Milestones :: Perspectives

Milestones :: Perspectives

Editor’s Note
We lead this week’s edition with developments around polio, including major commitments of new financial resources for eradication, and updates on type 2 (cVDPV2) outbreaks in Syria and DRC.

Global Leaders Unite to Bring Polio One Step Closer to Eradication
Countries and partners pledge US$ 1.2 billion to protect 450 million children from polio every year
ATLANTA (12 June 2017) – Today, global health leaders gathered at the Rotary Convention in Atlanta to reaffirm their commitment to eradicating polio and pledge US$ 1.2 billion to finance efforts to end the disease.

Thirty years ago, polio paralyzed more than 350,000 children each year in more than 125 countries around the world. Thanks to the extraordinary efforts of governments, health workers, donors and the partners of the Global Polio Eradication Initiative (GPEI), a public-private partnership dedicated to ending the disease, the highly contagious virus has now been eliminated in all but three countries: Afghanistan, Nigeria and Pakistan. There have been only five cases to date in 2017.

However, children remain at risk everywhere until polio is completely stopped. To end the disease for good, government representatives and partners came together to renew their commitment to supporting crucial activities such as vaccination and disease monitoring, which will protect more than 450 million children from polio each year.

“Thanks to the incredible efforts of Rotarians, governments, health workers, partners and donors – including those who have gathered at the Rotary Convention in Atlanta – we are closer than ever to making history,” said Chris Elias, Global Development President, Bill & Melinda Gates Foundation and Chair of the GPEI Polio Oversight Board. “These new commitments will help ensure that we will finish the job.”

In a time of many global challenges and priorities, governments and partners have stepped forward to demonstrate their collective resolve to seeing the second human disease ever eradicated. Major pledges include: US$ 75 million from Canada, US$ 61.4 million from the European Commission, US$ 55 million from Japan, US$ 30 million from Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, United Arab Emirates, US$ 30 million from the Dalio Foundation, US$ 25 million from Bloomberg Philanthropies, US$ 15 million from an anonymous donor, US$ 13.4 million from Australia, US$ 11.2 million from Germany, US$ 5 million from easyJet, US$ 5 million from Italy and US$ 4 million from the Republic of Korea.

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, and John Germ, president of Rotary International, also announced an extension of their partnership in front of more than 20,000 Rotarians. Up to US$ 150 million in funds raised by Rotary members over the next three years will be matched 2:1 by the Gates Foundation, resulting in up to US$ 450 million in the next three years for the GPEI. The Gates Foundation pledged a total of US$ 450 million, including this matching agreement.

“The global eradication of polio has been Rotary’s top priority since 1985. Rotary members have been the driving force behind the fight to end polio since its inception,” said John Germ, President of Rotary International. “Their continued commitment to raising funds for eradication – coupled with today’s match by the Bill & Melinda Gates Foundation – makes that impact even greater.”

Today’s funding helps address a US$1.5 billion funding need that will help ensure that the virus is eliminated from these remaining countries and prevented from regaining a foothold anywhere else in the world.

“Constant innovation has been key to improving vaccination coverage and reaching more children with the polio vaccine,” said Dr. Anne Schuchat, Acting Director of the U.S. Centers for Disease Control and Prevention. “The unrelenting commitment and support of these global leaders will help us do just that—and ultimately end this disease for everyone and forever. CDC remains deeply committed to polio eradication and has contributed US$ 2.28 billion since the beginning of the initiative.”

Today’s funding commitments will enable the program to continue to improve performance and overcome challenges to reach every child, including vaccinating children in conflict areas…

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Gavi to help protect millions more children against polio
Gavi Board agrees to extend support for inactivated polio vaccine (IPV) to 2020; new policy on fragile settings, emergencies and refugees also approved

Geneva, 15 June 2017 – Support for the introduction of inactivated polio vaccine (IPV) will be extended to 2020 in up to 70 low- and middle-income countries, Gavi, the Vaccine Alliance announced today. The Gavi Board decision will enable routine immunisation programmes to reach millions more children with this critical vaccine and support the final drive towards eradication.

“We now have a unique opportunity to consign polio to the history books, but we cannot afford to be complacent,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board. “We cannot and will not rest as long as any child anywhere in the world is at risk of contracting this terrible disease. Gavi fully supports the Global Polio Eradication Initiative and partners, and this decision means we will continue to work together as we edge ever closer to a polio-free world.”

As transmission of wild poliovirus has not yet been stopped, the target date for global certification of eradication has had to be pushed back by at least two years – from 2018 to 2020 at the earliest. Polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan. Five wild poliovirus cases have been recorded since the beginning of the year: three in Afghanistan and two in Pakistan.

Moreover vaccine supply constraints have delayed introductions or interrupted IPV use in some Gavi-supported countries. To date 53 countries have introduced IPV to their immunisation programme with Gavi support. Until all poliovirus cases are fully eradicated and contained all countries are at risk, especially those with weak vaccine coverage levels.

The cost of extending support to 2020 is projected to be up to US$ 250 million which will be financed by additional funding raised by the Global Polio Eradication Initiative (GPEI) and by existing funds from Norway, the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID). The Gavi Board decision should provide reassurance to countries and manufacturers of Gavi’s continued support for IPV and polio eradication.

