SIXTY-SIXTH WORLD HEALTH ASSEMBLY A66/18
Provisional agenda item 15.3 28 March 2013
Poliomyelitis: intensification of the
global eradication initiative
Report by the Secretariat
1.
The Executive Board at its 132nd session noted a previous version of this report.
1
The Boardprovided additional guidance on addressing the short-and long-term risks to attaining the milestones
of the new polio eradication and endgame strategic plan 2013–2018, particularly in the areas of:
vaccination of travellers; fast-tracking access to affordable inactivated poliovirus vaccination options
for all countries; strengthening routine immunization;and legacy planning, including that for the
human resource infrastructure currently funded by the Global PolioEradication Initiative. This
guidance has been incorporated into the final plan, which is due to be shared with Member States in
April 2013, in advance of the planned roll-out ofthe new plan at a Global Vaccine Summit scheduled
to be held in Abu Dhabi (24 and 25 April 2013). In addition, data have been updated in this version of
the report. In May 2014, the Secretariat will report to the Sixty-seventh World Health Assembly on
progress in implementing and financing the strategic plan; outcomes of the consultative process on the
legacy planning; and action required by the Health Assembly in advance of initiating the phased
removal of the type 2 component of the oral poliovirus vaccine from all routine use globally.
2.
In 2012, the Sixty-fifth World Health Assembly in resolution WHA65.5 declared the
completion of poliovirus eradication a programmatic emergency for global public health and requested
the Director-General, inter alia, to undertake the development and rapid finalization of a
comprehensive polio eradication and endgame strategy to the end of 2018. The present report gives
details of progress made, and challenges experienced, in implementing the global and national
emergency action plans against poliomyelitis; explains new challenges and risks, particularly in the
area of security; summarizes the new six-year polio eradication and endgame strategic plan
2013‒2018,
2
including its implications for the 144 Member States using oral poliovirus vaccine; and,
outlines the planning process for securing the broader legacy of the Global Polio Eradication Initiative.
IMPLEMENTATION OF EMERGENCY ACTION PLANS AGAINST POLIOMYELITIS
3.
The Global Polio Emergency Action Plan 2012‒2013 was launched on 24 May 2012, during the
Sixty-fifth World Health Assembly, in support of national emergency action plans against
poliomyelitis from the three remaining countries in which the disease is endemic, namely:
Afghanistan, Nigeria and Pakistan. At the international level, the five core agencies working in
partnership for the eradication of poliomyelitis have established the Polio Emergency Steering
Committee to manage risks and guide operations. The Committee reports to the agency heads, who
1
See the summary record of the Executive Board at its 132nd session, tenth meeting, section 2.
2
The working draft of the strategic plan, as approved by the Strategic Advisory Group of Experts on immunization, is
available at http://www.polioeradication.org/Resourcelibrary/Strategyandwork.aspx (accessed 18 March 2013).
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constitute the membership of the Polio Oversight Board, which meets on a quarterly basis. Emergency
operations centres and/or procedureshave been activated across the core partner agencies, and WHO
recruited 2500 additional workers to support government efforts against poliomyelitis in areas of
Afghanistan, Nigeria and Pakistan affected by the disease or where the outbreak risk was greatest.
UNICEF engaged more than 5000 additional community mobilizers in these priority areas. On
27 September 2012, the United Nations Secretary-General hosted a high-level meeting on the
poliomyelitis eradication emergency during the sixty-seventh session of the United Nations General
Assembly. The aim of the meeting was to reinforce national and international commitment to achieving
eradication and mobilizing the necessary financing. It was attended by the Heads of State of the three
countries where the disease is endemic, the heads of the partner agencies, donors and other stakeholders.
4.
In each of the three countries mentioned above, the Head of State or Government has appointed
a focal point to oversee the national effort to eradicate poliomyelitis and has engaged other sectors of
government and public administration to support implementation of the national emergency action
plan. In addition, in Nigeria and Pakistan, respectively, a Presidential task force and a Prime
Ministerial task force have been established to assess progress and ensure the accountability of local
authorities. In Nigeria, a national emergency operations centre has been established in Abuja with a
subnational centre in Kano state in order to further enhance operations planning, oversight and
accountability. New performance monitoring systemshave been put in place (i) to track whether
supplementary immunization activities using oral poliovirus vaccine were reaching the vaccination
coverage thresholds required to interrupt transmission and (ii) to guide rapid corrective action. In
Nigeria, the proportion of very-high-risk local government areas in which the vaccine coverage
reached the estimated target threshold of 80% for stopping poliovirus transmission in that setting
increased from 10% in February 2012 to 70% in February 2013. In Pakistan, the proportion of highest-
risk districts achieving the estimated target threshold of 95% in that setting increased from 59% in
January 2012 to a peak of 74% in October; increasing insecurity in late 2012 compromised the
capability to collect similar monitoring data through January 2013. In the 11 districts in southern
Afghanistan at highest risk for persistent transmission of poliovirus, the number of children
inaccessible during the oral poliovirus vaccine campaigns declined from more than 80 000 at the end
of 2011 to some 15 000 by December 2012.
5.
As a result of this emergency eradication effort, as at 14 February 2013 the numbers of both
cases of poliomyelitis and countries experiencing cases were at their lowest-ever recorded levels.
Globally, 222 cases had been reported in 2012, a 66%decline compared with 2011. Five countries
reported cases in 2012 compared with 16 in 2011.
In three of the countries with endemic or re-established transmission of wild poliovirus
‒ Chad, Pakistan and Afghanistan‒case numbers declined 96%, 70% and 53%, respectively, relative
to 2011. In Nigeria, case numbers increased by 95% compared with the same period in 2011, but by late 2012 had stabilized as programme performance improved significantly in the historically worst-performing areas. In the fifth country,
Niger, one case occurred in late 2012, linked to a wild poliovirus originating in northern Nigeria. In
Egypt, wild poliovirus imported from Pakistan was detected in sewage samples collected in December
2012 in two areas of greater Cairo; no case ofparalytic poliomyelitis was reported. Of the two
remaining serotypes of wild poliovirus (types 1 and 3), only 22 cases due totype 3 were reported –
19 in Nigeria and 3 in Pakistan. The three cases in Pakistan were all detected in the same district, with
the most recent having onset on 18 April 2012.
6.
Although substantial improvements were achieved in the quality and coverage of supplementary
immunization activities in infected areas in 2012, insecurity emerged as a more significant risk to the
completion of wild poliovirus eradication. In December 2012, attacks in Khyber Pakhtunkhwa and
Karachi, Pakistan resulted in the murder of nine polio vaccinators. In February 2013, attacks on two
health centres in Kano state, Nigeria, resulted in the deaths of 10 people who had worked on polio
