European Region’s 20th year of polio-free status confirmed – but there is no room for complacency

The European Regional Commission for Certification of Poliomyelitis Eradication (RCC) confirmed during its 36th meeting on 19–20 October 2022 that the WHO European Region continues to be free of any endemic spread of wild poliovirus. 

This conclusion was based on a thorough review of reports from all 53 Member States of the Region for 2021 detailing polio immunization coverage, outbreak preparedness and response, surveillance sensitivity, and laboratory containment activities. 

“We can say based on the information we have reviewed that this Region remains wild poliovirus free – something for which we should all be proud. But we cannot be complacent. Whilst transmission of wild poliovirus goes on in other parts of the world, we remain at risk,” RCC Chair Professor David Salisbury explained.

The RCC noted with concern that immunization coverage for the Region as a whole declined by 1% – from 95% in 2019 to 94% in 2020. This decline did not continue in 2021, with coverage still hovering at 94%. However, some countries experienced a significant drop in coverage during this period, and the many thousands of children who missed their vaccinations in past years remain vulnerable.

Gaps in population immunity have enabled spread of the virus already, with vaccine-derived poliovirus being detected in several countries in the Region in 2021 and 2022. Circulation of poliovirus is possible where immunity gaps persist, and all countries are therefore encouraged to sustain high coverage at every subnational level and to conduct catch-up campaigns where needed.

Preparedness and outbreak response 

The RCC also recommended that all countries strengthen their preparedness for possible poliovirus importations, and urged specific countries at higher risk of importation and subsequent spread of the virus to strengthen their outbreak response plans, immunization programmes and disease surveillance systems.

The RCC commended Tajikistan for taking immediate and comprehensive actions in 2021 to stop an outbreak of vaccine-derived poliovirus type 2, thereby successfully interrupting circulation of the virus within the 12-month period required for the Region to sustain its polio-free status. 

Similarly, detections of the virus in Israel, Ukraine and the United Kingdom in 2022 are being addressed with comprehensive actions, although the response in Ukraine is being hindered by the ongoing war there. The RCC will review the robustness and outcomes of these actions in its 2023 annual meeting. 

Disease surveillance 

In line with the global Polio Eradication Strategy 2022–2026, the RCC emphasized the importance of high-quality surveillance capable of rapid poliovirus detection in all countries. This includes ensuring that relevant stool and/or environmental samples are collected and shipped in a timely manner to either the WHO-accredited national polio laboratory or the designated regional reference laboratory for polio serving the country. 

The RCC expressed concern that a few national polio laboratories did not participate in or did not pass the annual virus isolation proficiency testing in 2021.

Laboratory containment 

Implementation of international poliovirus containment requirements is essential to minimize polio-associated risks for populations within each country and beyond. The risk of spread in the event of a containment breach is especially high in areas with lower immunization coverage and therefore low population immunity to polio.

Along with its recommendations related to poliovirus containment, the RCC noted that some countries have not yet appointed a National Poliovirus Coordinator. With wild poliovirus types 2 and 3 no longer circulating anywhere in the world, the RCC reminded countries to continuously reassess national inventories with a special focus on infectious and potentially infectious materials with wild poliovirus types 2 and 3, as well as vaccine-derived polioviruses. 

In line with the WHO global action plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII), countries must urgently ensure proper destruction or transfer of these materials if they are retained in poliovirus non-essential facilities.

The complete recommendations and conclusions of the RCC’s 36th annual meeting will be published on this website in a forthcoming meeting report.