Vaccines and Global Health: The Week in Review :: 30 March 2019

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

WHO – SAGE [Strategic Advisory Group of Experts] Meeting

Milestones :: Perspectives

WHO – SAGE [Strategic Advisory Group of Experts] Meeting
The next SAGE meeting will take place in Geneva from the 2-4 April 2019.
Draft agenda for SAGE April 2019 meeting  pdf, 76kb  [As of 25 March 2019]

Selected Agenda Items
:: Quality and Use of Immunization and Surveillance Data
:: Report from the Global Advisory Committee on Vaccine Safety (GACVS) meeting 5-6 December 2018
:: Update on the development of a Post-2020 Immunization Strategy
:: Malaria Vaccine
:: Polio the last mile
:: Meningococcal vaccines: Global Strategy
:: Ebola vaccines
:: Update on the SAGE Evaluation

Polio Eradication

Milestones :: Perspectives

Polio Eradication

Dr Tedros Adhanom Ghebreyesus, WHO Director-General and Chair of the Polio Oversight Board, issued a personal response [first text below] to the joint statement published in January by the Chairs of the main, independent, advisory and oversight committees of the GPEI [second text below].

March 2019
Dear Chairs of the GCC, IHR Emergency Committee, 1MB and SAGE,
On behalf of the Global Polio Eradication Initiative (OPEi) and as current Chair of the Polio Oversight Board, I would like to thank you for your recently-published joint communique on the polio eradication effort. Your assessment of the current global situation, and what needs to happen to achieve success, is as accurate as it is motivating. Thank you for this strong call for action.

Let me assure you: all partners of the OPEi fully agree with you.

As a global community, we have been engaged in this fight for 31 years now. Wild poliovirus cases now persist in only a handful of districts of just two countries – Pakistan and Afghanistan.

In January, I was joined by Dr Al Mandhari, Regional Director for the Eastern Mediterranean, and Dr Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation, as we visited both countries where we witnessed first-hand the tremendous efforts being undertaken to interrupt the remaining chains of wild polio transmission there. I have rarely been so impressed by public health efforts being undertaken as in these two areas, as both countries work hand-in-hand to tackle this joint epidemiological block, as both countries engage and mobilise all levels of public and civil society to support this effort.

As you rightly point out, eradication is an “all-or-nothing” approach. We either eradicate, or we do not. And the truth is, everything in place for success to be achieved. The Endgame Plan through 2013-2018 has brought us to the brink of being polio-free. And the Strategic Plan 2019-2023 aims to build on the lessons learned since 2013. Its aim is to increase performance everywhere, including using the proven tools of eradication and building blocks that have been established, while using opportunities to innovate using local knowledge and insights to overcome obstacles that in the past have seemed insurmountable. The key is to optimise all these approaches, and if the Plan is fully financed and implemented at all levels, a lasting polio-free world will be secured for all future generations to come.

That is why I commit to you today: we will rise to your call to action, and we will excel in our jobs, and this will lead to the success we all want to see. As you challenge us, we commit to making it our overriding objective to find and reach that last unvaccinated child before the poliovirus does. We will give the poliovirus nowhere to hide.

Your continued guidance, independent assessments and oversight will be critical to help us in securing this success. It is this guidance which has been instrumental in helping bring us to the threshold of a polio-free world, and it will be your continued guidance which will help us finally cross this threshold. Please continue with your assessments. Continue to critically evaluate what we are doing. Continue to issue your joint statements to draw attention to what needs to be done. We must have this oversight.

On behalf of our partners at Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation, and mostly on behalf of the children of the world, thank you!

Dr Tedros Ghebreyesus
Director-General, World Health Organization
Chair, Polio Oversight Board of the Global Polio Eradication Initiative



January 2019
Dear Polio Eradicator,

The global polio eradication effort is 31 years old.

The world is tantalizingly close to being free of polio. From 350,000 wild poliovirus cases every year in 1988, in 2018 the world reported just 29 cases of this devastating disabling disease because of extraordinary global efforts. Wild poliovirus transmission is endemic in only a handful of districts worldwide. The aim of the 2013-2018 Endgame Plan had been to be finished with this job by end 2018. This is not the case, and the Plan has to now be revised and extended through 2023.

