Vaccines: The Week in Review 25 May 2013

Editor’s Notes:

Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to

pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_25 May 2013

Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

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.

Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

UNICEF: Emergency measles vaccination campaign to protect 125,000 children in Central African Republic

   UNICEF: Emergency measles vaccination campaign to protect 125,000 children in Central African Republic
UNICEF and its partners announced an emergency measles vaccination campaign in Bangui, the conflict-hit capital of the Central African Republic, after eight children tested positive for the disease in April. UNICEF said it is working with the Ministry of Health, WHO and NGO partners Merlin, IMC, ACF, PU-AMI and COOPI to reach 125, 000 children during the 22-26 May campaign. UNICEF noted that “recent fighting in the country has led to a breakdown of basic services and increased the risk of disease outbreaks in Bangui and across the country. This, along with poor living conditions, and a historically low vaccination rate for measles of 62 per cent, means that the lives of large numbers of children are now at risk from the disease.”

UNICEF also said the campaign faces considerable challenges. “Secure humanitarian access to those in need remains difficult in CAR. Following the coup on 24 March 2013, the security situation continues to be tenuous as law and order have yet to be fully restored in the capital. Many regions remain difficult to reach because of violence and insecurity and will be even harder to access as the rainy season sets in. Despite this, UNICEF is working with partners on the ground to respond to the emergency that is either directly or indirectly affecting the entire population of 4.6 million.” In preparation for the measles campaign, UNICEF said that 246,500 units of vaccine arrived in Bangui on 15 May, including 100,000 vaccines purchased by funds donated by the airline easyJet.

Full media release:

WHO: Global Alert and Response (GAR) – Disease Outbreak News [MERS-CoV; Polio – Horn of Africa]

WHO: Global Alert and Response (GAR) – Disease Outbreak News

. Novel coronavirus infection – update (Middle East respiratory syndrome- coronavirus) – update 23 May 2013
23 May 2013 – The Ministry of Health in Saudi Arabia has notified WHO of an additional laboratory-confirmed case of infection with the Middle East respiratory syndrome coronavirus (MERS-CoV).
The fatal case was reported from Al-Qaseem region in the Central part of the country and is not related to the cluster of cases reported from Al-Ahsa region in the Eastern part of the country. The patient was a 63-year-old man with an underlying medical condition who was admitted to a hospital with acute respiratory distress on 15 May 2013 and died on 20 May 2013. Investigation into contacts of this case is ongoing.

The Saudi authorities are also continuing the investigation into the outbreak that began in a health care facility since the beginning of April 2013 in Al-Ahsa. To date, a total of 22 patients including 10 deaths have been reported from the outbreak.

Globally, from September 2012 to date, WHO has been informed of a total of 44 laboratory-confirmed cases of infection with MERS-CoV, including 22 deaths.

WHO has received reports of laboratory-confirmed cases from the following countries in the Middle East: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred for care of the disease or returned from Middle East and subsequently became ill. In France, Tunisia and the United Kingdom, there has been limited local transmission among close contacts who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhoea, in patients who are immunocompromised…

. Wild poliovirus in the Horn of Africa – 22 May 2013
22 May 2013 – The Horn of Africa is currently experiencing an outbreak of wild poliovirus type 1 (WPV1). A four-month-old girl near Dadaab, Kenya, developed symptoms of acute flaccid paralysis (AFP) on 30 April 2013. Two healthy contacts of the child tested positive for WPV1.    They are the first laboratory confirmed cases in Kenya since July 2011. Investigation into this outbreak is ongoing. In addition, a case of WPV1 in Banadir, Somalia was confirmed on 9 May 2013.

In response to the outbreak, the first vaccination campaign, reaching 440 000 children began on 14 May 2013 in Somalia and a second round of vaccination is planned for 26 May 2013 in synchronization with the affected parts of Kenya.

The risk to neighbouring countries is deemed as very high, due to large-scale population movements across the Horn of Africa and persistent immunity gaps in some areas. Dadaab hosts a major refugee camp, housing nearly 500 000 persons from across the Horn of Africa.

An alert for enhanced surveillance for polio has been issued to all countries across the Horn of Africa, highlighting the need to conduct active searches for any suspected cases. All countries are urged to rapidly identify sub-national surveillance gaps and to take measures to fill the gaps.

In 2005, polio spread east across the African continent, and into Yemen and the Horn of Africa, resulting in over 700 cases. Since then, international outbreak responses have been adopted and new monovalent and bivalent oral polio vaccines have been developed, which can significantly reduce the severity and length of polio outbreaks.

