Vaccines and Global Health: The Week in Review 30 May 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

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_30 May 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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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.
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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
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Sixty-eighth World Health Assembly

Sixty-eighth World Health Assembly [full documentation]

Editor’s Note:
The World Health Assembly concluded with a number high-level actions summarized in news releases as below. We focus below on action around immunization and include the full text of the WHA Global Vaccine Action Plan (GVAP) resolution. We note the aggressive call in the resolution for action on vaccine pricing transparency.

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Delegates discuss progress towards global immunization goals
25 May 2015 – Fifty-two speakers, including 46 delegates of Member States, one observer (Chinese Taipei), four civil society organizations and GAVI, the Vaccine Alliance took the floor during the discussion on the Global Vaccine Action Plan.

Delegates welcomed the GVAP assessment report, and commended the WHO Strategic Advisory Group of Experts (SAGE) on immunization on the recommendations in the report.

Delegates took note and expressed concern that the progress with the implementation of GVAP was patchy and slow and “far off-track” for achieving five out of six targets for 2014 and 2015.

WHO’s fundamental role in facilitating the implementation of the GVAP was acknowledged, stressing the important and leading role that WHO should play to:
:: Improve vaccine price transparency and build mechanisms that promote healthy and competitive vaccine markets, tackle the problems faced by middle income countries to secure sustainable supplies of vaccines at affordable prices, particularly for the newer vaccines.
:: Work to enhance awareness of the value of vaccines to increase acceptance of immunization and to mitigate the risks posed by misinformation leading to vaccine hesitancy and refusal.
:: Analyse the causes of vaccine stock out and develop tools to respond immediately to any supply shortfalls.
:: Regularly convene countries that remain off-track to assist with diagnosing the problems and finding solutions.
:: Support countries to improve the quality of data and to use data for informing decisions and for improving programme performance.
:: Expand the existing guidance for vaccination in humanitarian emergencies to also include guidance on sustaining routine immunization during periods of conflict and crisis, including outbreaks of disease, such as the current Ebola epidemic in west Africa.

Delegates acknowledged that countries and particularly national governments, play a leading role in making the needed investments in immunization. Governments are accountable for the progress as well as the monitoring of their own immunization programme performance.

The Health Assembly adopted a resolution tabled by Libya that specifically addresses the issue of access to sustainable supplies of affordable vaccines for low and middle income countries, including the promotion of vaccine price transparency, support for pooled procurement mechanisms and for increased capacity for the manufacture of vaccines of assured quality to foster competition for a healthy vaccine market.

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Note: List of Member States that made interventions during the GVAP discussion: Libya, Iceland, Panama, Chile, Australia, Brazil, Iran, Japan, Ethiopia, Morocco, Egypt, Republic of Korea, China, Ecuador, Pakistan, Lebanon, Brunei Darussalam, United Sates of America, Russians Federation, United Kingdom, Cape Verde, Thailand, Philippines, Tanzania, Nigeria, South Africa, Canada, Colombia, Bangladesh, Maldives, Jamaica, Bahamas, Bahrain, Saudi Arabia, Qatar, Malaysia, Argentina, Kuwait, Gabon, India, Venezuela, Latvia, Iraq, Senegal, Algeria, Greece

Note: List of civil society organizations that made interventions during the GVAP discussion: Save the Children, Médecins Sans Frontières, Medicus Mundi, International Pharmaceutical Federation

WHA Resolution – Global vaccine action plan A68/73 26 May 2015

World Health Assembly addresses antimicrobial resistance, immunization gaps and malnutrition
25 May 2015
News release
Excerpt
…Immunization
The Assembly agreed a resolution to improve access to sustainable supplies of affordable vaccines – a key issue for low- and middle-income countries aiming to extend immunization to the entire population. In 2012, the Assembly endorsed the Global Vaccine Action Plan, a commitment to ensure that no one misses out on vital immunization by 2020. A report from WHO’s Strategic Advisory Group of Experts on immunization, warns, however, that progress towards the Action Plan’s targets is slow and patchy.

