Convening on 30 August in Equatorial Guinea, the Ministers of Health from 46 African countries agreed to a concrete plan of action to grasp this rare opportunity to end polio in Africa. In response to multi-country epidemics which ravaged west, central and the Horn of Africa just 12 months ago, the leadership of Heads of State and Ministers of Health oversaw an unprecedented international outbreak response, featuring new strategic approaches to more rapidly boost population immunity levels. This resulted in a 98% decline in cases in Nigeria (previously the global epicentre of poliovirus), and the significant curbing of epidemics ranging from Senegal to Somalia. Concluding that an unprecedented epidemiologic opportunity currently existed to rapidly deliver a polio-free Africa, the Ministers endorsed a new Resolution, committing to provide the necessary leadership to implement the new strategies and ensure no African child will ever again be crippled for life by polio. Concurrently, however, experts cautioned that Angola and the Democratic Republic of the Congo (DR Congo), which combined have reported 48 of Africa’s 58 cases in the past six months (as of 20 October), posed the greatest threat to a polio-free African continent. And confirmation of new cases in Liberia and Uganda underscore the danger residual, ongoing low-level transmission pose to children everywhere.
Addressing the Regional Committee, WHO Director-General Dr Margaret Chan commended Africa’s progress against polio: “With your collaboration, we now have an aggressive new strategic plan to complete polio eradication. It also introduces accountability at the sub-national level.” Dr Chan was joined by WHO’s Regional Director for Africa, Dr Luís Gomes Sambo, in congratulating countries: “May I hail the immense efforts made by some countries in the implementation of corrective strategies aimed at eradicating polio. Indeed, at the end of July 2010, the number of polio cases dropped by 86% compared to the number of cases recorded in 2009.”
The African Regional Committee Meeting set the tone for the South-East Asia Regional Committee on 7 September. Meeting in Bangkok, Thailand, Health Ministers discussed the sharp downturn of polio cases in India in 2010, particularly the significant progress achieved in the two remaining endemic states of Uttar Pradesh and Bihar. However, the Ministers acknowledged that reaching mobile populations in India was an ongoing challenge that threatened the vision of a polio-free South-East Asia.
Meeting in Moscow, in the Russian Federation, on 13 September, Ministers of Health of the European Region expressed alarm at the recent spread of virus, with this Region, which has been certified polio-free, being re-infected with its first wild poliovirus since 2002. Discussions occurred as confirmation was received that an outbreak which had begun in Tajikistan, had spread to Turkmenistan, Kazakhstan, and the Caucasus region of the Russian Federation. Experts cautioned that Uzbekistan and neighbouring countries remained at extremely high risk of reinfection.
To urgently address the threat this outbreak poses, Dr Zsuzsanna Jakab, WHO Regional Director for Europe, convened an emergency meeting in the margins of the Regional Committee with the Ministers of Health of Russia, Tajikistan, Turkmenistan and Uzbekistan and formulated concrete plans to stop the outbreak before the end of 2010. A series of multi-country immunization campaigns and mop-ups around cases will be conducted across all infected and high-risk areas of these countries, to rapidly stop the outbreak and prevent it from spreading further.
At the Regional Committee for the Eastern Mediterranean on 3 October in Cairo Egypt, Ministers of Health commended the work of the polio infrastructure in Pakistan, which played a critical role in assisting WHO’s flood-relief work by rapidly assessing health facilities, establishing early warning systems for outbreaks and implementing a wide range of immunization services. At the same time, however, experts expressed concern at the ongoing vaccination coverage gap in high-risk areas of North West Frontier Province (now known as Khyber-Pakhtoonkhwa) and Federally Administered Tribal Areas (FATA).
All Regional Committees also discussed the urgent need for the continued support of the international development community. Globally, the Global Polio Eradication Initiative continues to face a US$810 million three-year funding gap, against a US$2.6 billion budget for the 2010-2012. A critical lack of resources has forced the cutting of both supplementary immunization and surveillance activities in key high-risk areas, and given the epidemiological opportunity which presents itself to complete polio eradication globally by 2013, this is a risk the world can not afford to take.