Humanitarian Exchange Magazine – Number 65, November 2015

Humanitarian Exchange Magazine
Number 65 November 2015
http://odihpn.org/wp-content/uploads/2015/10/HE_65_web.pdf
The crisis in Iraq

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Human trafficking in crises: a neglected protection concern
by Laura Lungarotti, Sarah Craggs and Agnes Tillinac

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Connecting humanitarian actors and displaced communities: the IDP call centre in Iraq
by Gemma Woods and Sarah Mace

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Unleashing the multi-purpose power of cash
by Su’ad Jarbawi
Iraq is an upper middle-income country with high literacy rates, sound infrastructure, functioning markets and a comprehensive hawala cash transfer network covering all 18 governorates, making it an appropriate context for cash transfer programmes. Despite this, cash transfers have been on the periphery of the Iraq humanitarian response. As of the last Humanitarian Response Plan in June 2015, cash transfer programmes (both conditional and unconditional) constituted only 3% of the total funding appeal of $497.9 million

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Hello, money: the impact of technology and e-money in the Nepal earthquake response
by Erik Johnson, Glenn Hughson and Alesh Brown
On 30 April 2015, five days after the massive earthquake in Nepal, the UN Office for the Coordination of Humanitarian Affairs (OCHA) hosted humanitarian agencies in the UN com-pound to start what came to be known as the Cash Coordination Group (CCG). Four working groups were established, focusing on geographical mapping of which agencies were doing cash and where; market analysis; analysis and comparison of financial service providers; and standardising transfer amounts. This article, written by three members of the CCG, highlights learning on market analysis through the use of a mobile application, the identification and use of financial service providers and e-cash.

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Using participatory tools to assess remittances in disasters
by Loic Le De, J. C. Gaillard and Wardlow Friesen
In many low-income countries, remittances help to sustain people’s livelihoods and reduce their vulnerability to disasters. However, most studies on this topic are short-term and rely on econometric methods and analysis. Research suggests that aid agencies are aware of the importance of remittances in disasters, but rarely consider them within their relief actions and recovery programmes since their understanding of such mechanisms is generally very limited. Drawing on fieldwork in Samoa, this article concludes that participatory methods, despite some limitations and challenges, contribute to a better understanding of the complexity of remittances and their importance in people’s livelihoods following disaster.

Knowledge, Behavioral, and Sociocultural Factors Related to Human Papillomavirus Infection and Cervical Cancer Screening Among Inner-City Women in Panama

Journal of Community Health
Volume 40, Issue 6, December 2015
http://link.springer.com/journal/10900/40/4/page/1

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Original Paper
Knowledge, Behavioral, and Sociocultural Factors Related to Human Papillomavirus Infection and Cervical Cancer Screening Among Inner-City Women in Panama
Cheryl A. Vamos, Arlene E. Calvo, Ellen M. Daley…

Journal of Epidemiology & Community Health November 2015

Journal of Epidemiology & Community Health
November 2015, Volume 69, Issue 11
http://jech.bmj.com/content/current

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Editorial
Transnational research partnerships: leveraging big data to enhance US health
Casey Crump1, Kristina Sundquist2,3, Marilyn A Winkleby3
Author Affiliations
1Department of Medicine, Stanford University, Stanford, California, USA
2Center for Primary Health Care Research, Lund University, Malmö, Sweden
3Stanford Prevention Research Center, Stanford University, Stanford, California, USA
Published Online First 12 March 2015
Extract
In the current era of big data and small research budgets, new strategies are needed for more cost-effective leveraging of big data to enhance our nation’s health. One strategy is to promote transnational partnerships to tap into the rich, extensive databases available in other countries, particularly in Europe. The National Institutes of Health (NIH) has increasingly recognised that new collaborations that bring together multiple data sources will play a critical role in advancing our knowledge of disease causation, improving patient care, and promoting healthier communities. However, given cuts in research funding and fierce competition for US grants, some question whether US dollars should be diverted to fund ‘foreign’ studies. In this commentary, we argue that transnational research partnerships offer significant advantages for enhancing the health of the US population as well as the broader global community.

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Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis
Victor T Adekanmbi1,2, Ngianga-Bakwin Kandala1,3, Saverio Stranges1,4, Olalekan A Uthman5,6
Author Affiliations
1Division of Health Sciences, University of Warwick Medical School, Coventry, UK
2Center for Evidence-based Global Health, Ilorin, Nigeria
3Division of Epidemiology and Biostatistics, University of Witwatersrand, School of Public Health, Johannesburg, South Africa
4Department of Population Health, Luxembourg Institute of Health (LIH), Luxembourg
5Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School, Coventry, UK
6International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
Published Online First 10 June 2015
Abstract
Background Childhood mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with childhood mortality beyond individual-level measures of socioeconomic status in Nigeria.
Methods Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS).
Results More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of childhood mortality: male sex, mother’s age at 15–24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in childhood mortality in Nigeria.
Conclusions The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of childhood mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.

