Emerging Infectious Diseases
Volume 25, Number 11—November 2019
http://wwwnc.cdc.gov/eid/

Dispatches
Clinical REsearch During Outbreaks (CREDO) Training for Low- and Middle-Income Countries [PDF – 576 KB – 4 pages]
N. Kayem et al.
We describe a pilot of the Clinical REsearch During Outbreaks (CREDO) initiative, a training curriculum for researchers in epidemic-prone low- and middle-income countries who may respond to disease outbreaks. Participants reported improved confidence in their ability to conduct such research and overall satisfaction with the course structure, content, and training.

International Journal of Infectious Diseases
November 2019 Volume 88, p1-158
https://www.ijidonline.com/issue/S1201-9712(19)X0017-X

Perspective
HPV vaccination: Are we overlooking additional opportunities to control HPV infection and transmission?
Alex Vorsters, Pierre Van Damme, F. Xavier Bosch
p110–112
Published online: September 12, 2019

Journal of Community Health
Volume 44, Issue 6, December 2019
https://link.springer.com/journal/10900/44/6

Original Paper
Hepatitis B Virus Screening and Vaccination in First-generation African Immigrants: A Pilot Study
Olorunseun O. Ogunwobi, Omar Dibba, Lin Zhu, Adeodat Ilboudo…

The Lancet
Nov 02, 2019 Volume 394Number 10209p1591-1684, e34
https://www.thelancet.com/journals/lancet/issue/current

Comment
Achieving health equity: democracy matters
Johanna Hanefeld, Aaron Reeves, Chris Brown, Piroska Östlin
Progress on health equity in the European region in the past two decades has been slower than expected. Indeed, some countries have even seen health inequalities widen.¹ This slow progress is, to some extent, surprising because there is almost unanimous political commitment to addressing health inequities and many countries have made great strides in implementing policies to reduce the health gap.¹, ² Europe, as a region, is on track to achieving the Sustainable Development Goals (SDGs) overall, but countries are not attaining SDG 10 and SDG 3 because ensuring healthy lives for all is impossible without reducing health inequities.

The report of the WHO European Health Equity Status Report Initiative (HESRI), launched on Sept 10, 2019, reviews achievements on the road to health equity to understand how to further accelerate action, and to discuss how to influence decisions related to fiscal policy and industrial strategy in order to deliver healthy, prosperous lives for all.³ The findings of the HESRI report³
show that the evidence on how to best tackle health inequity is clear and overwhelming, even more so in Europe, where we can draw on a wealth of health inequalities research.⁴ We know the size of the gaps in life expectancy, the social gradients in the burden of disease across the European region, and the root causes of these health inequalities, the social determinants of health.

The root causes of health inequities are driven by policies that structure access to the social determinants of health. Five conditions are necessary to reduce health inequity: good-quality and accessible health services; income security and an appropriate, fair level of social protection; decent living conditions; good social and human capital; and decent work and employment conditions.³ Of these, the two most important determinants are precarious housing and living conditions,⁵ and low income and weak social protection.⁶ When people live in unaffordable, cold, and unsafe housing on insecure contracts, their health is worse and they die prematurely.⁷ When people cannot make ends meet and when social protection systems are stigmatising and inadequate, their health suffers.⁸ Inadequate access to health services, conditions of employment, and personal and community capabilities are all important too. Health outcomes improve when people can access the care they think they need; when people work in secure employment with a living wage; and when people have someone to turn to for help and feel they have a voice in decision-making processes.^9,10

The drivers of health inequity are all too prevalent across the region. This situation is not inevitable. These determinants of health inequalities are all modifiable through policies focused on the five areas identified in the report:³ health services, social protection, decent living conditions, social and human capital, and decent employment. Why, then, has progress been so slow?

Emerging evidence indicates that policies to address health inequalities do not emerge out of thin air, rather they are the result of a country’s or region’s wider political economy.¹¹, ¹²
Policies are the product of people in particular socioeconomic contexts interacting with political institutions that shape the political process in a given location—be that a community, city, region, or country. Where these institutions are not accountable, transparent, participatory, or coherent, we will be far less likely to see the policy change necessary to deliver health equity. Governments and other stakeholders must actively work to alter how we incorporate the voices, lived experiences, and passions of the child, the young person, or adult who is not able to thrive and prosper because of health inequities. Democratic institutions, such as free and fair elections, are part of establishing the conditions that empower individuals and communities, ensure participation is meaningful, and establish decision-making processes that are accountable. Furthermore, accountable and transparent decision-making processes generate coherent policies by making participation inclusive. Beyond consulting people, participation can only be inclusive where economic barriers to participation are alleviated and where we alter the governance structures of policy processes to ensure the communities affected by policy decisions have a meaningful voice that influences outcomes in these processes.

There are countervailing forces, however. Vested interests, such as commercial actors or those who oppose health-enhancing policies, will seek to subvert efforts to address health equity.¹³m
Crucially, the influence of these groups depends on how our political systems are organised.¹⁴
Addressing health inequity requires a restructuring of our political systems so that we can deepen democracy through making our decision-making processes more inclusive.¹⁵, ¹⁶

To allow all people in Europe to prosper and flourish in health and in life, we need to recognise both the centrality of equity in health to the sustainable development of Europe and that political institutions are one of the essential conditions that make health equity possible.

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

Comment
Improving the performance of oral rotavirus vaccines
Gagandeep Kang

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

Articles
Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study
Karin Stenberg, Odd Hanssen, Melanie Bertram, Callum Brindley, Andreia Meshreky, Shannon Barkley, Tessa Tan-Torres Edejer

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis
Isolde Birdthistle, Clare Tanton, Andrew Tomita, Kristen de Graaf, Susan B Schaffnit, Frank Tanser, Emma Slaymaker

Lancet Global Health
Nov 2019 Volume 7Number 11e1467-e1583
http://www.thelancet.com/journals/langlo/issue/current

Mortality reduction benefits and intussusception risks of rotavirus vaccination in 135 low-income and middle-income countries: a modelling analysis of current and alternative schedules
Andrew Clark, Jacqueline Tate, Umesh Parashar, Mark Jit, Mateusz Hasso-Agopsowicz, Nicholas Henschke, Benjamin Lopman, Kevin Van Zandvoort, Clint Pecenka, Paul Fine, Colin Sanderson

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Comment
Increased mortality in survivors of Ebola virus disease
Hugues Fausther-Bovendo, Gary Kobinger

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Early vaccination: a provisional measure to prevent measles in infants
Nicola Principi, Susanna Esposito

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Articles
Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study
Mory Keita, et al

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: a systematic review and meta-analysis
Laura M Nic Lochlainn, et al

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis
Laura M Nic Lochlainn, et al
Open Access

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Review
A governance framework for development and assessment of national action plans on antimicrobial resistance
Michael Anderson, Kai Schulze, Alessandro Cassini, Diamantis Plachouras, Elias Mossialos

Lancet Infectious Diseases
Nov 2019 Volume 19Number 11p1149-1264, e370-e403
http://www.thelancet.com/journals/laninf/issue/current

Personal View
Outbreak response as an essential component of vaccine development
Richard Hatchett, Nicole Lurie
Summary
The Coalition for Epidemic Preparedness Innovations (CEPI) was created as a result of an emerging global consensus that a coordinated, international, and intergovernmental effort was needed to develop and deploy new vaccines to prevent future epidemics. Although some disease outbreaks can be relatively brief, early outbreak response activities can provide important opportunities to make progress on vaccine development. CEPI has identified six such areas and is prepared to work with other organisations in the global community to combat WHO priority pathogens, including the hypothetical Disease X, by supporting early activities in these areas, even when vaccine candidates are not yet available.

