Vaccines and Global Health: The Week in Review 18 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_18 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 – New global commitment to end tuberculosis

Milestones :: Perspectives

New global commitment to end tuberculosis
News release
17 November 2017 | MOSCOW/GENEVA – Today 75 ministers agreed to take urgent action to end tuberculosis (TB) by 2030. The announcement came at the first WHO Global Ministerial Conference on Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response, which brought together delegates from 114 countries in Moscow. President Vladimir Putin of the Russian Federation opened the Conference, together with Amina J Mohammed, UN Deputy Secretary General, and Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Today marks a critical landmark in the fight to end TB,” said Dr Tedros. “It signals a long overdue global commitment to stop the death and suffering caused by this ancient killer.”
The Moscow Declaration to End TB is a promise to increase multisectoral action as well as track progress, and build accountability. It will also inform the first UN General Assembly High-Level Meeting on TB in 2018, which will seek further commitments from heads of state.

Global efforts to combat TB have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%. However, progress in many countries has stalled, global targets are off-track, and persistent gaps remain in TB care and prevention.

As a result, TB still kills more people than any other infectious disease. There are major problems associated with antimicrobial resistance, and it is the leading killer of people with HIV.

“One of the main problems has been a lack of political will and inadequate investment in fighting TB,” added Dr Tedros. “Today’s declaration must go hand-in-hand with increased investment.”

The meeting was attended by ministers and country delegations, as well as representatives of civil society and international organizations, scientists, and researchers. More than 1000 participants took part in the two-day conference which resulted in collective commitment to ramp up action on four fronts:
[1] Move rapidly to achieve universal health coverage by strengthening health systems and improving access to people-centered TB prevention and care, ensuring no one is left behind.

[2] Mobilize sufficient and sustainable financing through increased domestic and international investments to close gaps in implementation and research.

[3] Advance research and development of new tools to diagnose, treat, and prevent TB.

[4] Build accountability through a framework to track and review progress on ending TB, including multisectoral approaches.

Ministers also promised to minimize the risk and spread of drug resistance and do more to engage people and communities affected by, and at risk of, TB.

The Russian Federation, host of the first Ministerial Conference to End TB, welcomed the Moscow Declaration. “Tuberculosis is a complex, multi-sectoral problem that requires a systemic and highly coordinated response to address the conditions which drive the disease,” said Professor Veronika Skvortsova, Minister of Health, Russian Federation. “The accountability framework we have agreed to develop marks a new beginning, and, with WHO’s support to coordinate and track progress, we expect the Moscow Declaration to lead us forward to the high-level meeting of the UN General Assembly in 2018.”
Ending TB means investing in R&D
Joint statement from Aeras, FIND, and TB Alliance
November 17, 2017
This week, as health ministers, diplomats and other representatives meet to discuss tuberculosis (TB) at the World Health Organization (WHO) Ministerial Conference in Moscow, millions of people are suffering from the disease. The governments around the world can and must end this suffering through a major and sustained investment in TB research and development (R&D).
There were 10.4 million new cases of active TB in 2016—of which only 6 million were diagnosed and notified. Drug-resistant infections are on the rise. There remains a dire need for better, faster-acting drugs, a new vaccine, and technologies that quickly diagnose TB and determine the degree of drug-resistance.
Science is not holding us back, funding and political will to implement is.
The WHO estimates that R&D budgets need more than US$1 billion annually to turn around the odds of patients potentially losing years of their lives to a toxic treatment course, missing the opportunity for treatment due to poor diagnostics, or contracting TB in the first place because of an ineffective vaccine.
The WHO also reports that despite accounting for about 2 percent of deaths globally, TB receives only 0.25 percent of the estimated US$265 billion spent worldwide on medical research each year.

Simply put, TB science is woefully underfunded. Governments must work together to dramatically reshape the investment landscape.

Today, the time needed to treat drug-resistant TB ranges from nine months to two years or more—and yet in common practice the success rate is only about 50 percent. The majority of drugs that these patients are given are probably not helping at all—but they are producing side effects, everything from nausea and dizziness to deafness and kidney failure. For some, the treatment can be worse than the disease itself.

A true point of care test is needed to find the 4 million missing patients every year, where and when they first seek care. New diagnostic technology is critical to ensure that the right treatment regimens are used—right from the start—to prevent the lengthy and arduous road to diagnosis and cure faced by many patients.