Barriers and Facilitators to Engaging Communities in Gender-Based Violence Prevention following a Natural Disaster

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 26, Number 3, August 2015
https://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.26.3.html

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Barriers and Facilitators to Engaging Communities in Gender-Based Violence Prevention following a Natural Disaster
pp. 1377-1390
Elizabeth Sloand, Cheryl Killion, Faye A. Gary, Betty Dennis, Nancy Glass, Mona Hassan, Doris W. Campbell, Gloria B Callwood

Ethical challenges of containing Ebola: the Nigerian experience

Journal of Medical Ethics
November 2015, Volume 41, Issue 11
http://jme.bmj.com/content/current

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Viewpoint
Ethical challenges of containing Ebola: the Nigerian experience
Omosivie Maduka1, Osaretin Odia2
Abstract
Responding effectively to an outbreak of disease often requires routine processes to be set aside in favour of unconventional approaches. Consequently, an emergency response situation usually generates ethical dilemmas. The emergence of the Ebola virus in the densely populated cities of Lagos and Port Harcourt in Nigeria brought bleak warnings of a rapidly expanding epidemic. However, these fears never materialised largely due to the swift reaction of emergency response and incident management organisations, and the WHO has now declared Nigeria free of Ebola. However, numerous ethical issues arose in relation to the response to the outbreak. This paper discusses some of these ethical challenges and the vital lessons learned. Ethical challenges relating to confidentiality, the dignity of persons, non-maleficence, stigma and the ethical obligations of health workers are examined. Interventions implemented to ensure that confidentiality and the dignity of persons improved and stigma was reduced, included community meetings, knowledge communication and the training of media personnel in the ethical reporting of Ebola issues. In addition, training in infection prevention and control helped to allay the fears of health workers. A potential disaster was also averted when the use of an experimental medicine was reconsidered. Other countries currently battling the epidemic can learn a lot from the Nigerian experience

The Lancet – Nov 07, 2015

The Lancet
Nov 07, 2015 Volume 386 Number 10006 p1795-1916 e27-e36
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Providing incentives to share data early in health emergencies: the role of journal editors
Christopher J M Whitty, Trevor Mundel, Jeremy Farrar, David L Heymann, Sally C Davies, Mark J Walport
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00758-8
Summary
The recent epidemic of Ebola virus disease in west Africa showed the power of data generated and analysed by the responder and academic communities to help shape and improve the public health response in international health emergencies. The swift response of clinical, public health, and academic professionals from diverse backgrounds was exemplary. Data and insights from many sciences, especially in peer-reviewed papers and online data, were crucial to planning the immediate and medium-term strategy.

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The Lancet Commissions
Health and climate change: policy responses to protect public health
Nick Watts, W Neil Adger, Paolo Agnolucci, Jason Blackstock, Peter Byass, Wenjia Cai, Sarah Chaytor, Tim Colbourn, Mat Collins, Adam Cooper, Peter M Cox, Joanna Depledge, Paul Drummond, Paul Ekins, Victor Galaz, Delia Grace, Hilary Graham, Michael Grubb, Andy Haines, Ian Hamilton, Alasdair Hunter, Xujia Jiang, Moxuan Li, Ilan Kelman, Lu Liang, Melissa Lott, Robert Lowe, Yong Luo, Georgina Mace, Mark Maslin, Maria Nilsson, Tadj Oreszczyn, Steve Pye, Tara Quinn, My Svensdotter, Sergey Venevsky, Koko Warner, Bing Xu, Jun Yang, Yongyuan Yin, Chaoqing Yu, Qiang Zhang, Peng Gong, Hugh Montgomery, Anthony Costello
Summary
The 2015 Lancet Commission on Health and Climate Change has been formed to map out the impacts of climate change, and the necessary policy responses, in order to ensure the highest attainable standards of health for populations worldwide. This Commission is multidisciplinary and international in nature, with strong collaboration between academic centres in Europe and China.

Nature Medicine | Editorial – Sharing data to save lives

Nature Medicine
November 2015, Volume 21 No 11 pp1235-1371
http://www.nature.com/nm/journal/v21/n11/index.html

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Nature Medicine | Editorial
Sharing data to save lives
Published online 05 November 2015
Journals can and should ensure that they erect no barriers to fast and wide sharing of critical data during major public health emergencies. But funders and scientists must also play a part.
On 1–2 September in Geneva, the World Health Organization (WHO) gathered a group of public health experts, scientists, funders, editors, industry and government representatives for a consultation related to the sharing of data during public health emergencies. Many attendees were directly involved in pathogen genome sequencing and in generating or using clinical, epidemiological and observational data during the 2014 Ebola epidemic in West Africa. Their experiences illustrate that improvements to the norms and process of data sharing in such scenarios are urgently needed.

A notable example was the way in which pathogen genome sequence data was handled. Although two batches of Ebola genome sequences obtained from patient samples were released in April and July 2014, no additional virus genome sequences were released until November that same year. Although restricted availability of patient samples hampered the sequencing of genomes, it is acknowledged that some viral genome sequence data were generated but not publicly released during this interval.

These viral genome sequences would remain useful to investigators seeking to understand the molecular features of virus evolution no matter when they are released. However, their utility to those seeking to trace the chain of transmission (e.g., human-to-human or animal-to-human), to determine whether a pathogen is genetically stable or rapidly mutating, and to track new pathogen variants entering the population, wanes days to weeks after the sequences are generated. Moreover, this ‘real-time’ utility is not restricted to pathogen genome sequence data; clinical trial and observational studies of the efficacy—or lack thereof—of candidate therapies can also enable clinicians to adapt in real-time. Waiting to release these data months after their generation during a public health emergency risks allowing medical workers to repeatedly test therapies that other clinicians had determined were ineffective.

