The document discusses the status of polio eradication efforts in the Eastern Mediterranean Region. It notes that wild poliovirus circulation continues in Afghanistan and Pakistan, and that a ban on mass vaccination campaigns in Afghanistan has left millions of children unvaccinated. There is increased risk of international spread from these endemic countries. Other countries in the region face high risks due to gaps in vaccination coverage, surveillance, and community engagement. Continued efforts are needed across the region to maintain high vaccination rates and outbreak preparedness. Transition planning is also underway to integrate polio resources into broader health systems.

1. Tehran,
Islamic Republic of Iran
14 –17 October 2019
Agenda item 3(a)
Dr Hamid Syed Jafari, Director,
Polio Eradication
Update on polio eradication in the
Eastern Mediterranean Region
1

2. 2
Global wild poliovirus type 1 (WPV1) and
circulating vaccine-derived poliovirus
(cVDPV) cases in the previous 12 months
Only the Eastern
Mediterranean Region
has reported wild
poliovirus circulation
since August 2016
Onset of paralysis: 25 Sept 2018–24
Sept 2019
WPV1 cases
cVDPV2 cases
cVDPV1 cases
Endemic country (WPV1)

3. 3
Resurgence of wild poliovirus:
cases and environmental samples, 2019
Cases (85)
Samples (273)
Infected districts
(61)

4. 0
50
100
150
200
250
300
350
400
2013 2014 2015 2016 2017 2018 2019
Number
Afghanistan
Pakistan
Iraq
Somalia
Syrian Arab
Republic
4
Eastern Mediterranean Region:
WPV1 cases by year and country 2013–2019
Years
PUBLIC HEALTH
EMERGENCY OF
INTERNATIONAL CONCERN
Declared under the
International Health
Regulations in May 2014,
Confirmed on 14 May 2019

5. 5
Eastern Mediterranean Region polio
situation and risk categories 20192020
Endemic countries:
Afghanistan and Pakistan
Countries with outbreaks and
at very high risk:
Somalia, Syrian Arab Republic,
Yemen
Countries at high risk:
Djibouti, Iraq, Libya, Sudan

6. 6
Wild poliovirus detection in environmental
samples, Islamic Republic of Iran
Konarak District, Sistan-Baluchistan,
Islamic Republic of Iran
Positive environmental samples

7. 7
Somalia cVDPV2 and cVDPV3 outbreak
2017–2019
Somalia: VDPV cases,
2018
Somalia: VDPV cases,
2019
2017–2018
cVDPV2 – first detection:
December 2017
(environmental sample)
 Last cVDPV2
positive sample: 11
October 2018
cVDPV3 – first detection
February 2018
(environmental sample)
 Last cVDPV3
detection 7
September 2018
2019
 Three cVDPV2
cases – the last
case was
8 May
 Evidence of spread within country, and to Kenya (2018) and
Ethiopia (2019)
 Origin? – large number of children not accessed for
vaccination for a significant period
Response:
 Synchronized monovalent oral poliovirus type 2 campaigns,
enhanced surveillance
 Djibouti and Yemen on high alert and at very high risk

8. 8
Surveillance in the Eastern Mediterranean
Region 2017–2019
Non-polio AFP rate and wild virus, 2019
Percent of AFP cases with adequate samples, 2019
 Certification standard maintained in
20 of 22 countries
 Strong support from laboratory
network
 Environmental surveillance
expansion: Islamic Republic of Iran,
Jordan, Lebanon, Somalia, Syrian
Arab Republic and Sudan; within
Pakistan and Afghanistan
 Independent reviews, quarterly risk
assessments
Priorities
 Maintain high-quality surveillance to
detect and respond; support
certification
 Expand environmental surveillance:
Iraq, Yemen, Gulf Cooperation
Council countries

9. 9
Environmental surveillance, Mogadishu

10. 10
Key challenge – inaccessibility; ban* on
mass vaccination in Afghanistan
*Ban partially lifted on 25 September, permitting
only health facility-based campaigns
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Target planned Children reached Children not reached
11 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8
million
Implemented
Not vaccinated
Not vaccinated
Not vaccinated
Not vaccinated
Planned
5–10 million
children not
vaccinated since
March 2019

11. 11
Type of challenge and level of influence on
programme success – Pakistan
Political leadership at all levels
(National, provincial and district level)
Community trust and
acceptance
Management
structures and
leadership
Vaccinator
motivation,
trust and
safety
Operation
s
...
Most
influence/
Most impact

12. 12
Way forward: Afghanistan and Pakistan
 Overriding priority: stopping endemic
WPV transmission in Afghanistan and
Pakistan
 Renewed national and international
commitment
 Reviews and assessments; sharpened
analysis of communities harbouring endemic
transmission
 Updated national emergency action plans
 Transforming tactics, operations and
communications
 Sharpened focus on core endemic reservoirs
 Contingency planning in Afghanistan
 Stronger synergy with Expanded Programme
on Immunization
 Integrated services to the most-affected
communities

13. 13
Way forward for the Region
 Prevent and control polio outbreaks
 Maintain certification standard quality,
expand environmental surveillance
 Maintain immunity, especially among
those at high risk
 Progress toward certification and
poliovirus containment
 Polio transition is an increasing focus of
WHO/Global Polio Eradication Initiative,
donors and Member States
– Polio staff perform essential public health functions
(e.g. measles, cholera and other outbreak
response campaigns)
– Polio assets transition to integrated systems to
sustain eradication, enhance broader surveillance,
essential immunization and emergency outbreak
response
– Support and ownership of Member States

14. 14
Summary
 Resurgence of wild poliovirus in Afghanistan and Pakistan
 Increased risk of international spread
 Large ban on mass vaccination campaigns in Afghanistan; now partially lifted
 Gaps in community trust and engagement, and in the management of frontline
workers
 Risk of spread of cVDPV2 from Ethiopia/Somalia to Yemen
 Need for Member States to maintain high levels of vaccination coverage,
surveillance and readiness for outbreak response as a national emergency
 Enhanced regional solidarity – Islamic Advisory Group for Polio Eradication,
bilateral support (e.g. United Arab Emirates), Islamic Development Bank
 Polio transition – a priority for Member States

15. 15
Thank you