action Plan. The article originally appeared on Intellectual Property Watch and can also be read at GenevaLunch.com.

World Health Assembly: WHO Carves Out Leadership Role In “Vaccine Decade”
By Rachel Marusak Hermann for Intellectual Property Watch
With a generous pledge and a grand vision, Bill Gates launched the “Decade of Vaccines” two years ago. By endorsing a “Global Vaccine Action Plan” during the World Health Assembly last week, the world’s health authority stands as the lead agency in advancing the initiative.

The 65th World Health Assembly (WHA), which met 21-26 May, endorsed the Global Vaccine Action Plan (GVAP), a broad set of objectives, goals and guiding principles to increase worldwide access to immunzsation.

Although member states and stakeholders widely supported the plan, some said that greater attention needed to be given to addressing the high-cost of new vaccines and that products needed to be better adapted for use in developing countries. Others called for the need to hammer out details related to governance and financial implications.

Read more here.

WHO, HPA offer immunization advice: EURO 2012; London Olympics

WHO and HPA offer travel health advice for EURO 2012 and the London Olympics
30-05-2012

[Full text]
Two major sporting events — the European football championships and the Olympic Games — happen this summer in the WHO European Region, while the fight to control outbreaks of vaccine-preventable diseases continues in several countries of the Region.    It is, therefore, critical to check your vaccination status, particularly before travelling to large public events. Measles, for example, is a very infectious disease, and mass gatherings can help it spread through intensive contact between large numbers of people. If you are up-to-date on your vaccines, you will be protected from diseases such as measles, rubella and polio. Vaccination also stops these diseases from spreading at public events and from being imported to your country.

WHO and the Health Protection Agency (HPA) have collaborated in providing travel health advice to team physicians both for the EURO 2012 football championships and for the 2012 London Summer Olympics. HPA have also produced guidance for travelers to London during the Olympic Games this summer alongside WHO/Europe’s health recommendations for travelers to Poland and Ukraine during EURO 2012.

http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2012/05/who-and-hpa-offer-travel-health-advice-for-euro-2012-and-the-london-olympics

WHO: contracted laboratories for vaccine prequalification programme

WHO: List of contracted laboratories performing tests on behalf of the WHO vaccine prequalification programme

Extract
In 2010 the prequalification programme for vaccines has undergone a substantial revision process following the recommendations of the ad hoc committee on vaccines prequalification. One of the changes introduced was the decision to publish on the website the list of laboratories contracted by WHO to perform tests on behalf of the prequalification programme.

The independent testing of vaccines is part of the procedure for evaluation of the acceptability, in principle, of vaccines for purchase by United Nations agencies. The testing is performed to assess the consistency of final product characteristics and represents one of the decision making criteria for granting prequalification. Tests undertaken are the most relevant to reflect the quality, safety and efficacy of the vaccines. Usually potency and toxicity are tested. However, depending on the nature of the vaccines, other relevant tests can be performed. A targeted testing strategy is followed. Vaccines are expected to comply with WHO recommended requirements as well as with the UN tender specifications…

…The publication of the list of qualified laboratories contracted by WHO for specific tests is important for transparency reasons, to recognize the work performed by these laboratories in a collaborative effort with WHO and also to give access to this information to countries that can become occasional users.

List of WHO contracted laboratories performing tests on behalf of the WHO vaccine prequalification programme
pdf, 37kb

Twitter Watch [accessed 2 June 2012 – 18:46]

Twitter Watch [accessed 2 June 2012 – 18:46]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

StateDept @StateDept
#SecClinton at #HealthOSL in #Norway: Improving #maternalhealth is a priority for the United States. http://youtu.be/OhsQ-tD25cY
View video

Partners In Health @PIH
New @TheLancet article by Drs. Ivers, Farmer & Pape on #cholera vaccine in #Haiti http://ow.ly/bj4yc
2:15 PM – 2 Jun 12

Partners In Health ‏@PIH
.@washingtonpost editorial board endorses #cholera vaccine rollout in #Haiti. http://ow.ly/bj5lX

UNICEF ‏@UNICEF
New White Paper on #BigData for #Development by @UN innovation initiative @UNGlobalPulse http://bit.ly/LN34sL
2:52 PM – 1 Jun 12

UNICEF ‏@UNICEF
In the Central African Republic, we’re reaching out to ethnic minorities in the fight against #polio http://uni.cf/N3ZITK @unicefpolio
2:40 PM – 1 Jun 12

Eurosurveillance ‏@Eurosurveillanc
#16 cases of #W135 #invasive #meningococcal infection reported in #France: #8 linked to #recent Sub-#Saharan travel: http://bit.ly/LtHaKr
Retweeted by ECDC
11:02 AM – 29 May 12

Sabin Vaccine Inst. @sabinvaccine
Chagas is making news today-We’re making a vaccine. http://nyti.ms/KDecaa
5:18 PM – 30 May 12

Sabin Vaccine Inst. @sabinvaccine
Finding the Final Fifth: Inequalities in Immunisation – http://www.viewsoftheworld.net/?p=2258 @savethechildren
1:42 PM – 30 May 12

IAVI @AIDSvaccine
IAVI (@AIDSvaccine) is pleased to announce the appointment of Louis Schwartz as CFO. Read more about Louis: http://bit.ly/L5MHF5
1:24 PM – 30 May 12

Report: Nearly 1,000 Medicines in Development Against Cancer

Report: Nearly 1,000 Medicines in Development to Help Patients in Their Fight Against Cancer
Date:5/30/2012
Source: Pharmaceutical Research and Manufacturers of America (PhRMA)

“America’s biopharmaceutical research companies are testing 981 medicines and vaccines to fight the many types of cancer affecting millions of patients worldwide, according to a report released today by the Pharmaceutical Research and Manufacturers of America (PhRMA). These potential medicines, which are either in clinical trials or under review by the Food and Drug Administration, include 121 for lung cancer, 117 for lymphoma and 111 for breast cancer.”

Modelling meningitis outbreaks in the Niger

Bulletin of the World Health Organization
Volume 90, Number 6, June 2012, 401-476
http://www.who.int/bulletin/volumes/90/6/en/index.html

A Bayesian network approach to the study of historical epidemiological databases: modelling meningitis outbreaks in the Niger
A Beresniak, E Bertherat, W Perea, G Soga, R Souley, D Dupont & S Hugonnet

Objective
To develop a tool for evaluating the risk that an outbreak of meningitis will occur in a particular district of the Niger after outbreaks have been reported in other, specified districts of the country.

Methods
A Bayesian network was represented by a graph composed of 38 nodes (one for each district in the Niger) connected by arrows. In the graph, each node directly influenced each of the “child” nodes that lay at the ends of the arrows arising from that node, according to conditional probabilities. The probabilities between “influencing” and “influenced” districts were estimated by analysis of databases that held weekly records of meningitis outbreaks in the Niger between 1986 and 2005. For each week of interest, each district was given a Boolean-variable score of 1 (if meningitis incidence in the district reached an epidemic threshold in that week) or 0.

Findings
The Bayesian network approach provided important and original information, allowing the identification of the districts that influence meningitis risk in other districts (and the districts that are influenced by any particular district) and the evaluation of the level of influence between each pair of districts.

Conclusion
Bayesian networks offer a promising approach to understanding the dynamics of epidemics, estimating the risk of outbreaks in particular areas and allowing control interventions to be targeted at high-risk areas.

“Healthy Governance” and WHO

Foreign Affairs
http://www.foreignaffairs.com/

Snapshot,
May 24, 2012
Healthy Governance
By Devi Sridhar, Lawrence O. Gostin, and Derek Yach

For decades, the WHO has debated whether to address specific diseases or to broadly strengthen healthcare systems. With the increasing threat of noncommunicable diseases, however, the WHO has to double down on the latter, and convince states that health concerns are integral to decisions about trade, agriculture, and urban planning — the whole of government.

Barriers to scaling up health interventions in low and middle income countries

Globalization and Health
[Accessed 2 June 2012]
http://www.globalizationandhealth.com/

Research
What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science
Gavin M Yamey

Abstract (provisional)
Background
Most low and middle income countries (LMICs) are currently not on track to reach the health-related Millennium Development Goals (MDGs). One way to accelerate progress would be through the large-scale implementation of evidence-based health tools and interventions. This study aimed to: (a) explore the barriers that have impeded such scale-up in LMICs, and (b) lay out an “implementation research agenda”–a series of key research questions that need to be addressed in order to help overcome such barriers.

