6 cases of Wild Polio Virus (WPV1) were confirmed – 2 from Kandahar, 2 from Hilmand, 1 from Uruzgan, and 1 from Khost
- 221 children with Acute Flaccid Paralysis (AFP) -96 girls and 125 boys – were reported.
Dr Elaha, at 22 years old, is a medical graduate and a District Polio Officer. She’s also helping fight the COVID-19 pandemic in Afghanistan.
“COVID-19 has affected both our work life and personal life. When I joined the polio team, I had plans to take initiative and look for innovative ways to fight polio, however, with the COVID-19 pandemic all my plans were challenged,” she says. “Campaigns were postponed and the number of cases were on the rise.”
The temporary pause in polio vaccination campaigns, necessary to keep health workers and communities safe during the early months of the pandemic, led to a widened immunity gap in both Afghanistan and Pakistan, the only two countries that still harbour wild poliovirus. Now, polio teams are urgently working to close the gap while continuing their support to Afghanistan’s COVID-19 response. To ensure their safety, all polio personnel have been trained to take precautionary measures against COVID-19, including wearing masks correctly and regular handwashing.
Dr Elaha doesn’t underestimate the danger of her work to fight COVID-19. She explains, “I start my day at 8am by visiting private and public clinics, pharmacies, traditional healers at their homes. Of course, I am worried about myself and my family getting COVID-19. My mother is elderly, and COVID-19 can be dangerous for her.”
“However, I am committed to serve my people and go out in the field to help save others’ lives. It is not easy. My family understand that I am a medical doctor, so no matter what virus is there, I have to do my job as a doctor.”
Through her work, Dr Elaha has come up against rumours and misinformation. A major part of both ending polio and fighting COVID-19 is working to inform and build trust with communities about diseases and how they can be prevented.
Elaha says, “A lot of people thought that COVID-19 was a disease of nonbelievers. At first, when I used to go to clinics, because of my medical degree, they respectfully listened to me. However, when I talked about COVID-19 and washing hands and other preventative methods, they would tell me that this disease was for nonbelievers.”
“Unfortunately, a lot of people got sick and many also lost their lives. People have started to believe the pandemic. They know that people can get sick and die of the disease.”
Although public awareness about the dangers of COVID-19 has improved, Dr Elaha believes there is still plenty to do to encourage communities to adopt disease prevention measures such as widespread mask wearing.
Until the pandemic is over, she is determined to work long hours to fight both polio and COVID-19. The polio workforce currently contributing to COVID-19 response includes almost 36,000 members of the Polio Surveillance Network, and over 47,000 polio frontline workers.
“I chose to continue to do public health awareness during the COVID-19 pandemic. I wanted to help save people’s lives and continue to serve my people,” says Farida, a polio worker and volunteer for the COVID-19 response.
Seven months since the first COVID-19 case was reported in Afghanistan, female polio programme frontline workers continue to support outbreak response. Often, they put concerns for their health to one side as they work in areas with many COVID-19 cases. Sometimes, their work brings them into conflict with the social norms of their community and society.
Farida has been working with the polio programme since 2010. Starting as a volunteer, she has moved up the ranks to become a district polio officer.
Stepping up for the COVID-19 response
During the pandemic, Farida has taken on extra duties to identify suspected COVID-19 cases, share accurate information and trace individuals returning from abroad to ensure they are isolating.
On a typical day she heads out to speak to small groups of women about hygiene, breastfeeding, nutrition and measures to prevent COVID-19. She is the focal point for communicable diseases within her clinic, and so must also keep all her colleagues up to date on the latest information about COVID-19, alongside reinforcing knowledge about polio and the importance of vaccination.
Farida’s work is often emotionally challenging. “Luckily, I still have not contracted COVID-19,” she says.
“I reported seven people as I suspected that they had COVID-19, unfortunately six of them died and one of them survived and is healthy now.”
A programme effort to respond to COVID-19
Ever since the first case of COVID-19 was reported in Afghanistan, the Polio Eradication Initiative (PEI) programme has been supporting the government response.
