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What is GPEI?

What is the Global Polio Eradication Initiative (GPEI)?

UNICEF is working to protect all children from polio by supporting the immunization of every child until the disease is eradicated. Along with national governments, the World Health Organization, Rotary International and the U.S. Centers for Disease Control and Prevention, we are a spearheading partner in the Global Polio Eradication Initiative – the largest and most far-reaching public health initiative of all time. This global initiative has a single goal – a polio-free world for all children.

Since the GPEI was launched in 1988 during the World Health Assembly, the number of global polio cases has decreased by 99%, from over 350,000 in 1988 to fewer than 1,000 in 2003. However, two major challenges to the initiative have emerged. First, wild polio transmission continues in four endemic countries and second, the polio virus continues to re-infect previously polio-free areas. International spread was exacerbated by the suspension of immunization in parts of northern Nigeria for up to 12 months in 2003 and 2004 due to rumors regarding oral polio vaccine (OPV) safety. Between 2003 and 2007, twenty seven countries were re-infected with imported poliovirus, twenty as a result of viruses originating from northern Nigeria.

Consequently, 2005-2006 was a period of unprecedented innovation to address these challenges. New tools such as monovalent vaccines (mOPV) were developed, and refined laboratory procedures allowed the confirmation of poliovirus 50% faster than before. The use of monovalent oral polio vaccine type 1 (mOPV1) significantly reduced the transmission of type 1 poliovirus and for the first time ever, worldwide, there were fewer cases of poliovirus type 1 (P1) than type 3 (P3) cases.

There was a renewed international determination to finish polio eradication as evidenced by additional measures taken specifically to stop international spread. These measures included the World Health Assembly's adoption of resolution 59.1, which outlined procedures for reporting and addressing polio cases, the inclusion of polio in the International Health Regulations (IHR) and the requirements issued by the Kingdom of Saudi Arabia for pilgrims attending Haj to be vaccinated against polio with OPV.

New tactics were developed to reach missed children in each of the four remaining endemic countries, such as an accelerated mOPV supplementary immunization activity (SIA) schedule in India, the Immunization Plus Days strategy in Nigeria, synchronization of campaigns and initiatives to negotiate access in security compromised areas in Afghanistan and Pakistan, which are considered a single transmission zone.

What is UNICEF’s role in GPEI?     

UNICEF continues to focus on specific programmatic components in which the agency has a comparative advantage, namely as the lead agency for vaccine procurement and programme communication. UNICEF procured over 2 billion doses of OPV for SIAs in 30 countries in 2007. The supply of polio vaccines requires major international tendering of all WHO pre-qualified suppliers of OPV. UNICEF also supported the delivery of other services such as vitamin A with polio supplementary activities. UNICEF also assists national governments to plan, monitor and evaluate all aspects of immunization activities.

Communication activities in 2007 and 2008 sought to ensure that polio endemic and re-infected countries have strategies tailored to specific needs both for broad national campaigns and also to address challenges specific to underserved populations that are more at-risk for poliovirus infection. Global support activities include training, strategic guidance and media / advocacy.

Towards the end of 2007, the intensified efforts had demonstrated that the GPEI could overcome the final hurdles to wild poliovirus eradication and interrupt transmission in areas that had stubbornly resisted the efforts of the programme. By utilizing the new tools and tactics, the GPEI passed key landmarks in the fight against polio. However in 2008, new challenges to PEI have emerged including, security in Pakistan, vaccine efficacy in India and the quality of operations in Nigeria.

Less than half-way through the intensified effort, the number of polio cases had been reduced by 63% and cases due to type 1 poliovirus, the most dangerous of the two remaining serotypes, had fallen a remarkable 84%, with the absence of type 1 from western Uttar Pradesh. By the end of 2007, northern Nigeria had seen a 76% decline in cases and a 50% reduction in the number of children that had never been immunized. New tactics had also been developed to access children in the security compromised areas of Afghanistan and Pakistan. Of particular note, 25 of the 27 countries re-infected with imported poliovirus between 2003 and 2006 have interrupted transmission again.

However, 2008 has seen setbacks in the GPEI; the number of cases is up in all four endemic countries.  Polio virus has infected children in at least five countries that had previously stopped transmission.  Despite these setbacks, the GPEI is committed to ending the threat of polio to children everywhere, and efforts to improve tools strategies and tactics are underway.






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