BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 29 August 2015)

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Research article
An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study − 2014
Abdulaziz Mohammed, Taiwo Sheikh, Saheed Gidado, Gabriele Poggensee, Patrick Nguku, Adebola Olayinka, Chima Ohuabunwo, Ndadilnasiya Waziri, Faisal Shuaib, Joseph Adeyemi, Ogbonna Uzoma, Abubakar Ahmed, Funmi Doherty, Sarah Nyanti, Charles Nzuki, Abdulsalami Nasidi, Akin Oyemakinde, Olukayode Oguntimehin, Ismail Abdus-salam, Reginald Obiako
BMC Public Health 2015, 15:824 (27 August 2015)

Development in Practice
Volume 25, Issue 5, 2015
http://www.tandfonline.com/toc/cdip20/current

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The origins of international child sponsorship
DOI:10.1080/09614524.2015.1064362
Brad Watson*
pages 867-879
Published online: 12 Aug 2015
Abstract
International child sponsorship typically involves the pairing of an individual, identifiable child, or young adult in a developing country with an individual donor or sponsor in a relatively wealthy country. Regular payments by sponsors, accompanied by the exchange of personal information, characterise a fundraising phenomenon which currently links sponsors to more than eight million children globally. Although child sponsorship underpins a multi-billion dollar flow of funds to developing countries, its origins have become obscured by the passing of time, to the point where many international NGOs utilising it as a fundraising mechanism are unaware of the aims and context of its early use. This article argues that the pairing of individual children with international donors was initiated by the UK-based Save the Children Fund and the Society of Friends Relief Mission in post-First World War Austria in 1919. Unlike the long-term support that would characterise later programmes, early sponsorship funded the short-term assistance of children and avoided the creation of dependency.

International Health
Volume 7 Issue 5 September 2015
http://inthealth.oxfordjournals.org/content/current

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Disease Elimination Special Issue
EDITORIAL
Eradication and elimination: facing the challenges, tempering expectations
David H. Molyneux
Extract
The words eradication, elimination and control have been regularly defined in attempts to avoid inappropriate use of terminology while addressing the realities and challenges of public health programmes.1,2
Whitty3 has recently outlined the dangers of raising expectations in the face of political, financial, biological and logistical efforts of eradication or elimination programmes, emphasising these risks in search of a holy grail. Bockarie et al.4 noted five categories that defined the elimination or endgame challenges—biological, socio-geographic, logistic, strategic and technical—providing examples from current programmes. These have created significant strategic and resource impediments to progress in implementation, requiring changes in approach often with significant financial implications.
A variety of strategies are used to reduce incidence and prevalence of infectious diseases: vaccination (smallpox, polio, measles), chemotherapy (onchocerciasis, lymphatic filariasis, schistosomiasis), vector control, (onchocerciasis, malaria, schistosomiasis) and provision of improved clean water and sanitation (trachoma, guinea worm, soil transmitted helminths, schistosomiasis). Such strategies are more effective when combined, for example, chemotherapy, vector control and behaviour change, thereby achieving proportionately greater and more rapid impact on transmission.
Eradication as a concept is specifically defined as a reduction to zero global incidence of a specific pathogen, not a disease, which results from such an infection. This represents a crucial distinction—the words disease and infection are often used interchangeably but incorrectly. Even WHO reporting recently on the yaws programme in India entitled their publication ‘Eradication of yaws in India.’ Thus, even WHO are unable to consistently use correct terminology. Another example is the call for the eradication of malaria. However, eradication is defined as the removal from the planet of a specific infection; raising the question, which of the five human species of Plasmodium is to be targeted? This is yet to be specified…

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Non-communicable disease training for public health workers in low- and middle-income countries: lessons learned from a pilot training in Tanzania
Evelyn P. Davilaa,*, Zubeda Suleimanb, Janneth Mghambab, Italia Rollec, Indu Ahluwaliad, Peter Mmbujib, Maximilian de Courtene, Andrea Baderf, S. Christine Zahniserg, Marlene Kragh and Bassam Jarrara
Author Affiliations
aDivision of Public Health Systems and Workforce Development, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
bField Epidemiology Laboratory Training Program Tanzania, Ministry of Health and Social Welfare, Tanzania
cOffice on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA
dDivision of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA
eDepartment of International Health, Immunology and Microbiology and Copenhagen School of Global Health, University of Copenhagen, Denmark
fDeloitte Consulting, Atlanta, USA
gGEARS Inc., Atlanta, USA and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA
hCopenhagen School of Global Health, University of Copenhagen, Denmark
Abstract
Background
Non-communicable diseases (NCDs) are increasing worldwide. A lack of training and experience in NCDs among public health workers is evident in low- and middle- income countries.
Methods
We describe the design and outcomes of applied training in NCD epidemiology and control piloted in Tanzania that included a 2-week interactive course and a 6-month NCD field project. Trainees (n=14 initiated; n=13 completed) were epidemiology-trained Ministry of Health or hospital staff. We evaluated the training using Kirkpatrick’s evaluation model for measuring reactions, learning, behavior and results using pre- and post-tests and closed-ended and open-ended questions.
Results
Significant improvements in knowledge and self-reported competencies were observed. Trainees reported applying competencies at work and supervisors reported improvements in trainees’ performance. Six field projects were completed; one led to staffing changes and education materials for patients with diabetes and another to the initiation of an injury surveillance system. Workplace support and mentoring were factors that facilitated the completion of projects. Follow-up of participants was difficult, limiting our evaluation of the training’s outcomes.
Conclusions
The applied NCD epidemiology and control training piloted in Tanzania was well received and showed improvements in knowledge, skill and self-efficacy and changes in workplace behavior and institutional and organizational changes. Further evaluations are needed to better understand the impact of similar NCD trainings and future trainers should ensure that trainees have mentoring and workplace support prior to participating in an applied NCD training.

