Polio Eradication Evaluation

An Independent Evaluation of Major Barriers to Interrupting Poliovirus Transmission has been completed, in response to a request in January 2009 from the Executive Board of WHO, prompted by delays in attaining global polio eradication.

The evaluation expressed confidence that if managerial, security and technical issues it identifies can be addressed, "polio eradication can be achieved. A message from many sites, however, was for the GPEI not to make too optimistic projections." (More on the composition and method of work of the Independent Evaluation).

The Executive Summary provides an overview of the conclusions. Full reports are available on: Nigeria¦ India ¦ Pakistan and Afghanistan ¦ International spread

Versions françaises: Résumé d'Orientation et Propagation Internationale

Versões de Portugueses: Resumo Executivo e Propagação Internacional

RECOMMENDATIONS COMMON TO POLIO-AFFECTED AREAS

Rapid application of new tools such as bivalent oral polio vaccine.
Expanding research on the optimal use of vaccines, be they new oral polio vaccines or inactivated polio vaccine.
Systematic attention by the polio eradication programme to strengthening routine immunization systems.
Investing key positions with more authority, in the complex administrative structure of the Global Polio Eradication Initiative, so that areas with poor operational performance can be swiftly corrected.

IN NIGERIA, high-level support as well as active involvement from traditional and religious leaders has had positive, visible impact. Ownership at the level of local government is highly variable, and the Independent Evaluation noted that the "war" on polio "will be won or lost at the local government level." Full report on Nigeria

The Independent Evaluation proposed a roadmap for Nigeria, including establishing dedicated polio focal points from the Federal level to the level of each LGA to monitor the quality of eradication activities.

AS PAKISTAN AND AFGHANISTAN constitute one epidemiological block for polio transmission, the Independent Evaluation considered them together and identified common as well as separate barriers and necessary strategies. Full report on Pakistan and Afghanistan.

IN PAKISTAN, the Independent Evaluation recognized a new and strong Federal Government commitment to polio eradication, which should be harnessed to address political interference and lack of accountability at the level of programme implementation, especially in greater Karachi (Sindh) and the Quetta area (Balochistan).
IN SECURITY-COMPROMISED ZONES of Pakistan and Afghanistan, polio is geographically confined, despite unstable conditions that make it very challenging to reach children. The Independent Evaluation recommended concentrating human and financial resources and targeting vaccination campaigns in these districts. District-specific plans and solutions should be tailored to the local culture, local partners (especially non-governmental organizations), and the nature of the conflict.

IN INDIA, the Independent Evaluation confirmed the excellent quality of eradication activities. To address India's uniquely efficient transmission, the report recommended a multi-pronged approach. Full report on India.

Heading this approach is an aggressive research agenda (e.g. comparing gut immunity conferred by oral polio vaccine vs. inactivated polio vaccine, the effect of poor nutrition and chronic diarrhoea on immunity).

Also recommended is a review of campaign strategies (including possibly a different mix of vaccines, older children, targeted use of inactivated polio vaccine), studying the effect of adding zinc to polio vaccination campaigns and taking basic sanitation measures (e.g.concrete plinths around water hand pumps).

TO LIMIT INTERNATIONAL SPREAD OF POLIO, the Independent Evaluation concluded that polio vaccination for travellers is appropriate and recommended strengthening routine immunization across the “importation belt” of African countries and scaling-up technical support to newly and persistently-infected areas to be in line with endemic areas. Full report on international spread of polio.

IMPLEMENTATION: Technical advisory bodies at international and national level, meeting over the next weeks, will guide strategies to implement the recommendations. WHO and its Global Polio Eradication Initiative partners are committed to rapidly turning the recommendations of the Independent Evaluation into concrete operational and managerial actions in a final push to end polio.

The recommendations and subsequent strategic decisions made by the advisory bodies will form the foundation for an urgent, three-year 2010-2012 Programme of Work to Interrupt Wild Poliovirus Transmission Globally, which will include a review of the programme at the 24-month mark to determine whether further investment is warranted. In January 2010, the WHO Executive Board will review the findings & recommendations of the Independent Evaluation as well as the three-year Programme of Work.