Nature
Volume 574 Issue 7780, 31 October 2019
http://www.nature.com/nature/current_issue.html

Comment | 29 October 2019
Ethical research — the long and bumpy road from shirked to shared
From all too scarce, to professionalized, the ethics of research is now everybody’s business, argues Sarah Franklin in the sixth essay in a series on how the past 150 years have shaped science, marking Nature’s anniversary.
Sarah Franklin

Nature Reviews Genetics
Volume 20 Issue 11, November 2019
https://www.nature.com/nrg/volumes/20/issues/11

Roadmap | 27 August 2019
Leveraging European infrastructures to access 1 million human genomes by 2022
Gary Saunders, Michael Baudis[…] & Serena Scollen
Abstract
Human genomics is undergoing a step change from being a predominantly research-driven activity to one driven through health care as many countries in Europe now have nascent precision medicine programmes. To maximize the value of the genomic data generated, these data will need to be shared between institutions and across countries. In recognition of this challenge, 21 European countries recently signed a declaration to transnationally share data on at least 1 million human genomes by 2022. In this Roadmap, we identify the challenges of data sharing across borders and demonstrate that European research infrastructures are well-positioned to support the rapid implementation of widespread genomic data access.

New England Journal of Medicine
October 31, 2019 Vol. 381 No. 18
http://www.nejm.org/toc/nejm/medical-journal

Persepctive
Enabling Healthful Aging for All — The National Academy of Medicine Grand Challenge in Healthy Longevity
Victor J. Dzau, M.D., Sharon K. Inouye, M.D., M.P.H., John W. Rowe, M.D., Elizabeth Finkelman, M.P.P., and Tadataka Yamada, M.D.
Recognizing that aging presents a defining challenge for this century, the National Academy of Medicine is launching a Healthy Longevity Global Grand Challenge, an international effort directed at improving health, productivity, and quality of life for older people.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 Nov 2019)

Editorial
Health and medical research for all: The challenge remains open
The PLOS Medicine Editors
| published 31 Oct 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002970

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 Nov 2019)

Early signal detection of adverse events following influenza vaccination using proportional reporting ratio, Victoria, Australia
Hazel J. Clothier, Jock Lawrie, Melissa A. Russell, Heath Kelly, Jim P. Buttery

Research Article | published 01 Nov 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0224702

EPLoS Medicine
http://www.plosmedicine.org/
(Accessed 2 Nov 2019)

The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers
Linda Cecilia Karlsson, Stephan Lewandowsky, Jan Antfolk, Paula Salo, Mikael Lindfelt, Tuula Oksanen, Mika Kivimäki, Anna Soveri
Research Article | published 31 Oct 2019 PLOS ONE
https://doi.org/10.1371/journal.pone.0224330

Science
01 November 2019 Vol 366, Issue 6465
http://www.sciencemag.org/current.dtl

Research Article
Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens
By Michael J. Mina, Tomasz Kula, Yumei Leng, Mamie Li, Rory D. de Vries, Mikael Knip, Heli Siljander, Marian Rewers, David F. Choy, Mark S. Wilson, H. Benjamin Larman, Ashley N. Nelson, Diane E. Griffin, Rik L. de Swart, Stephen J. Elledge
Science01 Nov 2019 : 599-606 Full Access
The toll of measles on the immune system
Many of the deaths attributable to measles virus are caused by secondary infections because the virus infects and functionally impairs immune cells. Whether measles infection causes long-term damage to immune memory has been unclear. This question has become increasingly important given the resurgence in measles epidemics worldwide. Using a blood test called VirScan, Mina et al. comprehensively analyzed the antibody repertoire in children before and after natural infection with measles virus as well as in children before and after measles vaccination. They found that measles infection can greatly diminish previously acquired immune memory, potentially leaving individuals at risk for infection by other pathogens. These adverse effects on the immune system were not seen in vaccinated children.
Abstract
Measles virus is directly responsible for more than 100,000 deaths yearly. Epidemiological studies have associated measles with increased morbidity and mortality for years after infection, but the reasons why are poorly understood. Measles virus infects immune cells, causing acute immune suppression. To identify and quantify long-term effects of measles on the immune system, we used VirScan, an assay that tracks antibodies to thousands of pathogen epitopes in blood. We studied 77 unvaccinated children before and 2 months after natural measles virus infection. Measles caused elimination of 11 to 73% of the antibody repertoire across individuals. Recovery of antibodies was detected after natural reexposure to pathogens. Notably, these immune system effects were not observed in infants vaccinated against MMR (measles, mumps, and rubella), but were confirmed in measles-infected macaques. The reduction in humoral immune memory after measles infection generates potential vulnerability to future infections, underscoring the need for widespread vaccination.

Social Science & Medicine
Volume 241 November 2019
https://www.sciencedirect.com/journal/social-science-and-medicine/vol/241/suppl/C

Review article Abstract only
Values, challenges and future directions of big data analytics in healthcare: A systematic review
P. Galetsi, K. Katsaliaki, S. Kumar
Article 112533

Vaccine
Volume 37, Issue 47, Pages 6931-7122 (8 November 2019)
https://www.sciencedirect.com/journal/vaccine/vol/37/issue/47

Vaccine Technology VII: Promises and achievements of the Decade of Vaccines
Edited by Amine A. Kamen, Linda H.L. Lua, Tarit K. Mukhopadhyay
Editorial Open access
Vaccine Technology VII: Beyond the “decade of vaccines”
Amine A. Kamen, Linda H.L. Lua, Tarit K. Mukhopadhyay
Pages 6931-6932

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

No new digest content identified.

Media/Policy Watch
This watch section is intended to alert readers to substantive news, analysis and opinion from the general media and selected think tanks and similar organizations on vaccines, immunization, global public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.
We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 2 Nov 2019
[No new, unique, relevant content]

BBC
http://www.bbc.co.uk/
Accessed 2 Nov 2019
[No new, unique, relevant content]

The Economist
http://www.economist.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

Financial Times
http://www.ft.com/home/uk
Accessed 2 Nov 2019
[No new, unique, relevant content]

Forbes
http://www.forbes.com/
Accessed 2 Nov 2019
The Political Battlefield Of Infections And Migrant Children’s Bodies
Deaths from influenza have occurred among migrant children in detention. Yet the US government is denying them flu vaccination, and recently went to court arguing that children are not entitled to basic sanitation, clean clothes, bathing, and toothbrushes.
By Judy Stone Senior Contributor

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

Foreign Policy
http://foreignpolicy.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

The Guardian
http://www.guardiannews.com/
Accessed 2 Nov 2019
Release of Vaxxed sequel prompts fears dangerous propaganda will spread again
Anti-vaccination film to premiere in theatres as several states have been battling against localised outbreaks of measles
31 Oct 2019
Anti-vaccination campaigners are preparing to release the sequel to Vaxxed, the highly contentious film that has been used to spread the unfounded claim that vaccines cause autism and other developmental problems.
Vaxxed II: The People’s Truth will be premiered on 6 November in 50 venues across America. Its producers, led by Robert F Kennedy Jr, are keeping locations secret with tickets sold quietly in advance in the hope of foiling efforts to block the movie.
From 7 November, the film will be taken on the road in the same “Vaxxed” bus that was deployed in 2016 to disseminate the original film, traveling more than 50,000 miles from coast to coast of the US. The movie was a powerful propaganda tool for the anti-vaccination movement, which has seen a surge in recent years within certain religious communities and among parents worried about scientifically unproven so-called “vaccine injuries”.’’

