PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 July 2016)
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Editorial
A Global Champion for Health—WHO’s Next?
The PLOS Medicine Editors
| published 28 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002059
[Excerpt]
… WHO’s next Director-General should be a proven leader and advocate, perhaps from a low-income or middle-income country. The new recruit will be greeted by a full in-tray, and featuring prominently are likely to be the constraints imposed by WHO’s current funding mechanisms. A substantial proportion of WHO’s existing budget is earmarked for specific projects, leaving the organization with little financial flexibility to respond to unanticipated demands. However, any improved funding mechanism is likely to follow, and be dependent on, organizational reform. According to Kruk, “WHO is both essential and hamstrung…the election of the Director-General should be a moment for member countries and other funders to reflect on whether they want an implementation agency for their favored health agenda, or an independent institution with the intelligence, agility, and operational capacity to tackle the coming global health challenges.”

Above all, the incoming leader of WHO will need to be open-minded and creative. More than one of the experts we contacted emphasized the fluid nature of the threats to human health to which WHO should shape the world’s response. WHO must be able to lead responses in some areas of global health, but, in other areas, working together with more nimble and focused organizations will be pragmatic. Large-scale infectious disease outbreaks are continuing, and noncommunicable diseases, including cancer, dementia, and mental illnesses, are growing in prevalence and increasing demand for treatment and care. The resources and ingenuity of researchers and clinicians will need to be harnessed, and interventions adapted to new settings, with much greater dynamism. The secular issues of population ageing, conflict, climate change, migration, and others will produce health problems that only an organization with a global reach, responsible to all, can hope to meet. We look forward to welcoming a new leader for WHO with the energy and vision to remold the organization to meet the health needs of the world’s people and societies for the 21st century.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 July 2016)
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Guidelines and Guidance |
Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement
Gretchen A. Stevens, Leontine Alkema, Robert E. Black, J. Ties Boerma, Gary S. Collins, Majid Ezzati, John T. Grove, Daniel R. Hogan, Margaret C. Hogan, Richard Horton, Joy E. Lawn, Ana Marušić, Colin D. Mathers, Christopher J. L. Murray, Igor Rudan, Joshua A. Salomon, Paul J. Simpson, Theo Vos, Vivian Welch, The GATHER Working Group
published 28 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002056

Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website (gather-statement.org).

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 July 2016)
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Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials
Benjamin Kasenda, Erik von Elm, John J. You, Anette Blümle, Yuki Tomonaga, Ramon Saccilotto, Alain Amstutz, Theresa Bengough, Joerg J. Meerpohl, Mihaela Stegert, Kelechi K. Olu, Kari A. O. Tikkinen, Ignacio Neumann, Alonso Carrasco-Labra, Markus Faulhaber, Sohail M. Mulla, Dominik Mertz, Elie A. Akl, Dirk Bassler, Jason W. Busse, Ignacio Ferreira-González, Francois Lamontagne, Alain Nordmann, Viktoria Gloy, Heike Raatz, Lorenzo Moja, Shanil Ebrahim, Stefan Schandelmaier, Xin Sun, Per O. Vandvik, Bradley C. Johnston, Martin A. Walter, Bernard Burnand, Matthias Schwenkglenks, Lars G. Hemkens, Heiner C. Bucher, Gordon H. Guyatt, Matthias Briel
| published 28 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002046
Abstract
Background
Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i) the existence and types of publication agreements in trial protocols, (ii) the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii) the frequency of co-authorship by industry employees.
Methods and Findings
We used a retrospective cohort of randomized clinical trials (RCTs) based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5%) mentioned an agreement regarding publication of results. Of these 456, 393 (86.2%) documented an industry partner’s right to disapprove or at least review proposed manuscripts; 39 (8.6%) agreements were without constraints of publication. The remaining 24 (5.3%) protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0%) trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]). Of 71 agreements reported in publications, 52 (73.2%) were concordant with those documented in the protocol. In 14 of 37 (37.8%) publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements.
Conclusions
Publication agreements constraining academic authors’ independence are common. Journal articles seldom report on publication agreements, and, if they do, statements can be discrepant with the trial protocol.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
[Accessed 2 July 2016]

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Editorial
Southern Europe’s Coming Plagues: Vector-Borne Neglected Tropical Diseases
Peter J. Hotez
| published 30 Jun 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004243
[Excerpts]
The factors responsible for promoting the vector-borne NTDs in Southern Europe are under investigation, but there are some key lead possibilities to consider:.
Poverty.
Throughout the world’s low- and middle-income countries, poverty is a major social determinant promoting the ongoing transmission of NTDs. Previous findings have determined that comparable levels of extreme poverty can also be found among the G20 countries and are also contributing to widespread NTDs [32,33]. It is interesting to note how the emergence or re-emergence of Southern Europe’s major NTDs roughly coincides with the European debt crisis that began in 2009 when countries such as Greece, Portugal, and Spain experienced difficulties in repaying their government debts without outside assistance. Ultimately, Greece defaulted on its debt to the International Monetary Fund in 2015, thereby precipitating a financial crisis linked to high unemployment. There is an important need to better understand the link between poverty and NTDs. So far, it has been found that NTDs flourish in impoverished settings, but also that NTDs exhibit a unique ability to reinforce poverty through their debilitating effects on workers, women, and growing and developing children.

Mass human migrations.
Still another key social factor may be the humanitarian crisis linked to hundreds of thousands of people fleeing conflicts in Libya, Syria, and Iraq due to the occupation of ISIS [34]. In so doing, they could be introducing or re-introducing NTDs endemic to the Middle East and North Africa, including the vector-borne NTDs highlighted above. For example, cutaneous leishmaniasis in Syria, where it is often known as “Aleppo Evil,” has reached hyperendemic proportions due to breakdowns in health systems and lack of access to essential medicine, with at least tens of thousands of new cases annually [35]. Quite possibly both cutaneous leishmaniasis and sand fly vectors are being routinely re-introduced into Southern Europe.

Climate change.
Finally, it has been noted that outside of the Arctic region, Europe’s single largest temperature increases associated with serious heat waves are now occurring in Southern Europe [36]. The factors promoting climate change include increased greenhouse gas emissions as a result of agriculture; burning of coal, oil, and gas (fossil fuels); landfills; and industrial pollutants [36]. Increased temperatures are helping to facilitate the survival and longevity of insects and snails with the capacity to transmit NTDs. Climate change may also promote the spread of some of Southern Europe’s vector-borne NTDs to Northern Europe, including WNV and leishmaniasis [19,37]…

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 2 July 2016)

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Pearls
Lessons from Nature: Understanding Immunity to HCV to Guide Vaccine Design
Zachary T. Freeman, Andrea L. Cox
| published 30 Jun 2016 | PLOS Pathogens
http://dx.doi.org/10.1371/journal.ppat.1005632
[Initial text]
Hepatitis C virus (HCV) is an important global health concern with approximately 185 million people infected [1]. HCV infection most often leads to chronic infection with few early symptoms, but chronically infected individuals can develop liver cirrhosis and hepatocellular carcinoma. Genome-wide association studies in humans have identified innate associated genes and HLA class II as important predictors of spontaneous clearance of HCV [2,3], but the correlates of protective immunity are not fully defined. The existence of few models to study protective immunity has hindered vaccine development research. Despite this limitation, significant advancements have been made in our understanding of protective immune responses to HCV using the chimpanzee model and humans exposed to HCV (Fig 1)…

Science
01 July 2016 Vol 353, Issue 6294
http://www.sciencemag.org/current.dtl

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Feature
South Africa’s bid to end AIDS
By Jon Cohen
Science01 Jul 2016 : 18-21
The tools exist, but the country’s epidemic—the largest in the world—won’t yield easily.
Summary
South Africa has more people living with HIV, an estimated 6.6 million, than any country in the world. About half are now receiving antiretroviral (ARV) treatment, which has greatly stressed the country’s health care system. Now, South Africa plans to encourage all infected people to learn their status and start treatment as part of the drive to end its epidemic. The cornerstone of the campaign is the fact that HIV-infected people who take ARVs and fully suppress their virus rarely transmit to others. Mathematical models suggest that 73% of the infected population has to achieve this to slow spread and start the epidemic’s downward spiral. South Africa has pledged to hit this target by 2020, in keeping with a global goal set by the Joint United Nations Programme on HIV/AIDS, but many experts doubt it can succeed by then—and others question the model itself. When the biannual International AIDS Conference takes place in Durban, South Africa, later this month, these issues likely will be in center stage.

Science Translational Medicine
29 June 2016 Vol 8, Issue 345
http://stm.sciencemag.org/

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Perspective
Multicriteria decision analysis and core values for enhancing vaccine-related decision-making
By Michèle A. Barocchi, Steve Black, Rino Rappuoli
Science Translational Medicine29 Jun 2016 : 345ps14
Abstract
Vaccines have the potential to transform the health of all individuals and to reduce the health inequality between rich and poor countries. However, to achieve these goals, it is no longer sufficient to prioritize vaccine development using cost-effectiveness as the sole indicator. During a symposium entitled “Mission Grand Convergence—The Role of Vaccines,” held in Siena, Italy, in July 2015, key stakeholders agreed that the prioritization of vaccine development and deployment must use multicriteria decision-making based on the following core concepts: (i) mortality and severity of the disease, (ii) vaccine safety considerations, and (iii) economic evaluation that captures the full benefits of vaccination.

