Vaccines and Global Health: The Week in Review :: 15 September 2018

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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

Global Preparedness Monitoring Board convenes for the first time in Geneva

Milestones :: Perspectives

Global Preparedness Monitoring Board convenes for the first time in Geneva
10 September 2018 | Statement
WHO and the World Bank Group today convened the first meeting of the Global Preparedness Monitoring Board (GPMB), a new body set up to monitor the world’s readiness to respond to outbreaks and other health emergencies.

The GPMB is chaired by Dr Gro Harlem Brundtland, former Prime Minister of Norway and former WHO Director-General and Mr Elhadj As Sy, Secretary General of the International Federation of Red Cross and Red Crescent Societies, and includes some of the most notable leaders in global health.

The GPMB has been established to monitor progress, identify gaps and advocate for sustained, effective work to ensure global preparedness. At its first meeting at WHO’s headquarters in Geneva, the GPMB today discussed key issues in global preparedness and agreed its terms of reference and governance structure. The board aims to publish its first report on the global state of preparedness in September 2019.

“Despite all the progress we have made, the world remains vulnerable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The Global Preparedness Monitoring Board brings together deep experience and expertise to help keep the world safe.”

“There’s no substitute for preparedness, and investing in it should be a top priority for the entire global community,” said Dr Jim Yong Kim, President of the World Bank Group. “It is important that countries are beginning to take pandemic preparedness much more seriously.”
The GPMB has its origins in the 2014 Ebola outbreak in West Africa, which devastated thousands of families, damaged economies and shook the world.

Since then, WHO has undergone major transformation, with the establishment of its health emergencies programme. In the Organization’s new strategic 5-year plan, one of the three “triple billion” targets for 2023 is to see 1 billion people better protected from health emergencies.

The World Bank has also established the Pandemic Emergency Financing Facility and made its first cash disbursement to the Ebola outbreak in Democratic Republic of the Congo in May this year.  As part of its IDA 18 commitment, the World Bank is supporting the development of pandemic preparedness plans in 25 low- and lower-middle income countries. It is also investing in preparedness in several countries in the East Asia and Pacific region, and in strengthening regional disease surveillance and monitoring capacity across East and West Africa.

Most importantly, countries and communities have embraced the need for preparedness, with WHO’s Member States recommitting to establishing the capacities required under the International Health Regulations and dozens requesting Joint External Evaluations.

 

 

06: Situation report on the Ebola outbreak in North Kivu :: Ebola virus disease – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

WHO – 06: Situation report on the Ebola outbreak in North Kivu 11 September 2018
[Excerpts]
Situation update
…Recent trends (Figure 1) suggest that control measures are working; however, these trends must be interpreted with caution. The outbreak remains active in Beni, Mabalako and Mandima health zones, and additional risks remain following the movement of several cases from these areas to Butembo and Masereka in recent weeks.
Since our last situation report on 4 September 2018 (External situation report 5), an additional 10 new confirmed or probable EVD cases have been reported from Butembo (2), Beni (5) Mabalako (1), Mandima (1), and Masereka (1) and nine new deaths. Currently there are nine suspected cases under investigation (Table 1).
As of 9 September 2018, a total of 132 confirmed and probable EVD cases, including 91 deaths and 36 cases who have recovered, have been reported. Among the 132 cases, 101 are confirmed and 31 are probable. Of the 91 deaths, 60 occurred in confirmed cases…

Case management
ETCs [Ebola Treatment Centers] continue to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board.
As of 6 September 2018, 29 patients have received investigational Ebola therapeutics, including: mAb114 (14 patients), Remdesivir (9 patients) and ZMapp (6 patients). Of the 20 patients, 14 have been discharged and nine have died. All the deaths were among patients with advanced organ failure on admission.
Médicines sans Frontièrs (MSF) Swiss and the Ministry of Health are building a 10 bed ETC in Butembo, which is expected to be operational by the end of this week…

Implementation of ring vaccination protocol
The SDB Commission plan for hard-to-reach areas started training on civil protection teams on 9 September 2018 with, the support of the Red Cross.
As of 10 September 2018, 48 vaccination rings have been defined, in addition to 13 rings of healthcare and other frontline workers. These rings notably include the contacts (and their contacts) of the confirmed cases from the last three weeks. To date, 8229 people consented and were vaccinated, including 2526 healthcare and front line workers, and 1968 children.    There is one area in Ndindi, where the implementation of vaccination is hampered by community resistance.
The ring vaccination teams are currently active in three health areas in North Kivu and one in Ituri.