New Yorker
http://www.newyorker.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

New York Times
http://www.nytimes.com/
Accessed 2 Nov 2019
Africa
Exclusive: WHO, Congo Eye Tighter Rules for Ebola Care Over Immunity Concerns
The World Health Organization and Congolese authorities are proposing changes to how some Ebola patients are cared for, new guidelines show, after a patient’s death challenged the accepted medical theory that survivors are immune to reinfection.
By Reuters Oct 31

Business
Merck to Ramp Up Gardasil Vaccine Production, Flags ‘Tempered’ Sales Growth in 2020
Merck & Co Inc said on Tuesday it intends to ramp up production of its top-selling vaccine Gardasil in 2023 and warned of a slowdown in revenue growth next year as demand for the therapy outpaces supply.
By Reuters Oct 29

Global health
New TB Vaccine Could Save Millions of Lives, Study Suggests
There are 10 million new cases each year of tuberculosis, now the leading infectious cause of death worldwide. Even a partly effective vaccine could help turn the tide.
Oct. 29, 2019
… The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa and Zambia. All of them already had latent tuberculosis — a silent infection that might or might not progress to active tuberculosis.
Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis…

Washington Post
https://www.washingtonpost.com/
Accessed 2 Nov 2019
[No new, unique, relevant content]

Think Tanks et al

Brookings
http://www.brookings.edu/
Accessed 2 Nov 2019
[No new relevant content]

Center for Global Development
http://www.cgdev.org/page/press-center
Accessed 2 Nov 2019
[No new relevant content]

CSIS
https://www.csis.org/
Accessed 2 Nov 2019
[No new relevant content]

Council on Foreign Relations
http://www.cfr.org/
Accessed 2 Nov 2019
[No new relevant content]

Kaiser Family Foundation
https://www.kff.org/search/?post_type=pre ss-release
November 1, 2019 Fact Sheet
The U.S. Government and Global Polio Efforts
This fact sheet provides a snapshot of global polio eradication efforts and examines the U.S. government’s role in addressing polio worldwide.

October 29, 2019 Issue Brief
Data Note: Donor Funding for the Current Ebola Response in the DRC
This data note provides the first comprehensive summary of donor funding for the Ebola response in the DRC.

Milestones :: Perspectives :: Research

Two out of three wild poliovirus strains eradicated
Global eradication of wild poliovirus type 3 declared on World Polio Day
24 October 2019 – In a historic announcement on World Polio Day, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a historic achievement for humanity.

“The achievement of polio eradication will be a milestone for global health. Commitment from partners and countries, coupled with innovation, means of the three wild polio serotypes, only type one remains,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board “We remain fully committed to ensuring that all necessary resources are made available to eradicate all poliovirus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” he added.

There are three individual and immunologically-distinct wild poliovirus strains: wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3).

Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains three separate viruses that must each be eradicated individually.

WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Since then, the strength and reach of the eradication programme’s global surveillance system has been critical to verify that this strain is truly gone. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.

At a celebration event at the headquarters of the World Health Organization in Geneva, Switzerland, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury [chair of the independent Global Commission for the Certification of Poliomyelitis Eradication].  “This this is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1. This virus remains in circulation in just two countries: Afghanistan and Pakistan. We cannot stop our efforts now: we must eradicate all remaining strains of all polioviruses.  We do have good news from Africa:  no wild poliovirus type 1 has been detected anywhere on the continent since 2016 in the face of ever improving surveillance.  Although the region is affected by circulating vaccine-derived polioviruses, which must urgently be stopped, it does appear as if the continent is free of all wild polioviruses, a tremendous achievement.”

Eradicating WPV3 proves that a polio-free world is achievable. Key to success will be the ongoing commitment of the international development community.  To this effect, as part of a Global Health Week in Abu Dhabi, United Arab Emirates, in November 2019, the Reaching the Last Mile Forum will focus international attention on eradication of the world’s deadliest diseases and provide an opportunity for world leaders and civil society organizations, notably Rotary International which is at the origin of this effort, to contribute to the last mile of polio eradication. The GPEI 2019–2023 Investment Case lays out the impact of investing in polio eradication.  The polio eradication efforts have saved the world more than US$27 billion in health costs since 1988. A sustained polio-free world will generate further US$14 billion in savings by 2050, compared to the cost countries would incur for controlling the virus indefinitely.

The GPEI is a public-private global effort made up of national governments, partners including the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and a broad range of long-term supporters.

WHO DG: Thank you to all who made WPV3-free world possible
DG calls for doubling of efforts to now finish all remaining poliovirus strains
25/10/2019

Milestones :: Perspectives :: Research

Press release
UNICEF and partners provide vaccination against polio and measles for nearly 232,000 children in Syria and Iraq, many affected by violence in northeast Syria
AMMAN, 25 October 2019 – UNICEF and partners have provided polio and measles vaccines for approximately 230,000 children under the age of five in Al-Hasakeh governorate, in northeast Syria, including in collective shelters and camps such as Al-Hol and A’reesha.

Since the latest wave of violence in northeast Syria escalated less than two weeks ago, at least 80,000 children have been forced to flee their homes.

Nearly 4,000 children have fled the violence to Iraq, crossing the border into the Kurdistan Region of Iraq via the Sahela and Al-Waleed border crossings and are now in Bardarash camp in Dohuk, north of Iraq. UNICEF-supported teams are at the border, working with partners to vaccinate children against polio and measles. To date, 2,790 children have been vaccinated against polio and 2,595 children have been vaccinated against measles.

“Nearly nine years of war have caused vaccination levels among children in Syria to plummet from 80 per cent pre-conflict to less than 50 per cent,” said Ted Chaiban, UNICEF Regional Director for the Middle East and North Africa. “Reaching children who are at high risk for diseases including measles and polio is critical”, he added.

In 2013, a polio outbreak paralyzed 36 children in Syria and another two in Iraq the following year. In response, UNICEF and partners launched the largest ever polio vaccination campaign in the history of the region, reaching more than 25 million children in seven countries, multiple times. No new cases of wild poliovirus have been reported in these countries since.

Milestones :: Perspectives :: Research

PAHO Director in Rio de Janeiro highlights achievements and challenges in vaccine production
Rio de Janeiro, 22 October 2019 (PAHO/WHO) – The Director of the Pan American Health Organization (PAHO), Carissa F. Etienne, highlighted the achievements and challenges of vaccine production during the opening of the 20th General Meeting of the Developing Countries Vaccine Manufacturers Network (DCVMN), today, in the city of Rio de Janeiro.

“I see this Network as a global public good, a network of manufacturers and innovators that have assumed the principle of collective action and solidarity, to protect global health. The vaccines you produce protect and promote the health of millions in this Region (Americas), and globally”, she stated.

The PAHO Director also encouraged the network of producers to continue efforts to invest in new vaccines that have high quality and are affordable.

“And more importantly,” she added, “I urge you to ensure and protect the global supply of the more ‘traditional and well established’ vaccines that are becoming less attractive to produce commercially.”

Maurício Zuma, Director of the Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos/Fiocruz) and co-chair of the Network, said the meeting aims to share experiences and discuss capacities, financing, supplies, regulatory issues, alliances, partnerships, innovations, among other topics.

“Our vaccines have prevented the spread and export of several diseases and saved millions of lives each year. It makes us proud. But we are aware of our responsibility and we know that innovation is key to our survival in the long term,” he said…

The Minister of Health of Brazil, Luiz Henrique Mandetta, announced during the event that after three years of discontinuation of yellow fever vaccine exports, Brazil will resume its capacity to supply its domestic demand and provide vaccines to other countries. Between 2017 and 2018, the country had yellow fever outbreaks and suspended its vaccine exports, focusing all its production for the Brazilian population. “Another important step we are taking, which is in the final stages of modeling, is the construction of the Health Biotechnology Industrial Complex. It will be a multiple platform that can produce different types of vaccines, quickly responding to domestic needs”, said Mandetta.

The Developing Countries Vaccine Manufactures Network (DCVMN) annual meeting runs until October 24, with the participation of experts from 14 countries. The event addresses topics such as technological advances, equitable access to vaccines around the world, regulatory issues and strategies, current industry challenges with an emphasis on developing countries, and partnership opportunities…

Established in the year 2000, the DCVMN network currently includes 50 vaccine manufacturers in 17 countries and territories, producing and supplying over 40 different types of vaccines in several presentations, totaling around 200 products.

Milestones :: Perspectives :: Research

NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale
Initial investment aims to advance accessible and scalable candidate interventions into clinical trials within 10 years.

