17 July 2014 – The displacement of more than 900,000 people from North Waziristan in Pakistan’s Federally Administered Tribal Areas (FATA) increases the risk that polio will spread, as the virus travels with people as they move out to other parts of the country. Due to a ban on polio vaccination since June 2012, the area has suffered 55 of the country’s 94 cases in 2014.
However, this displacement also creates an important opportunity. For the first time in more than two years, vaccinators can reach large numbers of children who could not previously get vaccine.
Between 21 May and 15 July, 406,051 doses of oral polio vaccine were administered at vaccination points set up along major transit routes on the way out of North Waziristan. Emergency vaccination campaigns have also been held in surrounding areas, including weekly activities in parts of Khyber Pakhtunkhwa and FATA. This week’s campaign was reported to have reached almost 550,000 children.
Afghanistan is also doing its part to protect both the displaced and host communities against polio. More than 35,000 displaced children under the age of 10 are reported to have received a dose of oral polio vaccine as they entered the Afghan provinces of Paktyka and Khost
Islamic Advisory Group adopts urgent plan of action against polio
Jeddah, 27 Feb 2014 – The world’s leading Islamic scholars, led by the Grand Imam of the Holy Mosque of Mecca, today stated that protection against diseases is obligatory and admissible under Islamic Shariah, and that any actions which do not support these preventive measures and cause harm to humanity are un-Islamic. The scholars adopted a strong “Jeddah Declaration” and a focused six-month Plan of Action to address critical challenges facing polio eradication efforts in the few remaining polio-endemic parts of the Islamic world: a ban on vaccinations and lack of access to children in some areas, deadly attacks on health workers, and misconceptions by the community about mass vaccination campaigns.
During the first meeting of the Global Islamic Advisory Group (IAG) for polio eradication, religious leaders denounced violence against health workers involved in polio vaccination campaigns, noting that such violence caused lasting harm to children and communities. The remarks were made in the context of a growing climate of violence against health workers and facilities in situations of conflict and instability, such as in Pakistan, Somalia and Syria.
The scholars reiterated the safety and acceptability in Islam of vaccination against polio, saying it was a sin to claim the contrary and expose children to unnecessary risk. While most of the world – including the Muslim community of nations – is polio-free, the three countries which remain endemic for polio are largely Muslim: Pakistan, Nigeria and Afghanistan.
The scholars expressed alarm that failure to vaccinate and protect children in parts of these countries threatens the rest of the Muslim world. Poliovirus from Pakistan and Nigeria has caused paralytic outbreaks of polio in Syria and Somalia respectively. Both the latter countries have seen their health infrastructures collapse in conflict, leaving children unvaccinated and making outbreak response particularly challenging.
Representing various schools of Islamic scholarship and thought, the IAG was convened following a consultation of leading scholars in March 2013. The group is intended to bolster the support of the Islamic community and leadership to polio eradication and to communicate trust in the safety and effectiveness of vaccination.
The group adopted a six-month action plan with a focus on support to Pakistan and Somalia, which have the highest number of children paralyzed by polio. IAG members will advocate with national and local religious leaders on the religious duty of parents and communities to protect children and to allow health workers to carry out their duties in safety. The group also resolved to ensure that information on the safety of vaccination is easily available to relevant religious and community leaders and to advocate for financial and technical support for polio eradication with the Islamic donor community.
The IAG is co-chaired by the International Islamic Fiqh Academy and Al Azhar Al Sharif. The Jeddah-based Fiqh Academy and the Cairo-based Al Azhar Al Sharif, together with the Islamic Development Bank and Organization of Islamic Cooperation (OIC) are the major founding members of IAG. The group meets at the headquarters of the 57-member OIC in Jeddah, Saudi Arabia.
Female polio front-line workers hold the key to eradicating polio from Afghanistan. Able to speak woman to woman, they convince mothers to vaccinate their children. UNICEF/Afghanistan/2013/Agron Dragaj
KABUL, AFGHANISTAN, 19 November 2013 – Afghanistan’s Southern Region has today, for the first time ever, reached one full year without any reported cases of wild poliovirus, giving a boost to the country’s fight against the crippling disease. This milestone will encourage the polio effort in the Eastern Region, which continues to fight an outbreak of polio that has seen nine cases reported so far this year.
Kandahar and Helmand have long been identified as the epicentres of polio in Afghanistan and the Southern Region as one of the most persistent reservoirs of poliovirus globally. This unprecedented progress is a sign of the effectiveness of the polio eradication strategies and their implementation in the Southern Region. It is also a testament to frontline health workers, the commitment the of Government of Afghanistan, community representatives, partners and donor countries, and to the effective implementation of the National Emergency Action Plan’s innovative approaches to gain access to areas where children previously were not being reached with the oral polio vaccine.
The number of ‘inaccessible’ children dropped dramatically in 2012, but campaign quality is still a challenge in the Southern Region, according to the Polio Eradication Initiative Afghanistan’s latest annual report. The report also confirms that most of Afghanistan is seeing consistently high coverage during polio vaccination campaigns.
The report put together by Afghanistan’s Ministry of Public Health, in conjunction with the World Health Organization and UNICEF, highlights the progress achieved across the country but notes that coverage in the Southern Region requires further improvement.
