Vaccines and Global Health: The Week in Review :: 16 February 2019

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

Thousands of children vaccinated in remote Rukban settlement amid severe lack of access to medical care

Milestones :: Perspectives

Thousands of children vaccinated in remote Rukban settlement amid severe lack of access to medical care
UNICEF, UN and Syrian Arab Red Crescent reach more than 40,000 people with life-saving supplies in largest-ever humanitarian convoy since the start of the Syria crisis

NEW YORK/DAMASCUS, 15 February 2019 – UNICEF-supported vaccinators were able to immunize thousands of children during a 9-day mission to the remote makeshift settlement in Rukban at the border with Jordan, home to more than 40,000 people – mostly women and children.

The joint UNICEF, UN and Syrian Arab Red Crescent mission to Rukban is the largest humanitarian delivery in Syria’s eight-year crisis. Thirty of the convoy’s 118 trucks were loaded with UNICEF’s life-saving supplies for children, including health and nutrition supplies for an estimated 20,000 children and mothers; hygiene kits for more than 40,000 people; recreational kits; and education supplies, including school books, stationery and school bags, for over 8,000 children…

New report shows global shift in use of antibiotics in animals

Milestones :: Perspectives

World Organisation for Animal Health (OIE)   [to 16 Feb 2019]
http://www.oie.int/en/for-the-media/press-releases/2018/
14/02/19
New report shows global shift in use of antibiotics in animals

Figures released in a new report today by the World Organisation for Animal Health (OIE) show positive global progress on the regulation and monitoring of antimicrobial use in animals. The report aims to build the capacity of all countries to collect critical data on the use of antimicrobials in animals.  

Paris, 14 February 2019 – The OIE has developed a voluntary data collection system on the use of antimicrobial agents in animals to which any country can contribute. The report presents the overall findings of the third annual data collection, providing a global and regional analysis from 2015 to 2017. A record of 155 countries participated in it, demonstrating increased international understanding and prioritisation of this issue.

“The OIE database is an important initiative building national and global surveillance capacity on antimicrobial use in animals,” said Dr Monique Eloit, Director-General of the OIE. “Irrespective of the financial resources at their disposal, the OIE aims to support countries to ensure that antibiotics and other important veterinary medicines are used prudently and responsibly. One of the OIE’s key recommendations is for countries to immediately phase out the use of critical antimicrobials for growth promotion.”

Indeed, the report shows that the reported use of antimicrobials for growth promotion has declined from 60 to 45 countries since the last round of data collection. However, key antimicrobials, classified by the WHO as ‘Highest Priority Critically Important Antimicrobials’, including colistin, continue to be used routinely in several regions for this purpose. This practice puts at risk many of the medicines that we take for granted today, for both animals and humans.

The development of a robust regulatory framework is a key component to protect and ensure responsible and prudent use of antimicrobial agents in animal health and production. It is also a powerful instrument to phasing out their use as growth promoters, while recognising that voluntary approaches can be effective in certain countries. The report shows positive progress, while 72 countries do not have a regulatory framework on the use of growth promotors, it is a decrease from the first database report in which 110 countries lacked such a framework. This decline suggests critical progress in the implementation of regulations on the use of antimicrobial agents.

“Many countries have already taken key actions, such as setting up surveillance systems and regulating the use of antimicrobials in human and animal health, but we still have a long way to go,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Working together is the only way to avoid the huge human, social, economic and environmental costs of antimicrobial resistance.”…

 

Potential new Ebola drugs being trialled in MSF treatment centres

Milestones :: Perspectives

DRC

DRC 2018 Ebola outbreaks
Potential new Ebola drugs being trialled in MSF treatment centres
Statement 12 Feb 2019
Four potential new treatments for Ebola are being used in a randomised controlled trial (RCT) at the Ebola Treatment Centres operated by Médecins Sans Frontières (MSF) in Katwa and Butembo, in North Kivu province, Democratic Republic of Congo (DRC).

The trial, being run in collaboration with the Ministry of Health, originally began in November 2018 in another treatment centre in the region, and MSF facilities are now able to contribute to providing valuable information on these developmental drugs.

