Fighting the world’s largest cholera outbreak: oral cholera vaccination campaign begins in Yemen   

Milestones :: Perspectives

Yemen
 
Fighting the world’s largest cholera outbreak: oral cholera vaccination campaign begins in Yemen   
Aden, 10 May 2018 – The first-ever oral cholera vaccination campaign in Yemen was launched on 6 May and concludes on 15 May, just before the start of Ramadan. The campaign aims to prevent the resurgence of the world’s largest cholera outbreak. The volatile mix of conflict, a deteriorating economic situation, and little or no access to clean drinking-water and sanitation have resulted in more than one million suspected cholera cases since the outbreak began in April 2017.

A race against time
This campaign is part of a broader cholera integrated response plan, implemented by national health authorities, WHO and UNICEF. Outbreak response activities include surveillance and case detection, community engagement and awareness, enhancing laboratory testing capacity, improving water and sanitation, and training and deploying rapid response teams to affected areas.

This epidemic has affected the entire country, and the implementation of this oral cholera vaccination campaign, as part of the entire response to cholera, marks a milestone in the combined efforts of WHO and UNICEF, in partnership with the World Bank and Gavi, the Vaccine Alliance, through the generous support of our donors.

“The ongoing conflict, lack of access to safe drinking-water, weak sewage systems due to lack of fuel for pumps and the collapsing health system is the perfect mix for a new explosion of cholera during Yemen’s rainy season, which is already in its beginning stages,” said Dr Nevio Zagaria, WHO Representative in Yemen.

“Hot” districts prioritized to prevent spread 
On 24 April, UNICEF delivered the first batch of 455 000 doses of oral cholera vaccine from the Gavi-funded global stockpile, targeting people over the age of 1 year, including pregnant women.  The Global Task Force for Cholera Control approved the request of more than 4.6 million doses of the vaccine from the global stockpile to target cholera hotspots across the country.

“This vaccination campaign comes at such a critical time. Children in Yemen were the worst hit by last year’s outbreak and remain the most vulnerable due to widespread malnutrition and deteriorating sanitation and hygiene,” said Meritxell Relaño, UNICEF Representative in Yemen.
Recent reports revealed that in the first 3 days of the campaign, more than 124 000 doses of oral cholera vaccine were administered. This represents 35% of the estimated target population in the 4 districts where the campaign began. A fifth district, will be included in the coming days, bringing the total target population to 470 905 individuals. The campaign currently involves 11 fixed teams and 328 mobile teams.

Cholera Vaccination Campaign Starts in Yemen After Year Delay-WHO
By Reuters   May 7, 2018
GENEVA — The first vaccine campaign against cholera in Yemen has started, 18 months after war and a sanitation crisis triggered an epidemic, but the World Health Organization said it did not yet have permission nationwide to do the vaccinations.
Some senior Houthi officials, whose forces control the capital Sanaa, have objected to vaccinations and this has already delayed the programme by nearly a year, aid workers say.
There have been more than one million suspected cases of cholera in Yemen, and 2,275 recorded deaths since Nov 2016, the WHO says.
The oral vaccination campaign, which began in four districts in Aden on Sunday targeting 350,000 people, coincides with the rainy season, which health workers fear could spread the disease further.
“We have plans in place for extending that to all of the at-risk zones and we are still negotiating with health authorities in the north of the country, in Sanaa, in order to plan those campaigns,” Michael Ryan, WHO Assistant Director-General, told a news briefing on Monday.
“As of yet we don’t have established dates for those campaigns, but we are ready to move… just as soon as we get those necessary approvals,” he added…
 

Concern over reported number of measles cases in Yemen

Milestones :: Perspectives

Concern over reported number of measles cases in Yemen
The Lancet | 12 May 2018
Over 3000 suspected measles cases have been reported in 2018 across Yemen, where conflict has plunged the country into the world’s largest humanitarian crisis. Xun Yuan reports.

As of April 20, over 3000 suspected measles cases have been reported across the country, more than 60 of which were fatal, according to data from UNICEF and WHO. According to UNICEF, the highest numbers of cases have been seen in Aden (786 patients), Al Bayda (324 patients), and Sana’a (245 patients). UNICEF Yemen told The Lancet that the exact number has not yet been confirmed due in part to the poor laboratory examination capacity in Yemen at the time.

Despite the uncertainty, the sheer number of suspected cases still raises alarm. From 2013 to 2017, the number of suspected cases has ranged from about 2000 to 4000 per year, according to UNICEF.

“Every 2 or 3 years, there is a spike in measles cases because the number of unvaccinated children accumulates”, WHO told The Lancet. “The last big outbreak of measles was in 2012, at which time the conflict had not yet begun.” According to WHO, the combination of the expected upsurge in cases since the last outbreak and the deterioration of the security situation—whereby reporting of new cases and access to communities is becoming problematic—makes this uptick of reported cases particularly worrisome.

Fouzia Shafique, chief of health and Nutrition of UNICEF Yemen, told The Lancet that reported coverage of the measles vaccine, MCV1, has generally been maintained on a national scale despite the challenges that the Expanded Program on Immunization faces in Yemen. Based on data shared by WHO and UNICEF with The Lancet, the last national campaign was initiated in November, 2014, and reached all 333 districts, covering 93% of the targeted individuals. In the following years, mop-up campaigns, door-to-door immunisations in specific areas where the virus is known or suspected to still be circulating, were done on a yearly basis, with coverage ranging from 41% to 92%.

A nationwide measles vaccination campaign is scheduled to occur at the end of this year, and is expected to target over 13 million children under the age of 15 years, said Shafique.

Some governorates and districts are nevertheless seeing declines in coverage, according to Shafique.

“Due to deterioration of security situation and considerable stress on the health system, with salaries unpaid in most of the country for over 18 months, and operational cost not paid for much longer, the access to quality services became affected”, she told The Lancet.

A risk assessment done by WHO with UNICEF and the local health authorities this year found that “more than 100 districts were identified as very-high-risk for measles and rubella”, said the Emergency Communications lead of WHO Yemen.

“There is certainly an upsurge of measles cases, at least in Aden. We have admitted 11 measles patients in the last 3 days. But, sadly, we do not have enough resources to vaccinate other children at risk”, a doctor based in Aden, who chose to remain anonymous because of safety concerns, told The Lancet. Doctors in the area have been known to be targeted by violent attacks, this doctor reported.

Local residents at Jayshan District in Abyan Governorate also expressed frustration with the near-complete collapse of the information system in Yemen, because of which they did not receive updates about vaccination programmes.

When asked about the past vaccination campaigns, Sadiq Basha, a Jayshan District local resident whose son was diagnosed with measles, seemed surprised and told The Lancet in Arabic, “I have never heard of such things. If I did, why would I let my kid go unvaccinated?”
Apart from the accessibility issue, a doctor based in Aden also raised concern about the inability to maintain the cold chain, which he said was due to lack of fuel to support the generators.

Although the Saudi-led coalition’s blockade on the Al Hudaydah port was officially lifted, sources told The Lancet that the decreased capacity of the port and the delayed clearances for imports continued to pose challenges to the import of fuel. The UN Verification and Inspection Mechanism has reported that the total fuel imports for April were 27% of the monthly national requirements.

UNICEF, however, believes that the break of the cold chain is rare. “UNICEF provides fuel to the national and all governorate-level cold rooms”, Shafique told The Lancet. “We have also helped installed solar panels in over 300 sites so as to not be dependent on electricity and fuel.”
Some local residents have said that concerns about the stability of the vaccines have deterred them from bringing their children to get vaccinated.

“We heard the vaccines distributed by local clinics are no longer effective”, Nawal Hanna, another local resident at Jayshan District, told The Lancet, “we don’t know if there are any harms coming from getting those vaccines, but we’d rather not take that risk.”

At The Age Of 81, Pioneering Virologist Dr. Robert Gallo To Lead Largest Study Ever On Impact Of HIV Programs

Milestones :: Perspectives

At The Age Of 81, Pioneering Virologist Dr. Robert Gallo To Lead Largest Study Ever On Impact Of HIV Programs

Gallo’s Institute of Human Virology (IHV) to lead $100 Million Project Which Will Enable Researchers to Better Understand HIV in Nigeria

BALTIMORE, May 9, 2018 /PRNewswire/ — The Institute of Human Virology (IHV) at the University of Maryland School of Medicine, led by Dr. Robert Gallo, who co-discovered HIV as the cause of AIDS, will lead a $100 million project to measure the reach and impact of HIV programs in Nigeria – the largest population-based HIV survey ever conducted in a single country.

The work is funded by the U.S. Centers for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR), in collaboration with the Government of Nigeria and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“With this new grant, IHV has been awarded close to $1 billion total in PEPFAR funds, a milestone that coincides with PEPFAR’s 15-year anniversary,” said Robert C. Gallo, MD, the Homer & Martha Gudelsy Distinguished Professor in Medicine who, just turned 81 and is still active in leading all aspects of the Institute’s work.  “We commend President George W. Bush, who signed PEPFAR into law, on this historical global health initiative.”…

 

Emergencies :: Polio this week as of 8 May 2018 :: Statement of the Seventeenth IHR Emergency Committee Regarding the International Spread of Poliovirus

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 8 May 2018 [GPEI]
:: Sweden is the first country to formally engage in the global poliovirus containment process.
:: Professor David Heymann, of the London School of Hygiene and Tropical Medicine, discusses what lessons smallpox eradication teaches us, and why it is critical to complete the job of polio eradication.

Summary of newly-reported viruses this week:
Nigeria: Two circulating vaccine-derived poliovirus type 2 (cVDPV2)  positive environmental samples have been confirmed in Jigawa province.
Somalia: One circulating vaccine-derived poliovirus type 2 (cVDPV2) positive environmental sample has been confirmed in Banadir province. Two circulating vaccine-derived poliovirus type 3 (cVDPV3)  positive environmental samples have been confirmed, also in Banadir province.

Statement of the Seventeenth IHR Emergency Committee Regarding the International Spread of Poliovirus
10 May 2018   Statement  Geneva
[Excerpts; Editor’s bolded text]
Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months.
::::::
The seventeenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 30 April 2018 at WHO headquarters with members, advisers and invited member states attending via teleconference…

Wild polio
Overall the Committee was encouraged by continued progress in WPV1 eradication, with the number of cases globally remaining low in 2018.  In addition, there has now been no international spread of WPV1 since October 2017.

The Committee commended the continued high level commitment seen in both Afghanistan and Pakistan, and the high degree of cooperation and coordination, particularly targeting the high risk mobile populations that frequently cross the international border.  The joint planning to cease transmission in the two recognized zones of transmission (the northern corridor which extends from Nangarhar to Islamabad and Rawalpindi, and the southern corridor from Kandahar to Quetta Block) is a key to success in achieving WPV eradication in Pakistan and Afghanistan, the region, and globally.

The Committee commended the achievements in Pakistan that have resulted in a sustained reduction in the number of cases, with only one case so far in 2018, and a fall in the proportion of environmental samples that have tested positive for WPV1.  No orphan virus (viruses that are not closely related to any other virus based on genetic analysis) has been detected so far in 2018, giving some confidence that surveillance is working well.  Notable achievements include better quality supplementary immunization activities (SIA) and improved communication to reduce missed children.  However, environmental surveillance continues to detect WPV1 transmission in many high risk areas of the country such as Karachi, Peshawar and the Quetta Block.  The robust response to environmental detections of WPV was welcomed.

The Committee was concerned by the stagnation in progress in Afghanistan and the ongoing risks to eradication posed by the number of inaccessible and missed children, particularly in the southern and eastern regions, resulting in fourteen cases in 2017, and already seven cases in 2018.  The continued inaccessibility in Kandahar, Paktika, and parts of Nangarhar and Kunar, and issues with vaccine acceptance in some high risk areas particularly in Kandahar, the Bermel district of Paktika, and Kunar are the biggest challenges.  Of greatest concern are the children chronically unreached by the polio program, these numbering around 13,000 children in Shahwalikot and 40,000 children living in areas controlled by militant anti- government elements in the eastern region.

The Committee commended the innovations that continue to be made in Nigeria to reach children in Borno, where the number of inaccessible children has fallen from 160,000 in late 2017 to around 104,000 currently.  While certain cross border activities are being undertaken, such as international synchronization of vaccination campaigns, these efforts appeared to be insufficient to ensure that any poliovirus still circulating undetected is not exported to neighboring Lake Chad basin countries. The Committee also noted that routine immunization coverage is low, particularly in high risk areas of northern Nigeria. The country however has declared routine immunization a national public health emergency and is actively planning for Gavi transition with strengthening of its routine immunization program in mind.  Although it is over 19 months since the last detection of WPV1 in Nigeria, the outbreak response assessment by global polio experts concluded ongoing undetected transmission could not be ruled out.

There is ongoing concern about the districts of the neighboring countries of the Lake Chad basin region that have been affected by the Boko Haram insurgency, with the consequent lack of services and presence of IDPs and refugees. The risk of international spread from Nigeria to the Lake Chad basin countries or further afield in sub-Saharan Africa remains substantial. The Committee was encouraged that the Lake Chad basin countries, Cameroon, Chad, the Central African Republic (CAR), Niger and Nigeria continued to be committed to sub-regional coordination of immunization and surveillance activities.  However, there are widespread persistent gaps in population immunity across these countries, and the ongoing population movement in the sub-region and insecurity are major challenges.  The committee urged that work to characterize and vaccinate transient and permanent populations on the Lake Chad islands continue urgently.

