Vaccines and Global Health: The Week in Review :: 13 October 2018

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

Dr. Kate O’Brien appointed Director of WHO’s Department of Immunization, Vaccines and Biologicals

Milestones :: Perspectives

IVAC 
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
October 2018

Dr. Kate O’Brien appointed Director of WHO’s Department of Immunization, Vaccines and Biologicals
Dr. William Moss named Interim Executive Director, IVAC

The International Vaccine Access Center (IVAC) congratulates Kate O’Brien, MD, MPH, Executive Director of IVAC in the Department of International Health, on her appointment as Director of the World Health Organization Department of Immunization, Vaccines and Biologicals.

Dr. O’Brien’s appointment reflects the important contributions of the Johns Hopkins Bloomberg School of Public Health’s Department of International Health and IVAC to strengthening global immunization programs, especially over the past 15 years since the beginning of IVAC’s work as PneumoADIP.

Dr. O’Brien’s career in vaccines and immunizations over the past 25 years at the Bloomberg School was sparked by her field experience in Haiti caring for children who needlessly suffered from vaccine-preventable diseases. Her contributions to on-the-ground field research in vaccine clinical trials, disease epidemiology, and vaccine impact studies have extended to policy- and implementation-oriented work in countries throughout Africa and South Asia. She also directed the Infectious Disease Prevention and Control Program at the Johns Hopkins Center for American Indian Health.

Dr. O’Brien served as IVAC’s Executive Director for six years and has made lasting contributions to the global immunization landscape through her tenure as a contributor to and member of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, which shapes global recommendations and practice. She is also a member of the Gavi board and an advocate for research and evidence-based policy, work that is enriched by deep experience on many global- and country-level immunization projects.

She brings to WHO a vision of delivering the greatest possible impact through the immunization and vaccine program for families, communities, and countries. At the center for her strategic direction for maximizing impact at WHO are innovation, tailored support for countries, committed partnership, strong evidence through high-quality data, forward-leaning policies, and equitable access.

Dr. O’Brien brought tremendous energy and drive to her tenure at IVAC and the school and leaves behind a strong team that will continue to advance IVAC’s mission. We look forward to working with Dr. O’Brien in her new role at WHO…

 

IAVI Announces Clinical Trial of Next-Generation HIV Vaccine Candidate Designed to Induce Antibodies to Block HIV Infection

Milestones :: Perspectives

IAVI Announces Clinical Trial of Next-Generation HIV Vaccine Candidate Designed to Induce Antibodies to Block HIV Infection

Phase I trial to evaluate safety and immunogenicity of vaccine candidate engineered to elicit targeted immune response against HIV
NEW YORK – OCTOBER 9, 2018 – The International AIDS Vaccine Initiative (IAVI) announces the start of a Phase I clinical trial (IAVI G001) to test a novel vaccine candidate designed to stimulate the immune system to initiate a key first step in the generation of potent proteins, known as broadly neutralizing antibodies (bNAbs), against HIV. The trial will evaluate the safety of the candidate and the immune responses it is able to induce. The candidate, known as eOD-GT8 60mer, represents an important step forward in the quest to develop an HIV vaccine.

Researchers widely agree that a vaccine that induces bNAbs will likely be the best way to confer durable protection against the virus. bNAbs are desirable because in laboratory experiments, they are effective against many of the genetically diverse strains of HIV, and in animal studies, they can block infection of a virus similar to HIV.

“The world urgently needs new ways to prevent HIV infection, and chief among these is a vaccine,” said Mark Feinberg, M.D., Ph.D., president and CEO of IAVI. “Fortunately, a new generation of HIV immunogen candidates, including eOD-GT8 60mer, is entering clinical trials. These candidates are being developed using highly sophisticated and elegant vaccine science and provide a precedent for vaccine strategies targeting the induction of specific immune responses believed to be critical in protecting against HIV infection.”…

 

Democratic Republic of Congo launches major vaccination drive

Milestones :: Perspectives

Democratic Republic of Congo launches major vaccination drive
11 October 2018
Mashako Plan aims to boost vaccine coverage by 15 percentage points, protecting 220,000 additional children.
Kinshasa, 11 October 2018 – A quarter of a million more children in the Democratic Republic of Congo (DRC) are set to be protected against some of the world’s deadliest diseases following the launch of a major new boost to the country’s routine immunisation programme.

