Health Affairs
February 2016; Volume 35, Issue 2
http://content.healthaffairs.org/content/current
Issue Focus: Vaccines
Vaccine Discovery, Production, And Delivery
Alan R. Weil
Extract
Vaccines are a bit like a wonder drug. A shot or two is all it takes to prevent premature death or a lifetime of disability. What more do we need to know? Quite a lot, it turns out. The gap between the potential vaccines offer and what we actually achieve is determined by myriad social, economic, political, and health system factors.

As Seth Berkley, CEO of Gavi, the Vaccine Alliance, notes in an interview in these pages: “Vaccines do not deliver themselves.” They also don’t finance their own development or distribution, educate the public about their benefits, or eliminate income disparities in access to health services.
The complex environment in which vaccines are discovered, produced, and delivered is the theme of this month’s Health Affairs.

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DataGraphic
Why The Decade Of Vaccines?
Health Aff February 2016 35:188-189; doi:10.1377/hlthaff.2015.1518

Interview
Eliminating Vaccine-Preventable Diseases Around The World
Alan R. Weil

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Value Of Vaccines
Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011–20
Sachiko Ozawa, Samantha Clark, Allison Portnoy, Simrun Grewal, Logan Brenzel, and Damian G. Walker

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Sustainable Financing For Vaccines
Vaccine Assistance To Low- And Middle-Income Countries Increased To $3.6 Billion In 2014
Annie Haakenstad, Maxwell Birger, Lavanya Singh, Patrick Liu, Stephen Lim, Marie Ng, and Joseph L. Dieleman

Gavi’s Transition Policy: Moving From Development Assistance To Domestic Financing Of Immunization Programs
Judith Kallenberg, Wilson Mok, Robert Newman, Aurélia Nguyen, Theresa Ryckman, Helen Saxenian, and Paul Wilson
Health Aff February 2016 35:250-258; doi:10.1377/hlthaff.2015.1079

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11
Logan Brenzel, Carl Schütte, Keti Goguadze, Werner Valdez, Jean-Bernard Le Gargasson, and Teresa Guthrie

ANALYSIS & COMMENTARY: Routes Countries Can Take To Achieve Full Ownership Of Immunization Programs
Michael McQuestion, Andrew Carlson, Khongorzul Dari, Devendra Gnawali, Clifford Kamara, Helene Mambu-Ma-Disu, Jonas Mbwanque, Diana Kizza, Dana Silver, and Eka Paatashvili
Health Aff February 2016 35:266-271; doi:10.1377/hlthaff.2015.1067

PERSPECTIVE: Country Ownership And Gavi Transition: Comprehensive Approaches To Supporting New Vaccine Introduction
Angela K. Shen, Jonathan M. Weiss, Jon Kim Andrus, Clint Pecenka, Deborah Atherly, Katherine Taylor, and Michael McQuestion

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Strengthening Immunization Programs
ANALYSIS & COMMENTARY: The Global Polio Eradication Initiative: Progress, Lessons Learned, And Polio Legacy Transition Planning
Stephen L. Cochi, Lea Hegg, Anjali Kaur, Carol Pandak, and Hamid Jafari
Health Aff February 2016 35:277-283; doi:10.1377/hlthaff.2015.1104

Reorganizing Nigeria’s Vaccine Supply Chain Reduces Need For Additional Storage Facilities, But More Storage Is Required
Ekundayo Shittu, Melissa Harnly, Shanta Whitaker, and Roger Miller

INNOVATION PROFILE: Argentina’s Successful Implementation Of A National Human Papillomavirus Vaccination Program
Hannah Patel, Ellen Wilson, Carla Vizzotti, Greg Parston, Jessica Prestt, and Ara Darzi

Strategies To Boost Maternal Immunization To Achieve Further Gains In Improved Maternal And Newborn Health
Mark R. Steedman, Beate Kampmann, Egbert Schillings, Hanan Al Kuwari, and Ara Darzi

As Oral Vaccines Fall Short In Low-Income Countries, Researchers Look For Solutions
Carina Storrs

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Eliminating Measles & Rubella
ANALYSIS & COMMENTARY: Combining Global Elimination Of Measles And Rubella With Strengthening Of Health Systems In Developing Countries
Jon Kim Andrus, Stephen L. Cochi, Louis Z. Cooper, and Jonathan D. Klein

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Human Rights Quarterly
Volume 38, Number 1, February 2016
http://muse.jhu.edu/journals/human_rights_quarterly/toc/hrq.38.1.html

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Articles
Rigorous Morality: Norms, Values, and the Comparative Politics of Human Rights
pp. 1-20
Todd Landman
ABSTRACT:
This article argues that there is a strong role for empirical analysis to be used to address fundamental normative questions. Using human rights as an example, the article shows that the evolution of the international regime of human rights provides a standard against which country level performance can be both judged and explained through the application of empirical approaches in comparative politics. It argues further that different kinds of human rights measures (events, standards, surveys, and official statistics) and comparative methods (large-N, small-N, and single-country studies) offer systematic ways in which to map, to explain, and to understand the variation in human rights abuse around the world. The comparative politics of human rights is a prime example of how the “is” of the world can be used to address the “ought” of international human rights theory, philosophy, and law. The example of human rights analysis in comparative politics shows a strong role for value-based and problem-based research that remains systematic in its approach while at the same time producing outputs that are of public value.

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Uncloaking Secrecy: International Human Rights Law in Terrorism Cases
pp. 58-84
Jeffrey Davis
Abstract
ABSTRACT:
When those swept up in counterterrorism operations try to hold governments accountable for rights violations, legal secrecy doctrines such as the “state secrets privilege” and “public interest immunity” frequently derail their efforts. This article shows the effects of legal secrecy doctrines on efforts to hold officials accountable for rights violations in counterterrorism cases. It sets out the limits imposed by international human rights law on these secrecy doctrines, and it explores how these limits are handled in US and British courts. Finally, it sets out requirements in order for legal secrecy practices to comply with international human rights law.

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Reaching the Tipping Point?: Emerging International Human Rights Norms Pertaining to Sexual Orientation and Gender Identity
pp. 134-163
Elizabeth Baisley
ABSTRACT:
This article challenges a few assumptions about emerging international norms pertaining to sexual orientation and gender identity (SOGI). First, although UN experts and expert bodies were the first to address SOGI issues at the UN, they have not been the most progressive. Second, social movement actors have not always been the most effective norm entrepreneurs. Third, although states are often accused of failing to take action on SOGI issues, there is a clear, emerging pattern of state involvement and progress. The norms constructed by states are less radical than those constructed by UN experts and civil society organizations, but they are more effective.

Health Research Policy and Systems
http://www.health-policy-systems.com/content
[Accessed 13 February 2016]

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Research
A multiple case study of intersectoral public health networks: experiences and benefits of using research
Anita Kothari, Charmaine McPherson, Dana Gore, Benita Cohen, Marjorie MacDonald and Shannon L. Sibbald
Published on: 11 February 2016

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Research
Setting priorities in health research using the model proposed by the World Health Organization: development of a quantitative methodology using tuberculosis in South Africa as a worked example
Damian Hacking and Susan Cleary
Published on: 9 February 2016

Journal of Global Infectious Diseases (JGID)
January-March 2016 Volume 8 | Issue 1 Page Nos. 1-56
http://www.jgid.org/currentissue.asp?sabs=n

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SPECIAL ARTICLE
The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG)
DOI: 10.4103/0974-777X.176140
Veronica Sikka1, Vijay Kumar Chattu2, Raaj K Popli3, Sagar C Galwankar4, Dhanashree Kelkar4, Stanley G Sawicki5, Stanislaw P Stawicki6, Thomas J Papadimos7
1 Department of Emergency Medicine, Veterans Affairs Medical Center, Orlando, USA
2 Institute for International Relations, The University of West Indies, St. Augustine, Trinidad and Tobago, USA
3 Digestive Disease Consultants of Central Florida, Altamonte Springs, Florida, USA
4 Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
5 Department of Medical Microbiology and Immunology, College of Medicine and the Life Sciences, University of Toledo, Toledo, USA
6 Department of Research and Innovation, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
7 Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
Abstract
The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding in utero fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed to generate sufficient resources and political traction to effectively halt and contain further expansion of the current outbreak.

