Vaccines and Global Health: The Week in Review 15 July 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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– blog edition: comprised of the approx. 35+ entries posted below.

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

Milestones :: Perspectives

Milestones :: Perspectives
Gavi Board reappoints Chair and CEO
Dr Ngozi Okonjo-Iweala and Dr Seth Berkley to help further protect millions of children from vaccine-preventable diseases
Geneva, 10 July 2017 – Dr Ngozi Okonjo-Iweala and Dr Seth Berkley have been unanimously reappointed Chair of the Gavi Alliance Board and Chief Executive Officer of Gavi, the Vaccine Alliance for three and four year terms, respectively.
Since her appointment in 2016, Dr Ngozi Okonjo-Iweala’s leadership has enabled the Alliance to further its engagement with developing countries and for partners to scale-up and finance immunisation programmes, while fostering public-private initiatives to improve access to healthcare for those most in need. Dr Okonjo-Iweala has also been an instrumental advocate for the positive economic benefits of vaccination. The direction she has provided to the Gavi Board has been critical in the implementation of the Gavi 2016-2020 strategy, which aims to support the vaccination of a further 300 million children against life-threatening diseases, preventing 5 to 6 million deaths.
“I am greatly honoured by the confidence the Gavi Alliance Board has placed in me and as Chair of the Board I am excited to be given the opportunity to continue to dedicate my work to that greatest purpose of protecting the lives of millions of the poorest children in the world with life-saving vaccines,” said Dr Ngozi Okonjo-Iweala. “Universal access to immunisation will play a fundamental role in bringing about healthy, resilient populations and in ensuring that we develop stronger economies as we face the challenges of the next century.”…
“I am extremely humbled and proud to have received the support of the entire Gavi Board,” said Dr Seth Berkley. “We are now entering a critical period for Gavi as we approach the mid-point of the 2016-2020 strategic period and as programme implementation reaches its peak. At the same time, Gavi is launching its mid-term review (MTR) process, the first milestone towards the next replenishment. I look forward to working together with partners to define our next strategy and achieve Gavi’s goal of providing equal access to life-saving vaccines.”
These reappointments follow an extensive performance review which drew on the excellent results of both individuals, as well as, in the case of the CEO, the performance of the Gavi Alliance since his appointment.
Appointment of Gunilla Carlsson as Vice-Chair of the Gavi Board
The Gavi Board has also appointed Gunilla Carlsson, former Swedish Minister for International Development Cooperation, as the new Vice-Chair of the Board. Ms Carlsson replaces Dr Flavia Bustreo, World Health Organization Assistant Director-General for Family, Women’s and Children’s Health.
Ms Carlsson joined the Gavi Board before the 2015 replenishment meeting in Berlin after playing a major role in supporting the Gavi replenishment event in London in 2011. Her extensive experience in domestic, European Union and international politics and negotiations, as well as in policy reform implementation and in mechanisms for ensuring both efficiency and accountability in complex organisations, will be crucial for the Gavi in the coming years.
Dr Flavia Bustreo who remains a Board member, was appointed Vice-Chair in January 2015…
Editor’s Note:
We include the full text of the G20 speech by Dr Tedros Adhanom Ghebreyesus. To our understanding, this is the first major international address by the new WHO DG.
Health emergencies represent some of the greatest risks to the global economy and security
Remarks delivered by Dr Tedros Adhanom Ghebreyesus to G20 8 July 2017
Hamburg, Germany

It’s really a great privilege for me to be with you today to discuss the critical health threats facing our world today. And I thank you, Chancellor Merkel for your leadership in putting health on the G20 agenda and for the successful emergency simulation exercise which we have seen with health ministers in Berlin in May.

I think the exercise, as has been said, highlighted two major things among others: number one is that pandemics of infectious diseases and other threats to health, such as anti-microbial resistance, transcend borders and national interests, so vulnerability for one is vulnerability for all of us. And viruses actually do not know or do not respect borders.

And the second thing from the exercise that we found out is that we are not well prepared. That we are very often reactive rather than proactive. Therefore we require a strong global response- that we need to remain connected in our inter-connected world.

The reason we ask you to support global health is because we want to support you, you the leaders, to achieve your goals. Because pandemics, health emergencies and weak health systems not only cost lives but represent some of the greatest risks to the global economy and security that we face today.

And we know what happened as has been said with Spanish flu in 1918: more than 50 million people died.

And the SARS outbreak cost the world economy around US$ 60billion.

We have seen bird flu, MERS, Zika. Now. Cholera, Yellow Fever are back in force. WHO detects around 3000 signals a month but the world actually knows very few of them.

We do not know where the next global pandemic will occur, we don’t know when it will occur, but it will be costly in lives and dollars. With airline travel (3 billion travellers every year) global spread of any new pathogen would occur in hours. As well as untold human suffering, the economic losses would be measured in trillions,-including the losses of tourism, trade, consumer confidence and also including political problems and challenges. There will be 2 epidemics – one caused by the virus, and the other one caused by fear.

During the Ebola outbreak of 2014 in West Africa, WHO and the global community had to confront a tough reality that had left the world unprepared-what Jim Kim, the President of the World Bank calls the cycle of panic and neglect. At the height of outbreaks, we are galvanized but we quickly lose focus. Our world cannot afford this vicious cycle to continue.

