Vaccines and Global Health: The Week in Review 18 October 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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Editor’s Note on this Edition:
  The pace and complexity of the Ebola/EVD crisis and global response continues. We will strive to present a coherent, high-level digest using official sources wherever possible.
We will focus on candidate vaccines and therapeutic interventions in development, in various trials globally, and in early deployment. We will also attempt to capture the activity of UN agencies, NGOs and other organizations that are making a material impact on the crisis. Reading this issue you will encounter significant Ebola/EVD content throughout, including a number of editorials and analyses in Journal Watch below.
Recognizing that polio is a continuing Public Health Emergency of International Concern (PHEIC), we lead this issue with the GPEI update which notes that Pakistan reported 19 new wild poliovirus type 1 (WPV1) cases last week alone.


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

POLIO [to 18 October2014]

POLIO [to 18 October2014]

GPEI Update: Polio this week – As of 15 October 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report:
:: More than 6 months has passed since a case of wild poliovirus was reported in Syria or Iraq. Over 22 million children have been vaccinated against polio multiple times in the past year, in the midst of active conflict and a humanitarian crisis.
:: Pakistan has reached 206 cases of paralysis caused by wild poliovirus in 2014. This is the highest number of cases on record by October in Pakistan in any year.
:: Reviews took place in both Equatorial Guinea and Cameroon in September to assess the quality of polio outbreak response activities conducted so far. Both assessments concluded that although much progress has been accomplished towards controlling the outbreaks, neither programme can be entirely confident that transmission has been interrupted. Recommendations have been made and follow up missions should take place by mid-December in Equatorial Guinea and by February 2015 in Cameroon.
:: Two new wild poliovirus type 1 (WPV1) cases were reported in the past week in Afghanistan. Both were from Kandahar province (1 from Kandahar district and one from the previously uninfected Panjwayi district). The most recent case had onset of paralysis on 18 September. The total number of WPV1 cases in 2014 is now 12.
:: Given the growing outbreak in neighbouring Pakistan, Afghanistan is taking protective steps to limit any spread of virus. Subnational Immunization Days (SNIDs) were held 12-14 October using bivalent oral polio vaccine (OPV) in high-risk areas of Southern Region and Eastern Region. The next National Immunization Days (NIDs) are scheduled for 19-21 October using bivalent OPV.
:: Nineteen new wild poliovirus type 1 (WPV1) cases were reported in the past week in Pakistan. Of these, 6 are from the Federally Administered Tribal Areas (FATA) (1 from North Waziristan, 1 from South Waziristan and 4 from Khyber Agency); 9 are from Khyber Pakhtunkhwa province (1 from Tank district, 2 from Mardan district, 1 from the previously uninfected district of Nowshera and 5 from Peshawar district); 1 case from Balochistan province in Quetta district; 2 from Sindh province (1 in Khigadap and the other from the previously uninfected Khibinqasim district); and 1 from Punjab province, in the previously uninfected district of Sheikupura. This brings the total number of WPV1 cases in 2014 to 206 compared to 39 in 2013 by this date. The most recent case had onset of paralysis on 22 September in Khyber Pakhtunkhwa.
:: Immunization activities are continuing with particular focus on known high-risk areas, in particular the newly opened areas of FATA. At exit and entry points, 163 permanent vaccination points are being used to reach internally displaced families as they leave their homes.
Central Africa
:: Reviews took place in both Equatorial Guinea and Cameroon in September to assess the quality and adequacy of polio outbreak response activities conducted so far. Both assessments concluded that although much progress has been accomplished towards controlling the outbreaks, neither programme can be entirely confident that transmission has been interrupted. Recommendations have been made and follow up missions should take place in by mid-December in Equatorial Guinea and by February 2015 in Cameroon.
Middle East
:: Last week marked 6 months with no cases of WPV1 in the Middle East. The most recent case reported from Syria had onset of paralysis on 21 January. The last case in Iraq occurred in Mada’in district, Baghdad-Resafa province, with onset of paralysis on 7 April.
:: Phase 2 of the Middle East Outbreak response continues to be implemented, with campaigns planned across the region in October, using a mix of bivalent and trivalent oral polio vaccine, depending on the area.
West Africa
:: Even as polio programme staff across West Africa support efforts to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio. National Immunization Days (NIDs) are planned in Benin, Burkina Faso, Cape Verde, Côte d’Ivoire, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Senegal and Togo starting 31 October. Subnational Immunization Days (SNIDs) will take place on the same dates in Niger.

