GPEI-This is what lab leaders look like: voices of women leading lab innovations to end polio

Addressing social norms

Giza, Egypt, is home to the ancient world-renowned pyramids and a medical marvel of the modern age — the accredited Polio Regional Reference Laboratory (RRL) at the Egyptian Holding Company for Biological Products and Vaccines (VACSERA). Director of the polio regional reference laboratory,

Amira Zaghloul oversees five different departments, working closely with her 25-member team. They regularly conduct poliovirus diagnostic tests on stool samples obtained from children as well as sewage samples from Egypt. Additionally, they carry out sequencing of samples that have been identified as positive for polio in Egypt, Iran, Iraq, Jordan, Sudan, and Syria, which determines if the polioviruses confirmed are related to any other ones. Their goal is to meet tight deadlines, to swiftly respond to any detection of the poliovirus.

Like her counterparts across the Region, Ms Zaghloul and her colleagues rely on the latest laboratory and digital technology. With support from partners, they regularly upgrade their technology and skills to ensure the shortest possible time between sample collection and churning out results. Soon, for example, Ms Zaghloul and her team will acquire the next generation of sequencing technology – that will help test the entire genome of a virus, or genetic materials that make up a virus, and identify any mutations. This will also help to determine the origin of detected polioviruses, and track epidemiological patterns of spread.

Her work doesn’t come without challenges though. When she first took on this role, Ms Zaghloul faced negative social perceptions of being a female leader of a mixed team of men and women. To address this, Ms Zaghloul introduced rules and regulations that apply to all, regardless of age and gender.

People working in health should exemplify a spirit of perseverance, devotion, hope and ambition – regardless of their gender – she emphasizes.

Negotiating to receive samples for polio tests

When Dr Hanan Al Kindi finally settled on what to study − over virology, medicine or business — she had no idea she would need negotiation skills in her job. As the head of nine polio and measles laboratory departments that test samples from Bahrain, Qatar, United Arab Emirates and Yemen for polioviruses, Dr Al Kindi ensures everything runs like clockwork.

At times, this involves thinking out of the box. After noting huge time lags in the delivery of stool samples – used to test for polioviruses – from Yemen to Oman, Dr Al Kindi rolled up her sleeves and got to action. She learnt that after driving through mountains and deserts to reach Oman’s borders, the refrigerated trucks that transport stool samples were kept at the border for hours of inspection. Dr Al Kindi and her team got the contacts of officials at the border and invited them over for a chat.

Her determined negotiation skills and ability to read the room – to understand when peripheral stakeholders such as officials at the border and couriers needed more context about the laboratory’s role in saving children from polio — eventually helped reduce the red tape at the border. This means Dr Al Kindi and her team can test for polioviruses and turn over their results to the polio programme in Yemen in less time than before. This steers timely and appropriate outbreak response activities, including polio immunization campaigns to protect children from polio.

Working in an equitable environment

Dr Nayab Mahmood plays a vital role in ensuring samples are tested for poliovirus as swiftly as possible for timely interventions in Afghanistan and Pakistan – the only two countries left with naturally occurring poliovirus.

Dr Mahmood is a virologist serving the polio programme of the Regional Reference Polio Laboratory at Pakistan’s National Institutes of Health in Islamabad. Her role involves intricate technical procedures, including molecular diagnostics, and genetic sequencing of the poliovirus genome. This work helps to determine how wild polioviruses are spreading across both endemic countries.

Being part of an emergency programme means that Dr Mahmood and her colleagues need to be available 24 hours a day – a pace that is impossible to maintain without feeling an impact in one’s personal life. She feels that the best way to maintain a work-life balance is for each member of a team to communicate their needs with each other, which further helps the programme’s leaders like her to shape policies and programmes that enable a good work-life balance.

Grateful that she hasn’t had to challenge any stereotypes related to gender dynamics in her role,
Dr Mahmood credits this to directives in her workplace that support gender equality, and to the culture of her individual team. These attributes have blended to create an equitable environment where everyone can use their abilities.

Sharing rare, much-needed skills

Chief of the Laboratory of Clinical Virology in the Pasteur Institute of Tunis, Professor Henda Triki makes a concerted effort to share her knowledge with others. Her altruistic spirit goes beyond her laboratory, especially as her specialty of work is still rare in North Africa: She teaches virology at the Faculty of Medicine of Tunis, and constantly keeps an eye on how best to upgrade her team’s skills and technology at work.

Professor Henda Professor Triki has a collaborative leadership style at work, which results in her sharing her team-building skills with her colleagues – which has helped them address challenges many times before, including during the COVID-19 pandemic. Amidst the chaos and anxiety during the pandemic, Professor Triki and her team had strong moments of solidarity and collaborative work.

Professor Triki wants her fellow female colleagues to be proud of working for the polio eradication programme, as it offers great opportunities. It has allowed women to distinguish themselves from others by acquiring skills that other laboratories do not have. She is pleased to note now that there are many women who are the face of specialized laboratory work in the Eastern Mediterranean Region.

This year, the UN’s theme for International Women’s Day is ‘DigitALL: Innovation and technology for gender equality’.

