News

27 February 2007

Stakeholders reach broad consensus to complete polio eradication - but without rapid injection of funds, global polio eradication effort is threatened

Geneva: Today, governments, donors and international agencies leading the drive to eradicate polio fully supported the planned final attack on the poliovirus.

Left to right: Bill Boyd, President of Rotary International; Julie Gerberding, Director of CDC; Kul Gautam, Deputy Executive Director of UNICEF; Dr. Margaret Chan, Director-General of the World Health Organization

Indigenous wild poliovirus survives in only parts of four countries – Nigeria, India, Pakistan and Afghanistan – where transmission has never been stopped. Today's high-level Consultation on polio eradication agreed to raise within 12 months - and then sustain for as long as needed - the levels of vaccination coverage and child immunity in the areas with endemic polio to levels that stopped the disease altogether in the polio-free parts of these countries. Ten other countries are currently fighting the tail-end of outbreaks caused by importations of poliovirus.

The Consultation outlined specific milestones in two areas where improvements would raise the coverage and immunity levels. The first is to ensure that vaccine reaches children by improving the quality of polio vaccination campaigns, strengthening health infrastructure, addressing security challenges, and by enhancing acceptance of vaccination through tailored social mobilization and community engagement strategies.

Second, the Consultation agreed that there was a collective responsibility to mobilize the resources needed to complete polio eradication, in particular by filling the funding gap of US$ 575 million for 2007-2008. Of this amount, US$ 60 million is urgently needed by April. Just today in its Parliament, India outlined its firm financing commitment, and other endemic countries have outlined specific steps to provide domestic resources. The international donor community will now need to rapidly fulfill its commitment to securing the necessary resources. The first step is for donors to take the case for polio eradication back to their capital cities and present it to major international development fora between March and May. Without a rapid injection of funding, polio eradication activities will have to be curtailed, threatening the global polio eradication effort.

The commitment of the four remaining polio-endemic countries remains strong and was re-affirmed by the presence at this Consultation of representatives from the offices of the Heads of Government. Together these countries vaccinate a total of 250 million children many times each year. The Consultation defined specific milestones to monitor whether the collective capacity of all polio eradication stakeholders is being fully harnessed to make concrete and rapid progress.

The Consultation, called for by Dr Margaret Chan, WHO's Director-General, was hosted by the World Health Organization, with top representation from the other spearheading partners of the Global Polio Eradication Initiative – Rotary International, the US Centers for Disease Control and Prevention and UNICEF – together with representatives from the endemic countries' ministries of finance and health, major donors, political organizations and independent technical experts. Of particular importance was the presence of special advisers to the heads of state of three of the four endemic countries.

The eradication effort, predicated on reaching every child multiple times with oral polio vaccine, has reduced the number of polio cases worldwide by over 99%. Of the 193 Member States of the WHO, 189 have stopped transmission of indigenous wild poliovirus.

For consultation agenda, presentations and full list of participants, click here.

23 February 2007
One year free from polio: Indonesia continues the fight against childhood disease

Jakarta, Indonesia - A year on from Indonesia’s last recorded case of polio, children under five across Java will receive another dose of polio vaccine as part of an integrated immunization campaign to protect them from childhood disease. Polio returned to Indonesia in March 2005 after being banished from the country ten years earlier. The disease spread at high speed infecting 10 of Indonesia’s 33 provinces in Java and Sumatra, paralyzing 305 children.

Five National Immunization Days (NIDs) targeting 24 million children under five in each round and several sub national rounds were crucial in stopping the virus’s spread. “This is a significant achievement and Indonesia should be commended for its efforts to combat this terrible disease”, said Dr. Keith Feldon, an immunization specialist from UNICEF, Indonesia. However, as long as polio exists anywhere in the world, children everywhere remain at risk. Indonesia must remain committed to improving routine immunization and ensuring surveillance systems are strong enough to identify any remaining virus or further importation.” Thousands of health workers across Java are mobilizing to offer targeted children several health interventions including measles vaccine, an additional dose of polio vaccine and Vitamin A, which builds a child’s immunity system. More than 13 million children in five provinces across Java (D.I. Yogyakarta completed their campaign after a devastating earthquake in 2006) will receive doses against the childhood killers as part of a phased national campaign to protect children.

