Ethiopia: Sound Health Strategy over Wild Polio Virus Transmission

... the external assessment team that conducted the final Polio outbreak assessment in Ethiopia on between 8-12 June 2015 confirmed that Ethiopia has successfully interrupted polio transmission

Health coverage in Ethiopia has improved markedly in the last decade as the government has been playing a key role in mobilizing resources and ensuring that they are used effectively. A central feature of the sector is the priority given to the Health Extension Programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children.

Ethiopia has demonstrated that low-income countries can achieve improvements in health and access to services if policies, programmes and strategies are underpinned by ingenuity, innovativeness, political will and sustained commitment at all levels. An example is the development and rapid implementation of the Poliomyelitis Eradication strategy.

Ethiopia introduced inactivated polio virus (IPV) into the routine programme as per Strategic Advisory Group of Experts on immunization (SAGE) recommendations. IPV induces immunity in a proportion of children and will protect them against polio caused by vaccine viruses (VAPP and cVDPVs) as well as by wild polio virus.

Since the World Health Assembly resolved in May 1988 to eradicate poliomyelitis, the estimated number of polio cases globally has declined more than 99 per cent. The number of countries in which polio was estimated to be endemic decreased from 125 in 1988 to 10 in 2001, and three WHO regions -American, European, and Western Pacific- comprising approximately 55 per cent of the world's population have been certified polio-free. Ethiopia, Somalia, and Sudan have achieved the lowest levels of polio virus circulation since the polio eradication initiative began and are approaching interruption of transmission.

Ethiopia is one of the countries in the "wild polio virus importation belt" - a band of countries stretching from west Africa to Central Africa and the Horn of Africa which are recurrently re-infected with imported polio virus, says WHO. The immediate priority is to stop all active outbreaks using mop-up campaigns with oral polio vaccine in the infected areas, combined with a series of large-scale, synchronized supplementary immunization activities across most of the "importation belt" countries to protect against further importations.

Thus, the external assessment team that conducted the final Polio outbreak assessment in Ethiopia between 8-12 June 2015 confirmed that Ethiopia has successfully interrupted polio transmission. This encouraging conclusion was received nearly two years after the outbreak was confirmed in the Horn of Africa and outbreak activities initiated to respond to and interrupt Polio transmission.

The assessment team, composed of experts from the US Centres for Disease Control (CDC), Rotary International, USAID, Bill & Melinda Gates Foundation (BMGF), CORE Group, UNICEF, WHO and WHO Horn of Africa Polio Coordination Office, aimed to simultaneously evaluate the response undertaken since the start of the outbreak in all the three outbreak affected countries - Kenya, Somalia and Ethiopia - and confirm if the outbreak response met the global standards and whether polio transmission has been interrupted. The final assessment in Ethiopia was conducted at central level with desk review and meetings with the Federal Ministry of Health (MoH), ICC and selected partners.

According to WHO, the assessment team received updates from the MoH and partners on key issues related to the response in Ethiopia including routine immunization progress, supplemental immunization activities, surveillance, laboratory support at EPHI, communication, coordination and funding aspects.

The team presented their findings, conclusions and recommendations to the MoH on 12 June 2015 in the presence of the country representatives of WHO and UNICEF. They recognized the significant improvement in the quality of the response since the onset of the outbreak and appreciated the role of the coordination mechanisms established for the outbreak response at national, state and zonal levels led by high level government officials, including the State Minister of Health, Dr. Kebede Worku, at the national command post level. The collective special efforts of the MOH, Somali State Health Bureau, Dollo Zone Administration, communities, partners and donors in the outbreak response were acknowledged.

The assessment team highlighted the need to update the outbreak preparedness and response plan and to sustain the coordination mechanisms for strengthening surveillance system and routine immunization to increase population immunity.

Welcoming the assessment team's conclusions and recommendations, the Health State Minister assured that his Ministry will continue to implement its Immunization Programme with due consideration of the recommendations to strengthen the immunization and surveillance system to sustain the achievements in polio eradication.

It has now been more than six months since the last case of WPV (wild polio virus type) was reported in the Horn of Africa. In particular, the last WPV was reported from Kenya on 14 July 2013, from Ethiopia on 5 January 2014 and from Somalia 11 August 2014.

After two years of persistent and aggressive response to the Polio outbreak that had gripped the Horn of Africa since mid-2013, Ethiopia has successfully interrupted transmission of the wild polio virus! This is according to an international team of assessors that conducted the final polio outbreak assessment in the Horn of Africa, and completed their mission in Ethiopia on 12 June 2015.

The National Immunization Programme in Ethiopia was launched in 1980, with measurable achievement in terms of reducing morbidity and mortality associated with vaccine preventable diseases (VPDs) such as polio since its launch. At the national level, the maternal and child health directorate of the FMOH coordinates the programme. Administrative coverage in Ethiopia showed significant improvement from as low as 42 per cent in the 1990s to more than 88 per cent in 2013.

Efforts are on track to launch the most ambitious vaccine introduction in history as part of the polio Endgame strategic plan. As recommended by the Strategic Advisory Group of Experts on Immunization (SAGE), 126 countries will introduce at least one dose of inactivated polio vaccine (IPV) by the end of 2015. To date, 72 countries are already using IPV, 49 countries have made a formal commitment to introduce it and an additional 35 have declared intent to introduce IPV in their routine immunization programme by the end of 2015.