Vaccines and Global Health: The Week in Review 15 April 2017

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_15 April 2017

– 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

Nationwide immunization campaign protects 5 million children against polio in war-torn Yemen
Joint WHO, UNICEF, World Bank news release
SANA’A, 8 April 2017— In an effort to keep Yemen polio-free, nearly 5 million children under the age of five have been vaccinated in a nationwide campaign covering all governorates in the country. The campaign was supported by a partnership between the World Bank, UNICEF and WHO launched in February 2017.

Despite intensifying violence in Sa’ada governorate, more than 369,000 children between the ages of 6 months and 15 years were immunized against measles – a highly contagious and potentially fatal disease – and over 155,000 children under the age of 5 were vaccinated against polio.

Thousands of dedicated health workers, health educators, religious leaders and local council officials played a key role in mobilizing their communities to maximize the immunization campaign’s reach. Thanks to their support, high-risk groups, such as internally displaced persons and refugees, have also been vaccinated.

“WHO, UNICEF and the World Bank, are working closely with health authorities to keep Yemen polio-free and curb the spread of measles,” said Dr Nevio Zagaria, WHO Representative in Yemen. “This partnership provides continuous support to national health authorities to increase vaccination coverage for vulnerable children across Yemen.”

The two year-long conflict in Yemen has all but destroyed the country’s health system, including the national immunization programme to protect all children from preventable diseases. WHO and UNICEF have provided sustained support for the programme, along with other essential health services for children, including:
:: Delivering fuel, generators and solar-powered refrigerators to keep vaccines at a constant cool temperature,
:: Support for transferring vaccines from national and governorate cold rooms to local health facilities and vaccination teams.
“Every minute, the situation of Yemen’s children gets worse. It is unacceptable that children in Yemen are dying of preventable diseases. This is why, together with partners, we are sparing no effort to save more lives,” said Ms. Meritxell Relaño, UNICEF Representative in Yemen.

“The World Bank is committed to investing in children’s health, which is a vital investment in the country’s future, through working with our UN partners in Yemen and strengthening the local health institutions” said Ms. Sandra Bloemenkamp, World Bank Country Manager for Yemen…

::::::
::::::

Ten years in public health 2007-2017
By Dr Margaret Chan, Director-General, WHO

13 April 2017 – Today we begin the launch of “Ten years in public health 2007-2017” – a report that chronicles the evolution of global public health over the decade that I have served as Director-General at WHO.

This series of chapters, which will be published over the next 6 weeks, evaluates successes, setbacks, and enduring challenges during my administration. They show what needs to be done when progress stalls or new threats emerge. The chapters show how WHO technical leadership can get multiple partners working together in tandem under coherent strategies. The importance of country leadership and community engagement is stressed repeatedly throughout the chapters.

Together we have made tremendous progress. Health and life expectancy have improved nearly everywhere. Millions of lives have been saved. The number of people dying from malaria and HIV has been cut in half. WHO efforts to stop TB saved 49 million lives since the start of this century. In 2015, the number of child deaths dropped below 6 million for the first time, a 50% decrease in annual deaths since 1990. Every day 19000 fewer children die. We are able to count these numbers because of the culture of measurement and accountability instilled in WHO.

The challenges facing health in the 21st century are unprecedented in their complexity and universal in their impact. Under the pressures of demographic ageing, rapid urbanization, and the globalized marketing of unhealthy products, chronic noncommunicable diseases have overtaken infectious diseases as the leading killers worldwide. Increased political attention to combat heart attacks and stroke, cancer, diabetes, and chronic respiratory diseases is welcome as a powerful way to improve longevity and healthy life expectancy. However, no country in the world has managed to turn its obesity epidemic around in all age groups. I personally welcome is the political attention being given to women, their health needs, and their contributions to society. Investment in women and girls has a ripple effect. All of society wins in the end.

Lessons learned from the 2014 Ebola outbreak in West Africa catalysed the establishment of WHO’s new Health Emergencies Programme, enabling a faster, more effective response to outbreaks and emergencies. The R&D Blueprint, developed following the Ebola response, cuts the time needed to develop and manufacture new vaccines and other products from years to months, accelerating the development of countermeasures for diseases such as Zika virus. For example, in December 2016, WHO was able to announce that the Ebola vaccine conferred nearly 100% protection in clinical trials conducted in Guinea.

The chapters reveal another shared priority for WHO: fairness in access to care as an ethical imperative. No one should be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic or social causes. That principle is profoundly demonstrated in WHO’s work on universal health coverage, which in the past decade has expanded from a focus on primary health care to the inclusion of UHC as a core element of the 2030 Agenda for Sustainable Development. Health has a central place in the global goals. Importantly, countries have committed to this powerful social equalizer. Universal health coverage reflects the spirit of the SDGs and is the ultimate expression of fairness, ensuring no one is left behind.

These chapters tell a powerful story of global challenges and how they have been overcome. In a world facing considerable uncertainty, international health development is a unifying – and uplifting – force for the good of humanity. I have been proud to witness this impressive spirit of collaboration and global solidarity.

