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FOR POLIO OUTBREAK R E S P O N S E
May–December 2014
THE SYRIAN ARAB REPUBLIC, IRAQ AND SURROUNDING COUNTRIES
SYRIAN ARAB REPUBLIC, IRAQ, JORDAN, LEBANON, TURKEY, WEST BANK AND GAZA STRIP,
EGYPT AND IRAN
PHASE II
STRATEGIC PLAN
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Design by Paprika (Annecy, France)
FOR POLIO OUTBREAK R E S P O N S E
May–December 2014
THE SYRIAN ARAB REPUBLIC, IRAQ AND SURROUNDING COUNTRIES
SYRIAN ARAB REPUBLIC, IRAQ, JORDAN, LEBANON, TURKEY, WEST BANK AND GAZA STRIP,
EGYPT AND IRAN
PHASE II
STRATEGIC PLAN
In October 2013, wild poliovirus was detected in the Syrian Arab Republic. A robust coordinated
multipartner plan was implemented to interrupt virus transmission to protect the children in the region from
paralytic polio.
CONTENTS
I. EXECUTIVE SUMMARY .................................................................................................................................................. 03
II. BACKGROUND .................................................................................................................................................................. 04
III. GOALS AND OBJECTIVES ............................................................................................................................................ 05
IV. SITUATION OVERVIEW AND EPIDEMIOLOGY ..........................................................................................................07
V. RESPONSE TO DATE ...................................................................................................................................................... 09
VI. CURRENT RISK ASSESSMENT ....................................................................................................................................12
VII. PHASE II: RESPONSE PRIORITIES AND KEY ACTIONS ......................................................................................13
Supplementary immunization activities ...................................................................................................................13
AFP surveillance ...............................................................................................................................................................14
Routine immunization services ....................................................................................................................................14
Social mobilization and communications ..................................................................................................................14
Vaccines logistics and cold chain ................................................................................................................................15
VIII. HARD-TO-REACH AND INACCESSIBLE POPULATIONS ......................................................................................16
IX. NATIONAL, INTERNATIONAL AND INTERAGENCY COORDINATION ................................................................17
National ...............................................................................................................................................................................17
International .......................................................................................................................................................................17
Interagency .......................................................................................................................................................................17
X. BUDGETS, HUMAN RESOURCES AND FINANCIAL PLANNING .........................................................................18
XI. MONITORING AND EVALUATION ................................................................................................................................19
XII. ANNEXES ........................................................................................................................................................................... 20
ANNEX 1: SUMMARY OF COUNTRY WORKPLANS........................................................................................................ 20
SYRIAN ARAB REPUBLIC ............................................................................................................................................. 20
IRAQ .....................................................................................................................................................................................21
JORDAN ............................................................................................................................................................................. 23
LEBANON ...........................................................................................................................................................................24
TURKEY ..............................................................................................................................................................................26
EGYPT ................................................................................................................................................................................ 28
WEST BANK AND GAZA STRIP .................................................................................................................................. 29
ISLAMIC REPUBLIC OF IRAN ....................................................................................................................................... 30
ANNEX 2 TABLES AND FIGURES ........................................................................................................................................32
WHO/POLIO/14.03
01PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201402
I. EXECUTIVE SUMMARY
The “Phase II WHO/UNICEF Strategic Plan for Polio Outbreak Response” in the Middle East outlines the specific actions that will be implemented across the Syrian Arab Republic, Iraq, Jordan, Lebanon, Turkey, Egypt, the Islamic Republic of Iran, and the West Bank and Gaza Strip11 from May to December 2014 to fully interrupt wild poliovirus transmission and prevent further international spread.
Since the Syrian Arab Republic announced a polio outbreak on 28 October 2013, 36 cases have been confirmed in the country, with the most recent reported case had the onset of paralysis on 21 January 2014. Furthermore, Iraq confirmed the first Syria-related poliovirus case in an unvaccinated child who had the onset of paralysis on 10 February 2014.
Following the confirmation of a polio outbreak in October 2013, a comprehensive multicountry strategic plan for a polio response in the Middle East was put in place. The multicountry response in Phase I has been rapid, coordinated and focused on reaching the maximum number of children across the seven countries with oral polio vaccine (OPV).
As of 30 April 2014, 30 supplementary immunization activities (SIAs) have been conducted across the seven target countries using over 100 million doses of vaccines and targeting approximately 25 million children in multiple rounds of vaccination. In addition, detection and reporting of acute flaccid paralysis (AFP) cases have been intensified, national communications plans have been developed and updated, and efforts are under way to strengthen routine immunization.
However, significant risks still remain that the outbreak will spread further within the Syrian Arab Republic
1 Throughout this document, the West Bank and Gaza Strip refer to the area defined by the UN General Assembly (GA Resolution 67/9) as the State of Palestine.
and/or Iraq, and expand to neighbouring countries and potentially beyond. This threatens a collective global good and demonstrates that until endemic areas are cleared of the poliovirus, the risk of reinfection in countries with low immunization rates will be ever-present.
Building on the successes of Phase I implementation, based on a new risk assessment for the region and recognizing the operational gaps and weaknesses identified in the Middle East Polio Outbreak Response Review, the overall goals of the Phase II strategic plan in two zones of intervention will be to:
• interrupt poliovirus transmission in remaining focal areas of transmission by August 2014 through high-quality SIAs;
• improve the quality of AFP cases surveillance to ensure that any new cases of poliomyelitis are rapidly confirmed and responded to; and
• sustain polio-free status through increased routine immunization coverage and periodic SIAs.
Phase II of the response will focus on:• quality – improving the quality and intensity of
key activities including SIAs, AFP surveillance and routine immunization services, with emphasis on monitoring during and after campaigns; and
• reach – systematic mapping of hard-to-reach populations wherever they may be, and specific targeting of these populations in subsequent SIAs and with routine immunization and surveillance services.
The costs of implementing Phase II of the strategy are estimated at US$ 59 million.
03PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
EXECUTIVE SUMMARY
II. BACKGROUND
On 28 October 2013, the Minister of Health of the Syrian Arab Republic announced that after 15 years’ absence, polio had returned to the Middle East. Since that time, 36 cases have been confirmed in the Syrian Arab Republic, with the most recent reported case had onset of paralysis on 21 January 2014. Furthermore, Iraq confirmed the first wild poliovirus type 1 (WPV1) case since 2000 in a 6-month-old, unvaccinated child who had the onset of paralysis on 10 February 2014.
Following the confirmation of a polio outbreak in October 2013, a comprehensive multicountry strategic plan for a polio response in the Middle East was put in place, which focused on conducting mass polio vaccination campaigns targeting approximately 25 million children aged under 5 years. The goal of the strategic plan was to interrupt wild poliovirus transmission in the Syrian Arab Republic and surrounding countries by the end of March 2014 through:• implementing large-scale and repeated supplementary
immunization activities (SIAs) to stop the outbreak and protect all populations at risk;
• enhanced reporting and investigation of acute flaccid paralysis cases (AFP) to ensure rapid detection and response to any wild poliovirus transmission; and
• improved routine immunization coverage to provide protection in the longer term and to sustain polio-free status.
As of 30 April 2014, 30 SIAs had been conducted across the region, targeting approximately 25 million children with multiple doses, in:• the Syrian Arab Republic (six nationwide SIAs);
• Iraq (three nationwide SIAs, three subnational SIAs and one SIA conducted in October 2013 planned prior to the outbreak);
• Jordan (three nationwide SIAs);
• Lebanon (four nationwide SIAs);
• Egypt (three nationwide SIAs and one subnational SIA);
• Turkey (four subnational SIAs); and
• the West Bank and Gaza Strip (two SIAs).
Details of these campaigns, including coverage estimates based on administrative and post-campaign evaluation data, can be found in Annex 2.
The multicountry intervention and response in Phase I have been rapid, coordinated and focused on reaching the maximum number of children across the seven countries. However, significant risks still remain. The operational gaps and weaknesses identified in the recent Middle East Polio Outbreak Response Review need to be addressed systematically in the planning and implementation of the Phase II response plans at country and regional levels, to ensure all children in remaining focal areas of transmission are vaccinated with multiple doses of oral polio vaccine (OPV).
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201404
III. GOALS AND OBJECTIVES
Building on the successes of Phase I implementation, based on a new risk assessment for the region, and recognizing the gaps and weaknesses identified in the Middle East Polio Outbreak Response Review, the overall goals of the Phase II strategic plan will be to:• interrupt poliovirus transmission in remaining
focal areas of transmission by:
• identifying unreached children and ensure they are all vaccinated;
• increasing the reach, intensity and quality of repeated large-scale and targeted SIAs;
• improve the sensitivity and quality of surveillance of AFP cases to ensure any new cases of poliomyelitis are rapidly confirmed and responded to; and
• sustain the polio-free status through increased routine immunization coverage and periodic SIAs.
Based on a risk assessment, two priority zones of intervention have been defined:
Zone 1: Primary Outbreak Intervention Zone: Syrian Arab Republic and Iraq
Zone 2: Risk Reduction Zone: Turkey, Lebanon, Jordan, the West Bank and Gaza Strip, Egypt and the Islamic Republic of Iran
Figure 1. Polio outbreak response zones, Phase II
Syrian Arab Republic
Iraq
Turkey
Iran (Islamic Republic of)
Jor
West bank and
Gaza Stripdan
Egypt
Lebanon
Zone 2: Risk Reduction Zone
Zone 1: Primary Outbreak Intervention Zone
Data as of 30 April 2014
05PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
GOALS AND OBJECTIVES
OBJECTIVESThe objective in Zone 1 is to interrupt wild poliovirus
(WPV) transmission in the Syrian Arab Republic and
Iraq by August 2014, by implementing the proven
Global Polio Eradication Initiative (GPEI) outbreak
response strategy.
• Target 1: at least two rounds of National
Immunization Days (NIDs) by November 2014,
reaching 95% of the targeted population (validated
by post-campaign monitoring);
• Target 2: Subnational Immunization Days (SNIDs)
in focal areas of transmission, areas with low
coverage or high risk of transmission, reaching
95% of the targeted population;
• Target 3: any new governorate with confirmed
WPV1 infection implements a large-scale mop-up
response within 14 days; and
• Target 4: reach an annualized non-polio AFP
(NPAFP) rate of ≥2/100 000 and ≥80% of
AFP cases with adequate stool specimens,
both nationally and in all governorates, by
September 2014.
The objective in Zone 2 is to prevent further polio spread to neighbouring countries at immediate risk of virus transmission (Turkey, Lebanon, Jordan, the West Bank and Gaza Strip, Egypt and the Islamic Republic of Iran).
• Target 1: reach an annualized NPAFP rate of ≥2/100 000 and ≥80% of AFP cases with adequate stool specimens by September 2014;
• Target 2: coverage of 95% of target population in at least one NID, validated by post-campaign monitoring;
• Target 3: at least two targeted SNIDs in areas with low coverage or high risk of transmission, reaching 95% of targeted population;
• Target 4: polio vaccination of 95% of Syrian refugees aged under 5 years on arrival in the country or camps near borders;
• Target 5: any new country with confirmed WPV1 infection implements a large-scale mop-up response within 14 days, and prepares a national outbreak response plan within 21 days; and
• Target 6: routine polio vaccination of 95% of children (POL-3) by December 2014 (including refugees), with a coverage of at least 85% in all governorates.