Vaccine derived poliovirus
The committee noted that in DR Congo, the vaccine-derived polio outbreak has now been declared a public health emergency, with resources being made available for an emergency operation centre, appointment of a national outbreak coordinator, and other resources.  However, there has been further transmission into new areas not covered by previous mOPV2 campaigns, with the report of a case in Haut Katanga province, and another eight cases reported in previously affected provinces.  Further rounds with mOPV2 are being planned.  Risks are compounded by poor surveillance in many areas, and widespread gaps in population immunity.  It was noted that upcoming elections with the possibility of civil unrest posed an additional risk to the ability of the country to halt the outbreak.  The movement of refugees and IDPs increases the risk of further spread, and the IPV shortage in neighboring countries is another risk, with the under 2 age group vulnerable to type 2 infection.  In DR Congo, insecurity and geographical remoteness of the affected area pose significant challenges to controlling the outbreak.

The committee noted that in Syria, there has been no new case for more than six months, giving hope that transmission may have stopped.  However, while AFP surveillance indicators are good, and environmental surveillance is now in operation, low level transmission cannot yet be ruled out.

The new outbreak of cVDPV2 with international spread affecting Somalia and Kenya is a major concern, together with the recent detection of cVDPV3 by environmental sampling in Mogadishu.  While the robust response to date was commendable, the lack of clarity about where the virus emerged and circulated for a prolonged period prior to detection means that it remains unsure whether the population currently being targeted is sufficient.  The persistently inaccessible districts in the South and Central zones of Somalia makes an effective response extremely difficult, with more than 300,000 children aged under 5 years believed to be living in these districts.  Nomadic and refugee movement make other areas in the sub-region (e.g. Somali region of Ethiopia, north east Kenya, and Yemen) potentially at risk of international spread.

The new outbreak of cVDPV2 recently detected in Jigawa, Nigeria, again underlines the vulnerability of northern Nigeria to poliovirus transmission.

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months.

The Committee considered the following factors in reaching this conclusion:
:: Although the risk of international spread of WPV may be diminishing as transmission falls, the impact of any delay in eradicating WPV caused by international spread, should it occur now, would be even more grave in terms of delaying certification and the need to maintain human and financial resources for a longer period to achieve eradication.The risk of global complacency developing increases as the numbers of WPV cases remains low and eradication becomes a tangible reality, and removing the PHEIC now could contribute to greater complacency, particularly at an inopportune time given the upcoming Hajj with its heightened population movement.
:: Many countries remain vulnerable to WPV importation, as evidenced by gaps in population immunity in several key high risk areas, and also the current number of cVDPV outbreaks, both type 2 and 3, which only emerge and circulate due to lack of polio population immunity.
:: Inaccessibility to vaccination programs remains another major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria and Somalia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.
   :: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees. There is a need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries in and bordering the Horn of Africa and DR Congo.
:: The inaccessible population in Borno state in Nigeria remains substantial despite the commendable efforts to reach all settlements.These populations have not received polio vaccine since WPV1 was detected in 2016, so ongoing transmission in these unreached pockets cannot be ruled out. The risk of transmission in the Lake Chad sub-region appears considerable, with significant gaps in population immunity in these vulnerable countries, compounded by international population movement.
:: The new international outbreak of cVDPV2 affecting Somalia and Kenya, with a highly diverged cVDPV2 that appears to have circulated undetected for up to four years highlights that there are still high-risk populations in South and Central zones of Somalia where population immunity and surveillance are compromised by inaccessibility.
:: The ongoing spread of cVDPV2 in DR Congo demonstrates significant gaps in population immunity at a critical time in the polio endgame; the lack of IPV vaccination in several countries neighboring DR Congo heightens the risk of international spread, as population immunity is rapidly waning.
:: The increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses another risk. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: A regional approach and strong cross­border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders…

Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets.  The Committee also noted that surveillance in these areas may also be sub-optimal, particularly where access is compromised by conflict. The Committee strongly encourages all these countries to make further efforts to improve routine immunization and strengthen surveillance in such areas, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also urged that Nigeria and the Lake Chad countries increase cross border efforts and joint planning and response.  Intensified effort is needed to identify and reach vulnerable populations in the sub-region, particularly in the Lake Chad islands.  Nigeria should ensure continuing political commitment and take measures to counter fatigue in the fight against polio.  Similarly, the DR Congo government needs to pay more attention to prevention of international spread of cVDPV2 from DR Congo, noting that neighboring countries are affected by the global shortage of IPV.

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by Afghanistan, DR Congo, Kenya, Pakistan, and Somalia, the Director-General accepted the Committee’s assessment and on 7 May 2018 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 7 May 2018.

Emergencies

WHO Grade 3 Emergencies  [to 12 May 2018]
Yemen 
:: Fighting the world’s largest cholera outbreak: oral cholera vaccination campaign begins in Yemen   Aden, 10 May 2018
[See Milestones above for more detail]

::::::
 
WHO Grade 2 Emergencies  [to 12 May 2018]
[Several emergency pages were not available at inquiry]
Myanmar
:: One million Rohingya refugees, host communities being vaccinated against cholera
SEAR/PR/1689
Cox’s Bazar, 6 May 2018: A massive cholera vaccination campaign began today to protect nearly one million Rohingyas and their host communities living in and around the refugee camps in Bangladesh, to prevent any potential outbreak during the ongoing monsoon season.
This is a second cholera vaccination campaign being held for the Rohingyas and their host communities. Earlier 900,000 doses of oral cholera vaccine were administered to the vulnerable population in two phases in October – November last year.
“Considering the water and sanitation conditions in the overcrowded camps and the increased risk of disease outbreaks in the monsoon season, the health sector is taking all possible measures to prevent cholera and other water and vector borne diseases,” says Dr. Bardan Jung Rana, WHO Representative to Bangladesh…

Looming monsoons and little funding threaten health gains in Cox’s Bazar
8 May 2018   News Release  Geneva
With monsoon hitting Bangladesh, WHO warns that life-saving health services for 1.3 million people—Rohingya refugees and host communities— living in Cox’s Bazar are under serious threat, unless urgent funding is secured.
Scaling up health operations since September 2017, WHO and health partners have supported the Government of Bangladesh in saving thousands of lives of refugees who crossed over from Myanmar in large numbers in a very short span of time. Given the high risk of outbreaks among the refugees in overcrowded, unsanitary camps, WHO prioritized disease control from the outset.
WHO rapidly set up a vital disease early warning system, and together with government and partners administered over 3 million doses of life- saving vaccines against deadly diseases such as cholera, measles, rubella, diphtheria, tetanus and polio. When an outbreak of diphtheria was detected, WHO responded rapidly, bringing in international experts, emergency medical teams and medicines and medical supplies.
To protect communities from a potential cholera outbreak during monsoon season, WHO and partners began a massive oral cholera vaccination campaign on 6 May. Nearly one million Rohingyas and their host community will be targeted. This is the third oral cholera vaccination campaign that builds on two rounds of vaccination last year that reached around 900,000 people…

::::::
::::::
 
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  
:: Turkey | Syria: Situation in North-western Syria – Situation Report No.4 (as of 8 May 2018)

Yemen 
:: Yemen Humanitarian Update Covering 1 – 7 May 2018 | Issue 14

::::::

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 #4 – Humanitarian impact of heavy rains | 8 May 2018

Ethiopia
:: Ethiopia – Floods Flash Update #2, 10 May 2018

WHO & Regional Offices [to 12 May 2018]

WHO & Regional Offices [to 12 May 2018]

See Milestones above for coverage of Ebola and Yemen.
 
Weekly Epidemiological Record, 11 May 2018, vol. 93, 19 (pp. 241–248)
Progress towards polio eradication, worldwide, January 2016–March 2018

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO supports South Sudan in vaccination campaign against cholera before transmission season   11 May 2018
:: Nigeria’s Lassa fever outbreak contained, but continued vigilance needed  10 May 2018
:: 600 000 people to benefit from oral cholera vaccines in Bauchi, Nigeria  10 May 2018
:: New Ebola outbreak declared in Democratic Republic of the Congo  09 May 2018
:: Largest cholera vaccine drive in history to target spike in outbreaks  08 May 2018
:: WHO supports six African countries conduct first joint health emergency operations exercise
08 May 2018

WHO Region of the Americas PAHO
:: Mosquito Awareness Week: Calling all citizens to the frontlines of mosquito control (05/10/2018)
:: PAHO calls on the role of nurses in primary health care to be expanded (05/10/2018)
:: Protecting achievements; expanding diagnosis and treatment; and preventing mother to child transmission – All vital elements of the fight against Chagas (05/07/2018)

WHO South-East Asia Region SEARO
:: One million Rohingya refugees, host communities being vaccinated against cholera  SEAR/PR/1689  Cox’s Bazar, 6 May 2018:
 
WHO European Region EURO
:: World Health Day 2018 in the WHO European Region – making health about the people, for the people 09-05-2018
:: Small team of cancer nurses has a big impact on Scotland’s Western Isles 08-05-2018
:: Fostering healthier and more sustainable diets – learning from the Mediterranean and New Nordic experience 07-05-2018

WHO Eastern Mediterranean Region EMRO
:: Last nationwide vaccination campaign in Afghanistan starts before the high transmission season for poliovirus  6 May 2018

WHO Western Pacific Region
:: Doing it for themselves: Peer-led HIV testing in Viet Nam improves access to care
7 May 2018

CDC/ACIP [to 12 May 2018]

CDC/ACIP [to 12 May 2018]

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

Thursday, May 10, 2018
Three CDC scientists named as 2018 Service to America Medal Finalists

MMWR News Synopsis for May 10, 2018
Progress Toward Polio Eradication – Worldwide, January 2016-March 2018
In 2016-2017 there was progress toward global eradication of wild poliovirus (WPV). To date in 2018 (as of April 24) there have been more reported WPV than in  the same time period in 2017. Identifying and vaccinating every last child remains challenging, but is necessary to end WPV transmission in Afghanistan, Nigeria, and Pakistan and to prevent outbreaks of circulating vaccine-derived polioviruses (cVDPV). Progress continued toward global eradication of wild poliovirus (WPV) in 2016-2017. WPV transmission continues in three countries — Afghanistan, Nigeria, and Pakistan. Reported WPV cases worldwide decreased from 37 in 2016 to 22 in 2017; to date in 2018 (as of April 24), eight WPV cases have been reported, compared to five during the same time period in 2017. Areas with low vaccination coverage, frequently due to inaccessibility and conflict, are at risk for not only WPV but also circulating vaccine-derived polioviruses (cVDPV). Stopping WPV transmission and prevention of cVDPV outbreaks will require reaching all unvaccinated children in hard-to-reach areas globally. As long as polio exists anywhere, it remains a threat everywhere. All countries must maintain high population immunity and strong poliovirus surveillance.

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.

ECDC – European Centre for Disease Prevention and Control  [to 12 May 2018]

ECDC – European Centre for Disease Prevention and Control  [to 12 May 2018]

https://ecdc.europa.eu/en/home
7 May 2018
First detected cases of extensively drug-resistant gonorrhoea
Within a matter of weeks, three cases of gonorrhoea that are resistant to the recommended first line antibiotic treatment have been detected in Europe and Australia. These are the first global reports of Neisseria gonorrhoeae with high-level resistance to azithromycin and ceftriaxone resistance that also show resistance to several other vital antibiotics. At a time with limited alternatives to the current dual therapy, lack of a vaccine and insufficient surveillance capacity in some regions, these cases highlight the growing threat of drug-resistance – which could lead to untreatable gonorrhoea.

Announcements

Announcements
 
FDA [to 12 May 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
May 11, 2018, 16:10 ET
Statement from FDA Commissioner Scott Gottlieb, M.D., on the Trump Administration’s plan to lower drug prices
 
 
Gavi [to 12 May 2018]
http://www.gavi.org/library/news/press-releases/
09 May 2018
IFPW and Gavi expand leadership training for a stronger supply chain
The partnership draws on private sector support to implement an innovative training and mentorship programme for supply chain managers in Gavi-supported countries.
07 May 2018

New management training for immunisation leaders kicks-off in Kigali
24 managers from five Gavi-supported countries will attend the first round of the nine-month programme.
07 May 2018

Largest cholera vaccine drive in history to target spike in outbreaks
Two million people in five African countries to be protected against cholera.
07 May 2018

Global Fund [to 12 May 2018]
http://www.theglobalfund.org/en/news/?topic=&type=NEWS;&country=
News
Global Fund Board Strengthens Sustainability and Domestic Financing
10 May 2018
SKOPJE – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, at its 39th Board meeting, highlighted the importance of strengthening sustainability and supporting successful transition to domestic financing to build long-term solutions and achieve greater health security.
The Global Fund is committed to being a good partner in working toward sustainability, acting as a catalyst to additional investment, filling short-term gaps, and addressing bottlenecks to successful transition to more domestic funding. While shifting financing often includes challenges, including how to effectively fund civil society, transition increases country ownership and is necessary to end epidemics.
Prime Minister Zoran Zaev spoke to the Board about the importance of allocating sufficient resources and engaging civil society in developing long-term sustainability of health programs. He expressed strong confidence that a collective approach can lead to success…

IVAC  [to 12 May 2018]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Undated

Now Available: HERMES (Highly Extensible Resource for Modeling Event-Driven Supply Chains)
Systems modeling is a tool for policymakers and program managers to capture all the direct and indirect effects of changes to a system, identify sustainable solutions to the root causes of issues and save time, effort, and resources in costly trial and error. Without systems modeling, evaluating systems, identifying gaps, and implementing solutions can be insufficient, unsustainable, and costly.

