Global Study on Children Deprived of Liberty

Children – Liberty, Rights

Global Study on Children Deprived of Liberty
November 2019 :: 789 pages
PDF of Full Study: https://omnibook.com/Global-Study-2019
Manfred Nowak, Independent Expert

United Nations High Level Interagency Task Force (UNITF)
Najat MAALLA M’JID – The Special Representative of the Secretary-General on Violence against Children
Virginia GAMBA – The Special Representative of the Secretary-General for Children and Armed Conflict
The Office of the High Commissioner for Human Rights (OHCHR)
The United Nations Children’s Emergency Fund (UNICEF)
The United Nations Office of Drugs and Crime (UNODC)
The United Nations Refugee Agency (UNHCR)
The United Nations Committee on the Rights of the Child (CRC)
The World Health Organization (WHO)
The International Organization for Migration (IOM)

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Press Release
United Nations Task Force calls on Member States to end children’s deprivation of liberty
Geneva/ New York – October 8 – The United Nations Task Force supporting the Global
Study on Children Deprived of Liberty calls on Member States to put an end to children’s
deprivation of liberty, following the submission and presentation of a report by the
Independent Expert to the UN General Assembly.

The Independent Expert’s report highlights that while this year marks the 30th anniversary of
the United Nations Convention on the Rights of the Child, a landmark treaty aiming at
promoting and protecting the rights of children’s worldwide, countless children still suffer
violations of their basic human rights. The UN Task Force further notes that in adopting the
2030 Agenda for Sustainable Development Member States made a clear commitment to
leave no child behind and yet, children deprived of liberty continue to be one of the most
vulnerable, invisible and forgotten groups in societies across the globe. The UN Task Force
joins the Independent Expert in calling on States to end the deprivation of liberty of children
or those at most risk as a matter of urgency. The Task Force emphasizes that it is indeed
time to put the most vulnerable first.

Children around the world are deprived of their liberty in closed institutions, psychiatric
centres or detention facilities, sometimes together with adults. Furthermore, children are
detained for national security, armed conflict or migration-related reasons. They are denied
family care and access to justice, often unable to challenge the legality of their detention.

These children are exposed to further human rights violations, enduring cruel, inhumane
and/or degrading conditions. Furthermore, they are often denied the right to education,
and health care, and do not benefit from tailored and long-term rehabilitation and
reintegration support. Deprivation of liberty has a destructive impact on children’s physical
and mental development, and often compounds trauma they have suffered.

The UN Task Force believes that the presentation of the report creates a unique momentum
to learn from children and Member States’ experiences. The UN Task Force member
organizations express their strong commitment to work together with Member States, civil
society and children themselves to end children’s deprivation of liberty and safeguard their
rights as enshrined in the Convention on the Rights of the Child and other international
standards, and further re-affirmed in the 2030 Agenda for Sustainable Development.

In December 2014 the United Nations General Assembly (A/RES/69/157, paragraph 52d)
invited the UN Secretary-General to commission an in-depth global study on children
deprived of liberty. In October 2016, Professor Manfred Nowak was designated as the
Independent Expert to lead the Global Study development. The Independent Expert
submitted his final report on the Study (A/74/136) to the General Assembly during its
seventy-fourth session and presents his main findings, conclusions and recommendations to
the Third Committee of the General Assembly on 8 October 2019.

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UNGA – A/74/136
Promotion and protection of the rights of children
11 July 2019
A. General recommendations [p.18]
98. The Independent Expert strongly recommends that States make all efforts to significantly reduce the number of children held in places of detention and prevent deprivation of liberty before it occurs, including addressing the root causes and pathways leading to deprivation of liberty in a systemic and holistic manner.

99. To address the root causes of deprivation of liberty of children, States should invest significant resources to reduce inequalities and support families to empower them to foster the physical, mental, spiritual, moral and social development of their children, including children with disabilities.

100. In all decisions that may lead to the detention of children, the Independent Expert calls upon States to most rigorously apply the requirement of article 37 (b) of the Convention on the Rights of the Child that deprivation of liberty shall be applied only as a measure of last resort in exceptional cases, and that the views of children shall be heard and taken duly into account.

101. The Independent Expert calls upon States to repeal all laws and policies that permit the deprivation of liberty of children on the basis of an actual, or perceived, impairment.

102. If detention is unavoidable under the particular circumstances of a case, it shall be applied only for the shortest appropriate period of time. States have an obligation to apply child-friendly conditions, without any discrimination. Children shall not be exposed to neglect, violence, sexual abuse or exploitation, ill-treatment, torture and inhuman conditions of detention. States should ensure that children have access to essential services aimed at their rehabilitation and reintegration into society, including education, vocational training, family contacts, sports and recreation, adequate nutrition, housing and health care. Health services in detention shall be of a standard equivalent to that available in the community at large.

103. Since children have the right under article 12 of the Convention on the Rights of the Child to actively participate in all matters directly affecting their lives, they shall be empowered to influence decisions relating to their treatment and enjoyment of such essential services and have the right to effective remedies, as well as to lodge complaints to an independent and impartial authority on any grievances and human rights violations during detention. Furthermore, States are strongly encouraged to ratify the third Optional Protocol to the Convention on the Rights of the Child on a communications procedure, enabling children to further seek redress for violations of their rights.

104. States are strongly encouraged to ratify the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and to establish independent and effective national preventive mechanisms with a particular expertise, to conduct visits to places where
children are, or may be, deprived of liberty.

105. States should enhance the capacity, by means of investing in human resources, awareness-raising and systematic education and training, of all professionals who work with and for children in decisions leading to their deprivation of liberty, and those who are responsible for their well -being while in detention. This applies to the police, judges, prosecutors, prison guards, psychiatrists, medical personnel, psychologists, educators, probation officers, social workers, child protection and welfare officers, asylum and migration personnel and any other individuals in contact with children at risk of
deprivation, or deprived, of liberty.

106. States are strongly encouraged to establish an appropriate system of data collection at the national level, involving all relevant ministries and other State agencies, coordinated by a focal point. Whenever possible, data on children should be obtained directly from them in accordance with the principle of informed consent and self-identification. When necessary, such information should be supplemented by data concerning their parents or primary caregivers.

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 71: 10 December 2019
Situation Update
In the week of 2 to 8 December 2019, eleven new confirmed Ebola virus disease (EVD) cases were reported from four health zones in North Kivu and Ituri provinces in Democratic Republic of the Congo… As of 8 December 2019, a total of 3324 EVD cases were reported, including 3206 confirmed and 118 probable cases, of which 2209 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (1873) were female, 28% (939) were children aged less than 18 years, and 5% (164) were healthcare workers…

…Vaccines
:: From 8 August 2018 to 10 December 2019, 256 381 persons were vaccinated with the rVSV-ZEBOV-GP Ebola vaccine.

