global polio eradication initiative the 'intensified effort' 18 may 2008
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Global Polio Eradication Initiative The 'Intensified Effort' 18 May 2008. Polio. Paralysis for life. Primarily affects children. Preventable with OPV. Polio – the world in 1988. >350,000 cases. >125 polio-endemic countries. 1988: World Health Assembly Resolution. - PowerPoint PPT PresentationTRANSCRIPT
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Global Polio Eradication Initiative
The 'Intensified Effort'
18 May 2008
www.polioeradication.org
Polio
Paralysis for life Primarily affects children
Preventable with OPV
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Polio – the world in 1988
1988: World Health Assembly Resolution
>350,000 cases
>125 polio-endemiccountries
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Polio - the world in 2008
Since 1988: >99% reduction in disease
423 cases
Endemic country
Re-infected country
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Global Polio Eradication Initiative
WHO, Rotary, CDC, UNICEF
Health Ministries
20 million volunteers
Donors (governments, development banks, private foundations, etc)
Private sector
UN agencies
NGOs
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Polio Eradication Strategies
1. Routine Immunization
2. National Immunization Days (NIDs/SNIDs)
3. Surveillance
4. Mop-ups
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India
Indonesia
Bangladesh
UK
Italy
Norway
Sweden
USCDCUSAIDFrance
Bill and Melinda Gates Foundation
WB Investment Partnership for Polio
IFFIm
Japan
EuropeanCommission
World Bank (India)
Rotary International
UN Foundation
Canada
Germany
Others
Netherlands
Denmark
2008-9 Funding Gap:US$ 490m of $1.3b budget
DomesticResources
14%
Non-G8 OECD/Other 8%
Multilateral Sector 15%
Private Sector 15%
Financial Contributions since 1988: US$ 6 billionand Funding Gap for 2008-2009
G8 48%
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Intensified eradication effort
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Launch of intensified eradication effortLaunch of intensified eradication effort
28 February 200728 February 2007
Dr Margaret Chan, WHO DG : "We will complete polio eradication!"
Stakeholder presence:
Endemic country representatives
International development community
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New Tools
New lab procedures(50% faster detection)
16%10%
66%
31%
0
25
50
75
100
India Nigeria
% children protected per dose
tOPV
mOPV1
Monovalent OPV1(mOPV1) Efficacy
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New tailored eradication tacticsIndia
Accelerated SIA schedule with monovalent OPVs Mop-up strategies for wild poliovirus type 1 (WPV1) Targeted strategies for access-compromised areas (Kosi river,
Bihar)
Afghanistan & Pakistan Synchronization of all activities, particularly in cross-border areas Improved access to populations (mobile and in areas of insecurity) Supplementary Interim Administered Dose (SIAD) strategy to
deliver extra dose in between large-scale campaigns
Nigeria 'Immunization Plus Days' New engagement by all sectors of civil society (eg Quranic school
engagement)
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New political engagement and commitmentNew political engagement and commitment
Afghanistan & PakistanApril 2007
India
December 2007
Nigeria, February 2008
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Impact of intensified eradication effort
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Wild Poliovirus, Asiaas of 14 May 2008
district infected with wild polio virus type 1
district infected with wild polio virus type 3
Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison
0
10
20
30
40
2007 2008
Type 1 Cases
No countriesre-infected with
Type 1 WPV
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Q1, 06 Q2, 06 Q3, 06 Q4, 06
Q1, 07 Q2, 07 Q3, 07 Q4, 07
* data as on 26th April 2008
Q1, 08
Compelling evidence of real progress in interrupting WPV1 in UP & Bihar, India
No WPV1 in UP since Nov 07;1 WPV1 in Bihar in Jan 08
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Very geographically restricted virus in Afghanistan & Pakistan in 2008
Afghanistan Pakistan
Type 1 polio cases at 6 May
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Wild Poliovirus, Africaas of 14 May 2008
district infected with wild polio virus type 1
district infected with wild polio virus type 3
Polio-infected districts, last 6 months Type 1 Polio, YTD Comparison
0
25
50
75
100
125
150
2007 2008
Type 1 Cases
7 countriesre-infected with
Type 1 WPV!
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Polio in Nigeria - 2008
• Borno, Kano, Katsina, Jigawa and Sokoto account for >50% of Nigeria’s cases
• >20% of children un-immunized in high-risk LGAs, leaving >1.5 million children vulnerable in these areas
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0
20
40
60
80
100
120
2007 2008
Year-to-date comparison of type 1 polio
Polio Eradication in NigeriaNew outbreak in 2008
• >6-fold increase in type 1 polio (most dangerous type)
• Nigeria accounts for 90% of all type 1 polio worldwide
• Progress achieved in 2007 put at risk by new outbreak
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The GPEI is on track to achieve
major landmarks in 2008-2009,
particularly in Asia.
But increase in cases in Africa needs
to be reversed
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Immediate next steps - Asia
India Properly implement mop-up strategy for WPV1 Fully implement close operational gaps in remaining endemic
areas (Kosi river, Bihar) Further curb WPV3 outbreak and prevent geographic spread
Pakistan Introduce 'SIAD strategy' in Sindh (planned for July) Systematic use of finger-marking to guide SIA improvements Concentrate on high-risk areas & mOPV1 in Sindh (all viruses to
date in 2008)
Afghanistan Fully implement SIAD strategy in Southern Region Use new access to build up immunity
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Immediate next steps - Africa
Nigeria Focus activities on high-risk LGAs in high-risk states Optimize operational improvements (micro-planning, vaccinator
selection, training and supervision) Accurate monitoring of immunization activities Urgent need for full engagement/ownership of LGA political
leaders (particularly high-risk LGAs) Continue to engage all community, traditional and religious leaders
Re-infected countries Maintain high population immunity levels in polio-free countries
(currently higher than in 2003-2005) Stop transmission of imported poliovirus in Angola, Chad and DR
Congo Rapidly fill sub-national surveillance gaps in key areas
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After interruption of transmission of wild
poliovirus…
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Long-term poliovirus risks(after containment & certification of wild polioviruses)
VAPP: Vaccine associated paralytic poliomyelitis
VDPV: Vaccine-derived polioviruses
– cVDPV: circulating VDPV
– iVDPV: 'chronic' VDPV excretion by an individual with a 1o immunodeficiency syndrome.
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Post-eradication timeline
PriorityActivities
WPV Containment& Certification
VAPP/VDPV Elim. & Verification
'Post OPV'Era
Earliest dates 2010 2011 2012 2013 2014 2015 2016
Full WPV containment.
Fill mOPV stockpile.
Refine 'affordable' options for IPV use.
Certify WPV eradication.
Stop trivalent OPV.
Interim containment of Sabin viruses.
Optimize IPV use.
Interrupt cVDPVs (mOPV).
Verify VDPVs eliminated.
Full Sabin containment (if possible replace with
alternate strains)
Longterm surveillance.
Stockpile maintenance.
IPV cessation in countries using for transition.
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Thank you…
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