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Major Funding Announcement Boosts Polio Eradication Effort
The Bill and Melinda Gates Foundation, Rotary
International, and the British and German governments have this year committed
more than US$ 630 million in funding to stop polio. On 21 January, the Gates
Foundation announced it was awarding a US$ 255 million challenge grant to Rotary,
which Rotary will match with US$ 100 million from its members over the next three
years. In addition, the United Kingdom and Germany are committing US$ 150 million
and US$ 130 million, respectively, over the next five years*.
“Rotarians, government leaders, and health professionals have made a
phenomenal commitment so polio afflicts only a small number of the world’s
children,” said Bill Gates, co-chair of the Gates Foundation. “Rotary in
particular has inspired my own personal commitment to get deeply involved in
achieving eradication.”
Mr Gates reaffirmed that his Foundation was prepared to go the distance to
see eradication achieved. “Eradicating a disease is hard, slow, painstaking
work,” he told a Rotary convention in San Diego in January. But failure was “no
alternative at all - we don’t let children die because it is fatiguing to save
them”.
The donors have earmarked these funds to be allocated to
support supplemental immunization activities, including the purchase of oral polio vaccine, in polio-endemic
countries and countries with imported cases; research into new vaccines and ways
to ensure they are available to vulnerable children; and surveillance to detect
polio cases and respond swiftly to outbreaks in neighbouring countries.
These contributions signal a clear vote of confidence in the intensified
polio eradication effort launched in 2007. This intensified effort has proven,
according to the Advisory Committee on Poliomyelitis Eradication (ACPE) and the
Strategic Advisory Group of Experts on Immunization (SAGE), that the remaining
technical, financial, and operational challenges to polio eradication, even in
key areas of each endemic country, can be overcome (see Page 4-5 for more
information). However,
recognizing the unique challenges in the remaining polio-endemic countries and
re-infected regions, the WHO Executive Board (EB) has requested a
country-specific evaluation to
guide polio eradication’s next vital steps.
Afghanistan honours polio workers killed in
line of duty
Afghanistan President Hamid Karzai has held a
special ceremony to honour the lives of two doctors and their driver killed on
WHO duty when attacked by a vehicle-borne suicide bomber. On 12 January, Mr
Karzai made a presentation to the families of Dr Mamoon Taher Taheri, Dr Shamsul
Haq M.H. Kakar and their driver Azizullah Almas, who were killed in Kandahar
Province on 14 September while preparing logistics for a regional polio
vaccination campaign to be carried out on UN Peace Day.
Dr. Hussein A. Gezairy, EMRO Regional Director, attended the event and gave
his deepest condolences to the men’s families.
“It is tragic beyond words that their dedication to a humanitarian mission
should have ended in the loss of their lives,” Dr Gezairy said. “While we will
never forget
those whom we have lost, we must rise above this challenge and do everything possible to reach the target. This
will be the best acknowledgement to all those lost during the polio eradication
efforts.”
The UN Secretary-General and WHO Director General also both strongly condemned
the killings. Although the suicide bombing
threatened to derail the polio immunization campaigns, the national team leading the polio eradication
effort in Afghanistan felt that completing the planned immunization days was the
best way to remember their colleagues. The death of these men is a poignant
reminder of the extraordinary sacrifices that continue to be made in the name of
eradicating polio.
UNICEF Redesigns Polio Teams in Nigeria and
India
UNICEF Representatives in Nigeria and India have
reorganized their polio teams to place a greater emphasis on stopping
transmission soon, placing all of the core polio program functions (program
communication, media and advocacy, vaccine supply and logistics) in one unit
reporting to a senior manager responsible only for polio eradication.
Some key appointments are overseeing the changes in both countries. In India,
Karin Hulshof (previously director of UNICEF’s Programme Funding Office) has
been named India Representative, with Lieven Desomer - one of UNICEF’s most
experienced immunization experts, having led UNICEF’s effort to support EPI
programs in Nigeria, Democratic Republic of Congo and Somalia - appointed to
lead the polio program.
