Vaccines: The Week in Review 26 May 2012

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WHA65: Notes: Saturday, 26 May 2012

Sixty-fifth World Health Assembly: daily notes on proceedings
– Notes: Saturday, 26 May 2012

Financing research and development

The Health Assembly unanimously adopted the resolution on the Consultative Expert Working Group on Research and Development: Financing and Coordination in the form presented as draft by the drafting group and circulated yesterday.

Implementation of International Health Regulations (2005)
The annual report on the implementation of the International Health Regulations (2005) was presented in Committee A. Tools are available for State Parties to monitor their national core capacities and to identify areas that require further action. Information collected for 2011 shows State Parties are making fair progress for a number of core capacities, notably surveillance, response, laboratory and zoonotic events. Most regions reported relatively low capacities in human resources and for preparedness to chemical and radiological events.

Many State Parties have requested or will request a two-year extension to the mid-2012 deadline for establishing core capacities under IHR. Delegates made references to the difficulties in implementing measures related to points of entry as well as the need for engaging stakeholders outside the health sector and enhancing regional and trans-regional networks. The draft resolution was approved with a recommendation for developing further progress reports.

Pandemic influenza preparedness
Member States acknowledged that the pandemic influenza preparedness (PIP) framework is a crucial development for global health security, based on the lessons from the 2009 influenza pandemic. Committee A reviewed some of the procedures and processes behind that framework and its future direction. Many delegates highlighted the need for WHO to be flexible. Delegates recognized that industry and other partners play important roles in the development of mass vaccines to counter outbreaks.

Delegates agreed on a 70% and 30% share of resources between preparedness and response respectively, but that this would be regularly reviewed. They welcomed the role of the advisory group which was described as strong and robust, but stressed the need for extra resources – both human and financial – to support WHO capacity and leadership so that the PIP framework can be fully implemented.

Global mass gatherings
Committee A considered and approved the report by the Secretariat on “Global mass gatherings: implications and opportunities for global health security”. The discussions were spearheaded by delegates from countries which hosted mass gatherings in the recent past or host such events on a regular basis. Delegates expressed the need to exchange experiences to ensure lessons learned on adequate preparedness and management. Member States representatives also stressed the need for efficient preventive measures and interventions such as surveillance through mobile teams and laboratories to identify and respond rapidly to outbreaks. They identified mass gatherings as opportunities to reinforce multi-sectoral collaboration and strengthen their health systems.

Progress reports
Committee A welcomed and approved the following progress reports:

– Health system strengthening;

– WHO’s role and responsibilities in health research;

– Global strategy and plan of action on public health, innovation and intellectual property;

– Smallpox eradication: destruction of variola virus stocks;

– Eradication of dracunculiasis;

– Chagas disease: control and elimination;

– Viral hepatitis;

– Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis;

– Cholera: mechanisms for control and prevention;

– Control of human African trypanosomiasis;

– Global health sector strategy on HIV/AIDS, 2011–2015;

– Prevention and control of sexually transmitted infections: global strategy…

WHA65: Intensification of the global polio eradication initiative

Sixty-fifth World Health Assembly: daily notes on proceedings
– Notes: Friday, 25 May 2012

Intensification of the global polio eradication initiative
Committee A today approved a draft resolution (EB130.R10) which declares the completion of poliomyelitis eradication a programmatic emergency for global public health. India was once again congratulated for stopping indigenous wild poliovirus circulation. However, three countries still face endemic transmission of wild polio virus; unless poliovirus transmission is stopped in these countries, there will be a global resurgence of the disease with a real risk of severe outbreaks in areas that have long been polio-free. The approved resolution requires the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas infected with poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas infected with poliovirus.

Member States with poliovirus transmission are urged to declare such transmission to be a “national public health emergency”, requiring the development and full implementation of emergency action plans. Pakistan, Nigeria and Afghanistan have already established national emergency plans for polio eradication and shifted their national polio eradication initiatives to an emergency status, with an all-of-government and society approach to ensure all children are reached and vaccinated. During the discussion, partners reiterated their support to the polio eradication initiative and the importance of treating polio eradication as a programmatic emergency, and urged all partners to be fully committed in their action and their financing.

26 May 2012
Third report of Committee A
Committee A held its eighth, ninth and tenth meetings on 25 May 2012. These meetings were held under the chairmanship of Mr Herbert Barnard (Netherlands) and Dr Zangley Dukpa (Bhutan).

