Milestones :: Perspectives :: Research

Two out of three wild poliovirus strains eradicated
Global eradication of wild poliovirus type 3 declared on World Polio Day
24 October 2019 – In a historic announcement on World Polio Day, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a historic achievement for humanity.

“The achievement of polio eradication will be a milestone for global health. Commitment from partners and countries, coupled with innovation, means of the three wild polio serotypes, only type one remains,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board “We remain fully committed to ensuring that all necessary resources are made available to eradicate all poliovirus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” he added.

There are three individual and immunologically-distinct wild poliovirus strains: wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3).

Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains three separate viruses that must each be eradicated individually.

WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Since then, the strength and reach of the eradication programme’s global surveillance system has been critical to verify that this strain is truly gone. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.

At a celebration event at the headquarters of the World Health Organization in Geneva, Switzerland, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury [chair of the independent Global Commission for the Certification of Poliomyelitis Eradication].  “This this is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1. This virus remains in circulation in just two countries: Afghanistan and Pakistan. We cannot stop our efforts now: we must eradicate all remaining strains of all polioviruses.  We do have good news from Africa:  no wild poliovirus type 1 has been detected anywhere on the continent since 2016 in the face of ever improving surveillance.  Although the region is affected by circulating vaccine-derived polioviruses, which must urgently be stopped, it does appear as if the continent is free of all wild polioviruses, a tremendous achievement.”

Eradicating WPV3 proves that a polio-free world is achievable. Key to success will be the ongoing commitment of the international development community.  To this effect, as part of a Global Health Week in Abu Dhabi, United Arab Emirates, in November 2019, the Reaching the Last Mile Forum will focus international attention on eradication of the world’s deadliest diseases and provide an opportunity for world leaders and civil society organizations, notably Rotary International which is at the origin of this effort, to contribute to the last mile of polio eradication. The GPEI 2019–2023 Investment Case lays out the impact of investing in polio eradication.  The polio eradication efforts have saved the world more than US$27 billion in health costs since 1988. A sustained polio-free world will generate further US$14 billion in savings by 2050, compared to the cost countries would incur for controlling the virus indefinitely.

The GPEI is a public-private global effort made up of national governments, partners including the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and a broad range of long-term supporters.

WHO DG: Thank you to all who made WPV3-free world possible
DG calls for doubling of efforts to now finish all remaining poliovirus strains
25/10/2019

Milestones :: Perspectives :: Research

Press release
UNICEF and partners provide vaccination against polio and measles for nearly 232,000 children in Syria and Iraq, many affected by violence in northeast Syria
AMMAN, 25 October 2019 – UNICEF and partners have provided polio and measles vaccines for approximately 230,000 children under the age of five in Al-Hasakeh governorate, in northeast Syria, including in collective shelters and camps such as Al-Hol and A’reesha.

Since the latest wave of violence in northeast Syria escalated less than two weeks ago, at least 80,000 children have been forced to flee their homes.

Nearly 4,000 children have fled the violence to Iraq, crossing the border into the Kurdistan Region of Iraq via the Sahela and Al-Waleed border crossings and are now in Bardarash camp in Dohuk, north of Iraq. UNICEF-supported teams are at the border, working with partners to vaccinate children against polio and measles. To date, 2,790 children have been vaccinated against polio and 2,595 children have been vaccinated against measles.

“Nearly nine years of war have caused vaccination levels among children in Syria to plummet from 80 per cent pre-conflict to less than 50 per cent,” said Ted Chaiban, UNICEF Regional Director for the Middle East and North Africa. “Reaching children who are at high risk for diseases including measles and polio is critical”, he added.

In 2013, a polio outbreak paralyzed 36 children in Syria and another two in Iraq the following year. In response, UNICEF and partners launched the largest ever polio vaccination campaign in the history of the region, reaching more than 25 million children in seven countries, multiple times. No new cases of wild poliovirus have been reported in these countries since.

Milestones :: Perspectives :: Research

PAHO Director in Rio de Janeiro highlights achievements and challenges in vaccine production
Rio de Janeiro, 22 October 2019 (PAHO/WHO) – The Director of the Pan American Health Organization (PAHO), Carissa F. Etienne, highlighted the achievements and challenges of vaccine production during the opening of the 20th General Meeting of the Developing Countries Vaccine Manufacturers Network (DCVMN), today, in the city of Rio de Janeiro.

“I see this Network as a global public good, a network of manufacturers and innovators that have assumed the principle of collective action and solidarity, to protect global health. The vaccines you produce protect and promote the health of millions in this Region (Americas), and globally”, she stated.

The PAHO Director also encouraged the network of producers to continue efforts to invest in new vaccines that have high quality and are affordable.

“And more importantly,” she added, “I urge you to ensure and protect the global supply of the more ‘traditional and well established’ vaccines that are becoming less attractive to produce commercially.”

Maurício Zuma, Director of the Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos/Fiocruz) and co-chair of the Network, said the meeting aims to share experiences and discuss capacities, financing, supplies, regulatory issues, alliances, partnerships, innovations, among other topics.

“Our vaccines have prevented the spread and export of several diseases and saved millions of lives each year. It makes us proud. But we are aware of our responsibility and we know that innovation is key to our survival in the long term,” he said…

The Minister of Health of Brazil, Luiz Henrique Mandetta, announced during the event that after three years of discontinuation of yellow fever vaccine exports, Brazil will resume its capacity to supply its domestic demand and provide vaccines to other countries. Between 2017 and 2018, the country had yellow fever outbreaks and suspended its vaccine exports, focusing all its production for the Brazilian population. “Another important step we are taking, which is in the final stages of modeling, is the construction of the Health Biotechnology Industrial Complex. It will be a multiple platform that can produce different types of vaccines, quickly responding to domestic needs”, said Mandetta.

The Developing Countries Vaccine Manufactures Network (DCVMN) annual meeting runs until October 24, with the participation of experts from 14 countries. The event addresses topics such as technological advances, equitable access to vaccines around the world, regulatory issues and strategies, current industry challenges with an emphasis on developing countries, and partnership opportunities…

Established in the year 2000, the DCVMN network currently includes 50 vaccine manufacturers in 17 countries and territories, producing and supplying over 40 different types of vaccines in several presentations, totaling around 200 products.

Milestones :: Perspectives :: Research

NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale
Initial investment aims to advance accessible and scalable candidate interventions into clinical trials within 10 years.

The collaboration will align aggressive, high-reward research efforts to accelerate progress on shared gene-based strategies (depicted in green) to cure sickle cell disease and HIV that are available globally including in low-resource settings, while continuing to invest in other parallel research efforts on cures for these two diseases outside of the collaboration.

Wednesday, October 23, 2019
The National Institutes of Health plans to invest at least $100 million over the next four years toward an audacious goal: develop affordable, gene-based cures for sickle cell disease (SCD) and HIV. The Bill & Melinda Gates Foundation will also invest $100 million toward this goal. The intention is for these cures to be made globally available, including in low-resource settings.

This initiative follows a bold announcement made earlier this year by President Donald J. Trump during the State of the Union Address to end the HIV epidemic in the United States in the next 10 years. Ending the HIV Epidemic: A Plan for America aims to leverage the powerful data and tools now available to reduce new HIV diagnoses in the United States by 75% in five years and by 90% by 2030. The Trump Administration has also elevated the attention paid to sickle cell disease, identifying it as an intractable health challenge with the potential for dramatic advances in the coming years.

Dramatic advances in genetics over the last decade have made effective gene-based treatments a reality, including new treatments for blindness and certain types of leukemia. Yet these breakthroughs are largely inaccessible to most of the world by virtue of the complexity and cost of treatment requirements, which currently limit their administration to hospitals in wealthy countries. To make these treatments effective and available for SCD and HIV, which disproportionately affect populations living in Africa or of African descent, new investment is needed to focus research on the development of curative therapies that can be delivered safely, effectively and affordably in low-resource settings.

The collaboration between the NIH and the Gates Foundation sets out a bold goal of advancing safe, effective and durable gene-based cures to clinical trials in the United States and relevant countries in sub-Saharan Africa within the next seven to 10 years. The ultimate goal is to scale and implement these treatments globally in areas hardest hit by these diseases.

“This unprecedented collaboration focuses from the get-go on access, scalability and affordability of advanced gene-based strategies for sickle cell disease and HIV to make sure everybody, everywhere has the opportunity to be cured, not just those in high-income countries,” said NIH Director Francis S. Collins, M.D., Ph.D. “We aim to go big or go home.”…

Milestones :: Perspectives :: Research

Global Health Progress launched to drive cross-sectoral collaborations in support of the Sustainable Development Goals
25 October 2019
Global Health Progress is a new knowledge hub highlighting over 200 collaborations between the innovative biopharmaceutical industry and more than 850 partners to support the SDGs. Users can explore collaborations by SDG target, disease area, program strategy, and more. Users are also encouraged to connect with partners via the platform to drive new collaborations in low- and middle-income countries.

Emergencies

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

Ebola Outbreak in DRC 64: 22 October 2019
1. Situation update
In the past week, from 14 to 20 October, 21 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. The incidence of new confirmed EVD cases remains substantial in parts of North Kivu and Ituri provinces – in particular in the Biakato Mine Health Area, Mandima Health, with the majority (76%) of newly confirmed cases linked to this health area.

The deployment of additional support to the Biakato Mine Health Area has led to improvements in response efforts. The proportion of confirmed cases listed as contacts has increased in the past week from 13% to 57%. This increase was similarly witnessed in confirmed cases with a known epidemiological link to a case which augmented from 47% to 90% in the past week. While this is encouraging, there remain notable challenges in accessing and mounting the full range of public health activities in some areas.

In the 21 days from 30 September to 20 October, the number of affected health areas has decreased, with 20 health areas and nine health zones reporting new cases (Table 1, Figure 2). During this period, a total of 50 confirmed cases were reported, with the majority coming from the health zones of Mandima (54%; n=27 cases) and Mambasa (10%; n=5 cases). While many cases detected outside of these zones have travelled from these hotspots, onward local transmission has been observed in Kalunguta and Mabalako health zones, highlighting the high risk of resurgence and redispersion of cases.

As of 20 October 2019, a total of 3243 EVD cases were reported, including 3127 confirmed and 116 probable cases, of which 2171 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1821) were female, 28% (923) were children aged less than 18 years, and 5% (163) were healthcare workers…

Implementation of ring vaccination protocol
As of 20 October 2019, 240,824 people at risk have consented to and received the rVSV-ZEBOV-GP Ebola vaccine.

The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine, manufactured by Johnson & Johnson. This vaccine, which is administered as a two-dose course, 56 days apart, will be circulated in at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. The Merck/MSD vaccine will continue to be provided to all people at high risk of Ebola infection including those who have been in contact with a person confirmed to have Ebola, all contacts of contacts, and others determined to be at high risk of contracting Ebola…

::::::
::::::

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 23 October 2019
:: Wild poliovirus type 3 (WPV3) has been declared as globally eradicated. At an event held on World Polio Day 2019, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication (GCC), presented the official certificate of WPV3 eradication to WHO Director General Dr Adhanom Ghebreyesus. Read more about this landmark declaration.
[See Milestones above for detail]
:: Polio eradication efforts do not only involve providing vaccines. For one Abdullahi Mahamed Noor, basketball is his way of bringing people together to raise awareness about the devastating disease. Read about his journey on using the sport to combat polio in Somalia.

Summary of new viruses this week:
:: Afghanistan— two WPV1 cases and six positive environmental samples;
:: Pakistan— four WPV1 cases and six WPV1-positive environmental samples;
:: Nigeria— two cVDPV2 positive environmental samples.
:: Chad— one cVDPV2 case;
:: Benin— one cVDPV2 case;
:: the Democratic Republic of the Congo— one cVDPV2 case;
:: Ghana— one cVDPV2 case and three cVDPV2 positive environmental samples;
:: Ethiopia— one cVDPV2 case:
:: Togo— one cVDPV2 case:
:: Zambia— one cVDPV2 case.

::::::

Philippines: Red Cross triples polio vaccination target
25 October 2019 IFRC
The Philippine Red Cross is more than tripling the number of children it aims to vaccinate in a door-to-door polio vaccination campaign, the Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) said today.

On 1 October 2019, the Red Cross announced support for a Department of Health campaign by activating volunteers in parts of Mindanao and Metro Manila to vaccinate 30,000 children in the hardest-to-reach communities. In fact, the Philippine Red Cross has reached nearly 60,000 children. Today, the target was increased to 100,000.

Announcing the increase, Philippine Red Cross Chairman Richard Gordon said:
“We’re particularly worried about children under five in urban slums, rural areas, migrant families and indigenous communities who have missed out on life-saving vaccinations. It’s simply not right that these children are at risk of death or lifelong disability in the 21st century. The tripling of our target reflects the commitment of Red Cross volunteers and staff, who are literally climbing mountains and crossing rivers to ensure no child is left behind. What’s more, they will do this again in a month when children need a booster, and a month after that too.”

Apart from low immunization rates, factors that contribute to the spread of polio, dengue and measles include low health literacy, unsafe water, poor sanitation, poor living conditions, high rates of chronic childhood malnutrition and poor access to healthcare. The Red Cross is also planning to reach 1 million people with life-saving health, hygiene and sanitation information…

::::::

WHO & Regional Offices [to 26 Oct 2019]

25 October 2019
News release
WHO expert panel on digital health meets for first time
WHO is convening global experts to help shape the Organization’s roadmap to advance the digital health ecosystem. The WHO Digital Health Technical Advisory Group met for the first time this week to discuss topics ranging from data governance, to ethical and equitable use of digital technologies, to helping communities benefit from proven and cost-effective digital health solutions.

“All governments are facing increasing demands to provide health services to their citizens, and many digital technologies offer solutions to help meet these needs,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But countries require confidence in what works. The action plan agreed today focuses our efforts on helping the world benefit from digital health technologies and solutions while safeguarding the misuse of people’s data and protecting their health.”

The two-day meeting at WHO’s headquarters in Geneva led to an agreed action plan to focus the expert group’s activities and priorities over the next two years. Meeting focused on better defining WHOs role in supporting global digital transformation. Topics included:
:: Developing a global framework for WHO to validate, implement and scale up digital health technology and solutions.
:: Recommendations for safe and ethical use of digital technologies to strengthen national health systems by improving quality and coverage of care, increasing access to health information.
:: Advice on advocacy and partnership models to accelerate use of digital health capabilities in countries to achieve better health outcomes.
:: Advice on emerging digital health technologies with global reach and impact, so no one is left behind.

Advisory group co-chair Steve Davis, president and chief executive officer of global health non-profit PATH, said the new plan provides direction to help WHO maximize the potential of the digital health landscape and chart future trends, tools and opportunities…

25 October 2019
News release
High rates of unintended pregnancies linked to gaps in family planning services: New WHO study

22 October 2019
WHO signs MoU with International Generic and Biosimilar Medicines Association to promote access
Full access to medicines is hampered by a variety of factors. Two important barriers are high prices and regulatory issues such as long lag times in bringing medicines to market.

To address these issues, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, and Jim Keon, Chair of the International Generic and Biosimilar Medicines Association, today signed a memorandum of understanding.
The new agreement is an important step in WHO’s drive towards universal health coverage by underscoring the importance of generic and biosimilar medicines to increasing access to affordable, quality treatment.

WHO is an active supporter of expanding use of generic medicines: The vast majority of the products in the WHO Essential Medicines List are generic. WHO’s prequalification programme – which assesses the quality of priority medicines supplied by UN agencies and other organizations in low-income countries – has prioritized generic medicines as a way to treat more people with the funds available; around 70% of the medicines it prequalifies are generic. A recent independent study by McKinsey estimated WHO prequalification saves the world up to US$ 590 million every year. Every $ 1 invested in WHO Prequalification has a return in terms of savings of between $ 30-40.

WHO has also supported use of and access to generics through normative guidelines. Implementation of WHO guidance on interchangeability of generic medicines is further supported by the WHO List of International Comparators, which provides information on reference products for clinical trials into bioequivalence – i.e. whether two different products achieve the same results. Another tool is the WHO Biowaiver List which describes generic medicines that are eligible for a waiver from such studies…

::::::

Weekly Epidemiological Record, 25 October 2019, vol. 94, 43 (pp. 497–504)
:: World Polio Day – 24 October 2019
:: Global routine vaccination coverage, 2018

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: New milestone towards a polio-free world, but there is no time to relax 24 October 2019
:: Communique on cross-border coordination, partnerships, and communication for Ebola v…
23 October 2019
:: Ten African countries endorse cross-border collaboration framework on Ebola outbreak…
21 October 2019

WHO Region of the Americas PAHO
:: Saint Lucia joins HEARTS initiative to improve prevention and control of hypertension (10/24/2019)
:: District of Columbia recognizes PAHO for including persons with developmental disabilities in the workplace (10/24/2019)
:: Ultra-processed foods gain ground among Latin American and Caribbean families (10/23/2019)
:: PAHO Director in Rio de Janeiro highlights achievements and challenges in vaccine production (10/22/2019)
[See Perspectives above for detail]

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

WHO European Region EURO
:: World Polio Day marks a major milestone towards polio eradication 24-10-2019
:: Parliaments urged to help deliver universal health coverage by 2030 23-10-2019
:: Public health at the centre of a sustainable future 22-10-2019
:: New country profiles show changes in environmental health inequalities 21-10-2019
:: What can you do about flu? 21-10-2019

WHO Eastern Mediterranean Region EMRO
:: Thalassemia patients have renewed hope through support provided by EHNP
23 October 2019

WHO Western Pacific Region
No new digest content identified.

Featured Journal Content

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 ǀ Flash Update #9, Humanitarian impact of the military operation in north-eastern Syria, 21 – 24 October 2019

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

 Featured Journal Content

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4
Impact, Innovation, and Inclusion of Civil Society Organizations in Polio Eradication: The Core Group Polio Project Story
Guest Editors: Henry Perry and Jon Andrus
Selected Articles
Community Engagement, Ownership, and Civil Society Organizations in Polio Eradication
Jon K. Andrus and Henry B. Perry
https://doi.org/10.4269/ajtmh.19-0529

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative
Lee Losey, Ellyn Ogden, Filimona Bisrat, Roma Solomon, David Newberry, Ellen Coates, Dora Ward, Lisa Hilmi, Karen LeBan, Vanessa Burrowes and Henry B. Perry
https://doi.org/10.4269/ajtmh.18-0916

Involvement of Civil Society in India’s Polio Eradication Program: Lessons Learned
Roma Solomon
https://doi.org/10.4269/ajtmh.18-0931

::::::

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 26 Oct 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 64: 22 October 2019
[See Ebola above for detail]

Yemen
:: Thalassemia patients have renewed hope through support provided by the Emergency Health and Nutrition Project (EHNP) 23 October 2019 (Yemen)

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

::::::

WHO Grade 2 Emergencies [to 26 Oct 2019]

Afghanistan
:: Dedication: 17 years, 15 years, 13 years, 11 years… meet the people who live to eradicate polio in Afghanistan 24 October 2019

Iraq
:: WHO intensifies support to vulnerable communities in Ba’aj by strengthening the delivery of primary health care services
21 October 2019 – The World Health Organization (WHO) has intensified its health support to vulnerable communities in areas of return in Ninewa governorate delivering more than 140 000 health interventions to people in and around Ba’aj town since January 2019…

Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – 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
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Niger – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::

WHO Grade 1 Emergencies [to 26 Oct 2019]

Kenya
:: Kenya takes vital step against cervical cancer and introduces HPV vaccine into routi…
18 October 2019
With President Uhuru Kenyatta leading the way, Kenya today joins an increasing number of African countries taking a vital step against a common cause of death among women – in the country and the region – by introducing the human papilloma virus (HPV) vaccine against cervical cancer into its routine immunization schedule…

Chad – No new digest announcements identified
Djibouti – 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

CDC/ACIP [to 26 Oct 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Monday, October 21, 2019
CDC-Supported Study Launches to Track Infectious Diseases in Central America & Caribbean
To better understand, detect and respond to emerging infectious disease threats such as dengue, chikungunya, Zika, Chagas disease, and malaria, the U.S. Centers for Disease Control and Prevention (CDC) is supporting studies to better understand acute febrile illnesses (AFIs) in Belize, Guatemala and the Dominican Republic. AFIs are characterized by a rapid onset of fever and symptoms such as headache, diarrhea, chills or muscle and joint pain, cough or other respiratory symptoms. AFIs are one of the most common reasons people seek health care and can be caused by viruses, bacteria, parasites or fungi that people inhale, eat or drink from contaminated food or water, or are exposed to by contact with animals, including insects.

CDC has convened a multi-disciplinary international team of experts to support ministries of health in Belize, Guatemala, and the Dominican Republic in developing a surveillance network to rapidly identify and track AFIs. The team, including CDC, Baylor College of Medicine, Universidad del Valle de Guatemala, and Brigham and Women’s Hospital, will create the network using a coordinated approach to detect and manage disease threats…

MMWR News Synopsis for October 25, 2019
Global Routine Vaccination Coverage, 2018
Summary
What is already known about this topic?
Since 1974, global coverage with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles has increased from <5% to 86%.
What is added by this report?
Global coverage with the third dose of diphtheria and tetanus toxoids and pertussis-containing vaccine has not increased above 86% since 2010. Coverage varies across regions and countries, with lower coverage in lower-income countries.
What are the implications for public health practice?
Equitable access to immunization to achieve and sustain high coverage can be enhanced through financial and technical support for program strengthening and vaccine introductions in lower-income settings, community engagement to increase vaccination acceptance and demand, collection and use of vaccination data, and commitment to improving immunization services

Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick — San Diego, California, 2019

Africa CDC   [to 26 Oct 2019]
http://www.africacdc.org/

News
JOINT PRESS RELEASE BETWEEN WHO AND AFRICA CDC : Ten African countries endorse cross-border collaboration framework on Ebola outbreak preparedness and response
Goma, DRC, 21 October 2019 –
The Democratic Republic of the Congo (DRC) and its nine neighbouring countries today, during a meeting of ministers, senior health and immigration officials and partners in Goma, endorsed a joint framework to strengthen cross-border collaboration on preparedness and response to Ebola virus and other disease outbreaks.

