Vaccines and Global Health: The Week in Review 20 September 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

Editor’s Note: Ebola Outbreak Coverage [to 20 September 2014]

Editor’s Note:
It was a week of extraordinary and historic action in the Ebola outbreak context.

Key developments included:
:: continuing escalation of the outbreak across Liberia, Guinea and Sierra Leone (see WHO Ebola Roadmap Report 4 below),

:: proposed formation by the UN Secretary General of an unprecedented UN mission – UNMEER (UN Mission for Emergency Ebola Response) – reporting directly to the SG and charged with coordinating UN system, government, NGO and private sector response and (see “Identical Letters dated 17 September 2014..” below),

:: unprecedented action by the UN Security Council and the General Assembly on resolutions declaring the Ebola outbreak a “threat the international peace and security,” affirming formation of UNMEER, and issuing calls-to-action to focus new global resources and coordinate their deployment (see Security Council and General Assembly resolutions below),

:: major commitments of support to fight the outbreak from a number of countries, including a commitment by the U.S. of 3,000 military personnel and other forms of support (see White House Fact Sheet below),

:: release by UN OCHA of a composite analysis detailing needed resources to fight the outbreak – now scaled at about US$1 billion – complementing the WHO Ebola Roadmap issued earlier (see OCHA joint report summary below),

:: release by the World Bank of dire projections of the economic impact on Guinea, Liberia, and Sierra Leone (see report at The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for Guinea, Liberia, and Sierra Leone)

:: implementation now underway in Sierra Leone of a three-day home “quarantine “ across the country to allow largely volunteer health worker teams to move house to house to educate about and assess potential new cases of Ebola (see UNICEF Watch below).

As we noted last week, the volume of coverage, comment and analysis driven by the Ebola outbreak is growing and is occurring across media sources well beyond those we actively monitor. We will strive to present a coherent digest of what is happening using official sources wherever possible, with a special focus on vaccines and other interventions now in development and various trials globally. Reading this issue you will encounter additional Ebola content throughout.

WHO: Ebola Response [to 20 September 2014]

:: WHO: Ebola Response Roadmap Situation Report
18 September 2014
This is the fourth in a series of regular situation reports on the Ebola Response Roadmap1. The report contains a review of the epidemiological situation based on official information reported by ministries of health, and an assessment of the response measured against the core Roadmap indicators where available….
…Following the roadmap structure, country reports fall into three categories: those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); those with an initial case or cases, or with localized transmission (Nigeria, Senegal); and those countries that neighbour areas of active transmission (Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, Senegal). An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of Ebola virus disease is occurring, is also provided…
The total number of probable, confirmed and suspected cases in the current outbreak of Ebola virus disease (Ebola) in West Africa was 5335, with 2622 deaths, as at the end of 14 September 2014…

:: WHO Director-General addresses UN Security Council on Ebola 18 September 2014
:: WHO welcomes Chinese contribution of mobile laboratory and health experts for Ebola response in west Africa 16 September 2014
:: WHO welcomes the extensive Ebola support from the United States of America 16 September 2014

Ebola – Identical letters dated 17 September 2014 from the Secretary-General to Security Council/General Assembly

Identical letters dated 17 September 2014 from the Secretary-General addressed to the President of the General Assembly and the President of the Security Council
18 September 2014 :: 5 pages
Editor’s excerpts and text bolding

…In recognition of the rapidly evolving situation on the ground, including the rapid spread of Ebola virus disease, and following consultations with Dr. Margaret Chan and Dr. Nabarro, I have decided to establish a United Nations Mission. The Mission will harness the capabilities and competencies of all the relevant United Nations actors under a unified operational structure to reinforce unity of purpose, effective ground-level leadership and operational direction, in order to ensure a rapid, effective, efficient and coherent response to the crisis. The singular strategic objective and purpose of the Mission will be to work with others to stop the Ebola outbreak. To achieve this, the strategic priorities of the Mission will be to stop the spread of the disease, treat the infected, ensure essential services, preserve stability and prevent the spread to countries currently unaffected.

