global polio eradication initiative the 'intensified effort' 18 may 2008

www.polioeradication.org

Global Polio Eradication Initiative

The 'Intensified Effort'

18 May 2008


Polio

Paralysis for life Primarily affects children

Preventable with OPV


Polio – the world in 1988

1988: World Health Assembly Resolution

>350,000 cases

>125 polio-endemiccountries


Polio - the world in 2008

Since 1988: >99% reduction in disease

423 cases

Endemic country

Re-infected country


Global Polio Eradication Initiative

WHO, Rotary, CDC, UNICEF

Health Ministries

20 million volunteers

Donors (governments, development banks, private foundations, etc)

Private sector

UN agencies

NGOs


Polio Eradication Strategies

1. Routine Immunization

2. National Immunization Days (NIDs/SNIDs)

3. Surveillance

4. Mop-ups


India

Indonesia

Bangladesh

UK

Italy

Norway

Sweden

USCDCUSAIDFrance

Bill and Melinda Gates Foundation

WB Investment Partnership for Polio

IFFIm

Japan

EuropeanCommission

World Bank (India)

Rotary International

UN Foundation

Canada

Germany

Others

Netherlands

Denmark

2008-9 Funding Gap:US$ 490m of $1.3b budget

DomesticResources

14%

Non-G8 OECD/Other 8%

Multilateral Sector 15%

Private Sector 15%

Financial Contributions since 1988: US$ 6 billionand Funding Gap for 2008-2009

G8 48%


Intensified eradication effort


Launch of intensified eradication effortLaunch of intensified eradication effort

28 February 200728 February 2007

Dr Margaret Chan, WHO DG : "We will complete polio eradication!"

Stakeholder presence:

Endemic country representatives

International development community


New Tools

New lab procedures(50% faster detection)

16%10%

66%

31%

0

25

50

75

100

India Nigeria

% children protected per dose

tOPV

mOPV1

Monovalent OPV1(mOPV1) Efficacy


New tailored eradication tacticsIndia

Accelerated SIA schedule with monovalent OPVs Mop-up strategies for wild poliovirus type 1 (WPV1) Targeted strategies for access-compromised areas (Kosi river,

Bihar)

Afghanistan & Pakistan Synchronization of all activities, particularly in cross-border areas Improved access to populations (mobile and in areas of insecurity) Supplementary Interim Administered Dose (SIAD) strategy to

deliver extra dose in between large-scale campaigns

Nigeria 'Immunization Plus Days' New engagement by all sectors of civil society (eg Quranic school

engagement)


New political engagement and commitmentNew political engagement and commitment

Afghanistan & PakistanApril 2007

India

December 2007

Nigeria, February 2008


Impact of intensified eradication effort


Wild Poliovirus, Asiaas of 14 May 2008

district infected with wild polio virus type 1


Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison

0

10

20

30

40

2007 2008

Type 1 Cases

No countriesre-infected with

Type 1 WPV


Q1, 06 Q2, 06 Q3, 06 Q4, 06

Q1, 07 Q2, 07 Q3, 07 Q4, 07

* data as on 26th April 2008

Q1, 08

Compelling evidence of real progress in interrupting WPV1 in UP & Bihar, India

No WPV1 in UP since Nov 07;1 WPV1 in Bihar in Jan 08


Very geographically restricted virus in Afghanistan & Pakistan in 2008

Afghanistan Pakistan

Type 1 polio cases at 6 May


Wild Poliovirus, Africaas of 14 May 2008



Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison

0

25

50

75

100

125

150

2007 2008

Type 1 Cases

7 countriesre-infected with

Type 1 WPV!


Polio in Nigeria - 2008

• Borno, Kano, Katsina, Jigawa and Sokoto account for >50% of Nigeria’s cases

• >20% of children un-immunized in high-risk LGAs, leaving >1.5 million children vulnerable in these areas


0

20

40

60

80

100

120

2007 2008

Year-to-date comparison of type 1 polio

Polio Eradication in NigeriaNew outbreak in 2008

• >6-fold increase in type 1 polio (most dangerous type)

• Nigeria accounts for 90% of all type 1 polio worldwide

• Progress achieved in 2007 put at risk by new outbreak


The GPEI is on track to achieve

major landmarks in 2008-2009,

particularly in Asia.

But increase in cases in Africa needs

to be reversed


Immediate next steps - Asia

India Properly implement mop-up strategy for WPV1 Fully implement close operational gaps in remaining endemic

areas (Kosi river, Bihar) Further curb WPV3 outbreak and prevent geographic spread

Pakistan Introduce 'SIAD strategy' in Sindh (planned for July) Systematic use of finger-marking to guide SIA improvements Concentrate on high-risk areas & mOPV1 in Sindh (all viruses to

date in 2008)

Afghanistan Fully implement SIAD strategy in Southern Region Use new access to build up immunity


Immediate next steps - Africa

Nigeria Focus activities on high-risk LGAs in high-risk states Optimize operational improvements (micro-planning, vaccinator

selection, training and supervision) Accurate monitoring of immunization activities Urgent need for full engagement/ownership of LGA political

leaders (particularly high-risk LGAs) Continue to engage all community, traditional and religious leaders

Re-infected countries Maintain high population immunity levels in polio-free countries

(currently higher than in 2003-2005) Stop transmission of imported poliovirus in Angola, Chad and DR

Congo Rapidly fill sub-national surveillance gaps in key areas


After interruption of transmission of wild

poliovirus…


Long-term poliovirus risks(after containment & certification of wild polioviruses)

VAPP: Vaccine associated paralytic poliomyelitis

VDPV: Vaccine-derived polioviruses

– cVDPV: circulating VDPV

– iVDPV: 'chronic' VDPV excretion by an individual with a 1o immunodeficiency syndrome.


Post-eradication timeline

PriorityActivities

WPV Containment& Certification

VAPP/VDPV Elim. & Verification

'Post OPV'Era

Earliest dates 2010 2011 2012 2013 2014 2015 2016

Full WPV containment.

Fill mOPV stockpile.

Refine 'affordable' options for IPV use.

Certify WPV eradication.

Stop trivalent OPV.

Interim containment of Sabin viruses.

Optimize IPV use.

Interrupt cVDPVs (mOPV).

Verify VDPVs eliminated.

Full Sabin containment (if possible replace with

alternate strains)

Longterm surveillance.

Stockpile maintenance.

IPV cessation in countries using for transition.


Thank you…


global polio eradication initiative the 'intensified effort' 18 may 2008

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