GLOBAL POLIO UPDATES, POLIO END

GAME AND HEALTH SYSTEMS

STRENGTHENING

CGPP-ADRA INDIA ANNUAL REVIEW MEETING,

17TH-18TH MAY 2016, MUSSOORIE

Dr. Suchitra Lisam, National Health Programs Manager,

ADRA India

PRESENTATION OUTLINE

PART I : POLIO AT A GLANCE

PART II: GLOBAL POLIO UPDATES

PART III: END GAME /ERADICATION TIMELINES

PART IV: HEALTH SYSTEMS STRENGTHENING, POLIO

LEGACY IN INDIA

POLIO AT A GLANCE

PART I

POLIO AT A GLANCE

Global Polio Eradication Initiatives (GPEI) is a public-private partnership spearheaded by WHO, Rotary International, US-CDC and UNICEF supported by key partners including BMG Foundation and GAVI- the vaccine alliance

99% reduction in polio since 1988

350,000 cases in 125 endemic countries in 1988

74 cases in 2 endemic countries (Pakistan, Afghanistan) in 2015

3 types of wild polio viruses (type 1, 2, 3)

Wild poliovirus type 2 last detected in 1999, global eradication declared in Sep 2015

POLIO AT A GLANCE –contd.

Wild poliovirus type 3 not detected since Dec 2012

2 types of vaccine- OPV and IPV

More than 1.5 million childhood deaths prevented since 1988

15 million cases averted since 1988

More than 5000 m child immunized every year through Routine Immunization and campaigns

World Health Assembly has declared completion of polio eradication as a programmatic emergency for global public health.

ELIMINATION STATUS

GLOBAL UPDATES

PART II

GLOBAL UPDATES (April’16)

The Global Oral Polio Vaccine Switch, statistics on

WPV/cVDPV

Immunization week

Strategic Advisory Group of Experts on

Immunization (SAGE) Meeting

Protecting Children in Countries Vulnerable to Polio

GLOBAL OPV SWITCH

GLOBAL OPV SWITCH-contd.

From the 17 April to the 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type 2 component of the vaccine to protect future generations against circulating vaccine derived polioviruses (cVDPV)

Type 2 component of the oral polio vaccine (OPV) is being removed from use from the trivalent to bivalent oral polio vaccine to withdraw OPV in a phased manner starting with type 2 component following the eradication of wild poliovirus type 2 in September 2015

GLOBAL OPV SWITCH-contd.

152 of 155 (98%) countries and territories have

stopped using the trivalent oral polio vaccine.

Independent monitoring to ensure the switch goes

smoothly has begun in 126 of 153 countries (82%).

The National Validation Committee has received switch

monitoring data from 16 of 153 countries.

The WHO Regional Office has received the National

Validation Report from 10 countries.

GLOBAL OPV SWITCH-Contd.

WPV TYPE 1 & cVDPV -STATISTICS

Total

cases

Year-to-date 2016 Year-to-date 2015 Total in 2015

WPV cVDPV WPV cVDPV WPV cVDPV

Globally 12 3 23 1 74 32

- in

endemic

countries

12 0 23 1 74 3

- in non-

endemic

countries

0 3 0 0 0 29

Countries

Year-to-date 2016 Year-to-date 2015 Total in 2015 Onset of paralysis of most recent case

WPV cVDPV WPV cVDPV WPV cVDPV WPV cVDPV

Afghanistan 4 0 1 0 20 0 27-Mar-16 NA

Pakistan 8 0 22 1 54 2 22-Mar-16 09-Feb-15

Guinea 0 0 0 0 0 7 NA 14-Dect-15

Lao PDR 0 3 0 0 0 8 NA 11-Jan-16

Madagascar 0 0 0 0 0 10 NA 22-Aug-15

Myanmar 0 0 0 0 0 2 NA 05-Oct-15

Nigeria 0 0 0 0 0 1 NA 16-May-15

Ukraine 0 0 0 0 0 2 NA 07-Jul-15

VULNERABLE COUNTRIES

Polio remains endemic in two countries – Afghanistan and Pakistan.

Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.

Circulating vaccine-derived poliovirus is causing an outbreak in Madagascar, Guinea and Ukraine.

Vulnerable countries : Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Somalia, South Sudan and Syrian Arab Republic.

POLIO IN NUMBERS-2016

Wild poliovirus in 2016

- Global Total: 12 (23)

- Global WPV1: 12 (23)

- Global WPV3: 0 (0)

Endemic: 12 (23)

-Afghanistan: 4 (1)

- Pakistan: 8 (22)

Importation Countries: 0 (0)

Data as of 27 April 2016. Numbers in brackets represent data at this time in 2015

POLIO PUBLIC HEALTH EMERGENCY

Temporary Recommendations to Reduce International Spread of Poliovirus

On 5 May 2014 the Director-General declared the international spread of wild poliovirus in 2014 a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations [IHR 2005], issued Temporary Recommendations to reduce the international spread of wild poliovirus, and requested a reassessment of this situation by the Emergency Committee every 3 months.

The eight meeting of the Emergency Committee was held in February 2016. Based on the committee’s advice and the reports made by affected States Parties, the Director-General extended the following Temporary Recommendations under the IHR (2005), effective February 2016.

