Vaccines and Global Health: The Week in Review 16 December 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

.– 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_16 Dec 2017

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

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

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Editor’s Note: We will resume publication on 6 January 2018 following the end-of-year holiday period.

Tokyo Declaration on Universal Health Coverage: All Together to Accelerate Progress towards UHC

Milestones :: Perspectives
 
Editor’s Note:
Universal Health Coverage [UHC] has become the nexus for much global health strategy and  governance focus in the larger context of Sustainable Development Goals/Agenda 2030 context. We present the full text of a joint statement underscoring UHC’s integrating role and a supporting press release below.

Tokyo Declaration on Universal Health Coverage: All Together to Accelerate Progress towards UHC
Statement December 14, 2017 – World Bank, WHO, UNICEF, JICA, UHC2030
Universal Health Coverage Forum 2017
[full text; editor’s text bolding]
 
We, the Co-Organizers of the Universal Health Coverage (UHC) Forum, reaffirm our commitment to accelerating progress towards UHC, and to achieving health for all people, whoever they are, wherever they live, by 2030.

We recognise the integrated and indivisible nature of the Sustainable Development Goals (SDGs), which balance the economic, social and environmental dimensions of sustainable development.

We reiterate the importance of target 3.8 of the SDGs, which seeks to provide all people with access to high-quality, integrated, “people-centred” health services. This must include promotive, preventive, curative, rehabilitative and palliative health services, as well as safe, effective, quality and affordable essential medicines and vaccines. We want to ensure that people do not suffer financial hardship when accessing services. We emphasize the importance of protecting all people from health risks such as outbreaks, and responding rapidly to outbreaks and crises.

We acknowledge that health is a human right and that UHC is essential to health for all and to human security. We adhere to the principle of Leaving No One Behind, which requires special effort to design and deliver health services informed by the voices and needs of people. This prioritizes the most vulnerable members of the world’s population — children and women — those affected by emergencies, refugees and migrants, and marginalized, stigmatized and minority populations, so often living in extremely difficult circumstances.

We affirm that UHC is both technically and financially feasible. UHC produces high returns across the life course and drives employment and inclusive economic growth. UHC is one of the cornerstones of the Sustainable Development Agenda and contributes to progress towards all SDGs. Without UHC, billions of people are at risk of losing the opportunity to live full and productive lives, and hundreds of millions risk impoverishment in their pursuit of health care. Millions of people live in countries and states considered to be fragile. Attaining UHC in these settings requires strong intersectoral collaboration.

We reaffirm and build on the G7 Ise-Shima Vision for Global Health, the TICAD VI Nairobi Declaration, which acknowledges the “UHC in Africa: A Framework for Action.” We also build on the G20 Berlin Declaration, which acknowledges the UHC2030 “Healthy systems for universal health coverage – a joint vision for healthy lives,” as well as other regional and international declarations. All of these stress the need to build and strengthen resilient and sustainable health systems and prepare for public health emergencies in an integrated way. In this context, we note the progress that has been made to reinforce preparedness and responses to public health emergencies, including formalization of coordination mechanisms among the World Health Organization (WHO) and other relevant United Nations (UN) partners, and funding mechanisms for emergencies like the WHO’s Contingency Fund for Emergencies (CFE) and the World Bank’s Pandemic Emergency Financing Facility (PEF).

We welcome the release of the 2017 UHC Global Monitoring Report. According to this report, much remains to be done to achieve UHC:  
   :: At least half of the world’s population still does not have access to quality essential services to protect and promote health. 
   :: 800 million people are spending at least 10 percent of their household budget on out-of-pocket health care expenses, and nearly 100 million people are being pushed into extreme poverty each year due to health care costs.

Concerned that progress towards UHC is too slow, despite the efforts made in each country, we call for greater commitment to accelerate progress towards UHC.

Strengthening global momentum towards UHC
:: By 2023, the midpoint towards 2030, the world needs to extend essential health coverage to 1 billion additional people and halve to 50 million the number of people being pushed into extreme poverty by health expenses.