Some areas of Somalia (south-central) are also affected by an outbreak due to circulating vaccine-derived poliovirus type 2 (cVDPV2), which has resulted in 18 cases in Somalia since 2009. In 2012, this strain spread to Dadaab, causing three cases.

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio…

GPEI Update: Polio this week – As of 22 May 2013

Update: Polio this week – As of 22 May 2013
Global Polio Eradication Initiative

[Editor’s extract and bolded text]
. A wild poliovirus type 1 (WPV1) case has been confirmed in Kenya, the first WPV in the country since July 2011, with onset of paralysis 30 April. The location is a refugee camp in the Dadaab area, close to the border with Somalia, where a child was paralysed by polio near the capital Mogadishu on 18 April. Outbreak response activities are being planned. See ‘Horn of Africa’ section for more.

. No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains eight. The most recent WPV case had onset of paralysis on 24 April (WPV1 from Federally Administered Tribal Areas – FATA).

. One new cVDPV2 case was reported in the past week (from North Waziristan, FATA), bringing the total number of cVDPV2 cases for 2013 to four. It is the most recent cVDPV2 case in the country and had onset of paralysis on 22 April.

. It is the second cVDPV2 case from North Waziristan, an area where immunizations have been suspended by local leaders since last June. To minimize the risk of a major outbreak in this area, it is critical that access to children is granted as quickly as possible. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.

. Pakistan is also affected by transmission of WPV1, with eight cases this year (compared to 16 cases for the same period in 2012). Wild poliovirus type 3 (WPV3) has not been detected in the country in more than 12 months (since April 2012, from Khyber Agency, FATA).

. Confirmation of these latest cases underscores the risk which ongoing polio transmission (be it due to WPV or cVDPV) in the country continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time.

. The security situation continues to be monitored closely, in consultation with law enforcement agencies. Immunization activities continue to be implemented, in some areas staggered or postponed, depending on the security situation at the local level.

Horn of Africa
. One new WPV case was reported in the past week (WPV1 from a refugee camp in Dadaab, north-eastern Kenya), with onset of paralysis on 30 April. It is the first WPV in Kenya since July 2011, and it follows last week’s confirmation of a WPV1 case from Somalia (onset of paralysis 18 April).

. The child is a four-month-old girl. Two healthy contacts of the child tested positive for WPV1. Dadaab hosts several large refugee camps, housing nearly 500,000 people from across the Horn of Africa, including from Somalia.

. An emergency outbreak response is being planned, to reach nearly 440,000 children aged less than 15 years across Dadaab, beginning on 26 May, using bivalent OPV. Further campaigns are planned across a wider area, including parts of Nairobi, on 9 June, followed by large-scale subnational immunization days (SNIDs) in late June.

. In Somalia, an outbreak response immunization activity was held last week (14-16 May), to reach 350,000 children across Banadir region (including Mogadishu), with further activities across Banadir and other regions planned for 26-29 May and again in early June.

. Immunization campaigns are also planned in other areas of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak. Countries across the Horn of Africa are at significant risk, due to large-scale population movements and persistent immunity gaps in some areas. In 2005, polio spread across the African continent, and into Yemen and the Horn of Africa, resulting in over 700 cases. The adoption of international outbreak response guidelines and the development of new vaccines since then, have – when fully implemented – considerably reduced the severity and duration of such outbreaks.

Sixty-sixth World Health Assembly – 20–28 May 2013 Daily notes on proceedings

Sixty-sixth World Health Assembly
20–28 May 2013
Daily notes on proceedings – Editor’s Excerpts

66th WHA – Notes: Monday, 20 May 2013
World Health Assembly opens with focus on the Post Millennium Development Goals Agenda
The Sixty-sixth World Health Assembly opened this morning with the election of  Dr Shigeru Omi, Special Assistant for International Affairs, Ministry of Health, Labour and Welfare of Japan, as its new president. Five vice-presidents were also appointed from Angola, Haiti, Nepal, Oman, and Ukraine, representing their respective regions.

. Last 1,000 days for MDGs and the path forward
In his message, which was read by Mr Kassym-Jomart Tokayev, Director-General of the United Nations Office in Geneva, UN Secretary-General Ban Ki-moon drew attention to the positive effect the Millennium Development Goals (MDGs) have had on the global health agenda. He noted that the Health Assembly will discuss a number of MDG-related issues, such as implementation of the Global Vaccine Action Plan and recommendations from the UN Commission on life-saving commodities for women and children. He described the pressing challenge presented by the rise in noncommunicable diseases, highlighting the role of universal health coverage in ensuring equitable access to health services. He emphasized the continuing need for WHO to handle unforeseen global health events, such as newly emerging viruses.

