A recent Presentation at National Annual Review Meeting of Core Group Polio Project (CGPP) -USAID funded project, ADRA India: implementing agency with technical support from CORE Secretariat

1. GLOBAL POLIO UPDATES, POLIO END
GAME AND HEALTH SYSTEMS
STRENGTHENING
CGPP-ADRA INDIA ANNUAL REVIEW MEETING,
17TH-18TH MAY 2016, MUSSOORIE
Dr. Suchitra Lisam, National Health Programs Manager,
ADRA India

2. PRESENTATION OUTLINE
 PART I : POLIO AT A GLANCE
 PART II: GLOBAL POLIO UPDATES
 PART III: END GAME /ERADICATION TIMELINES
 PART IV: HEALTH SYSTEMS STRENGTHENING, POLIO
LEGACY IN INDIA

3. POLIO AT A GLANCE
PART I

4. POLIO AT A GLANCE
 Global Polio Eradication Initiatives (GPEI) is a public-
private partnership spearheaded by WHO, Rotary
International, US-CDC and UNICEF supported by key
partners including BMG Foundation and GAVI- the
vaccine alliance
 99% reduction in polio since 1988
 350,000 cases in 125 endemic countries in 1988
 74 cases in 2 endemic countries (Pakistan, Afghanistan) in
2015
 3 types of wild polio viruses (type 1, 2, 3)
 Wild poliovirus type 2 last detected in 1999, global
eradication declared in Sep 2015

5. POLIO AT A GLANCE –contd.
 Wild poliovirus type 3 not detected since Dec 2012
 2 types of vaccine- OPV and IPV
 More than 1.5 million childhood deaths prevented since
1988
 15 million cases averted since 1988
 More than 5000 m child immunized every year through
Routine Immunization and campaigns
 World Health Assembly has declared completion of polio
eradication as a programmatic emergency for global public
health.

7. ELIMINATION STATUS

8. GLOBAL UPDATES
PART II

9. GLOBAL UPDATES (April’16)
 The Global Oral Polio Vaccine Switch, statistics on
WPV/cVDPV
 Immunization week
 Strategic Advisory Group of Experts on
Immunization (SAGE) Meeting
 Protecting Children in Countries Vulnerable to Polio

10. GLOBAL OPV SWITCH

11. GLOBAL OPV SWITCH-contd.
 From the 17 April to the 1 May, 155 countries and
territories participated in the historic trivalent to
bivalent oral polio vaccine switch, withdrawing the type
2 component of the vaccine to protect future
generations against circulating vaccine derived
polioviruses (cVDPV)
 Type 2 component of the oral polio vaccine (OPV) is
being removed from use from the trivalent to bivalent
oral polio vaccine to withdraw OPV in a phased
manner starting with type 2 component following the
eradication of wild poliovirus type 2 in September
2015


12. GLOBAL OPV SWITCH-contd.
 152 of 155 (98%) countries and territories have
stopped using the trivalent oral polio vaccine.
 Independent monitoring to ensure the switch goes
smoothly has begun in 126 of 153 countries (82%).
 The National Validation Committee has received switch
monitoring data from 16 of 153 countries.
 The WHO Regional Office has received the National
Validation Report from 10 countries.

13. GLOBAL OPV SWITCH-Contd.

14. WPV TYPE 1 & cVDPV -STATISTICS
Total
cases
Year-to-date 2016 Year-to-date 2015 Total in 2015
WPV cVDPV WPV cVDPV WPV cVDPV
Globally 12 3 23 1 74 32
- in
endemic
countries
12 0 23 1 74 3
- in non-
endemic
countries
0 3 0 0 0 29

15. Countries
Year-to-date 2016 Year-to-date 2015 Total in 2015 Onset of paralysis
of most recent case
WPV cVDPV WPV cVDPV WPV cVDPV WPV cVDPV
Afghanistan 4 0 1 0 20 0 27-Mar-16 NA
Pakistan 8 0 22 1 54 2 22-Mar-16 09-Feb-15
Guinea 0 0 0 0 0 7 NA 14-Dect-15
Lao PDR 0 3 0 0 0 8 NA 11-Jan-16
Madagascar 0 0 0 0 0 10 NA 22-Aug-15
Myanmar 0 0 0 0 0 2 NA 05-Oct-15
Nigeria 0 0 0 0 0 1 NA 16-May-15
Ukraine 0 0 0 0 0 2 NA 07-Jul-15

18. VULNERABLE COUNTRIES
 Polio remains endemic in two countries – Afghanistan and
Pakistan.
 Until poliovirus transmission is interrupted in these countries,
all countries remain at risk of importation of polio,
especially vulnerable countries with weak public health and
immunization services and travel or trade links to endemic
countries.
 Circulating vaccine-derived poliovirus is causing an outbreak
in Madagascar, Guinea and Ukraine.
Vulnerable countries : Cameroon, Equatorial Guinea,
Ethiopia, Iraq, Nigeria, Somalia, South Sudan and Syrian
Arab Republic.

19. POLIO IN NUMBERS-2016
 Wild poliovirus in 2016
- Global Total: 12 (23)
- Global WPV1: 12 (23)
- Global WPV3: 0 (0)
 Endemic: 12 (23)
-Afghanistan: 4 (1)
- Pakistan: 8 (22)
 Importation Countries: 0 (0)
Data as of 27 April 2016. Numbers in brackets represent data at this time in 2015

20. POLIO PUBLIC HEALTH EMERGENCY
 Temporary Recommendations to Reduce International Spread of
Poliovirus
 On 5 May 2014 the Director-General declared the international
spread of wild poliovirus in 2014 a Public Health Emergency of
International Concern (PHEIC) under the International Health
Regulations [IHR 2005], issued Temporary Recommendations to
reduce the international spread of wild poliovirus, and requested a
reassessment of this situation by the Emergency Committee every 3
months.
 The eight meeting of the Emergency Committee was held in
February 2016. Based on the committee’s advice and the reports
made by affected States Parties, the Director-General extended
the following Temporary Recommendations under the IHR (2005),
effective February 2016.

