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Introduction: Vaccine inequality inflames the COVID-19 pandemic. Ensuring equitable immunization, vaccine empathy is needed to boost vaccine donations among capable countries. However, damaging narratives built around vaccine donations such as "vaccine diplomacy" could undermine nations' willingness to donate their vaccines, which, in turn, further exacerbate global vaccine inequality. However, while discussions on vaccine diplomacy are on the rise, there is limited research related to vaccine diplomacy, especially in terms of its characteristics and effects on vaccine distribution vis-à-vis vaccine empathy. Thus, to bridge the research gap, this study aims to examine the defining attributes of vaccine diplomacy and its potential effects on COVID-19 immunization, particularly in light of vaccine empathy. Methods: A narrative review was conducted to shed light on vaccine diplomacy's defining attributes and effects in the context of COVID-19 vaccine distribution and dissemination. Databases such as PubMed and Medline were utilized for literature search. Additionally, to ensure up-to-date insights are included in the review, validated reports and reverse tracing of eligible articles' reference lists in Google Scholar have also been conducted to locate relevant records. Results: Vaccine empathy is an individual or a nation's capability to sympathize with other individuals or nations' vaccine wants and needs, whereas vaccine diplomacy is a nation's vaccine efforts that aim to build mutually beneficial relationships with other nations ultimately. Our findings show that while both vaccine empathy and vaccine diplomacy have their strengths and weaknesses, they all have great potential to improve vaccine equality, particularly amid fast-developing and ever-evolving global health crises such as COVID-19. Furthermore, analyses show that, compared to vaccine empathy, vaccine diplomacy might be a more sustainable solution to improve vaccine donations mainly because of its deeper and stronger roots in multilateral collaboration and cooperation. Conclusion: Similar to penicillin, automated external defibrillators, or safety belts amid a roaring global health disaster, COVID-19 vaccines are, essentially, life-saving consumer health products that should be available to those who need them. Though man-made and complicated, vaccine inequality is nonetheless a solvable issue—gaps in vaccine distribution and dissemination can be effectively addressed by timely vaccine donations. Overall, our study underscores the instrumental and indispensable role of vaccine diplomacy in addressing the vaccine inequality issue amid the COVID-19 pandemic and its potentials for making even greater contributions in forging global solidarity amid international health emergencies. Future research could investigate approaches that could further inspire and improve vaccine donations among capable nations at a global scale to advance vaccine equity further.

