REGIONAL COMMITTEE Sixtieth session Thimphu, Bhutan 31 August – 3 September 2007
Provisional Agenda item 16.5 SEA/RC60/21 16 July 2007
FOLLOW-UP ACTION ON SELECTED RESOLUTIONS/DECISIONS OF THE LAST THREE YEARS: CHALLENGES IN POLIO ERADICATION The Regional Committee resolution SEA/RC58/R6 on Polio Eradication: Final Strategy, affirmed the far-reaching humanitarian and economic benefits of achieving polio eradication, and provided the guiding framework for intensification of polio eradication activities at all levels. This paper summarizes the progress made with regard to implementation of strategies outlined in the WHO/UNICEF Global Immunization Vision and Strategy (GIVS), with particular focus on the two important elements of GIVS, namely strengthening of routine immunization, and introduction of new vaccines and technologies. The paper also provides a detailed update on activities related to polio eradication efforts at global, regional and national levels, with special focus on supplemental immunization activities in both countries still endemic to polio, as well as those where importation of wild or outbreaks of vaccine-derived polio viruses were seen. Finally, the paper outlines the major challenges facing the Global Polio Eradication Initiative (GPEI) and highlights some of the key WHO efforts for completing the task of polio eradication. The paper was discussed at the Joint Meting of Health Secretaries and the Consultative Committee for Programme Development and Management held in the Regional Office, New Delhi from 2-6 July 2007. The Joint Meeting made the following recommendations: Action by Member States To strengthen the EPI programme in order to maintain the highest surveillance levels and high routine immunization coverage as the best means to control the spread of polio virus and outbreaks in the Region. Action by WHO-SEARO (1) To support/facilitate a thorough review of the status of routine immunization in Member countries to strengthen polio eradication efforts and to maintain poliofree status in those countries where polio has been eradicated. (2) To convene the technical working group to evaluate the various options to prevent the spread of polio in the Region.
(3) To seek and facilitate mobilization of financial resources for supporting the polio and routine immunization programme of the Member States. (4) To support and facilitate the Member States to maintain the highest surveillance levels and high routine immunization coverage as the best means to control the spread of polio virus and outbreaks in the Region. (5) To report on the progress made towards polio eradication to the Regional Committee on an annual basis until polio-free status is achieved in the Region. The paper is now submitted to the Sixtieth session of the Regional Committee for its consideration.
SEA/RC60/21
Background 1. The WHO Regional Committee for South-East Asia adopted resolution SEA/RC58/R6 (Annex 1) at its Fifty-eighth Session, and urged Member States among others to: implement the strategies outlined in the Global Immunization Vision and Strategy (GIVS) framework, including the Reach Every District (RED) approach to achieve and maintain high levels of routine immunization coverage; maintain high quality AFP surveillance; develop plans of action for high quality polio outbreak response, particularly outbreaks caused by importation of wild polioviruses or vaccine-derived polioviruses (cVDPV), and develop national mechanism for eventual cessation of the use of OPV in the routine immunization programme. 2. With regard to the implementation of the GIVS framework, the development of the strategic plan, 2006 - 2009, for the work of Immunization and Vaccine Development (IVD), the Regional goals are set so that they are well aligned to the global goals of the GIVS document, while ensuring the specific needs and challenges for SEAR countries. The two main thrusts in the GIVS framework are (i) strengthening routine immunization and, (ii) introduction of new vaccines and technologies. WHO’s Reach Every District (RED) strategy was promoted in countries to increase coverage particularly in hard-to-reach areas. As an active partner of GAVI, WHO assisted several GAVI eligible countries in the implementation of the Immunization Services Strengthening (ISS) grant from the GAVI-Alliance and to use it to enhance coverage. In the case of some countries WHO is even helping to administer the grant. Mid-level management training of health workers has been carried out in Bangladesh, Nepal, Myanmar and Indonesia. Further, the Regional Office has also helped countries in data quality self-assessment (DQS) training, vaccine management and surveillance training to improve the quality and coverage of routine immunization. All countries that received GAVI Alliance ISS support have shown progressive improvement in coverage. 3. Realizing the special needs of large countries such as India, Indonesia and Bangladesh, the partners have been carrying out intense discussions with the GAVI Alliance to develop strategies and mobilize resources to meet the needs of these countries with large number of unimmunized children. The other key areas of the GIVS framework being the introduction of new vaccines and technology, all countries except Timor-Leste, have completed the introduction of hepatitis B vaccine: India is phasing it into 11 states this year. Bangladesh, Bhutan and Sri Lanka have already included Haemophilus influenzae type b (Hib) vaccine in their national immunization programme. 4. With regard to polio even in those countries where routine coverage with other antigens may be low, through SIAs, the overall coverage of polio vaccination has been maintained at very high levels, at least in the endemic areas. All countries of the Region, except Timor-Leste, have adopted their emergency preparedness plans for polio outbreak or detection of cVDPV. In 2006-2007 Bangladesh, Nepal and Myanmar saw outbreaks either of wild or of cVDPV, and WHO provided technical, logistical and financial support to respond swiftly and appropriately to these outbreaks.
