Category: APHA IH Section

Dengvaxia’s FDA Priority Review: Is the global health community settling on a Dengue vaccine?

by pragmaticsolidarity, posted in APHA IH Section, Vector-Borne Disease

The Food and Drug Administration (FDA) announced on October 30th that Dengvaxia’s, Sanofi Pasteur’s dengue vaccine, file has been accepted for priority review within the regulatory agency. With this announcement, the FDA will ensure that a decision will be declared on approval in the United States within six months for the world’s first licensed vaccine protecting against this flavivirus. While this declaration by the FDA displays an improved pragmatic approach to addressing neglected tropical diseases (NTDs), this vaccine has created controversy throughout the global health community. This vaccine is licensed in twenty countries to date and implemented into country wide vaccination programs. However, the concerns accompanying this recombinant, live, attenuated, tetravalent dengue vaccination have led to a discontinuation of this technology with a loss of confidence in several nation states. The Philippines, the first country to complement their vaccination program with this vaccine, has even instructed Sanofi to reimburse the $70 million the country spent to vaccinate 830,000 children. This has caused many global health experts to doubt the impact this vaccine can have throughout the world – causing many to wonder if the global health community is settling on a dengue vaccine.

The dengue virus is estimated to cause 400 million infections each year spanning each of the World Health Organization’s (WHO) regions. This arbovirus belongs to Flaviviridae family and is spread to humans through the bite of an infected female Aedes aegypti mosquito and to a lesser extent from the Aedes albopictus species. The dengue virus has four unique serotypes, DEN-1, DEN-2, DEN-3, and DEN-4, which has caused an effective vaccine to be eluded for centuries. When a person is infected with one certain serotype, the person gains life-long immunity to that serotype. However, if that person contracts a different serotype, it increases the risk of the person developing severe dengue. This phenomenon is called antibody-dependent enhancement (ADE) which allows the different serotype to enter cells more efficiently due to the previously created antibodies from the initial serotype. The symptoms that dengue causes depend on primary or secondary infection. Primary infection results in an acute febrile illness that is typically cleared by the immune system within seven days, while secondary infection can lead to dengue hemorrhagic fever or dengue shock syndrome causing serious morbidity and mortality. The dengue virus currently has no approved treatments – highlighting the importance of an effective and safe vaccine for children and adults alike.  

The significant setbacks for Dengvaxia first arose when Sanofi Pasteur released interim studies concerning children aged 2 to 16 receiving the vaccine who were seronegative. This information was released on November 29, 2017 and revealed that among dengue-seronegative participants, recipients had increased rates of hospitalization for virologically confirmed dengue (VCD) and severe VCD in the vaccine group than in the group not administered the vaccine. These risks were significantly elevated in patients who were aged 2 to 8 years of age and became evident earlier than those aged 9 to 16 years of age. When this data became available, it led to the Strategic Advisory Group of Experts on Immunization (SAGE) of the WHO to reconvene and update their guidance on Dengvaxia. On April 18, 2018, SAGE recommended that for countries considering implementing Dengvaxia, every individual should be screened to determine their serological status with only seropositive persons receiving the vaccine.

The flavivirus genus includes other NTDs including the Zika virus, Japanese Encephalitis, West Nile Fever and Yellow Fever in addition to the Dengue Virus. The symptoms of each these ailments can present almost identically, especially in their milder forms, seeming almost flu-like in nature. When considering these identical disease presentations and the WHO’s recommendation to prescreen individuals for Dengvaxia, health care professionals must turn to dengue serological testing to ensure best practice – if the vaccine is accidentally given to a person with, for example, the Zika virus with no previous case of dengue due to a misdiagnosis from medical history, this would increase the risk of morbidity and mortality if dengue was contracted subsequently. The gold standard for serological testing is isolation and characterization of the virus, like PCR; however, this typically takes six or more days to receive the results and can be burdensome with it’s cost on a public health care system. A more common approach is enzyme immunoassay (ELISA) which is cost effective and less time consuming. However, in areas where two or more of the aforementioned flaviviruses exist, there is IgG cross reactivity between the viruses causing false positives for the dengue virus when ELISA is used. This often rules out the use of ELISA due to a common vector, Aedes aegypti, being able to spread two or more of these viruses within the same zone. Since the dengue virus is endemic throughout the developing world, dedicated health care professionals in these areas often don’t have funds, technology, or training in order to utilize the gold standard, PCR, in dengue testing — further highlighting the health disparities that exist on this earth. This leaves a major barrier to giving proper care to a large portion of humanity including administering this vaccine safely.

With the addition of rapid, accurate dengue test for the serological status of individuals that is in the pipelines (although no estimate of how soon it will be developed has been released yet), this vaccine will certainly find its niche in the global health society. However, this niche will exclude an enormous percentage of humans that would benefit from a safe and effective dengue vaccine. Those individuals that are currently seronegative and those who don’t have access to well-funded public health care system will continue to be at risk for developing the fatal consequences of the dengue virus. Global health leaders need to continue to promote and demand a vaccine that will ensure protection for a greater majority of people. Although this vaccine will serve some well, health care professionals must not settle until the dengue virus and each neglected tropical disease is properly addressed.

