POLIO [to 23 May 2015] IMB Eleventh Report: May 2015

POLIO [to 23 May 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 20 May 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Ministers of Health from around the world are meeting in Geneva, Switzerland, this week for the annual World Health Assembly. The Ministers will discuss a number of topics related to public health, including polio eradication. The Global Polio Eradication Initiative has prepared a status report for delegates. The report and an accompanying resolution are expected to inform the discussions.
:: The 11th report of the Independent Monitoring Board has been published this week, reporting on progress towards polio eradication and making recommendations.
:: Polio staff continue to offer support to the humanitarian response to the devastating earth quakes in Nepal. Read more
:: Liberia and Sierra Leone have both conducted polio and measles vaccination campaigns during April and May. These are the first campaigns conducted in these countries since 2013 (due to the Ebola outbreak). Polio staff in these countries continue to assist in the Ebola outbreak response efforts
Selected excerpts from Country-specific Reports [No new polio cases reported]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported this week, with onset of paralysis in Charsada district of Khyber Pakhtunkhwa. This most recent case had onset of paralysis on 20 April. The total number of WPV1 cases for 2015 is now 23 (and remains 306 for 2014).

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The Rocky Road to Zero
The Independent Monitoring Board of the Global Polio Eradication Initiative
Eleventh Report: May 2015 :: 24 pages
Pdf of Report: 11th report of the Independent Monitoring Board
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…CONCLUSIONS AND RECOMMENDATIONS
Over recent years, the IMB has witnessed the polio programme improving its system, and improving performance as a result. But further fundamental work of system redesign remains to be done.

The IMB emphasizes that recent gains should be applauded, but should not be a source of triumphalism. There will be some temptation to coast; to think that it is now just a matter of time. The rocky road to eradication does not allow for coasting.

The IMB has made a series of recommendations intended to catalyse the further changes that are required. No crystal ball can now tell when polio will be eradicated. No crystal ball is required to know that polio will not be eradicated until the system is perfectly designed to so.

Speed in improving the system is key. Without the discipline of fast implementation, the polio virus will still be circulating more than a year from now – in short, the programme will have granted the polio virus permission to keep on paralyzing children for more than another whole year after the last failed deadline of ending transmission. It will be the polio virus celebrating, not the programme.

AFGHANISTAN
1.The IMB recommends that Afghanistan’s Minister of Health appoints a very senior official with the skills and credibility to lead the programme day-to-day on the Minister’s behalf.

2.The IMB recommends that programme officials from the Southern and Eastern regions of Afghanistan visit the Emergency Operations Centres of Pakistan at once, and return with lessons that can be appropriately applied in Afghanistan with urgency.

NIGERIA
3.The IMB recommends that the new President of Nigeria makes a clear public declaration that polio cannot yet be considered gone from Nigeria, and sets out and leads a plan to achieve polio-free certification in 2017.

PAKISTAN
4.The IMB recommends that Pakistan’s National Task Force meets at least monthly until polio transmission is stopped, to oversee strict implementation of the National Emergency Action Plan. The National Task Force should particularly ensure that a monthly meeting of each Chief Secretary with their Deputy Commissioners goes ahead without exception, and with full attendance, to tightly oversee implementation of the National Emergency Action Plan in each province.

5.The IMB recommends that Pakistan’s National Task Force, within the next four weeks, resolves the issues that are resulting in front-line workers not being properly paid, to stall any further deterioration in morale amongst this crucial group, which could be fatal to the programme.

OUTBREAKS
6.The IMB recommends that the Polio Oversight Board explicitly re-affirm that the programme’s planning – in and beyond the endemic countries – should be based on what is needed to achieve eradication, not limited by what funds are available, and that more funding should be sought in the event of a shortfall. The IMB further recommends that the Polio Partners Group formally endorse this approach, and actively seek to mobilise further funds that may be required. The work of the Financial Accountability Committee is critical in ensuring that finances are well-managed, and that donors have the appropriate information and assurances.

THE NEED TO HARNESS THE POWER OF PEOPLE
7.The IMB recommends that the GPEI partner agencies convene an urgent meeting to i) leave no stone unturned in urgently recruiting more top-notch staff into the polio-infected and highest-risk countries, cutting through red-tape as needed to achieve this, ii) explicitly analyse whether the best people are currently in the places where they are needed the most.

SURVEILLANCE FIT FOR THE PRESENT AND FUTURE
8.The IMB recommends that the program should expedite activity to improve surveillance, aiming to reach global-certification standard by the end of 2015. Any uncertainty about what global-certification standard now constitutes (particularly the role of environmental surveillance) should be clarified with input from the Global Certification Commission.

SIMPLE DROPS OF VACCINE
9.The IMB recommends that in the endemic and priority countries, vaccine wastage be urgently reduced to 15% as an absolute maximum in every subnational area, starting by full implementation of the programme’s standard operating procedure for reporting on vaccine utilization and stock balance.

VACCINE-DERIVED POLIO VIRUS: A POTENTIAL SHOW-STOPPER
10.The IMB recommends that the Prime Minister of Pakistan and the President of Nigeria each receive a monthly briefing on stopping circulating vaccine-derived polio virus in their countries, to ensure that neither country stands in the way of the planned global withdrawal of trivalent oral polio vaccine.

PERSISTENTLY MISSED CHILDREN
11.The IMB recommends that an urgent global polio summit is convened on the subject of the persistently missed child, charged with the task of producing a plan that will cut the number of such children by 50% within six months.

PERFORMANCE: MOVING FROM THE ORDINARY TO THE EXTRAORDINARY
12.The IMB recommends that the GPEI makes funds immediately available to appoint a company with an established track record in process redesign and quality improvement. This company should deploy staff to work in each of the Emergency Operations Centres and at global programme management level. The IMB asks that this recommendation is implemented urgently with the company selected by 1st July 2015, teams in place by 1st August 2015 and initial improvement results posted by the time of the IMB’s next meeting, in October 2015.