Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 March 2018 [GPEI]
::  New on www.polioeradication.org: In Nigeria, experts from the frontline of polio eradication are supporting the Lassa fever response. Meanwhile, we asked what it takes to vaccinate every child in Afghanistan.

Summary of newly-reported viruses this week:
Afghanistan: Two new cases of wild poliovirus type 1 (WPV1) have been confirmed this week, one occurring in Kunar province, and one in Kandahar province. These cases were advance notification last week.
Pakistan: One new WPV1 positive environmental sample has been reported in Sindh province.
Democratic Republic of the Congo: One new case of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, from Haut Lomami province.
Somalia: An advance notification of one new cVDPV2 positive environmental sample has been received, from Banadir province.

WHO Grade 3 Emergencies  [to 24 March 2018]
The Syrian Arab Republic
:: WHO is providing urgent health services in response to displacements from Afrin
23 March 2018, Cairo, Egypt – The World Health Organization (WHO) has deployed mobile medical clinics and critical health supplies to areas hosting newly displaced people from the northern Syrian district of Afrin, while supporting partners struggling to maintain health services in Afrin city and surrounding areas.
An estimated 167 000 people have been displaced by the recent hostilities in Afrin District in northern Aleppo Governorate. The majority have fled to Tal Refaat, while others are seeking shelter in Nubul, Zahraa and surrounding villages. The massive influx of displaced people is putting a strain on host communities and already overwhelmed health facilities…

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. 
:: Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Mark Lowcock: Statement to the Security Council on the humanitarian situation in the Democratic Republic of the Congo, New York, 19 March 2018

Syrian Arab Republic
:: 23 Mar 2018  UNICEF Briefing note on the situation of children in Idlib, Afrin and Eastern Ghouta, Syria, 23 March 2018
:: 19 Mar 2018 Statement attributed to Ali Al-Za’tari, UN Resident and Humanitarian Coordinator in Syria, on the catastrophic situation for people from East Ghouta and Afrin, 19 March 2018 [EN/AR]

:: 19 Mar 2018  Yemen Humanitarian Update Covering 12 March – 18 March 2018 | Issue 7

WHO & Regional Offices [to 24 March 2018]

WHO & Regional Offices [to 24 March 2018]

Latest News
Promote health, keep the world safe, serve the vulnerable
Civil society meeting on HIV, viral hepatitis, tuberculosis, sexually transmitted infections and universal health coverage
Statement by Dr Tedros Adhanom Ghebreyesus, WHO Director-General
22 March 2018
On the trail of Lassa fever in southern Nigeria
21 March 2018 – Some 3675 contacts of the 376 confirmed Lassa fever cases in Nigeria had been identified and more than three-quarters had completed their 21 days of monitoring as of 18 March. WHO, the Nigeria Centre for Disease Control (NCDC) and the local government are reaching out to communities with a large-scale awareness raising campaign. This feature story tell of the importance of contact tracing in controlling the disease outbreak.

WHO supports 16 African countries to protect against Listeriosis
March 2018 – WHO has reached out to 16 African nations to provide support for preparedness and response to a listeriosis outbreak that started in South Africa in 2017 but is now threatening other countries on the continent.

Call for Europe’s commitment to increase investment to end TB
March 2018 – The number of new tuberculosis (TB) patients has been decreasing at an average rate of 4.3% yearly in the last decade in the WHO European Region. Despite being the fastest decline in the world, the trend is insufficient to achieve the target of ending the TB epidemic by 2030.

Weekly Epidemiological Record, 23 March 2018, vol. 93, 12 (pp. 133–152)
:: Recommended composition of influenza virus vaccines for use in the 2018–2019 northern hemisphere influenza season
:: Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Annual peer review and planning workshop for Anglophone national malaria programmes in Africa takes place in Harare  23 March 2018
WHO continues to Support Response to Cholera Outbreak in Refugee Settlement  22 March 2018 Hoima
:: ESA EPI Managers and partners meet in Kigali to deliberate on immunization
20 March 2018  Nearly two hundred participants from East and Southern African (ESA)…
WHO European Region EURO
:: Time for revamped commitment by all to end TB 23-03-2018
:: Environment and Health Task Force meeting kicks off national planning in 7 key areas 22-03-2018
:: WHO supports large-scale polio and measles vaccination campaigns in northern Syria 21-03-2018
:: Safe drinking-water in Europe? 20-03-2018
:: WHO Europe/ECDC joint press release: 4% annual decrease too slow to end TB by 2030 – call for Europe’s commitment to increase investment to end TB 19-03-2018

