Vaccines and Global Health - The Week in Review - 13 September 2014

Vaccines and Global Health: The Week in Review
13 September 2014
Center for Vaccine Ethics & Policy (CVEP)

This weekly summary targets news, events, announcements, articles and research in the
vaccine and global health ethics and policy space and 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.

Vaccines and Global Health: The Week in Review is also posted in pdf form and as a set of
blog posts at http://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text
searching of over 6,500 entries.
Comments and suggestions should be directed to
David R. Curry, MS
Editor and
Executive Director
Center for Vaccine Ethics & Policy
david.r.curry@centerforvaccineethicsandpolicy.org

Request an email version: 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.

[Editors Note: We bring forward just below a set of three articles from the current issue of
Science Translational Medicine for special focus. Also, we note that the volume of coverage,
comment and analysis driven by the Ebola outbreak in West Africa is growing and is occurring
across media sources well beyond those we actively monitor. We will strive to present a
coherent digest of what is happening using official sources wherever possible, with a special
focus on vaccines now going into various trails]

Science Translational Medicine
10 September 2014 vol 6, issue 253
http://stm.sciencemag.org/content/current
Editorial
POLICY
WHO for the 21st Century
Margaret Chan
Margaret Chan is Director General of the World Health Organization, CH1211 Geneva 27,
Switzerland.
Next year, 2015, will be pivotal for global health. The deadline for reaching the United
Nations Millennium Development Goals (MDGs) expires, and the MDGs will be succeeded by a
new framework that focuses on poverty reduction and sustainable development (1). In the
lead-up to 2015, the spotlight is already on the achievements and disappointments of the MDG
era. Among the successes, 2 billion people have gained access to improved sanitation since
1990. Yet, there are still 2.5 billion people worldwide who do not have day-to-day use of
functioning toilets. The death rate of children under 5 years has been cut by about one-half,
and the rates of decline in child mortality in some African countries, notably Senegal and
Rwanda, are among the fastest ever recorded. Nevertheless, between 6 million and 7 million
children died in 2012, nearly half of whom died in the first month of life (2). The great majority
of these deaths could have been prevented. During this period of reflection on the MDGs, we
are also looking to the future. Our attention at the World Health Organization (WHO) is focused
on ways to build on the global health successes of the past 25 years, on how to fill in the gaps,
and on how we can continue to improve health in the post-2015 era.
Any allusion to our current place in the 21st century brings to mind events that take place
over decades. Such events include the long-running epidemiological transition from
communicable to noncommunicable diseases in our aging populations, now mostly located in
cities, and the long-term health impacts of climate change and environmental degradation. But
we must also contend with major events that take place on shorter time scales. The MDG era
has coincided with, and is partly a product of, the huge increase in development (financial)
assistance for health. This is reflected in the proliferation of health donors, global funds and
partnerships, nongovernmental and civil society organizations, philanthropists, and commercial
investors. The MDG era has also coincided with the growing wealth and more assertive voices
of formerly low-income countries, symbolized by the BRIC nations (Brazil, Russia, India, China),
and other countries such as Indonesia, Nigeria, and Thailand that have moved from low to
middle income. As these events have unfolded, the reach of health has extended far beyond
clinical practice and epidemiology. In the midst of debates about the changing role of
international aidand with the emergence of SARS, pandemic influenza, and most recently the
Ebola virusglobal health has become central to foreign policy and international relations.
In this time of transition, I will highlight some of the challenges we face in putting health at
the heart of sustainable development. In confronting these challenges, we can draw on 66
years of WHO experience, but we are also prepared to work in new ways (3). As the post-2015
agenda is being crafted through international debate, our most important message is that good
health is a valuable goal in its own right, and indispensable to poverty reduction and sustainable
development. This is a global message with a human face: People want assurance that they
have access to the health services they need and at a price they can afford. This is the essence
and the promise of universal health coverage (4).
WHO is often referred to as a technical agency. We are certainly thatin our use of science
and technology to underpin health policy. But WHO has a bigger role, in showing how technical
approaches to health promotion and disease control are part of a larger vision for health and
well-being, one in which good health for everyone is integral to social cohesion and stability.
The first of our challenges is to help reach, and surpass, the health targets set in the MDG
era. One urgent task is to tackle the persistent causes of maternal and neonatal mortality. From
a technical standpoint, we know how to do this, but we must find the right approach in each
and every setting. Most maternal and child deaths can be prevented with high-quality care
during pregnancy, delivery of babies by skilled birth attendants, breastfeeding, and through
guaranteed access to appropriate antibiotics and immunization. Another well-defined task is to
expand the coverage of antiretroviral therapy for HIV-positive people and to ensure prompt
diagnosis and treatment for people with malaria, tuberculosis, and hepatitis. During the MDG
era, disease control programs rightly emphasized the provision of good health services. But
there are some extra steps to be takenfor example, to ensure that people who live under the
threat of communicable diseases are adequately protected from financial risk, a vital ingredient
of universal health coverage. Furthermore, our commitments to communicable disease control
include elimination and eradication of, for example, malaria from selected countries, including
Mexico, Malaysia, and South Africa, and polio and guinea worm disease from all countries.
The growing importance of noncommunicable diseases such as heart disease, diabetes, and
cancer is, in part, the inevitable consequence of successfully controlling infections. In 2012, the
average life expectancy at birth worldwide had increased to 70 years. This astonishing fact
means that a large number of people now live long enough to suffer and eventually die from
chronic illnessesmainly cardiovascular disease and cancer. Clearly, we must all die of
something, but many deaths from noncommunicable diseases are premature and preventable.
Having examined the underlying causes and possible remedies, WHOs World Health Assembly
set a target of reducing premature mortality due to cardiovascular disease, cancer, diabetes, or
chronic respiratory disease by 25% between 2010 and 2025.
To achieve this goal, WHO, as an intergovernmental organization, is using all available
instruments at its disposal. The 2005 Framework Convention on Tobacco Control was the first
global health treaty negotiated under the auspices of WHO. In 2013, with 178 signatories, an
estimated 2.3 billion people were protected by at least one measure reducing tobacco demand
that had been fully implemented by governments worldwide. The entire campaign against
noncommunicable diseases was given a huge boost by the 2011 United Nations General
Assembly, which recognized chronic diseases to be a major challenge, not merely for health but
also for development in the 21st century.
The task of controlling communicable and noncommunicable diseases inevitably focuses on
specific causes or risk factors. These are aided and abetted by insidious, systemic causes of ill
health in populations, among which social inequality is a prime example. Despite some
arguments to the contrary, we still inhabit a very unequal world. The richest 1% of people own
~40% of the worlds assets, and less than 1% of all assets are owned by the poorest 50% of
people. The result is that 1.2 billion people still live in extreme poverty. And there are some
disturbing trends. Over the past two decades, income inequality has been growing on average
within and among countriesa trend that drives health inequalities, too. Social inequality is a
structural problem that requires many kinds of remedy, but universal health coverage can make
a powerful contribution. The first point about universal health coverage is that it must be
precisely that: universal. However, universal health coverage is not merely the quest to reach
an arithmetic target, but also has the goal of demanding equal rights to health and social
protection for all, even those in the smallest minority.
The 1978 Alma Ata Declaration was one of the 20th centurys landmarks in public health. It
emphasized the role of the state in providing adequate health and social measures. In the 21st
century, states still have this responsibility of course, but now, health depends on many more
actors. Recognizing that no intergovernmental organization can achieve its goals by operating
from within the public sector alone, WHO now works with a multiplicity of nonstate actors
including nongovernmental organizations, philanthropic organizations, and academic
institutionsto create and protect global public goods, such as standards of medical practice
and the quality control of health products. WHO also works with nonstate actors to draw on
private expertise, knowledge, commodities, personnel, and finances for the benefit of health
and to encourage nonstate actors to improve their own activities to protect and promote health.
Last, nearly 30 years after the publication of a seminal report from the Rockefeller
Foundation, we do still place a high premium on Good Health at Low Cost (5). Besides
supporting research into better ways of sharing financial risks, and in addition to providing
technical guidance for major funding initiatives (the Global Fund, the GAVI Alliance, and
others), WHO is also promoting market mechanisms to lower the prices of high-quality
commodities, including vaccines and essential medicines. Among the most successful efforts so
far is prequalification, a mechanism that guarantees the quality of vaccines, drugs, and
diagnostics for purchasing agencies, including the GAVI Alliance, and opens up the market to
new manufacturers. In 2013, for example, prequalification of a Japanese encephalitis vaccine
made in China cut the cost of each dose to US$0.30, well below the price of other Japanese
encephalitis vaccines then on the market. This decision followed WHO approval, in 2011, of the
China Food and Drug Administration as a functional regulatory authority for vaccines, a
milestone on Chinas road to becoming a global vaccine supplier.
In ventures of this kind, United Nations agencies often work best together, rather than alone.
The 2013 report on Promoting Access to Medical Technologies and Innovation, prepared jointly
by WHO, the World Intellectual Property Organization (WIPO), and the World Trade
Organization (WTO), is a comprehensive guide to the interface between health, trade, and
intellectual property. Likewise, the Pharmaceutical Manufacturing Plan for Africa, a proposal of
the African Union Commission, is jointly supported by WHO, the Joint United Nations
Programme on HIV and AIDS (UNAIDS), and the United Nations Industrial Development
Organization (UNIDO).
As WHO moves into the post-2015 era of development, we shall remain true to our roots. We
shall covetously guard our reputation for impartiality and sound science. We shall continue to
serve as an honest broker, acting in the best interests of our Member States. We shall monitor
health trends and track progress toward universal health coverage. We shall draw on our global
perspective to help shape the agenda for health research. From guidelines to treaties, we shall
use all of the instruments available to us in the cause of better health.
But, we are also open to new ways of doing business, by putting disease control programs in
the context of universal health coverage, by actively seeking alliances beyond the public sector,
and by promoting health, not only through health institutions, but also through agriculture, the
economy, education, and the environment.
Everyone has a stake in health, and WHO has always worked to guard the health of
everyone. But the professional business of health has changed profoundly since the turn of the
millennium. WHOs role, more than ever, is to provide leadership by building consensus around
a shared responsibility for health, and by responding with agility to the unexpected challenges
and new opportunities of the 21st century.
References
United Nations, Sustainable Development Knowledge Platform (United Nations, New York,
2014).
United Nations, The Millennium Development Goals Report 2013 (United Nations, New York,
2013).
World Health Organization, WHO Reforms for a Healthy Future. Report by the Director-General
(World Health Organization, Geneva, 2012).
World Health Organization, The World Health Report 2013: Research for Universal Health
Coverage (World Health Organization, Geneva, 2013).
S. Halstead, J. Walsh, K. Warren, Eds., Good Health at Low Cost (Rockefeller Foundation,
Bellagio, Italy, 1985).
Copyright 2014, American Association for the Advancement of Science
Perspective
INFECTIOUS DISEASE
Emerging Viral Diseases: Confronting Threats with New Technologies
Hilary D. Marston, Gregory K. Folkers, David M. Morens and Anthony S. Fauci*
Author Affiliations
National Institute of Allergy and Infectious Diseases at the National Institutes of Health,
Bethesda, MD 20892, USA.
Abstract
Emerging viral diseases pose ongoing health threats, particularly in an era of globalization;
however, new biomedical research technologies such as genome sequencing and structure-
based vaccine and drug design have improved our ability to respond to viral threats.
Perspective
VACCINES
Contemporary Vaccine Challenges: Improving Global Health One Shot at a Time
Walter A. Orenstein1,*, Katherine Seib1, Duncan Graham-Rowe2 and Seth Berkley2
Author Affiliations
1Emory University, School of Medicine, Department of Infectious Diseases, Atlanta, GA, USA.
2Gavi, the Vaccine Alliance, Geneva, Switzerland.
Vaccines have proved to be one of the most powerful and effective ways of reducing disease.
However, if we are to maximize their impact on global health, then we need to develop new
vaccines for additional diseases as well as to improve their supply and delivery, particularly in
developing countries.
[Concluding paragraph]
Vaccines and vaccination have been one of the worlds great success stories in reducing
disease, disability, and death. The progress expected in the next decade will lead to the
prevention of ever greater health burdens. However, to maintain this impact and to achieve the
full potential vaccines have to offer, current efforts, using existing vaccines, must be sustained
and even bolstered. And new vaccines, now under development or to be developed in the
future, must be made available to all countries with populations that could benefit from those
vaccines. This includes removing financial barriers to vaccine access while assuring that
financial incentives remain in place to develop new vaccines. In addition, delivery systems must
be supported in order to make sure that vaccines can be transported to all populations, can be
stored at recommended temperatures, and can be administered to all in need. Optimal control
of disease through vaccination can be facilitated by the development of vaccines that do not
require a cold chain and do not require delivery through needle and syringe. Vaccines are the
one medical intervention recommended repeatedly for all children, and efforts should be made
to link vaccination efforts to the delivery of other critical health care services. There is also a
need to support a research base to develop new vaccines so as to increase the numbers of
diseases preventable by vaccination. In addition, it is critical to have substantial interaction
between vaccine developers and regulatory authorities in order to assure that development
plans, if successful, will yield a licensed vaccine. Thus, the vaccine enterprise will require
collaboration of basic scientists, vaccine developers, manufacturers, vaccine and vaccination
financiers, governments, regulators, and public and private sector vaccine deliverers, among
others, to create successful, complex systems and products for the future.