Originally published here.

A moderator speaks in a workshop for the female frontline workers initiative. © BMGF/Sang-hee Min

ISLAMABAD – Poultry farming, EPI technicians, creative writing, midwifery, embroidery, online businesses: it’s a room filled with possibilities and dreams when women health workers come together to imagine their lives in a polio-free Pakistan.

These ambitions surface during the workshops the Pakistan Polio Programme initiated last year, as part of a unique project to actively listen to female frontline workers in the areas at highest risk for poliovirus transmission across the country.

The initiative used a bottom-up, data-informed approach to better understand the experiences of women on the frontlines and hear their ideas for how the programme can better support them to do their jobs safely and effectively. And came with a prior promise: leadership from all partners at the Emergency Operations Centres were to review – and implement – workable solutions.

This systematic listening process, which began in July 2022 and concluded last week, was done in two parts: First, an independent research company was brought on to conduct more than 2,600 randomized, anonymous surveys with polio frontline workers across Pakistan to understand their unique challenges and experiences in the field. After this, based on the results of these surveys, 14 workshops were designed to hear from women frontline workers themselves on what they think are the solutions to the challenges they face.

Female health workers from the polio endemic districts of Bannu, DI Khan, Lakki Marwat and Tank in southern Khyber Pakhtunkhwa to the geographically challenging terrains of Chaman, Quetta and Killa Abdullah in Balochistan to Punjab in central Pakistan to Sindh in the south of the country to the capital city of Islamabad were brought together in this series of workshops.

Participants during the workshops. © BMGF/Sang-hee Min

The workshops were also moderated by a third party to allow for open and honest discussions, and carefully curated to create spaces where, for the first time, the women were the chief guests, they were the people who mattered most, while everyone else had one job: to listen.

“When you get respect, you get everything. It’s the first time that we have talked, and other people have listened,” says Fauzia Naseem, an Area-In-Charge from Chaman.

As each of the two-day workshops finished, there was excitement, energy and almost a sense of disbelief that hours had been dedicated to listening to them. “I’ve been here since 2017 and no one has ever really asked us what we think. Otherwise we are only told where to go and what to do. Today I feel like what we say matters,” says Samreen, a polio worker, from Tank.

“This is a very special project – and a very insightful one too. It offers us the opportunity to gain from the wealth of knowledge of the polio programme’s frontline staff. For the very first time, the people who actually do the work of delivering the vaccine to a child have been systematically asked how they think it should be done. We are currently looking into their suggested solutions and seeing which are implementable and can be taken forward,” said Dr Shahzad Baig, the Coordinator of the National Emergency Operations Centre in Islamabad.

“For many women, this is the first time they are together to just talk to each other, hear from each other, take a selfie and be in a space where they have the right to simple joys that they otherwise may not have access to. The workshops for women from southern Khyber Pakhtunkhwa were particularly special. These were held in Islamabad and for many women, this was the first time they had visited the country’s capital city. Their excitement and sheer joy was infectious. It lit up the room,” said Dr Atiya Abro, Deputy Director Ministry of National Health Services.

Moderators guide the participants during a workshop for the female frontline workers initiative. © BMGF/Sang-hee Min

The last session in all workshops was dedicated to listening and understanding the women’s diverse interests in other career pathways after polio, and what skills or support the workers felt would be needed for them to transition into these jobs in the future.

This initiative was coordinated by the Pakistan Polio Programme’s National Gender Group, comprised of representatives from the government and partner agencies including WHO, UNICEF, BMGF and N-STOP.

“Having the opportunity to listen and give center stage to these women has been a true privilege. It’s encouraging to see such strong commitment from Pakistan programme leadership to support these female health workers – not only in their work toward our collective goal of eradicating polio, but also to facilitate transitions into other potential livelihood opportunities in the future. We look forward to the next phases of this exciting initiative as well,” said Sang-Hee Min, Senior Programme Officer, Bill & Melinda Gates Foundation and member of the National Gender Group.

“Polio teams are a valuable asset to our country,” said Dr Baig. “It is very important to me that when we finish polio from Pakistan, we don’t just pack up and leave but utilize this incredible workforce. We build systems and create opportunities to serve the workforce, a majority of them women, and find some way, however small, in giving back to the people who have worked tirelessly to protect the children of our country.”

