- - SAGE Report, November 2012, Section on Polio Eradication

Saturday, 12th of January 2013

Polio eradication

SAGE commended the countries and the Global Polio Eradication Initiative (GPEI) on the overall encouraging progress towards interrupting wild poliovirus transmission, but noted the increased number of poliomyelitis cases in some districts in Nigeria and Pakistan in 2012

compared to 2011. SAGE commended the level of detailed attention given to polio campaign planning and implementation with clear indications that best practices are being systematically applied. There is an impressive increase in the use and strengthening of

accountability frameworks, training and optimization of polio worker skills, and a visibly improved engagement of leaders and decision-makers at all administrative levels.

SAGE welcomed the long-term vision of the draft GPEI Polio Eradication and Endgame Plan, 2013–2018, and commended the GPEI for the extensive consultative process

used to develop the plan. SAGE endorsed the 4 major components of the plan: (i) interruption of remaining wild type 1 and 3 polio transmission, (ii) withdrawal of the type 2-component of oral polio vaccine (OPV2) use, (iii) containment and certification, and (iv) legacy planning and associated strategic approaches. SAGE supported the priority given to vaccine-associated polio disease (vaccine-associated paralytic poliomyelitis and circulating vaccine-derived poliovirus).

SAGE recommended that the draft Polio Eradication and Endgame plan be revised to include recommendations from current stakeholder consultations. The plan should be reviewed, completed and shared with other partners one month prior to the meeting of the WHO Executive Board in January 2013. The updated plan should provide more explanation for the rationale and public health benefit of the introduction of IPV, the global approach to

switching from trivalent OPV (tOPV) to bivalent OPV (bOPV), and the current efforts and future plans to use ongoing polio activities to strengthen routine immunization systems. The plan should be expanded to highlight, for all major objectives, the importance of using appropriate social mobilization and communication strategies.

SAGE was deeply appreciative of the diligent work of the SAGE polio working group and impressed by the progress achieved by the group in refining the evidence base for introducing IPV to mitigate risks associated with OPV2 withdrawal when replacing tOPV with bOPV for routine immunization (“OPV2 cessation”). SAGE concurred with the main recommendations of the working group.

SAGE recommended that all countries should introduce at least 1 dose of IPV in their routine immunization programme to mitigate the risks associated with the withdrawal of OPV2. SAGE accepted the detailed scientific evidence presented to illustrate the risk-mitigating benefits of IPV use in the context of OPV2 withdrawal, specifically the

evidence to show that, following OPV2 withdrawal, IPV vaccination will help to (i) prevent poliomyelitis in IPVvaccinated individuals exposed to vaccine-derived poliovirus type-2 (VDPV2) or wild poliovirus type-2 (WPV2), (ii) improve the response to monovalent OPV type-1 (mOPV1) or an additional dose of IPV in a type 2 polio outbreak, (iii) reduce the transmission of a reintroduced type 2 poliovirus, and (iv) accelerate wild poliovirus eradication by boosting immunity to wild poliovirus types 1 and 3.

In the context of interrupting wild poliovirus transmission before the end of 2014, SAGE will review progress every 6 months on achieving the prerequisites for OPV2 withdrawal, including the availability of affordable IPV products to ensure the earliest possible date for OPV2 withdrawal but with sufficient advance notification to ensure programmatic readiness and vaccine availability.

SAGE recommended that an IPV supply and funding strategy be established for timely introduction of IPV using existing whole dose products for a transition period

if needed. For its next meeting SAGE requested (i) additional details on the scientific evidence for, and programmatic implications of, targeting expanded age groups during polio campaigns in endemic areas, (ii) a report on the vision for the legacy planning, and

(iii) noting the circulation of VDPV in Somalia andChad, a report of progress in these countries.

SAGE expressed grave concern that because of funding shortfalls, OPV campaigns have been cancelled or scaled back in over 25 high-risk countries in 2012, which poses a threat to the success of the overall programme. This perennial problem exerts considerable pressure on the

programme at a time when eradication is in sight.