Vaccines and Global Health: The Week in Review 17 Feb 2018

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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 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_17 Feb 2018

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

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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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

WHO: Top epidemic-prone diseases without sufficient counter measure :: One year on, Global Observatory on Health R&D identifies striking gaps and inequalities

Milestones :: Perspectives

 
Top epidemic-prone diseases without sufficient counter measures – WHO
12 February 2018 – WHO releases its 2018 list of priority pathogens that have the potential to cause a public health emergency and which have no, or insufficient, countermeasures. WHO calls on the medical community to unite in greater R&D efforts for these 8 diseases to develop treatments and vaccines to help control outbreaks.
List of Blueprint priority diseases
2018 annual review of the Blueprint list of priority diseases
For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic.

The first list of prioritized diseases was released in December 2015. Using a published prioritization methodology, the list was first reviewed in January 2017.

The second annual review occurred 6-7 February 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

:: Crimean-Congo haemorrhagic fever (CCHF)
:: Ebola virus disease and Marburg virus disease
:: Lassa fever
:: Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute   
  Respiratory Syndrome (SARS)
:: Nipah and henipaviral diseases
:: Rift Valley fever (RVF)
:: Zika
:: Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS).

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged…
 
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One year on, Global Observatory on Health R&D identifies striking gaps and inequalities – WHO
February 2018
Each year, hundreds of billions of dollars are spent on research and development (R&D) into new or improved health products and processes, ranging from medicines to vaccines to diagnostics. But the way these funds are distributed and spent is often poorly aligned with global public health needs.

One year ago, the World Health Organization launched a new initiative to gather information and provide an accurate picture of where and how R&D monies are being spent, helping governments, funders and researchers to make better decisions on investment and policy making priorities.

Ensuring that decision-making about which diseases, countries and products receive investment funds is not entirely reliant on market forces is critical. The 2014 outbreak of Ebola virus disease in West Africa, which left more than 11,000 dead, dramatically exposed the lack of investments in products and approaches to prevent and minimize the impact of pathogens with epidemic potential. And gaps in R&D investments in the pipeline for antimicrobial medicines are a cause of global concern in the context of rapidly increasing antimicrobial resistance.

The Global Observatory on Health R&D has identified striking gaps and inequalities in investment both between countries and between health issues, with frequent disconnects between burden of disease and level of research activity.

:: High income countries have an average of 40 times more health researchers than low income countries. Based on data from 60 countries:
…The disparity in investment means the number of health research workers per million inhabitants in countries ranges from 1140 in Singapore to 0.2 in Zimbabwe.
…Women health researchers are underrepresented in low income countries. While the average number of female researchers in high income countries is approximately 51%, this drops to just 27% in low income countries.

Explore health researchers by country income group and by WHO Regions:
Health researchers data
:: Serious imbalances in funding flows mean countries with comparable levels of poverty and health needs receive strikingly different levels of Official development assistance (ODA) for medical research and basic health sectors (health ODA).
…In 2016, among low income countries, Liberia received the highest health ODA per capita – 3 times more than the weighted average amount received by other low income countries and 3.5 times more than Madagascar, which suffered from a serious outbreak of pneumonic plague this year.
…In 2016, Tuvalu, an upper middle income country, received the highest health ODA per capita (60.03 US$) anywhere in the world, 286 times more than the weighted average for the upper middle income group it belongs to, 39 times more than South Africa and 95 times more than Albania.
….Amongst countries in Africa, the Seychelles, a high income country, received the highest amount of health ODA per capita in 2016. At 34.17 US$ per capita, the country received almost 8 times more per capita than the weighted average for this region.

Explore ODA for medical research and basic health sciences per capita, by recipient country:
ODA data
:: As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, despite these diseases accounting for more than 12.5% of the global burden of disease.
…Public sector governments contributed almost two thirds of investments on product-related health R&D for neglected diseases, followed by philanthropies.
….The United States of America continues to be the lead country in investments on neglected diseases from public and philanthropic sources. Over 10 years of investments, USA has contributed almost two thirds of the total investments, followed by the United Kingdom of Great Britain and Northern Ireland and the European Union.
…Investments by the private sector in neglected diseases have increased since 2012, mostly due to investments in HIV/AIDS and malaria.