Making matters worse, there is no vaccine that can effectively play a major role in eliminating this disease. Today, the Bacillus Calmette–Guérin vaccine is the only TB vaccine available. It is nearly a century old, only moderately effective in preventing severe TB in infants and young children, and it doesn’t adequately protect teens and adults, who are most at risk for developing and spreading TB.

Progress has been made but we need a greater commitment. There are 12 different TB vaccine candidates in clinical trials today, a significant increase from 2000—when there were zero. Data from multiple mid- and late-stage efficacy trials will become available over the next 3 years, providing data that will help optimize and accelerate TB vaccine development. But it will take a significant increase in resources to achieve critical breakthroughs—and to reach success quickly
Similarly, only a handful of drug candidates were being tested in clinical trials. Today there are more than 30. Two new experimental treatments show promise—one that might be able to cure all forms of TB except for the most drug-resistant strains (known as extensively drug-resistant TB or XDR-TB), and another that might be able to cure XDR-TB. Both could take substantially less time and money than current treatments.

At first glance, the TB diagnostics pipeline looks healthy. However, emerging game-changers are at risk due to underfunding at the clinical trial stage. In addition, very few diagnostic candidates would address the most critical need—a point of care test for primary care facilities. Diversification of the point of care pipeline, and identification of new biomarkers are urgently needed.

While the meeting in Moscow will inform future discourse on TB, it must also serve as a springboard toward decisive action against the disease. TB is the world’s deadliest infectious disease and efforts to curb it remain underfunded. We are calling on governments to make major commitments to fund the R&D that will end TB once and for all.
Catharina Boehme, CEO, FIND
Jacqueline Shea, CEO, AERAS
Mel Spigelman, President and CEO, TB Alliance

Global Fund Appoints Peter Sands as Executive Director
14 November 2017  News Release
GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria today appointed a new Executive Director: Peter Sands, a former chief executive of Standard Chartered Bank who after a distinguished career in banking immersed himself in a range of global public health projects.

Sands, who is currently Chairman of the World Bank’s International Working Group on Financing Pandemic Preparedness, is also a research fellow at the Harvard Global Health Institute and the Mossavar Rahmani Center for Business and Government at Harvard’s Kennedy School, where he works on research projects in global health and financial regulation.

“Peter Sands brings exceptional management and finance experience, and a heart for global health,” said Aida Kurtović, Board Chair of the Global Fund. “At a time when we face complex challenges, his ability to mobilize resources while managing transformational change is exactly what we need. We expect him to take the Global Fund to the next level.”

Sands served as Chief Executive Officer of Standard Chartered PLC from 2006 to 2015, having joined the bank in 2002 as Group Finance Director. Under his leadership, Standard Chartered successfully navigated the turbulence of the global financial crisis in 2007-2009, continuing to support clients and counterparties throughout the worst of the financial stresses and without drawing on government support of any kind…

After stepping down from the bank in 2015, Sands deployed his skills and experience in international finance on global health. Sands served as Chairman of the U.S. National Academy of Medicine’s Commission on a Global Health Risk Framework for the Future, which published the influential report on pandemics entitled The Neglected Dimension of Global Security: a Framework to Counter Infectious Disease Outbreaks. Sands is also serving on the U.S. National Academy of Science’s Forum on Microbial Threats and Committee on Ensuring Access to Affordable Drugs. Sands has published articles on global health and epidemics in various peer-reviewed journals.

“I am deeply honored to join this extraordinary partnership,” Sands said. “Infectious diseases today represent one of the most serious risks facing humankind. If we work together to mobilize funds, build strong health systems and establish effective community responses we will be able to end epidemics, promote prosperity and increase our global health security.”…

As new Executive Director, Sands will oversee and guide the implementation of the Global Fund’s 2017-2022 strategy, designed to maximize impact against HIV, TB and malaria and build resilient and sustainable systems for health.

The Global Fund is a 21st-century partnership organization designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by the diseases.

The Global Fund raises and invests nearly US$4 billion a year to support programs run by local experts in countries and communities most in need. The Global Fund has been consistently rated as one of the most effective and transparent organizations in the development sector.

