World Health Organization
1August 2008
Health security under the International Health Regulations
World Health Organization
2August 2008
Polio eradication progressPolio eradication progress1988 - 20031988 - 2003
1988
350 000 children
125 countries
Inequitable access to polio vaccine
2003
784 children
6 countries
Equitable access to polio vaccine
Type 2 wild poliovirus last transmitted in 1999
World Health Organization
3August 2008
Challenge: suspension of polioChallenge: suspension of polio immunization, Nigeria, August 2003 immunization, Nigeria, August 2003
Polio Vaccines - Western Countries Exploit Developing Ones Says Kano State Governor Shekarau
BYLINE: Daily Trust
BODY:The Kano State governor, Malam Ibrahim Shekarau, has asserted that the people's objection to polio vaccines has confirmed that polio vaccination is damaging to young girls.
World Health Organization
4August 2008
6 polio endemic countries
18 countries with imported virus
Wild virus type 1
Wild virus type 3
International spread of polio from Nigeria, 2003-2005
World Health Organization
5August 2008
Points for discussionPoints for discussion
What are the international mechanisms that would help manage this situation?
Are there any other types of activity necessary?
World Health Organization
6August 2008
Vaccine safetyVaccine safety
Testing of vaccines in Nigerian programme for presence of impurities/hormones: WHO Collaborating Centre South Africa and India
Provision of polio vaccines manufactured in an Islamic country
Personal discussions with governor of Kano and eventual decision to convene expert group of state paediatricians
World Health Organization
7August 2008
Political Advocacy for PolioPolitical Advocacy for Polio
10th Islamic Summit Polio Resolution, Malaysia, 2003
Islamic Conference of Foreign Ministers Meeting Polio Resolutions (Turkey 2004, Pakistan 2007)
3rd Extraordinary Islamic Summit, Mecca, 2005
'Noting OIC countries now suffer the greatest burden of polio, call for political & financial support
of OIC member states to finish eradication'
World Health Organization
8August 2008
Religious Advocacy for PolioReligious Advocacy for Polio
Rulings & Fatwas on the need and safety of polio vaccines:
–the Grand Imam of El Azhar Al Sharif,
–International Union for Moslem Scholars
–The Mufti of Egypt
–Mawlana Fazul Rahman
–The Islamic Fiqh Academy - Jeddah
–Dr Y. Al Qaradawi, European Council for Fatwa and Research.
Visit of Imam Cheik Cisse to northern Nigeria.
World Health Organization
9August 2008
Weekly epidemiological record6 AUGUST, 2004
The international spread of wild poliovirus
On 30 June 2004, WHO highlighted an increasing
risk of international spread of wild poliovirus1
and updated its advice for travelers on steps
they could take to increase their personal protection
against wild poliovirus. Subsequently, on 16
July 2004, an*Ad Hoc Expert Consultative Group
on Polio and Public Health was convened by the
Director-General of WHO to discuss potential
measures to prevent or limit the international
spread of wild poliovirus.
World Health Organization
10August 2008
Standing recommendation, International Standing recommendation, International Health Regulations (2005)Health Regulations (2005)
Evidence that booster dose of vaccinedecreases time of wild virus carriage
World Health Organization
11August 2008
World Health AssemblyWorld Health Assembly
Resolution on polio eradication 1998
Resolutions on continued/strengthened effort in remaining endemic countries– 2004
– 2006
– 2007
– 2008
World Health Organization
12August 2008
Avian inlufenza: a major risk to public Avian inlufenza: a major risk to public health securityhealth security
1918: Spanish Flu
(H1N1)
1957: Asian Flu
(H2N2)
1968: Hong Kong Flu
(H3N2)
20-40 million deaths ~ 2.5 million deaths ~1 million deaths
World Health Organization
13August 2008
WHO influenza surveillance network: collective action to WHO influenza surveillance network: collective action to reduce vulnerability to influenzareduce vulnerability to influenza
1 laboratory > 1 laboratory national network
115 national influenza centres WHO Collaborating Centres
World Health Organization
14August 2008
Current Level of WHO Pandemic Alert
Inter-pandemic period
Phase 1 No new influenza virus detected in humans. If a new influenza virus presents in animals, the risk of human infection is considered to be low.
Phase 2 No human infections, but a circulating animal influenza virus poses a risk to humans.
Pandemic alert period
Phase 3 Human infection(s) with a new virus, but no (or very infrequent) human-to-human spread.
Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized.