The Lancet
Feb 13, 2016 Volume 387 Number 10019 p619-716 e20
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Australia’s immigration centres are no place for children
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00317-2
Summary
Last week, the High Court in Australia ruled that the country was within its constitutional rights to detain asylum seekers offshore. This ruling is scandalously objectionable not only for the health and wellbeing of individuals seeking asylum or refuge in Australia, but also for the more than 260 people, including children, on the mainland who are now at risk of deportation.

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Comment
A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj
Published Online: 06 February 2016
Habida Elachola, Ernesto Gozzer, Jiatong Zhuo, Ziad A Memish
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00274-9

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Series
Ending preventable stillbirths
Stillbirths: recall to action in high-income countries
Vicki Flenady, Aleena M Wojcieszek, Philippa Middleton, David Ellwood, Jan Jaap Erwich, Michael Coory, T Yee Khong, Robert M Silver, Gordon C S Smith, Frances M Boyle, Joy E Lawn, Hannah Blencowe, Susannah Hopkins Leisher, Mechthild M Gross, Dell Horey, Lynn Farrales, Frank Bloomfield, Lesley McCowan, Stephanie J Brown, K S Joseph, Jennifer Zeitlin, Hanna E Reinebrant, Claudia Ravaldi, Alfredo Vannacci, Jillian Cassidy, Paul Cassidy, Cindy Farquhar, Euan Wallace, Dimitrios Siassakos, Alexander E P Heazell, Claire Storey, Lynn Sadler, Scott Petersen, J Frederik Frøen, Robert L Goldenberg, The Lancet Ending Preventable Stillbirths study group, The Lancet Stillbirths In High-Income Countries Investigator Group

Ending preventable stillbirths
Stillbirths: ending preventable deaths by 2030
Luc de Bernis, Mary V Kinney, William Stones, Petra ten Hoope-Bender, Donna Vivio, Susannah Hopkins Leisher, Zulfiqar A Bhutta, Metin Gülmezoglu, Matthews Mathai, Jose M Belizán, Lynne Franco, Lori McDougall, Jennifer Zeitlin, Address Malata, Kim E Dickson, Joy E Lawn, The Lancet Ending Preventable Stillbirths Series study group, The Lancet Ending Preventable Stillbirths Series Advisory Group

Lancet Global Health
Feb 2016 Volume 4 Number 2 e69-e136
http://www.thelancet.com/journals/langlo/issue/current

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Editorial
Stillbirths: still neglected?
Zoë Mullan
Summary
5 years ago, The Lancet published a groundbreaking (and taboo-breaking) Series on stillbirths. Its powerful mix of advocacy and hard data attracted more media attention than perhaps any other Series, and made waves on numerous levels, from the individual to the intergovernmental. Working closely with countries and WHO, the Series authors fought to bring “out of the shadows” the unacceptable toll of intrapartum stillbirths in low-income countries, the addressable differences in stillbirth rates between countries with advanced health systems, and the deplorable absence of such devastating events from global tracking efforts such as those of the UN, the Millennium Development Goals, and the Global Burden of Disease.

Comment
Success of rotavirus vaccination in Africa: good news and remaining questions
Timo Vesikari

Borders and migration: an issue of global health importance
James Smith, Leigh Daynes

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Articles
National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis
Hannah Blencowe, Simon Cousens, Fiorella Bianchi Jassir, Lale Say, Doris Chou, Colin Mathers, Dan Hogan, Suhail Shiekh, Zeshan U Qureshi, Danzhen You, Joy E Lawn, The Lancet Stillbirth Epidemiology Investigator Group
Summary
Background
Previous estimates have highlighted a large global burden of stillbirths, with an absence of reliable data from regions where most stillbirths occur. The Every Newborn Action Plan (ENAP) targets national stillbirth rates (SBRs) of 12 or fewer stillbirths per 1000 births by 2030. We estimate SBRs and numbers for 195 countries, including trends from 2000 to 2015.
Methods
We collated SBR data meeting prespecified inclusion criteria from national routine or registration systems, nationally representative surveys, and other data sources identified through a systematic review, web-based searches, and consultation with stillbirth experts. We modelled SBR (≥28 weeks’ gestation) for 195 countries with restricted maximum likelihood estimation with country-level random effects. Uncertainty ranges were obtained through a bootstrap approach.
Findings
Data from 157 countries (2207 datapoints) met the inclusion criteria, a 90% increase from 2009 estimates. The estimated average global SBR in 2015 was 18·4 per 1000 births, down from 24·7 in 2000 (25·5% reduction). In 2015, an estimated 2·6 million (uncertainty range 2·4–3·0 million) babies were stillborn, giving a 19% decline in numbers since 2000 with the slowest progress in sub-Saharan Africa. 98% of all stillbirths occur in low-income and middle-income countries; 77% in south Asia and sub-Saharan Africa.
Interpretation
Progress in reducing the large worldwide stillbirth burden remains slow and insufficient to meet national targets such as for ENAP. Stillbirths are increasingly being counted at a local level, but countries and the global community must further improve the quality and comparability of data, and ensure that this is more clearly linked to accountability processes including the Sustainable Development Goals.
Funding
Save the Children’s Saving Newborn Lives programme to The London School of Hygiene & Tropical Medicine.

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Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis
Fidele Ngabo, Jacqueline E Tate, Maurice Gatera, Celse Rugambwa, Philippe Donnen, Philippe Lepage, Jason M Mwenda, Agnes Binagwaho, Umesh D Parashar
Summary
Background
In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings.
Methods
We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals.
Findings
Compared with the 2009–11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17–29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48–49%, and admissions specific to rotavirus captured by active surveillance fell by 61–70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group.
Interpretation
The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings.
Funding
Gavi, the Vaccine Alliance and the Government of Rwanda.

New England Journal of Medicine
February 11, 2016 Vol. 374 No. 6
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
A World Free of Polio — The Final Steps
Manish Patel, M.D., and Walter Orenstein, M.D.
N Engl J Med 2016; 374:501-503
February 11, 2016
DOI: 10.1056/NEJMp1514467
Audio Interview
Interview with Dr. Walter Orenstein on the final steps in the global effort to eradicate polio. (8:37) Listen Download

Global polio-eradication efforts have led to a dramatic decrease in polio cases, from an estimated 350,000 cases in 125 countries in 1988 to 72 cases in 2015. As of January 2016, endemic transmission of polio caused by wild polioviruses (WPVs) had been interrupted in all countries except Pakistan and Afghanistan. Indeed, the Global Commission for Certification of the Eradication of Poliomyelitis recently certified that type 2 wild poliovirus, one of three strains responsible for centuries of human paralysis and disfigurement, has been eradicated. Type 2 poliovirus now exists only in laboratories and in trivalent oral polio vaccine (tOPV) in an attenuated form, though in rare circumstances it surfaces in the community, through persistent transmission, in the form of outbreaks of vaccine-derived viruses. Getting to this point has not been easy. Sustaining our wins and traversing the last mile of the eradication journey calls for escalation of global immunization activities on an unprecedented scale.

