Vaccines: The Week in Review 12 January 2013 Center for Vaccine Ethics & Policy (CVEP

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This weekly summary targets news, events, announcements, articles and research in the global vaccine 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: 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 3,500 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

Editor’s Notes: - A pdf version of this issue is available on our blog:

http://centerforvaccineethicsandpolicy.wordpress.com/

The National Foundation for Infectious Diseases (NFID) announced that it will honor Dr. Paul A. Offit with the Maxwell Finland Award for Scientific Achievement at its Annual Awards Dinner on Tuesday, March 5, 2013. The award will be presented to Dr. Offit “for his outstanding work in the pediatric vaccine arena and his ongoing commitment to vaccine advocacy.” The Award is given to a scientist who has made outstanding contributions to the understanding of infectious diseases or public health. The announcement noted that ”Dr. Paul A. Offit is an impassioned advocate for immunization. He has rallied the scientific counterattack against the anti-vaccine movement. Dr. Offit is the co-inventor of the RotaTeg rotavirus vaccine which is recommended for universal use in infants in the US and is widely used in other countries. Dr. Offit is credited with saving countless lives worldwide.” Vijay Samant, president and chief executive officer of Vical, Inc., commented “I believe Dr. Offit is a most appropriate candidate for the Maxwell Finland Awards for his broad influence on the pediatric vaccine field, from his development of the life-saving rotavirus vaccines, to his exemplary pediatric practice, to his staunch support of childhood immunization against zealous opponents. His insightful and approachable style of writing has helped bridge the gap between medical research and the general public. His legacy must include both the hundreds of thousands of lives already saved by the rotavirus vaccines, and the million more that will be saved by his advocacy for prudent vaccine policy.” http://www.nfid.org/publications/helix/December-2012.pdf

Pfizer announced that the European Commission has approved expanding the use of Prevenar 13 to older children and adolescents aged 6 to 17 years for active immunization for the prevention of invasive disease, pneumonia and acute otitis media caused by vaccine-type Streptococcus pneumoniae. Children in this age group who have not previously received Prevenar 13 may receive a single dose of the vaccine. http://www.businesswire.com/news/home/20130108005435/en/Pfizer-Receives-EuropeanApproval-Expand-Prevenar-13

The PATH Malaria Vaccine Initiative (MVI) and Inovio Pharmaceuticals, Inc. announced a follow-on collaboration to advance malaria vaccine development and new vaccination delivery technologies. Researchers “will test whether a novel vaccine approach that combines genetically engineered DNA with an innovative vaccine delivery technology called electroporation could induce an immune response in humans that protects against malaria parasite infection.” This follow-on agreement for clinical development builds on a 2010 research and development collaboration between Inovio and MVI. Electroporation “deploys controlled electrical impulses to create temporary pores in a cell membrane, allowing uptake of the synthetic DNA. The cell then uses the DNA's instructions to produce proteins that mimic the presence of the malaria pathogen, with the aim of inducing an immune response that provides protection against malaria.” Dr. David C. Kaslow , director of MVI, said, "We are excited to bring this innovative delivery technology into clinical testing to see whether the compelling immune responses seen in animal models translate to humans. Determining if and how these potent immune responses lead to protection against infection with the most deadly form of malaria is a high priority in our efforts to develop a next generation malaria vaccine.” http://www.prnewswire.com/news-releases/path-malaria-vaccine-initiative-and-inoviopharmaceuticals-partner-to-accelerate-development-of-malaria-vaccines-and-innovativedelivery-technologies-185835962.html

GAVI said it welcomed results from its first ever review by MOPAN (Multilateral Organisation Performance Assessment Network) in which it was “…commended for its effectiveness in increasing access to immunisation and for its focus on results.” GAVI said the review noted strengths including financial management, accountability checks, country ownership support and relationship management, and that it “was rated adequate, strong or above for 95% of the key performance indicators as a result of the document review.” The review also highlighted areas where performance could be improved, such as iGAVI’s “strategic management, its use of indicators to measure progress towards Paris Declaration Commitments, the management practices used in its budgeting process and its guidelines on evaluation coverage.” MOPAN is a network of 17 donor countries, representing the majority of worldwide Overseas Development Assistance (ODA), which rates the effectiveness of multilateral organisations. MOPAN members share information, carry out joint assessments and draw on each other’s expertise in evaluation. This review was led by the governments of France, Spain and Sweden. To serve as a basis for the report, country-level surveys were undertaken in 15 GAVI-eligible countries, including Bangladesh, Cambodia, the Democratic Republic of the Congo, Georgia, Ghana, Honduras, Indonesia, Nicaragua, Niger, Nigeria,

Pakistan, Rwanda, the United Republic of Tanzania, the Republic of Yemen and Zimbabwe. http://www.gavialliance.org/library/news/statements/2013/gavi-recognised-for-effectivenessand-focus-on-results/

IFFIm (International Finance Facility for Immunisation) announced that “three longtime banking officials with significant international experience joined its board of directors on 1 January 2013. The 3-year terms were approved by the board in December and include: - Cyrus Ardalan, Vice Chairman of Barclays, where he has served in several key roles in government relations, emerging markets and investment banking… - Marcus Fedder, who most recently has focused on microfinance after a long career in banking, during which he held senior positions at Toronto Dominion Bank, CIBC and Deutsche Bank... Christopher Egerton-Warburton, who helped create IFFIm as the lead banker at Goldman Sachs at its creation… The appointments are in conjunction with the expiring term of John Cummins, who rotated off the board at year-end 2012, the upcoming expiration of the term of Dayanath Jayasuriya at end-June 2013, and the departure of Arunma Oteh at year-end 2011. “IFFIm is a multilateral development institution created to accelerate the availability of predictable, long-term funds for health and immunisation programmes through the GAVI Alliance in more than 50 of the world’s poorest countries. It has raised more than US$ 3.7 billion in the bond markets, backed by US$ 6.3 billion in pledges from nine countries.” http://www.iffim.org/library/news/press-releases/2013/iffim-appoints-three-new-members-toits-board-of-directors/