Since March 2020, nearly 36,000 members of the Polio Surveillance Network, almost 44,000 polio frontline workers, about 95,000 health providers and about 5,000 government and NGO staff have been trained on COVID-19 surveillance. Over 178,000 community and religious influencers have been trained to deliver outreach messages, and almost 7,000 coordination meetings have been held.
About 10,000 COVID-19 and polio surveillance visits have been made to health facilities, and more than 2,500 medical facilities have been surveyed for COVID-19 preparedness. Thanks to the efforts of the polio team, over 46,000 cases of COVID-19 have been detected, of which more than 8,000 have been confirmed.
Farida shares with her colleagues a sense of duty to her fellow citizens. She says, “I go out hoping that my work might save lives. If I stay home, who will give the information to people that I do?”
Vaccinators in countries including Afghanistan, Angola, Burkina Faso and Pakistan took to the streets this month to fill urgent immunity gaps that have widened in the under-five population during a four month pause to polio campaigns due to COVID-19.
Campaigns resumed in alignment with strict COVID-19 prevention measures, including screening of vaccinators for symptoms of COVID-19, regular handwashing, provision of masks and a ‘no touch’ vaccination method to ensure that distance is maintained between the frontline worker and child. Only workers from local communities provided house-to-house vaccination to prevent introduction of SARS-CoV2 infection in non-infected areas.
Although necessary to protect both health workers and communities from COVID-19, the temporary pause in house-to-house campaigns, coupled with pandemic-related disruptions to routine immunization and other essential health services, has resulted in expanding transmission of poliovirus in communities worldwide. Modelling by the polio programme suggests a potentially devastating cost to eradication efforts if campaigns do not resume.
In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. Vaccinators were trained on COVID-19 infection control and prevention measures and were equipped to answer parents’ questions about the pandemic. Through the campaign, teams distributed 500 000 posters and 380 000 flyers featuring COVID-19 prevention messages.
In Angola, 1 287 717 children under five years of age were reached by over 4000 vaccinators observing COVID-19 infection prevention and control measures. All health workers were trained on infection risk, and 90 000 masks and 23 000 hand sanitizers were distributed by the Ministry of Health.
In Burkina Faso, 174 304 children under five years of age were vaccinated in two high-risk districts by 2000 frontline workers. Vaccinators and health care workers were trained on maintaining physical distancing while conducting the vaccination. 41 250 masks and 200 litres of hand sanitizer were made available through the COVID-19 committee in the country to protect frontline workers and families during the campaign.
In Pakistan, almost 800 000 children under the age of five were reached by vaccinators in districts where there is an outbreak of circulating vaccine-derived poliovirus. Staff were trained on preventive measures to be followed during vaccination, including keeping physical distance inside homes and ensuring safe handling of a child while vaccinating and finger marking them.
“Our early stage analysis suggests that almost 80 million vaccination opportunities have been missed by children in our Region due to COVID-19, based on polio vaccination activities that had to be paused,” said Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean Region. “That’s close to 60 million children who would have received important protection by vaccines against paralytic polio.”
Over the coming months, more countries plan to hold campaigns to close polio outbreaks and prevent further spread, when the local epidemiological situation permits.
“Our teams have been working across the Region to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio,” said Dr Hamid Jafari. “We must now ensure that we work with communities to protect vulnerable children with vaccines, whilst ensuring strict safety and hygiene measures to prevent any further spread of COVID-19”.
Dr Matshidiso Moeti, WHO Regional Director for Africa, commented, “We cannot wait for the COVID-19 pandemic to be contained to resume immunization activities. If we stop immunization for too long, including for polio, vaccine-preventable diseases will have a detrimental effect on children’s health across the region.”
“The campaigns run by the Polio Eradication Programme demonstrate that mass immunization can be safely conducted under the strict implementation of COVID-19 infection prevention and control guidelines.”
In March 2020, polio social mobilisers from the UNICEF-run Immunization Communication Network (ICN) provided routine immunization referral services to over 37,000 children in southern and eastern Afghanistan.
The polio programme’s routine immunization efforts in Afghanistan have made important gains, especially in the country’s east, in the areas bordering Pakistan. Polio social mobilisers support mother and child health referral services, and help families keep track of their children’s health records. As the mobilisers are recruited from their community, they know the families in their neighborhood and can trace each child’s planned immunization schedule from birth.
It is critical that routine immunization continues throughout the pandemic to protect children from life-threatening diseases including polio. Polio mobilisers have found their work is even more valued during the COVID-19 response.
Masoud, a polio mobiliser, says ‘’I used to announce the immunization sessions through the Mosque but not all the targeted children were brought to the health facility. Now through the ICN support to routine immunization, the number of missed children has reduced due to tracking of every child in the community and coordinating with the health facility.”
“This is critical during the ongoing pandemic, as families are not sure if they can leave their homes to take their children to the health facility for immunization. The polio mobilisers are their guide in the community.’’
In 2003, Melissa Corkum received a call that would change her life. The World Health Organization wanted to interview her for a position in their polio eradication team. Like most people who are hearing about polio eradication for the first time, the story compelled her, and she packed her bags to embark on a new adventure. Seventeen years later, she remains a dedicated champion of polio eradication.
A self-proclaimed ‘virus chaser’, Melissa has worked in all three polio endemic countries – Afghanistan, Pakistan and Nigeria. She found inspiration in her first field job in Nigeria, where she realized the scale of the polio eradication programme and that she was a part of something tremendous in public health history.
“I was amazed and inspired when I first saw the efforts of the front-line workers delivering vaccines to the doorstep. It may seem simple to deliver a couple drops into a child’s mouth, but when you see it in motion for the first time, it is truly remarkable,” Melissa said.
To this day, Melissa remains in awe of the work required to make ‘reaching every child’ possible. From mobilizing financial resources, to getting vaccines where they need to be while keeping them cool. From the microplanning to ensure all children and their houses are on a map, to the mobilization of champions in support of polio and immunization. Along the way, the stewards of these processes play an essential role to deliver the polio vaccine.
Melissa has worn many hats during her time in polio eradication, but her current role may be the most challenging yet. As the Polio Outbreak Response Senior Manager with UNICEF, she must answer the formidable challenge of containing outbreaks, using her expertise to inform global policy, strategy and operations.
To do this Melissa spent 80% of her time in the field prior to the outbreak of COVID-19, working with partners of the Global Polio Eradication Initiative (GPEI), Ministries of Health and local health workers.
Her work is a mix of challenge and excitement – the challenges of containing outbreaks, including those affected by the COVID-19 emergency – and excitement in developing new tools and methods to overcome the evolving challenges that present barriers to eradicating polio.
“There is never a dull day no matter what hat you may be wearing within this programme. If we are going to put an end to polio for good, we are going to have to fight the fight on a number of fronts – endemics and now the emerging issue of outbreaks in a post-COVID world,” said Melissa.
“The key is a willingness to do whatever it takes to get the job done.”
At times, Melissa felt the weight of the enormous challenges to eradicate polio, especially during her time in Afghanistan, where protracted conflict has complicated efforts to deliver basic services to the most vulnerable. Melissa often reflects on her time as Polio Team Lead there and the emotional rollercoaster she faced trying to stay ahead of the virus, while watching the tragedy of war unfold in the country.
“But when I felt down, I would pick myself up and get ready to face the next challenge. I found hope and inspiration in the resilience of the Afghan people, especially the women who worked in the polio programme, risking their lives and demonstrating a courage that stood out amidst all the difficulties.”
Melissa sees gender as one of the keys to polio eradication. She firmly believes that the only way to tighten the gaps in the system is by involving and empowering women equally in all roles across the programme, and that the only way to reach every child is to ensure their caregivers are equally informed and engaged in the decision making process.
“Unless we involve more women in the programme in certain corners of the world, we will continue to reach the same children and miss the same children, making polio eradication ever more difficult,” Melissa said.
“Change won’t happen if we don’t change the way we think about involving women. We need to listen to their views and open the doors for more women to join and participate equally from the community level and all the way to the leadership, decision-making level.”
Melissa was born in a small town in Nova Scotia, Canada. Her views on the critical involvement of women and gender equality in the polio programme very much align with her government’s Feminist Aid Policy. The Government of Canada has been a long-time champion of polio eradication and recently generously pledged C$ 190 million to assist the GPEI achieve its objectives of polio eradication.
Greater gender equity is one of the legacies that the polio programme is working to leave behind after eradication. Reflecting on her career, Melissa explains what keeps her working to defeat polio after all these years.
“It is so inspiring to be part of something tangible and something that is completely possible if we commit ourselves to doing everything possible to find every last child”.
In response to the COVID-19 pandemic, the polio programme has diverted thousands of personnel to fight the virus. Repurposing extensive experience eradicating polio, the programme is supporting country response in areas including information dissemination, disease surveillance, risk communications and data management.
Community social mobilizers stepped up in March to deliver soap bars and information on COVID-19 to some of Afghanistan’s poorest and most vulnerable communities.
Social mobilizers are local people trained to communicate with the public about specific health issues in ways that are understandable and encourage behaviours to protect health. In Afghanistan, UNICEF coordinates a network of 3,750 mobilizers.
Social mobilizer Feroz explained the importance of his mission. “The families were especially happy with the soap distribution. If the social mobilisers were not here, people would have remained uneducated about COVID-19.”
Just a few days after the decision to mobilize polio teams for COVID-19 response, Feroz’s team distributed thousands of soap bars and educational materials on the virus to communities across his province. Many of the families served have limited access to adequate sanitation products or facilities. Providing a bar of soap and demonstrating its use is a simple COVID-19 prevention measure.
During the distribution, the teams emphasized the importance of routine immunization continuing throughout the pandemic, reminding parents to take their children to health facilities. With house-to-house polio vaccination campaigns paused for the time being, many more children may be vulnerable to polio and other vaccine-preventable diseases if they do not receive vaccinations at health clinics.
The soap packaging carried a pro-vaccine message, reading ‘let’s come together for a polio-free Afghanistan.
Zuhal, a colleague of Feroz, explained that she has noticed a change in how vaccine hesitant families react to the polio social mobilisers since the beginning of COVID-19 pandemic. ‘’The number of people who were interested exceeded our expectations. We were able to attract our communities’ attention. Parents who used to refuse polio vaccine in campaigns have participated in COVID-19 discussions and eagerly asked for information.’’
She added, ‘’During the last polio campaign, I had to wait 30 minutes in front of one house. When the door was opened, a man told me, “Go, we do not want to vaccinate our children. Never come here again”. The same man looked for me in his neighbourhood during our COVID-19 information and soap distribution, and this time he was desperate for information. This shows that people in the community recognize that we are a source of information when they are concerned about their health, even if they have rejected polio vaccines in the past.’’
Feroz agreed, saying, “The community has more trust in us now we are trying to minimize the risk of COVID-19 infection through public education.’’
It is hoped that the trust built up between the mobilizers and communities during this time will translate into stronger relationships far into the future. This may help the polio programme reach out to children in families where vaccination has previously been viewed with suspicion.
Feroz is pleased to serve his community. He says, “I feel proud seeing the results of my work, when children receive routine immunization on time and pregnant women deliver safely at the hospital. Knowledge matters.”
He adds, “Information at the time of crises can be lifesaving. The polio programme has a mission to protect every child against diseases – polio and now COVID-19.”
The COVID -19 pandemic response requires worldwide solidarity. The Global Polio Eradication Initiative (GPEI) has a public health imperative to ensure that its resources are used to support countries in their preparedness and response. The COVID-19 emergency also means that polio eradication will be affected. We will continue to communicate on impact, plans and guidance as they evolve.
