Yellow fever vaccine shortages could spark global crisis, experts warn

BY: Daily Mail

An outbreak of yellow fever could become the latest global health emergency, experts have warned.

A major flare up in Angola has been followed by two smaller outbreaks in Uganda and Congo, and while largely under control, scientists have warned countries to be vigilant.

Yellow fever is hard to spot early on and spreads quickly in towns, transmitted by the same mosquito that carries the Zika virus.

The pest bites in the daytime and has flourished during the abnormal El Nino weather of the past year caused by the warming of the Pacific Ocean off the coast of South America. 

'What we hope is that El Nino will not be faster than we are,' said Sylvie Briand, head of WHO's department of pandemic and epidemic diseases.

'We are concerned for other countries that have high densities of mosquitoes.'

The concern comes as two Georgetown University professors have called on the WHO to convene an emergency committee under the International Health Regulations.

In addition, with frequent emerging epidemics, they call for the creation of a 'standing emergency committee' to be prepared for future health emergencies.

In their editorial, published in JAMA Viewpoint, Professor Daniel Lucey and Professor Lawrence Gostin, of the O'Neill Institute for National and Global Health Law at Georgetown, explain that the ongoing spread, and potential future spread of yellow fever, coupled with a limited vaccine supply, should compel the WHO to 'urgently convene an emergency committee to mobilize funds, coordinate an international response and spearhead a surge in vaccine protection'.

An epidemic of yellow fever, first reported in January, has been spreading rapidly in Angola.  

The Pan American Health Organization (PAHO) declared an epidemiological alert on April 22 for yellow fever in Latin America, where the Aedes aegypti mosquito vector is also actively transmitting Zika and dengue viruses.

Vaccine 'supply shortages could spark a health security crisis', say the professors, pointing out that spread of yellow fever has already taken place in Kenya and the Democratic Republic of Congo, where efforts to vaccinate two million people are planned.

'Acting proactively to address the evolving yellow fever epidemic is imperative,' they say.

Professors Gostin and Lucey point out that an emergency committee meeting would allow its members to advise the director-general, Dr Margaret Chan on the epidemic and trigger discussions about a surge in vaccine production even if a public health emergency of international concern (PHEIC) is not declared.

Finally, the professors say time has come to consider a more efficient way to manage potential public health emergencies.

'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 sole responsibility and authority with the Director-General to convene currently ad hoc emergency committees,' Professors Lucey and Gostin write.

Instead, they support establishing a 'standing emergency committee' that would meet regularly to advise the director-general.

Until the development of the highly effective vaccine, yellow fever changed history, Ms Briand said, with outbreaks delaying construction of the Panama Canal and encouraging Napoleon to give up territorial ambitions in North America.

In Angola's capital Luanda, the first cases were at a roadside restaurant six months ago, when a group of friends fell ill with suspected food poisoning and several died. 

Only when the restaurant owner died was the alarm raised.

Angola has had 2,267 suspected cases and 293 deaths. 

Of the cases, 696 have been confirmed, including 445 from Luanda province. 

Democratic Republic of Congo has had 41 confirmed cases, almost all of them imported from Angola, but the outbreak was discovered early and should be stopped quickly, Ms Briand said.

Uganda, which has seven confirmed cases in rural areas, was also well set up to tackle such outbreaks, she said.

Luanda's population is now almost completely vaccinated, but it used up the world's entire emergency stockpile of vaccines, and the slow vaccination campaign allowed the virus to spread to other provinces.

'The vaccine supply, which is usually sufficient, may become stretched if we have more outbreaks in the coming months,' Ms Briand said.

An early risk is Angola's population of foreign oil workers, who are in danger of taking the disease home with them.

Portugal and China, which both have strong links to Angola, have both taken the right steps to protect themselves, Ms Briand said.

But many countries in Africa do not have vaccination coverage for children, and Nigeria, which suffered thousands of yellow fever deaths in a multi-year outbreak in the 1980s, was still 'definitely a country at risk', she said.

'We hope to be able to vaccinate everybody before there's a case.'


Credit: Daily Mail