10–12 November 2020Virtual Meeting

Meeting Report

26TH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS

ERADICATION IN THE WESTERN PACIFIC

26th Meeting of the Regional Commission for the Certification ofPoliomyelitis Eradication in the Western Pacific

10–12 November 2020

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

RS/2020/GE/35(virtual) English only

MEETING REPORT

TWENTY-SIXTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION

IN THE WESTERN PACIFIC

Convened by:

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Virtual Meeting 10–12 November 2020

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Printed and distributed by:

World Health Organization Regional Office for the Western Pacific

Manila, Philippines

February 2021

NOTE

The views expressed in this report are those of the participants of the Twenty-sixth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific and do not necessarily reflect the policies of the conveners.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Twenty-sixth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific, which was convened virtually from 10 to 12 November 2020.

CONTENTS

SUMMARY ............................................................................................................................................................... 1 

1. INTRODUCTION ................................................................................................................................................. 2 

1.1 Meeting organization ....................................................................................................................................... 2 

1.2 Meeting objectives ........................................................................................................................................... 2 

2. PROCEEDINGS .................................................................................................................................................... 2 

2.1 Opening session ............................................................................................................................................... 2 

2.2 Global update ................................................................................................................................................... 3 

2.3 Regional update ................................................................................................................................................ 3 

2.4 Update on regional laboratory network and GAP III implementation (laboratory containment) .................. 4 

2.5 Recommendations of the 2020 Technical Advisory Group on Immunization and Vaccine-Preventable Diseases .................................................................................................................................................................. 4 

2.6 Country/area discussions ................................................................................................................................. 5 

Malaysia ............................................................................................................................................................. 5 

Philippines .......................................................................................................................................................... 5 

Australia ............................................................................................................................................................. 6 

Brunei Darussalam ............................................................................................................................................. 6 

Cambodia ........................................................................................................................................................... 6 

China .................................................................................................................................................................. 6 

Hong Kong SAR (China) .................................................................................................................................... 7 

Macao SAR (China) ........................................................................................................................................... 7 

Japan ................................................................................................................................................................... 7 

Republic of Korea .............................................................................................................................................. 8 

Lao People’s Democratic Republic ................................................................................................................... 8 

Mongolia ............................................................................................................................................................ 8 

New Zealand ...................................................................................................................................................... 8 

Pacific island countries and areas (PICs) .......................................................................................................... 8 

Papua New Guinea ............................................................................................................................................. 9 

Singapore ............................................................................................................................................................ 9 

Viet Nam ............................................................................................................................................................ 9 

2.7 Twenty years free from indigenous wild poliovirus in the WHO Western Pacific Region ........................... 9 

2.8. Regional Polio Eradication in the Western Pacific and Regional Strategic Framework for Vaccine-Preventable Diseases and Immunization in the Western Pacific 2021-2030 ..................................................... 10 

2.9 Closing remarks ............................................................................................................................................. 10 

3. CONCLUSIONS AND RECOMMENDATIONS .............................................................................................. 10 

3.1 Conclusions .................................................................................................................................................... 10 

3.1.1 General conclusions ................................................................................................................................ 10 

3.1.2 Country-/area-specific conclusions ........................................................................................................ 11 

3.2 Recommendations .......................................................................................................................................... 14 

3.2.1 General recommendations ...................................................................................................................... 14 

3.2.2 Country-/area-specific recommendations............................................................................................... 15 

3.2.3 Recommendations for WHO .................................................................................................................. 17 

ANNEXES ............................................................................................................................................................... 18 

Annex 1. List of participants ................................................................................................................................ 18 

Annex 2. Programme of activities ......................................................................................................................... 1 

Keywords:

Immunization / Poliomyelitis – epidemiology, prevention and control / Poliovirus vaccines / Vaccination

ABBREVIATIONS

AFP acute flaccid paralysis

bOPV bivalent oral polio vaccine

COVID-19 coronavirus disease 2019

cVDPV circulating vaccine-derived poliovirus

cVDPV1 circulating vaccine-derived poliovirus type 1

cVDPV2 circulating vaccine-derived poliovirus type 2

EPI Expanded Programme on Immunization

GAPIII WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use

GCC Global Commission for the Certification of Poliomyelitis Eradication

GPEI Global Polio Eradication Initiative

IPV inactivated polio vaccine

mOPV monovalent oral polio vaccine

NCC national certification committee

OPV oral polio vaccine

PEF poliovirus-essential facility

PIM potentially infectious material

RCC Regional Commission for the Certification of Poliomyelitis Eradication

SIA supplementary immunization activity

SRCC Subregional Committee for the Certification of Poliomyelitis Eradication in Pacific Island Countries and Areas

TAG Technical Advisory Group on Immunization and Vaccine-Preventable Diseases

VDPV vaccine-derived poliovirus

VDPV1 vaccine-derived poliovirus type 1

VDPV2 vaccine-derived poliovirus type 2

WPV wild poliovirus

WPV1 wild poliovirus type 1

WPV2 wild poliovirus type 2

WPV3 wild poliovirus type 3

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SUMMARY

The Twenty-sixth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in the Western Pacific was held on 10–12 November 2020. The RCC meets annually to review and evaluate progress reports on maintaining polio-free status submitted by the national certification committees (NCCs) and by the Subregional Committee for the Certification of Poliomyelitis Eradication in Pacific Island Countries and Areas (SRCC). The NCC and SRCC reports also include updated information on the status of implementing recommendations from the 2019 RCC meeting. This year, due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the meeting was convened virtually.

During the meeting, the RCC reviewed the status of each Member State’s poliomyelitis (polio) eradication programme with special emphasis on achieving and maintaining sensitive acute flaccid paralysis surveillance, high population immunity through routine and supplementary immunization activities and timely and comprehensively response to polio outbreaks due to circulating vaccine-derived poliovirus (cVDPV).

The RCC expressed their concern about the exacerbating impact of the COVID-19 pandemic on the routine immunization and polio programmes in several of the Member States subsequently increasing the risk of VDPV emergence/importation and outbreaks. The RCC commended the contribution of the polio programme, particularly the regional polio laboratory network towards COVID-19 pandemic management. The RCC also commended the efforts of the Philippines and Malaysia to regain momentum of polio outbreak response activities amid pandemic. However, they expressed concern about the detection of the new or so-called young VDPV type 2 in areas where large-scale supplementary immunization activities of monovalent oral polio vaccine type 2 (mOPV2) were conducted. They also noted the progress made by the Member States towards poliovirus containment.

After thorough discussion and deliberation, the RCC concluded that the Region remains free of indigenous and imported wild poliovirus transmission.

Key general recommendations to all Member States included the following:

Moving forward, ensure routine immunization and polio surveillance programmes are maintained as an essential health service during COVID-19 pandemic and take necessary actions to mitigate the impact.

If using OPV, initiate preparation for, and introduction of, the second dose of inactivated polio vaccine in the routine immunization schedule.

Consider initiating surveillance for immunodeficiency-associated VDPV among persons with primary immunodeficiencies, in consultation with WHO.

Prepare for possible use of novel OPV2 in response to new cVDPV2 outbreaks.

Complete the national inventories to identify poliovirus potentially infectious materials in all remaining countries by the end of the first quarter of 2021.

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1. INTRODUCTION

1.1 Meeting organization

The Twenty-sixth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in the Western Pacific was convened virtually on 10–12 November 2020. The RCC meets annually to review the maintenance of polio-free status, the quality of acute flaccid paralysis (AFP) surveillance against standard indicators, and population immunity based on coverage of routine and supplemental poliomyelitis (polio) vaccination. This annual meeting fulfils the RCC’s mandate to assess progress and achievements every year, which are then reported to the Global Commission for the Certification of Poliomyelitis Eradication (GCC).