:: Vaccination with the Johnson & Johnson vaccine (Ad26.ZEBOV/MVA-BN-Filo) continued in the Karisimbi Health Zone, with 1300 people vaccinated as of 10 December 2019 since its introduction on 14 November 2019.

:: In the last 21 days (date of confirmation 17 November – 9 December 2019), there have been 12 rings opened covered the 35 reported cases.

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Johnson & Johnson Announces Commitment to Support Republic of Rwanda’s Preparedness Against Ebola Outbreak
Up to 200,000 Regimens of Janssen’s Investigational Ebola Vaccine to be Supplied to Rwanda for Use in Border Region near Democratic Republic of the Congo (DRC)
NEW BRUNSWICK, N.J., Dec. 8, 2019 /PRNewswire/ — Johnson & Johnson (NYSE: JNJ) today announced that its Janssen Pharmaceutical Companies will provide up to 200,000 Ebola vaccine regimens to the Republic of Rwanda. This commitment will support a new immunization program led by the Rwanda Government that aims to help protect the country’s citizens from the Ebola outbreak in neighboring Democratic Republic of the Congo (DRC). The first batches of Janssen vaccine have been delivered to the country, and further shipments are being organized.
On July 17, 2019, the World Health Organization (WHO) declared the DRC Ebola outbreak a Public Health Emergency of International Concern (PHEIC). More than 3,300 cases, including more than 2,200 deaths, have been reported to date, making the outbreak second only to the 2014-2016 West Africa epidemic, and raising concerns about its potential to cross international borders. In October, the Johnson & Johnson announced that the DRC would begin using the Janssen investigational vaccine as part of an expanded response to the outbreak.
“Johnson & Johnson recognizes the Rwandan Government’s decision to proactively deploy Janssen’s investigational Ebola vaccine to help prevent the spread of the disease into the country,” said Paul Stoffels, M.D., Vice Chairman of the Executive Committee and Chief Scientific Officer of Johnson & Johnson. “We stand ready to support Rwanda’s initiative on epidemic preparedness.”…

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 11 December 2019

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan — three WPV1 cases, nine WPV1 positive environmental samples and nine cVDPV2 positive environmental samples;
:: Democratic Republic of the Congo (DR Congo) — three cVDPV2 cases;
:: Angola — 12 cVDPV2 cases and two cVDPV2 positive environmental samples;
:: Ethiopia — two cVDPV2 cases;
: Malaysia — one cVDPV1 case;
:: Philippines — one cVDPV1 case and three cVDPV2 cases

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 14 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 71: 10 December 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 14 Dec 2019]

Iraq
:: Iraqi cancer data for 2017‒2018 announced  9 December 2019 ‒ Recently announced data from Iraq’s national cancer registry indicate that there are over 31,500 cancer and tumor-related cases in Iraq as of 2017‒2018. Cancer is considered one of the leading causes of mortality in the country, contributing to an estimated 11% of total deaths…

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 14 Dec 2019]

Djibouti
:: Djibouti mène une campagne de vaccination de masse pour protéger les enfants contre la poliomyélite tandis que des flambées sévissent dans la Corne de l’Afrique
5 décembre 2018 – L’analyse préliminaire des données de la campagne indique le succès d’une tournée de vaccination dans un pays exempt de poliomyélite confronté à un risque d’importation.
Au cours de la dernière semaine du mois d’octobre, le ministère de la Santé de Djibouti, en collaboration avec l’OMS, l’UNICEF et d’autres partenaires, a mené avec succès les premières journées nationales de vaccination antipoliomyélitique conduites dans le pays depuis 2015…

Chad – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: 10 Dec 2019 Kassala, Sudan: Life with hard choices

EBOLA OUTBREAK IN THE DRC
:: République démocratique du Congo Rapport de situation, 13 décembre 2019
FAITS SAILLANTS (13 déc. 2019)
:: Au moins 600 000 personnes sont estimées être affectées par des inondations dans 12 provinces, causées par des pluies diluviennes survenues en octobre
:: Des besoins importants sont rapportés, en particulier dans les secteurs de l’eau, hygiène assainissement, abris/ articles ménagers essentiels, sécurité alimentaire et santé
:: La réponse à l’impact de ces inondations est coordonnée par le Gouvernement de la RDC au niveau central et provincial, avec l’appui des acteurs humanitaires.
:: Des activités d’assistance sont en cours ou en préparation par les acteurs humanitaires dans 8 des12 provinces affectées, mais de nombreux besoins ne sont pas couverts.
:: Alors que la décrue a commencé, il est essentiel de privilégier une approche visant à soutenir les mécanismes de résilience de la population déjà existants

 

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The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 7 December 2019

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF: The Sentinel_ period ending 7 Dec 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

Attacks on multilateral system threaten global peace and security – The Elders

Governance – Multilateral System

Attacks on multilateral system threaten global peace and security
The Elders – 03 Dec 2019
The multilateral system is under unprecedented attack. Isolationist and arbitrary actions by leading powers, including the United States, are threatening to undermine critical efforts to tackle global challenges from nuclear disarmament and non-proliferation to climate change, and the regulation of international trade.

The Elders urge all world leaders to acknowledge that effective multilateralism is in their own national interest, regardless of size or strength. Getting others to cooperate by means of internationally-agreed mechanisms is less costly and more reliable than unilateral force.

Yet since 2017, the US has: withdrawn from the Paris Agreement on Climate Change; pulled out of the Iranian nuclear deal; left the UN Human Rights Council and UNESCO; abandoned the Intermediate-Range Nuclear Forces (INF) Treaty; unilaterally imposed trade barriers; and concurrently blocked the appointment of new judges at the World Trade Organization.

As an immediate step, WTO member states must respond to persistent US intransigence by appointing without further delay the necessary new judges to the Appellate Body by majority voting, to avoid the collapse of the WTO’s entire dispute settlement capability.

Following the formal US notification of its withdrawal from the Paris Agreement, all other signatories must now use the upcoming COP 25 summit in Madrid to urgently step up their climate action and ambition. Countries must cut carbon emissions more drastically and quickly than in previously-submitted pledges, and also adopt rigorous monitoring of compliance with such commitments.

The network of international covenants and institutions agreed and constructed since the end of the Second World War, with the United Nations at its core, is far from perfect. But it has nevertheless decisively supported the pursuit of peace, security and the protection of human rights, as well as economic and social progress across the globe, for over seven decades.

It is a sad irony that the multilateral system’s principal assailant, the US, is the very country that led the design and construction of its institutions in the 1940s and benefited enormously from it in the subsequent decades.

