Lessons Learned from Emergency Response Vaccination Efforts for Cholera, Typhoid, Yellow Fever, and Ebola

Abstract

Countries must be prepared to respond to public health threats associated with emergencies, such as natural disasters, sociopolitical conflicts, or uncontrolled disease outbreaks. Rapid vaccination of populations vulnerable to epidemic-prone vaccine-preventable diseases is a major component of emergency response. Emergency vaccination planning presents challenges, including how to predict resource needs, expand vaccine availability during global shortages, and address regulatory barriers to deliver new products. The US Centers for Disease Control and Prevention supports countries to plan, implement, and evaluate emergency vaccination response. We describe work of the Centers for Disease Control and Prevention in collaboration with global partners to support emergency vaccination against cholera, typhoid, yellow fever, and Ebola, diseases for which a new vaccine or vaccine formulation has played a major role in response. Lessons learned will help countries prepare for future emergencies. Integration of vaccination with emergency response augments global health security through reducing disease burden, saving lives, and preventing spread across international borders.

Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014–2015

“…Traditional “hygiene” recommendations did not prevent this epidemic, as there was no mechanism for the communities to remediate the water that was available to them nor to install proper latrines near their homes or near the market areas. Because necessary improvements to water and sanitation are likely to take decades to achieve, we think that targeted and appropriate vaccination campaigns or availability of typhoid vaccines at health facilities could potentially reduce morbidity and mortality [ 10 ]. Recommendations should also focus on targeting water treatment packs to the areas that have the bulk of cases, which would reduce risk of specific practices rather than discuss elimination, which is not practical in most affected areas.…”

Impact of prophylactic vaccination strategies on Ebola virus transmission: A modeling analysis

“…These actions include the European Commission's decision to grant a conditional marketing authorization to a vaccine candidate in November 2019 (which was followed by WHO prequalification), its subsequent independent approval by the United States Food and Drug Administration, and submission of a prophylactic vaccine candidate for accelerated assessment by Committee for Medicinal Products for Human Use of the European Medicines Agency. Given these recent developments, multiple relevant international public health institutions and governments of affected countries are considering stockpiling of vaccines both for emergency use in the event of an outbreak or epidemic and/or for preventive vaccination of selective at-risk populations (including HCW in endemic areas who carry a significantly higher risk of infection) and residents of densely-populated urban areas [12]. Henao-Restrepo and colleagues have postulated that effective ring vaccination can help control Ebola outbreaks [9], while Walldorf and colleagues have stated that rapid vaccination of vulnerable populations can constitute an integral part of the emergency response strategy [12].…”

“…Given these recent developments, multiple relevant international public health institutions and governments of affected countries are considering stockpiling of vaccines both for emergency use in the event of an outbreak or epidemic and/or for preventive vaccination of selective at-risk populations (including HCW in endemic areas who carry a significantly higher risk of infection) and residents of densely-populated urban areas [12]. Henao-Restrepo and colleagues have postulated that effective ring vaccination can help control Ebola outbreaks [9], while Walldorf and colleagues have stated that rapid vaccination of vulnerable populations can constitute an integral part of the emergency response strategy [12]. However, widespread vaccination in the midst of an outbreak or epidemic can pose challenges including estimation and allocation of resources to ensure timely vaccine availability, acceptance by the population, and speedy deployment over large geographical areas [12].…”

“…Henao-Restrepo and colleagues have postulated that effective ring vaccination can help control Ebola outbreaks [9], while Walldorf and colleagues have stated that rapid vaccination of vulnerable populations can constitute an integral part of the emergency response strategy [12]. However, widespread vaccination in the midst of an outbreak or epidemic can pose challenges including estimation and allocation of resources to ensure timely vaccine availability, acceptance by the population, and speedy deployment over large geographical areas [12]. The persistent epidemic in the Democratic Republic of Congo that has been ongoing since August 2018, with approximately 3,428 cases and 2,246 deaths having been reported as of February 2020 [13], has put large cities and neighboring countries at risk and reinforces the urgent need to formulate and implement effective prophylactic vaccination strategies [14].…”

Synergisms in Science: Climate Change and Integrated Pest Management Through the Lens of Communication—2019 Student Debates

“…Newly exposed human populations are also more susceptible to VBP outbreaks, and we have historically failed to adequately vaccinate populations even when vaccines are highly effective and cheaply produced ( Shearer et al 2017 ). Even when vaccines are available, global shortages have already occurred during severe outbreaks ( Walldorf et al 2017 ), disproportionately affecting countries with low gross domestic products or GDP ( Githeko et al 2000 ). Unpredictable vector range expansions from increased climate variability will make predicting outbreaks and maintaining vaccine stockpiles even more difficult.…”