The GPEI Strategic Plan 2010-2012 is a turning point in the eradication of polio. It acknowledges and addresses previous setbacks, approaches risks proactively, and builds on the lessons learned in the past several years.
Urgent financing of this strategic plan is critical to eradicating polio.
The independent evaluation, intense internal analysis of the program, and thorough consultation with polio-endemic countries and donors have helped ensure a comprehensive, time-bound and aggressive plan with measurable milestones and a robust review process.
In addition to the commitment of the polio eradication partnership, increased levels and new sources of funding are essential to achieving polio eradication.
Plans that are targeted at very limited areas and very precise population groups.
Because polio can persist in much smaller areas and population subgroups than previously thought, plans for eradication activities are now made according the unique circumstances – social, infrastructural and operational – of a district or even smaller administrative unit. Focus will be on quality of vaccination campaigns in these very limited areas rather than on a broad national scale. Intensive independent monitoring will allow the programme to pinpoint areas of poor quality and take prompt action.
Examples: In southern Afghanistan, this means taking into account the local nature of the conflict and the major players in that particular district. In India, this means adapting communication strategies to migrant groups. In all areas with polio, this means intense monitoring of whether children are being reached and additional tools to verify coverage.
Through mathematical modeling and studying how poliovirus behaves differently in different environments, the programme now knows that the population immunity level needed to stop polio transmission differs between Asia and Africa. This population immunity "threshold" is higher in Asia, so the strategies to reach that threshold are now creatively tailored for each continent.
Examples: In northern India – where sero-prevalence surveys reveal that children get polio despite high immunity – the programme will conduct research into the impact of simple sanitation measures or supplements such as zinc on eradicating polio there.
The spread of polio – and the risk of subsequent outbreaks – can now be largely predicted, as the virus follows known migration routes and exploits weaknesses in health systems. This drives the programme to a more proactive approach in helping prevent and respond to importations of polio.
Examples: In the belt of African countries which are frequently re-infected by imported polio, the programme is now holding pre-planned, synchronized campaigns to maximize immunity and prevent an outbreak in case of reintroduction. Activities to strengthen immunization systems are built into the plan and central to efforts to significantly reduce the number of susceptible children and to build systems that can be used for efforts beyond polio.
Monovalent oral poliovirus vaccines (mOPVs) are potent tools to protect children against the surviving strains of wild poliovirus – types 1 and 3 – but they can only be used consecutively, leading to alternating outbreaks of type 1 and 3 poliovirus in some countries. To stop both viruses at once, the programme fast-tracked a completely new 'bivalent' OPV (bOPV). This will be vastly simplify logistics and cut down type 1 and 3 at the same time.
Why these new things will make a difference?
Type 1 polio has been reduced dramatically due to use of mOPV1 (12 cases in 2010, compared to 78 at the same time in 2009, as of 16 March). There is optimal national and particularly local leadership in countries. The international outbreaks across west and central Africa have retracted significantly.
What is needed?
The Strategic Plan is accompanied by a document outlining the financial resource requirements (FRR): a core budget and sets of activities prioritized 1 to 3 based on epidemiology and financing.
The budget to fund the Strategic Plan is USD 2.6 billion, and the funding gap is USD 1.3 billion. This will cover core costs such as surveillance and technical assistance, activities in areas of ongoing polio transmission (Priority 1 activities) and activities to reduce the risk of international spread (Priorities 2 and 3).
Activities planned for the second quarter of 2010 are currently threatened by a funding gap of USD 200 million, which is required immediately in order for funds to flow.
This is the opportunity for present, past and new donors to finance the international commitment to eradicating polio and to give the remaining children of the world the same protection that children in polio-free areas already enjoy.
Not eradicating polio would cost USD 10 billion over the next 20 years – to keep polio at current levels.
When eradication of a disease is feasible, controlling that disease is never the most cost-effective option - nor is it equitable.
Polio Eradication Initiative June 2010 Report
PHOTOS: Dong Kurn Lee, Mia Farrow - a great supporter of Polio Eradication Initiative - and Jonathan Majiagbe, at Birmingham Convention (June 2009); Young Rotarians, as well as Leiria's Rotaractors today, working for Polio Eradication; my dear friend and colleague Dr. Bruce Aylward, WHO responsible for Polio Eradication, at Montreal Convention (June 2010); The Rotary District 1970 Governor Armindo Carolino and the member of the Portuguese Parliament José Miguel Medeiros, at Leiria Marathon for Polio Eradication; Dr. Bruce Aylward greets a mutilated polio survivor at Montreal Arena; Maria do Ceu Mendes and Ana Santos, Ministry for the Employment highest leaders at Leiria Marathon for Polio Eradication (Portugal); Gonçalo Lopes, Leiria Municipality responsible for Culture and Education at the Marathon; Governor Armindo Carolino, Manuela Santos, Rotary Club of Leiria President, Raúl Testa, Leiria Rotaractor responsible for Leiria Polio Marathon, and the Marathon winners, at the consacration moment; Leiria Mayor Raúl Castro before the race startiung.
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