Global Certification Commission

The first meeting of the Global Certification Commission was convened in Geneva, Switzerland, on 16–17 February 1995.[2] The commission was initially established as a 13-person board and assigned the responsibility of delineating the criterion for verification and certification of the eradication of the wild poliovirus.[3] The World Health Assembly, the governing body of the World Health Organization, had also created the Global Polio Eradication Initiative (GPEI) in 1988 with the resolution to eradicate the disease by 2000.[3] As of August 2020, the WHO partners with the Rotary International, United States Centers for Disease Control and Prevention, UNICEF, Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance while working towards the goals of the GPEI.[4]

The global eradication of wild poliovirus type 2 (WPV2) was certified in September 2015. The last detection of indigenous WPV2 was in 1999.[5][6] Indigenous wild poliovirus type 3 was last detected in 2012 and its global eradication was certified in October 2015.[7][8] Wild poliovirus type 1 is the only form of the virus that remains uninterrupted.[9]

The Global Certification Commission is the top-level decision making body of a three-tier process. Each WHO member state's national polio program appoints a National Certification Committee. These national committees meet annually to draft a report on polio surveillance and eradication. These reports are evaluated by Regional Certification Committees, expert panels appointed by the WHO with members that are independent of both the national committees and the GPEI. There are six Regional Certification Committees, one for each WHO region. The regional committees meet annually to review the reports of the national committees. The chairs of the six regional committees comprise the Global Certification Commission. They meet irregularly as needed for global decision making.[10]

The six WHO regions with a marker for the locations of WHO regional headquarters, which may be different from the Regional Certification Commission headquarters

Africa   Americas

Eastern Mediterranean   Europe

South East Asia   Western Pacific

By 1994, the disease had been certified to be eradicated in the Americas, one of the six WHO-designated regions.[3] The Western Pacific region was certified in 2000. From these early experiences, the WHO established a criterion for certification: three years of no new detection of wild poliovirus in the face of strict surveillance, where surveillance is further defined as the finding and examination of at least one case of nonpolio acute flaccid paralysis per 100,000 children under 15 years old – implying that wild poliovirus would be detected if in existence in the country or region.[3][11]

With the criteria established, the commission resolved to certify each of the remaining regions until the disease was eradicated globally.[3] The European Region was certified in 2004 and the South-East Asia Region in 2014.[12]

In 1996, African nations signed the Yaoundé Declaration on Polio Eradication in Africa, and Nelson Mandela started the "Kick Polio out of Africa" campaign. The WHO regional director for Africa appointed 16 people to the Africa Regional Certification Commission (ARCC) in 1998.[13] Based in Yaoundé, Cameroon, and led by Rose Leke as chairperson as of 2020,[14][15] the group was tasked with overseeing the eradication effort in the Africa WHO region.[13] The independent body is the only organisation recognized to certify that polio has been eradicated from the region.[16] On 25 August 2020, the ARCC declared that wild poliovirus has been eliminated in its region which includes 47 countries spanning most of Africa.[13][17] The last reported case of polio in the region was on 21 August 2016, in Borno, Nigeria.[11][15] Among the conditions for certification of the region was a requirement that 95% of the population be immunised.[18]

Cases of polio have seen an 99.99% decline globally since the start of the polio eradication initiative:[19] "From 350 000 cases annually in 125 countries in 1988, to 102 cases in two countries in 2020 as of [August] 19."[13] The Eastern Mediterranean Region is the only WHO region that has yet to be certified as having eradicated wild poliovirus.[20] The region includes 22 countries spanning from Morocco to Pakistan,[21] several of which have individually eradicated the disease. This region experiences significant political unrest, humanitarian crises, forced displacement, and deterioration of health care systems, which cripple eradication efforts.[22]

Syria, Yemen, and Somalia are categorized as very-high-risk, and Iraq, Sudan, and Libya are categorized as high-risk, while Pakistan and Afghanistan are the only countries in which the disease remains endemic as of 2019.[22] Since 2007, people administering polio vaccines have been the target of violence in Pakistan.[23] A 2011 US Central Intelligence Agency operation used a hepatitis vaccination program as a cover to search DNA evidence to confirm the location of Osama bin Laden.[24][23] Following his killing the same year, Islamist insurgents in the region have become more hostile to vaccination efforts. More recently, the hostility has been exasperated by the United States' expansion of the use of drone strikes in northwest Pakistan;[23] in June 2012, Mullah Nazir, leader of the Federally Administered Tribal Agencies, distributed leaflets calling for a ban on polio vaccination with the goal of persuading the US to stop drone strikes in the area.[25]

• Global Polio Eradication Initiative