Vaccines and Global Health: The Week in Review :: 24 November 2018

.– 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

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_24 Nov 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

330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar :: Nigeria to vaccinate 26 million people in 2nd phase of biggest-ever yellow fever vaccination campaign

Milestones :: Perspectives

330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar


Cox’s Bazar, Bangladesh, 17 November 2018

Nearly 330,000 Rohingyas refugees and Bangladesh host community will be vaccinated against cholera in a month-long campaign beginning today in the refugee camps in Cox’s Bazar and its nearby areas, to protect vulnerable population against the deadly disease amidst increased risk of flooding in the ongoing cyclone season.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization, UNICEF, and partners such as Gavi, the vaccine alliance, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities.

“Despite the progress and efforts made by humanitarian agencies to improve water and sanitation conditions in Rohingya camps, cholera remain a concern. Oral cholera vaccination is the most effective way to protect such a large section and reduce the risk of disease outbreak,” says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Nearly 2.2 million doses of oral cholera vaccines have been dispensed among Rohingya refugees and their host population through three massive vaccination campaigns since November 2017…


Nigeria to vaccinate 26 million people in 2nd phase of biggest-ever yellow fever vaccination campaign

Abuja, 22 November 2018 – The Government of Nigeria – with support from the World Health Organization (WHO), Gavi, the Vaccine Alliance and UNICEF aims to vaccinate 26.2 million people during the second phase of its biggest-ever yellow fever campaign as it seeks to establish high population immunity nationwide.

This step of the campaign, which is funded by Gavi will run from 22 November to 1 December 2018 and will target children and adults in Plateau, Sokoto, Kebbi, Niger and Borno states as well as the Federal Capital Territory.

“The vaccination will be for people within 9 months to 44 years cohort, parents are advised to avail themselves and their children to partake in the vaccination; The vaccine is free, safe and effective,” said Dr Joseph Oteri, Director of Special Duties at Nigeria’s National Primary Health Care Development Agency.

Yellow fever is caused by a virus spread through the bite of infected mosquitos. Some patients can develop serious symptoms, including high fever and jaundice (yellowing of the skin and eyes), but the disease can be easily prevented by a vaccine that provides immunity for life.

“Immunizing more than 26 million people is a massive undertaking,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “But this achievement will represent a huge step towards protecting people from the potentially deadly viral haemorrhagic disease not only in Nigeria but in the African region.”

To ensure this phase of the vaccination campaign runs smoothly, the Federal Ministry of Health, in collaboration with WHO with support from Gavi, has trained and deployed Management Support Teams (MST). The MSTs are overseeing preparations in the run-up to the campaign and, in partnership with WHO yellow fever experts, will act as supervisors and provide technical assistance during the campaign itself.

“Nigeria is on the front line in the global battle against yellow fever,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Routine immunisation coverage remains dangerously low, as shown by the latest outbreak, which is why this campaign is so important to protect the vulnerable. While this campaign will save lives, we need to focus our efforts on the best long-term solution – improving routine immunisation coverage so every child is protected, preventing outbreaks from happening in the first place.”…

Featured Journal Content: The state of vaccine confidence

Featured Journal Content

The Lancet
Nov 24, 2018 Volume 392 Number 10161 p2237-2324

The state of vaccine confidence
Heidi J Larson
On Oct 17, 2018, WHO reported 52,958 measles cases in the European region since the beginning of 2018, which is more than double the 23 757 cases reported for Africa in the same period.1  The USA reported about 80 000 influenza deaths and a record high of over 950 000 influenza-related hospital admissions during the winter of 2017–18. 2 Overall, seasonal influenza vaccination coverage in the USA in adults was only 37·1%, 6·2% lower than the 2016–17 season.3

In Europe, 29,464 of the measles cases were in Ukraine,4 where a combination of anxieties about vaccine safety, historic distrust in government, and a health system needing reform5n converged to create fertile ground for the outbreak. In England, too, by the end of October, 2018, there were 913 measles cases,6 largely among teenagers and young adults who missed their childhood measles, mumps, and rubella vaccination because of parental anxieties over a decade ago. The 2018 European measles outbreak should not be a surprise. In 2016, a global study on vaccine confidence found that vaccine scepticism was highest in Europe. 7 There were more than 37 measles-related deaths reported in countries across Europe in the first half of 2018, with the highest number of deaths in Serbia at 14. 8

Complex determinants of vaccination, such as alternative health beliefs, politics, histories, trust, relationships, and emotions, contribute to the overall stagnation of childhood and adult vaccine uptake globally. Vaccine anxieties are not new, but the viral spread of concerns, reinforced by a quagmire of online misinformation, is increasingly connected and global.