JAMA
August 25, 2015, Vol 314, No. 8
http://jama.jamanetwork.com/issue.aspx

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Viewpoint | August 25, 2015
Middle East Respiratory Syndrome – A Global Health Challenge
Lawrence O. Gostin, JD1; Daniel Lucey, MD, MPH2
Author Affiliations
JAMA. 2015;314(8):771-772. doi:10.1001/jama.2015.7646.
This Viewpoint discusses the importance of a well-trained and well-prepared health workforce in controlling outbreaks such as Middle East respiratory syndrome.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 26, Number 3, August 2015
https://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.26.2A.html

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Placing a Health Equity Lens on Non-communicable Diseases in sub-Saharan Africa
Helena E. Dagadu, Evelyn J. Patterson
pp. 967-989
Abstract
Deaths from non-communicable diseases are increasing worldwide. Low and middle-income countries, particularly those in sub-Saharan Africa (SSA), are projected to see the most rapid increase over the next two decades. While non-communicable diseases such as diabetes and cardiovascular disease increasingly contribute to mortality in SSA, communicable diseases such as malaria and HIV/AIDS remain major causes of death in this region, leading to a double burden of disease. In this paper, we use World Health Organization data and life table techniques to: (1) delineate the magnitude and toll of the double burden of disease in four SSA countries: Ghana, Gabon, Botswana, and Kenya, and (2) scrutinize assumptions linking changes in disease patterns to economic development and modernization. Our findings suggest that non-communicable and communicable diseases warrant equal research attention and financial commitment in pursuit of health equity.

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Mexican Immigrant Health: Health Insurance Coverage Implications
Henry Shelton Brown, Kimberly J. Wilson, Jacqueline L. Angel
pp. 990-1004
Abstract
A key facet of the Patient Protection and Affordable Care Act (PPACA) is the expansion of health insurance coverage. However, even with the PPACA, an estimated 11.2 million undocumented immigrants will remain uncovered. The majority of the remaining uncovered immigrant population is of Mexican origin. We assess the long-term benefits and short-term costs of providing coverage to male migrants from Mexico, employing data from the 2007–2011 Mexican Migration Project (MMP) and the 2009 Medical Expenditures Panel (MEPS) survey. Our results show that health status prior to migration, age at time of interview, emigrating from Central Mexico, and use of health services in the U.S. all predict declines in health at a significant level. We also find that having spent more than 10 cumulative years in the U.S. has borderline significance in predicting health decline (p=.052). Estimated coverage costs for health insurance for largely undocumented immigrants increase over time, but remain lower than those of comparable U.S.-born individuals. We conclude with several policy implications.

Journal of Public Health Policy
Volume 36, Issue 3 (August 2015)
http://www.palgrave-journals.com/jphp/journal/v36/n3/index.html

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Commentary: How useful is ‘burden of disease’ to set public health priorities for infectious diseases?
The authors use the example of Nipah virus to question the use of ‘burden of disease’ for setting priorities for controlling infectious diseases.
Ruth Berkelman and James LeDuc
J Public Health Pol 36: 283-286; advance online publication, April 30, 2015; doi:10.1057/jphp.2015.15

Middle east respiratory syndrome corona virus (MERS CoV): The next steps
Supplemental surveillance is urgently needed to detect MERS CoV when it arrives in a country carried by people who have worked in the Middle East.
Iype Joseph
J Public Health Pol 36: 318-323; advance online publication, March 26, 2015; doi:10.1057/jphp.2015.9

The Lancet
Aug 29, 2015 Volume 386 Number 9996 p829-930
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
An Ebola vaccine: first results and promising opportunities
The Lancet
Published Online: 03 August 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61177-1
Today, The Lancet publishes the first results from a phase 3 cluster randomised trial of a novel Ebola virus vaccine. The study, sponsored and led by WHO, is a remarkable scientific and logistical achievement. In the midst of an extreme public health emergency, researchers, health workers, and community facilitators in Guinea included 7651 people in a trial to test the efficacy of a recombinant, replication-competent vesicular stomatitis virus-based vaccine expressing a surface glycoprotein of Ebola (Zaire). The authors conclude that their interim analysis indicates the vaccine “might be highly efficacious and safe”.

The technique used in the trial was “ring vaccination”. This method involves identifying a newly diagnosed person with Ebola, and then tracking down their contacts and contacts of contacts. This procedure is not without its challenges (it was the same approach used to eradicate smallpox). To identify this often complex network of contacts required the help of family and friends in many small and dispersed communities across the most affected parts of the country. That such a trial was even possible is a testament not only to the skill of the research teams but also to the commitment of communities to defeating an epidemic that has devastated their nation. Over 90% of the study’s staff were from Guinea. Before this work, no clinical trial on this scale had ever been performed in the country.

This study will be the subject of intense scientific scrutiny and debate. But what do the results mean for those most at risk of Ebola virus infection in west Africa? The vaccine is not yet licensed. More data on efficacy are needed before it can be widely deployed. But if the evidence proves sufficient for licensing, a Global Ebola Vaccine Implementation Team, also under WHO’s leadership, has been preparing the ground for its introduction—creating guidelines for the vaccine’s use, strategies for community engagement, and mechanisms to expand country capacity for the vaccine’s distribution and delivery. In addition, the GAVI Alliance has approved substantial funding for the procurement and deployment of the vaccine.

One important message goes beyond even Ebola—the power of multilateralism and inclusive partnership to devise and execute critical clinical research. Ebola has been a catastrophe for west Africa. But out of this epidemic has come the opportunity to build unprecedented collaborations to generate evidence to advance health. There have been few better examples to prove the value and importance of WHO to strengthen global health security.

