PLoS Medicine
http://www.plosmedicine.org/
(Accessed 18 June 2016)

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Essay
Delinking Investment in Antibiotic Research and Development from Sales Revenues: The Challenges of Transforming a Promising Idea into Reality
Kevin Outterson, Unni Gopinathan, Charles Clift, Anthony D. So, Chantal M. Morel, John-Arne Røttingen
| published 14 Jun 2016 | PLOS Medicine
Summary Points
:: The current business model for antibiotics is plagued by market failures and perverse incentives that both work against conservation efforts and provide insufficient rewards to drive the development of much-needed new treatments for resistant infection.
:: Many new incentive mechanisms have been proposed to realign incentives and support innovation and conservation over the long term. The most promising of these are based on the idea of delinking rewards from sales volume of the antibiotic—the notion of “delinkage.”
:: Some critical design issues for delinkage remain, such as how to secure access to badly needed new products when resistance renders existing treatments ineffective, an increasingly urgent global problem. The issue of global access to antibiotics is not sufficiently addressed de facto by a delinked mechanism, and, as such, it must be addressed explicitly through specific design features of new mechanisms, including defining the eligibility criteria for delinkage rewards and appropriate management of intellectual property.
:: The idea of establishing a new business model to drive antibiotic development and improve conservation currently has the world’s attention. We must now work quickly to examine the remaining design questions to address this major public health concern for the longer term.

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

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Digital Participatory Surveillance and the Zika Crisis: Opportunities and Caveats
Claudia Pagliari, Santosh Vijaykumar
Viewpoints | published 13 Jun 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004795
Introduction
Managing the global threat of Zika requires innovative solutions. This article examines the potential of Digital Participatory Surveillance to support the management of global disease outbreaks by enabling citizens to report signs of infection. We discuss the status of the current evidence-base, contextual factors influencing user engagement and data quality, challenges for evaluation, and unique aspects of Zika with implications for design. We also suggest priorities for research, development and practice, to help translate the theoretical benefits of these methods into meaningful improvements in outbreak monitoring and public health.

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

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Research Article
Antibody Secreting Cell Responses following Vaccination with Bivalent Oral Cholera Vaccine among Haitian Adults
Wilfredo R. Matias, Brie Falkard, Richelle C. Charles, Leslie M. Mayo-Smith, Jessica E. Teng, Peng Xu, Pavol Kovac, Edward T. Ryan, Firdausi Qadri, Molly F. Franke, Louise C. Ivers, Jason B. Harris
| published 16 Jun 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004753
Abstract
Background
The bivalent whole-cell (BivWC) oral cholera vaccine (Shanchol) is effective in preventing cholera. However, evaluations of immune responses following vaccination with BivWC have been limited. To determine whether BivWC induces significant mucosal immune responses, we measured V. cholerae O1 antigen-specific antibody secreting cell (ASC) responses following vaccination.
Methodology/Principal Findings
We enrolled 24 Haitian adults in this study, and administered doses of oral BivWC vaccine 14 days apart (day 0 and day 14). We drew blood at baseline, and 7 days following each vaccine dose (day 7 and 21). Peripheral blood mononuclear cells (PBMCs) were isolated, and ASCs were enumerated using an ELISPOT assay. Significant increases in Ogawa (6.9 cells per million PBMCs) and Inaba (9.5 cells per million PBMCs) OSP-specific IgA ASCs were detected 7 days following the first dose (P < 0.001), but not the second dose. The magnitude of V. cholerae-specific ASC responses did not appear to be associated with recent exposure to cholera. ASC responses measured against the whole lipolysaccharide (LPS) antigen and the OSP moiety of LPS were equivalent, suggesting that all or nearly all of the LPS response targets the OSP moiety.
Conclusions/Significance
Immunization with the BivWC oral cholera vaccine induced ASC responses among a cohort of healthy adults in Haiti after a single dose. The second dose of vaccine resulted in minimal ASC responses over baseline, suggesting that the current dosing schedule may not be optimal for boosting mucosal immune responses to V. cholerae antigens for adults in a cholera-endemic area.
Author Summary
The bivalent whole-cell (BivWC) oral cholera vaccine (Shanchol) is effective in preventing cholera. Despite its increasing use as part of comprehensive cholera prevention and control efforts, evaluations of immune responses following vaccination with BivWC have been limited. In this study, we measured the development of cholera-specific antibody secreting cells, markers of mucosal immunity, following vaccination with BivWC among a population of adults in Haiti, where cholera is now endemic. BivWC induced development of robust immune responses following the first dose of vaccine, but similar ASC responses were not detected following the second dose, suggesting that the currently recommended 14-day interval between doses may not be optimal for boosting mucosal immune responses among adults in cholera endemic regions. These findings suggest that additional evaluation of the optimal dosing schedule for oral cholera vaccines is warranted with the goal of improving long-term immunity.

