Completing Polio Eradication

February 2012

Context

I n d i a

5

Routine Immunization

Immunization Days (NIDs)

Surveillance

Mop-ups

Polio

cas

es (t

hous

ands

)

300

200

100

0

400

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Polio-paralyzed Children, 1988-2011

Type 2 polio eradicated

> 40 countries 2011

Progress: 1988-2011

1988became re-infected

"WHO has removed

India from the list of

countries with wild

poliovirus"

Rukhsar Khatoon Dr Margaret Chan West Bengal, India Director-General, WHO January 2011 25 February 2012

World Health Assembly Resolution 65.5

"DECLARES polio eradication a programmatic

emergency for global public health…

…urges the Director-General to rapidly finalize

a polio endgame plan".

25 May 2012

The Polio Emergency

Response International:

• DG-led Polio Oversight Board

• emergency operations centers & SoPs

• surge of >5000 people to worst areas

National:

• Presidential/PM focal points

• multi-sectoral emergency action plans

• real-time monitoring & accountability

• extensive revision of field operations

Sharing Best Practices from India

Delegations from Nigeria, Pakistan,

Afghanistan

15 Indian polio staff in Nigeria x 2

missions

microplanning

operational tactics

monitoring & accountability

technical innovations

social mobilization

surge support

+++ +++

+++ +++

+++ +++

+++ +++

- +

+ ++

+ ++

++++++

- ++

+ ++

+ ++

+++ +

- +

++++

+ +

+++ +

+++ +++ + ++ + ++ + ++ +++ +++ + +++ + +++ + ++

Documenting & Applying Best Practices Status prior to WHA Resolution 65.5

Documenting & Applying Best Practices Status at end-2012

India Nigeria Pakistan Afghan

UN General Assembly Special Event on Polio, September 2012

Afghanistan Pakistan

Bill Gates Nigeria

Rotary WHO

IDB CDC

UNICEF

The Impact

Dec 2011 Dec 2012

Polio, type 3 cases

All type 3 cases in last 9 months were

in Nigeria

* 2012: Nigeria = 19 cases (most recent 10 Nov); Pakistan = 3 cases (most recent 18 Apr)

Polio-paralyzed children at 31 Dec 2011 vs. 2012

0

25

50

75

100

125

150

175

200

Pakistan Afghanistan Nigeria Chad

Cas

es

2011 2012

New evidence of improvement in key 'reservoirs' Inaccessible children in 13 high-risk

0

25,000

50,000

75,000

100,000

Jan Jun Jul Sep Oct

districts, Jan-Oct 2012

polio paralyzed children, last 4 months

Risks to the 2013 'low season push'

Pakistan: attacks on health workers

elections

Afghanistan: reduced access in AGE areas cross border transmission

Nigeria: spread into West Africa

Managing new risks:

• Provincial Security Coordination Committees

• Major polio campaign adjustments

• Leveraging broad Islamic community support

• Political all-party issue

The Polio Eradication &

Endgame Strategic Plan

Goal: to complete the eradication &

containment of all wild, vaccine-related

and Sabin polioviruses.

Last type 2 wild poliovirus: 1999

however…..

circulating Vaccine-Derived Poliovirus Outbreaks (cVDPVs), 2000-2011

Type 2 (478 cases)

Type 1 (79 cases)

Type 3 (9 cases)

Major Objectives

1. poliovirus detection & interruption

2. RI strengthening & OPV2 withdrawal

3. containment & certification

4. legacy planning

Last wild polio case Last OPV2 use Certification

2013 2014 2015 2016 2017 2018

Virus detection & interruption

RI strengthening & OPV 2 withdrawal

Introduce IPV

Wild virus interruption

Outbreak response (esp. cVDPVs)

RI strengthening & OPV2 pre-requisites

OPV2 withdrawal

Containment & certification

Finalize long-term containment plans

Complete containment & certification globally

Mainstream polio functions, infrastructure & learnings Consultation Legacy Planning

26

What's new?

1. addresses all polio disease (wild & vaccine)

2. urgent emphasis on routine immunization

3. introduces new IPV options for longterm risks

4. includes contingencies if delay in endemic areas

5. firm timeline to complete eradication effort

Routine Immunization Coverage Bihar, India

% Full immunization coverage

In 2006-10, Bihar conducted 9-11 OPV campaigns/year

Exploiting the polio infrastructure for routine immunization strengthening, priority focus:

• management

• microplanning

• mobilization

• monitoring

The new Strategic Plan 2013-18

addresses historical errors & exploits

new technologies in a comprehensive

approach to complete eradication.

Major Risks

Inputs • lack of vaccines

• lack of financing

• inability to recruit human resources

Implementation • insecurity

• accountability gaps

• drop in political or societal support

Risk-specific mitigation measures & contingency plans

World Health Assembly

Polio Oversight Board

Independent Monitoring Board

(IMB)

Obj 1: Poliovirus Detection & Interruption

Strategic Advisory Group of Experts

(SAGE)

Obj 2: Routine EPI strengthening &

OPV2 withdrawal

Polio Partners Group

Global Certification

Commission (GCC)

Obj 3: Global Containment &

Certification

Financial Requirements

US$ 5.5 billion

Global Commitment for Polio Eradication, 2012 – 2013 Total estimated global funding need: $2.23 billion

Summary

Today, the world has the lowest-ever number of polio

cases & infected countries, and the

best-ever opportunity to stop all transmission.