Although the USA reported only 143 measles cases by early October, 2018,9 there are growing anti-vaccine networks and vaccine refusals and increasing numbers of non-medical vaccine exemptions.10 In 2015, after an outbreak in California, measles spread across multiple US states, causing 188 cases largely among those who were unvaccinated.9 This outbreak became a tipping point for pro-vaccine parents who organised a movement to overturn the personal-belief exemption in California. The emotional appeal of a young boy named Rhett with leukaemia, dependent on others to be vaccinated, lent a powerful voice to the movement and the State Assembly passed the senate bill. Vaccine critics share emotional stories and personal testimonies using YouTube and Facebook as platforms. In this case, the story of Rhett was a powerful way to change minds in support of vaccination. In Italy, concerned teachers similarly mobilised to urge the government to keep compulsory vaccination intact because they did not want unvaccinated children in the classroom. 11 Initiatives like these need to be championed as examples to motivate others.

What else can be done? The international public health community and national immunisation programmes have increasingly acknowledged the seriousness of growing vaccine hesitancy. In November 2011, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization expressed concerns about growing vaccine reluctance and the Working Group on Vaccine Hesitancy was set up in March, 2012. 12 In February2013, the US National Vaccine Advisory Committee established the Vaccine Confidence Working Group. 13 These groups have produced analyses on the drivers of vaccine hesitancy and strategies to shift the tide of reluctance. In Europe, the European Commission is supporting a joint action involving 23 countries to strengthen vaccination efforts, with a key focus on vaccine hesitancy,14 and the European Centre for Disease Prevention and Control produced a Catalogue of Interventions Addressing Vaccine Hesitancy, 15 among other reports investigating the issue.

These initiatives have changed the policy landscape and created an openness for political and programmatic changes. But investments and other actions are needed to move analyses into action.

First, investment is needed at local levels to monitor public sentiments and fund the resources to respond. Although there are some common vaccine concerns and anxieties globally, specific local issues will differ. Resources are needed for immunisation programmes to undertake local research to better understand specific issues and to identify the key influencers and the emerging issues before they become crises.

Second, investment is needed for piloting and implementing strategies to find out what works best. There is a wealth of new research and proposed solutions to address vaccine hesitancy and build confidence. Many of these suggested interventions, such as motivational interviewing, innovative uses of social media, mapping and engaging trust networks, need to be trialled in different contexts to understand what works and then tailored to be taken to scale.

Third, dialogue, including through social media, is important. Public health officials too often shy away from social media, but they and other relevant stakeholders need to go where the discussions are happening and where influence is being leveraged. Social media engagement can help.16

Fourth, more opportunities need to be created—eg, in clinics and schools—for parents and other stakeholders to discuss their questions and concerns. The power of listening and dialogue should never be underestimated.17 Having someone available to answer questions in clinic waiting rooms or in community settings can help mitigate anxiety and allow hesitant parents to feel that their concerns are being listened to.

Finally, more support is needed for those on the front line of questioning. If there are good listening mechanisms—whether face-to-face discussions in clinics or other settings or through media monitoring— anticipating questions and preparing answers in advance can support health-care workers and officials who are confronted with difficult questions.18

Although there are some positive initiatives to address vaccine hesitancy, the spread of misinformation is moving quickly and boldly, appealing to emotions and heightening anxieties. Building vaccine confidence goes beyond changing an individual’s mind. The dissenting voices have become highly connected networks, undermining one of the most effective disease prevention tools. We need globally and locally connected positive voices and interventions that are vigilant, listening, and have the resources and capacity to respond.


