Vaccines and Global Health: The Week in Review :: 29 June 2019

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

New 2021-2025 high level strategy to leave no-one behind with immunisation approved by Gavi Board

Milestones :: Perspectives :: Research

 

New 2021-2025 high level strategy to leave no-one behind with immunisation approved by Gavi Board
Equitable and sustainable use of vaccines, support for health systems and healthier markets to drive Gavi’s work
Geneva, 27 June 2019 – The Gavi Board today approved a new strategy to guide the Vaccine Alliance’s work over the 2021-2025 period, prioritising reaching communities with immunisation that are currently missed, such as those in urban slums, remote areas and conflict settings.

“Gavi has achieved an incredible amount since it was founded in 2000,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “Over those two decades hundreds of millions of children have been protected against some of the world’s deadliest diseases, vaccine prices have dropped and new vaccines for diseases like pneumonia and cervical cancer have reached countries they otherwise wouldn’t have, all thanks to support from the Vaccine Alliance. For the next five-year period equity will be the Alliance’s key guiding principle. This will mean focussing on those left behind, whether they be girls and women, refugees or remote communities, to ensure nobody goes without lifesaving vaccines.”

The new strategy, which is the culmination of 18 months of consultations with stakeholders, analysis and discussion, will be anchored in the Sustainable Development Goals, echoing its driving mission to leave no one behind. To do this it will target four goals to save lives and protect people’s health by increasing the equitable and sustainable use of vaccines:

 

1. To introduce and scale-up vaccines
Since 2000, Gavi has supported countries to conduct more than 400 introductions of new and under-used vaccines. In Gavi’s first phase the Alliance began by supporting vaccines that protect against six infectious diseases. By 2025 this will have increased to at least 18, including the inactivated polio vaccine (IPV) and new vaccines like rabies, hepatitis B birth dose and multivalent meningococcal. Gavi will also support vaccines, like those for Ebola, cholera and typhoid, that tackle outbreaks, fight antimicrobial resistance and boost global health security. Given the increasing number of Gavi-supported vaccines, the Alliance will help countries to prioritise vaccines based on local epidemiology, national capacity and sustainability considerations.

 

2. Strengthen health systems to increase equity in immunisation
Gavi-supported countries reached a record 64 million children with a full course of basic vaccines in 2017, up from 41 million in 2000. Yet still as many as one in ten children in Gavi-supported countries receive no routine vaccines. To reach these missing millions Gavi will bring a much stronger focus on reaching those most marginalised, by strengthening primary healthcare systems, building and sustaining community demand, and using innovation to ensure that immunisation services reach these children. It will also bring a greater focus and enhanced approach to tackle gender-related barriers that stand in the way of reaching every child.

 

3. Improve sustainability of immunisation programmes
Gavi actively works with supported countries so they co-finance and gradually take over the financing of their vaccines as they get wealthier. In this regard, countries transition out of Gavi support over time, with the Alliance supporting them so their immunisation programmes remain strong. From 2011 to 2018, countries have increased the amount they themselves spend on Gavi-supported vaccines from US$ 36 million to US$ 475 million, and 19 countries are expected to have transitioned out of Gavi support completely by 2020. Gavi will continue its work building political support and increasing domestic public resources for immunisation and primary health care, as well as supporting countries as they move away from Gavi funding to self-finance their vaccine programmes.

 

4. Ensure healthy markets for vaccines and related products
Since Gavi was founded in 2000, its market shaping work has helped increase the number of vaccine manufacturers supplying Gavi-eligible countries has expanded from 5 to 17 and prices have reduced dramatically. In recent years the Alliance has widened the focus of its market shaping work towards building healthy markets for each of its vaccines, as well as related products like cold-chain equipment. Gavi will continue to work on balancing all the elements necessary to ensure healthy market dynamics for vaccines and immunisation-related products, focusing on reliable, consistent and affordable supply as an overarching objective. It will also bring a more purposeful approach to driving innovation for immunisation-related products and services.