Representatives of the 10 countries – Angola, Burundi, Central African Republic, Republic of the Congo, Democratic Republic of the Congo, Rwanda, South Sudan, Uganda, United Republic of Tanzania and Zambia – noted with concern the Ebola outbreak in north-eastern DRC, which has continued for more than one year, and the increasing potential to spread into the neighbouring countries. They recognized the shared threat that the outbreak poses to health and economic security in the subregion and other parts of Africa and the need to develop an action plan to mitigate the effects of these threats.

“Resources are always limited, and there are always gaps in emergency contingency plans. Setting up a mechanism for cross-border collaboration and the sharing of assets will contribute to the mitigation of suffering and minimize the social and economic impact of disease outbreaks,” said H.E. Amira Elfadil Mohammed, African Union Commissioner for Social Affairs…

COMMUNIQUE ON CROSS-BORDER COORDINATION, PARTNERSHIPS, AND COMMUNICATION FOR EBOLA VIRUS DISEASE PREPAREDNESS IN AT-RISK MEMBER STATES
21 October 2019
…Collectively, we resolve to:

1. Undertake actions to facilitate cooperation and collaboration between the Member States of Angola, Burundi, Central Africa Republic, Democratic Republic of Congo, Rwanda, Republic of Congo, South Sudan, Uganda, Tanzania, and Zambia for EVD preparedness and response, including:
   1. Cross-border EVD case and laboratory surveillance;
   2. Cross-border tracing and monitoring of contacts;
   3. Workforce capacity development, including joint training, exchange learning and benchmarking visits, and simulation exercises;
   4. Prompt communication of epidemiological and laboratory surveillance data and other relevant reports;
   5. Timely sharing information on potential security threats and other security issues occurring in areas affected by outbreaks;
   6. Sharing of technical expertise and other resources and assets necessary for EVD preparedness and control;
   7. Cross-border joint planning and implementation of EVD preparedness and response activities, including risk communication and community engagement campaigns;
   8. Movement of people across national borders in accordance with the International Health Regulations; and
   9. Legal and regulatory processes and logistics planning for rapid cross-border deployment and receipt of public health experts and medical personnel for EVD response.

2. Establish the Africa Ebola Coordination Task Force (AfECT), hosted at the African Union secretariat in Addis Ababa, Ethiopia, under the leadership of the Member States with support from the Africa CDC, WHO and other relevant partners to support the cooperation and collaboration described above. Whilst AfECT maintains political oversight through AU institutional arrangements, technical support would be facilitated through the WHO sub-regional technical coordination platforms in collaboration with the Africa CDC.

3. Exchange information in a timely manner on matters of common interest as deemed appropriate for preparedness and response, while acknowledging that withholding of, or falsification of, EVD data and information violates the IHR and threatens peace, security, and prosperity of the affected Member States and the entire region…

China CDC
http://www.chinacdc.cn/en/
No new digest content identified.

National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/
Selected Updates and Press Releases
No new digest content identified.

Announcements

Paul G. Allen Frontiers Group [to 26 Oct 2019]
https://alleninstitute.org/what-we-do/frontiers-group/news-press/
News
No new digest content identified.

BMGF – Gates Foundation [to 26 Oct 2019]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

Bill & Melinda Gates Medical Research Institute [to 26 Oct 2019]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.

CARB-X [to 26 Oct 2019]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.

CEPI – Coalition for Epidemic Preparedness Innovations [to 26 Oct 2019]
http://cepi.net/
News
No new digest content identified.

Clinton Health Access Initiative, Inc. (CHAI) [to 26 Oct 2019]
https://clintonhealthaccess.org/about/
News & Press Releases
No new digest content identified.

EDCTP [to 26 Oct 2019]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
No new digest content identified.

Emory Vaccine Center [to 26 Oct 2019]
http://www.vaccines.emory.edu/
No new digest content identified.

European Medicines Agency [to 26 Oct 2019]
http://www.ema.europa.eu/ema/
News & Press Releases
News: Dialogue with Chinese authorities on medicine regulation
Last updated: 25/10/2019
… China is one of the main suppliers of active pharmaceutical ingredients to the EU and constitutes one of the world’s largest national pharmaceutical markets.

European Vaccine Initiative [to 26 Oct 2019]
http://www.euvaccine.eu/news-events
No new digest content identified.

FDA [to 26 Oct 2019]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
Press Announcements
No new digest content identified.

Fondation Merieux [to 26 Oct 2019]
http://www.fondation-merieux.org/
News, Events
Over 2,300 students and professionals enrolled in the Mérieux Foundation’s first MOOC on quality management
October 24, 2019 – Lyon (France)
The Mérieux Foundation is launching a MOOC – Massive Open Online Course – on quality management in clinical laboratories. The course, which is open to all, teaches about the implementation of quality management systems.

Gavi [to 26 Oct 2019]
https://www.gavi.org/
Latest news
Gavi celebrates global eradication of wild poliovirus type 3  
Certification officially announced at World Polio Day event in Geneva
Geneva, 24 October 2019 – Gavi, the Vaccine Alliance has welcomed the announcement today by an independent commission of experts that wild poliovirus type 3 (WPV3) has been eradicated worldwide. The official announcement was made at a World Polio Day event organised by WHO in Geneva.
WPV3 is the second of three strains of wild poliovirus to have been certified eradicated. Wild poliovirus type 2 (WPV2) was confirmed eradicated in 2015 and wild poliovirus type 1 (WPV1) remains in circulation in areas of Pakistan and Afghanistan.
“This announcement represents a tremendous victory in the fight against polio.” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “It is a testament to decades of effort by hundreds of thousands of vaccinators and health care workers as well as WHO and its partners – and it is a reminder of the real strides we can make with focused commitment and collaboration. Harnessing this momentum and remaining vigilant will be critical as we continue to work towards a polio-free world.”…

GHIT Fund [to 26 Oct 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that No new digest content identified.

Global Fund [to 26 Oct 2019]
https://www.theglobalfund.org/en/news/
News & Stories
Updates
Technical Review Panel Observations on the 2017-2019 Allocation Cycle
24 October 2019
… Charged with evaluating funding requests for strategic focus, technical soundness and potential for impact, the Technical Review Panel reviewed each of the 225 applications in 2017-2019. At the request of the Strategy Committee of the Global Fund Board, the Technical Review Panel reflected upon these funding requests, identifying key trends, lessons learned, and recommendations for each of the diseases and for resilient and sustainable systems for health.
The panel’s recommendations include:
:: Improving the setting of priorities
:: Increasing the focus on prevention and reducing incidence
:: Strengthening cross-cutting programming in resilient and sustainable systems for health
:: Strengthening community systems
:: Increasing attention to sustainability and transition
The Technical Review Panel advises that their recommendations be considered as countries develop their funding requests for 2020-2022:
Technical Review Panel’s Observations on the 2017-2019 Allocation Cycle
download in English

News
World Bank and Global Fund Deepen Partnership with Co-Financing Agreement
22 October 2019
WASHINGTON – The World Bank and the Global Fund have signed a co-financing framework agreement to accelerate efforts by countries to end HIV, tuberculosis and malaria and build sustainable systems for health.
The framework agreement outlines a new approach for joint financing of investment-type operations between the two organizations, as well as results-based financing.
In recent years, the Global Fund and the World Bank have signed multiple innovative finance agreements, such as a loan buy-down for a program to fight tuberculosis in India, a performance-based funding project in the Democratic Republic of Congo and a Multi-Donor Trust Fund for Indonesia and Sri Lanka. The framework agreement is expected to reduce transaction costs and lays the foundation for a deeper partnership with the aim of increasing impact.
“Partnership is in the Global Fund’s DNA, and our work with partners such as the World Bank will accelerate the fight to end the epidemics,” said Peter Sands, Executive Director of the Global Fund. “Innovative financing mechanisms can play a significant role in improving the effectiveness of our investments and in pursuing new financial opportunities to increase impact.”…

Hilleman Laboratories [to 26 Oct 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 26 Oct 2019]
http://www.humanvaccinesproject.org/media/press-releases/
Press Releases
No new digest content identified.

IAVI [to 26 Oct 2019]
https://www.iavi.org/newsroom
No new digest content identified.

International Coalition of Medicines Regulatory Authorities [ICMRA]
http://www.icmra.info/drupal/en/news
Selected Statements, Press Releases, Research
No new digest content identified.

International Generic and Biosimilar Medicines Association [IGBA]
https://www.igbamedicines.org/
No new digest content identified.

IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.

IFRC [to 26 Oct 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
Asia Pacific
Philippines: Red Cross triples polio vaccination target
The Philippine Red Cross is more than tripling the number of children it aims to vaccinate in a door-to-door polio vaccination campaign, the Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) said today.
25 October 2019
[See Polio above for detail]

IVAC [to 26 Oct 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
No new digest content identified.

IVI [to 26 Oct 2019]
http://www.ivi.int/
Selected IVI News & Announcements
No new digest content identified.

JEE Alliance [to 26 Oct 2019]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 26 Oct 2019]
http://www.msf.org/
Latest [Selected Announcements]
Nigeria
Northeast Nigeria: Now is not the time to question lifesaving as…
Statement 25 Oct 2019
…Serious medical needs remain widespread in northeast Nigeria, while essential items and clean drinking water are scarce; in the first half of 2019 alone, our teams admitted more than 15,000 patients on an emergency basis, treated over 8,000 patients for malaria, ensured 2,446 safe deliveries and vaccinated 9,117 people against measles…

Iraq
MSF providing medical care in Iraq to people fleeing northeast Syria
Statement 21 Oct 2019

National Vaccine Program Office – U.S. HHS [to 26 Oct 2019]
https://www.hhs.gov/vaccines/about/index.html
No new digest content identified.

NIH [to 26 Oct 2019]
http://www.nih.gov/news-events/news-releases
Selected News Releases
Broadly protective antibodies could lead to better flu treatments and vaccines
October 25, 2019 — Isolated antibodies provided broad protection against several different strains of influenza.

Ending HIV will require optimizing treatment and prevention tools, say NIH experts
October 24, 2019 — Commentary emphasizes need to optimally implement current tools and develop new interventions.

Influenza human challenge study begins at NIH-sponsored clinical trial units
October 23, 2019 — Up to 80 people aged 18 to 50 years will be enrolled in the trial.
A clinical trial in which healthy adults will be deliberately infected with influenza virus under carefully controlled conditions is recruiting volunteers at four Vaccine and Treatment Evaluation Units (VTEUs) supported by the National Institute of Allergy and Infectious Diseases (NIAID). One study aim is to assess how levels of pre-existing influenza antibodies impact the timing, magnitude and duration of a volunteer’s flu symptoms following exposure to influenza virus. NIAID is part of the National Institutes of Health.

NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale
October 23, 2019 — Initial investment aims to advance accessible and scalable candidate interventions into clinical trials within 10 years.
[See Perspectives above for detail]

PATH [to 26 Oct 2019]
https://www.path.org/media-center/
Selected Announcements
No new digest content identified.

Sabin Vaccine Institute [to 26 Oct 2019]
http://www.sabin.org/updates/pressreleases
Statements and Press Releases
October 24, 2019
One Step Closer to a World Without Polio – Type 3 Polio Eradicated – A Statement by the Sabin Vaccine Institute
WASHINGTON, DC – Today, we are one step closer to a world without polio. The Sabin Vaccine Institute, founded in memory of oral polio vaccine creator Dr. Albert Sabin, applauds the tremendous achievement by the global polio community in eradicating wild poliovirus type 3.
…“At a time when the wins are hard-fought and far-between, the eradication of wild poliovirus type 3 is a much-needed reminder that just as the global community coalesced to eradicate smallpox, we can and we will make polio history,” said Dr. Bruce Gellin, president of Global Immunization at the Sabin Vaccine Institute. “We have come this far thanks parents and caregivers who ensure that their children are protected and to the unflagging efforts of organizers, advocates and the brave individuals who put themselves in harm’s way to ensure every child is protected from this deadly disease. But as we celebrate this accomplishment, we must remember that progress against wild poliovirus type 1 is precarious. Now, more than ever, we must recommit to realizing Dr. Sabin’s vision of a world without polio.”

UNAIDS [to 26 Oct 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
21 October 2019
Voluntary medical male circumcision―4.1 million performed in 2018
…About 11 million VMMCs have been performed in 15 priority countries in eastern and southern Africa since the beginning of 2016. In 2018 alone, about 4.1 million voluntary circumcisions were performed among males of all ages, a slight increase from the 4 million carried out in 2017.
There has been progress towards the target of 25 million additional circumcisions for HIV prevention from 2016 to 2020. However, at the end of 2018, when 15 million circumcisions should have been performed, the world was off-target by 4 million circumcisions…

21 October 2019
Educational show on how to talk with teenagers about health and sexual relations

UNICEF [to 26 Oct 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Press release
UNICEF and partners provide vaccination against polio and measles for nearly 232,000 children in Syria and Iraq, many affected by violence in northeast Syria
25/10/2019
[See Emergencies above for detail]

Press release
UNICEF update on the humanitarian situation for children in north east Syria
DAMASCUS/AMMAN/GENEVA/NEW YORK, 22 October 2019 – The latest estimates put the number of children displaced since 9 October at 80,000. Five children have been killed and 26 injured…
UNICEF teams are at the border, working with partners and the Directorate of Health, to provide water, ready to eat food, and hygiene kits, and vaccinate children against polio and measles. A mobile child protection team is also at the Sahela border, providing psychosocial support and responding to urgent cases. So far, nine unaccompanied children have been identified, six of whom have been reunited with families; two whose families have been traced, and one whose case is still being followed up. At Badarash camp, UNICEF is also vaccinating children, providing psychosocial support, and working to identify and refer children and women who require specialized assistance.

Press release
Lack of funding leaves millions of children in conflict and disaster zones at risk
$4 billion humanitarian appeal nearly 50 per cent unfunded heading into final quarter of 2019
22/10/2019

Vaccination Acceptance Research Network (VARN) [to 26 Oct 2019]
https://vaccineacceptance.org/news.html#header1-2r
No new digest content identified.

Vaccine Confidence Project [to 26 Oct 2019]
http://www.vaccineconfidence.org/
No new digest content identified.

Vaccine Education Center – Children’s Hospital of Philadelphia [to 26 Oct 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.

Wellcome Trust [to 26 Oct 2019]
https://wellcome.ac.uk/news
Opinion | 24 October 2019
Leaving academia: there are still opportunities to make a difference in research
Danil Mikhailov, Head of Wellcome Data Labs Wellcome
Leaving academia isn’t the same as leaving research, which is why we need to reimagine what a successful research career looks like.

Opinion | 22 October 2019
What accountability means to Wellcome
Mark Henderson, Director of Communications Wellcome
Philanthropic foundations aren’t answerable to taxpayers, shareholders or politicians. So what is their social value? For the past 18 months, we have been thinking about Wellcome’s social value – and what it means for our purpose and mission.

Why We Vaccinate [to 26 Oct 2019]
https://www.whywevax.org/
News
No new digest content identified.

The Wistar Institute [to 26 Oct 2019]
https://www.wistar.org/news/press-releases
Press Release Oct. 22, 2019
Wistar Institute Researcher Awarded American Cancer Society Research Professorship
PRINCETON, N.J. — PHILADELPHIA — (Oct. 22, 2019) — The American Cancer Society (ACS), the largest non-government, not-for-profit funding source of cancer research in the United States, has awarded a Research Professorship to Dmitry l. Gabrilovich, M.D., Ph.D., Christopher M. Davis Professor and leader of the Immunology, Microenvironment & Metastasis Program at The Wistar Institute. This lifelong designation, accompanied by a five-year $400,000 commitment, is the most prestigious research grant made by ACS.

World Organisation for Animal Health (OIE) [to 26 Oct 2019]
http://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

::::::

ARM [Alliance for Regenerative Medicine] [to 26 Oct 2019]
https://alliancerm.org/press-releases/
October 10, 2019
Gene Therapies: Sector Overview, New York Academy of Sciences Workshop
New York City

BIO [to 26 Oct 2019]
https://www.bio.org/insights/press-release
Oct 22 2019
America’s Bioeconomy Plays Critical Role in Feeding, Fueling, and Healing the World
“What has set the U.S. biotech sector apart has been thoughtful, bipartisan public policy approaches that create a favorable climate in which to undertake the lengthy and risky job of investing in and developing the next biotech breakthroughs.”

DCVMN – Developing Country Vaccine Manufacturers Network [to 26 Oct 2019]
http://www.dcvmn.org/
No new digest content identified.

IFPMA [to 26 Oct 2019]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
Global Health Progress launched to drive cross-sectoral collaborations in support of the Sustainable Development Goals
25 October 2019
Global Health Progress is a new knowledge hub highlighting over 200 collaborations between the innovative biopharmaceutical industry and more than 850 partners to support the SDGs. Users can explore collaborations by SDG target, disease area, program strategy, and more. Users are also encouraged to connect with partners via the platform to drive new collaborations in low- and middle-income countries.

PhRMA [to 26 Oct 2019]
http://www.phrma.org/
Selected Press Releases, Statements
No new digest content identified.

Industry Watch [to 26 Oct 2019]
:: GSK agrees to divest rabies and tick-borne encephalitis vaccines to Bavarian Nordic
GSK to receive upfront payment of approximately EUR301 million (£259m) and milestone payments for a total consideration of up to EUR955 million (£822m)
21 October 2019 Issued: London, UK
GlaxoSmithKline plc (LSE/NYSE: GSK) today announced the divestment of travel vaccines Rabipur (tradename Rabavert in the US) for the prevention of rabies, and Encepur for the prevention of tick-borne encephalitis, to Bavarian Nordic.
The decision to divest these brands, acquired from Novartis in 2015 as part of the acquisition of its vaccines business, supports GSK’s strategic intent to increase focus and reinvest in growth assets, innovation and a simplified supply chain in its vaccines business…

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focu-s on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

Impact, Innovation, and Inclusion of Civil Society Organizations in Polio Eradication: The Core Group Polio Project Story
Guest Editors: Henry Perry and Jon Andrus
Selected Articles
Community Engagement, Ownership, and Civil Society Organizations in Polio Eradication
Jon K. Andrus and Henry B. Perry
https://doi.org/10.4269/ajtmh.19-0529

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative
Lee Losey, Ellyn Ogden, Filimona Bisrat, Roma Solomon, David Newberry, Ellen Coates, Dora Ward, Lisa Hilmi, Karen LeBan, Vanessa Burrowes and Henry B. Perry
https://doi.org/10.4269/ajtmh.18-0916

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

Involvement of Civil Society in India’s Polio Eradication Program: Lessons Learned
Roma Solomon
https://doi.org/10.4269/ajtmh.18-0931

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 26 Oct 2019)

Research article
Patient and provider perspectives on how trust influences maternal vaccine acceptance among pregnant women in Kenya
Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunizatio…
Authors: Stacy W. Nganga, Nancy A. Otieno, Maxwell Adero, Dominic Ouma, Sandra S. Chaves, Jennifer R. Verani, Marc-Alain Widdowson, Andrew Wilson, Irina Bergenfeld, Courtni Andrews, Vincent L. Fenimore, Ines Gonzalez-Casanova, Paula M. Frew, Saad B. Omer and Fauzia A. Malik
Citation: BMC Health Services Research 2019 19:747
Published on: 24 October 2019

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 26 Oct 2019)

Research article
Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries
Authors: Cristina Munk, Allison Portnoy, Christian Suharlim, Emma Clarke-Deelder, Logan Brenzel, Stephen C. Resch and Nicolas A. Menzies
Citation: BMC Health Services Research 2019 19:741
Published on: 22 October 2019
Conclusions
There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 26 Oct 2019)

Commentary
Adaptive trials, efficiency, and ethics
Authors: Spencer Phillips Hey
Citation: BMC Medicine 2019 17:189
Published on: 22 October 2019

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 26 Oct 2019)

