Opening of the 75th World Health Assembly – 22 May 2022. © WHO

May 2022, Geneva, Switzerland – Global public health leaders convening last week at the World Health Assembly called for urgent action to end polio once and for all before a unique window of opportunity closes for good.

Recent efforts have had a clear impact on the global epidemiology of poliovirus, with endemic wild poliovirus transmission at extremely low levels, with just Pakistan and Afghanistan remaining endemic, and efforts to curb circulating vaccine-derived polioviruses (cVDPVs) showing fruit. Steps have been taken towards securing the legacy of polio eradication systems and know-how, under the Strategic Action Plan for Polio Transition. But delegates cautioned that this ‘window of opportunity’ will not remain open indefinitely, as experts pointed to recent concerning developments such as new wild poliovirus cases confirmed in Pakistan (the first cases reported in 15 months), wild poliovirus detected in south-east Africa (the first on the African continent since 2016), and polio re-emergence in Ukraine and Israel.

“Worrying developments in recent months highlight how fragile this progress is,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing the Assembly.  “These developments are tragic for the children affected and their families.  But the reality is that in the final stages of an eradication effort, this is expected.  This year, we have the real opportunity to halt wild poliovirus transmission.  At the same time, we must respond faster and better to cVDPV outbreaks, to interrupt all transmission by end-2023.”

Success, however, depends on reaching remaining children who have not been immunized – the ‘zero-dose’ children at the heart of the Immunization Agenda 2030 (IA2030).

Such a need was identified at this month’s G7 joint Development and Health Ministers meeting in Berlin, Germany, where discussions focused on “supporting vaccine equity and pandemic preparedness in developing countries”. The meeting cautioned against letting global crises interfere with other development and public health priorities and urged continued support for existing efforts, including global polio eradication.  Polio eradication is a clear and concrete example of the value of working in close integration with other public health and development efforts. Polio staff continue to contribute to the COVID-19 pandemic response and immunization recovery efforts, together with supporting the introduction and roll-out of COVID-19 vaccines.

Ministers and high-level delegations from 20 countries of regions affected by both WPV1 and cVDPV met with senior GPEI leaders for focused discussions on concrete ways to close the final chains of virus transmission. The meetings were chaired by Polio Oversight Board chair Dr Chris Elias from the Bill & Melinda Gates Foundation and respective WHO AFRO and EMRO Regional Directors, Dr Matshidiso Rebecca Moeti and Dr Ahmed Al-Mandhari.  Key priorities were the importance of reaching zero-dose children, the challenges of complex emergencies and weak health systems, as well as the importance of inter-country coordination and collaboration.

Underscoring the urgency in giving the world one less infectious disease to worry about once and for all, WHO Director-General Dr Tedros issued a clear challenge to the Assembly:  “For countries affected by polio, it is imperative that you reach every last child, and that you respond to vaccine-derived strains with the same urgency as you would to a wild strain.   For countries that are now polio-free, it is crucial to accelerate  efforts to use your polio assets and infrastructure to build stronger, more resilient health systems.  And for all partners and donors, please help us seize the moment to raise predicable funding, for eradication and transition.  I urge you to join us in Berlin this October at the pledging event* generously co-hosted by the Government of Germany.  Your decision this week to support a stronger, sustainably financed WHO will enable us to sustain capacity in countries that are now polio-free and on the pathway to transition.  Thank you all once again for your commitment to consigning polio to the history books.”

This call to action was echoed by Rotary International, the civil society partner of the global eradication effort.  Addressing the Assembly on behalf of its 1.2 million members worldwide, Rotarian and Rotary Representative to the UN in Geneva, Professor Dr Pierre Hoffmeyer, concluded:  “We call on all countries to address gaps in routine immunization levels and ensure robust surveillance to prevent further virus spread and avert future outbreaks.”

*In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.  In October 2022, Germany will generously co-host a global pledging moment, giving the international development community the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

Global health leaders at the opening session of the 144th Executive Board Meeting. © WHO
Global health leaders at the opening session of the 144th Executive Board Meeting. © WHO

WHO Director-General Dr Tedros Adhanom Ghebreyesus opened the Organization’s Executive Board (EB) on 24 January with a report from his first visit of the year, to the polio endemic countries of Afghanistan and Pakistan: “This year I have taken over as chair of the Polio Oversight Board. That’s why my first trip of the new year was to Afghanistan and Pakistan. These are the two countries that are the last frontiers of wild poliovirus. We are so close to ridding humanity of this disease, and I am personally committed to ensuring that we do. I was really impressed by the commitment of the governments of Afghanistan and Pakistan.”

