Vaccines: The Week in Review 25 August 2012

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Meeting Report: WHO Technical Working Group on creation of an oral cholera vaccine stockpile

Meeting Report: WHO Technical Working Group on creation of an oral cholera vaccine stockpile
Geneva, 26–27 April 2012
Authors: WHO
Publication details: 15 pages; WHO reference number: WHO/HSE/PED/2012

The 64th World Health Assembly (2011) called for an integrated, comprehensive strategy of cholera prevention and control. The WHA Resolution 64.15 included consideration of the use of oral cholera vaccines (OCV) “where appropriate, in conjunction with other recommended prevention and control methods and not as a substitute for such methods”.

This consideration was taken forward at a September 2011 consultation, which noted that an OCV stockpile for outbreak control could be initiated in the near future.

This is the report of a Technical Working Group which was convened, in April 2012, to develop an OCV stockpile implementation framework. Participants advised on: the criteria for choice of stockpiled vaccine and its deployment; the appropriate size of an OCV stockpile; the managing partnership and evaluation processes required; the decision-making procedure and operational issues; and the financing mechanism.

PAHO Technical Advisory Group on Vaccine-Preventable Diseases (TAG): cholera control and role of vaccines (OCV)

PAHO reported on a meeting of its Technical Advisory Group on Vaccine-Preventable Diseases (TAG) focused on cholera. The meeting was heldin Washington, D.C. on 16 August 2012. The group reported that elimination of cholera transmission on the Island of Hispaniola can be achieved by increasing and sustaining access to clean drinking water and adequate sanitation, and that “reaching the long-term goal will be greatly aided with complementary short-term actions such as the expanded use of oral cholera vaccine.” PAHO said the meeting of the Technical Advisory Group is “framed in the set of actions that governments of Haiti and Dominican Republic, PAHO/WHO, and other agencies and partners have been carrying out in the wake of the cholera outbreak in October 2010.” One example of this coordinated action is the launching last June of the Regional Coalition on Water and Sanitation for the Elimination of Cholera on the Island of Hispaniola, which helps governments to harmonize and streamline international assistance and investments in water and sanitation infrastructure on the island.  Dr. Jon Andrus, Deputy Director of PAHO, opened the meeting by tasking TAG with the provision of technical recommendations on cholera vaccination grounded in the best available science. “If the evidence indicates, especially with the recent experience of demonstration projects conducted in the field in Haiti, we should not fail to miss short-term opportunities to save more lives more quickly. However, such action must be balanced within the long-term vision of safe water and sanitation that will ultimately stop cholera transmission on the island.”

After the presentation of scientific evidence and the results of two demonstration projects, the Technical Advisory Group, chaired by Dr. Ciro de Quadros, recommended introduction of the oral cholera vaccine. This recommendation was supported by data presented by Partners in Health and GHESKIO, two nongovernmental health organizations with a long history of work in Haiti. Acting on PAHO’s suggestion, both had recently conducted projects which achieved high vaccination coverage of up to 90% for two doses of the oral cholera vaccine.

Given that current global supplies of the vaccine are limited, TAG experts also recommended prioritizing vaccination in densely populated urban areas with limited access to sanitation and drinking water, and in rural areas where access to health services is most challenging. As manufacturers ramp up production in the near future, the experts unanimously recommended moving toward universal vaccination. However, they noted that doing so will require urgent attention to mobilizing and sustaining the flow of financial resources, strengthening operational capacity, and insuring that vaccination efforts are well-integrated into the long-term vision of safe water and sanitation to stop cholera’s transmission. The Technical Advisory Group also highlighted the importance of finding solutions to the global scarcity of the cholera vaccine, as well as the need to strengthen epidemiological surveillance processes, which are critical in securing cholera prevention and control. TAG members additionally stressed the need to conduct research to close current knowledge gaps on the vaccine.

Members of PAHO’s Technical Advisory Group for Vaccine-Preventable Disease include Dr. Ciro de Quadros (Chairperson and Executive Vice- President of the Sabin Vaccine Institute), Dr. Peter Figueroa (Rapporteur and Acting Chief Medical Officer at the Ministry of Health of Jamaica), Dr. Roger Glass (Fogarty International Center, U.S. National Institutes of Health), Dr. Anne Schuchat (National Center for immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention), Dr. Jeannette Vega (Center for Epidemiology and Health Policy, Chile), Dr. Akira Homma (Policy and Strategy Council, Bio-Manguinhos Institute, Fiocruz, Brazil), Dr. Arlene King (Ministry of Health and Long-term Care, Canada), Dr. Ramiro Guerrero-Carvajal (PROESA, Colombia), Dr. José Ignacio Santos (Department of Experimental Medicine, National Autonomous University of Mexico) and Cuahtémoc Ruiz (PAHO).