Explore the distribution of R&D funding flows for neglected diseases by country, funder and recipient organizations:
R&D funding flows by country, funder, and recipient organizations and R&D funding flows by source and type of funding
Investing in R&D to discover and develop medicines and vaccines is key to improving access to medicines and quality health care for people across the world and to achieving universal health coverage. The Global Health Observatory on Health R&D builds on existing data and reports from a wide range of sources as well as newly gathered information to provide an accurate picture of the current investment situation and enable informed decision making on priorities.

FDA statement on the efficacy of the 2017-2018 influenza vaccine

FDA [to 17 February 2018]

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
February 15, 2018 –
Statement from FDA Commissioner Scott Gottlieb, M.D. on the efficacy of the 2017-2018 influenza vaccine
Seasonal flu has been widespread this year, impacting millions of people across the country. It has been an especially challenging season, with high rates of hospitalization for both influenza and its complications, which include pneumonia and the exacerbation of chronic conditions such as asthma and congestive heart failure. Many schools have closed in an attempt to control the spread of the illness and doctors’ offices are packed with patients seeking diagnosis and antiviral treatment.

This year much of the illness has been caused by one strain of influenza A called H3N2, with another strain of influenza A called H1N1 and strains of influenza B contributing to lesser extents. The flu is a respiratory illness caused by several types and strains of influenza virus that infect the respiratory tract in humans, which includes the nose, throat and lungs.
Vaccination is one of the best ways known to protect against the flu. However, because of the severity of this season, there have been questions raised about how well this year’s flu vaccine worked. Although the initial report of 36 percent overall efficacy for this year’s vaccine in the United States that has been reported by our colleagues at the U.S. Centers for Disease Control and Prevention (CDC) is better than some might have predicted, there is still clearly significant room for improvement. The FDA is committed to working together with the scientific and medical communities to better protect the public against the flu and apply lessons learned to next season’s flu vaccines.

Because influenza viruses can change their genetic make-up rapidly during the course of a single year, seasonal influenza vaccines are unlike most other preventative vaccines, in that the strains contained in the vaccine constantly need to be adjusted based on the viruses that are expected to be in circulation. Public health experts do their best each year to select the influenza viruses against which the vaccine should provide protection. In fact, in just two weeks, the FDA will be convening an advisory panel of experts to help us select strains for next season’s flu vaccines. It takes several months for influenza vaccines to be produced so flu strains for the next season need to be selected even before the current flu season ends. The majority of vaccine doses are made using chicken eggs, which adds time to the production process, but some doses are made in mammalian cells or by recombinant DNA technology.
Although some factors are beyond our control, such as the ability of flu virus to change rapidly as it circulates, there are steps that we can take to ensure that the seasonal influenza vaccine protects as many individuals as possible. The FDA is collaborating with CDC, the National Institutes of Health (NIH), and other federal partners to address the full spectrum of measures that need to be taken to ensure optimal protection against the flu. These measures include working to select the most appropriate flu strains for inclusion in seasonal influenza vaccines, providing seed viruses and quality control reagents to manufacturers, and ensuring the overall quality of the manufacturing process…

Dengvaxia: Philippines pathology group vows help to end vaccine ‘hysteria’

Dengvaxia
We continue to monitor developments associated with Dengvaxia, recognizing the continuing and troubling political overlay to the issues in the Philippines such as reported in the Business Mirror article below. We did not identify any new press releases or statements on the Sanofi website.

Pathology group vows help to end vaccine ‘hysteria’
Business Mirror [Philippines] February 15, 2018
ANOTHER group of Filipino doctors have stepped forward to fight what they described as the scare and hysteria stirred by the Dengvaxia controversy, saying there is no medical evidence to show that the anti-dengue vaccine caused the death of some 14 Filipino children.

The Dengvaxia scare, the group said, has also jeopardized the national immunization program, and has threatened to trigger epidemics in the country.

In a news statement, the Philippine Society of Pathologists (PSP), led by its president, Dr. Bernadette R. Espiritu, called for prudence in the dissemination of information about Dengvaxia.

To recall, the expert panel from the University of the Philippines-Philippine General Hospital (UP-PGH) found that none of the 14 children whose deaths they examined could be directly attributable to Dengvaxia.

Such fact is in stark contrast with the supposed findings of the Public Attorney’s Office’s (PAO) forensics team that linked Dengvaxia to the deaths.

“Paramount here is the welfare of our children. This is not a battle of who is the best specialty group,”  Esipiritu said.

The group further said it is committed to support the Philippine Medical Association and the Department of Health in their efforts to reach out to the Dengvaxia vaccine-recipient children and their families, and to help alleviate their plight as a result of the Dengvaxia scare.

“The PSP is always ready, able and willing to serve the Dengvaxia vaccine-recipient children and their families,” the group said.

The group noted that the children who received Dengvaxia vaccination, their families and friends, are now engulfed by the undue scare that death is almost an inevitable consequence of such vaccination.

The scare has been generated by the much-publicized autopsy findings from the supposed forensic consultant of the PAO, unduly and hastily linking Dengvaxia to the death of some 14 children.

“To these helpless Filipino countrymen, their lives have practically come to a halt until they find certain solution or assurance that their Dengvaxia-vaccinated children will not suffer the same fate as those who were autopsied by those who claim to be a forensics expert,” PSP said.

A member of the Philippine Medical Association (PMA), the PSP is the recognized professional medical association that is duly mandated to train and certify physicians in the field of pathology as a medical specialty.

PSP members have undergone residency training in duly accredited hospitals and who successfully hurdled the examinations to qualify as diplomate or fellow  pathologist in either anatomic pathology or clinical pathology, or both.

According to PSP, some of its pathologists further obtain trainings and qualifications in different pathology subspecialties, which include forensic pathology that is now at the core of the dengue vaccine scare.

A forensic pathologist is a medical graduate and licensed physician  who completed the prescribed residency training in anatomic or anatomic and clinical pathology and passed the diplomate board examinations for anatomic or both anatomic and clinical pathology; and successfully completed the prescribed training in forensic  pathology.

At present, the PSP recognizes only two Filipino physicians who have successfully hurdled the stringent trainings and are qualified in the medical subspecialty of forensic pathology and these exclude Dr. Edwin Erfe of PAO.

The group does not discount the capabilities of other physicians conducting autopsies without being trained, qualified and certified as diplomate or  fellow in anatomic or in  anatomic and clinical pathology.

However, it said, the medical profession as a field of science  adheres to certain standards and best practices, which are validated and ensured by medical societies of the PMA in their respective fields of medical specialization.

According to PSP, pathologists are trained to conscientiously handle and process tissue samples as specimens, starting with gross examinations thereof that have to be subsequently correlated with microscopic examinations of specimen slides.

PSP underscored that the most critical in the process is the training of pathologists to adequately sample and properly handle tissues/specimen for histopathologic examination. Any misstep in this process is prone to yield incorrect or misleading diagnosis, which is a mortal mistake especially in diagnosis of a patient, much less in determining the true cause of death.

Erfe, the PAO forensic consultant (and not a pathologist), who, the group said, made sweeping statements linking Dengvaxia to the death of Filipino children, came under fire from medical experts all over the country for allegedly triggering the scare on vaccines.

Dengvaxia: Lancet correspondence “Dengue vaccination: a more balanced approach is needed”

Dengvaxia

We continue to monitor developments associated with Dengvaxia, recognizing the continuing and troubling political overlay to the issues in the Philippines such as reported in the Business Mirror article below. We did not identify any new press releases or statements on the Sanofi website.
 
The Lancet
Feb 17, 2018 Volume 391 Number 10121 p631-712
http://www.thelancet.com/journals/lancet/issue/current
Correspondence
Dengue vaccination: a more balanced approach is needed
Tikki Pang, Duane Gubler, Daniel Yam Thiam Goh, Zulkifli Ismail on behalf of the Asia Dengue Vaccine Advocacy Group
DOI: https://doi.org/10.1016/S0140-6736(18)30245-9
Media reports have cast doubt on the safety of dengue vaccination, resulting in the suspension of school-based immunisation programmes in the Philippines.1 The main concern about the vaccine is the risk of severe disease in children naive to dengue virus. Although these concerns are justified, it is important to consider this risk in the context of the wider population and to consider the public health value of dengue vaccination for the prevention of a disease that affects 400 million people annually, mostly in developing countries.