The resolution calls on WHO to coordinate efforts to address gaps in progress. It urges Member States to increase transparency around vaccine pricing and explore pooling the procurement of vaccines. It requests the WHO Secretariat to report on barriers that may undermine robust competition that can enable price reductions for new vaccines, and to address any other factors that might adversely affect the availability of vaccines. The resolution also highlighted that immunization is a highly cost-effective public health interventions, playing a major role in reducing child deaths and improving health. It recommends scaling up advocacy efforts to improve understanding of the value of vaccines and to allay fears leading to vaccine hesitancy.

Last week, on the margins of the Health Assembly, the Secretariat brought together high-level representatives of 34 countries with low immunization coverage to discuss challenges and explore solutions to overcome them…

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WHA Resolution – Global vaccine action plan   A68/73 26 May 2015
The Sixty-eighth World Health Assembly,
Having considered the report on the global vaccine action plan A68/30;

Emphasizing the importance of immunization as one of the most effective interventions in public health and access to immunization as a key step towards access to health and universal health coverage;

Acknowledging the progress made in global immunization and the commitment under the 2011–2020 Decade of Vaccines to achieve immunization goals and milestones;

Recalling resolutions WHA58.15 and WHA61.15 on the global immunization strategy, resolution WHA65.17 on the global vaccine action plan, resolution WHA61.21 on the global strategy and plan of action on public health, innovation and intellectual property, resolution WHA54.11 on the WHO medicines strategy and resolution WHA67.20 on regulatory system strengthening for medical products;

Noting with concern that globally immunization coverage has increased only marginally since the late 2000s; and that in 2013 more than 21 million children under one year of age did not complete the three-dose series of diphtheria-tetanus-pertussis (DTP) vaccine;

Recognizing that the availability of new vaccines against important causes of vaccine preventable diseases such as pneumonia, diarrhoea and cervical cancer can prevent leading causes of childhood and women’s death;

Acknowledging that successful national immunization programmes require sustainable political and financial support of Member States;

Appreciating the contributions of WHO, UNICEF, the Gavi Alliance, and all partners in their efforts to support the introduction of new vaccines in developing countries and strengthen immunization services;

Concerned that inequities between Member States are growing, inter alia, due to the increased financial burden of new vaccines and based upon those that are eligible or ineligible for financial and technical support from global partners;

Concerned that many low- and middle-income countries may not have the opportunity to access newer and improved vaccines, particularly because of the costs related to the procurement and introduction of these vaccines; and concerned at the increase of costs of overall immunization programmes because of increase in price of the WHO-recommended vaccines;

Recognizing that publicly available data on vaccine prices are scarce, and that the availability of price information is important for facilitating Member States’ efforts towards introduction of new vaccines;

Recalling many Member States’ interventions on the Health Assembly’s immunization agenda item each year, expressing concern over the unaffordable cost of new vaccines and appealing to the global community to support strategies that will reduce prices;

Recalling the WHO global framework for expanding access to essential drugs, and its four components: the rational selection and use of medicines, reliable health and supply systems, sustainable financing, and affordable prices;

Taking into account the importance of competition to reduce prices and the need to expand the number of manufacturers, particularly in developing countries, that can produce WHO-prequalified vaccines and create a competitive market;

Stressing the critical life-saving role of vaccines and immunization programmes and striving to make immunization available to all;

Noting with concern the global shortage of certain traditional routine vaccines, for example BCG vaccine and combined measles-rubella vaccine;

Acknowledging that shortages of vaccines are quite often an important cause of disruption of vaccination schedules and that therefore the establishment of effective and sustainable vaccine production, supply, procurement and delivery systems is essential to ensure access to all the necessary vaccines of assured quality at the right time;

Concerned that scepticism against vaccination is continuing to grow in society despite the proven efficacy and safety of modern vaccines, and that many children do not receive life-saving vaccines as a result of insufficient information to parents or health care workers or even of active anti-vaccination propaganda,