WHO: Humanitarian Health Action [to 13 September 2014]
http://www.who.int/hac/en/
WHO responding to serious health concerns in conflict-affected Ukraine
9 September 2014 Geneva/Kiev--The crisis in eastern Ukraine is creating a looming health
emergency as hundreds of thousands of people have been displaced and are living in varying
and often exposed conditions as winter approaches, many without official status either as
internally displaced persons or as refugees.

No vaccine stocks in crisis-hit Ukraine: WHO
September 9, 2014 5:05 PM
Excerpt
Geneva (AFP) - Conflict-torn Ukraine is facing a health emergency, with no stocks of any
vaccines and dire shortages of many medicines, the World Health Organization warned
Tuesday.
"Ukraine has no vaccines... They don't have any vaccines in their storage," said Dorit Nitzan,
who heads WHO's country office in Ukraine.
"Even before the crisis they had low (immunisation) coverage," she told reporters in Geneva,
stressing that there was a dearth of "every kind of vaccine."
The shortage raises deep concerns that polio could break out in Ukraine, Nitzan said, pointing
out that the crippling disease that mainly hits young children "usually comes in countries in
turmoil."

EBOLA [to 13 September 2014]
WHO: Ebola Response Roadmap Situation Report 3
12 September 2014
Excerpts
This is the third in a series of regular situation reports on the Ebola Response Roadmap1. The
report contains a review of the epidemiological situation, and an assessment of the response
measured against the core Roadmap indicators where available. Additional indicators will be
reported as data are consolidated
Following the roadmap structure, country reports fall into three categories: those with
widespread and intense transmission (Guinea, Liberia, and Sierra Leone); those with an initial
case or cases, or with localized transmission (Nigeria, Senegal); and those countries that
neighbour areas of active transmission (Benin, Burkina Faso, Cote dIvoire, Guinea-Bissau, Mali,
Senegal)
1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
There has been no indication of any down-turn in the epidemic in the three countries that
have widespread and intense transmission (Guinea, Liberia, and Sierra Leone), with a surge in
new cases in Liberia a particular cause for concern(see table 1). Transmission is continuing in
urban areas, with the surge in Liberia being driven primarily by a sharp increase in the number
of cases reported in the capital, Monrovia
3. PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA
EXPOSURE
Forty of 41 countries in the WHO African Region have now responded to a preparedness
assessment (the six countries affected by Ebola were excluded from the survey; Mozambique
has not yet responded). Putting in place fully functional protocols for contact tracing and
monitoring, and for managing travellers arriving at major border crossings with febrile illness
appear to be the priority areas that need to be addressed.
Twenty-three of the 40 (58%) countries surveyed have a surveillance system in place and
functional at major land border crossings and key locations in the capital city (airport, seaport if
any, and major hospitals). 16 (40%) countries have a system in place but it is not yet
functional. 12 of the 40 (33%) countries have a protocol in place and functional for managing
travellers who arrive at major land crossing points with unexplained febrile illnesses. 17 (43%)
countries have a protocol in place but it is not yet functional.
Fourteen of 39 (35%; South Sudan has missing data for this question) countries have
identified functional facilities that could operate as an isolation unit for Ebola case investigation
and management if required. 21 (54%) countries have identified facilities, but they are not yet
functional. 27 of 40 (68%) countries have access to WHO-recognized laboratories, and have
procedures for specimen handling and shipment in place and functional. Eight (20%) countries
have a diagnostic protocol in place, but it is not yet functional.
Fourteen of 40 (35%) countries have a fully functional protocol in place for identifying and
monitoring the contacts of any suspected Ebola case. A protocol is in place but not yet
functional in 11 (28%) countries.

Additional WHO Content
:: Remarks at a press conference: Cuban government announces substantial support to WHO
Ebola response
Statement by WHO Director-General, Dr Margaret Chan
12 September 2014
Excerpt
The Ebola outbreak that is ravaging parts of west Africa is the largest, most severe, and
most complex in the nearly four-decade history of this disease.
This is Ebola Zaire, the most deadly in the Ebola family of viruses. This is a dreaded virus that
is highly contagious, but under only two very specific settings.
First, during care of patients at home by family members or in hospital settings without
proper protection against infection. Second, during certain traditional burial practices that
involve close contact with a highly infectious corpse.
In the 3 hardest-hit countries, Guinea, Liberia, and Sierra Leone, the number of new cases is
moving far faster than the capacity to manage them in Ebola-specific treatment centres.
In Liberia, for example, an Ebola treatment facility, set up jointly by WHO and the Ministry of
Health, was recently established to manage 30 patients. It had more than 70 patients the day it
opened.
Today, Liberia has not one single bed available for the treatment of an Ebola patient
anywhere in the entire country.
Our response is running short on nearly everything, from personal protective equipment, to
body bags, to mobile laboratories, to isolation wards.
But the thing we need most of all is people, health care workers. The right people. The right
specialists. And specialists who are appropriately trained, and know how to keep themselves
safe.
This is vitally important to stop transmission of the Ebola virus. Money and materials are
important, but those two things alone cannot stop Ebola virus transmission.
Human resources are clearly our most important need. We need most especially
compassionate doctors and nurses, who will know how to comfort patients despite the barriers
of wearing PPE and working under very demanding conditions
I thank the many countries that have already been providing support to WHO and also to
other UN agencies, such as UNICEF and the World Food Programme, especially for their support
to the three hardest-hit countries.
But we need more of this kind of support. We need a surge of at least three to four times to
catch up with the outbreaks that are moving very fast in these three countries.
I hope the announcement today by the Cuban government will stimulate more countries to
surge their support
:: WHO Director-General addresses the Regional Committee for South-East Asia
Dr Margaret Chan
Director-General of the World Health Organization
Address to the Regional Committee for South-East Asia, Sixty-seventh Session
Dhaka, Bangladesh
10 September 2014
Includes commentary on the Ebola outbreak and global implications, WHO response to date,
and need for health systems strengthening.
:: WHO welcomes Cuban doctors for Ebola response in west Africa
Statement - 12 September 2014
:: Ebola Situation in Senegal remains stable
12 September 2014
:: Ebola virus disease Democratic Republic of Congo
10 September 2014
:: Ebola situation in Liberia: non-conventional interventions needed
8 September 2014

IRIN
:: Liberian Ebola burial teams stressed, traumatized

UNICEF Watch [to 13 September 2014]
http://www.unicef.org/media/media_71724.html
Ebola crisis in Liberia hits child health and well-being
GENEVA/MONROVIA, Liberia, 12 September 2014 - As efforts to halt the spread of the Ebola
virus intensify, UNICEF warns of its far-reaching impact on children. In Liberia, Ebola has
severely disrupted health services for children, caused schools to close and left thousands of
children without a parent. Children are dying from measles and other vaccine preventable
diseases and pregnant women have few places to deliver their babies safely

Gates Foundation Commits $50 Million to Support Emergency Response to Ebola
SEPTEMBER 10, 2014
SEATTLE (September 10, 2014) The Bill & Melinda Gates Foundation today announced that it
will commit $50 million to support the scale up of emergency efforts to contain the Ebola
outbreak in West Africa and interrupt transmission of the virus.

Additional Ebola commentary and analysis in Journal Watch below: Please see
Eurosurveillance, JAMA, Nature, and Nature Medicine.

POLIO [to 13 September 2014]
GPEI Update: Polio this week - As of 10 September 2014
Global Polio Eradication Initiative
Editors Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: More than 650,000 individuals (more than 370,000 below 5 years) have been vaccinated from
21st May to 4th September 2014 in the Federally Administered Tribal Areas (FATA) and Khyber
Pakhtunkhwa of Pakistan. Most of those reached are internally displaced persons from North
Waziristan. In Nigeria, 97% of surveyed Local Government Areas achieved over 80% coverage
during the August polio immunization round, according to preliminary findings from the most
recent Lot Quality Assurance Sampling.
:: Protecting west Africa: Even as polio programme staff across west Africa support efforts to
control the Ebola outbreak affecting the region, preparations are going ahead for large scale
multi-country vaccination campaigns in those countries not affected by Ebola, in mid-
September.
:: A new case of wild poliovirus type 1 (WPV1) has been reported in Somalia. Planning for an
increased focus on reaching pastoral communities has begun, using innovative techniques such
as satellite imagery for micro-planning.
Afghanistan
:: Polio vaccination activities resumed in August in parts of Helmand Province in the Southern
Region of Afghanistan for the first time in five months. Since then, two campaigns have been
done. The upcoming 21-23 September activity will cover the entire province using bivalent OPV.
Pakistan
:: 21 new wild poliovirus type 1 (WPV1) cases were reported in the past week. Of these, 17 are
from the Federally Administered Tribal Areas (FATA) (2 from North Waziristan, 4 from South
Waziristan and 11 from Khyber agency) and 4 from Khyber Pakhtunkhwa (1 from Tank (the first
case from this district for 2014), 2 from Bannu, and 1 from Lakki Marwat). This brings the total
number of polio cases in 2014 to 138 compared to 28 in 2013 by this date. The most recent
onset of paralysis was on 24 August in Khyber Pakhtunkhwa.
:: The high number of WPV1 cases reported this week are due to a backlog in the laboratory,
and represents a period of onset from 20 July to 24 August.
Horn of Africa
:: One new case of wild poliovirus type 1 (WPV1) has been reported in the past week in
Somalia, the first case to be found in the Hobyo district of Mudug province. Onset of paralysis
was on 11 August. This brings the total number of cases that have been reported in the Horn of
Africa to date in 2014 to six: one in Ethiopia (date of onset of paralysis on 14 January) and five
in Somalia.
:: Activities are being initiated to address the spread of WPV-1 in Somalia, with an increased
focus on accessing pastoral communities, using satellite imagery for micro-plannin

The Weekly Epidemiological Record (WER) 12 September 2014, vol. 89, 37 (pp. 401
408) includes:
:: Elimination of onchocerciasis in the WHO Region of the Americas: Ecuadors progress towards
verification of elimination
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2014
http://www.who.int/entity/wer/2014/wer8937.pdf?ua=1

WHO & Regionals [to 13 September 2014]
SEARO
:: Sixty-seventh Session of the Regional Committee
9-12 September 2014, Dhaka, Bangladesh
:: Press release - Quality traditional medicine can deliver Universal Health Coverage: WHO
:: Press release - International initiative for neurodevelopmental disorders launched
:: Press release - Health Ministers resolve to accelerate efforts to improve health in the Region
Europe
:: WHO European governing body set to adopt innovative public health plans and nominate
regional head of agency
Copenhagen, 11 September 2014
On 15 September, the annual meeting of the WHO Regional Committee for Europe opens,
bringing together representatives of the 53 Member States in the WHO European Region to
take stock of what has been achieved and to decide what should be done next. During the four-
day meeting, about 350 participants will consider the progress made in implementing the WHO
European policy framework, Health 2020, and nominate the WHO Regional Director for Europe
for a five-year term of office. The Regional Committee is also expected to endorse innovative
action plans, negotiated over the last year, on some of the key public health issues in the
Region: vaccination, child and adolescent health, prevention of child maltreatment, and food
and nutrition.

CDC/MMWR Watch [to 13 September 2014]
http://www.cdc.gov/media/index.html
:: CDC Telebriefing update on respiratory illness affecting children in multiple states - Transcript
9/9/2014, 12:00 PM
MMWR for September 12, 2014 / Vol. 63 / No. 36
:: Measles Outbreak in an Unvaccinated Family and a Possibly Associated International Traveler
Orange County, Florida, December 2012January 2013
:: Assessment of Varicella Surveillance and Outbreak Control Practices United States, 2012
:: Severe Respiratory Illness Associated with Enterovirus D68 Missouri and Illinois, 2014
:: Notes from the Field: Measles in a Micronesian Community King County, Washington, 2014

GAVI Watch [to 13 September 2014]
http://www.gavialliance.org/library/news/press-releases/
No new digest content identified.

Global Fund Watch [to 13 September 2014]
http://www.theglobalfund.org/en/mediacenter/announcements/
No new digest content identified

European Medicines Agency Watch [to 13 September 2014]
http://www.ema.europa.eu/ema/
No new digest content identified.

