Vaccines and Global Health: The Week in Review :: 20 April 2019

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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

UNICEF launches #VaccinesWork campaign to inspire support for vaccines

Milestones :: Perspectives :: Research

UNICEF launches #VaccinesWork campaign to inspire support for vaccines
Amid growing outbreaks of vaccine-preventable diseases, UNICEF’s campaign will use social media to show that most parents trust vaccines to protect their children
NEW YORK, 18 April 2019 – UNICEF is launching a new global campaign on 24 April to emphasize the power and safety of vaccines among parents and wider social media users.

The campaign will run alongside World Immunization Week from 24 to 30 April to spread the message that together communities, including parents, can protect everyone through vaccines.

#VaccinesWork has long been used to bring together immunization advocates online. This year, UNICEF is partnering with the Bill & Melinda Gates Foundation, the World Health Organization (WHO), and Gavi, the Vaccine Alliance to encourage even greater reach. The Bill & Melinda Gates Foundation will contribute USD$ 1 to UNICEF for every like or share of social media posts using the hashtag #VaccinesWork in April, up to USD$1 million, to ensure all children get the life-saving vaccines they need…

… “We want the awareness that #VaccinesWork to go viral,” said Robin Nandy, UNICEF’s Chief of Immunization. “Vaccines are safe, and they save lives. This campaign is an opportunity to show the world that social media can be a powerful force for change and provide parents with trustworthy information on vaccines.”

The campaign is part of a global, week-long celebration under the theme, Protected Together: Vaccines Work, to honour Vaccine Heroes – from parents and community members to health workers and innovators.

“More children than ever before are being reached with vaccines today,” said Violaine Mitchell, Interim Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. “We are delighted to work with UNICEF and all the global and country partners around the world who are working tirelessly to ensure all children, especially those in the world’s poorest countries, can be protected from life-threatening infectious diseases.”

Despite the benefits of vaccines, an estimated 1.5 million children died of vaccine-preventable diseases in 2017. While this is often due to lack of access to vaccines, in some countries, families are delaying or refusing to vaccinate their children because of complacency or skepticism about vaccines. This has resulted in several outbreaks, including an alarming surge in measles, especially in higher-income countries. Uncertainty about vaccines on digital and social media platforms is one of the factors driving this trend.

That is why the centerpiece of this UNICEF campaign is a 60-second animated film, “Dangers,” which, along with illustrated animations for social media posts and posters, is based on the relatable insight that kids, by their very nature, are little daredevils who are constantly putting themselves in danger. Available in Arabic, Chinese, French, Hindi, Russian, Spanish and Tagalog, the video explains that while parents can’t prevent all the dangers their kids get themselves into, they can use vaccination to help prevent the dangers that get into their kids.

In addition, UNICEF experts will be answering questions about vaccination, including how vaccines work, how they are tested, why children should receive vaccines, as well as the risks of not vaccinating children in a timely manner.


Milestones :: Perspectives :: Research



New measles surveillance data for 2019 – WHO
15 April 2019, GENEVA – Measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.

While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.

Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the United States of America as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people…



New England Journal of Medicine
April 18, 2019   Vol. 380 No. 16
Measles in 2019 — Going Backward
Catharine I. Paules, M.D., Hilary D. Marston, M.D., M.P.H., and Anthony S. Fauci, M.D.

In 2000, the United States achieved a historic public health goal: the elimination of measles, defined by the absence of sustained transmission of the virus for more than 12 months. This achievement resulted from a concerted effort by health care practitioners and families alike, working to protect the population through widespread immunization. Unfortunately, that momentous achievement was short-lived, and localized measles outbreaks have recently been triggered by travel-related introductions of the virus by infected persons, with subsequent spread through under-vaccinated subpopulations. According to the Centers for Disease Control and Prevention, 555 cases of measles in 20 states had already been confirmed from January 1 through April 11, 2019 (see graph). The increase in measles cases in the United States mirrors patterns elsewhere: several other countries that had eliminated measles are now seeing resurgences.

