Framework for certification of polio eradication in the African Region: report of the Secretariat

Abstract

1. Certification of polio eradication is conducted on a World Health Organization (‎WHO)‎ regional basis. ARegion is considered for certification only when all Member States demonstrate the absence of wild poliovirus(‎WPV)‎ transmission for at least three consecutive years on the basis of certification-standard surveillance forpolio. By 2014, poliomyelitis had been certified to have been eradicated in four of the six WHO regions, exceptfor the African and East Mediterranean Regions.2. The Sixty-eighth World Health Assembly in 2015 adopted a resolution to ensure interruption of WPVtransmission; achieve and maintain certification standard surveillance; introduce inactivated polio vaccine (‎IPV)‎before the global withdrawal of the type-2 component of the trivalent oral polio vaccine (‎tOPV)‎; and ensure thatpolio assets, lessons learnt and knowledge acquired are used to support other national health priorities.3. The African Region has made marked progress towards poliomyelitis eradication. By June 2018, no WPVcase had been confirmed in the African Region for 22 months since the last case in Nigeria with onset on 21August 2016, and the last wild poliovirus isolated from the environment on 27 September 2016. All MemberStates in the Region withdrew the type 2 component of the oral polio vaccine (‎OPV)‎ by May 2016. Phase 1adocumentation of laboratory containment of polio viruses has been conducted by all Member States. IPV has beenintroduced in routine immunization programmes in Member States that received the vaccine from global stocks.As of June 2018, progressively, almost all Member States (‎39 out of 47)‎ have been supplied with IPV. A total of40 countries out of 47 have had their national documentation for claiming polio-free status accepted by the AfricanRegional Certification Commission (‎ARCC)‎ for Poliomyelitis Eradication. The ARCC plan for acceptingdocumentation of polio-free status from the remaining Member States by 2019 is in place.4. With this progress, the African Region could be certified to have eradicated polio by end 2019 or early 2020.However, despite the progress made, the current polio surveillance gaps in Member States pose the threat of theRegion fulfilling the criteria for certification of poliomyelitis eradication by end 2019. There have also beenoutbreaks of circulating vaccine-derived polioviruses (‎cVDPVs)‎ which indicate low population immunity and riskof poliovirus re-introduction in countries that have claimed polio-free status.5. This framework proposes to Member States priority interventions towards certification of polio eradication inthe Region and to remain polio-free post certification. These include conducting risk assessments; strengtheningsurveillance with expanded use of technological innovations; improving preparedness and the quality of poliooutbreak responses; reaching children in insecure areas; laboratory containment of polioviruses; strengtheningnational certification committees and processes; implementing the International Health Regulations (‎IHR, 2005)‎;strengthening routine immunization; institutionalizing accountability of polio-funded personnel; finalizing thepolio transition plans and implementing the post-polio certification strategy.6. The Regional Committee examined and adopted the actions proposed in the framework.