The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 30 November 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
Editor
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

PDF: The Sentinel_ period ending 30 Nov 2019

Contents
:: 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]

ILO – More than 500 billion dollars a year needed to ensure basic levels of social protection worldwide

Social Protection

Press Release
More than 500 billion dollars a year needed to ensure basic levels of social protection worldwide
25 November 2019
GENEVA (ILO News) – More than US$500 billion a year needs to be invested if countries are to meet a basic set of social protection measures – known as a social protection floor – by 2030, says a new ILO report.

According to the report, spending on coverage needs to increase dramatically to achieve universal coverage of a basic set of social protection measures. This would include:
:: Cash transfers to children
:: Maternity benefits for mothers with newborns
:: Disability benefits
:: Old age social pensions

Based on research carried out in 134 countries, the findings show that at current levels social protection covers only 8.5 per cent of children and 15.3 per cent of older persons in low-income countries. By contrast, in upper-middle income countries 35 per cent of children and 90 per cent of older persons are covered…

Many middle- or upper-middle-income countries have the domestic capacity to generate the resources to finance a universal social protection floor, say the report’s authors. However, substantial amounts of overseas development aid will be needed to close the financing gap in the 28 low-income countries covered in the research, to achieve universal coverage by 2030.

According to the report the low-income countries would need to spend 5.6 per cent (US$27 billion per year) of their Gross Domestic Product (GDP) to close the financing gap. The lower middle-income countries would need to earmark 1.9 per cent of GDP (US$ 136 billion per year), whereas the upper-middle income countries would need to spend 1.4 per cent of their GDP (US$ 365 billion per year).

Policy options to create the necessary financing presented in the report include, among others, increasing tax revenue, extending social security coverage and contributions, increasing official development assistance (ODA) with priority given to low-income countries, and eliminating illicit financing flows.

“Promoting the extension of contributory social insurance coverage to workers in the informal economy, in countries where social insurance is still underdeveloped, would create additional revenues of 1.2 per cent of the GDP of these countries,” said Fabio Duran-Valverde, Head of the Public Finance, Actuarial and Statistics Unit.

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ILO Working paper
Measuring financing gaps in social protection for achieving SDG target 1.3: Global estimates and strategies for developing countries
25 November 2019 :: 58 pages
F. Durán Valverde; J. Pacheco-Jiménez; T. Muzaffar; H. Elizondo-Barboza
PDF: https://www.ilo.org/wcmsp5/groups/public/—ed_protect/—soc_sec/documents/publication/wcms_729111.pdf
Social security is a human right but it is not yet a reality. Only 45 per cent of the global population are effectively covered by at least one social protection benefit, while the remaining 55 per cent – as many as 4 billion people – are unprotected. Closing the coverage gap will require additional investments in social protection, which can and should be achieved by increasing the “fiscal space” for social protection.

IOM – World Migration Report 2020

Migration

World Migration Report 2020
IOM
2019 :: 496 pages
ISSN: 1561-5502 E-ISBN: 978-92-9068-789-4
PDF: https://publications.iom.int/system/files/pdf/wmr_2020.pdf
Since 2000, IOM has been producing world migration reports. The World Migration Report 2020, the tenth in the world migration report series, has been produced to contribute to increased understanding of migration throughout the world. This new edition presents key data and information on migration as well as thematic chapters on highly topical migration issues, and is structured to focus on two key contributions for readers: Part I: key information on migration and migrants (including migration-related statistics); and Part II: balanced, evidence-based analysis of complex and emerging migration issues.

This flagship World Migration Report has been produced in line with IOM’s Environment Policy and is available online only. Printed hard copies have not been made in order to reduce paper, printing and transportation impacts.

Highlights from Part I: Data and information on migration and migrants
The number of international migrants globally in 2019: 272 million (3.5% of the world’s population)
• 52 per cent of international migrants were male; 48 per cent were female.
• 74 per cent of all international migrants were of working age (20–64 years).

India continued to be the largest country of origin of international migrants
• India had the largest number of migrants living abroad (17.5 million), followed by Mexico and
China (11.8 million and 10.7 million respectively).
• The top destination country remained the United States (50.7 million international migrants).

