World Health Assembly Review: Poliomyelitis, 2018 And Beyond

The recent World Health Assembly approved resolutions concerning the eradication and containment of polio, and how to deal with the transition to a polio-free world. The following is a report from the discussions during the Assembly.

The 71st World Health Assembly (WHA), which took place from 21-26 May, mapped out future action, and noted the developments under the Polio Eradication and Endgame Strategic Plan 2013-2018.

Eradication

With respect to eradication, particular attention was paid to the eradication of polio in Afghanistan, Pakistan and Nigeria, in addition to preventing recurrence in conflict areas.

In this regard, Afghanistan, which has the highest number of recorded cases of polio (standing at seven cases) this year, cited issues such as conflict, refusal by reluctant parents and the difficulty in reaching certain areas as impediments to eradication.

Nonetheless, the delegate said Afghanistan was optimistic about eradicating polio by the end of 2018.

Its neighbor, Pakistan, said it recorded one case this year but remains concerned as migration from Afghanistan continues. Pakistan reiterated its efforts of trying to immunize entrants at the borders.

Syria expressed concern about the re-emergence of polio viruses in 2013 long after it announced polio eradication in 1995. But it was able to contain polio within four months. However, new cases surfaced again 2017 due to migration and conflict.

Countries like Afghanistan, Nigeria, Syria, Pakistan, and Chad (which said it is vulnerable because of the situation in its neighbouring regions), still remain at risk. This led Canada, Russia and Australia to state that the timeframe for eradication, currently set for the end of 2018, may not be realistic.

Containment and Transition

Many other countries expressed their concern over the containment of polioviruses post eradication. This well-founded fear, which has the potential to undermine decades of effort, was triggered by an accidental release of wild poliovirus type 2 strains from a vaccine production facility in 2017.

Containment would require limiting the number of facilities where virus strains are stored as well as potentially infectious materials like samples taken from patients, they said.

Meanwhile, as the world hopes the end of 2018 might mean the end of polio, it is matched by concern of potential job losses.

Many polio immunization workers were trained only to administer oral polio vaccines and for future immunization where required, only the injectable vaccines would be used, according to WHA report A71/9.

While people in more technical positions and with higher qualifications can transition to other public health concerns, this decision may hit the vulnerable low skilled workers the hardest, sources have said.

The annual spending for polio eradication was around US$ 1 billion in 2016 and halved to 450 million in 2017, according to the report. Most of this substantial spending, despite the fact that only 12 children were affected by polio, went for immunization surveillance to ensure it does not reemerge.

The debate in the Health Assembly committee dealing with transition largely focused on laboratory containment and certification. However, document A71/9, on transition and post certification, contains a section devoted to the human resource management issue.

The document notes a 12 percent downscaling since 2016 and further downscaling in the coming years. In 2018, a sum of US$ 50 million was set aside to cover terminal indemnities and liabilities. Efforts are also being made to communicate to staff from the top to the grassroots about the implications of the reduced budget and transitions.

With respect to the issue of containment of the virus in the laboratories, Russia and the European Union requested amendments to document A71/26 preserving the autonomy to impose additional procedures and requirements in future. Russia asked that in addition to the WHO Global Action Plan to minimize poliovirus facility associated risk, additional national requirements be complied with as well.

Member states agreed to have National Authorities for Containment be set up. Such bodies have to report to WHO by the first quarter of March 2019.

As mentioned by the Philippines, the document reflects the need for harmonisation of certification mechanisms. Reporting to the Executive Board and Health Assembly on progress would ensure monitoring in the future. However, the European Union required that this be aligned with other polio reporting requirements.

The United States, meanwhile, stressed the ultimate goal of stopping the circulation of wild polioviruses and cautioned against implementing transition plans too quickly. It encouraged countries to seek technical assistance and do so systematically.

Separately, at an event hosted by the Graduate Institute Global Health Centre on the eve of the Assembly, a WHO official warned that failing to transition health workers from polio work could lead to a “disaster” and “complete collapse of local health systems.” He added, “There is an ethical duty on the part of the WHO to not leave these staff out in the cold,” but rather try to retrain or shift them.

William New contributed to this report.

 

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