::::::
::::::

Featured Journal Content

PNAS – Proceedings of the National Academy of Sciences of the United States
of America

http://www.pnas.org/content/early/
[Accessed 15 April 2017]
Editorial – Biological Sciences – Medical Sciences:
Simply put: Vaccination saves lives
Walter A. Orenstein and Rafi Ahmed
PNAS 2017 ; published ahead of print April 10, 2017, doi:10.1073/pnas.1704507114
Extract
Few measures in public health can compare with the impact of vaccines. Vaccinations have reduced disease, disability, and death from a variety of infectious diseases. For example, in the United States, children are recommended to be vaccinated against 16 diseases (1). Table 1 highlights the impact in the United States of immunization against nine vaccine-preventable diseases, including smallpox and a complication of one of those diseases, congenital rubella syndrome, showing representative annual numbers of cases in the 20th century compared with 2016 reported cases (2, 3). All of the diseases have been reduced by more than 90% and many have either been eliminated or reductions of 99% or more have been achieved. A recent analysis of vaccines to protect against 13 diseases estimated that for a single birth cohort nearly 20 million cases of diseases were prevented, including over 40,000 deaths (4). In addition to saving the lives of our children, vaccination has resulted in net economic benefits to society amounting to almost $69 billion in the United States alone. A recent economic analysis of 10 vaccines for 94 low- and middle-income countries estimated that an investment of $34 billion for the immunization programs resulted in savings of $586 billion in reducing costs of illness and $1.53 trillion when broader economic benefits were included (5). The only human disease ever eradicated, smallpox, was eradicated using a vaccine, and a second, polio, is near eradication, also using vaccines (6, 7)…

Vaccines not only provide individual protection for those persons who are vaccinated, they can also provide community protection by reducing the spread of disease within a population (Fig. 1). Person-to-person infection is spread when a transmitting case comes in contact with a susceptible person. If the transmitting case only comes in contact with immune individuals, then the infection does not spread beyond the index case and is rapidly controlled within the population. Interestingly, this chain of human-to-human transmission can be interrupted, even if there is not 100% immunity, because transmitting cases do not have infinite contacts; this is referred to as “herd immunity” or “community protection,” and is an important benefit of vaccination.

Mathematical modelers can estimate on average how many persons the typical transmitting case is capable of infecting if all of the contacts were susceptible (i.e., a population of 100% susceptibility). This number is known as R0, or the basic reproductive number. The immunity threshold needed within the population for terminating transmission can be calculated in percent as (R0 − 1)/R0 × 100 and is a guide to setting immunity levels and vaccination coverage targets for various diseases (8). For example, measles is one of the most contagious of vaccine-preventable diseases, with an estimated immunity threshold of 92–94%. In contrast, the protection threshold for rubella is estimated at 83–85%. Thus, eliminating rubella transmission is easier than measles, and when there are gaps in immunization coverage leading to accumulation of susceptibles, measles is often the first vaccine-preventable disease identified. Because of community protection induced by vaccines, persons who cannot be vaccinated (e.g., have contraindications or are younger than the age for whom vaccines are recommended), as well as persons who fail to make an adequate immune response to the vaccine (although most vaccines are highly effective, they are not 100% effective), can be protected indirectly because they are not exposed (Fig. 1). Thus, for most vaccines, achieving high levels of coverage is important not only for individual protection but in preventing disease in vulnerable populations that cannot be directly protected by vaccination. This provides the rationale for interventions to achieve high population immunity, such as removing barriers that may prevent access to vaccines (e.g., providing recommended vaccines without cost), as well as mandates for immunization requirements for attending school (9). There are many reasons why vaccinations may not be received as recommended. One extreme is outright opposition to vaccines. Probably even more common may be that making the effort to receive vaccines (e.g., making the healthcare visits at the appropriate time so vaccines can be administered) may be a low priority compared with other issues, so in the absence of having a mandate for vaccination, other things take priority. Thus, appropriate mandates could help in making vaccination a priority for all (10).

It’s often said that vaccines save lives, but this is not strictly true; it is vaccination that saves lives. A vaccine that remains in the vial is 0% effective even if it is the best vaccine in the world. Thus, it is imperative that we all work together to assure that a high level of coverage is obtained among populations for whom vaccines are recommended. In some sense, vaccines have become victims of their own success. Diseases that once induced fear and sparked desire for vaccines are now rare, and there is a false and dangerous sense of complacency among the public.

In addition, in recent years, growing numbers of persons have become hesitant about vaccines, fearing side effects and not appreciative of the enormous health and economic benefits that vaccines provide. A CDC report on 159 measles cases reported between January 4 and April 2, 2015, showed that 68 United States residents with measles were unvaccinated, and of these 29 (43%) cited philosophical or religious objections to vaccination (11). A 2014 national web-based poll of parents in the United States estimated that 90.8% (89.3–92.1%) reported accepting or planning to accept all recommended noninfluenza childhood vaccines, 5.6% (4.6–6.9%) reported intentionally delaying one or more, and 3.6% (2.8–4.5%) reported refusing one or more vaccines (12). A national survey of pediatricians in the United States reported that the proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (13). A 67-country survey on the state of vaccine confidence reported an average of 5.8% of respondents globally were skeptical about the importance of vaccines, with that proportion rising to more than 15% in some countries (14). One of the major concerns in recent years has been the allegations that vaccines can cause autism. There are three major theories advanced on the role of vaccines in causing autism: (i) measles, mumps, rubella vaccine (MMR); (ii) thimerosal, an ethyl mercury containing preservative in many vaccines in the United States in the past, now mostly out of vaccines recommended for children; and (iii) too many vaccines (15). There have been multiple well-conducted studies and independent reviews of those studies by the Institute of Medicine (now the National Academy of Medicine) that do not support a role for vaccines in causing autism (16). Independent evaluation of the safety of the immunization schedule has found it to be extremely safe (17). However, translating the science into information capable of influencing vaccine skeptics has been difficult.