The number of migrant workers declined slightly in high income countries while increasing elsewhere
• Between 2013 and 2017, high-income countries experienced a slight drop in migrant workers
(from 112.3 million to 111.2 million). Upper middle-income countries observed the biggest
increase (from 17.5 million to 30.5 million).
• Globally, male migrant workers outnumbered female migrant workers by 28 million in 2017.
There were 96 million male migrant workers (58%) and 68 million female migrant workers (42%).

International remittances increased to USD 689 billion in 2018
• The top 3 remittance recipients were India (USD 78.6 billion), China (USD 67.4 billion) and
Mexico (USD 35.7 billion).
• The United States remained the top remittance-sending country (USD 68.0 billion) followed by
the United Arab Emirates (USD 44.4 billion) and Saudi Arabia (USD 36.1 billion).

The global refugee population was 25.9 million in 2018
• 20.4 million refugees were under the mandate of the United Nations High Commissioner for
Refugees (UNHCR) and 5.5 million were refugees under the mandate of the United Nations
Relief and Works Agency for Palestine Refugees (UNRWA) in the Near East.
• 52 per cent of the global refugee population was under 18 years of age.

The number of internally displaced persons due to violence and conflict reached 41.3 million
• This was the highest number on record since the Internal Displacement Monitoring Centre
began monitoring in 1998.
• The Syrian Arab Republic had the highest number of people displaced (6.1 million) followed by
Colombia (5.8 million) and the Democratic Republic of the Congo (3.1 million).

The number of stateless persons globally in 2018 was 3.9 million
• Bangladesh had the largest number of stateless persons (around 906,000). It was followed by
Côte d’Ivoire (692,000) and Myanmar (620,000).

Migration patterns vary from region to region
• While most international migrants born in Africa, Asia and Europe reside within their regions
of birth, the majority of migrants from Latin America and the Caribbean and Northern America
reside outside their regions of birth. In Oceania, the number of intraregional migrants and those
residing outside the region remained about the same in 2019.
• More than half of all international migrants (141 million) lived in Europe and Northern America.

Migration has been a key determinant of population change in several countries
• Intraregional migration has been an important contributor to population change in some African
countries such as Equatorial Guinea.
• Labour migration has contributed to significant population changes especially in Gulf Cooperation
Council (GCC) States. With the exceptions of Oman and Saudi Arabia, migrants made up the
majority of the populations in GCC countries.

Displacement remained a major feature in some regions
• The Syrian Arab Republic and Turkey were the origin and host of the largest number of
refugees globally, 6.7 million and 3.7 million, respectively. Canada became the largest refugee
resettlement country, resettling more refugees than the United States in 2018.
• The Philippines had the largest number of new disaster displacements in 2018 (3.8 million).
• Around 4 million Venezuelans had left their country by mid-2019. The Bolivarian Republic of
Venezuela was the largest source country of asylum seekers in 2018 (over 340,000).

Migration research and analysis output remained high
• There was a continued increase in the number of migration-related academic publications, with
the largest ever academic output produced during the last two years. There was significant
output from international organizations on a wide range of migration issues.
• Academic output on migration is dominated with perspectives from destination countries,
especially in relation to Europe. A geographic comparison of the primary affiliations of authors
in selected journals shows that most are from institutions in developed countries.

NAS – Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators

Policy/Regulation

Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators
National Academies of Sciences, Engineering, and Medicine; doi.org/10.17226/25594.
Alastair Wood and Patricia Cuff, Editors
November 2019 :: 160 pages
Open Access – PDF: https://www.nap.edu/login.php?record_id=25594&page=https%3A%2F%2Fwww.nap.edu%2Fdownload%2F25594
Description
Globalization is rapidly changing lives and industries around the world. Drug development, authorization, and regulatory supervision have become international endeavors, with most medicines becoming global commodities. Drug companies utilize global supply chains that often include facilities in countries with inconsistent regulations from those of the United States, perform pivotal trials in multiple countries to support registration submissions in various jurisdictions, and subsequently market their medicines throughout most of the world. These companies operate across borders and require individual national regulators to ensure that drugs authorized for use in their countries are safe and effective, and appropriate for their health care system and their population. This process involves significant resources and often duplicative work. It is important to consider how this process can be improved in order to better allocate resources, time, and efforts to improve public health.

Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators considers the role of mutual recognition and other reliance activities among regulators in contributing to enhancing public health. This report identifies opportunities for leveraging reliance activities more broadly in order to potentially impact public health globally. Key topics in this report include the job of medicines regulators in today’s world, what policy makers need to know about today’s regulatory environment, stakeholder views of recognition and reliance, as well as removing impediments and facilitating action for greater recognition and reliance among regulatory authorities.

Joint statement on EPA proposed rule and public availability of data (2019)

Featured Journal Content

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 Nov 2019)
Perspective
Joint statement on EPA proposed rule and public availability of data (2019)
H. Holden Thorp, Magdalena Skipper, Veronique Kiermer, May Berenbaum, Deborah Sweet, Richard Horton
| published 26 Nov 2019 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1003014
Eighteen months after articulating our concerns [1] regarding the 2018 “Strengthening Transparency in Regulatory Science” rule proposed by the Environmental Protection Agency (EPA) [2], we have become more concerned in response to recent media coverage and a 13 November hearing on the role of science in decision-making at the EPA. These events suggest that the proposed rule is now moving toward implementation; whether it includes amendments sufficient to address the concerns raised by us and many others remains a question.

Our previous statement on the proposed rule, authored and published by the editors-in-chief of five major scientific journals in May 2018, reflected alarm that the proposal’s push for “transparency” would be used as a mechanism for suppressing the use of relevant scientific evidence in policy-making, including public health regulations. After the public comment period for the proposed rule closed, the EPA reported more than 590,000 comments from individuals and scientific, medical, and legal groups, many of which articulated similar concerns [3].

As leaders of peer-reviewed journals, we support open sharing of research data, but we also recognize the validity of scientific studies that, for confidentiality reasons, cannot indiscriminately share absolutely all data. Datasets featuring personal identifiers—including studies evaluating genomes of thousands of people to characterize medically relevant genetic variants—are but one example. Such data may be critical to developing new drugs or diagnostic tools but cannot be shared openly; even anonymized personal data can be subject to re-identification, and it has been a longstanding practice for agencies and journals to acknowledge the value of data privacy adjustments. The principles of careful data management, as they inform medicine, are just as applicable to data regarding environmental influences on public health. Discounting evidence from the decision-making process on the basis that some data is confidential runs counter to the EPA stated mission “to reduce environmental risks…based on the best available scientific information” [4].

We are also concerned about how the agency plans to consider options related to existing regulations. Even if a new standard is not applied retroactively, the standard could apply when a regulation is updated; thus, foundational science from years past—research on air quality and asthma, for example, or water quality and human health—could be deemed by the EPA to be insufficient for informing our most significant public health issues. That would be a catastrophe.

We urge the EPA to continue to adopt an approach that ensures the data used in decision-making are the best available, which will at times require consideration of peer-reviewed scientific data, not all of which may be open to all members of the public. The most relevant science, vetted through peer review, should inform public policy. Anything less will harm decision-making that claims to protect our health.

We hope that in the end, decisions that are made to inform the proposed EPA rule will rise above any form of politics, focusing on what’s best for our communities. We encourage anyone with concerns or opinions about this issue to express their views through relevant legislative channels. Whether submitting public comments to the EPA or communicating with lawmakers in Congress, it is important to emphasize that decision-making that affects us all should be informed by nothing less than the full suite of relevant science vetted through peer review.

