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WHO EMRO Weekly Epidemiological Monitor: Volume 15; Issue no 8; 20 February 2022

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Pakistan
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Fourth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks

The fourth meeting of Regional Subcommittee on Polio Eradication and Outbreaks was convened on 9 February 2022 by WHO’s Regional Director for the Eastern Mediterranean and was attended by health ministers or their representatives from Djibouti, Egypt, Islamic Republic of Iran, Pakistan, Qatar, Saudi Arabia, Sudan, United Arab Emirates and Yemen.

Editorial note

Global wild poliovirus (WPV) transmission at the start of 2022 was restricted to just two countries, Afghanistan and Pakistan, and the detection of WPV cases in both countries is at the lowest levels in history, with five cases reported in Afghanistan and one in Pakistan since January 2021. This presents a unique epidemiological window of opportunity to eradicate WPV once and for all; though the recent isolation of WPV from children in Afghanistan and from environmental samples in Pakistan confirms continued poliovirus circulation in this joint, cross-border epidemiological block.

Noting the sharp decrease in cases of WPV in those two countries in 2021, the Regional Subcommittee declared the spread of polio in the Eastern Mediterranean Region a pressing emergency and it remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005). The Subcommittee called on all authorities to enable uninterrupted access to vulnerable children through the resumption of house-to-house vaccination campaigns.

Several developments have taken place since the last Subcommittee meeting. These included the resumption of nationwide campaigns in Afghanistan after 3.5 years; the health and humanitarian crisis in Afghanistan, with WHO and UNICEF sustaining the Sehatmandi health project; Pakistan completed one year with no children paralyzed by WPV; Egypt implemented a national campaign using the novel oral polio vaccine type 2 (nOPV2), the first country in the Region to do so; Islamic Republic of Iran and Sudan remained free of any breakthrough transmission of circulating vaccine-derived poliovirus type 2 (cVDPV2); a new cVDPV2 outbreak in Yemen was spread to Djibouti and Egypt; and non-endemic countries transitioned out of the Global Polio Eradication Initiative (GPEI) to WHO funding support.

There is strong and sustained commitment in Pakistan at all levels. Peace and nationwide access in Afghanistan led to the first nationwide vaccination campaign after 3.5 years in November with three national immunization days implemented reaching 8.5 million children, of which 2.6 million were previously inaccessible. Afghanistan and Pakistan are intensifying cross-border coordination, however house-to-house vaccination is still not permitted in key reservoirs in Afghanistan, thus relying on mosque-to-mosque campaigns. The risk of resurgence in Afghanistan and Pakistan is still considerable.

Outbreaks of cVDPV1 and cVDPV2 continued to emerge and spread in the Region in 2021. As of February 2022, Afghanistan, Djibouti, Egypt,
Pakistan, Somalia, Sudan and Yemen are responding to transmission of vaccine-derived polioviruses. The concurrent outbreaks of cVDPV types 1 and 2 is ongoing in Yemen and now expanding internationally with environmental detection of cVDPV2 in both Djibouti and Egypt. House-to-house vaccination is not permitted in northern Yemen, and there is a risk of further persistence and spread of the outbreak.

The Subcommittee was requested to advocate for access to all children through house-to-house vaccination in Afghanistan and Yemen; to continue to mobilize support to avert the collapse of the health system in Afghanistan and advocate for humanitarian assistance to children in Yemen; to further intensify regional commitment to stop all polio outbreaks and rally Member States to maintain vigilance to detect and rapidly respond to any polio outbreak; and to encourage Members States to mobilize domestic financial resources for essential polio functions and outbreak response as GPEI funding declines.