Acknowledging that our common goal is to attain ‘Health for All by All’, which is a call for solidarity and action among all stakeholders;

Noting the progress achieved globally in eradicating wild poliovirus transmission since 1988, with endemic wild poliovirus transmission restricted to just two countries – Afghanistan and Pakistan;

Recalling that 2023 is the target year for interrupting all remaining poliovirus transmission globally, as per the Global Polio Eradication Initiative Strategy 2022–2026: Delivering on a Promise;

Appreciating the recent, intensified efforts made by both Afghanistan and Pakistan, resulting in a unique epidemiological window of opportunity to achieve success in 2023, as characterized by:

the geographic restriction of wild poliovirus transmission in 2022 to eastern Afghanistan and a few districts of north-western Pakistan;

the absence of any wild poliovirus case since September 2022;

the significant decline in genetic biodiversity of wild poliovirus to just a single lineage in each country; and

the successful interruption of circulating vaccine-derived polioviruses;

Emphasizing that the opportunity to interrupt wild poliovirus transmission must be seized now, given the unprecedented epidemiological progress and the inherent risks of delays in stopping polio, which would likely result in resurgence of polio;

Underscoring the ongoing risk of transmission of wild poliovirus, with detection of wild poliovirus from environmental samples in both countries since January 2023, confirming cross-border transmission ;

Highlighting that the key to success lies in reaching remaining zero-dose children (children who are un- or under-immunized) with oral polio vaccine in the most consequential geographies,¹ operating within a broader humanitarian emergency response, including increasing access to all populations in some areas;

Underscoring the importance and heroic work of health workers at the forefront in insecure settings, especially women, whose support and participation is critical to the eradication effort;

Recognizing the sustained commitment by leaders at all levels, notably by political leaders and law enforcement agencies, community and religious leaders, civil society, Global Polio Eradication Initiative partners, especially Rotary International, parents, caregivers and all health workers;

Recalling that the international spread of poliovirus constitutes a Public Health Emergency of International Concern under the International Health Regulations (2005);

Appreciating the support provided by the GPEI in responding to the devastating floods affecting Pakistan and the tragic earthquake affecting Afghanistan in 2022;

Appreciating the commitment of the United Arab Emirates through the initiative of His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of UAE, to promote and support polio eradication in Pakistan through the UAE Pakistan Assistance Programme;

Recognizing the longstanding support of donors like Rotary International and acknowledging the historical financial support of other Member States to the eradication effort, including the Kingdom of Saudi Arabia, Kuwait, Oman and Qatar;

Appreciating and supporting the decision of the WHO Regional Director for the Eastern Mediterranean to formally grade all polio emergencies and to apply relevant emergency standard operating procedures to WHO operations to address polio emergencies;

We, Member States of the Regional Subcommittee for Polio Eradication and Outbreaks for the Eastern Mediterranean,

DECLARE THAT:

1. We will focus all efforts on reaching remaining missed children with oral polio vaccine, within a broader humanitarian response context in the remaining most consequential geography of eastern Afghanistan and in north-western Pakistan;

COMMIT TO:

2. Mobilizing all necessary engagement and support by all political, community and civil society leaders and sectors across the Region, to fully achieve interruption of wild poliovirus transmission in the Region;

3. Facilitating the necessary support to fully implement all aspects of the Global Polio Eradication Initiative Strategy 2022–2026, including by ensuring rapid detection of and response to any poliovirus from any source, and implementing high-quality outbreak response;

4. Fostering coordination with other public health efforts, to ensure closer integration in particular with routine immunization efforts;

REQUEST THAT:

5. The international development and humanitarian communities and donors strengthen their support for full implementation of the National Emergency Action Plans to Eradicate Polio in Afghanistan and Pakistan; and

6. The Regional Director continue his strong leadership and efforts to achieve a Region free of all polioviruses for good, including by advocating for all necessary financial and technical support, reviewing progress, planning corrective actions as necessary and regularly informing Member States of the aforementioned and of any further action required through the World Health Organization Executive Board, World Health Assembly and Regional Committee for the Eastern Mediterranean.

PAKISTAN marked a historic moment for polio eradication a year ago. On Jan 27, 2022, for the first time, we clocked in a year without polio paralysing a child. There was a euphoric feeling that the country had finally turned a corner. The long battle to end this disease was thought to be close to an end. But the virus had other ideas.

Despite aggressive vaccination efforts, polio was surviving and continuing to spread in a small area in southern KP. First detected only in sewage water, the virus then paralysed a 15-month boy in North Waziristan. It was the first case of polio in nearly 15 months. I was in Karachi with several members of our team when the news came. Although not surprising given the circulation detected in the environment, it was heartbreaking to hear that another child in Pakistan would never walk again because of an easily preventable disease.

Emergency responses were immediately finalised. While preparing for the work ahead, memories took me back to Borno in Nigeria, a country where I spent a decade fighting polio. After the ‘last case’ of polio in Nigeria was reported in 2014, I started to check my phone every morning, relieved that another day had passed without the virus resurfacing. Typically, it takes three years without any poliovirus for a country to be declared polio-free. But in August 2016, 30 months after the last detection of the virus, a child from a security-compromised area of Borno was found paralysed by polio. As there was poor surveillance and no ability to vaccinate, the virus had found its hiding place. One paralysed child became three. And the outbreak brought Nigeria back to square one.

I knew that the case in North Waziristan was following a familiar pattern, but it was greatly challenging, nonetheless. The year 2022 was excruciatingly demanding. It was a year of feeling the weight of huge challenges, but moving on and choosing courage, commitment and hope every time.

We have aggressively responded to any outbreak in the country, restricting the virus to just seven districts in southern KP. Our virus surveillance network has nearly doubled. We have charted the movement patterns of nomads to reach children otherwise deprived of essential immunisation. We have launched a novel project that allows us to listen to hundreds of front-line women health workers and hear their recommendations for reaching the end goal. And we are consistently working towards improving overall healthcare in areas most at risk from polio.