Dr Omi observed that reform of WHO, the topic of tomorrow’s plenary discussion, aims to make the Organization more relevant, more effective and more dynamic.
Watch the President’s speech on video
Streaming wmv, 00:12:44

. Opening address of the WHO Director-General
In her opening address, WHO Director-General Dr Margaret Chan reiterated the importance of transparent reporting and vigilance in disease outbreaks, including recent cases of novel coronavirus and influenza H7N9, whilst at the same time maintaining the momentum made in addressing long-standing health issues such as tuberculosis, HIV, malaria; the emerging problem of noncommunicable diseases; and eradication of polio.

Dr Chan reiterated WHO’s refusal to work with the tobacco industry. However, she did not exclude the opportunity for cooperation with the food and beverage industry to address noncommunicable diseases, while supporting existing safeguards which ensure no conflicts of interest.

Read the Director-General’s address to the Sixty-sixth World Health Assembly

Watch the Director-General’s address
Streaming wmv, 00:31:48

66th WHA – Notes: Wednesday, 22 May 2013
. Accelerating achievement of health-related MDGs: The Global Fund New Funding Model, implications for country level cooperation and WHO’s support
Technical briefing
Dr Margaret Chan, Director-General of WHO, applauded the contribution made by the Global Fund to Fight AIDS, Tuberculosis and Malaria to progress towards the MDGs at today’s lunchtime technical briefing on the Fund’s New Funding Model. Dr Mark Dybul, Executive Director of the Global Fund, explained that the new approach builds on three core principles: working as a financing institution that partners with others to serve countries; providing predictability around resource availability; and creating a platform for broader public health support.

Ministers of Health from El Salvador, Myanmar and Zimbabwe, all of whom have made proposals using the new funding model, welcomed the changes enthusiastically and commended support provided by WHO and other technical partners. Other speakers praised the Fund’s closer alignment with country plans and willingness to provide more support for health systems as well as its readiness to learn from experience and to increase transparency.

66th WHA – Notes: Thursday, 23 May 2013
. Implementation of the International Health Regulations (2005)
Item 15.1 – documents A66/16 and A66/16 Add.1
Before the item was undertaken, delegates requested an update from the WHO Secretariat and the Kingdom of Saudi Arabia on the recent emergence of MERS-CoV (previously known as Novel Coronavirus). The Secretariat and the Saudi Ministry of Health provided background information and a history of the emergence and response to the virus to date. The WHO presentation is attached. The discussion of the item will restart tomorrow.
Global overview of an emerging novel coronavirus
pdf, 741kb

Saudi Arabia’s response to novel coronavirus
pdf, 993kb

Implementation of the International Health Regulations (2005) (A66/16)
pdf, 178kb
Implementation of the International Health Regulations (2005) (A66/16 Add.1)

66th WHA – Notes: Friday, 24 May 2013
. Implementation of the International Health Regulations (2005)
Item 15.1 – document A66/16 and A66/16 Add.1
The newly identified H7N9 and MERS-CoV outbreaks lent even greater relevance to discussions on the International Health Regulations. Delegates voiced widespread support for the IHR and acknowledgement of WHO’s role in assisting countries. The Director-General told delegates that WHO was committed to supporting countries affected by MERS-CoV and to helping “unpack the barriers” standing in the way of the full implementation of the IHR. She added newly emerging diseases are not just a country problem but a global problem and WHO and the IHR can help bring together “the assets of the world” to fight such threats. The Secretariat stressed the need for countries to provide the necessary resources to ensure IHR work can continue in countries and at WHO. Delegates noted a report updating progress in taking forward 15 recommendations that seek to further improve the effectiveness of the regulations. Countries that have not yet met their IHR obligations and are requesting an extension to the deadline beyond 2014, will be required to inform the WHO Director-General and explain why they have not been able to put IHR in place.
Implementation of the International Health Regulations (2005) (A66/16)
pdf, 177kb
Addendum (A66/16 Add.1)
pdf, 81.8kb
. Pandemic influenza preparedness: sharing of influenza viruses and access to vaccine and other benefits
Item 15.2 – document A66/17
This is the first annual report of the pandemic influenza preparedness (PIP) framework which delegates were agreed to note. The report covers three main areas: virus sharing, benefit sharing, and governance.
It was noted that many countries still lack basic capacities. Laboratory and disease surveillance were highlighted by some countries. A similar concern was highlighted on the regulation and deployment of influenza vaccines during a pandemic.

