Vaccines and Global Health: The Week in Review :: 27 October 2018

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Declaration of Astana :: Declaration of Astana

Milestones :: Perspectives

Declaration of Astana

Global Conference on Primary Health Care
From Alma-Ata towards universal health coverage and the Sustainable Development Goals
Astana, Kazakhstan, 25 and 26 October 2018
12 pages  :: pdf:
We, Heads of State and Government, ministers and representatives of States and Governments1, participating in the Global Conference on Primary Health Care: From Alma-Ata towards universal health coverage and the Sustainable Development Goals, meeting in Astana on 25 and 26 October 2018, reaffirming the commitments expressed in the ambitious and visionary Declaration of Alma-Ata of 1978 and the 2030 Agenda for Sustainable Development, in pursuit of Health for All, hereby make the following Declaration.

We envision

Governments and societies that prioritize, promote and protect people’s health and well-being, at both population and individual levels, through strong health systems;

Primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed;

Enabling and health-conducive environments in which individuals and communities are empowered and engaged in maintaining and enhancing their health and well-being;

Partners and stakeholders aligned in providing effective support to national health policies, strategies and plans.

We strongly affirm our commitment to the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind. Convening on the fortieth anniversary of the Declaration of Alma-Ata, we reaffirm our commitment to all its values and principles, in particular to justice and solidarity, and we underline the importance of health for peace, security and socioeconomic development, and their interdependence.

We are convinced that strengthening primary health care (PHC) is the most inclusive, effective and efficient approach to enhance people’s physical and mental health, as well as social well-being, and that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals. We welcome the convening in 2019 of the United Nations General Assembly high-level meeting on UHC, to which this Declaration will contribute. We will each pursue our paths to achieving UHC so that all people have equitable access to the quality and effective health care they need, ensuring that the use of these services does not expose them to financial hardship.

…Promotive, preventive, curative, rehabilitative services and palliative care must be accessible to all. We must save millions of people from poverty, particularly extreme poverty, caused by disproportionate out-of-pocket spending on health. We can no longer underemphasize the crucial importance of health promotion and disease prevention, nor tolerate fragmented, unsafe or poor-quality care. We must address the shortage and uneven distribution of health workers. We must act on the growing costs of health care and medicines and vaccines. We cannot afford waste in health care spending due to inefficiency….

  1. Build sustainable primary health care

PHC will be implemented in accordance with national legislation, contexts and priorities. We will strengthen health systems by investing in PHC. We will enhance capacity and infrastructure for primary care – the first contact with health services – prioritizing essential public health functions. We will prioritize disease prevention and health promotion and will aim to meet all people’s health needs across the life course through comprehensive preventive, promotive, curative, rehabilitative services and palliative care. PHC will provide a comprehensive range of services and care, including but not limited to vaccination; screenings; prevention, control and management of noncommunicable and communicable diseases; care and services that promote, maintain and improve maternal, newborn, child and adolescent health; and mental health and sexual and reproductive health2. PHC will also be accessible, equitable, safe, of high quality, comprehensive, efficient, acceptable, available and affordable, and will deliver continuous, integrated services that are people-centred and gender-sensitive. We will strive to avoid fragmentation and ensure a functional referral system between primary and other levels of care. We will benefit from sustainable PHC that enhances health systems’ resilience to prevent, detect and respond to infectious diseases and outbreaks…


News Release

New global commitment to primary health care for all at Astana conference

Declaration of Astana charts course to achieve universal health coverage, 40 years since declaration on primary health care in Alma-Ata

25 October 2018, Astana, Kazakhstan

Countries around the world today agreed to the Declaration of Astana, vowing to strengthen their primary health care systems as an essential step toward achieving universal health coverage. The Declaration of Astana reaffirms the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care.

“Today, instead of health for all, we have health for some,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO). “We all have a solemn responsibility to ensure that today’s declaration on primary health care enables every person, everywhere to exercise their fundamental right to health.”

While the 1978 Declaration of Alma-Ata laid a foundation for primary health care, progress over the past four decades has been uneven. At least half the world’s population lacks access to essential health services – including care for noncommunicable and communicable diseases, maternal and child health, mental health, and sexual and reproductive health.

“Although the world is a healthier place for children today than ever before, close to 6 million children die every year before their fifth birthday mostly from preventable causes, and more than 150 million are stunted,” said Henrietta Fore, UNICEF Executive Director. “We as a global community can change that, by bringing quality health services close to those who need them. That’s what primary health care is about.”

The Declaration of Astana comes amid a growing global movement for greater investment in primary health care to achieve universal health coverage. Health resources have been overwhelmingly focused on single disease interventions rather than strong, comprehensive health systems – a gap highlighted by several health emergencies in recent years.

