Five criteria for choosing among poverty programs

The author addresses the issue of how to choose among discreet poverty interventions such as food stamp programs, public works, or small enterprise credit schemes where little formal policy modeling is done prior to decisionmaking. The minimum criteria on which to judge the relative merits of poverty programs are the following. Administrative feasibility. This depends on the detailed designof the program, the level of resources available for administration, and the degree of imperfection that can be tolerated. Political feasibility. This depends on how the program is promoted to the public, how coalitions of supporters or detractors are built, and the relative power of beneficiaries, suppliers, and administrators. Collateral effects on the poverty strategy. How will a safety net program affect, for example, the participants'labor supply, participation in other programs, and receipt of private interhousehold transfers, and how will those changes affect markets and government finances? What will be the net effect on poverty reduction. Potential for targeting the poor. Will the program reach significant number of the poor? How much leakage of benefits will there be to the nonpoor? Tailoring the solution to the problem. The program choice should address the real problem. Where the poor have suffered a loss of real wages rather than a loss of jobs, for example, transfers to the working poor may be more relevant than creating jobs. This criterion may seem obvious, but many proposals seem to ignore it. The author illustrates her main points by applying these criteria to a range of poverty programs commonly used in Latin America. General subsidies of food prices, for example, are administratively and politically feasible and lower food costs to the consumer, but they may distort the economy, harming growth. Food stamps are easy to target to the poor, are fairly difficult to administer, depending on program design, but depending on program design, may encourage the use of schools and primary health care. But there is controversy about whether they encourage dependency and diminish the work ethic.Rural Poverty Reduction,Environmental Economics&Policies,Health Economics&Finance,Services&Transfers to Poor,Safety Nets and Transfers

An observation on the bias in clinic-based estimates of malnutrition rates

Clinic-based data on malnutrition are the most readily available for following malnutrition levels and trends in most countries, but there is a bias inherent in clinic-based estimates of malnutrition rates. The authors compare annual clinic-based malnutrition data and those from four household surveys in Jamaica. The clinic data give lower estimates of malnutrition than the survey data in all four cases - significantly so in three. The size of the bias was variable over time, so the clinic data were not a good indicator of either levels of trends in nutrition status.Health Monitoring&Evaluation,Early Child and Children's Health,Early Childhood Development,Health Systems Development&Reform,Regional Rural Development

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival