Vaccines and Global Health: The Week in Review 3 December 2016

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_3-december-2016

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

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.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Vaccines and Global Health: The Week in Review 26 November 2016

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_26-november-2016-docx

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

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.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Milestones :: Perspectives

Milestones :: Perspectives

The Vaccine Confidence Project [to 26 November 2106]
http://www.vaccineconfidence.org/
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Confidence Commentary
Dangerous liaisons
Heidi Larson | 19 Nov, 2016
Donald Trump could be the biggest single threat to vaccine confidence ever faced.

Trump’s links to the likes of Andrew Wakefield – with his network of celebrity supporters as well as multiple parent associations – is particularly worrying. Furthermore, although clearly not loved by all, both Trump and Wakefield have their champions well beyond the US and UK. An alliance between the world’s most widely known – and self-promoting – vaccine critic and the elected figure to one of most powerful political positions in the world is, to say the least, a dangerous liaison.

Anti-vaccination lobbyists are already seeing Trump as an ally. Shortly after the election results were known, the ‘The Age of Autism’ posted: ‘Now that Trump won, we can all feel safe in sharing that Mr Trump met with autism advocates in August. He gave us 45 minutes and was extremely educated on our issues.… Dr Gary ended the meeting by saying “Donald, you are the only one who can fix this”. He said ” I will”. We left hopeful. Lots of work left to do.’

Rightly or wrongly Trump is seen as ‘a man who can make things happen’, a challenger of orthodox thinking, and a beacon of hope to those who believe that any alternative is worth trying to break the status quo.

Trump’s widely followed tweets and public statements about children becoming autistic after vaccination, and calling for the end of combination vaccines because ‘tiny children are not horses,’ are a small indicator of Trump’s views on vaccines which are being propagated, unchecked by political or policy processes.

Trump’s views on science, climate change, abortion rights and the future of healthcare in general are all cause for concern, but a viral spread of negative sentiment around vaccines can tip confidence like swings in the stock market and, for the more infectious diseases, have immediate debilitating consequences…

Emergencies

Emergencies

Haiti’s Ministry of Health successfully vaccinates 729,000 persons against cholera
Port-au-Prince, Haiti, 23 Nov. 2016—Haiti’s Ministry of Health (MSPP) is nearing completion of its vaccination campaign against cholera, having reached more than 729,000 people with vaccines in Sud and Grand Anse departments, areas ravaged by Hurricane Matthew.

With support from the Pan American Health Organization / World Health Organization (PAHO / WHO) and other partners, vaccination teams fanned out across the two departments starting Nov. 8, aiming to reduce the burden of cholera cases by immunizing people in 16 different communes where cholera cases had been reported and where water and sanitation systems were damaged.

Ministry of Health early reports show that vaccination coverage reached 94 percent in Grande Anse and 90 percent in Sud Department, but the communes of Moron (Grande Anse), Port-a-Piment, and Chardonnieres (Sud) had lower than average coverage. In some areas teams were hampered by difficult access as roads were cut by the hurricane, and populations were displaced, said PAHO-WHO Representative Dr. Jean-Luc Poncelet. Ministry of Health officials are now collecting data and consolidating results, while looking for pockets of unvaccinated people in the communes.

Epidemiologists and immunization experts were mobilized to support the campaign, which was carried out with 1 million doses of oral cholera vaccine provided by GAVI through the Global Task Force for Cholera Control. The International Medical Corps (IMC), CDC, UNICEF, WFP, PIH, Gheskio, and other vaccination partners supported the Ministry in the campaign, with social mobilization and logistics, including cold chain to keep vaccines potent, and transport and support for vaccination brigades…

Since Hurricane Matthew struck Haiti October 4, more than 5,800 suspected cholera cases have been reported by the Ministry of Health, while the population in need of humanitarian assistance remains at 1.4 million, and more than 175,000 people are still in shelters, according to PAHO’s latest situation report. Increases in suspected malaria cases have been observed in Grand Ánse and Sud both Departments, and Haiti’s National program for Malaria Control began fumigation and destruction of mosquito breeding sites.

Haiti still needs humanitarian assistance for rural areas, rehabilitation of health facilities, household access to chlorinated water and community health workers especially for areas with non-functional facilities, Poncelet said.

