Statement: UNICEF – Report finds millions of children never vaccinated, UNICEF calls for action to reach them
NEW YORK, 20 June 2012 – “The Independent Monitoring Board on progress with global polio eradication reports the significant finding that 2.7 million children in six countries have never been reached with a single polio vaccine. This is a clarion call to accelerate all efforts to reach these unreached children,” said Anthony Lake, Executive Director of UNICEF.

“Not only have these millions of children never had a polio vaccine but many of these ‘never’ children have not been reached by the life-saving benefits of routine immunization. The report calls on all of us to help find and vaccinate these children, make every encounter with these children count, and make history by wiping out this crippling disease.
“As many of these ‘never’ children live in volatile areas of conflict such as eastern DR Congo, northern Nigeria, the Northwest region of Pakistan, humanitarian space must always be protected and preserved so that the heroes of the polio campaigns – the volunteers, the vaccinators and the social mobilizers – can have full access to children. This is especially the case in a global campaign like the fight against polio.
“The polio campaign is dangerously under-funded. But we are on the verge of victory. Not only can we make history by succeeding in eradicating polio but we will be condemned by history if we fail.
“UNICEF is committed, with partners, to implementing the recommendations outlined in the report such as using polio vaccination campaigns for integrated public health campaigns around good sanitation and nutrition, scaling up use of social mobilization activities so communities take ownership of the health campaigns and finding innovative ways of reaching missed children.”
http://www.unicef.org/media/media_62667.html

Report: Every Missed Child
Independent Monitoring Board of the Global Polio Eradication Initiative
June 2012
The 44-page report issued in conjunction with the 6th meeting of the IMB.
Pdf: http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/6IMBMeeting/IMB6_Report.pdf

The Weekly Epidemiological Record (WER) for 22 June 2012, vol. 87, 25 (pp 241–244) includes: Global Polio Eradication Initiative: 6th meeting of the Independent Monitoring Board; Monthly report on dracunculiasis cases, January–April 2012
http://www.who.int/entity/wer/2012/wer8725.pdf

Global Polio Eradication Initiative: 6th meeting of the Independent Monitoring Board

The Independent Monitoring Board (IMB) was established in November 2010, at the request of the World Health Assembly, to monitor and guide progress of the 2010–2012 Strategic Plan of the Global Polio Eradication Initiative (GPEI). The goal of this plan is to interrupt polio transmission globally by the end of 2012.

The IMB held its 6th meeting on 15–17 May 2012, in London, United Kingdom. Following this meeting the IMB issued its 5th report1 to the heads of WHO, the US Centers for Disease Control and Prevention (CDC), UNICEF, Rotary International, and the Bill & Melinda Gates Foundation’s Global Health Program. This report summarizes the conclusions of the IMB.

   1. Polio is no longer present in India.
No case of poliomyelitis has been reported from Angola or the Democratic Republic of Congo since the beginning of 2012, and Chad has reported only 3 cases. In Pakistan, less than half the number of poliomyelitis cases occurred in the first 4 months of 2012 than during the same period in 2011. However both Afghanistan and Nigeria have seen many more poliomyelitis cases in 2012 compared to the same period in 2011.

   2. Among the 6 persistently affected countries, 2.7 million children have never received a single dose of polio vaccine, an unacceptable situation.
The precise reasons for “Every Missed Child” – not only those who have never received 1 dose – should be exposed and rapid corrective action taken.

   3. During its meeting, the IMB spoke of a crisis because:
(i) recent successes have created a unique window of opportunity, which must not be lost;

(ii) a funding shortfall threatens to undermine the increasing containment of the polio virus;

(iii) an explosive resurgence in the immediate future would see country after country under attack from a disease against which their children were considered to be protected.

   4. In its latest report, the IMB highlights a number of key and urgent actions on which the GPEI must focus in order to avert this crisis.
– The primary risk to the programme is its precarious financial situation. Under-financing is not compatible with the ambitious goal of stopping polio transmission globally. Currently, vaccination campaigns are being cancelled, thereby escalating the risk of an explosive return of polio at a time when it is at its lowest recorded level.

– Greater emphasis on the “global public good” of polio eradication will drive the programme forward. Currently, participation in eradication efforts and the donation of resources are uneven. The 65th World Health Assembly adopted a resolution declaring polio to be a global health emergency. The IMB hopes that this will bring countries together once more in a common cause.

= Consistently high quality vaccination and surveillance must be achieved everywhere, not only in ‘islands of excellence’. Considerable improvements to the programme’s management approach have been set in motion, but the required degree of change has not yet been achieved.

– Stakeholders need to know what is planned for the months and years after 2012. This is a far-reaching and complex matter. Planning for the “polio end-game” is under way but the IMB is not convinced that the fundamental nature of what is required is fully understood by the programme.

– Further outbreaks risk substantially harming the programme, bolstering transmission and diverting finances and focus. More innovative methods need to be used to eliminate the possibility of outbreaks more comprehensively.

– The programme operates too much in isolation. Children missed by polio teams may be reached by other services. Stronger, more effective alliances can bring eradication closer.

   5. The IMB meeting focused on the “sanctuaries” for the polio virus – those discrete geographical locations with large numbers of missed children where the virus can take safe refuge and multiply. In these sanctuaries, reaching missed children is the first operational objective. The extraordinary challenges faced require extraordinary actions, determination and resolve.

   6. Of greatest current concern are the polio virus sanctuaries in Afghanistan and Nigeria:
– In Afghanistan insecurity has been an explanation for poor performance in the past, but it is a cause for considerable concern that although security has recently begun to show signs of improvement, poliomyelitis case numbers are rising.

– Nigeria is now the only country to have 3 types of polio virus and consequently it poses a substantial risk to the global goal, in part because many of its neighbouring countries are vulnerable to the spread of infection.

7. The IMB concluded that although the programme has missed all but one of its 2010–2012 Strategic Plan milestones, its operation has strengthened considerably in the last 6 months.

In order to capitalize on this once-in-a-generation opportunity the IMB made 7 recommendations:
i) An emergency meeting of the Global Polio Partners Group should be held to mobilize urgent funding to re-instate cancelled vaccination campaigns.

ii) The Polio Oversight Board should continuously review the effectiveness of the programme in order to achieve improvement.

iii) A polio “end-game and legacy” strategy should be published urgently for public and professional consultation.

iv) A plan to integrate polio vaccination into the humanitarian response to the food crisis and conflict in West Africa should be rapidly formulated and implemented. Alliances with all relevant programmes need to be urgently explored, in order to benefit from every contact.

v) The presence of polio virus in environmental samples should trigger action equivalent to that of an outbreak response (this recommendation subject to rapid feasibility review).

vi) Contingency plans should be drawn up immediately to invoke the International Health Regulations to require travellers from polio-affected countries to carry a valid vaccination certificate.

vii) The number of missed children should henceforth be the predominant metric for the programme.

The IMB will continue to provide a frank and independent assessment of the progress being made towards global interruption of polio transmission. The next IMB meeting will be held in London, United Kingdom, on 29–31 October 2012.