"This report summarizes polio eradication activities in 2010, the first year of implementation of the Strategic Plan 2010-2012, and measures progress against milestones established in that document. Mandated by the World Health Assembly (WHA), the GPEI developed the plan to stop polio in all of the areas where the virus still circulated by the end of 2012"--Page 3.

Since the creation in 1988 of the Global Polio Eradication Initiative (GPEI), the incidence of polio has been cut by 99%. Between 2003 and 2006, polio eradication faced several serious challenges: four countries continued to have transmission of wild poliovirus; international spread from two of these countries resulted in the re-infection of previously polio-free areas; and both these developments generated questions about the feasibility of polio eradication. The year 2007 marked a turning point for the GPEI. Aided by the development of new-generation tools and tactics, an intensified polio eradication effort was launched, sequentially targeting type 1 polio-virus (the most paralytic), then type 3. By the end of the year, type 1 polio was reduced by 81% over 2006, the sharpest ever drop in a single year. The intensified eradication effort was the outcome of a consultation of GPEI stakeholders in February 2007 to determine the collective capacity of the international community to overcome the remaining hurdles to stopping wild poliovirus transmission globally. Engaging the Heads of Government and local leaders in polio-affected countries in a sustained dialogue, this intensified effort optimized the use of powerful monovalent oral polio vaccines (mOPV), enhanced social research and new, tailored tactics to ensure that all children were reached with the vaccines. Two of the key landmarks at the end of the year encapsulate more clearly than any other the recent progress and re-affirm the technical feasibility of polio eradication. In India, the western end of Uttar Pradesh state has been at the heart of polio outbreaks in that country since 2000 and is the only area which has never stopped wild poliovirus transmission. By the end of 2007, no cases of type 1 poliovirus had been reported from the core "polio-reservoir" districts of western Uttar Pradesh for over 12 months. On the international arena, six re-infected countries continued to report polio cases in the second half of 2007. In Afghanistan and Pakistan, creative local solutions in conflict situations helped vaccinators reach children in insecure areas. In Nigeria, the bundling of polio vaccine with other health interventions and improvements in campaign operations halved the proportion of children missed in the highest-risk areas during vaccination campaigns. Engagement from top political leaders, stronger local ownership and community involvement resulted in greater visibility of polio eradication efforts, re-energizing local workers and contributing to higher-quality immunization activities. The Director-General and Regional Directors of the World Health Organization (WHO) travelled to transmission hot-spots in all four endemic countries within 12 months of the stakeholder consultation and discussed polio eradication with Heads of Government and leaders in the highest-risk areas. The gains against polio were underpinned by intensified surveillance work at field and laboratory levels, particularly in areas with known gaps in surveillance sensitivity. Most notably, the number of laboratories capable of using the new specimen testing algorithm was doubled, allowing the Global Polio Laboratory Network (GPLN) to detect poliovirus twice as fast in 2007 as in 2006 and enhancing rapid response capacity. With the continued prospect of eradication, research to broaden the current knowledge base for post-eradication risk management was accelerated. To finance the intensification of polio eradication activities, contributions from traditional development partners were substantially complemented by domestic financing from the Government of India and an extraordinary re-programming of International Finance Facility for Immunization (IFFIm) funds previously earmarked for a post-eradication vaccine stockpile. Advances made in the course of the year catalysed a vote of confidence from Rotary International and the Bill and Melinda Gates Foundation, which in November 2007 announced a partnership to inject US$ 200 million into the GPEI over the next four years. At the request of stakeholders, the GPEI has published, for the first time, a five year budget (2008-2012), requiring US$ 1.8 billion. The 2008-09 funding gap is US$ 490 million (US$ 135 million for 2008), as of May 2008. In November 2007, the principal advisory group to WHO for vaccines and immunization, the Strategic Advisory Group of Experts (SAGE), reviewed the intensified polio eradication effort and affirmed that interruption of wild poliovirus transmission globally was possible, noting that northern Nigeria presented a risk to this goal In the same month, the Advisory Committee on Poliomyelitis Eradication (ACPE), the global body providing strategic guidance to the polio eradication effort, stated that the progress achieved during the year warranted an extension of the intensified activities. In 2008, GPEI focus is on stopping all transmission of type 1 polio, while controlling the upsurge of type 3 polio in India, before moving on to address remaining type 3 poliovirus in 2009. As of March 2008, the single greatest risk to the end-2008 goal appears to be the situation in northern Nigeria, where more than a fifth of children continue to be missed during vaccination activities in key areas, resulting in a new outbreak that threatens progress both in the country and globally. In each of the four countries, the continued assessment, refinement and introduction of a range of new innovations will be essential to improving operations and creating an optimal environment to interrupt the remaining chains of transmission. The impetus to create this environment must come from sustained political dialogue at all levels and local accountability for reaching all children. The world has a unique chance to deliver a public good--a polio-free world for future generations. The attainment of this public health goal can create momentum for the achievement of other important health initiatives and the Millennium Development Goals (MDGs). In 2007, 1310 children were paralysed by wild poliovirus. Millions more were protected by vaccination. More than five million children and young adults are walking today because of the polio eradication effort; future generations will join them only if the eradication of polio is realized, once and for all.

The year 2008 witnessed a polio outbreak in Nigeria, with new international spread to bordering countries, persistent importations in south-central Africa and Sudan and the largest outbreak of polio in eight years in Pakistan. Elsewhere, western Uttar Pradesh in India - historically the world's most entrenched reservoir of polio but free of indigenous poliovirus type 1 for more than a year - was re-infected by a virus from a neighbouring state. By the end of the year, the number of children paralysed by polio in 2008 had returned to 1999 levels. And yet 2008 has proved to be a turning point in the fight against polio. To say 2008 was an arduous year in polio eradication is an understatement. To say it was a watershed for polio eradication is not. Against a sobering epidemiological backdrop, the progress made - in key political, technical, financial and operational areas - led the ACPE and SAGE1 to conclude in November 2008 that the intensified eradication effort had shown that the remaining challenges in the four polio-endemic countries could be overcome. First and foremost, all tiers of government in key polio- infected countries - from central to local levels - have realized the level of support and effort required to finish polio eradication and are engaging in the global effort as never before. In addition to financial and operational commitments, the remaining countries with indigenous polio - Nigeria, India, Pakistan and Afghanistan - now have special mechanisms to monitor the performance of eradication activities and hold local authorities accountable for their quality. Secondly, these efforts are being closely watched and frankly assessed. Following the re-infection of West Africa, for example, the international community has refocused its attention on key polio-affected countries, especially Nigeria, with a World Health Assembly Resolution (WHA) in May 2008 tasking each endemic country - by name - to act. Thirdly, the donor community has remained determined in the face of continued transmission of polio. Mindful that meeting established global health goals demands extraordinary perseverance, donors have redoubled efforts to finish the final lap. In January 2009, the Bill & Melinda Gates Foundation announced a further US$ 255 million grant for polio eradication to Rotary International, which the latter pledged to match with another US$ 100 million, bringing to US$ 200 million Rotary's matching funds in the past year alone. That same month, the United Kingdom announced a multi-year contribution of US$ 150 million, and Germany signalled its intention to provide US$ 130 million. By the end of the year, these global developments and country-specific strategies were showing an impact on wild poliovirus transmission. In India, monthly vaccination campaigns in the highest-risk areas, using monovalent vaccine, have reduced wild poliovirus type 1 - the more dangerous of the two remaining strains - to record lows. In Nigeria, stronger leadership at state level brought about new commitments to accountability for the quality of vaccination campaigns. By early 2009, the proportion of children with no polio vaccination in the highest-risk states of northern Nigeria fell to under 10% for the first time ever. In Afghanistan, teams exploited lulls in the conflict in the southern region to enter normally inaccessible areas and give children an additional dose of monovalent vaccine between large-scale campaigns. Pakistan started using finger-marking of vaccinated children to objectively measure coverage, thereby introducing real accountability of local authorities. With new multi-sectoral activities, the country laid the ground for the Prime Minister's Action Plan for Polio Eradication, launched in early 2009. Meanwhile, ongoing research in social attitudes, the development of new vaccines and behaviour of the poliovirus is expanding the current state of knowledge. In March 2008, Somalia became polio-free once again, demonstrating that full application of international outbreak response guidelines can stop the virus even in the most difficult conditions. This Annual Report of the Global Polio Eradication Initiative (GPEI) features progress made in 2008 towards the objectives defined in the GPEI Strategic Plan for 2004-08 and reports on intensified eradication activities.