Polio eradication has had remarkable support and remained a priority in one of the hardest years for the country. The prime minister holds quarterly meetings on polio eradication, bringing provincial and federal leadership together. The federal health minister has visited different provinces to encourage and support provincial health ministries. There is uniform consensus and commitment across all political parties that Pakistan must win this battle against polio, and now is the time.

This commitment is there at every level, from federal health secretaries, chief secretaries and chief ministers, to the deputy commissioners directly overseeing implementation. The military and law enforcement have given the programme their absolute support, making immunisation possible in some of the hardest areas to reach, while global advocates for polio eradication, including Bill Gates and the regional directors of WHO and Unicef, have made polio eradication a top priority in their visits to the country.

We have begun 2023 with great hope and greater commitment. The first nationwide campaign was recently concluded. Despite rain, cold, snow and ice, polio workers carried on with inspirational dedication. They are the face of Pakistan’s sincerity, perseverance and hard work.

The six months ahead are crucial to eradication. This is the closest Pakistan has ever been to interrupting transmission. But the risk of the virus continuing to circulate in the seven districts of KP’s south, and the risk of it exploding beyond and bringing the virus back to polio-free areas, is real.

Polio eradication now needs a renewed countrywide sense of urgency. It needs to be important to all of us to see this virus vanquished. After three decades of the polio programme in Pakistan, there is understandable fatigue. But this is not the time to tire. This is the time to believe. A world free of polio was the birth of a dream. In countless countries at countless times, it has felt like an impossible dream — until it was possible and actually happened.

Over 99 per cent of the world has made this dream come true. And it will come true for our children too if we take this as a collective fight and finish the job. Now is the time to strengthen that resolve, to come together and make the end of polio possible.

Written by Shahzad Baig, Lead, Pakistan Polio Eradication Initiative.

This article was originally published in Dawn on January 27, 2023.

In October 2022, the Technical Advisory Group (TAG) for Afghanistan and Pakistan met in Muscat, Oman, to conduct a thorough review of ongoing polio eradication efforts in the remaining polio endemic countries. During the 6-day meeting they also provided strategic technical guidance on steering efforts towards successful interruption of the poliovirus in both countries in 2023.

Polio programmes make significant progress, despite challenges

The TAG recognized the accomplishments of the polio programmes despite longstanding humanitarian crisis in Afghanistan and unprecedented levels of flooding across Pakistan that affected almost 33 million people. The progress comes due to concerted efforts by all stakeholders across all levels, intense vaccination schedule, timely programmatic pivots to changing epidemiology and the full support of law enforcement and security agencies in implementation of polio vaccination campaigns.

Members noted the high level of sustained political commitment to polio in both countries. In Afghanistan, since the political transition, nationwide campaigns have allowed the polio programme access to almost 10 million children, 3.5 million of whom were previously inaccessible. In Pakistan, intensified vaccination activities and strategic approaches were used to reach missed children.

The TAG also acknowledged the strategic role played by the Emergency Operations Centres (EOCs) in strengthening coordination and providing programmatic oversight at the national and regional levels.

Promising epidemiological trends provide a window of opportunity

Remarkable improvements in epidemiology in Afghanistan and Pakistan provide a window of opportunity for interrupting transmission of wild poliovirus. In Pakistan, the virus is endemic only in the southern districts of Khyber Pakhtunkhwa province, and in Afghanistan both cases have been reported from the eastern region. However, no cross-border transmission was recorded in 2022.

In addition to the limited geographical spread, the biodiversity of the genetic clusters is also at an all-time low: down from 8 in 2020 to 2 in 2022 in Afghanistan and from 11 in 2020 to one in 2022 in Pakistan.

Moreover, there has been no detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in either country in the last year. The last cVDPV2 case in Afghanistan had onset of paralysis on 9 July 2021, and the last cVDPV2 case in Pakistan had onset of paralysis on 23 April 2021.

Given the promising epidemiological trends seen in 2022, the TAG noted the possibility of full interruption of polioviruses this year. However, for the 2 programmes to succeed, the TAG proposed major strategic shifts in categorization of risks based on the epidemiological trends. The group of experts’ recommendations include context-specific tactics and technical guidance on activities to prioritize until mid-2023, when the TAGs for Afghanistan and Pakistan will meet again.

This new categorization redefines and re-demarcates the endemic zones in Afghanistan and Pakistan from the outbreak districts and the rest of the country where it is important to maintain children’s immunity. Additionally, it identifies highly vulnerable and consequential areas that are an additional risk category for Pakistan, where historically core reservoirs may play a role in establishing circulation in an event of reinfection.

The TAG also endorsed the 2023 polio supplementary immunization activities’ calendars for Afghanistan and Pakistan and emphasized continued cross-border coordination between the 2 countries, particularly in the key corridors. Finally, the TAG encouraged the continued use of strategies to integrate gender and social behavioural change communication into the programme’s activities, to reach every last child.

