Vaccines and Global Health: The Week in Review :: 19 January 2019

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– blog edition: comprised of the approx. 35+ entries posted below.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

WHO: Ten threats to global health in 2019

Milestones :: Perspectives

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WHO: Ten threats to global health in 2019

[Selected full text]
Air pollution and climate change
 
Noncommunicable diseases
 
Global influenza pandemic

The world will face another influenza pandemic – the only thing we don’t know is when it will hit and how severe it will be. Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.

WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved in global surveillance and response.

Every year, WHO recommends which strains should be included in the flu vaccine to protect people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO has set up a unique partnership with all the major players to ensure effective and equitable access to diagnostics, vaccines and antivirals (treatments), especially in developing countries.

Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.

Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remains unmet.

WHO will continue to work in these countries to strengthen health systems so that they are better prepared to detect and respond to outbreaks, as well as able to deliver high quality health services, including immunization.

Antimicrobial resistance

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.

Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.

Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provinces  is also in an active conflict zone.

This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is critical –  what happened in rural outbreaks in the past doesn’t always apply to densely populated urban areas or conflict-affected areas.

At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.

WHO’s R&D Blueprint identifies diseases and pathogens that have potential to cause a public health emergency but lack effective treatments and vaccines. This watchlist for priority research and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.

Weak primary health care  

Vaccine hesitancy

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.

Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.

A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.

An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.

HIV

The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection).

However, the epidemic continues to rage with nearly a million people every year dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV. Reaching people like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. Often these groups are excluded from health services. A group increasingly affected by HIV are young girls and women (aged 15–24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being only 10% of the population.

This year, WHO will work with countries to support the introduction of self-testing so that more people living with HIV know their status and can receive treatment (or preventive measures in the case of a negative test result). One activity will be to act on new guidance announced In December 2018, by WHO and the International Labour Organization to support companies and organizations to offer HIV self-tests in the workplace.

 

WHO statement on reports of alleged misconduct

Milestones :: Perspectives

WHO statement on reports of alleged misconduct

17 January 2019

Statement

WHO is aware of a news story published today about allegations of misconduct in the organization.

The allegations are being investigated according to WHO’s established procedures, having been referred to WHO’s Office of Internal Oversight Services by the Director-General, Dr Tedros Adhanom Ghebreyesus.

The anonymous allegations, which had been circulating internally, were also addressed openly by Dr Tedros in global meetings with staff in which he stressed that WHO has zero tolerance for misconduct or discrimination of any kind.

Since Dr Tedros took office as Director-General in July 2017, he has championed openness, transparency and diversity. WHO’s senior management team is now one of the most diverse and gender-balanced of any United Nations agency. All regions of the world are represented and almost two-thirds are women. WHO is working consistently to increase geographical diversity and improve gender balance at all levels as part of its ongoing transformation process.

WHO has established mechanisms by which anyone inside or outside the organization can report concerns about any form of suspected misconduct by WHO personnel. WHO has recently strengthened the capacity of its internal oversight mechanisms and has proven processes for reporting and dealing with allegations of misconduct.

These include an independently-run integrity hotline which anyone can use to report concerns confidentially and anonymously. We regularly report the outcome of substantiated allegations arising from independent investigations to Member States in our reports to Governing Bodies. All these reports are posted on our public website.

WHO listens to all feedback so we can learn and improve and provide the best possible advice and assistance to countries.

 

AP Exclusive: UN health chief orders probe into misconduct

Milestones :: Perspectives

AP Exclusive: UN health chief orders probe into misconduct

By MARIA CHENG

Associates Press  January 17, 2019

LONDON (AP) — The head of the World Health Organization has ordered an internal investigation into allegations the U.N. health agency is rife with racism, sexism and corruption, after a series of anonymous emails with the explosive charges were sent to top managers last year.

 

Three emails addressed to WHO directors — and obtained by the Associated Press — complained about “systematic racial discrimination” against African staffers and alleged other instances of wrongdoing, including claims that some of the money intended to fight Ebola in Congo was misspent.

 

Last month, WHO Director-General Tedros Adhanom Ghebreyesus told staffers he had instructed the head of WHO’s office of internal oversight to look into the charges raised by the emails. He confirmed that directive to the AP on Thursday.

 

A WHO statement issued after the AP story was published said the agency was “aware” of such allegations and has “zero tolerance for misconduct or discrimination of any kind.” The statement said Tedros has “championed openness, transparency and diversity” since he became WHO’s chief.

 

However, critics doubt that WHO can effectively investigate itself and have called for the probe to be made public.

 

The first email, which was sent last April, claimed there was “systematic racial discrimination against Africans at WHO” and that African staffers were being “abused, sworn at (and) shown contempt to” by their Geneva-based colleagues.