References at title link above
1. Berg J, Campbell P, Kiermer V, Raikhel N, Sweet D. Joint statement on EPA proposed rule and public availability of data. Science. 2018; 360: 6388. 10.1126/science.aau0116.
2. U.S. Environmental Protection Agency, News Releases. EPA Administrator Pruitt proposes rule to strengthen science used In EPA regulations. 24 Apr 2018. Available from: www.epa.gov/newsreleases/epa-administrator-pruitt-proposes-rule-strengthen-science-used-epa-regulations.
3. U.S. Environmental Protection Agency, Science Advisor Programs. Strengthening transparency in regulatory science. 30 Apr 2018. Available from: www.epa.gov/osa/strengthening-transparency-regulatory-science.
4. U.S. Environmental Protection Agency. Our mission and what we do. 2018. Available from: www.epa.gov/aboutepa/our-mission-and-what-we-do.

Lancet Editorial – Research integrity: time for global action

Featured Journal Content

The Lancet
Nov 30, 2019 Volume 394 Number 10213 p1965-2038, e38
https://www.thelancet.com/journals/lancet/issue/current
Editorial
Research integrity: time for global action
The Lancet
China has become a formidable global leader in scientific—including medical—research, with the world’s largest publication output, a rapid surge in the number of highly cited researchers, and an increasingly unparalleled quality of scientific publications. However, there is often a shadow hanging over any country’s progress, especially a nation that has advanced with spectacular velocity. China is no exception. And the current concern, escalated to the highest levels of the Chinese Government, is research integrity….

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The unfolding migrant crisis in Latin America
The Lancet
With the political crisis intensifying across Latin America, the difficulties in a region already struggling with massive migration and economic instability are becoming more complex. The number of people migrating across borders within this region has increased by 36% in the past 15 years, reaching 63·7 million in 2015; and of these migrants, 808 000 were defined as refugees, who are the most vulnerable type of migrants and often have insufficient access to appropriate health services. People smuggled by human trafficking and victims of violence are among these migrants.

There are several reasons for migration. Established migrant flows (eg, from Peru to Chile) are driven by labour markets, whereas more recent migration flows (eg, from Venezuela to Colombia) are driven by political and economic instability. Climate change might also become a substantial driver of migration: the UN estimates that of the top 25 nations most at risk for natural disasters, eight are in Latin America and the Caribbean. Inadequate sanitation and shelter, lack of sufficient water and food, and overcrowding in transit centres might increase the risk of migrants acquiring communicable diseases. Without adequate surveillance measures, diseases that were once eradicated from a country can re-emerge. According to the UN, the 634 migrant deaths registered in 2019 in the Americas has already surpassed the number in 2018 (517), and 2019 might be the deadliest year on record for migrants in the region.

The global UN resolution adopted in 2018 urged cooperation among member states in protecting migrants. However, although it is laudable to have migrants’ right to health on the global agenda, Latin American countries are still struggling to improve their national health policies. To protect migrants from the increasing political instability in Latin America, preparedness is crucial. All governments must take their share of responsibility, fully commit, and coordinate efforts with non-governmental organisations and civil society to translate the global agreement on migration into national practices.

Emergencies

Emergencies

Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 69: 26 November 2019
Situation Update
In the week of 18 to 24 November 2019, seven new confirmed EVD cases were reported from four health zones in two affected provinces in Democratic Republic of the Congo. The majority of the confirmed cases in this week came from Mabalako Health Zone (57%; n=4).

Violence and civil unrest in the week have led to the suspension of Ebola response activities in some areas of Beni, Butembo, and Oicha health zones. On 26 November 2019, some response personnel were temporarily relocated from Beni, though most remain in place to continue responding. The immediate focus will be on maintaining the safety and welfare of response personnel while preserving essential response activities in these places.

The disruptions to the response and lack of access to Ebola-affected communities is threatening to reverse recent progress. As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they often result in increased transmission…

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Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo
Attacks in eastern Democratic Republic of the Congo
28 November 2019 News release
Two attacks in eastern Democratic Republic of the Congo (DRC) have killed 4 workers responding to the Ebola outbreak and injured 5 others.
The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina.
We are heartbroken that people have died in the line of duty as they worked to save others,” said Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General. “The world has lost brave professionals.”
The dead include a member of a vaccination team, two drivers and a police officer. No WHO staff are among those killed, one staff member was injured.
“My heart goes out to the family and friends of the first responders killed in these attacks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are doing everything possible to bring the injured and front-line workers in the impacted areas to safety. These constant attacks must stop. We will continue to work with the DRC Government, partners and MONUSCO to ensure the security of our staff and other health workers.”…

