Polio [to 7 June 2014]
Independent Monitoring Board of the Global Polio Eradication Initiative: Ninth Report
May 2014 52 pages
Excerpts from Executive Summary; Editor’s bolded text
Eighteen months ago, as 2012 drew to a close, optimism was running high for the Global Polio Eradication Initiative. Polio transmission in India had been interrupted. The three remaining endemic countries (Pakistan, Nigeria, Afghanistan) had made significant programmatic improvements. Some believed that success was imminent; that polio would soon be history.
Within a matter of months, this optimism quickly unwound:
::Targeted killing of polio vaccinators in Pakistan shocked the world and created major operational constraints.
:: Polio virus entered Waziristan, a part of Pakistan in which polio vaccination had been – and remains – banned by Taliban commanders.
:: The national structure for managing polio eradication in Pakistan was dismantled at a time when it needed to be strengthened.
:: Nigeria’s security situation deteriorated. Here too, vaccinators tragically lost their lives and the program’s operations were severely impaired.
:: Nigeria polio virus was exported to southern Somalia, where it infected a population unprotected against polio because of an al-Shabab ban on vaccination that remains in place.
:: Pakistan polio virus spread to Syria, causing a major outbreak amidst the country’s civil war.
:: Pakistan polio virus spread also to Israel, West Bank and Gaza, and Iraq, and Nigeria polio virus to Cameroon and Equatorial Guinea – each outbreak over-stretching the global program’s resources and credibility.
In 2012, there were 223 polio cases in five countries. In 2013, there were 407 cases in eight countries…
…In 1988 (26 years ago now) every country in the world resolved to eradicate polio. Most managed to do so by the year 2000. For the last 14 years, we have been witnessing the excruciatingly long tail of completing global eradication. The “last 1%”, a phrase that only three years ago was an inspiring rallying call to finish the job, is becoming an open goal for eye-rolling cynics. Every additional polio year costs lives and money, saps morale, puts future donations at risk and holds the public health world back from making further health gains. The goal of stopping global polio transmission has been serially missed. The deadline year of 2000 came and went; so did 2004; and so too did 2012.
As the end-2014 deadline fast approaches, Nigeria and Pakistan are both at risk of failing to stop transmission in time (with Pakistan’s risk extreme). There is a significant risk of one or more of the current outbreaks becoming prolonged. There is serious risk of failure to anticipate and prevent an outbreak elsewhere. Given these factors, the IMB’s considered analysis is that the latest strategic plan goal of interrupting transmission by the end of 2014 stands at extreme risk.
The World Health Assembly has rightly declared polio eradication a programmatic emergency for global public health. WHO has rightly called the spread of polio a public health emergency of international concern. There is every reason why polio must be eradicated – and fast. Failure to do so is inexcusable. This last 1% cannot be allowed to drag on any longer. The program is failing children and families in the poorest parts of the world. These broken promises mean that every child paralysed in 2015 will be a child grossly let down, their paralysis an avoidable catastrophe.
All eyes must now be focused on minimising the number of such avoidable catastrophes – on ensuring that Nigeria succeeds in 2014; on Pakistan rebuilding a program that can succeed soon after; and on preventing and responding to outbreaks with consistency and vigour.
The IMB makes 11 recommendations:
1. We recommend the establishment of an Emergency Operations Center (EOC) in Pakistan, which builds upon Pakistan’s recent experiences in responding to natural disasters and other countries’ experiences in emergency polio response. Top-level civil servants, senior representatives of national, regional and local government, religious leaders as well as military leaders should be a key part of this process. We urge that this new body be fully operational by 1 July 2014.
2. We recommend that the heads of the Global Polio Eradication Initiative core partner agencies meet urgently with the President and Prime Minister of Pakistan to support their essential leadership of the Pakistan polio eradication program, and to offer every possible assistance in establishing the new EOC as a strong national body with the power, resources and capacity to drive transformative action.
3. We recommend that the President of Nigeria galvanizes action to gain the pledge of all national, state and local candidates in the forthcoming election, together with traditional and religious leaders, to protect the polio eradication program from disruption and politicization, returning it to its humanitarian role in saving the lives of Nigerian children.
4. We recommend that the Polio Oversight Board ensures that the promised Central Africa outbreak coordinator is installed by 1 July 2014, resourced appropriately, and that the Board formally investigates why the program’s response in Central Africa has been much weaker than in the Horn of Africa or in the Middle East.
5. We recommend that a new, dedicated team be established at global level to focus on outbreak response, its first job being to substantially strengthen the outbreak response Standard Operating Procedures to ensure that future responses will be consistently excellent.
6. We recommend that a dedicated team be established at global level to rapidly improve the program’s approach to outbreak prevention in the Red List countries and beyond. Scenarios and exercises should form a key part of its activities.
7. We recommend that the core partners meet in person to agree upon a way to address the three improvement aims for securing communities’ greater trust, based on the analysis of social mobilisation in our report.
8. We recommend that WHO relax its grip on the training of vaccinators and their supervisors, allowing UNICEF, CDC and other partners to contribute, particularly to enhance the interpersonal communication skills of vaccinators
9. We recommend that Pakistan and Nigeria take urgent steps to license additional oral polio vaccines so that they can be used within the next six months, in order to create greater flexibility in global vaccine supply.
10. We recommend that current concerns and unease about the transparency and communication of the polio eradication budget are properly and openly addressed. This might best be achieved by a frank discussion at the Polio Oversight Board.
11. We recommend, in relation to the management review that is underway, that the Polio Oversight Board appoints an advisory panel of four seasoned executives and management experts, who have experience of running or advising some of the most complex enterprises in the world, to help shape the management consultants’ analysis and recommendations before they are finalized for the Polio Oversight Board.
GPEI Update: Polio this week – As of 4 June 2014
Global Polio Eradication Initiative
Editor’s Excerpt – Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: The Independent Monitoring Board (IMB) has released its ninth quarterly report assessing progress toward polio eradication, including recommendations to overcome challenges. The board noted the progress in Nigeria and Afghanistan, and expressed alarm about the situation in Pakistan, highlighting the high likelihood that transmission of virus will continue into 2015. While the IMB commended the outbreak responses in the Middle East and the Horn of Africa, it also expressed concern about the activities in Central Africa, and recommended stronger global capacity and processes for outbreak response. The full report is available here [see excerpt above]
:: The GPEI mourns the passing of Dr. Ciro de Quadros, a member of the IMB and a true hero in the effort to protect all children from vaccine-preventable diseases.
:: Speaking at Rotary International’s Annual Convention in Sydney on 1 June, Australian Prime Minister Tony Abbott announced his government’s AUD$100 million commitment for polio eradication. Read more here.
:: Four new WPV1 cases were reported in the past week including two cases from North Waziristan, Federally Administered Tribal Areas – FATA, one case from Bannu, Khyber Pakhtunkhwa – KP, and one case from the previously uninfected district of Karachi (District of Sindh Industrial and Trading Estate), Sindh. The most recent WPV1 case had onset of paralysis on 15 May from North Waziristan. The total number of WPV1 cases reported from Pakistan for 2014 is 71.
Horn of Africa
:: A case of polio due to wild poliovirus type 1 (WPV1) was reported last week from Jariban district in Mudug province, Somalia, with onset of paralysis on 11 May. This is the second case of polio in the Horn of Africa this year. The other case was reported from Ethiopia with onset of paralysis on 5 January.