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WHO Grade 3 Emergencies [to 26 November 2106]
Iraq –
:: WHO scales up trauma care services for injured people from Mosul, Iraq
23 November 2016 – As military operations into Mosul continue, WHO is working with national health authorities to ensure that people with war-related trauma injuries have access to live-saving medical care. WHO anticipates that approximately 40 000 civilians will require care for trauma injuries as a result of Mosul military operations.

The Syrian Arab Republic
:: WHO supplies prosthetic devices for Syrians injured by conflict 25 November 2016
:: Statements – Eastern Aleppo without any hospitals for more than 250,000 residents
20 November 2016 – More than 250,000 men, women, and children living in Eastern Aleppo are now without access to hospital care following attacks on the remaining hospitals over the last week. According to reports to WHO from the Organization’s partners in Syria, there are currently no hospitals functioning in the besieged area of the city.

Nigeria – No new announcements identified.
South Sudan – No new announcements identified.
Yemen – No new announcements identified.

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WHO Grade 2 Emergencies [to 26 November 2106]
Cameroon – No new announcements identified.
Central African Republic – No new announcements identified.
Democratic Republic of the Congo – No new announcements identified.
Ethiopia – No new announcements identified.
Libya – No new announcements identified.
Myanmar – No new announcements identified.
Niger – No new announcements identified.
Ukraine – No new announcements identified.

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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.
Iraq –
:: Iraq: Mosul Humanitarian Response Situation Report #8 (14-20 November 2016)
:: Press Releases – Iraq Humanitarian Crisis, 25 November 2016
IN NUMBERS
10m – PEOPLE IN NEED OF SOME FORM OF HUMANITARIAN ASSISTANCE
4m – PEOPLE HAVE BEEN INTERNALLY DISPLACED SINCE JANUARY 2014
1.7m – PEOPLE ARE ESTIMATED TO LIVE IN AREAS OUTSIDE GOVERNMENT CONTROL IN NORTHERN AND WESTERN IRAQ; MANY ARE LIKELY TO BE VULNERABLE
8m – PEOPLE NEED PROTECTION ASSISTANCE
480,000 – PEOPLE HAVE BEEN NEWLY DISPLACED IN 2016
920,000 – DISPLACED PEOPLE ARE HOSTED IN THE KURDISTAN REGION OF IRAQ
$861m – REQUESTED TO SUPPORT 7.3 MILLION VULNERABLE IRAQIS
70% – OF THE REQUESTED FUNDING HAS BEEN RECEIVED
$284m – REQUESTED TO SCALE-UP PREPAREDNESS EFFORTS AHEAD OF THE EXPECTED MILITARY CAMPAIGN TO RETAKE MOSUL
73% – OF THE REQUIRED AMOUNT FOR THE MOSUL FLASH APPEAL HAS BEEN RECEIVED

Syria
:: Rajm Slebi evacuations completed – but further arrivals possible as Mosul offensive continues 26 Nov 2016
:: Statement on the resumption of life-saving assistance at the Jordan-Syria border 22 Nov 2016

Yemen
:: Yemen: Cholera Outbreak Weekly AWD/Cholera Situation Report 10 – 17 November 2016 21 Nov 2016

Zika virus [to 26 November 2106]

Zika virus [to 26 November 2106]
http://www.who.int/emergencies/zika-virus/en/

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Zika situation report – 24 November 2016
Full report: http://apps.who.int/iris/bitstream/10665/251648/1/zikasitrep24Nov16-eng.pdf?ua=1

Key Updates
:: Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
… None
:: Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
… None
:: Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
… None
:: The fifth meeting of the Emergency Committee (EC) on Zika virus, microcephaly and other neurological disorders was held on 18 November 2016. The Director-General accepted the recommendations of the EC and declared the end of the Public Health Emergency of International Concern (PHEIC). However, Zika virus and associated consequences remains a significant enduring public health challenge. Research has demonstrated the link between Zika virus infection and microcephaly, furthering the need for a robust technical mechanism to manage the global response and research agenda. The coordination and response to Zika virus is being escalated into a sustained programme of work with dedicated resources to address the long-term nature of the disease and its consequences. Recommendations from previous EC meetings will remain in place for three months while WHO implements the transition plan to shift activities into a longer-term programme. Building on established mechanisms and guided by the Zika Strategic Response Plan, WHO continues to coordinate and support more than 60 partners in the areas of detection, prevention, care and support, and research to strengthen preparedness and response in countries and territories where the Aedes mosquitoes are established.

