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Independent Monitoring Board of the Global Polio Eradication Initiative (Sixteenth Report: October 2018)

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INTRODUCTION

This is the 16th report produced by the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI).

The report is different to its predecessors. It follows on from the work of an independent Review Team commissioned by the IMB, at the request of the Polio Oversight Board. The Review Team travelled to each of the three remaining polio endemic countries and conducted extensive visits to the frontline of the Polio Programme in Pakistan, Afghanistan and Nigeria. The Review Team produced its own report that has now been released, available to read here.

This 16th IMB report follows meetings that discussed the Review Team’s findings held in London between 12-14 September 2018 with GPEI staff, donors and extended partners. It also takes account of discussions of the Review Team’s final report at the Polio Oversight Board’s meeting in New York City on 28 September 2018.

The IMB’s judgements focus on objective one of the GPEI’s Polio Eradication and End-game Strategic Plan 2013-2018: “Stop all wild polio virus transmission by the end of 2014 and new vaccine-derived polio virus outbreaks within 120 days of confirmation of the index case”. The 2014 date for interrupting wild poliovirus transmission was (by implication) modified when the Polio Oversight Board meeting endorsed an “intermediate” scenario whereby global transmission would be interrupted by the end of 2016.

The Polio Eradication and End-game Strategic Plan was updated after a mid-term review in 2015, and extended to 2019 by the Polio Oversight Board in September 2017. The GPEI is currently working to review this strategy and prepare a new document for the January 2019 WHO Executive Board meeting. The review will assess whether the current strategies, functions and activities in the existing strategy continue to be valid and sufficient to achieve the eradication goal and if new approaches are required.

Based on the Polio Programme’s epidemiological data, the IMB concludes that progress towards interrupting polio transmission globally has stalled and may well have reversed. The total number of wild poliovirus cases globally has increased: 25 compared to 13 for the same period (30 October) in 2017. The case count so far this year exceeds the total for the whole of 2017. The number of cases in Afghanistan has more than doubled: 19 in 2018 so far compared to 8 for the same period (30 October) in 2017. On average, a million children have been missed each round since May 2018 in Afghanistan. The number of wild poliovirus cases in Pakistan has increased since the same time in 2017: 6 compared to 5. In Pakistan, the percentage of positive poliovirus isolates drawn from environmental sampling is exactly the same as it was in 2017. More sites are detecting the poliovirus than in 2017. The number of vaccine-derived poliovirus cases has increased from 63 on 30 October 2017 to 75 in the same period of 2018.

The conclusion of the independent Review Team is: “Access limitations due to insecurity continue to represent the biggest threat to polio eradication and progress towards interrupting transmission has stalled. Afghanistan’s security situation is deteriorating and the number of cases has more than doubled compared to this time last year. Pakistan has widespread circulation of wild poliovirus documented by positive environmental specimens but isn’t acting decisively on these findings. Whether or not poliovirus transmission continues in Boko Haram controlled areas of Nigeria is unknown”.

Given the current state of progress, the IMB considers it implausible that wild poliovirus transmission will be eliminated globally by the end of 2018, thus requiring a fully committed and resourced Polio Programme going into 2019.