Immunization, Vaccines and Biologicals

SAGE Working Group on Vaccination in Humanitarian Emergencies (June 2011 to January 2014)

Terms of Reference

Develop a framework for public health decision-making for vaccination in humanitarian emergencies, to be reviewed by SAGE in April 2012.

The specific question that needs to be addressed:

What key scientific, ethical, economic, public health, operational and political criteria should be part of a decision-making framework to guide the use of vaccines in emergencies?

The approach to address this question may include:

Reviewing experiences with vaccination in humanitarian emergencies, compile the available data, identify the information gaps, guide the work required to address the information and action gaps, and prepare for a SAGE review of the general guidance on vaccination in humanitarian emergencies.

Specific issues to review in support of this approach would be:

  • Defining the scope of humanitarian emergencies;
  • Review of vaccination experiences in humanitarian emergencies with particular focus over the last 10 years and with respect to the political, ethical, public health/scientific, operational and economic aspects:
    • Vaccine preventable disease (VPD) burden and other available interventions for the prevention and control of these diseases;
    • Public health/scientific issues (evidence for effectiveness; purpose individual protection and/or interruption of transmission)
    • Economic aspects
    • Opportunity costs (due to competing public health priorities);
    • Availability of vaccines and acceptability range of cost per person immunized;
    • Operational/Programmatic Feasibility - supply availability, logistics need, procurement process and funding, human resources need and availability, cold chain space, training needs, supervision, injection safety, waste management, security, vaccine characteristics, regimens, regulatory issues; etc.
    • Ethical issues.


SAGE Members

  • Helen Rees, Chair of Working Group. University of Witwatersrand, South Africa
  • Zulfiqar Bhutta, The Aga Khan University, Pakistan
  • David Durrheim, Hunter New England Area Health Service and Professor of Public Health, Australia
  • Xiaofeng Liang, Chinese Center for Disease Control and Prevention, China
  • Narendra Arora, International Clinical Epidemiology Network, India


  • Brenton Burkholder (Member until November 2011. In December 2011, Dr Burkholder was recruited by WHO and as such is no longer eligible to serve as a formal member of the working group).
  • Jorge Castilla, European Commission DG for Humanitarian Aid, Kenya.
  • Francesco Checchi, London School of Hygiene and Tropical Medicine, UK.
  • Alejandro Cravioto, International Centre for Diarrhoeal Disease Research, Bangladesh.
  • Rebecca Freeman Grais, Epicentre, France.
  • Keymanthri Moodley, Bioethics Unit, Faculty of Health Sciences,University of Stellenbosch, South Africa.
  • Gopinath Nair, Scientific and Administrative Head of National Institute of Cholera and Enteric Diseases, India (resigned for personal reasons in September 2011)
  • Robin Nandy, Polio Eradication, UNICEF.
  • Muhammad Ali Pate, National Primary Health Care Development Agency, Nigeria.
  • Ronald Waldman, Global Health Bureau, Avian and Human Influenza Unit, US Agency for International Development, USA.

WHO Secretariat

  • Brenton Burkholder (Since December 2011)
  • Peter Mala
  • Peter Strebel
  • Pem Namgyal
  • Claire-Lise Chaignat
  • Michelle Gayer


All members completed a declaration of interest. Only three members reported any interests. It was concluded that all members could take part in full in all of the discussions. The reported relevant interests are summarized below:

Zulfiqar Bhutta
  • Received travel reimbursements from Sabin Institute for participation in two meetings as a member of the Pneumococcal Awareness Council of Experts. This interest was assessed as personal, non-specific and financially insignificant*.
  • His department received in March 2011 a research grant from Novartis Global Health Institute on a Phase II trail of Vi conjugate vaccination. This interest was assessed as non-personal, non-specific and financially significant*.
Xiaofeng Liang
  • Received a travel grant in 2010 from sanofi pasteur and PAREXEL (bio/ pharmaceutical consultancy organization) to attend the Global Meningococcal Initiative's scientific secretariat's meeting. This interest was assessed as personal, non-specific and financially insignificant*.
  • His institution receives funding from ten Chinese vaccine manufacturers for conducting a clinical trial on H1N1 vaccines for which he is the principal investigator. This interest was assessed as non-personal, non- specific and financially significant*.
Keymanthri Moodley
  • Supervised a study funded by Novartis for hypertension in a private capacity. These interests were assessed as personal, non-specific and financially insignificant.
  • Received small speaking engagement fees from a number of companies including GlaxoSmith Kline (GSK) and Pfizer. These interests were assessed as personal, non-specific and financially insignificant.

* According to WHO's Guidelines for Declaration of Interests (WHO expert), an interest is considered "personal" if it generates financial or non-financial gain to the expert, such as consulting income or a patent. "Specificity" states whether the declared interest is a subject matter of the meeting or work to be undertaken. An interest has "financial significance" if the honoraria, consultancy fee or other received funding, including those received by expert's organization, from any single vaccine manufacturer or other vaccine-related company exceeds 10,000 USD in a calendar year. Likewise, a shareholding in any one vaccine manufacturer or other vaccine-related company in excess of 1,000 USD would also constitute a “significant shareholding”.

Last updated: 24 January 2012