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201406
IV. SITUATION OVERVIEW AND EPIDEMIOLOGY
Since the return of polio to the Middle East in October 2013, 36 cases due to WPV1 have been confirmed in the Syrian Arab Republic. Genetic sequencing indicated that the virus had been in the region for nearly a year (linked to a virus detected in environmental samples in Egypt in December 2012, with closely related strains also detected in environmental samples in Israel and the West Bank and Gaza Strip since February 2013). Of the 36 polio cases confirmed in the Syrian Arab Republic, 70% are from Deir Al Zour (25); other cases are from Aleppo (5),
Idleb (3), Hasakeh (2) and Hama (1). Of the confirmed polio cases, 52% never received OPV (19/36). (In 2013, the proportion of “zero-dose”, non-polio AFP cases among children aged 6 to 59 months was 9% nationally and 8% in the first quarter of 2014, an increase from 5% in 2011.)
In the confirmed WPV1 case in Baghdad-Resafa governorate, Iraq (see Figure 2), genetic sequencing indicates the virus is most closely related to the virus detected in December 2013 in Hasakeh in the Syrian Arab Republic.
Figure 2. Map of wild poliovirus and compatible cases in the Syrian Arab Republic and Iraq
Data as of 30 April 2014
In the first quarter of 2014, the number of confirmed polio and compatible cases significantly declined. Within the context of a marked improvement in the AFP surveillance, only two WPV cases were confirmed in the first quarter of 2014, as compared to 35 confirmed WPV cases in 2013. From the available data, it seems
that the outbreak might have peaked in the Syrian Arab Republic in week 40 of 2013 (see Figure 3). The number of confirmed WPV cases steadily decreased from week 40 in the Syrian Arab Republic, with no new case confirmed for six consecutive weeks after the January case. This decline is largely attributed to the success of
07PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
SITUATION OVERVIEW AND EPIDEMIOLOGY
the aggressive outbreak response activities. As of the end of April, six NIDs were implemented in the Syrian Arab Republic, in addition to four SNIDs conducted in contested areas. Furthermore, there was a progressive
increase in the number of children vaccinated in each round. However, despite progress in the Syrian Arab Republic, polio encroached into neighbouring Iraq, with one polio case confirmed.
Figure 3. AFP and confirmed polio cases the Syrian Arab Republic and Iraq, April 2013–April 2014
0
2
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14
16
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W15
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W16
May Oct Dec Jan Feb Mar Apr
Wild Compatible Discarded Discarded tOPV bOPV
2013
W16
2013
W17
2013
W18
2013
W19
2013
W20
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W21
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W22
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W51
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W52
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W01
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W02
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W03
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W04
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W05
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W06
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W07
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W08
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W09
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W10
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W11
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W12
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W13
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W14
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W15
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W16
25
20
15
10
5
0
May Oct Nov Dec Jan Mar Apr
Data as of 30 April 2014
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201408
V. RESPONSE TO DATE
Overall, the Syrian Arab Republic and surrounding countries in the Middle East have engaged in a massive response to the emergence of wild poliovirus in the region. In a complex political and security environment, governments, with the assistance and partnership of UN agencies and nongovernmental organizations (NGOs), have accessed and vaccinated millions of children in multiple rounds of SIAs.
In addition, detection and reporting of AFP cases have been intensified, national communications plans have been implemented, and efforts are under way to strengthen routine immunization.
An interim review of the response thus far was carried out in March 2014 and an assessment of achievement of objectives to date is presented in Table 1.
Table 1. Targets by intervention zone and status as of March 2014
Zone Target Status Comments
All countriesTo interrupt wild polio
virus transmission by end of March 2014
At risk
The seven countries included in Phase I have implemented 24 SIAs. No polio was detected in Jordan, Lebanon, Egypt, and Turkey, and decline in virus in environmental samples in West Bank and Gaza Strip The last polio case in Syria had paralysis onset on 21 January 2014; however, polio was detected in Iraq.
Zone 1: Syrian Arab Republic
NPAFP rate greater than 2/100 000 On track
All governorates except Aleppo and Tartous achieved NPAFP rate ≥ 2/100 000 (Sep 2013–Feb 2014)
Six rounds of NIDs by April 2014 On track
Five rounds completed with two rounds planned for April and May 2014
December SIAs reach 90% of accessible population Partially
In Dec 2013, 2.2 million children under 5 years vaccinated Post-campaign monitoring covers 79%
January reaches 90% of entire target population Partially
2.5 million children under 5 years vaccinatedPost-campaign monitoring covers 88%
Zone 2: areas in surrounding countries bordering transmission zones
Annualized AFP rate greater than 2/100 000
Not achieved
NPAFP rate improved but still below 2/100 000 in provinces in Turkey, Iraq and Jordan
In at least three SNIDs or NIDs, 95% coverage Partially
All campaigns achieved high administrative coverageLow post-campaign monitoring coverage among hard-to-reach population and refugees in Jordan and Lebanon
Vaccination of 95% of refugee children on
registration/arrival in camps
AchievedAll children are referred to health service on arrival for routine vaccination
Zone 3: other areas in surrounding countries
Annualized AFP rate greater than 2/100 000
Not achieved
Annualized NPAFP rate was below the target in Turkey, Lebanon, West Bank and Gaza Strip, and Lebanon
In at least two NIDs, 95% coverage
Not achieved
High administrative SIA coverage, but no PCM data available for Turkey, West Bank and Gaza Strip, Egypt or Iraq
Routine polio vaccination of 95% by Dec 2014 At risk Low and/or falling coverage in Lebanon and Iraq
Data as of 30 April 2014
09PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
RESPONSE TO DATE
Supplementary immunization activities have been conducted across the region since October 2013, targeting approximately 25 million children with multiple doses of oral polio vaccine. The Ministry of Health (MoH) of the Syrian Arab Republic conducted the first SIA on 24 October 2013, within five days of the regional polio outbreak alert. As of 30 April, the seven target countries have carried out 30 SIAs. Further information on SIA campaign implementation can be found in Annex 2.
Particular challenges to implementing SIAs included:• insecurity, particularly in the Syrian Arab Republic
and Iraq, which affected access to some high-risk areas and resultant low coverage rates in these areas;
• low risk perception among families and medical personnel who did not fully understand the urgency and need of repeated rounds;
• fatigue within national health systems due to the human resources and time demands from the SIAs; and
• lack of independent monitoring in some countries and inconsistent use of finger marking made it difficult to objectively assess post-campaign coverage.
The following AFP surveillance targets were achieved up to March 2014:• four out of the seven countries met the target NPAFP
rate of ≥2/100 000;
• five out of the seven countries met the target of ≥80% of AFP cases notified within seven days of the onset of paralysis;
• all seven countries met the target of ≥80% of AFP cases investigated within 48 hours of being reported; and
• six out of the seven countries met the target of ≥80% proportion of AFP cases with adequate stool specimens.
Further information on AFP surveillance can be found in Annex 2. Particular challenges to AFP surveillance in the region included:• access to areas, particularly northern governorates
of the Syrian Arab Republic, to carry out active AFP case surveillance and sample collections;
• suboptimal active surveillance and AFP case reporting and investigation;
• lack of standard AFP case definitions and awareness among clinicians; and
• lack of standardized stool sample collection and transport protocols.
Jordan, Turkey and the West Bank and Gaza Strip have more than 95% estimated routine immunization coverage of three doses of polio (POL-3). Egypt has less than 95% POL-3 coverage and the Syrian Arab Republic, Lebanon and Iraq have less than 80% POL-3 coverage. Further information on routine immunization can be found in Annex 2.
Particular challenges to routine immunization in the region included: • the collapse of routine immunization infrastructure
(including facilities and cold chain) in the Syrian Arab Republic;
• a lack of mapping of areas and population groups with suboptimal routine immunization coverage;
• a lack of catch-up protocols for under-immunized children, particularly among refugee populations; and
• a lack of reporting and data sharing from the private sector and partners, particularly those serving refugee populations.
A regional communications for development strategy was implemented to ensure more than 90% of caregivers with children aged under 5 years had appropriate knowledge of polio vaccination. This included knowledge of campaign dates, the importance of repeated doses and routine immunization, vaccine safety, risk of non-compliance, and ensuring children are immunized during SIAs.
The regional external communications strategy emphasized the risk of polio returning to the region and the importance of a coordinated, regional response, advocating for health system strengthening and maintaining a political commitment.
High household awareness of polio campaigns has been achieved across the region, but low awareness rates are still prevalent in high-risk areas of unvaccinated children. Post campaign monitoring in the Syrian Arab Republic, Lebanon and Jordan indicated that 70% of missed children are in areas with low risk perception, unawareness of the campaign, and misconceptions about OPV.
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201410
Particular challenges to communications and social mobilization in the region include:• poor focus on community-level interventions
during campaigns and lack of engagement of local communication actors, particularly in hard-to-reach areas and underserved populations; and
• a lack of diversified media outlets that can reach a wider audience.
The region required more than 105 million doses of oral polio vaccine in the first six months of the outbreak response. Only the Syrian Arab Republic and the West Bank and Gaza Strip reported some delays in vaccine transport and provision to insecure areas.
Particular challenges to vaccine supply in the region included: • a lack of timely sharing of country plans and requests
with the vaccine supply division;
• suboptimal vaccine stock management procedures, including accurate reporting of balances and wastage rates at the country level;
• bOPV is not licensed for use in the region, except in Turkey, so each shipment needs a waiver and exemption; and
• use of non-standardized target populations which provides challenges to timely and accurate vaccine supply and delivery.
11PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
RESPONSE TO DATE
VI. CURRENT RISK ASSESSMENT
The risk is still high that the outbreak will spread further within the Syrian Arab Republic and/or Iraq, and expand to neighbouring countries and potentially beyond. This threatens a collective global good and demonstrates that until endemic areas are cleared of the poliovirus, the risk of reinfection in countries with low immunization rates will be ever-present.
The following positive factors exist:• the huge number of children reached in successive
SIAs blunts the risk of an explosive outbreak of poliomyelitis;
• surveillance is improving in detection rates, case investigations and laboratory confirmation;
• overall routine polio vaccination coverage remains high in the region; and
• there is a good understanding at the community level of the need for and benefits of vaccination, and demand for vaccination services is still high overall.
Yet, a significant number of negative factors remain:
• The detection of a case of WPV1 in Iraq, linked to the northern Syrian Arab Republic, demonstrates the capacity of the virus to spread across borders. It now represents a new challenge to full interruption of virus transmission in the region.
