Global Polio Eradication Initiative
Surveillance, Operation and
Monitoring
Vaccine Procurement,
Communication and Social
Mobilization
Advocacy, Funding & Social
Mobilisation
Funding and Surveillance
UNICEF WHO & GOVT.
CDC(US, Federal Govt)
ROTARY
Data as on 12/02/2014
GLOBAL POLIO CASESGLOBAL POLIO CASES
Global Polio Cases :Year 2000 = 719Year 2001 = 483Year 2002 = 1918Year 2003 = 784Year 2004 = 1255Year 2005 = 1979Year 2006 = 1998Year 2007 = 1315Year 2008 = 1651Year 2009 = 1604Year 2010 = 1352Year 2011 = 650Year 2012 = 223Year 2013 = 400Year 2014 = 11
Country or territory 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Indonesia 0 0 0 0 0 303 2India 265 268 1600 225 134 66 676 874 559 741 42 1Yemen 0 0 0 0 0 478 1Nigeria 28 56 202 355 782 830 1123 285 798 388 21 62 122 53 0Ethiopia 3 1 0 0 1 22 17 3 9 0Benin 1 0 0 2 6 0 0 0 6 20Bangladesh 1 0 0 0 0 0 17Pakistan 199 119 90 103 53 28 40 32 117 89 144 198 58 93 9Somalia 46 7 3 0 0 185 36 8 190 0Nepal 4 0 0 0 0 4 5 5 6 6Niger 2 6 3 40 25 10 11 11 12 15 2 5 1DRC 28 0 0 0 0 0 13 41 5 3 100 93Angola 55 1 0 0 0 10 2 8 29 29 33 5Car 3 0 0 1 30 0 0 0 3 14 4Syrian Arab Republic 23 0Sudan 4 1 0 0 127 27 0 1 26 45Afghanistan 27 11 10 8 4 9 31 17 31 38 25 80 37 14 2Chad 4 0 0 25 24 2 1 22 37 64 26 132 5Burkina Faso 0 0 1 11 9 0 0 0 6 15Ghana 1 0 0 8 0 0 0 0 8Mali 0 0 0 0 19 3 0 1 2 4 7Kazakhstan 0 0 0 0 0 0 0 0 0 0 1Togo 0 0 0 1 0 0 0 0 3 6Russian Federation 0 0 0 0 0 0 0 0 0 0 14Cote d'lvoire 1 0 0 1 17 0 0 0 1 27 36Guinea 0 0 0 0 7 0 0 0 0 42 3Liberia 0 0 0 0 0 0 0 0 0 11 2Sierra Leone 0 0 0 0 0 0 0 0 0 11 1Burundi 0 0 0 0 0 0 0 0 0 2Mauritania 0 1 0 0 0 0 0 0 0 13 5Senegal 0 0 0 0 0 0 0 0 0 0 18Tajikistan 0 0 0 0 0 0 0 0 0 0 460Turkmenistan 0 0 0 0 0 0 0 0 0 0 3Ghana 0 0 0 0 0 1 0Namibia 0 0 0 0 0 0 19Congo 22 0 0 0 0 0 0 0 0 0 441 1Myanmar 2 0 0 0 0 0 0 11Kenya 0 0 0 0 0 0 2 0 19 1 14 0Uganda 0 0 0 0 0 0 0 0 0 8 4Gabon 0 0 0 0 0 0 0 0 0 0 0 1China 0 0 0 0 0 0 21Cameroon 0 0 0 2 13 1 2 0 3 4 0Other 86 13 10 26 73 0 0Total 719 483 1918 784 1255 1979 1998 1315 1651 1604 1352 650 223 400 11No. of Countries 23 15 9 15 18 16 17 12 18 23 20 17 5 8 2Non-endemic country 4 0
500 PER DAY
BUT NOW…
0 in 2014
INDIA POLIO STATUS SINCE THE BEGINNING OF THE PROGRAMME…
INDIA POLIO STATUS SINCE THE BEGINNING OF THE PROGRAMME…
WILD POLIO CASES IN INDIAWILD POLIO CASES IN INDIA
Data as on 14.02.2014
Rotary’s India National PolioPlus Committee
The India National PolioPlus Committee in india plays the following roles:
Advocacy
Political Bureaucratic Religious Corporate
Financial
Social Mobilisation
Operational support
Financial Contribution towards GPEI
US$ 1.2
billion
Worldwide Contributions
US$ 9 billion
Raised From Donors
US$ 178 Million
INDIACONTRIBUTION
POLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGYPOLIO ERADICATION STRATEGY
4 PILLARS
ROUTINE OPV IMMUNISATION
MOPPING UP OPERATIONSIN HIGH RISK
AREAS
PPINID/SNID
REPORTING ALLAFP CASES
(Surveillance)