Research article
How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation
Vaccination misinformation is associated with serious public health consequences, such as a decrease in vaccination rates and a risk of disease outbreaks. Although social media offers organisations promoting v…
Authors: Maryke S. Steffens, Adam G. Dunn, Kerrie E. Wiley and Julie Leask
Citation: BMC Public Health 2019 19:1348
Published on: 23 October 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Challenges and solutions in the development of vaccines against emerging and neglected infectious diseases
Joel N. Maslow
Pages: 2230-2234
Published online: 23 Oct 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
“Running the Gauntlet”: Formidable challenges in advancing neglected tropical diseases vaccines from development through licensure, and a “Call to Action”
Maria Elena Bottazzi & Peter J. Hotez
Pages: 2235-2242
Published online: 10 Jul 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Challenges and perspectives on the use of mobile laboratories during outbreaks and their use for vaccine evaluation
Trina Racine & Gary P. Kobinger
Pages: 2264-2268
Published online: 23 Apr 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
A review of Dengvaxia®: development to deployment
Stephen J. Thomas & In-Kyu Yoon
Pages: 2295-2314
Published online: 07 Oct 2019
ABSTRACT
Dengue is the world’s most prevalent and important arboviral disease. More than 50% of the world’s population lives at daily risk of infection and it is estimated more than 95 million people a year seek medical care following infection. Severe disease can manifest as plasma leakage and potential for clinically significant hemorrhage, shock, and death. Treatment is supportive and there is currently no licensed anti-dengue virus prophylactic or therapeutic compound. A single dengue vaccine, Sanofi Pasteur’s Dengvaxia®, has been licensed in 20 countries but uptake has been poor. A safety signal in dengue seronegative vaccine recipients stimulated an international re-look at the vaccine performance profile, new World Health Organization recommendations for use, and controversy in the Philippines involving the government, regulatory agencies, Sanofi Pasteur, clinicians responsible for testing and administering the vaccine, and the parents of vaccinated children. In this review, we provide an overview of Dengvaxia’s® development and discuss what has been learned about product performance since its licensure.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Trends in vaccine investment in middle income countries
K. Onishchenko, S. Hill, M. Wasserman, C. Jones, M. Moffatt, L. Ruff & S. J. Pugh
Pages: 2378-2385
Published online: 12 Apr 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Safety profile of the RTS,S/AS01 malaria vaccine in infants and children: additional data from a phase III randomized controlled trial in sub-Saharan Africa
Yolanda Guerra Mendoza, Elodie Garric, Amanda Leach, Marc Lievens, Opokua Ofori-Anyinam, Jean-Yves Pirçon, Jens-Ulrich Stegmann, Pascale Vandoolaeghe, Lucas Otieno, Walter Otieno, Seth Owusu-Agyei, Jahit Sacarlal, Nahya Salim Masoud, Hermann Sorgho, Marcel Tanner, Halidou Tinto, Innocent Valea, Ali Takadir Mtoro, Patricia Njuguna, Martina Oneko, Godfrey Allan Otieno, Kephas Otieno, Samwel Gesase, Mary J Hamel, Irving Hoffman, Seyram Kaali, Portia Kamthunzi, Peter Kremsner, Miguel Lanaspa, Bertrand Lell, John Lusingu, Anangisye Malabeja, Pedro Aide, Pauline Akoo, Daniel Ansong, Kwaku Poku Asante, James A Berkley, Samuel Adjei, Tsiri Agbenyega, Selidji Todagbe Agnandji & Lode Schuerman
Pages: 2386-2398
Published online: 23 Apr 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Development of motivational interviewing skills in immunization (MISI): a questionnaire to assess MI learning, knowledge and skills for vaccination promotion
Arnaud Gagneur, Virginie Gosselin, Julie Bergeron, Anne Farrands & Geneviève Baron
Pages: 2446-2452
Published online: 05 Jun 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
A visual content analysis of vaccine coverage in the print media
Daniel Catalan-Matamoros & Carmen Peñafiel-Saiz
Pages: 2453-2459
Published online: 04 Apr 2019

JAMA
October 22/29, 2019, Vol 322, No. 16, Pages 1527-1620
http://jama.jamanetwork.com/issue.aspx

Viewpoint
Pay-to-Participate Trials and Vulnerabilities in Research Ethics Oversight
Holly Fernandez Lynch, JD, MBE; Steven Joffe, MD, MPH
JAMA. 2019;322(16):1553-1554. doi:10.1001/jama.2019.14703
This Viewpoint discusses ethical considerations surrounding randomized clinical trials (RCTs) funded by patients who pay to enroll in them, and gaps in IRB oversight that could allow the trials to be approved despite possible patient exploitation and questionable scientific quality and social value.

JAMA
October 22/29, 2019, Vol 322, No. 16, Pages 1527-1620
http://jama.jamanetwork.com/issue.aspx

Editorial
Cervical Cancer as a Global Concern – Contributions of the Dual Epidemics of HPV and HIV
Carla J. Chibwesha, MD, MSc; Jeffrey S. A. Stringer, MD
JAMA. 2019;322(16):1558-1560. doi:10.1001/jama.2019.16176
of the uterine cervix is among the most preventable human malignancies,^1,2 yet it remains a leading cause of death among women worldwide, accounting for more than 300 000 deaths annually.³ Well on its way to elimination in the global north, cervical cancer mostly affects women living in low- or middle-income countries (LMICs), where limited access to vaccination, screening, and therapy have made it overwhelmingly a disease of women who are poor and lack access to health care. Nowhere is this more evident than in sub-Saharan Africa, where HIV is endemic and where cervical cancer has surpassed breast cancer as the most common and deadly cancer in women.³

The Lancet
Oct 26, 2019 Volume 394 Number 10208 p1481-1590, e33
https://www.thelancet.com/journals/lancet/issue/current

Editorial
Where next for randomised controlled trials in global health?
The Lancet
The 2019 Nobel Memorial Prize in Economic Sciences was awarded to three economists—Esther Duflo, Abhijit Bannerjee, and Michael Kremer—for their experiment-based research to mitigate global poverty. The award was notable for several reasons. Esther Duflo was only the second woman to win the prize since it began in 1969, and the youngest ever winner. Previous prizes were awarded largely for contributions to theory—for example, by observing and interpreting the behaviour of markets. But this year, the Sveriges Riksbank committee’s recognition of the randomised controlled trial (RCT) elevates a method long used in medicine, but much less so in human development…

New England Journal of Medicine
October 24, 2019 Vol. 381 No. 17
http://www.nejm.org/toc/nejm/medical-journal

Editorials
Drug Regulation in the Era of Individualized Therapies
Janet Woodcock, M.D.,  and Peter Marks, M.D., Ph.D.

Pharmaceutics
Volume 11, Issue 10 (October 2019)
https://www.mdpi.com/1999-4923/11/10

Open Access Editorial
Drug Delivery Technology Development in Canada
by Kishor M. Wasan and Ildiko Badea
Pharmaceutics 2019, 11(10), 541;
Abstract
Canada has a long and rich history of ground-breaking research in drug delivery within academic institutions, pharmaceutical industry and the biotechnology community. Drug delivery refers to approaches, formulations, technologies, and systems for transporting a pharmaceutical compound in the body as needed to safely achieve its desired therapeutic effect. It may involve rational site-targeting, or facilitating systemic pharmacokinetics; in any case, it is typically concerned with both quantity and duration of the presence of the drug in the body. Drug delivery is often approached through a drug’s chemical formulation, medical devices or drug-device combination products. Drug delivery is a concept heavily integrated with dosage form development and selection of route of administration; the latter sometimes even being considered part of the definition. Drug delivery technologies modify drug release profile, absorption, distribution and elimination for the benefit of improving product efficacy and safety, as well as patient convenience and adherence. Over the past 30 years, numerous Canadian-based biotechnology companies have been formed stemming from the inventions conceived and developed within academic institutions. Many have led to the development of important drug delivery products that have enhanced the landscape of drug therapy in the treatment of cancer to infectious diseases. This Special Issue serves to highlight the progress of drug delivery within Canada. We invited articles on all aspects of drug delivery sciences from pre-clinical formulation development to human clinical trials that bring to light the world-class research currently undertaken in Canada for this Special Issue

Pharmaceutics
Volume 11, Issue 10 (October 2019)
https://www.mdpi.com/1999-4923/11/10

Open Access Review
Innovations in Pediatric Drug Formulations and Administration Technologies for Low Resource Settings
by Stephen E. Gerrard , Jennifer Walsh , Niya Bowers , Smita Salunke and Susan Hershenson
Pharmaceutics 2019, 11(10), 518; https://doi.org/10.3390/pharmaceutics11100518 – 08 Oct 2019
Abstract
Despite advances in regulations and initiatives to increase pediatric medicine development, there is still an unmet need for age-appropriate medicines for children. The availability of pediatric formulations is particularly lacking in resource poor areas, due to, for example, area-specific disease burden and financial constraints, as well as disconnected supply chains and fragmented healthcare systems. The paucity of authorized pediatric medicines often results in the manipulation and administration of products intended for adults, with an increased risk of mis-dosing and adverse reactions. This article provides an overview of the some of the key difficulties associated with the development of pediatric medicines in both high and low resource areas, and highlights shared and location specific challenges and opportunities. The utilization of dispersible oral dosage forms and suppositories for low and middle-income countries (LMICs) are described in addition to other platform technologies that may in the future offer opportunities for future pediatric medicine development for low resource settings

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 26 Oct 2019]

The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo
Chad R. Wells, Abhishek Pandey, Martial L. Ndeffo Mbah, Bernard-A. Gaüzère, Denis Malvy, Burton H. Singer, and Alison P. Galvani

PNAS first published October 21, 2019. https://doi.org/10.1073/pnas.1913980116
Significance
There is limited understanding of what ramifications conflict events have on disease transmission and control in regions plagued by civil unrest and violence. Furthermore, the multifaceted nature of the conflict events during an epidemic is yet to be characterized. Using conflict data, ethnographic appraisal, and a mathematical model, we provide a descriptive timeline of the events during the ongoing Ebola outbreak in the Democratic Republic of the Congo. We quantified the unrest preceding a conflict event and its subsequent impact on control activities to demonstrate how conflict events are contributing to the persistence of the epidemic. Our model framework can be extended to other infectious diseases in areas that have experienced chronic conflict and violence.
Abstract
The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.

Proceedings of the Royal Society B
16 October 2019 Volume 286 Issue 1913
https://royalsocietypublishing.org/toc/rspb/current

Review articles
Beyond drugs: the evolution of genes involved in human response to medications
Silvia Fuselli
Published:23 October 2019Article ID:20191716
Abstract
The genetic variation of our species reflects human demographic history and adaptation to diverse local environments. Part of this genetic variation affects individual responses to exogenous substances, such as food, pollutants and drugs, and plays an important role in drug efficacy and safety. This review provides a synthesis of the evolution of loci implicated in human pharmacological response and metabolism, interpreted within the theoretical framework of population genetics and molecular evolution. In particular, I review and discuss key evolutionary aspects of different pharmacogenes in humans and other species, such as the relationship between the type of substrates and rate of evolution; the selective pressure exerted by landscape variables or dietary habits; expected and observed patterns of rare genetic variation. Finally, I discuss how this knowledge can be translated directly or after the implementation of specific studies, into practical guidelines.

