BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 29 October 2016)
Editorial
Medicine and the future of health: reflecting on the past to forge ahead
Dale Fisher, Paul Wicks and Zaheer-Ud-Din Babar
BMC Medicine 2016 14:169
Published on: 25 October 2016
Abstract
The development of new therapies has a rich history, evolves quickly with societal trends, and will have an exciting future. The last century has seen an exponential increase in complex interactions between medical practitioners, pharmaceutical companies, governments and patients. We believe technology and societal expectations will open up the opportunity for more individuals to participate as information becomes more freely available and inequality less acceptable. Corporations must recognize that usual market forces do not function ideally in a setting where health is regarded as a human right, and as modern consumers, patients will increasingly take control of their own data, wellbeing, and even the means of production for developing their own treatments. Ethics and legislation will increasingly impact the processes that facilitate drug development, distribution and administration. This article collection is a cross-journal collaboration, between the Journal of Pharmaceutical Policy and Practice (JoPPP) and BMC Medicine that seeks to cover recent advances in drug development, medicines use, policy and access with high clinical and public health relevance in the future.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 29 October 2016]

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Research
Civil society participation in the health system: the case of Brazil’s Health Councils
Martha Gabriela Martinez and Jillian Clare Kohler
Globalization and Health 2016 12:64
Published on: 26 October 2016
Abstract
Background
Brazil created Health Councils to bring together civil society groups, heath professionals, and government officials in the discussion of health policies and health system resource allocation. However, several studies have concluded that Health Councils are not very influential on healthcare policy. This study probes this issue further by providing a descriptive account of some of the challenges civil society face within Brazil’s Health Councils.
Methods
Forty semi-structured interviews with Health Council Members at the municipal, state and national levels were conducted in June and July of 2013 and May of 2014. The geographical location of the interviewees covered all five regions of Brazil (North, Northeast, Midwest, Southeast, South) for a total of 5 different municipal Health Councils, 8 different state Health Councils, and the national Health Council in Brasilia. Interview data was analyzed using a thematic approach.
Results
Health Councils are limited by a lack of legal authority, which limits their ability to hold the government accountable for its health service performance, and thus hinders their ability to fulfill their mandate. Equally important, their membership guidelines create a limited level of inclusivity that seems to benefit only well-organized civil society groups. There is a reported lack of support and recognition from the relevant government that negatively affects the degree to which Health Council deliberations are implemented. Other deficiencies include an insufficient amount of resources for Health Council operations, and a lack of training for Health Council members. Lastly, strong individual interests among Health Council members tend to influence how members participate in Health Council discussions.
Conclusions
Brazil’s Health Councils fall short in providing an effective forum through which civil society can actively participate in health policy and resource allocation decision-making processes. Restrictive membership guidelines, a lack of autonomy from the government, vulnerability to government manipulation, a lack of support and recognition from the government and insufficient training and operational budgets have made Health Council largely a forum for consultation. Our conclusions highlight, that among other issues, Health Councils need to have the legal authority to act independently to promote government accountability, membership guidelines need to be revised in order include members of marginalized groups, and better training of civil society representatives is required to help them make more informed decisions.

JAMA
October 25, 2016, Vol 316, No. 16, Pages 1615-1726
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Systems Strategies for Health Throughout the Life Course
J. Michael McGinnis, MD, MA, MPP; Angela Diaz, MD, MPH; Neal Halfon, MD, MPH
JAMA. 2016;316(16):1639-1640. doi:10.1001/jama.2016.14896
This Viewpoint from the National Academy of Medicine’s 2016 Vital Directions initiative discusses strategies to improve the health of populations at each stage of life through incentivizing and measuring health system performance to improve health, creating an interoperable digital health platform, and fostering a culture and practice of continuous health improvement.

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Viewpoint
Addressing Social Determinants of Health and Health Inequalities
Nancy E. Adler, PhD; M. Maria Glymour, ScD, MS; Jonathan Fielding, MD, MPH
JAMA. 2016;316(16):1641-1642. doi:10.1001/jama.2016.14058
This Viewpoint from the National Academy of Medicine’s 2016 Vital Directions initiative emphasizes the importance of refocusing some health policies toward addressing social and behavioral determinants of health and the potential effects of reducing health inequalities and improving the health and longevity of all people in the United States.

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Viewpoint
Preparing for Better Health and Health Care for an Aging Population
John W. Rowe, MD; Terry Fulmer, PhD, RN; Linda Fried, MD
JAMA. 2016;316(16):1643-1644. doi:10.1001/jama.2016.12335
This Viewpoint from the National Academy of Medicine’s 2016 Vital Directions initiative recommends ways to improve the health and health care of older persons, including development of new care delivery models for people with chronic conditions and strengthening of the elder care workforce.

The Lancet
Oct 29, 2016 Volume 388 Number 10056 p2057-2208
http://www.thelancet.com/journals/lancet/issue/current

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Special Report
WHO’s Director-General candidates: visions and priorities
Richard Horton, Udani Samarasekera
A new Director-General of WHO will be selected in May, 2017. Richard Horton and Udani Samarasekera asked the six candidates competing for the position about their candidacy.
The forthcoming election of the next Director-General of WHO comes at a critical moment not only for the world’s only multilateral health agency but also for the precarious trajectory of global health itself. WHO is often criticised for failing to live up to the expectations of the health community. Sometimes, as in the case of how the agency managed the early stages of the Ebola virus outbreak, that criticism is justified. But WHO plays a vital and successful, and frequently neglected, part in setting norms and standards for health in countries. It has a powerful convening role. And, should a Director-General choose to do so, the agency has unprecedented authority to offer leadership in health.

As the world enters a new era—that of the Sustainable Development Goals—the Director-General has an essential voice in shaping the meaning of health in an era of human dislocation, pervasive inequality, mass migration, ecological degradation, climate change, war, and humanitarian crisis. Six excellent candidates for Director-General are standing. All have wide experience in health, as one would expect, but each offers a very different platform. Some candidates have formidable international experience in global health. Others have forged their reputations nationally. Some have strong technical credentials. Others offer political skills. Some come from countries that should be WHO’s greatest concern. Others are from nations that are traditionally seen as donors. Some have expertise in what might be considered the traditional agenda of global health (infectious diseases and women’s and children’s health). Others bring experience of newer concerns. This great diversity of candidates is a strength. It allows the Executive Board of WHO in January, 2017, and then the World Health Assembly in May, to select a candidate based on a clear diagnosis of the global predicament for health and the solutions needed. To help clarify their experience, visions, and ideas, we invited each candidate to offer a brief manifesto and to answer a series of ten questions to illuminate their positions on what we see as some priorities for the organisation…

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Series
Maternal Health
Diversity and divergence: the dynamic burden of poor maternal health
Wendy Graham, Susannah Woodd, Peter Byass, Veronique Filippi, Giorgia Gon, Sandra Virgo, Doris Chou, Sennen Hounton, Rafael Lozano, Robert Pattinson, Susheela Singh
2164
PDF

Maternal Health
Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide
Suellen Miller, Edgardo Abalos, Monica Chamillard, Agustin Ciapponi, Daniela Colaci, Daniel Comandé, Virginia Diaz, Stacie Geller, Claudia Hanson, Ana Langer, Victoria Manuelli, Kathryn Millar, Imran Morhason-Bello, Cynthia Pileggi Castro, Vicky Nogueira Pileggi, Nuriya Robinson, Michelle Skaer, João Paulo Souza, Joshua P Vogel, Fernando Althabe

Maternal Health
The scale, scope, coverage, and capability of childbirth care
Oona M R Campbell, Clara Calvert, Adrienne Testa, Matthew Strehlow, Lenka Benova, Emily Keyes, France Donnay, David Macleod, Sabine Gabrysch, Luo Rong, Carine Ronsmans, Salim Sadruddin, Marge Koblinsky, Patricia Bailey

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 29 October 2016]

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Quality of Life of Persons Injured on 9/11: Qualitative Analysis from the World Trade Center Health Registry
October 27, 2016 · Research Article
Introduction: A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors.
Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis.
Results: Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life.
Discussion: This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.

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Developing the Philippines as a Global Hub for Disaster Risk Reduction – A Health Research Initiative as Presented at the 10th Philippine National Health Research System Week Celebration
October 25, 2016 · Discussion
The recent Philippine National Health Research System (PNHRS) Week Celebration highlighted the growing commitment to Disaster Risk Reduction (DRR) in the Philippines. The event was lead by the Philippine Council for Health Research and Development of the Department of Science and Technology and the Department of Health, and saw the participation of national and international experts in DRR, and numerous research consortia from all over the Philippines. With a central focus on the Sendai Framework for Disaster Risk Reduction, the DRR related events recognised the significant disaster risks faced in the Philippines. They also illustrated the Philippine strengths and experience in DRR. Key innovations in science and technology showcased at the conference include the web-base hazard mapping applications ‘Project NOAH’ and ‘FaultFinder’. Other notable innovations include ‘Surveillance in Post Extreme Emergencies and Disasters’ (SPEED) which monitors potential outbreaks through a syndromic reporting system. Three areas noted for further development in DRR science and technology included: integrated national hazard assessment, strengthened collaboration, and improved documentation. Finally, the event saw the proposal to develop the Philippines into a global hub for DRR. The combination of the risk profile of the Philippines, established national structures and experience in DRR, as well as scientific and technological innovation in this field are potential factors that could position the Philippines as a future global leader in DRR. The purpose of this article is to formally document the key messages of the DRR-related events of the PNHRS Week Celebration.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 29 October 2016)
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Research Article
The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling
Rein M. G. J. Houben, Peter J. Dodd
| published 25 Oct 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002152
Abstract
Background
The existing estimate of the global burden of latent TB infection (LTBI) as “one-third” of the world population is nearly 20 y old. Given the importance of controlling LTBI as part of the End TB Strategy for eliminating TB by 2050, changes in demography and scientific understanding, and progress in TB control, it is important to re-assess the global burden of LTBI.
Methods and Findings
We constructed trends in annual risk in infection (ARI) for countries between 1934 and 2014 using a combination of direct estimates of ARI from LTBI surveys (131 surveys from 1950 to 2011) and indirect estimates of ARI calculated from World Health Organisation (WHO) estimates of smear positive TB prevalence from 1990 to 2014. Gaussian process regression was used to generate ARIs for country-years without data and to represent uncertainty. Estimated ARI time-series were applied to the demography in each country to calculate the number and proportions of individuals infected, recently infected (infected within 2 y), and recently infected with isoniazid (INH)-resistant strains. Resulting estimates were aggregated by WHO region. We estimated the contribution of existing infections to TB incidence in 2035 and 2050.
In 2014, the global burden of LTBI was 23.0% (95% uncertainty interval [UI]: 20.4%–26.4%), amounting to approximately 1.7 billion people. WHO South-East Asia, Western-Pacific, and Africa regions had the highest prevalence and accounted for around 80% of those with LTBI. Prevalence of recent infection was 0.8% (95% UI: 0.7%–0.9%) of the global population, amounting to 55.5 (95% UI: 48.2–63.8) million individuals currently at high risk of TB disease, of which 10.9% (95% UI:10.2%–11.8%) was isoniazid-resistant. Current LTBI alone, assuming no additional infections from 2015 onwards, would be expected to generate TB incidences in the region of 16.5 per 100,000 per year in 2035 and 8.3 per 100,000 per year in 2050.
Limitations included the quantity and methodological heterogeneity of direct ARI data, and limited evidence to inform on potential clearance of LTBI.
Conclusions
We estimate that approximately 1.7 billion individuals were latently infected with Mycobacterium tuberculosis (M.tb) globally in 2014, just under a quarter of the global population. Investment in new tools to improve diagnosis and treatment of those with LTBI at risk of progressing to disease is urgently needed to address this latent reservoir if the 2050 target of eliminating TB is to be reached.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 29 October 2016)

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Perspective
Texas and Its Measles Epidemics
Peter J. Hotez
| published 25 Oct 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002153
Globally, the situation was even worse. Measles was one of the leading killers of children, causing millions of deaths annually. Building on the successes of the World Health Organization (WHO)’s smallpox eradication campaign, in 1974, the Expanded Program on Immunization (EPI) was launched, followed by Gavi, The Vaccine Alliance in 2000. Global measles death rates began to decline precipitously. According to the Global Burden of Disease Study 2013, measles deaths decreased 83%, from 544,500 measles deaths in 1990 to 95,600 deaths in 2013 [3]. In the US, measles deaths disappeared [2].

Could large-scale measles outbreaks and deaths return to the US? The measles virus is one of the most highly transmissible human infectious disease agents known, with a basic reproduction number (R0) of 12–18 [4]. This number means that a single primary case in a susceptible population would generate on average 12–18 new cases [4]. Because R0 is so high for measles, vaccine coverage among a population needs to be extremely high, typically exceeding 90%–95%, in order to prevent a measles outbreak in a school or similar setting [4]. However, the latest numbers from Texas indicate a serious downward trend in vaccine coverage to the point where there is a high risk that measles outbreaks will return.

According to the Texas Department of State Health Services, there are now almost 45,000 children with nonmedical or “reasons of conscience” exemptions to school immunization laws, almost double the number of exemptions in 2010 [5,6] and a 19-fold increase compared to 2003 (Fig 2) [7].

Measles vaccination coverage in certain Texas counties is dangerously close to dropping below the 95% coverage rate necessary to ensure herd immunity and prevent measles outbreaks. For instance, in Gaines County in West Texas, the percentage of exemptions is now 4.83%, while in Briscoe County in the Texas Panhandle, the percentage is 3.55% (Table 1) [5]. In the very large Austin Independent School District (Travis County), the exemption rate is at 2.02% [5]. Especially troubling are many of the private schools, mostly in Travis County—the Austin, Texas area—where exemption rates often exceed 20%, including more than 40% of the Austin Waldorf School [6]. The rising numbers of nonmedical immunization exemptions across the state in combination with pockets of very low coverage in vulnerable populations is extremely troubling.

Although a detailed analysis has not been conducted on the sociology behind the alarming increase in vaccine exemptions in Travis County and elsewhere, a rapidly growing “anti-vaxxer” movement in the state appears to be contributing to the increase in vaccine exemptions. At its epicenter is the Austin-based “Texans for Vaccine Choice,” an organization that describes itself as “a political action committee [PAC] dedicated to protecting vaccine choice rights by ensuring the issue remains at the forefront of political discourse, promoting incumbents and candidates who strongly support our values, and drafting legislation to further solidify these rights” [8]. Their website is set up to take parents step-by-step through the exemption process [9]. Dr. Andrew Wakefield, whose outspoken views and writings alleging links between autism and the measles-mumps-rubella (MMR) vaccine have been refuted by the scientific community [10,11], also now resides in Austin, according to The New York Times [12]. Both Texans for Vaccine Choice and Wakefield are heavily promoting the 2016 documentary “Vaxxed: From Cover-Up to Catastrophe,” which was directed by Wakefield and alleges links between vaccination and autism and a cover-up by the US Centers for Disease Control and Prevention (CDC) [13].

In 2015, a study in The Journal of the American Medical Association (JAMA) of a large sample of privately insured children, comprising more than 95,000 children with older siblings—including 994 (1%) diagnosed with autism spectrum disorder (ASD) and 1,929 (2%) with older siblings with ASD—found “no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD” [14]. Similarly, in that same year, a large case-control study in Japan investigating the relationship between the risk of ASD onset and early exposure to MMR or thimerosal (a mercury-based preservative used in vaccines) also found no link [15], while a 2014 evidence-based meta-analysis of five cohort cases including more than 1.2 million children and five case-control studies including 9,920 children similarly found no relationship between vaccination and autism, nor any relationship between autism and MMR, thimerosal, or mercury [16].

As both a Texas-based research scientist developing vaccines to prevent poverty-related neglected diseases [17] and as a father of an adult child with autism [18], I am also intrigued by data indicating that the neurobiological changes in children with ASD begin early in pregnancy, well before vaccinations are given [19].

Despite the evidence base refuting links between vaccines and autism, as well as a lack of plausibility for such links, the numbers of vaccine exemptions for reasons of conscience continue to increase. We’re at the point at which I believe we might soon see a return of measles outbreaks, possibly far larger than the one that affected a megachurch in Tarrant County, Texas in 2013 [20]. Given that measles peaks in late winter or early spring [1], I predict measles outbreaks in Texas could happen as early as the winter or spring of 2018.

Sadly, the Texas anti-vaxxer movement has become conflated with fringe political elements to create a dangerous and toxic mix of pseudoscience and conspiracy theories. This is now manifesting as a powerful yet misleading, propaganda-filled film documentary, together with an emboldened PAC designed to influence the Texas State Legislature towards anti-vaccine platforms. I worry that, as the most second-most populated state in the US, Texas is seen as a battleground for the anti-vaxxer movement.

But future measles outbreaks in Texas and possible measles deaths are not inevitable. In California, faced with measles outbreaks in Marin and Orange counties, the State Legislature made the bold move of closing loopholes that allow for nonmedical exemptions to vaccines [21]. This measure could prove to be lifesaving in the coming years. We now need to enact something similar for the children of Texas in order to prevent imminent deaths from measles and other vaccine-preventable childhood diseases.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
[Accessed 29 October 2016]

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Review
Diagnostics in Ebola Virus Disease in Resource-Rich and Resource-Limited Settings
Robert J Shorten, Colin S Brown, Michael Jacobs, Simon Rattenbury, Andrew J. Simpson, Stephen Mepham
| published 27 Oct 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004948

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Editorial
Blue Marble Health and the Global Burden of Disease Study 2013
Peter J Hotez, Ashish Damania, Mohsen Naghavi
| published 27 Oct 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004744

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Research Article
Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs
Arianna Rubin Means, Julie Jacobson, Aryc W. Mosher, Judd L. Walson
| published 24 Oct 2016 PLOS Neglected Tropical Diseases

PLoS One
http://www.plosone.org/
[Accessed 29 October 2016]

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Research Article
Preparation and Response to the 2014 Ebola Virus Disease Epidemic in Nigeria—The Experience of a Tertiary Hospital in Nigeria
Dimie Ogoina, Abisoye Sunday Oyeyemi, Okubusa Ayah, Austin Onabor A, Adugo Midia, Wisdom Tudou Olomo, Onyaye E. Kunle-Olowu
| published 27 Oct 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0165271

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Research Article
Prevalence and Diagnosis of Latent Tuberculosis Infection in Young Children in the Absence of a Gold Standard
Tomas Maria Perez-Porcuna, Hélio Doyle Pereira-da-Silva, Carlos Ascaso, Adriana Malheiro, Samira Bührer, Flor Martinez-Espinosa, Rosa Abellana
| published 26 Oct 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0164181

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Research Article
The Impact of Internal Migration on under-Five Mortality in 27 Sub-Saharan African Countries
Abukari I. Issaka, Kingsley E. Agho, Andre M. N. Renzaho
| published 26 Oct 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0163179
Abstract
Objective
The literature on the impact of internal migration on under-five mortality in sub-Saharan Africa has been limited. This study examined the impact of internal migration on under-five mortality rate in 27 sub-Saharan African countries.
Design
The analysis used cross-sectional data from the most recent Demographic and Health Surveys of 27 sub-Saharan African countries. Information on the number of live births and the number of under-five deaths in the five years preceding the surveys in these countries was examined. Using variables from which migration data were generated, four migration statuses were computed, and the impact of each migration status on under-five mortality was analysed by using multivariate Cox proportional hazards regression models.
Results
Of the 96333 live births, 7036 deaths were reported. Adjusting for internal migration status revealed a 20% increase in under-five mortality rate among urban-rural migrant mothers [HR = 1.20; 95% confidence interval (CI): (1.06–1.35)], a 40% increase in under-five mortality rates among rural non-migrant mothers, [HR = 1.40; 95% CI: (1.29–1.53)] and a 43% increase in under-five deaths among rural-urban migrant mothers [HR = 1.43; 95% CI: (1.30–1.58)]. Whilst under-five mortality rate did not change considerably when we adjusted for country and demographic variables, there were significant decreases among rural non-migrant and rural-urban migrant mothers when health care service utilization factors were adjusted for [HR = 1.20; 95% CI: (1.07–1.33) and [HR = 1.29; 95% CI: (1.14–1.45)]. The decreased risk of under-five deaths was not significant among rural non-migrant and rural-urban migrant mothers when socio-economic factors were adjusted for. Other factors for which there were significant risks of under-five deaths included household poverty, lack of health care services
Conclusion
Although under-five child mortality rate declined by 52% between 1990 and 2015 (from 179 to 86 per1000 live births) in sub-Saharan Africa, the continent still has the highest rate in the world. This finding highlights the need to consider providing education and health care services in rural areas, when implementing interventions meant to reduce under-five mortality rates among internal migrant mothers.