Phase 5 Larger cluster(s) but human-to-human spread still localized
Pandemic period Phase 6 Increased and sustained transmission in general population.
World Health Organization
15August 2008
Rapid containment response, early phase 4 Rapid containment response, early phase 4 pandemic alert pandemic alert
Interrupt transmission from human to human/prevent further spread: ring containment– Early detection and response
– Prevention of human to human transmission using anti-viral drugs
– Prevention of human to human transmission by vaccination using H5N1 vaccine
World Health Organization
16August 2008
Vaccines and antiviral drugs for H5N1 Vaccines and antiviral drugs for H5N1 and pandemic influenzaand pandemic influenza
Antiviral drugs– Production now exceeds demand
– Market skewed towards industrialized countries
– Some developing countries produce oseltamivir; few maintain stockpiles
H5N1 and Pandemic vaccine – Production capacity limited to 1.5 billion doses/six
months for production
– Market skewed towards industrialized countries
– No developing countries produce influenza vaccines; few maintain stockpiles
World Health Organization
17August 2008
Minister of Health, Indonesia and H5N1 virus sharing: Minister of Health, Indonesia and H5N1 virus sharing: link sharing to more equitable benefitslink sharing to more equitable benefits
Ind
onesia S
tand
s Firm
In B
ird F
lu V
irus S
amp
les Row
With
WH
OJA
KA
RT
A (AP
)--Indonesia insisted Tuesday that it w
ill only resume sharing bird flu virus sam
ples with the W
orld Health O
rganization if the body stops providing them
to comm
ercial vaccine makers.
The defiant com
ments by H
ealth Minister S
iti Fadiliah S
upari came as top W
HO
officials met w
ith Indonesian counterparts and other global health chiefs in Jakarta to try to persuade the country to resume sharing its sam
ples.
World Health Organization
18August 2008
Points for discussionPoints for discussion
What are the international mechanisms that would help manage this situation?
Are there any other types of activity necessary?
World Health Organization
19August 2008
Meeting summary, Jakarta meeting on sharing in the Meeting summary, Jakarta meeting on sharing in the benefits of virus sharing, March 2007 benefits of virus sharing, March 2007
Types of benefits anticipated, developing countries:– Strengthening core laboratory capacities so that more
developing country laboratories can qualify for WHO designation
– Ensuring access to H5N1 and other potential pandemic influenza vaccines
– Developing more transparent virus handling procedures so that location of any shared virus can be known in real time
– Linking of virus sharing and vaccine production to sustained benefits
World Health Organization
20August 2008
Global Action Plan for Influenza VaccinesGlobal Action Plan for Influenza Vaccines
Request for proposals from developing country vaccine manufacturers for technology transfer
11 proposals received/reviewed Initial grants (up to US $2.5 million each) to six manufacturers:
– Brazil– India– Indonesia – Mexico– Thailand – Viet Nam
World Health Organization
21August 2008
Stockpiles for broader access toStockpiles for broader access toH5N1 and pandemic influenza vaccine vaccineH5N1 and pandemic influenza vaccine vaccine
Meeting with manufacturers and possible donor countries, April 2007
Individual meetings, Director General/CEOs of vaccine manufacturers, April - May 2007
Announcement of H5N1 stockpile development, Pacific Health Summit, June 2007 (for rapid response and essential populations should H5N1 show pandemic changes)
Mechanism for procurement of pandemic vaccine being developed: conceptual phase
World Health Organization
22August 2008
Strengthening developing country capacity to Strengthening developing country capacity to participate globallyparticipate globally
H5 reference laboratories established and certified: China, Indonesia, Brazil
H5N1 WHO Collaborating Centres being established: China, India Brazil
Regular training in laboratory and epidemiology including rapid response to early Phase 4 event
World Health Organization
23August 2008
Sharing of benefits: some of the requirements Sharing of benefits: some of the requirements identifiedidentified
Sustainability
Transparency
Bilateral versus multilateral
World Health Organization
24August 2008
World Health Assembly: sharing of influenza World Health Assembly: sharing of influenza viruses and benefitsviruses and benefits
Resolution 2007: Intergovernmental process to ensure access to vaccine and other benefits– Initial intergovernmental working group meeting November 2007
– Open-ended working group meeting March 2008
– Open-ended working group meeting followed by intergovernmental meeting planned November 2008
World Health Organization
25August 2008
Pandemic influenza control 1918Pandemic influenza control 1918
International Health Regulations (2005):
collective action for global public health security