Industry Watch [to 13 September 2014]
Selected media releases and other selected content from industry.
:: FDA Approves Use of Menactra Vaccine for Booster Immunization Against Potentially
Deadly Disease Sep 08, 2014

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

No new content identified.

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

The American Journal of Bioethics
Volume 14, Issue 9, 2014
http://www.tandfonline.com/toc/uajb20/current
Issue focused on minimal risk in research involving children.
[Reviewed earlier]

American Journal of Infection Control
Volume 42, Issue 9, p941-1024 September 2014
http://www.ajicjournal.org/current
[Reviewed earlier]

American Journal of Preventive Medicine
Volume 47, Issue 3, p233-374 September 2014
http://www.ajpmonline.org/current
[Reviewed earlier

American Journal of Public Health
Volume 104, Issue S4 (September 2014)
http://ajph.aphapublications.org/toc/ajph/current
[Reviewed earlier]

American Journal of Tropical Medicine and Hygiene
September 2014; 91 (3)
http://www.ajtmh.org/content/current
[Reviewed earlier]

Annals of Internal Medicine
2 September 2014, Vol. 161. No. 5
http://annals.org/issue.aspx
[Reviewed earlier]

BMC Health Services Research
(Accessed 13 September 2014)
http://www.biomedcentral.com/bmchealthservres/content
[No new relevant content]

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
Research article
Factors influencing adolescent girls' decision in initiation for human papillomavirus
vaccination: a cross-sectional study in Hong Kong
Albert Lee, Mandy Ho, Calvin Ka Cheung, Vera Mei Keung BMC Public Health 2014, 14:925 (8
September 2014)
Abstract (provisional)
Background
Cervical cancer is one of the common cancers among women worldwide. Despite HPV
vaccination being one of the effective preventive measures, it is not included in government
vaccination programme in Hong Kong. This study aimed to assess the knowledge of and
attitude towards cervical cancer prevention among Chinese adolescent girls in Hong Kong, and
to identify factors influencing the initiation of HPV vaccination.
Methods
This was a cross-sectional study conducted in Hong Kong during the period of October 2010 to
November 2010. A self-administered questionnaire was used, with 1,416 girls from 8 secondary
schools completing the questionnaire. Knowledge scores were composited and initiation of HPV
vaccination was staged based on stage of change. Analyses were conducted to identify the
association of initiation of HPV vaccination with participants personal and family factors as well
as their knowledge and attitude towards cervical cancer prevention.
Results
The uptake rate of HPV vaccination was low (7%) with 58% respondents in pre-contemplation
and contemplation stage. The survey identified a significant gap in knowledge on cervical
cancer prevention. The main channels of information were from media and very few from
schools or parents. However, 70% expressed their wishes to have more information on cancer
prevention, and 78% stated that they were willing to change their lifestyles if they knew the
ways of prevention. Multivariate analysis identified three independent significant factors for
initiation of vaccination (action and intention): perceived cancer as terrifying disease, school
should provide more information on cancer prevention, and comments from relatives and
friends having received the vaccine. The cost of vaccination and socio-economic background
were not found to be significant.
Conclusions
Public education on cervical cancer needs to be well penetrated into the community for more
sharing among friends and relatives. School as setting to provide source of information would
facilitate uptake rate of HPV vaccine as students have expressed their wishes that school should
provide more information on prevention of cancer. School and community education on cancer
prevention would help adolescents to have better understanding of the seriousness of cancer.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content

British Medical Journal
13 September 2014(vol 349, issue 7974)
http://www.bmj.com/content/349/7974
Research
Government health insurance for people below poverty line in India: quasi-
experimental evaluation of insurance and health outcomes
Neeraj Sood, associate professor123, Eran Bendavid, assistant professor45, Arnab Mukherji,
associate professor6, Zachary Wagner, PhD student7, Somil Nagpal, senior health specialist8,
Patrick Mullen, senior health specialist8
Author affiliations
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5114 (Published 11 September 2014) Cite
this as: BMJ 2014;349:g5114
Abstract
Objectives To evaluate the effects of a government insurance program covering tertiary care for
people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use,
and mortality.
Design Geographic regression discontinuity study.
Setting 572 villages in Karnataka, India.
Participants 31476 households (22796 below poverty line and 8680 above poverty line) in 300
villages where the scheme was implemented and 28633 households (21767 below poverty line
and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme.
Intervention A government insurance program (Vajpayee Arogyashree scheme) that provided
free tertiary care to households below the poverty line in about half of villages in Karnataka
from February 2010 to August 2012.
Main outcome measure Out-of-pocket expenditures, hospital use, and mortality.
Results Among households below the poverty line, the mortality rate from conditions potentially
responsive to services covered by the scheme (mostly cardiac conditions and cancer) was
0.32% in households eligible for the scheme compared with 0.90% among ineligible households
just south of the eligibility border (difference of 0.58 percentage points, 95% confidence
interval 0.40 to 0.75; P<0.001). We found no difference in mortality rates for households above
the poverty line (households above the poverty line were not eligible for the scheme), with a
mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared
with 0.55% in ineligible villages (difference of 0.01 percentage points, 0.03 to 0.03; P=0.95).
Eligible households had significantly reduced out-of-pocket health expenditures for admissions
to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35%
to 97%; P<0.001). There was no significant increase in use of covered services, although the
point estimate of a 44.2% increase approached significance (5.1% to 90.5%; P=0.059). Both
reductions in out-of-pocket expenditures and potential increases in use might have contributed
to the observed reductions in mortality.
Conclusions Insuring poor households for efficacious but costly and underused health services
significantly improves population health in India.

Bulletin of the World Health Organization
Volume 92, Number 9, September 2014, 621-696
http://www.who.int/bulletin/volumes/92/9/en/
[Reviewed earlier]

Clinical Infectious Diseases (CID)
Volume 59 Issue 13 September 15, 2014
http://cid.oxfordjournals.org/content/current
[Reviewed earlier]

Clinical Therapeutics
Volume 36, Issue 8, p1127-1314 August 2014
http://www.clinicaltherapeutics.com/current
[Reviewed earlier]

Cost Effectiveness and Resource Allocation
http://www.resource-allocation.com/

Current Opinion in Infectious Diseases
October 2014 - Volume 27 - Issue 5 pp: v-vi,403-469
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx
[Reviewed earlier]

Developing World Bioethics
August 2014 Volume 14, Issue 2 Pages iiviii, 59110
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2014.14.issue-2/issuetoc
[Reviewed earlier]

Development in Practice
http://www.tandfonline.com/toc/cdip20/current
Special issue on climate change adaptation and development
[Reviewed earlier]

Emerging Infectious Diseases
Volume 20, Number 9September 2014
http://wwwnc.cdc.gov/eid/
[Reviewed earlier]

Epidemics
Volume 8, In Progress (September 2014)
http://www.sciencedirect.com/science/journal/17554365
[Reviewed earlier]

Epidemiology and Infection
Volume 142 - Issue 10 - October 2014
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue
[Reviewed earlier]

The European Journal of Public Health
Volume 24 Issue 4 August 2014
http://eurpub.oxfordjournals.org/content/current
[Reviewed earlier]

Eurosurveillance
Volume 19, Issue 36, 11 September 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678
Editorials
Containing Ebola virus infection in West Africa
A J Kucharski, P Piot1
London School of Hygiene & Tropical Medicine, London, United Kingdom
Excerpt
Ebola virus disease (EVD) is leaving a mark deeper and wider than ever before. The current
outbreak now spans five countries in West Africa Guinea, Liberia, Nigeria, Senegal and Sierra
Leone with over 4,200 cases and 2,200 deaths reported to the World Health Organization
(WHO) as of 6 September 2014 (Figure 1) [1]. Unfortunately, with many cases either not
reported or yet to show symptoms, the true number of infections is likely to be considerably
higher. The first countries affected were among the worlds poorest, areas where long periods
of civil wars have battered health services and eroded public trust. As a result, the outbreak has
spread to other countries, and continues to expand. What began as a local problem has turned
into an international crisis

Global Health: Science and Practice (GHSP)
August 2014 | Volume 2 | Issue 3
http://www.ghspjournal.org/content/current
[Reviewed earlier]

Globalization and Health
[Accessed 13 September 2014]
http://www.globalizationandhealth.com/
Research
Trade and investment liberalization and Asia's noncommunicable disease epidemic -
A synthesis of data and existing literature
Phillip I Baker, Adrian Kay and Helen L Walls
Author Affiliations
Globalization and Health 2014, 10:66 doi:10.1186/s12992-014-0066-8
Published: 12 September 2014
Abstract (provisional)
Background
Trade and investment liberalization (trade liberalization) can promote or harm health.
Undoubtedly it has contributed, although unevenly, to Asias social and economic development
over recent decades with resultant gains in life expectancy and living standards. In the absence
of public health protections, however, it is also a significant upstream driver of non-
communicable diseases (NCDs) including cardiovascular disease, cancer and diabetes through
facilitating increased consumption of the `risk commodities tobacco, alcohol and ultra-
processed foods, and by constraining access to NCD medicines. In this paper we describe the
NCD burden in Asian countries, trends in risk commodity consumption and the processes by
which trade liberalization has occurred in the region and contributed to these trends. We further
establish pressing questions for future research on strengthening regulatory capacity to address
trade liberalization impacts on risk commodity consumption and health.
Methods
A semi-structured search of scholarly databases, institutional websites and internet sources for
academic and grey literature. Data for descriptive statistics were sourced from Euromonitor
International, the World Bank, the World Health Organization, and the World Trade
Organization.
Results
Consumption of tobacco, alcohol and ultra-processed foods was prevalent in the region and
increasing in many countries. We find that trade liberalization can facilitate increased trade in
goods, services and investments in ways that can promote risk commodity consumption, as well
as constrain the available resources and capacities of governments to enact policies and
programmes to mitigate such consumption. Intellectual property provisions of trade agreements
may also constrain access to NCD medicines. Successive layers of the evolving global and
regional trade regimes including structural adjustment, multilateral trade agreements, and
preferential trade agreements have enabled transnational corporations that manufacture,
market and distribute risk commodities to increasingly penetrate and promote consumption in
Asian markets.
Conclusions
Trade liberalization is a significant driver of the NCD epidemic in Asia. Increased participation in
trade agreements requires countries to strengthen regulatory capacity to ensure adequate
protections for public health. How best to achieve this through multilateral, regional and
unilateral actions is a pressing question for ongoing research.

Global Health Governance
http://blogs.shu.edu/ghg/category/complete-issues/summer-2013/

Global Public Health
Volume 9, Supplement 1, 2014
http://www.tandfonline.com/toc/rgph20/.Uq0DgeKy-F9#.U4onnCjDU1w
This Special Supplement is dedicated to all the Afghan and international health workers who
sacrificed their lives during the rebuilding of the Afghan health system.
[Reviewed earlier]

Health Affairs
September 2014; Volume 33, Issue 9
http://content.healthaffairs.org/content/current
Theme: Advancing Global Health Policy
Global Health Leaders Recommit To Reducing Child Deaths
Jessica Bylander
Health Aff September 2014 33:1503-1506; doi:10.1377/hlthaff.2014.0848
Abstract
Innovation & Implementation
Accountable Care Around The World: A Framework To Guide Reform Strategies
Mark McClellan, James Kent, Stephen J. Beales, Samuel I.A. Cohen, Michael Macdonnell, Andrea
Thoumi, Mariam Abdulmalik, and Ara Darzi
Abstract
ANALYSIS & COMMENTARY:
Lessons From Eight Countries On Diffusing Innovation In Health Care
Oliver P. Keown, Greg Parston, Hannah Patel, Fiona Rennie, Fathy Saoud, Hanan Al Kuwari, and
Ara Darzi
Abstract
ANALYSIS & COMMENTARY:
Developing Public Policy To Advance The Use Of Big Data In Health Care
Axel Heitmueller, Sarah Henderson, Will Warburton, Ahmed Elmagarmid, Alex Sandy Pentland,
and Ara Darzi
Abstract
The Hidden Cost Of Low Prices: Limited Access To New Drugs In India
Ernst R. Berndt and Iain M. Cockburn
Abstract
Improving Access To Malaria Medicine Through Private-Sector Subsidies In Seven
African Countries
Sarah Tougher, Andrea G. Mann, ACTwatch Group, Yazoume Ye, Idrissa A. Kourgueni, Rebecca
Thomson, John H. Amuasi, Ruilin Ren, Barbara A. Willey, Daniel Ansong, Katia Bruxvoort,
Graciela Diap, Charles Festo, Boniface Johanes, Admirabilis Kalolella, Oumarou Mallam, Blessing
Mberu, Salif Ndiaye, Samual Blay Nguah, Moctar Seydou, Mark Taylor, Marilyn Wamukoya, Fred
Arnold, Kara Hanson, and Catherine Goodman
Abstract

