Exploring the Time to Intervene with a Reactive Mass Vaccination Campaign in Measles Epidemics.

The current WHO policy during measles outbreaks focuses on case management rather than reactive vaccination campaigns in urban areas of resource-poor countries having low vaccine coverage. Vaccination campaigns may be costly, or not timely enough to impact significantly on morbidity and mortality. We explored the time available for intervention during two recent epidemics. Our analysis suggests that the spread of measles in African urban settings may not be as fast as expected. Examining measles epidemic spread in Kinshasa (DRC), and Niamey (Niger) reveals a progression of smaller epidemics. Intervening with a mass campaign or in areas where cases have not yet been reported could slow the epidemic spread. The results of this preliminary analysis illustrate the importance of revisiting outbreak response plans

Efficacy of chloroquine and sulfadoxine/pyrimethamine for the treatment of uncomplicated falciparum malaria in Koumantou, Mali.

We report the results of an in vivo antimalarial efficacy study with chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) conducted between 2003 and 2004 in Koumantou, southern Mali. A total of 244 children were included in the study; 210 children were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescence from re-infection. Global failure proportions at Day 14, without taking into account re-infections, were 44.2% (95% CI 34.9-53.5%) in the CQ group and 2.0% (95% CI 0.0-4.8%) in the SP group. PCR-adjusted failure proportions at Day 28 were even higher in the CQ group (90.5% (95/105), 95% CI 84.8-96.2%) and relatively low in the SP group (7.0% (7/100), 95% CI 1.9-12.1%). These results show that CQ is no longer efficacious in Koumantou. The use of SP in monotherapy is likely to compromise its efficacy. We recommend the use of artemisinin-based combination therapy as first-line treatment for uncomplicated Plasmodium falciparum malaria in Koumantou

The 2011 Pandemic Influenza Preparedness Framework: Global Health Secured or a Missed Opportunity?

In early 2007 the Indonesian government announced that it would cease sharing H5N1 influenza virus samples with the World Health Organization's Global Influenza Surveillance Network. At the heart of the government's complaint was the fact that samples were being passed by the WHO to pharmaceutical companies which developed, and patented, influenza vaccines that the Indonesian authorities could not purchase. The decision gained widespread support among advocates of greater equity of access to medicines, and in response the WHO established an intergovernmental process to agree a framework for influenza virus sharing. The process officially concluded in April 2011 and a new Pandemic Influenza Preparedness Framework (PIPF) was agreed at the 64th World Health Assembly in May 2011. This article investigates the events that prompted the re-examination of a technical cooperation system that has provided effective global health security on influenza for 60 years, and evaluates the framework that has now been agreed. Drawing the distinction between functional and moral-political benefits, the article argues that PIPF more accurately represents a diplomatic stand-off – one that has now been effectively sidelined with the passage of the agreement – rather than genuine reform. In fact, the PIPF papers over fundamental disagreements regarding authority in global health governance, the relationship between the WHO and governments, and the role of private industry. The article concludes by examining an alternative mechanism that would arguably better address the inherent tensions between national and collective interests, and accomplish the functional and moral-political benefits that the negotiations set out to achieve. </jats:p