Vaccines and Global Health: The Week in Review 21 February 2015

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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pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_21 February 2015

blog edition: comprised of the approx. 35+ entries posted below on this date.

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

POLIO [to 21 February 2015]

POLIO [to 21 February 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 18 February 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The fourth meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus is convening this week. Outcomes and the Committee’s final report will be made available on http://www.polioeradication.org.
:: It has been six months since the most recent case of wild poliovirus on the African continent had onset of paralysis, in Somalia on 11 August. Twelve months of absence of wild poliovirus, with certification-quality surveillance, will be necessary for the Horn of Africa outbreak to be declared as closed.
Selected country report content:
Afghanistan
:: On 15 – 17 February in most areas and 22 – 24 February in the south, Subnational Immunization Days (SNIDs) will take place across the entire south and east of the country, using bivalent OPV. The next National Immunization Days (NIDs) are planned for 15 – 17 March using trivalent OPV in most areas, and inactivated polio vaccine (IPV) combined with bivalent OPV in some areas of Hilmand, Kandahar and Nangarhar.

Four kidnapped polio workers are found dead in Pakistan
BBC News | 17 February 2015
Four members of a polio vaccination team have been found shot dead in south-west Pakistan, four days after being abducted.
Police said that the bodies of a health worker, his driver and two security guards were found in the region of Balochistan.
The team were seized on Friday by Taliban militants, security officials said.
Militants say polio teams are spies or that the vaccine causes infertility…

EBOLA/EVD [to 21 February 2015]

EBOLA/EVD [to 21 February 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 18 February 2015
[Excerpt; Editor’s text bolding]

SUMMARY
Total weekly case incidence increased for the second consecutive week, with 144 new confirmed cases reported in the week to 8 February. Guinea reported a sharp increase in incidence, with 65 new confirmed cases compared with 39 the week before. Transmission remains widespread in Sierra Leone, which reported 76 new confirmed cases, while the resurgence in cases in the western district of Port Loko continued for a second week. Liberia continues to report a low number of new confirmed cases.

Despite improvements in case finding and management, burial practices, and community engagement, the decline in case incidence has stalled. The spike in cases in Guinea and continued widespread transmission in Sierra Leone underline the considerable challenges that must still be overcome to get to zero cases. The infrastructure, systems, and people needed to end the epidemic are now in place; response measures must now be fully implemented.

The surge of new confirmed cases reported by Guinea was driven primarily by transmission in the capital, Conakry (21 confirmed cases) and the western prefecture of Forecariah (26 confirmed cases). Community engagement continues to be a challenge in Conakry and Forecariah, and in Guinea more widely. Almost one-third of the country’s EVD-affected prefectures reported at least one security incident in the week to 8 February. Effective contact tracing, which relies on the cooperation of communities, has also proved challenging. In the week to 1 February, just 7 of 42 cases arose among registered contacts. A total of 34 unsafe burials were reported, with 21 EVD-positive deaths reported in the community.

Seven new confirmed cases were reported in the east-Guinean prefecture of Lola. A field team is currently deployed to Côte d’Ivoire to assess the state of preparedness in western areas of the country that border Lola.

Follow-up preparedness missions are planned for Mali and Senegal later this month, culminating in a tri-partite meeting between Guinea, Mali, and Senegal to strengthen cross-border surveillance.

A total of 3 confirmed cases was reported from Liberia. All of the cases originated from the same area of Montserrado county, linked to a single chain of transmission.

Following the steep decline in case incidence in Sierra Leone from December until the end of January, incidence has now stabilized. A total of 76 cases were reported in the week to 8 February, a decrease from the 80 confirmed cases reported in the week to 1 February, but higher than the 65 confirmed cases reported in the week to 25 January. Transmission remains widespread, with 7 districts reporting new confirmed cases. A total of 41 unsafe burials were reported in the week to 8 February.

The case fatality rate among hospitalized cases (calculated from all confirmed and probable hospitalized cases with a reported definitive outcome) remains high, between 53% and 60%.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
There have been almost 23,000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 9000 reported deaths (outcomes for many cases are unknown). A total of 65 new confirmed cases were reported in Guinea, 3 in Liberia, and 76 in Sierra Leone in the 7 days to 8 February (data missing for 8 February in Liberia). At the start of the epidemic many reported suspected cases were genuine cases of EVD. At this stage, with improved surveillance systems in place, a far smaller proportion of suspected cases are confirmed to have EVD. Consequently, the incidence of new confirmed cases gives a more accurate picture of the epidemic.

