In its efforts to eradicate polio worldwide, the World Health Organization (WHO) has adopted The Polio Eradication and Endgame Strategic Plan 2013-2018, which stipulates the removal of all oral polio vaccine (OPVs) in the long term from all OPV using countries. This is to be performed in phases, the first one will begin with “the switch” from trivalent OPV (tOPV, containing weakened poliovirus types 1, 2, and 3) to the bivalent OPV (bOPV, containing weakened poliovirus types 1 and 3 only).

The justification behind the switch is that OPV, during replication in the gut, can result in circulating vaccine-derived polioviruses (VDPVs) which are capable of causing paralytic polio in communities with low vaccination coverage. In order to avert this threat, OPV must be withdrawn after the eradication of wild poliovirus (WPV) transmission starting with type 2, as no cases have been reported for this type since 1999. To diminish risks and boost immunity at this phase, at least one dose of the injectable inactivated polio vaccine (IPV) will be introduced into immunization programs before the switch to bOPV.

The switch must be performed worldwide during a two-week window in April 2016. All countries must carry out the switch during the same period to rule out the risk of importing a type 2 cVDPV from another country that continues to use tOPV. As soon as the switch is completed, all remaining tOPV vials must be disposed of as medical waste, as any use of tOPV after the switch could cause outbreaks of cVDPV2.

In Jordan, EMPHNET participated in the switch process which was done on April 23, 2016. EMPHNET’s role was to ensure the successful switch, particularly through effective monitoring of health facilities in all governorates to ensure that tOPV is no longer available for administration.

In order to ensure the removal of tOPV from the cold chain, EMPHNET staff-in collaboration with other stakeholders- conducted the monitoring at all the supply chain stores at different levels: national, district, and health facility levels.

For the monitoring, EMPHNET supported the National Switch Validation Committee in the selection of 11% of health facilities from all governorates, including high risk and hard-to-reach areas based on the WHO switch validation guidelines. All the supply chain stores were included for monitoring. The selection of additional 8% of health facilities was done by the validation committee in order to ensure the quality of the monitoring.

In collaboration with UNICEF, EMPHNET provided technical support to develop the questionnaire and the system in order to implement a mobile data collection tool for switch monitoring. Within this collaboration, EMPHNET provided training for monitors and the Validation Committee members in using the mobile device for data collection.

A total of 135 health facilities, which constitute 19% of the total health facilities in the country, and 25 cold rooms were monitored. 96% of the sites had bOPV and 92% of the monitored sites were found to have IPV. 100% of monitoring was done at all the national cold rooms and 11 regional cold rooms, where it has been found that they have 100% of bOPV. Monitoring was 100% at the district cold rooms (lower distribution level) and bOPV were present in 85% sites. IPV was found to be present in over 90% of the cold rooms. Only 2 health facilities among the monitored health facilities had tOPV (1.5%) and they were removed, burnt and discarded during monitoring.

At the conclusion of the switch process, EMPHNET organized a meeting where the final report on the monitoring of switching tOPV to bOPV was presented. Representatives of WHO, UNICEF, MoH and validation committee members were present for the meeting. The guests suggested that additional health centers should be supervised to ensure the removal of tOPV from the cold chain. The experts from the above organizations and the committee members further suggested to provide a good educational session to the physicians about the removal of tOPV. Suggestions were provided to ensure vaccinating all refugees at border’s entry point against polio. The report on the monitoring was submitted to WHO to validate the country for switching tOPV to bOPV.