Eighteen months ago, as 2012 drew to a close, optimism was running high for the Global Polio Eradication Initiative. Polio transmission in India had been interrupted. The three remaining endemic countries (Pakistan, Nigeria, Afghanistan) had made significant programmatic improvements. Some believed that success was imminent; that polio would soon be history.
Within a matter of months, this optimism quickly unwound:
• Targeted killing of polio vaccinators in Pakistan shocked the world and created major operational constraints.
• Polio virus entered Waziristan, a part of Pakistan in which polio vaccination had been – and remains – banned by Taliban commanders.
• The national structure for managing polio eradication in Pakistan was dismantled at a time when it needed to be strengthened.
• Nigeria’s security situation deteriorated. Here too, vaccinators tragically lost their lives and the program’s operations were severely impaired.
• Nigeria polio virus was exported to southern Somalia, where it infected a population unprotected against polio because of an al-Shabab ban on vaccination that remains in place.
• Pakistan polio virus spread to Syria, causing a major outbreak amidst the country’s civil war.
• Pakistan polio virus spread also to Israel, West Bank and Gaza, and Iraq, and Nigeria polio virus to Cameroon and Equatorial Guinea – each outbreak over-stretching the global program’s resources and credibility.
In 2012, there were 223 polio cases in five countries. In 2013, there were 407 cases in eight countries.
During last year and the first few months of this year, much hard work has been undertaken by infected countries and their global partners to try to reverse the negative eradication trend that became established in 2013:
• Nigeria has markedly improved vaccination coverage in many areas, most notably in Kano and in the highest- risk Local Government Areas, and has been rewarded with a substantial decrease in polio transmission.
• Afghanistan has maintained strong performance and is on track to stop endemic transmission before the end of 2014, although importation of Pakistan polio virus will continue to pose a threat.
• In Somalia, the program responded strongly to the outbreak of Nigeria polio virus and transmission has now been substantially quelled as a result. Responding quickly to the IMB’s criticism in October 2013, the program also strengthened its coordination across the Horn of Africa.
• In Pakistan, Peshawar and Karachi mounted innovative and determined campaigns to reach children with polio vaccine in a manner that maximizes the safety of the polio vaccinators – bright spots in an otherwise gloomy program.
• When Pakistan polio virus was detected in Syria, novel challenges mixed with some controversy over the program’s approach in a complex conflict-affected environment. Despite this, in the IMB’s view, the program responded well – in Syria and across the region.
• The global community, recognising the importance of polio eradication, requested WHO to convene an emergency committee under the International Health Regulations, as the IMB had recommended. On this committee’s advice, WHO has recommended mandatory travel vaccination for residents and long-term visitors travelling internationally from countries exporting polio (currently Pakistan, Cameroon, and Syria); but the recommendation would also immediately apply to Nigeria or any other country in the event of a future export.