It was decided to recommend to the Sixty-fifth World Health Agenda item 13.10
Poliomyelitis: intensification of the global eradication initiative
The Sixty-fifth World Health Assembly,
– Having considered the report on poliomyelitis: intensification of the global eradication initiative;

– Recalling resolution WHA61.1 on poliomyelitis: mechanism for management of potential risks to eradication, which, inter alia, requested the Director-General to develop a new strategy to reinvigorate the fight to eradicate poliovirus and to develop appropriate strategies for managing the long-term risks of reintroduction of poliovirus and re-emergence of poliomyelitis, including the eventual cessation of use of oral poliovirus vaccine in routine immunization programmes;

– Recognizing the need to make rapidly available the necessary financial resources to eradicate the remaining circulating polioviruses and to minimize the risks of reintroduction of poliovirus and reemergence of poliomyelitis after interruption of wild poliovirus transmission;

– Noting the finding by the Independent Monitoring Board of the Global Polio Eradication Initiative finding in its report of October 2011 that “polio simply will not be eradicated unless it receives a higher priority – in many of the polio-affected countries, and across the world”1 and its recommendation in its April 2011 report that the World Health Assembly “considers a resolution to declare the persistence of polio a global health emergency”;

– Noting the report of the meeting in November 2011 of the Strategic Advisory Group of Experts on immunization at which it stated “unequivocally that the risk of failure to finish global polio eradication constitutes a programmatic emergency of global proportions for public health and is not acceptable under any circumstances”;

– Recognizing the need for Member States to engage all levels of political and civil society so as to ensure that all children are vaccinated in order to eradicate poliomyelitis;

– Having noted the current high cost and limited supplies of inactivated polio vaccine that are hampering the introduction and scaling-up of inactivated polio vaccine, resulting in major programmatic and financial implications to developing countries;

– Noting that the technical feasibility of poliovirus eradication has been proved through the full application of new strategic approaches;

– Noting that continuing poliovirus transmission anywhere will continue to pose a risk to

poliomyelitis-free areas until such time as all poliovirus transmission is interrupted globally;

1. DECLARES the completion of poliovirus eradication a programmatic emergency for global public health, requiring the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas infected with poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas infected with poliovirus;1

2. URGES Member States with poliovirus transmission to declare such transmission to be a “national public health emergency” making poliovirus eradication a national priority programme, requiring the development and full implementation of emergency action plans, to be updated every six months, until such time as poliovirus transmission has been interrupted;

3. URGES all Member States:
(1) to eliminate the unimmunized areas and to maintain very high population immunity against polioviruses through routine immunization programmes and, where necessary, supplementary immunization activities;

(2) to maintain vigilance for poliovirus importations, and the emergence of circulating vaccine-derived polioviruses, by achieving and sustaining certification-standard surveillance and regular risk assessment for polioviruses;

(3) to make available urgently the financial resources required for the full and continued implementation, to the end of 2013, of the necessary strategic approaches to interrupt wild poliovirus transmission globally, and to initiate planning for the financing to the end of 2018 of the polio endgame strategy;

(4) to engage in multilateral and bilateral cooperation, including exchanging epidemiologic information, laboratory monitoring data, and carrying out supplementary immunization activities simultaneously as appropriate;

4. REQUESTS the Director-General:
(1) to plan for the renewed implementation through 2013 of the approaches for eradicating wild polioviruses outlined in the Global Polio Eradication Initiative Strategic Plan 2010–2012 and any new tactics that are deemed necessary to complete eradication, including the enhancement of the existing global polio eradication initiative within the Organization;

(2) to strengthen accountability and monitoring mechanisms to ensure optimal

implementation of eradication strategies at all levels;

(3) to undertake the development, scientific vetting, and rapid finalization of a

comprehensive polio eradication and endgame strategy and inform Member States of the potential timing of a switch from trivalent to bivalent oral poliovirus vaccine for all routine immunization programmes; and includes budget scenarios to the end of 2018 that include risk management;

(4) to coordinate with all relevant partners including vaccine manufacturers, to promote the research, production and supply of vaccines, in particular inactivated polio vaccines, to enhance their affordability, effectiveness and accessibility;

(5) to continue mobilizing and deploying the necessary financial and human resources for the strategic approaches required through 2013 for wild poliovirus eradication, and for the eventual implementation of a polio endgame strategy to the end of 2018;

(6) to report to the Sixty-sixth World Health Assembly and the subsequent two Health Assemblies, through the Executive Board, on progress in implementing this resolution.