Ebola/EVD: Vaccines & Therapeutics [to 18 October 2014]

Ebola crisis: GSK says vaccine not ready until 2016
BBC 17 October 2014 Last updated at 11:59 BST [Video]
UK pharmaceuticals firm GlaxoSmithKline says any Ebola vaccine it produces will come too late for the current epidemic.
GSK is one of several companies trying to fast-track a vaccine to prevent the spread of Ebola in West Africa.
Dr Ripley Ballou, head of GSK’s Ebola vaccine research, said full data on its safety and efficacy would not be ready until late 2015 and any mass production would not start until 2016.
He told Simon Cox, from the BBC’s File on Four, his fear that without effective controls the epidemic had real potential to “spread to surrounding countries”.

Chimerix: IND authorized for brincidofovir (BCV) for Ebola Virus Disease (EVD)
Chimerix announced that it has worked closely with the FDA to develop a Phase 2 clinical trial protocol to assess the safety, tolerability, and efficacy of brincidofovir in patients who are confirmed to have Ebola Virus Disease. An investigational new drug (IND) application for brincidofovir (BCV) for Ebola Virus Disease (EVD) has been authorized by the FDA. The FDA has authorized a Phase 2 protocol for BCV for EVD to begin immediately. Brincidofovir tablets are available for immediate use in clinical trials.
Full media release:

China sends thousands of doses of anti-Ebola drug to Africa
Financial Times | 16 October 2014
China has sent thousands of doses of an experimental anti-Ebola drug developed by the Chinese military to Africa. The company manufacturing the drug said it plans to start human clinical trials there soon. Sihuan Pharmaceutical, the private Chinese company that last week purchased the rights to commercialise jk-05 from a branch of the People’s Liberation Army (PLA), said it began manufacturing the drug after it was approved in August as a “special drug for military needs”.
The Chinese military has already sent enough drug to treat 10,000 people in West Africa…The aim is to have the drug on hand in case any of the Chinese medical personnel…fall ill and for use in clinical trials…

President Obama Names Ron Klain to Coordinate the U.S. Response to Ebola

President Obama Names Ron Klain to Coordinate the U.S. Response to Ebola
October 17, 2014 – 11:06 AM EDT
President Obama has asked Ron Klain to coordinate the government’s comprehensive response to Ebola. He will report to the President Obama’s Homeland Security Advisor Lisa Monaco and his National Security Advisor Susan Rice.
As former Chief of Staff to two Vice Presidents, Klain comes to the job with extensive experience in overseeing complex governmental operations and has good working relationships with leading Members of Congress as well as senior Administration officials.
Klain’s talent and managerial skill will be crucial in providing the resources and expertise we need to rapidly, cohesively, and effectively respond to Ebola at home and abroad. As the President said, while “the dangers of a serious outbreak are extraordinarily low” in the U.S., “we are taking this very seriously at the highest levels of government.” Klain will be an integral part of ensuring that we effectively respond and ultimately bring an end to Ebola.

BBC: Ebola crisis: UN defends response after WHO report

Ebola crisis: UN defends response after WHO report
BBC News – 18 October 2014 Last updated at 00:38 ET
UN Ebola coordinator David Nabarro: “We are putting in place the foundations of a very powerful response”

A senior UN health official has defended international moves to tackle the Ebola outbreak in West Africa.
David Nabarro, UN system coordinator for Ebola, told the BBC that plans were on course to provide 4,000 beds for Ebola patients by next month, compared with 300 at the end of August.

His comments follow a damning internal report from the World Health Organisation (WHO).

It said the UN agency had missed the chance to stop the disease spreading.

An internal document said those involved “failed to see some fairly plain writing on the wall”, according to the Associated Press.

Separately, sources close to the WHO told Bloomberg of multiple failures in the outbreak’s early stages.

In the worst affected countries – Liberia, Guinea and Sierra Leone – the Ebola virus has now killed 4,546 people with cases of infection numbering 9,191, according to the latest WHO figures.

Mr Nabarro was responding to criticism of medical charity Medecins Sans Frontieres (MSF), which said that pledges of deployment and aid had not yet had an impact on the epidemic.

He told the BBC that he had seen a big increase in the international response over the past two months.

“I am absolutely certain that when we look at the history, that this effort that has been put in place will have been shown to have had an impact, though I will accept that we probably won’t see a reduction in the outbreak curve until the end of the year.

“We are putting in place the foundations of a very powerful response.”

The reports have brought into focus the way the WHO dealt with the outbreak in the months after it received the first reports of Ebola cases in Guinea in March.
Medical charity Medecins Sans Frontieres (MSF) warned in April that the outbreak was out of control – something disputed by the WHO at the time.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” the document obtained by AP says.

The draft report – a timeline of the outbreak – also reportedly says that experts should have realised that traditional methods of containing infectious disease would not work in a region with porous borders and poor health systems.