 

Two further emails addressed to WHO directors complained that senior officials were “attempting to stifle” investigations into such problems and also alleged other instances of wrongdoing, including allegedly misspent Ebola funds.

 

The last email, sent in December, labeled the behavior of a senior doctor helping to lead the response against Ebola as “unacceptable, unprofessional and racist,” citing a November incident at a meeting where the doctor reportedly “humiliated, disgraced and belittled” a subordinate from the Middle East.

 

Tedros — a former health minister of Ethiopia and WHO’s first African director-general — said investigators looking into the charges “have all my support” and that he would provide more resources if necessary.

 

“To those that are giving us feedback, thank you,” he told a meeting of WHO’s country representatives in Nairobi last month. “We will do everything to correct (it) if there are problems.”

 

 

144th Session of the WHO Executive Board

Milestones :: Perspectives

144th Session of the WHO Executive Board

24 January – 1 February 2019 Coordinated Universal Time

Geneva, Switzerland

Selected Agenda Content

EB144/1 – Provisional agenda
EB144/1 (annotated) – Provisional agenda (annotated)

EB144/8 – Public health preparedness and response
Report of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme

EB144/9 – Polio Eradication
EB144/10 – Polio Transition

EB144/11 Rev.1 – Implementation of the 2030 Agenda for Sustainable Development

EB144/12 – Universal health coverage
Primary health care towards universal health coverage
EB144/13 – Universal health coverage
Community health workers delivering primary health care: opportunities and challenges
EB144/14 – Universal health coverage
Preparation for the high-level meeting of the United Nations General Assembly on universal health coverage

EB144/17 – Medicines, vaccines and health products
Access to medicines and vaccines
EB144/18 – Medicines, vaccines and health products
Cancer medicines
EB144/19 – Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Antimicrobial resistance

EB144/21 – Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues
Ending tuberculosis

EB144/23 – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits
Implementation of decision WHA71(11) (2018)

EB144/24 – Member State mechanism on substandard and falsified medical products

EB144/27 – Promoting the health of refugees and migrants
Draft global action plan, 2019–2023

 

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Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

24: Situation report on the Ebola outbreak in North Kivu  16 January 2019
[Excerpts]

  1. Situation update

As of 14 January 2019, a cumulative total of 402 deaths were reported, including 353 deaths among confirmed cases. The case fatality ratio among confirmed cases is 58% (353/609). Since 1 December 2018, 36% (72/202) of cases have occurred in children <15 years of age. Of these, 16 cases were <1 year of age. A total of 29 pregnant women have been reported so far. To date, 57 infected healthcare workers (including 20 deaths) have been reported, with an additional laboratory worker and a nurse identified retrospectively during the last reporting week. On 14 January 2019, one death among a healthcare worker occurred in Katwa Health Zone.

Case management

On 24 November 2018, MoH announced the launch of a randomized control trial for Ebola therapeutics. This first-ever multi-drug randomized control trial within an outbreak setting is an important step towards finding an effective evidence-based treatment for Ebola. The trial is coordinated by WHO and led and sponsored by the Democratic Republic of the Congo’s National Institute for Biomedical Research (INRB) which is the principal investigator. The trial has begun in the Alliance for International Medical Action (ALIMA) ETC in Beni, where patients are enrolled in the study after obtaining voluntary informed consent. MSF treatment centres are also preparing to launch the trial at their sites in the near future.

Until other ETCs are ready to launch the trial, they will continue to provide therapeutics under the Monitored Emergency Use of Unregistered Interventions (MEURI) (compassionate use) protocol, in collaboration with the MoH and the INRB, together with supportive care measures. WHO continues to provide technical clinical expertise on-site at all treatment centres. UNICEF is providing nutritional treatment and psychological support for all hospitalized patients…

…Implementation of ring vaccination protocol

As of 14 January 2019, a total of 60,460 individuals have been vaccinated since the start of the outbreak.

 

Emergencies

Emergencies

 

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 16 January 2019
Summary of new viruses this week:
:: Nigeria – advance notification one case of circulating vaccine derived poliovirus type 2 (cVDPV2) and two circulating VDPV2 positive environmental samples.
:: Pakistan – two cases of wild poliovirus type 1 (WPV1) and five WPV1 positive environmental samples
 

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Editor’s Note:

WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
WHO Grade 3 Emergencies  [to 19 Jan 2019]
Democratic Republic of the Congo
:: 24: Situation report on the Ebola outbreak in North Kivu  16 January 2019
:: DONs Ebola virus disease – Democratic Republic of the Congo  17 January 2019

[See Milestones above for more detail]

 