Update: Polio this week - As of 09 January 2013 Global Polio Eradication Initiative http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx [Editor’s Extract and bolded text] - Two years polio-free: January 13 will mark two years since a child was paralyzed by wild poliovirus in India, a country once considered the most complex challenge to global polio eradication. - Response to Niger outbreak: The first immunization activities start in Niger on 112 January 2013, in close coordination with Nigeria. This first outbreak of imported wild poliovirus in 2012 is due to virus of Nigerian origin. Afghanistan - Two new WPV cases were reported in the past week, bringing the total number of WPV cases for 2012 to 37. Both of the WPV cases occurred in Nangarhar (2 WPV1), a newly infected province, with onset of paralysis on 20 December 2012. Outbreak response immunization in 10 districts in Nangarhar will be conducted using bivalent OPV. - No new cases of circulating vaccine-derived poliovirus type (cVDPV) were reported in the past week. The total number of cVDPV cases for 2012 remains 4. Nigeria - Two new WPV cases were reported in the past week (1 WPV1 from Kano and 1 WPV1 from Katsina), bringing the total number of WPV cases for 2012 to 121. The most recent case

occurred in Federally Capital Territory and had onset of paralysis on 3 December 2012. Both of the cases reported this week occurred in previously-infected districts. - Two new cVDPV2 cases were reported in the past week, bringing the total number of cVDPV2 cases for 2012 to 6. Both cases occurred in Kebbi (Koko/Besse district), a province that had not previously reported any cases of cVDPV in 2012. The most recent had onset of paralysis on 24 November 2012. - Given the spread of WPV of Nigerian origin to Niger, targeted Supplementary Immunization Activities will take place in high-risk and under-served districts in Nigeria on 12-112 January and in the wards of Sokoto, Katsina and Zamfara states bordering Niger on 15-18 January, synchronized with Niger. - Staggered National Immunization Days across Nigeria are planned for 26 Jan – 2 February and 23 Feb – 2 March, also to be synchronized with Niger. Niger - Niger reports polio: In the first outbreak of polio in 2012 outside of an endemic country or a country with re-established poliovirus, Niger has reported a case of wild poliovirus. This is the first case in the country since December 2011 and is related to virus originating in Nigeria. The WHO Executive Board will review an update to the GVAP at its 132nd session [EB132] in Geneva, 21–29 January 2013. Meeting documentation is posted here: http://apps.who.int/gb/e/e_eb132.html The GVAP agenda item is listed as: 9. Communicable diseases 9.1 Global vaccine action plan The supporting document - EB132/18 – has now been posted at: http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_18-en.pdf The Weekly Epidemiological Record (WER) for 11 January 2013, vol. 88, 2 (pp 17–28) includes: - Monitoring and evaluation of preventive chemotherapy - Estimated number of people covered by preventive chemotherapy: update for 2010 and 2011 http://www.who.int/entity/wer/2013/wer8802.pdf WHO - Global Alert and Response (GAR) Disease Outbreak News - Most recent news items 12 December 2012 Yellow fever in the Republic of Congo 6 December 2012 Yellow fever in Sudan - update WHO - Humanitarian Health Action No new reports http://www.who.int/hac/en/index.html CDC Update: Flu Season and Vaccine Effectiveness

January 11, 2013 Media Advisory | Transcript (audio) |

Save the Children released a new report – Ending Poverty in Our Generation – which outlines a new development system it said could “end extreme poverty in the next 20 years,” and includes “one of the first proposals for new targets to replace the Millennium Development Goals.” Save the Children's CEO Carolyn Miles said, "With the 2015 deadline fast approaching, Save the Children is working globally to ensure that collectively, we learn the lessons of the current Millennium Development Goals and contribute to the evolution of an ambitious new global development framework. Our flagship report discusses what we believe are core priorities and identifies 10 key recommendations for fostering a post-2015 framework that emphasizes human development, equity, and accountability with a focus on our future – the children."." http://www.savethechildren.org/site/apps/nlnet/content2.aspx? c=8rKLIXMGIpI4E&b=8486805&ct=12713395&notoc=1 [Editor’s Note: We extract a short portion of the Executive Summary below.] “Save the Children’s suggested post-2015 development framework champions universal and equitable development, with human rights as its guiding principle and evidence as a foundation for its approaches. “Human rights principles such as universality, equality and inalienability must underpin everything that is agreed. And, unlike with the MDGs, these principles must be visible in the targets established. Now is the time to aim at no less than: - a zero target for absolute poverty reduction - a zero target for hunger - a zero target for preventable child and maternal deaths - a zero target for those without safe drinking water and sanitation… …We propose the following six goals for the new framework, to put in place the foundations for human development: - Goal 1: By 2030 we will eradicate extreme poverty and reduce relative poverty through inclusive growth and decent work - Goal 2: By 2030 we will eradicate hunger, halve stunting, and ensure universal access to sustainable food, water and sanitation - Goal 3: By 2030 we will end preventable child and maternal mortality and provide basic healthcare for all - Goal 4: By 2030 we will ensure children everywhere receive quality education and have good learning outcomes - Goal 5: By 2030 we will ensure all children live a life free from all forms of violence, are protected in conflict and thrive in a safe family environment - Goal 6: By 2030 governance will be more open, accountable and inclusive To provide a supportive environment for these goals we propose four more: - Goal 7: By 2030 we will establish effective global partnerships for development - Goal 8: By 2030 we will build disaster-resilient societies - Goal 9: By 2030 we will ensure a sustainable, healthy and resilient environment for all - Goal 10: By 2030 we will deliver sustainable energy to all http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a %7D/ENDING_POVERTY_IN_OUR_GENERATION_AFRICA_LOW_RES_US_VERSION.PDF

