Vaccines and Global Health: The Week in Review 21 November 2015

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

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_21 November 2015

blog edition: comprised of the approx. 35+ entries posted below on 23 November 2015.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

Global Vaccine Action Plan -assessment report 2015

Global Vaccine Action Plan -assessment report 2015
Strategic Advisory Group of Experts on Immunization (SAGE) Decade of Vaccines Working Group
November 2015 :: 24 pages
English pdf, 278kb

EXECUTIVE SUMMARY [Text bolding from original]
The Global Vaccine Action Plan (GVAP) set ambitious but achievable goals, to save thousands of lives through vaccination in this Decade of Vaccines to 2020.

The Decade of Vaccines is not on course to achieve its true potential. Good progress has been made in some countries, including those where large numbers of unimmunized children live. These isolated improvements will have to become the norm if the plan is to get back on track.

In recommending what needs to change, this report focuses on two major problems that are holding back progress in the Decade of Vaccines:
:: The elimination strategies for maternal and neonatal tetanus, and for measles and rubella, and their implementation, are in urgent need of change and adequate resourcing.

:: The monitoring and accountability framework for the Global Vaccine Action Plan has gaps in its mechanisms for accountability, undermining the translation of the plan’s goals into reality.

At this critical midpoint of the Decade of Vaccines, SAGE makes nine recommendations, focusing squarely on the major issues.

To improve accountability to achieve the GVAP goals, SAGE recommends that:
1. Countries have annual plans for immunization consistent with the GVAP and relevant regional vaccine action plans. The Ministries of Health, Finance and other pertinent ministries demonstrate leadership by establishing an annual process for monitoring and accountability at national and subnational levels. Monitoring should be through an independent body, for example the National Immunization Technical Advisory Group (NITAG). Each country should share, every year, with WHO regional offices, its monitoring report which should include monitoring progress towards achievement of outcomes but also sharing of best practices.

2. Once regional vaccine action plans are finalised (by December 2015), WHO regional offices establish a process of annual progress review through their regional technical advisory groups and report to the respective Regional Committees. The first annual review should take place in the first half of 2016 for countries with annual plans consistent with the GVAP. WHO Regional Committees’ reports should be made available annually to SAGE as part of the global review process.

3. Global, regional and national development partners align their efforts to support countries in strengthening their leadership and accountability frameworks and in implementing their national plans. This should include establishing and/or strengthening partner coordination mechanisms at each level.

4. Decade of Vaccines secretariat agencies report to SAGE in 2016 on their supporting activities conducted in the 10 countries where most of the unvaccinated and under-vaccinated children live. This annual reporting mechanism should include discussion of those reports in regional technical advisory groups.

To address the shortfalls in disease-specific areas of the Global Vaccine Action Plan’s implementation, SAGE recommends that:
5. Given poor progress with elimination of maternal and neonatal tetanus and the relatively small funding gap to achieve this goal, WHO and UNICEF convene a meeting of global partners and the remaining 21 countries to agree on an action plan, resources and respective responsibilities so that the goal is achieved no later than 2017 and thereafter strategies are in place to sustain elimination in all countries.

6. Global, regional and national development partners support countries in securing the required resources and in implementing their measles and rubella elimination or control strategies and plans. The recommendations of the mid-term review of the global measles and rubella strategic plan to be conducted in 2016, once endorsed by SAGE, should be taken into account in refining plans and for monitoring and enhancing quality of plan implementation.

To improve immunization coverage especially where many unvaccinated and under-vaccinated children live, including those affected by conflict and crisis, SAGE recommends that:
7. Global, regional and country development partners coordinate and align their efforts to support countries to immunize more children by strengthening their healthcare delivery systems, combined with targeted approaches to reach children consistently missed by the routine delivery system, particularly in the countries where vaccination rates are below 80% and to provide services to populations displaced due to conflict (both internally displaced persons and refugees).

8. WHO provide guidance for countries and partners on implementation of immunization programmes and immunization strategies during situations of conflict and chronic disruption.