• Population displacement both within the Syrian Arab Republic and beyond the country continues. Many children are still inaccessible within the Syrian Arab Republic due to conflict, and many refugees outside the country are either unregistered or living in informal tented settlements in host countries. Since the beginning of the conflict in the Syrian Arab Republic, over 9.5 million persons, almost half of the country’s population, have been displaced, including over 2.5 million into neighbouring countries, primarily Jordan, Lebanon, Iraq and Turkey (see Annex 2, Figure 5).
• Pockets of intense insecurity in Iraq persist, which hamper vaccine service delivery and can delay AFP investigation.
• The influx of refugees puts pressure on government services, and in some areas has led to resentment from local communities.
• Surveillance, while improving, is still suboptimal in some countries, especially at the subnational level (see Annex 2, Figure 4).
• Routine coverage is still too low in countries like Iraq, the Syrian Arab Republic and Lebanon. A disrupted routine immunization programme over the past three years has left large numbers of children susceptible to polio in both the Syrian Arab Republic and Iraq (see Annex 2, Figure 6).
• The region is entering the “high” transmission season.
Conclusion: Following the detection of wild poliovirus type 1 cases in the Syrian Arab Republic and Iraq, and despite a robust response in Phase I by the seven targeted countries, a continued multicountry intervention is needed to rapidly detect and interrupt wild poliovirus transmission and protect children in the region from paralytic poliomyelitis.
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201412
VII. PHASE II: RESPONSE PRIORITIES AND KEY ACTIONS
Phase II of the response will focus on:• quality – improving the quality and intensity of
key activities including SIAs, AFP surveillance and routine immunization services, with emphasis on monitoring during and after campaigns; and
• reach – systematic mapping of hard-to-reach populations wherever they may be, and specific targeting of these populations in subsequent SIAs, routine immunization and surveillance services.
With the confirmation of a WPV1 case in Iraq, Phase II countries include all from Phase I (the Syrian Arab Republic, Iraq, Turkey, Lebanon, Jordan, Egypt, and the West Bank and Gaza Strip) with the addition of the Islamic Republic of Iran for planning and SIA implementation purposes.
Supplementary immunization activities
Based on the current epidemiologic situation and in view of the recent confirmation of a polio case in Iraq, the following are the major activities planned:
• intensified SIAs in the Primary Outbreak Intervention Zone (the Syrian Arab Republic and Iraq) with a focus on reaching areas and populations previously not reached due to inaccessibility or insecurity;
• targeted campaigns to reach high-risk areas/populations in the Risk Reduction Zone (Lebanon, Jordan, Turkey, Egypt, the West Bank and Gaza Strip, and the Islamic Republic of Iran);
• synchronized, large-scale, multicountry campaigns by the fourth quarter of 2014; and
• systematic improvement of SIAs quality to ensure all children in remaining focal areas of transmission are reached by:
� mapping high-risk groups for special attention in SIAs and routine immunization services;
� implementing intra-campaign monitoring; and
� implementing post-campaign monitoring.
Table 2. Proposed schedule of SIAs for Phase II of the polio response
May Jun Jul Aug Sep Oct Nov Dec
Zone 1
The Syrian Arab Republic
NID (2.8, bOPV)
NID (2.8, tOPV)
SNIDs
(2.0, bOPV)
NID (2.8, bOPV)
NID (2.8, bOPV)
Iraq NID (5.6, tOPV)
SNIDs (3.0, bOPV)
SNIDs (3.0,
tOPV)NID (5.6,
tOPV)NID (5.6,
tOPV)
Zone 2
Lebanon
tOPV0.15
tOPV 0.15
bOPV 0.15
NID (0.6, bOPV)
NID (0.6, bOPV)
Jordan
SNIDs (0.20, tOPV)
SNIDs (0.20, tOPV)
NID (1.0,
tOPV)NID (1.0,
tOPV)
Turkey SNID Identify high-risk population and immunize them SNID SNID
EgyptIdentify high-risk population and immunize them
NID (14.5, tOPV)
SNID (4.5,
tOPV)
The West Bank and Gaza Strip
Identify high-risk population and immunize themNID (0.7,
OPV)NID (0.7,
OPV)
The Islamic Republic of Iran
SNID (0.25, bOPV)
SNID (0.25, bOPV)
Data as of 30 April 2014
13PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
PHASE II: RESPONSE PRIORITIES AND KEY ACTIONS
AFP surveillance
While AFP surveillance benchmark indicators are steadily improving, significant gaps and weaknesses still remain. Therefore, in Phase II of the response, all countries will develop a surveillance strengthening plan by June 2014 that will include:
• updated under-15 population figures including refugees and migrants;
• establishing/strengthening active surveillance to ensure a wide network, regular quality visits, supervision and performance monitoring;
• awareness meetings for orientation of health personnel together with training of surveillance focal points and sensitization of medical professionals (e.g. medical and paediatricians’ associations) and regular sharing of information on the current epidemiologic situation and performance;
• review of current AFP case investigation practices including stool transportation, identification of bottlenecks and development/updating of transport protocols to address delays;
• regular analysis of data at all levels to identify subnational gaps and feedback for action; and
• implementation of detailed investigations (to include social and behavioural determinates) of zero-dose AFP cases (and confirmed WPV, if applicable) to inform immunization and communication activities.
Routine immunization services
Of the eight countries in the regional polio response, five ( Jordan, Turkey, the West Bank and Gaza Strip, the Islamic Republic of Iran and Egypt) have POL-3 coverage of over 90% according to WHO/UNICEF estimates, whereas three countries (the Syrian Arab Republic, Iraq and Lebanon) have POL-3 coverage rates of between 50% and 79%.
Overall, the goals and targets for the Middle East polio response regarding routine immunization (RI) is routine polio vaccination of 95% (POL-3) by December 2014, with a coverage of at least 85% in all governorates.
To accomplish these targets, all countries will need to: • identify and map areas/groups with suboptimal
routine immunization using different sources of information;
• develop catch-up protocols for under-immunized children at different ages;
• maximize opportunities for delivering routine immunization
� at border crossing points;
� ensuring inclusion of RI in package of mobile teams;
� providing support to health facilities serving refugee populations (vaccine and staff);
• improve reporting and data sharing from the private sector and different partners involved in providing vaccination; and
• explore innovative strategies for including immunization with other antigens, for example child health interventions (e.g. child health days) and integration with other service providers (e.g. WASH, food services, education, etc.) by June 2014.
In addition, a specific plan for strengthening immunization services in the Syrian Arab Republic, Iraq and Lebanon will be developed by August 2014, building on the experiences from the polio outbreak response.
Social mobilization and communications
An updated regional communications strategy will be developed by May 2014 which will drive the social mobilization and communication activities across the eight target countries.
The communications objective is to increase awareness and risk perception, and create positive vaccine attitude and behaviour.
Plans will focus on:• mass media using regional and country media/print
material/social media and school packages; and
• community mobilization and strengthening of interpersonal communication (IPC) skills of health workers, especially in hard-to-reach areas/populations.
A wide variety of campaign monitoring and evaluation methods will be used to document the impact of the different interventions and ensure evidence-based planning.
The regional/country media strategy will be tailored to:• continue advocacy and raising risk perception of polio
and other vaccine preventable diseases to governments and communities amid competing priorities;
• develop high-impact content and involve targeted media channels to capture attention;
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201414
• promote regional protection against communicable diseases, including polio;
• proactively communicate immunization successes and remaining barriers;
• reduce stigmatization of Syrian refugees among host communities;
• use polio to show regional cohesion and support;
• strengthen communications, coordination and key messages with partners (OCHA, UNRWA, IOM, UNHCR); and
• invest in activities for regional immunization weeks.
At the national level, social mobilization and communication activities will continue to:
• highlight the continued risk of a virus outbreak without full protection against polio using OPV;
• diversify local strategies/channels to respond to different vaccine delivery approaches and communicate specific campaign dates;
• localize communications plans according to specific population groups and local media analysis;
• maintain public trust in the vaccine and the vaccinators;
• collect critical data on reasons for missed children during and after each SIA;
• develop quality materials that are tailored to the social context; develop high-quality attractive messages to address parents’ concerns and create
risk perception, demand and acceptance of repeated campaigns;
• strengthen IPC skills of health workers to address the public’s safety concerns and low risk perception;
• include messages on RI during and between SIAs;
• mitigate the tension from stigmatization of the Syrian population in the region; and
• be prepared with media packages that include answers to frequently asked questions (including difficult questions) and updated fact sheets, and use diverse spokespeople.
Vaccines logistics and cold chain
Countries supported by UNICEF and WHO will:• improve vaccine stock management, including
accurate reporting of balances and wastage rates to the regional office on a regular basis;
• provide timely sharing of plans and requests with the supply division;
• expedite the process of bOPV licensing;
• use specific CCL indicators for identifying gaps and strengthening in-country cold chain and logistics (this would also have a direct impact on the overall CCL capacity to deliver other vaccines in campaigns or through the routine immunization programme); and
• ensure micro-plans are updated regularly to adequately reflect gaps in cold chain equipment/vaccine storage, especially at the peripheral level.
15PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
PHASE II: RESPONSE PRIORITIES AND KEY ACTIONS
VIII. HARD-TO-REACH AND INACCESSIBLE POPULATIONS
Phase II of the outbreak response must have a special focus on children not reached in previous campaigns. The reasons for non-vaccination are different in each country, and solutions in each country will depend on local circumstances and opportunities.
In particular, special efforts will be made to reach children in insecure areas as well as in hard-to-reach populations, including refugees and nomadic populations. Different approaches and strategies may be needed in:• populations in contested areas
• populations in besieged cities/towns/areas
• populations in areas with active conflict or security operations
• populations that are mobile
• populations that may be discriminated against.
All the countries have hard-to-reach populations, including refugees and nomadic populations. Therefore, in Phase II, WHO and UNICEF along with partners in GPEI will:
• provide technical support to vaccination in areas not reachable by the Syrian Ministry of Health, through innovative arrangements for vaccine supply and delivery along with assistance in micro-planning, cold chain management and training;
• seek access to besieged areas through high-level advocacy and local negotiations including “humanitarian pauses”; and
• pre-position vaccine and cold chain equipment near areas of active conflict/security operations to rapidly take advantage of peaceful periods.
All countries will:• identify, map and track high-risk populations/
inaccessible areas after each SIA round at the lowest possible levels;
• conduct a security/access analysis to identify reasons for inaccessibility and determine risk mitigation actions;
• develop plans to access high-risk areas/hard-to-reach populations which involve NGOs, the Red Crescent and local communities in the high-risk areas;
• for refugees, encourage registration and develop mechanisms for tracking registered refugees, and implement strategies to reach unregistered refugees in host communities (e.g. liaison through UNHCR, IOM, community links and package delivery);
• identify health-care-seeking behaviour of high-risk populations;
• ensure acceptance in health facilities and provide support to those serving hard-to-reach populations;
• provide guidelines on routine immunization (catch-up) to the under-immunized; and
• expand the surveillance network to health facilities used by hard-to-reach populations and initiate community surveillance among them.
