In the Journals

WHO urged to consider Angola yellow fever outbreak public health emergency

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May 9, 2016

Two professors from Georgetown University Medical Center have appealed for WHO to convene an emergency committee and coordinate an international response for what they consider to be the worst yellow fever outbreak in Angola since 1986.

As of April 26, as many as 2,023 people may have been infected with yellow fever, resulting in 258 deaths. Additional cases were reported in China, the Democratic Republic of the Congo and Kenya among travelers returning from Angola.

Margaret Chan

Margaret Chan

In early April, WHO Director-General Margaret Chan, MD, traveled to Angola to join international partners in rolling out a mass yellow fever vaccination campaign that reached more than 7 million residents. However, in their recent viewpoint published in JAMA, Daniel Lucey, MD, MPH, and Lawrence O. Gostin, JD, of the O’Neill Institute for National and Global Health Law at Georgetown University, warned that a shortage of yellow fever vaccines is anticipated if the disease spreads to regions outside of the country. A vaccine stockpile maintained by the International Coordinating Group is currently limited due to a lack of specific pathogen-free chicken eggs needed for vaccine development. In response, the authors advised WHO to consider implementing its Emergency Use Assessment and Listing (EUAL) procedures, which were first introduced during the Ebola virus outbreak, to authorize a reduced yellow fever vaccine dose to prevent vaccine shortages and alleviate the epidemic.

Daniel Lucey

Daniel Lucey

Lawrence O. Gostin

Lawrence Gostin

“International experts have urged using one-fifth of the normal vaccine dose in Angola to avert acute shortages if the virus spreads,” Lucey and Gostin wrote. “Stewardship of scarce vaccine supplies is essential, but requires the WHO’s director-general to declare a public health emergency of international concern or determine it is ‘in the best interest of public health.’ ”

The authors also recommended that WHO meet with yellow fever vaccine manufacturers to amplify research and development with nonegg-based vaccines, and called for a vector control strategy for yellow fever in addition to Zika virus. Although they acknowledged that WHO has responded more quickly to the yellow fever outbreak than with the Ebola or Zika virus epidemics, Lucey and Gostin advocated for WHO to strengthen its governance in global health security.

“Global health advocates should not have to call for convening an emergency committee for each new international health threat. Instead, the WHO should establish a standing emergency committee to meet regularly to advise the director-general whether to declare an emergency, take necessary steps to avert a crisis, or both,” they wrote. “The complexities and apparent increased frequency of emerging infectious disease threats, and the catastrophic consequences of delays in the international response, make it no longer tenable to place the sole responsibility and authority with the WHO’s director-general to convene currently ad hoc emergency committees.” – by Stephanie Viguers

Disclosures: Lucey and Gostin report no relevant financial disclosures.

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