Attending APHA in San Diego this year? Visit us at one of our IH section events or meetings and attend our sessions!

by ihsection, posted in APHA IH Section

We hope that you are as excited as we are for the 2018 APHA Annual Meeting in San Diego! The APHA Annual Meeting represents the largest delegation of public health professionals of its kind and provides opportunities to learn, network with your peers and participate in meaningful public health discussions.

We believe that the greatest opportunity to get engaged and make the most of your APHA membership is through participation in your APHA Sections or Special Interest Groups (SPIGs), so we strongly encourage you to attend our business meetings and socials.  It’s a great way to network with your colleagues in the field of International Health and learn how to become more involved in our Section.  Below are a few events you may find beneficial to add to your calendar. Check out our complete IH section program list at APHA here: APHA 2018 – IH program highlights

International Health Special Sessions 

Session 3338.0  Forty Years since Alma Ata:  Achieving Health for All – Past, Present, and Future

Monday, November 12, 3:00 pm -4:30 pm: Collaborative Session (APHA Global Health-IH-MCH)

Session 4166.0 Health, Health Equity, and War: What is Happening in Yemen, Mexico, Syria and Gaza?

Tuesday, November 13, 10:30 am – 12:00 pm

Session 4274.1  Defending Women’s Rights in the Context of the Global Gag Rule

Tuesday, November 13, 1:00 pm – 2:30 pm:  Collaborative Session (IH-RSH)

International Health Section Awards Reception and Open House

Session 444.0  Tuesday, November 13, 6:00 pm – 9:00 pm.  (all IH members are welcome)

International Health Luncheon

Session 511.0  Wednesday, November 14, 12:30 pm – 2:00 pm  (tickets required)

International Welcome Desk

Please visit the International Welcome Desk next to the APHA Meeting Registration Area to let us know you arrived and to ask any questions.

IH Section Booth at the Public Health Expo

You can also visit us at the International Health Section booth in “Everything APHA” located in the Public Health Expo.  We would enjoy telling you about our Section benefits and learning from you what would be meaningful to you as an IH Section member in the future.

If you are new or need a refresher on getting the most out of the Annual Meeting, please join us at the Navigate & Network event on Sunday morning (details below).

Navigate and Network: APHA 2018

Sunday, November 11, 9:30 – 11:00 AM, Ballroom 6CF – SDCC

Please do not hesitate to contact Jay Nepal, membership committee co-chair at jnepal360@gmail.com, if you have any questions or comments.

We look forward to see you in sunny San Diego!

Join us for the 20th Annual Community-Based Primary Health Care (CBPHC) Working Group Pre-Conference of the APHA International Health Section

by ihsection, posted in APHA IH Section

Community Health Workers As Transformative Agents For Health Equity: Global Models, Tools and Lessons Learned from Across Borders

Join us for a lively discussion and workshop about health equity and the role of community health workers (CHWs)! A growing body of evidence demonstrates the impact of CHWs on improving and saving lives of mothers and children, reducing health inequities, and transforming health systems around the world. In this workshop we seek to gain a greater understanding of what types of conditions and health care systems allow CHWs to be transformative agents both locally in the US and globally. Additionally, we hope to build on this knowledge and explore how to create environments or support existing systems that allow CHW’s to optimize their ability to transform health care, both in the US and internationally. This workshop will bring together CHWs, community leaders, health professionals, students, program managers, social scientists, and national and international experts of community health work and community-based primary health care.

REGISTER: You can register for the Pre-Conference Workshop independent of APHA full conference registration. The link to register for the CBPHC Pre-Conference workshop here.

FOR MORE INFORMATION: Contact Dr. Laura Chanchien Parajon, Chair of CBPHC Working Group or Dr. Henry Perry, Co-Chair of the CBPHC Working Group at cbphcworkgroup@gmail.com

Be part of the CBPHC working group community! CBPHC is an empowering approach to improving healthcare that engages communities as full partners and extends preventive and curative health services beyond health facilities to communities and households. We are a group of dedicated and passionate health professionals, students and people all contributing to the dream of “health for all” as described in the inspirational 1978 Alma Ata Primary Health Care document. We seek to collaborate, connect, dialogue and reflect with others working in community based primary health care about best practices for achieving health equity.

