Seth Berkley: Here’s why global health suffers in a fractured world


Here’s why global health suffers in a fractured world
Seth Berkley CEO, Gavi, the Vaccine Alliance
10 Jan 2018 – World Economic Forum Annual Meeting
The world is today more fractured than at any time since the Cold War, with a new fortress narrative now emerging. But is it really possible for countries to reap the benefits of globalization and shun the responsibilities that come with a globalized economy, while avoiding the consequences of doing so?

Globalism may have fallen out of favour with some, but the forces driving it are not likely to be so easily swayed. Formidable trends will continue to drive both globalization and globalism, and in doing so will bring new challenges that will threaten us all by, among other things, making it harder to prevent the spread of deadly infectious disease. So, in the face of such growing threats to global health security, it should become increasingly clear that putting national interests first doesn’t always mean focusing all your attention at home.

The fact is that the same aspects of the modern world that have helped to make global trade and economic growth possible have also helped promote some of the biggest challenges we are likely to face in the 21st century. Climate change, population growth, human migration and urbanization are just some examples. All have an impact on global health security.
Just as it is possible to have dinner in Nairobi, breakfast in London and lunch in New York, you can now also order goods from halfway around the world and receive them within a timeframe shorter than the incubation period of many infectious diseases.

With more than a billion people travelling outside their country or region every year, it has never been easier for viruses to move around the world. We saw this recently, first with the Ebola epidemic in West Africa, which spread to 10 countries infecting nearly 29,000 people globally, killing 11,000 of them; and then with Zika, which affected more than 80 countries and territories, resulting in more than 220,000 confirmed cases.

If we want to keep the bugs at bay, border security and immigration control will only get us so far. Instead we need to look at how we can prevent outbreaks in the first place. That means embracing globalism by investing in global health to help to strengthen national health systems, disease surveillance and routine immunization in poor countries. By recognizing that infectious disease is not some far away exotic issue, but a global problem, and by sharing the responsibility for its prevention, diagnosis and control, the whole world will be a lot safer.

The problem is, thanks to the combined effects of population growth, climate change, migration and conflict, global health security is likely to become more challenging in the years to come. Land degradation, rising sea levels, famine and conflict will continue to drive people from their homes and towards cities, with megacities like Mexico City and Lagos becoming increasingly common in some of the poorest parts of the world. Without action, the effects of this on global health security could be profound, because as urban density increases, so too can the risk of urban epidemics.

More people living in less space can put greater strain on already limited sanitation resources, and this can create a fertile breeding ground for waterborne infectious disease and the insects spreading them. At the same time, the sheer scale of cities, and the number of vulnerable people living in them, has the potential to overstretch vaccine and antimicrobial supplies, limiting our ability to prevent or respond to outbreaks.

This is not just a hypothetical scenario. In 2016, we saw precisely this play out with the world’s largest yellow fever outbreak in three decades in Angola’s capital Luanda, which spread across Angola and to two other African countries, including threatening Kinshasa in the Democratic Republic of the Congo (DRC). During this outbreak, vaccine shortages made the situation so desperate that the World Health Organization and UNICEF had to resort to recommending fractional dosing in Kinshasa as part of its response, administering one-fifth of a normal dose to people.

We got lucky, and not just in averting major urban epidemics in two overcrowded capital cities, but also in preventing the spread of yellow fever to Asia. No one really knows why yellow fever has never taken hold in Asia, but with 1.8 billion unvaccinated people living in a region where the mosquito responsible for transmitting the disease – Aedes aegypti – is endemic, and with no cure for the disease, the potential of it doing so is a huge concern (particularly, when two other Aedes transmitted infections – dengue and chikungunya – are causing major epidemics).

With a large Chinese workforce in Angola, 11 yellow fever cases did manage to reach China, but were thankfully contained and the virus spread no further. And despite facing further vaccine shortages when another large outbreak occurred just a few months later in Brazil, the global health community rallied and was able to prevent this too from turning into an urban epidemic. But these were close calls.

As the global population continues to grow and become ever more urban, it is important that we are prepared for what it will bring. While it will almost certainly help boost globalization by opening up new markets, without a continued global effort to prevent outbreaks wherever they occur, through routine immunization and strengthened health systems, then such close calls could become full blown pandemics threatening us all with catastrophic human and economic consequences.



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 10 January 2018 [GPEI]
:: New on We join Dr Urs Herzog, polio eradicator, National PolioPlus Advocacy Advisor for Rotary Switzerland and polio survivor himself, as he explains the financial costs of the programme and why it is critical that we eradicate every last trace of the virus.

