Welcome to the fifth edition of The Containment Corner - Poliovirus Containment News. COVID-19 has disrupted polio eradication efforts worldwide, and containment of poliovirus - needed to secure a polio-free future - has also been affected.
In many countries, National Authorities for Containment (NACs) have been commandeered to assist in COVID-19 diagnostic and quarantine work.

Lab and research facilities have had to pause inventories for poliovirus infectious and potentially infectious materials, unable to physically access samples. Face-to-face training of auditors and staff has been waylaid due to social distancing measures. And retrofitting of infrastructure and biosafety equipment in designated poliovirus-essential facilities has been placed on hold. In spite of barriers, key bodies of work continue, mostly virtually, to advance the certification of facilities handling and storing poliovirus against the GAPIII-Containment Certification Scheme.

Below we give a snapshot of progress being made by countries moving through the certification process. We chat with an NAC on current challenges and present new draft guidance for polio vaccine manufacture. We also share a link to a scientific paper on eradication status, and given these challenging times, revisit a board game created for children in polio wards in the 1940s which still holds relevance today. Happy reading...

Current containment status

Currently, 25 countries plan to retain type 2 poliovirus in 76 designated poliovirus-essential facilities. A total of 30 facilities have received Global Certification Commission-endorsed Certificates of Participation (CPs) in the WHO GAPIII-Containment Certification Scheme.

Juggling act: Coordinating poliovirus containment during COVID-19 pandemic

Holding onto an eradicated pathogen is a risk and responsibility. At the World Health Assembly in May 2018, countries of the world committed to accelerating efforts to achieve the safe and secure containment of eradicated polioviruses. Part of this commitment involved that each country planning to retain poliovirus infectious materials, for reasons such as research, diagnostics and polio vaccine manufacture, set up a National Authority for Containment (NAC) to oversee domestic containment efforts. With many NACs established that same year, much progress has been made in guiding facilities handling and storing type 2 poliovirus through the initial stages of the global containment certification process. However, COVID-19 has pulled many NAC staff into other pressing areas of work. We chat briefly with the head of the Netherlands NAC about some of the current challenges.

Please tell us a little about your NAC and the types of poliovirus facilities you work with.

Hello, my name is Margreet van der Veer and I am Chair of the Netherlands NAC. The NAC is part of the Dutch Youth and Healthcare Inspectorate department under the Ministry of Health Welfare and Sports. Our office is situated in the center of the Netherlands in Utrecht and our job is essentially to ensure that Dutch potential poliovirus essential facilities (PEFs) comply with global containment requirements and handle and store poliovirus safely. The Ministry funds our operations and the training of auditors under WHO’s GAPIII-Containment Certification Scheme.

We have four members in our NAC – Helen, our administrative support, Bart and Menno whom both have backgrounds as biosafety officers, and myself with a background in molecular genetics. The potential PEFs we are working with include one vaccine manufacturer, three research labs of which some do small scale production, and a national reference lab that does diagnostic work and polio surveillance in the Netherlands. Since we have five PEFs, all four of us are dedicated to work for the NAC. At least, that was the situation before the COVID-19 pandemic.

How exactly has COVID-19 impacted your NAC and its work?

The pandemic had and still has a great impact on our work. As a NAC, we need to arrange audits of our facilities holding type 2 poliovirus. These are essential to make sure that infrastructure, equipment and protocols are up-to-scratch and meeting required biosafety and biosecurity standards, as this is needed [for facilities] to be able to continue working with the virus. We planned four audits this year of which two were already cancelled. Since we contracted people from abroad to train and assist the Dutch NAC auditors, it is still uncertain whether they can travel to the Netherlands on time for the next audit. The main focus for the NAC now is to write the GAPIII audit procedures and develop checklists and an audit instrument. We cannot meet in person anymore since all government employees have to work from home. All our meetings are done by Skype now as good COVID-19 preventing practice prescribes (see picture)! Some of us are assigned to various COVID-19 projects. As an example, I’m the project leader of a project to inspect the public health offices that are responsible for testing and following up the positive tested Dutch citizens.

How have your facilities been impacted?

I hope facilities are still working on implementing GAPIII requirements but I think they have something else on their minds. I know some of the facilities are working on the development of a vaccine for COVID-19. Hope they will be successful soon!

What are some measures to get facilities back on track after COVID-19?

It’s unclear exactly how facilities and for that matter, the NAC, will continue to be affected by the pandemic and associated restrictions. We are looking forward to the safe resumption of the auditing activities. It is very important that this work gets done and the NAC will continue to support our facilities throughout the process.

Team NAC Netherlands practising social distancing. Photo: M. van der Veer 

A polio laboratory specialist at work in the Netherlands. Photo: C. McNab/UNF 2018

Amendment to WHO Guidelines for polio vaccine production 

An amendment to WHO Guidelines for the safe production and quality control of poliomyelitis vaccine (WHO/BS/2020.2381, Annex 4, WHO TRS No. 1016) is available at WHO biological website http://www.who.int/biologicals/en/. This document has been prepared based on discussions at the fourth Containment Advisory Group (CAG) meeting in July 2019 and the WHO Expert Committee on Biological Standardization (ECBS) meeting in October 2019; it has taken into consideration comments received from the first round of public consultation via the WHO website during February-April this year. 
WHO is now publishing this draft to obtain additional feedback from public sectors including regulatory authorities, manufacturers, and other stakeholders. Comments received during this round of public consultation will be reviewed by the drafting group and presented to ECBS in late August 2020.

DEADLINE for submission of comments: 3 August 2020. Download the document directly herePlease use the WHO Comment Form to provide feedback.

Scientific article on eradication, cVDPVs and vaccination in the context of COVID-19

This newly published paper in CDC's Morbidity and Mortality Weekly Report (MMWR) provides a polio programme update on eradication status:

A quarantine game for the ages

Last year The Atlantic featured an article on a hit board game created in 1948 by a school teacher for children in American polio wards. Developed as escapist entertainment, 'Candyland' became a tool to alleviate boredom for not only patients restricted by medical apparatus but many more children confined to their living rooms due to quarantine measures. Seventy-plus years on, the game still sells approximately one million copies each year, according to the article. Read more here.

Photo: Strong Museum, Rochester, New York / The Atlantic 

Quick links

More on poliovirus containment
Global Action Plan III for the Containment of Polioviruses (GAPIII) and GAPIII Containment Certification Scheme (GAPIII-CCS)
Rolling timeline for review of containment certification applications
Could you be harbouring poliovirus? Potentially Infectious Material (PIM) guidance
Polio this week
For information, please contact: containment@who.int 

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