1. At an urgent stakeholders consultation of the Global Polio Eradication Initiative in February 2007 participants agreed on a 24-month intensified eradication effort with specific indicators to monitor progress. In May 2008, the Health Assembly in resolution WHA61.1 urged all remaining poliomyelitis-affected Member States to engage all levels of political and civil society to ensure that every child is consistently reached and vaccinated during every supplementary immunization activity against poliomyelitis. It also urged Nigeria to undertake intensified activities to stop rapidly the outbreak of poliomyelitis in the north of the country, and Afghanistan, India and Pakistan to implement large-scale mopping-up activities to interrupt their final chains of poliovirus transmission.

The Health Assembly requested the Director-General to assist in mobilizing the financial resources necessary for full implementation of the intensified eradication effort, to undertake the necessary research for managing the long-term risks of reintroduction of poliovirus and re-emergence of poliomyelitis and to develop a new strategy to reinvigorate the fight to eradicate poliomyelitis from the remaining affected countries.

2. In June 2008, the Minister of Health in Nigeria established a high-level task force in order to improve the quality of supplementary immunization activities. Two such activities were urgently undertaken across the northern states in July and August 2008. Although the large outbreak of the disease experienced in 2008 has subsided, monitoring indicates that significant gaps in coverage of these immunization activities persist, with more than 60% of children remaining not fully vaccinated (having received three or fewer doses of oral poliovirus vaccine). Because of a continuing outbreak caused by a type 2 vaccine-derived poliovirus, northern Nigeria is the only area in the world where all three poliovirus serotypes are circulating. Since June 2008, polioviruses originating in northern Nigeria have spread to Benin, Burkina Faso, Chad, Côte d'Ivoire, Ghana, Mali, Niger and Togo.

3. In October 2008, India confirmed that indigenous type 1 poliovirus had not been detected in Uttar Pradesh state for 12 consecutive months, affirming the technical feasibility of poliomyelitis eradication. However, a new outbreak due to type 1 poliovirus in western Uttar Pradesh, following importation of the virus from Bihar state in mid-2008, has highlighted the fragility of progress because of the suboptimal efficacy of oral poliovirus vaccine in this area. Mopping-up activities with monovalent oral poliovirus vaccines continue on average every six weeks in western Uttar Pradesh and central Bihar. New approaches to enhancing vaccine efficacy are being assessed in order to accelerate eradication in northern India. In December 2008, type 1 poliovirus originating in western Uttar Pradesh, was detected in a sewage sample in Cairo.

4. In Pakistan, and to a lesser extent Afghanistan, the number of poliomyelitis cases surged in the second half of 2008 as a deterioration in security resulted in large-scale population movements and outbreaks in poliomyelitis-free areas, particularly in the Punjab province of Pakistan. In late 2008 and early 2009 Pakistan increased the number of nationwide supplementary immunization activities to supplement mopping-up activities in known reservoir areas, such as Sindh province where coverage during supplementary immunization activities was suboptimal. By early 2009 poliomyelitis was largely restricted to areas where insecurity hampers supplementary immunization activities, notably North-West Frontier Province in Pakistan and three of Afghanistan's 34 provinces (all three are in that country's Southern Region). This reality was underscored by the deaths in 2008 of two doctors and their driver on WHO duty for poliomyelitis eradication, in Kandahar province, Afghanistan.

5. Responses to outbreaks are continuing in 16 countries where there are cases associated with the importation of poliovirus in 2008 and early 2009. It is a matter of concern that 12 of these countries have become re-infected since mid-2008, demonstrating that international spread of poliovirus is continuing. Three of the outbreaks have continued for more than 12 months because response activities have been suboptimal:¹ Angola, Chad and Ethiopia and border areas in southern Sudan.

Although the risk of poliovirus importation remains high globally, 90 Member States have not maintained certification-standard surveillance for acute flaccid paralysis, as requested for global certification, and 39 have not maintained routine immunization coverage with oral poliovirus vaccine at more than 80%, as recommended in resolution WHA61.1.

6. In order to reduce the risk of international spread of poliovirus, in November 2008 the Advisory Committee on Poliomyelitis Eradication urged WHO to amend its recommendations on immunization against poliomyelitis in International Travel and Health,² to ensure that all travellers to and from countries affected by poliomyelitis are fully immunized. Travellers who are resident in an area affected by the disease are recommended to receive an additional dose of oral poliovirus vaccine between one and 12 months prior to each international journey.

7. Resource mobilization activities have been enhanced in order to sustain the intensified eradication effort in 2009-2010. In 2008, countries where poliomyelitis was endemic and a range of new and existing donors provided additional funding for eradication activities, with important new multi-year commitments by Rotary International, the Bill & Melinda Gates Foundation and several G8 countries, the latter following a renewed commitment to poliomyelitis eradication by G8 leaders at the 2008 Summit (Hokkaido, Toyako, Japan, 7-9 July 2008). Rigorous resource mobilization activities will continue in order to ensure full funding of the intensified eradication effort. As at 27 February 2009, the Global Polio Eradication Initiative had a global funding gap for the period 2009-2010 of US$ 340 million, against a budget of US$ 1340 million.

8. New research on the management of the long-term risks of reintroduction of poliovirus and re-emergence of poliomyelitis includes: the development, field-testing and introduction of a real-time polymerase chain reaction test for more rapid detection of circulating vaccine-derived polioviruses; eight studies to characterize better the risks of chronic immunodeficiency-associated excretion of vaccine-derived polioviruses in low- and middle-income countries; investigation of the use of adjuvants and strategies to decrease doses and compress vaccination schedules in order to reduce the cost associated with existing inactivated poliovirus vaccines; and, a clinical development project for the production of an inactivated poliovirus vaccine using Sabin-strain polioviruses.

9. As a basis for a renewed fight to eradicate poliomyelitis, the Global Polio Eradication Initiative has developed a new strategic plan for 2009-2013. The plan consolidates the proven eradication strategies and recently-developed tools and tactics (i.e. monovalent oral poliovirus vaccines and their use), with new and country-specific initiatives to respond to the primary challenges in each remaining area affected by poliomyelitis.² These new initiatives include the following: development of new vaccines (e.g. bivalent oral poliovirus vaccine); novel use of existing vaccines in areas where the efficacy of oral poliovirus vaccines is compromised (i.e. higher-titre monovalent oral poliovirus vaccine type 1 and inactivated poliovirus vaccines); targeted use of seroprevalence surveys to assess vaccine efficacy and programme effectiveness more accurately; short interval additional dose strategies to deliver extra vaccine doses to communities living in security-compromised areas; ensuring the continuation of annual oral poliovirus vaccine campaigns in areas subject to recurrent importations; and full implementation of the commitments of state governors in northern Nigeria outlined in their communiqué of 2 February 2009 entitled the "Abuja Commitments to Polio Eradication in Nigeria".¹

10. In October 2008, the Director-General announced the commissioning of an independent evaluation of the intensified eradication effort at its 24-month mark in March 2009. After consultation with stakeholders in the Global Polio Eradication Initiative, the evaluation will focus on the principal affected areas, giving particular attention to the primary challenges identified in each,² and will establish a common roadmap for the actions needed in order to achieve the 2009 and 2010 milestones of the Global Polio Eradication Initiative Strategic Plan 2009-2013.

More information on the Sixty-second World Health Assembly available at:
http://www.who.int/mediacentre/events/2009/wha62/en/index.html