Journal of Public Health Policy
Volume 36, Issue 1 (February 2015)
http://www.palgrave-journals.com/jphp/journal/v36/n1/index.html

Editorial
Lessons from the public health response to Ebola
Journal of Public Health Policy (2015) 36, 1–3. doi:10.1057/jphp.2014.51; published online 11 December 2014
Anthony Robbins Co-Editor and Ruth Berkelman Member, JPHP Editorial Board

Anything we say today about Ebola is likely to seem dated by the time it is posted online in weeks or appears in print in months. So we look back, to consider missed opportunities, and into the unknown future to avoid worldwide ‘surprise’ again.

How could the public health world have been so ill prepared for this year’s Ebola virus disease outbreaks in Guinea, Sierra Leone, and Liberia? Although these outbreaks have grabbed the whole world’s attention, we can only describe the response as ‘scrambling to catch-up’.

The hemorrhagic fever caused by the Ebola virus was first described in 1976 in what was then Zaire. There have been additional small outbreaks in sub-Saharan Africa. Uganda and other countries controlled outbreaks, but not without resources and an organized response.

It looks like not everyone was asleep. Lab researchers did what they are good at, and the molecular biology of the Ebola virus is rather well described and advanced in understanding.1 Promising candidate vaccines and antiviral therapies have been developed but they have not progressed to licensure.2, 3 Was testing and licensure left largely to an industry that saw no profit selling an Ebola vaccine to the world’s poorest countries?

Research in the field has been less robust than in the laboratory. Months into the epidemic, there still seemed to be confusion about how the virus was spread. The question of whether some people are more likely to spread the disease than others, so-called ‘super-spreaders’, has lingered. More applied research is surely needed. We learned recently that management of waste disposal – from bodily fluids to personal protective equipment and mattresses – remains inadequately studied. Does everything need to be buried or burned? What works efficiently?

Perhaps it is unfair to expect the world’s major research institutes – the Institut Pasteur, the Karolinska, or the US National Institutes of Health – to put more researchers in the field. But, is there an explanation for the World Health Organization’s (WHO) failure to organize assistance for countries with inadequate resources; to help them prepare for Ebola and other infectious disorders? In the case of Ebola, WHO knew that with preparation and resources, the disease had, in the past, been successfully contained. New global interest in noncommunicable diseases4 must not absolve public health officials for their failure to prepare for infectious disease outbreaks.

Médecins Sans Frontières (MSF) has sent doctors and nurses into the field to help where resources are scarce. They also conduct field research. MSF’s applied research, organized by Epicentre MSF in Paris. Epicentre studies field operations of MSF to learn what works and what does not. They learn what knowledge, strategies, and resources are needed, and how to provide care and protection. MSF developed guidance for the use of personal protective equipment.

In June 2014 MSF was outspoken, calling for a robust response and stating that the outbreak was ‘out of control’ and that they had reached their limit in being able to care for patients with Ebola virus disease in 60 locations across Liberia, Guinea, and Sierra Leone. Was anyone listening? It took 6 weeks until WHO deemed Ebola a ‘Public Health Emergency of International Concern’ and called for a coordinated international response. Countries facing occasional imported cases were in a panic about how to respond at home, while thousands of people in West Africa became infected with Ebola.

Our list of ‘pending’ infectious challenges is far from exhaustive, but it confirms that there are many threats out there. Influenza has received some attention. The coronaviruses – Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome – and the paramyxoviruses – Nipah virus – remain serious threats to health globally.5, 6 Current efforts to control multi-drug resistant tuberculosis are dangerously ‘out of step’ with this grave peril.7, 8 Mosquito control needs to be reinforced so that Chikungunya and Dengue can be prevented. We must look ahead at the full range of threats.

Can we learn from Ebola? We must make sure that lab research, plus applied research and field studies, and the resources for care and prevention will be developed now so that we will not be ‘surprised’ in the future as we seem to have been with Ebola.
[References]

Editorial
Commentary: Ebola: The haves and the have-nots
Adolfo Martínez Palomoa
aCenter for Advanced Studies, Molecular Pathogenesis, Avenida IPN 2508, Mexico City (D.F.) Journal of Public Health Policy (2015) 36, 4–6. doi:10.1057/jphp.2014.50; published online 27 November 2014
Abstract
The Ebola epidemic exemplifies the importance of social determinants of health: poverty and illiteracy, among others.

Viewpoint: The role of sanitation in malnutrition – A science and policy controversy in India
Madhumita Dobea
aDepartment of Health Promotion & Education, All India Institute of Hygiene & Public Health, 110, Chittaranjan Avenue, West Bengal, Kolkata, 700073, India.
Abstract
Over the past decade, India’s economic growth has been remarkable – yet almost half of India’s children under 5 remain stunted. The National Food Security Bill is the country’s response to this critical situation. Studies reveal that Indian children are chronically undernourished, not only because of lack of food but also because of recurring gastrointestinal infections. The stunting problem revolves more around lack of sanitation than food insecurity. Despite acknowledging that malnutrition is ‘complex and multidimensional’, government action has consisted largely of nutritional interventions and subsidized food. Although improvements in sanitation would be the most effective way to reduce excessively high levels of chronic undernutrition and stunting, a review of policy formulation and implementation reveals deficits and disconnects with available scientific evidence. It is time to change these mistaken assumptions and focus on improving access and use of safe sanitation facilities to achieve India’s nutritional goals.

The Lancet
Jan 10, 2015 Volume 385 Number 9963 p89-200 e4
http://www.thelancet.com/journals/lancet/issue/current

Comment
Beyond Ebola: a new agenda for resilient health systems
Marie Paule Kieny, Delanyo Dovlo
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62479-X
Summary
A resilient health system is one able to absorb the shock of an emergency like Ebola and at the same time continue to provide regular health services, leaving other sectors of the country fully functioning. In Guinea, Liberia, and Sierra Leone, the 2014 Ebola outbreak has claimed many lives and laid waste to economies, food provision, and development. The World Bank’s forecast1 of tens of billions of dollars lost for the three affected countries and the broader west Africa region points to the interdependence between health and countries’ wider socioeconomic landscape.

Comment
Offline: Solving WHO’s “persisting weaknesses” (part 1)
Richard Horton
DOI: http://dx.doi.org/10.1016/S0140-6736(14)62485-5
When the 34 members of WHO’s Executive Board gather in Geneva on Jan 25—first, for a special session on the response to the Ebola outbreak and, second, for its 136th meeting—countries will have an unprecedented opportunity to reflect on the future of the world’s only global health agency. Why unprecedented? Because, in WHO’s own words (from documents submitted to the Board and available on WHO’s website), Ebola has put “enormous strain” on the agency’s managerial structures and systems. The outbreak has had a “significant impact” on WHO’s non-Ebola work, with the result that “time-bound projects will be affected”.

Articles
Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Mortality and Causes of Death Collaborators
Collaborators listed at the end of the Article
Published Online: 17 December 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)61682-2
Summary
Background
Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries.
Methods
We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer’s disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.
Findings
Global life expectancy for both sexes increased from 65•3 years (UI 65•0–65•6) in 1990, to 71•5 years (UI 71•0–71•9) in 2013, while the number of deaths increased from 47•5 million (UI 46•8–48•2) to 54•9 million (UI 53•6–56•3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10•7%, from 4•3 million deaths in 1990 to 4•8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.
Interpretation
For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
Funding
Bill & Melinda Gates Foundation.

Series
A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up
Dr Deanna Kerrigan, PhD, Caitlin E Kennedy, PhD, Ruth Morgan-Thomas, BA, Sushena Reza-aul, PhD, Peninah Mwangi, Kay Thi Win, Allison McFall, MHS, Virginia A Fonner, MPH, Jennifer Butler, PhD
Published Online: 21 July 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60973-9
Summary
A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV.

Series
Human rights violations against sex workers: burden and effect on HIV
Dr Michele R Decker, ScD, Anna-Louise Crago, MA, Sandra K H Chu, LLM, Prof Susan G Herman, PhD, Meena S Seshu, MSW, Kholi Buthelezi, Mandeep Dhaliwal, MD, Prof Chris Beyrer, MD
Published Online: 21 July 2014
DOI: http://dx.doi.org/10.1016/S0140-6736(14)60800-X
Summary
We reviewed evidence from more than 800 studies and reports on the burden and HIV implications of human rights violations against sex workers. Published research documents widespread abuses of human rights perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts. Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing. Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law. Protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing. Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.

Maternal and Child Health Journal
Volume 19, Issue 1, January 2015
http://link.springer.com/journal/10995/19/1/page/1

Maternal–Fetal Impact of Vitamin D Deficiency: A Critical Review
Letícia Schwerz Weinert, Sandra Pinho Silveiro
Abstract
Research into the extra-skeletal functions of vitamin D has been expanding in recent years. During pregnancy, maternal vitamin D status may be of concern because of the key role of this vitamin in fetal skeletal development and due to the association between hypovitaminosis D and adverse maternal–fetal outcomes. Therefore, the objective of this manuscript was to review the maternal–fetal impact of gestational vitamin D deficiency and the benefits of vitamin D supplementation during pregnancy. A literature search was performed in PubMed and Embase employing the following keywords: vitamin D deficiency, pregnancy, 25-hydroxyvitamin D, and hypovitaminosis D. All relevant articles in English language published since 1980 were analysed by the two authors. Neonatal complications derived from vitamin D deficiency include low birth weight, growth restriction, and respiratory tract infection. In the mother, vitamin D deficiency has been associated with altered glucose homeostasis and increased incidence of gestational diabetes mellitus, pre-eclampsia, and bacterial vaginosis. However, the current state of the evidence is controversial for some other endpoints and the actual benefit of vitamin D supplementation in pregnancy remains unclear. Additional longitudinal studies may clarify the actual impact of vitamin D deficiency during pregnancy, and randomised trials are required to define the benefits of vitamin D supplementation in reducing the incidence of adverse outcomes in the mother and infant.

