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

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Polio Strategic Plan

India Expert Advisory Group

13-14 July 2011

Impact & prospects at the half-way point

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Recap of Major Elements of the New Strategic Plan

West Uttar Pradesh

Central Bihar

High-Risk Blocks

New Tactics: high risk 'blocks' & migrants, India

New Tactics: sub-national & local leaders, Nigeria

1st bivalent OPV campaign

Afghanistan16 Dec 2009

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)

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Impact of the Strategic Planat July 2011

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Key Developments - ProgressPolio-infected districts, last 6 Months

wild virus type 1

wild virus type 3

India: 6 months with no polio case for 1st

time in history!

Nigeria: 95% drop in cases

sustained for > 18 months

Smallest type 3 infected area & cases in history

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

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Major Risks

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

Persistent outbreaks in the 3 're-established

transmission' countries*

* infected-districts, last 6 months

Chad

DR Congo

Angola

Virus that originated in

India can return by the

same routes!

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< 1 1 – 1.9

>= 2Pop under 15 yrs <100,000

Data in WHO/HQ as of 07 Jun 2011

Non Polio AFP

Sample Collection< 50% 50 – 79%

>= 80% Pop under 15 yrs <100,000

Persistent performance gaps in recently infected

areas.

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

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Summary

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At the mid-point in the new Polio Strategic Plan, there is strong

evidence that full application will stop all polio transmission.

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Strong progress globally, but India still

faces major risksRe-infected countryEndemic country with WPV

Wild virus type 1 Wild virus type 3

Wild Polioviruses Globally, last 4 months22 Feb – 21 Jun 2011

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Undetected low season transmission

Return of Indian viruses from Africa

New importations from reservoirs

Risks to India's US$1 Billion Investment in Polio Eradication

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• 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?

Potential IEAG Priorities

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Circulating Vaccine-derived Polioviruslast 6 months

cVDPV2 (13 cases)

cVDPV1 (0 case)

cVDPV3 (0 case)

0

1

2

3

4

5

Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11

Nigeria Afghanistan Somalia

cVDPV monthly distribution of cases by country

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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)

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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)

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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

• District-specific plans & oversight

• Population-specific approaches

• Bivalent OPV

• 'Importation belt' tactics

Key Elements of the New Strategic Plan

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Major Milestones at 24 March 2011

mid-2010: all 2009 importations interrupted Achieved (15/15)

within 6 months: all new (2010) imports interrupted Achieved/on-track

end-2010: all re-established viruses interrupted.

Achieved: Sudan Off-track: DR Congo Missed: Angola, Chad

end-2011: 2 of 4 endemic countries interrupted.

On-track: India, Nigeria, Afghanistan Off-track: Pakistan

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Genetic Clusters of Poliovirus 1

2008 2009 20102008

2009

2010

Virologic Progress in Africa

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RCCs: elim of cVDPV2

Roadmap for VDPV Elimination

Implementation

Biosafety

Outbreak response

* 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.

Validation/ Certification

Policy

12 mos

Decisions

RoutineImmunization

Surveillance

Timeline 0-12 mos?

Critical Events 6 months after last WPV in main African reservoir?

6 months after last WPV in the

world?

Last polio case in main Asian reservoir

EB

DG/WHO announceSAGE

WPV erad.• RCCs (3) • GCC

30 mos

bOPV cessation

6 mos 0-18 mos? 6 mos

• OPV

• IPV

• AFP

• Env.

Increased environmental sampling

(Event-based)

Prepare enhanced type 2 biosafety (inventory, BSL2)

GAP III for all WPVs

Enhancedtype 2 biosafety

VDPV elim.• RCCs (6) • GCC

WHA

RCCs assess WPV2 elim & no persistent cVDPV2s(?)

GAP III for all PVs

DG/WHO announce

Prepare nat'l OPV producers?Ensure min 50m IPV/year?

SIAstOPV/bOPV/mOPVs

1 or 2 dose IPV?*

tOPV

1 dose IPV?*

bOPV (with tOPV restart option)

tOPV pulse in HR areas?

bOPV/mOPVs

Uncertainty

mOPV1,2,3 +/- IPV IPV +/- mOPVs?mOPVs/tOPV

DG/WHO announce