Measles is a highly contagious cause of febrile illness typically seen in young children.1 It is transmitted primarily by means of respiratory droplets and small-particle aerosols and can remain viable in the air for up to 2 hours. Exposed people who are not immune have up to a 90% chance of contracting the disease, and each person with measles may go on to infect 9 to 18 others in a susceptible population.2

Most people with measles recover uneventfully after approximately 1 week of illness characterized by fever, malaise, coryza, conjunctivitis, cough, and a maculopapular rash. However, measles is by no means a trivial disease; before widespread vaccination, the virus caused 2 million to 3 million deaths globally per year.1 Even today, it remains a leading cause of vaccine-preventable illness and death worldwide, claiming more than 100,000 lives each

year.2 Common complications include secondary infections related to measles-induced immunosuppression, diarrhea, keratoconjunctivitis (which may lead to blindness, particularly in vitamin A–deficient populations), otitis media, and pneumonia (the leading cause of measles-related deaths). In approximately 1 in 1000 cases of measles, serious and often fatal neurologic complications such as acute disseminated encephalomyelitis and measles inclusion-body encephalitis occur, and most patients who survive these complications have long-term neurologic sequelae. In addition, a rare neurologic complication (affecting approximately 1 in 10,000 patients) called subacute sclerosing panencephalitis (SSPE) can occur years after measles virus infection, with a severe, progressive, and fatal course.

If the potential danger posed by measles is clear, so is the solution. Live-attenuated measles vaccines are among the most highly effective vaccines available (providing 97% protection with two doses, given at 12 to 15 months and 4 to 6 years of age), with a proven safety record.1 The most common side effects of the measles vaccine are a sore arm and fever. A small proportion of vaccinees (about 5%) will develop a rash; an even smaller proportion will have a febrile seizure or transient decrease in platelet counts. A very rare complication, meningoencephalitis, has been described, almost always in immunocompromised vaccinees.

Measles vaccination has prevented an estimated 21 million deaths worldwide since 2000.3

Despite these substantial gains, global elimination goals have not been met, and previous strides are now being threatened by a 31% increase in the number of measles cases reported globally between 2016 and 2017.3 The growing number of travel-related infections and local outbreaks in the United States reflects this alarming trend, yet the U.S. situation is dwarfed by outbreaks elsewhere in the world. For example, the World Health Organization (WHO) reported 117,075 measles cases and 1205 deaths in Madagascar between early October 2018 and early April 2019. Venezuela is also experiencing a large-scale epidemic, with endemic measles transmission now reestablished in a country where it had previously been eliminated.3 In Europe, the number of reported cases in 2018 was triple that in 2017 and 15 times that in 2016.4 In addition, it is likely that endemic measles has now been reestablished in several European countries where transmission had previously been interrupted.3

The resurgence in measles cases is all the more frustrating since the disease is entirely preventable through vaccination. Measles has all the components of an eradicable disease: there is a safe and highly effective vaccine, it has a readily diagnosable clinical syndrome, and it has no animal reservoir to maintain circulation.1 But because of the highly contagious nature of the virus, near-perfect vaccination coverage (herd immunity of 93 to 95%) is needed to effectively protect against a measles resurgence. Although there are valid reasons why some people might not be vaccinated, such as a medical contraindication due to marked immunosuppression, the failure to vaccinate too often stems from misconceptions about vaccine safety, especially those resulting from a now-debunked claim that posited a connection between the vaccine and autism. The growing antivaccination movement, based heavily on philosophical objections to vaccinations, poses a threat to public health. Vaccine hesitancy has been identified by the WHO as one of the top 10 threats to global health and is a serious hurdle to the global elimination and eradication of measles.

If we continue to lose ground on measles prevention through vaccination, we face the reemergence of measles into new populations, which will pose new and varied challenges. Historically, measles has been a disease of children, with severe disease seen primarily in children younger than 5 and those with poor nutritional status, particularly if they have vitamin A deficiency. The successful implementation of measles vaccination programs is changing the epidemiology of measles from seasonal epidemics in young children to sporadic cases in older children and adults, including pregnant women. Data assessing the effects of measles infection in these latter populations are sparse but are suggestive of increased morbidity and mortality.2

The greatest risk of measles-related complications occurs in immunosuppressed people. This population may have atypical presentations with severe complications that have not been documented in immunocompetent patients, such as giant-cell pneumonia and measles inclusion-body encephalitis. Exposure to measles in people with HIV infection has led to serious complications and even death. Higher rates of measles complications and deaths have also been reported in patients with cancer, patients with solid organ transplants, people receiving high-dose glucocorticoids, and those receiving immunomodulatory therapy for rheumatologic disease. People with profound immunosuppression cannot be safely vaccinated with the live-attenuated vaccine and must rely on herd immunity to protect them from measles infection.

