Report

CORE Group Polio Project FY21 Annual Report

The global picture of polio eradication is evolving and largely uncertain. Remarkably, there have been only five cases of wild polio virus (type one) reported in the world in 2021; three in Pakistan and two in Afghanistan and no new cases of wild poliovirus in Pakistan since January 2021. While we cannot rule out missed cases, this is certainly a strong and positive development. Additionally, the Taliban has lifted the ban on campaigns in Afghanistan and countrywide campaigns have now begun. If this trend continues, we may well see the last case of wild polio virus in the world in the very near future.

Circulating Vaccine Derived Polio Virus (cVDPV) is sadly moving in a very different direction and threatening to derail years of progress toward comprehensive paralytic polio eradication. The 2016 switch from trivalent to bivalent OPV use in both SIAs and routine immunization was intended to reduce the spread of cVDPVs but ironically the number of cVDPV cases reported has increased exponentially since then. As of the end of November, there were 2 cases of cVDPV type 2 reported in 2016, 96 in 2017, 71 in 2018, 366 in 2019, 1,078 in 2020 and 452 in 2021. This development is especially worrisome in Nigeria with 289 of the 452 global cVDPV2 cases in 2021 and also a concern in Afghanistan with 43 cVDPV2 cases and Pakistan with 8 cases in 2021. The recent cVDPV2 outbreaks have spread across West Africa through South Sudan and Somalia, looking very similar to historic wild polio virus outbreaks in 2013 and before.

The introduction of the Novel Oral Polio Vaccine type two (NOPV2) which was heralded as a more stable alternative to the existing monovalent oral polio vaccine type two (MOPV2) has been in short supply and unavailable to respond to many of the outbreaks. Use in Nigeria has been prioritized but has not so far slowed the outbreak. Also of concern is the wider spread of the virus in Nigeria to states that had long been polio free and a general perception in the country that polio had been eradicated and is therefore no longer a priority for funding or programming.

All of this has evolved against the background of the COVID-19 Pandemic which has put vaccine preventable diseases in the global spotlight as never before but also limited many of the critical programmatic activities such as SIAs, house-to-house social mobilization, and in-person meetings and trainings. At the project level,
most of the country projects were most disrupted in 2020 with the majority of project activities and SIAs resuming in 2021, albeit with various COVID security measures in place.

The project has continued to expand, evolve, and respond to the changing needs and pressures of pandemics and politics. CGPP is currently working in eight countries, India, Ethiopia, Kenya, Nigeria, Niger, Somalia, South Sudan, and Uganda. CGPP continues to be a global champion (and originator) of Community-Based Surveillance (CBS), a means of identifying potential Acute Flaccid Paralysis (AFP) at the community level to augment weak surveillance-based surveillance systems. This approach has been expanded to priority zoonotic diseases and other vaccine preventable diseases such as measles through Global Health Security Agenda funding for the project in Kenya, Ethiopia and Nigeria. The project has also responded to the COVID pandemic with COVID-specific funded programs in India, Nigeria and South Sudan and the addition of COVID messaging and protocols at no additional cost in all of our countries.

Programmatic support to SIAs and outbreak response campaigns was significant in 2021 as campaigns previously postponed due to COVID were brought back. The project cadre of over 19,000 Community mobilizers promoted vaccine uptake through numerous interpersonal interactions at the community level throughout program countries. The social mobilizers and project staff also promoted population immunity through logistical, educational, and social support to immunization systems throughout the project countries. Broadly, vaccine coverage dipped in 2020 due to the impact of COVID-19 but saw a resurgence in 2021.