[Citations available at title link above]


Statement of the Fifth Annual Meeting of the Islamic Advisory Group for Polio Eradication – Organisation of Islamic Cooperation:

Statement of the Fifth Annual Meeting of the Islamic Advisory Group for Polio Eradication – Organisation of Islamic Cooperation

Jeddah, Kingdom of Saudi Arabia
14 November 2018
[Editor’s text bolding]
…The Islamic Advisory Group for Polio Eradication (IAG) held its fifth annual meeting on 14 November 2018 at the headquarters of the Organisation of Islamic Cooperation (OIC) in Jeddah, Kingdom of Saudi Arabia, under the co-chairmanship of Al Azhar Al Sharif and the International Islamic Fiqh Academy (IIFA) and the participation of the other two core partners, the Islamic Development Bank (IsDB) and the OIC. Through the fifth annual meeting the IAG:

  1. Reaffirms its commitment to the global polio eradication initiative and protection of children against all vaccine-preventable diseases, and reiterates its trust in the safety and effectiveness of all routine childhood vaccinations as a life-saving tool which protects children and acknowledges that it conforms to Islamic Shariah;
  1. Commends and appreciates the efforts made by the governments, communities and parents of polio-infected countries in curbing endemic transmission of the disease in Afghanistan, Nigeria and Pakistan, where the disease is now restricted to the smallest geographical areas ever; as well as in countries affected by polio outbreaks,
  1. Commends the tremendous efforts made by health and frontline workers everywhere to protect children from polio as well as other infectious diseases, and encourages respect and support for their efforts;
  1. Urges the Governments of Afghanistan, Nigeria and Pakistan to continue playing their leadership roles at all levels to fully implement national emergency action plans, and to ensure the engagement of all Islamic scholars, community leaders and mosque imams;
  1. Refers to the OIC Strategic Health Programme of Action 2014-2023, and will ensure alignment and support in its implementation, notably in the programme’s thematic areas relevant to the IAG’s expanded mandate, and assign the executive committee to follow up on this;
  1. Urges the Ministries of Health to continue collaboration with technical organizations such as UNICEF and the World Health Organization (WHO) to further fast track efforts towards polio eradication;
  1. Appreciates the ongoing and critical support provided by the IsDB, and encourages other international development partners, notably Member States of the Gulf Cooperation Council, the Islamic Solidarity Fund and others, to join hands to eradicate polio as well as supporting the expanded mandate of IAG
  1. Appreciates the outstanding commitment and support of Al Azhar Al Sharif for the goal of polio eradication, and its lead role towards developing the manuals for training expatriate students from priority countries on polio eradication and other maternal and child health issues
  1. Commends the role of the International Islamic University Islamabad (IIUI) Pakistan and the Islamic University in Uganda (IUIU) on promoting health and special initiatives like polio eradication, and encourages other Islamic universities affiliated with the OIC, especially the Islamic University of Niger and the International Islamic University Malaysia to join the effort;
  1. Notes the ongoing efforts to engage Islamic NGOs approved by national governments in endeavor to reach the underserved populations with the maternal and child health initiatives including routine immunization and other lifesaving health interventions;
  1. Reiterates its support specifically to the Government and people of Indonesia for their efforts to eliminate measles and rubella (MR) nationally, and extends similar support to all other OIC Member States planning to intensify expanded outreach to underserved populations with MR vaccines and other lifesaving vaccines;
  1. Underscores its commitment to engage in high-level advocacy visits to priority countries to offer strategic support;
  1. Appreciates the support of global, regional, national and local media outlets, including social media networks, for highlighting the importance of vaccination and countering baseless rumors about community-based health interventions; and encourages the positive use of social media in promoting health related initiatives including vaccination campaigns;
  1. Notes that the upcoming low poliovirus transmission season in Afghanistan, Nigeria and Pakistan, which will run from the last quarter of 2018 through the second quarter of 2019, will provide the best opportunity to stop polio, and hence affirms the IAG’s willingness to support all religious scholars, health organizations and Governments in their efforts to interrupt transmission during this period with special focus on high risk communities and areas;
  1. Reaffirms the commitment of the Executive Committee of the IAG to advocate with the leadership of Islamic institutions and concerned Governments to ensure their ongoing commitment for polio eradication and support for the IAG expanded mandate; and,
  1. Expresses its gratitude to the Government of the Kingdom of Saudi Arabia and the OIC for their outstanding commitment and support for the goal of polio eradication, and for hosting the fifth annual meeting of the IAG.


