Polio Eradication Evaluation

Independent Evaluation of Major Barriers to
Interrupting Poliovirus Transmission

Evaluation Reports
Challenges in polio-infected areas
Objectives of Evaluation
Oversight
Evaluation Team
Country missions
Methodology & Reporting

On 27 February 2007, governments, donors and the international agencies leading the Global Polio Eradication Initiative (GPEI) launched an "intensified eradication effort" to overcome the remaining technical, operational and financial challenges to interrupting all wild poliovirus transmission globally.

Two years later, significant risks remained. In this context, WHO's Executive Board, at its January 2009 meeting, requested that an Independent Evaluation be conducted to review the remaining barriers to interrupting transmission.

Primary challenges in the remaining polio-infected areas

At the end of 2008, the GPEI's Advisory Committee on Polio Eradication (ACPE) and WHO's Strategic Advisory Group of Experts (SAGE) on immunization identified the specific challenges that would need to be addressed in each of the remaining polio-infected areas to achieve the specific levels of population immunity required to interrupt remaining chains of transmission:

Afghanistan : suboptimal or al poliovirus vaccine (OPV) coverage in three provinces of Southern Region, due mainly to ongoing conflict, and ongoing importations into Eastern Region.

India : suboptimal efficacy of OPV in west Uttar Pradesh, and possibly Bihar .

Nigeria : suboptimal OPV coverage in northern states due to insufficient community mobilization and weak campaign planning and implementation.

Pakistan : inability to sustain very high OPV coverage in the heavily-populated, accessible areas, and difficulties in achieving moderately-high coverage in the security -compromised areas of North-West Frontier Province and Baluchistan .

International spread : suboptimal implementation of international polio outbreak response guidelines due to in security and weak delivery systems.

Overall objectives

To evaluate, for each infected area, the primary challenge(s) to achieving sufficient population immunity to interrupt the remaining poliovirus transmission.
To determine, by reviewing the management, supervision and implementation of polio campaigns, whether other critical fact or s are compromising OPV coverage and population immunity.
To evaluate the risks, consequences and responses to the international spread of wild poliovirus to previously polio-free areas, with particular attention to those with persistent transmission.
To propose area-specific strategies f or addressing the primary challenge(s) and any other major fact or s that are compromising population immunity.
To outline actions local, state/provincial and federal authorities should take to ensure that the area-specific strategies are fully implemented and stop transmission.
To outline actions WHO, UNICEF and other GPEI stakeholders should take at the sub-national, national and international levels to supp or t implementation of the area-specific strategies, stop any persistent importation-associated outbreaks, and reduce the risks of new international spread.

Oversight Committee

An Oversight Committee, comprised of a senior representative of each of the GPEI spearheading partners, ensures the implementation of the Evaluation, including: finalizing the terms of reference of the Evaluation Team; determining the composition of the Evaluation Team; reviewing the proposed methodology of the Evaluation Team; receiving and reviewing the interim report for the Evaluation; and receiving the final report.

Members are:

Anarfi Asamoa-Baah, Deputy Director-General of WHO
Ron Burton, Vice-Chairman of the Rotary Foundation
Finbar O'Brien, Director of Evaluation at UNICEF
Anne Schuchat, Acting Deputy Director for Science and Program at the United States
Centers for Disease Control and Prevention (CDC).

Methodology and reporting

Evaluation Team chairpersons met in early July to work on the Evaluation protocol, determine preliminary itineraries for country missions and discuss composition of the respective Sub-Teams. The Evaluation protocol, which included these preliminary schedules and the provisional list of all team members, was submitted to the Oversight Committee in mid July for review.

Missions to countries took place in July and August. Further details

The chairpersons of the Team met again in Geneva in mid September to consolidate their findings and prepare their report. Their preliminary report has been reviewed by the Oversight Committee and is due to be finalized before the end of October. The main conclusions will be presented and discussed at technical advisory group meetings at global and national level in the latter part of 2009, and at the January 2010 session of WHO's Executive Board. The major findings and recommendations will be incorporated into the 2010-2014 Strategic Plan of the Global Polio Eradication Initiative.