Vaccines and Global Health: The Week in Review 25 November 2017

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_25 Nov 2017

– blog edition: comprised of the approx. 35+ entries posted below.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Milestones :: Perspectives

Milestones :: Perspectives
Editor’s Note
We generally reserve this section of our digest for major strategic announcements and significant milestones in the vaccines/immunization space. We share below the text from a retirement laudation plaque that represents, in our view, such a milestone.


In Recognition of Exemplary Leadership in Advancing Immunization Globally,
We Hereby Honor
       Dr. Jean M-Marie Okwo-Bele
       Director of Immunization, Vaccines and Biologicals
       World Health Organization
We thank you for your passion, unconditional commitment, and enduring dedicated service to public health.</em
Your legacy will live on in the many lives you have touched.
Your Friends, Colleagues and Partners Worldwide
November 2017
We understand that Okwo received this laudation during a celebratory event at the close of the SAGE meeting in October. Okwo’s retirement commences following his last day official working day at WHO on 29 November 2017.

We wish him a splendid next adventure…

IVI   [to 25 November 2017]
Commemorating our 20th anniversary, IVI thanks donors, partners for support
IVI expresses our deepest gratitude to all the donors and supporters for your commitment and generosity to the Institute over the past 20 years. In particular, we wish to thank our donors and partners who joined us at our 20th Anniversary Forum held on November 15.
The Forum brought together 170 scientists, partners and friends of IVI from across Korea and around the world, including Dr. Park Neung-hoo, Minister of Health and Welfare of Korea. Present at the Celebration and Dinner were some 120 donors and supporters, including awardees of plaques who were honored for their outstanding commitment and contribution to IVI. As we move into IVI’s third decade, we look forward to the continuing friendship and partnership with our donors and partners to make an even bigger impact in vaccine science and global public health in the years ahead.
We are pleased to share with you images of the commemorative events and greetings on our 20th Anniversary from donors, partners and friends of IVI below.
   Press release:
Photo images of the 20th Anniversary Forum and Celebrations:


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 22 November 2017 [GPEI]
:: On the 14 November, the 15th IHR Emergency Committee convened to review the risk of international spread of poliovirus. The committee agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months.
:: To mark World Children’s Day, we reported on how the polio eradication programme helps deliver a bright future to children in Nigeria.

:: Summary of newly-reported viruses this week:
Afghanistan: Four new wild poliovirus type 1 (WPV1) positive environmental samples, three collected from Kandahar province, and one from Kabul province.
Pakistan: One new WPV1 positive environmental sample, collected from Sindh province.
Syria: Seven new circulating vaccine derived poliovirus type 2 (cVDPV2) cases reported, all from Deir Ez-Zor governorate.

Statement of the 15th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement
14 November 2017
[Excerpts; Editor’s text bolding]
The fifteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director-General on 14 November 2017 at WHO headquarters with members, advisers and invited member states attending via teleconference.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 3 August 2017: Afghanistan, the Democratic Republic of Congo (DR Congo), Nigeria, Pakistan and the Syrian Arab Republic.
Wild polio

Overall the Committee was encouraged by continued steady progress in all three WPV1 infected countries, Afghanistan, Nigeria and Pakistan and the fall in the number of cases globally, and that international spread remained limited to between Afghanistan and Pakistan only. While falling transmission in these three countries decreased the risk of international spread, the consequences of any failure to prevent spread would increasingly be a set-back to eradication and a risk to public health, as funding winds down in the coming years.

The Committee commended the high-level commitment seen in both Afghanistan and Pakistan, and the high degree of cooperation and coordination, particularly targeting the high risk mobile populations that cross the international border, such as nomadic groups, local populations straddling the border, seasonal migrant workers and their families, repatriating refugees (official and informal), and guest children (children staying with relatives across the border). Stopping transmission in these populations remains a major challenge that cannot be under-estimated, underlining the critical continuing need for cross border activities in surveillance and vaccination.

