Vaccines and Global Health: The Week in Review :: 17 November 2018

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

Global Task Force on Cholera Control marks a year of progress toward ending cholera worldwide

Milestones :: Perspectives

Global Task Force on Cholera Control marks a year of progress toward ending cholera worldwide

GENEVA/ NEW YORK, 30 October 2018 – This month, partners of the Global Task Force on Cholera Control (GTFCC) mark one year since the launch of Ending Cholera: A Global Roadmap to 2030, which targets a 90% reduction in cholera deaths by 2030 and the elimination of cholera in at least 20 countries out of the 47 currently affected.

At the 4 October 2017 launch of the Global Roadmap in Annecy, France, 35 global health and WASH organizations leading the fight against cholera signed the Declaration on Ending Cholera, committing their financial and human resources in support of its implementation in countries.

One year later, the movement to end cholera has made exceptional progress. At least 10 countries are now taking active measures towards cholera control plans in alignment with the Global Roadmap: Bangladesh, Haiti, Kenya, Malawi, Nigeria, South Sudan, Uganda, Zambia, the United Republic of Tanzania, and Zimbabwe. In addition, 47 African countries adopted the Regional Framework for the Implementation of the Global Strategy for Cholera Prevention and Control on 28 August at the 68th session of the WHO Regional Committee for Africa.

In May 2018, at the 71st World Health Assembly (WHA), WHO Member States took the extraordinary step of passing a resolution—introduced by the Governments of Zambia and Haiti—committing to implementation of the Global Roadmap, calling for the resources and policy changes necessary to meet the goal.

In line with the Global Roadmap, the Africa Regional Framework and the WHA resolution commit countries to implement evidence-based measures including:

:: mapping of cholera hotspots

:: significant investment in safe water, sanitation, and hygiene (WASH)

:: use of oral cholera vaccine

:: enhanced epidemiological and laboratory surveillance

:: improving access to timely treatment

:: promoting community engagement.

Cholera-affected countries demonstrate strong leadership and determination to stop cholera outbreaks

Examples include:

:: The end of the longest cholera outbreak in South Sudan in February 2018 shows it is possible to stop persistent cholera outbreaks in endemic settings, achieving high vaccine coverage even in the context of conflict and instability. The outbreak, which started in June 2016, resulted in 20,000 cases and 436 deaths. South Sudan conducted 38 vaccination campaigns, using a flexible data-driven approach to allocate 2.8 million doses to people living in hotspots as conditions made it possible to reach them.

:: Yemen, the location of the world’s most severe cholera outbreak, saw its first use of Oral Cholera Vaccine in 2018 – a critical step in fighting cholera there. Nearly 700,000 people have already been vaccinated and, another 1.4 million people are expected to receive vaccines in the coming weeks.  However, widespread malnutrition, and destruction of water and sanitation infrastructure will require additional efforts to bring cholera under control in Yemen.

Cholera-affected countries plan a future without cholera by developing multi-sectoral cholera control plans .

:: The Government of Zanzibar, a semi-autonomous part of the United Republic of Tanzania, is ready to the Zanzibar Comprehensive Cholera Elimination Plan (ZACCEP), a costed multi-sectoral cholera elimination plan in alignment with the Global Roadmap, which aims to end cholera by 2027.

The Government of Bangladesh revised its National Program on Diarrheal Diseases Prevention, Management & Control to align it with the Global Roadmap, working with national WASH partners to collectively implement a plan to target elimination by 2030. Introduction of a phased large scale OCV campaign is planned to start in 2019. Professor Abul Kalam Azad, Director General of Health Services, Ministry of Health & Family Welfare, noted that cholera has no place in a country like Bangladesh, which is striving toward middle-income status: “Bangladesh has made huge strides in health outcomes in recent years. It is now time to commit the resources to ensure cholera will no longer be a threat to the people of Bangladesh.”

The Government of Zambia is launching a national multi-sectoral plan, aligned with the Global Roadmap strategy, targeting elimination of cholera by 2025. The response to the October 2017 outbreak triggered strong political engagement. Honorable Chitalu Chilufya, Minister of Health, observed “the government of Zambia has provided exemplary leadership in halting last year’s outbreak, bringing together a well-resourced, multi-sectoral response. With this strong political will and a sound national plan, I am confident that Zambia will be free from cholera by 2025.”