A stratified analysis of cumulative confirmed and probable cases indicates that the number of cases in males and females is similar (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are almost four times more likely to be affected than are children.

A total of 830 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths…
WHO: Guinea: Reopening schools safely – partnering with families and communities
16 February 2015

In General Assembly Meeting on Ebola, Secretary-General Urges Member States to Sustain Crucial Work, Provide Resources Needed to Reach ‘Zero Cases’

18 February 2015
SG/SM/16536-GA/11621
In General Assembly Meeting on Ebola, Secretary-General Urges Member States to Sustain Crucial Work, Provide Resources Needed to Reach ‘Zero Cases’
[Excerpt; Editor’s text bolding]
We met five months ago when the world was coming to terms with an unprecedented outbreak of Ebola in West Africa. The outbreak was gaining ground every hour, outpacing response efforts.

You recognized the grave threat that Ebola posed to the region and beyond. You welcomed the deployment of the United Nations Mission for Ebola Emergency Response — UNMEER — the first of its kind in the history of the United Nations.

Local, national, regional and international capacities mobilized in solidarity with the affected communities and countries to support nationally led response efforts. With the leadership of Presidents Condé, Koroma and Sirleaf Johnson, national Governments and communities took proactive steps to protect themselves, leading to reduced risks of infection and lower incidence rates.

Today, we face a critical turning point. The pattern of the Ebola outbreak has changed. 2015 has seen a significant decline in the number of new Ebola cases in the three affected countries. Liberia, once the worst affected country with several hundred cases per week, has been steadily reporting fewer than five cases per week for the past month, all isolated to a single chain of transmission in one county.

While overall figures remain much lower than what we saw in 2014, incidence rates rose again in Guinea and Sierra Leone in recent weeks. More than half of those newly infected have not been in contact with people known to have had Ebola. This reminds us that setbacks can quickly follow apparent gains, and highlights the need for constant vigilance and active surveillance, even in unaffected areas.

The response now faces a complicating factor: the impending rainy season, which will lead to increases in other diseases and impede road access for responders. To get the situation further under control, the UN system, through UNMEER, is mobilizing surge efforts to support national and local authorities in Guinea and Sierra Leone. We are accelerating our work to reach the targets set by the Presidents of the Mano River Union on 15 February — zero cases in 60 days, by mid-April.

A strong, effective response can bring the spread of Ebola under control. But, if communities, Governments and partners stop being vigilant, resort to unsafe practices and fail to conduct active surveillance, and if donors decide not to finance this vital push, flare-ups will occur. This could lead to a serious recurrence of the outbreak.

Too much progress has been made and too much is at stake to afford complacency. We must finish the job. Our collective efforts have made remarkable progress. We have succeeded in averting the worst-case scenarios we feared. There are encouraging signs that the worst of the outbreak is behind us. But, much important work lies ahead until the affected countries reach zero cases and begin the transition to reconstruction and recovery.

I call on all responders to redouble their efforts, and on donors to stay the course. Under the technical leadership of the World Health Organization, the UN system will continue supporting efforts to get to zero through active surveillance, case management and community engagement. The UN system will also contribute to the safe revival of essential services.

As the situation improves, the time will come for critical functions to transition progressively and seamlessly from UNMEER to the UN agencies, funds and programmes. Significant additional resources will be required by the UN system.

My Special Envoy, Dr. Nabarro, will continue to mobilize the resources needed to fill critical gaps, including through my Trust Fund. The UN system will work with national Governments and regional partners to ensure that the investments made in the fight to stop Ebola serve as a basis for longer-term recovery efforts. We must help the affected countries to become more resilient. Ebola must not be allowed to take hold again in the region.