Social Science & Medicine
Volume 158, Pages 1-172 (June 2016)
http://www.sciencedirect.com/science/journal/02779536/156

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Regular articles
Long-term health implications of school quality
Original Research Article
Pages 1-7
Rebecca N. Dudovitz, Bergen B. Nelson, Tumaini R. Coker, Christopher Biely, Ning Li, Lynne C. Wu, Paul J. Chung
Abstract
Objective
Individual academic achievement is a well-known predictor of adult health, and addressing education inequities may be critical to reducing health disparities. Disparities in school quality are well documented. However, we lack nationally representative studies evaluating the impact of school quality on adult health. We aim to determine whether high school quality predicts adult health outcomes after controlling for baseline health, socio-demographics and individual academic achievement.
Methods
We analyzed data from 7037 adolescents who attended one of 77 high schools in the Unites States and were followed into adulthood from the National Longitudinal Study of Adolescent to Adult Health. Selected school-level quality measures—average daily attendance, school promotion rate, parental involvement, and teacher experience—were validated based on ability to predict high school graduation and college attendance. Individual adult health outcomes included self-rated health, diagnosis of depression, and having a measured BMI in the obese range.
Results
Logistic regressions controlling for socio-demographics, baseline health, health insurance, and individual academic performance demonstrated that school quality significantly predicted all health outcomes. As hypothesized, attending a school with lower average daily attendance predicted lower self-rated health (Adjusted Odds Ratio (AOR) 1.59, p = 0.003) and higher odds of depression diagnosis (AOR 1.35, p = 0.03); and attending a school with higher parent involvement predicted lower odds of obesity (AOR 0.69, p = 0.001). However, attending a school with higher promotion rate also predicted lower self-rated health (AOR1.20, p < 0.001).
Conclusions
High school quality may be an important, but complex, social determinant of health. These findings highlight the potential inter-dependence of education and health policy.

Vaccine
Volume 34, Issue 30, Pages 3435-3556 (24 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/30

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Conference report
Emergency deployment of genetically engineered veterinary vaccines in Europe
Pages 3435-3440
Bahar Ramezanpour, Jean de Foucauld, Jeroen Kortekaas
Abstract
On the 9th of November 2015, preceding the World Veterinary Vaccine Congress, a workshop was held to discuss how veterinary vaccines can be deployed more rapidly to appropriately respond to future epizootics in Europe. Considering their potential and unprecedented suitability for surge production, the workshop focussed on vaccines based on genetically engineered viruses and replicon particles. The workshop was attended by academics and representatives from leading pharmaceutical companies, regulatory experts, the European Medicines Agency and the European Commission. We here outline the present regulatory pathways for genetically engineered vaccines in Europe and describe the incentive for the organization of the pre-congress workshop. The participants agreed that existing European regulations on the deliberate release of genetically engineered vaccines into the environment should be updated to facilitate quick deployment of these vaccines in emergency situations.

Vaccine
Volume 34, Issue 30, Pages 3435-3556 (24 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/30

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A national examination of pharmacy-based immunization statutes and their association with influenza vaccinations and preventive health
Original Research Article
Pages 3463-3468
Kevin W. McConeghy, Coady Wing
Abstract
Background
A series of state-level statute changes have allowed pharmacists to provide influenza vaccinations in community pharmacies. The study aim was to estimate the effects of pharmacy-based immunization statutes changes on per capita influenza vaccine prescriptions, adult vaccination rates, and the utilization of other preventive health services.
Methods
A quasi-experimental study that compares vaccination outcomes over time before and after states allowed pharmacy-based immunization. Measures of per capita pharmacy prescriptions for influenza vaccines in each state came from a proprietary pharmacy prescription database. Data on adult vaccination rates and preventive health utilization were studied using multiple waves of the Behavioral Risk Factor Surveillance System (BRFSS). The primary outcomes were changes in per capita influenza vaccine pharmacy prescriptions, adult vaccination rates, and preventive health interventions following changes.
Results
Between 2007 and 2013, the number of influenza vaccinations dispensed in community pharmacies increased from 3.2 to 20.9 million. After one year, adopting pharmacist immunization statutes increased per capita influenza vaccine prescriptions by an absolute difference (AD) of 2.6% (95% CI: 1.1–4.2). Adopting statutes did not lead to a significant absolute increase in adult vaccination rates (AD 0.9%, 95% CI: −0.3, 2.2). There also was no observed difference in adult vaccination rates among adults at high-risk of influenza complications (AD 0.8%, 95% CI: −0.2, 1.8) or among standard demographic subgroups. There also was no observed difference in the receipt of preventive health services, including routine physician office visits (AD −1.9%, 95% CI: −4.9, 1.1).
Conclusions
Pharmacists are providing millions of influenza vaccines as a consequence of immunization statutes, but we do not observe significant differences in adult influenza vaccination rates. The main gains from pharmacy-based immunization may be in providing a more convenient way to obtain an important health service.

Vaccine
Volume 34, Issue 30, Pages 3435-3556 (24 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/30

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Human papillomavirus vaccine series completion: Qualitative information from providers within an integrated healthcare organization
Original Research Article
Pages 3515-3521
Sharon M. Hudson, June Rondinelli, Beth A. Glenn, Melissa Preciado, Chun Chao
Abstract
Objective
This qualitative study aimed to identify doctors’ and nurses’ perceptions of patient-, provider-, and system-level factors associated with human papillomavirus (HPV) vaccine completion that may be targets for intervention.
Methods
We analyzed data from 61 qualitative interviews with pediatricians, family medicine physicians, and immunization nurses at medical centers that had the highest and lowest HPV vaccine completion rates within the same health care system.
Results
In both groups, almost all providers reported strong support for the HPV vaccine. In detailing how they talk to parents and patients about the vaccine, more of the providers working at higher completion centers described using effective communication techniques, including engaging parents and patients in two-way conversation and demonstrating awareness of cultural and practical barriers to completion that families may face. Providers at higher completion centers were also more likely to depict a local medical culture supportive of and committed to HPV vaccine completion, with greater levels of proactivity and teamwork. In contrast, providers working at lower completion medical centers described a lack of proactivity, and the strategies they suggested to improve HPV vaccine completion tended to be approaches that someone other than medical providers would implement. The comments made by these providers sometimes reflected a level of negativity and judgment absent from the comments of providers at higher completion centers.
Conclusion
Interventions to improve HPV vaccination completion rates should address both individual- and system-level factors. Improving communication skills, encouraging a supportive medical culture, and addressing resource issues is likely to improve vaccine adherence.

Vaccine
Volume 34, Issue 30, Pages 3435-3556 (24 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/30

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Special Section: National Foundation for Infectious Diseases (Guest Editor: Raphael Simon)
Introduction to issue of highlighted research presented at the 2015 National Foundation for Infectious Diseases Annual Conference on Vaccine Research
Pages 3522-3524
Walter A. Orenstein, Raphael Simon

AIDS Research and Human Retroviruses
Online Ahead of Editing: June 27, 2016

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The Landscape of Targeted Immune Responses in the HIV-1 Vaccine Field
Dr. Jeffrey T. Safrit, Dr. Georgia D Tomaras, Dr. Tomas Hanke, Dr. Allan C. deCamp, and Dr. Yegor Voronin
ABSTRACT
We conducted a survey of researchers that are advancing HIV-1 preventive vaccine candidates through early stages of clinical testing. We asked the researchers to identify immune responses that they view as potentially protective against HIV-1 infection. Survey results were visualized to obtain a high-level visual representation of the landscape of current hypotheses in the field. We observed a vibrant field with candidates targeting diverse immunological responses, illustrating the multiple underlying competing and complementing hypotheses as well as divergent approaches to vaccine development. Our analysis provides a unique view at the HIV-1 preventive vaccine field and similar approaches could be used to facilitate strategic planning across multiple stakeholders working on an HIV-1 vaccine.

American Society of Tropical Medicine and Hygiene
Published online June 27, 2016; doi:10.4269/ajtmh.16-0222.
The latest version is at http://ajtmh.org/cgi/doi/10.4269/ajtmh.16-0222

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Licensed Dengue Vaccine: Public Health Conundrum and Scientific Challenge
Scott B. Halstead1*
1Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Abstract
A tetravalent live attenuated vaccine composed of chimeras of yellow fever 17D and the four dengue viruses (chimeric yellow fever dengue [CYD]) manufactured by Sanofi Pasteur has completed phase III clinical testing in over 35,000 children 2–16 years of age. The vaccine was recently licensed in four countries. During the first 2 years of observation, CYD vaccine efficacy ranged between 30% and 79% in 10 different countries with an overall efficacy of 56.8%. During year 3, there was an overall efficacy against hospitalization of 16.7%, but a relative risk of hospitalization of 1.6 among children younger than 9 years and 4.95 in children 5 years of age and younger. Vaccination of seronegative children resulted in universal broad dengue neutralizing antibody responses, but poor protection against breakthrough dengue cases. Unless proven otherwise, such breakthrough cases in vaccinated subjects should be regarded as vaccine antibody-enhanced (ADE). The provenance of these cases can be studied serologically using original antigenic sin immune responses in convalescent sera. In conventional dengue vaccine efficacy clinical trials, persons vaccinated as seronegatives may be hospitalized with breakthrough ADE infections, whereas in the placebo group, dengue infection of monotypic immunes results in hospitalization. Vaccine efficacy trial design must identify dengue disease etiology by separately measuring efficacy in seronegatives and seropositives. The reason(s) why CYD vaccine failed to raise protective dengue virus immunity are unknown. To achieve a safe and protective dengue vaccine, careful studies of monotypic CYD vaccines in humans should precede field trials of tetravalent formulations.

Journal of Medical Internet Research
2016;18(6):e143
DOI: 10.2196/jmir.5591
Original Paper
Feasibility and Limitations of Vaccine Two-Dimensional Barcoding Using Mobile Devices
Cameron Bell1, BEng; Julien Guerinet1, BEng; Katherine M Atkinson1,2, BSc; Kumanan Wilson1,3, MD, MSc, FRCP(C)
1Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
2Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
3University of Ottawa, Departments of Medicine, Epidemiology and Community Medicine, Ottawa, ON, Canada
ABSTRACT
Background: Two-dimensional (2D) barcoding has the potential to enhance documentation of vaccine encounters at the point of care. However, this is currently limited to environments equipped with dedicated barcode scanners and compatible record systems. Mobile devices may present a cost-effective alternative to leverage 2D vaccine vial barcodes and improve vaccine product-specific information residing in digital health records.
Objective: Mobile devices have the potential to capture product-specific information from 2D vaccine vial barcodes. We sought to examine the feasibility, performance, and potential limitations of scanning 2D barcodes on vaccine vials using 4 different mobile phones.
Methods: A unique barcode scanning app was developed for Android and iOS operating systems. The impact of 4 variables on the scan success rate, data accuracy, and time to scan were examined: barcode size, curvature, fading, and ambient lighting conditions. Two experimenters performed 4 trials 10 times each, amounting to a total of 2160 barcode scan attempts.
Results: Of the 1832 successful scans performed in this evaluation, zero produced incorrect data. Five-millimeter barcodes were the slowest to scan, although only by 0.5 seconds on average. Barcodes with up to 50% fading had a 100% success rate, but success rate deteriorated beyond 60% fading. Curved barcodes took longer to scan compared with flat, but success rate deterioration was only observed at a vial diameter of 10 mm. Light conditions did not affect success rate or scan time between 500 lux and 20 lux. Conditions below 20 lux impeded the device’s ability to scan successfully. Variability in scan time was observed across devices in all trials performed.
Conclusions: 2D vaccine barcoding is possible using mobile devices and is successful under the majority of conditions examined. Manufacturers utilizing 2D barcodes should take into consideration the impact of factors that limit scan success rates. Future studies should evaluate the effect of mobile barcoding on workflow and vaccine administrator acceptance.

