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Independent Monitoring Board of the Global Polio Eradication Initiative, 20th Report

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ANOTHER CHANCE: Don’t let it slip away

Introduction

From a position two years previously, that felt close to global interruption of poliovirus circulation, the Polio Programme had regressed to such an extent that wild and vaccine-derived polioviruses were running rampant again in Pakistan and Afghanistan; moreover, vaccine-derived poliovirus outbreaks were assailing 26 countries during 2020 at a cost of $190 million. The 19th IMB report agreed with many observers that the repurposing of polio staff, assets and ways of working had helped enormously in the fight against the coronavirus pandemic.

Within the leadership of the Polio Programme, the IMB heard many references to a “silver lining”. There seemed to be a growing certainty among leaders that COVID-19 benefits – such as the formation of stronger multi-agency working relationships, the dissolution of silos and boundaries and, above all, the creation of an emergency response programmatic culture were being transferred to a new polio eradication modus operandi.

The 19th IMB report produced 16 recommendations calling for action in key strategic areas, including:

  • sustaining the post-COVID-19 momentum of resumed polio activities and the vaccination of polio workers to protect them against the pandemic virus;

  • resetting the Pakistan Polio Programme to strengthen performance and embed a culture of real-time programmatic working between national and provincial leadership;

  • achieving a breakthrough in access for the Polio Programme in Afghanistan and resolving problems of dysfunctional teamworking;

  • making more rapid, scaled-up progress in providing integrated models of service delivery and making good on promises to transform the sanitary and service infrastructure of multiply-deprived communities;

  • treating the vaccine-derived poliovirus outbreaks as an emergency and dealing with them more effectively and efficiently, as well as bringing the benefits of the new oral polio vaccine to outbreak-affected areas quickly and safely

The 19th IMB report’s assessment ended when the Polio Programme had resumed its activities after the COVID-19 pause and at a time of uncertainty about the likelihood and timing of future pandemic virus waves. It was during the polio low season in Pakistan and Afghanistan when case numbers usually fall as part of a natural epidemiological cycle.

The IMB ran a modified approach for its 20th meeting at the request of the GPEI’s strategy committee. The GPEI had asked for more time to fully implement the recommendations of the 19th IMB report. Also, the COVID-19 related workload was still very high and the burden of oversight and planning meetings involving the polio global leadership in summer 2021 was heavy.

Although the format of the 20th IMB meeting, from which this report follows, was different to normal, it was still based on extensive information gathering and discussion. The IMB members met with representatives of the Pakistan Federal Government, four Pakistan provincial governments, the Afghanistan Government, the polio donors and polio extended partners. In addition, the IMB chairman and members had individual discussions with a wide range of Polio Programme leaders, managers and experts.

This report has not produced a fresh set of recommendations but, rather, assesses progress, gives further advice and highlights certain weaknesses in the response to the recommended action in the last (19th) IMB report, given that most of this action was designed to address deepseated barriers to polio eradication that must be definitively and permanently surmounted.

The new GPEI strategy for 2022 to 2026, Delivering on a Promise, has been published. It includes two overarching shifts around re-establishing an emergency orientation and expanding integration efforts and unified partnerships. The strategy has been approved by the Polio Oversight Board, noted by the World Health Assembly in May 2021 and formally launched from the National Emergency Operations Centre in Pakistan in June 2021.