Milestones :: Perspectives :: Research

Drop in cholera cases worldwide, as key endemic countries report gains in cholera control
19 December 2019 WHO News release
The number of cholera cases decreased globally by 60% in 2018, the World Health Organization (WHO) announced in a report that points to an encouraging trend in cholera prevention and control in the world’s major cholera hotspots, including Haiti, Somalia and the Democratic Republic of the Congo.

“The decrease we are seeing in several major cholera-endemic countries demonstrates the increased engagement of countries in global efforts to slow and prevent cholera outbreaks and shows the vital role of mass cholera vaccination campaigns,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We continue to emphasize, however, that the long-term solution for ending cholera lies in increasing access to clean drinking water and providing adequate sanitation and hygiene.”

There were 499,447 cases of cholera and 2990 deaths in 2018, according to reports from 34 countries. While outbreaks are still ongoing in various countries, the case load represents a significant downward trend in cholera transmission that has continued into 2019, according to data collected by WHO.

“The global decrease in case numbers we are observing appears to be linked to large-scale vaccination campaigns and countries beginning to adopt the Global Roadmap to 2030 strategy in their national cholera action plans,” said Dr Dominique Legros, who heads WHO’s cholera programme in Geneva. “We must continue to strengthen our efforts to engage all cholera-endemic countries in this global strategy to eliminate cholera.”

Nearly 18 million doses of Oral Cholera Vaccine (OCV) were shipped to 11 countries in 2018. Since the OCV stockpile was created in 2013, almost 60 million doses have been shipped worldwide. Gavi, the Vaccine Alliance, has provided funding for purchase of the vaccine and financial support for the global vaccination drives….

Milestones :: Perspectives :: Research

New pneumococcal vaccine from Serum Institute of India achieves WHO prequalification
December 19, 2019 by Lauren Newhouse
This milestone marks a key step toward improving pneumococcal conjugate vaccine affordability and enabling sustainable access for low- and middle-income countries
Pune, India and Seattle, United States, December 19, 2019—PNEUMOSIL®, a vaccine against a leading cause of deadly childhood pneumonia—the pneumococcus bacterium—has achieved prequalification by the World Health Organization (WHO). Developed though a collaboration spanning over a decade between Serum Institute of India, Pvt., Ltd. (SIIPL) and PATH and with funding from the Bill & Melinda Gates Foundation, the vaccine is expected to provide protection for children on par with other pneumococcal conjugate vaccines at a price that is more affordable for low- and middle-income countries…

Milestones :: Perspectives :: Research

Global Vaccine Action Plan review and Lessons Learned Report
WHO/IVB/19.07 2019 :: 44 pages
Strategic Advisory Group of Experts on Immunization. The Global Vaccine Action Plan 2011-2020.
Report PDF: https://apps.who.int/iris/bitstream/handle/10665/329097/WHO-IVB-19.07-eng.pdf?ua=1
Preface [excerpt]
…This report expands on the annual assessment reports prepared by the SAGE Decade of Vaccines Working Group. It considers the entire decade, drawing on a review of progress toward GVAP’s goals and objectives as well as the perceptions of stakeholders captured through three surveys, which elicited 310 responses from immunization stakeholders, and two sets of semi-structured interviews with 80 stakeholders undertaken in 2017–2019. It also incorporates valuable insights from Working Group members and the representatives of partner organizations and WHO regional offices who have made important contributions to annual
assessments. Annex 3 provides links to the full body of evidence used to generate this report.
This document reflects on the lessons learned from GVAP, and makes recommendations for the development, content and implementation of the next global immunization strategy.

HIGH-LEVEL RECOMMENDATIONS
A post-2020 global immunization strategy should:
1. Build on GVAP’s lessons learned, ensuring more timely and comprehensive implementation at global, regional and national levels

2. Have a key focus on countries:
2a. Place countries at the centre of strategy development and implementation to ensure context specificity and relevance
2b. Strengthen country-led evidence-based decision-making
2c. Encourage the sourcing and sharing of innovations to improve programme performance
2d. Promote use of research by countries to accelerate uptake of vaccines and vaccine technologies and to improve programme performance

3. Maintain the momentum towards GVAP’s goals:
3a. Incorporate key elements of GVAP, recognizing its comprehensiveness and the need to
sustain immunization’s successes each and every year
3b. Add a specific focus on humanitarian emergencies, displacement and migration, and chronic fragility
3c. Encourage stronger integration between disease-elimination initiatives and national immunization programmes 3d. Encourage greater collaboration and integration within and beyond the health sector

4. Establish a governance model better able to turn strategy into action:
4a. Create a robust and flexible governance structure and operational model based on closer collaboration between partners at all levels
4b. Incorporate the flexibility to detect and respond to emerging issues
4c. Develop and maintain a strong communications and advocacy strategy

5. Promote long-term planning for the development and implementation of novel vaccine and other preventive innovations, to ensure populations benefit as rapidly as possible

6. Promote use of data to stimulate and guide action and to inform decision-making

7. Strengthen monitoring and evaluation at the national and sub-national level to promote greater accountability

Milestones :: Perspectives :: Research

Highest-Ever Funding Allocations Announced to Fight AIDS, TB and Malaria – Global Fund
18 December 2019
GENEVA − Following a record-breaking Replenishment in October 2019, the Global Fund today announced its largest-ever funding allocations for eligible countries to fight AIDS, tuberculosis and malaria and build systems for health over the next three years.

The allocations include US$12.71 billion for country allocations and US$890 million for catalytic investments for the period beginning 1 January 2020 – 23% more than for the previous three-year period. The funds will help save 16 million lives, cut the mortality rate for the three diseases in half and get the world back on track to end the epidemics of AIDS, tuberculosis and malaria by 2030.

“World leaders came together at our Replenishment and made commitments to step up the fight to end these epidemics by 2030,” said Peter Sands, Executive Director of the Global Fund. “Now the real work begins. Our allocations will allow partners to expand programs that work, and to find innovative solutions for new challenges. In addition to more money, we need better collaboration and more effective programs.”…

Featured Journal Content

Science Translational Medicine
18 December 2019 Vol 11, Issue 523
https://stm.sciencemag.org/
Research Articles
Biocompatible near-infrared quantum dots delivered to the skin by microneedle patches record vaccination
By Kevin J. McHugh, Lihong Jing, Sean Y. Severt, Mache Cruz, Morteza Sarmadi, Hapuarachchige Surangi N. Jayawardena, Collin F. Perkinson, Fridrik Larusson, Sviatlana Rose, Stephanie Tomasic, Tyler Graf, Stephany Y. Tzeng, James L. Sugarman, Daniel Vlasic, Matthew Peters, Nels Peterson, Lowell Wood, Wen Tang, Jihyeon Yeom, Joe Collins, Philip A. Welkhoff, Ari Karchin, Megan Tse, Mingyuan Gao, Moungi G. Bawendi, Robert Langer, Ana Jaklenec
Science Translational Medicine18 Dec 2019 Full Access
On the record
Vaccines prevent disease and save lives; however, lack of standardized immunization recordkeeping makes it challenging to track vaccine coverage across the world. McHugh et al. developed dissolvable microneedles that deliver patterns of near-infrared light-emitting microparticles to the skin. Particle patterns are invisible to the eye but can be imaged using modified smartphones. By codelivering a vaccine, the pattern of particles in the skin could serve as an on-person vaccination record. Patterns were detected 9 months after intradermal delivery of microparticles in rats, and codelivery of inactivated poliovirus led to protective antibody production. Discrete microneedle-delivered microparticle patterns in porcine and pigmented human skin were identifiable using semiautomated machine learning. These results demonstrate proof of concept for intradermal on-person vaccination recordkeeping.
Abstract
Accurate medical recordkeeping is a major challenge in many low-resource settings where well-maintained centralized databases do not exist, contributing to 1.5 million vaccine-preventable deaths annually. Here, we present an approach to encode medical history on a patient using the spatial distribution of biocompatible, near-infrared quantum dots (NIR QDs) in the dermis. QDs are invisible to the naked eye yet detectable when exposed to NIR light. QDs with a copper indium selenide core and aluminum-doped zinc sulfide shell were tuned to emit in the NIR spectrum by controlling stoichiometry and shelling time. The formulation showing the greatest resistance to photobleaching after simulated sunlight exposure (5-year equivalence) through pigmented human skin was encapsulated in microparticles for use in vivo. In parallel, microneedle geometry was optimized in silico and validated ex vivo using porcine and synthetic human skin. QD-containing microparticles were then embedded in dissolvable microneedles and administered to rats with or without a vaccine. Longitudinal in vivo imaging using a smartphone adapted to detect NIR light demonstrated that microneedle-delivered QD patterns remained bright and could be accurately identified using a machine learning algorithm 9 months after application. In addition, codelivery with inactivated poliovirus vaccine produced neutralizing antibody titers above the threshold considered protective. These findings suggest that intradermal QDs can be used to reliably encode information and can be delivered with a vaccine, which may be particularly valuable in the developing world and open up new avenues for decentralized data storage and biosensing.

Emergencies

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

Ebola Outbreak in DRC 72: 17 December 2019
Situation Update
In the week of 9 to 15 December 2019, 24 new confirmed Ebola virus disease (EVD) cases were reported from three health zones in two affected provinces in the Democratic Republic of the Congo. The majority of these new confirmed cases are from Mabalako (22/24; 92%), and the other cases were reported from Biena (1/24; 4%) and Mandima (1/24; 4%) health zones.