In most highly endemic countries, where the use of the dengue vaccine is recommended by WHO, 90% of the population are likely to have been infected with dengue virus by adolescence. These seropositive individuals would clearly benefit from receiving the vaccine. In the remaining 10% of the population who remain unexposed to the virus, the risk of severe disease is relatively small (two cases per 1000 individuals). Moreover, individuals who have become ill after receiving the vaccine had a milder form of dengue, which did not lead to shock, bleeding, or mortality, and were successfully treated.2 Nevertheless, in developing countries with weak health systems and high out-of-pocket health-care costs, the need for hospital admission remains a concern.

The vaccine has been shown to reduce severe disease and hospital admissions by 80–90%.3 The cost savings for health-care systems, and economic benefits more broadly, are of considerable importance. For example, it has been estimated that the annual economic burden of dengue in southeast Asia is US$950 million.4

Without trivialising the risk of severe disease in seronegative individuals receiving the vaccine, we propose two approaches to dengue vaccination. First, the vaccine can be used safely in highly endemic areas when introduced in a controlled fashion with enhanced surveillance and risk management. For example, physicians can have informed discussions with parents to highlight the fact that the potential benefits of vaccination far outweigh the potential risks for their child on the basis of factors such as the endemicity level where they live and the age of the individual. Second, a reliable laboratory testing method to detect previous exposure could be discussed and implemented. Newer, more rapid, affordable, and accurate diagnostic tests must be developed.

Although each country needs to make its own decisions regarding the use of the dengue vaccine, the public health value of the vaccine should not be underestimated. With an overall efficacy of 66%, the vaccine would prevent 66,000 new cases in a country in which 100,000 cases of dengue occur annually. Despite the controversy, some countries have decided to continue using the vaccine against dengue.5

The perfect vaccine does not exist and every new product is likely to have safety risks. Although uncertainties exist, the public health and economic benefits of Dengvaxia (Sanofi Pasteur, Lyon, France) far outweigh the potential risks. As the German theologian Meister Eckhart (1260–1328) is credited with saying, “the cost of inaction is far greater than the cost of making a mistake”.

The Asia Dengue Vaccine Advocacy Group is an independent advocacy group of experts, which has received unrestricted educational grants from Sanofi Pasteur. We declare no competing interests.
References available at title link above

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Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 14 February 2018 [GPEI]
:: New on http://polioeradication.org/: Sudan’s surveillance system under the microscope, and a new addition to our ‘Reaching the Hard-to-Reach’ series, on AFP surveillance in challenging areas of Afghanistan, Syria and Nigeria.
:: The 16th International Health Regulations Emergency Committee regarding the international spread of poliovirus recommended that the temporary recommendations to prevent virus spread be extended for a further period of three months.
:: Bill and Melinda Gates released their annual letter, answering the 10 tough questions that they hear most often.

:: Weekly country updates as of 14 February 2018
Afghanistan:  
:: One wild poliovirus type 1 (WPV1) positive environmental sample reported from Hilmand province.
Democratic Republic of the Congo:
:: Three cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, from Tanganyika province. Somalia: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province.
Somalia:
:: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province, Somalia.
 
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Statement of the Sixteenth IHR Emergency Committee Regarding the International Spread of Poliovirus
WHO statement  –  14 February 2018
[Editor’s text bolding]
The sixteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 7 February 2018 at WHO headquarters with members, advisers and invited member states attending via teleconference…

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months.