The 2016 GVAP assessment report will also serve as a mid-term review of progress in the Decade of Vaccines and SAGE recommends that:
9. This report be presented at the World Economic Forum in Davos where the Decade of Vaccines was launched. The 2016 report should aim to highlight those activities that were game-changers at global, regional and country levels.

Decade of Vaccines Global Vaccine Action Plan GVAP Secretariat report 2015
Update actions on taken by the secretariat in response to previous reports
Dr Thomas Cherian on behalf of the DoV GVAP Secretariat
SAGE, Geneva, 22nd October 2015
[PowerPoint from SAGE Meeting, October 2015]

EBOLA/EVD [to 21 November 2015]

EBOLA/EVD [to 21 November 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)


Ebola Situation Report – 18 November 2015
:: Guinea reported no confirmed cases of Ebola virus disease (EVD) in the week to 15 November. The most recent case from Guinea was reported on 29 October. That case is a child who was born in an Ebola treatment centre, and who was delivered by medical staff wearing full personal protective equipment (PPE). As such, no contacts are associated with this case, and all contacts associated with previous cases have completed their 21-day follow-up period. A second consecutive blood sample from the child tested negative for Ebola virus on 16 November.
:: On 7 November WHO declared that Ebola virus transmission had been stopped in Sierra Leone. The country has now entered a 90-day period of enhanced surveillance, which is scheduled to conclude on 5 February 2016. Both Liberia and Sierra Leone have now achieved objective 1 of the phase 3 response framework: to interrupt all remaining chains of Ebola virus transmission…

New Ebola cases hit Liberia after country declared virus free
Reuters – Health | Fri Nov 20, 2015 3:10pm EST
MONROVIA | By James Harding Giahyue
Three new cases of Ebola emerged in Liberia on Friday, a setback for a country that had been declared free of the disease on September 3 and also a blow for the wider region as it struggles to end an epidemic that has killed around 11,300 people.

The first of the new patients was a 10-year-old boy who lived with his parents and three siblings in Paynesville, a suburb east of the capital Monrovia, said Minister of Health Minister Bernice Dahn. Two direct family members have also since tested positive, officials said.

All six family members, as well as other high risk contacts, are in care at an Ebola Treatment Unit in Paynesville, she said.

“The hospital is currently decontaminating the unit. All of the healthcare workers who came into contact with the patient have been notified,” she told a news conference.

“We know how Ebola spreads and we know how to stop Ebola but we must remain vigilant and work together,” she said.

Bruce Aylward, who leads the Ebola response for the U.N. World Health Organisation, said the patient had no history of contact with an Ebola survivor or victim.

“The family obviously is at particular risk and is being investigated right now,” he told a news conference in Geneva, speaking before confirmation that two of the first patient’s siblings had also tested positive.

Liberia has seen more than 10,600 cases of the disease and 4,808 Ebola deaths since it was first announced in March, 2014, WHO figures show…

Dr. David Nabarro (Special Envoy of the Secretary-General on Ebola) on Ebola – Press Conference (18 November 2015) (English)
18 Nov 2015
Video – 00:37:45
Dr. David Nabarro, the Special Envoy on Ebola, providing an update on the Ebola outbreak, and also speaking in his capacity as Chair of the Advisory Group on Reform of the World Health Organization’s Work in Outbreaks and Emergencies.

First report of the Advisory Group on Reform of WHO’s work in outbreaks and emergencies

Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies with Health and Humanitarian Consequences

First report of the Advisory Group on Reform of WHO’s work in outbreaks and emergencies pdf, 659kb
15 November 2015
[Advance version highlighted in last week’s edition]

POLIO [to 21 November 2015]

POLIO [to 21 November 2015]
Public Health Emergency of International Concern (PHEIC)


GPEI Update: Polio this week as of 17 November 2015
:: In 2015, wild poliovirus transmission is at the lowest levels ever, with fewer cases reported from fewer areas of fewer countries than ever before. In 2015, 56 wild poliovirus cases have been reported from two countries (Pakistan and Afghanistan), compared to 290 cases from nine countries during the same period in 2014.