:: We commit to monitoring progress towards UHC as part of the UN SDG review process by issuing global monitoring reports regularly, and reviewing key findings at the subsequent UHC Forum. We welcome the use of a uniform measurement methodology for UHC indicators in the 2017 Global Monitoring Report. We also emphasize the importance of strengthening the breadth and depth of data at the national and subnational levels, including disaggregated data, to inform evidence-based policymaking and to assess progress, as well as strengthening the capacity of local stakeholders to analyse and use data.

:: In response to the recommendations of the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth, and as articulated in the Dublin Declaration on Human Resources for Health, we call upon all relevant stakeholders to expand and transform investments in the health and social workforce for UHC, emphasizing the empowerment of women and youth employment.

:: To maintain a high level of political momentum on UHC, we welcome the 40th anniversary conference in 2018 of the Alma Ata Declaration, from the International Conference on Primary Health Care. We also welcome the decision to designate December 12 of each year as International UHC Day and support the UN high-level meeting on UHC in 2019. Furthermore, we will support stronger global leadership at high level of the UN system to promote UHC.

Accelerating country-led process towards UHC
:: We commit to jointly mobilizing political leadership around the world so that countries develop their own roadmaps towards UHC, with clearly indicated targets, indicators and specific plans. We support the increased alignment of efforts among all development partners through country-led, multi-stakeholder coordination platforms in line with the UHC2030 Global Compact principles. We also promote country-level engagement with diverse stakeholders from non-governmental and private sector partners to enhance shared ownership and accountability. We welcome the contribution of international initiatives such as the Tokyo Joint UHC Initiative, the UHC Partnership, Providing for Health Partnership, and the Global Financing Facility (GFF), which aim to strengthen country systems and platforms for UHC and preparedness in a collaborative manner.

   :: In pursuing UHC, we commit to targeted investments to prevent, detect and respond to disease outbreaks and other emergencies including surveillance systems in order to safeguard health security and international collaboration under the International Health Regulations (2005). In doing so, we will promote a focus on fragile and conflict-affected settings to ensure UHC financing in such settings. We also commit to investing in building a sound foundation for healthy societies with equitable access to social services such as water, sanitation, nutrition, housing, and education, and mainstreaming gender throughout policies and programmes.

: On financing for UHC, we support a strong dialogue between the Ministries of Health and Finance to mobilize and manage domestic resources to increase public funding and reduce out-of-pocket payments. It is also critical for countries to mobilise citizen and community platforms, strengthening their budgetary processes, tracking expenditures to achieve value and equity of health spending, and enhancing the efficiency of health expenditures.

: Effective and innovative financing tools offered by development partners, such as the GFF and World Bank’s IDA, also complement domestic resources. In this regard, we welcome IDA18’s strong policy commitment to the global health agenda, which was supported by Japan and other donors, and look forward to further mobilization of IDA funds to promote UHC. We also call for expanded financing and increased alignment to support UHC by all development partners, particularly multilateral development banks and Global Health Initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and Gavi, the Vaccine Alliance, and foundations such as Bill and Melinda Gates Foundation. In order to further promote financing for UHC, we will explore holding a high-level dialogue with Health and Finance Ministries by 2019.

Innovation for UHC
:: We recognise that realising our ambition requires going beyond “business as usual,” and commit to developing and supporting strategies, policies and systems at the global and country level to harness and sustain the transformative potential of innovation. This commitment recognises the need for countries to articulate their local priorities for UHC and share best practices.

:: We also commit to improving access to medicines and vaccines through collaborative work and research and development, including during health emergencies building on platforms such as the Global Health Innovative Technology Fund (GHIT), the Coalition for Epidemic Preparedness and Innovations (CEPI) and the International AIDS Vaccine Initiative (IAVI). 

:: Accelerating progress towards UHC requires systematic learning from country experience through platforms such as UHC2030, increased focus on policy coherence, addressing implementation bottlenecks, and harnessing the potential of system innovations and effective and affordable technology in the health sector. We commit to stimulate learning on innovation for UHC by accelerating the generation and sharing of critical knowledge by building on and enhancing coordination of existing and future networks.

We look forward to future convenings and sharing the progress made towards UHC with the Global Community, in the context of the World Health Assembly, the High-Level Political Forum on Sustainable Development and the UN General Assembly, upcoming high-level UHC meetings such as the 2018 40th Anniversary of Alma Ata, and at the next UHC Forum. We extend our deep appreciation to the Government of Japan for its commitment to supporting the continuation of the UHC Fora in the future.

World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

Press release

World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses
TOKYO, December 13, 2017 — At least half of the world’s population cannot obtain essential health services, according to a new report from the World Bank and the World Health Organization. And each year, large numbers of households are being pushed into poverty because they must pay for health care out of their own pockets…

The findings, released today in Tracking Universal Health Coverage: 2017 Global Monitoring Report, have been simultaneously published in Lancet Global Health….

“It is completely unacceptable that half the world still lacks coverage for the most essential health services,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “And it is unnecessary. A solution exists: universal health coverage (UHC) allows everyone to obtain the health services they need, when and where they need them, without facing financial hardship.”

“The report makes clear that if we are serious – not just about better health outcomes, but also about ending poverty – we must urgently scale up our efforts on universal health coverage,” said World Bank Group President Dr. Jim Yong Kim. “Investments in health, and more generally investments in people, are critical to build human capital and enable sustainable and inclusive economic growth. But the system is broken: we need a fundamental shift in the way we mobilize resources for health and human capital, especially at the country level. We are working on many fronts to help countries spend more and more effectively in people, and increase their progress towards universal health coverage.”…

The report is a key point of discussion at the global Universal Health Coverage Forum 2017, currently taking place in Tokyo, Japan. Convened by the Government of Japan, a leading supporter of UHC domestically and globally, the Forum is cosponsored by the Japan International Cooperation Agency (JICA), UHC2030, the leading global movement advocating for UHC, UNICEF, the World Bank, and WHO. Japanese Prime Minister Shinzo Abe, UN Secretary-General Antonio Guterres, World Bank President Kim, WHO Director-General Tedros and UNICEF Executive Director Anthony Lake will all be in attendance, in addition to heads of state and ministers from over 30 countries. ..

The Forum is the culmination of events in over 100 countries, which began on Dec. 12—Universal Health Coverage Day—to highlight the growing global momentum on UHC. It seeks to showcase the strong high-level political commitment to UHC at global and country levels, highlight the experiences of countries that have been pathfinders on UHC progress, and add to the knowledge base on how to strengthen health systems and effectively promote UHC…

“Without health care, how can children reach their full potential? And without a healthy, productive population, how can societies realize their aspirations?” said UNICEF Executive Director Anthony Lake. “Universal health coverage can help level the playing field for children today, in turn helping them break intergenerational cycles of poverty and poor health tomorrow.”

UNICEF: New funding will allow countries to secure sustainable vaccine supplies and reach children more quickly

UNICEF: New funding will allow countries to secure sustainable vaccine supplies and reach children more quickly

Initiative to support countries’ vaccine supply through bridge financing receives financial boost from the Bill and Melinda Gates Foundation

COPENHAGEN, 13 December 2017 – UNICEF announced today that funding for its Vaccine Independence Initiative (VII), a mechanism to help countries secure a sustainable supply of life-saving vaccines, has more than doubled in the past year, increasing from $15 million to $35 million.

The increase was made possible especially by a $15 million financial guarantee from the Bill & Melinda Gates Foundation, adding to a VII capital base that also includes recent contributions from Gavi, the Vaccine Alliance, and the United States Fund for UNICEF.

Over 60 low-income countries currently benefit from Gavi support to purchase life-saving vaccines. As countries’ economies grow and transition away from Gavi support, the VII gives them access to short-term bridge “loans” so that they can purchase vaccines while waiting for the release of national budget funds. In addition, it provides countries assistance to strengthen the planning and budgeting processes to manage their essential supplies procurement moving forward.

VII is one tool to help countries minimize vaccine stock-outs and ensure more children receive vaccines on time. Since 2016, it has helped provide an estimated 91 million doses to children in 23 countries faster than would have otherwise been possible.

