POLIO [to 21 November 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week as of 11 November 2015
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Three years since no wild poliovirus type 3: the 10th of November is an opportunity to mark three years with no child paralysed by wild poliovirus type 3 (WPV3); a reminder of the role of surveillance in ensuring the world is polio free, and of innovations in driving the programme forward. For more, please click here.

:: Following its meeting in October, the Independent Monitoring Board (IMB) published its latest report evaluating the current status of polio eradication. The report is available here.

:: This week, the Emergency Committee of the International Health Regulations (IHR) is meeting by teleconference, to determine whether the current epidemiology continues to represent a public health emergency of international concern, and whether to maintain the temporary recommendations associated with it for a further three months. The Committee’s report is expected to be published by early next week.

:: The Global Commission for the Certification of Poliomyelitis Eradication (GCC) published an editorial in Science magazine, on the importance of ensuring global containment of type 2 polioviruses, following the group’s declaration in September that wild poliovirus type 2 has been globally eradicated. The containment of type 2 polioviruses is particularly critical, in the lead-up to the switch from trivalent OPV to bivalent OPV in April 2016. The editorial is available here.

[Selected elements from Country-level reports]
Afghanistan
:: Urgent efforts are underway to strengthen the implementation of the national emergency action plan in the country. Focus is on:
– Improving governance and coordination of partners through the National and Provincial Emergency Operations Centres
– Improving SIA quality by focusing resources on low-performing districts, and clearly identifying and targeting persistently missed children
– Maximising the impact of front-line health workers through more systematic vaccinator selection, training and supervision
– Ensuring closer cross-border coordination in border areas with Pakistan
– Further strengthening surveillance, including by expanding environmental surveillance activities
:: National Immunization Days (NIDs) took place on 1 – 3 November using trivalent oral polio vaccine (OPV). Mop up campaigns are planned in areas of Farah using inactivated polio vaccine (IPV) and bivalent OPV with dates to be confirmed, and Subnational Immunisation Days (SNIDs) are planned from 29 November to 1 December in the south and east of the country using bivalent OPV.
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 21 October. It is the most recent WPV1 case in the country, from Khyber in Federally Administered Tribal Areas (FATA). The total number of WPV1 cases for 2015 is 39.
September and October have historically been the months with the highest disease burden, as it is in the middle of the high transmission season. Epidemiologists are further evaluating data from this year, to more clearly ascertain current transmission patterns during this year’s high transmission season. This year, five WPV1 cases occurred during September and October, compared to 79 WPV1 cases in September/October 2014.
Lao People’s Democratic Republic
:: One new case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was reported in the past week, in Bolikhanh district of Borkihamxay province, with onset of paralysis on 29 September. The total number of cVDPV1 cases in 2015 is three.
:: Emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces. The first Subnational Immunization Days (SNIDs) using trivalent oral polio vaccine (OPV) is underway targeting an expanded age group of children under the age of fifteen in the three most high risk districts, and children under the age of ten elsewhere.
:: All three cases come from the same village. Efforts are underway to further strengthen surveillance activities in other parts of the country, to determine if other sources of transmission are occurring elsewhere in the country.
:: In neighbouring countries, notably Thailand and Vietnam, both surveillance and immunization activities have been stepped up, particularly in border areas.

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NOW IS THE TIME FOR PEAK PERFORMANCE
Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative
Twelfth Report, October 2015 :: 32 pages
OVERVIEW
1.. The number of cases of polio that have occurred so far in 2015 is at its lowest point in history.

2. Since the last report of the Independent Monitoring Board (IMB), Nigeria has been removed from the list of polio endemic countries. Only two now remain: Pakistan and Afghanistan. No Wild Polio Virus (WPV) Type 3 has been reported anywhere in the world since November 2012, no WPV2 has arisen since 1999, and no WPV1 has been found in Africa since August 2014 in Somalia. These are major achievements.

3. The Global Polio Eradication Initiative (GPEI) has implemented changes to its structure and functioning following the management and governance review that reported in 2014. Decision-making, partnership working, overall leadership, financial transparency, and the cohesiveness of the programme have steadily improved since then but the level of coordination across partners
necessary to assure high within-country performance remains problematic.

4. The Polio Oversight Board (POB), at its meeting at the end of September 2015, after reviewing four end-of-transmission scenarios, concluded that the most likely outcome of the eradication programme is that polio transmission will be interrupted in 2016, and eradication
officially certified by 2019. This was given the status of a formal voting decision by the Board. This scenario has been costed by the Board’s Finance and Accountability Committee and requires $1.5 billion of funding on top of the budget already earmarked for eradication.

5. Should polio transmission not be interrupted by 2016, a further at least $800 million per year would be needed to deal with the consequences. This figure could easily be $1 billion per year.

KEY STEPS
6. The Polio Oversight Board’s decision to pick 2016 as the year in which transmission will be stopped is not merely a planning assumption. In effect, it sets a new deadline to follow the sequence of earlier missed deadlines that were set in the polio programme’s periodic strategic plans.

7. To create a realistic chance for this new timescale to be achieved, the following five measures are the minimum required:
:: High quality campaigns during the low season (the last before the deadline) in both Pakistan and Afghanistan;
:: Greatly strengthened resilience in areas of inaccessibility, and poor coverage, in Nigeria;
:: Massive cuts in the number of missed, and persistently missed, children in both endemic countries, Nigeria, and all other areas that are vulnerable because of low immunity levels;
:: Rigorous application, and careful targeting, of combined IPV/OPV in a more consistent way than hitherto in Pakistan and Afghanistan;
:: Major and rapid expansion of environmental surveillance throughout Pakistan and Afghanistan coupled with rigorous outbreak response action when positive samples are found.

8. The programme must be in no doubt that if it comes out of the forthcoming low season in Afghanistan and Pakistan with polio cases still occurring or with many positive environmental samples, then there will surely be further outbreaks of the polio virus.