In Nigeria, Dr Suomi Sakai has taken over as Country Representative after
previously serving as Representative in Cambodia and Nepal, and UNICEF’s Chief
of Immunization.
Dr Sakai said UNICEF Nigeria was currently recruiting for the new “focused
and streamlined” structure, with staff hopefully in place in the first half of
this year. “In this team we have not only the dedicated polio specialists but
also the media and the communications staff focused on engaging the communities.
We’re bringing all of that together so our staff can be more dedicated to
focusing on polio, with obvious links to the routine immunization system,” Dr
Sakai said. “The other element is that in each of the zone offices in the field
we have people who are polio-focused. This is a job that needs to get done.”
While encouraged by displays of re-engagement in polio eradication by
high-ranking government officials, Dr Sakai said there was no room for
complacency. “There is re-engagement, yes, but it’s something that needs to
continue,” she said, adding that much more needed to be done at a local level.
“We need to provide the local-level leadership with the tools and the right
questions to monitor the polio program and ensure that they’re getting results.”
Polio goes to the Oscars
A film taking a first-person look at the massive
challenge of clearing the final hurdle in polio eradication was nominated for an
Academy Award in the best documentary short subject category. The Final Inch, a
38-minute film commissioned by the philanthropic division of Google, chronicles
the challenges health organizations and governments face during the final stages
of polio eradication.
The film follows health workers as they go door to door immunizing Indian
children during National Immunization Days, clearly illustrating the final
challenges in the remaining few polio-endemic areas. Director and producer Irene
Taylor Brodsky juxtaposes their experience with the memories of polio survivors
in the United States, placing the challenge of eradication
against the context of the reward for generations to come. The Final Inch will air on HBO in the United States
in early April.
Spearheading partners inducted into
Polio Hall of Fame in Warm Springs
All those who had a role in the 50th Anniversary
Induction Ceremony are pictured at the newly upgraded Polio Hall of Fame
Monument moments after its unveiling, including RWSIR Executive Director Greg
Schmieg, State Representative and RWSDF Trustee Carl Von Epps, Georgia Labor
Commissioner Michael Thurmond, FDR grandson H. Delano Roosevelt, Jonas Salk’s
eldest son Peter Salk, U.S. Congressman Ike Skelton, Rotary International
PolioPlus Director Carol Pandak, World Health Organization External Relations
Officer Werner Obemeyer, CDC Immunization Director Anne Schuchat and UNICEF
Senior Health Advisor Ahmed Magan.
Africa: synchronized outbreak response
Historic seven-country
cross-border synchronized vaccination campaign across
West Africa immunizes 55
million children on one weekend.
In the second half of 2008, a polio outbreak in
northern Nigeria spread to west Africa, with 55 polio cases linked to northern
Nigeria confirmed in Benin, Burkina Faso, Chad, Côte d’Ivoire, Ghana, Mali,
Niger and Togo (as of 18 March, 2009).
As part of the response, a seven-country synchronized cross-border
immunization campaign was held across west Africa from 27 February-2 March
(Ghana conducted its first-round immunization day on 12 February), with a second
round from 27-30 March.
More than 28 million children from Benin, Burkina Faso, Cote d’Ivoire, Mali,
Niger and Togo were immunized by almost 95,000 immunizers carrying 33 million
oral polio vaccine doses. A further 25 million children were immunized on these
days with mOPV1 in 15 states in Nigeria. High-quality acute flaccid paralysis
(AFP) surveillance is now underway to detect any further cases and verify when
transmission has been halted.
An outbreak of wild poliovirus
type 1 - previously restricted to southern
Sudan and western Ethiopia - has spread to northern Kenya, northern Uganda and
northern Sudan (Khartoum and Port Sudan). The report of a case in Port Sudan is
worrying, given it was from this port city that an outbreak spread to Saudi
Arabia, Indonesia, Somalia and Yemen in 2004-06, resulting in 1,200 cases and
requiring more than US$ 150 million in international emergency outbreak response
costs.
