Social media for public health: Reaping the benefits, mitigating the harms.

With more than 4.26 billion social media users worldwide, social media has become a primary source of health information, exchange, and influence. As its use has rapidly expanded, social media has proven to be a "doubled-edged sword," with considerable benefits as well as notable harms. It can be used to encourage preventive behaviors, foster social connectivity for better mental health, enable health officials to deliver timely information, and connect individuals to reliable information. But social media also has contributed to public health crises by exacerbating a decline in public trust, deteriorating mental health (especially in young people), and spreading dangerous misinformation. These realities have profound implications for health professionals, social media companies, governments, and users. We discuss promising guidelines, digital safety practices, and regulations on which to build a comprehensive approach to healthy use of social media. Concerted efforts from social media companies, governments, users, public interest groups, and academia are essential to mitigate the harms and unlock the benefits of this powerful new technology.

Adverse Events to SARS-CoV-2 (COVID-19) Vaccines and Policy Considerations that Inform the Funding of Safety Surveillance in Low- and Middle-Income Countries: A Mixed Methods Study.

INTRODUCTION/OBJECTIVE: Rapid global approval of coronavirus disease 2019 (COVID-19) vaccines and concurrent introduction in high-income countries and low- and middle-income countries (LMIC) highlights the importance of equitable safety surveillance of adverse events following immunization (AEFIs). We profiled AEFIs to COVID-19 vaccines, explored reporting differences between Africa and the rest of the world (RoW), and analyzed policy considerations that inform strengthening of safety surveillance in LMICs. METHODS: Using a convergent mixed-methods design we compared the rate and profile of COVID-19 vaccines' AEFIs reported to VigiBase by Africa versus the RoW, and interviewed policymakers to elicit considerations that inform the funding of safety surveillance in LMICs. RESULTS: With 87,351 out of 14,671,586 AEFIs, Africa had the second-lowest crude number and a reporting rate of 180 adverse events (AEs) per million administered doses. Serious AEs (SAEs) were 27.0%. Death accounted for about 10.0% of SAEs. Significant differences were found in reporting by gender, age group, and SAEs between Africa and the RoW. AstraZeneca and Pfizer BioNTech vaccines were associated with a high absolute number of AEFIs for Africa and RoW; Sputnik V contributed a considerably high rate of AEs per 1 million administered doses. Funding decisions for safety surveillance in LMICs were not based on explicit policies but on country priorities, perceived utility of data, and practical implementation issues. CONCLUSION: African countries reported fewer AEFIs relative to the RoW. To enhance Africa's contribution to the global knowledge on COVID-19 vaccine safety, governments must explicitly consider safety monitoring as a priority, and funding organizations need to systematically and continuously support these programs.

The Australian mixed-mode observing program.

Global geodetic VLBI is upgrading to its next-generation observing system, VGOS. This upgrade has turned out to be a process over multiple years, until VGOS reaches its full capabilities with the envisaged continuous observations. Until then, for the Australian stations, the upgrade means ceasing their legacy S/X observations, leaving a large gap in the global network as well as in the station time series. The Australian mixed-mode observing program is a series of sessions where the VGOS stations in Hobart and Katherine observe legacy S/X VLBI together with other stations in the region. This paper describes the technical details of these observations and their processing strategies and discusses their suitability for geodetic results by comparison with those of standard legacy S/X sessions. The presented mixed-mode sessions allow a continuation of the station time series, a benefit for the stations themselves as well as for future realisations of the terrestrial and celestial reference frames. A novel mode of observing is introduced and tested. The results are promising and it is suggested for acceptance into standard legacy S/X IVS observations, overcoming current gaps in the network due to VGOS upgrades and preventing a worsening of global results otherwise.

Probing a southern hemisphere VLBI Intensive baseline configuration for UT1 determination.

The deviation of Universal Time from atomic time, expressed as UT1-UTC, reflects the irregularities of the Earth rotation speed and is key to precise geodetic applications which depend on the transformation between celestial and terrestrial reference frames. A rapidly varying quantity such as UT1-UTC demands observation scenarios enabling fast delivery of good results. These criteria are currently met only by the Very Long Baseline Interferometry (VLBI) Intensive sessions. Due to stringent requirements of a fast UT1-UTC turnaround, the observations are limited to a few baselines and a duration of one hour. Hence, the estimation of UT1-UTC from Intensives is liable to constraints and prone to errors introduced by inaccurate a priori information. One aspect in this context is that the regularly operated Intensive VLBI sessions organised by the International VLBI Service for Geodesy and Astrometry solely use stations in the northern hemisphere. Any potential systematic errors due to this northern hemisphere dominated geometry are so far unknown. Besides the general need for stimulating global geodetic measurements with southern observatories, this served as a powerful motivation to launch the SI (Southern Intensive) program in 2020. The SI sessions are observed using three VLBI antennas in the southern hemisphere: Ht (South Africa), Hb (Tasmania) and Yg (Western Australia). On the basis of UT1-UTC results from 53 sessions observed throughout 2020 and 2021, we demonstrate the competitiveness of the SI with routinely operated Intensive sessions in terms of operations and UT1-UTC accuracy. The UT1-UTC values of the SI reach an average agreement of 32 µs in terms of weighted standard deviation when compared with the conventional Intensives results of five independent analysis centers and of 27 µs compared with the 14C04 series. The mean scatter of all solutions of the considered northern hemisphere Intensives with respect to C04 is at a comparable level of 29 µs. The quality of the results is only slightly degraded if just the baseline HtHb is evaluated. In combination with the e-transfer capabilities from Ht to Hb, this facilitates continuation of the SI by ensuring rapid service UT1-UTC provision.

