Emergency plan unveiled for major push against polio

Robert Roos

May 25, 2012 (CIDRAP News) – Saying recent major gains in the fight against polio are at risk, global health groups yesterday announced an Emergency Action Plan (EAP) to try to eradicate the disease by driving it out of its last three strongholds: Nigeria, Afghanistan, and Pakistan.

"Polio eradication is at a tipping point," says the 56-page plan released by the Global Polio Eradication Initiative (GPEI). "If immunity is not raised in the three remaining countries to levels necessary to stop poliovirus transmission, polio eradication will fail."

"We are in emergency mode to tip it toward success—working faster and better, focusing on the areas where children are most vulnerable," Margaret Chan, MD, director-general of the World Health Organization (WHO), said in a GPEI press release.

The plan aims to step up immunization in the three polio-endemic countries, maintain efforts to stop renewed outbreaks in previously polio-free countries, and close a nearly $1 billion funding gap.

The emergency plan comes on the heels of "landmark" successes in the past 2 years: Global cases dropped by 52% (from 1,352 to 649), India achieved polio-free status earlier this year, and four countries with re-established polio transmission either stopped the outbreaks or made good headway against them.

But on the downside, from 2010 to 2011 cases soared in Afghanistan (220%), Nigeria (185%), and Pakistan (37%), rising most sharply in the second half of last year, the GPEI report says. Also, polio leaked out of Nigeria to other countries.

By April 2012, Nigeria was the only polio-affected country where cases were not declining, the document says. The country "represents an imminent risk to west and central Africa."

Recent "explosive" outbreaks caused by imported cases in China, Tajikistan, and Congo illustrated the consequences of ailing to stamp out the disease, the report adds. In some areas affected by those outbreaks the adult case-fatality rates approached 50%.

On the financial side, the GPEI is facing a funding gap of $945 million against its overall 2012-13 budget of $2.19 billion. "This shortfall has already necessitated the cancellation or reduction of polio vaccination campaigns in 24 high-risk polio-free countries," the report says.

The emergency plan lists four objectives:

Increase support for "poorly performing areas" of Nigeria, Pakistan, and Afghanistan to expand vaccination coverage by the end of this year to levels needed to interrupt transmission of all polio viruses
Sustain momentum in Chad, the Democratic Republic of the Congo, and Angola to stop polio transmission this year and to stop within 6 months any new outbreaks in polio-free countries
Improve "GPEI partner accountability, coordination, and oversight to improve subnational outcomes in polio-affected countries"
Close the $945 million funding gap and develop a long-term plan to ensure funding and political will for the "Polio Eradication and Endgame Strategy 2014-2018"

The document lists a number of tactics designed to fit the circumstances of each polio-endemic country. For example, in high-risk areas of Afghanistan, low-visibility permanent polio teams are conducting house-to-house vaccination to provide children with at least one dose of oral vaccine every 3 months. And in Pakistan and Nigeria, special mapping and tracking strategies have been developed to reach migrant, mobile, and nomadic groups.

The GPEI is led by Rotary International, the WHO, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children's Fund (UNICEF), with support from the Bill & Melinda Gates Foundation.

The emergency plan was developed in response to a declaration by the WHO Executive Board in January that the completion of polio eradication must be treated as a "programmatic emergency for global public health."

The GPEI has shifted into emergency mode since then, the report says. As part of that, the CDC has activated its Emergency Operations Center, UNICEF has activated an emergency coordinating committee, and the WHO has moved its polio operations to its Strategic Health Operations Centre—the kinds of steps reserved for responding to emergencies like the 2009 H1N1 pandemic and the Southeast Asian tsunami of 2004.

At the World Health Assembly today in Geneva, the annual meeting of delegates from WHO member countries, a committee approved the polio resolution adopted by the Executive Board in January, but with an amendment, according to WHO Twitter messages. The resolution was awaiting a vote by the full assembly.