Ebola virus disease – Democratic Republic of the Congo
Disease Outbreak News (DONs) – 14 September 2018

 

UNICEF to scale up Ebola response following new cases in major commercial center of Butembo in the Democratic Republic of Congo

Milestones :: Perspectives

UNICEF to scale up Ebola response following new cases in major commercial center of Butembo in the Democratic Republic of Congo

KINSHASA/DAKAR/NEW YORK/GENEVA, 14 September 2018 – UNICEF is opening a new Ebola-response front in the Democratic Republic of Congo to provide support to thousands of people, including children, at risk in the city of Butembo, following the Government’s recent confirmation of two new Ebola cases.

“Butembo is an important commercial city and has nearly one million inhabitants. So there is a real risk the virus could spread quickly in such a large population centre,” said Dr Gianfranco Rotigliano, UNICEF Representative in the DRC during his visit to Butembo. “The number of confirmed Ebola cases in Butembo remains limited, but we have to ensure that everything is being done now to ensure that the outbreak is controlled at this early stage.”

UNICEF is expanding its Ebola response and deploying to Butembo a team of 11 specialists in community communication, education, psycho-social assistance, and water, sanitation and hygiene to help contain the disease and avoid any further spread of the epidemic. Prioritizing neighbourhoods in Butembo with confirmed Ebola cases and people who have been in contact with infected people, UNICEF together with its partners has already:
:: Trained 35 psycho-social workers to assist families and children affected by the disease;
:: Broadcast sensitization programmes on nine community radios and sensitized 36 journalists on prevention measures;
:: Informed 255 local community leaders in targeted neighbourhoods in Butembo about the Ebola virus, prevention measures and the alert number to contact for early and specialised health care for people with Ebola-like symptoms;
:: Sensitized about 7,000 people through religious leaders.

While expanding its response to the city of Butembo, UNICEF continues to work with its partners in Mangina and Beni. Since the beginning of the outbreak, UNICEF has collaborated with community, youth and religious leaders to reach more than 3.3 million people with Ebola prevention and advocacy messages. UNICEF is working with local communities and Ebola survivors to ensure that the strategies put in place are effective and sustainable, and to defuse local resistance against the Ebola response, especially in the Ndindi neighbourhood of Beni.

UNICEF multidisciplinary teams include anthropologists, who ensure that the response is sensitive to cultural believes and practices, particularly around caring for sick and diseased individuals, and addressing populations’ concerns about secure and dignified burials. In Ndindi, local committees are working hand-in-hand with UNICEF to identify and implement sensitization activities. Local committees have contributed to the setting up of sensitization trucks with megaphones driving through the neighbourhood. UNICEF has provided 120 local leaders with mobile phones to strengthen early detection and referral to relevant health services of people suspected to be infected.

WHO statement on the health situation in Yemen

Milestones :: Perspectives

WHO statement on the health situation in Yemen
Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean
7 September 2018 – The scale of human suffering and health needs in Yemen today is unprecedented. An entire country and its health infrastructure has been brought to its knees. People who have survived more than three and a half years of war now find themselves facing additional threats of hunger and disease.

Malnourished mothers are unable to breastfeed their equally malnourished babies. Parents have lost their children as entire families are afflicted by cholera and repeatedly infected with other diseases. People thrown into extreme poverty due to the war are unable to buy food for their families, with some families living only on bread for sustenance. As the Yemeni Riyal continues to plummet, poor families who could afford very little, will be left with nothing.

While medical care is free in public health facilities, many Yemenis can barely afford the cost of public transport to get to these facilities, and families are forced to sell all their belongings to buy medicines. Health care workers have not received their salaries in two years.

The need for our lifesaving work in Yemen has never been greater.

Despite serious challenges impeding our response, our commitment to saving lives in Yemen continues. We are providing hospitals with fuel, safe water, medicines and ambulances to keep them functioning. We are supporting centres for the treatment of cholera and other diseases, as well as supporting therapeutic feeding centres for severely malnourished children suffering from medical complications. And we are making sure health staff continue to report to work by providing rapid response teams, mobile medical teams in hard-to-reach areas, and public health and surgical teams in priority hospitals with incentives.

This year alone, we have been able to reach an estimated 8.7 million people with health aid. But there are many more we are unable to reach due to the insecurity, or who are unable to find the right medicines or specialized care. People in Yemen are dying today not just because of the bullets and bombs, but because they are unable to receive the medical care they need to stay alive.

We cannot allow ourselves to be sensitized into accepting this situation as the norm. Humanitarian laws protecting civilians, hospitals, health staff and patients must be respected by all parties. Unrestricted passage of medicines and medical supplies into all parts of the country must be granted. The people of Yemen need immediate and unrestricted access to lifesaving health care, and they need it now more than ever before
 
 

China’s drug regulator clears 45 vaccine makers in sweeping, scandal-triggered inspections

Milestones :: Perspectives

China’s drug regulator clears 45 vaccine makers in sweeping, scandal-triggered inspections

by Angus Liu |
Fierce Pharma Sep 10, 2018 10:35am
When Changchun Changsheng Life Sciences’ manufacturing malpractice sparked a nationwide outcry over vaccine safety in July, the Chinese drug authority dispatched teams to inspect all other vaccine companies. Now, the results are in.
China’s recently rebranded National Medical Products Administration (NMPA) said (Chinese) on Friday it had inspected all of the other 45 vaccine makers between July 23 and Aug. 9 and found no quality or safety problems.
Among the 45 manufacturers, 38 were complying with GMP practices and other regulations, while the other seven have ceased production for more than three years and have no products currently on the market, said the agency…
 

Emergencies

Emergencies

 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 4 September 2018 [GPEI]
The Johns Hopkins University is leading a project to document lessons learned from GPEI, and translating those lessons to improve delivery of other lifesaving health programmes and strengthening health systems globally. Read more and learn how you can contribute: GPEI Lessons Learned Project.

Summary of new viruses this week:
Afghanistan – One new case of wild poliovirus (WPV1).
Pakistan – One new case of wild poliovirus (WPV1).
Afghanistan and Pakistan continue to detect WPV1 through environmental sampling, indicating sustained transmission
Papua New Guinea – three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1).
Somalia – two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2).

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GPEI Lessons Learned Project
The Johns Hopkins University is leading a project to document lessons learned from GPEI, and translating those lessons to improve delivery of other lifesaving health programmes and strengthening health systems globally.

As an initial step in the project, a global survey is underway to map tacit knowledge of GPEI actors about implementation challenges (and the contexts in which those arose).

The specific objectives of the survey are:
:: Map tacit knowledge (ideas, approaches and experiences that were not documented, but relevant for both intended and unintended results) about GPEI under various context typologies
:: Identify key facilitators for GPEI programme implementation
:: Identify key implementation challenges, the level where they originated from (global, national, subnational), and how they were resolved.

The target audience for the global survey includes:
:: Individuals who have been directly involved in implementing activities under the GPEI between 1988 to date. Implementing activities refer to all cycles of implementation, including GPEI-related funding, policy, programming, and research cycles. The population includes individuals who have spent 12 or more continuous months working on activities under the GPEI between 1988 to date.

If you meet the specifications of the target audience, your participation is requested in this online survey, which takes approximately 15-30 minutes.

How to participate in the survey
Access to the survey can be granted by reaching out to the project team at poliolessonslearned@gmail.com with your name and organization.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies  [to 15 Sep 2018]
Bangladesh – Rohingya crisis
:: Using local materials to build health facilities  12 September 2018
:: Weekly Situation Report 42 – 6 September 2018pdf, 220kb
 KEY HIGHLIGHTS

  • The next round of oral cholera campaign (OCV) will begin on 6 October 2018, targeting 327 364 people.
  • Acute Respiratory Infection (ARI) and suspected malaria cases are showing an increasing trend.
  • A total of nine Mobile Medical Teams were deployed in week 35. Primary health care and dental care services were provided to 3 375 people across 13 camps.

SITUATION OVERVIEW

  • According to the Needs and Population Monitoring (NPM) exercise, there are an estimated 919 000 Rohingya refugees in Cox’s Bazar as of 22 July 2018. Of these, 706 364 are new arrivals since 25 August 2017.
  • More heavy rain from the current monsoon season and the second season of cyclones and monsoons toward the end of the year will increase the risk of water-borne diseases such as cholera and hepatitis A and vector-borne diseases such as malaria, dengue and chikungunya.

Democratic Republic of the Congo
:: 06: Situation report on the Ebola outbreak in North Kivu 11 September 2018
:: Disease Outbreak News (DONs) – Ebola virus disease – Democratic Republic of the Congo
14 September 2018
[See Milestones above for more detail]

Yemen
:: WHO statement on the health situation in Yemen  7 September 2018
Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean
[See Milestones above for more detail]

Iraq – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Syrian Arab Republic – No new announcements identified

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WHO Grade 2 Emergencies  [to 15 Sep 2018]
Cameroon  – See below
Central African Republic  – See below
Hurricane Irma and Maria in the Caribbean – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
Myanmar – No new announcements identified
South Africa Listeriosis (2017) – See below
Sudan – No new announcements identified
Ukraine – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified

Outbreaks and Emergencies Bulletin, Week 36: 1 – 7 September 2018
The WHO Health Emergencies Programme is currently monitoring 55 events in the region. This week’s edition covers key ongoing events, including:
:: Declaration of the end of the listeriosis outbreak in South Africa
:: Ebola virus disease in the Democratic Republic of the Congo
:: Cholera in Niger
:: Cholera in Cameroon
:: Hepatitis E in Namibia
:: Humanitarian crisis in Central African Republic.

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WHO Grade 1 Emergencies  [to 15 Sep 2018]
Afghanistan
Angola (in Portuguese)
Chad
Ethiopia
Kenya
Lao People’s Democratic Republic
Mali
Papua New Guinea
Peru
Tanzania
Tropical Cyclone Gira
Zambia
 
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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Yemen 
:: Yemen Humanitarian Update Covering 27 August – 6 September 2018 | Issue 26
Published on 06 Sep 2018
KEY ISSUES:
:: As the depreciation of the Yemeni Rial continues, a further 3.5 million people may become food insecure and an additional 2 million may face a heightened risk of famine.
:: The conflict in Yemen continues to exact a heavy toll on civilians. In August, 241 civilian impact incidents were reported.
:: Humanitarian partners continue to work to prevent a third outbreak of cholera; some 133,000 suspected cholera cases have been confirmed since January…

Syrian Arab Republic   No new announcements identified.

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  – No new announcements identified.
Somalia   No new announcements identified.

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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD  [to 15 Sep 2018]
http://www.who.int/ebola/en/
Disease outbreak news
:: 06: Situation report on the Ebola outbreak in North Kivu 11 September 2018
:: Disease Outbreak News (DONs) – Ebola virus disease – Democratic Republic of the Congo
14 September 2018
[See Milestones above for more detail]

MERS-CoV [to 15 Sep 2018]
http://who.int/emergencies/mers-cov/en/
DONs
Middle East respiratory syndrome coronavirus (MERS-CoV) infection – Republic of Korea
12 September 2018
 
Yellow Fever  [to 15 Sep 2018]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.

Zika virus  [to 15 Sep 2018]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.