Vaccine supply chains are complex systems, comprising all the equipment, personnel, policies and processes needed to deliver a vaccine from its point of origin to the population. Understanding how the various components of a vaccine supply chain interact with each other is critical to evaluating supply chain function, identifying the root causes of issues, and formulating sustainable solutions…

About HERMES
Funded by the Bill & Melinda Gates Foundation, HERMES is a software program that allows users to generate a detailed computer simulation model of a supply chain. Researchers from the Global Obesity Prevention Center (GOPC) and International Vaccine Access Center (IVAC) at Johns Hopkins University, as well as the Pittsburgh Supercomputing Center (PSC) at Carnegie Mellon University, are releasing the new HERMES software to help decision makers around the world improve the delivery of vaccines. The model can serve as a “virtual laboratory” for users to evaluate a supply chain and test the effects of implementing different potential policies, interventions, practices, and technology changes…
 
 
IVI   [to 12 May 2018]
http://www.ivi.int/
IVI acquires $6.46 million grant to measure single dose impact of HPV vaccine
The International Vaccine Institute (IVI) has acquired a 6.46 million-dollar grant from the Bill & Melinda Gates Foundation to conduct a Human papillomavirus (HPV) vaccine single-dose impact study in Thailand.  The study will be conducted in partnership with the Thailand Ministry of Public Health and proposes to measure the effectiveness of a single-dose of HPV vaccine administered to young women in Thailand, while also generating data of single dose effectiveness to inform global public health policy. IVI will receive a total of $6,465,516 from the foundation for this study through October 2023.

HPV is the most common viral infection of the reproductive tract. Some HPV strains are harmless but others cause cervical cancer, with HPV infection responsible for nearly all cases of cervical cancer. According to the World Health Organization, globally, cervical cancer is the fourth most common cancer in women with an estimated 530,000 new cases in 2012 alone, and accounts for 7.5 percent of all female cancer deaths. It is estimated that more than 270,000 die from cervical cancer yearly, with over 85 percent of these deaths occurring in less developed regions.

There are currently two internationally licensed HPV vaccines: Gardasil and Cervarix. Both vaccines are shown to be safe and very effective in preventing infection with HPV 16 and 18, which are known to cause at least 70 percent of all cervical cancers. By mid-2016, 65 countries had introduced HPV vaccines, including a growing number of middle- and low-income countries. Both vaccines are administered in a two- or three-dose regimen, which can be costly.

“Data of single dose effectiveness can be highly useful in informing the most cost-effective approach to HPV vaccination and global public health policy,” said Dr. Julia Lynch, Deputy Director General for Development and Delivery at IVI, who will lead the study. “If one dose is confirmed to offer sufficient protection, it could significantly reduce vaccine and administration costs while increasing uptake to save more lives.”
 
 
JEE Alliance  [to 12 May 2018]
https://www.jeealliance.org/
11.5.2018   Events
“Investing for a Rainy Day: How to Finance Outbreak Preparedness?”
Geneva
 
 
MSF/Médecins Sans Frontières  [to 12 May 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
MSF Responds to President Trump’s Speech on Drug Pricing
May 11, 2018
The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) made the following statement today in response to President Trump’s speech on drug pricing.

Press release
DRC: Emergency Team Supports Rapid Response to Ebola Cases
May 09, 2018
[See Milestones above for more detail]

Press release
Yemen: Scores of civilians treated after airstrikes target Sana’a city center
May 08, 2018
A series of airstrikes by the Saudi and Emirati-led coalition aimed at the Presidential office in the heart of Sana’a, Yemen, killed at least six people and injured 72 others on Monday morning, according to staff at two hospitals supported by Doctors Without Borders/Médecins Sans Frontières (MSF) who received the dead and wounded. The airstrikes took place in a bustling area near a hotel, bank, pharmacies, and shops.

 
NIH  [to 12 May 2018]
http://www.nih.gov/news-events/news-releases
May 8, 2018
Despite mutations in Makona Ebola virus, disease consistent in mice, monkeys
— Scientists previously speculated that genetic diversity of the Makona strain would result in more severe disease.
 
 
PATH  [to 12 May 2018]
http://www.path.org/news/index.php
Press release | May 07, 2018
New management training for immunisation leaders kicks-off in Kigali
24 managers from five Gavi-supported countries will attend the first round of the nine-month programme
KIGALI, May 7 2018—Yale’s Global Health Leadership Initiative (GHLI), the Rwanda-based University of Global Health Equity (UGHE), PATH, and Gavi, the Vaccine Alliance have joined forces to strengthen national leadership and management of immunisation programmes in Gavi-supported countries. The Expanded Program on Immunisation Leadership and Management Programme (EPI LAMP) is an innovative management training course for immunisation leaders in developing countries. The programme will improve the managerial capacity of governments to support Gavi’s mission to ensure every child is protected with lifesaving vaccines…

Sabin Vaccine Institute  [to 12 May 2018]
http://www.sabin.org/updates/pressreleases
May 7, 2018
Georgian Leaders Gather to Discuss Immunization Regulations
TBILISI, GEORGIA —— Today, the Sabin Vaccine Institute and the Ministry of Labour, Health and Social Affairs of Georgia, together with the Parliament of Georgia, assembled senior officials and stakeholders to evaluate and prioritize policies to improve routine immunization coverage in Georgia.
 
 
UNAIDS [to 12 May 2018]
http://www.unaids.org/en
11 May 2018  Feature story
UNAIDS Executive Director puts the spotlight on the HIV response in Lesotho, South Africa and Zambia during five-day visit
UNAIDS Executive Director, Michel Sidibé, completed a five-day visit to three countries in southern Africa. The mission included high-level political discussions, the launch of the Lesotho HIV Health and Situation Room and frank and an open dialogue with women activists about how to address sexual harassment and abuse.

07 May 2018  Feature story
Measuring progress against the 10 commitments through Global AIDS Monitoring
At the United Nations High-Level Meeting on Ending AIDS in 2016, countries pledged to achieve a set of 10 Fast-Track commitments by 2020—an acceleration agenda that aims to end the AIDS epidemic by 2030 as part of the Sustainable Development Goals. To help ensure that the deadlines are met, the United Nations General Assembly requested an annual report on progress achieved in meeting those 10 commitments.
UNAIDS supports countries to collect information on their national HIV responses through the Global AIDS Monitoring (GAM) framework—an annual collection of 72 indicators on the response to HIV in a country. These data form part of the data set used to report back to the General Assembly.

07 May 2018  Feature story
Heads of H6 agencies embrace new results framework
…To accelerate change, the executive heads of the H6 partnership met on the sidelines of the United Nations System Chief Executives Board in London, United Kingdom, on 2 May and agreed a new results framework, H6 Results 2020. H6 Results 2020 aims to shape the H6 partnership into a trusted, valued source for technical support, strategic policy advice and best practices for the health and well-being of women, children and adolescents.
Developed under the chairpersonship of UNAIDS Executive Director Michel Sidibé, H6 Results 2020 is closely aligned with the Every Woman Every Child Every Adolescent Global Strategy and the 2020 Every Woman Every Child Partners’ Framework. H6 Results 2020 sets ambitious goals while committing to deliver on a number of concrete results for 2020.
“I am excited about our revitalized H6 partnership. As the technical arm of the Every Woman Every Child movement, we plan to further streamline and simplify the health architecture, coordinating with key partners to leverage political capital, technical expertise and advocacy for results for women, children and adolescents everywhere,” said Mr Sidibé…

UNICEF  [to 12 May 2018]
https://www.unicef.org/media/
Selected Press Releases/Reports
770,000 children under five suffering from acute malnutrition in Kasai region of Democratic Republic of the Congo
NEW YORK/DAKAR/GENEVA/JOHANNESBURG/KINSHASA, 11 May 2018 – At least 770,000 children in the Kasai region in the Democratic Republic of Congo are suffering from acute malnutrition, including 400,000 children who are severely malnourished and at risk of death – UNICEF said in a report released today. The children’s agency went on to warn that unless urgent action was taken to strengthen the humanitarian response, the number of child deaths could skyrocket.

UNICEF welcomes Education Under Attack report
NEW YORK, 10 May 2018 – Speaking today at the launch of Education under Attack 2018, a new report by the Global Coalition to Protect Education from Attack (GCPEA), Shahida Afzar, UNICEF Deputy Executive Director, said: “Today’s report is helping us shine a light on an issue that is too often overlooked. Children are under attack around the globe.

On Mother’s Day, UNICEF calls for the narrowing of “breastfeeding gaps” between rich and poor worldwide
NEW YORK, 10 May 2018 – The number of babies missing out on breastfeeding remains high, particularly among the world’s richest countries, UNICEF said in a new analysis released today. Worldwide, approximately 7.6 million babies each year are not breastfed.

Immunization Financing in MENA Middle-Income Countries
May 2018
PDF: https://www.unicef.org/mena/sites/unicef.org.mena/files/2018-04/immunization%20financing%20Web_0.pdf
Highlights 
Most MENA countries have high immunization coverage rates. But immunization coverage has dropped considerably in some (including Iraq, the Syrian Arab Republic and Yemen), due to the conflicts, instability and the prevailing geopolitical situation in the region. Approximately 1.3 million surviving infants in MENA missed their third dose of DTP vaccine in 2016. In many of the region’s countries, problems of equity persist, particularly concerning displaced populations, nomads, ethnic groups and marginalized urban populations.
Key Points:
:: The Ministry of Health budget remains the mainstay of immunization financing in most of the countries.
:: New vaccine introductions pose challenges for the region.
:: The Sudan will be the first of the Gavi countries in MENA to move into the ‘accelerated transition process’
:: Local and external factors have made procuring and purchasing vaccines and related products a considerable challenge for most MENA countries.

Wellcome Trust  [to 12 May 2018]
https://wellcome.ac.uk/news
News  Published: 10 May 2018
Wellcome pledges £2m after new Ebola outbreak confirmed
Wellcome is making an initial fund of up to £2 million available to support a rapid response to the new Ebola outbreak in the Democratic Republic of Congo (DRC).
The pledge comes after the DRC government announced the latest outbreak this week, following tests that confirmed two cases of Ebola in the Bikoro area, near the north-west border. It’s the ninth Ebola outbreak in DRC.
The funding will be available to the government of the DRC and the World Health Organization (WHO) for the critical research needed to support the operational response now underway in the country.
Wellcome’s £2m emergency funding will also be supported by £1m funding from the UK Department for International Development (DFID) through the Joint Initiative on Epidemic Preparedness.
Jeremy Farrar, Director of Wellcome, said: “It’s vital the global response to this outbreak is swift. We know from previous outbreaks that the DRC are ready to act, but they need global support to ensure this outbreak is contained effectively. We must ensure the very best protection for the communities at risk and for the health workers working to protect lives – now and for future outbreaks…

Distinguished scientists elected as Fellows and Foreign Members of the Royal Society
09 May 2018 – Fifty eminent scientists have been elected as Fellows of the Royal Society and ten as new Foreign Members for their exceptional contributions to science…
[10 Wellcome researchers have today been elected Fellows of @royalsociety. They are named in a list that celebrates over 50 eminent scientists and researchers for their exceptional contributions to science.]