The Emergency Plan for the Revitalisation of Routine Immunisation in the DRC, named the Mashako Plan after former DRC Minister of Health Professor Leonard Mashako Mamba, aims to raise routine immunisation coverage by 15 percentage points over the next 18 months, meaning 220,000 children that otherwise wouldn’t have will receive lifesaving vaccines.

“Vaccination is the most cost effective public health intervention,” said Dr Oly Ilunga Kalenga, Minister of Health of DRC. “When children get vaccinated, they are protected against all sorts of preventable diseases that would otherwise prevent them from developing their full potential. Yet more than one million Congolese children are still not completely vaccinated. The ambitious Emergency Plan for Routine Immunisation will be a game-changer. It is an honour to name this plan after the late Dr Mashako, a true visionary who transformed the Congolese health system.”

In 1999, just 25% of children born in the DRC received basic Diphtheria, Tetanus, Whooping Cough vaccine (DTP3). After nearly 20 years of Gavi support, that figure has grown to 81%. In the same period child mortality has shrunk from 165 to 91 children in every thousand dying before their fifth birthday. Vaccines to protect children from measles, diphtheria, pertussis, tetanus, hepatitis B, Haemophilus influenzae, pneumococcal and polio are now delivered by the country’s routine immunisation programme.

Despite this progress, the DRC still has one of the highest rates of child mortality worldwide and 1.8 million children miss out on a full course of vaccines every year. As a result the country has seen major outbreaks of measles, polio and yellow fever – all vaccine-preventable diseases – in recent years…

The Mashako Plan will target eight vulnerable provinces; Ituri, Kasai, Haut-Katanga, Mongala, Kwilu, Tanganyika, Kinshasa, Tshuapa and Haut-Lomami. It will focus on five key objectives to improve coverage:
:: Immunisation services: Increase the number of immunisation sessions by 20%
:: Vaccine availability: Reduce stockouts by 80% at local health centres
:: Monitoring and evaluation: Monthly updated dashboard of key indicators of the plan
:: Inspection and control: Monthly inspection of immunisation activities in health zones and areas by inspectors
:: Coordination and financing: Operational steering committee of the plan meeting weekly for the next 18 months…

 

Ebola virus disease – Democratic Republic of the Congo

Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

Ebola virus disease – Democratic Republic of the Congo
11 October 2018
Disease Outbreak News (DONs)
The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community.

Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation…

…Vaccination: As of 10 October, 90 vaccination rings have been defined, in addition to 31 rings of health and frontline workers. To date, 15 828 eligible and consented people have been vaccinated, including 6327 health and frontline workers and 3439 children. Vaccination preparedness progress is being made in neighbouring Uganda, South Sudan, Rwanda, and Burundi. The Ebola Treatment Centre (ETC) managed by the Alliance for International Medical Action (ALIMA) in Beni has increased its capacity to 25 beds…

 
10: Situation report on the Ebola outbreak in North Kivu  9 October 2018

 

Strategies to increase vaccine acceptance and uptake: From behavioral insights to context-specific, culturally-appropriate, evidence-based communications and interventions

Featured Journal Content

 

Vaccine
Volume 36, Issue 44, Pages 6457-6578 (22 October 2018)
https://www.sciencedirect.com/journal/vaccine/vol/36/issue/44
Special Issue – Vaccine Hesitancy: Towards a Better Understanding of Drivers and Barriers to Awareness, Acceptance and Activation
Edited by Angus Thomson, Gaëlle Vallée-Tourangeau, L. Suzanne Suggs

Editorial  Open access
Strategies to increase vaccine acceptance and uptake: From behavioral insights to context-specific, culturally-appropriate, evidence-based communications and interventions
Angus Thomson, Gaëlle Vallée-Tourangeau, L. Suzanne Suggs
Pages 6457-6458
Vaccines save least 5 lives a minute, but they could save many more [1]. An estimated 1.5 million deaths – the equivalent of 8 jumbo jets crashing every day – could be averted if global vaccination uptake improved [2]. Yet, increasing vaccine coverage is not as simple as educating people about the benefits of vaccination. There are many barriers and drivers which affect vaccine uptake, ranging from logistics such as ensuring people have access to and are aware of affordable vaccines, to socio-psychological factors underpinning people’s acceptance to be vaccinated [3]. Until recently, much that had been done to address vaccine hesitancy and low vaccine coverage was based on untested beliefs or good ideas rather than on solid evidence, but this is changing. This special issue, stemming from an annual meeting on vaccine confidence and coverage [4], builds on an increasing body of empirical evidence seeking to identify the determinants of vaccine acceptance and uptake. Importantly, it also echoes changes in this field, by moving beyond understanding to action, highlighting a number of social and behavior change interventions that have been designed and tested for impact. In the remainder of this Editorial, we highlight the key points from the contributing articles and their implications for designing effective communication and intervention strategies to increase vaccine acceptance and uptake.

  1. Communicating your reasons are not enough: Begin by understanding your target audience

“People just need to understand the benefits and value of vaccines!” This commonly-heard cry unfortunately assumes that low acceptance is due to lack of knowledge and thus providing facts and arguments will suffice to induce action. Most smokers understand the benefits and value of quitting smoking, illustrating that knowledge attainment does not necessarily influence health related behaviors. The research included in this issue highlights that vaccine hesitancy has numerous possible demographic and socio-psychological root causes, many of which are not knowledge-related. The development of effective strategies to sustain trust in vaccination programs requires an understanding of the particular social and psychological factors that determine the vaccination decisions of different populations with different vaccines. In this issue, a number of studies which variously investigated hesitant compliers (concerned but fully-vaccinated parents), hesitant mothers, pregnant women, parents of young children, and community leaders and members identified both common (eg. trust) and specific factors that may underpin vaccine acceptance in these different groups [5], [6], [7], [8], [9], [10]. The important role in vaccine acceptance and uptake of communities, which may manifest through co-localization or common interests, is also highlighted [11].

  1. Saying it is not enough: Target your communications to the needs of your audience

Communication is important to sustaining uptake in any vaccination program, and while the content should be evidence-based, the development and implementation of communication is not always grounded in communication science principles. As a result, when vaccination communication strategies are tested for efficacy in terms of intentions to vaccinate they may often be ineffective, or may even backfire [12]. Through understanding the different communication needs of parents with different attitudes to vaccination, the study by Berry et al. helps facilitate tailoring of a communications intervention [8]. The lessons learned from an online hub of pro-vaccine information, that highlight the importance of transparency and credibility to build trust, and of tone, style (storytelling), and content (videos and animations) to increase resonance with readers provides a practical playbook for other online, and interpersonal, communications projects [13]. Ohlrogge et al. found that national influenza communications in Europe were often inconsistent with national recommendations and were rarely evaluated [14]. One challenge to the development of effective communications is a lack of consistent and validated outcome measures. This has, in part, been addressed by Kaufman et al., whose mapping of core outcome domains for communication on childhood vaccination allows the selection of appropriate measures for different communications approaches [15]. Parrish-Sprowl argues that research and practice that only account for message content misses the impact of the broader communication process and context [16]. Or, the way a healthcare professional (HCP), for example, talks about vaccination to a patient is as important, or perhaps more so, that what they actually say in terms of behavioral outcomes.

  1. Communicating to people is not enough: Listen to and engage healthcare professionals too

A recommendation from an HCP consistently emerges as an important determinant of vaccination acceptance. While HCPs are usually the most trusted source of information on vaccines, they themselves may be unsure about vaccination or vaccination conversations with their patients. Attwell et al. observed that while most midwives studied supported vaccination, they held a broad of beliefs and concerns related to vaccination [17]. Two new validated scales for measuring motivation of HCPs towards influenza vaccination and towards advocating influenza vaccination [18] can be used to better understand the drivers of hesitancy among HCPs. A six-country study showed that these scales can identify meaningful and actionable clusters of HCPs, which may inform the tailoring of communications or interventions according to underlying motivations [19]. Equipping HCPs with tools to communicate with their patients may also contribute to establish a more trusting and constructive dialogue. For example, an intervention based on motivational interviewing, which acknowledges the importance of the communication process and context through emphasizing the importance of respect and empathy, and of understanding the position of the parent regarding vaccines, showed effectiveness on acceptance, intention to vaccinate, and actual vaccine coverage [20].

