Vaccines and Global Health: The Week in Review 19 May 2018

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

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 pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_19 May 2018

– blog edition: comprised of the approx. 35+ entries posted below.

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

World Health Assembly :: Director-General brings ambitious agenda for change to World Health Assembly

Milestones :: Perspectives

World Health Assembly
21–26 May 2018
Main Documents:
A71/1 Rev.1 – Provisional agenda
Director-General brings ambitious agenda for change to World Health Assembly
18 May 2018 – News Release
After one year in office, WHO Director-General, Dr Tedros Adhanom Ghebreyesus will open the Seventy-first World Health Assembly next week in Geneva with an ambitious agenda for change that aims to save 29 million lives by 2023.

Ministers of Health and other delegates from WHO’s 194 Member States will meet to discuss a range of issues, including the 13th General Programme of Work, which is WHO’s 5-year strategic plan to help countries meet the health targets of the Sustainable Development Goals (SDGs).

“This is a pivotal health Assembly. On the occasion of WHO’s 70th anniversary, we are celebrating 7 decades of public health progress that have added 25 years to global life expectancy, saved millions of children’s lives, and made huge inroads into eradicating deadly diseases such as smallpox and, soon, polio,” said Dr Tedros.

“But the latest edition of the World Health Statistics, published yesterday, shows just how far we still have to go.  Too many people are still dying of preventable diseases, too many people are being pushed into poverty to pay for health care out of their own pockets and too many people are unable to get the health services they need. This is unacceptable,” he added.

Next week’s Health Assembly will open against the backdrop of a new outbreak of Ebola in central Africa, a stark reminder that global health risks can erupt at any time and that fragile health systems in any country pose a risk for the rest of the world.

The WHO General Programme of Work, designed to address these challenges and accelerate progress towards the SDGs, is the result of 12 months of intensive discussion with countries, experts and partners, and centres on the “triple billion” targets:
1 billion more people benefitting from universal health coverage
1 billion more people better protected from health emergencies
1 billion more people enjoying better health and well-being.
“We are transforming how we work to achieve our vision of a world in which health is a right for all. We are changing the way we do business,” Dr Tedros said.

Other topics that will be covered at this year’s World Health Assembly include WHO’s work in health emergencies, polio, physical activity, vaccines, the global snakebite burden and rheumatic heart disease…

WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo :: Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018 :: FAQ on Ebola virus disease vaccine

Milestones :: Perspectives

EBOLA/EVD  [to 19 May 2018]

WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo
17 May 2018   News Release
One new case of Ebola virus disease (EVD) has been confirmed in Wangata, one of the three health zones of Mbandaka, a city of nearly 1.2 million people in Equateur Province in northwestern Democratic Republic of the Congo.

The Ministry of Health of the Democratic Republic of the Congo announced the finding, after laboratory tests conducted by the Institut National de Recherche Biomédicale (INRB) confirmed one specimen as positive for EVD.

Until now, all the confirmed Ebola cases were reported from Bikoro health zone, which is also in Equateur Province but at a distance of nearly 150 km from Mbandaka. The health facilities in Bikoro have very limited functionality and the affected areas are difficult to reach, particularly during the current rainy season, as the roads are often impassable.

“This is a concerning development, but we now have better tools than ever before to combat Ebola,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO and our partners are taking decisive action to stop further spread of the virus.”

WHO is deploying around 30 experts to conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases.

“The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
WHO is also working with Médecins Sans Frontières (MSF) and other partners to strengthen the capacity of health facilities to treat Ebola patients in special isolation wards.

As of 15 May, a total of 44 Ebola virus disease cases have been reported: 3 confirmed, 20 probable, and 21 suspected.

WHO partners in the DRC Ebola response include:
The International Federation of Red Cross and Red Crescent Societies (IFRC), the Congolese Red Cross (Congo ICRC), the  Red Cross of the Democratic Republic of the Congo (DRC ICRC), Médecins Sans Frontières (MSF), the Disaster Relief Emergency Fund (DREF), the Africa Centers for Disease Control and Prevention (Africa-CDC), the US Centers for Disease Control and Prevention (US-CDC), the World Food Programme (WFP), UNICEF, UNOCHA, MONUSCO, International Organization for Migration (IOM), the FAO Emergency Management Centre – Animal Health (EMC-AH), the International Humanitarian Partnership (IHP), Gavi – the Vaccine Alliance, the African Field Epidemiology Network (AFENET), the UK Public Health Rapid Support team, the EPIET Alumni Network (EAN), and the International Organisation for Animal Health (OIE) and and the Emerging Diseases Clinical Assessment and Response Network (EDCARN). Additional coordination and technical support is forthcoming through the Global Outbreak Alert and Response Network (GOARN) and Emergency Medical Teams (EMT).

Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018
The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion
It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:
Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
If the event constitutes a PHEIC, what Temporary Recommendations should be made.

Current situation
On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges
After discussion and deliberation on the information provided, the Committee concluded these key challenges:
:: The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
:: The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders.
:: There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:
:: The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
:: Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
:: In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:
:: Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
:: Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
:: It is particularly important there should be no international travel or trade restrictions.
:: Neighbouring countries should strengthen preparedness and surveillance.
:: During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
:: Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
:: Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;
:: If the outbreak expands significantly, or if there is international spread,  the Emergency Committee will be reconvened.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

FAQ on Ebola virus disease vaccine
14 May 2018


First-ever WHO list of essential diagnostic tests to improve diagnosis and treatment outcomes

Milestones :: Perspectives

First-ever WHO list of essential diagnostic tests to improve diagnosis and treatment outcomes
15 May 2018
WHO today published its first Essential Diagnostics List, a catalogue of the tests needed to diagnose the most common conditions as well as a number of global priority diseases.
“An accurate diagnosis is the first step to getting effective treatment,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “No one should suffer or die because of a lack of diagnostic services, or because the right tests were not available.”

The list concentrates on in vitro tests – i.e. tests of human specimens like blood and urine. It contains 113 products: 58 tests are listed for detection and diagnosis of a wide range of common conditions, providing an essential package that can form the basis for screening and management of patients.  The remaining 55 tests are designed for the detection, diagnosis and monitoring of “priority” diseases such as HIV, tuberculosis, malaria, hepatitis B and C, human papillomavirus and syphilis.

Some of the tests are particularly suitable for primary health care facilities, where laboratory services are often poorly resourced and sometimes non-existent; for example, tests that can rapidly diagnose a child for acute malaria or glucometers to test diabetes.  These tests do not require electricity or trained personnel.  Other tests are more sophisticated and therefore intended for larger medical facilities.

“Our aim is to provide a tool that can be useful to all countries, to test and treat better, but also to use health funds more efficiently by concentrating on the truly essential tests,” says Mariângela Simão, WHO Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals. “Our other goal is to signal to countries and developers that the tests in the list must be of good quality, safe and affordable.”

For each category of test, the Essential Diagnostics List specifies the type of test and intended use, format, and if appropriate for primary health care or for health facilities with laboratories. The list also provides links to WHO Guidelines or publications and, when available, to prequalified products.

Similar to the WHO Essential Medicines List, which has been in use for four decades, the Essential Diagnostics List is intended to serve as a reference for countries to update or develop their own list of essential diagnostics. In order to truly benefit patients, national governments will need to ensure appropriate and quality-assured supplies, training of health care workers and safe use. To that end, WHO will provide support to countries as they adapt the list to the local context…

First edition of the WHO Model List of Essential In Vitro Diagnostics (EDL)


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 15 May 2018 [GPEI]
Summary of newly-reported viruses this week:
Afghanistan: One new wild poliovirus type 1 (WPV1)  positive environmental sample has been reported, in Kandahar province.
Pakistan: One new WPV1  positive environmental sample has been reported, in Sindh.


WHO Grade 3 Emergencies  [to 19 May 2018]

:: Reaching out with mental health services for displaced Syrians  16-05-2018

WHO Grade 2 Emergencies  [to 19 May 2018]
[Several emergency pages were not available at inquiry]

UNICEF: Over 16K babies born in Rohingya camps in Bangladesh
Khmer Times (Cambodia)/Reuters (5/18/2018),
More than 16,000 babies have been born in Rohingya refugee camps in Bangladesh in the past nine months, and only 3,000 of them were delivered in medical facilities, according to UNICEF. “Around 60 babies a day are taking their first breath in appalling conditions, away from home, to mothers who have survived displacement, violence, trauma and, at times, rape,” says UNICEF representative Edouard Beigbeder.

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 Humanitarian Update Covering 8 – 14 May 2018 | Issue 15


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.
:: OCHA Somalia Flash Update #5 – Humanitarian impact of heavy rains | 15 May 2018 [EN/SO]

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 19 May 2018]
[See Milestones above for detail]


WHO & Regional Offices [to 19 May 2018]

WHO & Regional Offices [to 19 May 2018]

See Milestones above for coverage of Ebola and Yemen.
Weekly Epidemiological Record, 18 May 2018, vol. 93, 20 (pp. 249–304)
Dr Peter Salama
Deputy Director-General
Emergency Preparedness and Response

The WHO Health Emergencies (WHE) programme was established in 2016 to strengthen WHO capacity to prevent, detect and respond to emergencies. Over the last two years the WHE has markedly strengthened systems and processes to detect and manage hazards. This includes through more systematic assessment of notifications and alerts and through development and implementation of the Emergency Response Frame­work. Each month the programme assesses 7000 signals of potential public health concern. Around 30 of these require field investigation.