The major challenges hindering efforts in the Southern Region – which includes Helmand and Kandahar, the country’s only remaining polio reservoirs – are stated as being gaps in management and accountability, followed by low community demand and insecurity. An analysis of the reasons for children missing out on the vaccine in the Southern Region found that 20% missed out due to insecurity but 80% were in accessible areas. Some of these children missed out because they were absent or sleeping, pointing to low community demand for vaccination, while others missed out for operational reasons, such as their house not being included in micro-plans.
Dealing with these challenges is a top priority in 2013, with a particular focus on building management capacity and accountability, engaging district and provincial governors to ensure local ownership and increasing coverage of the Immunization Communication Network (ICN).
Other facts of note:
Afghanistan finished 2012 with just 37 cases of wild poliovirus – down more than 50% on the previous year’s total – and the number of infected districts decreased from 34 in 2011 to 21.
There has not been a single case of wild poliovirus type 3 (WPV3) in the country in almost three years. The last case of WPV3 was reported back in April 2010.
Most of the country, except the Southern Region, has maintained high quality vaccination campaigns, reduced the proportion of zero-dose cases (children who have not received a single dose of vaccine) and improved routine immunization coverage.
Improvements were seen in the Southern Region in 2012, but campaign quality and routine immunization coverage continued to be less than expected and below the level required to stop circulation.
Insecurity took a backseat to other issues, as the number of inaccessible children dropped from 77,000 in June down to 15,000 in December 2012.
Vitamin A, deworming tablets and measles vaccines were all delivered alongside polio vaccination campaigns in 2012.
Innovations like the short interval additional dose strategy (SIADs) and Permanent Polio Teams (PPTs) were successfully implemented in low performing districts.
A new communications strategy, “Ending polio is my responsibility”, was rolled out to build community demand and instil a sense that Afghans from all walks of life have a role to play in ending polio.
Grand Imam of Al-Azhar receiving Muslim Scholars to discuss children rights to be protected by vaccination WHO/EMRO
Cairo, 7 March 2013 – The Grand Imam of Al-Azhar, Doctor Ahmad Al Tayyeb, today called for the protection of Muslim children against poliovirus transmission by ensuring they receive the required polio vaccine. He stressed the importance of increasing the awareness of the correct Islamic teachings on the subject to combat all deformed and false beliefs, and confirmed that Al-Azhar is ready to continue to exert all efforts to enlighten Muslim individuals and communities about the rights of children to be protected against polio and all other diseases and the obligation of all muslims to ensure that their children are protected. “Crippled children lead to a crippled Muslim Ummah” Dr Al-Tayyeb warned.
This was announced today at a meeting held at Al-Azhar during which the Grand Imam met with Muslim scholars from several countries. The scholars expressed their solidarity with the children of the Islamic world and reaffirmed their resolve to support the people, health workers and governments of the three countries where polio is not yet eradicated, namely Afghanistan, Nigeria and Pakistan.
The Global Polio Eradication Initiative, launched in 1988 by the health ministers of the Member States of the World Health Organization, has been successful in stopping the transmission of this crippling disease in all but these three countries of the world. Except for in Afghanistan, Nigeria and Pakistan, Muslim communities and countries everywhere have eradicated polio, including 54 out of 57 member states of the Organization of Islamic Cooperation (OIC) that have successfully interrupted transmission of wild poliovirus. This has been achieved through the application of proven eradication strategies, the administration of the safe oral polio vaccine and with financial and political support from the Islamic world.
Recognizing with grave concern the ongoing transmission of wild poliovirus in parts of Afghanistan, Nigeria and Pakistan, and the remaining political, cultural, societal and security challenges preventing all children in these areas from being vaccinated against polio, and in particular the tragic and deadly attacks against frontline health workers in parts of Pakistan and Nigeria in the past three months, Islamic scholars from several countries are meeting for two days in Cairo from 6–7 March to discuss the major obstacles preventing these countries from stopping polio transmission and trying to reach a consensus on how the Islamic leadership can help Muslim communities to overcome these barriers and ensure protection for all Muslim children.
President Karzai of Afghanistan, President Zardari of Pakistan, B. Gates, Gates Foundation, polio survivor R. Ferris, President Jonathan of Nigeria, W.J. Wilkinson, chair Rotary Foundation Trustees, and Dr M.Chan, Girector-General of WHOStuart Ramson/Insider Images
UNITED NATIONS, 27 September 2012 – In a display of solidarity, leaders from around the world today vowed to capitalize on progress achieved this year and to step up the fight to eradicate polio. Heads of state from Afghanistan, Nigeria and Pakistan stood alongside donor government officials and new donors from the public and private sector to outline what is needed to stamp out this disease forever: long-term commitment of resources, applying innovative best practices, and continued leadership and accountability at all levels of government in the endemic countries.
“This decisive moment is a matter of health and justice. Every child should have the right to start life with equal protection from this disease. That’s why I have made eradicating polio a top priority for my second term as Secretary-General,” said UN Secretary-General Ban Ki-moon.
Polio is a vaccine-preventable disease that is more than 99 percent eliminated from the world. Today, there are the fewest number of polio cases in the fewest districts in the fewest countries than at any time in history. In 1988, when the global fight against polio began, there were 125 countries where polio raged. Today, there are only three: Nigeria, Pakistan and Afghanistan. India, long-regarded as the nation facing the greatest challenges to eradication, has been polio-free for more than 18 months.