:: However, in the end stages of polio eradication, with most of the world polio-free, the risks posed remaining vaccination coverage gaps anywhere is becoming more evident. On extremely rare occasions, in areas of chronic vaccination coverage gaps, circulating vaccine-derived polioviruses (cVDPVs) can emerge to cause outbreaks of polio cases. This is not a side effect of the oral polio vaccine, but rather an effect of low vaccination coverage in a community, which is enabling such strains to emerge. Though typically less virulent than wild polioviruses (ie typically causing fewer cases and having a lower profile for geographic spread), such strains nevertheless are this year causing paralysis in children at a rate greater than wild polioviruses. More countries are affected by cVDPV outbreaks (Ukraine, Guinea, Lao, Nigeria, Madagascar) than wild polioviruses (Pakistan and Afghanistan); 3 WHO Regions are affected by cVDPV outbreaks.

:: Efforts are ongoing by the Global Polio Eradication Initiative to urgently address both remaining wild poliovirus transmission and cVDPV outbreaks. This is particularly important in the lead-up to next year’s start of the phased removal of OPVs, beginning with the globally-coordinated switch from trivalent OPV to bivalent OPV in April 2016.

[Selected elements from Country-level reports]
:: Three new wild poliovirus type 1 (WPV1) cases were reported in the past week, from Faryab and Nangahar provinces. The most recent case had onset of paralysis on 27 October, from Nangahar. The total number of WPV1 cases for 2015 is 16.
:: One new WPV1 environmental positive sample was reported in the past week, collected on 25 October from Wardad.
:: Urgent efforts are underway to strengthen the implementation of the national emergency action plan in the country. Focus is on:
– Improving governance and coordination of partners through the National and Provincial Emergency Operations Centres
– Improving SIA quality by focusing resources on low-performing districts, and clearly identifying and targeting persistently missed children
– Maximising the impact of front-line health workers through more systematic vaccinator selection, training and supervision
– Ensuring closer cross-border coordination in border areas with Pakistan
– Further strengthening surveillance, including by expanding environmental surveillance activities
:: National Immunization Days (NIDs) took place on 1 – 3 November using trivalent oral polio vaccine (OPV). Mop up campaigns are planned in areas of Farah using inactivated polio vaccine (IPV) and bivalent OPV with dates to be confirmed, and Subnational Immunisation Days (SNIDs) are planned from 29 November to 1 December in the south and east of the country using bivalent OPV.
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 22 October. It is the most recent WPV1 case in the country, from Peshawar in Federally Administered Tribal Areas (FATA). The total number of WPV1 cases for 2015 is 40.
:: Two new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were retrospectively reported this week. The cases had onset of paralysis in February, from Khyber Paktunkhwa and FATA. No further cases have been identified since then, and the areas were covered by three vaccination campaigns with trivalent OPV.
:: One new environmental sample positive for WPV1 was reported in the last week, from Gadap, greater Karachi, Sindh, collected on 13 October.
:: September and October have historically been the months with the highest disease burden, as it is in the middle of the high transmission season. Epidemiologists are further evaluating data from this year, to more clearly ascertain current transmission patterns during this year’s high transmission season. This year, six WPV1 cases were reported during September and October, compared to 79 WPV1 cases in September/October 2014.

WHO & Regionals [to 21 November 2015]

WHO & Regionals [to 21 November 2015]

WHO calls on countries to protect health from climate change
WHO statement
17 November 2015
Climate change is the defining issue for the 21st century.
According to WHO estimates, climate change is already causing tens of thousands of deaths every year – from shifting patterns of disease, from extreme weather events, such as heat-waves and floods, and from the degradation of air quality, food and water supplies, and sanitation.
The upcoming United Nations Climate Change Conference (COP-21) in Paris offers the world an important opportunity to not only reach a strong international climate agreement, but also to protect the health of current and future generations. WHO considers the Paris treaty to be a significant public health treaty – one that has the potential to save lives worldwide…

15 million babies are born prematurely every year
Complications of preterm births are the leading cause of death among children under 5 years of age. Without appropriate treatment, those who survive often face lifelong disabilities, including learning, visual and hearing problems and their quality of life is greatly affected.

