An Investigation of the successes and failures of the Global Polio Eradication Initiative (GPEI) in

African and Asian countriesPrepared by: Kimberly Fleek, MD and Christopher Weekes

Narrated by: Kimberly Fleek, MD

1) Introduction and Scopeo History of Disease o Epidemiological aspects of Polio Myelitis

2) Health Service Deliveryo Global Polio Eradication Initiative (GPEI)

3) Administration of the vaccineo Two types of vaccines

4) Management of personnel and materials5) Funding6) Conclusion

o Lessons learnedo Future outlook and recommendations

Outline

Source: http://www.polioeradication.org/Aboutus/History.aspx

Polio, was first described by Michael Underwood as a ‘ debility of the lower extremities in children’ in 1789

Polio outbreaks were first reported in the US in 1843 Karl Landsteiner and Erwin Popper discovered the virus

underlying the disease in 1908 Jonas Salk, using funds raised from the March of Dimes

campaign, developed the inactivated polio virus vaccine (IPV) in 1955 which was later followed by the introduction of oral polio vaccine (OPV) in 1961

Elimination of wild polio virus (WPV) in the US in 1972 (Nathanson & Kew, 2010)

Poliomyelitis: A brief history

Epidemiology of Polio: Distribution

Epidemiology of Polio: Determinants

Improved sanitation, reduced the exposure to Polio, but it inadvertently lowered the natural immunity of populations which has then followed by increasing severity of disease

As the epidemics of Polio became more severe, the average age of the infected population rose.

The increased average age of the infected population led to more severe cases of paralysis and more deaths

Countries with improved sanitation and vaccination were able to effectively immunize their population and lower the incidence of disease. Those that were not able to improve their sanitation network and effectively immunize their population continued to experience the burden of disease

The Epidemiology of Polio: Deterrents

Polio eradication campaigns are believed to improve health systems by (Loevinsohn, Aylward, Steinglass, Ogden, Goodman, & Melgaard, 2002):

enabling social mobilization

promoting inter-sectoral cooperation

simplifying health tasks (Aylward & Linkins, 2005)

broadening the distribution

of Vitamin A supplements

SIAs and NIDs (Aylward & Linkins, 2005)

Health Service Delivery of Polio Vaccine

In 1988, the World Health Assembly (WHA) set a 12-year eradication goal (Paul and Priva, 2004).

Between 1988 to 2004, the Global Polio Eradication Initiative (GPEI) grew to be one of the largest international health efforts in history

Challenges:

Barriers to coverage

Inadequate operational approaches

Vaccine Formulations

Continued Commitment

The Global Eradication Initiative (GPEI): History and Challenges

OPV , IPV , and vaccine related paralysis (VAPP) (Aaby, et al., 2004)

Spotlight: Trivalent Oral Polio Vaccine (tOPV) (John, et al., 2011)

Recrudescence

Administration of the Polio Vaccine

IPV: SAFER, LONGER RESIDUAL IMMUNITY

IPV: costlyOPV: Improved mucosal immunity; improved protection against unimmunized

OPV: Risk of VAPP; limited effectiveness in regions with other enteroviral disease prevalence

1% of the overall cases from 1988 are remaining worldwide

Outreach for marginal communities (Larson & Ghinai, 2011)

Local engagement

Mass-transit site vaccinations

Management of Personnel and Materials

Funding of GPEI

Lessons learned:

Successes

Difficulties

Future outlook and recommendations:

Strategic Plan Objectives

Enabling factors (i.e. vaccine vial monitors (Halm et al, 2010), geographic tailoring, site-specific strategizing, synchronization of SIAs, mixed vaccination schemes )

Conclusion

Aylward, R. B., & Linkins, J. (2005). Polio eradication: mobilizing and managing the human resources. Bulletin of the World Health Organization, 268 - 273.

Centers for Disease Control and Prevention. (2009). Progress Toward Interruption of Wild Poliovirus Transmission, 2009.Atlanta: Morbidity and Mortality Weekly Report.

Halm, A., Kamissoko, M., Kartogulu, U., Keita, T., Modjurom, N., Ronveaux, O., … Zipursky, S. (2010). Using oral polio vaccine beyond the cold chain: A feasibility study conducted during the national immunization campaign in Mali. Vaccine 28(2010). (3467-3472).

John, T. J., Jain, H., Ravishankar, K., Amaresh, A., Verma, H., Deshpande, J., . . . Sutter, R. W. (2011). Monovalent type 1 oral poliovirus vaccine among nfants in India: Report of two randomized double-blind controlled clinical trials. Elsevier, 5793-5801.

Larson, H & Ghinai, I. (2011). Lessons from polio eradication. Nature, 473:446-447

Loevinsohn, B., Aylward, B., Steinglass, R., Ogden, E., Goodman, T., & Melgaard, B. (2002). Impact of targeted programs on health systems: A case study of the Polio Eradication Initiative. American Journal of Public Health, 19-23.

Nathanson, N., & Kew, O. M. (2010). From Emergence to Eradication: The Epidemiology of Poliomyelitis Deconstructed. American Journal of Epidemiology, 1213-1229.

Shah et al. (2010). Improving polio vaccination during supplementary campaigns at areas of mass transit in India. BMC Public Health, 10:243. http://www.biomedcentral.com/1471-2458/10/243

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