“The evidence is clear: if we all do our part, we can and will end this disease. But we must act quickly and give ourselves the very best chance to succeed,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation, one of the leading donors to the Global Polio Eradication Initiative (GPEI). “When we defeat polio, it will motivate us to aim for other great health and development milestones.”
Earlier this year, at the World Health Assembly, 194 member states declared the completion of polio eradication to be a “programmatic emergency for global public health.” In order to look beyond short-term challenges, however, GPEI is developing a long-term roadmap for ending polio. The strategy also will ensure that the legacy of investments in polio supports other vaccine-preventable disease goals.
“Failure to eradicate polio is unforgiveable, forever. Failure is not an option. No single one of us can bring this long, hard drive over the last hurdle. But together we can,” said Dr. Margaret Chan, Director-General of the World Health Organization.
Ending polio is an important early milestone in the Decade of Vaccines, a global vision and commitment to reach all children with the vaccines they need. A polio-free world also will lay the foundation for a better public health system that provides critical health services for children in the poorest and most inaccessible places.
“Together we can make history by eradicating polio – thanks mostly to the heroes in the field who risk their lives, every day, to deliver vaccines to children in some of the most dangerous parts of the world,” said Anthony Lake, UNICEF Executive Director.
The high-level event, “Our Commitment to the Next Generation: The Legacy of a Polio-free World,” featured opening remarks from UN Secretary-General Ban Ki-moon and was moderated by Senator Timothy E. Wirth, president of the UN Foundation.
Speakers included leaders of the three polio-endemic countries: President Hamid Karzai, Islamic Republic of Afghanistan; President Goodluck Jonathan, Federal Republic of Nigeria; and President Asif Ali Zardari, Islamic Republic of Pakistan. Earlier this year, these leaders launched national emergency plans to stop transmission of polio in their countries.
“Governments need to step up and honor their commitments to polio eradication if we are to achieve a polio-free world,” said Wilfrid J. Wilkinson, Chair of Rotary Foundation Trustees. “We must seize the advantage by acting immediately, or risk breaking our pledge to the world’s children.” Rotary International, which already has contributed US$1.2 billion to polio eradication, announced additional funding of $75 million over three years to GPEI.
Australian Prime Minister Julia Gillard reinforced Australia’s commitment and called on the Commonwealth to do its part. Last October, Australia committed $50M during the Commonwealth Heads of Government Meeting. Also speaking was Kathleen Sebelius, Secretary of Health and Human Services for the United States. The United States has been the leading donor to the GPEI and provides technical support through the US Centers for Disease Control & Prevention (CDC).
“We have been given the unique opportunity to end polio and provide a lasting legacy for the world’s children,” said Dr. Thomas Frieden, Director of the CDC. “Together we must strive to achieve this important global milestone.”
The Islamic Development Bank, a new donor to the polio eradication effort, announced a three-year $227 million financing package to Pakistan which will cover the majority of the country’s polio vaccination campaign costs. It also announced a $3 million grant for polio eradication activities in Afghanistan.
Additional leaders pledged new and continued commitment to polio eradication. These included:
H.E. Julian Fantino, Minister, International Cooperation, Canada, who announced an initiative to engage civil society to match funds to GPEI;
Rt. Hon. Alan Duncan, Minister of State, International Development, United Kingdom, whose government committed an additional £25M to polio eradication in 2012;
Mr. Sandro Rosell, President, Football Club Barcelona (FCB) and FCB Foundation, who announced the club’s engagement on the polio issue in collaboration with the Gates Foundation and Etisalat, the largest telecomm operator in the Middle East;
Ms. Aseefa Bhutto Zardari, Pakistan’s Goodwill Ambassador on Polio Eradication.
On 29 September, the Global Poverty Project, a campaign group aimed at ending extreme poverty, will host the Global Citizen Festival, a concert bringing together more than 60,000 people in New York’s Central Park with the aim of inspiring a global movement to voice support for eradicating polio and ending extreme poverty.
The Global Polio Eradication Initiative (GPEI), launched in 1988, is spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation.
Since its launch, the incidence of polio has been reduced by more than 99 percent. In 1988, more than 350,000 children were paralyzed each year in more than 125 endemic countries. In 2012, 145 new cases have been reported, and only three countries remain endemic: Nigeria, Pakistan and Afghanistan.
Bill & Melinda Gates Foundation: media@gatesfoundation.org, +1 206 709 3400
Rotary International: Petina Dixon-Jenkins. petina.dixon@rotary.org, +1 847 866 3054
UNICEF: Christian Moen. cmoen@unicef.org, +1 212 326 7516 or mobile +1 917 299 1041
US CDC: Alan Janssen. axj3@cdc.gov, +1 404 639 8517
WHO: Oliver Rosenbauer, Communications Officer, WHO, rosenbauero@who.int; +41 22 791 3832
In September, HE President Hamid Karzai officially signed the national polio eradication emergency action plan (2012–2013). WHO Afghanistan
In September, His Excellency, Mr Hamid Karzai, President of Afghanistan, officially signed the national polio eradication emergency action plan (2012–2013), in the presence of Her Excellency, Dr Suraya Dalil, Minister of Public Heath, and other main development partners supporting the joint efforts towards the polio eradication target.
