Yellow fever, Zika, Ebola — We’re reading about outbreaks old and new, and the global response

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Yellow fever outbreak in Brazil – Brazil’s Ministry of Health reports dozens of deaths resulting from a yellow fever outbreak in Minas Gerais, a large, inland state with low yellow fever vaccine coverage. Because Minas Gerais is adjacent to the states of Sao Paolo, Rio de Janeiro and other highly populated states with low vaccine coverage, the World Health Organization warns that a larger yellow fever epidemic is a possibility. Yellow fever is transmitted from the same mosquito that transmits the Zika virus, dengue fever, and chikungunya. Still recovering from the Zika virus outbreak that infected over 200,000 and resulted in almost 2,500 children born with congenital birth defects, Brazil’s Ministry of Health has deployed teams to investigate the outbreak, perform mosquito control and immunize residents. Minas Gerais and neighboring states are no stranger to small yellow fever outbreaks, with the last outbreak occurring in 2003. The largest yellow fever outbreak in most recent history occurred in Angola in 2016, with over 3,000 suspected cases and 354 deaths.

How the response to Zika failed millions – From partisan bickering that delayed Zika response funds for months, to inadequate public health advice to at-risk women, to the spraying of pesticides that didn’t work, this piece from the New York Times outlines the various ways the international community and local governments failed to adequately respond to the Zika outbreak in the Western Hemisphere. The article notes that while the World Health Organization, Centers for Disease Control and Prevention and other agencies did well to warn travelers from visiting Zika-affected regions in Latin America, tens of millions of women living in those areas were left with little to no protection. One particularly damaging failure, the article notes, is the unequal and inadequate advice given to women on reproductive health: “The failure to advise women to postpone pregnancy, if they could, until the epidemic passed ‘was the single greatest travesty of the epidemic,’ said Amir Attaran, a professor of law and medicine at the University of Ottawa. It was ‘hideously racist hypocrisy,’ he added. ‘Female American tourists were given the best and safest public health advice, while brown Puerto Rican inhabitants were told something else entirely.’”

Completing the development of Ebola vaccines – While Merck has successfully completed a field efficacy trial of rVSV-ZEBOV — a vaccine to prevent Ebola, the challenge remains of licensing and delivering a vaccine to prevent outbreaks similar to the West African outbreak of 2014. This report from the Wellcome Trust and the Center for Infectious Disease Research and Policy offers several recommendations on delivering a safe and effective vaccine, including restructuring global leadership for Ebola vaccine preparedness, addressing readiness gaps, and developing strategies for post-licensure trials. The report also outlines steps that remain for the rVSV-ZEBOV vaccine and challenges for other vaccine candidates and manufacturers.

Experimental therapies for Ebola Virus disease: What have we learned? – This editorial on experimental Ebola treatments calls for the global health community to capitalize on the lessons learned from the Ebola outbreak in West Africa and take a number of steps improve the development and regulatory processes for experimental interventions. Recommendations include accelerating the pace of clinical trials during future infectious disease outbreaks, prioritizing drug candidates, and setting logistical frameworks for rapid operationalization, among others, to rapidly evaluate experimental interventions.

New global coalition launched to create vaccines – This week at the World Economic Forum in Davos, Switzerland, the Bill and Melinda Gates Foundation, the Wellcome Trust, and the governments of Japan, Norway and Germany announced the launch of a global coalition to create new vaccines for emerging infectious diseases. The Coalition for Epidemic Preparedness Innovations, or CEPI, received an initial investment of $500 million from partners to address the “world’s woeful lack of preparedness” seen during the 2014 Ebola epidemic in West Africa.” While the United States is not providing funding and is not a formal partner, subject expertise may be offered, according to Rick Bright, director of the U.S. Biomedical Advanced Research and Development Authority. Initially, CEPI will focus on MERS, Lassa fever and Nipah – an emerging infection which infected 300 and killed 100 in Singapore where it was first identified. The Coalition hopes to develop two vaccine candidates for each target disease.

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