WHO welcomes appointment of new Executive Director of the Global Fund
14 November, 2017 – WHO welcomes the appointment of Peter Sands as the new Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Gavi welcomes new Global Fund Executive Director
12 November 2017 – Gavi collaborates with the Global Fund in the vast majority of Gavi-supported countries.

FDA announces comprehensive regenerative medicine policy framework

FDA announces comprehensive regenerative medicine policy framework
Comprehensive regenerative medicine policy framework to spur innovation, efficient access to potentially transformative products, while ensuring safety & efficacy
November 16, 2017 –
Today the U.S. Food and Drug Administration announced a comprehensive policy framework for the development and oversight of regenerative medicine products, including novel cellular therapies.

The framework – outlined in a suite of four guidance documents – builds upon the FDA’s existing risk-based regulatory approach to more clearly describe what products are regulated as drugs, devices, and/or biological products. Further, two of the guidance documents propose an efficient, science-based process for helping to ensure the safety and effectiveness of these therapies, while supporting development in this area. The suite of guidance documents also defines a risk-based framework for how the FDA intends to focus its enforcement actions against those products that raise potential significant safety concerns. This modern framework is intended to balance the agency’s commitment to safety with mechanisms to drive further advances in regenerative medicine so innovators can bring new, effective therapies to patients as quickly and safely as possible. The policy also delivers on important provisions of the 21st Century Cures Act.

“We’re at the beginning of a paradigm change in medicine with the promise of being able to facilitate regeneration of parts of the human body, where cells and tissues can be engineered to grow healthy, functional organs to replace diseased ones; new genes can be introduced into the body to combat disease; and adult stem cells can generate replacements for cells that are lost to injury or disease. This is no longer the stuff of science fiction. This is the practical promise of modern applications of regenerative medicine,” said FDA Commissioner Scott Gottlieb, M.D. “But this field is dynamic and complex. As such, it has presented unique challenges to researchers, health care providers, and the FDA as we seek to provide a clear pathway for those developing new therapies in this promising field, while making sure that the FDA meets its obligation to ensure the safety and efficacy of the medical products that patients rely upon. Alongside all the promise, we’ve also seen products marketed that are dangerous and have harmed people. With the policy framework the FDA is announcing today, we’re adopting a risk-based and science-based approach that builds upon existing regulations to support innovative product development while clarifying the FDA’s authorities and enforcement priorities. This will protect patients from products that pose potential significant risks, while accelerating access to safe and effective new therapies.”

The framework includes two final guidance documents and two draft guidance documents.

New Final Guidance Documents
The two final guidance documents clarify the FDA’s interpretation of the risk-based criteria manufacturers use to determine whether a product is subject to the FDA’s premarket review.
The first guidance provides greater clarity around when cell and tissue-based products would be excepted from the established regulations if they are removed from and implanted into the same individual within the same surgical procedure and remain in their original form. The second final guidance helps stakeholders better understand how existing regulatory criteria apply to their products by clarifying how the agency interprets the existing regulatory definitions “minimal manipulation” and “homologous use.” As this field advances, the FDA has noted that there are a growing number of regenerative medicine products subject to FDA premarket authorization. These guidance documents will help explain how the FDA will provide a risk-based framework for its oversight. The policy framework defines how we intend to take action against unsafe products while facilitating continued innovation of promising technologies…
New Draft Guidance Documents
The two draft guidances provide important information to help spur development and access to innovative regenerative therapies. The first draft guidance, which builds off the regenerative medicine provisions in the 21st Century Cures Act, addresses how the FDA intends to simplify and streamline its application of the regulatory requirements for devices used in the recovery, isolation, and delivery of regenerative medicine advanced therapies (RMATs), including combination products. The guidance specifies that devices intended for use with a specific RMAT may, together with the RMAT, be considered to comprise a combination product.

The second draft guidance describes the expedited programs that may be available to sponsors of regenerative medicine therapies, including the new Regenerative Medicine Advanced Therapy (RMAT) designation created by the 21st Century Cures Act, Priority Review, and Accelerated Approval. In addition, the guidance describes the regenerative medicine therapies that may be eligible for RMAT designation – including cell therapies, therapeutic tissue engineering products, human cell and tissue products, and combination products using any such therapies or products, as well as gene therapies that lead to a durable modification of cells or tissues (including genetically modified cells)…
Statement from FDA Commissioner Scott Gottlieb, M.D. on FDA’s comprehensive new policy approach to facilitating the development of innovative regenerative medicine products to improve human health
November 16, 2017 –
One of the most promising fields of science is the area of cell-based therapies and their use in regenerative medicine. These new technologies, most of which are in early stages of development, hold transformative promise for patients.

