Vaccines and Global Health: The Week in Review :: 25 May 2019

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

United Nations strengthens Ebola response in Democratic Republic of the Congo

Milestones :: Perspectives :: Research

 

DRC – Ebola

United Nations strengthens Ebola response in Democratic Republic of the Congo
Statement – Kinshasa/Butembo
23 May 2019
With the Ebola epidemic in the Democratic Republic of the Congo now in its tenth month and the number of new cases increasing in recent weeks, the United Nations announced today measures to strengthen its response and end the outbreak.

The Ebola epidemic has claimed more than 1,200 lives and the risk of spread to other provinces in the eastern Congo as well as neighbouring countries remains very high. A third of those who have fallen ill are children, which is a higher proportion than in previous outbreaks.

Under the leadership of the Government and Congolese communities, with support from the UN and non-governmental organizations (NGOs), the response has contained Ebola in parts of Ituri and North Kivu provinces. But ongoing insecurity and community mistrust in the response continue to hamper access to communities. This is hindering efforts by WHO and the Ministry of Health to detect sick people and ensure access to treatment and vaccination, ultimately leading to more intense Ebola transmission.

In view of the increasingly complex environment, the UN in partnership with the Government and all partners is now strengthening its political engagement and operational support to negotiate access to communities; increasing support for humanitarian coordination; and bolstering preparedness and readiness planning for Goma and surrounding countries. WHO is adapting public health strategies to identify and treat people as quickly as possible; expanding vaccination to reach and protect more people; and redoubling work to end transmission in health facilities.

 

The UN Secretary-General has established a strengthened coordination and support mechanism in the epicenter of the outbreak, Butembo.

MONUSCO Deputy UN Special Representative of the Secretary-General (DSRSG) David Gressly has been appointed UN Emergency Ebola Response Coordinator (EERC) in the Ebola affected areas of the DRC. Mr. Gressly, who brings a wealth of humanitarian leadership and political and security experience to the role, will report to the SRSG, Leila Zerrougui. He will oversee the coordination of international support for the Ebola response and work to ensure that an enabling environment—particularly security and political—is in place to allow the Ebola response to be even more effective.

Mr. Gressly will work closely with WHO, which will continue to lead all health operations and technical support activities to the Government response to the epidemic. Dr. Ibrahima Socé Fall, Assistant Director-General, Emergency Response, who has been in Butembo since end-March, is leading the WHO response in DRC. WHO will also continue to coordinate public health interventions that are being implemented by other UN partners.

“The Ebola response is working in an operating environment of unprecedented complexity for a public health emergency—insecurity and political protests have led to periodic disruptions in our efforts to fight the disease. Therefore, an enhanced UN-wide response is required to overcome these operating constraints and this includes moving senior leadership and operational decision making to the epicenter of the epidemic in Butembo. We have no time to lose,” said DSRSG Gressly.

WHO’s Dr. Fall said: “This system-wide and international support is exactly what WHO has been calling for. We know that the outbreak response must be owned by the local population, and this new approach reflects what they have asked for: better security for patients and health workers, wider access to vaccination, and a more humane face to the response.” Dr. Fall has been working alongside Dr. Michel Yao, the WHO Ebola Incident Manager who has been in place since August 2018.  In Kinshasa, WHO has also appointed a special representative to the Ebola Response, Dr. Peter Graaff, to coordinate with partners there.

Additional UN measures will bolster the critical work of non-governmental organizations (NGOs) and agencies already on the ground, including UNICEF. Working with NGOs, UNICEF leads community engagement activities; provides psychosocial interventions; and helps prevent infection through water, sanitation and hygiene services.
Financial planning and reporting will also be strengthened and efforts will be accelerated to ensure sustainable and predictable funding required for the Ebola strategic response plan considering the ongoing needs.
Initiative,

U.N. grants sanctions exemption for UNICEF’s aid projects in N. Korea

Milestones :: Perspectives :: Research

 

U.N. grants sanctions exemption for UNICEF’s aid projects in N. Korea
Yonhap News Agency
SEOUL, May 21 (Yonhap) — The U.N. Security Council has granted a sanctions exemption to allow the U.N. Children’s Fund (UNICEF) to carry out aid programs in North Korea to improve the health and nutrition of people in the impoverished country, according to the U.N. website.
The exemption, granted on April 11, paves the way for UNICEF to import items to deliver safe water supplies to communities and enable effective treatment at hospitals, especially for malnourished children and mothers.