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 18 June 2016]

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Research
Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries
Having a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality. We sought to estimate the frequencies of (a) skilled birth attendant c…
Gary Joseph, Inácio Crochemore Mohnsam da Silva, Fernando C. Wehrmeister, Aluísio J. D. Barros and Cesar G. Victora
Reproductive Health 2016 13:77
Published on: 17 June 2016

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Study protocol
Global, regional and national levels and trends of preterm birth rates for 1990 to 2014: protocol for development of World Health Organization estimates
The official WHO estimates of preterm birth are an essential global resource for assessing the burden of preterm birth and developing public health programmes and policies. This protocol describes the methods ...
Joshua P. Vogel, Saifon Chawanpaiboon, Kanokwaroon Watananirun, Pisake Lumbiganon, Max Petzold, Ann-Beth Moller, Jadsada Thinkhamrop, Malinee Laopaiboon, Armando H. Seuc, Daniel Hogan, Ozge Tunçalp, Emma Allanson, Ana Pilar Betrán, Mercedes Bonet, Olufemi T. Oladapo and A. Metin Gülmezoglu
Reproductive Health 2016 13:76
Published on: 17 June 2016

Science
17 June 2016 Vol 352, Issue 6292
http://www.sciencemag.org/current.dtl
Special Issue: Signals in RNA

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Northeastern North America as a potential refugium for boreal forests in a warming climate
By L. D’Orangeville, L. Duchesne, D. Houle, D. Kneeshaw, B. Côté, N. Pederson
Science17 Jun 2016 : 1452-1455
Tree-ring data from black spruce indicate increased growth in response to increased temperatures.
Editor’s Summary
A future for boreal forests
Conservation under climate change presents the challenge of predicting where will be suitable for particular organisms and ecological communities in the future. D’Orangeville et al. assess the probable future range for boreal forests in eastern North America, which are expected to be subject to large temperature increases in their natural range. Using tree-ring data from many thousands of forest stands, they delineate the geographical extent of the region where tree growth responds favorably to higher temperatures and where the forest should persist at least until 2070.

Stability: International Journal of Security & Development
http://www.stabilityjournal.org/articles
[accessed 18 June 2016]

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Research Article
Toward a Realistic and Responsible Idea of Stabilisation
Philipp Rotmann
15 Jun 2016
Abstract
What is stabilisation, and why do we need a conceptual discussion? Based on interviews and policy documents from Canada, Germany, the Netherlands, the United Kingdom and the United States, this article distils two conceptual visions of stabilisation, outlines a range of institutional and budgetary designs and offers a number of lessons of what a realistic and responsible idea of stabilisation might look like. Given the ubiquity of fragility and the lack of generalised knowledge about social engineering, this article argues in favour of a narrow understanding of stabilisation that seeks only to mitigate acute situations of crisis marked by extreme political volatility and violence. Even this more limited goal is ambitious enough to require sober assessment and communication of risk, continuing improvements to the conceptual and institutional tools for stabilisation and stronger commitment to constant reflection and learning.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 11 June 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 11 June 2016

:: 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 Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 11 June 2016)