Methods
Interviews were conducted with fourteen key informants, all of whom are academic leaders in the field of implementation science, who were purposively selected for their expertise in scaling up in LMICs. Interviews were transcribed by hand and manually coded to look for emerging themes related to the two study aims. Barriers to scaling up, and unanswered research questions, were organized into six categories, representing different components of the scaling up process: attributes of the intervention; attributes of the implementers; scale-up approach; attributes of the adopting community; socio-political, fiscal, and cultural context; and research context.

Results
Factors impeding the success of scale-up that emerged from the key informant interviews, and which are areas for future investigation, include: complexity of the intervention and lack of technical consensus; limited human resource, leadership, management, and health systems capacity; poor application of proven diffusion techniques; lack of engagement of local implementers and of the adopting community; and inadequate integration of research into scale-up efforts.

Conclusions
Key steps in expanding the evidence base on implementation in LMICs include studying how to: simplify interventions; train “scale-up leaders” and health workers dedicated to scale-up; reach and engage communities; match the best delivery strategy to the specific health problem and context; and raise the low profile of implementation science.

The complete article is available as a provisional PDF

Comment: Oral cholera vaccine and integrated cholera control in Haiti

The Lancet  
Jun 02, 2012  Volume 379  Number 9831  p777 – 2116
http://www.thelancet.com/journals/lancet/issue/current

Comment
Oral cholera vaccine and integrated cholera control in Haiti
Louise C Ivers, Paul E Farmer, William J Pape

Preview
On April 14, 2012, some 18 months after the first cases of cholera were documented in Haiti, a group of Haitians were offered the first of two doses of oral cholera vaccine as part of the Haiti cholera vaccination project. The epidemic is not only the first in this region in nearly two decades, it is also the worst epidemic of the post-antibiotic, post-vaccine era.1 This vaccine rollout, linked to efforts to increase access to safe drinking water, seeks to vaccinate 100 000 people with a low-cost vaccine recently prequalified by WHO.

The Lancet Commissions – Shaping cities for health

The Lancet  
Jun 02, 2012  Volume 379  Number 9831  p777 – 2116
http://www.thelancet.com/journals/lancet/issue/current

Editorials
Shaping cities for health: a UCL/Lancet Commission
The Lancet

Preview
Cities are bustling, vibrant, built-up places where millions of people reside, often in close proximity to each other. Most, whether in high-income or low-income countries, exist with vast, and very visible, social and health inequalities between inhabitants. But the provision of health services cannot reduce these inequalities alone; the physical fabric and design of a city also have parts to play. In today’s Lancet, we publish a joint Commission with University College London (UCL) that sets out how policy makers can develop urban areas to foster the health of citizens so that they become healthy cities.

The Lancet Commissions
Shaping cities for health: complexity and the planning of urban environments in the 21st century
Yvonne Rydin, Ana Bleahu, Michael Davies, Julio D Dávila, Sharon Friel, Giovanni De Grandis, Nora Groce, Pedro C Hallal, Ian Hamilton, Philippa Howden-Chapman, Ka-Man Lai, CJ Lim, Juliana Martins, David Osrin, Ian Ridley, Ian Scott, Myfanwy Taylor, Paul Wilkinson, James Wilson

Key messages
– Cities are complex systems, so urban health outcomes are dependent on many interactions
– The so-called urban advantage—whereby urban populations are, on average, at an advantage compared with rural populations in terms of health outcomes—has to be actively promoted and maintained
– Inequalities in health outcomes should be recognised at the urban scale
– A linear or cyclical planning approach is insufficient in conditions of complexity
– Urban planning for health needs should focus on experimentation through projects
– Dialogue between stakeholders is needed, enabling them to assess and critically analyse their working practices and learn how to change their patterns of decision making

Editorial A war not yet won (polio)

Nature  
Volume 485 Number 7400 pp547-672  31 May 2012
http://www.nature.com/nature/current_issue.html

Editorial
A war not yet won
Nature 485, 547–548 (31 May 2012)
doi:10.1038/485547b
Published online
30 May 2012
The eradication of polio is within reach, but it is too early for self-congratulation.

Extract
Just 25 years ago, some 350,000 people contracted polio every year. So far this year, just 60 cases have been reported across four countries worldwide. No wonder, then, that some can foresee world leaders slapping one another on the back for ending polio’s scourge on humanity in a few years’ time, much as their predecessors did in 1980 when the world was declared smallpox-free.

The Global Polio Eradication Initiative started in 1988 to target poliomyelitis, a paralysing viral disease that mostly affects children. Some US$9 billion later, the result is the lowest number of cases ever tallied, as well as the fewest countries affected.

But it is too early for self-congratulation and complacency. The polio-eradication campaign faces a US$1-billion budget shortfall over the next two years that threatens to erase this year’s hard-won successes. Despite a long history of mismanagement and missed deadlines (goals of ending viral spread by 2000 and 2005 passed the programme by, and the same is likely to be true of 2012), the world has come too close to vanquishing this ancient disease to fail to see the task through…

Pandemic Influenza A in Residential Summer Camps—Maine, 2009

The Pediatric Infectious Disease Journal
June 2012 – Volume 31 – Issue 6   pp: A7-A8,547-658,e78-e91
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Pandemic Influenza A in Residential Summer Camps—Maine, 2009
Robinson, Sara; Averhoff, Francisco; Kiel, John; Blaisdell, Laura; Haber, Michael; Sites, Anne; Copeland, Daphne
Pediatric Infectious Disease Journal. 31(6):547-550, June 2012.
doi: 10.1097/INF.0b013e31824f8124

Abstract:
Objective: The aim of this study was to evaluate the preparedness for and response of Maine summer camps to the 2009 pandemic influenza H1N1 (pH1N1).

Methods: We conducted a retrospective web-based survey of the Maine Youth Camping Foundation members at the end of the 2009 camping season. The outcome measures were responses to the pandemic including educational efforts, isolation practices and antiviral usages as well as percentage of influenza-like illness (ILI) and laboratory-confirmed influenza outbreaks among Maine residential summer camps.

Results: Of 107 residential camps queried, 91 (85%) responded. Although 43 (47%) of 91 camps reported cases of ILI, and 19 (21%) had outbreaks (ie, 3 or more confirmed cases of pH1N1), no respondents reported closing camps or canceling sessions. Most camps reported that they communicated with campers’ families about pH1N1 and implemented control measures, including educating campers and staff about symptoms, isolating ill campers and staff, encouraging increased hand washing and hygiene practices and increasing the availability of hand sanitizers. Of the 43 camps with cases of ILI or laboratory-confirmed pH1N1, 25 (58%) used antiviral medication for treatment, and 18 (42%) used antiviral medications for prophylaxis; antiviral practices varied among camps.

Conclusions: Summer camps in Maine were in general well prepared for pH1N1. Most camps followed public health guidance and implemented preventive measures. Many camps experienced ILI and outbreaks during the season, but did not report major disruptions. Camps should review their preparedness and disease control plans annually and public health authorities should keep guidance and recommendations simple and consistent.

Vaccination Attitudes: Healthcare Workers Working in Pediatric Departments in Greece

The Pediatric Infectious Disease Journal
June 2012 – Volume 31 – Issue 6   pp: A7-A8,547-658,e78-e91
http://journals.lww.com/pidj/pages/currenttoc.aspx

Vaccine Reports
Attitudes Regarding Occupational Vaccines and Vaccination Coverage Against Vaccine-preventable Diseases Among Healthcare Workers Working in Pediatric Departments in Greece
Maltezou, Helena C.; Lourida, Athanasia; Katragkou, Aspasia; Grivea, Ioanna N.; Katerelos, Panos; Wicker, Sabine; Syrogiannopoulos, George A.; Roilides, Emmanuel; Theodoridou, Maria
Pediatric Infectious Disease Journal. 31(6):623-625, June 2012.
doi: 10.1097/INF.0b013e31824ddc1e

Abstract:
We studied the attitudes with regard to occupational vaccines and vaccination coverage among healthcare workers in pediatric departments. Completed vaccination rates were 33%, 33%, 41.7%, 3%, 5.8%, 69.2% and 36.3% against measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Susceptibility rates were 14.2%, 15.7%, 14.6%, 7.6%, 87.4%, 22.6% and 61.8% for measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Mandatory vaccinations were supported by 70.6% of healthcare workers, with considerable differences by target disease.