The COVID-19 pandemic has triggered a global vaccine race, and distributive questions about which countries will receive scarce doses and under which conditions pervade international law and diplomacy. As vaccines are distributed worldwide throughout 2021, this essay analyzes the problem of vaccine access as a critical question in the literature on sources of international law and the influence of those sources. As with past pandemics, research and development capacity is largely concentrated in the wealthy countries of Europe and North America with growing capabilities in East and South Asia. Over the course of 2020, some governments exercised extreme forms of "vaccine nationalism," refusing to share, or contemplate sharing, COVID-19 vaccines or related knowledge with any populations but their own. Other governments balanced the needs of their domestic populations with regional or global diplomatic objectives. Within this latter category, some governments shared bilaterally as a means of furthering local or international influence while others participated in a multilateral sharing mechanism coordinated by international organizations. Of course, as with past pandemics, the great majority of governments were left without vaccine development and manufacturing capacity, possessed few resources with which to procure vaccines under prevailing commercial circumstances, and were therefore vulnerable and open to overtures from both bilateral and multilateral acquisition sources.This essay aims to explain this unique constellation of vaccine development and access from the lens of international law, focusing on the nascent global governance regime for vaccine research, development, and distribution. As wealthy governments used bilateral contracts, Advanced Purchase Agreements (APA), to secure vaccines for populations in the world's richest countries, those in poor countries remained at risk. Yet both multilateral and bilateral mechanisms emerged that prioritized vaccine access to those populations, an occurrence arguably at odds with realpolitik conceptions of how and why governments assess their legal options during international emergencies. We explore this dissociation between global public health imperatives and nationalist responses to the pandemic within the frameworks of "vaccine diplomacy," "vaccine nationalism" and "viral sovereignty." The essay ultimately argues that, over the course of the last thirty years, a global regime of vaccine access has emerged and, while not yet cohesive or uniform, it has manifested common characteristics through two vaccine-preventable global public health emergencies: H1N1 pandemic influenza and COVID-19. A third, more regional epidemic, Ebola, demonstrated similar characteristics. Even more importantly, this regime has been formed and implemented by international organizations, rather than coordinated through individual governments.Within the broader context of international law scholarship, the essay contributes a significant case of international organizations as international law-makers. The essay focuses on two international agreements — the 2011 Pandemic Influenza Preparedness Framework (PIP), and the 2020 COVAX Vaccines Pillar of the ACT Accelerator (COVAX) — neither of which is a treaty, neither of which codifies customary international law as it would be conventionally defined, but both of which have been negotiated and implemented by international organizations. These organizations include specialized U.N. agencies like the World Health Organization and UNICEF, as well as international organizations technically formed under national law, but which include a broader set of decision-makers, including governments, like CEPI and GAVI. Each agreement represented a legal solution to disputes between high-income countries seeking to hoard medicines for their citizens, and low-income countries seeking greater shares of vaccines manufactured in high-income countries. Yet realizing those agreements depended on the coordinating and facilitating efforts of international organizations, rather than by individual or collective action by governments.The importance of this development is significant not only in the context of sources of international law, but in the relative influence of those sources. "Vaccine diplomacy", the efforts of primarily China, India, and Russia to use access to COVID-19 vaccines for regional or international influence, has been fundamentally shaped by international organizations advocating an international norm of vaccine access codified in multilateral legal instruments. COVAX has conditioned the diplomatic outcomes China, India, and Russia may realize through vaccine dipomacy.The international norm of vaccine access did not emerge because of altruism or self-interest. Rather, it represents a brokered institutional compromise between vaccine nationalism and "viral sovereignty," the proprietary claims over pathogens by mainly biodiverse countries that limit access to the genetic resources necessary for the development of many therapeutics and vaccines. Without that access, there may be no vaccines and without vaccines there may be no vaccine nationalism. This balance has resulted in consecutive international legal arrangements, mostly facilitated by the World Health Organization, that indicate an interest in collaboration, division of gains from trade, and sustained governance structures: the Pandemic Influenza Preparedness Framework and COVAX. The recurrence of these legal arrangements suggests that in order to save the transaction costs generated by repeated development of ad hoc structures that centralize vaccine distribution, that a permanent facility may be developed. One possibility for such a facility is the Pandemic Influenza Preparedness Framework, adapted to become an all- or most-pathogen sharing international organization. A second possibility has been introduced in light of the COVID-19 pandemic: a Pandemic Treaty that establishes the terms under which pandemic vaccines will be developed and shared in the future.Whatever alternative materializes, this essay is the first to describe the phenomena that have driven the development of international vaccine sharing mechanisms, identify the international organizational forces that explain the phenomena, and explain how international organizations may facilitate international cooperation before, during, and after global crises.

Epidemics of seasonal influenza viruses cause considerable morbidity and mortality each year. Various types and subtypes of influenza circulate in humans and evolve continuously such that individuals at risk of serious complications need to be vaccinated annually to keep protection up to date with circulating viruses. The influenza vaccine in most parts of the world is a trivalent vaccine, including an antigenically representative virus of recently circulating influenza A/H3N2, A/H1N1, and influenza B viruses. However, since the 1970s influenza B has split into two antigenically distinct lineages, only one of which is represented in the annual trivalent vaccine at any time. We describe a lineage selection strategy that optimizes protection against influenza B using the standard trivalent vaccine as a potentially cost effective alternative to quadrivalent vaccines. ; Sera used in this research were kindly provided by the following collaborators: for Australia by Dr. Ian Barr, WHO Collaborating Center, Melbourne, Australia, pediatric sera for the United States by Dr. Jackie Katz, WHO Collaborating Center, Atlanta, US, for Japan by Dr. Takato Odagiri, WHO Collaborating Center, Tokyo, Japan, for China by Dr. Yuelong Shu, WHO Collaborating Center, Beijing, China, for the United Kingdom by Dr. John Wood, NIBSC, Hertfordshire, UK. Additional thanks to Drs Nancy Cox, Michael Shaw, and Alexander Klimov. This work was supported by European Union FP7 program EMPERIE (22349). JMF is supported by a Fellowship in Biomedical Informatics from the Medical Research Council (UK) and a Junior Research Fellowship from Homerton College, Cambridge. Funded by: ERCPMC grant number: FP7 22349. ; This is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.vaccine.2016.01.042