“Adoption of the Declaration at this global conference in Astana will set new directions for the development of primary health care as a basis of health care systems,” said Yelzhan Birtanov, Minister of Health of the Republic of Kazakhstan. “The new Declaration reflects obligations of countries, people, communities, health care systems and partners to achieve healthier lives through sustainable primary health care.”

UNICEF and WHO will help governments and civil society to act on the Declaration of Astana and encourage them to back the movement. UNICEF and WHO will also support countries in reviewing the implementation of this Declaration, in cooperation with other partners.

Notes to editors:

The Global Conference on Primary Health Care is taking place from 25-26 October in Astana, Kazakhstan, co-hosted by WHO, UNICEF and the Government of Kazakhstan. Participants include ministers of health, finance, education and social welfare; health workers and patient advocates; youth delegates and activists; and leaders representing bilateral and multilateral institutions, global health advocacy organizations, civil society, academia, philanthropy, media and the private sector.

The Declaration of Astana, unanimously endorsed by all WHO Member States, makes pledges in four key areas: (1) make bold political choices for health across all sectors; (2) build sustainable primary health care; (3) empower individuals and communities; and (4) align stakeholder support to national policies, strategies and plans.



UNICEF Airlifts 4.7 Million Doses of Measles, Rubella and Polio Vaccines for Children in Libya


UNICEF Airlifts 4.7 Million Doses of Measles, Rubella and Polio Vaccines for Children in Libya

Press release

TRIPOLI, 25 October 2018 – The third UNICEF-chartered plane has arrived at Mitiga airport, Tripoli, completing the delivery of a total 4.7 million doses of Measles, Rubella and Polio vaccines, as well as 2.75 million doses of Vitamin ‘A’ supplement, syringes and safety boxes. These supplies will be essential in Libya’s National Vaccination Campaign run in coordination with the World Health Organization [WHO] taking place at the end of November, which aims to protect some 2.75 million children at risk of vaccine-preventable diseases.

The current protracted conflict in Libya has resulted in damage to health infrastructure, disruption of public health services and access to basic health care. Limited investment in the health system has severely affected childhood vaccination, among other essential programmes.

Compounded by the desperate situation of migrants using Libya as a transit point, many of whom have not received immunizations in their country of origin or missed the required dose in Libya, routine immunization services in Libya have not been sufficient. Evidence shows that a number of boys and girls, particularly among the migrant communities and those living in hard-to-reach and conflict-affected areas of the country, have not been vaccinated.

“Deadly diseases such as measles don’t discriminate. They can hit any vulnerable child, anywhere. We are working closely with the Libyan authorities to ensure that the lifesaving vaccines are available across the country, including in hard to reach areas. Being vaccinated is every child’s right”, said Abdel-Rahman Ghandour, UNICEF Special Representative to Libya.

“The recent Measles outbreak and the existing risk of importation of poliovirus makes it very important to increase the immunity of the children against these diseases. WHO and UNICEF joining hands in conducting a national campaign for Measles and Polio is the most strategic approach to pre-empt major outbreaks as well as targeting migrant children”, said Dr Syed Jaffar Hussein, WHO Representative and Head of Mission, Libya.

UNICEF, WHO and the United Nations Central Emergency Response Fund (CERF) have allocated US$5.0 million to conduct a nationwide measles outbreak response immunization, vaccination against polio and vitamin A supplementation. The campaign will be run in partnership with the Ministry of Health – Center for National Disease Control, WHO, IOM and UNHCR.

NEW REPORT: The State of Vaccine Confidence in the EU: 2018

NEW REPORT: The State of Vaccine Confidence in the EU: 2018

Heidi Larson | 26 Oct, 2018
Confidence Commentary: Vaccine Confidence Project
High confidence in vaccination programmes is crucial for maintaining high coverage rates, especially at levels that exceed those required for herd immunity. Across the European Union (EU), however, vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks. Recent measles outbreaks – the highest in the EU for seven years – illustrate the immediate impact of declining coverage on disease outbreaks.

In this report  we assess the overall state of confidence in vaccines among the public in all 28 EU member states and among general practitioners (GP) in ten EU member states. As vaccine confidence varies by vaccine, confidence is assessed for vaccines in general as well as for the measles and seasonal influenza vaccines, in order to reflect vaccines targeting different population groups. Confidence in (and demand for) vaccines is influenced by a number of factors, including the importance, safety, and effectiveness of vaccines. To examine the extent of public and GP confidence in vaccines, we have conducted the largest ever study on attitudes to vaccines and vaccination in the EU. We find a range of novel EU-wide and country-specific insights into vaccination behaviours that may immediately impact on public policy.

