Vaccines and Global Health: The Week in Review :: 03 Aug 2019

.– Request anEmail Summary:Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to

pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_3 Aug 2019

– blog edition: comprised of the approx. 35+ entries posted below.

– Twitter:Readers can also follow developments on twitter: @vaxethicspolicy.
– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

Support this knowledge-sharing service: Your financial support helps us cover our costs and to address a current shortfall in our annual operating budget. Click here to donate and thank you in advance for your contribution.

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

Publication of Vaccines and Global Health: The Week in Review will resume in full with the edition of 24 August 2019, following annual leave by the editor/publisher.

Dengue Vaccine :: Philippines weighs re-use of controversial dengue vaccine

Milestones :: Perspectives :: Research


Dengue Vaccine

Philippines weighs re-use of controversial dengue vaccine
August 2, 2019
MANILA (Reuters) – The Philippines is considering re-introducing a dengue vaccine whose use it halted because of links to the deaths of several children, as authorities battle to contain a dengue outbreak that has killed more than 450 people this year.

Concerns over dengue immunization for nearly 734,000 children aged nine or older sparked two congressional inquiries, a criminal investigation and a sharp fall in the number of parents seeking routine vaccinations for their children.

If the government decided to revive the use of Dengvaxia, developed by French drugmaker Sanofi, it would be administered with “utmost caution”, presidential spokesman Salvador Panelo said.

“If Dengvaxia is proven effective to those who already had dengue in the past, then its application to these individuals will surely cause the decline of the overall number of cases,” he told reporters.

The Philippines stopped using Dengvaxia in late 2017 and ordered Sanofi to stop selling, distributing and marketing it after Sanofi warned the vaccine could worsen the disease in some cases.

In March, the Department of Justice said it had found probable cause to indict Sanofi officials, and former and current Philippine health officials, over 10 deaths it said were linked to the use of Dengvaxia, which Sanofi has repeatedly said is safe and effective.

Panelo said the government would follow a protocol set by the World Health Organization for all individuals to be screened before receiving the vaccine, to determine if they have ever been exposed to the infection.

Any decision to start administering the vaccine again would not affect cases against individuals involved in the controversy, he added.

This year, the Philippines has reported more than 100,000 cases of dengue, a mosquito-borne tropical disease that kills about 20,000 people annually and infects hundreds of millions…

International Coalition of Medicines Regulatory Authorities (ICMRA) Antimicrobial Resistance Press Release (July 2019)

Milestones :: Perspectives :: Research

International Coalition of Medicines Regulatory Authorities (ICMRA)
Antimicrobial Resistance Press Release (July 2019)
31 July 2019
… ICMRA4 recognizes that AMR is a complex, multi-faceted problem, and is calling for a coordinated, One Health5 response across all sectors, including public health, animal health, and the environment. Its member medicines regulators from around the globe have united with the WHO to strongly encourage policy makers, industry, academia, healthcare professionals, non-governmental organizations, media organizations, and the public to come
together to:

:: continue advances in antimicrobial surveillance, infection prevention and control, and stewardship;
:: prioritize the development of innovative new medicines and other therapeutic products that will help combat AMR, including diagnostics and alternatives to antimicrobials;
:: ensure equitable access to antimicrobials across the globe; and
:: minimize the release of substances with antimicrobial properties into the environment.

There are unique challenges facing the development, commercialization and viability of products that tackle AMR, and there is a need for modern regulatory systems that can adapt to these needs. Medicines regulators therefore commit to work together to streamline regulatory requirements, without compromising the quality, efficacy and safety review of these products. We also commit to develop processes that facilitate the review of emerging
technologies, such as phage therapy6 and point-of-care diagnostics. We invite research and development stakeholders to seek advice at any time from medicines regulators for help navigating regulatory systems and to identify emerging challenges specific to the issue of AMR.

While global medicines regulators are fully prepared to continue to take action to address this public health threat, they are encouraging other partners to do their part to address this One Health issue:

:: ICMRA calls on leaders of industry to increase their collective investment in research and development. There is a dire need for new antimicrobials that will work when all other options fail, for alternatives to antimicrobials so that their use can be minimized, and for diagnostic products that facilitate prudent and appropriate use. Infection prevention and control is the foundation of modern healthcare and innovation to combat AMR must coincide with advancements in other areas to ensure a stable global health system.