The new cases from Mabalako and Biena, are linked to a single chain of transmission, in which one individual was a potential source of infection for 24 people. This was the second documentation of EVD illness in this individual within a 6-month period. Based on the preliminary sequencing of samples from the case, this is being classified as a relapse of EVD. Rare cases of relapse have been documented, in which a person who has recovered from EVD gets disease symptoms again, but this is the first documented relapse in this outbreak.

The volume of alerts reported has returned to levels seen before the security incidents in the past weeks. In general, the overall average proportion of contacts under surveillance in the last seven days has returned to previously observed levels. However, Mabalako, the health zone with the highest volume of contacts, has the lowest performance with 73% of contacts under surveillance…

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First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response
December 19, 2019
The U.S. Food and Drug Administration announced today the approval of Ervebo, the first FDA-approved vaccine for the prevention of Ebola virus disease (EVD), caused by Zaire ebolavirus in individuals 18 years of age and older. Cases of EVD are very rare in the U.S., and those that have occurred have been the result of infections acquired by individuals in other countries who then traveled to the U.S., or health care workers who became ill after treating patients with EVD.

“While the risk of Ebola virus disease in the U.S. remains low, the U.S. government remains deeply committed to fighting devastating Ebola outbreaks in Africa, including the current outbreak in the Democratic Republic of the Congo,” said Anna Abram, FDA Deputy Commissioner for Policy, Legislation, and International Affairs. “Today’s approval is an important step in our continuing efforts to fight Ebola in close coordination with our partners across the U.S. Department of Health and Human Services, as well as our international partners, such as the World Health Organization. These efforts, including today’s landmark approval, reflect the FDA’s unwavering dedication to leveraging our expertise to facilitate the development and availability of safe and effective medical products to address urgent public health needs and fight infectious diseases, as part of our vital public health mission.”…

… “Ebola virus disease is a rare but severe and often deadly disease that knows no borders. Vaccination is essential to help prevent outbreaks and to stop the Ebola virus from spreading when outbreaks do occur,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “The FDA’s approval of Ervebo is a major advance in helping to protect against the Zaire ebolavirus as well as advancing U.S. government preparedness efforts. The research approach used to study the effectiveness and safety of this vaccine was precedent-setting during a public health emergency and may help create a model for future studies under similar circumstances. The FDA is committed to continuing our work across the U.S. government and with our international partners to prevent future Ebola outbreaks and mitigate the current outbreak in the DRC, reflecting our nation’s commitment to preparing for and responding to biological threats, like Ebola.”’’’

…The FDA granted this application Priority Review and a Tropical Disease Priority Review Voucher under a program intended to encourage development of new drugs and biologics for the prevention and treatment of certain tropical diseases. The FDA also granted Breakthrough Therapy designation for Ervebo to facilitate the development and scientific evaluation of the vaccine. Because of the public health importance of a vaccine to prevent EVD, the FDA worked closely with the company and completed its evaluation of the safety and effectiveness of Ervebo in less than six months. The approval was granted to Merck & Co., Inc.

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Merck Announces FDA Approval for ERVEBO® (Ebola Zaire Vaccine, Live)
Action Represents Another Milestone for the Global Partnership Against Ebola
December 20, 2019 07:15 AM Eastern Standard Time
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (NYSE:MRK), known as MSD outside the United States and Canada, today announced that the U.S. Food and Drug Administration (FDA) has approved ERVEBO® (Ebola Zaire Vaccine, Live) (pronounced er-VEE-boh) for the prevention of disease caused by Zaire ebolavirus in individuals 18 years of age and older. The duration of protection conferred by ERVEBO is unknown. ERVEBO does not protect against other species of Ebolavirus or Marburgvirus. Effectiveness of the vaccine when administered concurrently with antiviral medication, immune globulin (IG), and/or blood or plasma transfusions is unknown. Do not administer ERVEBO to individuals with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine, including rice protein.

“Approval of this vaccine by the FDA represents another important milestone in the global response to Ebola Virus Disease and stands as a tremendous accomplishment by a unique global partnership,” said Dr. Roger M. Perlmutter president, Merck Research Laboratories. “In acknowledging this event, I wish in particular to recognize the heroic efforts being made by frontline responders to the ongoing outbreak in the Democratic Republic of the Congo. We are proud and honored to play a role in supporting their vital activities, and we remain focused on the important work ahead.”

“Having an Ebola vaccine approved by the FDA is a significant milestone in Ebola preparedness and prevention efforts,” said Rick Bright, Ph.D., deputy assistant secretary for preparedness and response and director of the Biomedical Advanced Research and Development Authority (BARDA). “At BARDA, we are tremendously proud to have been a part of this unprecedented collaboration between private and public sectors in multiple countries that has led to this important moment in public health history.”…

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 18 December 2019

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan – two WPV1 cases and two WPV1-positive environmental samples.
:: Pakistan – seven WPV1 cases, one cVDPV2 case and 12 WPV1-positive environmental samples.
:: DR Congo – Eight cVDPV2 cases.
:: Somalia – two cVDPV2-positive environmental sample.
:: Angola – 11 cVDPV2 cases and two cVDPV2-positive environmental samples.
:: Chad – one cVDPV2 case.
:: Ethiopia – one cVDPV2-positive environmental sample.
:: Ghana – three cVDPV2 cases.

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 21 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 72: 17 December 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 21 Dec 2019]
Measles in Europe
:: Nordic countries working together to sustain measles and rubella elimination 20-12-2019
:: 2019: the WHO European Region’s year in review 19-12-2019

Myanmar
:: Bi‐weekly Situation Report 24 – 5 December 2019
HIGHLIGHTS
:: A total of 1,270,70 doses of oral cholera vaccine (OCV) was approved for the OCV campaign, targeting around 635,000 individuals, which will take place from 8 to 14 December in the Rohingya camps and 8 to 31 December in the host communities.
:: Since 5 September 2019, a total of 213 cases of Acute Watery Diarrhea (AWD) have tested positive by cholera Rapid Diagnostic Tests (RDTs), or culture.
:: An assessment undertaken for the operational risks associated with Fecal Sludge management (FSM) and water sources has concluded that, urgent actions are required to improve the water safety situation in these camps…

Immunization
Oral Cholera Vaccine and Measles Outbreak Response Immunization campaigns
:: The Civil Surgeon, with support from WHO and UNICEF, established an immunization core group. The first meeting took place at the Ministry of Health and Family Welfare (MoHFW) Coordination Cell offices. Details of the upcoming Oral Cholera Vaccine (OCV) campaign were discussed.
:: A total of 1 270 170 doses of OCV was approved for the OCV campaign targeting around 635 000 individuals. The campaign will take place from 8 to 14 December in the Rohingya camps and 8 to 31 December in the host communities.
:: Several preparatory meetings have taken place. This includes District planning and Coordination meeting on 27 November, Upazila planning and microplanning meetings on 28 November and several advocacy meetings involving different target leaders including political leaders, Imams, Ministry of Education officials, among others.
:: Training has taken place for 34 OCV Camp Coordinators, 34 OCV Associate Camp Coordinators on 23 and 24 November 2019. These trainings were cascaded to over 2750 Community Health Workers and Communication for Development volunteers and 240 team supervisors between 28 and 30 November 2019, with support from partners.
:: For the host community, 300 vaccinators and mobilizers have been trained alongside 50 supervisors. Training for 1 050 and 900 volunteers commenced and will be completed by 4 December 2019, for Teknaf and Ukhia respectively.
:: The Rohingya Camp Wide Measles Rubella Outbreak Response Immunization (MR ORI) is planned in response to the measles outbreak that is currently confirmed in 16 of 34 camps in the Ukhia and Teknaf Upazila. Discussions on MR ORI took place 28 November 2019 during Scientific and Technical Sub- Committee (STSC) of the National Committee for Immunization Practices (NCIP) meeting held in Dhaka. There is need for timely ORI while ensuring quality, good coverage and proper capacity and management plan for any Adverse Events Following Immunization (AEFI).
:: MR ORI implementation planned for first week of January 2020 subject to Government approvals and favorable preparedness assessment. The target age group for this ORI is all children 6 months to less than 10 years of age in the Rohingya camps of Ukhia and Teknaf in Cox’s Bazar district.

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
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 21 Dec 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Flash Update No. 1 – As of 20 December 2019
HIGHLIGHTS
:: Following the intensification of airstrikes and shelling since 16 December in southern Idleb, tens of thousands of civilians are reportedly fleeing from Ma’arrat An-Nu’man area in southern Idleb governorate to north. Thousands of others are reportedly waiting for the bombardment to ease allowing them to move. The shortage of fuel in Idleb area is also limiting the movement of civilians fleeing from hostilities.
:: As of 20 December, ground fighting also resumed along the frontlines in southern Idleb governorate, amplifying displacement from southern Idleb as civilians are fleeing in anticipation of fighting directly affecting their communities.
:: Displacement happening in winter months is exacerbating the vulnerability of people in need. Many of those who fled are in urgent need of humanitarian support, particularly shelter, food, health, non-food and winterization assistance.

Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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WHO & Regional Offices [to 21 Dec 2019]
19 December 2019 News release
Drop in cholera cases worldwide, as key endemic countries report gains in cholera control
[See Milestones above for detail]

19 December 2019 News release
WHO launches new report on global tobacco use trends

18 December 2019 News release
WHO prequalifies first biosimilar medicine to increase worldwide access to life-saving breast cancer treatment

16 December 2019 News release
More than one in three low- and middle-income countries face both extremes of malnutrition

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Weekly Epidemiological Record, 20 December 2019, vol. 94, 51/52 (pp. 613–628)
Index of countries/areas
Index, Volume 94, 2019, Nos. 1–52
Weekly Epidemiological Record, 24 May 2019, vol. 94, SPECIAL ISSUE (pp. i–xlviii)
Immunization and Vaccine-related Implementation Research Advisory Committee Executive summary, September 2019
Monthly report on dracunculiasis cases, January-October 2019

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: Pan American Health Organization and Airbnb Announce Collaboration (12/20/2019)
:: PAHO/WHO urges southern hemisphere countries to prepare for heatwaves (12/19/2019)
:: Rabies Elimination in Haiti: Dog vaccination campaign launched (12/16/2019)

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

WHO European Region EURO
:: 2019: the WHO European Region’s year in review 19-12-2019
:: Promoting health literacy as powerful tool to address public health challenges 19-12-2019
:: Tobacco use declining globally but set to miss targets 19-12-2019
:: Migrant mothers receiving the support they need 18-12-2019

WHO Eastern Mediterranean Region EMRO
:: Seasonal influenza in Yemen 18 December 2019
:: Giving disabled children in Syria new hope 17 December 2019

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 21 Dec 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html
Wednesday, December 18, 2019
Nine Health Threats that Made Headlines in 2019: A CDC Review

MMWR News Synopsis for Friday, December 20, 2019
Estimating the Incidence of Influenza at the State Level — Utah, 2016–17 and 2017–18 Influenza Seasons
Timely state- or local-level estimates of the number of people who are ill and seek medical care due to influenza (flu) contribute to preparedness and communication messages needed during flu season and in the event of a flu pandemic. As flu season approaches, pilot work done at the Utah Department of Health and Salt Lake County Health Department to estimate seasonal flu burden and severity may help inspire other health departments to adopt similar measures. Methods used by CDC to estimate the numbers of people who are ill, seek medical care, or who are hospitalized due to flu nationally were applied for the first time at state and local levels. Results showed that in Utah during the 2017-18 flu season, approximately 11% of Utah residents were sick due to flu, and 3,900 of these people had severe flu illness requiring hospitalization. These findings complement a previous report (https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a7.htm) on real-time flu season severity estimation in Utah that is now actively used in the state (http://health.utah.gov/epi/diseases/influenza/surveillance/2019-2020/Utah_Weekly_Influenza_Report.htmlexternal icon). State or county health departments may consider adapting these reproducible methods in their jurisdictions to estimate local flu disease burden and severity to help public health officials, policymakers, and clinicians tailor flu messaging, planning, and responses for seasonal flu epidemics and pandemics.

Ebola Virus Disease Outbreak — Democratic Republic of the Congo, August 2018–November 2019
The Democratic Republic of Congo’s (DRC) Ministry of Health (MoH), along with international partners, have improved the MoH’s ability to respond to the DRC’s current Ebola epidemic and to identify targeted intervention strategies for affected health zones. However, because this outbreak is happening in the context of more violence than seen in earlier outbreaks, there is a need for innovative approaches beyond the conventional Ebola response. On August 1, 2018, the DRC MoH declared the tenth outbreak of Ebola virus disease (Ebola) in DRC, in the North Kivu Province in eastern DRC on the border with Uganda. From the beginning of the outbreak to November 17, 2019, a total of 3,296 Ebola cases and 2,196 (67%) deaths were reported, making this the second largest documented outbreak after the 2014–2016 epidemic in West Africa. Since August 2018, the DRC MoH has been collaborating with international partners to control the outbreak. Although the DRC has successfully contained Ebola outbreaks in the past, challenges specific to North Kivu and Ituri provinces have complicated outbreak control. Limited infrastructure and resources, armed conflict, and community distrust of local authorities and international partners are major challenges faced by the Ebola response.

Africa CDC [to 21 Dec 2019]
http://www.africacdc.org/
News
Togo Health Minister Elected Chair of Africa CDC Governing Board
02-12-2019
The Health Minister of Togo, Prof. Moustafa Mijiyawa, has been elected Chair of the Africa CDC Governing Board for a term of three years. He was unanimously chosen by representatives of Member States present in the 6th meeting of the Board in Addis Ababa, Ethiopia, on 2 December 2019. Prof. Mijiyawa, an Officer of the Order of Academic Palms and Knight of the Order of Mono, has been Togo’s Minister of Health and Public Hygiene since June…

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/
Updated: 2019-12-19
TCM further incorporated into medical systems of B&R countries
Xinhua
BEIJING — Traditional Chinese Medicine (TCM) has been further incorporated into medical systems of Belt and Road countries due to China’s increased medical exchanges and cooperation in the region, according to a forum on TCM development.

China has set up a group of overseas TCM centers in relevant B&R countries and regions and is building a batch of bases for international cooperation on TCM, according to participants at the forum, which was held in Beijing Dec 18.

Chinese TCM experts have also taken research tours to other countries, including Russia and Poland. Experts from China and the ASEAN have co-published a book listing 350 kinds of traditional medicines in the above countries.

Lui Tuck Yew, Singaporean ambassador to China, said Singapore attaches great importance to TCM development, and that acupuncture has been introduced in public hospitals for rehabilitative therapies.

Li Malin, vice-governor of Yunnan province in Southwest China, said nearly 800 foreign students come to Yunnan to study TCM on an annual basis, and that over one-third of the 350,000 foreign patients received by local hospitals are treated with TCM each year.

However, experts said the development of TCM in B&R countries still needs to address issues ranging from standardization, trade barriers, legal barriers, and the differences in cultural backgrounds and market demands between different countries.

The forum, the third of its kind, was co-organized by the Chinese People’s Association for Friendship with Foreign Countries and the Beijing municipal people’s government. It aimed to promote international cooperation on TCM.

Announcements
December 19, 2019 – First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response
[See Milestones above for detail]

Fondation Merieux [to 21 Dec 2019]
http://www.fondation-merieux.org/
News, Events
20 – 22 Jan 2020
Mérieux Foundation co-organized event
Dengue pre-vaccination screening strategies workshop
Les Pensières Center for Global Health, Veyrier-du-Lac (France)

Gavi [to 21 Dec 2019]
https://www.gavi.org/
No new digest content identified.

GHIT Fund [to 21 Dec 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 21 Dec 2019]
https://www.theglobalfund.org/en/news/
News & Stories
Updates
Technical Evaluation Reference Group: Market Shaping Strategy Mid-Term Review
20 December 2019
Thematic Review of Market Shaping Strategy (Mid-Term) download in English

News
Highest-Ever Funding Allocations Announced to Fight AIDS, TB and Malaria
18 December 2019
[See Milestones above for detail]

Feature Story
2019: A Record Year for Global Health
17 December 2019

Hilleman Laboratories [to 21 Dec 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 21 Dec 2019]
http://www.humanvaccinesproject.org/media/press-releases/
Press Releases
No new digest content identified.

IAVI [to 21 Dec 2019]
https://www.iavi.org/newsroom
December 18, 2019
EDCTP-Funded Clinical Trial of New TB Vaccine Initiates Vaccinations
Partners collaborate in trial to evaluate whether vaccine candidate can prevent recurrence of TB disease
18 DECEMBER 2019 — Statens Serum Institut (SSI) in Copenhagen, Denmark, is the coordinator of a consortium that has been granted EUR 13.8 million from the European & Developing Countries Clinical Trial Partnership (EDCTP) supported by the European Union. The grant finances a clinical trial in South Africa and Tanzania of a new and promising tuberculosis (TB) vaccine candidate H56:IC31* developed by SSI. SSI and Aeras Global TB Vaccine Foundation NPC (a South African affiliate of IAVI) are co-sponsors of the trial.
The consortium consists of partners from South Africa, Tanzania, Italy, and Denmark: the South African Tuberculosis Vaccine Initiative (SATVI; Cape Town, South Africa), University of Cape Town Lung Institute (Cape Town, South Africa), TASK Applied Science (Cape Town, South Africa), the Aurum Institute (Johannesburg, South Africa), the National Institute for Medical Research (NIMR; Mbeya, Tanzania), Ospedale San Raffaele (Milan, Italy), the Aeras Global TB Vaccine Foundation NPC (Cape Town, South Africa), and SSI (a governmental research institution under the Danish Ministry of Health)…

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 21 Dec 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
No new digest content identified.

IVAC [to 21 Dec 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
No new digest content identified.

IVI [to 21 Dec 2019]
http://www.ivi.int/
Selected IVI News & Announcements
IVI appoints three new members to its Board of Trustees
December 18, 2019 – SEOUL, South Korea – The International Vaccine Institute (IVI), a Seoul, Korea-based international organization dedicated to accelerating vaccines for global health, announced today that Professor Gordon Dougan, Dr. Melanie Saville, and Dr. Jean-Marie Okwo-Bele will join its Board of Trustees (BOT) early next year. The three new members were elected at a face-to-face board meeting last month, and their terms will commence at the end of the next BOT meeting, scheduled for February 27, 2020.
“I’m very pleased to announce that three exemplary leaders across vaccinology, vaccine development and Global Health have joined the IVI Board of Trustees,” said Dr. Jerome Kim, Director General of IVI. “As we continue to diversify our vaccine portfolio and expand into different research areas, we and our global network of partners will greatly benefit from the expertise and guidance of Professor Dougan, Dr. Saville, and Dr. Okwo-Bele.”
:: Professor Gordon Dougan, GSK Professor, Department of Medicine at Cambridge University
:: Dr. Melanie Saville, Director of Vaccine Development, Coalition for Epidemic Preparedness Innovations (CEPI)
:: Dr. Jean-Marie Okwo-Bele, Independent Public Health Consultant

JEE Alliance [to 21 Dec 2019]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 21 Dec 2019]
http://www.msf.org/
Latest [Selected Announcements]
Democratic Republic of Congo
Extra humanitarian assistance urgently needed in southern North Kivu crisis
Press Release 16 Dec 2019
:: A little-known humanitarian crisis is affecting the territories of Masisi, Rutshuru and Walikale in the southern part of DRC’s North Kivu province.
:: More than 685,000 displaced people live in camps or are hosted by local families, with worrying levels of malnutrition and sexual violence.
:: With almost no aid organisations on the ground, MSF urges humanitarian organisations and donors to immediately return to this neglected area.