Why are such data not rapidly and widely released in a systematic manner? Many barriers to data sharing were identified during the meeting in Geneva, including patient privacy concerns, government restrictions on the export of patient samples, lack of access to advanced technology in limited resource settings, and lack of personnel and time.
As editors, we wish to address another concern, which a consensus felt was a formidable barrier to early data release: the perception that public release of data will have a negative effect on later scientific publication of the same data. More specifically, many data producers worry that if they publicly release their data prior to submitting a manuscript to a peer-reviewed journal, the editors of the journal may consider the released data no longer novel and reject their manuscript for that reason. In addition, especially when data producers are on the ground working to stem an outbreak and are thus occupied with tasks more important than writing manuscripts, other scientists may analyze the released data, submit the resulting manuscript, and ultimately ‘scoop’ the data-producing lab.

Allaying the first concern is the responsibility of scientific journals. Encouragingly, all editors in attendance emphatically declared that their journals do not wish to hinder real-time sharing of data that could have a clinical impact during public health emergencies. Reflecting this sentiment, the WHO summary released after the consultation states, “It was unequivocally agreed by representatives from leading biomedical journals that public disclosure of important information of potential relevance to public health emergencies should not be delayed by publication timelines, and that pre-publication disclosure must not and will not prejudice journal publication.” The Nature journals agree with this statement; it is consistent with our long-standing policy of not penalizing authors for posting most data on preprint servers. Moving forward, although we already require that all data be available to editors and referees at the time of submission—and freely available to all at the time of publication—when we feel that the data in a submitted manuscript may be useful more broadly to agencies working to stem a public health emergency, we will encourage authors to publicly release the data immediately. We will use editorial discretion in defining major public health emergencies and the relevance of the data in question. To regularly remind readers of these principles, we will ask authors of papers that present data that were released prior to submission or publication to add a sentence to the final published paper explicitly stating this fact.

But these steps address just one part of the problem. Scientists, funders and governments must work to solve the rest. For instance, journals become aware of the existence of data when it is submitted for consideration for publication; yet this could be months after it was initially generated. Only scientists, with the cooperation of governments, can ensure that the data are broadly released as quickly as possible. Scientists are also responsible for ensuring that data users are aware of any limitations of rapidly released potentially preliminary data.

Just as crucially, journals cannot allay concerns about scientists scooping each other. Communities of data producers and users must agree on guidelines for the etiquette of data sharing and data use. Useful precedents might be found in guidelines crafted by other communities that successfully grappled with similar challenges, such as the 2006 Global Initiative on Sharing Avian Influenza Data. Once data producers and users coalesce around a set of guidelines, funders can create policies to ensure that they are followed as often as possible, and that data producers remain incentivized to quickly share their results.

Attendees at the WHO consultation agreed on a list of practical steps that can be taken to remove all identified barriers to data sharing. A list of these steps was submitted to the WHO emergency R&D preparedness blueprint Advisory Group, and it awaits endorsement by the WHO and its partners.

The Nature journals’ commitment to enable rather than hinder data sharing in major public health emergencies is effective immediately.

Deferred Consent for Randomized Controlled Trials in Emergency Care Settings

Pediatrics
November 2015, VOLUME 136 / ISSUE 5 http://pediatrics.aappublications.org/content/136/5?current-issue=y

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Deferred Consent for Randomized Controlled Trials in Emergency Care Settings
Katie Harron, Kerry Woolfall, Kerry Dwan, Carrol Gamble, Quen Mok, Padmanabhan Ramnarayan, Ruth Gilbert
Abstract
BACKGROUND: There is limited experience in using deferred consent for studies involving children, which was legalized in the United Kingdom in 2008. We aimed to inform future studies by evaluating consent rates and reasons for nonconsent in a large randomized controlled trial in pediatric intensive care.
METHODS: In the CATCH trial, eligible children from 14 PICUs in England and Wales were randomly assigned to 3 types of central venous catheters. To avoid delay in treatment, children admitted on an emergency basis were first randomly assigned to a trial central venous catheter, and we deferred seeking consent to use already collected data and blood samples until after stabilization.
RESULTS: Consent was obtained for 984/1358 (72%) of children admitted on an emergency basis. Failure to obtain consent resulted mainly from a lack of opportunity (early discharge or transfer) for survivors and difficulties in seeking consent for children who died. For admissions where there was an opportunity to approach (n = 1298), inclusion rates differed according to survival status: 93/984 (9%) of consented patients died, compared with 58/314 (18%) of nonconsented patients. For children admitted on an emergency basis whose families were approached, 984/1178 (84%) provided deferred consent (n = 15 sites), compared with 441/641 (69%) of children admitted on an elective basis who were approached for prospective consent (n = 9 sites).
CONCLUSIONS: Design of emergency randomized controlled trials should balance the potential burden that seeking consent in difficult situations may cause against risk of bias by disproportionately excluding children who die or are transferred. Ethics committees could consider approving the use of already collected data when best efforts to obtain deferred consent are unsuccessful.