:: ICMRA calls on all health care practitioners, in both human and animal health, to prioritize the appropriate use of antimicrobials and incorporate responsible antimicrobial prescribing principles into clinical practice. The WHO has developed the AWaRe tool to help guide decision-making on which antibiotic to use when7.

:: ICMRA calls on global health leaders to come together with industry to determine the most effective way to address the economic issues surrounding new product development to incentivize innovation and implement required changes.

:: ICMRA also calls for continued research in all aspects of AMR, including continual monitoring of the effectiveness of existing antimicrobial agents and conducting active surveillance of emerging antimicrobial resistance.

:: ICMRA calls on media organizations around the globe to keep AMR at the forefront of the news cycle and to help increase public awareness of this issue. AMR is one of the largest global threats to public health and the public needs to be aware of what is at stake and what individuals can do to combat this health threat.

We all have a role to play in combatting AMR. A coordinated effort from all partners is essential to ensuring our success in addressing this threat to our health, economies and security. Lives around the world depend on it.



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 31 July 2019
:: July 2019 Polio News is available online for all the latest news, polio in numbers and the funding updates.

Summary of new viruses this week:
:: Afghanistan — one wild poliovirus type 1 (WPV1) case;
:: Pakistan— two WPV1-positive cases and eight WPV1-positive environmental samples;
:: Nigeria —one circulating vaccine-derived poliovirus type 2 (cVDPV2) case and one cVDPV2-positive environmental sample;
:: Democratic Republic of the Congo (DRC) — one cVDPV2 sample isolated from a contact case and one cVDPV2 community isolate;
:: Central African Republic — one cVDPV2-positive environmental sample and 13 cVDPV2 samples isolated from community;
:: Myanmar — one cVDPV type 1 case and five cVDPV1 samples isolated from a contact case.


Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Inter-Agency Statement on Ebola outbreak in the Democratic Republic of the Congo, one year on
Joint statement from WHO Director-General Dr Tedros Adhanom Ghebreyesus, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock, UNICEF Executive Director Henrietta Fore, and World Food Programme Executive Director David Beasley
NEW YORK/GENEVA/KINSHASA/DAKAR/ROME, 31 July 2019 – “Tomorrow, 1 August, marks one year since the Government of the Democratic Republic of the Congo (DRC) declared an outbreak of the Ebola virus disease in North Kivu province of the DRC. Two weeks ago, it was declared a public health emergency of international concern.

“Just yesterday, a new case of the disease was confirmed in Goma, with the patient later dying – the second case to be confirmed this month in the city of around 1 million people. This latest case in such a dense population center underscores the very real risk of further disease transmission, perhaps beyond the country’s borders, and the very urgent need for a strengthened global response and increased donor investment.

“In the last year, there have been more than 2,600 confirmed cases, including more than 1,800 deaths in parts of Ituri and North Kivu provinces. Almost one in three ‘cases’ is a child. Every single ‘case’ is someone who has gone through an unimaginable ordeal. More than 770 have survived.

“The disease is relentless and devastating.

“Ebola passes from mother to child, husband to wife, patient to caregiver, from the dead body of a victim to the mourning relative. The disease turns the most mundane aspects of everyday life upside down — hurting local businesses, preventing children from going to school and hampering vital and routine health services. It is primarily a health crisis, but one that also critically impacts how people care for their family, view their neighbours and interact with their community.

“The challenges to stopping further transmission are indeed considerable. But none are insurmountable. And none can be an excuse for not getting the job done. The United Nations and partners are continuing to ramp up the response in support of the Government and to further bolster joint action. The UN is working to ensure an enabling environment for the public health response that its health agency supports, including appropriate security, logistics, political and community engagement, and action to address the concerns of affected communities. We commend the recent Government decision to take measures to ensure its efforts are further joined up.

“We also salute the heroic efforts of the mostly Congolese healthcare workers on the front line, the people of affected communities and partners. Despite their ceaseless work, the disease continues to spread. This outbreak is occurring in an active conflict zone which makes an effective response far more complicated because of insecurity, including armed attacks on health workers and facilities, and population displacement. In some of the affected areas, violence is preventing us from reaching communities and working with them to stop further transmission.

“We call on all parties to the violence to ensure that responders can do their work safely and that those seeking care can access it without fear of attacks.

