Polio Eradication Progress & Challenges

Polio Eradication: Strategies 1. Routine Immunization 2. Surveillance 3. National Immunization Days 4. Mop-up Campaigns 5

Polio Eradication: Progress 2008 1988 4 countries never stopped polio >40 countries had importations Last type 2 polio in the world © 2009 Bill & Melinda Gates Foundation 3

World Health Assembly, 2008 'Requests the Director-General to develop a new strategy to eradicate polio…'.

Lessons Learned & 'What's New'

What's different: district-specific plans; special tactics Lesson 1: immunity gaps allow virus to persist in smaller areas & sub-groups than thought. Persistent poliovirus transmission areas Asia, end-2009 What's different: district-specific plans; special tactics for underserved populations; independent monitoring. © 2009 Bill & Melinda Gates Foundation 6

New Tactics: high risk 'blocks' & migrants, India West Uttar Pradesh High-Risk Blocks Central Bihar

New Tactics: sub-national & local leaders, Nigeria

What's different: geographic approach, with campaigns Lesson 2: immunity thresholds to stop polio differ, being higher in Asia than Africa. Asia Africa What's different: geographic approach, with campaigns & monitoring tailored to local circumstances. © 2009 Bill & Melinda Gates Foundation 9

Serosurvey results children 6-7 months UP & Bihar, India Moradabad UP, Nov 2007 (N=121) UP & Bihar Aug 2010 (N=1280) Polio type 1 78% 98% Polio type 3 69% 77% Serosurvey results children 6-7 months UP & Bihar, India LQAS results children 0-5 years Northern Nigeria

What's different: bivalent oral polio vaccine (bOPV); Lesson 3: very difficult to optimize balance of monovalent & trivalent oral polio vaccines mOPV mOPV What's different: bivalent oral polio vaccine (bOPV); balance of bOPV, mOPV & tOPV campaigns. © 2009 Bill & Melinda Gates Foundation 11

1st bivalent OPV campaign Afghanistan 16 Dec 2009

What's different: pre-planned, synchronized campaigns; Lesson 4: routes of poliovirus spread & outbreaks are now largely predictable. Endemic countries Outbreak countries 2003-10 What's different: pre-planned, synchronized campaigns; imm. systems strengthening; new response standards © 2009 Bill & Melinda Gates Foundation 13

Impact

Strategic Plan: Impact Polio cases last 4 months 2009-2010 Comparison Polio cases last 12 months

Virologic Progress in Africa 2008 Genetic Clusters of Poliovirus 1 2008 2009 2010 2009 2010

Major Risks

Pakistan, 2010-11 Explosive outbreak chronic campaign gaps complicated by floods spread to high risk areas

'Re-established Transmission' Countries* Chad Persistent virus in the east Explosive outbreak after new import DR Congo Persistent virus in the east Large outbreaks after new imports Angola Persistent virus, widely dispersed Int'l exports: DRC, Congo, Gabon * infected-districts, last 6 months

Pakistan President Zardari launches new plan (24 Jan '11) Angola President Dos Santos meets UNICEF ExD on new plan (Jan '11) DR Congo President Kabila meets WHO DG on new plan (7 Feb 2011)

Explosive new outbreaks due to int'l spread Tajikistan (Feb-Jul) 458 cases 30% > 5 years of age 6% mortality SIA Round 1 Round 2 Round 3 Round 4 Congo (Oct-ongoing) 588 AFP cases 70% > 15 years of age 32% case mortality rate

Polio eradication financing gap, 2011-2012 12% Domestic Resources 21% Multilateral Sector 2% Non-G8 OECD/ Other 2% Private Sector 24% 2011-12 Funding Gap: US$ 670 m of $1.87 b budget Funding Gap 39% 22

Wrap-up

Polio cases, last 4 months Opportunity to achieve major new landmarks, especially in India & Nigeria, & possibly with type 3 Data at WHO/Geneva as of 23 March 2010

'Eradication attacks inequities & provides the ultimate in social justice.' Dr Bill Foege

2010 progress: polio can now be stopped globally.

net benefits: US$ 40-50 billion by 2035 KEY FINDINGS net benefits: US$ 40-50 billion by 2035 US $17-90 billion add'l from Vitamin A low-income countries: 85% of savings Vaccine 29(2011): 334-43

2o spread - Central Asia & Caucasus 2010 Polio case Infected area Russian Federation 14 cases Kazakhstan 1 case Turkmenistan 3 cases Tajikistan 458 cases

Advocacy & accountability Polio eradication – overcoming thresholds Advocacy & accountability

> 20 million volunteers 2.5 billion children immunized The Polio Programme 20 years > 200 countries > 20 million volunteers 2.5 billion children immunized Since 1988, the initiative has become the largest public health initiative in history. In 20 years, over 20 million volunteers across the world have immunized over 2 billion children - one-third of the global population.