Polio transition and polio post-certification strategy

Graham Crouch

The South-East Asia has been free of wild poliovirus since 2011. In order to maintain this status and keep the population protected countries must ensure that population immunity remains high; through routine immunization coverage of >90% with polio vaccines. High quality surveillance is needed for being on guard and outbreak response plans must be in place; should polio return. Polioviruses still stored in laboratories need to also be kept safe - or even better - destroyed. While protecting the success achieved and investments made, capacities established to eliminate polio from the Region are further used to strengthen routine immunization programmes and support a wide range of other public health interventions.

Polio-free certification of the WHO South-East Asia Region

Home to more than a quarter of the world's population, the South-East Asia Region was certified polio-free on 27 March 2014 by an independent commission , and has remained polio-free since.

Millions of children have been protected from the crippling disease, immunization systems have been revitalized, and polio vaccination campaigns have been used as a platform for the delivery of other health services particularly vitamin A and deworming drugs. Health systems have been strengthened through improved management, community outreach, social mobilization and intersectoral collaboration. Surveillance systems and laboratory networks developed for polio eradication are used to monitor other infectious diseases, particularly measles and rubella. Research undertaken on new polio vaccines and immunity studies is advancing the global polio science agenda and benefiting also countries outside the Region.

The strategy to eradicate polio rested on four main pillars; routine immunization, mass polio immunization drives, surveillance to detect the disease and “mop-up” local immunization campaigns to hit viruses wherever they appeared. The motto for the effort was “Every Child, everywhere, every time” and all 11 countries demonstrated their regional solidarity.

Strategic planning and policy development was evidence based and innovative. Partnership management and donor coordination resulted in commitment from the early days to the final achievement and beyond. Mobilizing political and social support were key to reaching out to families and communities and most vulnerable. Real-time programme monitoring systems enabled rapid detection of polio cases and outbreak and response. An independent oversight framework involving key stake holders ensured consistency and data driven feedback to the countries to ensure that the programme stayed on track.

polio drops rotary
Alyce Henson

Despite being polio-free for more than 8 years years, all countries in the Region continue to be at risk of importation of wild poliovirus from where it still circulates, and of subsequent spread. Countries also face the threat of outbreaks due to circulating vaccine-derived poliovirus (cVDPV).

To mitigate these risks, maintaining high population immunity against polio and high quality surveillance systems for poliovirus detection is critical. Robust outbreak response plans need to be in for any polio resurgence. Laboratories and other facilities that handle or store poliovirus materials represent a threat for accidental reintroduction of the virus into communities to again cause paralysis and death. It is critical that these laboratories and facilities follow containment procedures to minimize this risk. Maintaining the Region’s polio-free status is being monitored and regularly assessed by the Regional Certification Commission for Polio Eradication.

Laboratory containment

WHO/Roesel S

As global eradication approaches, comprehensive work has begun on polio laboratory and facility containment which is an integral part of the strategy to keep the world safe from polioviruses. It includes biosafety and biosecurity requirements for laboratories, vaccine production sites, or any other facility that handles or stores eradicated polioviruses, to minimize the risk of these viruses being released into the community. Requirements and strategies are specified in the WHO Global Action Plan to minimize poliovirus facility-associated risk (GAPIII).

Polio transition planning and post-certification strategy

Surveillance and laboratory infrastructure established for polio eradication is a key source of technical expertise not only for polio, but also for a wide range of other public health programmes. Maintaining continuity of this infrastructure after polio is gone is a priority and requires concerted efforts and investments by countries and the global health community. Planning for the transition of polio assets is already well underway, particularly in the five countries where polio assets are concentrated (Bangladesh, India, Indonesia, Myanmar, and Nepal).

The Global Polio Eradication Initiative has developed a post-certification strategy to define the essential functions that must be sustained to maintain a polio-free world after eradication.

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Celebrating a polio-free Region

The journey towards eradication

Polio Surveillance Data

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Immunization and Vaccine Development
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