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New England Journal of Medicine
Online November 27, 2019
DOI: 10.1056/NEJMoa1910993
Original Article
A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics
Sabue Mulangu, M.D., Lori E. Dodd, Ph.D., Richard T. Davey, Jr., M.D., Olivier Tshiani Mbaya, M.D., Michael Proschan, Ph.D., Daniel Mukadi, M.D., Mariano Lusakibanza Manzo, Ph.D., Didier Nzolo, M.D., Antoine Tshomba Oloma, M.D., Augustin Ibanda, B.S., Rosine Ali, M.S., Sinaré Coulibaly, M.D., Adam C. Levine, M.D., Rebecca Grais, Ph.D., Janet Diaz, M.D., H. Clifford Lane, M.D., Jean-Jacques Muyembe-Tamfum, M.D., and the PALM Writing Group for the PALM Consortium Study Team*
Abstract
Background
Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
Methods
We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase–polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.
Results
A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P=0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P=0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.
Conclusions
Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM ClinicalTrials.gov number, NCT03719586. opens in new tab.)

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Investigational Drugs Reduce Risk of Death from Ebola Virus Disease – NIH
Study Leaders Publish Results from NIH-DRC-WHO Clinical Trial of Four Experimental Therapies.
November 27, 2019
The investigational therapeutics mAb114 and REGN-EB3 offer patients a greater chance of surviving Ebola virus disease (EVD) compared to the investigational treatment ZMapp, according to published results from a clinical trial conducted in the Democratic Republic of the Congo (DRC). The new report also shows that early diagnosis and treatment are associated with an increased likelihood of survival from EVD.
The results appear online this week in the New England Journal of Medicine. An announcement made on August 12, 2019, noted that the study leaders halted the trial early, on August 9, 2019, as recommended by an independent data and safety monitoring board based on its review of preliminary data from 499 study patients. The preliminary analysis found that both mAb114 and REGN-EB3 performed better than ZMapp. The fourth drug, remdesivir, performed similarly to ZMapp. Today’s publication provides a comprehensive analysis of the full dataset from nearly 200 additional patients enrolled in the clinical study.
The clinical trial known as PALM, short for “Pamoja Tulinde Maisha,” a Kiswahili phrase that translates to “together save lives,” was organized by an international research consortium coordinated by the World Health Organization (WHO). It is led and funded by the DRC’s National Institute for Biomedical Research (INRB) and Ministry of Health, and the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. Professor Jean-Jacques Muyembe-Tamfum, M.D., Ph.D., director-general of the INRB and head of the DRC’s Ebola response, and Richard T. Davey, Jr., M.D., deputy director of NIAID’s Division of Clinical Research, are co-principal investigators for the study.
“Response teams have faced unprecedented challenges in ongoing efforts to save lives and control the outbreak of Ebola in a highly insecure region of the Democratic Republic of the Congo,” said NIAID Director Anthony S. Fauci, M.D. “Although effective treatments alone will not end this outbreak, the PALM study findings identify the first efficacious treatments for Ebola virus disease and therefore mark a significant step forward in improving care for Ebola patients. We thank the study team for their extraordinary efforts to conduct this landmark trial.”
The study enrolled 681 people with Ebola virus disease between November 2018 and August 2019 at four Ebola treatment centers (ETCs) in the cities of Beni, Butembo, Katwa and Mangina. Staff from The Alliance for International Medical Action (ALIMA), International Medical Corps (IMC), Médecins Sans Frontières/Doctors Without Borders (MSF) and the DRC Ministry of Health implemented the trial at the ETCs with support from Congolese staff, the World Health Organization, the Frederick National Laboratory for Cancer Research and The Mitchell Group.
The study was designed to compare mortality among patients who received one of three investigational Ebola drugs with that from a control group of patients who received the investigational monoclonal antibody cocktail ZMapp, developed by Mapp Biopharmaceutical, Inc. The other therapies were mAb114, a single monoclonal antibody product developed for clinical use by NIAID’s Vaccine Research Center and the INRB and licensed to Ridgeback Biotherapeutics and Mapp Biopharmaceutical; REGN-EB3, a monoclonal antibody cocktail developed by Regeneron Pharmaceuticals, Inc.; and remdesivir, an antiviral drug developed by Gilead Sciences, Inc. The Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services, also has provided support for the development of REGN-EB3, ZMapp and mAb114.
The four therapies are administered as intravenous infusions. REGN-EB3 and mAb114 are administered as single infusions and ZMapp and remdesivir are administered as infusions over multiple days. Study participants also received optimized supportive care, including oral and/or intravenous fluids, electrolyte replacement, monitoring of oxygen levels and blood pressure (with supportive measures as needed), blood transfusions, pain management, and antibiotics and antimalarials as indicated….
All four study drugs were generally well tolerated. There were a total of four serious adverse events that were judged to be potentially related to the experimental drugs. Three of these were in two of the patients who received ZMapp. One was in a patient who received remdesivir.
The authors note that despite encouraging findings regarding mAb114 and REGN-EB3, approximately one-third of patients who received these therapeutics died, highlighting the potential to improve upon these results, whether through further optimization of supportive care, combination therapy using agents with complementary mechanisms of action or other strategies.
“Despite unprecedented challenges — including an unstable electrical power grid and evacuations of staff and patients from treatment centers due to violent attacks — the PALM trial demonstrates that scientifically rigorous and ethically sound clinical research can be conducted during disease outbreaks,” said H. Clifford Lane, M.D., NIAID deputy director for Clinical Research and Special Projects. “We thank the patients and the medical staff in the field and at the treatment sites for their participation and exceptional commitment to the trial.”