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169
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Original Research Article
Financing the HIV response in sub-Saharan Africa from domestic sources: Moving beyond a normative approach
Pages 66-76
Michelle Remme, Mariana Siapka, Olivier Sterck, Mthuli Ncube, Charlotte Watts, Anna Vassall
Abstract
Despite optimism about the end of AIDS, the HIV response requires sustained financing into the future. Given flat-lining international aid, countries’ willingness and ability to shoulder this responsibility will be central to access to HIV care. This paper examines the potential to expand public HIV financing, and the extent to which governments have been utilising these options.
We develop and compare a normative and empirical approach. First, with data from the 14 most HIV-affected countries in sub-Saharan Africa, we estimate the potential increase in public HIV financing from economic growth, increased general revenue generation, greater health and HIV prioritisation, as well as from more unconventional and innovative sources, including borrowing, health-earmarked resources, efficiency gains, and complementary non-HIV investments. We then adopt a novel empirical approach to explore which options are most likely to translate into tangible public financing, based on cross-sectional econometric analyses of 92 low and middle-income country governments’ most recent HIV expenditure between 2008 and 2012.
If all fiscal sources were simultaneously leveraged in the next five years, public HIV spending in these 14 countries could increase from US$3.04 to US$10.84 billion per year. This could cover resource requirements in South Africa, Botswana, Namibia, Kenya, Nigeria, Ethiopia, and Swaziland, but not even half the requirements in the remaining countries. Our empirical results suggest that, in reality, even less fiscal space could be created (a reduction by over half) and only from more conventional sources. International financing may also crowd in public financing.
Most HIV-affected lower-income countries in sub-Saharan Africa will not be able to generate sufficient public resources for HIV in the medium-term, even if they take very bold measures. Considerable international financing will be required for years to come. HIV funders will need to engage with broader health and development financing to improve government revenue-raising and efficiencies.

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169
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Review Article
Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women’s perceptions and experiences
Pages 157-170
Susan Bradley, Christine McCourt, Juliet Rayment, Divya Parmar
Abstract
The psycho-social elements of labour and delivery are central to any woman’s birth experience, but international efforts to reduce maternal mortality in low-income contexts have neglected these aspects and focused on technological birth. In many contexts, maternity care is seen as dehumanised and disrespectful, which can have a negative impact on utilisation of services. We undertook a systematic review and meta-synthesis of the growing literature on women’s experiences of facility-based delivery in sub-Saharan Africa to examine the drivers of disrespectful intrapartum care. Using PRISMA guidelines, databases were searched from 1990 to 06 May 2015, and 25 original studies were included for thematic synthesis. Analytical themes, that were theoretically informed and cognisant of the cultural and social context in which the dynamics of disrespectful care occur, enabled a fresh interpretation of the factors driving midwives’ behaviour. A conceptual framework was developed to show how macro-, meso- and micro-level drivers of disrespectful care interact. The synthesis revealed a prevailing model of maternity care that is institution-centred, rather than woman-centred. Women’s experiences illuminate midwives’ efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge.
Midwives and women are caught between medical and social models of birth. Global policies encouraging facility-based delivery are forcing women to swap the psycho-emotional care they would receive from traditional midwives for the technical care that professional midwives are currently offering. Any action to change the current performance and dynamic of birth relies on the participation of midwives, but their voices are largely missing from the discourse. Future research should explore their perceptions of the value and practice of interpersonal aspects of maternity care and the impact of disrespectful care on their sense of professionalism and personal ethics

Social Science & Medicine
Volume 169, Pages 1-202 (November 2016)
http://www.sciencedirect.com/science/journal/02779536/169

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Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world
Review Article
Pages 119-131
Pierre Pratley
Abstract
Research on the association between women’s empowerment and maternal and child health has rapidly expanded. However, questions concerning the measurement and aggregation of quantitative indicators of women’s empowerment and their associations with measures of maternal and child health status and healthcare utilization remain unanswered. Major challenges include complexity in measuring progress in several dimensions and the situational, context dependent nature of the empowerment process as it relates to improvements in maternal and child health status and maternal care seeking behaviors. This systematic literature review summarizes recent evidence from the developing world regarding the role women’s empowerment plays as a social determinant of maternal and child health outcomes. A search of quantitative evidence previously reported in the economic, socio-demographic and public health literature finds 67 eligible studies that report on direct indicators of women’s empowerment and their association with indicators capturing maternal and child health outcomes. Statistically significant associations were found between women’s empowerment and maternal and child health outcomes such as antenatal care, skilled attendance at birth, contraceptive use, child mortality, full vaccination, nutritional status and exposure to violence. Although associations differ in magnitude and direction, the studies reviewed generally support the hypothesis that women’s empowerment is significantly and positively associated with maternal and child health outcomes. While major challenges remain regarding comparability between studies and lack of direct indicators in key dimensions of empowerment, these results suggest that policy makers and practitioners must consider women’s empowerment as a viable strategy to improve maternal and child health, but also as a merit in itself. Recommendations include collection of indicators on psychological, legal and political dimensions of women’s empowerment and development of a comprehensive conceptual framework that can guide research and policy making.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
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Short Communications
The role of healthcare provider attitudes in increasing willingness to accept seasonal influenza vaccine policy changes
Pages 5704-5707
Jason M. Slaunwhite, Steven M. Smith, Beth A. Halperin, Joanne M. Langley, Scott A. Halperin
Abstract
Background
This research explored the role of attitudes in acceptance of organizational change initiatives.
Methods
A survey assessed factors associated with health care provider (HCP) likelihood to accept seasonal influenza vaccine policy changes. We evaluated the impact of knowledge and individual attitudes on this outcome measure.
Results
Knowledge of seasonal influenza vaccine and influenza recommendations was a significant predictor of HCP’s attitudes toward vaccine at the individual (p < 0.001), organizational (p < 0.05), and legislative level (p < 0.05). Mixed results were obtained when investigating the impact of knowledge on actual willingness to accept vaccine, suggesting that knowledge was only a significant predictor at the organizational (p < 0.05) and legislative levels (p < 0.05). Attitudes fully mediated the impact of knowledge at both the organizational and legislative levels.
Interpretation
Knowledge of seasonal influenza and vaccine recommendations is an important, but insufficient predictor of willingness to accept policy change.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
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Review
Impact of pharmacists as immunizers on vaccination rates: A systematic review and meta-analysis
Review Article
Pages 5708-5723
J.E. Isenor, N.T. Edwards, T.A. Alia, K.L. Slayter, D.M. MacDougall, S.A. McNeil, S.K. Bowles
Abstract
Background
Underutilization of vaccination programs remains a significant public health concern. Pharmacists serve as educators, facilitators, and in some jurisdictions, as administrators of vaccines. Though pharmacists have been involved with immunizations in various ways for many years, there has yet to be a systematic review assessing the impact of pharmacists as immunizers in these three roles.
Objective
To complete a systematic review of the literature on the impact of pharmacists as educators, facilitators, and administrators of vaccines on immunization rates.
Methods
We identified 2825 articles searching the following databases from inception until October 2015: PubMed, EMBASE, Cochrane Libraries, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Google Scholar. Grey literature was identified through use of the Canadian Agency for Drugs and Technology in Health “Grey Matters” search tool. Content from relevant journals and references of included studies were also searched. Inclusion criteria were clinical or epidemiologic studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms.
Results
Thirty-six studies were included in the review, 22 assessed the role of pharmacists as educators and/or facilitators and 14 assessed their role as administrators of vaccines. All studies reviewed found an increase in vaccine coverage when pharmacists were involved in the immunization process, regardless of role (educator, facilitator, administrator) or vaccine administered (e.g., influenza, pneumococcal), when compared to vaccine provision by traditional providers without pharmacist involvement. Limitations of the results include the large number of non-randomized trials and the heterogeneity between study designs.
Conclusions
Pharmacist involvement in immunization, whether as educators, facilitators, or administrators of vaccines, resulted in increased uptake of immunizations.
PROSPERO Registration: CRD42013005067.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
.
Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis
Original Research Article
Pages 5724-5735
Juan Yang, Katherine E. Atkins, Luzhao Feng, Mingfan Pang, Yaming Zheng, Xinxin Liu, Benjamin J. Cowling, Hongjie Yu
Abstract
Background
To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national “free-at-the-point-of-care” vaccination program for priority populations recommended by the World Health Organization.
Methods
In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures.
Results
Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5–2.2% between 2004 and 2014. A free national vaccination program for priority populations (n = 416 million), would cost government US$ 757 million (95% CI 726–789) annually (uptake rate = 20%).
Conclusions
An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
.
Willingness to participate in Ebola viral disease vaccine trials and receive vaccination by health workers in a tertiary hospital in Ile-Ife, Southwest Nigeria
Original Research Article
Pages 5758-5761
Samuel A. Olowookere, Emmanuel A. Abioye-Kuteyi, O. Adekanle
Abstract
Background
Ebola viral disease (EVD) epidemic need to be contained through means which include vaccination of susceptible population. Vaccination has eradicated major killer diseases.
Objective
The study determined the health workers willingness to participate in EVD vaccine clinical trials and receive EVD vaccine.
Materials and methods
A descriptive cross-sectional study design involving 370 consenting health workers of Obafemi Awolowo University, Ile-Ife that completed a self administered semi-structured questionnaire. Data analysed using descriptive and inferential statistics.
Results
Mean age was 34.4 ± 8.6 years (range, 19–60 years). Most were females (60.3%), and had worked Conclusion
Male gender, medical doctor and vaccine safety determine willingness to participate in Ebola vaccine trials while vaccine safety determines willingness to receive vaccine when ready. Researchers should ensure gender equality and vaccine safety in vaccine trials.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
.
Improving hepatitis B birth dose in rural Lao People’s Democratic Republic through the use of mobile phones to facilitate communication
Original Research Article
Pages 5777-5784
Anonh Xeuatvongsa, Siddhartha Sankar Datta, Edna Moturi, Kathleen Wannemuehler, Phanmanisone Philakong, Viengnakhone Vongxay, Vansy Vilayvone, Minal K. Patel
Abstract
Background
Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People’s Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits.
Methods
From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study.
Findings
Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p < 0.0001, comparison p = 0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32–88%, p < 0.0001) in intervention districts, compared with 20% (IQR 0–50%, p < 0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p = 0.0009).
Conclusion
Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement in both arms are multifactorial and discussed.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
.
Evaluation of scanning 2D barcoded vaccines to improve data accuracy of vaccines administered
Original Research Article
Pages 5802-5807
Ashley Daily, Erin D. Kennedy, Leslie A. Fierro, Jenica Huddleston Reed, Michael Greene, Warren W. Williams, Heather V. Evanson, Regina Cox, Patrick Koeppl, Ken Gerlach
Abstract
Background and objective
Accurately recording vaccine lot number, expiration date, and product identifiers, in patient records is an important step in improving supply chain management and patient safety in the event of a recall. These data are being encoded on two-dimensional (2D) barcodes on most vaccine vials and syringes. Using electronic vaccine administration records, we evaluated the accuracy of lot number and expiration date entered using 2D barcode scanning compared to traditional manual or drop-down list entry methods.
Methods
We analyzed 128,573 electronic records of vaccines administered at 32 facilities. We compared the accuracy of records entered using 2D barcode scanning with those entered using traditional methods using chi-square tests and multilevel logistic regression.
Results
When 2D barcodes were scanned, lot number data accuracy was 1.8 percentage points higher (94.3–96.1%, P < 0.001) and expiration date data accuracy was 11 percentage points higher (84.8–95.8%, P < 0.001) compared with traditional methods. In multivariate analysis, lot number was more likely to be accurate (aOR=1.75; 99% CI, 1.57–1.96) as was expiration date (aOR=2.39; 99% CI, 2.12–2.68). When controlling for scanning and other factors, manufacturer, month vaccine was administered, and vaccine type were associated with variation in accuracy for both lot number and expiration date.
Conclusion
Two-dimensional barcode scanning shows promise for improving data accuracy of vaccine lot number and expiration date records. Adapting systems to further integrate with 2D barcoding could help increase adoption of 2D barcode scanning technology.