::::::
 
BIO    [to 12 May 2018]
https://www.bio.org/insights/press-release
May 11 2018
BIO Statement on Trump Administration’s Plan to Lower Drug Costs
“We have concerns that some of the ideas proposed today could, if adopted, hurt patient access to the medicines they need …”

DCVMN – Developing Country Vaccine Manufacturers Network  [to 12 May 2018]
http://www.dcvmn.org/
19 April 2018
Biovac awarded manufacturing licence
Cape Town, 18 April 2018 – The Biovac Institute (Biovac) has been awarded a manufacturing licence by a South African regulator, taking it one step closer to realising the government’s ambition of producing its own vaccines.
Biovac is a public-private partnership that was formed in 2003 to try and revitalise the state’s human vaccine manufacturing capacity, after the demise of the state vaccine institute…
 
PhRMA    [to 12 May 2018]
http://www.phrma.org/press-room
May 11, 2018
PhRMA Statement on President Trump’s Drug Pricing Blueprint
PhRMA president and CEO Stephen J. Ubl issued a statement on President Donald Trump’s drug pricing blueprint.
“These far-reaching proposals could fundamentally change how patients access medicines and realign incentives across the entire prescription drug supply chain. While some of these proposals could help make medicines more affordable for patients, others would disrupt coverage and limit patients’ access to innovative treatments…

Industry Watch    [to 12 May 2018]
:: Proposed Acquisition of Shire plc by Takeda  May 8, 2018 Osaka, Japan
Transaction Highlights
:: Brings together complementary positions in gastroenterology (GI) and neuroscience; provides leading positions in rare diseases and plasma-derived therapies to complement strength in oncology and focused efforts in vaccines
:: Creates a global, values-based, R&D-driven biopharmaceutical leader headquartered in Japan, with an attractive geographic footprint and provides the scale to drive future development
:: Creates a highly complementary, robust, modality-diverse pipeline and a strengthened R&D engine focused on breakthrough innovation
:: Enhances Takeda’s cash flow profile, with management confident of delivering substantial annual cost synergies and generating attractive returns for shareholders
:: Takeda’s transformation positions the combined group to successfully integrate Shire and maximize value from the combination

 

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

Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey

American Journal of Tropical Medicine and Hygiene
Volume 98, Issue 5, 2018
http://www.ajtmh.org/content/journals/14761645/98/5

Articles
Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey
Authors: Mary H. Hayden, Erika Barrett, Guyah Bernard, Eunice N. Toko, Maurice Agawo, Amanda M. Okello, Jayleen K. L. Gunn and Kacey C. Ernst
https://doi.org/10.4269/ajtmh.17-0693

Evaluating Vaccination Strategies for Zika Virus in the Americas

Annals of Internal Medicine
1 May 2018 Vol: 168, Issue 9
http://annals.org/aim/issue

Original Research
Evaluating Vaccination Strategies for Zika Virus in the Americas
David P. Durham, PhD; Meagan C. Fitzpatrick, PhD; Martial L. Ndeffo-Mbah, PhD; Alyssa S. Parpia, MPH; Nelson L. Michael, MD, PhD; Alison P. Galvani, PhD
Conclusion:
A Zika vaccine of moderate to high efficacy may virtually eliminate prenatal infections through a combination of direct protection and transmission reduction. Efficiency of age-specific targeting of Zika vaccination depends on the timing of future outbreaks.

Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper

Annals of Internal Medicine
1 May 2018 Vol: 168, Issue 9
http://annals.org/aim/issue

Position Papers
Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper
Matthew DeCamp, MD, PhD; Lisa Soleymani Lehmann, MD, PhD; Pooja Jaeel, MD; Carrie Horwitch, MD, MPH; for the ACP Ethics, Professionalism and Human Rights Committee *
Abstract
This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low-technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them.

Humanitarian response in urban areas

Humanitarian Exchange Magazine
Number 71  March 2018
https://odihpn.org/magazine/humanitarian-response-urban-areas/

Humanitarian response in urban areas
Humanitarian crises are increasingly affecting urban areas either directly, through civil conflict, hazards such as flooding or earthquakes, urban violence or outbreaks of disease, or indirectly, through hosting people fleeing these threats. The humanitarian sector has been slow to understand how the challenges and opportunities of working in urban spaces necessitate changes in how they operate. For agencies used to working in rural contexts, the dynamism of the city, with its reliance on markets, complex systems and intricate logistics, can be a daunting challenge. Huge, diverse and mobile populations complicate needs assessments, and close coordination with other, often unfamiliar, actors is necessary.
[Reviewed earlier]

Vaccination Patterns in Children After Autism Spectrum Disorder Diagnosis and in Their Younger Siblings

JAMA Pediatrics
May 2018, Vol 172, No. 5, Pages 401-504
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation
Vaccination Patterns in Children After Autism Spectrum Disorder Diagnosis and in Their Younger Siblings
Ousseny Zerbo, PhD; Sharareh Modaressi, MPH; Kristin Goddard, MPH; et al.
JAMA Pediatr. 2018;172(5):469-475. doi:10.1001/jamapediatrics.2018.0082
This matched cohort study investigates if children after receiving an autism spectrum disorder diagnosis obtain their remaining scheduled vaccines and compares their vaccination patterns with those of younger siblings of children without autism spectrum disorder.

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination A Cluster Randomized Clinical Trial

JAMA Pediatrics
May 2018, Vol 172, No. 5, Pages 401-504
http://archpedi.jamanetwork.com/issue.aspx
Special Communication

Effect of a Health Care Professional Communication Training Intervention on Adolescent Human Papillomavirus Vaccination A Cluster Randomized Clinical Trial
Amanda F. Dempsey, MD, PhD, MPH; Jennifer Pyrznawoski, MSPH; Steven Lockhart, MPH; et al.
JAMA Pediatr. 2018;172(5):e180016. doi:10.1001/jamapediatrics.2018.0016
This cluster randomized clinical trial evaluates the effect of a 5-component health care professional human papillomavirus vaccine communication intervention on adolescent human papillomavirus vaccination.

Key Implications of Data Sharing in Pediatric Genomics

JAMA Pediatrics
May 2018, Vol 172, No. 5, Pages 401-504
http://archpedi.jamanetwork.com/issue.aspx
Special Communication

Key Implications of Data Sharing in Pediatric Genomics
Vasiliki Rahimzadeh, MSc; Christoph Schickhardt, JD, PhD; Bartha M. Knoppers, PhD; et al.
JAMA Pediatr. 2018;172(5):476-481. doi:10.1001/jamapediatrics.2017.5500
This special communication discusses the current ethical, legal, and social implications of sharing genomic and associated clinical data involving children.
Abstract
Accurate clinical interpretation of children’s whole-genome and whole-exome sequences relies on comparing the patient’s linked genomic and phenotypic data with variant reference databases of both healthy and affected patients. The robustness of such comparisons, in turn, is made possible by sharing pediatric genomic and associated clinical data. Despite this, sparse ethical-legal policy attention has been paid to making such sharing routine in practice. The interdisciplinary Paediatric Task Team of the Global Alliance for Genomics and Health considered in detail the current ethical, legal, and social implications of sharing genomic and associated clinical data involving children. An initial set of points to consider was presented at a meeting of the Paediatric Task Team at the 4th Plenary of the Global Alliance for Genomics and Health. The Key Implications for Data Sharing (KIDS) framework for pediatric genomics was developed based on feedback from this group and was supplemented by findings from a critical appraisal of the data-sharing literature. The final points to consider that comprise the KIDS framework are categorized into the following 4 primary themes: children’s involvement, parental consent, balancing benefits and risks, and data protection and release requirements.

Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh

The Lancet
May 12, 2018 Volume 391 Number 10133 p1865-1964
http://www.thelancet.com/journals/lancet/issue/current

Comment
Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh
Firdausi Qadri, Abul Kalam Azad, Meerjady Sabrina Flora, Ashraful Islam Khan, Md Taufiqul
…This OCV campaign was undertaken in challenging conditions and provides a model for pre-emptive delivery of OCV from the stockpile to prevent major cholera epidemics in complex humanitarian emergencies at high risk for cholera. It shows the importance of cooperation and collaboration of governments, the ICG OCV stockpile group, and international partners for OCV implementation in humanitarian crises. The conditions in which the Rohingya live remain precarious. Although the OCV campaign has so far appeared to prevent a cholera outbreak or epidemic, there has been a continued influx of unvaccinated Rohingya after the campaign who, together with people who were missed in the campaign or received only a single dose, constitute a potentially at-risk population as the major cholera season approaches. Provision of adequate clean water and sanitation remains a challenge and there are fears that cyclones and landslides will further aggravate the situation. Accordingly, an additional tranche of OCV doses from the stockpile was approved on April 12, 2018, and vaccination of the new arrivals and of the host population living in close proximity and those aged 5 years and older at the time of the earlier campaign, who received only a single dose, began on May 6, 2018.

icddr,b and the IEDCR were involved in leading the surveillance described in this Comment and all the authors were involved in supporting the OCV campaigns…

Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales

The Lancet
May 12, 2018 Volume 391 Number 10133 p1865-1964
http://www.thelancet.com/journals/lancet/issue/current

Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales
Justin Lessler, Sean M Moore, Francisco J Luquero, Heather S McKay, Rebecca Grais, Myriam Henkens, Martin Mengel, Jessica Dunoyer, Maurice M’bangombe, Elizabeth C Lee, Mamoudou Harouna Djingarey, Bertrand Sudre, Didier Bompangue, Robert S M Fraser, Abdinasir Abubakar, William Perea, Dominique Legros, Andrew S Azman

Pathology and laboratory medicine in low-income and middle-income countries Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

The Lancet
May 12, 2018 Volume 391 Number 10133 p1865-1964
http://www.thelancet.com/journals/lancet/issue/current

Pathology and laboratory medicine in low-income and middle-income countries
Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action
Susan Horton, Richard Sullivan, John Flanigan, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Sanjay A Pai, Mark Lawler

Passive immunotherapy of viral infections: ‘super-antibodies’ enter the fray

Nature Reviews Immunology
Volume 18 Issue 5, May 2018
https://www.nature.com/nri/journal/v18/n4/index.html

Review Article | 30 January 2018
Passive immunotherapy of viral infections: ‘super-antibodies’ enter the fray
So-called super-antibodies are highly potent, broadly reactive antiviral antibodies that offer promise for the treatment of various chronic and emerging viruses. This Review describes how recent technological advances led to their isolation from rare, infected individuals and their development for the prevention and treatment of various viral infections.
Laura M. Walker  & Dennis R. Burton

Zika virus outbreak in Suriname, a report based on laboratory surveillance data

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
[Accessed 12 May 2018]

Zika virus outbreak in Suriname, a report based on laboratory surveillance data
May 10, 2018 · Research Article
Introduction : Since the identification of ZIKV in Brazil in May 2015, the virus has spread extensively throughout the Americas. Cases of ZIKV infection have been reported in Suriname since October 2, 2015.  Methods : A laboratory-based surveillance system was quickly implemented according to previous experience with the emergence of chikungunya. General practitioners and public health centers located in different districts of Suriname were asked to send blood samples from suspicious cases to Academic Hospital for molecular diagnosis of Zika virus infection. We investigated Zika-related laboratory data collected during surveillance and response activities to provide the first outbreak report in Suriname in terms of time, location and person. Results : A total of 791 molecularly confirmed cases were reported during a 48-week interval from October 2015 to August 2016. The majority of ZIKV-positive cases involved women between 20 and 39 years of age, reflecting concern about Zika infection during pregnancy. The outbreak peaked in mid-January and gradually spread from the district of Paramaribo to western coastal areas. Discussion : This report provides a simple and comprehensive description of the outbreak in Suriname and demonstrates the utility of laboratory data to highlight the spatiotemporal dynamics of the outbreak in that country.

The next forum for unraveling FDA off-label marketing rules: State and federal legislatures

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 12 May 2018)

Editorial
The next forum for unraveling FDA off-label marketing rules: State and federal legislatures
Michael S. Sinha, Aaron S. Kesselheim
Editorial | published 08 May 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002564
…Buoyed by a narrow victory in one appeals court, advocates have turned to state and federal legislatures to unravel current FDA rules relating to off-label promotion. But these rules are essential for the ability of the FDA to fulfill its public health mission by defining what uses of drugs have benefits that outweigh their risks versus those that lack sufficient evidence to warrant such use. These distinctions are crucial for individual physicians—who do not have the time or expertise to perform the same critical data evaluation conducted by the scores of highly trained scientists at the FDA—and for patients, who could be exposed to more non–evidence-based and potentially dangerous off-label uses of high-cost drugs.

Controlling epidemics with transmissible vaccines

PLoS One
http://www.plosone.org/
[Accessed 12 May 2018]

Research Article
Controlling epidemics with transmissible vaccines
Scott L. Nuismer, Ryan May, Andrew Basinski, Christopher H. Remien
| published 10 May 2018 PLOS ONE
https://doi.org/10.1371/journal.pone.0196978
Abstract
As the density of human and domestic animal populations increases, the threat of localized epidemics and global pandemics grows. Although effective vaccines have been developed for a number of threatening pathogens, manufacturing and disseminating vaccines in the face of a rapidly spreading epidemic or pandemic remains a formidable challenge. One potentially powerful solution to this problem is the use of transmissible vaccines. Transmissible vaccines are capable of spreading from one individual to another and are currently being developed for a range of infectious diseases. Here we develop and analyze mathematical models that allow us to quantify the benefits of vaccine transmission in the face of an imminent or ongoing epidemic. Our results demonstrate that even a small amount of vaccine transmission can greatly increase the rate at which a naïve host population can be protected against an anticipated epidemic and substantially reduce the size of unanticipated epidemics if vaccination is initiated shortly after pathogen detection. In addition, our results identify key biological properties and implementation practices that maximize the impact of vaccine transmission on infectious disease.