“The World Health Organization (WHO) fully supports Indonesia’s continued commitment to ensuring a polio-free Indonesia. Giving supplementary doses of vaccine to at risk children is an important component of the WHO-recommended strategy for eradication. Adding polio vaccine to the scheduled measles campaign is smart and maximizes the use of limited funds and resources”, said Dr Bardan Jung Rana, Polio Eradication Team Leader, WHO Indonesia. Director General of Indonesia’s Centre for Disease Control (CDC), Dr. I. Nyoman Kandun said improving the surveillance system is a priority to ensure polio can not return. “Indonesian’s must stay alert and I appeal to the community to remain vigilant of the dangers of polio. Any child who shows sudden symptoms of paralysis or floppy arms or legs should immediately be reported to the nearest health centre”, he said.

A country is generally considered polio-free after 12 months of no polio cases. However, official certification is made at a regional level. Three years must pass without any cases of polio for a WHO region to be officially declared polio free. A strong certified surveillance network and high routine immunization coverage amongst children are also crucial.

21 February 2007
Focus on Pakistan: 34 million children immunized in first polio campaign of year

On 16-18 January 2007, Pakistan conducted its first polio National Immunization Days (NIDs) of the year, aiming to reach more than 35.2 million children under five years of age.

Data analysis from the NIDs indicate that the activity went very well, despite exaggerated reports of communities refusing vaccine. Through the strong engagement of the Government of Pakistan and a wide scope of civil society actors, including religious, community and traditional leadership, an estimated 97% of the target population was reached (34.1 million children).

The reasons for missing children are carefully charted and show that some children were missed largely for operational reasons rather than fears about the vaccine: 70% of the 'missed children' were not reached as the children were not available – whether at school or otherwise away from their homes. A further 26% were missed because vaccination teams did not or could not visit the home: this happens for a variety of reasons ranging from poor micro-planning (or mapping) of an area or inaccessibility of some settlements. What is known as the "community refusal" rate, whether due to religious or other resistance, ran at approximately 0.3%.

For poliovirus to be stopped, every child must be reached with oral polio vaccine. In Pakistan, communities are continuously involved and engaged in vaccination campaigns, and all data indicate that community resistance is not the major challenge to polio eradication in the country. The primary challenges to polio eradication remain operational.

WHO and its partners Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF commend the support being given to polio eradication by all sectors of society in Pakistan. Key to success will be to overcome the operational challenges of reaching populations to whom access is hampered, due to population movements, insecurity or cultural conservatism in some tribal areas. 'Targeted strategies' have been launched to help overcome these challenges.

14 February 2007
Planning the final phase for polio eradication: Urgent consultation in Geneva

Among her first major meetings of her term, WHO Director-General Dr Margaret Chan has convened an urgent consultation on polio eradication on 28 February. After reviewing the recommendations of the Advisory Committee on Polio Eradication, which concluded in October 2006 that eradication was technically feasible in the remaining four endemic areas, Dr Chan has examined the progress made since October in Nigeria, India, Pakistan and Afghanistan. She concurs with the findings that eradication is feasible if enough children are vaccinated to stop transmission of the virus.

Given that the Global Polio Eradication Initiative is built on the complementary strengths of various partners, of which WHO is the lead technical agency, Dr Chan has invited all major stakeholders to the consultation to examine the collective capacity to meet the remaining operational and financial challenges. She emphasized, "I am alarmed that without an immediate, fresh surge of commitment from the last four polio endemic countries and all major stakeholders, we are at grave risk of squandering the work of 20 million people, and the international investment of US$ 5 billion, on this global effort to deliver the perpetual gift of polio eradication to future generations."

The one-day agenda will centre on solutions to the operational challenges of reaching enough children in each area, namely carrying out campaigns in security-compromised districts, improving health service delivery and strengthening social mobilization.

The aim is to agree on milestones to measure progress on each challenge and to examine the cost implications of sufficient activities to stop the virus, recoup the investment made since 1988 and protect all children everywhere from polio forever.

Representation is expected from: finance and health ministries, technical experts, as well as the office of the head of government of the endemic countries; donors with investments of over US$ 10 million; spearheading partners Rotary International, CDC and UNICEF; political organizations such as the Commonwealth. The directors of the three WHO regions which have polio: AFRO, SEARO and EMRO are also attending.

Polio could be history within a few years, reports the World Health Organization Bulletin in its January 2007 issue, but what will become of the vast network set up to fight the disease is unclear. Health experts fear that once polio is eradicated, donors will stop funding the diversified network, which now helps immunize children against many other diseases, fight outbreaks and respond to natural disasters. The World Health Bulletin examines the question in its February issue.