In attendance were five members of the RCC, the chair of the Technical Advisory Group on Immunization and Vaccine-Preventable Diseases in the Western Pacific Region, 17 national certification committee (NCC) chairpersons or delegates, and 12 observers/representatives. The meeting was supported by staff from World Health Organization (WHO) headquarters and the WHO Regional Office for the Western Pacific.

Dr Nobuhiko Okabe was appointed Chairperson, Dr Wang Yu served as Vice-Chairperson, and Dr Bruce Robinson Thorley served as Rapporteur. The list of participants and meeting timetable are available in Annexes 1 and 2, respectively.

1.2 Meeting objectives

The objectives of the meeting were:

1) to update the RCC members on the global status of polio eradication and recent activities in the Western Pacific Region;

2) to review and evaluate NCC annual progress reports, including the implementation status of the 2019 RCC recommendations; and

3) to recommend actions for countries to sustain polio-free status and implement polio endgame activities.

2. PROCEEDINGS

2.1 Opening session

Dr Yoshihiro Takashima, Coordinator, Vaccine-Preventable Diseases and Immunization unit, WHO Regional Office for the Western Pacific, welcomed all participants to the meeting. The opening remarks were delivered by Dr Huong Tran, Director, Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific. She gave an update about the important polio eradication events and activities in the Region. During the meeting of the Emergency Committee under the International Health Regulations, known as IHR (2005), on the international spread of poliovirus, Papua New Guinea and China were removed from the list of states infected with circulating vaccine-derived poliovirus (cVDPV) with potential risk of international spread. She expressed her concern over the ongoing outbreaks of cVDPV in the Philippines and Malaysia and that the recent use of monovalent oral polio vaccine (mOPV) type 2 may lead to the emergence of new outbreaks in future. She appreciated the ongoing outbreak response efforts of the regional and concerned country teams despite COVID-19 pandemic challenges. She highlighted the need to further strengthen routine immunization

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programmes, particularly among the high-risk and vulnerable subpopulations of the Member States. She said that she hoped the Regional Strategic Framework for Vaccine-preventable Diseases and Immunization for the Western Pacific (2021–2030), endorsed by the Regional Committee in October 2020, will support Member States of the Region to achieve the visions, goals and strategic objectives for expansion of immunization systems and programmes, as well as control, reduction and elimination of vaccine-preventable morbidity, mortality and disability including polio.

Dr Nobuhiko Okabe also gave his opening remarks as the chairperson of the RCC. He welcomed all participants to the meeting and highlighted the significant global and regional challenges and achievements. After four years without wild poliovirus, Nigeria was removed from the list of endemic countries and the African Region was certified as polio-free. He also commended the successful interruption of cVDPV circulation in Papua New Guinea and China. He remained optimistic that the Commission will be able to conclude that the Western Pacific Region has remained free from wild poliovirus circulation for the last 20 years, since its certification in 2000. He expressed his concern about the unprecedented challenges faced by the polio eradication programme due to the coronavirus disease 2019 (COVID-19) pandemic noting that the pandemic led to decreased routine vaccination activities and affected performance of surveillance for polio. Dr Okabe urged the countries to prioritize polio surveillance in the current challenging time and hoped that the vigorous efforts to interrupt circulation of cVDPVs in the Philippines and Malaysia will allow to close these outbreaks soon.

2.2 Global update

The Global Polio Eradication Initiative (GPEI) achieved the polio free certification in the African Region. To date, GPEI has experienced a growing number of paralytic cases of polio caused by wild poliovirus type 1 (WPV1) in the two endemic countries: Afghanistan and Pakistan. In addition, an unprecedented increase of cVDPV outbreaks, particularly of VDPV type 2, was seen throughout Africa and in the Western Pacific Region (Philippines and Malaysia), as well as Pakistan and Afghanistan. GPEI is expediting the authorization of novel oral polio vaccine (OPV) type 2 rollout for outbreak response under Emergency Use Listing. The role of the polio staff in managing the current COVID-19 pandemic was highlighted, as well as the impact of the pandemic on routine immunization and the polio programme. Polio and measles supplementary immunization activities (SIAs) were postponed in more than 35 countries and approximately 80 million children aged under 1 year were at risk of contracting polio. The top priorities in the coming six months will be to resume SIAs in endemic countries and safely continue response activities in outbreak countries, in terms of financing to secure additional funds through advocacy with donors and with recipient countries to increase ownership and accountability, as well as to implement the recommendations of the GPEI governance review. In terms of poliovirus type 2 containment, 25 countries retain poliovirus type 2 material in 72 poliovirus essential facilities. These numbers will increase once type 1 and 3 inventories are completed.

2.3 Regional update

The majority of Member States were able to maintain more than 90% coverage with three doses of polio vaccines in routine immunization and the key AFP surveillance indicators at the required benchmark level. In light of the COVID-19 pandemic, several Member States reported an impact on routine immunization (12 of 16 Member States) and AFP surveillance (7 of 15 Member States). Overall, based on the region-level risk assessment model, three Member States were classified as high risk (Philippines, Lao People’s Democratic Republic and Papua New Guinea), three as medium risk (Malaysia, Viet Nam and Cambodia) and the remaining 10 as low risk for poliovirus circulation. The coverage with one dose of inactivated polio vaccine (IPV) in OPV-using countries remained less than

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90% for the Lao People’s Democratic Republic, Viet Nam, the Philippines, Papua New Guinea, Samoa and Vanuatu. Preventive bivalent OPV (bOPV) SIAs in the Lao People’s Democratic Republic and Papua New Guinea were postponed to November 2020 due to the COVID-19 pandemic, and the catch-up IPV SIAs in Mongolia and Viet Nam are planned to be conducted between the last quarter of 2020 and the first quarter of 2021. The cVDPV1 and cVDPV2 outbreak response activities in the Philippines and Malaysia continue, including a large-scale vaccination response with monovalent OPV2 and bOPV. The global rollout of novel OPV2 under Emergency Use Listing is expected in 2021, and the WHO Regional Office supported the implementation of a novel OPV2 briefing, which was held recently in collaboration with a global novel OPV2 working group, to update the high-risk countries about recent developments. All eligible countries are encouraged to introduce a second dose of IPV, targeting introduction between 2021 and 2023. Supply may not be sufficient for all countries in 2021, so prioritization will be based on risk assessment. In the wake of recent global and regional upsurge in VDPV emergence and outbreaks, there is a need to identify and propose strategic directions for the polio programme in the Region for 2021–2030 to mitigate the risk. A regional-level consultation in February 2020 brought together world-renowned experts with wide expertise and extensive experience in the global and regional polio eradication initiative.

2.4 Update on regional laboratory network and GAP III implementation (laboratory containment)

A total of 25 countries plan to retain poliovirus type 2 materials in 76 poliovirus-essential facilities (PEFs). With certification of global eradication of WPV3 in 2019, the number of countries retaining poliovirus materials will increase once type 3 and later type 1 inventories are completed. The revision process of the WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII) was launched in September 2020 with a goal towards having an updated document in early 2021. Novel OPV2 and all S19 strains, also covered by GAPIII, have been temporarily waived from Annex 3 (and also Annex 2 for S19 strains) for specific uses. The way forward for the Auditor’s Qualification and Auditors Support, or AQAS, Plan will include qualification of auditors, audit and certification of facilities. Beyond type 2 containment, WHO will follow up with the GCC on the timeline and process for including WPV3 in containment. The preparation for implementation of GAPIII in the Western Pacific Region started in 2015. Strong advocacy from WHO in the Region and commitment from countries has resulted in a reduced number of PEFs (total 17). Certification of participation is approved for Japan and the Republic of Korea, submitted and under review for Australia, and not yet submitted by China and Viet Nam. The next steps will include provision of support for completion of Phase 1 for potentially infectious material (PIM), assisting the national authorities for containment of China and Viet Nam in the certification process, working with countries for auditors’ qualification and audit training, conducting simulation exercises for containment breaches in countries with PEFs, and supporting those countries in preparing outbreak response plans.