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201416
IX. NATIONAL, INTERNATIONAL AND INTERAGENCY COORDINATION
National
Activities aimed at ending polio transmission, preventing its importation and reducing the risk of transmission where the disease is imported must be coordinated at the national level by a multiagency and multidisciplinary team led by the Ministry of Health.
• WHO, UNICEF, partners in GPEI and other UN agencies will continue to support national polio response control teams/rooms.
• Weekly meetings of polio control rooms/teams will be held at the national level.
• Each country will produce and share a weekly situation report.
• Countries will provide regular updates to WHO and UNICEF on planning for NIDs, AFP surveillance and activities aimed at strengthening routine immunization services.
International
• The response at the regional level will continue to be coordinated by a joint WHO/UNICEF outbreak response team based in Amman, Jordan.
• The regional response team, with the support of other partners in GPEI (the Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation) will continue to support national polio risk management efforts.
• An inter-ministerial meeting is planned for May 2014 in conjunction with the WHO World Health Assembly, to review progress in the response and address any outstanding issues.
• A weekly Epidemiological Situation Report covering all eight countries will be produced and disseminated as well as a weekly briefing for technical partners based in Amman.
• A monthly bulletin for partners will continue to be produced, summarizing the epidemiological situation, country activities, financial situation and ongoing needs, and a monthly donors/partners briefing meeting will be held for partners based in Amman.
Interagency
• A format for sharing information between agencies (WHO, UNICEF, UNHCR and IOM) will be developed and will ensure regular, timely sharing of data.
• Agencies will explore ways to increase involvement of NGOs and use their operational capacity, especially in hard-to-reach populations.
• Regular, weekly WHO/UNICEF meetings at the regional and country level will be held for information sharing.
• The WHO-UNICEF Regional Office and Country Offices will hold conference calls as needed.
17PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
NATIONAL, INTERNATIONAL AND INTERAGENCY COORDINATION
X. BUDGETS, HUMAN RESOURCES AND FINANCIAL PLANNING
In Phase I of the response (November 2013–May 2014), the seven countries involved responded with large financial commitments to implement SIAs and enhance AFP surveillance. Where needed, financial contributions from donors were channelled through the UN agencies to close funding gaps.
Moving into Phase II, funding mechanisms are transitioning from emergent systems to standardized systems. As part of this transition, greater detail
surrounding funding requests to donors is required, and a more standardized donor reporting format is expected. To facilitate these changes in financial requirements, WHO and UNICEF are providing technical assistance in funding planning and reporting to the eight countries involved in the Phase II response.
The implementation of Phase II of the Middle East polio outbreak response is estimated to cost approximately US$ 59 million.
Table 3. Budget summary for the Phase II Middle East polio outbreak response
Item Budget
Vaccine procurement 14 525 000*
Operational costs (SIAs) 28 270 000
Assistance to AFP surveillance 2 886 500
Strengthening of routine immunization services 3 745 000
Communications campaigns 9 190 000
Effective coordination 1 028 500
Total 59 645 000
*Includes extra vaccine for border vaccination in the Islamic Republic of Iran
Data as of 30 April 2014
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201418
XI. MONITORING AND EVALUATION
Reviews of polio outbreak responses are mandated and required by World Health Assembly Resolution 59.1. The reviews should occur at three-month intervals and focus on determining the speed and effectiveness of the outbreak response, as well as identify gaps in implementation and make recommendations to improve the intervention.
The next outbreak response reviews will be carried out on September 2014. If required, a third review and planning meeting will be held in December 2014.
Countries are requested to develop and implement quarterly financial audits, and to conduct monitoring and evaluation activities for SIAs, RI and AFP surveillance in August 2014.
19PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
MONITORING AND EVALUATION
AN
NE
X 1
: SU
MM
AR
Y O
F C
OU
NTR
Y W
OR
KP
LA
NS
SY
RIA
N A
RA
B R
EP
UB
LIC
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
3.5
mil
lion
of w
hic
h O
PV
cost
sU
S$ 2
.35
mil
lion
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
NID
NID
SNID
NID
NID
Targ
et p
opu
lati
on
(in
mil
lion
s)2.
82.
82
2.8
2.8
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
bOP
VtO
PV
bOP
VbO
PV
bOP
V
Ass
ista
nce
to A
FP
surv
eill
ance
Impl
emen
tati
on/i
nten
sifi
cati
on o
f ac
tive
su
rvei
llan
ce•
Con
duct
fiel
d v
isit
s an
d r
efre
sher
tra
inin
g in
gov
erno
rate
s/d
istr
icts
wh
ere
AF
P su
rvei
llanc
e is
sub
opti
mal
• D
evel
op a
nd d
istr
ibut
e A
FP
surv
eilla
nce
man
uals
and
pos
ters
•
Dev
elop
and
dis
trib
ute
wee
kly
surv
eilla
nce
upda
te•
Rev
iew
nat
iona
l pro
toco
l and
pro
cedu
res f
or A
FP c
ase
inve
stig
atio
n in
clud
ing
spec
imen
co
llect
ion
US$
100
000
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
• Id
enti
fy a
nd m
ap g
over
nora
tes
and
dis
tric
ts w
ith
poor
RI
per
form
ance
inc
lud
ing
nom
adic
gro
ups,
and
tra
in s
taff
in p
rior
ity
dist
rict
s•
Dev
elop
str
ateg
y fo
r in
crea
sed
rout
ine
cove
rage
: Rea
ch E
very
Dis
tric
t (R
ED
)•
Supp
ort f
acili
ties
ser
ving
har
d-to
-rea
ch p
opul
atio
ns
(vac
cine
, col
d ch
ain,
sta
ff)
• D
eplo
y “m
obile
team
s” fo
r em
erge
ncy
publ
ic in
form
atio
n (E
PI)
impl
emen
tatio
n•
Con
duct
com
plex
cov
erag
e su
rvey
at t
he n
atio
nal
leve
l
US$
385
000
Com
mu
nic
atio
ns
cam
paig
n
• D
esig
n/d
evel
op te
levi
sion
spo
ts a
nd m
edia
, air
ing
on lo
cal a
nd r
egio
nal
med
ia•
Des
ign
and
deve
lop
prin
ted
mat
eria
l (po
ster
s an
d fly
ers,
Q&
A, s
ign
s)•
Des
ign
and
deve
lop
PR s
trat
egy
(tel
evis
ion
talk
sho
ws
appe
aran
ce/c
eleb
riti
es)
• D
esig
n an
d de
velo
p sc
hool
pac
kage
s
US$
200
000
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
• N
atio
nal
: po
lio c
ontr
ol r
oom
, w
eekl
y po
lio r
espo
nse
bul
leti
n, b
iwee
kly
mee
ting
of
polio
res
pon
se p
artn
ers
• In
tern
atio
nal
: te
chn
ical
con
trib
uti
on t
o W
eek
ly M
idd
le E
ast
Situ
atio
n R
epor
t,
part
icip
atio
n in
reg
ion
al c
oord
inat
ion
mee
ting
s an
d re
view
s
US$
110
000
XII. ANNEXES
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201420
IRA
Q
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
19.
4 m
illio
nof
wh
ich
OPV
co
sts
US$
4.4
mil
lion
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
NID
SNID
SNID
NID
NID
Targ
et p
opu
lati
on
(in
mil
lion
s)5.
63
35.
65.
6
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
tOP
VbO
PV
bOP
VtO
PV
tOP
V
Ass
ista
nce
to A
FP
surv
eill
ance
Stre
ngt
hen
ing
AF
P s
urv
eill
ance
in
th
e h
igh
-ris
k zo
nes
• M
uth
ann
a in
add
itio
n to
the
nin
e pr
iori
ty p
rovi
nces
• M
inis
ter
of H
ealt
h m
eets
wit
h D
Gs
of h
ealt
h be
fore
eac
h SI
A r
ound
to
ensu
re t
heir
le
ader
ship
and
full
invo
lvem
ent i
n po
lio e
radi
catio
n ac
tivi
ties
• R
efre
sher
trai
ning
on
surv
eilla
nce
for d
octo
rs, s
urve
illan
ce fo
cal p
oint
s and
par
amed
ical
st
aff
• Sh
arin
g of
info
rmat
ion
on N
PAF
P am
ong
part
ners
and
at p
rovi
ncia
l lev
el•
Map
ping
of d
ata
by d
istr
icts
for
surv
eilla
nce
• W
eekl
y A
FP
surv
eilla
nce
bulle
tin
• O
ne n
atio
nal
AF
P su
rvei
llanc
e re
view
mee
ting
•
Inde
pend
ent s
urve
illan
ce r
evie
w
• St
reng
then
ing
of c
omm
unit
y-ba
sed
surv
eilla
nce
• St
ren
gth
enin
g of
com
mu
nic
atio
n ac
tivi
ties
for
AF
P su
rvei
llan
ce (
educ
atio
n an
d
com
mun
icat
ion
s m
ater
ials
and
tra
inin
g)•
Iraq
labo
rato
ry a
ccre
dita
tion
by fi
eld
visi
t •
Act
ive
surv
eilla
nce
• Su
ppor
t of A
FP
surv
eilla
nce
acti
viti
es (n
otifi
catio
n an
d in
vest
igat
ion,
etc
.)•
Twen
ty a
dvoc
acy
mee
ting
s, o
ne fo
r ea
ch g
over
nora
te•
Twen
ty s
uper
viso
ry v
isit
s, o
ne fo
r ea
ch g
over
nora
te•
Two
wor
ksho
ps e
ach
for
two
days
, on
e fo
r Ba
ghda
d an
d ne
ar g
over
nora
tes,
and
the
ot
her
for
far
gove
rnor
ates
to b
e he
ld w
ith
the
assi
stan
t of t
he N
atio
nal
Pol
io L
ab (N
PL)
US$
1 m
illio
n
21PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
2014
Budg
et
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
Stre
ngt
hen
ing
RI
in h
igh
-ris
k go
vern
orat
es•
Rev
iew
cov
erag
e in
dis
pute
d di
stri
cts
• C
ondu
ct c
ross
-bor
der
plan
ning
(bo
rder
syn
chro
nize
d m
icro
-pla
nni
ng)
• R
evie
w a
nd u
pdat
e R
I da
ta m
anag
emen
t to
ol a
nd t
rain
sta
ff t
o ac
com
mod
ate
new
sc
hedu
le•
Upd
ate
EPI
res
pon
se p
lan
focu
sed
on lo
gist
ics
• R
eact
ivat
e R
ED
app
roac
h st
rate
gy
• A
dvoc
ate
for
prim
ary
heal
th-c
are
staf
fing
to b
e re
view
ed•
Incl
ude
evid
ence
-bas
ed c
omm
unic
atio
ns
plan
s in
the
mic
ro-p
lan
• Fo
cus
com
mun
icat
ion
s tr
aini
ng o
n va
ccin
ator
s an
d he
alth
sta
ff•
Stre
ngth
en c
omm
unit
y en
gage
men
t •
Ass
ess
regi
onal
and
dis
tric
t col
d ch
ain
s•
Exp
and
and
stre
ngth
en c
old
chai
n m
anag
emen
t•
Adv
ocat
e am
ong
deci
sion
-mak
ers
for
usin
g bi
vale
nt v
acci
ne
US$
1 m
illio
n
Com
mu
nic
atio
ns
cam
paig
n
Impr
ovin
g ge
ner
al a
war
enes
s an
d d
eman
d•
Mob
ilize
com
mun
ity
tow
ard
s hi
gh-r
isk
grou
ps in
volv
ing
loca
l lea
ders
hip
• St
reng
then
par
tner
ship
s w
ith
priv
ate
med
ical
sec
tor
• Pa
rtne
r w
ith
priv
ate
sect
or c
ompa
nies
• In
crea
se v
isib
ility
and
urg
ency
of c
ampa
ign
thro
ugh
soci
al a
nd m
ass
med
ia•
Inst
itut
ion
aliz
e co
mm
unic
atio
ns
for
deve
lopm
ent-
trai
ned
staf
f in
all m
inis
trie
s of
the
G
over
nmen
t of I
raq
• C
ondu
ct k
now
ledg
e, a
ttit
udes
and
pra
ctic
es (
KA
P) s
tudy
• A
udie
nce
anal
ysis
seg
men
tatio
n •
Trai
n va
ccin
ator
s in
IPC
• St
reng
then
loca
tion-
base
d te
chno
logy
wit
h lo
w im
mun
ity
profi
le
• U
se Y
ouTu
be a
nd G
oogl
e pu
blic
mes
sagi
ng
• E
ngag
e in
med
ia –
tal
k sh
ows
on te
levi
sion
•
Use
sch
ool p
acka
ge fo
r he
alth
adv
ocac
y th
roug
h ch
ildre
n •
Invo
lve
relig
ious
lead
ers
in a
dvoc
acy
• Pr
int m
ater
ials
and
air
tele
visi
on s
pots
on
loca
l ch
anne
ls
US$
5 m
illio
n
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
• Fo
rm n
atio
nal
pol
io s
teer
ing
com
mitt
ee c
ompr
isin
g M
oH, U
NIC
EF,
WH
O a
nd o
ther
st
akeh
olde
rs•
Hol
d w
eekl
y re
view
mee
ting
s w
ith
MoH
, UN
ICE
F an
d W
HO
•
UN
Hum
anit
aria
n C
ount
ry T
eam
dis
cuss
es p
olio
res
pon
se
US$
300
000
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201422
JOR
DA
N
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
3.2
mil
lion
of w
hic
h O
PV
cost
sU
S$ 4
60 0
00
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
SNID
SNID
NID
NID
Targ
et p
opu
lati
on
(in
mil
lion
s)0.
