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Global Polio Eradication Initiative The 'Intensified Effort' 18 May 2008

Global Polio Eradication Initiative The 'Intensified Effort' 18 May 2008. Polio. Paralysis for life. Primarily affects children. Preventable with OPV. Polio – the world in 1988. >350,000 cases. >125 polio-endemic countries. 1988: World Health Assembly Resolution.

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Global Polio Eradication Initiative The 'Intensified Effort' 18 May 2008

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  1. Global Polio Eradication InitiativeThe 'Intensified Effort'18 May 2008

  2. Polio Paralysis for life Primarily affects children Preventable with OPV

  3. Polio – the world in 1988 >350,000 cases >125 polio-endemic countries 1988: World Health Assembly Resolution

  4. Polio - the world in 2008 423 cases Endemic country Re-infected country Since 1988: >99% reduction in disease

  5. Global Polio Eradication Initiative Donors (governments, development banks, private foundations, etc) UN agencies WHO, Rotary, CDC, UNICEF Health Ministries 20 million volunteers Private sector NGOs

  6. Polio Eradication Strategies 1. Routine Immunization 3. Surveillance 2. National Immunization Days (NIDs/SNIDs) 4. Mop-ups

  7. Financial Contributions since 1988: US$ 6 billionand Funding Gap for 2008-2009 G8 48% Domestic Resources 14% Multilateral Sector 15% Non-G8 OECD/ Other 8% 2008-9 Funding Gap: US$ 490m of $1.3b budget Private Sector 15%

  8. Intensified eradication effort

  9. Launch of intensified eradication effort28 February 2007 Dr Margaret Chan, WHO DG : "We will complete polio eradication!" Stakeholder presence: Endemic country representatives International development community

  10. New Tools New lab procedures (50% faster detection) Monovalent OPV1 (mOPV1) Efficacy

  11. New tailored eradication tactics India • Accelerated SIA schedule with monovalent OPVs • Mop-up strategies for wild poliovirus type 1 (WPV1) • Targeted strategies for access-compromised areas (Kosi river, Bihar) Afghanistan & Pakistan • Synchronization of all activities, particularly in cross-border areas • Improved access to populations (mobile and in areas of insecurity) • Supplementary Interim Administered Dose (SIAD) strategy to deliver extra dose in between large-scale campaigns Nigeria • 'Immunization Plus Days' • New engagement by all sectors of civil society (eg Quranic school engagement)

  12. New political engagement and commitment India December 2007 Afghanistan & Pakistan April 2007 Nigeria, February 2008

  13. Impact of intensified eradication effort

  14. Wild Poliovirus, Asiaas of 14 May 2008 Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison No countries re-infected with Type 1 WPV district infected with wild polio virus type 1 district infected with wild polio virus type 3

  15. Compelling evidence of real progress in interrupting WPV1 in UP & Bihar, India Q1, 06 Q2, 06 Q3, 06 Q4, 06 Q1, 07 Q2, 07 Q3, 07 Q4, 07 Q1, 08 No WPV1 in UP since Nov 07; 1 WPV1 in Bihar in Jan 08 * data as on 26th April 2008

  16. Very geographically restricted virus in Afghanistan & Pakistan in 2008 Pakistan Afghanistan Type 1 polio cases at 6 May

  17. Wild Poliovirus, Africaas of 14 May 2008 Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison 7 countries re-infected with Type 1 WPV! district infected with wild polio virus type 1 district infected with wild polio virus type 3

  18. Polio in Nigeria - 2008 • Borno, Kano, Katsina, Jigawa and Sokoto account for >50% of Nigeria’s cases • >20% of children un-immunized in high-risk LGAs, leaving >1.5 million children vulnerable in these areas

  19. Polio Eradication in NigeriaNew outbreak in 2008 • >6-fold increase in type 1 polio (most dangerous type) • Nigeria accounts for 90% of all type 1 polio worldwide • Progress achieved in 2007 put at risk by new outbreak Year-to-date comparison of type 1 polio 120 100 80 60 40 20 0 2007 2008

  20. The GPEI is on track to achieve major landmarks in 2008-2009, particularly in Asia. But increase in cases in Africa needs to be reversed

  21. Immediate next steps - Asia India • Properly implement mop-up strategy for WPV1 • Fully implement close operational gaps in remaining endemic areas (Kosi river, Bihar) • Further curb WPV3 outbreak and prevent geographic spread Pakistan • Introduce 'SIAD strategy' in Sindh (planned for July) • Systematic use of finger-marking to guide SIA improvements • Concentrate on high-risk areas & mOPV1 in Sindh (all viruses to date in 2008) Afghanistan • Fully implement SIAD strategy in Southern Region • Use new access to build up immunity

  22. Immediate next steps - Africa Nigeria • Focus activities on high-risk LGAs in high-risk states • Optimize operational improvements (micro-planning, vaccinator selection, training and supervision) • Accurate monitoring of immunization activities • Urgent need for full engagement/ownership of LGA political leaders (particularly high-risk LGAs) • Continue to engage all community, traditional and religious leaders Re-infected countries • Maintain high population immunity levels in polio-free countries (currently higher than in 2003-2005) • Stop transmission of imported poliovirus in Angola, Chad and DR Congo • Rapidly fill sub-national surveillance gaps in key areas

  23. After interruption of transmission of wild poliovirus…

  24. Long-term poliovirus risks(after containment & certification of wild polioviruses) VAPP: Vaccine associated paralytic poliomyelitis VDPV: Vaccine-derived polioviruses • cVDPV: circulating VDPV • iVDPV: 'chronic' VDPV excretion by an individual with a 1oimmunodeficiency syndrome.

  25. Post-eradication timeline WPV Containment & Certification VAPP/VDPV Elim. & Verification 'Post OPV' Era Full Sabin containment (if possible replace with alternate strains) Longterm surveillance. Stockpile maintenance. IPV cessation in countries using for transition. Stop trivalent OPV. Interim containment of Sabin viruses. Optimize IPV use. Interrupt cVDPVs (mOPV). Verify VDPVs eliminated. Full WPV containment. Fill mOPV stockpile. Refine 'affordable' options for IPV use. Certify WPV eradication. Priority Activities Earliest dates 2010 2011 2012 2013 2014 2015 2016

  26. Thank you… www.polioeradication.org

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