# Each of these components is essential for the complete eradication of Polio.
Mop Up Immunization
Outbreak Response Immunization (ORI)
Acute Flaccid Paralysis (AFP) Surveillance
The number of AFP cases reported each year is used as an indicator of a country’s ability to detect polio-even in countries where the disease no longer occurs. A country’s surveillance system needs to be sensitive enough to detect at least one case of AFP for every 100 000 children under 15 – even in the absence of polio.
250
500
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Nationwide campaigns
Sub-national campaigns
2013
2013
Reaching every child during mass polio vaccination campaigns
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2014
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2015
Routine Immunization
• Current level of Routine Immunization is 60-61%. To protect our children against wild polio virus it is more important to increase the vaccine of Polio under R.I.
High risk areas identified in India, April 2012
~ 257,000 Migrant sites
Migrant sites High risk areas in settled population
~ 154,000 HR areas in settled population
= 10 Migrant sites = 10 HR sites
411,000 HRAs
Intensification of Routine Immunization• 9 priority states & 239 districts with weak RI identified for focused attention
HR Districts (based on Full Imm. <50% in DLHS3)
Strengthening Routine Immunization
• Fourth pillar for polio eradication - Helps sustain population immunity against polio – reduces risk of circulation of poliovirus
• Important component of the polio endgame strategy before & after withdrawal of OPV
• Protects children against other vaccine preventable diseases
Preparing for India to be Certified as Polio Free
Certification ProcessCertification ProcessCertification ProcessCertification Process
The Goal of the GPEI is the Global Certification of the eradication of polio.
Global certification of eradication will be reached when all countries demonstrate the absence of wild poliovirus transmission for at least three consecutive years in the presence of excellent surveillance.
Certification Committee Structure• Global Commission for the Certification of
the Eradication of Poliomyelitis
• Six Regional Certification Commissions for Polio Eradications
• Every country has a National Certification Committee for Polio Eradication (NCCPE) India NCCPE established on Aug 7, 1998
Process of Regional Certification• NCCPEs to prepare detailed documentation as per
standard format.
• These are reviewed by the regional Commission and it will recommend to the Global Commission
• Only Global Commission can certify a region as polio free
Only WHO regions and NOT individual countries certified as polio free
(26-27 March, 2014)
3 of the 6 WHO Regions Already Certified Polio Free
• 1994 - North, Central and South America (PAHO region)
• 2000 - Western Pacific region (that includes China)
• 2005 - European region in 2005.
2014 –WHO South East Asia region that includes India is the next region to be certified as polio free. Preparations are underway
Importation• Recently Govt of India has issued the
notification:
• A dose of oral polio vaccine (OPV) for all travellers to and from India from polio endemic countries : Afghanistan, Nigeria and Pakistan and countries with poliovirus circulation following importation : Ethiopia, Kenya, Somalia and Syria. In the absence of which VISAS will not be issued.
• Govt of India has set up immunisation booths across borders.
