Vaccines and Global Health: The Week in Review :: 16 June 2018

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

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– blog edition: comprised of the approx. 35+ entries posted below.

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

Ebola/EVD :: At one-month mark in Ebola outbreak, the focus shifts to remote areas of DRC

Milestones :: Perspectives


At one-month mark in Ebola outbreak, the focus shifts to remote areas
WHO Statement,  Geneva
9 June 2018
[Editor’s text bolding]
One month into the response to an Ebola outbreak in the Democratic Republic of the Congo, the focus has moved from urban areas to some of the most remote places on earth.
The shift comes after a series of unprecedented actions that have led to cautious optimism about the effectiveness of the response.
A series of firsts
On 9 May, the day after country declared an outbreak of Ebola virus disease in Bikoro, the first WHO and Ministry of Health response team arrived in the provincial capital Mbandaka to begin setting up the specialized cold chain needed to store a vaccine.
By 11 May, teams had started to trace contacts of all active cases and WHO partners were setting up treatment centres in Bikoro. The next day, an air bridge was established to Bikoro and a mobile lab deployed to speed up testing for infection.
And then, just 6 days after the alert, the first batch of more than 4000 doses of vaccine was on its way from Geneva to Kinshasa. This marked the first time vaccines were available so early in a response.
Ring vaccination of contacts began on 21 May.
   On 4 June, an ethics committee in the country approved the use of 5 investigational therapeutics under the framework of compassionate use, following recommendations from a group of experts convened by WHO. This is the first time such treatments were available in the midst of a response.
“It’s far too early to declare victory, but the signals are positive and we are cautiously optimistic,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We have new weapons and together with the government and our partners, we have acted with urgency to save lives. We will remain vigilant until this outbreak is over.”
As of 7 June, there were a total of 59 confirmed, probable and suspected Ebola cases, of which 27 people had died.  A new case was confirmed on 6 June…

Ebola response – building trust and engaging with affected communities
13 June 2018 – The following resources can be used to guide RCCE work which is central to stopping the outbreak and preventing its further amplification. Unlike other areas of response, RCCE draws heavily on volunteers, frontline personnel and on people without prior training in this area. As such, these resources provide basic background information, scopes the socio-economic and cultural aspects, and provides the latest evidence-based advice and approaches.
:: Risk communication and community engagement considerations for Ebola outbreak in DRC
:: ePROTECT occupational health and safety briefing
:: Ebola: Knowledge resources for responders

Ebola virus disease – Operational readiness and preparedness in nine countries neighbouring the Democratic Republic of the Congo
11 June 2018
Following the notification of an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo on 5 May 2018, WHO conducted a formal rapid risk assessment which determined that the public risk is high at the regional level.

On the basis of the rapid risk assessment, the WHO Regional Office for Africa identified nine countries neighbouring the Democratic Republic of the Congo to support them with preparedness and readiness activities: Angola, Burundi, Central African Republic, Republic of Congo, Rwanda, South Sudan, Tanzania, Uganda and Zambia. During the past month, WHO deployed teams of experts known as Preparation Support Teams (PST) to eight of the countries. The aim of these missions was to assess countries’ readiness using the WHO standardized checklist, and to provide technical support to countries to develop and initiate national contingency plans in collaboration with partners.

Risk in the nine neighbouring countries
There is a significant risk of spread of the ongoing EVD outbreak in the Democratic Republic of the Congo to neighbouring countries because of the geographic proximity, high volume of movement of people and goods across borders and along the Congo River, insufficient national capacities to prevent, detect and respond to EVD cases, and other factors which may enable transmission. The nine neighbouring countries were categorized into three priority levels based on their capacity to manage EVD and viral haemorrhagic fever (VHF) outbreaks and proximity to the affected areas (Figure 1).

The nine countries were categorized as follows, with priority 1 being the highest:
:: Priority 1: Central Africa Republic and Republic of Congo due to their proximity to the current event. These two countries share borders with the epicentre of the outbreak in Equateur Province and there is continuous population movement through the porous land borders and by the Congo and Oubangui rivers.
:: Priority 2: Angola, Burundi, Rwanda, South Sudan, Tanzania and Zambia which neighbour the Democratic Republic of the Congo but are not directly linked with Equateur Province.
:: Priority 3: Uganda because although it borders the Democratic Republic of the Congo, Uganda has regularly demonstrated the capacity to respond to recent previous VHF outbreaks…

Adel Mahmoud, global health leader and Princeton faculty member, dies at 76

Milestones :: Perspectives

Adel Mahmoud, global health leader and Princeton faculty member, dies at 76

Princeton University – The Office of Communications

June 13, 2018
Dr. Adel Mahmoud, a pioneer in the treatment and prevention of infectious diseases around the world, died Monday, June 11, in New York City. He was 76. The cause was a brain hemorrhage…

…In 1998, Mahmoud was recruited to serve as president of Merck Vaccines, a position he held until 2006. During his tenure at Merck, Mahmoud played a pivotal role in the development and commercialization of new vaccines to help prevent severe gastroenteritis, human papillomavirus (HPV) and shingles, as well as the quadrivalent formulation of measles-mumps-rubella-varicella vaccine. As of 2017, more than 500 million doses of these four vaccines have been distributed globally, according to the company.

“Adel was as beloved as he was accomplished, said Ken Frazier, Merck’s chairman and CEO. “He leaves an enduring legacy of protecting the health of infants, adolescents and adults around the world. Few physician-scientists have had the global public health impact that Adel Mahmoud had.”

Mahmoud frequently provided scientific advice to the World Health Organization, the National Institutes of Health, the Centers for Disease Control, the National Academies, the Rockefeller Foundation, and universities and research institutions around the world. He served as president of the International Society of Infectious Diseases from 1990-92 and on boards of directors at GAVI, the International AIDS Vaccine Initiative, International Vaccine Institute and several companies in the private sector…

“Adel was always one of the very first people to whom we turned when we needed sage advice about difficult policy issues,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “His judgment was flawless.”

…Mahmoud began his Princeton career in 2007 as a senior policy analyst at the Woodrow Wilson School of Public and International Affairs and transferred to the faculty in 2011 as a lecturer with the rank of professor in the Department of Molecular Biology and international affairs, Woodrow Wilson School. He also was an integral part of the Global Health Program.

Mahmoud is survived by his wife of 25 years, Dr. Sally Hodder, and a son, Jay Thornton, as well his siblings, Dr. Olfat Abdelfattah and Dr. Mahmoud Abdelfattah.

View or share comments on a blog intended to honor Mahmoud’s life and legacy.

The Charlevoix G7 Summit Communique

Milestones :: Perspectives

The Charlevoix G7 Summit Communique

8-9 June 2018, Charlevoix, Canada

[Editor’s Note: The recent G& meeting issued its communique [full text at title link] which included one paragraph [of 28] focused on health as below. Editor’s text bolding]

  1. We, the Leaders of the G7, have come together in Charlevoix, Quebec, Canada on June 8–9, 2018, guided by our shared values of freedom, democracy, the rule of law and respect for human rights and our commitment to promote a rules-based international order. As advanced economies and leading democracies, we share a fundamental commitment to investing in our citizens and meeting their needs and to responding to global challenges. We collectively affirm our strong determination to achieve a clean environment, clean air and clean water. We are resolved to work together in creating a healthy, prosperous, sustainable and fair future for all.

…6. To support growth and equal participation that benefits everyone, and ensure our citizens lead healthy and productive lives, we commit to supporting strong, sustainable health systems that promote access to quality and affordable healthcare and to bringing greater attention to mental health. We support efforts to promote and protect women’s and adolescents’ health and well-being through evidence-based healthcare and health information. We recognize the World Health Organization’s vital role in health emergencies, including through the Contingency Fund for Emergencies and the World Bank’s Pandemic Emergency Financing Facility, and emphasize their need for further development and continued and sustainable financing. We recommit to support our 76 partners to strengthen their implementation of the International Health Regulations, including through their development of costed national action plans and the use of diverse sources of financing and multi-stakeholder resources. We will prioritize and coordinate our global efforts to fight against antimicrobial resistance, in a “one health” approach. We will accelerate our efforts to end tuberculosis, and its resistant forms. We reconfirm our resolve to work with partners to eradicate polio and effectively manage the post-polio transition. We affirm our support for a successful replenishment of the Global Fund in 2019




