Public Health Emergency of International Concern (PHEIC)

Polio this week as of 19 August 2020
:: A cVDPV1 outbreak has been detected in Yemen. WHO and UNICEF are supporting local health authorities to plan and launch an effective outbreak response to limit virus spread.
:: Next week the African Regional Certification Committee is anticipated to announce that the African Region has met the required standard to be certified as wild polio free. To mark the occasion, a live stream to the virtual ceremony will be publicly accessible via WHO channels and a dedicated website.
:: The 18th report of the Independent Monitoring Board has been published on the GPEI website. The report presents an analysis of the current status of eradication efforts and makes recommendations to help accelerate progress toward interruption of wild poliovirus and the absence of all circulating vaccine-derived polioviruses (cVDPVs). The GPEI welcomes the IMB’s recommendations, scrutiny and shared commitment to polio eradication, and will continue to work closely with the IMB, polio-affected countries and partners to optimize the polio. [See excerpts below]
:: Dr Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. In the latest story in our ‘Women Leaders’ series, she shares advice for the next generation of women leaders.

Summary of new WPV and cVDPV viruses this week (AFP cases and environmental samples):
:: Afghanistan: three WPV1 cases, one WPV1 positive environmental sample and five cVDPV2 positive environmental samples
:: Pakistan: two WPV1 cases, two WPV1 positive environmental samples and two cVDPV2 positive environmental samples
:: Cote d’Ivoire: four cVDPV2 cases
:: Nigeria: one cVDPV2 case
:: Somalia: two cVDPV2 cases and four cVDPV2 positive environmental samples
:: Sudan: two cVDPV2 cases
:: Yemen: 15 cVDPV1 cases


18th report of the Independent Monitoring Board
July 2020 :: 60 pages
INTRODUCTION. [excerpts]
…It is essential that the Polio Programme remembers that, by the end of 2019, it stood on very shaky ground. There were massive challenges both in interrupting wild poliovirus transmission in the endemic areas and in managing many vaccine-derived poliovirus outbreaks.

Cases of poliovirus had increased fivefold between 2018 and 2019. There was uncertainty and doubt surrounding the effectiveness of strategies and tools.

At the Polio Oversight Board meeting, that immediately followed the Abu Dhabi Pledging Conference, on 20 November 2019, donor countries made an unprecedented demand that the GPEI should review and reform its governance and accountability structures. This did not reflect a reduced determination by these donors to get the job done, but rather the depth of their concern that there was no clear end in sight for polio eradication, and a lack of clear accountability in a $1 billion a year spending programme.

Even before COVID-19, many donor countries’ overseas aid budgets were being heavily scrutinised. With the coronavirus’s savage impact on national economies, the case that polio dollars are safe in GPEI hands will, in future, need to be more convincingly made to the governments and taxpayers of these countries. At the same time, there is greater need for resources than originally planned.

Each year of failure to eradicate polio results in enormous health, opportunity, and economic costs. The budgetary needs of the programme are increasing steeply. They will increase further if vaccine-derived poliovirus outbreaks continue to occur on a wide scale. Also, conducting polio campaigns in a COVID-19 environment will be much slower, will need many more precautions (such as personal protective equipment), and, as a result, will be more expensive.

…Overall, since late February and early March 2020, more than 60 polio vaccination campaigns, of different geographical scales, have been paused in 38 countries. Six million doses of vaccine had been delivered to those countries. They could not be used. Another 100 million doses have been procured, but still await shipment because of air freight disruption. Some of these vaccines have been delivered, in the weeks running up to vaccination campaigns that were resumed in July 2020. However, other batches of vaccines will be nearing the end of their shelf life and the Polio Programme will have to bear the costs of the waste and resupply. Also, some of the suppliers are reaching storage capacity and may well be forced to stop production, and there may be longer-term implications for manufacturers…

The Polio Programme is now poised for resumption when vaccine rounds can be planned and start again. The GPEI has set up a new committee to oversee this process, to be called the GPEI Continuity Planning and Facilitation Group (PFG). Its objectives include:
:: To facilitate development and tracking of a comprehensive global level GPEI workplan, in support of regional and country polio eradication activities, to adjust to the COVID-19 pandemic;
:: To identify any long-term strategic adjustments to the Polio Endgame Strategy 2019–2023 that may be required in the post-emergency phase of the COVID-19 pandemic in order to ensure sustainable, effective programme operations…

CONCLUSIONS. [excerpts]
It remains deeply inspiring to have a global vision of a world free of polio. It is a noble cause. It is important to many dedicated individuals currently working in the Polio Programme, and to others who have given a major part of their professional careers to the endeavour. It is a solemn reminder of front-line workers who lost their lives, and those who still do, to blind hatred for their personification of a humanitarian ideal. Ultimately, it will be a public good for all people of the world.

That vision currently seems a distant pinpoint of light. The Polio Programme is in dire straits. With a worsening epidemiological position, during 2019, for both wild and vaccine-derived poliovirus cases, the world was hit by a devastating pandemic of coronavirus. A yawning funding gap is opening up.

The Polio Programme stands in the middle of 2020 confronted by twin challenges that stand in the way of eradication. The first is the challenge of facing up to the real reasons that it went off track in 2019 into a jaw-dropping slump of performance at a time that the “almost there” narrative was believed by too many people. The phrase now being used to encourage everyone is: “The last mile is always the most difficult”. The Polio Programme is too forgiving of itself.

The second is the challenge of making the right choice of paths, emerging from the coronavirus crisis. An oft-repeated phrase at the IMB meeting was that the COVID-19 pandemic has a “silver lining” for the polio eradication programme. What that meant to those at the meeting who referred to it, or what it should mean for everyone involved in the future delivery is less clear.

What is overwhelmingly clear, though, for the Polio Programme at country level, at regional level, and at global level is that to “keep calm and carry on” through this complex situation would be inexcusable.

The criticality of developments over the next several months for polio eradication cannot be overstated. The opportunity of COVID-19 to finally determine innovative and integrated delivery strategies provides a lifeline for polio eradication. The risk of a Polio Programme going back into the field tired and half-hearted about needing new ideas could be the death knell of the programme. The GPEI Strategy Committee, in particular, needs to understand the gravity of the times and treat them as such..