Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO
Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO

Contracting the infectious virus at 11 months of age, few believed Soni would ever be able to work. Today, she’s a nominee for one of Pakistan’s most prestigious awards.

Soni started out in the programme in 1999, initially as a vaccinator. Now a mother of three children, these days, Soni works with the programme as a social mobilizer. Her role includes dispelling people’s misconceptions about the vaccine and engaging with parents about the importance of vaccinating their children.

When Soni received a notification from the Government of Pakistan that she had been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work, she didn’t quite know how she felt. “I’m not really interested in accolades, but my son and my husband were very excited” she said.

Soni says her work with the polio eradication programme has given her life meaning and purpose. “People would look at my leg and say, ‘How will she work?! She can’t work. But when I started working, then everyone could see, ‘yes, yes she can’,” she says.

“The polio programme has given me so much confidence. After I started working in polio, I had the confidence of meeting new people. Meeting family, going to weddings, all of it became easier. Before that, I had no confidence to even step out of the house,” she continues.

Soni recalls how hesitant her father was when she first told him she wanted to join the programme. “He was concerned I won’t be able to manage because of my health, but he understood very soon that this was something I just had to do. He told my mother ‘let her do it’.”

During her early training as a vaccinator, Soni recalls the words of one of her trainers – ‘If you can save one child from polio, then you would have served the purpose of your life’. “I knew, then, this was it, “she says. “This is what I had to do.”

The year Soni was diagnosed with polio – 1984 – nearly 200 other children in her neighbourhood of Liaquatabad in Karachi were also diagnosed with the virus. At the time, there were no door-to-door campaigns and children could only be vaccinated at health centres.

Today, Pakistan and Afghanistan are the last two countries in the world where wild poliovirus is endemic. In 2021, only one child was paralyzed by the virus in Pakistan and four in neighbouring Afghanistan. In 2020, a total of 84 cases were reported in Pakistan and 56 in Afghanistan.

The eldest of six siblings, Soni came from a very conservative family, where her grandmother would not let children leave the house. “In our family, all the children were born at home because the women were not allowed to leave the house, and so I was never taken to a health centre for vaccination.”

“My father always lived with the regret of not vaccinating his daughter,” she says. “Often parents make these decisions, and it is the child who has to suffer for all their life.”

Both Soni’s parents tried everything they could to heal her condition – visiting different doctors, acupuncture specialists, and anyone they could find who might offer any assurances. She also went through a very extensive operation, with steel bolts put in her leg resulting in excruciating pain that lasted for months.

“No matter what you do, whatever you try, there is no cure for polio,” she says. “I wanted to study sciences, and my teacher didn’t allow me to because she would say how will you stand in labs all day. I would go to college and one of the women in the bus would see me and say ‘Look at her, such a beautiful girl and look at what happened to her foot’.”

Soni says that when she is working on campaigns and some people see her, they immediately want to vaccinate their children, while others question why she is telling them to vaccinate while having polio herself.

“To them I say, I am here because I know exactly how hard it is if you are not vaccinated.”

In December:

  • No case of WPV1 was confirmed
  • 43.5 million children were vaccinated during the December NID.
  • 0.9 million children were vaccinated at 73 Permanent Transit Points

Downloads

In November:

  • No case of WPV1 was confirmed
  • 35 million children were vaccinated during the MR Campaign in November 2021.
  • 1 million children were vaccinated at 73 Permanent Transit Points

Downloads

Vaccination team crossing river in West Garo Hills of Meghalaya. ©WHO

With the ongoing COVID-19 pandemic, continued wild polio transmission in the remaining endemic countries and spreading outbreaks of circulating vaccine-derived polioviruses type 2 (cVDPV2), this year began with many challenges facing polio eradication efforts. But amid this new reality, countries and partners of the Global Polio Eradication Initiative (GPEI) intensified their efforts to protect children from lifelong paralysis.

In June, the GPEI launched the new GPEI Strategy 2022-2026, which lays out the roadmap to achieving a lasting world free of all forms of polioviruses through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies. These new tools include the novel oral polio vaccine type 2 (nOPV2), which began deployment under Emergency Use Listing (EUL) as part of the GPEI’s broader polio vaccine repository to curb cVDPV2 transmission. In August, the WHO African Region celebrated one year since it was certified wild polio-free, and countries recommitted to strong cVDPV2 outbreak response across the continent with the support of the GPEI.

Further critical progress took place in Afghanistan – one of two final countries endemic for wild poliovirus, along with Pakistan. For the first time in more than three years, nationwide polio immunization campaigns resumed across Afghanistan reaching 8.5 million children, including 2.4 million children who were previously inaccessible.

At the same time, polio programme health workers at the forefront continued to support global COVID-19 response efforts by delivering vaccines, mobilizing communities, and countering misinformation among other activities. The use of GPEI infrastructure for health emergency response has provided critical lessons for integrating polio resources into broader health systems as more countries work towards transition and the post-certification period.

