Vaccines: The Week in Review 30 June 2012

Editor’s Notes:

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Report: WHO – Accountability of Dr Margaret Chan during her first term as WHO Director-General

Report: WHO – Accountability of Dr Margaret Chan during her first term as WHO Director-General
June 2012
“This document sets out the Director General’s assessment of achievements, setbacks, and remaining challenges, structured around the 22 specific promises made prior to her election.” http://www.who.int/entity/dg/Report_card_cover_28_06.pdf

Forward:
Keeping promises
During 2006, to support my candidacy for the post of WHO Director-General, I issued a manifesto with a six-point agenda for leading the Organization forward. Specific commitments were made under each agenda item. I promised results and am holding myself accountable.

This document sets out my frank and personal assessment of achievements, setbacks, and remaining challenges, structured around the 22 specific promises I made prior to my election.

These commitments were personal and are not always formal WHO priorities, which are established by Member States. Some commitments addressed neglected problems.     Others aligned with internationally agreed goals. Still others were “natural” choices as they reflect the traditional technical strengths of WHO.

Given the large number of agencies and initiatives working to improve health, many of the achievements described in this document cannot be attributed solely to the efforts of WHO. At the same time, WHO has unquestionably shaped the health agenda and gathered the technical expertise and guidance that have paved the way for other initiatives to move forward towards their goals.

Across the board, the greatest gains were made when governments gave health objectives high-level political support. In such cases, the job of WHO, at country, regional, and head office levels, has been to follow the country’s lead, stepping in with technical support and guidance whenever needed or requested.

I am proud that WHO, as a custodian of vast technical expertise, can be called upon to provide this kind of support, and trusted to deliver it well.

Midway through my term, the world was rocked by financial, fuel, and food crises, all highly contagious and all with disruptive and lingering effects. I am equally pleased that the determination to improve health remained steadfast despite these jolts, though the task has, in some areas, become harder as funding has fallen.

As my first term in office draws to a close, I humbly submit this personal account of my promises made nearly six years ago, and the extent to which these promises have been kept.

Extracts around immunization/vaccine topics and issues
p.2 “…To expand the power of vaccines to save lives, innovative mechanisms were established to purchase more vaccines and guarantee a market for new vaccines that protect against pneumonia and severe diarrhoea, the two biggest killers of young children. With GAVI support, many countries added yellow fever, hepatitis B, rotavirus, and pneumonococal vaccines to their routine immunization programmes. For the rotavirus vaccine, the impact in early-adopting countries was dramatic, in some cases halving deaths from diarrhoeal disease.

“The Decade of Vaccines was launched in 2010. The following year, leading drug companies announced significant slashes in vaccine prices for the developing world, including a 95% price reduction for the new rotavirus vaccines. Also in 2011, donors pledged more than $4 billion to support the work of GAVI, an amount that exceeded expectations.

“Despite these positive developments, several countries were reluctant to introduce expensive new vaccines into their routine immunization programmes, especially in the absence of an evidence base demonstrating their efficacy. To guide sound policy decisions, WHO supported research, funded in part by GAVI, to establish an evidence base, published in a 2012 supplement to the journal Vaccine, assessing the efficacy of oral rotavirus vaccines in a range of epidemiological settings….”

p.7   “…Several public-private partnerships established to develop new products for the neglected diseases of the poor have matured. Vaccines for malaria have reached the most advanced stage of clinical trials ever experienced for this disease. The Medicines for Malaria Venture has recently licensed new products and has a promising portfolio of novel molecules in the R&D pipeline.

“The Meningitis Vaccine Project, coordinated by WHO and PATH, culminated in December 2010 with the introduction of a new conjugate vaccine, priced at only 50 cents per dose, in the most hyper-endemic countries among the 25 countries that make up Africa’s Meningitis Belt. Coverage was expanded in 2011, when more than 35 million people were protected, promising to end the terror and havoc of recurring seasonal epidemics. The payback will be enormous. A single case of meningitis can cost a household the equivalent of three to four months of income. Mounting a reactive emergency response to epidemics can absorb more than 5% of the country’s entire health budget.

“African countries frequent have to wait years, if not decades, for new medical products to trickle into their health systems. For once, the best technology that the world, working together, can offer was introduced in Africa.

