Polio outbreak simulation exercises (POSE)

A polio outbreak simulation exercise (POSE) is a two-day tabletop exercise designed to help Member States critically review and update their national plans for responding to the detection of imported wild polioviruses (WPV) and vaccine-derived polioviruses (VDPV), including use of the International Health Regulations mechanism. The exercise addresses communication, coordination and collaboration at an international and national level and exposes any weaknesses in polio preparedness and response arrangements.

Exercise scenario

Each exercise proposes a specific scenario starting with detection of a suspected polio case and progressing into cross-border transmission. Participants are asked to simulate implementation of country preparedness plans aimed at containing the outbreak. The exercise concludes with a post event scenario some 25 weeks after the last case was reported.

Cross-border and national preparedness

Since the need for heightened preparedness was demonstrated by an outbreak of imported polio in Tajikistan in 2010, sub- and inter-regional exercises have been conducted in:

  • Bosnia and Herzegovina in 2011 for representatives of Bosnia and Herzegovina, Montenegro and Serbia;
  • Ukraine in 2013 for representatives of Armenia, Azerbaijan, Georgia and Ukraine, an observer from the Russian Federation, as well as experts from European polio reference laboratories;
  • Romania in 2015 for representatives of Czech Republic, Hungary, the Republic of Moldova, Romania and Slovakia;
  • Kazakhstan in 2015 for representatives of Kyrgyzstan, the Russian Federation (WHO European Region), China and Mongolia (WHO Western Pacific Region);
  • Kazakhstan in 2016 for representatives of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan.

National exercises have been conducted in the United Kingdom in February 2013 and Tajikistan in 2017.

The exercises are also attended by observers from WHO headquarters, country offices and partner agencies.


By facilitating hands-on practice, POSE exercises:

  • emphasize the importance of communications as the key element of any response;
  • point to the need for crisis communications plans;
  • provide an opportunity to review national plans from a new perspective and using a novel methodology;
  • highlight the importance of liaising across borders/countries and building partnership as part of outbreak response preparedness.

WHO/Europe plans to conduct further regional and inter-regional POSE exercises in the coming years.