The National Vaccine Advisory Committee (NVAC) in the United States issued a report in 2015, with 23 recommendations to assure high levels of vaccine confidence (18). The recommendations have five focus areas: (i) measuring and tracking vaccine confidence, (ii) communication and community strategies to increase vaccine confidence, (iii) healthcare provider strategies to increase vaccine confidence, (iv) policy strategies to increase vaccine confidence, and (v) continued support and monitoring of the state of vaccine confidence. Critical to assuring confidence is evidence-based research to evaluate which interventions are most effective. The NVAC recommended that a repository of evidence-based best practices for informing, educating, and communicating with parents and others in ways that foster or increase vaccine confidence be created. And while we have focused on children, vaccine preventable diseases exact a substantial health burden in adults and immunization coverage rates for most recommended vaccines are substantially lower for adults than those achieved for recommended vaccines in children. Thus, there is need not only in enhancing immunization rates in children but also in adults.

In summary, vaccines are some of the most effective and also cost-effective prevention tools we have. But vaccines that are not administered to persons for whom they are recommended are not useful. It is incumbent upon all of us who work in the healthcare setting, as well as community leaders, to stress to our friends and colleagues the importance of vaccination both for the individual vaccinated as well as for the communities in which the individuals live. Also critically important, there remains an urgent need for greater emphasis on research to develop vaccines for global diseases for which vaccines either do not exist or need improvement.
[References and Acknowledgment at title link above]

::::::

New England Journal of Medicine
April 13, 2017  Vol. 376 No. 15
http://www.nejm.org/toc/nejm/medical-journal
Perspective
Yellow Fever — Once Again on the Radar Screen in the Americas
Catharine I. Paules, M.D., and Anthony S. Fauci, M.D.
Four arthropod-borne viruses (arboviruses) have recently emerged or reemerged in the Americas, spreading rapidly through populations that had not previously been exposed to them and causing substantial morbidity and mortality.1 The first was dengue, which reemerged to cause widespread disease predominantly in South America and the Caribbean in the 1990s. This epidemic was followed by West Nile virus in 1999, which has since become endemic in the continental United States, and chikungunya in 2013, which continues to cause disease, predominantly in the Caribbean and South America. Most recently, Zika virus emerged in Brazil in 2015 and spread through infected travelers to more than 60 countries and territories in the Americas, including the United States.

Over the past several weeks, a fifth arbovirus, yellow fever virus, has broken out in Brazil, with the majority of the infections occurring in rural areas of the country. These are referred to as sylvatic, or jungle, cases, since the typical transmission cycle occurs between forest mosquitoes and forest-dwelling nonhuman primates, with humans serving only as incidental hosts. In this ongoing outbreak, health authorities have reported 234 confirmed infections and 80 confirmed deaths as of February 2017.2 Confirmed infections have occurred in the Brazilian states of Minas Gerais, Espírito Santo, and São Paulo (see map – Confirmed Cases of Yellow Fever in the Current Outbreak.), and hundreds of additional cases remain under investigation. The high number of cases is out of proportion to the number reported in a typical year in these areas.

Although there is currently no evidence that human-to-human transmission through Aedes aegypti mosquitoes (urban transmission) has occurred, the outbreak is affecting areas in close proximity to major urban centers where yellow fever vaccine is not routinely administered. This proximity raises concern that, for the first time in decades, urban transmission of yellow fever will occur in Brazil.

As we have seen with dengue, chikungunya, and Zika, A. aegypti–mediated arbovirus epidemics can move rapidly through populations with little preexisting immunity and spread more broadly owing to human travel. Although it is highly unlikely that we will see yellow fever outbreaks in the continental United States, where mosquito density is low and risk of exposure is limited, it is possible that travel-related cases of yellow fever could occur, with brief periods of local transmission in warmer regions such as the Gulf Coast states, where A. aegypti mosquitoes are prevalent.

It is also conceivable that yellow fever outbreaks may occur in the U.S. territories, just as the recent Zika epidemic reached Puerto Rico, causing a significant outbreak there and leading to thousands of travel-related cases and more than 250 locally transmitted cases in the continental United States. In an era of frequent international travel, any marked increase in domestic cases in Brazil raises the possibility of travel-related cases and local transmission in regions where yellow fever is not endemic. In light of the serious nature of this historically devastating disease, public health awareness and preparedness are critical, even for individual cases.

Yellow fever most likely originated in Africa and was imported into the Americas in the 1600s.3 It claimed hundreds of thousands of lives in the 18th and 19th centuries. The Philadelphia yellow fever epidemic of 1793, for example, killed approximately 10% of the city’s population and prompted the federal government to flee the city. In 1881, Cuban epidemiologist Carlos Finlay proposed that yellow fever was a mosquito-borne infection. The U.S. Army physician Walter Reed and a Yellow Fever Commission verified that fact in 1900. Subsequently, mosquito-control efforts and better sanitation practices virtually eliminated yellow fever from the United States and other nonendemic areas of the Americas, although sporadic outbreaks of varying magnitude continued to occur in tropical regions where the disease was endemic.4

In 1937, virologist Max Theiler developed a live attenuated yellow fever vaccine that is still in use today and that provides lifetime immunity in up to 99% of vaccinees, according to the World Health Organization (WHO). Extensive vaccination campaigns combined with effective vector-control strategies have significantly reduced the number of yellow fever cases worldwide. However, localized outbreaks continue to occur in parts of Africa and Central and South America, resulting in an estimated 84,000 to 170,000 severe cases and 29,000 to 60,000 related deaths per year, according to the WHO.

Beginning in December 2015, a large urban outbreak of yellow fever occurred in Angola and subsequently spread to the Democratic Republic of Congo, causing 961 confirmed cases and 137 deaths. In addition, cases related to travel from those countries were noted in nonendemic areas such as China, raising concern about international spread of disease. During the outbreak, the world’s emergency vaccine stockpile reserved for epidemic response was exhausted, prompting health authorities to immunize inhabitants of some areas using one fifth of the standard dose in order to extend the vaccine supply.5 Since vaccination is the mainstay of epidemic response, the limited number of stockpiled vaccine doses and the long time needed to produce additional vaccine made this outbreak difficult to control. To prevent a similar occurrence in Brazil or in future yellow fever outbreaks, early identification of cases and rapid implementation of public health management and prevention strategies, such as mosquito control and appropriate vaccination, are critical.