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

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 2 July 2016
Zika Is the ‘Most Difficult’ Emergency Health Response Ever, CDC Official Says
24 June 2016 Julie Beck
How the virus is spread, its disproportionate danger for pregnant women, and the delay in its worst effects combine to make this outbreak particularly tough.

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Forbes
http://www.forbes.com/
Accessed 2 July 2016
The Hunt For A Zika Vaccine: Why The Olympics Should Be Postponed
It will likely be two years or more before a vaccine can come to market …
Kenneth L. Davis, Contributor Jun 30, 2016

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The Guardian
http://www.guardiannews.com/
Accessed 2 July 2016
More people in less space: rapid urbanisation threatens global health
As city populations swell worldwide, our ability to prevent and control infectious disease will come under ever greater strain
28 June 2016
By Seth Berkley
The global population looks set to rise to 9.7 billion people by 2050, when it is expected that more than two-thirds of humanity will be living in urban areas. The global health community is bracing itself. Compared to a more traditional rural existence, the shift in lifestyle and inevitable increase in exposure to pollution will lead to significant long-term rises in non-communicable diseases such as cancer and cardiovascular disease.
Austin Fraktimmediate problems…

Zika virus vaccine for animals brings hope for human protection
Trial version in US giving successful immunisation to mice could help fight disease, but complications warned for those who have contracted dengue fever
28 June 2016
Ian Sample, Science editor
An experimental vaccine that completely protects animals from the Zika virus has raised hopes for a jab that can bring the fast-spreading disease under control…

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New York Times
http://www.nytimes.com/
Accessed 2 July 2016
Low Prices for Vaccines Can Come at a Great Cost
Austin Frakt 27 June 2016
A $30,000 price tag for cancer drug therapy that extends life only a few weeks is understandably alarming. But a $2,000 price tag for all childhood vaccines — credited with eradicating smallpox, preventing a million or more cases of other diseases and averting thousands of deaths each year — is a bargain. In fact, the price of childhood vaccines may be too low for our own good because it contributes to shortages.

Vaccine shortages have popped up in the United States many times over the past 50 years. In 2001, eight of 11 recommended childhood vaccines were unavailable or in short supply. A recently published study by the economist David Ridley and other Duke University researchers found that between 2004 and 2014, an average of nearly three out of 22 vaccines were in short supply in the United States. In 2007, one-third of vaccines were. (Looking globally, limited vaccine supplies hampered the response to a recent yellow fever outbreak that began in Angola and spread elsewhere.)

Vaccine prices have gone up over the years, in large part because of newer vaccines that command higher prices. The number of recommended vaccine doses has also increased, which pushes up the overall cost of full vaccination. Still, vaccines are inexpensive relative to their value. A typical dose costs $50 and, apart from an annual flu shot, only a few doses are required over a lifetime. According to the Duke study, vaccines with lower prices were more likely to be in short supply than those with higher prices. There were no shortages of vaccines with a price per dose above $75…

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 2 July 2016
World
Refugee Crises in Mideast Spawn Health Threats
Years of conflict leave millions of displaced people vulnerable to communicable diseases
By Nour Malas
Updated June 27, 2016 6:22 p.m. ET
QAB ELIAS, Lebanon—Hundreds of thousands of Syrian refugees scattered in makeshift camps among the farms in the fertile Bekaa Valley are facing an increasingly worrisome threat: disease…

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Washington Post
http://www.washingtonpost.com/
Accessed 2 July 2016
Why researchers are releasing millions of mosquitoes to combat the Zika virus
30 June 2016
In the world’s largest mosquito farm, millions of males are being bred at a furious pace for release on an island in Southern China. It’s all part of a plan to suppress a mosquito that can transmit the Zika virus. And so far, the results are stunning. The man behind this government-backed experiment is Xi Zhiyong, professor at Sun Yat-sen University in Guangzhou, China. Inside the fluorescent compound, Xi and a team of researchers are experimenting with using the biology of the Aedes mosquito against itself. The process goes like this. Male mosquitoes are infected with Wolbachia bacteria, which does two things: inhibit the Zika virus and disrupt the reproduction process. Researchers then cart the mosquitoes out to Shazai Island, where they are set free…

A yellow fever epidemic in Angola could turn into a global crisis
26 June 2016
Almost 80 years after the yellow fever vaccine was created in a New York laboratory, a massive outbreak of the disease has killed hundreds of people in this country, where most were never immunized. Now, the virus is jumping across borders into other nations whose populations are also largely unvaccinated. More than 3,000 suspected cases are in Angola and 1,000 are in neighboring Congo, making this the biggest urban epidemic in decades. More than 400 people have died. There are growing concerns that Chinese workers — of whom there are thousands in Angola — will carry the virus to Asia, where nearly all of the rural poor are also unvaccinated…

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_25 June 2016

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

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

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

Zika virus [to 25 June 2016]
Public Health Emergency of International Concern (PHEIC)
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 23 June 2016
Full report: http://apps.who.int/iris/bitstream/10665/246112/1/zikasitrep-23Jun2016-eng.pdf?ua=1
Summary [Initial text]
As of 22 June 2016, 61 countries and territories report continuing mosquito-borne transmission (Fig. 1) of which:
:: 47 countries are experiencing a first outbreak of Zika virus since 2015, with no previous evidence of circulation, and with ongoing transmission by mosquitoes.
:: 14 countries reported evidence of Zika virus transmission between 2007 and 2014, with ongoing transmission…

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Zika Open [to 25 June 2016]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

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CDC/ACIP [to 25 June 2016]
http://www.cdc.gov/media/index.html
MMWR, June 24, 2016 / Vol. 65 / No. 24
:: Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016
:: Zika Virus Surveillance and Preparedness — New York City, 2015–2016

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WHO European Region EURO
24-06-2016
European countries agree to build on existing systems for rapid response to Zika virus
Countries in Europe need to build on existing systems for vector control, disease surveillance, laboratory testing and emergency risk communications in order to strengthen their preparedness and response to Zika virus, and prevent or contain quickly any outbreak in Europe.

This is the main conclusion reached at a meeting of 18 European countries at high or moderate likelihood of Zika virus transmission. Experts from these countries gathered in Lisbon, Portugal, during 22–24 June 2016 to participate in the WHO regional technical consultation on Zika virus for Europe.

The 80 participants with expertise in epidemiology, entomology, laboratory diagnosis and risk communications found the meeting timely and useful in preparing for a possible Zika virus outbreak. They discussed the experience in responding to Zika virus in Brazil and the Americas as well as in addressing previous vector-borne disease outbreaks in Europe.

They recommended that all four pillars of Zika virus response — vector control, disease surveillance, laboratory testing and emergency risk communications — are better integrated. Interventions should focus on:
:: preparing now and acting early;
:: selecting the most effective interventions in different scenarios of Zika virus transmission and related complications;
:: addressing vector-borne diseases as a whole; and
:: coordinating centrally and acting locally.

Countries called on WHO to support them with guidance, standards, templates and trainings in all pillars of Zika virus preparedness and response. They recommended that the Organization should facilitate sharing of information, expertise and best practice and provide support in case of a Zika virus outbreak.

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NIH [to 25 June 2016]
http://www.nih.gov/news-events/news-releases
June 21, 2016
NIH launches large study of pregnant women in areas affected by Zika virus
International effort to enroll approximately 10,000 women
The National Institutes of Health and Fundacao Oswaldo Cruz-Fiocruz (Fiocruz), a national scientific research organization linked to the Brazilian Ministry of Health, have begun a multi-country study to evaluate the magnitude of health risks that Zika virus infection poses to pregnant women and their developing fetuses and infants. The study is opening in Puerto Rico and will expand to several locations in Brazil, Colombia and other areas that are experiencing active local transmission of the virus.

Zika virus is spread primarily through bites from infected Aedes aegypti mosquitoes, although other forms of transmission — notably, mother-to-child and sexual transmission — also occur. Active virus transmission currently is ongoing in 60 countries and territories. The virus has been linked to a spike in cases of microcephaly, a condition in which babies are born with abnormally small heads and possible neurological damage, sparking international concern. In addition to microcephaly, other problems have been detected in pregnancies and among fetuses and infants infected with Zika virus before birth, including miscarriage, stillbirth, absent or poorly developed brain structures, eye defects, hearing deficits, and impaired growth.

The Zika in Infants and Pregnancy (ZIP) study aims to enroll as many as 10,000 pregnant women ages 15 years and older at up to 15 sites. The participants will be in their first trimester of pregnancy and will be followed throughout their pregnancies to determine if they become infected with Zika virus and if so, what outcomes result for both mother and child. The participants’ infants will be carefully followed for at least one year after birth.

The National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Environmental Health Sciences (NIEHS), all part of the NIH, are funding and conducting the study, along with Fiocruz.

“The full scope of the effect of Zika virus in pregnancy has not yet been fully determined,” said NIAID Director Anthony S. Fauci, M.D. “This large prospective study promises to provide important new data that will help guide the medical and public health responses to the Zika virus epidemic.”…

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Wellcome Trust [to 25 June 2016]
http://www.wellcome.ac.uk/News/2016/index.htm
News 23 June 2016
Dengue exposure may ‘amplify’ Zika infection
People who have previously been infected with the dengue virus may be more at risk from Zika.
Early-stage laboratory research, part-funded by Wellcome, suggests that the recent outbreak of Zika in South America may have been driven in part by the high prevalence of dengue in the region.

“We now need further studies to confirm these findings, and to progress towards a vaccine,” said senior author Professor Gavin Screaton from Imperial College London.