Lengthy negotiations to conclude binding SMTA2s (Standard Material Transfer Agreement 2) are ongoing. Delegates called for an acceleration on the processes to enable agreements to be signed.

Delegates emphasized the need for transparency related to use of partnership contribution funds.
Pandemic Influenza Preparedness Framework 2013 biennial report (A66/17)
pdf, 204Kb

. Poliomyelitis: intensification of the global eradication initiative
Item 15.3 – document A66/18
The World Health Assembly acknowledged the progress achieved in the past year in bringing polio to its lowest ever levels, thanks to actions of Member States in placing polio eradication on an emergency footing. Delegates endorsed the new Polio Eradication and Endgame Strategic Plan 2013-2018 to secure a lasting polio-free world and urged for its full implementation and financing.

At the same time, the Assembly received stark warning of the ongoing risk the disease poses to children everywhere, with confirmation of a new polio outbreak in the Horn of Africa (Somalia and Kenya)

Noting the generous pledges made to support polio eradication at the Global Vaccine Summit, delegates urged donors to rapidly convert these pledges into contributions. The WHA pointed out that this funding was critical for accelerated implementation of the Plan, given the complexity and scale of introducing inactivated polio vaccine worldwide.

Delegates condemned the deadly attacks on health workers in Pakistan (in December 2012) and Nigeria (in February 2013), and called on all governments to ensure the safety and security of frontline health workers.
Poliomyelitis: intensification of the global eradication initiative (A66/18)
pdf, 146kb

66th WHA – Notes: Saturday, 25 May 2013
. Global Vaccine Action Plan
Item 16.1 – document A66/19
Member States reiterated their support to the Global Vaccine Action Plan (GVAP) to prevent millions of deaths by 2020 through more equitable access to vaccines for people in all communities, and for the proposed Framework for Monitoring, Evaluation and Accountability (which is linked to the Commission on Information and Accountability for Women’s and Children’s Health).

Delegates also supported the independent review process to assess and report progress and acknowledged the leadership demonstrated by the Strategic Advisory Group of Experts on immunization (SAGE) in this process. Speakers highlighted the need to mobilize greater resources to support low- and middle-income countries to implement the Plan and monitor impact; ensure that support to countries to implement the Plan includes a strong focus on strengthening routine immunization; and to facilitate vaccine technology transfer.
Global Vaccine Action Plan (A66/19)
pdf, 205kb

Speech and Response [Seth Berkley]: Harnessing the power of science and the private sector: a 21st century model for international development

Speech and Response: Harnessing the power of science and the private sector: a 21st century model for international development
Dr Seth Berkley, CEO of the GAVI Alliance
Inaugural Lecture: Wellcome Trust – Cambridge Centre for Global Research University of Cambridge
2nd May 2013



Video HD:

“The world-leading flu expert, Professor Derek Smith (Director of the WHO Collaborating Centre for Modelling, Evolution and Control of Emerging Infectious Diseases at the University of Cambridge, and Co-PI for the WT-CCGHR) gave a great presentation in response to Dr Berkley’s lecture, and that talk is also available on the video recording.”

GAVI Coverage: Excerpt
“…In the lecture Dr Berkley explained how GAVI operates and why this is critical to ensuring it has a lasting impact. As a 21st Century development organisation, GAVI is an inclusive and diverse partnership bringing together the World Health Organization, UNICEF, and recipient and donor countries together with NGOs, vaccine manufacturers, technical research institutes and individuals with skills and commitment to immunise children.

“In the GAVI model, developing countries lead vaccine uptake and co-finance the cost of the vaccines they receive to ensure immunisation programmes are sustainable after GAVI support ends. With a Board structure drawn from a diverse range of sectors, GAVI seeks to inject private sector innovation into public health issues…”

PATH CEO pledges “…to work with partners to save the lives of two million children affected by pneumonia and diarrhea by the end of 2015″

PATH CEO Steve Davis announced a pledge “…to work with partners to save the lives of two million children affected by pneumonia and diarrhea by the end of 2015.”  Mr. Davis said “PATH is in the business of providing the world—particularly many of the poorest parts of the world—with a set of tools so good health can be in reach of everyone. And we’re here today to discuss these tools, and how PATH is thinking and acting differently to deploy them.”

Webcast of the event