Vaccines and Global Health: The Week in Review :: 22 December 2018

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

Child given world’s first drone-delivered vaccine in Vanuatu – UNICEF

Milestones :: Perspectives

Child given world’s first drone-delivered vaccine in Vanuatu – UNICEF

With 1 in 5 children in the remote Pacific island nation not fully immunized, UNICEF partners with the Government on first-ever commercial contract to deliver vaccines by drone

PORT VILA/ NEW YORK, 18 December 2018 –One month old Joy Nowai today became the world’s first child to be given a vaccine delivered commercially by drone in a remote island in the South Pacific country of Vanuatu.

The vaccine delivery covered almost 40 kilometers of rugged mountainous terrain from Dillon’s Bay on the west side of the island to the east landing in remote Cook’s Bay, where 13 children and five pregnant women were vaccinated by Miriam Nampil, a registered nurse. Cook’s Bay, a small, scattered community that does not have a health centre or electricity, is only accessible by foot or small local boats.

“Today’s small flight by drone is a big leap for global health,” said Henrietta H. Fore, UNICEF Executive Director. “With the world still struggling to immunize the hardest to reach children, drone technologies can be a game changer for bridging that last mile to reach every child.”…

…“It’s extremely hard to carry ice boxes to keep the vaccines cool while walking across rivers, mountains, through the rain, across rocky ledges. I’ve relied on boats, which often get cancelled due to bad weather,” said Miriam Nampil, the nurse who injected the world’s first drone-delivered vaccine. ”As the journey is often long and difficult, I can only go there once a month to vaccinate children. But now, with these drones, we can hope to reach many more children in the remotest areas of the island.”

During the drone flight on Erromango, the vaccines were carried in Styrofoam boxes with ice-packs with a temperature logger. An electronic indicator is triggered if the temperature of the vaccines swings out of acceptable range.

In tests last week, the Ministry of Health, with support from UNICEF, conducted drone trials with two drone operators, Swoop Aero and WingCopter, using test payloads. Swoop Aero, the Australian company responsible for today’s successful drone delivery, passed the first phase of trials by landing the payloads within 2 meters of the target after a 50-km flight over numerous islands and way points.

This is also the first time globally that a government is contracting a commercial drone company to transport vaccines to remote areas. The drone operators are selected after a bidding process, and as per the contract, they are held accountable and not paid if they don’t deliver.

In the long term, the Government of Vanuatu is interested in integrating the drone delivery of vaccines into their national immunization programme and using drones more widely to distribute health supplies. The data from the trials will also be used to show how drones can be used commercially in similar settings around the world.

“Today’s first-of-a-kind vaccine delivery has enormous potential not only for Vanuatu, but also for the thousands of children who are missing out on vaccines across the world,” added Fore. “This is innovation at its best, and shows how we can unlock the potential of the private sector for the greater good of the world’s children.”

 

Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

20: Situation report on the Ebola outbreak in North Kivu
18 December 2018 [Excerpts]
…Case Management
:: On 24 November 2018, MoH announced the launch of a randomized control trial for Ebola therapeutics. This first ever multi-drug randomized control trial within an outbreak setting is an important step towards finding an effective treatment for Ebola. The trial is coordinated by WHO and led and sponsored by the DRC’s National Institute for Biomedical Research (INRB) which is the principal investigator. The trial has begun in the ALIMA facility in Beni, where patients are enrolled in the study after obtaining voluntary informed consent.

:: Other ETCs continue to provide therapeutics under the MEURI (compassionate use) protocol, in collaboration with the MoH and the 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. UNICEF is providing nutritional treatment and psychological support for all hospitalized patients.

:: As of 15 December 2018, a total of 140 patients were hospitalised in transit centres and ETCs, of whom 29 were laboratory confirmed…

::::::

DONs Ebola virus disease – Democratic Republic of the Congo
20 December 2018 [Excerpt]
…WHO risk assessment
This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

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…

::::::
::::::

Emergencies

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 18 December 2018 [GPEI]
:: Featured on http://www.polioeradication.org:  interview with Jean- Marc Olivé, Chairman of the Technical Advisory Group, on what needs to be done to end polio in the Horn of Africa; Djibouti carried out a successful round of National Immunization Days (NIDs) since 2015 to avoid risk of polio virus importation.

Summary of new viruses this week:
Afghanistan –WPV1-positive environmental samples;
Pakistan – seven WPV1-positive environmental samples;
Nigeria – one cVDPV2 AFP 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 22 Dec 2018]
Democratic Republic of the Congo
:: 20: Situation report on the Ebola outbreak in North Kivu  18 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo  20 December 2018

[See Milestones above for more detail]

Bangladesh – Rohingya crisis
:: Weekly Situation Report 55 – 13 December 2018
[Excerpt]
Highlights
:: The fourth round of oral cholera vaccination (OCV) campaign was completed with 108% coverage. A total of 356,202 people received vaccination.
:: A total of three new diphtheria case-patients (three suspected) were reported this week. Total case-patients reported in EWARS is now 8,327. 

Syrian Arab Republic
:: Cancer treatment in Syria improves following State of Kuwait donation  19 December 2018

Yemen
:: WHO enhances access to basic health care in Yemen  17 December 2018

Myanmar – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified

 ::::::

WHO Grade 2 Emergencies  [to 22 Dec 2018]
Iraq
:: Italy supports physical and mental health services in Ninewa   Baghdad 18 December

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
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 49: 08-14 December 2018
The WHO Health Emergencies Programme is currently monitoring 57 events in the region. This week’s edition covers key ongoing events, including:
:: Lassa fever in Benin
:: Ebola virus disease in the Democratic Republic of the Congo
:: Yellow fever in Nigeria
::Measles in Madagascar.

::::::

WHO Grade 1 Emergencies  [to 22 Dec 2018]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut
Tanzania

::::::

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 1 – 13 December 2018 | Issue 34

Key Issues
:: Recent IPC analysis indicates that over 20 million face severe food insecurity in Yemen.
:: The upsurge in Yemen’s migrant arrivals exceeds 2018 arrivals to Europe via the Mediterranean Seaw.
:: Polio campaign reaches 4.6 million children, 84 per cent of target.
:: The trend of suspected cholera cases remains stable.

Syrian Arab Republic   
:: Syria Crisis: Northeast Syria Situation Report No. 30 (1 November – 14 December 2018)
:: Fact Sheet: United Nations Cross-border Operations from Turkey to Syria | as of 30 November 2018 [EN/AR] Published on 17 Dec 2018

::::::

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

::::::

“Other Emergencies”
Indonesia: Central Sulawesi EarthquakeNo new announcements identified.

 
::::::
::::::
 
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 22 Dec 2018]
http://www.who.int/ebola/en/
:: 19: Situation report on the Ebola outbreak in North Kivu  12 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   13 December 2018
[See Milestones above for more detail]

MERS-CoV [to 22 Dec 2018]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.

Yellow Fever  [to 22 Dec 2018]
http://www.who.int/csr/disease/yellowfev/en/
:: Disease outbreak newsYellow Fever – Kingdom of the Netherlands   18 December 2018

Zika virus  [to 22 Dec 2018]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.

 

 

WHO & Regional Offices [to 22 Dec 2018]

WHO & Regional Offices [to 22 Dec 2018]

WHO launches technical guidance series on the health of refugees and migrants
18-12-2018
WHO is marking International Migrants Day on 18 December 2018 with the launch of a technical guidance series on the health of refugees and migrants. Produced in collaboration with the European Commission, each publication addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve their health.