The collaboration will align aggressive, high-reward research efforts to accelerate progress on shared gene-based strategies (depicted in green) to cure sickle cell disease and HIV that are available globally including in low-resource settings, while continuing to invest in other parallel research efforts on cures for these two diseases outside of the collaboration.

Wednesday, October 23, 2019
The National Institutes of Health plans to invest at least $100 million over the next four years toward an audacious goal: develop affordable, gene-based cures for sickle cell disease (SCD) and HIV. The Bill & Melinda Gates Foundation will also invest $100 million toward this goal. The intention is for these cures to be made globally available, including in low-resource settings.

This initiative follows a bold announcement made earlier this year by President Donald J. Trump during the State of the Union Address to end the HIV epidemic in the United States in the next 10 years. Ending the HIV Epidemic: A Plan for America aims to leverage the powerful data and tools now available to reduce new HIV diagnoses in the United States by 75% in five years and by 90% by 2030. The Trump Administration has also elevated the attention paid to sickle cell disease, identifying it as an intractable health challenge with the potential for dramatic advances in the coming years.

Dramatic advances in genetics over the last decade have made effective gene-based treatments a reality, including new treatments for blindness and certain types of leukemia. Yet these breakthroughs are largely inaccessible to most of the world by virtue of the complexity and cost of treatment requirements, which currently limit their administration to hospitals in wealthy countries. To make these treatments effective and available for SCD and HIV, which disproportionately affect populations living in Africa or of African descent, new investment is needed to focus research on the development of curative therapies that can be delivered safely, effectively and affordably in low-resource settings.

The collaboration between the NIH and the Gates Foundation sets out a bold goal of advancing safe, effective and durable gene-based cures to clinical trials in the United States and relevant countries in sub-Saharan Africa within the next seven to 10 years. The ultimate goal is to scale and implement these treatments globally in areas hardest hit by these diseases.

“This unprecedented collaboration focuses from the get-go on access, scalability and affordability of advanced gene-based strategies for sickle cell disease and HIV to make sure everybody, everywhere has the opportunity to be cured, not just those in high-income countries,” said NIH Director Francis S. Collins, M.D., Ph.D. “We aim to go big or go home.”…

Milestones :: Perspectives :: Research

Global Health Progress launched to drive cross-sectoral collaborations in support of the Sustainable Development Goals
25 October 2019
Global Health Progress is a new knowledge hub highlighting over 200 collaborations between the innovative biopharmaceutical industry and more than 850 partners to support the SDGs. Users can explore collaborations by SDG target, disease area, program strategy, and more. Users are also encouraged to connect with partners via the platform to drive new collaborations in low- and middle-income countries.

Emergencies

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

Ebola Outbreak in DRC 64: 22 October 2019
1. Situation update
In the past week, from 14 to 20 October, 21 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. The incidence of new confirmed EVD cases remains substantial in parts of North Kivu and Ituri provinces – in particular in the Biakato Mine Health Area, Mandima Health, with the majority (76%) of newly confirmed cases linked to this health area.

The deployment of additional support to the Biakato Mine Health Area has led to improvements in response efforts. The proportion of confirmed cases listed as contacts has increased in the past week from 13% to 57%. This increase was similarly witnessed in confirmed cases with a known epidemiological link to a case which augmented from 47% to 90% in the past week. While this is encouraging, there remain notable challenges in accessing and mounting the full range of public health activities in some areas.

In the 21 days from 30 September to 20 October, the number of affected health areas has decreased, with 20 health areas and nine health zones reporting new cases (Table 1, Figure 2). During this period, a total of 50 confirmed cases were reported, with the majority coming from the health zones of Mandima (54%; n=27 cases) and Mambasa (10%; n=5 cases). While many cases detected outside of these zones have travelled from these hotspots, onward local transmission has been observed in Kalunguta and Mabalako health zones, highlighting the high risk of resurgence and redispersion of cases.

As of 20 October 2019, a total of 3243 EVD cases were reported, including 3127 confirmed and 116 probable cases, of which 2171 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1821) were female, 28% (923) were children aged less than 18 years, and 5% (163) were healthcare workers…

Implementation of ring vaccination protocol
As of 20 October 2019, 240,824 people at risk have consented to and received the rVSV-ZEBOV-GP Ebola vaccine.

The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine, manufactured by Johnson & Johnson. This vaccine, which is administered as a two-dose course, 56 days apart, will be circulated in at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. The Merck/MSD vaccine will continue to be provided to all people at high risk of Ebola infection including those who have been in contact with a person confirmed to have Ebola, all contacts of contacts, and others determined to be at high risk of contracting Ebola…

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

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 23 October 2019
:: Wild poliovirus type 3 (WPV3) has been declared as globally eradicated. At an event held on World Polio Day 2019, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication (GCC), presented the official certificate of WPV3 eradication to WHO Director General Dr Adhanom Ghebreyesus. Read more about this landmark declaration.
[See Milestones above for detail]
:: Polio eradication efforts do not only involve providing vaccines. For one Abdullahi Mahamed Noor, basketball is his way of bringing people together to raise awareness about the devastating disease. Read about his journey on using the sport to combat polio in Somalia.

Summary of new viruses this week:
:: Afghanistan— two WPV1 cases and six positive environmental samples;
:: Pakistan— four WPV1 cases and six WPV1-positive environmental samples;
:: Nigeria— two cVDPV2 positive environmental samples.
:: Chad— one cVDPV2 case;
:: Benin— one cVDPV2 case;
:: the Democratic Republic of the Congo— one cVDPV2 case;
:: Ghana— one cVDPV2 case and three cVDPV2 positive environmental samples;
:: Ethiopia— one cVDPV2 case:
:: Togo— one cVDPV2 case:
:: Zambia— one cVDPV2 case.

::::::

Philippines: Red Cross triples polio vaccination target
25 October 2019 IFRC
The Philippine Red Cross is more than tripling the number of children it aims to vaccinate in a door-to-door polio vaccination campaign, the Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) said today.

On 1 October 2019, the Red Cross announced support for a Department of Health campaign by activating volunteers in parts of Mindanao and Metro Manila to vaccinate 30,000 children in the hardest-to-reach communities. In fact, the Philippine Red Cross has reached nearly 60,000 children. Today, the target was increased to 100,000.

Announcing the increase, Philippine Red Cross Chairman Richard Gordon said:
“We’re particularly worried about children under five in urban slums, rural areas, migrant families and indigenous communities who have missed out on life-saving vaccinations. It’s simply not right that these children are at risk of death or lifelong disability in the 21st century. The tripling of our target reflects the commitment of Red Cross volunteers and staff, who are literally climbing mountains and crossing rivers to ensure no child is left behind. What’s more, they will do this again in a month when children need a booster, and a month after that too.”

Apart from low immunization rates, factors that contribute to the spread of polio, dengue and measles include low health literacy, unsafe water, poor sanitation, poor living conditions, high rates of chronic childhood malnutrition and poor access to healthcare. The Red Cross is also planning to reach 1 million people with life-saving health, hygiene and sanitation information…

::::::

WHO & Regional Offices [to 26 Oct 2019]

25 October 2019
News release
WHO expert panel on digital health meets for first time
WHO is convening global experts to help shape the Organization’s roadmap to advance the digital health ecosystem. The WHO Digital Health Technical Advisory Group met for the first time this week to discuss topics ranging from data governance, to ethical and equitable use of digital technologies, to helping communities benefit from proven and cost-effective digital health solutions.

“All governments are facing increasing demands to provide health services to their citizens, and many digital technologies offer solutions to help meet these needs,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But countries require confidence in what works. The action plan agreed today focuses our efforts on helping the world benefit from digital health technologies and solutions while safeguarding the misuse of people’s data and protecting their health.”

The two-day meeting at WHO’s headquarters in Geneva led to an agreed action plan to focus the expert group’s activities and priorities over the next two years. Meeting focused on better defining WHOs role in supporting global digital transformation. Topics included:
:: Developing a global framework for WHO to validate, implement and scale up digital health technology and solutions.
:: Recommendations for safe and ethical use of digital technologies to strengthen national health systems by improving quality and coverage of care, increasing access to health information.
:: Advice on advocacy and partnership models to accelerate use of digital health capabilities in countries to achieve better health outcomes.
:: Advice on emerging digital health technologies with global reach and impact, so no one is left behind.