Among the problems cited in the information obtained by AP and Bloomberg are:
– A failure of WHO experts in the field to send reports to WHO headquarters in Geneva
– Bureaucratic hurdles preventing $500,000 reaching the response effort in Guinea
– Doctors unable to gain access because visas had not been obtained…

WHO – Ebola Virus Disease (EVD) [to 18 October 2014]

WHO Ebola Virus Disease (EVD)

Situation report update – 17 October 2014
A total of 9216 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been Reported in seven affected countries (Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the United States of America) up to the end of 14 October. There have been 4555 deaths. A second EVD–negative sample was obtained from the single confirmed case in Senegal on 5 September (42 days ago). WHO officially declares the Ebola outbreak in Senegal over…

Virtual press briefing on Ebola response
14 October 2014
Speakers: Dr Bruce Aylward, WHO Assistant Director-General, Polio and Emergencies
Audio of the press briefing
mp3, 66 Mb, [01:11:00]

Ebola situation assessments
The outbreak of Ebola virus disease in Senegal is over
17 October 2014
Are the Ebola outbreaks in Nigeria and Senegal over?
14 October 2014

Consolidated Ebola virus disease preparedness checklist
pdf, 220kb October 2014
The checklist will be adapted based on feedback by the countries.
WHO and Partners agree on a common approach to strengthen Ebola preparedness in unaffected countries
Brazzaville, 10 October 2014 – The World Health Organization (WHO) and partner organizations meeting in Brazzaville have agreed on a range of core actions to support countries unaffected by Ebola in strengthening their preparedness in the event of an outbreak.
Building on national and international existing preparedness efforts, a set of tools is being developed to help any country to intensify and accelerate their readiness.
One of these tools is a comprehensive checklist of core principles, standards, capacities and practices, which all countries should have or meet. The checklist can be used by countries to assess their level of preparedness, guide their efforts to strengthen themselves and to request assistance. Items on the checklist include infection prevention control, contact tracing, case management, surveillance, laboratory capacity, safe burial, public awareness and community engagement and national legislation and regulation to support country readiness….
The initial focus of support by WHO and partners will be on “highest priority countries – Cote d’Ivoire, Guinea Bissau, Mali and Senegal – followed by “high priority countries” – Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Mauritania, Nigeria, South Sudan, and Togo. Criteria used to prioritize countries include geographical proximity to affected countries, trade and migration patterns and strength of health systems.
There are other ongoing epidemics of Ebola virus disease in Democratic Republic of Congo and Mar-burg hemorrhagic fever in Uganda. Given the history of epidemics in the Central Africa region, countries sharing borders with these States should be supported to strengthen their preparedness….

Liberia: working with communities is the key to stopping Ebola
12 October 2014
Related news on Ebola
WHO congratulates Senegal on ending Ebola transmission
17 October 2014
CDC/MMWR Watch [to 18 October2014]

Ebola Outbreak – 2014
:: FAQ: Frequently Asked Questions about Dallas and Ohio Flights 10/17/2014 -
:: Media Statement: CDC Expands Passenger Notification 10/16/2014 -
Transcript: CDC Update on Ebola Response 10/15/2014 -
:: CDC and Frontier Airlines Announce Passenger Notification Underway – Media Statement10/15/2014, 11:32 AM
:: Texas Reports Positive Test for Ebola in One Additional Healthcare Worker – Media Statement10/15/2014, 5:00 AM
:: CDC Taking Active Steps Related to Hospital Preparedness for Ebola Treatment – Fact Sheet – Media Statement10/14/2014, 10:00 PM
:: CDC update on Ebola Response, 10-14-2014 – Transcript10/14/2014, 5:01 PM

MMWR October 17, 2014 / Vol. 63 / No. 41
:: Cluster of Ebola Cases Among Liberian and U.S. Health Care Workers in an Ebola Treatment Unit and Adjacent Hospital — Liberia, 2014
:: Developing an Incident Management System to Support Ebola Response — Liberia, July–August 2014
:: Surveillance and Preparedness for Ebola Virus Disease — New York City, 2014
:: Vaccination Coverage Among Children in Kindergarten — United States, 2013–14 School Year
CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs each year, to assess state and national vaccination coverage and exemption levels among kindergartners. This report describes vaccination coverage in 49 states and the District of Columbia (DC) and vaccination exemption rates in 46 states and DC for children enrolled in kindergarten during the 2013–14 school year.

UNMEER [UN Mission for Ebola Emergency Response] [to 18 October 2014]

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 18 October 2014.

UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Medical
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
Beginning with this issue of “Week in Review” we will present selected elements of interest from these reports. The full report is available as a pdf using the link provided by the report date.