To read the reports from the Technical Advisory Group meeting on Afghanistan and Pakistan, click here.

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The site at Pezand Pana Dafter in Nangarhar province has produced three positive environmental samples since coming online in September. © WHO/Afghanistan

The review team, comprising of experts including virologists and epidemiologists, visited Afghanistan in June, conducting a comprehensive nationwide assessment of the country’s polio surveillance system. Among their recommendations was the need to address gaps in environmental surveillance and expand the number of environmental surveillance sites in areas deemed high risk for polio, including the country’s east, southeast, south and west regions, to ensure any presence of the virus is quickly detected.

Afghanistan’s AFP surveillance system – monitoring for signs of Acute Flaccid Paralysis in children under 15 years of age – is complemented by environmental surveillance – the collection of sewage samples at designated sites to check for the presence of the virus in the community. Together, they enable the programme to detect where the virus may be circulating and, importantly, mount a timely response.

Following the review’s recommendations, three new environmental surveillance sites have now come online, bringing the total number of sites in Afghanistan to 32. One of those sites, at Pezand Pana Dafter in Nangarhar province has produced three positive environmental samples since coming online in September. The programme quickly mounted a response targeting 1.4 million children under 5 years of age in all four eastern provinces – Nangarhar, Kunar, Laghman and Nuristan.

“Surveillance is the eyes and ears of the polio programme, and environmental surveillance plays an important part in eradicating polio because it enables the programme to detect the presence of the virus,” says Dr. Khushhal Khan Zaman, who oversees polio surveillance for WHO Afghanistan. “Environmental surveillance tells us very plainly where transmission is likely happening.”

WHO guidelines stipulate that an environmental site be located in areas with substantial populations, and with flowing sewage water. In Afghanistan, sites are established in major cities and larger population centres with existing wastewater and drainage systems. Communities with mobile populations are also a focus. Samples are regularly taken and sent to a WHO-accredited polio laboratory for testing.

Afghanistan has made significant progress in interrupting transmission of the virus. From 56 children paralysed by WPV1 in 2020, so far this year there have been two cases, in Paktika and Kunar provinces. Seventeen positive environmental samples have been detected in 2022, all in the country’s east region.

Further environmental surveillance sites are planned as WHO Afghanistan continues to implement recommendations from the surveillance review.

A child in Karachi receiving the polio vaccine. @WHO

There is unprecedented support and commitment to ending polio in Pakistan by 2023, and with the current momentum maintained, the country will be able to interrupt transmission in the coming year, a high-level global delegation on polio concluded at the end of its visit to the country on Thursday.

The delegation was led by Chair of the Polio Oversight Board (POB) Dr Chris Elias, WHO Regional Director Dr Ahmed Al-Mandhari and UNICEF Regional Director George Laryea-Adjei.

“The last steps to ending polio are the toughest but eradication is within reach thanks to the hard work happening in Pakistan,” Dr Elias said.

“During my three-day visit, I was again impressed by the resolve of the government and community, especially frontline workers, to ensure polio is gone forever,” he added. “Reaching every child during the upcoming polio campaigns and strengthening the routine immunization system are now critical to success.”

The Polio Oversight Board is the highest decision-making body of the Global Polio Eradication Initiative. This is the delegation’s second visit together to Pakistan this year. The earlier visit was in May following the detection of a polio case in Pakistan after nearly 15 months. The recent visit comes following the destruction of several health facilities and mass displacement due to catastrophic floods, which increased the risk of polio transmission.

WHO Regional Director Dr Ahmed Al-Mandhari reaffirmed that Pakistan is in the “final stretch” of the road to eradication.

“The progress this year has well-positioned the country to end all poliovirus transmission in 2023. However, ensuring that we reach our goal will require sustained political and administrative commitment during 2023, a year of elections and political transition,” he said. “Under our regional vision of health for all by all, we all have a role to play in ending polio through our collective solidarity and action.”

UNICEF Regional Director for South Asia George Laryea-Adjei said that Pakistan’s success in containing the spread of polio through joint efforts by the government, donors, frontline health workers and partners is truly commendable.

“The recent flooding has exacerbated health risks for millions of children, especially those living in districts historically at the highest risk for polio, so we must redouble efforts to engage parents and caregivers to protect these children,” he said. “The end of polio is near, and we must now go the last mile to ensure every child is protected against this debilitating disease.”

During the visit, the delegation met the prime minister, federal health minister, Pakistan Army’s engineer-in-chief and the heads of provincial governments of Balochistan, Khyber Pakhtunkhwa and Sindh, and reiterated support to help Pakistan end poliovirus transmission by 2023.

Pledging table

2022 pledges from various donors

As Pakistan continues to struggle from the effects of the devastating floods affecting parts of the country, polio staff on the ground continue to assist emergency relief efforts.

