Vaccines and Global Health: The Week in Review 1 August 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 david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_1 August 2015

blog edition: comprised of the approx. 35+ entries posted below on this date.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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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.

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Editor’s Note:
Vaccines and Global Health: The Week in Review will resume publication on 22 August 2015 following annual leave for the editor. The edition for that date will cover the intervening period from 2 August.

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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
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

EBOLA/EVD [to 1 August 2015]

EBOLA/EVD [to 1 August 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 29 July 2015
[Excerpts]
SUMMARY
:: There were 7 confirmed cases of Ebola virus disease (EVD) reported in the week to 26 July: 4 in Guinea and 3 in Sierra Leone. This is the lowest weekly total for over a year, and comes after 8 consecutive weeks during which case incidence had plateaued at between 20 and 30 cases per week. Although this decline in case incidence is welcome, it is too early to tell whether it will be sustained. There have been several high-risk events in both Guinea and Sierra Leone in the past 14 days, and past experience has shown that it can take a single high-risk case or missed contact to spark a new cluster of cases. In addition, there are over 2000 contacts still within their 21-day follow-up period in Guinea, Liberia, and Sierra Leone, representing a substantial residual risk of further cases. Refinements to the response continue to yield improvements, with recent weeks seeing a higher proportion of cases arising from contacts and a lower proportion of cases identified post-mortem than at any time previously, but the continued occurrence of high-risk transmission events means that an increase in case incidence in the near term is a strong possibility…

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 27,748 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1) up to 26 July, with 11,279 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 4 new confirmed cases were reported in Guinea and 3 in Sierra Leone in the week to 26 July…

Ebola Vaccine Trial – VSV-EBOV Interim Results – Efficacious

WHO: World on the verge of an effective Ebola vaccine
News release
Geneva ¦ 31 July 2015 – Results from an interim analysis of the Guinea Phase III efficacy vaccine trial show that VSV-EBOV (Merck, Sharp & Dohme) is highly effective against Ebola. The independent body of international experts – the Data and Safety Monitoring Board – that conducted the review, advised that the trial should continue. Preliminary results from analyses of these interim data are published today in the British journal The Lancet.

“This is an extremely promising development,” said Dr Margaret Chan, Director-General of the World Health Organization. “The credit goes to the Guinean Government, the people living in the communities and our partners in this project. An effective vaccine will be another very important tool for both current and future Ebola outbreaks.”

While the vaccine up to now shows 100% efficacy in individuals, more conclusive evidence is needed on its capacity to protect populations through what is called “herd immunity”. To that end, the Guinean national regulatory authority and ethics review committee have approved continuation of the trial.

A line of defence against a terrible disease
“This is Guinea’s gift to West Africa and the world,” said Dr Sakoba Keita, Guinea’s national coordinator for the Ebola response. “The thousands of volunteers from Conakry and other areas of Lower Guinea, but also the many Guinean doctors, data managers and community mobilisers have contributed to finding a line of defence against a terrible disease.”

“The ‘ring’ vaccination method adopted for the vaccine trial is based on the smallpox eradication strategy,” said John-Arne Røttingen, Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health and Chair of the Study Steering Group. “The premise is that by vaccinating all people who have come into contact with an infected person you create a protective ‘ring’ and stop the virus from spreading further. This strategy has helped us to follow the dispersed epidemic in Guinea, and will provide a way to continue this as a public health intervention in trial mode.”

The Guinea vaccination trial began in affected communities on 23 March 2015 to evaluate the efficacy, effectiveness and safety of a single dose of the vaccine VSV-EBOV by using a ring vaccination strategy. To date, over 4 000 close contacts of almost 100 Ebola patients, including family members, neighbours, and co-workers, have voluntarily participated in the trial.