WHO Eastern Mediterranean Region EMRO
:: WHO is providing urgent health services in response to displacements from Afrin  23 March 2018
:: WHO Director-General calls for urgent action to improve health conditions in Gaza, March 2018
19 March 2018

WHO Western Pacific Region
:: TB down in past decade; universal health coverage key to faster progress
MANILA, 23 March 2018 – New estimates show a 14% reduction in the incidence of tuberculosis (TB) in the World Health Organization (WHO) Western Pacific Region over the past decade, but with 1.8 million people newly infected in the Region each year, more needs to be done. On the eve of World Tuberculosis Day, WHO calls on governments to provide all citizens access to TB testing and treatment as part of universal health coverage.

CDC/ACIP [to 24 March 2018]

CDC/ACIP [to 24 March 2018]

Latest News
World TB Day – Press Release Thursday, March 22, 2018
Latest analysis of tuberculosis trends shows continued decline in the U.S., but progress toward elimination is slowing.
New preliminary data released today by CDC show tuberculosis (TB) cases declining in the U.S, but at a rate too slowly to eliminate TB during this century. In 2017, 9,093 new cases of TB were reported in the U.S, a 1.8 percent drop from the prior year. However, the current TB rate (2.8 cases per 100,000 persons) remains at levels 28 times higher than the TB elimination target rate…

Unique Program Improves Rapid Detection of Deadly Outbreaks in Uganda – Press Release Wednesday, March 21, 2018
An innovative program launched in 2010 in Uganda has dramatically sped the detection of outbreaks of some of the world’s most dangerous viruses, according to a Centers for Disease Control and Prevention report published today in The Lancet Infectious Diseases.
Between 2010 and 2017, CDC and Ugandan scientists identified 16 outbreaks of viral hemorrhagic fevers (VHFs) in an average of 2.5 days – down from the two-week average detection time over the previous 10 years. The program, the CDC-UVRI Viral Hemorrhagic Fever Surveillance and Laboratory Program, identified five times as many outbreaks between 2010 and 2017 as were documented in the decade before the program began.
This first-of-its-kind national VHF program is a collaboration between CDC, the Uganda Ministry of Health (MOH), and the Uganda Virus Research Institute (UVRI). It combines real-time surveillance with laboratory testing and emergency response to significantly decrease both intensity and length of VHF outbreaks in the country, potentially saving hundreds or thousands of lives…

Telebriefing Transcript: CDC Update on Outbreak of Yellow Fever in Brazil, Vaccination Recommendations – Transcript Tuesday, March 20, 2018

CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil – Media Statement Friday, March 16, 2018
In response to a large, ongoing outbreak of yellow fever in multiple states of Brazil, including near large urban areas and popular tourist destinations, CDC is recommending travelers to the country protect themselves from yellow fever by getting the yellow fever vaccine at least 10 days before travel, and taking steps to prevent mosquito bites during their travel.
CDC recommends that people who are unable to get yellow fever vaccine or aren’t recommended to get it should avoid traveling to areas of Brazil where yellow fever vaccination is recommended

MMWR News Synopsis for MARCH 22, 2018
:: Tuberculosis – United States, 2017
Eliminating tuberculosis (TB) in the United States requires a continued effort to control TB disease as well as expanded testing and treatment of latent TB infection. Preliminary 2017 U.S. data show the lowest number of reported TB cases on record.  New, expanded approaches are needed to accelerate progress towards TB elimination. Data from CDC’s National TB Surveillance System show a total of 9,093 U.S. TB cases in 2017, indicating slight declines in TB cases (-1.8 percent) and TB rates (-2.5 percent) compared to 2016. The preliminary data bring the overall annual TB rate for 2017 down slightly to approximately 2.8 cases per 100,000 people (compared to 2.9 in 2016). However, the rate is 28 times higher than the goal for TB elimination. Epidemiologic modeling suggests that at continued slow rates of decline, TB elimination will not be achieved in this century. In order to achieve TB elimination, continued and expanded efforts to control both active TB and latent TB infection are necessary.



EDCTP    [to 24 March 2018]
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
23 March 2018
World TB Day: EDCTP commits EUR 34M to TB vaccine clinical trials
True to the World Tuberculosis Day 2018 theme ‘Wanted: Leaders for a TB-free world’, the European Union and European member states continue to take an important role in fighting this disease. Recently, the European & Developing Countries Clinical Trials Partnership (EDCTP) committed EUR 34 million in funding for four large clinical trials on candidate TB vaccines. This is the largest European investment into clinical development of TB vaccines to date (with two grants signed and two under preparation), and boosts the joint commitment to combat one of the world’s most devastating diseases. The trials will be conducted by 28 research institutions from sub-Saharan Africa, Europe and India…

22 March 2018
TB treatment consortium PanACEA2 held second annual meeting
The EDCTP-funded PanACEA2 consortium held its second annual meeting in Cape Town, South Africa from 28 February to 1 March 2018. Over the next five years, the consortium plans to use novel trial designs to accelerate the development of new anti-tuberculosis drug regimens. Three clinical trials will be conducted to optimise existing drugs and evaluate novel agents, with the aim of testing combination regimens that will shorten and simplify TB treatment. EDCTP Senior Project Officer Dr Monique Rijks-Surette participated in the programme…


Emory Vaccine Center    [to 24 March 2018]
EVC Faculty Win Paper of the Year by International Society for Vaccines


European Medicines Agency  [to 24 March 2018]
Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 19-22 March 2018
Six medicines recommended for approval, including one orphan …

European Vaccine Initiative  [to 24 March 2018]
21 March 2018
Recommendations on the design of multi-centre validation studies
Findings from a workshop organised within the VAC2VAC project (Vaccine batch to vaccine batch comparison by consistency testing) on the improved design of multi-centre validation studies and the use the data generated for product-specific validation purposes have now been published (Halder et al, 2018). The recommendations also address aspects of validation within the consistency approach context.

Fondation Merieux  [to 24 March 2018]
March 14, 2018  Bamako, Mali
6th Better Foods for Better Health Symposium
The Mérieux Foundation is organizing the 6th edition of the Better Foods for Better Health symposium from March 20-22, at Les Pensières Center for Global Health, Veyrier-du-Lac, in France, with the support of Mérieux NutriSciences. This edition gathers about 100 experts from the scientific community, regulatory institutions, academia, agro-food and industry stakeholders to discuss “Childhood nutrition, building a healthy life”.’’
Gavi [to 24 March 2018]
23 March 2018
U.S. approves $290 million for Gavi in fiscal year 2018 appropriations omnibus
Funding to provide critical vaccines to some of the poorest children in the world.
Washington, 23 March 2018 – Gavi, the Vaccine Alliance welcomed final approval of the United States fiscal year 2018 appropriations bill. The budget includes US$ 290 million for Gavi, which will go towards increasing the organization’s capacity to purchase and deliver life-saving vaccines for poor and vulnerable children around the world.
The contribution to Gavi is part of the US$ 829.5 million approved for the U.S. Agency for International Development (USAID) Maternal and Child Health programs for 2018. This funding not only supports the introduction of new vaccines and innovative approaches and tools to expand equitable access to vaccines, but a range of other life-saving interventions.
“Gavi is grateful to the United States for continuing to invest in vaccines, one of the most cost-effective ways to save lives, improve health and ensure long-term prosperity,” said Gavi CEO Dr. Seth Berkley…