1. URGES Member States [And, where applicable, regional economic integration organizations]
(1) to allocate adequate financial and human resources for the introduction of vaccines into national immunization schedules and for sustaining strong immunization programmes in accordance with national priorities;

(2) to strengthen efforts, as and where appropriate, for pooling vaccine procurement volumes in regional and interregional or other groupings, as appropriate, that will increase affordability by leveraging economies of scale;

(3) to provide, where possible and available, timely vaccine price data to WHO for publication, with the goal of increasing affordability through improved price transparency, particularly for the new vaccines;

(4) to seek opportunities for establishing national and regional vaccine manufacturing capacity, in accordance with national priorities, that can produce to national regulatory standards, including WHO-prequalification;

(5) to create mechanisms to increase the availability of comparable information on government funding for vaccine development and work towards strategies that enhance public health benefit from government investments in vaccine development;

(6) to support the ongoing efforts of various partners coordinated by WHO to design and implement the strategies to address the vaccine and immunization gaps faced by the low- and middle-income countries that request assistance;

(7) to improve and sustain vaccine purchasing and delivery systems in order to promote the uninterrupted and affordable safe supply of all the necessary vaccines and their availability to all immunization service providers;

(8) to strengthen immunization advocacy and provide training to health professionals and information to the public regarding immunization issues to achieve a clear understanding of the benefits and risks of immunization;

2. REQUESTS the Director-General:
(1) to explore ways to mobilize funding to fully support collaborative efforts with international partners, donors, and vaccine manufacturers to support low- and middle-income countries in accessing affordable vaccines of assured quality in adequate supply;

(2) to continue developing and adequately managing publicly available vaccine price databases, like the WHO Vaccine Product, Price and Procurement project, working with Member States to increase availability of price information;

(3) to monitor vaccine prices through annual reporting of the global vaccine action plan;

(4) to provide technical support and facilitate financial resources for establishing pooled procurement mechanisms, where appropriate, for use by Member States;

(5) to strengthen the WHO prequalification programme and provide technical assistance to support developing countries in capacity building for research and development, technology transfer, and other upstream to downstream vaccine development and manufacturing strategies that foster proper competition for a healthy vaccine market;

(6) to report upon technical, procedural and legal barriers that may undermine robust competition that can enable price reductions for new vaccines, and address other factors that can adversely affect the availability of vaccines;

(7) to assist in mobilizing resources for countries that request assistance in the introduction of new vaccines in line with the global vaccine action plan and in accordance with national priorities;

(8) to continue to assist Member States to improve and sustain their vaccine delivery systems and to continue to provide technical support to Member States to strengthen the knowledge and skills of their health care professionals in vaccination programmes;

(9) to report back on progress in implementing this resolution to the Health Assembly through the Executive Board in the annual report on the global vaccine action plan.

WHA68 Side Meeting on Immunization

WHA68 Side Meeting on Immunization
“Achieving the Global Vaccine Action Plan Objective for Routine Coverage: What can be done to get back on track?”
20 May 2015 ¦ Geneva – During the WHA68, a side meeting on immunization with delegates from Member States with DTP3 coverage below 80% was convened by WHO. The objectives were to discuss the challenges faced by countries to reach global vaccination targets for 2015 and explore solutions to overcome them. Lead agencies in the Decade of Vaccines Collaboration and other development partners were given the opportunity to reiterate their commitments to support countries to achieve this important goal.

The WHA side meeting was co-sponsored by Thailand, the Democratic Republic of Congo and the United States of America and was chaired by Dr Flavia Bustreo, Assistant Director General, Family, Women’s and Children’s Health. Dr Margaret Chan, the Director-General of WHO, was in attendance. Representatives of agencies comprising the Global Vaccine Action Plan (GVAP) Secretariat, namely Gavi, the Vaccine Alliance, UNICEF and the Bill & Melinda Gates Foundation were present, as well as representatives from Civil Society Organizations.