Early recognition may be difficult in countries such as the United States, where most physicians have never seen a case of yellow fever and know little about the clinical manifestations. Typically, yellow fever is suspected on the basis of clinical presentation and confirmed later, since definitive diagnosis requires testing available only in specialized laboratories. The clinical illness manifests in three stages: infection, remission, and intoxication.3 During the infection stage, patients present after a 3-to-6-day incubation period with a nonspecific febrile illness that is difficult to distinguish from other flulike diseases. High fevers associated with bradycardia, leukopenia, and transaminase elevations may provide a clue to the diagnosis, and patients will be viremic during this period.

This initial stage is followed by a period of remission, when clinical improvement occurs and most patients fully recover. However, 15 to 20% of patients have progression to the intoxication stage, in which symptoms recur after 24 to 48 hours.3 This stage is characterized by high fevers, hemorrhagic manifestations, severe hepatic dysfunction and jaundice (hence the name “yellow fever”), renal failure, cardiovascular abnormalities, central nervous system dysfunction, and shock. Antibodies may be detected during this stage; however, viremia has usually resolved. Case-fatality rates range from 20 to 60% in patients in whom severe disease develops, and treatment is supportive, since no antiviral therapies are currently available.3,4

Yellow fever is the most severe arbovirus ever to circulate in the Americas, and although vaccination campaigns and vector-control efforts have eliminated it from many areas, sylvatic transmission cycles continue to occur in endemic tropical regions. The most recent outbreak in Brazil highlights this phenomenon. If the current outbreak leads to urban spread through A. aegypti mosquitoes, clinicians should adopt a high index of suspicion for yellow fever, particularly in travelers returning from affected regions. As with all potentially reemerging infectious diseases, public health awareness and preparedness are essential to prevent a resurgence of this historical threat

 

Emergencies

Emergencies

Public Health Emergencies of International Concern (PHEIC)  [to 15 April 2017]

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 12 April 2017
:: The Polio Research Committee (PRC) is meeting this week in Geneva, to continue to provide guidance to the eradication effort’s research agenda. Research underpins polio eradication, evaluating new strategies, products and solutions to long-standing operational, epidemiological and virological challenges.
:: Summary of newly-reported viruses this week: two new wild poliovirus type 1 positive environmental samples from Pakistan.

Country Updates [Selected Excerpts]
New cases or environmental samples reported across the monitored country/region settings: Afghanistan, Pakistan, Nigeria, Lake Chad Basin. Guinea and West Africa, and Lao People’s Democratic Republic have been removed from the monitored geographies list.
Afghanistan
:: On 4-5 April, the Technical Advisory Group (TAG) on Polio Eradication in Afghanistan convened in Kabul. This independent technical body of experts reviewed latest epidemiology by region, remaining gaps and strategies for the rest of the year.
::Pockets of remaining unreached children in particular in Bermel, Helmand and Kandahar needs to be addressed, as such pockets continue to present a risk to the national effort.
Pakistan
:: Two new WPV1 positive environmental samples were reported in the past week, from Islamabad and Gadap (greater Karachi), Sindh, collected on 11 and 9 March, respectively.

[See joint WHO, UNICEF, World Bank news release on polio immunization in Yemen in Milestones above]

:::::::

WHO Grade 3 Emergencies  [to 15 April 2017]
YemenNo new announcements identified
Nationwide immunization campaign protects 5 million children against polio in war-torn Yemen     8 April 2017
[See Milestones above for more detail]

Iraq  – No new announcements identified
NigeriaNo new announcements identified
South Sudan  – No new announcements identified
The Syrian Arab Republic  – No new announcements identified
 

::::::

WHO Grade 2 Emergencies  [to 15 April 2017]
Cameroon  – No new announcements identified.
Central African Republic  – No new announcements identified.
Democratic Republic of the CongoNo new announcements identified.
EthiopiaNo new announcements identified.
LibyaNo new announcements identified.
MyanmarNo new announcements identified.
Niger  – No new announcements identified.
Ukraine  – No new announcements identified.

::::::

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 No. 28 (2 – 9 April 2017) [EN/KU/AR]
Highlights [Excerpts]
…Humanitarian needs in western Mosul remain high, with shortages of food and water being reported. Although some areas of western Mosul are accessible to humanitarian partners, regular water supply has been very severely impact by the conflict resulting in serious shortages of water supplies of acceptable quality.
…Since the start of the operation in western Mosul on 19 February, an estimated 275,000 displaced people have passed through the Hammam al Alil screening site as of 9 April, according to the Government of Iraq.
…The cumulative number of IDPs since the beginning of the Mosul Operation on 17 October 2016 has reached beyond 436,000 people as of 9 April, according to the government. The government reports that 91,000 individuals have returned to eastern Mosul, and around 345,000 people are currently displaced as of 9 April…

:: UN Damage Assessment Shows Extensive Destruction in Western Mosul [EN/AR/KU]
(Baghdad, 13 April 2017): The most recent assessment from UN-Habitat, the United Nations Human Settlements Programme, confirms that extensive damage has occurred in western Mosul…
“The level of damage in western Mosul is already far greater than in the east, even before the battle to retake the Old City begins,” said Lise Grande, Humanitarian Coordinator for Iraq. “Nearly 300,000 civilians have fled western Mosul. Hundreds of thousands more may in the days and weeks ahead.”
“Homes are being destroyed. Schools and health centres are damaged and crucial public infrastructure including electricity and water stations are in ruins,” said Ms. Grande. “Under international humanitarian law, parties to the conflict are obliged to do everything possible to protect civilians and limit damage to civilian infrastructure. Nothing is more important.”…