Detection of polio sparked rapid outbreak response activities in the
re-infected countries. Genetic sequencing data suggests that the importations
into these countries have been rapidly detected, improving the prospects for
interrupting transmission in the near term.
In northern Sudan, a large-scale supplementary immunization activity (SIA)
began on 15 February and continued on 23 March, with more planned for late
April.
In southern Sudan, rapid-fire
SIAs were held on 13 January, 23 February, 23
March and late April in the hope of delivering the optimum number of doses
before the onset of the rainy season in May, when access becomes difficult. The
President of the Government of Southern Sudan, His Excellency General Salva
Kiir, has declared the outbreak a national emergency and pledged to do all he
can to support the emergency response.
Pakistan tackles polio — from police to
politicians
If your car is stopped by police in Pakistan
during an immunization activity, you’re just as likely to be asked if the
children in the car have been immunized against polio as you are to have your
driver’s licence checked. Since late last year, police, together with district
health teams, have been manning vaccination booths at border crossings, transit
points, road stops and bus stops - including 58 toll booths - in targeted
regions of Pakistan.
Meanwhile, on busy train station platforms, Railways Health staff are setting
up vaccination booths and immunizing children as they get on and off trains.
These are crucial examples of how Pakistan is tackling one of its greatest
challenges in eradicating polio - ensuring that children who move into and out
of high-risk poliovirus
areas, including across the border into Afghanistan, are immunized.
This civil support and co-operation is being driven from the top down: on 26
February, the Prime Minister of Pakistan Syed Yusuf Raza Gilani, chaired a
meeting at the Ministry of Health, Islamabad,
and approved an Action Plan for polio eradication in Pakistan. This plan
focuses mainly on securing the active involvement of other sectors beyond the
health sector to support polio eradication efforts, to ensure a truly national
campaign.
Global advisory body outlines challenges and solutions to ending polio
transmission in remaining endemic countries
In February, 2007, the Global
Polio Eradication Initiative launched the Intensified Eradication Effort.
In
November 2008, the Advisory Committee on Poliomyelitis Eradication (ACPE)
declared the
Intensified Eradication Effort had proven that although the
remaining endemic countries - Nigeria,
India, Pakistan and Afghanistan - posed
unique challenges, polio eradication could be achieved.
Nigeria
“Nigeria will continue to pose a high risk to international health until the
new, top political commitment is translated into field level improvements in
campaign quality.” - ACPE CONCLUSION
Primary challenge:
- If 90% of Nigeria’s children under five receive three doses of vaccine,
the country will halt polio transmission. Despite increased community demand
for polio immunization, operational issues are affecting the quality of
vaccination campaigns, particularly in the highest-risk northern states,
where more than 60% of children are under-immunized. The primary challenge
is to overcome the sub-optimal delivery of OPV during SIAs.
- Nigeria benefits from a renewed high-level political engagement. In
February 2009, under the leadership of HE President Umaru
Yar’Adua, the
governors of the 36 states of Nigeria collectively signed the ‘Abuja Commitments to Polio Eradication in
Nigeria, publicly committing themselves to provide the necessary active
leadership urgently needed for polio eradication.
Strategic approaches:
- Systematically translating new high-level engagement into engagement at
State and Local Government Area (LGA - district) level, to urgently improve
operational quality of vaccination campaigns. Progress has been seen in
areas where state governors and LGA Chairpersons are fully engaged.
- Putting in place International monitoring systems – based on experience in
other countries – to evaluate LGA-level engagement and accountability to
ensure the full implementation of the ‘Abuja Commitments’.
- In long-standing areas of low coverage which have international
implications, notably Kano, scaling-up international technical support.
- Scaling-up activities to further enhance community engagement, including
through the systematic and regular assessment of community perceptions and
tailoring of social mobilization activities as necessary.
Afghanistan
Afghanistan has an eradication program which,
with modest improvements in access in security-compromised areas and campaign
oversight and quality in accessible areas, should interrupt poliovirus
transmission.” - ACPE CONCLUSION
Primary challenge:
- Polio transmission in Afghanistan is primarily restricted to the country’s
Southern Region, where access to all populations during SIAs is hampered by
insecurity.
