Status Report January – June 2014: Progress against the Polio Eradication and Endgame Strategic Plan 2013-2018

SUMMARY

In March 2014, the GPEI celebrated one of the world’s great achievements in global health as the WHO South-East Asian Region was certified polio-free. Five years previously, India was regarded as the hardest place on earth to stop polio. India’s accomplishment in eradicating polio opened the door to the certification of the eleven countries in WHO’s South East Asian Region, representing 1.8 billion people, as polio-free; a major step toward clearing the world of polio. Where children are being reached with polio vaccines, improvements in campaign quality are making a difference. Nigeria has seen a significant decrease in the number of wild poliovirus type 1 (WPV1) cases as new tactics help the programme reach more children, boosting immunity in insecure areas. Afghanistan has reduced transmission to very low-levels with only 8 cases during the reporting period of this document. Wild poliovirus type 3 (WPV3) has not been detected anywhere globally since November 2012, strongly indicating that this strain may have been eliminated. The programme is working with communities to improve not only acceptance of polio vaccine, but also to increase vaccination demand. Civil society groups such as the Islamic Advisory Group play an important role in these social mobilization and community engagement efforts.

However, in the few reservoirs where children cannot receive vaccinations, cases are increasing. In North and South Waziristan in Pakistan, an ongoing ban on immunization campaigns since June 2012 remains in place. However, following military campaigns in North Waziristan, intensive immunization campaigns have been conducted to reach internally displaced persons (IDPs) and host communities surrounding the area. There are 163 permanent vaccination posts in place to vaccinate persons travelling in and out of North Waziristan, which have enabled the vaccination of more than 700,000 persons this year including over half a million children.

Despite opportunities such as this, however, poliovirus continues to spread internationally to previously polio-free areas. The virus has been exported internationally from three major epidemiological zones this year: in central Asia (from Pakistan to Afghanistan), in the Middle East (Syria to Iraq) and in Central Africa (from Cameroon to Equatorial Guinea, and from Equatorial Guinea to Brazil, where poliovirus was detected in an environmental sample). On 5 May WHO Director-General Dr. Margaret Chan declared the recent international spread of wild poliovirus a “public health emergency of international concern”, and issued Temporary Recommendations under the International Health Regulations (2005) to prevent further spread of the disease.

Efforts are on track to launch the most ambitious vaccine introduction in history as part of the polio Endgame strategic plan. As recommended by the Strategic Advisory Group of Experts on Immunization (SAGE), 126 countries will introduce at least one dose of inactivated polio vaccine (IPV) by the end of 2015. To date, 72 countries are already using IPV, 49 countries have made a formal commitment to introduce it and an additional 35 have declared intent to introduce IPV in their routine immunization programme by the end of 2015. These countries account for approximately 96% of the global birth cohort. This work is critical to help prepare for an eventual global switch from trivalent OPV to bivalent OPV as early as 2016.