Vaccines and Global Health: The Week in Review 19 July 2014

Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
- Division of Medical Ethics, NYU Medical School
- The Wistar Institute Vaccine Center
- Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

WHO-UNICEF: Immunization coverage reaches 84%, still short of 90% goal

WHO-UNICEF: Immunization coverage reaches 84%, still short of 90% goal
Excerpt from Overview
More than 111 million infants received vaccines in 2013 to protect them from deadly diseases. These infants account for about 84% of the world’s children, but an estimated 21.8 million infants remained unvaccinated, according to new estimates from WHO and UNICEF

The estimates tell a success story for the Expanded Programme on Immunization, namely that global coverage with vaccines, measured by the proportion of kids who received 3 doses of vaccines containing diphtheria tetanus-pertussis (DTP3), rose from 73% in 2000 to 84% in 2013, a substantial increase.

But the numbers still fall short of the goal set out in the Global Vaccine Action Plan, which was endorsed by the World Health Assembly in 2012. That plan, which aims to prevent millions of deaths through more equitable access to vaccines, has a target of 90% coverage for all vaccines by the year 2020. The percentage of children who receive vaccines has been above 80% since 2006.

“We face a challenge in closing the gap between 84% and 90%,” said Michel Zaffran, Coordinator of WHO’s Expanded Programme on Immunization. “The countries have succeeded in maintaining a high level of vaccination coverage while, at the same time, introducing new vaccines and immunizing an increasing number of children born each year. However, it is hard for them to reach all children including those in remote areas or in urban slums.”

Small anti vaccination groups in some countries, Zaffran noted, also sometimes cause difficulties with misinformation about vaccines, presenting added challenges to national immunization programs in some cases.

Three of WHO’s regions reported very high immunization coverage: the Western Pacific with 96%; the European Region with 96%; and the Region of the Americas with 90%. Coverage was slightly lower in the: Eastern Mediterranean Region at 82%; in the South-East Asia Region at 77%; and in the African Region at 75%.

The data used in these estimates comes from official reports by national authorities as well as survey data from the published and grey literature. On a country by country basis, about two thirds of WHO’S 194 Member States achieved immunization coverage of 90% or higher for the commonly used DPT3 vaccine measurement, the figures show.

Global coverage with at least one dose of measles containing vaccine was 84% and 128 WHO member states reached at least 90% national coverage. An estimated 52% of children were vaccinated with 2 doses of measles containing vaccine during 2013 through routine immunization services.
Data on WHO immunization coverage

UN OCHA: Central Emergency Response Fund allocates $1.4 million to fight measles outbreak in Somalia

UN Watch [to 19 July 2014]
:: UN OCHA: Central Emergency Response Fund allocates $1.4 million to fight measles outbreak in Somalia
UN Office for the Coordination of Humanitarian Affairs
Mogadishu, 14 July 2014: The United Nations Central Emergency Response Fund (CERF) has allocated US$1.4 million for an emergency campaign to combat the outbreak of measles in Somalia, that has already left thousands of children at risk of disability and death. The funding will be used to vaccinate 520,000 children under 5 years in the worst affected areas of Banadir, Lower Juba and Puntland.

Around 4,000 suspected cases of measles were reported between January and June, more than double the suspected cases seen in the same period last year. Three quarters of cases were reported in children under 5 years.

“The CERF funding comes at a crucial time when thousands of children’s lives are at risk,” said the Humanitarian Coordinator for Somalia, Philippe Lazzarini, who is responsible for pooled fund allocation at country level. “The vaccination drive will help prevent the spread of the disease to other locations, particularly those inaccessible to vaccination teams. A nationwide catch-up campaign will be conducted in the next six months as part of the overall measles control strategy.”…The CERF allocation will be complemented by $300,000 from the Somalia Common Humanitarian Fund.

The Central Emergency Response Fund is a global pooled humanitarian fund set up in 2005 to enable more timely and reliable humanitarian assistance to people affected by armed conflicts and natural disasters. It is funded by voluntary contributions from UN Member States, NGOs, local government, the private sector and individual donors, and is managed by UNOCHA. The Common Humanitarian Fund is country-based and managed by UNOCHA on behalf of the Humanitarian Coordinator.

POLIO [to 19 July 2014]

POLIO [to 19 July 2014]

GPEI Update: Polio this week – As of 9 July 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report:
:: Momentous opportunity for Africa: In its 2-3 July meeting, the Central African Technical Advisory Group noted that there is now a “momentous opportunity” for Africa to be polio-free and warned that there is a lack of urgency to capitalize on this opportunity.
:: New case in Afghanistan of Pakistan origin: A child who had onset of polio-paralysis in Khost Province of Afghanistan is a member of the displaced community from Pakistan’s North Waziristan Agency, where children have not had access to vaccination for two years. Ahead of and during military action in that Agency, the population has largely left the area and moved into surrounding areas of Pakistan and into Afghanistan. Massive vaccination operations are taking place at the transit points out of North Waziristan in order to protect Waziri children and the rest of Pakistan from polio.
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Khost Province. The child is from a Pakistani family from polio-endemic North Waziristan who fled to Afghanistan to escape conflict at home. Already ill with fever when leaving Pakistan, the child developed paralysis on 16 June, 2014, in Khost province, one day after arrival from N. Waziristan. Including this most recent case, Afghanistan has reported eight polio cases to date in 2014, compared to three at this time in 2013.
:: Khost Province borders Pakistan, where communities displaced by military action have been leaving North Waziristan Agency. In preparation for the displacement of people – and possible movement of the virus – ahead of the Pakistan military’s actions in North Waziristan, health authorities in surrounding districts of Pakistan and across the border in Afghanistan have been vaccinating displaced children: more than 35,000 displaced children under the age of 10 are reported to have received a dose of bivalent oral polio vaccine (bOPV) as they entered the Afghan provinces of Paktyka and Khost.
:: Two new cVDPV2 cases were reported in the past week, from Borno and Kano states. The total number of cVDPV2 cases for 2014 is now 13, and for 2013 is four. The most recent cVDPV2 case was the one from Damboa in Borno, which had onset of paralysis on 9 June. The continuing circulation of cVDPV2, as evident both from AFP and environmental surveillance , reflects very low levels of routine coverage with tOPV (and therefore very low immunity against type 2 poliovirus) in the north of the country and the need for increased use of type-2 containing vaccine (tOPV) during SIAs. It is also urgent that the quality and coverage of SIAs in northern Nigeria continue to improve this year
:: Four new wild poliovirus type 1 (WPV1) cases were reported in the past week, bringing the country’s total case count to 94. The most recent cases had onset of paralysis on 24 June, one from Khyber Agency of the Federally Administered Tribal Areas (FATA), one from Peshawar in Khyber Pakhtunkhwa province and one from Sanghar in Sindh province.
Central Africa
:: In its 2-3 July meeting, the Central African Technical Advisory Group noted that there is now a “momentous opportunity” for Africa to be polio-free, given the decline in cases in Nigeria, and warned that there is a lack of urgency to capitalize on this opportunity. The group recommended systematic engagement with the Heads of State and a region-wide alert on the potential spread of polio to ensure countries reduce their vulnerability and are prepared to deal with importation of poliovirus.
:: The entire population of Equatorial Guinea, regardless of age, will be vaccinated starting 23 July. A house-to-house search for acute flaccid paralysis cases will be conducted during the campaign; a similar search is currently taking place in Gabon. Cameroon, the Central African Republic, the Democratic Republic of the Congo (DR Congo), Gabon and the Republic of Congo also have mass vaccination campaigns planned for July. DR Congo, Equatorial Guinea and Gabon are also planning to carry out campaigns in August.
Horn of Africa
:: Three new cases of wild poliovirus type 1 were reported in the past week. Five cases have been reported in the Horn of Africa to date in 2014 – one WPV1 in Ethiopia and four WPV1 in Somalia. The most recent case had onset of paralysis on 3 June in Mudug, Somalia.
:: The three new cases reported from Mudug in Somalia bring the total no. of cases reported from the Mudug Region (Jariban) this year to four and indicate that the polio outbreak in Somalia continues. The cases are caused by virus closely related to that previously detected in Mogadishu in July 2013. No cases have been detected in the epicentre of the outbreak, in Mogadishu, Banadir region, since 19 July 2013.
:: Mudug is a remote area with challenging conditions to plan and implement immunization campaigns and with hard-to-reach, under-served nomadic populations. While the proportion of children with three or more doses of oral polio vaccine has risen since 2012, it is still below 80%. None of the children paralyzed in Mudug had ever been vaccinated against polio.
Special outreach is currently taking place to reach and vaccinate nomadic communities, as well as to map of these communities to ensure their inclusion in vaccination plans.