The Ebola outbreak has also taught us another lesson. Our global system is only as strong as its weakest link. We must address the root causes of this problem: the lack of access of the most vulnerable people to health care, especially primary health care.

Universal health coverage and health security are the two sides of the same coin. This year, 400 million people, that is 1 out of 17, mostly poor people, women and children, around the world remain without access to health care. Strong health systems will not only be our best defence but will also be critical for attaining the SDGs.

So we propose 4 ways forward which we actually all know.
Number one is sustainably financing the global health security system to prevent, detect and respond to emerging threats, whether natural or man-made. Ensuring a guaranteed level of contingency financing for outbreaks and emergencies would be a great start.

And the second is mapping all the capacities we have can help us to move forward, mapping all capacities in countries and use them in a coordinated manner, based on their comparative advantage to strengthen preparedness.

And the third recommendation is to support the goal of Universal Health Coverage in line with the SDGs. This is the strategic solution actually, to prevent epidemics and provide quality care to our people by strengthening health systems of countries, especially in the most fragile and vulnerable parts of our world.

And number four, prioritize research and development of new medical counter-measures through the Research and Development Blueprint of the World Health Organization. WHO strongly supports the German proposal to establish the Global Collaboration Hub on Antimicrobial resistance research and development.

Delivering on these priorities will cost money but only a fraction of what remaining unprepared will cost.

WHO is prepared to fully play its leadership role. And together we need to take the responsibility of making the world a healthier and safer place. It’s possible and it’s in our hands.
Thank you.

Announcement on the passing of Olga Popova
12 July2017
by Johan Van Hoof, Global Head, Infectious Diseases & Vaccines, Janssen; Managing Director, Janssen Vaccines & Prevention B.V.
Dear all,
I am sorry to have to share some very sad news today. Olga Popova, Janssen’s Head of Global Vaccine Policy & Partnerships and member of the company’s Vaccines Leadership Team, passed away on Monday after fighting a brave battle with cancer.

Olga joined Janssen Vaccines in 2007 to lead the Government Affairs group. Since then, she directed international policy development for Janssen and was a true thought leader, helping to shape Janssen’s public policy priorities, perspectives and contributions on vaccine development and pandemic preparedness issues. Olga oversaw our relationships and ongoing dialogue with numerous international stakeholders, such as the WHO and GAVI Alliance, major philanthropic foundations, and many industry associations such as IFPMA.

Olga was always very committed to the development and implementation of life-saving vaccination programs, especially for children. She provided expert ongoing counsel to the Board of GAVI, including to support the organization’s replenishment campaign with the goal of immunizing an additional 300 million children in developing countries by 2020. And she was one of the leaders of Janssen’s Quinvaxem program, for which we are immensely grateful for her invaluable contribution.

Perhaps most notably, Olga was a driving force when Johnson & Johnson, through its Janssen Pharmaceutical Companies, accelerated the development of our Ebola vaccine at the height of the 2014 Ebola outbreak. She played an instrumental role in forging and maintaining our relationships with key global partners, including WHO, the European Commission and the Innovative Medicines Initiative. These partnerships, and Olga’s tireless work in support of them, were critical in accelerating the development of our Ebola vaccine.

Beyond these many professional achievements, Olga was a true public champion for vaccines. She shared – proudly and with pictures – that she had her daughter vaccinated. Her dedication to the public health value of vaccines was inspiring.

Above all, we will remember Olga as a very positive, warm person and a great person. She was widely esteemed as a passionate, energetic leader and champion for people in developing nations. Her vibrant embrace of every opportunity and challenge made her a joy to work with, and she will be sorely missed by all of us who had that privilege.

Olga’s funeral was held yesterday in Calabria, Italy. Our deepest condolences and thoughts go out to her family and young daughter.

If you would like to express your own personal condolences, you may reply to me and we will be sure to include your thoughts in a condolence book from Janssen that we will ultimately share with Olga’s family.

Olga was an exceptional colleague with many talents, a great ambassador for us at many international organizations and a great human being. She will be missed dearly.


