Abbreviation | GCC |
---|---|
Formation | February 16, 1995 |
Legal status | Active |
Headquarters | Geneva, Switzerland |
Parent organization | World Health Organization |
The World Health Organization (WHO) created the Global Commission for the Certification of the Eradication of Poliomyelitis (commonly known as the Global Certification Commission or GCC) in 1995 to independently verify the eradication of wild poliovirus. [1] The GCC certified the worldwide eradication of indigenous wild poliovirus type 2 on 20 September 2015, [2] [3] and wild poliovirus type 3 on 17 October 2019. [4] [5] In addition, five of the six World Health Organization Regions certified their status as free of indigenous transmission of all three serotypes of wild poliovirus (types 1, 2, and 3):
Afghanistan and Pakistan are the only remaining polio endemic countries, with polio cases caused by type 1 wild poliovirus reported in 2021. Since 1988, international efforts led by the Global Polio Eradication Initiative have reduced poliomyelitis cases caused by wild poliovirus by over 99.99% using vaccination.
In the 1980s, Rotary International led a successful campaign to end polio in the Americas with support from the US Centers for Disease Control and Prevention(CDC) (for technical assistance, including surveillance), Pan American Health Organization (PAHO)/World Health Organization (WHO) (for coordination and project management), United Nations Children's Fund (UNICEF) (for vaccine procurement), and other funding partners. [11] Demonstration of the potential for eradication by the Americas supported interest in global polio eradication. In 1988, the World Health Assembly, the governing body of the World Health Organization, approved Resolution WHA41.28, which committed to global eradication of poliomyelitis by the year 2000. [12] By 1993, coordination of global activities on polio eradication by the Global Polio Eradication Initiative (GPEI) involved 4 spearheading partners led by the WHO Secretariat - WHO, UNICEF, Rotary International, and CDC - and the GPEI received broad support from world leaders, development agencies, and both public and private donors. [13] The list of core GPEI partners expanded to include the Gates Foundation in 2013 and GAVI in 2020. [14]
Following the first regional certification of polio eradication in 1994 by the Americas, [6] the WHO convened the first meeting of the Global Certification Commission in Geneva, Switzerland, on 16–17 February 1995. [15] [16] The commission was initially established as a 13-person board and assigned the responsibility of delineating the criterion for the verification and certification of eradication of the wild poliovirus. [17]
The GCC certified the global eradication of wild poliovirus type 2 (WPV2) at its 14th meeting on 20 September 2015. [2] [3] which led to the launch of containment efforts for type 2 wild poliovirus. [18] The GCC certified the global eradication of wild poliovirus type 3 (WPV3) at its 20th meeting on 17 October 2019. [4] [5] Wild poliovirus type 1 is the only type of wild poliovirus that remains uninterrupted globally. The GCC held its 21st meeting in July 2021. [15]
The Global Certification Commission is the top-level decision-making body of a three-tier process. Each WHO member state's national polio program appoints a National Certification Committee (NCC). These NCCs meet annually until national certification to report on the status of national polio surveillance and elimination. A country is regarded as polio free or non-endemic if no cases have been detected by high-quality surveillance for a year. [19] [20] The Regional Certification Committees (RCC) meet annually until regional certification to evaluate the reports from the NCCs. The six RCCs, which are panels of WHO-appointed experts who are independent of both the NCCs and the GPEI, are charged with certification of their WHO region. The chairs of the six regional committees comprise the Global Certification Commission, which meets as needed for global decision making. [21]
Africa Americas | Eastern Mediterranean Europe | South East Asia Western Pacific |
The Region of the Americas certified polio eradication in 1994. [6] As part of the regional certification process, the expert committee established the criteria of "verification of the absence of virologically confirmed indigenous poliomyelitis cases in the Americas for a period of at least 3 years under circumstances of adequate surveillance," [22] which the GCC adopted as its criteria at its first meeting. [15] The criteria for adequate surveillance included finding and examining at least one case of nonpolio acute flaccid paralysis per 100,000 children under 15 years old. [22] [17] A statistical analysis of regional data [23] and mathematical infection transmission modeling [24] supported the criteria. The modeling showed that with a perfect surveillance system, any wild poliovirus transmission would be detected within 3–4 years with very high (e.g., 95%) confidence. [24]
With the criteria established, the GCC resolved to certify each of the remaining regions until the disease was eradicated globally. [17] The Western Pacific regional certification occurred in 2000 [7] and Europe certified polio eradication in 2002. [8] The Southeast Asia region certified polio eradication in 2014. [9] [25]