Unprecedented use of Oral Cholera Vaccine in 2018, including the largest cholera vaccination drive in history

As countries voted to pass the WHA resolution, five countries were already preparing for the largest cholera vaccination drive in history. The oral cholera vaccines were sourced from the global stockpile, funded by Gavi, the Vaccine Alliance, for five major campaigns in Zambia, Uganda, Malawi, South Sudan and Nigeria. The campaign protected over two million people from the threat of cholera. UNICEF procured 15.2 million doses to 12 countries to date, on top of nearly 10 million doses delivered in 2017. This compares to just 200,000 doses delivered in 2013, when the stockpile was created. OCV is just one tool in a much larger toolbox that includes sustainable safe water, sanitation, and hygiene (WASH), but it serves as a critical bridge to these longer-term efforts.

An energized GTFCC partnership supports countries in the fight to #EndCholera

GTFCC partners are taking action on their commitment from October 2017, by aligning their programs with the Global Roadmap and by increasing resources to concretely support cholera control efforts. In partnership with WHO, UNICEF brings strong leadership to the GTFCC working group on Water Sanitation and Hygiene (WASH). In 2018, the International Federation of Red Cross and Red Crescent Societies (IFRC) launched the One WASH program, an integrated approach that will support more than 20 cholera-affected countries. Projects are already in start-up phase in Uganda, Ghana, Malawi and Rwanda with an initial commitment of US$2.5 million. The Wellcome Trust and the UK Department for International Development (DFID) issued a call for proposals to support the cholera research agenda. The US Centers for Disease Control and Prevention (CDC) is providing technical experts in-country upon request, which is a critical allocation of human and other resources in the fight against cholera.

Ministers agree on international action to address antimicrobial resistance in animals and to safeguard medicines for humans and animals alike

Ministers agree on international action to address antimicrobial resistance in animals and to safeguard medicines for humans and animals alike

Marrakesh, 31 October 2018 –  The World Organisation for Animal Health (OIE) hosted this week global leaders in animal health from the private and public sectors and civil society to discuss new ideas and solutions to the global rise of antimicrobial resistance (AMR). The three-day event was placed under the high patronage of his majesty Mohammed VI, King of Morocco. Entitled the 2nd Global Conference on Antimicrobial Resistance and Prudent Use of Antimicrobial Agents in Animals, it focussed on the role played by animal health in what is one of the 21st century’s starkest global health challenges.

Prevention of AMR in farming is critical to human health, as well as to food safety, food security, animal health and animal welfare. Antimicrobials are used around the world to control and treat infections in animals and humans, but their overuse and misuse puts their efficacy at risk. Unprecedented movements of people, animals, goods and food worldwide, enable resistant pathogens to populate the planet with ease.

The conference was attended by more than 500 participants, including representatives of OIE’s 182 Member Countries, of international partners (such as FAO, WHO, World Bank, and the United Nations Interagency Coordination Group on AMR), as well as representatives from the meat, dairy, poultry, egg, aquaculture and pharmaceutical industries, civil society and academia.

A prominent theme of the discussions was the need for cross-sector, national level coordination through national action plans to prevent the development and spread of antimicrobial resistance. Conference speakers included Ministers, Deputy Ministers and State Secretaries from countries across the world, including Morocco, Germany, Senegal, Thailand, Japan, Norway, Botswana, Serbia, and Uzbekistan.

“It is only by promoting the responsible and prudent use of antimicrobials that their efficacy can be safeguarded, ensuring that essential medicines that protect both human and animal health can continue to be used.” said Dr Monique Eloit, Director General of OIE. “We have made important progress in this mission today. International Standards on prudent use already exist. We now need to put them into practice at national level to tackle AMR. For this, international collaboration is essential. By working together, countries can discuss challenges, share best practice and make global improvements.”

 

Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

13: Situation report on the Ebola outbreak in North Kivu 
30 October 2018
The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored by the Ministry of Health (MoH), WHO and partners.  Of concern is the increased incidence of confirmed cases reported in the past four weeks, most notably in the city of Beni and communities around Butembo. Security remains the biggest challenge faced by the response teams in Beni and Butembo, undermining the response activities. Continued security incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. Moreover, with heightened transmission of the virus in outbreak affected areas, the risk of exportation of cases to neighbouring provinces and countries is increased. Neighbouring countries need to be ready in case the outbreak spreads beyond the Democratic Republic of the Congo….