Researchers from the UK, France and Thailand found that antibodies the body makes against dengue can also react to the Zika virus.
But instead of clearing the Zika virus, the antibodies instead allow it to enter cells where it can quickly replicate. Higher levels of Zika in the blood may in turn lead to increased transmission of the virus.

This phenomenon, known as antibody-dependent enhancement, is seen also seen in dengue and is thought to explain why a second dengue infection is often more serious than the first.

Dengue and Zika are very similar viruses. They are members of the same virus ‘family’ – called flaviviridae – and both are transmitted by the Aedes mosquito.

The research results appear in two new studies published today in Nature and Nature Immunology.  For more information, please read the Imperial College press release.

EBOLA/EVD [to 25 June 2016]
“Threat to international peace and security” (UN Security Council)

[Editor’s Note:
We deduce that WHO has suspended issuance of new Situation Reports after resuming them for several weekly cycles. Most recent report summary below]

EBOLA VIRUS DISEASE – Situation Report – 10 JUNE 2016
[Excerpt]
Risk assessment:
Guinea and Liberia declared the end of the most recent outbreak of EVD on 1 and 9 June, respectively. The performance indicators suggest that Guinea, Liberia and Sierra Leone still have variable capacity to prevent, detect and respond to new outbreaks (Table 1). The risk of additional outbreaks originating from exposure to infected survivor body fluids remains and requires sustained mitigation through counselling on safe sex practices and testing of body fluids.

POLIO [to 25 June 2016]
Public Health Emergency of International Concern (PHEIC)

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Polio this week as of 21 June 2016
:: On 24 June, stakeholders of the Global Polio Eradication Initiative including member states and donors are gathering in Geneva at the meeting of the Polio Partners Group to review progress and discuss the trivalent to bivalent oral polio vaccine switch, transition planning and the financial resources urgently needed to see eradication through to the end.

:: The knowledge, skills and infrastructure built to end polio are helping to make dramatic progress on improving children’s health more broadly. In this factsheet discover how the eradication infrastructure is expanding the reach of health services, improving disease surveillance and building health worker capacity. By planning now, we can keep the world polio-free and ensure that the investments made in ending polio have a broad and lasting impact on children’s health and development, long after polio is gone.

Selected Country Levels Updates [excerpted]
No new case reports in affected countries

Yellow Fever [to 25 June 2016]
http://www.who.int/emergencies/yellow-fever/en/

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Launch of emergency vaccination campaigns on the DR Congo and Angola border – WHO
Brazzaville, 22 June 2016 – As the yellow fever outbreak in Angola and Democratic Republic of the Congo continues, the World Health Organization will launch emergency pre-emptive vaccination campaigns on the DR Congo, Angola border and the city of Kinshasa in the DR Congo to halt the epidemic and prevent the risk of further international spread.

The initial phase of the campaign which begins in July will focus on districts where there is high movement of people and intense trade activities, particularly the northern border districts of Angola and targeted border districts in neighbouring countries. Specifically, within a 75-100km belt spanning the border between Angola and DR Congo and targeted health zones/communes at risk in Kinshasa city in the DR Congo. This will create an immune buffer to prevent further international spread.

Important gains in preventive vaccination campaigns have been achieved. So far more than 15 million doses of vaccine have been delivered to Angola and DR Congo. However, the urgent need to accelerate vaccination campaigns and the lack of sufficient funds for field operational activities, remain a challenge in Angola and DR Congo.

“While WHO is working with partners and vaccine manufacturers to increase vaccine production and replenish the emergency stockpile currently being used for this outbreak, it is vital to interrupt transmission, especially in cross-border areas to rapidly bring this outbreak under control and halt further international spread,” said Dr Matshidiso Moeti, the World Health Organization Regional Director for Africa.

Angola and DR Congo are being supported by WHO and partners to strengthen yellow fever screening for evidence at all major points of entry including – Luanda, Kinshasa, Lubumbashi and Matadi. Yellow fever vaccination is being offered at these points of entry for eligible travelers.

“WHO will continue to work with partners to scale up the required human resources, financial and other logistics so that response teams are present in every province of Angola where cases have been reported or where there is high risk. WHO will also continue its resource mobilization efforts as more resources are needed to address the operational challenges in Angola. In addition, to this a multidisciplinary team of experts will next week begin an evaluation of the response efforts in Angola and DR Congo and address any gaps.” the Regional Director added.

As of 13 June 2016, three countries – China, Kenya, and the Democratic Republic of the Congo – had reported cases linked to the Angola outbreak. An alert issued by the Republic of Congo is under investigation by a joint Ministry of Health, WHO and UNICEF team. Two suspected cases of yellow fever earlier reported in Sao Tome and Principe were investigated and have been ruled out. Another outbreak of yellow fever reported in Uganda and not linked to the Angola outbreak has been controlled.

As of 19 June 2016, 1106 suspected cases, including 75 deaths, had been reported in the country in five provinces (Bas-Uélé, Kwango, Tshuapa, Kongo Central and Kinshasa). At least 7 cases are confirmed as locally transmitted. WHO has dispatched multidisciplinary teams to Kongo Central, Kwango and Kinshasa provinces and is supporting the country with active case investigations, reactive vaccination and social mobilization activities.

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Yellow Fever – Situation Report – 16 June 2016
Full Report:
http://www.who.int/emergencies/yellow-fever/situation-reports/23-june-2016/en/

MERS-CoV [to 25 June 2016]

Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 22 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 19 June 2016

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WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia
23 June 2016
Between 19-22 June 2016, WHO published 3 reports on the Disease Outbreak News (DON) describing 25 cases of Middle East Respiratory Syndrome (MERS). Twenty-four of the cases were identified as having contact with a probable, single index case who was diagnosed with MERS in a hospital in Riyadh City, Riyadh Region. The 22 June 2016 DON reported that the index case had died.

Based on available information, the probable index case is a woman who presented on 10 June 2016 to the hospital with a critical health condition, not consistent with MERS symptoms. She was triaged in the emergency room of the hospital and admitted to the vascular surgery ward. Following admission the patient showed signs of respiratory illness, and MERS was suspected. The hospital diagnosed and confirmed MERS on 12 June 2016, within 48 hours of her original admission. The patient’s MERS clinical symptoms were initially masked by other predominant symptoms.

Immediately following diagnosis the Ministry of Health of Saudi Arabia dispatched a rapid response team to the hospital. The team conducted active screening and contact tracing to identify health care workers, visitors, patients and household contacts who may have been exposed to MERS by the probable index patient. In addition, other public health control measures were immediately implemented in the hospital to limit further transmission.

As of 22 June 2016 twenty-four (24) contacts have tested positive for MERS including twenty (20) healthcare contacts and three (3) household contacts. In addition, one case has been diagnosed in a household contact of a hospital patient who was diagnosed with the disease after exposure to the probable index case. Twenty (20) of the twenty-four (24) have not exhibited any MERS symptoms.

According to WHO General-Director Margaret Chan “the Kingdom of Saudi Arabia has worked to improve its response to this challenging disease, especially through infection prevention and control in health care facilitates. Diagnosis is often complicated in patients affected by multiple co-morbidities.”

Globally since September 2012 WHO has been notified of over 1,700 laboratory-confirmed cases of infection with MERS, in 27 countries, including more than 600 related deaths…

WHO & Regional Offices [to 25 June 2016]

Health advice for the Rio 2016 Olympic and Paralympic Games
21 June 2016 – WHO, today, releases health advice for the Rio 2016 Olympic and Paralympic Games geared towards national health authorities and health workers. The health advice gives measures travellers can take to be as safe as possible from any public health risk. WHO provides advice and support to host governments preparing for mass gathering events, including major sporting, religious, and cultural events.
:: Read the health advice

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Highlights
Research and development blueprint to prevent epidemics
June 2016 — WHO’s research and development blueprint is a global strategy that accelerates lifesaving R&D during epidemics. The strategy aims to fast-track the availability of effective tests, vaccines and medicines when they are most needed in emergency situations.

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Antiretroviral therapy reduces risk of life-threatening infections from HIV
June 2016 — Two new WHO studies confirm that HIV-related deaths can be dramatically reduced in both adults and children if access to antiretroviral therapy is provided as soon as possible, regardless of the stage of HIV infection. Opportunistic infections are the major cause of death for people with HIV.

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Weekly Epidemiological Record (WER) 24 June 2016, vol. 91, 25 (pp. 317–328)
Contents
317 Maternal and neonatal tetanus validation assessment in Region 4, Indonesia, May 2016

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Disease Outbreak News (DONs)
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 22 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 21 June 2016
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 19 June 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: From refusal to promotion: Religious leaders in Lunda Norte, Angola agree to advocate for yellow fever vaccination
The district health authorities, WHO and the Red Cross on 19 June 2016, met with leaders of one religious group based in Estufa neighbourhood, Chitato district, Lunda North province to explain the importance of yellow fever vaccination in protecting members of their communities from the disease.

The religious group is known for refusing any kind of medical assistance including vaccination. In the first encounter, the religious leaders resisted vaccination on the basis of biblical teachings. However following discussions between WHO and the pastors during which WHO’s mission was explained as Ensuring that all people stay healthy, a common ground was reached. WHO also helped the pastors define the meaning of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The group’s religious leader, Abel Moisés concluded that both the partners and they shared the same mission.
“In accordance with our faith, believers may be vaccinated,” said Moisés.

Moisés proceeded to orient the church members on the benefits of yellow fever vaccination, which they accepted to take. Among those who later went to seek vaccination was a pastor from the group. Since then 711 people have been vaccinated in this community.

The social mobilization team then visited three other churches and requested its religious leaders to share information on the benefits of yellow fever vaccination with the congregation. This helped to mobilize church members for vaccination at the nearby booth.

“Collaborating with religious leaders is a priority for WHO because of their influence in the community.” said Dr Hernando Agudelo, WHO Representative Angola. “By bringing religion and health together, we are able to properly inform communities and mobilize them to protect themselves in order to stop yellow fever in its tracks.”