The Committee commended the achievements in Pakistan that have resulted in the number of cases falling to just five so far in 2017; achievements included the improved accessibility, improved communication to reduce missed children and better quality supplementary immunization activities (SIA). However, WPV1 transmission continues to be widespread geographically as detected by environmental surveillance and this remains a source of major concern, notwithstanding that the intensity of environmental surveillance is now higher than previously, meaning the probability of environmental detection is now higher.
The Committee was concerned by the ongoing risks to eradication posed by the number of inaccessible and missed children in Afghanistan, particularly in the southern region resulting in ten cases to date in 2017.

The Committee was impressed by the innovations that continue to be made in Nigeria to reach children in Borno, but was very concerned that although the number of inaccessible settlements has fallen, there remains a substantial population in Borno state that is totally inaccessible, including around 160,000 – 200,000 children aged under five. The Committee concluded that there is a substantial risk that polioviruses are still circulating in these inaccessible areas. Nigeria also reported on ongoing efforts to ensure vaccination at international borders (including at airports), other transit points, IDP camps and in other areas where nomadic populations existed, but the Committee felt that efforts to date were inadequate. The Committee also noted that routine immunization, particularly in high risk areas of northern Nigeria, is performing poorly and along with polio eradication has been made a national priority. Although it is over 13 months since the last detection of WPV1 in Nigeria, the recent outbreak response assessment by global polio experts concluded ongoing transmission could not be ruled out.

There was ongoing concern about the Lake Chad basin region, and for all the countries that are affected by the insurgency, with the consequent lack of services and presence of IDPs and refugees. The risk of international spread from Nigeria to the Lake Chad basin countries or further afield in sub-Saharan Africa remains high. The Committee was encouraged that the Lake Chad basin countries including, Cameroon, Chad, the Central African Republic (CAR), Niger and Nigeria continued to be committed to sub-regional coordination of immunization and surveillance activities. However, there is concern about the Lake Chad islands which are currently inaccessible and also about significant gaps in population immunity exist in some areas of these countries in border areas with Borno, and the ongoing population movement in the sub-region was a major challenge.

Vaccine derived poliovirus
The Committee commended the efforts made in some very challenging circumstances in DR Congo and the Syrian Arab Republic. These outbreaks highlighted the presence of vulnerable under-immunized populations in areas with inaccessibility, either due to conflict or geographical remoteness. Furthermore, the delay in detection of these outbreaks illustrated that serious gaps in surveillance exist in many areas of the world, often related to weak health systems or to conflict resulting in disrupted health systems.

In DRC, there has been transmission after the initial SIA’s with geographical spread outside the health zones covered, into Tanganyika, necessitating further rounds with mOPV2. Risks are compounded by poor surveillance in many areas, and widespread gaps in population immunity.

The Committee was very concerned by the size of the outbreak in the Syrian Arab Republic, and the difficulty of reaching target populations because of the conflict. As type 2 population immunity rapidly wanes, the risk of spread within the Syrian Arab Republic and beyond its borders will increase substantially, meaning urgent action is needed to stop transmission. The Committee commended countries surrounding the outbreak zone that are responding to prevent importation, particularly among Syrian refugees in Lebanon, Jordan, and Turkey. The Committee urged any country receiving Syrian refugees, particularly from Deir Ez-Zor and Raqqa, to ensure polio vaccination with IPV.

The Committee noted with concern the recent detection of a single highly diverged VDPV2 in sewage in Mogadishu in Somalia, with genetic evidence of more than three years of replication without detection.

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of revised Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

  • The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
  • The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
  • The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be grave and a major set-back to achieving eradication.
  • The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
  • The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears high.
  • The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
  • The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
  • Additionally with respect to cVDPV:

:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, Nigeria, Pakistan and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies
:: The global shortage of IPV which poses an additional risk.

Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee strongly encourages all these countries to make further efforts to improve routine immunization, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also strongly encouraged countries newly infected with WPV or cVDPV to act with a great degree of urgency in responding to outbreaks as national public health emergencies, and to ensure emergency operations are used to facilitate this accelerated response…

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 20 November 2017 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV…


Syria cVDPV2 outbreak situation report 23: 21 November 2017
Situation update 21 November 2017
…Seven (7) new cases of cVDPV2 were reported this week— 4 cases from Mayadeen and 3 from Boukamal district, Deir Ez-Zor governorate. The most recent case (by date of onset) is 9 September 2017 from Mayadeen district.
…The total number of confirmed cVDPV2 cases is 70.
…Outbreak response teams are planning a third mass immunization round to reach children under 5 with mOPV2 in areas where evidence of virus transmission continues.
…A request from the Syrian Ministry of Health for up to one (1) million doses of mOPV2 and 500 000 inactivated polio vaccine doses is being processed to ensure readiness for the second phase of the outbreak response
…Subnational immunization days aiming to reach children under 5 with bOPV started this week in areas of Rural Damascus, districts of Damascus, Homs, Aleppo and accessible areas of Deir Ez-Zor city. Children aged 2-23 months will also be reached with supplementary IPV during the subnational campaign, particularly in areas with large IDP populations.
…A joint supervisory team is monitoring the IPV campaign in all areas of Damascus, with a focus on areas where there are large IDP populations from Deir Ez-Zor to ensure campaign quality.


WHO Grade 3 Emergencies  [to 25 November 2017]
The Syrian Arab Republic
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syrian Arab Republic
22 November 2017, Damascus, Syrian Arab Republic – Seven people have been killed and 42 people injured in Damascus city and surrounding areas in recent days.
In eastern Ghouta, Rural Damascus, local health authorities report that during a 4-day period alone from 14 to 17 November, 84 people were killed, including 17 children and 6 women; and 659 people were injured, including 127 children and 87 women.
During the same period, more than 200 surgical operations were conducted in eastern Ghouta’s overwhelmed and under-resourced hospitals.
Despite escalating violence and increasing humanitarian needs, life-saving medicines, medical equipment, and surgical supplies are prevented from entering the area…

:: Polio- Situation update 21 November 2017
[See Polio above for detail]

South Sudan
:: WHO in collaboration with the Ministry of Health established water quality control to prevent water-borne diseases in South Sudan
21 November 2017 Juba — The cost of delivering safe water, sanitation and hygiene services is a public health concern in South Sudan. To ensure high quality, sustainable water quality testing, monitoring and surveillance, WHO provided mobile water quality and safety testing kits to the National Public Health Laboratory. The mobile kits are to be used to test and monitor the quality and safety of water in the country.

:: Yemen – Cholera Response  W46 2017 [Nov 13-Npv 19]
Cumulative figures
-The cumulative total from 27 April 2017 to 19 Nov 2017 is 945,362 suspected cholera cases and 2,211 associated deaths, (CFR 0.23%), 1049 have been confirmed by culture.
-The median age of suspected cases is (20) and the median age of death is (38)
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 18%
– The national attack rate is 343.26 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain Amran (801), Al Mahwit (760), Al Dhale’e (641), Abyan (491) and Sana’a (459).
– Children under 5 years old represent 27.8% of total suspected cases.
– In total, 20,884 rapid diagnostic tests (RDT) have been performed which represents 22.1% coverage.
– 2,375 cultures have been performed which represents 22.6% coverage.
– The last positive culture was on 7 Nov 2017 in Al Garahi district
– Among the 305 affected districts, 43 districts in 12 governorates (Abyen, Al Baydha, Al Hudei deh, Al mahrah, Hajjah, Lahj ,Marib, Mokal l a, Sa’dah, Seyoun, Shabwah, Taizz) did not report any suspected case the last three consecutive 3 weeks.
Governorate and District level
– At governorate level, the trend from W43-W45 decrease or was stable in all governorates.
– No district is reporting a CFR higher than 1%.
– The weekly number of cases is decreasing for the 10th consecutive week.
– The weekly proportion of severe cases has significantly decreased representing now 10% of the admitted cases.
-The use of RDTs has significantly increased since week 40.
Week 46
– 14,955 suspected cases and 6 associated deaths were reported.
– 10 % are severe cases
– 924 RDTs were performed, 176 were positive
– 0 Positive culture