DONs Ebola virus disease – Democratic Republic of the Congo
1 November 2018
[Excerpts]
Vaccination: As of 31 October, 154 vaccination rings have been defined, in addition to 37 rings of health and frontline worker. To date, 25 298 eligible and consented people have been vaccinated, including 8916 health and frontline workers and 6578 children. Overall, vaccination teams have reached an additional 3345 eligible and consenting people in the past week.
Partners
To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including: European Civil Protection and Humanitarian Aid Operation (ECHO); International Organization for Migration (IOM); UK Public Health Rapid Support Team; United Nations Children’s Fund (UNICEF); UN High Commission on Refugees (UNHCR); World Bank and regional development banks; World Food Programme (WFP) and UN Humanitarian Air Service (UNHAS); UN mission and UN Department of Safety and Security (UNDSS); Inter-Agency Standing Commission; United Nations Office for the Coordination of Humanitarian Affairs (OCHA); and the United Nations Population Fund (UNFPA); Africa Centres for Disease Control; US CDC; UK Department for International Development (DFID); United States Agency for International Development (USAID); Adeco Federación (ADECO); Association des femmes pour la nutrition à assisse communautaire (AFNAC); Alliance for International Medical Action (ALIMA); CARITAS DRC; CARE International; Centre de promotion socio-sanitaire (CEPROSSAN); Cooperazione Internationale (COOPE); Catholic Organization for Relief and Development Aid (CORDAID/PAP-DRC); International Medical Corps; International Rescue Committee (IRC); Intersos – Organizzatione Umanitaria par l’Emergenza (INTERSOS); MEDAIR; Médecins Sans Frontières (MSF); Oxfam International; Red Cross of the Democratic Republic of Congo, with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC) and International Committee of the Red Cross (ICRC); Samaritan’s Purse; Save the Children (SCI); Global Outbreak Alert and Response Network (GOARN), Emerging and Dangerous Pathogens Laboratory Network (EDPLN), Emerging Disease Clinical Assessment and Response Network (EDCARN), technical networks and operational partners, and the Emergency Medical Team Initiative (EMT). GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.

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Adopting Resolution 2439 (2018), Security Council Condemns Attacks by Armed Groups in Democratic Republic of Congo Jeopardizing Response to Ebola Outbreak
30 October 2018
SC/13559
The Security Council today adopted a resolution condemning attacks by armed groups in the Democratic Republic of the Congo and their role in exacerbating the country’s ongoing Ebola outbreak, while demanding full, safe, immediate and unhindered access for the humanitarian and medical personnel working to save lives and prevent the virus from spreading across the region.

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:: Uganda Finalizes Plans to Vaccinate Front-line Health Workers against Ebola  03 November 2018
:: Zambia heightens its capacity for preventing and responding to the threat of an outbreak of Ebola Virus Disease  02 November 2018
:: WHO enhances Ebola Rapid Response Readiness Capacities in South Sudan  01 November 2018
:: WHO and the Ministry of Health Train Members of the Armed Forces on Ebola Case Management [Uganda]  29 October 2018

 

Emergencies

Emergencies
 
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 30 October 2018 [GPEI]
:: World Polio Day activities garnered global attention. Partners, donors, and popular public figures around the world brought attention to the cause of polio and the efforts to eradicate polio. A quick overview of some of the World Polio Day highlights
:: The Every Last Child project series was launched by UNICEF, which covers over 30 wide-ranging profiles of governments, front-line workers, and the stakeholders involved in the collective polio eradication efforts across Nigeria, Afghanistan, and Pakistan.
:: Featured on polioeradication.org: Coffee with Polio Experts – Dr Arlene King, Chair of the RCC for the Americas, and GCC Containment Working Group talks to WHO about the importance of safe and secure containment of polioviruses, in places where needed, and the accompanying risk and responsibility that come with retaining the pathogen.
 
Afghanistan – Three new cases of wild poliovirus (WPV1) and four WPV1 positive environmental samples.
  
Democratic Republic of Congo – one new case of circulating vaccine-derived poliovirus type 2 (cVDPV2).
 
Pakistan – No new case of wild poliovirus (WPV1) and seven WPV1 positive environmental samples
 
Nigeria – two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2).
 
Somalia – four new cVDPV2 positive environmental samples. See country sections below for more details.