“We are proud of the work that we and our partners have done so far, collaborating with communities in support of the Government-led response to protect those at risk and care for those affected:
:: Over 170,000 people vaccinated;
:: 1,300 people treated with investigational therapies across 14 treatment and transit centres;
:: 77 million screenings of national and international travelers;
:: 20,000 contacts visited daily to ensure they do not also become sick;
:: 3,000 samples tested in 8 laboratories every week;
:: More than 10,000 handwashing sites installed in critical locations;
:: More than 2,000 community engagement workers operating in affected – areas listening to concerns, gaining trust, and mobilizing local action;
:: Over 440,000 patients and contacts provided with food assistance, crucial to limiting movement among people who could spread the disease; and
:: Daily meals provided to 25,000 schoolchildren in Ebola-affected areas to help build trust within communities.

“Now we must build on those achievements, but to do so we urgently need far more support from the international community. The Government needs more support than ever before. The public health response to an Ebola outbreak requires an exceptional level of investment; 100 per cent of cases must be treated and 100 per cent of contacts must be traced and managed. We need air transport to get responders and critical equipment to some of the most remote areas and warehousing to safely store precious health supplies including vaccines. We will continue to accelerate our response, and we ask partners old and new to do the same.

“At this critical juncture, we reaffirm our collective commitment to the people of the DRC; we mourn for those we have lost; and we call for solidarity to end this outbreak.”


Rwanda’s border with DRC remains open
Kigali, August 1 2019 — The Ministry of Health confirms that Rwanda’s border with the Democratic Republic of Congo is open, following traffic slow-down this morning as measures were put in place to reinforce screening procedures and public safety at entry points.
To date, Rwanda remains Ebola free. The Ministry has advised against unnecessary travels to Goma-Eastern Congo, following increasing number of cases confirmed in DRC, and requested that individuals who have recently travelled to an Ebola affected area to report to the nearest screening station and to report any suspected Ebola cases via the Ministry of health toll-free lines 114, police number 112 or to community health workers or the nearest health centre…


Geneva Palais briefing note on the impact of the Ebola outbreak on children in the Democratic Republic of the Congo
Press release
This is a summary of remarks by Jerome Pfaffman, UNICEF Senior Health Specialist – to whom quoted text may be attributed – at today’s press briefing at the Palais des Nations in Geneva
…This Ebola response is far more complex because it is in an active conflict zone. People living in North Kivu and Ituri are facing a public health emergency and a humanitarian crisis at the same time.
Both provinces, for example, are also facing a major measles outbreak. In Ituri, about half of the health facilities have been damaged or destroyed during fighting over the past two years. There is mass displacement. We have just completed a first vaccination campaign in the provincial capital, Bunia, where we vaccinated more than 40,000 children against measles. But we need to vaccinate far more children, against the full array of diseases, in order to protect them from all the public health risks they are exposed to.
This is why the new strategic response plan includes both an intensification of the public health response, and a whole program to address acute humanitarian and social needs.
UNICEF will need to triple its budget to respond to this complex crisis. This includes about 70 million dollars for epidemic control activities, 30 million to build community capacities in at-risk areas, and another 70 million to deliver essential services.
Colleagues and communities are fighting the outbreak tirelessly but we desperately need the international community to back us up…


Press release
UNICEF ramps up Ebola prevention efforts as South Sudan assessed as ‘high-risk’ country
UN children’s agency reaches 3 million with Ebola prevention messages
…UNICEF South Sudan is focusing on and engaging populations that are most at risk in the states bordering DRC and Uganda. The UN children’s agency and its partners have trained 450 front-line mobilizers who are knocking on doors, organizing community meetings and engaging religious and local leaders to disseminate life-saving messages.
“Our teams and partners on the ground working in the communities confirm that an increasing number of people are now aware of Ebola, and the protection measures they can take to avoid infection,” said Ayoya, “The early detection and containment of the three Ebola cases in Uganda in June came as a result of increased public awareness and shows the true value of the prevention work and of working with communities. As long as Ebola remains on our doorstep, we cannot rest and must continue our efforts.”…


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 3 Aug 2019]

Democratic Republic of the Congo
[See DRC Ebola+ above for detail]

Cyclone Idai – No new digest announcements identified
Mozambique floods – 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 3 Aug 2019]

:: Libya: Five medical staff dead in latest attack on health facilities in Tripoli
Tripoli, 28 July 2019 – The World Health Organization strongly condemns yesterday’s attack on Az Zawiyah Field Hospital in the south of Tripoli. Five health workers were killed and eight were injured in the attack. The hospital was damaged and forced to suspend its services.