The Executive Board, comprised of 34 Member States’ designated experts in the field of health, convened in Geneva in late January to discuss a wide-ranging agenda on the most pressing and urgent health concerns of our times, including the urgency to rev up efforts in this last mile of polio eradication efforts.

The EB was encouraged by the progress achieved through the Endgame Strategic Plan 2013-2018, which has led the world to the brink of polio eradication and laid the groundwork for the new strategy – the Global Polio Eradication Initiative Strategic Plan 2019-2023. The new strategy will aim to sharpen the tools and tactics that led to the global progress in bringing down the case load from 350 000 annual wild polio virus cases in 1988 to only 33 cases in 2018. Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all.

In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero. On the sidelines of the EB, the DG held a stakeholder consultation to ensure that the 2019-2023 Strategic Plan reflects a transparent and inclusive stakeholder participation. The DG stressed the need for strengthened and systematic collaboration between partners, health, and non-health actors across cross-cutting areas of management, research and financing activities for polio eradication. Given that polio eradication effort continues to be a global priority, one of the salient features of the consultation was a renewed commitment to transparent long-term budgets for eradication efforts, including key post-certification costs such as stockpiles and inactivated polio vaccine to help protect more than 430 million children from polio each year.

“In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero.”

Voicing similar sentiments earlier, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all stakeholders, partners, countries, and individuals to strengthen their collective resolve to seeing polio fully eradicated for good. Polio continues to be a global health risk as confirmed at the end of last year, the Emergency Committee reiterated its advice that polio remains a public health emergency of international concern.

Polio resources for over three decades have helped reduce the number of endemic countries from 135 down to only 3 (Pakistan, Afghanistan, and Nigeria), eradicate polio from some of the most challenging areas in the world, and continue to enable countries around the world in advancing other national health goals.

With the continued commitment of all donors and partners, 2019 may very well become the decisive year when we finally stop wild polio virus transmission in Afghanistan and Pakistan.

Report by the Director General to the Executive Board
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140th session of WHO Executive Board, Geneva, Switzerland. Photo: WHO/C.Black

27 January 2017, Geneva, Switzerland – Ministries of health gathering at this week’s Executive Board of the World Health Organization (WHO) reviewed the latest global poliovirus epidemiology and concluded that the world has never had a better chance to complete the job. Amid discussions on Ebola, Zika and pre-elections for the new WHO Director-General, delegates stressed the urgent need to secure a lasting polio-free world, by fully implementing the Global Polio Eradication Initiative (GPEI) Polio Eradication Endgame Strategic Plan.

Endemic polio is now restricted to a handful of areas of Pakistan, Afghanistan and Nigeria, all of which are implementing regionally-coordinated emergency plans to reach and vaccinate the remaining pockets of under-immunized children.

Despite more children being reached in these traditional ‘reservoir’ areas for the virus, delegates cautioned that risks remained, as underscored by the detection of polio cases in Borno state of Nigeria, the first in two years anywhere in Africa.  Countries are now focusing on making sure there are no surveillance gaps at a subnational level so that virus cannot circulate undetected, while working to increase population immunity levels.

Delegates commended the successful global switch from trivalent oral polio vaccine (OPV) to bivalent OPV in 2016, and emphasized that strong surveillance to detect any type 2 poliovirus from any source is now critical.  A global stockpile of monovalent OPV type 2 (mOPV2) remains on hand for potential response as needed.  A critical global supply shortage of inactivated polio vaccine (IPV) continues to pose a risk, but is being managed by prioritizing available supply to high-risk areas and implementing new measures to stretch available supply, notably use of fractional IPV, as recommended by the Strategic Advisory Group of Experts on immunization (SAGE).

At the same time, countries expressed appreciation at the ongoing efforts to fully implement global laboratory containment activities. They also encouraged plans to transition the infrastructure of the GPEI for the long-term, to ensure the assets and infrastructure established to eradicate polio will continue to benefit broader public health efforts even after the disease is gone.  At the World Health Assembly in May, the GPEI will present a strategic roadmap towards polio transition and the development of a post-certification strategy.