20.
21
1
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
tOP
VtO
PV
tOP
VtO
PV
Ass
ista
nce
to A
FP
surv
eill
ance
Stre
ngt
hen
ing
AF
P/m
easl
es/r
ubel
la s
urv
eill
ance
• Se
nsi
tiza
tion
to h
ealt
h di
rect
ors
• Se
nsi
tiza
tion
to
clin
icia
ns
(pae
dia
tric
ian
s, n
euro
logi
sts,
gen
eral
pra
ctit
ion
ers,
or
thop
aedi
cs)
• Tr
aini
ng o
f EPI
offi
cers
at g
over
nora
te le
vel,
clin
icia
ns,
sta
ff n
urse
s, s
anit
aria
ns
• Tr
aini
ng o
f foc
al p
erso
ns
in h
ospi
tals
(inf
ectio
n co
ntro
l offi
cer/
staf
f nur
se)
• Tr
aini
ng a
nd p
laci
ng o
f five
sur
veill
ance
offi
cers
• Tr
aini
ng o
f soc
ial m
obili
zers
•
Dev
elop
men
t, pr
inti
ng a
nd d
istr
ibut
ion
of A
FP
guid
elin
es•
Dev
elop
men
t, p
rin
tin
g an
d d
ispl
ay o
f st
ool
colle
ctio
n p
roto
col
in a
ll p
aed
iatr
ic
depa
rtm
ents
•
Dev
elop
men
t of o
ne-p
age
AF
P su
rvei
llanc
e bu
lleti
n m
onth
ly
US$
750
000
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
• C
ondu
ct in
-dep
th a
naly
sis o
f RI c
over
age a
t sub
-gov
erno
rate
leve
l and
take
cor
rect
ive a
ctio
ns
• St
reng
then
and
sus
tain
the
reg
ular
RI
cove
rage
in S
yria
n re
fuge
es c
amp
sett
ings
•
En
sure
eas
y ac
cess
ibili
ty o
f all
out-
of-c
amps
ref
ugee
s to
nea
rest
vac
cin
atio
n ce
ntre
•
Map
har
d-to
-rea
ch a
reas
/pop
ulat
ion
s to
en
sure
cov
erag
e w
ith
mob
ile te
ams
• E
nsu
re c
over
age
of o
ut-o
f-ca
mps
non
-Jor
dani
an c
hild
ren
wit
h R
I •
Offe
r re
fres
her
trai
ning
for
heal
th-c
are
wor
kers
on
rout
ine
EPI
• U
pdat
e, p
rint
and
dis
trib
ute
imm
uniz
atio
n gu
idel
ines
•
Dev
elop
, pri
nt a
nd d
istr
ibut
e po
ster
s on
vac
cine
man
agem
ent
• C
ondu
ct n
atio
nal
EPI
cov
erag
e su
rvey
US$
250
000
Com
mu
nic
atio
ns
cam
paig
n
• U
se c
ivil
soci
ety,
NG
Os
and
com
mun
ity-
base
d or
gani
zatio
ns
• St
reng
then
the
cap
acit
y of
hea
lth-
care
wor
kers
reg
ardi
ng c
omm
unic
atio
ns
• M
obili
ze t
he p
riva
te s
ecto
r •
En
sure
func
tion
al a
nd c
onti
nued
par
tner
ship
wit
h m
edia
US$
500
000
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(nat
ion
al, i
nter
agen
cy, i
nter
nat
ion
al)
• St
reng
then
the
exi
stin
g co
ordi
nat
ion
mec
han
ism
(esp
ecia
lly w
ith
the
priv
ate
sect
or)
US$
80
000
23PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
LEB
AN
ON
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
3 m
illio
nof
wh
ich
OPV
co
sts
US$
270
000
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
Hig
h-r
isk
area
/pop
ula
tion
app
roac
h +
su
rvei
llan
ce +
cap
acit
y to
sca
le u
p
NID
NID
Targ
et p
opu
lati
on
(in
mil
lion
s)0.
2*3
anti
cip
ated
mop
-up
s
0.6
0.6
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
OP
V (
tOP
V u
ntil
exi
stin
g st
ock
run
s ou
t, t
hen
sw
itch
to
bOP
V)
bOP
V
Ass
ista
nce
to A
FP
surv
eill
ance
To a
ddre
ss t
he a
lrea
dy id
enti
fied
gaps
and
issu
es r
elat
ed t
o A
FP
surv
eill
ance
, as
wel
l th
e ri
goro
us
appl
icat
ion
s of
the
set
-up
reco
mm
end
atio
ns,
nam
ely:
• fu
ll A
FP
surv
eilla
nce
revi
ew in
clud
ing
bi-m
onth
ly w
orks
hop;
•
upda
te p
roto
cols
for
spec
imen
col
lect
ion
and
tran
spor
tatio
n;•
prov
isio
n of
add
itio
nal
col
d bo
xes
for
spec
imen
tra
nsp
ort;
• se
ntin
el s
tool
sur
veys
(ran
dom
sam
plin
g fr
om h
ospi
tals
);•
mon
thly
feed
back
bul
leti
n (s
ubn
atio
nal
leve
l);•
awar
enes
s-ra
isin
g am
ong
clin
icia
ns;
• ex
ten
sion
of a
ctiv
e su
rvei
llanc
e to
hos
pita
ls r
ecei
ving
Syr
ian
refu
gees
;•
refr
eshe
r tr
aini
ngs
of a
ll M
inis
try
of P
ublic
Hea
lth
(MoP
H)
and
hosp
ital
foca
l poi
nts;
• tr
aini
ngs
for
com
mun
ity
surv
eilla
nce
info
rman
ts (S
haw
ish,
Mok
htar
, etc
.);•
deve
lopm
ent o
f pro
fess
ion
al to
ols
for
AF
P su
rvei
llanc
e;•
deve
lopm
ent
of i
nfo
rmat
ion
, ed
ucat
ion
and
com
mu
nic
atio
ns
mat
eria
ls f
or A
FP
awar
enes
s, d
etec
tion
and
repo
rtin
g;•
deve
lopm
ent o
f APF
e-l
earn
ing
and
digi
tize
d co
nten
t;•
sele
ctio
n, t
rain
ing
and
depl
oym
ent o
f APF
sur
veill
ance
offi
cers
;•
reh
abili
tatio
n of
sur
veill
ance
pre
mis
es;
• se
t-up
of a
n A
FP
hotl
ine;
and
• tr
aini
ng o
f all
Mob
ile M
edic
al U
nits
team
s on
AF
P su
rvei
llanc
e.
US$
400
000
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201424
2014
Budg
et
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
Stre
ngth
ened
rou
tine
pol
io im
mu
niz
atio
n (I
PV +
bO
PV)
wit
h en
han
cem
ent
of o
ther
im
mu
niz
atio
n se
rvic
es t
hro
ugh
add
ress
ing
all i
dent
ified
gap
s an
d is
sues
.•
Impr
ove
plan
ning
by
deve
lopi
ng s
peci
al p
lan
s to
cov
er h
igh-
risk
are
as/p
opul
atio
ns
(im
prov
ing
heal
th-s
eeki
ng b
ehav
iour
)•
Impr
ove
supe
rvis
ion
by in
trod
ucin
g th
ird-
part
y m
onito
ring
usi
ng r
eal t
ime
repo
rtin
g th
roug
h m
obile
tech
nolo
gy•
Prov
ide
stoc
k-m
anag
emen
t tra
inin
g to
Qad
a ph
ysic
ian
s•
Enc
oura
ge r
epor
ting
from
the
pri
vate
sec
tor
• Fa
cilit
ate
dist
ribu
tion
of O
PV in
the
pri
vate
sec
tor
• E
xpan
d an
d st
reng
then
mob
ile s
trat
egie
s fo
r hi
gh-r
isk
popu
latio
ns
incl
udin
g bo
rder
do
ses
• W
ork
wit
h U
NH
CR
and
MoP
H to
en
sure
pro
visi
on a
nd u
ptak
e of
free
imm
uniz
atio
n se
rvic
es b
y re
fuge
es in
pub
lic h
ealt
h ce
ntre
s an
d ho
spit
als
• Pr
ovid
e te
chni
cal s
taff
to M
oPH
(cen
tral
ly a
nd p
erip
hera
lly)
• R
evis
e th
e E
PI m
ulti
year
pla
n in
the
con
text
of t
he p
olio
out
brea
k•
Stre
ngth
en t
he c
old
chai
n as
it p
erta
ins
to t
he p
olio
out
brea
k
US$
600
000
Com
mu
nic
atio
ns
cam
paig
n
The
re a
re fi
ve p
rior
ity
focu
s ar
eas.