In flood-affected districts, the polio effort is supporting establishment of critical health camps, to provide basic clinical services, particularly ensuring treatment of water-borne and vector-borne diseases, and distributing water purification tablets. All routine immunization antigens are also provided to target children and pregnant women. Staff are actively conducting surveillance for communicable diseases, identifying nutrition needs of displaced populations, and collecting and analysing life-saving data to help target response strategies. Polio programmes around the world have a long history of supporting broader public health and humanitarian emergencies, as was the situation earlier this year in Afghanistan, following the devasting earthquake there.

At the same time, the polio programme is adapting its operations, to ensure polio eradication efforts can continue unabated, even amid the tragedy. The programme is at a critical juncture – intensive response is ongoing to stop this year’s outbreak in southern Khyber Pakhtunkhwa. Virus linked to this outbreak was this month detected in an environmental sample from Karachi, in the south of the country. At the same time, the high transmission season for polio transmission is now starting and this transmission risks being particularly intense given the floods.

But despite these challenges, polio staff are working double-time: adapting polio approaches, while supporting life-saving flood relief efforts.

“I have been fortunate enough to be present when a number of countries successfully eradicated polio,” commented Dr Hamid Jafari, Director for Polio Eradication at the World Health Organization’s Regional Office for the Eastern Mediterranean. “Rarely have I seen such commitment and dedication than I have seen in Pakistan – from national political leaders, to health workers, right to the mother and father on the ground. To all who are involved, all I can say is: Thank you! You are making a huge difference to people’s lives, which goes far beyond the effort to eradicate polio.”

While detection of virus in Karachi is not unexpected, given the large-scale and frequent population movements between Karachi and the rest of the country, in particular Khyber Pakhtunkhwa. urgent efforts are underway, coordinated by the national and provincial Emergency Operations Centres (NEOC and PEOC), to continue surveillance efforts in greater Karachi and further boost immunity levels through health camps, to prevent polio from establishing a foothold in Pakistan’s largest city which has historically been a major polio reservoir.

Despite the extraordinary climatic conditions and consequent operational challenges aggravated by the collapse of infrastructure, the programme continued with the August polio campaign – including across Karachi – and re-adjusted the schedule in all accessible areas. While the immunization campaign could not be conducted in Balochistan and parts of Sindh, the effort managed to reach nearly 32 million children in the country, with health workers wading through deep water to reach children with the life-saving vaccine.

At the same time, the programme has undertaken contingency planning to resume intensified vaccination activities in southern Khyber Pakhtunkhwa to stop the outbreak, as soon as the situation allows. The programme continues to innovate, adapt, and find opportunities to build children’s immunity through vaccination at health camps, at transit points, in settlements for displaced persons.

And, of course, national and subnational authorities are coordinating activities with neighbouring Afghanistan, particularly in border regions, given that both countries represent a single epidemiological block. Confirmation this month of Afghanistan’s second case this year, from Kunar province, confirms the risk any residual transmission on either side of the border continues to pose to children across this block.

Kunar, along with the rest of the country’s Eastern Region, is part of one of three, critical cross-border epidemiological corridors with Pakistan, the northern corridor specifically comprising of Eastern Region and central Khyber Pakhtunkhwa in Pakistan. Case response is currently being planned in the immediate area and the broader corridor. The other two cross-border epidemiological corridors are the southern corridor, comprising Quetta Block of Pakistan and Southern Region, Afghanistan; and, the central corridor, comprising southern Khyber Pakhtunkhwa and South-East Region in Afghanistan.

Districts along the border of Pakistan and Afghanistan in the three epidemiological corridors are at high-risk for poliovirus transmission, given the high proportion of zero-dose children and inconsistent quality of polio vaccination campaigns in some areas.

The Pakistan and Afghanistan polio programmes continue to coordinate on surveillance and vaccination activities through the Global Polio Eradication Initiative Support Hub, based in Amman, Jordan.

A polio worker administers the oral polio vaccine to a child in Karachi. Credit: @SalmanMahar

Polio is one of the world’s most devastating diseases. It mainly affects children under five and in one in 200 cases it results in lifelong paralysis. Amazing progress has been made in fighting polio globally: according to UNICEF, there were a reported 20,000 children paralysed by polio in Pakistan in 1994. By 2021, new paralysis cases had dropped to just one child. However, as long as just one child remains infected, all children are at risk.

Identifying and reaching unvaccinated children has been a challenge, but big data startups like Zenysis, in partnership with Pakistan government partners, are making inroads.

Vaccination data is only useful if it’s accurate

Abid Hasan is the project manager for Zenysis – a Gavi INFUSE pacesetter since 2017 – in Pakistan, and he explains the barriers to a more effective vaccination programme in the country:

“Data is like people, in that if data sets don’t talk to each other then they won’t work well. Zenysis gets data and data sets talking.”

Community health workers employed through Pakistan’s Polio Eradication Programme and the Expanded Programme of Immunisation go door to door to collect vaccination data, sometimes using datasheets, sometimes paper, sometimes recording data through WhatsApp. It can be difficult to track families with no formal address, or mobile communities with no fixed address. With 14 million children requiring a polio vaccination every two months, recording accurate data is a mammoth task.