With all technical and programmatic building blocks in place to achieve success, ministries urged all stakeholders to ensure that the necessary financial resources to fully implement the Endgame Plan are rapidly mobilized.

Closing the discussion, partners from civil society addressed the ministries through Rotary International with a clear call to action:  “We must protect hard won gains by sustaining immunity levels and careful monitoring of virus transmission.  An additional US$1.3 billion is needed through 2019 to reach more than 400 million children in up to 60 countries and to ensure high quality surveillance.  The eradication of polio will be a monumental achievement by a global partnership.  Such achievements exemplify what we can do when united for a common purpose.  Together we can end polio and forever build a better future for all children.”

Report highlights need for ‘heightened attention’ at all levels; calls funding gap ‘single greatest threat’.

20 April 2011, Geneva, Switzerland – The report of the 31 March-1 April meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) offers its assessment of the progress towards achieving the major milestones of the GPEI Strategic Plan 2010-2012.

Reviewing the latest global epidemiology, the IMB notes considerable achievements since the launch of the Strategic Plan. Of 15 countries with outbreaks starting in 2009, all have been successfully stopped. All new outbreaks from 2010 have been curbed within six months (or are on track to being so). The group concludes, however, that of the remaining endemic and re-established transmission countries, only India is on track to achieve its key milestone, of stopping poliovirus transmission by end-2011, and that therefore, the end-2012 goal of global eradication is at risk. The IMB expresses particular alarm at the current polio situation in Chad, considering it a public health emergency requiring the greatest urgency of action among all remaining polio-affected countries. The IMB called the US$665 million funding gap through end-2012 the ‘single greatest threat to the GPEI’s success’.

Despite these challenges, however, the IMB concludes that polio eradication is feasible in the near term, but warns that this goal will only be achieved with ‘heightened attention’ at all levels. The group welcomes the development of countries’ emergency plans to address remaining operational challenges, and urges for monitoring of these plans at the highest levels of government. The IMB urges the World Health Assembly (WHA) in May to evaluate whether the persistence of polio now constitutes a ‘global health emergency’. And with the economic case for completing polio eradication clearly established, the IMB reminds the international development community that all WHO Member States have together decided to eradicate polio, and therefore full financing of the effort should be a shared responsibility.

The GPEI welcomes the findings and recommendations of the IMB. The heads of the spearheading partner agencies – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF – and the President of the Global Health Program of the Bill and Melinda Gates Foundation will in the coming days discuss the report and its implications, and commit to specific actions their organizations can take to further support countries’ eradication efforts and ensure critical factors identified by the IMB are addressed.

The IMB was established in 2010, at the request of the Executive Board of WHO and the WHA, to monitor progress against the milestones of the GPEI Strategic Plan 2010-2012. The group’s next meeting is scheduled for 30 June-1 July 2011 in London, United Kingdom.

To help inform the new Independent Monitoring Board

A child is immunized against polio in Senegal. Following multi-country synchronized campaigns in west Africa, no cases of polio have been reported in the region since 1 May 2010. UNICEF Senegal. Date March 2010
A child is immunized against polio in Senegal. Following multi-country synchronized campaigns in west Africa, no cases of polio have been reported in the region since 1 May 2010.
UNICEF Senegal. Date March 2010

Geneva, Switzerland – The World Health Organization (WHO) has published its first quarterly ‘data compilation’ against the global milestones of the new Global Polio Eradication Initiative (GPEI) Strategic Plan 2010-2012. The status update provides basic epidemiological information on milestones and major indicators.

This update is part of a series of reports which will inform the deliberations of a new Independent Monitoring Board (IMB). The IMB is being established at the request of stakeholders and the policy-setting bodies of WHO, to facilitate independent evaluation of progress against the global milestones of the GPEI Strategic Plan.

Expected to convene for the first time in late 2010, the IMB – comprised of global experts from a variety of fields relevant to the work of the GPEI – will evaluate whether global milestones and major indicators are on track, at risk or missed. The IMB is expected to convene on a quarterly basis to review progress and assess emergency corrective action plans, as necessary. Reports from the group are presented to the heads of the spearheading partner agencies WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, as well as to the Bill and Melinda Gates Foundation, and will be made publicly available.

Additionally, the IMB is expected to assess the financial risks to fully the implementation of the Strategic Plan 2010-2012. As at October 2010, the GPEI faces a global funding gap of US$810 million for the life of the plan.