2.5 Recommendations of the 2020 Technical Advisory Group on Immunization and Vaccine-Preventable Diseases

The 29th Meeting of the Technical Advisory Group on Immunization and Vaccine-Preventable Diseases in the Western Pacific Region (TAG) was convened in June 2020. The TAG endorsed the draft Regional Strategic Framework for Vaccine-preventable Diseases and Immunization in the Western Pacific for 2021–2030. The TAG acknowledged that overall population immunity against poliovirus in the Region remained high, including surveillance performance that met standard

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benchmarks, and the regional polio laboratory network maintained high quality. The TAG noted that countries that use OPV in their routine immunization schedules will be able to introduce a second dose of IPV starting 2021. The TAG noted with concern that the ongoing COVID-19 pandemic seriously affected the performance of national immunization and polio eradication programmes and activities. It remained concerned about the continuing decrease in GPEI funding to the Western Pacific Region in 2020–2021, while the demand on resources increased due to increasing numbers of cVDPV outbreaks. The TAG urged Member States: to maintain high polio immunization coverage and address population immunity gaps; to achieve and maintain regional targets for AFP surveillance; to integrate analyses of environmental surveillance for polioviruses and epidemiologic surveillance for polio; to continue efforts to initiate poliovirus surveillance among patients with primary immunodeficiency disorders; to ensure that national polio outbreak response plans are updated and outbreak simulation exercises are conducted; and to complete the containment process for poliovirus PIM.

2.6 Country/area discussions

Malaysia

The immunization coverage remains high nationally, but subnational-level gaps exist. The IPV only schedule is being followed in the routine immunization programme since 2010. Most children born in or after 2010 in Malaysia have limited intestinal mucosal immunity to any poliovirus. The country continues to respond to the ongoing cVDPV1 and cVDPV2 outbreaks using bOPV and mOPV2 for large-scale SIAs in Sabah state and Labuan federal territory. The non-citizen population remains a high-risk subgroup. The updated national-level risk assessment in 2019 identifies nine out of 15 states as high or medium risk, and the state-level risk assessment in Sabah identified 14 districts as high risk and the remaining 11 districts as medium risk for poliovirus circulation. National-level AFP surveillance indicators for 2019 and 2020 remain variable. Environmental surveillance for polio commenced in 2012, with the scope expanded in terms of number of sites and frequency of sample collection to enhance sensitivity during the outbreak response. The COVID-19 pandemic has impacted vaccination uptake, vaccine-preventable disease staff have been mobilized to assist in COVID-19 management, and data reporting and transportation of specimens have also been affected. Mitigation efforts include continuity of SIA and RI activities at health facilities and drive-through stations, risk communication on importance of SIAs and continuing routine immunization using local media and community leaders; and close follow-up on data reporting and mobilization of additional staff to assist laboratory operations for COVID-19. The RCC emphasized the need to critically assess the reliability of the denominator used to calculate and report the vaccine coverage in routine sessions and during SIAs. It was also mentioned that addressing financial barriers to basic routine vaccination (like fees for non-citizen populations) could be considered.

Philippines

The national routine immunization coverage for three doses of poliovirus vaccine and IPV remains less than 80%. According to the 2019/20 risk assessment, 97 out of 177 provinces and cities remain at medium or high risk for poliovirus circulation. The AFP surveillance system performance remains variable, although significant progress has been made during the outbreak response period. The country continues to respond to the cVDPV1 and 2 outbreaks including activation of an incident command system, implementation of large-scale SIAs with mOPV2 and bOPV, enhanced AFP and environmental surveillance activities, and strengthened advocacy and communications activities. High coverage was achieved in all SIAs that were conducted before the COVID-19 pandemic. The pandemic impacted the routine immunization and outbreak response activities. The country has resumed large-scale mOPV2

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and bOPV SIAs since July 2020. The way forward includes close monitoring of the outbreak response amid the COVID-19 pandemic, the administration’s close follow-up on all response activities, continued enhanced AFP surveillance and sustainability planning for routine immunization.

Australia

No case of polio was detected during the reporting period (January 2019 to June 2020). Routine immunization coverage at national and subnational levels remained optimal (95.22%). The non-polio AFP rate for the country remains above the target (1.34 for 2019 and 1.02 by mid-2020), stool adequacy has improved considerably but remains below the target. To improve performance, a focused risk assessment, which was conducted in 2020 as a follow-up to a national risk assessment in 2019, concluded that the risk for VDPV, WPV reintroduction or sustained transmission remains very low. To improve stool adequacy, an action plan was developed and implemented by the Paediatric Active Enhanced Disease Surveillance (PAEDS) network. A PIM survey for poliovirus containment is yet to be finalized. The COVID-19 pandemic transmission was classified as “clusters of cases” overall and “community transmission” in Victoria as of September 2020. The routine immunization programme performance was maintained throughout the pandemic overall, but the non-polio AFP rates for Victoria and Queensland were below target rates during the first six months of 2020. The Australia NCC recommends: implementation of a PIM survey and laboratory containment planning as soon as possible; consideration to pilot a second site for environmental surveillance in a suitable metropolitan area; and pilot screening of patients with primary immune deficiency syndrome (PIDs) for poliovirus infection.

Brunei Darussalam

The country has retained high performance in its routine immunization programme and AFP surveillance system in the last several years. The required AFP surveillance benchmarks were met for 2019 and mid-2020. Although there is low overall risk for polio in the country, the challenge of ongoing cVDPV1 and cVDPV2 outbreaks in bordering Sabah state in Malaysia must be vigilantly monitored. The COVID-19 pandemic transmission was classified as “clusters of cases” overall, with no impact on the overall immunization and polio programmes.

Cambodia

The country continues efforts to improve national immunization coverage and AFP surveillance performance, but subnational gaps persist. The efforts to reach the unreached in high-risk provinces through community outreach and catch-up immunization activities continued. The COVID-19 pandemic transmission was classified as “sporadic cases” as of September 2020. Routine immunization service delivery and AFP surveillance performance were affected. Some health facilities had vaccine stock-outs in July 2020 because of delayed arrivals of vaccines in the country, and AFP reporting was also poor in the early part of the year. Sample shipments to regional reference laboratories were also delayed considerably. Interim guidance for immunization programmes during and after the COVID-19 pandemic was developed and implemented. Ongoing efforts are required to continue to further strengthen AFP surveillance performance and improve vaccination coverage in all high-risk areas by continuing the catch-up and outreach activities.

China

China maintained high immunization coverage and overall AFP surveillance performance at the national level in 2019. In October 2020, the Emergency Committee under the International Health Regulations, known as IHR (2005), removed China from the list of countries infected with cVDPV2. Efforts to enhance AFP surveillance performance and maintain immunization coverage continued.

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A second dose of IPV has been added to the routine immunization schedule since January 2020, preventive bOPV SIAs were conducted in all high-risk areas, and an inventory of 62 964 laboratories to identify poliovirus type 2 was conducted. Progress towards containment certification process remained slow with PEFs not officially nominated yet. As of September 2020, the COVID-19 pandemic transmission was classified as “sporadic cases”. During the initial period of the pandemic, almost 80% of immunization clinics were suspended and immunization staff were repurposed for COVID-19 management. In continued efforts to mitigate the impact, the Chinese Center for Disease Control and Prevention published guidance for conducting routine immunization services during the pandemic. Catch-up campaigns have been completed. AFP surveillance system performance was also affected with a decline in non-polio AFP reporting and stool adequacy. Most of the provinces have transitioned back to again reach the required surveillance benchmarks, but challenges remain in the worst-hit provinces.