Health and Human Rights
Volume 16, Issue 1
http://www.hhrjournal.org/
Climate Justice and the Right to Health A Special Issue
[Reviewed earlier]

Health Economics, Policy and Law
Volume 9 - Issue 04 - October 2014
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue
[Reviewed earlier]

Health Policy and Planning
Volume 29 Issue 6 September 2014
http://heapol.oxfordjournals.org/content/current
[Reviewed earlier]

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
September 2014 Volume 10, Issue 9
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/8/
Special focus: Vaccine acceptance
[Reviewed earlier]

Infectious Agents and Cancer
http://www.infectagentscancer.com/content

Infectious Diseases of Poverty
http://www.idpjournal.com/content

International Health
http://inthealth.oxfordjournals.org/content/6/3.toc
[Reviewed earlier]

International Journal of Epidemiology
Volume 43 Issue 4 August 2014
http://ije.oxfordjournals.org/content/current
[Reviewed earlier]

International Journal of Infectious Diseases
Vol 26 Complete | September 2014 | Pages 1-172
http://www.ijidonline.com/current
[Reviewed earlier]

JAMA
September 10, 2014, Vol 312, No. 10
http://jama.jamanetwork.com/issue.aspx
Editorial | September 10, 2014
Open Access to Clinical Trials Data
Harlan M. Krumholz, MD, SM1; Eric D. Peterson, MD, MPH2,3
[+] Author Affiliations
JAMA. 2014;312(10):1002-1003. doi:10.1001/jama.2014.9647.
Excerpt
Well-conducted randomized clinical trials (RCTs) are the gold standard for evaluating the safety
and efficacy of medical therapeutics. Yet most often, a single group of individuals who
conducted the trial are the only ones who have access to the raw data, conduct the analysis,
and publish the study results. This limited access does not typically allow others to replicate the
trial findings. Given the time and expense required to conduct an RCT, it is often unlikely that
others will independently repeat a similar experiment. Thus, the scientific community and the
public often accept the results produced and published by the original research team without an
opportunity for reanalysis. Increasingly, however, opinions and empirical data are challenging
the assumption that the analysis of a clinical trial is straightforward and that analysis by any
other group would obtain the same results.1- 3
Medical News & Perspectives | September 10, 2014
Largest-Ever Outbreak of Ebola Virus Disease Thrusts Experimental Therapies,
Vaccines Into Spotlight
Tracy Hampton, PhD
JAMA. 2014;312(10):987-989. doi:10.1001/jama.2014.11170.
As efforts to successfully contain the largest outbreak of Ebola virus disease in history prove
elusive, the mounting number of cases and deaths has brought research to develop much-
needed treatments and protective vaccines into the spotlight. Although the approval process for
drugs and vaccines is typically slow and deliberate, the latest outbreak, declared by the World
Health Organization (WHO) on August 8 as an international health emergency, has galvanized
regulatory officials to consider proposals for providing as-yet unproven treatments under special
emergency New Drug Applications.

JAMA Pediatrics
September 2014, Vol 168, No. 9
http://archpedi.jamanetwork.com/issue.aspx
[Reviewed earlier]

Journal of Community Health
Volume 39, Issue 4, August 2014
http://link.springer.com/journal/10900/39/4/page/1
[Reviewed earlier]

Journal of Global Ethics
http://www.tandfonline.com/toc/rjge20/.U2V-Elf4L0l#.VAJEj2N4WF8
Tenth Anniversary Forum: The Future of Global Ethics
[Reviewed earlier]

Journal of Global Infectious Diseases (JGID)
July-September 2014 Volume 6 | Issue 3 Page Nos. 93-137
http://www.jgid.org/currentissue.asp?sabs=n
[Reviewed earlier]

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 25, Number 3, August 2014
http://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.2
5.3.html
[Reviewed earlier]

Journal of Health Organization and Management
Volume 28 issue 4 - Latest Issue
http://www.emeraldinsight.com/journals.htm?issn=1477-7266&show=latest
[Reviewed earlier]

Journal of Immigrant and Minority Health
Volume 16, Issue 5, October 2014
[Reviewed earlier]

Journal of Infectious Diseases
Volume 210 Issue 13 September 15, 2014
http://jid.oxfordjournals.org/content/current
[Reviewed earlier]

Journal of Medical Ethics
September 2014, Volume 40, Issue 9
http://jme.bmj.com/content/current
[Reviewed earlier]

Journal of Medical Internet Research
Vol 16, No 8 (2014): August
http://www.jmir.org/issue/current
[Reviewed earlier]

Journal of Medical Microbiology
September 2014; 63 (Pt 9)
http://jmm.sgmjournals.org/content/current
[Reviewed earlier]

Journal of the Pediatric Infectious Diseases Society (JPIDS)
http://jpids.oxfordjournals.org/content/current
[Reviewed earlier]

Journal of Pediatrics
Vol 165 | No. 3 | September 2014 | Pages 427-646
http://www.jpeds.com/current
[No relevant content]

Journal of Public Health Policy
Volume 35, Issue 3 (August 2014)
http://www.palgrave-journals.com/jphp/journal/v35/n3/index.html
[Reviewed earlier]

Journal of the Royal Society Interface
October 6, 2014; 11 (99)
http://rsif.royalsocietypublishing.org/content/current
[Reviewed earlier]

Journal of Virology
September 2014, volume 88, issue 18
http://jvi.asm.org/content/current
[Reviewed earlier]

The Lancet
Sep 13, 2014 Volume 384 Number 9947 p929 1070 e38
http://www.thelancet.com/journals/lancet/issue/current
Editorial
The silver bullet of resilience
The Lancet
The irony of September being US National Preparedness month was not lost as Mdecins sans
Frontires (MSF) made an uncharacteristic global call for rapid deployment of civil and military
medical assets with expertise in biohazard containment to west Africa. With 42% of all reported
Ebola infections occurring in the past month, and more than 2000 reported deaths, local health
systems and international organisations were not prepared for the scale and speed of the
current outbreak. MSF called for countries such as the UK and USA to deploy disaster response
teams with medical and logistical experts for water and sanitation, building of mobile
laboratories, isolation centres, hospitals, crematoriums, and the establishment of dedicated air
bridges to move personnel and equipment between countries. On Sept 7, the US government
announced that their military would be mobilised to set up isolation units and equipment, and
provide security for public health workers.
Delayed international action has been largely blamed on the chronic underfunding and
inability of WHO to mount an adequate initial response to manage the outbreak. This
institutional failure begs first and foremost an urgent rethink of how the world responds to
outbreaks, and with whom. The second equally important task is building resilience into health
systems.
The notion of resilience is defined as the capacity to adapt and thrive in the face of challenge.
For health organisations, this could mean creating more redundancy and organisational slack to
respond efficiently to crises. For companies, it might mean rethinking the development pipeline
of their products, delinked from profit, to contribute to a better prepared world. For countries
and their partners, it means investing in weak health systems, building back the trust of
communities, and examining the complex interactions between people and the environment.
However, to earn the luxury of a much needed resilience debate for west Africa, countries and
international organisations must heed the call to immediately deploy medical assets to contain
the Ebola outbreak and offset further deaths.
Global, regional, and national levels of neonatal, infant, and under-5 mortality
during 19902013: a systematic analysis for the Global Burden of Disease Study
2013
Haidong Wang, et al.
Summary
Background
Remarkable financial and political efforts have been focused on the reduction of child mortality
during the past few decades. Timely measurements of levels and trends in under-5 mortality
are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of
reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.
Methods
We generated updated estimates of child mortality in early neonatal (age 06 days), late
neonatal (728 days), postneonatal (29364 days), childhood (14 years), and under-5 (04
years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census,
vital registration, and sample registration datapoints. We used Gaussian process regression with
adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for
each country, and a separate model to estimate mortality for more detailed age groups. We
used explanatory mixed effects regression models to assess the association between under-5
mortality and income per person, maternal education, HIV child death rates, secular shifts, and
other factors. To quantify the contribution of these different factors and birth numbers to the
change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley
decomposition. We used estimated rates of change between 2000 and 2013 to construct under-
5 mortality rate scenarios out to 2030.
Findings
We estimated that 63 million (95% UI 6066) children under-5 died in 2013, a 64%
reduction from 176 million (171181) in 1970. In 2013, child mortality rates ranged from
1525 per 1000 livebirths (13061774) in Guinea-Bissau to 23 (1829) per 1000 in
Singapore. The annualised rates of change from 1990 to 2013 ranged from 68% to 01%. 99
of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in
child mortality during 200013 than during 19902000. In 2013, neonatal deaths accounted
for 416% of under-5 deaths compared with 374% in 1990. Compared with 1990, in 2013,
rising numbers of births, especially in sub-Saharan Africa, led to 14 million more child deaths,
and rising income per person and maternal education led to 09 million and 22 million fewer
deaths, respectively. Changes in secular trends led to 42 million fewer deaths. Unexplained
factors accounted for only 1% of the change in child deaths. In 30 developing countries,
decreases since 2000 have been faster than predicted attributable to income, education, and
secular shift alone.
Interpretation
Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5
mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa.
The Millennium Declaration and increased development assistance for health might have been a
factor in faster decreases in some developing countries. Without further accelerated progress,
many countries in west and central Africa will still have high levels of under-5 mortality in 2030.
Funding
Bill & Melinda Gates Foundation, US Agency for International Development.
Global, regional, and national levels and causes of maternal mortality during 19902013: a
systematic analysis for the Global Burden of Disease Study 2013
Nicholas J Kassebaum, et al
Summary
Background
The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the
maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between
1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key
causes contributing to maternal death, and timing of maternal death with respect to delivery.
Methods
We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to
analyse a database of data for 7065 site-years and estimate the number of maternal deaths
from all causes in 188 countries between 1990 and 2013. We estimated the number of
pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk
of dying during pregnancy for HIV-positive women compared with HIV-negative women. We
also estimated the fraction of these deaths aggravated by pregnancy on the basis of a
systematic review. To estimate the numbers of maternal deaths due to nine different causes,
we identified 61 sources from a systematic review and 943 site-years of vital registration data.
We also did a systematic review of reports about the timing of maternal death, identifying 142
sources to use in our analysis. We developed estimates for each country for 19902013 using
Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.
Findings
292 982 (95% UI 261 017327 792) maternal deaths occurred in 2013, compared with
376 034 (343 483407 574) in 1990. The global annual rate of change in the MMR was 03%
(11 to 06) from 1990 to 2003, and 27% (39 to 15) from 2003 to 2013, with
evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast
Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa
during the 1990s. 2070 (12902866) maternal deaths were related to HIV in 2013, 04%
(0206) of the global total. MMR was highest in the oldest age groups in both 1990 and
2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and
between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013,
from 9568 (685112628) in South Sudan to 24 (1636) in Iceland.
Interpretation
Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015.
Accelerated reductions since the Millennium Declaration in 2000 coincide with increased
development assistance for maternal, newborn, and child health. Setting of targets and
associated interventions for after 2015 will need careful consideration of regions that are
making slow progress, such as west and central Africa.
Funding
Bill & Melinda Gates Foundation.
Global, regional, and national incidence and mortality for HIV, tuberculosis, and
malaria during 19902013: a systematic analysis for the Global Burden of Disease
Study 2013
Christopher J L Murray, et al
Summary
Background
The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and
malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden
of Disease 2013 study provides a consistent and comprehensive approach to disease estimation
for between 1990 and 2013, and an opportunity to assess whether accelerated progress has
occured since the Millennium Declaration.
Methods
To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model
appropriately modified based on a systematic review of available studies of mortality with and
without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum
models to fit vital registration data corrected for misclassification of HIV deaths. In generalised
epidemics, we minimised a loss function to select epidemic curves most consistent with
prevalence data and demographic data for all-cause mortality. We analysed counterfactual
scenarios for HIV to assess years of life saved through prevention of mother-to-child
transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal
autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data
for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys,
and estimated cause-specific mortality using Bayesian meta-regression to generate consistent
trends in all parameters. We analysed malaria mortality and incidence using an updated cause
of death database, a systematic analysis of verbal autopsy validation studies for malaria, and
recent studies (201013) of incidence, drug resistance, and coverage of insecticide-treated
bednets.
Findings
Globally in 2013, there were 18 million new HIV infections (95% uncertainty interval 17 million
to 21 million), 292 million prevalent HIV cases (281 to 317), and 13 million HIV deaths (13
to 15). At the peak of the epidemic in 2005, HIV caused 17 million deaths (16 million to 19
million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller
than previously estimated. Through interventions including PMTCT and ART, 191 million life-
years (166 million to 215 million) have been saved, 703% (654 to 761) in developing
countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of
life saved through intervention was US$4498 in developing countries. Including in HIV-positive
individuals, all-form tuberculosis incidence was 75 million (74 million to 77 million),
prevalence was 119 million (116 million to 122 million), and number of deaths was 14 million
(13 million to 15 million) in 2013. In the same year and in only individuals who were HIV-
negative, all-form tuberculosis incidence was 71 million (69 million to 73 million), prevalence
was 112 million (108 million to 116 million), and number of deaths was 13 million (12
million to 14 million). Annualised rates of change (ARC) for incidence, prevalence, and death
became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs
in men and boys (versus women and girls); 640% of cases (636 to 643) and 647% of
deaths (608 to 703). Globally, malaria cases and deaths grew rapidly from 1990 reaching a
peak of 232 million cases (143 million to 387 million) in 2003 and 12 million deaths (11 million
to 14 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have
decreased by 315% (157 to 441). Outside of Africa, malaria mortality has been steadily
decreasing since 1990.
Interpretation
Our estimates of the number of people living with HIV are 187% smaller than UNAIDS's
estimates in 2012. The number of people living with malaria is larger than estimated by WHO.
The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At
the global level, upward trends for malaria and HIV deaths have been reversed and declines in
tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have
increasing HIV incidence. Substantial progress since the Millennium Declaration is an
encouraging sign of the effect of global action.
Funding
Bill & Melinda Gates Foundation.

