Milestones :: Perspectives :: Diphtheria vaccination campaign for 2.7 million children concludes in Yemen

Milestones :: Perspectives

Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
SANA’A, YEMEN, 16 March 2018 — The World Health Organization (WHO), UNICEF and national health authorities have completed a large-scale vaccination campaign to control the spread of diphtheria in Yemen.

The campaign targeted nearly 2.7 million children aged 6 weeks to 15 years in 11 governorates. It focused on locations reporting suspected cases of diphtheria and areas at high risk of spread of the infectious respiratory disease. More than 6000 health workers were mobilized during the campaign, including for community engagement and the administration of the vaccine.
First reported in October 2017, the outbreak has spread rapidly across the country, infecting more than 1300 people and killing over 70. Almost 80% of the caseload is children and young adults below 25 years of age.

“We are in a race against time to control this outbreak and save lives,” says Dr Nevio Zagaria, WHO Representative to Yemen. “The almost collapsed health system and the conflict has severely hampered the response, but we have managed to deliver urgently needed antibiotics and diphtheria anti-toxins (DAT) to support treatment, and are now scaling up vaccination efforts to stop the outbreak from spreading even further.”

The rapid spread of diphtheria in Yemen highlights major gaps in routine vaccination coverage in recent years and signifies a collapsing health system. Only 50% of all health facilities are partially or fully functioning.

In November and December 2017, WHO and UNICEF vaccinated almost 450,000 children under 7 years of age against diphtheria in Ibb – the worst affected governorate accounting for nearly 35% of all cases reported.

The vaccination campaign is part of a larger response plan to control diphtheria implemented by national health authorities, UNICEF and WHO. Parallel activities include strengthening surveillance and case detection, enhancing laboratory testing capacity, procuring and distributing the DAT to the Diphtheria Isolation Units in health facilities, and training and deploying Rapid Response Teams to trace contacts and provide preventative antibiotics in the community. Health education and awareness campaigns are also being conducted to inform communities on how to protect themselves against diphtheria and other infectious diseases…

Milestones :: Perspectives :: PAHO urges countries to vaccinate against measles to maintain its elimination in the Americas

Milestones :: Perspectives

PAHO urges countries to vaccinate against measles to maintain its elimination in the Americas
Maintaining high and homogeneous immunization coverage, strengthening surveillance and quickly responding to suspected cases are some of the suggested measures to maintain measles elimination in the Americas
Washington, DC, 16 March 2018 (PAHO/WHO)-  The Pan American Health Organization/World Health Organization (PAHO/WHO) warned that in the face of ongoing measles outbreaks in the Americas, countries should redouble efforts to vaccinate their populations, strengthen surveillance to detect possible patients, and implement measures to quickly respond to any suspected cases, according to an epidemiological update released today.
Measles was declared eliminated from the Americas in 2016, following the declaration of rubella and CRS elimination in 2015. The Region was the first in the world to have eliminated all three diseases, culminating a 22-year effort involving mass vaccination against measles, mumps, and rubella throughout the Americas. However, the highly contagious nature of the measles virus and the fact that both it and the rubella virus continue to circulate in the rest of the world mean that the Region is at risk of outbreaks.
In the first months of 2018, there were night countries in the Region reporting confirmed cases: Antigua and Barbuda (1 case), Brazil (14 cases), Canada (4 cases), Guatemala (1 case), Mexico (4 cases), Peru (2 cases), the United States (13 cases), and Venezuela (886 cases in total, 159 cases in 2018), according to the epidemiological update

Milestones :: Perspectives :: Delhi TB Summit: WHO South-East Asia countries commit to intensified efforts, concrete progress to End TB

Milestones :: Perspectives

Delhi TB Summit: WHO South-East Asia countries commit to intensified efforts, concrete progress to End TB
New Delhi, 14 March 2018: Tracking progress to eliminate tuberculosis, Member countries of WHO South-East Asia Region today committed to further intensifying efforts to ensure rapid and concrete progress to End TB by 2030.

In a statement adopted at the Delhi End TB Summit here, member countries unanimously agreed to actualizing and intensifying essential actions agreed to in the Delhi Call to Action which was adopted in March last year to accelerate efforts to End TB in the Region, host to one fourth of the global population but a disproportionate 46% of the global TB burden.

“Progress against TB in this Region will have a major impact on the progress globally,” said Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “Too much is at stake, we cannot afford to fail. We must remember that the war against TB will be won in communities. It will be won by nurses, doctors, community health workers and others at the frontlines. We must give them the resources they need to find every last person with TB, to diagnose them, to treat them, and to cure them,” he said.

Welcoming the statement, Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, said, “it gives shape to our momentum and aspirations, and does so by setting out a series of strategic priorities which include establishing strong leadership of TB programmes at the national level; increasing budgetary and human resource allocations to TB programmes from domestic and global sources; enabling each and every TB patient to access the best possible care available; and supplementing medical care for TB with social and financial protection.”

Reviewing efforts being made to end TB since the adoption of the Delhi Call for Action on 16 March 2017, Member countries noted that though efforts have been strengthened with increased attention, investments and initiatives; the stepped-up response was falling short of what was required to reach the critical thresholds for ending TB.

The Member countries of the Region stressed their firm intent to collectively reach out to 2 million missing TB cases and 150 000 multidrug-resistance cases by 2020 and implement a response that is demonstrably adequate for ending TB.

In the statement, the countries committed to multisectoral and empowered national initiatives, reporting to the highest levels of government, to lead the TB programme…

The Summit sets the stage for the September 2018 United Nations High-Level Meeting on TB. For the first time TB will be discussed in the UN General Assembly at the Heads of State level. The UN high-level meeting is expected to endorse an ambitious set of goals to put the world on course to ending TB.

Perspective: Vaccinating Against Poverty


Vaccinating Against Poverty
Project Syndicate | 12 March 2018
By Seth Berkley
A new study shows that developing countries could reduce poverty by targeting higher vaccination rates in poorer and more marginalized communities. Moreover, by making affordable, quality health care available to everyone, regardless of their income, immunization programs are an important step toward universal health-care coverage.
For most people, the choice between a life-threatening disease and a lifetime of crippling debt is no choice at all. Yet every year, hundreds of millions of people around the world are forced to make it, owing to the prohibitive cost of medical treatment. And, paradoxically, the hardest-hit people are not those with the largest medical bills, but rather those living in the poorest parts of the world.
Although countries like the United States have notoriously high treatment costs, with medical debt being one of the leading causes of personal bankruptcy, people living in poor countries actually spend more on health care costs relative to their income. And, because medical insurance is unavailable or too expensive, and because bankruptcy protection is not usually an option, too often they and their families end up being pushed into poverty.
But this tragedy – befalling some of the world’s most vulnerable people – could in many cases be entirely avoided. A new study, published in February in the journal Health Affairs, suggests that there is another option: in many cases, the medical bills can be preempted by prevention, through the widespread and affordable use of vaccines:.

Perspective: The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries

Health Affairs
Vol. 37, No. 2: February 2018

Diffusion Of Innovation
The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries
Angela Y. Chang1, Carlos Riumallo-Herl2, Nicole A. Perales3, Samantha Clark4, Andrew Clark5,
Dagna Constenla6, Tini Garske7, Michael L. Jackson8, Kévin Jean9, Mark Jit10, Edward O. Jones11, Xi Li12, Chutima Suraratdecha13, Olivia Bullock14, Hope Johnson15, Logan Brenzel16, and Stéphane Verguet17
PUBLISHED: February 2018
Open Access
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs’ total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.

Perspective: Working together for the health and welfare of humankind


Working together for the health and welfare of humankind
Joint Statement of INCB, UNODC and WHO in Implementation of the UNGASS 2016 Recommendations
12 March 2018 – 61st session of the Commission on Narcotic Drugs

  1. We, the Heads of the International Narcotics Control Board, the United Nations Office on Drugs and Crime and the World Health Organization are committed to support our Member States to effectively address and counter the world drug problem.

We agree that if we are to achieve the 2030 Sustainable Development Goals, including its health targets, we need to vigorously address the world drug problem with a greater focus on the health and well-being of people. We need a balanced, comprehensive and multidisciplinary approach that puts people at the centre of the response and in particular those who are the most vulnerable.

This is in line with the objectives of the three international drug control conventions, to which we are committed. This is also aimed at facilitating implementation of the outcome document of the 30th Special Session of the General Assembly, entitled “Our joint commitment to effectively addressing and countering the world drug problem”. It is also consistent with the aim to achieve universal health coverage, where all people receive the health services they need, including people who use drugs and their families.

Our three entities complement one another, given the different roles they play and the mandates entrusted to them. By working together, we can “deliver as one” to serve people, communities and countries as a whole. We are committed to strengthen this collaboration, to advocate and to promote quality programmes and policies that improve public health and support high-impact actions that leave no one behind, are driven by science, and champion equity and human rights.

We recognize the challenges that lie ahead, but also the opportunities that we should embrace. We reaffirm our support for the full implementation of the outcome document of UNGASS 2016 and we also recognize that the world is a rapidly changing place and that urgent action is required to address emerging threats.

We will focus our joint efforts on addressing the following priorities:
:: improving equitable access to controlled medicines in particular for the management of pain and for palliative care;
:: scaling up effective prevention of non-medical drug use, and treatment services and interventions for drug use disorders;
:: confronting the ‘opioid crisis’ that is devastating so many communities;
:: intensifying delivery to people who use drugs of a comprehensive set of effective and scientific evidence-based measures aimed at minimizing the adverse public health and social consequences of drug abuse laid out in the technical guide issued by WHO, UNODC and UNAIDS 1, towards eliminating AIDS, tuberculosis and viral hepatitis epidemics;

  1. We therefore will work to proactively support countries:

:: to implement public health and social welfare measures as key elements of our response to the world drug problem;
:: to enhance information-sharing and early warning mechanisms in support of a scientific evidence-based review of the most prevalent, persistent and harmful new psychoactive substances and precursors to facilitate informed scheduling decisions by the Commission on Narcotic Drugs;
:: to ensure and improve access to and quality of:
…internationally controlled medicines including to manage pain and for palliative care while preventing their misuse;
…evidence-based prevention of drug use, and treatment services for drug use disorders with special focus on youth, families and communities;
…comprehensive services to prevent, diagnose and treat viral hepatitis, HIV and tuberculosis infections among people who use drugs.
:: to help monitor the progress in addressing the world drug problem and implementation of the UNGASS 2016 operational recommendations.

  1. We stress the importance of Member States taking action to:

:: strengthen their public health systems and their national coordination efforts to address the drug problem and dedicate appropriate resources and capacity for the successful implementation of their comprehensive drug-related policies;
:: advance universal health coverage efforts, by taking action to improve access to controlled medicines and effective and ethical prevention of drug use, and treatment services for people with drug use disorders and associated health conditions, including HIV, viral hepatitis and tuberculosis;
: facilitate information exchange and share the relevant data and information with our three entities to enable us to perform our respective treaty-based core functions; and
:: enhance political support and adequate resources to enable our three entities to deliver on these commitments and advance the achievement of the UN 2030 Agenda for Sustainable Development.




Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 March 2018 [GPEI]
::  New on For International Women’s Day, we highlighted the critical role that women play in global polio eradication efforts. Dr Adele Daleke Lisi Aluma works to reach children who have never been vaccinated, whilst in Somalia, women are the face of polio eradication. In Nigeria, dedicated female mobilizers are ending polio, one home at a time.
::  We also launched the Gender and Polio section of our website.
:: The Strategic Advisory Group of Experts on immunization (SAGE) Polio Working Group recently met in Geneva, Switzerland, to review global progress against polio. The group reviewed and endorsed the main elements of the Post-Eradication Strategy (PCS) currently being developed at the request of Member States, aimed at ensuring the availability of core functions to sustain a polio-free world after global certification (such as outbreak response capacity, surveillance, immunization and containment).  The PCS will be presented in April to the full SAGE, and to Member States at the World Health Assembly (WHA) in May. The group also reviewed current outbreak response protocols to vaccine-derived poliovirus, and agreed with a proposed plan to harmonize recommendations on immunization schedules in countries with Polio Essential Facilities (PEFs – facilities that will continue to handle poliovirus stock under appropriate containment).
Summary of newly-reported viruses this week:
Afghanistan: Advance notifications have been received of two new cases of wild poliovirus type 1 (WPV1), one occurring in Kunar province, and one in Kandahar province. Three new wild poliovirus type 1 (WPV1) positive environmental samples have been reported in Nangarhar province.
Pakistan: One new WPV1 positive environmental sample has been reported in Balochistan province.
Democratic Republic of the Congo: Two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, one from Tanganyika province, and one from Haut Lomami province.

WHO Grade 3 Emergencies  [to 17 March 2018]
:: Seven years of Syria’s health tragedy
News release       14 March 2018 | Geneva – After seven years of conflict in Syria, WHO has renewed its call for the protection of health workers and for immediate access to besieged populations.
Attacks on the health sector have continued at an alarming level in the past year. The 67 verified attacks on health facilities, workers, and infrastructure recorded during the first two months of 2018 amount to more than 50% of verified attacks in all of 2017.
“This health tragedy must come to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Every attack shatters communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.”…

:: Diphtheria vaccination campaign for 2.7 million children concludes in Yemen
SANA’A, YEMEN, 16 March 2018
[See Milestones/Perspectives above for more detail]

WHO Grade 2 Emergencies  [to 17 March 2018]
Bangladesh/Myanmar: Rakhine Conflict 2017 
:: Weekly Situation Report #17 – 13 March 2018
… The third round of 13-day Diptheria campaign has started on 10 March. By day 3, 86 497 (21%) children aged 6 weeks to 15 years have been vaccinated in Ukhiya and Teknaf Upazilas. 1479 humanitarian workers have also received Td vaccine at session sites during campaign days.
… A fixed site at Cox’s Bazar has started vaccinating humanitarian workers and will continue every Saturday henceforth.
… Routine EPI training was conducted in Teknaf and Ukhiya to reorient 270 vaccinators, supervisors, medical officers, and volunteers from Government and various NGOs who would be supporting EPI session sites in camps.
… Microplans for routine EPI in Rohingya refugee settings have been developed and EPI services at fixed sites are ongoing…

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. 
:: UN Humanitarian Chief and Dutch Minister call for urgent international support to meet spiralling humanitarian needs in DR Congo
(Kinshasa, 13 March 2018) UN humanitarian chief Mark Lowcock and Minister for Foreign Trade and Development Cooperation of the Kingdom of the Netherlands, Sigrid Kaag, today called on the international community to urgently address the crisis facing the Democratic Republic of the Congo (DRC) where humanitarian needs have doubled since last year.
More than 13 million people in DRC need humanitarian assistance and 4.5 million have been forced to flee their homes as a result of fighting. More than 4.6 million Congolese children are acutely malnourished, including 2.2 million cases of severe acute malnutrition. Epidemics are spreading, including the worst outbreak of cholera in 15 years.

Syrian Arab Republic
:: 16 Mar 2018   Update on the situation of children in Afrin and Eastern Ghouta

:: 13 Mar 2018  Yemen Humanitarian Update Covering 05 March – 11 March | Issue 6

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.
:: Ethiopia: Government and partners launch the humanitarian and disaster resilience plan (HDRP) for 2018  13 Mar 2018
US$1.66 billion urgently needed to address food and non-food needs for 7.88 million people
(Addis Ababa, 13 March 2018): The Government of Ethiopia and humanitarian partners today launched the Ethiopia Humanitarian and Disaster Resilience Plan (HDRP) for 2018. The HDRP seeks US$1.66 billion to reach 7.88 million people with emergency food or cash and non-food assistance, mainly in the southern and south-eastern parts of the country. “In the last two years, the Government of Ethiopia, with the support of international donors and humanitarian partners, was able to mount a robust drought response operation. Today, we need that partnership once again as continuing drought, flooding and conflict-related displacement has left 7.88 million vulnerable people in need of urgent assistance”, says Mr. Mitiku Kassa, Commissioner of the National Disaster Risk Management Commission (NDRMC). “The Government of Ethiopia has committed $138 million for drought response and rehabilitation of IDPs,” added the Commissioner…
:: UN allocates $9 million to support life-saving aid in north-east Nigeria
(Abuja, 15 March 2018): The United Nations, through the Nigeria Humanitarian Fund, has allocated US$9 million to provide life-saving aid to some 60,000 children, women and men recently displaced by ongoing hostilities in Borno State, including $2 million in support of the UN Humanitarian Air Service for frontline responders in north-east Nigeria.
The humanitarian crisis in the region remains one of the most severe in the world today, with at least 7.7 million people in need of humanitarian assistance in 2018 in the worst-affected states of Borno, Adamawa and Yobe states. About 80 per cent of them, 6.1 million, are targeted for humanitarian assistance…
Rohinga Refugee Crisis 
:: Joint Response Plan for the Rohingya crisis requests US$951M to provide life-saving assistance to 1.3M people
16 March 2018
A new Joint Response Plan for the Rohingya humanitarian crisis has been launched today in Geneva. It requests US$951 million to provide life-saving assistance to 1.3 million people, including Rohingya refugees who fled Myanmar to Bangladesh and local host communities.
The priority needs in the plan, which covers the March-December 2018 timeframe, include food, water and sanitation, shelter, and medical care…
:: ISCG Situation Report: Rohingya Refugee Crisis, Cox’s Bazar | 11 March 2018