Low Rates of Influenza Immunization in Young Children Under Ontario’s Universal Influenza Immunization Program

Pediatrics
June 2012, VOLUME 129 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Low Rates of Influenza Immunization in Young Children Under Ontario’s Universal Influenza Immunization Program
Michael A. Campitelli, Miho Inoue, Andrew J. Calzavara, Jeffrey C. Kwong, and Astrid Guttmann
Pediatrics 2012; 129:e1421-e1430

Abstract
OBJECTIVES: To determine physician-administered influenza vaccine coverage for children aged 6 to 23 months in a jurisdiction with a universal influenza immunization program during 2002–2009 and to describe predictors of vaccination.

METHODS: By using hospital records, we identified all infants born alive in Ontario hospitals from April 2002 through March 2008. Immunization status was ascertained by linkage to physician billing data. Children were categorized as fully, partially, or not immunized depending on the number and timing of vaccines administered. Generalized linear mixed models determined the association between immunization status and infant, physician, and maternal characteristics.

RESULTS: Influenza immunization was low for the first influenza season of the study period (1% fully immunized during the 2002–2003 season), increased for the following 3 seasons (7% to 9%), but then declined (4% to 6% fully immunized during the 2006–2007 to 2008–2009 seasons). Children with chronic conditions or low birth weight were more likely to be immunized. Maternal influenza immunization (adjusted odds ratio 4.31; 95% confidence interval 4.21–4.40), having a pediatrician as the primary care practitioner (adjusted odds ratio 1.85; 95% confidence interval 1.68–2.04), high visit rates, and better continuity of care were all significantly associated with full immunization, whereas measures of social disadvantage were associated with nonimmunization. Low birth weight infants discharged from neonatal care in the winter were more likely to be immunized.

CONCLUSIONS: Influenza vaccine coverage among children aged 6 to 23 months in Ontario is low, despite a universal vaccination program and high primary care visit rates. Interventions to improve coverage should target both physicians and families.

Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations

Pediatrics
June 2012, VOLUME 129 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations
Christina A. Suh, Alison Saville, Matthew F. Daley, Judith E. Glazner, Jennifer Barrow, Shannon Stokley, Fran Dong, Brenda Beaty, L. Miriam Dickinson, and Allison Kempe
Pediatrics 2012; 129:e1437-e1445

Abstract
OBJECTIVE: To assess the effectiveness of reminder/recall (R/R) for immunizing adolescents in private pediatric practices and to describe the associated costs and revenues.

METHODS: We conducted a randomized controlled trial in 4 private pediatric practices in metropolitan Denver. In each practice, 400 adolescents aged 11 to 18 years who had not received 1 or more targeted vaccinations (tetanus-diphtheria-acellular pertussis, meningococcal conjugate, or first dose of human papillomavirus vaccine for female patients) were randomly selected and randomized to intervention (2 letters and 2 telephone calls) or control (usual care) groups. Primary outcomes were receipt of >1 targeted vaccines and receipt of all targeted vaccines 6 months postintervention. We calculated net additional revenue for each additional adolescent who received at least 1 targeted vaccine and for those who received all targeted vaccines.

RESULTS: Eight hundred adolescents were randomized to the intervention and 800 to the control group. Baseline rates of having already received tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and first dose of human papillomavirus vaccine before R/R ranged from 33% to 54%. Postintervention, the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine (47.1% vs 34.6%, P < .0001) and receipt of all targeted vaccines (36.2% vs 25.2%, P < .0001) compared with the control group. Three practices had positive net revenues from R/R; 1 showed net losses.

CONCLUSIONS: R/R was successful at increasing immunization rates in adolescents and effect sizes were comparable to those in younger children. Practices conducting R/R may benefit financially if they can generate additional well-child care visits and keep supply costs low.

Effectiveness and Cost: Immunization Recall at School-Based Health Centers

Pediatrics
June 2012, VOLUME 129 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Effectiveness and Cost of Immunization Recall at School-Based Health Centers
Allison Kempe, Jennifer Barrow, Shannon Stokley, Alison Saville, Judith E. Glazner, Christina Suh, Steven Federico, Lisa Abrams, Laura Seewald, Brenda Beaty, Matthew F. Daley, and L. Miriam Dickinson
Pediatrics 2012; 129:e1446-e1452

Abstract
BACKGROUND AND OBJECTIVE: Effectiveness of recall for immunizations has not been examined in the setting of school-based health centers (SBHCs). We assessed (1) immunization rates achieved with recall among sixth-grade girls (demonstration study); (2) effectiveness of recall among sixth-grade boys (randomized controlled trial [RCT]); and (3) cost of conducting recall in SBHCs.

METHODS: During October 2008 through March 2009, in 4 Denver public SBHCs, we conducted (1) a demonstration study among 265 girls needing ≥1 recommended adolescent vaccine and (2) an RCT among 264 boys needing vaccines, with half randomized to recall and half receiving usual care. Immunization rates for recommended adolescent vaccines were assessed 6 months after recall. First dose costs were assessed by direct observation and examining invoices.

RESULTS: At the end of the demonstration study, 77% of girls had received ≥1 vaccine and 45% had received all needed adolescent vaccines. Rates of receipt among those needing each of the vaccines were 68% (160/236) for tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, 57% (142/248) for quadrivalent meningococcal conjugate vaccine, and 59% (149/253) for the first human papillomavirus vaccine. At the end of the RCT, 66% of recalled boys had received ≥1 vaccine and 59% had received all study vaccines, compared with 45% and 36%, respectively, of the control group (P < .001). Cost of conducting recall ranged from $1.12 to $6.87 per recalled child immunized.

CONCLUSIONS: SBHC-based recall was effective in improving immunization rates for all adolescent vaccines, with effects sizes exceeding those achieved with younger children in practice settings.

Middle School Vaccination Requirements and Adolescent Vaccination Coverage

Pediatrics
June 2012, VOLUME 129 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Middle School Vaccination Requirements and Adolescent Vaccination Coverage
Erin Bugenske, Shannon Stokley, Allison Kennedy, and Christina Dorell
Pediatrics 2012; 129:1056-1063

Abstract
OBJECTIVE: To determine if middle school vaccination requirements are associated with higher coverage for adolescent vaccines.

METHODS: School entry requirements for receipt of vaccination for school entry or education of parents for 3 vaccines recommended for adolescents: tetanus/diphtheria-containing (Td) or tetanus/diphtheria/acellular pertussis (TdaP), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccines in place for the 2008–2009 school year were reviewed for the 50 states and the District of Columbia. Vaccination coverage levels for adolescents 13 to 17 years of age by state requirement status and change in coverage from 2008 to 2009 were assessed by using the 2008–2009 National Immunization Survey-Teen.

RESULTS: For the 2008–2009 school year, 32 states had requirements for Td/TdaP (14 specifically requiring TdaP) and none required education; 3 states required MenACWY vaccine and 10 others required education; and 1 state required HPV vaccine and 5 required education. Compared with states with no requirements, vaccination requirements were associated with significantly higher coverage for MenACWY (71% vs 53%, P < .001) and Td/TdaP (80% vs 70%, P < .001) vaccines. No association was found between education-only requirements and coverage levels for MenACWY and HPV vaccines. States with new 2008–2009 vaccination requirements (n = 6, P = .04) and states with preexisting vaccination requirements (n = 26, P = .02) for Td/TdaP experienced a significant increase in TdaP coverage over states with no requirements.

CONCLUSIONS: Middle school vaccination requirements are associated with higher coverage for Td/TdaP and MenACWY vaccines, whereas education-only requirements do not appear to increase coverage levels for MenACWY or HPV vaccines. The impact on coverage should continue to be monitored as more states adopt requirements.

Post-Arrival Health Screening in Karen Refugees in Australia

PLoS One
[Accessed 2 June 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Post-Arrival Health Screening in Karen Refugees in Australia
Georgia A. Paxton, Katrina J. Sangster, Ellen L. Maxwell, Catherine R. J. McBride, Ross H. Drewe
PLoS ONE: Research Article, published 31 May 2012 10.1371/journal.pone.0038194

Abstract 
Objective
To document the prevalence of nutritional deficiencies, infectious diseases and susceptibility to vaccine preventable diseases in Karen refugees in Australia.