To make matters worse, the response by other influential powers has too often been erratic, uncoordinated and counter-productive. Most have opted to negotiate bilaterally with the US to try to resolve crises, further eroding existing multilateral frameworks.

This is myopic and self-harming. A regression from a rules-based system into power-based strategies will not result in a safer, more predictable or propitious environment for any country.

Without a concerted commitment to defend multilateralism, we will not bequeath a safe world to future generations. They will neither forget nor forgive such a collective failure.

UN asks the world to invest $29 billion in humanity in 2020

UN asks the world to invest $29 billion in humanity in 2020
:: A record 168 million people worldwide will need humanitarian assistance and protection in 2020.
:: Protracted conflicts, extreme weather events and crumbling economies have pushed millions to the brink of survival.
:: Humanitarian organizations today present their plans for how to respond and what it will cost.

(Geneva, 4 December 2019) – The United Nations in collaboration with hundreds of non-governmental humanitarian organizations today present the global overview of their plans to assist 109 million of the most vulnerable people caught up in humanitarian crises worldwide.

The Global Humanitarian Overview (GHO) 2020 is launched simultaneously in five locations – Geneva, Berlin, Brussels, London and Washington DC.

One in every 45 people on the planet are in need of food, shelter, health care, emergency education, protection or other basic assistance. The global humanitarian community stands ready to help and counts on the international community’s continued generosity to help them save more lives and alleviate human suffering in crises spanning 53 countries from Afghanistan to Zambia…

Comparable figures show that the number of people in need globally has increased by some 22 million over the past year. The main drivers of need are protracted and highly violent conflicts, extreme weather events associated with climate change and under-performing economies. The plans set out in the GHO 2020 aim to reach 109 million vulnerable people with aid and protection. The combined requirements are nearly US$29 billion.

“The brutal truth is 2020 will be difficult for millions of people. The good news is that the humanitarian response is getting better and faster in reaching the most vulnerable, including women, children and people with disabilities,” Emergency Relief Coordinator Mark Lowcock said, launching the GHO 2020 in Geneva…

In 2019, more people than forecasted needed humanitarian assistance, mostly because of conflicts and natural disasters. Donors generously provided a record $16 billion for inter-agency appeals between January and November 2019. Aid groups reached 64 per cent of the people targeted to receive aid through Humanitarian Response Plans in 22 of the countries for which data were available.

The GHO 2020 is available online http://unocha.org/GHO2020

Note to Editors
[1] The Global Humanitarian Overview 2020 is based on Humanitarian Response Plans in Afghanistan, Burkina Faso, Burundi, Cameroon, Сentral African Republic, Chad, Democratic Republic of the Congo, Ethiopia, Haiti, Iraq, Libya, Mali, Myanmar, Niger, Nigeria, occupied Palestinian territories, Somalia, South Sudan, Sudan, Syria, Ukraine, Venezuela and Yemen.
[2] Other types of inter-agency plans are included for Bangladesh, DPR Korea and Venezuela/Regional.
[3] The GHO also includes Regional Refugee Response Plans for Burundi, Democratic Republic of the Congo, Nigeria, South Sudan and Syria.

IRC: Failure to end civil war in Yemen could cost $29 billion

Yemen

Failure to end civil war in Yemen could cost $29 billion
IRC Press Release
Sana’a, Yemen, December 2, 2019 — Almost one year since the Stockholm agreement, the war in Yemen continues unabated. New International Rescue Committee research highlights the devastating impact of continued conflict on ordinary Yemenis. The international community must push the warring parties to build on a rare window of opportunity for peace to secure a nationwide ceasefire.

:: At the current rate of decline, it will take 20 years to return Yemen to pre-crisis levels of child hunger.
:: If the war continues for another five years it will cost the international community as much as $29 billion in humanitarian funding – more than the entire annual humanitarian budget globally.
:: The IRC is calling on members of the UN Security Council to use their significant diplomatic influence to build on recent political developments and kick-start UN-led negotiations.
:: The IRC reaches more than 21,000 people each week with healthcare and nutrition services, women’s protection and empowerment programs and education for children.

The IRC released a new report today detailing the devastating consequences a continuation of the war will have for the people of Yemen. “The War Destroyed Our Dreams” shows that at the current rate of decline, it will take 20 years for the country to return to pre-war levels of child malnutrition, which were already amongst the worst in the world. Another five years of fighting will cost the international community as much as $29 billion USD just to sustain the current level of humanitarian aid.

Recent developments in Yemen suggest a rare window of opportunity has opened to push for peace. The recent power sharing agreement between the Internationally Recognized Government (IRG) and the Southern Transitional Council (STC) offers hope for more inclusive peace talks. However, this is far from assured. World leaders must invest in diplomacy and put their full focus on bringing together warring parties for negotiations. A nationwide ceasefire is needed immediately to avoid further catastrophe…

Educational Attainment :: Young people struggling in digital world, finds latest OECD PISA survey

Educational Attainment

PISA [Program for International Student Assessment] 2018 Results
The OECD Programme for International Student Assessment (PISA) examines what students know in reading, mathematics and science, and what they can do with what they know. It provides the most comprehensive and rigorous international assessment of student learning outcomes to date. Results from PISA indicate the quality and equity of learning outcomes attained around the world, and allow educators and policy makers to learn from the policies and practices applied in other countries. This is one of six volumes that present the results of the PISA 2018 survey, the seventh round of the triennial assessment.

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Young people struggling in digital world, finds latest OECD PISA survey
03/12/2019 –
One in four students in OECD countries are unable to complete even the most basic reading tasks, meaning they are likely to struggle to find their way through life in an increasingly volatile, digital world. This is one of the findings of the OECD’s latest PISA global education test, which evaluates the quality, equity and efficiency of school systems.

The OECD’s PISA 2018 tested around 600,000 15-year-old students in 79 countries and economies on reading, science and mathematics. The main focus was on reading, with most students doing the test on computers.

Most countries, particularly in the developed world, have seen little improvement in their performances over the past decade, even though spending on schooling increased by 15% over the same period. In reading, Beijing, Shanghai, Jiangsu and Zhejiang (China), together with Singapore, scored significantly higher than other countries. The top OECD countries were Estonia, Canada, Finland and Ireland…

The share of students with only very basic reading skills highlights the challenge countries, including those in the developed world, face in achieving the United Nations Sustainable Development Goals for 2030 (SDGs), particularly in relation to “ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all.” (SDG 4). The share of low-performers, both girls and boys, also increased on average between 2018 and 2009, the last time reading was the main focus of PISA…

Around 1 in 10 students across OECD countries, and 1 in 4 in Singapore, perform at the highest levels in reading. However, the gap between socio-economically advantaged and disadvantaged students is stark: the reading level of the richest 10% of students in OECD countries is around three years ahead of the poorest 10%. In France, Germany, Hungary and Israel, the gap is four years.

