In WHO prequalified the OCV Dukoral SBLVaccin

In 2001, WHO prequalified the OCV Dukoral (SBLVaccin, Sweden) for purchase by UN agencies. Through a successful technology transfer agreement, a modified bivalent formulation, Shanchol (Shantha Biotechnics, India), was developed and manufactured and was prequalified in 2011. Both Shanchol and the newly prequalified Korean vaccine (Euvichol) are reformulated versions of Dukoral. Because these newer versions do not contain the cholera toxin, they do not require co-administration with an oral buffer, making these versions both easier to deliver in challenging field conditions and substantially less costly for the standard two-dose regimen (US$3·7 for Shanchol and Euvichol >$10·5 for Dukoral). In July, 2013, a global OCV stockpile was created. A stockpile is a mechanism to encourage change in vaccine use for underserved populations: a change from low demand, low production, high unit costs, and inequitable distribution, to an increased demand and production, lower unit costs, and greater equity of distribution. The Gavi Alliance approved funding of US$115 million from 2014–18 for a global stockpile delivery strategy for use in epidemic and endemic settings. Since inception, 21 shipments of OCV have been approved to be used in large preventive or reactive ci-1033 campaigns (about 4 million doses) in 11 countries. Because of limited supply, OCV is released from this stockpile after review and recommendation of country applications by the International Coordinating Group, composed of UNICEF, Médecins Sans Frontières, The International Federation of Red Cross, and WHO. The vaccine has been used successfully in various contexts—humanitarian crises (eg, South Sudan and Ethiopia), disease outbreaks (eg, Guinea, Malawi, Tanzania, and Iraq), and endemic hotspots (eg, Bangladesh, Democratic Republic of Congo, and Haiti). A major development during 2015 was that OCV demand exceeded supply (). The main reasons for this increase in demand are the observed feasibility of mass OCV campaigns and their ability to confer protection to underserved populations in complex situations. The increased availability and use of OCV has a multifaceted added value. OCV and established cholera response measures (eg, water, sanitation, and hygiene [WASH] measures; treatment regimens; surveillance; and social mobilisation) have often been viewed in the past as competitive, if not mutually exclusive. With greater awareness and use of OCV, these measures and vaccines are now being considered as complimentary and have proven to be synergistic on many occasions. In this sense, the stockpile becomes an operational data generator. In other words, with emphasis on vaccine availability accompanying the use of OCV, many donors and partners have worked together within the framework of the Global Task Force on Cholera Control to show the public health potential of a coordinated effort against cholera. The growing body of evidence of vaccine effectiveness and costing data is contributing to inform large investments in integrated control and prevention strategies. Over recent years, countries have become more prepared to report cholera, which is an important and positive change from the past, in which political and economic imperatives prevailed.
Women\'s health has gone through a major epidemiological transition in the past decades. It is now time to rethink how global health defines maternal in order to encompass challenges to the health of all women, as well as their transformative potential as productive members of society. The term refers, as generally defined, to life experiences that are not unique or restricted to pregnancy. Yet, the current global health use of maternal health concentrates attention to a narrow period of women\'s lives—pregnancy, childbirth, and 6 weeks\' post partum. While this definition of maternal health shows tremendous inequities affecting women, it is restricted by its exclusive focus on the . It does not consider the health of women who are not mothers, the many other problems that lead to premature death and disability, or the multiple roles women have in all societies. Furthermore, deaths associated with pregnancy, childbirth, and the postpartum period represent a decreasing fraction of women\'s overall burden of disease. The narrow focus on maternal health in relation to pregnancy and childbirth was appropriate historically. In low-income and middle-income countries (LMICs), the improvements in maternal deaths around childbirth were very modest during most of the 20th century, prompting a maternal and child health approach as a worldwide campaign to improve maternal health. These path-breaking initiatives successfully oriented work in global health for women—especially towards Millennium Development Goal 5. The most recent global estimates of the maternal mortality ratio show a decline from 385 per 100 000 live births in 1990 to 216 per 100 000 in 2015, with 303 000 maternal deaths in 2015. While estimates vary across sources, all coincide with a . These major reductions are largely due to improvements in countries of low income, but most preventable maternal deaths continue to happen to the world\'s poorest women.