By the end of 2016, progress continued towards each of the Endgame Plan’s four objectives.
The world has never been closer to eradicating polio, with fewer cases in fewer areas of fewer countries than at any time in the past. The virus is now more geographically constrained than at any point in history.
In the second half of 2016, Pakistan and Afghanistan continued to intensify eradication efforts and implement their respective national emergency action plans, overseen by each country’s head of state. They continued to treat the virus transmission as a single epidemiological block and focused on coordinating activities in both countries.
In August, wild poliovirus type 1 (WPV1) was detected in Borno, Nigeria, the first WPV detected in the country since 2014, a sobering reminder of the fragility of global progress and of the dangers of any subnational surveillance gap and low-level residual virus transmission.
The outbreak was immediately declared a regional public health emergency, and an emergency outbreak response across Nigeria and the Lake Chad subregion was launched.
Although falling outside the reporting period of this report, the first case in 2017 was reported, from Afghanistan, with onset of paralysis on 13 January. With confirmation of transmission into early 2017, global certification of poliomyelitis eradication will now occur at the earliest in 2020.
Following the successful globally coordinated switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) in April, surveillance and response for type 2 polioviruses continued to be intensified in the second half of the year. Outbreak response to previously detected circulating vaccinederived poliovirus type 2 (cVDPV2) continued in Guinea, Lao People’s Democratic Republic and Madagascar, with no new cases reported during the reporting period. In Nigeria, the regional outbreak response to the detected WPV1 also addressed two separate cVDPV2s, in Borno and Sokoto states.
A global supply constraint of inactivated polio vaccine (IPV) continued to be managed carefully, allocating available supply to areas deemed at highest risk of cVDPV2 emergence. Increasing clinical evidence indicates that fractional dose IPV provides equal (and in a two-dose schedule, even superior) protection to full dose IPV, and this approach could substantially stretch limited supply further. India, Bangladesh and Sri Lanka successfully maintained this approach, ensuring their national supply could meet their respective population needs. In October, the Strategic Advisory Group of Experts on immunization (SAGE) urged countries to adopt this approach, in lieu of full dose IPV, in their routine immunization programmes. The GPEI continued to work with other partners and manufacturers to further alleviate the supply constraint. The primary outbreak response tool, should it be needed, remained the global stockpile of monovalent OPV type 2 (mOPV2), which is not affected by a global supply constraint.
To minimize the risk of accidental release of polioviruses into the environment, which could lead to outbreaks, countries intensified their efforts to ensure the identification, destruction or safe handling and containment of polioviruses in vaccine manufacturing or research facilities. Priority was given to containing the type 2 polioviruses in such facilities.
The overriding priority remained to eradicate the final strains of poliovirus transmission and to ensure that the full capacity to do so was in place. At the same time, a comprehensive transition planning process intensified in the latter half of 2016. In 16 priority countries, accounting for 95% of GPEI assets, national transition planning was under way to ensure that the capacity to continue supporting other health programmes remains in place, even after polio has been eradicated from the world. A comprehensive strategic road map towards polio transition and the development of a post-certification strategy will be presented to the World Health Assembly in 2017.
Fully implementing all Endgame Plan strategies requires an additional US$ 1.3 billion. Securing a lasting polio-free world will not only be associated with significant humanitarian benefits but also with economic advantages, as eradicating polio worldwide will result in global savings of US$ 50 billion.
The world is closer than ever to being poliofree.
Now is the time to redouble efforts and step over the finish line once and for all. It has been said of Edward Jenner, the medical doctor from rural England who in 1796 pioneered the world’s first vaccine (against smallpox), that no other single human being who has ever lived has saved more lives in history. That is the power of vaccination and disease eradication. By securing a polio-free world, it is possible to show what can be achieved when everyone unites towards a common goal.
Together with GPEI partners Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF and the Bill & Melinda Gates Foundation, the GPEI stands ready to support all stakeholders, partners and countries in their final push to secure a polio-free world once and for all.