Five publications are currently available, each with a special focus on one of the following:
:: children’s health;
:: health promotion;
:: healthy ageing;
:: maternal and newborn health; and
:: mental health.
Health of refugee and migrant children (2018)
Health promotion for improved refugee and migrant health (2018)
Health of older refugees and migrants (2018)
Improving the health care of pregnant refugee and migrant women and newborn children (2018)
Mental health promotion and mental health care in refugees and migrants (2018)
News – Global migration pact to ensure fundamental human rights for migrants in all policies and practices

::::::
 
Weekly Epidemiological Record, 21 December 2018, vol. 93, 51/52 (pp. 693–708)
Review of the 2018 influenza season in the southern hemisphere
Index of countries/areas
Index, Volume 93, 2018, Nos. 1–52

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: WHO HTS Info app: from concept to reality  21 December 2018
This app provides easy, on-the-go access to current HIV testing services (HTS) guidelines and information on your smartphone or tablet, whether you are online or offline.
:: Women join hands to oust Ebola from the Democratic Republic of the Congo  21 December 2018
:: Situation Update on the Yellow Fever outbreak in South Sudan  20 December 2018
:: A new multipurpose Infectious Disease Unit opens in Juba, South Sudan  20 December 2018
:: Nigeria launches Yellow fever vaccination campaign to stop outbreak in Edo state  18 December 2018

WHO Region of the Americas PAHO
– No new announcement identified
 
WHO South-East Asia Region SEARO
– No new announcement identified
 
WHO European Region EURO
:: 2018: The WHO European Region’s Year in Review 21-12-2018
:: WHO launches technical guidance series on the health of refugees and migrants 18-12-2018

 
WHO Eastern Mediterranean Region EMRO
:: WHO Regional Director praises Pakistan’s strong political commitment to achieving universal health coverage on official visit  Islamabad, Pakistan, 18 December 2018

WHO Western Pacific Region
:: 19 December 2018 | Feature Story  New Zealand showcases and strengthens preparedness for outbreaks and emergencies

 

Announcements

Announcements
 
 
BMGF – Gates Foundation  [to 22 Dec 2018]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.
 
 
Bill & Melinda Gates Medical Research Institute    [to 22 Dec 2018]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.
 
 
CARB-X   [to 22 Dec 2018]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.
 
 
CEPI – Coalition for Epidemic Preparedness Innovations  [to 22 Dec 2018]
http://cepi.net/
No new digest content identified.
 
 
EDCTP    [to 22 Dec 2018]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
21 December 2018
Report on the Lisbon meeting for the next EDCTP programme published
EDCTP organised a high-level meeting on the character, scope and shape of its next programme in Lisbon, Portugal, on 17 September 2018. Approximately 100 participants representing EDCTP member countries and strategic partners in global health participated to discuss their involvement…
 
 
Emory Vaccine Center    [to 22 Dec 2018]
http://www.vaccines.emory.edu/
No new digest content identified.
 
 
European Medicines Agency  [to 22 Dec 2018]
http://www.ema.europa.eu/ema/
News and press releases
No new digest content identified.
 
 
European Vaccine Initiative  [to 22 Dec 2018]
http://www.euvaccine.eu/news-events
No new digest content identified.
 
 
FDA [to 22 Dec 2018]
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
No new digest content identified.
 
 
Fondation Merieux  [to 22 Dec 2018]
http://www.fondation-merieux.org/
Mérieux Foundation co-organized event
Dengue pre-vaccination screening based on serostatus: rapid tests and implementation strategies
January 14 – 16, 2019 – Les Pensières Center for Global Helath, Veyrier du Lac (France)

Event
Alain Mérieux receives the prestigious Chinese Reform Friendship Award
December 18, 2018 – Beijing (China)
Alain Mérieux received the Reform Friendship Award at a conference celebrating the 40th anniversary of China’s Reform and Opening Up on December 18, 2018. The event took place at the Great Hall of the People in Beijing, in the presence of President Xi Jinping.

Gavi [to 22 Dec 2018]
https://www.gavi.org/
No new digest content identified.

GHIT Fund   [to 22 Dec 2018]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that devastate the world’s poorest people. Other funders include six Japanese pharmaceutical
No new digest content identified.
 
 
Global Fund  [to 22 Dec 2018]
https://www.theglobalfund.org/en/news/

Feature Story
2018: A Look Back
18 December 2018
As the calendar page turns, we look back on some of the stories and moments that shaped 2018. Celebrating the 27 million lives saved. Honoring those we have lost. Amplifying the voices of people and communities most affected by the epidemics. Welcoming new leadership and partnerships. And accelerating investment and innovation to achieve a future free of the burden of HIV, tuberculosis, and malaria

 

Hilleman Laboratories   [to 22 Dec 2018]
http://www.hillemanlabs.org/
No new digest content identified.
 
 
Human Vaccines Project   [to 22 Dec 2018]
http://www.humanvaccinesproject.org/media/press-releases/
No new digest content identified.
 
 
IAVI  [to 22 Dec 2018]
https://www.iavi.org/newsroom
No new digest content identified.
 
 
IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.
 
 
IVAC  [to 22 Dec 2018]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
No new digest content identified.
 
 
IVI   [to 22 Dec 2018]
http://www.ivi.int/
IVI News & Announcements
No new digest content identified.
 
 
JEE Alliance  [to 22 Dec 2018]
https://www.jeealliance.org/
No new digest content identified.
 
 
MSF/Médecins Sans Frontières  [to 22 Dec 2018]
http://www.msf.org/
Selected News; Project Updates, Reports

Niger
Preventing future outbreaks in a cholera hotspot
Project Update 17 Dec 2018
Since early July, Niger has been battling its worst cholera outbreak in years.
As the disease ebbs, Médecins Sans Frontières (MSF) and local health authorities shift their focus to preventing future outbreaks in the southern region of Maradi, most affected by the current epidemic and known as a hotspot for cholera along the border of Niger and Nigeria.
These efforts include vaccinating over 145,000 people with an easy-to-administer oral vaccine in three of Maradi’s health zones: Tchadoua, Aguié and Gazaoua.
MSF has provided local health authorities with logistical and technical support. Epicentre, a research unit created by MSF to provide epidemiological expertise that underpins operations, is supporting the intervention with a post-vaccination survey…
 
 
NIH  [to 22 Dec 2018]
http://www.nih.gov/news-events/news-releases
No new digest content identified.
 
 
PATH  [to 22 Dec 2018]
https://www.path.org/media-center/
No new digest content identified.
 
 
Sabin Vaccine Institute  [to 22 Dec 2018]
http://www.sabin.org/updates/pressreleases
No new digest content identified.
 
 
UNAIDS [to 22 Dec 2018]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
No new digest content identified.
 
 
UNICEF  [to 22 Dec 2018]
https://www.unicef.org/media/press-releases
Selected Press Releases/Reports/Statements
Press release
Child given world’s first drone-delivered vaccine in Vanuatu – UNICEF
With 1 in 5 children in the remote Pacific island nation not fully immunized, UNICEF partners with the Government on first-ever commercial contract to deliver vaccines by drone
18/12/2018
[See Milestones above for detail]
 
 
Vaccine Confidence Project  [to 22 Dec 2018]
http://www.vaccineconfidence.org/
No new digest content identified.
 
 
Vaccine Education Center – Children’s Hospital of Philadelphia  [to 22 Dec 2018]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.
 
 
Wellcome Trust  [to 22 Dec 2018]
https://wellcome.ac.uk/news
19 December 2018
Why we need a globally coordinated approach to preparing for epidemics
At $60 billion a year, not preparing for epidemics costs far more than putting the systems in place to prevent infectious diseases from spreading around the globe. Here’s why.

News | 18 December 2018
Value of Wellcome’s investments passes £25 billion
The value of our investments portfolio grew to almost £25.9 billion by 30 September 2018, strengthening our ambition to spend more than £5 billion over five years on our charitable activities.

17 December 2018
Research should be at the heart of an epidemic response
If we put research at the heart of epidemic response, it’s a double win – helping fight outbreaks that are underway and protecting us in the future.