Containment area monitoring in India. ©WHO

Following dire predictions issued at the end of 2020, the polio programme once again proved its ability to adapt to programmatic, epidemiological and political developments. Entering 2022, there is much cause for cautious optimism – wild poliovirus transmission has slowed drastically, and cases of cVDPV2 have also declined compared to last year.

Importantly, commitment to achieving a lasting polio-free world is evident at all levels: by core GPEI partners, including among the Polio Oversight Board, which travelled to Pakistan twice in 2021; by health workers, communities and parents; and by country leaders worldwide who helped champion this year’s milestones. With the new strategy, new tools and adapted approaches, the stage is set to achieve lasting success.

To stop all forms of polio for good, the GPEI aims to capitalize on the positive epidemiological situation leading into 2022. A key opportunity to kick-start the year will be the WHO Executive Board meeting in January, where Member States plan to discuss building on the successes of this past year by fully implementing and financing the programme’s new strategy. Rotary and other key global GPEI partners are planning a renewed and intensified outreach across the broader international development community to secure the necessary financial resources to achieve success. Polio immunization campaigns will also continue in full force in both endemic and outbreak countries.

Twelve months ago, the programme was in a much different place, as WHO and UNICEF launched an Emergency Call to Action to draw attention to the need for renewed commitment. A year later, thanks to a strengthened and unified response, the GPEI is meeting the moment and is more committed than ever to end all forms of poliovirus, once and for all.

WHO Regional Director, Dr Ahmed Al-Mandhari, observes polio vaccination in Karachi. ©WHO EMRO

In November, George Laryea-Adjei (Regional Director for South Asia, UNICEF) and Dr Ahmed Al-Mandhari ( WHO Regional Director for the Eastern Mediterranean ) joined fellow GPEI leaders on a visit to Pakistan. The regional directors met with government stakeholders and health workers, and commended Pakistan on its impressive progress interrupting poliovirus transmission. See why the regional directors emphasized that there is no room for complacency on the path to a polio-free Pakistan.  For more information please visit WHO Regional Office for the Eastern Mediterranean and UNICEF websites.

 

In October:

  • No case of WPV1 was confirmed
  • 3.53 million children were vaccinated during October 2021 in KP outbreak response.
  • 0.6 million children were vaccinated at 73 Permanent Transit Points

Downloads

 

In September:

  • No case of WPV1 was confirmed
  • 41.5 million children were vaccinated during NIDs.
  • 0.8 million children were vaccinated at 72 Permanent Transit Points

Downloads

 

In August:

  • No case of WPV1 was confirmed
  • 23.4 million children were vaccinated during sNIDs.
  • 1 million children were vaccinated at 121 Permanent Transit Points

Downloads

The funding will be used to vaccinate approximately 16 million children in 84 highest-risk districts. © UAE

The United Arab Emirates (UAE) on July 24 announced an additional US$9.5 million support to the Pakistan Polio Eradication Initiative (PEI). The funding will be used to vaccinate approximately 16 million children during door-to-door immunization campaigns in 84 highest-risk districts as well as an additional US$376,000 to provide personal protective equipment against COVID-19 for the frontline campaign workers.

The funding, which will be utilized from July to December, brings to more than US$23 million made available by the UAE in 2021. The Emirates, a long-time supporter of Pakistan’s polio programme and its main funder, has provided over US$200 million in financial support since 2014. Pakistan is one of two countries where wild poliovirus remains endemic.

Speaking on behalf of the Global Polio Eradication Initiative, Dr Palitha Mahipala, the World Health Organization Representative in Pakistan, thanked the UAE for its generous contribution, noting the UAE’s steadfast commitment not only to protecting children from lifelong paralysis but to the overall goal of polio eradication.

“The UAE has firmly stood by the polio programme with vital yearly contributions and in pleas for extra funding to address unforeseen challenges such as COVID-19,” he said. “This would not be possible without their support.”

Only one case of wild poliovirus has been reported in Pakistan in the first six months of the year, a significant decrease from the 59 cases reported during the same period in 2020. In order to be certified polio-free, Pakistan is required to report zero cases of wild poliovirus over a three-year period. The Government of Pakistan remains fully committed to reaching the goal of zero in the coming months.

The Emirates Polio Campaign plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. © UAE

Through the Emirates Polio Campaign initiative, the UAE Pakistan Assistance Programme (UAE-PAP) plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. In 2020, as part of the Emirates Polio Campaign, UAE-PAP support ensured close to 16 million children under five years of age received protection through repeated polio campaigns and all frontline workers in 84 districts received personal protective equipment and training to facilitate protection from COVID-19.

“The efforts and sacrifices of the field vaccination teams, who faced difficult field conditions and dangerous challenges, greatly contribute to the success of the campaigns and reducing the spread of poliovirus in the Islamic Republic of Pakistan,” said Mr. Abdullah Alghfeli, Director of the UAE-PAP.