“For Gavi, the 2021-25 period will mean new vaccines, new technologies and new approaches to help build healthier, wealthier communities across the developing world,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “With this new strategy we will make the millions of children around the world who are missing out on vaccines our absolute priority. By bringing immunisation to these missed communities the Alliance will also be extending primary health care systems, building a foundation for Universal Health Coverage. We will be bringing all the economic benefits that come with a healthier population, and we will provide a first line of defence against deadly outbreaks, boosting global health security. That’s why this strategy will help ensure that immunisation makes a powerful contribution to the success of the Sustainable Development Goals.”

To support the global effort to eradicate polio and mitigate the risk of the disease re-emerging, the Board also agreed a cost-sharing approach for the inactivated polio vaccine (IPV). Gavi will fully-finance the vaccine for the very poorest countries, however other countries which receive Gavi support for IPV will need to use the amount they currently spend on bivalent oral polio vaccine (bOPV) – roughly US$ 0.60 per child – for IPV once bOPV is withdrawn after eradication is certified. Gavi will provide the remaining finance.

In addition, the Board requested that the Gavi Secretariat explore approaches to engaging with self-financing lower middle-income countries in recognition of major challenges in those countries.

As part of the Gavi Board meeting, which took place in Geneva on 26-27 June, the Board also exceptionally approved an extension of Papua New Guinea’s (PNG) accelerated transition phase until the end of 2025. The country had been due to transition out of Gavi support at the end of 2020. But it remains extremely fragile, with a very weak health system, the lowest vaccine coverage in the region, high child mortality and recent outbreaks of polio and measles despite considerable economic growth driven by the extractive industries. The Board therefore agreed that this exceptional situation warranted an extension to the country’s transition, subject to the government setting out and committing to reforms to the health sector.

The plans set out in the strategy, including funding for all vaccines, are dependent on a successful replenishment for the 2021-25 period, which will culminate in a pledging event next summer in London. The replenishment process will begin at a high-level event hosted by the Japanese government on the occasion of TICAD 7 in Yokohama in August 2019, where Gavi will launch its investment opportunity for the next period. Richard Clarke, Director General for Policy, Research and Humanitarian at the UK Department for International Development (DFID), and Masashi Nakagome, Minister at the Permanent Mission of Japan in Geneva, both addressed the Board meeting to discuss these events and the road to replenishment.

Gavi’s unique public-private partnership model means it needs predictable financing to allow manufacturers and implementing countries to forecast demand over a five-year period. This helps to drive value for money and maximise the impact of every dollar invested in the Vaccine Alliance. The upcoming 2021-25 strategic period will be Gavi’s fifth.

DRC – Ebola/Measles/Cholera/Polio

Milestones :: Perspectives :: Research

 

DRC – Ebola/Measles/Cholera/Polio

Disease Outbreak News (DONs}
Ebola virus disease – Democratic Republic of the Congo
27 June 2019
The Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces continues at a stable pace this week. Although response operations were temporarily interrupted in Beni following two days of insecurity in the surrounding areas, operations have largely resumed. However, in the town of Musienene, violent threats persist against healthcare workers (HCW) and local security forces providing assistance to the response efforts. Furthermore, response activities in Kambau health area, Manguredjipa health zone were also suspended following security incidents.
Of growing concern this week, are the current hotspots of Mabalako, particularly the Aloya health area, and Mandima (Figure 1), which were the first health zones to report EVD cases in August/September 2018. Sporadic reintroduction events in areas such as Vuhovi, which had not reported any new cases in the past 24 days, further compound the evolving situation. Other areas experiencing a similar resurgence in EVD cases after a period of prolonged absence include Komanda and Masereka…

47: Situation report on the Ebola outbreak in North Kivu
25 June 2019
…Implementation of ring vaccination protocol
:: As of 22 June 2019, 140 794 people at risk have consented to and received the rVSV-ZEBOV-GP Ebola vaccine. Of those, 37 373 are contacts and 67 756 contacts-of-contacts. The total number of vaccines includes 31 016 HCWs/FLWs and 34 522 children 1-17 years of age.