National Vaccine Program Office – U.S. HHS [to 21 Dec 2019]
https://www.hhs.gov/vaccines/about/index.html
NVAC 2020 Meetings
February 13-14, 2020 NVAC Meeting
June 9-10, 2020 NVAC Meeting
September 23-24, 2020 Meeting (Virtual)

NIH [to 21 Dec 2019]
http://www.nih.gov/news-events/news-releases
Selected News Releases
Infectious Diseases Clinical Research Consortium awards announced
New NIH grants build on established clinical trials program.
Thursday, December 19, 2019
The National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health, today announced the establishment of the Infectious Diseases Clinical Research Consortium, a clinical trials network that will encompass the Institute’s long-standing Vaccine and Treatment Evaluation Units (VTEUs) and create a new consortium leadership group. NIAID intends to provide approximately $29 million per year for seven years for the VTEU program and its companion leadership group.
The consortium leadership group will be headed by co-principal investigators David S. Stephens, M.D., of Emory University, and Kathleen M. Neuzil, M.D., M.P.H., of the University of Maryland School of Medicine. The group will include VTEU investigators as well as scientific experts in infectious diseases who will prioritize candidate vaccines, diagnostics, therapeutics and other interventions to test in clinical trials. To respond to public health emergencies, the leadership group will have the capacity to rapidly organize and initiate clinical trials at the VTEU sites. It also will coordinate activities with VTEU sites implementing specific clinical trials and with scientific staff in the NIAID Division of Microbiology and Infectious Diseases (DMID).
The nine VTEUs are located at institutions across the United States. They will conduct Phase 1 through 4 vaccine and treatment trials, including clinical studies in collaboration with industry partners. Depending on the disease or condition, the VTEUs may establish study sites and enroll participants at locations outside the United States. Additionally, sites will have the capacity to conduct human challenge trials—where healthy volunteers are exposed to infection under tightly controlled conditions—of influenza, malaria and other diseases….

NIH-developed Zika vaccine improves fetal outcomes in animal model
December 19, 2019 — Zika virus is primarily transmitted to humans by Aedes mosquitoes.

Children with HIV score below HIV-negative peers in cognitive, motor function tests
December 18, 2019 — Disparity worsens over time despite early HIV treatment, NIH study finds.

PATH [to 21 Dec 2019]
https://www.path.org/media-center/
Selected Announcements
New pneumococcal vaccine from Serum Institute of India achieves WHO prequalification
December 19, 2019 by Lauren Newhouse
This milestone marks a key step toward improving pneumococcal conjugate vaccine affordability and enabling sustainable access for low- and middle-income countries
Pune, India and Seattle, United States, December 19, 2019—PNEUMOSIL®, a vaccine against a leading cause of deadly childhood pneumonia—the pneumococcus bacterium—has achieved prequalification by the World Health Organization (WHO). Developed though a collaboration spanning over a decade between Serum Institute of India, Pvt., Ltd. (SIIPL) and PATH and with funding from the Bill & Melinda Gates Foundation, the vaccine is expected to provide protection for children on par with other pneumococcal conjugate vaccines at a price that is more affordable for low- and middle-income countries…

Sabin Vaccine Institute [to 21 Dec 2019]
http://www.sabin.org/updates/pressreleases
Statements and Press Releases
No new digest content identified.

UNAIDS [to 21 Dec 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
18 December 2019
Health kiosks expanding HIV services in Zimbabwe

18 December 2019
Communities are making the difference in the HIV response

17 December 2019
Young people and men less likely to know their HIV status

UNICEF [to 21 Dec 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Press release
Waves of protests around the world are reminder that voices of children and adolescents must be heard and their rights protected
Statement by UNICEF Executive Director Henrietta Fore
17/12/2019

Vaccination Acceptance Research Network (VARN) [to 21 Dec 2019]
https://vaccineacceptance.org/news.html#header1-2r
No new digest content identified.

Vaccine Confidence Project [to 21 Dec 2019]
http://www.vaccineconfidence.org/
No new digest content identified.

Vaccine Education Center – Children’s Hospital of Philadelphia [to 21 Dec 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
December 2019
Newsletter

Wellcome Trust [to 21 Dec 2019]
https://wellcome.ac.uk/news
Opinion | 18 December 2019
This is the decade we made one of the world’s deadliest diseases preventable and curable
by Jeremy Farrar
The commitment to research during the last two Ebola outbreaks has changed the course of this disease. Jeremy Farrar reflects on what made this possible.

Opinion | 18 December 2019
How ‘connectors’ bridge the gap between research and the public
by Carla Ross

News | 17 December 2019
Stellar science and research funded by another year of strong investment returns
Strong investment returns in 2019 mean Wellcome has been able to spend over £1.1 billion on improving health for everyone.

The Wistar Institute [to 21 Dec 2019]
https://www.wistar.org/news/press-releases
Press Release Dec. 19, 2019
The Wistar Institute Received Nearly $2.5M in Philanthropic Support
PHILADELPHIA — (Dec. 19, 2019) — In the past six months, scientists at The Wistar Institute received funding from private foundations totaling $2,418,000 that will fuel new discoveries in cancer, immunology and infectious diseases.

World Organisation for Animal Health (OIE) [to 21 Dec 2019]
https://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

::::::

ARM [Alliance for Regenerative Medicine] [to 21 Dec 2019]
https://alliancerm.org/press-releases/
No new digest content identified.

BIO [to 21 Dec 2019]
https://www.bio.org/press-releases
Press Releases
No new digest content identified.

DCVMN – Developing Country Vaccine Manufacturers Network [to 21 Dec 2019]
http://www.dcvmn.org/
News
No new digest content identified.

IFPMA [to 21 Dec 2019]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
No new digest content identified.

PhRMA [to 21 Dec 2019]
http://www.phrma.org/
Selected Press Releases, Statements
No new digest content identified.

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

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 Dec 2019)

Comparing alternative cholera vaccination strategies in Maela refugee camp: using a transmission model in public health practice
Cholera is a major public health concern in displaced-person camps, which often contend with overcrowding and scarcity of resources. Maela, the largest and longest-standing refugee camp in Thailand, located al…
Authors: Joshua Havumaki, Rafael Meza, Christina R. Phares, Kashmira Date and Marisa C. Eisenberg
Citation: BMC Infectious Diseases 2019 19:1075
Content type: Research Article
Published on: 21 December 2019

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 21 Dec 2019)

Prepared for PrEP: preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey
Pre-exposure prophylaxis (PrEP) is not widely available in China. Previous studies reported low awareness and inconclusive findings on the acceptability of PrEP among Chinese men who have sex with men (MSM).
Authors: Wenting Huang, Dan Wu, Jason J. Ong, M. Kumi Smith, Fan Yang, Hongyun Fu, Weiming Tang and Joseph D. Tucker
Citation: BMC Infectious Diseases 2019 19:1057
Content type: Research article
Published on: 16 December 2019

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 21 Dec 2019)

Community perspectives on randomisation and fairness in a cluster randomised controlled trial in Zambia
One important ethical issue in randomised controlled trials (RCTs) is randomisation. Relatively little is known about how participating individuals and communities understand and perceive central aspects of ra…
Authors: Maureen Mupeta Kombe, Joseph Mumba Zulu, Charles Michelo and Ingvild F. Sandøy
Citation: BMC Medical Ethics 2019 20:99
Content type: Research article
Published on: 21 December 2019

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 21 Dec 2019)

Determinants of influenza vaccination uptake in pregnancy: a large single-Centre cohort study
Although vaccination of pregnant women against influenza is recommended, the vaccination rate remains low. We conducted a study to identify determinants of influenza vaccination uptake in pregnancy in order to…
Authors: Stéphanie Bartolo, Emilie Deliege, Ophélie Mancel, Philippe Dufour, Sophie Vanderstichele, Marielle Roumilhac, Yamina Hammou, Sophie Carpentier, Rodrigue Dessein, Damien Subtil and Karine Faure
Citation: BMC Pregnancy and Childbirth 2019 19:510
Content type: Research article
Published on: 19 December 2019

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 21 Dec 2019)

Pharmacy-based interventions to increase vaccine uptake: report of a multidisciplinary stakeholders meeting
Despite the existence of efficacious vaccines, the burden of vaccine-preventable diseases remains high and the potential health benefits of paediatric, adolescent and adult vaccination are not being achieved d…
Authors: Fiona Ecarnot, Gaetano Crepaldi, Philippe Juvin, John Grabenstein, Giuseppe Del Giudice, Litjen Tan, Susan O’Dwyer, Susanna Esposito, Xavier Bosch, Gaetan Gavazzi, John Papastergiou, Jacques Gaillat, Robert Johnson, Marco Fonzo, Andrea Rossanese, Caterina Suitner…
Citation: BMC Public Health 2019 19:1698
Content type: Debate
Published on: 18 December 2019

