Search

We analyzed an attempt to develop and clinically test a pneumococcal conjugate vaccine for the developing world, undertaken by public health institutions from the Netherlands, Sweden, Denmark, Norway and Finland: the Dutch Nordic Consortium (DNC), between 1990 and 2000. Our review shows that the premature termination of the project was due less to technological and scientific challenges and more to managerial challenges and institutional policies. Various impeding events, financial and managerial challenges gradually soured the initially enthusiastic collaborative spirit until near the end the consortium struggled to complete the minimum objectives of the project. By the end of 1998, a tetravalent prototype vaccine had been made that proved safe and immunogenic in Phase 1 trials in adults and toddlers in Finland. The planned next step, to test the vaccine in Asia in infants, did not meet approval by the local authorities in Vietnam nor later in the Philippines and the project eventually stopped.The Dutch DNC member, the National Institute of Public Health and the Environment (RIVM) learned important lessons, which subsequently were applied in a following vaccine technology transfer project, resulting in the availability at affordable prices for the developing world of a conjugate vaccine against Haemophilus influenzae type b. We conclude that vaccine development in the public domain with technology transfer as its ultimate aim requires major front-end funding, committed leadership at the highest institutional level sustained for many years and a competent recipient-manufacturer, which needs to be involved at a very early stage of the development.At the national level, RIVM's policy to consolidate its national manufacturing task through securing a key global health position in support of a network of public vaccine manufacturers proved insufficiently supported by the relevant ministries of the Dutch government. Difficulties to keep up with high costs, high-risk innovative vaccine development and production in a public sector setting led to the gradual loss of production tasks and to the 2009 Government decision to privatize the vaccine production tasks of the Institute. [ABSTRACT FROM AUTHOR]

Two rotavirus vaccines have been licensed in >100 countries worldwide since 2006. As of October 2105, these vaccines have been implemented in the national immunization programs of 79 countries, including 36 low-income countries that are eligible for support for vaccine purchase from Gavi, the Vaccine Alliance. Rotavirus vaccines were initially introduced in Australia and countries of the Americas and Europe after completion of successful clinical trials in these regions, and the impact of routine vaccination in reducing the health burden of severe childhood gastroenteritis in these regions has been well documented. Because of concerns around the performance of orally administered rotavirus vaccines in developing countries, vaccine implementation in these settings only began after additional clinical trials were completed and the World Health Organization issued a global recommendation for use of rotavirus vaccines in 2009. This supplementary issue of Clinical Infectious Diseases includes a collection of articles describing the impact and effectiveness of routine rotavirus vaccination in developing countries that were among the early adopters of rotavirus vaccine. The data highlight the benefits of vaccination and should provide valuable evidence to sustain vaccine use in these countries and encourage other countries to adopt routine rotavirus vaccination to reduce the health burden of severe childhood gastroenteritis. [ABSTRACT FROM AUTHOR]

In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality worldwide with and a serious public health threat to developing countries. Recognizing the importance and urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was to understand the current situation of different NCD public health programs and the current trends in NCD research and policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy participants representing scientists, physicians, academics and students from several institutes in Germany and abroad. Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the participants to learn about evidence-based practices and policies for prevention and management of major NCDs and to debate the way forward. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Despite increases in routine vaccination coverage during the past three decades, the percent of children completing the recommended vaccination schedule remains below expected targets in many low and middle income countries. In 2008, the World Health Organization Strategic Advisory Group of Experts on Immunization requested more information on the reasons that children were under-vaccinated (receiving at least one but not all recommended vaccinations) or not vaccinated in order to develop effective strategies and interventions to reach these children. Methods: A systematic review of the peer-reviewed literature published from 1999 to 2009 was conducted to aggregate information on reasons and factors related to the under-vaccination and non-vaccination of children. A standardized form was used to abstract information from relevant articles identified from eight different medical, behavioural and social science literature databases. Findings: Among 202 relevant articles, we abstracted 838 reasons associated with under-vaccination; 379 (45%) were related to immunization systems, 220 (26%) to family characteristics, 181 (22%) to parental attitudes and knowledge, and 58 (7%) to limitations in immunization-related communication and information. Of the 19 reasons abstracted from 11 identified articles describing the non-vaccinated child, 6 (32%) were related to immunization systems, 8 (42%) to parental attitudes and knowledge, 4 (21%) to family characteristics, and 1 (5%) to communication and information. Conclusions: Multiple reasons for under-vaccination and non-vaccination were identified, indicating that a multi-faceted approach is needed to reach under-vaccinated and unvaccinated children. Immunization system issues can be addressed through improving outreach services, vaccine supply, and health worker training; however, under-vaccination and non-vaccination linked to parental attitudes and knowledge are more difficult to address and likely require local interventions. [Copyright &y& Elsevier]

To raise the awareness of a global crisis in human resources for health care, the World Health Organization has suggested a minimum target for all countries: 2.3 health professionals per 1,000 people. Many countries cannot afford to meet the target; in fact, funding the proposed number of health workers would require some countries to devote 50 percent of their gross domestic product to health. We offer an alternative solution that would allow governments to set targets that are realistic and achievable within their financial constraints. [ABSTRACT FROM AUTHOR]

The article explores the effectiveness of the 1959 World Health Organization (WHO) Smallpox Eradication Program (SEP), initiated through the efforts of Deputy Minister of Health of the Soviet Union Viktor M. Zhdanov at the 1958 meeting of the World Health Assembly (WHA), the governing body of WHO. It became a fully funded program in 1967 and in 1977 global eradication of smallpox occurred. SEP was funded by the U.S., the Soviet Union supplied the vaccine, and the program was predominantly carried out in the developing countries of Latin America, Africa, and Asia simultaneously. The author explores the American-Soviet collaboration to improve global public health during the Cold War and considers how nongovernmental organizations impact the foreign policies of world powers.

The article discusses the World Health Organization's goal to strengthen health systems and manage the migration of health workers from developing countries in an effort to achieve health equity. The Global Health Workforce Alliance commissioned guidelines to help countries attract and retain health professionals. The importance of efficient and effective utilisation of the health workforce is discussed. Financial and non-financial incentives to recruit and retain health workers are explained. The recruitment practices of health systems in developed countries is addressed including the ethical recruitment of health workers covered in a green paper published by the European Commission. INSET: UNDERSTANDING INCENTIVES.

This article discusses research by Enayet Chowdhury, presented elsewhere in this article, into the treatment of childhood pneumonia in the developing world. The development of health interventions that can improve health services accessibility for children with pneumonia is explored. The study focused on implementation research and the use of this data to improve the World Health Organisation Integrated Management of Childhood Illness (IMCI) guidelines. In developing countries such as Bangladesh compliance with hospitalisation recommendations is low, so Chowdhury recommends developing treatment strategies that rely on local health care providers.

The article presents news briefs on public health and medical care reported by the World Health Organization (WHO). The United Nations Children's Fund (UNICEF) and World Health Organization (WHO) released a report on diarrhoea in children, calling for a resurgence of attention to reduce associated child mortality. UNICEF and WHO also released statistics on growth in the number of people receiving antiretroviral therapy as of the end of 2008.

The article discusses a report from the World Health Organization which predicts that the number of deaths from heart and lung disease in developing countries will rise in the next 25 years. An aging population and a decline in deaths from infectious diseases are contributing factors. The report "The Global Burden of Disease: 2004," predicts that ischaemic heart disease, cerebrovascular disease and obstructive pulmonary diseases will be among the leading causes of death in 2030.

This editorial discusses the priorities laid out by the United Nations World Health Organisation report on Social Determinants of health. The journal notes its support of the project and also ties its success to the implementation of the Millennium Development Goals. The relationship between improvements in medical care and economic improvements to the everyday life of people in the developing world is explored.