POLIO END GAME – GLOBAL PERSPECTIVE

A.Parthasarathy

Egyptian Stele (1403 – 1365 B.C.)

April 19, 20233

What exactly is polio eradication?

AFP due to Non-polios

Infection:OPV virus

Infection: wild virus

Endemicity + + +

Eradication

Phase “w” + + 0

Eradication

Phase “v” + 0 0

(John TJ. Frontiers in Pediatrics 1996; NEJM 2000)

1988

350,000 cases

125 countries

Polio Eradication Initiative: Progress 1988-2012

2012*96 cases

4 countries

*Data as of 17th July, 2012

Polio Eradication Challenges

• Maintaining immunity• Maintaining surveillance• Readiness to respond• Reducing risk• Building on Wpv /cVdpv • transmission cessation/eradication• Preparing for the endgame

Risks

• Importing WPV

• Development of cVDPVs

Global Spread of Wild Polio Virus 2003 - 2011

wild virus type 3

ongoing importationendemic countries

wild virus type 1

Data in WHO/HQ as of 7th August, 2012

cVDPV type 1 (79 cases)

cVDPV type 2 (510 cases)

cVDPV type 3 (9 cases)

Cambodia2005-06

DOR/Haiti2000-01

China2004

Indonesia2005

Myanmar2006-07

Philippines2001

Nigeria2005-12

DR Congo2008-2012

Ethiopia2008-2010

Madagascar2001-02; 2005

Niger2006

6 outbreaks with cVDPV112 outbreaks with cVDPV22 outbreak with cVDPV3

598 circulating Vaccine-derived Polioviruses, 2000-12*17 countries, 20 outbreaks

598 circulating Vaccine-derived Polioviruses, 2000-12*17 countries, 20 outbreaks

Preparing for the endgame

Recent developments

• SAGE Nov 2011: recommended that the endgame strategy be based on phased rather than simultaneous Sabin strain removal

• WHO Executive Board Jan 2012: requested Director-General to develop comprehensive endgame strategy and timeline based on phased Sabin strain removal

• SAGE Apr 2012: may consider an 'early switch' (by Apr 2014), preceded by universal introduction of at least 1 dose of IPV (ID or IM) at DPT3 contact.

'Endgame'Following the WHO Executive Board resolution of January 2012 endorsing

eventual replacement of tOPV with bOPV globally, member states should start

preparing appropriate policies, esp. on the role of IPV, guided by and considering the

global recommendations of SAGE.

1. The national immunization programme should now begin incorporating into its planning:

(a) an eventual tOPV-bOPV switch globally, potentially as early as April 2014, and

(b) eventual cessation of all remaining bOPV globally at some point in the future (e.g. 2017-18 period).

'Endgame' planning (1)

2. This planning should include consideration of the introduction, in advance of a tOPV-bOPV switch, of at least one dose of IPV (e.g. at DPT3 contact), to boost population immunity thereby reducing the risk of a type 2 cVDPV emergence & the consequences of a potential cVPDV.

'Endgame' planning (2)

• According to GPEI’s IMG recommendations a new 'endgame' strategy could accelerate eradication, boost routine immunization & reduce long-term risks

• Depending on IPV price, the new 'polio endgame' could be cost-neutral in the near term & cost-saving in the long term(No.of doses 1/2/3 in the NIP IM/ID)

• Next steps (by Nov 2012): o Further cost-effectiveness analysis by Individual Nations(Affordable IPV IM/ID)o Consultation with with (a) Regional & National authorities on policy & program

implications, (b) regulators & manufacturers on licensing & supply.o Consolidation of a draft Polio Endgame Strategic Plan replacing tOPV with bOPV

1&3 to start with and finally phasing out bOPV with affordable All IPV schedule & Budget for the time line of 2013-18

o Feasibility introducing cost effective Hexavalent DTPw-HB-Hib-SabinIPV in the NIPs of developing countries.

SUMMARY

NID NID

0Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May

Polio Endgame Strategy-India, Potential Timeline

2011 2012 2013 2014

Last WPV case

Polio certification

IPV intro? NID NID

tOPV NID

Post-switch VDPV type 2 risk mgt.

tOPV-bOPV switch

NID NID NID NID

Certification standard surveillance, improved RI coverage

Modelling, Research, Development