The trial stopped randomisation on 26 July to allow for all people at risk to receive the vaccine immediately, and to minimize the time necessary to gather more conclusive evidence needed for eventual licensure of the product. Until now, 50% of the rings were vaccinated 3 weeks after the identification of an infected patient to provide a term of comparison with rings that were vaccinated immediately. This now stops. In addition, the trial will now include 13 to 17-year-old and possibly 6 to 12-year-old children on the basis of new evidence of the vaccine’s safety.

If the vaccine is effective, then we are protecting frontline workers from the virus
“In parallel with the ring vaccination, we are also conducting a trial of the same vaccine on frontline workers,” said Bertrand Draguez, Medical Director at Médecins sans Frontières. “These people have worked tirelessly and put their lives at risk every day to take care of sick people. If the vaccine is effective, then we are already protecting them from the virus. With such high efficacy, all affected countries should immediately start and multiply ring vaccinations to break chains of transmission and vaccinate all frontline workers to protect them.”

The trial is being implemented by the Guinean authorities, WHO, Médecins sans Frontières (MSF) and the Norwegian Institute of Public Health, with support from a broad partnership of international and national organizations.

“This is a remarkable result which shows the power of equitable international partnerships and flexibility,” said Jeremy Farrar, Director of the Wellcome Trust, one of the funders of the trial. “This partnership also shows that such critical work is possible in the midst of a terrible epidemic. It should change how the world responds to such emerging infectious disease threats. We, and all our partners, remain fully committed to giving the world a safe and effective vaccine.”

“This record-breaking work marks a turning point in the history of health R&D,” said Assistant Director-General Marie-Paule Kieny, who leads the Ebola Research and Development effort at WHO. “We now know that the urgency of saving lives can accelerate R&D. We will harness this positive experience to develop a global R&D preparedness framework so that if another major disease outbreak ever happens again, for any disease, the world can act quickly and efficiently to develop and use medical tools and prevent a large-scale tragedy.”

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In Interim Results from Phase 3 Study, Merck’s Investigational Ebola Vaccine Efficacious; Study is Continuing
Global Collaboration Enabled Vaccine to Move from First-in-Human Studies to Initial Phase 3 Results Within One Year
July 31, 2015
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (known as MSD outside the US and Canada) said today that its investigational Ebola vaccine candidate, rVSV-ZEBOV, was found to have 100 percent efficacy in an analysis of interim data from a Phase 3 ring vaccination trial in Guinea. Preliminary conclusions from this study, which is continuing, were published on-line today in The Lancet. The authors report that vaccine efficacy was 100 percent (95% confidence interval: 74.7 – 100%; p=0.0036) following vaccination with a single dose of the rVSV-ZEBOV vaccine. It appeared that all vaccinated individuals were protected against Ebola virus infection within 6 to 10 days of vaccination.

“Building on pioneering early work by the Public Health Agency of Canada and NewLink Genetics Corporation, the extraordinary efforts of the team in Guinea and other experts have yielded interim results that suggest a potential role for our rVSV-ZEBOV vaccine in the fight against Ebola disease.”

To date, more than 4,000 participants have received the vaccine in this innovative trial, called “Ebola ça suffit” or “Ebola, that’s enough.” The trial was conducted by a team that included researchers from the World Health Organization (WHO), the Norwegian Institute of Public Health, the Health Ministry of Guinea and Médecins sans Frontières, among others. The results from this continuing study, as well as other studies already underway (see below) and additional studies to be conducted, will be used to support worldwide regulatory submissions.

“Merck has an enduring commitment to develop vaccines and medicines that address the world’s most devastating infectious diseases,” said Dr. Roger M. Perlmutter, president of Merck Research Laboratories. “Building on pioneering early work by the Public Health Agency of Canada and NewLink Genetics Corporation, the extraordinary efforts of the team in Guinea and other experts have yielded interim results that suggest a potential role for our rVSV-ZEBOV vaccine in the fight against Ebola disease.”…

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Gavi: Encouraging trial results offer significant hope for rapid availability of Ebola vaccine to end current outbreak
Ring vaccination trial data suggests vaccine is highly effective.
Geneva, 31 July 2015 – An Ebola vaccine should be made available to stop infections in affected communities in West Africa as soon as possible, Gavi CEO Dr Seth Berkley said today, after interim trial results from the World Health Organization suggested it is 100% effective at preventing the disease.