Vaccine refusal puts members of the community at risk of the country’s yellow fever outbreak. To date 861 cases of yellow fever cases have been confirmed in Angola since December 2015…

:: Launch of emergency vaccination campaigns on the DR Congo and Angola border – 22 June 2016

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: European countries agree to build on existing systems for rapid response to Zika virus 24-06-2016
:: WHO/Europe stands with refugees on World Refugee Day 20-06-2016

WHO Eastern Mediterranean Region EMRO
:: Syria reaches 2 million children in first ever deworming campaign 24 June 2016
:: Clarification on a MERS-CoV case in Saudi Arabia 23 June 2016
:: Health advice for the Rio 2016 Olympic and Paralympic Games 21 June 2016

WHO Western Pacific Region
:: 7 Million Deaths Averted through Hepatitis B Vaccination
Hong Kong, 22 June 2016 – New data shows that hepatitis B vaccination across the Western Pacific has averted 7 million deaths that would have occurred among children born between 1990 and 2014. This signifies a tremendous public health achievement for the Region. This significant achievement represents an important step towards the elimination of viral hepatitis as a public health threat in the Western Pacific Region by 2030.

CDC/ACIP [to 25 June 2016]
http://www.cdc.gov/media/index.html

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WEDNESDAY, JUNE 22, 2016
ACIP votes down use of LAIV for 2016-2017 flu season
CDC’s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season. ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone 6 months and older.
ACIP is a panel of immunization experts that advises the Centers for Disease Control and Prevention (CDC). This ACIP vote is based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016…

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MMWR, June 24, 2016 / Vol. 65 / No. 24
:: National HIV Testing Day — June 27, 2016
:: Evaluation of the Impact of National HIV Testing Day — United States, 2011–2014
:: Health Care Use and HIV Testing of Males Aged 15–39 Years in Physicians’ Offices — United States, 2009–2012
:: Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016
:: Zika Virus Surveillance and Preparedness — New York City, 2015–2016

Gavi [to 25 June 2016]
http://www.gavialliance.org/library/news/press-releases/

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23 June 2016
Gavi Board makes decisions on malaria vaccine pilots, health systems, and supply and procurement strategy
At her first Board meeting, Dr. Ngozi Okonjo-Iweala calls on funders to match Gavi’s proposed malaria vaccine pilot commitment

Geneva – Gavi, the Vaccine Alliance is ready to play a role in supporting WHO’s malaria vaccine pilots. The decision, taken today by the Gavi Board, would see up to US$ 27.5 million of support for the first phase of the pilots, provided other organisations come forward to match the Vaccine Alliance’s commitment.

The pilots will provide real-world insight into how the RTS,S malaria vaccine, developed by GSK, could be implemented in Africa, given that three of the four doses of the vaccine will be given outside the normal schedule for childhood vaccinations. They also will generate further evidence on the vaccine’s potential to reduce the death toll from malaria, which claims almost 440,000 lives every year.

WHO is currently finalising the design of the pilots and will select three African locations to begin implementation, as recommended jointly by the Strategic Advisory Group of Experts on Immunisation (SAGE) and the Malaria Policy Advisory Committee (MPAC).

“Gavi is ready to play its part in helping the world to understand the opportunities and challenges of implementing the world’s first malaria vaccine in real life settings,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “Malaria’s heavy burden on Africa means it is vital that we understand the impact of this vaccine in communities, as was so powerfully articulated by the African Ministers of Health represented at the Board. We call on others to come forward with sufficient funding to enable the pilots to proceed.”…

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PATH [to 25 June 2016]
http://www.path.org/news/index.php
Press release | June 23, 2016
GSK and PATH welcome commitment by Gavi, the Vaccine Alliance, to co-fund pilot implementation programme for RTS,S malaria vaccine candidate in Africa
UNITAID funding decision expected later this summer

GSK and PATH welcome the commitment by the Board of Gavi, the Vaccine Alliance, to provide up to US$ 27.5 million in co-funding to the World Health Organization (WHO) for a pilot implementation programme for the RTS,S malaria vaccine candidate in sub-Saharan Africa.

This commitment comes as UNITAID’s Executive Board today indicated that providing funding towards the pilot implementation programme aligns with UNITAID’s mandate, but that any funding should be limited and proportionate. This statement paves the way for a funding decision later this summer.

Together, the Gavi and UNITAID announcements represent another critical step towards helping the world’s first malaria vaccine reach young children in Africa. PATH and GSK remain committed to working in partnership with the WHO, Gavi, UNITAID, and other stakeholders to ensure successful implementation of the pilot programme.

In support of the programme, GSK and PATH will collaborate to donate doses of RTS,S for use in the WHO pilots.

Luc Debruyne, President, Vaccines at GSK said: “Gavi’s commitment is a critical milestone in preparation for the pilot programme and in the 30-year effort to bring a malaria vaccine to the children who need it most. We believe that the potential of this vaccine to reduce the burden of disease in sub-Saharan Africa is significant and we welcome the support for the pilot programme to enable us to gain additional information about how best to deliver RTS,S in a real-world setting.”

David C. Kaslow, MD, head of PATH’s Center for Vaccine Innovation and Access and vice president for product development at PATH, said, “The results of Phase 3 studies demonstrated the potential public health impact of RTS,S, when used alongside bed nets and other malaria control interventions, in the setting of clinical trials. Our goal is to work urgently with WHO, GSK, and other partners to further evaluate the full public health impact of RTS,S—as well as aspects of both implementation feasibility and safety—when provided in a routine use setting. Although Gavi’s support comes with contingencies—including that other organizations match its commitment—we are closer to our goal of understanding the full public health value of RTS,S to young children in Africa.”

WHO will provide an estimated US$ 17 million in in-kind contributions and PATH, a grantee of the Bill & Melinda Gates Foundation, will receive a grant of approximately US$ 8 million towards the project. The funds committed by Gavi are for the first phase of the pilot programme and contingent upon WHO securing funding from other sources to fill the remaining gap. The pilot programme will be complementary to the follow-up Phase IV clinical studies; GSK is investing more than US$ 200 million in those studies and other remaining development costs..

Sabin Vaccine Institute [to 25 June 2016]
http://www.sabin.org/updates/ressreleases

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June 22, 2016
Sabin Vaccine Institute Partners with King Saud University to Build Vaccine Research and Development Capacity in Saudi Arabia
WASHINGTON, D.C. —— The Sabin Vaccine Institute is partnering with King Saud University (KSU) in Riyadh, Saudi Arabia, to advance vaccine research and development capacity in the Middle East and North Africa. As part of the new $6.6 million agreement, Saudi scientists will receive technical training in vaccine development at the Sabin Vaccine Institute Product Development Partnership (Sabin PDP) laboratories in Houston, Texas

Global Fund [to 25 June 2016]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=

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24 June 2016
South Africa Seeks to End Epidemics among Women and Girls
PIETERMARITZBURG , South Africa – South Africa’s deputy president Cyril Ramaphosa today launched a national campaign to transform the health of young women and girls in the country.

The new program led by the government and supported by global health partners will go beyond biomedical approaches that seek to prevent young women and girls from HIV and treat those infected with the virus. It will encompass long-term measures that address structural barriers, which predispose young women and girls to diseases.

Despite the great progress made against HIV, tuberculosis and malaria in the last decade, gender inequalities continue to increase women’s and girls’ vulnerability to the diseases. In South Africa in particular, HIV is a significant threat for young women and girls. About 2,500 girls and young women of 15-24 are infected with the virus every week. Young women and girls in that age group are four times likely to become infected with HIV than males of the same group.

“This is a pivotal moment in reaching our National Development Plan goal of a generation free of HIV by 2030, which illustrates South Africa’s commitment to achieving the global target of ending AIDS by 2030,” South Africa’s Health Minister Aaron Motsoaledi said. “We wish to thank the Global Fund, PEPFAR and the German Government for their financial contribution to our national campaign which will assist us to accelerate the implementation of specific programs that target young people in selected districts over the next three years.”…

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21 June 2016
Global Fund Honored with Geneva’s “Vigne des Nations 2016”
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria has been honored by the Canton of Geneva and awarded the “Vigne des Nations”, a symbolic recognition given every year to an international organization that contributes to reinforce Geneva’s international commitment…

During this event, the Republic and Canton of Geneva recognized the Global Fund for its engagement in the fight against AIDS, tuberculosis, malaria and in building resilient and sustainable systems for health and for the organization’s contribution to the larger family that is known as “Geneva International”.

The recognition of the “Vigne des Nations 2016” also comes at a very significant time for the Global Fund, as it only a few days ago participated in the stone-setting ceremony for Geneva’s new Health Campus, a building in Grand-Saconnex that will house several health organizations, including the Global Fund. The new offices to be rented by the Global Fund will deliver substantial savings to the organization through lower rental costs…

European Medicines Agency [to 25 June 2016]
http://www.ema.europa.eu/

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24/06/2016
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 20-23 June 2016
Six new medicines, including one cell-based therapy, recommended for approval ..

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22/06/2016
EMA and FDA reinforce collaboration on patient engagement
New working group established to exchange best practices
The European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) have set up a new ‘cluster’ on patient engagement. The cluster will provide a forum to share experiences and best practices on the way the two agencies involve patients in development, evaluation and post-authorisation activities related to medicines.

Patients bring real-life experience, as well as specific knowledge and expertise, to scientific discussions on medicines and on the impact of regulatory decisions. Therefore, their involvement is a priority for both agencies.

“Our aim as regulators is to make sure that patients have access to safe and effective medicines that improve their lives. It is important to engage to be able to fully understand their needs and priorities and make their voice heard along a medicine’s lifecycle,” explains Guido Rasi, EMA Executive Director. “Many of the challenges and benefits of working with patients are similar for both regulators. We look forward to increasing our collaboration with FDA in this area in order to benefit from each other’s experiences, and to advance patient involvement.”

The first meeting of the cluster took place by teleconference on 22 June 2016…

EDCTP  [to 25 June 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.

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23 June 2016
Fit for Health 2.0 to organise a webinar on grant agreement preparation for EDCTP2 projects
Fit for Health 2.0 will host a webinar to address the challenges of negotiating the grant and consortium agreement for…

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22 June 2016
EDCTP 2016 stakeholder meetings on Diarrhoeal Diseases & Lower Respiratory Tract Infections
EDCTP will hold two stakeholder meetings on Diarrhoeal Diseases and Lower Respiratory Tract Infections on 5 and 6 July, respectively….