This is an effort that cannot be sustained indefinitely: 31 years is long enough. It is resource intensive. It is intensive on the countries affected. It is intensive on donors. It is intensive on health services. It is intensive on communities. Most of all, it is intensive on those children and their families who bear the burden of this terrible disease, needlessly.

There is no reason why polio should persist anywhere in the world.

To succeed by 2023, all involved in this effort must find ways to excel in their roles. If this happens, success will follow.

This means stepping up the level of performance even further. It means using the proven tools of eradication and building blocks that have been established in parts of the world that have been free of polio for years. The vaccines, the cold chains, the networks of vaccinators, the surveillance capacity, the governance, policy, financing and oversight structures must be at peak levels of performance. There must be an unrelenting focus to tighten the management of the effort at all levels.

It also means looking for opportunities to innovate, using local knowledge and insights to overcome obstacles that in the past have seemed insurmountable. It means looking at new and different ways to reach children. It means really understanding the views of parents, and communities, who are unwilling to accept the vaccine and finding ways to address their concerns and come together with them. It means more effectively engaging with communities and better serving their needs than we have been doing thus far. Each person must dedicate themselves to one clear objective – to reach that very last child with polio vaccine.

Please commit to finding that very last child first, before the poliovirus does. Give the poliovirus nowhere to hide.

Whatever barrier to reaching that very last child, the programme has the expertise and experience to overcome it. Let everyone perfect what we know works. Let everyone free their mind to come up with new ideas and transformative solutions. We must all treat this as the public health emergency that it is.

As a global community, we have stood before where we stand today, with smallpox. The scourge of smallpox is gone, for which the world is a much better place. Let us make history again. It is time to finish the job of polio eradication now. The philosopher, poet and essayist Ralph Waldo Emerson said: “To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition, to know even one life has breathed easier because you have lived – this is to have succeeded.”

Eradicate polio, and make the world a better place for future generations.

Thank you.

Professor Alejandro Cravioto
   Chair of the Strategic Advisory Group of Experts on immunization (SAGE)

Sir Liam Donaldson
   Chair of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative

Professor Helen Rees
   Chair of the Emergency Committee of the International Health Regulations (IHR) Regarding
      the International Spread of Poliovirus

Professor David Salisbury
   Chair of the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC)

Trust issues

Featured Journal Content

Lancet Infectious Diseases
Apr 2019  Volume 19Number 4p339-448, e109-e147

Trust issues
The Lancet Infectious Diseases
In November, 2017, we published an Editorial on measles vaccination, calling for strong interventions to curb preventable diseases. 18 months later, how have things changed? As reported in a news story in this issue, 229,000 cases of measles were reported in 2018, and 98 countries reported an increase in cases compared with 2017. Measles is a global health crisis and it is getting worse. Although the reasons vary by country, mistrust and misplaced reluctance to vaccinate, largely related to unfounded fears over safety, are important contributing factors from the Philippines to France, from Ukraine to the USA. WHO has named vaccine hesitancy as one of the top ten threats to global health in 2019.

Lack of trust is also central to another of the world’s major health emergencies: the Ebola virus disease outbreak in DR Congo. The epidemic is focused in the northeast of the country, where conflict, political tensions, and social grievances have instilled fear and suspicion in much of the local population. 40% of new cases so far this year have been in people who died in the community (ie, they hadn’t been to a treatment centre), and a large proportion of cases, particularly in Katwa and Butembo, cannot be linked to any other patients, suggesting that unknown chains of transmission exist. If patients are wary of seeking proper care, and if contact tracing cannot be done, the outbreak will not be stopped.

Mistrust has also manifested with more direct and violent consequences in DR Congo. Médecins Sans Frontières (MSF) has reported dozens of attacks on its workers in the region. In February, two treatment centres were attacked and burned down, forcing MSF to suspend its activities in Katwa and Butembo. Joanne Liu, the president of MSF, has been quoted as describing the atmosphere towards the response as “toxic”.

