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n 29 October, the Director-General
of the |
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transmission, children are |
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World Health Organization
released her first six month report on new milestones to measure
progress towards polio eradication. The interim report shows
that the polio-affected countries are largely on track to meet
the milestones by the end of the year, but that the mid-year
financial milestone remains unmet: a US$ 60 million funding
gap – needed to cover activities through the end of 2007 – still
threatens the completion of eradication. In endemic countries:
the number of polio-infected districts has fallen by 50% compared
to 2006; in all but two of the nine “zones” of poliovirus
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either getting the same vaccination coverage
as their peers in polio-free areas or are steadily catching
up with them. Ten of the 13 countries with circulation
of imported poliovirus in 2006 had stopped their outbreaks.
Districts infected with type 1 poliovirus have declined
by 75%.
The new milestones are central to The Case for Completing
Polio Eradication. Requested by financial stake-holders,
The Case outlines immediate actions for intensifying
national and international eradication efforts and includes
the milestones for measuring progress.  |
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Shortly after her husband Haji
Umaru Yar’Adua was elected President of Nigeria, First Lady Hajia
Turai Yar’Adua (on left) stressed that immunization and child survival
were high priorities for the country. While launching and taking part
in vaccination campaigns in the northern state of Kebbi, she pledged,
“We will do whatever we can to make Nigeria polio-free.” The First
Lady was accompanied at far right by Titilola Koleoso-Adelekan, Executive
Director of Nigeria’s National Primary Health Care Development Agency. |
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n 26 November 2007, Rotary International
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and the Bill and Melinda Gates Foundation (BMGF) announced a
partnership to provide US$ 200 million over 4 years for the
intensified push to eradicate polio. The BMGF has awarded the
Rotary Foundation with one of its largest-ever challenge grants
of US$ 100 million, which Rotary will match dollar-for-dollar
over the coming three years.
Bill Gates, co-chair of the BMGF, commented: “The extraordinary
dedication of Rotary members has played a critical role in bringing
polio to the brink of eradication. Eradicating polio will be
one of the |
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most significant public health
accomplishments in history, and we are committed to helping
reach that goal.”
The exemplary leadership shown by Rotary Internatio-
nal and the BMGF is a heartening response to WHO Director-General
Dr Margaret Chan’s call for funds made at a stakeholder consultation
on polio eradication on 28 February 2007. It is hoped that this
shared commitment will inspire and challenge other donors and polioaffected
countries themselves to ensure that the financial resources
necessary to eradicate polio once and for all are rapidly mobilized. |
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• by end-2007 there should be a 50%
reduction in the number of polio-infected districts relative to 2006.
• Status: average 51% decline, with 75% decline in type 1 polio-infected
districts. |
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• by end-2007, Oral Polio Vaccine coverage
in the endemic transmission zones should be equal to or greater than
in the polio-free zones.
• Status: 7 of 9 transmission zones on track. |
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• Afghanistan: the proportion of
zero-dose (nevervaccinated) children in the southern zone has
increased from 4% in 2006 to 12% to date in 2007, due to deteriorating
security.
• Nigeria: the proportion of zero-dose
children in very high-risk, high-risk and medium high-risk transmission
zones has declined from an average of 27% in 2006 to an average
of 16% in 2007. |
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• by end-2007, countries
with circulation of imported poliovirus in 2006 should have stopped
their outbreaks*. |
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• Status: outbreaks stopped in 10 of
13 countries.
* i.e. most recent case was before April
2007. |
32 of 36 separate
importations have been
stopped in the 13 countries. |
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The boundaries
and names shown and the designations used on this map do not imply
the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. Dotted lines on maps
represent approximate border lines for which there may not yet be
full agreement. © WHO 2008. All rights reserved. |
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• by mid-2007 sufficient funding will
have been pledged to finance all eradication activities planned through
end-2007.
• Status: missed, with US$ 60 million funding gap for 4th quarter
2007 activities.
Nota bene: represents figures available
in October. |
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Sources on
this page: WHO/UNICEF 2006 Joint Reporting Form (2005 for India);
2007 NPAFP cases 6-35 months old.
Data in WHO/HQ as of Sept 07. NPAFP cases with unknown OPV status
excluded from analysis. Data on this page: as of 18 Sept 2007. |
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n average across the endemic countries,
the number of districts re- |
porting type 1 poliovirus has declined by 75% since 2006. The
poliovirus serotype with the highest paralytic attack rate and
the greatest potential for international spread, type 1 has
been the primary target of the eradication effort since 2006.
Following the use of more effective monovalent oral polio vaccine
against type 1 (mOPV1), no type 1 polio cases have been reported
since October 2006 in the core highest-risk districts of western
Uttar Pradesh, India, the epicentre of last year’s polio type
1 outbreak. In northern Nigeria, from where type 1 poliovirus
caused international outbreaks from 2003 to 2006, the virus
is down by 90%. In the remaining two endemic countries, type
1 is restricted largely to the cross-border |
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area between north-western Pakistan
and north- eastern Afghanistan.