Yet some countries have shown an impressive improvement over the past few years. Portugal has advanced to the level of most OECD countries, despite being hit hard by the financial crisis. Sweden has improved across all three subjects since 2012, reversing earlier declines. Turkey has also progressed while at the same time doubling the share of 15-year-olds in school.

The latest PISA findings also reveal the extent to which digital technologies are transforming the world outside of school. More students today consider reading a waste of time (+ 5 percentage points) and fewer boys and girls read for pleasure (- 5 percentage points) than their counterparts did in 2009. They also spend about 3 hours outside of school online on weekdays, an increase of an hour since 2012, and 3.5 hours on weekends…

Around one in four students in OECD countries, on average, do not attain the basic level of science (22%) or maths (24%). This means that they cannot, for example, convert a price into a different currency…

Girls significantly outperformed boys in reading on average across OECD countries, by the equivalent of nearly a year of schooling. Across the world, the narrowest gaps were in Argentina, Beijing, Shanghai, Jiangsu and Zhejiang (China), Chile, Colombia, Costa Rica, Mexico, Panama and Peru. Boys overall did slightly better than girls in maths but less well in science…

One in four students in OECD countries are unable to complete even the most basic reading tasks, meaning they are likely to struggle to find their way through life in an increasingly volatile, digital world…

Ensuring access to affordable, timely vaccines in emergencies

Featured Journal Content

Bulletin of the World Health Organization
Volume 97, Number 12, December 2019, 789-856
https://www.who.int/bulletin/volumes/97/12/en/
PERSPECTIVES
Ensuring access to affordable, timely vaccines in emergencies
— Kate Elder, Barbara Saitta, Tanja Ducomble, Miriam Alia, Ryan Close, Suzanne Scheele, Elise Erickson, Rosalind Scourse, Patricia Kahn & Greg Elder
http://dx.doi.org/10.2471/BLT.18.228585
Vaccination is an effective intervention to reduce disease, disability, death and health inequities worldwide. Over the last two decades, vaccines have become more accessible in low-income countries; however, significant gaps remain, particularly in humanitarian emergencies, where populations face increased risks of many diseases. In 2013, the World Health Organization (WHO) published Vaccination in acute humanitarian emergencies: a framework for decision-making, to provide guidance on which vaccines to prioritize during emergencies.1 However, substantial obstacles, especially high prices for new vaccines, hinder implementation of this framework and of critical vaccination activities in emergency settings.

In response to these challenges, global health stakeholders held a series of consultations in 2016 and proposed a WHO-based mechanism, the Humanitarian Mechanism, for the rapid procurement of affordable vaccines during emergencies, to be used by nongovernmental organizations (NGOs), civil society organizations, United Nations (UN) agencies and governments.
Here we present the background of the creation of the mechanism from the perspective of Médecins Sans Frontières (MSF), including a description of our past challenges in accessing affordable pneumococcal conjugate vaccine (PCV; Box 1), a critical vaccine during many emergencies. We then describe how the mechanism has so far facilitated access to more affordable PCV and outline steps that could increase its potential for saving lives…

Next steps
Building on these initial successes, we see three critical elements of the mechanism, which if fully implemented, could greatly enhance its impact.

First, the mechanism needs to be better known among global health actors, including UN agencies and NGOs, who should be encouraged to use it under appropriate circumstances.

Second, while the mechanism’s terms of reference includes use by governments responding to emergencies,8 conditions attached to the PCV pledges discussed here (the only pledges to the mechanism so far) exclude governmental use. Manufacturers should allow governments to access the mechanism during emergencies to procure critical vaccines needed to protect their populations. Many middle-income countries already grapple with high vaccine prices for routine immunization programmes and may find the cost of extending vaccination to influxes of displaced people during emergencies prohibitive. While Gavi adopted a fragility, emergencies and refugees policy in June 2017 to allow more flexible use of Gavi-supported vaccine doses in specific contexts, strict criteria exist for how and where this flexibility can be applied, and it can only cover Gavi-eligible countries.12

Finally, the types of vaccines pledged to the mechanism by manufacturers should be expanded: the only commitments to date are for pneumococcal conjugate vaccines. Current and future manufacturers should commit other vaccines with affordability and accessibility challenges to the mechanism, so they can be procured rapidly at the lowest global price

Conclusion
The mechanism is a significant step forward in delivering life-saving vaccines to populations caught in emergencies and conflict. The mechanism’s mandate is strengthened by multiple organizations recognizing the gap between existing technical guidelines and constraints on their implementation, that is, the lack of rapidly available, affordable vaccines. While the mechanism does not address the broader systemic failures of the vaccine market, it was created to specifically address the failure of the global vaccine market to meet relatively small, urgent vaccine procurement needs efficiently and affordably. Further steps are needed for the mechanism to reach its full potential; however, it already provides a critical platform during humanitarian crises for expanding the number of people who can receive life-saving vaccines.

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 70: 03 December 2019
Situation Update
In the week of 25 November to 1 December 2019, 10 new confirmed EVD cases were reported from two health zones in two affected provinces in the Democratic Republic of the Congo. The confirmed cases in this week came from Mabalako (50%, n=5) and Mandima (50%, n=5) Health Zones.
In the past week, violence, widespread civil unrest, and targeted attacks have severely disrupted the Ebola response and restricted access to affected communities in multiple locations.
On the night of 27 November 2019, an attack on the Ebola response camp in Biakato Mines resulted in the death of three responders and the injury of seven others. Response personnel in Biakato were relocated to Goma, and the majority of response activities in the area have been suspended. On the same night, a separate attack on the Ebola coordination office in Mangina resulted in one death. Most response personnel in Mangina have also been relocated. As of 2 December 2019, North Kivu Province has declared ‘ville morte’ and many response activities have been suspended across the province.
As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they may result in increased transmission…

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WHO Director-General praises bravery of health workers during visit to eastern Democratic Republic of Congo following fatal attacks on Ebola responders
1 December 2019 News release

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Democratic Republic of Congo
As security situation deteriorates, MSF withdraws staff from Biakato
Statement 6 Dec 2019
On 4 December 2019, Medecins Sans Frontières (MSF) took the painful decision to temporarily withdraw our staff from the Biakato region of Ituri province, Democratic Republic of Congo. After months of working extremely closely with the community to address the health needs in the region, MSF is saddened to have made this decision….

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Gavi Board approves new Ebola vaccine programme
New Delhi, 5 December 2019 – A global emergency stockpile of Ebola vaccines will be available to countries for outbreak response and prevention following the approval of a new Ebola vaccine programme by the Board of Gavi, the Vaccine Alliance, which met this week in New Delhi, India.

