Polio Update ACRONYMS OPV Oral Polio Vaccine IPV

Polio Update

ACRONYMS OPV Oral Polio Vaccine IPV Inactivated Polio Vaccine WPV Wild Polio Virus GPEI Global Polio Eradication Initiative FRRS Financial Resource Requirements series GAVI !!!!!!!

The situation in 1988

In 1988, when the Global Polio Eradication Initiative began polio paralysed more than 1000 children worldwide every day. Since then, more than 2. 5 billion children have been immunized against polio thanks to the cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of more than US$ 9 billion. There are now only 3 countries that have never stopped polio transmission and global incidence of polio cases has decreased by 99 %. In 2013, 416 cases were reported for the entire year as opposed to over 350, 000 in 1988.

In February 2012 India long-regarded as the nation facing the greatest challenges to eradication, was removed from the list of polioendemic countries, convincing doubters that global polio eradication is feasible. There has also been success in eradicating certain strains of the virus; of the three types of wild polioviruses (WPVs), the last case of type 2 was reported in 1999 and the last case of type 3 in November 2012.

The situation now

Afghanistan Nigeria Pakistan

Polio this week as of 15 October 2014 • More than 6 months has passed since a case of wild poliovirus was reported in Syria or Iraq. Over 22 million children have been vaccinated against polio multiple times in the past year, in the midst of active conflict and a humanitarian crisis. • Pakistan has reached 206 cases of paralysis caused by wild poliovirus in 2014. This is the highest number of cases on record by October in Pakistan in any year.

• Reviews took place in both Equatorial Guinea and Cameroon in September to assess the quality of polio outbreak response activities conducted so far. Both assessments concluded that although much progress has been accomplished towards controlling the outbreaks, neither programme can be entirely confident that transmission has been interrupted. Recommendations have been made and follow up missions should take place by mid-December in Equatorial Guinea and by February 2015 in Cameroon.

Year-to-date 2014 Year-to-date 2013 Total in 2013 Globally 243 293 416 in endemic countries 224 99 160 19 194 256 Total cases in non-endemic countries

Case breakdown by country Year-to-date 2014 Countries Year-to-date 2013 Total WPV 3 W 1 W in WPV 1 Total WPV 1 WPV 3 Total 3 3 2013 Pakistan 206 43 Afghanist an 12 7 Nigeria 6 6 Somalia 5 Equatorial Guinea 5 Iraq 2 Cameroon Syria Ethiopia Date of most recent case 43 93 22 -Sep-14 7 14 18 -Sep-14 49 49 53 24 -Jul-14 5 174 194 11 -Aug-14 5 0 0 03 -May-14 2 0 0 07 -Apr-14 5 5 0 4 09 -Jul-14 1 1 0 35 21 -Jan-14 1 6 6 9 05 -Jan-14 0 14 14 14 -Jul-13 293 416 99 160 1 Kenya Total 243 0 0 243 293 0 Total in endemic countries 224 0 0 224 99 0

Comparison

Afghanistan Nigeria Pakistan

Problems

However, tackling the last 1% of polio cases has still proved to be difficult. Conflict, political instability, hard-to-reach populations, and poor infrastructure continue to pose challenges to eradicating the disease. Each country offers a unique set of challenges which require local solutions.

NIGERIA The Centre for Disease Control has declared that the ongoing endemic transmission in Nigeria is a major threat to the success of Global Polio Eradication Initiative. The challenge in Nigeria is that parents refuse vaccination for religious and superstitious reasons. The Nigerian is facing a serious information war with some miscreants who had spread rumors questioning the safety and efficacy of the vaccine. The need in Nigeria is to “stop politicizing polio. ” Achieving control over Nigeria is of utmost importance because it is the only infective focus in the whole of Africa. With the Nigerian situation is still not in control the CDC's recommendation of vigilant surveillance and maintaining high population level immunity across Africa is something that is to be taken seriously.

PAKISTAN & AFGHANISTAN The polio endemic areas consist of three groups of districts, Karachi city, a group of districts in Balochistan, and a group of districts in Federally Administered Tribal Areas and North-West Frontier Province. These are also the areas with incomplete vaccination coverage primarily due to poor security situation although poor administration and corruption are also responsible. For example, media sources claim that more than 1 million children have been deprived of polio vaccine in the North Waziristan Agency region only. Not only are there problems in convincing people to get their children immunized, but also there are problems with poor organization, corruption, and lack of determination among health care workers. Even the media and health activist groups until lately too have failed to lobby effectively to pressurize the government. Security issues also crop up in some regions of Pakistan often thereby leading to failure of vaccination programs. In addition, Pakistan and neighboring Afghanistan repeatedly keep on reinfecting one another due to substantial population shifts between the two countries.

Plans for future action

In 2013 the Global Polio Eradication Initiative launched its most comprehensive and ambitious plan for completely eradicating polio.

Polio eradication and endgame timeline The Polio Eradication and Endgame Strategic Plan 2013– 2018 is a comprehensive, long-term strategy that addresses what is needed to deliver a polio-free world by 2018. The Plan has four objectives, with associated timelines for delivery.