“We will need to evaluate Gavi support to IPV beyond 2020 to make sure that the disease doesn’t re-emerge after global certification,” said Dr Seth Berkley, CEO of Gavi the Vaccine Alliance. “The vaccine will have to be assessed differently from other vaccines based on its value to the global public good. Polio eradication will rank as one of the greatest achievements in the history of global health, reflecting the combined efforts of funders and of hundreds of thousands of scientists, health workers and ordinary vaccinators over three decades.”

Ensuring continued high immunisation coverage of children in the poorest countries is critical to protect children everywhere from the spread of infectious diseases.

New policy on Fragility, Emergencies and Refugees
Gavi operates in many of the most fragile settings where health needs are often the greatest. These circumstances require a different approach to ensure children get the vaccines they need. The Gavi Board approved a new policy on Fragility, Emergencies and Refugees to enable a rapid and tailored response in these settings.

“As climate change, conflict and economic crises continue to drive people from their homes and devastate health systems, we must make sure that the weakest and most vulnerable are not excluded from receiving life-saving vaccines,” added Dr Berkley. “Good health is a fundamental human right. It is unacceptable that hundreds of thousands of child refugees or children trapped in war-torn countries are excluded from receiving basic health services, including vaccines.”

Gavi-supported host countries will for instance be able to request additional support to immunise refugees. In the case of emergencies, countries can request flexibility in the vaccine application process or while implementing Health System Strengthening (HSS) support. Where needed, the new policy enables Gavi to work more directly with partners and non-state actors including civil society organisations (CSO) operating in affected areas.

Lastly, the Board decided that, due to the on-going conflict, Yemen will continue to receive Gavi support in spite of co-financing challenges that the country is facing.
 
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POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 14 June 2017 [GPEI]
:: Global health leaders are meeting this week at the Rotary International Convention in Atlanta, USA, and reaffirmed their commitment to eradicating polio by pledging US$1.2 billion to end the disease.  [See above]

:: Addressing Rotarians from around the world, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, said:  “People often ask me how I know the world is getting better. I usually point to numbers like this one: Because of efforts to eradicate polio by groups like Rotary International, more than 16 million people are walking today who would otherwise have been paralyzed.  That’s more than 16 million people who can walk to school. More than 16 million people who are better able to start a business or carry their child to bed. More than 16 million people who are living better lives, because a group of health care workers, volunteers, government leaders, and funders devoted themselves to fighting polio. Polio eradication is a testament to the compassion, generosity, and kindness of more than a million Rotarians around the world. You are the people who are making it possible to get to zero. And that will be something worth celebrating. Thank you.”  More.

:: Newly-elected WHO Director-General Elect Dr Tedros Adhanom Ghebreyesus addressed the assembled Rotarians:  “Today I speak to you as the Director-General Elect of the World Health Organization and as a Paul Harris Fellow with Rotary International. In both roles, the eradication of polio is close to my heart.  Together we have achieved something phenomenal.  Thanks to all of you, generations of children have grown up without ever experiencing polio.   The end of polio is now in sight, but this is the most critical moment of covering the last mile. We must keep our eyes firmly on the final goal.  Thank you for your commitment.  Together, we will continue to make a difference”.

:: Summary of newly-reported viruses this week: Afghanistan – one new wild poliovirus type 1 (WPV1) was isolated from a healthy household contact of an acute flaccid paralysis (AFP) case.

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WHO: Disease Outbreak News [DONs]
Circulating vaccine-derived poliovirus type 2 – Syrian Arab Republic
Disease outbreak news
13 June 2017
A circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in the Deir Al Zour Governorate of the Syrian Arab Republic. There is evidence of genetic linkage among three isolates of type-2 vaccine-derived polioviruses (VDPV2) isolated in the stool specimens of two acute flaccid paralysis (AFP) cases with dates of onset of paralysis on 5 March and 6 May 2017, and the contact specimen of an AFP case collected on 17 April 2017. Al Mayadeen was also the epi-centre of the wild poliovirus type 1 (WPV1) outbreak in Syrian Arab Republic in 2013. Aggressive multi-country polio outbreak response effectively controlled the WPV1 outbreak and no WPV1 case has been reported in Syrian Arab Republic since 21 January 2014…

Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo
Disease outbreak news
13 June 2017
In the Democratic Republic of the Congo (DRC), two separate circulating vaccine-derived poliovirus type 2s (cVDPV2s) have been confirmed. The first cVDPV2 strain has been isolated from two acute flaccid paralysis (AFP) cases from two districts in Haut-Lomami province, with onset of paralysis on 20 February and 8 March 2017. The second cVDPV2 strain has been isolated from Maniema province, from two AFP cases (with onset of paralysis on 18 April and 8 May 2017) and a healthy contact in the community.
Public health response
The Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative (GPEI), has completed a risk assessment, including evaluating population immunity and the risk of further spread.
Outbreak response plans are currently being finalized, consisting of strengthening surveillance, including active case searching for additional cases of AFP, and supplementary immunization activities (SIAs) with monovalent oral polio vaccine type 2 (mOPV2), in line with internationally-agreed outbreak response protocols.
Surveillance and immunization activities are being strengthened in neighbouring countries…