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Polio Strategic Plan

Polio Strategic Plan. Impact & prospects at the half-way point. India Expert Advisory Group 13-14 July 2011. Recap of Major Elements of the New Strategic Plan. HR blocks =41. New Tactics: high risk 'blocks' & migrants, India. West Uttar Pradesh. High-Risk Blocks. Central Bihar.

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Polio Strategic Plan

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  1. Polio Strategic Plan Impact & prospects at the half-way point India Expert Advisory Group 13-14 July 2011

  2. Recap of Major Elements of the New Strategic Plan

  3. HR blocks =41 New Tactics: high risk 'blocks' & migrants, India West Uttar Pradesh High-Risk Blocks Central Bihar

  4. New Tactics: sub-national & local leaders, Nigeria

  5. 1st bivalent OPV campaign Afghanistan 16 Dec 2009

  6. Pakistan President Zardari launches new plan (24 Jan '11) Angola President Dos Santos meets UNICEF ExD on new plan (Jan '11) DR Congo President Kabila meets WHO DG on new plan (7 Feb 2011)

  7. Impact of the Strategic Planat July 2011

  8. Nigeria: 95% drop in cases sustained for > 18 months India: 6 months with no polio case for 1st time in history! Smallest type 3 infected area & cases in history Key Developments - ProgressPolio-infected districts, last 6 Months wild virus type 1 wild virus type 3

  9. Polio cases due to type 3 wild virus 2007-11 (at 13 July 2011)

  10. Major Risks

  11. Polio Cases in Endemic CountriesYear-to-Date 2010-11

  12. Chad Persistent outbreaks in the 3 're-established transmission' countries* DR Congo Virus that originated in India can return by the same routes! Angola * infected-districts, last 6 months

  13. Non Polio AFP < 1 1 – 1.9 Persistent performance gaps in recently infected areas. Pop under 15 yrs <100,000 >= 2 Sample Collection < 50% 50 – 79% Pop under 15 yrs <100,000 >= 80% Data in WHO/HQ as of 07 Jun 2011

  14. Polio Financing, 2011-2012 US$665 million funding gap

  15. Summary

  16. At the mid-point in the new Polio Strategic Plan, there is strong evidence that full application will stop all polio transmission.

  17. Wild Polioviruses Globally, last 4 months 22 Feb – 21 Jun 2011 Strong progress globally, but India still faces major risks Wild virus type 1 Wild virus type 3 Endemic country with WPV Re-infected country

  18. Risks to India's US$1 Billion Investment in Polio Eradication Undetected low season transmission Return of Indian viruses from Africa New importations from reservoirs

  19. Potential IEAG Priorities • What extra actions could protect very high risk areas through the 2011 high season? • How to ensure preparedness for a rapid, massive response to a new or persistent virus? • How to enhance surveillance in very high risk areas to rapidly detect a new or residual virus? • Is there a robust Emergency Preparedness plan for polio with a state-by-state risk assessment?

  20. Circulating Vaccine-derived Polioviruslast 6 months cVDPV1 (0 case) cVDPV2 (13 cases) cVDPV3 (0 case) cVDPV monthly distribution of cases by country

  21. Institutionalizing Best Practices (examples) OPV campaign quality & impact: • district-specific planning process (HR areas) • public tracking of sub-national leaders actions • scaled-up role of traditional/local leaders • short-interval additional dose (SIAD) strategies • mobile population & transit strategies • bivalent OPV • operational research (e.g. serosurveys)

  22. Institutionalizing Best Practices (examples) OPV campaign monitoring: • standardized Independent Monitoring • Lot Quality Assurance Sampling (LQAS) • serologic surveys Poliovirus surveillance: • Rapid field reviews (insecure areas, new import., orphan virus) • Environmental surveillance • Enhanced performance standards (e.g. AFP rate >2)

  23. Key Elements of the New Strategic Plan • District-specific plans & oversight • Population-specific approaches • Bivalent OPV • 'Importation belt' tactics Major Lessons • immunity thresholds differ • virus persists in smaller areas & pops than thought • new mOPVs harder to optimize than thought • int’l spread & outbreaks largely predictable

  24. Major Milestones at 24 March 2011

  25. Virologic Progress in Africa 2008 Genetic Clusters of Poliovirus 1 2010 2008 2009 2009 2010

  26. Uncertainty Roadmap for VDPV Elimination 6 months after last WPV in the world? Last polio case in main Asian reservoir 6 months after last WPV in main African reservoir? • Critical Events bOPV cessation • Decisions • DG/WHO announce • DG/WHO announce • DG/WHO announce • SAGE • EB • WHA • Policy • Validation/ Certification • RCCs assess WPV2 elim & no persistent cVDPV2s(?) • RCCs: elim of cVDPV2 • WPV erad. • RCCs (3) • GCC • VDPV elim. • RCCs (6) • GCC • Biosafety • Prepare enhanced • type 2 biosafety • (inventory, BSL2) • Enhanced • type 2 biosafety • GAP III for all WPVs • GAP III for all PVs • Timeline • 12 mos • 6 mos • 30 mos • 6 mos • 0-12 mos? • 0-18 mos? • Implementation • tOPV pulse in HR areas? • OPV • Routine • Immunization • tOPV • bOPV (with tOPV restart option) • Prepare nat'l OPV producers? • Ensure min 50m IPV/year? • IPV • 1 dose IPV?* • 1 or 2 dose IPV?* • SIAs • tOPV/bOPV/mOPVs • bOPV/mOPVs • Outbreak • response • IPV +/- mOPVs? • mOPVs/tOPV • mOPV1,2,3 +/- IPV • AFP • Surveillance • (Event-based) • Env. • Increased environmental sampling * for areas facilities with type II PV/WPVs, high RI coverage with > 2 doses IPV; for areas with high cVDPV2 risk >1 dose IPV; other areas subject to SAGE IPV WG recs.

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