• M
ass
awar
enes
s: c
reat
e a
high
nat
ion
al-t
o-lo
cal p
rofil
e ar
ound
cam
paig
ns
and
for c
ore
cam
paig
n m
essa
ges
on u
rgen
cy, O
PV s
afet
y an
d m
ultip
le d
ose
• Po
litic
al s
uppo
rt:
bols
ter
soci
o-po
litic
al c
omm
itm
ent
to a
chie
ve q
ualit
y ca
mpa
ign
s fr
om n
atio
nal
to Q
ada
leve
l•
Und
erse
rved
str
ateg
y: b
oost
ris
k aw
aren
ess
and
syst
emat
ic u
ptak
e am
ong
Syri
ans
and
vuln
erab
le L
eban
ese
in t
arge
ted
popu
latio
n ce
ntre
s, p
artic
ular
ly t
he u
rban
poo
r•
Priv
ate
sect
or: u
nloc
k pr
ivat
e se
ctor
res
ista
nce
to c
lose
the
mid
dle
clas
s im
mun
ity
gap
• H
ealt
h co
mm
unic
atio
ns a
nd m
onito
ring
: str
engt
hen
field
cap
acit
y fo
r on-
mes
sage
IPC
an
d ev
iden
ce-b
ased
pla
nni
ng
US$
2.3
mil
lion
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(nat
ion
al, i
nter
agen
cy, i
nter
nat
ion
al)
Th
roug
h th
e fo
llow
ing:
•
gove
rnm
ent l
eads
the
resp
onse
with
par
tner
supp
ort f
rom
WH
O, U
NIC
EF a
nd U
NH
CR
, w
ith
a ca
mpa
ign
laun
ch (
HE
MoH
) an
d m
edia
bri
efing
s;•
task
for
ce (
MoP
H,
WH
O,
UN
ICE
F, N
CC
-EPI
) m
eeti
ngs
ever
y m
onth
du
ring
the
ou
tbre
ak p
erio
d an
d ev
ery
thre
e m
onth
s du
ring
non
-out
brea
k pe
riod
s, to
tak
e pl
ace
for
effe
ctiv
e st
rate
gy im
plem
enta
tion
and
role
s di
stri
butio
n;•
coor
din
atio
n w
ith
Qad
a ph
ysic
ian
s an
d M
oPH
par
tner
s to
cla
rify
the
req
uire
d se
t of
ru
les
and
stra
tegy
th
at n
eed
to b
e im
plem
ente
d lo
cally
;•
regu
lar
and
tim
ely
data
sh
arin
g am
ong
part
ners
(wee
kly
sum
mar
y of
act
ivit
ies)
; and
• a
desk
top
sim
ulat
ion
exer
cise
.
US$
100
000
25PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
TU
RK
EY
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
1.5
mil
lion*
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
SNID
SN
IDSN
ID
Targ
et p
opu
lati
on
(in
mil
lion
s) 0
.62
TB
CT
BC
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
tO
PV
tOP
VtO
PV
Ass
ista
nce
to A
FP
surv
eill
ance
• Fi
eld
visi
ts a
nd r
efre
sher
tra
inin
g in
pro
vinc
es/d
istr
icts
whe
re A
FP
surv
eilla
nce
is
subo
ptim
al•
Trai
ning
sup
port
on
AF
P su
rvei
llanc
e –
revi
taliz
atio
n of
act
ive
surv
eilla
nce
• U
pdat
e an
d di
stri
butio
n of
AF
P su
rvei
llanc
e m
anua
ls a
nd p
oste
r on
AF
P su
rvei
llanc
e•
Dev
elop
men
t and
dis
trib
utio
n of
wee
kly
surv
eilla
nce
upda
te•
Dev
elop
men
t and
intr
oduc
tion
of A
FP
surv
eilla
nce
mod
ule
to s
uppo
rt n
atio
nal
cas
e-ba
sed
data
base
, an
alys
is a
nd r
epor
ting
to W
HO
, and
sh
arin
g w
ith
part
ners
• Fa
cilit
atio
n in
tran
spor
tatio
n of
sto
ol s
ampl
es to
the
Nat
ion
al In
stit
ute
of P
ublic
Hea
lth
and
the
Env
iron
men
t (R
IVM
), Bi
ltho
ven,
The
Net
herl
and
s •
Prov
isio
n of
nec
essa
ry s
uppo
rt a
nd a
ssis
tanc
e (c
olle
ctio
n ki
ts,
carr
iers
, et
c.)
to t
he
nat
ion
al la
b in
Ank
ara
• Tu
rkey
labo
rato
ry a
ccre
dita
tion
by fi
eld
visi
t•
Inde
pend
ent fi
eld
surv
eilla
nce
revi
ew
US$
250
000
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
• In
-dep
th a
nal
ysis
of
rout
ine
imm
un
izat
ion
cove
rage
at
the
subn
atio
nal
lev
el a
nd
corr
ecti
ve a
ctio
ns
• N
atio
nal
cov
erag
e su
rvey
and
in-
dept
h an
alys
is o
f th
e si
ze o
f su
scep
tibl
e (h
igh-
risk
) po
pula
tion
(loc
al a
nd r
efug
ees)
• St
reng
then
ing
and
sust
aini
ng o
f the
regu
lar R
I cov
erag
e in
Syr
ian
refu
gees
cam
p se
ttin
gs•
Eas
y ac
cess
ibili
ty o
f urb
an re
fuge
es to
nea
rest
vac
cina
tion
cent
re, a
nd e
nsur
ing
cove
rage
of
out
-of-
cam
ps, n
on-T
urki
sh c
hild
ren
wit
h R
I•
Ref
resh
er t
rain
ing
for
heal
th-c
are
wor
kers
on
rout
ine
imm
uniz
atio
n•
Upd
atin
g, p
rint
ing
and
dist
ribu
tion
of im
mun
izat
ion
guid
elin
es•
Dev
elop
men
t, pr
inti
ng a
nd d
istr
ibut
ion
of p
oste
rs o
n va
ccin
e m
anag
emen
t
US$
300
000
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201426
2014
Budg
et
Com
mu
nic
atio
ns
• Su
pp
ort
the
gove
rnm
ent
to d
evel
op a
com
mu
nic
atio
ns
pla
n,
incl
ud
ing
a ri
sk
com
mun
icat
ion
s co
mpo
nent
• E
ngag
e w
ith
civi
l soc
iety
and
NG
Os/
ING
Os
to in
crea
se o
utre
ach,
incl
udin
g to
Syr
ian
refu
gees
• St
reng
then
the
cap
acit
y of
hea
lth-
care
wor
kers
reg
ardi
ng c
omm
unic
atio
ns
• Su
ppor
t the
dev
elop
men
t and
dis
sem
inat
ion
of c
omm
unic
atio
ns
mat
eria
ls•
Use
the
wel
l-de
velo
ped
netw
ork
of U
NIC
EF
thro
ugh
the
child
-fri
endl
y sp
aces
pro
ject
; U
NIC
EF
will
look
for
oppo
rtun
itie
s to
use
the
exis
ting
chi
ld-f
rien
dly
spac
es n
etw
ork
and
scho
ols
to im
prov
e IP
C in
the
cam
ps
US$
500
000
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
• O
vera
ll st
reng
then
ing
of th
e co
ordi
nat
ion
of a
n em
erge
ncy
polio
out
brea
k re
spon
se b
y th
e M
oH, U
NIC
EF
and
WH
O w
ith
UN
par
tner
s, N
GO
s, t
he d
onor
com
mun
ity,
and
he
alth
aut
hori
ties
at t
he c
ount
ry a
nd p
rovi
ncia
l lev
els
• R
egul
ar te
chni
cal m
eeti
ngs
and
disc
ussi
ons
betw
een
WH
O, U
NIC
EF
and
the
Publ
ic
Hea
lth
Inst
itut
ion
of t
he T
urki
sh M
oH a
t the
cou
ntry
/pro
vinc
ial l
evel
• C
oord
inat
ion
of p
olio
-rel
ated
issu
es o
n th
e bo
rder
US$
415
000
* C
ost
of O
PV; t
he G
over
nm
ent
of T
urk
ey b
ears
op
erat
ion
al c
osts
for
SIA
s an
d th
is in
form
atio
n is
not
cu
rren
tly
avai
labl
e.
Targ
et p
opul
atio
n fo
r O
ctob
er a
nd N
ovem
ber
2014
rou
nds
will
be
con
firm
ed fo
llow
ing
the
WH
O p
olio
ris
k as
sess
men
t m
issi
on o
n 14
-15
May
201
4 an
d th
e Eu
rope
an R
egio
nal
Cer
tific
atio
n C
omm
issi
on fo
r Po
liom
yelit
is E
rad
icat
ion
mee
ting
on
3-5
June
201
4.
27PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
EGY
PT
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
10.
1 m
illio
n*of
wh
ich
OPV
co
sts
US$
4.5
mil
lion*
1
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
SNID
sN
IDs
SNID
s
Targ
et p
opu
lati
on
(in
mil
lion
s)4.
514
.54.
5
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
tOP
VtO
PV
tOP
V
Ass
ista
nce
to A
FP
surv
eill
ance
• M
aint
ain
high
leve
l of s
urve
illan
ce in
dica
tors
at a
ll le
vels
• C
oope
rate
wit
h U
NIC
EF
and
UN
HC
R in
loca
ting
Syr
ian
refu
gees
in E
gypt
and
con
duct
an
act
ive
AF
P su
rvei
llanc
e U
S$ 3
00 0
00
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
• M
aint
ain
OPV
3 co
vera
ge a
bove
95%
at a
ll le
vels
•
Cre
ate
a m
ap o
f Syr
ian
child
ren
and
com
plet
e va
ccin
atio
n of
thei
r rou
tine
imm
uniz
atio
n •
Mak
e sp
ecia
l pla
ns
for
har
d-to
-rea
ch a
reas
and
diffi
cult
grou
ps U
S$ 1
00 0
00
Com
mu
nic
atio
ns
cam
paig
n
• U
NIC
EF
and
MoH
P is
coo
per
atin
g in
pla
nn
ing,
im
plem
enti
ng a
nd m
onito
ring
a
com
preh
ensi
ve m
edia
cam
paig
n an
d so
cial
mob
iliza
tion
acti
viti
es.
• H
ealt
h aw
aren
ess
sess
ion
s w
ill b
e co
nduc
ted
wit
h ca
reta
kers
, pa
rtic
ular
ly m
othe
rs,
duri
ng t
heir
vis
its
to t
he P
HU
s of
the
MoH
P to
offe
r th
eir
child
ren
imm
uniz
atio
n du
ring
the
SIA
s.•
Spec
ial
outr
each
com
mun
icat
ion
acti
viti
es w
ill b
e co
nduc
ted
wit
h Sy
rian
wom
en,
com
mun
ity
and
relig
ious
lead
ers,
and
NG
Os i
n Eg
ypt t
o pr
omot
e th
e SI
As a
nd ro
utin
e im
mun
izat
ion.
