GPEI annual report 2011

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. Success in India was the most remarkable milestone, deemed "magnificent" by the Independent Monitoring Board (IMB) of the GPEI. Long considered one of the most challenging countries in which to eradicate polio, India accomplished what the IMB called the "systematic enforcement of best practice" to reach over 98% of children with polio vaccine. The country freed itself of endemic polio and finally laid to rest the question of whether polio eradication is technically feasible. Globally, polio cases fell to half the level of the previous year. In two of the four countries with re-established transmission of polio, no cases have been reported in the Republic of South Sudan and in Angola since June 2009 and July 2011, respectively. In the other two, Chad geographically restricted polio in the second half of the year and cases plummeted in the Democratic Republic of the Congo, after aggressive response to extensive outbreaks in early 2011. All of the eight outbreaks recorded in previously polio-free countries were successfully stopped, all but one within six months. On the other side of the scales, the three remaining endemic countries witnessed an unexpected and serious upsurge of polio. In Nigeria and Pakistan, the continued circulation of two wild poliovirus serotypes - and a vaccine- derived poliovirus in the former - had the ripple effect of international spread to two neighbours. In Afghanistan, the number of cases also increased, with the national programme unable to reach enough children to stop outbreaks in the insecure Southern Region. At the end of 2011, the three endemic countries were off-track for eradicating polio. The Independent Monitoring Board (IMB) warned in October 2011 that polio eradication would not be achieved on the programme's current trajectory. In November, an alarmed Strategic Advisory Group of Experts on immunization (SAGE) warned that failure to eradicate polio would constitute a failure of public health. By January 2012, the World Health Organization's (WHO) Executive Board had called for polio eradication to be declared a programmatic emergency for global health. Completing polio eradication is now a global emergency because of the clear - and, as stated by SAGE - "unacceptable" consequences of failure. The children of Nigeria, Pakistan and Afghanistan bear the brunt of current polio transmission, but the consequences reach much farther. In recent years, the international spread of polio has become deadlier. Recent outbreaks on three continents -Tajikistan, Congo and China, all far from polioendemic areas - paralysed mostly adults. In some of these outbreaks, half the affected adults died. When the virus affects adults who have grown up in previously polio-free countries and have received little or no vaccination, it kills far more frequently. These consequences have triggered emergency actions among countries and the international polio partners. The Global Polio Emergency Action Plan 2012_2013, and the revised national emergency action plans that underpin it, capture the fundamental changes that polio-affected countries and their partners are making in their approach and structure, to ultimately bring about polio eradication. Compounding this emergency is a 50% gap in financing needed to fully carry out the necessary activities in 2012_2013 (as of April 2012). In the first quarter of 2012, this has already dictated the scale-back of activities in 24 countries in Asia and Africa, increasing the risk of unchecked spread if poliovirus from endemic areas enters these countries. The emergency eradication programme is about speed, focus and most of all accountability. From heads of state to chiefs of multilateral agencies and donors, from parent to vaccinator, every link in the chain must be tempered and strengthened to bring about a polio-free world.Executive summary -- -- Key events 2011-- -- Stopping transmission of polioviruses - 1. On track - 2. Back on track - 3. Off track - 4. Protecting polio-free areas -- -- Polio eradication - an emergency -- -- Financing -- -- Annex 1: 2011 progress report of the global milestones and process indicators of the GPEI Strategic Plan 2010-2012 -- Annex 2: Supporting data for progress report -- -- Acronyms and abbreviations"WHO/POLIO/12.02."On cover: logos for World Health Organization, Rotary International, CDC (U.S. Centers for Disease Control and Prevention), UNICEF.Available via the World Wide Web as an Acrobat .pdf file (10.45 MB, 52 p.)