Vaccines and Global Health: The Week in Review 14 January 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

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

Milestones :: Perspectives

Milestones :: Perspectives

140th session of the Executive Board
23 January–1 February 2017, Geneva
Main Documents [Selected]
EB140/7
Health emergencies
WHO response in severe, large-scale emergencies

EB140/9
Research and development for potentially epidemic diseases
A blueprint for research and development preparedness and rapid research response

EB140/13
Poliomyelitis

EB140/14
Implementation of the International Health Regulations (2005)
Draft global implementation plan

EB140/15
Implementation of the International Health Regulations (2005)
Public health implications of the implementation of the Nagoya Protocol

EB140/16
Review of the Pandemic Influenza Preparedness Framework

EB140/25
Global vaccine action plan
[Excerpt]
ANNEX
A SUMMARY OF THE 2016 ASSESSMENT REPORT OF THE GLOBAL VACCINE ACTION PLAN BY THE STRATEGIC ADVISORY GROUP OF EXPERTS ON IMMUNIZATION [1]
1. At the midpoint of the Global Vaccine Action Plan, or GVAP (2012–2020), the Strategic Advisory Group of Experts on Immunization (SAGE) remains gravely concerned that progress toward the goals to eradicate polio, eliminate measles and rubella, eliminate maternal and neonatal tetanus, and increase equitable access to life saving vaccines is too slow.

2. Despite improvements in individual countries and a strong global rate of new vaccine introduction, global average immunization coverage has increased by only 1% since 2010.

3. In 2015, 68 countries fell short of the target to achieve at least 90% national coverage with the third dose of diphtheria-tetanus-pertussis vaccine. Not only that, 26 countries reported no change in coverage levels and 25 countries reported a net decrease in coverage since 2010.

4. The 16 countries that have made measurable progress since 2010 are to be commended for reaching more people, especially vulnerable and marginalized members of society with immunization. Some of the countries with the highest numbers of unvaccinated people have made the most progress, including the Democratic Republic of the Congo, Ethiopia and India, and even though coverage targets have not been achieved in these countries, they are moving forward in the right direction.

5. The 111 countries that entered the decade with high immunization coverage and sustained it through 2015 are already setting their sights on more aggressive goals, additional vaccines, and more equitable coverage. Immunization programmes in these countries can lead the way by increasing access to other public health interventions and providing a platform for the delivery of preventive health services throughout the life course. Vaccine research and development is progressing rapidly, and an expanding pipeline of new vaccines underscores the need to build health systems that can reliably reach new target age groups.

6. The members of the SAGE are steadfast and passionate believers in the power of immunization to give individuals and their families a better start in life and to protect people from a growing array of debilitating illnesses. Immunization is one of the world’s most effective and cost-effective tools against the threat of emerging diseases and has a powerful impact on social and economic development. Recognizing the role that immunization plays in ensuring good health and the role that good health plays in achieving sustainable development, the SAGE has supported the inclusion of immunization indicators to measure progress toward the Sustainable Development Goals.

7. The next four years present unprecedented opportunities for countries to leverage the attention and support that immunization receives and apply it for the benefit of people everywhere. Strident efforts on the part of all countries and immunization stakeholders are required to catch up and achieve GVAP goals by 2020…

[1]http://www.who.int/entity/immunization/global_vaccine_action_plan/SAGE_GVAP_Assessment_ Report_2016_EN.pdf (accessed 10 November 2016).

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Emergencies

Emergencies

Millions of children to receive measles vaccine in north-eastern Nigeria
12 January 2017 – A mass vaccination campaign to protect more than 4 million children against a measles outbreak in conflict-affected states in north-eastern Nigeria is planned to start this week. The two-week campaign, which starts on 13 January, will target all children aged from 6 months to 10 years in accessible areas in Borno, Yobe and Adamawa States.

“This measles vaccination campaign is an emergency intervention to protect more than 4 million children against a highly contagious and sometimes deadly disease,” says Dr Wondimagegnehu Alemu, WHO Representative in Nigeria. “Massive disruption to health services in conflict-affected areas for many years has deprived these children of essential childhood vaccinations. In addition, many of them have severe malnutrition, making them extremely vulnerable to serious complications and death from measles.”

Polio programme provides crucial support
WHO is supporting the 3 state Primary Healthcare Development Agencies to prepare for the campaign; working with partners including UNICEF, the United States Centers for Disease Control (CDC) and other health nongovernmental organizations. WHO is providing expertise in areas including logistics, data management, training, social mobilization, monitoring and evaluation, supportive supervision (human resource) and waste management.

“Nigeria’s well-established polio vaccination programme provides a strong underpinning for the campaign,” says Dr Alemu. “Population data from the polio programme has been essential to guide planning for the measles campaign. We are also able to make use of staff that have vast experience in providing health services in very difficult and risky areas.”

High insecurity, difficult terrain and lack of functioning health facilities add to the enormous logistical challenges of organizing a large mass vaccination campaign that requires assembling and training more than 4000 vaccination teams and ensuring the vaccine is kept within cold chain conditions (+2⁰ to 8⁰ C) in a climate where average daytime temperatures are above 30⁰ C.