Exposure to measles in the community certainly represents a danger to high-risk persons during a local outbreak; however, nosocomial transmission may pose an even greater threat and has been reported throughout the world. For example, during a measles outbreak in Shanghai in 2015, a single child with measles in a pediatric oncology clinic infected 23 other children, more than 50% of whom ended up with severe complications, and the case fatality rate was 21%.5 When the umbrella of herd immunity is compromised, such populations are highly vulnerable.

Unlike many infectious diseases, measles is a public health problem with a clear scientific solution. Measles vaccination is highly effective and safe. Each complication or death related to measles is a preventable tragedy that could have been avoided through vaccination. The recent upsurge in U.S. measles cases, including the worrisome number seen thus far in 2019, represents an alarming step backward. If this trend is not reversed, measles may rebound in full force in both the United States and other countries and regions where it had been eliminated. Promoting measles vaccination is a societal responsibility, with the ultimate goal of global elimination and eradication — relegating measles to the history books

DRC – Ebola

Milestones :: Perspectives :: Research

DRC – Ebola


37: Situation report on the Ebola outbreak in North Kivu
16 April 2019
…Implementation of ring vaccination protocol
:: As of 16 April 2019, 101,195 contacts and contacts of contacts have been vaccinated. Of those 26,613 were contacts and 74,367 contacts of contacts. The vaccinated people at risk included 29,688 HCWs/FLWs, and 26,361 children 1-6 years old. Detailed micro-plans are also in use to monitor the progress and number of cases with and without rings. Table 2 provides an overview of the status as of 15 April 2019.

:: Between 2-4 April 2019, Strategic Advisory Group of Experts (SAGE) convened a meeting to review epidemiological data from North Kivu for children below 1 year of age and for lactating women. Although clinical data on the safety and efficacy of the rVSV-ZEBOV-GP Ebola vaccine for these two specific groups are absent, SAGE considers that the high attack rates and high case fatality ratios for these groups, together with the accumulating data on vaccine safety and efficacy for other groups, justify inclusion of children who are above the age of 6 months and of lactating women in the ongoing ring vaccination efforts in North Kivu. SAGE strongly urged the implementation of studies to evaluate additional Ebola candidate vaccines, including where possible in pregnant and lactating women and in infants. (Please see here for a summary of the SAGE meeting highlights)

:: On 12 April 2019, INRB and WHO published a preliminary analysis of the efficacy of RVSV-ZEBOV-GP emerging from the DRC outbreak data (Please see here for preliminary analysis). The data suggest high efficacy of this candidate vaccine and of the ring vaccination in this outbreak.

:: There are currently 23 vaccination teams comprised of 276 Congolese vaccinators with basic GCP training, 50 Congolese with formal GCP training, and 43 experienced Guinean/African GCP researchers.

:: There is continuation of ring vaccination in Beni, Katwa, Butembo, Mandima, Bunia, Vuhovi, and Lubero health zones around confirmed cases, as well as front-line providers in Goma.

:: Current vaccination strategies being employed on the ground include site by site vaccination, simultaneous vaccination of contacts and their contacts in the community, healthcare worker vaccination, and targeted geographic vaccination of areas where contacts of contacts cannot be clearly identified due to insecurity…

Disease Outbreak News (DONs)
Ebola virus disease – Democratic Republic of the Congo
11 April 2019
The rise in number of Ebola virus disease (EVD) cases observed in the North Kivu provinces of the Democratic Republic of the Congo continues this week. During the last 21 days (20 March to 9 April 2019), 57 health areas within 11 health zones reported new cases…

…WHO and partners in Risk Communication and Community Engagement are continuing with activities to build and maintain a trusting relationship between communities and the Ebola response teams. Dialogues with community committees are ongoing in the hotspot areas of Butembo, Katwa, and Vuhovi, and form a key part of a larger increase ownership of the Ebola response by the communities. Information about community disquiet are systematically collected and monitored to ensure that any misunderstanding leading to reluctance, refusal, or resistance of the Ebola response is followed up with and resolved as quickly as possible. This has been made possible by feedback from the community members, received through ongoing dialogue and various research activities within both the Democratic Republic of the Congo, and neighbouring areas.

