GPEI Independent Monitoring Board: Letter to WHO Director-General
26 February 2014
Full text: More
Excerpts [Editor’s bolded text]
“…The current situation in Pakistan is a powder key that could ignite widespread polio transmission. The number of cases in this country is going in the wrong direction…the adequacy of the government’s plans will be in full public view at our May meeting and at the subsequent World Health Assembly…”

“..At our suggestion, the program has identified a Red List of the countries most vulnerable to a polio outbreak. In the IMB’s view, when a country is placed on the Red List, all possible means must be used to get it out of this precarious situation as swiftly as possible. As the ongoing outbreak in the Horn of Africa demonstrates, the program softens its focus on such countries at its peril…We are deeply worried about the present situation in the Ukraine, which was very vulnerable even before the recent civil conflict, and recommend that the country be included in the program’s Red List.

“Since our October meeting, a new outbreak has emerged in Syria. The program has done a commendable job of responding to this outbreak, within the constraints of a major conflict. Protecting children from this scourge should be part of a core humanitarian response. We suggest that when humanitarian emergencies occur in countries where the reintroduction (or export) of poliovirus is possible, the GPEI seek to work with the United Nations – OCHA – as a key partner, and that OCHA be asked to include polio vaccination as a priority of the health clusters under the Humanitarian Reform system…”

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GPEI Update: Polio this week – As of 5 March 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: On 28 February, UNICEF concluded its tender process which makes accessible sufficient quantities of affordable inactivated polio vaccine (IPV) to support country introductions. The vaccine will now be available to GAVI-supported countries for as little as EUR0.75 per dose (approximately US$1 at current exchange rate) in ten-dose vials. The introduction of IPV globally, prior to a phased removal of oral polio vaccines (OPV), is a major element of the comprehensive plan to end all polio disease. More than 120 countries have yet to introduce IPV, more than half of which are eligible for GAVI support. The conclusion of UNICEF’s tender ensures that affordable IPV will be made available, removing a major obstacle to global introduction. More.
:: On 27 February, the world’s leading Islamic scholars, led by the Grand Imam of the Holy Mosque of Mecca, stated that protection against diseases is obligatory and admissible under Islamic Shariah, and that any actions which do not support these preventive measures and cause harm to humanity are un-Islamic. The scholars adopted a strong ‘Jeddah Declaration’ and a focused six-month Plan of Action to address critical challenges facing polio eradication efforts in the few remaining polio-endemic parts of the Islamic world: a ban on vaccinations and lack of access to children in some areas, deadly attacks on health workers, and misconceptions by communities about mass vaccination campaigns. More.
:: The Independent Monitoring Board (IMB) issued its letter to the heads of the GPEI partner agencies, following the group’s additional meeting two weeks ago, and ahead of the group’s next regularly meeting on 6-7 May. The IMB reviewed the current global epidemiology, and expressed concern by the persistent shortfall in funds, seemingly due to significant delays in some donors following through on their pledges. More.
:: In Nigeria, the first wild poliovirus type 1 (WPV1) case of 2014 has been reported, from Kano state. It is the first WPV1 case in the country since December. Since September 2013, seven WPV1 cases have been reported, five from Kano. Together with Borno (the location of the last previous case from December), Kano state holds the key to a polio-free Nigeria.

Nigeria
:: One new WPV1 case was reported in the past week, the first in 2014. The case had onset of paralysis on 1 February, from Gaya Local Government Area (LGA), Kano. The total number of WPV cases for 2013 remains 53 (all WPV1).
:: A full case investigation of this latest WPV1 case has been launched. Technical support to Gaya LGA and surrounding areas was maximised for this week’s national Immunization Plus Days (IPDs – 1-4 March, with bivalent OPV), to ensure high-quality implementation, supervision and monitoring.
:: The IMB underscored that stopping polio transmission in 2014 is potentially feasible, though far from certain. The group welcomed the country’s determination to succeed this year, but warned Nigeria needed continuity and unwavering commitment particularly in the face of election-related distraction. The IMB underscored that the governors of Kano and Borno are vital figures in global polio eradication, and should be strongly supported and encouraged to apply their unique influence at this critical time.

Pakistan
:: Three new WPV1 cases were reported in the past week, all from Federally Administered Tribal Areas (FATA – two from North Waziristan and one from FR Bannu). The total number of cases for 2014 is now 24. The total number of cases for 2013 remains 93..
:: The IMB expressed particular concern at the polio situation in Pakistan, concluding that the country risked being the last place on earth in which polio exists, if current trend continues. While commending some new initiatives, the IMB cautioned that authorities needed to fully grasp the fundamental seriousness of the situation.
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild and cVDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunizations resumed in North Waziristan.
However, at the same time, concerning trends have been noted in greater Karachi, Sindh and in Quetta, Balochistan. Environmental positives isolates from every major city of Punjab confirm widespread virus circulation

Horn of Africa
:: One new WPV1 case was reported from Somalia in the past week, with onset of paralysis on 8 August 2013 from Middle Shabelle. The case was reported late due to laboratory processing backlog.

Middle East
:: One new WPV1 case was reported in the past week (onset of paralysis on 1 October 2013 from Deir Al Zour). The total number of laboratory-confirmed WPV1 cases is 25. The most recent case had onset of paralysis on 17 December and was reported from Mara, Edleb governorate.
:: Additionally, there are 13 cases confirmed from contested areas but not yet reflected in official figures.
:: In the Middle East, a comprehensive outbreak response continues to be implemented across the region. The most recent SIAs in Syria were held in early January and early February. Initial reporting indicates that over three million children were reached during both SIAs, with OPV reaching most if not all districts, and coverage attaining more than 85% in all but three governorates.

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Cross border movements threaten Afghan polio eradication efforts – IRIN

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Polio-free certification: WHO South-East Asia

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7th Meeting of the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) – New Delhi, India, 27 March 2014
The WHO South-East Asia Region has been maintaining its polio-free status for the last 3 years. After the last wild polio case was reported from India on 13 January 2011, the Region is firmly on track for polio-free certification in March 2014.
In order to ensure all the requirements for certification of polio eradication are met by the Member States, a review of the annual updates of respective national documentation including phase-1 wild poliovirus laboratory containment will be conducted during the 7th meeting of the SEA-RCCPE. This review will take place in the WHO Regional Office in New Delhi, India on 27 March 2014….
http://www.searo.who.int/entity/immunization/topics/polio/eradication/sea-polio-free/en/

MSF responds to inactivated polio vaccine price announcement
http://www.msfaccess.org/content/msf-responds-inactivated-polio-vaccine-price-announcement