Vaccines and Global Health: The Week in Review 27 January 2018

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

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_27 Jan 2018

– 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


Milestones :: Perspectives

Milestones :: Perspectives

 142nd session of the WHO Executive Board
19 January 2018 – Next week the WHO Executive Board will set the agenda for the World Health Assembly, and determine how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on 22–27 January 2018 in Geneva, Switzerland, and will be webcast live.
:: Provisional agenda
:: All documentation
[Selected Documentation]
Decisions [interim report]
In an effort to respond to Member States’ needs, the present texts have been made available as quickly as possible. The definitive versions of the resolutions and decisions adopted, edited for the Official Records, will be made available in due course.

EB142(1) – Implementation of International Health Regulations (2005): draft five-year global strategic plan to improve public health preparedness and response, 2018–2023

EB142(2) – Polio transition planning

EB142(3) – Addressing the global shortage of, and access to, medicines and vaccines

EB142(4) – Global strategy and plan of action on public health, innovation and intellectual property

EB142(5) – Health, environment and climate change

EB142(6) – Maternal, infant and young child nutrition

EB142(7) – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits

EB142(8) – Evaluation of the election of the Director-General of the World Health Organization

EB142(9) – Engagement with non-State actors
Dr Carissa Etienne elected for a second term as WHO Regional Director for the Americas
WHO | 23 January 2018
The WHO Executive Board, currently holding its 142nd session in Geneva, has appointed Dr Carissa Etienne for a second term as WHO Regional Director for Americas….
“My vision for the Americas is of a society free from inequality where everyone, particularly the most vulnerable and disadvantaged people, can lead healthy, meaningful and productive lives,” said Dr Etienne. “One of my top priorities is ensuring that everyone has access to quality health services without fear of being impoverished.”
Under her leadership, during these past five years PAHO led preparedness and response efforts to the regional Zika and chikungunya epidemics as well as to yellow fever outbreaks in Brazil. The Americas became the first WHO Region to eliminate the endemic transmission of measles, rubella and congenital rubella syndrome…

Dengvaxia Update

Dengvaxia Update
We continue to monitor developments associated with Dengvaxia. We did not identify any new press releases or statements on the Sanofi website.
Sanofi agrees to pay for proven Dengvaxia adverse events in the Philippines
by Eric Sagonowsky | Fierce Pharma
Jan 23, 2018 11:41am
Sanofi had already agreed to refund the Philippines for unused Dengvaxia shots as part of an ongoing safety controversy there. Now an executive has told legislators the company will “shoulder the cost” of any adverse events that are scientifically linked to vaccination.

Speaking at a Senate hearing on Monday, Sanofi Pasteur Asia-Pacific head Thomas Triomphe said that “should there be any case related to vaccination, death or any other case, we will shoulder the cost, if there is a causality that has been demonstrated through scientific evidence,” according to The Inquirer.

The testimony came as a safety controversy for the vaccine intensified over the last week, with reports that preliminary autopsy results showed a common cause of death among children who died after vaccination, though experts said no causal link was found. At the same hearing, an expert panel from the Philippine General Hospital reported that there was “no evidence linking Dengvaxia to any deaths,” a Sanofi spokesperson told FiercePharma on Monday.

“This finding is consistent with the fact that Sanofi Pasteur has not had any reports of deaths due to vaccination in any of the clinical studies of the vaccine involving over 40,000 people nor in the public or private use of Dengvaxia where over 1 million dose of the vaccine have been administered in several endemic countries,” the spokesperson added…


The Lancet Infectious Diseases
February 2018
The dengue vaccine dilemma 
Dengue is the most common mosquito-transmitted viral infectious disease. A 2016 study estimated nearly 60 million symptomatic dengue cases worldwide every year (estimates including asymptomatic cases are at least six times higher), resulting in about 10,000 deaths. 4 billion people are at-risk in 128 countries where aedes mosquito vectors are present. Efforts to develop a vaccine against dengue have been ongoing for decades. The first such vaccine to be used routinely is CYD-TDV (marketed as Dengvaxia), a live, attenuated tetravalent product developed by Sanofi Pasteur. Following two phase 3 clinical trials published in 2014, Dengvaxia was licenced in December, 2015, and approved in 19 countries. Subsequently, regional mass vaccination programmes were launched in the Philippines and Brazil, targeting 1 million people.