Oral polio vaccine (OPV) has been the lynchpin of successful control of paralytic polio. However, in very rare instances, it has been associated with cases of paralysis caused by vaccine-associated paralytic polio (VAPP) or circulating vaccine-derived polioviruses (cVDPVs) — the latter when the viruses included in the vaccine have mutated over time, acquiring the neurovirulence and transmissibility of WPV. For this reason, it is of paramount importance to discontinue the use of OPV after polio eradication has been certified. Since the last case of naturally occurring type 2 WPV in 1999, continued use of OPV2 (the type 2 component of tOPV) has paralyzed an estimated 1600 to 3200 people with VAPP and more than 600 people with type 2 cVDPV.1 Because routine use of type 2–containing vaccine is no longer needed, the global community has a moral imperative to discontinue it as soon as programmatically feasible. Because WPV types 1 and 3 have not yet been eradicated, however, the phased withdrawal of OPV antigens will begin with a shift from tOPV (containing types 1, 2, and 3) to bivalent OPV (bOPV, containing types 1 and 3).

Global cessation of OPV2 use poses a low but real risk of outbreaks of cVDPV2 or WPV infections associated with declining immunity to type 2 poliovirus.2 The overarching strategy for reducing this risk is to maximize immunity against type 2 before and after withdrawal of the vaccine and to prepare for an appropriate outbreak response. Doing so requires a comprehensive, multipronged approach (see table Risks and Risk-Mitigation Strategies for Switching from Trivalent Oral Polio Vaccine (tOPV) to Bivalent OPV (bOPV).).

First, it is important to stop current cVDPV2 outbreaks in advance of the switch, through aggressive tOPV vaccination in any place where cVDPV2 is detected. Programs with lower routine coverage will have to boost type 2 immunity through additional tOPV campaigns just before OPV2 withdrawal.2 A high level of immunity, especially OPV2-induced intestinal immunity, will prevent sustained transmission of vaccine viruses, which could lead to generation of new cVDPV2s.

Second, all countries should have access to enough inactivated polio vaccine (IPV) to administer at least one dose to all children through the routine immunization program. IPV provides immunity against all three polioviruses without generating any infectious vaccine-associated polioviruses. Introduction of IPV is intended to provide some immunity against type 2 viruses in new birth cohorts to mitigate future outbreaks of type 2 WPV and type 2 cVDPVs, should the viruses be reintroduced.3 IPV, however, may not prevent cVDPV2 emergence, which will be greatest during the first 6 to 12 months after OPV2 withdrawal.

Third, there had to be certified eradication of type 2 WPV, which has been accomplished.

Fourth, all countries must have destroyed type 2 WPV or securely contain it in essential laboratory and vaccine-production facilities by the end of 2015 and must do the same with OPV2 within 3 months after it is withdrawn.

Fifth, a global stockpile of monovalent type 2 OPV should be available to control outbreaks of type 2 polio, should type 2 viruses be reintroduced.

Finally, leaders of the Global Polio Eradication Initiative (GPEI) should finalize a protocol for surveillance of and response to such outbreaks.

Recently, the Strategic Advisory Group of Experts on Immunization (SAGE) reviewed progress on these readiness indicators.1,4 All high-risk countries are on track for introducing IPV. Supply shortages will delay introduction by a few months in some low-risk countries but are unlikely to increase the short-term risk of cVDPV2. SAGE also recommended accelerating implementation of the containment plan. Overall, it determined that the benefits of withdrawing OPV2 outweighed the risks, reaffirming the decision to proceed with the global switch from tOPV to bOPV between April 17 and May 1, 2016. Furthermore, it reiterated that OPV2 withdrawal must be synchronized worldwide. A prolonged, staggered withdrawal would pose a risk of continuous generation of cVDPV2s and potential exportation of these viruses to regions or countries with susceptible children born after the switch. Withdrawal of OPV2 during the seasonally low-transmission month of April further reduces the risk of type 2 polio outbreaks.

Switching from tOPV to bOPV may sound simple, but synchronization requires global coordination on an unprecedented scale. To use bOPV in routine immunization, all countries must either license a bivalent vaccine or accept one that is prequalified by the World Health Organization. Recent trial data and use of bOPV in campaigns since 2009 indicate that it is safe and more immunogenic to types 1 and 3 than is tOPV.5 Multilevel efforts to manage the global supply of OPV have begun, including discontinuation of tOPV production, scale-up of bOPV production, initiation of interactions between procurement agencies or manufacturers and countries, management of countrywide tOPV inventories to ensure that stocks are adequate until the switch and to track collection and destruction afterward, and allocation of funds for procuring bOPV. Fundamentally, countries will strive to avoid having either excess or insufficient quantities of tOPV leading up to the switch and to ensure the availability of bOPV after the switch.

Coordinated communication among global health organizations, countries, manufacturers, and funders is imperative to ensure synchronized OPV2 withdrawal with minimal disruption in vaccination services to children worldwide. Successful synchronization also requires GPEI leaders and countries to monitor the timely completion of preparatory steps both globally and within each country (e.g., managing of tOPV inventories; bOPV licensure, procurement, and shipment; securing of financial resources; establishment of communication; and training of logisticians, health workers, and monitors). Equally, if not more, important, however, will be the monitoring of outcomes of withdrawal of the vaccine in April 2016. Although it is nearly impossible to monitor every vaccination service point — India alone has more than 26,000 — a targeted monitoring strategy for high-risk areas, such as facilities storing large stocks of tOPV, could provide further reassurance of low risk of cVDPV2 reemergence. Countries will need to dispose of residual tOPV stocks using their existing pharmaceutical-waste-disposal procedures to avoid continued use of the discontinued vaccine.

More preparation for the switch is required in the coming months, and for completing polio eradication in the coming years. But collaboration in eradication efforts has reached a high point never before achieved by the immunization community. Getting here has required tireless effort and practical innovation in science, policy, and implementation. Capitalizing on the gains made to date should push overall polio eradication over the finish line and may pave the way for measles eradication and future global health initiatives.

Pediatrics
February 2016, VOLUME 137 / ISSUE 2
http://pediatrics.aappublications.org/content/137/2?current-issue=y

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From the American Academy of Pediatrics
Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism
DISASTER PREPAREDNESS ADVISORY COUNCIL
Pediatrics Feb 2016, 137 (2) 1-9; DOI: 10.1542/peds.2015-4273
Abstract
Significant strides have been made over the past 10 to 15 years to develop medical countermeasures (MCMs) to address potential disaster hazards, including chemical, biological, radiologic, and nuclear threats. Significant and effective collaboration between the pediatric health community, including the American Academy of Pediatrics, and federal partners, such as the Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention, Federal Emergency Management Agency, National Institutes of Health, Food and Drug Administration, and other federal agencies, over the past 5 years has resulted in substantial gains in addressing the needs of children related to disaster preparedness in general and MCMs in particular. Yet, major gaps still remain related to MCMs for children, a population highly vulnerable to the effects of exposure to such threats, because many vaccines and pharmaceuticals approved for use by adults as MCMs do not yet have pediatric formulations, dosing information, or safety information. As a result, the nation’s stockpiles and other caches (designated supply of MCMs) where pharmacotherapeutic and other MCMs are stored are less prepared to address the needs of children compared with those of adults in the event of a disaster. This policy statement provides recommendations to close the remaining gaps for the development and use of MCMs in children during public health emergencies or disasters. The progress made by federal agencies to date to address the needs of children and the shared commitment of collaboration that characterizes the current relationship between the pediatric health community and the federal agencies responsible for MCMs should encourage all child advocates to invest the necessary energy and resources now to complete the process of remedying the remaining significant gaps in preparedness.