PLOS Currents: Disasters [Accessed 7 November 2015]

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 7 November 2015]

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Who Is Worst Off? Developing a Severity-scoring Model of Complex Emergency Affected Countries in Order to Ensure Needs Based Funding
November 3, 2015 · Research article
Background: Disasters affect close to 400 million people each year. Complex Emergencies (CE) are a category of disaster that affects nearly half of the 400 million and often last for several years. To support the people affected by CE, humanitarian assistance is provided with the aim of saving lives and alleviating suffering. It is widely agreed that funding for this assistance should be needs-based. However, to date, there is no model or set of indicators that quantify and compare needs from one CE to another. In an effort to support needs-based and transparent funding of humanitarian assistance, the aim of this study is to develop a model that distinguishes between levels of severity among countries affected by CE.
Methods: In this study, severity serves as a predictor for level of need. The study focuses on two components of severity: vulnerability and exposure. In a literature and Internet search we identified indicators that characterize vulnerability and exposure to CE. Among the more than 100 indicators identified, a core set of six was selected in an expert ratings exercise. Selection was made based on indicator availability and their ability to characterize preexisting or underlying vulnerabilities (four indicators) or to quantify exposure to a CE (two indicators). CE from 50 countries were then scored using a 3-tiered score (Low-Moderate, High, Critical).
Results: The developed model builds on the logic of the Utstein template. It scores severity based on the readily available value of four vulnerability and four exposure indicators. These are 1) GNI per capita, PPP, 2) Under-five mortality rate, per 1 000 live births, 3) Adult literacy rate, % of people ages 15 and above, 4) Underweight, % of population under 5 years, and 5) number of persons and proportion of population affected, and 6) number of uprooted persons and proportion of population uprooted.
Conclusion: The model can be used to derive support for transparent, needs-based funding of humanitarian assistance. Further research is needed to determine its validity, the robustness of indicators and to what extent levels of scoring relate to CE outcome.

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Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs
November 2, 2015 · Perspective
Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people. Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities. Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident. Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents. Furthermore, the identity of the hazardous material released may not be known early in an incident. Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents. Experts from the Global Health Security Initiative’s Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident.

Editorial – Eradicating polio

Science
6 November 2015 vol 350, issue 6261, pages 597-712
http://www.sciencemag.org/current.dtl

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Editorial
Eradicating polio
Anthony Adams1,*, David M. Salisbury2,
1Anthony Adams is a former professor of public health at the Australian National University and the former Chief Medical Officer of Australia.
2David M. Salisbury is an associate fellow at the Centre for Global Health Security, Chatham House, London, UK.

On 20 September 2015, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared that type 2 wild poliovirus had been eradicated. The GCC examined reports from 189 of 195 countries around the world and studied separate data [held by the World Health Organization (WHO)] from the remaining countries. According to WHO, nearly 2 million appropriate clinical samples had been tested, and no type 2 wild polioviruses were found. The announcement is the first step toward eradicating all three wild poliovirus types. But this landmark will only be declared when the GCC is confident that there have been no wild virus cases of any type for 3 years.

The last case of type 3 wild poliovirus occurred in northern Nigeria 3 years ago. In theory, declaration of its eradication could happen now. However, the polio programs from 18 African countries have not yet been scrutinized by the African Regional Certification Commission to ensure that no cases have been missed. This assessment will happen 3 years after each country’s last case of any wild poliovirus. By the end of 2017, all African countries must have gone successfully through their regional commission’s scrutiny, and no wild virus cases must have occurred. If that happens, all countries in the world will submit their data to the GCC and type 3 wild poliovirus eradication can be declared.

That will leave just the type 1 poliovirus, which is still circulating in Pakistan and Afghanistan. To date, the 51 cases of 2015 are far fewer than the 334 cases reported in 2014. This is probably the result of improved access to vaccination in key regions. But there are always fewer cases the year after high numbers are reported, because natural infection reduces the numbers of children susceptible to polio in the following year. The polio programs in both countries must further accelerate their activities. If transmission is interrupted by the end of 2016, then the world can be declared polio-free in 2019.

One underappreciated consequence of the path toward eradication is that all polioviruses (wild and vaccine strains) in laboratory, research, and manufacturing facilities will have to be destroyed or securely contained. Last month, the WHO Strategic Advisory Group of Experts on immunization reaffirmed April 2016 as the date for the globally synchronized withdrawal of type 2 oral poliovirus vaccine. This first step toward the eventual phased removal of all three vaccine types brings urgency to completing the destruction, and securing the containment, of type 2 wild polioviruses in all facilities. The fewer the places that hold either polioviruses or specimens that could contain polioviruses, the more certain we can be that they will not be released inadvertently. This means that the vaccine industry will have to comply with high levels of assurance of containment in their manufacturing processes. Researchers and institutions holding samples collected from places where there could have been polioviruses must ensure that these are destroyed or secured under appropriate biocontainment levels. Countries will need to submit inventories of all laboratories to the GCC for review, and manufacturers and laboratories planning to retain type 2 polioviruses will need to be inspected for compliance with containment guidelines.

In 1980, smallpox was declared eradicated after a global immunization campaign led by WHO. But 2 years earlier, a year after the last natural smallpox case (in Somalia), there was an inadvertent release of smallpox virus from a research lab in the United Kingdom, from which one person died. While we wait for Pakistan and Afghanistan to stop the spread of type 1, we must prepare to safely and securely contain all polioviruses. A second human virus may soon be consigned to history. Until then, the whole world, especially countries with fragile health systems, remains at risk of this disease.
A.A. and D.M.S. are writing on behalf of the GCC: Anthony Adams (Chair), Supamit Chunsuttiwat, Arlene King, Rose Gana F. Leke, Yagob Al Mazrou, and David M. Salisbury.

Evidence gaps and ethical review of multicenter studies

Science
6 November 2015 vol 350, issue 6261, pages 597-712
http://www.sciencemag.org/current.dtl

Policy Forum
Research Ethics
Evidence gaps and ethical review of multicenter studies
Ann-Margret Ervin1,*, Holly A. Taylor1,2, Curtis L. Meinert1, Stephan Ehrhardt1
Author Affiliations
1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
2Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.