Mr. Abdullah praised the humanitarian approach and the generous support of His Highness Sheikh Mohamed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, adding that His Highness’s humanitarian initiative to eradicate polio is a major factor contributing to the elimination of the disease.

Dr Shahzad Baig, National Coordinator of the National Emergency Operations Centre (NEOC) for polio eradication warmly welcomed the contribution as an important boost in ensuring the programme continued door-to-door polio campaigns, the most effective way of immunizing against the virus, and ending polio in Pakistan.

“We are getting closer to our goal but this is not the time to be complacent,” he warned. “We are re-doubling our efforts to ensure the gains of the past don’t slip away.”

Zubaida Bibi leads a team in Khyber Pakhtunkhwa province in the country’s north. © WHO/EMRO

Health interventions and immunization activities are most effective when delivered by women.  During each nationwide polio vaccination campaign in Pakistan, women make up around 62 percent of the 280, 000+ frontline workforce vaccinating millions of children across the country.

With each campaign depending on the dedication of staff to reach all children, given their trusted roles and responsibilities in communities, female polio frontline workers are playing a key role in eradicating polio.

Breaking barriers to immunization

After three years as a monitor of campaign activities, Zubaida Bibi has progressed from being a polio team member to a team leader in Khyber Pakhtunkhwa province in the country’s north, one of the most affected areas in Pakistan.

Breaking the gender-related barriers to immunization, Zubaida travels extensively including hard-to-reach areas. Not even the winter season, when the roads and tracks are covered with snow, deters Zubaida.

“I would always tell them that the polio vaccine is totally safe for their children,” says Shumaila Majeed at work in Lahore. © Hassan Raza

“It leaves us with no option but to travel for miles and hours on foot to reach the children,” she says “Despite the challenges, I always try and motivate my teams, telling them that we are on a national mission to save the future of our children,” she says.

“It gives me a feeling of gratitude and satisfaction when the community appreciates our efforts for improving the health of their children,” adds Zubaida.

Building trust

For nine years, Shumaila Majeed has worked as a community-based health worker in Lahore, with a firm belief in empowering women and supporting their important presence in the polio programme.

Mothers would frequently ask her about the safety of the polio vaccine. “I would always tell them that the polio vaccine is totally safe for their children and build their trust,” says Shumaila.

“It’s very important to have women in every walk of life,” she explains. “Not only because women and grandmothers feel more comfortable when their children are vaccinated but to give more opportunities for woman to grow and excel.”

Through her work Shumaila wants to give young girls a message: stay focused on their goals and leave no stone unturned to make their dreams come true.

Persuading parents

In Pakistan, a significant number of parents and caregivers still doubt the effectiveness of vaccines. Karachi has long been a core reservoir for the poliovirus, with continuous and intense circulation.

Shagufta Naz, a community-based health worker in charge of Gulshan town, has been working for 21 years to ensure all children in her area are vaccinated on time. “Initially, parents used to hide their children from us due to their fear,” she explains.

Shagufta Naz is a trusted source of information about polio for her community in Karachi. © WHO/EMRO

Everyone who works with Shagufta is immediately impressed by her great care, her attention to detail and her meticulous record-keeping which is key to achieving vaccination targets. As a result of Shagufta’s hard work, vaccine refusals have reduced significantly. Her work is now so highly regarded that some parents will only have their children vaccinated by Shagufta, asking for her by name with each polio campaign.

“I got to know the community very well, built their trust,” she explains. “I know every pregnant woman and can tell you when she is due. Now, mothers regularly ask me about the next vaccination campaign.”

Going against all odds

Gul Parana, a Tehsil Communication Officer for the polio eradication programme in Balochistan province in the country’s southwest, recently graduated with a master’s degree.

Assigned to raise awareness about the benefits of vaccination in Chaman District, one of the most challenging areas for the polio programme, she is proud of her work despite many challenges.

Gul Parana raises awareness about the benefits of vaccination in remote Chaman District in Balochistan province. © WHO/EMRO

“Since Chaman is a very remote and conservative area, it’s not easy for a young girl like me to go out of the house. Most of my friends are not allowed to work. But I have a mission to save our children and give them a healthy future,” she says.

With support of her family, Gul Parana has become a symbol of strength for the girls of her locality. “I want to inspire other girls so they can also get an education and work. We need to have equal opportunities for every girl in Balochistan,” she adds.

In April:

  • No case of WPV1 was confirmed
  • 2,500,000 children were vaccinated during the April National Immunization Days (NIDs) in Balochistan
  • 800,000 children were vaccinated 126 Permanent Transit Points

Download

The Executive Board Room at WHO Headquarters during the 74th World Health Assembly. © WHO

Meeting virtually this week at the 74th World Health Assembly (WHA), global health leaders and ministers of health noted the new Global Polio Eradication Initiative Strategic Plan 2022-2026 and highlighted the importance of collective action to achieve success.

Member States emphasised the urgency of implementation of the strategic plan and urged the WHO Secretariat and Member States to build on recent advances to keep surveillance high, ensure sustained, improved coverage in campaigns and respond rapidly to outbreaks. Several Members States welcomed the establishment of a new EMRO Ministerial Regional Subcommittee on Polio Eradication and Outbreaks, and roll-out of the novel oral polio vaccine type 2 (nOPV2) to more effectively and sustainably address outbreaks of circulating vaccine-derived polioviruses (cVDPVs). The Minister of Health of Egypt, Dr Hala Zaid, as a Co-Chair of the Regional Sub-Committee said: “The Regional Subcommittee offers a new, ministerial-level channel to galvanize political support, leverage funding, particularly domestic funding, and raise the profile of polio as a Public Health Emergency of International Concern. Its establishment reflects the firm commitment of the Eastern Mediterranean Region to do whatever it takes to stamp out poliovirus transmission and achieve eradication.”

Dr Ahmed Al-Mandhari, the Regional Director for the Eastern Mediterranean, addressed the delegates and noted a year of hard work across the Region. He emphasised the critical step of establishing the ministerial Sub-Committee to ensure more coordinated support for the remaining wild poliovirus-endemic and polio outbreak-affected countries in the Region. Speaking of the new vaccine, Dr Al-Mandhari said, “We are also at the dawn of what we hope will be a new era in responding to VDPV type-2 outbreaks, with an improved vaccine, the novel oral poliovirus type 2, approved for Emergency Use Listing and soon to be used in the Region.”

Member States noted support for local community, progress on closing outbreaks and welcomed efforts to unite with other initiatives to close gaps in immunization.  The WHA paid tribute to female frontline workers and highlighted their role in building community relationships. Amid the new COVID-19 reality, the WHA also expressed deep appreciation for the GPEI’s ongoing support to COVID-19 response. WHO’s Deputy Director-General, Dr Zsuzsanna Jakab, highlighted the value of the polio infrastructure in addressing public health emergences, noting that the polio network has been the first in line of defence for COVID-19 response in many countries, and now providing valuable support to the rollout of Covid-19 vaccines. “It is our chance to retain the polio knowledge and expertise to build back stronger and more robust health systems. If we don’t act now, we will lose this enormous opportunity,” said Dr Jakab.

A vaccinator marking a vaccinated child during the March 2021 NIDs in Punjab district, Pakistan. © WHO/EMRO

The Regional Director for the African Region, Dr Matshidiso Moeti, thanked African countries and partners for rapidly restarting and innovating to deliver polio activities after a pause during the COVID-19 pandemic, especially following the successful certification of eradication of wild polioviruses last year in the region. Integrating polio functions into other programmes will be critical to maximising the gains against this disease, she said, and to leveraging the wealth of expertise and experience that has been built.

Rotary International welcomed the new strategy and its priority on integration and extended collaboration with partners, as well as its focus on gender equality. Gavi, the Vaccine Alliance, highlighted the new strategy’s alignment with the Immunization Agenda 2030 and Gavi’s new 5-year strategy, and shared importance of reaching 0-dose children and missed communities with comprehensive and equitable immunization services.

Aidan O’Leary, WHO Director for Polio Eradication, addressed delegates, saying: “Wild poliovirus transmission is restricted to Afghanistan and Pakistan, and while we have seen a sharp decrease in incidence this year, this is no time for complacency.  Gaining and sustaining access to all children in Afghanistan and increasing coverage of missed children in core reservoir areas of Pakistan remain the key challenges, and we must all work together to overcome these to achieve and sustain zero cases.  At the same time, we must continue to respond to cVDPV2s.  The solutions focus not just on the new nOPV2, but also more timely detection, more timely and higher quality outbreak response and strengthening essential immunization services in zero-dose communities and children, aligned with the IA2030 agenda. The new strategy addresses the broader needs of communities through expanded integration and partnership efforts along six distinct workstreams. Implementation will be strengthened through a more systematic approach to performance, risk management and accountability at all levels.”

The new strategy – Delivering on a Promise – will be officially launched at a virtual event on 10 June 2021.  Details about the event are available here.

In March:

  • No case of WPV1 was confirmed
  • 37.7 children under the age of five were vaccinated during the March National Immunisation Days (NIDs)

Downloads

In his English writing class, Mujahid Miran was asked to write an essay titled the “Aim of life”. This was a space for the students to imagine who they could be and what they saw themselves as when they grew up.

Miran wanted to be a captain in the army and he eagerly shared this ‘aim of life’ in his essay. After his hopes made it to the page, his teacher immediately shot it down: There was no way he would make it, she told him, because he had polio.

