Vaccines and Global Health: The Week in Review :: 15 June 2019

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

DRC – Ebola/Measles/Cholera

Milestones :: Perspectives :: Research


DRC – Ebola/Measles/Cholera

Editor’s Note:
With the confirmed cases of Ebola in Uganda, a number of parallel announcements from governments, agencies and NGOs working in the crisis areas emerged this week as captured below. We lead with the IHR Emergency Committee statement:

Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo
14 June 2019 [Editor’s text bolding]
The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding Ebola virus disease in the Democratic Republic of the Congo (DRC) took place on Friday, 14 June 2019, from 12:00 to 17:00 Geneva time (CEST).

Context and Discussion
The Committee expressed its deep concern about the ongoing outbreak, which, despite some positive epidemiological trends, especially in the epicentres of Butembo and Katwa, shows that the extension and/or reinfection of disease in other areas like Mabalako, presents, once again, challenges around community acceptance and security. In addition, the response continues to be hampered by a lack of adequate funding and strained human resources.


The cluster of cases in Uganda is not unexpected; the rapid response and initial containment is a testament to the importance of preparedness in neighbouring countries. The Committee commends the communication and collaboration between DRC and Uganda.

At the same time, the exportation of cases into Uganda is a reminder that, as long as this outbreak continues in DRC, there is a risk of spread to neighbouring countries, although the risk of spread to countries outside the region remains low.

The Committee wishes to commend the heroic work of all responders, who continue to work under extremely challenging and stressful conditions.

The Committee extensively debated the impact of a PHEIC declaration on the response, possible unintended consequences, and how these might be managed. Differing views were expressed, as the Committee acknowledged that recent cases in Uganda constitute international spread of disease.

Conclusions and Advice
It was the view of the Committee that the outbreak is a health emergency in DRC and the region but does not meet all the three criteria for a PHEIC under the IHR. While the outbreak is an extraordinary event, with risk of international spread, the ongoing response would not be enhanced by formal Temporary Recommendations under the IHR (2005).

The Committee provided the following public health advice, which it strongly urges countries and responding partners to heed:
:: At-risk countries should improve their preparedness for detecting and managing exported cases, as Uganda has done.
:: Cross-border screening in DRC should continue and its quality improved and sustained.
:: Continue to map population movements and sociological patterns that can predict risk of disease spread.
:: All priority countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness.
:: Optimal vaccine strategies that have maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE), should be implemented rapidly.
:: The Committee is deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak. The international community must step up funding and support strengthening of preparedness and response in DRC and neighbouring countries.
:: Continue to strengthen community awareness, engagement, and participation. There has been a great deal of progress in community engagement activities. However, in border communities, where mobility is especially likely, community engagement needs to be more sharply targeted to identify the populations most at risk.
:: The implementation by the UN and partners of more coordinated measures to reduce security threats, mitigate security risks, and create an enabling environment for public health operations is welcomed and encouraged by the Committee as an essential platform for accelerating disease-control efforts.
:: The Committee strongly emphasizes its previous advice against the application of any international travel or trade restrictions.
:: The Committee does not consider entry screening at airports or other ports of entry to be necessary.

The Committee advised the WHO Director-General to continue to monitor the situation closely and reconvene the Emergency Committee as needed….

…Representatives of the National Communicable Disease Control Commission in Uganda reviewed recent cases, contacts, and contact tracing. They updated the Committee on their response actions, including notification to WHO and political involvement, and preparedness activities that have been taking place since August 2018. A national coordination task force has been activated and a rapid response team deployed. Clinical management is available in an Ebola Treatment Unit in Bwera. Screening is taking place at official points of entry. Ring vaccination will begin on 15 June.

A representative of the WHO Regional Office for Africa presented the status of regional preparedness activities, particularly in Burundi, Rwanda, South Sudan, and Uganda. Ongoing challenges were noted, especially at district/subnational levels, as well as inadequate crossborder collaboration and a lack of funding to sustain preparedness activities.


