2.2.4 Polio eradication and transition plans implemented in partnership with the Global Polio Eradication Initiative

Scorecard

Across all levels of WHO, Output 2.2.4 assessment aggregate scores were strong for the dimensions technical support, leadership and value-for-money. The polio programme performed strongly in providing technical support to regions and countries affected by poliovirus transmission, or at risk of it. The support focused on a wide range of expertise, from boosting immunity levels to strengthening disease surveillance. WHO also provided technical support for polio transition tailored to country context and strong leadership and strategic oversight for transition activities. Value-for-money continues to be demonstrated by health economic evidence that polio eradication is a “best buy” versus trying to control the disease. In fact, the polio programme offers twice the impact for its money, given that it supports other public health interventions, as demonstrated recently through its successful and critical support to COVID-19. The “satisfactory” score for effective delivery of global public health goods was primarily due to the temporary suspension of polio campaigns for a four-month period. The “satisfactory” score for the gender, equity and human rights dimension was an achievement given that this is an emerging area.

Achievements and challenges

The Global Polio Eradication Initiative (GPEI) aims to secure a lasting world free of all poliovirus transmission, wild or vaccine-derived. The polio transition planning process seeks to maintain or selectively repurpose essential polio assets, integrating them into national health systems. Polio eradication and transition are twin goals and the ambition is to make progress towards both.

In 2020, the African Region became the fifth WHO region to be independently certified as free of all wild polioviruses. To address an evolving health emergency due to circulating vaccine-derived poliovirus type 2 (cVDPV2), a comprehensive strategy to respond to such strains was developed, using a novel oral polio vaccine type 2 (nOPV2), which received emergency use listing in November 2020. In six countries in Africa, 18 genetically distinct outbreaks were successfully curbed during 2020. However, the cVDPV2 emergency continues to expand, with strains affecting parts of other WHO regions, pointing to continuing gaps in routine immunization coverage.

The infrastructure built up to eradicate polio has a long history of supporting broader public health emergencies. In 2020, this infrastructure supported the global COVID-19 response: polio laboratories were utilized for laboratory analyses and polio staff supported outbreak response teams, contact tracing and disease surveillance, and educated communities on hygiene and social distancing. This support will continue in 2021, particularly during the critical vaccine delivery phase. These contributions highlight the need to sustain and successfully transition the polio network in order to serve national health programmes.

Polio transition remains a corporate priority for WHO. Two critical achievements are better alignment of this workstream with priorities and mainstreaming of polio transition into relevant outputs within the Programme Budget 2022–23. This new, integrated planning approach is a significant move to successfully transition out of GPEI support.

A key step towards transition is represented by programmatic integration, which has been accelerated by COVID-19. WHO is rolling out Integrated Public Health Teams (IPHTs) in WHO country offices that are pledged to the polio programme: these will provide integrated health services to communities and adopt a primary health care approach. Overall, COVID-19 has slowed down polio transition activities in priority countries, leading to revision of implementation timelines. Securing long-term political commitments and sustainable funding is becoming more challenging in the pandemic situation.

A continuing major challenge in 2020 is wild poliovirus type 1 (WPV1), which remains endemic in Afghanistan and Pakistan. The planned transformation in the performance trajectory of these two endemic countries was not completed owing to the months-long delay in supplementary immunization and other activities on account of the coronavirus pandemic. WPV1 cases fell from 176 to 140 even as an explosive outbreak of cVDPV2 developed. In Afghanistan, more than three million inaccessible children continue to pose a major challenge, resulting in ongoing WPV1 transmission and cVDPV2 intensification. Widespread virus transmission coupled with an immunization campaign of insufficient quality and high levels of missed children remain the key challenges in Pakistan in general, and in central Pakistan, Quetta region and Karachi in particular.

At the same time, a public health emergency associated with cVDPV2 continued to spread throughout 2020, primarily in Africa, but also in parts of the Eastern Mediterranean, South-East Asia and Western Pacific regions. The spread of existing outbreaks as well as the emergence of new cVDPVs point to gaps in routine immunization coverage.

Sustaining the necessary political will to support polio eradication must remain a top priority. For polio eradication to achieve its goals, it will be critical for Member States and GPEI to collaborate and leverage the efforts of other health programmes and initiatives to address chronically low immunization coverage and demand-based refusals. More comprehensive and systematic integration is the route towards both achieving and sustaining zero cases.

The changing epidemiological situation in 2019 and 2020, notably a severe cVDPV2 public health emergency, the risk of renewed international spread, particularly in Africa, and the successful eradication of wild polioviruses in the African region, all warranted a renewed analysis of strategic and operational approaches. All these factors led to the development of a strengthened plan for polio eradication in 2022–26, which focuses on overcoming residual operational challenges to reaching every child, including integrating with essential immunization services. Full financing and implementation of the strengthened plan will result in a sustainable polio-free world.

Despite unprecedented challenges, the COVID-19 pandemic presents a unique opportunity for the systematic and careful transitioning of polio assets and functions. The pandemic demonstrated that synergies and efficiencies can be made through programmatic integration: polio transition needs to be a part of a broader dialogue about resilient health systems and health financing. Continued country ownership and commitment will be critical for the successful transition of polio assets.