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Wednesday, December 16, 2015

Another year, another step closer to a polio-free world

Progress in 2015 has laid the groundwork for a final push towards a polio-free world.

A child is vaccinated with oral poliovirus vaccine during a National Immunization Day in Afghanistan.
A child is vaccinated with oral poliovirus vaccine during a National Immunization Day in Afghanistan.
WHO/Afghanistan

When we look back on 2015, it may well be seen as the year the tide irreversibly turned on polio. Wild poliovirus is more geographically constrained than it has been at any point in recorded history. As of 10 December 2015, 66 wild poliovirus cases have been reported from the only two remaining polio endemic countries, Pakistan and Afghanistan, compared to the 324 cases found in nine countries during the same period in 2014.

 
From Nigeria being removed from the list of polio endemic countries to the declaration of wild poliovirus type 2 (WPV2) eradication to the closure of several outbreaks, progress against polio has accelerated in its remaining strongholds. We are rapidly closing in on the finishing line.

 
While we saw important steps forward this year, we also faced challenges which we must address in 2016 to achieve a polio-free world.

 
Nigeria polio-free

 
In 2015, the three remaining polio endemic countries were reduced to two.

 
After many years of determination and hard-work, Nigeria reached one year without polio on 24 July, and was removed from the endemic country list in September. With large populations in remote, hard-to-reach areas, as well as regional insecurity, success in Nigeria was thanks to renewed political commitment and attention to detail at every level of the programme. August 11 marked one year without any wild poliovirus across the entire African continent. The hard work must continue if Africa is to be declared polio-free; in Nigeria and other at risk countries in Africa, the focus must shift from stopping transmission to building resilience. Three years with no case of wild polio are needed for the WHO Africa Region to be declared polio-free.

 
Progress in Afghanistan and Pakistan

 
Cases in Afghanistan remained low in 2015, with a total of 16 cases compared to 21 by this time in 2014. While in 2014 most cases in Afghanistan came from cross border transmission from Pakistan, this year saw endemic cases in areas of the south and east. Security threats continued to pose a threat to reaching children with vaccines in some areas of the country; but healthcare workers and volunteers continued to work tirelessly to protect children everywhere, as can be seen in this photo story.

 
Vast improvements have been seen in Pakistan, with more than 80% fewer cases in the country than in 2014. In part, this is thanks to the establishment of the Emergency Operations Centre (EOC), which serves as a platform for increased government ownership of the polio programme. The EOC has played an important role in the implementation of new strategies such as health camps, which have reached almost 350,000 people in high-risk areas, with additional health services alongside polio vaccines this year. Encouragingly, the number of inaccessible children has declined to just 35,000 in comparison to 300,000 in 2014. While this gives much cause for optimism, environmental surveillance shows widespread transmission continues in several provinces. Pakistan must leverage the low-season to the best of its ability if we are to be successful in eliminating transmission in 2016. 

 
Political commitment

 
In May, the sixty-eighth World Health Assembly adopted a landmark resolution to finish polio once and for all. This puts into place all the necessary building blocks to complete the polio endgame and urges all member states to fully implement and finance it.

 
Securing a polio-free world

 
The switch

To make the world polio-free, we must stop all kinds of poliovirus. While wild poliovirus cases are at an all-time low, circulating vaccine-derived polioviruses (cVDPVs) are taking on an increasing significance in the eradication endgame. In 2015, more countries were affected by cVDPVs than by WPVs, giving them a greater precedence and illustrating how important the trivalent to bivalent OPV switch will be in 2016.

 
In 2015, WPV2 was declared eradicated with no case since 1999 in northern India.

 
This was one of the factors that enabled the Strategic Advisory Group of Experts on immunization (SAGE) to give the go-ahead for the globally synchronised trivalent to bivalent oral polio vaccine (OPV) switch in April 2016. This will play an important role in preventing the emergence of cVDPVs.

 
This year saw six countries affected by cVDPV outbreaks: Guinea, Lao People’s Democratic Republic, Madagascar, Myanmar, Nigeria and Ukraine. This is far less than in 2015, but the fact that any cases continue to be found underlines the fact that children are still under-immunized.

 
Ahead of the switch, all we are focused on fully stopping residual cVDPV2 transmission everywhere. By the close of 2015, 83% of the global birth cohort will be receiving a routine dose of the inactivated polio vaccine, which will boost immunity against all polioviruses and provide a base-layer of protection against type 2. This includes all of the highest risk countries that have reported cVDPV2 transmission since 2000 or that are endemic for wild polio.

 

The polio legacy

 

Countries and partners have also continued to ensure that the polio infrastructure continues to pay dividends for other health programmes once polio has been eradicated. In the last 26 years, the GPEI has mobilized and trained millions of health workers and volunteers, accessed households untouched by other health initiatives and established a global surveillance and response capacity which has huge potential to contribute to future health objectives. Countries with a strong polio eradication presence have begun to plan for the transition of the polio infrastructure to other programmes; but at the same time, the polio infrastructure is already strengthening routine immunization, reaching remote children with other health services and was also integral in fighting Ebola in western Africa.

 
Looking ahead

 
As we enter the home stretch, it is more important than ever that we maintain the momentum that has brought us this far. In order to fully eradicate poliovirus, and remove the burden of polio from all future generations, high coverage of immunization is essential. Surveillance must be improved yet further to ensure polio is rooted out from all existing reservoirs. Funding must continue until every last case is found.

 
2015 has been a great year in the fight against polio. With continued drive and commitment we can make 2016 even better.