“The WHO prequalification programme allows manufacturers from low- and middle-income countries to enter the market on an equal footing with established manufacturers, provided they produce products that meet international standards for quality, efficacy, and safety. Expansion of the programme continues to change the dynamics of the market for public health vaccines. By assuring the quality of products manufactured in developing and emerging economics, the programme has increased competition as well as supplies, getting prices down and augmenting the purchasing power of investment dollars….”

p.8 …Commitment: Complete polio eradication.
“This commitment has not been met. Though progress towards polio eradication has been made, the goal remains elusive. At the request of the World Health Assembly, an Independent Monitoring Board was convened to monitor and guide the progress of the Global Polio Eradication Initiative’s 2010–2012 Strategic Plan. The plan aims to interrupt polio transmission globally by the end of 2012.

“The Board’s reports have been frequent and hard-hitting. They are consistently frank in their assessment of obstacles and strident in their demands for better programme performance. This public and critical prodding, which has included some bold proposals for doing things differently, brought several significant changes in both operational aspects of the initiative and signals of government commitment in the remaining countries where transmission continues.

“In May 2012, the Health Assembly approved a resolution declaring the completion of poliovirus eradication a “programmatic emergency for public health, requiring the full implementation of current and new eradication strategies, the institution of strong national oversight and accountability mechanisms for all areas affected by poliovirus, and the application of appropriate vaccination recommendations for all travellers to and from areas affected with poliovirus. ”

“In June 2012, the Independent Monitoring Board issued its most optimistic report to date. As noted, polio is at its lowest level since records began and the virus is gone from India, “a magnificent achievement and proof of the capability of a country to succeed.” The report also stressed the magnitude of remaining challenges, pointing out that 2.7 million children in the persistently affected countries have never received even a single dose of polio vaccine. While recent successes have created a unique window of opportunity, the current funding shortfall threatens to undermine the increasing containment of the virus. As the report concluded, “the prize of a polio-free world is drawing closer, but is far from secure”…

p.11   “…In 2010, the international humanitarian community was overwhelmed by two mega-disasters following the earthquake in Haiti and the massive floods in Pakistan. Events in Haiti, and earlier in Zimbabwe, dramatically illustrated the impact of cholera on vulnerable populations. No one anticipated the cholera outbreak in Haiti, a country that had not seen a case of this disease for more than half a century.

“The international humanitarian community needs to anticipate that, as the climate continues to change and extreme weather events become more common, more mega-disasters will occur, often accompanied by outbreaks of infectious diseases.    As part of the reform process at WHO, capacity to lead the health cluster during humanitarian emergencies is being strengthening, also by relying on mechanisms and operational protocols that have been so successful in outbreak response.

“Mechanisms that worked well against epidemics of meningitis and yellow fever are now being used to strengthen WHO’s response to cholera outbreaks. The deaths in Haiti were way too high and tragic, but each and every year in Africa, similar numbers of people, sometimes more, die from cholera.

“Much controversy has surrounded the role of vaccines in bringing a cholera outbreak under control. In April 2012, WHO brought the world’s top cholera experts to Geneva for an urgent consultation. They advised WHO to establish a 2-million dose stockpile of oral cholera vaccines, under the same umbrella mechanism as used for vaccines for epidemic meningitis and outbreaks of yellow fever. WHO will do so, also as a way of stimulating increased vaccine manufacturing capacity.

“At the same time, vaccines will not solve the cholera problem. Evidence of the impact of vaccines during cholera outbreaks is incomplete. This is another objective of the initiative: to gather the evidence to support well-informed policy decisions when responding to future outbreaks of cholera….”

Milestone: WHO European Region marks tenth anniversary of polio-free certification

Milestone: European Region marks tenth anniversary of polio-free certification
Copenhagen, 21 June 2012

“The WHO European Region marked 10 years since it was certified free of poliomyelitis (polio). Stopping transmission of indigenous wild poliovirus in the 53 countries in the Region was a landmark in the effort to eradicate polio globally, and helped accelerate international momentum towards that goal. Certification “followed years of intensive effort by Member States, supported by a public–private coalition of WHO, the United Nations Children’s Fund (UNICEF), Rotary International and the United States Centers for Disease Control and Prevention (CDC). Thus, countries demonstrated the value of large, internationally coordinated vaccination campaigns and of special efforts to reach traditionally underserved groups, such as migrants or nomads.”

“…the past 10 years have not been without challenges, as surveillance for polio and immunity against it have waned. While poliovirus could travel to the Region easily from infected areas, this had not led to outbreaks before 2010, thanks to quick detection and a well-vaccinated population. By 2010, however, immunity had dropped to the point where an importation of wild poliovirus type 1 led to a large polio outbreak in Tajikistan and three neighbouring countries. This outbreak paralysed 478 people – including many adults – and killed 29. The risk of further deadly outbreaks is rising, underscoring the urgent need to eradicate polio globally.