Skilled Birth Attendants in Tanzania: A Descriptive Study of Cadres and Emergency Obstetric Care Signal Functions Performed
Etsuko Ueno, Adetoro A. Adegoke, Gileard Masenga, Janeth Fimbo, Sia E. Msuya
Abstract
Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.

New England Journal of Medicine
January 8, 2015 Vol. 372 No. 2
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Efficacy of a Tetravalent Dengue Vaccine in Children in Latin America
Luis Villar, M.D., Gustavo Horacio Dayan, M.D., José Luis Arredondo-García, M.D., Doris Maribel Rivera, M.D., Rivaldo Cunha, M.D., Carmen Deseda, M.D., Humberto Reynales, M.D., Maria Selma Costa, M.D., Javier Osvaldo Morales-Ramírez, M.D., Gabriel Carrasquilla, M.D., Luis Carlos Rey, M.D., Reynaldo Dietze, M.D., Kleber Luz, M.D., Enrique Rivas, M.D., Maria Consuelo Miranda Montoya, M.D., Margarita Cortés Supelano, M.D., Betzana Zambrano, M.D., Edith Langevin, M.Sc., Mark Boaz, Ph.D., Nadia Tornieporth, M.D., Melanie Saville, M.B., B.S., and Fernando Noriega, M.D. for the CYD15 Study Group
N Engl J Med 2015; 372:113-123 January 8, 2015 DOI: 10.1056/NEJMoa1411037
Abstract
Background
In light of the increasing rate of dengue infections throughout the world despite vector-control measures, several dengue vaccine candidates are in development.
Methods
In a phase 3 efficacy trial of a tetravalent dengue vaccine in five Latin American countries where dengue is endemic, we randomly assigned healthy children between the ages of 9 and 16 years in a 2:1 ratio to receive three injections of recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV) or placebo at months 0, 6, and 12 under blinded conditions. The children were then followed for 25 months. The primary outcome was vaccine efficacy against symptomatic, virologically confirmed dengue (VCD), regardless of disease severity or serotype, occurring more than 28 days after the third injection.
Results
A total of 20,869 healthy children received either vaccine or placebo. At baseline, 79.4% of an immunogenicity subgroup of 1944 children had seropositive status for one or more dengue serotypes. In the per-protocol population, there were 176 VCD cases (with 11,793 person-years at risk) in the vaccine group and 221 VCD cases (with 5809 person-years at risk) in the control group, for a vaccine efficacy of 60.8% (95% confidence interval [CI], 52.0 to 68.0). In the intention-to-treat population (those who received at least one injection), vaccine efficacy was 64.7% (95% CI, 58.7 to 69.8). Serotype-specific vaccine efficacy was 50.3% for serotype 1, 42.3% for serotype 2, 74.0% for serotype 3, and 77.7% for serotype 4. Among the severe VCD cases, 1 of 12 was in the vaccine group, for an intention-to-treat vaccine efficacy of 95.5%. Vaccine efficacy against hospitalization for dengue was 80.3%. The safety profile for the CYD-TDV vaccine was similar to that for placebo, with no marked difference in rates of adverse events.
Conclusions
The CYD-TDV dengue vaccine was efficacious against VCD and severe VCD and led to fewer hospitalizations for VCD in five Latin American countries where dengue is endemic. (Funded by Sanofi Pasteur; ClinicalTrials.gov number, NCT01374516.)

Editorial
Preventing Dengue — Is the Possibility Now a Reality?
Stephen J. Thomas, M.D.
N Engl J Med 2015; 372:172-173 January 8, 2015 DOI: 10.1056/NEJMe1413146
Dengue is a mosquito-borne flaviviral illness that is endemic in the tropics and subtropics. An estimated 390 million infections occur annually, of which 96 million have clinical manifestations.1 Although mortality is relatively lower than that for other tropical infectious diseases, the scale of human suffering and economic resources that are expended to control dengue makes it a major global public health problem.2 The factors driving transmission and infection persist without evidence of decline. For these reasons, the world needs a safe and effective dengue vaccine.

Infection with one of the four types of dengue virus (serotypes 1, 2, 3, and 4) may result in an asymptomatic infection, a mild nonspecific viral illness, classic dengue fever, or severe dengue manifested by plasma leakage, hemorrhagic tendencies, and possibly death. Patients with a second infection with a different serotype are at increased risk for severe disease. The mechanisms responsible for enhanced disease have not been completely elucidated. It is theorized the humoral and cellular convalescent immune profiles that are present after a first infection may not only fail to control a second infection with a different serotype but may also facilitate increased target-cell infection, viral replication, and generation of a so-called proinflammatory cytokine storm.3,4

The dengue-vaccine field is facing numerous challenges. First, a viable dengue vaccine must be capable of protecting against disease caused by any of the four serotypes, a process that has been burdened by the absence of a validated animal model of disease or a well-characterized human infection model. The incomplete understanding of dengue immunopathology introduces risk into clinical development programs. Finally, the reliance on neutralizing antibody assays, which are notorious for interassay variability and cross-reactivity among serotypes, to generate immunologic end-point data introduces error into data interpretation.5

After decades of attempts to develop a dengue vaccine, the results of a phase 3 efficacy trial that are now described in the Journal are a milestone. The vaccine candidate that is described by Villar et al.6 has been tested in three clinical end-point studies. In all the studies, three doses of vaccine or a control injection were administered at 0, 6, and 12 months, and all efficacy determinations were made at study month 25.

The first study was a phase 2b efficacy trial involving children between the ages of 4 and 11 years in a single center in Thailand. The trial did not meet the primary efficacy end point, with a per-protocol efficacy of 30.2%, and showed wide variation in serotype-specific efficacy: 55.6% for serotype 1, 9.2% for serotype 2, 75.3% for serotype 3, and 100% for serotype 4.7 The first phase 3 trial, which was conducted in five Asian countries and involved children between the ages of 2 and 14 years, showed a per-protocol efficacy of 56.5%, with a similar trend in serotype-specific efficacy: 50.0% for serotype 1, 35.0% for serotype 2, 78.4% for serotype 3, and 75.3% for serotype 4.8 The phase 3 trial by Villar et al., which was conducted in five Latin America countries and involved children between the ages of 9 and 16 years, had a per-protocol efficacy of 60.8%, with serotype-specific efficacies of 50.3%, 42.3%, 74.0%, and 77.7%, respectively. Additional end points included efficacy against hospitalization (80.3%) and against severe dengue (95.5%). In each of the three studies, the cohort was highly immune to at least one of the serotypes at baseline. In the phase 2b and 3 trials in Asia, average rates of seropositive status for one or more dengue serotypes were 69.5% and 67.5%, respectively; in the study by Villar et al., the average rate was 79.4%.

These studies have answered important questions with respect to the development of a dengue vaccine but have generated numerous others. Vaccine safety, immunogenicity, and efficacy were consistent across the phase 3 studies, with measures of performance similar to those in the phase 2b trial. There were no safety signals identified and no evidence of the hypothetical risk of administering a dengue vaccine to children with a mixture of seropositive and seronegative status who are living in an area in which dengue is endemic. However, it is not clear whether this favorable safety profile will be sustained through periods of waning immunity and successive dengue exposures remote from vaccination.
Vaccination of children with seropositive status produced high seroconversion rates and broad, potent neutralizing-antibody profiles. Despite such elicitation of antibody responses, why was there such disparity in efficacy across the dengue serotypes? Could too much preexisting immunity interfere with a serotype-specific vaccine response, leaving deficits in tetravalent efficacy? It is possible that the antibodies that were measured after vaccination were not all neutralizing but were a mixture of neutralizing and cross-reactive antibodies that were poorly functioning and potentially enhancing.9 If so, this could explain the discordance between the favorable serotype-specific serologic response to vaccination and the absence of corresponding serotype-specific efficacy.
Efficacy was higher in vaccine recipients with seropositive status than in those with seronegative status. Does the inferior efficacy in seronegative vaccine recipients preclude the usefulness of this vaccine for travelers or military personnel? If the vaccine is licensed and an immunization program is implemented, will this factor have an effect on its age-specific placement in the vaccination schedule?

The observed reduction in the severity of clinical disease and the prevention of hospitalization are encouraging. Although outpatient dengue has a substantial societal cost, dengue requiring hospitalization reflects morbidity.10 Is it possible that a vaccine candidate with a modest overall efficacy could be licensed and included in a national immunization program on the basis of its ability to reduce morbidity and other outcomes driving expenditures?