Vaccine
Volume 34, Issue 47, Pages 5697-5818 (11 November 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/47
.
A comparison of language use in pro- and anti-vaccination comments in response to a high profile Facebook post,
Original Research Article
Pages 5808-5814
Kate Faasse, Casey J. Chatman, Leslie R. Martin
Abstract
Background
Vaccinations are important for controlling the spread of disease, yet an increasing number of people are distrustful of vaccines, and choose not to (fully) vaccinate themselves and their children. One proposed contributor to this distrust is anti-vaccination misinformation available on the internet, where people search for and discuss health information. The language people use in these discussions can provide insights into views about vaccination.
Methods
Following a prominent Facebook post about childhood vaccination, language used by participants in a comment thread was analysed using LIWC (Linguistic Inquiry and Word Count). Percentage of words used across a number of categories was compared between pro-vaccination, anti-vaccination, and unrelated (control) comments.
Results
Both pro- and anti-vaccination comments used more risk-related and causation words, as well as fewer positive emotion words compared to control comments. Anti-vaccine comments were typified by greater analytical thinking, lower authenticity, more body and health references, and a higher percentage of work-related word use in comparison to pro-vaccine comments, plus more money references than control comments. In contrast, pro-vaccination comments were more authentic, somewhat more tentative, and evidenced higher anxiety words, as well as more references to family and social processes when compared to anti-vaccination comments.
Conclusion
Although the anti-vaccination stance is not scientifically-based, comments showed evidence of greater analytical thinking, and more references to health and the body. In contrast, pro-vaccination comments demonstrated greater comparative anxiety, with a particular focus on family and social processes. These results may be indicative of the relative salience of these issues and emotions in differing understandings of the benefits and risks of vaccination. Text-based analysis is a potentially useful and ecologically valid tool for assessing perceptions of health issues, and may provide unique information about particular concerns or arguments expressed on social media that could inform future interventions.

Scientific Reports
6, Article number: 35742 (2016)
doi:10.1038/srep35742,
Immune Responses to an Oral Cholera Vaccine in Internally Displaced Persons in South Sudan
AS Iyer, M Bouhenia, J Rumunu, A Abubakar…
Abstract
Despite recent large-scale cholera outbreaks, little is known about the immunogenicity of oral cholera vaccines (OCV) in African populations, particularly among those at highest cholera risk. During a 2015 preemptive OCV campaign among internally displaced persons in South Sudan, a year after a large cholera outbreak, we enrolled 37 young children (1–5 years old), 67 older children (6–17 years old) and 101 adults (≥18 years old), who received two doses of OCV (Shanchol) spaced approximately 3 weeks apart. Cholera-specific antibody responses were determined at days 0, 21 and 35 post-immunization. High baseline vibriocidal titers (>80) were observed in 21% of the participants, suggesting recent cholera exposure or vaccination. Among those with titers ≤80, 90% young children, 73% older children and 72% adults seroconverted (≥4 fold titer rise) after the 1st OCV dose; with no additional seroconversion after the 2nd dose. Post-vaccination immunological endpoints did not differ across age groups. Our results indicate Shanchol was immunogenic in this vulnerable population and that a single dose alone may be sufficient to achieve similar short-term immunological responses to the currently licensed two-dose regimen. While we found no evidence of differential response by age, further immunologic and epidemiologic studies are needed.

International Journal of Community Medicine and Public Health
2016; 3(11): 2987-2992
doi: 10.18203/2394-6040.ijcmph20163507
Cross sectional study of knowledge of cervical cancer and awareness, knowledge and vaccine acceptance human papillomavirus vaccine among school girls of government and private school of Central India
S Parmar, B Waskel, S Dixit, G Shivram, A Patidar…
Abstract
Background:
Cervical cancer is the second most common cancer worldwide and in India, it is the number one killer cancer among women. About 500,000 women are diagnosed with cervical cancer contributing to around 270,000 deaths, across the globe every year. Out of these, the burden of 230,000 (85%) deaths is owned by developing countries, with bare minimal resources to cope with the situation. In India alone there are an estimated 132,000 new cases and 74,000 deaths each year. The discovery that human papillomavirus (HPV) is responsible for virtually all cervical cancers opens exciting new possibilities for controlling this disease.
Methods:
Randomly 300 girls were selected from private and government schools of central India aged between 16-18 years a semi structured questionnaire was provided to asses’ knowledge of cervical cancer and awareness, knowledge and vaccine acceptance HPV vaccine among the school girls.
Results:
Total 85% of the students are aware about cervical cancer overall. (80% of Government school students and 90% of the private school students) but only 43% of the students have heard about HPV overall,53% of the students know that cervical cancer is preventable, and 54% of Pvt. School students know that it is preventable. 50% of the students are aware that there are screening methods for cervical cancer, only 3% of the students are aware of all the modes of transmission and 72% are aware about Sexual intercourse is mode of transmission. 39.3% are aware that multiple sexual partners are a risk factor for HPV infection and 38.2% are aware that unprotected sexual intercourse is a risk factor. Only 8.9% are aware that first intercourse at young age is a risk factor and only 13.45% are aware that other STDs are also a risk factor for HPV infection, 55% of the students was aware about availability of vaccine against HPV. 54% of the students are not aware that the vaccine is available in India.
Conclusions:
The low level of knowledge indicates that the larger population of less educated women is in greater lack of awareness. During this survey we accessed a population that has not been widely studied and our observations leads to conclude that the absence of an active national cervical screening and awareness program has resulted in the lack of basic knowledge about important risk factors for cervix cancer even among the literate population of school girls.

International Journal of Community Medicine and Public Health
2016; 3(11): 3195-3201
doi: 10.18203/2394-6040.ijcmph20163935
Determinants of uptake of pentavalent vaccine in Benin city, Southern Nigeria
EO Ogboghodo, HA Esene, OH Okojie
Abstract
Background:
The Nigerian government in 2012 introduced the pentavalent vaccine into her routine immunization schedule with a view to fast track reduction in child mortality. Despite the advantages of pentavalent vaccine, it has been linked to adverse effects following immunizations including clusters of infant deaths. The objective of the study was to assess knowledge, attitude and experience of care-givers whose under-fives are receiving pentavalent vaccines as determinants of uptake of the vaccine in Benin city.
Methods:
A descriptive cross-sectional study design was utilized for this study. Data was analyzed using IBM SPSS version 21.0 software. The level of significance was set at p Results:
The About three-quarters 554 (76.9%) of caregivers had a good knowledge on pentavalent vaccines. Good knowledge increased with increasing level of education and being married (p≤0.001 and p=0.015 respectively). Majority, 568 (78.9%), of caregivers had a positive attitude towards the pentavalent vaccination. With increasing level of education, there was an increase in the proportion of caregivers who had a positive attitude towards the vaccine (p≤0.001).
Conclusions:
Two hundred (27.8%) caregivers had children who had experienced at least a side effect following pentavalent vaccination. Of these, 171 (85.5%) were willing to continue with the vaccine despite AEFIs experienced.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
.
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 29 October 2016
Trade Oct 28, 2016
What Past Trade Deals Reveal About Drug Pricing – The TPP’s Good Medicine?
Thomas J. Bollyky

West Africa November/December 2016
Ebola: How a People’s Science Helped End an Epidemic
Nicolas van de Walle

.
The Guardian
http://www.guardiannews.com/
Global Health
A water-chilled coolbox gets vaccines on tap to the world’s poorest
At the Grand Challenges conference in London, innovations in refrigeration and sanitation are among those making a difference to global healthcare
Monday 24 October 2016
A UN vaccine programme in Darfur in 2011. An innovative refrigeration system that doesn’t need a constant power supply is helping deliver vaccines to remote communities.
Kate Hodal

.
New York Times
http://www.nytimes.com/
Accessed 29 October 2016
Ban proposes UN fund to help Haitian cholera victims
(10/24),
United Nations Secretary-General Ban Ki-moon has proposed a $400 million cholera response package to assist Haitians who contracted cholera due to UN peacekeepers in the country. “We want to do this because we think it’s the right thing to do for the Haitian people, but frankly speaking, it’s the right thing to do for the United Nations,” said Jan Eliasson, the UN deputy secretary-general.

Sanofi Partners With Brazil to Accelerate Zika Vaccine Work
(Reuters) – Sanofi has struck a collaboration deal with a leading Brazilian research institute to speed development of a Zika vaccine, consolidating the French drugmaker’s position in the race to defeat the mosquito-borne virus. The
October 27, 2016

.
Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 29 October 2016
World
Billionaires Pony Up More Funds in Fight to Eradicate Polio
By Betsy McKay
Oct. 24, 2016 8:00 am ET
Bill Gates is getting help from some fellow billionaire philanthropists as he and other health leaders work to overcome setbacks that have delayed the eradication of polio despite a recent sharp decline in the number of cases.
Former New York City Mayor Michael Bloomberg, who donated $100 million in 2013 to the Global Polio Eradication Initiative, is contributing another $25 million now to help stamp out the virus, which is highly infectious and can cause paralysis and death. Ray Dalio, chairman and co-chief investment officer of Bridgewater Associates LP, who gave $50 million in 2013, is adding another $30 million. An anonymous donor is contributing $15 million.
The $70 million in new money will help cover costs of the polio-eradication effort that has been extended by about 18 months, Mr. Gates, co-chair of the Bill & Melinda Gates Foundation, said in an interview…

.
Washington Post
http://www.washingtonpost.com/
Accessed 29 October 2016
In a first, U.S. trial to test Cuban lung-cancer vaccine
The international collaboration will enroll up to 90 patients in this country.
Laurie McGinley | National/health-science | Oct 27, 2016

Scientists are bewildered by Zika’s path across Latin America
24 October 2016
Nearly nine months after Zika was declared a global health emergency, the virus has infected at least 650,000 people in Latin America and the Caribbean, including tens of thousands of expectant mothers. But to the great bewilderment of scientists, the epidemic has not produced the wave of fetal deformities so widely feared when the images of misshapen infants first emerged from Brazil. Instead, Zika has left a puzzling and distinctly uneven pattern of damage across the Americas.