Global Fund [to 24 March 2018]
Global Fund Thanks U.S. Congress for Steadfast Support against HIV, TB and Malaria
23 March 2018
The Global Fund applauds the U.S. Congress for approving $1.35 billion in funding for the Global Fund for the 2018 U.S. fiscal year. This tremendous support from the United States is essential as the Global Fund accelerates progress in the fight against AIDS, tuberculosis, and malaria.
The Global Fund also welcomed Congressional appropriation of $4.65 billion for the U.S. President’s Emergency Plan for AIDS Relief, $755 million for the U.S. President’s Malaria Initiative, and $261 million for USAID’s TB program. The Global Fund is a critical partner to all three of these U.S. bilateral efforts.
The sustained U.S. support for the Global Fund will strengthen economic growth and help reduce poverty in Global Fund implementing countries. It will also save lives, reduce suffering, and bolster health security across the globe. The Global Fund matches every dollar from the U.S. with two dollars from other donors to drive global progress.
“The support of the American people is fundamental to global progress in ending the epidemics of HIV, TB, and malaria,” said Peter Sands, Executive Director of the Global Fund. “Together, we will continue to deliver results – in close collaboration with PEPFAR, PMI, and USAID’s TB program – and will accelerate the end of these epidemics.”…
Human Vaccines Project   [to 24 March 2018]
Mar 22, 2018
Human Vaccines Project Appoints Dr. Moncef Slaoui as New Board Member
NEW YORK, March 22, 2018 /PRNewswire/ — The Human Vaccines Project, a nonprofit public-private partnership focused on decoding the immune system to improve human health, welcomes Moncef Slaoui, PhD, to its Board of Directors.
Moncef Slaoui, PhD, has had a highly distinguished career in vaccine R&D and has led the development of numerous vaccines that are in use worldwide. In 2016, he was recognized as one of Fortune Magazine’s “50 Greatest World Leaders” for his work on under-researched diseases that are common in the developing world. Dr. Slaoui is currently a partner at Medicxi, a leading European venture capital firm.
“We are honored to have Dr. Slaoui join the Project’s Board of Directors. He brings tremendous expertise in technology development and vaccine research to the table that is specifically relevant to the Project’s mission,” said Wayne C. Koff, PhD, president and CEO of the Human Vaccines Project. “We look forward to his guidance on this next phase of development, as the Project’s clinical research advances our understanding of the immune system.”…
IAVI  [to 24 March 2018]
March 20, 2018
IAVI Remembers HIV Treatment Pioneer David Cooper
IAS Past President David Cooper championed breakthrough AIDS treatment and advocated for a vaccine
IAVI is saddened by the passing of David Cooper, MD, DSc, whose breakthrough research and unrelenting advocacy helped usher in the use of life-saving antiretroviral (ARV) therapy and advance efforts to turn the tide of the epidemic. David leaves behind an indelible legacy as a scientist, clinician, and advocate whose contributions over three decades in the fight against AIDS helped enable transformation of the disease from an almost invariably fatal one to one where highly effective, well-tolerated, and simple-to-use treatment regimens are now available.
“David Cooper was an early leader in HIV treatment and prevention, and an inspiration for so many people in the AIDS field, myself included,” said Mark Feinberg, MD, PhD, CEO of IAVI. “David was exceptionally dedicated to the care of individuals living with HIV and so very thoughtful and generous with his colleagues. His passing is a loss not only to our field but to the many people who were encouraged by him in their efforts to combat AIDS.”…


IVAC  [to 24 March 2018]
Latest IVAC News
IVAC Launches Immunization Reminder and Information SMS System (IRISS) in Nigeria
MSF/Médecins Sans Frontières  [to 24 March 2018]
Press release
Syria: Military Operations in Eastern Ghouta Drastically Limit Medical Aid
MARCH 21, 2018—Lorena Bilbao, Syria operations coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF), gave the following statement today on the situation in eastern Ghouta, Syria:

Press release
Mediterranean: European Governments Continue to Obstruct Lifesaving Rescues and Return People to Unsafe Conditions in Libya
March 21, 2018
The decision by Italian authorities to seize Open Arms, a rescue vessel belonging to the Spanish NGO Proactiva, shortly after its crew rescued and disembarked 216 people in the Central Mediterranean on Sunday is the latest in a long series of actions obstructing non-governmental organizations from carrying out lifesaving rescue operations at sea, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

Press release
Greece: Europe’s Two-Year-Old Deal with Turkey Traps Thousands in Disastrous Conditions
ATHENS /NEW YORK, MARCH 17, 2018—Two years after the signing of a deal between the European Union (EU) and Turkey, Europe’s cynical strategy to contain and return people seeking asylum has trapped thousands of vulnerable people in disastrous conditions on Greek islands, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, calling on Greek and EU authorities to increase transfers to the Greek mainland.

NIH  [to 24 March 2018]
March 23, 2018
NIH Statement on World Tuberculosis Day 2018
— Statement of Christine F. Sizemore, Ph.D., Richard Hafner, M.D., and Anthony S. Fauci, M.D.
[See Milestones/Perspectives above for full text]

March 22, 2018
NIH scientists say advanced vaccines could limit future outbreaks
— Novel vaccine technologies are critical to improving the public health response to infectious disease threats that continually emerge and re-emerge, according to scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. In a perspective in The Journal of the American Medical Association, the experts highlight innovations that could significantly shorten the typical decades-long vaccine development timeline.
[See Milestones/Perspectives above for full text]
PATH  [to 24 March 2018]
Press release | March 23, 2018
Ministry of Health and Internet innovators discuss the exciting potential of Vietnam’s growing social media ecosystem to boost HIV control
Workshop highlights how cutting edge online tools are bringing HIV services and support into the digital age
Hanoi, March 23, 2018—Today, the Vietnam Administration for HIV/AIDS Control (VAAC) and the US Agency for International Development’s (USAID) Healthy Markets project, implemented by PATH, brought together young Vietnamese innovators who are using digital and online technology to increase access to HIV-related information and services for at-risk populations. The forum in Hanoi brought together government leaders, private-sector partners, social media and communications experts, civil society leaders, and social enterprises to discuss how the rise of social media, mobile apps, and online commerce in Vietnam can be leveraged to support Vietnam’s commitment to its 90-90-90 goals to eliminate HIV in Vietnam by 2030…


UNAIDS [to 24 March 2018]
Update  23 March 2018
UNAIDS Special Ambassador receives UNWDPA Leadership Award
The United Nations Women for Peace Association (UNWDPA) has honoured Lorena Castillo de Varela, the First Lady of Panama and UNAIDS Special Ambassador for AIDS in Latin America, with its Leadership Award. The award was made in recognition of her work in the response to HIV and the promotion of human rights and women’s empowerment…

Update   21 March 2018
UNAIDS saddened by the death of pioneering HIV researcher David Cooper
UNAIDS is saddened by the news of the sudden death of David Cooper on 18 March. He was a pioneering HIV researcher, immunologist and professor at Australia’s University of New South Wales and in 1986 became the first Director of the National Centre of HIV Epidemiology and Clinical Research, now known as the Kirby Institute.
Mr Cooper diagnosed the first documented case of HIV in Australia in the mid-1980s, and in 1991 was named Chair of the WHO Global Programme on AIDS’ Committee on Clinical Research and Drug Development.
He was a past President of the International AIDS Society and worked with colleagues to found the HIV Netherlands Australia Thailand Research Collaboration, known as HIV-NAT, in Bangkok, Thailand.
“The world has lost a bold and compassionate leader in the response to HIV,” said Michel Sidibé, UNAIDS Executive Director. “David Cooper firmly believed in health as a fundamental human right. Without the groundbreaking research and advances in treatment that he helped to make a reality, many more lives would have been lost to AIDS. Our thoughts during this difficult time are with his family, colleagues and the many people his life and work touched.”…


Wellcome Trust  [to 24 March 2018]
News / Published: 22 March 2018
First Japanese company joins CARB-X partnership
As pharmaceutical company Shionogi becomes the first Japanese company to join CARB-X, Tim Jinks, head of Wellcome’s Drug-Resistant Infections Priority Programme, gives an update on the partnership’s work to develop new drugs and diagnostics.
Last March, Wellcome announced it was committing up to $155 million dollars to CARB-X. CARB-X, which stands for Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, now has 28 promising projects in its portfolio. Eight are focusing on new class antibiotics.
These advances mean CARB-X has the world’s largest and most technically diverse portfolio of early development projects to tackle the rapidly increasing global problem of drug-resistant infections…

The Wistar Institute   [to 24 March 2018]
Press Release   Mar. 23, 2018
Wistar and YourEncore Unite to Advance Life Sciences Opportunities
YourEncore will provide targeted support to Wistar and its international life sciences partners
PHILADELPHIA – (March 23, 2018) -The Wistar Institute and YourEncore, Inc., a life sciences and consumer goods consulting company engaging highly experienced, top talent industry experts, have signed a Memorandum of Understanding (MoU) to help accelerate the advancement of Wistar’s early-stage discoveries, start-ups and international collaborations.
Under the Memorandum, YourEncore and Wistar will be working together to develop a tailored, flexible model that deploys YourEncore’s team of pharmaceutical, biotech and regulatory experts around Wistar’s leading therapeutic and diagnostic programs. YourEncore will also be assisting Wistar’s international partners such as bioXclusters plus, an enterprise of European life sciences companies, on individual projects aimed at strengthening international business relations between the Philadelphia research and biotechnology community and its European life sciences cluster…

Press Release   Mar. 19, 2018
The Campbell Foundation Awards $100,000 Grant to The Wistar Institute
nonprofit organization, which is dedicated to funding HIV/AIDS research, has awarded the grant to Mohamed Abdel-Mohsen, Ph.D., assistant professor in Wistar’s Vaccine & Immunotherapy Center.


