The convergence of nuclear and radiological preparedness with epidemic and pandemic response, reveals valuable opportunities for cross-disciplinary learning and capability development. Insights from the extensive career of Dr. C. Norman Coleman illustrate how methodologies from radiation medical countermeasures can inform strategies for managing emerging infectious diseases. While nuclear incidents are infrequent, infectious disease outbreaks occur regularly, underscoring the need for sustained, adaptable capabilities to detect and respond to such threats. To draw on some examples, case studies on the development and deployment of vaccines against filoviruses highlight measurable advances in response speed and efficacy, while persistent challenges related to equitable access to medical countermeasures during public health emergencies can be addressed drawing lessons from the COVID-19 pandemic. Iterative improvement, strategic planning and performance optimization is very important, as is, the value of understanding the structure of a problem to find its solution.

Vaccine hesitancy was a major concern during the Covid-19 pandemic, and a significant percentage of healthcare workers (HCWs) proved to be hesitant too. Various governments, including that of Greece, reacted aggressively, imposing mandates stipulating dismission of HCWs from work unless vaccinated. Hesitancy was understood as a case of moral failing and against the principle of ‘do no harm’. In this article, we deploy hermeneutics policy analysis based on interviews and analysis of texts to challenge this view. On the basis of qualitative analysis of transcripts of press conferences organized by the Greek Ministry of Health and 74 interviews with hesitant HCWs, we show that government’s and HCWs’ understanding of the risk of infection and the associated threat posed to the public health system were starkly different. For HCWs, hesitancy was linked to distrust toward political institutions, which should be treated in a different manner from a case of moral failing of HCWs. We argue that, rather than mandates, persuasion is a better strategy, since hesitancy raises the question of trust toward the politicoscientific establishment. Therefore, reforming science advice institutions so that they make use of local expertise and engage civil society is key. We focus on Greece, as we consider it to be an interesting case of a newly established science advice system with a distinctive character that we term the ‘look from inside’, based on the model of ‘ethical chief scientist,’ which makes it a brilliant case study for others considering building or reforming their systems.

Leishmaniasis is a neglected parasitic disease responsible for significant morbidity and mortality. Currently, there is no vaccine approved for clinical use. Therefore, controlling infections in infected individuals depends on interventions to prevent infected female sand flies from biting humans, treatment of clinical infections or alternative treatment methods. This review focuses on the types of vaccine developed to control leishmaniasis and which vaccines have made it through to clinical trials. It also discusses the role CRISPR technology may play in improving vaccine candidates design.

Following the trajectories of vaccines against foot-and-mouth disease (FMD) in France and Britain up to the 1960s, this paper will show how vaccine efficacy has two meanings: 1) technical – or experimental – which refers to test protocols and regimes of evidence, and 2) practical – or experiential – which refers to the experience various actors have of diseases and their direct or indirect impacts on society and the economy, as well as on representations and imaginaries they share about diseases, vaccines, and vaccination. The assessment protocols in the two countries are analysed to show how these two meanings are deeply intertwined and influence the different public policies chosen by each country. Although statistically assessed, the efficacy of the same vaccines appears situated, depending not only on regimes of evidence but also on the reality of agricultural practices, on national stock exchanges, and on various imaginaries about animal health and the absence of disease that differ between and within countries. As a consequence, this analysis reveals how public policies regarding vaccination do not always come from governmental incentives but can also emerge from private and local initiatives.

Monkeypox virus (MPXV) is a contagious disease that has been endemic in central and west Africa since 1970, characterized by symptoms such as fever, headache, and skin rash. While there is no approved treatment for MPXV infections, vaccination has proven effective in limiting its transmission, and previous smallpox vaccinations may also provide protection against monkeypox. However, the dependence of monkeypox on animal hosts makes eradication more complicated than with smallpox. Research should focus on assessing the safety of the vaccines, their duration of immunity, and their efficacy against the prevalent strains of monkeypox. The virus’s accelerated rate of mutation poses additional challenges, as does the fact that it can be transmitted through animals, making eradication more complex than with smallpox. A comprehensive global immunization strategy is needed to address these complexities and draw on lessons learned from past eradication efforts.

The efficacy of COVID-19 vaccines against the Delta variant has been observed to be high, both against severe disease and infection. The full population level vaccine effectiveness, however, also contains the indirect effects of vaccination, which require analysis of transmission dynamics to uncover. Finland was close to naïve to SARS-CoV-2 infections before the Delta dominant era, and non-pharmaceutical interventions (NPIs) were at an internationally low level. We utilize Finnish register data and a mathematical model for transmission and COVID-19 disease burden to construct a completely unvaccinated control population and estimate the different components of the vaccine effectiveness. The estimated direct effectiveness was 72% against COVID-19 cases and 87–96% against severe disease outcomes, but the estimated indirect effectiveness was even better, 93% against cases and 94–97% against severe disease. The total and overall effectiveness, including both direct and indirect effects of vaccination, were thus excellent. Our results show how well the population was protected by vaccination during the Delta era, especially by the indirect effectiveness, providing protection also to the unvaccinated part of the population. The estimated averted numbers of hospitalizations, ICU admissions, and deaths in Finland during the Delta era under the implemented NPIs were about 100 times the observed numbers.

The article explores how the COVID-19 pandemic revived discussions on the importance of local pharmaceutical production for promoting health security and resilient health systems. It examines the World Health Organization's hub and spoke mRNA vaccine production model (mRNA hub), a global initiative that aims to establish sustainable, local mRNA manufacturing capabilities in low- and middle-income countries in response to the inequities in access to COVID-19 vaccines and the trade disruptions during the pandemic. Using the mRNA hub as case study, the paper discusses how the tectonic shift towards local production implicates supply and license agreements, and thus IPRs. The paper maps the intellectual property challenges that might impact the mRNA hub's sustainability and provides recommendations on how to enhance the initiative's chances of success and foster a more equitable pharmaceutical sector in the future.