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Pediatrics Perspectives
Planning for Research on Children During Public Health Emergencies
Laura J. Faherty, Sonja A. Rasmussen, Nicole Lurie
Pediatrics Feb 2016, 137 (2) 1-4; DOI: 10.1542/peds.2015-3611
Extract
The recent Ebola epidemic exposed critical knowledge gaps about the disease and its impact on different populations, particularly children, which hindered the public health and medical response. For instance, unanswered questions remain about the natural history of Ebola virus disease in young children and its transmissibility in breast milk. Other emerging infectious diseases, such as Middle East Respiratory Syndrome (MERS), remind us that there will always be another pathogen lurking around the corner. Public health emergencies (PHEs) resulting from natural disasters are increasing in ferocity and frequency.1 How can we ensure that we address our current knowledge gaps to better prepare for future disasters?
Awareness of the need to integrate scientific research into PHE response is growing,2 but the discussion of research involving children has been limited. Although several efforts have addressed the unique physical and socio-emotional needs of children in PHEs,3,4 pediatric research during PHEs has been lacking, resulting in significant knowledge gaps for children compared to adults. Conducting research, especially in children, without interfering with the PHE response is challenging. The present article discusses the importance of including children in PHE research and proposes components of a robust infrastructure that need to be in place to facilitate this research.
Barriers to Including Children in PHE Research
Including children in PHE research presents special challenges, including issues with recruitment, informed consent, and enrollment.3,5 Institutional review boards (IRBs) have more stringent requirements for inclusion of children in research than for adults.6 A life course …

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Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review
Pathma D. Joseph, Patrina H.Y. Caldwell, Allison Tong, Camilla S. Hanson, Jonathan C. Craig
Pediatrics Feb 2016, 137 (2) 1-19; DOI: 10.1542/peds.2015-2800
Abstract
CONTEXT: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides.
OBJECTIVE: To describe stakeholder beliefs and experiences of conducting trials in children in LMICs.
DATA SOURCES: Electronic databases were searched to August 2014.
STUDY SELECTION: Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs.
DATA EXTRACTION: Findingswere analyzed by using thematic synthesis.
RESULTS: Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives’ pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits).
LIMITATIONS: Studies not published in English were excluded.
CONCLUSIONS: Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 13 February 2016)

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Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Nigeria
Saskia van der Kam, Nuria Salse-Ubach, Stephanie Roll, Todd Swarthout, Sayaka Gayton-Toyoshima, Nma Mohammed Jiya, Akiko Matsumoto, Leslie Shanks
Research Article | published 09 Feb 2016 | PLOS Medicine
10.1371/journal.pmed.1001952

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Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Uganda
Saskia van der Kam, Stephanie Roll, Todd Swarthout, Grace Edyegu-Otelu, Akiko Matsumoto, Francis Xavier Kasujja, Cristian Casademont, Leslie Shanks, Nuria Salse-Ubach
Research Article | published 09 Feb 2016 | PLOS Medicine
10.1371/journal.pmed.1001951

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 13 February 2016)

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Perspective: Do geographically isolated wetlands influence landscape functions?
Matthew J. Cohen, Irena F. Creed, Laurie Alexander, Nandita B. Basu, Aram J. K. Calhoun, Christopher Craft, Ellen D’Amico, Edward DeKeyser, Laurie Fowler, Heather E. Golden, James W. Jawitz, Peter Kalla, L. Katherine Kirkman, Charles R. Lane, Megan Lang, Scott G. Leibowitz,
David Bruce Lewis, John Marton, Daniel L. McLaughlin, David M. Mushet, Hadas Raanan-iperwas, Mark C. Rains, Lora Smith, and Susan C. Walls
PNAS 2016 ; published ahead of print February 8, 2016, doi:10.1073/pnas.1512650113
Abstract
Geographically isolated wetlands (GIWs), those surrounded by uplands, exchange materials, energy, and organisms with other elements in hydrological and habitat networks, contributing to landscape functions, such as flow generation, nutrient and sediment retention, and biodiversity support. GIWs constitute most of the wetlands in many North American landscapes, provide a disproportionately large fraction of wetland edges where many functions are enhanced, and form complexes with other water bodies to create spatial and temporal heterogeneity in the timing, flow paths, and magnitude of network connectivity. These attributes signal a critical role for GIWs in sustaining a portfolio of landscape functions, but legal protections remain weak despite preferential loss from many landscapes. GIWs lack persistent surface water connections, but this condition does not imply the absence of hydrological, biogeochemical, and biological exchanges with nearby and downstream waters. Although hydrological and biogeochemical connectivity is often episodic or slow (e.g., via groundwater), hydrologic continuity and limited evaporative solute enrichment suggest both flow generation and solute and sediment retention. Similarly, whereas biological connectivity usually requires overland dispersal, numerous organisms, including many rare or threatened species, use both GIWs and downstream waters at different times or life stages, suggesting that GIWs are critical elements of landscape habitat mosaics. Indeed, weaker hydrologic connectivity with downstream waters and constrained biological connectivity with other landscape elements are precisely what enhances some GIW functions and enables others. Based on analysis of wetland geography and synthesis of wetland functions, we argue that sustaining landscape functions requires conserving the entire continuum of wetland connectivity, including GIWs.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 13 February 2016)

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Social Sciences – Sustainability Science:
Measuring the value of groundwater and other forms of natural capital
Eli P. Fenichel, Joshua K. Abbott, Jude Bayham, Whitney Boone, Erin M. K. Haacker, and Lisa Pfeiffer
PNAS 2016 ; published ahead of print February 8, 2016, doi:10.1073/pnas.1513779113
Significance
Economists have long argued, with recent acceptance from the science and policy community, that natural resources are capital assets. Pricing of natural capital has remained elusive, with the result that its value is often ignored, and expenditures on conservation are treated as costs rather than investments. This neglect stems from a lack of a valuation framework to enable apples to apples comparisons with traditional forms of capital. We develop such an approach and demonstrate it on Kansas’ groundwater stock. Between 1996 and 2005, groundwater withdrawal reduced Kansas’ wealth approximately $110 million per year. Wealth lost through groundwater depletion in Kansas is large, but in a range where offsetting investments may be feasible.
Abstract
Valuing natural capital is fundamental to measuring sustainability. The United Nations Environment Programme, World Bank, and other agencies have called for inclusion of the value of natural capital in sustainability metrics, such as inclusive wealth. Much has been written about the importance of natural capital, but consistent, rigorous valuation approaches compatible with the pricing of traditional forms of capital have remained elusive. We present a guiding quantitative framework enabling natural capital valuation that is fully consistent with capital theory, accounts for biophysical and economic feedbacks, and can guide interdisciplinary efforts to measure sustainability. We illustrate this framework with an application to groundwater in the Kansas High Plains Aquifer, a rapidly depleting asset supporting significant food production. We develop a 10-y time series (1996−2005) of natural capital asset prices that accounts for technological, institutional, and physical changes. Kansas lost approximately $110 million per year (2005 US dollars) of capital value through groundwater withdrawal and changes in aquifer management during the decade spanning 1996–2005. This annual loss in wealth is approximately equal to the state’s 2005 budget surplus, and is substantially more than investments in schools over this period. Furthermore, real investment in agricultural capital also declined over this period. Although Kansas’ depletion of water wealth is substantial, it may be tractably managed through careful groundwater management and compensating investments in other natural and traditional assets. Measurement of natural capital value is required to inform management and ongoing investments in natural assets.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 6 February 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 6 February 2016

blog edition: comprised of the 35+ entries  posted below on 7-8 February 2016

Zika virus  [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC)

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WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
1 February 2016
Based on the advice of the International Health Regulations (2005) Emergency Committee on Zika virus the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005).