Strategic approaches:
- Implementing quarterly programme reviews to quantify and prioritize
problems and their implications based on the evolving security situation,
population size and movements, and number of missed children during each
SIA.
- Applying area-specific tactics, based on experience in other
conflict-affected areas and the quarterly reviews.
- Enhancing negotiations with community leaders, irrespective of
affiliation, to allow increased and safe passage to all populations by
vaccination teams.
- In between large-scale NIDs and subnational immunization days (SNIDs),
during any window of opportunity as they arise, delivering an extra dose of
vaccine to communities (Short Interval Additional Dose strategy – SIAD).
India
India has a very high-performing eradication
program which, if current efforts are sustained and contingency plans rapidly
implemented to enhance program efficacy, will interrupt poliovirus
transmission.” - ACPE CONCLUSION
Primary challenge:
- India benefits from a highly performing eradication program, with more
than 95% coverage during vaccination campaigns. During National Immunization
Days (NIDs), more than 172 million children are immunized in just six days.
However, due to several contributing factors -- high population levels
living in close density (in Uttar Pradesh alone, 500,000 children are born
each month); frequent population movements; inadequate sanitation
infrastructure, and suboptimal routine health services -- efficacy of oral
polio vaccine (OPV) is
sub-optimal in the remaining infected areas of the country, notably in the western part of
Uttar Pradesh.
- Key to success is maximising the impact of each immunization, and
sustaining the high-quality SIA operations.
Strategic approaches:
- Implementing large-scale vaccination campaigns every four to six weeks in
Uttar Pradesh and Bihar, with monovalent OPV type 1 (mOPV1).
- Implementing cross-cutting new initiatives, including the use of
inactivated polio vaccine (IPV), higher titre mOPV1, and developing bivalent
OPV as a supplement to current immunization campaigns with mOPV1 in
highest-risk districts of northern India. Strategically optimizing the mix
of vaccines to prioritize interruption of type 1 polio transmission, while
maintaining immunity to type 3
Pakistan
Pakistan has an eradication program which is
sound, but which, because of very efficient virus transmission, gaps in campaign
quality, and a deterioration in security in a key transmission zone, requires
further improvements in campaign quality and continued innovation to interrupt
poliovirus transmission.” - ACPE CONCLUSION
Primary challenges:
- Hampered access to populations in security-compromised areas, such as
North-West Frontier Province/Federally Administered Tribal Areas (FATA),
coupled with large-scale population movements, including with neighbouring
Afghanistan, make reaching immunization targets difficult.
- At the same time, in some accessible areas of the country (eg Sindh),
operational challenges continue to hamper vaccination efforts.
- Due to this, as well as frequent population movements, a
cross-sectoral
approach is needed to interrupt the remaining chains of polio
transmission. Key is full provincial- and district-level engagement, which will
ensure that supervisor and implementing staff are accountable to improving the
quality of SIA operations.
- Pakistan benefits from strong high-level political engagement. In February
2009, Prime Minister of Pakistan Syed Yousaf Raza Gillani launched a ‘Polio
Action Plan’, with the immediate aim of assuring inter-sectoral support for
polio eradication and fostering provincial- and district-level
accountability.
Strategic approaches:
- Putting in place international monitoring systems to monitor the
engagement of provincial and district leaderships.
- Developing provincial-level operational plans to target eradication
strategies. Independently monitoring SIA performance through finger-marking,
and immediately re-covering
Nigeria: improvement in zero dose children
in highest-risk areas
Response to outbreak in Africa
(date of
activity plus target population)
Financial Resource Requirements
for 2009-2013 published
A draft Financial Resource Requirements (FRR)
document outlining a five-year budget through 2013 was made available in January
2009. This preliminary FRR, to be refined in May, summarizes the funding needed
to successfully interrupt wild poliovirus transmission globally and prepare for
the post-eradication era. The FRR was developed in conjunction with the
framework for a new global polio eradication initiative strategic plan for the
same period (2009-2013), which has been endorsed by the Advisory Committee for
Polio Eradication (ACPE). The document is available at
www.polioeradication.org.