WORLD IMMUNIZATION WEEK

In 2016(April) there have only been 12 cases of polio, down from 23 cases in the same period for 2015.

World Immunization Week took place between 24 – 30 April with the theme “Close the Immunization Gap”.

SAGE MEETING

Recommends amendments of surveillance

case definition to include type 2 Sabin so

that all type 2 polioviruses will be notified

Urges all countries to ensure completion of

phase I for all type 2 polioviruses, incl.

Sabin 2

Endorsed the components of updated

MOV strategy to improve coverage,

equity and timeliness of vaccination

Implementation research- more attention

Immunization specific indicators to assess

progress towards <5 mortality target of

SDGs

PROTECTING CHILDREN IN VULNERABLE AREAS

Keeping levels of immunity high by strengthening RI, carrying out polio vaccination campaigns and keeping vigilant surveillance systems for early warning should the virus return is a top priority for the GPEI.

In Jordan, the Ministry of Health with the support of WHO, UNICEF and partners, recently completed a mass immunization campaign against polio, reaching >1 million children <5 across the country with OPV

KEY CHALLENGES

Delivering quality health services.

Improving reach, tracking missed children with OPV

in endemic countries

Keeping up the pressure

Despite the gains, there is still much to be done, not

only in Afghanistan and Pakistan but also in

countries with declining immunization rates. So long

as polio continues to circulate anywhere, children

everywhere are at risk.

END GAME PLAN/ ERADICATION TIMELINES

PART-III

Polio Eradication and Endgame Strategic Plan 2013–2018

IPV INTRODUCTION TIMELINES

POLIO ERADICATION TIMELINES

GPEI AND HEALTH SYSTEMS STRENGTHENING,

POLIO LEGACY-HEALTH SECTOR

PART -IV

BUILDING BLOCKS FRAMEWORKS OF HEALTH

SYSTEMS

POLIO LEGACY/SCOPE IN VPDs PROG

Over the past 25 years, GPEI-funded personnel

and infrastructure have supported the distribution

of global and country health priorities including

anti-measles vaccines

vitamin A supplements

anti-malarial bednets

deworming pills

surveillance for yellow fever and avian influenza

INDIA POLIO LEGACY

Polio legacy in Action

Mainstreaming critical polio eradication functions into other priority health programmes

Ensuring that the best practices and knowledge gained over years are shared with other health initiatives

Transitioning certain polio functional areas to government counterparts

Transitioning the capacities, processes and assets created by the programme to support other vaccine preventable diseases & strengthening health systems

TRANSITION OF ACTION

Polio funded assets of WHO, UNICEF & CORE and others are

supporting RI strengthening activities in India

Lessons learnt from polio/best practices being applied for RI &

control/elimination of VPDs

Mission Indradhanush (MI) as a good example of government

led legacy in action for RI campaigns.

Other transition areas- health, sanitation, nutrition, Ebola

Transition/Legacy Plans are progressing and new initiatives to

bring it under one umbrella.

Legacy Documentation is a major priority, ongoing

TRANSITION OF ACTION

Transitioning assets/functions and applying lessons learned

Strengthening routine immunization • Intensified RI monitoring –generating data on quality of immunization, availability of vaccines/logistics, reasons for low RI coverage and Zinc/ORS availability.

Accountability through Task Forces, established in 36 states and 668 districts to review program data.

Capacity building of frontline workers

Advocacy and integrated communication including high risk areas in RI session planning – 96% of high risk areas now included in RI micro plans.

New vaccine introduction (Pentavalent; IPV, MR, Rotavirus) – Developing field guidelines, training material and checklists for assessing preparedness at district/state levels; conducting post-introduction and coverage evaluations. Measles elimination and rubella control –

TRANSITION IN ACTION

Supported catch-up campaigns covering approximately 119 million children. Visceral leishmaniasis (Kala Azar) elimination – Monitoring indoor residual spraying; contributing to national elimination strategy development. VPD surveillance

Coordinating validation of MNT elimination; capacity building for lab personnel; launched lab supported surveillance for diphtheria, pertussis and neonatal tetanus with expansion planned in 2015

AEFI surveillance – Assisting with updated guidelines; training AEFI committees; supporting electronic case reporting. Supporting international health programs –Indian SMOs deployed to Nigeria, Sierra Leone and Liberia in 2014-15.

LEGACY DOCUMENTATION

Completed

Hosting Learning Missions – Afghanistan

and Pakistan

Documents on Transition/Successful

Strategies in States

Completed Legacy photographic book

– demonstrating innovations/game

changers to triumph over polio

Several films 7 documenting Social

Mobilization strategies, new PBS film

on transition polio to RI, short film

polio for RI.

India Polio Learning Exchange website

Underway/planned 2015-2016

Joint papers with WHO, GOI and

partners under discussion

SMNet Legacy Review (PWC) –

critical factors for success, SMNet

location/# for RI, and transition options

SMNet Impact on RI, Convergence,

Diarrhea morbidly and mortality

IPV Introduction preparedness

KAP

Impact on the mobilizers themselves