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

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– 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

American Medical Association – Letter to Tech Company CEOs on Vaccination  

Milestones :: Perspectives

American Medical Association – Letter to Tech Company CEOs on Vaccination  
March 13, 2019

Facebook – Attn: Mark Zuckerberg, CEO
Pinterest – Ben Silbermann, Co-Founder and CEO
Amazon – Jeffrey Bezos, CEO, President and Chairman
Google –  Sundar Pichai, CEO
YouTube –  Susan Wojcicki, CEO
Twitter  – Jack Dorsey, CEO

Dear CEOs of Leading Technology Companies:

At a time when vaccine-preventable diseases, particularly measles, are reemerging in the United States and threatening communities and public health, physicians across the country are troubled by reports of anti-vaccine related messages and advertisements targeting parents searching for vaccine information on your platforms. As physicians, we are concerned that the proliferation of this type of health-related misinformation will undermine sound science, further decrease vaccinations, and persuade people to make medical decisions that could spark the spread of easily preventable diseases.

With public health on the line and with social media serving as a leading source of information for the American people, we urge you to do your part to ensure that users have access to scientifically valid information on vaccinations, so they can make informed decisions about their families’ health. We also urge you to make public your plans to ensure that users have access to accurate, timely, scientifically sound information on vaccines.

We applaud companies that have already taken action, but encourage you to continue evaluating the impact of these policies and take further steps to address the issue as needed.

The overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health. When immunization rates are high, people who cannot be protected directly by the vaccines are protected because they are not exposed to the disease. This includes children too young to receive vaccinations and people with medical contraindications.

The reductions we have seen in vaccination coverage threaten to erase many years of progress as nearly eliminated and preventable diseases return, resulting in illness, disability and death. In order to protect our communities’ health, it is important that people be aware not just that these diseases still exist and can still debilitate and kill, but that vaccines are a safe, proven way to protect against them.

As evident from the measles outbreaks currently impacting communities in several states, when people decide not to be immunized as a matter of personal preference or misinformation, they put themselves and others at risk of disease. That is why it is extremely important that people who are searching for information about vaccination have access to accurate, evidence-based information grounded in science.

Thank you for your attention to this critical, public health matter. We look forward to hearing from you.


James L. Madara, MD
Executive Vice President, CEO

Global influenza strategy 2019-2030 :: WHO launches new global influenza strategy

Milestones :: Perspectives

Global influenza strategy 2019-2030
March 2019 :: 31 pages   ISBN 9789241515320


News Release
WHO launches new global influenza strategy
11 March 2019,  Geneva

WHO today released a Global Influenza Strategy for 2019-2030 aimed at protecting people in all countries from the threat of influenza. The goal of the strategy is to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic.

“The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.”

Influenza remains one of the world’s greatest public health challenges. Every year across the globe, there are an estimated 1 billion cases, of which 3 to 5 million are severe cases, resulting in 290 000 to 650 000 influenza-related respiratory deaths. WHO recommends annual influenza vaccination as the most effective way to prevent influenza. Vaccination is especially important for people at higher risk of serious influenza complications and for health care workers.

The new strategy is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals:
Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security.

Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.

“With the partnerships and country-specific work we have been doing over the years, the world is better prepared than ever before for the next big outbreak, but we are still not prepared enough,” said Dr Tedros. “This strategy aims to get us to that point. Fundamentally, it is about preparing health systems to manage shocks, and this only happens when health systems are strong and healthy themselves.”

To successfully implement this strategy, effective partnerships are essential.  WHO will expand partnerships to increase research, innovation and availability of new and improved global influenza tools to benefit all countries.  At the same time WHO will work closely with countries to improve their capacities to prevent and control influenza.

The new influenza strategy builds on and benefits from successful WHO programmes.  For more than 65 years, the Global Influenza Surveillance and Response System (GISRS), comprised   of WHO Collaborating Centres and national influenza centres, have worked together to monitor seasonal trends and potentially pandemic viruses. This system serves as the backbone of the global alert system for influenza.

Important to the strategy is the on-going success of the Pandemic Influenza Preparedness Framework, a unique access and benefit sharing system that supports the sharing of potentially pandemic viruses, provides access to life saving vaccines and treatments in the event of a pandemic and supports the building of pandemic preparedness capacities in countries through partnership contributions from industry.

The strategy meets one of WHO’s mandates to improve core capacities for public health, and increase global preparedness and was developed through a consultative process with input from Member States, academia, civil society, industry, and internal and external experts.

Supporting countries to strengthen their influenza capacity will have collateral benefits in detecting infection in general, since countries will be able to better identify other infectious diseases like Ebola or Middle East respiratory syndrome-related coronavirus (MERS-CoV).