 
The Wistar Institute   [to 22 Dec 2018]
https://www.wistar.org/news/press-releases
No new digest content identified.
 
 
World Organisation for Animal Health (OIE)   [to 22 Dec 2018]
http://www.oie.int/en/for-the-media/press-releases/2018/
No new digest content identified.
 
 
::::::
 
BIO    [to 22 Dec 2018]
https://www.bio.org/insights/press-release
Dec 20 2018
BIO Applauds House Passage of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act
Washington, DC (December 20, 2018) – Biotechnology Innovation Organization (BIO) President and CEO Jim Greenwood issued the following statement applauding passage today by the House of Representatives of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (H.R. 7328). The legislation would re-authorize critical federal biodefense programs and agencies, including the BioShield Special Reserve Fund (SRF), the Biomedical Advanced Research and Development Authority (BARDA), and the Strategic National Stockpile (SNS).
 
 
DCVMN – Developing Country Vaccine Manufacturers Network  [to 22 Dec 2018]
http://www.dcvmn.org/
No new digest content identified.
 
 
IFPMA   [to 22 Dec 2018]
http://www.ifpma.org/resources/news-releases/
No new digest content identified.
 
 
PhRMA    [to 22 Dec 2018]
http://www.phrma.org/press-room
No new digest content identified.
 
 
Industry Watch    [to 22 Dec 2018]
:: Merck and Instituto Butantan Announce Collaboration Agreement to Develop Vaccines to Protect Against Dengue Infections
Wednesday, December 12, 2018 10:30 am EST
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (NYSE:MRK), known as MSD outside the United States and Canada, and Instituto Butantan, Sao Paulo, Brazil, a non-profit producer of immunobiologic products for Brazil today announced a collaboration agreement to develop vaccines to protect against dengue virus disease, the mosquito-borne infection. Instituto Butantan and Merck have licensed certain rights from National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), for the development of live attenuated tetravalent vaccines (LATV). Instituto Butantan’s dengue vaccine candidate, TV003, is currently being evaluated in a large Phase 3 study in Brazil.

“By sharing data from our ongoing vaccine development programs, Instituto Butantan and Merck are better positioned to achieve our goal of reducing the significant human and economic toll of dengue virus in Brazil and around the world,” said Dr. Dimas Covas, director, Instituto Butantan. “We look forward to collaborating with Merck, an established global leader in vaccine development.”

Under the agreement, Merck and Instituto Butantan have agreed to collaborate to share clinical data and other learnings from their respective dengue vaccine development programs, both derived from licensed materials from the NIAID. Instituto Butantan will receive a $26 million upfront payment from Merck and is eligible to receive up to $75 million for the achievement of certain milestones related to the development and commercialization of Merck’s investigational vaccine as well as potential royalties on sales. Instituto Butantan will retain responsibility for the manufacturing and commercialization of their investigational vaccine, TV003, in Brazil.

“This agreement recognizes the tremendous progress that scientists and clinicians at the Instituto Butantan have made in developing their investigational dengue virus vaccine,” said Dr. Roger M. Perlmutter, president, Merck Research Laboratories. “Through our new collaboration, we together have made a commitment to help protect people around the world who are at risk of developing dengue virus disease.”

The agreement builds upon a productive long-term collaboration between MSD Brazil and Instituto Butantan, initiated in 2012, for human papillomavirus (HPV) and Hepatitis-A vaccine products.

Journal Watch

Journal Watch

   Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.

If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

 

Mass drug administration for malaria elimination: do we understand the settings well enough?

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 22 Dec 2018)

Commentary
Mass drug administration for malaria elimination: do we understand the settings well enough?
Mass drug administration (MDA) of antimalarials has re-emerged as a recommended tool for interrupting malaria transmission, but evidence from low endemicity settings is scarce. A trial in Zanzibar found that t…
Authors: Manuel W. Hetzel and Blaise Genton
Citation: BMC Medicine 2018 16:239
Published on: 19 December 2018

Avoiding rash decisions about zoster vaccination: insights from cost-effectiveness evidence

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 22 Dec 2018)

Commentary
Avoiding rash decisions about zoster vaccination: insights from cost-effectiveness evidence
de Boer and colleagues present a cost-effectiveness analysis based in the Netherlands of two vaccines available for the prevention of herpes zoster. Zostavax® was the first vaccine available for the prevention…
Authors: Chester B. Good, Natasha Parekh and Inmaculada Hernandez
Citation: BMC Medicine 2018 16:238
Published on: 18 December 2018

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 22 Dec 2018)

Research article
Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme
In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were dev…
Authors: Nor Asiah Muhamad, Saidatul Norbaya Buang, Safurah Jaafar, Rohani Jais, Phaik Sim Tan, Normi Mustapha, Noor Aliza Lodz, Tahir Aris, Lokman Hakim Sulaiman and Shahnaz Murad
Citation: BMC Public Health 2018 18:1402
Published on: 22 December 2018

Under vaccination of children among Maasai nomadic pastoralists in Kenya: is the issue geographic mobility, social demographics or missed opportunities?

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 22 Dec 2018)

Research article
Under vaccination of children among Maasai nomadic pastoralists in Kenya: is the issue geographic mobility, social demographics or missed opportunities?
Nomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our stud…
Authors: Anne M. Pertet, Dan Kaseje, Careena F. Otieno-Odawa, Lydia Kirika, Caleb Wanjala, Jackline Ochieng, Millicent Jaoko, Winnie Otieno and Dan Odindo
Citation: BMC Public Health 2018 18:1389
Published on: 19 December 2018

 

Knowledge on HBV vaccine and vaccination status among health care workers of Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia: a cross sectional study

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content

Research note
Knowledge on HBV vaccine and vaccination status among health care workers of Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia: a cross sectional study
The study was conducted to assess the knowledge on HBV vaccine and vaccination status among health care workers of Hawassa University Comprehensive Specialized Hospital.
Authors: Asres Bedaso, Bereket Duko and Remla Fedlu
Citation: BMC Research Notes 2018 11:912
Published on: 20 December 2018

 

Rohingya refugees in Bangladesh: the humanitarian response

Humanitarian Exchange Magazine
Number 73,  October 2018
https://odihpn.org/magazine/mental-health-and-psychosocial-support-in-humanitarian-crises/

Rohingya refugees in Bangladesh: the humanitarian response
More than 700,000 Rohingya refugees have arrived in Bangladesh since 25 August 2017 fleeing violence and persecution in Rakhine State, Myanmar. Over a million are sheltering in overcrowded camps without adequate assistance or protection. Stateless in Myanmar and denied refugee status in Bangladesh, the Rohingya have few rights or freedoms. Monsoons and cyclones are causing landslides, destroying shelters and infrastructure and disrupting services.

This edition of Humanitarian Exchange focuses on the humanitarian response to the Rohingya crisis. In the lead article, Mark Bowden outlines the historical, local and national political context in Bangladesh, and its operational implications. Amal de Chickera highlights the links between statelessness and displacement, and the international community’s failure to prioritise human rights in its dealings both with Bangladesh and with Myanmar. Puttanee Kangkun and John Quinley document the persistent persecution and denial of rights the Rohingya have faced for decades. Jeff Crisp reflects on the premature, involuntary and unsafe return of Rohingya refugees to Myanmar in the 1970s and 1990s, and asks whether this could happen again.

