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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David R. Curry, MS
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School
WHO: South-East Asia Region certified polio-free
New Delhi, 27 March: WHO South-East Asia Region, home to a quarter of the world’s population, was certified polio-free today by an independent commission under the WHO certification process. This is the fourth of six WHO Regions to be certified, marking an important step towards global polio eradication. With this step, 80% of the world’s population now lives in certified polio-free regions.
An independent panel of 11 experts in public health, epidemiology, virology, clinical medicine and related specialties constituting the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) met for two days to review evidence from countries before reaching the decision that all 11 countries of the Region are now polio-free and have met the requirements for certification…
… “This is a momentous victory for the millions of health workers who have worked with governments, nongovernmental organizations, civil society and international partners to eradicate polio from the Region. It is a sign of what we can bequeath our children when we work together,” said Dr Poonam Khetrapal Singh, Regional Director for the WHO South-East Asia Region…
…While celebrating the historic achievement, the WHO Regional Director also sounded a word of caution to maintain high vigilance against importation of polio. “Until polio is globally eradicated, all countries are at risk and the Region’s polio-free status remains fragile. High immunization coverage can prevent an imported virus from finding an underimmunized, susceptible population. A sensitive surveillance system, able to quickly detect and identify any importation and guide a programmatic response, is critical,” she added.
Full press release: http://www.searo.who.int/mediacentre/releases/2014/pr1569/en/
:: Polio-free certification of the WHO South East Asia Region
:: Photo Story – How communities are being informed about immunization services
WHO: Poliomyelitis – intensification of the global eradication initiative
Report by the Secretariat
67th World Health Assembly
A67/38 – Provisional agenda item 16.4
21 March 2014
Editor’s selected segments and bolding; full text here
:: OBJECTIVE 1: POLIOVIRUS DETECTION AND INTERRUPTION
…5. Insecurity, targeted attacks on health workers and/or a ban by local authorities on polio immunization resulted in a deterioration in access in the Federally Administered Tribal Areas and Khyber Pakhtunkhwa province of Pakistan and the state of Borno in Nigeria. Chronically poor implementation of activities remained a critical challenge in other priority areas, most notably in the state of Kano, Nigeria, and Balochistan province and the city of Karachi in Sindh province, Pakistan. In poliovirus-affected areas of Pakistan and Nigeria an estimated combined total of 530 000 children remained inaccessible for vaccination; in the reinfected area of south-central Somalia more than 500 000 children were inaccessible for polio vaccination.1
6. The risk of further international spread remains high, particularly in central Africa (especially from Cameroon), the Middle East and the Horn of Africa. Consequently, the Regional Committee of the Eastern Mediterranean Region at its sixtieth session in October 2013 declared polio transmission an emergency for all Member States of the Region.2 Following the deliberations of the Executive Board at its 134th session, the Director-General convened the Polio Working Group of the Strategic Advisory Group of Experts on immunization (Geneva, 5–6 February 2014) to update WHO’s vaccination recommendations for travellers from polio-infected countries. The convening of an Emergency Committee under the International Health Regulations (2005) is planned in advance of the Sixty-seventh World Health Assembly in order to advise the Director-General on measures to limit the international spread of wild poliovirus…
:: OBJECTIVE 2: STRENGTHENING IMMUNIZATION SYSTEMS AND WITHDRAWAL OF ORAL POLIO VACCINE
…9. The Strategic Advisory Group of Experts on immunization finalized its policy recommendations for the administration of inactivated poliovirus vaccine in routine immunization schedules, and endorsed the strategy that was developed for the financing, supply and introduction of inactivated poliovirus vaccine globally.1 The strategy prioritizes the 126 countries that currently use only oral polio vaccine into four tiers, on the basis of the risk of the emergence and spread of circulating vaccine-derived poliovirus type 2; 72% of the strategy’s target population is concentrated in the 33 countries of tiers 1 and 2. The strategy combines funding through the GAVI Alliance and expedited processes for the 73 countries eligible for its support with volume purchasing and UNICEF-assisted procurement for other countries in order to obtain the lowest possible prices for inactivated poliovirus vaccine. In February 2014, UNICEF announced a procurement price of €0.75 per dose (about US$ 1 per dose at current exchange rates) of inactivated poliovirus vaccine in 10-dose vials for GAVI-eligible countries and a price of €1.49–2.40 (about US$ 2.04–3.28 at current exchange rates) per dose for middle-income countries. In addition, UNICEF has awarded volumes for five-dose vials at the price of US$ 1.90 per dose for both low- and middle-income countries, expected to be available from the fourth quarter of 2014. Work continues to develop and license new products and approaches for inactivated poliovirus vaccine, which may contribute to further reductions in the cost of inactivated poliovirus vaccine for the medium-term (that is to say beyond 2018)…
:: OBJECTIVE 3: CONTAINMENT AND CERTIFICATION