The vaccination teams for this campaign are made up of 7 people including a supervisor, vaccinators (health workers), record keepers, community mobilizers and town criers. The teams will also give children deworming medication and vitamin A supplements at the same time as the measles vaccination.

To prevent double vaccinations especially in schools and camps for displaced people, vaccination cards will be issued to all vaccinated children as well as the use of pen markers to mark their thumbs…

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WHO Grade 3 Emergencies [to 14 January 2017]

The Syrian Arab Republic
:: Survey raises concerns about hepatitis C infection in Syria
10 January 2017 – A survey of more than 20 000 people in Syria has found a concerning number of people infected with hepatitis C, especially among people who are at higher risk.

IraqNo new announcements identified.
South SudanNo new announcements identified.
NigeriaSee measles immunization campaign announcement above.
YemenNo new announcements identified.

WHO Grade 2 Emergencies [to 14 January 2017]

CameroonNo new announcements identified.
Central African RepublicNo new announcements identified.
Democratic Republic of the CongoNo new announcements identified.
Ethiopia No new announcements identified.
LibyaNo new announcements identified.
Myanmar No new announcements identified.
Niger No new announcements identified.
UkraineNo 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 #15 (2 – 8 January 2017) [EN/AR/KU]

Syria
:: 14 Jan 2017 Syrian Arab Republic: Wadi Barada Situation Report No. 1 (14 January 2017)

Yemen
:: 9 Jan 2017 Yemen Humanitarian Bulletin Issue 19 (31 December 2016)

Corporate Emergencies
Haiti
:: Haiti: Hurricane Matthew – Situation Report No. 31 (09 January 2017)
… 807,395 Individuals living in high-risk areas, including the hurricane zone, received cholera vaccine Source: UNICEF

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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO pages for updates and key developments. No new digest content identified for this edition.

Yellow Fever [to 14 January 2017]

Yellow Fever [to 14 January 2017]
http://www.who.int/emergencies/yellow-fever/en/

Disease Outbreal News [DONs}
Yellow fever – Brazil
13 January 2017
On 6 January 2017, the Brazil Ministry of Health (MoH) reported 12 suspected cases of yellow fever from six municipalities in the state of Minas Gerais…
On 12 January, the Brazil IHR NFP provided an update on the event informing that a total of 110 suspected cases, including 30 deaths, had been reported from 15 municipalities of Minas Gerais…

Public Health Response
Health authorities at the federal, state, and municipal levels are implementing several measures to respond to the outbreak:
:: The Ministry of Health has deployed technical teams to the state of Minas Gerais to assist the state and municipal secretary of health with surveillance and outbreak investigation, vector control, and coordination of health care services;
:: A house-to-house immunization campaign is being conducted in the rural areas of affected municipalities;
:: Preparedness activities are being conducted in states bordering Minas Gerais, for a potential introduction of yellow fever;
:: The local press is working together with the MoH to keep the public constantly informed on the situation.

WHO Risk Assessment
Yellow fever outbreak has previously been detected in Minas Gerais. The most recent outbreak occurred in 2002–2003, when 63 confirmed cases, including 23 deaths (CFR: 37%), were detected.
The current yellow fever outbreak is taking place in an area with relatively low vaccination coverage, which could favor the rapid spread of the disease…

Zika virus [to 14 January 2017]

Zika virus [to 14 January 2017]
http://www.who.int/emergencies/zika-virus/en/

Zika situation report – 05 January 2017
Full report: http://apps.who.int/iris/bitstream/10665/252762/1/zikasitrep5Jan17-eng.pdf?ua=1
Key Updates
:: This is the last weekly situation report. Going forward, the reports will be published every two weeks. The next report will be issued on 19 January.

WHO’s response to Zika virus and its associated complicationsReport to donors: December 2016
WHO, 2016 :: 11 pages
[Excerpt]
On 1 February 2016 WHO Director-General Margaret Chan declared that the spread of Zika virus and its associated complications constituted a public health emergency of international concern (PHEIC). On 14 February, WHO launched a global Strategic Response Framework and Joint Operations Plan, subsequently updated on 15 July, in which WHO and partners set out their strategy for preventing, detecting, and responding to Zika virus and its complications. Support from donors has ensured that this strategy has been realised.
Between February and November 2016 WHO/PAHO received US$ 23.9 million in direct contributions from 13 donors (Annex 1). This document highlights some of WHO’s key activities during this period, and points to priority areas for funding through to December 2017, including investment in research and development to foster a better understanding of Zika virus epidemiology, and how we can prevent and treat the adverse health outcomes associated with Zika virus infection.
The figure below shows how funds were received over time to pay for the response outlined in the Zika Strategic Response Plan. Funds from the WHO Contingency Fund for Emergencies (CFE) were disbursed within 24 hours of the declaration of the PHEIC, and were crucial in the early stages of the response, enabling a full Incident Management Structure (IMS) to be implemented in WHO headquarters in Geneva and all WHO regional offices. Without this bridge funding the response would have been delayed until the first contributions from Japan and Australia were received, 6 weeks after the declaration of the PHEIC. Eleven months after the declaration of the PHEIC, and thanks to the generosity of donors, funding has been secured..