Introduction of the Evidence synthesis: article type

Proceedings of the Royal Society B
16 May 2018; volume 285, issue 1878
http://rspb.royalsocietypublishing.org/content/285/1878?current-issue=y

Editorial
Introduction of the Evidence synthesis: article type
Gary Carvalho
Published 9 May 2018.DOI: 10.1098/rspb.2018.0858

1.Introduction

With over two million scientific publications appearing each year worldwide, there is an escalating need to access evidence and opinion to inform policy. In response, articles encompassing a breadth of policy and practice, from clinical medicine through to conservation science increasingly adopt an Evidence Synthesis framework. These articles access, appraise and synthesize scientific information and makes them readily available to non-specialists. They are rigorous, objective and transparent and driven by stakeholder needs, enabling the reader to make informed decisions. In an exciting new development, Proceedings of the Royal Society B will be extending its publication portfolio by launching a new article type entitled Evidence synthesis in June 2018, as part of a joint programme by the Academy of Medical Sciences and the Royal Society https://royalsociety.org/topics-policy/projects/evidence-synthesis/. Articles can range from brief review-style papers, through to meta-analysis and full systematic reviews of contentious issues. This editorial will serve to explain the appetite for such articles and the benefits for us in publishing them, as well as explain to authors the journal requirements for these pieces…

Vaccine Technology VI: Innovative and integrated approaches in vaccine development

Vaccine
Volume 36, Issue 22, Pages 3061-3190 (24 May 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/22

Vaccine Technology VI
Edited by Laura A. Palomares, Tarit K. Mukhopadhay, Yvonne Genzel, Linda L.H. Lua, Manon M.J. Cox
Vaccine Technology VI: Innovative and integrated approaches in vaccine development
Pages 3061-3063
Laura A. Palomares, Tarit K. Mukhopadhyay, Yvonne Genzel, Linda H.L. Lua, Manon M.J. Cox

Rare Diseases: Addressing the Challenges in Diagnosis, Drug Approval, and Patient Access

Value in Health                   

May 2018 Volume 21, Issue 5, p491-630
http://www.valueinhealthjournal.com/current
THEMED SECTION: Rare Diseases
Editorial
Rare Diseases: Addressing the Challenges in Diagnosis, Drug Approval, and Patient Access
Kati Copley-Merriman
p491–492
Published online: April 10, 2018
Rare diseases represent a wide range of disorders and constellations of clinical signs and symptoms. Many rare diseases cause chronic or progressive physical deterioration, disability, or premature death and start in childhood, creating a huge burden on parents and caregivers. Most rare diseases are thought to be genetic and there may be as many as 7000 rare diseases [1]. Although there is no universally accepted terminology or definition as to what constitutes a rare disease, it is typically characterized by its low frequency of occurrence. A global review of rare disease terminology found that 58% of definitions included a prevalence threshold with an average global threshold of 40 cases per 100,000 people [2]. Although the frequency of a single rare disease is low, because of the large number of rare diseases, the total number of people with a rare disease is large.

Rare diseases became known as orphan diseases because drug companies were not interested in adopting them to develop treatments. The Orphan Drug Act of 1983 passed by the US Congress created incentives to encourage companies to develop new drugs for rare diseases. There is similar legislation in the European Union. Drugs are granted an orphan designation if they are for the treatment of rare diseases that are life-threatening or seriously debilitating. The definition of “rare disease” varies from jurisdiction to jurisdiction, being a disease or condition affecting fewer than 200,000 patients in the United States (6.4 per 10,000 inhabitants), or a disease with a prevalence of 5 per 10,000 inhabitants or lower in the European Union [3]. In the decade leading up to the passage of the Orphan Drug Act, only 10 industry-supported products for rare diseases were brought to market. Since 1983, more than 600 orphan drug indications were approved from more than 450 distinct drug products, representing a huge increase in rare disease research and clinical development of new technologies [4].

Nevertheless, the development of new rare disease therapies has encountered significant obstacles with respect to understanding the incidence and prevalence (epidemiology), patient-reported burden of disease, economic cost of the disease and treatment, health technology assessment, and patient access. In June 2013, two working groups were established by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) under the ISPOR Rare Disease Special Interest Group. An article by the first working group provided rare disease terms and definitions [2]. The second working group (Challenges in Assessment and Appraisal of Diagnostics and Treatments Working Group) undertook a broad identification of challenges confronting those engaged in rare disease–focused research and development, as well as technology assessment.

Subsequently, Value in Health issued a special Call for Papers to attract submissions for a themed section dedicated to rare diseases. The resulting nine selected articles are published in this issue.

  • The first article, written by a group of authors from the ISPOR Rare Disease Special Interest Group, develops a multistakeholder catalogue of the principal difficulties faced in real-life rare disease research [5].

2.The article by Auvin et al. [6] provides a method to estimate the prevalence of rare diseases on the basis of reported incidence, to capture the time it takes for the diagnosis of newly discovered rare diseases to become part of mainstream diagnostic practice.

3.Building on a previously published report in Value in Health titled “Patient-Reported Outcome and Observer-Reported Outcomes Assessment in Rare Disease Clinical Trials: An ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force Report” [7], the article by Phillips [8] in this issue describes rare disease clinical outcome assessments specific to pediatric patients and developmental changes while maturing.

4.The article by Knight et al. [9] describes economic modeling considerations for rare diseases and strategies that manufacturers have used to overcome challenges in submissions to the highly specialized technologies of the National Institute for Health and Care Excellence in England and in ultra-orphan appraisals to the Scottish Medicines Consortium.

5.Schlander et al. [10] conducted a systematic review of the literature-reported expenditures for drugs for rare and ultra-rare diseases in Europe to explore the budget impact of rare diseases.

6.The article by Magalhaes [11] reports a structured deliberation to elicit and describe the values of the general public in Alberta, Canada, regarding whether the severity of a rare condition can achieve priority in funding over common conditions, and what aspects of a condition drive this judgment.

7.The article by Hughes et al. [12] reports a person trade-off and discrete choice experiment among 3950 adults representative of the UK general population to estimate societal preferences for funding of non–cost-effective orphan drug treatments (i.e., Does the UK general public consider rarity in itself as being sufficient to justify special consideration for additional National Health Service funding?).

8.The article by Ollendorf et al. [13] explores the general ethical dilemmas that rare diseases present, the rare disease landscape in health technology assessment and US payer systems, the role of contextual factors in rare diseases (beyond cost effectiveness), and possible ways forward.

9.The final article by Kos et al. [14] investigates patient access to medicines for rare diseases from the Orphanet list in various European countries in the past decade using IMS Health sales data.

Although the international community has taken steps to address the rare disease challenges outlined in these articles, it has done so with a high degree of variation. The ISPOR Rare Disease Special Interest Group plans to continue its multistakeholder efforts toward providing recommendations to address rare disease challenges regarding evidence generation and health technology assessment. This collection of articles should help those attempting to address these challenges

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

 

Journal of Community Health
First Online: 05 May 2018
Assessing and Improving Zoster Vaccine Uptake in a Homeless Population
L Kaplan-Weisman, E Waltermaurer, C Crump
Abstract
The herpes zoster (shingles) vaccine is recommended for all adults aged ≥ 60 years without contraindications to prevent shingles and post-herpetic neuralgia. There are no published studies on zoster vaccination rates, barriers, or workflows in adults who have experienced homelessness. Due to barriers specific to this vaccine, including difficulty determining insurance coverage, high upfront costs, need for storage in a freezer, and under-prescription by physicians, uptake is lower compared to other recommended vaccines for older adults. To address these barriers, we developed a new approach of partnering our on-site primary care clinic in a transitional homeless shelter with a local pharmacy and offering vaccination on Shingles Immunization Days with a goal of matching or exceeding the national zoster immunization rate of 30.6%. Over a 3-year period, the live attenuated zoster vaccine was offered to 86% of eligible patients resulting in an immunization rate of 38.1%. This is higher than the estimated national rate but significantly lower than rates of tetanus (80.6%), pneumococcal (76.3%), and influenza (69.6%) vaccination in the same population, highlighting the unique obstacles to zoster immunization. Major reasons that patients were not immunized included lack of insurance coverage and patient refusal of all vaccines. Our findings demonstrate that homeless adults are interested in zoster vaccination and a model of on-site primary care in a shelter partnering with a pharmacy can successfully improve vaccine uptake in this population. Coverage of the new inactivated zoster vaccine under Medicare Part B could increase the national zoster immunization rate.
 
 
System Dynamics Review
Volume 33, Issue 2  Pages: 87-180  April/June 2017
https://onlinelibrary.wiley.com/toc/10991727/current
Early View – Main Article
Using integrated modeling to support the global eradication of vaccine‐preventable diseases
RJ Duintjer Tebbens, KM Thompson – 2018
Abstract
The long‐term management of global disease eradication initiatives involves numerous inherently dynamic processes, health and economic trade‐offs, significant uncertainty and variability, rare events with big consequences, complex and interrelated decisions, and a requirement for cooperation among a large number of stakeholders. Over the course of more than 16 years of collaborative modeling efforts to support the Global Polio Eradication Initiative, we developed increasingly complex integrated system dynamics models that combined numerous analytical approaches, including differential equation‐based modeling, risk and decision analysis, discrete‐event and individual‐based simulation, probabilistic uncertainty and sensitivity analysis, health economics and optimization. We discuss the central role of systems thinking and system dynamics in the overall effort and the value of integrating different modeling approaches to appropriately address the trade‐offs involved in some of the policy questions. We discuss practical challenges of integrating different analytical tools and we provide our perspective on the future of integrated modeling.
 
 
Influenza and other respiratory viruses
Volume 12, Issue 3  Pages: 305-420  May 2018
https://onlinelibrary.wiley.com/toc/17502659/current
Accepted Manuscript
65 Years of influenza surveillance by a WHO‐coordinated global network
T Ziegler, A Mamahit, NJ Cox –
ABSTRACT
The 1918 devastating influenza pandemic left a lasting impact on influenza experts and the public, and the importance of global influenza surveillance was soon recognized. The WHO Global Influenza Surveillance Network (GISN) was founded in 1952 and renamed to Global Influenza Surveillance and Response System in 2011 upon the adoption by the World Health Assembly, of the Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits (“PIP Framework”). The importance of influenza surveillance had been recognized and promoted by experts prior to the years leading up to the establishment of WHO. In the 65 years of its existence, the Network has grown to comprise 143 National Influenza Centers recognized by WHO, 6 WHO Collaborating Centers, 4 Essential Regulatory Laboratories, and 13 H5 Reference Laboratories. The Network has proven its excellence throughout these 65 years, providing detailed information on circulating seasonal influenza viruses, as well as immediate response to the influenza pandemics in 1957, 1968, and 2009, and to threats caused by animal influenza viruses and by zoonotic transmission of coronaviruses. For its central role in global public health, the Network has been highly recognized by its many partners and by international bodies. Several generations of world renown influenza scientists have brought the Network to where it is now and they will take it forward to the future, as influenza will remain a pre-eminent threat to humans and to animals.
 
 
Journal of Clinical Epidemiology
March 2018 Volume 95, p1-142
https://www.jclinepi.com/issue/S0895-4356(17)X0016-4
Controversy and Debate on Dengue Vaccine Series
Controversy and debate on dengue vaccine series—paper 1: review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Antonio L. Dans, Leonila F. Dans, Mary Ann D. Lansang, Maria Asuncion A. Silvestre, Gordon H. Guyatt
Published online: November 24, 2017
Highlights
:: The possibility that dengue vaccines can cause severe dengue has led to serious concern regarding the safety of mass vaccination programs.
:: This paper points out problems in the analyses of a published meta-analysis addressing this safety issue for a new vaccine against dengue fever—Dengvaxia.
:: Although the authors of the meta-analysis show a sevenfold rise in hospitalization for dengue fever in children <5 years old, they fail to point out two signals of harm for another outcome—hospitalization for severe dengue fever in children younger than 9 years, the relative risk was 8.5 (95% confidence interval [CI]: 0.5, 146.8), and in the overall study group, the relative risk was 5.5 (95% CI: 0.9, 33).
:: The selective reporting and inappropriate subgroup claims mask the potential harm of dengue mass vaccination programs.
:: Countries planning public use of the vaccine must conduct diligent postmarketing surveillance, secure informed consent from parents of potential recipients, and closely monitor the results of ongoing long-term follow-up of clinical trial participants.
Abstract
Severe life-threatening dengue fever usually occurs when a child is infected by dengue virus a second time. This is caused by a phenomenon called antibody-dependent enhancement (ADE). Since dengue vaccines can mimic a first infection in seronegative children (those with no previous infection), a natural infection later in life could lead to severe disease. The possibility that dengue vaccines can cause severe dengue through ADE has led to serious concern regarding the safety of mass vaccination programs. A published meta-analysis addressed this safety issue for a new vaccine against dengue fever—Dengvaxia. The trials in this meta-analysis have been used to campaign for mass vaccination programs in developing countries. We discuss the results of this paper and point out problems in the analyses. Reporting the findings in an Asian trial (CYD14), the authors show a sevenfold rise in one outcome—hospitalization for dengue fever in children <5 years old. However, they fail to point out two signals of harm for another outcome—hospitalization for severe dengue fever (as confirmed by an independent data monitoring committee): 1. In children younger than 9 years, the relative risk was 8.5 (95% confidence interval [CI]: 0.5, 146.8), and 2. In the overall study group, the relative risk was 5.5 (95% CI: 0.9, 33).

The authors conduct a subgroup analysis to support claims that the vaccine is probably safe among children aged 9 years or more. This subgroup analysis has limited credibility because: (1) it was a post hoc analysis; (2) it was one of a large number of subgroup analyses; (3) the test of interaction was not reported, but was insignificant (P=0.14); and (4) there is no biological basis for a threshold age of 9 years. The more likely explanation for the higher risk in younger children is ADE, that is, more frequent seronegativity, rather than age itself. The selective reporting and inappropriate subgroup claims mask the potential harm of dengue mass vaccination programs. Countries planning public use of the vaccine must conduct diligent postmarketing surveillance, secure informed consent from parents of potential recipients, and closely monitor the results of ongoing long-term follow-up of clinical trial participants.

Controversy and debate on dengue vaccine series—paper 2: response to review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Sri Rezeki S. Hadinegoro, Jose Luis Arredondo-García, Maria Rosario Capeding, Sophie Pallardy, Fernando Noriega, Alain Bouckenooghe
Published online: January 3, 2018

Controversy and debate on dengue vaccine series—paper 3: final response to review of a licensed dengue vaccine: inappropriate subgroup analyses and selective reporting may cause harm in mass vaccination programs
Antonio L. Dans, Leonila F. Dans, Mary Ann D. Lansang, Maria Asuncion A. Silvestre, Gordon H. Guyatt
Published online: January 3, 2018

Media/Policy Watch

Media/Policy Watch

This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.
 
 
The Atlantic
http://www.theatlantic.com/magazine/
Accessed 12 May 2018
The New Ebola Outbreak Could Take ‘Three Months’ to Control
Ed Yong   May 11, 2018
The DRC ministry of health is also considering whether to deploy an experimental Ebola vaccine that has proven its effectiveness in clinical .
 

Huffington Post
https://www.huffingtonpost.co.uk/
Accessed 12 May 2018
Why The World Needs Pop-up Vaccine Factories
10 May 2018
Dr Harris Makatsoris, Professor of Manufacturing Operations in the Sustainable Manufacturing Systems Centre at Cranfield University
… The existing model for manufacturing vaccines is geared towards the economies of scale demanded by commerce: huge factories producing a product for a global market. Cranfield is working closely with Imperial on the engineering and manufacturing aspects of the Hub to find workable models of production: novel kinds of processing equipment, strategies for supply chains, storage and distribution linked to the pop-up operations. Once data has been analysed and models tested as digital versions, there are expected to be trials of working operations in the partner countries in 2019.
Ultimately, the work of the Hub is about independence – enabling more countries, and particularly those in the developing world, to access a cost-effective way of meeting their needs for vaccines as they arise rather than being dependent on systems of global business. At the heart of the threat from pandemics is the issue of globalisation, of a world that has been shrinking, where there are very few locations or communities that aren’t inter-linked in some way with every other. Inter-dependencies continue to grow and become more complex, meaning, in many cases including health, we can’t afford to think solely in terms of national interests.
 
 
New York Times
http://www.nytimes.com/
Accessed 12 May 2018
Health
Ebola Erupts Again in Africa, Only Now There’s a Vaccine
12 May 2018

Security Tight as Pakistan Starts 5-Day Anti-Polio Drive
7 May 2018
A Pakistani health official says a five-day anti-polio drive has been launched in the country to vaccinate millions of children under five years of age against the crippling disease. Aimal Khan, a spokesman with the anti-polio drive, says the campaign was launched on Monday amid tight security. He says a total of 23.8 million children are to be vaccinated in the campaign, which involves a total of 161,000 health workers in 109 districts…

Vaccines and Global Health: The Week in Review 5 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

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_5 May 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

Vaccination: Commission calls for stronger EU cooperation against preventable diseases   :: Questions & Answers: EU cooperation on vaccine preventable diseases

Milestones :: Perspectives

Vaccination: Commission calls for stronger EU cooperation against preventable diseases  
European Commission – Press release
Brussels, 26 April 2018
Today, the Commission is issuing a set of recommendations for how the EU can strengthen cooperation in the fight against diseases that can be prevented by vaccines. This follows President Juncker’s call, in his 2017 State of the Union address, for action to increase vaccination coverage and to ensure that everyone in the EU has access to vaccines.

Commissioner for Health and Food Safety, Vytenis Andriukaitis said: ”Vaccination is one of the most powerful and cost-effective public health measures developed in the 20th century. As a medical doctor, I find it disheartening to witness children dying because of low uptake, vaccine hesitancy, or vaccine shortages. Infectious diseases are not confined within national borders. One Member State’s immunisation weakness puts the health and security of citizens at risk across the EU. Cooperating in this area is in all of our interests. Protect our children, vaccinate!”

Vaccination saves between 1 and 3 million lives worldwide every year. According to the World Health Organisation, vaccines will save 25 million more lives in the coming decade. And yet, according to ECDC, several EU countries are facing unprecedented outbreaks of measles and a resurgence of other vaccine-preventable diseases due to insufficient vaccination coverage, and children and adults in the EU are still dying from these diseases.

The Commission’s proposal focuses on 3 main pillars for action: tackling vaccine hesitancy and improving vaccination coverage; sustainable vaccination policies in the EU; and EU coordination and contribution to global health.

The proposal calls for 20 concrete actions by the Commission and Member States, including:
:: Developing and implementing national and/or regional vaccination plans by 2020, including a target of at least 95% vaccination coverage for measles;
:: Introducing routine checks of vaccination status and regular opportunities to vaccinate across different stages of life, for example in schools and workplaces;
:: Presenting options for a common vaccination card that can be shared electronically across borders;
:: Establishing a European vaccination information portal by 2019 to provide online objective, transparent and updated evidence on the benefits and safety of vaccines;
:: Mitigating the risks of shortages by developing a virtual repository EU data warehouse with information on vaccine stocks and needs to facilitate voluntary exchange of information on available supplies and shortages of essential vaccines;
:: Equipping all healthcare workers with the necessary training to confidently deliver vaccinations and address hesitant behaviours;
:: Convening a Coalition for Vaccination to bring together European associations of healthcare workers as well as relevant students’ associations in the field, to commit to delivering accurate information to the public, combating myths and exchanging best practice;
:: Establishing a European Information Sharing System to gather knowledge and develop guidelines for a core EU vaccination schedule by 2020 with doses and ages that EU Member States agree as being common to all countries;
:: Strengthening partnerships and collaboration on vaccination with international partners.

Next steps
The Commission’s proposal for a Council recommendation will be discussed by the Council, with the aim of seeing it adopted before the end of 2018, with an immediate entry into force. Following this, every 3 years the Commission will report on progress made in the implementation of the recommendation. In addition the Commission will also produce a report on ‘The State of Confidence in Vaccines in the EU’, to monitor attitudes towards vaccination, in the context of the State of Health in the EU process.

Questions & Answers: EU cooperation on vaccine preventable diseases
26/04/2018  –
 

Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12,000 this year

Milestones :: Perspectives

Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12,000 this year
04-05-2018
Over 12 000 people have been infected with measles in Ukraine so far this year. Of those affected, 9158 have required hospitalization and 9 have died, according to information provided by national health authorities as of 27 April 2018. Large-scale outbreak response measures have been undertaken since the start of the outbreak in 2017 to curb further spread of the disease and restore high routine immunization coverage.

“Ukrainian health authorities, with WHO and UNICEF support, have recovered huge ground in the fight against measles. But there are still many vulnerable children and adults in the country; and this highly infectious disease continues to find them,” says Marthe Everard, WHO Representative in Ukraine. “More needs to be done to ensure that everyone is protected.”

Dramatic drop in immunization coverage
In 2008, 95% of eligible children in Ukraine received their second (and final) recommended dose of measles-mumps-rubella vaccine (MMR) on time according to the national routine schedule. By 2016, this rate had fallen to 31%, the lowest coverage in the WHO European Region and among the lowest in the world. In addition, in 2016 only 19% of children received the third recommended vaccine dose of diphtheria-tetanus-pertussis (DTP) and 56% of children received the third recommended dose of oral polio vaccine (OPV).

This tragic nationwide drop in immunization coverage left an increasing number of children in Ukraine susceptible to dangerous, preventable diseases. Among these dangers, it created the ideal setting for the extensive spread of measles, one of the most infectious diseases affecting humans. Measles can affect people of all ages, but infants, young children and older adults are the most at risk of serious measles-related complications and death.

Large-scale outbreak response
Since July 2017, a national Measles Task Force, including the Ministry of Health, key stakeholders and partners such as WHO and the United Nations Children’s Fund (UNICEF), has been working to:
:: vaccinate every eligible child as they reach the appropriate age for MMR vaccination according to the national routine immunization schedule;
:: vaccinate every child who missed routine immunization in the past;
:: train laboratory staff to ensure early detection of all measles (and rubella) cases;
:: inform health-care professionals and parents about the disease and the importance of ensuring that children and their families are fully protected;
:: ensure the availability of vaccines at all vaccination points.

During European Immunization Week (23–29 April 2018) stakeholders were sensitized to the importance of immunization. Kicking off with a press conference on 23 April, events involving the Ministry of Health, WHO, UNICEF, Rotary International and national Rotary clubs, a parents group (Parents for Immunization), bloggers and even participants dressed as super heroes, included a national conferences with opinion leaders, a flash mob at schools in Kyiv, a webinar on vaccination and a roundtable discussion with paediatricians.

Routine immunization coverage back on track and pool of vulnerable people shrinking
By the end of 2017, routine vaccination coverage had drastically improved compared to previous years: 93% of 1-year-olds received the first dose of MMR on time in 2017 and 91% of 6-year-olds received their second dose as recommended. Figures for January and February 2018 indicate that the country is on track to reach at least 95% routine coverage with both doses of MMR vaccine by the end of the year.

If Ukraine can reach and sustain this target, it will prevent the renewed accumulation of susceptible individuals and ultimately protect the population from future outbreaks of measles…

NFID Recognizes Infectious Disease Heroes and Calls for 2019 Awards Nominations

Milestones :: Perspectives

NFID Recognizes Infectious Disease Heroes and Calls for 2019 Awards Nominations
BETHESDA, Md., May 1, 2018 /PRNewswire-USNewswire/ — To mark its 45th anniversary, the National Foundation for Infectious Diseases (NFID) will celebrate three infectious disease heroes during the 2018 annual awards dinner on the evening of May 10, at the historic Willard InterContinental Washington, D.C.

The 2018 NFID awardees are:
   Roger I. Glass, M.D., Ph.D., Director of the Fogarty International Center at the National Institutes of Health, is the recipient of the 2018 Jimmy and Rosalynn Carter Humanitarian Award in recognition of his lasting contributions to improving children’s health worldwide, including novel scientific research for the prevention of gastroenteritis from rotaviruses and noroviruses.
   Kathryn M. Edwards, M.D., Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt University School of Medicine, is the recipient of the 2018 Maxwell Finland Award for Scientific Achievement as one of the world’s authorities on vaccinology, pediatric respiratory infections and pneumococcal disease, who has conducted pivotal studies on vaccine-preventable diseases and vaccine safety that have transformed the field and driven policy change.
   Anne Schuchat, M.D., (Rear Adm., U.S. Public Health Service), Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), is the recipient of the 2018 John P. Utz Leadership Award in recognition of her outstanding leadership throughout her long-standing tenure at CDC, her ongoing dedication to mentoring future generations of infectious disease professionals and her continued support of NFID.

“As NFID celebrates 45 successful years of providing education about the causes, prevention and treatment of infectious diseases, we are proud to honor these three outstanding infectious disease heroes,” said Marla Dalton, CAE, Executive Director and Chief Executive Officer of NFID. “Drs. Glass, Edwards and Schuchat have saved countless lives through their collective work on serious infectious diseases and public policy.”…

Roger Glass: celebrating the Fogarty at 50

Featured Journal Content
 
The Lancet
May 05, 2018 Volume 391 Number 10132 p1749-1864
http://www.thelancet.com/journals/lancet/issue/current

Perspectives
Roger Glass: celebrating the Fogarty at 50
Marianne Guenot
Published: 05 May 2018
At the Fogarty International Center, “we’re small, but we’re catalytic”, says Roger Glass, the centre’s Director and Associate Director for International Research at the US National Institutes of Health (NIH). The Fogarty celebrates its 50th anniversary this month and has been under Glass’s leadership since 2006. By training scientists, supporting research, and building partnerships, the Fogarty serves a bridge between the NIH and the global health community. Since its creation in 1968, about 6000 scientists have received research training through its programmes and the centre funds about 500 projects. “We really invest in capacity building of young people interested in research in biomedical and health sciences”, says Glass. “I visit institutes and attend meetings in Africa, Asia, and Latin America and people come up to me and say ‘I was a Fogarty trainee and that experience transformed my career!’ It brings a smile to my face.” Many Fogarty trainees and grantees become leaders in health, politics, and other fields.

It was his work with diarrhoeal diseases that brought Glass into global health. After medical and public health studies at Harvard, he did research on cholera at the then International Centre for Diarrheal Disease Research in Bangladesh in 1979 for the US Centers for Disease Control and Prevention (CDC). He joined the NIH’s Laboratory of Infectious Diseases in 1984 and 2 years later became Chief of the CDC’s Viral Gastroenteritis Unit, a role he held until 2006. His work focused on rotavirus research. “Because new diagnostics were available, we developed epidemiologic and laboratory methods…we trained people from probably 50 countries around the world to conduct surveillance of rotavirus and participate in a global surveillance network now run by WHO. That surveillance system is ongoing today in over 60 countries, now managed by WHO and PAHO”, he explains.

