REGIONAL COMMITTEE
Provisional Agenda item 4.7.1
Sixty-sixth Session SEARO, New Delhi, India 10–13 September 2013
SEA/RC66/13 19 July 2013
Progress reports on selected Regional Committee resolutions: Challenges in polio eradication (SEA/RC60/R8) Polio eradication continues to be a priority in the WHO South-East Asia Region. This paper presents an update on the progress towards, and challenges to, polio eradication. The Region has made tremendous progress towards polio eradication in the past year. In January 2013, the South-East Asia Region marked two polio-free years – its longest polio-free period. The last wild poliovirus case in the Region was reported from India on 13 January 2011. The Region is currently on track for polio-free certification in February 2014, three years after the last reported case. Successes and lessons learnt in building a highly sensitive surveillance network for polio eradication have been expanded to include strengthening surveillance for other vaccinepreventable diseases and monitoring of routine immunization activities. Despite the tremendous progress made towards polio eradication, the Region remains at risk to importation of polioviruses as long as they are circulating anywhere in the world. Risk mitigation activities are critical to monitoring and maintaining regional gains in polio eradication, which include high-quality sensitive acute flaccid paralysis (AFP) surveillance and high population immunity against polio through routine immunization. Polio eradication requires sustained funding; a substantial proportion is currently being met through external funding. Member States can help the eradication effort by committing funds for vaccine-preventable disease surveillance, outbreak response and strengthening routine immunization service delivery. As the Region approaches polio-free certification in early 2014, its focus will need to shift to post-polio eradication activities, which include implementation of the Polio Eradication and Endgame Strategic Plan 2013 –2018 and legacy planning for the Global Polio Eradication Initiative (GPEI). The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 1 to 3 July 2013 reviewed the attached working paper and made the following recommendations:
Actions by Member States (1) (2) (3) (4) (5) To maintain high population immunity through strengthening routine immunization and supplementary immunization, as appropriate, based on periodic risk assessment. To ensure that all children, including migrants, the unreached, marginalized and underserved, also receive the vaccine. To strengthen surveillance for early detection of acute flaccid paralysis (AFP). To develop plans of action for the Polio Eradication and Endgame Strategic Plan 2013-2018. To review and strengthen national policy on vaccination for travellers to mass gatherings and to and from polio-endemic countries and areas with active polio transmission.
Actions by WHO-SEARO (1) (2) To monitor periodically the risk status of Member States and provide advice on the most appropriate response. To provide technical support and resource mobilization for development of countryspecific plans of action for the polio endgame, including the switch to bOPV and introduction of IPV. To promote technology transfer to the extent possible for vaccine development in vaccine-developing countries in the Region.
(3)
The working paper and the HLP Meeting recommendations are submitted to the Sixtysixth Session of the Regional Committee for its consideration.
SEA/RC66/13
Introduction 1. The last wild poliovirus case detected in the Region was in India on 13 January 2011, more than two years ago, which is the longest polio-free period the Region has seen. The only other country with recently circulating poliovirus is Nepal with its last case on 30 August 2010, nearly three years ago. The other nine countries in the Region have been polio-free for more than five years. 2. On 25 February 2012, after more than a year without a reported wild poliovirus case, the WHO Director-General removed India from the list of polio-endemic countries. The Region is currently on track for polio-free certification in February 2014, three years after the last reported wild poliovirus case. In order to ensure on-time polio-free certification in February 2014, the independent group of experts that composes the South-East Asia Regional Certification Commission for Polio Eradication has intensified its activities in 2013 to include country-level support by Commission members. 3. Despite the tremendous progress made towards polio eradication, the Region remains at risk to importation as long as there is wild poliovirus circulating globally. In all countries of the Region, maintaining a highly functional and responsive AFP surveillance system and laboratory network is paramount to being able to detect and respond to wild poliovirus cases. Maintaining routine oral polio vaccine immunization coverage (OPV3 coverage) greater than 80% in all districts of a country will help prevent reinfection. In addition, all polio-free countries should conduct periodic risk assessments to determine the level of risk of reinfection and spread, and to decide whether polio supplementary immunization activities are required to boost population immunity. 4. Polio eradication requires substantial funding, which has always been a challenge for the programme. Currently a large proportion is being met through external funding. Member States can help the eradication effort by committing funds for surveillance, outbreak response and strengthening routine immunization service delivery. 5. In May 2013, the Sixty-sixth World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan 2013–2018, which was developed in response to resolution WHA65.5 that requested the WHO Director-General to develop a comprehensive polio endgame strategy. The new strategic plan provides a concrete timeline for completion of the Global Polio Eradication Initiative (GPEI), by eliminating all paralytic poliomyelitis cases due to both wild and vaccine-related polioviruses. The four principal objectives in the plan are: (1) detection and interruption of all poliovirus transmission; (2) strengthening of immunization systems and withdrawal of OPV; (3) containment and certification of all poliovirus; and (4) development of a comprehensive legacy plan. Due to the goal of stopping all polio disease, the new Plan has substantial near-term implications for both polio-infected and polio-free countries, particularly the countries that use only the oral polio vaccine for routine immunization. Currently, all countries in the South-East Asia Region are using oral polio vaccine in their routine immunization programmes.
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6. While OPV is the only vaccine recommended for achieving the eradication of wild polioviruses worldwide, in rare instances its use can cause paralysis: vaccine-associated paralytic poliomyelitis (VAPP) and poliomyelitis due to vaccine-derived polioviruses (VDPV).1 Therefore, the continued use of OPV after the interruption of transmission of wild poliovirus is inconsistent with global polio eradication. Paralyses due to VAPP and VDPV are the two main reasons for eventually stopping the use of OPV. The polio endgame strategy begins to address these risks as part of the global post-polio eradication activities. 7. An important part of the polio endgame strategy is the switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) and the use of inactivated polio vaccine (IPV). Two regional consultations on IPV introduction in the South-East Asia Region were conducted with national programmes in Bali, Indonesia, in 2008 and Bangkok, Thailand, in 2012. Member States agreed on the scientific basis for the switch and use of IPV but had concerns about operational issues, mainly focused on the cost of IPV, supply of bOPV and availability of external resources. 8. A primary goal of legacy planning for the GPEI is to ensure that the knowledge, capacities, processes and assets created by the polio eradication programme will continue to be of broader benefit to other public health programmes. Over the past 25 years, the GPEI has developed the ability to access the chronically unreached, marginalized and most vulnerable populations in the world. This has provided the opportunity for health workers not only to vaccinate children, but also to provide a range of additional, basic health services. This far-reaching access has also delivered a global surveillance capacity for vaccine-preventable diseases and a response capacity for both health and humanitarian emergencies in some of the world’s most demanding settings. A key aim of the legacy planning process is to establish consensus on whether, and how, this capacity should be used to benefit other health priorities beyond the closure of the GPEI.
1
Framework for National Policy Makers in OPV-Using Countries. WHO/POLIO/05.02