The Lancet Global Health
Sep 2014 Volume 2 Number 9 e488 549
http://www.thelancet.com/journals/langlo/issue/current
[Reviewed earlier]

The Lancet Infectious Diseases
Sep 2014 Volume 14 Number 9 p779 - 898
http://www.thelancet.com/journals/laninf/issue/current
[Reviewed earlier]

Medical Decision Making (MDM)
August 2014; 34 (6)
http://mdm.sagepub.com/content/current
[Reviewed earlier]

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
June 2014 Volume 92, Issue 2 Pages 167405
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-0009/currentissue
Power and Persuasion in the Vaccine Debates: An Analysis of Political Efforts and
Outcomes in the United States, 19982012
DENISE F. LILLVIS1,2,*, ANNA KIRKLAND1 andANNA FRICK2
Article first published online: 9 SEP 2014
DOI: 10.1111/1468-0009.12075
Context
This article examines trends in state-level childhood vaccine policies in the United States from
1998 to 2012 and explains the trajectories for both vaccine-critical and proimmunization
legislative efforts. Successful mobilization by vaccine critics during the height of the autism and
thimerosal scares (roughly 1998 to 2003) yielded a few state-level expansions for the most
permissive type of exemption from vaccine mandates for public school attendance, those based
on personal beliefs. Vaccine-critical positions, however, have largely become discredited. How
has vaccine critics ability to advance preferred policies and prevent the passage of unfavorable
legislation changed over time?
Methods
We created a unique data set of childhood vaccine bills (n = 636), introduced from 1998 to
2012 across the 50 state legislatures, and coded them by type of effort (exemption, mandate,
mercury ban, and information policies) and outcome. We then mapped out the trends in
vaccine policies over time. In order to contextualize the trends we identified, we also reviewed
numerous primary sources and conducted interviews with stakeholders.
Findings
In general, we found that vaccine critics legislative success has begun to wane. In only 20 bills
in our data set were vaccine critics able to change policy in their preferred direction via the
legislative process. Only 5 of those wins were significant (such as obtaining a new philosophical
exemption to vaccine mandates), and the last of these was in 2007. Critics were more
successful at preventing passage of proimmunization legislation, such as mandates for the
human papillomavirus (HPV) vaccine.
Conclusions
Recent legislation in California, Oregon, and Washington that tightened philosophical
exemptions by means of informational requirements suggests that vaccine politics may be
entering another phase, one in which immunization supporters may be able to counter
increasing opt-out rates, particularly in states with recent outbreaks and politicians favoring
science-based policies.

Nature
Volume 513 Number 7517 pp143-272 11 September 2014
http://www.nature.com/nature/current_issue.html
Nature | Editorial
Ebola: time to act
Governments and research organizations must mobilize to end the West African outbreak.
09 September 2014
After disproportionate media attention on Ebolas negligible risk to people in Western and
Asian countries, the focus seems at last to be shifting towards how to stop the outbreak in West
Africa. The grim reality is that medical organizations are struggling: the flood of new cases far
outpaces available beds and treatment centres. Many of those who are ill are not receiving the
basic health care that could keep them alive.
The tragedy is that we know how to stop Ebola. Well-informed communities can reduce the
main routes of spread by avoiding unprotected home-based care of infected people and by
modifying traditional burial practices. Infection-control measures protect health-care workers.
Together with rapid identification and isolation of ill people, and tracing and monitoring of their
contacts for 21 days (the maximum incubation period of the disease), such measures have
stopped Ebola outbreaks in the past.
But the dysfunctional health-care infrastructure of the three countries at the centre of the
outbreak Guinea, Sierra Leone and Liberia, which are poor and struggling to emerge from
years of war is simply not up to the task. The nations need help, and urgently.
The international community must mobilize now. Aid is increasing, but most of those involved,
from governments and the World Health Organization (WHO) to researchers, all initially
underestimated the threat. This is perhaps because most past outbreaks have been small and
relatively straightforward to control.
The WHO has a part to play, but contrary to a widespread assumption, it does not have the
in-house capacity to send large teams into the field. The agencys funding for outbreak
responses has been slashed, and it has shifted focus to helping countries to reinforce their
health systems so that they can respond better themselves. How the international community
should best react to outbreaks, and what role the bureaucratic WHO should have, is a debate
for after this outbreak is over. The pressing need now is to bring all available resources and
talent to bear.
The pressing need now is to bring all available resources and talent to bear.
It is a sign of how desperate the situation has become that on 2 September, Joanne Liu,
international president of medical group Mdecins Sans Frontires (or Doctors Without
Borders), called on countries to immediately deploy their military and civilian biodefence teams
units that have been developed to respond to bioterror attacks. The crucial priorities, she
said, are to scale up isolation centres, deploy mobile diagnostic labs (see page 145), build a
network of field hospitals and establish dedicated air links to shift staff and equipment to where
they are needed. In short, a military-style response, with its associated strong chain of
command, logistical capacities and speed. The concept makes a lot of sense and is an approach
that governments should consider adopting or explain why, if they choose not to do so. US
President Barack Obama indicated last weekend that he would deploy the US military to assist
in the outbreak.
It cannot be repeated enough that public-health measures and good old-fashioned
epidemiological tracking of the infected and their contacts will bring this outbreak to an end.
The priority must be to scale these up, alongside establishing more Ebola treatment centres on
the ground. For instance, Ebolas high death rate could be slashed by better patient care, in
particular by giving intravenous rehydration.
A highly effective Ebola vaccine would be a game-changer. A WHO-convened meeting on 4
5 September agreed on an unprecedented set of measures, including relaxing regulatory
requirements so that experimental drugs and vaccines can be quickly tested under the difficult
field conditions of this outbreak, and perhaps even widely deployed. The measures will, for
example, permit expedited vaccine trials and informal clinical studies of drugs that could
produce useful initial data within months.
Regulators and researchers should be applauded for their speed and pragmatism in exploring
innovative methods for conducting trials during this outbreak. Crucially, all those who organize
trials must be willing to standardize and share the data they collect to maximize their scientific
and medical value, and to allow rapid decisions to be made on which products to prioritize.
West Africas outbreak illustrates the serious weaknesses in the international communitys ability
to respond to outbreaks of emerging diseases, despite years of debate. It should also hammer
home a truism for future planning the costs of setting up infrastructure to ensure an early
response are small compared with the huge social and economic costs of a large deadly disease
outbreak.
Make diagnostic centres a priority for Ebola crisis
Bottlenecks in testing samples for Ebola leave patients stranded for days in isolation wards and
raise fears of seeking treatment, says J. Daniel Kelly.

Nature Immunology
September 2014, Volume 15 No 9 pp789-894
http://www.nature.com/ni/journal/v15/n9/index.html
[Reviewed earlier]

Nature Medicine
September 2014, Volume 20 No 9 pp967-1078
http://www.nature.com/nm/journal/v20/n9/index.html
Nature Medicine | Editorial
Ebola: a call to action
Nature Medicine 20, 967 (2014)
doi:10.1038/nm.3689
Published online
04 September 2014
The size, speed and potential reach of the 2014 Ebola virus outbreak in West Africa presents
a wake-up call to the research and pharmaceutical communitiesand to federal governments
of the continuing need to invest resources in the study and cure of emerging infectious
diseases.
At the time of this writing, more than 2,200 people are estimated to have been infected by a
new strain of Zaire ebolavirus in four West African nations, and more than 1,200 have died.
Infection can cause fever, vomiting, diarrhea and internal and external hemorrhaging that can
lead to death. Neighboring as well as non-neighboring countries are at risk because of porous
borders and air travel of presymptomatic infected individuals, the latter having resulted in the
spread of infection to Nigeria. And while the death rateestimated at 55%is lower than that
of many previous Ebola outbreaks, the total number of cases exceeds all ebolavirus infections
since 1976. We don't know when the outbreak will end, or how far it will spread, but its control
is expected to take months and may involve extraordinary measures.
Ebola virus first emerged in the Democratic Republic of the Congo (DRC) and in South Sudan
in 1976 and reappeared in South Sudan in 1979, but it caused no further outbreaks until 1994.
Since then, there have been several outbreaks in Africa, but none approached the magnitude of
the current outbreak. The natural reservoir of the virus remains unclear, but it is suspected to
be the fruit bat. However, Ebola virus also infects nonhuman primates, a species of antelope
and porcupines, all of which could be sources of human transmission.
The unusually rapid and far-reaching spread of the virus during the current outbreak has
been facilitated by insufficient treatment and containment facilities in West African nations that
had no prior experience with Ebola; a distrust of Western medical practices; the stigma
associated with infection, causing failure to seek early treatment; as well as the long
asymptomatic incubation period of the virus (up to 21 days), which enables dissemination
through travel.
Similar to the situation with severe acute respiratory syndrome (SARS), caused by the SARS
coronavirus SARS-CoV and that killed more than 700 people in 29 countries during the 2003
epidemic, there is no approved vaccine or cure for Ebola virus infection. For both pathogens,
vaccine development is hampered by the fact that the diseases are not endemic, resulting in a
lack of identifiable at-risk populations in which to test vaccine candidates. Moreover, there have
been no recorded cases of SARS since 2004, and the current Ebola outbreak began more than
2,000 miles from the previous Zaire ebolavirus outbreak in 20082009 in the DRC. These
circumstances lessen the urgency in preparing for these threats.
What's more, unlike with malaria, drugs or vaccines for SARS and Ebola cannot be tested in
the setting of experimental human infection. Demonstrating their efficacy and safety is
restricted to animal models, which themselves have limitations. For example, preclinical testing
of treatments against ebolavirus is generally initiated within hours or a few days after infection,
whereas in humans the virus may be first identified weeks after initial infection, and the viral
loadand its sequelaemay or may not be comparable to those in animal models.
Financial challenges also slow development of vaccines and treatments for these infections.
The market for drugs against SARS or Ebola is likely to be small and sporadic. Lacking market-
driven forces, financial investment in their development is therefore dependent on governments
of wealthy nations. However, the citizens of these nations may have limited exposure to the
specific pathogens, and, as such, governments may not prioritize the development of drugs to
fight them. For example, in 2012, around the time of the US 'fiscal cliff' scenario, the US
Department of Defense (DoD), citing budget constraints, issued separate stop-work orders to
Sarepta Therapeutics and Tekmira Pharmaceuticals on their programs aimed at developing
morpholinos and RNAi therapeutics, respectively, against Ebola virus. The DoD ultimately
reinstated Ebola research funding to Tekmira but not Sarepta.
In view of the unprecedented severity of the current Ebola outbreak, the World Health
Organization (WHO) has stated that it would be ethical to use experimental medicines to
combat the disease. Sarepta has said it would mobilize its stock of candidate drug, which was
tested for safety in humans, if requested. The Tekmira drug might also be used in Ebola
patients, although owing to concerns about cytokine-associated side effects, the US Food and
Drug Administration placed a clinical holdrecently revised to a 'partial hold'on testing in
healthy volunteers. Two Americans, a Spanish priest and three Liberian doctors infected with
Ebola have received ZMapp, a cocktail of monoclonal antibodies produced by Mapp
Biopharmaceutical that was shown to neutralize the virus in monkeys but had not been tested
for safety in humans. But the supply of ZMapp is now exhausted, and the company estimates it
will take several months before more is available. The WHO is also weighing the possibility of
the use of serum from individuals who recovered from Ebola infection. And Canada has
committed up to 1,000 doses of an experimental Ebola vaccineVSV-EBOVto the WHO. Other
companies and governments also have drugs and vaccines in various stages of development.
These actions are laudable, but piecemeal. When this outbreak has run its course, what will
become of these candidate drugs and vaccines? Which ones will be rigorously tested and
stockpiled, and by which nations? Which countries will continue to invest in cures for Ebola,
SARS and other emerging infectious diseases, such as Marburg hemorrhagic fever or the Middle
East respiratory syndrome, once they cease to command global attention? Encouragingly, on 21
August the Wellcome Trust announced two initiatives: rapid funding for research proposals
targeting the current and future Ebola outbreaks and a five-year 40 million commitment to
fund research focusing on health challenges facing Africa, including emerging and endemic
infections. The latter initiative, which takes a more long-term view, is a step in the right
direction. The ability to survive the next outbreak requires continued investment by all nations
in detection, prevention, containment, treatment and education. Anything less would be
unethical.