Sally Shevach and colleagues explore how the ‘localisation’ agenda has influenced the operational response, and Kerrie Holloway draws on research by the Humanitarian Policy Group to test the common assumption that local actors necessarily have a better understanding of people’s needs. Nasif Rashad Khan and colleagues and Ashish Banik reflect on their experiences of engaging with the international humanitarian response system. Margie Buchanan-Smith and Marian Casey-Maslen discuss evaluation findings relating to communication and community engagement, a theme taken up by Nick Van Praag and Kai Hopkins, who report on a Ground Truth survey on refugees’ perceptions of assistance. Julia Brothwell discusses the British Red Cross/Bangladesh Red Crescent involvement in disaster preparedness and risk reduction during the monsoon season, and Gina Bark, Kate White and Amelie Janon outline the consequences of long-term exclusion from basic healthcare services in increasing vulnerability to preventable diseases. Matthew Wencel and colleagues round off the issue with reflections on data collection coordination and other challenges associated with monitoring large concentrations of refugees.

 

The Ethics of Heritable Genome EditingNew Considerations in a Controversial Area

JAMA
December 25, 2018, Vol 320, No. 24, Pages 2499-2608
http://jama.jamanetwork.com/issue.aspx

Viewpoint
The Ethics of Heritable Genome EditingNew Considerations in a Controversial Area
Eli Y. Adashi, MD, MS; I. Glenn Cohen, JD
JAMA. 2018;320(24):2531-2532. doi:10.1001/jama.2018.18270
This Viewpoint about heritable genome editing–the modification of DNA of an embryo, sperm, or egg to alter its characteristics for future generations–summarizes the 2018 Nuffield Council on Bioethics report on social and ethical issues raised by the technique, and questions its rejection of a distinction between gene editing for therapeutic vs feature enhancement purposes.

Immunogenicity, safety, and tolerability of the measles-vectored chikungunya virus vaccine MV-CHIK: a double-blind, randomised, placebo-controlled and active-controlled phase 2 trial

The Lancet
Dec 22, 2018  Volume 392Number 10165p2655-2744, e17-e18
https://www.thelancet.com/journals/lancet/issue/current

Articles
Immunogenicity, safety, and tolerability of the measles-vectored chikungunya virus vaccine MV-CHIK: a double-blind, randomised, placebo-controlled and active-controlled phase 2 trial
Emil C Reisinger, Roland Tschismarov, Eckhard Beubler, Ursula Wiedermann, Christa Firbas, Micha Loebermann, Andrea Pfeiffer, Matthias Muellner, Erich Tauber, Katrin Ramsauer
Interpretation
MV-CHIK showed excellent safety and tolerability and good immunogenicity, independent of pre-existing immunity against the vector. MV-CHIK is a promising candidate vaccine for the prevention of chikungunya fever, an emerging disease of global concern.

Health and dignity of Palestine refugees at stake: a need for international response to sustain crucial life services at UNRWA

The Lancet
Dec 22, 2018  Volume 392Number 10165p2655-2744, e17-e18
https://www.thelancet.com/journals/lancet/issue/current

Health Policy
Health and dignity of Palestine refugees at stake: a need for international response to sustain crucial life services at UNRWA
Akiko Kitamura, Masamine Jimba, Julia McCahey, Gloria Paolucci, Sayed Shah, Majed Hababeh,
Yousef Shahin, Akihiro Seita
Summary
The UN Sustainable Development Goals affirm equality and dignity as essential to the enjoyment of basic human rights, including the right to the highest attainable standard of physical and mental health, which promotes global solidarity among all people, including refugees. The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has provided support to Palestine refugees in Jordan, Lebanon, Syria, the Gaza Strip, and the West Bank since the 1950s. Today, however, conflict and violence, occupation, high levels of poverty, and other social determinants of health jeopardize the wellbeing of Palestine refugees. Health concerns include non-communicable diseases, mental health conditions, and access to hospital care. Additionally, UNRWA is continuing to face a severe funding crisis. Using a historical and health policy perspective, this Health Policy examines UNRWA strategies that facilitate continuous provision of health-care services for Palestine refugees. Given the increasingly volatile environment faced by this population, a multifaceted international response is needed to enable UNRWA to deliver sustainable services to Palestine refugees and avert further loss of life, dignity, and hope, pending a just and lasting solution to their plight in accordance with applicable international law and UN General Assembly resolutions.

 

Members of Minority and Underserved Communities Set Priorities for Health Research

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
Volume 96, Issue 4   Pages: 607-882  December 2018

https://onlinelibrary.wiley.com/toc/14680009/current
Original Scholarship
Members of Minority and Underserved Communities Set Priorities for Health Research
SUSAN DORR GOOLD, C. DANIEL MYERS,MARION DANIS, JULIA ABELSON, STEVE BARNETT, KAREN CALHOUN, ERIC G. CAMPBELL, LYNETTE LaHAHNN, ADNAN HAMMAD, RENÉ PÉREZ, ROSENBAUM, HYUNGJIN MYRA KIM, CENGIZ SALMAN, LISA SZYMECKO, ZACHARY E. ROWE

Pages: 675-705
First Published: 09 December 2018 Abstract
Policy Points
:: Engaging and involving underrepresented communities when setting research priorities could make the scientific research agenda more equitable, more just, and more responsive to their needs and values.
:: Groups and individuals from minority and underserved communities strongly prioritized child health and mental health research, often choosing to invest at the highest possible level.
:: Groups consisting of predominantly Native American or Arab American participants invested in culture and beliefs research at the highest level, while many groups did not select it at all. The priority given to culture and beliefs research by these groups illustrates the importance of paying special attention to unique preferences, and not just commonly held views, when getting public input on spending priorities for research.

Vaccine candidates for poor nations are going to waste

Nature 
Volume 564 Issue 7736, 20 December 2018
http://www.nature.com/nature/current_issue.html

Comment | 18 December 2018
Vaccine candidates for poor nations are going to waste
Promising immunizations for diseases that affect mostly people in low- and middle-income countries need help getting to market, urge David C. Kaslow and colleagues.
David C. Kaslow, Steve Black, David E Bloom, Mahima Datla, David Salisbury & Rino Rappuoli
[Excerpt]
…A way forward
So what should be done? In our view, the main stakeholders must come together to define a new path for the sustainable development of vaccines that are socially justified but that have no business case, an uncertain one, or that require considerable public funding to reach the clinic.
Participants should include funding agencies such as the Wellcome Trust, the Bill & Melinda Gates Foundation and the NIH; early-development partners such as PATH and the International Vaccine Institute in Seoul; vaccine manufacturers from wealthy and emerging economies; and organizations that recommend and procure vaccines for poor countries, such as the WHO and Gavi, the Vaccine Alliance.

The first aim should be to assess all the candidates in the pipeline. To ensure the best use of limited resources, the focus must be the most favourable candidates that face uncertain business cases. Those that are unlikely to have a significant impact socially and economically must be deprioritized.

Ultimately, the stakeholders must specify which organization, or alliance, should drive development for the prioritized vaccines from beginning to end, and what role each partner should have. They must also lay out the practical steps that are most likely to lead to the successful late-stage development and use of these vaccines — including schemes for resourcing.

Money is the main limiting factor. In principle, subsidies from governments, such as those of the G20 countries, and philanthropic organizations such as the Bill & Melinda Gates Foundation, could remedy the market failure threatening vaccine development for LMICs. Gavi provides one form of subsidy (see ‘Spreading the cost’). Support to develop vaccines or to make them available during epidemics is also provided by public organizations, such as the Coalition for Epidemic Preparedness Innovations in Oslo and the Biomedical Advanced Research and Development Authority, part of the US Department of Health and Human Services.

Such schemes need to be expanded and rethought to give vaccine developers more certainty and upfront financial backing. For instance, Gavi could commit to purchasing a vaccine before it has been developed, on the condition that the developers meet certain regulatory milestones. At present, the alliance buys vaccines to distribute to LMICs after they have been licensed or recommended by the WHO for general use.

Regulation is another hurdle. Stakeholders should define clear pathways. They should negotiate more alignment between the various organizations involved in planning, development and oversight. Finally, they should identify what infrastructure and human capacity are needed to ensure that a reliable supply of vaccines can be provided long-term to the people who need them.