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UN OHCHR Office of the United Nations High Commissioner for Human Rights [to 6 February 2016]
http://www.ohchr.org/EN/NewsEvents/Pages/media.aspx?IsMediaPage=true

Upholding women’s human rights essential to Zika response – Zeid
GENEVA (5 February 2016) – Upholding women’s human rights is essential if the response to the Zika health emergency is to be effective, UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein said Friday, adding that laws and policies that restrict access to sexual and reproductive health services in contravention of international standards, must be repealed and concrete steps must be taken so that women have the information, support and services they require to exercise their rights to determine whether and when they become pregnant.

“Clearly, managing the spread of Zika is a major challenge to the governments in Latin America,” Zeid said. “However, the advice of some governments to women to delay getting pregnant, ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common.”

“In Zika-affected countries that have restrictive laws governing women’s reproductive rights, the situation facing women and girls is particularly stark on a number of levels,” the UN Human Rights Chief said. “In situations where sexual violence is rampant, and sexual and reproductive health services are criminalized, or simply unavailable, efforts to halt this crisis will not be enhanced by placing the focus on advising women and girls not to become pregnant. Many of the key issues revolve around men’s failure to uphold the rights of women and girls, and a range of strong measures need to be taken to tackle these underlying problems.”

The World Health Organization has declared a Public Health Emergency of International Concern amid concerns of a possible association between upsurges in reported cases of Zika virus disease and of microcephaly in Latin America. A causative link between Zika and microcephaly (babies born with abnormally small heads), and Zika and Guillain-Barré Syndrome (a neurological condition), is still under investigation.

Amid the continuing spread of the Zika virus, authorities must ensure that their public health response is pursued in conformity with their human rights obligations, in particular relating to health and health-related rights.

“Upholding human rights is essential to an effective public health response and this requires that governments ensure women, men and adolescents have access to comprehensive and affordable quality sexual and reproductive health services and information, without discrimination,” Zeid said, noting that comprehensive sexual and reproductive health services include contraception — including emergency contraception — maternal healthcare and safe abortion services to the full extent of the law.

“Health services must be delivered in a way that ensures a woman’s fully informed consent, respects her dignity, guarantees her privacy, and is responsive to her needs and perspectives,” he added….

Syria Pledging Conference – London, 4 February 2016

Record $10 billion pledged in humanitarian aid for Syria at UN co-hosted conference in London
UN News Service – 4 February 2016 – An international conference on war-torn Syria in London today pledged a record $10 billion after United Nations Secretary-General Ban Ki-moon laid out three main objectives: raising $7 billion in immediate humanitarian aid, mustering long-term support, and protecting civilians.

“Never has the international community raised so much money on a single day for a single crisis,” he told a news briefing at the end of the day-long conference, co-hosted by the UN and the Governments of the United Kingdom, Kuwait, Germany and Norway.

More than half of the pledged amount is earmarked to meet immediate needs in 2016 in a country where nearly five years of war has killed over 250,000 people, sent over 4 million fleeing Syria, displaced 6.5 million internally, and put 13.5 million people inside the country in urgent need of humanitarian aid.

Today, let us change the narrative. Let us, by and with our solidarity and generosity, and compassionate leadership, bring true hope to the people of Syria and the region.

“Today’s pledges will enable humanitarian workers to continue reaching millions of people with life-saving aid,” Mr. Ban said. “The promises of long-term funding and loans mean that humanitarian and development partners will be able to work together to get children back into school, design employment programmes and begin rebuilding infrastructure.

The commitment of countries hosting large numbers of refugees to open up their labour markets is a breakthrough, he added, thanking the Governments of Jordan, Lebanon and Turkey “for choosing solidarity over fear.”

He hailed the commitment to get 1.7 million children in Jordan, Lebanon and Turkey into school, and to increase access to learning opportunities for children inside Syria.

“Perhaps most important, I welcome the shared commitment of today’s attendees to use their influence to end sieges and other grave human rights abuses,” he said. “What will most help the people of Syria is not just food for today, but hope for tomorrow. Yet the parties to the conflict remain deeply divided – even on improving the humanitarian situation.”…

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Editor’s Note:
In addition to those links just below, a number of organizations. including UN agencies and NGOs, released statements on the pledging conference. Please see links to this content as captured with other news by organization title: UNDP, UNESCO, FAO, World Bank, IMF, US Department of State, EU, DFID, Care, HelpAge, IRC, Islamic Relief, NRC, Oxfam, Save the Children, The Elders, Interaction…

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Sudden Spike in Military Action, Insufficient Humanitarian Access ‘Deeply Disturbing’, Secretary-General Tells Supporting Syria Conference
4 February 2016 SG/SM/17512

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Syrian Arab Republic: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien Remarks at Syria Conference Plenary Session, London, 4 February 2016
04 Feb 2016

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Syria Pledging Conference: ICRC President’s call to the international community
04 February 2016
Speech given by Peter Maurer, President of the International Committee of the Red Cross, at the Syria Pledging Conference 2016 in London.

Excellencies, Ladies and gentlemen,
When my colleagues arrived in Madaya three weeks ago, Fatma, a little girl maybe six years old, walked up to them and said ‘We have been waiting for you. Did you bring any food?’ Every person my colleagues talked to, hundreds of them, malnourished, with pale green skin, asked them: ‘Did you bring food?’

Anyone who has been to Syria knows the people’s extraordinary hospitality and great pride. For a six year-old girl to walk up to a stranger, to ask for food – this shows in a nutshell what the crisis has done to the spirit of the people of Syria.

So how did we get here?
The answer is alarmingly easy: constant violations of international humanitarian law: use of illegal weapons and the illegal use of weapons, an epidemic of sieges, urban warfare destroying electricity and water infrastructure, deliberate attacks on schools and hospitals have cumulated into full system failure, forcing more than half of the Syrian population from their homes.
Over four and a half million Syrians have fled abroad, the vast majority to countries neighbouring Syria. But twice as many – twice as many! – About 8 million people – are displaced inside Syria, until the next attack forces them to flee yet again. These people need help, they need protection; they need you to work for their safety, urgently.

Let me be clear: attacks on civilians are not collateral damage. Bombing civilians is a standard practice of warfare in Syria – but that does not make it acceptable. While the fronts have hardly moved over the last years, the civilian population’s suffering has surged. The letter and spirit of international humanitarian law aims to protect people from direct and indiscriminate attacks; from blind violence; from unacceptable pain. It does not outlaw warfare or strategy, but it outlaws the deliberate creation of humanitarian catastrophes, like the one we witness in Syria today.

We got here also because of the lack of political action and ambition to resolve the crisis. International attention outweighs political investment to find a long-term solution to the crisis, allowing for people to resume their lives, safely, in dignity. At the same time, humanitarian aid is becoming a bargaining chip in political negotiations.

Last year, the ICRC and the Syrian Arab Red Crescent aided over 16 million people inside Syria, but we can’t reach everyone and for those we do reach, we can’t do nearly enough.

Humanitarian aid is always just a quick fix, and never enough. Because the reality is that access to people is restricted; cities are under siege; we estimate that nearly half a million people are completely cut off from the world. As long as this goes on, people will lack food, so they will get weak. They have no fuel for heating, so they get sick. They have no medicine, so they get sicker. And they have no hospitals, so, eventually, they die.

So how do we get out of here?
Ladies and gentlemen, Lift all sieges immediately.

Fatma isn’t here today, so on her behalf, I say to you:
:: Start putting Syrians first, and your own interests second.
:: Find a political solution, urgently.
:: In the meantime, ensure that international humanitarian law is respected by you and your partners, whoever they are.
:: And – give us access so we can bring food and medicine to Fatma and all the other children, women and men in Syria.

We need you to show more political ambition to open impartial humanitarian spaces and less political meddling in humanitarian work.

