Polio eradication programme continuity: implementation in the context of the COVID-19 pandemic Interim guide: May 2020 update v2.0 What is new in the guide On the 25th of March, the GPEI circulated the first update of the interim guide to help ensure continuity of the programme’s operations in the context of the COVID-19 pandemic, as well as its support to the pandemic response while also ensuring the safety of its personnel and the communities it works with. Since then, new evidence has emerged about the characteristics of the pandemic that set pathways for more effective response and adaptation of essential health services and disease control/eradication initiatives such as polio eradication, measles/rubella elimination, and others. The GPEI, in collaboration with partners from other disease initiatives and immunization partners, developed guidance for the implementation of poliovirus surveillance and implementation of the outbreak response and preventive immunization campaigns. This update synthesizes and references new evidence and recommendation to help orient the GPEI’s teams on how to best adapt and manage the polio eradication programme delivery to ensure its alignment with the public heath response to COVID-19 at national and sub-national levels, while conducting context- appropriate polio eradication activities. More specifically, this update builds on the following technical and strategy documents: 1. COVID-19 Strategy Update; 14 April 20201 2. Guiding principles for immunization activities during the COVID-19 pandemic2 3. Interim guidance for the polio surveillance network in the context of Coronavirus (COVID-19)3 4. Guidance on implementation of mass vaccination campaigns. A framework for decision-making and Operational Guidance for Maintaining Essential Health Services that are in development jointly with the IVB and HIS teams An important shift reflected in this edition of the guide is based on better recognition of the dynamics of the pandemic and the short-to-medium term objectives for COVID-19 control. COVID-19 transmission will likely continue worldwide in multiple, often overlapping waves that will likely continue throughout 2020 and, possibly 2021 until sufficient immunity to the COVID-19 is built either through populations’ exposure to the virus or mass vaccination. Until that happens the countries will be aiming at achieving sustainable suppression of transmission at a low level whilst enabling elements of economic and social life. This makes it imperative for the polio eradication teams at the country, regional and global levels to build and implement robust systems for context and programme monitoring, and to adapt the eradication service delivery strategies to effectively mitigate the polio transmission risks as well as building a platform for full- scale resumption of the polio eradication activities when the situation permits. This guide explores ways to adapt the programme’s strategies to enable resumption and effective implementation of eradication activities in the context of COVID-19 pandemic. It promotes close coordination and, where feasible, integration of design, planning and delivery of polio eradication activities with essential immunization the COVID-19 response and delivery of other essential health services, such as essential immunization. 1 Link to the document: https://www.who.int/docs/default-source/coronaviruse/covid-strategy-update- 14april2020.pdf?sfvrsn=29da3ba0_6 2 Link to the document: https://apps.who.int/iris/bitstream/handle/10665/331590/WHO-2019-nCoV- immunization_services-2020.1-eng.pdf?ua=1 3 Link to the document: http://polioeradication.org/wp-content/uploads/2020/04/Interim-Guidance-Polio-Surveillance- in-the-context-of-COVID19.pdf 1 | Page May 2020 The purpose of this document is to guide polio programme continuity planning in the context of the COVID-19 pandemic. Its intended users are the polio programme planners and managers in the GPEI target countries and regional offices. Considering the global nature of the polio eradication programme, it also provides recommendations for the areas of work relevant to global level planning. This document summarises guidance available as of the date of its development. It will be revisited and updated regularly as we learn more about the COVID-19 pandemic and polio eradication operations in the context of disruptions caused by it. It complements, and provides links to, more detailed technical guidance published by the GPEI and its partner agencies. Background and introduction In just a short time, a localised outbreak of COVID-19 evolved into a global pandemic that caused severe societal and economic disruption. Among others, it had serious implications for the delivery of a range of public health interventions and essential health services, including polio eradication. The polio eradication programme largely depends on field surveillance and house-to-house supplementary immunization activities (SIAs) along with large-scale community mobilization and engagement. The pandemic heavily affected poliovirus eradication activities, particularly implementation of the outbreak response and preventative SIAs that were suspended in majority of the GPEI target countries. This is largely because of the morbidity caused by COVID-19 and because countries increasingly divert human, logistical and financial resources to respond to the pandemic. The situation is further complicated with the suspension of flights and closure of international borders. Against this backdrop, it is imperative for the polio eradication programme to strategically plan and repurpose GPEI assets to effectively contribute to the control of COVID-19, whilst also maintaining critical GPEI functions and enabling the full-scale resumption of its activities as the COVID-19 situation evolves. Objectives and principles The polio eradication programme continuity plans should pursue the following four objectives: 1. Maximize the contribution of the polio eradication programme to controlling the COVID-19 pandemic. Facilitate whole-of-government and whole-of-society strategic action adapted according to specific national and sub-national situations and capacities in response to this public health crisis. 2. Ensure effective delivery of the core functions of the polio eradication programme tailored to the local epidemiological context and health systems’ capacity: a. Coordination and communication. b. AFP and environmental surveillance. c. Vaccine supply and management. d. Supplementary immunization activities. e. Novel OPV introduction. 3. Protect polio eradication programme personnel and the communities targeted by the programme from COVID-19 infection through full implementation of infection prevention and control measures, in keeping with the principles of “duty of care” and “do no harm”. 4. Plan for a phased transition towards full-scale, effective resumption of polio eradication activities, including SIAs, as soon as the public health situation with COVID-19 allows. 5. Develop contingency plans, aligned with national and sub-national COVID-19 pandemic preparedness and response to adapt the programme to potential deterioration of the COVID-19 epidemiological situation and/or subsequent waves of the pandemic. 2 | Page May 2020 The following principles should be applied throughout the process of planning and implementation of the programme continuity plans: 1. Tailor response to the specific policy, operational as well as epidemiological (COVID-19 and polio) contexts at the regional, national and sub-national levels. The final decision on how to alter the implementation of polio eradication in the interim period of COVID-19 pandemic rests with the national authorities. 2. Appropriate strategies at the national and sub-national levels must balance measures that address the direct risks attributable to COVID‑19, the impact caused by interruption of poliovirus eradication activities and other essential health and social services, and the acute and long-term detrimental effects on health and wellbeing as a consequence of certain response measures. 3. Protect the gains of the polio eradication programme and minimize the risk of implementing poorly planned and executed polio eradication activities resulting in suboptimal use of resources. 4. Observe principles of “duty of care” and “do no harm” to frontline workers and target communities and ensure gender-responsive programming, acknowledging the impact of the pandemic on the health work force, including frontline health workers, particularly women. 5. Maintain stakeholder confidence in the programme and manage expectations by keeping them informed of programmatic and financial impact of COVID-19. 6. Take lessons from the experience of COVID-19/polio eradication synergy to build on innovations and commitment shown by countries to further improve sustainability of polio eradication efforts once campaigns are resumed. Planning timelines and scenarios The GPEI is currently recommending that the polio eradication programme continuity plans are designed initially until the end of June 2020. Meanwhile, the new COVID-19 strategy calls for countries to implement National Action Plans based on a whole-of-society approach and a realistic appraisal of what is feasible to achieve; first, in terms of slowing down transmission and reducing mortality, and, subsequently, in terms of sustaining low level transmission while society and economic activity resumes. Plans must be flexible enough to react to rapidly changing epidemiological situations