Large, multicenter clinical studies are the backbone of evidence-based prevention and health care. Ethical review of multicenter research is usually conducted by the institutional review board (IRB) of each participating institution. However, variation in interpretation of regulations by IRBs is common and can have ethical and scientific implications (1, 2). Recent mandates in the United States aim to reduce the administrative burden and to expedite multicenter research by conducting ethical review with a single, central IRB of record (CIRB). Yet the quality of ethical review must not suffer. We characterize current models of ethical review in the United States and identify research gaps that must be addressed before such policies are instituted.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 31 October 2015

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 31 October 2015

blog edition: comprised of the 35+ entries  posted below on 4-6 November 2015

World Migration Report 2015 – Migrants and Cities: New Partnerships to Manage Mobility

World Migration Report 2015 – Migrants and Cities: New Partnerships to Manage Mobility
International Organization for Migration (IOM)
October 2015 :: 227 pages
ISBN 978-92-9068-709-2 ISSN 1561-5502
The Report can be downloaded in English, French and Spanish
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Foreword [excerpt]
The eighth report in IOM’s World Migration Report (WMR) series─ focuses on migrants and how migration is shaping cities and the situation of migrants in cities.

While much of the current international discussion about migration trends and migration policy tends to focus on the national level, this report takes migration enquiries to the city level and aims to raise understanding of the local socioeconomic dynamics of migration and the close connection between migration and urban development.

The main chapters of the World Migration Report 2015 investigate both the challenges and opportunities arising from increasing migration to diverse urban settings. They present findings on the potential benefits of all forms of migration and mobility for city growth and development. The report showcases innovative ways in which migration and urbanization policies can be better designed for the benefit of migrants and cities.

The report particularly focuses on migrants’ situations in the cities of the Global South, broadening the current focus on the cities of the Global North. It highlights how cities and migrants can work together in order to reduce the risks of migration to cities and take advantage of growing urban diversity in such areas as community resilience building and local economic, social and cultural development through migrants’ connections between origin and host communities.

The report concludes with a set of recommendations for future city initiatives to include migrants as partners and migrants’ issues in the discussion on urbanization and the post-2015 global development framework…

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Press Release
IOM Launches 2015 World Migration Report
10/28/15
Geneva – IOM yesterday (27/10) launched its flagship World Migration Report 2015 – Migrants and Cities: New Partnerships to Manage Mobility, during the second day of the two-day high-level Conference on Migrants and Cities in Geneva.

The report, the eighth in IOM’s World Migration Report series, focuses on how migration and migrants are shaping cities and how the life of migrants is shaped by cities, their people, organizations and rules.

Speaking at the launch, Dr. June Lee, the report’s editor-in-chief, noted that while much of the current international discussion about migration trends and policy is at national level, this report takes the migration debate to the city level.

“The report focuses on how migration is shaping cities and how the situation of migrants in cities – how they live, work and shape their habitat – helps to reveal the close connection between human mobility and urban development,” she said.

The report reveals that nearly one in five of all migrants live in the world’s 20 largest cities and in many of these cities migrants represent over a third or more of the population.
According to the report, over 54 per cent of people across the globe were living in urban areas in 2014. The current urban population of 3.9 billion is expected to grow to some 6.4 billion by 2050. Migration is driving much of the increase in urbanization, making cities much more diverse places in which to live.

Addressing the notion that existing discussions on migrants and cities tend to focus primarily on the Global North and the integration of international migrants, Lee told the conference that the report takes a global perspective, with particular attention to the situation of migrants in the cities of the Global South. As a result, and for the first time in the WMR series, the 2015 report examines both internal and international migration.

A key finding of the report is that human mobility is growing and will continue to be overwhelmingly urban. “At the same time, the geography of migration flows is changing in line with changes in the global economy. For example, migrants are increasingly attracted to the cities in the countries experiencing higher economic growth in East Asia, Brazil, southern Africa and western India,” said Lee.

Increasingly, the cities of developing countries have become places of both immigration and emigration, given the growing South-South migration – population movements among low- and middle-income countries, the report shows.

Another key finding emerging from the report is that rising migration to cities brings both risks and opportunities for the migrants, communities and governments concerned. “Super-diversity brings challenges, such as residential segregation when certain ethnicities, nationalities or a socioeconomic status concentrate in particular neighborhoods of a city or metropolitan area. Although there are some positive effects of ethnic clustering, policy makers try to combat residential segregation becoming generational,” said Lee.
The report points out that multi-ethnic make-up is the normal condition of many cities in the less developed world and such cities often face mixed migration flows, with a particularly high concentration of internally displaced people and migrants stranded in transit.

Noting the reality that many cities are insufficiently resourced and motivated to become truly inclusive, the report calls for a platform for migration and urbanization to discuss how to balance knowledge, capacities and commitments towards good policymaking and practice for inclusive urban governance across countries.

“We need to consider what roles international communities and organizations play, while bearing in mind that the good practices of more advanced countries might not be globally applicable,” said Lee.

Refugee crisis in Europe and rights of children – Statement from ECPAT

Refugee crisis in Europe and rights of children
Statement from ECPAT
20 October 2015

Recent crises and war in several countries, including Syria, Afghanistan and Eritrea among others, have led to tens of thousands of refugees arriving in the European Union via southern Europe and across the Mediterranean Sea. Among them are a significant number of children, some of whom are separated from their families.