:: MERS-CoV global summary and assessment of risk – August 2018
pdf, 570kb

:: Bi‐weekly Situation Report 15 – 1 August 2019

Afghanistan – 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
HIV in Pakistan – 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
Measles in Europe – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017)
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified


WHO Grade 1 Emergencies [to 3 Aug 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


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 – No new digest announcements identified
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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified



WHO & Regional Offices [to 3 Aug 2019]

WHO & Regional Offices [to 3 Aug 2019]
31 July 2019
At 1-year mark, we mourn the lives lost, and call for solidarity
Joint statement by heads of agencies on the Ebola outbreak in the Democratic Republic of the Congo
Statement New York, Geneva, Kinshasa, Rome
[See Ebola above for detail]



Weekly Epidemiological Record, 26 July 2019, vol. 94, 30/31 (pp. 329–344)
:: Progress towards poliomyelitis eradication in Nigeria, January 2018 – May 2019
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2019



WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Rwanda’s border with DRC remains open 02 August 2019
:: World Hepatitis Day:  Nigerians implored to be screened and vaccinated   01 August 2019
:: WHO marks one year since the beginning of the Ebola outbreak in the Democratic Republic of the Congo  31 July 2019
:: Ethiopia joins global efforts to end cholera by 2030 29 July 2019
:: EBOLA, Cascade training in IPC, Case Management, Hand Hygiene, Chlorine Preparation and Mental Health conducted in Rwanda 29 July 2019
:: WHO and the Africa Centres for Disease Control and Prevention call on countries in the region to work together on the Ebola response 29 July 2019

WHO Region of the Americas PAHO
:: Improving health service monitoring of high-risk populations seeks to prevent new HIV infections (08/01/2019)
:: Maternity Protection Laws must be implemented throughout the Americas to protect breastfeeding mothers in the workplace (08/01/2019)

WHO South-East Asia Region SEARO
:: Bangladesh, Bhutan, Nepal and Thailand achieve Hepatitis B control: WHO
SEAR/PR/1714 New Delhi, July 26, 2019: Bangladesh, Bhutan, Nepal and Thailand have become the first countries in WHO South-East Asia Region to achieve Hepatitis B control, with prevalence of the deadly disease dropping to less than one per cent among five-year-old children, the World Health Organization announced today.

WHO European Region EURO
:: Nationwide campaign aims to educate women in Ukraine on the harm of alcohol consumption during pregnancy 02-08-2019

WHO Eastern Mediterranean Region EMRO
:: WHO Regional Director’s statement on Pakistan
Cairo, Egypt, 1 August 2019 — I have just returned from my third, and most fruitful and memorable visit to Pakistan as WHO Regional Director for the Eastern Mediterranean. The 4 days I spent in the country this week were truly effective and productive. I had the chance to visit different areas in the country, including Larkana, where the current HIV…

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 3 Aug 2019]

CDC/ACIP [to 3 Aug 2019]
Thursday, August 1, 2019
CDC Remains Committed One Year into the Fight against Ebola in the Democratic Republic of the Congo
…“As the WHO PHEIC declaration makes clear, this Ebola outbreak continues to be a complex and serious public health threat,” said CDC Director Robert R. Redfield, MD. “CDC remains prepared for the prolonged journey ahead and remains committed to working with our U.S. government and international partners to support the response and end this outbreak.”
One year into the fight against Ebola, CDC and the U.S. government remain committed to working with and empowering the ministries of health of DRC and neighboring countries, in collaboration with other international partners, to ensure the outbreak response is well coordinated to stop the spread of disease and end the outbreak. CDC is committed to strengthening the healthcare system in DRC to help reduce the risk of future outbreaks, not only of Ebola, but of other diseases such as HIV, measles, tuberculosis, and malaria. CDC’s commitment to global health goes hand in hand with CDC’s commitment to the safety and security of the American public.

Africa CDC [to 3 Aug 2019]

Africa CDC [to 3 Aug 2019]
Inspection Visit to Africa CDC Headquarters Building Site
ADDIS ABABA, ETHIOPIA, 29 JULY 2019. The African Union Commissioner for Social Affairs, H.E. Amira Elfadil Mohammed Elfadil, and the Ambassador and Head of Mission of China to the African Union, H.E. Mr Yuxi Liu, visited the site of the Africa CDC headquarters building in company of other representatives of the African Union and China today. The visit was to view the site and receive detail briefing about the construction.