Through the implementation of the new WHO global influenza strategy, the world will be closer to reducing the impact of influenza every year and be more prepared for an influenza pandemic and other public health emergencies.
Read the Global Influenza Strategy 

More about influenza


WHO Director General: Press Briefing on Ebola  14 March 2019

Milestones :: Perspectives

DRC – Ebola

WHO Director General: Press Briefing on Ebola  14 March 2019
Audio [48:26]:
Transcript 11 pages]:

TAG [Tedros]:  …I would just like to say a few words on the situation. The latest data from the Ministry of Health; we have 927 confirmed and probable cases, 584 deaths and we have vaccinated more than 87,000 people, including 27,000 health workers in DRC and 5,000 in surrounding countries; more than 400 patients treated with novel therapeutics and we’re happy that people are surviving.

More than 58,000 contact registered and more than 4,200 currently being monitored for signs of illness and there are half as many new cases per week now as there were in January. In January there were 50 cases per week; now we have an average of 25 cases per week so there is a decline in the number of cases per week.

Despite the incredibly difficult situation the outbreak has been contained in 11 out of the [20] communities that have had cases. We have been able to stop transmission in Beni, Mangina, Komanda, Oicha. Now the Ebola virus is concentrated in Butembo and Katwa so the cases are now shrinking in a certain geographic area…

Selected Media Q&A

:: Laurent Sierrot, Swiss News Agency. Last week the president of Doctors Without Borders, Joanne Liu, made a few remarks and among them she said that in the communities there are a lot of people who don’t understand why they can’t access the vaccine and why the vaccine is now just for the people who have been affected or the contacts or the contacts of contacts. Do you think there is still a lack of education in that regard? What steps could you do more of or better in that regard?

TAG Can you repeat the question? I’m sorry.

LA She says that there is a lack of education in the communities towards the need to focus only on a few, a bunch of people affected, contacts and contacts of contacts for the vaccination and that a lot of people don’t understand that. How could things be made better in that regard?

TAG Yes, thank you. That’s the strategy we follow now, what we call the ring vaccination and we vaccinate contacts and contacts of contacts. I can understand that there will be a need to increase awareness of the communities of why we’re doing that. In other areas, by the way, the community has started to understand after our explanation to communities, especially through engagement. I hope we can address this problem too in the Butembo and Katwa area.

:: Cathrine for France 24. I would like to know if the attacks on the different treatment centres have affected your ring vaccination; are you running out of vaccines? That’s my first question. My second one is, how do you collaborate with Uganda, which is the closest country to the two places that you’ve mentioned to Butembo and Katwa?

TAG Thank you. With regard to the amount of vaccines we have, with the current epidemiologic situation and the strategy we follow, the ring vaccination, we have enough stock of vaccines. Not only that, we’re in regular contact with the manufacturer of the vaccine, Merck; I’m personally in contact and they’re doing everything to boost when needed.

…TAG: So by any account there is progress but of course a delicate one and we have to continue to push and push until we finish the job. But one thing I would like to stress on that; you know what the community said; why are you so aggressive in terms of Ebola – they’re right – we have malaria, we have cholera, we have other health problems and you shouldn’t just say Ebola, Ebola, help us with the other things.

That’s why I said in my opening statement, not just to fight Ebola; we will stay there to address the concerns and demands of the community, the other demands because there are other serious problems, not just Ebola and I would like to call upon the international community to link the outbreak control now, Ebola, with developing the health system. That’s a big challenge. Otherwise we will appear as if we’re preventing Ebola from getting into other countries and we don’t care about the demands of the community, the additional demands.

The most important thing here is we care not just about Ebola, we care to address the other challenges the communities face and that’s the challenge not only for WHO but for all the international community, while fighting Ebola to start development, to start rehabilitating the health systems of DRC, to start showing to the communities of those affected by Ebola, we’re with you to address the other problems too, we’re not here only to prevent Ebola because it goes to other neighbouring countries.

We shouldn’t really stay there if that’s our goal. Our goal should be to help them with not only Ebola but with the development of the health system. Sorry I’m taking a lot of your time here but it’s because that’s what I believe. That’s what they’re asking; that’s what we should do, and

the international community should also be prepared to help for the long haul of really developing the health system as per the requests from the community and we should be on their side. That’s what we’re focused on now.

Then on the strategic response plan, it addresses the second issue you raised. The focus should be community engagement. The focus should be local capacity-building and that’s the shift we have already made, and I fully agree if that’s what our partners like MSF say; I really fully agree and that’s what we have already included in our new strategic response plan. Thank you….

:: TO   Thanks. I have a couple of questions, Dr Tedros, about the outlook. The easy first question is, when will you be able to tell us something about the success of the therapeutics that you’re trying? And also, about the future, is it possible that this outbreak, this disease could linger in the area for years, are you preparing for that?

And a related question about vaccines; obviously at the moment you’re using the Merck vaccine and there’s this ring vaccination programme going on but there’s the possibility, I guess, in future that there could be a change in the available options like it could be licensed for a general vaccination campaign or another vaccine could come online. Is there a point at which you can foresee the response changing because you have a new vaccine option available? Thanks.