All of these children are extremely vulnerable to a range of abuses and may arrive already as victims of trafficking. It is vital that these children are identified early and afforded the protection they need to prevent further abuse and to stop them going missing. Other children arriving in Europe, with or without their families, are also extremely vulnerable to exploitation and require protection to prevent this risk becoming a reality.

In the face of this huge crisis, the importance for a robust child protection response cannot be underestimated. Whether it is criminal records checks for volunteers working with refugees or resourcing investigations to dismantle trafficking groups, whether organised or not, the necessary levels of child protection at all stages must not be diluted. The need to maintain and uphold children’s rights and child protection laws is more important now than ever in order to create a protective environment for these children on arrival, as well as working to find durable solutions for each and every one of them.

Key reports by the Fundamental Rights Agency on guardianship for children deprived of parental care in the EU highlight the need for functioning guardianship systems in order to protect children who are victims of trafficking or those who are at risk of exploitation – in line with the EU’s Strategy Towards the Eradication of Trafficking in Human Beings 2012-2016. It acknowledges the vulnerability of these children and identifies guardianship systems as an effective measure to identify victims and to prevent abuse. Yet the way in which individual Member States enforce child protection laws and operate systems of guardianship vary massively, which may mean children are put at risk.

ECPAT urges the European Commission to ensure all children affected in the refugee crisis are prioritised and protected effectively by a well-planned and resourced strategic response. Protection systems in all Member States and neighbouring countries must be consistent and work together, cross-border, to safeguard children. The European Commission must lead the way in promoting the rights of refugee and migrant children who are arriving or who are already in Europe, ensuring that – despite the challenges they face in their young lives – they are able to exercise their rights and live their lives free from the threat of abuse.

Signatories to the statement: Children’s Human Rights Center of Albania, Defence for Children-ECPAT Netherlands, ECPAT Austria, ECPAT Belgium, ECPAT France, ECPAT International, ECPAT Luxembourg, ECPAT Sweden, ECPAT UK, FAPMI-ECPAT Spain, Neglected Children’s Society-ECPAT Bulgaria, Nobody’s Children Foundation.

11 major companies to promote inclusion of persons with disabilities in the workplace – ILO

11 major companies to promote inclusion of persons with disabilities in the workplace
The new Global Business and Disability Network Charter is a global tool for businesses to promote the inclusion of persons with disabilities in the world of work
International Labour Organization News | 28 October 2015
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GENEVA (ILO News): Eleven major international companies have become the first signatories of the newly-created “ILO Global Business & Disability Network Charter ” in a ceremony held at ILO headquarters in Geneva.

The Charter expresses their commitment to promoting and including persons with disabilities throughout their operations worldwide.

It covers a wide range of areas, from protecting staff with disabilities from any kind of discrimination to making the company premises and communication to staff progressively
All signatories are members of the ILO Global Business and Disability Network , which brings businesses together to promote disability inclusion by highlighting the business advantages of employing people with disabilities. It also facilitates the exchange of knowledge and good practices between companies, company networks and the ILO.

Created in 2010, the Network acts as a facilitator and responds to requests from members to develop tools, share knowledge, and facilitate business-to-business meetings and dialogues around disability issues. It combines the interests of the ILO employer constituents and of multinational enterprises.

The signing companies are: Accenture, AccorHotels, Adecco Group, AXA Group, Carrefour Group, Dow Chemical, Groupe Casino, L’Oréal, Orange, the Standard Bank Group, and Michelin.

Charter Principles
As a member of the ILO Global Business and Disability Network, the signatory multinational enterprises support the following principles and commits to work towards their company-wide implementation:
1. Promote and respect the rights of persons with disabilities by raising awareness and combating stigma and stereotypes faced by persons with disabilities.
2. Develop policies and practices that protect persons with disabilities from all types of discrimination.
3. Promote equal treatment and equal opportunities for persons with disabilities by providing reasonable accommodation in the recruitment process, on-the-job, apprenticeships, training, job retention, career development and other relevant terms and conditions of employment.
4. Progressively make the company premises and communication to staff accessible for all employees with disabilities.
5. Undertake appropriate measures to enable current employees who acquire a disability to retain or return to their employment.
6. Respect confidentiality of personal information regarding disability.
7. Consider the needs of those persons with disabilities who face particular challenges accessing the labour market, including persons with intellectual and psychosocial disabilities.
8. Promote employment of persons with disabilities among business partners and other companies and collaborate with national employer and business networks on disability as well as with organizations working to advance the rights of persons with disabilities.
9. Review regularly the company disability inclusion policies and practices for their effectiveness.
10. Report on company efforts to promote the employment of persons with disabilities to all relevant stakeholders and share information and experiences with the members of the ILO Global Business and Disability Network. The ILO will utilize the company reports and practices in its own communication, wherever relevant.

Doing Business 2016- Measuring Regulatory Quality and Efficiency – World Bank Group

Doing Business 2016- Measuring Regulatory Quality and Efficiency
World Bank Group
October 27, 2015 :: 348 pages
Pdf: http://www.doingbusiness.org/~/media/GIAWB/Doing%20Business/Documents/Annual-Reports/English/DB16-Full-Report.pdf Also available as mini book (PDF, 2.4MB) (15460.3 KB PDF)

Overview
Doing Business 2016: Measuring Regulatory Quality and Efficiency, a World Bank Group flagship publication, is the 13th in a series of annual reports measuring the regulations that enhance business activity and those that constrain it. Doing Business presents quantitative indicators on business regulations and the protection of property rights that can be compared across 189 economies—from Afghanistan to Zimbabwe—and over time.

