1. Completing The Endgame Global Polio Eradication
March 11, 2015

2. Outline Progress toward polio eradication GPEI Priorities in 2015
Withdrawal of Oral Polio Vaccine type 2
Legacy of polio eradication

3. Wild Poliovirus Eradication, 1988-2012
125 Polio Endemic countries to
3 endemic countries
2012
1988
125 Polio Endemic countries
Last type 2 polio in the world
Last Polio Case in India 3

4. Beginning of the Endgame
Success in India established strategic & scientific feasibility of poliovirus eradication
Poliovirus Type 2 eradication raised concerns about continued use of tOPV

5. Endgame Plan, 2013-18 Poliovirus detection & interruption
OPV withdrawal, IPV introduction, RI strengthening
Facility Containment & Global Certification
Legacy Planning

6. Interrupting Poliovirus Transmission

7. Not detected since Nov 2012

8. Polio Cases, Last 6 months
No WPV Reported in Africa or Middle East

9. Wild Poliovirus type 1 (WPV1) Cases, 2013
Endemic countries
Infected countries
Israel = Env. positive isolates (2013 , N=136 )
Gaza = Env. positve isolates (2013 , N= 7)

10. WPV1 Cases, 2014*
306
359
Endemic countries
Infected countries
Israel = Env. positive isolates (2013 , N=136 ; 2014, N=14 , last 30 Mar 2014)
Gaza = Env. positve isolates (2013, N= 7 ; 2014, N=1, Jan )
*Data as of 9 March (including advance notifications as of this date)

11. Progress in Endemic Countries

12. WPV1 Cases, *
*Data as of 9 March (including advance notifications as of this date)

13. Risks in Nigeria Insecurity and conflict in the northeast
Upcoming elections
Loss of political commitment
Complacency

14. Pakistan: The Final Challenge Polio Cases, Last 6 Months* N=132
No. of Cases
*10 Sep to 9 March

15. Getting Pakistan on Track in 2015
Can the Program
Vaccinate everywhere?
Monitor everywhere?
Enforce accountability?

16. WPV1 Cases Afghanistan, 2014 N=28
Most Cases importation related , but
endemic strain persists in Southern Region

17. Ensuring Progress in Afghanistan
Accelerate Engagement with new leadership
Maintain dialogue with non-state actors
Ensure program neutrality
Reduce missed children in Southern Region

18. Public Health Emergency of International Concern

19. International exportation of poliovirus in 2014
February
January
April
June
August
September
October
March
March

20. Preventing International spread
Public Health Emergency of International Concern (PHEIC) declared by DG, WHO, on 5 May 2014; extended 31 July, 13 November, 2014, 3 March
New emphasis on regional cooperation and cross- border coordination
Countries with circulating wild poliovirus, but NOT currently exporting
Countries currently exporting wild poliovirus

21. 2015 – a crucial year

22. 2015 – the Crucial Year Can Africa & Middle East remain polio free?
Can Pakistan stop polio transmission?
Can the world prepare for OPV withdrawal?
Can GPEI maintain public confidence and funding?

23. Program Priorities in 2015 Intensify surveillance for poliovirus
Reduce risk in Africa & Middle East
Get Pakistan/Afghanistan back on track
Prevent international spread, build stronger outbreak response capacity
Ensure preparedness for OPV2 withdrawal
Launch legacy planning

24. Risks Increasing costs National commitment
Pakistan: Gaps in implementation & accountability
Afghanistan: New leadership, security transition
Nigeria: Elections in March, GoN financing
Central Africa & Horn: Gaps in Surveillance & immunity
Expanding insecurity, conflict
Ebola outbreak?
Increasing costs

25. Type 2 OPV Withdrawal

26. Vaccine-derived polio outbreaks (cVDPVs) 2000-2013
>90% VDPV cases are type 2
(40% of Vaccine-associated polio is also type 2)
Type 1 (79 cases)
Type 2 (478 cases)
Type 3 (9 cases)
Type 1
Type 2
Type 3

27. Justification for new endgame
Polio eradication not feasible without removal of all poliovirus strains from populations

28. 5 ‘Readiness Criteria’ to Stop type 2 OPV
‘on track’ - SAGE, Oct 2014
at least 1 dose IPV for all OPV-using countries
bOPV licensed for routine immunization
WPV2 'certification' & type 2 containment
surveillance & notification of type 2 virus
mOPV2 stockpile & response capacity
There are 6 pre requisites, being one of them the trigger point that will provide the go ahead to the switch: elimination of persistent cVDPV type 2 (Nigeria and Pakistan outbreaks) plus wild type 2 eradication (wild type 2 has not been seen since 1999).
The other pre requisites are part of other work streams within the strategic plan and will not be covered in this presentation. Just say that other groups are working and progressing on these work streams.
Pre-requisite for tOPV withdrawal:
elimination of 'persistent cVDPV2s'

29. January 2013 : 126 OPV-only using countries
IPV ONLY (47 countries)
IPV/OPV (19 countries)
OPV ONLY (126 countries)

30. IPV Introduction status - March 2015
World Health Organization
20 April, 2017
IPV Introduction status - March 2015
15 introductions
109 commitments/plans to introduce in 2015
Introduced to date
Albania, Andorra, Australia, Austria, Bahrain, Belarus, Belgium, Bosnia and Herzegovina, Brazil, Brunei Darussalam, Bulgaria, Canada, China, Colombia, Comoros (the), Costa Rica, Croatia, Cyprus, Czech Republic (the), Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Jordan, Kazakhstan, Kuwait, Latvia, Lebanon, Libya, Lithuania, Luxembourg, Malaysia, Malta, Marshall Islands (the), Mexico, Micronesia (Federated States of), Monaco, Montenegro, Nepal, Netherlands (the), New Zealand, Nigeria, Niue, Norway, Oman, Palau, Panama, Peru, Philippines (the), Poland, Portugal, Qatar, Rep of Korea, Romania, Russian Federation (the), San Marino, Saudi Arabia, Senegal, Serbia, Singapore, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Syrian Arab Republic (the), Tunisia, Turkey, Ukraine, United Arab Emirates (the), United Kingdom of Great Britain and Northern Ireland (the), United States of America (the), Uruguay
Formal commitment to introduce in 2015
Afghanistan, Algeria, Angola, Antigua and Barbuda, Argentina, Armenia, Azerbaijan, Bahamas (the), Bangladesh, Barbados, Belize, Benin, Bhutan, Bolivia (Plurinational State of), Botswana, Burkina Faso, Burundi, Cabo Verde, Cambodia, Cameroon, Central African Republic (the), Chad, Chile, Congo (the), Cote d'Ivoire, Cuba, Djibouti, Dominica, Dominican Republic (the), DPR Korea, DR Congo, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia (the), Georgia, Ghana, Grenada, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras, India, Indonesia, Iran (Islamic Republic of), Iraq, Jamaica, Kenya, Kiribati, Kyrgyzstan, Lao People's Democratic Republic (the), Lesotho, Liberia, Madagascar, Malawi, Maldives, Mali, Mauritania, Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nauru, Nicaragua, Niger (the), Pakistan, Papua New Guinea, Paraguay, Republic of Moldova (the), Rwanda, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Samoa, Sao Tome and Principe, Seychelles, Sierra Leone, Solomon Islands, Somalia, South Sudan, Sri Lanka, Sudan (the), Suriname, Swaziland, Tajikistan, The former Yugoslav Republic of Macedonia, Timor-Leste, Togo, Tonga, Trinidad and Tobago, Tuvalu, Uganda, United Republic of Tanzania (the), Uzbekistan, Vanuatu, Venezuela (Bolivarian Republic of), Viet Nam, Yemen, Zambia, Zimbabwe
Intend to introduce in 2015
Cook Islands, Fiji, Mauritius, Turkmenistan
Formal commitment to introduce in 2016
Saint Lucia
Intend to introduce in 2016
Thailand
Introduced to date
(82 countries or 42%)
Formal commitment to introduce in 2015 (106 countries or 55%)
Intend to introduce in 2015 (4 countries or 2%)
(Cook Islands, Fiji, Mauritius, Turkmenistan)
Intend to introduce in 2016 (Thailand)
Formal commitment to introduce in 2016 (Saint Lucia)
Not Available
Not applicable
Date of slide: 3 March 2015