“We have had many successes in the past 10 years, and we should recognize and applaud them,” said the WHO Regional Director for Europe, Zsuzsanna Jakab. “When we faced challenges, such as the 2010 outbreak, we saw countries and international partners mount a rapid and effective response. While this was a powerful reminder of the success we can achieve when we work together to fight common threats, it is important to emphasize that we cannot afford to become complacent. What we do here in Europe will have a significant impact on both the regional and global fight to eradicate polio.”

…“Less than 24 months ago, the countries of Europe rallied to respond to a terrible outbreak on the Region’s eastern borders,” said Bruce Aylward, WHO Assistant Director-General for Polio, Emergencies and Country Collaboration at WHO headquarters. “Today, there are fewer cases of polio in fewer places of the world than ever before, but Europe faces the spectre of similar outbreaks unless it invests in the emergency plan to eradicate polio in the last reservoirs of the virus. The generosity of the people and governments of Europe will be essential to protecting future generations of children in perpetuity.”

http://www.euro.who.int/en/what-we-publish/information-for-the-media/sections/latest-press-releases/european-region-marks-tenth-anniversary-of-polio-free-certification

GAVI launches public consultation on Country by Country Approach

GAVI said it launched a public consultation on its Country by Country Approach. The consultation will be open until Monday 30 July 2012. At its November 2011, the GAVI Alliance Board requested the Secretariat “to develop a policy that clearly defines the GAVI Alliance’s approach to fragile and under-performing countries”. The main objectives of this work are to:

– Recognise current limitations faced by a subset of countries in their ability to access and leverage GAVI support.

– Ensure that country-specific challenges to accessing immunisation support are identified.

– Propose flexibilities in current GAVI policies and how they could be applied equitably on a country by country basis.

Based on preliminary analysis from the work, GAVI’s Programme and Policy Committee (PPC) on 23-24 April 2012 “agreed that a country by country approach would be a more useful option than developing a policy centred on a specific fragile states definition. At the PPC, it was further agreed that links with fragility would, if possible, include immunisation coverage and government structure. The policy should stay simple and indicate clearly what the approaches are and who is eligible, and the final framework should be transparent to avoid an unfair application of the policy between countries.” The Country by Country policy process has consisted of country and expert consultations with various groups of stakeholders.

The consolidated comments and feedback received during this consultation process as well as a revised draft version of the Country by Country Approach and framework will be presented to the PPC in October before it is taken to the Board for endorsement in December 2012.

More information is available on the GAVI Alliance website http://www.gavialliance.org/about/gavis-business-model/country-by-country-approach/

GAVI posts Board Meeting documentation (12-13 June 2012) – measles prevention decision

GAVI posted documentation associated with its Board meeting held 12-13 June 2012 in Washington DC: http://www.gavialliance.org/about/governance/gavi-board/minutes/2012/12-june/

Editor’s Note: The GAVI Board meting covered a range of topics as detailed in the posted agenda document. WE extract language about a specific decision on measles below:

Decision 7: Options for enhancing GAVI’s investment in measles prevention
The GAVI Alliance Board:
– Approved, on an exceptional basis, the Secretariat to put in place the necessary arrangements in accordance with Annex 2, Option 2 of Doc 12, for six large countries at high risk of measles outbreaks (Afghanistan, Chad, DR Congo, Ethiopia, Nigeria, and Pakistan) to be able to receive GAVI support for measles vaccines and operational costs until these countries are forecasted to have implemented a measles-rubella (MR) campaign, or by no later than 2017. This support would be provided in collaboration with the Measles & Rubella Initiative (MR Initiative, formerly the Measles Initiative).

– Approved US$ 55 million to be made available to the MR Initiative through the UN Foundation for use through 2017 for outbreaks and other emerging needs requiring rapid responses, using the mechanism described in Annex 2, Option 1 of Doc 12.

– Requested the Secretariat – given the importance of measles as an indication of country support for routine immunisation – to develop an indicator for measles first dose routine vaccine coverage as part of the achievement of GAVI’s 2011-2015 Strategy for review by the Evaluation Advisory Committee.

World Bank President Robert B. Zoellick to join Harvard’s Belfer Center and the Peterson Institute

World Bank President Robert B. Zoellick said he would join the Belfer Center for Science and International Affairs at Harvard University and the Peterson Institute for International Economics in Washington DC after he steps down as World Bank Group President on June 30. Mr. Zoellick will become the Peterson Institute’s first Distinguished Visiting Fellow as a Senior Fellow at the Belfer Center.  http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23229940~pagePK:34370~piPK:34424~theSitePK:4607,00.html