Access to Medicines Index 2018

Access to Medicines Index 2018
Access to Medicine Foundation. November 2018 :: 258 pages
Funders: UK Department for International Development; The Dutch Ministry of Foreign Affairs;
Bill & Melinda Gates Foundation

Executive Summary
Globally, two billion people cannot access the medicines they need, with millions in low- and middle-income countries dying each year from diseases because the vaccines, medicines and diagnostic tests that they need are either unavailable or unaffordable. Pharmaceutical companies control products that can greatly alleviate disease burdens; they also have the expertise to meet the need for new and adapted innovative products; the power to address the affordability of those products through more refined access strategies; and the ability to strengthen supply chains and support healthcare infrastructures. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play

in improving access to medicine.

For more than a decade, the Access to Medicine Foundation has worked to stimulate change within pharmaceutical companies. Every two years, it publishes its Access to Medicine Index, which analyses the top 20 research-based pharmaceutical companies and ranks them according

to their efforts to improve access to medicine in developing countries. A total of 69 indicators

make up a framework within which company performances relating to 77 diseases, conditions and pathogens in 106 low- and middle-income countries can be compared.

The Index analysis brings out best practices and examples, highlights areas where progress

has been made and areas where critical action is required. The Index also acts as a benchmark

where companies can compare their own contributions to improving access to medicine with their peers. While companies are held to a single standard, they are different in the way they operate and in their portfolio of investigational and marketed products. The Index is a relative ranking: scores cannot be directly compared between Indices.

The methodology is updated every two years in line with developments in access to medicine

following a wide-ranging multi-stakeholder dialogue. For the first time this year, the Index examines company efforts to increase access to cancer products. Also for the first time, the Index zeroes in on 53 products on the market that it considers particularly critical candidates for company access initiatives and evaluates what companies are doing to facilitate their affordability and supply. These are products that are on patent, first-line therapies and on the World Health Organization Model List of Essential Medicines (EML).

This report outlines the key findings and overall ranking analysis of the 2018 Access to Medicine

Index before presenting a detailed analysis of company performances and rankings in each of the seven areas of corporate activity it focuses on. The report concludes with detailed, tailored company report cards that explain each company’s performance, highlight industry-leading practices and company-specific opportunities to improve access

to medicine.


:: Most priority R&D projects are being conducted by five companies: GSK, Johnson & Johnson,

Merck KGaA, Novartis and Sanofi. Such concentration is also seen in the industry’s  overwhelming focus on five of the 45 priority diseases – malaria, HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis– targeting that reflects international donor priorities.

:: Access initiatives for cancer focus on pricing but have limited reach, mainly for small population groups and fewer than five key countries on average. Meanwhile, access planning for cancer products in the pipeline lags far behind that for communicable disease candidate products and plans are less comprehensive.

:: The majority of the 53 key on-patent products have an access initiative attached to them, but

these are limited in scope, with pricing schemes being applied in fewer than five countries where greater affordability is a priority. Many of these key products with access initiatives are for diseases prioritised by global health donors or international procurers.


Ebola – Democratic Republic of the Congo

Ebola – Democratic Republic of the Congo

WHO statement on latest attacks in the Democratic Republic of the Congo
17 November 2018,  Geneva
Following deadly attacks on Friday in the town of Beni, in the Democratic Republic of the Congo, Ebola response activities are continuing.

While all WHO, Ministry of Health and partner staff are safe and accounted for, 16 WHO staff were evacuated to Goma for psychological care after their residence was hit by a shell which did not explode.

Ebola response operations were on-going but limited in Beni on Saturday.

