13.10 Poliomyelitis: intensification of the global eradication initiative

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Documents

Documents A65/20 and EB130/2012/REC/1, resolution EB130.R10
 See Watchers Report of Discussion at EB130

The issues before the Assembly

Two papers are before the Assembly: first, a report by the Secretariat on the current state of progress towards polio eradication (A65/20); and second a resolution forwarded from the EB urging a redoubled effort from MSs and the Secretariat to complete the ‘end game’ of polio eradication (EB130.R10).

PHM Comment

The Secretariat report is a useful review of the state of play.  Perhaps in its next iteration there might be some reference to the reasons of the 2011 polio recrudescence and to the case management of people affected by polio.

The resolution (EB130.R10) declares the completion of poliovirus eradication a programmatic emergency for global public health and provides a strategic path forward; hopefully it will attract government  and donor support.

Complete eradication of polio virus necessitates continuous monitoring of occurrence of new infections. Health systems strengthening, and development of the necessary human capacities need to be in place for proper surveillance.

The eradication of polio should not be reduced to vaccination. Polio should be seen within the context of SDH. Other strategies (including access to safe water and sanitation) have a key role to play in the process of polio eradication.

The Global Polio Eradication Initiative has faced difficult challenges recently, with Afghanistan, Nigeria and Pakistan experiencing a significant increase in new cases in 2011 compared with 2010.  For these reasons the Global Polio Eradication Initiative intensified its extensive programme of work.

The Independent Monitoring Board has declared that the emergency approach must be extended to front-line workers, especially in Pakistan and Nigeria which “represent the gravest risk to global eradication”.

This approach involves considering additional  measures such as the possibility of using the International Health Regulations to limit the potential spread from affected countries” (para 6) and that  for some emergency eradication activities more financing is required.

In the new Global Polio Emergency Action Plan 2012–2013 a more efficient medium-term strategy is being examined, combining the eradication of residual wild poliovirus transmission with the polio “endgame” strategy designed to deal with vaccine-derived polioviruses.

Report of debate at WHA65

All Member States appreciated the intensification of the global polio eradication initiative and the  Global Polio Emergency Action Plan 2012–2013 to support Afghanistan, Nigeria and Pakistan, agreeing  “that the risk of failure to finish global polio eradication constitutes a programmatic emergency of global proportions for public health and is not acceptable under any circumstances”.
The report states also that  for 2012  the Strategic Advisory Group of Experts on immunization will provide recommendations on the actual implementation.

The main open issues are:
-how the removal of Sabin polioviruses from immunization programmes should be phased, beginning with the particularly problematic Sabin type 2 poliovirus.
-the availability of bivalent oral poliovirus vaccine, and new low-cost approaches for the use of inactivated poliovirus vaccine.
-the risk of international spread which will continue until the complete eradication of polio
-implementation of all basic routine vaccinations

During the discussion Kenya expressed the concern of not being ready to pass from OPV to injectable vaccine because of the active circulation of the virus in the country and lack of sanitation plus the higher cost of IPV.

Nigeria asked for an implementation of the epidemiological surveillance introducing GPS mapping and HIS system to focus on high-risk areas and reaffirmed the importance of building relationships with community and religious leaders.

After the discussion the draft resolution was finally approved.The Secretariat affirmed that WHO is working in close collaboration with GAVI and UNICEF to mobilize resources, especially for the extra cost of IPV and Dr Margaret Chan encouraged all Member States to redouble the efforts to succeed in the eradication.