Advisory group co-chair Steve Davis, president and chief executive officer of global health non-profit PATH, said the new plan provides direction to help WHO maximize the potential of the digital health landscape and chart future trends, tools and opportunities…

25 October 2019
News release
High rates of unintended pregnancies linked to gaps in family planning services: New WHO study

22 October 2019
WHO signs MoU with International Generic and Biosimilar Medicines Association to promote access
Full access to medicines is hampered by a variety of factors. Two important barriers are high prices and regulatory issues such as long lag times in bringing medicines to market.

To address these issues, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, and Jim Keon, Chair of the International Generic and Biosimilar Medicines Association, today signed a memorandum of understanding.
The new agreement is an important step in WHO’s drive towards universal health coverage by underscoring the importance of generic and biosimilar medicines to increasing access to affordable, quality treatment.

WHO is an active supporter of expanding use of generic medicines: The vast majority of the products in the WHO Essential Medicines List are generic. WHO’s prequalification programme – which assesses the quality of priority medicines supplied by UN agencies and other organizations in low-income countries – has prioritized generic medicines as a way to treat more people with the funds available; around 70% of the medicines it prequalifies are generic. A recent independent study by McKinsey estimated WHO prequalification saves the world up to US$ 590 million every year. Every $ 1 invested in WHO Prequalification has a return in terms of savings of between $ 30-40.

WHO has also supported use of and access to generics through normative guidelines. Implementation of WHO guidance on interchangeability of generic medicines is further supported by the WHO List of International Comparators, which provides information on reference products for clinical trials into bioequivalence – i.e. whether two different products achieve the same results. Another tool is the WHO Biowaiver List which describes generic medicines that are eligible for a waiver from such studies…

::::::

Weekly Epidemiological Record, 25 October 2019, vol. 94, 43 (pp. 497–504)
:: World Polio Day – 24 October 2019
:: Global routine vaccination coverage, 2018

::::::

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
:: New milestone towards a polio-free world, but there is no time to relax 24 October 2019
:: Communique on cross-border coordination, partnerships, and communication for Ebola v…
23 October 2019
:: Ten African countries endorse cross-border collaboration framework on Ebola outbreak…
21 October 2019

WHO Region of the Americas PAHO
:: Saint Lucia joins HEARTS initiative to improve prevention and control of hypertension (10/24/2019)
:: District of Columbia recognizes PAHO for including persons with developmental disabilities in the workplace (10/24/2019)
:: Ultra-processed foods gain ground among Latin American and Caribbean families (10/23/2019)
:: PAHO Director in Rio de Janeiro highlights achievements and challenges in vaccine production (10/22/2019)
[See Perspectives above for detail]

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

WHO European Region EURO
:: World Polio Day marks a major milestone towards polio eradication 24-10-2019
:: Parliaments urged to help deliver universal health coverage by 2030 23-10-2019
:: Public health at the centre of a sustainable future 22-10-2019
:: New country profiles show changes in environmental health inequalities 21-10-2019
:: What can you do about flu? 21-10-2019

WHO Eastern Mediterranean Region EMRO
:: Thalassemia patients have renewed hope through support provided by EHNP
23 October 2019

WHO Western Pacific Region
No new digest content identified.

Featured Journal Content

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
:: Syria ǀ Flash Update #9, Humanitarian impact of the military operation in north-eastern Syria, 21 – 24 October 2019

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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

 Featured Journal Content

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4
Impact, Innovation, and Inclusion of Civil Society Organizations in Polio Eradication: The Core Group Polio Project Story
Guest Editors: Henry Perry and Jon Andrus
Selected Articles
Community Engagement, Ownership, and Civil Society Organizations in Polio Eradication
Jon K. Andrus and Henry B. Perry
https://doi.org/10.4269/ajtmh.19-0529

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative
Lee Losey, Ellyn Ogden, Filimona Bisrat, Roma Solomon, David Newberry, Ellen Coates, Dora Ward, Lisa Hilmi, Karen LeBan, Vanessa Burrowes and Henry B. Perry
https://doi.org/10.4269/ajtmh.18-0916

Involvement of Civil Society in India’s Polio Eradication Program: Lessons Learned
Roma Solomon
https://doi.org/10.4269/ajtmh.18-0931

::::::

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 26 Oct 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 64: 22 October 2019
[See Ebola above for detail]

Yemen
:: Thalassemia patients have renewed hope through support provided by the Emergency Health and Nutrition Project (EHNP) 23 October 2019 (Yemen)

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

::::::

WHO Grade 2 Emergencies [to 26 Oct 2019]

Afghanistan
:: Dedication: 17 years, 15 years, 13 years, 11 years… meet the people who live to eradicate polio in Afghanistan 24 October 2019

Iraq
:: WHO intensifies support to vulnerable communities in Ba’aj by strengthening the delivery of primary health care services
21 October 2019 – The World Health Organization (WHO) has intensified its health support to vulnerable communities in areas of return in Ninewa governorate delivering more than 140 000 health interventions to people in and around Ba’aj town since January 2019…

Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Niger – 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 26 Oct 2019]

Kenya
:: Kenya takes vital step against cervical cancer and introduces HPV vaccine into routi…
18 October 2019
With President Uhuru Kenyatta leading the way, Kenya today joins an increasing number of African countries taking a vital step against a common cause of death among women – in the country and the region – by introducing the human papilloma virus (HPV) vaccine against cervical cancer into its routine immunization schedule…

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

CDC/ACIP [to 26 Oct 2019]
http://www.cdc.gov/media/index.html
https://www.cdc.gov/vaccines/acip/index.html

Monday, October 21, 2019
CDC-Supported Study Launches to Track Infectious Diseases in Central America & Caribbean
To better understand, detect and respond to emerging infectious disease threats such as dengue, chikungunya, Zika, Chagas disease, and malaria, the U.S. Centers for Disease Control and Prevention (CDC) is supporting studies to better understand acute febrile illnesses (AFIs) in Belize, Guatemala and the Dominican Republic. AFIs are characterized by a rapid onset of fever and symptoms such as headache, diarrhea, chills or muscle and joint pain, cough or other respiratory symptoms. AFIs are one of the most common reasons people seek health care and can be caused by viruses, bacteria, parasites or fungi that people inhale, eat or drink from contaminated food or water, or are exposed to by contact with animals, including insects.

CDC has convened a multi-disciplinary international team of experts to support ministries of health in Belize, Guatemala, and the Dominican Republic in developing a surveillance network to rapidly identify and track AFIs. The team, including CDC, Baylor College of Medicine, Universidad del Valle de Guatemala, and Brigham and Women’s Hospital, will create the network using a coordinated approach to detect and manage disease threats…

MMWR News Synopsis for October 25, 2019
Global Routine Vaccination Coverage, 2018
Summary
What is already known about this topic?
Since 1974, global coverage with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles has increased from <5% to 86%.
What is added by this report?
Global coverage with the third dose of diphtheria and tetanus toxoids and pertussis-containing vaccine has not increased above 86% since 2010. Coverage varies across regions and countries, with lower coverage in lower-income countries.
What are the implications for public health practice?
Equitable access to immunization to achieve and sustain high coverage can be enhanced through financial and technical support for program strengthening and vaccine introductions in lower-income settings, community engagement to increase vaccination acceptance and demand, collection and use of vaccination data, and commitment to improving immunization services

Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick — San Diego, California, 2019

Africa CDC   [to 26 Oct 2019]
http://www.africacdc.org/

News
JOINT PRESS RELEASE BETWEEN WHO AND AFRICA CDC : Ten African countries endorse cross-border collaboration framework on Ebola outbreak preparedness and response
Goma, DRC, 21 October 2019 –
The Democratic Republic of the Congo (DRC) and its nine neighbouring countries today, during a meeting of ministers, senior health and immigration officials and partners in Goma, endorsed a joint framework to strengthen cross-border collaboration on preparedness and response to Ebola virus and other disease outbreaks.