Urgent updated country and regional recommendations from the Polio Oversight Board – 26 May 2020
| English |
Use of oral polio vaccine (OPV) to prevent SARS-CoV2 | English |
Safeguarding in-country mOPV2 stocks during COVID-19 pandemic pause | English |
Interim guidance for the polio surveillance network in the context of coronavirus (COVID-19) | English |
Using the vast infrastructure developed to identify the poliovirus and deliver vaccination campaigns, the polio eradication programme is pitching in to protect the vulnerable from COVID-19, especially in polio-endemic countries. From Pakistan to Nigeria, the programme is drawing on years of experience fighting outbreaks to support governments as they respond to the new virus.
Few health programmes have as much practice tracking virus or reaching out to communities as the Pakistan polio eradication programme. This means the polio team is in a strong position to support the Government of Pakistan in COVID-19 preparedness and response.
Currently, the polio team is providing assistance across the entire country, with a special focus on strengthening surveillance and awareness raising. Working side-by-side with the Government of Pakistan, within three weeks the team has managed to train over 280 surveillance officers in COVID-19 surveillance. It has also supported the development of a new data system that’s fully integrated with existing data management system for polio. All polio surveillance staff are now doubling up and supporting disease surveillance for COVID-19. Through cascade trainings, they have sensitized over 6,260 health professionals on COVID-19, alongside their polio duties, in light of the national emergency. These efforts will continue unabated as the virus continues to spread.
Adding to the capacity of the government and WHO Emergency team, the polio team are also engaged in COVID-19 contact tracing and improving testing in six reference laboratories. They have been trained to support and supplement the current efforts, preparing for a sudden surge in cases and responding to the increase in travelers that need to be traced as a result of the rise in cases. The regional reference laboratory for polio in Islamabad is also providing technical support to COVID-19 testing and has been evolving to cater to the increased demands.
As this is a new disease, polio staff are lending their skills as health risk communicators – providing accurate information and listening to people’s concerns. The government of Pakistan extended a national help line originally used for polio-related calls to now cater to the public’s need for information on COVID-19. The help line was quickly adapted by the polio communication team once the first COVID-19 case was announced. The polio communications team is using strategies routinely used to promote polio vaccines to disseminate information about the COVID-19 virus, including working with Facebook, to ensure accurate information sharing, and airing television adverts. As time goes on, the teams will train more and more people ensuring the provision of positive health practices messages that can curb the transmission of the virus.
Currently, community volunteers who work for the polio programme to report children with acute flaccid paralysis (AFP) are delivering messages on handwashing to reduce spread of COVID-19, in addition to polio. UNICEF is similarly using its Immunization Communication Network to disseminate information on personal hygiene.
Field staff have taken the initiative of using their routine visits to health facilities, during which they check for children with AFP, to check for and report people who may have COVID-19. Meanwhile, programme staff are building the capacity of health workers to respond to the novel coronavirus.
To coordinate approaches, the WHO Afghanistan polio team has a designated focal point connecting with the wider COVID-19 operation led by the Government of Afghanistan. The polio eradication teams at regional and provincial levels are working closely with the Ministry of Public Health, non-governmental organizations delivering Afghanistan’s Basic Package of Health Services and other partners to enhance Afghanistan’s preparedness.
“In the field, when there is an emergency, WHO’s first call for support to the state governments is the polio personnel,” says Fiona Braka, WHO polio team lead in Nigeria.
In Ogun and Lagos states, where two cases of COVID-19 have been detected, over 50 WHO polio programme medical staff are working flat out to mitigate further spread, using lessons learnt from their years battling the poliovirus. Staff are engaged in integrated disease surveillance, contact tracing, and data collection and analysis. Public health experts working for the Stop Transmission of Polio programme, supported by the US Centers for Disease Control and Prevention, are using their skills to undertake COVID-19 case investigations.