UN wants $200 million to compensate Haiti cholera victims
24 October 2016
The United Nations says it is looking to raise $200 million from member states to compensate the families of people who have died from cholera in Haiti. David Nabarro, a special adviser to the secretary-general, said Monday that the money to “provide material assistance” was part of a new U.N. approach to dealing with the disease that is believed to have been introduced to Haiti by U.N. peacekeepers from Nepal. He denied, however, that the proposed assistance amounted to acknowledgement of responsibility on the part of the U.N. for the disease which has sickened nearly 800,000 Haitians and killed some 9,300.

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

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

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

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

* * * *
* * * *

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_22-october-2016

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

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_15-october-2016-docx

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

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_8-october-2016

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

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_1-october-2016

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

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_24-september-2016

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

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_17-september-2016

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

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

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

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

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

– pdf version:  A pdf of the current issue is available here: vaccines-and-global-health_the-week-in-review_10-september-2016

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

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

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

Zika virus [to 10 September 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 8 September 2016
Full report: http://www.who.int/emergencies/zika-virus/situation-report/8-september-2016/en/

Key Updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
…None
…Malaysia has reported one locally acquired mosquito-borne Zika infection in the past week. Prior to this, the only evidence of Zika in Malaysia had been a scientific publication that had reported a case of Zika infection identified in Germany in an individual with travel history to Malaysia.

:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
…None

:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
…None
The Netherlands reported evidence of person-to-person transmission of Zika virus (probably via a sexual route) for the first time in the past week.

:: Operational updates from the WHO Regional Office for the Americas:
…WHO convened a workshop in Barbados on clinical management of neurological complications.
…A technical mission to Brazil by WHO/PAHO for laboratory assessment and strengthening of Zika diagnostic capacity of State laboratories was completed in August.
…WHO facilitated two meetings in Panama for updating the strategic plan for vector surveillance and control.
…WHO/PAHO carried out missions to Colombia and El Salvador to organize and help launch “Mosquito Awareness Week”.
…In Haiti, WHO and the Ministry of Public Health and Population’s Division of Epidemiology, Laboratory and Research (DELR) held three train-the-trainer workshops on epidemiological surveillance of Zika and its complications in August.

:: The results from the sequencing analysis of Zika virus cases in Singapore indicate that the virus belongs to the Asian lineage and likely evolved from the strain that was previously circulating in Southeast Asia. The recent cases in Singapore do not appear to be the result of imported virus from South America.
:: The 2016 Summer Paralympic Games opened in Rio de Janeiro, Brazil, on 7 September. WHO continues to provide technical support to the Ministry of Health to ensure the 2016 Summer Paralympic Games are as safe as possible for all athletes, volunteers, visitors and residents. There is a low, but not zero, risk of Zika transmission in this setting. All persons should continue to follow guidance on avoiding Zika infection.
:: The fourth meeting of the Emergency Committee was held on 1 September 2016. Having considered the evidence presented, the Committee agreed that due to continuing geographic expansion and considerable gaps in understanding of the virus and its consequences, Zika virus infection and its associated congenital and other neurological disorders continues to be a Public Health Emergency of International Concern.
:: Based on a systematic review of the literature, WHO has concluded that Zika virus infection during pregnancy is a cause of congenital brain abnormalities, including microcephaly, and that Zika virus is a trigger of GBS.
:: Revised guidance on the prevention of sexual transmission was published on 6 September 2016.

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Zika Open [to 10 September 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

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WHO
Updated guidance on prevention of sexual transmission of Zika virus
6 September 2016 – The interim guidance on prevention of sexual transmission of Zika virus has been updated with new evidence and advice. The primary transmission route of Zika virus is via the Aedes mosquito, however mounting evidence shows that sexual transmission of Zika virus is possible and more common than previously assumed. This is of concern due to an association between the Zika virus and adverse pregnancy outcomes.
Read the guidance

Information for travellers
Updated 6 September 2016

Information for health authorities
Updated 6 September 2016

Fact sheet: Zika virus
Updated 6 September 2016

Q&A: Zika virus
Updated 6 September 2016

POLIO [to 10 September 2016]
Public Health Emergency of International Concern (PHEIC)

Please see the extended excerpts from the IMB’s 13th Report below in the “Reports…” section.

Polio this week as of 7 September 2016
: In Nigeria, one new wild poliovirus type 1 (WPV1) case has been reported, from Borno state, following confirmation of two cases in August. Regional outbreak response across north-eastern Nigeria and the Lake Chad sub-region is continuing within the broader humanitarian emergency context. Detection of new cases at this point is not unexpected or unusual, particularly as surveillance is being strengthened (including by conducting retrospective acute flaccid paralysis case searches).

:: The polio outbreak has been declared a national public health emergency by the Government of Nigeria and a regional public health emergency by the Governments of the Lake Chad sub-region, to ensure all-of-government, all-of-society approaches to the outbreak response. See ‘Nigeria’ section below for more.

: The Global Polio Eradication Initiative has launched an emergency appeal to respond to the polio outbreak across the region. Against the planned outbreak response budget of US$116 million, a critical funding gap of US$33 million must be urgently filled. More.
[excerpt from appeal]
KEY FACTS
:: Wild poliovirus type 1 outbreak in Nigeria: 2 cases
:: High risk of poliovirus spread in the Lake Chad area
:: Ongoing Polio Outbreak Response in Northern Nigeria and Lake Chad area implemented as part of the broader humanitarian response effort
:: WHO has declared Northern Nigeria a Grade 3 Humanitarian Emergency
:: UNICEF has activated its Level 3 Corporate Emergency Procedure for North – East Nigeria
:: Budget requirements: US116 million
:: Funding gap: US$33 million

:: Selected Country Updates [excerpts]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from South Waziristan, Federally Administered Tribal Areas (FATA), with onset of paralysis on 27 July. It is the most recent case in the country, bringing the total number of WPV1 cases for 2016 to 14.

Nigeria
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Monguno Local Government Area (LGA), Borno state, with onset of paralysis on 6 August. It is the most recent case in country and brings the total number of WPV1 cases for 2016 to three.
:: Detection of new cases at this point is not unexpected or unusual, particularly as surveillance is being strengthened (including by conducting retrospective acute flaccid paralysis case searches).
:: A full case investigation of the third case is ongoing, however the child had onset of paralysis on 6 August and was detected in an accessible internally-displaced persons camp in Monguno LGA. The child’s family had originally arrived from Marte LGA (as had the family of the case from Jere LGA reported in August).
:: An emergency regional outbreak response is continuing under the guidance of the Emergency Operations Committee, led by the Government of Nigeria and with support from WHO and GPEI partners, including with inactivated polio vaccine (IPV). The outbreak response is being coordinated with neighbouring countries and in the broader humanitarian emergency response context affecting the region. Similar approaches to outbreak response were successfully implemented in previous years in the Middle East and the Horn of Africa.

Yellow Fever [to 10 September 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Yellow Fever – Situation Report – 9 September 2016
Full Report:
http://apps.who.int/iris/bitstream/10665/250077/1/yellowfeversitrep9Sep16-eng.pdf?ua=1

Key updates
Angola epidemiological update (as of 1 September):
:: There have been no new confirmed cases since 23 June.
:: Phase I of the preventive vaccination campaign in Angola was completed and, as of 1 September, 2,807,628 people had been vaccinated. Phase II of the campaign is being prepared and will target more than three million people in 12 provinces.

Democratic Republic of The Congo (DRC) epidemiological update (as of 8 September):
:: There have been no confirmed cases related to the current outbreak since 12 July.
:: The first notified case reported in Bominenge Health Zone in Sud Ubangi province is still under investigation. A second case was notified from Budjala Health Zone, a different zone within Sud Ubangui province, in the week to 8 September and is being investigated.
:: The pre-emptive vaccination campaign in DRC has concluded. The preliminary results indicate that the administrative immunization coverage reached 103.1% in Kinshasa, 101% in Kasai Central, 98.3% in Kongo Central, 101% in Kasai, 101% in Kwango, and 100.8% in Lualaba. Independent monitoring assessed that vaccination coverage is 98.2% in Kinshasa.

Uganda declared the end of their yellow fever outbreak on 6 September 2016. This outbreak was not linked to the outbreak in Angola and DRC.

.

Updated strategy for the Elimination of Yellow fever Epidemics (EYE)
Partners’ meeting
Date: 12 September 2016
Place: Geneva, Switzerland
Purpose
Bring together partners involved in development and implementation of the updated strategy for the Elimination of Yellow fever Epidemics.
Objectives
:: Update partners on objectives and strategic axis of the new strategy.
:: Engage with partners on development and implementation.
:: Define immediate and long-term steps to support the strategy.
Preliminary agenda pdf, 380kb

MERS-CoV [to 10 September 2016]
http://www.who.int/emergencies/mers-cov/en/

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WHO statement on the tenth meeting of the IHR Emergency Committee regarding MERS
3 September 2015
[Editor’s text bolding]
The tenth meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding the Middle East respiratory syndrome 1 was held by teleconference on 2 September 2015, from 1300 to 1620 Central European Summer Time (UTC +2). During the meeting the WHO Secretariat provided an update to the Committee on epidemiological and scientific developments, including recent cases and transmission patterns in the Kingdom of Saudi Arabia (KSA), Jordan and the United Arab Emirates. The Secretariat also provided current risk assessments with regard to these events, and information on control and prevention measures…

…Members of the EC agreed that the situation still does not constitute a Public Health Emergency of International Concern (PHEIC). At the same time, they emphasized that they have a heightened sense of concern about the overall MERS situation. Although it has been three years since the emergence of MERS in humans was recognized, the global community remains within the grip of this emerging infectious disease. There is continued virus transmission from camels to humans in some countries and continued instances of human-to-human transmission in health care settings. Nosocomial outbreaks have most often been associated with exposure to persons with unrecognized MERS infection. The major factors contributing to the ongoing situation are insufficient awareness about the urgent dangers posed by this virus, insufficient engagement by all relevant sectors, and insufficient implementation of scalable infection control measures, especially in health care settings such as emergency departments. The Committee recognizes that tremendous efforts have been made and some progress has been achieved in these areas. However, the Committee also notes that the progress is not yet sufficient to control this threat and until this is achieved, individual countries and the global community will remain at significant risk for further outbreaks.

