© courtesy Addis Ababa Fistula Hospital
© courtesy Addis Ababa Fistula Hospital

The drive to eradicate polio has always been about more than polio alone. During polio vaccination campaigns in Ethiopia, polio frontline health workers and vaccinators are actively looking for women suffering from fistula.

Fistulas are devastating injuries sustained by women during prolonged and obstructed labour, requiring surgical intervention to rectify. Often the bladder is completely destroyed, or rectum and urethra significantly damaged. The longer that such injuries are left untreated, the more complex and serious they become.

In Ethiopia, the Addis Ababa Fistula Hospital and its regional fistula centres provides life-saving operations to women affected by fistula. One of the key challenges, however, is to identify women suffering from such injuries, particularly in remote or hard-to-reach areas.

That is why the polio programme in Ethiopia is now collaborating with the hospital in helping identify patients. As vaccinators and health workers travel town to town, village to village and house to house delivering polio vaccine, they actively engage with communities, community leaders and parents, to identify women suffering from fistula. As a result of this collaboration, more than 2,400 women have so far been identified with such injuries, particularly from remote areas, who can now be referred to the hospital for appropriate and urgently-needed intervention.

The polio network routinely conducts surveillance for other diseases of public health importance, including measles, yellow fever, neonatal tetanus and avian influenza. With local knowledge of communities, health systems and government structures, the polio network’s technical capacity in disease surveillance and planning of large-scale operations often helps sustain international and national relief efforts.

The extensive polio eradication network at country-level has proved itself repeatedly to be uniquely equipped to provide immediate support during emergencies or other disease outbreaks, for example providing frontline relief following the Nepal earthquake in 2015. Front line polio workers are equipped with vaccines, medications, potable water and sleeping bags, in addition to critical logistics support such as vehicles and radio and satellite equipment. The medical officers conducted the initial rapid assessment of the disaster and communicated their observations to the capital to allow effective relief planning. They also provided emergency medical care during the following days, setting up treatment camps and transporting patients, while planning and implementing mass vaccination campaigns against measles, polio and tetanus. Similar support was given during the Sahel drought in 2013 and the Horn of Africa drought in 2011-2012, and to the Ebola outbreak response effort across western Africa.

Polio-funded staff at country level spend, on average, 50% of their time working on broader public health efforts, over and beyond polio eradication. They provide a critical contribution to strengthening health systems. Ensuring that the infrastructure built up to eradicate polio continues to support essential polio functions and broader health services, even after the disease has been eradicated, is now one of the highest priorities for the programme. An extensive ‘transition planning’ process is underway at the country and global level that engages partners and governments to fully map the polio infrastructure, ensure that the key lessons and best practises of polio eradication are captured prior to programme closure, and essential polio functions are sustained through integration into other broader public health initiatives.

“We’re all immunized against polio!” UNICEF Africa

Six months after polio found its way back to the Horn of Africa, the pace of transmission appears to be slowing.

After several rounds of immunization campaigns, the number of cases being reported at the outbreak’s epicentre in Mogadishu, Somalia, has dropped off. At the same time, Kenya has not seen a case in more than four months and Ethiopia has contained the outbreak to the Somali region alone.

That may be little consolation, however, for the more than 200 children across the Horn of Africa whose lives have been changed forever by this devastating disease – and the outbreak is not completely finished yet. There’s no room for complacency with the high risk that polio will continue to spread.

“While we are pleased with the results achieved thus far, we must remain vigilant as there is still a risk that the virus could spread further, not only within the affected countries, but also cross borders into neighbouring countries,” said Steven Allen, UNICEF Regional Director for Eastern and Southern Africa. “Children in this region and elsewhere will not be safe from polio until we reach every unimmunized child.”

Across the Horn of Africa, close to one million children, most of them in Somalia, have never been immunized or have not received the required number of doses. Low immunization coverage was a key factor behind the outbreak, which was also fuelled by frequent population movement and areas of insecurity.

“WHO and UNICEF have supported countries in their response, working closely with health authorities as well as civil society groups to ensure children everywhere can be vaccinated,” said Hamid Jafari, Director, Polio Operations and Research, WHO.

With the outbreak slowing down, the affected countries are now moving into a new phase of polio outbreak response. The priority is to stop the residual transmission in South Central Somalia and in the Somali region of Ethiopia, reduce vulnerability by boosting immunity of populations and increasing immunization coverage, especially in hard-to-reach and inaccessible parts of the region.

In Somalia, in addition to immunization campaigns, strategies have been put in place to reach the most vulnerable children. Around areas affected by insecurity, 284 permanent vaccination posts have been set up at transit points, and vaccines are readily available in health facilities, so that children moving in or out will not miss out on the opportunity of immunization. In Ethiopia, 28 permanent vaccination points have also been set up in border-crossing and large transit points.

UNICEF and WHO require at least $88 million to support governments’ polio eradication efforts in 2014 and maintain the momentum built over the last six months.