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Research
Mothers’ willingness to pay for HPV vaccines in Anambra state, Nigeria: a cross sectional contingent valuation study
Ifeoma Blessing Umeh, Sunday Odunke Nduka and Obinna Ikechukwu Ekwunife
Published: 6 June 2016
Abstract
Background
Human papilloma virus (HPV) vaccination in Nigeria will require substantial financing due to high cost of HPV vaccine and inexistence of structures to support adolescent vaccination. Alternative sources are needed to sustain the government funded HPV vaccination programme. This study assessed Nigerian mothers’ willingness-to-pay (WTP) for HPV vaccine. We also compared the difference between the average WTP and estimated costs of vaccinating a pre-adolescent girl (CVG).
Methods
We conducted a quantitative, cross-sectional, survey-based study in which 50 questionnaires were distributed to each of 10 secondary schools located in two rural and one urban city in Anambra state. The questionnaires were then randomly distributed to girls aged 9–12 years of age to give to their mothers. Contingent valuation approach using the payment card technique was used to estimate the average maximum WTP among the survey participants. Correlates of WTP for HPV vaccination were obtained using multivariate logistic regression. Estimated CVG was obtained by adapting cost of HPV vaccine delivery in Tanzania to the Nigerian setting.
Results
A total of 438 questionnaires (88 %) were returned. The average WTP was US$ 11.68. This is opposed to estimated delivery cost of US$ 18.16 and US$ 19.26 for urban and rural populations respectively at vaccine price offered by the Vaccine Alliance (Gavi) and US$ 35.16 and US$ 36.26 for urban and rural populations respectively at the lowest obtainable public sector vaccine price. Demand for HPV vaccine was deemed high (91.6 %) and was significantly associated with respondents previously diagnosed of HPV infection.
Conclusion
Demand for HPV vaccine was high although short of estimated CVG. High demand for vaccine should be capitalized upon to increase vaccine uptake. Education on cervical cancer and provider-initiated vaccination should be promoted to increase vaccine uptake. Co-payment could be a feasible financing strategy in the event of national HPV vaccination.

BMC Infectious Diseases

(Accessed 11 June 2016)

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Research article
A survey of tuberculosis infection control practices at the NIH/NIAID/DAIDS-supported clinical trial sites in low and middle income countries
Health care associated transmission of Mycobacterium tuberculosis (TB) is well described. A previous survey of infection control (IC) practices at clinical research sites in low and middle income countries (LMIC)…
Catherine Godfrey, Gail Tauscher, Sally Hunsberger, Melissa Austin, Lesley Scott, Jeffrey T. Schouten, Anne F. Luetkemeyer, Constance Benson, Robert Coombs and Susan Swindells
BMC Infectious Diseases 2016 16:269
Published on: 10 June 2016

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Research article
Global research trends of Middle East respiratory syndrome coronavirus: a bibliometric analysis
Middle East respiratory syndrome coronavirus (MERS-CoV) is a virus that causes severe viral pneumonia in humans, known to have a high mortality rate and a similarity in clinical symptoms with severe acute resp…
Sa’ed H. Zyoud
BMC Infectious Diseases 2016 16:255
Published on: 7 June 2016

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 11 June 2016)

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Research article
Steps toward improving ethical evaluation in health technology assessment: a proposed framework
While evaluation of ethical aspects in health technology assessment (HTA) has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response …
Nazila Assasi, Jean-Eric Tarride, Daria O’Reilly and Lisa Schwartz
BMC Medical Ethics 2016 17:34
Published on: 6 June 2016

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Debate
Citizen science or scientific citizenship? Disentangling the uses of public engagement rhetoric in national research initiatives
The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. …
J. Patrick Woolley, Michelle L. McGowan, Harriet J. A. Teare, Victoria Coathup, Jennifer R. Fishman, Richard A. Settersten, Sigrid Sterckx, Jane Kaye and Eric T. Juengst
BMC Medical Ethics 2016 17:33
Published on: 4 June 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 11 June 2016)

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Research article
Impact of interventions to improve the quality of peer review of biomedical journals: a systematic review and meta-analysis
The peer review process is a cornerstone of biomedical research. We aimed to evaluate the impact of interventions to improve the quality of peer review for biomedical publications.
Rachel Bruce, Anthony Chauvin, Ludovic Trinquart, Philippe Ravaud and Isabelle Boutron
BMC Medicine 2016 14:85
Published on: 10 June 2016

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content

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Research article
Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana
Religiosity in health care delivery has attracted some attention in contemporary literature. The religious beliefs and practices of patients play an important role in the recovery of the patient.
Lydia Aziato, Philippa N. A. Odai and Cephas N. Omenyo
BMC Pregnancy and Childbirth 2016 16:138
Published on: 6 June 2016