The importance of community engagement to build trust was well recognised in the aftermath of the west Africa Ebola epidemic, but the difficulties of the DR Congo outbreak have led to the use of coercion against patients and their contacts, and a reliance on police and UN peacekeepers for security has further alienated the local population. MSF has criticised the use of coercion in DR Congo, and in an interview with STAT, Liu has said that “using police to force people into complying with health measures is not only unethical, it’s totally counterproductive“. WHO is taking a different tack: on March 9, it announced that it had sought further support from UN and local police forces to protect treatment centres, despite recognising the importance of “maintaining the neutrality of the response”.

As for trust in measles vaccination, a Danish study of more than 650,000 children once again confirms that measles, mumps, and rubella (MMR) vaccination is not associated with autism. But while the findings are welcome, the paper will not change the beliefs of anti-vaccination advocates. The safety of MMR was already well established before this study—a shortage of reliable scientific evidence is not the problem. And in countries such as the USA, the dangers of not vaccinating have been shown repeatedly, most recently in an outbreak of measles among mainly unvaccinated children in Washington and Oregon, as reported in our March issue. Rather, it is the abundance of misinformation and distrust of authority that must be addressed. Social media companies such as YouTube and Facebook have made changes to begin to stem the tide of misleading claims, but the impact of these initiatives remains to be seen.

An anti-vaxxer in California, USA, for example, is vastly different from someone potentially exposed to Ebola in rural DR Congo. Yet there are similarities in their mistrust. A belief that vaccines cause autism or that Ebola is a government ploy likely has as much to do with wider grievances and distrust of authority as with the specifics of the scientific evidence and education. Part of the problem is that a lack of faith in government, the health-care system, and pharmaceutical companies is not always irrational. In DR Congo, the postponement of elections in the regions affected by Ebola has been considered to be motivated more by politics than by public health (the region is a stronghold for opposition to the ruling party). The poverty and conflict in the region have long been neglected. In the USA, the country is plagued by prescription opioid misuse fuelled by aggressive pharmaceutical marketing, the people of Flint, MI, have been without safe drinking water for 3 years, and the most basic drugs are often unaffordable because of profit-driven health care. Little wonder that some individuals question the authorities’ desire to prioritise their wellbeing. It is impossible to build trust while at the same time abusing it.


WHO reaffirms commitment to Democratic Republic of the Congo as Ebola outbreak nears 1000 cases amid increased violence

Featured Journal Content

DRC – Ebola

WHO reaffirms commitment to Democratic Republic of the Congo as Ebola outbreak nears 1000 cases amid increased violence

WHO calls on international community to join urgent push to end outbreak
23 March 2019   Geneva/Brazzaville/Goma
As the Ebola outbreak in the Democratic Republic of the Congo (DRC) approaches 1000 cases amid increased violence, WHO reaffirmed its commitment both to ending the outbreak and working with the government and communities to build resilient health systems.

Since the outbreak was declared in August 2018 there have been 993 confirmed and probable cases and 621 deaths in North Kivu and Ituri provinces.

“We use words like ‘cases’ and ‘containment’ to be scientific, but behind every number is a person, a family and a community that is suffering,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This outbreak has gone on far too long. We owe it to the people of North Kivu to work with them in solidarity not only to end this outbreak as soon as possible, but to build the health systems that address the many other health threats they face on a daily basis.”

More than 96,000 people have been vaccinated against Ebola in DRC, along with health workers in Uganda and South Sudan. As of 21 March, 38 of 130 affected health areas have active transmission. More than 44 million border screenings have helped to slow the spread of Ebola in this highly mobile population. No cases have spread beyond North Kivu and Ituri provinces, and no cases have crossed international borders.

However, the risk of national and regional spread remains very high, especially when episodes of violence and instability impact the response.