Building from the HIV Response toward Universal Health Coverage.

Jonathan Jay and colleagues draw lessons from the the global HIV response that could help guide the universal health coverage movement.

Quality use of medicines within universal health coverage: challenges and opportunities.

BACKGROUND: Medicines are a major driver of quality, safety, equity, and cost of care in low and middle-income country health systems. Universal health coverage implementers must explicitly address appropriate use of medicines to realize the health benefits of medicines, avoid wasting scarce resources, and sustain the financial viability of universal health coverage schemes. DISCUSSION: Medicines are major contributors to the health and well-being of individuals and populations when used appropriately, and they waste resources and endanger health when used unnecessarily or incorrectly. Stakeholders need to balance inherently competing objectives in the pharmaceutical sector. Emerging and expanding UHC schemes provide potential levers to balance competing system objectives.To use these levers, sustainable universal coverage programs will require a) information systems that can track medicines utilization, expenditures, and quality of medicines use; b) routine monitoring of indicators of medicines availability, access, affordability, and use; c) policies and programs that facilitate appropriate medicines use by prescribers, dispensers, and patients; d) transparency in setting priorities for medicines coverage under resource constraints; and e) a system perspective to engage diverse actors.As they operationalize paths toward universal health coverage and include targeted medicines coverage policies and programs, systems can build on, and innovate, pharmaceutical policy frameworks and management tools from different countries' settings. SUMMARY: Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal.

Improving women's health through universal health coverage.

Jonathan Quick and colleagues discuss how women's health world-wide can be improved through universal health coverage.

A quiet revolution in global public health: The World Health Organization's Prequalification of Medicines Programme.

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP's greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.

Straight talk with...Jonathan Quick. Interview by Roxanne Khamsi.

In April 2012, an e-mail announcing the impending closure of the Global Health Council following the cancellation of its annual conference sent shockwaves through its community of 325 organizational members spanning 39 countries. For 40 years, the Alexandria, Virginia-based nonprofit had acted as an umbrella organization for stakeholders that include some of the world's most prominent medical institutions and drug companies. As the June 2012 closure of the GHC approached, several members stepped in to rescue the operation, including Jonathan Quick, a family physician and CEO of Management Sciences for Health, a Cambridge, Massachusetts-based outfit that works to strengthen health systems and infrastructure around the globe. In January, a new GHC board was elected, with Quick at the helm. In the ensuing months the board members have built the organization back up-albeit as a leaner and more targeted operation. This past summer, they launched a revamped website (www.globalhealth.org) and are looking ahead to convening GHC members at the UN General Assembly on 18 September in New York, where the discussion of Millennium Development Goals will take place. As Nature Medicine went to press, the relaunched GHC was in the midst of recruiting for its first staff position, executive director. Roxanne Khamsi spoke with Quick about the health of the organization.

How AIDS funding strengthens health systems: progress in pharmaceutical management.

In recent years, new global initiatives responding to the AIDS crisis have dramatically affected-and often significantly improved-how developing countries procure, distribute, and manage pharmaceuticals. A number of developments related to treatment scale-up, initially focused on AIDS-related products, have created frameworks for widening access to medicines for other diseases that disproportionally impact countries with limited resources and for strengthening health systems overall. Examples of such systems strengthening have come in the areas of drug development and pricing; policy and regulation; pharmaceutical procurement, distribution, and use; and management systems, such as for health information and human resources. For example, a hospital in South Africa developed new tools to decentralize provision of antiretroviral therapy to local clinics-bringing treatment closer to patients and shifting responsibility from scarce pharmacists to lower level pharmacy staff. Successful, the system was expanded to patients with other chronic conditions, such as mental illness. Progress toward universal access to HIV prevention, treatment, care, and support will continue the push to strengthen pharmaceutical sectors that serve not only HIV-related needs but all health needs; health experts can likely take these achievements further to maximize their expansion into the wider health system.

Promoting GMP implementation: developing training materials for the international audience.

This paper outlines the development of a CD-ROM training package entitled: The WHO Basic Training Modules on GMP, intended to support the creation of training courses aimed particularly at government compliance officials who inspect pharmaceutical manufacturing facilities. The material was created over a three-year period in collaboration with a team of external experts, WHO regional and local offices, and Drug Regulatory Authorities of participating countries. The nine training workshops and courses that contributed to the development and evaluation processes were attended by approximately 240 participants from 47 countries. To date over 5,800 copies of the CD-ROM have been distributed.