"The GPEI's new Strategic Plan must be very different to its predecessors. It must address human factors as strongly as technical factors."
This sixth report follows from the seventh meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI), held in London, United Kingdom (UK), from October 29 to 31 2012. The IMB was convened at the request of the World Health Assembly to monitor and guide the progress of the Global Polio Eradication Initiative (GPEI)'s 2010-2012 plan to interrupt polio transmission globally by the end of 2012. This goal could not be achieved, despite the fact, as reported here, that "the Programme is enjoying an unprecedented level of priority and commitment, much of it stemming from the World Health Assembly's declaration of polio eradication as an emergency for global public health." All but 0.1% of polio has been eradicated globally: There were 350,000 cases in 1988; there were just 175 so far in 2012 as of the writing of this report.
The body of this report describes the situation in various countries, including India (which has been removed from the list of polio-endemic countries: "a great achievement in the history of global public health"), Angola, Democratic Republic of the Congo (DR Congo), Chad, Pakistan, Nigeria, and Afghanistan. Here is an example of a communication-related approach implemented in Chad: "Reaching the sizeable nomadic population has been vital - analysis of polio cases shows that nomadic children are disproportionately affected. This is an under-served segment of the population, not previously mapped in any detail. The Programme has sought the help of these communities to develop strategies to find and vaccinate their children. This innovative work, which has also involved the veterinary sector, and the contacting of nomadic leaders by mobile telephone, is paying dividends in Chad and could be replicated elsewhere in the Global Programme....Community engagement remains key, though. The percentage of children missed for 'social reasons' is still high. Caregivers' poor awareness of vaccination campaigns is now rated as high-risk by UNICEF [the United Nations Children's Fund], not helped by the fact that many core communications personnel are not yet in place in the field."
The report also sets out the strategic areas that need thorough development in 2013 and beyond. These include ensuring clarity and realism about how the Programme relates to routine immunisation and making sure that the mission of eradication is truly led by the countries where polio persists. In the words of the IMB, it is recommended that...:
- "...the International Health Regulations Expert Review Committee urgently issue a standing recommendation by May 2013 that will introduce pre-travel vaccination or vaccination checks in Afghanistan, Nigeria and Pakistan until national transmission is stopped."
- "...programme leaders in Afghanistan, Nigeria, Pakistan and Chad discuss their country's plan and best practice elsewhere to write, with their partners, a list of no more than five priority goals that they will achieve by the end of April 2013, circulate these goals to all programme staff, and maintain the focus and pace necessary to achieve them."
- "...an analysis be urgently commissioned to examine the relationship between the frequency and quality of vaccination campaigns, to guide programmatic decisions about the optimum interval between campaigns."
- "...every endemic country district-level task force (or equivalent)...be constituted to include a parent, representing parents of the district" ["In many countries, the Programme's mass-media messaging seeks to build the sense of ownership, of shared responsibility. Social mobilisers do the same with individuals and communities. But it is notable that the Programme's power structures do not reflect this."]
- "...every opportunity be taken to 'pair' other health and neighbourhood benefits with the polio vaccine." ["We hear of mosquito nets distributed by polio social mobilisers in collaboration with malaria programmes."]
- "...a report on vaccine supply [be supplied] at each of its [the IMB's] future meetings."
- "...the Programme accelerate planning to set out how the learning from polio eradication can be captured rigorously and comprehensively as part of the strategic legacy plan - overseen and funded with minimal distraction to current work."
- "...an intensive 'Polio Watch' be established in the countries at highest risk of a polio outbreak."
- "...India plans for a simulation exercise to test the readiness of its emergency response plans."
- "...a continual live audiovisual feed be broadcast online from the Nigerian Emergency Operations Centre, with a facility for the world's polio experts and the IMB to observe and provide input at any time."
In going forward, according to the IMB: "There is one ingredient...that is still missing in the affected countries - absolute ownership. Ownership means parents demanding the vaccine, making it their mission to protect their children. Ownership means local leaders grasping the challenge of wiping polio from their area. Ownership means a critical mass in the population believing that their children can, must and will be protected through the eradication of polio."
Click here for the 50-page report in PDF format.
Click here for a graphical synopsis of the report in PDF format.
Click here to read a note from the IMB to Dr. Margaret Chan, Director-General of WHO, which - amongst other things - addresses the international response to the murder of polio vaccinators in Pakistan in the closing days of 2012.