H.E. President Karzai restated his personal commitment and leadership of a ‘whole of government and society approach’ to enhance eradication efforts, including the introduction of innovative mechanisms to secure access to children in areas of insecurity and increased oversight to strengthen the management and accountability of the national polio programme, particularly in the high-risk southern provinces.
President Karzai’s endorsement of the national plan coincided with the third nationwide immunization campaign being conducted in Afghanistan from 16–18 of September 2012.
India and Afghanistan team members swapping signed bats to support the eradication of polio from the region. UNICEF
18 September 2012 – Indian cricket sensations Virender Sehwag , Suresh Raina, Harbhajan Singh and Rohit Sharma, today met with Afghanistan captain Nowroz Mangal, and his Afghanistan team mates Mohammad Shahzad, Karim Sadeq and Mohammad Ashghar Stanikzai, to exchange cricket bats signed by both national Twenty20 teams. The bats were exchanged as symbols of both countries’ commitment to end polio once and for all. On the teams’ return to their home countries, UNICEF will present the bats to the Governments of Afghanistan and India to underline cricket’s support in the fight against polio. More
1 July 2012 – The progress of the polio eradication campaign in Afghanistan and Pakistan from 2006 to 2011 has come under focus in a recent journal article by scientists from Imperial College, London. Published in the Lancet, the study found that declines in vaccination coverage led to a rise in the number of new cases between 2006 and 2011. This decline in coverage was partially offset by the use of new monovalent and bivalent vaccines that have proven to be more effective against the main circulating strain of the virus.
The study found that vaccine coverage in southern Afghanistan and parts of Pakistan, including Balochistan and the Federally Administrated Tribal Areas (FATA), declined from 2006 through 2011. Dr Kath O’Reilly from the Medical Research Council (MRC) Centre for Outbreak Analysis and Modeling at Imperial College London, who led the study, commented: “The new (bivalent and monovalent) vaccines appear to be more effective than the trivalent vaccine, which offers encouragement that polio eradication is achievable. But the best vaccine in the world will not work unless it reaches the children it is intended to protect.”
In 2012 both countries are implementing national polio emergency action plans to reverse the trend of declining coverage. Efforts are focusing on addressing the underlying challenges which prevent all children being systematically reached with polio vaccine. The emergency plans focus on increasing technical support for worst performing areas; making district-level leadership more accountable; increasing the demand for immunisation through social mobilisation; identifying and reaching mobile populations and underserved groups; and sensitive planning for immunisation campaigns to more accurately map out where children live and how best to reach them.
Early indications from the first half of 2012 indicate that these activities are beginning to improve the situation, with 22 reported cases in Pakistan to date compared to 58 in the same period in 2011. It is anticipated that Imperial College will conduct a follow-on analysis in the second half of 2012 to more clearly determine the full impact of the national emergency action plans on vaccination coverage.
A female vaccinator in Kandahar enters a household to speak to the mother inside. UNICEF Afghanistan / K. Joshi
15 June, 2012 – This week marked one year since the world pledged US $4.3 billion to save 4 million lives by 2015 through vaccination. Assessing the progress achieved since this goal was set at its pledging conference last year, GAVI Alliance has released its report card, Delivering on the Promise: Year One. Among other things, this report highlights the fact that one in every five children continues to miss out on basic life-saving vaccines.
The global effort to eradicate polio is leading the way when it comes to reaching the seemingly unreachable – devising the tools and tactics necessary to get to the children who are beyond the reach of traditional health care services.
But if polio is to finally be eradicated, every last child must receive multiple doses of the vaccine. There are small pockets remaining where polio vaccinators haven’t been able to reach children. The Independent Monitoring Board for polio eradication calls these ‘polio sanctuaries’. What does it take to reach every last child? A new series of articles will attempt to answer this question and outline the strategies in place to make sure that no child misses out. This first article will look at reaching the last child in Afghanistan.
It would be easy to assume that children miss out on polio vaccine in Afghanistan because of insecurity. And traditionally, that has been the case.
Around 75% of Afghanistan’s polio cases over the past decade have been within 13 districts of the country’s troubled Southern Region – of which Helmand and Kandahar are a part.
However, insecurity is no longer the main reason why Afghan children miss out on polio vaccine. The good news is that during the polio vaccination campaigns held in March, less than 5% of all children in Southern Region were inaccessible, compared to 30% at the beginning of 2011.
The not-so-good news is that, even with this increased access, vaccination coverage has declined.
This suggests that there are much more mundane reasons for children not receiving the vaccine. Operational issues are now the biggest thorn in the side of Afghanistan’s efforts to eradicate the disease.
Data collected during polio vaccination campaigns has shown that 23% of unvaccinated children in the Southern Region miss out due to ‘social reasons’ – the progamme’s shorthand for reasons that are not related to operational weaknesses but are embedded in a community’s practices and beliefs.
In some of these communities, there are strong traditional beliefs around how and when to vaccinate a child – and so children who are sick, sleeping, or newly born are the ones who are most often excluded. Poorly-trained or supervised vaccinators cannot adequately address these concerns; women vaccinators – more easily accepted into the household – are not always easy to recruit.
