Tokelau champions ‘polio endgame’ to keep Western Pacific polio-free

Lealaiauloto Aigaletaulealea F. Tauafiafi

The threat of children paralyzed by the poliomyelitis virus globally is virtually non-existent. In fact, the Western Pacific region, which includes Polynesia, has been polio-free for the past 15 years.
In Tokelau’s case, it has been polio free for over 40-years.
However, wild strains of the virus still exist. In 2012, it crippled 223 children globally which means the threat of poliovirus importations and subsequent outbreaks still persist. It poses a real threat to the Western Pacific as the increased frequency of international travel means long-distance transmission is also on the rise.
It means that for polio-free nations like Tokelau, they need to be equipped to detect and respond to any importation. However, maintaining polio-free status is not simply about reacting to outbreaks following an importation.
Maintaining polio-free status also includes taking preventive actions such as conducting risk assessments to identify high-risk areas and conducting special preventive activities in these populations, strengthening routine immunization to ensure high population immunity, strengthening surveillance to ensure immediate detection of a wild or vaccine-related poliovirus, and having a solid outbreak response protocol.
It is these considerations that in 2012, led the Global Polio Eradication Initiative (GPEI) and its partners to develop the Polio Eradication and Endgame Strategic Plan 2013–2018. The plan, more popularly known as the “polio endgame” outlines not only the final steps of polio eradication but also the actions to be taken during the post-eradication world.
However, there are slight differences in priorities at the global level compared to those of the Western Pacific Region because it has had no endemic polio transmission for almost 15 years.
The priorities for the Western Pacific region are:
  1. maintain polio-free status;
  2. introduce inactivated poliovirus vaccine (IPV), then switch from trivalent oral poliovirus vaccine (tOPV) to bivalent oral poliovirus vaccine (bOPV) and later, withdraw all oral poliovirus vaccine (OPV);
  3. contain polioviruses; and
  4. develop the polio legacy.
As part of the ‘Polio Endgame’ for Tokelau, a workshop for its health officials was conducted by UNICEF and WHO at the end of July.
It was a refresher course for health officials on immunization techniques, and training administering a new vaccine regimen outlined as Priority 2 of the ‘Polio Endgame’ for the region.
Priority 2, is one of the major challenges of the plan. It is about switching from the current trivalent oral vaccine (tOPV) to the bivalent bOPV. The switch from tOPV to bOPV is needed in order to proactively address the growing concerns related to type 2 vaccine-derived poliovirus (VDPV). In recent years, type 2 VDPVs accounted for 98% of all VDPVs. By using bOPV instead of tOPV, this risk will be greatly diminished.
However, before the switch from tOPV to bOPV can happen, every country should introduce at least one dose of inactivated poliovirus vaccine (IPV) into their routine immunization schedule. This dose of IPV will provide children with the critical protection against type 2 polioviruses after tOPV is replaced with bOPV.
It has been recommended that countries, like Tokelau, using only oral vaccines should introduce IPV into their routine immunization schedules by the end of 2015 so that all countries in the Region can switch from tOPV to bOPV in April 2016. If successful, this vaccine introduction will be the fastest of its kind in the Region.
According to WHO, given the unprecedented speed called for by this immunization policy, implementing it will require high levels of political commitment, close collaboration among all immunization partners, financial support from governments and donors, and strong internal and external communication.
Tokelau has shown its political and operational commitment to take an active part in the ‘Polio Endgame’ as evidenced at the July workshop.
At the highest level, Tokelau leader, Ulu-o-Tokelau Siopili Perez, was present to open the workshop. He encouraged and challenged health department officials to ensure standards are in line with international levels. He also acknowledged the assistance from WHO and UNICEF.
Participants rose to the challenge with results showing that officials improved their knowledge and skills in the Expanded Programme on Immunization (EPI) services, IPV and OPV switch where their average score improved from 47% pre-workshop to 87% post workshop.
The work put in by Tokelau will be worth it according to WHO.
And just as the Western Pacific Region was seen as a leader in polio eradication by being the second ever WHO region to be certified as polio-free, it can also be a champion in the implementation of the polio endgame.
Tokelau, irrespective of its size has shown it is up to the challenge to ensure stay true to its goal “Let no one be left behind”.