The efficacy trial by Villar et al. shows that we can protect populations from dengue disease and perhaps even reduce the proportion of patients with severe disease. Although the available results are not broadly generalizable across diverse populations, a foundation for additional studies has been laid. The global enrollment of more than 30,000 children in the phase 2b and 3 studies has assuaged fears focusing on the theoretical risk that dengue vaccination could predispose recipients to enhanced rates of severe disease. It remains to be seen whether licensure will be sought on the basis of these data and what effect this could have on future attempts to conduct efficacy trials with different candidate vaccines. For now, practitioners should remain optimistic that one day it will be possible to prevent dengue.

Oxford Monitor of Forced Migration
Volume 4, No. 2 December 2014
http://oxmofm.com/current-issue/
[issue presnted as a pdf of all articles:http://oxmofm.com/wp-content/plugins/as-pdf/generate.php?post=5 ]

Boundaries of Civility Transgressed? Studying Practices of Humanitarian Government, Difference, and Power in Kakuma Refugee Camp
By Mandy Jam
This article draws on ethnographic observations of structures of refugee governance in
Kenya’s Kakuma Refugee Camp. It revisits the continued relevance and functionality of the
concept of governmentality in the analysis of forms of authority and power dynamics in
settings of humanitarian and camp government. By means of a case study analysis, the article
aims to demonstrate how, in the socio-politically remote and geographically isolated setting
of Kakuma, locally enacted practices of refugee governance cause tension and relationships
characterised by a simmering animosity between agency staff and camp residents. It is
argued that the camp’s day-to-day governance structures bear a compelling resemblance to
the pseudoscientific, essentialist, stereotypical bodies of imagery that informed and directed
previous colonial relationships of domination. In doing so, the article aims to contribute to
the ongoing exploration of historically constituted connections between the project of
colonialism and that of contemporary humanitarianism in the context of refugee assistance.

The Syrian Displacement Crisis: Future Durable Solutions
By Catherine Tyson
The Syrian refugee crisis, a result of the violence of the several military groups sweeping the
country during the prolonged civil war, is escalating each day as more people flee their
homes and seek refuge in neighbouring nations. As the crisis has already become protracted,
it is now more necessary to evaluate the access to the durable solutions – resettlement,
integration, and repatriation – promoted by UNHCR once the conflict ceases. I argue that
currently, from a governmental viewpoint, repatriation is the most likely solution to the
Syrian refugee crisis due more to the unlikelihood of integration and the small scale of
resettlement rather than any potentially quick reconstruction and stabilisation of Syria after
the conflict ends.

Implications of the New Turkish Law on Foreigners and International Protection and Regulation no. 29153 on Temporary Protection for Syrians Seeking Protection in Turkey
By Meltem Ineli-Ciger
More than 800,000 Syrians registered in Turkey have now been protected under a temporary
protection regime, being addressed as ‘guests’ or ‘temporary protection beneficiaries’ by the
Turkish authorities. Implementation of the temporary protection policy for Syrians means
that Syrians are neither refugees nor asylum seekers under Turkish domestic law. In 2013
Turkey adopted its first law that regulates asylum, namely the Law on Foreigners and
International Protection (the 2013 Law), which entered into force in April 2014. The 2013
Law promises better protection standards and more safeguards for asylum seekers and
refugees, but how about Syrians in Turkey? In view of recent legal developments on asylum
namely, adoption of the 2013 Law and Regulation no. 29153 on Temporary protection (the
2014 Regulation), this article examines the current legal protection regime of Syrians in
Turkey.

Australian Immigration Detention after Plaintiff S4: New Limits, Little Change
By Nathan Van Wees
Mandatory detention of asylum-seekers has been a constant feature of Australia’s
immigration policy since 1992. With indefinite detention considered lawful and the average
length of detention exceeding one year, a recent case (‘Plaintiff S4’) in the High Court of
Australia was reported to be ‘the end of Australian immigration detention as we know it,’
potentially limiting the availability of lengthy (and indefinite) detention. This article assesses
the likely extent of this change. The court’s new temporal limitations on detention are
(unfortunately) unlikely to add much to existing purposive limitations, meaning that reality
will be unlikely to match the media’s expectations.

PLoS Medicine
(Accessed 10 January 2015)
http://www.plosmedicine.org/

Essay
Randomized Controlled Trials in Environmental Health Research: Unethical or Underutilized?
Ryan W. Allen mail, Prabjit K. Barn, Bruce P. Lanphear
Summary Points
:: Efficacious environmental interventions are needed because environmental risks account for a large fraction of the global disease burden.
:: Randomized controlled trials have not been widely embraced by environmental health researchers and comprise less than 1% of research publications in the field.
:: Additional randomized controlled trials in environmental health would complement a strong tradition of observational research by creating new knowledge on exposure–health relationships, providing more definitive evidence of causality, identifying efficacious interventions to reduce or eliminate hazards, and countering the perception that environmental risks are evaluated with inadequate rigor.
:: Ethical issues—including clinical equipoise, the distribution of benefits and risks, and the relevance of the intervention and health outcome to the study population—must be carefully considered before conducting a randomized controlled trial of an environmental intervention.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 10 January 2015)

Research Article
Effectiveness of Routine BCG Vaccination on Buruli Ulcer Disease: A Case-Control Study in the Democratic Republic of Congo, Ghana and Togo
Richard Odame Phillips, Delphin Mavinga Phanzu, Marcus Beissner, Kossi Badziklou, Elysée Kalundieko Luzolo, Fred Stephen Sarfo, Wemboo Afiwa Halatoko, Yaw Amoako, Michael Frimpong, Abass Mohammed Kabiru, Ebekalisai Piten, Issaka Maman, Bawimodom Bidjada,
[ … ], Karl-Heinz Herbinger mail, [ view all ]
Published: January 08, 2015
DOI: 10.1371/journal.pntd.0003457
Abstract
Background
The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guérin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD.
Methodology
The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors.
Principal Findings
After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31), sex (p = 0.24), age (p = 0.96), and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions.
Conclusions
In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD.
Author Summary
After tuberculosis and leprosy, Buruli Ulcer Disease (BUD) is the third most common human mycobacterial disease. The only available vaccine that could be potentially beneficial against these diseases is BCG. Even though BCG vaccine is widely used, the results on its effectiveness are partially contradictory, probably since different BCG strains are used. The aim of this study was to evaluate the possible protective effect of BCG vaccines on BUD. The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors. Considering the three countries, sex, and age, the analysis confirmed that the BCG vaccination did not significantly decrease the risk for developing BUD or for developing severe forms of BUD. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or to time to healing of lesions. In our study, we could not find any evidence of a protective effect of routine BCG vaccination on BUD.

Strengthening Research Capacity—TDR’s Evolving Experience in Low- and Middle-Income Countries
Olumide A. T. Ogundahunsi mail, Mahnaz Vahedi, Edward M. Kamau, Garry Aslanyan, Robert F. Terry, Fabio Zicker, Pascal Launois
Published: January 08, 2015
DOI: 10.1371/journal.pntd.0003380
Introduction
In the 1970s, very few international programmes provided support to strengthen tropical disease research capacity and most research for the diseases prevalent in low- and middle-income countries (LMICs) was done by scientists and institutions in advanced industrialised countries. Soon after inception in 1974, TDR established a research capacity strengthening (RCS) programme with a goal to train individuals and strengthen research capacity in disease-endemic countries so that they can find and implement appropriate solutions to their health problems [1], [2]. At that time, very little research addressed the burden of these diseases. For most of its existence, up to a third of TDR’s total resources were earmarked for strengthening research capacity in LMICs. In the past 20 years, other charities, foundations, health research councils, and development agencies have begun their own capacity strengthening programmes, so today, the concept is well accepted, although the means to achieve the end vary [3]–[5]. This paper presents a broad description from the TDR secretariat’s perspective on evolving approaches used to promote research capacity strengthening in LMICs. The paper is part of a special series commemorating TDR’s 40-year anniversary.

TDR has an intertwined approach: training support for individuals and collaborative research programmes for institutions [1], [2]. Research training requires adequate research facilities, which may need strengthening. Similarly, strengthening an institution so that it can fully participate in a research partnership often calls for supporting training facilities and staff. The specific needs and priorities that are funded by TDR have been identified by a capacity building steering committee and approved by the TDR Scientific and Technical Advisory Committee (STAC), which comprises 15 to 18 experts in a wide range of scientific disciplines who peer review the programme’s scientific and technical activities.

TDR’s placement within the United Nations system provides close collaboration with country offices of not only the World Health Organization but also of other co-sponsoring agencies UNICEF and UNDP, and with the World Bank. As a consequence, those who are supported by TDR often work closely with disease control programmes as well as other international organizations.