Travel Medicine and Infectious Diseases
Volume 31 September–October 2019
https://www.sciencedirect.com/journal/travel-medicine-and-infectious-disease/vol/31/suppl/C

Editorial No access
Brazil burning! What is the potential impact of the Amazon wildfires on vector-borne and zoonotic emerging diseases? – A statement from an international experts meeting
D.Katterine Bonilla-Aldana, José Antonio Suárez, Carlos Franco-Paredes, Stalin Vilcarromero, … Alfonso J. Rodríguez-Morales
Article 101474

Travel Medicine and Infectious Diseases
Volume 31 September–October 2019
https://www.sciencedirect.com/journal/travel-medicine-and-infectious-disease/vol/31/suppl/C

Research article Abstract only
Bacterial respiratory carriage in French Hajj pilgrims and the effect of pneumococcal vaccine and other individual preventive measures: A prospective cohort survey
Van-Thuan Hoang, Mohammed Meftah, Tran Duc Anh Ly, Tassadit Drali, … Philippe Gautret
Article 101343

Vaccine
Volume 37, Issue 46 Pages 6857-6930 (31 October 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/46

Research article Abstract only
Maternal reasons for non-receipt of valid Hepatitis B birth dose among mother-infant pairs attending routine immunization clinics, South-east, Nigeria
Uchechukwu Joel Okenwa, Magbagbeola David Dairo, Belinda Uba, Olufemi Ajumobi
Pages 6894-6899

Vaccine
Volume 37, Issue 46 Pages 6857-6930 (31 October 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/46

Research article Abstract only
Healthcare workers’ knowledge, beliefs, and coverage regarding vaccinations in critical care units in Italy
Francesco Napolitano, Aida Bianco, Alessia D’Alessandro, Rosa Papadopoli, Italo Francesco Angelillo
Pages 6900-6906

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 26 Oct 2019)

Open Access Article
Knowledge of Human Papillomavirus (HPV), Attitudes and Practices Towards Anti-HPV Vaccination Among Israeli Pediatricians, Gynecologists, and Internal Medicine Doctors: Development and Validation of an Ad Hoc Questionnaire
by Rola Khamisy-Farah , Mohammad Adawi , Haneen Jeries-Ghantous , Jacob Bornstein , Raymond Farah , Nicola Luigi Bragazzi and Marwan Odeh
Vaccines 2019, 7(4), 157; https://doi.org/10.3390/vaccines7040157 – 21 Oct 2019
Abstract
Human papillomavirus (HPV) is a highly widespread virus which is responsible for one of the most common sexually transmitted infections. Two main preventative strategies exist: anti-HPV vaccination and cervical screening. Health-care workers play a key role in promoting public health campaigns; however, vaccine hesitancy is an often under-recognized challenge. To investigate the overall knowledge of HPV and HPV-related issues, as well as the attitudes and practices of health professionals towards recommending the anti-HPV vaccine, an ad hoc knowledge, attitudes, and practices (KAP) questionnaire was developed and validated in a sample of 139 Israeli pediatricians, gynecologists, and internal medicine doctors. The KAP questionnaire was found to be psychometrically valid and sound (with an rKR-20 coefficient of 0.74 for the second part and a Cronbach’s alpha of 0.85 for the third part). Furthermore, the present study confirmed the importance of health-care providers in recommending the immunization practice. Parents that had been strongly advised by health-care providers to vaccinate their children accepted immunization for their girls (odds ratio (OR) 1.09 (95% CI 1.04–1.14)) and boys (OR 1.06 (95% CI 1.02–1.10)), had a lower probability of deciding to postpone the immunization appointment (OR 0.81 (95% CI 0.66–0.98)), had fewer doubts and concerns about the vaccine (OR 0.69 (95% CI 0.54–0.89)), and had a lower probability of refusing the vaccination (OR 0.93 (95% CI 0.86–0.99)). Interestingly, the use of new, emerging tools such as ad hoc websites, applications, and other interactive devices reduced vaccine hesitancy (OR 0.90 (95% CI 0.82–0.99)) and concerns about the side-effects of the vaccine (OR 0.92 (95% CI 0.86–0.99)). However, among Israeli health-care workers, knowledge was generally moderate, with updated information lacking in about 30% of surveyed health-care providers and approximately 20% of them not recommending the anti-HPV vaccine among boys. This study has practical implications for policy- and decision-makers in that they should be aware of the overall level of knowledge among health-care workers and should implement ad hoc educational interventions to address gaps in knowledge and help medical providers routinely recommend the anti-HPV vaccine both to male and female children and adolescents

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Vaccine Hesitancy: Guidance and Interventions
Tull, Kerina, DFID K4D Helpdesk Report 672 :: October 2019 – 24 pages
PDF: 672_Vaccine_Hesitancy.pdf (1.048Mb)
Research shows that vaccine hesitancy (i.e. ‘the delay in acceptance or refusal of vaccines despite the availability of vaccination services’ (WHO SAGE, 2014a) is rising, resulting in alarming figures on disease outbreaks reported globally. Despite availability of vaccines, the number of countries reporting hesitancy has steadily increased since 2014 (Lane et al., 2018). Therefore, there is a need to understand what governments and partners can do to tackle this problem. The evidence for this rapid review is gender blind and taken from grey literature, including systematic reviews, interviews, research reports, and peer-reviewed academic papers from vaccine-related projects (e.g. Vaccine Confidence Project). Strategies aimed at specific populations in grey literature differed from those in peer reviewed literature (WHO SAGE, 2014a). This review does not focus on anti-vaccination (anti-vaxx/anti-vac) sentiments or movements. Drivers of vaccine hesitancy are also not explored in this review.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 26 Oct 2019
[No new, unique, relevant content]

BBC
http://www.bbc.co.uk/
Accessed 26 Oct 2019
Vaccine reminder system ‘inconsistent’, report concludes
Published Date: 25 Oct 2019
The NHS system for reminding parents to have their children vaccinated is “inconsistent” and making an appointment can be difficult, says a report on vaccine uptake in England.

The Economist
http://www.economist.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

Financial Times
http://www.ft.com/home/uk
Accessed 26 Oct 2019
[No new, unique, relevant content]

Forbes
http://www.forbes.com/
Accessed 26 Oct 2019
Mark Zuckerberg’s Answer To An Anti-Vaxxer Question Highlights Facebook’s Problematic Response To Misinformation
By Michael Nunez. Forbes Staff
Oct 23, 2019
Facebook CEO Mark Zuckerberg returned to Capitol Hill on Wednesday for the first time since April 2018, answering a litany of questions about Facebook’s digital currency project and how it balances freedom of expression with demands it prevent the spread of false information.
…Zuckerberg, who told Congressman that his “understanding of the scientific consensus” is that people should get their vaccines, said Facebook won’t stop its users from posting information that’s wrong.
“If someone wants to post anti-vaccination content, or if they want to join a group where people are discussing that content, we don’t prevent them from doing that. But we don’t go out of our way to make sure our group recommendation systems try to encourage people to join those groups.”
In other words, Facebook won’t prevent one of its 2 billion users from posting false information—it may not even flag it as wrong. The Facebook algorithm just won’t help it gain traction. If the user can spread that information on his own, then in Zuckerberg’s words, that’s “freedom of expression.”…

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

The Guardian
http://www.guardiannews.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

New Yorker
http://www.newyorker.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

New York Times
http://www.nytimes.com/
Accessed 26 Oct 2019
U.S.
Disneyland Visitor With Measles May Have Exposed Hundreds to Infection
The theme park was the site of a major outbreak about five years ago.
By Adeel Hassan
Oct. 23

Health
UN Says 1st Local Polio Case Found in Zambia Since 1995
The World Health Organization says Zambia has reported its first local case of polio since 1995, in a 2-year-old boy paralyzed by a virus derived from the vaccine.
By The Associated Press
Oct. 23

Washington Post
https://www.washingtonpost.com/
Accessed 26 Oct 2019
[No new, unique, relevant content]

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 26 Oct 2019
[No new relevant content]

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 26 Oct 2019
[No new relevant content]

CSIS
https://www.csis.org/
Accessed 26 Oct 2019
Commentary
An Ounce of Prevention is Worth a Pound of Cure
October 24, 2019
As Congress aims to finalize FY 2020 appropriations and as the FY 2021 budget process begins, it should consider new and strengthened investments in global health security to protect the U.S. public from the most pressing health security threats. A global pandemic could have vast human and economic costs. Yet with small, strategic investments in critical areas, we can prepare ourselves for the inevitable…

Council on Foreign Relations
http://www.cfr.org/
Accessed 26 Oct 2019
[No new relevant content]

Kaiser Family Foundation
https://www.kff.org/search/?post_type=pre ss-release
Accessed 26 Oct 2019
[No new relevant content]

Milestones :: Perspectives :: Research

CEPI – Faster, more agile vaccine tech needed to fight tomorrow’s epidemics
15 Oct 2019 By Richard Hatchett
The next epidemic is coming. It’s not a question of if, but when. To head off the threat posed by an unknown “Disease X”—which could be a new pathogen or a dangerous mutation of an already known disease, such as influenza—the world must harness new technologies.

That is why the Coalition for Epidemic Preparedness Innovations (CEPI) is calling for new proposals and offering more funding to companies and academic groups with promising ideas for vaccine platforms and novel manufacturing processes that can produce, at scale, candidate vaccines in a matter of weeks or months rather than years.

CEPI is also expanding the types of technology it will fund by accepting applications for technologies that may provide immunoprotective benefits, even if the products these generate aren’t traditional vaccines.  Gene-encoded antibodies, for example, have shown promise as a high-speed and adaptable method of generating transient protective immunity for populations at risk. We are encouraging interested parties with technologies that might help CEPI achieve our mission to speak with us before submitting a proposal.

Achieving our goals will be challenging, of course, but this is important work – not least because the endeavour shows how cutting-edge healthcare science could help advance healthcare in poor countries. After all, in an outbreak situation, it’s imperative these latest technologies are made available regardless of the ability of affected countries to pay—as is the case with all CEPI vaccines.

Platform technologies can be a versatile tool to help prepare for future epidemics, which could kill millions and wreak economic chaos. Standardised platform systems allow the same basic components to be used as a backbone for producing vaccines against different pathogens. This “plug-and-play” approach is already used with influenza, where different vaccines are produced every year on an existing platform. Now the goal is to find similar approaches for novel emerging infectious diseases that could generate a product ready for clinical trials within 16 weeks of identifying a target.

With the number of emerging infectious diseases growing rapidly, the need for action is clear. Last month, the Global Preparedness Monitoring Board reported a “very real” threat of a rapidly moving, highly lethal pandemic of a respiratory disease killing 50–80 million people and wiping out nearly 5% of the world’s economy.

CEPI has already committed up to $54 million to fund the development of vaccine platforms, under a programme launched in 2017. Today, we are casting the net wider by renewing the call for such technologies and making it clear we will entertain funding of relevant “vaccine-like” immunoprophylactics.

One approach involves transferring genes – effectively creating factories in our bodies to make antibodies against specific pathogens. The genes encoding these antibodies would be transferred into people’s cells using a harmless viral vector, in a similar process to that used in gene therapy.

Another idea involves monoclonal antibodies (mAbs). In this case, the agent responsible for creating a protective immune response is produced outside the body and is then transferred into the person. While most mAbs are used to treat existing disease, they can also prevent infection. One such antibody, palivizumab, won U.S. approval back in 1998 to prevent respiratory syncytial virus in at-risk babies.

Gene-encoded antibodies and mAbs are just two examples of “vaccine-like” immunoprophylactic platforms that CEPI could potentially fund, as part of this call for proposals; CEPI would fund such platforms as a means of disease prevention not as therapeutics.

Overall, CEPI aims to fund multiple platform technologies through this call, including ideas to scale-up manufacturing once novel products have been developed. After all, without systems to churn out new vaccines and immunoprophylactics cheaply and quickly, all the clever science won’t be able to help people on the frontline of the next epidemic. If CEPI and our partners succeed in this endeavour, we will not only equip humanity with the tools to combat Disease X, we would take one step closer to neutralising the threat of epidemics once and for all.

For more information on our call for applications, click here.