Yellow fever (YF) is an acute viral communicable disease transmitted by an arbovirus of the Flavivirus genus. It is primarily a zoonotic disease, especially the monkeys. Worldwide, an estimated 200 000 cases of yellow fever occurred each year, and the case-fatality rate is ~15%. Forty-five endemic countries in Africa and Latin America, with a population of close to 1 billion, are at risk. Up to 50% of severely affected persons from YF die without treatment. During 2009, 55 cases and 18 deaths were reported from Brazil, Colombia, and Peru. Brazil reported the maximum number of cases and death, i.e., 42 cases with 11 deaths. From January 2010 to March 2011, outbreaks of YF were reported to the WHO by Cameroon, Democratic Republic of Congo, Cote d'Ivoire, Guinea, Sierra Leone, Senegal, and Uganda. Cases were also reported in three northern districts of Abim, Agago, and Kitugun near the border with South Sudan. YF usually causes fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting. Most patients improve, and their symptoms disappear after 3 to 4 d. Half of the patients who enter the toxic phase die within 10–14 d, while the rest recover without significant organ damage. Vaccination has been the single most important measure for preventing YF. The 17D-204 YF vaccine is a freeze-dried, live attenuated, highly effective vaccine. It is available in single-dose or multi-dose vials and should be stored at 2–8 °C. It is reconstituted with normal saline and should be used within 1 h of reconstitution. The 0.5 mL dose is delivered subcutaneously. Revaccination is recommended every 10 y for people at continued risk of exposure to yellow fever virus (YFV). This vaccine is available worldwide. Travelers, especially to Africa or Latin America from Asia, must have a certificate documenting YF vaccination, which is required by certain countries for entry under the International Health Regulations (IHR) of the WHO.

The influenza virus circulates continuously, causing regional epidemics and outbreaks, leading to thousands of deaths. For instance, according to the Centers for Disease Control and Prevention (CDC) data statistics, more than 13 million flu cases were recorded so far in the 2019-20 timeframe. The changing character of the virus is compelling an annual change in the vaccine strain to match the influenza virus strain worldwide. The increasing prevalence of influenza epidemics and seasonal outbreaks is likely to expand the product sales during the projected period. There are numerous licensed seasonal influenza vaccines recommended by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and other governmental organizations to help fight the disease in the current market scenario. Governments have focused on advising people to get vaccinated early to provide maximum protection during the flu season. Moreover, pharmaceutical companies are continually facing new challenges in developing a suitable vaccine against a particular strain. Therefore, the rising demand for effective flu vaccines is anticipated to surge the global market. The coronavirus pandemic naturally impacted the routine immunization programs and campaigns conducted worldwide in developing and developed countries. However, Flu vaccination rates have gone up considerably during the pandemic owing to factors such as push from health experts/health departments as well as extension/expansion of various government programs that provide free vaccination against the flu. Additionally, growing awareness among the public about the higher risk of getting infected with COVID-19 if the flu weakens the immune system is also another factor contributing to the uptake of flu vaccines. For instance, according to the Centers for Disease Control & Prevention (CDC), as of May, over 189.4 million flu vaccines for the 2020-2021 flu season have been distributed in the U.S compared to 174 million in the 2019-2020 season. Growing prevalence ...

Introduction: Vaccine inequality inflames the COVID-19 pandemic. Ensuring equitable immunization, vaccine empathy is needed to boost vaccine donations among capable countries. However, damaging narratives built around vaccine donations such as "vaccine diplomacy" could undermine nations' willingness to donate their vaccines, which, in turn, further exacerbate global vaccine inequality. However, while discussions on vaccine diplomacy are on the rise, there is limited research related to vaccine diplomacy, especially in terms of its characteristics and effects on vaccine distribution vis-à-vis vaccine empathy. Thus, to bridge the research gap, this study aims to examine the defining attributes of vaccine diplomacy and its potential effects on COVID-19 immunization, particularly in light of vaccine empathy. Methods: A narrative review was conducted to shed light on vaccine diplomacy's defining attributes and effects in the context of COVID-19 vaccine distribution and dissemination. Databases such as PubMed and Medline were utilized for literature search. Additionally, to ensure up-to-date insights are included in the review, validated reports and reverse tracing of eligible articles' reference lists in Google Scholar have also been conducted to locate relevant records. Results: Vaccine empathy is an individual or a nation's capability to sympathize with other individuals or nations' vaccine wants and needs, whereas vaccine diplomacy is a nation's vaccine efforts that aim to build mutually beneficial relationships with other nations ultimately. Our findings show that while both vaccine empathy and vaccine diplomacy have their strengths and weaknesses, they all have great potential to improve vaccine equality, particularly amid fast-developing and ever-evolving global health crises such as COVID-19. Furthermore, analyses show that, compared to vaccine empathy, vaccine diplomacy might be a more sustainable solution to improve vaccine donations mainly because of its deeper and stronger roots in multilateral ...