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 21 Dec 2019)

Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population
All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly v…
Authors: Ausenda Machado, Irina Kislaya, Amparo Larrauri, Carlos Matias Dias and Baltazar Nunes
Citation: BMC Public Health 2019 19:1690
Content type: Research article
Published on: 16 December 2019

The CRISPR Journal
Volume 2, Issue 6 / December 2019
https://www.liebertpub.com/toc/crispr/2/6

Perspectives
Genetic Protection Modifications: Moving Beyond the Binary Distinction Between Therapy and Enhancement for Human Genome Editing
Rasmus Bjerregaard Mikkelsen, Henriette Reventlow S. Frederiksen, Mickey Gjerris, Bjørn Holst,
Poul Hyttel, Yonglun Luo, Kristine Freude, and Peter Sandøe
Pages:362–369
Published Online:16 December 2019
https://doi.org/10.1089/crispr.2019.0024
Abstract
The current debate and policy surrounding the use of genome editing in humans typically relies on a binary distinction between therapy and human enhancement. Here, we argue that this dichotomy fails to take into account perhaps the most significant potential uses of CRISPR-Cas9 genome editing in humans. We argue that genetic treatment of sporadic Alzheimer’s disease, breast and ovarian cancer predisposing BRCA1/2 mutations, and the introduction of human immunodeficiency virus resistance in humans should be considered within a new category of genetic protection treatments. We suggest that if this category is not introduced, life-altering research might be unnecessarily limited by current or future policy. Otherwise ad hoc decisions might be made, which introduce a risk of unforeseen moral costs, and might overlook or fail to address some important opportunities.

The CRISPR Journal
Volume 2, Issue 6 / December 2019
https://www.liebertpub.com/toc/crispr/2/6

Open Access
Safety of Germline Genome Editing for Genetically Related “Future” Children as Perceived by Parents
Tetsuya Ishii and Iñigo de Miguel Beriain
Pages:370–375
Published Online:19 November 2019
https://doi.org/10.1089/crispr.2019.0010
Abstract
The social acceptability of germline genome editing (GGE) depends on its perceived safety, as well as respect for reproductive autonomy. However, it is doubtful that prospective parents sufficiently understand the risks of GGE. In the future, the use of GGE in specific situations seems plausible, as it offers couples potential means to safeguard genetically related future children from a serious disease and overcome infertility due to a gene mutation. Should GGE fail, however, some couples may be obliged to abort affected fetuses, or give birth to adversely affected children, which would be a tragedy. Some children might develop diseases later in life due to overlooked off-target mutations. Compounding this, some parents are unlikely to inform their offspring about the details of conception, hampering necessary follow-up. Prospective parents, scientists and policy makers should carefully discuss the safety implications of GGE for genetically related future children.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 21 Dec 2019]

Urban health: an example of a “health in all policies” approach in the context of SDGs implementation
Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providin…

Authors: Oriana Ramirez-Rubio, Carolyn Daher, Gonzalo Fanjul, Mireia Gascon, Natalie Mueller, Leire Pajín, Antoni Plasencia, David Rojas-Rueda, Meelan Thondoo and Mark J. Nieuwenhuijsen
Citation: Globalization and Health 2019 15:87
Content type: Research
Published on: 18 December 2019

Health Research Policy and Systems

[Accessed 21 Dec 2019]

Strengthening capacity to use research evidence in health sector policy-making: experience from Kenya and Malawi
Among the many barriers to evidence use in decision-making, weak capacity for evidence use has attracted a lot of focus in the last decade. The study aims to inform and enrich ongoing and future efforts to str…

Authors: Rose N. Oronje, Violet I. Murunga and Eliya M. Zulu
Citation: Health Research Policy and Systems 2019 17:101
Content type: Research
Published on: 19 December 2019

Human Gene Therapy
Volume 30, Issue 12 / December 2019
https://www.liebertpub.com/toc/hum/30/12

Editorials
Prime Editing: A Novel Cas9-Reverse Transcriptase Fusion May Revolutionize Genome Editing
Terence R. Flotte and Guangping Gao
Pages:1445–1446
Published Online:16 December 2019
https://doi.org/10.1089/hum.2019.29098.trf

Journal of Global Ethics
Volume 15, Issue 3, 2019
http://www.tandfonline.com/toc/rjge20/current

Special Issue: Global Justice and Childhood
introduction
Global justice and childhood: introduction
Johannes Drerup & Gottfried Schweiger
Pages: 193-201
Published online: 07 Nov 2019
ABSTRACT
This brief introduction frames a guest-edited collection of eleven contributed articles in the Journal of Global Ethics focused on global justice and childhood. On a general level, there is widespread consensus that there is a strong need for improvement in the lives of children around the globe. What global justice demands in this regard, however, has never been fleshed out in detail and there is only a little philosophical literature on this topic. Against this background, five aspects of the question of global justice for children need to be addressed. First, one has to take into account the debate between cosmopolitanism and particularism, as well as the debate as to whether and to what extent individual, collective or institutional actors should be prioritized. Secondly, a theory of global justice for children must explain how the content of global justice for children is founded and justified, and what it comprises. Third, different principles can be used to assess global justice for children. Only two prominent alternatives are mentioned here: egalitarianism and sufficiency. Fourthly, the temporal dimension of global justice is of particular importance for children. Fifthly, an approach focusing on the examination of injustices is equally necessary.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 30, Number 4, November 2019, Supplement
https://muse.jhu.edu/issue/41320

Contents
Framework for Ethical Community Engagement (ECE) with Underserved Populations in the Rural South: A Help for Bioethics and Healthcare Promotion
Wylin D. Wilson, Faye Hall Jackson, Joan R. Harrell
pp. 91-104
DOI: 10.1353/hpu.2019.0120

The Lancet
Dec 21, 2019 Volume 394 Number 10216 p2201-2284
https://www.thelancet.com/journals/lancet/issue/current

Editorial
Health and medicine in 2019: what have we learned?
The Lancet

Nature
Volume 576 Issue 7787, 19 December 2019
http://www.nature.com/nature/current_issue.html

Editorial | 18 December 2019
The scientific events that shaped the decade
The 2010s have seen breakthroughs in frontiers from gene editing to gravitational waves. The coming one must focus on climate change.

Nature
Volume 576 Issue 7787, 19 December 2019
http://www.nature.com/nature/current_issue.html

Review Article | 18 December 2019
Why and where an HIV cure is needed and how it might be achieved
Current barriers and limitations to HIV treatments are reviewed, and suggestions for future steps to achieve an effective curative intervention are discussed.
Thumbi Ndung’u, Joseph M. McCune & Steven G. Deeks

New England Journal of Medicine
December 19, 2019 Vol. 381 No. 25
http://www.nejm.org/toc/nejm/medical-journal

Original Articles
Final Analysis of a Trial of M72/AS01E Vaccine to Prevent Tuberculosis
Dereck R. Tait, M.B. et al
Results of an earlier analysis of a trial of the M72/AS01E candidate vaccine against Mycobacterium tuberculosis showed that in infected adults, the vaccine provided 54.0% protection against active pulmonary tuberculosis disease, without evident safety concerns. We now report the results of the 3-year final analysis of efficacy, safety, and immunogenicity…
…Among adults infected with M. tuberculosis, vaccination with M72/AS01E elicited an immune response and provided protection against progression to pulmonary tuberculosis disease for at least 3 years. (Funded by GlaxoSmithKline Biologicals and Aeras; ClinicalTrials.gov number, NCT01755598. opens in new tab.)

PLoS One
http://www.plosone.org/
[Accessed 21 Dec 2019]

Towards elimination of measles and rubella in Italy: Progress and challenges
In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country’s National Verification Committee (NVC) through an annual status update (ASU).

Giovanna Adamo, Valentina Baccolini, Azzurra Massimi, Domenico Barbato, Rosario Cocchiara, Carolina Di Paolo, Annamaria Mele, Sara Cianfanelli, Aurora Angelozzi, Fulvio Castellani, Carla Salerno, Claudia Isonne, Antonino Bella, Antonietta Filia, Martina del Manso, Melissa Baggieri, Loredana Nicoletti, Fabio Magurano, Stefania Iannazzo, Carolina Marzuillo, Paolo Villari
Research Article | published 16 Dec 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0226513

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
https://www.paho.org/journal/en

Latest articles
20 Dec 2019
Operational research in the context of advancing towards tuberculosis elimination in the Americas
Editorial | English |

Science
20 December 2019 Vol 366, Issue 6472
http://www.sciencemag.org/current.dtl

Special Issue: 2019 Breakthrough of the Year
Darkness made visible
By Daniel Clery
Science20 Dec 2019 : 1434-1435 Full Access
An international team of astronomers has produced the first ever image of a black hole.

Science
20 December 2019 Vol 366, Issue 6472
http://www.sciencemag.org/current.dtl

Runners-up
By Elizabeth Pennisi, Elizabeth Culotta, Kai Kupferschmidt, Adrian Cho, Paul Voosen, Jennifer Couzin-Frankel

Science20 Dec 2019 : 1436-1441 Full Access
Summary
The runners up for Science’s 2019 Breakthrough of the Year include discoveries in different areas of evolution. The culturing and sequencing of an elusive microbe sheds light on the early evolution of life on Earth; the discovery that a fossilized jaw belongs to a group of ancient humans called Denisovans and the reconstruction of the face of a Denisovan girl from genetic data bring these mysterious people into focus; several studies documented the devastation and subsequent recovery of life around the planet following the asteroid impact that wiped out the big dinosaurs; and a close-up look at an object in the outer Solar System supports a new notion of planetary formation and evolution. Other advances named by Science are the attainment of a milestone in quantum computing called quantum supremacy, the approval of a drug that combats most cases of cystic fibrosis, research on gut microbes that has led to the development of supplements to treat severe childhood malnutrition, the testing of two drugs that dramatically increase Ebola patients’ chances of survival, and the development of an artificial intelligence program that beat some of the world’s best poker experts in games involving multiple players.