31. Good Progress but Remaining Challenges
1. Tight supply situation
Both main manufacturers will supply less than committed volumes
Pakistan and Nigeria planning more IPV SIAs
2. Busy 2015 introduction schedule
Over 39 countries planning introduction in Q4

32. Complete replacement of tOPV by bOPV
OPV type 2 withdrawal
Complete replacement of tOPV by bOPV
156 tOPV using countries and territories (tOPV only and sequential schedules)

33. OPV type 2 withdrawal Protocol
Globally Synchronized over a 2 week period
Within these 2-week window, all countries switch on one day (national switch date)
Countries choose the day according to their plan
Recall – destruction – Validation
During the 2 weeks following the national switch date
No use of any tOPV after the national switch date
In routine, in campaigns and in trials/studies
Manufacturers will not supply any tOPV after the switch date

34. Example at country level
Last Switch Date
No more tOPV use
Only bOPV is used globally
2 weeks Switch Window defined globally
April 2016
National Switch Date selected by the country: Any day during that 2 week period W1 W2 W3 W4
Global Validation
Country switches to bOPV
Recall & Disposal of tOPV and validation
bOPV distribution
starts 2 weeks before
The protocol for the Switch was endorsed by SAGE in October 2014

35. Planning type 2 withdrawal at country level
Switch protocol
Discussion with countries during EPI managers meetings
Dry –run of protocol in 3-4 countries by April
Countries to develop Switch plan by September
Technical Assistance
Through WHO and Unicef Regional Offices
Training of consultants planned for April
Training of STOP teams
Intense communication effort
Series of Webinar starting next week
High level communication by DG and UNICEF EXD to all MoH (end of March)
Briefing and technical materials to all WHO and UNICEF country offices
Briefing sessions with all countries through regional meetings

36. bOPV Licensing for Routine Vaccination
Issues:
150 countries [and 6 territories] switch from tOPV to bOPV
bOPV label change to include routine vaccination is not yet available
WHA resolution:
The May 2015 resolution will urge countries to accept bOPV for use in routine programmes
National registration
On the basis of WHO-prequalification, while National registration is on-going

37. bOPV label change
3 manufacturers / fillers have applied for label change
Sanofi Pasteur in November 2014
Approval expected in mid-2015
GSK in March 2015
Panacea Biotec Ltd in March 2015
DCGI approval in process

38. Polio Legacy in Action

39. Polio Eradication and Ebola Response Legacy in Action
Polio staff and systems:
Deployed immediately & extensively
Current deployment from NPSP, India
Instrumental in rapid containment of Ebola in Nigeria
Maintained eradication activities in W Africa
Restoring immunization systems in affected countries

40. Legacy of Polio Eradication a public health asset & international health security
Assets concentrated in countries with weak health systems, conflict, complex emergencies
Global field and laboratory surveillance systems
A well-trained disease detection & containment force
Engages & accesses the hardest-to-reach groups
Builds public health capacity
Supports immunization programs

41. Summary – 2015 a defining year
Unprecedented progress in Africa, risks remain
Pakistan: not yet on track, remains an international risk
Strategic Priorities: Surveillance, risk reduction, response capacity
Impressive progress toward IPV introduction
Legacy: Harness broader benefits of polio eradication
Financial & political support essential for the Endgame

42. THANK YOU!

43. Alignment of Containment & OPV Withdrawal Timelines, (2014-2020)
6 x Regional certification of WPV eradication
WPV2/cVDPV2 containment
Phase I:
Global readiness coordination
(until end-2015)
Phase II:
Global poliovirus type 2 containment period
(2016 – 2018)
Phase III:
Long-term poliovirus containment
(as of 2019)
Global
readiness criteria met 2
OPV2
withdrawal
Sabin
Destruction, prep.
for containment
NOW
bOPV
cessation
Sabin2 containment
WPV +
cVDPV
Inventory, destruction, preparation for containment
Final containment
of all WPV/cVDPV 1
Certifica
tion
Containment
of all Sabin
Certification