Given this area’s rapid growth, dynamism and complexity, this field has also presented unique challenges to researchers, health care providers and the FDA. We need to provide a clear, efficient pathway for product developers, while making sure that we meet our obligation to help ensure the safety and efficacy of these medical products so that patients can benefit from these novel therapies.

To achieve these goals, today we’re taking steps to advance an innovative framework for how we intend to apply the existing laws and regulations that govern these products. Our aim is to make sure we’re being nimble and creative when it comes to fostering innovation, while taking steps to protect the safety of patients.

The FDA originally established a regulatory framework for these products that went into effect in 2005. But in the last decade, we’ve seen improbable advances that hold out great hope for patients. I believe that with the ability to facilitate the regeneration of parts of the human body, we’re bearing witness to the beginning of a paradigm shift in the practice of medicine.

These concepts are no longer the stuff of science fiction, but rather real-life science where cells and tissues can be engineered to grow healthy, functional organs to replace diseased ones; where new genes can be introduced into the body to combat disease; and where adult stem cells can generate replacements for cells that are lost to injury or illness. The promise of this technology is why the FDA is so committed to encouraging and supporting innovation in this field.

But the rapid growth and promise of this field has increasingly sowed the ground for the entry of some unscrupulous actors, who have opportunistically seized on the clinical potential of regenerative medicine to make deceptive claims to patients about unproven and, in some cases, dangerous products. By exploiting the lack of consumer understanding of this area, as well as the fear and uncertainties posed by the diseases these bad actors claim to treat, they’re jeopardizing the legitimacy and advancement of the entire field. This underscores the importance of having a clear regulatory framework for developers, and ensuring that those who skirt these regulations are held accountable.

To realize the full potential of regenerative medicine, we need to support the innovation pursued by responsible product developers – who represent the vast majority of the field – to help ensure that they clearly understand where the regulatory lines are drawn. We must advance a modern, efficient and least burdensome framework that recognizes the breakneck speed of advancement in the products we’re being asked to evaluate, while ensuring patient safety. That is the goal of the policy we’re announcing today.

To achieve this balance, embedded in our comprehensive framework are many proposed novel and modern approaches to regulation, where we intend to adapt our regulatory model to meet the revolutionary nature of the products we’re being asked to evaluate.

One example is how we’re considering innovative trial designs whereby individual academic investigators would follow the same manufacturing protocols and share combined clinical trial data in support of approval from the FDA. This is an innovative way of making sure that small investigators who are working with cells that are being manufactured in ways that render them subject to our current laws and regulations — because the cells are, for example, more than “minimally manipulated” — can nonetheless seek the FDA’s approval through a less burdensome process.

There are other similarly proposed novel approaches embedded in our broad policy framework. Our goal is to achieve a risk-based and science-based approach to support innovative product development, while clarifying the FDA’s authorities and enforcement priorities and making sure we are protecting patients.

The suite of four guidance documents we are making public today also delivers on important provisions of the 21st Century Cures Act, including our continued promise to fully implement the Regenerative Medicine Advanced Therapy (RMAT) designation program, which is designed to expedite the development and review of regenerative medicine advanced therapies.

We understand that there will be questions and it will take time for product developers to determine whether their products require FDA approval. Our policy will allow product manufacturers that time to engage with the FDA to determine if they need to submit a marketing authorization application and, if so, seek guidance on how to submit their application to the FDA for approval.