Industry Watch [to 25 June 2016]

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:: CDC Advisory Committee On Immunization Practices Votes To Recommend Vaxchora, PaxVax’s Single-Dose Oral Cholera Vaccine
Vaxchora™ is the only licensed vaccine in the U.S. for protection against cholera
June 23, 2016
REDWOOD CITY, Calif.–(BUSINESS WIRE)–PaxVax today announced that the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted yesterday on a recommendation for the use of Vaxchora™, a single-dose oral, live attenuated cholera vaccine indicated for use in adults 18 to 64 years of age. Vaxchora received marketing approval from the United States (U.S.) Food and Drug Administration (FDA) on June 10, 2016.

The ACIP voted unanimously at their June 22 meeting to recommend Vaxchora for the prevention of toxigenic Vibrio cholerae O1 for travelers to areas of active cholera transmission. The Category A recommendation made by the ACIP for Vaxchora will be forwarded to the director of the CDC and the U.S. Department of Health and Human Services for review and approval. Once approved, the recommendations will be published in the Morbidity and Mortality Weekly Report (MMWR). Category A recommendations are made for all persons in an age- or risk-factor-based group.

“Cholera is an underestimated disease that is found in many popular global travel destinations in the Caribbean, Africa and Asia. Until now, U.S. travelers have not had access to a vaccine to help protect against this potentially deadly pathogen,” said Lisa Danzig, M.D., Vice President, Clinical Development and Medical Affairs. “We are very proud to offer the only licensed vaccine against cholera and are encouraged by the ACIP’s recommendation which recognizes the value of Vaxchora as an important option for the protection of adults traveling to cholera-affected areas.”…

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:: Takeda Initiates World’s First Norovirus Vaccine Field Trial
Vaccine candidate will target the leading cause of acute gastroenteritis around the globe
June 20, 2016
OSAKA, Japan–(BUSINESS WIRE)–Takeda Pharmaceutical Company Limited (“Takeda”) today announced that it has dosed the first subject in a Phase 2b field efficacy trial of Takeda’s norovirus vaccine candidate (TAK-214), the only norovirus vaccine candidate in human clinical trials.

The Phase 2b, double-blind, randomized, placebo-controlled trial involves healthy male or female adults aged 18 – 49 years. It will evaluate the efficacy of intramuscular administration of Takeda’s norovirus vaccine candidate against moderate or severe acute gastroenteritis (AGE) due to norovirus, a common intestinal infection marked by watery diarrhea, vomiting, abdominal cramps, nausea and sometimes fever that may lead to clinically significant dehydration.1,2

Norovirus is recognized as the leading cause of acute gastroenteritis across the age spectrum.3 It is estimated that norovirus causes nearly 700 million cases of illness3 with significant morbidity and social burden worldwide. More than 200,000 deaths per year are estimated to result from norovirus illness, primarily in low-income countries.”…

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

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1st International Vaccines Against Shigella and ETEC (VASE) Conference
June 28-30, Washington, DC
PATH
The inaugural Vaccines Against Shigella and ETEC (VASE) Conference will bring together scientists, public health professionals, immunization leaders, vaccine industry representatives, international donors, and other experts from across the globe to work toward the goal of developing and introducing new enteric vaccines.

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USAID Releases Plan to Save 8 Million Women and Children & Commits Funds To Strengthen Community Health
Tuesday, June 21, 2016
Washington, D.C. – Today, USAID released the third annual Acting on the Call report, which details how a renewed focus on the poorest 40% of the population can save the lives of 8 million women and children by 2020. The report also announces Burma as the twenty fifth priority country for USAID’s effort to end preventable child and maternal death. Alongside the report, USAID announced a new $9.2 million program – Integrating Community Health – which will leverage an additional $10 million investment from other sources and is designed to strengthen the role of community health in USAID’s efforts to end preventable child and maternal deaths.
This third annual Acting on the Call report provides country-by-country updates on progress made over the past year in priority countries, which together account for more than two-thirds of the child and maternal deaths worldwide. The report also examines how to accelerate progress through an equity based approach, describing what can be achieved if the bottom two wealth quintiles have the same opportunities and access to health interventions as the rest of the population…

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Fight Against Bite: ASEAN committed in battle against Dengue
BANGKOK, 22 June 2016 – …The two-day activity commenced with an ASEAN Dengue Conference, which discussed updates on the management of dengue, including information on the development and use of the dengue vaccine. There were deliberations on the progress of the regional dengue situation as well as the initiatives to promote community empowerment through sustaining the fight against dengue and other disease prevention and control in ASEAN. A “Bangkok Call for Action on the Prevention and Control of Dengue” was finalised to enhance the cause….

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Lack of action on Non-Communicable Diseases damaging Pacific economies: World Bank
June 20, 2016 -PRESS RELEASE
New World Bank report highlights the potential economic burden of NCDs in the Pacific
NUKU’ALOFA, June 20, 2016 – A new World Bank report has put the spotlight on the economic threat non-communicable diseases (NCDs) pose to the Pacific Islands, with heart disease, cancer, diabetes and chronic respiratory disease emerging as the top killers in the region.

The draft report, Pacific Possible: Health and Non-Communicable Diseases, was released for public comment today at the Pacific NCDs Summit in the Tongan capital Nuku’alofa. It shows that the economic burden of NCDs continues to rise in the Pacific. It projects that if no action is taken, the economic loss due to NCD mortality across 11 Pacific Island countries will reach between 8.5 and 14.3 percent of gross domestic product by 2040. The costs of NCD morbidity could increase, on average, from 13.2 percent of gross domestic product in 2015 to 18.8 percent by 2040.

“NCDs are a major public health issue in the Pacific region. Their economic burden is much greater in the Pacific Island countries than the global average,” said report lead author and World Bank senior health economist, Xiaohui Hou. “The number of Pacific Islanders affected by these conditions will continue to rise unless we work together to reduce unhealthy habits and ensure limited health resources are delivering the most value for the greatest number of people.”

The report also raises concerns over the long term financial sustainability of public health expenditures in the region, given that Pacific countries already spend a greater share of government funds on health care than the average across lower-middle incomes countries worldwide.

The report includes a number of key recommendations that Pacific Island governments could consider to help inform public health policies aimed at reducing NCDs, which directly cause up to 77 percent of deaths in the Pacific and are a major reason for premature deaths…

Journal Watch

Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

  If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 25 June 2016)

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Research article
The swine flu vaccine, public attitudes, and researcher interpretations: a systematic review of qualitative research
Benedicte Carlsen and Claire Glenton
Published on: 24 June 2016
Abstract
Background
During pandemics, health authorities may be uncertain about the spread and severity of the disease and the effectiveness and safety of available interventions. This was the case during the swine flu (H1N1) pandemic of 2009–2010, and governments were forced to make decisions despite these uncertainties. While many countries chose to implement wide scale vaccination programmes, few accomplished their vaccination goals. Many research studies aiming to explore barriers and facilitators to vaccine uptake have been conducted in the aftermath of the pandemic, including several qualitative studies.
Aims
1.To explore public attitudes to the swine flu vaccine in different countries through a review of qualitative primary studies.
2. To describe and discuss the implications drawn by the primary study authors.
Methods
Systematic review of qualitative research studies, using a broadly comparative cross case-study approach. Study quality was appraised using an adaptation of the Critical Appraisal Skills Programme (CASP) quality assessment tool.
Results
The review indicates that the public had varying opinions about disease risk and prevalence and had concerns about vaccine safety. Most primary study authors concluded that participants were uninformed, and that more information about the disease and the vaccine would have led to an increase in vaccine uptake. We find these conclusions problematic. We suggest instead that people’s questions and concerns were legitimate given the uncertainties of the situation at the time and the fact that the authorities did not have the necessary information to convince the public. Our quality assessment of the included studies points to a lack of reflexivity and a lack of information about study context. We suggest that these study weaknesses are tied to primary study authors’ lack of acknowledgement of the uncertainties surrounding the disease and the vaccine.
Conclusion
While primary study authors suggest that authorities could increase vaccine uptake through increased information, we suggest instead that health authorities should be more transparent in their information and decision-making processes in future pandemic situations.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 25 June 2016)
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Research article
Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak
The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolu…
Javier Arranz, Karen Marie Lundeby, Shoaib Hassan, Luis Matías Zabala Fuentes, Pedro San José Garcés, Yngvar Lunde Haaskjold, Hakon Angell Bolkan, Kurt Osthuus Krogh, James Jongopi, Sindre Mellesmo, Ola Josendal, Asmund Opstad, Erling Svensen, Alfred Sandy Kamara, David P. Roberts, Paul D. Stamper…
BMC Infectious Diseases 2016 16:308
Published on: 22 June 2016

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Debate
Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities
Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital.
Delia Boccia, Debora Pedrazzoli, Tom Wingfield, Ernesto Jaramillo, Knut Lönnroth, James Lewis, James Hargreaves and Carlton A. Evans
BMC Infectious Diseases 2016 16:307
Published on: 21 June 2016

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BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 25 June 2016)

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Research article
Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel
Rami Yaari, Ehud Kaliner, Itamar Grotto, Guy Katriel, Jacob Moran-Gilad, Danit Sofer, Ella Mendelson, Elizabeth Miller, Amit Huppert, E. Anis, E. Kopel, Y. Manor, O. Mor, L. Shulman, R. Singer and M. Weil
BMC Medicine 2016 14:95
Published on: 23 June 2016
Abstract
Background
Polio eradication is an extraordinary globally coordinated health program in terms of its magnitude and reach, leading to the elimination of wild poliovirus (WPV) in most parts of the world. In 2013, a silent outbreak of WPV was detected in Israel, a country using an inactivated polio vaccine (IPV) exclusively since 2005. The outbreak was detected using environmental surveillance (ES) of sewage reservoirs. Stool surveys indicated the outbreak to be restricted mainly to children under the age of 10 in the Bedouin population of southern Israel. In order to curtail the outbreak, a nationwide vaccination campaign using oral polio vaccine (OPV) was conducted, targeting all children under 10.
Methods
A transmission model, fitted to the results of the stool surveys, with additional conditions set by the ES measurements, was used to evaluate the prevalence of WPV in Bedouin children and the effectiveness of the vaccination campaign. Employing the parameter estimates of the model fitting, the model was used to investigate the effect of alternative timings, coverages and dosages of the OPV campaign on the outcome of the outbreak.
Results
The mean estimate for the mean reproductive number was 1.77 (95 % credible interval, 1.46–2.30). With seasonal variation, the reproductive number maximum range was between zero and six. The mean estimate for the mean infectious periods was 16.8 (8.6–24.9) days. The modeling indicates the OPV campaign was effective in curtailing the outbreak. The mean estimate for the attack rate in Bedouin children under 10 at the end of 2014 was 42 % (22–65 %), whereas without the campaign the mean projected attack rate was 57 % (35–74 %). The campaign also likely shortened the duration of the outbreak by a mean estimate of 309 (2–846) days. A faster initiation of the OPV campaign could have reduced the incidence of WPV even if a lower coverage was reached, at the risk of prolonging the outbreak.
Conclusions
OPV campaigns are essential for interrupting WPV transmission, even in a developed country setting with a high coverage of IPV. In this setting, establishing ES of WPV circulation is particularly crucial for early detection and containment of an outbreak.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 25 June 2016)