Moreover, the current outbreak is occurring close to the start of the Hajj and many pilgrims will return to countries with weak surveillance and health systems. The recent outbreak in the Republic of Korea demonstrated that when the MERS virus appears in a new setting, there is great potential for widespread transmission and severe disruption to the health system and to society….

WHO & Regional Offices [to 10 September 2016]

WHO and partners battle multiple disease outbreaks in South Sudan
9 September 2016
Infectious diseases continue to pose a major public health threat in South Sudan. Adding to the chronic burden of disease, regular outbreaks further threaten people’s health.
In a conflict setting, WHO and partners are responding to multiple outbreaks including cholera, malaria, measles, suspected hemorrhagic fever, and kala-azar.
“In spite of the insecurity, WHO is taking every opportunity to ensure that we reach the people with health care services to protect them at this time when the health system has crumbled,” says Dr, Abdulmumini Usman, WHO Representative to South Sudan…

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WHO-IVB: Call for nomination for experts to serve on a Strategic Advisory Group of Experts (SAGE) on Immunization working group on Pneumococcal Conjugate Vaccine (PCV)
5 September 2016
Deadline for application: 30 September 2016

.

Highlights
WHO certifies Sri Lanka malaria-free
September 2016 − In a remarkable public health achievement, Sri Lanka was certified today by WHO on having eliminated malaria, a life-threatening disease which long affected the island country.

.

:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO :
:: DRC vaccinates more than 10 million people in Africa’s largest yellow fever vaccination campaign
BRAZZAVILLE, 6 September 2016 – The largest emergency vaccination campaign against yellow fever ever attempted in Africa, came to an end on 5 September 2016 with more than 10.6 million people in the Democratic Republic of Congo (DRC) vaccinated against the lethal disease.

WHO Region of the Americas PAHO
:: New PAHO publication brings together strategies for suicide prevention in the Americas (09/09/2016)

WHO South-East Asia Region SEARO
:: South-East Asia countries to set up fund for health emergencies preparedness
9 September 2016
:: Focus on migrant health: WHO 8 September 2016

WHO European Region EURO
:: Preventing alcohol exposure in pregnancy: examples from Member States 08-09-2016
:: WHO governing body for the European Region convenes with eight strategic proposals on the agenda 08-09-2016
:: Evidence-informed policy-making in the spotlight in new edition of Public Health Panorama 07-09-2016
:: WHO Europe launches new action plan for noncommunicable diseases, appeals for urgent joint policy action to achieve global goals and targets 06-09-2016

WHO Eastern Mediterranean Region EMRO
:: Millions of children in Pakistan reached with polio vaccine thanks to United Arab Emirates campaign 7 September 2016
:: WHO supports training of Somali health workers to scale up the cholera outbreak response
4 September 2016

WHO Western Pacific Region
No new announcements identified.

Industry Watch [to 10 September 2016]
:: Takeda Initiates Global Phase 3 Clinical Trial (TIDES) of Dengue Vaccine Candidate (TAK-003)
Study to evaluate vaccine protection against all four strains of dengue virus, regardless of previous exposure
September 07, 2016
OSAKA, Japan–(BUSINESS WIRE)–Takeda Pharmaceutical Company Limited today announced that it has vaccinated the first subject in the Tetravalent Immunization against Dengue Efficacy Study (TIDES), a Phase 3 double-blind, randomized and placebo-controlled trial of its live-attenuated tetravalent dengue vaccine candidate (TAK-003).

TIDES will enroll approximately 20,000 healthy children between the ages of four and 16 years living in dengue-endemic countries in Latin America and Asia. The study will evaluate the efficacy of the vaccine candidate to protect subjects against symptomatic dengue fever caused by any of the four dengue virus serotypes, regardless of age and whether the individual has previously been exposed to the virus. The study will also evaluate vaccine safety and immunogenicity and will involve two doses of the vaccine candidate or placebo administered 90 days apart.1 …

.

:: U.S. Biomedical Advanced Research and Development Authority (BARDA) Awards Protein Sciences Multi-Million Dollar Contract for Pandemic Preparedness
MERIDEN, Conn., Sept. 7, 2016 /PRNewswire/ — Protein Sciences Corporation announced today that the Biomedical Advanced Research and Development Authority (BARDA), a division of the U.S. Department of Health and Human Services, has awarded the Company a contract that is part of the Authority’s medical countermeasures against pandemic influenza and influenza strains with pandemic potential (contract number HHSO100201600005I). Protein Sciences will perform the contract using its proprietary platform technology for producing vaccines that according to the Food and Drug Administration has revolutionized influenza vaccine manufacturing and stands to receive up to $610 million through 2021 if BARDA exercises all options…

.

:: Gyeongbuk Kick-Starts Vaccine Industry with ‘Global Vaccine Industry Forum 2016’
– More than 200 experts from industry, academia, research institutes from Korea and abroad, including IVI, in attendance
– MOU between IVI, Gyeongbuk (province), Andong (city) signed; keynote speech, presentations, discussions delivered
– Officials from global vaccine enterprises including GSK, Sanofi Pasteur, Bill & Melinda Gates Foundation invited to attend
Gyeongsangbuk-do (Gyeongbuk or North Gyeongsang Province) held the opening ceremony of the ‘Gyeongbuk Global Vaccine Industry Forum 2016’ at Richell Hotel in Andong on September 9 to seek to set direction and strategy for development of the vaccine industry, form a network with domestic and overseas partners, and expedite mutual exchange in order to lay the foundation to nurture the vaccine industry.

Held under the theme “Present and Future of Globalization of the Korean Vaccine Industry,’ the forum is taking place on September 8 – 10. The opening ceremony on September 9 was a huge success, as it brought together more than 200 vaccine experts and officials including Gyeongbuk Governor Kim Kwan-yong, Rep. Kim Kim Gwang-lim, Andong Mayor Kwon Young-se, and Jerome Kim, Director General of the International Vaccine Institute…

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:: DCVMN [Developing Country Vaccine Manufacturers Network] Annual General Meeting
24 October 2016 to 27 October 2016
Buenos Aires / / Argentina

IAVI – International AIDS Vaccine Initiative [to 10 September 2016]
https://www.iavi.org/

September 8, 2016
New Vaccination Strategies Successfully Coach Immune System to Make Powerful HIV-Neutralizing Antibodies
New approaches that could spur the human body to produce HIV-blocking antibodies have been successful in mice mimicking the human immune system, according to five studies published today in the research journals Cell, Immunity and Science.

The results were produced by scientists affiliated with the International AIDS Vaccine Initiative (IAVI); The Scripps Research Institute (TSRI); U.S National Institute of Health’s National Institute of Allergy and Infectious Diseases (NIAID); Howard Hughes Medical Institute (HHMI); The Rockefeller University; Ragon Institute of Massachusetts General Hospital, MIT and Harvard; Boston Children’s Hospital; Massachusetts Institute of Technology (MIT); Harvard Medical School (HMS); Vanderbilt University; Columbia University; Fred Hutchinson Cancer Research Center (FHCRC); Duke University School of Medicine and Kymab Ltd…

::::::

European Medicines Agency [to 10 September 2016]
http://www.ema.europa.eu/
07/09/2016
Fighting antimicrobial resistance globally
EMA, FDA and PMDA discuss regulatory approaches for the evaluation of new antibacterial agents

::::::

NIH [to 10 September 2016]
http://www.nih.gov/news-events/news-releases
September 8, 2016
Federal prize competition seeks innovative ideas to combat antimicrobial resistance
Contestants will vie for $20 million in prizes to develop new innovative laboratory diagnostic tools that detect and distinguish antibiotic resistant bacteria.

NCI embraces scientific road map to achieve Cancer Moonshot goals
September 7, 2016 — Blue Ribbon Panel outlines 10 transformative approaches for accelerating progress against cancer.

::::::

FDA [to 10 September 2016]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
:: Influenza Virus Vaccine for the 2016-2017 Season Posted: 9/7/2016
:: Public Hearing; Request for Comments – Draft Guidances Relating to the Regulation of Human Cells, Tissues or Cellular or Tissue-Based Products
Updated to include a link to the webcast; Updated: 9/8/2016
:: Statistical Review – Afluria Quadrivalent (PDF – 251KB) Posted: 9/6/2016
:: Clinical Review – Afluria Quadrivalent (PDF – 587KB) Posted: 9/6/2016
:: Final Agenda: Part 15 Hearing: Draft Guidances Relating to the Regulation of Human Cells, Tissues, or Cellular or Tissue-Based Products Updated: 9/6/2016

::::::

European Vaccine Initiative [to 10 September 2016]
http://www.euvaccine.eu/news-events
News
EVI Annual Report 2015 now available
09 September 2016
The EVI 2015 Annual Report provides a detailed insight into all of EVI’s activities, projects, important meetings etc. We hope you will find it not only enlightening, but interesting reading.

News
New publication emanating from EVI project AMA1
08 September 2016
New article published on 30 August 2016 in Malaria Journal emanating from EVI project AMA1

::::::

Fondation Merieux [to 10 September 2016]
Mission: Contribute to global health by strengthening local capacities of developing countries to reduce the impact of infectious diseases on vulnerable populations.
http://www.fondation-merieux.org/news
7 September 2016, Lyon (France)
“Better Foods for Better Health” White Book: 30 global experts share the latest findings on microbiota in disease prevention and obesity
The 5th edition of the Better Foods for Better Health White Book has been published, providing new insight from 30 thought leaders from science and industry on the growing role and potential of gut microbiota to improve health.

::::::

EDCTP [to 10 September 2016]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials.
6 September 2016
Notice of voluntary liquidation of EDCTP-EEIG (legal structure for the first EDCTP programme, 2003-2015)
The EDCTP-EEIG, the legal structure for the first EDCTP programme (2003-2015), is in liquidation (Dutch: in liquidatie). The EDCTP-EEIG was incorporated for the implementation of the activities set out in the contract signed between the EDCTP-EEIG and the European Commission. Following the successful completion of the first programme, the EDCTP-EEIG General Assembly approved on 3 June 2016 the complete liquidation of the EDCTP-EEIG legal entity and the winding up of its affairs…

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

THE 13TH REPORT OF THE INDEPENDENT MONITORING BOARD (IMB) OF THE GLOBAL POLIO ERADICATION INITIATIVE (GPEI)
August 2016 :: 28 pages
Overview
This report follows the 14th meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI). The Report comes at a critical time. It is making an assessment of the progress of the Polio Programme with six months to go before the declared GPEI deadline. By the end of December 2016, transmission of the poliovirus should be interrupted everywhere in the world.