To be clear, we remain committed to ensuring that patients have access to safe and effective regenerative medicine products as efficiently as possible. We are also committed to making sure we take action against products being unlawfully marketed that pose a potential significant risk to their safety. The framework we’re announcing today gives us the solid platform we need to continue to take enforcement action against a small number of clearly unscrupulous actors.
With this balanced approach, we’re well positioned to support and help advance breakthrough science, like regenerative medicine, and promote responsible and flexible regulation that leverages science to advance public health…

Africa CDC [to 18 November 2017]

Editor’s Note:
We are pleased to begin regular coverage of news and announcements from the Africa CDC…overdue…
Africa CDC   [to 18 November 2017]
November 07, 2017
Africa Partnership and Coordination Forum agree on joint priorities to fast track implementation of the Catalytic Framework to end AIDS, TB and eliminate Malaria in Africa by 2030
Johannesburg, 07 November 2017- The African Union Commission (AUC) convened regional and continental partners last week to discuss joint priorities to support countries end AIDS, TB and Malaria by 2030. In attendance were: African Union Organs, Regional Economic Communities, Regional Health Organisations, development partners, civil society the private sector and invited guests.

“We have the science and tools to end AIDS, TB and Malaria by 2030. The continental targets set for the three diseases can be achieved with sustained leadership, ownership, sustained financing, effective partnerships and accountability,” said Dr. Richard Kamwi, former health minister of Namibia who is the current Goodwill Ambassador of Elimination 8 and Africa CDC Champion.

The Catalytic Framework to end AIDS, TB and Eliminate Malaria in Africa by 2030 is a continental framework that enunciates key policy issues, strategic priorities, targets and accountability mechanisms…

07 November 2017
African countries launch framework to tackle the threat of antibiotic resistant infections
Annecy, France – Africa CDC launched its framework to fight antibiotic resistant infections during the eighth edition of the Advanced Courses on Diagnostics convened by the Fondation Mérieux. Antibiotic resistant infections occur when bacteria, viruses, and other microorganisms change in ways that make medications ineffective against them. In Africa, antibiotic resistance is already a major problem for malaria, tuberculosis, typhoid, meningitis, gonorrhea, and dysentery. Recognising the urgent need for action, the World Health Assembly adopted the Global Action Plan to address the challenge in May 2015. The Africa CDC Framework describes priorities for African Union Member States to improve diagnosis and treatment of, collect more accurate data about, and strengthen policies to address antibiotic resistance.

‘Africa CDC developed a remarkably comprehensive framework, fully aligned with the Global Action Plan and the Global Antimicrobial Resistance Surveillance System which if fully implemented will address the growing threat of antibiotic resistant infections’, said Dr Marc Sprenger, Director of the Antimicrobial Resistance Secretariat at the World Health Organisation who chaired the launch.

“Antimicrobial resistance is a major threat to Africa’s economic growth and structural transformation goals. We need to urgently strengthen partnerships and leverage our existing assets across Africa to fully implement the Africa CDC Framework for Antimicrobial Resistance,” said Dr. John Nkengasong, the Director of the Africa Centres for Disease Control and Prevention…

Immunization needs a technology boost

Featured Journal Content
Volume 551 Number 7680 pp271-398   16 November 2017
World View
Immunization needs a technology boost
Tracking who receives vaccines is essential, but will be impossible without innovations in digital technologies, says Seth Berkley.
Today, about 80% of infants living in the world’s 73 poorest countries receive routine immunizations, a measure currently assessed by whether they have been given a full course of a vaccine regime to prevent diphtheria, pertussis and tetanus. In 2000, only about 60% received such protection. That progress is great, but achieving 100% coverage will require better insight into which children are missing out.

For that, we need a new approach: the global health community must move to digital systems. My organization, Gavi, the Vaccine Alliance, spends an average of nearly US$2 billion a year on getting vaccines to children in the poorest countries. It has also invested tens of millions of dollars in innovations to monitor immunization.

Current methods for measuring immunization coverage are based on how many vaccine doses are distributed — not how many children are fully immunized. Doses delivered are much easier to count, but knowing which children are covered is much more important. That picture is vague. Surveys done to plug this knowledge gap are rare, costly and — to be reliable — require mothers to have retained paper-based child health cards.

Putting the child at the centre of tracking efforts is not as simple as it sounds. Tens of millions of children have no formal record of their existence — especially those living in remote, impoverished or vulnerable communities. This global identity crisis is so important that it has its own indicator (number 16.9) under the United Nations’ Sustainable Development Goals (SDGs) intended to ensure that everyone has a legal identity by 2030. Right now, unregistered births are one of the biggest barriers to achieving another SDG, which aims to end preventable deaths of children under five and achieve universal health coverage, with access to affordable essential vaccines for all, by 2030.