Analysis
:: Overall, the global risk assessment has not changed. Zika virus continues to spread geographically to areas where competent vectors are present. Although a decline in cases of Zika infection has been reported in some countries, or in some parts of countries, vigilance needs to remain high.

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Zika Open [to 26 November 2106]
[Bulletin of the World Health Organization]
:: All papers available here
No new papers identified.

POLIO [to 26 November 2106]

POLIO [to 26 November 2106]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 23 November 2016
:: Rotary Foundation named “world’s outstanding foundation for 2016”, by the Association of Fundraising Professionals. The judges cited Rotary’s PolioPlus efforts as a major driver for its selection. More.

:: The GPEI report to the January Executive Board (EB) meeting has now been finalized and is available here. The report summarizes the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015, including the impact of national emergency action plans in the remaining infected countries and of the IHR Temporary Recommendations; the achievements of the globally coordinated switch from trivalent OPV to bivalent OPV and associated IPV global supply issues and risk mitigation strategies (including fractional-dose IPV); the status of global containment activities; transition planning; and, the global budget. This report will be the main tool to inform the discussions by Member States at the January EB.

:: Also published this week: WHO’s Human Resources Update to the EB. The report includes an update on WHO’s component of the human resources infrastructure funded by the GPEI and the associated financial liabilities.

: The 11th meeting of the Emergency Committee under the International Health Regulations (IHR) met on 11 November and concluded that current epidemiology continues to constitute a Public Health Emergency of International Concern (PHEIC). Read about the IHR findings and recommendations here. [see below]

Country Updates [Selected Excerpts]
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, from Sujawal district in central Sindh, with onset of paralysis on 3 November. It is the most recent case in the country and brings the total number of WPV1 cases for 2016 to 17.
:: One new WPV1 positive environmental sample was reported in the past week, from Lahore, Punjab (collected on 18 October).

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Statement of the 11th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement – 11 November 2016
[Selected excerpts; text bolding by Editor]

The eleventh meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director General on 11 November 2016.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine-derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the implementation of the WHO Temporary Recommendations since the Committee last met on 11 August 2016: Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger…

…Conclusion
The Committee unanimously agreed that the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: The new outbreak of WPV1 in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears very high.
:: The continued international spread of wild poliovirus during 2016 from Pakistan to Afghanistan, resulting in intense transmission in vulnerable populations.
:: The persistent, wide geographical distribution of positive WPV1 in environmental samples in Pakistan.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though global transmission has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur would be grave.
:: The possibility of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a possibility.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The continued necessity for a coordinated international response to improve immunization and surveillance for wild poliovirus, to stop international spread and reduce the risk of new spread.
:: The importance of a regional approach and strong cross¬border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.

Additionally with respect to cVDPV:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The ongoing circulation of cVDPV2 in Nigeria and possibly in Guinea, and in Lao PDR, demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including Ebola;
:: The global shortage of IPV which poses an additional threat from cVDPVs…

…Additional considerations for all infected and high risk countries
The Committee strongly urged global partners in polio eradication to provide optimal support to all infected and vulnerable countries at this critical time in the polio eradication programme for implementation of the Temporary Recommendations under the IHR, as well as providing ongoing support to countries, such as Somalia that were recently subject to Temporary Recommendations. The Committee requested that future secretariat reports should include a cumulative table of countries which have been removed from the ‘vulnerable country’ list, with comments on the current situation in those countries.

Learning from recent events in Nigeria, the committee requested the secretariat provide a global report on all inaccessible areas where polio surveillance may be compromised. Recognizing that cVDPV illustrates serious gaps in routine immunization programmes in otherwise polio free countries, the Committee recommended that the international partners in routine immunization, for example Gavi, should assist affected countries to improve the national immunization programme.

The Committee noted the threat posed to eradication efforts caused by the global IPV shortage and requested that SAGE continue to monitor and make recommendations to address this situation.

The Committee noted the Secretariat’s report on the identification of Sabin 2 virus detected in environmental samples in India probably due to the ongoing use of tOPV in the private sector. As Sabin 2 virus has also been detected in Russia, Nigeria and Afghanistan, the Committee requested a full report on this at the next meeting.