Representatives of the 10 countries – Angola, Burundi, Central African Republic, Republic of the Congo, Democratic Republic of the Congo, Rwanda, South Sudan, Uganda, United Republic of Tanzania and Zambia – noted with concern the Ebola outbreak in north-eastern DRC, which has continued for more than one year, and the increasing potential to spread into the neighbouring countries. They recognized the shared threat that the outbreak poses to health and economic security in the subregion and other parts of Africa and the need to develop an action plan to mitigate the effects of these threats.

“Resources are always limited, and there are always gaps in emergency contingency plans. Setting up a mechanism for cross-border collaboration and the sharing of assets will contribute to the mitigation of suffering and minimize the social and economic impact of disease outbreaks,” said H.E. Amira Elfadil Mohammed, African Union Commissioner for Social Affairs…

COMMUNIQUE ON CROSS-BORDER COORDINATION, PARTNERSHIPS, AND COMMUNICATION FOR EBOLA VIRUS DISEASE PREPAREDNESS IN AT-RISK MEMBER STATES
21 October 2019
…Collectively, we resolve to:

1. Undertake actions to facilitate cooperation and collaboration between the Member States of Angola, Burundi, Central Africa Republic, Democratic Republic of Congo, Rwanda, Republic of Congo, South Sudan, Uganda, Tanzania, and Zambia for EVD preparedness and response, including:
   1. Cross-border EVD case and laboratory surveillance;
   2. Cross-border tracing and monitoring of contacts;
   3. Workforce capacity development, including joint training, exchange learning and benchmarking visits, and simulation exercises;
   4. Prompt communication of epidemiological and laboratory surveillance data and other relevant reports;
   5. Timely sharing information on potential security threats and other security issues occurring in areas affected by outbreaks;
   6. Sharing of technical expertise and other resources and assets necessary for EVD preparedness and control;
   7. Cross-border joint planning and implementation of EVD preparedness and response activities, including risk communication and community engagement campaigns;
   8. Movement of people across national borders in accordance with the International Health Regulations; and
   9. Legal and regulatory processes and logistics planning for rapid cross-border deployment and receipt of public health experts and medical personnel for EVD response.

2. Establish the Africa Ebola Coordination Task Force (AfECT), hosted at the African Union secretariat in Addis Ababa, Ethiopia, under the leadership of the Member States with support from the Africa CDC, WHO and other relevant partners to support the cooperation and collaboration described above. Whilst AfECT maintains political oversight through AU institutional arrangements, technical support would be facilitated through the WHO sub-regional technical coordination platforms in collaboration with the Africa CDC.

3. Exchange information in a timely manner on matters of common interest as deemed appropriate for preparedness and response, while acknowledging that withholding of, or falsification of, EVD data and information violates the IHR and threatens peace, security, and prosperity of the affected Member States and the entire region…

China CDC
http://www.chinacdc.cn/en/
No new digest content identified.

National Health Commission of the People’s Republic of China
http://en.nhc.gov.cn/
Selected Updates and Press Releases
No new digest content identified.

Announcements

Paul G. Allen Frontiers Group [to 26 Oct 2019]
https://alleninstitute.org/what-we-do/frontiers-group/news-press/
News
No new digest content identified.

BMGF – Gates Foundation [to 26 Oct 2019]
http://www.gatesfoundation.org/Media-Center/Press-Releases
No new digest content identified.

Bill & Melinda Gates Medical Research Institute [to 26 Oct 2019]
https://www.gatesmri.org/
The Bill & Melinda Gates Medical Research Institute is a non-profit biotech organization. Our mission is to develop products to fight malaria, tuberculosis, and diarrheal diseases—three major causes of mortality, poverty, and inequality in developing countries. The world has unprecedented scientific tools at its disposal; now is the time to use them to save the lives of the world’s poorest people
No new digest content identified.

CARB-X [to 26 Oct 2019]
https://carb-x.org/
CARB-X is a non-profit public-private partnership dedicated to accelerating antibacterial research to tackle the global rising threat of drug-resistant bacteria.
No new digest content identified.

CEPI – Coalition for Epidemic Preparedness Innovations [to 26 Oct 2019]
http://cepi.net/
News
No new digest content identified.

Clinton Health Access Initiative, Inc. (CHAI) [to 26 Oct 2019]
https://clintonhealthaccess.org/about/
News & Press Releases
No new digest content identified.

EDCTP [to 26 Oct 2019]
http://www.edctp.org/
The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, tuberculosis and malaria as well as other poverty-related and neglected infectious diseases in sub-Saharan Africa, with a focus on phase II and III clinical trials
Latest news
No new digest content identified.

Emory Vaccine Center [to 26 Oct 2019]
http://www.vaccines.emory.edu/
No new digest content identified.

European Medicines Agency [to 26 Oct 2019]
http://www.ema.europa.eu/ema/
News & Press Releases
News: Dialogue with Chinese authorities on medicine regulation
Last updated: 25/10/2019
… China is one of the main suppliers of active pharmaceutical ingredients to the EU and constitutes one of the world’s largest national pharmaceutical markets.

European Vaccine Initiative [to 26 Oct 2019]
http://www.euvaccine.eu/news-events
No new digest content identified.

FDA [to 26 Oct 2019]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/default.htm
Press Announcements
No new digest content identified.

Fondation Merieux [to 26 Oct 2019]
http://www.fondation-merieux.org/
News, Events
Over 2,300 students and professionals enrolled in the Mérieux Foundation’s first MOOC on quality management
October 24, 2019 – Lyon (France)
The Mérieux Foundation is launching a MOOC – Massive Open Online Course – on quality management in clinical laboratories. The course, which is open to all, teaches about the implementation of quality management systems.

Gavi [to 26 Oct 2019]
https://www.gavi.org/
Latest news
Gavi celebrates global eradication of wild poliovirus type 3  
Certification officially announced at World Polio Day event in Geneva
Geneva, 24 October 2019 – Gavi, the Vaccine Alliance has welcomed the announcement today by an independent commission of experts that wild poliovirus type 3 (WPV3) has been eradicated worldwide. The official announcement was made at a World Polio Day event organised by WHO in Geneva.
WPV3 is the second of three strains of wild poliovirus to have been certified eradicated. Wild poliovirus type 2 (WPV2) was confirmed eradicated in 2015 and wild poliovirus type 1 (WPV1) remains in circulation in areas of Pakistan and Afghanistan.
“This announcement represents a tremendous victory in the fight against polio.” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “It is a testament to decades of effort by hundreds of thousands of vaccinators and health care workers as well as WHO and its partners – and it is a reminder of the real strides we can make with focused commitment and collaboration. Harnessing this momentum and remaining vigilant will be critical as we continue to work towards a polio-free world.”…

GHIT Fund [to 26 Oct 2019]
https://www.ghitfund.org/newsroom/press
GHIT was set up in 2012 with the aim of developing new tools to tackle infectious diseases that No new digest content identified.

