2022-01-16-世界卫生组织-5th_Report_of_the_Polio_Transition_Independent_Monitoring_Board_68页_8mb

Summary of the Polio Transition Independent Monitoring Board Report

Core Content

The Polio Transition Independent Monitoring Board (TIMB) report, prepared following its November 2021 meeting, provides an overview of the progress, challenges and strategic shifts in the global polio transition process. The report highlights the impact of the ongoing COVID-19 pandemic on immunisation, surveillance, and health emergency preparedness, while also outlining efforts to adapt and integrate these functions into broader public health frameworks.

Main Points

TIMB Overview

• The TIMB was established in 2016 by the Global Polio Eradication Initiative (GPEI) to monitor and guide the transition from polio eradication to routine immunisation.
• It was reconstituted after the World Health Organization (WHO) took over leadership of the transition process.
• The report is based on presentations, discussions, and external data, and is fully independent with no prior sharing with WHO or other entities.

TIMB Members

• Sir Liam Donaldson: Former Chief Medical Officer for England, Professor of Public Health, UK.
• Professor Sheila Leatherman: CBE, Hon RCP, Professor of Global Health Policy, USA.
• Dr Boluwatife Oluwafunmilola Lola-Dare: President, CHESTRAD Global, Nigeria.
• Dr Senjuti Saha: Scientist, Child Health Research Foundation, Bangladesh.

Strategic Shifts in Polio Transition

1. Risk-based approach: Countries are now prioritised based on regional and local contexts, with 10 high-risk countries in Africa, and others in South-East Asia and Eastern Mediterranean.
2. Realistic scope and timelines: Transition plans are being revised to reflect practical realities, especially in light of the pandemic's impact.
3. Stronger coordination and accountability: A new system has been developed to align global, regional, and country-level activities, with a specific focus on the Africa Region.
4. Programmatic integration: Polio eradication functions are being fully integrated into WHO’s immunisation and health emergencies programmes.
5. Strategic communications: Efforts are being made to ensure a unified message across polio, immunisation, and health emergency programmes.
6. Alignment with broader health agendas: The Immunization Agenda 2030 and Gavi 5.0 strategy are being aligned with polio transition goals.
7. Civil society engagement: There is a growing recognition of the need for more strategic and systematic engagement with civil society organisations.

Essential Immunisation

• The COVID-19 pandemic significantly disrupted essential immunisation efforts in 2020, leading to a drop in DTP3 coverage from 86% to 83%, affecting over 3.7 million children.
• Zero-dose children are a major concern, with 17 million living in communities with limited access to immunisation services.
• These children are predominantly found in dense urban, remote rural, and conflict-affected areas.
• A joint approach to reaching zero-dose children has been piloted in Pakistan, showing the potential of integrated immunisation and polio programmes.
• Gavi’s Equity Accelerator Funding is a key initiative targeting zero-dose communities, with a $500 million fund dedicated to this effort.
• UNICEF supports the integration of polio transition with immunisation strengthening and sees it as a critical opportunity to align with the Immunization Agenda 2030.

Surveillance

• Vaccine-preventable disease surveillance is aligned with the Immunization Agenda 2030 and is being integrated into national and regional health systems.
• WHO has categorised countries into four tiers based on their surveillance capacity and disease burden:
  • Tier 1: Low and lower-middle-income countries with limited capacity, need support for five diseases.
  • Tier 2: Lower-middle-income countries, need support for at least seven diseases.
  • Tier 3: Upper-middle-income countries with lower disease burden, need support for at least 10 diseases.
  • Tier 4: High-income countries with strong surveillance capacity and low disease burden.
• Costing and budgeting for surveillance is a key focus, with a minimum of $300 million required annually, up from recent donations.
• The Integrated Disease Surveillance and Response strategy is being developed in the Africa and Eastern Mediterranean regions, though progress has been impacted by the pandemic.

Health Emergencies

• The Strategic Action Plan on Polio Transition 2018–2023 includes strengthening health emergency preparedness and response.
• Polio teams have played a critical role in health emergency preparedness, especially in fragile and conflict-affected settings.
• WHO's Health Emergencies Programme has expanded its structure, including a new division for health emergency intelligence and surveillance.
• The Berlin Hub, launched in September 2021, is a collaborative intelligence platform aimed at managing pandemic and epidemic risks.
• The Polio Programme continues to have operational presence in countries like Pakistan, Somalia, and Afghanistan, where health emergency infrastructure is less developed.

Containment

• All WHO Member States are committed to the polio containment plan under Resolution 71-16 (May 2018).
• Key actions include:
  • Completing inventories and destroying unneeded type 2 poliovirus materials.
  • Ensuring prompt reporting of containment breaches.
  • Reducing the number of facilities retaining poliovirus to those with critical functions.
  • Appointing a National Authority for Containment by the end of 2018.
  • Submitting applications for the Containment Certification Scheme by 2019.
• WHO’s containment team reported that national officials were largely diverted by the pandemic in 2020, but some countries have resumed containment activities since 2021.

Key Recommendations

• Ensure continued support for essential immunisation and surveillance, especially in high-risk and conflict-affected areas.
• Strengthen coordination and integration across health programmes.
• Maintain and expand health emergency preparedness and response capacities.
• Engage civil society in a more strategic and systematic manner.
• Develop and implement new tools and strategies for polio transition and integration.
• Monitor and adapt to the evolving impact of the pandemic and new variants like Omicron.