Update on the polio eradication programme in Pakistan and Afghanistan

1. 64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017
Update on polio eradication in
Pakistan and Afghanistan
and progress in the Region

2. Outline
• Epidemiological and programme update
• Key achievements
• Challenges
• Next steps for ensuring eradication
and certification
• Transition planning
2
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

3. 3
Endemic country
Wild poliovirus type 1 (WPV1)
cVDPV type 2
1 Excludes viruses detected from environmental surveillance
2 Onset of paralysis 20 September 2016–19 September 2017
Global wild poliovirus and circulatory vaccine-
derived poliovirus cases1
, previous 12 months2
In the Region:
- wild poliovirus is restricted to small areas in Pakistan and Afghanistan
- Circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in an
access-compromised area of Syrian Arab Republic
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

4. 4
Poliovirus isolates, Afghanistan-Pakistan
(WPV1 + cVDPV2) last 6 months
Environmental
isolates (46)
Infected districts (20)
Polio cases (5)
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on
maps represent approximate border lines for which there may not yet be full agreement.

5. National emergency action plans – solid
foundations with close oversight mechanism
5
Sustained engagement of leadership and Emergency Operations Centre oversight
Focus on vaccination teams - protection, trust of community and reaching every last
child – community-based volunteers, high-risk populations
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

6. Polio cases – lowest level ever!
6
2014 2015 2016 2017
cVDPV 0 0 0 0
WILD 28 20 13 6
0
5
10
15
20
25
30
Number of cases from WPV1 and cVDPV2
2014 2015 2016 2017
cVDPV 22 2 1 0
WILD 306 54 20 5
0
50
100
150
200
250
300
350
Afghanistan Pakistan
*As of 21 September 2017
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

7. 7
Syrian Arab Republic: outbreak of cVDPV2
in 2017
Vaccination response
• Two rounds implemented in Deir Ez-
Zor on 22 July and 22 August and one
round implemented in Raqqa on 12
August, second round planned in
October
Results
• Deir ez-Zor
– Around 80% of targeted children
reported reached in two rounds
with mOPV2, and 71% with
inactivated polio vaccine (IPV)
• Raqqa
‒ Around 86% of targeted children
reported reached in the first round
with mOPV2; second round October
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

8. Key achievements in the Region in 2017
• Poliovirus transmission increasingly restricted.
• Children across the Region protected – 270 million doses
of oral polio vaccine given in polio supplementary
immunization activities to date in 2017.
• Key indicators for surveillance meet certification
standards in all but two countries.
• 17 of 22 countries completed Polio Outbreak Simulation
Exercises (POSE).
• Upwards of US$ 451 million mobilized by the Global
Programme and the Region to support polio eradication
in 2016–2017.
8
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

9. 9
Result - polio is on the retreat in the
Region
H.E. President of Somalia and the WHO Regional
Director as Somalia celebrates three successive
years without a case of polio, August 2017
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

10. But challenges remain …
• Ensuring that WPV transmission in Pakistan and
Afghanistan is stopped in the coming low season.
• Ensuring that cVDPV2 transmission in Syrian Arab Republic
is stopped.
• Protecting populations throughout the Region – sustaining
basic immunization services.
• Effectively detecting and responding to any poliovirus
appearing in polio-free areas, especially conflict areas
• Addressing global decrease in resources to fund/support
eradication activities.
• Sustaining political will in the Region.
10
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

11. Pakistan
Bill & Melinda Gates
Foundation
Challenge – maintaining programme funding
contribution to polio eradication in the Region
by donor, 2016‒2017
Regional contribution
22% of total
Potential for increasing
regional support?
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

12. 12
Priorities for the coming 12 months
2. Ensure
cVDPV2
outbreak is
stopped.
1. STOP
endemic
transmission.
3. Protect all ‘at-risk’ countries from polio.
4. Ensure surveillance quality and expand environmental surveillance in selected areas.
5. Ensure countries are prepared for outbreak response if needed (POSE and plans).
6. Prepare for certification and containment.
7. Accelerate transition planning.
Legend:
Endemic countries
At-risk countries
Other countries in the Region
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on
maps represent approximate border lines for which there may not yet be full agreement.

13. 13
Coming phase: certification and containment
Certification
 The 2017 Regional Certification Commission (RCC) accepted
reports of all but two countries.
 National Certification Committees Chairs and National
Containment Coordinators are enhancing collaborative
work.
 The RCC acknowledged quarterly risk assessment of six
conflict-affected countries and POSE (Polio Outbreak and
Simulation Exercise) in 17 countries.
Containment
 Phase 1a successfully completed in 21 countries.
 All countries are requested to complete Phase 1b.
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region

14. Coming phase: polio transition
14
Syria
Pakistan
Afghanistan
Iraq
Sudan
Somalia
Yemen
Legend
Global priority
Regional priority
Other countries in the Region
 Transition plans developed for Sudan and Somalia by end of 2017.
 Start the transition planning process in endemic countries in 2018.
 Start the transition planning process in Iraq, Syrian Arab Republic and Yemen in 2018.
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on
maps represent approximate border lines for which there may not yet be full agreement.

15. What Member States can do
15
 Mobilize regional resources to stop polio
transmission and achieve certification in the Region.
 Keep basic immunization services at the top of the
agenda.
 Allocate adequate national resources for surveillance
for polio and other priority diseases.
 Prepare for certification and containment.
 Be engaged in transition planning as appropriate.
Update on polio eradication in Pakistan and Afghanistan
and progress in the Region