Global Fund [to 26 Oct 2019]
https://www.theglobalfund.org/en/news/
News & Stories
Updates
Technical Review Panel Observations on the 2017-2019 Allocation Cycle
24 October 2019
… Charged with evaluating funding requests for strategic focus, technical soundness and potential for impact, the Technical Review Panel reviewed each of the 225 applications in 2017-2019. At the request of the Strategy Committee of the Global Fund Board, the Technical Review Panel reflected upon these funding requests, identifying key trends, lessons learned, and recommendations for each of the diseases and for resilient and sustainable systems for health.
The panel’s recommendations include:
:: Improving the setting of priorities
:: Increasing the focus on prevention and reducing incidence
:: Strengthening cross-cutting programming in resilient and sustainable systems for health
:: Strengthening community systems
:: Increasing attention to sustainability and transition
The Technical Review Panel advises that their recommendations be considered as countries develop their funding requests for 2020-2022:
Technical Review Panel’s Observations on the 2017-2019 Allocation Cycle
download in English

News
World Bank and Global Fund Deepen Partnership with Co-Financing Agreement
22 October 2019
WASHINGTON – The World Bank and the Global Fund have signed a co-financing framework agreement to accelerate efforts by countries to end HIV, tuberculosis and malaria and build sustainable systems for health.
The framework agreement outlines a new approach for joint financing of investment-type operations between the two organizations, as well as results-based financing.
In recent years, the Global Fund and the World Bank have signed multiple innovative finance agreements, such as a loan buy-down for a program to fight tuberculosis in India, a performance-based funding project in the Democratic Republic of Congo and a Multi-Donor Trust Fund for Indonesia and Sri Lanka. The framework agreement is expected to reduce transaction costs and lays the foundation for a deeper partnership with the aim of increasing impact.
“Partnership is in the Global Fund’s DNA, and our work with partners such as the World Bank will accelerate the fight to end the epidemics,” said Peter Sands, Executive Director of the Global Fund. “Innovative financing mechanisms can play a significant role in improving the effectiveness of our investments and in pursuing new financial opportunities to increase impact.”…

Hilleman Laboratories [to 26 Oct 2019]
http://www.hillemanlabs.org/
No new digest content identified.

Human Vaccines Project [to 26 Oct 2019]
http://www.humanvaccinesproject.org/media/press-releases/
Press Releases
No new digest content identified.

IAVI [to 26 Oct 2019]
https://www.iavi.org/newsroom
No new digest content identified.

International Coalition of Medicines Regulatory Authorities [ICMRA]
http://www.icmra.info/drupal/en/news
Selected Statements, Press Releases, Research
No new digest content identified.

International Generic and Biosimilar Medicines Association [IGBA]
https://www.igbamedicines.org/
No new digest content identified.

IFFIm
http://www.iffim.org/library/news/press-releases/
No new digest content identified.

IFRC [to 26 Oct 2019]
http://media.ifrc.org/ifrc/news/press-releases/
Selected Press Releases, Announcements
Asia Pacific
Philippines: Red Cross triples polio vaccination target
The Philippine Red Cross is more than tripling the number of children it aims to vaccinate in a door-to-door polio vaccination campaign, the Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) said today.
25 October 2019
[See Polio above for detail]

IVAC [to 26 Oct 2019]
https://www.jhsph.edu/research/centers-and-institutes/ivac/index.html
Updates
No new digest content identified.

IVI [to 26 Oct 2019]
http://www.ivi.int/
Selected IVI News & Announcements
No new digest content identified.

JEE Alliance [to 26 Oct 2019]
https://www.jeealliance.org/
Selected News and Events
No new digest content identified.

MSF/Médecins Sans Frontières [to 26 Oct 2019]
http://www.msf.org/
Latest [Selected Announcements]
Nigeria
Northeast Nigeria: Now is not the time to question lifesaving as…
Statement 25 Oct 2019
…Serious medical needs remain widespread in northeast Nigeria, while essential items and clean drinking water are scarce; in the first half of 2019 alone, our teams admitted more than 15,000 patients on an emergency basis, treated over 8,000 patients for malaria, ensured 2,446 safe deliveries and vaccinated 9,117 people against measles…

Iraq
MSF providing medical care in Iraq to people fleeing northeast Syria
Statement 21 Oct 2019

National Vaccine Program Office – U.S. HHS [to 26 Oct 2019]
https://www.hhs.gov/vaccines/about/index.html
No new digest content identified.

NIH [to 26 Oct 2019]
http://www.nih.gov/news-events/news-releases
Selected News Releases
Broadly protective antibodies could lead to better flu treatments and vaccines
October 25, 2019 — Isolated antibodies provided broad protection against several different strains of influenza.

Ending HIV will require optimizing treatment and prevention tools, say NIH experts
October 24, 2019 — Commentary emphasizes need to optimally implement current tools and develop new interventions.

Influenza human challenge study begins at NIH-sponsored clinical trial units
October 23, 2019 — Up to 80 people aged 18 to 50 years will be enrolled in the trial.
A clinical trial in which healthy adults will be deliberately infected with influenza virus under carefully controlled conditions is recruiting volunteers at four Vaccine and Treatment Evaluation Units (VTEUs) supported by the National Institute of Allergy and Infectious Diseases (NIAID). One study aim is to assess how levels of pre-existing influenza antibodies impact the timing, magnitude and duration of a volunteer’s flu symptoms following exposure to influenza virus. NIAID is part of the National Institutes of Health.

NIH launches new collaboration to develop gene-based cures for sickle cell disease and HIV on global scale
October 23, 2019 — Initial investment aims to advance accessible and scalable candidate interventions into clinical trials within 10 years.
[See Perspectives above for detail]

PATH [to 26 Oct 2019]
https://www.path.org/media-center/
Selected Announcements
No new digest content identified.

Sabin Vaccine Institute [to 26 Oct 2019]
http://www.sabin.org/updates/pressreleases
Statements and Press Releases
October 24, 2019
One Step Closer to a World Without Polio – Type 3 Polio Eradicated – A Statement by the Sabin Vaccine Institute
WASHINGTON, DC – Today, we are one step closer to a world without polio. The Sabin Vaccine Institute, founded in memory of oral polio vaccine creator Dr. Albert Sabin, applauds the tremendous achievement by the global polio community in eradicating wild poliovirus type 3.
…“At a time when the wins are hard-fought and far-between, the eradication of wild poliovirus type 3 is a much-needed reminder that just as the global community coalesced to eradicate smallpox, we can and we will make polio history,” said Dr. Bruce Gellin, president of Global Immunization at the Sabin Vaccine Institute. “We have come this far thanks parents and caregivers who ensure that their children are protected and to the unflagging efforts of organizers, advocates and the brave individuals who put themselves in harm’s way to ensure every child is protected from this deadly disease. But as we celebrate this accomplishment, we must remember that progress against wild poliovirus type 1 is precarious. Now, more than ever, we must recommit to realizing Dr. Sabin’s vision of a world without polio.”

UNAIDS [to 26 Oct 2019]
http://www.unaids.org/en
Selected Press Releases/Reports/Statements
21 October 2019
Voluntary medical male circumcision―4.1 million performed in 2018
…About 11 million VMMCs have been performed in 15 priority countries in eastern and southern Africa since the beginning of 2016. In 2018 alone, about 4.1 million voluntary circumcisions were performed among males of all ages, a slight increase from the 4 million carried out in 2017.
There has been progress towards the target of 25 million additional circumcisions for HIV prevention from 2016 to 2020. However, at the end of 2018, when 15 million circumcisions should have been performed, the world was off-target by 4 million circumcisions…

21 October 2019
Educational show on how to talk with teenagers about health and sexual relations

UNICEF [to 26 Oct 2019]
https://www.unicef.org/media/press-releases
Selected Statements, Press Releases, Reports
Press release
UNICEF and partners provide vaccination against polio and measles for nearly 232,000 children in Syria and Iraq, many affected by violence in northeast Syria
25/10/2019
[See Emergencies above for detail]

Press release
UNICEF update on the humanitarian situation for children in north east Syria
DAMASCUS/AMMAN/GENEVA/NEW YORK, 22 October 2019 – The latest estimates put the number of children displaced since 9 October at 80,000. Five children have been killed and 26 injured…
UNICEF teams are at the border, working with partners and the Directorate of Health, to provide water, ready to eat food, and hygiene kits, and vaccinate children against polio and measles. A mobile child protection team is also at the Sahela border, providing psychosocial support and responding to urgent cases. So far, nine unaccompanied children have been identified, six of whom have been reunited with families; two whose families have been traced, and one whose case is still being followed up. At Badarash camp, UNICEF is also vaccinating children, providing psychosocial support, and working to identify and refer children and women who require specialized assistance.

