As part of efforts to prepare for the polio post-eradication era, the World Health Organization (WHO) and its partners have facilitated the development and transfer of new polio vaccine technology to vaccine production facilities in India and the Republic of Korea.

In collaboration with the Netherlands Vaccine Institute (NVI), and more recently the National Institute for Public Health and the Environment (RIVM) in the Netherlands, clinical lots of inactivated polio vaccine (IPV) produced from Sabin poliovirus seed-strains have been prepared. Traditional IPV is manufactured using wild poliovirus and an inadvertent biocontainment failure could be associated with serious consequences in some areas of the world in the post-eradication era (ie areas with high population density, inadequate sanitation infrastructure and low population immunity levels). Sabin seed strains for IPV have the advantage over wild polioviruses that they are attenuated, and hence are safer for handling and IPV production in developing country settings in the post-eradication era.

In this first phase of a broader intended technology transfer programme, two manufacturers have been selected to receive this new technology for vaccine production: Panacea Biotech, Ltd in India, and LG Life Sciences, Ltd in the Republic of Korea. Both manufacturers have confirmed their intention to use all reasonable efforts to apply for registration of their Sabin IPV products in the country of production within four years from the dates of conclusions of the bilateral agreement with RIVM. WHO and RIVM will continue the technology transfer programme this year with further manufacturers.

This transfer of technology is a significant milestone in preparations for the polio post-eradication era. Following the eradication of wild poliovirus globally, use of all oral polio vaccine (OPV) in routine immunization programmes will need to be stopped due to the risks associated with the continued administration, in the post-eradication era, of the live (attenuated, but not inactivated) polioviruses contained in OPV. These risks include vaccine-associated paralytic polio and the generation of new, circulating vaccine-derived polioviruses. Therefore, after the eradication of all wild polioviruses, and the eventual cessation of OPV for use in routine immunization programmes, any country choosing to continue to immunize its population against polio will need to do so with IPV, the only option which will be available to do so at that time.

Recognizing that the manufacturing costs and price of IPV are currently substantially higher than that for OPV, the Global Polio Eradication Initiative (GPEI) is studying a range of approaches to establish affordable strategies for IPV use in low-income settings following OPV cessation. The development, manufacture and distribution of a safe, effective and affordable Sabin IPV that can be produced securely in developing country settings is a key landmark in this programme of work. This technology transfer will also help to boost more broadly the domestic production capacity for vaccines and the strengthening public of health systems to ensure more equitable access to vaccines.

The development of Sabin IPV and the related technology transfer work has been generously supported by the Bill & Melinda Gates Foundation.

The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99%. In 1988, more than 350,000 children were paralysed each year in more than 125 endemic countries. In 2010, 1,291 cases were reported worldwide, from 20 countries. Only four countries remain endemic: Afghanistan, India, Nigeria and Pakistan.

Global eradication of polio cannot be achieved without the support of the people living in polio-affected communities. A community forum, as recently held in three districts of eastern Chad, allows communities to ask questions, express concerns , make suggestions and take ownership of polio eradication.

Heads of cantons and villages in Am Dam UNICEF/Chad/2011
Heads of cantons and villages in Am Dam
UNICEF/Chad/2011

17 May, N’djamena – In three districts of Eastern Chad with recent polio cases, UNICEF organized community fora on 9 and 10 May. The fora in Biltine, Guéréda and Am Dam brought together all local authorities, religious leaders, women and youth groups, as well as other influential personalities, to reinforce social mobilization against the disease, which is dangerously spreading through the country.

The fora provided a space for open dialogue on the epidemic and the obstacles to polio eradication. This kind of engagement is not merely about convincing parents to vaccinate their children, but is an opportunity to source local solutions to local problems. For example, micro-plans to reach every child were developed with all the operational heads of villages and ferricks, and the representatives of nomads. These fora also provided the opportunity to refute previous immunization coverage figures that were reportedly well above 100% – many villages and ferricks identified during the fora were never vaccinated. More

The Hausa people have a saying: When you shave a man’s head, it is getting the last hair that is the most difficult. So it is with eradicating polio.

 A health worker visits a house and vaccinates an infant. During supplementary immunization activities, health workers walk from house to house, vaccinating every child under five. Tom Moran/WHO

A health worker visits a house and vaccinates an infant. During supplementary immunization activities, health workers walk from house to house, vaccinating every child under five.
Tom Moran/WHO

Dr Muhammad Pate, Executive Director of Nigeria’s National Primary Healthcare Development Agency, blogs about his country’s fight against polio.

In Nigeria we have made remarkable progress in the fight against polio, with campaigns that drove polio down from 388 cases in 2009 to 21 in 2010—a 95 percent reduction. We are extremely hopeful these gains continue and we know much hard work remains.