Data also shows a major reason for children being missed was simply because their house wasn’t visited – suggesting a shortcoming in planning, vaccinator training and/or supervision.
As part of the global shift into emergency mode, the Afghan Government has already put together a new Emergency Action Plan to set out a strategy to stop the transmission of polio – including a greater focus on management and accountability. One of the steps is to establish new teams at a district level.
Another is stronger management capacity. At a management training held in Kabul on 19-23 of May, participants came up with a motto – “By changing yourself, you can change the world” – and a mission to extend their training to those at the district and sub-district level.
And while sending vaccination teams into conflict and general insecurity is not an option, that does not mean that these children are being abandoned. Instead, tactics have been developed to boost immunity whenever a lull in insecurity allows, such as ‘permanent polio teams’. Recruited from and living within community, these teams are able to pass through and vaccinate even when outsiders cannot enter an area.
The vast majority of this vast and rugged country is polio-free. Vaccinators have braved insecurity, myriad militant groups and harsh terrain to reach children in remote compounds where conservative beliefs hold sway. Less than 4% of Afghan children have never been vaccinated against polio.
The Afghan Government knows where the last children are – in those 13 districts of Southern Region – it’s just a matter of putting the appropriate plans in place and ensuring those responsible for vaccination campaigns are held accountable for the success or failure of their efforts.
But if 300,000 children are missing out on polio vaccine, you can be sure that many more are missing out on many other health interventions. Polio eradication is playing an important role in clearing a path for other health initiatives to follow – including the delivery of other vaccines. Reaching every last child with polio vaccine will not only result in the eradication of polio, but better health outcomes more broadly.
Stay tuned for the next part in the series, which will look at reaching the last child in Gadap, in the megacity of Karachi, Pakistan.
Rotary International President Kalyan Banerjee awards medal to Afghan President Hamid Karzai for his commitment to polio eradication
Rotary International President Kalyan Banerjee presenting the medal to Afghan President Hamid Karzai Rotary International
EVANSTON, Illinois, USA, April 4, 2012 – Rotary International President Kalyan Banerjee made history April 2 when he met with Afghan President Hamid Karzai in Kabul to encourage continued national support for the campaign to eradicate the crippling disease polio. He is the first Rotary president to visit Afghanistan.
Afghanistan is one of only three countries where the wild poliovirus has never been stopped. India, Banerjee’s home country, was removed from the polio-endemic list in February, and during their 45-minute meeting the two leaders discussed how lessons learned from India’s success might be applied in Afghanistan.
“I encouraged the president to keep up the intensity of the immunization program because, by doing so, you can stop polio as we did in India,” Banerjee said. “Once it stops, it stops. You don’t know when it will happen, or where the last polio case will be; but one day it will happen if you remain ever vigilant.”
Banerjee presented Karzai with a special Rotary medal recognizing the leader’s commitment to the Global Polio Eradication Initiative. Karzai vowed his government will continue to support the eradication program and said he personally would help encourage and educate the Afghan public on the importance of reaching all children with the oral polio vaccine. Afghan polio eradication workers are among the heroes of public health, often risking their lives to vaccinate children. On March 26, a polio supervisor was killed by an improvised explosive device while conducting his duties.
So far in 2012, Afghanistan has reported five new polio cases out of the 36 recorded globally. The country reported 80 cases in 2011. The other two endemic countries are Nigeria and neighboring Pakistan. Polio infections due to cross-border traffic between Afghanistan and Pakistan are a continuing problem, making bi-national cooperation essential. Pakistan has reported 15 cases so far this year.
In efforts to find new ways to reach children that live in areas plagued by insecurity, Afghanistan is preparing to send out Permanent Polio Vaccination Teams. These teams are formed by members of local communities and tasked with vaccinating every child under five living within their jurisdiction once every quarter. They will travel from house to house on an ongoing basis and will therefore be able to visit children whenever a lull in insecurity allows.
By their nature, the permanent teams will have the opportunity to build rapport with the communities within which they are working. The strategy is designed to work in tandem with other supplementary immunization activities and with routine immunization. Team members have already been recruited for two districts of Kandahar Province and three districts of Helmand Province (southern Afghanistan), while recruitment for two districts in Farah Province in the west is currently under way. If the strategy is successful, it may be replicated in other areas facing similar challenges.
By their nature, the permanent teams will have the opportunity to build rapport with the communities within which they are working. The strategy is designed to work in tandem with other supplementary immunization activities and with routine immunization. Team members have already been recruited for two districts of Kandahar Province and three districts of Helmand Province (southern Afghanistan), while recruitment for two districts in Farah Province in the west is currently under way. If the strategy is successful, it may be replicated in other areas facing similar challenges.
Ministry of Public Health, WHO and UNICEF working to reach all underimmunized children wherever they live, priority outreach is being directed to Southern Region.
A vaccinator heads out to immunize children, carrying polio vaccine on his shoulder. WHO/J-M Giboux
Afghanistan’s Ministry of Public Health (MoPH), with the support of World Health Organization (WHO) and UNICEF, is intensifying efforts to wipe out polio from the country by the end of 2012.