The development of a rotavirus vaccine took another 30 years; the Indian Neonatal Rotavirus Vaccine Project, begun in 1985 as a collaboration with Maharaj Krishan Bhan and other colleagues, led to the licensure of the oral rotavirus vaccine, Rotavac. “Earlier vaccines from the multinational manufacturers worked well but were too costly for low-income countries”, he says. Glass and coworkers set out to develop a more affordable vaccine through a public–private partnership. “Through this extraordinary partnership, this vaccine probably cost less than US$80 million to develop compared with Big pharma that claims that a new vaccine would cost half a billion or more to produce”, he says. In 2016, the Indian Government introduced the vaccine into its national immunisation programme and on Jan 24, 2018, Rotavac was prequalified by WHO for distribution by UNICEF and Gavi, the Vaccine Alliance.

Glass’s work on enteric and diarrhoeal diseases has taken him to many countries and he is fluent in five languages, in which he often lectures and engages with researchers. “I learned from the experience that if you get people involved in research on an important problem early on in their career, many will end up pursuing this for their career, a great return on investment”, he says. Glass is proud of the Fogarty’s ability to accelerate globalisation of health research and training because he “feels strongly that we must take science where the problems are and where we can most rapidly seek their solutions”. Fogarty programmes have facilitated research and training collaborations between academic institutions in the USA and in low-income and middle-income countries. “We have no monopoly on knowledge in the USA, good ideas come from all over…We only have to listen, and maybe help them or bring something else to the table.”

A recent turning point, says Michele Barry, Senior Associate Dean for Global Health and Director of the Center for Innovation in Global Health at Stanford University, was when the Trump administration “tried to zero out the budget at Fogarty” in 2017. “Roger had so many supporters around the world that we all came together to stage a campaign. This was really because of Roger’s leadership”, says Barry, who has served on Fogarty’s advisory board. The centre’s budget for this year was not reduced.

Looking to the future, Glass thinks that while infectious diseases and pandemic control remain important, non-communicable diseases (NCDs) and environmental health will increasingly shape global health research. “There is an explosion of new research tools—in point-of-care diagnostics, genomics, mHealth, imaging—that will change our ability to work in the global space”, he says. Glass points out that “solutions will depend upon other partners—in business to consider supply chain logistics to deliver services, drugs, and vaccines; bioengineering to develop low-cost technologies and devices; law to write documents like the Framework Convention on Tobacco Control or laws to instate taxes to reduce the sugar content of beverages or the salt content of foods”.

Glass will be presented with the National Foundation for Infectious Diseases’ Jimmy and Rosalynn Carter Humanitarian Award on May 10. He is “optimistic about the future of the Fogarty International Center”, he says. “Our trainees and grantees have been on the cutting edge of research to make HIV/AIDS a chronic, treatable disease, of combating Ebola and Zika outbreaks, and of establishing research platforms in low- and middle-income countries. Fogarty trainees and grantees today will be on the cutting edge of research and leadership into the critical health problems of the NCDs, as well as the next pandemics of tomorrow.”

Emergencies

Emergencies
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 1 May 2018 [GPEI]
:: In Iraq, polio vaccinators work to protect conflict-affected children.
:: In preparation for the Seventy-first World Health Assembly, taking place on 21-26 May, the Director-General’s office has finalized the Strategic Action Plan on Polio Transition. The Plan has three strategic objectives, which are highly interlinked:

  1. a) Sustaining a polio-free world after eradication (with the Post-Certification Strategy as its main pillar);
  2. b) Strengthening immunization systems;
  3. c) Strengthening emergency preparedness, detection and response capacity.

The Plan aims at aligning these objectives with the overall vision of the 13th General Programme of Work and WHO’s support at the country level, with the eventual phasing out of resources from the Global Polio Eradication Initiative. The action plan in all official UN languages may be found here.

Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1)  positive environmental sample has been reported, in Kandahar province.
Pakistan: Five new wild poliovirus type 1 (WPV1)  positive environmental samples have been reported, one in Balochistan province, two in Khyber Pakhtunkhwa province, and two in Sindh province.
Nigeria: Three circulating vaccine-derived poliovirus type 2 (cVDPV2)  positive environmental samples have been confirmed, one in Gombe province, and two in Jigawa province.

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

WHO Grade 3 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

::::::
 
WHO Grade 2 Emergencies  [to 5 May 2018]
[Several emergency pages were not available at inquiry]

::::::
::::::
 
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 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
:: Humanitarian Bulletin Somalia, 5 April – 2 May 2018
:: OCHA Somalia Flash Update #3 – Humanitarian impact of heavy rains | 2 May 2018
 

WHO & Regional Offices [to 5 May 2018]

WHO & Regional Offices [to 5 May 2018]

UN’s Health and Development Agencies Join Forces for Good Health
4 May 2018
London
While real progress has been made on a number of serious health issues, half of the world’s citizens lack access to essential health services.
Today, the United Nations Development Programme (UNDP) and WHO signed a five year Memorandum of Understanding (MoU) to help support countries to achieve the health-related targets across the 2030 Agenda for Sustainable Development and the agenda’s commitment to leave no-one behind.
“Universal health coverage is a powerful tool not only for better health, but for reducing poverty, creating jobs, fueling inclusive economic growth and promoting gender equality,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “But achieving a healthier world is not a job for the health sector alone. By working with partners like UNDP, we can better address the social, economic and environmental determinants of health and make progress towards a fairer, safer and more prosperous future for everyone.”…

::::::

GIN April 2018  pdf, 1.15Mb
2 May 2018

::::::
 
Weekly Epidemiological Record, 4 May 2018, vol. 93, 18 (pp. 229–240)
:: Progress towards measles elimination, Western Pacific Region, 2013–2017
:: Monthly report on dracunculiasis cases, January-March 2018

::::::
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Wellbeing Foundation Africa seeks WHO’s support in major nationwide campaign to curb disease outbreaks.  04 May 2018
:: Uganda vaccinates more than 360,000 people against cholera  03 May 2018
:: Celebrating African Vaccination Week in Sierra Leone: “Vaccines work, do your part!”  29 April 2018

WHO Region of the Americas PAHO
:: PAHO/WHO calls for grant applications to support health policy, programs and systems on projects related to the SDGs (05/03/2018)
:: Bahamian pioneer in disease elimination is named a PAHO Health Hero of the Americas (05/03/2018)

WHO South-East Asia Region SEARO
:: Fast-track efforts to eliminate rabies: WHO
SEAR/PR/1688
Kathmandu, 3 May 2018: The World Health Organization today called upon Member States and partners to accelerate efforts to end rabies which causes 59 000 agonizing and painful deaths globally every year, one person every nine minute, mostly children and the poor.
Eight of the 11 Member countries of WHO South-East Asia Region account for nearly 26 000 rabies deaths, 45% of the global rabies toll, as over 1.5 million people in the Region remain at risk of rabies.
“Human rabies is caused mostly by dogs and can be eliminated by increasing awareness about the disease, vaccinating dogs and most importantly by making the already available life-saving rabies vaccines, medicines, tools and technologies affordable and available to all. We can, and must break the disease cycle and save lives,” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, told the global meeting ‘Driving progress towards rabies elimination’ here.
At the meeting, the global rabies partners comprising of WHO, OIE, FAO and UNICEF and rabies endemic countries from Asia-Pacific and Africa, shared and deliberated on measures to fast-track elimination of dog transmitted rabies by 2030.
Countries from Africa and Asia, including Bangladesh, Bhutan, Cambodia, India, Kenya, Nepal, Sri Lanka and Vietnam, who have assessed access, delivery and distribution of rabies post-exposure prophylaxis, shared outcomes of their studies. These studies were conducted with WHO support to enable GAVI take an informed decision to support rabies vaccines. The rabies endemic countries are seeking GAVI support to improve affordability and access to rabies vaccines for vulnerable populations, of which many are children…
 
WHO European Region EURO
:: Celebrating nurses’ and midwives’ role in bringing health services to everyone, everywhere 04-05-2018
:: Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12 000 this year 04-05-2018
:: Hand Hygiene Day: It’s in your hands – prevent sepsis in health care 03-05-2018
:: Over half a million premature deaths annually in the European Region attributable to household and ambient air pollution 02-05-2018
:: New law on cigarettes and tobacco coming into effect in Georgia 01-05-2018

WHO Eastern Mediterranean Region EMRO
:: Statement on the death of a WHO team member in Somalia  2 May 2018
WHO Director-General visits Saudi Arabia  30 April 2018

WHO Western Pacific Region
:: One third of global air pollution deaths in Asia Pacific
MANILA, 2 MAY 2018 – Air pollution levels remain dangerously high in many parts of Asia according to new data from the World Health Organization (WHO). Around one third, or 2.2 million of the world’s 7 million premature deaths each year from household (indoor) and ambient (outdoor) air pollution are in the WHO Western Pacific Region—home to one quarter of the world’s population.

CDC/ACIP [to 5 May 2018]

CDC/ACIP [to 5 May 2018]

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

MMWR News Synopsis for May 3, 2018
Progress Toward Measles Elimination – Western Pacific Region, 2013-2017
2017 saw the lowest rate of new measles cases ever recorded in the WHO Western Pacific Region, 5.2 per million population. However, outbreaks in several countries and an overall increase in cases between 2013 and 2016 indicate countries must continue to strengthen immunization systems, maintain high-quality surveillance, and improve outbreak response in order to achieve regional measles elimination. In 2017, rates of new measles cases in the WHO Western Pacific Region were lower than they have ever been, but recent outbreaks and a rise in cases shows more work needs to be done to completely eliminate the disease from the region. Measles cases decreased substantially in the WHO Western Pacific Region to a low of 5.9 per million population in 2012. During 2013–2016, however, measles cases rose sharply due to large-scale outbreaks in Mongolia, the Philippines, and Vietnam. There was also increased measles transmission in China. Cases rose from 19.2 cases per million population in 2013 to 68.9 in 2014. After controlling the outbreaks, cases in the region decreased to 5.2 per million in 2017, a new historic low. The recent measles resurgence demonstrates a need for collective efforts by countries to achieve high population immunity, strengthen immunization systems, maintain high-quality surveillance, and improve outbreak preparedness and response, so that measles can be eliminated from the region.

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.
::::::
 
ECDC – European Centre for Disease Prevention and Control  [to 5 May 2018]
https://ecdc.europa.eu/en/home
27 Apr 2018
Communicable disease threats report, 29 April – 5 May 2018, Week 18
Publication series: Communicable Disease Threats Report (CDTR)
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 22-5 May 2018 and includes updates on dengue, chikungunya, seasonal influenza, yellow fever, gonorrhoea and cholera.

Announcements

Announcements

European Medicines Agency  [to 5 May 2018]
http://www.ema.europa.eu/ema/
02/05/2018
EMA 2017 annual report published
Report highlights major achievements and includes key figures …

30/04/2018
Update of EU recommendations for 2018/2019 seasonal flu vaccine composition
Update to recommendations issued in March 2018 …

 
European Vaccine Initiative  [to 5 May 2018]
http://www.euvaccine.eu/news-events
04 May 2018
EVI 20th Anniversary Symposium
EVI 20th Anniversary Symposium in Heidelberg, Germany, 20-21 November 2018
 
Gavi [to 5 May 2018]
http://www.gavi.org/library/news/press-releases/
02 May 2018
Cervical cancer vaccine introduced in Zimbabwe
800,000 girls to be protected against disease following introduction of HPV vaccine.
Geneva, 2 May 2018 – Girls across Zimbabwe will be protected against one of the country’s most deadly diseases following the introduction of Human Papillomavirus (HPV) vaccine into the country’s routine immunisation programme, First Lady of Zimbabwe Auxillia C. Mnangagwa announced today at a launch ceremony in Harare.
The vaccines, which will be funded by Gavi, the Vaccine Alliance and the Government of Zimbabwe, will reach over 800,000 girls aged between 10-14 years old across the country. UNICEF, WHO and partners will work alongside the Zimbabwe Ministry of Health on implementation…
 
 
IAVI  [to 5 May 2018]
https://www.iavi.org/
No new digest content identified
CSIS – Pursuing a Vaccine for HIV
May 3, 2018 | By Sara M. Allinder Podcast Episode
Despite substantial progress made in expanding access to HIV/AIDS treatment and prevention options, a vaccine for HIV—even an imperfect one—is likely needed to put a durable end to the epidemic. In this episode of Take as Directed, Dr. Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI) discusses the landscape of HIV vaccine development and why he thinks a vaccine remains a necessary pursuit. Dr. Feinberg also discusses the facilitating role that IAVI plays in the HIV vaccine development process.
 
 
MSF/Médecins Sans Frontières  [to 5 May 2018]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Press release
Libya: Time Running Out For Hundreds of Migrants and Refugees in Dangerously Overcrowded Detention Center
May 03, 2018
Hundreds of migrants and refugees are being held in a dangerously overcrowded detention center in Libya, without adequate food or water and in inhumane conditions, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned today.