Design
Retrospective audit of pathology results.

Setting
Community based cohort in Melbourne over the period July 2006–October 2009.

Participants
1136 Karen refugee children and adults, representing almost complete local area settlement and 48% of total Victorian Karen humanitarian intake for the time period.

Main Outcome Measures
Prevalence of positive test results for refugee health screening, with breakdown by age group (<6 years, 6–11 years, 12–17 years, 18 years and older).

Results
Overall prevalence figures were: anaemia 9.2%, microcytosis 19.1%, iron deficiency 13.1%, low vitamin B12 1.5%, low folate 1.5%, abnormal thyroid function tests 4.4%, vitamin D<50 nmol/L 33.3%, hypocalcaemia 7.4%, raised alkaline phosphatase 5.2%, abnormal liver transaminases 16.1%, hepatitis B surface antigen positive 9.7%, hepatitis B surface antibody positive 49.5%, isolated hepatitis B core antibody positive 9.0%, hepatitis C positive 1.9%, eosinophilia 14.4%, Schistosoma infection 7%, Strongyloides infection 20.8%, malaria 0.2%, faecal parasites 43.4%. Quantiferon-gold screening was positive in 20.9%. No cases of syphilis or HIV were identified. Serological immunity to vaccine preventable diseases was 87.1% for measles, 95% for mumps and 66.4% for rubella; 56.9% of those tested had seroimmunity to all three.

Conclusions
Karen refugees have high rates of nutritional deficiencies and infectious diseases and may be susceptible to vaccine preventable diseases. These data support the need for post-arrival health screening and accessible, funded catch-up immunisation.

Editorial: Chagas Disease: “The New HIV/AIDS of the Americas”

PLoS Neglected Tropical Diseases
May 2012
http://www.plosntds.org/article/browseIssue.action

Editorial
Chagas Disease: “The New HIV/AIDS of the Americas”
Peter J. Hotez, Eric Dumonteil, Laila Woc-Colburn, Jose A. Serpa, Sarah Bezek, Morven S. Edwards, Camden J. Hallmark, Laura W. Musselwhite, Benjamin J. Flink, Maria Elena Bottazzi

Endemic Chagas disease has emerged as an important health disparity in the Americas. As a result, we face a situation in both Latin America and the US that bears a resemblance to the early years of the HIV/AIDS pandemic.

Indirect, out-of-pocket and medical costs from influenza-related illness in young children

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 28  pp. 4123-4298 (13 June 2012)

Regular Papers
Indirect, out-of-pocket and medical costs from influenza-related illness in young children
Original Research Article
Pages 4175-4181
Ismael R. Ortega-Sanchez, Noelle-Angelique M. Molinari, Gerry Fairbrother, Peter G. Szilagyi, Kathryn M. Edwards, Marie R. Griffin, Amy Cassedy, Katherine A. Poehling, Carolyn Bridges, Mary Allen Staat

Abstract
Background
Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza.

Objective
To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children.

Methods
Using a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003–2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications.

Results
Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p > 0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients.

Conclusions
Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination.

H1N1 vaccine acceptance among ethnically diverse populations in the urban south

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 28  pp. 4123-4298 (13 June 2012)

Regular Papers
Factors mediating seasonal and influenza A (H1N1) vaccine acceptance among ethnically diverse populations in the urban south
Original Research Article
Pages 4200-4208
Paula M. Frew, Julia E. Painter, Brooke Hixson, Carolyn Kulb, Kathryn Moore, Carlos del Rio, Alejandra Esteves-Jaramillo, Saad B. O

Abstract
Objective
We examined the acceptability of the influenza A (H1N1) and seasonal vaccinations immediately following government manufacture approval to gauge potential product uptake in minority communities. We studied correlates of vaccine acceptance including attitudes, beliefs, perceptions, and influenza immunization experiences, and sought to identify communication approaches to increase influenza vaccine coverage in community settings.

Methods
Adults ≥18 years participated in a cross-sectional survey from September through December 2009. Venue-based sampling was used to recruit participants of racial and ethnic minorities.

Results
The sample (N = 503) included mostly lower income (81.9%, n = 412) participants and African Americans (79.3%, n = 399). Respondents expressed greater acceptability of the H1N1 vaccination compared to seasonal flu immunization (t = 2.86, p = 0.005) although H1N1 vaccine acceptability was moderately low (38%, n = 191). Factors associated with acceptance of the H1N1 vaccine included positive attitudes about immunizations [OR = 0.23, CI (0.16, 0.33)], community perceptions of H1N1 [OR = 2.15, CI (1.57, 2.95)], and having had a flu shot in the past 5 years [OR = 2.50, CI (1.52, 4.10). The factors associated with acceptance of the seasonal flu vaccine included positive attitudes about immunization [OR = 0.43, CI (0.32, 0.59)], community perceptions of H1N1 [OR = 1.53, CI (1.16, 2.01)], and having had the flu shot in the past 5 years [OR = 3.53, CI (2.16, 5.78)]. Participants were most likely to be influenced to take a flu shot by physicians [OR = 1.94, CI (1.31, 2.86)]. Persons who obtained influenza vaccinations indicated that Facebook (χ2 = 11.7, p = 0.02) and Twitter (χ2 = 18.1, p = 0.001) could be useful vaccine communication channels and that churches (χ2 = 21.5, p < 0.001) and grocery stores (χ2 = 21.5, p < 0.001) would be effective “flu shot stops” in their communities.

Conclusions
In this population, positive vaccine attitudes and community perceptions, along with previous flu vaccination, were associated with H1N1 and seasonal influenza vaccine acceptance. Increased immunization coverage in this community may be achieved through physician communication to dispel vaccine conspiracy beliefs and discussion about vaccine protection via social media and in other community venues.

Cost-effectiveness of 13-valent pneumo vaccine in Switzerland

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 28  pp. 4123-4298 (13 June 2012)

Regular Papers
Cost-effectiveness of 13-valent pneumococcal conjugate vaccine in Switzerland
Original Research Article
Pages 4267-4275
Patricia R. Blank, Thomas D. Szucs

Abstract
The 7-valent pneumococcal conjugate vaccine (PCV7) has been shown to be highly cost-effective. The 13-valent pneumococcal conjugate vaccine (PCV13) offers seroprotection against six additional serotypes. A decision-analytic model was constructed to estimate direct medical costs and clinical effectiveness of PCV13 vaccination on invasive pneumococcal disease (IPD), pneumonia, and otitis media relative to PCV7 vaccination. The option with a one-dose catch-up vaccination in children of 15–59 months was also considered. Assuming 83% vaccination coverage and considering indirect effects, 1808 IPD, 5558 pneumonia and 74,136 otitis media cases could be eliminated from the entire population during a 10-year modelling period. The PCV13 vaccination programme would lead to additional costs (+€26.2 Mio), but saved medical costs of −€77.1 Mio due to cases averted and deaths avoided, overcompensate these costs (total cost savings −€50.9 Mio). The national immunisation programmes with PCV13 can be assumed cost saving when compared with the current vaccine PCV7 in Switzerland.

Vaccines: The Week in Review 26 May 2012

Editor’s Notes:

Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_26 May 2012

Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

WHA65: Notes: Saturday, 26 May 2012

Sixty-fifth World Health Assembly: daily notes on proceedings
– Notes: Saturday, 26 May 2012

Financing research and development

The Health Assembly unanimously adopted the resolution on the Consultative Expert Working Group on Research and Development: Financing and Coordination in the form presented as draft by the drafting group and circulated yesterday.

Implementation of International Health Regulations (2005)
The annual report on the implementation of the International Health Regulations (2005) was presented in Committee A. Tools are available for State Parties to monitor their national core capacities and to identify areas that require further action. Information collected for 2011 shows State Parties are making fair progress for a number of core capacities, notably surveillance, response, laboratory and zoonotic events. Most regions reported relatively low capacities in human resources and for preparedness to chemical and radiological events.

Many State Parties have requested or will request a two-year extension to the mid-2012 deadline for establishing core capacities under IHR. Delegates made references to the difficulties in implementing measures related to points of entry as well as the need for engaging stakeholders outside the health sector and enhancing regional and trans-regional networks. The draft resolution was approved with a recommendation for developing further progress reports.

