Polio Eradication Finishing the Job

1
Polio EradicationFinishing the Job Protecting
our Investment
2
Major Issues for GAVI

• Six country focus in 2004-5.
• Revised date for Global Certification (by 2008).
• Decision to stop immunization with OPV (by 2010).
• Mainstreaming of the polio infrastructure (by
  2010).

3
Interrupting Poliovirus Transmission

• 2004-2005

4
Intensified Polio Campaigns Rapid Response to
Importations
type 1 polio
type 3 polio
endemic country
importation
5
Risks - Campaign Quality
Planned Coverage in Country
Activities, 2004 infected areas

• India 5 NIDs 1 SNID gt85
• Pakistan 4 NIDs 2 SNIDs gt80
• Nigeria 4 NIDs 2 SNIDs 50

based on monitoring results of most recent SIAs
in 2003
6
Polio-free Areas
2. establish detailed importation plans. 3.
continue NIDs/SNIDs in high risk areas.
(e.g. areas bordering Nigeria, India)
7
Risks - Financing Interrupting Polio, US 3
billion, 1988-2005
Public Sector 65
Multilateral Sector 10
2003-5 Funding Gap US 210 million
Private Sector 25
Other includes the Governments of Australia,
Belgium, Finland, Ireland, Italy, Luxembourg,
Malaysia, New Zealand, Norway, Oman, Republic of
Korea, Russian Federation, Switzerland, Saudi
Arabia, the United Arab Emirates Aventis, De
Beers, Inter-American Development Bank,
International Federation of Red Cross and Red
Crescent Societies, Millennium Fund, Oil for Food
Programme, OPEC Foundation, Smith Kline
Biologicals, UNICEF National Committees, UNICEF
Regular Resources United Arab Emirates Red
Crescent Society, UK National Committee/British
Airways, Trick-or-Treat for UNICEF, WHO Regular
Budget and Wyeth.
8
Global Certification and Mainstreaming

• 2006-2008

9
Priorities - Certification
10
Rationale - OPV Cessation Outbreaks due to
vaccine virus
Hispaniola Type 1, 2000-01 22 cases
Egypt Type 2,1988-93 32 cases
continued use of OPV will compromise the goal
of eliminating paralytic disease due to
circulating wild polioviruses . Expert
Consulation Sept 2003, Geneva
Philippines Type 1, 2001 3 cases
Madagascar 2002, Type 2 4 cases
11
Priorities - OPV Cessation

• Develop products
• 3rd Edition of Global Action Plan for Laboratory
  Containment.
• guidelines to assist national decisions on future
  polio policy.
• monovalent OPV.
• Sabin-based IPV.
• appropriate IPV combos.
• Develop policy for each product.

12
Products - OPV Cessation Global immunity based
on current coverage
2008
Options
No polio vaccine
OPV
IPV
13
Priorities - Mainstreaming

• Incorporate longterm polio functions into
  existing mechanisms for serious pathogens
• surveillance lab (e.g. International Health
  Regs)
• stockpiles response (e.g. yellow fever,
  mening.).
• lab containment verification (e.g. smallpox).

• Integrate polio-funded human resources
  infrastructure into Country Focus, surveillance,
  control EPI initiatives (esp. measles, RED).

14
Mainstreaming Human Resources

• 2004-6 transition immunization socmob staff
  (eg. to measles)
• 2006 reduce surveillance lab staff to min. for
  certification.
• 2006-8 explore cost-sharing of staff with other
  programmes.
• 2010 discontinue polio funding for field
  positions.

15
Recommendations to the Board

• Note the 2004-8 Strategic Plan update GAVI
  milestones (i.e. 2008 for certification of global
  eradication).
• Enhance high level advocacy with endemic and high
  risk countries to ensure transmission stops in
  2004-2005.
• Explore GAVI role in the development of products
  for the OPV cessation phase.
• Reflect implications of polio mainstreaming in
  GAVI plans.

16
(No Transcript)
17
Polio Financing, 1988-2008
18
Uttar Pradesh, IndiaRapid progress 2002-3
19
Summary

• India Pakistan on track Nigeria is highest
  country risk.
• Jan 2004 launch of intensified activities
  countdown.
• OPV cessation requires rapid product development.
• Polio infrastructure will be fully mainstreamed
  by 2010.
• Insufficient funding threatens this GAVI
  milestone.

20
Wild Poliovirus, 2003data as of 27 November
Endemic Cases
Imports
21
Advocates for theStrategic Plan

• Ministers of Health endemic areas
• The G8 Summit
• The African Union Summit
• The Islamic Conference Summit
• Strategic Plan Launch
• January 2004

22
Close Gaps in AFP Surveillance
23
Kano, NigeriaNeed for effective advocacy SIA
quality
24
NWFP Sindh, PakistanVerge of Eradication - Low
or Zero Cases in High Season
25
Global Certification Priorities

• Improve surveillance in 19 lagging
  countries/areas 10 in Africa, 7 Eastern
  Mediterranean, 2 Southeast Asia.
• Maintain the laboratory surveillance network.
• Complete phase II of the Global Action Plan for
  the Laboratory Containment of Wild Polioviruses.
• Complete the certification process (document
  verification)