1. Polio Eradication
Progress & Challenges

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

3. 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

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

5. Lessons Learned & 'What's New'

6. 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

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

8. New Tactics: sub-national & local leaders, Nigeria

9. 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

10. 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

11. 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

12. 1st bivalent OPV campaign
Afghanistan
16 Dec 2009

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

14. Impact

15. Strategic Plan: Impact
Polio cases
last 4 months
Comparison
Polio cases
last 12 months

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

17. Major Risks

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

19. '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

20. 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)

21. 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

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

23. Wrap-up

24. 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

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

26. 2010 progress: polio can now be stopped globally.

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

29. 2o spread - Central Asia & Caucasus 2010
Polio case
Infected area
Russian Federation
14 cases
Kazakhstan
1 case
Turkmenistan
3 cases
Tajikistan
458 cases

30. Advocacy & accountability
Polio eradication – overcoming thresholds
Advocacy & accountability

31. > 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.