Yemen – Cholera – OCV
Editor’s Note:
   We have been monitoring the cholera outbreak in Yemen [currently the globe’s largest] for some time, with particular focus on the recent decision to allocate 1 million doses of OCV from the global stockpile for deployment in country. It has been unclear what the status of that deployment might be, and what review and decision processes might be underway as the volume of suspected cases and fatalities have continued to mount.
  We provide below a chronological sample of information and characterizations from WHO, other agencies, and the media on the status of the cholera epidemic and the OCV allocated to help address it. 
  We will continue to monitor this, noting the shifting narratives below, the absence of any posted information or announcement about the OCV decisions, and that no mention of the OCV intervention was included in the new WHO DG’s presentation on Yemen to the Security Council [see below].
10 July 2017
UN OCHA – L3 Emergencies Yemen
:: Key messages on cholera (10 July 2017)
Yemen, the world’s largest food security crisis, is now facing the world’s worst cholera outbreak which in the span of two months has spread to the entire country except for one governorate….
[No mention of OCV]
10 July 2017
WHO and partners, including UNICEF, scale up efforts to minimize spread of acute watery diarrhoea/cholera in the Eastern Mediterranean Region
10 July 2017 – With increasing numbers of people in some countries of the World Health Organization’s Eastern Mediterranean Region affected by acute watery diarrhoea and cholera, WHO in the Region is working with partners, including UNICEF, to save lives in areas where outbreaks are active, and reduce the risk of these diseases crossing into unaffected areas and neighbouring countries.
“The situation has reached a critical point. The number of people with acute watery diarrhoea/cholera in countries in the Region in 2017 alone is higher than the number of people affected worldwide in 2016. Infectious diseases know no borders, and can quickly spread if they are not effectively contained. As the numbers of cases grow day by day, it is imperative that we exert all efforts to make sure populations in cholera-endemic countries and neighbouring countries are protected,” said Dr Mahmoud Fikri, WHO Regional Director for the Eastern Mediterranean.
Population movement is increasing the risk of epidemic-prone diseases crossing into unaffected areas. In Somalia, the cholera outbreak has spread to the northern region, which had previously been cholera-free for more than 10 years. In Sudan, cases of acute watery diarrhoea have appeared for the first time in camps hosting internally displaced Sudanese in Darfur. Increasing numbers of people are expected to be affected during the current high season for transmission of waterborne disease due to deteriorating humanitarian conditions and lack of access to safe water and sanitation.  Acute watery diarrhoea/cholera are easily treatable, but can be life-threatening without immediate medical care. National health authorities in affected countries, supported by WHO and partners, are responding to the current outbreaks through disease surveillance for the early detection of cases, improving case management and infection control through the establishment of treatment centres, improving and monitoring water quality, providing medicines and supplies, introducing the oral cholera vaccine, and promoting safe hygiene practices in communities.
WHO and UNICEF co-hosted a sub-regional meeting region from 8 to 9 July 2017 in Beirut, Lebanon, on scaling up preparedness and response to acute watery diarrhoea/cholera in the Region. The meeting was attended by health officials from affected and neighbouring countries, as well as key partners involved in the health response.
A regional roadmap was developed during the meeting focusing on the areas of (a) strengthening coordination at sub-national level; (b) enhancing integrated, multi-sector rapid response teams in affected areas; (c) decentralising and expanding laboratory testing; (d) reinforcing guidelines for case management and infection prevention and control; (e) scaling up water and sanitation activities at household level; and
(f) enhancing risk communications at community level.

In line with the International Health Regulations (IHR 2005), WHO will also work closely with neighbouring countries to reinforce disease surveillance, laboratory and preparedness capacity, including at Points of Entry, to rapidly detect potential cases and ensure that all suspected acute watery diarrhoea/cholera cases are referred to appropriate health facilities.

11 July 2017
Geneva Press Briefing: UNHCR, OCHA, UNICEF, ITU, ILO, IOM, WHO,  TUESDAY, 11 JULY 2017
[Video: 01:09:01]
WHO – Christian Lindmeier [at approx.. 59:00 – 01:09; Editor’s excerpts as no transcript of the press briefing has been posted]
Reporter: Follow up on [OCV] vaccines for Yemen, what is status?
Response: Government still deciding…likelihood that OCV will not be used…OCV will likely be re-routed to other settings where they might be used more effectively…

Reporter: Wait…A number of agencies had been working on this…it was clear from you [WHO] and other agencies that these vaccines were going there…vaccines are staged…what has changed?
Response: Yemen a “complex situation” with regard to cholera…outbreak is at different stages in different districts…it’s a race against the clock…can’t plan a campaign like a normal country…security situation difficult…also, huge volume of vaccines…cold chain issues right to point of use…also now in middle of an outbreak…need to get ahead of the curve…makes no sense now…must get ahead of the situation to make best use of OCV…logistically a huge effort…

Reporter: Follow-up – We are talking about 300,000 cases…many deaths…what might you have done differently…
Response:  Too early to speculate…volatile situation…
11 July 2017
U.N. Suspending Plan for Cholera Vaccination in Yemen
New York Times, July 11, 2017 – By NICK CUMMING-BRUCE and RICK GLADSTONE
United Nations officials said a cholera vaccination campaign no longer made sense in Yemen because the war would make the effort difficult.
GENEVA — The United Nations said on Tuesday that it was suspending plans for a cholera vaccination campaign in Yemen — reversing a decision made a month ago — because the disease’s rampant spread and the ravages of war there would make such an effort ineffective.
Jamie McGoldrick, the United Nations aid coordinator in Yemen, said plans for preventive vaccination were being “set aside.” He attributed the change to obstacles in delivering vaccines in the middle of a conflict that has crippled the country’s health system and hampered access to some areas threatened by the contagious disease.
Christian Lindmeier, a spokesman for the World Health Organization, told reporters the vaccine doses originally designated for shipment to Yemen would probably be sent to other countries threatened by cholera, where they could be used more effectively.
The surprise disclosure, made at a regular news briefing at the United Nations headquarters in Geneva, came as the number of Yemenis afflicted with cholera reached 313,000 and the death toll exceeded 1,700
… A vaccination effort in Yemen, Mr. Lindmeier said, is a “difficult approach because you can’t plan a campaign like you would do in a normal country” where war and insecurity are absent…
12 July 2017
The situation in the Middle East (Yemen) – Security Council, 7999th meeting – 12 Jul 2017 – 
[Video: 1:09:43]
WHO DG Tedros Report [at approx. 24:00 – 30:00]
No mention of OCV

Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Stephen O’Brien: Statement to the Security Council on Yemen, 12 July 2017
… Nearly 16 million people do not have access to adequate water, sanitation and hygiene, and more than 320,000 suspected cholera cases have been reported in all of the country’s governorates bar one. At least 1,740 people already are known to have died from this entirely preventable disease – probably many more in the many very remote areas of Yemen we can’t reach….
…This cholera scandal is entirely manmade by the conflicting parties and those beyond Yemen’s borders who are leading, supplying, fighting and perpetuating the fear and fighting…
Just for the sake of reaching all the millions of Yemenis with cholera vaccines, so desperately needed, the people of Yemen need stability. Failure to do so renders their fate, and our – and your – ability to intervene useless and hopeless. We should all feel deeply guilty about that – and especially the conflicting parties in Yemen should do so and those who drive them from outside Yemen. Our joint – your –top common priority should be always to save civilian lives and protect them. The Yemeni people deserve this equally to any other citizen of the world – be it one of you around this table or someone cowering in fear somewhere in Sana’a or Taizz in Yemen…
14 July 2017
Geneva Press Briefing: WHO, OHCHR, UNHCR, IOM – 14 Jul 2017 
Biweekly Geneva Press Briefing Chaired by Alessandra Vellucci, Director of the United Nations Information Service in Geneva
[Video: 1:09:03]
Dominic LeGros, WHO focal point for cholera [at approx 04:40 to 22:00; Editor’s excerpts as no transcript of the press briefing has been posted]
:: Began by relating the status of a number of other cholera outbreaks underway globally.
:: Referenced October 2017 meeting as call for action to address recurring cholera outbreaks…notes that solution is not a technical issue…a matter of engagement/political will by countries and development donors.

Reporter: Could you elaborate on thinking behind not proceeding with selected OCV vaccinations?
Response: Decisions made by Yemeni authorities to delay. We understand that decision… outbreak is so mature in Yemen…difficult to find districts where OCV could make maximum contribution. 43 OCV campaigns since formation of stockpile. Also, need resources for classic response strategies [WASH]…

Reporter: Follow up…so, effectively, was the window of opportunity to use the vaccine [OCV] missed at some point in the past?
Response: Dealing with a country that so far did not choose the vaccine…[OCV] is a new strategy, new tool…we have seen this kind of delay in decision to use. The other fact is that epidemic is moving very fast there so difficult to project course…

14 July 2017
Vaccine deployment for cholera suspended in Yemen
By Daniella Emanuel, CNN
Updated 9:29 AM ET, Fri July 14, 2017
(CNN)The cholera outbreak in Yemen is spreading so quickly that plans have been suspended to deploy one million doses of vaccines to the country, according to the World Health Organization.
The number of suspected cases affected by the outbreak is now more than 325,000. Cholera is an acute diarrheal illness which kills thousands of people worldwide each year.
“The situation has evolved so rapidly that vaccines are not the priority tool to use right now,” Tarik Jasarevic, WHO spokesperson, said in an email.
“Now that cholera has spread to 91% of Yemen’s governorates, the focus will instead be on scaling up other interventions that will have a greater effect on the evolution of the outbreak and save lives.”
Those interventions include scaling up access to clean water and sanitation, treatment to people affected and working with communities to promote hygiene, sanitation and cholera prevention, explained Jasarevic.
The one million doses of vaccine were initially approved by the International Coordinating Group, an organization established in 1997 with the purpose of managing and coordinating the use of emergency vaccine supplies and antibiotics to countries in the midst of major outbreaks, according to WHO.
The one million doses of vaccine were initially approved by the International Coordinating Group, an organization established in 1997 with the purpose of managing and coordinating the use of emergency vaccine supplies and antibiotics to countries in the midst of major outbreaks, according to WHO.
Five hundred thousand doses were shipped to Djibouti in East Africa because of the country’s close proximity to Yemen, Jasarevic said. The country is across the Bab al-Mandab Strait from Yemen.
The vaccines are still there, and they may be shipped to another country for use, he said.
“The decision to suspend was taken by the Yemeni authorities in consultation with the technical teams that are working on cholera from the United Nations side,” said George Khoury, Head of Office at the UN Office for the Coordination of Humanitarian Affairs in Yemen.
WHO confirmed that they and other partners were consulted on the decision. They serve as advisers to the Yemen health authorities on vaccines and other interventions related to the ongoing cholera outbreak in the country, Jasarevic said.
“It was decided by the professionals that all the risks and the potential problems may outweigh the benefits of administering the vaccine,” Khoury said. “Given the limited number of vaccines, administering the vaccines in some areas and not others may create disputes on who gets and who doesn’t get the vaccine…

Public Health Emergency of International Concern (PHEIC)

Polio this week as of 12 July 2017 [GPEI]
:: At the G20 Head of State Summit in Hamburg, Germany, last weekend, leaders acknowledged the efforts to eradicate and committed to completing the job of polio eradication.  More.