Pandemic influenza preparedness
Member States acknowledged that the pandemic influenza preparedness (PIP) framework is a crucial development for global health security, based on the lessons from the 2009 influenza pandemic. Committee A reviewed some of the procedures and processes behind that framework and its future direction. Many delegates highlighted the need for WHO to be flexible. Delegates recognized that industry and other partners play important roles in the development of mass vaccines to counter outbreaks.

Delegates agreed on a 70% and 30% share of resources between preparedness and response respectively, but that this would be regularly reviewed. They welcomed the role of the advisory group which was described as strong and robust, but stressed the need for extra resources – both human and financial – to support WHO capacity and leadership so that the PIP framework can be fully implemented.

Global mass gatherings
Committee A considered and approved the report by the Secretariat on “Global mass gatherings: implications and opportunities for global health security”. The discussions were spearheaded by delegates from countries which hosted mass gatherings in the recent past or host such events on a regular basis. Delegates expressed the need to exchange experiences to ensure lessons learned on adequate preparedness and management. Member States representatives also stressed the need for efficient preventive measures and interventions such as surveillance through mobile teams and laboratories to identify and respond rapidly to outbreaks. They identified mass gatherings as opportunities to reinforce multi-sectoral collaboration and strengthen their health systems.

Progress reports
Committee A welcomed and approved the following progress reports:

– Health system strengthening;

– WHO’s role and responsibilities in health research;

– Global strategy and plan of action on public health, innovation and intellectual property;

– Smallpox eradication: destruction of variola virus stocks;

– Eradication of dracunculiasis;

– Chagas disease: control and elimination;

– Viral hepatitis;

– Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis;

– Cholera: mechanisms for control and prevention;

– Control of human African trypanosomiasis;

– Global health sector strategy on HIV/AIDS, 2011–2015;

– Prevention and control of sexually transmitted infections: global strategy…

http://www.who.int/mediacentre/events/2012/wha65/journal/en/index.html

WHA65: Intensification of the global polio eradication initiative

Sixty-fifth World Health Assembly: daily notes on proceedings
– Notes: Friday, 25 May 2012

Intensification of the global polio eradication initiative
Committee A today approved a draft resolution (EB130.R10) which declares the completion of poliomyelitis eradication a programmatic emergency for global public health. India was once again congratulated for stopping indigenous wild poliovirus circulation. However, three countries still face endemic transmission of wild polio virus; unless poliovirus transmission is stopped in these countries, there will be a global resurgence of the disease with a real risk of severe outbreaks in areas that have long been polio-free. The approved resolution requires the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas infected with poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas infected with poliovirus.

Member States with poliovirus transmission are urged to declare such transmission to be a “national public health emergency”, requiring the development and full implementation of emergency action plans. Pakistan, Nigeria and Afghanistan have already established national emergency plans for polio eradication and shifted their national polio eradication initiatives to an emergency status, with an all-of-government and society approach to ensure all children are reached and vaccinated. During the discussion, partners reiterated their support to the polio eradication initiative and the importance of treating polio eradication as a programmatic emergency, and urged all partners to be fully committed in their action and their financing.

http://www.who.int/mediacentre/events/2012/wha65/journal/en/index1.html

 
SIXTY-FIFTH WORLD HEALTH ASSEMBLY (Draft) A65/55
26 May 2012
Third report of Committee A
(Draft)
Committee A held its eighth, ninth and tenth meetings on 25 May 2012. These meetings were held under the chairmanship of Mr Herbert Barnard (Netherlands) and Dr Zangley Dukpa (Bhutan).

It was decided to recommend to the Sixty-fifth World Health Agenda item 13.10
Poliomyelitis: intensification of the global eradication initiative
The Sixty-fifth World Health Assembly,
– Having considered the report on poliomyelitis: intensification of the global eradication initiative;

– Recalling resolution WHA61.1 on poliomyelitis: mechanism for management of potential risks to eradication, which, inter alia, requested the Director-General to develop a new strategy to reinvigorate the fight to eradicate poliovirus and to develop appropriate strategies for managing the long-term risks of reintroduction of poliovirus and re-emergence of poliomyelitis, including the eventual cessation of use of oral poliovirus vaccine in routine immunization programmes;

– Recognizing the need to make rapidly available the necessary financial resources to eradicate the remaining circulating polioviruses and to minimize the risks of reintroduction of poliovirus and reemergence of poliomyelitis after interruption of wild poliovirus transmission;

– Noting the finding by the Independent Monitoring Board of the Global Polio Eradication Initiative finding in its report of October 2011 that “polio simply will not be eradicated unless it receives a higher priority – in many of the polio-affected countries, and across the world”1 and its recommendation in its April 2011 report that the World Health Assembly “considers a resolution to declare the persistence of polio a global health emergency”;

– Noting the report of the meeting in November 2011 of the Strategic Advisory Group of Experts on immunization at which it stated “unequivocally that the risk of failure to finish global polio eradication constitutes a programmatic emergency of global proportions for public health and is not acceptable under any circumstances”;

– Recognizing the need for Member States to engage all levels of political and civil society so as to ensure that all children are vaccinated in order to eradicate poliomyelitis;

– Having noted the current high cost and limited supplies of inactivated polio vaccine that are hampering the introduction and scaling-up of inactivated polio vaccine, resulting in major programmatic and financial implications to developing countries;

– Noting that the technical feasibility of poliovirus eradication has been proved through the full application of new strategic approaches;

– Noting that continuing poliovirus transmission anywhere will continue to pose a risk to

poliomyelitis-free areas until such time as all poliovirus transmission is interrupted globally;

1. DECLARES the completion of poliovirus eradication a programmatic emergency for global public health, requiring the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas infected with poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas infected with poliovirus;1

2. URGES Member States with poliovirus transmission to declare such transmission to be a “national public health emergency” making poliovirus eradication a national priority programme, requiring the development and full implementation of emergency action plans, to be updated every six months, until such time as poliovirus transmission has been interrupted;

3. URGES all Member States:
(1) to eliminate the unimmunized areas and to maintain very high population immunity against polioviruses through routine immunization programmes and, where necessary, supplementary immunization activities;

(2) to maintain vigilance for poliovirus importations, and the emergence of circulating vaccine-derived polioviruses, by achieving and sustaining certification-standard surveillance and regular risk assessment for polioviruses;

(3) to make available urgently the financial resources required for the full and continued implementation, to the end of 2013, of the necessary strategic approaches to interrupt wild poliovirus transmission globally, and to initiate planning for the financing to the end of 2018 of the polio endgame strategy;

(4) to engage in multilateral and bilateral cooperation, including exchanging epidemiologic information, laboratory monitoring data, and carrying out supplementary immunization activities simultaneously as appropriate;

4. REQUESTS the Director-General:
(1) to plan for the renewed implementation through 2013 of the approaches for eradicating wild polioviruses outlined in the Global Polio Eradication Initiative Strategic Plan 2010–2012 and any new tactics that are deemed necessary to complete eradication, including the enhancement of the existing global polio eradication initiative within the Organization;

(2) to strengthen accountability and monitoring mechanisms to ensure optimal

implementation of eradication strategies at all levels;

(3) to undertake the development, scientific vetting, and rapid finalization of a

comprehensive polio eradication and endgame strategy and inform Member States of the potential timing of a switch from trivalent to bivalent oral poliovirus vaccine for all routine immunization programmes; and includes budget scenarios to the end of 2018 that include risk management;

(4) to coordinate with all relevant partners including vaccine manufacturers, to promote the research, production and supply of vaccines, in particular inactivated polio vaccines, to enhance their affordability, effectiveness and accessibility;

(5) to continue mobilizing and deploying the necessary financial and human resources for the strategic approaches required through 2013 for wild poliovirus eradication, and for the eventual implementation of a polio endgame strategy to the end of 2018;

(6) to report to the Sixty-sixth World Health Assembly and the subsequent two Health Assemblies, through the Executive Board, on progress in implementing this resolution.

1 International travel and health. Geneva, World Health Organization, 2012 edition.

Global Polio Eradication Initiative (GPEI) announces Emergency Action Plan (EAP

  The Global Polio Eradication Initiative (GPEI) announced the Emergency Action Plan (EAP) developed in coordination with new country national emergency plans.  The plan builds on India’s successes and outlines a range of new strategies and initiatives to better support eradication efforts, including:

– Intensified focus on worst-performing areas of Nigeria, Pakistan and Afghanistan to increase vaccination coverage by end of 2012 to levels needed to stop transmission;

– New approaches tailored to each country to tackle persistent challenges and improve polio vaccination campaign performance;

– Heightened accountability, coordination and oversight to ensure success at every level of government and within every partner agency and organization.