The Committee considered the following factors in reaching this conclusion:
:: The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
:: The risk and consequent costs of failure to eradicate globally a highly debilitating vaccine preventable disease. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be even more grave and a major set-back to achieving eradication.
:: The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
:: The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears considerable.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
 
Additionally with respect to cVDPV:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning in many countries;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies;
:: The global shortage of IPV which poses an additional risk, in that the cohort of children with no type 2 immunity is growing in number in countries affected by the shortage…

Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee also noted that surveillance in these areas may also be sub-optimal, particularly where access is compromised by conflict. The Committee strongly encourages all these countries to make further efforts to improve routine immunization and strengthen surveillance in such areas, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also urged that Nigeria and the Lake Chad countries increase cross border efforts and joint planning and response. Intensified effort is needed to identify and reach vulnerable populations in the sub-region, particularly in the Lake Chad islands. Noting the low number of international travelers being vaccinated in Nigeria, the committee again recommended that the country needs to improve implementation of the Temporary Recommendations regarding traveler vaccination, including reporting of achievements, and requests the secretariat to report back on this aspect of Nigeria’s response to the next Committee meeting. Nigeria should ensure continuing political commitment and take measures to counter fatigue in the fight against polio. Similarly, the DR Congo government needs to regard the current outbreak of cVDPV2 as a public health emergency and pay more attention to prevention of international spread of cVDPV2 from DR Congo, noting that neighboring countries are affected by the global shortage of IPV.

Noting the issues that continue in countries previously subject to Temporary Recommendations such as the Ukraine and Somalia, the Committee requested the secretariat to continue to monitor these and other previously infected countries, and highlight to the Committee issues that pose a risk of international spread. The Committee requested an update on the situation in Somalia at its next meeting.

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 13 February 2018 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 13 February 2018.
 
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Global Certification Commission – GPEI
Special Meeting of the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC) on Poliovirus Containment
Geneva, Switzerland, 23 – 25 October 2017
Release date [not identified] :: 15 pages
Summary of recommendations

  1. Role of GCC in containment

:: WHO should review GCC’s ToRs at the time of certification of eradication to determine GCC’s role in the post-certification period as the oversight body for containment.

  1. Reduction in the number of PEFs

:: WHO should continue to work with Member States so that only those facilities fulfilling critical national or international functions in countries and complying with secondary and tertiary safeguards (as and when required) enter the containment certification process.
:: Member States should coordinate and communicate closely with facilities to make them aware of the implications of becoming and remaining PEFs.
:: WHO should engage the Regional Directors to raise awareness of containment during the Regional Committee Meetings. This could be explored through the Global Policy Group http://www.who.int/dg/global-policy/en/.
:: Countries using PQ polio vaccines are recommended to accept the release certificate issued by the NRA of reference to avoid duplication of testing and use of PV material

  1. Completion of Phase I (Preparation for containment of poliovirus type 2) of GAPIII

:: GCC encourages the establishment of a standardized data collection and verification mechanism.
:: NCC/RCC reports need to clearly indicate where and when activities in Phase I have been completed, based on a standardized data collection and verification mechanism, so that, on the basis of equivalent data quality between regions, the GCC can declare global completion of Phase I.
:: The deadline for completion of Phase I for all PV2 is set at one year after the publication of the Guidance for non-poliovirus facilities to minimize risk of sample collections potentially infectious for polioviruses
:: GCC urges countries affected by ongoing transmission of cVDPV2 to repeat their inventories and destroy, transfer or contain PV2 materials after the outbreak is declared closed.
:: GCC requests RCCs to urge countries to complete the identification, destruction, transfer or containment (Phase I) of WPV1 and WPV3 materials by the end of Phase II.
:: GCC urges countries planning to designate facilities for the retention of WPV1 and WPV3 materials to weigh the risks and benefits of having such facilities and the commitments that will be required to comply with the primary (facility), secondary (population immunity) and tertiary (sanitation and hygiene) safeguards.
:: GCC requests a letter be prepared and distributed via Regional Offices formally acknowledging countries for the completion of Phase I of GAPIII.

  1. Acceleration of the implementation of the CCS process

:: WHO should consider an EB request for a WHA 2018 resolution urging countries hosting PEFs to accelerate the appointment of a competent NAC as soon as possible and no later than 31 Dec 2018, processing all CP applications as soon as possible and no later than 30 June 2019. After June 2019, new PEF applications will not be considered unless under exceptional circumstances GCC will review these dates in early 2018.
:: WHO should carry out a risk assessment of designated PEFs’ status to ensure that facilities at highest priority are entered into the CCS process as soon as possible.