Born in 1985, Miran grew up in Kohat and contracted polio when he was two. This was a year before the Global Polio Eradication Initiative was founded in 1988, leading to a worldwide vaccination campaign to fight the spread of the disease. In the decade of the ’80s, the estimated number of cases was over 350 000 per year, while the disease was still prevalent in 125 countries. With focused efforts around the world to eradicate the poliovirus, the number of paralytic cases was reduced by 99.99% with 42 cases in 2016.

For Miran, school was among the most challenging periods of his life. “School life was generally very hard. It must be easier for polio survivors to study in special schools, but in a usual school, I was always referred to as langra, mazoor (derogatory words in Urdu for people with disabilities). I was always made to feel different.”

The challenges were frequent, never letting him forget that he couldn’t walk from one leg. “Among the things that would hurt a lot was sports class or recess. “Every time kids would be chosen for a sports activity, I was completely sidelined – as if I wasn’t even there.” he says.

Academically, Miran always performed well in class and would usually be among the top three students. I always had among the best grades, but I would never be nominated to be the class monitor or get a position as part of the student council, he says. “Every week I’d go to my teacher and ask her why I was never nominated because other students who would be poorer than me academically would be chosen instead. A part of me knew even back then that it was my disability, but now looking back, I know it was exactly that.”

After having lived with polio for 33 years now,  Miran is now based in Karachi and is part of a small seafood export business. He buys seafood from factories in Pakistan to sell in southeast Asia and makes an income for the commission he makes per sale.

Miran is able to independently support his family of his wife and two children, aged six and two, but the everyday realities of living with polio make the smallest of tasks harder.

“There is such little awareness in Pakistan, and it’s even within government institutions. I had to get my special driver’s license and when I went to get it made, the officer on duty asked me to raise my shalwar in front of a group of people and stand on one foot to prove I had a disability, he adds. “The humiliation is too much.”

This virus has also been an obstacle in maintaining friendships, as most places for leisure in Pakistan have no access for people with disabilities. “Plus, there is also so much shame in it.  I was in Dubai once and I was walking with a friend who turned around to me and said that the way I was walking was embarrassing for him.  This virus impacts your life in every way.”

Last year, Africa was declared wild polio-free after Nigeria, the last remaining country in the region that had polio and accounted for more than half of all global cases less than a decade ago, had no cases of wild poliovirus for the fourth year running.

Today, Pakistan and Afghanistan are the only two endemic countries in the world and global efforts continue to vaccine children in this epidemiological block, and finally make the dream of a polio-free world possible.

Miran says this interview is his personal effort to spread awareness on polio. “I talk to everyone in my friends and family circle who have young children. I give them my example and tell them they can’t afford to miss out on vaccination. I am very regular with my children’s vaccination too. Whenever polio teams come to our house, I make sure the children take polio drops.”

At many times in the interview, Miran mentions how the physical pain caused by the disease is often unbearable. “I almost never express how much pain I feel because people will think I’m asking them for financial help or wanting their sympathy. But I just want everyone to know that living with polio is hard. Very, very hard.”

Health worker Saira Faisal vaccinates a child against polio in Saddar town, Karachi, in August 2020. ©UNICEF/Pakistan

With masks on their faces and sanitizers in their pockets, an immunization team makes their way through the narrow lanes of Lahore’s historic old city.

Our children are like flowers and these anti-polio drives help them grow up healthy and strong,” says Zubair, who along with his colleague Afzal is part of Pakistan’s 260,000-strong frontline vaccinator workforce.

It is the second day of the National Immunization Days (NID) campaign, which launched on 21 September, and the third immunization drive after a four-month suspension of door-to door campaigns due to the risks associated with COVID-19.

After polio campaigns were stopped in March 2020, the number of polio cases in Pakistan continued to increase. An initial small-scale round of vaccinations resumed in July, when over 700,000 children were reached. A second round went ahead in August, where 32 million children were vaccinated across the country. In both campaigns, vaccinators took precautions to prevent the spread of COVID-19, including wearing masks and regularly washing hands.

Making their way from the crowded streets of Taxila Gate, the polio team reaches a historic cultural hub of Lahore city called Heera Mandi.

In this neighbourhood, the team knocks on one door after another. “Sister, do you have children under five at home?”, they say.

When the answer is yes, one of the vaccinators stands to the side while Zubair hands them a hand sanitizer. They all stand at a safe distance from each other, to remain compliant with COVID-19 safety measures, and to make sure the dual message of the necessary fight against both polio and COVID-19 reaches home.

Polio Worker Aliza Mukhtiyar Using Hand Sanitizer ©WHO/EMRO

Zubair says that since the resumption of immunization campaigns in Pakistan, parents have been more enthusiastic to ensure their children are vaccinated.

Next door, a Maulana (a religious cleric) answers. When he sees the polio team, he immediately goes back inside. Team members worry that he may reject the vaccine, but soon enough, he returns with his two children.