Regular reviews of TDR’s research capacity strengthening programmes have helped reorient the strategy as needed, shifting focus from institutional strengthening in the 1980s to human resources strengthening in the 1990s [1], as well as identifying the need to move to a more demand-driven model of national health research systems [4]. Over the years, TDR has continued to support multidisciplinary research, particularly to bring social science research and biomedical research together through different mechanisms [6], and has reinforced this effort through training in implementation research [7] and operations research [8]…

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A Changing Model for Developing Health Products for Poverty-Related Infectious Diseases
Piero L. Olliaro, Annette C. Kuesel, John C. Reeder Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003379

Applied Research for Better Disease Prevention and Control
Johannes Sommerfeld, Andrew Ramsay, Franco Pagnoni, Robert F. Terry, Jamie A. Guth, John C. Reeder Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003378

What Have We Learned from 40 Years of Supporting Research and Capacity Building?
John C. Reeder, Jamie A. Guth Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003355

Shaping the Research Agenda
Edith Certain, Robert F. Terry, Fabio Zicker Historical Profiles and Perspectives | published 08 Jan 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003350

Policy Forum
Global Food Supply
China’s aquaculture and the world’s wild fisheries
Ling Cao1, Rosamond Naylor1,*, Duncan Leadbitter3, Marc Metian4, Max Troell4,5, Wenbo Zhang6,7
Author Affiliations
1Stanford University, Stanford, CA 94035, USA.
2Leiden University, 2333 CC Leiden, the Netherlands.
3University of Wollongong, Wollongong NSW 2522, Australia.
4Stockholm University, 106 91 Stockholm, Sweden.
5The Royal Swedish Academy of Sciences, 104 05 Stockholm, Sweden.
6University of Stirling, FK9 4LA, UK.
7Shanghai Ocean University, Shanghai 201306, PR China.
China is the world’s largest producer, consumer, processor, and exporter of finfish and shellfish (defined here as “fish”), and its fish imports are steadily rising (1–3). China produces more than one-third of the global fish supply, largely from its ever-expanding aquaculture sector, as most of its domestic fisheries are overexploited (3–6). Aquaculture accounts for ∼72% of its reported domestic fish production, and China alone contributes >60% of global aquaculture volume and roughly half of global aquaculture value (1, 3).

Stability: International Journal of Security & Development
[accessed 10 January 2015]
http://www.stabilityjournal.org/articles

Behavioral Patterns among (Violent) Non-State Actors: A Study of Complementary Governance
Annette Iris Idler, James J.F. Forest
Abstract
This article is part of a multi-year study of governance structures in the midst of insecurity and organized crime in fragile sub-state regions, where in the absence of a strong state, non-state actors (like insurgents, traffickers and tribal warlords) engage in political and socioeconomic governance. Building on our prior work on West Africa and the Afghanistan-Pakistan tribal belt, this paper focuses on the Andean borderlands, drawing on recent fieldwork in Colombia, Ecuador and Venezuela. We explore patterns of behavior in which competition among violent non-state actors is not the norm. Instead, several instances were found in which violent non-state actors work collaboratively or have tacit non-interference agreements to provide public goods through arrangements we characterize as “complementary governance.” We therefore argue that, to understand how illicit authority emerges, it is not sufficient to consider one armed non-state actor in isolation or in a dichotomy to the state. As we contend, we have to take into account the complex connections and interactions among different (violent) non-state structures. Moving beyond state versus non-state governance to governance that is constitutive of various non-state groups, the perspective put forward in this article thus is aimed to enrich the current debate on governance and security

Ebola/EVD: Additional Coverage

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse

Editor’s Note: UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and other format.

We present a composite below from the week ending 10 January 2015. We also note that 1) a regular information category in these reports – human rights – has apparently eliminated as it no longer appears in any of these week’s updates, and 2) the content level of these reports has, in our view, become less informative and less coherent over the last several week cycles.

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UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Response Efforts and Health
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present highly-selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

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:: 09 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. Guinea is facing a fuel shortage which is impacting the Ebola response. The UNMEER Field Crisis Manager for Macenta reported that on 8 January the Guinea Red Cross was unable to transport a suspected case to the Ebola Treatment Centre (ETC) due to the fuel shortage. Reports indicate that local authorities have been working on to support the French Red Cross at the ETC. In addition the UNMEER Field Crisis Manager for N’zérékoré, Lola and Yomou has reported that fuel supplies are down to 5,000 liters (10 days of supply) at the Ebola Treatment Unit (ETU) and that radio stations which broadcast sensitization messages have not been working for 4 days.
Response Efforts and Health
5. The planned launch of the campaign “Zero Ebola in 60 days” (refer to Sitrep of 5 January) which was to be held in Forécariah prefecture, Guinea on 10 January has been put on hold due to the continuing resistance of the communities to EVD response in that area. According to WHO, on 6 January, there were 31 sub-prefectures in the country where EVD response efforts were facing community resistance.
Resource Mobilisation
9. The OCHA Ebola Virus Outbreak Overview of Needs and Requirements, now totaling USD 1.5 billion, has been funded for USD 1.16 billion, which is around 77% of the total ask.
10. The Ebola Response Multi-Partner Trust Fund currently has USD 134.9 million in commitments. In total USD 140 million has been pledged.
Essential Services
13. In addition to the procurement of 15,000 thermo-guns (refer to Sitrep of 6 January), UNICEF initiated procurement of sanitation and hygiene supplies (hand-washing buckets, sprayers, protective equipment for cleaning) to ensure that all 5,181 Liberian schools have the essential hygiene and hand-washing materials to promote safe learning environments and to be in compliance with the endorsed protocols upon reopening.

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:: 8 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. SRSG Ould Cheikh Ahmed continued his familiarization visit to Liberia on 7 January, and conducted a field mission to Robertsport and Sinje in Grand Cape Mount county, accompanied by Special Envoy David Nabarro, WHO Assistant Director-General Bruce Aylward and UNMEER Liberia’s ECM Peter Graaff. The delegation also included the Presidential Advisor on EVD and the Deputy Minister for Health in charge of the Incident Management System (IMS). In light of the recent flare-ups in EVD transmission in the county, and the risk of cross-border transmission along the frontier with Sierra Leone, the UNMEER leadership invited the county’s traditional and religious leaders, along with county health and security officials, for a series of meetings. The SRSG underlined the importance of national ownership to defeat the epidemic. He also emphasized the need to respect local communities and their values when implementing internationally-sponsored support activities, especially with regard to safe and dignified burials. He reiterated that coordinating activities at the district levels was essential. During the County Health Team meeting, the participants discussed the evolution of the epidemic in the county, as well as the emergency measures taken in response to the recent flare-up. Participants highlighted key challenges, including inadequate monitoring of cross-border traffic along the Sierra Leone frontier, ongoing traditional practices, secret burials, community pockets of denial and resistance, as well as lack of motivation among the response teams. The delegation also visited the recently opened Ebola Treatment Unit (ETU) in Sinje, before the SRSG is today in Sierra Leone.
2. On 7 January, the national trade unions in Guinea called off the general strike throughout the country, which had started on 6 January (refer to UNMEER Sitrep of 6 January), after reaching an agreement on salary increases with the Government.
Response Efforts and Health
3. To date, the UNICEF-led Family Tracing and Reunification (FTR) network in Sierra Leone has identified 14,766 children as being directly affected by the Ebola crisis (7,410 girls and 7,356 boys), with 7,938 children having lost one or both parents to EVD and 1,578 being unaccompanied or separated from their caregiver. The Ministry of Social Welfare, Gender and Children’s Affairs’ (MSWGCA) figures have jumped markedly from 24 – 31 December as child protection networks strengthened across the country.
Outreach and Education
13. Due to the persistent community resistance in 31 sub-prefectures in Guinea to EVD response efforts, WHO commissioned a number studies on this topic that will be collated as soon as possible.
Essential Services
14. Following reported cases of measles in Lofa county, Liberia, UNICEF supported periodic intensification of routine immunization against measles throughout the country. So far, the routine immunization has been completed in 8 counties, is underway in 4 and is about to begin in the last 3 counties (namely Maryland, Bong and River Gee). This is activity is being implemented in lieu of an immunization campaign, which is not recommended in the Ebola context and aims at rapidly reducing the number of unimmunized children against measles.

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:: 07 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. As part of a visit to the three most affected countries, President Ould Abdel Aziz of the Islamic Republic of Mauritania and current Chair of the African Union (AU), arrived in Guinea yesterday and met with President Condé. The President pledged USD 400,000 to help Guinea in its fight against EVD, and also announced that Air Mauritania would operate flights to Guinea. The Chair of the AU travelled to Liberia today.
2. Today, President Mahamadou Issoufou of Niger and President Boni Yayi of Benin are jointly visiting Guinea to demonstrate their support in the fight against EVD.
Response Efforts and Health
4. A Community Transit Centre (CTCom) was burnt down yesterday in Bossou, Lola prefecture, Guinea. The centre, which was still under construction, would have been one of the first functional CTCom in Guinea. This act of arson is likely to be due to the continuing resistance of the local community to EVD response efforts.
5. The Ministry of Education (MoE), UNICEF and education partners have been working together in preparation of the reopening of schools in Guinea. In this regard, UNICEF plans to reach 7,055 schools (56% of schools at all levels) and 1.4 million children (53% of all school children) with 16,000 school hygiene kits (containing buckets and soap). In addition, the Islamic Development Bank (IDB) confirmed its commitment to support the provision of Thermoflashes for schools in Guinea. An IDB consultant is scheduled to arrive in Conakry on 9 January to help implement this project.
Outreach and Education
18. UNICEF signed a partnership agreement with Search for Common Ground to support the Liberian Ministry of Education’s (MoE) Emergency Radio Education program in light of closed schools across the country. In collaboration with MoE’s radio content development team, Search for Common Ground will expand broadcast coverage across all 15 counties in Liberia, integrating targeted programs on peacebuilding and education to build resilience amongst listeners during times of crisis.