The approved items worth some US$5.75 million in total include emergency health kits, wheelchairs and electronic devices, a document on the website showed.

 

The most expensive set of materials was vaccine cold chain equipment from Denmark worth $3.87 million. UNICEF said the items will be used to store vaccines for around 355,000 children under 1 year of age and 362,000 pregnant women.

UNICEF said its staff will conduct regular monitoring to ensure the goods are used for their intended purposes.

Including the latest approval, the total number of humanitarian exemptions related to North Korea currently in effect stands at 22. The exemptions are valid for six months.

Humanitarian activities are not banned under international sanctions, but related materials are subject to sanctions waivers from the U.N.

Infecting People Isn’t a Religious Right

Milestones :: Perspectives :: Research

 

Featured Media Content

 

New York Times
Opinion
Infecting People Isn’t a Religious Right
The measles outbreak makes it vital for New York lawmakers to end religious exemptions for vaccinations.
The Editorial Board – May 21, 2019
It’s no coincidence that measles is spreading across the United States after a decade in which the number of parents claiming exemption for their children from vaccination has grown. The outbreak has been most intense in New York, particularly in deeply insular ultra-Orthodox Jewish communities in Brooklyn and upstate that have been vulnerable to misinformation and resistant to vaccination.

To halt the spread of the disease, bills in the State Senate and Assembly would prevent parents from claiming that their religious beliefs exempt them from legal requirements that their children be vaccinated before going to school. The American Academy of Pediatrics has made the elimination of such nonmedical exemptions its top priority this year.

The legislation would allow exemptions only if a licensed doctor certified that the immunization was detrimental to the child’s health, as is the case in current law.

Action on these sensible bills has stalled, however, just weeks before legislators leave for the summer —  even as the latest cases of the highly contagious and sometimes fatal disease were diagnosed in New York last week.

While bills in both chambers are in committee, opposition to the legislation is centered on the Assembly, where a bill before the Health Committee has not received a vote and the chairman, Richard Gottfried, said it would not until a majority of the committee supported it. More disturbingly, Mr. Gottfried said he and other committee members thought the legislation could violate the First Amendment, echoing one of the anti-vaccine movement’s favored talking points — that beliefs about vaccines are protected by the Constitution. Mr. Gottfried said he was still wrestling with where he stood on the issue.

And while Gov. Andrew Cuomo says he opposes religious exemptions for vaccines, last month he hedged that stance, also expressing concern for First Amendment protections.
Religious freedom is important to protect, but the courts have ruled it doesn’t apply here. In upholding a California law that removed religious exemptions, a federal appeals court last year noted an earlier ruling that, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.”
Mr. Gottfried said he was uneasy anyway. “There are probably several issues where views on the Constitution and constitutional values may differ from what the Supreme Court majority thinks,” he said.

It’s not clear what these concerns are even based on. Faith leaders themselves have acknowledged that the grounds for religious opposition to vaccines are shaky, at best. The Orthodox Union and the Rabbinical Council of America have organized a public health campaign to get parents to vaccinate their children.

Legal mandates are one of the best ways to accomplish that goal. They increase the likelihood that vaccine-wary parents will consult legitimate medical professionals who have the capacity to allay their fears. They provide a crucial counter to the factually vacuous anti-vaccine campaign, which is being waged not only on social media platforms like Facebook, but also in statehouses across the country. And, as recent experience shows, they work: When legislators in California and Michigan strengthened their mandates, vaccination rates in those states went up.

New York City has declared a public health emergency around the measles outbreaks in Brooklyn and Queens, even closing several yeshivas — and threatening to close others — that did not comply with mandatory vaccination orders. But children throughout New York State remain vulnerable. State Senator Brad Hoylman, a lead sponsor of the legislation to end the religious exemption, said in a phone interview on Tuesday that he didn’t want to wait for tragedy to act.

Mr. Hoylman is right, and New York’s leaders must not let this legislation continue to languish. The bill could go further — as currently written, it wouldn’t impose any penalties, for instance, on parents who violate the law and send their children to school unvaccinated. Yet, in a state with an urgent public health crisis, this is the best place to begin.

72nd session of the World Health Assembly :: World Health Assembly Update, 24 May 2019 :: Antimicrobial resistance

Featured Media Content

 

Editor’s Note:
The WHA continues through early next week. Below are updates selected for their relevanxce to vaccines/immunization. Next week’s edition will include additional reports on resolutions and other actions.

