Global Polio Eradication Initiative

Surveillance, Operation and

Monitoring

Vaccine Procurement,

Communication and Social

Mobilization

Advocacy, Funding & Social

Mobilisation

Funding and Surveillance

UNICEF WHO & GOVT.

CDC(US, Federal Govt)

ROTARY

Data as on 12/02/2014

GLOBAL POLIO CASESGLOBAL POLIO CASES

Global Polio Cases :Year 2000 = 719Year 2001 = 483Year 2002 = 1918Year 2003 = 784Year 2004 = 1255Year 2005 = 1979Year 2006 = 1998Year 2007 = 1315Year 2008 = 1651Year 2009 = 1604Year 2010 = 1352Year 2011 = 650Year 2012 = 223Year 2013 = 400Year 2014 = 11

Country or territory 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Indonesia 0 0 0 0 0 303 2India 265 268 1600 225 134 66 676 874 559 741 42 1Yemen 0 0 0 0 0 478 1Nigeria 28 56 202 355 782 830 1123 285 798 388 21 62 122 53 0Ethiopia 3 1 0 0 1 22 17 3 9 0Benin 1 0 0 2 6 0 0 0 6 20Bangladesh 1 0 0 0 0 0 17Pakistan 199 119 90 103 53 28 40 32 117 89 144 198 58 93 9Somalia 46 7 3 0 0 185 36 8 190 0Nepal 4 0 0 0 0 4 5 5 6 6Niger 2 6 3 40 25 10 11 11 12 15 2 5 1DRC 28 0 0 0 0 0 13 41 5 3 100 93Angola 55 1 0 0 0 10 2 8 29 29 33 5Car 3 0 0 1 30 0 0 0 3 14 4Syrian Arab Republic 23 0Sudan 4 1 0 0 127 27 0 1 26 45Afghanistan 27 11 10 8 4 9 31 17 31 38 25 80 37 14 2Chad 4 0 0 25 24 2 1 22 37 64 26 132 5Burkina Faso 0 0 1 11 9 0 0 0 6 15Ghana 1 0 0 8 0 0 0 0 8Mali 0 0 0 0 19 3 0 1 2 4 7Kazakhstan 0 0 0 0 0 0 0 0 0 0 1Togo 0 0 0 1 0 0 0 0 3 6Russian Federation 0 0 0 0 0 0 0 0 0 0 14Cote d'lvoire 1 0 0 1 17 0 0 0 1 27 36Guinea 0 0 0 0 7 0 0 0 0 42 3Liberia 0 0 0 0 0 0 0 0 0 11 2Sierra Leone 0 0 0 0 0 0 0 0 0 11 1Burundi 0 0 0 0 0 0 0 0 0 2Mauritania 0 1 0 0 0 0 0 0 0 13 5Senegal 0 0 0 0 0 0 0 0 0 0 18Tajikistan 0 0 0 0 0 0 0 0 0 0 460Turkmenistan 0 0 0 0 0 0 0 0 0 0 3Ghana 0 0 0 0 0 1 0Namibia 0 0 0 0 0 0 19Congo 22 0 0 0 0 0 0 0 0 0 441 1Myanmar 2 0 0 0 0 0 0 11Kenya 0 0 0 0 0 0 2 0 19 1 14 0Uganda 0 0 0 0 0 0 0 0 0 8 4Gabon 0 0 0 0 0 0 0 0 0 0 0 1China 0 0 0 0 0 0 21Cameroon 0 0 0 2 13 1 2 0 3 4 0Other 86 13 10 26 73 0 0Total 719 483 1918 784 1255 1979 1998 1315 1651 1604 1352 650 223 400 11No. of Countries 23 15 9 15 18 16 17 12 18 23 20 17 5 8 2Non-endemic country 4 0

500 PER DAY

BUT NOW…

0 in 2014

INDIA POLIO STATUS SINCE THE BEGINNING OF THE PROGRAMME…

INDIA POLIO STATUS SINCE THE BEGINNING OF THE PROGRAMME…

WILD POLIO CASES IN INDIAWILD POLIO CASES IN INDIA

Data as on 14.02.2014

Rotary’s India National PolioPlus Committee

The India National PolioPlus Committee in india plays the following roles:

Advocacy

Political Bureaucratic Religious Corporate

Financial

Social Mobilisation

Operational support

Financial Contribution towards GPEI

US$ 1.2

billion

Worldwide Contributions

US$ 9 billion

Raised From Donors

US$ 178 Million

INDIACONTRIBUTION

POLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGY

4 PILLARS

ROUTINE OPV IMMUNISATION

MOPPING UP OPERATIONSIN HIGH RISK

AREAS

PPINID/SNID

REPORTING ALLAFP CASES

(Surveillance)

# Each of these components is essential for the complete eradication of Polio.

Mop Up Immunization

Outbreak Response Immunization (ORI)

Acute Flaccid Paralysis (AFP) Surveillance

The number of AFP cases reported each year is used as an indicator of a country’s ability to detect polio-even in countries where the disease no longer occurs. A country’s surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 – even in the absence of polio.

250

500

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Nationwide campaigns

Sub-national campaigns

2013

2013

Reaching every child during mass polio vaccination campaigns

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2014

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2015

Routine Immunization

• Current level of Routine Immunization is 60-61%. To protect our children against wild polio virus it is more important to increase the vaccine of Polio under R.I.