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:: 06 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. Following an impasse in the negotiations between the Government of Guinea and six national trade unions, including the public health workers union, on salary increases and other demands, the unions called for a general strike throughout the country as of today. Limited demonstrations and road closures have been observed in Conakry.
2. Following the announcement by the President of Sierra Leone on New Year’s day of his intention to reopen schools soon, the Governments of Liberia and Guinea similarly announced that schools would reopen. While Guinea did not provide a specific date, President Ellen Johnson Sirleaf provided 2 February as the target date.
9. In support of the Minister of Education’s school reopening plan in Liberia, UNICEF initiated procurement of infrared thermometers for every Liberian school (15,000 thermometers) to ensure effective health screening of all individuals upon entry to school campuses.
10. In Sierra Leone, UNICEF, in partnership with the National Ebola Response Centre (NERC), the Ministry of Health and Sanitation, and the Centre for Disease Control (CDC), continues the national scale up of trainings at all 1,188 Public Health Units (PHUs) in the country on Infection Prevention and Control (IPC) and the screening of suspected Ebola patients. As of 27 December, a total of 4,368 health personnel and 2,698 support staff including cleaners and security personnel have benefitted from IPC trainings.
11. Following the registration of 13,608 households in 9 chiefdoms within 29 Ebola affected communities in Kono District, Sierra Leone, which were identified as major EVD hotspots, WFP has begun the delivery of over 1,000 metric tons of assorted food commodities to quarantined communities. Food distributions will be undertaken by World Vision. In Waterloo, Western Area Rural, Sierra Leone, WFP and its cooperating partner CIDO are also continuing general food distributions to meet the needs of over 47,000 households where high EVD rates have been identified. Since mid-December over 25,000 households have received one month rations.

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:: 05 Jan 2015 UNMEER External Situation Report
Key Political and Economic Developments
1. The New Head of UNMEER, SRSG Ismail Ould Cheikh Ahmed, assumed his functions on 3 January. In a joint townhall meeting with outgoing SRSG Banbury, SRSG Ould Cheikh Ahmed praised the achievements of all Ebola response partners, but also noted challenges ahead. He stressed that “this is a global crisis. We definitely have a difficult time ahead of us, but we can achieve our goal of zero cases,” said Ould Cheikh Ahmed. “This is within our reach, but we should not be complacent. We need to keep going until we don’t have even one case, because even one case is too many”. Together with the Special Envoy on Ebola, Dr. David Nabarro, SRSG Ould Cheikh Ahmed will be visiting Liberia, Sierra Leone this week and Guinea shortly after.
Response Efforts and Health
1. In Guinea, the National Coordinator briefed key response partners on 2 January on the launch of the campaign “Zero Ebola in 60 days”. Working groups have in recent days developed action plans for the campaign across the main lines of intervention: surveillance, case management, infection prevention and control, community engagement and social mobilization, safe burials and coordination. The first step of the campaign will involve the fielding of teams including experts from each line of action in six regions of the country for one or two weeks starting 6 January. The purpose of the missions will be for each team to assess the response efforts at the local level and develop with each prefecture the coordination of a local plan of action mirroring the national plan of action.
2. The total number of children registered as orphaned by EVD in Liberia is 4,128. All registered orphans are currently receiving follow-up and psychosocial support. More than 250 volunteer contact tracers trained and engaged by UNICEF are reporting cases of children orphaned or otherwise affected by EVD. UNICEF is working to ensure that children who have lost their parents due to EVD continue to receive care through a kinship arrangement, to prevent them from becoming institutionalized in an orphanage. To strengthen this, UNICEF provides onetime cash transfers to families that take the responsibility to care for orphaned children of relatives.
Outreach and Education
13. According to WHO, on 31 December, there were 25 sub-prefectures in Guinea where EVD response efforts were facing community resistance. These sub-prefectures are located in the prefectures adjacent to Conakry (Dubreka, Forécariah, Coyah and Kindia), in the Forest Region (Kissidougou, Guéckédou, Nzérékoré), in Upper Guinea (Dabola) and in Western Guinea (Télimélé and Labé).
14. On 1 January, a team of the Guinean Red Cross was assaulted by the local community in Kindia, Guinea resulting in one injured Red Cross volunteer and one vandalized vehicle. According to the IFRC, the team had travelled to Kindia to conduct a safe burial and to transfer suspected cases. The prefectural coordination solicited the support of the military which proceeded to arrest two persons suspected of taking part in the assault.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 3 January 2015

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortiums and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf verion: The Sentinel_ two weeks ending 3 January 2015

blog edition: comprised of the 35+ entries to be posted below on 4 January 2015

Secretary-General Says Arms Trade Treaty’s Entry into Force Is Testimony of International Commitment to Stop Irresponsible Arms Transfers
23 December 2014
SG/SM/16436-DC/3537-L/T/4440
Press Release
The following statement by UN Secretary General Ban Ki moon was issued today:
Tomorrow, 24 December 2014, the Arms Trade Treaty will enter into force.

This marks the opening of a new chapter in our collective efforts to bring responsibility, accountability and transparency to the global arms trade. From now on, the States parties to this important Treaty will have a legal obligation to apply the highest common standards to their international transfers of weapons and ammunition.

The speed with which the Arms Trade Treaty came into force — less than two years since its historic adoption by the United Nations General Assembly — is testimony to the commitment of States, international organizations and civil society to stop irresponsible arms transfers. Ultimately, it attests to our collective determination to reduce human suffering by preventing the transfer or diversion of weapons to areas afflicted by armed conflict and violence and to warlords, human rights abusers, terrorists and criminal organizations.

I am encouraged by the multitude of initiatives and activities that have already been undertaken by various entities to assist in the implementation of the Arms Trade Treaty. The United Nations will continue to work in partnership with States, regional organizations and civil society to ensure that all States parties will have the capacity to fully comply with the provisions of the Treaty. The multi-donor United Nations Trust Facility Supporting Cooperation on Arms Regulation (UNSCAR) has proven to be an effective tool to that end.
It is also critical that we continue to promote universal participation in the Arms Trade Treaty by encouraging all States, particularly major arms exporters and importers, to join this Treaty. With this in mind, I call on those States who have not yet done so, to accede to it without delay.

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Arms Trade Treaty
New York, 2 April 2013
Entry into force: 24 December 2014
UN Treaty Collection: https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=XXVI-8&chapter=26&lang=en

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Excerpt from 25 September 2014 Press Release marking 50 ATT ratifications:
…Today, the Secretary-General remarked: “The need for the [Arms Trade Treaty] remains abundantly clear. Deadly weaponry continues to find its way into irresponsible hands. Unscrupulous arms brokers defy United Nations arms embargoes. Ruthless leaders turn their arsenals on their own citizens. Ammunition depots are poorly guarded. State-owned weapons go missing. Civilian airplanes end up in the crosshairs. End-use certificates are not standardized and can be easily forged. Pirates wield grenade launchers and machine guns against merchant ships. Drug traffickers outgun police forces. Just as with other commodities, the trade in arms should comply with vigorous, internationally agreed standards. All actors involved in the arms trade must be held accountable.

In adopting the Arms Trade Treaty, Member States came together to support a robust, legally binding commitment to provide a measure of hope to millions of people around the world. Today, we can look ahead with satisfaction to the date of this historic new Treaty’s entry into force. Now, we must work for its efficient implementation and seek its universalization, so that the regulation of armaments — as expressed in the Charter of the United Nations — can become a reality once and for all.”…

Historic modernisation of official development assistance
OECD – Paris, 16 December 2014
Press Release [Full text]
The OECD Development Assistance Committee ended its High Level Meeting 15-16 December 2014 with an historic agreement to modernise the statistical system underpinning development co-operation. These steps will create incentives to mobilise more and better financing for development.

The DAC members agreed to modernise the reporting of concessional loans, which will encourage more resources on softer terms to the poorest nations while putting in place safeguards to ensure debt sustainability.

They also agreed to target more development assistance to the least developed countries and other nations most in need including small island developing states, land-locked developing countries and fragile and conflict-affected states.

This reform package by the DAC will enable donors to mobilise more private finance for development by making use of the available instruments in the financing tool box, such as guarantees and equity investments.

“This modernisation of official development assistance comes at an important time now as the world prepares for post-2015 and a new set of sustainable development goals,” said Erik Solheim, Chair of the OECD Development Assistance Committee.

‘’To eradicate poverty and continue the huge development success of the past decades, we need to direct more development assistance and concessional loans to the poorest nations and mobilise much more private finances for development.”

