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Global Containment Efforts Integral to Poliovirus Eradication

If poliovirus is not securely contained, release of the virus can result in reestablishment of endemic or epidemic poliovirus transmission.

Significant progress has been made in the global effort to eradicate poliovirus. Wild poliovirus type 2 (WPV2) was deemed eradicated in 2015, type 3 (WPV3) has not been reported since 2012, and only Afghanistan and Pakistan reported type 1 (WPV1) in 2017 and 2018.

Once the virus is eradicated, however, there will be a need for facilities that possess poliovirus materials to implement containment activities in order to reduce the risk of reintroducing the virus back into communities.

As such, at this year’s 71st World Health Assembly, World Health Organization (WHO) Member States adopted a resolution to accelerate those activities worldwide, including the creation of national authorities for containment (NACs) which would oversee these efforts. A recent Morbidity and Mortality Weekly Report detailed progress made towards this goal and challenges that remain.

The WHO Global Action Plan defines biorisk management standards that facilities that contain poliovirus materials should adhere to. The standards require national inventories for facilities that contain poliovirus materials and define recommendations for compliance verification with containment requirements in poliovirus essential facilities (PEFs).

In an effort to help facilities identify, minimize, and eliminate risks for storing and handling materials that might incidentally contain poliovirus, the WHO issued guidance in 2018.

In May, the WHO Member States all adopted the resolution calling for the accelerated implementation of poliovirus containment activities. Now, the countries have been requested to complete poliovirus type 2 material inventories, destroy materials that are no longer needed and begin inventories for WPV1 and WPV3 materials.

All of the WHO Member States—194—have been asked to implement the guidance and complete reports regarding poliovirus type 2 materials by April 2019.

Authors of the MMWR report add that over 100 PEFs currently exist worldwide, but the number of these facilities that contain these materials will need to be reduced in order to decrease risk.

As of August 2018, 81 PEFs have been designated by governments in 29 countries to keep PV2 materials, including 22 that have established NACs, which are the authorities for auditing facilities and issuing containment certificates.

The WHO continues to provide biorisk management and auditor training throughout the 6 WHO regions in an effort to enhance NAC auditing capacity and eventually establish a pool of auditors necessary to keep this resolution.

“Poliovirus containment is a national responsibility, and it is expected that the number of designated PEFs will be further reduced as countries carefully determine whether the programs, funding, and other resources needed to achieve and maintain full compliance with GAPIII requirements are a national or international priority,” the authors write.

The authors add that the completion of the PV2 inventories, establishment of the NACS, and the certification of PEFs is taking more time than initially estimated, and, as such, the timeline for implementing the poliovirus containment activities has been extended resulting in the following delays: submission of inventories, adequate training of auditors, and necessary preparations for PEFs to meet standards.

“Continued global engagement, education and technical body oversight; a robust communication strategy; and enhanced political will are required to resolve these issues,” the authors write.

All countries should still complete their inventories, eliminate or transfer unneeded PV2 materials, and begin the inventory and destruction of unneeded WPV1 and WPV3 materials. Countries with PEFs should be creating NACs and after the GAPIII-CCS process, they should start the certification process.