Syrian Arab Republic
:: WHO statement on health situation in Rukban, Syria
17 January 2019, Damascus, Syria – The World Health Organization expresses severe concern about the deteriorating humanitarian conditions in Rukban settlement close to the border with Jordan, and calls for immediate access to the settlement to assess the health situation, provide essential medicines and medical supplies, and support the medical evacuation of critically ill patients.
Approximately 40 000 people, mostly women and children, remain stranded in the settlement and are unable to leave, and harsh winter conditions have reportedly led to several deaths. Health care facilities are barely functioning and have very few staff or medical supplies. There are no generators or fuel to provide even minimum warmth to alleviate the bitterly cold weather…

 

Bangladesh – Rohingya crisis – No new digest announcements identified
Myanmar – No new digest announcements identified
NigeriaNo new digest announcements identified
SomaliaNo new digest announcements identified
South SudanNo new digest announcements identified
YemenNo new digest announcements identified

 

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WHO Grade 2 Emergencies  [to 19 Jan 2019]
occupied Palestinian territory – No new digest announcements identified
Brazil (in Portugese) – No new digest announcements identified
Cameroon  – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
Hurricane Irma and Maria in the Caribbean – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies  [to 19 Jan 2019]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut

Tanzania

 

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Yemen
:: Yemen Humanitarian Update Covering 13 December 2018 – 15 January 2019 | Issue 1  Published on 15 Jan 2019

KEY ISSUES:

  • Humanitarian partners assisted about 1 million people displaced by conflict in Al Hudaydah Governorate in the last six months. Partners are preparing to assist about 342,000 people who are projected to return to Al Hudaydah City if the situation improves.
  • The assisted displaced people include 127,644 in Hajjah Governorate where about 140,000 displaced people have been registered since June 2018.
  • The Central Emergency Response Fund made US$32 million available to support critical services for the scaleup of the life-saving humanitarian responses in Yemen.

Syrian Arab Republic   – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  – No new digest announcements identified
Somalia  – No new digest announcements identified

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“Other Emergencies”
Indonesia: Central Sulawesi Earthquake – No new digest announcements identified
 

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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
EBOLA/EVD  [to 19 Jan 2019]
http://www.who.int/ebola/en/
:: 24: Situation report on the Ebola outbreak in North Kivu  16 January 2019
:: DONs Ebola virus disease – Democratic Republic of the Congo  17 January 2019

[See Milestones above for more detail]

MERS-CoV [to 19 Jan 2019]
http://who.int/emergencies/mers-cov/en/
– No new digest announcements identified.

Yellow Fever  [to 19 Jan 2019]
http://www.who.int/csr/disease/yellowfev/en/
9 January 2019
Yellow fever – Nigeria

Zika virus  [to 19 Jan 2019]
http://www.who.int/csr/disease/zika/en/
– No new digest announcements identified.

 

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WHO & Regional Offices [to 19 Jan 2019]
WHO statement on reports of alleged misconduct
17 January 2019
Statement
[See Milestones above]

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144th Session of the WHO Executive Board
24 January – 1 February 2019 Coordinated Universal Time
Geneva, Switzerland
[See selected agenda content in Milestones above]

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Weekly Epidemiological Record, 18 January 2019, vol. 94, 03 (pp. 17–44)
:: Editorial
:: Application of social science in the response to Ebola, Équateur Province, Democratic Republic of the Congo
:: Lessons learnt from Ebola virus disease surveillance in Équateur Province, May–July 2018
:: Preventing the international spread of Ebola virus by comprehensive, risk-informed measures at points of entry and compliance with the International Health Regulations (2005)
:: Risk communication, community engagement and social mobilization during the outbreak of Ebola virus disease in Équateur Province, Democratic Republic of the Congo, in 2018
:: A package for monitoring operational indicators of the response to the outbreak of Ebola virus disease in the Democratic Republic of the Congo
::Operational readiness and preparedness for Ebola virus disease outbreak in countries neighbouring the Democratic Republic of the Congo: progress, challenges and the way forward
:: Monthly report on dracunculiasis cases, January–November 2018

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Cabo Verde leads the way in ending new HIV infections in children in West and Central Africa
17 January 2019
:: UNAIDS, UNICEF and WHO urge countries in western and central Africa to step up the pace in the response to HIV for children and adolescents  16 January 2019
:: EVD – Rwanda conducts a Full Scale Simulation Exercise  14 January 2019
WHO Region of the Americas PAHO
– No new announcement identified

WHO South-East Asia Region SEARO
– No new announcement identified 

WHO European Region EURO
– No new announcement identified

WHO Eastern Mediterranean Region EMRO
:: Medical kits and supplies delivered to Diyala, Iraq  17 January 2019

WHO Western Pacific Region ::
:: WHO-recommended newborn care cuts life-threatening infections by two thirds
15 January 2019