Disasters
July 2016 Volume 40, Issue 3 Pages 385–588
http://onlinelibrary.wiley.com/doi/10.1111/disa.2016.40.issue-3/issuetoc

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Papers
Barriers to the long-term recovery of individuals with disabilities following a disaster (pages 387–410)
Laura M. Stough, Amy N. Sharp, J. Aaron Resch, Curt Decker and Nachama Wilker
Version of Record online: 17 NOV 2015 | DOI: 10.1111/disa.12161
Abstract
This study examines how pre-existing disabling conditions influenced the recovery process of survivors of Hurricane Katrina. It focuses specifically on the barriers that hindered the recovery process in these individuals. Focus groups were convened in four Gulf Coast states with 31 individuals with disabilities who lived in or around New Orleans, Louisiana, prior to Hurricane Katrina in August 2005. Qualitative data were analysed using grounded theory methodology. Five themes emerged as the most significant barriers to recovery: housing; transportation; employment; physical and mental health; and accessing recovery services. While these barriers to recovery were probably common to most survivors of the disaster, the research results suggest that disability status enhanced the challenges that participants experienced in negotiating the recovery process and in acquiring resources that accommodated their disabilities. The findings indicate that, when disaster recovery services and resources did not accommodate the needs of individuals with disabilities, recovery was hindered. Recovery efforts should include building accessible infrastructure and services that will allow for participation by all.

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Disaster preparedness in a complex urban system: the case of Kathmandu Valley, Nepal (pages 411–431)
Samuel Carpenter and François Grünewald
Version of Record online: 17 NOV 2015 | DOI: 10.1111/

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Mental and social health in disasters: the Sphere standards and post-tsunami psychosocial interventions in Asia (pages 432–451)
Silja E.K. Henderson, Peter Elsass and Peter Berliner
Version of Record online: 17 NOV 2015 | DOI: 10.1111/disa.12159
disa.12164
Abstract
The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project’s Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long-term humanitarian psychosocial programmes in different countries in post-tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long-term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long-term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication.

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Towards a natural disaster intervention and recovery framework (pages 494–517)
Peter M. Lawther
Version of Record online: 17 NOV 2015 | DOI: 10.1111/disa.12163

Eurosurveillance
Volume 21, Issue 23, 09 June 2016
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Editorials
Zika virus, the new kid on the block
by M Zambon

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Sexual transmission of Zika virus in an entirely asymptomatic couple returning from a Zika epidemic area, France, April 2016
by T Fréour, S Mirallié, B Hubert, C Splingart, P Barrière, M Maquart, I Leparc-Goffart

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Sexual transmission of Zika virus in Germany, April 2016
by C Frank, D Cadar, A Schlaphof, N Neddersen, S Günther, J Schmidt-Chanasit, D Tappe

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 11 June 2016]

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Debate
Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy
The U.S Congress initiated sanctions against Iran after the 1979 U.S. Embassy hostage crisis in Tehran, and since then the scope of multilateral sanctions imposed by the United States, the European Union, and …
Sogol Setayesh and Tim K. Mackey
Globalization and Health 2016 12:31
Published on: 8 June 2016

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Commentary
The Trans-Pacific Partnership Agreement and health: few gains, some losses, many risks
In early October 2015, 12 nations signed the Trans-Pacific Partnership Agreement (TPPA), promoted as a model ‘21st century’ trade and investment agreement that other countries would eventually join. There are gro…
Ronald Labonté, Ashley Schram and Arne Ruckert
Globalization and Health 2016 12:25
Published on: 6 June 2016

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 11 June 2016]

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Research
The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study
Allese B. McVay, Katherine A. Stamatakis, Julie A. Jacobs, Rachel G. Tabak and Ross C. Brownson
Published on: 10 June 2016
Abstract
Background
Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population’s health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments.
Methods
In a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination.
Results
Slightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received.
Conclusions
There is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 5, 2016
http://www.tandfonline.com/toc/khvi20/current

