Expanded programme on immunization

Securing the gains: How international collaboration can protect polio-free areas

"The polio virus is a dangerous enemy and does not recognize international borders. We need intercountry and interregional collaboration for the best possible surveillance and immunization activities."

Those were the words of Dr Shin Young-soo, WHO Regional Director for the Western Pacific, in a video address to an international workshop on polio eradication held 21 and 22 July, in Urumqi, Xinjiang, China; co-hosted by WHO and the Chinese Centre for Disease Control and Prevention.

This was echoed by more than 40 international public health specialists, senior officials and experts engaged in the field of polio eradication, from China, India, Kazakhstan, Kyrgyzstan, Mongolia, Myanmar, Nepal, Pakistan, Russian Federation, Tajikstan, Uzbekistan, Viet Nam, WHO headquarter and offices in the European Region, South-East Asia Region and Western Pacific Region, and WHO partner agencies.

The workshop heard that there had been encouraging break-through developments in global polio eradication. Only 232 cases were reported in the four endemic countries in 2010, with India not having reported a wild poliovirus case for over 6 months in 2011 and the Western Pacific Region certified polio-free status for a decade.

However, a polio outbreak in Tajikistan in 2010 following virus importation and a subsequent spread to at least three other countries was a wake-up call that global eradication is still an unfinished business. Neighbouring countries like Mongolia and China came under the threat of the virus travelling across borders.

"As long as there is polio anywhere in the world, any child who has not been fully vaccinated is vulnerable," said Dr Shin.

Dr Wang Yu, Director General of China CDC, in his opening speech at the workshop, said that global polio eradication is moving into a critical stage: "On one hand, we have witnessed the encouraging achievements on a global basis, with the total number of polio cases at a historically low level; on the other hand, however, polio outbreaks occur in certain countries where polio had been successfully eradicated before. The global battle to eradicate polio is challenged with the double pressure of becoming polio-free and maintaining polio-free status. This is why this workshop is convened."

Recognizing that polio eradication is a global activity and an ongoing process and certification of polio-free status is not a guarantee, meeting participants summarized five major lessons learned in 2010.

  • Importations occur all the time and will continue until polio eradication is achieved.
  • The most vulnerable populations will be affected the most. Reported immunization coverage may not always represent true childhood population immunity. Even if accurate, subnational variation is what matters—“the weakest link” defines risk.
  • Rapid response is vital. Delays mean any outbreak could become catastrophic in size and fatal. It requires sensitive surveillance at all critical subnational levels. Every step in acute flaccid paralysis (AFP) surveillance needs to be timely. Early notification of suspicion is best.
  • Response to threat requires full political support. Cross-border coordination and cooperation is critical.
  • Outbreaks are much less expensive to prevent than control and interrupt. Risk assessment should be undertaken by countries and provinces and should lead to risk reduction. Funding prevention requires local mobilization.

In a time of increasing globalization, infectious disease control efforts cannot focus just on the domestic situation. Working together to optimize early detection and response capacities is the key to protecting those areas that are polio-free and to prevent the risk of a major outbreak.

Meeting participants agreed that it is important to define and develop mechanisms for timely sharing of information and data – for example, national and subnational coverage and surveillance data, subnational risk assessments in “bordering” geographic areas, and plans for immunization campaigns.

Workshop participants realized that strategies to immunize cross-border migrant populations are needed. It is critical to support each other with emergency vaccine needs, where possible. And where appropriate and feasible, it is good to combine risk assessments and use them for joint advocacy and resource mobilization efforts.

Meeting participants also discussed cross-regional collaboration through professional exchanges of staff, delivery of training workshops, online collaboration, and resource sharing. Future meetings between a few polio-infected countries and workshops with all countries are also anticipated.

The world cannot contain polio. It must be eradicated, meeting participants vowed. "Let's find new ways of working together and supporting each other to ensure that no child, anywhere in the world, will ever again suffer the pain of lifelong polio paralysis," said Dr Shin.