WHO Grade 2 Emergencies  [to 25 November 2017]
:: Weekly Situation Report 4 – 22 November 2017
Key Highlights
…As of 21 November 2017, the cumulative number of new arrivals in all sites was 622,000. …This number includes over 341,000 arrivals in Kutupalong Balukhali expansion site, 235,000 in other camps and settlements, and 46,000 arrivals in host communities.
…153,765 adolescents and children received measles vaccination
…WHO Mental Health Gap Action Training commenced
Situation Overview
Approximately 170 health care facilities are known to be operating across all camps and settlements. However, many of these facilities provide a basic level of services and referrals for additional services within camps and outside of the camps remains a challenge. Government hospital facilities are overcrowded and do not have the resources to cope with the high volumes of referral patients. Moreover, the services provided are not standardized and the quality of health care services varies considerably.
The latest EWARS data show that fevers of unexplained origin are the most commonly reported disease (29%), followed acute respiratory infections (27%) and acute watery diarrhoea (21%). In view of the low immunization coverage among the Rohingya population, strengthening vaccination programmes is a priority.
Potential outbreaks of diarrhoeal diseases including

Rohingya refugees in Bangladesh: Health Sector Bulletin No. 1
Period: 01 October – 15 November 2017
[1] Health Situation
Around 1.2 million people are estimated to be in need of health assistance. This number includes both newly arrived Rohingyas from Myanmar since 25 August, and their host communities. Based on the public health situation analysis published on 10 October 2017, WHO has graded this crisis as a level 3 emergency. the highest possible rating.

[5.4] Vaccines and Immunization
The baseline coverage for routine immunization is low. This, combined with crowded living conditions, lack of adequate water and sanitation and reported levels of high malnutrition, represents a public health risk to both the new arrivals and the host population.
Health Sector Response
The health sector has conducted several vaccination campaigns. In the first campaign, which ended on 3 October 2017, 135 519 children under 15 years of age were vaccinated against measles and rubella, 72 334 children under 5 years of age were vaccinated against polio and 72 064 children received Vitamin A.
To mitigate the outbreak of cholera, the International Coordinating Group (ICG) on Vaccine Provision mobilized 900,000 doses of oral cholera vaccine (OCV) for a large-scale cholera vaccination campaign among recently arrived Rohingyas and their host communities. The health sector worked with the MOHFW to plan, train volunteers, fund, implement and monitor this campaign. The campaign to administer the first dose (targeting 650 000 individuals over one year of age) was successfully implemented from 10 to 18 October 2017. It reached a total of 712 797 people, 179 848 of whom were children aged from one to five years old. To help improve personal hygiene, vaccinators handed out soap to each person vaccinated.
From 4 to 9 November 2017, the health sector supported the MOHFW in implementing the second phase of a cholera and polio vaccination campaign for children. A total of 199 472 children aged between one and five years received a second dose of oral cholera vaccine for added protection (estimated target population: 180 000), and 236 696 children under five years received oral polio vaccine (estimated target population: 210 000).
In addition, the health sector continues to support the MOHFW’s efforts to strengthen routine vaccination. Approximately 100 vaccinators have been trained on the current routine Expanded Programme on Immunization (EPI) schedule, key EPI messages, the importance of maintaining the cold chain, monitoring vaccine vials, injection safety, registration, reporting and waste management. Polio, measles and tetanus immunization began on 11 November from static sites within the camps. Through these static sites, to date 719 children have been vaccinated against polio, 589 children against measles and 476 pregnant women against tetanus.
Additionally, since 1 November, 970 children (6 months – 15 years) passing through the two transit sites have been vaccinated against measles and rubella (MR) and 1038 children under five years received oral polio vaccine (bOPV).
Establishing the routine Expanded Programme on Immunization (EPI) in camps and settlements and setting up vaccination posts at entry points into Bangladesh are both key to controlling measles and other diseases. However, in response to the significant increase in measles cases, MoHFW and health sector have agreed to rapidly initiate a measles campaign targeting 360 000 children under 15 for MR vaccination. In view of the urgency of the situation, the campaign is planned to start on 18 November and microplanning has begun…