[Introductory Content]
THE IMB CALL FOR PEAK PERFORMANCE
When the IMB issued its previous report, it did so against a background that the Polio Programme in the two remaining endemic countries (Pakistan and Afghanistan) had the
advantage of facing the last Low Season (before the GPEI deadline) with the smallest burden of poliovirus in human history. The IMB entitled its last report: Now is the Time for Peak Performance. This title reflected the IMB’s analysis that, despite a rising tide of improving performance, the Polio Programme still had many islands of mediocrity (within countries and systemically across the programme) where sub-optimal delivery meant that the goal of stopping polio transmission in the near future remained improbable.

PROGRESS ACHIEVED BUT NOT YET PEAK PERFORMANCE
Since the last IMB report, there have been further, very substantial, improvements:
:: the global footprint of the poliovirus is the smallest in human history
:: the continent of Africa still has no polio endemic countries within it
:: the Polio Programme in Pakistan is achieving a high level of performance overall and in this respect is transformed from its position three years ago
: the establishment of an Emergency Operations Centre and changes of GPEI personnel in Afghanistan have led to a jump up in the level of performance
:: more female health workers are making a difference, meeting mothers on doorsteps that have not been reached before
:: within the GPEI, the quality of working relationships, the effectiveness of governance structures, and the management of big strategic changes is much better than previously

However, the IMB is quite clear that the Polio Programme has not yet reached peak performance, and this is disappointing. With six months to go, it must do so if the goal of ending polio transmission by the end of 2016 is to be realized. This challenge has become more complex since the last IMB report. It is no longer the polio Low Season in Pakistan and Afghanistan: the High Season is upon those countries’ programmes. There has been a planned global strategic switch in the type of oral polio vaccine used in immunization campaigns, with a resulting heightened risk of outbreaks of vaccine-derived viruses (these are also capable of causing paralysis). There is a world shortage of the inactivated polio vaccine (administered by injection). This vaccine should be acting as vital adjunct to boosting children’s immunity, particularly in communities where access is only being achieved intermittently but there is not
enough of it to go round…

…VULNERABLE AREAS: REINSTATEMENT OF THE RED LIST
The Polio Programme is entering uncharted waters. The GPEI promise to interrupt polio transmission everywhere in the world by the end of 2016 is only six months from its intended delivery. No one can be sure what it will take to remove every last vestige of the disease from the planet. This is in circumstances where there are many pockets of low immunity in some of the most marginalized populations of the world, and where ongoing use of the oral vaccine can
release virus that causes paralytic polio. The only modern parallel is the smallpox eradication programme: a different disease, in a different time.

Taken together, a weakness in effective surveillance, a heightened risk of vaccine-derived poliovirus, and variable performance of routine immunization demonstrate a potentially hazardous combination for the programme. There are many parts of the world that are in just this situation. In an earlier report, the IMB urged the GPEI to establish a publicly prominent list of vulnerable countries and call it The Red List. This was accepted and ran for a short time but then sank from view, thereby losing the power and transparency of the concept.

The IMB believes that the concept of a Red List should be re-established. The Polio Programme should not be waiting for the predictable to happen, it should be advocating many more preventive immunization activities – both through routine immunization and IPV and OPV campaigns…

…SUMMARY OF THE IMB’S MAJOR CONCERNS
1 The level of joint working between the governments of Pakistan and Afghanistan is still falling below that required to interrupt polio transmission in the border areas and from the large reservoirs of infection that span the two countries.

2 The low degree of political engagement in Northern Sindh is a major barrier to eliminating polio from that part of Pakistan.

3 The Polio Programme in many parts of Karachi has been chronically underperforming.

4 The number of missed children in the inaccessible eastern area of Afghanistan has gone up from 26,000 in March 2016 to 130,000 in May 2016.

5 In the southern region of Afghanistan, the proportion of missed children has hardly changed in two years and the proportion of refusals continues to be the highest of all polio-affected countries (and has been stagnant for four years).

6 The Afghanistan Polio Programme is continuing to use male vaccinators from outside despite it being well known that matching of a vaccinator’s characteristics with the religious and cultural composition of the local population is vital to acceptance; the failure of the GPEI to scale up within Afghanistan the use of local female health workers is a serious failing.

7 The performance of the Non-Governmental Organizations (NGOs) that deliver basic health
services through a contract with the Afghanistan Government is patchy and accountability and
performance management arrangements are far too weak. The relationship between this model of service delivery and the requirements to deliver a high-performing Polio Programme are not at all clear.

8 There seems to be either a lack of openness or a lack of situational awareness in the Afghanistan Polio Programme that, taken together with the other concerns, suggests an inappropriate reliance on ending transmission in Pakistan and a “good enough” performance philosophy.

9 The surveillance functions of the Polio Programme have been given much less emphasis than the immunization activities; as a result, surveillance is not fit for the purpose of addressing the challenges that the Programme now faces.

10 A poliovirus was discovered in Borno that had been circulating undetected for nearly two years, whilst half a million children have been missed. This, and multiple IMB sources speaking of a waning commitment in Nigeria, means that the Polio Programme in this country is not yet fully resilient against a re-emergence of poliovirus.

11 It is alarming that the Polio Programme has failed to meet the standards for dealing with outbreaks of vaccine-derived polioviruses (particularly so in Guinea and Madagascar). Slow reactions and delayed decision-making when viruses are discovered could be the Polio Programme’s downfall unless it learns quickly from these dysfunctions.

12 The apparent intractability of a situation, in a $1billion a year programme, in which an area of 1.5 Km in Eastern Afghanistan with a population of 1000 people has been responsible for 20% of the entire world’s polio cases in 2016 is extraordinary; the area has been inaccessible to
polio immunization teams for four years.

13 The list of countries with low levels of immunity to polio and inadequate surveillance is lengthy; the Polio Programme is not gaining from the beneficial pressures that flow from maintaining a publicly prominent Red List (as previously).

14 The Polio Programme has a wide range of innovative quantitative social data but their use is
not mainstreamed at all levels, it needs qualitative data; as a result striking findings on parental and community attitudes are not being used to generate definitive and transformational improvement in performance.

15 The outbreak of wild poliovirus in Bannu, Pakistan in April and May was a surprise; it seemed to be well protected. The Polio Programmes in Pakistan, Afghanistan, and Nigeria need to have more structured systems of soft intelligence to identify places where official monitoring data shows a “too good to be true” situation; the Programme cannot afford “more Bannus.”

16 The global oral polio vaccine switch will have left many countries with large supplies of redundant trivalent vaccine. There is a risk that an ill-informed local decision maker, mindful of waste and costs, might deploy the trivalent vaccine in immunization campaigns; it is not clear whether the GPEI has eliminated this source of risk.

17 After polio eradication has been officially certified, the oral polio vaccine will still be in use. At this point the GPEI will have been disbanded. It is not clear that there is a plan for this eventuality.

RECOMMENDATIONS
1 A very high-level GPEI leader should be appointed to strengthen the cohesiveness of the joint working of the Pakistan and Afghanistan governments. The person appointed should have the seniority and personal qualities to operate effectively in this role and should be perceived as politically neutral. The person should work out of Geneva, not the WHO Eastern Mediterranean Office (EMRO). In post by mid-September 2016.

2 The WHO Eastern Mediterranean Office (EMRO) should appoint a senior female official to its Polio Programme team. She should be charged with rapidly strengthening the role and capacity of female workers in the successful delivery of polio immunization (and in due course routine immunization). She should give immediate attention to removing the barriers to progress in Afghanistan. In post by end September 2016.

3 CDC Atlanta should facilitate the Polio Programmes in Pakistan and Afghanistan in undertaking a full process mapping of Acute Flaccid Paralysis (AFP) reporting and assessment. This should involve evaluating the shortfalls in quality in each step of the process and identify measures to strengthen them. It should be well informed with detailed local knowledge of the current situation and sufficiently granular to take account of context-specific aspects of the process that will vary from place to place. An action plan, informed by this work, should be
immediately implemented in Karachi, as a pilot, and its impact monitored. Completed by end-
September 2016.

4 The GPEI should introduce a system of financial incentives for reporting Acute Flaccid Paralysis (AFP) cases in Pakistan. To this end, any healthcare worker who reports a case should be paid, with a higher payment being given for confirmed cases. Safeguards should be built in for independent validation to prevent unfair manipulation of the system. The scheme should
be piloted in Karachi where awareness of frontline healthcare staff is very low. The urgent advice of public health officials in the Egyptian government should be sought in designing the scheme. Operational by end September 2016.

5 UNICEF should specially commission rapid qualitative data gathering to provide an in-depth understanding of the reasons for poor performance on social indicators in communities within the Pakistan-Afghanistan Core Reservoirs. Report of the findings to be with the IMB by end-September 2016.

6 Each Emergency Operations Centre (EOC) – both national and regional –should designate one team member to regularly gather soft intelligence from the field to identify situations where monitoring data are providing a falsely positive picture. This person should be someone who is completely trusted by field workers, who can speak to him or her on condition of anonymity, and who can feed back synthesized information to the EOC team; the information should be used for learning and improvement and on no account for retribution against any fieldworker.
Arrangements in place by end-September 2016.

7 The contractual arrangements governing the accountability and performance management of the Non-Governmental Organizations delivering basic health services in Afghanistan should be redrawn to address chronic underperformance and strengthen alignment with polio activities. Redesigned accountability and performance management arrangements in place by end-October 2016.

8 A publicly prominent Red List of countries and areas vulnerable to polio transmission should be re- established and more targeted, preventive immunization activities should be funded and
implemented. Red List to be posted by end-September 2016.

9 The process of implementing the GPEI standards for responding to outbreaks should be urgently reviewed at high level. This should include an open and honest assessment of the poor response to recent outbreaks, notably in Guinea. It should involve a thorough examination of the working relationships and decision-making between the headquarters of the United Nations GPEI Partners and their Regional and Country Offices. A senior independent person would be best placed to do this. Lessons learned report to be ready by end October 2016.

10 The GPEI leadership should make an intervention to urgently engage with the political leadership in Northern Sindh to establish a clear commitment and ownership of the goals of the Polio Programme. This should be done in consultation with the Pakistan Government and the Polio Programme leadership in this part of Pakistan. Political engagement secured by end-September 2016.

11 The GPEI should urgently review options for innovative approaches to environmental sampling in areas without substantial sewage systems. Environmental sampling programme
commenced in FATA by early November 2016.

12 Nigeria’s Presidential Task Force should reconvene–and the Executive Governors of each of the states should publicly reconfirm their commitment to the actions agreed in the Abuja Commitment. By end of September 2016.