Physical inactivity and diabetes
November 2015 — Worldwide, people are less physically active. As physical activity decreases, noncommunicable diseases like diabetes are increasing. In the WHO European Region, one third of adults and two thirds of adolescents are insufficiently active.

Clean water and building toilets improves nutrition in Mali
19 November 2015 — WHO, in collaboration with USAID and UNICEF, are calling for nutrition and water, sanitation and hygiene programmes to work together to maximize nutrition gains. A new report recommends high-impact solutions such as improving access to latrines. Mali has already started implementing some of these recommendations with great success.

Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 20 November 2015 Microcephaly – Brazil
:: 16 November 2015 Acute respiratory syndrome – Republic of Korea

Weekly Epidemiological Record (WER) 20 November 2015, vol. 90, 47 (pp. 633–644)
633 Preparedness for outbreaks of meningococcal meningitis due to Neisseria meningitidis serogroup C in Africa: recommendations from a WHO expert consultation
637 Progress towards poliomyelitis eradication: Pakistan, January 2014–September 2015
643 Monthly report on dracunculiasis cases, January- September 2015

Request for proposals: GAVI transition support consultant
20 November 2015
Terms of reference pdf, 128kb
Deadline for application: 9 December 2015

:: WHO Regional Offices
WHO African Region AFRO
:: Dr Moeti lauds health development efforts in Chad
N’Djamena, 19 November 2015 – The World Health Organization Regional Director for Africa, Dr. Matshidiso Moeti, has commended ongoing efforts in Chad to improve the health and wellbeing of the people. Dr Moeti made the remarks during a courtesy call on the Chadian Prime Minister Kalzeubé Payimi Deubet.During the meeting, the Regional Director observed that the priority that the Chadian government has placed on health is making a difference despite the prevailing challenges. Since 2012 Chad has drastically reduced the occurrences of meningitis and cholera outbreaks. Polio transmission has been stopped as well. Furthermore maternal deaths have been reduced from…

WHO Region of the Americas PAHO
:: PAHO to update its manuals on management of obstetric emergencies (11/18/2015)
:: Antibiotics should be ‘handled with care’ to preserve their life-saving qualities (11/18/2015)
:: MERCOSUR countries create a negotiating mechanism to procure high-cost medicines, with PAHO support (11/16/2015)

WHO South-East Asia Region SEARO
:: Antibiotics, handle with care 16 November 2015

WHO European Region EURO
:: Addressing the largest single cause of preventable deaths in Europe – cardiovascular disease 19-11-2015
:: Efforts must be scaled up in order to halve road traffic deaths by 2020 19-11-2015
:: New WHO report shows comparable antibiotic resistance in EU and non-EU countries in the European Region 16-11-2015

WHO Eastern Mediterranean Region EMRO
:: Launch of first World Antibiotics Awareness Week from 16 to 22 November 2015

WHO Western Pacific Region
:: World Health Organization launches World Antibiotic Awareness Week to promote best practices in the Western Pacific Region
MANILA, 16 November 2015

Sabin Vaccine Institute [to 21 November 2015]

Sabin Vaccine Institute [to 21 November 2015]

Sabin PDP, King Saud University Sign Project Agreement to Build Vaccine Research and Development Capacity in Saudi Arabia
New Initiative Will Focus on Public Health Preparedness for Emerging, Neglected Diseases
WASHINGTON, D.C. — November 16, 2015 — The Sabin Vaccine Institute Product Development Partnership (Sabin PDP) today signed a project agreement with King Saud University to build vaccine research and development capacity in the Middle East and North Africa (MENA) region and advance the establishment of a vaccine research institute in Saudi Arabia. The project will focus on training activities that could lead to vaccine development for major and emerging neglected diseases and parasitic infections in the region.
As part of this U.S.-Saudi initiative, Saudi scientists, including students and faculty, from Prince Naif Bin Abdulaziz Health Research Center at King Saud University in Riyadh, and other Saudi institutions, will receive technical training in vaccine development processes at the Sabin PDP laboratories, in Houston, Texas. Both partners will work to build the necessary workforce needed for vaccine process development and scale-up, in Saudi Arabia while also developing a total quality management system, including quality control and quality assurance…