Did you ever believe that the polio vaccination was a conspiracy?,” the Maulana is asked. In some parts of Pakistan, false rumours about the vaccine have damaged confidence in immunization, with sometimes devastating results for children subsequently infected with polio.

No Sir, only a fool can think like that,” he replies.

Afzal, another member of the immunization team, says that he finds his work fulfilling because it allows him to directly speak to parents about polio and explain that they can give their children a healthy future by vaccinating them.

With a physical disability, Afzal often faces discrimination based on his health condition. He explains that this hasn’t prevent him from pursuing his ambitions.

I never allowed my disability to become an obstacle. I completed my master’s degree while attending regular classes at college, and now I have been working with the polio programme for nine years.”

“If a family is hesitant during a polio campaign, I approach the parents,” he says. I show the parents my polio-affected leg and ask them if they really want their child to have one too. This changes hesitation to acceptance.”

Health workers like Zubair and Azfal are working every day to achieve the dream of ending polio in Pakistan. With their effort and the efforts of thousands like them, the September campaign successfully reached over 39 million children across the country. These promising results, achieved during a pandemic, are a testament to an ongoing commitment to overcome challenges and move Pakistan closer to a polio-free future.

Polio worker Aliza Mukhtyar vaccinates a child in Saddar town, Karachi, during an August 2020 campaign. Work continues to support women’s full participation in the polio programme. ©UNICEF/Pakistan

In 2018, Jawahir Habib, a Programme Officer in UNICEF’s Polio Outbreak Team based in Geneva, received a letter. It was from a Pakistani woman she had met while working in the Quetta block – one of the most high-risk polio areas of Pakistan. The letter read:

“I have four daughters, and my daughters are in school because of the polio programme. I can afford to teach my girls which my husband opposed. Now they too can get education and live an independent life. I will make sure every child is covered and this is my mission.”

Words like these inspired Jawahir and set her on a path to a ten year career in polio eradication. She recalls her first day at work, “That day was very interesting – I was chased by dogs in the Kharoatabad area of Quetta. Although I managed to save myself, I spent the whole day crying and realizing that polio workers face this type of adversity day to day. I knew that I must become a part of this and ten years later, I am still working to eradicate polio”.

Jawahir has over ten years’ experience in polio eradication. Despite the challenges, she has stayed motivated throughout.

The more Jawahir became involved in the polio programme, the more she witnessed women facing social challenges. At the time, suboptimal campaigns in the polio reservoirs was one of the major hurdles faced by the programme and the number of missed children in Quetta block remained very high.  More than 70% of frontline workers were male or non-locals, resulting in limited access to households.

It was then that the Pakistan programme began looking at success stories from other parts of the world, including Nigeria, where Volunteer Community Mobilizers (VCMs) were making significant strides in eradicating polio. The need to build a network of local female health workers who were trusted and could gain access became more and more clear. Balochistan, where Jawahir is originally from, is one of the most remote and conflict-ridden areas of Pakistan and strict conservative religious and cultural norms, tribal conflicts and insecurity would prove very challenging.

When Jawahir’s team started recruiting, training and deploying women frontline workers in Quetta block, she was told it was impossible. “I was told that there was no way we could manage a workforce comprising of women working in these areas”. As a team leader, Jawahir had to create an enabling environment for women to work, keep them motivated and ensure systems were in place for them to reach every child in the block. “At a personal level, I had to lead by example and show everyone that women could work in these difficult areas, face resistance and achieve what a man could – in this case, even more.”

Jawahir knew well the challenges of being a young woman in a male dominated society. Born in Kili Mengal Noshki, a remote village in Balochistan bordering Afghanistan, she faced a lot of challenges. Despite this, Jawahir got her bachelors degree, a postgraduate diploma in public health management and a masters degree in health communication from the University of Sydney.

While working on polio, she had to work twice as hard as men, facing threats, gender biases and intimidation. What kept her inspired and motivated was being a part of something much bigger which she believed could change the world.

During this time, Jawahir’s team managed to identify, train and deploy a workforce of 3500 Community Based Workers (CBV) where 85% of the frontline vaccinators were women. During the first few campaigns 700,000 children in the core reservoir area were registered and vaccinated and more than 150,000 children who had previously been missed during the campaigns were mapped and given oral polio vaccine. One of the notable success of female teams was seen in Chaman Tehsil, on the border with Afghanistan, where within four months, the number of chronic vaccine refusals went from 15,000 to 400 children. That was a huge success for Pakistan’s polio eradication goal.

A father and daughter polio vaccination team at a refugee camp in Pakistan. Women play an integral role to build trust with communities and reach as many children as possible with vaccines. ©UNICEF Pakistan / Jawahir Habib

Jawahir attributes the success to the brave women who have made a major contribution to their society. She sees the empowerment of woman in one of the most difficult parts of the world as GPEI’s legacy of social change now and for the future. “Imagine a workforce of thousands of women having access to every household – imagine the venues we have for routine immunization, for nutrition, health and even education”.