72nd session of the World Health Assembly
20-28 May 2019, Geneva
Main documents

World Health Assembly Update, 24 May 2019
Pandemic Influenza Preparedness Framework
Further to requests made by the World Health Assembly in 2017 and 2018, today delegates considered the final text of WHO’s analysis of the issues raised by the 2016 PIP Framework Review Group’s recommendations concerning seasonal influenza and genetic sequence data. The Health Assembly also considered the information provided by the Secretariat regarding implementation of the recommendations contained in the Director-General’s report on progress to implement decision WHA70(10).

Delegates adopted a decision to request WHO, inter alia, to work with the Global Influenza Surveillance and Response System (GISRS) and other partners to improve influenza virus sharing, and to prepare a report with Member States and stakeholders on influenza virus sharing and public health in the context of legislation and regulatory measures including those implementing the Nagoya Protocol.

Furthermore, the Health Assembly requested more information on the prototype search engine previously developed and asked WHO to explore possible next steps in raising awareness of the PIP Framework among databases, data users and data providers.

The decision also agreed to amend a footnote relating to SMTA2 (Standard Material Transfer Agreement 2) in the PIP Framework. This will help ensure that the integrity of the PIP Framework access and benefit-sharing system continues to be well maintained.

The PIP Framework is an international normative instrument adopted by the Health Assembly in 2011 that brings together WHO, Member States, industry, and other relevant stakeholders to implement a global approach to pandemic influenza preparedness and response. The objective of the PIP Framework is to ensure a fair, transparent, equitable, efficient and effective system for, on an equal footing, the sharing of influenza viruses with human pandemic potential and access to vaccines and other benefits.

Antimicrobial resistance
23 May 2019 News release Geneva
Member States at the World Health Assembly today agreed a resolution calling for continued high-level commitments to implement and adequately resource multi-sectoral National Action Plans.

The resolution urges Member States to strengthen infection prevention and control measures including water sanitation and hygiene; enhance participation in Global Antimicrobial Surveillance System; ensure prudent use of quality-assured antimicrobials; and support multisectoral annual self-assessment survey.

It requests the WHO Director-General to significantly enhance support to countries in implementing their national action plans and help mobilize needed financial resources, in collaboration with other UN agencies and partners. It also calls on the WHO Director-General to maintain the WHO list of Critically Important Antimicrobials for human medicine and keep Member States informed of WHO’s work with the other members of the Tripartite (the Food and Agriculture Organisation and the World Organisation for Animal Health) and UN agencies.

The resolution acknowledges the work of the Interagency Coordination Group on Antimicrobial Resistance to provide practical guidance to enhance global action to address antimicrobial resistance, and stresses the importance of addressing antimicrobial resistance to the achievement of the 2030 Agenda for Sustainable Development.

Emergencies

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2019
:: Health ministers and delegates attending the World Health Assembly this week in Geneva welcomed the new Polio Endgame Strategy 2019-2023, reiterating the need to fully implement and fund all aspects of the strategy to secure a lasting polio-free world.  The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization community and health emergencies.

:: Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.  The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. Read more here.

:: The GPEI is committed to advancing gender equality and the empowerment of women in its efforts to eradicate polio. On 11 May 2019, the GPEI Polio Oversight Board officially endorsed the GPEI Gender Equality Strategy, 2019-2023 with the objective to promote the integration of a gender perspective into different aspects of the GPEI’s programming, to support countries in addressing gender-related barriers to polio vaccination to increase coverage and increase women’s meaningful participation in the polio programme. Read strategy here. Watch an animation explaining the
relations between gender and polio eradication here.

:: Watch Coffee with Polio Experts: Sini Ramo, Gender Analyst as she talks about the role of gender in determining health goals—including access to polio vaccines— and GPEI’s part in integrating gender equality and mainstreaming in its work to end polio.

Summary of new viruses this week:
:: Afghanistan—one wild poliovirus type 1 (WPV1)-positive environmental sample;
:: Pakistan— two WPV1 cases and seven WPV1-positive environmental samples;
:: Niger—one circulating vaccine-derived poliovirus type 2 (cVDPV2) isolated from a healthy community contact;
:: Nigeria—One case classified cVDPV2 based on a positive contact and three cVDPV2-positive environmental samples.