In an effort to address the feedback received and specific concerns over the outbreak response, guided visits of the Ebola Treatment Centres (ETCs) in various affected areas have been organized. Students and community associations who attended these guided visits to the ETCs can see first-hand how EVD patients are treated and help stop the potential dissemination of misinformation surrounding EVD and the ongoing response efforts…





Public Health Emergency of International Concern (PHEIC)
Polio this week as of 17 April 2019
:: Co-chairs of Immunization Management Group (IMG) announced that the global goal set out in 2013 of 126-OPV using countries to introduce 1 dose of IPV in their immunization programme has been achieved.
:: Eminent Islamic religious scholars from Afghanistan and Pakistan came together in Muscat, Oman for the first ever joint Ulama Conference, under the aegis of the Islamic Advisory Group (IAG). for polio eradication The IAG convened religious scholars in a bid to appreciate their value as community leaders and secure bilateral support for polio eradication efforts across the joint poliovirus transmission corridors. At the end of the two-day conference, the scholars issued a joint declaration in support of the polio efforts. Watch the Opening Session here. Read the declaration here.
:: In keeping with the recommendations of the Emergency Committee under the International Health Regulations (IHR), Afghanistan and Pakistan have introduced an all-age polio vaccination for travelers crossing international borders to increase general population immunity the common wild poliovirus transmission corridor. Read more.

Summary of new viruses this week:
:: Afghanistan—three wild poliovirus type 1 (WPV1)-positive environmental samples;
:: Pakistan—three WPV1-positive environmental samples;
:: Nigeria—one circulating vaccine-derived type 2 (cVDPV2) case and seven cVDPV2-positive environmental samples.


Joining hands across the border
All travellers crossing the border between Pakistan and Afghanistan are vaccinated against polio, regardless of age
GPEI  16/04/2019
On both sides of the historical 2640-kilometre-long border between Pakistan and Afghanistan, communities maintain close familial ties with each other. The constant year-round cross border movement makes for easy wild poliovirus transmission in the common epidemiological block.

As a new tactic in their joint efforts to defeat poliovirus circulation, Afghanistan and Pakistan have introduced all-age polio vaccination for travellers crossing the international borders in efforts to increase general population immunity against polio and to help stop the cross-border transmission of poliovirus. The official inauguration of the all-age vaccination effort took place on 25 March 2019 at the border crossings in Friendship Gate (Chaman-Spin Boldak) in the south, and in Torkham in the north…

…It is estimated that the Friendship Gate border alone receives a daily foot traffic of 30 000. Travellers include women and men of all ages, from children to the elderly.

Pakistan and Afghanistan first increased the age for polio vaccination at the border in January 2016, from children under five years to those up to 10 years old. The decision was in line with the recommendations of the Emergency Committee under the International Health Regulations (IHR) which declared the global spread of polio a “public health emergency of international concern”,

The all-age vaccination against polio at the border crossings serves a practical implementation of another recommendation of the IHR Committee: that Pakistan and Afghanistan should “further intensify cross­border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations.

…As part of the newly introduced all-age vaccination, all people above 10 years of age who are given OPV at the border are issued a special card as proof of vaccination. The card remains valid for one year and exempts regular crossers from receiving the vaccination again. Children under 10 years of age will be vaccinated each time they cross the border.

Before all-age vaccination began at Friendship Gate and Torkham, public officials held extensive communication outreach both sides of the border to publicize the expansion of vaccination activities from children under 10 to all ages. Radio messages were played in regional languages, and community engagement sessions sensitized people who regularly travel across the border. Banners and posters were displayed at prominent locations….



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 20 Apr 2019]
Bangladesh – Rohingya crisis
:: Bi‐weekly Situation Report 7 – 11 April 2019

:: Ten new diphtheria cases were reported in week 14, (1 confirmed, 9 suspected), bringing the total number of reported case-patients to 8 545.
:: To gain an understanding of how women and men perceive immunization in camps, WHO organized two focus group discussions.
:: Water Quality Surveillance round 10 has been started in all refugee areas.

Varicella Update
A total of 2161 varicella cases were reported this week via weekly report form (2783 cases in week 13).
Risk Communication
WHO organized, two separate focus group discussions (FGDs), one for only women of all ages, and another of only men of all ages, held at the Camp 14 in Ukhiya of the Cox’s Bazar district. This was to gain an understanding of how women and men perceive immunization in the camps. The questions were kept open-ended to understand perception and attitude related to importance of Immunization, importance of Immunization schedule and compliance, gaps in communication with respect to immunization. Observations from these FGDs revealed that everyone in both the groups had heard about necessity of immunization but did not have clear reasons to believe or act. People opted for it because it is a free service and they trust health workers. Absence of knowledge about relevance of complying with the immunization schedule and dangers of missing out on any vaccine was identified.