Interim results of the trials of the rVSV-ZEBOV vaccine, which began in the Basse-Guinée area of Guinea in March 2015, were published in The Lancet. Funded and organised by a consortium of partners including the Guinean Government, the Canadian Government, the Norwegian Government, Médecins Sans Frontières, the Wellcome Trust, and the WHO, the trial involved vaccinating more than 3,500 people using ring vaccination, a known public health approach, to study the effects of the vaccine on volunteers.

Ring vaccination involves tracing known contacts of an Ebola patient and vaccinating them as soon as possible, thereby creating a ring of immunised people to prevent further spread of the virus. The trial also showed that infection rates fell in the broader community, beyond those vaccinated, indicating that ring vaccination is an effective strategy to help end the on-going outbreak. The trial also compared the effects of immediate vaccination with delayed vaccination. Following the positive trial results, delayed vaccination was stopped and the vaccine was offered immediately following all cases of Ebola.

“Today’s Ebola vaccine trial results offer tremendous hope to communities that have been blighted by the devastating impact of the outbreak,” said Dr Berkley. “These communities need an effective vaccine sooner rather than later and Gavi stands ready to support the implementation of a WHO-recommended Ebola vaccine while continuing to work closely with all partners involved in the Ebola response.”

“The consortium of partners should be congratulated on the remarkable speed with which it put together these important and practical trials,” added Dr Berkley. “The global community will rightly expect the pace – alongside a high level of diligence – to be maintained so that people in affected communities and others living in countries at risk of Ebola can have access to a vaccine as soon as possible. We need to be ready to act wherever the virus is a threat.”

The Ebola crisis has claimed the lives of more than 11,000 people, with nearly 28,000 infected, in West Africa in the past 20 months. There is currently no treatment for the disease, which, according to the WHO, has an average fatality rate of around 50%.

In December 2014, the Gavi Board agreed to make funding available to purchase doses of Ebola vaccine, once approved by the WHO. The funding is also available to support the operational costs countries face when introducing an Ebola vaccine and to help rebuild severely damaged health systems.

Through the funding, Gavi is also helping Ebola-affected countries to restart their routine immunisation systems, which were devastated by the Ebola outbreak. As well as supporting immunisation campaigns, Gavi funding will enable Guinea, Liberia and Sierra Leone to recruit and retrain health workers, upgrade supply chains and trace children who have missed out on vaccinations.

UN Mission for Ebola Emergency Response [UNMEER] closes 31 July 2015

UNMEER: Statement by Secretary-General Ban Ki-moon on the transition of UN Ebola emergency response
New York/Geneva, 31 July 2015
As we continue to actively strive to end the Ebola outbreak in West Africa, we have reached an important milestone in the global Ebola response.

The UN Mission for Ebola Emergency Response – UNMEER – will close on 31 July. The Mission has achieved its core objective of scaling up the response on the ground and establishing unity of purpose among responders in support of the nationally led efforts. As of 1 August, oversight of the UN system’s Ebola emergency response will fully be led by the World Health Organization (WHO), under the direct authority of the WHO Director-General. UN agencies, funds and programmes, the UN Office for the Coordination of Humanitarian Affairs, the UN Mission in Liberia and national and international partners have undertaken the necessary steps, to enable this seamless transition.

I have determined that, to maintain the high-level, dedicated UN leadership needed to get to zero cases, the Ebola Crisis Managers will remain in the countries under the oversight of WHO and with the support of the UN Resident Coordinators and UN country teams. In Liberia, this high-level UN leadership for the Ebola emergency response will be provided by my Deputy Special Representative and Resident Coordinator, with the support of the UN country team. My Special Envoy on Ebola will continue to provide strategic guidance for the response.