US$
600
000
*2
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
• A
n ac
tive
inte
r-co
untr
y co
ordi
nat
ion
com
mitt
ee (
ICC
) re
gula
rly
mee
ts to
pla
n fo
r th
e SI
As
and
avai
l the
req
uire
d su
ppor
t to
MoH
P.•
Mem
bers
of
the
ICC
are
MoH
P, W
HO
, U
NIC
EF,
USA
ID,
Rot
ary
and
the
Japa
nese
go
vern
men
t.•
MoH
P is
har
mon
izin
g it
s SI
A a
ctiv
itie
s w
ith
the
glob
al a
nd r
egio
nal
pla
n of
act
ion
and
guid
elin
es.
US$
1 0
00
*1 M
oHP
is in
the
pro
cess
of r
egis
teri
ng b
OPV
and
, whe
n ap
prov
ed, w
ill b
e u
sed
inst
ead
of t
OPV
.*2
Incl
uded
in t
he N
IDs
budg
et a
nd c
over
ed b
y U
NIC
EF
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201428
WE
ST
BA
NK
AN
D G
AZ
A S
TR
IP
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
1 m
illio
n
of w
hic
h O
PV
cost
‡
US$
300
000
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
Iden
tify
hig
h-r
isk
pop
ula
tion
an
d i
mm
un
ize
them
N
ID*
NID
*
Targ
et p
opu
lati
on
(in
mil
lion
s)
.6
75*2
.675
*2
Vac
cine
typ
e*3
Ass
ista
nce
to A
FP
surv
eill
ance
• M
aint
ain
good
sur
veill
ance
ind
icat
ors
– 20
13 N
PAF
P ra
te 2
.2,
stoo
l ad
equa
cy 9
5%;
2014
NPA
FP
1.7,
sto
ol a
dequ
acy
100%
• M
aint
ain
and
enh
ance
env
iron
men
tal s
urve
illan
ce/s
urve
y•
Col
lect
env
iron
men
tal s
ampl
e re
gula
rly
and
cont
inuo
usly
in 1
7 di
stri
cts
• M
aint
ain
and
enh
ance
an
acti
ve s
urve
illan
ce s
yste
m•
Con
duct
tra
inin
g fo
r he
alth
wor
kers
US$
50
000
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
for
2014
-201
5
• U
pdat
e co
ld c
hai
n m
ater
ials
and
equ
ipm
ent
• E
stab
lish
six
new
col
d ro
oms
• Pu
rch
ase
300
refr
iger
ator
s •
Con
duct
13
trai
ning
ses
sion
s fo
r he
alth
wor
kers
on
safe
ty i
njec
tion,
col
d ch
ain
and
vacc
ine
mon
itori
ng
US$
600
000
Com
mu
nic
atio
ns
cam
paig
n
• Im
prov
e co
mm
unit
y K
AP
(rou
tine
imm
uniz
atio
n, c
ampa
ign)
• St
reng
then
hea
lth
wor
ker
capa
city
in c
omm
unic
atio
ns
• D
istr
ibut
e ad
voca
cy m
ater
ials
(po
ster
s, b
anne
rs, b
roch
ures
, mug
s an
d T-
shir
ts)
• Im
plem
ent a
spo
t mes
sage
on
loca
l tel
evis
ion
and
radi
o•
Con
du
ct a
dvo
cacy
mee
tin
gs w
ith
par
tner
s (U
NR
WA
an
d N
GO
s) a
nd
med
ical
as
soci
atio
ns
(pae
diat
rici
ans
and
neur
olog
ists
)
US$
50
000
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
• C
ondu
ct q
uart
erly
, and
as
need
ed, E
PI c
omm
ittee
rev
iew
mee
ting
s•
Stre
ngth
en c
oord
inat
ion
betw
een
MoH
, W
HO
, U
NIC
EF,
UN
RW
A a
nd P
aed
iatr
ic
Med
ical
Ass
ocia
tion
• In
crea
se t
he n
umbe
r of
mee
ting
s fo
r th
e n
atio
nal
im
mun
izat
ion
tech
nica
l ad
viso
ry
grou
ps, n
atio
nal
pol
io c
erti
ficat
ion
com
mitt
ee a
nd m
easl
es e
limin
atio
n co
mm
ittee
• D
ocum
ent a
ctiv
itie
s pe
rfor
med
and
sh
are
wid
ely
(all
polio
effo
rts
incl
udin
g m
op-u
ps,
NID
s, t
arge
ted
cam
paig
ns
and
mob
ile te
am e
ffort
s)
US$
20
000
* N
IDs
dep
end
ing
on n
eed
and
base
d on
epi
dem
iolo
gy w
ith
in t
he r
egio
n*2
NID
tar
get
pop
ula
tion
~ 6
75,0
00
child
ren
aged
und
er 5
yea
rs; S
NID
s ta
rget
dep
end
s on
the
hig
h-ri
sk p
opu
lati
on t
arge
ted
at t
hat
tim
e*3
Dis
cuss
ion
s w
ill t
ake
plac
e w
ith
the
EPI
Com
mit
tee,
Gen
eral
Dir
ecto
rate
and
Min
iste
r of
Hea
lth
to d
eter
min
e if
bO
PV w
ill b
e u
sed
in P
has
e II
cam
pai
gn a
ctiv
itie
s.‡
OPV
fin
anci
al fi
gure
abo
ve in
clud
es c
osts
for
add
itio
nal
vac
cine
to
be u
sed
both
in t
he S
IAs
and
in t
he c
ross
-bor
der
acti
viti
es
29PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
ISL
AM
IC R
EP
UB
LIC
OF
IRA
N
2014
Budg
et
Plan
ned
activ
ities
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
US$
350
000
for
Ops
and
US$
670
000
* fo
r O
PV fo
r
Supp
lem
enta
ry
imm
un
izat
ion
ac
tivi
ties
Typ
e: N
ID, S
NID
SN
IDs
SNID
S
Targ
et p
opu
lati
on
(in
mil
lion
s).2
5 .2
5
Vac
cine
typ
e
(if k
now
n: t
OPV
, bO
PV)
bO
PV
bO
PV
Ass
ista
nce
to A
FP
surv
eill
ance
Inte
nsi
fy p
riva
te s
ecto
r aw
aren
ess
• C
onti
nuou
sly
sen
siti
ze p
hysi
cian
s to
pol
io im
port
ance
, im
port
atio
n da
nger
s, e
tc.
• C
reat
e a
part
ners
hip
wit
h th
e pr
ivat
e se
ctor
(pa
edia
tric
ass
ocia
tion
s) –
rec
ogn
ize
phys
icia
ns
and
the
priv
ate
heal
th fa
cilit
ies
on t
heir
AF
P su
rvei
llanc
e ef
fort
s
US$
36
500*
Stre
ngth
ened
rou
tine
pol
io
imm
un
izat
ion
/im
mu
niz
atio
n se
rvic
es
Mai
ntai
n h
igh
cov
erag
eC
onti
nue
vacc
inat
ing
at c
ross
-bor
der
poin
ts a
nd a
irpo
rts
for
child
ren
aged
und
er
15 y
ears
, inc
lud
ing
Iran
ian
s vi
siti
ng I
raq
and
Iraq
is c
omin
g to
the
Isl
amic
Rep
ublic
of
Ira
n.M
ap o
ut u
nre
gist
ered
pop
ula
tion
s am
ong
the
com
mu
nit
ies
usi
ng C
HV
s.•
Ass
ess
the
profi
le o
f un
regi
ster
ed p
opul
atio
ns
(siz
e, a
ge g
roup
, va
ccin
atio
n st
atus
, lit
erac
y le
vel a
nd s
ocio
-eco
nom
ic/d
emog
raph
ic s
tatu
s), u
pdat
ing
the
hous
e-to
-hou
se
chec
klis
ts•
Ass
ess
the
capa
city
of t
he h
ealt
h sy
stem
(sta
ff, c
omm
unic
atio
ns
skill
s an
d kn
owle
dge
of t
he is
sues
/gap
s), a
nd r
evis
e th
e he
alth
faci
lity
catc
hmen
t pop
ulat
ion
• E
stab
lish
com
mun
ity
netw
orks
, and
par
tner
wit
h co
mm
unit
y le
ader
s to
cre
ate
trus
t in
the
unr
egis
tere
d po
pula
tion
s•
Plan
for
the
acti
viti
es•
Mon
itor
and
eval
uate
the
pla
nne
d ac
tivi
ties
, inc
ludi
ng c
omm
unic
atio
n of
the
issu
es/
gaps
, and
rev
ise
the
heal
th fa
cilit
y ca
tchm
ent p
opul
atio
n
US$
510
000
*1
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201430
2014
Budg
et
Com
mu
nic
atio
ns
cam
paig
n
Mai
ntai
n h
igh
aw
aren
ess
• A
sses
s th
e ca
paci
ty o
f th
e he
alth
sys
tem
, co
mm
unic
atio
ns
skill
s an
d kn
owle
dge
of
the
issu
es/g
ap•
Tailo
r m
essa
ges
to t
he c
omm
unit
y pr
ofile
• M
onito
r an
d ev
alua
te c
omm
unic
atio
ns
US$
40
000
Eff
ecti
ve c
oord
inat
ion
of c
ount
ry
supp
ort
(n
atio
nal
, int
erag
ency
, int
ern
atio
nal
)
Stre
ngt
hen
coo
rdin
atio
n w
ith
Ira
q go
vern
men
t, e
spec
iall
y w
ith
th
e K
urd
ista
n
regi
on U
S$ 2
500
* a)
Nat
ion
al a
nd P
rovi
ncia
l Aut
hori
ty m
eeti
ng =
1.5
mil
lion
x 1
= 1.