Public Health Emergency of International Concern (PHEIC)
Polio this week as of 12 June 2018 [GPEI]
:: Following unconfirmed reports on 8 June of suspected polio re-emergence in Venezuela, final laboratory testing has confirmed the cause of the paralysis is not wild poliovirus or vaccine-derived poliovirus. The full statement from the Global Polio Eradication Initiative may be read here.
:: World leaders at the G7 summit affirmed continued commitment to global polio eradication in the summit communique: “We reconfirm our resolve to work with partners to eradicate polio and effectively manage the post-polio transition”. [See Milestones above] for text]

Summary of newly-reported viruses this week:
Pakistan: One new wild poliovirus type 1 (WPV1) case reported.

Update on suspected polio case in Venezuela
Following unconfirmed reports on 8 June of suspected polio re-emergence in Venezuela, final laboratory testing has confirmed the cause of the paralysis is not wild poliovirus or vaccine-derived poliovirus.
15/06/2018 – Statement from the Global Polio Eradication Initiative
A 34-month old child had presented with symptoms of acute flaccid paralysis (AFP) on 29 April, from a community with low vaccination coverage in Orinoco delta, Delta Amacuro state.
A Sabin type 3 poliovirus was isolated from stool samples of the child. Isolation of Sabin type 3 poliovirus can be expected in children and communities immunized with bivalent oral polio vaccine, which contains attenuated (weakened) type 1 and type 3 Sabin strains.  Final laboratory analysis received today has confirmed that the AFP symptoms are not associated with wild or vaccine-derived poliovirus.
A number of conditions or infections can lead to AFP, poliovirus being just one of them.  As part of global polio surveillance efforts, every year more than 100 000 AFP cases are detected and investigated worldwide. Clinical evaluation of the child is underway to determine the cause of the paralysis. The most important point is that the child should be provided with appropriate care and support.
While wild and vaccine-derived polio have both been ruled out as the cause of this child’s symptoms, this area of Venezuela is experiencing vaccination coverage gaps. It is critical that countries maintain high immunity to polio in all communities, and strong disease surveillance, to minimize the risk and consequences of any eventual poliovirus re-introduction or re-emergence.
The partners of the Global Polio Eradication Initiative (GPEI) – WHO, the US Centers for Disease Control and Prevention, Rotary International, UNICEF and the Bill & Melinda Gates Foundation – will continue to support national and local public health authorities in these efforts, together with the Pan American Health Organization…


WHO Grade 3 Emergencies  [to 16 Jun 2018]
:: WHO and partners working with national health authorities to contain disease outbreaks
13 June 2018 – Infectious disease outbreaks are a serious public health concern, posing a direct threat to families, especially children, in every home in Yemen. Emergency preparedness and response structures could mean the difference between life and death for many people. Through the quick mobilization of readily available teams, the number of people affected could be reduced and the spread of deadly diseases controlled.
In the midst of war and faced with a collapsing health system, WHO, national health authorities, along with local and international partners, have scaled-up their operations, through the establishment of rapid response teams (RRTs) in the fight against disease outbreaks. These teams are critical; investigating outbreaks and ensuring that prevention and control measures are rapidly executed to contain any infectious disease threat.
These multi-disciplinary teams comprise health care professionals each with a specific skillset, designed to rapidly detect and contain a potential outbreak before it has a chance to spiral out of control.
…The fight against cholera 
As Yemen faces what is now known as the world’s largest cholera outbreak, these dedicated RRTs ensure that laser-focus on early detection, or the early identification of suspected cholera cases, and the investigation of the source are top priorities. The national epidemiological surveillance programme and WHO utilized the already established electronic integrated disease early warning system (eIDEWS) to support the early detection of suspected cholera. eIDEWS was initiated in 2013 as a pilot in 4 governorates (Aden, lahj, Abyan and Taiz) with a total 98 selected sites.
The eIDEWS is a surveillance and data collection program designed to rapidly detect potential outbreaks and public health threats at the earliest possible stages. The program then generates an alert in order to facilitate timely interventions and prompt response to help prevent or reduce the spread of the disease. These findings influence the response plan at district level, using essential findings from rapid assessments to formulate an informed and effective outbreak response.
The fight against cholera also resulted in the request of national health authorities for a way in which they could increase the mobility of RRTs to reach otherwise inaccessible areas in order to investigate and respond to reported outbreaks. This resulted in the procurement and planned distribution of 1000 motorbikes in Yemen.
“With disease outbreaks threatening the lives of millions of Yemeni people, an effective response relies heavily on the ability of RRTs to rapidly detect and investigate potential outbreaks. Early detection leads to timely interventions that save lives,” said Dr Zagaria.
:: Weekly epidemiology bulletin, 28 May–3 June 2018