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Articles
Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial
Ana Maria Henao-Restrepo, Ira M Longini, Matthias Egger, Natalie E Dean, W John Edmunds, Anton Camacho, Miles W Carroll, Moussa Doumbia, Bertrand Draguez, Sophie Duraffour, Godwin Enwere, Rebecca Grais, Stephan Gunther, Stefanie Hossmann, Mandy Kader Kondé, Souleymane Kone, Eeva Kuisma, Myron M Levine, Sema Mandal, Gunnstein Norheim, Ximena Riveros, Aboubacar Soumah, Sven Trelle, Andrea S Vicari, Conall H Watson, Sakoba Kéïta, Marie Paule Kieny, John-Arne Røttingen
Published Online: 03 August 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61117-5
Summary
Background
A recombinant, replication-competent vesicular stomatitis virus-based vaccine expressing a surface glycoprotein of Zaire Ebolavirus (rVSV-ZEBOV) is a promising Ebola vaccine candidate. We report the results of an interim analysis of a trial of rVSV-ZEBOV in Guinea, west Africa.
Methods
For this open-label, cluster-randomised ring vaccination trial, suspected cases of Ebola virus disease in Basse-Guinée (Guinea, west Africa) were independently ascertained by Ebola response teams as part of a national surveillance system. After laboratory confirmation of a new case, clusters of all contacts and contacts of contacts were defined and randomly allocated 1:1 to immediate vaccination or delayed (21 days later) vaccination with rVSV-ZEBOV (one dose of 2 × 107 plaque-forming units, administered intramuscularly in the deltoid muscle). Adults (age ≥18 years) who were not pregnant or breastfeeding were eligible for vaccination. Block randomisation was used, with randomly varying blocks, stratified by location (urban vs rural) and size of rings (≤20 vs >20 individuals). The study is open label and masking of participants and field teams to the time of vaccination is not possible, but Ebola response teams and laboratory workers were unaware of allocation to immediate or delayed vaccination. Taking into account the incubation period of the virus of about 10 days, the prespecified primary outcome was laboratory-confirmed Ebola virus disease with onset of symptoms at least 10 days after randomisation. The primary analysis was per protocol and compared the incidence of Ebola virus disease in eligible and vaccinated individuals in immediate vaccination clusters with the incidence in eligible individuals in delayed vaccination clusters. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201503001057193.
Findings
Between April 1, 2015, and July 20, 2015, 90 clusters, with a total population of 7651 people were included in the planned interim analysis. 48 of these clusters (4123 people) were randomly assigned to immediate vaccination with rVSV-ZEBOV, and 42 clusters (3528 people) were randomly assigned to delayed vaccination with rVSV-ZEBOV. In the immediate vaccination group, there were no cases of Ebola virus disease with symptom onset at least 10 days after randomisation, whereas in the delayed vaccination group there were 16 cases of Ebola virus disease from seven clusters, showing a vaccine efficacy of 100% (95% CI 74·7–100·0; p=0·0036). No new cases of Ebola virus disease were diagnosed in vaccinees from the immediate or delayed groups from 6 days post-vaccination. At the cluster level, with the inclusion of all eligible adults, vaccine effectiveness was 75·1% (95% CI −7·1 to 94·2; p=0·1791), and 76·3% (95% CI −15·5 to 95·1; p=0·3351) with the inclusion of everyone (eligible or not eligible for vaccination). 43 serious adverse events were reported; one serious adverse event was judged to be causally related to vaccination (a febrile episode in a vaccinated participant, which resolved without sequelae). Assessment of serious adverse events is ongoing.
Interpretation
The results of this interim analysis indicate that rVSV-ZEBOV might be highly efficacious and safe in preventing Ebola virus disease, and is most likely effective at the population level when delivered during an Ebola virus disease outbreak via a ring vaccination strategy.
Funding
WHO, with support from the Wellcome Trust (UK); Médecins Sans Frontières; the Norwegian Ministry of Foreign Affairs through the Research Council of Norway; and the Canadian Government through the Public Health Agency of Canada, Canadian Institutes of Health Research, International Development Research Centre, and Department of Foreign Affairs, Trade and Development.

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Articles
ReEBOV Antigen Rapid Test kit for point-of-care and laboratory-based testing for Ebola virus disease: a field validation study
Mara Jana Broadhurst, John Daniel Kelly, Ann Miller, Amanda Semper, Daniel Bailey, Elisabetta Groppelli, Andrew Simpson, Tim Brooks, Susan Hula, Wilfred Nyoni, Alhaji B Sankoh, Santigi Kanu, Alhaji Jalloh, Quy Ton, Nicholas Sarchet, Peter George, Mark D Perkins, Betsy Wonderly, Megan Murray, Nira R Pollock
Summary
Background
At present, diagnosis of Ebola virus disease requires transport of venepuncture blood to field biocontainment laboratories for testing by real-time RT-PCR, resulting in delays that complicate patient care and infection control efforts. Therefore, an urgent need exists for a point-of-care rapid diagnostic test for this disease. In this Article, we report the results of a field validation of the Corgenix ReEBOV Antigen Rapid Test kit.
Methods
We performed the rapid diagnostic test on fingerstick blood samples from 106 individuals with suspected Ebola virus disease presenting at two clinical centres in Sierra Leone. Adults and children who were able to provide verbal consent or assent were included; we excluded patients with haemodynamic instability and those who were unable to cooperate with fingerstick or venous blood draw. Two independent readers scored each rapid diagnostic test, with any disagreements resolved by a third. We compared point-of-care rapid diagnostic test results with clinical real-time RT-PCR results (RealStar Filovirus Screen RT-PCR kit 1·0; altona Diagnostics GmbH, Hamburg, Germany) for venepuncture plasma samples tested in a Public Health England field reference laboratory (Port Loko, Sierra Leone). Separately, we performed the rapid diagnostic test (on whole blood) and real-time RT-PCR (on plasma) on 284 specimens in the reference laboratory, which were submitted to the laboratory for testing from many clinical sites in Sierra Leone, including our two clinical centres.
Findings
In point-of-care testing, all 28 patients who tested positive for Ebola virus disease by RT-PCR were also positive by fingerstick rapid diagnostic test (sensitivity 100% [95% CI 87·7–100]), and 71 of 77 patients who tested negative by RT-PCR were also negative by the rapid diagnostic test (specificity 92·2% [95% CI 83·8–97·1]). In laboratory testing, all 45 specimens that tested positive by RT-PCR were also positive by the rapid diagnostic test (sensitivity 100% [95% CI 92·1–100]), and 214 of 232 specimens that tested negative by RT-PCR were also negative by the rapid diagnostic test (specificity 92·2% [88·0–95·3]). The two independent readers agreed about 95·2% of point-of-care and 98·6% of reference laboratory rapid diagnostic test results. Cycle threshold values ranged from 15·9 to 26·3 (mean 22·6 [SD 2·6]) for the PCR-positive point-of-care cohort and from 17·5 to 26·3 (mean 21·5 [2·7]) for the reference laboratory cohort. Six of 16 banked plasma samples from rapid diagnostic test-positive and altona-negative patients were positive by an alternative real-time RT-PCR assay (the Trombley assay); three (17%) of 18 samples from individuals who were negative by both the rapid diagnostic test and altona test were also positive by Trombley.
Interpretation
The ReEBOV rapid diagnostic test had 100% sensitivity and 92% specificity in both point-of-care and reference laboratory testing in this population (maximum cycle threshold 26·3). With two independent readers, the test detected all patients who were positive for Ebola virus by altona real-time RT-PCR; however, this benchmark itself had imperfect sensitivity.
Funding
Abundance Foundation.