“As we mourn the lives lost, we must also recognize that thousands of people have been protected from this terrifying disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are working in exceptionally challenging circumstances, but thanks to support from donors and the efforts of the Ministry of Health, WHO and partners, we have saved thousands of lives.”

WHO has more than 700 people in DRC and is working hard with partners to listen to the affected communities and address their concerns and give them greater ownership of the response, particularly in the current outbreak hotspots of Katwa and Butembo.

“The communities affected by this outbreak are already traumatized by conflict,” said Dr Tedros. ”Their fear of violence is now compounded by fear of Ebola. Community engagement takes time. There are no quick fixes. But we are learning and adapting to the evolving context every day.”

Despite the challenges, most communities accept response interventions. More than 90% of those eligible for vaccination accept it and agree to post-vaccination follow-up visits. Independent analysis of vaccination data indicate that the vaccine is protecting at least 95% of those who receive it in a timely manner. More than 80% of people also accept safe and dignified burials, a key to preventing onward transmission.

“Despite the increased frequency of attacks by armed groups, WHO will stay the course and will work with communities to end this outbreak together with the Ministry of Health and partners,” said Dr Tedros. “We need redoubled support from the international community, and a commitment to push together to bring this outbreak to an end.”

For the next 6 months, the combined financial need for all response partners is at least US$148 million. As of 19 March, US$ 74 million had been received.

“We count on donors to help close the funding gap so we can end this outbreak as soon as possible,” said Dr Tedros. “We will still be in DRC long after this outbreak has finished, working with the government and communities on the road to universal health coverage. We are committed to improving the health of the people of DRC now and in years to come.”


:: 34: Situation report on the Ebola outbreak in North Kivu  26 March 2019

:: Ebola virus disease – Democratic Republic of the Congo   28 March 2019



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 20 March 2019
:: Dr Tedros Adhanom Ghebreyesus, WHO Director-General and Chair of the Polio Oversight Board, has issued a personal response to the extraordinary joint statement published in January by the Chairs of the main, independent, advisory and oversight committees of the GPEI.  The joint statement is an impassioned plea by the Chairs of the Strategic Advisory Group of Experts on immunization (SAGE), the Independent Monitoring Board, the Emergency Committee of the International Health Regulations (IHR) Regarding International Spread of Poliovirus and the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC) – the Chairs urged everyone involved in the GPEI to ensure polio will finally be assigned to the history books by 2023. [see above]
:: On 27 March 2019, the WHO’s Southeast Asia Region marked five years since being declared wild polio-free, with the last case in the Region detected in India on 13 January 2011. The five-year anniversary of SEARO certification celebrated success in India and across countries of the region, showcasing how countries have used the skills, knowledge and infrastructure built up by the polio programme after eradication and highlight lessons learned from the Region that are now being applied in other parts of the world.

 Summary of new viruses this week:
:: Pakistan – two wild poliovirus type 1 (WPV-1) cases and 15 WPV1-positive environmental samples;
:: Nigeria— two circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, one cVDPV2-positive environmental.


 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 30 Mar 2019]
Democratic Republic of the Congo
:: 34: Situation report on the Ebola outbreak in North Kivu  26 March 2019
:: Ebola virus disease – Democratic Republic of the Congo   28 March 2019

Syrian Arab Republic
:: Health situation – Al-Hol camp  16 March 2019

South Sudan
::  Kawthar defeats tuberculosis: improving access to diagnosis and treatment in rural areas in Syria  27 March 2019

:: WHO appeals for international community support; warns of grave health risks to Rohingya refugees in rainy season
Dhaka, 29 March 2018 – With a grossly underfunded health sector grappling to meet the needs of 1.3 million Rohingyas in Bangladesh’s Cox’s Bazar, the World Health Organization has appealed to the international community to contribute generously to enable appropriate and timely health services to this highly vulnerable population, now facing grave risks to their lives and health in view of the coming rainy season…