However, after reassessment of data from the clinical trials, Sanofi warned on Nov 29, 2017, that the vaccine can increase the risk of severe dengue in particular circumstances. The vaccination programme in the Philippines has been suspended, with information released to WHO by Sanofi raising questions about future use of Dengvaxia.

How any vaccine against dengue is used is complicated by the fact that virus occurs in four serotypes, and immunity against any one serotype does not generate lasting immunity against the other three, hence the need for a tetravalent vaccine. Furthermore, being infected with—and developing immunity to—one viral serotype seems to be the trigger that can lead to a patient having more severe disease manifestations when subsequently infected with a different serotype, a phenomenon known as antibody-dependent enhancement. Infections with the third and fourth serotypes, if they occur, usually result in milder disease.

Expert opinion and a position paper on Dengvaxia were issued by WHO in 2016. When licenced, the vaccine was approved for people aged 9–45 years, in which group the phase 3 trials at 2 years of follow-up showed a reduction in severe dengue of 93% and of hospital admissions due to dengue of 82%. The vaccine was not approved in younger children because of less favourable efficacy and safety; in particular, an increase in hospital admissions due to dengue among those aged 2–5 years. This finding, which might have been an effect of age or because of more dengue-unexposed (ie, seronegative) individuals in the younger age group, could not then be explained since serostatus before immunisation was unknown for most trial participants. However, some experts warned in 2016 that the increased risk of hospital admission was a serious safety concern, including Maíra Aguiar and colleagues in this journal, a point emphasised by Aguiar and Nico Stollenwerk in their Correspondence published online on Dec 21, 2017.

Sanofi’s statement in November came about because—prompted by WHO—the company developed an assay to estimate dengue serostatus before vaccination in trial participants. A supplemental statement from WHO on Dec 22, 2017, verifies that overall Dengvaxia reduces the risk of confirmed severe dengue and hospital admissions. Vaccine recipients presumed to be seropositive at immunisation had sustained protection during 5 years’ follow-up. However, among recipients seronegative before immunisation—and regardless of age at vaccination—there was a higher risk of severe dengue disease and hospital admission compared with unvaccinated controls. Thus, in seronegative individuals, the vaccine seems to enhance the severity of subsequent dengue infection.

Where then do these findings leave the status of Dengvaxia and other candidate vaccines against dengue? The Dec 22 WHO statement notes that in settings of high dengue seroprevalence, the vaccine is likely still beneficial at a population level. However, Aguiar and Stollenwerk state that “ethically no one should have been put under risk by receiving this vaccine”. Age was clearly used as a proxy for seropositive status in the original recommendations, a position that is no longer tenable. Indeed, the new WHO recommendation is for vaccination only in individuals with proven past dengue infection. But no point-of-care test for dengue serostatus exists. In a phase 2 trial of the Takeda TDV tetravalent dengue vaccine published in this issue, serostatus at the time of vaccination was measured, but follow-up is too short to detect risks associated with being seronegative. Phase 3 trials of the Takeda vaccine and another from the Instituto Butantan, Brazil, whose primary completion dates are later this year, might provide more answers. A new position paper from WHO is also expected later this year. In the meantime, a rapid assay of dengue serostatus is surely a priority.

The influence of political ideology and trust on willingness to vaccinate

Featured Journal Content

PLoS One
[Accessed 27 January 2018]

Research Article
The influence of political ideology and trust on willingness to vaccinate
Bert Baumgaertner, Juliet E. Carlisle, Florian Justwan
Research Article | published 25 Jan 2018 PLOS ONE
In light of the increasing refusal of some parents to vaccinate children, public health strategies have focused on increasing knowledge and awareness based on a “knowledge-deficit” approach. However, decisions about vaccination are based on more than mere knowledge of risks, costs, and benefits. Individual decision making about vaccinating involves many other factors including those related to emotion, culture, religion, and socio-political context. In this paper, we use a nationally representative internet survey in the U.S. to investigate socio-political characteristics to assess attitudes about vaccination. In particular, we consider how political ideology and trust affect opinions about vaccinations for flu, pertussis, and measles. Our findings demonstrate that ideology has a direct effect on vaccine attitudes. In particular, conservative respondents are less likely to express pro-vaccination beliefs than other individuals. Furthermore, ideology also has an indirect effect on immunization propensity. The ideology variable predicts an indicator capturing trust in government medical experts, which in turn helps to explain individual-level variation with regards to attitudes about vaccine choice.