Endemic Countries: Details of external funding requirements for 2014 -2016 Afghanistan Nigeria Pakistan On 25 April 2013 at the Global Vaccine Summit, global leaders, donor nations and polio-affected countries pledged over US$ 4 billion towards the Strategic Plan’s US$ 5. 5 billion six year budget. Since then, the GPEI has continued to work with partners to convert the pledges into signed agreements and cash disbursements and to secure the remaining US$ 1. 5 billion in additional resources. As of 1 February 2014, US$ 1. 5 billion has been operationalized through signed agreements and/or cash payments against funds committed at the Summit. In 2013, the GPEI received US$ 1. 1 billion in contributions.

Countries using and planning to introduce IPV October 2014 status report This slide deck provides a summary per country on the status of planning for the introduction of Inactivated Poliomyelitis Vaccine (IPV). Information here is updated monthly based on information shared by WHO and UNICEF Regional Offices. Please contact polio 2@who. int with any questions or updates on this data. Definitions l Formal decision to introduce: The country has documentation of its decision to introduce IPV which has been verified by the relevant WHO Regional Office, or for GAVI eligible countries, a complete application for IPV has been submitted to the GAVI Secretariat. l Intent to introduce: The country has informally indicated that it plans to introduce IPV, e. g. planning an application to GAVI, or by requesting technical assistance to develop an IPV introduction plan. Tracking these decisions and informal intents provide an indication of the global trend towards meeting the targets of the Polio Eradication and Endgame Strategic Plan.

Countries using IPV vaccine to date and formal decision/intent to introduce Introduced to date (75 countries, 39%) Formal commitment to Introduce in 2014 -2015 (77 countries, 39%) Intent to Introduce in 2015 Since January 2013, the following countries have introduced IPV: Kazakhstan (July 2013); Peru (July 2013); Libya (March 2014); Albania (May 2014); Panama (2014), Nepal (Sep 2014) and Tunisia (Sep 2014) (29 countries, 15%) Not Available, Not Introduced /No Plans Not applicable (13 countries, 7%) Data Source: WHO/IVB Database, as at 01 October 2014 Data of slide: 02 October 2014 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2014. All rights reserved

Countries using IPV vaccine to date and introductions planned according to GAVI eligibility status Introduced to date (75 countries, 39%) GAVI countries with formal commitment to introduce in 2014 -2015 (66 countries, 34%) Since January 2013, the following countries have introduced IPV: Non GAVI countries with formal Kazakhstan (July 2013); Peru (July 2013); Libya (March 2014); Albania commitment to introduce in 2014 -2015 (11 countries, 5%) (May 2014); Panama (2014), Nepal (Sep 2014) and Tunisia (Sep 2014) GAVI countries with intent to introduce in 2015 (4 countries, 2%) Data Source: WHO/IVB Database, as at 01 October 2014 Data of slide: 02 October 2014 Non GAVI countries with intent to introduce in 2015 (25 countries, 13%) Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization Not Available, Not Introduced /No Plans (13 countries, 7%) Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2014. All rights reserved

What do you know about GAVI ?

What’s OUR part in this

ADVOCATE The fight to end polio is a massive effort that Rotary and its partners cannot do alone. Help secure support from governments, non-governmental organizations, corporations and the public. Your advocacy efforts help ensure that no child will suffer from this crippling disease ever again.

SHARE YOUR VOICE Get the facts about polio and spread the word via your social networks, throughout your local community, with the press, and to your government. Outreach Guide and Key Messages Advocacy Flyer Global Outlook: Advocating for Polio Eradication End Polio Now Brochure Guide to Lighting Up Iconic Structures

CLUB MEETINGS Invite policy makers (members of parliament, ministers, members of Congress, development agency representatives) to a local Rotary club meeting to discuss the progress against polio and how they can make history by supporting the fight to end polio. Sample Invitation Letter Certificate of Appreciation

SHARE YOUR STORY Each person has his or her own personal reason for supporting the fight to end polio. You story can help convince others to get involved. Share your story with Rotary for a chance to be featured on this website.

FUNDRAISE Rotary and the Bill & Melinda Gates Foundation have extended their partnership during the critical endgame phase of the Global Polio Eradication Initiative. From 2013 to 2018, every US dollar Rotary commits to polio eradication will instantly become three dollars, thanks to a 2 -to 1 match by the Bill & Melinda Gates Foundation. Join Rotary in the final push to end polio and help make history today.

GRAPHICS Make History Today Infographics Make History Today Banners

END POLIO NOW BROCHURE Secure support from governments, nongovernmental organizations, corporations, and the public to fully fund the polio endgame plan. End Polio Now brochure

SHOP END POLIO NOW Purchase T-shirts, pins and other materials to show your support for polio eradication. Shop. rotary. org EDUCATE Send a letter to the editor. Suggest a polio eradication story to a local reporter. Share Rotary infographics to raise awareness about polio eradication. SAMPLE PRESS RELEASE Develop a press release four local media to use to tell your community about the work you are doing to end polio. Include examples of how you are making an impact and quotes from local Rotary members and other supporters. Download Press Release

Web sites to visit http: //www. endpolio. org https: //www. rotary. org/myrotary/en/take-action/end-polio http: //www. polioeradication. org http: //www. polioaustralia. org. au