SIXT TY-FIFTH WORLD W HEA ALTH ASS SEMBLY Prov visional age enda item 13.10
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Poliom myelitis s: inten nsificat tion of the glo obal er radicati ion init tiative Repor rt by the Secretariat
1. In 2008, th he Sixty-first World Heal lth Assembly y in resolutio on WHA61.1 1 requested the t DirectorGene eral to develop a new st trategy to re einvigorate th he fight to eradicate e pol liomyelitis. The T ensuing g al Polio Erad Globa dication Initi iative Strateg gic Plan 2010–2012 was subsequentl ly launched in i June 2010 0 and, i in keeping with w the guid dance from th he Executive e Board,1 an Independen nt Monitoring g Board was s established to mo onitor the sit tuation by re eference to the t milestones in the Str rategic Plan. . This report t provi ides an upda ate, as at mid d-February 2 012, on prog gress toward ds – and chal llenges to reaching – the e Strate egic Plan’s milestones, m summarizes s the Independ dent Monitoring Board’s s concerns re egarding the e risks to completin ng eradication, and propo oses next step ps for the Global Polio E Eradication In nitiative. 2. Cases of paralytic p poli iomyelitis du ue to wild polioviruses p declined d by 52% in 201 11 compared d with 2010 (649 cases comp pared with 1 1352 cases).2 Cases due e to the sero otype 1 wild poliovirus s declin ned by 54% % (582 cases compared w with 1265), and a cases du ue to the ser rotype 3 wil ld poliovirus s declin ned by 23% (67 cases co ompared with h 87 cases). Of the four countries wi ith endemic transmission t n of wi ild poliovirus s, India met its end-2011 1 milestone of o stopping virus v circulat tion, its most recent case e havin ng onset of paralysis p on 13 January 2011. Of the e four countries with “re e-established d” poliovirus s transm mission, Sou uth Sudan ha as not had a c case since 27 7 June 2009. Angola had a substantial decrease in n new c cases in 2011 and may also a have sto opped transm mission, with its most rec cent case hav ving onset of f paraly ysis on 7 July 2011. In Chad C and the e Democrati ic Republic of o the Congo o, intensive transmission t n in ear rly 2011 dec clined substa antially in the e second hal lf of the year, following corrective actions a taken n by bo oth countries s. Of eight co ountries with h outbreaks of o poliomyel litis due to n new importat tions of wild d poliovirus in 201 11, all but on ne such outb break, in Ma ali, were stop pped within six months. As at midFebru uary 2012, th hree of these new outbr reaks were ongoing, o thou ugh for less than six mo onths, in the e Centr ral African Republic R (m most recent c case 8 Decem mber 2011), China (9 O October 2011 1) and Niger r (12 D December 2011). One out tbreak from 2 2010 persisted into 2011 and for mor re than 12 months m on the e borde er between Kenya K (most recent case 3 30 July 2011) and Ugand da. 3. By contras st, in Afgha anistan, Nige eria and Pak kistan, the other o three countries with w endemic c transm mission of wild w polioviru us, there wa as a significa ant increase in i new cases s in 2011 com mpared with h 2010, particularly y in the seco ond half of th he year. Nig geria saw a 185% increas se in cases, especially e in n 1 Documents EB126/2010/R REC/2, summary y record of the thirteenth meet ting, section 4A A, and EB128/35 Add.1, section n C.
Data availab ble at www.polioeradication.or rg/Dataandmon nitoring/Polioth hisweek.aspx (ac accessed 20 Mar rch 2012). All case data are reported d to WHO throu ugh national acu ute flaccid para alysis surveillan nce systems.
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the northern n states of Kano, Jigawa, , Borno and Sokoto (62 cases c compar red with 21 c cases for the e same period in 20 010, 44 of which w are fro om the four northern sta ates mentione ed). Afghani istan and Pa akistan experienced d a 220% an nd 37% incre ease in cases s, respectively (80 cases compared w with 25 cases, and ly). Furtherm 198 cases c compared wi ith 144 cases s, respectivel more, Nigeri ia and Pakist stan were the e only countries in n the world with confir rmed type 3 wild polio ovirus circul lation since September 2011. Nigeria is t the only cou untry in the e world with h re-established transmission of a t type 2 circu ulating vaccine-der rived poliovi irus. In 2011 1, wild polio oviruses originating in Nigeria N and P Pakistan wer re also associated w with outbreak ks in previou usly polio-fre ee countries. 4. Since e December 2010, the Independent t Monitoring g Board has s met quarte erly and pro ovided recommend dations to th he heads of agency a of th he Global Polio P Eradica ation Initiativ ve’s spearhe eading partners and d the Bill & Melinda Ga ates Foundati ion. In April l 2011, the In ndependent M Monitoring Board October 201 stated that “ “Completing g the eradicat tion of polio o is a global health emergency”.1 In O 11, the Independen nt Monitoring g Board reaf ffirmed that a assessment, but b expresse ed conviction n that “polio can – and must – be eradicate ed,” and high hlighted issue es at the glob bal, cross-pro ogramme an nd country-sp pecific levels that u urgently need ded to be add dressed, espe ecially “ acco ountability an nd its enforc cement at all levels of the prog gramme”. In November 2011, 2 the St trategic Adv visory Group p of Experts on immunization endorsed th he findings of f the Indepen ndent Monito oring Board, concluding unequivocal lly “that the risk r of failure to fi inish global polio p eradica ation constitu tutes a progr rammatic em mergency of g global propo ortions for public h health and is not accept table under any circums stances”. Th he World He ealth Organization Regional Committee fo or Africa in August A 2011 1 adopted res solution AFR R/RC61/R4, in which it urged Member Sta ates to decla are the persis stence of pol lio a nationa al public health emergenc cy. The Executive Board at it ts 130th ses ssion consid dered an ear rlier version n of this report2 and a adopted reso olution EB130.R10 0 on 21 Janu uary 2012, declaring the completion of polioviru us eradication on a program mmatic emergency for global pu ublic health. 