Vaccination was suspended and the operations centre was closed, but teams still went out into the communities to follow up on some alerts of potential cases, to meet contacts and ensure they are still well, and to bring sick people to treatment centres. The treatment centers, which are run by partners, remained operational.

The response was not affected in areas outside Beni. On Sunday, all activities have re-launched, including vaccination.

“WHO will continue to work side-by-side with the ministry and our partners to bring this Ebola outbreak to an end,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We honour the memory of those who have died battling this outbreak, and deplore the continuing threats on the security of those still working to end it.”



16: Situation report on the Ebola outbreak in North Kivu 
21 November 2018
Implementation of ring vaccination protocol
:: Vaccination activities were paused in Beni after the security incidents on 16 November 2018, but continued in Katwa, Butembo, Vuhovi and Kalunguta.
:: As of 19 November 2018, 518 new contacts were vaccinated in 13 rings in affected health zones, bringing the cumulative number of people vaccinated to 32 626. The current stock of vaccine in Beni is 5920 doses.

DONs Ebola virus disease – Democratic Republic of the Congo
22 November 2018
WHO risk assessment
…As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 20 November2018 [GPEI]
:: The Islamic Advisory Group (IAG) for Polio Eradication concluded its fifth annual meeting in Jeddah, Saudi Arabia on 14 November 2018, reaffirming a renewed commitment to continue supporting the Global Polio Eradication Initiative, protecting children against all vaccine-preventable diseases and expanding its mandate to support other health priorities. The full meeting statement is available here.
Summary of new viruses this week:
Afghanistan – five wild poliovirus type 1 (WPV1) positive environmental samples.
Pakistan – one WPV1 positive environmental sample.
Papua New Guinea – three cases of circulating vaccine-derived poliovirus type 1 (cVDPV1).
DRC- one case of circulating vaccine-derived poliovirus type 2 (cVDPV2).
Nigeria – two cases of cVDPV2..
Somalia– two 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 24 Nov 2018 ]
Democratic Republic of the Congo
:: 16: Situation report on the Ebola outbreak in North Kivu  21 November 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   22 November 2018
[See Milestones above for more detail]
Bangladesh – Rohingya crisis
:: 330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar
SEAR/PR/1702  Cox’s Bazar, Bangladesh, 17 November 2018
[See Milestones above for more detail]
:: Weekly Situation Report 51 -15 November 2018 pdf, 545kb
:: 330,000 Rohingyas and host community to get cholera vaccine in Cox’s Bazar
17 November 2018
[See Milestones above for more detail]

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 24 Nov 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
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
WHO-AFRO: Outbreaks and Emergencies Bulletin, Week 46: 10-16 November 2018
The WHO Health Emergencies Programme is currently monitoring 53 events in the region. This week’s edition covers key ongoing events, including:
:: Ebola virus disease in the Democratic Republic of the Congo
:: Cholera in the Democratic Republic of the Congo
:: Cholera in Cameroon
:: Humanitarian crisis in Central African Republic
:: Humanitarian crisis in north-east Nigeria.
WHO Grade 1 Emergencies  [to 24 Nov 2018 ]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut
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 – 21 November 2018 | Is …

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
:: 18 November 2018  Central Sulawesi Earthquake & Tsunami: Humanitarian Country Team Situation Report #8 (as of 16 November 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 24 Nov 2018 ]
:: 16: Situation report on the Ebola outbreak in North Kivu  21 November 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   22 November 2018
 [See Milestones above for more detail]
MERS-CoV [to 24 Nov 2018 ]
Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
20 November 2018   From 16 through 30 October 2018, the International Health Regulations (IHR 2005) National Focal Point of Saudi Arabia reported four additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including one death. Details of these cases can be found in a separate document (see link below)…
Yellow Fever  [to 24 Nov 2018 ]
:: Nigeria to vaccinate 26 million people in 2nd phase of biggest-ever yellow fever vaccination campaign   Abuja, 22 November 2018
[See Milestones above for more detail]
Zika virus  [to 24 Nov 2018 ]
No new announcements identified.