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Review
A review of clinical models for the evaluation of human TB vaccines
pages 1177-1187
Matthew K. O’Shea & Helen McShane
Open access
DOI:10.1080/21645515.2015.1134407
ABSTRACT
While much progress has been made in the fight against the scourge of tuberculosis (TB), we are still some way from reaching the ambitious targets of eliminating it as a global public health problem by the mid twenty-first century. A new and effective vaccine that protects against pulmonary TB disease will be an essential element of any control strategy. Over a dozen vaccines are currently in development, but recent efficacy trial data from one of the most advanced candidates have been disappointing. Limitations of current preclinical animal models exist, together with a lack of a complete understanding of host immunity to TB or robust correlates of disease risk and protection. Therefore, in the context of such obstacles, we discuss the lessons identified from recent efficacy trials, current concepts of biomarkers and correlates of protection, the potential of innovative clinical models such as human challenge and conducting trials in high-incidence settings to evaluate TB vaccines in humans, and the use of systems vaccinology and novel technologies including transcriptomics and metabolomics, that may facilitate their utility.

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Research Papers
Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review
pages 1202-1216
Edward Gibson, Najida Begum, Birgir Sigmundsson, Alfred Sackeyfio, Judith Hackett & Sankarasubramanian Rajaram
Open access
DOI:10.1080/21645515.2015.1131369
ABSTRACT
This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation — 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond’s checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 11 June 2016]

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Commentary
Malaria: Global progress 2000 – 2015 and future challenges
2015 was the target year for malaria goals set by the World Health Assembly and other international institutions to reduce malaria incidence and mortality. A review of progress indicates that malaria programme…
Richard E. Cibulskis, Pedro Alonso, John Aponte, Maru Aregawi, Amy Barrette, Laurent Bergeron, Cristin A. Fergus, Tessa Knox, Michael Lynch, Edith Patouillard, Silvia Schwarte, Saira Stewart and Ryan Williams
Infectious Diseases of Poverty 2016 5:61
Published on: 9 June 2016

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Research Article
Rapid assessment of knowledge, attitudes, practices, and risk perception related to the prevention and control of Ebola virus disease in three communities of Sierra Leone
Hai Jiang, Guo-Qing Shi, Wen-Xiao Tu, Can-Jun Zheng, Xue-Hui Lai, Xin-Xu Li, Qiang Wei, Mei Li, Li-Quan Deng, Xiang Huo, Ming-Quan Chen, Feng Xu, Long-Jie Ye, Xi-Chen Bai, Tong-Nian Chen, Shao-Hua Yin…
Infectious Diseases of Poverty 2016 5:53
Published on: 6 June 2016

The Lancet
Jun 11, 2016 Volume 387 Number 10036 p2351-2478 e29
http://www.thelancet.com/journals/lancet/issue/current
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Editorial
Dear Mr Ban Ki-moon
The Lancet
We have greatly admired your leadership as Secretary-General of the UN. Over your 10 years heading the world’s most important international organisation, you have played an exemplary part in strengthening the global health agenda—championing awareness of women’s and children’s health, global warming, and humanitarianism. But there is one issue that concerns us deeply.

In 2010, UN soldiers from Nepal were deployed to help after Haiti’s devastating earthquake and cholera contaminated sewage was discarded from their camp into the country’s major river. This triggered the largest cholera outbreak in the world, leaving more than 30 000 Haitians dead and more than 2 million affected.

6 years later a cholera epidemic still rages—14 000 new cases and 150 deaths are reported this year alone. The UN has yet to accept responsibility for introducing cholera into Haiti, despite two investigations establishing these facts.

We applaud the considerable work that the UN has done since 2010 to improve hygiene standards for peacekeepers and support immunisation campaigns. But we are distressed by reports that less than 20% of the funds pledged by the UN after the outbreak to eradicate cholera have been raised.

Calls for you to do more are intensifying. 2000 letters were sent to the UN by Haitians with stories of hardship. Diaspora leaders have urged the UN to install water and sanitation infrastructure to control cholera and to compensate victims. Failing to accept the UN’s responsibilities sets a poor example for the Haitian government to assume theirs, they say. Your own human rights advisers have implored you to respond. Instead, the UN continues to say it is immune from these claims.

It is disappointing that the UN’s silence has forced the matter into the US courts. The UN has enormous power to act. But its power to ignore is what prevails here.

We hope you can address this issue. Please endorse the facts. Please acknowledge the injustice. Please apologise for the indifference. Responsibility is not about vengeance, but about accountability from which needed reparation and reconciliation can flow. The UN has long emphasised the need for accountability—we urge you to make this a final act in your celebrated career as Secretary-General.