The resulting data can be imperfect, with duplication a particular challenge. This is where Zenysis’s platform comes in. Zenysis software integrates, de-deplicates and harmonises more than 20 siloed datasets, including polio data, immunisation registries and population data.

Combined, the data can be used far more effectively for analysis and, importantly, action on the ground. The result? A new and improved vaccination plan, personalised for each vaccinator’s district – known as a microplan.

A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register. Credit: @SalmanMahar — A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register.
Credit: @SalmanMahar

Microplans help health workers target zero-dose children

The enhanced microplans provide health workers with granular information on each child in a region, including their vaccination status, age and address. This information can be used to identify individual children and highlight neighbourhoods where there are clusters of unvaccinated (zero-dose) children. This in turn means better use of time and energy, and better outcomes for communities.

The effect, explains Hasan, is seen in three key areas. “Firstly, the newmicroplans give community health workers the real picture. Second, frontline workers now have a plan to follow and are no longer using broad or inflated data that is hard to actionize. Third, this approach is measurable – when you reach a target, that goes into the system. With accurate data, you can really see the impact.”

Health workers on the ground have seen the difference. Sadaf, a community health worker for Polio, in Karachi, says: “Before the microplans the vaccinators were given a long list of children with duplicate entries in them, and they were extremely difficult to track. After receiving these microplans we can easily decide where to set up our outreach sites and mobilise children to bring them there for vaccination in a systematic manner.”

The impact has been impressive. Since January 2022, the Expanded Programme on Immunisation in the Sindh region has used the Zenysis platform to identify over 28,500 true zero-dose children in the region and vaccinate 12,724 of them with the aid of microplans. In March to June of this year, 3,854 zero-dose children were vaccinated with the help of the new microplans in the regions where they have been implemented.

Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi. Credit: @SalmanMahar — Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi.
Credit: @SalmanMahar

Gavi support has been vital in creating goals and driving change

Zenysis was part of Gavi’s INFUSE programme, which connects high-impact innovations with the countries that need them most. Hasan explains that for countries like Pakistan, the investment from Gavi is vital to enhance healthcare budgets, but also to help provide momentum and set goals for vaccination programmes.

Looking ahead, Zenysis is collaborating closely with government partners to expand the platform and vaccination approach throughout Sindh province, tackle other vaccine-preventable diseases, and improve the government’s technical platform management capacity.

As Hasan says, “Not everyone is a data expert – but if you can go on a platform, go into a dashboard, and see all your data into one workspace then you can reach a zero-dose child and their family, and get them vaccinated.”

And with each child vaccinated, we get a step closer to a world where infection by wild poliovirus is a thing of the past.

Reposted with permission from gavi.org

In 2021, when the news of cancer hit, Nomina Akhtar felt her world collapsing. It was discovered too late. By the time she knew, it was already stage-3 breast cancer.

Since 2015, Akhtar has been part of Pakistan’s polio programme as a community health worker. During these six years, she has found friends and well-wishers among her team members who have given her the support to carry on.

Akhtar, 43 and a mother of three continues to work for polio eradication as she undergoes treatment for cancer. “I gathered my courage and promised that I will fight till the end and live for my children. All my family, colleagues and seniors were with me whenever I needed support. That gave me courage and made me believe that I could, in fact, beat cancer.”

Based in Peshawar, Nomina’s husband and her three children, aged six, seven and 18, rely solely on her income. The lockdowns due to the pandemic caused her husband, a motorcycle mechanic, to close down his shop that has yet to reopen.

A life with cancer has been both physically and emotionally exhausting. She is undergoing both radiation and chemotherapy in Peshawar. This means a commute of almost 20 kilometers after a whole day of work.

“When I have to go for chemotherapy after work, it becomes very draining. I have to take public transport and wait at the hospital for hours. There are times when I have to return without treatment because either the machine is faulty or something else comes up. This treatment regime along with the medicine will continue for at least five years. It’s excruciatingly painful,” she says.

Polio programme: a great source of strength for Akhtar

“My colleagues are like my extended family, and I am like a sister to them. When I found out about my cancer, they wept with me. They have stood by my children and myself every step of the way.”

The supervisor of her area, Uzma Mansoor, says that when they first heard the news, they were devastated. “But it’s great to see that she has not lost hope and is fighting the disease like a champion,” she said.

The community she works in has also been incredibly supportive. “Some of the people in my work area came to know about my illness and they appreciated the fact that despite fighting cancer, I come to their doorstep during every polio campaign. Irrespective of extreme temperatures and illness, I am there to vaccinate their children and protect them from this life-threatening disease. Their support has increased manifold after this.”

Sahibullah, the Union Council Polio Officer of her area, says not only does Nomina continue to vaccinate children, but she is a role model for all other polio workers.

“It was God’s will, and we will face it with courage,” says her husband Aurangzeb Akhtar. “Despite being ill, Nomina is the one who keeps us going. She is working and earning for our family as well as motivating us to not lose hope. My children and I are so proud of her. Inshallah she will get well very soon.”

Nomina has strong conviction. She is fighting cancer and polio simultaneously, and is determined that she will defeat both very soon. “At least cancer has treatment,” she says. “Polio is incurable and the sooner we end this disease forever, the better.”

