Vaccines and Global Health: The Week in Review :: 27 September 2014

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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blog edition: comprised of the 35+ entries posted below on 28 September 2014

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David R. Curry, MS
Executive Director
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: EBOLA [to 27 September 2014]

EBOLA [to 27 September 2014]

:: Situation report update – 26 September 2014
Continuing escalation of the outbreak across Liberia, Guinea and Sierra Leone

:: Experimental therapies: growing interest in the use of whole blood or plasma from recovered Ebola patients (convalescent therapies)
26 September 2014

:: WHO Director-General addresses high-level meeting on the Ebola response
25 September 2014

:: Ebola outbreak response: maps

UN: High-Level Meeting on Response to Ebola Virus Disease Outbreak

UN: High-Level Meeting on Response to Ebola Virus Disease Outbreak
25 September 2014 – AM Meeting
‘Every Day, Every Minute, Counts,’ Warns World Health Organization Head at High-Level Meeting on Response to Ebola Virus Disease Outbreak
[Excerpt; Editor’s text bolding]

With the Ebola virus claiming the lives of 200 people each day, most of them women, world leaders at a high-level Headquarters meeting Thursday implored the international community to swiftly ramp up the response to the epidemic ravaging West Africa before it turned into a humanitarian catastrophe.

“Every day, every minute, counts,” said Margaret Chan, Director-General of the World Health Organization (WHO), insisting “We must try harder.” Overflowing treatment centres were turning away sick and dying patients. In some areas no treatment beds were available, she said, stressing the need for more centres, as well as community-based care facilities.

United States President Barack Obama agreed. “We are not moving fast enough. We are not doing enough. Right now, everybody has the best of intentions, but people are not putting in the kind of resources that are necessary to put a stop to this epidemic,” he said.

The worst ever outbreak of the virus already had caused a collapse of the public health systems in Liberia, Guinea and Sierra Leone — the three most affected countries. If left unchecked, the crisis could quickly become a global threat; stopping it was in everyone’s interest. Last week, the Security Council determined that the outbreak was a threat to international peace and security, adopting resolution 2177 (2014) to that effect.

Mr. Obama today called on international organizations to “cut through red tape and mobilize partners on the ground”, and on Governments to contribute more critical assets such as air transport, medical evacuation, health-care workers and equipment…

…United Nations Secretary-General Ban Ki-moon said advance teams had already deployed to the three most-affected countries and to the newly formed United Nations Mission for Ebola Emergency Response (UNMEER), based in Accra, Ghana, which would lead the Organization’s system-wide response. “We are focusing on stopping the outbreak, treating the infected, providing essential services, preserving stability, and preventing outbreaks in non-affected countries,” he said.

The crisis had highlighted the need to strengthen early identification systems and action, he said. The international community should consider forming a stand-by “white coats” corps of medical professionals, backed by WHO expertise and the United Nations logistical capacity.

“Now is the time for a robust and united effort to stop the outbreak. The world can and must stop Ebola — now,” he said, warning that while dozens of countries and organizations were making lifesaving contributions, they fell short of the 20-fold increase required….

…Liberian President Ellen Johnson-Sirleaf said “partners and friends, based on understandable fears, have ostracized us, shipping and airline services have sanctioned us and the world has taken some time to fully appreciate and adequately respond to the enormity of our tragedy”.

More than 1,700 Liberians had died already, among them 85 health-care workers, she said. Facing perhaps its greatest challenge ever, her nation was fighting back, building and staffing more treatment centres, and moving more aggressively to prevent the disease’s spread and to change the behaviour at the local level through community outreach.

“We cannot allow the projection of a worst-case scenario: that over 100,000 of our innocent citizens will die from an enemy disease they did not start and do not understand, that the resulting effect will reverse our gains in malaria control and child and maternal mortality,” she said.

Ernest Bai Koroma, President of Sierra Leone, said he had declared a state of emergency, shutting down the country for three days to get more than 27,000 health-care educators into every household in the country and reallocating millions of dollars from other vital services to combat Ebola….

…Alpha Condé, President of Guinea, said the outbreak was a threat to international peace and security. The response should be used to rebuild and strengthen the affected countries’ infrastructure so that once the crisis was over they could again foster economic growth and maintain stability….

White House FACT SHEET: Global Health Security Agenda: Getting Ahead of the Curve on Epidemic Threats

White House FACT SHEET: Global Health Security Agenda: Getting Ahead of the Curve on Epidemic Threats

The Ebola epidemic in West Africa highlights the urgency for immediate action to establish global capacity to prevent, detect and rapidly respond to biological threats like Ebola. Beginning in his 2011 speech at the United Nations General Assembly, the President has called upon all countries to work together to prevent, detect, and respond to outbreaks before they become epidemics.

The Global Health Security Agenda (GHSA) was launched on February 13, 2014 to advance a world safe and secure from infectious disease threats and to bring together nations from all over the world to make new, concrete commitments, and to elevate global health security as a national leaders-level priority. The G7 endorsed the GHSA in June 2014; and Finland and Indonesia hosted commitment development meetings to spur action in May and August.