:: Two years since world’s largest outbreak of acute watery diarrhoea and cholera, Yemen witnessing another sharp increase in reported cases with number of deaths continuing to increase
Muscat/Amman/Cairo, 26 March 2019 – “In Yemen, since the beginning of the year until 17 March, nearly 109 000 cases of severe acute watery diarrhoea and suspected cholera were reported with 190 total associated deaths since January. Nearly one third of the reported cases are children under the age of 5. This comes 2 years since Yemen witnessed the world’s largest outbreak when more than 1 million cases were reported.
“We fear that the number of suspected cholera cases will continue to increase with the early arrival of the rainy season and as basic services, including lifesaving water systems and networks, have collapsed. The situation is exacerbated by the poor status of sewage disposal systems, the use of contaminated water for agriculture, unreliable electricity to store food and    the displacement of families as they flee escalating violence, especially in Hudaydah and Tai’z.
“Our teams in Yemen are working day and night with a wide network of local partners to respond and stop the further spread and transmission of disease. Focusing on 147 priority districts, additional health, water, hygiene and sanitation supplies are being mobilized. Rapid response teams have been deployed. A total of 413 diarrhoea treatment centres and oral rehydration centres are operational in all 147 priority districts. Partners are repairing water and sanitation systems. In the past weeks, we scaled up chlorination activities to disinfect water in 95 priority districts and provided fuel and spare parts to keep going water supply and sanitation networks. A round of oral cholera vaccine campaign reached over 400 000 people in several districts. Meanwhile, community-based awareness-raising efforts reached 600 000 people in house-to-house campaigns since early 2019 to provide families with information on hygiene practices and improve the reporting of symptoms and seeking of treatment…

Bangladesh – Rohingya crisis – No new digest announcements identified  
Nigeria – No new digest announcements identified  
Somalia – No new digest announcements identified


 WHO Grade 2 Emergencies  [to 30 Mar 2019]
occupied Palestinian territory 
:: WHO strongly condemns killing of health worker in the West Bank, March 2019
The World Health Organization (WHO) strongly condemns the killing of Sajed Mazher, a first responder working with the Palestinian Medical Relief Society in the West Bank, occupied Palestinian territory…

Brazil (in Portugese) – No new digest announcements identified
Cameroon  – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
Hurricane Irma and Maria in the Caribbean – No new digest announcements identified
Iraq – No new digest announcements identified  
Libya – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified


WHO Grade 1 Emergencies  [to 30 Mar 2019]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut


WHO AFRO – Outbreaks and Emergencies Bulletin – Week 12/2019
Week 12: 18- 24 March 2019
The WHO Health Emergencies Programme is currently monitoring 65 events in the region. This week’s edition covers key new and ongoing events, including:
:: Cyclone in Mozambique and Zimbabwe
:: Ebola virus disease in Democratic Republic of the Congo
:: Humanitarian crisis in Mali
:: Humanitarian crisis in Central African Republic 



UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Yemen Humanitarian Update Covering 7 – 21 March 2019 | Issue …

Syrian Arab Republic   – No new digest announcements identified


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: Ethiopia Humanitarian Bulletin Issue #5 | 4-17 March 2019

Somalia  – No new digest announcements identified

WHO Regional Offices

WHO & Regional Offices [to 30 Mar 2019]

27 March 2019 | News Release
Diseases cost African region $2.4 trillion per year
WHO launches an investment case to achieve SDGs and universal health coverage in Africa 
Praia, Cabo Verde, 27 March 2019 – The World Health Organization (WHO) estimates that nearly 630 million years of healthy life were lost in 2015 due to the diseases afflicting the population across its 47 Member States in Africa, now amounting to a loss of more than 2.4 trillion international dollars ($) from the region’s gross domestic product value annually.
Noncommunicable diseases have overtaken infectious diseases as the largest drain on productivity, accounting for 37 per cent of the disease burden. Other culprits for lost healthy years are communicable and parasitic diseases; maternal, neonatal and nutrition-related conditions; and injuries.
Around 47%, or $ 796 billion, of this lost productivity value could be avoided in 2030 if the Sustainable Development Goals related to these health conditions are achieved, WHO found.
“Four years into the implementation of countries’ efforts towards achieving UHC, current average expenditure on health in the Region falls short of this expectation,” the WHO Regional Director for Africa, Dr Matshidiso Moeti, writes in the foreword to A Heavy Burden: The Productivity Cost of Illness in Africa, which was launched during the second WHO Africa Health Forum this week in Cabo Verde.
As a target of Sustainable Development Goal 3, universal health coverage would require countries in the WHO African Region to spend, on average, at least $ 271 per capita per year on health, or 7.5% of the region’s gross domestic product…