TAG Yes, I would actually look for that day, when we have a vaccine that can be used at large scale and is easier to manage in terms of the cold-chain requirements that we have now. We’re encouraging institutions to really give us more options and we will be happy to work with those who have additional options to offer so in the future it will be just one of the vaccines in a routine that can be used in health facilities rather than using it on a small scale as in the ring vaccination only…





Public Health Emergency of International Concern (PHEIC)

Polio this week as of 13 March 2019

:: On the occasion of the International Women’s Day on 8 March 2019, the Global Polio Eradication Initiative featured stories of women on-ground working for polio eradication efforts. Read all the IWD news here.

:: Wild poliovirus continues to transmit in Afghanistan—one of the most challenging geographical and socio-political landscapes—but GPEI is working with the partners and the government to make concrete gains in eliminating the disease. More on the efforts here.

:: Real-time disease surveillance is the future of disease of surveillance, which is being rolled-out at the World Health Organization’s Regional Office for Africa in collaboration with the Bill & Melinda Gates Foundation. Read more.

Summary of new viruses this week:
:: Pakistan – nine WPV1-positive environmental samples;
:: Nigeria – one circulating vaccine-derived poliovirus type 2 (cVDPV2)- positive community contact case and three cVDPV2-positive environmental samples.


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 Mar 2019]
Democratic Republic of the Congo
::  32: Situation report on the Ebola outbreak in North Kivu  12 March 2019
:: DONS – Ebola virus disease – Democratic Republic of the Congo   14 March 2019

Syrian Arab Republic
:: 8 ways WHO supports health in Syria   14 March 2019

The Syrian crisis is one of the world’s biggest and most complex humanitarian emergencies. 8 years of conflict have taken a huge toll on a health system that was once among the best in the region. Here are 8 things to know about how WHO works in Syria to save lives and support health despite immense challenges.

Bangladesh – Rohingya crisis – No new digest announcements identified  
Myanmar – No new digest announcements identified  
Nigeria – No new digest announcements identified  
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified  
Yemen – No new digest announcements identified  


WHO Grade 2 Emergencies  [to 16 Mar 2019]
:: Disease Commodity Package for MERS-CoV  pdf, 149kb  March 2019

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
Iraq – No new digest announcements identified  
Libya – 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 Mar 2019]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut
WHO AFRO – Outbreaks and Emergencies Bulletin – Week 10/2019
Week 10: 04 – 10 March 2019
The WHO Health Emergencies Programme is currently monitoring 59 events in the region. This week’s edition covers key new and ongoing events, including:
:: Plague in Uganda
:: Ebola virus disease in the Democratic Republic of the Congo
:: Hepatitis in Namibia
:: Lassa fever in Nigeria.


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


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 Mar 2019]
::  32: Situation report on the Ebola outbreak in North Kivu  12 March 2019
:: DONS – Ebola virus disease – Democratic Republic of the Congo   14 March 2019

MERS-CoV [to 16 Mar 2019]
– No new digest announcements identified.

Yellow Fever [to 16 Mar 2019]
– No new digest announcements identified.

Zika virus [to 16 Mar 2019]
– No new digest announcements identified.

WHO & Regional Offices [to 16 Mar 2019]

WHO & Regional Offices [to 16 Mar 2019]

WHO launches new global influenza strategy
11 March 2019,  Geneva News Release
WHO today released a Global Influenza Strategy for 2019-2030 aimed at protecting people in all countries from the threat of influenza. The goal of the strategy is to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic
[See Milestones above for detail]

Weekly Epidemiological Record, 15 March 2019, vol. 94, 11 (pp. 129–140)
:: Strengthening governance, partnerships and transparency to secure global health: the International Coordinating Group on Vaccine Provision and its impact in 2018


GIN January 2019  pdf, 1.81Mb 8 March 2018

Selected Press Releases, Announcements
WHO African Region AFRO
:: Over 2 million Nigerian children receive treatment against parasitic worms   15 March 2019
:: Ethiopia is making significant progress in the implementation of International Health Regulation (IHR) core capacities: The country plans to launch the National Action Plan costed at over 368 million USD  13 March 2019
:: Nigerian women are penetrating enclaves to reach children and vulnerable populations.
13 March 2019

WHO Region of the Americas PAHO
:: President of Paraguay and PAHO Director address the country’s health priorities (03/12/2019)
WHO South-East Asia Region SEARO
– No new digest announcements identified.


WHO European Region EURO
:: 8 ways WHO supports health in Syria 15-03-2019
:: New WHO study shows more action needed to monitor and limit digital marketing of unhealthy products to children 13-03-2019


WHO Eastern Mediterranean Region EMRO
:: Prosthetic rehabilitation centre brings hope for patients in Iraq  12 March 2019
:: Driving change for Somali mothers and children  11 March 2019
:: Children’s survival rates in Dohuk see significant improvement  11 March 2019

WHO Western Pacific Region
– No new digest announcements identified.