“Financing mechanisms such as the VII are an essential part of a vaccine supply financing toolkit to improve financial sustainability and ensure supplies are reaching children when they are most needed,” Shanelle Hall, UNICEF Deputy Executive Director for Field Results, explained. “We look forward to continuing our work supporting countries, together with the Foundation and other donors and partners. It is especially critical now, in light of many countries graduating from donor support, inequities in Middle Income Countries and the broader Sustainable Development Goals agenda.”…

Recent contributions to the VII have been key to support countries who are expanding their national budgets to purchase vaccines, such as Kenya and Chad. Additionally, the recently increased size of VII has allowed the new countries such as Uzbekistan, Cote d’Ivoire, and most recently Tajikistan to sign-up to the mechanism. More countries are in active discussions for new subscriptions. These efforts contribute to providing sustained immunization supplies to an increasing number of newborns in these countries.

New Michelson Prizes for Human Immunology and Vaccine Research launch

New Michelson Prizes for Human Immunology and Vaccine Research launch

The Michelson Medical Research Foundation and the Human Vaccines Project announce young investigator prizes to advance the development of future vaccines and therapies to defeat major global diseases
December 13, 2017, LOS ANGELES and NEW YORK – The Michelson Medical Research Foundation (MMRF) together with the Human Vaccines Project announced today the establishment of the Michelson Prizes for Human Immunology and Vaccine Research. The $20 million initiative, funded by the MMRF and administered by the Human Vaccines Project, aims to support young investigators applying innovative research concepts and disruptive technologies to significantly advance the development of future vaccines and therapies to defeat major global diseases.

A rigorous and competitive global search will be undertaken to identify the most innovative projects by young scientists across a broad spectrum of scientific fields. Two investigators under the age of 35 will each be awarded a $150,000 prize. To be considered, applicants need to show how they are going beyond conventional approaches in their field and clearly articulate how their contribution will make a lasting impact on human immunology and vaccine research.

“The Prizes give young scientists the freedom to think outside-of-the-box and explore disruptive technologies,” said Gary Michelson, MD, Founder of the Michelson Medical Research Foundation. “Our collaboration with the Human Vaccines Project in establishing the Michelson Prizes will help unravel the complexity of the human immune system to accelerate development of vaccines and therapies for some of the world’s most threatening diseases.”

While the Michelson Prizes are focused on research outcomes in the fields of human immunology and vaccinology, early career scientists across a wide array of disciplines, including clinical research, biomedicine, bioengineering, artificial intelligence/machine learning, and nanotechnology, are encouraged to apply. Proposals will be reviewed and winners selected by a distinguished committee of internationally recognized, independent scientists….

Dengue Vaccine – Dengvaxia Update

Dengue Vaccine – Dengvaxia Update
 
Editor’s Note:
We will continue to monitor and present major announcements and milestones around Dengvaxia as below. We have not identified any press releases from Sanofi Pasteur since its 30 November 2017 announcement:
Sanofi updates information on dengue vaccine
 
 
WHO advises Dengvaxia be used only in people previously infected with dengue
13 December 2017 – Following a consultation of the Global Advisory Committee on Vaccine Safety, the World Health Organization (WHO) finds that the dengue vaccine CYD-TDV, sold under the brand name Dengvaxia, prevents disease in the majority of vaccine recipients but it should not be administered to people who have not previously been infected with dengue virus.

This recommendation is based on new evidence communicated by the vaccine’s manufacturer (Sanofi Pasteur), indicating an increase in incidence of hospitalization and severe illness in vaccinated children never infected with dengue.

The WHO Global Advisory Committee on Vaccine Safety considered the company’s new results from clinical trial data analyses. Those studies indicate that increased risk of severe dengue disease in people who have never been infected affects about 15% of the vaccinated individuals. The magnitude of risk is in the order of about 4 out of every 1000 seronegative patients vaccinated who developed severe dengue disease during five years of observation. The risk of developing severe dengue disease in non-vaccinated individuals has been calculated as 1.7 per 1000 over the same period of observation. By contrast, for the 85% who have had dengue disease before immunization, there is a reduction of 4 cases of severe dengue per 1000 who are vaccinated.

The possibility of risk for seronegative people was raised by WHO and published in a position paper in July 2016: “…vaccination may be ineffective or may theoretically even increase the future risk of hospitalized or severe dengue illness in those who are seronegative at the time of first vaccination regardless of age.”[i] As this risk had at that time not been seen in the age groups for which the vaccine was licensed, WHO issued a conditional recommendation, emphasizing the use of the vaccine in populations having been previously infected with dengue virus.

To minimize illness for seronegative vaccinated people, WHO recommends enhancing measures that reduce exposure to dengue infection among populations where the vaccine has already been administered. For vaccine recipients who present with clinical symptoms compatible with dengue virus infection, access to medical care should be expedited to allow for proper evaluation, identification, and management of severe forms of the disease…
 
 
Former Philippine President Defends Controversial Dengue Programme
December 14, 2017 – By REUTERS (Reporting by Karen Lema; Editing by Robert Birsel)
MANILA — Former Philippine President Benigno Aquino defended on Thursday his decision to implement a controversial immunisation programme using a new dengue vaccine in 2016, saying it was justified with millions of people at risk of being infected by the virus.
The decision was made to help prevent a disease affecting up to 2.8 million people, Aquino told senators investigating the campaign after the company Sanofi said its Dengvaxia vaccine was to be strictly limited due to evidence it could worsen the disease in people who had not previously been exposed to the virus.
“I want to stress, before, during, and after my government decided to use Dengvaxia, nobody expressed their objection to the vaccine,” Aquino said.
Aquino approved the use of 3.5 billion pesos ($69 million) worth of government savings during his last few months in office to buy the Dengvaxia vaccine to be used for one million children in parts of the Philippines hard-hit by dengue.
“These types of drugs undergo years of development to ensure its efficacy, especially its safety,” Aquino said…
The current government of President Rodrigo Duterte stopped the immunisation programme on Dec. 1 after Sanofi issued the warning. About 830,000 children, aged 9 and older, have been inoculated with Dengvaxia.
Two Philippine congressional inquiries have begun and a criminal investigation has also been launched to determine how the danger to public health came about.
Senator Richard Gordon, chairman of the senate investigation panel, said approval and procurement for the programme went through with “unbelievable haste and phenomenal speed” given how quickly the Department of Health received funding for the campaign.
But Duterte said on Wednesday the previous government acted in good faith and that he was “not prepared to pass judgment”.
 
 
Philippines defied experts’ advice in pursuing dengue immunWecontinue to montior major annoucnements and milestones asation programme
Reuters | 10 December 2017
… Documents reviewed by Reuters that have not been disclosed until now, as well as interviews with local experts, show that key recommendations made by a Philippines Department of Health (DOH) advisory body of doctors and pharmacologists were not heeded before the program was rolled out to 830,000 children.
After Garin’s announcement, the Formulary Executive Council (FEC) of advisers urged caution over the vaccine because it said its safety and cost-effectiveness had not been established.
After twice meeting in January, the panel approved the state’s purchase of the vaccine on Feb 1, 2016 but recommended stringent conditions, minutes of all three meetings show.
“Based on the available scientific evidence presented to the Council, there is still a need to establish long-term safety, effectiveness and cost-effectiveness,” the FEC told Garin in a letter on that day. The letter was reviewed by Reuters.
The FEC said Dengvaxia should be introduced through small-scale pilot tests and phased implementation rather than across three regions in the country at the same time, and only after a detailed “baseline” study of the prevalence and strains of dengue in the targeted area, the FEC letter and minutes of the meetings said.
The experts also recommended that Dengvaxia be bought in small batches so the price could be negotiated down. An economic evaluation report commissioned by Garin’s own department had found the proposed cost of 1,000 pesos ($21.29) per dose was “not cost-effective” from a public payer perspective, the minutes from the meetings reveal.
For reasons that Reuters was unable to determine, these recommendations were ignored.