From 17 through 19 September, more than 55,000 medical staff and volunteers across the country went door-to-door to give two drops of oral polio vaccine (OPV) to 7.8 million children as part of the latest National Immunization Days (NIDs).
The move comes at a critical time in Afghanistan’s polio eradication effort. Although indigenous transmission is primarily restricted to key high-risk districts of Southern Region, Afghanistan has seen an increase in new cases over the past months. A total of 36 cases have now been reported in 2011, compared to 18 cases for the same period in 2010, all primarily from Southern Region.
And while the MoPH, WHO and UNICEF are working to engage all sectors of the government and society to ensure that service providers have access to all underimmunized children wherever they live in Afghanistan, priority outreach is being directed to Southern Region. “In 2009, there was no access to children for nearly a year in Marja district, Helmand province, because of ongoing military operations,” said Dr Arshad Quddus, head of WHO’s polio programme in Afghanistan. Humanitarian access in Afghanistan overall has shrunk in the past several years, according to the UN Office for the Coordination of Humanitarian Aid (OCHA). UN Secretary-General Ban Ki-moon dedicated his Rotary Polio Eradication Champion Award in 2009 to three polio staff killed in September 2008 while monitoring the UN polio campaign in Spin Boldak district of Kandahar.
To secure greater access to some communities, the UN negotiates with local leaders, such as tribal elders and teachers, and enlists local volunteers who are trained and monitored by health supervisors. The UN also relies on a “window of opportunity” strategy where children who live in areas that are only accessible for a short period of time, are reached through specially arranged and focused campaigns to deliver an additional OPV dose, an approach known as the Short Interval Additional Dose (SIAD) approach.
The success of the Global Polio Eradication Initiative is in large part due to the neutrality of the polio vaccination programme. “The programme is neutral. Irrespective of tribal or political affiliation, all children are vaccinated,” said UNICEF’s senior polio worker, Carmen Garrigos.
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Polio eradication was a hot topic at the 38th Session of the Council of Foreign Ministers of the newly renamed Organisation of Islamic Cooperation (OIC – formerly known as the Organisation of Islamic Conferences).
A resolution resulting from the session urges, among other things, that “the member states affected by polio, AIDS, tuberculosis and malaria … undertake necessary steps to fight these dangerous communicable diseases and requests the potential donors to give generously to the GPEI [Global Polio Eradication Initiative] and the Global Fund”.
The resolution also recognizes the ongoing efforts by Afghanistan, Nigeria and Pakistan to eradicate polio, reminds the other member states to ensure their children are immunized against the virus, and requests that the Islamic Development Bank consider funding polio vaccine for Afghanistan.
As part of efforts to prepare for the polio post-eradication era, the World Health Organization (WHO) and its partners have facilitated the development and transfer of new polio vaccine technology to vaccine production facilities in India and the Republic of Korea.
In collaboration with the Netherlands Vaccine Institute (NVI), and more recently the National Institute for Public Health and the Environment (RIVM) in the Netherlands, clinical lots of inactivated polio vaccine (IPV) produced from Sabin poliovirus seed-strains have been prepared. Traditional IPV is manufactured using wild poliovirus and an inadvertent biocontainment failure could be associated with serious consequences in some areas of the world in the post-eradication era (ie areas with high population density, inadequate sanitation infrastructure and low population immunity levels). Sabin seed strains for IPV have the advantage over wild polioviruses that they are attenuated, and hence are safer for handling and IPV production in developing country settings in the post-eradication era.
In this first phase of a broader intended technology transfer programme, two manufacturers have been selected to receive this new technology for vaccine production: Panacea Biotech, Ltd in India, and LG Life Sciences, Ltd in the Republic of Korea. Both manufacturers have confirmed their intention to use all reasonable efforts to apply for registration of their Sabin IPV products in the country of production within four years from the dates of conclusions of the bilateral agreement with RIVM. WHO and RIVM will continue the technology transfer programme this year with further manufacturers.
This transfer of technology is a significant milestone in preparations for the polio post-eradication era. Following the eradication of wild poliovirus globally, use of all oral polio vaccine (OPV) in routine immunization programmes will need to be stopped due to the risks associated with the continued administration, in the post-eradication era, of the live (attenuated, but not inactivated) polioviruses contained in OPV. These risks include vaccine-associated paralytic polio and the generation of new, circulating vaccine-derived polioviruses. Therefore, after the eradication of all wild polioviruses, and the eventual cessation of OPV for use in routine immunization programmes, any country choosing to continue to immunize its population against polio will need to do so with IPV, the only option which will be available to do so at that time.
Recognizing that the manufacturing costs and price of IPV are currently substantially higher than that for OPV, the Global Polio Eradication Initiative (GPEI) is studying a range of approaches to establish affordable strategies for IPV use in low-income settings following OPV cessation. The development, manufacture and distribution of a safe, effective and affordable Sabin IPV that can be produced securely in developing country settings is a key landmark in this programme of work. This technology transfer will also help to boost more broadly the domestic production capacity for vaccines and the strengthening public of health systems to ensure more equitable access to vaccines.
The development of Sabin IPV and the related technology transfer work has been generously supported by the Bill & Melinda Gates Foundation.