The treatments that will be used in the RCT are drugs remdesivir, mAb114, REGN-EB3 and ZMapp. They have been offered to patients since the beginning of the current Ebola outbreak under Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) protocols.

The switch from MEURI protocols to a clinical trial is a critical step, as a clinical trial can generate the scientific data needed to draw conclusions on how effective these treatments are. The main objective of the trial is to identify the most effective of the four products to treat Ebola patients.

The trial is overseen by a steering committee convened by the World Health Organization and led by the National Institute of Biomedical Research of DRC (INRB) and the US National Institute of Health (NIH) in collaboration with other national and international organisations.
Butembo and Katwa are currently the hotspots of the Ebola epidemic that was declared in DRC on 1 August 2018.

The Butembo treatment centre can admit 96 people, while the one in Katwa, which opened last month, has a 62-bed capacity. Since they opened, MSF has admitted more than 2,100 patients to these two centres, of which 250 were confirmed cases, with 110 people recovering.

 

Ebola in the Democratic Republic of the Congo: time to sound a global alert?

Featured Journal Content

The Lancet
Feb 16, 2019  Volume 393  Number 10172p611-716, e29
https://www.thelancet.com/journals/lancet/issue/current

Comment
Ebola in the Democratic Republic of the Congo: time to sound a global alert?
Lawrence Gostin, Alexandra Phelan, Alex Godwin Coutinho, Mark Eccleston-Turner, Ngozi Erondu, Oyebanji Filani, Tom Inglesby, Rebecca Katz, Allan Maleche, Jennifer B Nuzzo, Oyewale Tomori, Matthew Kavanagh
[Excerpt]
…We call upon the WHO Director-General to reconvene the EC to review the grounds for a PHEIC declaration. He should invite states, the UN, and NGOs to attend and submit evidence. 10  The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO), UNHCR, the UN Refugee Agency, and civil society could provide critical information. The EC should recommend proactive measures on health, diplomacy, security, and community engagement. Concrete recommendations could specify the level and kind of resources needed and composition of security and diplomatic assets.

A PHEIC is a clarion call to galvanise high-level political, financial, and technical support. A PHEIC would provide a clear signal from the world’s global health body that UN leadership is urgent. A PHEIC also empowers the WHO Director-General to make temporary, non-binding recommendations that have normative force.10

The IHR do not specify any surge in authority or financing when declaring a PHEIC. In the past, states did not heed WHO warnings that travel and trade restrictions are harmful. During the west African Ebola epidemic, 58 states restricted travel from affected areas, and during the 2009 influenza A H1N1 pandemic, states imposed trade and travel restrictions.12,13,14]

Trade or travel barriers in the DRC would have devastating impacts. WHO, with UN support, should take active steps to prevent unlawful and harmful restrictions. In 2009, WHO and the World Trade Organization (WTO) criticised governments that took non-evidence-based actions; going forward, WHO and WTO could publicly name non-compliant countries. Governments should also agree to dispute resolution, including binding IHR arbitration.10

If a PHEIC escalated conflict by raising the profile of the international response, it would be deeply concerning. Recent elections in DRC were clouded by concerns about vote-rigging, unsettling lines of power and legitimacy. Armed groups have used violence to generate chaos. A PHEIC could increase incentives to target Ebola responders to gain leverage. As in South Sudan, armed groups could manipulate aid for non-humanitarian purposes.15 Like any complex multilateral negotiation, cultural competence and smart diplomacy are required. Outsiders are unlikely to be privy to all on-the-ground realities and risks.

The IHR were designed to respond to a health emergency like the DRC Ebola epidemic. We urge the WHO Director-General to reconvene the EC and re-assess the declaration of a PHEIC. The UN and governments should increase support for WHO and partners. If the IHR fails, or worse, increases political instability, it will require urgent reform.

State non-compliance should not obscure the value of the IHR in establishing norms of rapid identification, notification, and response. The IHR require states to develop health-system capacities, assessed by WHO’s Joint External Evaluation. IHR reform should focus on technical and financial assistance for national health capacities. A PHEIC should trigger surge capacity in relation to authority and finances, with effective mechanisms to gain state compliance.