Digital technology and social media offer an opportunity. The technology sector is on a mission to equip everyone on the planet with a digital and online presence. And the innovations that will help to achieve that goal are exactly those that could aid the global public-health community in vaccinating every child.

Many relevant technologies are largely in place already. Big data, for example, can help public-health officials to anticipate the spread of disease and hone vaccination campaigns. Geospatial mapping and drones are already being used in Nigeria to identify communities that have not received polio vaccines, and in Rwanda to deliver blood needed for transfusions for mothers who haemorrhage after giving birth.

One of the biggest needs is for affordable, secure digital identification systems that can store a child’s medical history, and that can be accessed even in places without reliable electricity. That might seem a tall order, but it is both achievable and necessary. Technology is already intertwined with vaccine delivery. For example, — the charitable arm of Google — and Gavi are working together to scale-up wireless temperature monitoring to provide real-time data on refrigerators used to store medications. This will notify workers when the refrigerators are starting to fail, and generally ensure that vaccines are kept at safe temperatures. We are also supporting the use of cloud-based databases to track vaccines along the supply chain.

Other projects help to inform us of who receives vaccines. We are working with a company in India called Khushi Baby, which creates off-grid digital health records. A necklace worn by infants contains a unique identification number on a short-range communication chip. Community health workers can scan the chip using a mobile phone, enabling them to update a child’s digital record even in remote areas with little phone coverage. In the Indian state of Rajasthan, Khushi Baby has tracked more than 15,000 vaccination events of thousands of children across 100 villages.

We still have a long way to go. We should be more ambitious in defining what 100% vaccination coverage means. Although the common measure of routine immunization coverage suggests that only one in five children misses out, the reality is much bleaker. The current measurement leaves out at least 8 of the 11 antigens that the World Health Organization (WHO) recommends be included in vaccines given to all infants. Among the missing ones are the highly contagious measles. Also missing are antigens for pneumococcus, which causes pneumonia, and rotavirus, which causes severe diarrhoea — the two biggest killers globally of children under five.

Our analysis suggests that just 7% of infants in the 73 poorest countries — those that most need our attention — are fully immunized. That means that more than nine of every ten children in these countries are not getting the minimum recommended protection against infectious diseases.

A UN expert group is meeting this week in Bahrain to review indicators for the SDGs. Expanding indicators to include all the WHO-recommended antigens will help. And in theory, governments have already signed up to finding a solution to the problem of birth registration. Both moves are essential to improve understanding of how many children are fully immunized. A third essential ingredient is information technologies targeted at helping the developing world. If we want to make sure that preventable childhood deaths are actually prevented, we need to go digital.


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 November 2017 [GPEI]
:: Underlining their commitment to a polio-free world for all future generations, Italy has provided €4.5 million to deliver polio vaccines in Afghanistan and Pakistan.
[In Afghanistan, the contribution will be used to support and train vaccinators and social mobilizers in generating demand for vaccination, the delivery of vaccines and monitoring whether vaccination activities are well-implemented. In Pakistan, the contribution will support vaccination campaigns in the most challenging areas of the country, as well as the immunization of communities that are at particularly high risk due to their mobility, through tactics such as giving vaccine established transit points. The Bill & Melinda Gates Foundation have matched Italy’s contribution, doubling its impact to €9 million…]

Summary of newly-reported viruses this week:
Afghanistan:  One new wild poliovirus type 1 (WPV1) case, reported in Kandahar province. One new WPV1 positive environmental sample, collected from Kandahar province.
Pakistan: Six new  WPV1 positive environmental samples, one collected from Punjab province, two collected from Sindh province, and three collected from Balochistan province.


Syria cVDPV2 outbreak situation report 22: 14 November 2017
Situation update 14 November 2017
14 November 2017 [Editor’s text bolding]
:: No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week. The total number of cVDPV2 cases remains 63. All confirmed cases to date have had onset of paralysis before 25 August 2017.

:: Inactivated polio vaccine activities aimed at reaching children aged 2–23 months are ongoing. IPV will be offered alongside bOPV as part of the subnational immunization days in 6 districts of Damascus and 200 hotels in the city, 3 areas of Rural Damascus, 2 districts of Homs and 1 district of Aleppo with large internally displaced populations from Deir Ez-Zor.

:: Almost 3000 children under 5 have received all routine immunization antigens in newly accessible areas of Deir Ez-Zor city between 7 and 10 November in opportunistic vaccination activities.

