How to ensure lasting protection against Polio

Jos Vandelaer
Chief of Immunization, UNICEF
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What would it take to introduce a vaccine into 126 countries—including those with the world’s weakest health systems—in two and a half years?

Eighteen months ago, we were approached with that very request: Could we coordinate efforts to support over 120 countries to add the injectable inactivated polio vaccine (IPV) into their routine immunization programmes before the end of 2015?

The scale of planning, coordination, and collaboration required for such an effort would be unprecedented. Resources weren’t confirmed. Sufficient vaccines at an affordable price were not yet available. Countries had already planned for other priorities. To say it was daunting would be an understatement. How could we make this happen?

We had solid evidence giving us this direction, documented in the global Endgame Strategic Plan, and a landmarkWorld Health Assembly declaration declaring polio eradication as a programmatic emergency. Working quickly, we gathered a coalition of core partners: CDC, Rotary international, Gavi, the Bill and Melinda Gates Foundation (BMGF), the Task Force for Global Health (TFGH), UNICEF and WHO – collectively now known as the Immunization systems Management Group (IMG). In the last 18 months, the IMG has engaged over 150 people at global and regional levels who, together, are working towards the same formidable goal.

Ending polio requires a transition of vaccines timed simultaneously across the world. Building on the eradication successes so far, we are planning to start phasing out the live attenuated oral polio vaccine (OPV) in early 2016. Coordination of this transition requires significant preparation and risk management. In order to ensure greater protection against poliovirus and to boost population immunity, all countries currently using only OPV in their immunization programs have been asked to add at least one dose of IPV to their immunization schedules, to help mitigate the potential risks related to the withdrawal of OPV.

High immunization coverage is also an essential part of the Endgame Plan. The push to end polio provides an opportunity to examine immunization systems so that we can reach the world’s most under-vaccinated children with many life-saving vaccines, including the polio vaccines. Our colleagues and partners are working closely with countries to strategize on how the process of adding IPV can help to improve their overall immunization programme performance, and to document their experiences and learning for future reference. Harnessing existing polio-funded staff, lessons and infrastructure to help deliver other vaccines is one such example of how our eradication efforts can help improve immunization programs.

So where are we now, with just over a year to go?

The critical elements have been secured: donors have agreed to the necessary financial support for countries who cannot afford to introduce IPV on their own; Gavi has developed an expedited application process for countries; vaccine manufacturers have offered lower prices; and partners, led by WHO and UNICEF, are providing technical support to countries. A wide range of information, tools and templates are now available online, covering areas such as IPV introduction planning, supply chain and logistics, communication, and health worker training.

Figure 1. Status of country planning for IPV introduction. A larger version of this map is available on the IPV web site.

What initially seemed overwhelming now looks within reach. Thanks to the engagement of all partners, all 126 countries are expected to introduce at least one dose of IPV into their routine immunization schedules by the end of 2015 (see Figure 1).

The combination of global and regional coordination with country-level engagement has been central to our success to date, but we are carefully tracking progress, because we know that 2015 will be critical—countries must move from planning to actually introducing the vaccine—and this is no small feat.  Continuous efforts and ongoing support for countries during this transition is imperative, and progress to date is encouraging. The introduction of IPV by all OPV-only using countries is a critical step in this direction. With the dedication of our countries and partners, we are confident that we will make it.

This article is published in collaboration with Impatient Optimists. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Dr. Jos Vandelaer is the Chief of UNICEF’s global Immunization program, based in New York, USA. Michel Zaffran is the Coordinator of the Expanded Programme on Immunization (EPI) team at the World Health Organization (WHO).

Image: Human genetic material is stored at a laboratory in Munich May 23, 2011. REUTERS/Michael Dalder.

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