Global Polio Eradication Initiative The 'Intensified Effort' 18 May 2008

Polio Paralysis for life Primarily affects children Preventable with OPV

Polio – the world in : World Health Assembly Resolution >350,000 cases >125 polio-endemic countries

Polio - the world in 2008 Since 1988: >99% reduction in disease 423 cases Endemic country Re-infected country

Global Polio Eradication Initiative WHO, Rotary, CDC, UNICEF Health Ministries 20 million volunteers Donors (governments, development banks, private foundations, etc) Private sector UN agencies NGOs

Polio Eradication Strategies 1. Routine Immunization 2. National Immunization Days (NIDs/SNIDs) 3. Surveillance 4. Mop-ups

Funding Gap: US$ 490m of $1.3b budget Domestic Resources 14% Non-G8 OECD/ Other 8% Multilateral Sector 15% Private Sector 15% Financial Contributions since 1988: US$ 6 billion and Funding Gap for G8 48%

Intensified eradication effort

Launch of intensified eradication effort 28 February 2007 Dr Margaret Chan, WHO DG : "We will complete polio eradication!" Stakeholder presence: Endemic country representatives International development community

New Tools New lab procedures (50% faster detection) Monovalent OPV1 (mOPV1) Efficacy

New tailored eradication tactics India  Accelerated SIA schedule with monovalent OPVs  Mop-up strategies for wild poliovirus type 1 (WPV1)  Targeted strategies for access-compromised areas (Kosi river, Bihar) Afghanistan & Pakistan  Synchronization of all activities, particularly in cross-border areas  Improved access to populations (mobile and in areas of insecurity)  Supplementary Interim Administered Dose (SIAD) strategy to deliver extra dose in between large-scale campaigns Nigeria  'Immunization Plus Days'  New engagement by all sectors of civil society (eg Quranic school engagement)

New political engagement and commitment Afghanistan & Pakistan April 2007 India December 2007 Nigeria, February 2008

Impact of intensified eradication effort

Wild Poliovirus, Asia as of 14 May 2008 district infected with wild polio virus type 1 district infected with wild polio virus type 3 Polio-infected districts, last 6 monthsType 1 Polio, YTD Comparison No countries re-infected with Type 1 WPV

Q1, 06Q2, 06Q3, 06Q4, 06 Q1, 07Q2, 07Q3, 07Q4, 07 * data as on 26 th April 2008 Q1, 08 Compelling evidence of real progress in interrupting WPV1 in UP & Bihar, India No WPV1 in UP since Nov 07; 1 WPV1 in Bihar in Jan 08

Very geographically restricted virus in Afghanistan & Pakistan in 2008 Afghanistan Pakistan Type 1 polio cases at 6 May

Wild Poliovirus, Africa as of 14 May 2008 district infected with wild polio virus type 1 district infected with wild polio virus type 3 Polio-infected districts, last 6 monthsType 1 Polio, YTD Comparison 7 countries re-infected with Type 1 WPV!

Polio in Nigeria Borno, Kano, Katsina, Jigawa and Sokoto account for >50% of Nigeria’s cases >20% of children un- immunized in high- risk LGAs, leaving >1.5 million children vulnerable in these areas

Year-to-date comparison of type 1 polio Polio Eradication in Nigeria New outbreak in 2008 >6-fold increase in type 1 polio (most dangerous type) Nigeria accounts for 90% of all type 1 polio worldwide Progress achieved in 2007 put at risk by new outbreak

The GPEI is on track to achieve major landmarks in , particularly in Asia. But increase in cases in Africa needs to be reversed

Immediate next steps - Asia India  Properly implement mop-up strategy for WPV1  Fully implement close operational gaps in remaining endemic areas (Kosi river, Bihar)  Further curb WPV3 outbreak and prevent geographic spread Pakistan  Introduce 'SIAD strategy' in Sindh (planned for July)  Systematic use of finger-marking to guide SIA improvements  Concentrate on high-risk areas & mOPV1 in Sindh (all viruses to date in 2008) Afghanistan  Fully implement SIAD strategy in Southern Region  Use new access to build up immunity

Immediate next steps - Africa Nigeria  Focus activities on high-risk LGAs in high-risk states  Optimize operational improvements (micro-planning, vaccinator selection, training and supervision)  Accurate monitoring of immunization activities  Urgent need for full engagement/ownership of LGA political leaders (particularly high-risk LGAs)  Continue to engage all community, traditional and religious leaders Re-infected countries  Maintain high population immunity levels in polio-free countries (currently higher than in )  Stop transmission of imported poliovirus in Angola, Chad and DR Congo  Rapidly fill sub-national surveillance gaps in key areas

After interruption of transmission of wild poliovirus…

Long-term poliovirus risks (after containment & certification of wild polioviruses) VAPP: Vaccine associated paralytic poliomyelitis VDPV: Vaccine-derived polioviruses – cVDPV: circulating VDPV – iVDPV: 'chronic' VDPV excretion by an individual with a 1 o immunodeficiency syndrome.

Post-eradication timeline Priority Activities WPV Containment & Certification VAPP/VDPV Elim. & Verification 'Post OPV' Era Earliest dates Full WPV containment. Fill mOPV stockpile. Refine 'affordable' options for IPV use. Certify WPV eradication. Stop trivalent OPV. Interim containment of Sabin viruses. Optimize IPV use. Interrupt cVDPVs (mOPV). Verify VDPVs eliminated. Full Sabin containment (if possible replace with alternate strains) Longterm surveillance. Stockpile maintenance. IPV cessation in countries using for transition.

Thank you…