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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 25 May 2019]

Democratic Republic of the Congo
:: United Nations strengthens Ebola response in Democratic Republic of the Congo
23 May 2019
:: Taking risks to provide care in a conflict zone 22 May 2019
:: 42: Situation report on the Ebola outbreak in North Kivu 21 May 2019
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo
23 May 2019
[See Ebola DRC above for detail]

Bangladesh – Rohingya crisis
:: Rohingya crisis: WHO introduces new software for epidemiologists to control disease outbreak
Cox’s Bazar (18-21 March 2019) – Over the past week, WHO and the Global Outbreak Alert and Response Network (GOARN) have trained public health experts in Cox’s Bazar, Bangladesh, in using a newly developed piece of software called Go.Data. The training is part of the global roll-out of Go.Data, a software which allows conducting outbreak investigations, including field data collection, contact tracing and visualization of disease chains of transmission. The new software was developed in collaboration with GOARN, WHO and other partner organizations…

Nigeria
:: Strengthening the healthcare system in north-east Nigeria – a priority for WHO 22 May 2019
:: Over 850,000 Nigerians in 12 States at risk of poisoning from mercury use 20 May 2019

Syrian Arab Republic
:: Supporting Syrian refugees in Turkey with the health services and guidance they need
20 May 2019

Mozambique floods – No new digest announcements identified
Myanmar – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 25 May 2019]

Libya
:: WHO distributes urgently needed medical supplies as Libya conflict continues
21 May 2019

Brazil (in Portugese)
:: Organização Mundial da Saúde certifica Argélia e Argentina como livres da malária
22 de maio de 2019 – Argélia e Argentina foram oficialmente reconhecidas pela Organização Mundial da Saúde (OMS) como livres da malária. A certificação é concedida quando um país prova que interrompeu a transmissão autóctone da doença por pelo menos três anos consecutivos.

MERS-CoV
:: MERS situation update, April 2019
At the end of April 2019, a total of 2428 laboratory-confirmed cases of Middle East respiratory syndrome (MERS), including 838 associated deaths (case–fatality rate: 34.5%) were reported globally; the majority of these cases were reported from Saudi Arabia (2037 cases, including 760 related deaths with a case–fatality rate of 37.3%). During the month of April, a total of 29 laboratory-confirmed cases of MERS were reported globally. All the 29 cases were reported from Saudi Arabia with 11 associated deaths.

occupied Palestinian territory
:: Health attacks continue during Gaza’s Great March of Return 20 May 2019

Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Cyclone Idai – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Malawi floods – No new digest announcements identified
Niger – 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 25 May 2019]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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::::::

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: Situation Report 3: Recent Developments in Northwestern Syria (as of 24 May 2019)
HIGHLIGHTS
:: Ongoing conflict in northwest Syria continues to impact civilians, civilian infrastructure, and humanitarian service provision in the deescalation zone of northern Hama, southern Idleb governorates, and the countryside of Aleppo.
:: More than 200,000 people were displaced between 1 and 16 May, while 20 health facilities, three IDP settlements, and one refugee camp were reportedly affected by hostilities. This number is in addition to those people displaced prior to that date. There are unconfirmed local reports that up to 25 schools have been affected since the beginning of May.
:: The humanitarian response is ongoing with tens of thousands of people being provided food, protection, nutrition, health, shelter, education and WASH services, while critical gaps remain across sectors.

Yemen – No new digest announcements identified

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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.
CYCLONE IDAI and Kenneth
::  25 May 2019 Mozambique: Cyclone Idai & Floods Situation Report No. 22 (As of 20 May 2019)
:: 24 May 2019 Zimbabwe: Emergency Situation Report No. 8, As of 22 May 2019

 

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WHO & Regional Offices [to 25 May 2019]

WHO & Regional Offices [to 25 May 2019]
25 May 2019 News release
World Health Assembly Update, 25 May 2019

24 May 2019 News release
World Health Assembly Update, 24 May 2019

23 May 2019 Statement
United Nations strengthens Ebola response in Democratic Republic of the Congo

23 May 2019 News release
World Health Assembly Update, 23 May 2019

23 May 2019
What the first malaria vaccine means to a mother and child
The world’s first malaria vaccine in childhood vaccination is being rolled out in 2019 in selected areas of Ghana, Malawi and Kenya, through a pilot programme supported by the World Health Organization
Vida tells the story of her baby Lordina, one of the first to get the vaccine in Ghana, and how this additional prevention tool gives her “more peace of mind.” Her story is a stirring testament to the potential of this additional form of protection against malaria for young children.
Watch the video