The Mission, through presences within the affected States, will provide needed field-level support to the Governments and peoples of West Africa as they respond to the crisis. The Mission will assist Member States and regional and sub-regional organizations, upon request, as well as other partners, including non-governmental organizations, in delivering their bilateral and multilateral assistance in a coordinated and coherent manner on the ground. In particular, the Mission will coordinate with the African Union, the Economic Community of West African States and the Mano River Union.

Under the joint initiative of the Director-General of WHO and myself, Dr. Nabarro will continue to represent the United Nations system and provide overarching strategic leadership, coordination and guidance, including through consultations with the Member States and other stakeholders participating in or contributing to the international efforts in response to Ebola virus disease. He will lead international efforts to mobilize and sustain the political will and strategic resources necessary to combat this crisis. I invite all Member States, other intergovernmental organizations, civil society and the private sector to join a broad international coalition at the earliest opportunity and to contribute decisively to the international response to the disease.

At the operational level, I intend to immediately establish a United Nations Mission for Ebola Emergency Response (UNMEER), to be headed by a Special Representative of the Secretary-General (Under-Secretary-General) whom I shall appoint following consultation with Dr. Chan and who will report directly to me. The Mission will build and maintain a regional operational platform, ensuring the rapid delivery of international assistance against the needs identified in the affected States, lead the response at the operational level and provide strategic direction to the United Nations system and other implementing partners on the ground. It will also work closely with all Governments and partners contributing to this effort….

…The Mission will bring together the range of United Nations actors and capabilities, as well as Governments, Member States, non-governmental organizations and other relevant stakeholders, in order to provide effective leadership, avoid unnecessary duplication and ensure the efficient prioritization of available assets and resources. The Mission will work closely with the national Ebola operational centres established by the Governments concerned, as well as with contributing Member States that are providing assistance within affected countries. The Mission will also engage closely with the private sector in order to ensure that the collective international community is drawing upon all possible assets to overcome the outbreak and its destructive secondary effects.

The Mission will be guided by six principles:
1.Reinforce government leadership;
2.Deliver rapid impact on the ground;
3.Closely coordinate and collaborate with actors outside the United Nations;
4.Tailor responses to particular needs in the different countries;
5.Reaffirm WHO lead on all health issues;
6.Identify benchmarks for transition post-emergency and ensure that actions strengthen systems.

Furthermore, the Mission will be responsible for catalysing a rapid and massive mobilization of international human, material, logistic and financial resources, under a single overarching framework, in pursuit of the objectives of the mandate and strategic priorities cited above. To achieve those strategic objectives, the Mission will focus on 12 mission-critical actions identified by the Senior United Nations System Coordinator, following consultations with major stakeholders, including the Governments of the affected countries, including:
1. Identification and tracing of people with Ebola virus disease;
2. Care for the infected and infection control;
3. Safe and dignified burial;
4. Medical care for responders;
5. Food security and nutrition;
6. Access to basic health services;
7. Cash incentives for health workers;
8. Economic protection and recovery;
9. Supplies of material and equipment;
10. Transportation and fuel;
11. Social mobilization;
12. Messaging.

…The Ebola situation has highlighted the need to determine if and how early identification systems need to be improved and how those systems can better translate into more timely action. I intend to consult with Dr. Chan on this issue in order to make recommendations to accelerate the global response in the future. Input from the affected Governments, Member States and other relevant stakeholders will be an essential part of this process….

…I count on the support of the Security Council, the General Assembly and all Member States in this vital endeavour. A more detailed report outlining the required resource requirements will be submitted for the approval and consideration of the Assembly. I also intend to establish a trust fund to mobilize the necessary voluntary contributions and other resources to further this task and to assist in funding the broader effort, including by addressing any gaps in the activities of United Nations system partners. I intend to make maximum use of the authority provided to me, including in the area of human resources, in order to promote the timely and effective response to the Ebola crisis.
No one country, no one organization has the resources to stem the tide of the Ebola crisis. Each Government is ultimately responsible for its own people.

The Governments and the people of West Africa have asked for our help. We must come together as one United Nations, and we call upon Member States to join us in answering their call….