Annals of Internal Medicine
6 September 2016, Vol. 165. No. 5
http://annals.org/issue.aspx

.
Original Research
The Anticipated Clinical and Economic Effects of 90–90–90 in South Africa
Rochelle P. Walensky, MD, MPH; Ethan D. Borre, BA; Linda-Gail Bekker, MD, PhD; Stephen C. Resch, PhD; Emily P. Hyle, MD, SM; Robin Wood, MMed, DSc (Med); Milton C. Weinstein, PhD; Andrea L. Ciaranello, MD, MPH; Kenneth A. Freedberg, MD, MSc; and A. David Paltiel, MBA, PhD
Abstract
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 global treatment target aims to achieve 73% virologic suppression among HIV-infected persons worldwide by 2020.
Objective: To estimate the clinical and economic value of reaching this ambitious goal in South Africa, by using a microsimulation model of HIV detection, disease, and treatment.
Design: Modeling of the “current pace” strategy, which simulates existing scale-up efforts and gradual increases in overall virologic suppression from 24% to 36% in 5 years, and the UNAIDS target strategy, which simulates 73% virologic suppression in 5 years.
Data Sources: Published estimates and South African survey data on HIV transmission rates (0.16 to 9.03 per 100 person-years), HIV-specific age-stratified fertility rates (1.0 to 9.1 per 100 person-years), and costs of care ($11 to $31 per month for antiretroviral therapy and $20 to $157 per month for routine care).
Target Population: South African HIV-infected population, including incident infections over the next 10 years.
Perspective: Modified societal perspective, excluding time and productivity costs.
Time Horizon: 5 and 10 years.
Intervention: Aggressive HIV case detection, efficient linkage to care, rapid treatment scale-up, and adherence and retention interventions toward the UNAIDS target strategy.
Outcome Measures: HIV transmissions, deaths, years of life saved, maternal orphans, costs (2014 U.S. dollars), and cost-effectiveness.
Results of Base-Case Analysis: Compared with the current pace strategy, over 5 years the UNAIDS target strategy would avert 873 000 HIV transmissions, 1 174 000 deaths, and 726 000 maternal orphans while saving 3 002 000 life-years; over 10 years, it would avert 2 051 000 HIV transmissions, 2 478 000 deaths, and 1 689 000 maternal orphans while saving 13 340 000 life-years. The additional budget required for the UNAIDS target strategy would be $7.965 billion over 5 years and $15.979 billion over 10 years, yielding an incremental cost-effectiveness ratio of $2720 and $1260 per year of life saved, respectively.
Results of Sensitivity Analysis: Outcomes generally varied less than 20% from base-case outcomes when key input parameters were varied within plausible ranges.
Limitation: Several pathways may lead to 73% overall virologic suppression; these were examined in sensitivity analyses.
Conclusion: Reaching the 90–90–90 HIV suppression target would be costly but very effective and cost-effective in South Africa. Global health policymakers should mobilize the political and economic support to realize this target.
Primary Funding Source: National Institutes of Health and the Steve and Deborah Gorlin MGH Research Scholars Award.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 10 September 2016)

Research article
Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization
Katherine Kentoffio, John D. Kraemer, Thomas Griffiths, Avi Kenny, Rajesh Panjabi, G. Andrew Sechler, Stephen Selinsky and Mark J. Siedner
BMC Health Services Research 2016 16:478
Published on: 7 September 2016
Abstract
Background
Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.
Methods
We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.
Results
Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).
Conclusions
Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 10 September 2016)

Debate
Research involving adults lacking capacity to consent: the impact of research regulation on ‘evidence biased’ medicine
Victoria Shepherd
Published on: 8 September 2016
Abstract
Background
Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a result of ‘evidence biased’ medicine.
Main Text
This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use (Clinical Trials) Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs.
Conclusion
The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 10 September 2016)
.
Research article
Spatiotemporal dynamics of the Ebola epidemic in Guinea and implications for vaccination and disease elimination: a computational modeling analysis
Marco Ajelli, Stefano Merler, Laura Fumanelli, Ana Pastore y Piontti, Natalie E. Dean, Ira M. Longini, M. Elizabeth Halloran and Alessandro Vespignani
Abstract
Background
Among the three countries most affected by the Ebola virus disease outbreak in 2014–2015, Guinea presents an unusual spatiotemporal epidemic pattern, with several waves and a long tail in the decay of the epidemic incidence.
Methods
Here, we develop a stochastic agent-based model at the level of a single household that integrates detailed data on Guinean demography, hospitals, Ebola treatment units, contact tracing, and safe burial interventions. The microsimulation-based model is used to assess the effect of each control strategy and the probability of elimination of the epidemic according to different intervention scenarios, including ring vaccination with the recombinant vesicular stomatitis virus-vectored vaccine.
Results
The numerical results indicate that the dynamics of the Ebola epidemic in Guinea can be quantitatively explained by the timeline of the implemented interventions. In particular, the early availability of Ebola treatment units and the associated isolation of cases and safe burials helped to limit the number of Ebola cases experienced by Guinea. We provide quantitative evidence of a strong negative correlation between the time series of cases and the number of traced contacts. This result is confirmed by the computational model that suggests that contact tracing effort is a key determinant in the control and elimination of the disease. In data-driven microsimulations, we find that tracing at least 5–10 contacts per case is crucial in preventing epidemic resurgence during the epidemic elimination phase. The computational model is used to provide an analysis of the ring vaccination trial highlighting its potential effect on disease elimination.
Conclusions
We identify contact tracing as one of the key determinants of the epidemic’s behavior in Guinea, and we show that the early availability of Ebola treatment unit beds helped to limit the number of Ebola cases in Guinea.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 10 September 2016)

Commentary
Infectious diseases epidemic threats and mass gatherings: refocusing global attention on the continuing spread of the Middle East Respiratory syndrome coronavirus (MERS-CoV)
Alimuddin Zumla, Abdulaziz N. Alagaili, Matthew Cotten and Esam I. Azhar
BMC Medicine 2016 14:132
Published on: 7 September 2016
Abstract
Media and World Health Organization (WHO) attention on Zika virus transmission at the 2016 Rio Olympic Games and the 2015 Ebola virus outbreak in West Africa diverted the attention of global public health authorities from other lethal infectious diseases with epidemic potential. Mass gatherings such as the annual Hajj pilgrimage hosted by Kingdom of Saudi Arabia attract huge crowds from all continents, creating high-risk conditions for the rapid global spread of infectious diseases. The highly lethal Middle Eastern respiratory syndrome coronavirus (MERS-CoV) remains in the WHO list of top emerging diseases likely to cause major epidemics. The 2015 MERS-CoV outbreak in South Korea, in which 184 MERS cases including 33 deaths occurred in 2 months, that was imported from the Middle East by a South Korean businessman was a wake-up call for the global community to refocus attention on MERS-CoV and other emerging and re-emerging infectious diseases with epidemic potential. The international donor community and Middle Eastern countries should make available resources for, and make a serious commitment to, taking forward a “One Health” global network for proactive surveillance, rapid detection, and prevention of MERS-CoV and other epidemic infectious diseases threats.

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 10 September 2016)

Research article
The social patterning of risk factors for noncommunicable diseases in five countries: evidence from the modeling the epidemiologic transition study (METS)
Associations between socioeconomic status (SES) and risk factors for noncommunicable diseases (NCD-RFs) may differ in populations at different stages of the epidemiological transition. We assessed the social p…
Silvia Stringhini, Terrence E. Forrester, Jacob Plange-Rhule, Estelle V. Lambert, Bharathi Viswanathan, Walter Riesen, Wolfgang Korte, Naomi Levitt, Liping Tong, Lara R. Dugas, David Shoham, Ramon A. Durazo-Arvizu, Amy Luke and Pascal Bovet

Debate
Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?
Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges….
Fauziah Rabbani, Leah Shipton, Franklin White, Iman Nuwayhid, Leslie London, Abdul Ghaffar, Bui Thi Thu Ha, Göran Tomson, Rajiv Rimal, Anwar Islam, Amirhossein Takian, Samuel Wong, Shehla Zaidi, Kausar Khan, Rozina Karmaliani, Imran Naeem Abbasi…

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 10 September 2016]

Research
Mapping of research on maternal health interventions in low- and middle-income countries: a review of 2292 publications between 2000 and 2012
Matthew Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Josephine Kavanagh, Ashar Dhana, Francisco Becerra-Posada, Langelihle Mlotshwa, Victor Becerril-Montekio, Priya Mannava, Stanley Luchters, Minh Duc Pham…
Published on: 6 September 2016
Abstract
Background
Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings.
Methods
Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on health systems strengthening, health promotion; and on five tracer conditions (haemorrhage, hypertension, malaria, HIV and other sexually transmitted infections (STIs)). Following review of 35,078 titles and abstracts in duplicate, data were extracted from 2292 full-text publications.
Results
Over time, the number of publications rose several-fold, especially in 2004–2007, and the range of methods used broadened considerably. More than half the studies were done in sub-Saharan Africa (55.4 %), mostly addressing HIV and malaria. This region had low numbers of publications per hypertension and haemorrhage deaths, though South Asia had even fewer. The proportion of studies set in East Asia Pacific dropped steadily over the period, and in Latin America from 2008 to 2012. By 2008–2012, 39.1 % of articles included health systems components and 30.2 % health promotion. Only 5.4 % of studies assessed maternal STI interventions, diminishing with time. More than a third of haemorrhage research included health systems or health promotion components, double that of HIV research.
Conclusion
Several mismatches were noted between research publications, and the burden and causes of maternal deaths. This is especially true for South Asia; haemorrhage and hypertension in sub-Saharan Africa; and for STIs worldwide. The large rise in research outputs and range of methods employed indicates a major expansion in the number of researchers and their skills. This bodes well for maternal health if variations in research priorities across settings and topics are corrected.

Health Affairs
September 2016; Volume 35, Issue 9
http://content.healthaffairs.org/content/current
Issue Focus: Payment Reforms, Prescription Drugs & More

Global
Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa
Hannah H. Leslie, Anna Gage, Humphreys Nsona, Lisa R. Hirschhorn, and Margaret E. Kruk
Health Aff September 2016 35:1716-1724; doi:10.1377/hlthaff.2016.0261
Abstract
In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest—at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18–40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 10 September 2016]

Research Article
Bibliometric study of research and development for neglected diseases in the BRICS
Large numbers of people are suffering from a group of diseases that mainly affect developing countries, as there are no available or affordable products for prevention or treatment. Research and development (R…
Jing Bai, Wei Li, Yang-Mu Huang and Yan Guo