WHO AFRO – Outbreaks and Emergencies Bulletin, Week 46: 11 – 17 November 2017
The WHO Health Emergencies Programme is currently monitoring 46 events in the region. This week’s edition covers key ongoing events, including:
:: Dengue fever in Burkina Faso,
:: Plague in Madagascar,
:: Lassa fever in Nigeria,
:: Marburg virus disease in Uganda,
:: Humanitarian Crisis in Central African Republic,
:: Humanitarian Crisis in the Democratic Republic of the Congo.

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: 25 Nov 2017  Urgent Call to Address Gender-based Violence in Syria [EN/AR]

:: 24 Nov 2017 – Yemen: Impact of the closure of seaports and airports on the humanitarian situation – Situation Update 3 | 23 November 2017
:: 24 Nov 2017 – Yemen Humanitarian Bulletin Issue 29 | 20 November 2017

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 23 November 2017
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
Yellow Fever  [to 25 November 2017]
Disease outbreak news
Yellow fever – Brazil – 24 November 2017

WHO & Regional Offices [to 25 November 2017]

WHO & Regional Offices [to 25 November 2017]

Uganda steps up to support women subjected to violence
24 November 2017 – Violence against women is a global public health problem. In Uganda more than half of all women have experienced violence at least once in their life, most likely from an intimate partner.
In response Uganda has developed the National Action Plan on the Elimination of Gender-based Violence. To date more than 400 health workers have been trained, helping to address violence against women….
The paradox of migrant women care workers
21 November 2017 – Migrating in the same numbers as men, many migrant women take on personal care work in informal and home-based settings – often without social protection, labour rights, or health care.
A new WHO report shows an emerging paradox: that migrant women carers support health and social systems, while their own health care and other needs may be unfulfilled.
   WHO Report
Weekly Epidemiological Record, 24 November 2017, vol. 92, 47 (pp. 717–728)
:: Progress towards poliomyelitis eradication: Pakistan, January 2016–September 2017
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2017

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Experts ramp up efforts to leave no one behind  24 November 2017
Brazzaville, 24 November 2017 – With growing momentum to ensure that…
:: Call for behaviour change in antibiotic use and prescription  24 November 2017
:: Making health services a safe place for women: Uganda steps up to support women subjected to violence  24 November 2017
:: Monitoring the efficacy of antimalarial medicines in Tanzania  23 November 2017
:: Promoting Interagency Collaboration to Ensure Pharmaceutical Manufacturing Development in Ethiopia  23 November 2017
:: Political will and evidence-based action to end TB in the African Region a must – WHO Regional Director for Africa  23 November 2017
23 November 2017 – World Health Organization (WHO) Africa…
:: WHO in collaboration with the Ministry of Health established water quality control testing hub within the National Public Health Laboratory to guide water safety management and prevent water-borne diseases in South Sudan  22 November 2017
:: EU commended for renewed commitment to boost Africa’s health development Africa on course to reach health some targets by 2030  21 November 2017
:: World Antibiotics Awareness Week in Tanzania  21 November 2017
:: Tackling antibiotic resistance in Sierra Leone  20 November 2017

WHO European Region EURO
:: Leaving no one behind in eliminating violence against women 24-11-2017
:: WHO/Europe introduces sustainable health workforce toolkit at Dublin Forum 24-11-2017
:: New HEN report reveals gaps in protection of refugees and migrants from vaccine-preventable diseases 21-11-2017
:: University of Pécs designated as WHO Collaborating Centre for migration and health 21-11-2017
:: Health in focus at the UN Climate Change Conference 21-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO gravely concerned by deteriorating situation in eastern Ghouta, Syria  22 November 2017
:: Islamic Advisory Group launches training manual on polio eradication, mother and child health and immunization  22 November 2017

CDC/ACIP [to 25 November 2017]