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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 20 November 2019
:: A four-day regional emergency preparedness workshop is currently underway in Lomé, Togo, for senior public health officials to strengthen the capabilities within West African countries to respond to polio outbreaks. Read more about the workshop.
:: “It was good to know that a country like India could eradicate polio. It gives us hope that Pakistan can do it too, and we will soon be polio free.” These are the words of Aziz Memon, a Rotarian who has dedicated his life to fight polio in Pakistan. Read about his journey.

Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan— five WPV1 cases, two cVDPV2 cases and one cVDPV2 positive environmental sample;
:: Democratic Republic of the Congo (DR Congo)- five cVDPV2 cases;
:: Benin – four cVDPV2 cases;
:: Ghana— four cVDPV2 cases and two cVDPV2 positive environmental samples;
:: Philippines – three cVDPV2 cases and five cVDPV2 positive environmental samples;
:: Togo – two cVDPV2 cases.

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More than 3.1 million Iraqi children to be vaccinated against polio
Baghdad, 26 November 2019 – Health authorities in Iraq, in partnership with the World Health Organization (WHO) and UNICEF, have launched a campaign to reach more than 3.1 million children under-5 years of age with lifesaving polio vaccine.

The 5-day campaign aims to target children in 65 districts in the governorates of Baghdad, Babylon, Diwaniya, Diyala, Muthanna, Thi-Qar, Missan and Basra.

“Over the years, WHO, the Ministry of Health and UNICEF have worked hard to improve immunization coverage in the country. Therefore, it is important that we keep building on our work by making sure that children are vaccinated against childhood preventable diseases like polio and we keep Iraq polio free,” said Dr Adham Ismail, WHO Representative for Iraq. “During this second phase of the campaign, we want to reach all the children under 5 regardless of their previous vaccination status with oral polio vaccine leaving no one out no matter where they are,” added Dr Adham…

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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 30 Nov 2019]

Democratic Republic of the Congo
:: Dead and injured following attacks on Ebola responders in the Democratic Republic of the Congo 28 November 2019
:: Ebola Outbreak in DRC 69: 26 November 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 30 Nov 2019]

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – 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
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Myanmar – 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

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WHO Grade 1 Emergencies [to 30 Nov 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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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

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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.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified

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