A New Vaccine for Tuberculosis: The Challenges of Development and Deployment.

Tuberculosis (TB) is one of the world's leading causes of death due to infection and efforts to control TB would be substantially aided by the availability of an improved TB vaccine. There are currently nine new TB vaccines in clinical development, and the first efficacy trials are due to commence in 2009. There are many complex ethical issues which arise at all stages of TB vaccine development, from the need to conduct trials in developing countries to informed consent and the process of ethical review. While it is important that these issues are discussed, it may also be timely to consider the challenges which may arise if a vaccine in clinical development proves to be highly effective. We examine a number of scenarios where decisions on the deployment of a new TB vaccine may impact on the rights and liberty of the individual

Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa

Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk

Towards shoestring solutions for UK manufacturing SMEs

In the Digital Manufacturing on a Shoestring project we focus on low-cost digital solution requirements for UK manufacturing SMEs. This paper shows that many of these fall in the HRI domain while presenting the use of low-cost and off-the-shelf technologies in two demonstrators based on voice assisted production

Tying Together Solutions for Digital Manufacturing: Assessment of Connectivity Technologies & Approaches

This paper concerns the development of low-cost solutions to address challenges in digital manufacturing (DM). Service Oriented Architectures (SOAs) are a promising approach for addressing the requirements of a low-cost DM architecture. Interaction between services in a SOA is facilitated by a connectivity technology, i.e., a framework for interoperable data exchange between heterogeneous participants. We review a variety of connectivity technologies according to their suitability for use in an SME manufacturer’s production environment, and we assess how they have been integrated into past architectures. We then provide insights into an incremental and modular architecture for manufacturing SMEs.Digital Manufacturing on a Shoestring [Digital Shoestring]. EPSRC Reference: EP/R032777/1

Childhood tuberculosis: progress requires an advocacy strategy now

Childhood tuberculosis (TB) is a preventable and curable infectious disease that remains overlooked by public health authorities, health policy makers and TB control programmes. Childhood TB contributes significantly to the burden of disease and represents the failure to control transmission in the community. Furthermore, the pool of infected children constitutes a reservoir of infection for the future burden of TB. It is time to prioritise childhood TB, advocate for addressing the challenges and grasp the opportunities in its prevention and control. Herein, we propose a scientifically informed advocacy agenda developed at the International Childhood TB meeting held in Stockholm, Sweden, from March 17 to 18, 2011, which calls for a renewed effort to improve the situation for children affected by Mycobacterium tuberculosis exposure, infection or disease. The challenges and needs in childhood TB are universal and apply to all settings and must be addressed more effectively by all stakeholders

Digital manufacturing on a shoestring: Low cost digital solutions for SMEs

One of the key findings in a number of recent studies has been that small and medium sized manufacturers (SMEs) have been slow in adopting digital solutions within their organisations. Cost is understood to be one of the key barriers to adoption. Digital Manufacturing on a Shoestring is an approach to increasing the digital capabilities of SMEs via a series of low cost solutions. The programme proposes using off-the-shelf, (possibly non-industrial) components and software to address a company’s (digital) solution needs, adding capabilities one step at a time with minimal a priori infrastructure required. This paper will introduce the Digital Manufacturing on a Shoestring programme as a whole and demonstrate the way in which it addresses the need for low cost digital solutions for SME Manufacturers. It will discuss challenges associated with integrating low cost technologies into industrial solutions and the style of IT architectures best suited for integrating such solutions into industrial environments

Human newborn bacille Calmette–Guérin vaccination and risk of tuberculosis disease: a case-control study

: An incomplete understanding of the immunological mechanisms underlying protection against tuberculosis (TB) hampers the development of new vaccines against TB. We aimed to define host correlates of prospective risk of TB disease following bacille Calmette-Guérin (BCG) vaccination. : In this study, 5,726 infants vaccinated with BCG at birth were enrolled. Host responses in blood collected at 10 weeks of age were compared between infants who developed pulmonary TB disease during 2 years of follow-up (cases) and those who remained healthy (controls). : Comprehensive gene expression and cellular and soluble marker analysis failed to identify a correlate of risk. We showed that distinct host responses after BCG vaccination may be the reason: two major clusters of gene expression, with different myeloid and lymphoid activation and inflammatory patterns, were evident when all infants were examined together. Cases from each cluster demonstrated distinct patterns of gene expression, which were confirmed by cellular assays. : Distinct patterns of host responses to Mycobacterium bovis BCG suggest that novel TB vaccines may also elicit distinct patterns of host responses. This diversity should be considered in future TB vaccine development

SATVI - after 10 years closing in on a new and better vaccine to prevent tuberculosis

The vision of the South African Tuberculosis Vaccine Initiative (SATVI) (www.satvi.uct.ac.za) is ‘A World Without TB’ and our mission is ‘Innovative and high-quality TB vaccine research in Africa, to impact the global epidemic’. Over the last 10 years, our focus has been twofold: first, clinical trials of BCG and of new candidate vaccines, and second, complementary research that addresses critical questions in TB vaccine development. SATVI is now widely regarded as the leading TB vaccine clinical research site in the world

The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting. The need for treatment guidelines has frequently been expressed by South African psychiatrists and other medical practitioners, as well as by other role players such as medical scheme and other funding body advisors and the pharmaceutical industry. While several well-developed international treatment guidelines are readily accessible and are indeed extensively utilised in South Africa, they are not always applicable to our own circumstances. There are often important differences, not only regarding the availability of various psychotropic medications, but also in healthcare settings and availability of resources that need to be considered when selecting particular medications. For example, prescribing compounds that require regular monitoring such as lithium and clozapine may not always be feasible in certain rural settings in South Africa.http://www.sajp.org.za/index.php/sajpam201