During the last year the WHE has supported operations to control and manage Ebola in Democratic Republic of Congo, Marburg in Uganda, pneumonic plague in Madagascar, cholera, diphtheria and the collapse of the health system in Yemen, chemical events in Syria, war related injuries in Iraq, the Rohingya refugee crisis in Bangladesh to name but a few.

This special edition of the Weekly Epidemiology Record provides a flavour of some of the work that WHE is doing with partners to strengthen global capacity to prepare, prevent, detect, respond to and recover from public health emergencies with the goal of creating a safer world.

The first set of articles focuses on WHE’s work to strengthen surveillance and risk assessment including through the use of technology. Teams in AFRO, SEARO and PAHO document the tools they are using to assess and understand their hazards. WHO describe the use of Spatial analysis to map out geographical zones for the most common haemorrhagic fevers, chikungunya, yellow fever, Zika virus, plague, anthrax, meningitis, cholera and malaria. SEARO outlines how they have used multiple tools to understand their capacity gaps and vulnerabilities in order to guide investments in risk reduction and preparedness. In the Americas they are adapting tools for surveillance and operational readi­ness to take into account changes in social behaviours from urbanisation, travel and trade. And finally the article on the Epidemic Intelligence from Open Sources (EIOS) shows how a multi-agency collaboration is using open source data to support early detection, verification and assessment of public health risks allowing better identification of events that warrant more detailed risk analysis.

The second set of articles presents some examples of the WHE work in strengthening country preparedness. The article on Early Warning, Alert and Response outlines work that is ongoing to develop a robust tool that can be applied in both routine and emergency contexts with the aim of making EWAR processes smoother and more efficient. The piece on Asia Pacific Strategy for Emerging Diseases and Public Health Emer­gencies (APSED) shares lessons learnt in rolling out a common framework for building core capacity across two WHO regions for application beyond Asia and the Pacific in order to strengthen global health security.

The third set of articles focuses on mechanisms and initiatives to support smoother and more rapid responses to emergencies starting with a piece on our newly adapted Incident Management System which is helping ensure a more predictable and effective response in many settings. The piece on vaccine stockpiles outlines the importance behind these stockpiles and the importance of transparent and clear governance in ensuring equi­table access to vaccines ensuring maximum public health impact, in particular where managing multiple requests for the same vaccine are being made.

And finally the pieces on Ukraine and on DARES in Yemen help us look to the future, providing two exam­ples of WHEs work with governments and partners can use emergency operations to deliver public health outcomes and to catalyse and stimulate broader health system reform and system strengthening.

These pieces provide an opportunity to reflect on how far we have come in building a stronger WHO emergen­cies programme. But our work is not done. This next year will see our work continue as we support govern­ments to ensure compliance with the International Health Regulations, and as we work across WHO and with development and humanitarian partners to coor­dinate our support in fragile and conflict settings to prevent health system collapse whilst continuing to access and provide critical services to populations in need.
I thank you for your support and we look forward to serving you further.

:: Mapping the distribution and risk of epidemics in the WHO African Region
:: A health emergency risk profile of the South-East Asia Region
:: Importance of surveillance for preparedness and country readiness in a hazard-prone region
:: The Epidemic Intelligence from Open Sources initiative: a collaboration to harmonize and standardize early detection and epidemic intelligence among public health organizations
:: Early Warning, Alert and Response (EWAR): a key area for countries in preparedness and response to health emergencies
:: Confronting health security threats: The Asia–Pacific Strategy for Emerging Diseases and Public Health Emergencies to advance core capacity for the International Health Regulations (2005)
:: Adapting the Incident Management System for response to health emergencies – early experience of WHO
:: Access to life-saving vaccines during outbreaks: a spotlight on governance
:: Crisis in Ukraine as an opportunity for rebuilding a more responsive primary health care system
:: Who DARES wins. Delivering accelerated results effectively and sustainably
:: Implementation of the International Health Regulation (2005) in Oman: progress, lessons learnt and way forward
:: Accelerating implementation of the International Health Regulations (2005): the interface between health systems and health security

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018  19 May 2018
:: WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo  17 May 2018
:: WHO supports stabilization centres to treat malnourished children in South Sudan 17 May 2018
WHO European Region EURO
:: European Immunization Week helps highlight and boost the positive impact of vaccines 17-05-2018
:: The WHO Barcelona Course on Health Financing for Universal Health Coverage now open for application 16-05-2018
:: Reaching out with mental health services for displaced Syrians 16-05-2018
:: Belarus pilot project shows the way to people-centred TB services 16-05-2018

WHO Eastern Mediterranean Region EMRO
:: Last nationwide vaccination campaign in Afghanistan starts before the high transmission season for poliovirus  6 May 2018