The Red Cross and Red Crescent Movement is by far the foremost humanitarian actor in Syria today. In five years, 58 of our colleagues died, while they tried to save people. Our principles, neutrality, independence, impartiality, have not changed. The ICRC and the Syrian Arab Red Crescent can still do more, together, but we need unimpeded access, and we need your support. Movement partners also need your support to help more Syrians in the region, and beyond.

Ladies and gentlemen,
When my colleagues got ready to leave Madaya three weeks ago, after offloading food, blankets and medicine, a family stopped them. They had prepared food, saying “You saved us. You have to eat with us.”

Ensure that the dignity, pride and generosity of the Syrian people will survive. Thank you.

International Day of Zero Tolerance to Female Genital Mutilation 2016

New statistical report on female genital mutilation shows harmful practice is a global concern – UNICEF
NEW YORK, 5 February 2016 – At least 200 million girls and women alive today have undergone female genital mutilation in 30 countries, according to a new statistical report published ahead of the United Nations’ International Day of Zero Tolerance for Female Genital Mutilation.

The report – Female Genital Mutilation/Cutting: A Global Concern – notes that half of the girls and women who have been cut live in three countries – Egypt, Ethiopia and Indonesia – and refers to smaller studies and anecdotal accounts that provide evidence FGM is a global human rights issue affecting girls and women in every region of the world. Female genital mutilation refers to a number of procedures. Regardless of which form is practiced, FGM is a violation of children’s rights.

“Female genital mutilation differs across regions and cultures, with some forms involving life-threatening health risks. In every case FGM violates the rights of girls and women. We must all accelerate efforts – governments, health professionals, community leaders, parents and families – to eliminate the practice,” said UNICEF Deputy Executive Director Geeta Rao Gupta.

According to the data, girls 14 and younger represent 44 million of those who have been cut, with the highest prevalence of FGM among this age in Gambia at 56 per cent, Mauritania 54 per cent and Indonesia where around half of girls aged 11 and younger have undergone the practice. Countries with the highest prevalence among girls and women aged 15 to 49 are Somalia 98 per cent, Guinea 97 per cent and Djibouti 93 per cent. In most of the countries the majority of girls were cut before reaching their fifth birthdays…

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‘We Can End Female Genital Mutilation within a Generation’, Secretary-General Says in Message to Mark Global Zero-Tolerance Day for Harmful Practice
4 February 2016
SG/SM/17513-OBV/1578-WOM/2058

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Eliminate Female Genital Mutilation by 2030, say UNFPA and UNICEF
Joint statement by UNFPA Executive Director Dr. Babatunde Osotimehin and UNICEF Executive Director Anthony Lake on the 2016 International Day of Zero Tolerance for FGM
NEW YORK, 5 February 2016 – “FGM is a violent practice, scarring girls for life — endangering their health, depriving them of their rights, and denying them the chance to reach their full potential.

“FGM is widespread. It is a global problem that goes well beyond Africa and the Middle East, where the practice has been most prevalent — affecting communities in Asia, Australia, Europe, North and South America. And the number of girls and women at risk will only get larger if current population trends continue, wiping out hard-won gains.

“FGM is discrimination. It both reflects and reinforces the discrimination against women and girls, perpetuating a vicious cycle that is detrimental to development and to our progress as a human family.

“FGM must end. In September at the United Nations Sustainable Development Summit, 193 nations unanimously agreed to a new global target of eliminating FGM by 2030. This recognition that FGM is a global concern is a critical milestone.

“But the recognition, while important, is not enough. To protect the wellbeing and dignity of every girl, we need to take responsibility as a global community for ending FGM.

“That means we need to learn more — improving our data collection to measure the full extent of the practice — and do more. We need to encourage more communities and families to abandon FGM. We need to work with larger numbers of medical communities — including traditional and medical professionals — persuading them to refuse to perform or support FGM. We need to support more women and girls who have undergone the harmful practice and provide them with services and help to overcome the trauma they have suffered. And we need to support and empower girls around the world to make their voices heard and call out to put an end to FGM.

“All of us must join in this call. There simply is no place for FGM in the future we are striving to create – a future where every girl will grow up able to experience her inherent dignity, human rights and equality by 2030.

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Statement by UN Women Executive Director Phumzile Mlambo-Ngcuka for International Day of Zero Tolerance for Female Genital Mutilation
Date: 05 February 2016
The 2030 Agenda for Sustainable Development brings renewed urgency to the call for “Zero Tolerance for Female Genital Mutilation”, explicitly naming this as an instance of a “harmful practice” that is targeted for elimination as part of our collective efforts to achieve gender equality and women’s empowerment.

Today, we assert again every girl’s right to live as a full human being with control over her own body and informed choice in what happens to it. Some 200 million women and girls in 30 countries have already undergone female genital mutilation (FGM). In most countries, the majority were cut before the age of five.

It is not a simple matter to challenge and change customary behaviours. Yet where those practices enforce gender inequality, this is what we must do, supported by collective international agreements that bring universal condemnation to this most private of violations.

One aspect of achieving change is legislation that bans FGM, with policies that securely implement the laws. While 41 Member States have already criminalized FGM, legislation is not yet having its desired impact in every country.

Next month, in a series of meetings and events that draw thousands of representatives from government and civil society, the Commission on the Status of Women will review global progress in ending violence against women and girls, including the practice of FGM, as a matter of urgency, within the context of the overall priority theme of women’s empowerment and its link to sustainable development. The scope of this review underlines our understanding that a comprehensive approach is necessary to address the root causes of gender inequality, violence against women and girls, and harmful practices such as FGM.

The prevalence of FGM is decreasing in most countries – but it is far from zero. Eliminating FGM is also an essential step to realizing other Sustainable Development Goals, including targets on health and well-being, quality education, decent work and economic growth, all of which are underpinned by work that empowers women and girls and achieves gender equality.

There are success stories: national action plans are in place in a growing number of countries, through which governments are supporting community engagement in prevention activities, with hotlines to receive reports of FGM and provide information on support services, and specialized clinics to treat survivors.

Working with governments, the UN system, civil society, and the media, we must continue to change how girls are valued in their community, reduce the pressure they experience from their families, communities and peers, and help in the search for alternative rites of passage, and means of income for those who perform the ritual, finding creative solutions, for example, that engage men in culture change. Let this International Day of Zero Tolerance galvanize us in all our collective efforts to achieve our goals and eliminate FGM for good.

UN: Draft Strategy for Global Initiative on Decent Jobs for Youth
HLCP Task Team on the Global Initiative on Decent Jobs for Youth
CEB/2015/HLCP-30/CRP.5 :: 28 pages
[Excerpt]
…2 Vision and objective of the Global Initiative on Decent Jobs for Youth
The vision of the Global Initiative on Decent Jobs for Youth is a world in which young women and men have greater access to decent jobs everywhere.

The objective of the Initiative is to facilitate increased impact and expanded country-level action on decent jobs for youth through multi-stakeholder partnerships, the dissemination of evidence-based policies and the scaling up of effective and innovative interventions.