This progress is largely due to the immense momentum of our polio campaign. It has demonstrated that immunizations are safe, cost-effective tools to prevent infectious diseases and ultimately save children’s lives. The number of parents who refuse immunizations is falling because parents and traditional leaders have witnessed the effectiveness of oral polio vaccines to protect their children from paralysis and death.

The polio program has provided the momentum to combat other vaccine-preventable diseases like measles, which cost us our children’s lives as well.

In January 2011, Nigeria launched a major campaign to administer both measles and polio vaccines to 31 million children under the age of five—thereby protecting children from two diseases. And during an upcoming national campaign later this month, health workers at fixed posts around the country will offer children doses of oral polio vaccines—along with an integrated package of other health interventions, including Vitamin A, deworming tablets and other routine immunizations.

From this broad perspective, conquering polio has an impact far beyond the immediate benefits of eradication. Perhaps polio eradication’s most enduring legacy will be that it lays the groundwork for countries like Nigeria to defeat other childhood diseases.

Still, there is significant work to be done. As long as polio exists in Nigeria, it can exist anywhere. To finally finish the job, we must maintain the momentum for mass immunization campaigns. Once Nigeria and the world win the fight against polio, it will inspire us to continue to tackle other pressing health challenges.

The Hausa people, who live in northern Nigeria, have a saying: When you shave a man’s head, it is getting the last hair that is the most difficult.

Similarly, the final chapter of polio eradication – in Nigeria and globally—will require even more effort than the previous ones. When we work tirelessly to ensure that our momentum is sustained we get closer to finishing the job on polio and building upon that success to protect children from other deadly diseases as well.

Watch the full video – Ending Polio: Building on the momentum

More than 180 countries across Africa, the Americas, Europe, the Middle East and the Pacific rim demonstrate their commitment to immunisation.

A child is vaccinated against polio in Kolkata, India Rod Curtis/UNICEF
A child is vaccinated against polio in Kolkata, India
Rod Curtis/UNICEF

Starting 23 April, countries unite under the umbrella of immunization week and implement activities to raise awareness, inform and engage key audiences on the value, importance and challenges regarding immunization.

During the week, polio supplementary immunization campaigns are taking place in India, central Asia and west Africa. In addition, vaccination services such as tracking of unvaccinated people, implementing large-scale vaccination campaigns and using Child Health Days to deliver an integrated package of life-saving health interventions will take place. These health interventions include: providing vitamin A supplementation to boost children’s immune systems; provision of deworming medicine; growth monitoring; and distribution of insecticide-treated nets to prevent malaria.

This unprecedented collaborated effort between the regions is building public and professional awareness of the value of immunization as well as saving lives.

For videos, regional resources and more

Kolkata, 30 March 2011 — Rukhsar Khatoon takes one look at her visitors and tucks her face into her mother’s shoulder, crying in fear.

From the safety of her mother’s lap, Rukhsar Khatoon looks suspiciously at her visitors in the hospital where she is being treated for polio-paralysis. S. Bari/WHO

Ever since she was paralyzed by polio, Rukhsar has had to confront doctors, epidemiologists, physiotherapists and nurses – and this pesky photographer is the last straw. To her, they are all “doctor-folk”, and she wants nothing to do with them, her mother explains apologetically.

The attention around Rukhsar started when her paralysis was reported to the health authorities in her district of Howrah, in the Indian state of West Bengal. She is the only child to have been paralysed by polio in India this year.

Always a sickly child, Rukhsar was never vaccinated against polio. Her young mother Sabera Bibi explains, “I didn’t know what polio was. I thought the polio drops were for general good health.” Sabera’s two older children were regularly given oral polio vaccine during supplementary immunization campaigns, but because Rukhsar was often sick with diarrhoea, Sabera and her husband Abdul Shah were reluctant to vaccinate her.

When Rukhsar couldn’t walk on 13 January of this year, her parents took her to the local hospital. On 7 February, analysis of her stool samples confirmed that she had polio. Within a week, a mop-up vaccination campaign was taking place around Rukhsar’s home, to ensure other children wouldn’t fall victim to poliovirus. By May, three campaigns will have taken place in Howrah and the greater Kolkata area, to build a wall of immunity around West Bengal.

“I made a mistake,” her father Abdul says quietly, “by not giving her polio drops. I would beg every parent to vaccinate their child and not make the same mistake.”

Sabera adds, “This is the one child I did not vaccinate, and now she is the one affected. You must vaccinate your child,” she reminds her visitors.

Although her condition is improving with physiotherapy, it is not certain that Rukhsar will regain the ability to walk. Married herself at 15, Sabera worries about her daughter’s prospects for schooling and marriage. Abdul, who works in the zari (fine embroidery) industry like most of his neighbours in their village, frets about the financial costs of Rukhsar’s treatments. “The doctors have been very kind,” Sabera says, “but we have to think of the future and our other children.”

