TRF Tagung 2008

POLIO und ROTARY

Was ist Polio (1)

• Virus Infektion mit RNA Picornaviren

• 3 Typen, keine Kreuzimmunität

• Fäkal-orale Übertragung unter Menschen

• Typ 1 + 3 noch existent

• Typ 2 seit 1999 nicht mehr nachweisbar

Was ist Polio (2)

• 95% - 99% stumme Infektionen

• nur max. 1% manifest, davon 5 – 10% Todesfälle

• keine medikamentöse Behandlung

• nur Vorbeugung = Impfung (oral, i.m.)

Polio 1988

Polio 2007 / 2008

• Endemisch in 125 Staaten

• 350 000 Erkrankungen p.a., > 20 000 Todesfälle

• >99% Reduktion der Erkrankungen = >1300, 5% Todesfälle

• Endemisch in 4 Staaten : Afghanistan, Indien, Nigerien, Pakistan

• Re-Infektionen in 6 Staaten durch Virusimport:

• Chad, Congo, Niger Sudan, Myanmar, Nepal

• 2007: Impfung v. 400Mio Kindern, 2,3 Mrd.Dosen, 27 Staaten, 0,6 US $ p. Dosis

Risks at end-2006

Remaining endemic countries as of 2002

4 parts of 4 countries were 'stuck'

2 of the 4 countries had re-infected 27 others

Int'l spread of polio from India & Nigeria, 2003-7

Active conflict

Autonomous areas

Political & societal buy-in

Very efficient transmission

Major Barriers at Feb 2007

Technical: inability to interrupt poliovirus despite very high coverage (i.e. northern India).

Financial: inability to maintain US$700 million/year expenditure due to limited progress.

Operational: chronic failure to reach >90% of children in parts of all 4 endemic areas.

Type 1 Polio Cases at 1 July 2008

Endemic countries

Wild virus type 1

New importations (2008)

Persistent imports (2006-7)

Type 3 Polio Cases at 1 July 2008

Endemic countries

Wild virus type 3

New importations (2008)

Persistent imports (2006-7)

India

Denmark

Netherlands

Others

Russian Federation

Germany

UN Foundation

Rotary International

World Bank (India)

IFFIm

Japan

European Commission

WB Investment Partnership for Polio

Bill and Melinda Gates Foundation

Canada

FranceUSAID

Sweden

Norway

US CDC

Italy

UK

Bangladesh

Indonesia

2008-9 Funding Gap:US$ 355m of $1.36b budget

‘Other’ includes: the Governments of Angola, Austria, Australia, Azerbaijan, Belgium, Brunei, Czech Republic, Cyprus, Finland, Hungary, Iceland, Ireland, Kuwait, Liechtenstein, Luxembourg, Malaysia, Malta, Monaco, Namibia, New Zealand, Nigeria, Oman, Pakistan, Portugal, Qatar, Republic of Korea, Saudi Arabia, Singapore, , Spain, Switzerland, Turkey, the United Arab Emirates; African Development Bank; AG Fund; American Red Cross; De Beers, Inter-American Development Bank, Central Emergency Response Fund (CERF), International Federation of Red Cross and Red Crescent Societies, Oil for Food Programme, OPEC Fund, Sanofi Pasteur; Saudi Arabian Red Crescent Society, Smith Kline Biologicals, UNICEF National Committees, UNICEF Regular and Other Resources, United Arab Emirates Red Crescent Society, WHO Regular Budget and Wyeth.

DomesticResources

13%

Non-G8 OECD/Other 5%

Multilateral Sector

14%

Private Sector 17%

Financial Contributions since 1988: US$ 6.38 billionand Funding Gap for 2008-2009

G8 51%

Table 1: Summary of external resource requirements by major category of activity, 2008-2012 (all figures in US$ millions).

Activity Category 2008 2009 2008-2009 2010-2012

Oral polio vaccine 277,00$ 182,34$ 459,33$ -$

NIDs/SNIDs operations* 299,27$ 171,64$ 470,91$ -$

Emergency response/ mOPV evaluation -$ 45,00$ 45,00$ 95,00$

Surveillance** 66,07$ 57,89$ 123,96$ 138,87$

Laboratory 8,18$ 8,26$ 16,44$ 20,61$

Technical assistance*** 96,03$ 81,79$ 177,82$ 191,78$

Certification and containment -$ 5,00$ 5,00$ 30,00$

Product development for OPV cessation 8,45$ 8,45$ 16,90$ 15,00$

Vaccine for post-eradication era stockpile (finished product and bulk) -$ 49,22$ 49,22$ -$

Subtotal 755,00$ 609,59$ 1.364,59$ 491,26$

Contributions 662,67$ 347,07$ 1.009,74$ 2,56$

Funding gap 92,33$ 262,52$ 354,85$ 488,70$

Funding gap (rounded) 90,00$ 265,00$ 355,00$ 490,00$

* Operations costs include manpower and incentives, training and meetings, supplies and equipment, transportation, social mobilization and running costs.** Country-level surveillance and laboratory summary for 2008 provided in Table 4.*** Technical assistance includes the cost of human resources deployed through UN agencies. Country-level breakdown for 2008 provided in Table 5.

