Dr Marc ShawWorldwise Travellers

16:30 - 17:25 WS #180: Vaccination Forum (Part 1)

Ms Michelle TannerImmunisation Nurse and Rotarian

Polio eradication: where in the world

are we?2019 CME Conference, Rotorua22 June 2019

Michelle TannerDistrict Polio Chair

Rotary Matamata

Remind me. What is polio?

• An enterovirus most commonly found colonizing the oropharynx or intestine

• Spread oral-faecal, sometimes oral-oral

• Three equally virulent serotypes (PV1, PV2 and PV3) with similar presentation but minimal cross immunity

• PV1 most prevalent and often association with paralysis

• Humans the only host

• Dates back to 1400BC

Where did it begin?

• The industrial revolution fuelled epidemics

• 1970’s lameness surveys

• WHO adds OPV to Expanded Programme if Immunisation in 1984

Photo courtesy of Library of Congress, Washington DC

Why is Rotary involved?

• 1979 Rotarians vaccinated six million children in the Philippines

• Presented during 1984 WHA and pledged to raise US$120million

• 1985 Rotary launched PolioPlus

The Global Polio Eradication Initiative

By 1988

• Rotary has raised US$247million

• At WHA WHO passes a resolution to eradicate polio

• GPEI launched

125 countries are polio endemic

Polio distribution, past and present

33

Progress to date

• WPV 3 not seen since 2012

• WPV 2 declared eradicated in 2015

• WPV 1 transmission interrupted everywhere except Pakistan/Afghanistan and a 90% reduction since 2014

WPV1 and cVDPV as at 12th June 2019

The Endgame Strategy

Four core points:

1. Poliovirus detection and interruption

2. Immunisation systems strengthening and OPV withdrawal

3. Containment and certification

4. Legacy planning

The Endgame Strategy

“..reorienting efforts to current realities that impede the delivery of critical health

interventions – and realigning so that the GPEI is fit for purpose…”

Goals:

1. Eradication

2. Integration

3. Certification and containment

Endgame challenges

Photo courtesy of the Telegraph, UK

1. Insecurity and conflict

“The primary underlying challenge in the last mile to WPV eradication is missing children in the delivery of polio vaccines.”

Photo courtesy of the Arayarx.com

2. Weak or fragile health systems

3. Operational, management and resources risks

Why we cannot stop now

Control vs eradication

• US$25b saving over 20 years

• 650,000 cases saved/year

So here we are

What we have:

• the political and social will

• the knowledge

• massive achievement

The challenges

• resources (finances, vaccine supply)

• conflict and security issues

• health systems

Vaccinating 100,000 Pacific Island children by 2021

www.everychildafuture.com

Papua New Guinea

• Circulation of vaccine-derived poliovirus type 1 (cVDPV1) confirmed

• In 2018: cVDPV1 cases = 18, 1 death

• Surveillance for AFP cases strengthened and an outbreak response implemented

• cVDPV is a risk when low-coverage is low