5 m
illio
n (U
S$ 5
00)
, (31
pae
dia
tric
ass
ocia
tion
ch
airs
and
nat
ion
al t
eam
) =
31 x
1.5
mil
lion
= 46
.5 m
illio
n to
man
s (U
S$ 1
5 0
00)
; b)
eig
ht p
rovi
ncia
l m
eeti
ngs
(wit
h pr
ovin
cial
pae
dia
tric
ian
s) f
or 1
day
= 8
x 1
.5 m
illio
n =
12 m
illio
n to
man
s (U
S$ 4
00
0),
c) 3
1 d
istr
ict-
leve
l aw
aren
ess
mee
ting
s =
31 x
1.5
mil
lion
= 46
.5 m
illio
n to
man
s (U
S$ 1
5 0
00)
, d)
supp
ort
cont
inuo
us
sen
siti
zati
on =
6 m
illio
n to
man
s (U
S$ 2
00
0)
*1 St
reng
then
com
mu
nic
atio
ns
for
mai
ntai
nin
g h
igh
cove
rage
, pro
cure
men
t of v
acci
nes
for
cros
s-bo
rder
, air
por
t and
che
ckp
oint
vac
cin
atio
n =
1.5
bill
ion
tom
ans
(US$
50
0 0
00)
; con
duct
a
desk
rev
iew
: coo
rdin
atio
n of
the
desk
rev
iew
, five
pro
vinc
ial m
eeti
ngs
@ 3
mil
lion
tom
ans
(US$
1 0
00)
per
mee
ting
; con
duct
trai
nin
g fo
r he
alth
wor
kers
: 3 x
26
dis
tric
ts @
1.5
mil
lion
tom
ans
(US$
50
0); c
ondu
ct m
eeti
ngs
at t
he c
omm
un
ity
leve
l, 1
mee
ting
x 2
6 d
istr
icts
x 1
mil
lion
tom
ans
(US$
350
) =
26 m
illio
n to
man
s; s
uper
viso
ry v
isit
s, o
ne p
er q
uar
ter
x 26
x
4 te
ams
x 10
day
s @
1.5
mil
lion
= 6
mil
lion
tom
ans
(US$
2 0
00)
*2 P
rodu
ctio
n of
tel
evis
ion
spot
s: 3
x 3
00
00
0 p
er s
pot
= 9
00
00
0 to
man
s (U
S$ 3
00)
; mee
ting
wit
h m
edia
: 2 m
eeti
ngs
x 1.
5 m
illio
n =
3 m
illio
n to
man
s (U
S$ 1
00
0); e
stab
lish
/mai
ntai
n a
dat
abas
e fo
r co
mm
un
icat
ion
s in
dic
ator
s =
2 m
illio
n to
man
s (U
S$ 7
00)
; co
mm
un
ity-
leve
l tr
ain
ing
on I
PC =
3 m
eeti
ng x
3 p
erso
ns
per
dis
tric
t x
26 d
istr
icts
x 1
.5 m
illio
n to
man
s (U
S$ 5
00)
= 7
.4 m
illio
n to
man
s (U
S$ 2
50
0)
31PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
AN
NE
X 2
TA
BLE
S A
ND
FIG
UR
ES
Tab
le 4
. C
hil
dre
n v
acci
nat
ed i
n p
oli
o c
am
paig
ns
in t
he
Mid
dle
Ea
st:
No
vem
ber
201
3–A
pri
l 2
014
Cou
ntr
y/A
rea
Nu
mb
er o
f ch
ild
ren
vac
cin
ated
Post
-cam
pai
gn m
onit
orin
g (r
ecal
l)
Nov
-13
Dec
-13
Jan-
14Fe
b-14
Mar
-14
Apr
-14
Nov
-13
Dec
-13
Jan- 14
Feb- 14
Mar
-14
14-
Apr
Syri
an A
rab
Rep
ublic
2 43
2 75
12
246
762
2 5
32 4
76
2 7
45 5
54
2 9
19 6
82
2 9
13 6
40
ND
79%
88%
88%
93%
92%
Jord
an1
138
285
915
420
1 08
4 77
694
%76
%*
88%
Leba
non
580
770
589
054
49
2 70
690
%78
%N
D78
%
Iraq
1 20
8 08
74
846
158
649
105
235
366
5 37
2 15
65
840
387
ND
ND
ND
92%
Egyp
t14
226
411
14 3
87 5
7868
770
14 7
79 7
41N
DN
D
Turk
ey1
148
918
1 31
6 32
626
6 14
1N
D
Wes
t Ban
k an
d G
aza
Stri
p63
9 48
165
5 23
6N
DN
D
Tota
l20
735
222
24 9
40 7
793
836
817
3 24
7 06
19
938
090
23 5
33 7
68
ND
Not
don
e *
R
apid
ass
essm
ent s
urve
y am
ong
Syri
an r
efug
ees
Dat
a as
of
30 A
pri
l 2
014
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201432
Table 5. AFP surveillance indicators by country/area, 2013 and 2014
NPAFP rate*
% AFP case notified within seven days
from onset of paralysis
% cases investigated within 48 hours from
notification
% adequate stool specimens
Country/area & Year 2013 2014 2013 2014 2013 2014 2013 2014
Syrian Arab Republic
1.7 3.2 78 75 94 95 68 92
Iraq 3.1 3.0 82 89 89 81 84 93
Jordan 1.4 1.1 77 83 100 100 91 100
Lebanon 2.2 1.6 30 43 94 100 46 71
Turkey 1.2 0.7 50 58 99 98 80 88
West Bank and Gaza Strip
2.2 2.1 87 88 84 100 95 100
Egypt 3.0 3.0 97 99 93 92 93 82
Target met
Target not met
Table 6. Polio immunization schedules and POL-3 reported, and WHO-UNICEF estimated coverage 2009-2012
Country/AreaPolio
Immunization Schedules
POL-3-2009WHO-UNICEF
(Official)
POL-3-2010WHO-UNICEF
(Official)
POL-3-2011WHO-UNICEF
(Official)
POL-3-2012WHO-UNICEF
(Official)
Egypt OPV: B, 1w, 2m, 4m, 6m, 12m, 18mIPV: 2m, 4m, 6m, 9m, 12m, 18m
97%(97%)
97%(97%)
96%(97%)
93%(93%)
Iraq OPV: B, 2m, 4m, 6m, 18m, 4yDTwP-Hib-HepB-IPV: 2m, 4m, 6m
78%(86%)
74%(83%)
80%(89%)
70%(79%)
Jordan OPV: 4m, 5m, 9m, 18m, 6yDTap-Hib-IPV: 3m, 4m, 5m
98%(98%)
98%(98%)
98%(98%)
98%(98%)
Lebanon OPV: 4m, 6mIPV: 2m
76%(93%)
76%(94%)
77%(96%)
77%(96%)
The Syrian Arab Republic
OPV: 6m, 12m, 18mIPV: 2m, 4m
83%(99%)
83%(99%)
75%(91%)
52%(68%)
Turkey OPV: 6m, 18mDTap-Hib-IPV: 2m, 4m, 6m, 18mDTap-IPV: 6y
96%(96%)
97%(96%)
97%(97%)
97%(97%)
The West Bank and Gaza Strip
OPV: 2m, 4m, 6m, 18m, 6yIPV: 1m, 2m
100%‡ 100%‡ 100%‡ 98%‡
Source: WHO-UNICEF estimates 2012* WHO-UNICEF estimate is provided with the official coverage in parenthesis. ‡ Coverage from the West Bank and Gaza Strip is self-reported.
Data as of 30 April 2014
33PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
Tab
le 7
. G
PE
I co
stin
g fr
am
ework
for
resp
on
se t
o p
oli
o o
utb
reak
in
th
e S
yri
an
Ara
b R
epu
bli
c an
d I
raq
( i
n U
S$)
Cou
ntr
y/A
rea
OP
V
Op
s co
sts/
Soc
ial
mob
iliz
atio
n
Op
s co
st/
Stre
ngt
hen
ing
RI
Op
s co
st/
surv
eill
ance
O
p c
ost
/SIA
s im
ple
men
tati
on O
ps
cost
/ co
ord
inat
ion
Tot
al c
ost
s
U
NIC
EF
UN
ICE
FU
NIC
EF
WH
OW
HO
WH
O
Syri
a2
350
000
20
0 0
00
385
000
10
0 0
00
1 1
50 0
00
110
000
4
295
000
Iraq
4 4
00 0
00
5 0
00 0
00
1 0
00 0
00
1 0
00 0
00
15 0
00 0
00
300
000
26
700
000
Leba
non
345
000
2
300
000
60
0 0
00
400
000
2
730
000
10
0 0
00
6 4
75 0
00
Jord
an46
0 0
00
500
000
25
0 0
00
750
000
2
740
000
80
000
4
780
000
Egyp
t4
500
000
60
0 0
00
100
000
30
0 0
00
5 6
00 0
00
1 0
00
11 1
01 0
00
Iran
670
000
40
000
51
0 0
00
36 5
00
350
000
2
500
1
609
000
Wes
t Ban
k an
d G
aza
Stri
p30
0 0
00
50 0
00
600
000
50
000
70
0 0
00
20 0
00
1 7
20 0
00
Turk
ey1
500
000
50
0 0
00
300
000
25
0 0
00
41
5 0
00
2 9
65 0
00
Tota
l14
525
000
9
190
000
3
745
000
2
886
500
28
270
000
1
028
500
59
645
000
Dat
a as
of
30 A
pri
l 2
014
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201434
Figure 4. Subnational NPAFP rates for Phase II countries, October 2013–March 2014
Afghanistan
AzerbaijanArmenia
Bulgaria
Chad
Georgia
Greece
Iran (IslamicRepublic of)
Iraq
Jordan
Libyan ArabJamahiriya
The formerYugoslav Republic
of Macedonia
Oman
Pakistan
RussianFederation
Syrian ArabRepublic
United ArabEmirates
TurkeyTurkmenistan
Uzbekistan
SaudiArabia
Yemen
Israel
Egypt
Sudan
Survellience data for South Sudan unavailable due to reporting issues
*01 NOV 2013 - 30 APR 2014
Map represents the first level administrative boundaries.Both stools collected within 14 days from onset with good stoolcondition.NPAFP rate for Turkey is calculated using classified NPAFP casesAge group - 6- 59 monthsGrey areas in the map are not included as part of the analysis.
NPAFP RATE< 1>= 4.0 1.00 - 1.992.00 - 3.99
Population < 100,000No shape files or population
data or no reporting
35PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
Figure 5. Syrian refugee movements as of 30 April 2014
registered
Registered: 990 458Awaiting registration:
49,864
registered
registered
registeredregistered
*Morocco, Algeria and
Libya
Syrian Arab Republic IRAQ
JORDAN
N. AFRICA* EGYPT
LEBANON
TURKEY
219 579
588 135
19 697 136 654
1 040 322
722 234
Hassakah
AleppoRaqqah
As Suweida
Damascus
Dara
Dayr Az ZorHama
Homs
IdlebLattakia
Al Qunaytira
Damascus
Tartus
Total number of refugees registeredand awaiting registration 2 726 621
Registered refugees
Awaiting registration with UNHCR
2 676 757
49 864
Sources: AFAD, Government of Egypt, Government of Iraq, Government of Jordan, Government of Lebanon, UNHCR Regional Datawarehouse, Common Operational Dataset (COD), UNGIWG, Natural Earth, UNCS
0 50 100 150 20025Kilometers
The boundaries and names used on this map do not imply official endorsement or acceptance by the United Nations.
±
PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 201436
Figure 6. Estimated POL-3 routine immunization coverage, 2012
Iraq
Saudi Arabia
Egypt
Turkey
Iran (Islamic Republic of)
Jordan
Syrian Arab Republic
Israel
Kuwait
Cyprus
Lebanon
Qatar
Bahrain
Bahrain
Sudan
0 110 220 330 44055Kilometers Data as of 30 April 2014
50-79% ≥90%80-89%<50%
±
West Bank and
Gaza Strip
37PHASE II WHO/UNICEF STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE MAY-DECEMBER 2014
ANNEXES