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Research article
Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands
Adee J. Bodewes and Anton E. Kunst
BMC Research Notes 2016 9:319
Published on: 21 June 2016
Abstract
Background
There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands.
Methods
We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis.
Results
The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies.
Conclusions
The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Local and foreign authorship of maternal health interventional research in low- and middle-income countries: systematic mapping of publications 2000–2012
Matthew F. Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Ashar Dhana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Francisco Becerra-Posada, Josephine Kavanagh, Priya Mannava, Langelihle Mlotshwa, Victor Becerril-Montekio, Katharine Footman and Helen Rees
Published on: 23 June 2016
Abstract
Background
Researchers in low- and middle-income countries (LMICs) are under-represented in scientific literature. Mapping of authorship of articles can provide an assessment of data ownership and research capacity in LMICs over time and identify variations between different settings.
Methods
Systematic mapping of maternal health interventional research in LMICs from 2000 to 2012, comparing country of study and of affiliation of first authors. Studies on health systems or promotion; community-based activities; and haemorrhage, hypertension, HIV/STIs and malaria were included. Following review of 35,078 titles and abstracts, 2292 full-text publications were included. Data ownership was measured by the proportion of articles with an LMIC lead author (author affiliated with an LMIC institution).
Results
The total number of papers led by an LMIC author rose from 45.0/year in 2000–2003 to 98.0/year in 2004–2007, but increased only slightly thereafter to 113.1/year in 2008–2012. In the same periods, the proportion of papers led by a local author was 58.4 %, 60.8 % and 60.1 %, respectively. Data ownership varies markedly between countries. A quarter of countries led more than 75 % of their research; while in 10 countries, under 25 % of publications had a local first author. Researchers at LMIC institutions led 56.6 % (1297) of all papers, but only 26.8 % of systematic reviews (65/243), 29.9 % of modelling studies (44/147), and 33.2 % of articles in journals with an Impact Factor ≥5 (61/184). Sub-Saharan Africa authors led 54.2 % (538/993) of studies in the region, while 73.4 % did in Latin America and the Caribbean (223/304). Authors affiliated with United States (561) and United Kingdom (207) institutions together account for a third of publications. Around two thirds of USAID and European Union funded studies had high-income country leads, twice as many as that of Wellcome Trust and Rockefeller Foundation.
Conclusions
There are marked gaps in data ownership and these have not diminished over time. Increased locally-led publications, however, does suggest a growing capacity in LMIC institutions to analyse and articulate research findings. Differences in author attribution between funders might signal important variations in funders’ expectations of authorship and discrepancies in how funders understand collaboration. More stringent authorship oversight and reconsideration of authorship guidelines could facilitate growth in LMIC leadership. Left unaddressed, deficiencies in research ownership will continue to hinder alignment between the research undertaken and knowledge needs of LMICs.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Training the next generation of global health experts: experiences and recommendations from Pacific Rim universities
Mellissa Withers, David Press, Heather Wipfli, Judith McCool, Chang-Chuan Chan, Masamine Jimba, Christopher Tremewan and Jonathan Samet
Published on: 23 June 2016
Abstract
Background
Finding solutions to global health problems will require a highly-trained, inter-disciplinary workforce. Global health education and research can potentially have long-range impact in addressing the global burden of disease and protecting and improving the health of the global population.
Methods
We conducted an online survey of twelve higher education institutions in the Pacific Rim that spanned the period 2005–2011. Program administrators provided data on program concentrations, student enrollment and student funding opportunities for 41 public health programs, including those specific to global health.
Results
The Master of Public Health (MPH) was the most common degree offered. A growing demand for global health education was evident. Enrollment in global health programs increased over three-fold between 2005–2011. Very few institutions had specific global health programs or offered training to undergraduates. Funding for student scholarships was also lacking.
Conclusions
The growing demand for global health education suggests that universities in the Pacific Rim should increase educational and training opportunities in this field. Schools of medicine may not be fully equipped to teach global health-related courses and to mentor students who are interested in global health. Increasing the number of dedicated global health research and training institutions in the Pacific Rim can contribute to building capacity in the region. Faculty from different departments and disciplines should be engaged to provide multi-disciplinary global health educational opportunities for undergraduate and graduate students. New, innovative ways to collaborate in education, such as distance education, can also help universities offer a wider range of global health-related courses. Additional funding of global health is also required.

Health and Human Rights
Volume 18, Issue 1, June 2016
http://www.hhrjournal.org/

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Special Section: Tuberculosis and the Right to Health
in collaboration with the International Human Rights Clinic, University of Chicago Law School
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Editorial: Developing a Human Rights-Based Approach to Tuberculosis
Brian Citro, Evan Lyon, Mihir Mankad, Kiran Raj Pandey, and Camila Gianella, Guest Editors

Falling Short of the Rights to Health and Scientific Progress: Inadequate TB Drug Research and Access
Mike Frick, Ian Henry, and Erica Lessem

TB in Vulnerable Populations: The Case of an Indigenous Community in the Peruvian Amazon
Camila Gianella, César Ugarte-Gil, Godofredo Caro, Rula Aylas, César Castro, and Claudia Lema

Double Standards in Global Health: Medicine, Human Rights Law, and Multidrug-Resistant TB Treatment Policy
Thomas Nicholson, Catherine Admay, Aaron Shakow, and Salmaan Keshavjee

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Perspective Essays on TB and the Right to Health
Petition 329: A Legal Challenge to the Involuntary Confinement of TB Patients in Kenyan Prisons
Allan Maleche and Nerima Were

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General Papers
An Independent Review and Accountability Mechanism for the Sustainable Development Goals: The Possibilities of a Framework Convention on Global Health
Eric A. Friedman

Essential Medicines in National Constitutions: Progress Since 2008
S. Katrina Perehudoff, Brigit Toebes, and Hans Hogerzeil

Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors
Corinne Schwarz, Erik Unruh, Katie Cronin, Sarah Evans-Simpson, Hannah Britton, and Megha Ramaswamy

Indigenous Child Health in Brazil: The Evaluation of Impacts as a Human Rights Issue
Anna R. Coates, Sandra del Pino Marchito, and Bernardino Vitoy

Assessing and Improving Children’s Rights in Hospitals: Case Studies from Kyrgyzstan, Tajikistan, and Moldova
Ana Isabel Fernandes Guerreiro, Aigul Kuttumuratova, Kubanychbek Monolbaev, Larisa Boderscova, Zulfiya Pirova, and Martin W. Weber

Human Rights-Based Approaches to Mental Health: A Review of Programs
Sebastian Porsdam Mann, Valerie J. Bradley, and Barbara J. Sahakian

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Perspective Essays
Medical Hostages: Detention of Women and Babies in Hospitals
Delan Devakumar and Rob Yates

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 25 June 2016]

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Short Report
Good laboratory practices guarantee biosafety in the Sierra Leone-China friendship biosafety laboratory
Qin Wang, Wei-Min Zhou, Yong Zhang, Huan-Yu Wang, Hai-Jun Du, Kai Nie, Jing-Dong Song, Kang Xiao, Wen-Wen Lei, Jian-Qiang Guo, He-Jiang Wei, Kun Cai, Yan-Hai Wang, Jiang Wu, Gerard Kamara, Idrissa Kamara…
Published on: 23 June 2016
Abstract
Background
The outbreak of Ebola virus disease (EVD) in West Africa between 2014 and 2015 was the largest EDV epidemic since the identification of Ebola virus (EBOV) in 1976, and the countries most strongly affected were Sierra Leone, Guinea, and Liberia.
Findings
The Sierra Leone-China Friendship Biological Safety Laboratory (SLE-CHN Biosafety Lab), a fixed Biosafety Level 3 laboratory in the capital city of Sierra Leone, was established by the Chinese government and has been active in EBOV detection since 11 March 2015. Complete management and program documents were created for the SLE-CHN Biosafety Lab, and it was divided into four zones (the green, yellow, brown, and red zones) based on the risk assessment. Different types of safe and appropriate personnel protection equipment (PPE) are used in different zones of the laboratory, and it fully meets the Biosafety Level 3 laboratory standards of the World Health Organization.
Conclusion
Good preparedness, comprehensive risk assessment and operation documents, appropriate PPE, effective monitoring and intensive training, together with well-designed and reasonable laboratory sectioning are essential for guaranteeing biosafety.

International Journal of Infectious Diseases
July 2016 Volume 48, p1-124 Open Access
http://www.ijidonline.com/current

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Editorial
Why is the yellow fever outbreak in Angola a ‘threat to the entire world’?
J.P. Woodall, T.M. Yuill
p96–97
Published online: May 6 2016
Preview
The short answer to the World Health Organization (WHO) declaration is because yellow fever has spread throughout the country, causing probably thousands of cases and hundreds of deaths, and the world has run out of vaccine. This is very bad because cases so far have been imported into the Democratic Republic of the Congo (DRC), Mauritania, Kenya, and even China, the first time in history that cases have been confirmed in Asia. In fact, more travelers infected with yellow fever have now been seen than in the last 50 years, each one with the potential to spread it on arrival, and still further to more countries worldwide via international airlines.

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Reviews
Traditional and syndromic surveillance of infectious diseases and pathogens
Cédric Abat, Hervé Chaudet, Jean-Marc Rolain, Philippe Colson, Didier Raoult
p22–28
Published online: April 30 2016
Preview
Classified as the second leading cause of death in humans by the World Health Organization, with approximately 15 million deaths worldwide every year,1 infectious diseases remain a serious public health problem in the 21st century. Among them, HIV/AIDS, tuberculosis, and malaria have been nicknamed the ‘big three’ because of their important impact on global human health. In 2011, tuberculosis infected two billion people and killed 1.3 million, malaria infected 207 million people and killed 62 700, and HIV infected 35.3 million people and killed 1.6 million.