:: Journal of Infectious Diseases publishes supplement of articles on polio endgame and legacy implementation lessons learned and best practices. [see below]

:: The Global Certification Commission for the Eradication of Poliomyelitis (GCC) met on 4-5 July in Paris, France.  This was the 16th meeting of the GCC, and the first under the group’s new Chair, Professor David Salisbury from the UK, following the retirement of the previous Chair Professor Tony Adams from Australia.  The meeting was attended by all six Regional Certification Committee (RCC) Chairs, along with partners of the Global Polio Eradication Initiative (GPEI).

:: In Syria, one of the previously-reported cases from Raqua, on re-testing, has been confirmed as negative for circulating vaccine-derived poliovirus type 2 (cVDPV2), and has been removed from the list of cases.  The total number of cVDPV2 cases is now 23 (22 from Deir-Al-Zour and one from Raqua).

:: The Pakistan and Afghanistan National Emergency Operation Centre teams convened a coordination meeting in Amman, Jordan, on 10–11 July.  A joint response plan was put together for new wild poliovirus type 1 (WPV1) cases / isolates in the southern corridor (comprising Quetta Block / Greater Kandahar). The teams also reviewed the situation in the greater Peshawar / Nangarhar and South East Afghanistan / Southern KP-FATA Corridors and agreed on further actions to improve the quality of immunization activities and surveillance with special focus on high-risk mobile populations.

:: Summary of newly-reported viruses this week:  Pakistan – one new wild poliovirus type 1 (WPV1) isolated from an acute flaccid paralysis case; Afghanistan – one new WPV1-positive environmental sample.  See country-specific section below, for more details.

Journal of Infectious Disease
Volume 216, Issue suppl_1  1 July 2017
Polio Endgame & Legacy-Implementation, Best Practices, and Lessons Learned
49 articles focused on themes including:
Addressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future
Manish Patel; Stephen Cochi
The Global Commission for the Certification of the Eradication of Poliomyelitis certified the eradication of type 2 poliovirus in September 2015, making type 2 poliovirus the first human pathogen to be eradicated since smallpox. The eradication of type 2 poliovirus, the absence of detection of type 3 poliovirus worldwide since November 2012, and cornering type 1 poliovirus to only a few geographic areas of 3 countries has enabled implementation of the endgame of polio eradication which calls for a phased withdrawal of oral polio vaccine beginning with the type 2 component, introduction of inactivated poliovirus vaccine, strengthening of routine immunization in countries with extensive polio resources, and initiating activities to transition polio resources, program experience, and lessons learned to other global health initiatives. This supplement focuses on efforts by global partners to successfully launch polio endgame activities to permanently secure and sustain the enormous gains of polio eradication forever.

WHO Grade 3 Emergencies  [to 15 July 2017]
::  YEMEN: cholera outbreak – Daily epidemiology update: 15 July 2017
From 27 April to 14 July 2017, 338 969 suspected cholera cases and 1 770 deaths (CFR: 0.5%)
have been reported in 91.3% (21/23) of Yemen governorates, and 87.7% (292/333) of the

Iraq  – No new announcements identified.
NigeriaNo new announcements identified.
South SudanNo new announcements identified.
The Syrian Arab Republic – No new announcements identified.
WHO Grade 2 Emergencies  [to 15 July 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: Mosul Humanitarian Response Situation Report No. 39 (29 June to 11 July 2017)
:: Humanitarian funding is urgently required to assist 700,000 civilians displaced from Mosul [EN/AR/KU]
(Baghdad, 9 July 2017) – Since the military campaign to retake Mosul began on 17 October 2016, 920,000 civilians have fled their homes. Close to 700,000 people are still displaced, nearly half of whom are living in 19 emergency camps.
“It’s a relief to know that the military campaign in Mosul is ending. The fighting may be over, but the humanitarian crisis is not,” said the Humanitarian Coordinator for Iraq, Ms. Lise Grande.
“Many of the people who have fled have lost everything. They need shelter, food, health care, water, sanitation and emergency kits. The levels of trauma we are seeing are some of the highest anywhere. What people have experienced is nearly unimaginable,” said Ms. Grande.
“We’ve been working around the clock for months. Enormous efforts have been made by the Government and front-line partners to stay one step ahead of the crisis. We’ve done our best to protect and assist the people who need it the most.”
“There’s a lot to do in the weeks and months ahead. Of the 54 residential neighborhoods in western Mosul, 15 are heavily damaged and at least 23 are moderately damaged.”
“The civilians who are trapped in the areas where fighting is likely to occur, including Tel Afar, Hawija and western Anbar, will be at extreme risk. We have to make sure we are ready to help them,” said Ms. Grande.
Only 43 percent of the USD 985 million Humanitarian Response Plan for Iraq has been received. Partners urgently require US$562 million to meet the needs of millions of Iraqis who need help.

Syrian Arab Republic
:: 14 Jul 2017  Syrian Arab Republic: CCCM Whole of Syria Ar-Raqqa Displacement Map as of July 5, 2017

:: Key messages on cholera (10 July 2017)
Current situation
Yemen, the world’s largest food security crisis, is now facing the world’s worst cholera outbreak which in the span of two months has spread to the entire country except for one governorate (Socotra island)….