Have you read the latest issue of our newsletter, Section Connection?

by ihsection, posted in APHA IH Section, Section Announcements

Make sure to check out our APHA Annual Meeting Edition of the Section Connection and see how you can contribute and network during the upcoming annual meeting! You can find the latest issue here: http://bit.ly/SectionConnection9 

If you cannot access the newsletter for any reason please email Theresa Majeski, Global Health Connections Chair, at theresa.majeski@gmail.com 

The Man-Made Health Crisis in Yemen Cannot Wait for the End of the War: What Can Humanitarian Actors Do?

by Yara Asi, posted in APHA IH Section, Human Rights, Policy and Advocacy, Refugee and Migrant Health

In 2017, only a few years into a brutal civil war, Yemen reported a cholera outbreak of one million cases, more than half of which were children, making it the worst outbreak in history. At the time, Yemen was already in the midst of what was considered a dire humanitarian crisis, with more than 20 million citizens affected. A year later, the situation has become even more critical, with the United Nations warning of “the worst famine in 100 years” within the next few months if the war continues. Many more Yemenis have died from lack of access to basic needs, such as clean water, food, medical care, and sanitation, than fighting.

Yemen was already considered one of the poorest countries in the world before the war, with low rankings on all indicators of human development. However, the war has completely devastated the nation and the health of its citizens. Multiple outbreaks of infectious disease such as cholera and malaria, high rates of food insecurity and malnutrition, tens of thousands of trauma-related injuries, and widespread mental distress have exhausted the healthcare system. Almost 80% of Yemeni children reported symptoms of post-traumatic stress disorder, an exceedingly high rate even when compared to other conflict-affected nations. Healthcare workers, many of whom have been unpaid for months or years, have been kidnapped, harassed, and killed, while hospitals have been directly attacked and bombed. Medical facilities are left with barely functional equipment, empty supply shelves, and sometimes no medical staff at all. One article detailed how the grandmothers of an infant born four months premature brought him to a hospital where they found no physicians, who had all walked out in protest the previous day after one of them was beaten up by one of the hospital guards. The grandmothers attempted to place the infant into an incubator themselves, but both machines were broken.

In April 2018, as long-term wars in Syria, Iraq, Afghanistan, and South Sudan rage on, as a probable Rohingya genocide in Myanmar goes into its second year, and as natural disasters strike with increasing frequency and strength around the world, United Nations Secretary-General António Guterres called Yemen the world’s worst humanitarian crisis. The International Rescue Committee reports that 16 million people (almost three quarters of the country’s population) cannot access basic medical care, with more than half of the country’s already limited health facilities destroyed. What is left of the health system is Yemen is almost entirely sustained by contributions of medicines, supplies, and money by international donors. An estimated 9.5 million people were provided some form of medical intervention by the WHO and their partners in 2017 alone. However, the politics of the conflict have rendered even this emergency care inconsistent and unreliable. Médecins Sans Frontières (MSF) has occasionally had to cease providing services in some parts of the country due to sustained attacks on their facilities and staff by both Houthi fighters and Saudi warplanes. An intermittent Saudi blockade on Yemen’s ports has prevented humanitarian agencies from bringing in food, medicines, and fuel, and even when supplies can enter the country, distribution networks are insecure due to airstrikes and combatants. Like many of the world’s worst humanitarian crises, the devastating circumstances are almost entirely man-made. It is not lack of money or resources that has brought Yemen to this point- the entirety of the budget that the Yemen Ministry of Health proposed for 2018 amounts to just three days of what Saudi Arabia alone spends on the war campaign.

Yemen would not be the first country to see the health and well-being of its citizens used as a bargaining chip in an intractable conflict. Alex de Waal, a professor at Tufts University and the Executive Director of the World Peace Foundation, called these types of man-made famines and humanitarian emergencies “economic war,” which is much more difficult to classify under international humanitarian law than a violent bombing campaign or overt starvation tactics. “The coalition air strikes are not killing civilians in large numbers but they might be destroying the market and that kills many, many more people,” he told The New Yorker. Couple destroyed markets with ruined medical facilities and it is clear that the quality of life of human civilians will be devastated for the long term. This is by no means a new wartime strategy. Perpetrators try to bring their enemy -combatants and civilians who are in any way affiliated with them- to the brink of humanitarian desperation to force concessions.

What is needed is immediate and meaningful action on the part of the actors involved in the war as well as the international community that is both providing the weapons and aid that sustain the conflict. Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, outlined three requests to ease the humanitarian burden in the country. First, he called for guaranteed safe access throughout all of Yemen so that aid agencies can provide goods and services. Second, he demanded an end to all attacks on health workers and facilities. Lastly, he insisted that civilian health workers who remain in Yemen must be paid for their vital services. Similarly, a report by the International Peace Institute recommends that the international community, especially the UN Security Council, enforce compliance to international humanitarian laws and norms. Humanitarian actors must also work to coordinate their responses by sharing data, involving local stakeholders, and collectively pushing against blockade efforts. While meeting immediate needs is the clear priority, prevention and long-term health capacity building must also be pursued to both avert widespread catastrophe and prepare for the Yemen that will remain after the war ends. None of these actions must wait for a political end to the war, which is the only way to truly protect civilian life and ensure basic access to the human rights of food, water, sanitation, and health. However, these actions can push back against efforts by all sides of the conflict to use the health and well-being of Yemen’s citizens as pawns in the achievement of their aims.