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 24 January 2018 [GPEI]
:: New on In one of the final strongholds of the poliovirus, vaccination coverage is improving thanks to the women working to access children.
:: In Pakistan, we documented some of the high-risk mobile children that must be visited by vaccinators during the low transmission season.
::  By expanding environmental surveillance, Afghanistan hopes to track the movement of poliovirus with more accuracy than ever before.

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

Syria cVDPV2 outbreak situation report 31, 23 January 2018
Situation update 23 January 2018
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: The first round of the second phase of the outbreak response has been completed in all governorates (Deir Ez-Zor, Homs, Hasakah and Raqqa) with vaccination activities finishing on 21 January.
:: Administrative data has been received from all areas except eastern Deir Ez-Zor.
:: Post-campaign monitoring began 21 January in all governorates.
:: Preparation for the second round (IPV) continues. Global Polio Eradication Initiative (GPEI) partners continue to assist.


WHO Grade 3 Emergencies  [to 27 January 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 31, 23 January 2018
[See Polio above for detail]

:: WHO airlifts 200 tonnes of health supplies to Yemen
SANA’A, 18 January 2018 — The World Health Organization has delivered 200 tonnes of life-saving medicines and health supplies to Yemen. Four United Nations planes carrying the cargo landed in Sana’a Airport this week.
The shipments include essential medicines, insulin vials, antibiotics, rabies vaccines, intravenous (IV) fluids, and other medical supplies and equipment…

Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever  24 January 2018
[See Yellow Fever below for more detail]
WHO Grade 2 Emergencies  [to 27 January 2018]
:: Ukraine’s efforts to stop measles outbreak continue as case total increases
16 January 2018 — Measles continues to spread in Ukraine, with new cases now being reported in all oblasts and Kyiv. These cases are the latest in an expanding outbreak that affected over 3000 people and claimed the lives of 5 children and adults in 2017, according to preliminary data. The latest information from other countries in the WHO European Region also indicates a rise in cases, including large measles outbreaks affecting Greece, Italy and Romania.

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
:: 26 Jan 2018 – Is the world becoming numb to the killing of children? – Statement by Fran Equiza, UNICEF Representative in Syria [EN/AR]

:: Deteriorating humanitarian crisis in DR Congo demands largest ever appeal
(Kinshasa, 18 January 2018) The dramatic deterioration of the humanitarian situation in the Democratic Republic of the Congo in 2017 has forced humanitarian actors to launch an appeal for USD 1.68 billion for 2018, the largest ever funding appeal for the country where 13.1 million people require humanitarian assistance.
The funding is required to urgently assist some 10.5 million Congolese people in 2018. Geographical expansion of the humanitarian needs and worsening situations in existing crisis hotspots all require a step change of the response of the international community to address life-threatening humanitarian and protection needs…

:: 20 Jan 2018  US$ 2.96 billion needed to provide life-saving assistance to 13.1 million people in Yemen in 2018 [EN/AR]

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 | 21 January 2018

:: 23 Jan 2018  Ethiopia Humanitarian Bulletin Issue 45 | 08 – 20 January 2018
…Opening of Gaaluun bridge at Dawa river improves humanitarian access to Dawa zone.
…As part of the national plan to rehabilitate internally displaced persons in Oromia and Somali regions, the Oromia region is settling some 86,000 IDPs in 12 towns across the region.
…An ‘Alert’ released by Government and humanitarian partners estimated up to 7 million people in need of humanitarian assistance in the first half of 2018, requiring some US$895 milliON
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