22 May 2019 News release
World Health Assembly 72 Update

22 May 2019 News release
Algeria and Argentina certified malaria-free by WHO

22 May 2019 News release
Five billion people still at risk from industrial trans fat exposure

20 May 2019 News release
WHO announces four new goodwill ambassadors for promoting global health
…The new ambassadors are:
:: Alisson Becker, goalkeeper of the Brazilian national and Liverpool football teams, and
:: Dr Natália Loewe Becker, medical doctor and health advocate from Brazil, as WHO Goodwill Ambassadors for Health Promotion;
:: Cynthia Germanotta, President of Born This Way Foundation, which was co-founded with her daughter Lady Gaga, as WHO Goodwill Ambassador for Mental Health;
:: Ellen Johnson Sirleaf, former President of Liberia, as WHO Goodwill Ambassador for Health Workforce

20 May 2019
Draft: Developing together the vision and strategy for immunization 2021-2030
pdf, 2.00Mb

Comments and Feedback by 14 June

 

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Weekly Epidemiological Record, 24 May 2019, vol. 94, SPECIAL ISSUE (pp. i–xlviii)
Editorial
Improvement in annual reporting of self-assessments to the International Health Regulations
(2005)
Gaining knowledge on the concept of monitoring and evaluation for effective implementation of
the International Health Regulations (2005) in the United Republic of Tanzania
Accelerating implementation of the International Health Regulations (2005) in the WHO South-
East Asia Region
Supporting the development of strong laboratory leaders for global health security: the Global
Leadership Programme (GLLP)
Climate change in the Eastern Mediterranean Region: priorities in enhancement of health
systems preparedness
National public health institutes collaborate with WHO to promote global health security
National legislation in implementation of the International Health Regulations (2005)
Improved country preparedness through implementation of the Pandemic Influenza
Preparedness Framework partnership contribution, 2018
After-action reviews and simulations exercises within the monitoring and evaluation framework
for the International Health Regulations (2005): main trends in 2018
Survey of pandemic influenza preparedness in WHO Member States, 2018
Country preparedness for health and humanitarian emergencies in the WHO African Region:
progress, lessons learnt and way forward
Review of preparedness and readiness for Ebola virus disease in South Sudan by joint
monitoring missions: progress, successes, challenges and the way forward

Weekly Epidemiological Record, 24 May 2019, vol. 94, 21 (pp. 253–260)
Progress towards polio eradication, worldwide, January 2017–March 2019

 

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: WHO and partners provide life-saving vaccine to more than 1.2 million children against measles in Borno State. 24 May 2019
:: African Parliamentarians commit to urgent action to increase immunization rates and advance universal health coverage, as Pan-African Parliament session concludes 23 May 2019
:: United Nations strengthens Ebola response in Democratic Republic of the Congo 23 May 2019
:: Algeria and Argentina certified malaria-free by WHO 22 May 2019

WHO Region of the Americas PAHO
:: World Health Assembly approves resolutions on climate change and health, noncommunicable diseases, and influenza preparedness (05/24/2019)
:: World Health Assembly Adopts Resolution on Antimicrobial Resistance (05/23/2019)
:: Ministers of Health of the Pacific and the Caribbean to join forces on climate change and health, regulatory frameworks, health security and NCDs (05/23/2019)
:: Delegates Adopt Resolutions on Universal Health Coverage at World Health Assembly (05/22/2019)
:: Argentina certified malaria-free by WHO (05/22/2019)
:: Roadmap to Universal Health Discussed on Day Two of the World Health Assembly (05/21/2019)
:: 72nd World Health Assembly Opens in Geneva (05/20/2019)

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

WHO European Region EURO
:: Creativity and commitment on display during European Immunization Week 2019 21-05-2019
:: WHO’s strategic priorities in focus at Seventy-second World Health Assembly 21-05-2019
:: Supporting Syrian refugees in Turkey with the health services and guidance they need 20-05-2019

WHO Eastern Mediterranean Region EMRO
:: WHO distributes medical supplies as Libya conflict continues 21 May 2019
:: Health attacks continue during Gaza’s Great March of Return 20 May 2019

WHO Western Pacific Region
No new digest content identified.