LETTER FROM THE CHAIR OF THE INDEPENDENT MONITORING BOARD TO DIRECTOR-GENERAL, WHO

Wednesday, 6th of June 2012

LETTER FROM IMB CHAIR TO DIRECTOR-GENERAL, WHO

Dear Dr Chan

The World Health Assembly is considering a Resolution next week to declare polio eradication a programmatic emergency. The Independent Monitoring Board (that I chair) believes this is essential.

At our quarterly meeting this week, the Board used the word ‘crisis’ to describe the current situation. A crisis because recent successes have created a unique window of opportunity, which must not be lost. A crisis because a funding shortfall threatens to undermine the increasing containment of the virus. A crisis because an explosive resurgence now would see country after country under attack from a disease that they thought their children were protected from.

The World Health Assembly established the Global Polio Eradication Initiative in 1988. In its first fifteen years, the Initiative achieved astounding success. In 1988, 125 countries were polio-endemic; by 2003, just six remained. Over the same period, the number of children paralysed by polio annually was reduced by 99%.

But then advancement stalled. For almost a decade, the Initiative made little or no progress in overcoming the ‘final 1%’ of polio. In its global epidemiology, the Initiative was stuck in stalemate.

Our independent board was formed 18 months ago. We have assessed the Initiative thoroughly and frankly. We have recommended major corrective measures to break the stalemate. The Initiative has responded well. The intensity of action and sense of emergency has heightened, and real progress has been made.

The recent upturn in progress has two major highlights:

In the last four months, there have been fewer cases, in fewer districts of fewer countries than at any time in history;

For years, many believed that the challenges of stopping polio transmission in India would be the downfall of the Global Initiative; that, quite simply, it could not be done. They were wrong. With not a single case for over a year, India is no longer polio-endemic. This deeply impressive achievement should significantly enhance confidence that the Initiative can stop transmission globally.

After a decade of little progress, the Initiative has finally broken through. It now needs the greatest possible global support. But alarm bells should be ringing. The Initiative is being severely jeopardized by a major funding shortfall. It now plans to cancel crucial vaccination campaigns in 36 countries in 2012, due to lack of funds. This is an extreme and unacceptable risk. In particular, it would leave whole swathes of West Africa at high risk of importing polio from Nigeria. This would not only spell disaster for the countries affected; it could set this global endeavour back by many years, and vastly increase the eventual cost of achieving eradication.

More than polio eradication is at stake here. Success in this Initiative would form the bedrock to deliver further ambitious global health goals. Failure would cause confidence to crumble, jeopardizing the potential of existing and future vaccination programmes.

We feel it our duty to highlight three particular points:

This final phase of polio eradication absolutely demands a true emergency approach with global governmental support. With this in place, eradication can succeed. Without it, it will fail.

If the Initiative is under-financed, there can be little doubt that it will fail. All of the planned vaccination campaigns are required; none are optional extras. Cancelling them spells disaster.

Case numbers are at an historic low. The Initiative is closer than ever before to stopping transmission globally, realising the ultimate benefit of the huge investment that has been made. To jeopardize its success now makes no sense at all.

The global community has invested billions of dollars to reach this point. After 24 years, the world is more than 99% of the way to stopping transmission. The final 1% is immensely difficult but, at last, progress is being made. The members of the 2012 World Health Assembly have the once-in-a-generation opportunity to realize the vision that they set out nearly a quarter of a century ago: to make history, as they did with smallpox; to rid the world of a scourge of humankind forever. With true global ownership and the necessary financial support, this inspirational vision can become a reality.

Yours sincerely

SIR LIAM DONALDSON CHAIR