Risk Analysis
May 2016 Volume 36, Issue 5 Pages 863–1068
http://onlinelibrary.wiley.com/doi/10.1111/risa.2016.36.issue-5/issuetoc

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Current Topics
Risk Management Should Play a Stronger Role in Developing and Implementing Social Responsibility Policies for Organizations (pages 870–873)
Shital A. Thekdi
Version of Record online: 19 MAY 2016 | DOI: 10.1111/risa.12643

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Exploring the Predictors of Organizational Preparedness for Natural Disasters (pages 1040–1053)
Abdul-Akeem Sadiq and John D. Graham
Version of Record online: 1 SEP 2015 | DOI: 10.1111/risa.12478
Abstract
There is an extensive body of research on the determinants of disaster preparedness at the individual and household levels. The same cannot be said for the organizational level. Hence, the purpose of this study is to shed light on the predictors of organizational preparedness for natural disasters. Since leaders of organizations have an incentive to overstate their level of preparedness and because surveys of organizational leaders suffer from selection bias and low response rates, we take the novel approach of interviewing employees about the organizations that employ them. Using an online survey, we collected information from a national sample of 2,008 U.S. employees and estimated the predictors of preparedness at the organizational level. We find, among other results, that organization size (facility level) is a consistent predictor of preparedness at the organizational level. We conclude with policy recommendations and outline an agenda for future research on organizational preparedness for natural disasters.

Science
20 May 2016 Vol 352, Issue 6288
http://www.sciencemag.org/current.dtl

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Introduction to special issue
Cities are the Future
By Nicholas S. Wigginton, Julia Fahrenkamp-Uppenbrink, Brad Wible, David Malakoff
Science20 May 2016 : 904-905
Rapid urbanization is overtaxing the planet, but it may not have to

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Editorial
Leave no city behind
By Michele Acuto, Susan Parnell
Science20 May 2016 : 873
Summary
Close to 4 billion people live in cities. As the driver of environmental challenges, accounting for nearly 70% of the world’s carbon emissions, and as sites of critical social disparities, with 863 million dwellers now living in slums, urban settlements are at the heart of global change. This momentum is unlikely to disappear, as approximately 70 million more people will move to cities by the end of this year alone. The good news is that recent multilateral processes are now appreciating this key role of cities and are increasingly prioritizing urban concerns in policy-making. Yet, how can we ensure that these steps toward a global urban governance leave no city, town, or urban dweller behind?

Science Translational Medicine
11 May 2016 Vol 8, Issue 338
http://stm.sciencemag.org/

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Editorial
The need for global regulatory harmonization: A public health imperative
By Elias Zerhouni, Margaret Hamburg
Science Translational Medicine11 May 2016 : 338ed6
Because public health and innovation are no longer national issues, regulatory authorities must apply a global view to oversight.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 14 May 2016

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 14 May 2016

Aga Khan Foundation [to 21 May 2016]
http://www.akdn.org/pr.asp

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12 May 2016
Increasing access to quality health care in Naryn [Kyrgyz Republic]

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12 May 2016
Portuguese Republic and Ismaili Imamat sign Research Cooperation Agreement
Lisbon, Portugal, 12 May 2016 – The Ministry of Science, Technology and Higher Education of the Portuguese Republic and the Ismaili Imamat today signed an Agreement of Cooperation to strengthen research capacity and to improve the quality of life in Portugal and in Portuguese-speaking countries, particularly in Africa. This endeavour will be supported by the Ismaili Imamat with a 10 million euro grant over 10 years.

The agreement emphasises research in the areas of poverty alleviation, food security and biodiversity, early childhood development, sustainable energy systems and urban development, resettlement of migrants, civil society and pluralism. It will also build research capacity to support the forthcoming establishment in Lisbon of the International Centre for Advanced Training of Researchers from Portuguese speaking Countries…

Conrad N. Hilton Foundation [to 21 May 2016]
http://www.hiltonfoundation.org/news

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Our News
An anniversary unmarked, but not forgotten
By Robert Miyashiro, May 10, 2016
…For our part, following Steven Hilton’s call to action, we made another firm commitment to the children of Syrian refugees living in Turkey. The Conrad N. Hilton Foundation has partnered with Theirworld offsite link, to support the rapid scale-up of access to formal primary education for refugee children. The catalytic funding provided in this grant is aimed at replicating a similar program Theirworld implemented in Lebanon, which expanded access to education through research, advocacy, and campaigning. The program in Lebanon is on track to provide classes to 200,000 refugee schoolchildren during this school year alone. Ultimately, this project aims to generate additional transnational support from donor countries, foundations, and other stakeholders capable of financing the delivery of education for 450,000 Syrian refugee children in Turkey for the 2016-17 school year.