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Viewpoint
Public health, universal health coverage, and Sustainable Development Goals: can they coexist?
Harald Schmidt, Lawrence O Gostin, Ezekiel J Emanuel
Published Online: 29 June 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60244-6

Nature
Volume 524 Number 7566 pp387-510 27 August 2015
http://www.nature.com/nature/current_issue.html
[New issue; No relevant content identified]

12 August 2015
Can randomized trials eliminate global poverty?
A new generation of economists is trying to transform global development policy through the power of randomized controlled trials.
Jeff Tollefson
In 70 local health clinics run by the Indian state of Haryana, the parents of a child who starts the standard series of vaccinations can walk away with a free kilogram of sugar. And if the parents make sure that the child finishes the injections, they also get to take home a free litre of cooking oil.

These simple gifts are part of massive trial testing whether rewards can boost the stubbornly low immunization rates for poor children in the region. Following the model of the randomized controlled trials (RCTs) that are commonly used to test the effectiveness of drugs, scientists randomly assigned clinics in the seven districts with the lowest immunization rates to either give the gifts or not. Initial results are expected next year. But smaller-scale experiments suggest that the incentives have a good chance of working. In a pilot study conducted in India and published in 2010, the establishment of monthly medical camps saw vaccination rates triple, and adding on incentives that offered families a kilogram of lentils and a set of plates increased completion rates by more than sixfold1.

“We have learned something about why immunization rates are low,” says Esther Duflo, an economist at the Massachusetts Institute of Technology (MIT) in Cambridge, who was involved in the 2010 experiment and is working with Haryana on its latest venture. The problem is not necessarily that people are opposed to immunization, she says. It is that certain obstacles, such as lack of time or money, are making it difficult for them to attend the clinics. “And you can balance that difficulty with a little incentive,” she says.

This is one of a flood of insights from researchers who are revolutionizing the field of economics with experiments designed to rigorously test how well social programmes work. Their targets range from education programmes to the prevention of traffic accidents. Their preferred method is the randomized trial. And so they have come to be known as the ‘randomistas’…

New England Journal of Medicine
August 27, 2015 Vol. 373 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Shifting Vaccination Politics — The End of Personal-Belief Exemptions in California
Michelle M. Mello, J.D., Ph.D., David M. Studdert, L.L.B., Sc.D., and Wendy E. Parmet, J.D.
N Engl J Med 2015; 373:785-787
August 27, 2015
DOI: 10.1056/NEJMp1508701
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Perspective
Community Trust and the Ebola Endgame
Ranu S. Dhillon, M.D., and J. Daniel Kelly, M.D.
N Engl J Med 2015; 373:787-789 August 27, 2015
DOI: 10.1056/NEJMp1508413
[Free full text]

Perspective
Ebola in the United States — Public Reactions and Implications
Gillian K. SteelFisher, Ph.D., Robert J. Blendon, Sc.D., and Narayani Lasala-Blanco, Ph.D.
N Engl J Med 2015; 373:789-791 August 27, 2015
DOI: 10.1056/NEJMp1506290
[Free full text]

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 29 August 2015)

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The Impact of a One-Dose versus Two-Dose Oral Cholera Vaccine Regimen in Outbreak Settings: A Modeling Study
Andrew S. Azman, Francisco J. Luquero, Iza Ciglenecki, Rebecca F. Grais, David A. Sack, Justin Lessler
Research Article | published 25 Aug 2015 | PLOS Medicine
10.1371/journal.pmed.1001867
Abstract
Background
In 2013, a stockpile of oral cholera vaccine (OCV) was created for use in outbreak response, but vaccine availability remains severely limited. Innovative strategies are needed to maximize the health impact and minimize the logistical barriers to using available vaccine. Here we ask under what conditions the use of one dose rather than the internationally licensed two-dose protocol may do both.
Methods and Findings
Using mathematical models we determined the minimum relative single-dose efficacy (MRSE) at which single-dose reactive campaigns are expected to be as or more effective than two-dose campaigns with the same amount of vaccine. Average one- and two-dose OCV effectiveness was estimated from published literature and compared to the MRSE. Results were applied to recent outbreaks in Haiti, Zimbabwe, and Guinea using stochastic simulations to illustrate the potential impact of one- and two-dose campaigns. At the start of an epidemic, a single dose must be 35%–56% as efficacious as two doses to avert the same number of cases with a fixed amount of vaccine (i.e., MRSE between 35% and 56%). This threshold decreases as vaccination is delayed. Short-term OCV effectiveness is estimated to be 77% (95% CI 57%–88%) for two doses and 44% (95% CI −27% to 76%) for one dose. This results in a one-dose relative efficacy estimate of 57% (interquartile range 13%–88%), which is above conservative MRSE estimates. Using our best estimates of one- and two-dose efficacy, we projected that a single-dose reactive campaign could have prevented 70,584 (95% prediction interval [PI] 55,943–86,205) cases in Zimbabwe, 78,317 (95% PI 57,435–100,150) in Port-au-Prince, Haiti, and 2,826 (95% PI 2,490–3,170) cases in Conakry, Guinea: 1.1 to 1.2 times as many as a two-dose campaign. While extensive sensitivity analyses were performed, our projections of cases averted in past epidemics are based on severely limited single-dose efficacy data and may not fully capture uncertainty due to imperfect surveillance data and uncertainty about the transmission dynamics of cholera in each setting.
Conclusions
Reactive vaccination campaigns using a single dose of OCV may avert more cases and deaths than a standard two-dose campaign when vaccine supplies are limited, while at the same time reducing logistical complexity. These findings should motivate consideration of the trade-offs between one- and two-dose campaigns in resource-constrained settings, though further field efficacy data are needed and should be a priority in any one-dose campaign.