Only with this kind of leadership will the global community secure vaccines for some of the world’s most debilitating diseases.

Defining rights-based indicators for HIV epidemic transition

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 22 Dec 2018)

Policy Forum
Defining rights-based indicators for HIV epidemic transition
Joseph J. Amon, Patrick Eba, Laurel Sprague, Olive Edwards, Chris Beyrer
| published 21 Dec 2018 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002720
Summary points
:: Stark differences in HIV incidence and mortality across locations and populations demonstrate the challenge of identifying a single indicator, at national scale, of progress toward the control of HIV epidemics.
:: Even in countries that report decreases in HIV incidence, incidence may be increasing among groups that are particularly vulnerable and face political and social exclusion, especially sex workers, people who inject drugs, transgender persons, men who have sex with men, and prisoners.
:: To comprehensively evaluate national progress on HIV, five categories of indicators should be examined that address: levels of coverage of key evidence-based prevention and treatment interventions; incidence and prevalence of HIV infection; AIDS-related or all-cause mortality among people living with HIV; stigma and discrimination; and the legal and policy environment.
Indicators should be disaggregated, whenever feasible, to fully reflect progress and challenges relating to all populations and locations in the national response.
:: The process of evaluating indicators of national progress should meaningfully involve people living with HIV and from key populations as an important part of data validation.

On the mechanisms of conjugate vaccines

PNAS – Proceedings of the National Academy of Sciences of the United States
of America

http://www.pnas.org/content/early/
[Accessed 22 Dec 2018]

On the mechanisms of conjugate vaccines
Rino Rappuoli, Ennio De Gregorio, and Paolo Costantino
PNAS published ahead of print December 21, 2018. https://doi.org/10.1073/pnas.1819612116
Abstract
During the last three decades, the development and commercialization of conjugate vaccines against Haemophilus influenzae type b (Hib), pneumococcus, and serogroups C, A, W, and Y of meningococcus contributed to the virtual elimination of bacterial meningitis caused by the bacteria included in the vaccines and to the prevention of diseases that used to cause more than a million deaths annually (1, 2). Despite the great impact on public health of these vaccines, our understanding of the way these vaccines work is still limited, and we have many unanswered questions. In PNAS, Sun et al. (3) report new mechanistic insights on conjugate vaccines.

Runners-up

Science         
21 December 2018  Vol 362, Issue 6421
http://www.sciencemag.org/current.dtl
Special Issue: Breakthrough of the Year

Runners-up
By Eric Hand, Gretchen Vogel, Ken Garber, Jocelyn Kaiser, Kelly Servick, Daniel Clery, Robert F. Service, Meredith Wadman
Science21 Dec 2018 : 1346-1351 Full Access
Science has named nine scientific advances as runners-up for the 2018 Breakthrough of the Year.

Comment on “The impact of past vaccination coverage and immunity on pertussis resurgence”

Science Translational Medicine
19 December 2018  Vol 10, Issue 472
http://stm.sciencemag.org/

Technical Comment

Comment on “The impact of past vaccination coverage and immunity on pertussis resurgence”
By Kathleen Winter, Nicola P. Klein, Sarah Ackley, James D. Cherry
Science Translational Medicine19 Dec 2018 Full Access
A recently published study does not accurately model the resurgence of pertussis observed in the United States due to the lack of acellular pertussis vaccine recipients in the study cohort.
Abstract
Limitations in the data used for a recent modeling study of pertussis resurgence in the US may explain why the results were not consistent with several observational studies demonstrating a shorter duration of protection after acellular pertussis vaccine administration.

Response to Comment on “The impact of past vaccination coverage and immunity on pertussis resurgence”

Science Translational Medicine
19 December 2018  Vol 10, Issue 472
http://stm.sciencemag.org/

Technical Response

Response to Comment on “The impact of past vaccination coverage and immunity on pertussis resurgence”
By Matthieu Domenech de Cellès, Aaron A. King, Pejman Rohani
Science Translational Medicine19 Dec 2018 Full Access
We present new evidence that the immunity conferred against pertussis by the DTaP acellular vaccine wanes more slowly than widely believed.

 

 

The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia

Vaccine
Volume 37, Issue 2  Pages 211-400 (7 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/2

Research article   Abstract only
The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia
Jenny O’Neill, Fiona Newall, Giuliana Antolovich, Sally Lima, Margie Danchin
Pages 272-279

Motivation for participating in phase 1 vaccine trials: Comparison of an influenza and an Ebola randomized controlled trial

Vaccine
Volume 37, Issue 2  Pages 211-400 (7 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/2

Research article   Abstract only
Motivation for participating in phase 1 vaccine trials: Comparison of an influenza and an Ebola randomized controlled trial

  1. Cattapan, K. Browne, D.M. Halperin, A. Di Castri, … S.A. Halperin

Pages 289-295

Development of a US trust measure to assess and monitor parental confidence in the vaccine system

Vaccine
Volume 37, Issue 2  Pages 211-400 (7 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/2

Research article   Abstract only
Development of a US trust measure to assess and monitor parental confidence in the vaccine system
Paula M. Frew, Raphiel Murden, C. Christina Mehta, Allison T. Chamberlain, … Robert A. Bednarczyk
Pages 325-332

Oral polio vaccine response in the MAL-ED birth cohort study: Considerations for polio eradication strategies

Vaccine
Volume 37, Issue 2  Pages 211-400 (7 January 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/2

Research article  Open access
Oral polio vaccine response in the MAL-ED birth cohort study: Considerations for polio eradication strategies
William K. Pan, Jessica C. Seidman, Asad Ali, Christel Hoest, … Pascal Bessong
Pages 352-365

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

 

PNAS |
December 18, 2018 | vol. 115 | no. 51
SPECIAL FEATURE: PERSPECTIVE
Why the evolution of vaccine resistance is less of a concern than the evolution of drug resistance
David A. Kennedya,1 and Andrew F. Reada
Edited by Rino Rappuoli, GlaxoSmithKline, Siena, Italy, and approved March 7, 2018 (received for review November 29, 2017)

Vaccines and antimicrobial drugs both impose strong selection for resistance. Yet only drug resistance is a major challenge for 21st century medicine. Why is drug resistance ubiquitous and not vaccine resistance? Part of the answer is that vaccine resistance is far less likely to evolve than drug resistance. But what happens when vaccine resistance does evolve? We review six putative cases. We find that in contrast to drug resistance, vaccine resistance is harder to detect and harder to confirm and that the mechanistic basis is less well understood. Nevertheless, in the cases we examined, the pronounced health benefits associated with vaccination have largely been sustained. Thus, we contend that vaccine resistance is less of

a concern than drug resistance because it is less likely to evolve and when it does, it is less harmful to human and animal health and well-being. Studies of pathogen strains that evolve the capacity to replicate and transmit from vaccinated hosts will enhance our ability to develop next-generation vaccines that minimize the risk of harmful pathogen evolution.

