Strengthening New Vaccine Introduction in Low- and Middle-Income Countries: Establishing Hospital-Based Sentinel Surveillance for Vaccine Safety Monitoring

Vaccine safety Large-scale immunization programmes now extend to all parts of the world, including least developed countries, where they reach unprecedented numbers of people. The number of vaccine doses administered worldwide continues to increase as new vaccines are developed and made available, and more people have access to immunization services. Development of immunization programmes in low- and middle-income countries (LMICs) has increased immunization coverage, which in turn has led to a reduction in vaccine-preventable diseases. However, as vaccine use has increased in LMICs, so has public attention to vaccine safety issues, as happened previously in high-income countries. This has created additional vulnerability for all immunization programmes. Whether or not they are well founded, concerns about serious adverse events following immunization may rapidly undermine public confidence and become a serious threat to effective vaccination strategies, eroding the enormous gains in disease control achieved with decades of effort. Patterns of global access to vaccines and programme implementation are evolving. In the past, vaccines that became available for programmes in LMICs had already been used for years in high-income countries. Currently, however, some newly developed vaccines (e.g. rotavirus vaccine) have become available in LMICs only a short time after being introduced in high-income countries. Other new vaccines, such as meningococcal A vaccine or candidate vaccines against dengue and malaria, may be introduced first in LMICs, where the capacity for adequate safety monitoring is limited. Some of these vaccines may contain elements that have not been widely used in humans, including multiple antigens or recombinant viral vectors. As a result, for the first time people in LMICs are being administered with newly developed vaccines in settings where monitoring capacity is limited. In addition, there are important population groups for which the safety profile of vaccines may differ; for example, people with immune deficiency (in areas with high rates of human immunodeficiency virus prevalence), malnutrition and chronic conditions, as well as pregnant women. Although toxicity and safety are monitored in pre-licensing studies, the number of vaccine recipients observed in such studies is limited. Also, because serious vaccine reactions are very rare, it is generally only after licensure and administration to millions of people that such reactions are detected. Thus, a well-designed and well-structured global approach that involves adequate monitoring of large populations is required for early recognition of potential issues, timely investigation of concerns, informed decision-making and corrective actions. Optimizing vaccine safety The Decade of Vaccines, which was launched in 2010, aims to increase coordination within the vaccine community worldwide. The Global Vaccine Action Plan (1)--the framework endorsed by the World Health Assembly for the Decade of Vaccines--includes a vaccine safety strategy, the Global Vaccine Safety Blueprint. (2) The aim of the blueprint is to enhance the safety of vaccines through effective use of pharmacovigilance principles and methods. Its three strategic goals are: to assist LMICs to have at least minimal capacity for vaccine safety activities; to enhance capacity for vaccine safety assessment in countries that introduce newly developed vaccines, that introduce vaccines in settings with novel characteristics, or that manufacture and use prequalified vaccines; and to establish a global support structure for vaccine safety. The blueprint proposes eight complementary strategic objectives. Four of these objectives aim to improve the technical aspects of spontaneous reporting, active surveillance and risk communication; and to ensure the availability of harmonized methods and tools. The remaining four objectives promote the establishment of effective managerial principles to facilitate international collaboration and information exchange relating to vaccine safety monitoring. …

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ABSTRACT: Several studies have used various datasets and methodologies to analyze the relationship between bilateral trade and income convergence among trading partners. However, most studies have not paid attention to the effect that income levels and nature of bilateral trade have on the speed of income convergence. In this paper, we argue that the income levels of trading partners and the nature of bilateral trade play important role in the relationship between bilateral trade and international income convergence. To account for the effect of income levels of trading partners, this paper presents an approach that explicitly accounts for bilateral trade among high-income (OECD) countries, bilateral trade between high-income and low-income (SSA) countries, and bilateral trade among low-income (SSA) countries. We also used total trade data for 25 OECD countries and 30 Sub-Saharan African countries over the period 1980-2018 to avoid the potential bias for selecting certain countries based on arbitrary percentage of trade relationship. We used the 2SLS estimations technique to avoid endogeneity problems due to the nature of the dataset. The paper finds that the bilateral trade-income convergence relationship for OECD to SSA is the strongest. This result throws light on the claim that the nature of bilateral trade between high-income and low-income countries promotes one directional knowledge spillover from high-income to low-income countries which enables low-income countries to adopt new technologies and grow faster than their high-income counterparts. Also, bilateral trade among OECD countries, which mostly comprises of differentiated products, promotes descent income convergence among them. However, bilateral trade among SSA countries has the least effect on income convergence. Findings of the study have important implications for bilateral trade among low-income countries and between low income and high income countries. First, if SSA countries want to develop and catch up with their rich counterparts, they should continue to promote free trade with high income countries by dismantling remaining protection policies. Second, the African Continental Free Trade Area's (AfCFTA) efforts to boost the manufacturing sector through industrialization is in the right direction to promote the production of more differentiated products in Africa which will create growth in income for member countries as they trade more. Finally, there is the need for SSA countries to increase investment rates and improve human capital accumulation to enable them to accelerate the adoption of new technologies and grow faster than their high-income counterparts, while bridging the income gap between them through trade.

An affordable pneumococcal conjugate vaccine after 20 years

Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action

Navigating the violent process of decolonisation in global health research: a guideline

Objectives: To analyze the effect or impact of Digital Services Trade on economic growth (GDP) of a panel of Low, Middle and High Income Countries.
 Study Design: Panel Quantitative Study.
 Methodology: Dynamic Difference GMM (Diff-GMM) and System GMM (Sys-GMM), Panel pooled OLS (POLS) and Fixed Effects (FE) models were employed in the analyses.
 Results: The System GMM estimator seems to predict that, ceteris paribus, a 1 unit increase in digital services exports significantly impacts GDP growth in Low and High Income countries panels in the short run by 5.7% and 52.4% respectively. The panel POLS models estimate that digital services exports cause a significant long run increase in GDP in High income countries by 39.67% relative to 6.68% in the panel of Middle Income countries and negative growth in Low income countries of 7.74%. The FE models predict that for every 1 unit increase in the number of people using the internet, GDP significantly increases by 42.7%, 27.8% and 0.03% in the Middle, High, and Low Income countries panels respectively.
 Conclusion: The findings of this study indicate that generally, digital services trade seems to have a significant positive effect on GDP of all country panels. However, Low and Middle Income countries are lagging behind. Therefore, this study recommends that, to promote digital trade driven economic growth, the panel of Low and Middle Income countries’ policy makers should increase investments in both institutional and physical digital infrastructure that enable more people, Small and Medium enterprises(SMEs) and rural populations have access to stable, high speed and affordable digital services.

Roadmap for the international collaborative epidemiologic monitoring of safety and effectiveness of new high priority vaccines

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Equity in Global Health Research.

PROTOCOL: Impact of the food environment on diet-related health outcomes in school-age children and adolescents in low- and middle-income countries: a systematic review.

Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Prioritise research on vaccines for pregnant and breastfeeding women