Polio Ausrottung – 2013 erreichbar?

• Dzt. 179 Staaten ( 86% ) von 206 Staaten als poliofrei zertifiziert

• Erforderliche Mittel 700,0 Mio US$ p.a.

• Notwendige Begleitmassnahmen : Überwachung, Laborkontrollen, Lager mit mOPV und IPV

• Harvard-Studie: bei vorzeitigem Impfstopp vielfache Kosten in 10 Jahren!

Polio Eradication – Prospects

Asia: on track to stop type 1 polio in 2008. <15 cases in each country.

no indigenous type 1 for >12 months in UP, India.

all type 1 outbreaks stopped.

Africa: type 1 will be delayed > 12 mos. >300 cases in north Nigeria.

8 countries have ongoing outbreaks.

Chad, DRC, Niger & SUD/ETH outbreaks >24 mos.

BUT….it is still biologically

'easier' to eradicate polio in

Africa than in Asia (average number of OPV doses = 4 vs. >8).

Key Landmarks at June 2008

India: stop Type 1 transmission

on track

Nigeria: <15% missed children

not on track

DG Intensification – June 2008 (1)

Establishing as 'WHO's top operational priority' directive to all ADGs during June retreat. discussed with RD/AFRO. wrote to all RDs & WRs of endemic & re-infected countries.

Enhancing partner commitments discussed with heads of UNICEF, CDC & Rotary. conducted joint press conference.

Encouraging resource mobilization helped launch Rotary's US$100 m Challenge. promoted as top priority during Gates Foundation mtgs. G8 advocacy.

DG Intensification – June 2008 (2)

Addressing Nigeria situation wrote to Presidents of Nigeria, Niger and African Union. met & discussed with UN Secretary-General. requested 4 G8 Heads of State to discuss at Summit. requesting follow-up with President at UN in September.

Encouraging India: wrote to CM UP on new importation. writing follow-up to CM Bihar in advance of flood season.

Pakistan & Afghanistan: writing to new Prime Minister following 'emergency' TAG. evaluating options to improve SIA security in conflict areas.

Leistungen von Rotary

• 1985 – 1988 Anfangsinitiativen 240 Mio US $

• 1988 Partnerschaft mit WHO, UNICEF und CDC

• - 2008 Rotary Beiträge 750 Mio US $ und hands-on Leistungen

• BMGF 100 Mio US $

• Rotary-Challenge weitere 100 Mio US $ - 2010

• Rotary Zusage belastet jeden Club mit ca. 3300.- in 3 Jahren

Leistungen D 1910 & D 1920

• Bis 2007 1,16 Mio US $

• 2008 – 2010 bereits beschlossen D 1910 € 25.- p.a./ Mitglied (BIH € 15.- )

D 1920 € 18.- p.a./Mitglied

• D 1910 – A € 90 000.- p.a. gesamt € 270 000.- Nicht-A € 45 000.- p.a. gesamt € 135 000.-

. D 1920 – A € 55 000.- p.a. gesamt € 165 000.-

• zu erwartende Gesamtleistung mind. € 570 000.- !!!

• zusätzlich : Clubaktivitäten & freiwillige Spendenaktionen

Barrieren für Polio-Aktionen

• Impfmüdigkeit

• „Konkurrenzkrankheiten“ wie Aids, Malaria, TBC etc.

• in Industriestaaten Polio nicht mehr „sichtbar“

• (zu)lange Dauer der Aktion

• Versprechung „Eradication“ sehr hoch gegriffen, besser . „Stop the transmission“!

Trotzdem, oder gerade deswegen

• „Alt“ Rotarier dürfen jetzt nicht müde werden!

• „Jung“ Rotarier müssen motiviert werden und finanziell beitragen

• generell „ Awareness – Bewusstsein“ schaffen und verstärken

• Partnerschaft-Gründer Rotary darf jetzt nicht „aussteigen“, denn . „mitgefangen-mitgehangen“