In 1996, African nations signed the Yaoundé Declaration on Polio Eradication in Africa, and Nelson Mandela started the "Kick Polio out of Africa" campaign. In Africa, the most recent region to certify polio eradication in 2020, [10] regional certification efforts began in 1998, when the WHO regional director for Africa appointed 16 people to the Africa Regional Certification Commission (ARCC). [26] Based in Yaoundé, Cameroon, and led by Rose Leke as chairperson as of 2020, [27] [28] the group was tasked with overseeing the eradication effort in the Africa WHO region. [26] The independent body is the only organisation recognized to certify that polio has been eradicated from the region. [29] On 25 August 2020, the ARCC declared that wild poliovirus has been eliminated in its region which includes 47 countries spanning most of Africa. [26] [30] The last reported case of polio in the region was on 21 August 2016, in Borno, Nigeria. [31] [28] Among the conditions for certification of the region was a requirement that 95% of the population be immunised. [32]
The Eastern Mediterranean Region is the only WHO region remaining that has not certified wild poliovirus eradication. [33] The region includes 22 countries spanning from Morocco to Pakistan, [34] several of which have individually eradicated the disease. This region experiences significant political unrest, humanitarian crises, forced displacement, and deterioration of health care systems, which hinder eradication efforts. [35] Syria, Yemen, and Somalia are categorized as very-high-risk, and Iraq, Sudan, and Libya are categorized as high-risk, while Pakistan and Afghanistan are the only countries in which the disease remains endemic as of 2019. [35] Since 2007, people administering polio vaccines have been the target of violence in Pakistan. [36] A 2011 US Central Intelligence Agency operation used a hepatitis vaccination program as a cover to search DNA evidence to confirm the location of Osama bin Laden. [37] [36] Following his killing the same year, Islamist insurgents in the region have become more hostile to vaccination efforts. More recently, the hostility has been exasperated by the United States' expansion of the use of drone strikes in northwest Pakistan; [36] in June 2012, Mullah Nazir, leader of the Federally Administered Tribal Agencies, distributed leaflets calling for a ban on polio vaccination with the goal of persuading the US to stop drone strikes in the area. [38]
Building on modeling used to support regional polio certification in the Americas, [24] additional modeling explored how different characteristics of the three serotypes of wild poliovirus and the specific conditions in the countries with the last reported regional and global cases could impact changes in confidence about no circulation with increasing time since the last reported case. [39] [40] Specific modeling studies for Nigeria, [40] [41] [42] which reported the last wild poliovirus cases in Africa, supported African regional certification. Modeling of the countries with the last type 3 wild poliovirus cases (i.e., Nigeria, [40] [42] Pakistan and Afghanistan [43] ) supported global certification of type 3 wild poliovirus eradication.
Sensitivity of monitoring for circulation can be improved by environmental surveillance, which relies on sampling sewage. [40] [44] The availability of environmental surveillance data can shorten the time required to achieve high confidence about no circulation of poliovirus in a population, but this depends on the quality of polio surveillance. [40] [45]
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 75% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe symptoms develop such as headache, neck stiffness, and paresthesia. These symptoms usually pass within one or two weeks. A less common symptom is permanent paralysis, and possible death in extreme cases. Years after recovery, post-polio syndrome may occur, with a slow development of muscle weakness similar to that which the person had during the initial infection.
Polio vaccines are vaccines used to prevent poliomyelitis (polio). Two types are used: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV). The World Health Organization (WHO) recommends all children be fully vaccinated against polio. The two vaccines have eliminated polio from most of the world, and reduced the number of cases reported each year from an estimated 350,000 in 1988 to 33 in 2018.
Poliovirus, the causative agent of polio, is a serotype of the species Enterovirus C, in the family of Picornaviridae. There are three poliovirus serotypes, numbered 1, 2, and 3.
The oral polio vaccine (OPV) AIDS hypothesis is a now-discredited hypothesis that the AIDS pandemic originated from live polio vaccines prepared in chimpanzee tissue cultures, accidentally contaminated with simian immunodeficiency virus and then administered to up to one million Africans between 1957 and 1960 in experimental mass vaccination campaigns.
Pulse Polio is an immunisation campaign established by the government of India to eliminate poliomyelitis (polio) in India by vaccinating all children under the age of five years against the polio virus. The project fights polio through a large-scale, pulse vaccination programme and monitoring for poliomyelitis cases.
Enterovirus is a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases. Enteroviruses are named by their transmission-route through the intestine.
Ali Maow Maalin was a Somali hospital cook and health worker from Merca who is the last person known to have been infected with naturally occurring Variola minor smallpox. He was diagnosed with the disease in October 1977 and made a full recovery. Although he had many contacts, none of them developed the disease, and an aggressive containment campaign was successful in preventing an outbreak. Smallpox was declared to have been eradicated globally by the World Health Organization (WHO) two years later. Maalin was subsequently involved in the successful poliomyelitis eradication campaign in Somalia, and he died of malaria while carrying out polio vaccinations after the re-emergence of the poliovirus in 2013.
