Global leaders commit to polio eradication at WHA

•Canada announces $19.9m for campaign in Nigeria as country tops list of seven nations infected with vaccine-derived version of virus
•WHO blames current outbreaks on serious gaps in routine immunization, raises high alert of possible international spread of strain from country

Global political commitment to eradicating polio was over the weekend affirmed at the World Health Assembly (WHA) in Geneva, Switzerland.

The WHA is the apex decision-making body of the WHO, which meets every year in May, in Geneva, to discuss issues affecting global health.

During the polio agenda item, member states discussed progress made in the last year and the remaining hurdles that stand in the way of polio eradication.

Director General of WHO, Dr. Margaret Chan, in her address to the WHA, said polio eradication has never been so close to the finish line.

“During the short span of two weeks in April, 155 countries successfully switched from trivalent to bivalent oral polio vaccine, marking the largest coordinated vaccine withdrawal in history. I thank you and your country teams for this marvellous feat,” she said.

Member states reviewed the latest global epidemiology, noting the strong progress made across Africa with no case of wild poliovirus in approaching two years. Delegates from Afghanistan and Pakistan, the final remaining polio endemic countries, outlined the steps they are taking to ensure that transmission is interrupted as a matter of urgency. With fewer missed children than ever before and just 74 cases across the two in 2015, achieving eradication has never appeared to be such an achievable target.

Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr. Ado Gana Muhammad, who was part of the Nigerian delegate to the Assembly reaffirmed the country’s commitment to fulfilling the objectives of the resolution passed at the last WHA to commit to ending polio once and for all.

Meanwhile, the Government of Canada announced a Can$19.9 million contribution to Nigeria’s polio programme to help keep the country free from the debilitating virus, as part of its Can$ 250 million commitment to polio eradication for 2013 to 18.

The announcement was made by Canada’s Minister for International Development, Hon. Marie-Claude Bibeau at the global Women Deliver conference in Copenhagen, Denmark. This high-level event focused on the Sustainable Development Goals and developing solutions to the health, economic and social challenges facing girls and women around the world today.

Meanwhile, Nigeria tops the list of seven countries infected with circulating vaccine­derived poliovirus (cVDPV) but not currently exporting.

Other countries on the list, according to a statement/communique released by the WHO after the 9th meeting of the Emergency Committee (EC) under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus, include: Guinea, Madagascar, Ukraine, Lao People’s Democratic Republic, and Myanmar.

The EC meeting was convened last week, May 12, 2016, via teleconference by the Director General of WHO, Dr. Margaret Chan.

The committee noted that a very robust outbreak response is under way by the Government of Nigeria, but was concerned that the risk of international spread of this strain of cVDPV2 from Nigeria was high. It, however, noted that surveillance and immunization activities need to be strengthened in neighbouring countries in the Lake Chad region.

The EC noted: “… As with the seventh and eighth meetings, the EC reviewed the data on wild poliovirus as well as cVDPV. The latter is important as cVDPVs reflect serious gaps in immunity to poliovirus due to weaknesses in routine immunization coverage in otherwise polio­free countries. In addition, any further spread of type 2 cVDPVs is a public health emergency following the globally synchronized withdrawal of type 2 Oral Polio Vaccine (OPV2) completed May 1, 2016.”

According to the statement, Nigeria is the only country that recorded two different strains of the circulating vaccine­derived poliovirus type two (cVDPV2)- one case of Acute Flaccid Paralysis (1 AFP) and one case of environmental isolate (1 env isolate); Ukraine recorded two cases circulating vaccine­derived poliovirus type one (cVDPV1)- 2 AFP- on July 7, 2015; Guinea had seven cases of cVDPV2 (7 AFP cases) on December 14, 2015; Madagascar had ten cases of cVDPV1 (10 AFP cases) on August 22, 2015; Lao People’s Democratic Republic had eleven cases of cVDPV1 (11 AFP cases) on January 11, 2016; and Myanmar with two cases of cVDPV2 (2 AFP cases) on October 5, 2015.

The statement noted: “The current cVDPV outbreaks across four WHO regions illustrate serious gaps in routine immunization programmes, leading to significant pockets of vulnerability to polio outbreaks. In 2015, six outbreaks of circulating vaccine-derived poliovirus occurred – three cVDPV type 1 outbreaks (Lao People’s Democratic Republic, Madagascar and Ukraine) and three cVDPV type 2 outbreaks (Guinea, Myanmar and Nigeria). In 2016, transmission is continuing in Lao People’s Democratic Republic, Nigeria and possibly Guinea.

“The committee was very concerned that in Nigeria, a circulating vaccine-derived poliovirus type 2 (cVDPV2) has been detected in an environmental sample in March 2016 in Maiduguri, Borno State, north-east Nigeria. Genetic sequencing of the isolated strain indicates it is most closely linked genetically to a cVDPV2 strain from Borno in November 2013 and last detected in May 2014, indicating the strain has been circulating without detection for almost two years, but different to the strain identified in 2015 in the Federal Capital Territory and Kaduna….”

Through WHO’s ‘Sustaining Polio Eradication Through Strengthened Routine Immunization project’, the additional funding will help to immunize more than 13 million children against polio in 11 high-risk Nigerian states, and train upwards of 150,000 vaccinators. It complements Canada’s polio eradication support for the Hard-to-Reach Project through United Nation Children Fund (UNICEF), an initiative to bring polio vaccines to the most vulnerable and remote communities alongside other health interventions such as routine vaccines, maternity care, deworming tablets and Vitamin A supplements.

Director of Polio Eradication at WHO, Michel Zaffran, stated that strong progress had been made against all four objectives of the Polio Eradication and Endgame Strategic Plan.

Nigeria successfully removed itself from the list of polio endemic countries in 2015 with its last case in July 2014, a remarkable achievement for a country that for decades struggled to stamp out the virus. Although now polio-free, like many other countries, it remains at significant risk of poliovirus importation.