The geographical distribution of children with poliomyelitis associated with wild-type poliovirus shown by serotype for 2012 and (inset) the total number of children with
poliomyelitis globally by serotype reported each year during 2001–2012.
93 polio cases in Pakistan, 53 in Nigeria and 14 in Afghanistan . The Horn of Africa – Somalia-190, Kenya-14, Ethiopia-9 , Cameroon-4 and An outbreak of cases in Syrian Arab Republic – 23 (Syria reported polio case after 1999) in the year 2013. Still Pakistan is reporting fresh cases of Polio during the current year numbering to 9 and Afghanistan is following up with 2 cases reported till date.
Continuous vaccination of children at border crossing points
PAKISTAN
INDIA
BANGLADESH
MYANMAR
NEPAL
Vaccination post
88 vaccination postsalong Indo-Nepal border since Apr
2011
5 vaccination postsalong Indo-Pak border
since Sep 2011
2 vaccination posts along Indo-Bangladesh border since Mar 13
2 vaccination posts along Indo-Myanmar border since April 13
Lessons
• Its not over until its over everywhere
• 'The price of freedom is eternal vigilance'
Challenges• Maintaining immunity• Maintaining surveillance• Readiness to respond• Reducing risk• Building on polio• Preparing for the endgame
POLIO NOW A PUBLIC HEALTH EMERGENCY
• 194 member states to fully fund the GPEI & fill $945M gap in budget for 12-13.
• All remaining infected countries to declare polio to be a NATIONAL PUBLIC HEALTH EMERGENCY requiring the implementation of emergency action plans monitored at the highest levels
POLIO A PUBLIC HEALTH EMERGENCY
• New approaches to tackle persistent challenges and improve polio vaccination campaign performance
• Heightened accountability, coordination, and oversight to ensure success at every level of government and within every partner agency and organization
POLIO A PUBLIC HEALTH EMERGENCY
• A surge of technical assistance and social mobilization capacity
• If any child in the world is permanently paralysed by Polio it is now a Global Emergency
• If any child in the world is not reached by Oral Polio Vaccine it is now an emergency.
Emergency Preparedness and Response Plan 2011
The Govt. of India has constituted a “Central Emergency Preparedness and Response Group” to ensure adequate preparedness for a rapid response and manage the actual response to the detection of a wild poliovirus anywhere in India.
Rotary’s Role in Emergency Preparedness and
Response Plan
Advocacy at state and district levels for quaility implementation of polio eradication activities.Support IEC/Social mobilization activities & media management in coordination with Govt.. UNICEF and NPSP.Any other essential emergency support activities.
Emergency Preparedness &Response
• Withdrawal of oral polio vaccine to minimize risks associated with use of OPV in the post eradication phase
• Switch from tOPV to bOPV in 2016
• Withdraw all OPV from programme in 2018/2019
• Before switch over IPV will be introduced in 2015. The introduction will also protect the occurrence of vDPV cases.
Switch Over- Preparing for Polio Endgame Strategy
End Game Strategic Plan 2013-18End Game Strategic Plan 2013-18
Funding GapFunding Gap
• The Total funding requirement from 2013-2018 is $ 5.5 billion.
• Committed - $ 4 billion
• Deficit - $ 1.5 billion
World Polio Day 24 October 2013India on World Polio Day illuminated iconic sites across the country including historic monuments India Gate, Red Fort with End Polio Now message.
Red Fort
India Gate
India Celebrated 3 years of last case reported in the country on 13 January 2014
India Gate Red Fort
Celebrations on India’s Victory over Polio on 11 February 2014 in New Delhi by Govt of India
Towards a polio-free IndiaTowards a polio-free India
Rukhsar. Let's ensure she is the last polio case in India!
Rotary’s Continued Engagement Very Crucial.
• Thank and appreciate those who have been working so hard.
• Continued advocacy in high risk areas against complacency
• Respond to local problems with local solutions
You started the race and so you better be there at the finishing line when celebrations start