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OECD: DAC (Development Assistance Committee) High Level Meeting
Development Co-operation Directorate (DCD-DAC)
15 to 16 December 2014, Paris
The OECD Development Assistance Committee DAC convened its 2014 High Level Meeting from 15 to 16 December 2014 in Paris. The principal objective of the meeting was the modernisation of the OECD DAC development finance measurement framework to ensure that it is credible and fit-for-purpose in today’s global context. The decisions and actions taken in the meeting (see final 2014 HLM Communiqué in English – French version forthcoming – and statement by the DAC Chair) will enable the OECD and its members to make an important contribution to future monitoring of the financing framework underpinning the forthcoming Sustainable Development Goals.
This meeting was the culmination of an imperative fully endorsed by political leaders at the DAC High Level Meeting in December 2012. They called on the DAC to adapt its long-standing statistical concepts to the profound changes in the global financial and economic landscape. (See 2012 HLM Final Communiqué — EN, FR)

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Final 2014 HLM Communiqué in English
16 December 2015
[Excerpts from opening clauses, and Annexes; Editor’s text bolding]
1. We, the members of the OECD Development Assistance Committee (DAC), convened at high level in Paris on 15-16 December 2014. We welcomed the five new members who have joined the Committee since our last High-Level Meeting in 2012: the Czech Republic, Iceland, Poland, the Slovak Republic and Slovenia. We also welcomed the United Arab Emirates as the first country beyond the OECD membership to become a Participant of our Committee. The International Monetary Fund, the World Bank, the United Nations Development Programme, the Inter-American Development Bank and non-DAC OECD members – Chile, Estonia, Hungary, Israel, Mexico and Turkey – participated in our deliberations.1

2. We have witnessed tremendous development progress over the past 15 years. Globally, extreme poverty has been halved, substantial progress has been made toward reaching gender parity in school enrolment at all levels and in all developing regions and child mortality has been halved as has the proportion of people without access to safe water. Yet the job of ending global poverty is unfinished, and we encounter continued instability and conflict, humanitarian crises and rising inequality. Addressing all these challenges in a sustainable way requires a renewed global partnership for development.

3. We met as the world prepares the ground for the post-2015 agenda, an ambitious global framework for achieving inclusive, sustainable development for all. Three decisive events taking place next year will sharpen the vision and clarify the means of implementation underpinning this agenda: the Third International Conference on Financing for Development, the United Nations Summit for the Adoption of the Post-2015 Development Agenda, and the 21st Conference of the Parties on the United Nations Framework Convention on Climate Change.

4. As we shape the new sustainable development goals for the post-2015 era, we want to ensure our contributions make the difference that is needed. We invite the OECD to fully use its interdisciplinary expertise to support members and partners as they design and implement the range of policies needed to achieve these goals in all countries. This new set of goals will require both financial and non-financial means and efforts. As regards the financing challenge, a wide array of domestic and international resources – both concessional and commercial in nature – needs to be mobilised from public and private sources and from all providers. These different resources must also be used effectively, drawing on their respective comparative advantages. In this context, we welcome relevant efforts from across the OECD on development finance, including in the areas of taxation and investment. We consider that improving global access to reliable statistics regarding all these resources will be essential for all stakeholders, including developing and provider countries, to optimally plan, allocate, use and account for development resources. Reliable statistics will also facilitate national, regional and global transparency and accountability.

5. OECD DAC statistics on development finance are a global public good that informs policy choices, promotes transparency and fosters accountability. Following a mandate that we adopted at the 2012 High Level Meeting, we began work to modernise our statistical system, measures and standards to ensure the integrity and comparability of data on development finance and create the right incentive mechanisms for effective resource mobilisation. We have today taken stock of progress achieved in this regard, and have taken decisions in a number of areas.

6. Official Development Assistance (ODA) will remain a crucial part of international development co-operation in implementing the post-2015 agenda, particularly for countries most in need. We also acknowledge the important role of international private flows. Domestic resources, however, will continue to be the main pillar of development finance for the broad majority of developing countries.

7. We note that despite challenging fiscal circumstances in many OECD countries, we have maintained high levels of ODA – which reached an all-time high of USD 134.8 billion in 2013. We reaffirm our respective ODA commitments, including those of us who have endorsed the UN target of 0.7 per cent of Gross National Income (GNI) as ODA to developing countries, and agree to continue to make all efforts to achieve them…

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Annex 3: Developing a new measure – Total Official support for Sustainable Development
[Excerpt]
1. We, DAC members, recognise that the development agenda is broad and complex and that we need to mobilise resources and expertise to address related challenges.

2. We agree, therefore, that there is a need to capture in OECD DAC statistics the wide array of support we are providing beyond concessional finance through a measure of Total Official support for Sustainable Development (working title). Such a measure would encourage visibility and understanding about development financing options and impacts, enhance transparency and foster accountability beyond ODA, and facilitate information-sharing with providers of development co-operation beyond our Committee. This will contribute to broader global efforts to monitor international resource mobilisation for implementing the post-2015 agenda.

3. We have reviewed the work carried out on this measure and express our appreciation to various stakeholders who have participated in our ongoing efforts to shape its narrative and possible components.

4. We agree, today, to create a TOSD measure, which will:
:: complement and not replace ODA;
:: potentially cover the totality of resource flows extended to developing countries and multilateral institutions in support of sustainable development and originating from official sources and interventions, regardless of the types of instruments used and associated terms, i.e. including both concessional and non-concessional financing provided through various instruments, such as grants, loans, equity and mezzanine finance;
:: cover activities that promote and enable sustainable development, including contributions to global public goods when these are deemed relevant for development and aligned with developing countries’ priorities;
:: make a clear distinction between official support and flows mobilised through official interventions, but also between flows and contingent liabilities; and
:: capture and report resources on a gross cash-flow basis, while also collecting and publishing net flows so as to ensure full transparency of support and flows.

5. We agree to consult broadly with developing countries, international institutions, other providers of development co-operation and stakeholders on the scope, definition and statistical features of the measure, with the hope of contributing to a more global monitoring mechanism. We will also explore whether and how private finance mobilised by official interventions could be reflected in this new measure.

6. We will clarify the ultimate parameters once the final shape of the post-2015 agenda has been agreed. We will share the emerging features of this measure with the international community at the July 2015 Financing for Development conference in Addis Ababa, as an additional DAC contribution to the post-2015 monitoring framework, and use the opportunity to collect feedback on these features…

EBOLA/EVD [to 3 January 2014]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Editor’s Note:
Our extensive coverage of Ebola/EVD activity continues – including detailed coverage of UNMEER and other INGO/agency activity now available at the end of this digest. Please also note that many of the organizations and journals we cover continue to publish important EVD content which is threaded throughout this edition.
We note that the WHO Situation Report just below references the “100% goals” re-affirmed at the 60-day mark (see bolded text, second paragraph), but we have not encountered any update from UNMEER on performance against these goals.

WHO: Ebola response roadmap – Situation report 31 December 2014
Summary [Excerpt]
A total of 20,206 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in four affected countries (Guinea, Liberia, Mali and Sierra Leone) and four previously affected countries (Nigeria, Senegal, Spain and the United States of America) in the seven days to 28 December (week 52). There have been 7,905 reported deaths (case definitions are provided in Annex 1). On 29 December, the United Kingdom reported its first confirmed EVD case. Reported case incidence has fluctuated between 70 and 160 confirmed cases in Guinea over the past 15 weeks. In Liberia, case incidence has mostly declined in the past six weeks. In Sierra Leone, there are signs that the increase in incidence has slowed, although the country’s west is now experiencing the most intense transmission of all the affected countries. The reported case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is known is 71%.

Interventions in the three countries continue to progress in line with the UN Mission for Ebola Emergency Response aim to conduct 100% of burials safely and with dignity, and to isolate and treat 100% of EVD cases by 1 January, 2015. Every country has sufficient capacity to isolate patients, but the uneven geographical distribution of beds and cases means shortfalls persist in some districts. In the past month, the average number of beds per reported patient has grown from 6.6 to 13.9 in Liberia, and 1.4 to 3.6 in Sierra Leone. In Guinea, it has fallen slightly from 2.3 to 1.9 beds per patient, reflecting a small increase in probable and confirmed cases. Each country has sufficient capacity to bury all people known to have died from Ebola, yet the under-reporting of deaths is a persistent challenge. The number of trained safe burial teams has significantly grown in the past month – from 34 to 64 in Guinea, 56 to 89 in Liberia, and 50 to 101 in Sierra Leone. This is close to the capacity needed in each country. All three countries report that more than 90% of registered contacts associated with known cases of EVD are being traced, although the number of contacts traced per EVD case remains low in many districts. Social mobilization is a vital component of an effective response. Engaging communities promotes burial practices that are safe and culturally acceptable, and the isolation and appropriate treatment of patients with symptoms of EVD.

