Vaccines and Global Health: The Week in Review :: 26 October 2019

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

Two out of three wild poliovirus strains eradicated

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

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

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.

PAHO Director in Rio de Janeiro highlights achievements and challenges in vaccine production

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.

NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale

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.”…

Global Health Progress launched to drive cross-sectoral collaborations in support of the Sustainable Development Goals

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.



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…


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…