We report a number of key findings. We find that younger adults in the survey have less confidence in the safety and importance of both the MMR and seasonal influenza vaccines (and vaccines generally) than older age groups. The results of the survey suggest that a number of member states – including France, Greece, Italy, and Slovenia – have become more confident in the safety of vaccines since 2015; while Czech Republic, Finland, Poland, and Sweden have become less confident over the same period. While GPs generally hold higher levels of vaccine confidence than the public, 7 the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% (respectively) do not believe it is important. We find that the majority of GPs surveyed in these countries report that they are not likely to recommend the seasonal influenza vaccine, yet Czech Republic, Poland, and Slovakia all report to the WHO that they recommend the seasonal influenza vaccine to pregnant women (WHO, Immunization Schedule by Antigens, 2018).

More information on the European Commission vaccination policy can be found here.



IAVI and Serum Institute of India to Develop and Manufacture Globally Affordable and Accessible Antibody Products for HIV

IAVI and Serum Institute of India to Develop and Manufacture Globally Affordable and Accessible Antibody Products for HIV

NEW YORK – October 22, 2018 – The International AIDS Vaccine Initiative (IAVI) and Serum Institute of India, the world’s largest vaccine manufacturer, today announced a strategic partnership to develop and manufacture affordable and accessible monoclonal antibody products for HIV and other global health challenges.

“IAVI is committed to translating scientific innovation into public health solutions, and we are collaborating with Serum Institute to enable global access to broadly neutralizing monoclonal antibodies (bNAbs) against HIV, if they are proven effective at preventing HIV infection. Through this partnership, we will work to pioneer a viable and sustainable pathway toward accessible, low-cost, antibody-based products for HIV, which if successful, may also be applied more broadly to innovative monoclonal antibody therapeutics targeting other disease areas,” said Mark Feinberg, M.D., Ph.D., president and CEO, IAVI.

“We have a proven record of developing and delivering vaccines and pharmaceutical products globally, and we are already applying this expertise in the field of antibody development. I am extremely pleased that Serum Institute and IAVI have joined forces in the fight against HIV with the aim of making cost-effective monoclonal antibodies for HIV, and in the fields of antimicrobial resistance and anti-snake venom. Provided the breadth of our technology, I am confident that we will be able to make positive contributions in these important areas,” said Adar Poonawalla, CEO, Serum Institute of India. “Monoclonal antibodies are providing significant therapeutic benefit in the treatment of a growing number of serious diseases. However, due to their high cost, the availability of current products is limited to wealthier countries. In light of the demonstrated efficacy of monoclonal antibodies and their future promise as globally relevant tools for disease treatment and prevention, this must change. Serum Institute is committed to developing high quality, affordable, monoclonal antibodies with the potential to treat and prevent HIV and other diseases in India and across the globe.”..


Ebola virus disease – Democratic Republic of the Congo :: 12: Situation report on the Ebola outbreak in North Kivu 

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

Ebola virus disease – Democratic Republic of the Congo   
25 October 2018
Public Health Response
As of 24 October, 122 vaccination rings have been defined, in addition to 37 rings of health and frontline workers. To date, 22 288 eligible and consented people have been vaccinated, including 8471 health and frontline workers and 5488 children. Overall, vaccination teams have reached an additional 3345 eligible and consenting people in the past week…

12: Situation report on the Ebola outbreak in North Kivu 
23 October 2018
Situation Update
… Since WHO’s last situation report issued on 17 October 2018 (External Situation Report 11), an additional 22 new confirmed EVD cases, from Beni (19) and Butembo (3), and 16 new deaths have been reported. As of 21 October 2018, a total of 238 confirmed and probable EVD cases, including 155 deaths, have been reported, resulting in a case fatality ratio (CFR) of 65%. Among the 238 cases, 203 are confirmed and 35 are probable cases. Of the 155 deaths reported since the beginning of the outbreak, 120 were among confirmed cases and 35 among probable cases. The proportion of deaths among confirmed cases was 59% (120/203). On 21 October, 14 new suspected cases were under investigation in Beni (8), Mabalako (1), Butembo (2) and Mandima (3).
As of 21 October 2018, 63 cases have recovered, been discharged from ETCs, and re-integrated into their communities. On 21 October, a total of 60 cases remained hospitalized in four ETCs in Beni (38), Butembo (19), Mangina (two) and Makeke (one). On that day, the treatment centres in Beni and Butembo recorded an occupancy rate of 93% (38/41) and 79% (19/24) respectively…
Case management
Ebola Treatment Centres (ETCs) 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) together with supportive care measures. WHO is providing technical clinical expertise on-site and is assisting with the creation of a data safety management board…


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 23 October 2018 [GPEI]
:: World Polio Day activities are in full swing.  Join partners around the world in raising awareness about the global effort to eradicate polio.