The Committee noted a more detailed analysis of the public health benefits and costs of implementing temporary recommendations was under way and requested a report be made available to the committee in February 2017.

The Committee urged all countries to avoid complacency which could easily lead to a polio resurgence. Surveillance particularly needs careful attention to quickly detect any resurgent transmission.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger, the Director General accepted the Committee’s assessment and on 18 November 2016 determined that the events relating to poliovirus continue to constitute a PHEIC, with respect to wild poliovirus and cVDPV. The Director General endorsed the Committee’s recommendations for countries falling into the definition of ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 18 November 2016.

WHO & Regional Offices [to 26 November 2106]

WHO & Regional Offices [to 26 November 2106]

International day for the elimination of violence against women
25 November 2016 – Worldwide, 1 in 3 women will experience physical and/or sexual violence by an intimate partner, or sexual violence by a non-partner at some point in their life. Women who have experienced violence use health services more than non-abused women. Health professionals are in a unique position to address the health, psychosocial, and legal needs of women who have experienced violence.

Eliminating malaria in the Greater Mekong Subregion
25 November 2016 – Since 2012, countries across the Greater Mekong Subregion have reported a sharp decline in malaria cases and deaths. But the spread of antimalarial drug resistance threatens to undermine these gains. A new report from WHO offers a set of tried-and-tested approaches that can help countries countries end transmission of this deadly disease.
Report

Highlights
WHO scales up trauma care services for injured people from Mosul, Iraq
November 2016 – As military operations into Mosul continue, WHO is working with national health authorities to ensure that people with war-related trauma injuries have access to live-saving medical care. WHO anticipates that approximately 40 000 civilians will require care for trauma injuries as a result of Mosul military operations.

WHO and partners immunized over 155,000 migrant children in South Sudan
November 2016 – In response to the poliomyelitis outbreak associated with type 2 circulating vaccine-derived poliovirus and ambiguous vaccine derived polio virus identified in Unity state, WHO, in collaboration with Ministry of Health and partners immunized over 155 000 migrant children under the age of 15 through special vaccination posts.

Handbook: Strategizing national health in the 21st century
November 2016 – A new WHO handbook on national health planning and strategizing has been launched, providing up-to-date and practical guidance. The handbook establishes a set of best practices to support strategic plans for health and represents the wealth of experience accumulated by WHO on national health policies, strategies and plans (NHPSPs).

UN urges protection for breastfeeding, end of inappropriate marketing of substitutes
November 2016 – Today, UN human rights experts told countries that they need to do more to support and protect breastfeeding as a human right, including ending the inappropriate marketing of breast-milk substitutes and other foods intended for infants and young children.

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Stories from countries
Winning the war against yellow fever
25 November 2016

Finding the gaps in meeting adolescent health needs in Nepal
22 November 2016

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Weekly Epidemiological Record, 25 November 2016, vol. 91, 47 (pp. 549–560)
:: Progress towards poliomyelitis eradication: Pakistan, January 2015–September 2016
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2016

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:: WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Regional consultation in Chad to discuss accelerating progress towards the prevention and control of HIV infection in children and adolescents – 22 November 2016
:: Global leaders agree to promote health to achieve Sustainable Development Goals – 21 November 2016

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
:: Countries of the South-East Asia Region Launch Path-breaking Initiative to Guarantee High-Quality Medical Products
25 November 2016

WHO European Region EURO
:: Influenza A(H5N8) virus detected in birds in several countries in the WHO European Region 24-11-2016
:: WHO and European Committee of the Regions join forces to improve European dialogue on health policy 22-11-2016

WHO Eastern Mediterranean Region EMRO
:: WHO scales up trauma care services for injured people from Mosul, Iraq 24 November 2016
:: WHO denounces false reporting regarding Iraq 20 November 2016

WHO Western Pacific Region
:: Partnership, protection, response and empowerment: rolling out essential services to end gender-based violence against women and girls in Asia and the Pacific
BANGKOK, 24 November 2016 – Governments, civil society and the United Nations family in Asia and the Pacific are strengthening efforts to respond to the persistent scourge of gender-based violence against women and girls in the region, with the roll-out of an essential services package that incorporates prevention and response underpinned by strategic partnerships, impactful laws and policies, and justice and healing for survivors.