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Curtis Design & layout: Services Concept, Meyrin, Switzerland WHO/POLIO/12.02 Annual Report 2011 INDIA 2012 POLIO- FREE 2 global polio eradication initiative This report is dedicated to the polio vaccinator. ran O WHO/T. M WHO/T. gpei | annual report 2011 global polio eradication initiative 3 Table of Contents e xecutive Summary .................................................................................................... 4 Key events 2011 ............................................................................................................ 5 Stopping transmission of polioviruses .................................................................. 7 1 | On track ................................................................................................................. 7 India South Sudan new Outbreaks 2 | Back on track ...................................................................................................... 13 Angola Chad Democratic republic of the Congo 3 | Off track .............................................................................................................. 19 Nigeria Pakistan afghanistan p 4 | rotecting polio-free areas ................................................................................ 27 Preventing and managing international spread to polio-free areas Polio surveillance: chasing down the virus Strengthening immunization systems p olio eradication – An emergency ........................................................................ 32 Financing ...................................................................................................................... 35 The response: unprecedented financial support in 2011 Going beyond traditional financing Contributors Annex 1: 2011 progress report of the global milestones and process indicators of the GPEI Strategic plan 2010-2012 ...................................... 40 Annex 2: Supporting data for progress report ............................................................ 45 Acronyms and abbreviations .................................................................................. 48 gpei | annual report 2011 4 global polio eradication initiative e xecutive summary Looking back on the second year of the Global Polio Eradication Initiative (GPEI) Strategic Plan 2010–2012, the scales are balanced between significant achievements on the one side and, on the other, some disappointing setbacks. uccess in India was the most remarkable milestone, 2012, the World Health Organization’s (WHO) Execu- Sdeemed “magnificent” by the Independent Monitor- tive Board had called for polio eradication to be declared ing Board (IMB) of the GPEI. Long considered one of a programmatic emergency for global health. the most challenging countries in which to eradicate polio, India accomplished what the IMB called the “sys- Completing polio eradication is now a global emergency tematic enforcement of best practice” to reach over 98% because of the clear – and, as stated by SAGE – “unac- of children with polio vaccine. The country freed itself ceptable” consequences of failure. The children of Nige- of endemic polio and finally laid to rest the question of ria, Pakistan and Afghanistan bear the brunt of current whether polio eradication is technically feasible. polio transmission, but the consequences reach much farther. In recent years, the international spread of polio Globally, polio cases fell to half the level of the previous has become deadlier. Recent outbreaks on three conti- year. In two of the four countries with re-established nents –Tajikistan, Congo and China, all far from polio- transmission of polio, no cases have been reported in the endemic areas – paralysed mostly adults. In some of these Republic of South Sudan and in Angola since June 2009 outbreaks, half the affected adults died. When the virus and July 2011, respectively. In the other two, Chad geo- affects adults who have grown up in previously polio-free graphically restricted polio in the second half of the year countries and have received little or no vaccination, it and cases plummeted in the Democratic Republic of the kills far more frequently. Congo, after aggressive response to exten- sive outbreaks in early 2011. All of the These consequences have triggered emergency eight outbreaks recorded in previously actions among countries and the interna- polio-free countries were successfully tional polio partners. The Global Polio stopped, all but one within six months. Emergency Action Plan 2012−2013, and the revised national emergency On the other side of the scales, the INDIA action plans that underpin it, capture three remaining endemic countries the fundamental changes that polio- witnessed an unexpected and serious 2012 POLIO- affected countries and their partners upsurge of polio. In Nigeria and Paki- are making in their approach and stan, the continued circulation of two FREE structure, to ultimately bring about po- wild poliovirus serotypes – and a vaccine- lio eradication. derived poliovirus in the former – had the rip- ple effect of international spread to two neighbours. Compounding this emergency is a 50% gap in In Afghanistan, the number of cases also increased, with financing needed to fully carry out the necessary activi- the national programme unable to reach enough children ties in 2012−2013 (as of April 2012). In the first quar- to stop outbreaks in the insecure Southern Region. At the ter of 2012, this has already dictated the scale-back of end of 2011, the three endemic countries were off-track activities in 24 countries in Asia and Africa, increasing for eradicating polio. the risk of unchecked spread if poliovirus from endemic areas enters these countries. The Independent Monitoring Board (IMB) warned in Oc- tober 2011 that polio eradication would not be achieved The emergency eradication programme is about speed, on the programme’s current trajectory. In November, an focus and most of all accountability. From heads of state alarmed Strategic Advisory Group of Experts on immu- to chiefs of multilateral agencies and donors, from parent nization (SAGE) warned that failure to eradicate polio to vaccinator, every link in the chain must be tempered would constitute a failure of public health. By January and strengthened to bring about a polio-free world. gpei | annual report 2011 global polio eradication initiative 5 Key events 2011 January Bruce Aylward, Assistant Director-General for Polio, Rukhsar Khatoon becomes the only child in India to be Emergencies and Country Cooperation at the World paralysed by polio in 2011. Health Organization, gives a “TED Talk” on polio erad- ication. February The world loses a true polio eradication champion – March Bill Sergeant, former Chairman of Rotary’s Internation- 317 polio cases from the Republic of Congo’s deadly al’s Polio Plus Committee, passes away on 13 February 2010 outbreak, for which no specimens had been col- at his home in Tennessee, USA. lected, are confirmed by the National Polio Expert Com- mittee. ab Cn UNICEF Executive Director Anthony Lake is invited to WHO/C. M the Democratic Republic of the Congo and meets with the Prime Minister and the Minister of Health to dis- cuss the Government’s vital role in putting an end to polio. April Bill Sergeant holds the award given to him by During Immunization Week, polio vaccination cam- the 2006 World Health paigns are organized throughout India, central Asia Assembly, in recognition and west Africa. of his commitment to polio eradication. May WHO Director-General Margaret Chan and Bill Gates, Rotary International celebrates its 106th anniversary co-chair of the Bill & Melinda Gates Foundation,