While we are fortunate to be part of some of this forward momentum to bring both attention and resources to the countries adjacent to the conflict in Syria, we also understand that the situation in the region itself remains dire. As the number of refugees hosted by Jordan, Lebanon, and Turkey tops five million, the challenges will loom larger and the need for support from the international community will become greater. Moreover, the increased instability caused by the stresses of the refugee influx could further destabilize what is already a tense region. The international community must redouble its efforts to support the refugees in a manner that addresses their livelihoods more directly within the countries that are bearing the brunt of the massive humanitarian needs resulting from this civil war, as it enters its sixth year.

MacArthur Foundation [to 21 May 2016]
http://www.macfound.org/

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Publication
Report Examines States’ Retiree Health Plan Spending
Published May 13, 2016
State strategies for addressing post-employment benefit liabilities vary greatly, and the methods states choose to contribute to their retirees’ health insurance premiums substantially affect those liabilities, according to a report issued as part of the State Health Care Spending Project, an initiative of The Pew Charitable Trusts and MacArthur. The report is the first of its kind to provide data about the cost in today’s dollars of benefits to be paid to current workers and retirees over future years. It is intended to help states better understand how their spending, long-term liabilities, and criteria for premium contributions and coverage eligibility compare with those of other states.

Gordon and Betty Moore Foundation [to 21 May 2016]
https://www.moore.org/news

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May 13, 2016
Moore Foundation commits $31M to deepen understanding of ocean microbial ecosystems as a pillar of microbiome science
The Gordon and Betty Moore Foundation will provide $31 million in research grants during the next four years to uncover a deeper understanding of microbial ecosystems in the sea and their role in supporting the ocean’s food webs and global elemental cycles.

“The Moore Foundation has been a steady supporter of fundamental research in microbial science,” said Robert Kirshner, Ph.D., chief program officer for science at the Moore Foundation. “We want to help deepen understanding of these fascinating natural systems: we have confidence that advances in biology will benefit society.”

The White House Office of Science and Technology Policy will announce the funding this afternoon at its event on microbiomes—communities of microorganisms that live on and in people, animals, plants, soil and the ocean.

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May 12, 2016
Brazilian soy agreement renewed indefinitely: provides long-term conservation of the Amazon
The landmark Soy Moratorium, a primary outcome of the foundation’s support of the Amazon Environmental Research Institute (IPAM) and the subject of extensive research by the University of Wisconsin’s Holly Gibbs, has been renewed indefinitely–a boon for long-term conservation of the Amazon. Originally renewed on an annual basis, the moratorium aims to prevent soy trade linked to deforestation, and ensure producers and trading companies can continue to rely on forest-friendly Amazon soy.

Soy tops the list of exports of agricultural commodities in Brazil, having generated $31.27 billion in revenue in 2015. This agreement guarantees market access only to soy that is free from deforestation, slave labor or threats to indigenous lands.

For more information about this announcement, see the press release from Greenpeace USA: Brazilian Soy Moratorium Renewed Indefinitely…

Pew Charitable Trusts [to 21 May 2016]
http://www.pewtrusts.org/en/about/news-room/press-releases

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May 11, 2016
Pew Releases Scientific Roadmap to Spur Antibiotic Discovery and Innovation
Press Release – Antibiotic Resistance Project
WASHINGTON—The Pew Charitable Trusts today released a strategy to end the 30-year drought in the discovery of new types of antibiotics, key to fighting some of the most serious microbial threats. The Scientific Roadmap for Antibiotic Discovery identifies priority research goals and specific steps to break through the most significant scientific barriers impeding antibiotic discovery and to pave the way for urgently needed new drugs.

