WHO: Poliomyelitis – intensification of the global eradication initiative

WHO: Poliomyelitis – intensification of the global eradication initiative
Report by the Secretariat
67th World Health Assembly
A67/38 – Provisional agenda item 16.4
21 March 2014
Editor’s selected segments and bolding; full text here
…5. Insecurity, targeted attacks on health workers and/or a ban by local authorities on polio immunization resulted in a deterioration in access in the Federally Administered Tribal Areas and Khyber Pakhtunkhwa province of Pakistan and the state of Borno in Nigeria. Chronically poor implementation of activities remained a critical challenge in other priority areas, most notably in the state of Kano, Nigeria, and Balochistan province and the city of Karachi in Sindh province, Pakistan. In poliovirus-affected areas of Pakistan and Nigeria an estimated combined total of 530 000 children remained inaccessible for vaccination; in the reinfected area of south-central Somalia more than 500 000 children were inaccessible for polio vaccination.1
6. The risk of further international spread remains high, particularly in central Africa (especially from Cameroon), the Middle East and the Horn of Africa. Consequently, the Regional Committee of the Eastern Mediterranean Region at its sixtieth session in October 2013 declared polio transmission an emergency for all Member States of the Region.2 Following the deliberations of the Executive Board at its 134th session, the Director-General convened the Polio Working Group of the Strategic Advisory Group of Experts on immunization (Geneva, 5–6 February 2014) to update WHO’s vaccination recommendations for travellers from polio-infected countries. The convening of an Emergency Committee under the International Health Regulations (2005) is planned in advance of the Sixty-seventh World Health Assembly in order to advise the Director-General on measures to limit the international spread of wild poliovirus…
…9. The Strategic Advisory Group of Experts on immunization finalized its policy recommendations for the administration of inactivated poliovirus vaccine in routine immunization schedules, and endorsed the strategy that was developed for the financing, supply and introduction of inactivated poliovirus vaccine globally.1 The strategy prioritizes the 126 countries that currently use only oral polio vaccine into four tiers, on the basis of the risk of the emergence and spread of circulating vaccine-derived poliovirus type 2; 72% of the strategy’s target population is concentrated in the 33 countries of tiers 1 and 2. The strategy combines funding through the GAVI Alliance and expedited processes for the 73 countries eligible for its support with volume purchasing and UNICEF-assisted procurement for other countries in order to obtain the lowest possible prices for inactivated poliovirus vaccine. In February 2014, UNICEF announced a procurement price of €0.75 per dose (about US$ 1 per dose at current exchange rates) of inactivated poliovirus vaccine in 10-dose vials for GAVI-eligible countries and a price of €1.49–2.40 (about US$ 2.04–3.28 at current exchange rates) per dose for middle-income countries. In addition, UNICEF has awarded volumes for five-dose vials at the price of US$ 1.90 per dose for both low- and middle-income countries, expected to be available from the fourth quarter of 2014. Work continues to develop and license new products and approaches for inactivated poliovirus vaccine, which may contribute to further reductions in the cost of inactivated poliovirus vaccine for the medium-term (that is to say beyond 2018)…
… 11. As of 28 February 2014, the South-East Asia Region was on track for certification of polio eradication at end-March 2014. The Global Commission for the Certification of the Eradication of Poliomyelitis will review data from all six WHO regions in late 2014 or early 2015 to determine whether there is sufficient evidence to conclude formally that wild poliovirus type 2 has been eradicated globally…
…13. An independent study was conducted on the 22,000 people who are deployed by the Global Polio Eradication Initiative, including the more than 7000 contracted by WHO.1 Senior representatives of national governments, donor agencies and other health initiatives most frequently cited the surveillance (86%), laboratory (50%) and social mobilization (46%) functions performed by this workforce as of potential value for transition to other health initiatives. Two thirds of respondents stated that the future administration of this human resources infrastructure should be the responsibility of national governments…
15. In April 2013, donors and governments of polio-affected countries pledged US$ 4040 million towards the US$ 5530 million budget of the Endgame Plan at the Global Vaccine Summit (Abu Dhabi, 24 and 25 April 2013). A further US$ 490 million has been pledged since then. In order to operationalize these pledges and mobilize additional funding for the remaining US$ 1000 million gap, WHO and its Global Polio Eradication Initiative partners have enhanced their resource mobilization and strategic communications capacities and refocused their cross-agency polio advocacy group on intensified resource mobilization. A cross-agency finance working group ensures stronger cost control, accountability and resource management.
16. At the end of November 2013, aggregated requests for financing of eradication activities in 2014 exceeded the budget of US$ 1033 million by US$ 286 million. Reconciling these requests with available financing required a substantial rescheduling of supplementary immunization activities in many countries and allocation of part of the programme’s limited discretionary funds for inactivated poliovirus vaccine introduction. As at 23 January 2014, the cash gap for eradication activities planned for 2014 was still US$ 497.52 million, against the 2014 budget of US$ 1033 million, requiring intensified efforts to operationalize financing pledges.
17. The major risks to eradication are: the bans on immunization campaigns in the North Waziristan agency in Pakistan and parts of southern and central Somalia; the continued targeting of vaccinators in Khyber Pakhtunkhwa province and Karachi in Pakistan; ongoing military operations in Khyber Agency (within the Federally Administered Tribal Areas) of Pakistan; insecurity in Eastern Region, Afghanistan, and Borno state, Nigeria; active conflict in the Syrian Arab Republic; and gaps in programme performance in Kano state, Nigeria, and in the outbreak response performance in Cameroon. These risks are compounded by gaps in polio surveillance and the continued threat of new international spread of wild poliovirus.
18. Management of these risks requires full national ownership of the eradication programme in all infected countries, with deep engagement of all relevant line ministries and departments, and the holding of local authorities fully accountable for the quality of activities, particularly in accessible areas such as Kano state, Nigeria, and in Cameroon. Accessing and vaccinating children in insecure and conflict-affected areas will in addition require the full engagement of relevant international bodies, religious leaders and humanitarian actors to implement area-specific plans, generate greater community demand and participation, and adapt eradication approaches in line with local contexts. In order to minimize the risks and consequences of international spread of poliovirus, Member States are urged to enhance surveillance and immunization activities and implement fully recommendations for immunization of travellers…