The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99%. In 1988, more than 350,000 children were paralysed each year in more than 125 endemic countries. In 2010, 1,291 cases were reported worldwide, from 20 countries. Only four countries remain endemic: Afghanistan, India, Nigeria and Pakistan.
The Crown Prince of Abu Dhabi joins the Bill & Melinda Gates Foundation to purchase and deliver polio vaccines for Afghan and Pakistani children and protect them from paralysis.
His Highness Sheikh Mohammed bin Zayed Al Nahyan and Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, announced today they are working together to provide life-saving vaccinations to children in Afghanistan and Pakistan. The partnership commits a total of US$100 million – US$50 million from each partner – for the purchase and delivery of vital vaccines that will save Afghan and Pakistani children and prevent disease for a lifetime.
Of the total funds, two-thirds will be given to the GAVI Alliance for the purchase and delivery of the pentavalent vaccine and for the introduction of the new pneumococcal vaccine in Afghanistan. The remaining US$34 million of the allocated funds will be directed to the World Health Organization and UNICEF to deliver polio vaccines in Afghanistan and Pakistan. Although worldwide polio has been reduced by 99 percent during the past 20 years, Afghanistan and Pakistan are two of only four countries where polio transmission has never been stopped. To date, there has been a cycle of re-infection of this crippling disease between the populations of the two countries.
The partnership will help polio eradication workers reach approximately 35 million children in Afghanistan and Pakistan with oral polio vaccines.
A child is immunized in Jalalabad, eastern Afghanistan on a memorable day for polio eradication: 16 December 2009, the first day the groundbreaking bivalent oral polio vaccine was ever used. Cornelia Walther/UNICEF
A head to head trial against current poliovirus vaccines has found that the new bivalent oral vaccine against poliovirus, which targets both the remaining types of poliovirus concurrently, induces a stronger immune response than the traditional trivalent vaccine and a similar immune response to the latest monovalent (monovalent type 1 or monovalent type 3) vaccines. Furthermore, it is easier to administer, allowing children to be immunised against the two remaining types of wild poliovirus in a single oral dose. These are the conclusions of an Article published Online First in The Lancet.
September 2010 / Kabul, Afghanistan – In a region that has been polio-free for nearly a decade, a new polio case has been detected in the Imam Sahib district of the north-eastern Afghan province of Kunduz bordering Tajikistan. The case was quickly identified, thanks to the well-functioning Acute Flaccid Paralysis (AFP) surveillance system.
The initial assumption was that source of the virus might have been neighbouring Tajikistan, which is currently experiencing a large polio outbreak, but it now seems that it might have the result of cross-border population movement from neighbouring Pakistan.
The Ministry of Public Health has launched a rapid response plan to prevent further circulation and spread of the virus. From 5-7 September, 1.5 million children under five years of age are being vaccinated in 5 adjacent provinces, namely Badakahshan, Takhar, Kunduz, Baghlan and Balkh.
To guarantee that no child is left unvaccinated, a four-pronged approach will be taken: carrying out house-to-house visits; setting up mobile clinics; establishing fixed teams in hospitals and setting up immunization posts at border crossing points.
“In addition to next week’s campaign, surveillance will be further enhanced in the area,” said Peter Graaff, WHO Representative to Afghanistan. “We will also need to have ever-stronger cross-border coordination mechanisms, which include synchronising vaccination activities, data sharing and joint supervision, building on what already exists between Afghanistan and Pakistan.”
Already in early June, 1.2 million children aged under 5 years were vaccinated against polio in the north-eastern region at the onset of the outbreak in Tajikistan.
“Afghanistan’s northern regions have been polio-free for some 10 years, making it all the more important to contain possible spill-over effects from outbreaks in neighbouring areas,” said Peter Crowley, UNICEF Representative to Afghanistan.
Polio is a highly infectious and sometimes fatal disease and is often marked by acute flaccid paralysis among sufferers. It has been eradicated from much of the world, but remains endemic in Afghanistan, Pakistan, India and Nigeria, where major eradication efforts are still ongoing. The Global Polio Eradication Initiative is spearheaded by national governments, WHO, Rotary International, US CDC and UNICEF.
Every year, the Ministry of Public Health of Afghanistan and its partners conduct at least 4 nationwide campaigns and 4 sub-national campaigns in Afghanistan’s populated southern, south-eastern and eastern regions. During each nationwide campaign, approximately 8 million children aged under 5 years are targeted across the country.
As a result of a large wild poliovirus outbreak in neighboring Tajikistan, Afghanistan has moved to safeguard children in its northern border regions through large-scale immunization campaigns.
UNICEF Afghanistan Communication Specialist Cornelia Walther travelled to Afghanistan’s northern border regions to attend the June immunization activity and file this report. See her photo essay (pdf).
With partnership and peace, polio can be eradicated in Afghanistan – Cornelia Walther/UNICEF
For the past three days, 19 000 health workers travelled from house-to-house in 14 provinces to reach 2.8 million children under 5 years of age in southern, south-eastern, western and eastern Afghanistan. The immunization drive is part of an ongoing effort to eradicate polio in Afghanistan, which is together with Pakistan, India and Nigeria the only country still affected by the disease.