“Drug-resistant bacteria are an ever-increasing threat, but the discovery of new antibiotics has slowed to a crawl,” said Allan Coukell, senior director for health programs at The Pew Charitable Trusts. “Every antibiotic in use today is based on a discovery made more than 30 years ago.”…

Rockefeller Foundation [to 21 May 2016]
http://www.rockefellerfoundation.org/newsroom

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May 12, 2016
The Rockefeller Foundation launches “100×25” campaign to reach 100 women CEOs of the Fortune 500 companies by 2025
New research report commissioned by The Rockefeller Foundation shows American men and women believe business leaders and companies have the greatest responsibility when it comes to creating gender equality in the workplace
NEW YORK—Today at the Forbes Women’s Summit, The Rockefeller Foundation announced a commitment to accelerate the number of women leaders in corporate America through the launch of “100×25,” an ongoing and multi-faceted campaign that will influence decision makers to achieve the goal of 100 women leading Fortune 500 companies by 2025. 100×25 is the first in a series of campaigns that will ask “what if” questions that will define the future of work and the global economy.

The Foundation also released a new research report conducted by grantee Global Strategy Group on the topic of gender parity in leadership positions in business. The underlying research found that men and women believe corporate America is falling short in terms of advancing gender equality in leadership positions and that business leaders are best positioned to create solutions to the problem.

Currently, only 21 women are at the helm of Fortune 500 companies and only one woman was hired as a CEO in 2015. This reality is at odds with Americans’ perceptions of progress toward gender parity in leadership positions in 2016. According to The Rockefeller Foundation’s new research report, 9 in 10 Americans think there are more women leading Fortune 500 companies than there actually are. And 40 percent of Americans think women should make up at least half of the top executives at Fortune 500 companies…

:: Journal Watch
The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 14 May 2016)

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Research article
Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey
Chi Huang, Chao-Jie Liu, Xiong-Fei Pan, Xiang Liu and Ning-Xiu Li
BMC Health Services Research 2016 16:177
Published on: 12 May 2016

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Research article
Economic burden of multimorbidity among older adults: impact on healthcare and societal costs
Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern.
Louisa Picco, Evanthia Achilla, Edimansyah Abdin, Siow Ann Chong, Janhavi Ajit Vaingankar, Paul McCrone, Hong Choon Chua, Derrick Heng, Harish Magadi, Li Ling Ng, Martin Prince and Mythily Subramaniam
BMC Health Services Research 2016 16:173
Published on: 10 May 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 14 May 2016)

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Commentary
Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services
Ole F. Norheim
Published on: 11 May 2016
Abstract
Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population’s health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 14 May 2016)

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Research article
Signal functions for measuring the ability of health facilities to provide abortion services: an illustrative analysis using a health facility census in Zambia
Annually, around 44 million abortions are induced worldwide. Safe termination of pregnancy (TOP) services can reduce maternal mortality, but induced abortion is illegal or severely restricted in many countries…
Oona M. R. Campbell, Estela M. L. Aquino, Bellington Vwalika and Sabine Gabrysch
BMC Pregnancy and Childbirth 2016 16:105
Published on: 14 May 2016

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Research article
Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis
Unsafe abortion is a leading cause of death among young women aged 10–24 years in sub-Saharan Africa. Although having multiple induced abortions may exacerbate the risk for poor health outcomes, there has been…
Caroline W. Kabiru, Boniface A. Ushie, Michael M. Mutua and Chimaraoke O. Izugbara
BMC Pregnancy and Childbirth 2016 16:104
Published on: 14 May 2016

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Research article
Antenatal consultation for parents whose child may require admission to neonatal intensive care: a focus group study for media design
For parents whose child may require admission to a neonatal intensive care unit (NICU), the antenatal consultation is often their first point of contact with the child’s medical team.
Patrick von Hauff, Karen Long, Barbara Taylor and Michael A. van Manen
BMC Pregnancy and Childbirth 2016 16:103
Published on: 14 May 2016

Current Opinion in Infectious Diseases
June 2016 – Volume 29 – Issue 3 pp: v-v,229-318
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx
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PAEDIATRIC AND NEONATAL INFECTIONS
Edited by Paul T. Heath

