The United States described a four-pronged strategy to accelerate the eradication of polio globally at the WHO Executive Board session on poliomyelitis on Thursday.
No. 1: Halt circulation in Afghanistan, Pakistan
The first action, the U.S. representative said, would be the intensification of efforts to halt the circulation of the wild poliovirus in Afghanistan and Pakistan by the end of December 2024. Synchronised campaigns across borders would be imperative, with the representative noting, “Decisive action now can pave the way for a polio-free future.”
No. 2: Surveillance, campaigns, community engagement
The second action would be closing surveillance gaps, conducting high-quality campaigns and community engagement in the African region, where there continues to be persistent variant polioviruses.
“These are not just strategies; they are indispensable keys to our success in eradicating polio globally,” the representative said.
The U.S. also urged member states to support incremental measures for rebuilding capacity in high-risk countries. The representative highlighted the unique challenges faced by these countries, calling for solidarity and support to rebuild health infrastructure.
No. 3: Alignment of eradication, containment efforts
The third pillar calls for alignment of eradication and containment efforts.
“Eradication and containment must go hand-in-hand,” the representative said.
All member states were urged to intensify actions to speed up the progress of poliovirus containment and certification.
No. 4: Immunisation
Lastly, the U.S. underscored the importance of integrating polio eradication efforts with routine immunisation activities.
Recognising the challenges of reaching communities not responsive to standalone polio campaigns, the representative said, “Integration with routine immunisation is crucial to reaching every child, even in the most remote areas.”
Reiterating support for a comprehensive approach, the U.S. urged donors to expedite and increase their contributions to polio eradication.
“Continued investments are not just essential; they are the lifeline that ensures we reach all children, multiple times, and ultimately end the polio scourge globally,” she said.
Tackling persistent challenges
WHO member states stressed the global commitment to fighting the spread of polio.
The Afghan representative addressed the specific challenges his country faces in eradicating the disease from the country. He said that despite some successes, the country faces several impediments to implementing crucial house-to-house campaigns, an important component of any polio eradication strategy.
“The inability to conduct these campaigns jeopardises the effectiveness and efficiency of our collective effort to eliminate polio on the ground,” the representative said.
He added that there was a negative impact from not being able to reach vulnerable children specifically. And he stressed the need for national ownership over the polio eradication program and collaboration with international institutions, as well.
The Afghan representative also called for investments in human capital, highlighting the pivotal role that the right professionals can play in eradicating the disease and ensuring it remains eradicated. The representative also noted that technology could revolutionise the program, making data collection, monitoring, and response strategies more efficient.
Challenges in the Eastern Mediterranean region
Yemen, speaking on behalf of the member states of the Eastern Mediterranean region, acknowledged the progress made in reducing poliovirus circulation in 2023. However, challenges persist, the representative said, particularly in preventing the virus from gaining a foothold in previously identified reservoirs.
The representative stressed, “We must reach all children with polio vaccines and strive to prevent other vaccine-preventable diseases.”
The call for global solidarity and action was reinforced, urging the WHO to provide financial assistance to countries facing internal and external obstacles, including those managing refugee influxes. The importance of routine immunisation and vaccination campaigns against polio was emphasised, particularly in regions like Yemen.
African region’s concerns and call to action
Representatives from the African region expressed gratitude for poliomyelitis being placed on the WHO Executive Board agenda, highlighting the collective efforts to end polio circulation. Concerns were raised about the persistent circulation in specific regions of the Democratic Republic of the Congo. Delays in introducing the polio vaccine and challenges in the move to the novel oral polio vaccine were also noted.
Comoros, speaking on behalf of the African region, urged countries to act on recommendations, improve information campaigns, and ensure vaccination coverage, especially for low or zero-dose children. The increased risk of a major epidemic outbreak due to a drop in immunity across the continent was described as a significant concern. The representatives called for further mobilisation of resources to implement strategies preventing cross-border and international transmission.
The world’s only public health emergency of international concern
Aidan O’Leary, director of Polio Eradication at WHO, while commending member states and partners for their commitment and support, highlighted the significance of the ongoing efforts.
“Polio is the only public health emergency of international concern in the world as we speak today,” O’Leary said.
He emphasised the collaborative nature of the fight against polio, noting the vaccination of over 800 million children globally in 2023.
The director also stressed the importance of vigilance in surveillance in the face of emerging variants concentrated in specific regions. He reiterated the challenge of reaching zero-dose children and the necessity of maximising coverage through innovative delivery modalities. O’Leary also emphasised the ongoing innovation at every level, citing the prequalification of the novel oral polio vaccine as a significant milestone.
“We are committed to making every effort [in] … 2024,” O’Leary said.
Meanwhile, WHO Director-General Dr. Tedros Adhanom Ghebreyesus described the final leg of the polio eradication journey as the most challenging.
Despite the difficulty, he conveyed optimism, stating, “The finish line is within reach.”
In his report on poliomyelitis eradication, Tedros called for the implementation of risk mitigation strategies in highest-risk polio-free areas, notably in the Afghan city of Kandahar. He also revealed the ongoing conflict in Sudan “continues to hamper the response to the new outbreak of circulating vaccine-derived poliovirus type 2, detected in 2023.”
To direct future polio transition efforts, Tedros’ report revealed a post-2023 strategic framework for polio transition is already being developed, and it is based on a theory of change and will build upon lessons learned from the strategic action plan on polio transition (2018–2023).
“The operationalisation of the framework will begin in 2024; it will be closely aligned with evolving epidemiology and polio eradication timelines, and will address the recommendations of the Polio Transition Independent Monitoring Board outlined in its most recent report published in July 2023. This work is essential to ensure that the eradication gains once made are sustained,” the report stated.
Focus for 2024 and beyond
In 2024, the report revealed the focus of the WHO will be on updating the polio post-certification strategy, with the aim of “aligning it with updated eradication timelines and reflecting new developments in post-certification policy, strategy and research.”
The strategy will also be aligned with the post-2023 strategic framework for polio transition.
“Working groups have been established for each key thematic area. During this process, efforts will be made to identify and apply lessons learnt from the 2016 switch from trivalent oral polio vaccine to bivalent oral polio vaccine in routine immunisation programmes, in support of preparations for the eventual cessation of all oral polio vaccine use from routine immunisation programmes,” the report stated.
Following the successful eradication of wild polioviruses globally, the report revealed that the use of all remaining oral polio vaccines in routine immunisation programmes will end. The aim of this action, the DG reported, is to eliminate the risk of vaccine-derived polioviruses.