… 11. As of 28 February 2014, the South-East Asia Region was on track for certification of polio eradication at end-March 2014. The Global Commission for the Certification of the Eradication of Poliomyelitis will review data from all six WHO regions in late 2014 or early 2015 to determine whether there is sufficient evidence to conclude formally that wild poliovirus type 2 has been eradicated globally…
:: OBJECTIVE 4: LEGACY PLANNING
…13. An independent study was conducted on the 22,000 people who are deployed by the Global Polio Eradication Initiative, including the more than 7000 contracted by WHO.1 Senior representatives of national governments, donor agencies and other health initiatives most frequently cited the surveillance (86%), laboratory (50%) and social mobilization (46%) functions performed by this workforce as of potential value for transition to other health initiatives. Two thirds of respondents stated that the future administration of this human resources infrastructure should be the responsibility of national governments…
:: FINANCING AND RESOURCE MANAGEMENT
15. In April 2013, donors and governments of polio-affected countries pledged US$ 4040 million towards the US$ 5530 million budget of the Endgame Plan at the Global Vaccine Summit (Abu Dhabi, 24 and 25 April 2013). A further US$ 490 million has been pledged since then. In order to operationalize these pledges and mobilize additional funding for the remaining US$ 1000 million gap, WHO and its Global Polio Eradication Initiative partners have enhanced their resource mobilization and strategic communications capacities and refocused their cross-agency polio advocacy group on intensified resource mobilization. A cross-agency finance working group ensures stronger cost control, accountability and resource management.
16. At the end of November 2013, aggregated requests for financing of eradication activities in 2014 exceeded the budget of US$ 1033 million by US$ 286 million. Reconciling these requests with available financing required a substantial rescheduling of supplementary immunization activities in many countries and allocation of part of the programme’s limited discretionary funds for inactivated poliovirus vaccine introduction. As at 23 January 2014, the cash gap for eradication activities planned for 2014 was still US$ 497.52 million, against the 2014 budget of US$ 1033 million, requiring intensified efforts to operationalize financing pledges.
:: MAJOR RISKS AND PROGRAMME PRIORITIES FOR 2014
17. The major risks to eradication are: the bans on immunization campaigns in the North Waziristan agency in Pakistan and parts of southern and central Somalia; the continued targeting of vaccinators in Khyber Pakhtunkhwa province and Karachi in Pakistan; ongoing military operations in Khyber Agency (within the Federally Administered Tribal Areas) of Pakistan; insecurity in Eastern Region, Afghanistan, and Borno state, Nigeria; active conflict in the Syrian Arab Republic; and gaps in programme performance in Kano state, Nigeria, and in the outbreak response performance in Cameroon. These risks are compounded by gaps in polio surveillance and the continued threat of new international spread of wild poliovirus.
18. Management of these risks requires full national ownership of the eradication programme in all infected countries, with deep engagement of all relevant line ministries and departments, and the holding of local authorities fully accountable for the quality of activities, particularly in accessible areas such as Kano state, Nigeria, and in Cameroon. Accessing and vaccinating children in insecure and conflict-affected areas will in addition require the full engagement of relevant international bodies, religious leaders and humanitarian actors to implement area-specific plans, generate greater community demand and participation, and adapt eradication approaches in line with local contexts. In order to minimize the risks and consequences of international spread of poliovirus, Member States are urged to enhance surveillance and immunization activities and implement fully recommendations for immunization of travellers…
GPEI Update: Polio this week – As of 26 March 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: World’s most populous region certified polio-free: the WHO South East Asia Region was certified polio-free at a ceremony in India this week, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.
:: A case of polio due to wild poliovirus type 1 (WPV1) was reported from Iraq this week. This is the first polio case in the country since 2000 and is further evidence of regional spread of the virus. The case, a six-month old boy from Baghdad who had not been immunized, developed paralysis on 10 February 2014. Genetic sequencing indicates the virus is most closely related to virus detected in Syria. WPV1 was also isolated from the child’s three-year old sister, who did not develop symptoms. More
:: The GPEI report to the upcoming World Health Assembly in May is now available online. It summarizes the status against each of the four objectives of the Polio Endgame Strategic Plan, and presents an overview of programmatic priorities for the rest of 2014. The full report is available here and above.
:: A new case of WPV1 was reported this week from Muhmand Dara district in Nangarhar province (previously without wild poliovirus in 2014) with onset of paralysis on 22 February, bringing the total number of WPV1 cases for 2014 to four. The total number of WPV1 cases for 2013 is 14.
:: Seven new WPV1 cases were reported in the past week, five from North Waziristan, Federally Administered Tribal Areas – FATA, one from Bannu, Khyber Pakhtunkhwa (KP), and one from Peshawar, KP, bringing the total number of cases for 2014 to 36. The most recent case had onset of paralysis on 7 March (WPV1 from North Waziristan, Federally Administered Tribal Areas – FATA).