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Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries
Prendergast, Andrew J.; Kelly, Paul
Abstract
Purpose of review: This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children.
Recent findings: Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections.
Summary: Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
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HIV-1 at the placenta: immune correlates of protection and infection
Johnson, Erica L.; Chakraborty, Rana
Abstract
Purpose of review: Mother-to-child transmission (MTCT) of HIV-1 remains a significant global health concern despite implementation of maternal combination antiretroviral therapy for treatment as prevention to offset transmission. The risk of in-utero HIV-1 transmission in the absence of interventions is ∼7%. This low rate of transmission points to innate and adaptive mechanisms to restrict lentiviral infection within the placenta.
Recent findings: Placental macrophages (Hofbauer cells) are key mediators in in-utero transmission of HIV-1. Hofbauer cells constitutively express elevated concentrations of regulatory cytokines, which inhibit HIV-1 replication in vitro, and possess intrinsic antiviral properties. Hofbauer cells sequester HIV-1 in intracellular compartments that can be accessed by HIV-1-specific antibodies and may occur in vivo to offset MTCT. Intriguingly, studies have reported strong associations between maternal human cytomegalovirus (HCMV) viremia and MTCT of HIV-1. HCMV infection at the placenta promotes inflammation, chronic villitis, and trophoblast damage, providing potential HIV-1 access into CD4+CCR5+ target cells. The placenta exhibits a variety of mechanisms to limit HIV-1 replication, yet viral-induced activation with maternal HCMV may override this protection to facilitate in-utero transmission of HIV-1.
Summary: Understanding immune correlates of protection or transmission at the placenta during on-going HIV-1 exposure may contribute to understanding HIV pathogenesis and the development of effective immunotherapies.
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Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections
Dangor, Ziyaad; Lala, Sanjay G.; Kwatra, Gaurav; More
Abstract
Purpose of review: Maternal vaccination to prevent invasive Group B Streptococcus (GBS) disease in infants is an important alternative strategy to intrapartum antibiotic prophylaxis. Licensure of GBS vaccines could be expedited using immunological correlates of protection.
Recent findings: Between 2014 and 2015, we identified two studies that demonstrated an inverse association between invasive GBS disease and maternal serotype III capsular antibody levels greater than 1 μg/ml and greater than 3 μg/ml, and higher maternal antibody levels were associated with protection against serotype Ia disease. Furthermore, serotype Ia and III antibody levels greater than 3 μg/ml were associated with a reduced risk of GBS colonization in pregnant women.
Experimental studies have investigated the use of GBS surface proteins as vaccine candidates. Although the immunogenic potential of pilus island and other surface proteins has been shown in animal-model studies, no association between maternal pilus island antibody levels and invasive GBS disease was demonstrated in infants. Additionally, several novel innate immune mediators that prevent GBS infection have been described in human and experimental studies.
Summary: Recent studies suggest that maternal capsular antibody thresholds may be used as immunological correlates of protection for vaccine licensure. Surface proteins, as candidate vaccines or conjugates to the polysaccharide-protein vaccine, may broaden protection against invasive GBS disease.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 14 May 2016]
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Research
The use of technology enhanced learning in health research capacity development: lessons from a cross country research partnership
E. Byrne, L. Donaldson, L. Manda-Taylor, R. Brugha, A. Matthews, S. MacDonald, V. Mwapasa, M. Petersen and A. Walsh
Globalization and Health 2016 12:19
Published on: 10 May 2016
Abstract
Background
With the recognition of the need for research capacity strengthening for advancing health and development, this research capacity article explores the use of technology enhanced learning in the delivery of a collaborative postgraduate blended Master’s degree in Malawi. Two research questions are addressed: (i) Can technology enhanced learning be used to develop health research capacity?, and: (ii) How can learning content be designed that is transferrable across different contexts?
Methods
An explanatory sequential mixed methods design was adopted for the evaluation of technology enhanced learning in the Masters programme. A number of online surveys were administered, student participation in online activities monitored and an independent evaluation of the programme conducted.
Results
Remote collaboration and engagement are paramount in the design of a blended learning programme and support was needed for selecting the most appropriate technical tools. Internet access proved problematic despite developing the content around low bandwidth availability and training was required for students and teachers/trainers on the tools used. Varying degrees of engagement with the tools used was recorded, and the support of a learning technologist was needed to navigate through challenges faced.
Conclusion
Capacity can be built in health research through blended learning programmes. In relation to transferability, the support required institutionally for technology enhanced learning needs to be conceptualised differently from support for face-to-face teaching. Additionally, differences in pedagogical approaches and styles between institutions, as well as existing social norms and values around communication, need to be embedded in the content development if the material is to be used beyond the pilot resource-intensive phase of a project.
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Research
Analysis of the corporate political activity of major food industry actors in Fiji
Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors t…
Melissa Mialon, Boyd Swinburn, Jillian Wate, Isimeli Tukana and Gary Sacks
Globalization and Health 2016 12:18
Published on: 10 May 2016
Abstract
Background
Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors to the NCD epidemic, and the food industry is widely identified as having strong economic and political power. However, little research has been undertaken on the attempts by the food industry to influence public health-related policies and programs in its favour. The “corporate political activity” (CPA) of the food industry includes six strategies (information and messaging; financial incentives; constituency building; legal strategies; policy substitution; opposition fragmentation and destabilisation). For this study, we aimed to gain a detailed understanding of the CPA strategies and practices of major food industry actors in Fiji, interpreted through a public health lens.
Methods and results
We implemented a systematic approach to monitor the CPA of the food industry in Fiji for three months. It consisted of document analysis of relevant publicly available information. In parallel, we conducted semi-structured interviews with 10 stakeholders involved in diet- and/or public health-related issues in Fiji. Both components of the study were thematically analysed. We found evidence that the food industry adopted a diverse range of strategies in an attempt to influence public policy in Fiji, with all six CPA strategies identified. Participants identified that there is a substantial risk that the widespread CPA of the food industry could undermine efforts to address NCDs in Fiji.
Conclusions
Despite limited public disclosure of information, such as data related to food industry donations to political parties and lobbying, we were able to identify many CPA practices used by the food industry in Fiji. Greater transparency from the food industry and the government would help strengthen efforts to increase their accountability and support NCD prevention. In other low- and middle-income countries, it is likely that a systematic document analysis approach would also need to be supplemented with key informant interviews to gain insight into this important influence on NCD prevention.

