WHO to declare polio global health emergency

The WHO document on polio prepared for the WHA and sent to India's health ministry says Afghanistan, Nigeria and Pakistan - the only three polio endemic countries - have seen a significant increase in new cases in 2011 as compared to 2010.

Nigeria saw 185% increase in cases. Afghanistan and Pakistan experienced 220% and 37% rise, respectively.

Nigeria and Pakistan were the only two countries with confirmed circulation of the P3 virus strain since last September. Compounding the problem is the finance gap that is plaguing the polio fight. WHO says the world is short by $1,090 million against an overall budget of $2,230 million.

The document says, "Already in the first quarter of 2012, an insufficiency of financing required some emergency eradication activities to be scaled back in 24 at risk countries. In line with the development of the Global Polio Emergency Action Plan 2012-13, a new more efficient strategy is being examined which would combine the eradication of the residual wild poliovirus transmission with the polio endgame strategy."

One of the decisions to be taken includes shelving an anti-polio vaccine, which is being used in India since 1978.

Once cleared, India will stop the use of trivalent oral polio vaccine (TOPV) and shift to solely using the oral bivalent one. Experts say chances of vaccine derived polio virus infection (VDPV) are higher with the use of TOPV (that targets all three strains of polio virus P1, P2 and P3) against the bivalent vaccine (that targets P1 and P3).

The new bivalent vaccine was the game-changer for India's fight against polio. Soon after its introduction in 2009, India saw a 94% decline in polio cases in 2010. It recorded only 42 polio cases. The number of affected districts also saw a sharp dip - from 90 in 2008, 56 (2009) and 17 (2010).

Polio hotbed Uttar Pradesh reported only 10 polio cases in 2010 as compared to 602 cases in 2009. Bihar recorded nine polio cases in 2010 against 117 in 2009.

Scientific studies showed that BOPV induced a significantly higher immunity response - 30% more than other trivalent or monovalent vaccines being used earlier.

Oral polio vaccines (OPV) contain a weakened version of poliovirus, activating an immune response in the body. A vaccinated person transmits the weakened virus to others that also develop antibodies to polio, ultimately stopping transmission of poliovirus in a community.

Importation of the virus is India's biggest concern, specially from its neighbours.

WHO has said, "Travelers to and from Pakistan should be fully vaccinated, and travelers to the country who in the past have had three or more doses of OPV) should have another one before they travel. Some countries require travelers from Pakistan to be fully immunized against polio before they grant an entry visa."

WHO board is urging member states with poliovirus transmission to declare such transmission to be a "national public health emergency", requiring the development and full implementation of emergency action plans, to be updated every six months, until such time as poliovirus transmission has been interrupted. It has also urged member states to maintain very high population immunity against polio viruses through routine immunization programmes and, where necessary, supplementary immunization activities.

"Maintain vigilance for poliovirus importations, and the emergence of circulating vaccine-derived polioviruses, by achieving and sustaining certification-standard surveillance for polioviruses," the board says.

Sir Liam Donaldson, chairperson of the Independent Monitoring Board, said, "Tackling the remaining one percent of polio is the greatest challenge yet, but it can be achieved if the funding and political commitment is there. Achieving this goal would be an immense triumph, making polio the second disease ever to be wiped from the planet. Failure would be a global health catastrophe."