5. esponse to the t evolving g polio epid demiology in n 2011 and d Executive Board reso olution In re EB130.R10 0, the Gove ernments of Nigeria an nd Pakistan developed or augment ted their na ational emergency action plans for polio er radication, an nd the Head of Governm ment in each c country appo ointed a focal poi int to oversee national efforts and established d a monitoring mechani ism to hold local authorities accountable for the perf formance an nd quality of f activities. The Global Polio Eradication Initiative in ntensified it ts extensive e programm me of work, , initiated following f th he October 2011 Independen nt Monitoring g Board rep port, to stren ngthen accou untability pr rocesses, pro omote innov vation, ensure criti ical real-time evaluation n of eradicat tion plans in n key infect ted areas, de eepen stakeh holder engagement t, and reduc ce outbreak risks. A Gl lobal Polio Emergency Action Plan n 2012–2013 3 was developed t to support Af fghanistan, Nigeria N and P Pakistan in im mplementing g corrective a actions to achieve, by end-2012 2, the covera age levels ne eeded to inte errupt poliov virus transmis ssion in each h of the rema aining infected are eas. The plan n draws hea avily on less sons learnt in all infecte ed areas, par rticularly Ind dia, in 2010–2011, , on the recommendation ns of the Inde ependent Mo onitoring Board, and on r recent innov vations for enhanci ing program mme implem mentation and d impact. The T plan als so commits partner age encies, particularly WHO and UNICEF, to deploy su ubstantial ad dditional surg ge support t to enable str rategy implementa ation in prior rity infected areas. a
Indep pendent Monito oring Board of the t Global Poli io Eradication Initiative. Repor rt, April 2011. A Available at www.polioera adication.org. 2
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Docu ument EB130/19.
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6. In its Febru uary 2012 re eport1, the In ndependent Monitoring M Board B highlig ghted that the e emergency y appro oach must be e extended to o front-line w workers, esp pecially in Pa akistan and N Nigeria whic ch “represent t the gr ravest risk to o global erad dication”. Th he Independe ent Monitorin ng Board sta ated that “An n emergency y appro oach involve es considerin ng every me easure that can c help. Th his should in nclude, for example, e the e possibility of usi ing the Inter rnational Hea alth Regulat tions to limit the potenti ial spread fr rom affected d count tries”. Alread dy in the firs st quarter of f 2012, howe ever, an insuf fficiency of financing required some e emerg gency eradi ication activ vities to be scaled bac ck in 24 at t-risk countr ries. The Global G Polio o Eradi ication Initia ative continu ues to engage e with the in nternational development d t community to close the e finan ncing gap for r 2012–2013 which, at F February 201 12, stood at US$ U 1090 m million against an overall l budge et of US$ 22 230 million. 7. In line wit th the develo opment of th he Global Po olio Emergen ncy Action P Plan 2012–2 2013, a new, , more efficient medium-term m strategy is being exam mined, which h would com mbine the er radication of f residu ual wild poli iovirus transmission with h the polio “endgame” st trategy. The latter had be een designed d to de eal with vacc cine-derived polioviruses s, but only after a certifica ation of wild d poliovirus eradication. . The n new strategy y is based on new diagno ostic tests for r vaccine-der rived poliovi iruses, the av vailability of f bivale ent oral poli iovirus vaccine, and new w low-cost approaches a for f the use o of inactivate ed poliovirus s vacci ine. The Stra ategic Advisory Group o of Experts on n immunizat tion endorse ed the centra al premise of f the n new strategy: in summar ry, the remo oval of Sabi in poliovirus ses from imm munization programmes s liovirus in th shoul ld be phased, beginning with w the part ticularly prob blematic Sab bin type 2 pol he near term, , follow wed by the remaining r se erotypes, afte er certificatio on of wild poliovirus p era adication glo obally.2 This s appro oach could fa acilitate the eradication e o of the remain ning wild polioviruses typ pes 1 and 3 (by ( replacing g all tri ivalent oral poliovirus vaccine v with h the more efficacious e bivalent oral poliovirus vaccine) v and d allow w action to be e taken to co ontrol any ne ew type 2 cir rculating vac ccine-derived d polioviruse es during the e period that global l surveillance and respon nse capacity is highest. Substantial S p planning is re equired for a globa ally synchro onized switc ch from tr rivalent to bivalent oral polioviru us vaccine for routine e immu unization an nd, potentially, the intro oduction bef forehand of one or mo ore doses of f inactivated d poliovirus vaccin ne. In 2012, the Strategic c Advisory Group G of Ex xperts on im mmunization will provide e recom mmendations s on the actu ual impleme entation of th his strategy based on br road-based consultations c s acros ss a number of o work strea ams.
ACT TION BY THE T HEAL LTH ASSEM MBLY 8. The Health h Assembly is i invited to a adopt the res solution reco ommended by y the Execut tive Board in n resolu ution EB130 0.R10.
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Independent t Monitoring Board of the Glo obal Polio Eradi ication Initiative. Report, Febru ruary 2012. Ava ailable at www.p polioeradication n.org. In 2011, the ere were six out tbreaks due to a circulating vac ccine-derived poliovirus in sev ven countries; five f were due to the type 2 serotype e. Fifty-six of th he 58 cases due to these circula ating vaccine-d derived polioviru ruses were caused by the type 2 serot type . Data are available at http p://www.polioe eradication.org/ /Dataandmonito oring/Poliothisw week/ Circulatingvaccinede erivedpoliovirus s.aspx (accessed d 20 March 201 12). 2
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