[Editor’s Note 2: A search of the report using the terms “vaccine” and “immunization” yielded one occurrence on P.31 in the discussion of potential indicators for Goal 3] - Goal 3: By 2030 we will end preventable child and maternal mortality and provide healthcare for all Potential Indicators: 2j Percentage of infants aged 12–23 months who received three doses of diphtheria, pertussis and tetanus vaccine
Statement: UNICEF UNICEF said it welcomed the launch of the Save the Children report, noting it as an “important contribution to discussions on the critical question of how the world can best address the survival, development and protection of its children in the coming years and decades, as part of an overall framework for sustainable and effective development.” UNICEF noted that the report “..provides concrete ideas on setting new goals that will accelerate efforts for the progress and protection of the world’s most marginalized children. Valuably, it also addresses the question of how the most deep-seated challenges for children and families – such as inequalities, environmental fragility, weak accountability, natural disasters and conflict – can be better targeted in the present and coming generations.” http://www.unicef.org/media/media_67149.html

Conferences/Reports/Research/Analysis/Book Watch Vaccines: 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
WHO: Global Maternal Health Conference 15–17 January 2013 Arusha, Tanzania The Global Maternal Health Conference is a technical conference for scientists, researchers, and policy-makers to network, share knowledge, and build on progress toward eradicating preventable maternal mortality and morbidity by improving quality of care. The 2013 conference will build on the successful technical focus and abstract-driven structure of the 2010 conference. There will be 5 conference tracks: Programme approaches and tools to improve the quality of maternal health care. - Measurement of the quality of maternal health care. - Strengthening health systems for improving the quality of maternal health care. - Access to and utilization of quality maternal health care. - Evidence-informed policy and advocacy for quality maternal health care. http://www.who.int/mediacentre/events/meetings/2013/maternal_health_conference/en/index. html WHO: Technical consultative meeting on novel human coronavirus 14–15 January 2013 Cairo

9 January 2013 – To date, a total of nine laboratory-confirmed cases of infection with the novel human coronavirus have been reported to WHO – five cases, including three deaths, from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan. The novel coronavirus first raised concerns in September 2012 when it caused severe respiratory disease in two patients from the Region. The subsequent discovery of two clusters of cases, one in a family in Saudi Arabia and the second in a group of health care workers in Jordan, increased the urgency of better understanding the virus. The potential of the virus to cause widespread serious consequences is thought to be significant, yet current knowledge of its epidemiology and natural history of infection with this agent is limited. Many critical questions about the source of the virus, its potential for transmission, important exposures and the clinical appearance of disease remain unanswered. Many activities have already been conducted in investigating the new virus and managing its public health consequences. Within this context, WHO has organized a technical consultative meeting to take place at the WHO Regional Office in Cairo from 14 to 112 January 2013 on the novel human coronavirus. The meeting will bring together representatives of the three countries already affected, in addition to key partners and WHO collaborating centres involved in managing this public health issue, together with WHO experts… http://www.emro.who.int/media/news/coronavirus-consultative-meeting.html

Journal Watch Vaccines: 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
American Journal of Public Health Volume 103, Issue 2 (February 2013) http://ajph.aphapublications.org/toc/ajph/current Effects of Socioeconomic Status and Health Care Access on Low Levels of Human Papillomavirus Vaccination Among Spanish-Speaking Hispanics in California Shingisai Chando, Jasmin A. Tiro, T. Robert Harris, Sarah Kobrin, Nancy Breen American Journal of Public Health: February 2013, Vol. 103, No. 2: 270–272. ABSTRACT Little is known about the effect of language preference, socioeconomic status, and health care access on human papillomavirus (HPV) vaccination. We examined these factors in Hispanic parents of daughters aged 11 to 17 years in California (n=1090). Spanish-speaking parents were less likely to have their daughters vaccinated than were English speakers (odds ratio [OR] = 0.55; 95% confidence interval [CI] =  0.31, 0.98). Adding income and access to multivariate analyses made language nonsignificant (OR = 0.68; 95% CI = 0.35, 1.29). This confirms that health care use is associated with language via income and access. Low-income Hispanics, who lack access, need information about free HPV vaccination programs.

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300920 Annals of Internal Medicine 1 January 2013, Vol. 158. No. 1 http://www.annals.org/content/current [Reviewed earlier] BMC Public Health (Accessed 12 January 2013) http://www.biomedcentral.com/bmcpublichealth/content Research article Current experience with applying the GRADE approach to public health interventions: an empirical study Eva A Rehfuess, Elie A Akl BMC Public Health 2013, 13:9 (8 January 2013) http://www.biomedcentral.com/1471-2458/13/9/abstract Abstract (provisional) Background The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by many national and international organisations as a systematic and transparent framework for evidence-based guideline development. With reference to an ongoing debate in the literature and within public health organisations, this study reviews current experience with the GRADE approach in rating the quality of evidence in the field of public health and identifies challenges encountered. Methods We conducted semi-structured interviews with individuals/groups that have applied the GRADE approach in the context of systematic reviews or guidelines in the field of public health, as well as with representatives of groups or organisations that actively decided against its use. We initially contacted potential participants by email. Responses were obtained by telephone interview or email, and written interview summaries were validated with participants. We analysed data across individual interviews to distil common themes and challenges. Results Based on 25 responses, we undertook 18 interviews and obtained 15 in-depth responses relating to specific systematic reviews or guideline projects; a majority of the latter were contributed by groups within the World Health Organization. All respondents that have used the GRADE approach appreciated the systematic and transparent process of assessing the quality of the evidence. However, respondents reported a range of minor and major challenges relating to complexity of public health interventions, choice of outcomes and outcome measures, ability to discriminate between different types of observational studies, use of non-epidemiological evidence, GRADE terminology and the GRADE and guideline development process. Respondents' suggestions to make the approach more applicable to public health interventions included revisiting terminology, offering better guidance on how to apply GRADE to complex interventions and making modifications to the current grading scheme. Conclusions Our findings suggest that GRADE principles are applicable to public health and well-received but also highlight common challenges. They provide a starting point for exploring options for