The WHO Field Offices -which are usually used for polio eradication coordination- are doubling up as coordination hubs for WHO teams supporting the COVID-19 response. The programme is also lending phones, vehicles and administrative support to the COVID-19 effort.
In states where no cases of COVID-19 have been reported, polio staff are supporting preparedness activities. At a local level, polio programme infrastructure is being used to strengthen disease surveillance. Polio staff are working closely with government counterparts and facilitating capacity building on COVID-19 response protocols and are working to build awareness of the virus in the community. Specials efforts are being undertaken to train frontline workers as they are at high risk of contagion.
Beyond polio-endemic countries
Trained specialists in the STOP program, part of the Global Polio Eradication Initiative, are actively supporting preparations or response to COVID-19 in 13 countries worldwide. The WHO Regional Office for Africa’s Rapid Response Team, who usually respond to polio outbreaks, are aiding COVID-19 preparedness in countries including Angola, Cameroon and the Central African Republic. Meanwhile, polio staff in other offices are ready to lend support, or are already lending support, to colleagues working to mitigate and respond to the new virus.
In our work to end polio, the programme sees the devastating impact that communicable diseases have. With this in mind, we are fully committed to supporting national health systems by engaging our expertise and assets to help mitigate and contain the COVID-19 pandemic, alongside continuing concerted efforts to eradicate polio.
For the latest information and advice on the COVID-19 disease outbreak visit the WHO website.
Dr Faten Kamel is on a flying visit to the WHO Eastern Mediterranean Regional Hub, stopping for meetings and to deliver a lecture on the relationship between polio and patients with primary immunodeficiencies. Then she’s off again – to Pakistan to take part in a polio programme management review.
Dr. Faten has travelled to every country in the Eastern Mediterranean Region, and many more besides. Alongside working as a Senior Global Expert for the programme, she is a wife, a mother, grandmother, and an informal mentor to women in public health.
Growing up in Alexandria, Egypt, Dr. Faten was exposed to the life-altering effects of polio on the people around her and was inspired by the work of her father, a surgeon and a Rotarian.
“My father was my role model, he had great passion for helping others and was also a Rotary Club president in 1989. His project for that year was on polio eradication.”
“Polio was prevalent in Egypt in those days. A number of people around me were affected. I was touched by their suffering in a place which was not highly equipped for people with special needs at that time.”
Making rapid gains against polio
After graduating from her Medical Degree and Doctorate in Public Health, and lecturing for several years at Alexandria University, Dr. Faten moved into a role for WHO. She found her niche working in the immunization team. “Immunization is the most cost effective public health tool – it can prevent severe and deadly diseases with just two drops or a simple injection – I strongly believe in preventive medicine,” she explains.
“I became the Eastern Mediterranean Regional Medical Officer for polio eradication in 1998. At that time many countries were still endemic.”
The 1990s and early 2000s were years of rapid gains against the virus. However to fully eradicate polio, it was becoming clear that the programme would have to be more ingenious than any disease elimination or eradication project that had come before.
Dr. Faten took a leading role. She explains, “Strategies for immunization and disease surveillance were established, and these methods evolved over time. We pushed the boundaries to make the programme more effective – shifting to house to house vaccination, detailed microplanning and mapping, retrieval of missed children and independent monitoring.”
“We started as a small team – covering different aspects of work and supporting all the countries. My team started the regular analysis and publishing of data in “Poliofax”, we supported the shift to case based and active surveillance and gradually added different supplementary activities including environmental surveillance.”
“I was blessed to have the support of my parents, my husband and my son. As a married woman I think it is very important to have the support of your family. I also had wonderful supervisors who believed in my capabilities and gave me opportunities. I am similarly impressed with many of the young women in the programme today.”
Sometimes the biggest challenges for Dr. Faten and her team came out of the blue, such as when the programme faced huge polio outbreaks in areas that had become free of the virus.
“We didn’t expect polio to cause large outbreaks, but we were faced with them. To overcome the situation we started to work together as partners on effective response strategies within and across regions. The virus does not stop at borders and we had to coordinate multi-country activities.”