– Surge of technical assistance and social mobilization capacity.

GPEI noted that the EAP is currently hindered by a critical funding gap of nearly US$1 billion through 2013, with funding shortages already forcing the GPEI to cancel or scale-back critical vaccination activities in 24 high-risk countries.

Global Emergency Action Plan (EAP) 2012-2013

http://www.prnewswire.com/news-releases/polio-eradication-shifts-into-emergency-mode-153533405.html

65th World Health Assembly – Draft global vaccine action plan GVAP

65th World Health Assembly
Journal, Number 6
26 May 2012
pdf, 171kb

Fourth meeting of Committee B
Chairman: Dr Mohammad Hossein Nicknam (Islamic Republic of Iran)
Later: Dr Enrique Tayag (Philippines),Vice-Chairman

Item 13 (continued) Technical and health matters (Subitems transferred from Committee A)
Item 13.12 (continued) – Draft global vaccine action plan
The Chairman reopened the subitem. The Secretariat read the amendments to draft resolution entitled World Immunization Week. The Committee approved the resolution
contained in document EB130.R12 as amended. The Secretariat read the amendments to draft resolution entitled Global vaccine action plan. The Committee approved the resolution contained in document A65/22 as amended.

World Health Assembly Endorses New Plan to Increase Global Access to Vaccines (Decade of Vaccines Collaboration)

– The Measles & Rubella Initiative Welcomes World Health Assembly Commitment to Measles and Rubella Elimination Goal
http://www.unicef.org/media/media_62517.html

Statement of Support for New Global Vaccine Action Plan [Sabin Vaccine Institute]

Statement by Bill Gates on the Occasion of the World Health Assembly Resolutions Declaring Completion of Polio Eradication a Global Emergency and Endorsing the Global Vaccine Action Plan

Meningococcal disease: situation in the African Meningitis Belt – 24 May 2012

WHO – Meningococcal disease: situation in the African Meningitis Belt

24 May 2012

From 1 January to 17 April 2012 (epidemiologic week 17), outbreaks of meningococcal disease have been reported in 42 districts in 10 of the 14 countries of the African Meningitis Belt 1. These outbreaks have been detected as part of the enhanced surveillance.

The 10 countries (Benin, Burkina Faso, Chad, Central African Republic, Côte d’Ivoire, Gambia, Ghana, Mali, Nigeria and Sudan) reported a total of 11 647 meningitis cases including 960 deaths resulting in a case fatality ratio of 8.2%. The outbreaks were mainly caused by the W135 serogroup of Neisseria meningitidis (Nm) bacteria.

In response to the outbreaks, the Ministries of Health implemented a series of preventive and control measures which included enhancement of surveillance, case management, sensitization of the population, strengthening of cross border collaboration and provision of vaccines through the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG).

The ICG released a total of 11,000 vials of antibiotic (Ceftriaxone) and 1,665,673 doses of vaccines to six countries (see table below 2) most affected by the epidemic, upon requests. The vaccines released include 919,023 doses of polysaccharide ACW/ACYW vaccine, 746,650 doses of meningitis A conjugate vaccine and 81,418 doses of polysaccharide AC vaccine.

The ICG is working with manufacturers and partners to ensure the stockpiles of the appropriate vaccines are maintained in sufficient quantities, for responding effectively to epidemics in the future. ICG partners include WHO, International Federation of Red Cross and Red Crescent Societies (IFRC), United Nations Children Fund (UNICEF), and Médecins Sans Frontières (MSF).

The emergency stockpile was established with the support of Global Alliance for Vaccines and Immunization (GAVI). The vaccination campaigns were conducted with the support of MSF, UNICEF, IFRC, the European Community Humanitarian Aid Office (ECHO), and the United Nations through its Central Emergency Response Fund (CERF).

WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministries of Health in the affected countries.


1 The 14 countries in the African Meningitis Belt with enhanced surveillance for meningococcal disease include Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo.

http://www.who.int/csr/don/2012_05_24/en/index.html

Launch in Rwanda of Africa’s first national rotavirus vaccination program

Merck (MSD outside the United States and Canada) said it welcomed the launch in Rwanda of Africa’s first national rotavirus vaccination program with ROTATEQ (rotavirus vaccine, live, oral, pentavalent). Merck noted that the first infants will receive ROTATEQ at a health center in Musanze District, Northern Province, Rwanda. Following the initial launch, ROTATEQ will be routinely administered to all infants in Rwanda as part of its national vaccination program. During 2012, the Government of Rwanda Ministry of Health expects more than 100,000 children will receive the vaccine. Mark Feinberg, M.D., Ph.D., chief public health and science officer, Merck Vaccines, said, “We congratulate the Government of Rwanda for the launch of this important public health initiative and applaud its efforts to help protect Rwanda’s children against rotavirus-associated diarrhea through a comprehensive initiative including vaccination and other public health efforts. Rwanda is committed to the vaccination of their children and their accomplishments to date have been impressive. Given the impact of rotavirus gastroenteritis in children, working to help reduce severe rotavirus disease represents a critically important public health goal and we’re pleased to be able to work with the GAVI Alliance to make ROTATEQ available to Rwanda and other GAVI-eligible countries worldwide.”

http://www.businesswire.com/news/home/20120525005315/en/Government-Rwanda-Introduces-Mercks-ROTATEQ%C2%AE-Rotavirus-Vaccine

Study Designs for the Safety Evaluation of Different Childhood Immunization Schedules

Opportunity for Public Comment: Study Designs for the Safety Evaluation of Different Childhood Immunization Schedules

The Committee on Assessment of Studies of Health Outcomes Related to the Recommended Childhood Immunization Schedule has commissioned a paper from a consultant, Martin Kulldorff, Ph.D. We will be inviting comments and reactions to the paper to inform the committee discussion. The comment period will be open from May 14th until May 31st, 2012, and can be accessed on http://www.iom.edu/HealthOutcomesCommissionedPaper

Please note that any comments that you submit to the committee, including your name and identifying information, will not be kept confidential and will be included in a Public Access File in compliance with Section 15 of the Federal Advisory Committee Act (FACA). The National Academies shall be authorized to use any such comments or submissions in accordance with the National Academies’ Terms of Use Statement.

The responsibility for the content of the paper rests with the author and does not necessarily represent the views of the Institute of Medicine or its committees and convening bodies.

For more information, please visit the Committee on Assessment of Studies of Health Outcomes Related to the Recommended Childhood Immunization Schedule’s webpage: http://www.iom.edu/Activities/PublicHealth/ChildhoodImmunization.aspx

Editorial: Influenza vaccination in healthcare professionals

British Medical Journal
26 May 2012 (Vol 344, Issue 7858)
http://www.bmj.com/content/344/7858

Editorial
Influenza vaccination in healthcare professionals
BMJ 2012; 344 doi: 10.1136/bmj.e2217 (Published 28 March 2012)
Cite this as: BMJ 2012;344:e2217
Harish Nair, Alison Holmes, Igor Rudan, Josip Car

Extract
Should be mandatory

There is clear evidence that healthcare workers play an important role in transmitting infections to their patients.1 The World Health Organization and national immunisation guidelines in 60% of developed and emerging economies strongly recommend annual vaccination against seasonal influenza for all healthcare workers in acute and long term care facilities.2 However, unlike other prophylactic measures targeted at healthcare workers, such as hepatitis B vaccination, the uptake of flu vaccine has been generally poor. In the United States, two decades of consistent advocacy by the Centers for Disease Control and Prevention achieved a self reported vaccine coverage of only 64% among healthcare workers by 2010-1.3 In the United Kingdom, despite recommendations by the Department of Health, uptake of seasonal flu vaccine was a dismal 35% among frontline healthcare workers in the same year.4

Flu contributes greatly to global mortality and morbidity and has important economic consequences. Each year, seasonal flu affects 5-10% of the world’s population, causing 3-5 million severe infections and resulting in 250 000-500 000 deaths. Young children (especially those under 1 year); pregnant …

Viewpoint: Assessing Value in Health Care Programs

JAMA   
May 23, 2012, Vol 307, No. 20
http://jama.ama-assn.org/current.dtl

Viewpoint
Assessing Value in Health Care Programs
Kevin G. Volpp, MD, PhD; George Loewenstein, PhD; David A. Asch, MD, MBA
JAMA. 2012;307(20):2153-2154. doi:10.1001/jama.2012.3619

Many health care services provided in the United States are of low value, meaning that the cost of providing those services is high relative to the health care benefit they confer. In some cases, the care provided may have no value or even, on average, may be harmful. Examples of low- or negative-value services include unnecessary surgery or diagnostic imaging that will not change management. Given estimates that 30% of the $2.5 trillion the United States spends on health care services each year may provide little benefit,1 there is a widespread eagerness to enhance the ratio of benefits to costs.