The United Nations remains steadfast in its commitment to supporting the Governments of Guinea, Liberia and Sierra Leone in getting to and staying at zero cases. We have made considerable progress, but the crisis is not yet over. At this critical juncture, additional resources are needed by the United Nations and partners to sustain full support to nationally led efforts to end the outbreak and to support recovery activities in affected countries. I therefore urge Member States to sustain the financial and political support necessary to end the outbreak.

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UNMEER Statement: UN Mission for Ebola Emergency Response (UNMEER)
UNMEER, the first-ever UN emergency health mission, was established on 19 September 2014 and closed on 31 July 2015, having achieved its core objective of scaling up the response on the ground.

The Mission achieved its core objective of scaling up the response on the ground and establishing unity of purpose among responders in support of the nationally led efforts. As of 1 August, oversight of the UN system’s Ebola emergency response is led by the World Health Organization (WHO), under the direct authority of the WHO Director-General. UN agencies, funds and programmes, the UN Office for the Coordination of Humanitarian Affairs, the UN Mission in Liberia and national and international partners have undertaken the necessary steps, to enable this seamless transition.

The Ebola Crisis Managers remain in the countries under the oversight of WHO and with the support of the UN Resident Coordinators and UN country teams. In Liberia, the high-level UN leadership for the Ebola emergency response is provided by the Deputy Special Representative and Resident Coordinator, with the support of the UN country team. The Special Envoy on Ebola continues to provide strategic guidance for the response.

In a statement on 31 July the Secretary-General Ban Ki-moon said ‘the United Nations remains steadfast in its commitment to supporting the Governments of Guinea, Liberia and Sierra Leone in getting to and staying at zero cases’.

UNMEER, was established on 19 September 2014 after the unanimous adoption of General Assembly resolution 69/1, and the adoption of Security Council resolution 2177 (2014) on the Ebola outbreak. UNMEER was set up as a temporary measure to meet immediate needs related to the unprecedented fight against Ebola. The Mission deployed financial, logistical and human resources to Guinea, Liberia and Sierra Leone to support the push to zero cases:

Ebola/EVD Impacts – UNICEF; Islamic Relief

UNICEF [to 1 August 2015]
http://www.unicef.org/media/media_78364.html
More than 70,000 children born during the Ebola outbreak in Liberia at risk of exclusion if not registered, warns UNICEF
MONROVIA, Liberia 31 July 2015 – UNICEF is supporting a drive by the Liberian Government to register more than 70,000 children whose births were not recorded during the Ebola crisis, leaving them vulnerable to marginalization and exclusion.

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Islamic Relief [to 1 August 2015]
http://www.islamic-relief.org/category/news/
Christian and Muslim leaders played “essential role” in tackling the Ebola virus
July 30, 2015
Faith leaders in Sierra Leone and Liberia played an “essential role” in stemming the spread of the Ebola virus, according to a new report, but the delay in involving them in the response cost lives.

Keeping the Faith, a joint report by CAFOD, Christian Aid, Tearfund and Islamic Relief, shows that Christian and Muslim leaders were able to deliver health messages in parts of the two countries that governments and NGOs could not reach. As trusted sources of information, they quashed rumours about the disease – such as that the disease was man-made and being spread deliberately – and encouraged communities to accept life-saving advice from health workers. They also played a crucial role in counselling survivors and challenging stigma.