.

Original Papers
Yellow fever vaccination status and safety in hemodialysis patients
Tila Facincani, Maia Nogueira Crown Guimarães, Sigrid De Sousa dos Santos
p91–95
Published online: May 18 2016
Preview
The live attenuated yellow fever vaccine seems to be safe in patients on hemodialysis in a transition area.

The Lancet
Jun 25, 2016 Volume 387 Number 10038 p2575-2664 e30
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
What can public health do for mental health?
The Lancet
Summary
Public health practitioners should prioritise and advance the public’s mental health wherever possible, argues Better Mental Health For All, a report published last week by the UK’s Faculty of Public Health, in collaboration with the Mental Health Foundation. The report aims to be a resource for public health professionals to support the promotion of mental wellbeing and the primary prevention of mental ill health.

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Comment
Who should finance WHO’s work on emergencies?
Y-Ling Chi, Jaya Krishnakumar, Jürgen Maurer, Dejan Loncar, Antoine Flahault
Summary
In May, 2015, the 68th World Health Assembly approved the decision to reform the work of WHO on emergencies by creating a single programme for outbreaks and health emergencies, and an accompanying Contingency Fund for Emergencies (CFE).1 According to latest estimations, the core funding needs for the programme and the initial capital of the CFE will, respectively, range about US$300 million per year and $100 million.2 To respond effectively to emergencies, these resources should be flexible, predictable, and directly accessible.

New England Journal of Medicine
June 23, 2016 Vol. 374 No. 25
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
From Patient to Patient — Sharing the Data from Clinical Trials
Charlotte J. Haug, M.D., Ph.D.
N Engl J Med 2016; 374:2409-2411 June 23, 2016 DOI: 10.1056/NEJMp1605378
[Excerpt]
…Instead of spending time and resources on complicated techniques to try to deidentify and anonymize complex patient data — and risk failing and making populations or patient groups skeptical about the whole concept of data sharing — it may be better to define a core set of data that can be released (and freely accessed) from all trials and to allow sharing of the more complex data only through real and inclusive collaborations, the way successful data sharing related to specific diseases already happens in global health today. “It is not only about sharing of the raw data, but sharing of the questions, the problems, and the code that everybody is using,” Shasha Jumbe said. “It means collaborations throughout the whole process, definition of the goals, framing of the questions — and also thinking about inclusive attribution all the way from subjects that are part of these studies to the data science team.”

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Perspective
A Global, Neutral Platform for Sharing Trial Data
Barbara E. Bierer, M.D., Rebecca Li, Ph.D., Mark Barnes, J.D., LL.M., and Ida Sim, M.D., Ph.D.
N Engl J Med 2016; 374:2411-2413 June 23, 2016 DOI: 10.1056/NEJMp1605348

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 June 2016)

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Essay
Why Most Clinical Research Is Not Useful
John P. A. Ioannidis
Essay | published 21 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002049
Summary Points
:: Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.
:: Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.
:: Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.
:: The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.
:: Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Health and Ethical Consequences of Outsourcing Pivotal Clinical Trials to Latin America: A Cross-Sectional, Descriptive Study
Núria Homedes, Antonio Ugalde
Research Article | published 23 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157756
Abstract
Introduction
The implications of conducting clinical trials in low and middle income countries on the financial accessibility and safety of the pharmaceutical products available in those markets have not been studied. Regulatory practices and ethical declarations lead to the commercialization of the new products, referred to as New Molecular Entities (NMEs), in the countries where tested as soon as they are approved in high surveillance countries. Patients and patients’ associations use the Latin American courts to access new and expensive treatments, regardless of their safety profile and therapeutic value.
Design and Objectives
Cross-sectional, descriptive study. To determine the therapeutic value and safety profile of the NMEs approved by the Food and Drug Administration (FDA) in 2011 and 2012 that had been tested in Latin America, and the implications of their market approval for the pharmaceutical budgets in the countries where tested.
Setting
Latin America.
Measures
To assess the therapeutic value and safety of the NMEs commercialized in the different countries we used f independent drug bulletins. The prices of the NMEs for the consumers were obtained from the pharmaceutical price observatories of the countries were the medicines had been tested. If the price was not available in the observatories, it was obtained from pharmaceutical distributors. We used the countries’ minimum wage and per capita income to calculate the financial accessibility of a course of treatment with the NMEs.
Results
We found that 33 NMEs approved by the FDA in 2011 and 2012 have been tested in Latin America. Of these, 26 had been evaluated by independent drug bulletins and only five were found to add some value to a subset of patients and had significant side-effects. The pharmaceutical prices were very high, varied widely across countries and were unrelated to the countries’ income per capita or minimum wage.
Conclusion
The implementation of clinical trials in Latin America results in the commercialization of medicines with questionable safety profiles and limited therapeutic value, putting patients at risk and causing budgetary strains in pharmaceutical budgets.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right
Michael J. Harvey, Lisa A. Prosser, Mark L. Messonnier, David W. Hutton
Research Article | published 22 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156737
Abstract
Objective
To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage.
Methods
A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved.
Results
Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease.
Discussion and Conclusion
These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Research Article
Use of Seasonal Influenza Vaccination and Its Associated Factors among Elderly People with Disabilities in Taiwan: A Population-Based Study
Yu-Chia Chang, Ho-Jui Tung, Shang-Wei Hsu, Lei-Shin Chen, Pei-Tseng Kung, Kuang-Hua Huang, Shang-Jyh Chiou, Wen-Chen Tsai
| published 23 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0158075
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Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey
Levent Akın, Bérengère Macabéo, Zafer Caliskan, Serdar Altinel, Ilhan Satman
Research Article | published 20 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157657

Public Health Reports
Volume 131 , Issue Number 3 May/June 2016
http://www.publichealthreports.org/issuecontents.cfm?Volume=131&Issue=3
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Original Articles
Lifestyle Vaccines and Public Health: Exploring Policy Options for a Vaccine to Stop Smoking
Anna Wolters, Guido de Wert, Onno C. P. van Schayck, and Klasien Horstman
Public Health Ethics (2016) 9 (2): 183-197 doi:10.1093/phe/phw004
Abstract
Experimental vaccines are being developed for the treatment of ‘unhealthy lifestyles’ and associated chronic illnesses. Policymakers and other stakeholders will have to deal with the ethical issues that this innovation path raises: are there morally justified reasons to integrate these innovative biotechnologies in future health policies? Should public money be invested in further research? Focusing on the case of an experimental nicotine vaccine, this article explores the ethical aspects of ‘lifestyle vaccines’ for public health. Based on findings from a qualitative study into a vaccine for smoking cessation, the article articulates possible value conflicts related to nicotine vaccination as an intervention in tobacco control. The ‘vaccinization’ of lifestyle disease piggybacks on the achievements of classic vaccines. Contrary to expectations of simplicity and success, quitting smoking with a vaccine requires a complex supportive network. Social justice and public trust may become important ethical challenges when deciding whether to use further public funds for research or whether to implement these innovative vaccines in the future.

Science
24 June 2016 Vol 352, Issue 6293
http://www.sciencemag.org/current.dtl

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Policy Forum
Capitalizing on convergence for health care
By Phillip Sharp, Tyler Jacks, Susan Hockfield
Science24 Jun 2016 : 1522-1523
Summary
For decades, scientists have called for more collaboration between the life and physical sciences, and in the past 5 years, we have been among those calling for a new national research strategy—one we call “convergence”—that would integrate engineering, physical, computational, and mathematical sciences with biomedical science (1). Thanks to the accelerating pace of biological discovery, the expanding power of computation, and a new focus in engineering on biocompatible materials and nanotechnology, the potential of such a strategy for advances in health care is greater than ever (see the photo). Technologies emerging from such efforts have potential implications far beyond health care: creating jobs; speeding products to market; and improving everything from agriculture and the environment to defense, the economy, and energy production. It all adds up to a moment of unprecedented opportunity, if we choose to invest in it meaningfully. But so far we have not. We detail below, and in greater depth in a new report with colleagues from across the country (2), the stakes in the convergence revolution and what we should do to capitalize on it.

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Review
Childhood undernutrition, the gut microbiota, and microbiota-directed therapeutics
By Laura V. Blanton, Michael J. Barratt, Mark R. Charbonneau, Tahmeed Ahmed, Jeffrey I. Gordon
Science24 Jun 2016 : 1533
Editor’s Summary
Gut microbiota and undernutrition
Poor nutrition during the early years of life can have severe consequences for subsequent skeletal, immunological, and intellectual development. Blanton et al. review the evidence showing that undernutrition is not caused by food insecurity alone. Other factors range from the length of the breastfeeding period and the availability of milk oligosaccharides, enteropathogen exposure, and enteric dysfunction marked by villus atrophy and loss of gut barrier function. Unfortunately, nutritional restoration with or without antibiotic treatment may not be effective in the longer term. Differences in the succession of microbial establishment and maturity can explain much of family discordances in nutritional status. The evidence indicates that microbiota-directed therapeutics could be a promising route to nutritional restoration in these children

Vaccine
Volume 34, Issue 29, Pages 3331-3434 (17 June 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/29

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Barriers to timely administration of birth dose vaccines in The Gambia, West Africa
Original Research Article
Pages 3335-3341
Reiko Miyahara, Momodou Jasseh, Pierre Gomez, Yusuke Shimakawa, Brian Greenwood, Karamba Keita, Samba Ceesay, Umberto D’Alessandro, Anna Roca
Abstract
Objective
Although vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6–12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia.
Methods
We used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0–1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014.
Results
Most of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR) = 6.13, 95%CI: 3.20–11.75, east rural: AOR = 6.72, 95%CI: 3.66–12.33) and maternal education (senior-educations: AOR = 2.43, 95%CI: 1.17–5.06); and inversely associated with distance to vaccination delivery points (≧2 km: AOR = 0.41, 95%CI: 0.24–0.70), and Fula ethnicity (AOR = 0.60, 95%CI: 0.40–0.91).
Conclusion
Vaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.