17 October 2014 Excerpts
:: Key Political and Economic Developments
1. UN Secretary General Ban Ki Moon made a strong call to turn pledges into action, appealing to the international community to provide the $1 billion that will enable the crisis response to get ahead of the curve and meet its target of reducing the rate of transmission by December 1st…
2. The UN Ebola Response Operational Planning Conference, arranged by UNMEER in Accra, Ghana (15-18 October) has led inter-agency discussions on putting together a credible operational plan to combat EVD…
:: Human Rights
5. UN High Commissioner on Human Rights, Zeid Ra’ad Al Hussein, stated that respect for the rights of survivors and affected communities are at risk of being sacrificed. He also stressed that a disregard for human rights to things like health, education, sanitation and good governance had allowed Guinea, Liberia and Sierra Leone to become fertile ground for the outbreak in the first place.
6. Human Rights Watch has said some EVD quarantines had been ineffective and did not meet human rights standards as they disproportionately impact people unable to evade the restrictions, including the elderly, the poor, and people with chronic illness or disability.
:: Outreach and Education
20. The International Federation of the Red Cross and Red Crescent Societies (IFRC)’s report on disasters stated that the current EVD epidemic has shown that culture and beliefs are vital when tackling emergency situations. IFRC Deputy Secretary General Matthias Schmale said that the population should feel we understand their practices and in the case of EVD, funerals are an opportunity to make a community realize no one is against their culture.
26. London Mining, which owns an iron ore mine in Sierra Leone and has built an Ebola treatment centre, has reportedly gone bankrupt. The collapse of the company raises concerns about international efforts to combat Ebola.
:: Essential Services
28. UNFPA reported that EVD is wiping out gains in safe motherhood made in Guinea, Liberia and Sierra Leone. An estimated 800,000 women in these three countries should give birth in the next 12 months but many pregnant women are afraid to visit or have been turned away from overstretched health facilities. UNFPA says that USD 64.5 million is needed to provide reproductive and maternal health services in the next three months.
29. Some 108,000 children due to sit their secondary school exams have missed them, says the UNICEF education head in Sierra Leone. Teachers are still being paid and the government has just launched a radio education programme aired over a 12-hour period to four different age groups.
:: OCHA financial tracking of overall contributions to the Ebola response

16 October 2014 Excerpts
:: Human Rights
7. A standard operating procedure (SOP) for enforcing roadblocks and quarantines, drafted with the help of UNDP, has been approved by the Government of Sierra Leone. UNDP will work to scale-up the implementation of the SOP and support the training of 4,000 – 5,000 officers nationwide.
:: Medical
14. Fiji will stop sending peacekeeping police officers to Liberia due to the Ebola crisis. The Fiji Police Force will phase out the 27 officers currently stationed in UNMIL after the completion of their one-year tour of duty.
15. Firestone Tire and Rubber Company’s production facility in Liberia, which employs more than 8,000 workers, has seen approximately 71 employees, family members, retirees, and people living in the surrounding communities contract EVD. Firestone’s Ebola Treatment Center (ETC) has helped 17 people survive and become a model ETC in the process.
:: Logistics
23. Director of operations for Medecins Sans Frontieres, Brice de le Vingne, reports that it is reaching its limit and called on all partners step up efforts against EVD.
:: Outreach and Education
24. Social media users in Sierra Leone are turning to chat apps to disseminate information about EVD. Private groups are being set up on WhatsApp, a smartphone instant messaging service, so that information about Ebola can be shared in a space where conversations can take place more freely than on Facebook.


UNMEER site: Press Releases
:: Ebola wiping out gains in safe motherhood (16 October 2014)
:: WFP Operational Update (15 October 2014)
:: Community Mobilization, Local Investment Needed to Win Fight Against Ebola, says UN (14 October 2014)

UNMEER site: Statements
:: WHO declares Ebola outbreak over in Senegal (17 October 2014)
:: Security Council Press Statement — Ebola (15 October 2014)
:: Briefing by Mr. Anthony Banbury Special Representative of the Secretary-General and Head of the United Nations Mission for Ebola Emergency Response

UNMEER site: Developments
:: Aid for Sierra Leone, Guinea and Liberia
15 October 2014 – New York A German aircraft arrived Wednesday morning at Kotoka International Airport in Accra, Ghana, where it was to be loaded with UN humanitarian supplies and equipment for delivery this week to Sierra Leone and Guinea, said Farhan Haq, the Deputy Spokesman for the UN Secretary-General.

:: Sierra Leone’s contact tracers work to curtail Ebola outbreak
14 October 2014 – Kailahun/New YorkAs Ebola infections continue to escalate at an alarming rate in West Africa, UNFPA-trained contact tracers in Sierra Leone are playing a vital role in mitigating the public health crisis.

:: Nabarro: Ebola outbreak could begin to be brought under control by year’s end
13 October 2014 – New York The Ebola outbreak that has struck Western Africa could begin to be brought under control by the end of 2104 if international donors act quickly and generously, according to the United Nations Special Envoy on Ebola.