Science
20 December 2019 Vol 366, Issue 6472
http://www.sciencemag.org/current.dtl

Policy Forum
Biotechnologies nibbling at the legal “human”
By Bartha Maria Knoppers, Henry T. Greely
Science20 Dec 2019 : 1455-1457 Full Access
Recent advances in the biosciences invite reconsideration of fundamental legal concepts such as the definition of “human”
Summary
The law has always viewed living human beings—and the tissues, organs, and other body parts derived from them—as special and different from the nonliving, nonhuman. But bioscientific advances are nibbling away at classical legal boundaries that form the bedrock of the normative structures on which societies are based. Recent developments such as in human genetics, neuroscience, and cell and tissue research pose qualitatively different challenges than what has come before, seeming to blur legal distinctions between human beings and other living organisms, between living human beings and dead ones, and between human tissues and cells and nonhuman ones. Although cognizant of the important bioethical and philosophical debates surrounding the issues raised, we focus on how legal systems may respond to these bioscience challenges to traditional binary, legal classifications. Determining whether some “thing” is now some “one” carries with it profound implications for the rights and obligations the law recognizes for “humans.” Although it may be tempting to think that these new developments require us to reconsider the time-honored legal definitions of humans, living humans, or human tissue, we suggest that current legal dualisms can be applied in ways that provide adequate flexibility to allow weighing the many issues that surround developments in genetics, neurosciences, and cellular bioengineering and challenge how we legally define what is “human.”

Science
20 December 2019 Vol 366, Issue 6472
http://www.sciencemag.org/current.dtl

Breakdowns of the year
By Erik Stokstad, Meredith Wadman, Elizabeth Pennisi, David Malakoff

Science Translational Medicine
18 December 2019 Vol 11, Issue 523
https://stm.sciencemag.org/

Research Articles
Biocompatible near-infrared quantum dots delivered to the skin by microneedle patches record vaccination
By Kevin J. McHugh, Lihong Jing, Sean Y. Severt, Mache Cruz, Morteza Sarmadi, Hapuarachchige Surangi N. Jayawardena, Collin F. Perkinson, Fridrik Larusson, Sviatlana Rose, Stephanie Tomasic, Tyler Graf, Stephany Y. Tzeng, James L. Sugarman, Daniel Vlasic, Matthew Peters, Nels Peterson, Lowell Wood, Wen Tang, Jihyeon Yeom, Joe Collins, Philip A. Welkhoff, Ari Karchin, Megan Tse, Mingyuan Gao, Moungi G. Bawendi, Robert Langer, Ana Jaklenec
Science Translational Medicine18 Dec 2019 Full Access
On the record
Vaccines prevent disease and save lives; however, lack of standardized immunization recordkeeping makes it challenging to track vaccine coverage across the world. McHugh et al. developed dissolvable microneedles that deliver patterns of near-infrared light-emitting microparticles to the skin. Particle patterns are invisible to the eye but can be imaged using modified smartphones. By codelivering a vaccine, the pattern of particles in the skin could serve as an on-person vaccination record. Patterns were detected 9 months after intradermal delivery of microparticles in rats, and codelivery of inactivated poliovirus led to protective antibody production. Discrete microneedle-delivered microparticle patterns in porcine and pigmented human skin were identifiable using semiautomated machine learning. These results demonstrate proof of concept for intradermal on-person vaccination recordkeeping.
Abstract
Accurate medical recordkeeping is a major challenge in many low-resource settings where well-maintained centralized databases do not exist, contributing to 1.5 million vaccine-preventable deaths annually. Here, we present an approach to encode medical history on a patient using the spatial distribution of biocompatible, near-infrared quantum dots (NIR QDs) in the dermis. QDs are invisible to the naked eye yet detectable when exposed to NIR light. QDs with a copper indium selenide core and aluminum-doped zinc sulfide shell were tuned to emit in the NIR spectrum by controlling stoichiometry and shelling time. The formulation showing the greatest resistance to photobleaching after simulated sunlight exposure (5-year equivalence) through pigmented human skin was encapsulated in microparticles for use in vivo. In parallel, microneedle geometry was optimized in silico and validated ex vivo using porcine and synthetic human skin. QD-containing microparticles were then embedded in dissolvable microneedles and administered to rats with or without a vaccine. Longitudinal in vivo imaging using a smartphone adapted to detect NIR light demonstrated that microneedle-delivered QD patterns remained bright and could be accurately identified using a machine learning algorithm 9 months after application. In addition, codelivery with inactivated poliovirus vaccine produced neutralizing antibody titers above the threshold considered protective. These findings suggest that intradermal QDs can be used to reliably encode information and can be delivered with a vaccine, which may be particularly valuable in the developing world and open up new avenues for decentralized data storage and biosensing.

Science Translational Medicine
18 December 2019 Vol 11, Issue 523
https://stm.sciencemag.org/

DNA vaccination before conception protects Zika virus–exposed pregnant macaques against prolonged viremia and improves fetal outcomes
By Koen K. A. Van Rompay, Rebekah I. Keesler, Amir Ardeshir, Jennifer Watanabe, Jodie Usachenko, Anil Singapuri, Christina Cruzen, Eliza Bliss-Moreau, Ashley M. Murphy, JoAnn L. Yee, Helen Webster, Maria Dennis, Tulika Singh, Holly Heimsath, Danilo Lemos, Jackson Stuart, Kaitlyn M. Morabito, Bryant M. Foreman, Katherine E. Burgomaster, Amy T. Noe, Kimberly A. Dowd, Erin Ball, Kevin Woolard, Pietro Presicce, Suhas G. Kallapur, Sallie R. Permar, Kathryn E. Foulds, Lark L. Coffey, Theodore C. Pierson, Barney S. Graham

Science Translational Medicine18 Dec 2019 Restricted Access
Curbing congenital Zika virus infection
The impact on a developing fetus is one of the most pressing concerns for developing vaccines or treatments for Zika virus. To assess fetal protection, Van Rompay et al. immunized nonhuman primates with a DNA vaccine before conception and then performed multiple Zika virus challenges in the first few months of pregnancy. Compared to unvaccinated controls, vaccinated animals had reduced viremia in terms of both magnitude and duration. Early fetal loss and fetal pathology was accordingly reduced. These results show that Zika virus vaccines given to women of childbearing age may help prevent damaging sequelae in offspring.
Abstract
Zika virus (ZIKV) infection of pregnant women is associated with congenital Zika syndrome (CZS) and no vaccine is available, although several are being tested in clinical trials. We tested the efficacy of ZIKV DNA vaccine VRC5283 in a rhesus macaque model of congenital ZIKV infection. Most animal vaccine experiments have a set pathogen exposure several weeks or months after vaccination. In the real world, people encounter pathogens years or decades after vaccination, or may be repeatedly exposed if the virus is endemic. To more accurately mimic how this vaccine would be used, we immunized macaques before conception and then exposed them repeatedly to ZIKV during early and mid-gestation. In comparison to unimmunized animals, vaccinated animals had a significant reduction in peak magnitude and duration of maternal viremia, early fetal loss, fetal infection, and placental and fetal brain pathology. Vaccine-induced neutralizing antibody titers on the day of first ZIKV exposure were negatively associated with the magnitude of maternal viremia, and the absence of prolonged viremia was associated with better fetal outcomes. These data support further clinical development of ZIKV vaccine strategies to protect against negative fetal outcomes.

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 21 Dec 2019)

Open Access Review
Addressing Vaccine Hesitancy in China: A Scoping Review of Chinese Scholarship
by Ronghui Yang , Bart Penders and Klasien Horstman
Vaccines 2020, 8(1), 2; https://doi.org/10.3390/vaccines8010002 – 20 Dec 2019
Abstract
Despite the well-developed Chinese National Immunization Program, vaccine hesitancy in China is rising. As part of the response, Chinese scholars have studied determinants and proposed solutions to vaccination hesitancy. We performed a scoping review of Chinese literature (2007–2019), drawn from four Chinese databases. We mapped relevant information and presented a systemic account of the proposed determinants and responses to vaccine hesitancy in China. We identified 77 relevant studies that reveal four approaches to vaccine hesitancy. Most Chinese studies define vaccine hesitancy as a problem of vaccine safety and vaccine incident response and place accountability on the level of governance, such as regulation deficits and inappropriate crisis management. A first minority of studies tied vaccination hesitancy to unprofessional medical conduct and called for additional resources and enhanced physician qualifications. A second minority of studies positioned vaccination hesitancy as a problem of parental belief and pointed to the role of media, proposing enhanced communication and education. Chinese literature ties vaccine hesitancy primarily to vaccine safety and medical conduct. Compared to international research, parental concerns are underrepresented. The Chinese context of vaccination scandals notably frames the discussion of vaccination hesitancy and potential solutions, which stresses the importance of considering vaccination hesitancy in specific social and political contexts.

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

No new digest content identified.