Nature Reviews Immunology
September 2014 Vol 14 No 9
http://www.nature.com/nri/journal/v14/n9/index.html
[Reviewed earlier]

New England Journal of Medicine
September 11, 2014 Vol. 371 No. 11
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Lessons from a Public Health Emergency Importation of Wild Poliovirus to Israel
Eran Kopel, M.D., M.P.H., Ehud Kaliner, M.D., M.P.H., and Itamar Grotto, M.D., Ph.D.
N Engl J Med 2014; 371:981-983September 11, 2014DOI: 10.1056/NEJMp1406250
Excerpt
Last year, Israel's polio-free status was seriously challenged. On May 28, 2013, a sample
obtained during routine supplementary environmental surveillance at a sewage-treatment plant
in the South district tested positive for wild poliovirus type 1.1 Additional analyses
retrospectively confirmed that the virus had already been present in February 2013 in samples
from sewage-treatment plants near the capital of the South district. The virus found in these
samples was closely related to polioviruses that have been circulating in polio-endemic Pakistan
since 2012 and to the poliovirus that had been isolated from sewage samples in neighboring
Egypt in December 2012.2
This public health emergency posed two major challenges for decision makers in Israel. The
first one concerned the sustainability and interpretation of our supplementary environmental
surveillance. Since the last poliomyelitis outbreak in Israel in 1988,1 the country has developed
the capacity in our environmental laboratories to detect pathogens such as polioviruses in very
low quantities within large volumes of sewage, and we have fully deployed this high-sensitivity
detection on a national scale. This system routinely covered approximately 30 to 40% of the
population in a representative fashion,2 and it was substantially intensified beginning in June
2013, shortly after the detection of the wild poliovirus importation. The number of sewage sites
being sampled increased from a range of 8 to 10 per month to 80 per month at the height of
the effort, to keep up with poliovirus activity.2 The coverage of the sampling was thereby
expanded to include as much as 80% of Israel's population, and the sampling frequency was
increased from monthly to weekly.
This dramatically enhanced environmental surveillance, which has continued in 2014, has
demonstrated the gradual clearance of the imported wild poliovirus since September 2013.
Samples at all sampling sites outside the epicenter sites in southern Israel began testing
negative quite rapidly, and later, the wild poliovirus gradually disappeared from the epicenter
sites themselves findings that indicated the fading out of human-to-human transmission of
the virus and its excretion in feces. The latest surveillance data (from August 14, 2014) confirm
the consistently negative results for all tested sites in Israel.

The Pediatric Infectious Disease Journal
September 2014 - Volume 33 - Issue 9 pp: 893-996,e219-e246
http://journals.lww.com/pidj/pages/currenttoc.aspx
[Reviewed earlier]

Pediatrics
September 2014, VOLUME 134 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml
[Reviewed earlier]

Pharmaceutics
Volume 6, Issue 3 (September 2014), Pages 354-
http://www.mdpi.com/1999-4923/6/2
[Reviewed earlier]

Pharmacoeconomics
Volume 32, Issue 9, September 2014
[Reviewed earlier]

PLoS One
http://www.plosone.org/
Research Article
The Influence of Compositional and Contextual Factors on Non-Receipt of Basic
Vaccines among Children of 12-23-Month Old in India: A Multilevel Analysis
Daouda Sissoko mail, Helen Trottier, Denis Malvy, Mira Johri
Published: September 11, 2014
DOI: 10.1371/journal.pone.0106528
Abstract
Background
Children unreached by vaccination are at higher risk of poor health outcomes and India
accounts for nearly a quarter of unvaccinated children worldwide. The objective of this study
was to investigate compositional and contextual determinants of non-receipt of childhood
vaccines in India using multilevel modelling.
Methods and Findings
We studied characteristics of unvaccinated children using the District Level Health and Facility
Survey 3, a nationally representative probability sample containing 65 617 children aged 1223
months from 34 Indian states and territories. We developed four-level Bayesian binomial
regression models to examine the determinants of non-vaccination. The analysis considered two
outcomes: completely unvaccinated (CUV) children who had not received any of the eight
vaccine doses recommended by Indias Universal Immunization Programme, and children who
had not received any dose from routine immunisation services (no RI). The no RI category
includes CUV children and those who received only polio doses administered via mass
campaigns. Overall, 4.83% (95% CI: 4.625.06) of children were CUV while 12.01% (11.68
12.35) had received no RI. Individual compositional factors strongly associated with CUV were:
non-receipt of tetanus immunisation for mothers during pregnancy (OR = 3.65 [95% CrI: 3.30
4.02]), poorest household wealth index (OR = 2.44 [1.813.22] no maternal schooling (OR =
2.43 [1.414.05]) and no paternal schooling (OR = 1.83 [1.302.48]). In rural settings, the
influence of maternal illiteracy disappeared whereas the role of household wealth index was
reinforced. Factors associated with no RI were similar to those for CUV, but effect sizes for
individual compositional factors were generally larger. Low maternal education was the
strongest risk factor associated with no RI in all models. All multilevel models found significant
variability at community, district, and state levels net of compositional factors.
Conclusion
Non-vaccination in India is strongly related to compositional characteristics and is
geographically distinct. Tailored strategies are required to overcome current barriers to
immunisation.
Research Article
The Impact of Disability on the Lives of Children; Cross-Sectional Data Including
8,900 Children with Disabilities and 898,834 Children without Disabilities across 30
Countries
Hannah Kuper mail, Adrienne Monteath-van Dok, Kevin Wing, Lisa Danquah, Jenny Evans,
Maria Zuurmond, Jacqueline Gallinetti
Abstract
Background
Children with disabilities are widely believed to be less likely to attend school or access health
care, and more vulnerable to poverty. There is currently little large-scale or internationally
comparable evidence to support these claims. The aim of this study was to investigate the
impact of disability on the lives of children sponsored by Plan International across 30 countries.
We conducted a cross-sectional survey including 907,734 children aged 017 participating in
the Plan International Sponsorship Programme across 30 countries in 2012. Parents/guardians
were interviewed using standardised questionnaires including information on: age, sex, health,
education, poverty, and water and sanitation facilities. Disability was assessed through a single
question and information was collected on type of impairment. The dataset included 8,900
children with reported disabilities across 30 countries. The prevalence of disability ranged from
0.4%3.0% and was higher in boys than girls in 22 of the 30 countries assessed generally in
the range of 1.31.4 fold higher. Children with disabilities were much less likely to attend formal
education in comparison to children without disabilities in each of the 30 countries, with age-sex
adjusted odds ratios exceeding 10 for nearly half of the countries. This relationship varied by
impairment type. Among those attending school, children with disabilities were at a lower level
of schooling for their age compared to children without disabilities. Children with disabilities
were more likely to report experiencing a serious illness in the last 12 months, except in Niger.
There was no clear relationship between disability and poverty.
Conclusions
Children with disabilities are at risk of not fulfilling their educational potential and are more
vulnerable to serious illness. This exclusion is likely to have a long-term deleterious impact on
their lives unless services are adapted to promote their inclusion.
Research Article
Parents' Knowledge, Risk Perception and Willingness to Allow Young Males to
Receive Human Papillomavirus (HPV) Vaccines in Uganda
Wilson Winstons Muhwezi mail, Cecily Banura, Andrew Kampikaho Turiho, Florence Mirembe
Abstract
The Ministry of Health in Uganda in collaboration with the Program for Appropriate Technology
for Health (PATH) supported by Bill and Melinda Gates Foundation in 20082009 vaccinated
approximately 10,000 girls with the bivalent humanpapilloma virus (HPV) vaccine. We assessed
parent's knowledge, risk perception and willingness to allow son(s) to receive HPV vaccines in
future through a cross-sectional survey of secondary school boys aged 1023 years in 4
districts. 377 questionnaires were distributed per district and 870 were used in analysis. Parents
that had ever heard about cervical cancer and HPV vaccines; those who would allow
daughter(s) to be given the vaccine and those who thought that HPV infection was associated
with genital warts were more willing to allow son(s) to receive the HPV vaccine. Unwilling
parents considered HPV vaccination of boys unimportant (p = 0.003), believed that only
females should receive the vaccine (p = 0.006), thought their son(s) couldn't contract HPV (p =
0.010), didn't know about HPV sexual transmissibility (p = 0.002), knew that males could not
acquire HPV (p = 0.000) and never believed that the HPV vaccines could protect against HPV (p
= 0.000). Acceptance of HPV vaccination of daughters and likelihood of recommending HPV
vaccines to son(s) of friends and relatives predicted parental willingness to allow sons to receive
HPV vaccines. Probable HPV vaccination of boys is a viable complement to that of girls.
Successfulness of HPV vaccination relies on parental acceptability and sustained sensitization
about usefulness of HPV vaccines even for boys is vital.
Research Article
The Effect of Measles on Health-Related Quality of Life: A Patient-Based Survey
Dominic Thorrington mail, Mary Ramsay, Albert Jan van Hoek, W. John Edmunds, Roberto
Vivancos, Antoaneta Bukasa,
Ken Eames
Abstract
Background
Measles is a highly contagious and potentially fatal illness preventable through vaccination.
Outbreaks in the UK and many other European countries have been increasing over recent
years, with over 3,207 laboratory-confirmed cases reported by Public Health England from
January 2012 to the end of June 2013. To aid rational decision making regarding measles
control versus other use of healthcare resources, it is important to measure the severity of
measles in units that are comparable to other diseases. The standard metric for this in the UK is
the quality-adjust life year (QALY). To our knowledge, the impact of measles on health-related
quality of life (HRQoL) in terms of QALYs has not been quantified.
Individuals with confirmed measles were sent questionnaires requesting information on the
short-term impact of the illness on their HRQoL using the EuroQol EQ-5D-3L questionnaire.
HRQoL was reported for the day the questionnaire was received, the worst day of infection and
at follow-up three weeks later. 507 questionnaires were sent to individuals with confirmed
measles with 203 returned (40%). The majority of respondents were not vaccinated. The mean
time off work or school was 9.6 days. The mean duration of perceived illness was 13.8 days.
The mean number of QALYs lost was 0.019 (equivalent to 6.9 days). The overall burden of
disease in terms of QALYs lost in England based on the total number of confirmed cases in the
twelve month period from 1st June 2012 was estimated to be 44.2 QALYs.
Conclusion
The short-term impact of measles infection on HRQoL is substantial, both at the level of the
individual patient and in terms of the overall disease burden. This is the first attempt to quantify
QALY-loss due to measles at a population level, and provides important parameters to guide
future intervention and control measures.
Research Article
Costs and Cost-Effectiveness of 9-Valent Human Papillomavirus (HPV) Vaccination
in Two East African Countries
Sorapop Kiatpongsan mail, Jane J. Kim
Abstract
Background
Current prophylactic vaccines against human papillomavirus (HPV) target two of the most
oncogenic types, HPV-16 and -18, which contribute to roughly 70% of cervical cancers
worldwide. Second-generation HPV vaccines include a 9-valent vaccine, which targets five
additional oncogenic HPV types (i.e., 31, 33, 45, 52, and 58) that contribute to another 1530%
of cervical cancer cases. The objective of this study was to determine a range of vaccine costs
for which the 9-valent vaccine would be cost-effective in comparison to the current vaccines in
two less developed countries (i.e., Kenya and Uganda).
The analysis was performed using a natural history disease simulation model of HPV and
cervical cancer. The mathematical model simulates individual women from an early age and
tracks health events and resource use as they transition through clinically-relevant health states
over their lifetime. Epidemiological data on HPV prevalence and cancer incidence were used to
adapt the model to Kenya and Uganda. Health benefit, or effectiveness, from HPV vaccination
was measured in terms of life expectancy, and costs were measured in international dollars
(I$). The incremental cost of the 9-valent vaccine included the added cost of the vaccine
counterbalanced by costs averted from additional cancer cases prevented. All future costs and
health benefits were discounted at an annual rate of 3% in the base case analysis. We
conducted sensitivity analyses to investigate how infection with multiple HPV types,
unidentifiable HPV types in cancer cases, and cross-protection against non-vaccine types could
affect the potential cost range of the 9-valent vaccine. In the base case analysis in Kenya, we
found that vaccination with the 9-valent vaccine was very cost-effective (i.e., had an
incremental cost-effectiveness ratio below per-capita GDP), compared to the current vaccines
provided the added cost of the 9-valent vaccine did not exceed I$9.7 per vaccinated girl. To be
considered very cost-effective, the added cost per vaccinated girl could go up to I$5.2 and
I$16.2 in the worst-case and best-case scenarios, respectively. At a willingness-to-pay threshold
of three times per-capita GDP where the 9-valent vaccine would be considered cost-effective,
the thresholds of added costs associated with the 9-valent vaccine were I$27.3, I$14.5 and
I$45.3 per vaccinated girl for the base case, worst-case and best-case scenarios, respectively.
In Uganda, vaccination with the 9-valent vaccine was very cost-effective when the added cost
of the 9-valent vaccine did not exceed I$8.3 per vaccinated girl. To be considered very cost-
effective, the added cost per vaccinated girl could go up to I$4.5 and I$13.7 in the worst-case
and best-case scenarios, respectively. At a willingness-to-pay threshold of three times per-
capita GDP, the thresholds of added costs associated with the 9-valent vaccine were I$23.4,
I$12.6 and I$38.4 per vaccinated girl for the base case, worst-case and best-case scenarios,
respectively.
Conclusions
This study provides a threshold range of incremental costs associated with the 9-valent HPV
vaccine that would make it a cost-effective intervention in comparison to currently available
HPV vaccines in Kenya and Uganda. These prices represent a 71% and 61% increase over the
price offered to the GAVI Alliance ($5 per dose) for the currently available 2- and 4-valent
vaccines in Kenya and Uganda, respectively. Despite evidence of cost-effectiveness, critical
challenges around affordability and feasibility of HPV vaccination and other competing needs in
low-resource settings such as Kenya and Uganda remain.