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Editors’ Summary
Background
Cholera—a bacterial gut infection caused by Vibrio cholerae—is a major global killer. Every year, epidemics (outbreaks) of cholera make 2 to 3 million people ill and kill about 100,000 people. People get cholera by eating food or drinking water contaminated with feces from an infected person, so cholera epidemics occur in places with poor sanitation such as slums and refugee camps. Earthquakes, floods, and other natural disasters that disrupt water and sanitation systems can also trigger cholera epidemics. Most people who become infected with V. cholerae have no or mild symptoms, but they may shed bacteria in their feces for up to two weeks. Other infected individuals develop severe diarrhea, producing profuse watery feces. The standard treatment for cholera is replacement of the fluids and salts lost through diarrhea by drinking an oral rehydration fluid or, in the worst cases, by fluid replacement directly into a vein. With prompt treatment, less than 1% of patients die, but untreated patients with severe cholera can die from dehydration within hours of developing symptoms.

Why Was This Study Done?
The best way to control cholera is to ensure that everyone has access to safe water and good sanitation, but this is often impossible in poor countries, in refugee camps, or after natural disasters. In 2013, the World Health Organization created a global stockpile of an oral cholera vaccine (a preparation given by mouth that stimulates the immune system to attack V. cholerae) for use in cholera outbreaks. The licensed protocol for the currently stockpiled vaccine requires two doses of the vaccine to be given two weeks apart, but it can be difficult to ensure that everyone at risk of infection receives two doses. Moreover, the stockpile contains only one to two million doses of vaccine, which would have been insufficient to protect every individual at risk of infection in several recent cholera outbreaks. Here, the researchers use mathematical modeling to investigate whether one dose of oral cholera vaccine, rather than two doses, could be used to maximize the health impact of cholera vaccination and minimize logistical barriers to cholera vaccination during cholera outbreaks.

What Did the Researchers Do and Find?
The researchers used cholera transmission models to determine the “minimum relative single-dose efficacy” (MRSE), the threshold at which single-dose vaccination campaigns begun after an outbreak has started (reactive vaccination) are expected to be as or more effective than two-dose campaigns with the same amount of vaccine. The researchers report that, at the start of an epidemic, the MRSE is between 35% and 56%. That is, a single dose of vaccine must be at least 35%–56% as efficacious as two doses to avert the same number of cases with a fixed amount of vaccine. By searching the literature, the researchers estimated that the short-term protection against infection provided by oral cholera vaccines is 77% for two doses and 44% for one dose—a one-dose relative efficacy of 57%, which is above the MRSE estimate. Finally, the researchers used their models to project that, in three recent cholera outbreaks, a single-dose campaign could have prevented between 1.1 and 1.2 times more cases of cholera than a two-dose campaign using the same amount of vaccine.

What Do These Findings Mean?
The finding that the relative single-dose efficacy of oral cholera vaccination is above the estimated MRSE suggests that one-dose reactive vaccination campaigns might avert more cases and deaths than a standard two-dose campaign when vaccine supplies are limited. The accuracy of this and other study findings is limited, however, by the assumptions used to build the mathematical models and by the quality of the data used to run them. In particular, a lack of data on the efficacy of single-dose vaccination limits the ability to apply these findings. Thus, before one-dose campaigns are used widely, more data on the effectiveness on one-dose vaccination must be obtained. Notably, by increasing herd immunity (the vaccination of a significant portion of a population provides some protection for individuals in the population who have not been vaccinated), one-dose campaigns are likely to provide better population-level protection than two-dose campaigns. On the other hand, the individual who is given one rather than two vaccine doses is more vulnerable to cholera illness if exposed to cholera-causing bacteria. Strategies that balance the trade-off between individual- and population-level benefits must be carefully considered to ensure the best future use of the oral cholera vaccine stockpile. Moreover, every effort should be made to increase the size and availa

PLoS One
http://www.plosone.org/
[Accessed 29 August 2015]

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A Multi-Site Knowledge Attitude and Practice Survey of Ebola Virus Disease in Nigeria
Garba Iliyasu, Dimie Ogoina, Akan A. Otu, Farouq M. Dayyab, Bassey Ebenso, Daniel Otokpa, Stella Rotifa, Wisdom T. Olomo, Abdulrazaq G. Habib
Research Article | published 28 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135955

Has Wild Poliovirus Been Eliminated from Nigeria?
Michael Famulare
Research Article | published 28 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135765

Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review
Sonja Merten, Adriane Martin Hilber, Christina Biaggi, Florence Secula, Xavier Bosch-Capblanch, Pem Namgyal, Joachim Hombach
Research Article | published 28 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135222
Abstract
Using meta-ethnographic methods, we conducted a systematic review of qualitative research to understand gender-related reasons at individual, family, community and health facility levels why millions of children in low and middle income countries are still not reached by routine vaccination programmes. A systematic search of Medline, Embase, CINAHL, Cochrane Library, ERIC, Anthropological Lit, CSA databases, IBSS, ISI Web of Knowledge, JSTOR, Soc Index and Sociological Abstracts was conducted. Key words were built around the themes of immunization, vaccines, health services, health behaviour, and developing countries. Only papers, which reported on in-depth qualitative data, were retained. Twenty-five qualitative studies, which investigated barriers to routine immunisation, were included in the review. These studies were conducted between 1982 and 2012; eighteen were published after 2000. The studies represent a wide range of low- to middle income countries including some that have well known coverage challenges. We found that women’s low social status manifests on every level as a barrier to accessing vaccinations: access to education, income, as well as autonomous decision-making about time and resource allocation were evident barriers. Indirectly, women’s lower status made them vulnerable to blame and shame in case of childhood illness, partly reinforcing access problems, but partly increasing women’s motivation to use every means to keep their children healthy. Yet in settings where gender discrimination exists most strongly, increasing availability and information may not be enough to reach the under immunised. Programmes must actively be designed to include mitigation measures to facilitate women’s access to immunisation services if we hope to improve immunisation coverage. Gender inequality needs to be addressed on structural, community and household levels if the number of unvaccinated children is to substantially decrease.

Prehospital & Disaster Medicine
Volume 30 – Issue 04 – August 2015
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue
Original Research
Pneumonia Prevention during a Humanitarian Emergency: Cost-effectiveness of Haemophilus Influenzae Type B Conjugate Vaccine and Pneumococcal Conjugate Vaccine in Somalia
Lisa M. Garganoa1 c1, Rana Hajjeha2 and Susan T. Cooksona1
a1 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia USA
a2 Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia USA
Abstract
Background Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia.
Problem This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency.
Methods An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values.
Results Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden.
Conclusions The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child’s life, cost is reasonable, and herd immunity is possible.

Original Research
The Development of a Humanitarian Health Ethics Analysis Tool
Veronique Frasera1a2 c1, Matthew R. Hunta3a4, Sonya de Laata5 and Lisa Schwartza6
a1 Centre for Clinical Ethics, St-Joseph’s Health Centre, Toronto, Ontario, Canada
a2 University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada
a3 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
a4 Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
a5 Faculty of Information and Media Studies, Western University, London, Ontario, Canada
a6 Clinical Epidemiology and Biostatics, McMaster University, Hamilton, Ontario, Canada
Abstract
Introduction Health care workers (HCWs) who participate in humanitarian aid work experience a range of ethical challenges in providing care and assistance to communities affected by war, disaster, or extreme poverty. Although there is increasing discussion of ethics in humanitarian health care practice and policy, there are very few resources available for humanitarian workers seeking ethical guidance in the field. To address this knowledge gap, a Humanitarian Health Ethics Analysis Tool (HHEAT) was developed and tested as an action-oriented resource to support humanitarian workers in ethical decision making.
While ethical analysis tools increasingly have become prevalent in a variety of practice contexts over the past two decades, very few of these tools have undergone a process of empirical validation to assess their usefulness for practitioners.
Methods A qualitative study consisting of a series of six case-analysis sessions with 16 humanitarian HCWs was conducted to evaluate and refine the HHEAT.
Results Participant feedback inspired the creation of a simplified and shortened version of the tool and prompted the development of an accompanying handbook.
Conclusion The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.

Refugee Survey Quarterly
Volume 34 Issue 3 September 2015
http://rsq.oxfordjournals.org/content/current

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A Gendered Human Security Perspective on Humanitarian Action in IDP and Refugee Protection
Refugee Survey Quarterly (2015) 34 (3): 1-23 doi:10.1093/rsq/hdv006
Kerstin Rosenow-Williams and Katharina Behmer

Back Home Again: Assessing the Impact of Provisions for Internally Displaced Persons in Comprehensive Peace Accords
David R. Andersen-Rodgers
Refugee Survey Quarterly (2015) 34 (3): 24-45 doi:10.1093/rsq/hdv010

The Role of Farming in Place-Making Processes of Resettled Refugees
Refugee Survey Quarterly (2015) 34 (3): 46-69 doi:10.1093/rsq/hdv007
Melissa Jean

The Reluctant Asylum-Seekers: Migrants at the Southeastern Frontiers of the European Migration System
Marko Valenta, Drago Zuparic-Iljic, and Tea Vidovic
Refugee Survey Quarterly (2015) 34 (3): 95-113 doi:10.1093/rsq/hdv009

Reproductive Health
http://www.reproductive-health-journal.com/supplements/12/S1
[Accessed 29 August 2015]

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Research
Domestic violence against women and associated factors in Ethiopia; systematic review
Agumasie Semahegn, Bezatu Mengistie Reproductive Health 2015, 12:78 (29 August 2015)

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 22 August 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, consortia 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 version: The Sentinel_ week ending 22 August 2015

blog edition: comprised of the 35+ entries to be posted below on 24 August 2015

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 29 August 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, consortia 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 version: The Sentinel_ week ending 29 August 2015

blog edition: comprised of the 35+ entries to be posted below on 30 August 2015

World Humanitarian Day – 19 August 2015
A number of organizations released statements recognizing World Humanitarian Day which are presented along with other announcements.

‘Each of Us Has the Power, Responsibility to Create a More Humane World’, Secretary-General Says at Event Marking World Humanitarian Day
Press Release 18 August 2015
SG/SM/17018-IHA/1373-OBV/1506
Following are UN Secretary-General Ban Ki-Moon’s remarks at the event marking World Humanitarian Day, in New York today:

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…Each year, on World Humanitarian Day, we honour the selfless dedication and sacrifice of those who devote themselves — often at great personal risk — to assisting the world’s most vulnerable people.

The General Assembly designated World Humanitarian Day to mark the anniversary of the bomb attack in Baghdad that took the lives of 22 people, including our colleague, the great humanitarian, Sergio Vieira de Mello.

Today we remember Sergio and all the humanitarian aid workers who have given their lives helping others. These workers and volunteers from around the world remind us of our common humanity — and our duty to support those who need us most.