Press release
Lack of funding leaves millions of children in conflict and disaster zones at risk
$4 billion humanitarian appeal nearly 50 per cent unfunded heading into final quarter of 2019
22/10/2019

Vaccination Acceptance Research Network (VARN) [to 26 Oct 2019]
https://vaccineacceptance.org/news.html#header1-2r
No new digest content identified.

Vaccine Confidence Project [to 26 Oct 2019]
http://www.vaccineconfidence.org/
No new digest content identified.

Vaccine Education Center – Children’s Hospital of Philadelphia [to 26 Oct 2019]
http://www.chop.edu/centers-programs/vaccine-education-center
No new digest content identified.

Wellcome Trust [to 26 Oct 2019]
https://wellcome.ac.uk/news
Opinion | 24 October 2019
Leaving academia: there are still opportunities to make a difference in research
Danil Mikhailov, Head of Wellcome Data Labs Wellcome
Leaving academia isn’t the same as leaving research, which is why we need to reimagine what a successful research career looks like.

Opinion | 22 October 2019
What accountability means to Wellcome
Mark Henderson, Director of Communications Wellcome
Philanthropic foundations aren’t answerable to taxpayers, shareholders or politicians. So what is their social value? For the past 18 months, we have been thinking about Wellcome’s social value – and what it means for our purpose and mission.

Why We Vaccinate [to 26 Oct 2019]
https://www.whywevax.org/
News
No new digest content identified.

The Wistar Institute [to 26 Oct 2019]
https://www.wistar.org/news/press-releases
Press Release Oct. 22, 2019
Wistar Institute Researcher Awarded American Cancer Society Research Professorship
PRINCETON, N.J. — PHILADELPHIA — (Oct. 22, 2019) — The American Cancer Society (ACS), the largest non-government, not-for-profit funding source of cancer research in the United States, has awarded a Research Professorship to Dmitry l. Gabrilovich, M.D., Ph.D., Christopher M. Davis Professor and leader of the Immunology, Microenvironment & Metastasis Program at The Wistar Institute. This lifelong designation, accompanied by a five-year $400,000 commitment, is the most prestigious research grant made by ACS.

World Organisation for Animal Health (OIE) [to 26 Oct 2019]
http://www.oie.int/en/for-the-media/press-releases/2019/
No new digest content identified.

::::::

ARM [Alliance for Regenerative Medicine] [to 26 Oct 2019]
https://alliancerm.org/press-releases/
October 10, 2019
Gene Therapies: Sector Overview, New York Academy of Sciences Workshop
New York City

BIO [to 26 Oct 2019]
https://www.bio.org/insights/press-release
Oct 22 2019
America’s Bioeconomy Plays Critical Role in Feeding, Fueling, and Healing the World
“What has set the U.S. biotech sector apart has been thoughtful, bipartisan public policy approaches that create a favorable climate in which to undertake the lengthy and risky job of investing in and developing the next biotech breakthroughs.”

DCVMN – Developing Country Vaccine Manufacturers Network [to 26 Oct 2019]
http://www.dcvmn.org/
No new digest content identified.

IFPMA [to 26 Oct 2019]
http://www.ifpma.org/resources/news-releases/
Selected Press Releases, Statements, Publications
Global Health Progress launched to drive cross-sectoral collaborations in support of the Sustainable Development Goals
25 October 2019
Global Health Progress is a new knowledge hub highlighting over 200 collaborations between the innovative biopharmaceutical industry and more than 850 partners to support the SDGs. Users can explore collaborations by SDG target, disease area, program strategy, and more. Users are also encouraged to connect with partners via the platform to drive new collaborations in low- and middle-income countries.

PhRMA [to 26 Oct 2019]
http://www.phrma.org/
Selected Press Releases, Statements
No new digest content identified.

Industry Watch [to 26 Oct 2019]
:: GSK agrees to divest rabies and tick-borne encephalitis vaccines to Bavarian Nordic
GSK to receive upfront payment of approximately EUR301 million (£259m) and milestone payments for a total consideration of up to EUR955 million (£822m)
21 October 2019 Issued: London, UK
GlaxoSmithKline plc (LSE/NYSE: GSK) today announced the divestment of travel vaccines Rabipur (tradename Rabavert in the US) for the prevention of rabies, and Encepur for the prevention of tick-borne encephalitis, to Bavarian Nordic.
The decision to divest these brands, acquired from Novartis in 2015 as part of the acquisition of its vaccines business, supports GSK’s strategic intent to increase focus and reinvest in growth assets, innovation and a simplified supply chain in its vaccines business…

Journal Watch
Vaccines and Global Health: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focu-s on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher.
If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

Impact, Innovation, and Inclusion of Civil Society Organizations in Polio Eradication: The Core Group Polio Project Story
Guest Editors: Henry Perry and Jon Andrus
Selected Articles
Community Engagement, Ownership, and Civil Society Organizations in Polio Eradication
Jon K. Andrus and Henry B. Perry
https://doi.org/10.4269/ajtmh.19-0529

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative
Lee Losey, Ellyn Ogden, Filimona Bisrat, Roma Solomon, David Newberry, Ellen Coates, Dora Ward, Lisa Hilmi, Karen LeBan, Vanessa Burrowes and Henry B. Perry
https://doi.org/10.4269/ajtmh.18-0916

American Journal of Tropical Medicine and Hygiene
Volume 101, Issue 4, Supplement_2019
http://www.ajtmh.org/content/journals/14761645/101/4

Involvement of Civil Society in India’s Polio Eradication Program: Lessons Learned
Roma Solomon
https://doi.org/10.4269/ajtmh.18-0931

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 26 Oct 2019)

Research article
Patient and provider perspectives on how trust influences maternal vaccine acceptance among pregnant women in Kenya
Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunizatio…
Authors: Stacy W. Nganga, Nancy A. Otieno, Maxwell Adero, Dominic Ouma, Sandra S. Chaves, Jennifer R. Verani, Marc-Alain Widdowson, Andrew Wilson, Irina Bergenfeld, Courtni Andrews, Vincent L. Fenimore, Ines Gonzalez-Casanova, Paula M. Frew, Saad B. Omer and Fauzia A. Malik
Citation: BMC Health Services Research 2019 19:747
Published on: 24 October 2019

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 26 Oct 2019)

Research article
Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries
Authors: Cristina Munk, Allison Portnoy, Christian Suharlim, Emma Clarke-Deelder, Logan Brenzel, Stephen C. Resch and Nicolas A. Menzies
Citation: BMC Health Services Research 2019 19:741
Published on: 22 October 2019
Conclusions
There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data.

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 26 Oct 2019)

Commentary
Adaptive trials, efficiency, and ethics
Authors: Spencer Phillips Hey
Citation: BMC Medicine 2019 17:189
Published on: 22 October 2019

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 26 Oct 2019)

Research article
How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation
Vaccination misinformation is associated with serious public health consequences, such as a decrease in vaccination rates and a risk of disease outbreaks. Although social media offers organisations promoting v…
Authors: Maryke S. Steffens, Adam G. Dunn, Kerrie E. Wiley and Julie Leask
Citation: BMC Public Health 2019 19:1348
Published on: 23 October 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Challenges and solutions in the development of vaccines against emerging and neglected infectious diseases
Joel N. Maslow
Pages: 2230-2234
Published online: 23 Oct 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
“Running the Gauntlet”: Formidable challenges in advancing neglected tropical diseases vaccines from development through licensure, and a “Call to Action”
Maria Elena Bottazzi & Peter J. Hotez
Pages: 2235-2242
Published online: 10 Jul 2019

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 15, Issue 10, 2019
http://www.tandfonline.com/toc/khvi20/current

Article
Challenges and perspectives on the use of mobile laboratories during outbreaks and their use for vaccine evaluation
Trina Racine & Gary P. Kobinger
Pages: 2264-2268
Published online: 23 Apr 2019