Cyclone Idai
:: Cyclone-affected communities in Zimbabwe being vaccinated against cholera
Campaign targets nearly 500,000 people in Chimanimani and Chipinge
HARARE, Zimbabwe, 16 April 2019 – An oral cholera vaccine (OCV) campaign targeting some 487,825 people began Tuesday in Zimbabwe in the two districts most affected by cyclone Idai.
During the campaign all residents of Chimanimani and Chipinge districts aged 12 months and older will receive the vaccine to protect them against cholera.
While there have been no reported cases of cholera in the cyclone-affected areas in Zimbabwe, the Zimbabwe Ministry of Health and Child Care is launching the campaign, with support from UNICEF and the World Health Organization (WHO), as a proactive, preventative measure.
Funded by Gavi, the Vaccine Alliance, more than 975 000 OCV doses will be administered in two rounds for full immunity. The second dose will be given approximately two weeks after the first…

Democratic Republic of the Congo
:: 37: Situation report on the Ebola outbreak in North Kivu  16 April 2019
:: Disease Outbreak News (DONs)Ebola virus disease – Democratic Republic of the Congo
11 April 2019
[See Ebola above for detail]

Myanmar  – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen  – No new digest announcements identified

WHO Grade 2 Emergencies  [to 20 Apr 2019]
Brazil (in Portugese)
:: Últimas notícias – Cerca de 70 milhões de pessoas serão vacinadas durante a Semana de Vacinação nas Américas  18 de abril de 2019

Cameroon  – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
occupied Palestinian territory  – No new digest announcements identified
Sudan – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified


WHO Grade 1 Emergencies  [to 20 Apr 2019]
Afghanistan – No new digest announcements identified
Chad  – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018  – No new digest announcements identified
Kenya   – No new digest announcements identified
Lao People’s Democratic Republic  – No new digest announcements identified
Mali  – No new digest announcements identified
Namibia – viral hepatitis  – No new digest announcements identified
Peru  – No new digest announcements identified
Philippines – Tyhpoon Mangkhut  – No new digest announcements identified
Tanzania  – No new digest announcements identified


UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic  
:: Syria: Humanitarian Response in Al Hol camp, Situation report No. 2
Yemen – 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.
:: 20 April 2019   Mozambique: Cyclone Idai & Floods Situation Report No. 16 (A …
:: 18 April 2019   Zimbabwe: Floods Situation Report No. 3, As of 17 April 2019

WHO & Regional Offices [to 20 Apr 2019]

WHO & Regional Offices [to 20 Apr 2019]

17 April 2019   News release
WHO releases first guideline on digital health interventions
WHO today released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services.
“Harnessing the power of digital technologies is essential for achieving universal health coverage,” says WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.”
Over the past two years, WHO systematically reviewed evidence on digital technologies and consulted with experts from around the world to produce recommendations on some key ways such tools may be used for maximum impact on health systems and people’s health…

13 April 2019   News release
At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices
At a global forum on fair pricing and access to medicines, delegates from governments and civil society organizations called for greater transparency around the cost of research and development as well as production of medicines, to allow buyers to negotiate more affordable prices.

The forum, co-hosted by the World Health Organization (WHO) and the Government of South Africa, aimed to provide a global platform for frank discussion among all stakeholders – including governments, civil society organizations and the pharmaceutical industry – in order to identify strategies to reduce medicine prices and expand access for all.

The affordability of medicines has long been a concern for developing countries, but today it is also a global one. Each year, 100 million people fall into poverty because they have to pay for medicines out-of-pocket. High-income countries’ health authorities are increasingly having to ration medicines for cancer, hepatitis C and rare diseases. The problem extends to older medicines whose patents have expired, such as insulin for diabetes.

“Medical innovation has little social value if most people cannot access its benefits,” said Dr Mariângela Simão, WHO Assistant Director General for Medicines and Health Products.  “This is a global human rights issue – everyone has a right to access quality healthcare.”

report commissioned by WHO in 2017 showed that the cost of production of most medicines on WHO’s Essential Medicines List was a small fraction of the final price paid by governments, patients or insurance schemes. Some delegates at the forum noted that a lack of transparency around prices paid by governments means that many low- and middle-income countries pay higher prices for certain medicines than wealthier countries do.