Milestones :: Perspectives :: Research

Johns Hopkins Center for Health Security, World Economic Forum and Bill & Melinda Gates Foundation Host Pandemic Exercise and Livestream
Underscoring immediate need for global public-private cooperation to mitigate severe world-wide economic and societal impacts of pandemics
October 16, 2019
NEW YORK–(BUSINESS WIRE)–The Johns Hopkins Center for Health Security, with the World Economic Forum and the Bill & Melinda Gates Foundation, will host Event 201, a multimedia global pandemic exercise on Friday, Oct. 18, 2019, in New York City. The public may register and participate in the simultaneous virtual exercise in English, 8:50 a.m.-12:30 p.m. EDT at centerforhealthsecurity.org/event201/. The exercise underscores the need for global public-private cooperation to mitigate economic and societal impacts of severe pandemics.

#Event201 pandemic exercise and livestream this Friday! Follow the story as global business and government leaders make critical response decisions in real-time. More info and register at centerforhealthsecurity.org/event201/. Hosts @JHSPH_CHS @wef & @gatesfoundation
In recent years, the world has seen a growing number of epidemic events, about 200 per year, which strain limited resources. A large global pandemic would be disruptive to health, economies, and society. Economic studies show that pandemics could be the cause of an average annual economic loss of 0.7% of global GDP—or $570 billion.

Event 201, played by 15 leaders of businesses, governments, and public health, will illustrate realistic policy problems that must be addressed under pressure during a pandemic. At the video-driven exercise, players will be presented with a scenario that reveals unresolved and controversial policy and economic issues that could be solved with sufficient political will, financial investment, and attention…

Milestones :: Perspectives :: Research

WHO gravely concerned about humanitarian situation in northeast Syria
13 October, Cairo, Egypt — WHO is gravely concerned about the humanitarian health situation in northeast Syria, where up to 200,000 people have been displaced as a result of increased military operations since 9 October, and almost 1.5 million people are in need of health aid. Many of those affected by the recent hostilities have already experienced immense physical and mental stress as a result of years of conflict and repeated displacement.

People in need of essential health care services face challenges related to insecurity and limited access to health care. Already weakened health services in northeast Syria have been severely impacted by the latest security developments. The national hospital in Ras Al-Ain is currently out of service, and the national hospital and two health centers in Tel Abyad are also currently non-functional. The three field hospitals in Al-Hol camp have limited their services since 12 October as a result of the escalation of hostilities which has impeded access of health staff to the camp. All health facilities in camps hosting displaced people in Ain Issa and Ras al Ain have also been evacuated, with additional facilities under threat as the conflict rapidly escalates.

A number of health partners have already suspended services due to insecurity, further disrupting access to essential health care services. On 12 October, a trauma stabilization point located south of Ras Al Ain was evacuated after being reportedly attacked, resulting in two health staff injured and two ambulances destroyed. On the same day, the hospital in Ras Al-Ain was also reportedly attacked. There were no casualties as the facility had already been evacuated.

Across northeast Syria, shortages of health workers is widespread as they too have been among those displaced by the ongoing insecurity, aggravating an already critical situation and further depriving underserved populations of access to medical care.

Damages to the pumping station in Ras Al Ain, the main water source for most of Al Hassakeh governorate, has increased the risk of outbreaks of infectious diseases. Even before the current escalation in conflict, acute diarreah and typhoid were two of the most reported diseases among people in northeast Syria in August 2019. Ongoing displacements, overcrowded living conditions, and limited access to safe water and sanitation services, will likely lead to an increase in the number of people affected by water-borne diseases.

Amid this chaotic and fast-moving situation, WHO and health partners are working hard to respond to urgent health needs. Almost 314,000 medical treatments, vaccines, in addition to trauma medicines for 500 trauma patients have already been prepositioned in Qamishly hub. An additional shipment of more than 100,000 treatments and medicines for 640 trauma patients will be airlifted to Qamishly in the coming week. Medicines for diarrheal diseases, have also been prepositioned for delivery to health facilities as needed. Despite the challenges, many health NGOs continue to operate or shift to new locations. Some casualty cases requiring hospitalization are referred to a WHO-supported facility in Al-Hassakeh, and WHO is in the process of contracting two additional hospitals in Al-Hassakeh and Al-Raqqa to support referral services.

As the situation evolves, WHO and partners will continue to assess health needs and scale up their response as needed.

WHO calls on all parties to the conflict to preserve the right to health for hundreds of thousands of innocent civilians in northeast Syria, and comply with International Humanitarian Law to protect all civilians, including health care workers and patients, as well as health facilities.

Milestones :: Perspectives :: Research

Global TB Report
WHO :: October 2019 :: 297 pages
PDF: https://www.who.int/tb/publications/global_report/en/
New data on tuberculosis trends in 202 countries
TB remains one of the top 10 causes of death worldwide. Millions of people continue to fall sick from TB each year. The Global TB Report 2019 provides a comprehensive and up-to-date assessment of the TB epidemic, and progress in the response, at global, regional and country levels. It features data on disease trends and the response to the epidemic in 202 countries and territories.
The Global Report includes trends in TB incidence and mortality, data on case detection and treatment results for TB, multidrug-resistant TB (MDR-TB), TB/HIV, TB prevention, universal health coverage as well as financing. It presents progress towards targets set at the first-ever United Nations General Assembly high-level meeting on TB in 2018, that brought together heads of state, as well as the targets of the WHO End TB Strategy and the Sustainable Development Goals.
The report also includes an overview of pipelines for new TB diagnostics, drugs and vaccines. Additionally, it outlines a monitoring framework that features data on SDG indicators that can be used to identify key influences on the TB epidemic at national level and inform the multi-sectoral actions required to end the TB epidemic.

Excerpt [p.4]
…TB research and development
The SDG and End TB Strategy targets set for 2030 cannot be met without intensified research and development. Technological breakthroughs are needed by 2025, so that the annual decline in the global TB incidence rate can be accelerated to an average of 17% per year. Priorities include a vaccine to lower the risk of infection, a vaccine or new drug treatment to cut the risk of TB disease in the 1.7 billion people already latently infected, rapid diagnostics for use at the point of care, and simpler, shorter drug regimens for treating TB disease.

The diagnostic pipeline appears robust in terms of the number of tests, but no new technology emerged in 2019. As of August 2019, there were 23 drugs, various combination regimens and 14 vaccine candidates in clinical trials. Recently, the M72/AS01E vaccine candidate was found to be protective against TB disease in a Phase IIb trial among individuals with evidence of latent TB infection. If the findings are confirmed in a Phase III trial, this vaccine could transform global TB prevention efforts.

The latest data published by Treatment Action Group showed funding of US$ 772 million for TB research and development in 2017, much less than the target of at least US$ 2 billion per year set at the UN high-level meeting on TB…

News Release
7 million people receive record levels of lifesaving TB treatment but 3 million still miss out
Severe underfunding, lack of access to care jeopardize at-risk populations
17 October 2019 Geneva I Washington DC
More people received life-saving treatment for tuberculosis (TB) in 2018 than ever before, largely due to improved detection and diagnosis. Globally, 7 million people were diagnosed and treated for TB – up from 6.4 million in 2017 – enabling the world to meet one of the milestones towards the United Nations political declaration targets on TB.

WHO’s latest Global TB Report says that 2018 also saw a reduction in the number of TB deaths: 1.5 million people died from TB in 2018, down from 1.6 million in 2017.  The number of new cases of TB has been declining steadily in recent years. However, the burden remains high among low-income and marginalized populations: around 10 million people developed TB in 2018.

“Today we mark the passing of the first milestone in the effort to reach people who’ve been missing out on services to prevent and treat TB,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“This is proof that we can reach global targets if we join forces together, as we have done through the Find.Treat.All.EndTB joint initiative of WHO, Stop TB Partnership and the Global Fund to Fight AIDS, TB and Malaria”.

WHO’s latest Global TB Report, released today, highlights that the world must accelerate progress if it is to reach the Sustainable Development Goal of ending TB by 2030. The report also notes that an estimated 3 million of those with TB still are not getting the care they need…

Emergencies

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

Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 18 October 2019
[Excerpts]
…The WHO Secretariat provided details on the latest risk assessment. Risk remains very high at national and regional levels but still low at global level. In recent weeks, the incidence of EVD cases has consistently declined, with 15 new confirmed cases, reported in North Kivu and Ituri provinces during the last epidemiological week of 7–13 October, in comparison with 128 confirmed cases per week reported at the peak of the outbreak in April 2019. There is a shift in hot spots from urban settings to more rural, hard-to-reach communities, across a more concentrated geographical area. At present, 10 health zones are affected. These areas pose major security challenges. When response activities are suspended, the likelihood of underreporting and the potential for the disease to spread to new areas increases. In addition, continued transmission in remote areas where access is difficult creates the possibility of transmission chains going undetected.

The ring vaccination strategy is proving efficient and successful. Issues related to vaccine supply were reviewed. Given the uncertainty of the evolution of the epidemic, current supplies should be managed carefully.  The Secretariat also welcomed the commencement of Johnson and Johnson vaccine studies in Uganda and the imminent commencement of similar studies in the Democratic Republic of the Congo, in addition to continuing to track progress with other vaccine candidates.

The United Nations Ebola Emergency Response Coordinator gave an update on the situation and efforts to maintain an enabling environment to improve access and acceptance of Ebola response in communities. He re-emphasized the need for stronger community engagement and access in all areas, increased multisectoral collaboration, and more financial and human resources. Insecurity remains the greatest concern. Efforts to increase security are underway. There is a need to focus both on intervention gaps and the quality of interventions. Identifying areas where the virus might migrate and securing these areas constitutes a major priority.

The Committee was also appraised by the WHO Secretariat on progress on preparedness efforts in the nine neighbouring countries (priority 1: Burundi, Rwanda, South Sudan, and Uganda, and priority 2: Angola, Republic of the Congo, Central African Republic, Tanzania, and Zambia).  Bilateral roadmaps for cross-border coordination between DRC and the priority 1 countries are being implemented. On 21 October 2019, a high-level ministerial meeting will be held in Goma, DRC, to further strengthen alignment and coordination of cross-border surveillance across all nine high-risk neighbouring countries. A major challenge is the lack of funding for preparedness, particularly in the priority 2 countries. Of the US$ 66.6 million required for all the 9 countries, only US$ 4.5 million has been pledged. Compliance with IHR requirements for notification and verification of alerts was highlighted, in particular with regards to transparency and timely sharing of public health information.

Context and Discussion
The Committee commended the response to date, under the leadership of the Democratic Republic of the Congo Ministry of Health, and appreciated the progress made under the multisectoral coordination commission established in July 2019. Support provided by WHO, UN agencies, NGOs and other partners has also contributed to limiting the spread and impact of this virus in a difficult context in many areas in the Democratic Republic of the Congo. The courage and commitment of all frontline workers were specifically praised by the Committee.

While the Committee commended the efforts made by the neighbouring countries to strengthen preparedness, it remained deeply concerned by the lack of sustained financial support for these activities.