I appeal to you today to stay engaged and sustain this crucially important work. Let us provide the resources needed to get to zero. Let us ensure that reconstruction and recovery can occur without delay. Let us translate the lessons from this collective effort into building stronger national systems for health security…
Letter from the Secretary-General to the President of the General Assembly: Work on the UN in response to the Ebola outbreak [120-day report], A/69/759 (10 February 2015)

UNMEER [to 21 February 2015]

UNMEER [to 21 February 2015]
https://ebolaresponse.un.org/un-mission-ebola-emergency-response-unmeer

:: Statements from United Nations officials and Coalition partners.
19 Feb 2015
– Special Representative and Head of UNMEER’s remarks at the Ministry of Information, Cultural Affairs and Tourism Press Briefing in Monrovia

18 Feb 2015
– Special Representative and Head of UNMEER’s statement at the informal plenary meeting of the General Assembly on Ebola
– President of the General Assembly’s statement at the informal plenary meeting of the General Assembly on Ebola
– Dr. David Nabarro’s statement at the informal plenary meeting of the General Assembly on Ebola

17 Feb 2015
– Remarks by Dr. David Nabarro at the Opening of the International Responders’ Meeting, WHO/Geneva

CDC/MMWR Watch [to 21 February 2015]

CDC/MMWR Watch [to 21 February 2015]
http://www.cdc.gov/media/index.html

:: Ebola containment strategy succeeding in Liberia – Friday, February 20, 2015
Data reveal dramatic impact of Rapid Isolation and Treatment of Ebola (RITE) strategy
The Rapid Isolation and Treatment of Ebola (RITE) strategy is helping to end the Ebola epidemic in Liberia, according to new data reported in this week’s Morbidity and Mortality Weekly Report (MMWR).
The strategy—a rapid, coordinated response to Ebola cases in remote areas—is now being used in Sierra Leone and Guinea….

:: MMWR Weekly, February 20, 2015 / Vol. 64 / No. 6
– Update on Progress in Selected Public Health Programs After the 2010 Earthquake and Cholera Epidemic — Haiti, 2014
– Measles Outbreak — California, December 2014–February 2015

WHO urges governments to increase investment to tackle 17 neglected tropical diseases

WHO urges governments to increase investment to tackle 17 neglected tropical diseases
News release
19 February 2015 ¦ GENEVA – WHO urges affected countries to scale up their investment in tackling 17 neglected tropical diseases in order to improve the health and well-being of more than 1.5 billion people. This investment would represent as little as 0.1% of current domestic expenditure on health in affected low- and middle-income countries for the period 2015-2030.

Neglected tropical diseases cause blindness, disfigurement, permanent disability and death, particularly among the poor…

“Increased investments by national governments can alleviate human misery, distribute economic gains more evenly and free masses of people long trapped in poverty,” says WHO Director-General Dr Margaret Chan.

Progress
The report highlights progress made in recent years, largely attributed to a scale-up of control interventions in reaching the poorest. For example, in 2012 alone, more than 800 million people were treated for at least one neglected tropical disease. In 2014 there were just 126 cases reported of Dracunculiasis (guinea-worm disease), compared to almost 1800 in 2010 and 3.5 million in the mid-1980s. Eradication of this disease is achievable with continued effort and investment.
Need for increased domestic investment targets

The report sets specific investment targets for many of the 17 diseases. It stresses that countries must make firm and sustainable budgetary commitments if they are to meet WHO targets and accelerate progress.

The investments
:: An annual investment of US$ 2.9 billion until 2020 (including vector control), is required to reach targets set in 2012 in the WHO Roadmap for 2015-2020.
:: For the following 10 years (2021-2030), investment requirements will drop to US$ 1.6 billion per year. Annual investments will continue to decrease as diseases are reduced or eliminated.
:: This adds up to a total investment of US$ 34 billion (over 16 years) and excludes cost of donated medicines and other in-kind contributions.
The impacts
:: By 2017, the number of people receiving preventive treatment for at least one of the diseases should reach 1.5 billion. As diseases are reduced or eliminated, the number of people needing and receiving treatment will obviously fall. Early detection of some neglected tropical diseases will allow more children to continue school and adults to work while reducing the costs associated with treating more advanced forms of these diseases.
:: Moving towards universal health coverage will ensure that all people have access to preventive and curative health services for neglected tropical diseases without the risk of financial hardship when paying for them.
:: Investing to overcome the impact of neglected tropical diseases – Third WHO report on neglected tropical diseases