WHA moves for enhanced polio fight, phasing of oral vaccines

DELEGATES at the ongoing sixty-eighth session of the World Health Assembly (WHA) in Geneva, Switzerland, over the weekend, agreed on a resolution in which member states recommit to stopping polio and preparing for the phased withdrawal of oral polio vaccines.

The WHA is the supreme decision-making body of the World Health Organisation (WHO). The 68th session of WHA, which began May18, ends 26th of this monrh. It is attended by delegations from all WHO member states. Its main functions are to determine the policies of the Organisation, supervise financial policies as well as review and approve the proposed programme budget. The Health Assembly is held yearly in Geneva.

WHO, in a press statement yesterday, noted that polio eradication could only be achieved through global solidarity. Reviewing the latest global epidemiology and impact of on-going efforts, delegates highlighted progress across Africa, which has not seen a case due to wild poliovirus since August 2014, and success in halting three large multi-country outbreaks in the Middle East, Horn of Africa and Central Africa.

They also noted continuous efforts in Pakistan, and the huge progress being made, in close coordination with Gavi and the Vaccine Alliance, towards introduction of inactivated polio vaccine (IPV) and preparations for the phased withdrawal of oral polio vaccines.

Meanwhile, according to the latest edition of the Weekly Polio Update published by the Global Polio Eradication Initiative (GPEI), Nigeria plans Subnational Immunisation Days (SNIDs) for June 7 to 9 and July 25 to 28 this year in the northern and eastern parts of the country.

The GPEI report read: “No new wild poliovirus type 1 (WPV1) cases were reported in the past week. No cases have been reported in 2015. Nigeria’s total WPV1 case count for 2014 remains six. The most recent case had onset of paralysis on 24 July in Sumaila Local Government Area (LGA), southern Kano State.

“No new Type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported this week. The most recent case had onset of paralysis on 16 November in Barde Local Governmental Area of Yobe state. No cases have been reported in 2015. The total number of cVDPV2 cases for 2014 in Nigeria remains 30.

“Environmental sampling continues to compliment surveillance, with cVDPV circulation last detected in March in Kaduna and Sokoto.”

Also, the WHA recommendation suggests that yellow fever vaccination may be mandatory of any traveller leaving an area at risk of yellow fever transmission. In 2013, WHO’s expert advisory group on immunization (SAGE) recommended that a single dose of yellow fever vaccine provides life-long immunity to the disease, making boosters unnecessary.

Under the International Health Regulations (2005), vaccination may be required of any traveller leaving an area at risk of yellow fever transmission. The Regulations currently specify that travellers should renew immunization every ten years. Changes to the Regulations recognizing the adequacy of a single dose of the vaccine will come into force in June 2016.

According to the WHO statement, some countries may, however, wish to institute the changes immediately.

Delegates agreed to inform WHO if their governments decide to apply these changes immediately, and accept the validity of yellow fever vaccination certificates as life-long.

WHO will publish an updated list of these countries online to inform international travellers. The secretariat has also agreed to establish a scientific advisory group to work with affected countries to maintain up-to-date analysis of areas at risk.

Delegates endorsed the International Health Regulations Review Committee recommendation to extend the deadline to 2016 to all countries that need more time to implement the Regulations. The recommendation also emphasizes a dynamic, ongoing process of evaluation and improvement, and the value of independent assessment.
The meeting observed that substandard, spurious, falsely labelled, falsified and counterfeit medical products continue to threaten health, not only because they do not provide the benefits they advertise, but because they also pose a serious health risk, and undermine the credibility of health systems.

The World Health Assembly had set up a mechanism to raise awareness, gather evidence, implement policies and evaluate effectiveness of efforts to address this issue, and had planned to review the impact of that mechanism in 2016. Delegates agreed to postpone this to 2017 – both to allow more time for the review itself and for implementation of new policies to tackle the problem.

The delegates said the recent Ebola outbreak has highlighted the importance of all countries having strong capacities to rapidly detect, respond to and prevent global public health threats such as disease outbreaks. The International Health Regulations (2005), oblige all member states to have these capacities in place. Only one-third of all countries (64), however, reported that they had met the minimum requirements in 2014.

The delegates recognized the important role WHO plays in providing expertise and guidance to help countries enhance surveillance systems and laboratory services, build early warning and alert systems, and train health workers so that they can deal with major public health threats. They expressed strong support for pairing well-resourced countries with other countries to help them to meet the IHR requirements.

The delegates said a wide range of conditions – from cancer and diabetes to obstructed labour and road traffic injuries – could be successfully treated by surgery. In many parts of the world, access to emergency and essential services is extremely limited, with low and middle-income countries concentrating available surgical care in urban centres. As a result, maternal mortality rates remain high, minor surgical issues become lethal and treatable injuries can lead to death or disability.

This resolution will help countries adopt and implement policies, which will integrate safe, quality and cost effective surgical care into the health system as a whole. It highlights the importance of both expanding access and improving the quality and safety of services; strengthening the surgical workforce; improving data collection, monitoring and evaluation; ensuring access to safe anaesthetics such as Ketamine; and fostering global collaboration and partnerships. The resolution also underscores the need to raise awareness of the issue and build political commitment.