Targeted strategies to overcome unique challenges to immunizing every child have been launched by each of the remaining four polio-endemic countries:  Nigeria, India, Afghanistan and Pakistan .

With indigenous transmission of polio now geographically restricted to key, identified populations, all four countries convened technical oversight body meetings in early December 2006 to review the epidemiological data and agree local strategies to overcome uniquely local challenges.  The strategies aim to accelerate eradication efforts in the most targeted manner possible, zeroing in on those areas and populations where the poliovirus continues to circulate.  

In Nigeria , strong progress was noted in reaching a higher number of children during campaigns in the second half of 2006, following the introduction of 'Immunization Plus Days' (where in addition to polio vaccine, supplemental antigens and health interventions are offered to communities).  A risk-classification for ongoing polio transmission has now categorized each geographical area, to drive focused prioritization of activities.  All activities will now be state-driven, to ensure the most effective implementation of all targeted recommendations.  Three states - Kano , Katsina and Jigawa - have been classified as 'very high risk', due to ongoing coverage gaps of greater than 25% during campaigns. See full report of the Expert Review Committee for polio eradication in Nigeria.

In India, after a thorough review of epidemiological and programmatic data, the technical group concluded that - despite an outbreak in 2006 - the remaining population immunity gap has now been limited to children aged less than two years.  In a major strategic shift, the group called for a multi-pronged strategy aimed at rapidly closing this remaining immunity gap.  Central to success will be a dramatic increase in the number of campaigns - targeting children aged less than three years - in the highest-risk districts of western Uttar Pradesh and Bihar (the only two states in India with ongoing endemic transmission).  Large-scale campaigns with monovalent oral polio vaccine type 1 (mOPV1) - which protect children twice as fast than the traditional trivalent OPV - will now be held on average every four weeks, supplemented by the administration of a birth-dose.  The technical group concluded that given high population immunity and large-scale use of mOPV1, prospects for interrupting type 1 polio transmission in the country were significant in 2007.  Read the full report here.

In Afghanistan and Pakistan, most areas are today polio-free.  Cross-border polio transmission between the two countries is currently sustained among populations to whom access is hampered, due to either insecurity or large-scale population movements.  Both countries agreed necessary steps to increase access to all populations, by coordinating both campaign and surveillance activities.  As part of strategic efforts, the Ministers of Health of both countries have already undertaken key activities, including jointly addressing a historic health jirga of tribal elders, urging their support to ensure no Afghan and Pakistani child slips through the net.  This activity followed a high-level meeting of both health ministers one week earlier, in Islamabad. See the conclusions of the technical consultations.

With outbreaks in previously polio-free countries stopped or on the verge of being stopped, the world has a unique opportunity in 2007 to focus all efforts on stopping the disease in the remaining four endemic countries.  Key to success will be the ongoing financial support of the international donor community, as the intensification of targeted eradication activities in Nigeria, India, Afghanistan and Pakistan in 2007 will have a substantial impact on budgets.  A full update of the External Financial Resource Requirements (FRR) reflecting new budgetary needs will be published by the spearheading partners of the Global Polio Eradication Initiative by the end of January 2007.