Hong Kong SAR (China)

Hong Kong SAR (China) maintained high routine immunization coverage. The non-polio AFP rate met the required benchmark, while stool adequacy in 2019 remained low. The efforts to maintain high immunization coverage continue through activities such as default tracing, catch-up visits to schools and inspection of vaccination records at preschool institutions. With regard to recent VDPV outbreaks in the region, a high number of people from Filipino ethnic minorities residing in Hong Kong may pose a risk of cVDPV2 importation. The COVID-19 pandemic affected the routine immunization programme – comparing the first three doses among the 2018 birth cohort as of June 2019 to the 2019 birth cohort as of June 2020, a drop of 3–10% coverage was observed. A contingency plan on school immunization has been implemented since May 2020, and catch-up vaccination is being planned for the schoolchildren who may have missed doses because of school suspension. For enterovirus surveillance, the number of specimens in the non-polio typing results decreased in 2020 compared to 2019. Starting from February 2020, non-polio enterovirus typing data (respiratory specimens) are only collected from persons aged below 18 years during the COVID-19 outbreak.

Macao SAR (China)

Macao SAR (China) has maintained high routine immunization coverage and good quality of AFP surveillance. Efforts to further improve routine immunization continue. Since April 2019, the entry requirement of immunization has been extended to all students, including overseas students for higher educational institutes, and the Health Bureau has implemented annual random checks in selected schools to evaluate compliance. The COVID-19 pandemic transmission was classified as “clusters of cases” as of September 2020. Routine immunization services were temporarily interrupted from January to February 2020. The health centres are now doing vaccination by appointment, a school mass vaccination programme for the fifth DTPa-IPV resumed, and the catch-up activities were completed in July 2020.

Japan

Routine immunization against polio remains high. AFP surveillance was initiated in 2018, but the AFP reporting concept has not been generalized yet, which has resulted in suboptimal performance. Both key AFP surveillance indicators (non-polio AFP rate and stool adequacy) remain low. Efforts are ongoing to streamline the AFP surveillance system. Progress towards appropriate containment of poliovirus strains and poliovirus PIM continues. With regard to the regional reference laboratory functions, the sample transportation from other national polio laboratories to the National Institute of Infectious Diseases remained challenging due to the COVID-19 situation.

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Republic of Korea

The country continues to maintain high performance in routine immunization and AFP surveillance. Financial support for the private sector in the immunization delivery system has been increased, vaccination status verification is a mandatory requirement at school entry, and an advocacy campaign is run every year. The Korea Disease Control and Prevention Agency (KDCA) also distributes foreign language immunization guide booklets for multicultural families, foreign residents and migrants. For AFP surveillance, training programmes are conducted for all newly assigned doctors and the Government provides incentives to doctors who report the suspected cases. A retrospective review of medical records in 2020 is planned in all major health-care facilities to ensure there are no missed cases. Efforts were also made to mitigate the impact of the COVID-19 pandemic on the routine immunization programme.

Lao People’s Democratic Republic

Overall routine immunization programme remains suboptimal, and AFP surveillance performance indicators have declined. Efforts are ongoing to improve the Expanded Programme on Immunization (EPI) and surveillance data quality. To close widening immunity gaps, a preventive bOPV SIA is planned in November to December 2020. Transportation of AFP stool samples to regional reference laboratory was also delayed due to COVID-19-related restrictions. In efforts to improve surveillance, supportive supervision and on-the-job training are being reinforced, and there is close monitoring of routine immunization and AFP surveillance activities at the subnational levels. The national immunization programme has also considered introducing the second dose of IPV into the routine immunization schedule.

Mongolia

High routine immunization coverage was maintained overall. AFP surveillance performance has been declining in terms of the non-polio AFP rate, and it was further impacted by the ongoing COVID-19 pandemic with no cases reported as of 1 November 2020. In ongoing efforts to improve AFP surveillance, trainings and sensitization sessions are being conducted for health-care workers and clinicians, and interim guidance material is being developed to manage essential polio activities amid the pandemic. The country plans to conduct IPV catch-up vaccination for all children born after 2016 (the switch from trivalent to bivalent oral polio vaccine).

New Zealand

The country continues to achieve overall high coverage with polio vaccine, but subnational gaps remain in some areas. The non-polio AFP rate indicator was less than 1 per 100 000 children, and stool adequacy, although improved in 2020, is still below the regional target. Efforts to further improve immunization coverage continue, including an accelerated vaccinator training programme and the provision of immunization services at refugee resettlement centres. For AFP surveillance, regular sensitization of clinicians on the importance of stool sample collection was completed. The COVID-19 pandemic situation was classified as sporadic cases as of September 2020. The routine immunization services continued, but coverage decreased during the pandemic. AFP surveillance activities were also affected as staff worked from home and sample collection became a challenge.

Pacific island countries and areas (PICs)

Routine immunization coverage as well as the AFP surveillance performance remained suboptimal in several countries. Six countries have yet to complete the national survey to identify poliovirus PIM. The OPV-using countries aim to start preparations for the introduction of the second IPV dose in 2021.

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With regard to the COVID-19 pandemic, efforts are under way to ensure that essential routine immunization and AFP surveillance activities are maintained in all countries and areas.

Papua New Guinea

The VDPV1 outbreak of 2018 is now officially closed, and Papua New Guinea was removed from the list of Member States infected with cVDPV with potential risk of international spread during the meeting of the Emergency Committee under the International Health Regulations (2005) on the international spread of poliovirus. Overall routine immunization coverage remains very low, and AFP surveillance performance also remains suboptimal. National and the provincial emergency operations centres continue to coordinate surveillance and immunization activities, as well as the COVID-19 response. The Department of Health has initiated catch-up activities in 13 selected high-risk provinces to provide routine immunization services through intensified mobile and outreach sessions, including provision of IPV. The COVID-19 pandemic transmission was classified as “community transmission” as of September 2020. The routine immunization programme and AFP surveillance activities were affected. A national polio SIA using bOPV will be implemented in November 2020.

Singapore

Routine immunization coverage remains high. The AFP surveillance system is also functioning optimally, although declines were noted in AFP reporting due to the COVID-19 pandemic in 2020. As there are many visitors from polio high-risk countries, risk assessments are regularly conducted to closely monitor any possible importation of polio from outbreak and endemic countries. The archived faecal and respiratory samples collected from 2009 to 2016 are considered poliovirus PIM and hence are required to be destroyed.

Viet Nam

Routine immunization and AFP surveillance performance remain variable throughout the reporting period. Low AFP surveillance performance in densely populated areas such as Ho Chi Minh City remains a concern. As part of the ongoing efforts to improve routine AFP surveillance, formal trainings and sensitization sessions are being conducted. The containment certification process needs to be expedited. Community transmission of COVID-19 continued, and the immunization activities were postponed due to lockdown implementation. The country plans to implement catch-up vaccination with IPV in early 2021 or as soon as the vaccine is available.

2.7 Twenty years free from indigenous wild poliovirus in the WHO Western Pacific Region

The Western Pacific Region was certified as WPV-free in 2000. Throughout the 20 years since certification, WPV was imported into the Region several times, but none of these importations led to re-establishment of endemic WPV transmission. The major import-related WPV1 outbreak (Xinjiang, China) in 2011 was responded to and stopped rapidly. VDPV emergences were detected throughout the past 20 years and led to several outbreaks representing serious threats, particularly following the trivalent to bivalent OPV switch, and for countries with low-performing immunization/surveillance. To date, all major cVDPV outbreaks have been successfully stopped. During these efforts, the countries carried the major burden of eradicating poliovirus and maintaining polio-free status and regional and global partners also made major contributions (financial, technical). It is concerning that polio funding from GPEI for the Western Pacific Region has decreased, even though demand for resources increased (increasing cVDPV outbreaks). The RCC put a strong focus on systematic national and regional polio risk assessment, and all countries maintain detailed outbreak preparedness plans, which are updated annually. Sensitive surveillance for poliovirus has been maintained, though gaps persist in some

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countries. A comprehensive network of polio laboratories continues to be the backbone of poliovirus surveillance in the Western Pacific Region. Progress has been made for containment measures with five countries intending to designate 17 PEFs. The RCC continues to collaborate with WHO in the Region and relevant stakeholders to urgently facilitate the progress in China and Viet Nam towards certification of their PEFs.