PLoS Medicine
http://www.plosmedicine.org/

PLoS Neglected Tropical Diseases
http://www.plosntds.org/

PNAS - Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/

Pneumonia
Vol 5 (2014)
https://pneumonia.org.au/index.php/pneumonia/issue/current
Special Issue "Pneumonia Diagnosis"
[Reviewed earlier]

Public Health Ethics
Volume 7 Issue 2 July 2014
http://phe.oxfordjournals.org/content/current
[Reviewed earlier]

Qualitative Health Research
September 2014; 24 (9)
http://qhr.sagepub.com/content/current
[Reviewed earlier]

Revista Panamericana de Salud Pblica/Pan American Journal of Public Health
(RPSP/PAJPH)
July 2014 Vol. 36, No. 1
http://www.paho.org/journal/index.php?option=com_content&view=article&id=148&Itemid=26
1&lang=en
[Reviewed earlier]

Risk Analysis
August 2014 Volume 34, Issue 8 Pages 13591579
http://onlinelibrary.wiley.com/doi/10.1111/risa.2014.34.issue-8/issuetoc
[Reviewed earlier]

Science
12 September 2014 vol 345, issue 6202, pages 1209-1416
http://www.sciencemag.org/current.dtl
Editorial
Ebola's perfect storm
Peter Piot
Peter Piot is director and professor of Global Health at the London School of Hygiene & Tropical
Medicine, London, UK.
The devastating Ebola epidemic in West Africa is the result of a perfect storm: dysfunctional
health services as the result of decades of war, low public trust in government and Western
medicine, traditional beliefs and even denials about the cause or existence of the virus, and
burial practices that involve contact with contagious Ebola-infected corpses. There are now five
affected West African countries: Guinea, Liberia, Nigeria, Sierra Leone, and most recently,
Senegal. Ebola has killed around 2000 and infected more than 3500, with over 40% of cases
occurring within the past few weeks. The World Health Organization (WHO) predicts that
20,000 may become infected. This fast pace of Ebola's spread is a grim reminder that epidemics
are a global threat and that the only way to get this virus under control is through a rapid
response at a massive global scalemuch stronger than the current efforts.
In Depth
Infectious Disease
Ebola vaccines racing forward at record pace
Jon Cohen
Experimental Ebola vaccines started human tests last week and beginning in November may
be rolled out to as many as 10,000 people in West Africa. The two vaccines being tested first
must prove safe and capable of stimulating relevant immune responses in small trials taking
place in four countries. No vaccine has ever moved more quickly into widespread use. Many
issues remain on how to determine whether the vaccines actually protect people from Ebola.
Because the vaccines are in short supply, they also will only be offered to health care workers
and other first-line responders. One vaccine is being manufactured by a collaboration between
the U.S. National Institute of Allergy and Infectious Diseases and GlaxoSmithKline, and the
other is being made by NewLink Genetics.
In Depth
Interview
Ebola: Wow, that is really tough
Leslie Roberts
The news out of West Africa is grim. By early this week, Ebola cases had topped 4000 and
deaths exceeded 2000, and the World Health Organization (WHO) had warned that thousands
more should be expected in Liberia alone in the next few weeks. In an interview with Science
on 4 September, WHO's Bruce Aylward, an assistant director-general who is running operations
as part of WHO's new $600 million Ebola emergency plan, talked about why the international
community has been slow to respond to the unprecedented epidemic and described the huge
gap between the number of cases and the capacity in countries to deal with them.
Governments are now keen to help, he says, but are having trouble mobilizing. Relief
organizations are used to dealing with wars and natural disasters, not dangerous pathogens,
and few have any experience in running the many treatment centers that are required. WHO's
just-released plan calls for stopping the outbreak in 6 to 9 months. That goal is still possible,
Aylward says, but only if the international community takes immediate action.
Special Issue: Global Health
Perspectives
Putting women and girls at the center of development
Melinda French Gates
Science 12 September 2014: 1273-1275.
Abstract
The state of global health in 2014
Jaime Seplveda and Christopher Murray
Abstract
Getting essential health products to their end users: Subsidize, but how much?
Pascaline Dupas
Abstract
Models of education in medicine, public health, and engineering
Patricia Garcia, Robert Armstrong, and Muhammad H. Zaman
Abstract
Prioritizing integrated mHealth strategies for universal health coverage
Garrett Mehl and Alain Labrique
Abstract
How to transform the practice of engineering to meet global health needs
Deb Niemeier, Harry Gombachika, and Rebecca Richards-Kortum
Abstract
Strengthening the evidence base for health programming in humanitarian crises
A. Ager, G. Burnham, F. Checchi, M. Gayer, R. F. Grais, M. Henkens, M. B. F. Massaquoi,
R. Nandy, C. Navarro-Colorado, and P. Spiegel
Abstract
Emerging, evolving, and established infectious diseases and interventions
M. Elizabeth Halloran and Ira M. Longini Jr.
Abstract
Virus sharing, genetic sequencing, and global health security
Lawrence O. Gostin, Alexandra Phelan, Michael A. Stoto, John D. Kraemer, and K. Srinath
Reddy
Abstract
Monitoring parasite diversity for malaria elimination in sub-Saharan Africa
Anita Ghansah, Lucas Amenga-Etego, Alfred Amambua-Ngwa, Ben Andagalu, Tobias Apinjoh,
Marielle Bouyou-Akotet, Victoria Cornelius, Lemu Golassa, Voahangy Hanitriniaina
ndrianaranjaka, Deus Ishengoma, Kimberly Johnson, Edwin Kamau, Oumou Maga-Ascofar,
Dieudonne Mumba, Paulina Tindana, Antoinette Tshefu-Kitoto, Milijaona Randrianarivelojosia,
Yavo William, Dominic P. Kwiatkowski, and Abdoulaye A. Djimde
Abstract
Antibiotic effectiveness: Balancing conservation against innovation
Ramanan Laxminarayan
Abstract
Creating a global observatory for health R&D
Robert F. Terry, Jos F. Salm Jr., Claudia Nannei, and Christopher Dye
Abstract

Social Science & Medicine
Volume 118, In Progress (October 2014)
http://www.sciencedirect.com/science/journal/02779536/118
[Reviewed earlier]

Tropical Medicine and Health
Vol. 42(2014) No. 2
https://www.jstage.jst.go.jp/browse/tmh/42/2/_contents
[Reviewed earlier]

Vaccine
Volume 32, Issue 42, Pages 5371-5530 (22 September 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/42
Obituary
Remembering Dr. Ciro de Quadros
Pages 5371-5374
Jon Kim Andrus
[No abstract]
Adjuvants for vaccines to drugs of abuse and addiction
Review Article
Pages 5382-5389
Carl R. Alving, Gary R. Matyas, Oscar Torres, Rashmi Jalah, Zoltan Beck
Abstract
Immunotherapeutic vaccines to drugs of abuse, including nicotine, cocaine, heroin, oxycodone,
methamphetamine, and others are being developed. The theoretical basis of such vaccines is to
induce antibodies that sequester the drug in the blood in the form of antibody-bound drug that
cannot cross the blood brain barrier, thereby preventing psychoactive effects. Because the
drugs are haptens a successful vaccine relies on development of appropriate hapten-protein
carrier conjugates. However, because induction of high and prolonged levels of antibodies is
required for an effective vaccine, and because injection of T-independent haptenic drugs of
abuse does not induce memory recall responses, the role of adjuvants during immunization
plays a critical role. As reviewed herein, preclinical studies often use strong adjuvants such as
complete and incomplete Freund's adjuvant and others that cannot be, or in the case of many
newer adjuvants, have never been, employed in humans. Balanced against this, the only
adjuvant that has been included in candidate vaccines in human clinical trials to nicotine and
cocaine has been aluminum hydroxide gel. While aluminum salts have been widely utilized
worldwide in numerous licensed vaccines, the experience with human responses to aluminum
salt-adjuvanted vaccines to haptenic drugs of abuse has suggested that the immune responses
are too weak to allow development of a successful vaccine. What is needed is an adjuvant or
combination of adjuvants that are safe, potent, widely available, easily manufactured, and cost-
effective. Based on our review of the field we recommend the following adjuvant combinations
either for research or for product development for human use: aluminum salt with adsorbed
monophosphoryl lipid A (MPLA); liposomes containing MPLA [L(MPLA)]; L(MPLA) adsorbed to
aluminum salt; oil-in-water emulsion; or oil-in-water emulsion containing MPLA.
The Vaccine Safety Datalink: successes and challenges monitoring vaccine safety
Review Article
Pages 5390-5398
Michael M. McNeil, Julianne Gee, Eric S. Weintraub, Edward A. Belongia, Grace M. Lee, Jason M.
Glanz, James D. Nordin, Nicola P. Klein, Roger Baxter, Allison L. Naleway, Lisa A. Jackson, Saad
B. Omer, Steven J. Jacobsen, Frank DeStefano
Abstract
The Vaccine Safety Datalink (VSD) is a collaborative project between the Centers for Disease
Control and Prevention (CDC) and 9 health care organizations. Established in 1990, VSD is a
vital resource informing policy makers and the public about the safety of vaccines used in the
United States. Large linked databases are used to identify and evaluate adverse events in over
9 million individuals annually. VSD generates rapid, important safety assessments for both
routine vaccinations and emergency vaccination campaigns. VSD monitors safety of seasonal
influenza vaccines in near-real time, and provided essential information on the safety of
influenza A (H1N1) 2009 monovalent vaccine during the recent pandemic. VSD investigators
have published important studies demonstrating that childhood vaccines are not associated with
autism or other developmental disabilities. VSD prioritizes evaluation of new vaccines; searches
for possible unusual health events after vaccination; monitors vaccine safety in pregnant
women; and has pioneered development of biostatistical research methods.
Primary care providers human papillomavirus vaccine recommendations for the
medically underserved: A pilot study in U.S. Federally Qualified Health Centers
Original Research Article
Pages 5432-5435
Katherine B. Roland, Vicki B. Benard, April Greek, Nikki A. Hawkins, Mona Saraiya
Abstract
Introduction
In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that
provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically
underserved women, some of whom may be at risk for developing cervical cancer. National
guidelines recommend against using screening test results or sexual history to determine
vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care
providers in FQHCs may aid in promoting evidence-based practices and prioritizing health
interventions for vulnerable populations.
Methods
Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in
IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics,
HPV vaccine recommendations, and provider's belief about whether their screening and
management procedures would change for women who were vaccinated.
Results
93% of providers recommended the HPV vaccine, most frequently for females aged 1326
years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap
test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More
than half of providers (55%) reported they will not change their screening and management
practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests
(71%) and referrals for colposcopy (74%).
Conclusion
Study providers routinely recommended the HPV vaccine for their patients. However, providers
made fewer recommendations to vaccinate females ages 912 years (which includes the target
age for vaccination) compared to older females, and used pre-vaccination assessments not
recommended by U.S. guidelines, such as screening test results and number of sexual partners.
In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer,
adherence to guidelines is necessary, especially in settings that provide care to medically
underserved women.
Economic evaluation of meningococcal serogroup B childhood vaccination in
Ontario, Canada
Pages 5436-5446
Hong Anh T. Tu, Shelley L. Deeks, Shaun K. Morris, Lisa Strifler, Natasha Crowcroft, Frances B.
Jamieson, Jeffrey C. Kwong, Peter C. Coyte, Murray Krahn, Beate Sander
Abstract
Highlights
:: Neisseria meningitidis serotype B (MenB) causes invasive meningococcal disease.
:: Examined novel MenB vaccine (Bexsero) approved in Europe, Canada and Australia.
:: Assessed cost-effectiveness of MenB infant vaccination program in Ontario, Canada.
:: Program is highly unlikely to be cost-effective in this low incidence setting.
Maternal determinants of timely vaccination coverage among infants in rural
Bangladesh
Pages 5514-5519
Lavanya Vasudevan, Alain B. Labrique, Sucheta Mehra, Lee Wu, Orin Levine, Danny Feikin, Rolf
Klemm, Parul Christian, Keith P. West Jr.
Abstract
Highlights
:: Timely vaccination rates among infants in rural Bangladesh examined between 2001 and
2007.
:: 23,435 infants classified as vaccinated on time by 14 weeks of age with all vaccines or not.
:: Only 19% of infants included in study received timely vaccinations by 14 weeks of age.
:: Mothers receipt of antenatal care positively associated with timely vaccination status of
infants.
:: Timely vaccination rates lower for infants perceived as small at birth by their mothers.