“VERY ANGRY”
The DOH purchased 3 million doses of Dengvaxia in one lot, enough for the required three vaccinations for each child in the proposed immunization program and paid 1,000 pesos per dose, a copy of the purchase order reviewed by Reuters shows.
It did conduct a “limited baseline study” in late February and March 2016, but the survey looked at “common illnesses” rather than the prevalence of dengue, according to guidelines issued by Garin’s office at the time and reviewed by Reuters.
Garin, who was part of the government of former president Benigno Aquino and replaced when President Rodrigo Duterte took power in June, 2016, did not respond to requests for comment on why she ignored the local experts’ recommendations.
A physician, Garin has defended her conduct and a program that she said was “implemented in accordance with WHO guidance and recommendations”.
“I understand the concern,” she told Philippine TV station ABS-CBN on Friday. “Even us, we’re also very angry when we learned about Sanofi’s announcement about severe dengue. I‘m also a mother. My child was also vaccinated. I was also vaccinated.”
DOH spokesman Lyndon Lee Suy also did not respond to text messages or questions emailed to him.
Sanofi Philippines declined comment on the Philippines government decision. However, Dr. Su-Peing Ng, Global Medical Head of Sanofi Pasteur, told Reuters: “We communicated all known benefits and risks of the vaccine to the Philippines government.”…

Emergencies

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 December 2017 [GPEI]
:: In Pakistan, the polio eradication programme and the routine immunization programme are working hand in hand to increase vaccination coverage in urban areas.
:: Pakistan and Afghanistan are implementing sub-national rounds during the second half of December; the rounds are synchronized to ensure that all the high risk mobile populations are efficiently reached with polio vaccine.
:: Summary of newly-reported viruses this week:
Afghanistan:  Two new WPV1 positive environmental samples reported, both collected from Nangarhar province.
Pakistan: One new case of wild poliovirus type 1 (WPV1) reported in Sindh province, Pakistan. This follows the advance notification of the case last week. Two new WPV1 positive environmental samples reported, one from Sindh province, and one from Balochistan province. Syria: Four new circulating vaccine derived poliovirus type 2 (cVDPV2) cases reported, all from Deir Ez-Zor governorate.

::::::
 
Editor’s Note:
It continues to be unclear why the weekly GPEI report on new cases at country level [above] does not capture cases in Syria [below].
 
Syria cVDPV2 outbreak situation report 26, 12 December 2017
Situation update 12 December 2017
:: Four new cases of circulating vaccine-derived poliovirus (cVDPV2) were reported this week. Three cases were reported from Mayadeen district, one case from Boukamal district, Deir Ez-Zor governorate. The most recent case (by date of onset) is 21 September 2017 from Boukamal district.
:: The total number of confirmed cVDPV2 cases is 74.
:: Global Polio Eradication Initiative (GPEI) partners continue to support the Syrian Ministry of Health with planning for the second phase of the outbreak response.
:: A new environmental surveillance laboratory has been successfully established in Damascus this week. WHO has led the training of surveillance officers and staff from the Ministry of Health and Ministry of Water Resources.

::::::
::::::

WHO Grade 3 Emergencies  [to 16 December 2017]
The Syrian Arab Republic
:: Saving the lives of Syrian mothers and children
13 December 2017, Damascus, Syrian Arab Republic — Through a donation from the Government of Spain, WHO is providing medicines to support health services in 7 governorates in the Syrian Arab Republic. WHO has provided anti-D immunoglobulin injections and other medicines, including anesthetics, to health facilities in 7 governorates in Syria through a generous donation from the Government of Spain. The grant provided sufficient medicines for more than 4500 treatments
:: Syria cVDPV2 outbreak situation report 26, 12 December 2017
[See Polio above for detail]

::::::
 
WHO Grade 2 Emergencies  [to 16 December 2017]
Myanmar 
:: Bangladesh moves to protect Rohingya children from diphtheria 12 December 2017
[See joint announcement below]

::::::

Bangladesh moves to protect Rohingya children from diphtheria
COX’S BAZAR, Bangladesh, 12 December 2017 – The Government of Bangladesh, with the support of UNICEF, the World Health Organization and GAVI, the Vaccine Alliance, today launched  a vaccination campaign against diphtheria and other preventable diseases for all Rohingya children aged 6 weeks to 6 years living in 12 camps and temporary settlements near the Myanmar border.
Accelerated immunization will cover nearly 255 000 children in Ukhiya and Teknaf sub-districts in Cox’s Bazar, while the Government and health partners continue to increase support for diphtheria treatment and prevention….