Rotary puts spotlight on polio eradication
From Sydney’s Opera House to Rome’s Coliseum,
from Cape Town’s Table Mountain to New York’s High Falls, Rotary’s commitment to
“End Polio Now” has been lighting up the night sky. Throughout the third week of
February, floodlit messages across some of the world’s most iconic landmarks
called on the millions that saw them to join the remarkable 20-year campaign to
rid the world of polio. “By illuminating these historic landmarks with our
pledge to end polio, Rotary clubs are announcing to the world that we will not
stop until the goal is achieved,” says Jonathan Majiyagbe, the Rotary
Foundation’s trustee chair.
“We hope people everywhere will see these words, either in person or through
the media, and join
with us and our partners in this historic effort to rid the world of polio
once and for all.”
UK boosts funds to eradicate polio in Pakistan
On October 21, the United Kingdom’s Department
for International Development (DFID) announced that it will provide an
additional £7.5 million (US$ 13.5 million) through WHO to help eliminate polio
in Pakistan.
The new funds will be used to
support supplementary immunization activities.
In announcing the additional funding, the Minister for International
Development, Mike Foster, paid tribute to the Pakistan Government’s efforts. “We
are proud to be
a partner in Pakistan’s quest to fight polio, and we commend the government
of Pakistan for its work to safeguard all children from this disease.”
The UK has contributed US$ 894 million since 1988 to eradicate polio.
Indian individuals rally to end polio now
Three Indian individuals made a November dinner
meeting between Bill Gates and Rotary business leaders in India a night to
remember when between them, they donated US$ 2.75 million.
Rajashree Birla, who had already contributed US$ 1 million to Rotary’s challenge
in early 2008, committed a further US$ 1 million, Rotary member Harshad R. Mehta,
who has already committed US$ 2 million to the challenge, committed an additional
US$ 1.5 million, and Rotary member Rajnikant D. Shroff Gujarat committed US$ 250,000.
“India’s leaders have made significant investments to protect its 172 million
children from polio,” Bill Gates said at the meeting.
“The commitment from everyone
involved is impressive, especially Rotary International, that has launched their worldwide program.”
Moving snapshot of Indian Immunization Day
Photojournalist Richard Wainwright joined Rotary
on a National Immunization Day in Saharanpur, northern Uttar Pradesh, on 1
February. To see his excellent slideshow of what it takes to immunize each child
in India under five against polio, go to
www.richwainwright.com.
New Contributions/Projections received
between August 2008 - March 2009, for
the period
2009-2010 (in $US millions)
Publications and resources on www.polioeradication.org
- Polio Pipeline, Issue 02, Autumn 2008
- Polio Pipeline, Issue 03, Winter 2009
- Financial Resource Requirements, 2009-2013 (as of March, 2009)
- Abuja Commitments to Polio Eradication
- Framework for the new GPEI Strategic Plan 2009-2013
- Progress Report from 124th Session of Executive Board to the World Health
Assembly (Jan 2009)
- Final Report of the Advisory Committee on Polio Eradication (ACPE) (Dec
2008)
- Strategic Advisory Group of Experts on Immunization (SAGE) meeting (Nov
2008)
Events
- April 7-9: SAGE meeting, Geneva, Switzerland
- May 12-14, EMRO Regional Certification Commission meeting, Cairo, Egypt
- May 13-22, STOP 31 Field Training, Atlanta, USA
- May 18-27: 62nd World Health Assembly, Geneva, Switzerland
- June 1-3: Polio Research Committee meeting, Geneva, Switzerland
- June 3-4: SAGE Intravenous Polio Vaccine Working Group meeting, Geneva,
Switzerland
- June 21-24: Rotary Convention, Birmingham, UK
- June 23-25: 15th Informal Consultation of LAB Network, Geneva, Switzerland
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Wild virus type 1 
Wild virus type 3 
Spread of virus
Zero Dose 
1-2
Doses 
3+ Doses
