Global Polio Eradication Initiative Surveillance, Operation and Monitoring Vaccine Procurement, Communication and Social Mobilization Advocacy, Funding & Social Mobilisation Funding and Surveillance UNICEF WHO & GOVT. CDC (US, Federal Govt) ROTARY

Data as on 12/02/2014 GLOBAL POLIO CASES Global Polio Cases : Year 2000 = 719 Year 2001 = 483 Year 2002 = 1918 Year 2003 = 784 Year 2004 = 1255 Year 2005 = 1979 Year 2006 = 1998 Year 2007 = 1315 Year 2008 = 1651 Year 2009 = 1604 Year 2010 = 1352 Year 2011 = 650 Year 2012 = 223 Year 2013 = 400 Year 2014 = 11

500PER DAY BUT NOW… 0 in 2014 INDIA POLIO STATUS SINCE THE BEGINNING OF THE PROGRAMME…

WILD POLIO CASES IN INDIA Data as on

Rotary’s India National PolioPlus Committee The India National PolioPlus Committee in india plays the following roles:  Advocacy Political Bureaucratic Religious Corporate  Financial  Social Mobilisation  Operational support

Financial Contribution towards GPEI US$ 1.2 billion Worldwide Contributions US$ 9 billion Raised From Donors US$ 178 Million INDIA CONTRIBUTION

POLIO ERADICATION STRATEGY 4 PILLARS ROUTINE OPV IMMUNISATION MOPPING UP OPERATIONS IN HIGH RISK AREAS PPI NID/SNID REPORTING ALL AFP CASES (Surveillance) # Each of these components is essential for the complete eradication of Polio.

Mop Up Immunization  Outbreak Response Immunization (ORI) Acute Flaccid Paralysis (AFP) Surveillance  The number of AFP cases reported each year is used as an indicator of a country’s ability to detect polio-even in countries where the disease no longer occurs. A country’s surveillance system needs to be sensitive enough to detect at least one case of AFP for every children under 15 – even in the absence of polio.

JanFebMarAprMayJunJulAugSepOctNovDec Nationwide campaigns Sub-national campaigns 2013 Reaching every child during mass polio vaccination campaigns JanFebMarAprMayJunJulAugSepOctNovDec 2014 JanFebMarAprMayJunJulAugSepOctNovDec 2015

Routine Immunization Current level of Routine Immunization is 60-61%. To protect our children against wild polio virus it is more important to increase the vaccine of Polio under R.I.

High risk areas identified in India, April 2012 ~ 257,000 Migrant sites Migrant sites High risk areas in settled population ~ 154,000 HR areas in settled population = 10 Migrant sites = 10 HR sites 411,000 HRAs

Intensification of Routine Immunization 9 priority states & 239 districts with weak RI identified for focused attention HR Districts (based on Full Imm. <50% in DLHS3)

Strengthening Routine Immunization Fourth pillar for polio eradication - Helps sustain population immunity against polio – reduces risk of circulation of poliovirus Important component of the polio endgame strategy before & after withdrawal of OPV Protects children against other vaccine preventable diseases

Preparing for India to be Certified as Polio Free

Certification Process  The Goal of the GPEI is the Global Certification of the eradication of polio.  Global certification of eradication will be reached when all countries demonstrate the absence of wild poliovirus transmission for at least three consecutive years in the presence of excellent surveillance.

Certification Committee Structure Global Commission for the Certification of the Eradication of Poliomyelitis Six Regional Certification Commissions for Polio Eradications Every country has a National Certification Committee for Polio Eradication (NCCPE) India NCCPE established on Aug 7, 1998

Process of Regional Certification NCCPEs to prepare detailed documentation as per standard format. These are reviewed by the regional Commission and it will recommend to the Global Commission Only Global Commission can certify a region as polio free Only WHO regions and NOT individual countries certified as polio free (26-27 March, 2014)

3 of the 6 WHO Regions Already Certified Polio Free North, Central and South America (PAHO region) Western Pacific region (that includes China) European region in –WHO South East Asia region that includes India is the next region to be certified as polio free. Preparations are underway

Importation Recently Govt of India has issued the notification: A dose of oral polio vaccine (OPV) for all travellers to and from India from polio endemic countries : Afghanistan, Nigeria and Pakistan and countries with poliovirus circulation following importation : Ethiopia, Kenya, Somalia and Syria. In the absence of which VISAS will not be issued. Govt of India has set up immunisation booths across borders.

