Ebola virus disease – Democratic Republic of the Congo


Ebola virus disease – Democratic Republic of the Congo
25 April 2019
This past week witnessed a notable escalation of security incidents surrounding the Ebola virus disease (EVD) response efforts. On 19 April, an attack on a hospital in Katwa by armed militia resulted in the tragic death of Dr Richard Mouzoko Kiboung, a WHO epidemiologist, and the injury of two other healthcare workers. To ensure the safety of all outbreak responders, Ebola response activities have been temporarily halted in some high-risk health areas until security measures can be reinforced.

WHO, the UN, and the government of the Democratic Republic of the Congo are actively collaborating to review current strategic and operational security measures to ensure the protection of healthcare workers in the field, and improve effective coordination and information sharing amongst all security elements covering the response. Existing operational security measures continue to be implemented and strengthened as well, including the establishment of security perimeters around the residences of EVD response personnel, increasing security at fixed locations, enhancing the joint quick response team (QRT) capacities of local police and UN security forces, and ensuring staff compliance with tracking procedures and adherence to curfew. These measures and other security risk management processes will be continually updated to reflect the needs of the evolving security situation on the ground.

In addition to revising security measures, efforts in community outreach through direct dialogue with various community leaders are also being intensified. Since January, there has been a notable increase in community resistance incidents, primarily around Katwa and Butembo. Incidents in April are anticipated to reach or go beyond March levels. As gaining community understanding and acceptance is integral to our ability to mount an effective outbreak response, community engagement efforts remain a significant element of our response to alleviate future security risks to healthcare workers, develop and increase local community capacity to ensure continuity of response operations, and improve the overall security situation in EVD hotspot areas…



Public Health Emergency of International Concern (PHEIC)
Polio this week as of 24 April 2019
:: Starting 24 April to 30 April 2019, World Immunization Week is celebrated across the world. This year’s theme is Protected Together: Vaccines Work!, which aims to spotlight the important role parents, communities, health workers, innovators and everyday vaccine heroes play in ensuring everybody benefits from the lifesaving vaccines.

Summary of new viruses this week:
:: Afghanistan—three wild poliovirus type 1 (WPV1) cases and three WPV1-positive environmental samples;
:: Pakistan—advance notification of two wild poliovirus type 1 (WPV1) cases and 13 WPV1-positive environmental samples;
:: Nigeria—two circulating vaccine-derived type 2 (cVDPV2) cases and six cVDPV2-positive environmental samples;
:: Democratic Republic of Congo — one cVDPV2 case and two cVDPV2 community isolates; :: Somalia—one cVDPV2 case and one cVDPV2 contact isolate.


New York Times
Accessed 27 Apr 2019
Asia Pacific
Polio Vaccinator Is Shot and Killed in Pakistan
April 25
The woman was part of a vaccination campaign. Another worker in her team was injured. A total of three polio workers have been killed this week as unfounded rumors against vaccines spread.
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 27 Apr 2019]

Democratic Republic of the Congo
:: Zero Palu: Each household, each community, accelerate the commitment in the fight against malaria in the Democratic Republic of the Congo
25 April 2019 Kinshasa — The Democratic Republic of Congo has joined forces with the entire international community to commemorate World Malaria Day, under the theme: ‘Zero palu! I’m in !’. Read the story in French
:: 38: Situation report on the Ebola outbreak in North Kivu 24 April 2019
:: DONs – Ebola virus disease – Democratic Republic of the Congo 25 April 2019

Syrian Arab Republic
:: WHO-supported vaccination campaign to immunize 2.8 million children against vaccine-preventable diseases
22 April 2019, Damascus, Syria ‒ Over the next 6 days, the World Health Organization (WHO), in cooperation with the Syrian Ministry of Health and UNICEF, will conduct a series of national immunization days to immunize children under the age of 5 against vaccine-preventable diseases, including tuberculosis, pertussis, diphtheria, polio, tetanus, hepatitis B, haemophilus influenza, measles, mumps and rubella.
WHO aims to vaccinate approximately 2.8 million children under the age of 5 in 13 governorates in Syria. The campaign will focus on reaching almost 250 000 children who were not vaccinated during previous campaigns. Over 6800 vaccinators and 2487 mobile medical teams will be deployed to 900 public health centres and 1268 temporary vaccination posts. WHO is providing technical support to the Ministry of Health and covering the operational costs of the campaign…