Eboal: UN Security Council & General Assembly Resolutions :: 18-19 Sep 2014

UN Security Council :: Resolution 2177 (2014)
S/RES/2177 (2014)
Adopted by the Security Council at its 7268th meeting, on 18 September 2014
[Excerpt, primarily of action elements from resolution; Editor’s text bolding]

…“Recalling its primary responsibility for the maintenance of international peace and security,

“Expressing grave concern about the outbreak of the Ebola virus in, and its impact on, West Africa, in particular Liberia, Guinea and Sierra Leone, as well as Nigeria and beyond,

“Recognizing that the peacebuilding and development gains of the most affected countries concerned could be reversed in light of the Ebola outbreak and underlining that the outbreak is undermining the stability of the most affected countries concerned and, unless contained, may lead to further instances of civil unrest, social tensions and a deterioration of the political and security climate,

“Determining that the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security,

“Expressing concern about the particular impact of the Ebola outbreak on women,…

…“Emphasizing the key role of Member States, including through the Global Health Security Agenda where applicable, to provide adequate public health services to detect, prevent, respond to and mitigate outbreaks of major infectious diseases through sustainable, well-functioning and responsive public health mechanisms,

“Recalling the International Health Regulations (2005), which are contributing to global public health security by providing a framework for the coordination of the management of events that may constitute a public health emergency of international concern, and aim to improve the capacity of all countries to detect, assess, notify and respond to public health threats and underscoring the importance of WHO Member States abiding by these commitments,

“Underscoring that the control of outbreaks of major infectious diseases requires urgent action and greater national, regional and international collaboration and, in this regard, stressing the crucial and immediate need for a coordinated international response to the Ebola outbreak…

…1. Encourages the governments of Liberia, Sierra Leone and Guinea to accelerate the establishment of national mechanisms to provide for the rapid diagnosis and isolation of suspected cases of infection, treatment measures, effective medical services for responders, credible and transparent public education campaigns, and strengthened preventive and preparedness measures to detect, mitigate and respond to Ebola exposure, as well as to coordinate the rapid delivery and utilization of international assistance, including health workers and humanitarian relief supplies, as well as to coordinate their efforts to address the transnational dimension of the Ebola outbreak, including the management of their shared borders, and with the support of bilateral partners, multilateral organizations and the private sector;

2. Encourages the governments of Liberia, Sierra Leone and Guinea to continue efforts to resolve and mitigate the wider political, security, socioeconomic and humanitarian dimensions of the Ebola outbreak, as well as to provide sustainable, well-functioning and responsive public health mechanisms, emphasizes that responses to the Ebola outbreak should address the specific needs of women and stresses the importance of their full and effective engagement in the development of such responses;

3. Expresses concern about the detrimental effect of the isolation of the affected countries as a result of trade and travel restrictions imposed on and to the affected countries;

4. Calls on Member States, including of the region, to lift general travel and border restrictions, imposed as a result of the Ebola outbreak, and that contribute to the further isolation of the affected countries and undermine their efforts to respond to the Ebola outbreak and also calls on airlines and shipping companies to maintain trade and transport links with the affected countries and the wider region;

5. Calls on Member States, especially of the region, to facilitate the delivery of assistance, including qualified, specialized and trained personnel and supplies, in response to the Ebola outbreak to the affected countries and, in this regard, expresses deep appreciation to the government of Ghana for allowing the resumption of the air shuttle of UNMIL from Monrovia to Accra, which will transport international health workers and other responders to areas affected by the Ebola outbreak in Liberia;

6. Calls on Member States, especially of the region, and all relevant actors providing assistance in response to the Ebola outbreak, to enhance efforts to communicate to the public, as well as to implement, the established safety and health protocols and preventive measures to mitigate against misinformation and undue alarm about the transmission and extent of the outbreak among and between individuals and communities and, in this regard, requests the Secretary-General to develop a strategic communication platform using existing United Nations System resources and facilities in the affected countries, as necessary and available, including to assist governments and other relevant partners;

