New tools move polio eradication drive into final stage
Technical body highlights Nigeria as single greatest risk to polio-free world
11 October 2005 | Geneva - Strong advances in the remaining polio endemic areas and the recent introduction of new tools have moved the global polio eradication effort into its final phase in all but one country of the world. The conclusion reached this week in Geneva by the Advisory Committee on Polio Eradication (ACPE), the independent, technical oversight body of the Global Polio Eradication Initiative, is that polio could be finished within the next six months everywhere, except in Nigeria.
The recently introduced monovalent oral polio vaccine (mOPV1), which accelerates protection to specific virus types, appears to have stopped transmission in Egypt and most areas of India - the two greatest technical challenges to polio eradication. Developed earlier this year in less than 6 months, mOPVs appear to work faster than traditional trivalent OPV to build immunity against specific polio types. The ACPE recommended that mOPV use be rapidly expanded to ‘mop up’ the remaining polio strains worldwide, including in countries hit by outbreaks such as Indonesia, Yemen, Ethiopia, Somalia and Angola.
"The ACPE concluded that monovalent oral polio vaccines should be the 'workhorse' for the final mop-up stage of the global polio eradication effort," stated Dr Steve Cochi, Chairperson of the ACPE and Director of the National Immunization Programme, CDC. "The power and advantages of monovalent polio vaccines can now be fully used. Of the three types of poliovirus, type 2 has been eliminated since 1999 and type 3 is limited to three areas of focal transmission."
At the same time, however, the group singled out ongoing polio transmission in Nigeria as the single greatest risk to a polio-free world. The group concluded that at least a further 12 months were needed to finish the job in Nigeria, following the 12-month suspension of polio immunization in parts of the country in 2003/2004. The burden of disease in Nigeria is 13-times higher than the endemic country with the next highest number of cases (India), while the decline in new cases this year has been slower than anticipated. The ACPE strongly endorsed efforts to improve the quality of immunization campaigns in Nigeria to ensure every child is reached, and the introduction of mOPVs to maximise the impact of each contact.
"As Nigeria intensifies its eradication effort, we will monitor the epidemiological situation there closely," continued Cochi, "and if necessary, provide further recommendations to polio-free countries to protect themselves from re-infection." Following a year dominated by high-profile outbreaks, the ACPE issued new guidelines requiring more rapid and large-scale immunization responses in such areas.
"The ACPE has concluded that all the tools are now in place to finish polio once and for all," concluded Cochi. "It is now up to the remaining polio-affected countries to effectively use these tools. There is no reason why polio should continue to exist anywhere in the world after next year."
The ACPE stressed that the success of these strategies is largely dependent on ensuring sufficient funds are rapidly made available. Multi-year, flexible funding for 2006-2008 is needed to cover polio immunization and surveillance activities. Most urgently, a US$ 200 million funding gap for 2006 must be filled, US$ 75 million of which is needed by November to ensure activities in the first quarter of 2006 can proceed.
Note: A 'mop-up' refers to a rapid and massive, house-to-house immunization response within four weeks of confirmation of a circulating poliovirus.
Notes to editors: The Global Polio Eradication Initiative is spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.
The polio eradication coalition includes governments of countries affected by polio; private sector foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, Luxembourg, Malaysia, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Russian Federation, Spain, Sweden, United Arab Emirates, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. Sanofi Pasteur, De Beers, Wyeth). Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.
Global eradication efforts have reduced the number of polio cases from 350 000 annually in 1988 to 1 349 cases in 2005 (as of 11 October). Six countries remain polio endemic (Nigeria, India, Pakistan, Afghanistan, Niger and Egypt), however poliovirus continues to spread to previously polio-free countries. In total, 10 previously polio-free countries have been re-infected in late 2004 and 2005 (Somalia, Indonesia, Yemen, Angola, Ethiopia, Chad, Sudan, Mali, Eritrea and Cameroon).