improvements and, where applicable, testing these across different types of public health interventions. Several public health organisations are currently testing GRADE, and the GRADE Working Group is eager to engage with these groups to find ways to address concerns. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. British Medical Bulletin Volume 104 Issue 1 December 2012 http://bmb.oxfordjournals.org/content/current [Reviewed earlier; No relevant content] British Medical Journal 12 January 2013 (Vol 346, Issue 7890) http://www.bmj.com/content/346/7890 [No relevant content] Bulletin of the World Health Organization Volume 91, Number 1, January 2013, 1-80 http://www.who.int/bulletin/volumes/90/12/en/index.html [Reviewed earlier] Cost Effectiveness and Resource Allocation (Accessed 12 January 2013) http://www.resource-allocation.com/ [No new relevant content] Emerging Infectious Diseases Volume 19, Number 1—January 2013 http://www.cdc.gov/ncidod/EID/index.htm [Reviewed earlier] Eurosurveillance Volume 18, Issue 2, 10 January 2013 http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678 [No relevant content] Global Health Governance Volume VI, Issue 1: Fall 2012 – December 31, 2012 [Reviewed earlier]

Globalization and Health [Accessed 12 January 2013] http://www.globalizationandhealth.com/ [No new relevant content] Health Affairs January 2013; Volume 32, Issue 1 http://content.healthaffairs.org/content/current Theme: Transforming The Delivery Of Health Care [No specific relevant content on vaccines/immunization] Health and Human Rights Vol 14, No 2 (2012) http://hhrjournal.org/index.php/hhr [Reviewed earlier] Health Economics, Policy and Law Volume7 / Issue04 / October 2012, pp 383 - 384 http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue Special Issue: End of Life Care and Evaluation [Reviewed earlier; No specific relevant content on vaccines/immunization] Health Policy and Planning Volume 28 Issue 1 January 2013 http://heapol.oxfordjournals.org/content/current Original articles Reforming antiretroviral price negotiations and public procurement: the Mexican experience Health Policy Plan. (2013) 28(1): 1-10 doi:10.1093/heapol/czs015 Abstract Since antiretroviral (ARV) medicines represent one of the most costly components of therapy for HIV in middle-income countries, ensuring their efficient procurement is highly relevant. In 2008, Mexico created a national commission for the negotiation of ARV prices to achieve price reductions for their public HIV treatment programmes. The objective of this study is to assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures. A longitudinal retrospective analysis of procurement prices, volumes and type of the most commonly prescribed ARVs procured by the two largest providers of HIV/AIDS care in Mexico between 2004 and 2009 was carried out. These analyses were combined with 26 semistructured key informant interviews to identify changes in the procurement process. Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the Commission was successful in price negotiations. However, when compared with other upper-middle-income countries, Mexico continues to pay an average of six times more for ARVs.

The Commission's negotiations were successful in achieving lower ARV prices. However, price reduction in upper-middle-income countries suggests that the price decrease in Mexico cannot be entirely attributed to the Commission's first round of negotiations. In addition, key informants identified inefficiencies in the forecasting and procurement processes possibly affecting the efficiency of the negotiation process. A comprehensive approach to improving efficiency in the purchasing and delivery of ARVs is necessary, including a better clarification in the roles and responsibilities of the Commission, improving supply data collection and integration in forecasting and procurement, and the creation of a support system to monitor and provide feedback on patient ARV use. http://heapol.oxfordjournals.org/content/28/1/1.abstract Global Immunization Vision and Strategy (GIVS): a mid-term analysis of progress in 50 countries Health Policy Plan. (2013) 28(1): 11-19 doi:10.1093/heapol/czs020 Lidija Kamara, Patrick Lydon, Julian Bilous, Jos Vandelaer, Rudi Eggers, Marta Gacic-Dobo, William Meaney, and Jean-Marie Okwo-Bele Abstract Within the overall framework set out in the Global Immunization Vision and Strategy (GIVS) for the period 2006–2015, over 70 countries had developed comprehensive Multi-Year Plans (cMYPs) by 2008, outlining their plans for implementing the GIVS strategies and for attaining the GIVS Goals at the midpoint in 2010 or earlier. These goals are to: (1) reach ≥90% and ≥80% vaccination coverage at national and district level, respectively; and (2) reduce measlesrelated mortality by 90% compared with the 2000 level. Fifty cMYPs were analysed along the four strategic areas of the GIVS: (1) protecting more people in a changing world; (2) introducing new vaccines and technologies; (3) integrating immunization, other health interventions and surveillance in the health system context; and (4) immunizing in the context of global interdependence. By 2010, all 50 countries planned to have introduced hepatitis B (HepB) vaccine, 48 the Haemophilus influenzae type B (Hib) vaccine and only a few countries had firm plans to introduce pneumococcal or rotavirus vaccines. Countries seem to be inadequately prepared in terms of cold-chain requirements to deal with the expected increases in storage that will be required for vaccines, and in making provisions to establish a corresponding surveillance system for planned new vaccine introductions. Immunization contacts are used to deliver other health interventions, especially in the countries in the World Health Organization (WHO) Africa Region. The cost for the planned immunization activities will double to U$27 per infant, of which U$5 per infant is the expected shortfall. Global Alliance for Vaccines and Immunization (GAVI) funding is becoming the largest contributor to immunization programmes. http://heapol.oxfordjournals.org/content/28/1/11.abstract Editor's Choice: The emergence of global attention to health systems strengthening Health Policy Plan. (2013) 28(1): 41-50 doi:10.1093/heapol/czs023 Tamara Hafner and Jeremy Shiffman Free full text Abstract After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears

among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors. http://heapol.oxfordjournals.org/content/28/1/41.abstract Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India Madhu Gupta, Shankar Prinja, Rajesh Kumar, and Manmeet Kaur Health Policy Plan. (2013) 28(1): 51-61 doi:10.1093/heapol/czs025 Abstract Objective In India, Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization programme requires evidence of its potential health impact and costeffectiveness, as it is a costly vaccine. Since childhood mortality, vaccination coverage and health service utilization vary across states, the cost-effectiveness of introducing Hib vaccine was studied in Haryana state. Methodology A mathematical model was used to compare scenarios with and without Hib vaccination to estimate the cost-effectiveness of Hib vaccine in Haryana from 2010 to 2024. Demographic and National Family Health Surveys were used to estimate vaccination coverage and mortality rates among children under 5. Hib pneumonia, Hib meningitis and invasive Hib disease incidence were based on Indian studies. Vaccine and syringe prices of the UNICEF supply division were used. Cost-effectiveness from government and societal perspectives was calculated as the net incremental cost per unit of health benefit gained [disability-adjusted life years (DALYs) averted, life years saved, Hib cases averted, Hib deaths averted]. Sensitivity analysis was done using variation in parameter estimates among different states of India. Findings The incremental cost of Hib vaccine introduction from a government and a societal perspective was estimated to be US$81.4 and US$27.5 million, respectively, from 2010 to 2024. Vaccination of 73.3, 71.6 and 67.4 million children with first, second and third dose of pentavalent vaccine, respectively, would avert 7 067 817 cases, 31 331 deaths and 994 564 DALYs. Incremental cost per DALY averted from a government (US$819) and a societal perspective (US$277) was found to be less than the per capita gross national income of India in 2009. In sensitivity analysis, Hib vaccine introduction remained cost-effective for India. Conclusion Hib vaccine introduction is a cost-effective strategy in India. http://heapol.oxfordjournals.org/content/28/1/51.abstract Human Vaccines & Immunotherapeutics (formerly Human Vaccines) Volume 9, Issue 1 January 2013 http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/ [Reviewed earlier] Infectious Diseases of Poverty

2012, 1 http://www.idpjournal.com/content [Accessed 12 January 2013] Editorial Elimination of tropical disease through surveillance and response Xiao-Nong Zhou, Robert Bergquist, Marcel Tanner Infectious Diseases of Poverty 2013, 2:1 (3 January 2013) Abstract (provisional) Surveillance and response represent the final crucial steps in achieving effective control and particularly elimination of communicable diseases as recognized in the area of neglected tropical diseases (NTDs), applied in increasing numbers in endemic countries with ongoing control and elimination programmers. More and more national NTD elimination initiatives are scheduled based on the innovative and effective One world-One health perspective to detect pockets of transmission/disease reintroduction. Resource-constrained countries, which carry the heaviest NTD burdens, face various challenges how to strengthen the health system as well as developing effective and novel tools for surveillance and response tailored to local settings. Surveillance-response approaches take place in two different stages corralling the basic components of the surveillance-response system for NTD elimination. Six different research priorities have been identified:1) dynamic mapping of transmission; 2) near real-time capture of population dynamics; 3) modelling based on a minimum essential database/dataset; 4) implementation of mobile health (m-health) and sensitive diagnostics; 5) design of effective response packages tailored to different transmission settings and levels; and 6) validation of approaches and responses. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. International Journal of Infectious Diseases January 2013, Vol. 17, No. 1 http://www.ijidonline.com/ [No relevant content] JAMA January 09, 2013, Vol 309, No. 2 http://jama.ama-assn.org/current.dtl [No relevant content] Journal of Health Organization and Management Volume 26 issue 6 - Published: 2012 http://www.emeraldinsight.com/journals.htm?issn=1477-7266&show=latest [Reviewed earlier; No relevant content] Journal of Infectious Diseases Volume 207 Issue 3 February 1, 2013 http://www.journals.uchicago.edu/toc/jid/current

[Reviewed earlier; No relevant content] Journal of Global Infectious Diseases (JGID) October-December 2012 Volume 4 | Issue 4 Page Nos. 187-224 http://www.jgid.org/currentissue.asp?sabs=n [Reviewed earlier; No relevant content] Journal of Medical Ethics January 2013, Volume 39, Issue 1 http://jme.bmj.com/content/current [Reviewed earlier] Journal of Medical Microbiology January 2013; 62 (Pt 1) http://jmm.sgmjournals.org/content/current [Reviewed earlier; No relevant content] Journal of the Pediatric Infectious Diseases Society (JPIDS) Volume 1 Issue 4 December 2012 http://jpids.oxfordjournals.org/content/current [Reviewed earlier] The Lancet Jan 12, 2013 Volume 381 Number 9861 p89 - 176 http://www.thelancet.com/journals/lancet/issue/current [No relevant content] The Lancet Infectious Disease Jan 2013 Volume 13 Number 1 p1 - 96 http://www.thelancet.com/journals/laninf/issue/current [Reviewed earlier] Medical Decision Making (MDM) January 2013; 33 (1) http://mdm.sagepub.com/content/current Special Issue: Decision Aids and Risk Perception Cornelia Betsch, Frank Renkewitz, and Niels Haase Effect of Narrative Reports about Vaccine Adverse Events and Bias-Awareness Disclaimers on Vaccine Decisions: A Simulation of an Online Patient Social Network

Med Decis Making January 2013 33: 14-25, first published on August 8, 2012 doi:10.1177/0272989X12452342 http://mdm.sagepub.com/content/33/1/14.abstract Abstract Background. As the number of individuals who search for health information in interactive online environments is increasing, patient networks deserve more scientific attention. Objective. To quantitatively examine if and how reading statistical and/or narrative information as typically displayed in patient networks (e.g., patientslikeme.com) affects decisions for pharmaceuticals. Previous work suggests that narrative information (e.g., about vaccine adverse events, VAE) affects risk perceptions and intentions. The authors compare the effect of narrative and statistical information about VAE on vaccination decisions and examine if a disclaimer reduces the narrative bias as well as if low numeracy leads to increased use of the narratives. Method and Design. In an online experiment, 458 participants were randomly assigned to a 3 (relative frequency of vaccine adverse events in 1, 7, or 17 of 20 cases) × 3 (type of information: narratives, summary statistics, or both) × 2 (bias awareness v. control disclaimer) between-subjects design. Measurements. Perceived risk, vaccination intention, and subjective numeracy. Results. A higher relative frequency of cases reporting VAE decreased the intention to get vaccinated. This relation was mediated by increased risk perception. The type of information moderated the contents’ impact: Summary statistics had the smallest impact, whereas narrative information was more influential, and the presence of both types of information had the greatest impact on risk perception. Individuals who received the bias-awareness disclaimer were less influenced by the patient network. Highly numerate individuals were generally more sensitive to the provided information independent of its format. Conclusions. Patient networks can influence vaccination decisions by delivering risk-related information. Disclaimers may help to reduce the influence if desired. The Milbank Quarterly A Multidisciplinary Journal of Population Health and Health Policy December 2012 Volume 90, Issue 4 Pages 631–807 http://onlinelibrary.wiley.com/doi/10.1111/milq.2012.90.issue-4/issuetoc [Reviewed earlier] Nature Volume 493 Number 7431 pp133-264 10 January 2013 http://www.nature.com/nature/current_issue.html [No relevant content] Nature Immunology January 2013, Volume 14 No 1 pp1-99