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: 10 Jul 2017 Ethiopia Weekly Humanitarian Bulletin, 10 July 2017

:: DRC: Number of internally displaced people rises to 3.8 million – the highest in Africa
7 July, 2017  The Democratic Republic of the Congo (DRC) is experiencing a significant change in conflict patterns, with growing intercommunal tensions and violence affecting new parts of the country. DRC is now one of the world’s most complex humanitarian crises, in which 7.3 million people need humanitarian assistance.
The relentlessly acute nature of the crisis, the lack of basic social services throughout the country and the persistent armed conflict have led to the internal displacement of 3.8 million people. This is the highest number of displaced people in the African continent…

WHO & Regional Offices [to 15 July 2017]

WHO & Regional Offices [to 15 July 2017]

Extending health coverage in the Democratic Republic of the Congo
13 July 2017 – In the Tanganyika province of the Democratic Republic of the Congo, going to a health centre often means traveling long distances over poor roads, while carrying a sick child and supplies. WHO’s Rapid Access Expansion Programme (RAcE) is bringing diagnosis and treatment for malaria, pneumonia, and diarrhoea – the three deadliest childhood diseases – into remote communities.

Trachoma: 85 million people treated through expanded access to medicine
2017 – New WHO data show a remarkable increase of 63% in the number of people treated with an antibiotic for trachoma from 2014–2016, considerably improving prospects for the global elimination of the disease. The surge is mainly due to expanded access to azithromycin.

Measles continues to spread and take lives in Europe
July 2017 – Ongoing measles outbreaks in the Europe have caused 35 deaths in the past year. The most recent fatality was a 6-year-old boy in Italy, where over 3300 measles cases and 2 deaths have occurred since June 2016. Several other countries have also reported outbreaks, according to national public health authorities.

Scaling up efforts to minimize spread of acute watery diarrhoea/cholera in the Eastern Mediterranean Region
July 2017 – With increasing numbers of people in some countries of WHO’s Eastern Mediterranean Region affected by acute watery diarrhoea and cholera, WHO is working with partners, including UNICEF, to save lives in areas where outbreaks are active, and reduce the risk of these diseases crossing into unaffected areas and neighbouring countries.


Weekly Epidemiological Record, 14 July 2017, vol. 92, 28 (pp. 393–404)
:: Meeting of the Global Advisory Committee on Vaccine Safety, 7–8 June 2017
:: Monthly report on dracunculiasis cases, January– May 2017

Disease outbreak news
:: Cholera – Nigeria – 12 July 2017
:: Acute hepatitis E – Nigeria  – 12 July 2017
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Mobile teams deliver healthcare to more than 400 000 in remote areas of north-eastern Nigeria  13 July 2017 – Among many women who brought their children to the WHO-supported…
:: 5 places where WHO needs more emergencies funding to help people now
12 July 2017 – To help people living in some of the world’s most dire emergency…
:: WHO in collaboration with the Ministry of Health and health partners strategizes efforts to combat cholera in South Sudan  10 July 2017 – Cholera contributes substantially to the disease burden in South…
:: Paramount rulers in the Northern Nigeria recommit to improving health indicators in the region.  10 July 2017 – Sokoto, 10 July 2017 – Paramount rulers under the umbrella body,…

WHO European Region EURO
:: Using experience and lessons learned to help countries combat tobacco industry tactics 13-07-2017
:: Public health advice as heatwave continues across southern and central Europe 13-07-2017
:: Measles continues to spread and take lives in Europe 11-07-2017
:: Collaboration among immunization programmes aims to bring Europe closer to stopping HPV 10-07-2017
:: Minister of Health of Lithuania visits WHO/Europe to discuss key priorities and collaboration 10-07-2017

WHO Eastern Mediterranean Region EMRO
:: WHO and partners, including UNICEF, scale up efforts to minimize spread of acute watery diarrhoea/cholera in the Eastern Mediterranean Region  10 July 2017

CDC/ACIP [to 15 July 2017]

CDC/ACIP [to 15 July 2017]

MMWR News Synopsis for July 13, 2017

Measles Outbreak — Minnesota, April–May 2017
Recent U.S. and international measles cases are concerning and serve as a reminder of the seriousness of the disease and the importance of vaccination. Addressing parents’ questions and concerns and correcting misinformation about childhood vaccines through healthcare professionals and other trusted community leaders is critical in protecting children and communities from vaccine-preventable diseases. Since April 2017, a measles outbreak in Minnesota has been demonstrating the importance of maintaining high vaccination rates to protect communities from measles. Measles quickly spread in an under-vaccinated population, resulting in a large-scale and intensive public health response to prevent further illnesses and possible deaths. The outbreak also highlighted the importance of building trust with communities and identifying effective, culturally appropriate ways to address questions, concerns, and misinformation about the MMR vaccine.

Pneumococcal Vaccination Among Medicare Beneficiaries Following the Advisory Committee on Immunization Practices Recommendation for Routine Use of 13-valent Pneumococcal Conjugate Vaccine and 23-valent Pneumococcal Polysaccharide Vaccine for Adults Aged ≥65 Years
Providers should ensure that older adults initiate and complete the recommended pneumococcal vaccination series to reduce their risk of contracting pneumococcal disease. To reduce the burden of pneumococcal disease, providers should ensure that older adults initiate and complete the recommended pneumococcal vaccination series. CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS) to help measure PCV13 and PPSV23 vaccination uptake among adults aged ≥65 years before and after implementation of revised recommendations in September 2014. By September 18, 2016, 43.2 percent of Medicare Parts A and B beneficiaries aged ≥65 years had claims for at least one dose of PPSV23 (regardless of PCV13 status), 31.5 percent had claims for at least one dose of PCV13 (regardless of PPSV23 status), and 18.3 percent had claims for at least one dose each of PCV13 and PPSV23.


