Tag Archives: Bill & Malinda Gates Foundation

Ebola – the search for a vaccine

LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

[Courtesy of IRIN]

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Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

YAOUNDÉ, 26 March 2014 (IRIN) – Three new polio cases have been confirmed in Cameroon over the past two weeks, making it the country’s first outbreak since 2011 and causing alarm among health officials who link the virus’s spread to weak vaccine campaign coverage and displacement following violence in neighbouring northeastern Nigeria and the Central African Republic (CAR).
Cameroon has confirmed seven polio cases since 2013. Just one case is enough to instigate emergency country-wide vaccination measures under the national health policy. It last experienced a polio outbreak in 2009, the strain also identified in Nigeria and Chad.

The World Health Organization (WHO) has said the virus is at a “very high risk” of crossing borders, and one polio case of the same strain as in Cameroon has just been confirmed in Equatorial Guinea, which saw its last case in 1999.

Cameroon has put in place emergency measures to try to contain the virus, but weak or non-existent monitoring in the cross-border areas with Nigeria and CAR is seriously hampering any national efforts, said Paul Onambelle, a doctor at the Cité Vert district hospital in Yaoundé.

The estimated 100,000 refugees in Cameroon who have fled violence in Nigeriaand CAR make control efforts even harder, said Elisse Clarisse Onambany of the National Expanded Program on Immunization (EPI), who insists refugee children must be included in any immunization campaign, “which means the supply and resources needed must increase”, she said. Half of the refugee population is made up of children aged 11 or under, according to the health authorities.

Immunization in the Far North Region has been extended to include some of the children in the Nigerian refugee population, but thousands of children are still not being accessed because of insecurity in the border area with Nigeria, families being continually on the move, and difficult terrain, said Maria Enjema, a nurse at Far North district hospital of Maroua. “Despite continuous effort by the government to reduce the risk of polio in the north, it is very difficult for health workers to reach all the children, particularly those living along the borders with Nigeria because of the high risk [of Boko Haram-related violence] involved,” she told IRIN.

Meanwhile, ongoing polio campaigns have not always successfully reached the 90 percent of children (aged 0-5 years) needed to eliminate the disease. Some 43 percent of children in Cameroon have not received the three doses required for immunity, and 30 percent have never been vaccinated, said health officials.

The government and partners issue regular polio campaigns for children aged 0-5 in the three northern regions: Far North, North and Adamawa, where the risk of infection is high, but cultural resistance in these areas has limited campaign efforts, said Onambany. “People have different beliefs when it comes to maternal care. Some communities with various religious standpoints on the vaccine say the body is sacred and does not need any chemical to feel better, while some Cameroonians see it as some sort of a public plot.”

Onambany said lack of resources also limited ongoing polio campaign coverage.

Many parents do not understand or believe that three oral vaccinations are required and so they drop out after the first or second round.

Loveline Penda, a mother of five in Yaoundé, told IRIN: “The numbers of vaccines keep increasing and I doubt sometimes what the difference will be if my child does not take a vaccine. Sometimes I miss out but I don’t have to worry because I just believe that my child will be fine.”

The government must take cultural resistance and lack of understanding more seriously and “work to change people’s opinions and knowledge [on polio],” said Idris Haman, a researcher at the University of Yaoundé.


Cameroon health officials are expanding the region-specific immunization campaign nationwide in April, May and June 2014, with the help of partners, said Onambany.

The National EPI will also soon launch an intensive awareness-raising campaign about the vaccination.

“The upcoming campaigns will ensure that the quality of campaign is improved by reaching children three times. We will also intensify communication and sensitization effort so that no family is left untold of the dangers of missing out vaccinations,” Onambany told IRIN.

Over recent years the government has stepped up its surveillance and response to polio, working through networks of trained staff in district hospitals, as well as with community-based monitoring networks and NGO partners. Without support from development partners like WHO and the UN Children’s Fund (UNICEF), containment issues would be lagging far behind, said the EPI.

But unless surveillance steps up across borders, the risk that the polio virus could continue to spread remains a top concern, said Onambelle.

[Courtesy of IRIN Africa]

Syria: Mass Polio Immunization Campaign

Syrian children receive vaccination against polio at a Syrian refugee camp in Lebanon, Nov. 7, 2013.

 

Syria 13 Nov 2013:
The The largest-ever immunization campaign in the Middle East is under-way to stop an outbreak of polio in Syria from spreading throughout the region.

 
In mid-October, 22 suspected cases of polio were detected in north east Syria.  The virus has left 10 children paralysed.  But U.N. health agencies warn hundreds of thousands of children across the region are at risk of contracting this crippling disease. 
 
Now, The World Health Organization and U.N. children’s agency are joining forces to immunize more than 20 million children in seven countries and territories during the coming six months.
 
WHO Polio Eradication Program Spokeswoman Sona Bari notes the virus has been circulating in the region for some time, notably in Egypt, Israel and the West Bank and Gaza.  But she says the outbreak in Syria, a country that had been polio-free for 14 years, has accelerated this emergency response in the region.
 
Bari says emergency immunization campaigns to prevent transmission of polio and other preventable diseases have vaccinated more than 650,000 children in Syria.  She says this includes 116,000 in the highly contested north-east Deir-ez Zor province where the polio outbreak was confirmed a week ago. 
 
