Polio Eradication & Endgame

1 Polio Eradication & EndgameStrategic Plan 2013-2018 World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO web site ( ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO web site ( ).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.)

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3 The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its in FranceFrontcover photos: WHO/Thomas Moran, UNICEF Afghanistan 2012/Aziz FroutanDesign & Layout: Eradication & EndgameStrategic Plan 2013-2018 WHO/ oErloalEdc tan &algEaga&a &amdrloalEdc tan &algEeEdgtP SdE2&c &dPanEro gE013-8013 IAEFI Adverse event following immunizationAFP Acute flaccid paralysisaVDPV Ambiguous vaccine-derived poliovirusBMGF Bill & Melinda Gates FoundationbOPV Bivalent oral Polio vaccineCDC US Centers for Disease Control and PreventioncVDPV Circulating vaccine-derived poliovirusDTP3 Diphtheria tetanus pertussis vaccine third doseEMG Eradication Management GroupEPI Expanded Programme on ImmunizationFATA Federally Administered Tribal Areas (Pakistan)

4 FOMWAN Federation of Muslim Women s Associations in NigeriaFRR Financial Resource RequirementsFWG Finance Working GroupGAP Global Action PlanGAPIII Third edition of the Global Action Plan to minimize post- Eradication poliovirus facility-associated riskGAVI GAVI AllianceGCC Global Commission for Certification of the Eradication of PoliomyelitisGIS Geographic information systemGPEI Global Polio Eradication InitiativeGPS Global positioning systems deviceGVAP Global Vaccine Action PlanICC Interagency Coordinating CommitteeIFFIm Innovative Financing Facility for ImmunizationIMB Independent Monitoring BoardIMG Immunization Systems Management GroupIPV Inactivated Polio vaccineIVD Immunization and Vaccine DevelopmentiVDPV Immunodeficiency-associated vaccine-derived poliovirusLGA Local Government AreaLQAS Lot Quality Assurance SamplingmOPV Monovalent oral Polio vaccineNCC National Certification CommitteeNGO Non-governmental organizationNID National Immunization Day NSTOP Nigeria Stop Transmission of Polio programmeOPV Oral Polio vaccineOPV2 Oral Polio vaccine type 2 PAG Polio Advocacy GroupPOB Polio Oversight BoardPPG Polio Partners GroupPRC Polio Research CommitteePSC Polio Steering CommitteeRCC Regional Certification CommissionRED Reaching Every DistrictAcronyms and

5 AbbreviationsGLOBAL Polio Eradication INITIATIVEPOLIO Eradication & Endgame STRATEGIC PLAN 2013-2018 IIISAGE Strategic Advisory Group of Experts on ImmunizationSIA Supplementary immunization activitySIAD Short Interval Additional DoseSNID Subnational Immunization DaySTOP Stop Transmission of Polio programmeTAG Technical Advisory GrouptOPV Trivalent oral Polio vaccineUNICEF United Nations Children s FundVAPP Vaccine-associated paralytic poliomyelitisVDPV Vaccine-derived poliovirusVfM Value for moneyVPD Vaccine-preventable diseaseWHA World Health AssemblyWHO World Health OrganizationWPV Wild poliovirusWPV1 Wild poliovirus type 1 WPV2 Wild poliovirus type 2 WPV3 Wild poliovirus type 3 IVPoli oErloalEdc tan &algEaga&a &amdrloalEdc tan &algEeEdgtP SdE2&c &dPanEro gE013-8013 ITable of contentsExecutive summary.

6 11 Statement of intent ..102 Background ..113 Overview .. What s new? .. The major objectives ..144 Context .. Where we are today .. Acknowledging the past Lessons learnt .. New evidence that WPV transmission can be interrupted by the end of 2014 .. The case for completing Polio Eradication ..285 Objective 1: Poliovirus detection and interruption .. Introduction .. The goal .. What is required to interrupt transmission?.. What will be done? ..32 Strengthening global surveillance to detect virus circulation ..32 Maintaining an appropriate supplementary OPV immunization schedule ..34 Enhancing OPV campaign quality to interrupt endemic transmission.

7 36 Enhancing the safety of OPV campaign operations in insecure areas ..46 Preventing and responding to Polio outbreaks .. Who oversees this work? ..486 Objective 2: Immunization systems strengthening and OPV withdrawal .. Introduction .. The goal .. What is required? .. What will be done? ..53 Increasing immunization coverage ..53 Ensuring appropriate IPV, bOPV and mOPV products ..58 Introducing IPV ..61 Withdrawing OPV from routine and supplementary immunization activities .. Who oversees this work? ..647 Objective 3: Containment and certification .. Introduction .. The goal .. What is required? .. What is the current situation?

8 What will be done? ..69 Containing poliovirus stocks ..69 Certifying the Eradication of WPVs .. Who oversees this work? ..72 GLOBAL Polio Eradication INITIATIVEPOLIO Eradication & Endgame STRATEGIC PLAN 2013-2018V8 Objective 4: Legacy planning .. Introduction .. The goal .. What is required? .. What is the current situation? .. What will be done? ..77 Mainstreaming Polio functions ..77 Leveraging the knowledge and lessons learnt ..77 Transitioning the assets and infrastructure .. Who oversees this work? ..789 Risks, risk mitigations and contingency planning .. Insufficient funding .. Inability to recruit and retain the right people.

9 Insufficient supply of appropriate vaccines .. Inability to operate in areas of insecurity .. Decline in political and/or social will .. Lack of accountability for quality activities ..8610 Enabling functions .. Strategic planning and priority setting .. Resource mobilization and advocacy .. Financial resources and management .. Vaccine security and Research and policy development ..9511 Governance, monitoring, oversight and management .. Governance .. Advisory and monitoring .. Oversight .. Executive management .. Programme management ..10012 Monitoring .. Monitoring Framework ..102 Annex A: Endemic country SIA quality specifics.

10 103 Afghanistan ..103 Pakistan ..108 Nigeria ..113 Annex B: Monitoring Framework 2013-2018 ..120 Since 1988, the GPEI has reduced the global incidence of Polio by more than 99%. In 2012, the fewest number of Polio cases, from the fewest number of countries, were reported. The world now has a historic opportunity to stop Polio , forever ensuring the protection of future generations of children from this terrible SUMMARYGLOBAL Polio Eradication INITIATIVEPOLIO Eradication & Endgame STRATEGIC PLAN 2013-20181 Executive summary1. Since its launch at the World Health Assembly (WHA) in 1988, the Global Polio Eradication Initiative (GPEI) has reduced the global incidence of Polio by more than 99% and the number of countries with endemic Polio from 125 to 3.