WHO has shown leadership and operational endurance, working tirelessly to combat the DRC Ebola epidemic. But WHO and partners cannot succeed alone. We live at a political moment when international solutions to collective threats are increasingly hard to achieve. But WHO and the UN system will be called upon with ever-greater frequency in the future to manage complex humanitarian crises. We must plan for a future in which political violence and instability become the new abnormal.

[References at title link above]

Emergencies

Emergencies
 
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 13 February 2019
:: The 2019 Annual Letter by Bill & Melinda Gates makes a case for investment in global health. Progress by Global Polio Eradication Initiative is a good reminder of how investment in global health funds benefits people around the world. Read the letter here.
:: In Indonesia, a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak is confirmed.
 
 
Summary of new viruses this week:
:: Pakistan – once case of wild poliovirus type 1 (WPV1) and four wild polioviruses type 1 (WPV1) positive environmental samples;
:: Nigeria – two circulating vaccine derived poliovirus type 2 (VDPV2) positive environmental samples;
:: Indonesia– one case of circulating vaccine derived poliovirus type 1 (cVDPV1).
 
 

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 16 Feb 2019]
Democratic Republic of the Congo
:: Ebola virus disease – Democratic Republic of the Congo   14 February 2019
… Main challenges this past week primarily pertain to community mistrust, particularly in Katwa, and the difficulty in encouraging community members to be more proactive in reporting suspected cases, presenting early to ETCs for treatment, and participating in community-based prevention and response efforts. However, in the face of these protracted challenges, response strategies have demonstrated to be effective in curtailing the spread of EVD. Fostering greater community trust by strengthening engagement with its members remains a top priority for response teams.
 
On 13 February, the Ministry of Health (MoH) launched the Strategic Response Plan 3 (SRP 3). The plan lays out the response strategy, objectives and budget requirements for the MoH, WHO, and all implementing partners for the next six months (February through July 2019). SRP 3 takes into account recommendations from operational reviews, and builds on a series of new strategic directions that capitalize on lessons learned under the scope of SRP 2. Activities laid out aim to stop the transmission of EVD in North Kivu and Ituri provinces, and prevent its spread to other provinces and neighbouring countries.
 
WHO remains confident that this outbreak can be successfully brought to an end through strategies outlined in SRP 3. To achieve the goals set out by the plan, MoH, WHO, and partners are appealing for US$ 148 million. WHO and partners count on the continued support of the international community to provide the required funding in order to stop this outbreak…
 
Nigeria
:: WHO supports five countries to fight lassa fever outbreaks   8 February 2019
 
Bangladesh – Rohingya crisis – No new digest announcements identified  
Myanmar – No new digest announcements identified  
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified  
Syrian Arab Republic – No new digest announcements identified  
Yemen – No new digest announcements identified
 
::::::
 
WHO Grade 2 Emergencies  [to 16 Feb 2019]
Libya
:: US$ 43.5 million needed to provide life-saving health aid in Libya in 2019
Cairo, 11 February 2019 – The World Health Organization and health partners are appealing for US$ 43.5 million to provide life-saving interventions for 388 000 people inside Libya affected by ongoing conflict…
 
Iraq
:: WHO intercountry cooperation yields rich health dividends
13 February 2019 – Intercountry collaboration between Iraq and Jordan allowed WHO and health authorities in Iraq to rapidly and successfully respond to an increase in cases of acute respiratory infections…
 
MERS-CoV
:: MERS therapeutics and vaccines workshop 30 November 2018
13 Feb 2019
Meeting report pdf, 606kb
Final Agendapdf, 290kb
List of participantspdf, 348kb
 
 
Brazil (in Portugese) – 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
Hurricane Irma and Maria in the Caribbean – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory  – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified
 
 
WHO Grade 1 Emergencies  [to 16 Feb 2019]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut
Tanzania
 
::::::
 
WHO AFRO Outbreaks – Week 06: 04 – 10 February 2019
The WHO Health Emergencies Programme is currently monitoring 60 events in the region. This week’s edition covers key new and ongoing events, including:
:: Ebola virus disease in the Democratic Republic of the Congo
:: Lassa fever in Nigeria
:: Ebola virus disease in the Democratic Republic of the Congo
:: Measles in Madagascar
:: Humanitarian crisis in Central African Republic
 
 
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. 
Yemen – No new digest announcements identified
Syrian Arab Republic   – No new digest announcements identified
 
 
UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  – No new digest announcements identified
Somalia  – No new digest announcements identified

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

 
Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.