MERS-CoV [to 27 January 2018]
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia  26 January 2018
Between 9 December 2017 and 17 January 2018, the National IHR Focal Point of The Kingdom of Saudi Arabia reported 20 additional cases of Middle East Respiratory Syndrome (MERS), including eight deaths. In addition, one death from a previously reported case was reported to WHO…
Yellow Fever  [to 27 January 2018]
:: Brazil launches world’s largest campaign with fractional-dose yellow fever vaccine
Brasilia, January 25, 2018 (PAHO) – Brazil today launched a mass immunization campaign that will deliver fractional doses of yellow fever vaccine to residents of 69 municipalities in the states of Rio de Janeiro and São Paulo. The strategic plan for the campaign was developed with support from the Pan American Health Organization (PAHO) and the World Health Organization (WHO). It will be the world’s largest vaccination campaign, to date, using fractional doses of yellow fever vaccine.
Some 23.8 million people are expected to be vaccinated during the campaign, including 10.3 million in the state of São Paulo and 10 million in the state of Rio de Janeiro. The state of Bahia is expected to begin vaccinating on 19 February 2018 with an estimated target population of 3.3 million people to be reached with the vaccine..

:: Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever
24 January 2018, Abuja – The Government of Nigeria will launch a mass vaccination campaign to prevent the spread of yellow fever on Thursday (January 25) with support from the World Health Organization (WHO) and partners. More than 25 million people will be vaccinated throughout 2018, in the largest yellow fever vaccination drive in the country’s history.
The immunization plan is part of efforts to eliminate yellow fever epidemics globally by 2026. The preventive campaign will use vaccines funded by Gavi, the Vaccine Alliance, and will be supported by UNICEF. It will begin on 25 January in Kogi, Kwara and Zamfara states, and then move to Borno state where the campaign will focus on camps for internally displaced persons and surrounding host communities. More than 8.6 million people will be vaccinated in the four states in the coming days.
“The goal of the Yellow Fever Preventive Mass Vaccination Campaign is to reduce yellow fever transmission by achieving 90% coverage in implementing States and Local Government Areas in line with the strategy for the Elimination of Yellow fever Epidemics by 2026,” said Dr Faisal Shuaib, Executive Director of National Primary Healthcare Development Agency…

WHO & Regional Offices [to 27 January 2018]

WHO & Regional Offices [to 27 January 2018]

142nd session of the WHO Executive Board
19 January 2018 – Next week the WHO Executive Board will set the agenda for the World Health Assembly, and determine how to best promote health, keep the world safe, and serve the vulnerable. The session takes place on
22–27 January 2018 in Geneva, Switzerland, and will be webcast live.
:: Provisional agenda
:: All documentation
[See Milestones above for more detail]

World Leprosy Day: ending transmission among children
26 January 2018 – National programmes must boost active case-finding, strengthen surveillance, improve contact-tracing and focus more on early detection of leprosy cases among children to ensure achievement of the global target of zero child infections by 2020. This call comes as the world observers World Leprosy Day on Sunday, 28 January.
Weekly Epidemiological Record, 26 January 2018, vol. 93, 04/05 (pp. 33–44)
:: Meeting of the International Task Force for Disease Eradication, October 2017
:: Fact sheet on tuberculosis (updated January 2018)

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO promotes one-health approach to enhance response to zoonoses in South Sudan
25 January 2018
:: Nigeria set to vaccinate 25 million people, its biggest yellow fever campaign ever – Copy
24 January 2018
:: WHO prioritizes water, sanitation and hygiene (WASH) services in health care facilities to achieve health goals in South Sudan  24 January 2018
:: Government of Uganda confirms outbreak of Crimean-Congo hemorrhagic and Rift Valley fevers  24 January 2018
:: Antimicrobial Consumption Monitoring in Mauritius  23 January 2018
:: Strengthening rational use of Medicines in Tanzania  23 January 2018
:: The United Nations in Zambia, CDC and DFID commend government’s initiative of setting up an efficient cholera treatment hospital and for scaling up preventive interventions in the community 22 January 2018

WHO Region of the Americas PAHO
:: 2017 in review: 10 key public health events in the Americas (12/20/2017)

WHO South-East Asia Region SEARO
:: Nearly half a million children being vaccinated against diphtheria in Cox’s Bazar  14 January 2018
WHO European Region EURO
::  Understanding and addressing the mental health needs of adolescents 26-01-2018
:: Cross-sectoral toolkit to guide Member States along SDG roadmap 25-01-2018