Antimicrobial resistance and the role of vaccines
David E. Bloom, Steven Black, David Salisbury, and Rino Rappuoli
Proc Natl Acad Sci USA December 18, 2018 115 (51) 12868-12871; https://doi.org/10.1073/pnas.1717157115

Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

  1. P. Sevilla, David E. Bloom, Daniel Cadarette, Mark Jit, and Marc Lipsitch

Proc Natl Acad Sci USA December 18, 2018 115 (51) 12911-12919; https://doi.org/10.1073/pnas.1717161115

 

PharmacoEconomics & Outcomes News
December 2018, Volume 818, Issue 1
Clinical study
Transparency and consistency of economic evidence on vaccines
J Pike –

Willingness to pay for dengue vaccination in Malaysia
HY Yeo
 
 
 

Media/Policy Watch

Media/Policy Watch

This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 22 Dec 2018
[No new, unique, relevant content]

BBC
http://www.bbc.co.uk/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
The Economist
http://www.economist.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
Financial Times
http://www.ft.com/home/uk
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
Forbes
http://www.forbes.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
Foreign Affairs
http://www.foreignaffairs.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
Foreign Policy
http://foreignpolicy.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
The Guardian
http://www.guardiannews.com/
Accessed 22 Dec 2018
The new populism
Vaccines and immunisation
Rightwing populists ride wave of mistrust of vaccine science
Antivaxers are on the rise in countries such as Italy, Poland and France where the far right has made gains
Sarah Boseley in London, Angela Giuffrida in Rome, Christian Davies in Warsaw, Angelique Chrisafis in Paris and Oksana Grytsenko in Kiev
Fri 21 Dec 2018 14.01 GMT
As long as there have been vaccines, there have been doubters. Some people have religious or philosophical reservations. Others are more anxious about the possible side-effects of a jab than about falling sick with a poorly understood disease.
But now vaccine doubt is spreading faster and further than ever through social media, and populist rightwing politicians in Europe and the US are riding on the back of a wave of mistrust of vaccine science.
The arguments align. Populists are often suspicious of the establishment and authority figures. Antivaxers are hostile to government, medical institutions, Big Pharma and science. In several countries – Italy, France, Poland, the US – both are on the rise…
 
 
New Yorker
http://www.newyorker.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
New York Times
http://www.nytimes.com/
Accessed 22 Dec 2018
Dec. 20, 2018

Africa
Congo: Ebola Outbreak ‘Certainly’ to Last 3-4 Months More
The second-deadliest Ebola outbreak in history is “certainly” expected to continue for another three or four months, Congo’s health minister said Thursday.

Africa
As Ebola Threatens Mega-Cities, Vaccine Stockpile Needs Grow
Doubts are growing about whether the world’s emergency stockpile of 300,000 Ebola vaccine doses is enough to control future epidemics as the deadly disease moves out of rural forest areas and into urban mega-cities.
Dec. 20
 
 
Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 22 Dec 2018
[No new, unique, relevant content]
 
 
Washington Post
http://www.washingtonpost.com/
Accessed 22 Dec 2018
[No new, unique, relevant content]

Vaccines and Global Health: The Week in Review :: 15 December 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 david.r.curry@centerforvaccineethicsandpolicy.org.

 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_15 Dec 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

Announcing the Allen Institute for Immunology, a new research endeavor focused on human immune health and disease

Milestones :: Perspectives

Announcing the Allen Institute for Immunology, a new research endeavor focused on human immune health and disease

Press Release   
December 12, 2018
Seeded by $125 million donation by the late Paul G. Allen, the Allen Institute for Immunology will study human immune health, cancer, and autoimmune diseases

The Allen Institute today announced the launch of the Allen Institute for Immunology, a new division of the Institute that is dedicated to studying the human immune system. Seeded by a generous commitment of $125 million by Allen Institute founder, the late Paul G. Allen, the new Institute will work to understand the dynamic balancing act of the human immune system, how it senses friend from foe and what goes wrong when we’re ill.

“Paul Allen always challenged us to go after the really hard problems, to do work that would have a significant impact in our scientific fields,” said Allan Jones, Ph.D., President and Chief Executive Officer of the Allen Institute. “Understanding the human immune system in detail and figuring out what goes wrong in disease is an incredibly complex but solvable problem. I’m thrilled to see us launch into this new area of complexity in biology with a real opportunity to directly impact human health.”

The Allen Institute for Immunology’s goal is to improve human immune health and lay the groundwork for better ways to diagnose, treat and prevent immune-related diseases. In its initial phase, the Institute will focus on studies of two cancers, multiple myeloma and melanoma, and three autoimmune disorders, rheumatoid arthritis and inflammatory bowel disease, specifically, ulcerative colitis and Crohn’s disease. The researchers will also take a deep dive into the immune systems of healthy volunteers with the goal of understanding what makes a “normal” immune baseline and how to help patients return to that healthy state.

Thomas F. Bumol, Ph.D., is the Executive Director for the Allen Institute for Immunology. Bumol joins the Institute from Lilly Research Laboratories where he worked for more than 35 years, most recently as Senior Vice-President of the Biotechnology and Immunology Research component and the Site Head of Lilly’s Biotechnology Center of San Diego. His work at Lilly focused on drug discovery and early clinical development of treatments for many disease areas including diabetes, pain and immune-related diseases such as psoriasis, lupus, rheumatoid arthritis and inflammatory bowel disease.

“By unraveling the mysteries of the dynamic immune system in healthy individuals and focusing the same cutting-edge tools on patients in various disease states, we believe we will find new ways to diagnose and ultimately treat disease,” Bumol said. “We are looking at problems that have large unmet needs. Patients are not only suffering from these immune-based illnesses, patients are dying from some of these disorders, and we would like to change that.”

 

Gavi Mid-Term

Milestones :: Perspectives

Gavi Mid-Term

Global health leaders hail immunisation as shortest path to healthy lives

Gavi Mid-Term Review closes with commitments to accelerate immunisation programmes in the poorest countries to reach more children with lifesaving vaccines.

Abu Dhabi, 12 December 2018 – More than 300 leaders of the global health community, including representatives from governments, civil society and the private sector, came together for the Gavi Mid-Term Review this week in Abu Dhabi, UAE. The high-level conference celebrated the 700 million children immunised and 10 million lives saved in the world’s poorest countries thanks to Gavi support since 2000…

…While Gavi is on track to meet its commitments, it still faces a number of challenges including the difficulty of reaching underimmunised children in isolated rural communities, urban slums and conflict settings.  It will also need to help countries deal with a growing number of disease outbreaks coupled with the looming challenges of climate change, population growth and urbanization, as well as the fact that more and more of the world’s poorest people will be living in middle-income countries not supported by Gavi.

“We still have a long way to go,” said Dr Ngozi Okonjo-Iweala, Gavi Board Chair. “Despite improvements in vaccine coverage, it is not accelerating as fast as we would like and this is particularly the case in fragile countries. In order to further its mission and to reach the children who are still missing out on basic vaccines, this week we heard from participants that the Alliance needs to keep on learning from its experiences and continue to adapt. Success will require exploring more innovative and tailored approaches with countries while selectively forging new partnerships with the private sector.”

“By reaching more than 65 million children annually in Gavi-supported countries, vaccination is the shortest path to healthy lives,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Vaccines don’t deliver themselves.  Expanding health systems to deliver immunisation in low coverage areas builds the base of the primary health system. This is a key contributor to the third Sustainable Development Goal.” Immunisation connects the vast majority of families with the primary health system up to five times in the first year of a child’s life – more than any other health intervention. It ranks among the most equitable interventions, disproportionately benefiting the most marginalised populations and is equally distributed to boys and girls.

New and expanded partnerships

During the mid-term review, Gavi announced a series of new innovative partnerships with the private sector and governments to further strengthen immunisation in developing countries.

:: The German Federal Ministry of Development and Cooperation through the German development bank KfW will explore the application of blockchain technology to Gavi’s cash support and supply chain management systems.

:: Mastercard will leverage its expertise and technology, enabling ministries of health and authorised health workers to provide a card with a digital immunisation record to each participating child’s caregiver. The program aims to strengthen the efficiency and reach of health services in developing countries where children are most at risk of missing out on immunisation.

:: Parsyl Inc will help to boost vaccine supply chains in Uganda and Senegal. The partnership will use Parsyl’s advanced supply chain data platform to support Senegal and Uganda to track and monitor cold chain conditions while vaccines are being distributed within countries.

:: The Uganda Ministry of Health, UPS and Freight in Time Ltd (FIT) will implement an 18 month pilot project using a customised mobile app and a wireless temperature monitoring system to help address supply chain challenges in three Ugandan districts which have the highest number of unimmunised children in the country.

:: Unilever through Lifebuoy, its leading health soap brand, will expand its support to further scale up its ‘Safal Shuruaat’ programme. This India-based initiative, launched in 2018, promotes handwashing with soap and immunisation – two of the most cost-effective child survival interventions – and aims to improve the health of young children by helping to prevent illnesses which are often associated with premature death. The partnership with Gavi contributes to two major public health priorities of the Government of India: Mission Indradhanush and Swachh Bharat. Unilever’s increased financial contribution will be matched by the Government of the Netherlands as part of the Gavi Matching Fund mechanism.

:: Zenysis Technologies – This new strategic partnership agreement will jointly invest to provide countries with access the company’s software platform, analytical training and support IT skills development. Countries will use the platform’s interoperability capabilities to integrate data from their fragmented information systems and help decision makers see where their country’s immunisation programmes are leaving children behind. The project also has the backing of one of Zenysis’ investors, internet services giant Tencent Holdings, Asia’s largest company.

The International Finance Facility for Immunisation (IFFIm) and the Islamic Development Bank Group (IsDB), a development partner of Gavi, the Vaccine Alliance, announced plans to issue an Islamic-compliant financial instrument, or Sukuk, aimed at accelerating funding for immunisation efforts to save children’s lives in the world’s poorest countries.

New funding commitments

The Republic of Korea announced US$ 15 million in new funding that will be delivered from 2019-2021 and will be funded through Korea’s Global Disease Eradication Fund.

The Kuwait Fund for Arab Economic Development (Kuwait Fund) formally approved a grant of US$ 1 million to accelerate the availability of funding for immunisation programmes supported by Gavi, the Vaccine Alliance.

Lastly, Mohamed Al Ansari, Chairman and Managing Director of Al Ansari Exchange, a leading exchange company in the UAE announced a US$ 1 million pledge to support life-saving vaccines and immunisation in the poorest countries of the world.

The Gavi Mid-Term review was also an opportunity to celebrate global figures whose dedication to the Vaccine Alliance’s mission has played a key role in helping Gavi and its partners to protect hundreds of millions of children across the world. Dr Cyrus Poonawalla, Founder of Serum Institute of India (SII) and Chairman of Poonawalla Group, was given the first ever Vaccine Hero award by Gavi, the Vaccine Alliance.

::::::

Gavi and Mastercard join forces to reach more children with lifesaving vaccines

Strengthening efficiency and reach of health services in developing countries with digital immunisation records.

Abu Dhabi, 11 December 2018 – Mastercard and Gavi, the Vaccine Alliance announced today at a high-level conference for Gavi’s 2018 mid-term review, a new transformative partnership to ensure more children from the poorest countries are able to benefit from life-saving immunisation programs.

Although major progress has been made to increase immunisation rates, one in five children in Gavi-supported countries are still not reached with basic lifesaving vaccines. In many developing countries, common barriers may include a lack of information about a child’s immunisation record and limited means by which to remind care givers about follow up appointments.

This partnership will leverage Mastercard expertise and technology, enabling ministries of health and authorised health workers to provide a card with a digital immunisation record, to each participating child’s caregiver. By empowering caregivers to stay on track to receive critical vaccinations, the program aims to strengthen the efficiency and reach of health services in developing countries where children are most at risk of missing out on immunisation.

Governments will benefit from having a better understanding of the immunisation needs of their communities.

“Access to services like healthcare and education are vital to helping families build a promising future. By applying our technology to humanitarian and development challenges, we can help optimise and scale life-saving programs in underserved communities around the world,” said Michael Froman, vice chairman and president of strategic growth at Mastercard.

“Children, especially those living in the most remote, impoverished communities, lack immunisation records,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “That represents an enormous impediment to Gavi’s mission of ensuring that every child worldwide receives the essential vaccines they need to survive and thrive. This partnership with Mastercard has the potential to overcome that challenge.”

The partnership aims to be implemented across five countries over the next two years with the goal of expanding the solution to all other interested Gavi-supported countries, based on mutually agreed targets…

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Gavi and Germany partner to harness blockchain technology

German government and the Vaccine Alliance to explore the application of blockchain technology to increase efficiency of immunisation programmes.

Abu Dhabi, 11 December 2018 – Gavi, the Vaccine Alliance and the German Federal Ministry for Economic Cooperation and Development (BMZ), through the KfW Development Bank, announced at Gavi’s high-level 2018 mid-term review conference in Abu Dhabi, UAE, that they will partner to explore the application of blockchain technology to Gavi’s cash support and supply chain management systems.

Before a vaccine can protect a child, immunisation programmes involve complex planning and procedures. Outdated vaccine supply and distribution systems can delay and limit the impact that vaccines have on people’s health. BMZ, KfW and Gavi recognise that blockchain technology could radically transform health systems by reducing wastage and creating trust amongst development partners, funders and countries.

“Blockchain technology could help us understand in real-time all the steps taken while a vaccine is being delivered,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This technology has the potential to increase efficiency and reduce costs for developing countries but, most importantly, it could save lives.”

Starting in 2019, the joint project will focus on exploring practical areas of application for this technology in the immunisation space to, for example, effectively track funds and vaccines…

Global Consortium Supporting Low- and Middle-Income Countries to Make Evidence-Based Healthcare Investment Decisions Receives $14.5 Million Boost

Milestones :: Perspectives

Global Consortium Supporting Low- and Middle-Income Countries to Make Evidence-Based Healthcare Investment Decisions Receives $14.5 Million Boost

December 12, 2018  [Editor’s text bolding]

“Policymakers’ decisions about what healthcare to make available and at what cost can be a life or death decision for people across the developing world.”

London – A global consortium working with low- and middle-income countries as they aim to make healthcare investment decisions that reflect the best value for money has received a $14.5 million grant from the Bill & Melinda Gates Foundation, announced the Center for Global Development today. The grant covers the next five years and specifically supports the International Decision Support Initiative (iDSI), made up of health policymakers, researchers, and development experts.

The most cost-effective health interventions produce as much as 15,000 times the benefit as the least cost-effective, and up to $2.8 trillion USD is reported to be wasted each year and could be redirected to save more lives. This means that allocating healthcare according to maximum health gain could save countless lives.

iDSI will harness the funding to extend its engagement with policymakers and healthcare payers in low- and middle-income countries, primarily in sub-Saharan Africa, working with them to understand and respond to the challenges they face when deciding on benefits—whether ensuring the financial sustainability of a health insurance fund or fair access to good quality care across public health facilities.

The network endeavors to generate long-term, locally owned solutions to healthcare challenges through building capacities for using evidence in policy and clinical decisions. Its impact to date includes influencing policy in eight countries—China, India, Indonesia, Philippines, Vietnam, South Africa, Tanzania, and Ghana—where there has been tangible progress toward national institutions being established to embed value-for-money into decision-making about what medicines, vaccines, or other health services should be offered to the population, and how these could be procured in the most cost-effective way. Already the coalition has supported Tanzania to prioritise its Essential Medicines List from 500 to 400 drugs, reducing spending on poor-value items and freeing up resources to improve access to the most cost-effective medicines; trained Kenya’s Health Benefits Package Committee on measuring the added value of a new health intervention compared to existing ones; piloted a local quality improvement initiative with hospital staff in Vietnam to reduce inappropriate antibiotic prescribing for pneumonia; and brought together more than 100 policymakers working across sub-Saharan Africa to share knowledge and best practices.