But many of those interviewed believe that faith leaders should have been involved far sooner. According to a senior member of the Ebola Task Force in Kenema District in Sierra Leone, the country “would have saved more lives and more money had religious leaders been engaged at an earlier stage of the disease outbreak.”…

POLIO [to 1 August 2015]

POLIO [to 1 August 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 29 July 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: 24 July marked one year since a child was last paralyzed by wild poliovirus in Nigeria. Final laboratory results on all specimens for the full 12 month period are expected by September 2015, which, if clear for poliovirus, may lead to Nigeria being removed from the list of polio-endemic countries. The Global Polio Eradication Initiative commends the hard work of the Nigerian government, partners, religious and community leaders, and health workers for such strong progress towards stopping polio. Yet the job is not yet finished, and it is crucial that commitment from all stakeholders is maintained. Read more
:: Despite the deteriorating security situation in Yemen, a humanitarian pause enabled 50,000 children to be reached with the oral polio vaccine during the final week of Ramadan. Read more

Selected excerpts from Country-specific Reports
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week in Shindand district of Hirat province, with onset of paralysis on 27 June. This is the most recent case reported in Afghanistan. The total number of WPV1 cases for 2015 is now six. .
:: Intensive and strengthened supplementary immunization activities are planned in the coming months. National Immunization Days (NIDs) are scheduled on 16 – 18 August using bivalent oral polio vaccine (OPV). Subnational Immunization Days (SNIDs) will follow across the south of the country on 20 – 22 September, and NIDs using trivalent OPV will take place on 18 – 20 October.

WHO & Regionals [to 1 August 2015]

WHO & Regionals [to 1 August 2015]

The Weekly Epidemiological Record (WER) 31 July 2015, vol. 90, 31 (pp. 381–392) includes:
:: Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2015
:: Meeting of the International Task Force for Disease Eradication, April 2015

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Global Immunization Meeting: “Protect, Innovate, Accelerate”
23-25 June 2015, Sitges/Barcelona, Spain.
:: Report pdf, 618kb
:: Conference guide pdf, 1.05Mb

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World Breastfeeding Week: 1-7 August
31 July 2015 — The theme for this year’s World Breastfeeding Week is, “Breastfeeding and Work. Let’s make it work!”, to encourage family-friendly policies in the workplace. Breastfeeding is the key to a child’s survival, health, growth and development. WHO recommends exclusive breastfeeding in the first hour of life and the following 6 months to stimulate brain development, and to prevent childhood obesity and non-communicable diseases later in life.

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WHO Fact sheet: Cholera 29 July 2015
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:: WHO Regional Offices
WHO African Region AFRO
:: World on the verge of an effective Ebola vaccine
:: WHO calls for urgent action to curb hepatitis – 28 July 2015
:: WHO and Gates Foundation agree on ways to strengthen collaboration to improve health in the African Region – 27 July 2015

WHO Region of the Americas PAHO
:: Support for mothers’ breastfeeding can benefit employers’ bottom line (07/31/2015)
:: PAHO/WHO calls for urgent action to curb hepatitis (07/27/2015)
:: Experts seek answers to increasing rates of HPV-related oral cancer (07/27/2015)

WHO South-East Asia Region SEARO
:: WHO sets up advisory group to guide post-quake recovery support in Nepal
The World Health Organization has set up an advisory group to guide its support to earthquake-hit Nepal for rebuilding resilient health systems. Over 80% health facilities have been damaged in 14 districts worst hit by earthquakes that rocked Nepal on 25 April and 12 May this year.
“Improving health system in Nepal as it goes through recovery, requires all of us to rethink and innovate. Long-term development and scaling up risk reduction and preparedness for the health sector are key features of WHO’s ongoing engagement in Nepal, ” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, told the first meeting of the advisory group in New Delhi on July 31.
The advisory group, comprising of academicians, policy makers, social scientists, economists, epidemiologists and other experts, will advise on WHO strategic approaches to ensure that the needs of the affected people are met through the process of transition from response to recovery and development…
:: WHO calls for strengthening malaria elimination strategy, says 3.2 billion people still at risk
29 July 2015

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
:: Intensified public health measures help control MERS-CoV outbreak in the Republic of Korea
Web update
MANILA, 28 July 2015 – Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the Middle East respiratory syndrome coronavirus (MERS-CoV) under control in the Republic of Korea. Since 4 July no new cases have been reported. Yesterday, all remaining contacts were released from quarantine symptom-free, following 14 days of isolation and monitoring…