Stories from the Field
Sierra Leone: How Kailahun district kicked Ebola out
29 December 2014
Sierra Leone communities organize Ebola response
24 December 2014
Cured of Ebola, Rebecca returns to cure others
22 December 2014

UNMEER Watch [to 3 January 2014]
:: Ould Cheikh Ahmed Arrived in Accra to Officially Take Over as Head of UN Ebola Mission
03 Jan 2015

:: Outgoing UNMEER Chief: Zero Ebola Cases is “only acceptable outcome”
UNMEER PRESS RELEASE
[Full text]
Accra, 2 January 2015 – Anthony Banbury, Head of the United Nations Mission for Ebola
Emergency Response (UNMEER), gave a final review of progress in the fight against Ebola today as he prepares to hand over the role to his successor, Ismail Ould Cheikh Ahmed of Mauritania on Saturday.
“It’s important to remember where we were when we started,” Banbury told journalists during a press conference in Accra. “At the time, there were predictions of up to 1.4 million cases of Ebola by the start of the year…Here we are in January and we have a total of around 20,000 cases instead of 1.4 million. That’s 1.4% of what was being projected as a possibility by credible scientists back in September.”
According to the latest World Health Organization report, there are 20,206 confirmed, probable or suspected cases of Ebola and 7,905 reported deaths.
“We are engaged in a big battle with this disease,” he said. “It’s an insidious, invasive disease that attacks people through acts of caring and kindness…It’s going to be extremely hard for us to bring it down to zero but that is what we will do. That is the only acceptable outcome.”
Returning from a final review mission in Guinea, Liberia and Sierra Leone, Banbury, who was
appointed in September, says there has been significant progress in the fight against Ebola over
the past 90 days. Banbury pointed, for instance, to the increased number of isolation beds in each country, which stands at two beds per patient in Guinea, 3.5 in Sierra Leone, and 14 in Liberia.
With support from UNMEER and other partners, the three countries now also have sufficient
capacity to isolate and treat 100 percent of confirmed Ebola patients and enough burial teams to ensure safe and dignified burials for 100 percent of all deaths due to Ebola.
Banbury, however, said several challenges remain, including the geographical dispersion of
Ebola. He also cited behavior change and community resistance as major obstacles in some areas despite massive interventions.
“It’s a bit like putting seatbelts in cars,” said Banbury. “If you have seatbelts in cars you can save a lot of lives, but only if people use those seatbelts.”
The key to success, according to Banbury, is to effectively engage with communities, and also to maintain vigilance and commitment as the number of cases continues to drop.
“It’s an obligation to set very ambitious targets so we can bring this crisis to an end as quickly as possible,” he said. “For the UN, it’s a very heavy responsibility. But it’s also a privilege to work with these communities and these people. We will succeed together.”
Banbury is succeeded by Ismail Ould Cheikh Ahmed of Mauritania, who will himself be visiting
the affected countries next week to reinforce UNMEER’s strategic priorities. Before his new
appointment, Ould Cheikh Ahmed was appointed Deputy Special Representative and Deputy
Head of the United Nations Support Mission in Libya (UNSMIL).

:: Secretary-General’s press encounter on Ebola (full transcript)
22 Dec 2014
UNICEF Watch [to 3 January 2014]
:: UNICEF Ebola response: 400+ survivors receive psycho-social support and kits to restart their lives
KENEMA, Sierra Leone, 24 December 2014 – More than 400 Ebola survivors have taken part in four separate survivor conferences over the past few days in the districts of Kailahun, Kenema and Bo, where they learned more about protecting their communities, were informed as to how their bodies defeated the disease, and received psycho-social support.
CDC/MMWR Watch [to 3 January 2014]
http://www.cdc.gov/media/index.html
:: Ebola epidemic continues to spread, requiring intensified effort – Press Release
December 22, 2014
After more than a year of Ebola transmission in Guinea and more than 7 months of transmission in Liberia and Sierra Leone, there is still much to be done to stop the world’s first Ebola epidemic, CDC director Tom Frieden, M.D., M.P.H reported from his second visit to the three affected nations.
Dr. Frieden yesterday returned from West Africa, where he spoke with patients and staff; met with many of CDC’s 170 staff working in each of the countries; and met with the presidents, health ministers, and Ebola leadership of each country. He described the situation as both inspiring and sobering.
“It is inspiring to see how much better the response has become in the past two months, how much international commitment there is, and, most importantly, how hard people from each of the three countries are working to stop Ebola,” Dr. Frieden said. “But it is sobering that Ebola continues to spread rapidly in Sierra Leone and that in parts of Monrovia and Conakry Ebola is spreading unabated. Improvements in contact tracing are urgently needed.”
At a telebriefing held to discuss the results of his trip to Guinea, Liberia, and Sierra Leone, Dr. Frieden described progress in some areas but continued growth in Ebola cases in other areas. Lingering unmet needs throughout the region continue to challenge response efforts.
“In Liberia, the outbreak has slowed dramatically and at the moment the country has the upper hand against the virus, in part due to improvements in access to Ebola Treatment Units and Community Care Centers, safe burials, and community engagement,” Dr. Frieden said. “But the outbreak continues to surge in Sierra Leone, and there has been a troubling spread in Guinea’s capitol city. We’ve got a long way to go and this is no time to relax our grip on the response.”…

:: MMWR Weekly, January 2, 2014 / Vol. 63 / Nos. 51 & 52
– Perceptions of the Risk for Ebola and Health Facility Use Among Health Workers and Pregnant and Lactating Women — Kenema District, Sierra Leone, September 2014
MSF/Médecins Sans Frontières [to 3 January 2014]
:: A Mixed Welcome for Homecoming Ebola Survivors
December 31, 2014
Moses’s family has been hard hit by Ebola. Four of them were infected with the virus—his father and brother died, but Moses and his sister both survived. Moses was recently discharged from the Doctors Without Borders/Médecins Sans Frontières (MSF) Ebola management center in Bo, Sierra Leone, and made the journey back to his home village, accompanied by MSF health promoter Esmee de Jong.

:: Clinical Trial for Potential Ebola Treatment Starts in MSF Clinic in Guinea
December 29, 2014
A clinical trial for a possible treatment for Ebola started in Guinea on December 17. The trial is led by the French medical research institute INSERM and is taking place at the Doctors Without Borders/Médecins Sans Frontières (MSF) Ebola treatment center in Guéckédou, in the east of the country. Although every experimental treatment for Ebola patients offers hope, MSF remains prudent. There’s no guarantee that the drug will be effective and safe, and, even if it is, it will not mean the end of the epidemic which continues to spread in the three most affected countries of West Africa.
The trial aims to include as many Ebola-positive patients presenting at the MSF treatment center as possible. There will be no control group (group of patients who do not receive the treatment) in this study, as it is considered unethical to deny a group of patients the higher chance of survival that may come with the new treatment, especially given the high mortality rate of Ebola. Instead, the outcomes of the patients will be measured against those of MSF patients admitted earlier this year, before the trial began. The first conclusive results are not expected before the first trimester of 2015.
All new patients arriving at the MSF Ebola treatment center in Guéckédou are informed about the possibility of receiving the experimental treatment and can elect to participate in the study or not. Those who do not wish to be given the new treatment will receive the same supportive care as those who do, but without the administration of the trial drug.
The drug being used in Guéckédou is favipiravir, an antiviral drug produced by the Japanese company Toyama/FujiFilm. This drug has had good results against Ebola in animal studies and good safety results in humans when used as treatment for another viral infection. But, as the drug has never been studied in humans with Ebola, it is important to wait for the results of the trial before declaring favipiravir a treatment for the disease.
If favipiravir is shown to be safe and effective, it will be made accessible to Ebola patients in other Ebola treatment centers through advancing the trial to the next phase. This means that after approval from national authorities and independent ethics committees more Ebola-positive patients in West Africa will be started on the treatment.
A safe and effective treatment for Ebola will prevent many patients from dying, but it will not change the course of the epidemic. Interventions like early admission of patients in specialized centers, thorough and accurate contact tracing, tailored health promotion, and necessary hygiene and sanitation measures will continue to be the most important strategies in ending the outbreak. Research into other treatments including vaccines and new diagnostics will also remain important.
EBOLA: THE FIRST PATIENT TREATED WITH ZMAB IN AFRICA DISCHARGED FROM EMERGENCY NGO’S CENTRE
Press Release [Full text]
December 30, 2014
On the 28th December, the first Ebola patient treated in Africa with the experimental drug ZMAb has been discharged from the Ebola Treatment Centre run by EMERGENCY NGO in Goderich, Sierra Leone.
A.M., 72 years old, had been admitted 2 weeks ago in very critical conditions.
The ZMAb used for A. M. had been requested by the Ministry of Health of Sierra Leone to treat Dr. Victor Willoughby, a leading doctor in the country. Dr. Willoughby, unfortunately died as soon as the drug arrived in country.
The Ministry of Health asked EMERGENCY to give the ZMAb to A.M., wife and mother of two of the patients of Dr Willoughby, both died of Ebola few days before.
The high standard Ebola Treatment Centre run by EMERGENCY NGO is the only centre in Africa that has used ZMAb so far. It opened on 14th of December in collaboration with DFID, the Department for International Development of the British Government.
Save The Children [to 3 January 2014]
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6150563/k.D0E9/Newsroom.htm
Save the Children’s Sierra Leone Ebola Center Discharges its 60th Survivor
December 24, 2014
Plan International [to 3 January 2014]
http://plan-international.org/about-plan/resources/media-centre
Children’s futures impacted due to Ebola school closures
29 December 2014:
Children in Ebola-stricken Liberia are playing, working or begging to fill their time while schools are closed, according to Plan International.
The virus has kept schools shut for more than five months, in a country which already suffered from limited learning facilities and trained teachers, as well as a high illiteracy rate.
New research from Plan shows that a cohort of children and youth will lose half a year or more of education, which is expected to affect their prospects in life, as well as dent their confidence and self-esteem.
The report, entitled Young Lives on Lockdown: The impact of Ebola on children and communities in Liberia, says that while teachers and older children are continuing to teach their children and sibling at home, the majority of parents are themselves uneducated and thus cannot give their children home schooling.
“Most parents cannot read or write so they cannot help their children at home, and at the same time they don’t let other people come to their houses to conduct lessons for them or let their children out for even 30 minutes,” said one community leader interviewed for the research.
Once schools do re-open, parents worry they will not have the money to pay their children’s fees. “Schools will reopen but there’s no money to put kids in school,” said another community leader, speaking to researchers…
European Vaccine Initiative Watch [to 3 January 2014]
http://www.euvaccine.eu/news-events
Senior Project Manager position open at GAVI The Vaccine Alliance
24 December 2014
GAVI is currently looking for a Senior Project Manager, Ebola Vaccine.