Summary of new viruses this week:
Afghanistan – one wild poliovirus type 1 (WPV1) positive environmental sample;
Pakistan – two WPV1 cases and four WPV1-positive environmental samples;
Nigeria – one cVDPV2 case and three cVDPV2-positive environmental samples

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 27 Oct 2018 ]
Democratic Republic of the Congo
:: Beni: Ministry of Health and WHO condemn violence against civilians and health professionals in Ebola affected areas [in French]  22 October 2018
:: 12: Situation report on the Ebola outbreak in North Kivu  23 October 2018
:: Ebola virus disease – Democratic Republic of the Congo   25 October 2018
[See Milestones above for more detail]
Bangladesh – Rohingya crisis
:: Weekly Situation Report 47 – 17 October 2018
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Syrian Arab Republic – No new announcements identified
Yemen – No new announcements identified

WHO Grade 2 Emergencies  [to 27 Oct 2018 ]
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
Iraq – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Myanmar – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Sudan – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified
Outbreaks and Emergencies Bulletin, Week 42: 13-19 October 2018

The WHO Health Emergencies Programme is currently monitoring 55 events in the region. This week’s edition covers key ongoing events, including:
:: Ebola virus disease outbreak in the Democratic Republic of the Congo
:: Dengue Fever in Senegal
:: Hepatitis E in Namibia
:: Cholera in Zimbabwe.

WHO Grade 1 Emergencies  [to 27 Oct 2018 ]
Angola (in Portuguese)
Lao People’s Democratic Republic
Papua New Guinea
Tropical Cyclone Gira
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 7 October – 21 October …
:: Yemen: Cyclone Luban Flash Update #3 (21 October 2018) [EN/A …

Syrian Arab Republic   No new announcements identified.


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.

“Other Emergencies”
Indonesia: Central Sulawesi Earthquake
:: Central Sulawesi Earthquake & Tsunami: Humanitarian Country Team Situation Report #5 (as of 23 October 2018)

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 27 Oct 2018 ]
[See Milestones above for more detail]

MERS-CoV [to 27 Oct 2018 ]
No new announcements identified.
Yellow Fever  [to 27 Oct 2018 ]
No new announcements identified.
Zika virus  [to 27 Oct 2018 ]
No new announcements identified.
WHO & Regional Offices [to 27 Oct 2018 ]
25 October 2018
News Release
New global commitment to primary health care for all at Astana conference
Declaration of Astana charts course to achieve universal health coverage, 40 years since declaration on primary health care in Alma-Ata
[See Milestones/Perspectives above for more detail]

23 October 2018
News Release
HH Pope Francis and WHO Director-General: Health is a right and not a privilege

Weekly Epidemiological Record, 26 October 2018, vol. 93, 43 (pp. 577–588)
:: Joint external evaluation of implementation of the International Health Regulations (2005) in Libya: a bridge to safeguard nationals
:: Update on vaccine-derived polioviruses – worldwide, January 2017–June 2018

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Uganda’s Prime Minister lauds WHO for the support during disease outbreak emergencies
26 October 2018
:: Protecting girls against cervical cancer in Tanzania  24 October 2018

:: Joint Statement on World Polio Day: WHO, UNICEF and Rotary International reaffirm their commitments to stop off polio in the Horn of Africa. 24 October 2018
:: Polio infrastructure remains crucial for mounting initial response to disease outbreaks in Nigeria   23 October 2018

WHO Region of the Americas PAHO
:: New global commitment to Primary Health Care for all at Astana Conference (10/25/2018)
:: Countries of the Americas urged to take action to keep polio at bay (10/23/2018)
WHO South-East Asia Region SEARO
– No new announcement identified
WHO European Region EURO
:: Social marketing insights help solve the puzzle of low influenza vaccination rates among health-care workers in the west of Ireland 26-10-2018
:: New global commitment to primary health care for all at Astana conference 26-10-2018
:: Primary health care: the time is now 24-10-2018
:: World Polio Day celebrates history in the making 23-10-2018
:: Is it just a “touch of the flu” for you, or do you face a greater risk? 22-10-2018

WHO Eastern Mediterranean Region EMRO
:: Pool of experts for Middle East respiratory syndrome established  23 October 2018
:: Contribution of United Arab Emirates acknowledged on World Polio Day  23 October 2018
:: HH Pope Francis and WHO Director-General: Health is a right and not a privilege 23 October 2018
:: Health system strengthening boosts immunization in Somalia  22 October 2018

WHO Western Pacific Region
– No new announcement identified