According to Bari the campaigns fanning out throughout the region aim to vaccinate 22 million children.
 
“This is a sustained six-month effort.  There will be repeated campaigns over this period of time.  It is going to need quite an intense period of activity to raise the immunity in a region that has been ravaged both by conflict in some parts, but also by large population movements.  So, the virus is moving throughout the region,” she said.
 
The WHO reports in the past few days, nearly 19,000 children under age five in Jordan’s Zaatari refugee camp have been vaccinated against polio.  And, it says a nationwide campaign is currently under way to reach 3.5 million people with polio, measles, and rubella.  It says a vaccination campaign has started in western Iraq and soon will begin in the Kurdistan region. Lebanon, Turkey and Egypt also plan campaigns this month. 
 
The polio virus usually infects children in unsanitary conditions through faecal-oral transmission.  It attacks the nerves and can kill or cause paralysis.  There is no cure for polio, but it can be prevented through immunization.
 
Bari says 12 suspected cases of polio are under investigation.  She says preliminary evidence indicates the polio virus circulating in the region is of Pakistani origin. 
 
There have been media reports that Pakistani fighters brought the polio virus into Syria but the WHO spokeswoman said that is unlikely. 
 
“We are never going to know exactly how it arrived in Syria.  What we do know is that we have seen a virus that is very similar in Egypt, in the West Bank and Gaza, and in Israel over the past 12 months.  We also know that adults tend to have a much higher level of immunity already developed.  So, it is unlikely that adults brought this in.  It is probably more likely some other route.  But, we will never really know for sure.  All we can say for certain is that it is of Pakistani origin and that it has been in this region for a little while,” she said.
 
Pakistan, Nigeria and Afghanistan are the last three endemic countries in the world, so it is from there that polio will continue to spread.  Since WHO began its polio eradication campaign in 1988, vaccination has reduced this crippling disease by more than 99 percent globally.
 
Despite this setback, Bari says the World Health Organization remains optimistic the outbreak can be stopped and polio, eventually, will be eradicated.

[Courtesy of VOA]

Chad: Meningitis Vaccine Cuts Cases By 94 Per Cent

Thurs 12 September 2013 @ 16.30

A meningitis vaccine that has recently been rolled out in several African countries has reduced the incidence of the disease by 94 per cent in Chad after just a single dose per person, in what scientists say is a startling success for the new vaccine, called MenAfriVac.

And the presence of the bacteria responsible for the disease in people’s throats – carriage prevalence – dropped by 98 per cent, according to the study published in The Lancet today.

The research, based on an analysis of data from 1.8 million vaccinations in Chad, revealed that there were no cases of serogroup A meningococcal meningitis, the most dangerous strain of the disease, following vaccination.

“This is one of the most dramatic outcomes from a public health intervention that I have seen,” said lead author Brian Greenwood.

“There are now real prospects that the devastating effects of this infection in Africa can be prevented,” said Greenwood, a professor of clinical tropical medicine at the London School of Hygiene & Tropical Medicine, United Kingdom, which carried out the study together with the Centre de Support en Santé Internationale in Chad and other partners.

Deadly epidemics of meningitis A occur regularly in Sub-Saharan Africa’s meningitis belt, a band of 21 countries stretching from Senegal in the west to Ethiopia in the east, where around 450 million people are at risk.

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Somalia: Polio Outbreak Thwarts Global Eradication Effort

The global community came tantalizingly close earlier this year to ridding the world of polio. But then in May, the eradication effort took a powerful blow. The virus turned up again in the Horn of Africa, first in Somalia.

The Banadir region of Somalia, which includes a Mogadishu refugee camp, is thought to be the so-called “engine” of the Horn of Africa polio outbreak.

In June, three-year-old Mohamed Naasir became ill. His mother, Khadija Abdullahi Adam, said soon after one leg became permanently disabled.

“My son was fine, but he started having a high fever which lasted for almost four days,” she explained. “I gave him medicine, but there was no change. The following morning he said to me ‘Mom, I can’t stand up.'”

The virus has spread at a rapid pace, triggering massive vaccination efforts.

Earlier in 2013, polio was confined to three so-called “endemic countries” — Nigeria, Afghanistan and Pakistan — where the virus has never been snuffed out. Combined there were fewer than 100 cases in those three countries.

Since the virus re-emerged in the Horn of Africa, there have been at least 160 polio cases in Somalia alone, and the virus has spread to Kenya and Ethiopia.

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Kenya: 30,000 Children Targeted in Polio Campaign

THE government aims to immunize at least 30,100 children in Bondo district during the five-day polio vaccination which begins today.

The vaccination programme coordinator Ann Okoth said the door to door exercise will target children from the age of 5 years and below.

She appealed to parents and guardians to ensure all eligible children get the vital immunization. She was speaking yesterday during a preparation forum ahead of the exercise.

Okoth lamented that some parents had a tendency of denying their children access to such important services, and therefore warned that such cases will not be tolerated whatsoever.

She said the vaccination team was prepared to traverse the district including the islands of Mageta, Sifu, Ndeda and Oyamo to ensure that no child is left out during the exercise.

Okoth cautioned the parents to be wary of criminal elements who may take advantage of the exercise to rob residents by impersonating vaccination officials. “Our team will be provided with certified accreditation from the Ministry,” she added.

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