  1. Coordination and oversight

:: The WHO secretariat needs to ensure coordination of information exchanges between the ECBS, CAG, CWG, SAGE, IHR EC, CMG, SC and the GCC
:: WHO should determine which group is best placed to advise CWG on requirements associated with secondary and tertiary safeguards.
:: A mechanism needs to be established for the CWG to obtain more frequent technical support from CAG for clarifications on the operationalization of GAPIII.

  1. GCC-CWG capacity

:: GCC requests WHO to expand the CWG membership.

  1. Containment criteria for global certification of eradication

:: The GCC recommends that facilities awarded a CP should begin the CC application process and only if absolutely needed, obtain an ICC for the shortest possible duration.

:: At the time of the declaration of WPV eradication, all facilities retaining WPVs should have a CC, and if not, have a time-limited ICC, with a clear end point for obtaining a CC agreed with the GCC.

  1. Containment breaches: public health management of breaches in PV containment

:: WHO should ensure GCC is also informed.

  1. Verification of compliance with GAPIII

:: The CWG should establish an agreement with NACs to enable verification of containment under routine working circumstances or when breaches or other exceptional situations arise, and to clarify the possible impact of a containment breach on the potential award/status of a containment certificate.

  1. Communication strategy for Certification and Containment

:: GCC encourages WHO to ensure that the new communication officer being recruited by WHO is assigned to cover both areas of Objective 3 of the Polio Eradication and Endgame Strategic Plan (PEESP, Certification and Containment)
:: GCC requests WHO to develop a communication strategy as soon as possible addressing Objective 3 of the PEESP
:: GCC recommends ensuring the containment communication strategy encourages risk elimination by destruction of PV materials. It should also address the long term nature of the commitment to host a PEF, including cost and personnel required.
 
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Syria cVDPV2 outbreak situation report 34, 13 February 2018
Situation update 13 February 2018
[Editor’ text bolding]
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus and Hasakah governorates, parts of Aleppo governorate and Jurmana district of rural Damascus as part of the second phase of the outbreak response. A total of 233,518 children aged 2-23 months received IPV, representing 71% of the estimated target. Activities are ongoing in accessible areas of Aleppo governorate.
:: A total of 1,456 children under 5 years have received mOPV2 in Hasakah governorate during the IPV vaccination round, as part of special strategies to reach children who were missed by mOPV2 vaccination in January.
:: Independent post campaign monitoring of the IPV campaign is ongoing in all areas that have completed the vaccination round.
:: The Emergency Committee under the International Health Regulations (IHR) was briefed this week on the cVDPV2 outbreak in Syria and the response to date.
   :: An orientation session was held this week with Syrian Arab Red Crescent (SARC) to strengthen the coordination and to refresh training on reporting of vaccine preventable diseases in inaccessible areas. SARC has been supporting the implementation of immunization activities for outbreak response, routine immunization and AFP surveillance. 
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WHO Grade 3 Emergencies  [to 17 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 34, 13 February 2018
[See Polio above for detail]

Nigeria 
:: WHO moves to contain Nigeria’s Lassa fever outbreak
13 February 2018, ABUJA – The World Health Organization is scaling up its response to an outbreak of Lassa fever in Nigeria, which has spread to 17 states and may have infected up to 450 people in less than five weeks.
From the onset of the outbreak, WHO Nigeria deployed staff from the national and state levels to support the Government of Nigeria’s national Lassa fever Emergency Operations Centre and state surveillance activities. WHO is helping to coordinate health actors and is joining rapid risk assessment teams travelling to hot spots to investigate the outbreak.
Between 1 January and 4 February 2018, nearly 450 suspected cases were reported, of which 132 are laboratory confirmed Lassa fever. Of these, 43 deaths were reported, 37 of which were lab confirmed…
 

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WHO Grade 2 Emergencies  [to 17 February 2018]
No new announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Iraq   
:: Iraq: 2018 Humanitarian Response Plan Overview – February 2018 [EN/AR]  Published on 13 Feb 2018
Protection remains the overriding humanitarian priority during 2018