2.8. Regional Polio Eradication in the Western Pacific and Regional Strategic Framework for Vaccine-Preventable Diseases and Immunization in the Western Pacific 2021-2030

Since regional eradication in 2000, efforts to sustain the polio-free status have successfully continued. A regional vaccine-preventable disease laboratory network was established and has been expanding ever since; regional technical advisory bodies were established and continue to expand. Overall for routine immunization, tetanus elimination, accelerated hepatitis B control, measles elimination, rubella elimination and accelerated Japanese encephalitis control targets were also added to the immunization programme. With regard to polio, the cVDPV outbreaks in the Region have continued to get more severe over the years. During the 2015–2020 period as compared to the 2001–2014 period, the cVDPV outbreaks showed higher nucleotide differentiation from Sabin vaccine and affected a larger number of children and caused paralytic polio. Several countries continue to use OPV, and the challenge to reach the high-risk unreached subpopulations remains. Responses to the ongoing cVDPV1 and cVDPV2 outbreaks in the Philippines and Malaysia are ongoing, including mOPV2 for type 2 outbreak. The Regional Strategic Framework for Vaccine-preventable Diseases and Immunization in the Western Pacific (2021–2030) has been developed to address the challenges in the coming decade. These challenges include repeated vaccine-preventable disease outbreaks, increased vaccine-preventable disease incidence among older children and adults, public health emergencies including pandemics, vaccine hesitancy, underutilized vaccines and diversification of country needs. For polio, the proposed goal for 2030 is elimination of infection (including VDPV), and the target is zero incidence of polio due to any type of poliovirus infection. The strategic directions to achieve this goal will include to sustain high-level population immunity, withdraw OPV from use and introduce IPV, sustain a sensitive surveillance system, ensure sustainable domestic funding for polio-essential functions, fully prepare and promptly respond to polio events and outbreaks, and fully implement GAPIII.

2.9 Closing remarks

Dr Okabe delivered the closing remarks, expressing his appreciation for the continuity of essential polio activities in the Region to address the unprecedented challenges due to the ongoing COVID-19 pandemic. Dr Okabe closed the meeting by acknowledging the commitment and dedication of all the ministries of health and the support of international partners to eradicate polio.

3. CONCLUSIONS AND RECOMMENDATIONS

3.1 Conclusions

3.1.1 General conclusions

• The RCC is deeply concerned about the exacerbating impact of the COVID-19 pandemic on declining routine immunization and surveillance activities in several Member States, which may lead to increased risk of emergence or importation of cVDPV and subsequent outbreaks.

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• The RCC commends the efforts of the Philippines and Malaysia to regain momentum to deliver large-scale outbreak response immunization activities amid the pandemic, as well as mitigation activities.

• The RCC is concerned that isolation of ambiguous vaccine-derived poliovirus (aVDPV) type 2 in the areas where mOPV2 outbreak response SIAs were conducted probably represents the limited quality of these SIAs.

• The RCC notes the progress made towards implementing poliovirus containment in most countries and overall progress in the Region for completing inventories of facilities storing poliovirus PIM. The RCC particularly commends Japan and the Republic of Korea for receiving approval of certificates of participation for their PEFs.

• The RCC commends countries for leveraging resources of the polio network to support the initial COVID-19 response activities.

• The RCC commends the contribution of the regional polio laboratory network virologists towards laboratory diagnosis of COVID-19.

3.1.2 Country-/area-specific conclusions

Australia

• The RCC commends further efforts to improve stool adequacy rate.

• The RCC notes the submission of the certificate of participation to the GCC Containment Working Group for review.

• The RCC notes that environmental surveillance resumed in September 2020.

• The RCC thanks the Polio Regional Reference Laboratory from the Victorian Infectious Diseases Reference Laboratory for their critical support of the Malaysia polio outbreak.

Brunei Darussalam

• The RCC commends maintenance of high-level performance in polio immunization and AFP surveillance.

• The RCC acknowledges the risk (although low) of importation of cVDPV1 and cVDPV2 due to ongoing outbreaks in Sabah state, Malaysia.

Cambodia

• The RCC commends the efforts to mitigate the impact of the COVID-19 pandemic on routine immunization services (catch-up immunization activities, interim guidelines on sustaining routine immunization).

• The RCC also notes that AFP surveillance performance and routine immunization remain suboptimal in some areas.

China

• The RCC commends the rigorous and comprehensive efforts to close the cVDPV2 outbreak in Sichuan province.

• The RCC commends the endeavours to mitigate the impact of the COVID-19 pandemic on the polio programme.

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• The RCC commends the introduction of a second dose of IPV in the routine immunization schedule since January 2020.

• The RCC commends the completion of the national inventory to identify poliovirus PIM (69 296 laboratories surveyed).

• The RCC notes with concern that the National Authority for Containment has not been established yet and the containment certification process has not started.

• The RCC notes with concern that many laboratories (40+) still have poliovirus type 2 infectious material that requires containment.

Hong Kong SAR (China)

• The RCC commends continued efforts to sustain high polio immunization coverage.

• The RCC notes continuous efforts for the timely detection and response to the possible importation of poliovirus from endemic and outbreak countries.

Macao SAR (China)

• The RCC commends continued good-quality AFP surveillance and efforts to achieve high polio immunization coverage among migrant children.

• The RCC notes that the polio seroprevalence survey has been impacted by the COVID-19 pandemic.

Japan

• The RCC thanks the Government of Japan and the National Institute of Infectious Diseases Polio Global Specialized Laboratory for their ongoing support towards polio surveillance activities in the Western Pacific Region, including the recent outbreak in the Philippines.

• The RCC notes and commends continued efforts and progress towards appropriate containment of poliovirus strains and poliovirus PIM.

• The RCC notes with concern the negative impact of the COVID-19 pandemic on the ongoing efforts to establish an effective AFP surveillance system.

Lao People’s Democratic Republic

• The RCC notes with concern the persistent coverage gaps in routine immunization and declining AFP surveillance performance.

• The RCC notes efforts to close immunity gaps with preventive bOPV SIAs.

Malaysia

• The RCC commends:

the launch of the polio outbreak response to stop the ongoing cVDPV1 and cVDPV2 outbreaks and continued momentum amid the COVID-19 pandemic; and

ongoing efforts to strengthen AFP surveillance, which still remains suboptimal, and the rapid expansion of environmental surveillance.

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• The RCC notes:

the efforts to enhance polio immunization coverage among the high-risk population in Sabah state, particularly among the stateless population and non-citizens; and

the suboptimal performance of mOPV2 outbreak response SIAs in Sabah state.

Mongolia

• The RCC commends maintenance of high routine immunization coverage.

• The RCC notes with concern the declining AFP surveillance performance (also impacted by the COVID-19 pandemic).

• The RCC notes the plan to conduct IPV catch-up vaccination for children born after the switch from trivalent to bivalent OPV in 2016.

New Zealand

• The RCC commends the efforts to mitigate the impact of the COVID-19 pandemic on AFP surveillance.

• The RCC commends the ongoing efforts to improve AFP surveillance, including sensitization of the health-care providers.

• The RCC notes that efforts are under way to destroy poliovirus PIM from a recent collaborative study.