CEPI – Coalition for Epidemic Preparedness Innovations  [to 15 July 2017]
08 July 2017
Norway strengthens its commitment to CEPI
CEPI welcomes global leadership shown by government of Norway
CEPI welcomes the vital contribution of additional funding from the government of Norway, which today announced it is increasing its original investment in CEPI by $70m. The government of Norway is a founding investor in CEPI, which will create new vaccines against epidemic threats through an innovative partnership between public, private, philanthropic and civil organizations.
Together with the governments of Germany and Japan, the Bill & Melinda Gates Foundation and Wellcome, the founding investors contributed a total of $540m to launch CEPI in January 2017. CEPI’s mission is to outsmart epidemics by developing safe and effective vaccines against known infectious diseases that can be deployed rapidly to contain outbreaks, before they become global health emergencies.
Responding to the announcement by the Prime Minister of Norway, Erna Solberg, at the G20 summit, Richard Hatchett, CEO of CEPI said:
“Norway was at the forefront of the world’s response to Ebola. Its far-sightedness helped facilitate the clinical evaluation of an Ebola vaccine that showed 100% effectiveness. It demonstrated that same spirit when it became a founding investor in CEPI. And today, we thank the government of Norway for this additional vital investment. This is a wonderful example of global leadership that will strengthen our defenses against the diseases that threaten the health, prosperity and security of us all. It is further proof of the momentum within the G20 to support collective action against future epidemics.”…

The Vaccine Confidence Project  [to 15 July 2017]
12 Jul, 2017
EU judgment on vaccine claims: Vaccine confidence breaker or trust builder?
Confidence Commentary – Heidi Larson With Shalini Anand reporting from India
A recent landmark judgment by the European Court of Justice (ECJ) has shaken the global health community. Scientists from all over the world have voiced dissent, as the ruling threatens to undermine science-based evidence and impact on vaccine confidence….
NIH  [to 15 July 2017]
July 13, 2017
Experimental Zika virus vaccines restrict in utero virus transmission in mice
— Vaccines protect against Zika-related congenital damage.

July 12, 2017
HIV hijacks surface molecule to invade cell
— NIH discovery could lead to new drugs to prevent HIV infection.

July 10, 2017
NIH launches prospective study of Zika and HIV co-infection during pregnancy
— Study to determine potential risks that infection with Zika may pose for pregnancies in which the mother is also has HIV.
UNAIDS  [to 15 July 2017]
Selected Press Releases & Updates
Review of Global Commission on HIV and the Law identifies progress and challenges
“Laws that criminalize HIV are anti-science, unjust and unconstructive”
14 July 2017
Five years ago, a landmark report published by the Global Commission on HIV and the Law urged governments to promote laws and policies grounded in evidence and human rights in order to turn the tide against AIDS. On 12 and 13 July, members of the commission and other experts came together to assess the progress made in advancing the report’s recommendations, look at the barriers that remain and discuss opportunities for further progress.
The participants recognized the role of the commission as a catalyst for social justice and human rights in the HIV response. Since the release of the commission’s report in 2012, efforts to advance the report’s recommendations have been documented in 88 countries. Several countries have conducted comprehensive assessments of laws, policies and practices affecting people living with HIV and have changed legislation as a result. National conversations on the rights of people living with and vulnerable to HIV have led countries to reform discriminatory practices against people living with HIV. Judges, civil society organizations and partners have been instrumental in helping to overturn discriminatory legislation and counter HIV stigma…

European Medicines Agency  [to 15 July 2017]
Call for independent scientific experts to join EMA’s Pharmacovigilance Risk Assessment Committee (PRAC)
Expressions of interest to be submitted to European Commission by 30 September 2017
Wellcome Trust  [to 15 July 2017]
11 July 2017
Researchers establish key mechanism controlling cell division
Researchers at the Francis Crick and Gurdon Institutes have pinpointed the mechanism that activates a key point in embryonic development. This could help scientists develop new treatments for diseases where the cell cycle is disrupted, such as cancer.
Industry Watch
:: Sanofi to acquire Protein Sciences 
Acquisition adds recombinant-based influenza vaccine to Sanofi Pasteur’s portfolio
Paris, France – July 11, 2017 – Sanofi announced today it will acquire Protein Sciences, a privately held vaccines biotechnology company based in Meriden, Connecticut in the United States. Under the terms of the agreement, Sanofi will make an upfront payment of $650 million and pay up to $100 million upon achievement of certain milestones.
Protein Sciences received approval from the US Food and Drug Administration (FDA) in October 2016 for their Flublok® Quadrivalent Influenza Vaccine (QIV). Flublok® is the only recombinant protein-based influenza vaccine approved by the FDA.
“The acquisition of Protein Sciences will allow us to broaden our flu portfolio with the addition of a non-egg based vaccine,” said David Loew, Sanofi Executive Vice President and Head of Sanofi Pasteur, Sanofi’s vaccines division.
“Protein Sciences was actively looking for an opportunity to grow its business, particularly in the US,” said Manon M.J. Cox, President and Chief Executive Officer, Protein Sciences. “As part of Sanofi Pasteur, we expect our Flublok influenza vaccine to benefit from Sanofi Pasteur’s expertise in the field of influenza vaccines.”
The acquisition, which has been unanimously approved by the board of directors of Protein Sciences and a majority of Protein Sciences shareholders, is expected to close in the third quarter of 2017, subject to customary regulatory approvals.