Syrian Arab Republic
:: 16 Feb 2018   Statement attributed to Ali Al-Za’tari, UN Resident and Humanitarian Coordinator in Syria, on the humanitarian situation in Nashabieh, East Ghouta…

Yemen 
:: 12 Feb 2018   Yemen Humanitarian Update Covering 5 – 11 February 2018
 
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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  
:: 12 Feb 2018  Ethiopia: Humanitarian Response Situation Report No.17 (January 2018)

ROHINGYA REFUGEE CRISIS 
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar | 11 February 2018
 

WHO & Regional Offices [to 17 February 2018]

WHO & Regional Offices [to 17 February 2018]

Latest news
World leaders join new drive to beat noncommunicable diseases
News release
16 February 2018 | Geneva – WHO is announcing today a new high-level commission, comprised of heads of state and ministers, leaders in health and development and entrepreneurs. The group will propose bold and innovative solutions to accelerate prevention and control of the leading killers on the planet – noncommunicable diseases (NCDs) like heart and lung disease, cancers, and diabetes.

The WHO Independent Global High-level Commission on NCDs is co-chaired by President Tabaré Vázquez of Uruguay; President Maithripala Sirisena of Sri Lanka; President Sauli Niinistö of Finland; Veronika Skvortsova, Minister of Healthcare of the Russian Federation; and Sania Nishtar, former Federal Minister of Pakistan.

Seven in 10 deaths globally every year are from NCDs, the main contributors to which are tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity. More than 15 million people between the ages of 30 and 70 years die from NCDs annually. Low- and lower-middle income countries are increasingly affected, with half of premature deaths from NCDs occurring in those countries. Many lives can be saved from NCDs through early diagnosis and improved access to quality and affordable treatment, as well as a whole-of-government approach to reduce the main risk factors.

“NCDs are the world’s leading avoidable killers but the world is not doing enough to prevent and control them,” says Dr Vázquez. “We have to ask ourselves if we want to condemn future generations from dying too young, and living lives of ill health and lost opportunity. The answer clearly is ‘no.’ But there is so much we can do to safeguard and care for people, from protecting everyone from tobacco, harmful use of alcohol, and unhealthy foods and sugary drinks, to giving people the health services they need to stop NCDs in their tracks.”

Mr Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Commission member, said: “For the first time in history, more people are dying of noncommunicable diseases, such as heart disease and diabetes, than infectious diseases. This loss of human life spares no one — rich or poor, young or old – and it imposes heavy economic costs on nations. The more public support we can build for government policies that are proven to save lives – as this Commission will work to do – the more progress we’ll be able to make around the world.”

The new Commission was established by WHO Director-General Dr Tedros Adhanom Ghebreyesus and runs until October 2019. It will provide actionable recommendations to contribute to the Third United Nations General Assembly High-level Meeting on NCDs scheduled for the second half of 2018. This will include the submission of its first report to Dr Tedros in early June…

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Weekly Epidemiological Record, 16 February 2018, vol. 93, 07 (pp. 61–72)
:: Implementation of hepatitis B birth dose vaccination – worldwide, 2016
 
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Tenders
:: Medical Writer for the GVAP Assessment Reportpdf, 828kb  Deadline for applications: 6 March 2018
:: Graphic Designer for the GVAP Reports  \pdf, 845kb Deadline for applications: 6 March 2018
 
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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO reaches returnees and displaced families with lifesaving supplies and services in the former Central Equatoria State of South Sudan  16 February 2018
:: WHO promptly responds to the suspected Rift Valley Fever outbreak in Yirol East, Eastern Lakes State, Republic of South Sudan  15 February 2018
:: WHO moves to contain Nigeria’s Lassa fever outbreak  13 February 2018
:: WHO steps up efforts to reach severely malnourished children with life-saving treatment in South Sudan  13 February 2018
 
WHO European Region EURO
::  Improving quality of life and survival for young cancer patients 14-02-2018
:: Summit of Mayors adopts Copenhagen Consensus, committing to build healthier, happier cities 14-02-2018
:: Merging approaches to health systems strengthening and health emergencies response 12-02-2018