The geographical distribution of children with poliomyelitis associated with wild-type poliovirus shown by serotype for 2012 and (inset) the total number of children with poliomyelitis globally by serotype reported each year during 2001– polio cases in Pakistan, 53 in Nigeria and 14 in Afghanistan. The Horn of Africa – Somalia-190, Kenya- 14, Ethiopia-9, Cameroon-4 and An outbreak of cases in Syrian Arab Republic – 23 (Syria reported polio case after 1999) in the year Still Pakistan is reporting fresh cases of Polio during the current year numbering to 9 and Afghanistan is following up with 2 cases reported till date.

Continuous vaccination of children at border crossing points PAKISTAN INDIA BANGLADESH MYANMAR NEPAL Vaccination post 88 vaccination posts along Indo-Nepal border since Apr vaccination posts along Indo-Pak border since Sep vaccination posts along Indo-Bangladesh border since Mar 13 2 vaccination posts along Indo-Myanmar border since April 13

Lessons Its not over until its over everywhere 'The price of freedom is eternal vigilance'

Challenges Maintaining immunity Maintaining surveillance Readiness to respond Reducing risk Building on polio Preparing for the endgame

POLIO NOW A PUBLIC HEALTH EMERGENCY 194 member states to fully fund the GPEI & fill $945M gap in budget for All remaining infected countries to declare polio to be a NATIONAL PUBLIC HEALTH EMERGENCY requiring the implementation of emergency action plans monitored at the highest levels

POLIO A PUBLIC HEALTH EMERGENCY New approaches to tackle persistent challenges and improve polio vaccination campaign performance Heightened accountability, coordination, and oversight to ensure success at every level of government and within every partner agency and organization

POLIO A PUBLIC HEALTH EMERGENCY A surge of technical assistance and social mobilization capacity If any child in the world is permanently paralysed by Polio it is now a Global Emergency If any child in the world is not reached by Oral Polio Vaccine it is now an emergency.

Emergency Preparedness and Response Plan 2011 The Govt. of India has constituted a “Central Emergency Preparedness and Response Group” to ensure adequate preparedness for a rapid response and manage the actual response to the detection of a wild poliovirus anywhere in India. Rotary’s Role in Emergency Preparedness and Response Plan Advocacy at state and district levels for quaility implementation of polio eradication activities. Support IEC/Social mobilization activities & media management in coordination with Govt.. UNICEF and NPSP. Any other essential emergency support activities.

Mop up conducted National level partners meeting Media plan operationalized Vaccine arrived in district State & District Task Force Meetings 14 additional SMOs arrive in districts IEC plan developed Marker pens & other logistics procured RRT members arrive in districts Meeting with key distt officials and partners Mop up planning meeting with health officials Convene State EPRG Depute RRT members to districts Wild Polio virus notified to GoI and State Day 6Day 4Day 3Day 2Day 1 Day 0Day5 Vaccine & other logistics reach blocks Step II response Day 10Day 9Day 8Day 7

Emergency Preparedness &Response

Withdrawal of oral polio vaccine to minimize risks associated with use of OPV in the post eradication phase Switch from tOPV to bOPV in 2016 Withdraw all OPV from programme in 2018/2019 Before switch over IPV will be introduced in The introduction will also protect the occurrence of vDPV cases. Switch Over- Preparing for Polio Endgame Strategy

End Game Strategic Plan

Funding Gap The Total funding requirement from is $ 5.5 billion. Committed-$ 4 billion Deficit-$ 1.5 billion

World Polio Day 24 October 2013 India on World Polio Day illuminated iconic sites across the country including historic monuments India Gate, Red Fort with End Polio Now message. Red Fort India Gate

India Celebrated 3 years of last case reported in the country on 13 January 2014 India GateRed Fort

Celebrations on India’s Victory over Polio on 11 February 2014 in New Delhi by Govt of India

Towards a polio-free India Rukhsar. Let's ensure she is the last polio case in India!

Rotary’s Continued Engagement Very Crucial. Thank and appreciate those who have been working so hard. Continued advocacy in high risk areas against complacency Respond to local problems with local solutions You started the race and so you better be there at the finishing line when celebrations start