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 21 Dec 2019
[No new, unique, relevant content]

BBC
http://www.bbc.co.uk/
Accessed 21 Dec 2019
20 Dec 2019
African swine fever: Fears rise as virus spreads to Indonesia
Indonesia has become the latest Asian country to face an outbreak of African swine fever, a deadly pig virus devastating farmers across the region.
On Wednesday, the country’s agriculture ministry said nearly 30,000 pigs have died from the disease in North Sumatra.
The virus is expected to wipe out more than half of China’s pig herd this year.
Australia has grown increasingly concerned, stepping up biosecurity measures to keep swine fever out.
Although it’s harmless to humans, the disease can kill pigs within a few days, and the fatality rate can be up to 100%, according to the World Organisation for Animal Health (OIE)….
The race for a vaccine
As long as animals were sick only in Africa and occasional outbreaks in Europe were successfully tackled by culling, there was little effort to develop a vaccine.
Since the outbreak has spread to Asia with millions of animals affected, scientists are racing to find one. But the virus is unusually complex…

The Economist
http://www.economist.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

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

Forbes
http://www.forbes.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

The Guardian
http://www.guardiannews.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

New Yorker
http://www.newyorker.com/
Accessed 21 Dec 2019
[No new, unique, relevant content]

New York Times
http://www.nytimes.com/
Accessed 21 Dec 2019
Dec. 20
Africa
Merck Says Ebola Vaccine to Be Available at Lowest Access Price for Poor Nations
Merck & Co said on Friday it expects to make licensed doses of its recently approved Ebola vaccine available in the third quarter of 2020 and price the single-dose injection at the lowest possible access price for poor and middle-income countries.
By Reuters

Dec. 18
Asia Pacific
Gunmen in Pakistan Kill Two Police Escorting Polio Vaccinators
Gunmen shot and killed two police officers escorting a polio vaccination team on Wednesday forcing a suspension of the immunization campaign in a district of northwest Pakistan, where the crippling disease is endemic.
By Reuters

Dec. 17
Health
Dr. John Robbins, Developer of a Meningitis Vaccine, Dies at 86
His method of boosting immune protection in babies helped save seven million lives. But he never profited from it.
By Donald G. McNeil Jr.

Dec. 16
New York
Strict Vaccine Law Stumbles in N.J. Legislature
There were not enough votes in the State Senate to end religious exemptions to vaccine requirements for all students.
By Sharon Otterman and Tracey Tully

Washington Post
https://www.washingtonpost.com/
Accessed 21 Dec 2019
A major funder of the anti-vaccine movement has made millions selling natural health products
Neena Satija and Lena H. Sun · Dec 20, 2019

John Robbins, pioneer of a meningitis vaccine, dies at 86
Emily Langer · Dec 19, 2019

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 21 Dec 2019
[No new relevant content]

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 21 Dec 2019
[No new relevant content]

CSIS
https://www.csis.org/
Accessed 21 Dec 2019
Report
Ensuring Healthy Populations through a New Era of Global Immunization
December 20, 2019 | By Nellie Bristol

Council on Foreign Relations
http://www.cfr.org/
Accessed 21 Dec 2019
[No new relevant content]

Kaiser Family Foundation
https://www.kff.org/search/?post_type=pre ss-release
December 19, 2019 Issue Brief
The Current Ebola Outbreak and the U.S. Role: An Explainer
An outbreak of Ebola is currently ongoing in the Democratic Republic of Congo (DRC), now the second largest Ebola epidemic ever recorded. This Issue Brief gives an overview of the current situation, explains the U.S. role in responding to the outbreak, and answers key questions about the broader global response.

Milestones :: Perspectives :: Research

WHO commemorates the 40th anniversary of smallpox eradication
Historic milestone underscores urgent need to invest in global health security and universal health coverage
13 December 2019 News release Geneva, Switzerland
The World Health Organization commemorated the 40th anniversary of smallpox eradication today, recognizing the historic moment on 9 December 1979 when the end of smallpox was confirmed to have been eradicated. Five months later, in May 1980, the 33rd World Health Assembly issued its official declaration that ‘the world and all its peoples have won freedom from smallpox’.

A plaque marking the end of a scourge that had afflicted millions for thousands of years was unveiled at WHO headquarters in Geneva in the very same meeting room where, four decades earlier, the 19 members of the Global Commission for the Certification of Smallpox Eradication certified that smallpox had been eradicated from the world.

Speaking at the event attended by country representatives, UN representatives and WHO staff who worked on smallpox, WHO Director-General Tedros Adhanom Ghebreyesus said, “Today, smallpox is the only human disease ever eradicated, a testimony to what we can achieve when all nations work together.

“When it comes to epidemic disease, we have a shared responsibility and a shared destiny.  With this plaque, we commemorate the heroes around the world who came together to fight smallpox and worked to keep future generations safe.”

Until it was wiped out, smallpox had plagued humanity for at least 3000 years, killing 300 million people in the 20th century alone. The last known endemic case of smallpox was reported and the outbreak promptly contained in Somalia in 1977.

The successful smallpox eradication programme yielded vital knowledge and tools for the field of disease surveillance, the benefits of ring vaccination and the importance of health promotion in fighting diseases such as poliomyelitis and the Ebola virus. It also laid the foundation for stronger national immunization programmes worldwide, underpinning the establishment of primary health care in many countries and creating momentum toward Universal Health Coverage.

Today’s commemoration kicks off a year-long campaign in which WHO and partners will mark the eradication of smallpox and raise awareness about the need to continue the fight against polio and other diseases and accelerate investments in global health security. A smallpox eradication exhibition will be unveiled at the World Health Assembly in May 2020 and is expected to travel to other events, including the United Nations General Assembly in New York.

Milestones :: Perspectives :: Research

Sanofi awarded $226 million by US government to expand pandemic influenza preparedness
SWIFTWATER, Pa., Dec. 9, 2019 /PRNewswire/ — Sanofi Pasteur, the vaccines global business unit of Sanofi, has entered into an agreement with the U.S. Department of Health and Human Services (HHS) to increase the company’s domestic pandemic influenza vaccine production capabilities based in Swiftwater, Pennsylvania.

The contract is supported by federal funds from the Biomedical Advance Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at HHS.

“We are pleased to be taking this critical next step in our longstanding relationship with BARDA, which will enable us to significantly enhance flu vaccine supply under pandemic influenza scenarios,” said David Loew, Executive Vice President, Vaccines at Sanofi. “We are deeply committed to advancing influenza vaccine technology and manufacturing, and our public and private partnerships are an important part of these ongoing efforts to help protect people from influenza.”

“The question is not if, but when the next influenza pandemic will occur, carrying potentially devastating consequences for public health and the U.S. economy,” said BARDA Director Rick Bright, Ph.D. “As the recent presidential executive order on pandemic preparedness emphasized, technology to produce effective vaccines quickly and safely in the United States can improve access, protect more people sooner and, ultimately, strengthen national and global health security. Public-private partnerships, such as this one with Sanofi Pasteur, are essential in moving such technology forward.”…

Milestones :: Perspectives :: Research

The Africa Centers for Disease Control and Prevention Receives Support to Strengthen Continental and Regional Infectious-Disease Detection and Response Systems
The World Bank provides $250 million to Ethiopia, Zambia, and the African Union to combat epidemics and advance critical public health priorities
WASHINGTON, December 10, 2019— The Board of the World Bank Group has approved a total of $250 million in International Development Association (IDA) credits and grants to help the Federal Republic of Ethiopia, the Republic of Zambia, and the African Union (AU) counter the spread of infectious diseases and address key regional and continental public health issues.

The Africa Centers for Disease Control and Prevention Regional Investment Financing Project (ACDCP) will strengthen disease surveillance, prevention, and emergency-response systems across the African continent. The project will finance the establishment of laboratories, transnational surveillance networks, emergency-response mechanisms, and other public health assets designed to manage diseases on a regional and continental scale. It will support the development of guidelines and standards to improve coordination between the Africa Centers for Disease Control and Prevention (Africa CDC) Secretariat and national public health institutions across the continent and facilitate the sharing of public health assets and the exchange of vital data on infectious diseases…

The ACDCP’s benefits will extend far beyond Ethiopia and Zambia, as national health authorities and Africa CDC institutions in both countries will play a key role in addressing the incidence and spread of infectious diseases across eastern and southern Africa. Strengthening epidemic preparedness and response capacities in Ethiopia and Zambia will help protect vulnerable populations in neighboring countries, including refugees and displaced groups in border areas…

Milestones :: Perspectives :: Research

Immunization Agenda 2030

Terms of Reference for Consultant – IA2030 Project Management
Universal Health Coverage and the Life Course (UHC-LC)
Department of Immunization, Vaccines and Biologicals (IVB)
Expanded Programme on Immunization (EPI)
Deadline for application: 1 January 2020

Purpose of the Consultancy
The purpose of this consultancy is to support the project management work of the “Immunization Agenda 2030: A Global Strategy to Leave No One Behind” (IA2030). The consultancy is proposed for a duration of six months (from early January 2020 through 30 June 2020), with the option to be renewed for an additional semester.

1. RFP Background
Immunization Agenda 2030
With the Global Vaccine Action Plan (GVAP) soon coming to an end, a new vision and strategy for vaccines and immunization for the coming decade has been in development over the past year. With this objective in mind, and at the request of the Regional Offices and partner organizations, WHO convened a technical consultation process over the course of 2019, to generate the post-2020 vaccines and immunization vision and strategy, which resulted in the development of “Immunization Agenda 2030: A Global Strategy to Leave No One Behind” (IA2030).