This objective is directly linked to the achievement of the SDGs relating to youth employment and more specifically to the outcome document of the United Nations Summit for the adoption of the post-2015 development agenda titled “Transforming our World: The 2030 Agenda for Sustainable Development”, annexed in draft resolution A/69/L.85. The outcome document includes the following youth employment targets: (i) 4.4 “By 2030, increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship”; (ii) 8.5: “By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value”; and (iii) 8.6: “By 2020, substantially reduce the proportion of youth not in employment, education or training”.11

The objective will be pursued by using the power of the United Nations system to convene multi-stakeholder partnerships and by pooling cutting-edge advice, expertise, resources and support. More specifically, the objective will be operationalized by:
a) engaging stakeholders and world leaders in high-level policy action on youth employment;
b) expanding and scaling up context-specific interventions at the national and regional levels for systematic and coherent policies and interventions on youth employment;
c) pooling existing expertise and enhancing knowledge development and dissemination on what works for youth employment, including through the development of tools and capacity building; and
d) leveraging resources from existing facilities and mobilizing additional resources…

…4 Key elements
The strategy includes the following inter-connected elements:
[i] A strategic multi-stakeholder alliance.
The Initiative addresses decent jobs for youth as an issue of global concern which requires the highest possible level of policy attention and action. It is a development imperative that builds on and transcends the action of any individual organization or actor. The alliance will be set up by leveraging the convening power of the United Nations system, its overarching policy frameworks and its multiple and diverse partners from governments and non-governmental entities. It will bring together major actors of substantive significance to the issue of decent jobs for youth, including national institutions, the private sector, the United Nations system and other multilateral organizations, representatives of academia, representatives of the social partners and youth organizations. It will be an umbrella forum for global advocacy and will raise existing activities on youth employment to a higher level of action and impact. The main functions of the alliance will be to: (1) advocate high-level policy commitment and action on youth employment; (2) support policy convergence and coherence; and (3) stimulate innovative thinking and resource mobilization to scale up youth employment interventions and their impact.

[ii] Expanded and scaled up regional and country level action on decent jobs for youth.
The Initiative will promote and monitor multi-pronged interventions through broad partnerships and joint action on decent jobs for youth. These interventions will focus on scalable and innovative solutions that have proved effective in improving youth employment outcomes at the regional and national levels with a view to developing sustainable policies and institutions. This element will respond to national development priorities, support United Nations country programming and be implemented through broad multi-stakeholder partnerships under the leadership of United Nations Country Teams (UNCTs). It will involve governmental and non-governmental institutions, private sector actors, representatives of the social partners, youth and other organizations active in the region and/or country. In particular, support will be provided to UNCTs that are engaged in the implementation of the employment and entrepreneurship priority of the Youth-SWAP.

[iii] Knowledge facility on decent jobs for youth.
The knowledge facility will promote the sharing of knowledge and experience, capacity building and peer learning, including through South-South and triangular cooperation mechanisms. It will facilitate the exchange of information and good practice on what works for youth employment, support the testing and evaluation of policy packages, encourage the development and implementation of innovative strategies and disseminate broadly evidence, guidelines and tools for the replication of effective and scalable youth employment responses. It will identify and document successful practices in the design, implementation, monitoring and evaluation of interventions for decent jobs for youth. Finally, it will support policy and multi-stakeholder dialogue during the implementation of youth employment initiatives in pilot countries.

[iv] Funding modalities and resource mobilization.
This component will pool domestic resources and those available from existing funds.12 It will mobilize additional resources where required. Funding will support innovative initiatives that have the potential for wide replication and high impact in selected countries.13 Resources will principally be used to support youth employment action at the country and local levels, including work undertaken through the knowledge facility that is instrumental for country-level implementation. Resources management will be based on the criteria of efficiency, cost-effectiveness, accountability and transparency…

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Press Release
UN initiative targets job creation and decent work conditions for young people
FAO to lead efforts for youth in agriculture and the rural economy
1 February 2016, New York – FAO welcomed today the launch in New York of the UN Global Initiative on Decent Jobs for Youth, which includes a focus on promoting decent employment opportunities for young people in agriculture and the rural economy.

Under the lead of the International Labour Organization (ILO), the Initiative was developed by 19 international organizations that are committed to increasing the impact of youth employment policies and expanding country-level action on decent jobs for young women and men…

FAO will be leading one of the eight thematic areas of the strategy, on Youth in the Rural Economy, while contributing to others.

“Poverty and hunger cannot be eradicated without addressing the inadequacy of employment conditions and opportunities facing the world’s young people, especially for young women and those living in rural areas,” said Brave Ndisale, FAO Social Protection Division Deputy Director…

To date, in many parts of the world employment and entrepreneurial opportunities for young women and men remain limited, poorly remunerated and of poor quality, particularly for those living in economically stagnant rural areas of developing countries.

The majority of rural youth are employed in the informal economy as contributing family workers, subsistence farmers, home-based micro-entrepreneurs or unskilled workers. They typically earn low wages, are employed through casual or seasonal work arrangements and face unsafe, often exploitive working conditions that compel many to migrate to urban areas – or abroad…

FAO has placed the promotion of decent rural employment as one of its top priorities, and has established a specific programme of work targeting youth.

UN-Habitat to lead in planning Kenya’s first Integrated Settlement in Kalobeyei, Turkana County
Kenya, 04 February 2016 – UN-Habitat has joined in the implementation of Kalobeyei Integrated Socio-Economic Development Program (KISEDP), a Turkana-based initiative that seeks to facilitate collaboration and coordination between the Kenyan Government, UN agencies, development actors, NGOs, private sector and civil society to build sustainable services and economic opportunities in Kalobeyei, a new settlement in Kenya that is expected to accommodate more than 60,000 refugees and host communities. The programme focuses on both short-term (humanitarian) and long-term (sustainable development) interventions and will be implemented through four thematic areas: sustainable integrated service delivery and skills development; spatial planning and infrastructure development; agriculture and livestock development and private sector and entrepreneurship.

UN-Habitat, having gained unique and universally-acknowledged expertise in human settlements development for the past 40 years, will lead the spatial planning and infrastructure development thematic area in close collaboration with the World Bank, Turkana County Government, United Nations High Commissioner for Refugees (UNHCR), national government agencies, refugees and host communities as well as humanitarian implementing partners such as Peace Winds Japan. UN-Habitat’s intervention will be participatory and is expected to lead to the establishment of a support function for the county government of Turkana, sustainable livelihoods development for refugee and host communities and formulation of detailed re-settlement plan that will include an integrated spatial and investment plan…

Mercy Corps Pilots Refugee Cash Assistance Program in Serbia
February 3, 2016 Presevo, Serbia – The global organization Mercy Corps has launched a new pilot program to distribute MasterCard prepaid debit cards to an estimated 5,600 eligible refugees traveling through Serbia, in partnership with the Serbian Ministry of Labor. Families will receive cards of 210 Euros, and individuals will receive cards of 70 Euros, which can be used to purchase what they need most. It is the first such program in the region to use an international payment mechanism to help the tens of thousands of refugees and migrants seeking haven in Europe.

“At Mercy Corps, we believe cash assistance is the most rapid, efficient and dignified manner of providing humanitarian aid,” says Rebecca Thompson, Mercy Corps’ team leader for its refugee response in the Balkans. “Even a small amount of cash lets people choose how they prioritize their individual needs, in addition to offering a measure of protection. And an important side benefit is that this kind of program infuses cash into the economy and markets of the communities that are hosting refugees.”

The stream of people journeying to Europe continues steadily despite the harsh winter weather, with an estimated 1,000 to 3,000 people traveling through the Balkans every day. Mercy Corps is focusing its distributions on people who are the most vulnerable: people with disabilities, the elderly, women traveling alone, those in financial need and others at particular risk. The card can be used anywhere in the world that accepts MasterCard. It comes pre-loaded with the estimated funds families would need to buy essential supplies and obtain shelter over the 72-hour period typically spent in Serbia.

“Although we are able to help several thousand people over the next two months, the reality is that thousands more urgently need assistance,” says Thompson.

Urban Institute Announces New Partnership to Develop Solutions for Social Mobility in America
WASHINGTON, DC, February 5, 2016 — Today, the Urban Institute announced a grant from the Bill & Melinda Gates Foundation to establish The US Partnership on Mobility from Poverty, a new collaborative aimed at discovering permanent ladders of mobility for the poor.

