FOR the Global Polio Eradication Initiative (GPEI), 2009 was a pilot year: an irony for a 20-year effort, but one that breathed innovation and fresh thinking into the initiative. At the beginning of the year, poliovirus survived in parts of four countries and was causing a large-scale international outbreak for the second time in five years. Poliovirus had - for the first time - re-established transmission in several countries. Noting that the strategies which successfully eradicated polio from 99% of the world were not working in the remaining 1%, the World Health Assembly in 2008 had called on the GPEI to develop new approaches to tackle the surviving reservoirs of wild poliovirus.
In response, the GPEI developed a special oneyear Programme of Work 2009, embarking on an independent evaluation of the remaining barriers to stopping polio, introducing new strategies to tackle those barriers and evaluating new vaccines to enhance the impact of each contact with a child. The situation had improved enough by the end of the year for the Strategic Advisory Group of Experts on Immunization (SAGE) and the Advisory Committee for Poliomyelitis Eradication (ACPE) to recommend the development of a new, three-year programme of work to exploit these new approaches and urgently interrupt wild poliovirus transmission.
2009 was marked by a type of progress in the polioendemic countries which had not been seen before. In Nigeria, the unprecedented ownership of the programme by all levels of government, and critically, the traditional and religious leadership, quickly closed vaccination gaps and drove immunization levels upwards, resulting in case numbers falling by more than 99%. India now faces the final surviving genetic chain of type 1 transmission, down from nine chains four years ago. Sustained monovalent oral polio vaccine type 1 (mOPV1) campaigns targeted this chain throughout 2009, and the new 107-Block Plan for the remaining blocks with persistent transmission was drawn up and implemented to tackle the ongoing transmission of poliovirus among migrant groups and in the most difficult-to-access areas head on. In Afghanistan and Pakistan, 2009 was marked by repeated military offensives that resulted in the mass movement of internally displaced people, in some cases hampering access to children and in others, opening up areas that had long been inaccessible. Persistent transmission of polio was restricted to 23 districts between the two countries - emphasizing the value of new district-specific approaches.