DCVMN – Developing Country Vaccine Manufacturers Network  [to 24 March 2018]
5 April 2018
Webinar: The new Future Vaccine Manufacturing Hub, collaborating with DCVMN
Prof Robin Shattock, Professor of Mucosal Infection and Immunity, Imperial College, London
Thursday, April 5, 2018 9:00 am
Europe Summer Time (Paris, GMT+02:00)

An unhealthy state to be in

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

Vaccines and Global Health: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org
An unhealthy state to be in
by Seth Berkley | Gavi, The Vaccine Alliance
Thomson Reuters Foundation | 20 March 2018
Most refugees are living in low- and middle-income countries which are usually in no great position to support a huge influx of people

For the millions of people living in conflict zones, often the biggest killer isn’t bullets or bombs, but infectious disease. This was true of the First World War, where Spanish flu claimed four times more lives than conflict, and it is true of modern wars, even particularly brutal ones, like in Darfur. There, non-violent deaths, mainly due to infectious disease compounded by nutritional issues, were responsible for a ten-fold increase in mortality. Yet, for refugees it’s a very different story. There are always exceptions, but generally those people fleeing conflict or persecution who make it across national borders are on average no more likely to die than the residents of their new host country.

What this highlights is the vital role that aid agencies and host countries play in providing refugees with critical health interventions, such as vaccines, which may not have been available in their home country due to a breakdown of health services. As U.N. officials meet in Geneva this month to discuss a new draft global agreement on refugees, it’s also a role that is now likely to come under increasing pressure in the face of growing fragility, as the number of conflicts continues to rise, displacing more and more people.

With a record high of more than 65 million people across the world now displaced from their homes, conflict is only one driving force. Climate change, in the form of land degradation, desertification, rising sea levels and extreme weather events, is also now a contributing factor, as is the poverty that often comes with it. And in the coming decades this is expected to get worse.

All this points to two worrying challenges. The first is the question of how we continue to make immunisation and other vital preventive health interventions a priority for refugees. This can be challenging at the best times, as the ongoing diphtheria outbreak among the 650,000 Rohingya refugees in Cox’s Bazar demonstrates. But as the number of refugees continues to rise, this continuity of healthcare is likely to become less sustainable, raising difficult questions about who is responsible for providing for these essentially “stateless” people.

Indeed, given that refugee crises are rarely resolved quickly, and that it can take years before people can be safely repatriated, there is also the long-term pressure placed on host countries to consider. While headlines about the global refugee crisis mainly focus on the burden placed on wealthy nations, most refugees are living in low- and middle-income countries which are usually in no great position to support a huge influx of people. Countries like Jordan, Kenya, Ethiopia and Uganda currently have millions of Syrian, Somali and Sudanese refugees in vast camp cities. Should countries like these be expected to use their limited resources or take out additional borrowing and incur sovereign debt in order to fund the needs of millions of people who are not their citizens, but are nevertheless on their territory?

The second arguably even greater challenge will be finding better ways to reach those tens of millions of people who are displaced but remain in their home country, which is the vast majority of the global total. These people are in so many ways more vulnerable, and yet harder to reach, with their health and safety often at the mercy of the same forces that drove them from their homes in the first place.

Continued fighting and a lack of basic infrastructure can make it extremely difficult for aid agencies to reach these displaced civilians populations, who are often sheltering in over-crowded situations, with limited access to food, water and sanitation, conditions that are ripe for outbreaks of disease and the vectors that spread them. If the children within that population miss out on vaccinations, such outbreaks become almost inevitable.

This is precisely what triggered the diphtheria outbreak among the Rohingya in Cox’s Bazar and this is what is now unfolding in Yemen. The only difference is that while aid agencies were able to get vaccines to the Rohingya refugees when they crossed over into Bangladesh, in Yemen access to the 22 million people in need of humanitarian assistance is limited. With around 1,300 suspected cases of diphtheria and 73 deaths, there are now 7.2 million doses of the diphtheria vaccine on their way. It remains to be seen whether they make it to each and every person at risk.

Ensuring that health remains a priority in the new global agreement on refugees is one solution. In seeking to create a global public good that eases pressure on host countries and delivers services, as well supporting self-reliance of refugees and making it easier for them to either resettle in third countries or voluntarily repatriate, should be a positive step for all parties. However, we also need to find solutions to help people on the other side of the border, those millions of internally displaced people who are ultimately more at risk. By supporting their human right to lead healthy lives through the prevention of vaccine preventable disease, we can not only reduce the risk of outbreaks, but also end the tragedy of people fleeing violence only to be struck down by disease.

Journal Watch

Journal Watch

   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org