United Nations – Selected Press Releases [to 3 January 2014]
Secretary General, Security Council, General Assembly
http://www.un.org/en/unpress/

30 December 2014
SC/11722
Resolution in Security Council to Impose 12-Month Deadline on Negotiated Solution to Israeli-Palestinian Conflict Unable to Secure Nine Votes Needed for Adoption
The Security Council today failed to adopt a draft resolution calling for Israel, within three years, to withdraw from Palestinian territory occupied since 1967 and, within one year, for the parties to reach a negotiated solution to the conflict.

23 December 2014
GA/11606
General Assembly Adopts Resolution to Reinforce United Nations Emergency Humanitarian Response, Decisions on International Criminal Tribunals
The General Assembly today, nearing completion of its work for the main part of the session, adopted three draft texts on international tribunals and on bolstering emergency humanitarian response.
The General Assembly today, nearing completion of its work for the main part of the session, adopted three draft texts on international tribunals and on bolstering emergency humanitarian response.
Resuming its consideration of its agenda item on strengthening the coordination of emergency humanitarian assistance of the United Nations, the Assembly adopted, without a vote, a draft resolution on international cooperation on humanitarian assistance in the field of natural disasters, from relief to development.
The representative of Bolivia, speaking for the “Group of 77” developing countries and China, introduced the text, saying that it recognized the clear relationship between emergency response, rehabilitation and development, and reaffirmed that, in order to ensure a smooth transition, emergency assistance must be provided in ways that would be supportive of short-term and medium-term recovery leading to long-term development.
The draft resolution also emphasized the fundamentally civilian character of humanitarian assistance, he said, noting that it urged Member States, the United Nations and development organizations to prioritize risk management and to work towards a common understanding of risks and responsibilities.

22 December 2014
SC/11720
Security Council, in Divided Vote, Puts Democratic People’s Republic of Korea’s Situation on Agenda following Findings of Unspeakable Human Rights Abuses
Concerted action by the international community was needed following a Human Rights Council report on appalling, systematic abuses in the Democratic People’s Republic of Korea, high United Nations officials told the Security Council today, following a procedural vote of 11 in favour to 2 against (China, Russian Federation), with 2 abstentions (Chad, Nigeria) that put the situation on the body’s agenda.

23 December 2014
SG/SM/16436-DC/3537-L/T/4440
Secretary-General Says Arms Trade Treaty’s Entry into Force Is Testimony of International Commitment to Stop Irresponsible Arms Transfers
Secretary-General
Press Release
The following statement by UN Secretary General Ban Ki moon was issued today:
Tomorrow, 24 December 2014, the Arms Trade Treaty will enter into force.
This marks the opening of a new chapter in our collective efforts to bring responsibility, accountability and transparency to the global arms trade. From now on, the States parties to this important Treaty will have a legal obligation to apply the highest common standards to their international transfers of weapons and ammunition.

UNICEF [to 3 January 2014]
http://www.unicef.org/media/media_71508.html

Media Releases [selected]
UNICEF Ebola response: 400+ survivors receive psycho-social support and kits to restart their lives
KENEMA, Sierra Leone, 24 December 2014 – More than 400 Ebola survivors have taken part in four separate survivor conferences over the past few days in the districts of Kailahun, Kenema and Bo, where they learned more about protecting their communities, were informed as to how their bodies defeated the disease, and received psycho-social support.

UNICEF – Tsunami 10 years on
NEW YORK, 23 December 2014 – “The Indian Ocean tsunami changed lives around the world forever. Entire communities were obliterated in moments. Families were robbed of children, sisters, brothers and parents. In an unprecedented expression of international grief and solidarity, millions of people across the globe mobilised in support of one of the largest relief efforts in history.

UNHCR [to 3 January 2014]
http://www.unhcr.org/cgi-bin/texis/vtx/hom

Statement by Vincent Cochetel, UNHCR Europe Bureau Director, on new boat arrival in Italy
2 Jan 2015
“The use of larger cargo ships is a new trend, but it is part of an ongoing and worrying situation that can no longer be ignored by European governments. We need urgent European concerted action in the Mediterranean Sea, increasing efforts to rescue people at sea and stepping up efforts to provide legal alternatives to dangerous voyages. Without safer ways for refugees to find safety in Europe, we won’t be able to reduce the multiple risks and dangers posed by these movements at sea.
UNHCR thanks the Italian authorities for their response to these latest incidents, despite the phasing down of the Mare Nostrum operation. We have expressed concerns over the ending of this operation without a similar European search-and-rescue operation to replace it. This will undoubtedly increase the risk for those trying to find safety in Europe.”

WHO & Regionals [to 3 January 2014]

WHO: 2014 in review: key health issues
Health headlines have recently been dominated by the Ebola outbreak in West Africa and humanitarian emergencies in many other countries. 2014 also saw major public health successes, and a clearer understanding of a number of public health threats. WHO produced reports on a range of critical health issues and provided new advice to help countries improve their people’s health. Here are a few highlights:
:: January – April
:: May – August
:: September – December

:: Global Alert and Response (GAR): Disease Outbreak News (DONs)
– Ebola virus disease – United Kingdom 30 December 2014
On 29 December 2014, WHO was notified by the National IHR Focal Point for the United Kingdom of a laboratory-confirmed case of Ebola Virus Disease (EVD). This is the first EVD case to be detected on UK soil.
– Human infection with avian influenza A(H7N9) virus – China 30 December 2014
– Human infection with avian influenza A(H5N6) virus – China 28 December 2014
– Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia 26 December 2014
– Human infection with avian influenza A(H7N9) virus – China 24 December 2014

:: The Weekly Epidemiological Record (WER) 19 December 2014, vol. 89, 51/52 (pp. 577–588) includes:
– Index of countries/areas
– Index, Volume 89, 2014, Nos. 1–52
– Revised guidance on meningitis outbreak response in sub-Saharan Africa
– Monthly report on dracunculiasis cases, January– October 2014
WHO Regional Offices
WHO African Region AFRO
Press Releases
:: National health systems – Africa’s big public health challenge 22 December 2014
Feature Stories
:: Cured of Ebola, Rebecca returns to cure others – 24 December 2014
:: Liberia: Local students become active Ebola case finders – 22 December 2014

WHO Region of the Americas PAHO
:: PAHO year in review: 2014 public health highlights in the Americas
Washington, D.C., 24 December 2014 (PAHO/WHO) – The year 2014 was marked by progress as well as significant challenges for public health in the Americas. The region’s countries advanced toward goals including universal health coverage, expanded access to vaccination, and ensuring that fewer babies are born with HIV. They also confronted major new challenges, including the arrival and spread of the chikungunya virus and the need to prepare for the possible imported cases of Ebola…

WHO South-East Asia Region SEARO
:: Strengthening emergency preparedness, response capacities can save lives in mega disasters like tsunami 24 December 2014

WHO European Region EURO
:: First Ebola case detected on UK soil 02-01-2015
:: Avian influenza A(H5N8) continues to spread in poultry 23-12-2014

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
:: 2014: Pacific year in review
2 January 2015 – The Pacific responded to a number of challenges in 2014, from outbreaks of vector-borne diseases to strengthening capacity to respond to public health threats such as Ebola. At the same time, work to combat the NCD crisis accelerated, through, for example, the launch of the Tobacco Free Pacific initiative and salt reduction activities. The Pacific voice was heard on the global stage at the World Health Assembly and the 3rd International Conference on Small Islands Developing States…

UNFPA United Nations Population Fund [to 3 January 2014]
http://www.unfpa.org/public/

UN calls for intensified efforts to end fistula
23 December 2014
UNITED NATIONS, New York – The United Nations General Assembly has adopted a resolution calling for increased actions to end obstetric fistula. The largely preventable condition is estimated to afflict some 2 million women around the world – most of them marginalized, impoverished and without access to essential maternal health services…

The UNFPA-backed resolution, adopted on 18 December, calls on the international community to intensify technical and financial support to maternal health efforts, including action to eliminate fistula, before the end of 2015. The end of next year is the deadline to achieve the Millennium Development Goals, including Goal 5, which calls for improving maternal health.

“The resolution is important for millions of women suffering the pain and shame of fistula,” said Dr. Babatunde Osotimehin, Executive Director of UNFPA…

UN Women [to 3 January 2014]
http://www.unwomen.org/

Timeline: Gender equality, 2014 year in review
Date : December 23, 2014
From the passing of one of the Arab region’s most progressive Constitutions enshrining women’s rights to changes in legislation to provide long overdue redress to wartime survivors of sexual violence, this timeline is a selection of some of the gender equality achievements, milestones and noteworthy moments from around the world this year.