:: A joint mission between the World Health Organization and the local health authority to visit newly accessible areas of Aleppo was conducted this week. The mission also met with the Aleppo University Hospital and Aleppo Pediatric Association to advocate for acute flaccid paralysis surveillance and to support ongoing immunization activities to reach IDPs from infected areas.

:: The advisory group on mOPV2 vaccine provision met this week to review the revised risk assessment for Syria cVDPV2 outbreak and discuss contingency plans for outbreak response. The group endorsed, in principle, the proposal to preposition approximately 1 million doses mOPV2 in Damascus (pending receipt of formal vaccine request from the Ministry of Health) to enable rapid response in the event of any ongoing outbreak response activities


Devex: Exclusive: The Gates Foundation picks a partner to share lessons learned from polio eradication
By Catherine Cheney
16 November 2017
SAN FRANCISCO — The Johns Hopkins Bloomberg School of Public Health has received a new grant to translate the lessons learned from polio eradication to other global health initiatives, the Bill & Melinda Gates Foundation told Devex.

Polio is one of the top priorities of the largest foundation in the world, and in their 2017 annual letter, Bill and Melinda Gates said they think it is possible that polio could be eliminated this year. At the Reaching the Last Mile summit in Abu Dhabi this week, panelists talked about the near eradication of both polio and Guinea worm disease, and what lessons smallpox — the only infectious disease to be wiped off the face of the planet — might offer. But as the Gates Foundation funds this effort to get to zero case of polio, its program staff wants to make sure to improve upon one of the failures of the smallpox eradication effort by documenting the lessons learned.

Dr. Olakunle Alonge, assistant professor at JHSPH, will lead this new grant, $3.7 million over five years, resulting from a request for proposals called “Applying the Lessons Learned from Polio Eradication to Global Health.” Working with the Global Polio Eradication Initiative, Alonge and a team of partners from seven countries — Nigeria, India, Afghanistan, Ethiopia, the Democratic Republic of Congo, Bangladesh, and Indonesia — will develop courses and clinics that capture the best practices of the polio eradication effort. The goal, said Alonge, is to capture the lessons learned and prevent this knowledge from being lost so that systems and strategies can be repurposed, not recreated….


WHO Grade 3 Emergencies  [to 18 November 2017]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 22: 14 November 2017
 [See Polio above]

WHO Grade 2 Emergencies  [to 18 November 2017]
::  Mortality and Morbidity Weekly Bulletin – Volume No 5: 12 November 2017
…4.1 Second round of Oral Cholera Vaccination Campaign
…From 4-9 November 2017, the second round of OCV was conducted targeting 182,317 FDMNs between 1 and 5 years. As of 9 November 2017, a total of 199,472 persons were reported to have been vaccinated, representing 109% (199,472/182,317) of the target population (table 2). Oral cholera vaccines represent a tool to fight cholera and are licensed as two-dose regimens with 2-4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera….

:: Rift Valley fever in Niger
November 2016 — Rift Valley Fever (RVF) is caused by a virus transmitted by mosquitoes and blood feeding flies that usually affects animals (commonly cattle and sheep) but can also involve humans. In humans the disease ranges from a mild flu-like illness to severe haemorrhagic fever that can be lethal. When livestock are infected the disease can cause significant economic losses due to high mortality rate in young animals and waves of abortions in pregnant females

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
:: 16 Nov 2017  WFP Condemns Destruction of Humanitarian Food Supplies in Eastern Ghouta Area of Syria

:: Statement by the Humanitarian Community on the Blockade in Yemen | 16 November 2017
:: Yemen: Impact of the closure of seaports and airports on the humanitarian situation – Situation Update 2 | 15 November 2017
:: Ensuring Yemen’s lifeline: the criticality of all Yemeni ports
:: Yemen: Key messages on the continued closure of Yemen’s ports – 13 November 2017

:: Democratic Republic of the Congo Overview (November 2017)   16 Nov 2017
The humanitarian situation in the Democratic Republic of the Congo (DRC) has deteriorated dramatically over the past year. The crisis has deepened and spread, affecting people in areas previously considered stable and stretching the coping mechanisms of people in areas already impacted. A surge in violent conflict and intercommunal tensions has forced more than 1.7 million people to flee their homes in 2017 – an average of more than 5,500 people per day. Today, the total number of internally displaced people in the DRC has reached 4.1 million, which is the highest number of any country on the African continent. Insecurity has had a devastating impact on people’s ability to access food, and 7.7 million people across the DRC are facing severe food insecurity – a 30 per cent increase from the same time last year. The situation is further complicated by political uncertainty and economic downturn.

:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock – Remarks at the Member States briefing on the Democratic Republic of the Congo – 16 November 2017
:: Earthquake in northeast Iraq 14 November 2017 – 12:30, Flash Update #3 [EN/AR/KU]
:: Humanitarian partners are rushing to help the victims of the earthquake [EN/AR/KU]  13 Nov 2017
WHO airlifts medical supplies to treat wounded in Islamic Republic of Iran-Iraq earthquake
16 November 2017, Cairo, Egypt – WHO has airlifted trauma kits and medical supplies to the Islamic Republic of Iran to support the treatment of thousands people injured as a result of the recent earthquake in the  Islamic Republic of Iran-Iraq border region…

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 – 16 November 2017

:: 15 Nov 2017  Ethiopia: Humanitarian Response Situation Report No.15 (October 2017)
:: Fact Sheet NE Nigeria: Pulka, Gwoza LGA (November 2017)
:: Fact Sheet NE Nigeria: Rann, Kala/Balge LGA (November 2017)


WHO & Regional Offices [to 18 November 2017]

WHO & Regional Offices [to 18 November 2017]

Preterm birth
November 2017 – Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015.

Nutrition Report highlights an increase in malnutrition in Africa
November 2017 – A newly released nutrition report by WHO has revealed that undernutrition is still persistent in the region and the number of stunted children has increased. The Report also a growing number of children under five years old are overweight.

River blindness: shifting to surveillance and elimination
November 2017 – After years of painstaking control and prevention activities, the world is finally edging to eliminate river blindness. Latest data show globally almost 133 million people received treatment in 2016, compared with 46 million in 2005.


Progress towards rubella and congenital rubella syndrome control and elimination
17 November 2017
A new report published in todays’ edition of the WHO Weekly Epidemiological Record shows that 53 more countries introduced rubella vaccine into their national immunization schedules since 2000. This led to a decline in cases by 97% from 2000-2016. But, improved disease surveillance and stronger country commitment are still needed to reach elimination goals.
WHO recommends that all countries that have not yet introduced rubella vaccine should consider doing so using existing, well-established measles immunization programmes.

Weekly Epidemiological Record, 17 November 2017, vol. 92, 46 (pp. 701–716)
:: Global routine vaccination coverage, 2016
::Progress in rubella and congenital rubella syndrome control and elimination – worldwide, 2000–2016

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Ghanaians urged to seek advice from qualified health practitioners before taking antibiotics
17 November 2017
:: Women and Girls should be empowered to strengthen their capacity to prevent Type 2 Diabetes  17 November 2017
:: WHO’s Africa Nutrition Report highlights an increase in malnutrition in Africa. 16 November 2017
:: International Health Emergency Response plan on Marburg virus disease  15 November 2017
:: Plague in Madagascar – Disease Outbreak News Update  15 November 2017
:: WHO implements Emergency Response Plan  15 November 2017
:: WHO strengthening the capacity of frontline healthcare workers in Yei River State, Central Equatoria hub to improve the management of cases of priority diseases in South Sudan
14 November 2017
:: South Sudan conducts Polio Outbreak Simulation Exercise to strengthen Polio outbreak preparedness and response  14 November 2017

WHO European Region EURO
:: Tuberculosis (TB) research and innovation among key priorities at global conference to end TB 17-11-2017
:: Planning cities to boost physical activity 14-11-2017
:: Turkey takes strong action to reduce antibiotic consumption and resistance 13-11-2017
::  Every infection prevented is an antibiotic treatment avoided 13-11-2017

WHO Eastern Mediterranean Region EMRO
:: WHO airlifts medical supplies to treat wounded in Islamic Republic of Iran-Iraq earthquake
16 November 2017
:: WHO delivers urgent health assistance for earthquake trauma patients  15 November 2017
:: Government of Italy boosts efforts to eradicate polio and improve child nutrition in Afghanistan  14 November 2017