::::::

South Sudan implements the second round of Oral Cholera Vaccination to enhance outbreak response efforts in high risk locations
Juba, 14 December 2017:  Cholera in South Sudan remains an important public health problem which has affected 21 571 people and resulted in 462 deaths since the onset of the outbreak on 18 June 2016. This has been the longest and largest outbreak in magnitude and geographical extent, its impact exacerbated by the protracted crisis, insecurity, displacements and declining access to safe drinking water and sanitation. Access to improved sanitation facilities across South Sudan remains at less than 10% while access to safe drinking water from improved water sources is estimated at 60%.
As part of the ongoing cholera response, the Ministry of Health of South Sudan with support from WHO and partners has deployed cholera vaccines to complement traditional cholera response strategies in several high-risk populations and locations. From the 2,178,177 doses secured by WHO in 2017, a total of 1,133,579 doses have already been deployed with 879,239 doses used during the first round and 254,340 doses utilized in second round campaigns in 16 cholera-affected and high-risk populations countrywide.
“When used alongside other interventions for improving access to safe water and sanitation, oral cholera vaccines are very effective for cholera prevention and control, giving protection to those at risk, especially when the recommended two doses are administered,” emphasized Dr Pinyi, Director General for Preventive Services at the Ministry of Health of South Sudan.
The most recent consignment of 737,819 doses, requested by WHO from the Global Task Force on Cholera Control (GTFCC) stockpile was in Juba by 11 December, 2017. The vaccines have been deployed to areas and counties with pending second round vaccination campaigns and these include Kapoeta South, Kapoeta East, Tonj East, Aburoc and Malakal Town…

::::::
::::::
 
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
:: 14 Dec 2017  Health Cluster Weekly Situation Report: Whole of Syria, Week 50 (8 – 15 December 2017)

Yemen 
:: 11 Dec 2017  Statement by the Humanitarian Coordinator for Yemen, Jamie McGoldrick, Calling on Parties to Facilitate Unimpeded Aid Delivery [EN/AR]
:: Yemen: Escalation of armed clashes and airstrikes in Sana’a City – Flash Update 2 | 7 December 2017

Iraq   
:: Iraq: Humanitarian Bulletin, November 2017 | Issued on 8 December
 
::::::

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.
ROHINGYA CRISIS
:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar – 14 December 2017

Ethiopia   
:: 12 Dec 2017  Ethiopia Humanitarian Bulletin Issue 42 | 27 Nov – 10 Dec 2017
HIGHLIGHTS
…Ethiopia launched Comprehensive Refugee Response Framework in line with pledges made at Leaders’ Summit on Refugees in September 2016.
…30,000 refugees to benefit from employment opportunities under the “Ethiopian Jobs Compact”.
…Government to phase out encampment policy over 10 years and advance out-of-camp and local integration options.

Nigeria    
:: Fact Sheet NE Nigeria: Bama, Bama LGA (as of 12 December 2017)
:: UN allocates $13.4 million to support 1 million people with life-saving aid in North-East Nigeria
(Abuja, 11 December 2017): The United Nations, through the Nigeria Humanitarian Fund, has allocated $13.4 million to help thousands of children, women and men in need of urgent humanitarian assistance in crisis-hit north-east Nigeria.
The humanitarian emergency in the northeastern Nigeria is one of the most severe in the world today, with 8.5 million people in need of life-saving aid in 2017 in the worst-affected states of Borno, Adamawa and Yobe.
The Nigeria Humanitarian Fund (NHF) allocation will help address this devastating situation by financing 24 projects in the sectors of protection, nutrition, water and sanitation, health, education, shelter and non-food items, rapid response and early recovery, targeting a total of 950,000 people…