The virus which stilled Rukhsar’s legs is related to poliovirus found in New Delhi. Poliovirus can travel long distances easily, hitching a ride among travellers and migrants and ferreting out the most vulnerable – the unvaccinated, the under-vaccinated, the very young. In Rukhsar’s village, which is largely Muslim, most families have a member working in Mumbai, India’s melting-pot megacity. The village also has contact with communities from Bihar and Uttar Pradesh, the two polio-endemic states of India.

Many of Rukhsar’s neighbours are what public health advocates call the ‘under-served’. Poor, marginalized, often belonging to a minority or migrant community, these groups have less access to health and other government services. Polio in India is now nearly entirely restricted to these communities. The state and federal authorities use specific tactics to reach such children, tactics which range from mapping a migrant group’s seasonal movements to special efforts to address the needs or concerns of minority communities about vaccination.

But all of this matters little to Rukhsar, who is in treatment in a hospital in Kolkata. The paralysis has not affected her spirit, and she keeps her brows knitted in warning at her visitors, adding a sharp cry whenever they venture too close. “She has always been a handful,” Sabera rues. “Everyone at home misses her. But I cannot leave here until she walks.”

Launching campaigns in Buddhism’s holiest site

An infant receives polio vaccine from the Dalai Lama UNICEF/India
An infant receives polio vaccine from the Dalai Lama
UNICEF/India

 

The Dalai Lama inaugurated polio vaccination campaigns here today, in Buddhism’s holiest site. The campaigns in Bihar state, India, were the first in the country to use the new bivalent oral polio vaccine, which protects children from both surviving types of wild poliovirus.

A landmark polio project puts thousands of newborns on the map every month

Mobile polio immunization teams walk from house to house to vaccinate newborn babies
Mobile polio immunization teams walk from house to house to vaccinate newborn babies

In the teeming streets of Uttar Pradesh (UP), ensuring each of the estimated 38 million children in India’s most populous state is immunized remains one of the global polio eradication initiative’s greatest challenges. Here, more than 400 000 children are born every month and until recently, up to half those names were not making it onto the official government registry.

Week by week, mobile polio immunization teams, which literally walk from house to house throughout UP to ensure blanket immunization coverage, continue to find unregistered, unimmunized newborns. These infants are not only susceptible to contracting polio; they also act as a reservoir for the virus to survive in the community and make for inaccurate immunization coverage figures.

Seeking a solution, the National Polio Surveillance Project (NPSP) – a joint project of the Government of India and the World Health Organization – established the Tracking Every Newborn initiative, where individual immunization teams recorded the details of each newborn infant on their house-to-house visits, moments before giving them their first dose of oral polio vaccine. In a 12-month pilot project undertaken across one block in each of eight districts of western Uttar Pradesh, the names of all newborns were added – at the block level – to the immunization registers held by the local Auxiliary Nurse Midwives (ANMs). After six months, the number of registered infants had nearly doubled. Results from the eight pilot blocks showed that while the ANM’s registers had shown 16 569 newborn children, polio workers had confirmed an additional 15 742 newborn children – who now had access to routine immunization session in the villages.

This improvement made it possible to determine more accurate immunization coverage: for example, of the 32 311 infants that now appeared on the official register, only 60% had received a DPT3 (diphtheria, polio and tetanus) immunization.

The Tracking Every Newborn project has also motivated the community – from ANMs to polio teams to the parents themselves – to ensure that all newborn children are placed on the official register for immunization purposes. The success of the pilot phase of the project has led the Uttar Pradesh Government to request that the initiative be expanded to other blocks from March 2009, to ensure every child in Uttar Pradesh gets counted – because every child counts.

Message on British Houses of Parliament to celebrate 103 years of Rotary

The Rotary wheel logo and the “End Polio Now” message is beamed onto the Houses of Parliament, UK Rich Hendry, courtesy of Rotary International
The Rotary wheel logo and the “End Polio Now” message is beamed onto the Houses of Parliament, UK
Rich Hendry, courtesy of Rotary International

A giant Rotary wheel – the organization’s logo – and the words “End Polio Now” were beamed onto the side of the House of Commons to the left of Big Ben on Rotary International’s 103rd Birthday on Saturday, 23rd February – to start a challenge to raise US$ 100 million to help finally eradicate polio from the world.

Polio eradication has been Rotary’s top priority since 1985, inspiring the launch of the Global Polio Eradication Initiative, a partnership which has cut the number of polio cases by 99 per cent since then. The disease is now only endemic in four countries: India, Pakistan, Afghanistan and Nigeria. Recently, the Bill and Melinda Gates Foundation gave Rotary a US$ 100 million challenge grant, which Rotary will match over the next three years.

The BBC aired images of the display, along with interviews with DG Colin Mathews and Gautam Lewis, a 30-year-old polio-survivor who immunized children on behalf of Rotary in his birthplace of India in November 2007. More

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