There was consensus that countries can take an initial step towards fostering greater transparency by sharing price information. Countries from the so-called Beneluxa network have already joined forces to share such information, and the results have been promising. The data highlights discrepancies in what different countries are paying and can serve as a powerful tool to negotiate reduced prices. WHO’s database on vaccine markets and shortages – MI4A – was also highlighted at the forum as a useful tool to achieve competitive vaccine prices.

The event highlighted other successful examples of countries’ collaboration around achieving more affordable medicine prices; these include pooled procurement and voluntary sharing of policies. If several countries in the same region purchase medicines as a block, they can negotiate reduced prices due to the larger volume of medicines purchased.  And European countries led by Austria have been sharing different policies to expand access to medicines through the WHO-supported PPRI (Pharmaceutical Pricing and Reimbursement Policies).

Industry bodies at the forum expressed support for the goal of access to medicines for all, and expressed their commitment to the Sustainable Development Agenda, which calls for partnership with the private sector to address global challenges such as access to medicines.

WHO will launch a public online consultation in the coming weeks to collect views and suggestions for a definition of what actually constitutes a ‘fair price’ from relevant stakeholders.


Weekly Epidemiological Record, 19 April 2019, vol. 94, 16 (pp. 189–196)
:: Joint External Evaluation of the International Health Regulations (2005): common priority actions for improvement in the Eastern Mediterranean Region


WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO Africa mourns the loss of a colleague killed in a hospital attack in the Democratic Republic of the Congo  19 April 2019
:: Cyclone-affected communities in Zimbabwe being vaccinated against cholera: Campaign targets nearly 500,000 people in Chimanimani and Chipinge  17 April 2019
:: WHO and partners successfully vaccinate over 400,000 children against Measles in Borno State -Target 838,582 children more.  12 April 2019

WHO Region of the Americas PAHO
:: Colombia, an example to follow in the effort of ensuring ‘health for all” (04/19/2019)
:: Director General of WHO recognizes Colombia’s solidarity in ensuring the health of migrants (04/19/2019)
:: Nearly 70 million people to be vaccinated during Vaccination Week of the Americas (04/18/2019)


WHO South-East Asia Region SEARO
No new digest content identified.


WHO European Region EURO
:: Celebrating universal health coverage across the WHO European Region 17-04-2019


WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.


CDC/ACIP [to 20 Apr 2019]

CDC/ACIP [to 20 Apr 2019]


MMWR News Synopsis for Friday, April 19, 2019
Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women — United States, 2008 and 2016
This first estimate of U.S. cervical precancers using population-based data, including the decline in detection of precancers in women under 30 years old, is important in understanding precancer trends across all age groups and helps explain the impact of changing cervical cancer prevention strategies, including HPV vaccination and cervical cancer screening guidelines. We report the first estimate of the number of high-grade cervical precancers (CIN2+ cases) in the United States using population-based data. In 2008, before vaccine impact, an estimated 216,000 women were diagnosed with CIN2+, and 10 years after vaccine introduction, an estimated 196,000. In 2008, 55% of cervical precancers were detected in women less than 30 years of age; in 2016, only 36% of cervical precancers were diagnosed in this age group. This decline reflects both the impact of the U.S. HPV vaccination program and changes in cervical cancer screening recommendations between 2008 and 2016. Some of the changes include initiating cervical cancer screening at an older age, incorporating HPV testing as part of screening, and having longer intervals between screenings. Overall, an estimated 76% of cervical precancers were attributable to HPV vaccine types.

Outbreak of Human Immunodeficiency Virus Infection Among Heterosexual Persons Who Inject Drugs and Are Living Homeless — Seattle, Washington, 2018
Vulnerability to outbreaks of HIV infection among people who inject drugs is widespread throughout the U.S. and control of these outbreaks requires sustained vigilance and rapid public health responses. Public health officials in King County, WA, identified a cluster of 14 cases of HIV infection diagnosed between February and November 2018 among homeless heterosexuals, most of whom were injecting drugs. This cluster was part of a larger, almost 300% increase in new HIV diagnoses among heterosexuals who injected drugs in King County between 2017 and 2018. That this outbreak occurred in King County, the first urban area in the U.S. to achieve World Health Organization goals for HIV diagnosis and treatment and despite the presence of a syringe exchange program that distributed over 7 million syringes in 2018, highlights the fact that vulnerability to outbreaks of HIV among people who inject drugs is widespread.