  1. Communicating is not enough: Design culturally targeted interventions to improve access to vaccines

Bedford et al underscore the importance of viewing vaccine hesitancy as only one possible determinant of under-vaccination [21]. In India, where just over half of infants are fully vaccinated, mothers reported that non-vaccination of their children was variously due to challenges related to awareness, acceptance and affordability (both financial and non-financial costs) [22]. While Nagar et al.’s randomized controlled trial of a multicomponent intervention with a culturally tailored digital vaccination record and reminders in rural India did not significantly increase timely vaccination, the inclusion of process outcomes will allow further adaptation of the approach to better match communication to the user [23].

The contributions from this special issue illustrate implications for designing effective communication and intervention strategies to increase vaccine acceptance and uptake. Clearly, context matters and communications must be designed to fit the needs and motivations of individuals. However, such communication needs to be designed based on evidence and with validated process and outcome measures. This requires that national authorities, researchers, HCPs and public health professionals understand and act upon the fact that that there is no one-size fits all strategy to solve vaccine hesitancy and that collaborative efforts are needed and must be sustained over time. To sustain and extend the remarkable successes of global immunization programs, governments and funding agencies should not just expand funding and support for research, monitoring and evaluation related to vaccine acceptance and uptake, but they should also mandate that efforts are evidence based and that communications and interventions are culturally and context appropriate.

[Citations at title link above]

 

Emergencies

Emergencies
 

POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 25 September 2018 [GPEI]
:: Papua New Guinea’s National Department of Health, WHO, UNICEF and partners issue a ‘100 Days Report’: featuring the highlights of response operations so far, the report is dedicated to the thousands of front-line polio workers who brave difficult conditions and work long hours to protect children in Papua New Guinea from polio.
:: The G20 group of countries keeps polio eradication in their priorities: in their statement following the G20 Health Ministerial meeting, Ministers recognize “the importance of eradicating polio” and planning for a sustainable polio-free world.
:: World Polio Day is coming up on 24 October: join partners around the world in making this year’s World Polio Day a success.

Summary of new viruses this week:
Pakistan – Positive samples from environmental surveillance: wild poliovirus in Pakistan (10)
Niger – one new case of cVDPV2
Nigeria – two new cases of cVDPV2
Papua New Guinea – one new case of cVDPV1
Somaiia – one new case of cVDPV2

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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 13 Oct 2018 ]
Democratic Republic of the Congo
:: 10: Situation report on the Ebola outbreak in North Kivu  9 October 2018
:: Disease Outbreak News (DONs)  Ebola virus disease – Democratic Republic of the Congo
11 October 2018
[See Milestones above for detail]

Bangladesh – Rohingya crisis – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Syrian Arab Republic – No new announcements identified
Yemen – No new announcements identified

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WHO Grade 2 Emergencies  [to 13 Oct 2018 ]
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
Iraq – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Myanmar – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Sudan – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified

Outbreaks and Emergencies Bulletin, Week 40: 29 September – 05 October 2018

The WHO Health Emergencies Programme is currently monitoring 54 events in the AFRO region. This week’s edition covers key ongoing events, including:
:: Hepatitis E in Central African Republic
:: Monkeypox in Central African Republic
:: Dengue fever in Senegal
:: Ebola virus disease in the Democratic Republic of the Congo
:: Humanitarian crisis in Cameroon.

::::::
 
WHO Grade 1 Emergencies  [to 13 Oct 2018 ]
Afghanistan
Angola (in Portuguese)
Chad
Ethiopia
Kenya
Lao People’s Democratic Republic
Mali
Papua New Guinea
Peru
Tanzania
Tropical Cyclone Gira
Zambia 

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:: Yemen Humanitarian Update Covering 28 September – 6 October 2018 | Issue 29

Key Issues
…Suspected cholera cases have increased with roughly 10,000 reported per week, double the average in the first eight months of this year.

Syrian Arab Republic   No new 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.

Ethiopia  :: Ethiopia: Gedeo-West Guji, Displacement Crisis, Situation update No.8, 9 October 2018

Somalia  No new announcements identified.

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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 13 Oct 2018 ]
http://www.who.int/ebola/en/
[See Milestones above for more detail]

MERS-CoV [to 13 Oct 2018 ]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.

Yellow Fever  [to 13 Oct 2018 ]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.

Zika virus  [to 13 Oct 2018 ]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.