Situation analysis

At the start of 2010, 9 countries in west and central Africa are considered to have active outbreaks of polio (i.e. cases within the last six months): Burkina Faso, Chad, Guinea, Liberia, Mali, Mauritania, Nigeria, Senegal and Sierra Leone.
Since the second half of 2008, a polio outbreak originating in northern Nigeria has been spreading in west and central Africa.
The outbreak spread gradually from east to west: the first wave of affected countries were those immediately bordering Nigeria. The outbreak has been mostly stopped in these countries, while the outbreak continues farther west.
Key challenges

In areas which have not carried out polio immunization campaigns for some years, experience and capacity has been lacking to fully implement the international response guidelines in 2009, and the outbreak has been allowed to spread further west. Experience has shown that full implementation of internationally-agreed outbreak response guidelines (World Health Assembly Resolution WHA59.1) rapidly stops outbreaks due to importations. Globally, poliovirus was imported into polio-free countries 55 times in 2008-2009, and transmission was stopped in 38 of these (70%).
Inadequate immunization systems (i.e. routine immunization levels below 80%) are a known contributory risk factor in re-infection being followed by large-scale outbreaks.
Monitoring of outbreak response activities has been inadequate in some areas – whether due to not checking enough children in enough locations, not being independent of the agency implementing the vaccination campaign, or simply not recording information thoroughly.
Financing is a real risk to conducting planned campaigns across this "importation belt" of sub-Saharan Africa and to protect children from further spread.
Solutions

On 24 April, synchronized cross-border vaccination campaigns will be conducted across west Africa. These campaigns are a follow-up to an earlier campaign that started on 6 March and which involved 16 countries (including polio-endemic Nigeria), and more than 167,000 volunteers and health workers who aimed to immunize more than 36 million children under the age of five years.
In coordination, Cameroon, Central African Republic, Chad and Nigeria – the only polio-endemic country in Africa and the source of the outbreak – are conducting polio vaccination campaigns at the same time.
On 26 March the new Short Interval Additional Dose (SIAD) approach was administered in six countries identified as particularly high-risk (i.e. poor performance and/or persistent virus transmission). Two doses of monovalent OPV were administered in rapid succession to more rapidly build population immunity in such areas. The six countries are Burkina Faso, Guinea, Liberia, Mauritania, Senegal and Sierra Leone.
Better campaigns

To ensure each child is reached during these vaccination campaigns, the Head of Government or State in each participating country has been formally requested to directly oversee the planning, launch and supervision, and to establish a mechanism to hold local leaders accountable for campaign performance in their areas.
Outbreak response microplans are currently being updated, and refresher training conducted where needed. In areas of inadequate capacity, substantial short-term international technical assistance is being deployed to assist in micro-planning, training and supervision.
Collaboration is being strengthened with other operational partners at country level, such as the International Federation of Red Cross and Red Crescent Societies (IFRC). Such partners have a strong presence in and knowledge of local communities and civil administrations, and their human resources can often be more flexibly and rapidly mobilized than those of governments and UN agencies.
Real-time independent monitoring will be used to more rapidly identify poor-performing areas for immediate re-vaccination, and to guide corrective actions as necessary.
To improve overall immunity levels and minimize the risk of large-scale outbreaks following re-infection, such campaigns are pre-planned and coordinated so that financial and human resources are correctly positioned.
In areas where immunization systems are known to be inadequate, Global Polio Eradication Initiative staff will be trained on key activities to help strengthen immunization systems.