26 March 2019 | News Release
Yemen witnessing sharp increase in reported cases of acute watery diarrhoea and cholera

22 March 2019   Statement
WHO reaffirms commitment to Democratic Republic of the Congo as Ebola outbreak nears 1000 cases amid increased violence

WHO calls on international community to join urgent push to end outbreak

[See Ebola above for detail]


Weekly Epidemiological Record, 29 March 2019, vol. 94, 13 (pp. 161–168)
:: Retrospective detection of Zika virus transmission in Paraguay – January to December 2016
:: Addendum to the Recommended composition of influenza virus vaccines for use in the 2019–2020 northern hemisphere influenza season

WHO Regional Offices
Selected Press Releases, Announcements

WHO African Region AFRO
:: In Madagascar, mothers show grit to protect their children as government, partners battle measles epidemic  29 March 2019
:: Diseases cost the African Region $2.4 trillion a year, says WHO  27 March 2019
:: WHO Mobilizes Urban-based Congolese Refugees in Uganda for Ebola action  26 March 2019
:: WHO reaffirms commitment to Democratic Republic of the Congo as Ebola outbreak nears 1000 cases amid increased violence  24 March 2019
WHO Region of the Americas PAHO
– No new digest announcements identified.
WHO South-East Asia Region SEARO
:: Marking five years of polio-free certification, WHO South-East Asia Region uses polio legacy to enhance overall immunization   SEAR/PR/1708
New Delhi, 27 March 2019: On this day in 2014, WHO South-East Asia Region was certified polio-free, proving wrong many public health experts who believed that the Region, which accounts for one-fourth of the global population, would be the last bastion for polio eradication. Five years on, the Region not only continues to maintain its polio-free status but is demonstrating how the polio legacy can effectively strengthen overall immunization and other programs…
WHO European Region EURO
:: Improving TB patient care in the Russian Federation with video-observed treatment 28-03-2019
WHO Eastern Mediterranean Region EMRO
:: WHO strongly condemns killing of health worker in the West Bank  27 March 2019
:: Yemen witnessing sharp increase in reported cases of acute watery diarrhoea and cholera
27 March 2019
:: Improving health outcomes for people with TB in Syria  27 March 2019
:: Polio immunization campaign in Somalia aims to leave no child under 5 behind  26 March 2019
:: WHO to release Arabic version of package on health system response to violence against women and girls
27 March 2019 ‒ As part of its effort to address violence against women and girls, the WHO Regional Office for the Eastern Mediterranean is launching an Arabic version of the WHO package on health system response to violence against women and girls. In releasing this evidence-based guidance, WHO seeks to ensure that preventing and responding to violence against women and…

WHO Western Pacific Region
:: Immunization gaps threaten gains on measles
29 March 2019   News Release  Manila, Philippines
Measles outbreaks in the World Health Organization (WHO) Western Pacific Region are putting babies, children and young people at risk and threatening progress towards wiping out the disease.
The Region had historically low levels of measles cases and no major outbreaks in 2017. This landmark decline was achieved through steady efforts to vaccinate all children against measles, but last year, measles cases in the Region increased by 250%, and more than two-thirds of cases were in the Philippines. So far this year, the Philippines has reported 23 000 cases with 333 deaths — already more than all of last year. Tragically, most of the cases were among children under 5 years old.
Measles can cause debilitating complications, including encephalitis, severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.
“In recent months, we’ve seen how swiftly and easily measles can make a comeback in communities where not enough children have been immunized,” said WHO Regional Director for the Western Pacific Takeshi Kasai…