Today more than 100 million women and men, children and adolescents require life-saving humanitarian assistance. Each has a unique and heart-rending story. Each hopes for a better future. Some are victims of natural disasters. Others are fleeing violence and persecution.

Not since the Second World War have so many people been displaced by conflict.

The families and communities struggling to survive in today’s emergencies do so with resilience and dignity. They need and deserve our solidarity.

Each one of us can make a difference. Each of us has the power — and the responsibility — to help create a more humane world.

On this World Humanitarian Day, I urge everyone to show solidarity as global citizens by signing up to the ShareHumanity campaign.

Help us to share moving stories of hope and resilience from around the world. Help us to inspire new heights of humanitarian awareness and action…

…As we celebrate tonight, I also ask you to look ahead to the first ever World Humanitarian Summit, next May, in Istanbul, Turkey.

The Summit will focus world attention on how we can better reduce risk, build resilience and meet the needs of millions of people affected by conflict, disaster and crisis.
I expect Heads of State and Government, and leaders from civil society and private sector, crisis-affected communities and multilateral organizations to announce bold new ideas to help set the course of humanitarian action for years and decades to come.

The Summit will also reinforce the 2030 agenda for sustainable development and our global commitment to end poverty and leave no one behind. I count on the support of all sectors of society to make the World Humanitarian Summit a great success.

I know you are all as pained as I am by the suffering in so many places across the world. We see systemic brutality against women and girls, indiscriminate bomb attacks on civilians, migrants facing exploitation and mortal danger as they undertake desperate journeys in search of a better life. And all the while, repressive governance continues in too many places.

Indifference among those with the power to make a difference leaves too many people without hope.

World Humanitarian Day is a day on which we express our determination not just to empathize but to engage.

In this year, in which we mark the seventieth anniversary of the founding of the United Nations, let us reaffirm our commitment to unite our strength to fulfil our shared humanitarian imperative.

Let us work to make this a better [world] for all. I thank you for your commitment and engagement…

Humanitarian System Urgently Needs Reform to Save More Lives
Fairfield, Conn. (August 19, 2015) — On World Humanitarian Day, Save the Children issued a stark warning that the current humanitarian system is not fit for purpose, putting the lives of vulnerable children and families at risk.

The children’s aid agency claims that as the frequency and severity of natural and man-made disasters continues to rise, major overhauls in the aid sector are needed to ensure adequate funding for, and improved efficiencies of, delivering support to those affected.

Save the Children CEO Carolyn Miles said: “Disasters like earthquakes and cyclones blighted the lives of 107 million people in 2014. At the same time, 60 million people have been forced from their homes because of conflict. This is the greatest movement of humanity since the Second World War. Yet the humanitarian system meant to help them is not fit for purpose and urgently needs reform.”

The aid agency says the humanitarian system needs four fundamental changes:
A greater proportion of funding ought to go to agencies directly involved in delivering aid, rather than UN agencies who sub-contract to operational partners. This reduces double-handling of humanitarian funds, and ultimately means greater efficiency on the ground.
More inventiveness in acquiring humanitarian funding by tapping the tens of billions from the corporate sector and from very wealthy individuals

Increased emphasis on what is known in the aid sector as Disaster Risk Reduction (DRR) so aid agencies can prepare for and mitigate the impact of extreme weather events before they occur. For a relatively modest investment in DRR, billions of dollars and thousands of lives worldwide could be saved.

The aid sector needs to become better innovators, pioneering new ways of solving humanitarian problems and reaching the most vulnerable people. For example, using mobile phone call data to chart the likely spread of a disease by tracking population flows, then deploying resources accordingly. While this has been successfully used in the past, it was not used following the outbreak of Ebola due to privacy concerns and other red tape.

“Our cause is not helped by the all-too familiar trend of slashing aid budgets. Globally, the gap between funds needed and funds provided continues to widen, meaning that aid agencies like Save the Children are asked to do a lot more with a lot less,” Miles said.

“The humanitarian system is stretched beyond capacity. There is a perfect storm brewing resulting from a system that is not fit for purpose, a lack of funding and a huge increase in man-made and so-called natural disasters,” Miles said.

World Humanitarian Day takes place on August 19, coinciding with the anniversary of the 2003 bombing of the United Nations headquarters in Baghdad, Iraq. The day was designated by the United Nations General Assembly as a time to recognise those who face danger and adversity in order to help others. It is also an opportunity to celebrate the spirit that inspires humanitarian work around the globe.

Global Evaluation Report: Reproductive Health in Humanitarian Emergencies Remains Fatal Omission
04 Aug 2015 IRC Press Release
:: While the majority of preventable deaths in women and girls occur in crisis-affected countries, these same countries receive less than half of the amount of funding as compared to non-conflict countries.
:: Lack of access to reproductive health care is the leading cause of death and illness among women of reproductive age in the developing world. Consequences are particularly dangerous in areas affected by crisis, which are responsible for a staggering 60 percent of preventable maternal deaths.
:: Evaluation released today by the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises shows that reproductive health in crisis settings remains chronically underfunded.

August 5th 2015 – Reproductive health remains drastically underfunded in humanitarian settings according to a global evaluation released today by the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises. The largest gaps— including the provision of comprehensive family planning, emergency contraception and abortion care — have only marginally improved since the last global evaluation in 2002.

David Miliband, CEO of the International Rescue Committee, a steering committee member of the group, said: “Women in conflict are being short-changed by international efforts to address their reproductive health needs. Millions of women lack access to life-saving health services, despite extreme needs for family planning and obstetric care, and heightened risk of experiencing sexual violence. As the scale of humanitarian crises reaches historic proportions, we cannot betray our commitment to these paramount needs.”

Evaluation Highlights
The global evaluation finds that conflict-affected countries receive 57 percent less funding for reproductive health than those countries not experiencing conflict. While funding for reproductive health has increased since 2004, it amounts to only 43 percent of the total need.
“The international community cannot claim to prioritize saving the lives of women and children while neglecting some of the most life-saving and cost-effective interventions in health,” said Sandra Krause, Director of Reproductive Health at the Women’s Refugee Commission, another steering committee member.