:: Government of Japan support to WHO response in Yemen 24 April 2019
…n 2019, donations from Japan will continue to allow WHO to scale up its capacity-building actives for national health care personnel. These activities will target thousands of health professionals across the country, building on their capacity to deliver pre-hospital care…

Bangladesh – Rohingya crisis – No new digest announcements identified
Cyclone Idai – 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 27 Apr 2019]

Brazil (in Portugese)
:: Últimas notícias OPAS lança iniciativa que prioriza combate à malária em municípios onde se concentram maioria dos casos 
26 de abril de 2019 – Uma nova iniciativa da Organização Pan-Americana da Saúde (OPAS) tem como objetivo abordar a carga da malária na região das Américas, onde o número de casos é mais concentrado. Chamado de “Municípios eliminando a malária”, o projeto se centrará em reunir atores chaves com o fim de apoiar os esforços locais para adotar medidas efetivas contra a doença.

Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – 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 27 Apr 2019]
Afghanistan – No new digest announcements identified
Chad – No new digest announcements identified
Indonesia – Sulawesi earthquake 2018 – No new digest announcements identified
Kenya – No new digest announcements identified
Lao People’s Democratic Republic – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Peru – No new digest announcements identified
Philippines – Tyhpoon Mangkhut – No new digest announcements identified
Tanzania – No new digest announcements identified


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.
:: 26 April 2019 Southern Africa: Tropical Cyclone Kenneth Flash Update No. 3 …

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 20 April 2019

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: The Sentinel_ period ending 20 Apr 2019

:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: 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  [see PDF]

UNESCO solemnly expresses the support of the international community to the President of the French Republic following the fire at Notre-Dame

Heritage Stewardship – Notre-Dame de Paris

UNESCO solemnly expresses the support of the international community to the President of the French Republic following the fire at Notre-Dame
19 April 2019
Paris, Elysée, 19 April 2019- Audrey Azoulay, Director-General of UNESCO, H.E Lee Byong-hyun, President of the executive Board and H.E Zohour Alaoui, president of the general Conference, accompanied by a delegation of ambassadors representing UNESCO’s Member States, bestowed this morning to the President of the Republic of France, Emmanuel Macron, a solemn declaration from the Organization’s Executive Board.

Through this unprecedented approach, UNESCO wishes to express the solidarity of the international community in the face of the tragic fire at Notre-Dame de Paris Cathedral, which is part of the “Paris, Rives de la Seine” site, inscribed as a UNESCO World Heritage Site since 1991…

UNESCO protects heritage worldwide, including endangered heritage. Since 2015, emergency missions have been deployed by UNESCO in more than 50 countries around the world to safeguard and rehabilitate heritage following disasters:


Statement by the Executive Board of UNESCO following the fire at Notre-Dame Cathedral in Paris, France
16 April 2019
We, the Member States of UNESCO, meeting today in the Executive Board at UNESCO Headquarters in Paris, wish to solemnly express our deep emotion at the fire that affected Notre-Dame Cathedral in Paris yesterday.

This tragedy reminds us that through the world heritage, it is the bond that unites humanity that is at stake. UNESCO stands always alongside the heritage, as an expression of the values we all share.

Notre-Dame Cathedral, in the heart of Paris, is a powerful symbol not only of France, but of humanity as a whole because of its exceptional architecture, its spiritual function, its place in history and its literary and artistic legacy. This is the outstanding universal value recognized and honoured by UNESCO in 1991, when it included the Cathedral in the World Heritage List.

