Vaccines and Global Health: The Week in Review :: 18 May 2019

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

72nd session of the World Health Assembly

Milestones :: Perspectives :: Research


72nd session of the World Health Assembly
20-28 May 2019, Geneva
Main documents [selected]
A72/1 – Provisional agenda

A72/5 – Proposed programme budget 2020–2021
Thirteenth General Programme of Work, 2019-2023
WHO Impact Framework

A72/6 – Public health emergencies: preparedness and response
Report of the Independent Oversight and Advisory Committee for the WHO Health
Emergencies Programme

A72/7 – Public health emergencies: preparedness and response
WHO’s work in health emergencies

A72/8 – Public health emergencies: preparedness and response
International Health Regulations (2005)
Annual report on the implementation of the International Health Regulations (2005)

A72/9 – Polio Eradication

A72/10 – Polio Transition

A72/11 – Implementation of the 2030 Agenda for Sustainable Development

A72/12 – Universal health coverage
Primary health care towards universal health coverage

A72/17 – Access to medicines and vaccines

A72/18 – Follow-up to the high-level meetings of the United Nations General Assembly on
health-related issues
Antimicrobial resistance

A72/19 – Follow-up to the high-level meetings of the United Nations General Assembly on
health-related issues
Prevention and control of noncommunicable diseases

A72/20 – Follow-up to the high-level meetings of the United Nations General Assembly on
health-related issues
Ending tuberculosis

A72/21 – Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and
access to vaccines and other benefits
Implementation of decision WHA71(11) (2018)

A72/22 – Member State mechanism on substandard and falsified medical products

A72/25 – Promoting the health of refugees and migrants Draft global action plan, 2019–2023

A72/28 – Smallpox eradication: destruction of variola virus stocks

[Full Main Documents inventory at title link above]

Vaccination lags behind in middle-income countries

Featured Journal Content


Volume 569 Issue 7756, 16 May 2019
World View | 14 May 2019
Vaccination lags behind in middle-income countries
Poor children in relatively rich nations are being let down by immunization programmes
Seth Berkley, Gavi
Indonesia, Iraq and South Africa now rank among the ten countries with the highest number of under-immunized children worldwide, even though these countries are richer than many of their neighbours. What is going on?

Not so long ago, improving the health of the world’s poorest people meant focusing on the world’s poorest countries. That’s changing. Soon, the majority of the most vulnerable populations will be in middle-income countries (MICs), where gross national income per capita is between US$995 and $12,055 per year. Increasing migration, urbanization, conflict and climate change are causing inequities to yawn ever wider, despite United Nations Sustainable Development Goals to leave no one behind.

As the World Health Assembly meets in Geneva, Switzerland, next week, the development community must tackle an emerging conundrum: how do we increase access to vaccines, primary health care and other essential health interventions in countries that can — at least according to their gross national incomes — afford them?

My organization, Gavi, the Vaccine Alliance, was founded in 2000 to boost immunization in the poorest countries. It is credited with helping to vaccinate more than 700 million children against a range of diseases, from measles and diphtheria to pneumonia and cervical cancer. Despite success in the poorest countries, an analysis we carried out this year found that, since 2010, routine immunization levels have either stagnated or dropped in 54 of 85 MICs too prosperous to qualify for Gavi support.

We project that by 2030, almost 70% of the world’s under-immunized children will be living in countries ineligible for Gavi’s vaccination programmes, such as Nigeria, India and the Philippines.

Gavi’s programmes subsidize new and expensive childhood vaccinations. Governments take on more of the cost as countries’ economies grow. This means that children in some of the countries with the weakest economies are actually better protected against infectious disease than are those in some wealthier countries. South Africa, for example, has a gross national income per capita of around seven times that of Rwanda. Yet only 66% of its children receive the routine three doses of the DTP3 vaccine against diphtheria, tetanus and pertussis — compared with 98% in Rwanda.

Unsupported MICs are also neglecting important new vaccines that have huge impacts on death and disease rates. For example, 52% are yet to introduce the pneumococcal conjugate vaccine, and in 61%, plans to introduce rotavirus vaccine are still pending . Together, these vaccines can help to protect against two of the biggest killers of under-fives: pneumonia and diarrhoea.

That does not mean that MICs are investing less in health care. Those that have never received Gavi support currently spend an average of $90 per live birth on routine immunization, versus $25 in Gavi-supported low-income countries. Yet immunization programmes in these MICs struggle to reach vulnerable populations. That’s often for a combination of reasons: domestic resources are allocated inefficiently; efforts to reach marginalized communities are not a political priority; and health systems are unable to cope with additional stressors.

Those interacting factors help to explain why the main burden of unimmunized people is shifting from mostly low-income countries to MICs. By 2025, nearly 80% of people in the lowest income brackets — those living on less than $8 a day — will be in MICs. This is almost double the proportion in 2000. As the economies of very populous low-income countries grow, many, including India (with 1.3 billion people) and Vietnam (with 96 million people), are being re-classified to middle-income status. As a result, a greater portion of the world’s population lives in MICs. However, because economic growth is not distributed equitably, many people in these countries remain poor.