Doing Business measures regulations affecting 11 areas of the life of a business. Ten of these areas are included in this year’s ranking on the ease of doing business: starting a business, dealing with construction permits, getting electricity, registering property, getting credit, protecting minority investors, paying taxes, trading across borders, enforcing contracts and resolving insolvency. Doing Business also measures labor market regulation, which is not included in this year’s ranking.

Data in Doing Business 2016 are current as of June 1, 2015. The indicators are used to analyze economic outcomes and identify what reforms of business regulation have worked, where and why. This year’s Doing Business report continues a two-year process of introducing improvements in 8 of 10 Doing Business indicator sets—to complement the emphasis on the efficiency of regulation with a greater focus on its quality.

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Main Findings
:: Doing Business 2016: Measuring Regulatory Quality and Efficiency finds that entrepreneurs in 122 economies saw improvements in their local regulatory framework last year. Between June 2014 and June 2015, the report, which measures 189 economies worldwide, documented 231 business reforms. Among reforms to reduce the complexity and cost of regulatory processes, those in the area of starting a business were the most common in 2014/15, as in the previous year. The next most common were reforms in the areas of paying taxes, getting electricity and registering property. Read about business reforms.

:: Costa Rica, Uganda, Kenya, Cyprus, Mauritania, Uzbekistan, Kazakhstan, Jamaica, Senegal and Benin are among the economies that improved the most in 2014/2015 in areas tracked by Doing Business. Together, these 10 top improvers implemented 39 regulatory reforms making it easier to do business.

:: Sub-Saharan Africa alone accounted for about 30% of the regulatory reforms making it easier to do business in 2014/15, followed closely by Europe and Central Asia. Members of the Organization for the Harmonization of Business Law in Africa were particularly active: 14 of the 17 economies implemented business regulation reforms in the past year—29 in total. Twenty-four of these reforms reduced the complexity and cost of regulatory processes, while the other five strengthened legal institutions.

:: This year’s report adds indicators of quality to four indicator sets: registering property, dealing with construction permits, getting electricity and enforcing contracts. In addition, the trading across borders indicators have been revised to increase their relevance. The underlying case study now focuses on the top export product for each economy, on a very common manufactured product (auto parts) as its import product and on its largest trading partner for the export and import products.

:: Seven case studies featured in the report: Five focus on legal and regulatory features covered by new or expanded indicators being introduced this year—in the areas of dealing with construction permits, getting electricity, registering property, trading across borders and enforcing contracts. The other two analyze other areas of interest in the historical data set. See all case studies.

UNAIDS 2016–2021 Strategy – On the Fast-Track to end AIDS [by 2030]

UNAIDS 2016–2021 Strategy – On the Fast-Track to end AIDS [by 2030]
Issue date: 27 October 2015 :: 130 pages
UNAIDS PROGRAMME COORDINATING BOARD
UNAIDS/PCB (37)/15.18.rev1
THIRTY-SEVENTH MEETING
Date: 26 – 28 October 2015
WHO, Geneva

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Executive summary [excerpt]
A defining moment
1. The UNAIDS 2016–2021 Strategy comes at a critical moment in the history of the HIV epidemic and response. Evidence demonstrates that if the current, unprecedented level of HIV service coverage is simply maintained, progress will slip backwards with rising numbers of people newly infected, and more people dying from AIDS-related causes. Nevertheless, we have never had more opportunities to leverage our momentum to accelerate the response over the next five years: a new sustainable development agenda; fresh, innovative solutions; and the rise of regional, national and local leadership and institutions – including strong political commitment to the 90–90–90 treatment target. By seizing this moment, we can end the AIDS epidemic as a public health threat by 2030. The next five years provide a fragile window of opportunity to Fast-Track the AIDS response and empower people to lead dignified and rewarding lives….

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Press Release
UNAIDS Board adopts bold and ambitious strategy to end the AIDS epidemic by 2030
GENEVA, 30 October 2015—At its 37th meeting, the UNAIDS Programme Coordinating Board adopted a new strategy to end the AIDS epidemic as a public health threat by 2030. The UNAIDS 2016–2021 Strategy is one of the first in the United Nations system to be aligned to the Sustainable Development Goals, which set the framework for global development policy over the next 15 years, including ending the AIDS epidemic by 2030.

With a universal agenda, firmly grounded in evidence and rights-based approaches, the strategy maps out the UNAIDS Fast-Track approach to accelerate the AIDS response over the next five years to reach critical HIV prevention and treatment targets and achieve zero discrimination. Members of the Board from across all regions called the strategy bold, ambitious, yet achievable, and praised the highly inclusive and consultative process to develop it.

In his opening address, the Executive Director of UNAIDS, Michel Sidibé, described the strategy as an urgent call to front-load investment, to close the testing gap, to increase focus and financing for HIV prevention and to protect the health of the 22 million people living with HIV who are not yet accessing treatment. He said that the strategy would be an instrument for social justice and dignity…

…During the dedicated thematic day, the Board discussed the importance of shared responsibility and global solidarity for an effective, equitable and sustainable HIV response. It was agreed that the most critical next step for achievement of the Sustainable Development Goals will be to have clarity on the means of implementation. Participants emphasized that multisectorality and equitable, transparent and inclusive governance are central bases for effective shared responsibility and global solidarity, and that the AIDS response—and in particular UNAIDS—provides an important model to be replicated for other health, development, gender and rights outcomes…

World Health Organisation right to be wary about first malaria vaccine [Seth Berkley, Gavi and Mark Dybul, Global Fund]

World Health Organisation right to be wary about first malaria vaccine
By Seth Berkley, Gavi and Mark Dybul, Global Fund
Voices on 29 October 2015
Mosquirix is one of the most widely anticipated vaccines to have been developed. It is the first vaccine for malaria – a disease that kills more than 1,200 children every day– and has been clinically proven to provide protection against the disease. So, given that it has passed the toughest regulatory hurdles required of it, why is it only being made available in a handful of countries?