The IA2030 vision and strategy has been “co-created” through an iterative process, with extensive engagement of global, regional and country stakeholders. It builds on the lessons-learned from GVAP, but also responds to the new global context and addresses emerging challenges. IA2030 was endorsed by SAGE on 9 October 2019. The aim is to present the new vision and strategy for endorsement to the 73rd World Health Assembly, in May 2020.

The IA2030 core document is the first step. It will be complemented by a set of technical documents (technical “annexes”), fleshing out each strategic priority and guiding implementation of the IA2030 Strategic Framework. These will co-exist with other technical documents on an online resource repository. More importantly, the vision and strategy will need to be turned into practice through operational plans at the regional and country level, a governance mechanism and a Monitoring and Evaluation (M&E) Framework. Communications and advocacy will be a critical enabling component to ensure continued visibility and momentum throughout the decade.
Please refer to the Annex for more information on the workstreams.

Project Management Background
The project is overseen by a small core project team, made up WHO headquarters as the Secretariat, and partner agencies (WHO, UNICEF, The Bill and Melinda Gates Foundation (BMGF), Wellcome Trust and Gavi, The Vaccine Alliance, CSO constituency). At the WHO Secretariat, the Director of the Department of Immunization, Vaccines and Biologicals (IVB) provides overall supervision and strategic direction to the project, supported by one full time and three part time (10-50%) technical staff…more at title link above

Emergencies

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

Ebola Outbreak in DRC 71: 10 December 2019
Situation Update
In the week of 2 to 8 December 2019, eleven new confirmed Ebola virus disease (EVD) cases were reported from four health zones in North Kivu and Ituri provinces in Democratic Republic of the Congo… As of 8 December 2019, a total of 3324 EVD cases were reported, including 3206 confirmed and 118 probable cases, of which 2209 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (1873) were female, 28% (939) were children aged less than 18 years, and 5% (164) were healthcare workers…

…Vaccines
:: From 8 August 2018 to 10 December 2019, 256 381 persons were vaccinated with the rVSV-ZEBOV-GP Ebola vaccine.

:: Vaccination with the Johnson & Johnson vaccine (Ad26.ZEBOV/MVA-BN-Filo) continued in the Karisimbi Health Zone, with 1300 people vaccinated as of 10 December 2019 since its introduction on 14 November 2019.

:: In the last 21 days (date of confirmation 17 November – 9 December 2019), there have been 12 rings opened covered the 35 reported cases.

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Johnson & Johnson Announces Commitment to Support Republic of Rwanda’s Preparedness Against Ebola Outbreak
Up to 200,000 Regimens of Janssen’s Investigational Ebola Vaccine to be Supplied to Rwanda for Use in Border Region near Democratic Republic of the Congo (DRC)
NEW BRUNSWICK, N.J., Dec. 8, 2019 /PRNewswire/ — Johnson & Johnson (NYSE: JNJ) today announced that its Janssen Pharmaceutical Companies will provide up to 200,000 Ebola vaccine regimens to the Republic of Rwanda. This commitment will support a new immunization program led by the Rwanda Government that aims to help protect the country’s citizens from the Ebola outbreak in neighboring Democratic Republic of the Congo (DRC). The first batches of Janssen vaccine have been delivered to the country, and further shipments are being organized.
On July 17, 2019, the World Health Organization (WHO) declared the DRC Ebola outbreak a Public Health Emergency of International Concern (PHEIC). More than 3,300 cases, including more than 2,200 deaths, have been reported to date, making the outbreak second only to the 2014-2016 West Africa epidemic, and raising concerns about its potential to cross international borders. In October, the Johnson & Johnson announced that the DRC would begin using the Janssen investigational vaccine as part of an expanded response to the outbreak.
“Johnson & Johnson recognizes the Rwandan Government’s decision to proactively deploy Janssen’s investigational Ebola vaccine to help prevent the spread of the disease into the country,” said Paul Stoffels, M.D., Vice Chairman of the Executive Committee and Chief Scientific Officer of Johnson & Johnson. “We stand ready to support Rwanda’s initiative on epidemic preparedness.”…

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 11 December 2019

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan — three WPV1 cases, nine WPV1 positive environmental samples and nine cVDPV2 positive environmental samples;
:: Democratic Republic of the Congo (DR Congo) — three cVDPV2 cases;
:: Angola — 12 cVDPV2 cases and two cVDPV2 positive environmental samples;
:: Ethiopia — two cVDPV2 cases;
: Malaysia — one cVDPV1 case;
:: Philippines — one cVDPV1 case and three cVDPV2 cases

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 14 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 71: 10 December 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 14 Dec 2019]

Iraq
:: Iraqi cancer data for 2017‒2018 announced  9 December 2019 ‒ Recently announced data from Iraq’s national cancer registry indicate that there are over 31,500 cancer and tumor-related cases in Iraq as of 2017‒2018. Cancer is considered one of the leading causes of mortality in the country, contributing to an estimated 11% of total deaths…

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
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
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 14 Dec 2019]

Djibouti
:: Djibouti mène une campagne de vaccination de masse pour protéger les enfants contre la poliomyélite tandis que des flambées sévissent dans la Corne de l’Afrique
5 décembre 2018 – L’analyse préliminaire des données de la campagne indique le succès d’une tournée de vaccination dans un pays exempt de poliomyélite confronté à un risque d’importation.
Au cours de la dernière semaine du mois d’octobre, le ministère de la Santé de Djibouti, en collaboration avec l’OMS, l’UNICEF et d’autres partenaires, a mené avec succès les premières journées nationales de vaccination antipoliomyélitique conduites dans le pays depuis 2015…

Chad – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth
:: 10 Dec 2019 Kassala, Sudan: Life with hard choices

EBOLA OUTBREAK IN THE DRC
:: République démocratique du Congo Rapport de situation, 13 décembre 2019
FAITS SAILLANTS (13 déc. 2019)
:: Au moins 600 000 personnes sont estimées être affectées par des inondations dans 12 provinces, causées par des pluies diluviennes survenues en octobre
:: Des besoins importants sont rapportés, en particulier dans les secteurs de l’eau, hygiène assainissement, abris/ articles ménagers essentiels, sécurité alimentaire et santé
:: La réponse à l’impact de ces inondations est coordonnée par le Gouvernement de la RDC au niveau central et provincial, avec l’appui des acteurs humanitaires.
:: Des activités d’assistance sont en cours ou en préparation par les acteurs humanitaires dans 8 des12 provinces affectées, mais de nombreux besoins ne sont pas couverts.
:: Alors que la décrue a commencé, il est essentiel de privilégier une approche visant à soutenir les mécanismes de résilience de la population déjà existants

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WHO & Regional Offices [to 14 Dec 2019]

WHO commemorates the 40th anniversary of smallpox eradication
Historic milestone underscores urgent need to invest in global health security and universal health coverage
13 December 2019 News release Geneva, Switzerland
[See Milestones above for detail]

WHO gets new advice on curbing deadly noncommunicable diseases
10 December 2019 News release Muscat, Oman
World leaders and health experts, today, handed 8 recommendations to WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus, that could save millions of lives and promote mental health. The WHO Independent High-level Commission on noncommunicable diseases was convened by Dr Tedros in October 2017 to identify innovative ways to curb the world’s leading causes of death: cardiovascular disease, cancers, diabetes, respiratory diseases and mental health conditions.

The Commission highlighted that noncommunicable diseases still account for more than 70% of deaths and stressed that, “progress against NCDs and mental health conditions must be greatly accelerated if the 2030 Agenda is to succeed.” It also noted that many countries face challenges and need more support to implement solutions.

The report laid out a set of 8 recommendations for WHO:
:: Encourage Heads of State and Government to fulfil their commitment to provide strategic leadership by involving all relevant government departments, businesses, civil society groups as well as health professionals and people at risk from or suffering from NCDs and mental health conditions.
:: Support countries in efforts to empower individuals to make healthy choices, including by ensuring that the environment is conducive to living a healthy life, and that people receive the information they need to make healthy choices.
:: Encourage countries to invest in the prevention and control of NCDs and mental health conditions as a key opportunity to enhance human capital and accelerate economic growth.
:: Advise countries to include services to prevent and treat NCDs and mental health as essential components of Universal Health Coverage.
:: Ensure that no one falls into poverty because they have to pay for health care out of their own pockets through the provision of adequate social protection for everyone.
:: Increase engagement with businesses and provide technical support to Member States so they can mount effective national responses to NCDs and mental health conditions.
:: Encourage governments to promote meaningful engagement with civil society.
:: Advocate for the establishment of a multi-donor trust fund to support countries in activities to reduce NCDs and promote mental health.

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Weekly Epidemiological Record, 13 December 2019, vol. 94, 50 (pp. 601–612)
:: Schistosomiasis and soil-transmitted helminthiases: numbers of people treated in 2018y

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WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
No new digest content identified.

WHO Region of the Americas PAHO
:: Countries must reduce barriers to access and increase financing in primary care to ensure Universal Health in the Americas. (12/12/2019)
:: Projects in Colombia and Peru win Social Innovation in Health prizes (12/09/2019)

WHO South-East Asia Region SEARO
:: WHO congratulates Sri Lanka for eliminating mother-to-child transmission of HIV, Syphilis
10 December 2019 News release

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
:: Early Warning Alert and Response Network launched in Djibouti to detect epidemic-prone diseases 11 December 2019
:: Saving Somali children from vaccine-preventable diseases 8 December 2019

WHO Western Pacific Region
:: 14 October 2019 | Feature story Addressing the needs of ageing populations
:: 12 December 2019 News release WHO hosts dialogue on climate change and health
:: 11 October 2019 News release Region’s leaders discuss need to protect health in relation to climate change and the environment