Health Affairs
May 2016; Volume 35, Issue 5
http://content.healthaffairs.org/content/current
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Prescription Drugs, Global Health & More
From The Editor-in-Chief
Prescription Drugs, Global Health, And Population Health
Alan R. Weil
This month’s issue of Health Affairs covers a broad range of topics. We begin with prescription drugs, noting the recent report from IMS Health that drug spending increased by 8.5 percent in 2015.
Prescription Drugs
Unit prices for cancer drugs are higher in the United States than other developed countries. Sebastian Salas-Vega and Elias Mossialos compare the value in lives saved for cancer drug spending in nine countries, including the United States. Assigning a standard value for extended life-years, the authors calculate a $32.6 billion net positive return from cancer drug care in 2014 in the United States—a lower return per dollar spent than in all other countries analyzed. Japan achieved almost seven times the US rate of return.
Anomalies in the US drug market often yield price increases over time after a drug has been released. Caroline Bennette and colleagues set out to understand why. Analyzing data for twenty-four cancer drugs over six …
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Global Health
Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia’s Experience
Ravindra P. Rannan-Eliya, Chamara Anuranga, Adilius Manual, Sondi Sararaks, Anis S. Jailani,
Abdul J. Hamid, Izzanie M. Razif, Ee H. Tan, and Ara Darzi
Author Affiliations
1Ravindra P. Rannan-Eliya (raviofficelk@gmail.com) is executive director of the Institute for Health Policy, in Colombo, Sri Lanka.
2Chamara Anuranga is a research associate at the Institute for Health Policy.
3Adilius Manual is a research officer at the Institute for Health Systems Research, National Institutes of Health (NIH), in Selangor, Malaysia.
4Sondi Sararaks is a senior medical officer at the Institute for Health Systems Research, NIH, Malaysia.
5Anis S. Jailani is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
6Abdul J. Hamid is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
7Izzanie M. Razif is a research officer in the National Health Financing Unit of the Ministry of Health, in Putrajaya, Malaysia.
8Ee H. Tan is senior principal assistant director of the Oral Health Division of the Ministry of Health, in Putrajaya.
9Ara Darzi is executive chair of the World Innovation Summit for Health, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London, in the United Kingdom.
Abstract
Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia’s health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia’s results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia’s hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia’s hybrid health system presents continuing unresolved policy challenges, but the country’s experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.