WHO Grade 2 Emergencies  [to 16 Jun 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. 
:: Yemen Humanitarian Update Covering 4 – 11 June 2018 | Issue 19
:: Yemen: Al Hudaydah Update Situation Report No. 1, 14 June 2018
…Heavy fighting in Al Hudaydah put hundreds of thousands of civilians at risk;
…Al Hudaydah port remains open and food is being offloaded from vessels;
…Humanitarian organizations continue to provide life-saving assistance to displaced and vulnerable people despite a deterioration in the security situation;

Syrian Arab Republic 
:: Syrian Arab Republic: Humanitarian situation update in Afrin District and for IDPs in surrounding communities (as of 15 June 2018)


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.
:: OCHA Flash Update #4 Tropical Cyclone Sagar | 14 June 2018

WHO & Regional Offices [to 16 Jun 2018]

WHO & Regional Offices [to 16 Jun 2018]

WHO certifies Paraguay malaria-free
11 June 2018
News Release
San José / Geneva
The World Health Organization (WHO) today certified Paraguay as having eliminated malaria, the first country in the Americas to be granted this status since Cuba in 1973…
In 2016, WHO identified Paraguay as one of 21 countries with the potential to eliminate malaria by 2020. Through the “E-2020 initiative,” WHO is supporting these countries as they scale up activities to become malaria-free. Other E-2020 countries in the Americas include Belize, Costa Rica, Ecuador, El Salvador, Mexico and Suriname…


Weekly Epidemiological Record, 15 June 2018, vol. 93, 24 (pp. 345–356)
:: Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC): executive summary, 6–8 March 2018, Chamonix, France
Monthly report on dracunculiasis cases, January-April 2018
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Measles outbreak confirmed in northern Sierra Leone  14 June 2018
:: Yobe declares end of cholera, commends WHO’s leadership and coordination   13 June 2018
:: Scale-up measures to reduce adverse events and increase immunization uptake in Nigeria
13 June 2018
:: Returning home after surviving Ebola in the Democratic Republic of the Congo  13 June 2018
:: The Central African Republic prepares for Ebola response  12 June 2018

WHO Region of the Americas PAHO
:: Laboratory tests rule out the presence of wild and vaccine-derived poliovirus in the case of acute flaccid paralysis in Venezuela (06/15/2018)
:: CDB and PAHO sign agreement to support mental health in aftermath of natural disasters (06/13/2018)
:: Voluntary blood donation must be improved to ensure better patient outcomes (06/12/2018)
:: WHO certifies Paraguay malaria-free (06/10/2018)

WHO European Region EURO
:: Policy dialogue on implementing 2030 Agenda held during Regional Director’s visit to Romania 08-06-2018
:: New report reveals need for more humane, personalized approach in European Region’s long-term institutions for adults with intellectual and psychosocial disabilities 06-06-2018
:: Protect our environment, protect our health: World Environment Day 2018 05-06-2018

WHO Eastern Mediterranean Region EMRO
:: World Elder Abuse Awareness Day: alarmingly high rates of abuse in residential facilities 14-06-2018
:: European Working Group on Health in Climate Change supports countries in implementing key commitments 14-06-2018
:: 2018 FIFA World Cup: protect your health and score! 13-06-2018
:: Health payments are pushing people into poverty, even in high-income countries 12-06-2018