Pakistanis use fake polio vaccination cards to travel overseas
Thomson Reuters Foundation | 11 July 2014
NEW DELHI, July 11 (Thomson Reuters Foundation) – Pakistanis seeking to travel overseas have used fake polio vaccination certificates to circumvent rules put in place to stem the spread of the crippling virus, the Dawn newspaper reported.
The World Health Organisation (WHO) in May advised Pakistan, Syria and Cameroon to put in place emergency travel measures as they pose the greatest risk of exporting the virus and undermining a U.N. plan to eradicate polio by 2018.
The WHO recommended that residents and long-term visitors to these three countries be vaccinated and show proof of vaccination before being allowed to travel.
But since the rule was put in place in Pakistan in June, immigration staff at Islamabad’s Benazir Bhutto International Airport told the Dawn newspaper they had found around 150 polio certificates to be counterfeit.
An airport official, who declined to be named, said that some people had obtained fake certificates because they believed the vaccine could endanger their health…

Editor’s Note: Please note “comment” articles on polio from the current issue of Nature in Journal Watch below:
:: Within reach — A redoubling of efforts should swiftly eradicate polio from its last strongholds
Nature editors
:: Infectious disease: Polio eradication hinges on child health in Pakistan
Zulfiqar Ahmed Bhutta

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 19 July 2014]

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 19 July 2014]

:: Update on polio in Equatorial Guinea 17 July 2014
As of 16 July 2014, Equatorial Guinea has reported a total of 5 wild poliovirus type 1 (WPV1) cases, with onset of paralysis between 28 January 2014 (first case) and 3 May 2014 (most recent case). Genetic sequencing indicated that the cases are linked to the ongoing outbreak in Cameroon.
A national emergency action plan to respond to the polio outbreak was developed by the Ministry of Health and polio partner agencies and is being implemented. Three nationwide campaigns with bivalent oral polio vaccine (bOPV) have already been conducted in the country – two campaigns targeting children under 15 years old in April 2014 and early May 2014, and one in late May 2014 targeting children under 5 years old. Two nationwide bOPV campaigns are planned for mid-July 2014 and mid-August 2014; the July 2014 round will target the entire population, and the August 2014 round will target children under 15 years old…
…According to the International Health Regulations (IHR) Temporary Recommendations issued by the Director-General of WHO on 5 May 2014, Equatorial Guinea is considered as a polio exporting country.
The country is therefore working to ensure that all residents and long-term visitors (of more than 4 weeks) who travel internationally receive a supplementary dose of polio vaccine between 4 weeks and 12 months prior to departure

:: Ebola virus disease, West Africa – update 15 July 2014
Epidemiology and surveillance
The World Health Organization (WHO) continues to closely monitor the evolving Ebola virus disease (EVD) outbreak in Guinea, Liberia, and Sierra Leone. The current epidemic trend in Sierra Leone and Liberia remains serious, with high numbers of new cases and deaths being reported. Between 8 – 19 July 2014, 79 new cases, and 65 deaths were reported from Liberia and Sierra. In Liberia, 30 new cases and 13 deaths were reported, while in Sierra Leone, 49 new cases and 52 deaths have been reported. These include suspect, probable and laboratory confirmed cases. This trend indicates that a high level of transmission of the Ebola Virus continues to take place in the community. The epidemic situation in Guinea is being closely observed, with 6 new cases and 3 deaths reported between 8 – 19 July 2014. The respective Ministries of Health are working with WHO and partners to step up outbreak containment measures….

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 14 July 2014

Global Fund Watch [to 19 July 2014]

Global Fund Watch [to 19 July 2014]

:: Global Fund Results Show Strong Gains
17 July 2014
GENEVA – The Global Fund announced today that 6.6 million people are getting antiretroviral treatment for HIV through programs supported by Global Fund grants, with particularly strong gains in Nigeria, Mozambique, India, and Uganda this year. In mid-year results for 2014, the Global Fund also reported that programs supported by its grants have distributed a total of more than 410 million mosquito nets to protect children and families against malaria, an increase of 14 percent.

In addition, 11.9 million people have been treated for tuberculosis in programs supported by the Global Fund. In the first half of 2014, the number of people treated for multidrug resistant tuberculosis rose to nearly 140,000 from 110,000.

“These results show that we are accelerating progress against HIV, TB and malaria,” said Mark Dybul, Executive Director of the Global Fund. “We can do even more, and reach more people, when we work together and concentrate our efforts on those who are most vulnerable.”

This year, the Global Fund is in a transition in how to assess impact that better reflects the collective contribution towards goals and targets. In that process, the Global Fund is working with partners and experts to arrive at an improved methodology to measure health impact of HIV, TB and malaria programs…