Health Policy and Planning
Volume 31 Issue 5 June 2016
http://heapol.oxfordjournals.org/content/current
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Original Articles
The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi
B Adam Williams, Teklay Kidane, Geoffrey Chirwa, Neghist Tesfaye, Marta R Prescott, Soleine T Scotney, Moussa Valle, Sintayehu Abebe, Adija Tambuli, Bridget Malewezi, Tahir Mohammed, Emily Kobayashi, Emily Wootton, Renee Wong, Rahima Dosani, Hamsa Subramaniam, Jessica Joseph, Elif Yavuz, Aliza Apple, Yann Le Tallec, and Alice Kang’ethe
Health Policy Plan. (2016) 31 (5): 563-572 doi:10.1093/heapol/czv103
Abstract
Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction.
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Resource needs and gap analysis in achieving universal access to HIV/AIDS services: a data envelopment analysis of 45 countries
Wu Zeng, Donald S Shepard, Carlos Avila-Figueroa, and Haksoon Ahn
Abstract
Background—To manage the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic, international donors have pledged unprecedented commitments for needed services. The Joint United Nations Programme on HIV/AIDS (UNAIDS) projected that low- and middle-income countries needed $25 billion to meet the 2010 HIV/AIDS goal of universal access to AIDS prevention and care, using the resource needs model (RNM).
Methods—Drawing from the results from its sister study, which used a data envelopment analysis (DEA) and a Tobit model to evaluate and adjust the technical efficiency of 61 countries in delivering HIV/AIDS services from 2002 to 2007, this study extended the DEA and developed an approach to estimate resource needs and decompose the performance gap into efficiency gap and resource gap. In the DEA, we considered national HIV/AIDS spending as the input and volume of voluntary counseling and testing (VCT), prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as the outputs. An input-oriented DEA model was constructed to project resource needs in achieving 2010 HIV/AIDS goal for 45 countries using the data in 2006, assuming that all study countries maximized efficiency.
Findings—The DEA approach demonstrated the potential to include efficiency of national HIV/AIDS programmes in resource needs estimation, using macro-level data. Under maximal efficiency, the annual projected resource needs for the 45 countries was $6.3 billion, ∼47% of their UNAIDS estimate of $13.5 billion. Given study countries’ spending of $3.9 billion, improving efficiency could narrow the gap from $9.6 to $2.4 billion. The results suggest that along with continued financial commitment to HIV/AIDS, improving the efficiency of HIV/AIDS programmes would accelerate the pace to reach 2010 HIV/AIDS goals. The DEA approach provides a supplement to the AIDS RNM to inform policy making.