Another factor is fragility. The past ten years have seen conflicts more than double. This has contributed to unprecedented global migration. Of the 68.5 million people currently displaced from their homes and less likely to receive vaccinations, more than half are in MICs. At the same time, urbanization is increasing fastest in these countries. More than one-third of urban populations in MICs live in slums, where infections can spread quickly.

All this demands a rethink of global health policy. MICs need support to strengthen their health systems and to improve how they procure vaccines and regulate them. They need access to information technologies to monitor who is getting vaccines, to target at-risk communities and to evaluate strategies. And mechanisms are needed that set prices according to what countries can reasonably pay. Prosperous countries should pay more for vaccines. But according to World Health Organization data, the pneumococcal vaccine, for example, costs, on average, eight times more in never-supported MICs than in countries receiving Gavi support, even though the MICs’ gross national incomes and ability to pay might not be commensurately larger.

Since 1990, childhood mortality has more than halved worldwide — mainly because fewer under-fives now die from infectious disease. Polio is on the brink of eradication, with just 33 cases last year. It is time for the global health community to adapt: we must not leave behind vulnerable populations in middle-income countries.

Global Fund Board Steps Up the Fight Against AIDS, TB and Malaria

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Global Fund Board Steps Up the Fight Against AIDS, TB and Malaria
16 May 2019
GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria approved an allocation approach to maximize the impact of investments to end the epidemics and to build resilient and sustainable systems for health, stepping up efforts for the next three-year funding period.


At the Board’s 41st meeting, members approved a methodology for allocation and for catalytic investments in the 2020-2022 period, to focus funding on countries with the highest disease burden and lowest economic capacity, and accounting for key and vulnerable populations disproportionately affected by HIV, TB and malaria.

The Board expressed a consensus that the Global Fund’s allocation model is maturing well. The Board’s decision incorporates lessons from implementation and includes refinements based on recommendations by its Strategy Committee and technical partners including WHO, UNAIDS, the Stop TB Partnership, and the RBM Partnership to End Malaria.

As a partnership organization, the Global Fund brings together governments, civil society, technical partners, the private sector and people affected by HIV, TB and malaria, and maximizes impact through increased funding and greater effectiveness of available resources.
On several topics at the Board meeting, members stressed the strong advantages of leveraging partnerships in an evolving landscape on global health. The Global Fund is working closely together with multiple organizations on the SDG 3 Global Action Plan.

The Global Fund expressed determination to raise at least US$14 billion in its Sixth Replenishment, to be hosted by France in October 2019.

“We need more innovation, better collaboration, better execution, and we also need more money,” said Peter Sands, Executive Director of the Global Fund. “The next six months are an absolutely critical period in the fight against AIDS, TB and malaria. We need a successful Replenishment. We need to step up the fight.”…

Ebola virus disease – Democratic Republic of the Congo

Featured Journal Content


DRC – Ebola

Disease Outbreak News (DONs)
Ebola virus disease – Democratic Republic of the Congo
16 May 2019
Although the security situation has subsided mildly into an unpredictable calm, the transmission of Ebola virus disease (EVD) continues to intensify in North Kivu and Ituri provinces with more than 100 confirmed cases reported this week.
The main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centres (ETCs)/Transit Centres (TCs)…




Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2019
:: On 9 May 2019, the World Health Organization received notification of the detection of wild poliovirus type 1 (WPV1) from an environmental sample, collected on 20 April, in Seestan and Balochistan province, Iran. The virus collected is an environmental sample only, and no associated cases of paralysis have been detected.  Genetic sequencing confirmed it is linked to WPV1 circulating in Karachi, Pakistan.
:: On 21 May 2019, taking advantage of the presence of major Global Polio Eradication Initiative (GPEI) stakeholders attending the World Health Assembly (WHA) in Geneva, the GPEI is hosting an informal reception marking the launch of its new Polio Endgame Strategy 2019-2023: To Succeed by 2023 – Reaching Every Last Child for a Polio-Free World. Delegates who will be in Geneva are invited. Please RSVP here.