Highlights of the global evaluation include:
:: Obstetric and newborn care: While obstetric and newborn care receives the largest share of the funding, money primarily supports less expensive, rather than life-saving, interventions.
:: Comprehensive family planning: Only 14 percent of funding appeals for reproductive health included family planning. Long-acting or permanent methods of contraception were rarely mentioned.
:: Abortion care: Less than 1 percent of proposals mentioned abortion, which included post-abortion care.
:: Emergency contraception beyond post-rape care: Emergency contraception was provided at less than half of facilities evaluated.
:: Clinical care for rape survivors: Providers could identify less than half of the 11 essential services that should be provided to rape victims in a clinical setting.

The evaluation’s recommendations call for:
:: Sustained, dedicated, predictable funding for reproductive health
:: Commodity management and security, including long-acting family planning methods; obstetric and newborn care, and comprehensive clinical and psychosocial care for rape survivors
:: Support for regional actors, Ministries of Health and Disaster Management, national and community-based organizations, health workers and communities themselves to lead and manage humanitarian reproductive health response

“We must seize upon this sobering evaluation and the growing momentum of worldwide efforts to expand access to reproductive health needs for women and girls around the world,” said Barbara Jackson, Global Humanitarian Director of CARE International, another steering committee member. “We look forward to working with all of our humanitarian and development colleagues to ensure that this gap is closed as quickly as possible.”

Islamic Declaration on Global Climate Change
[Introductory language from symposium website]
This year, 2015, is a watershed year for the climate movement. In December governments will converge in Paris where they are expected to forge a new, international climate agreement that is robust, ambitious and commensurate with the scientific imperatives outlined by the Intergovernmental Panel on Climate Change. We believe that their ambition has to be driven by a bigger, broader and stronger citizens’ movement.

Faith communities increasingly recognise that the climate crisis is also a moral crisis. The adverse impacts of climate change that we have witnessed so far, present a clear case for people of faith to examine the underlying moral causes of this phenomenon. It prompts faith communities to take action to halt the desecration of nature that leads to destruction of creation, human and otherwise. Furthermore this is an opportunity for faith communities to provide a vision, inspire others and lead the way in building a fairer, safer, cleaner world built on renewable energy – leading the way on a journey to an economic system that meets development goals and is also spiritually fulfilling. The Islamic faith community represents a significant section of the global population and certainly, can be influential in the discourse on climate change.

A group of top academics has been engaged in drafting an “Islamic Declaration on Climate Change” and the initial draft has been circulated widely for consultation.

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[Excerpt from Declaration below; Full text at: http://islamicclimatedeclaration.org/islamic-declaration-on-global-climate-change/ ]

3.1 We call upon the Conference of the Parties (COP) to the United Nations Framework Convention on Climate Change (UNFCCC) and the Meeting of the Parties (MOP) to the Kyoto Protocol taking place in Paris this December, 2015 to bring their discussions to an equitable and binding conclusion, bearing in mind –
:: The scientific consensus on climate change, which is to stabilize greenhouse gas concentration in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate systems;
:: The need to set clear targets and monitoring systems;
:: The dire consequences to planet earth if we do not do so;
:: The enormous responsibility the COP shoulders on behalf of the rest of humanity, including leading the rest of us to a new way of relating to God’s Earth.

3.2 We particularly call on the well-off nations and oil-producing states to –
:: Lead the way in phasing out their greenhouse gas emissions as early as possible and no later than the middle of the century;
:: Provide generous financial and technical support to the less well-off to achieve a phase-out of greenhouse gases as early as possible;
:: Recognize the moral obligation to reduce consumption so that the poor may benefit from what is left of the earth’s non-renewable resources;
:: Stay within the ‘2 degree’ limit, or, preferably, within the ‘1.5 degree’ limit, bearing in mind that two-thirds of the earth’s proven fossil fuel reserves remain in the ground;
:: Re-focus their concerns from unethical profit from the environment, to that of preserving it and elevating the condition of the world’s poor.
:: Invest in the creation of a green economy.

3.3 We call on the people of all nations and their leaders to –
:: Aim to phase out greenhouse gas emissions as soon as possible in order to stabilize greenhouse gas concentrations in the atmosphere;
:: Commit themselves to 100 % renewable energy and/or a zero emissions strategy as early as possible, to mitigate the environmental impact of their activities;
:: Invest in decentralized renewable energy, which is the best way to reduce poverty and achieve sustainable development;
:: Realize that to chase after unlimited economic growth in a planet that is finite and already overloaded is not viable. Growth must be pursued wisely and in moderation; placing a priority on increasing the resilience of all, and especially the most vulnerable, to the climate change impacts already underway and expected to continue for many years to come.
:: Set in motion a fresh model of wellbeing, based on an alternative to the current financial model which depletes resources, degrades the environment, and deepens inequality.
:: Prioritise adaptation efforts with appropriate support to the vulnerable countries with the least capacity to adapt. And to vulnerable groups, including indigenous peoples, women and children.

3.4 We call upon corporations, finance, and the business sector to –
:: Shoulder the consequences of their profit-making activities, and take a visibly more active role in reducing their carbon footprint and other forms of impact upon the natural environment;
:: In order to mitigate the environmental impact of their activities, commit themselves to 100 % renewable energy and/or a zero emissions strategy as early as possible and shift investments into renewable energy;
:: Change from the current business model which is based on an unsustainable escalating economy, and to adopt a circular economy that is wholly sustainable;
:: Pay more heed to social and ecological responsibilities, particularly to the extent that they extract and utilize scarce resources;
:: Assist in the divestment from the fossil fuel driven economy and the scaling up of renewable energy and other ecological alternatives.

3.5 We call on all groups to join us in collaboration, co-operation and friendly competition in this endeavour and we welcome the significant contributions taken by other faiths, as we can all be winners in this race…