Global health leaders say polio-free world within grasp

No child need ever again suffer polio-paralysis, but experts warn of grave humanitarian consequences if success is not reached

29 January 2015 – Ministers of health, health leaders and other global public health experts attending this week’s Executive Board (EB) meeting in Geneva, Switzerland, were encouraged by progress towards achieving a polio-free world. Yet they warned that as long as the disease remained anywhere, children everywhere are at risk. The meeting noted that achieving eradication, a global public good, could only be achieved through global solidarity.

Reviewing latest global epidemiology and impact of emergency outbreak plans, the Board noted in particular the strong progress across Africa, which has not seen a case due to wild poliovirus in almost six months, and in stopping a devastating outbreak affecting the Middle East despite conflict and large-scale population movements affecting the region. The Board commended the unwavering commitment of governments, health workers, humanitarian organizations, NGOs and civil society across the region, underscoring what successes could be achieved in the spirit of global solidarity. The Board cautioned, however, that these positive developments needed to be further validated through intensified surveillance activities, including through rapid scale-up of environmental surveillance as appropriate.

At the same time, however, the Board expressed alarm at intensified transmission of the virus in Pakistan, which now accounts for 85% of all new polio cases worldwide, and virus continuing to spread beyond its borders. Failure to eradicate polio in the last remaining endemic hotspots would result in massive resurgence of the disease, with virus spreading to cause outbreaks in polio-free countries around the world.

The Board noted the major ramp-up in Pakistan’s government commitment at all levels, to urgently address the situation through the development of an emergency ‘low season plan’ for the first half of 2015, which had all elements to rapidly eradicate polio. Success, however, hinges on its full implementation at all levels, and the discussions highlighted the need for strong international support to ensure eradication strategies in all remaining infected countries can be fully implemented.

The Board also noted the strong progress being made, in close coordination with Gavi, the Vaccine Alliance, towards preparing for the phased withdrawal of oral polio vaccines (OPV), and urged all countries to ensure global readiness for the coordinated global switch from trivalent OPV to bivalent OPV in early 2016, including by ensuring sufficient global supply of inactivated polio vaccine (IPV) to facilitate the switch, and equitable access to the global stockpile of monovalent OPV type 2 (mOPV2). The Board underscored the need to intensify efforts to urgently stop the persistent circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks in Nigeria and Pakistan, which will be the trigger for the switch in April 2016.

On financing, however, Member States expressed grave concern at the ongoing funding gap affecting the programme, and the risk it posed to fully implementing the Polio Endgame Plan. It called on all donors to rapidly fulfil pledges and fill the residual funding gap as urgently as possible. This is critical not only for polio eradication, but also as the polio eradication effort represents a concrete contribution towards broader maternal and child health development goals.

Repeatedly, Member States paid tribute to the heroic work of frontline health workers, working under often difficult and dangerous conditions, risking their lives to reach children everywhere.

On legacy planning, Member States commended the GPEI’s infrastructure support to the Ebola outbreak, notably in Nigeria, calling it an example of ‘legacy in action’. It looked forward to continuing consultations to secure the legacy of the GPEI, including in particular on further supporting the strengthening of routine immunization.

Rotary International provided an impassioned plea for all stakeholders to redouble their efforts, while reiterating the unwavering commitment of Rotarians worldwide. Regional Director for the Eastern Mediterranean Dr Ala Alwan assured Member States of his region’s unwavering commitment to polio eradication, including in particular to supporting Pakistan through the immediate deployment of an additional 800 emergency surge staff. Director-General Dr Margaret Chan re-affirmed WHO’s commitment across all levels, and thanked all partners and stakeholders for bringing the world to the threshold of being polio-free. Turning to Pakistan, she concluded: “Your country will be the one that delivers a polio-free world. It will be a historic achievement.”

In short, there is clear and unprecedented support for completing eradication as urgently as possible, given the epidemiological opportunity which presents itself. Success, however, requires a re-doubling of efforts by all stakeholders at all levels.