Syria
:: 14 Apr 2017  Syria – IDP Situation Monitoring Initiative (ISMI) Weekly Update, Major Reported IDP Movements (03/04/17 – 09/04/17)
:: Northwest Syria – Flash Update (As of 11 April 2017)

Yemen
:: 14 Apr 2017 – Yemen Humanitarian Bulletin Issue 22 | 14 April 2017
:: 13 Apr 2017 – Situational briefing to the General Assembly on the Secretary-General’s Call to Action on famine response and prevention
:: 11 Apr 2017 – Statement by the Humanitarian Coordinator in Yemen, Jamie McGoldrick,on the need to improve humanitarian access to Taizz City [EN/AR]

::::::
::::::

Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

Zika virus  [to 15 April 2017]
http://www.who.int/emergencies/zika-virus/en/
[No new digest content identified]

MERS-CoV [to 15 April 2017]
http://www.who.int/emergencies/mers-cov/en/
[No new digest content identified]

Yellow Fever  [to 15 April 2017]
http://www.who.int/emergencies/yellow-fever/en/
[No new digest content identified]

EBOLA/EVD  [to 15 April 2017]
http://www.who.int/ebola/en/
[No new digest content identified]

::::::
::::::

WHO & Regional Offices [to 15 April 2017]

WHO & Regional Offices [to 15 April 2017]

World Immunization Week, 24-30 April
Immunization saves millions of lives and is widely recognized as one of the world’s most successful and cost-effective health interventions.

Radical increase needed in funding for water and sanitation
13 April 2017 – Countries are not increasing spending fast enough to meet the water and sanitation targets under the Sustainable Development Goals, says a new report published by WHO on behalf of UN-Water. According to the report, countries have increased their budgets for water, sanitation and hygiene over the last 3 years, yet 80% of countries report that this financing is still insufficient to meet nationally-defined targets

Highlights
WHO and partners provide vaccines to control meningitis C in Nigeria
April 2017 — A vaccination campaign is underway in Nigeria to contain an outbreak of meningitis C, a strain of meningitis which first emerged in the country in 2013.

WHO boosts emergency lifesaving care for civilians severely injured in west Mosul
April 2017 – Since the start of the campaign in Mosul late last year, over 6000 patients have been referred to hospitals in Mosul and neighbouring governorates. To further boost all levels of trauma care, the EU has committed an additional €10 million to WHO.

Reference Guide: Developing health financing strategy
April 2017 – A new guide published by WHO examines policy development for health financing, expanding on areas including revenue raising, pooling revenues, purchasing services, benefit design, and rationing mechanisms. Health financing is key to improving health system performance and progressing towards universal health coverage (UHC).

::::::

Weekly Epidemiological Record, 14 April 2017, vol. 92, 15 (pp. 181–192)
:: Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC): summary of conclusions and recommendations, 1–2 February 2017 meeting
:: Zika virus: an epidemiological update

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: African Vaccination Week 24-30 April 2017
:: Elephantiasis is no longer a public health problem in Togo: WHO commends Togo for Historic Achievement
Brazzaville, 14 April 2017 – After over a decade of persistent efforts, Togo has eliminated lymphatic filariasis—also known as elephantiasis—as a public health problem. The announcement follows a formal validation by the World Health Organization (WHO) which congratulated the Togolese government for this historic achievement.

WHO Region of the Americas PAHO
:: PAHO opens contest on best experiences in health promotion in cities, schools and universities in the Americas (04/11/2017)

WHO South-East Asia Region SEARO
:: Scaling up health sector response to viral hepatitis
WHO today launched the Regional Action Plan for Viral Hepatitis which provides an actionable framework of evidence-based, priority interventions to support national responses for prevention, control and management of viral hepatitis. The goal of the action plan is to eliminate viral hepatitis as a major public health threat in the Region by 2030.
The action plan was launched at a three-day meeting of programme managers from all member countries, partners and donors, to accelerate efforts to end viral hepatitis.

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: WHO increases support for cancer patients, the forgotten casualties of the Syrian war
13 April 2017
:: WHO welcomes support from Government of Brazil to Syria health response  13 April, 2017
:: WHO’s Regional Director launches National Immunization Week in Lebanon  10 April 2017

WHO Western Pacific Region
No new digest content identified.

::::::
::::::

CDC/ACIP [to 15 April 2017]
http://www.cdc.gov/media/index.html

No new digest content identified

Announcements

Announcements

Human Vaccines Project [to 15 April 2017]
http://www.humanvaccinesproject.org/media/press-releases/
Apr 11, 2017, 09:00 ET
The Human Vaccines Project, Vanderbilt And Illumina Join Forces To Decode The Human Immunome
NEW YORK, April 11, 2017 /PRNewswire-USNewswire/ — The Human Vaccines Project and Vanderbilt University Medical Center today announced that they joined forces with Illumina, Inc., to decipher the human immunome, the genetic underpinnings of the immune system. Illumina will provide the genetic sequencing technologies and expertise required to process the massive amounts of data required to decode the human immunome.

The Human Vaccines Project is a public-private partnership of academic research centers, industry, non-profits and government agencies that aims to decode the human immune system to accelerate development of next-generation vaccines and immunotherapies. A core initiative of the Project is the Human Immunome Program, an internationally led effort by Vanderbilt University Medical Center to determine key principles of how the human immune system prevents and controls disease by illuminating the complete set of genes and molecular structures known as the human immunome.