:: Donors agree measures to prevent famine in Somalia in 2018   06 Mar 2018
In support of The Federal Government of Somalia, the United Kingdom and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) convened an event in London on 6 March 2018 to draw urgent attention to the humanitarian crisis in Somalia and the need for a swift and substantial response…The event was attended by 31 Member States, UN Agencies, international organizations and non-governmental organizations committed to ensuring support for the humanitarian situation in Somalia for 2018…
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 17 March 2018]
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – Oman  15 March 2018
Yellow Fever  [to 17 March 2018]
:: Yellow fever – Brazil  9 March 2018
…WHO risk assessment
The exponential increase in human cases and epizootics during January and February 2018, as indicated in Figure 1, is concerning due to the persistence of high viral circulation in at-risk areas and the spread to new areas, particularly near urban areas of large cities, such as São Paulo and Rio de Janeiro, and in municipalities that were previously not considered at-risk for Yellow fever.

The preliminary results of the mass vaccination campaign in São Paulo and Rio de Janeiro states indicate low vaccination coverage which suggests a significant number of persons remain at-risk and the necessity to intensify risk communications among high-risk groups.

Despite the significant efforts made to vaccinate large portion of the population, the increasing number of human cases and the persistence and geographical spread of epizootics among non-human primates illustrate the potential risk of further spread to new areas within Brazil that were not previously considered as at risk and where therefore yellow fever immunization coverage is low. The seasonality need also to be taken in to account as the outbreak is occurring the period of the year the most favourable for sylvatic yellow fever transmission.

The increasing occurrence of confirmed yellow fever infection also shows the potential of international spread. Although to date most imported cases have been reported in countries where the vector is absent (or absent during winter). These reports illustrate the importance of maintaining high levels of awareness especially for international travellers from areas with favourable ecosystem for yellow fever transmission.

To date, yellow fever transmission by Aedes aegypti has not been documented. The sylvatic yellow fever virus is transmitted to monkeys by forest dwelling mosquitoes such as Haemagogus and Sabethes spp. Humans who are exposed to these mosquitoes can become infected if they are not vaccinated. In entomological studies conducted during the 2016/2017 outbreak in some of the affected states, isolated Haemagogus mosquitoes were found to be positive for yellow fever indicating predominantly sylvatic transmission. More recently, an investigation conducted by the Evandro Chagas Institute reported by the Brazil Ministry of Health revealed the detection of yellow fever virus in Aedes albopictus mosquitoes captured in rural areas of two municipalities in Minas Gerais (Ituêta and Alvarenga) in 2017. The significance of this finding requires further investigation. The last documented outbreak of urban yellow fever in Brazil was recorded in 1942.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information.

WHO advice
WHO encourage Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination, and to inform them of the designated specific yellow fever vaccination centres within their territories, in accordance with Annex 7 of the International Health Regulations (2005). Travellers should also be made aware of yellow fever symptoms and signs and instructed to seek rapidly medical advice when presenting signs. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

Yellow fever can easily be prevented through vaccination. A single dose of WHO approved yellow fever vaccines, administered at least 10 days before travel, is sufficient to confer sustained immunity and life-long protection against the disease, and a booster dose of the vaccine is not needed.

WHO recommends vaccination of international travellers going to Brazil. The updated areas at risk for yellow fever transmission and the related recommendations for vaccination of international travellers were updated by WHO on 16 January 2018; the map of revised areas at risk and yellow fever vaccination recommendations is available on the WHO ITH website: Yellow fever vaccination recommendations in the Americas, 2018

WHO does not recommend that any general travel or trade restriction be applied on Brazil based on the information available for this event.
[See also: CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil – Media Statement
Friday, March 16, 2018]