CDC/ACIP [to 25 November 2017]
Wednesday, November 15, 2017

MMWR News Synopsis for November 24, 2017
Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017
CDC Media Relations
Even a single measles case is expensive and burdensome to public health agencies. Measles can be prevented by a safe and effective vaccine. Measles outbreaks in the United States occur after introduction from international travelers and can be amplified in undervaccinated communities. Effective interruption of transmission requires timely case investigation. The Tri-County Health Department in the metropolitan Denver area assessed the total economic burden of two measles case investigations. Each case exposed hundreds of people, prompting a complex and coordinated response by multiple public health agencies. Public health costs of disease investigation in the first and second case were an estimated $49,769 and $15,573, respectively. Single measles cases prompted extensive public health action and were costly and resource intensive for local public health agencies.

Progress Toward Poliomyelitis Eradication – Pakistan, January 2016-September 2017
Interruption of wild poliovirus (WPV) circulation, and therefore eradication, is within reach in Pakistan. Despite progress made during 2016, virus is still detected in the environment of high-risk areas in the country, and children continue to be missed by vaccination efforts. These factors pose a challenge to the goal of achieving zero cases. To reach this goal, Pakistan must continue heightened polio surveillance, respond aggressively to any new cases, and vaccinate all children. Pakistan is one of three countries – including Afghanistan and Nigeria –where WPV has never stopped circulating. During 2017, Pakistan made significant improvements to its polio eradication program. As a result, the number of reported polio cases decreased by 69 percent, with five WPV cases compared to 16 cases reported during the same period in 2016. Despite the decrease, the virus continues to circulate in certain areas and children continue to be missed by immunization campaigns.


Africa CDC   [to 25 November 2017]
No new digest content identified.


China CDC    [to 25 November 2017]
No new digest content identified.



European Medicines Agency  [to 25 November 2017]
New guidelines on good manufacturing practices for advanced therapies
Adaptations ensure a high level of quality for ATMPs and patient protection

European Vaccine Initiative  [to 25 November 2017]
20 November 2017
MVVC2 study published
EDCTP funded MVVC2 study published today in Frontiers in Immunology: showing safety and immunogenicity of malaria vectored…
FDA [to 25 November 2017]
November 21, 2017 –
FDA approves first two-drug regimen for certain patients with HIV
The U.S. Food and Drug Administration today approved Juluca, the first complete treatment regimen containing only two drugs to treat certain adults with human immunodeficiency virus type 1 (HIV-1) instead of three or more drugs included in standard HIV treatment. Juluca is a fixed-dose tablet containing two previously approved drugs (dolutegravir and rilpivirine) to treat adults with HIV-1 infections whose virus is currently suppressed on a stable regimen for at least six months, with no history of treatment failure and no known substitutions associated with resistance to the individual components of Juluca…
IAVI  [to 25 November 2017]
November 21, 2017
New Findings to Help HIV Scientists Establish ‘Template’ for Potent Antibodies
Natural-infection studies in Africa and India continue to inform HIV vaccine design
New data published today in Immunity further illuminate how some human beings generate powerful, HIV-blocking antibodies. Led by scientists at the International AIDS Vaccine Initiative (IAVI) and The Scripps Research Institute (TSRI), the results offer important insight into a potential AIDS vaccine design.
“Uncovering the process by which neutralizing antibodies develop is critical to HIV vaccine design,” said Elise Landais, Senior Research Scientist with IAVI and lead author of the study. “A small fraction of people living with HIV can naturally produce exceptionally powerful and broad antibodies that could prevent HIV from infecting their immune cells, but not until several years post-infection – long after that protection can help them. But it is of enormous interest to vaccine researchers.”…
MSF/Médecins Sans Frontières  [to 25 November 2017]
Press release
MSF: India’s Decision to Give Pfizer Unmerited Patent on Lifesaving Pneumonia Vaccine Limits Access for Children Globally
November 20, 2017
At High Court of Delhi hearing tomorrow, Doctors Without Borders will urge India to remain the “pharmacy of the developing world” and rethink decision that solidifies Pfizer monopoly on critical pneumonia vaccine