:: Due to continued poliovirus circulation in Cameroon, gaps in surveillance and influx of vulnerable populations from CAR, WHO is elevating the risk assessment of international spread of polio from Cameroon to very high.
:: Since confirmation of the outbreak in Cameroon in October, five nationwide campaigns have been conducted. However, the quality of implementation varied greatly by region, and serious coverage gaps remain. As many as 40% of children remain under-immunized (with 30% having received zero doses) during SIAs.
:: The recent confirmation of new cases in Cameroon has resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity in April 2014, and implementing nationwide campaigns in May and June 2014. Critical to success will be to ensure substantial improvement in the quality campaigns so that all children are reached multiple times with OPV. Equally important will be efforts to rapidly improve the quality of surveillance so that the full extent of the outbreak can be determined and tracked.
:: Immunity levels and surveillance sensitivity are also being assessed in neighbouring countries, in particular in Gabon and the Republic of Congo, and additional immunization activities are being considered in these countries.
Horn of Africa
:: One new WPV1 case was reported in the past week, from Ethiopia. It is the first case in the Horn of Africa in 2014, and had onset of paralysis on 5 January, from Somali region.
:: A case of polio due to wild poliovirus type 1 (WPV1) was reported from Iraq last week. This is the first polio case in the country since 2000 and further evidence of regional spread of the virus. The case, a six-month old boy from Baghdad who had not been immunized, developed paralysis on 10 February 2014. Genetic sequencing indicates the virus is most closely related to virus detected in Syria. WPV1 was also isolated from the child’s three-year old sister, who did not develop symptoms.
:: In Iraq, since October, two nationwide immunization campaigns and three subnational campaigns have been conducted, achieving overall high quality. Approximately 95% of children were reported to have been reached during each campaign, though coverage has varied by area. WHO and UNICEF estimates from 2012 put routine immunization levels in Iraq at 70%. Routine immunization levels in Baghdad are estimated to be 81%.
Displacement, violence likely cause of Iraq’s first polio case in 14 years
IRIN – UNOCHA
DUBAI, 24 March 2014 (IRIN) – Health officials in Iraq are stepping up polio immunization and surveillance following the first confirmed case of the virus in the country in more than a decade.
“It is a huge blow because for 14 years Iraq has been polio free,” Syed Jaffar Hussain, head of mission for the World Health Organization (WHO) in Iraq, told IRIN.
WHO’s Eastern Mediterranean Region poliovirus laboratory in Egypt and the Centres for Disease Control and Prevention (CDC) in the USA both confirmed the outbreak, detected after a six-month-old baby living on the outskirts of Baghdad became paralysed.
The strain’s genetic sequence matches the one found last September in Syria – wild polio virus type 1 (WPV1) – but it is not yet clear how the virus made it to the Iraqi capital or how the boy became infected. His family has no links with Syria or record of recent travel there…
WHO: Poliomyelitis Fact sheet N°114
Updated March 2014
:: Polio (poliomyelitis) mainly affects children under 5 years of age.
:: One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
:: Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 406 reported cases in 2013. The reduction is the result of the global effort to eradicate the disease.
:: In 2014, only 3 countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988.
:: As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200,000 new cases every year, within 10 years, all over the world.
:: In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.
Cameroon announced the introduction of rotavirus vaccines into its routine immunisation programme with GAVI Alliance support. Rotavirus results in almost 6,000 death of Cameroonian children under five each year. GAVI Deputy CEO Helen Evans said, “Immunisation is one of the best investments that a country can make in the health and well-being of its children. Cameroon’s decision to protect its children against severe diarrhoea by vaccinating them against rotavirus will have a strong, positive impact on families and communities across the country.”
Joint UNICEF, WHO, GAVI Alliance Media Release: Cameroon to protect its children against leading cause of severe diarrhoea
GAVI Watch [to 29 March 2014]
:: UK public support for Sport Relief to help vaccinate children in Africa and Asia
London, 23 March 2014 – Children in Africa and Asia are set to benefit from the sporting efforts of thousands of Britons thanks to a generous donation from Sport Relief towards the GAVI Alliance’s mission to increase immunisation in the world’s poorest countries.
Sport Relief has announced a £3 million pledge to the Alliance for 2014 to support vaccine programmes in the world’s poorest countries. This funding will be matched by the Bill & Melinda Gates Foundation through the GAVI Matching Fund, bringing the total to £6 million.
GAVI Alliance Deputy CEO, Helen Evans, said, “The support the GAVI Alliance receives from Sport Relief, thanks to donations from the UK public, makes a tremendous impact in the lives of children living in some of the most difficult circumstances. We are grateful for the continued support of Sport Relief and the generosity of the UK public towards our mission to ensure that children receive vital vaccines no matter where they live.”…