Member States highlighted critical operational needs and challenges to ensure wider vaccination and delivery on the ground to reach every last child especially those living in remote and inaccessible areas, the need to strengthen vaccine supply chains, the challenges posed by conflict, natural disasters and vaccine stock out and the importance of mechanisms to secure sustainable supplies of vaccines at affordable prices.

Dr Chan highlighted several areas that require attention, including the need to address vaccine hesitancy and refusal, improve communications to create greater awareness of the importance of immunization and the science behind vaccines, the need for collective actions and the importance of private public partnerships to come up with new funding mechanisms. She emphasized the need to build on the lessons learned from the polio eradication initiative.

Notable achievements have been made with the help of Gavi, the Vaccine Alliance to enhance access and the roll out of new vaccines. It was acknowledged that problems remain with reaching the “5th child”. UNICEF is working hand-in-hand with WHO and partners to address the issues impeding the achievement of high coverage and plays an important role in strengthening supply chains.

Dr Elias highlighted that a collective effort was required and encouraged each in the room, international agencies, development partners and national governments “to challenge ourselves to find new solutions to address the remaining barriers to universal access to immunization”.

“The fifth child is often part of undocumented migrant or urban populations or living in remote or insecure areas. Hence, the strategies to reach them cannot be a continuation of what we have done till now”
Dr Chris Elias, President of the Global Development Programme, the Bill & Melinda Gates Foundation

Weekly Epidemiological Record (WER) 29 May 2015, vol. 90, 22 (pp. 261–280)

The Weekly Epidemiological Record (WER) 29 May 2015, vol. 90, 22 (pp. 261–280) includes:
Monthly report on dracunculiasis cases, January– April 2015
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Meeting of the Strategic Advisory Group of Experts on immunization, April 2015: conclusions and recommendations
[Meeting Report Sections and Editor’s Excerpts]

Report from the WHO Department of Immunization, Vaccines and Biologicals
The report focused on: the implementation of the Global Vaccine Action Plan (GVAP) and the related discussions during meetings of the WHO Governing Bodies at global and regional levels; the programmatic priorities to close the immunization gap; an update on implementation of selected SAGE recommendations; and agenda items on the horizon for future meetings.

The report stressed that reaching the GVAP goals is resource intensive (human and financial) and emphasized the urgent need for adequate investments and focus in order to increase routine immunization coverage which has been almost static, at global level, since 2009 and below the expected 90% coverage.

The report noted the current global short¬age of bacille Calmette–Guérin (BCG) vaccine and proposed interim solutions while stressing the need for the global community to pay more attention and take measures to avoid future shortages of other recommended vaccines.

SAGE took note of regional progress and commended the work carried out to advance regional vaccine action plans and promote activities to strengthen routine immunization.

SAGE stressed that additional disaggregation was needed in the analysis of the progress achieved on the ground, and in identifying bottlenecks for progress, and recommended that reports display disparities observed at subnational levels.

In view of weak infrastructure in some countries with a related inability to deliver vaccines, SAGE called for new politically supported initiatives to mobilize part¬ners and resources to apply technological know-how in fragile countries and find ways to build infrastructure in fragile systems. SAGE reaffirmed the need for solu¬tions that simplify operations on the ground, including delivery technologies such as compact pre-filled auto-disable injection technology. In this context SAGE also acknowledged the importance of the polio infrastruc-ture and noted how it had been critical in helping to deal with the Ebola situation, particularly in Nigeria.

SAGE stressed the importance of applying rigour and science in implementation programme design and eval¬uation of delivery of vaccines, in order to maximize the impact of current and future vaccines and delivery tech¬nologies.

SAGE also stressed the need to draw lessons from the Ebola epidemic regarding mobilization of communities as well as the encouragement of countries and partners to mobilize the private sector.