Human Rights Quarterly
Volume 38, Number 2, May 2016
http://muse.jhu.edu/issue/33495
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Articles
The Rights of Man and the Rights of the Man-Made: Corporations and Human Rights
Turkuler Isiksel
ABSTRACT:
The Citizens United and Hobby Lobby decisions of the US Supreme Court stoked the longstanding controversy over the court’s doctrine that corporations are persons entitled to certain constitutional rights on the same basis as citizens. It is less widely noted that, in some fields of international economic law, firms are increasingly considered not just legal persons but bearers of human rights. This article critically examines the incipient arrogation of human rights discourse in the context of international investment arbitration, where the claims of firms are often articulated and adjudicated with language and standards borrowed from human rights law. This development, which the article describes as the dehumanization of human rights, is part of a larger process whereby international economic institutions accord legal recognition and certain protections to private economic actors. The article traces the important implications of business corporations being considered as bearers of human rights for determining the proper scope and purpose of international human rights norms, and for conceptualizing their relationship to constitutional democracy.
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Chronicity and Pseudo Inheritance of Social Exclusion: Differences According to the Poverty of the Family of Origin Among Trash Pickers in León, Nicaragua
José Juan Vázquez, Sonia Panadero
ABSTRACT:
People living in extreme poverty or social exclusion mainly come from poor families, and their social difficulties tend to become chronic. This situation appears to be especially pronounced in countries with lower levels of development. This article analyzes different aspects of people (n = 99) who make their living collecting trash from dumps in León, Nicaragua, one of the countries with the lowest levels of development in Latin America. This group is difficult to access, heavily stigmatized, lives in chronic and extreme poverty and their families were also poor. The results show that the pickers in León whose families were poorest had the highest illiteracy rates, were poorest in health, had experienced more stressful life events, and had poorer future expectations. Negative health and life circumstances, low levels of education, and fatalism may lead to the pickers’ situations of social exclusion becoming chronic.
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Nepali Widows’ Access to Legal Entitlements: A Human Rights Issue
Pamela G. Poon, Kiely Houston, Abina Shrestha, Rajin Rayamajhi, Lily Thapa, Pamela J. Surkan
Abstract
Despite legal reforms, Nepali widows face barriers in exercising their property rights. This article provides a qualitative perspective on Nepali widows’ understanding of their rights and their ability to pursue legal entitlements due to widowhood. In-depth interviews and focus groups were conducted with seventy-six Nepali widows, four paralegals, and three key informants. They demonstrate that widows have limited success in exercising their property rights and seeking government benefits primarily because of a dominant patriarchal society, familial traditions, and bureaucratic restrictions. Nepali widows’ continued denial of property constitutes a human rights violation that Nepal’s new government should seek to redress.
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Forced Marriage, Slavery, and Plural Legal Systems: An African Example
Jody Sarich, Michele Olivier, Kevin Bales
Abstract
Slavery, long abolished under international law, left a devastating imprint on Africa. However, enslavement of women through forced marriages remains a common phenomenon in many African states. These African states share the common feature of legal pluralism where traditional legal systems continue to be observed alongside national laws in which slavery is outlawed. Where traditional practices condone the marriage of underage girls who are legally unable to consent, the questioning of age-old accepted forms of marriage can generate strong reactions. This article traces the position of forced and child marriages in international law, and investigates how legality becomes a moveable target when legal systems exist in parallel. Despite international and African Union conventions on slavery and human rights declaring that marriages not based on the full and free consent of both parties are considered a violation of human rights and a form of slavery, these practices persist. These instruments are assessed to gauge the level of conformity (or variance) of African state practice where forced marriages commonly occur. Importantly, the reasons behind noncompliance and the impact of legal pluralism are explored in African states where forced marriages commonly occur.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 4, 2016
http://www.tandfonline.com/toc/khvi20/current
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Reviews
Vaccines in pregnancy: The dual benefit for pregnant women and infants
pages 848-856
H. Marshall, M. McMillan, R. M. Andrews, K. Macartney & K. Edwards
ABSTRACT
Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.
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Reviews
Improving rates of maternal immunization: Challenges and opportunities
pages 857-865
Donna M. MacDougall & Scott A. Halperin
ABSTRACT
Objectives: An increasing number of vaccines are recommended or are being developed for use during pregnancy to protect women, fetuses, and/or newborns. For vaccines that are already recommended, vaccine uptake is variable and well below desired target. We reviewed the literature related to factors that affect a healthcare provider’s recommendation and a woman’s willingness to be vaccinated during pregnancy. Design: A scoping review of published literature from 2005 to 2015 was undertaken and all relevant articles were abstracted, summarized, and organized thematically. Results: Barriers and facilitators were identified that either decreased or increased the likelihood of a healthcare provider offering and a pregnant woman accepting vaccination during pregnancy. Concern about the safety of vaccines given during pregnancy was the most often cited barrier among both the public and healthcare providers. Other barriers included doubt about the effectiveness of the vaccine, lack of knowledge about the burden of disease, and not feeling oneself to be at risk of the infection. Major facilitators for maternal immunization included specific safety information about the vaccine in pregnant women, strong national recommendations, and healthcare providers who both recommended and provided the vaccine to their patients. Systems barriers such as inadequate facilities and staffing, vaccine purchase and storage, and reimbursement for vaccination were also cited. Evidence-based interventions were few, and included text messaging reminders, chart reminders, and standing orders. Conclusions: In order to have an effective vaccination program, improvements in the uptake of recommended vaccines during pregnancy are needed. A maternal immunization platform is required that normalizes vaccination practice among obstetrical care providers and is supported by basic and continuing education, communication strategy, and a broad range of research.
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Review
Current status of new tuberculosis vaccine in children
DOI:10.1080/21645515.2015.1120393
Yu Pangab#, Aihua Zhaoc#, Chad Cohend, Wanli Kanga, Jie Lue, Guozhi Wangc, Yanlin Zhaob & Suhua Zhenga*
pages 960-970
ABSTRACT
Pediatric tuberculosis contributes significantly to the burden of TB disease worldwide. In order to achieve the goal of eliminating TB by 2050, an effective TB vaccine is urgently needed to prevent TB transmission in children. BCG vaccination can protect children from the severe types of TB such as TB meningitis and miliary TB, while its efficacy against pediatric pulmonary TB ranged from no protection to very high protection. In recent decades, multiple new vaccine candidates have been developed, and shown encouraging safety and immunogenicity in the preclinical experiments. However, the limited data on protective efficacy in infants evaluated by clinical trials has been disappointing, an example being MVA85A. To date, no vaccine has been shown to be clinically safer and more effective than the presently licensed BCG vaccine. Hence, before a new vaccine is developed with more promising efficacy, we must reconsider how to better use the current BCG vaccine to maximize its effectiveness in children.