WHO Eastern Mediterranean Region EMRO
:: New tool supports systematic use of research evidence for public health decision-making
Cairo, 25 January 2018 – As a result of collaborative work between WHO and several academic institutions, a tool has been developed to streamline use of qualitative research evidence in public health decision-making. A series of academic papers published in the Implementation Science journal this week provides a scientific tool for assessing how much confidence to place in findings from qualitative evidence syntheses. The tool known as CERQual has been designed to help decision-makers use qualitative evidence for decisions and policies about health care and social welfare
:: WHO responds to humanitarian needs in Tripoli with the support of ECHO  22 January 2018

WHO Western Pacific Region
:: Healthy Islands: South Pacific Tourism Organisation and WHO forge new partnership
SUVA, Fiji, 17 January 2018 – The World Health Organization and the South Pacific Tourism Organisation join forces to promote healthy tourism in the Pacific. Through a new partnership, the organizations commit to promoting the health and well-being of tourists and the tourism workforce by establishing smoke-free public places, increasing access to healthy local food options and physical activities and improving accessibility for persons with disabilities in the tourism sector.

CDC/ACIP [to 27 January 2018]

CDC/ACIP [to 27 January 2018]
Friday, January 26, 2018
CDC Update on Widespread Flu Activity – Transcript
… . It has been a tough flu season so far this year. And while flu activity is beginning to go down in parts of the country, it remains high for most the U.S., with some areas still rising. Most people with influenza are being infected with the H3N2 influenza virus. And in seasons where H3N2 is the main cause of influenza, we see more cases, more visits to the doctor, more hospitalizations, and more deaths, especially among older people. This season now looking like the 2014-15 season where H3N2 predominated. In that season, was categorized as a high severity season..

Thursday, January 25, 2018
More birth defects seen in parts of U.S. with local Zika spread – Press Release
Birth defects most strongly linked to Zika virus infection during pregnancy have increased in parts of the United States that have had local Zika virus transmission, according to a report in CDC’s Morbidity and Mortality Weekly Report (MMWR). Areas with local transmission of Zika – southern Florida, a portion of south Texas, and Puerto Rico – saw a 21 percent increase in births with outcomes most strongly linked to Zika virus in the last half of 2016 compared with births in the first half of that year…
MMWR News Synopsis for January 25, 2018
Population-Based Surveillance of Birth Defects Potentially Related to Zika Virus Infection – 15 States and U.S. Territories
Zika remains a threat to mothers and babies in the United States. Though the relationship between the increase in birth defects in certain areas and local Zika virus transmission has not been confirmed, this increase highlights the critical need for strong and rapid public health surveillance systems to identify babies with birth defects. About 3 out of every 1,000 babies born in 15 U.S. states and territories in 2016 had a birth defect meeting the case definition for birth defects potentially related to Zika virus infection during pregnancy. Areas with local Zika virus transmission in the U.S. had a 21 percent increase in the birth defects most strongly linked to Zika virus infection during pregnancy in the last half of 2016 compared with the first half. It is not known if this increase is due to local transmission of Zika virus alone, or if there are other contributing factors. These findings underscore the importance of surveillance for early identification of birth defects potentially related to Zika virus infection and the need for continued monitoring in areas at risk for Zika.

Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
Vaccination is our best tool to prevent shingles, and Shingrix® is now the preferred shingles vaccine. Every year in the U.S., about 1 million people get shingles – and the vast majority are older than 50. On October 25, 2017, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted that the Shingrix® vaccine is the preferred vaccine to prevent shingles. This new vaccine is more than 90 percent effective, even among the elderly, and maintained high protection during the four years of clinical trials. Previously, Zostavax® had been the only vaccine for seniors to prevent shingles. For adults 60 years and older, Zostavax is about 51 percent effective in preventing shingles. Zostavax is less protective in the elderly and protection wanes over time. Shingrix is now recommended as the preferred vaccine to prevent shingles for adults 50 and older. Eligible adults should get Shingrix even if they previously received Zostavax.