Gavi will open a new funding window, with estimated investment of US$ 178 million between now and 2025 for the new Ebola vaccine programme. Gavi-supported low- and middle-income countries will be able to access the stockpile free of charge and will receive support for the operational costs of vaccination campaigns. Wealthier countries will be able to access vaccines but will be expected to self-finance.

As well as creating the emergency stockpile, Gavi will also support targeted preventative vaccination outside of an outbreak in high-risk populations, such as health workers, in countries at risk. The target populations and scope of countries will be based on future recommendations by the WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE).

“Today, I think about Ebola victim Dr Ameyo Adadevoh, a true vaccine hero who died stopping the Ebola virus from spreading in Nigeria and we should all be excited by the Alliance decision,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “This is a historic milestone in humanity’s fight against this horrific disease. Just five years ago we faced an Ebola outbreak in West Africa with no vaccine and no way to treat the disease. Today, thanks to the heroic efforts of countless patients, health workers, scientists, manufacturers, donors, partners as well as the leadership of African countries, we now have one vaccine approved for use and more on their way, as well as rapid diagnostics and several promising treatments. With these tools at our disposal, the battle against Ebola can be won, and I’m proud of the role Gavi has played in this.”
The W
HO’s SAGE Working Group on Ebola Vaccines and Vaccination has provided guidance that the global emergency stockpile should be maintained at 500,000 licensed doses of vaccines. The price of Ebola vaccines funded by Gavi will be defined as part of a tender process managed by UNICEF, as Gavi’s partner and procurement agency.

There are currently eight candidate Zaire Ebolavirus vaccines at different phases of development. This includes Merck’s vaccine currently being used under compassionate use as part of the response to the ongoing DRC outbreak, which has recently received conditional marketing approval from the European Commission and prequalification from the WHO. More than 250,000 people have received it since the outbreak started in August last year. Moreover, close to a thousand people have received a second candidate vaccine manufactured by Johnson & Johnson as part of a study in North Kivu, DRC.

“The Ebola vaccine has shown extraordinary efficacy in tackling the outbreak in the DRC,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This achievement demonstrates the Alliance at its best. Now that funding has been approved, we will get to work with manufacturers and our Alliance partners to build the stockpile. It will be critical for Gavi to secure enough funding for the 2021-2025 period to maintain this Ebola vaccine programme in order to protect people, health systems and economies that may be threatened by this devastating disease in the future.”

A coordinating mechanism to decide how and when the vaccine stockpile will be deployed will be established with partner organisations.

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::::::

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 04 December 2019
:: To provide an insight on the status of polio eradication efforts as at September 2019, the WHO Director-General’s report on polio eradication to the upcoming Executive Board (EB) meeting has been published here. Available in six languages, the report summarizes the programmatic, epidemiological and financial challenges to securing a lasting polio-free world.

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan — one WPV1 case and one WPV1 positive environmental sample;
:: Pakistan — 25 WPV1 positive environmental samples;
:: Angola — 16 cVDPV2 cases and four cVDPV2 positive environmental samples.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 7 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 70: 03 December 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 7 Dec 2019]

Angola
:: WHO supports Angola’s Government efforts to end polio outbreak 02 December 2019

Afghanistan – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 7 Dec 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: 06 December 2019 Southern Africa: Humanitarian Key Messages, December 2019

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 30 November 2019

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
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF: The Sentinel_ period ending 30 Nov 2019

Contents
:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

ILO – More than 500 billion dollars a year needed to ensure basic levels of social protection worldwide

Social Protection

Press Release
More than 500 billion dollars a year needed to ensure basic levels of social protection worldwide
25 November 2019
GENEVA (ILO News) – More than US$500 billion a year needs to be invested if countries are to meet a basic set of social protection measures – known as a social protection floor – by 2030, says a new ILO report.

According to the report, spending on coverage needs to increase dramatically to achieve universal coverage of a basic set of social protection measures. This would include:
:: Cash transfers to children
:: Maternity benefits for mothers with newborns
:: Disability benefits
:: Old age social pensions

Based on research carried out in 134 countries, the findings show that at current levels social protection covers only 8.5 per cent of children and 15.3 per cent of older persons in low-income countries. By contrast, in upper-middle income countries 35 per cent of children and 90 per cent of older persons are covered…

Many middle- or upper-middle-income countries have the domestic capacity to generate the resources to finance a universal social protection floor, say the report’s authors. However, substantial amounts of overseas development aid will be needed to close the financing gap in the 28 low-income countries covered in the research, to achieve universal coverage by 2030.

According to the report the low-income countries would need to spend 5.6 per cent (US$27 billion per year) of their Gross Domestic Product (GDP) to close the financing gap. The lower middle-income countries would need to earmark 1.9 per cent of GDP (US$ 136 billion per year), whereas the upper-middle income countries would need to spend 1.4 per cent of their GDP (US$ 365 billion per year).

Policy options to create the necessary financing presented in the report include, among others, increasing tax revenue, extending social security coverage and contributions, increasing official development assistance (ODA) with priority given to low-income countries, and eliminating illicit financing flows.

“Promoting the extension of contributory social insurance coverage to workers in the informal economy, in countries where social insurance is still underdeveloped, would create additional revenues of 1.2 per cent of the GDP of these countries,” said Fabio Duran-Valverde, Head of the Public Finance, Actuarial and Statistics Unit.

.

ILO Working paper
Measuring financing gaps in social protection for achieving SDG target 1.3: Global estimates and strategies for developing countries
25 November 2019 :: 58 pages
F. Durán Valverde; J. Pacheco-Jiménez; T. Muzaffar; H. Elizondo-Barboza
PDF: https://www.ilo.org/wcmsp5/groups/public/—ed_protect/—soc_sec/documents/publication/wcms_729111.pdf
Social security is a human right but it is not yet a reality. Only 45 per cent of the global population are effectively covered by at least one social protection benefit, while the remaining 55 per cent – as many as 4 billion people – are unprotected. Closing the coverage gap will require additional investments in social protection, which can and should be achieved by increasing the “fiscal space” for social protection.

IOM – World Migration Report 2020

Migration

World Migration Report 2020
IOM
2019 :: 496 pages
ISSN: 1561-5502 E-ISBN: 978-92-9068-789-4
PDF: https://publications.iom.int/system/files/pdf/wmr_2020.pdf
Since 2000, IOM has been producing world migration reports. The World Migration Report 2020, the tenth in the world migration report series, has been produced to contribute to increased understanding of migration throughout the world. This new edition presents key data and information on migration as well as thematic chapters on highly topical migration issues, and is structured to focus on two key contributions for readers: Part I: key information on migration and migrants (including migration-related statistics); and Part II: balanced, evidence-based analysis of complex and emerging migration issues.

This flagship World Migration Report has been produced in line with IOM’s Environment Policy and is available online only. Printed hard copies have not been made in order to reduce paper, printing and transportation impacts.

