Global Polio Eradication Initiative; strategic plan, 2010-2012
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Global Polio Eradication Initiative; strategic plan, 2010-2012

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  • Alternative Title:
    Every last child
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  • Description:
    Alarmed that polio remained entrenched in the four countries that had never stopped transmission1, and that an increasing number of polio-free areas were becoming reinfected, in May 2008 the World Health Assembly (WHA) called for a new strategy to complete polio eradication. The multi-year planning process of the Global Polio Eradication Initiative (GPEI) was subsequently replaced with a one-year 2009 Programme of Work which: examined the major barriers to interrupting wild poliovirus (WPV) transmission in each of the remaining endemic areas (through an Independent Evaluation)2; fast-tracked the development and clinical trials of four new vaccines or vaccine approaches3; and assessed new approaches to reach children previously missed by vaccination efforts due to weak operations management, insecurity or other factors. The new GPEI Strategic Plan 2010-2012 builds on the special 2009 Programme of Work and incorporates the myriad lessons learnt since the GPEI began. These lessons underpin the new approaches for achieving each of the Strategic Plan’s major objectives: interrupting wild poliovirus transmission in Asia; interrupting wild poliovirus transmission in Africa; enhancing global surveillance and outbreak response; and strengthening immunization systems. Four major lessons have had the most substantive implications for the new GPEI Strategic Plan 2010-2012. First, mathematical modeling has supported programme experience that the population immunity thresholds needed to interrupt WPV transmission differ in the remaining infected areas, being substantively higher in Asia, particularly in northern India and parts of Pakistan, than Africa. This has allowed the tailoring of polio campaign strategy and monitoring processes to each area, improving programme efficiency. Secondly, it is now clear that endemic WPV transmission can persist, and imported viruses be re-established, in areas and among sub-populations that are much smaller than previously understood. This has led to the systematic development of district- and population-specific strategies and capacity to address heterogeneity in oral polio vaccine (OPV) coverage. Thirdly, in polio-free areas the routes of WPV spread, and the risk of subsequent outbreaks, are now largely predictable, following known migration routes and exploiting evidently weak health systems; while outbreaks can occur in other geographic areas where there are gaps in OPV coverage (as evidenced by the large outbreak confirmed in April 2010 in Tajikistan), this knowledge allows for sharper targeting of both supplementary immunization activities (SIAs) and immunization systems strengthening efforts to reduce such risks. Finally, optimizing the impact of the new monovalent OPVs has proven more complicated than anticipated and in some settings contributed to alternating outbreaks of the remaining wild poliovirus type (WPV1) and wild poliovirus type 3 (WPV3) serotypes. The fast-tracked development and introduction of a bivalent OPV formulation in 2009, and its scale-up globally in 2010, directly addresses this problem with a new vaccine that complements the existing armamentarium of monovalent and trivalent OPVs. Although epidemiologic data as of May of 2010 must be interpreted cautiously due to reporting lag times and the seasonality of WPV transmission, the aggressive application of the operating principles of the new GPEI Strategic Plan 2010-2012 appears to be showing positive results. Among the four endemic countries, WPV1 had not been detected for four months in northern Nigeria and the northern Indian states of Uttar Pradesh and Bihar. As importantly, two of the four countries with probable ‘reestablished’ transmission of an imported virus, the Democratic Republic of the Congo and Sudan, had not reported cases within the previous six months. Similarly, 10 of the 15 previously polio-free countries that were re-infected in 2009 had already stopped their outbreaks. Recognizing the fragility of this progress given the substantial financing gap for eradication activities and the setbacks that have been encountered in the past, the new GPEI Strategic Plan 2010-2012 details seven major enabling factors that are designed to more proactively mitigate key risks: (1) A coordinated advocacy agenda has been established to help national governments ensure their commitment to polio eradication is translated into local action to improve the quality and coverage of mass polio immunization campaigns. (2) Programme communications is being revitalized by enhancing the data and evidence base for tailoring activities and by increasing capacity to sustain community engagement in, and acceptance of, OPV campaigns in priority areas. (3) A process for real-time monitoring and management of the global OPV supply is in place to optimize supply-demand, especially for new bivalent OPV products. (4) The technical assistance deployed by WHO and UNICEF to assist national capacity-building efforts is being expanded, particularly in areas of re-established transmission. (5) The GPEI research agenda is being tailored to address country-specific issues, systematically engaging national research and academic institutions in the process. (6) Given the chronic financing challenges the GPEI has faced, a more robust system has been established for prioritizing eradication activities, based on epidemiological risks, in the event of insufficient resources. (7) Intensified engagement of the core GPEI donor partners will expand the GPEI’s capacity to mobilize sufficient domestic and international financing to implement the full schedule of activities called for in the new GPEI Strategic Plan 2010-2012. Accompanying this Strategic Plan is the GPEI Financial Resource Requirements 2010-2012 (FRR) document. Updated on a quarterly basis the FRR explains the full budget for the three-year period as well as the current financing gap which at April 2010 was approximately 50% of the 2010-2012 budget. The four major milestones of the new GPEI Strategic Plan 2010-2012 will be internationally analyzed every quarter and graded as ‘on-track’, ‘progressing but with issues of concern’ or ‘at risk for completion’ to alert countries and stakeholders as to emerging risks and guide mid-course corrections. For milestones which are ‘progressing but with issues of concern’ or ‘at risk for completion’, the appropriate national or international Technical Advisory Group (TAG) will be asked to work with the relevant national authorities to establish a corrective plan within two weeks. A new global advisory body will evaluate the milestones and major process indicators, monitor corrective action plans and provide overall guidance on policy, strategy and priorities. This body will work closely with the Strategic Advisory Group of Experts on Immunization (SAGE), consulting on its findings at each of the six-monthly SAGE meetings. The aggressive, time-bound programme of work elaborated in this new GPEI Strategic Plan 2010-2012 exploits the lessons learnt from 20 years of experience in polio eradication. The GPEI Strategic Plan 2010-2012 was developed through an extensive consultative process with all major GPEI stakeholders, especially the endemic and reestablished transmission countries. This process has led to a broad consensus that - with full financing and implementation - this Strategic Plan can lead to the interruption of the remaining reservoirs of WPV worldwide by 2013, setting the stage for eventual certification of that achievement and cessation of OPV use globally. The world now has its best opportunity ever to eradicate this devastating disease.
  • Content Notes:
    On cover: logos for World Health Organization, Rotary International, CDC (U.S. Centers for Disease Control and Prevention), UNICEF.

    Includes bibliographical references.

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