The existing national policy framework vis-à-vis vaccines reflects an aggressive push towards introduction of new vaccines in the Universal Immunisation Programme (UIP) without providing an uncompromising scientific basis or committing itself to proven epidemiological needs of the population. The idea of selective immunisation is being undermined by slogans like 'prevention is better than cure' that are being trumped up to impart credibility to the effort, given shape by the projected panacea for all ills, that is, Public–Private Partnership (PPP), to push the line that all immunisation is universal. This article examines the aims and motives behind deliberate destruction of the public sector in favour of PPPs and establishes the need for a vaccine policy that is designed to enhance national public capacity for public immunisation programmes as opposed to the present policy that justifies spending public money on privately produced vaccines in the name of protection from diseases whose incidence figures and public health statistics are dubious and industry-manufactured.

Addresses the underlying rhetoric of vaccination debates by examining the full spectrum of viewpoints to develop a nuanced way forward.

BACKGROUND: Vaccine hesitancy has been defined as a delay in acceptance or refusal of vaccines, despite the availability of vaccine services. In the past, despite an impressive record of vaccine effectiveness in the United States, several factors have contributed to a decreased acceptance of vaccines that has resulted in outbreaks of infectious diseases, e.g., measles. More recently, vaccine hesitancy has spread to coronavirus disease 2019 (COVID-19) vaccines. There are many causes of vaccine hesitancy, such as misinformation, fallacies, and myths, that have contributed to vaccine hesitancy. OBJECTIVE: The purpose of the present report is to address the many causes of vaccine hesitancy and to suggest ways that the allergist/immunologist can be involved in the promotion of vaccine acceptance. METHODS: The current COVID-19 vaccines were reviewed, together with their mechanisms(s) of action and adverse reactions to them. RESULTS: The many causes of vaccine hesitancy include many doubts and concerns related to COVID-19 vaccines as well as a diminished level of confidence and trust by segments of the public in the nation's leaders in government, medical, and business communities, that those groups once enjoyed. CONCLUSION: Vaccination with COVID-19 vaccines is the only way that COVID-19 will be eliminated or at least controlled today, and vaccine hesitancy is the potential nemesis. The present report describes how the allergist/immunologist not only plays a major role in the delivery of specialized therapy of COVID-19 but also in educating the public with regard to the importance of COVID-19 vaccines, in dispelling misinformation, and in promoting trust for vaccine acceptance but must be informed with the most accurate and current information to do so.

Adenovirus Types 4 and 7 (Ad4 and Ad7) are associated with acute respiratory distress (ARD). In order to prevent widespread Ad-associated ARD (Ad-ARD) the United States military immunizes new recruits using a safe and effective lyophilized wildtype Ad4 and Ad7 delivered orally in an enteric-coated capsule. We cloned Ad4 and Ad7 and modified them to express either a GFP-Luciferase (GFPLuc) fusion gene or a centralized influenza H1 hemagglutinin (HA1-con). BALB/c mice were injected with GFPLuc expressing viruses intramuscularly (i.m.) and intranasally (i.n.). Ad4 induced significantly higher luciferase expression levels as compared with Ad7 by both routes. Ad7 transduction was restored using a human CD46+ transgenic mouse model. Mice immunized with serial dilutions of viruses expressing the HA1-con influenza vaccine gene were challenged with 100 MLD50 of influenza virus. Ad4 protected BALB/c mice at a lower dose by i.m. immunization as compared with Ad7. Unexpectedly, there was no difference in protection by i.n. immunization. Although Ad7 i.m. transduction was restored in CD46+ transgenic mice, protection against influenza challenge required even higher doses as compared with the BALB/c mice. However, Ad7 i.n. immunized CD46+ transgenic mice were better protected as compared with Ad4. Interestingly, the restoration of Ad7 transduction in CD46+ mice did not increase vaccine efficacy and indicates that Ad7 may transduce a different subset of cells through alternative receptors in the absence of CD46. These data indicate that both Ad4 and Ad7 can effectively induce anti-H1N1 immunity against a heterologous challenge using a centralized H1 gene. Future studies in non-human primates or human clinical trials will determine the overall effectiveness of Ad4 and Ad7 as vaccines for influenza.