Vaccines and Global Health: The Week in Review :: 26 May 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

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

World Health Assembly :: Seventy-first World Health Assembly update, 26 May

Milestones :: Perspectives

Editor’s Note:
The WHA closes today. We will provide a more detailed analysis of outcomes in next week’s edition.

World Health Assembly
21–26 May 2018
Geneva

Seventy-first World Health Assembly update, 26 May
26 May 2018 – News Release, Geneva
The Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, told delegates to the World Health Assembly today that they had charted a new course for the Organization.

Closing the Assembly, he said that everything WHO did going forward would be evaluated in the light of the “triple billion” targets which were approved this week in WHO’s new five-year strategic plan. By 2023 the targets aim to achieve:
1 billion more people benefitting from universal health coverage
1 billion more people better protected from health emergencies
1 billion more people enjoying better health and wellbeing.

On the final day of the Assembly, delegates also came to agreement on maternal, infant and young child nutrition and on poliovirus containment.

Nutrition
Delegates unanimously renewed their commitment to invest and scale up nutrition policies and programmes to improve infant and young child feeding.

Member States discussed efforts to achieve the World Health Assembly Global Nutrition Targets, concluding progress has been slow and uneven, but noted a small step forward in the reduction of stunting, with the number of stunted children under 5 years falling from 169 million in 2010 to 151 million in 2017. WHO is leading global action to improve nutrition, including a global initiative to make all hospitals baby friendly, scaling up prevention of anaemia in adolescent girls, and preventing overweight in children through counselling on complementary feeding. A new report was launched on the implementation of the Code of Marketing Breastmilk Substitutes, highlighting that 6 more countries had adopted or strengthened legislation in 2017 to regulate marketing of breastmilk substitutes.

Polio
With wild poliovirus transmission levels lower than ever before, and the world closer than ever to being polio-free, discussions focused on securing a lasting polio-free world. As at May 2018, only 9 cases due to wild poliovirus had been reported globally, from just 2 countries: Afghanistan and Pakistan. Delegates reviewed emergency plans to interrupt the last remaining strains of the virus.

To prepare for a polio-free world, global poliovirus containment activities continue to be intensified, and Member States adopted a landmark resolution on poliovirus containment. In a limited number of facilities, poliovirus will continue to be retained, post-eradication, to serve critical national and international functions such as the production of polio vaccine or research. It is crucial that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions to ensure that the virus is not released into the environment, either accidentally or intentionally, to again cause outbreaks of the disease in susceptible populations.

Member States expressed overwhelming commitment to fully implement and finance all strategies to secure a lasting polio-free world in the very near term. Rotary International, speaking on behalf of the Global Polio Eradication Initiative (which consists of WHO, Rotary, CDC, UNICEF and the Bill & Melinda Gates Foundation) offered an impassioned plea to the global community to eradicate a human disease for only the second time in history, and ensure that no child will ever again be paralysed by any form of poliovirus anywhere.

Closing remarks
In his final speech to this year’s Assembly, Dr Tedros said that everywhere he went, he had the same message: health as a bridge to peace. “Health has the power to transform an individual’s life, but it also has the power to transform families, communities and nations,” he told delegates.

The Organization’s new 5-year strategic plan, he said, called on WHO to measure its success not by its outputs, but by outcomes – by the measurable impact it delivers where it matters most – in countries.

“Ultimately, the people we serve are not the people with power; they’re the people with no power,” the Director-General said. He told delegates the true test of whether the discussions held in the Assembly this week were successful would be whether they resulted in real change on the ground and he urged them to go back to their countries with renewed determination to work every day for the health of their people.

“The commitment I have witnessed this week gives me great hope and confidence that together we can promote health, keep the world safe, and serve the vulnerable,” he concluded.

WHO supports Ebola vaccination of high risk populations in the Democratic Republic of the Congo

Milestones :: Perspectives

EBOLA/EVD  [to 26 May 2018]
http://www.who.int/ebola/en/

WHO supports Ebola vaccination of high risk populations in the Democratic Republic of the Congo
News Release – Geneva  21 May 2018
[Editor’s text bolding]
The Government of the Democratic Republic of Congo, with the support of WHO and partners, is preparing to vaccinate high risk populations against Ebola virus disease (EVD) in affected health zones.

Health workers operating in affected areas are being vaccinated today and community outreach has started to prepare for the ring vaccination.

More than 7,500 doses of the rVSV-ZEBOV Ebola vaccine have been deployed to the Democratic Republic of the Congo to conduct vaccination in the northwestern Equator Province where 46 suspected, probable and confirmed Ebola cases and 26 deaths have been reported (as of May 18). Most of the cases are in Bikoro, a remote rural town, while four confirmed cases are in Mbandaka, the provincial capital with a population of over 1 million people.