The COVID-19 pandemic has compounded a rise in polio cases in Pakistan in 2019 and 2020, and polio eradicators once more have their work cut out to bring down virus transmission and protect populations.

“I believe now it is the responsibility of each and every one of us in the polio programme, whether a polio worker in Chaman or an Officer in Geneva, to ensure that this disease is eradicated once and for all. We will carry on no matter the hurdles and obstacles placed on our road, and we will finish the race.”

The Executive Board Room at WHO Headquarters during the first ever virtually-held World Health Assembly. © WHO/C. Black

In a year marked by the global COVID-19 pandemic, global health leaders convening virtually at this week’s World Health Assembly called for continued urgent action on polio eradication. The Assembly congratulated the African region on reaching the public health milestone of certification as wild polio free, but highlighted the importance of global solidarity to achieve the goal of global eradication and certification.

Member States, including from polio-affected and high-risk countries, underscored the damage COVID-19 has caused to immunization systems around the world, leaving children at much more risk of preventable diseases such as polio.  Delegates urged all stakeholders to follow WHO and UNICEF’s joint call for emergency action launched on 6 November to prioritise polio in national budgets as they rebuild their immunization systems in the wake of COVID-19, and the need to urgently mobilise an additional US$ 400 million for polio for emergency outbreak response over the next 14 months.  In particular, Turkey and Vietnam have already responded to the call, mobilising additional resources and commitments to the effort.

The Assembly expressed appreciation at the GPEI’s ongoing and strategic efforts to maintain the programme amidst the ‘new reality’, in particular the support the polio infrastructure provides to COVID-19-response efforts. Many interventions underscored the critical role that polio staff and assets play in public health globally and underline the urgency of integrating these assets into the wider public health infrastructure.

At the same time, the GPEI’s work on gender was recognized, with thanks to the Foreign Ministers of Australia, Spain and the UK for their roles as Gender Champions for polio eradication.

Delegates expressed concern at the increase in circulating vaccine-derived poliovirus (cVDPV) outbreaks, and urged rapid roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation oral polio vaccine aimed at more effectively and sustainably addressing these outbreaks.  This vaccine is anticipated to be initially rolled-out by January 2021.

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked the global health leaders for their continued dedication to polio eradication and public health, and appealed for intensified global action to address immunization coverage gaps, by prioritizing investment in robust immunization systems to prevent deadly and debilitating diseases such as polio and measles.

Related resources

Community Health Workers deliver polio vaccine in Pehlwan Goth in Karachi. ©PEI/2020

Welcome to Pehlwan Goth, Pakistan. A low-income neighbourhood on the edge of Karachi city, it is home to many families from Khyber Pakhtunkhwa province who have moved here for work.

An open sewage drain lined with litter runs the length of the settlement. Cattle are often seen grazing near the heaps of garbage. It is a high-risk area for polio, and virus is regularly detected in the environment.

Samreen, a 25-year-old Polio Area Supervisor, leads a team of four community health workers in the area.

“I started working with the Polio Eradication Programme four years ago and I am happy to say that we have made a lot of progress here. This is my neighbourhood; this is where I grew up and this helps me immensely. People here listen to me, especially the women, and I know most of the children by name,” says Samreen.

Converting refusals

There are around 32,000 children under five years of age in Pehlwan Goth. In April 2019, parents of around 3,000 children refused the polio vaccine. Through the hard work of supervisors like Samreen however, now over 80% of these children have received vaccines.

“I am in charge of an area that has 210 households with 196 children. In 2019, families of more than 50 children refused vaccines. That’s almost one fourth of all the children in my area,” said Samreen.

Samreen delivers polio drops to children whose parents initially rejected vaccination. ©PEI/2020

“Building trust takes time, and we continued engaging with community members, visiting families, listening to their concerns, and explaining the benefits of vaccination. Today, we have only eight refusal cases out of the previous 50. I will try my level best to bring this number down to zero during the polio campaign next month.”

“But for me, it is not just about just converting refusals during every campaign, I want all families to understand the benefits of vaccines in the long run and ensure the immunization of their children against polio and other diseases.”

Her rapport with families is apparent during house visits. A family with three children, who had refused vaccination in previous months, agreed that their children could this time receive the life-saving polio drops.

Confronting misconception

Building trust with the community has not been an easy task. Samreen is supported by a social mobilizer as well as a local religious support person. The team members work together to address misconceptions and raise awareness of good health practices among caregivers in Pehlwan Goth.

Samreen and Maulana Mohammad Hanif vaccinate the children of local resident Tayyab Khan. ©PEI/2020

“We speak the same language and our homes are in the same area where we work. It is easier to communicate with people when you are part of the same community,” said Maulana Mohammad Hanif, the religious support person in Samreen’s team.