Summary of new viruses this week:
:: Pakistan — four wild poliovirus type 1 (WPV1) cases and four WPV1-positive environmental samples;
: Iran—one WPV1-positive environmental sample three wild poliovirus type 1 (WPV1) cases and five WPV1-positive environmental samples



Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 18 May 2019]

Democratic Republic of the Congo
:: 41: Situation report on the Ebola outbreak in North Kivu 14 May 2019
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo
16 May 2019
[See Ebola DRC above for detail]

Bangladesh – Rohingya crisis
:: Bi-weekly Situation Report #09 Date of issue: 09 May 2019
:: The Mental Health and Psychosocial Support (MHPSS) team conducted an mhGAP training for health workers from Sadar Hospital, Ukhiya, Ramu and Moheskhali Upazila health complexes.
:: Refurbishment work for Microbiology Room of Institute of Epidemiology, Disease Control and Research(IEDCR) Field Lab in Cox’s Bazaar Medical College has been completed.
:: Acute respiratory infection (ARI), acute watery diarrhea (AWD) and unexplained fever were the conditions with highest proportional morbidity this week.
:: World Immunization Week was observed in Rohingya camps from 24-30 April 2019 with the theme of ‘Protected Together – Vaccine works’. The week has featured, among others, an advocacy meeting with relevant stakeholders, awareness meetings with community influencers, dropout listing and vaccination by vaccinators, distribution of Information, Education and Communication (IEC) materials to service providers and others.
:: The health sector held bilateral meetings with a UN agency to plan on establishing first line support and referral services on gender-based violence (GBV) for ten of its supported health posts where GBV services are currently not available to meet minimum essential service package.
:: The Health Sector coordinated preparation for potential damage from heavy rains and winds, associated with cyclone Fani.

Mozambique floods
:: More than 500 000 doses of cholera vaccine available for Cabo Delgado 18 May 2019

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 18 May 2019]

:: WHO mobile medical clinics reach displaced persons in Kalar district, Sulaymaniyah governorate, Iraq 16 May 2019

:: The rush to deliver cholera vaccines to remote communities in Zimbabwe 10 May 2019

Cyclone Idai – No new digest announcements identified
Libya – No new digest announcements identified
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
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified



WHO Grade 1 Emergencies [to 18 May 2019]
:: Países avanzan hacia la eliminación de la transmisión de la madre al hijo del VIH, la sífilis, la hepatitis B y la enfermedad de Chagas

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
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: Situation Report 2: Recent Developments in Northwestern Syria (as of 17 May 2019)
Northweste ..

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.
CYCLONE IDAI and Kenneth
:: Mozambique: Brave mothers in the midst of hardship 11 May 2019



WHO & Regional Offices [to 18 May 2019]

WHO & Regional Offices [to 18 May 2019]
16 May 2019 News release
Too many babies are born too small

15 May 2019 News release
Smarter research & development to tackle global health priorities
Today, WHO’s new Science Division launched an online resource to guide the development of new health products for which there are limited markets or incentives for research and development. An essential tool for realizing universal health coverage, the Health Product Profile Directory aims to promote  research and development for products to combat neglected diseases and threats to global health, including antimicrobial resistance and diseases with pandemic potential.
The Health Product Profile Directory is a free-to-use online resource created and developed by TDR, the Special Programme for Research and Training in Tropical Diseases, on behalf of WHO as a global public good. It provides a searchable database of profiles for health products needed to tackle pressing health issues in global health including those prioritized by WHO. The summary of the published profiles outlines 8-10 key characteristics (such as target population, measures of efficacy and dosage) for the development of health products, including medicines, vaccines and diagnostics. Building in these characteristics at an early stage of the development process is essential to ensure that the final products will be accessible to the populations that need them…

14 May 2019 News release
Adopting a healthy lifestyle helps reduce the risk of dementia



Weekly Epidemiological Record, 17 May 2019, vol. 94, 20 (pp. 233–252)
:: Dracunculiasis eradication: global surveillance summary, 2018
:: Monthly report on dracunculiasis cases, January- March 2019



Calls for consultants / proposals
Proposal for the development of a guidance on strategic multi-year planning for national immunization programme pdf, 160kb 13 May 2019
Deadline for applications: 7 June 2019

Consultant: Survey data analysispdf, 284kb 10 May 2019

Deadline for applications: 10 June 2019



WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: More than 500 000 doses of cholera vaccine available for Cabo Delgado 18 May 2019
Pemba, Mozambique.
:: Africa advances on goal of cervical cancer elimination across the continent 15 May 2019
The US Ambassador to South Sudan and Hon Minister of Health visit Ebola Vaccination site in Juba 12 May 2019

WHO Region of the Americas PAHO
:: Ministers of Health of the Americas to participate in the 72nd World Health Assembly (05/17/2019)
:: PAHO receives award from the World Hypertension League for its efforts to address hypertension in the Americas (05/17/2019)
:: Countries move towards the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas disease (05/16/2019)
:: Myths and Truths about Seasonal Influenza and the Flu Vaccine (05/14/2019)

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

WHO European Region EURO
:: Moving one step closer to better health and rights for transgender people 17-05-2019
:: New WHO guidelines promote healthy lifestyle to reduce risk of dementia 14-05-2019
:: Fast-track to strong primary health care 14-05-2019

WHO Eastern Mediterranean Region EMRO
:: Mobile medical clinics reach displaced people in Iraq 16 May 2019
: Increasing access to health care for returnees in Ninewa, Iraq 12 May 2019

WHO Western Pacific Region
No new digest content identified.