The vaccines are donated by Merck, while Gavi, the Vaccine Alliance is contributing US$1 million towards operational costs. The Wellcome Trust and DFID have also pledge funds to support research activities.

“Vaccination will be key to controlling this outbreak,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We are grateful for the support of our partners in making this possible.”

The Ministry of Health with WHO, Medecins Sans Frontieres (MSF), UNICEF and other key partners are implementing a ring vaccination with the yet to be licensed rVSV-ZEBOV Ebola vaccine, whereby the contacts of confirmed cases and the contacts of contacts are offered vaccination. Frontline healthcare workers and other persons with potential exposure to EVD – including but not limited to laboratory workers, surveillance teams and people responsible for safe and dignified burials – will also receive the vaccine.

“We need to act fast to stop the spread of Ebola by protecting people at risk of being infected with the Ebola virus, identifying and ending all transmission chains and ensuring that all patients have rapid access to safe, high-quality care,” said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response.

A ring vaccination strategy relies on tracing all the contacts and contacts of contacts of a recently confirmed case as soon as possible. Teams on the ground have stepped up the active search and follow up of all contacts. More than 600 have been identified to date.

“Implementing the Ebola ring vaccination is a complex procedure,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “The vaccines need to be stored at a temperature of minus 60 to minus 80 degrees centigrade and so transporting them to and storing them in affected areas is a major challenge.”

WHO has sent special vaccine carriers, which can keep their contents in sub-zero temperatures for up to a week and has set up freezers to store the vaccines in Mbandaka and Bikoro. The Organization is deploying both Congolese and Guinean experts to build the capacities of local health workers. The Ministry of Health, WHO, UNICEF and partners are engaging communities to inform people about Ebola, including the vaccine.

The vaccine was shown to be highly protective against Ebola in a major trial in 2015 in Guinea. Among the 5,837 people who received the vaccine, no Ebola cases were recorded nine days or more after vaccination. While the vaccine is awaiting review by relevant regulatory authorities, WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) has recommended the use of the rVSV-ZEBOV Ebola vaccine under an expanded access/compassionate use protocol during Ebola outbreaks linked to the Zaire strain such as the one ongoing in the DRC.

WHO and partners need US$26 million for the Ebola Response in the Democratic Republic of the Congo over the next three months. Funding has been received from Italy, UN CERF, Gavi – the Vaccine Alliance, USAID, the Wellcome Trust and UK DFID. WHO has also released US$2 million from its Contingency Fund for Emergencies

WHO partners in the DRC Ebola response include:
The International Federation of Red Cross and Red Crescent Societies (IFRC), the Red Cross of the Democratic Republic of the Congo (DR Congo Red Cross), Médecins Sans Frontières (MSF), the Disaster Relief Emergency Fund (DREF), the Africa Centers for Disease Control and Prevention (Africa-CDC), the US Centers for Disease Control and Prevention (US-CDC), the World Food Programme (WFP), UNICEF, UNOCHA, MONUSCO, International Organization for Migration (IOM), the FAO Emergency Management Centre – Animal Health (EMC-AH), the International Humanitarian Partnership (IHP), Gavi – the Vaccine Alliance, the African Field Epidemiology Network (AFENET), the UK Public Health Rapid Support team, the EPIET Alumni Network (EAN), the International Organisation for Animal Health (OIE), the Emerging Diseases Clinical Assessment and Response Network (EDCARN), the World Bank and PATH. Additional coordination and technical support is forthcoming through the Global Outbreak Alert and Response Network (GOARN) and Emergency Medical Teams (EMT).
 
 

Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 22 May 2018 [GPEI]
This week, the World Health Assembly is meeting in Geneva, Switzerland, and will be presented with a Strategic Action Plan on Polio Transition (including the Post-Certification Strategy), a status report on polio eradication, and a proposed resolution on containment of polioviruses.

Summary of newly-reported viruses this week:
Pakistan: Three new WPV1 positive environmental samples have been reported, Two in Sindh province, and one in Balochistan province.
Nigeria: One new case of cVDPV2 has been reported, in Jigawa state. Somalia: One new cVDPV3 positive environmental sample has been reported, in Banadir province. Two new cVDPV2 positive environmental samples have been reported, also in Banadir province.