Vaccine: Development and Therapy
http://www.dovepress.com/vaccine-development-and-therapy-journal

Vaccines Open Access Journal
http://www.mdpi.com/journal/vaccines

Value in Health
Vol 17 | No. 5 | July 2014 | Pages 491-660
http://www.valueinhealthjournal.com/current
[Reviewed earlier]

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

Health Research Policy and Systems
http://www.health-policy-systems.com/content
Research
Advancing the application of systems thinking in health: analysing the contextual
and social network factors influencing the use of sustainability indicators in a health
system a comparative study in Nepal and Somaliland
Karl Blanchet1*, Jennifer Palmer1, Raju Palanchowke2, Dorothy Boggs3, Ali Jama4 and Susan
Girois5
Author Affiliations
1 International Centre for Evidence in Disability, London School of Hygiene and Tropical
Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
2 Handicap International, Narayan Gopal Chowk Sallaghari, PO Box 10179, Kathmandu, Nepal
3 Handicap International, 9 Rushworth Street, London SE1, UK
4 Disability Action Network, Hargeisa, Somaliland
5 Norfolk Community Services Board, 6401 Tidewater Dr, Norfolk, VA 23509, USA
Health Research Policy and Systems 2014, 12:46 doi:10.1186/1478-4505-12-46
Abstract
Background
Health systems strengthening is becoming a key component of development agendas for low-
income countries worldwide. Systems thinking emphasizes the role of diverse stakeholders in
designing solutions to system problems, including sustainability. The objective of this paper is to
compare the definition and use of sustainability indicators developed through the Sustainability
Analysis Process in two rehabilitation sectors, one in Nepal and one in Somaliland, and analyse
the contextual factors (including the characteristics of system stakeholder networks) influencing
the use of sustainability data.
Methods
Using the Sustainability Analysis Process, participants collectively clarified the boundaries of
their respective systems, defined sustainability, and identified sustainability indicators. Baseline
indicator data was gathered, where possible, and then researched again 2 years later. As part
of the exercise, system stakeholder networks were mapped at baseline and at the 2-year
follow-up. We compared stakeholder networks and interrelationships with baseline and 2-year
progress toward self-defined sustainability goals. Using in-depth interviews and observations,
additional contextual factors affecting the use of sustainability data were identified.
Results
Differences in the selection of sustainability indicators selected by local stakeholders from Nepal
and Somaliland reflected differences in the governance and structure of the present
rehabilitation system. At 2 years, differences in the structure of social networks were more
marked. In Nepal, the system stakeholder network had become more dense and decentralized.
Financial support by an international organization facilitated advancement toward self-identified
sustainability goals. In Somaliland, the small, centralised stakeholder network suffered a critical
rupture between the systems two main information brokers due to competing priorities and
withdrawal of international support to one of these. Progress toward self-defined sustainability
was nil.
Conclusions
The structure of the rehabilitation system stakeholder network characteristics in Nepal and
Somaliland evolved over time and helped understand the changing nature of relationships
between actors and their capacity to work as a system rather than a sum of actors. Creating
consensus on a common vision of sustainability requires additional system-level interventions
such as identification of and support to stakeholders who promote systems thinking above
individual interests.

Journal of Epidemiology & Community Health
2014;68:A59-A60 doi:10.1136/jech-2014-204726.127
PP31 Factors affecting variation in the uptake of HPV vaccine in secondary schools
in the West Midlands
Oral Presentations
CM Chivu, A Clarke, G Hundt
Author Affiliations
Warwick Medical School, University of Warwick, Coventry, UK
Abstract
Background
In 2008, the health departments of the United Kingdom implemented routine and catch-up
human papillomavirus (HPV) immunisation programme in schools to reduce the incidence of
cervical cancer. European studies conducted from 2007 to 2012 showed inconsistent results on
HPV vaccine uptake in relation to ethnicity and girls age. The aim of the study was to explore
the views and experiences of students, teachers and health providers on the HPV vaccine to
understand how mechanisms of delivery contributed to HPV vaccine uptake in a town in the
West Midlands.
Methods
Data was collected through 47 semi-structured individual interviews with nine nurses, four
school staff and 34 year 8 girls as well as through non-participant observations in 12 schools
during the delivery of the first, the second and the third dose of HPV vaccine between February
and September 2013. The school staff and the girls were sampled from four secondary schools
that accepted to participate in the study. Thematic analysis was employed to identify major
themes related to the school context of implementation of the HPV vaccine programme in
secondary schools in the town of the study.
Results
Year 8 girls were aged 1213 years. Some were Christian, Muslim and Hindu while others had
no religion. The health professionals were nurse coordinators, school nurses, vaccinators,
sexual health nurses and practice nurses. The school staff were teachers, support staff and
head of year 8. Three main themes emerged from the analysis (1) school policy related to HPV
vaccine, (2) the organisation of delivery of HPV vaccination programme in the schools before
and on the day of vaccination, (3) promotion of HPV vaccine in schools. The findings showed
that most of the schools have supported the delivery of the programme, but it has been more
difficult for nurses to go to some of the faith schools in comparison to others. Chasing up the
consent forms and communication with the parents have been the most challenging activities in
the HPV vaccination administration, however they are essential for a high HPV vaccine uptake.
The HPV vaccine was poorly promoted in the school environment because of tight curriculum
for compulsory subjects and lack of adequate staff.
Conclusion
Implementation of a school-based HPV programme is resource intensive in terms of time as well
as of school staff and staff nurse.

Technovation
Available online 5 September 2014
In Press, Corrected Proof
Policy-driven ecosystems for new vaccine development
Julia Fan Li, Elizabeth Garnsey1,
Abstract
This paper examines the relationship between biomedical policies and entrepreneurial R&D
strategies. Public health programs have been unable to provide effective and affordable
treatment of infectious diseases for the poor. While governments have become more open to
private sector contributions to policy objectives, it is rare to find new ventures commercializing
healthcare innovations for neglected diseases. Two case studies of entrepreneurial ventures, in
the UK and China, provide evidence on how resource-constrained firms mobilize participants in
policy-specific ecosystems to achieve their goals of new vaccine development for tuberculosis.
Ecosystem analysis reveals how the innovators business models can align their strategies with
national policy objectives.

International Journal for Parasitology
Available online 13 September 2014
In Press, Uncorrected Proof
Invited Review
Genome-based vaccine design: the promise for malaria and other infectious
diseases
Denise L. Doolan, Simon H. Apte, Carla Proietti
DOI: 10.1016/j.ijpara.2014.07.010
Highlights
:: Vaccines against complex pathogens and chronic diseases have proved challenging.
:: Rational vaccine design exploiting advances in genomics and other omics has great
potential.
:: Malaria is an excellent model for genome-based vaccine design.
Abstract
Vaccines are one of the most effective interventions to improve public health, however, the
generation of highly effective vaccines for many diseases has remained difficult. Three chronic
diseases that characterise these difficulties include malaria, tuberculosis and HIV, and they
alone account for half of the global infectious disease burden. The whole organism vaccine
approach pioneered by Jenner in 1796 and refined by Pasteur in 1857 with the isolate, inactive
and inject paradigm has proved highly successful for many viral and bacterial pathogens
causing acute disease but has failed with respect to malaria, tuberculosis and HIV as well as
many other diseases. A significant advance of the past decade has been the elucidation of the
genomes, proteomes and transcriptomes of many pathogens. This information provides the
foundation for new 21st Century approaches to identify target antigens for the development of
vaccines, drugs and diagnostic tests. Innovative genome-based vaccine strategies have shown
potential for a number of challenging pathogens, including malaria. We advocate that genome-
based rational vaccine design will overcome the problem of poorly immunogenic, poorly
protective vaccines that has plagued vaccine developers for many years.

Journal of Consumer Health On the Internet
Beta-Test Results for an HPV Information Web Site: GoHealthyGirls. orgIncreasing
HPV Vaccine Uptake in the United States
Randall Starlinga*, Jessica A. Nodulmana, Alberta S. Kongb, Cosette M. Wheelerc, David B.
Bullerd & W. Gill Woodalla
DOI: 10.1080/15398285.2014.931771
pages 226-237
Abstract
A Web site, GoHealthyGirls, was developed to educate and inform parents and their adolescent
daughters about human papillomavirus (HPV) and HPV vaccines. This article provides an
overview of web site development and content followed by the results of a beta-test of the Web
site. Sixty-three New Mexican parents of adolescent girls tested the site. Results indicated that
GoHealthyGirls was a functioning and appealing Web site. During this brief educational
intervention, findings suggest that the Web site has the potential to increase HPV vaccine
uptake. This research supports the Internet as a valuable channel to disseminate health
education and information to diverse populations.

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.

Al Jazeera
http://www.aljazeera.com/Services/Search/?q=vaccine
Accessed 13 September 2014
[No new, unique, relevant content]

The Atlantic
http://www.theatlantic.com/magazine/

BBC
http://www.bbc.co.uk/

Brookings
http://www.brookings.edu/

Council on Foreign Relations
http://www.cfr.org/
.
Economist
http://www.economist.com/

Financial Times
http://www.ft.com

Forbes
http://www.forbes.com/

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

Foreign Policy
http://www.foreignpolicy.com/

The Guardian
http://www.guardiannews.com/

The Huffington Post
http://www.huffingtonpost.com/

Le Monde
http://www.lemonde.fr/

New Yorker
http://www.newyorker.com/

New York Times
http://www.nytimes.com/
U.S. Scientists See Long Fight Against Ebola
By DENISE GRADY
SEPT. 12, 2014
The deadly Ebola outbreak sweeping across three countries in West Africa is likely to last 12
to 18 months more, much longer than anticipated, and could infect hundreds of thousands of
people before it is brought under control, say scientists mapping its spread for the federal
government.
We hope were wrong, said Bryan Lewis, an epidemiologist at the Virginia Bioinformatics
Institute at Virginia Tech.
Both the time the model says it will take to control the epidemic and the number of cases it
forecasts far exceed estimates by the World Health Organization, which said last month that it
hoped to control the outbreak within nine months and predicted 20,000 total cases by that
time. The organization is sticking by its estimates, a W.H.O. spokesman said Friday.
But researchers at various universities say that at the viruss present rate of growth, there
could easily be close to 20,000 cases in one month, not in nine. Some of the United States
leading epidemiologists, with long experience in tracking diseases such as influenza, have been
creating computer models of the Ebola epidemic at the request of the National Institutes of
Health and the Defense Department.

Reuters
http://www.reuters.com/

Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us

Washington Post
http://www.washingtonpost.com/

* * * *

Vaccines and Global Health: The Week in Review is a service of the Center for Vaccines
Ethics and Policy (CVEP) which is solely responsible for its content. Support for this service is
provided by its governing institutions Department of Medical Ethics, NYU Medical School;
The Wistar Institute Vaccine Center and the Childrens Hospital of Philadelphia Vaccine
Education Center. Additional support is provided by the PATH Vaccine Development Program;
the International Vaccine Institute (IVI); the Bill & Melinda Gates Foundation; industry resource
members Janssen, Pfizer, and Sanofi Pasteur U.S. (list in formation), and the Developing
Countries Vaccine Manufacturers Network (DCVMN). Support is also provided by a growing list
of individuals who use this membership service to support their roles in public health, clinical
practice, government, NGOs and other international institutions, academia and research
organizations, and industry.

* * * *

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