Sometimes, however, it can take only one negative social media video or news item to reignite refusals and overturn all their efforts.

“The process takes time. The work is tough but I am grateful to Allah for this job, which allows me to feed my family, and contribute to a noble cause, which will save future generations of Pakistanis,” added Maulana Mohammad Hanif.

It’s clear that Samreen and her team will do whatever it takes to deliver a polio-free future to all 196 children in their care. Pakistan and Afghanistan are the final two polio endemic countries in the world and there are still many challenges that remain.

It is the local efforts of teams like Samreen’s that will make all the difference – by listening to communities, building trust and ensuring rapport, they are playing a crucial role to bring their country closer to ending polio.

Nabeela, a polio frontline worker in Pakistan, vaccinates a child in Liaqatabad using the ‘no touch’ method. © UNICEF/Pakistan

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.

A child has their finger marked during the campaign in Angola. ©WHO/AFRO

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.

Farzana, a polio worker in Karachi’s Liaqatabad Town, Pakistan uses hand sanitizer during the campaign. ©UNICEF/Pakistan

“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”.

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. ©WHO/Afghanistan

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.”

Related news

Watching a video with COVID-19 prevention messages, designed to be easily be shared using messaging applications. ©2020/UNICEF Pakistan

Nida, a polio community worker in Lahore, is glued to her mobile phone. But this is not a leisurely conversation with a friend. She is messaging a mother in her neighbourhood who is worried about COVID-19.

Since the pandemic began, polio programme workers across the country have pivoted to use messaging applications, especially WhatsApp, to disseminate COVID-19 prevention and care messages to communities. This is one aspect of the extensive support being offered by the Pakistan polio programme to the COVID-19 response.

Over the last few months, the polio programme has produced a suite of videos, digital pamphlets and posters on COVID-19 prevention and care in formats that can be easily shared and viewed via messaging platforms.

“This is an example of resilience – how the polio team has adapted to the change and found an effective way to support the people across the country during the COVID-19 crisis,” said UNICEF’s Dennis Chimenya, the Communication Task Team lead of the Pakistan Polio Programme. “Standing with the community during these challenging times will certainly contribute to building further trust in polio frontline workers.”

Engaging religious and community influencers

Engaging religious leaders and local influencers is a critical part of effective community outreach. Now, many are receiving messages and calls from polio community workers seeking their support for the COVID-19 response.

Qari Zafar, a religious cleric from Lahore, gives COVID-19 updates and safety messages using the information he receives from polio community workers. ©2020/UNICEF Pakistan

Qari Zafar, a religious cleric at a mosque in Lahore, was a staunch opponent of restrictions to religious gatherings.

“Initially, I was totally against the idea of asking people to pray at home. I felt that people need to pray together at the mosque during this difficult time and support each other,” said Zafar.

“Then I started receiving messages and posters from [polio community workers] Nida and Uzma about how the coronavirus spreads. Our chats helped me understand the seriousness of the situation.”

“I have started making announcements through the mosque loudspeakers, asking people to offer their prayers at home, even during Ramadan. I also regularly message my followers, reminding them about healthy practices.”

The ‘new normal’ for community outreach work

“Messaging platforms have become the ‘new normal’ to carry out community outreach activities,” said Muhammad Asif, a polio frontline worker in Quetta, Balochistan province.

 At the north west frontier region of Pakistan, in Khyber Pakhtunkhwa province, the polio communication teams have created 63 group chats, tailored for different audiences, to amplify COVID-19 preventive messages.

In Punjab, similar groups have helped the programme reach over 110,000 people with digital posters and leaflets. Messaging applications are also helping the programme communicate with religious pilgrims and other mobile populations, whose travel patterns put them at greater risk of becoming infected with COVID-19.

In Sindh, WhatsApp has helped the programme reach over 200,000 people at risk, 4,000 religious leaders, 3,000 influencers and more than 80 journalists with awareness materials and guidelines for ethical reporting.

“The potential of using such platforms under the present circumstances is huge. Yes, our movement is limited but we have to find a way to do our job and to ensure that the correct messages reach the right audience on time,” said Fatima Fraz, Communication for Development Specialist for the polio programme in Sindh.

Salman Mahar, a member of the polio social media team, shares COVID-19 awareness materials with polio frontline workers for further dissemination. ©2020/UNICEF Pakistan

“Just imagine, there are 14,000 polio frontline staff in Karachi. If each staff member sends out the messages and then follows up by phone with just 20 people, that’s 280,000 people reached right then and there.”

WHO has launched a dedicated messaging service in languages including Arabic, English, French, Hindi, Italian, Spanish, Portuguese, Urdu and Somali to keep people safe from coronavirus.

Find out how to join WHO’s Health Alert on WhatsApp.