Highlights from Part I: Data and information on migration and migrants
The number of international migrants globally in 2019: 272 million (3.5% of the world’s population)
• 52 per cent of international migrants were male; 48 per cent were female.
• 74 per cent of all international migrants were of working age (20–64 years).

India continued to be the largest country of origin of international migrants
• India had the largest number of migrants living abroad (17.5 million), followed by Mexico and
China (11.8 million and 10.7 million respectively).
• The top destination country remained the United States (50.7 million international migrants).

The number of migrant workers declined slightly in high income countries while increasing elsewhere
• Between 2013 and 2017, high-income countries experienced a slight drop in migrant workers
(from 112.3 million to 111.2 million). Upper middle-income countries observed the biggest
increase (from 17.5 million to 30.5 million).
• Globally, male migrant workers outnumbered female migrant workers by 28 million in 2017.
There were 96 million male migrant workers (58%) and 68 million female migrant workers (42%).

International remittances increased to USD 689 billion in 2018
• The top 3 remittance recipients were India (USD 78.6 billion), China (USD 67.4 billion) and
Mexico (USD 35.7 billion).
• The United States remained the top remittance-sending country (USD 68.0 billion) followed by
the United Arab Emirates (USD 44.4 billion) and Saudi Arabia (USD 36.1 billion).

The global refugee population was 25.9 million in 2018
• 20.4 million refugees were under the mandate of the United Nations High Commissioner for
Refugees (UNHCR) and 5.5 million were refugees under the mandate of the United Nations
Relief and Works Agency for Palestine Refugees (UNRWA) in the Near East.
• 52 per cent of the global refugee population was under 18 years of age.

The number of internally displaced persons due to violence and conflict reached 41.3 million
• This was the highest number on record since the Internal Displacement Monitoring Centre
began monitoring in 1998.
• The Syrian Arab Republic had the highest number of people displaced (6.1 million) followed by
Colombia (5.8 million) and the Democratic Republic of the Congo (3.1 million).

The number of stateless persons globally in 2018 was 3.9 million
• Bangladesh had the largest number of stateless persons (around 906,000). It was followed by
Côte d’Ivoire (692,000) and Myanmar (620,000).

Migration patterns vary from region to region
• While most international migrants born in Africa, Asia and Europe reside within their regions
of birth, the majority of migrants from Latin America and the Caribbean and Northern America
reside outside their regions of birth. In Oceania, the number of intraregional migrants and those
residing outside the region remained about the same in 2019.
• More than half of all international migrants (141 million) lived in Europe and Northern America.

Migration has been a key determinant of population change in several countries
• Intraregional migration has been an important contributor to population change in some African
countries such as Equatorial Guinea.
• Labour migration has contributed to significant population changes especially in Gulf Cooperation
Council (GCC) States. With the exceptions of Oman and Saudi Arabia, migrants made up the
majority of the populations in GCC countries.

Displacement remained a major feature in some regions
• The Syrian Arab Republic and Turkey were the origin and host of the largest number of
refugees globally, 6.7 million and 3.7 million, respectively. Canada became the largest refugee
resettlement country, resettling more refugees than the United States in 2018.
• The Philippines had the largest number of new disaster displacements in 2018 (3.8 million).
• Around 4 million Venezuelans had left their country by mid-2019. The Bolivarian Republic of
Venezuela was the largest source country of asylum seekers in 2018 (over 340,000).

Migration research and analysis output remained high
• There was a continued increase in the number of migration-related academic publications, with
the largest ever academic output produced during the last two years. There was significant
output from international organizations on a wide range of migration issues.
• Academic output on migration is dominated with perspectives from destination countries,
especially in relation to Europe. A geographic comparison of the primary affiliations of authors
in selected journals shows that most are from institutions in developed countries.

NAS – Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators

Policy/Regulation

Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators
National Academies of Sciences, Engineering, and Medicine; doi.org/10.17226/25594.
Alastair Wood and Patricia Cuff, Editors
November 2019 :: 160 pages
Open Access – PDF: https://www.nap.edu/login.php?record_id=25594&page=https%3A%2F%2Fwww.nap.edu%2Fdownload%2F25594
Description
Globalization is rapidly changing lives and industries around the world. Drug development, authorization, and regulatory supervision have become international endeavors, with most medicines becoming global commodities. Drug companies utilize global supply chains that often include facilities in countries with inconsistent regulations from those of the United States, perform pivotal trials in multiple countries to support registration submissions in various jurisdictions, and subsequently market their medicines throughout most of the world. These companies operate across borders and require individual national regulators to ensure that drugs authorized for use in their countries are safe and effective, and appropriate for their health care system and their population. This process involves significant resources and often duplicative work. It is important to consider how this process can be improved in order to better allocate resources, time, and efforts to improve public health.

Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators considers the role of mutual recognition and other reliance activities among regulators in contributing to enhancing public health. This report identifies opportunities for leveraging reliance activities more broadly in order to potentially impact public health globally. Key topics in this report include the job of medicines regulators in today’s world, what policy makers need to know about today’s regulatory environment, stakeholder views of recognition and reliance, as well as removing impediments and facilitating action for greater recognition and reliance among regulatory authorities.

Joint statement on EPA proposed rule and public availability of data (2019)

Featured Journal Content

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 Nov 2019)
Perspective
Joint statement on EPA proposed rule and public availability of data (2019)
H. Holden Thorp, Magdalena Skipper, Veronique Kiermer, May Berenbaum, Deborah Sweet, Richard Horton
| published 26 Nov 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1003014
Eighteen months after articulating our concerns [1] regarding the 2018 “Strengthening Transparency in Regulatory Science” rule proposed by the Environmental Protection Agency (EPA) [2], we have become more concerned in response to recent media coverage and a 13 November hearing on the role of science in decision-making at the EPA. These events suggest that the proposed rule is now moving toward implementation; whether it includes amendments sufficient to address the concerns raised by us and many others remains a question.

Our previous statement on the proposed rule, authored and published by the editors-in-chief of five major scientific journals in May 2018, reflected alarm that the proposal’s push for “transparency” would be used as a mechanism for suppressing the use of relevant scientific evidence in policy-making, including public health regulations. After the public comment period for the proposed rule closed, the EPA reported more than 590,000 comments from individuals and scientific, medical, and legal groups, many of which articulated similar concerns [3].