21. WORLD IMMUNIZATION WEEK
 In 2016(April) there
have only been 12
cases of polio, down
from 23 cases in the
same period for
2015.
 World Immunization
Week took place
between 24 – 30
April with the
theme “Close the
Immunization Gap”.

22. SAGE MEETING
 Recommends amendments of surveillance
case definition to include type 2 Sabin so
that all type 2 polioviruses will be notified
 Urges all countries to ensure completion of
phase I for all type 2 polioviruses, incl.
Sabin 2
 Endorsed the components of updated
MOV strategy to improve coverage,
equity and timeliness of vaccination
 Implementation research- more attention
 Immunization specific indicators to assess
progress towards <5 mortality target of
SDGs

23. PROTECTING CHILDREN IN VULNERABLE AREAS
 Keeping levels of immunity high by strengthening RI,
carrying out polio vaccination campaigns and
keeping vigilant surveillance systems for early
warning should the virus return is a top priority for
the GPEI.
 In Jordan, the Ministry of Health with the support of
WHO, UNICEF and partners, recently completed a
mass immunization campaign against polio,
reaching >1 million children <5 across the country
with OPV

24. KEY CHALLENGES
 Delivering quality health services.
 Improving reach, tracking missed children with OPV
in endemic countries
 Keeping up the pressure
 Despite the gains, there is still much to be done, not
only in Afghanistan and Pakistan but also in
countries with declining immunization rates. So long
as polio continues to circulate anywhere, children
everywhere are at risk.

25. END GAME PLAN/ ERADICATION TIMELINES
PART-III

26. Polio Eradication and Endgame Strategic Plan 2013–2018

27. IPV INTRODUCTION TIMELINES

28. POLIO ERADICATION TIMELINES

29. GPEI AND HEALTH SYSTEMS STRENGTHENING,
POLIO LEGACY-HEALTH SECTOR
PART -IV

30. BUILDING BLOCKS FRAMEWORKS OF HEALTH
SYSTEMS

31. POLIO LEGACY/SCOPE IN VPDs PROG
 Over the past 25 years, GPEI-funded personnel
and infrastructure have supported the distribution
of global and country health priorities including
 anti-measles vaccines
 vitamin A supplements
 anti-malarial bednets
 deworming pills
 surveillance for yellow fever and avian influenza

32. INDIA POLIO LEGACY
 Polio legacy in Action
 Mainstreaming critical polio eradication functions into
other priority health programmes
 Ensuring that the best practices and knowledge gained
over years are shared with other health initiatives
 Transitioning certain polio functional areas to
government counterparts
 Transitioning the capacities, processes and assets
created by the programme to support other vaccine
preventable diseases & strengthening health systems

33. TRANSITION OF ACTION
 Polio funded assets of WHO, UNICEF & CORE and others are
supporting RI strengthening activities in India
 Lessons learnt from polio/best practices being applied for RI &
control/elimination of VPDs
 Mission Indradhanush (MI) as a good example of government
led legacy in action for RI campaigns.
 Other transition areas- health, sanitation, nutrition, Ebola
 Transition/Legacy Plans are progressing and new initiatives to
bring it under one umbrella.
 Legacy Documentation is a major priority, ongoing

34. TRANSITION OF ACTION
 Transitioning assets/functions and applying lessons learned
 Strengthening routine immunization • Intensified RI monitoring –generating
data on quality of immunization, availability of vaccines/logistics, reasons
for low RI coverage and Zinc/ORS availability.
 Accountability through Task Forces, established in 36 states and 668
districts to review program data.
 Capacity building of frontline workers
 Advocacy and integrated communication including high risk areas in RI
session planning – 96% of high risk areas now included in RI micro plans.
 New vaccine introduction (Pentavalent; IPV, MR, Rotavirus) – Developing
field guidelines, training material and checklists for assessing preparedness
at district/state levels; conducting post-introduction and coverage
evaluations. Measles elimination and rubella control –

35. TRANSITION IN ACTION
 Supported catch-up campaigns covering approximately
119 million children. Visceral leishmaniasis (Kala Azar)
elimination – Monitoring indoor residual spraying;
contributing to national elimination strategy
development. VPD surveillance
 Coordinating validation of MNT elimination; capacity
building for lab personnel; launched lab supported
surveillance for diphtheria, pertussis and neonatal
tetanus with expansion planned in 2015
 AEFI surveillance – Assisting with updated guidelines;
training AEFI committees; supporting electronic case
reporting. Supporting international health programs –
Indian SMOs deployed to Nigeria, Sierra Leone and
Liberia in 2014-15.

36. LEGACY DOCUMENTATION
Completed
 Hosting Learning Missions – Afghanistan
and Pakistan
 Documents on Transition/Successful
Strategies in States
 Completed Legacy photographic book
 – demonstrating innovations/game
changers to triumph over polio
 Several films 7 documenting Social
Mobilization strategies, new PBS film
on transition polio to RI, short film
polio for RI.
 India Polio Learning Exchange website
Underway/planned 2015-2016
 Joint papers with WHO, GOI and
 partners under discussion
 SMNet Legacy Review (PWC) –
critical factors for success, SMNet
location/# for RI, and transition
options
 SMNet Impact on RI, Convergence,
Diarrhea morbidly and mortality
 IPV Introduction preparedness
 KAP
 Impact on the mobilizers themselves