“By decoding the human immune system, we have the potential to uncover novel diagnostic biomarkers for a wide range of diseases,” said James Crowe Jr., M.D., director of the Vanderbilt Vaccine Center and lead investigator of the Human Immunome Program. “This will enable the development of highly targeted vaccines and immunotherapies against infectious and non-communicable diseases like AIDS, Alzheimer’s, multiple sclerosis and cancer.”

Due to its scale and complexity, the human immunome is estimated to be billions of times larger than the human genome. With recent technological advances from biomedical and computational sciences, it is now possible to undertake such a mammoth genetic sequencing and data analysis program.

“We are very pleased to collaborate with the Human Vaccines Project, Vanderbilt and its partners, by bringing Illumina’s state of the art genetic sequencing and bioinformatics technologies to help solve this major challenge,” said Gary Schroth, Ph.D., distinguished scientist and vice president for product development at Illumina. “Successfully defining the human immunome will provide the foundational knowledge to usher in a new era of vaccine, diagnostic and therapeutic development.”…

::::::

PATH [to 15 April 2017]
http://www.path.org/news/index.php
Announcement | April 12, 2017
Vietnam launches National Immunization Information System
The government-led scale-up of PATH’s ImmReg and VaxTrak systems aims to track the immunization of every individual in Vietnam, from birth until the end of their life
On March 24, Vietnam’s Deputy Prime Minister, Vu Duc Dam, officially launched the National Immunization Information System (NIIS) in Hanoi. This system evolved from ImmReg, a digital immunization registry, and VaxTrak, a vaccine tracking tool, both developed and tested by PATH beginning in 2012.

ImmReg allows health workers to use computers, smartphones, and tablets to enter and search for immunization records, and send short message service (SMS) reminders to those due for vaccination. It has shown to increase the on-time vaccination rates for essential vaccines for children, as well as reduce the time and costs associated with local routine immunization programs. VaxTrak tracks vaccine supply chain, thus decreasing the likelihood of stock-outs and reducing waste. Since 2016, PATH has supported the Ministry of Health (MOH) and Viettel, the largest telecom company in Vietnam, to integrate ImmReg and VaxTrak into a national system. They aim to track immunization records of the entire Vietnamese population, from birth to death, and make the vaccine supply chain more efficient.

The NIIS is an ambitious system that positions Vietnam as a global leader in digital health. Health centers throughout the world, in both developed and developing countries, have relied on paper-based records to record patient and vaccine information by hand. Paper-based records make it challenging to track which children are due for vaccination and can be prone to error. Inaccurate data leads to poor management of vaccine stocks, resulting in vaccines delivery delays. A paper-based system also makes it more difficult for health workers to develop reports for health officials to use in developing immunization plans and strategies.

Through initiatives such as ImmReg, VaxTrak, and the Better Immunization Data Initiative, PATH is helping countries adopt digital solutions that allow health workers to better record and access data, ultimately leading to better health service delivery…

Press release | April 12, 2017
Viet Nam’s first human milk bank to serve as model for learning and replication across the country
Human milk banks fill a vital nutritional gap for at-risk newborns without access to their own mother’s milk, but few exist across Southeast Asia. Viet Nam’s first human milk bank demonstrates the feasibility of establishing a facility of international standards in the region, and will serve as a model across the country and Southeast Asia.

::::::

IAVI – International AIDS Vaccine Initiative [to 15 April 2017]
https://www.iavi.org/
April 13, 2017
IAVI Mourns the Passing of Major Force in HIV Science Dr. Mark Wainberg
The world lost a leader in the fight against AIDS this week with the passing of Dr. Mark Wainberg. The pioneering Canadian researcher is widely recognized for his involvement in the 1989 identification of antiviral drug Lamivudine, which is now one of the most extensively used drugs in treating  HIV  and its co-infections.

“Dr. Wainberg’s passing is a tremendous loss for the scientific community,” said IAVI President and CEO Mark Feinberg. “His extraordinary contributions to the field of HIV research and development continue to be an inspiration to me and to all who knew him.  Discoveries stemming from his investigations and collaborations have significantly advanced treatment, prevention and cure research.”

Among these contributions was the identification of several mutations in the HIV genome that are responsible for drug resistance.  In recent years, he also turned his attention to researching a potential HIV cure based on the possibility that HIV may be unable to form resistance to compounds called integrase inhibitors that block viral replication…

::::::

UNAIDS [to 15 April 2017]
http://www.unaids.org/
Selected Press Releases & Updates
Press statement
UNAIDS saddened by the death of HIV researcher Mark Wainberg
GENEVA, 13 April 2017—UNAIDS is deeply saddened by the tragic death of pioneering HIV researcher Mark Wainberg. An internationally renowned scientist, Dr Wainberg was a leading HIV researcher from the start of the AIDS epidemic.

“Mark Wainberg was a giant in HIV science. His work contributed to saving millions of lives,” said Michel Sidibé, Executive Director of UNAIDS.

Dr Wainberg and colleagues identified one of the main antiretroviral medicines used to treat HIV infection, lamivudine. He contributed to the understanding of HIV drug resistance and more recently was working towards a cure for HIV. Dr Wainberg was the head of AIDS research at the Lady Davis Institute for Medical Research at the Jewish General Hospital and Director of the McGill University AIDS Centre, Canada, at the time of his death…

Update
UNAIDS Scientific and Technical Advisory Committee calls for HIV testing revolution
13 April 2017
The participants of a meeting of the UNAIDS Scientific and Technical Advisory Committee (STAC) have called on UNAIDS to lead global efforts to galvanize an HIV testing revolution. The target is to achieve 90% of people living with HIV knowing their HIV status by 2020. In 2015, only 60% of people living with HIV knew their HIV status.