This episode, like all the other episodes of inestimable loss and destruction that have unfortunately marked our history, reminds us that the heritage is vulnerable and that, accordingly, the commitment of the international community remains crucial for its protection and safeguarding. This is an opportunity to reaffirm our unwavering attachment to the protection of the heritage, an objective that the United Nations has set itself through UNESCO.

We, the Member States, express our full solidarity and determination to act. We share the grief of all those who have lost a majestic figure in the collective imagination of peoples around the world as a result of the destruction, which was fortunately stopped by the heroic efforts of the emergency

We stand resolutely with the French authorities to support the work to restore Notre-Dame Cathedral, and to share UNESCO’s expertise in this task, in line with its mandate for the protection of the world heritage. For us and for future generations, it is our responsibility to ensure a future for our past.

At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices

Access to Medicines

At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices
13 April 2019 News release
At a global forum on fair pricing and access to medicines, delegates from governments and civil society organizations called for greater transparency around the cost of research and development as well as production of medicines, to allow buyers to negotiate more affordable prices.

The forum, co-hosted by the World Health Organization (WHO) and the Government of South Africa, aimed to provide a global platform for frank discussion among all stakeholders – including governments, civil society organizations and the pharmaceutical industry – in order to identify strategies to reduce medicine prices and expand access for all.

The affordability of medicines has long been a concern for developing countries, but today it is also a global one. Each year, 100 million people fall into poverty because they have to pay for medicines out-of-pocket. High-income countries’ health authorities are increasingly having to ration medicines for cancer, hepatitis C and rare diseases. The problem extends to older medicines whose patents have expired, such as insulin for diabetes.

“Medical innovation has little social value if most people cannot access its benefits,” said Dr Mariângela Simão, WHO Assistant Director General for Medicines and Health Products. “This is a global human rights issue – everyone has a right to access quality healthcare.”

A report commissioned by WHO in 2017 showed that the cost of production of most medicines on WHO’s Essential Medicines List was a small fraction of the final price paid by governments, patients or insurance schemes. Some delegates at the forum noted that a lack of transparency around prices paid by governments means that many low- and middle-income countries pay higher prices for certain medicines than wealthier countries do.

There was consensus that countries can take an initial step towards fostering greater transparency by sharing price information. Countries from the so-called Beneluxa network have already joined forces to share such information, and the results have been promising. The data highlights discrepancies in what different countries are paying and can serve as a powerful tool to negotiate reduced prices. WHO’s database on vaccine markets and shortages – MI4A – was also highlighted at the forum as a useful tool to achieve competitive vaccine prices.

The event highlighted other successful examples of countries’ collaboration around achieving more affordable medicine prices; these include pooled procurement and voluntary sharing of policies. If several countries in the same region purchase medicines as a block, they can negotiate reduced prices due to the larger volume of medicines purchased. And European countries led by Austria have been sharing different policies to expand access to medicines through the WHO-supported PPRI (Pharmaceutical Pricing and Reimbursement Policies).

Industry bodies at the forum expressed support for the goal of access to medicines for all, and expressed their commitment to the Sustainable Development Agenda, which calls for partnership with the private sector to address global challenges such as access to medicines.

WHO will launch a public online consultation in the coming weeks to collect views and suggestions for a definition of what actually constitutes a ‘fair price’ from relevant stakeholders.


“Global Fragility Landscape” – World Bank

Concept Note – April 2019 :: 14 pages
Fragility, conflict, and violence (FCV) has become the new development frontier. By 2030, at least half of the world’s poor people will be living in fragile and conflict-affected settings.1 The impact of FCV is particularly profound on the most vulnerable people and communities, whose livelihoods and economic opportunities are threatened. The global fragility landscape has worsened significantly, with more violent conflicts than at any time in the past 30 years; the largest forced displacement crisis since World War II; high levels of interpersonal and gang violence; and conflicts driving 80 percent of all humanitarian needs.

Today, conflict and violence impact more civilians than at any point over the last two decades. FCV
situations have a clear impact on poverty and, strikingly, the extreme poverty rate is rising only in fragile countries.2 In many contexts, this is due to large-scale violence, a collapse in basic services delivery, and the weakening of core state functions—dynamics that characterize most FCV situations and represent both a humanitarian and development challenge that calls for comprehensive and coordinated international responses. It will prove impossible to achieve the World Bank Group’s twin goals of ending extreme poverty and boosting shared prosperity unless fragility, conflict, and violence are tackled.

For these reasons, addressing FCV has become the core business of the World Bank Group (WBG)…

Building on the progress made over the past years, notably under IDA18 as well as in a number of MICs, the WBG’s FCV Strategy aims to identify a conceptual and operating framework and a set of priority actions over the next five years, with the ultimate goal of developing a more systematic
approach to strengthen the WBG’s support to client countries and vulnerable populations.

Recognizing the suffering of those affected by FCV, and lost opportunities that can span generations, this comprehensive Strategy will more clearly identify both what to do and how the institution can adapt to deliver to those in greatest need. It will discuss how to scale-up development efforts to address the underlying drivers of FCV and enhance the WBG’s impact in FCV settings.

This Concept Note outlines proposed areas of focus for the FCV Strategy. It outlines the global and institutional FCV context; explains the rationale for, and objectives of, the Strategy; presents key
focus areas; introduces preliminary options to address operational challenges; and lays out the Strategy development process…

Press Release
World Bank Group Launches Worldwide Consultations on Future Strategy for Fragility, Conflict and Violence
WASHINGTON, April 16, 2019 — The World Bank Group today announced the launch of global consultations to inform the development of its first formal strategy for Fragility, Conflict and Violence (FCV). Consultations will be held in more than 30 countries, covering all World Bank Group regions, between April and June 2019, with a final strategy expected in November.

The consultations will focus on gathering perspectives in countries faced with diverse FCV challenges, as well as in countries that support World Bank Group programs in FCV settings. They will aim to capture lessons learned and best practices for reducing fragility, conflict and violence and promoting peace and prosperity. Inputs gathered from representatives of government, civil society organizations, international partners, the private sector and others, will be integrated into a comprehensive operational strategy focused on addressing the drivers of fragility and maximizing the World Bank Group’s support for affected people and communities.

The development of a World Bank Group FCV strategy comes at a pivotal time: By 2030, at least half of the world’s poor will live in fragile and conflict-affected settings. The strategy will therefore support the World Bank Group’s goals of ending extreme poverty and promoting shared prosperity. The strategy is being developed jointly by the International Finance Corporation (IFC), the Multilateral Investment Guarantee Agency (MIGA) and the World Bank. It will cover the period from 2020 to 2025.

“To achieve our goal of ending extreme poverty, we must focus on people living in countries that suffer from conflict and fragility,” said World Bank CEO Kristalina Georgieva. “Our new strategy aims to address the underlying causes of fragility and invest in the long-term development that helps create the conditions for peace and prosperity”.

The consultations will be conducted in two phases: From April to June 2019, stakeholders will be asked to provide feedback on the FCV strategy concept through face-to-face meetings and by completing an online questionnaire. From August to September 2019, a draft of the proposed FCV strategy will be shared online for feedback. Throughout the process, the public is invited to share questions and comments by email and via social media channels, using the hashtag #fragility2stability…

The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis

Featured Journal Content

The Lancet
Apr 20, 2019 Volume 393 Number 10181 p1569-1668, e38
The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis
Thomas J Bollyky, Tara Templin, Matthew Cohen, Diana Schoder, Joseph L Dieleman, Simon Wigley
Open Access
Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains.

We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods—synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression—which together provide a robust analysis of the association between democratisation and population health.

HIV-free life expectancy at age 15 years improved significantly during the study period (1970–2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country’s increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (−9·64%, 95% CI −6·38 to −12·90), other non-communicable diseases (−9·14%, −4·26 to −14·02), and tuberculosis (−8·93%, −2·08 to −15·77). Increases in a country’s democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=–0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=–0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries.

When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases.

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.