http://www.nature.com/ni/journal/v14/n1/index.html [Reviewed earlier; No relevant content] Nature Medicine January 2013, Volume 19 No 1 pp1-112 http://www.nature.com/nm/journal/v19/n1/index.html Editorial When true enough is not good enough - p1 doi:10.1038/nm.3061 Extract “…A recent court ruling that favored freedom of speech over the authority of the US Food and Drug Administration (FDA) to regulate off-label drug promotion may have profound implications for the way drugs are marketed and, ultimately, for patients' interests… Opinion Poor definitions threaten drug trial safety in India - p15 Nupur Chowdhury doi:10.1038/nm0113-15 Extract India has become a hotbed of clinical trials, but recent reports of safety lapses have prompted calls for better regulation in this area. Currently, trial requirements can be relaxed if doing so is in the 'public interest', but a clearer definition of what this means is needed before this provision should be used…. Nature Reviews Immunology January 2013 Vol 13 No 1 http://www.nature.com/nri/journal/v13/n1/index.html [Reviewed earlier; No relevant content] New England Journal of Medicine January 10, 2013 Vol. 368 No. 2 http://content.nejm.org/current.shtml [No relevant content] OMICS: A Journal of Integrative Biology January 2013, 17(1): http://online.liebertpub.com/toc/omi/16/12 [No relevant content] The Pediatric Infectious Disease Journal January 2013 - Volume 32 - Issue 1 pp: A13-A14,1-98,e1-e44 http://journals.lww.com/pidj/pages/currenttoc.aspx [Reviewed earlier]

Pediatrics January 2013, VOLUME 131 / ISSUE 1 http://pediatrics.aappublications.org/current.shtml [Reviewed earlier] Pharmacoeconomics December 1, 2012 - Volume 30 - Issue 12 pp: 1097-1214 http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx [Reviewed earlier; No relevant content] PLoS One [Accessed 12 January 2013] http://www.plosone.org/ [No new relevant content] PLoS Medicine (Accessed 12 January 2013) http://www.plosmedicine.org/ [No new relevant content] PLoS Neglected Tropical Diseases December 2012 http://www.plosntds.org/article/browseIssue.action [Reviewed earlier] PNAS - Proceedings of the National Academy of Sciences of the United States of America (Accessed 12 January 2013) http://www.pnas.org/content/early/recent [No new relevant content] Public Health Ethics Volume 5 Issue 3 November 2012 http://phe.oxfordjournals.org/content/current [Reviewed earlier] Qualitative Health Research February 2013; 23 (2) http://qhr.sagepub.com/content/current Special Issue: The Experiences of Others

[No relevant content] Trends in Molecular Medicine Volume 19, Issue 1, Pages 1-70 (January 2013) http://www.sciencedirect.com/science/journal/14714914 [reviewed earlier; No relevant content] Science 11 January 2013 vol 339, issue 6116, pages 113-244 http://www.sciencemag.org/current.dtl [No relevant content] Science Translational Medicine 9 January 2013 vol 5, issue 167 http://stm.sciencemag.org/content/current [No relevant content] Vaccine Volume 31, Issue 4, Pages 567-724 (11 January 2013) http://www.sciencedirect.com/science/journal/0264410X Systematic review of reporting rates of adverse events following immunization: An international comparison of post-marketing surveillance programs with reference to China Review Article Pages 603-617 Biao Guo, Andrew Page, Huaqing Wang, Richard Taylor, Peter McIntyre Abstract Background China is the most populous country in the world, with an annual birth cohort of approximately 16 million, requiring an average of 500 million vaccine doses administered annually. In China, over 30 domestic and less than 10 overseas vaccine manufacturers supply over 60 licensed vaccine products, representing a growing vaccine market mainly due to recent additions to the national immunization schedule, but data on post-marketing surveillance for adverse events following immunization (AEFI) are sparse. Objectives To compare reporting rates for various categories of AEFI from China with other routine postmarketing surveillance programs internationally. Methods Systematic review of published studies reporting rates of AEFI by vaccine, category of reaction and age from post-marketing surveillance systems in English and Chinese languages. Results Overall AEFI reporting rates (all vaccines, all ages) in Chinese studies were consistent with those from similar international studies elsewhere, but there was substantial heterogeneity in regional reporting rates in China (range 2.3–37.8/100,000 doses). The highest AEFI reporting

rates were for diphtheria–tetanus–pertussis whole-cell (DTwP) and acellular (DTaP) vaccines (range 3.3–181.1/100,000 doses for DTwP; range 3.5–92.6/100,000 doses for DTaP), with higher median rates for DTwP than DTaP, and higher than expected rates for DTaP vaccine. Similar higher rates for DTwP and DTaP containing vaccines, and relatively lower rates for vaccines against hepatitis B virus, poliovirus, and Japanese encephalitis virus were found in China and elsewhere in the world. Conclusions Overall AEFI reporting rates in China were consistent with similar post-marketing surveillance systems in other countries. Sources of regional heterogeneity in AEFI reporting rates, and their relationships to differing vaccine manufacturers versus differing surveillance practices, require further exploration. Sources of pertussis infection in young infants: A review of key evidence informing targeting of the cocoon strategy Review Article Pages 618-625 K.E. Wiley, Y. Zuo, K.K. Macartney, P.B. McIntyre Abstract Background The relative contribution of different categories of contact in transmitting pertussis to very young infants, who experience the most severe morbidity, is the most important single factor determining the likely benefit of pertussis vaccination of their close contacts (the “cocooning” strategy). Objective To identify, evaluate the quality of and summarise existing data on potential sources of infant pertussis infection in high income countries, focussing on infants under 6 months old. Data sources: Online databases MEDLINE and EMBASE. Additional studies were identified from the reference lists of relevant articles. Study selection and analysis: Study quality was evaluated by standardised criteria, based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Pooled estimates of the proportion of pertussis cases attributable to various contact sources were calculated using data from the highest quality studies. Results Nine studies met the inclusion criteria; seven included data on contacts of hospitalised infants less than 6 months old. Case definitions and methods of contact ascertainment were variable. Most identified sources were from the household, of which 39% (95%CI 33–45%) were mothers, 16% (95%CI 12–21%) fathers, and 5% (95%CI 2–10%) grandparents. Estimates for siblings (16–43%) and non-household contacts (4–22%) were more heterogeneous. For 32– 52% of infant cases, no source was identified. Asymptomatic pertussis infection was found in 8–13% of contacts evaluated. Conclusions These data suggest that the greatest potential impact of pertussis vaccination of adults to prevent severe disease in young infants comes from vaccinating mothers, followed by fathers, with grandparents having a minor role. Siblings varied in importance and, given recent data regarding waning immunity in vaccinated children, need further study. Non-household sources are also well documented, highlighting the potential limitations of the cocoon strategy to prevent severe infant disease. Models of strategies for control of rubella and congenital rubella syndrome—A 40 year experience from Australia

Original Research Article Pages 691-697 Zhanhai Gao, James G. Wood, Margaret A. Burgess, Robert I. Menzies, Peter B. McIntyre, C. Raina MacIntyre Abstract We investigated the impact of vaccination on rubella epidemiology in Australia, using a mathematical model fitted to Australian serosurvey data and incorporating pre-vaccination European estimates of rubella transmissibility. Mass infant measles–mumps–rubella (MMR) vaccination produced a 99% reduction in both rubella and congenital rubella syndrome (CRS) incidence by 2010 compared to the pre-vaccination era (1960–70). The model is consistent with reductions in CRS based on surveillance of congenital hearing impairment. Model simulations suggest that selective schoolgirl vaccination (1971–88) was associated with a 90% reduction in CRS incidence, but only a 1–4% reduction in rubella incidence. Our model predicted that these reductions in rubella were much less vulnerable to reductions in MMR vaccine coverage than for measles. In the future, a less than 15% decrease in MMR vaccine coverage is estimated to have minimal impact before 2060, but a 20% reduction may result in a 7-fold increase in rubella incidence, with the effective reproductive number R rising from 0.28 to 0.78 by 2060. The 99% reduction in both rubella and CRS incidence and low effective reproductive number (R ≤ 0.28) we documented after 2010 are consistent with Australia having achieved rubella elimination. Vaccine: Development and Therapy (Accessed 12 January 2013) http://www.dovepress.com/vaccine-development-and-therapy-journal [No new relevant content] Value in Health Vol 15 | No. 8 | December 2012 | Pages 991-1192 http://www.valueinhealthjournal.com/current [Reviewed earlier]

From Google Scholar+: Dissertations, Theses, Selected Journal Articles
Adapting Group Sequential Methods to Observational Postlicensure Vaccine Safety Surveillance: Results of a Pentavalent Combination DTaP-IPV-Hib Vaccine Safety … JC Nelson, O Yu, CP Dominguez-Islas, AJ Cook… - American Journal of …, 2013 Abstract To address gaps in traditional postlicensure vaccine safety surveillance and to promote rapid signal identification, new prospective monitoring systems using large healthcare database cohorts have been developed. We newly adapted clinical trial group ... Qualitative Health Research 2012 Dec 28. [Epub ahead of print] Margaret Jane Pitts and Kimberly Adams Tufts Implications of the Virginia Human Papillomavirus Vaccine Mandate for Parental Vaccine Acceptance

Qual Health Res 1049732312470871, first published on December 28, 2012 as doi:10.1177/1049732312470871 Abstract In 2009, Virginia became the first state in the United States to enact a school vaccine mandate for the human papillomavirus (HPV), putting it at the forefront of the national HPV vaccine mandate controversy. It is critical to explore the public response and sense making where the mandate has already been enacted. Thus, we conducted 8 focus group discussions among 33 Virginia parents to explore how they conceptualized the virus and vaccine and their responses to the mandate. Findings suggest that many parents are skeptical of and reluctant to follow a state-mandated vaccine requirement, choosing instead to opt out of the vaccine until they decide the time is right for their daughter and/or until they feel confident in their knowledge about the virus, vaccine, and the impetus for the mandate. Study results can inform future legislation among states considering HPV-related mandates and aid in the development of health-promotion materials within the context of a state mandate. http://qhr.sagepub.com/content/early/2012/12/27/1049732312470871.abstract

Media Watch Beginning in June 2012, Vaccines: The Week in Review expanded 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 of 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.
BBC http://www.bbc.co.uk/ Accessed 12 January 2013 [No new, unique, relevant content] Economist http://www.economist.com/ Accessed 12 January 2013 [No new, unique, relevant content] Financial Times http://www.ft.com Accessed 12 January 2013 Editorial January 11, 2013 6:42 pm Pakistan’s victims - Muslim leaders should do more to support polio vaccines

Rarely has extremism become such an enemy of human health as in Pakistan. Alongside an escalating campaign of indiscriminate bombings, including the series of attacks that killed more than 100 people on Thursday, has been a steady trickle of targeted assassinations of immunisation workers engaged in efforts to beat polio. The Islamic world has to ensure the deaths are not in vain. It is tempting to see the vaccine killings as a response to the CIA’s use of a hepatitis B programme as cover for its operation to track down Osama bin Laden in 2010. While few mourn the al-Qaeda leader, the grisly truth is that extremist groups have used this part of the story as a pretext to politicise vaccination and deter participants through violence. It is difficult to prove a direct causal link, but previous western military actions and local illinformed claims that vaccines are a covert sterilisation technique have helped to undermine programmes in several countries, notably in northern Nigeria, another residual outpost of polio. In Pakistan, factors such as US drone attacks have been used to justify strikes against western targets extending beyond immunisers. Yet, the country’s use of “lady health workers” is particularly delicate: most communities prefer that women carry out the work. Extremists, however, are hostile to an active role for women on all counts. It is tragic that vaccines should be wrongly perceived as western or Christian, let alone detrimental. The earliest records of immunisation are in China, India and the Ottoman Empire. Today many vaccines are manufactured in Asia. It is understandable that public concern over the dangers of polio has fallen in direct proportion to the success of vaccination campaigns over the past 50 years in reducing the number of people affected. But outbreaks of other preventable diseases, such as measles, should serve as a reminder of the value of immunisation. The Pakistani authorities need to take vaccination more seriously, with better funding, supervision, support and partnership with respected religious and secular leaders. Other Muslim governments and clerics should play a greater role in advocating and acting as mediators with religious groups in vaccine programmes around the world. Oil-rich countries in particular should become more active in funding. Politicians should encourage “days of tranquility” of the type introduced during conflicts in Afghanistan and Sudan, with all sides benefiting from access to health workers. Finally, polio should become less of an exceptional campaign and be more integrated alongside other vaccination, health and social programmes. That would save costs and spread visible benefits for all regardless of their beliefs or social issues. Forbes http://www.forbes.com/ Accessed 12 January 2013 Boston Declares Public Health Emergency; Flu Vaccines Run Dry Flu outbreak leads Boston to declare public health emergency; nearby city runs out of vaccines. Foreign Affairs http://www.foreignaffairs.com/ November/December 2012 Volume 91, Number 6 Accessed 12 January 2013 [No new unique, relevant content] Foreign Policy http://www.foreignpolicy.com/

Accessed 12 January 2013] [No new unique, relevant content]
The Guardian http://www.guardiannews.com/ Accessed 12 January 2013 [No new unique, relevant content] The Huffington Post http://www.huffingtonpost.com/ Accessed 12 January 2013 The evolving role of the private sector in global health 8 January 2013 http://www.huffingtonpost.com/jeffrey-l-sturchio/the-evolving-role-health_b_2432823.html Jeffrey L. Sturchio, Senior Partner, Rabin Martin [We work with multi-national corporations, non-profit and advocacy organizations, foundations, major universities, think tanks and government to help clients improve health and shape policy. We draw on diverse expertise to shape emerging issues with multidisciplinary strategies and programs.] Co-authored with Dr. Adel Mahmoud, former president, Merck Vaccines New Yorker http://www.newyorker.com/ Accessed 12 January 2013 [No new, unique, relevant content] NPR/National Public Radio [U.S.] Public Health Accessed 12 January 2013 [No new, unique, relevant content] New York Times http://www.nytimes.com/ Accessed 12 January 2013. Lessons from India: How to promote the polio vaccine in Pakistan New York Times | 11 January 2013 Extract “…What we did in India shows that by working hand-in-glove with the true faith leaders of the communities at risk — by gaining their trust and support through sincere dialogue and by keeping the focus always on the well-being of the child – polio eradication is achievable even under the most challenging conditions.” By Ashok Mahajan, a member of the Rotary Club of Mulund, Maharashtra, is a Trustee of The Rotary Foundation of Rotary International, a spearheading partner in the Global Polio Eradication Initiative. Reuters http://www.reuters.com/ Accessed 12 January 2013 [No new, unique, relevant content]

Wall Street Journal http://online.wsj.com/home-page Accessed 12 January 2013 [No new, unique, relevant content] Washington Post http://www.washingtonpost.com/ Accessed 12 January 2013 [No new, unique, relevant content]

Twitter Watch (12 Janaury 2013 – 17:50) Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.
World Bank Data @worldbankdata Browse 250 #health, nutrition and population indicators for over 200 countries #opendata http://bit.ly/QaHb7W Retweeted by World Bank 9:30 AM - 11 Jan 13 CDC Flu @CDCFlu 128 of 135 million total flu vax doses have been distributed. Vax may be hard to find. Try http://flushot.healthmap.org or call your doc or pharmacy Retweeted by CDCgov 12:40 PM - 11 Jan 13 PATH @PATHtweets Where there is no reliable clean water or electricity, a new test will make screening for #cervicalcancer possible. http://ow.ly/gK5fq 12:50 PM - 11 Jan 13 GAVI Alliance @GAVIAlliance In 1st MOPAN review @GAVIAlliance is commended 4 effectiveness in increasing access 2 immunisation & focus on results! http://ht.ly/gJt1c 7:34 AM - 11 Jan 13 Sabin Vaccine Inst. @sabinvaccine Did you know that our Sustainable Immunization Financing team works in 18 countries? Read more to find out which ones http://www.sabin.org/programs/vaccine-advocacyeducation/sustainable-immunization-financing-sif … 9:28 AM - 10 Jan 13 GAVI Alliance @GAVIAlliance VIDEO: Great interview of @GAVIAlliance CEO, @GAVISeth, on Al Jazeera (8 January 2013): http://ht.ly/gHkS2 @AJEnglish

7:00 AM - 10 Jan 13 · Details * * * *

Vaccines: 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 Children’s Hospital of Philadelphia Vaccine Education Center. Additional support is provided by PATH Vaccine Development Program and the International Vaccine Institute (IVI), and by vaccine industry leaders including GSK, Merck, Pfizer, and sanofi pasteur (list in formation), as well as the Developing Countries Vaccine Manufacturers Network (DCVMN). Support is also provided by a growing list of individuals who use this 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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