The aggressive use of mOPV1 has – not unexpectedly – been accompanied
by a rise in type 3 wild poliovirus. In western Uttar Pradesh,
where the attack on type 1 has yielded historic results, the
vast majority of cases are type 3. Anticipating this rise, countries
have aimed for an equilibrium of vaccine use, alternating between
mOPV1, mOPV3 and trivalent vaccine as demanded by the risk profile
of an area. At its November 2007 meeting, the independent technical
oversight body for polio eradication – the Advisory Committee
on Polio Eradication – will examine further the issue of achieving
the correct balance of vaccines. |
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or the past year in Afghanistan,
at least |
80.000 children were unable to get their polio vaccine
because their part of the country was in conflict and
vaccinators could not reach them. In September, discussions
through neutral mediators and directly with parties in
conflict created safe access for vaccinators to reach
these children. While international headli-
nes in conflict zones – from Sudan and Somalia to Afghanistan
and Pakistan – count the dead, wounded and displaced,
thousands of polio vaccinators and health workers in these
countries quietly continue supplemen-
tary immunization and national surveillance activi-
ties at great personal risk.
Even with the safety mechanisms set up in September, the
southern region of Afghanistan remains very dangerous
– vaccinators risk their lives with every passage, and
the geographic reach of the poliovirus mirrors the secu-
rity situation fairly closely. In Pakistan, polio eradica-
tion teams are creatively exploiting opportunities to
vaccinate: as fighting in |
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October in one
of the Federally Administered Tri-
bal Areas of Pakistan forced 50.000 people to flee to
safer ground, special vacci-
nation posts were set up for the arrivals. In both countries,
if insecurity threa-
tens a vaccination campaign local vaccination teams continue
to monitor the security situation in all areas to seize
any opportunity of safe passage which might allow them
to reach inaccessible areas and vaccinate the children.
Chad, harbouring poliovirus of Nigerian origin, has continued
eradication activi-
ties in the face of instability and resultant mass popula-
tion movements. These conditions have helped the poliovirus
move into South Darfur, Sudan, where vaccination teams
carry out their work despite the intense security challenges.
Both countries host large numbers of travellers on their
way to and from the pilgrimage to Mecca. Saudi Arabia
has in place vaccination requirements for pilgrims from
polio-infected areas in order to minimize the spread of
polio following the pilgrimage. |
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ne month after the WHO Director-General
released the Case |
for Completing Polio Eradication, the GAVI Fund Affiliate
in June finalized a reprogramming of US$ 104.62 million – initially
intended for a stockpile for polio vaccine once eradication
is complete – into intensified polio eradication activities.
While not a new contribution, this one-time gesture does ensure
that polio funds are being used most strategically, and provides
time for other donors to firm up pledges for 2008 activities.
This re-programming complements new funding totalling US$ 41
million provided between May and August from Austria, Italy,
Japan, Kuwait, Liechtenstein, Monaco, New Zealand and the World
Bank Partnership for Polio (for Pakistan), among others. |
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| These contributions free up much-needed
cash to maintain surveillance and carry out new activities
in endemic and highrisk areas in the rest of the 2007
and give other donors time to confirm their pledges for
2008. |
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A father in Baluchistan province of Pakistan brings
his child for polio vaccination. Communities such as his
are nomads and often have little access to health care.
Tracking the children of such families for polio vaccination
requires special operational plans, which involve mapping
their seasonal movements to ensure vaccinators reach each
child in the right place at the right time. |
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* Estimate of 2007 US funds through
WHO and UNICEF. Figure will be adjusted at year-end
to include full Congressional allocation for polio eradication.
** AGFUND, Angola, Austria, Azerbaijan, Iceland, Kuwait,
Liechtenstein, Luxembourg, Monaco, Netherlands, New
Zealand, Nigeria, UAE, UN Foundation, UNICEF National
Committees. |
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uwait’s ambassador to the
United Nations in Geneva, |
Dharar Abdul-Razzak Razzooqi, presents US$ 1 million,
his country’s first contribution for polio eradication,
to WHO Director-General Margaret Chan. |
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t their Heiligendamm Summit in June 2007,
G8 leaders committed to make |
utmost efforts in cooperation with international organizations
and partners to eradicate polio and [to] work with others to
close urgent funding shortfalls”. |
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Only the United States, Germany
and Russian Federation are on track to fulfil their 2005 Gleneagles
commitment to ‘continue or increase’ polio funding for 2006-2008. |
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| • 27-28 November 2007: Advisory
Committee on Polio Eradication, Geneva Switzerland. Discussions
centre on use of appropriate monovalent and trivalent
vaccine and responses to outbreaks of wild and circulating
vaccine-derived polioviruses – and better diagnostics
for the latter. On the research segment of the meeting,
development of bivalent vaccine and progress towards a
safer, affordable inactivated polio vaccine are on the
agenda. |
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