A representative of the International Organization for Migration updated the Committee on prevention, detection, and control measures at points of entry, for cross-border preparedness…

The UN Ebola Emergency Response Coordinator gave an update on the security situation and efforts to create a dynamic, nimble enabling environment to support outbreak response. There have been frequent disruptions to the response, which has had implications for increased numbers of cases. UN-wide support is needed to strengthen the public health response and coordinate international assistance. Access and community acceptance are increasing, with decreases in cases in some areas. Increases in attacks in some areas are being addressed…

Based on the above advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment that the Ebola outbreak in the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern



Disease Outbreak News (DONs)
Ebola virus disease – Democratic Republic of the Congo 13 June 2019
The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) continues to show a decrease in the number of new cases in hotspots such as Katwa, Beni and Kalunguta health zones. However, in other areas such as Mabalako and Butembo, moderate rates of transmission continue…

45: Situation report on the Ebola outbreak in North Kivu 12 June 2019
Points of Entry (PoE)
From 3 to 9 June, 1,873,230 screenings were performed, giving a total over 65 million cumulative screenings. This week, a total of 62 alerts were notified, of which 19 were validated as suspect cases following investigation; none were returned positive for EVD after laboratory testing. This brings the cumulative number of alerts to 1,214, with 467 validated as suspect cases, and 11 subsequently confirmed with EVD following laboratory testing. An average of 92% PoEs and PoCs reported screenings daily this week.
On 5 June 2019, four vaccinated contacts lost to follow-up were intercepted at PoC OPRP, travelling from Butembo to Goma on their 13th day of follow-up. All four have agreed to return to Butembo until the end of their follow-up period…

…Implementation of ring vaccination protocol
As of 8 June 2019, 131,471 people at risk have consented to and received the rVSV-ZEBOV-GP Ebola vaccine. Of those, 33,046 are contacts and 87,886 contacts-of-contacts. The total number of vaccines includes 31,016 HCWs/FLWs and 34,522 children 1-17 years of age.
Four new rings (2 in Katwa, 1 in Mandima and 1 in Mabalako) have opened around six confirmed cases from 5 June 2019 and three new rings (2 in Katwa and 1 in Butembo) were opened around eight confirmed cases on 7 June 2019.

Despite the challenges in the field and considering the cases reported between 30 April 2019 and 20 May 2019, only 31/337 (9.2%) of the cases do not have a ring defined and their contacts and contacts-of-contacts vaccinated. For 113/337 (33.5%) of the cases the ring vaccination was completed and for 193/337 (57.2%) ring vaccination was ongoing at the time of writing this report. This important progress is the result of the use of innovative delivery strategies (i.e. pop-up vaccination and targeted geographic vaccination) and strong community negotiations and engagement…



Update On African Union Actions in Response to Recent Ebola Outbreaks
Africa CDC 13 June 2019
Following the recent outbreak of Ebola cases reported in Uganda, The African Union (AU) is collaborating with the Ministry of Health of the Republic of Uganda to mobilise support to ensure adequate response and implementation of prevention and control measures, including deployment of senior experts from the AU’s Africa Centres for Disease Control and Prevention (Africa CDC).
Africa CDC teams are also currently deployed to the Democratic Republic of Congo (DRC) and have been involved in implementing key interventions in partnership with the Government and other partners.



CDC Activates Emergency Operations Center for Ebola Outbreak in Eastern DRC
Wednesday, June 12, 2019
Today the U.S. Centers for Disease Control and Prevention (CDC) is announcing activation of its Emergency Operations Center (EOC) on Thursday, June 13, 2019, to support the inter-agency response to the current Ebola outbreak in eastern Democratic Republic of the Congo (DRC). The DRC outbreak is the second largest outbreak of Ebola ever recorded and the largest outbreak in DRC’s history. The confirmation this week of three travel-associated cases in Uganda further emphasizes the ongoing threat of this outbreak. As part of the Administration’s whole-of-government effort, CDC subject matter experts are working with the USAID Disaster Assistance Response Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to support the Congolese and international response. The CDC’s EOC staff will further enhance this effort.
CDC’s activation of the EOC at Level 3, the lowest level of activation, allows the agency to provide increased operational support for the response to meet the outbreak’s evolving challenges. CDC subject matter experts will continue to lead the CDC response with enhanced support from other CDC and EOC staff.
“We are activating the Emergency Operations Center at CDC headquarters to provide enhanced operational support to our expanded Ebola response team deployed in DRC,” said CDC Director Robert R. Redfield, M.D. “Through CDC’s command center we are consolidating our public health expertise and logistics planning for a longer term, sustained effort to bring this complex epidemic to an end.”…



Press release
UNICEF launches swift response as first Ebola cases and deaths confirmed in Uganda
5-year-old boy and his grandmother die from Ebola virus in western Uganda
KAMPALA/NAIROBI/NEW YORK, 13 June 2019 – UNICEF has launched an emergency Ebola response plan in Uganda following the confirmation of the first three cases of Ebola Virus Disease in the country over the past two days.