Demand for the vaccine is likely to be high. With more than 200m cases a year, malaria is endemic in almost every country in sub-Saharan Africa, as well as large parts of Asia and Latin America. Last week, two advisory bodies to the World Health Organisation, the strategic advisory group of experts on immunisation and the malaria policy advisory committee, recommended against its immediate widespread use, and many people may have been left wondering why.

But it was a smart call. While there is a potential to save many lives with this vaccine, we have reason to tread carefully. Rather than being a simple solution, Mosquirix comes with complex caveats and some outstanding questions that the clinical studies were not able to address. While some may argue that any delay in getting the vaccine out to people could end up costing lives, experts first want certainty that, in a real-life setting, it indeed brings the benefits we expect, based on what was shown in the trials.

Clinical trials found Mosquirix to be both safe and effective, providing 39% efficacy at preventing clinical cases of malaria over the course of a four-year trial. While this is low for a vaccine, it is worth remembering that given the large number of people at risk, providing protection in just four out of 10 cases could still go a very long way. Moreover, since there can be more than one episode per child, the trials found that the vaccine prevented on average 1,774 cases of malaria per 1,000 children.

However, what happens during the controlled setting of a clinical trial does not necessarily translate into a real-world situation, and here lies the concern.

To begin with, Mosquirix requires four doses. That’s a lot for a vaccine. What’s more, trials suggest that its already low efficacy is further reduced if the fourth dose is not administered, down to about 28% protection against clinical malaria and reducing its impact on severe cases of malaria to nearly zero. That is worrying because, typically, the more doses required of a vaccine the higher the dropout rate.

It then becomes a question of how reliably the vaccine can be administered – and, again, Mosquirix presents challenges. To achieve maximum effect, it should be given to children from five months, with the fourth dose given around the age of two. This is out of sync with the typical immunisation schedule for children in poorer countries, who are brought in for routine vaccination when they are six to 14 weeks old.

Delivering the vaccine will require unprecedented efforts to inform and mobilise people to bring their children to health clinics at the prescribed time to complete all four doses. But, with many of the countries in question already struggling to improve routine immunisation rates, it remains to be seen how reliably four doses of Mosquirix can be deployed.

That doesn’t mean it can’t be done. In light of how big a priority malaria is for these countries they may well indeed make it work. After all, we have seen this happen with the human papillomavirus (HPV) vaccine, another much sought after vaccine for developing countries, which is given to school-age girls to prevent cervical cancer.

But even if high coverage can be achieved, there is still a danger that news of the vaccine will give people a false sense of security and lead to a reduction in the use of other malaria interventions, which would be tragic. Insecticide treated bednets and anti-malarial medicine have already led to a 37% global decrease in malaria cases since 2000, and a 60% decline in the malaria mortality rate.

Mosquirix is no magic bullet and at best may prove to be a useful complementary tool in reducing malaria, but only one of many already being used.

All this combined is why the WHO has been so cautious, recommending that we proceed with just a few demonstration projects in three to five settings, and involving around 1 million children. This is a sensible approach; it is due diligence. With so many lives at stake, it is critical that we shed more light on these unknowns, so that we fully understand the impact of this vaccine before, or even if, we should make it more widely available.

United Nations – Secretary General, Security Council, General Assembly [to 31 October 2015]

United Nations – Secretary General, Security Council, General Assembly  [to 31 October 2015]
http://www.un.org/en/unpress/
Selected Press Releases/Meetings Coverage

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28 October 2015
SC/12101
Security Council Presidential Statement Voices Deep Concerns about Growing Insecurity, Increasing Violence, Persisting Political Impasse in Burundi
The Security Council today voiced its deep concerns about the growing insecurity, the continued rise in violence, and the persisting political impasse in Burundi, marked by a lack of dialogue among Burundian stakeholders.

28 October 2015
GA/11714
General Assembly Elects 18 Members to Human Rights Council, Confirms Six States Nominated to Programme and Coordination Committee
The General Assembly today elected 18 States to serve on the Human Rights Council, the United Nations body responsible for the promotion and protection of all human rights around the globe.

27 October 2015
GA/SHC/4144
Disability Is Not Inability, Special Rapporteurs Tell Third Committee, Urging National Reforms to Ensure Social Inclusion, Human Rights Protection
Legislative and institutional reforms must be undertaken by States to ensure coherent social systems that include – and recognize the rights of – persons with disabilities, the Third Committee (Social, Humanitarian and Cultural) heard today as it continued its consideration of the promotion and protection of human rights.

27 October 2015
SC/12098
Briefing Security Council on Syria, Relief Chief Urges Political Solution Addressing Root Causes of Conflict, Increase in Humanitarian Aid
The failure of the parties to the Syrian conflict to uphold the basic tenets of international humanitarian and human rights law had propelled the Syrian people to levels of tragedy and despair that could barely have been imagined five years ago, Stephen O’Brien, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, told the Security Council this morning.