“The eradication of polio in Afghanistan is tantalizing close, and yet we are still so far away;” said Peter Graaff, WHO Representative in Afghanistan at the campaign’s launch in Jalalabad. “I hope that 2010 will be a major step towards a polio-free Afghanistan.”
Three-and-a-half million doses of bivalent oral polio vaccine were required for this campaign, which is supported by UNICEF, WHO and other long-term partners, such as Rotary International and the Centers for Disease Control (CDC), Atlanta. “The progress that has been achieved so far was possible only thanks to the strong partnership that we have built over the past years,” emphasized Ms Catherine Mbengue, UNICEF Representative.
In 2009, six rounds of national immunization days (NIDS) reaching almost 7.5 million children took place. Four rounds of subnational campaigns (SNID) were conducted in areas where polio cases have been recorded, in order to stop the virus and prevent the disease from spreading to other parts of the country and across the border to Pakistan. Six rounds of NID and four rounds of SNID are planned this year.
Yet, despite ongoing efforts, circulation of the polio virus continues. Thirty-eight cases have been reported in 2009, seven more than the year before. Lack of community awareness and inadequate health infrastructure are among the major concerns. Population movement from polio-free areas to polio-endemic locations and vice-versa are another concern, especially along the border between Afghanistan and Pakistan. With the support of Rotary International, vaccination checkpoints have been set up at both sides of the border to make sure that children crossing into the respective countries are being vaccinated.
The first and foremost concern is insecurity. As access of vaccination teams to children living in conflict-affected areas is limited, an average of 100 000 children cannot be reached through either vaccination campaigns or routine immunization efforts.
“We should not forget that health is neutral. The right to vaccination is not being denied by anybody. Please do not only allow the immunization campaign to take place, but facilitate access for the vaccinators to your children;” pleaded Mr Graaff.
Ms Mbengue concluded the launching event with words of hope: “We can eradicate polio, with partnership and peace. Our efforts mean progress for the children of Afghanistan, Pakistan and worldwide – today and tomorrow.”
Photo and story from Cornelia Walther, UNICEF Afghanistan
Under-fives in Nad Ali District are missing out on polio immunization due to an ongoing military operation
Many children are missing out on polio immunization due to ongoing military operations WHO/Afghanistan
Under-five children in Nad Ali District, Helmand Province, southern Afghanistan, are missing out on polio immunization due to an ongoing military operation against the Taliban by Afghan and NATO forces.
A three-day sub-national polio immunization campaign, targeting 2.8 million children began on 14 February in the south, southeast, west and east of the country, the Ministry of Public Health said.
Of the 500,000 children targeted for polio immunization in Helmand, about 170,000 were not accessed on 14 February – mostly in Nad Ali, Musa Qala and Sangeen districts – Tahir Pervaiz Mir, polio eradication officer for the World Health Organization (WHO) in Afghanistan, told IRIN.
“Polio immunization would not be conducted in Nad Ali and Marjah due to the ongoing conflict there,” Enayatullah Ghafari, provincial director of the health department, told IRIN.
Poliovirus is believed to be virulent in Nad Ali: Two polio cases have been confirmed there this year, according to the UN. “We are concerned about the transmission of poliovirus from Nad Ali District,” said Mir.
Health workers say they were able to reach children in Taliban-controlled areas in Helmand and elsewhere in the country during several polio immunization campaigns in 2009. Taliban leaders reportedly issued a “support letter” for each polio immunization round through the International Committee of the Red Cross.
Provincial health officials said efforts were under way to regain access to children in Musa Qala and Sangeen districts for the current immunization drive. “[The Taliban] have given us a green light and we hope to be able to immunize children in the two districts soon,” said Ghafari.
About 15,000 Afghan and foreign forces are fighting Taliban insurgents in Marjah and Nad Ali in what has been described as NATO’s biggest military operation in Afghanistan since the Taliban were ousted in late 2001.
WHO says about 84 percent of Afghanistan is polio-free but the disease remains virulent in 13 insecure districts in the south and southeast, where health workers have little or no access, and where most of the 38 polio cases in 2009 were reported. Four polio cases, three in Helmand and one in the neighbouring province of Farah, have been reported so far in 2010, according to WHO.
Courtesy IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs.
Message on British Houses of Parliament to celebrate 103 years of Rotary
The Rotary wheel logo and the “End Polio Now” message is beamed onto the Houses of Parliament, UK Rich Hendry, courtesy of Rotary International
A giant Rotary wheel – the organization’s logo – and the words “End Polio Now” were beamed onto the side of the House of Commons to the left of Big Ben on Rotary International’s 103rd Birthday on Saturday, 23rd February – to start a challenge to raise US$ 100 million to help finally eradicate polio from the world.
Polio eradication has been Rotary’s top priority since 1985, inspiring the launch of the Global Polio Eradication Initiative, a partnership which has cut the number of polio cases by 99 per cent since then. The disease is now only endemic in four countries: India, Pakistan, Afghanistan and Nigeria. Recently, the Bill and Melinda Gates Foundation gave Rotary a US$ 100 million challenge grant, which Rotary will match over the next three years.
The BBC aired images of the display, along with interviews with DG Colin Mathews and Gautam Lewis, a 30-year-old polio-survivor who immunized children on behalf of Rotary in his birthplace of India in November 2007. More
