Public Health Emergency of International Concern (PHEIC)
Polio this week as of 27 February 2019
:: The Global Commission for Certification of the Eradication is convening this week in Geneva. The outcomes of the previous meeting are available are available here. The GCC oversees the certification process for polio eradication and most recently met in Amman, Jordan in October 2018.
:: A delegation of Korea International Cooperation Agency (KOICA) visiting the WHO Regional Office for Africa in Brazzaville received a first-hand demonstration of the “real-time” surveillance system for polio monitoring in Africa. Strong and timely disease surveillance is the key for rapid outbreak response. The Republic of Korea is a key partner in strengthening eradication efforts. Read more here.

Summary of new viruses this week:
::  Afghanistan— one wild poliovirus type 1 (WPV1)-positive environmental sample;
:: Pakistan – five WPV1-positive environmental samples;
:: Mozambique— one circulating vaccine-derived poliovirus type 2 (cVDPV2) from a contact;
:: Nigeria— two cVDPV2-positive environmental samples and 8 cVDPV2 isolates from healthy contacts

Statement of the Twentieth IHR Emergency Committee
1 March 2019
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: Rising number of WPV1 cases:  Although the declaration of the PHEIC and issuance of Temporary Recommendations has reduced the risk of international spread of WPV, progress is fragile, and should international spread now occur, the impact on WPV eradication would be even more grave in terms of delaying certification and prolonging requirements for dedicated human and financial resources in support of the eradication effort.  The increasing cases in Afghanistan and Pakistan with associated cross border spread of WPV1 continuing between the two countries as well as the widespread geographic detection through environmental sampling of the virus in Pakistan heighten concerns, especially as cases have increased during the current low season
:: Complacency: There is a risk of global complacency as the numbers of WPV cases remains low and eradication becomes a tangible reality, and a concern that removal of the PHEIC now could contribute to greater complacency.
:: Rising number of cVDPV outbreaks: Many countries remain vulnerable to WPV importation.  Gaps in population immunity in several key high-risk areas is evidenced by the current number of cVDPV outbreaks of all serotypes, which only emerge and circulate when polio population immunity is low as a result of deficient routine immunization programs.  Currently four WHO Regions are managing polio outbreaks.
:: International spread of cVDPV: The international spread of cVDPV2 affecting Somalia and Kenya, and Nigeria and Niger, are other examples of the current heightened risk of international spread of polioviruses.  Waning population immunity to type 2 polioviruses in the face of the limited IPV supply and weak routine immunization in many countries means that significant numbers of countries neighboring these outbreaks may be at high risk of importation of cVDPV2.
:: Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.
:: Surveillance gaps: The appearance of highly diverged VDPVs in Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed in various countries.  Similar gaps exist in Lake Chad countries and around the Horn of Africa.
:: Protracted outbreaks: The difficulty in rapidly controlling VDPV outbreaks in Nigeria and DR Congo was another risk.
:: Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger and Somalia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.
:: Population movement: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees. There is a need for international coordination to address these risks.  A regional approach and strong cross­border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders…

Additional considerations

The world is at a critical point in polio eradication. Failure to boost population immunity through strengthening routine immunization, and failure to prevent outbreaks through implementation of high quality SIAs in areas of known high risk, could jeopardize or severely delay polio eradication.  The current situation calls for unabated efforts and use of every tool available, to achieve the goal in these most challenging countries.  Particularly in the three remaining endemic countries, further engagement with senior levels of government and other key stakeholders is needed to advocate for polio eradication, and ensure all levels of government maintain a strong commitment until the job is done.

Noting the spread of polioviruses in several areas close to international borders, the committee strongly urges that surveillance, population immunity assessments and outbreak preparedness activities intensify in all neighboring countries, particularly in Benin, Malawi, Ethiopia, South Sudan, Djibouti, Lake Chad basin countries and the Central African Republic.  There needs to be a renewed urgency to addressing these gaps wherever they exist.

Countries using mOPV2 should take great care in accounting for all vials of the vaccine, to avoid unauthorized and inappropriate use outside a globally agreed SIA campaign.
Based on the current situation regarding WPV1 and cVDPV, and the reports provided by Afghanistan, Indonesia, Mozambique, Nigeria, Niger, Pakistan and Papua New Guinea, the Director-General accepted the Committee’s assessment and on 28 February 2019 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV…



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 2 Mar 2019]
Democratic Republic of the Congo
:: 30: Situation report on the Ebola outbreak in North Kivu  26 February 2019
:: DONSEbola virus disease – Democratic Republic of the Congo  28 February 2019

Syrian Arab Republic
:: WHO concerned over critical health situation in Al-Hol camp, Al-Hasakeh  26 February 2019,
Damascus, Syria – WHO-supported medical teams working round the clock at Al-Hol camp to provide health care services to new arrivals from rural Deir–ez-Zor.

:: Remarks at the Yemen High-Level Pledging Conference – WHO  Geneva, Switzerland
26 February 2019  Dr Mike Ryan, ADG, Emergency Preparedness and Response, WHO

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



WHO Grade 2 Emergencies  [to 2 Mar 2019]
:: WHO condemns violence against health workers in Iraq
Baghdad, 26 February 2019 – The World Health Organization (WHO) strongly condemns the recent attack on a medical practitioner who was physically assaulted while providing medical care to a critically ill 70-year old female in Azadi Teaching Hospital in the Kirkuk governorate on 18 February 2019.
“WHO calls on the authorities in Iraq to ensure the safety of health workers, health facilities, and the sanctity of health care,” said Dr Adham Rashad Ismail, acting WHO Representative in Iraq. “Such attacks constitute a serious violation of international humanitarian law and deprive the most vulnerable population of children, women and the elderly of their right to essential health services,” he added…

occupied Palestinian territory 

:: WHO Regional Director for the Eastern Mediterranean calls for respecting the right to health of all Palestinians and protection for health care
27 February 2019, oPt – Concluding a three-day visit to the occupied Palestinian territory (oPt), Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, called for ensuring regular and reliable access to health for all Palestinians and respect for the sanctity of health care.
During his visit, the Regional Director met with Prime Minister Dr Rami Hamdallah for a discussion on the importance of achieving universal health coverage, and reiterated WHO’s support to ongoing efforts to improve the health and well-being of all Palestinians.
In his meeting with Minister of Health Dr Jawad Awad, the Regional Director commended the progress made to improve health services that best meet people’s needs, noting that WHO will continue to work closely with the Ministry of Health to strengthen the Palestinian health system and respond to humanitarian health needs.
   The Regional Director underlined that the recently enforced restrictions on vaccine imports to the oPt might, if not resolved, jeopardize sustainability of the highly successful immunization programme and pose a serious health security threat, not only to the West Bank and Gaza, but also to neighbouring countries…

Brazil (in Portugese) – No new digest announcements identified
Cameroon  – No new digest announcements identified
Central African Republic  – No new digest announcements identified
Ethiopia – No new digest announcements identified
Hurricane Irma and Maria in the Caribbean – No new digest announcements identified
Libya – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified



WHO Grade 1 Emergencies  [to 2 Mar 2019]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut


UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic   – No new digest announcements identified
Yemen – No new digest announcements identified


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  – No new digest announcements identified
Somalia  – No new digest announcements identified