:: Five new rings were opened around nine confirmed cases on 18 June 2019, another four new rings were opened around seven new cases on 17 June 2019 and an additional ring around two cases reported on 22 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.

Risk communication, social mobilization and community engagement
:: Mass communication on the Ebola outbreak situation and the response activities are being aired on over 100 radio stations, particularly in outbreak hotspots to update the public on the situation in their localities and to urge their collaboration in stopping the outbreak. Discussions on Ebola are also regularly organized to address community concerns and clarify misinformation that may be spreading through various social media or other platforms.

:: Community Ebola committees have been actively engaged in the Ebola response in 20 localities in Butembo, Katwa and Vuhovi. These areas were previously difficult to reach due to security and other challenges.

:: To expand community ownership of the Ebola response to other Ebola-affected and non-affected areas in and around North Kivu and Ituri, a Community Animation Committee (CAC), which is a community participation platform for health, is being established in 1600 areas over the next weeks.

:: Social scientists are working with local communities in Mangina and other areas to better understand the local practices that can influence a community’s health./..

Polio this week as of 26 June 2019 – GPEI
:: Two new cVDPV2 emergences are reported this week in DR Congo; one from Sankuru province and one from Kasai province. Sankuru province is in the centre of the country and had previously not participated in mOPV2 outbreak response campaigns.  However, it is neighboring known infected provinces, where mOPV2 response continues to be implemented.  Kasai had already been participating in mOPV2 outbreak campaigns, as it had already been affected by a separate cVDPV2.  Currently, total six, genetically-distinct cVDPV2 outbreaks affecting the country.

Emergencies

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 26 June 2019
:: Two new cVDPV2 emergences are reported this week in DR Congo; one from Sankuru province and one from Kasai province. Sankuru province is in the centre of the country and had previously not participated in mOPV2 outbreak response campaigns.  However, it is neighboring known infected provinces, where mOPV2 response continues to be implemented.  Kasai had already been participating in mOPV2 outbreak campaigns, as it had already been affected by a separate cVDPV2.  Currently, total six, genetically-distinct cVDPV2 outbreaks affecting the country.
:: One of the major factors that determines whether a child will receive vaccinations is the primary caregiver’s receptiveness to immunization.  The decision to vaccinate is a complex interplay of various socio-cultural, religious, and political factors. Read how everyday people in Pakistan are advocating for vaccinations.
:: Bayelsa State in the Niger Delta, Nigeria, is a riverine state with precarious transportation and rivers crisscrossing the land. Thanks to healthcare workers, community engagement and innovations in immunization practices, Bayelsa State jumped from one of the most poor-performing states in terms of routine immunization to be the second best in the country. Read more here.
Summary of new viruses this week:

Summary of new viruses this week:
:: Afghanistan — two wild poliovirus type 1 (WPV1) cases;
:: Pakistan — three WPV1 cases;
:: Nigeria — one circulating vaccine-derived poliovirus type 2 (cVDPV2) case;
:: DRC— four cVDPV2 cases;
:: Ethiopia— three cVDPV2 isolated from healthy community contacts.

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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 29 Jun 2019]

Democratic Republic of the Congo
:: Winning the hearts of communities fearful of Ebola 24 June 2019
:: 47: Situation report on the Ebola outbreak in North Kivu 25 June 2019
:: Disease Outbreak News (DONs} Ebola virus disease – Democratic Republic of the Congo
27 June 2019
[See DRC Ebola above for detail]

Mozambique floods
:: 200 000 people lack access to health services in Mozambique 21 June 2019

Nigeria
:: States in Nigeria’s South West zone conclude second round of outbreak response
26 June 2019 All six States in the South West Zone have completed the ‘2nd Outbreak Response’ (OBR2) to the circulating Vaccine Derived Polio Virus (cVDPV2) with varying degrees of success. The exercise, implemented on 15 – 24 June, was in response to confirmed reports by the Lagos State Government of environmental strains of Polio Virus in Makoko, Itire and Maracana canals, as well as in Imeko Afon LGA of Ogun State.
Initial large-scale zonal supplementary immunization activities were coordinated across all States (Lagos, Ogun, Osun, Oyo, Ondo and Ekiti), during the OBR1 conducted on 18 -21 May, 2019. Polio eradication teams on the ground covered 89,841 settlements. The teams maximized the impact of available resources and ensured that oral polio vaccine be administered to 9,927,112 under-five year old children in all the States…

Somalia
:: WHO and UNICEF Somalia and partners call on all Somalis to vaccinate children against polio
25 June 2019

Myanmar – 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

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WHO Grade 2 Emergencies [to 29 Jun 2019]

Bangladesh – Rakhine conflict
:: Bi‐weekly Situation Report 12 – 20 June 2019

Libya
:: Mental health support in a time of war 25 June 2019
:: Mental illness: training Libya’s health workers 24 June 2019

Afghanistan – No new digest announcements identified
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
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

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WHO Grade 1 Emergencies [to 29 Jun 2019]

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
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Situation Report No. 6 – as of 28 June 2019

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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: Assistant Secretary-General for Humanitarian Affairs and Deputy Emergency Relief Coordinator, Ursula Mueller – Opening remarks at ECOSOC Humanitarian Affairs Segment Side Event “Cyclone Idai: The Ongoing Needs,” 26 June 2019

EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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WHO & Regional Offices [to 29 Jun 2019]

WHO & Regional Offices [to 29 Jun 2019]
27 June 2019 News release
Eliminating trachoma: WHO announces sustained progress with hundreds of millions of people no longer at risk of infection

27 June 2019 News release
A New WHO Goodwill Ambassador for Universal Health Coverage
Professor Keizo Takemi. Japan

26 June 2019
WHO advice for international travel in relation to measles
Measles is one of the world’s most contagious diseases and the best protection against the disease is through receiving two doses of the measles vaccine.
Over recent months, spikes in measles case numbers have occurred including in countries with high overall vaccination coverage as the disease has spread fast among clusters of unvaccinated people.

25 June 2019 News release
WHO and UNICEF Somalia and partners call on all Somalis to vaccinate children against polio
Mogadishu, 25 June 2019 – Health authorities rolled out a polio campaign yesterday in Puntland and Somaliland to vaccinate more than 940,000 children under 5 years of age to stop an ongoing outbreak of a strain of poliovirus.
The campaign runs from 24 to 27 June 2019, with support from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). It targets all children in 12 districts in Somaliland and 9 districts in Puntland.
By the numbers:
:: 945,480 children to be vaccinated
:: 3160 vaccinators knocking on doors
:: 677 team supervisors taking part
:: 1558 social mobilizers sharing messages on vaccination and children’s health
:: 15 children have been infected with the polioviruses so far, since outbreaks began

 

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Weekly Epidemiological Record, 28 June 2019, vol. 94, 26 (pp. 293–300)
:: Index of countries/areas
:: Index, Volume 94, 2019, Nos. 1–26
:: Weekly Epidemiological Record, 24 May 2019, vol. 94, SPECIAL ISSUE (pp. i–xlviii)
:: Validation of elimination of maternal and neonatal tetanus in Chad

 

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Ethiopia sets new standards for the management of acute malnutrition 28 June 2019
:: Behind the scenes in the Ebola response : The call centre manager 27 June 2019
:: WHO Regional Director commends Uganda’s Ebola preparedness response 26 June 2019
:: Winning the hearts of communities fearful of Ebola 24 June 2019

