January 2007
Data as of 16 January 2007        English PDF        Version français en PDF
 

Headlines

• Margaret Chan takes office as new WHO Director-General - pledges to eradicate polio: on 4 January 2007, Dr Margaret Chan took office as new WHO Director-General. Addressing both staff in Geneva and in regional and country offices around the world, she pledged to eradicate polio: "Quite simply, we must succeed," she said. "This is not just about meeting a goal. It is about delivering a perpetual gift to every future generation of children to be born. We start this year with new tools and strategies capable of doing the job twice as well as in the past. We also need a fresh surge of conviction and commitment, from both political leaders and the donor community." As part of immediate efforts, Dr Margaret Chan is calling an urgent consultation of all major stakeholders in polio eradication on 27-28 February 2007 in Geneva, to critically examine the capacity to address the challenges to finishing polio eradication. In her invitation letter, Dr Chan emphasized that an immediate and fresh surge of commitment is urgently needed from the last four polio endemic countries and all major stakeholders.
   
• Endemic countries to 'zero in' on remaining polioviruses in 2007: with indigenous transmission of polio geographically restricted to key, identified populations in the four remaining endemic countries (Nigeria, India, Afghanistan and Pakistan), all four countries convened national, technical oversight body meetings in early December 2006 to agree on 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.
   
• Intensified eradication efforts significantly affect budgets, as new financial resource requirements are announced: the new targeted, intensified eradication strategies launched in the four endemic countries will have significant financial implications on the global effort to eradicate polio. A key to success will be the ongoing financial support of the international donor community and polio endemic countries, to rapidly make available the necessary funds. The Global Polio Eradication Initiative is facing a global funding gap of US$ 575 million for 2007-2008; of this, US$ 100 million is needed by March 2007, to ensure activities in the first half of the year can proceed as planned. A full update of the External Financial Resource Requirements (FRR) reflecting the new budgetary needs has been published and information can be found on www.polioeradication.org/fundingbackground.asp.
   

Country Focus

Nigeria

• In 2006, northern Nigeria continues to account for the majority of global cases (1,077 of 1,912 cases).
• In the second half of 2006, strong progress was noted in reaching a higher number of children during campaigns, following the introduction of Immunization Plus Days (IPDs), where in addition to oral polio vaccine, supplemental antigens and health interventions are offered to communities. The proportion of children in northern states who had never been immunized was reduced to an average of 20% (from >50% at end-2005), and routine immunization coverage markedly increased (to an estimated >60% DTP3 coverage). At the same time, the disease burden significantly decreased in the latter half of the year, with the bulk of cases (75%) from 2006 occurring in the first six months.
• The Expert Review Committee on Polio Eradication (ERC) convened on 7-8 December 2006 in Abuja to review the latest epidemiology data. A risk-classification for ongoing polio transmission has now categorized each geographical area, to drive focused prioritization of activities in 2007. 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. Following the ERC meeting, authorities in Kano called a meeting of experts from the three states to discuss polio eradication strategies.
   

India

• In 2006, India accounts for one third of all new polio cases worldwide (643 of 1,912 cases).
• The India Expert Advisory Group on Polio Eradication (IEAG) convened in Delhi on 11-12 December 2006. After a thorough review of epidemiological and programmatic data, the technical group concluded that - despite the outbreak in 2006 - the prospects for interrupting type 1 polio transmission in the country were significantly positive in 2007, due to high population immunity and large-scale use of monovalent oral polio vaccine type 1 (mOPV1).
• A careful evaluation of the epidemiological situation by the IEAG indicates that continued circulation of poliovirus appears to be due to an immunity gap limited to children aged less than two years, and facilitated by high population density, large birth cohorts, suboptimal routine health services and inadequate sanitation infrastructure.
• To rapidly close this remaining immunity gap, a major strategic shift will be implemented in 2007, by conducting large-scale campaigns every four weeks - targeting specifically children aged less than three years - in the highest-risk districts of western Uttar Pradesh and Bihar (the only two states in the country to sustain indigenous polio transmission).
   

Afghanistan and Pakistan

• In Afghanistan, 31 cases have been reported in 2006; in Pakistan, 39 cases have been reported.
• 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.
• A technical consultation on polio eradication in Afghanistan and Pakistan was held on 6-7 December 2006, in Muscat, Oman, and identified strategies for increasing access to all populations, by coordinating both campaign and surveillance activities in both countries.
• Subsequent to this consultation, and as part of strategic efforts, the Ministers of Health of both countries have undertaken key activities in December 2006, including jointly addressing a historic health jirga of tribal elders, urging their support to ensuring every Afghan and Pakistani child be reached during campaigns. This activity followed a high-level meeting of both health ministers one week earlier, in Islamabad.
   

Re-infected countries

• Of the 26 previously polio-free countries re-infected since 2003, only nine continued to report polio cases in the second half of 2006. In 2006, re-infected countries accounted for only 6% of all new polio cases worldwide (compared to nearly 60% in 2005).

• Focus for 2007 is on stopping the remaining high-risk outbreaks, where polio transmission is continuing:
  o Central Africa (Angola and Democratic Republic of Congo): although transmission has been reduced to very low levels, there is continued geographic extension of the outbreak in the Democratic Republic of Congo (two cases had onset of paralysis in Bandundu and Bas-Congo in October), and new cases are still being detected in Angola (the most recent case had onset of paralysis on 14 November in Cunene Province, bordering Namibia). Subnational surveillance gaps in Angola remain while campaigns continue on both sides of the border.
  o Horn of Africa: northwest Somalia and the Somali region of Ethiopia continue to report cases due to cross-border transmission of an imported poliovirus. The Somali region of Ethiopia also has cases due to continued internal transmission of an earlier importation. Frequent population movements and insecurity in the infected areas complicate the outbreak response operations in both countries.
  o Bangladesh: although six National Immunization Days (NIDs) have been conducted in 2006, transmission of the imported poliovirus continues (the most recent case had onset of paralysis on 4 November 2006), requiring further outbreak response activities.

The state of polio eradication
The world now has a second and best chance to eradicate polio: after the international spread of 2003-2005, endemic poliovirus has been beaten back to only four parts of four countries. Global polio eradication depends on the engagement of the leaders of the "final four" countries: Nigeria, India, Pakistan and Afghanistan.

The strategies and tools to eradicate polio are better than ever. The programme now has vaccines which are twice as effective and diagnostic tools that detect and track poliovirus twice as fast as before.
Policies to minimize the risks and consequences of international spread of poliovirus are now in place: travellers to and from polio-endemic countries are advised to be fully vaccinated before travel.

The remaining challenges to a polio-free world are:

• Strengthening political oversight at national, state and district level.

• Curbing the intense transmission in the high-priority states in northern Nigeria and western Uttar Pradesh, India.

• Maintaining funding.
  
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  Polio eradication will only succeed if the necessary funds are made available, and with strong political commitment in polio-affected countries. More than 10 million children will be paralysed in the next 40 years if the world fails to capitalize on its US$4 billion global investment in eradication.