WHO Western Pacific Region
:: Doing it for themselves: Peer-led HIV testing in Viet Nam improves access to care
7 May 2018


CDC/ACIP [to 19 May 2018]

CDC/ACIP [to 19 May 2018]

Wednesday, May 16, 2018
New Rapid Rabies Test Could Revolutionize Testing and Treatment
A new rabies test developed at the Centers for Disease Control and Prevention (CDC) could mean people exposed to potentially rabid animals could forego the weeks-long regimen of shots to prevent the deadly disease.
The new test, designed for use in animals, can more easily and precisely diagnose rabies infection, according to a study published today in PLOS One. The new LN34 test is simpler and easier to use than current tests. During the pilot study, it produced no false negatives, fewer false positive, and fewer inconclusive results. It could allow doctors and patients to make better informed decisions about who needs treatment for rabies, which is nearly always fatal once symptoms start.
The LN34 test can also be run on testing platforms already widely used in the U.S. and worldwide, without any extra training. And it yields results even from decomposing animal brain tissue. The current gold-standard for rabies testing in animals is the direct fluorescent antibody (DFA) test, which can only be interpreted by laboratory workers with special skills, extensive training, and a specific type of microscope…

MMWR News Synopsis for May 17, 2018
Community-Based Services to Improve Testing and Linkage to Care Among Non-U.S.-Born Persons with Chronic Hepatitis B Virus Infection – Three U.S. Programs, October 2014-September 2017
   Strategic partnerships with public health departments, medical clinics, and community organizations are successful in developing hepatitis B programs that offer community-based testing services and linkage to care in hard to reach, non-U.S.-born populations.
In the United States, 70 percent of people living with chronic hepatitis B virus (HBV) infection are non-U.S. born. To mitigate morbidity and mortality associated with HBV among this heavily impacted population, CDC funded a cooperative agreement to develop hepatitis B testing and linkage to care programs serving non-U.S.-born people from October 2014 to September 2017. This report summarizes the efforts of these programs and their partnerships with primary care centers, community-based services, and public health departments. Among the findings: 7.5 percent of program participants tested positive for HBV; 85 percent of those who tested positive attended at least one medical visit; and 78 percent received recommended care.

Trends in Antiretroviral Therapy Eligibility and Coverage Among HIV-Infected Children Aged <15 Years – 20 PEPFAR-Supported Sub-Saharan African Countries, 2012-2016
   A CDC analysis of 20 African countries shows that more children living with HIV were on treatment in 2016 than in 2012, but 56 percent remain without treatment. More work is needed to control the HIV epidemic among children by diagnosing those living with HIV, and starting and maintaining them on treatment.
A CDC analysis of 20 African countries, supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), shows more children living with HIV are on antiretroviral therapy (ART), which can help them live longer, healthier lives. The study revealed the percentage of HIV-positive children on ART in these countries increased from 24 percent in 2012 to 44 percent in 2016. However, 56 percent of children living with HIV were not receiving treatment in 2016. The study also showed that 13 of the 20 countries adopted the 2016 World Health Organization guidelines, which expanded treatment eligibility to all children by 2016. The research suggests that more work is needed to control the HIV epidemic by increasing diagnosis of HIV-positive children, as well as starting and maintaining them on treatment.

Cholera Epidemic – Lusaka, Zambia, 2017-2018
Cholera will remain a global health risk until underlying and widespread water, sanitation and hygiene gaps are addressed. Under a new strategy called “Ending Cholera,” the Global Task Force for Cholera Control, chaired by WHO, recently proposed investments in water, sanitation, and hygiene; emergency preparedness; and cholera vaccination in cholera hotspots to reduce cholera deaths by 90 percent and eliminate local cholera transmission in 20 countries by 2030.
A recent cholera outbreak in Lusaka, Zambia demonstrates the need for rapid and robust responses during initial stages of outbreaks, enhanced surveillance, and access to chlorinated drinking water. The outbreak began in October 2017 and resulted in almost 5,000 cases and 93 deaths in the capital city of Lusaka. Of the local water sources tested, 73 percent had insufficient chlorine levels and one third had fecal contamination. During January–February 2018, the Zambian government and partners collaborated to improve water supplies, provide education, and administer oral cholera vaccine. However, heavy flooding and widespread water shortages led to a resurgence of cholera in March. Cholera remains a significant global public health problem with about 3 million cases each year and over a billion people at risk for infection, primarily due to contaminated drinking water.

Register for upcoming June ACIP meeting
June 20-21, 2018
Deadline for registration:
Non-US Citizens: May 16, 2018
US Citizens: June 11, 2018
Registration is NOT required to watch the live meeting webcast or to listen via telephone.