:: Summary of newly-reported viruses this week:
Afghanistan:  Three new wild poliovirus type 1 (WPV1) positive environmental samples have been reported, one collected from Kandahar, one from Hilmand, and one from Nangarhar provinces.
Pakistan: Four new WPV1 positive environmental samples have been reported, three collected from Sindh province, and one from Khyber Pakhtunkhwa province.
Democratic Republic of the Congo: Advance notifications have been received of five cases of circulating vaccine-derived poliovirus type 2 (cVDPV2). These will be confirmed in next week’s data reporting.

Syria cVDPV2 outbreak situation report 29, 9 January 2018
Situation update 9 January 2018
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74.
:: The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: Preparations continue at national and governorate levels for the upcoming first round of the second phase of the outbreak response. mOPV2 and IPV will be used in two immunization rounds through house-to-house and fixed centre vaccination.
:: mOPV2 stocks have arrived in Beirut, Lebanon, for onward transportation to Damascus. The shipment process for IPV is underway.

WHO Grade 3 Emergencies  [to 13 January 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 29, 9 January 2018
[See Polio above for detail]

:: Weekly epidemiology bulletin, 25–31 December 2017
Cumulative figures
-The cumulative total from 27 April 2017 to 31 December 2017 is 1,019,044 suspected cholera cases and 2,237 associated deaths,
(CFR 0.22%), 1094 have been confirmed by culture.
– 59.3 % of death were severe cases at admission
– The total proportion of severe cases among the suspected cases is 16.9%
– The national attack rate is 370 per 10,000. The five governorates with the highest cumulative attack rates per 10,000 remain  Amran (870), Al Mahwit (824), Al Dhale’e (644), Hajjah (498) and Abyan (494).
– Children under 5 years old represent 28.6% of total suspected cases.
– In total, 25,889 rapid diagnostic tests (RDT) have been performed which represents 24.3% coverage.
– 2,651 cultures have been performed which represents 25.4% coverage.
– The last positive culture was on 19 Dec 2017 in Al-Sabeen distric in Amanat Al-Asimah
– 70 districts did not report any suspected case the last three consecutive 3 weeks
Governorate and District level
– At governorate level, the trend from W50-W52 decrease or was stable in all governorates except (Sana’a governorate (+25%),
Hajjah governorate (+16%), Sada’a (+17%) .
– The weekly number of cases is decreasing for the 16 consecutive weeks.
– The weekly proportion of severe cases has significantly decreased representing now 10% of the admitted cases.
Week 52
– 9,169 suspected cases and 4 associated deaths were reported
– 11 % are severe cases
– 740 RDTs were performed, 136 were positive
– 0 Positive culture

WHO Grade 2 Emergencies  [to 13 January 2018]
:: Weekly Situation Report # 9
Date of issue: 6 January 2018; Period covered: 31 December – 6 January
…As of 6 January 2018, a total of 3 523 cases clinically suspected with diphtheria and 58 laboratory confirmed cases (out of 185 cases tested) have been reported. 104 clinically suspected cases were admitted at diphtheria treatment facilities on 6 January 2018. A total of 30 deaths have been recorded so far. The last reported death was on 2 January.
…Preparations are underway for the second round of Penta/Td vaccination for Forcibly Displaced Myanmar Nationals (FDMN), which will occur in January.
…A vaccination campaign targeting children in the host community was held on 02 January during free book distribution day across 104 schools in Ukhia. A total of 29 377 children were vaccinated – 6 514 children 6 weeks to under 7 were vaccinated with pentavalent vaccine and 22 823 children 7 to 15 years were vaccinated with Td.
…The upgraded EWARS system was launched on 1 January. Training is ongoing for DGHS representatives, agency focal

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: UN Humanitarian Chief sees first hand “colossal toll that the brutal and sustained hostilities have taken”  11 January, 2018
:: Health Cluster Weekly Situation Report: Whole of Syria, Week 2, 5-11 January 2018
:: Turkey | Syria: Recent Developments in Northwestern Syria (as of 10 January 2018)

:: Statement by the Humanitarian Coordinator for Yemen, Jamie McGoldrick,on the vital importance of keeping Yemen’s entry points open, 11 January 2018 [EN/AR]

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.
:: WASH Sector Cox’s Bazar Situation Report, 13 January 2018

:: 11 Jan 2018 – Ethiopia Humanitarian Bulletin Issue 44 | 25 Dec. 2017 – 7 Jan. 2018

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 6 January 2018

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice

pdf version:The Sentinel_ period ending 6 January 2018

:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals