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

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– blog edition: comprised of the approx. 35+ entries posted below.

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

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…




Public Health Emergency of International Concern (PHEIC)
Polio this week as of 18 December 2018 [GPEI]
:: Featured on  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
:: 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

:: 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]
:: 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]
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 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]
:: 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]
No new announcements identified.

Yellow Fever  [to 22 Dec 2018]
:: Disease outbreak newsYellow Fever – Kingdom of the Netherlands   18 December 2018

Zika virus  [to 22 Dec 2018]
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
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