Among the cases was a 5-year-old boy who, following a visit with his family to the neighbouring Democratic Republic of the Congo (DRC), returned to Uganda on 9 June and died on Tuesday night after having been transferred to the Bwera Ebola Treatment Unit in Kasese.
The boy’s grandmother also died from the virus in Kasese district on Wednesday, where almost 400,000 children live.

UNICEF’s shift to its response phase in Uganda follows months of preparedness and prevention efforts as Ebola cases increased in neighbouring Democratic Republic of the Congo (DRC).
“As our thoughts are with this young boy’s family, this is a tragic reminder that even one case of Ebola is one too many,” said UNICEF Representative in Uganda, Dr. Doreen Mulenga. “We must do everything possible to stop this outbreak in its tracks and prevent other needless deaths.  UNICEF is intensifying its efforts to do so and minimize this outbreak’s potentially devastating impact on children and communities at-large in Uganda.”…



DRC Ebola outbreaks – MSF/Médecins Sans Frontières
Crisis update – June 2019

Democratic Republic of Congo
Restoring trust among communities fearful of Ebola
Project Update 13 Jun 2019

Democratic Republic of Congo
Massive mobilisation urgently needed to curb fast-spreading measles…
Press Release 11 Jun 2019
:: New measles outbreak in DRC is anticipated to be the worst the country has seen since 2012
:: MSF urges national and international organisations to immediately coordinate to help curb the spread, including vaccination
:: Vaccines and supplies to help with the outbreak response must be urgently secured



Africa, Democratic Republic of the Congo, Uganda
Red Cross on alert as Uganda confirms first Ebola case
Kampala/Nairobi/Geneva, 12 June – Red Cross teams are on high alert following the confirmation of the first Ebola case in Uganda. According to the Ministry of Health, a five-year-old boy from Uganda returned from the Democratic Republic of the Congo (D …
12 June 2019

IBM, KPMG, Merck and Walmart to collaborate as part of FDA’s program to evaluate the use of blockchain to protect pharmaceutical product integrity

Milestones :: Perspectives :: Research


IBM, KPMG, Merck and Walmart to collaborate as part of FDA’s program to evaluate the use of blockchain to protect pharmaceutical product integrity
The FDA pilot program explores innovative and emerging approaches for the tracing and verification of prescription products
ARMONK, N.Y., NEW YORK, KENILWORTH, N.J., and BENTONVILLE, Ark., June 13, 2019 /PRNewswire/ — IBM (NYSE: IBM), KPMG, Merck (NYSE: MRK), and Walmart (NYSE: WMT) today announced that the companies have been selected by the United States Food and Drug Administration (FDA) to be included in a program in support of the U.S. Drug Supply Chain Security Act (DSCSA) that addresses requirements to identify, track and trace prescription medicines and vaccines distributed within the United States.

The program is intended to assist drug supply chain stakeholders, including FDA, in developing the electronic, interoperable system that will identify and trace certain prescription drugs as they are distributed within the United States.

“Our supply chain strategy, planning and logistics are built around the customers and patients we serve,” said Craig Kennedy, Senior Vice President, Supply Chain, at Merck, which is known as MSD outside the U.S. and Canada. “Reliable and verifiable supply helps improve confidence among all the stakeholders—especially patients—while also strengthening the foundation of our business.”

Each company brings unique expertise to the project, which will create a shared permissioned blockchain network that allows real-time monitoring of products. The proposed network is intended to help reduce the time needed to track and trace inventory; allow timely retrieval of reliable distribution information; increase accuracy of data shared among network members; and help determine the integrity of products in the distribution chain, including whether products are kept at the correct temperature.

“With successful Blockchain pilots in pork, mangoes and leafy greens that provide enhanced traceability, we are looking forward to the same success and transparency in the biopharmaceutical supply chain,” said Karim Bennis, Walmart’s Vice President of Strategic Planning and Implementation, Health and Wellness. “We believe we have to go further than offering great products that help our customers live better at everyday low prices. Our customers also need to know they can trust us to help ensure products are safe. This pilot and U.S. Drug Supply Chain Security Act requirements will help us do just that.”

Blockchain is designed to establish a permanent record and may be integrated with existing supply chain and traceability systems…




Public Health Emergency of International Concern (PHEIC)

Regular Weekly Update not published.