Global Fund signs two grant agreements (US$225 million) with Nigeria for malaria programs

The Global Fund said it signed two grant agreements with Nigeria worth a total of US$225 million to support programs that will prevent and treat malaria. The grant agreements “expand a partnership with the Global Fund that has yielded remarkable progress in recent years, such as undertaking the largest distribution of bed nets done anywhere – more than 45 million to date.”  Included is an additional US$50 million for bed nets, “approved in an unusual move by the Global Fund Board that was linked to additional commitments by the Government of Nigeria.” During a transformation of the Global Fund’s grant management structure this year, Nigeria was identified as one of 20 ‘high impact’ countries now under a special designation.

NIAID awards 14 grants/US$7.8 million in first-year funding for basic research on HIV vaccines

   NIAID said it awarded 14 grants totaling US$7.8 million in first-year funding for “basic research to identify new approaches for designing a safe and effective HIV vaccine.” The grants were awarded under the Innovation for HIV Vaccine Discovery (IHVD) initiative, which is expected to receive up to $34.8 million over the next four years. NIAID Director Anthony S. Fauci, M.D. commented, “Recent discoveries about the basic biology of HIV and how the virus adapts to its host have provided useful information and new opportunities to guide vaccine development. These grants are designed to build on that information and stimulate discovery of new ways to design a robust vaccine that prevents acquisition and establishment of latent infection.” The 14 IHVD grant recipient organizations include:

– Altravax Inc. (Sunnyvale, Calif.)

– Catholic University of America (Washington, D.C.)

– Dartmouth College (Hanover, N.H.)

– Duke University (Durham, N.C.)

– Harvard Medical School (Boston)

– Massachusetts General Hospital (Boston)

– NYU Langone Medical Center (New York City)

– University of California (Irvine)

– University of Maryland (Baltimore)

– University of Medicine and Dentistry of New Jersey (Newark)

– University of Minnesota (Minneapolis)

– University of North Carolina (Chapel Hill)

– University of Rochester (Rochester, N.Y.)

– University of Texas at El Paso

Post: A Global Partnership for Vaccine Design

Post: A Global Partnership for Vaccine Design
Posted by Guest blogger Margaret McGlynn, IAVI President and CEO on Monday, August 13th 2012

When you’re dealing with a global public health crisis, having an international presence isn’t just advisable – it is imperative. This applies as much to the development of new tools to prevent disease as it does to treatment. An AIDS vaccine candidate, for example, must be tested in the people who will eventually use it and against the strains of HIV it is devised to protect them from.

That’s why the International AIDS Vaccine Initiative (IAVI), in partnership with USAID, has worked diligently over the past several years to establish itself as a truly global non-profit partner. Using donor funds, IAVI has created an enviable network of research centers in sub-Saharan Africa dedicated to assessing novel AIDS vaccine candidates in clinical trials and conducting supporting epidemiological studies on HIV. These partnerships have made meaningful contributions to the research capacity of many developing countries—a capability that is now helping local researchers tackle other diseases.

IAVI and its partners are now applying that same model to support the design of a new generation of AIDS vaccine candidates. Today, IAVI and the Translational Health Sciences and Technology Institute (THSTI), an autonomous institute of the Indian government’s Department of Biotechnology (DBT), launched an HIV Vaccine Design Programme near New Delhi. The Programme is dedicated to the large-scale generation and preclinical evaluation of immunogens, the active ingredients of vaccines. It will focus on devising immunogens capable of eliciting antibodies that can prevent infection by a broad range of the circulating genetic variants of HIV.

That challenge, known to researchers as the neutralizing antibody problem, has long stymied progress toward an AIDS vaccine. But recent discoveries of antibodies capable of blocking a number of HIV variants have provided researchers with clues to the design of potentially powerful new vaccine candidates. The HIV Vaccine Design Programme will use these insights to develop new methods to generate large numbers of potential HIV immunogens and rapidly assess their potential for use in candidate vaccines. Much of the work will take place in a laboratory housed within THSTI that is being built and staffed with support from IAVI, DBT and THSTI.

The Programme’s location is no accident. Over the past decade, IAVI has enjoyed a productive partnership for the clinical evaluation of candidate AIDS vaccines with key medical research institutions of the Indian government. Indian scientists have also actively participated in an international consortium of HIV laboratories supported by IAVI to advance HIV vaccine research. The government of India, meanwhile, is in the early phase of its “Decade of Innovation”, a policy that seeks to harness a growing roster of home-grown biotechs, the nation’s deep pool of scientific talent and global research partnerships to boost innovation in a variety of high-tech fields.

The HIV Vaccine Design Programme provides an opportunity to engage an emerging economy in the global quest to develop a vaccine against HIV. For India, it creates an opportunity to address a crisis of significant relevance to Indians.  As importantly, it seeds the kinds of collaborations that often foster scientific and technical innovation and generate ideas that might be applied to address other diseases that have long hampered development.