Polio eradication, the goal of permanent global cessation of circulation of the poliovirus and hence elimination of the poliomyelitis (polio) it causes, is the aim of a multinational public health effort begun in 1988, led by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Rotary Foundation. These organizations, along with the U.S. Centers for Disease Control and Prevention (CDC) and The Gates Foundation, have spearheaded the campaign through the Global Polio Eradication Initiative (GPEI). Successful eradication of infectious diseases has been achieved twice before, with smallpox in humans and rinderpest in ruminants.
Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause. This abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles. For example, if the somatic nerves to a skeletal muscle are severed, then the muscle will exhibit flaccid paralysis. When muscles enter this state, they become limp and cannot contract. This condition can become fatal if it affects the respiratory muscles, posing the threat of suffocation. It also occurs in the spinal shock stage in complete transection of the spinal cord occurring in injuries such as gunshot wounds.
The history of polio (poliomyelitis) infections began during prehistory. Although major polio epidemics were unknown before the 20th century, the disease has caused paralysis and death for much of human history. Over millennia, polio survived quietly as an endemic pathogen until the 1900s when major epidemics began to occur in Europe. Soon after, widespread epidemics appeared in the rest of the world. By 1910, frequent epidemics became regular events throughout the developed world primarily in cities during the summer months. At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year.
Mass vaccination is a public policy effort to vaccinate a large number of people, possibly the entire population of the world or of a country or region, within a short period of time. This policy may be directed during a pandemic, when there is a localized outbreak or scare of a disease for which a vaccine exists, or when a new vaccine is invented.
The eradication of infectious diseases is the reduction of the prevalence of an infectious disease in the global host population to zero.
Muhammad Ali Pate is a Nigerian physician and politician who is the current Minister of Health and Social Welfare of Nigeria since 2023. He's also a professor of the Practice of Public Health Leadership in the Department of Global Health and Population at Harvard University. He formerly served as the Global Director for Health, Nutrition and Population and director of the Global Financing Facility for Women, Children and Adolescents (GFF) at the World Bank Group. Pate is also the former Minister of State for Health in Nigeria.
Pakistan is one of the two remaining countries in the world where poliomyelitis (polio) is still categorized as an endemic viral infection, the other one being Afghanistan. While it has yet to fully eradicate Polio, there has been a major downwards trend in the number of reported cases per year; the total count of wild poliovirus cases in Pakistan in 2019 was down to 147, compared to 84 in 2020, 1 in 2021, 20 in 2022, 6 in 2023 and 8 as of June 2024.
World Polio Day was established by Rotary International to commemorate the birth of Jonas Salk, who led the first team to develop a vaccine against poliomyelitis. Use of this inactivated poliovirus vaccine and subsequent widespread use of the oral poliovirus vaccine developed by Albert Sabin led to establishment of the Global Polio Eradication Initiative (GPEI) in 1988. Since then, GPEI has reduced polio worldwide by 99 percent.
India National PolioPlus Society is a non-profit organization. The Initiative has achieved significant progress toward its goals. There has been a dramatic decline in cases everywhere in the seventeen years since the target was set in 1988.
The Global Polio Eradication Initiative is an initiative created in 1988, just after the World Health Assembly resolved to eradicate the disease poliomyelitis. Led by the World Health Organization, it is the largest international public health initiative in history.
Isao Arita was a Japanese physician, virologist and vaccination specialist who headed the World Health Organization (WHO) Smallpox Eradication Unit in 1977–85. During this period, smallpox became the first infectious disease of humans to be eradicated globally. He and his colleagues were awarded the Japan Prize in 1988 for this work. He also advised the successful programme to eradicate poliovirus from the Western Pacific region.
Vaccine shedding is a form of viral shedding which can occasionally occur following a viral infection caused by an attenuated vaccine. Illness in others resulting from transmission through this type of viral shedding is rare. Most vaccines are not attenuated vaccines, and therefore cannot cause vaccine-induced viral shedding, though the idea of shedding is a popular anti-vaccination myth.
Michael Joseph Ryan is an Irish epidemiologist and former trauma surgeon, specialising in infectious disease and public health. He is executive director of the World Health Organization's Health Emergencies Programme, leading the team responsible for the international containment and treatment of COVID-19. Ryan has held leadership positions and has worked on various outbreak response teams in the field to eradicate the spread of diseases including bacillary dysentery, cholera, Crimean–Congo hemorrhagic fever, Ebola, Marburg virus disease, measles, meningitis, relapsing fever, Rift Valley fever, SARS, and Shigellosis.
In the past few years, Islamist insurgency has had a strong effect on where polio cases occur. This is because Islamist insurgents deliberately undermine the efficacy of immunization campaigns by spreading misinformation and attacking polio workers. The evidence for all types of non-Islamist insurgency is less compelling. First, in some cases the relationship is no longer significant when we control for variables that operationalize the level of development in a country. This suggests that the relationship is spurious.