As leaders of peer-reviewed journals, we support open sharing of research data, but we also recognize the validity of scientific studies that, for confidentiality reasons, cannot indiscriminately share absolutely all data. Datasets featuring personal identifiers—including studies evaluating genomes of thousands of people to characterize medically relevant genetic variants—are but one example. Such data may be critical to developing new drugs or diagnostic tools but cannot be shared openly; even anonymized personal data can be subject to re-identification, and it has been a longstanding practice for agencies and journals to acknowledge the value of data privacy adjustments. The principles of careful data management, as they inform medicine, are just as applicable to data regarding environmental influences on public health. Discounting evidence from the decision-making process on the basis that some data is confidential runs counter to the EPA stated mission “to reduce environmental risks…based on the best available scientific information” [4].

We are also concerned about how the agency plans to consider options related to existing regulations. Even if a new standard is not applied retroactively, the standard could apply when a regulation is updated; thus, foundational science from years past—research on air quality and asthma, for example, or water quality and human health—could be deemed by the EPA to be insufficient for informing our most significant public health issues. That would be a catastrophe.

We urge the EPA to continue to adopt an approach that ensures the data used in decision-making are the best available, which will at times require consideration of peer-reviewed scientific data, not all of which may be open to all members of the public. The most relevant science, vetted through peer review, should inform public policy. Anything less will harm decision-making that claims to protect our health.

We hope that in the end, decisions that are made to inform the proposed EPA rule will rise above any form of politics, focusing on what’s best for our communities. We encourage anyone with concerns or opinions about this issue to express their views through relevant legislative channels. Whether submitting public comments to the EPA or communicating with lawmakers in Congress, it is important to emphasize that decision-making that affects us all should be informed by nothing less than the full suite of relevant science vetted through peer review.

References at title link above
1. Berg J, Campbell P, Kiermer V, Raikhel N, Sweet D. Joint statement on EPA proposed rule and public availability of data. Science. 2018; 360: 6388. 10.1126/science.aau0116.
2. U.S. Environmental Protection Agency, News Releases. EPA Administrator Pruitt proposes rule to strengthen science used In EPA regulations. 24 Apr 2018. Available from: www.epa.gov/newsreleases/epa-administrator-pruitt-proposes-rule-strengthen-science-used-epa-regulations.
3. U.S. Environmental Protection Agency, Science Advisor Programs. Strengthening transparency in regulatory science. 30 Apr 2018. Available from: www.epa.gov/osa/strengthening-transparency-regulatory-science.
4. U.S. Environmental Protection Agency. Our mission and what we do. 2018. Available from: www.epa.gov/aboutepa/our-mission-and-what-we-do.

Lancet Editorial – Research integrity: time for global action

Featured Journal Content

The Lancet
Nov 30, 2019 Volume 394 Number 10213 p1965-2038, e38
https://www.thelancet.com/journals/lancet/issue/current
Editorial
Research integrity: time for global action
The Lancet
China has become a formidable global leader in scientific—including medical—research, with the world’s largest publication output, a rapid surge in the number of highly cited researchers, and an increasingly unparalleled quality of scientific publications. However, there is often a shadow hanging over any country’s progress, especially a nation that has advanced with spectacular velocity. China is no exception. And the current concern, escalated to the highest levels of the Chinese Government, is research integrity….

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The unfolding migrant crisis in Latin America
The Lancet
With the political crisis intensifying across Latin America, the difficulties in a region already struggling with massive migration and economic instability are becoming more complex. The number of people migrating across borders within this region has increased by 36% in the past 15 years, reaching 63·7 million in 2015; and of these migrants, 808 000 were defined as refugees, who are the most vulnerable type of migrants and often have insufficient access to appropriate health services. People smuggled by human trafficking and victims of violence are among these migrants.

There are several reasons for migration. Established migrant flows (eg, from Peru to Chile) are driven by labour markets, whereas more recent migration flows (eg, from Venezuela to Colombia) are driven by political and economic instability. Climate change might also become a substantial driver of migration: the UN estimates that of the top 25 nations most at risk for natural disasters, eight are in Latin America and the Caribbean. Inadequate sanitation and shelter, lack of sufficient water and food, and overcrowding in transit centres might increase the risk of migrants acquiring communicable diseases. Without adequate surveillance measures, diseases that were once eradicated from a country can re-emerge. According to the UN, the 634 migrant deaths registered in 2019 in the Americas has already surpassed the number in 2018 (517), and 2019 might be the deadliest year on record for migrants in the region.

The global UN resolution adopted in 2018 urged cooperation among member states in protecting migrants. However, although it is laudable to have migrants’ right to health on the global agenda, Latin American countries are still struggling to improve their national health policies. To protect migrants from the increasing political instability in Latin America, preparedness is crucial. All governments must take their share of responsibility, fully commit, and coordinate efforts with non-governmental organisations and civil society to translate the global agreement on migration into national practices.

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 69: 26 November 2019
Situation Update
In the week of 18 to 24 November 2019, seven new confirmed EVD cases were reported from four health zones in two affected provinces in Democratic Republic of the Congo. The majority of the confirmed cases in this week came from Mabalako Health Zone (57%; n=4).

Violence and civil unrest in the week have led to the suspension of Ebola response activities in some areas of Beni, Butembo, and Oicha health zones. On 26 November 2019, some response personnel were temporarily relocated from Beni, though most remain in place to continue responding. The immediate focus will be on maintaining the safety and welfare of response personnel while preserving essential response activities in these places.

The disruptions to the response and lack of access to Ebola-affected communities is threatening to reverse recent progress. As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they often result in increased transmission…

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Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo
Attacks in eastern Democratic Republic of the Congo
28 November 2019 News release
Two attacks in eastern Democratic Republic of the Congo (DRC) have killed 4 workers responding to the Ebola outbreak and injured 5 others.
The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina.
We are heartbroken that people have died in the line of duty as they worked to save others,” said Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General. “The world has lost brave professionals.”
The dead include a member of a vaccination team, two drivers and a police officer. No WHO staff are among those killed, one staff member was injured.
“My heart goes out to the family and friends of the first responders killed in these attacks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and MONUSCO to ensure the security of our staff and other health workers.”…

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New England Journal of Medicine
Online November 27, 2019
DOI: 10.1056/NEJMoa1910993
Original Article
A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics
Sabue Mulangu, M.D., Lori E. Dodd, Ph.D., Richard T. Davey, Jr., M.D., Olivier Tshiani Mbaya, M.D., Michael Proschan, Ph.D., Daniel Mukadi, M.D., Mariano Lusakibanza Manzo, Ph.D., Didier Nzolo, M.D., Antoine Tshomba Oloma, M.D., Augustin Ibanda, B.S., Rosine Ali, M.S., Sinaré Coulibaly, M.D., Adam C. Levine, M.D., Rebecca Grais, Ph.D., Janet Diaz, M.D., H. Clifford Lane, M.D., Jean-Jacques Muyembe-Tamfum, M.D., and the PALM Writing Group for the PALM Consortium Study Team*
Abstract
Background
Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
Methods
We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase–polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.
Results
A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P=0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P=0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.
Conclusions
Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM ClinicalTrials.gov number, NCT03719586. opens in new tab.)