On September 26, President Obama, National Security Advisor Rice, Assistant to the President for Homeland Security and Counterterrorism Monaco, and Secretaries Kerry, Hagel, and Burwell will meet with Ministers and senior officials from 44 countries and leading international organizations to make specific commitments to implement the GHSA and to work toward a commitment to assist West Africa with needed global health security capacity within 3 years.

Commitments to Action
In 2014, countries developed 11 lines of effort in support of the GHSA – known as Action Packages. The Action Packages are designed to outline tangible, measurable steps required to prevent outbreaks, detect threats in real time, and rapidly respond to infectious disease threats —whether naturally occurring, the result of laboratory accidents, or an act of bioterrorism. The Action Packages include specific targets and indicators that can be used as a basis to measure how national, regional, and global capacities are developed and maintained over the long-term. Since February, countries have made over 100 new commitments to implement the 11 Action Packages. For its part, the United States has committed to assist at least 30 countries over five years to achieve the objectives of the GHSA and has placed a priority for our actions on combating antibiotic resistant bacteria, to improve biosafety and biosecurity on a global basis, and preventing bioterrorism.

Next Steps: Governance and Tracking
Going forward, 10 countries have agreed to serve on the GHSA Steering Group, which will be chaired by Finland starting in 2015, with representation from countries around the world, including: Canada, Chile, Finland, India, Indonesia, Italy, Kenya, the Kingdom of Saudi Arabia, the Republic of Korea, and the United States. The Steering Group is charged with tracking progress, identifying challenges, and overseeing implementation for achieving the objectives of the GHSA in support of international standards set by the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health. This includes the implementation of internationally agreed standards for core capacities, such as the World Health Organization International Health Regulations, the World Organization for Animal Health Performance of Veterinary Services Pathway, and other global health security frameworks. To provide accountability and drive progress toward GHSA goals, an independent, objective and transparent assessment process will be needed. Independent evaluation conducted over the five-year course of the GHSA will help highlight gaps and needed course corrections to ensure that the GHSA targets are reached.

All nations share a responsibility to provide health security for our world and for accelerating action toward a world safe and secure from all infectious disease threats.
Participating Nations—Australia, Azerbaijan, Canada, Chile, China, Denmark, Ethiopia, Finland, France, Georgia, Germany, Guinea, India, Indonesia, Israel, Italy, Japan, Jordan, Kenya, Liberia, Malaysia, Mexico, Netherlands, Norway, Pakistan, Peru, Portugal, Republic of Korea, Saudi Arabia, Sierra Leone, Singapore, South Africa, Spain, Sweden, Switzerland, Thailand, Turkey, Uganda, Ukraine, United Arab Emirates, United Kingdom, United States, Vietnam, and Yemen.

CDC Watch [to 27 September 2014] [Ebola analysis]

CDC Watch [to 27 September 2014]

:: New Modeling Tool for Response to Ebola Virus Disease – Fact Sheet
Tuesday, September 23, 2014
CDC has developed a dynamic modeling tool called Ebola Response that allows for estimations of projected cases over time in Liberia and Sierra Leone.

:: CDC Statement from the Director
September 23, 2014
Ebola is a critical issue for the world community. This week’s meetings in NY and Washington are a critical opportunity for increased international commitments and, more importantly, action.

The Ebola case estimates published today in the MMWR are based on data from August and reflect a moment in time before recent significant increases in efforts to improve treatment and isolation. They do not account for actions taken or planned since August by the United States and the international community. We anticipate that these actions will slow the spread of the epidemic.

The Ebola Response model is an important tool for people working to stop Ebola. It provides the ability to help Ebola response planners make more informed decisions on the emergency response to help bring the outbreak under control – and what can happen if these resources are not brought to bear quickly.

The model shows that there are severe costs of delay, and the need for increased resources and immediate and ongoing action by the international community.

It is still possible to reverse the epidemic, and we believe this can be done if a sufficient number of all patients are effectively isolated, either in Ebola Treatment Units or in other settings, such as community-based or home care.

Once a sufficient number of Ebola patients are isolated, cases will decline very rapidly – almost as rapidly as they rose.

Tom Frieden, M.D., M.P.H.
Director, Centers for Disease Control and Prevention

NIH to admit patient exposed to Ebola virus for observation

NIH Watch [to 27 September 2014]

NIH to admit patient exposed to Ebola virus for observation
September 27, 2014
NIH expects to admit a patient who has been exposed to the Ebola virus to its Clinical Center in the coming days. The patient is an American physician who was volunteering services in an Ebola treatment unit in Sierra Leone.

The patient is being admitted to the NIH Clinical Center for observation and to enroll in a clinical study.

Out of an abundance of caution, the patient will be admitted to the NIH Clinical Center’s special clinical studies unit that is specifically designed to provide high-level isolation capabilities and is staffed by infectious diseases and critical care specialists. The unit staff is trained in strict infection control practices optimized to prevent spread of potentially transmissible agents such as Ebola…