SAGE supported WHO’s plan to expand guidance beyond the current framework on the use of vaccines in humanitarian emergencies to include guidance on how to re-establish routine vaccination in those settings.

At the January 2015 WHO Executive Board meeting, Member States endorsed a resolution for pre-emptive development of vaccines against emerging infectious diseases such as Ebola virus disease. WHO was asked to provide leadership in supporting a prioritized research agenda. A framework for action in relation to vaccine development was proposed, which would include public health criteria, technical feasibility, regu¬latory pathways, and economic considerations. The issues will be reviewed by SAGE, the Product Develop¬ment for Vaccines Advisory Committee (PDVAC), the Expert Committee on Biological Standardization (ECBS) and other forums, with the aim of reaching an agree¬ment within a year.

A SAGE Working Group on Dengue Vaccine was established in March 2015.
Subject to the completion and conclusions of the vaccine assessment by the European Medicines Agency, it is planned that SAGE and the Malaria Programme Advi¬sory Committee will issue policy recommendations on the use of RTS,S malaria vaccine during a joint session in October 2015.
..1 See http://www.who.int/immunization/sage/en
..2 The complete set of presentations and background materials used for the SAGE meeting of 14-16 April 2015 together with the list of SAGE members and the summarized declarations of interests provided by SAGE members are available at http://www.who.int/immunization/sage/meetings/2015/april/en
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Report from Gavi, the Vaccine Alliance
Report of the Global Advisory Committee on Vaccine Safety (GACVS)
Report of the Product Development for Vaccines Advisory Committee (PDVAC
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Polio eradication
SAGE reviewed progress towards eradication of wild poliovirus (WPV) and elimination of persistent circulating vaccine-derived poliovirus type 2 (cVDPV2) as well as the plans, preparedness and timeline for with¬drawal of type 2 oral polio vaccine (OPV2).

SAGE noted that the programme had made substantial progress since the previous SAGE meeting. No WPV case has been reported in the Middle East or Africa since April 2014 and August 2014, respectively. In polio-endemic countries there were definite improvements in the quality of supplementary immunization activities (SIAs), increasing access to children in conflict-affected areas of Pakistan, improvements in AFP surveillance and expansion of environmental surveillance…

…SAGE concluded that progress towards elimination of persistent cVDPV2 is on track. SAGE recommended that all countries and GPEI should plan firmly for April 2016 as the designated date for withdrawal of OPV2. SAGE will consider delaying OPV2 withdrawal only if the WG reports in October 2015 that the assessed risk of contin¬ued cVDPV2 transmission is high. SAGE requested the polio WG to continue monitoring progress towards cVDPV2 elimination and ensuring that remaining chal¬lenges are addressed including contingencies for vaccine supplies (IPV, bOPV and tOPV), registration of bOPV for routine use, surveillance sensitivity, and reaching inaccessible children. The Working Group will make a full report to SAGE in October 2015, when SAGE may reconfirm April 2016 as the definite date for OPV2 withdrawal.

SAGE endorsed the proposed approach to verification of compliance of poliovirus containment in essential facilities. Under the WHO Global Action Plan (GAP III), facilities planning to handle or store type 2 poliovirus are requested to implement containment measures and appropriately manage associated biorisks. National Regulatory Authorities for containment (NRAcs) are expected to certify facilities according to GAP III. Certification reports are submitted to Regional Certification Commissions (RCCs) for evaluation. In support of this process, RCCs, NRAcs or concerned facilities may request that WHO verify compliance of certified facili¬ties in keeping with GAP III. SAGE requested that the programme consider mechanisms to address the risks associated with research and therapeutic uses of live polioviruses.

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Administration of multiple injectable vaccines in a single visit
…SAGE supported the following Good Practice Statement on multiple vaccine injections in a single visit, recognizing that the country context is an important determinant of success and acceptability among caregivers and providers: National vaccination schedules recommending administration of multiple injections in the same visit are widely used and provide benefits insofar as they support timely and efficient vaccination of children. Where studies have evaluated the immunogenicity and safety of co-administered vaccines, these practices are encouraged based on the benefits they confer.