In a mid-term review of progress towards the 90–90–90 targets, held on 9 and 10 April in Geneva, Switzerland, the participants heard that late HIV diagnosis represents the single greatest barrier to increasing rates of HIV viral suppression globally. New testing technologies have emerged, but programmes must reach the people who need HIV testing services.

Key barriers to HIV testing uptake include lack of individual awareness of risk, stigma, legal and structural barriers, associated costs such as travel to facilities and the perception that there is little benefit from diagnosing HIV infection if no symptoms are present. The participants heard that many people avoid seeking HIV testing services at health facilities, since both travel and waiting times can often be long. Barriers to testing are often experienced by young people, men and members of key populations.

The participants agreed that political and financial support for HIV testing must be significantly increased and that the central focus of HIV testing services should be moved from the health facility to the community. Community workers have a critical role in scaling up these community-centred strategies. The STAC recommended that UNAIDS develop a road map for the HIV testing revolution, for review and comment by the STAC at its next meeting in July…

::::::

European Medicines Agency [to 15 April 2017]
http://www.ema.europa.eu/ema/
12/04/2017
Update of EMA recommendations for 2017/2018 seasonal flu vaccine composition
Update completes previous recommendations issued in March 2017

10/04/2017
Reporting irregularities that may affect medicines
EMA Board adopts new policy on handling information on alleged improprieties from external sourcesThe European Medicines Agency’s (EMA) Management Board has adopted a new policy on how EMA handles allegations of improprieties received from external parties. These improprieties may include allegations of departures from standards of good practices that could have an impact on the evaluation and supervision of medicines.
The goal is to create an environment where individuals from outside the Agency feel confident to raise their concerns on improprieties in their area of work. The policy helps EMA assess these reports and co-ordinate any further investigation in a structured way, while protecting the confidentiality of the reporter.
Since 2013, EMA has received a total of 43 reports that relate, for example, to the manufacturing of medicines or the conduct of clinical trials. Although no formal policy has existed until now, all reports were dealt with in line with the principles included in the new policy.
A dedicated email inbox, reporting@ema.europa.eu, has been created. Individuals external to EMA can raise their concerns by sending a message or providing information to this address. They can also send a letter to the Agency. Their identity will be kept confidential…

::::::

NIH [to 15 April 2017]
http://www.nih.gov/news-events/news-releases
April 12, 2017
NIH study of Ebola patient traces disease progression and recovery
The patient was at the NIH Clinical Center for 26 days.
Excerpt
Analysis of daily gene activation in a patient with severe Ebola virus disease cared for at the National Institutes of Health in 2015 found changes in antiviral and immune response genes that pinpointed key transition points in the response to infection. The changes included a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. The analysis also showed that the preponderance of host responses shifted rapidly from activation of genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair. This pivot came before the first signs of clinical improvement in the patient, who was admitted to the NIH Clinical Center on day 7 of illness and remained at the hospital for 26 days. Researchers from the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) led the study…
… Although this study represents only a single case, it provides unprecedented detail on the host response to Ebola virus disease and may inform the development of therapeutics designed to boost or accelerate host factors that most effectively counter the virus and promote healing. It may also lead to better prognostic criteria to enable clinicians to tailor the treatment of patients with Ebola virus disease in ways that can best promote recovery…

NIH scientists advance understanding of herpesvirus infection
April 12, 2017
Protein complexes identified that control infection and reactivation.

::::::

FDA [to 15 April 2017]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
What’s New for Biologics
Complete List of Currently Approved NDA and ANDA Application Submissions (PDF – 17KB)
Posted: 4/10/2017; Updated as of 4/5/2017

Complete List of Currently Approved Premarket Approvals (PMAs) (PDF – 16KB)
Posted: 4/10/2017; Updated as of 4/6/2017

::::::

Wellcome Trust [to 15 April 2017]
https://wellcome.ac.uk/news
News / Published: 12 April 2017
One of our researchers wins global health award
Professor César Victora, a Wellcome Investigator, has been awarded the prestigious John Dirks Canada Gairdner Global Health Award 2017 for his work on maternal and child health in low- and middle-income countries.
The award recognises Professor Victora’s (opens in a new tab) contributions to child health and nutrition, health programme monitoring and evaluation, and health equity.
His key achievement has been his work on cohort studies. He helped set up the 1982 Pelotas Birth Cohort, in Brazil, one of the world’s longest running birth cohort studies. It is still monitoring around 6,000 individuals, and has been followed by further cohort studies set up in 1993 and 2004.
Professor Victora’s research helped to demonstrate the impact of the first 1,000 days of life on influencing lifelong outcomes, in particular the importance of breastfeeding for preventing infant mortality…

::::::

GHIT Fund [to 15 April 2017]
https://www.ghitfund.org/
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical companies, the Japanese Government and the Bill & Melinda Gates Foundation.
2017.04.10
GHIT Fund 5th Anniversary Website Launched
In celebration of our 5th anniversary we have launched a special site featuring substantive interviews with key global health leaders and GHIT partners. Interviews examine GHIT and Japan’s impact on global health R&D to date, and the potential for further impact in the years to come. The site also offers background on the history of our institution and staff, as well as our plans for our next 5 years. We invite you to visit the site and take a journey with us through our past and future.
:: GHIT 5th Anniversary Website   http://5th.ghitfund.org/top/en

::::::

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders
Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

Integrating Clinical Research into Epidemic Response: The Ebola Experience
National Academy of Sciences – Committee on Clinical Trials During the 2014-15 Ebola Outbreak
Released April 12, 2017 :: 287 pages
PDF: https://download.nap.edu/cart/download.cgi?record_id=24739
Overview
The 2014 Ebola epidemic in western Africa was the longest and deadliest Ebola outbreak in history, resulting in 28,616 cases and 11,310 deaths. In the midst of the rapidly spreading, highly dangerous contagious disease—with no Ebola-specific vaccines or therapeutics available to help curb the epidemic—the international community implemented clinical trials on investigational agents, not yet studied in humans for safety or efficacy. Within that context, the Office of the Assistant Secretary for Preparedness and Response, the National Institute of Allergy and Infectious Disease, and the U.S. Food and Drug Administration, supported the National Academies of Sciences, Engineering, and Medicine to convene a committee to analyze the clinical trials that were conducted during the epidemic and consider the many scientific, ethical and practical issues related to the conduct of research in similar contexts. The resulting report, Integrating Clinical Research into Epidemic Response: The Ebola Experience, assesses the value of the trials and makes recommendations about how the conduct of trials could be improved in the context of a future international emerging or re-emerging infectious disease event.

