Polio certification

March 2018

Certification

The certification process requires data collection and verification of the eradication of wild poliovirus by independent bodies at the national, regional, and global level. 

In countries, data collected and polio eradication activities conducted are assessed and verified by National Certification Committees (NCCs). Certification of poliomyelitis eradication is done at regional Level by the Regional Certification Commission of the 6 WHO regions respectively. 

Individual countries can’t be and are not certified polio free. The major role of the NCC is to oversee certification activities at country level, and to review and endorse country reports and national documents on polio-free status. The NCCs present national documentation on polio-free status to their respective Regional Certification Commissions (RCCs), who conduct certification for the whole WHO region.

A region is eligible for regional certification after meeting all criteria for certification, and after three years has passed without detection of any wild poliovirus in any country in that region, from any source, in the presence of high quality certification-standard surveillance. For the region to be certified polio free, the ARCC will in total consider the following:  (i) the absence of wild poliovirus for at least 3 consecutive years from any source, in the presence of high quality, certification-standard AFP surveillance; (ii) high routine immunization coverage in OPV3 (high numbers of children receiving at least three doses of oral polio vaccine); (iii) the completion of phase 1 poliovirus containment activities; (iv) country readiness to respond to any poliovirus importation and; (v) the presence of a functional NCC to critically review, endorse and submit complete documentation to the ARCC.

The Africa Regional Certification Commission (ARCC) has not yet certified Africa as free of wild poliovirus. As at January 2018, a total of 39 countries out of 47 in the region have successfully presented their complete documentation justifying a poliovirus free status to the ARCC, and have been accepted. AFRO is supporting the remaining countries to strengthen their polio eradication programme performance and documentation process, bringing the region closer to certification.  

As at January 2018, the most recent wild poliovirus was detected in AFR in 2016 in Borno state, in Nigeria. Therefore, the earliest the region would be eligible for regional certification would be in 2019.   

After national documentation is accepted by the ARCC, countries must continue to submit every year an annual update report on polio eradication activities to the ARCC, until global certification is declared. The countries are also requested to submit to the ARCC their updated poliovirus containment report as well as their polio outbreak and preparedness plan. Using this, the ARCC continues to follow up and monitor country’s progress and performances (even after the national documentation is accepted) by reviewing and providing timely feedback on these annual reports. 

If countries encounter issues with their performance after the ARCC has accepted their national documentation, (such as significant decline overtime in surveillance performances, ongoing poliovirus transmission, or lack of information/data from conflict inaccessible areas), the ARCC may call on them to present again their complete country documentation, or may ask for updated reports on polio eradication activities in country to improve performance. The intention is to ensure that countries are supported to remain polio free.

The world will be eligible for certification following the successful certification of poliomyelitis eradication in all six WHO regions worldwide. The certification process at global level is conducted by the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC) which will certify the world polio free when the global commission is convinced and satisfied by the evidence that wild poliovirus transmission has been successfully interrupted, and that all polioviruses are contained.

Cooperation: Cross-border and cross-sectoral 
The polio programme works hard to achieve cooperation in every possible area of activities, and in every country in which we work. This takes the form of cross border collaboration, for instance vaccinating at border points between the Lake Chad countries. It also takes the form of collaborating with partners, governments, and communities, to ensure swift action and reaction, as has been the case in the Lake Chad basin. 

The polio programme also works with other UN agencies, and NGOs to ensure that vaccination of polio and other essential vaccine-preventable diseases goes ahead in areas where there is conflict, internal displacement, or other disasters. To achieve this, polio infrastructure is often mobilized, ensuring that as many vulnerable children are reached with medication as possible. 

Committed local communities, parents, leaders, and social mobilizers have successfully spread a message about the importance of vaccination widely across the region. Using the expertise and skills of the people living in poliovirus vulnerable communities, mobilized and trained by UNICEF, the programme has been able to increase coverage, and reject anti-vaccination rumours. For instance, in Southern Nigeria, steps were taken in 2017 to counteract a rumour that linked polio vaccination to Monkey pox, whilst in Côte d’Ivoire, ceremonies involving religious and community leaders have helped to ensure that vaccinators are welcomed into local communities. 

Working with other programmes to deliver health outcomes
Polio resources have contributed tremendously to responding to humanitarian emergencies and diseases outbreaks across the African region. Measles campaigns supported by polio infrastructure have resulted in a 50% decline in measles deaths since the start of the millennium, whilst the successful response to Ebola outbreak in Nigeria is also attributed in part to the support offered by the polio programme. The poliovirus surveillance network, supported by the US Centers for Disease Control and Prevention, regularly detects and helps to respond to outbreaks of yellow fever, cholera, NNT and other diseases. We also routinely offer infrastructural, logistical and personnel support to other health programmes, including through distributing vitamin A and deworming medication. Recently, the programme has contributed to efforts to relieve droughts in the Horn of Africa and in the Sahel. 

Universal Health Coverage/UN Sustainable Development Goals
The World Health Organization’s 13th General Programme of Work provides a new vision for polio transition planning, which supports the WHO’s three strategic priorities to help achieve the health-related objectives of the UN Sustainable Development Goals (SDGs). 
Immunization cuts across all three of these priorities. The first is Universal Health Coverage (UHC). Polio infrastructure and knowledge in the 16 priority polio transition countries has been an important support to countries’ efforts to strengthen health systems and progress towards UHC. As part of transition, polio eradication staff, assets and functions can continue strengthening country capacity in delivering essential health-care services, including vaccination.

Critical functions of the polio programme in many fragile and conflict-affected states, including immunization, surveillance, laboratory services, response, and risk communication, will be essential to support WHO’s second strategic priority of keeping the world safe from epidemics and other health emergencies. 

In many polio transition countries with relatively weak health infrastructure, existing polio assets can support WHO’s third strategic priority, to support countries to drive progress in attaining specific health-related SDGs, in priority areas including women, children and adolescent health, measles and other vaccine preventable diseases and immunization activities.