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Investigational Drugs Reduce Risk of Death from Ebola Virus Disease – NIH
Study Leaders Publish Results from NIH-DRC-WHO Clinical Trial of Four Experimental Therapies.
November 27, 2019
The investigational therapeutics mAb114 and REGN-EB3 offer patients a greater chance of surviving Ebola virus disease (EVD) compared to the investigational treatment ZMapp, according to published results from a clinical trial conducted in the Democratic Republic of the Congo (DRC). The new report also shows that early diagnosis and treatment are associated with an increased likelihood of survival from EVD.
The results appear online this week in the New England Journal of Medicine. An announcement made on August 12, 2019, noted that the study leaders halted the trial early, on August 9, 2019, as recommended by an independent data and safety monitoring board based on its review of preliminary data from 499 study patients. The preliminary analysis found that both mAb114 and REGN-EB3 performed better than ZMapp. The fourth drug, remdesivir, performed similarly to ZMapp. Today’s publication provides a comprehensive analysis of the full dataset from nearly 200 additional patients enrolled in the clinical study.
The clinical trial known as PALM, short for “Pamoja Tulinde Maisha,” a Kiswahili phrase that translates to “together save lives,” was organized by an international research consortium coordinated by the World Health Organization (WHO). It is led and funded by the DRC’s National Institute for Biomedical Research (INRB) and Ministry of Health, and the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. Professor Jean-Jacques Muyembe-Tamfum, M.D., Ph.D., director-general of the INRB and head of the DRC’s Ebola response, and Richard T. Davey, Jr., M.D., deputy director of NIAID’s Division of Clinical Research, are co-principal investigators for the study.
“Response teams have faced unprecedented challenges in ongoing efforts to save lives and control the outbreak of Ebola in a highly insecure region of the Democratic Republic of the Congo,” said NIAID Director Anthony S. Fauci, M.D. “Although effective treatments alone will not end this outbreak, the PALM study findings identify the first efficacious treatments for Ebola virus disease and therefore mark a significant step forward in improving care for Ebola patients. We thank the study team for their extraordinary efforts to conduct this landmark trial.”
The study enrolled 681 people with Ebola virus disease between November 2018 and August 2019 at four Ebola treatment centers (ETCs) in the cities of Beni, Butembo, Katwa and Mangina. Staff from The Alliance for International Medical Action (ALIMA), International Medical Corps (IMC), Médecins Sans Frontières/Doctors Without Borders (MSF) and the DRC Ministry of Health implemented the trial at the ETCs with support from Congolese staff, the World Health Organization, the Frederick National Laboratory for Cancer Research and The Mitchell Group.
The study was designed to compare mortality among patients who received one of three investigational Ebola drugs with that from a control group of patients who received the investigational monoclonal antibody cocktail ZMapp, developed by Mapp Biopharmaceutical, Inc. The other therapies were mAb114, a single monoclonal antibody product developed for clinical use by NIAID’s Vaccine Research Center and the INRB and licensed to Ridgeback Biotherapeutics and Mapp Biopharmaceutical; REGN-EB3, a monoclonal antibody cocktail developed by Regeneron Pharmaceuticals, Inc.; and remdesivir, an antiviral drug developed by Gilead Sciences, Inc. The Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services, also has provided support for the development of REGN-EB3, ZMapp and mAb114.
The four therapies are administered as intravenous infusions. REGN-EB3 and mAb114 are administered as single infusions and ZMapp and remdesivir are administered as infusions over multiple days. Study participants also received optimized supportive care, including oral and/or intravenous fluids, electrolyte replacement, monitoring of oxygen levels and blood pressure (with supportive measures as needed), blood transfusions, pain management, and antibiotics and antimalarials as indicated….
All four study drugs were generally well tolerated. There were a total of four serious adverse events that were judged to be potentially related to the experimental drugs. Three of these were in two of the patients who received ZMapp. One was in a patient who received remdesivir.
The authors note that despite encouraging findings regarding mAb114 and REGN-EB3, approximately one-third of patients who received these therapeutics died, highlighting the potential to improve upon these results, whether through further optimization of supportive care, combination therapy using agents with complementary mechanisms of action or other strategies.
“Despite unprecedented challenges — including an unstable electrical power grid and evacuations of staff and patients from treatment centers due to violent attacks — the PALM trial demonstrates that scientifically rigorous and ethically sound clinical research can be conducted during disease outbreaks,” said H. Clifford Lane, M.D., NIAID deputy director for Clinical Research and Special Projects. “We thank the patients and the medical staff in the field and at the treatment sites for their participation and exceptional commitment to the trial.”

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 20 November 2019
:: A four-day regional emergency preparedness workshop is currently underway in Lomé, Togo, for senior public health officials to strengthen the capabilities within West African countries to respond to polio outbreaks. Read more about the workshop.
:: “It was good to know that a country like India could eradicate polio. It gives us hope that Pakistan can do it too, and we will soon be polio free.” These are the words of Aziz Memon, a Rotarian who has dedicated his life to fight polio in Pakistan. Read about his journey.

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan— five WPV1 cases, two cVDPV2 cases and one cVDPV2 positive environmental sample;
:: Democratic Republic of the Congo (DR Congo)- five cVDPV2 cases;
:: Benin – four cVDPV2 cases;
:: Ghana— four cVDPV2 cases and two cVDPV2 positive environmental samples;
:: Philippines – three cVDPV2 cases and five cVDPV2 positive environmental samples;
:: Togo – two cVDPV2 cases.

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More than 3.1 million Iraqi children to be vaccinated against polio
Baghdad, 26 November 2019 – Health authorities in Iraq, in partnership with the World Health Organization (WHO) and UNICEF, have launched a campaign to reach more than 3.1 million children under-5 years of age with lifesaving polio vaccine.

The 5-day campaign aims to target children in 65 districts in the governorates of Baghdad, Babylon, Diwaniya, Diyala, Muthanna, Thi-Qar, Missan and Basra.

“Over the years, WHO, the Ministry of Health and UNICEF have worked hard to improve immunization coverage in the country. Therefore, it is important that we keep building on our work by making sure that children are vaccinated against childhood preventable diseases like polio and we keep Iraq polio free,” said Dr Adham Ismail, WHO Representative for Iraq. “During this second phase of the campaign, we want to reach all the children under 5 regardless of their previous vaccination status with oral polio vaccine leaving no one out no matter where they are,” added Dr Adham…

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 30 Nov 2019]

Democratic Republic of the Congo
:: Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo 28 November 2019
:: Ebola Outbreak in DRC 69: 26 November 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 30 Nov 2019]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 30 Nov 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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