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 15 Jun 2019]

Democratic Republic of the Congo
:: 45: Situation report on the Ebola outbreak in North Kivu 12 June 2019
:: Disease Outbreak News (DONs) Ebola virus disease – Democratic Republic of the Congo 13 June 2019
[See Ebola DRC above for detail]

Bangladesh – Rohingya crisis – No new digest announcements identified
Mozambique floods – No new digest announcements identified
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 15 Jun 2019]

Central African Republic
:: The Central African Republic prepares for Ebola response
12 June 2018 – Bangui “The Central African Republic has made a good start in preparing for a possible Ebola outbreak,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), at the end of a short visit to the country. “But we must remain vigilant, and consolidate the work started.”…

Afghanistan – No new digest announcements identified
Cameroon – 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
Libya – No new digest announcements identified
Malawi floods – 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
Zimbabwe – No new digest announcements identified



WHO Grade 1 Emergencies [to 15 Jun 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



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 5: Recent Developments in Northwestern Syria (as of 14 June 2019)
:: Violence in northwest Syria continued over the last ten days throughout Eid al Fitr, which marks the end of Ramadan.
Airstrikes and shelling in southern Idleb, northern Hama and western Aleppo governorates is putting civilians at risk and impeding the delivery of assistance.
:: Humanitarian response is ongoing with hundreds of thousands of people receiving critical assistance essential for their survival. Violence in areas directly affected by conflict is driving displacement into densely-populated areas, putting a strain on service delivery for partners.
:: A further escalation of violence, triggering waves of displacement and complicating humanitarian access and provision of humanitarian assistance risks overwhelming an already stretched response.

:: Yemen: Flash floods Flash Update No. 1 As of 11 June 2019



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: “Three months on, the world’s attention has moved on. We cannot let this happen” 14 Jun 2019



WHO & Regional Offices [to 15 Jun 2019]

WHO & Regional Offices [to 15 Jun 2019]
13 June 2019 News release
New study finds no link between HIV infection and contraceptive methods

11 June 2019 News release
Collaboration between France and WHO to realize the vision of the WHO Academy
Today Emmanuel Macron, President of the French Republic and Dr Tedros Adhanom Ghebreyesus, WHO Director-General met at WHO Headquarters in Geneva signed a Declaration of Intent to establish the WHO Academy that will revolutionize lifelong learning in health. The Academy aims to reach millions of people with innovative learning via a state-of-the-art digital learning experience platform at a campus in Lyon and embedded in the six WHO regions. The WHO Academy Lyon hub will feature high-tech learning environments, a world-class health emergencies simulation centre and collaboration spaces for learning co-design, research and innovation…



Weekly Epidemiological Record, 14 June 2019, vol. 94, 24 (pp. 281–288)
:: Progress towards measles elimination in Pakistan, 2000–2018



WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Promising results from malaria-prevention medication among children in Borno State, Nigeria
14 June 2019
:: New WHO scorecard shows poor progress of the viral hepatitis response in the African region
14 June 2019
:: Cross border disease outbreak simulation exercise reinforces preparedness in East Africa
12 June 2019
:: Confirmation of case of ebola virus disease in Uganda 11 June 2019
:: Local leaders help turn the tide on Ebola 10 June 2019

WHO Region of the Americas PAHO
:: PAHO calls for blood donation systems to be strengthened to ensure 100% voluntary donations (06/12/2019)

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

WHO European Region EURO
:: Ljubljana Statement on Health Equity agreed – High-level Conference on Health Equity closes 14-06-2019
:: Are you a leader for road safety? The Region marks United Nations Global Road Safety Week 12-06-2019
:: High-level Conference on Health Equity opens – achieve, accelerate and influence 12-06-2019
:: New report shows persistent environment and health inequalities in Europe 12-06-2019
:: Five conditions must be met to achieve health equity, says WHO 11-06-2019

WHO Eastern Mediterranean Region EMRO
:: HIV outbreak in Sindh, Pakistan 13 June 2019
:: WHO delivers 10 ambulances to support medical services in hard-to-reach areas in Iraq
12 June 2019
:: WHO support reaches flood victims in Ghat, southern Libya 10 June 2019

WHO Western Pacific Region
:: Dengue increase likely during rainy season: WHO warns 11 June 2019 News release
Several Asian countries are experiencing unusually high numbers of dengue cases for this time of year. With the rainy season approaching, the World Health Organization (WHO) is calling for action to minimize illness and deaths from dengue…

CDC/ACIP [to 15 Jun 2019]

CDC/ACIP [to 15 Jun 2019]
Wednesday, June 12, 2019
CDC Activates Emergency Operations Center for Ebola Outbreak in Eastern DRC
[See Ebola – DRC above for detail]

Tuesday, June 11, 2019
First case of Ebola virus disease diagnosed in Uganda

MMWR News Synopsis for Friday, June 14, 2019
Notes from the Field: Administration of Expired Injectable Influenza Vaccines Reported to the Vaccine Adverse Event Reporting System — United States, July 2018–March 2019