BIO    [to 15 July 2017]
Jul 13 2017
Jennifer Dent (BIO Ventures for Global Health) at the 2017 BIO International Convention
Mike Huckman interviews Jennifer Dent (BIO Ventures for Global Health) at the 2017 BIO International Convention Buzz Center

Jul 13 2017
Nima Farzan (PaxVax) at the 2017 BIO International Convention
Mike Huckman interviews Nima Farzan (PaxVax) at the 2017 BIO International Convention Buzz Center.

PhRMA    [to 15 July 2017]
July 12, 2017
PhRMA Statement on House Passage of PDUFA VI Reauthorization
PhRMA president and CEO Stephen J. Ubl issued the following statement on the House passage of PDUFA reauthorization.

July 12, 2017
New “Let’s Talk About Cost” campaign convenes national dialogue on medicine costs
Discussions about costs are important. We recognize that many are struggling to access their medicine and have important questions about their medicine costs.

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:

Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines
July 2017 :: 110 pages
This report presents the first ever estimates of the population using ‘safely managed’ drinking water and sanitation services – meaning drinking water free from contamination that is available at home when needed, and toilets whereby excreta are treated and disposed of safely. It also documents progress towards ending open defecation and achieving universal access to basic services. The report identifies a number of critical data gaps that will need to be addressed in order to enable systematic monitoring of Sustainable Development Goal (SDG) targets and to realize the commitment to ‘leave no one behind’.

Joint press release
2.1 billion people lack safe drinking water at home, more than twice as many lack safe sanitation
WHO, UNICEF release first global estimates for water, sanitation and hygiene for the Sustainable Development Goals
12 JULY 2017 GENEVA/ NEW YORK – Some 3 in 10 people worldwide, or 2.1 billion, lack access to safe, readily available water at home, and 6 in 10, or 4.5 billion, lack safely managed sanitation, according to a new report by the World Health Organization (WHO) and UNICEF.
The Joint Monitoring Programme report, Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and Sustainable Development Goal Baselines, presents the first global assessment of “safely managed” drinking water and sanitation services. The overriding conclusion is that too many people still lack access, particularly in rural areas.

“Safe water, sanitation and hygiene at home should not be a privilege of only those who are rich or live in urban centres,” says Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “These are some of the most basic requirements for human health, and all countries have a responsibility to ensure that everyone can access them.”

Billions of people have gained access to basic drinking water and sanitation services since 2000, but these services do not necessarily provide safe water and sanitation. Many homes, healthcare facilities and schools also still lack soap and water for handwashing.  This puts the health of all people – but especially young children – at risk for diseases, such as diarrhoea.
As a result, every year, 361 000 children under 5 years die due to diarrhoea. Poor sanitation and contaminated water are also linked to transmission of diseases such as cholera, dysentery, hepatitis A, and typhoid.

“Safe water, effective sanitation and hygiene are critical to the health of every child and every community – and thus are essential to building stronger, healthier, and more equitable societies,” said UNICEF Executive Director Anthony Lake. “As we improve these services in the most disadvantaged communities and for the most disadvantaged children today, we give them a fairer chance at a better tomorrow.”

Significant inequalities persist
In order to decrease global inequalities, the new SDGs call for ending open defecation and achieving universal access to basic services by 2030.
Of the 2.1 billion people who do not have safely managed water, 844 million do not have even a basic drinking water service. This includes 263 million people who have to spend over 30 minutes per trip collecting water from sources outside the home, and 159 million who still drink untreated water from surface water sources, such as streams or lakes.

In 90 countries, progress towards basic sanitation is too slow, meaning they will not reach universal coverage by 2030.

Of the 4.5 billion people who do not have safely managed sanitation, 2.3 billion still do not have basic sanitation services. This includes 600 million people who share a toilet or latrine with other households, and 892 million people – mostly in rural areas – who defecate in the open. Due to population growth, open defecation is increasing in sub-Saharan Africa and Oceania.

Good hygiene is one of the simplest and most effective ways to prevent the spread of disease. For the first time, the SDGs are monitoring the percentage of people who have facilities to wash their hands at home with soap and water.  According to the new report, access to water and soap for handwashing varies immensely in the 70 countries with available data, from 15 per cent of the population in sub-Saharan Africa to 76 per cent in western Asia and northern Africa.

Additional key findings from the report include::: Many countries lack data on the quality of water and sanitation services. The report includes estimates for 96 countries on safely managed drinking water and 84 countries on safely managed sanitation.
:: In countries experiencing conflict or unrest, children are 4 times less likely to use basic water services, and 2 times less likely to use basic sanitation services than children in other countries.
:: There are big gaps in service between urban and rural areas. Two out of three people with safely managed drinking water and three out of five people with safely managed sanitation services live in urban areas. Of the 161 million people using untreated surface water (from lakes, rivers or irrigation channels), 150 million live in rural areas.