Sabin Vaccine Institute  [to 25 November 2017]
Monday, November 20, 2017
Journalists Gather for Information Session on Vaccines
BUENOS AIRES, ARGENTINA – Today, the Sabin Vaccine Institute (Sabin) convened journalists from across Latin America to contribute to their understanding of the science of vaccines…
During the three-day information session hosted by Sabin, in partnership with the Universidad I Salud and the Centro de Estudos para la Prevención y el Control de Enfermedades Transmisibles, journalists will learn from public health experts about clinical trials, vaccine safety, how to communicate the impact of immunization, and basic epidemiology and immunology of vaccines, among other topics. By bringing together public health experts and 25 journalists from 18 countries, the information session will provide Latin American journalists with a baseline understanding of vaccines, vaccine safety and related global health issues….

UNAIDS [to 25 November 2017]
Global ministerial conference ends with adoption of the Moscow Declaration to End TB
23 November 2017
A global ministerial conference held in Moscow, Russian Federation, on 16 and 17 November that united more than 1000 participants, including 75 ministers and 114 country delegations, concluded with the adoption of the Moscow Declaration to End TB.

The Moscow Declaration to End TB is a new commitment to increase multisectoral action and enhance accountability in the global TB response towards ending tuberculosis (TB) by 2030. The declaration will also inform the first United Nations General Assembly High-Level Meeting on TB, in 2018, which will seek to advance commitments to end TB from heads of state and government.

The declaration outlines the importance of international action to address key areas to respond to TB: sustainable financing, pursuing science, research and development and the establishment of a multisectoral accountability framework.

The conference, the First World Health Organization Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: a Multisectoral Response, was opened by the President of the Russian Federation, Vladimir Putin. It was attended by high-level United Nations leaders, including Amina J. Mohammed, the United Nations Deputy Secretary-General, Tedros Adhanom Ghebreyesus, the World Health Organization Director-General, and Michel Sidibé, the UNAIDS Executive Director…
[See last week’s edition for more detail]

UNICEF  [to 25 November 2017]
Geneva Palais Briefing Note: Urgent measures to improve hygiene practices underway inside Rohingya refugee camps
GENEVA, 21 November 2017 – This is a summary of what was said by Christophe Boulierac, UNICEF Spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

Despite progress, 180 million children face bleaker prospects than their parents – UNICEF
NEW YORK, 20 November 2017 – Despite global progress, 1 in 12 children worldwide live in countries where their prospects today are worse than those of their parents, according to a UNICEF analysis conducted for World Children’s Day.

Wellcome Trust  [to 25 November 2017]
November 21, 2017  STAT
First Opinion
Focused projects can help Tedros restore confidence in the WHO
By Jeremy Farrar
Like many people around the world, I was dismayed last month by the appointment of Robert Mugabe, the embattled president of Zimbabwe, as a World Health Organization goodwill ambassador. While I believe it is important for the WHO to work with political leaders of every variety, Mugabe’s record in Zimbabwe, which has led to incredible pressure for him to step down, made him profoundly unsuitable for such a role. That wasn’t the only reason this decision seemed so extraordinary to me: It stands as an outlier amid many very sound judgments made by Tedros Adhanom Ghebreyesus, WHO’s newly elected director-general.

In his first 100 days in office, Tedros, as he is known, has assembled an able and extremely diverse senior leadership team. He has also engaged meaningfully and constructively with critics — not least by quickly reversing the Mugabe appointment and without equivocation. He acknowledged a misstep and, I believe, deserves our support because his leadership is a critical opportunity to rebuild the WHO into the force it should be in global health.

Tedros’s election has given him a mandate that no other head of a United Nations agency can claim. His election was the first of its kind in terms of transparency and openness, complete with manifestos, an election platform, and a vote among all WHO member states. His legitimacy, coupled with focused minds at WHO after the failures of Ebola, means he can do what the global health community has been asking the WHO director-general to do for decades: lead its member states with an ambitious program of effective and measurable work, rather than simply reacting passively to their diverse wishes…

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Reports/Research/Analysis/Commentary/Conferences/Meetings/Book Watch/Tenders

Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at:

Women on the move: Migration, care work and health
World Health Organization
2017 : 102 pages
ISBN: 978-92-4-151314-2
PDFs:    Women on the move: Full report
Women on the move: Policy brief
Executive Summary [Excerpt; text bolding from original]
Ageing in late industrial and middle-income economies, combined with rising demographic dependency ratios and female labour force participation, has led to emerging care deficits in many developed and developing countries. Around the world, more women are entering the labour force, thus taking them away from traditional unpaid caring roles.