SAGE concluded that countries should not make modifications to recommended immunization schedules with the aim of preventing multiple injections during the same visit when such modifications are not evidence-based…

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Reducing pain and distress at the time of vaccination

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Sustainable access to vaccines in middle-income countries (MICs): report of the WHO-convened MIC Task Force
The MIC Task Force, a group of 9 immunization part¬ners, presented a proposed strategy for coordinated action to enhance sustainable access to vaccines in MICs. Over the past decade, access to vaccines in MICs has been much debated, fuelled by the fact that the majority of poor people are now in MICs and concern that this group of countries may be missing out on opportunities to introduce new vaccines, as donors focus on low-income countries. In view of this situation and at the request of SAGE, in June 2014 WHO convened the MIC Task Force to develop a coordinated strategy and plan of action.

A comprehensive review of MICs’ performance shows that they are far from attaining the GVAP targets. While 40 MICs are well supported by Gavi, 63 do not benefit from a unified international strategy for action. In these countries, vaccine-preventable disease burden and numbers of unvaccinated children are relatively low compared to the Gavi-supported MICs, but nonetheless substantial and unacceptable. Many of these countries have strong health systems and potential for rapid gains if key barriers are removed. The MIC strategy, aligned with the GVAP time frame (2016–2020), proposes a way forward for non-Gavi countries. Importantly, solutions and platforms set up as part of the strategy would also benefit countries that graduate from Gavi support over time, ensuring sustainability of current investments…

…SAGE acknowledged that the strategy represents a strong proposal for a coordinated and comprehensive approach to the MIC situation. SAGE concurred with the general direction of the strategy and valued the menu of options as an approach to tailoring activities to the individual needs of a heterogeneous group of countries. SAGE appreciated that the strategy builds upon lessons learnt and existing activities as the most efficient way to use resources and achieve impact.

SAGE called on partners to support implementation of the strategy and on countries to take advantage of the proposed solutions.

SAGE noted that prompt implementation of the MIC strategy is particularly important given the impending graduation of several large Gavi countries, which will require long-term solutions to be put in place…

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Ebola vaccines and vaccination
…In parallel with the vaccine trials, WHO and partners, including the 3 most affected countries, have established a framework to develop guidelines to support planning, implementing and monitoring vaccination once a vaccine becomes available for use, according to SAGE recommendations.

A proposed framework for making recommendations was presented, which aims to adopt a scenario-based approach, while also taking account of a number of programmatic, socio-cultural and other factors. Considerations guiding the use of the framework are: specific scenario relating to the epidemiology and the type of authorization for vaccine use; objectives for vaccination (primary – stopping transmission, secondary – individual protection); prioritization of target populations; and additional considerations which would inform SAGE’s recommendations. The framework would be adjusted based on evolution of the current epidemic, the type of regulatory or emergency use authorization given for a vaccine, and on the data that become avail¬able from the clinical trials.

In the discussion that followed, it was noted that the quality of the reported disease data had limitations and that the data on cultural and other factors that may have contributed to differences in the epidemic patterns were not fully captured in the national databases. However, there was confidence that the available data correctly reflected the epidemic patterns and the relative incidence of disease in different age groups.

SAGE members expressed concern about the likelihood that efficacy estimates may not be generated from the phase 3 trials, given the declining number of cases in all 3 countries and felt that the trials must also contribute additional data (including those related to programmatic aspects) that could inform recommendations. Noting WHO’s unique position to coordinate the development of Ebola vaccines, SAGE stressed the importance of transparent and prompt sharing of information on the trial protocols and data from the phase 3 clinical trials, and the need for a greater role for WHO in facilitating the sharing of information so that results between studies will generate the greatest benefit for policy decision-making.