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POLIO [to 14 January 2017]

POLIO [to 14 January 2017]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 11 January 2017
:: Summary of newly-reported viruses this week (see country-specific section below for further details): Pakistan: one circulating vaccine-derived poliovirus type 2 (cVDPV2) isolated from an acute flaccid paralysis (AFP) case; three positive environmental samples (two wild poliovirus type 1 – WPV1, and one cVDPV2).

Country Updates [Selected Excerpts]
Pakistan
:: Two new WPV1-positive environmental samples were reported in the past week, from Multan, Punjab (collected on 8 December) and Karachi-Landhi (greater Karachi), Sindh (collected on 14 December).
:: One new circulating vaccine-derived poliovirus type 2 (cVDPV2) case was reported in the past week, from Quetta, Balochistan, with onset of paralysis on 17 December.
:: One new cVDPV2-positive environmental sample was reported in the past week, from Quetta (collected on 20 December).
:: The isolates from both the cVDPV2 case and environmental sample are linked to an ongoing, confirmed cVDPV2 outbreak currently affecting Quetta. The case is the first associated with this outbreak – previous isolates of this strain had been found only in environmental samples.
:: An outbreak response is currently ongoing. Last week, a campaign using monovalent oral polio vaccine type 2 (mOPV2) was implemented in Quetta and surrounding areas, followed this week by an activity with inactivated polio vaccine (IPV). The Ministry of Health, supported by the World Health Organization (WHO) and partners, is further strengthening active search for cases of acute flaccid paralysis (AFP), and conducting an in-depth field investigation to more clearly ascertain the extent of circulation of the cVDPV2.

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WHO & Regional Offices

WHO & Regional Offices [to 14 January 2017]

140th session of the Executive Board
23 January–1 February 2017, Geneva
[see selected main documents summary above]

Tobacco control can save billions of dollars and millions of lives
10 January 2017 – Policies to control tobacco use, including tobacco tax and price increases, can generate significant government revenues for health and development work, according to a new landmark global report from WHO and the National Cancer Institute of the United States of America.

Highlights
Dracunculiasis eradication: Mali reports zero cases in 2016
January 2017 – In 2016, a total of 25 human cases of dracunculiasis (guinea-worm disease) were reported to WHO; Mali reported zero cases for the first time. In 2015, Mali reported 5 human cases.

Consultation: Global Accelerated Action for the Health of Adolescents (AA-HA!) Implementation Guidance Draft
January 2017 – The first draft of the Global AA-HA! Implementation Guidance is now available for review by individuals and institutions. If you have feedback, please respond by 15th January 2017 so that your comments can influence and be incorporated into the final document.

Response to trauma cases saves hundreds of lives in Iraq
January 2017 – Since 17 October 2016, WHO has supported the Government of Iraq and the Kurdish Regional Government with emergency lifesaving health services, including emergency medicines and other medical supplies like trauma and surgery kits.

Weekly Epidemiological Record, 13 January 2017, vol. 92, 2 (pp. 13–20)
Global Advisory Committee on Vaccine Safety, 30 November – 1 December 2016

:: WHO Regional Offices
Selected Press Releases, Announcements

WHO African Region AFRO
:: Millions of children to receive measles vaccine in north-eastern Nigeria
A mass vaccination campaign to protect more than 4 million children (4 766 214) against a measles outbreak in conflict-affected states in north-eastern Nigeria is planned to start this week.

WHO Region of the Americas PAHO
:: Tobacco control can save billions of dollars and millions of lives (01/10/2017)

WHO South-East Asia Region SEARO
:: Countries in South-East Asia Region combat polio vaccine shortage, committed to remain polio-free 13 January 2017
On the sixth anniversary of the last case of wild poliovirus in the South-East Asia Region, World Health Organization commends countries in the Region for their continued efforts to protect children against this crippling virus and maintain the Region’s polio-free status, despite challenging conditions.
Amid a global shortage of injectable inactivated polio vaccine (IPV), countries in the WHO South-East Asia Region are opting to use fractional doses of IPV, an evidence-based intervention that not only ensures continued protection of children against all types of polioviruses, but also helps save vaccine – a move bound to positively impact global vaccine supply in the coming years.
India became the first country globally to introduce fractional doses of IPV in childhood immunization programme in eight of its 36 states / union territories in early 2016. The initiative is now being scaled up nationwide. Sri Lanka followed suit in July 2016. Bangladesh has decided to introduce fractional IPV doses this year. Other countries in the Region are also considering a shift to the use of fractional IPV doses in their immunization schedule…

WHO European Region EURO
:: Kick-off meeting of UN European coalition on health identifies 4 workstreams for joint action 13-01-2017
:: What can countries expect during the 2016–2017 influenza season? 13-01-2017

WHO Eastern Mediterranean Region EMRO
:: Survey raises concerns about hepatitis C infection in Syria 10 January 2017

WHO Western Pacific Region
:: Tobacco control can save billions of dollars and millions of lives 10 JANUARY 2017

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