1 International travel and health. Geneva, World Health Organization, 2012 edition.

Global Polio Eradication Initiative (GPEI) announces Emergency Action Plan (EAP

  The Global Polio Eradication Initiative (GPEI) announced the Emergency Action Plan (EAP) developed in coordination with new country national emergency plans.  The plan builds on India’s successes and outlines a range of new strategies and initiatives to better support eradication efforts, including:

– Intensified focus on worst-performing areas of Nigeria, Pakistan and Afghanistan to increase vaccination coverage by end of 2012 to levels needed to stop transmission;

– New approaches tailored to each country to tackle persistent challenges and improve polio vaccination campaign performance;

– Heightened accountability, coordination and oversight to ensure success at every level of government and within every partner agency and organization.

– Surge of technical assistance and social mobilization capacity.

GPEI noted that the EAP is currently hindered by a critical funding gap of nearly US$1 billion through 2013, with funding shortages already forcing the GPEI to cancel or scale-back critical vaccination activities in 24 high-risk countries.

Global Emergency Action Plan (EAP) 2012-2013

65th World Health Assembly – Draft global vaccine action plan GVAP

65th World Health Assembly
Journal, Number 6
26 May 2012
pdf, 171kb

Fourth meeting of Committee B
Chairman: Dr Mohammad Hossein Nicknam (Islamic Republic of Iran)
Later: Dr Enrique Tayag (Philippines),Vice-Chairman

Item 13 (continued) Technical and health matters (Subitems transferred from Committee A)
Item 13.12 (continued) – Draft global vaccine action plan
The Chairman reopened the subitem. The Secretariat read the amendments to draft resolution entitled World Immunization Week. The Committee approved the resolution
contained in document EB130.R12 as amended. The Secretariat read the amendments to draft resolution entitled Global vaccine action plan. The Committee approved the resolution contained in document A65/22 as amended.

World Health Assembly Endorses New Plan to Increase Global Access to Vaccines (Decade of Vaccines Collaboration)

– The Measles & Rubella Initiative Welcomes World Health Assembly Commitment to Measles and Rubella Elimination Goal

Statement of Support for New Global Vaccine Action Plan [Sabin Vaccine Institute]

Statement by Bill Gates on the Occasion of the World Health Assembly Resolutions Declaring Completion of Polio Eradication a Global Emergency and Endorsing the Global Vaccine Action Plan

Meningococcal disease: situation in the African Meningitis Belt – 24 May 2012

WHO – Meningococcal disease: situation in the African Meningitis Belt

24 May 2012

From 1 January to 17 April 2012 (epidemiologic week 17), outbreaks of meningococcal disease have been reported in 42 districts in 10 of the 14 countries of the African Meningitis Belt 1. These outbreaks have been detected as part of the enhanced surveillance.

The 10 countries (Benin, Burkina Faso, Chad, Central African Republic, Côte d’Ivoire, Gambia, Ghana, Mali, Nigeria and Sudan) reported a total of 11 647 meningitis cases including 960 deaths resulting in a case fatality ratio of 8.2%. The outbreaks were mainly caused by the W135 serogroup of Neisseria meningitidis (Nm) bacteria.

In response to the outbreaks, the Ministries of Health implemented a series of preventive and control measures which included enhancement of surveillance, case management, sensitization of the population, strengthening of cross border collaboration and provision of vaccines through the International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG).

The ICG released a total of 11,000 vials of antibiotic (Ceftriaxone) and 1,665,673 doses of vaccines to six countries (see table below 2) most affected by the epidemic, upon requests. The vaccines released include 919,023 doses of polysaccharide ACW/ACYW vaccine, 746,650 doses of meningitis A conjugate vaccine and 81,418 doses of polysaccharide AC vaccine.

The ICG is working with manufacturers and partners to ensure the stockpiles of the appropriate vaccines are maintained in sufficient quantities, for responding effectively to epidemics in the future. ICG partners include WHO, International Federation of Red Cross and Red Crescent Societies (IFRC), United Nations Children Fund (UNICEF), and Médecins Sans Frontières (MSF).

The emergency stockpile was established with the support of Global Alliance for Vaccines and Immunization (GAVI). The vaccination campaigns were conducted with the support of MSF, UNICEF, IFRC, the European Community Humanitarian Aid Office (ECHO), and the United Nations through its Central Emergency Response Fund (CERF).

WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministries of Health in the affected countries.

1 The 14 countries in the African Meningitis Belt with enhanced surveillance for meningococcal disease include Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria, Sudan and Togo.