SAGE supported the proposed framework for making recommendations, but asked that it be made explicit that the identification and prioritization of target populations for vaccination will be based on a thorough assessment of risks (from disease as well as from vaccination) and benefits. It was recognized that the final recommendations would be driven by the evolution of the current epidemic, the conditions laid down in the regulatory authorization for use of vaccines and social and cultural considerations.

SAGE recommended that the further development of the Emergency Use Assessment and Listing procedure being developed by WHO, which would allow use of a vaccine in the context of a Public Health Emergency of Inter¬national Concern, be done in close consultation with relevant regulatory authorities, including those of the affected countries.

SAGE again noted the probability that efficacy data for any of the Ebola vaccines may not be available by the end of the current outbreak, and therefore recom¬mended that future use of unproven Ebola vaccines should be in the context of studies that would generate safety and effectiveness data.

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Maternal vaccination during pregnancy
SAGE encouraged WHO to promote more implementation research to generate generalizable data on the best ways to integrate maternal immunization into routine antenatal care in low resource settings. SAGE also encouraged the Regional Office for the Americas to document the successful regional experience of deliver¬ing influenza vaccine to pregnant women.

It was considered unnecessary to establish a SAGE working group to review maternal influenza immunization at present, given that substantial data still being generated will not be available until late 2015–2016. SAGE emphasized the importance of the maternal immunization platform, in general, and called upon WHO to affirm its commitment to building the evidence base to strengthen vaccine delivery during pregnancy, as it has great potential for infection prevention in high-risk groups worldwide.

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Pertussis vaccination schedules

Nepal earthquake 2015 – Grade 3 emergency

Nepal earthquake 2015 – Grade 3 emergency
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:: Health situation report No. 19 pdf, 317kb – 26 May 2015
KEY HIGHLIGHTS
:: The repeated earthquakes and aftershocks since 25 April 2015 have had a major public health consequences, with a total 1085 health facilities (402 completely and 683 partially) damaged.
:: A total of 2088 people have undergone major surgeries and 26,160 have received psychosocial support in the highly affected 14 districts.
:: Nepal’s Ministry of Health and Population (MOHP) identifies 429 patients in Bhaktapur, Kathmandu and Lalitpur who require longer term treatment support.
:: 42 Foreign Medical teams (FMTs) are operating in the country with a total 802 persons including 264 doctors and 236 nurses.
:: Currently there are over 100 beds available for patients requiring ongoing rehabilitation or nursing care within the Kathmandu valley.

:: Health Cluster Bulletin No. 4 pdf, 1.83Mb 27 May 2015
Situation update
Up to 26 May, just a little over a month after the first earthquake of 7.8 on the Richter scale struck Nepal on 25 April, followed by a 7.3 magnitude on 12 May and numerous aftershocks, the MoHP is reporting that there has been 8673 earthquake-related deaths and 21952 injuries. Of this amount, eight health workers and 10 FCHVs have lost their lives, 75 have been injured and two remain missing.
The Ministry of Health and Population’s (MoHP) Early Warning and Response System for epidemic-prone diseases (EWARS) show a generally stabilizing trend in numbers of outbreak prone diseases in the 14 severely affected districts. No major outbreaks have been reported to date…

EBOLA/EVD [to 30 May 2015]

EBOLA/EVD [to 30 May 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 27 May 2015
[Excerpts]
SUMMARY
:: There were 12 confirmed cases of Ebola virus disease (EVD) reported in the week to 24 May: 9 from Guinea and 3 from Sierra Leone. A total of 5 districts (3 in Guinea, 2 in Sierra Leone) reported at least one confirmed case, compared with 6 districts the previous week. The west-Guinean prefecture of Forecariah reported the most cases of any one district, and continues to present the greatest challenge in terms of response, with multiple chains of transmission over a wide geographical area (4 sub-prefectures), and the continued occurrence of cases from unknown sources of infection.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 27,013 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 11,134 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 9 new confirmed cases were reported in Guinea and 3 in Sierra Leone in the 7 days to 24 May. The outbreak in Liberia was declared over on 9 May.