Pacific island countries and areas

• The RCC is concerned about the suboptimal routine immunization coverage in several countries and notes the plan to implement catch-up vaccination in several countries.

• The RCC is also concerned about the suboptimal AFP surveillance stool adequacy indicator and notes the efforts that are being made to improve it.

Papua New Guinea

• The RCC notes that the emergency operations centres at national and subnational levels, which were established for the 2018 cVDPV1 outbreak response, are being leveraged to enhance the routine immunization programme and AFP surveillance, as well as COVID-19 pandemic management.

• The RCC commends:

The successful implementation of the reverse cold chain study to strengthen performance of AFP surveillance; and

the launch of a nationwide bOPV SIA amid the COVID-19 pandemic with integrated interventions of vitamin A supplementation and deworming.

• The RCC remains highly concerned about the persistent suboptimal routine immunization coverage at national and subnational levels.

• The RCC notes with concern the decline in performance of AFP surveillance and the discontinuation of environmental surveillance.

• The RCC notes that the national inventory to identify poliovirus PIM has not been completed.

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Philippines

• The RCC commends:

– vigorous efforts to contain the cVDPV1 and cVDPV2 outbreaks and further enhance environmental surveillance in response to these outbreaks; and

– maintenance of the polio outbreak response amid the COVID-19 pandemic as well as the launch of a preventive polio, measles and rubella SIA.

• The RCC notes with concern:

– suboptimal performance of mOPV2 SIAs in regions III and IVA; and

– emergence of several aVDPV2 in mOPV2 response areas in the National Capital Region and region IVA.

• The RCC is concerned that routine immunization and AFP surveillance performance remain suboptimal.

Republic of Korea

• The RCC commends continued efforts to maintain high polio immunization coverage and AFP surveillance.

• The RCC notes the impact of the COVID-19 pandemic on AFP surveillance performance and that the country plans to do a retrospective review of medical records to identify potentially unreported AFP cases in 2020.

Singapore

• The RCC commends maintenance of high immunization coverage and quality AFP surveillance.

Viet Nam

• The RCC notes with concern:

• the subnational gaps in routine immunization coverage;

• the subnational gaps in AFP surveillance performance, particularly in Ho Chi Minh City; and

• that the containment certification process has not started yet.

3.2 Recommendations

3.2.1 General recommendations

Member States are encouraged to consider the following:

1) Moving forward, ensure routine immunization and polio surveillance programmes are maintained as an essential health service during the COVID-19 pandemic and take necessary actions to mitigate the impact.

2) For all countries using OPV, initiate preparation for, and introduction of, the second dose of IPV in routine immunization schedules.

3) Consider initiating surveillance for immunodeficiency-associated vaccine-derived poliovirus among persons with primary immunodeficiencies, in consultation with WHO.

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4) Prepare for possible use of novel OPV2 in response to new cVDPV2 outbreaks.

5) Complete the national inventories to identify poliovirus PIM in all remaining countries by the end of the first quarter of 2021.

3.2.2 Country-/area-specific recommendations

Australia

1) Complete the national inventory to identify facilities storing poliovirus PIM.

Brunei Darussalam

1) In collaboration with WHO, explore with the polio laboratories (in Australia, the Philippines or Singapore) the feasibility of establishing environmental surveillance to monitor the possible importation of poliovirus, specifically from Malaysia.

2) Consider implementation of a targeted healthy children stool survey in prioritized areas to detect possible importation of poliovirus in consultation with WHO.

Cambodia

1) Continue to strengthen all aspects of AFP surveillance and improve the subnational polio immunization coverage in provinces consistently reporting less than 90% coverage.

2) Continue working with WHO to establish environmental surveillance.

China

1) Continue efforts to maintain strong AFP and environmental surveillance in high-risk and previous outbreak areas.

2) Continue to assess the risk of poliovirus transmission and implement preventive SIAs in identified high-risk areas.

3) Urgently establish the National Authority for Containment and start the certification process with WHO support for capacity-building of qualified auditors.

4) Urgently decide on the destruction or transfer of type 2 poliovirus PIM in remaining non-essential facilities.

Hong Kong SAR (China)

1) Continue to maintain high-quality polio immunization and surveillance activities.

Macao SAR (China)

1) Maintain high-level poliovirus surveillance and immunization performance.

2) Collaborate with the Chinese Center for Disease Control and Prevention or other laboratories (in Japan or the United States of America) that are able to conduct the poliovirus antibody neutralization test for completion of the seroprevalence survey.

Japan

1) Continue efforts to strengthen the performance of the AFP surveillance system in line with the standard guidelines and indicator targets.

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Lao People’s Democratic Republic

1) Continue efforts to enhance routine immunization and AFP surveillance focusing on high-risk areas and population subgroups.

2) Urgently ensure stool specimens held in the country due to the COVID-19 pandemic are shipped to the Polio Global Specialized Laboratory.

3) Continue working with WHO to establish environmental surveillance.

Malaysia

1) Make urgent efforts to improve routine immunization coverage and enhance poliovirus surveillance in all states in view of the recent cVDPV1 and cVDPV2 outbreaks in Sabah state and Labuan federal territory.

2) Continue efforts to address immunity gaps and maintain high vaccination coverage with all Expanded Programme on Immunization antigens in high-risk groups (stateless population, non-citizens and others).

3) Maintain strong accountability for mOPV2 used during the outbreak response as per GPEI guidelines.

4) Review the laboratory results of environmental surveillance to assess the suitability of the sites and implement corrective actions, if required.

5) Prepare for an independent external review to assess the outbreak response.

Mongolia

1) Take urgent actions to improve the performance of AFP surveillance.

2) Conduct as soon as feasible an IPV catch-up campaign for children missed since May 2016 due to the delayed introduction of IPV.

New Zealand

1) Continue to maintain high-quality immunization activities.

2) Sustain AFP surveillance at the required level of sensitivity.

Pacific island countries and areas

1) Complete the national survey to identify poliovirus PIM in the six remaining countries and areas.

Papua New Guinea

1) Prioritize strengthening routine immunization and poliovirus surveillance.

2) Complete the national survey to identify poliovirus PIM and submit the report to WHO as soon as possible.

3) Consider resuming environmental surveillance in two provinces (Morobe and National Capital District).

Philippines

1) Continue strong efforts to address routine immunization and AFP surveillance gaps in all regions.

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2) Continue to closely monitor the ongoing detection of aVDPV2 to ensure there is no circulation (including expansion of environmental surveillance in areas where new aVDPV2 are detected).

3) Prepare a rigorous plan of action to respond to any new cVDPV2 outbreaks.

4) Continue to maintain strong accountability for mOPV2 used during the outbreak response as per GPEI guidelines.

Republic of Korea

1) Proceed with the planned follow-up survey on poliovirus PIM to ensure completeness of national data.

2) Ensure proper containment or destruction/transfer of WPV3/VDPV3 as per GAPIII requirements.

Singapore

1) Consider destruction of archived faecal and respiratory samples collected from 2009 to April 2016, which are poliovirus PIM (collected within six weeks of receiving trivalent OPV).

Viet Nam

1) Ensure the final classification of AFP cases notified in Ho Chi Minh City are reported in the national data.

2) Ensure health-care providers are sensitized about the syndromic AFP case definition and inclusion criteria.

3) Receive official confirmation from the Ministry of Health that POLYVAC will not be designated as a PEF and that Sabin 2 materials stored in POLYVAC will be destroyed, and report to WHO.

4) Conduct as soon as feasible an IPV catch-up campaign for children missed since May 2016 due to the delayed introduction of IPV.

5) Update the subnational polio risk assessment using 2019 data.

3.2.3 Recommendations for WHO

WHO is requested to consider the following:

1) Raise awareness of the continuing risks of poliovirus outbreaks and ensure long-term commitment of national authorities to sustain high polio immunization coverage and surveillance to remain polio-free.