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5. The World Health Assembly in 2006 adopted resolution WHA59.1 which detailed the required response by Member States to the detection of circulating polioviruses. Accordingly, in 2006, several Member States of the SEA Region intensified supplemental immunization rounds, both small and large-scale. For example, India implemented 10 rounds, Bangladesh seven rounds, Nepal nine rounds, Indonesia six rounds, and Myanmar two rounds of supplemental immunization activities (SIAs). For 2007, a similar number of rounds are planned according to the specific epidemiological situation in the Member countries. 6. Another innovative strategy added to combat polio includes the use of monovalent OPV1 (mOPV1) to raise and maintain the high population immunity through multiple rounds of supplementary immunization activities using mOPV1, and this has started to pay dividends in India by showing signs of rapid reduction in type 1 polio cases; in the highest risk districts of Western UP: no P1 has been detected since October 2006. 7. The Regional Office is preparing the guidelines for the eventual cessation of OPV vaccine use. By the end of 2009, all Member States are expected to have developed their own national OPV cessation policies, based on the generic guidelines from the Regional Office. With regard to the laboratory containment of polioviruses, phase one laboratory containment activities have been completed for all countries except India and Timor-Leste. However, due to recent outbreaks, Bangladesh, Indonesia, Myanmar and Nepal will need to repeat the phase one exercise. Phase two will begin for all countries only when the whole Region is free of polio.
Pressing on with the Case for Completing Polio Eradication 8. The global polio eradication programme is at a critical juncture. It is so close to finishing the job and yet, it is at a most vulnerable period in the eradication efforts. The greatest challenge faced by the global polio eradication initiative (GPEI) is the lack of sufficient funding to complete the job. By July 2007 the GPEI will have a negative cash flow, which, if not addressed, will require an immediate reduction in planned polio eradication activities in the remaining infected countries. Even a temporary cutback would result in the reinfection of polio-free areas, delays in outbreak response, a surge in polio-paralyzed children and an increase in overall costs. 9. On 17 May 2007, the WHO Director-General convened a side-meeting during the World Health Assembly with the four countries that have yet to interrupt polio, as well as spearheading partners and key donors, to release her new Case for Completing Polio Eradication. This document, developed following the DG's Urgent Stakeholder Consultation on Polio Eradication on 28 February 2007, lays out Dr Chan's compelling arguments for the technical and operational feasibility of polio eradication, as well as the economic and humanitarian rationale for completing this programme. The DG is sparing no efforts to liaise closely with all potential donors to ensure their urgent attention to closing the US$540 million funding gap for 2007-8 activities. 10. The gains of eradication efforts can only be maintained through sustained, high quality, high coverage with routine immunization. Routine immunization continues to be a concern in several countries, particularly so in those areas where polio cases are still encountered, whether it indigenous or imported. Maintaining high routine immunization coverage in all the districts and sub-districts, especially in unstable and vulnerable countries or areas in countries is a priority as well as a challenge.
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Annex 1
SEA/RC58/R6
Polio Eradication: Final Strategy
The Regional Committee, Recalling resolutions SEA/RC34/R2, SEA/RC38/R9 and SEA/RC49/R6, Reaffirming WHO’s commitment to the global goal of eradication of poliomyelitis, Recognizing that substantial progress has been made in the Region towards the achievement of the goal of polio eradication in 2005, Noting that as of August 2005, poliomyelitis remains endemic only in a few districts in India, but that all countries remain at risk, as exemplified by Indonesia where a largeoutbreak of polio is occurring, Realizing that such outbreaks resulting from importations of wild poliovirus and fundingshortfalls are major obstacles to achieving the goal of eradication in the Region, and Affirming that poliomyelitis eradication will result in far-reaching humanitarian and economic benefits to all countries, 1. URGES Member States where poliovirus transmission is endemic or where wild poliovirus importations have occurred, to further intensify the implementation of their eradication strategies to interrupt wild poliovirus transmission in 2005; 2. URGES all Member States, particularly those which are free from poliomyelitis: (a) to implement the strategies outlined in the Global Immunization Vision and Strategy (GIVS) framework, including the Reach Every District (RED) approach, to achieve and maintain high levels of routine immunization coverage uniformly across all administrative units until global certification of polio eradication; (b) to allocate adequate resources for enhancing and maintaining AFP surveillance at subnational level, achieving high and uniform quality across all sections of communities; (c) to develop an action plan with adequate resources to respond effectively to a polio outbreak caused by an importation of wild poliovirus or circulating vaccine-derived polioviruses (cVDPVs); (d) to fully implement and verify appropriate containment of wild and vaccine-derived polio viruses, and prepare for eventual containment of vaccine viruses, and (e) to analyse and consider the risks, benefits and opportunity costs while developingnational mechanisms for eventual cessation of the use of OPV in the routine immunization programme and destruction of remaining stocks of trivalent OPV,and
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3.
REQUESTS the Regional Director: (a) to advocate with Member States in ensuring the highest political support for polio eradication, including maintenance of high quality surveillance; (b) to coordinate with partners and all Member States in mobilizing financial and technical resources necessary to implement GIVS; (c) to collaborate with all partners in mobilizing the required resources for polio eradication and in ensuring adequate supply of vaccine, and (d) to promote and support the international certification scheme for polio eradication in the Region.
Seventh Meeting, 10 September 2005