EBOLA/EVD  [to 16 Feb 2019]
http://www.who.int/ebola/en/
:: Ebola virus disease – Democratic Republic of the Congo   14 February 2019
 
 
MERS-CoV [to 16 Feb 2019]
http://who.int/emergencies/mers-cov/en/
:: MERS therapeutics and vaccines workshop 30 November 2018  13 Feb 2019
Meeting report pdf, 606kb
Final Agendapdf, 290kb
List of participantspdf, 348kb
 
 
Yellow Fever  [to 16 Feb 2019]
http://www.who.int/csr/disease/yellowfev/en/
– No new digest announcements identified.
 
 
Zika virus  [to 16 Feb 2019]
http://www.who.int/csr/disease/zika/en/
– No new digest announcements identified.

 

WHO & Regional Offices [to 16 Feb 2019]

WHO & Regional Offices [to 16 Feb 2019]
 
12 February 2019
News Release
New WHO-ITU standard aims to prevent hearing loss among 1.1 billion young people
 
12 February 2019
News Release
International push to improve food safety
 
11 February 2019 | News release
US$ 43.5 million needed to provide life-saving health aid in Libya in 2019
 
::::::
  
Weekly Epidemiological Record, 15 February 2019, vol. 94, 07 (pp. 81–84)
:: 7th Meeting of the WHO Expert Working Group of the Global Influenza Surveillance and Response System for Surveillance of Antiviral Susceptibility
:: Executive summary of the 10th meeting of the WHO Working Group for the Molecular :: Detection and Subtyping of Influenza Viruses and the use of next-generation sequencing in the Global Influenza Surveillance and Response System
 
 
WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: Cabo Verde is ready to host 2nd African Health Forum and share good practices on progress towards Universal Health Coverage  14 February 2019
:: Uganda Health Workers Respond Swiftly to a Suspected Ebola Death  12 February 2019
:: Ethiopia Launches Measles Vaccine Second Dose (MCV2) Introduction: Over 3.3 million children will receive the vaccine annually  11 February 2019
:: Nigeria’s call to action – Time to Eliminate Cervical Cancer in Nigeria  10 February 2019
 
 
WHO Region of the Americas PAHO
:: Latest PAHO “Basic Indicators” shed light on health situation in the Americas (02/13/2019)

Vaccination
Vaccination coverage in 2017 varies for different vaccines: 94% percent of the target population of children in the Americas received the tuberculosis (BCG) vaccine; 90% received the vaccine for the first dose of measles, mumps, and rubella (MMR1); 88% received three doses of diphtheria, tetanus and pertussis (DTP3) vaccine; 85% received three doses of polio vaccine; and 73% received the last dose of rotavirus vaccine.
 
WHO South-East Asia Region SEARO
– No new digest announcements identified.
 
WHO European Region EURO
:: Towards a digital health roadmap for the WHO European Region 14-02-2019
 
 
WHO Eastern Mediterranean Region EMRO
:: Effective collaboration mitigates risk of potential outbreak
13 February 2019 – Intercountry collaboration between Iraq and Jordan allowed WHO and health authorities in Iraq to rapidly and successfully respond to an increase in cases of acute respiratory infections.
The last week of November 2018 witnessed an alarming rise in the incidence of acute respiratory infections in Suleimaniya governorate in the Kurdistan Region of Iraq. By 31 December, more than 35 suspected cases of influenza were admitted to Shaheed Hemin Hospital for Internal Medicine in the governorate…
:: US$ 43.5 million needed to provide life-saving health aid in Libya  11 February 2019
 
 
WHO Western Pacific Region
– No new digest announcements identified.