Residual blood specimens collected at health facilities may be a source of samples for serosurveys of adults, a population often neglected in community-based serosurveys. Anonymized residual blood specimens were collected from individuals 15 – 49 years of age attending two sub-district hospitals in Palghar District, Maharashtra, from November 2018 to March 2019. Specimens also were collected from women 15 – 49 years of age enrolled in a cross-sectional, community-based serosurvey representative at the district level that was conducted 2 – 7 months after the residual specimen collection. Specimens were tested for IgG antibodies to measles and rubella viruses. Measles and rubella seroprevalence estimates using facility-based specimens were 99% and 92%, respectively, with men having significantly lower rubella seropositivity than women. Age-specific measles and rubella seroprevalence estimates were similar between the two specimen sources. Although measles seropositivity was slightly higher among adults attending the facilities, both facility and community measles seroprevalence estimates were 95% or higher. The similarity in measles and rubella seroprevalence estimates between the community-based and facility serosurveys highlights the potential value of residual specimens to approximate community seroprevalence.

Ticks and tick-borne diseases affect humans, livestock, and wildlife in most regions of the globe. Although there are over 900 tick species globally, only approximately 10% of species are second to mosquitoes as major vectors of human and veterinary diseases. The 17 articles of this themed Special Issue highlight the current research trends associated with newly discovered tick species, concepts of tick evolution, new vaccinology approaches, factors affecting disease transmission, and factors affecting tick ecology and tick-borne disease epidemiology. Table 1 summarizes the articles in this Special Issue in alphabetical author order and Fig. 1 is a word cloud generated from the article titles. Of the 17 articles in this Special Issue, two are review articles (vaccinology) while the remaining 15 are original research articles. The topics range from tick control, to epidemiology, ecology, tick-borne disease control, tick-borne disease transmission, vaccine approaches, and the description of novel extant and extinct tick species. Fig. 2 is graphical representation of the articles within this Special Issue including tick hosts and the most representative tick species studied. The articles also include authors from most continents globally with first author contributions from Australia, Bangladesh, Brazil, Czech Republic, Germany, India, Mexico, Pakistan, South Africa, Spain, Turkey, United Arab Emirates, USA and Zambia. This issue is thus truly diverse which reflects the diversity of ticks, tick-borne diseases and they hosts they infest globally.

Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, Maharashtra, before and after a measles-rubella supplemental immunization activity (MR-SIA) from 2018 to 2019. Anonymized residual specimens from children 9 months to younger than 15 years of age were collected from public and private diagnostic laboratories and public hospitals and tested for IgG antibodies to measles and rubella viruses. Significant increases in seroprevalence were observed following the MR SIA using the facility-based specimens. Younger children whose specimens were tested at a public facility in Kanpur Nagar District had significantly lower rubella seroprevalence prior to the SIA compared to those attending a private hospital, but this difference was not observed following the SIA. Similar increases in rubella seroprevalence were observed in facility-based and community-based serosurveys following the MR SIA, but trends in measles seroprevalence were inconsistent between the two specimen sources. Despite challenges with representativeness and limited metadata, residual specimens can be useful in estimating seroprevalence and assessing trends through facility-based sentinel surveillance.

The 2023 Texas federal district court decision Braidwood Management, Inc. vs. Becerra enjoined the enforcement of the Affordable Care Act’s preventive care mandate, which requires “first-dollar” insurance coverage for a range of preventive measures, including pre-exposure prophylaxis (PrEP), an HIV prophylactic drug. Most scholars have analyzed the case with respect to the conflict between public health goals and the Religious Freedom Restoration Act (RFRA). This Article suggests another reading of the Braidwood decision in light of a broader socio-legal phenomenon I call preventive health stigma. Stereotypes attach to the underlying medical condition that a given measure is aimed at preventing, or to the actual preventive measure resulting in stigmatization. Preventive health stigma penetrated the Braidwood decision through the case’s focus on PrEP users’ signaled prurient behavior instead of the drug’s proven health benefits. After offering a novel reading of the Braidwood decision, this Article also shows how preventive health stigma surfaces in the legal treatment of other preventive measures, such as abortion pills, masking, and vaccines. Understanding how stigma attaches to preventive medicine constitutes an important step in understanding how law and prejudice can undermine health reform.

The Covid-19 pandemic elevated global attention to the complex problem of allocating and disseminating newly approved vaccines. Following early calls for vaccine equity,1 global health leaders made progress but struggled to fully realize distribution goals.2 With respect to vaccination rates, low and middle income countries have not achieved full parity with high income countries.3 In this issue, Harmon, Kholina, and Graham follow longstanding critiques of market-based vaccine procurement to propose “legal and practical solutions for realizing a new access to vaccines environment”4 that will, they suggest, further the goal of global health justice.

A decline in routine vaccinations, attributed to vaccine hesitancy, undermines preventative healthcare, impacting health and exacerbating vaccine disparities. University-public health partnerships can improve vaccination services. This study describes and evaluates a university-public health use case employing social determinants of health (SDoH)-based strategies to address vaccination disparities. Guided by the Translational Science Benefits Logic Model, the partnership offered no-cost preventative vaccines at community-based organization (CBO) sites, collected CBO clientele’s vaccination interest, hesitancy, and demographic data, and conducted descriptive analyses. One hundred seven vaccination events were held, administering 3,021 vaccines. This partnership enhanced health outcomes by addressing disparities through co-located vaccination and SDoH services.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health — a partnership of public health law organizations — has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.