2) Provide technical support to countries for polio immunization and surveillance activities.

3) Discuss with the technical advisory groups on how to mitigate the risk of cVDPV emergence and outbreaks.

4) Coordinate cross-border and cross-regional responses to cVDPV outbreaks.

5) Provide support to countries interested in pursuing novel OPV2 use.

6) Provide technical support to countries to implement GAPIII requirements.

7) Establish environmental surveillance in Cambodia, the Lao People’s Democratic Republic and Viet Nam.

8) Establish immunodeficiency-associated VDPV surveillance.

ANNEXES

Annex 1. List of participants

1. Regional Certification Commission Members

Dr Nobuhiko Okabe, (Chairman, Regional Certification Commission), Director General, Kawasaki City Institute for Public Health, Life Science and Environment Research, 2F 3-25-3 Tono-Machi Kawasaki-ku, Kawasaki City, Kanagawa 210-0834, Japan, Tel no.: +81 4 4 2444985, Fax no.: +81 4 2462602, Email: okabe-n@city.kawasaki.jp, okabenobu46@gmail.com

Dr Wang Yu, Distinguished Profressor, Health City Research Center, Institute for China Sustainable Urbanization, Tsinghua University, Beijing, People's People's Republic of China, Tel no.: +86-10-58900216, Fax no.: +86-10-58900240, Email: wangyu@chinacdc.cn

Dr Bruce Robinson Thorley, Senior Medical Scientist, Head, WHO Polio Regional Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia, Tel no.: (613) 9342 9607, Fax no.: (613) 9342 9665, Email: bruce.thorley@vidrl.org.au, bruce.thorley@mh.org.au

Dr Steven Wassilak, Medical Epidemiologist, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Atlanta, Georgia 30333, United States of America, Tel no.: +1 404 639 1867, Fax no.: +1 404 639 8573, Email: sgw1@cdc.gov

Dr Olen M. Kew, Coordinator, National Poliovirus Containment Coordinator, 270 North Peak Drive, Alpharetta, Georgia 30022, United States of America, Tel no.: +1 770 993 3069, Fax no.: +1 404 639 4011, Email: omk1@cdc.gov; omk1@bellsouth.net

2. Temporary Adviser

Dr Christopher John Morgan, Senior Technical Advisor (Immunization), Jhpiego , 229 Scotchmer Street, Fitzroy North, Victoria 3068, Australia, E-mail: : christopher.morgan@jhpiego.org

Dr Rudolf Tangermann, Die Alte Schule, Eichelberger Weg 5, 96106 Ebern. Germany, Email: rudi.tangermann@gmail.com

3. Participants (National Certification Committee Members – Designates)

AUSTRALIA Professor David Durrheim, Professor of Public Health Medicine, University of Newcastle, University Dr., Callaghan,New South Wales 2308, Australia, Telephone: 02-49246395, Fax: 02-49246247 Email: david.durrheim@newcastle.edu.au

BRUNEI DARUSSALAM Pg Dr Haji Md Khalifah bin Pg Hj Ismail, Acting Director General, Medical and Health Services, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan 3910 Tel no. : +67 3 2380170 or +673 888 9901 Email : khalifah.ismail@moh.gov.bn

CAMBODIA Dr Ly Sovann, Director, Department of Communicable Disease Control, Ministry of Health, #80, Samdech Penn Nouth, Phnom Penh, Cambodia, Tel no.: +855 12 825424, Fax no.: +855 23 880441, Email: sovann_ly@online.com.kh

CHINA Dr Liang Xiaofeng, Secretary General & Executive Vice President, Chinese Preventive Medicine Association, 5th Floor, No. 25 Huaweili, Panjiayuan, Chaoyang District, Beijing 100021, China, Tel no.: +86 10 84016195, Fax no.: +86 10 84039873; Email: liangxf@cpma.org.cn

MACAO SAR (CHINA) Dr Wong Fong Ian, Consultant Pediatrician, Centro Hospitaler, Conde de Sao Januario, Estrada de Visconde de Sao Januario, Macao, Tel no.: +853 6686 6678 Email: wongfongian@gmail.com

HONG KONG SAR (CHINA) Professor Yu-Lung Lau, Doris Zimmern Professor in Community Child Health, Chair Professor of Paediatrics, Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Telephone : +852 2255 4481, Facsimile: +852 2855 1523, Email: lauylung@hku.hk

JAPAN Dr Takaji Wakita, Director General, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku Tokyo 162-8640, Japan, Tel no.: +81 3 5285 1111, Fax no.: +81 3 5285 1193, Email: wakita@nih.niid.jp

LAO PEOPLE'S DEMOCRATIC REPUBLIC

Dr Khamla Choumlivong, Deputy Director, Setthathirath Hospital, Donekoy Village, Sisattanak District, Vientiane Capital, Telephone: + 856 20 2222 6104, Fax no.: + 856 21 351160, Email: khamla_choumlivong@yahoo.fr

MALAYSIA Dato' Dr Chong Chee Kheong, Deputy Director General (Public Health), Ministry of Health Malaysia, Level 2, Block E10, Complex E, 62590 Putrajaya Tel no.: +603 88832544, Fax no.: +603 88834158, Email: drchongck@moh.gov.my

MONGOLIA Dr Janchiv Oyunbileg, Consultant, Leading Scientist, National Center for Public Health, Peace Avenue – 17, Ulaanbaatar, Tel no.: +99762000, Email: jobileg@gmail.com

NEW ZEALAND Professor Stephen Chambers, Specialist Physician, Pathology and Medical Science, University of Otago, Christchurch, P.O. Box 4345, Christchurch 8140, New Zealand, Telephone: +64 3 3640 590 Email: Steve.chambers@otago.ac.nz

PACIFIC ISLAND COUNTRIES AND AREAS

Dr Ilisapeci Tuibeqa, Head Department of Paediatrics, Colonial War Memorial Hospital, Box 115, Suva, Republic of Fiji, Tel no.: +67 7522778 Email: beth.vereti@gmail.com

PAPUA NEW GUINEA Professor John Vince, Deputy Dean (Academic), School of Medicine and Health Sciences, University of Papua New Guinea P.O. Box 5255, Boroko, Tel no.: +67 5 73260185, Email: johndvince@gmail.com

PHILIPPINES Dr Nina G. Gloriani, Consultant, Clinical Microbiology Section, Institute of Pathology, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Avenue, Quezon City, Tel no.: +63 917 865 5353, Fax no.: +63 2 521 1394 Email: ninagloriani@gmail.com

REPUBLIC OF KOREA Professor Park Sueun, Professor, Pediatrics, Pusan National, University Children's Hospital, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, Republic of Korea, Tel no.: +82 55 3603155, Email: psepse@maver.com

SINGAPORE Dr Jeffery Cutter, Senior Consultant, Public Health Group, Ministry of Health, College of Medicine Building, 16 College Road, Singapore 1698854, Email: Jeffery_cutter@moh.gov.sg

VIET NAM Dr Pham Quang Thai, Vice head of Epidemiology Department, Deputy EPI Manager Northern Region, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung district, Hanoi, Tel no.: +84 4 38211634 Email: phamquangthai@gmail.com

4. Observers/Representatives

AUSTRALIA Dr Meryta May, Senior Medical Officer, Infection Management and Prevention Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Queensland 4101, Tel no.: +61 7 3377 8545, Email: Meryta_may@snp.com.au

Ms Rhonda Owen, Assistant Secretary, Health Emergency Management Branch, Office of Health Protection, Department of Health, Canberra, Tel no.: +61 2 62898813, Email: ronda.owen@health.gov.au

