Inactivated polio vaccine support

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There is no cure for polio but it can be prevented with polio vaccine

By the end of 2014, only three countries in the world remained polio-endemic

Nepali child receive IPV.jpg

First child in Nepal to be immunised with IPV as part of its introduction into the routine immunisation schedule, the first Gavi-supported country to do so.
Credit: UNICEF Nepal/2014

Crippling, potentially fatal

Polio is a highly contagious viral infection, mainly affecting children under the age of five, which can lead to paralysis or even death.

Many infected people have no symptoms, but do excrete the virus, hence transmitting infection to others. In areas with poor sanitation, the virus easily spreads through contaminated water or food.

One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5-10% die when their breathing muscles become immobilised.

Global Polio eradication efforts

Without a cure, polio can only be prevented with a polio vaccine. Multiple doses of the polio vaccine are required and usually provide life-long protection.

When the Global Polio Eradication Initiative (GPEI) was launched in 1988, polio was endemic in 125 countries and paralysed about 1,000 children per day. Thanks to these efforts and vaccination, polio cases have decreased by 99%: from more than 350,000 cases a year to 413 reported cases in 2014.

Today, more than 10 million people are walking who would otherwise have been paralysed by the poliovirus.1 India, once the world’s epicentre of polio, has been polio-free since January 2011. Only parts of three countries – Afghanistan, Nigeria and Pakistan – remain polio-endemic.

POLIO’S FINAL MILE

As long as a child anywhere remains infected with polio, children in all countries are at risk. Half of polio cases from 2009-2011 resulted largely from weak immunisation and health systems, accessibility and security issues.2 In the past decade, polio has spread to over 20 polio-free countries from endemic areas.

In May 2013, the World Health Assembly endorsed the new Polio Eradication & Endgame Strategic Plan 2013-2018, calling on countries to introduce at least one dose of the inactivated polio vaccine (IPV) and begin the phased removal of oral polio vaccines.

Removing the live-attenuated oral polio vaccines (OPV) will eliminate the risk of vaccine-associated polio outbreaks. Introducing IPV is a critical step to manage any risks associated with this phased removal. Adding IPV to routine immunisation programmes will also improve immunity and help prevent further OPV-associated outbreaks from emerging.

Overcoming the final 1% of cases is similar to completing a marathon - the final stretch is often the most difficult to complete, takes the most focused effort and yet can be the most rewarding.

A 2010 study3 estimates that polio eradication could provide at least US$ 40-50 billion of net benefits for the world’s poorest countries, primarily from avoided treatment costs and productivity gains.

The Global Polio Eradication Initiative (GPEI) is a public-private partnership led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and UNICEF. Its goal is to eradicate polio worldwide.


1 GPEI Polio Eradication & Endgame Strategic Plan 2013 -2018, chapter 4 

2 GPEI Polio Eradication & Endgame Strategic Plan 2013 -2018, p9

3 Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SGF, Linkins J, Sutter RW, Aylward RB, Thompson KM. Economic analysis of the Global Polio Eradication Initiative. Vaccine 2011;29(2):334-343.

Gavi is supporting the GPEI endgame plan by supporting the introduction of inactivated polio vaccine into routine immunisation programmes and strengthening routine immunisation services

Supporting the polio endgame

To complement GPEI’s efforts, Gavi is leveraging its experience with introducing new vaccines to facilitate the introduction of inactivated polio vaccine (IPV) to meet the unprecedented timelines of the Endgame strategy. Gavi is currently supporting the introduction of IPV with funding from GPEI, in up to 73 countries eligible for support, and helping to strengthen routine immunisation programmes.

IPV introduction

There has been high country demand for IPV and all of the 71 countries expected to apply for support had done so by January 2015. Nepal became the first Gavi-supported country to introduce the vaccine in September 2014, only 10 months after the programme was initiated. As of March 2015, all countries are expected to introduce IPV before the end of 2015.

Countries introducing IPV will receive a one-time cash grant from Gavi, funded by GPEI, to support some of the additional activity costs related to introducing this new vaccine. These activities may include health worker training, social mobilisation, micro-planning, expansion or rehabilitation of cold chain equipment, printing of materials (such as immunisation cards), technical assistance, and modifications to the surveillance systems.

Gavi and GPEI have worked closely with UNICEF to ensure sufficient and affordable quantities of IPV. Enhancing the base of supply to provide sufficient and uninterrupted supply of IPV is critical to supporting successful IPV introductions.

STRENGTHENING ROUTINE IMMUNISATION

Routine immunisation is the sustainable, reliable and timely interaction between the vaccine, those who deliver it and those who receive it to ensure every person is fully immunised against vaccine-preventable diseases.

Strengthening routine immunisation is a pillar of the polio eradication strategy. High routine immunisation coverage establishes a strong base for population immunity to prevent polio outbreaks and builds a sustainable platform for the introduction of IPV and other lifesaving vaccines.

In polio-endemic countries, the virus persists in marginalised populations where health and immunisation services are largely non-existent and oversight and management of primary health care systems are weak.

However, the poliovirus cannot survive for long periods outside of the human body. Without an unvaccinated person to infect, the polio virus will die out. As a result, strengthening routine immunisation is a critical factor to successfully interrupting all poliovirus transmission.

Polio endgameGavi is working with GPEI to strengthen routine immunisation in 10 focus countries targeted by the Polio Endgame Strategy.  The focus countries (Angola, Afghanistan, Chad, DR Congo, Ethiopia, India, Nigeria, Pakistan, Somalia, South Sudan) all contain significant numbers of partially and non-vaccinated children. These ambitions are aligned with Gavi’s new strategic plan (2016-20), which focuses on coverage and equity improvements.

These efforts benefit from the expertise developed by GPEI polio assets since 1988 to support and strengthen broader immunisation activities.

Maximise, manage, mobilise, monitor

Strengthening routine immunisation involves:

  • maximising the reach of vaccines through a well-functioning supply and cold chain system, detecting unreached groups, efficient service delivery and the capacity building of vaccinators and supervisors;
  • managing programmes with strong political and management support, effective planning, as well as policy and strategy development;
  • mobilising people to generate demand  through community and caretaker engagement; and
  • monitoring programme performance with rigorous disease surveillance, data analysis and evaluation.

Countries approved for IPV introduction receive a one-time cash grant from Gavi, funded by GPEI, to support additional activity costs related to introducing IPV and help strengthen RI. This may include health worker training, social mobilisation, micro-planning, expansion or rehabilitation of cold chain equipment, printing of materials (such as immunisation cards), technical assistance, and modifications to the surveillance systems.

Together, routine immunisation and polio assets amplify each other’s impact towards a polio-free world and improving children’s health overall.

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