The WHO recalibrates its vaccine doctrine: caution on Ebola, an offensive on mpox

The period has been marked by a strategic adjustment on the part of the World Health Organization in its management of epidemics, with a restrictive approach to the Ebola Bundibugyo vaccine contrasting with the launch of a global stockpile of mpox vaccines. This dual manoeuvre reveals an intent to tailor the response to the robustness of the scientific data available for each pathogen. In parallel, the diplomatic agenda has been dense in South-East Asia, with the adoption of the Dili Declaration on human resources for health and the celebration of trachoma elimination in Timor-Leste, underscoring concrete progress in regional public health.

The humanitarian situation in Gaza continues to dominate concerns, with the WHO issuing repeated warnings about the collapse of the health system as winter approaches. Finally, financial-governance signals are emerging with controversies over the management of Global Fund grants in Malawi, while new studies highlight persistent gaps in epidemic surveillance in the United States and the emergence of antimalarial resistance in Uganda, a reminder of how fragile health gains remain.

The WHO adjusts its vaccine strategy in the face of Ebola and Mpox outbreaks

This month, the World Health Organization (WHO) clarified its vaccine doctrine for two distinct viral threats. On 2 September, the organization published new emergency guidance on the use of Ebola vaccines during outbreaks of the Bundibugyo strain (BDBV). Following an extraordinary meeting of the Strategic Advisory Group of Experts on Immunization (SAGE), the WHO ruled that the Ervebo vaccine, effective against the Zaire strain, should be used against BDBV only within research protocols (WHO, 02/09). This decision rests on evidence deemed insufficient to warrant large-scale programmatic use, marking a cautious, data-driven approach.

Conversely, the WHO adopted a proactive posture on mpox (monkeypox). A global initiative was launched on 27 August to establish a vaccine stockpile, in order to guarantee equitable access for countries in the event of future outbreaks (WHO, 02/09; GAVI, 02/09). This initiative is particularly relevant for the WHO African Region, which accounts for two-thirds of reported cases. The mechanism aims to avoid a repeat of the access inequalities observed during previous health emergencies.

Progress and persistent challenges in the fight against poliomyelitis

The fight against poliomyelitis presents a mixed picture. On 11 September, the WHO announced the extension of the public health emergency of international concern (PHEIC) for poliovirus, signalling that the global threat has not been averted (respiratory-therapy.com, 11/09).

Nevertheless, significant progress is to be noted on the African continent. On 19 August, the WHO confirmed that independent teams had validated the interruption of poliovirus transmission in five countries: Burundi, Ghana, Guinea-Bissau, the Republic of the Congo and Uganda (WHO, 19/08). This advance constitutes a major step towards the complete eradication of the disease in Africa, although vaccination and surveillance efforts must continue in order to consolidate these gains.

The crisis in Gaza and the challenges of access to care

The humanitarian and health situation in Gaza has been the subject of repeated warnings from the WHO's most senior officials. On 3 September, the Director-General, Dr Tedros Adhanom Ghebreyesus, again stressed that "the humanitarian emergency continues to worsen", with growing health risks as winter approaches (Tedros WHO, 03/09). He warned that the health system, already overwhelmed, would not be able to withstand new waves of disease, describing peace as "the best medicine". The WHO has facilitated the medical evacuation of 13,285 patients since October 2023, but is calling for the reopening of transfers and for the international community to take in more patients (Tedros WHO, 02/09).

A complex signal nonetheless emerged in a WHO communication dated 3 September. While the main message relayed the alert on the health crisis, an Italian-language text included in the original source and dated late August, citing UNICEF and the Coordination of Government Activities in the Territories (COGAT), stated that the food-aid market was saturated and that Gaza had the lowest rate of acute child malnutrition in the Middle East (WHO, 03/09). This divergence underscores the complexity of assessing the situation on the ground.

Diplomatic momentum in South-East Asia and public-health successes

The 79th session of the WHO Regional Committee for South-East Asia (RC79), held in Dili, Timor-Leste, was the setting for intense diplomatic activity. The event culminated, on 8 September, in the adoption of the Dili Declaration on Human Resources for Health (Tedros WHO, 08/09). This declaration commits the region's health ministers to strengthening their health workforces in order to guarantee equitable access to specialised care, including for rural and remote populations.

The period was also marked by a notable achievement: Dr Tedros congratulated Timor-Leste on eliminating trachoma as a public-health problem, a victory attributed to rigorous planning and modern surveillance (Tedros WHO, 03/09).

Emergence of new threats and surveillance gaps

Several studies and reports published during the period highlight emerging challenges and flaws in global health systems. - Antimalarial resistance: A study published in Nature Medicine on 17 August revealed the emergence and rapid spread in Uganda of Plasmodium falciparum parasite polymorphisms associated with reduced treatment susceptibility (Nature Medicine, 17/08). This warning signal about the parasite's evolution threatens the efficacy of current therapies. - Measles surveillance: In the United States, an analysis published in Nature Medicine showed that county-level surveillance systems had failed to detect that the risk of measles transmission had exceeded the epidemic threshold in schools 2 to 3 years before the 2025-2026 outbreaks (Nature Medicine, 20/08). This study exposes a critical flaw in the early detection of epidemic risks at the local level. - Financing and governance: Financial-governance questions were raised in Malawi, where World Vision Malawi was flagged for 576 million kwacha in non-compliant expenditure under a Global Fund grant (Global Fund, 10/08). In addition, the Global Fund warned of high HIV and malaria rates in the Bunyoro region of Uganda, linked to the oil influx and to condom shortages (Global Fund, 07/09).

To watch

• Deployment of the global mpox vaccine stockpile: The operational modalities and financing of the initiative launched by the WHO and Gavi will bear close watching, notably the access criteria for countries.
• Follow-up on the Dili Declaration: The implementation by South-East Asian countries of the commitments made to strengthen human resources for health, particularly in underserved areas.
• Response to antimalarial resistance: The recommendations of the WHO and national health agencies following confirmation of the spread of resistant polymorphisms in Uganda.
• Ebola epidemiological situation in the DRC: The conclusions and recommendations from the second meeting of the IHR Emergency Committee on the Ebola Bundibugyo outbreak (of which only the report title had been published as of 28/08) are awaited.