Because value matters in health care, when new health care programs are proposed it has become common to ask, “What is the return on investment from implementing this new program?” Implicit in this question is that programs should be supported if they save money but not otherwise. Positive return on investment, meaning that more money is saved than is spent, has become the standard by which new initiatives are evaluated.      This standard has been used to evaluate new programs such as the primary care medical home, disease management, and the projects submitted for the new Center for Medicare & Medicaid Services Innovation Challenge.

Although asking about return on investment might seem to make sense given concerns about health care cost and value, asking about return on investment is the wrong question when assessing whether a health care program is successful. What would happen if the rule were applied to every health care decision that is made? Besides childhood vaccination and flu shots for the elderly, few health care services save money.2 The positive return-on-investment criterion is not applied to most health care services because almost nothing satisfies it. Medicare is prohibited by law from considering cost in coverage decisions, and other insurers tend to follow suit, even if the benefits are small and the costs very large. Would anyone ever ask, “What is the return on investment in treatment of this patient’s cancer?” This is not a meaningless question, but almost certainly one that most people would think inappropriate to ask.

Cost is important and should be considered in many more settings for both existing and new services. Clinicians and policy makers should not apply one standard when tacitly continuing the status quo and a different standard when evaluating innovative programs that might be implemented. It certainly does not make sense to use one criterion—Are there clinical benefits?—for coverage decisions for treatments and a different criterion—Are health care savings greater than program costs?—for preventive services or for delivery system innovations designed to improve health. Programs designed to improve health and prevent disease should be evaluated based on whether they improve health at a reasonable price, essentially comparing whether improvements in health are achieved for less resources than through alternatives, eg, expenditures on health care services.

Health care reimbursement tends to be disease fixated and should be evaluated the same way based on the value of expenditures in achieving improvements in health.3 If an employer spends $100 000 treating late-stage emphysema or lung cancer for its employees—an expenditure with a negative return on investment but one that adds value to employees’ lives—should that employer be willing to spend money on smoking cessation programs? The answer is almost undoubtedly yes. However, if health promotion programs or health system delivery innovations are required to save money, they will likely be labeled failures even if they improve health at a lower price than many of the services that we now willingly pay for under Medicare and private insurance. If we continue with the approach of insisting on a positive return on investment to fund such programs, low-value spending will persist at higher rates than would otherwise be the case.

For example, consider a program that would improve medication adherence after acute myocardial infarction (AMI). Adherence rates to β-blockers, statins, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers after an AMI event is poor; a recent large-scale study showed that even when copayments were lowered to $0 among insured patients, average adherence for these medications was only about 45%.4 If a new program could increase adherence to 70%, it is plausible that the program could significantly reduce the rate of hospital admissions for MI, stroke, and revascularization procedures. If the average cost of health events requiring hospitalization in the 12 months following a hospital admission for a new MI is about $20 000 and the new program reduced the rate of events requiring hospitalization by 10%, the new program could cost up to $2000 per year and still save money. Does that mean the program should not be adopted if it costs $3000? At that point, the calculated return on investment for the program is negative because it costs more than it saves.    But wouldn’t this program still be a much better use of money than letting those MIs occur (mortality rates from AMI are typically more than 10% among hospitalized patients in the 30 days after admission, and many patients die before making it to a hospital)? If this is deemed not a good use of resources, then why are so many other services covered that yield lower value?5 Many insurers, including Medicare, are continuing to cover bevacizumab for metastatic breast cancer, despite the unanimous recommendation by a US Food and Drug Administration panel that it not be covered because it is not helping patients to live longer, does not control their tumors, and exposes them to serious adverse effects6 and despite an average annual cost of $99 000.7

There are political, ethical, and emotional challenges to making explicit resource allocation issues in treating diseases and applying the same metrics used to evaluate the effectiveness of programs that prevent diseases in largely unidentified patients. It is always more difficult to shut down existing programs than to say no to new ones, a phenomenon related to inertia, also known as status quo bias.8 It is also more difficult to justify investments in prevention across broad populations than investments in the treatment of identifiable patients, a phenomenon known as the rule of rescue.9 Changing the criteria used to evaluate health system delivery innovations might help overcome these tendencies. Evaluating success using the same criteria—whether a preventive service, delivery system innovation, or treatment—may be the best way to ensure the maximal value in terms of improvements in health for the resources expended on health care services.

A recent conversation with a benefits manager from a medium-sized employer brought this point home. She reported that when asked by the chief financial officer, “What is the return on investment in putting in place this $125 000 wellness program?” she responded, “What is the return on investment on the $28 million we are spending on treating disease through our health benefits?” If cost is not considered when thinking about the value of covered treatments, it does not make sense to use positive return on investment as a criterion for determining whether promising new delivery system innovations should be covered. A better approach would be to adopt similar metrics for treatment and prevention for current and proposed care, for which the goal in all cases is achieving the most improvement possible with the resources available.

Rotavirus Vaccination, Postlicensure Safety Monitoring, Intussusception

Journal of Infectious Diseases
Volume 206 Issue 1 July 1, 2012
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Michelle Clarke and H. Marshall
Editor’s choice: Rotavirus Vaccination for Prevention of Serious Acute Gastroenteritis and the Importance of Postlicensure Safety Monitoring
J Infect Dis. (2012) 206(1): 3-5 doi:10.1093/infdis/jis318
(See the major article by Yen et al, on pages 41–8.)

Extract
With the ability to save millions of lives each year in both the developed and developing nations, vaccination against childhood infectious diseases is a priority area for global health. An essential aspect of the success of any vaccination program is the careful monitoring following implementation to ensure that the benefits of the program outweigh any risks to the recipients or the community. Infant rotavirus vaccination programs are an important example of the collaborative expertise required for effective and timely monitoring and reporting of any adverse events following implementation. Rotavirus vaccines have been instrumental in reducing morbidity from rotavirus infection. Prior to the introduction of rotavirus vaccine, it is estimated that >500 000 rotavirus-related child deaths occurred globally each year [1]. Studies assessing the impact of rotavirus vaccine on incidence of rotavirus hospitalizations have occurred in numerous countries, including Australia and the United States, with dramatic reductions in the incidence of rotavirus hospitalizations (up to 80% reduction) shown following implementation of the rotavirus vaccination programs and suggestions of herd immunity benefits for older, unvaccinated populations [2–6]. The development of vaccines to prevent serious infectious diseases has been a global triumph, but large-scale postlicensure studies are essential to ensure that vaccination programs deliver the anticipated benefits.

In response to the overwhelming global burden of rotavirus infections, particularly in children aged <5 years, a live, attenuated tetravalent rotavirus vaccine (RotaShield) was licensed for routine use in infants in 1998, before being withdrawn in 1999 due to concerns about an increased risk of intussusception in vaccine recipients …

Catherine Yen, Jacqueline E. Tate, Claudia A. Steiner, Margaret M. Cortese, Manish M. Patel, and Umesh D. Parashar
Editor’s choice: Trends in Intussusception Hospitalizations Among US Infants Before and After Implementation of the Rotavirus Vaccination Program, 2000–2009
J Infect Dis. (2012) 206(1): 41-48 doi:10.1093/infdis/jis314

Abstract
Background. Although US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate  a possible low risk, primarily after the first dose.

Methods. Among infants in 26 US states comprising 75% of the birth cohort, we examined age-specific trends in population-level intussusception hospitalization rates before (2000–2005) and after (2007–2009) rotavirus vaccine introduction.

Results. Compared with 2000–2005 (35.3 per 100 000), the rate was greater in 2007 (39.0 per 100 000; rate ratio [RR], 1.10; 95% confidence interval [CI], 1.04–1.18), similar in 2008 (33.4 per 100 000; RR, 0.95; 95% CI, .89–1.01), and lower in 2009 (32.9 per 100 000; RR, 0.93; 95% CI, .87–.99). Among infants aged 8–11 weeks, compared with 2000–2005 (6.9 per 100 000), a small, significant increase was observed in each of 2007 (11.4 per 100 000; RR, 1.64; 95% CI, 1.08–2.50), 2008 (12.2 per 100 000; RR, 1.76; 95% CI, 1.17–2.65), and 2009 (11.0 per 100 000; RR, 1.59; 95% CI, 1.04–2.44).

Conclusions. Following rotavirus vaccine introduction, a small increase in intussusception rates was seen among US infants aged 8–11 weeks, to whom most first doses of vaccine are given; no sustained population-level change in overall rates was observed.

Comment: The US Global Health Initiative

The Lancet  
May 26, 2012  Volume 379  Number 9830  p1923 – 2022  e53 – 54
http://www.thelancet.com/journals/lancet/issue/current

Comment
The US Global Health Initiative: where does it stand?
Jennifer Kates, Josh Michaud

Preview
In May, 2009, shortly after taking office, President Barack Obama announced the Global Health Initiative (GHI), which was to be a 6-year (2009–14), US$63 billion effort to refocus US global health activities by developing the first comprehensive US Government global health strategy.1 The GHI was conceived as a “whole of government approach”2 to act as an umbrella over existing US global health programmes—most notably, the President’s Emergency Plan for AIDS Relief. As President Obama said at the time, “We cannot simply confront individual preventable illnesses in isolation.

Editorial: The rise and fall of bioterrorism research

The Lancet Infectious Disease
Jun 2012  Volume 12  Number 6  p423 – 496
http://www.thelancet.com/journals/laninf/issue/current

Editorial
The rise and fall of bioterrorism research
The Lancet Infectious Diseases

In the months after the September 11, 2001, attacks in New York, USA, the world was on heightened awareness for terrorist attacks of all kind. The anthrax scares in the USA in the final months of that year led to a focus on bioterrorism. A decade ago this threat was viewed as one of the key areas for infectious disease research: the topic dominated the agendas at academic and clinical conferences at the time, and governments devised plans to address the threat of bioterrorism, often involving substantial investments in research. But a decade on, are we any more prepared for bioterrorist attacks, and what have we gained from the huge resources invested in the research?

Bioterrorism is defined by the US Centers for Diseases Control and Prevention as “the deliberate release of viruses, bacteria, toxins or other harmful agents used to cause illness or death in people, animals, or plants”; although this clearly leads to a murky distinction from biological warfare, and research into both goes hand in hand. Attempts in the early 20th century to weaponise biological agents quickly led to the realisation of the potency of such tactics as terrorist devices. And an arms race developed with governments simultaneously aiming to produce weapons with these agents and the countermeasures to use when faced with their deployment.

Despite a long history of research, the use of biological weapons in warfare and terrorism has been uncommon: the major downsides to their use are their lack of specificity and an inability to contain an infection within a target population. An infectious agent used against one group will almost inevitably infect unintended victims, even those who originally deployed the weapon.

However, in the late 20th century the face of terrorism changed, from one of targeted attacks to the use of indiscriminate tactics, in which the collateral damage of deaths on the aggressor’s side was accepted. In the late 1990s, the threat of bioterrorism was generating serious interest. The topic was a key theme at the 1998 International Conference on Emerging Infectious Diseases, at which experts warned that the growing interest in and proliferation of biological weapons was not being matched by investment in research to counter the effects of such attacks. But the watershed moment was the 9/11 attacks on New York.

The following year, the World Health Assembly agreed that a concerted effort to address bioterrorism was needed. One of their acts was to drop the 2002 deadline for the destruction of smallpox virus stocks. The USA established several initiatives to address potential bioterrorist threats. Among them, the National Institutes of Health launched the National Science Advisory Board for Biosecurity (NSABB) to monitor potential dual-use research and the Department of Defense launched the Transformational Medical Technologies Initiative (TMTI), a US$1·5 billion initiative to sequence the genomes of key microorganisms with bioterrorism potential and to develop one-size-fits-all measures against them.

For all the international concern and efforts to prepare, there has been no major bioterrorist attack. The TMTI has introduced no new antibiotics into clinical trials, the three drugs that have entered clinical trials are for single pathogens rather than providing multifaceted solutions, and now many of its projects have been redistributed to other defence departments. The NSABB has assessed just six papers. Furthermore, bioterrorism has dropped off the programmes of scientific conferences.

Nonetheless, the fear is still present, even if the threat has not materialised. In this month’s Newsdesk, Kathryn Senior discusses two recent bioterrorism scares involving Bacillus anthracis spores, and the case of research in which investigators generated strains of H5N1 transmissible between mammals spawned much debate about dual-use research—as well as providing the NSABB with two of the six papers.

Groups that would willingly instigate a major bioterrorism attack undoubtedly exist. The consequences of widespread dissemination of anthrax spores or a haemorrhagic fever virus such as Ebola, or release of an engineered highly infective and highly pathogenic influenza are almost too dire to contemplate. However, bioterrorism research is perhaps a diversion—resources invested in combating bioterrorist threats would be well invested in research into the real and present damage of these pathogens in nature. Such research need not be viewed as a separate effort, but a much needed integrated effort in biodefence, since undoubtedly it would provide vital information, vaccines, and drugs for the fight against bioterrorism as well as combating natural infections.

Correspondence: Poliovirus eradication

The Lancet Infectious Disease
Jun 2012  Volume 12  Number 6  p423 – 496
http://www.thelancet.com/journals/laninf/issue/current

Correspondence
Poliovirus eradication
Carlos Franco-Paredes
Preview |
Your Editorial in the October, 2011, issue covers the theme of polio eradication. Everyone that has a scientific or humanitarian interest in achieving the noble task of eliminating poliomyelitis remains confident that it is an attainable public-health goal in the near future. There is also an agreement that eradication should be a global effort that requires increased financial and political support. However, polio eradication efforts may be at risk of losing political and financial momentum in view of the persistent failures of the Global Polio Eradication Initiative (GPEI) and its inability to consistently reach target dates.

Poliovirus eradication
Masahiko Hachiya, Shinsaku Sakurada, Tomomi Mizuno, Yasuo Sugiura
Preview |
The Editorial,1 in the October, 2011, issue of The Lancet Infectious Diseases discusses innovations for polio eradication. We agree that social factors are one of the most important barriers to a polio eradication initiative. The essential problem is that the Global Polio Eradication Initiative (GPEI) is not consistent with current local priorities. Moreover, the Ministry of Health in Pakistan was devolved, and the relevant federal programme disappeared in June, 2011. Therefore, local governments take more responsibility for immunisation programmes than before.

Ethical dimensions of vaccines against substance abuse

Nature Immunology
June 2012 – Vol 13 No 6
http://www.nature.com/ni/journal/v13/n6/index.html

Commentary
Immune to addiction: the ethical dimensions of vaccines against substance abuse – pp521 – 524
Michael J Young, Dominic A Sisti, Hila Rimon-Greenspan, Jason L Schwartz & Arthur L Caplan
doi:10.1038/ni.2321

Abstract
Promising advances have been made in recent years for a unique class of immunotherapies that use vaccination to combat substance-use disorders. Although such vaccines are potentially useful for addictions, they raise a variety of ethical and social questions.

Rationing, Fruglaity, Ethics

New England Journal of Medicine
May 24, 2012  Vol. 366 No. 21
http://content.nejm.org/current.shtml

Perspective
From an Ethics of Rationing to an Ethics of Waste Avoidance
H. Brody
Extract [Free full text]
Bioethics has long approached cost containment under the heading of “allocation of scarce resources.” Having thus named the nail, bioethics has whacked away at it with the theoretical hammer of distributive justice. But in the United States, ethical debate is now shifting from rationing to the avoidance of waste. This little-noticed shift has important policy implications…

Beyond the “R Word”? Medicine’s New Frugality
M.G. Bloche
Extract [Free full text]
Quietly, Washington policymakers have begun to concede the need to weigh health care’s benefits against its costs if our country is to avert fiscal ruin. That costs must be counted against benefits is common sense in other domains — and among health policy professionals. But it’s anathema in public discussion of medical care. To silence talk of tradeoffs, politicians invoke the “R word” — rationing…