WHO Region of the Americas PAHO
:: PAHO Executive Committee concludes sessions with agreements on advancing health in the Region of the Americas
Washington, DC, June 28, 2019 (PAHO/WHO) – The Executive Committee of the Pan American Health Organization (PAHO) concluded its 164th session on June 27, following discussions and deliberations on a variety of strategies, actions plans and policies that address a number of key health challenges for the population in the Americas.
Issues that were advanced during the Committee include: strategies and action plans to improve quality of care in health service delivery; to ensure donations and equitable access to organ, tissue and cell transplants; on ethnicity and health; and on health promotion within the context of the Sustainable Development Goals. The Executive Committee also addressed issues around the elimination of industrially produced trans-fatty acids, and the strengthening of information systems for health, as well as a PAHO disease elimination initiative for an integrated approach to communicable disease…

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

WHO European Region EURO
:: Alongside European Development Days, WHO and the European Commission reinforce cooperation to help countries move towards universal health coverage 26-06-2019

WHO Eastern Mediterranean Region EMRO
:: Ending cholera in Somalia 26 June 2019
:: Vaccines protect children from preventable diseases in Iraq 23 June 2019
:: Cholera vaccination drive begins in high-risk districts in Somalia 23 June 2019

WHO Western Pacific Region
– No new digest announcements identified

CDC/ACIP [to 29 Jun 2019]

CDC/ACIP [to 29 Jun 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Thursday, June 27, 2019
CDC Press Release: Most Americans Have Never Had an HIV Test, New Data Show
The CDC recommends that everyone between the ages of 13 – 64 years be screened at least once in their lifetime, yet less than 40% of people in the U.S. have ever been tested for HIV, according to a CDC report published today in the Morbidity and Mortality Weekly Report (MMWR).

The new data, released on National HIV Testing Day, underscore the urgent need to scale up HIV testing to end America’s HIV epidemic. The analysis of 2016-2017 data from a national population-based survey suggest most people are not getting the recommended screening, even in areas with a high burden of HIV. Highlights of the analysis include the following:
:: Overall, fewer than 40% of people in the United States have ever had an HIV test.
:: Nationally, less than 30% of people in the United States most at risk of acquiring HIV were tested in the past year.
:: In the 50 local jurisdictions where more than half of HIV diagnoses occur, less than 35% of people recommended for annual HIV testing were tested in the past year.
:: In states with rural areas that are particularly affected by HIV, just 26% of people recommended for annual HIV testing were tested in the past year…

MMWR News Synopsis for Friday, June 28, 2019
HIV Screening in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016–2017
CDC analysis demonstrates the urgent need to expand HIV testing as part of the proposed federal plan to end the U.S. HIV epidemic. CDC recommends that everyone ages 13-64 years be screened for HIV at least once in their lifetime. New CDC data show that fewer than 40% of people in the U.S. have ever been tested for HIV. The 2016-2017 data, from a national population-based survey, suggest that most people are not getting the recommended screening – even in areas with the greatest burden of HIV. Expanding HIV testing is a critical part of the proposed federal plan to end the U.S. HIV epidemic, as testing can be a gateway to prevention options like pre-exposure prophylaxis (PrEP) or can link a person with HIV to care and treatment that protects their health and prevents new infections.

Africa CDC [to 29 Jun 2019]

Africa CDC [to 29 Jun 2019]
https://au.int/en/africacdc
June 24, 2019
Training of Trainers Workshop on Public Health Emergency Operations Centres Open
A nine-day training of trainers workshop on the management and operations of a Public Health Emergency Operations Centre (PHEOC) opened in Addis Ababa, Ethiopia, Monday 24 June 2019. Thirty-one trainees from 21 African Union Member States and Saudi Arabia are participating in the workshop, which is facilitated jointly by the West Africa Health Organization (WAHO), WHO Headquarters, WHO Regional Office for Africa, WHO Regional Office for the Eastern Mediterranean, US CDC and Africa CDC.