Press release
Greece: As Prime Minister Visits Lesvos, Moria Camp is Overcrowded, Dangerous and Without Adequate Health Care
May 03, 2018
As the Greek Prime Minister, Alexis Tsipras, visits Lesvos for a regional conference, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warns that thousands of men, women, and children in Lesvos are living in squalid, overcrowded conditions in Moria camp, with insufficient access to health care.

Press release
Preventive Oral Cholera Vaccination Campaign Underway in Juba, South Sudan
May 01, 2018
Working with the health authorities and partners, Doctors Without Borders/Médecins Sans Frontières (MSF) is carrying out a four-week preventive oral cholera vaccination campaign in Juba, to increase the immunity of people at risk of this deadly disease.

 
NIH  [to 5 May 2018]
http://www.nih.gov/news-events/news-releases
May 4, 2018
NIAID-Sponsored Trial of a Universal Influenza Vaccine Begins
— Phase 2 clinical trial of investigational universal influenza vaccines has begun in the U.S.

Essential malaria parasite genes revealed
May 3, 2018 — NIAID-funded research could aid antimalarial drug development
 
 
PATH  [to 5 May 2018]
http://www.path.org/news/index.php
Announcement | May 04, 2018
PATH names Michael Fahey as Chief Information Officer
 

UNAIDS [to 5 May 2018]
http://www.unaids.org/en
04 May 2018
Update
Metrics matter in identifying gaps and key populations to find solutions in each country
The International Association of Providers of AIDS Care (IAPAC) hosted its 2018 Controlling the HIV Epidemic Summit in Geneva, Switzerland, on 3 and 4 May. Speakers at the summit discussed new metrics for assessing progress in national and subnational HIV responses as well as scaling up HIV services to include other health conditions, such as tuberculosis…

Feature story
South Africa tests ATMs for medicine
03 May 2018
People living with HIV and other chronic illnesses are getting faster, simpler access to essential medicines thanks to new medicine dispensing machines being piloted in Johannesburg, South Africa.
The non-profit organization Right to Care is testing three pharmacy dispensing units at a shopping mall and two hospitals. Most of the people using the new machines are accessing repeat prescriptions for HIV medicines…

UNICEF  [to 5 May 2018]
https://www.unicef.org/media/
Selected Press Releases
UN urges the world to act now to save lives in West Africa’s Sahel
DAKAR, 3 May 2018 – Drought, high food prices and conflict are set to drive millions of people into acute hunger and malnutrition in parts of West Africa’s Sahel, if the global community does not act now, three United Nations agencies warned today.

Over 140 million children at greater risk of illness as they miss life-saving vitamin A supplements
NEW YORK, 2 May 2018  – Over 140 million children are at greater risk of illness, hearing loss, blindness and even death if urgent action is not taken to provide them with life-saving vitamin A supplements, warns UNICEF in a new report released today. Two doses of vitamin A every year can save thousands of children’s lives, yet as the report finds, the coverage of this low-cost intervention fell alarmingly in 2016.

Geneva Palais briefing note: 55,000 Rohingya refugee children at risk due to floods and landslides as pre-monsoon rains start in Bangladesh
GENEVA, 1 May 2018 – This is a summary of what was said by Christophe Boulierac, UNICEF spokesperson in Geneva – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva.

Wellcome Trust  [to 5 May 2018]
https://wellcome.ac.uk/news
Published: 3 May 2018
Policies to promote positive research cultures
Alyson Fox, our Director of Grants, explains how Wellcome’s grant conditions and policies help great ideas to thrive.
Today, Wellcome is introducing a new policy that clarifies our responsibilities as a funder in relation to bullying and harassment. In it, we set out what we expect from researchers we fund and the organisations that employ them, to ensure that people involved in Wellcome-funded activities are treated with dignity and respect.
This complements our guidelines on good research practice, updated in April, and other policies currently under review, including those on clinical trials and intellectual property…

Lassa fever: what Wellcome is doing to support Nigerian research
Explainer / Published: 1 May 2018
In mid-February, the World Health Organisation (WHO) announced a scaled-up response to the outbreak of Lassa fever in Nigeria. Josie Golding explains what Wellcome is doing to help. 

Can AI improve health for everyone? We want to fund research to find out
News / Published: 30 April 2018
Wellcome has commissioned a new report that focuses on the ethical, social and political challenges of using artificial intelligence (AI) in health. And to respond to the issues this raises, we’re launching AI-themed Seed Awards. Dan O’Connor, head of Wellcome’s Humanities and Social Science team, explains…
Wellcome has partnered with think-tank Future Advocacy (opens in a new tab) to produce a report: Ethical, social and political challenges of artificial intelligence in health [PDF 5MB].

Eight cutting-edge immunology projects we fund
Published: 29 April 2018
29 April is World Immunology Day 2018. Divya Shah and Pete Gardner, from our Science team, highlight some of the researchers we fund who are exploring different aspects of immunology and the immune system.

Industry Watch    [to 5 May 2018]
:: FDA Grants PaxVax Fast Track Designation for its Chikungunya Vaccine
May 4, 2018 /PRNewswire/ — PaxVax, a leading independent specialty vaccine company, announced today that it has received Fast Track designation from the U.S. Food and Drug Administration (FDA) for its vaccine for the prevention of disease caused by the chikungunya virus.

A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region

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
 
 
A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region
WHO Health Evidence Network Synthesis Reports 53.  – 55 pages
Editors – De Vito E, Parente P, de Waure C, Poscia A, Ricciardi W.
Source – Copenhagen: WHO Regional Office for Europe; 2017.
PDF: https://www.ncbi.nlm.nih.gov/books/n/whohen53/pdf/
Excerpt
This review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services. Evidence was obtained by a scoping review of academic and grey literature in English and a further 11 languages and included official documents available from the websites of ministries of health and national health institutes of the WHO European Region Member States. The review highlights that vaccination policies tailored to migrants and refugees are very heterogeneous among WHO European Region Member States. By comparison, common barriers for the implementation and utilization of immunization services can be identified across countries. Outlined policy options are intended to strengthen information about immunization for migrants and refugees, support future evidence-informed policy-making, enable the achievement of national vaccination coverage goals and improve the eligibility of migrants and refugees to access culturally competent immunization services.
 
SUMMARY
The issue
Providing equitable access to safe and cost-effective vaccines is vital to protect vulnerable groups in any country and to reduce morbidity and mortality from vaccine-preventable diseases (VPDs), particularly among children. Migrants and refugees in the WHO European Region may be particularly vulnerable to VPDs. Children, who constitute approximately 25% of the total migrant population, are considered at greatest risk of VPDs because they may not have yet been vaccinated or may not have completed the schedule for all vaccines. In November 2015, WHO, the United Nations High Commissioner for Refugees and the United Nations Childrens Fund made a joint recommendation that migrants and refugees in the WHO European Region should be vaccinated without unnecessary delay according to the immunization schedule of the host countries. The WHO European Region’s Strategy action plan and resolution on refugee and migrant health, adopted in September 2016, addresses the issue of immunization among migrants and refugees.

The synthesis question
The objective of the review is to address the following question: “What is the evidence on equitable delivery, access and utilization of immunization services for migrants and refugees within WHO European Region?” The review focuses on existing immunization policies and practices for migrants and refugees and provides an overview of barriers and facilitators for access to and utilization of immunization services.

Types of evidence
Evidence was obtained by a scoping review of academic and grey literature, in English and Russian, including official documents available from the websites of ministries of health and national health institutes in the Region. A total of 56 articles/papers/documents published between 2007 and July 2017 were considered for this review.

Results
Immunization policies, vaccine delivery practices and barriers to access and utilization of immunization services by migrants and refugees vary widely in WHO European Region:
:: national immunization programmes seldom include specific recommendations for immunization for migrants and refugees;
:: fewer than one third of the countries have specific directives on immunization focusing on migrants and refugees, including children and pregnant women;
:: undocumented migrants receive immunization services in very few countries because of inbuilt administrative barriers in the host countries related to their entitlement to free health services, including immunization;
:: in most of the countries of the Region, the delivery of immunization services is primarily carried out by the public health care systems, but international organizations and nongovernmental organizations are also involved in a few;
:: lack of financial and human resources, in particular cultural mediators and/or interpreters, is seen as a barrier to the effective implementation of national immunization policies and to the systematic collection and evaluation of data for corrective actions;
:: socioeconomic, sociocultural and educational issues remain important obstacles for migrants and refugees in accessing the available immunization services in the host countries; and
:: targeted interventions have been shown to be successful in improving the uptake of immunization programmes among migrants and refugees, for example door-to-door vaccination initiatives, media campaigns, thematic lectures, peer-to-peer interactions and health promotion days.

Policy considerations
A systemic and tailored approach to the management of immunization among migrants and refugees is critical. Adequate protection of migrants and refugees from VPDs may require long-term strategies by national health systems. This review suggests the following policy options to be considered by policy-makers in strengthening immunization for migrants and refugees in the WHO European Region.

:: Ensure national policies are in place for provision of equitable and high-quality
immunization services tailored to migrant and refugee populations:
– national immunization programmes should ensure that migrants and refugees benefit from easy access to the vaccines offered free of charge under the national vaccination schedule; and
– appropriate strategies, such as outreach activities, and existing initiatives, such as tailored immunization programmes, should be considered to improve the delivery and uptake of vaccines.

:: Provide appropriate administrative mechanisms and ensure political commitment to address the existing barriers to vaccination service delivery and utilization; useful interventions include:
– interpreters and cultural mediators to support interactions;
– provision of information in the languages of the migrants;
– models for collection of relevant data on migrants and refugees that avoid issues of stigma and discrimination;
– effective collaboration on service delivery between national health services, existing social services networks and local service providers in the country;
– provision of adequate training and culturally relevant information for health care professionals to ensure that they understand the specific needs of the migrants and refugees they link with and can avoid detrimental inappropriate behaviours and/or stereotypical attitudes; and
– inclusive decision-making that involves migrants and refugees during planning and implementation of vaccination programmes.

:: Promote strategies to address wider issues such as marginalization, health literacy and other social determinants of health that contribute to low vaccination coverage among migrants and refugees.

:: Develop realistic implementation plans together with a robust monitoring and evaluation framework to review existing policies periodically in light of population movement and VPD epidemiology in the host countries.

:: Foster research to further understand and address the barriers related to immunization service delivery and utilization in these groups.

:: Devise appropriate mechanisms to promote cross-border collaboration and sharing of good practices among countries in the Region.

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

Clinical trial registration and reporting: a survey of academic organizations in the United States

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 5 May 2018)

Research article
|   2 May 2018
Clinical trial registration and reporting: a survey of academic organizations in the United States
Many clinical trials conducted by academic organizations are not published, or are not published completely. Following the US Food and Drug Administration Amendments Act of 2007, “The Final Rule” (compliance date April 18, 2017) and a National Institutes of Health policy clarified and expanded trial registration and results reporting requirements. We sought to identify policies, procedures, and resources to support trial registration and reporting at academic organizations.
Authors: Evan Mayo-Wilson, James Heyward, Anthony Keyes, Jesse Reynolds, Sarah White, Nidhi Atri, G. Caleb Alexander, Audrey Omar and Daniel E. Ford

Patients’ understanding of telemedicine terms required for informed consent when translated into Kiswahili

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Patients’ understanding of telemedicine terms required for informed consent when translated into Kiswahili
In Africa, where access to specialist medical services is often limited, telemedicine, the use of information and communication technologies for the provision of healthcare at a distance, can contribute towards enhancing access to healthcare. Informed consent is considered the cornerstone of ethical practice, especially when technology and techniques are considered new and or unproven. It is advised that informed consent should be gained in the patient’s mother tongue. However, many African languages have not kept pace with technology and lack the words and terms needed to describe computing and technical terms. Additionally, even when present, patients may not understand these words and terms. This affects the validity of informed consent given.
Authors: Rachael Odhiambo and Maurice Mars
Citation: BMC Public Health 2018 18:588
Published on: 3 May 2018

Vaccination hesitancy in the antenatal period: a cross-sectional survey

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Vaccination hesitancy in the antenatal period: a cross-sectional survey
Recent reports of childhood vaccination coverage in Australia have shown steadily improving vaccination coverage and narrowing differences between highest and lowest coverage regions, yet the NSW North Coast c…
Authors: Paul Corben and Julie Leask
Citation: BMC Public Health 2018 18:566
Published on: 2 May 2018

Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture – a qualitative survey

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Research article
Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture – a qualitative survey
Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes…
Authors: Pierre Verger, Aurélie Bocquier, Chantal Vergélys, Jeremy Ward and Patrick Peretti-Watel
Citation: BMC Public Health 2018 18:569
Published on: 2 May 2018

The value of program science to optimize knowledge brokering on infectious diseases for public health

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 5 May 2018)

Debate
The value of program science to optimize knowledge brokering on infectious diseases for public health
Knowledge translation (KT) and related terms have variously been defined as process and as products. In this paper we contribute to debates on effective KT, specifically knowledge brokering, by describing an a…
Authors: Marissa Becker, Margaret Haworth-Brockman and Yoav Keynan
Citation: BMC Public Health 2018 18:567
Published on: 2 May 2018