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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 3 Nov 2018 ]
Democratic Republic of the Congo
:: 13: Situation report on the Ebola outbreak in North Kivu  30 October 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo  1 November 2018
[See Milestones above for more detail]

Bangladesh – Rohingya crisis
:: Weekly Situation Report 48 – 25 October 2018
[Excerpt]
…WHO immunization team is planning to start passive surveillance activity of Acute Flaccid Paralysis (AFP), Vaccine Preventable diseases m(VPDs), Congenital rubella syndrome (CRS) and Adverse Event Following Immunization (AEFIs) for early notification and in compliance with the

Ministry of Health (MoH) surveillance program….
 
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
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WHO Grade 2 Emergencies  [to 3 Nov 2018 ]
Myanmar
:: Weekly Situation Report 48 – 25 October 2018 [see above]
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
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 43: 20 – 26 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
:: Cholera in Cameroon
:: Dengue in Senegal
:: Hepatitis E in Central African Republic.
::::::
 
WHO Grade 1 Emergencies  [to 3 Nov 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. 
Syrian Arab Republic   No new announcements identified.
YemenNo 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 
:: Ethiopia Humanitarian Bulletin Issue 66 | 15-28 October 2018
 
Somalia  No new announcements identified.
 
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“Other Emergencies”
Indonesia: Central Sulawesi Earthquake
:: Central Sulawesi Earthquake & Tsunami: Humanitarian Country Team Situation Report #6 (as of 30 October 2018)
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
EBOLA/EVD  [to 3 Nov 2018 ]
http://www.who.int/ebola/en/
[See Milestones above for more detail]
 
MERS-CoV [to 3 Nov 2018 ]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.
 
Yellow Fever  [to 3 Nov 2018 ]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.
 
Zika virus  [to 3 Nov 2018 ]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.
 
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WHO & Regional Offices [to 3 Nov 2018 ]
News Release
29 October 2018
More than 90% of the world’s children breathe toxic air every day
::::::
 
Weekly Epidemiological Record, 2 November 2018, vol. 93, 44 (pp. 589–604)
:: Global programme to eliminate lymphatic filariasis: progress report, 2017
:: Monthly report on dracunculiasis cases, January-September 2018
::::::
 
 
WHO Regional Offices
Selected Press Releases, Announcements

WHO African Region AFRO
Selected Featured News
:: Uganda Finalizes Plans to Vaccinate Front-line Health Workers against Ebola  03 November 2018
:: Zambia heightens its capacity for preventing and responding to the threat of an outbreak of Ebola Virus Disease
02 November 2018
:: WHO enhances Ebola Rapid Response Readiness Capacities in South Sudan  01 November 2018
:: WHO and the Ministry of Health Train Members of the Armed Forces on Ebola Case Management [Uganda]  29 October 2018

WHO Region of the Americas PAHO
:: ‘Health is a right of the people and a responsibility of government,’ says PAHO Director (10/29/2018)
 

WHO South-East Asia Region SEARO
– No new announcement identified
 
 
WHO European Region EURO
:: Simulated poliovirus containment breach helps countries increase biorisk safety and security 01-11-2018
:: Revitalizing primary health care for the 21st century 01-11-2018
 
 
WHO Eastern Mediterranean Region EMRO
– No new announcement identified
 
 
WHO Western Pacific Region
:: 31 October 2018 – Singapore wipes out measles; Australia, Brunei Darussalam and Macao SAR (China) eliminate rubella
:: 30 October 2018  – Joint News Release  <ahref=”http://www.who.int/westernpacific/news/detail/30-10-2018-regional-conference-towards-the-implementation-of-inspire-seven-strategies-for-ending-violence-against-children”>Regional Conference towards the Implementation of INSPIRE: Seven Strategies for Ending Violence against Children
 

CDC/ACIP [to 3 Nov 2018 ]

CDC/ACIP [to 3 Nov 2018 ]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

MMWR News Synopsis for November 2, 2018

Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel

The Advisory Committee on Immunization Practices updated its recommendations on the use of hepatitis A (HepA) vaccine for postexposure prophylaxis and the use of HepA vaccine in infants prior to international travel. Postexposure prophylaxis (PEP) with HepA vaccine or immune globulin (IG) prevents hepatitis A virus infection (HAV) if given within two weeks of exposure. In February 2018, the Advisory Committee on Immunization Practices (ACIP) approved an update of recommendations for use of HepA vaccine for PEP in healthy persons 12 months and older. In addition to HepA vaccine, IG may be administered to persons over 40 years of age, depending on the provider’s risk assessment. HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel were also reviewed. ACIP recommended that HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended. The updated recommendations specify new guidance for administering PEP for people over 40, and infants for international travel.