7. Calls on Member States to provide urgent resources and assistance, including deployable medical capabilities such as field hospitals with qualified and sufficient expertise, staff and supplies, laboratory services, logistical, transport and construction support capabilities, airlift and other aviation support and aeromedical services and dedicated clinical services in Ebola Treatment Units and isolation units, to support the affected countries in intensifying preventive and response activities and strengthening national capacities in response to the Ebola outbreak and to allot adequate capacity to prevent future outbreaks;

8. Urges Member States, as well as bilateral partners and multilateral organizations, including the AU, ECOWAS, and European Union, to mobilize and provide immediately technical expertise and additional medical capacity, including for rapid diagnosis and training of health workers at the national and international level, to the affected countries, and those providing assistance to the affected countries, and to continue to exchange expertise, lessons learned and best practices, as well as to maximize synergies to respond effectively and immediately to the Ebola outbreak, to provide essential resources, supplies and coordinated assistance to the affected countries and implementing partners and calls on all relevant actors to cooperate closely with the Secretary-General on response assistance efforts;

9. Urges Member States to implement relevant Temporary Recommendations issued under the International Health Regulations (2005) regarding the 2014 Ebola Outbreak in West Africa, and lead the organization, coordination and implementation of national preparedness and response activities, including, where and when relevant, in collaboration with international development and humanitarian partners;

10. Commends the continued contribution and commitment of international health and humanitarian relief workers to respond urgently to the Ebola outbreak and calls on all relevant actors to put in place the necessary repatriation and financial arrangements, including medical evacuation capacities and treatment and transport provisions, to facilitate their immediate and unhindered deployment to the affected countries;

11. Requests the Secretary-General to help to ensure that all relevant United Nations System entities, including the WHO and UNHAS, in accordance with their respective mandates, accelerate their response to the Ebola outbreak, including by supporting the development and implementation of preparedness and operational plans and liaison and collaboration with governments of the region and those providing assistance;

12. Encourages the WHO to continue to strengthen its technical leadership and operational support to governments and partners, monitor Ebola transmission, assist in identifying existing response needs and partners to meet those needs to facilitate the availability of essential data and hasten the development and implementation of therapies and vaccines according to best clinical and ethical practices and also encourages Member States to provide all necessary support in this regard, including the sharing of data in accordance with applicable law;

13. Decides to remain seized of the matter.


Measures to contain and combat the recent Ebola outbreak in West Africa – Draft resolution submitted by the President of the General Assembly
Sixty-ninth session
Agenda item 125 of the provisional agenda* – Global health and foreign policy

The General Assembly,

Expressing grave concern at the recent Ebola outbreak in West Africa and its unprecedented nature and scope,

Expressing grave concern also at the rapid deterioration of the situation, in particular in Guinea, Liberia and Sierra Leone, and the threat that this poses to their post-conflict recovery,

Expressing deep concern about the potential reversal of the gains made by the affected countries in peacebuilding, political stability and the reconstruction of socioeconomic infrastructure in recent years,

Underscoring the urgent need to contain this public health crisis owing to its possible grave humanitarian, economic and social consequences,

Underlining its strong commitment to responding to this emergency in a timely, effective and coordinated manner,

Recognizing the central role being played by the World Health Organization in leading worldwide support for the courageous responses of countries whose people are affected by, and at risk of, Ebola,

Welcoming all national, regional and international efforts aimed at ending the crisis, and reaffirming the important role of regional and sub-regional organizations in this regard, in particular, the African Union and the Economic Community of West African States,

Expresses appreciation for the appointment by the Secretary-General of a United Nations System Senior Coordinator for Ebola Virus Disease and a Deputy Ebola Coordinator and Emergency Crisis Manager, in order to assist Governments in the region to address the Ebola outbreak,

Noting the adoption by the Security Council of resolution 2176 (2014)of 15 September 2014,

1. Welcomes the intention of the Secretary-General to establish the United Nations Mission for Ebola Emergency Response;1

2. Requests the Secretary-General to take such measures as may be necessary for the prompt execution of his intention and to submit a detailed report thereon for consideration by the General Assembly at its sixty-ninth session;

3. Calls upon all Member States, relevant United Nations bodies and the United Nations system to provide their full support to the United Nations Mission for Ebola Emergency Response.