::::::

Fostering Integrity in Research
National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Committee on Science, Engineering, and Public Policy
2017 :: 284 pages
ISBN 978-0-309-39125-2 | DOI: 10.17226/21896
PDF: https://www.nap.edu/login.php?record_id=21896&page=https%3A%2F%2Fwww.nap.edu%2Fdownload%2F21896
Description
The integrity of knowledge that emerges from research is based on individual and collective adherence to core values of objectivity, honesty, openness, fairness, accountability, and stewardship. Integrity in science means that the organizations in which research is conducted encourage those involved to exemplify these values in every step of the research process. Understanding the dynamics that support – or distort – practices that uphold the integrity of research by all participants ensures that the research enterprise advances knowledge.
The 1992 report Responsible Science: Ensuring the Integrity of the Research Process evaluated issues related to scientific responsibility and the conduct of research. It provided a valuable service in describing and analyzing a very complicated set of issues, and has served as a crucial basis for thinking about research integrity for more than two decades. However, as experience has accumulated with various forms of research misconduct, detrimental research practices, and other forms of misconduct, as subsequent empirical research has revealed more about the nature of scientific misconduct, and because technological and social changes have altered the environment in which science is conducted, it is clear that the framework established more than two decades ago needs to be updated.
Responsible Science served as a valuable benchmark to set the context for this most recent analysis and to help guide the committee’s thought process. Fostering Integrity in Research identifies best practices in research and recommends practical options for discouraging and addressing research misconduct and detrimental research practices.

::::::

News Release
Kaiser Permanente Study Tests New Way to Reduce ‘Vaccine Hesitancy’
Parent volunteers who value immunization show promise as advocates to help protect communities against contagious diseases
SEATTLE, April 11, 2017 /PRNewswire/ — Results are promising for a new approach to reducing “vaccine hesitancy,” which happens when parents’ concerns about vaccine safety lead them to delay or skip their children’s immunizations, according to a Kaiser Permanente study published today in Health Promotion Practice: The Immunity Community: A Community Engagement Strategy for Reducing Vaccine Hesitancy.

The approach, called the Immunity Community, mobilizes parents who value vaccination to be advocates and to have positive conversations with other parents at their kids’ childcare centers, preschools and schools — in person and through social media.

Parents took a survey before and after the three-year intervention in two communities in Washington state. The surveys showed significant improvements in vaccine-related attitudes:
:: Parents concerned about others not vaccinating their children rose from 81 percent to 89 percent.
:: Those who called themselves “vaccine hesitant” fell from 23 percent to 14 percent.
Fewer parents thought children receive vaccines at too young an age.
:: More parents were confident that vaccinating their children is a good decision.
:: More parents knew the vaccination rates at their children’s childcare or school.

“Our evaluation found that the Immunity Community program was successful at empowering parents to communicate positive messages about vaccines in a way that was not confrontational,” said study principal investigator Clarissa Hsu, PhD, of Kaiser Permanente Washington Health Research Institute’s Center for Community Health and Evaluation.

“Strong negative rhetoric about vaccines can circulate widely on social media. And some parents feel hesitant about early childhood vaccines and may delay or refuse some or all vaccines, which may put others in their community at risk,” Hsu said. “This project was designed to counterbalance prevalent anti-vaccine messages that do not reflect the fact that most (at least four in five) people vaccinate their kids and are supportive of vaccines.”…

Health Promotion Practice
First published date: April-11-2017
10.1177/1524839917697303
The Immunity Community: A Community Engagement Strategy for Reducing Vaccine Hesitancy
Jennie Schoeppe, MPH, MSPT, Allen Cheadle, PhD, Mackenzie Melton, MPH, Todd Faubion, PhD, Creagh Miller, MPH, Juno Matthys, BS, Clarissa Hsu, PhD
Abstract
Parental concerns about vaccine safety have grown in the United States and abroad, resulting in delayed or skipped immunizations (often called “vaccine hesitancy”). To address vaccine hesitancy in Washington State, a public–private partnership of health organizations implemented and evaluated a 3-year community intervention, called the “Immunity Community.” The intervention mobilized parents who value immunization and provided them with tools to engage in positive dialogue about immunizations in their communities. The evaluation used qualitative and quantitative methods, including focus groups, interviews, and pre and post online surveys of parents, to assess perceptions about and reactions to the intervention, assess facilitators and barriers to success, and track outcomes including parental knowledge and attitudes. The program successfully engaged parent volunteers to be immunization advocates. Surveys of parents in the intervention communities showed statistically significant improvements in vaccine-related attitudes: The percentage concerned about other parents not vaccinating their children increased from 81.2% to 88.6%, and the percentage reporting themselves as “vaccine-hesitant” decreased from 22.6% to 14.0%. There were not statistically significant changes in parental behaviors. This study demonstrates the promise of using parent advocates as part of a community-based approach to reduce vaccine hesitancy.

Journal Watch

Journal Watch
   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org