Ending Polio

Protecting Gains

Humanity is on the verge of one of the greatest public health achievements in history – eradicating polio. In 2016, fewer children were paralysed by polio than in any other year to date, with the virus restricted to a few areas of Pakistan, Afghanistan and Nigeria. While the detection of polio cases in Nigeria in 2016 after two years was a setback, there has been significant progress toward ending polio in the country, the African region and around the world in recent years. Two of the three strains of wild polio seem to be eliminated and India and the entire World Health Organization South-East Asia Region have been declared polio-free.

The Global Polio Eradication Initiative’s success in reducing polio cases by 99.9% since 1988 has already shown how much can be achieved when individuals, communities, governments and international organisations come together behind a common goal. With renewed support from the international community, strengthened routine immunisation, virus surveillance and outbreak response capacity, and full commitment from affected countries, we can end polio forever.

POLIO-ENDEMIC COUNTRIES

Virus Cornered• Only one of the three wild poliovirus strains survives. Wild Poliovirus Type 2 (WPV2) was

certified eradicated in 2015 and Wild Poliovirus Type 3 (WPV3) hasn’t been detected since November 2012.

• In 2016, wild poliovirus cases were reported in only three countries: Pakistan, Afghanistan and Nigeria.

• The world has not experienced any outbreaks of wild poliovirus outside the three polio-endemic countries since August 2014.

Worldwide Vaccine Rollout • In 2016, 155 countries and territories successfully removed the polio type 2 strain from

the oral polio vaccine (OPV) via the global switch from trivalent to bivalent OPV. This was the largest and fastest vaccine rollout in history.

• This was the first step in the eventual phase-out of OPV, which is necessary because, in extremely rare cases, the live weakened virus contained in the oral polio vaccine can mutate and spread, causing circulating vaccine-derived poliovirus (cVDPV). Immunisation rates must remain high everywhere to protect against both wild poliovirus and cVDPV.

India and South-East Asia Polio-Free• India, once described as the most challenging place in the world to end polio, has been polio-

free since 2011. • The World Health Organization’s South-East Asia Region, home to 1.8 billion people, was

certified polio-free in March 2014.

AFGHANISTAN

PAKISTAN

NIGERIA

Wild poliovirus transmission continues

Building a Polio-Free World• As long as polio exists anywhere, it is a threat to children everywhere. If polio is not

eradicated, we could see a global resurgence of the disease, with as many as 200,000 new cases each year within a decade. The programme must remain vigilant and strive for continued improvement to stop polio once and for all.

• Eradicating polio will have an impact for all future generations. Polio eradication will generate savings of US$50 billion over the next 20 years. The polio programme is taking steps to ensure that the knowledge acquired, the tools developed and the infrastructure established by the polio programme continue to benefit other child health challenges long after polio is gone.

Vaccinating every last child: The polio programme delivers more than a billion doses of the polio vaccine to children every year. To ensure vaccines are delivered to the hardest-to-reach places in the world, innovative measures are used, such as permanent transit teams, special teams focused on vaccinating nomadic children and rapid vaccination campaigns based on windows of opportunity.

Delivering needed health services: The knowledge, skills and infrastructure built up over three decades working to end polio have already benefitted other health areas. The polio programme has been used to enhance delivery of nutritional supplements, routine immunisation and maternal and child care, including in difficult to reach areas.

Developing a global partnership: Across the world, governments, businesses, scientists and civil society have united behind the Polio Eradication & Endgame Strategic Plan. Ensuring the programme remains fully funded will yield the ultimate return: children everywhere will be free from the threat of polio forever, and the world will benefit from the programme’s knowledge and experience.

Nigeria: Stopping the Virus

• The detection of wild polio in Nigeria in July 2016 after two years without a case was a sobering reminder of the complex challenge of eradicating polio, especially in areas with ongoing humanitarian crises and faltering health systems.

• In response to the outbreak, the GPEI has implemented 14 campaigns and vaccinated up to 57.9 million children to protect them from the disease and raise population immunity across the country.

• Vaccinators are steadily reaching more children than ever, using strategies such as engaging and collaborating with local communities, as well as vaccinating in camps for internally displaced people and in markets and at transit points. In the past year, the number of inaccessible children has been reduced from over 500,000 to less than 400,000.

• There is a need to maintain strong political leadership, maximise quality of vaccination campaigns, and strengthen both virus surveillance and routine immunisation services.

Pakistan: Progress in Polio’s Largest Reservoir

• Pakistan has made important progress against polio, reducing cases by more than 99% since 2014. However, intensive nationwide virus surveillance indicates that the virus continues to circulate in Pakistan.

• Strategies to reach children include the establishment of Emergency Operations Centres (EOCs) to increase campaign coordination and improve management and accountability. In difficult to reach areas, the support of community-focused campaigns has been instrumental in improving delivery of health services. The polio programme now has access to almost all children in the country.

• Still, more must be done to stop polio for good. Pakistan must continue to improve programme management and accountability, focus on core reservoirs and maintain the highest levels of virus surveillance.

Afghanistan: Intensifying Eradication Efforts

• The Afghanistan programme is reaching more children with vaccines in the midst of a shifting security landscape. The programme has vast experience in addressing insecurity and inaccessibility through tried and tested approaches: ensuring community trust, rapid vaccination whenever the opportunity arises and engaging in dialogue with all parties of an active conflict to allow health activities to continue.

• Much of the country remains polio-free, but these gains are fragile. Finding and vaccinating missed children through better trained front-line workers, expanded community engagement and improved micro-plans is essential.

• The EOCs and the National Emergency Action Plan have improved programme quality and oversight, and are helping to ensure that all children are immunised. The establishment of these emergency resources has strengthened management and coordination, with the Afghanistan government team working closely with WHO and UNICEF.

Stopping cVDPV Outbreaks

• As we near the end of wild poliovirus transmission, outbreaks of cVDPV reveal gaps in population immunity and reinforce the need to take additional steps to boost immunity and secure a lasting polio-free world.

• In mid-2017, outbreaks of cVDPV type 2 were confirmed in Syria and the Democratic Republic of the Congo.

• The polio programme has implemented a swift and targeted response, with immunisation rounds taking place in affected areas. These outbreaks demonstrate why it is critical for the programme to continue vaccinating children everywhere and bolster virus surveillance systems.

Factors for Success

Tackling the Remaining Risks