1 See A/69/389-S/2014/679.

FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa – September 16, 2014

FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa
The White House
September 16, 2014
Excerpt focused on opening language and commitment of military assets

As the President has stated, the Ebola epidemic in West Africa and the humanitarian crisis there is a top national security priority for the United States. In order to contain and combat it, we are partnering with the United Nations and other international partners to help the Governments of Guinea, Liberia, Sierra Leone, Nigeria, and Senegal respond just as we fortify our defenses at home. Every outbreak of Ebola over the past 40 years has been contained, and we are confident that this one can—and will be—as well.

Our strategy is predicated on four key goals:
:: Controlling the epidemic at its source in West Africa;
:: Mitigating second-order impacts, including blunting the economic, social, and political tolls in the region;
:: Engaging and coordinating with a broader global audience; and,
:: Fortifying global health security infrastructure in the region and beyond.

The United States has applied a whole-of-government response to the epidemic, which we launched shortly after the first cases were reported in March. As part of this, we have dedicated additional resources across the federal government to address the crisis, committing more than $175 million to date. We continue to work with Congress to provide additional resources through appropriations and reprogramming efforts in order to be responsive to evolving resource needs on the ground. Just as the outbreak has worsened, our response will be commensurate with the challenge.

New Resources to Confront a Growing Challenge
The United States will leverage the unique capabilities of the U.S. military and broader uniformed services to help bring the epidemic under control. These efforts will entail command and control, logistics expertise, training, and engineering support.
:: U.S. Africa Command will set up a Joint Force Command headquartered in Monrovia, Liberia, to provide regional command and control support to U.S. military activities and facilitate coordination with U.S. government and international relief efforts. A general from U.S. Army Africa, the Army component of U.S. Africa Command, will lead this effort, which will involve an estimated 3,000 U.S. forces.
:: U.S. Africa Command will establish a regional intermediate staging base (ISB) to facilitate and expedite the transportation of equipment, supplies and personnel. Of the U.S. forces taking part in this response, many will be stationed at the ISB.
:: Command engineers will build additional Ebola Treatment Units in affected areas, and the U.S. Government will help recruit and organize medical personnel to staff them.
:: Additionally, the Command will establish a site to train up to 500 health care providers per week, enabling healthcare workers to safely provide direct medical care to patients.
:: The United States Public Health Service Commissioned Corps is preparing to deploy 65 Commissioned Corps officers to Liberia to manage and staff a previously announced Department of Defense (DoD) hospital to care for healthcare workers who become ill. The deployment roster will consist of administrators, clinicians, and support staff…

Full text of fact sheet:

UN OCHA EBOLA VIRUS DISEASE OUTBREAK – Overview of needs and requirements [16 Sep 2014]

EBOLA VIRUS DISEASE OUTBREAK – Overview of needs and requirements
Compiled by OCHA in collaboration with WHO, UN partner agencies and other key responders.
September 2014 :: 34 pages
The overview of requirements covers primarily Guinea, Liberia and Sierra Leone, the three countries with intense transmission of the virus. The overview also provides information on countries with localized transmission of the virus, such as Senegal and Nigeria, or at risk of Ebola Virus Disease (EVD) transmission.
Building upon the WHO Ebola Roadmap and the activities and plans of all UN entities responding to the ebola crisis, this overview describes the collective requirements needed to defeat the ebola outbreak and to mitigate the immediate and longer term social, economic, development and security consequences in affected countries and the region.
These needs go beyond the sizeable medical requirements needed to treat, contain, and prevent the ebola outbreak, and include needs and requirements related to non-ebola medical service (i.e. reproductive healthcare and malaria and tuberculosis (TB) treatment); food availability; clean water; livelihoods, and logistics concerns related to travel and transport of goods and services within and outside the ebola affected areas.
The overview covers a period of six months, in line with the analysis that it will take 6-9 months overcome the outbreak according to the WHO Ebola Roadmap. As the outbreak is rapidly evolving, the needs and requirements contained in this overview will be updated and disseminated accordingly.