Report: Polio’s Last Stand 
Independent Monitoring Board of the Global Polio Eradication Initiative
November 2012

The full report is available as a 50-page pdf here: http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/7IMBMeeting/7IMB_Report_EN.pdf

[Editor’s Note: We present the final section of the report titled “Conclusions and Recommendations” in full text below. We draw reader attention to the first recommendation (our bolding which suggests that “the International Health Regulations Expert Review Committee urgently issue a standing recommendation by May 2013 that will introduce pre-travel vaccination or vaccination checks in Afghanistan, Nigeria and Pakistan until national transmission is stopped. No country should allow a citizen from any endemic polio state to cross their border without a valid vaccination certificate.”

Conclusions
With just weeks remaining, the Programme is certain to fail in its main 2010-2012 Strategic Plan target of interrupting polio transmission globally by the end of 2012. The impact of this failure has been mitigated by a final strategic plan phase of high achievement: India and Angola polio-free for over a year; DR Congo close behind; numbers of cases in Afghanistan, Chad and Pakistan down on last year; globally the number of polio cases at their lowest level in history. Only Nigeria has clouded the picture but there are encouraging signs here with strong new policies in place and actions in train. The IMB is heartened that global and country programmes have acted on its guidance set out in five reports.

To all appearances the polio virus is making its last stand, in 0.2% of the world’s land surface.

The uninformed observer might conclude that it had no chance of survival. But those who have targeted the polio viruses for three decades to make it extinct know what a formidable foe it is. It survives for reasons that are well known. The polio virus finds friends amongst missed children, badly managed campaigns, weak data, ill-informed parents, poor political and public health leadership and resistance in adopting best practice.

There is one ingredient, a magic formula for transformation, that is still missing in the affected countries – absolute ownership. Ownership means parents demanding the vaccine, making it their mission to protect their children. Ownership means local leaders grasping the challenge of wiping polio from their area. Ownership means a critical mass in the population believing that their children can, must and will be protected through the eradication of polio. Most of all ownership is about national pride: a country determined to be a vibrant, respected 21st century nation, not one that is looked down on because it remains tainted by a disease that almost everywhere else in the world survives only in the memory of grandparents.

A new strategic plan is being prepared. It needs to be very different to its predecessors. It needs to be built on a foundation of knowledge and understanding about what the remaining barriers to polio eradication are – not just the technical elements, but the ever-important, ever-challenging ‘human factors’ too. It needs to be rigorous in establishing the case for why polio must and can be eradicated, and how this will be achieved. It needs to be deeply compelling, to draw in everybody in the world who can help the Programme to overcome polio’s last stand.

Recommendations
This report makes ten recommendations:

    1. We recommend that the International Health Regulations Expert Review Committee urgently issue a standing recommendation by May 2013 that will introduce pre-travel vaccination or vaccination checks in Afghanistan, Nigeria and Pakistan until national transmission is stopped. No country should allow a citizen from any endemic polio state to cross their border without a valid vaccination certificate.

2. We recommend that within the next fortnight, programme leaders in Afghanistan, Nigeria, Pakistan and Chad discuss their country’s plan and best practice elsewhere to write, with their partners, a list of no more than five priority goals that they will achieve by the end of April 2013, circulate these goals to all programme staff, and maintain the focus and pace necessary to achieve them.

3. We recommend that an analysis be urgently commissioned to examine the relationship

between the frequency and quality of vaccination campaigns, to guide programmatic decisions about the optimum interval between campaigns.

4. We recommend that every endemic country district-level task force (or equivalent) should be constituted to include a parent, representing parents of the district.

5. We recommend that every opportunity be taken to ‘pair’ other health and neighbourhood benefits with the polio vaccine.

6. The IMB requests a report on vaccine supply at each of its future meetings.

7. We recommend that the Programme accelerate planning to set out how the learning from polio eradication can be captured rigorously and comprehensively, overseen and funded with minimal distraction to current work.

8. We recommend that an intensive ‘Polio Watch’ be established in the countries at highest risk of a polio outbreak. We further recommend that the responsible WHO Regional Offices should issue within the next month an action plan for strengthening vaccination coverage and surveillance in these areas.

9. We recommend that India plans for a simulation exercise to test the readiness of its emergency response plans. We recommend that the exercise should begin, on an unannounced date in mid-2013, by selecting a sample of districts at random and carrying out real-time simulation-based scrutiny of their emergency response capability

10. We recommend that a continual live audiovisual feed should be broadcast online from the Nigerian Emergency Operations Centre, with a facility for the world’s polio experts and the IMB to observe and provide input at any time.