“In the polio eradication programme we cannot be satisfied with 80% or 90% coverage – we need to reach each and every child no matter where they are, even in the hard to reach and insecure places. So there was always a lot of innovation and adaptive strategies, we were thinking how can we bridge this, and reach these children.”
“That’s how we came up with access analysis and negotiation, days of tranquility, using windows of opportunities and short interval campaigns, community involvement and collaboration with NGOs, intensifying work at exit points, thinking out of the box all the time.”
Tracking polio down unexpected paths
Dr. Faten was determined to possess firsthand information on polio cases, no matter where they occurred. Sometimes, this led her down unexpected paths – such as when she travelled 21 hours through the Sudanese bush to track down a polio case in a remote village.
“I’ll never forget when a wild poliovirus type 3 (WPV3) case appeared in a very faraway place in Sudan after years without WPV3. I said, “I have to see it myself”. This mission was one of my most challenging fieldtrips.”
“We faced many difficulties, it was the rainy season, the car slipped on its side on our way and we arrived after midnight.”
“I thought the virus must have been hiding in this place for years. But I found the disease surveillance to be very good. Then by investigating, we found there was a wedding, and relatives were coming from another province, so I could nearly point my finger to where the virus came from. The virus was detected in that area and we managed to curtail its spread.
A career spent getting ahead of the virus
In 2016, Dr. Faten set up the Rapid Response Unit in Pakistan – a dedicated ‘A team’ that can jump into an at-risk area to mitigate virus spread. Today, she is working with medical professionals to ensure that individuals with primary immunodeficiencies get tested for poliovirus, as some of them are at risk of prolonged virus shedding.
What keeps her awake at night?
“I care about where we are not reaching. Polio eradication is beyond health – it needs all the sectors to come together especially in a big country. In the last strongholds of the virus we have population movement across the border, some areas that are difficult to reach, and there are some misconceptions.”
“If someone comes and says this area is inaccessible, this is not an answer for me. I ask: What should we do to reach? I like to make use of the ideas and experience that come from local people. The virus strongholds are in certain areas, so let us work closely with the people in these areas, empower them, and allow them to change the situation.”
Dr Faten is proud to be part of the polio eradication programme and looks forward to the day when polio eradication is achieved, so she can spend more time with her family in Australia.
“As a grandmother, I am especially determined to finish the job. I want my grandkids to grow up in a world free of polio. This will be my contribution to their futures.”
Amidst the extreme heat of the Afghan summer, Masooda, a polio outreach worker, moves with confidence between houses. Her aim is to talk to families that refuse to vaccinate their children against polio. Her energy is endless and she tops that with a smile and a warm way of talking with women and men.
Masooda has an impressive range of skills. She works as a skilled midwife with passion for her community. She is also a District Communications Officer for the polio programme, leading a team of 56 community outreach workers in her neighbourhood.
“I want to help my people – polio is a danger to every child, and we should eradicate it”, says Masooda.
Masooda recalls her early days with the programme, “I faced tough refusal families who denied their children the polio vaccine. A woman refused to vaccinate her younger sister. After one year, the sister died of measles as she hadn’t been vaccinated against it. Now, the same woman has a baby girl and she frequently takes her baby to the health centre for vaccination. Sadly, she learnt her lesson the hard way”.
Masooda leaves her house at 6:30am during immunization campaigns, just as the sun rises. She checks the outreach plans with her teams before they disperse around the town. Through the day, she makes supervisory visits to her teams and obtains updates on vaccine uptake issues. When she receives reports on absent and missing children, she converses with families in order to encourage them to vaccinate their children.
To eradicate polio from Afghanistan, Masooda thinks there is a lot more to do. She says, “I will continue to work hard, for every child to be able to walk, attend school and grow healthy. It is the whole community cause for generations to come.”
The 72nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.
The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.
The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.
Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”
Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”
Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.
Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”
Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners: Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”
In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”
As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”