Dr Jason Roberts, Senior Medical Scientist Director, Electron Microscopy Facility, Victorian Infectious Diseases Reference Laboratory, Melbourne, Tel no.: +61 3 9342 9610, Email: Jason.roberts@vidrl.org.au

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION

Dr Yang Hong, Epidemiologist, National Immunization Program, Chinese Center for Disease Control and Prevention,No.27,Nanwei Road, Xicheng District, Beijing 100050, Tel no. : +8610-63027946-8005, Email: yanghong@chinacdc.cn

MINISTRY OF HEALTH, BRUNEI DARUSSALAM

Dr Hjh Anie Haryani Binti Hj Abdul Rahman, Director, Environmental Health Service, Public Health Services, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan, Tel no. : +67 3 2381470, Email : anie.rahman@moh.gov.bn

Dr Martina Kifrawi, Medical Officer, Disease Control Division, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan, Tel no.: +67 3 8727533, Email: martina.kifrawi@moh.gov.bn

MINISTRY OF HEALTH, MALAYSIA

Dr Mohd Hanif bin Zailani, Public Health Medicine Specialist, Disease Control Division, Level 2, Block E10, Complex E, 62590 Putrajaya, Tel no.: +603 88834503, Email: hanif@moh.gov.my

MINISTRY OF HEALTH, NEW ZEALAND

Dr Mavis Duncanson, Co-Director, Paediatric Surveillance Unit, University of Otago, Christchurch, P.O. Box 4345, Christchurch, New Zealand, Tel no.: +603 88834503, Email: mavis.duncanson@otago.ac.nz

MINISTRY OF HEALTH, SINGAPORE

Mr Yuske Kita, Senior Public Health Officer, Strategy and Prevention, Ministry of Health, College of Medicine Building, 16 College Road, Singapore 1698854, Tel no.: +65 6221 5528, Email: yuske_kita@moh.gov.sg

NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY

Dr Dang Thi Thanh Huyen, Vice Head, National EPI Office, National Institute of Hygiene and Epidemiology, No. 1 Yersin Street, Hai Ba Trung District, Hanoi, Email: epi.huyen1@gmail.com

NATIONAL INSTITUTE OF INFECTIOUS DISEASES

Dr Hiroyuki Shimizu, Chief, Laboratory of Enteroviruses, Department of Virology II, National Institute of Infectious Diseases, Tokyo 208-0011, Japan, Tel no.: + 82-43-719-8392Fax no.: +82-43-719-8379, Email: hshimizu@nih.go.jp

CENTERS FOR DISEASE CONTROL AND PREVENTION

Dr Cindi Snider, Epidemiologist, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, Email: bex4@cdc.gov

5. SECRETARIAT

WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO)

Dr Yoshihiro Takashima, Coordinator, Vaccine-Preventable Diseases and Immunization, Division of Programmes for Disease Control, World Health Organization, United Nations Avenue, 1000 Manila, Telephone: +63 2 8528 9746, Facsimile: +63 2 8521 1036, Email: takashimay@who.int

Dr Tigran Avagyan, Technical Officer, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines, Tel no.: +63 2 8528 9737, Fax no.: +63 2 8526 0279, Email: avagyant@who.int

Ms Varja Grabovac, Scientist, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines, Tel no.: +632 85289747 Fax no.: +632 85211036 Email: grabovacv@who.int

Dr Syeda Kanwal Aslam, Short-term Consultant, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines Tel no.: +632 5288001, Fax no.: +632 5211036, Email: saslam@who.int

WHO HEADQUARTERS GENEVA

Ms Liliane Dalila Boualam, Technical Officer, Research Policy and Containment, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland, Tel no.: +41 22 791 2163, Email: boualaml@who.int

Annex 2. Programme of activities

WORLD HEALTH

ORGANIZATION

ORGANISATION MONDIALE

DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

TWENTY-SIXTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC

Virtual

10–12 November 2020

PROVISIONAL PROGRAMME OF ACTIVITIES1

Time

[Manila time] Activities Speaker(/Moderator)

Day 1: Tuesday, 10 November 2020

08:00 – 08:30

08:30 – 08:40

08:40 – 09:00

09:00 – 09:20

09:20 – 09:40

09:40 – 10:00

1. Opening of the meeting

1.1. Welcome remarks by the Responsible Officer

1.2. Opening remarks of the Regional Director

1.3. Remarks by the Chair of the RCC

1.4. Administrative/other announcements

2. Meeting objectives

3. Global update

4. Regional update

5. Update on regional laboratory network and GAP III implementation (laboratory containment)

6. Recommendations of the 2020 Technical Advisory Group on Immunization and Vaccine-preventable Diseases

Dr Yoshihiro Takashima

Dr Huong Thi Giang Tran

Dr Nobuhiko Okabe

Dr Yoshihiro Takashima

Dr Nobuhiko Okabe

Ms Liliane Boualam

Dr Tigran Avagyan

Ms Varja Grabovac

Dr Chris Morgan

1 The provisional programme of activities is subject to change. Final copy will be communicated directly to the participants of the meeting.

Time

[Manila time] Activities Speaker(/Moderator)

10:00 – 10:15 COFFEE BREAK

10:15 – 10:45

10:45 – 11:15

11:15 – 11:30

7. Country presentations

7.1. Malaysia

7.2. Philippines

Discussion

Dr Mohd Hanif bin Zailani Dr Nina Gloriani

11:30 – 12:00 REVIEW OF DRAFT CONCLUSIONS AND RECOMMENDATIONS

RCC members and Secretariat

Day 2: Wednesday, 11 November 2020

08:00 – 08:15

08:15 – 08:30

08:30 – 08:45

08:45 – 09:00

09:00 – 09:15

09:15 – 09:30

09:30 – 09:45

09:45 – 10:00

8. Review of the NCC reports

8.1. Australia

8.2. Brunei Darussalam

8.3. Cambodia

8.4. China

8.5. Hong Kong SAR (China)

8.6. Macao SAR (China)

8.7. Japan

8.8. Republic of Korea

Professor David Durrheim Pg Dr Haji Md Khalifah bin Pg Hj Ismail

Dr Ly Sovann

Professor Liang Xiaofeng

Professor Lau Yu-lung

Dr Wong Fong Ian

Dr Takaji Wakita

Dr Park Sueun

10:00 – 10:15 COFFEE BREAK

10:15 – 10:30

10:30 – 10:45

10:45 – 11:00

11:00 – 11:15

11:15 – 11:30

11:30 – 11:45

11:45 – 12:00

8. Review of the NCC reports (continuation)

8.9. Lao People's Democratic Republic

8.10. Mongolia

8.11. New Zealand

8.12. Pacific island countries and areas

8.13. Papua New Guinea

8.14. Singapore

8.15. Viet Nam

Dr Khamla Choumlivong

Dr Janchiv Oyunbileg

Dr Stephen Chambers

Dr Ilisapeci Tuibeqa

Professor John Vince

Dr Jeffery Cutter

Dr Pham Quang Thai

12:00 – 12:30 REVIEW OF DRAFT CONCLUSIONS AND RECOMMENDATIONS

RCC members and Secretariat

Day 3: Thursday, 12 November 2020

08:00 – 09:30 REVIEW OF DRAFT CONCLUSIONS AND RECOMMENDATIONS

RCC members and Secretariat

09:30 – 09:45 COFFEE BREAK

09:45 – 10:15

10:15 – 11:00

11:00 – 12:20

12:20 – 12:30

9. Twenty years free from indigenous wild poliovirus Conclusions and recommendations

10. Regional Strategic Framework for Vaccine-preventable Diseases and Immunization in the Western Pacific (2021–2030)

11. Regional Certification Commission conclusions and recommendations

12. Closure of meeting

Dr Rudi Tangermann

Dr Yoshihiro Takashima

Dr Bruce Thorley

www.wpro.who.int