This report focuses largely on one population group: women migrant care workers who provide home-based personal care. However, many of the issues, and the next steps suggested here, also apply to other migrants and refugees – particularly women and girls – as well as to other socially excluded and marginalized groups engaged in paid and unpaid care work across the world.

Without a doubt, women migrant care workers play an increasingly prominent role in securing and protecting the health status of others and are contributing both to health in the broadest sense and to health systems. Yet relatively little is known about their own health status, the health implications to their families of their out-migration, and the extent of their important contributions to health systems. Around the world, care workers are overwhelmingly female, and many are migrants. This report documents how, despite making a large contribution to global public health, they are exposed to many health risks themselves, while enjoying few labour market and health protections. The report also underscores that paid and unpaid care work is central to the broad health and well-being of individuals, their families and communities, as well as society at large.

The care paradox: global public health and the role of migrant women care workers
Increasingly, immigrant women are being imported into receiving country economies to care, often in informal settings, and are frequently engaged by private households, without full access to social protection and labour rights. Yet this group of migrants provides essential care services and, increasingly, health-care services, thus contributing to health systems and to health and well-being worldwide.

As the leading normative agency on health, the World Health Organization (WHO) calls attention to the paradox that migrant women care workers buttress health systems in countries with shortfalls in health-care provision, while their own rights to health may be eroded and their health-care needs are unfulfilled. Migrant women care workers act as a cushion for states that lack adequate public provision for long-term care, child care and care for the sick.
Unmet needs and growing demand for care
Home-based personal care – whether for older persons, children, or those with chronic diseases or disabilities – constitutes an important component of modern health systems. This applies to both high-income countries, where formal health-care institutions and services are struggling to meet the growing demand for such care, as well as to middle- and lower-income countries and regions where home-based care relieves the demand for, and expense of, institutional care. In all societies there is a cultural preference for care “in the family” or for “ageing in place”.

One area in which the care deficit in receiving countries is particularly pronounced is long-term care for older persons. Critical shortages of long-term care workers make quality services  unavailable for large parts of the global population aged 65 years and over. The extent of the unmet need varies worldwide, but in Europe alone the shortage is estimated at around 2.3 million formal long-term care workers.

The policy architecture related to care work, migration and women
The unique status of migrant women care workers as both providers and consumers of health and social care requires that both sending and receiving countries reflect on this paradox and work urgently, and much more collaboratively, to overcome challenges, contradictions, gaps and inconsistencies in international, regional, national and subnational policies, laws and programmes across all relevant sectors. This report proposes the integration of policy actions – and of gender, equity and human rights approaches – to mediate concerns about care deficits and decent and safe work in the care sector as a crucial component of maintaining global and national public health.

Why this report?
WHO initiated this report in response to growing global political interest in population health and development, particularly noting discussions at the 42nd G7 meeting in Japan in May 2016 which called for more attention to migrants and their role in paid and unpaid care work. It is hoped that this report, and its reflection on potential next steps, will foster further debate about approaches to ensure that the global community meets its obligations to leave no one behind in securing long-term equitable and sustainable development. The analysis is also shaped by commitments to the principles of human rights, the Tanahashi Framework on health service coverage and evaluation, the United Nations Migration Governance Framework,i the Framework of priorities and guiding principles for a World Health Assembly Resolution on the health of migrants and refugees, the concept of progressive universalism towards achieving universal health coverage (UHC), and the 2030 Agenda for Sustainable Developmentii with its overarching goal of leaving no one behind…

[See also full-text of Lancet editorial “Caring for migrant health-care workers” in Journal Watch below]