High risk areas identified in India, April 2012

~ 257,000 Migrant sites

Migrant sites High risk areas in settled population

~ 154,000 HR areas in settled population

= 10 Migrant sites = 10 HR sites

411,000 HRAs

Intensification of Routine Immunization• 9 priority states & 239 districts with weak RI identified for focused attention

HR Districts (based on Full Imm. <50% in DLHS3)

Strengthening Routine Immunization

• Fourth pillar for polio eradication - Helps sustain population immunity against polio – reduces risk of circulation of poliovirus

• Important component of the polio endgame strategy before & after withdrawal of OPV

• Protects children against other vaccine preventable diseases

Preparing for India to be Certified as Polio Free

Certification ProcessCertification ProcessCertification ProcessCertification Process

The Goal of the GPEI is the Global Certification of the eradication of polio.

Global certification of eradication will be reached when all countries demonstrate the absence of wild poliovirus transmission for at least three consecutive years in the presence of excellent surveillance.

Certification Committee Structure• Global Commission for the Certification of

the Eradication of Poliomyelitis

• Six Regional Certification Commissions for Polio Eradications

• Every country has a National Certification Committee for Polio Eradication (NCCPE) India NCCPE established on Aug 7, 1998

Process of Regional Certification• NCCPEs to prepare detailed documentation as per

standard format.

• These are reviewed by the regional Commission and it will recommend to the Global Commission

• Only Global Commission can certify a region as polio free

Only WHO regions and NOT individual countries certified as polio free

(26-27 March, 2014)

3 of the 6 WHO Regions Already Certified Polio Free

• 1994 - North, Central and South America (PAHO region)

• 2000 - Western Pacific region (that includes China)

• 2005 - European region in 2005.

2014 –WHO South East Asia region that includes India is the next region to be certified as polio free. Preparations are underway 

Importation• Recently Govt of India has issued the

notification:

• A dose of oral polio vaccine (OPV) for all travellers to and from India from polio endemic countries : Afghanistan, Nigeria and Pakistan and countries with poliovirus circulation following importation : Ethiopia, Kenya, Somalia and Syria. In the absence of which VISAS will not be issued.

• Govt of India has set up immunisation booths across borders.

The geographical distribution of children with poliomyelitis associated with wild-type poliovirus shown by serotype for 2012 and (inset) the total number of children with

poliomyelitis globally by serotype reported each year during 2001–2012.

93 polio cases in Pakistan, 53 in Nigeria and 14 in Afghanistan . The Horn of Africa – Somalia-190, Kenya-14, Ethiopia-9 , Cameroon-4 and An outbreak of cases in Syrian Arab Republic – 23 (Syria reported polio case after 1999) in the year 2013. Still Pakistan is reporting fresh cases of Polio during the current year numbering to 9 and Afghanistan is following up with 2 cases reported till date.

Continuous vaccination of children at border crossing points

PAKISTAN

INDIA

BANGLADESH

MYANMAR

NEPAL

Vaccination post

88 vaccination postsalong Indo-Nepal border since Apr

2011

5 vaccination postsalong Indo-Pak border

since Sep 2011

2 vaccination posts along Indo-Bangladesh border since Mar 13

2 vaccination posts along Indo-Myanmar border since April 13

Lessons

• Its not over until its over everywhere

• 'The price of freedom is eternal vigilance'

Challenges• Maintaining immunity• Maintaining surveillance• Readiness to respond• Reducing risk• Building on polio• Preparing for the endgame

POLIO NOW A PUBLIC HEALTH EMERGENCY

• 194 member states to fully fund the GPEI & fill $945M gap in budget for 12-13.

• All remaining infected countries to declare polio to be a NATIONAL PUBLIC HEALTH EMERGENCY requiring the implementation of emergency action plans monitored at the highest levels

POLIO A PUBLIC HEALTH EMERGENCY

• New approaches to tackle persistent challenges and improve polio vaccination campaign performance

• Heightened accountability, coordination, and oversight to ensure success at every level of government and within every partner agency and organization

POLIO A PUBLIC HEALTH EMERGENCY

• A surge of technical assistance and social mobilization capacity

• If any child in the world is permanently paralysed by Polio it is now a Global Emergency

• If any child in the world is not reached by Oral Polio Vaccine it is now an emergency.

Emergency Preparedness and Response Plan 2011

The Govt. of India has constituted a “Central Emergency Preparedness and Response Group” to ensure adequate preparedness for a rapid response and manage the actual response to the detection of a wild poliovirus anywhere in India.

Rotary’s Role in Emergency Preparedness and

Response Plan

Advocacy at state and district levels for quaility implementation of polio eradication activities.Support IEC/Social mobilization activities & media management in coordination with Govt.. UNICEF and NPSP.Any other essential emergency support activities.

Emergency Preparedness &Response

• Withdrawal of oral polio vaccine to minimize risks associated with use of OPV in the post eradication phase

• Switch from tOPV to bOPV in 2016

• Withdraw all OPV from programme in 2018/2019

• Before switch over IPV will be introduced in 2015. The introduction will also protect the occurrence of vDPV cases.

Switch Over- Preparing for Polio Endgame Strategy

End Game Strategic Plan 2013-18End Game Strategic Plan 2013-18

Funding GapFunding Gap

• The Total funding requirement from 2013-2018 is $ 5.5 billion.

• Committed - $ 4 billion

• Deficit - $ 1.5 billion

World Polio Day 24 October 2013India on World Polio Day illuminated iconic sites across the country including historic monuments India Gate, Red Fort with End Polio Now message.

Red Fort

India Gate

India Celebrated 3 years of last case reported in the country on 13 January 2014

India Gate Red Fort

Celebrations on India’s Victory over Polio on 11 February 2014 in New Delhi by Govt of India

Towards a polio-free IndiaTowards a polio-free India

Rukhsar. Let's ensure she is the last polio case in India!

Rotary’s Continued Engagement Very Crucial.

• Thank and appreciate those who have been working so hard.

• Continued advocacy in high risk areas against complacency

• Respond to local problems with local solutions

You started the race and so you better be there at the finishing line when celebrations start