[See WHA above for Polio action summary]

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WHO Grade 3 Emergencies  [to 26 May 2018]
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WHO Grade 2 Emergencies  [to 26 May 2018]
[Several emergency pages were not available at inquiry]

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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. 
Yemen 
:: Yemen Humanitarian Update Covering 15 – 21 May 2018 | Issue 16

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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.
Somalia
:: OCHA Somalia Flash Update #6 – Humanitarian impact of heavy rains | 25 May 2018
:: OCHA Flash Update #3 – Tropical Cyclone Sagar | 23 May 2018

Ethiopia
:: Ethiopia Humanitarian Bulletin Issue 53 | 07-20 May 2018
 
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD  [to 26 May 2018]
http://www.who.int/ebola/en/
[See Milestones above for detail]

 

WHO & Regional Offices [to 26 May 2018]

WHO & Regional Offices [to 26 May 2018]

See Milestones above for coverage of WHA and Ebola.
 
Weekly Epidemiological Record, 25 May 2018, vol. 93, 21 (pp. 305–320)
Dracunculiasis eradication: global surveillance summary, 2017
 
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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO Launches Business Case for Immunization in Africa at the World Health Assembly
23 May 2018
:: South Sudan launches an Ebola sensitization and awareness campaign to enhance preparedness in the country  23 May 2018
:: With another Ebola Containment Effort Underway, New Report Tracks Progress Made by the WHO in the African Region in its Transformation Agenda  23 May 2018
:: Africa Vaccination Week comes to an end with calls for civil servants to become immunization champions  21 May 2018
:: Zambia Charts the Way forward for Cholera Elimination  21 May 2018
 
WHO European Region EURO
:: Strategic country mission to Libya advances health of migrants and displaced people 25-05-2018
:: Latest data shows southern European countries have highest rate of childhood obesity 24-05-2018
:: World Cup 2018: reaching out to football fans to promote healthier and more active lives 23-05-2018
 

CDC/ACIP [to 26 May 2018]

CDC/ACIP [to 26 May 2018]

http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for May 24, 2018
HIV Preexposure Prophylaxis in the U.S. Military Services – 2014-2016
The U.S. military is implementing strategies to reduce barriers to receiving HIV prevention and care services. These strategies include patient self-referrals for HIV pre-exposure prophylaxis (PrEP) evaluations, increasing the number and quality of provider education efforts, and developing of a new health policy to provide universal access to the provider, laboratory, and pharmacy service elements required for an effective PrEP program. This report describes HIV PrEP in the U.S. military. The findings indicate that more than 2000 beneficiaries have accessed PrEP in the U.S. military healthcare system. However, current estimates indicate that approximately 10,000 more service members are eligible. Currently, the availability of PrEP services varies widely based on the individual patient’s geographic location. New DoD policy is being developed to address identified gaps through initiatives to improve provider education, to ensure universal access to PrEP at the primary care level, and to standardize pharmacy and laboratory service delivery at all military treatment facilities.

Vaccination Coverage Among Children Aged 2 Years – U.S. Affiliated Pacific Islands, April-October, 2016
While CDC found vaccination coverage was low and varied widely among children age 2 years in five United States Affiliated Pacific Islands (USAPI), CDC and USAPI now have the information they need to improve vaccination coverage in the region and to reduce the occurrence of vaccine-preventable diseases. It is an important first step in overcoming the challenges of geographic remoteness and difficulty tracking highly mobile populations across the USAPI. CDC conducted the first region-wide assessment of vaccination coverage in the United States Affiliated Pacific Islands (USAPI). Vaccination coverage was low and varied widely among children age 2 years in the five USAPI assessed. Coverage for the recommended six-vaccine series did not meet the 85% coverage target in any jurisdiction. The results serve as a baseline for coordinated USAPI and CDC efforts to improve vaccination coverage. By using medical records, CDC is able to overcome the challenges of geographic remoteness and difficulty tracking highly mobile populations to conduct rapid vaccination coverage assessment to support timely programmatic decision-making. Effectively monitoring vaccination coverage, coupled with implementation of data-driven interventions, is essential to maintain protection from VPD outbreaks.

Notes from the Field:
Vaccine Administration Errors Involving Recombinant Zoster Vaccine – United States, 2017-2018

Register for upcoming June ACIP meeting
June 20-21, 2018
Deadline for registration:
Non-US Citizens: May 16, 2018
US Citizens: June 11, 2018
Registration is NOT required to watch the live meeting webcast or to listen via telephone.

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ECDC – European Centre for Disease Prevention and Control  [to 26 May 2018]

ECDC – European Centre for Disease Prevention and Control  [to 26 May 2018]

https://ecdc.europa.eu/en/home
Publication
Communicable disease threats report, 20-26 May 2018, week 21
publication – 25 May 2018

Data
Yellow fever distribution and areas of risk in Brazil, as of 25 May 2018
map – 25 May 2018

Publication
Rapid risk assessment: Ebola virus disease outbreak in Equateur Province, Democratic Republic of the Congo, First update
risk assessment – 25 May 2018