The committee noticed with appreciation that the general compliance of all states with the WHO recommendations to keep borders open and air travel meant operations could continue and economies in the area were not harmed by border closures.

However, the Committee is concerned that a year into the outbreak, the access and security situations on the ground could hinder final efforts to eliminate the virus from rural communities.

Conclusions and Advice
It was the view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).

…Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 October 2019 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).

The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 18 October 2019.

::::::

Major milestone for WHO-supported Ebola vaccine
18 October 2019 News release Geneva
The World Health Organization (WHO) welcomes the European Medicines Agency (EMA) announcement recommending a conditional marketing authorization for the rVSV-ZEBOV-GP vaccine, which has been shown to be effective in protecting people from the Ebola virus.

Today’s announcement by EMA, the European agency responsible for the scientific evaluation of medicines developed by pharmaceutical companies, is a key step before the European Commission decision on licensing. In parallel, WHO will move towards prequalification of the vaccine.

“The conditional authorization of the world’s first Ebola vaccine is a triumph for public health, and a testimony to the unprecedented collaboration between scores of experts worldwide,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “My deepest gratitude is to the studies’ volunteers, researchers, health workers in Guinea, other countries and the Democratic Republic of the Congo who have put themselves at risk to ensure people are protected with this vaccine.”

In the past five years, WHO has convened experts to review the evidence on various Ebola vaccine candidates, informed policy recommendations, and mobilized a multilateral coalition to accelerate clinical evaluations. The EMA review was unique in that WHO and African regulators actively participated through an innovative cooperative arrangement put in place by WHO, which will help accelerate registration for the countries most at risk.

A randomized trial for the vaccine began during the West Africa Ebola outbreak in 2015. When no other organization was positioned to run a trial in Guinea during the complex emergency, the government of Guinea and WHO took the unusual step to lead the trial.

A global coalition of funders and researchers provided the critical support required. Funders included the Canadian Government (through the Public Health Agency of Canada, Canadian Institutes of Health Research, International Development Research Centre, Global Affairs Canada); the Norwegian Ministry of Foreign Affairs (through the Research Council of Norway’s GLOBVAC programme); the Wellcome Trust; the UK government through the Department for International Development; and Médecins Sans Frontières.

The trial was successfully run using an innovative ring vaccination design. In the 1970s, this ring strategy helped to eradicate smallpox, but this was the first time that an experimental vaccine was evaluated this way…

Merck Receives EU CHMP Positive Opinion for Investigational V920 Ebola Zaire Vaccine for Protection Against Ebola Virus Disease
October 18, 2019
[See Industry Watch below for detail]

::::::

Ebola Outbreak in DRC 63: 15 October 2019
Situation Update
In the past week, from 7 to 13 October, 15 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. While it is encouraging to see another week of relatively low numbers of newly confirmed cases (Figure 1), these are occurring in a concentrated area where limited access and insecurity pose challenges for the response. In such environments, risks of resurgence remain very high, as do the risks of re-dispersion of cases. For example, this past week, several people who were eventually confirmed as positive for EVD sought healthcare in health zones which are no longer experiencing ongoing transmission, such as Beni…

::::::
::::::

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 16 October 2019
:: Preparations for World Polio Day taking place next week on 24 October are in full swing. On that day, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) is expected to declare poliovirus type 3 (WPV3) as globally eradicated. The event will be broadcast on the internet. Viewers are welcome to follow the proceedings through a WebEx broadcast that will be available here.

:: The Polio Oversight board (POB) met on 6 September 2019 for its third meeting of the year to discuss the current status of work within the programme. The meeting summary is now available.

Summary of new viruses this week:
:: Pakistan — two WPV1-positive environmental samples;
:: Philippines — two cVDPV1-positive environmental samples.

::::::

Meeting of the Polio Oversight Board (POB)—Teleconference
6 September 2019 | 16h00-18h00 GVA time
The Polio Oversight Board held its third meeting of the year by teleconference to discuss the status of polio eradication efforts and preparations for the upcoming GPEI pledging moment in Abu Dhabi on November 19th, 2019.

[Excerpt below; full report available at title link above]
1. Key Challenges/Risks to Polio Programme
Michel Zaffran gave POB members an update on the status of global polio eradication, which is of great concern.
:: In Afghanistan, the lack of access due to the Taliban’s ban on house to house vaccination and more recently on all WHO/ICRC activities is leading to a large, vulnerable cohort of unvaccinated children. Even in the areas where vaccination activities are ongoing, the inability of the programme to have outside experts participate, in both training and supervision, as well as conducing post campaign monitoring, is leading to declines in campaign quality. The upcoming leadership transitions at all levels—from national elections to turnover in WHO and UNICEF staff—is both a potential risk and opportunity.

:: In Pakistan, the program is on, what the recent Technical Advisory Group meeting called a “failing trajectory”. Issues such as community resentment and mistrust, combined with sub-optimal SIA quality in certain areas is resulting in sizeable pockets of unimmunized children. This is leading to ongoing widespread virus circulation and a substantial increase in the number of polio cases (58 as of August 31st, compared to 12 reported in all of 2018). The program needs to be transformed, with national unity and all-party consensus at all levels to be effective. On an encouraging note, high levels of national commitment are now seen in Pakistan—what remains to be seen is if this commitment will translate to all levels and action.

:: Nigeria has made remarkable strides against the wild poliovirus, with the last case seen over three years ago—meaning that the entire continent has likely been Wild Poliovirus (WPV) type 3 free since September 2016. However, the Circulating Vaccine Derived Polio Virus (cVDPV) situation is extremely worrying. There appears to be a lack of political support and slow and poor-quality responses, exacerbated by a reluctance, in some countries, to declare an emergency and limited availability/access of trained experts to deploy rapidly. The budget reduction in the country is a real risk, given the increase in outbreaks and lack of ability to rapidly control them. The announcement of the certification of WPV3 eradication will need to be carefully communicated taking into account cVDPV outbreaks .

:: The world is facing more cVDPV2s than our modeling predicted at the time of the switch. Three years after the global withdrawal of Oral Poliovirus type 2 from National immunization programmes, the population mucosal immunity against type 2 poliovirus has waned dramatically. While monovalent OPV type 2 (mOPV2) is the only tool currently available to stop these outbreaks, the programme is now facing two challenges: i) the stockpile is being depleted and ii) the use of mOPV2 is seeding new VDPV2 outbreaks. A new vaccine that is less likely to revert to neurovirulence and cause outbreaks, the novel OPV (nOPV), is showing great promise in clinical trials and its use will be expedited under WHO’s Emergency Use License (EUL), but time will be needed to scale up production to phase out the use of mOPV2 altogether. Financing is a big challenge, as funds are not available currently. With the number of outbreaks higher than expected, funds are being pulled from preventative SIAs, which of course raises other risks. (GPEI lacks flexible funding). To ensure the responses being conducted are as effective as possible, new guidelines are being put into action to ensure rapid access to technical expertise as well as local financing…
…
[Excerpt from POB Discussion]
Seth Berkley (POB member, CEO, Gavi) asked GPEI to provide further details on plan B if nOPV doesn’t work or is delayed. We all know that scaling up vaccine production is a challenge and not without risks of delays. He agreed with Dr Elias that WHO needs to ensure EUL is ready to be rolled out without any problems. He expressed his concern that he felt the POB needed to really discuss, as a Board, what needs to be done to turn things around and get eradication back on track. He also noted his concern that the current investment case is based on a strategy that assumed the last case of WPV would be in 2020, which is now no longer a feasible assumption. He expressed that he thought donors would be expecting GPEI to be rethinking its approach in light of this and coming up with new ideas, and that the POB, as highest-level body, should ensure that happens. This means rethinking strategies, not just towing the line that getting access will solve all our problems. Dr Berkley requested that the management report done by McKinsey be circulated to the POB as a critical input to this rethink and prior to any POB visits to the field.

::::::
::::::

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 19 Oct 2019]

Democratic Republic of the Congo
:: Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 18 October 2019
:: Ebola Outbreak in DRC 63: 15 October 2019
[See Ebola above for detail]

Syrian Arab Republic
:: WHO gravely concerned about humanitarian situation in northeast Syria 13 October 2019
[See Milestones above for detail]

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
Yemen – No new digest announcements identified

::::::

WHO Grade 2 Emergencies [to 19 Oct 2019]

Iran floods 2019 – No new digest announcements identified
Libya – No new digest announcements identified

MERS-CoV
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – The Kingdom of Saudi Arabia
18 October 2019
From 1 through 30 September 2019, the National IHR Focal Point of Saudi Arabia reported 4 additional laboratory-confirmed cases of Middle East respiratory syndrome (MERS-CoV) infection and one associated death…

Myanmar
:: Bi‐weekly Situation Report 20 – 10 October 2019
SITUATION OVERVIEW
There are an estimated 911,566 Rohingya refugees in Cox’s Bazar, according to the latest ISCG situation report (August 2019). This includes 34,172 refugees from Myanmar who registered before 31st August 2017. All refugees, including new arrivals, face compounding vulnerabilities, including in health. WHO has been responding to this crisis since September 2017…
Immunization
A comprehensive review of the work of WHO Health field monitors has taken place, and activities were subsequently revised with the aim of increasing catch up for drop-out and left-out children (through child registration validation) and improvements of reporting/feedback mechanisms…
A campaign strategy for the upcoming Measles-Rubella Supplementary Immunization Activity (MR SIA) in 2020 is under development, as well as implementation plans for major recommendations of the quarterly review meeting which took place in collaboration with the national programme.

occupied Palestinian territory
:: WHO Report – Right to health 2018 Regional Office for the Eastern Mediterranean
…This report analyses some of the major barriers to realization of the right to health for
Palestinians in the occupied Palestinian territory. It focuses on four main topics: provision and
availability of healthcare; access to healthcare; underlying determinants of health; and health
attacks. The West Bank and Gaza Strip have been under Israeli military occupation for over 50 years…

Sudan
:: Vaccination campaign against cholera kicks off in Sudan
Attributable to the Federal Ministry of Health in Sudan, WHO and UNICEF
KHARTOUM, 11 October 2019 – “Sudan has launched an oral cholera vaccination campaign in response to the ongoing outbreak of cholera. More than 1.6 million people aged one year and above in the Blue Nile and Sinnar states will be vaccinated over the coming five days.
“The announcement of the Federal Ministry of Health in Sudan on the cholera outbreak last month allowed national and state authorities, and health partners, to act quickly and respond to the outbreak…

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – 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
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
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

::::::

WHO Grade 1 Emergencies [to 19 Oct 2019]

Kenya
:: Kenya takes vital step against cervical cancer and introduces HPV vaccine into routi…
18 October 2019
With President Uhuru Kenyatta leading the way, Kenya today joins an increasing number of African countries taking a vital step against a common cause of death among women – in the country and the region – by introducing the human papilloma virus (HPV) vaccine against cervical cancer into its routine immunization schedule…

Chad – No new digest announcements identified
Djibouti – 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 ǀ Flash Update #7, Humanitarian impact of the military operation in north-eastern Syria, 16 – 18 October 2019

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

::::::
::::::