Building Stronger Resilience: The Essential Path to a Polio-Free World

"...more scope for donor and wider partner engagement in key discussions and decisions; a relationship based on liaison and briefing is not enough..."

The Transition Independent Monitoring Board (TIMB) was created in 2016 by the Global Polio Eradication Programme (GPEI) to monitor and guide the process of polio transition planning as the GPEI winds down its operations and eventually comes to a close in the post-eradication era. This fifth TIMB report includes two parts: The first features accounts of programmatic progress and new developments given at the TIMB's November 3-5 2021 meeting, and the second covers the TIMB's assessment, analysis, and conclusions. (For earlier reports, see Related Summaries, below.)

At the time of the meeting, the COVID-19 pandemic was still affecting large numbers of people and putting pressure on health services and systems. The rollout of COVID-19 vaccines on a massive scale was diverting capacity from many childhood immunisation programmes. The Polio Transition Programme was forced to rapidly adapt to this new context and to show increasing operational sensitivity to poliovirus epidemiology.

COVID-19 has, however, created the opportunity to "'popularise' the importance of surveillance beyond its role as a hidden, behind-the-scenes technical function. First, the polio infrastructure - especially the surveillance infrastructure - has been indispensable and very visibly effective in the fight against COVID-19. Second, surveillance will be necessary for the control of COVID-19 and in the evaluation of...vaccines and treatments for many years to come. Third, COVID-19 now falls into the vaccine-preventable disease category."

As the TIMB notes, polio teams have played, and continue to play, a key role in the health emergency preparedness and response role in many of the polio transition countries. For example, in Pakistan, Somalia, and Afghanistan, it is the Polio Programme that has a field-level presence and operational capacity that the health emergency programme does not yet have. The Polio Programme also has experience in running emergency operation centres. Once polio funding ceases, it will be important to make sure this capacity and expertise remain in place.

The report outlines the challenges going forward with regard to essential immunisation performance, noting that the zero-dose agenda is building momentum across polio and essential immunisation programmes. The TIMB was told that three strategies are particularly important: (i) listening and understanding to identify where the children are and why they are zero-dose; (ii) using that evidence to make the case for political action and resources; and then (iii) reaching children with tailored and sustainable strategies that address the barriers to vaccination.

In reporting to the plenary session of the TIMB meeting, the World Health Organization (WHO) Polio Transition Team described its adaptations to the changing transition context in terms of strategic shifts:

1. A more risk-based approach, tailored to the regional and country context;
2. More realistic scope and timelines for country transition;
3. Stronger coordination, management, and accountability mechanisms;
4. Programmatic integration by the polio eradication programme into WHO's immunisation and health emergencies activities;
5. Strategic communications that align eradication, integration, and transition messaging, so that all speak with one voice;
6. Alignment with the broader health agenda (e.g., Immunization Agenda 2030); and
7. More systematic and strategic engagement of civil society.

The Polio Transition Teams from each of the three WHO regions containing priority countries provided a progress report to the TIMB, which are shared in the report. These plans aim to define how the government will integrate essential public health functions - supported to date by external funding - into its national health programmes. The transition plans include mapping human resources and, where possible, matching and aligning them to existing functions within the country's national health priorities. The TIMB stressed that transition planning should be transparently communicated, with a clear, open methodology and milestones and markers for assessing quality on a continuous basis.

Per the TIMB, there are three "lenses" through which each country's polio transition plan can be viewed and judged:

• The extent to which plans have been written, discussed, agreed, endorsed, and implemented;
• The reality, credibility, and feasibility of the plans, given the immediate and future prospects for a range of wider influences on them that are part of the country's political, socioeconomic and conflict context and operating environment; and
• The current strength and readiness of the public health functions to achieve optimum levels of immunity, run a high standard of surveillance, and identify outbreaks early and close them down quickly and effectively.

The report concludes with 10 recommended actions, such as stepping up timely and assertive polio outbreak responses: "Each country government with a current, or recent, vaccine-derived poliovirus outbreak (or judged to be at risk of one) should receive an urgent, high-level communication, warning of the clear and present danger of failing to comply with GPEI standards and SAGE [Strategic Advisory Group of Experts] advice on response timescales and vaccine use." This recommendation is presented in the context that "It has been something of a communications nightmare to have the juxtaposition of Africa's polio-free status and a large number of paralytic (vaccine-derived poliovirus) cases on the self-same continent."