The partnership will be made up of 24 leading experts, advocates, and academics from across the country. Over the next two years, the group will identify breakthrough solutions that can be put into action by philanthropy, practitioners, and the public and private sectors. The initiative will also be a resource for the field: all its work will be public, sharing insights and ideas with those poised for action.

The partnership will uncover the country’s most successful programs, collaborate with outside innovative organizations to test promising new models, and identify new approaches to improving social mobility in America. It will be chaired by well-known poverty and social policy scholar David Ellwood, the Scott M. Black Professor of Political Economy at Harvard University, who also served as Dean of the John F. Kennedy School of Government from 2004 to 2015.

“Working with communities across the country, we will develop an action plan that builds on what works and deploys new ideas,” said Ellwood. “Our approach will be geographically agnostic and politically nonpartisan; our findings will be transparent and available to all. We will consult widely, seeking out diverse voices and expertise as we examine the causes of persistent poverty and stagnant mobility. Rather than producing a single report, this partnership will regularly release its findings and ideas as we do our work. We hope that as a result, we can reset our country’s approach to social mobility.”…

Sarah Rosen Wartell, president of the Urban Institute, noted: “The partnership is about putting the country’s best ideas into practice and learning from diverse voices, experiences, and research. The approach of the partnership will be grounded, pragmatic, and action-oriented.”

The partnership will operate independently of the Bill & Melinda Gates Foundation, which has committed $3.7 million toward the effort. It also will be independent of any other potential private or public funders. The partnership will be staffed and supported by the Urban Institute, but it will engage other institutions and experts.

“This partnership is being created to serve as a resource for the field that we hope will provide insight, analysis, and expertise around causes of persistent poverty and approaches to improving mobility out of poverty,” said Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation. “While education is one of the most important interventions for improving mobility in the United States—and the focus of our investments here—it is not the only intervention that is needed to improve opportunity. We look forward to working with the partnership to better understand those factors, in addition to education, that shape long-term outcomes for children, families, and individuals.”…

List of partnership members

Editor’s Note:
We include the full text of the Marrakesh Declaration below and the overview of the conference which produced it. Additional content is available on the Declaration website.

Marrakesh Declaration
Executive Summary of the Marrakesh Declaration on the Rights of Religious Minorities in Predominantly Muslim Majority Communities
25th-27th January 2016
WHEREAS, conditions in various parts of the Muslim World have deteriorated dangerously due to the use of violence and armed struggle as a tool for settling conflicts and imposing one’s point of view;

WHEREAS, this situation has also weakened the authority of legitimate governments and enabled criminal groups to issue edicts attributed to Islam, but which, in fact, alarmingly distort its fundamental principles and goals in ways that have seriously harmed the population as a whole;

WHEREAS, this year marks the 1,400th anniversary of the Charter of Medina, a constitutional contract between the Prophet Muhammad, God’s peace and blessings be upon him, and the people of Medina, which guaranteed the religious liberty of all, regardless of faith;

WHEREAS, hundreds of Muslim scholars and intellectuals from over 120 countries, along with representatives of Islamic and international organizations, as well as leaders from diverse religious groups and nationalities, gathered in Marrakesh on this date to reaffirm the principles of the Charter of Medina at a major conference;

WHEREAS, this conference was held under the auspices of His Majesty, King Mohammed VI of Morocco, and organized jointly by the Ministry of Endowment and Islamic Affairs in the Kingdom of Morocco and the Forum for Promoting Peace in Muslim Societies based in the United Arab Emirates;

AND NOTING the gravity of this situation afflicting Muslims as well as peoples of other faiths throughout the world, and after thorough deliberation and discussion, the convened Muslim scholars and intellectuals:

DECLARE HEREBY our firm commitment to the principles articulated in the Charter of Medina, whose provisions contained a number of the principles of constitutional contractual citizenship, such as freedom of movement, property ownership, mutual solidarity and defense, as well as principles of justice and equality before the law; and that,

The objectives of the Charter of Medina provide a suitable framework for national constitutions in countries with Muslim majorities, and the United Nations Charter and related documents, such as the Universal Declaration of Human Rights, are in harmony with the Charter of Medina, including consideration for public order.

NOTING FURTHER that deep reflection upon the various crises afflicting humanity underscores the inevitable and urgent need for cooperation among all religious groups, we

AFFIRM HEREBY that such cooperation must be based on a “Common Word,” requiring that such cooperation must go beyond mutual tolerance and respect, to providing full protection for the rights and liberties to all religious groups in a civilized manner that eschews coercion, bias, and arrogance.

BASED ON ALL OF THE ABOVE, we hereby:

Call upon Muslim scholars and intellectuals around the world to develop a jurisprudence of the concept of “citizenship” which is inclusive of diverse groups. Such jurisprudence shall be rooted in Islamic tradition and principles and mindful of global changes.

Urge Muslim educational institutions and authorities to conduct a courageous review of educational curricula that addresses honestly and effectively any material that instigates aggression and extremism, leads to war and chaos, and results in the destruction of our shared societies;

Call upon politicians and decision makers to take the political and legal steps necessary to establish a constitutional contractual relationship among its citizens, and to support all formulations and initiatives that aim to fortify relations and understanding among the various religious groups in the Muslim World;

Call upon the educated, artistic, and creative members of our societies, as well as organizations of civil society, to establish a broad movement for the just treatment of religious minorities in Muslim countries and to raise awareness as to their rights, and to work together to ensure the success of these efforts.

Call upon the various religious groups bound by the same national fabric to address their mutual state of selective amnesia that blocks memories of centuries of joint and shared living on the same land; we call upon them to rebuild the past by reviving this tradition of conviviality, and restoring our shared trust that has been eroded by extremists using acts of terror and aggression;

Call upon representatives of the various religions, sects and denominations to confront all forms of religious bigotry, vilification, and denigration of what people hold sacred, as well as all speech that promote hatred and bigotry; AND FINALLY,

AFFIRM that it is unconscionable to employ religion for the purpose of aggressing upon the rights of religious minorities in Muslim countries.
Marrakesh
January 2016, 27th

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Pre-Conference Overview
The Rights of Religious Minorities in Predominantly Muslim Lands: Legal Framework and a Call to Action
In order to examine more deeply what entails the rights of religious minorities in Muslim lands, both in theory and practice, His Highness, King Muhammad VI of Morocco, will host a conference in Marrakesh in the Kingdom of Morocco. The Ministry of Endowments and Islamic Affairs of the Kingdom of Morocco and the Forum for Promoting Peace in Muslim Societies, based in the U.A.E., will jointly organize the conference, scheduled to be held from 25th – 27th January, 2016 (15th – 17th Rabi al-Thani, 1437).

A large number of ministers, muftis, religious scholars, and academics from various backgrounds and schools of thought will, God willing, participate in this conference. Representatives from various religions, including those pertinent to the discussion, from the Muslim world and beyond, as well as representatives from various international Islamic associations and organizations will be in attendance.

The conference’s discussions and research will focus on the following areas:
:: Grounding the discussion surrounding religious minorities in Muslim lands in Sacred Law utilizing its general principles, objectives, and adjudicative methodology;
:: exploring the historical dimensions and contexts related to the issue;
:: and examining the impact of domestic and international rights.

This conference, with God’s help and providence, aims to begin the historic revival of the objectives and aims of the Charter of Medina, taking into account global and international treaties and utilizing enlightening, innovative case studies that are good examples of working towards pluralism. The conference also aims to contribute to the broader legal discourse surrounding contractual citizenship and the protection of minorities, to awaken the dynamism of Muslim societies and encourage the creation a broad-based movement of protecting religious minorities in Muslim lands…