“With government and aid budgets under pressure, many developing countries have to make difficult choices,” said iDSI Director Kalipso Chalkidou, who also directs the Global Health Policy program at the Center for Global Development and is a professor of global health practice at Imperial College London. “Policymakers’ decisions about what healthcare to make available and at what cost can be a life or death decision for people across the developing world. We will inform these critical decisions with data and evidence that map out how best to spend limited funds to improve outcomes and save lives.”

The Chinese, Thai, and Norwegian governments have backed iDSI, which also receives funding from the Department for International Development, a United Kingdom government department responsible for administering overseas aid; and this renewed phase will see a stronger emphasis on sub-Saharan Africa. iDSI’s flagship countries include Kenya and Ghana, where global health funders will be departing and domestic health care spending is on the rise. Additionally, many sub-Saharan African countries are currently introducing national health insurance or coverage plans and making important decisions about what health services and technologies should be included in universal health coverage offerings, where value-for-money considerations could make a huge difference in health outcomes.

The Center for Global Development…will lead iDSI. The six other core partners in this global effort include the Global Health and Development Group at Imperial College London; the Asia HTA consortium, which includes the National Health Foundation of Thailand, the Saw Swee Hock School of Public Health at the National University of Singapore, and Health Intervention and Technology Assessment Program (HITAP); the China National Health Development Research Center; the Health Economics Research Unit (HERU) of the KEMRI  Wellcome Trust Programme; the Norwegian Institute of Public Health; and the Clinton Health Access Initiative, Inc. (CHAI).

iDSI was born out of the recommendations of the Center for Global Development’s Priority-Setting Institutions for Global Health Working Group in 2012.

“Previous healthcare decision-making in developing countries has too often been driven by inertia and lobbying rather than science, economics, ethics, and the public interest,” said Amanda Glassman, Chief Operating Officer at the Center for Global Development. “We want to change that.”

Ebola – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo
Children account for more than one third of Ebola cases in eastern Democratic Republic of the Congo – UNICEF
Press release
KINSHASA, DAKAR, NEW YORK, GENEVA, 11 December 2018 – Children now account for more than one third of the Ebola cases in affected regions of the eastern Democratic Republic of the Congo (DRC), UNICEF said today. The UN children’s agency also reported that one in ten Ebola cases is under five-years-old, while children who contract the Ebola virus are at higher risk of dying from the disease than adults.

“We are deeply concerned by the growing number of children confirmed to have contracted Ebola,” said UNICEF’s Regional Director for West and Central Africa, Marie-Pierre Poirier, returning this week from Beni, one of the current epicentres of the Ebola outbreak. “The earlier children infected with Ebola receive treatment in a specialized health facility, the greater their chances of survival. Community mobilization and public awareness activities are also crucial to ensuring early detection and quick referral of suspected cases to Ebola treatment centres.”

Continued efforts are needed to raise awareness of prevention methods and promote early access to treatment which dramatically improves survival rates.

The impact of the disease on children goes beyond those who have been infected. When parents or caregivers with the disease are taken to treatment centres or pass away, some children are left on their own. UNICEF and its partners have so far identified more than 400 children who have been orphaned or left unaccompanied because of the virus. The growing number of separated children is linked to the high caseload of patients in the Ebola treatment centres of Beni and Butembo, the current epicentres of the disease.

UNICEF provides Ebola-infected children, orphans and unaccompanied children with appropriate assistance, including nutritional care and psychosocial and educational support. Together with its partners, UNICEF has opened a kindergarten next to the Ebola treatment centre of Beni to assist the youngest children whose parents are isolated in the centre. The creche has taken care of more than 20 separated infants and young children, aged up to eight years, since its opening early November.

Marie-Pierre Poirier met in Beni with national authorities, who are leading the Ebola-response, along with UN agencies and NGO partners. “Children are suffering a lot because of this epidemic – both those who have lost parents or caregivers as well as those who have been infected themselves,” said Poirier. “That’s why it’s imperative that children are put at the heart of the Ebola response.”

Since the start of the response to the latest Ebola outbreak in the DRC, UNICEF and its partners have:
Ø Provided psycho-social and material assistance to 520 affected families with children;
Ø Provided psychosocial support to 421 children in the Ebola Treatment Centers;
Ø Sensitized more than 91,000 children with Ebola prevention messages in schools;
Ø Briefed 4,310 teachers in schools on Ebola;
Ø Equipped 444 schools in high risk areas with hand-washing facilities;
Ø Reached more than 6,753,000 people with Ebola-prevention messages;
Ø Provided access to water to 889,440 people in the affected areas.

With more than 50 specialists in the impacted regions, UNICEF is operating out of Beni, Butembo, Mangina and Komanda.

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19: Situation report on the Ebola outbreak in North Kivu 
12 December 2018
[Excerpts]
…Case Management
:: On 24 November 2018, MoH announced the launch of a randomized control trial for Ebola therapeutics. This first ever multi-drug randomized control trial within an outbreak setting is an important step towards finding an effective treatment for Ebola. The trial is coordinated by WHO and led and sponsored by the DRC’s National Institute for Biomedical Research (INRB) which is the principal investigator. The trial has begun in the ALIMA facility in Beni, where patients are briefed on the trial and given the choice to participate.

:: Other ETCs continue to provide therapeutics under the MEURI (compassionate use) protocol, in collaboration with the MoH and the 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. UNICEF is providing nutritional treatment and psychological support for all hospitalized patients.

:: New patients continue to be treated in transit centres and ETCs. Over the reporting period, bed occupancy varied from 0% in Goma and Tchomia to 90% in Beni ETC.

: On 9 December 2018, a total of 131 patients were hospitalised in transit centres and ETCs, of whom 39 were laboratory confirmed.

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DONs Ebola virus disease – Democratic Republic of the Congo
13 December 2018
[Excerpt]
…WHO risk assessment
This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

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…

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South Sudan set to vaccinate targeted healthcare and frontline workers operating in high risk states against Ebola

Juba 8 December, 2018 – The Ministry of Health of the Republic of South Sudan with support from the World Health Organization (WHO), DFID, GAVI vaccine alliance and other partners, is set to vaccinate targeted healthcare and frontline workers operating in high risk states bordering the Democratic Republic of Congo (DRC) against Ebola virus disease (EVD) as part of national preparedness efforts.

To facilitate the process, a training for the Vaccination team was incorporated into the micro plan developed by the vaccine technical working group (TWG). The members of the TWG among others include MoH, UNICEF, CDC, WHO, MSF, Health Cluster and others.  Accordingly, a four days training for 60 participants drawn from the states of Juba, Yei, Yambio and Nimule on Good Clinical Practice (GCP) course (4-7 December, 2018) in Juba.

The vaccination team members selected by their respective State Ministry of Health included representatives from health facilities, private sector and Civil Society Organizations. Each state vaccination team comprised of 15 members including vaccinators, clinicians, social mobilizers, and logisticians.

The GCP training is mandatory prior to the administration of the vaccine. Participants were equipped with knowledge and skills on Ebola vaccine (rVSV-ZEBOV) administration including vaccination techniques, and exposed through a simulation exercise.

Through this training, the vaccination team members were GCP certified and are now ready to conduct the Ebola vaccination scheduled to start with Juba on 19 December, 2018, and follow up the vaccinated individuals for a period of 21 days as the minimum standard of care.

The Ministry of Health, with technical support from the Vaccine Technical Working Group of the National EVD Task Force, the states, and NGOs operating in health care facilities in the respective States will coordinate the administration of the Ebola vaccine.

With support from GAVI vaccine alliance, 2,160 doses of the Ebola vaccine (rVSV-ZEBOV) have been allocated to South Sudan and will be administered to protect against Ebola virus-Zaire, the strain that is confirmed in the current outbreak in DRC. Although this vaccine is not yet licensed, it is being used under the compassionate-use guidelines in response to the ongoing Ebola outbreak in DRC as recommended by the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE)…

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