Development and Health Ministers of the G7 countries met in Berlin, Germany, last week to hold urgent joint consultations on “supporting vaccine equity and pandemic preparedness in developing countries”. The joint group highlighted the need to accelerate equitable and sustainable access to vaccines everywhere, and to strengthen pandemic preparedness and response in low- and middle-income countries. At the same time, however, the meeting cautioned against letting global crises interfere with other development and public health priorities and urged continued support for existing efforts, including global polio eradication.

The global effort to eradicate polio is a clear and concrete example of the value of working in close integration with other development and public health efforts, and contribute to global pandemic preparedness and response. Polio staff continue to contribute to the COVID-19 pandemic response and immunization recovery efforts, together with the introduction and roll-out of COVID-19 vaccines.

In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.

In October 2022, Germany will generously co-host a global pledging moment, giving the international development community the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

In this two-part video series, we chat with Dr Ananda Bandyopadhyay, Deputy Director of Polio Technology, Research & Analytics, BMGF, about the new tool in GPEI’s kit to combat cVDPV2: novel oral polio vaccine type 2 (nOPV2).

GENEVA, 26 April 2022

Today, the Global Polio Eradication Initiative (GPEI) announced that it is seeking new commitments to fund its 2022-2026 Strategy at a virtual event to launch its investment case. The strategy, if fully funded, will see the vaccination of 370 million children annually for the next five years and the continuation of global surveillance activities for polio and other diseases in 50 countries.

During the virtual launch, the Government of Germany, which holds the G7 presidency in 2022, announced that the country will co-host the pledging moment for the GPEI Strategy during the 2022 World Health Summit in October.

“A strong and fully funded polio programme will benefit health systems around the world. That is why it is so crucial that all stakeholders now commit to ensuring that the new eradication strategy can be implemented in full,” said Niels Annen, Parliamentary State Secretary to the Federal Minister for Economic Cooperation and Development, Germany. “The polio pledging moment at the World Health Summit this October is a critical opportunity for donors and partners to reiterate their support for a polio-free world. We can only succeed if we make polio eradication our shared priority.”

Wild poliovirus cases are at a historic low and the disease is endemic in just Pakistan and Afghanistan, presenting a unique opportunity to interrupt transmission. However, recent developments, due in part to impacts of the COVID-19 pandemic, underscore the fragility of this progress. In February 2022, Malawi confirmed its first case of wild polio in three decades and the first on the African continent since 2016, linked to virus originating in Pakistan, and in April 2022 Pakistan recorded its first wild polio case since January 2021. Meanwhile, outbreaks of cVDPV, variants of the poliovirus that can emerge in under-immunized communities, were recently detected in Israel and Ukraine and circulate in several countries in Africa and Asia.

The investment case outlines new modelling that shows achieving eradication could save an estimated US $33.1 billion this century, compared to the price of controlling polio outbreaks. At the launch event, GPEI leaders and polio-affected countries urged renewed political and financial support to end polio and protect children and future generations from the paralysis it causes.

“Despite enormous progress, polio still paralyses far too many children around the world – and even one child is too many,” said UNICEF Executive Director Catherine Russell. “We simply cannot allow another child to suffer from this devastating disease – not when we know how to prevent it. Not when we are so close. We must do whatever it takes to finish the fight – and achieve a polio-free world for every child.”

“The re-emergence of polio in Malawi after three decades was a tragic reminder that until polio is wiped off the face of the earth, it can spread globally and harm children anywhere. I urge all countries to unite behind the Global Polio Eradication Initiative and ensure it has the support and resources it needs to end polio for everyone everywhere,” said Hon. Khumbize Kandodo Chiponda MP, Minister of Health, Malawi.

The new eradication strategy centres on integrating polio activities with other essential health programs in affected countries, better reaching children in the highest risk communities who have never been vaccinated, andstrengthening engagement with local leaders and influencers to build trust and vaccine acceptance.

“The children of Pakistan and Afghanistan deserve to live a life free of an incurable, paralyzing disease. With continued global support, we can make polio a disease of the past,” said Dr Shahzad Baig, National Coordinator, Pakistan Polio Eradication Programme. “The polio programme is also working to increase overall health equity in the highest-risk communities by addressing area needs holistically, including by strengthening routine immunization, improving health facilities, and organizing health camps.”

The investment case outlines how support for eradication efforts will enable essential health services in under-served communities and strengthen the world’s defences against future health threats.

Since 2020, GPEI infrastructure and staff have provided critical support to governments as they respond to the COVID-19 pandemic, including by promoting COVID-safe practices, leveraging polio surveillance and lab networks to detect the virus, and assisting COVID-19 vaccination efforts through health worker trainings, community mobilization, data management and other activities.

“The global effort to consign polio to the history books will not only help to spare future generations from this devastating disease, but serve to strengthen health systems and health security,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

Additional quotes from the GPEI Investment Case:

“We have the knowledge and tools to wipe polio off the face of the earth. GPEI needs the resources to take us the last mile to eradicating this awful disease. Investing in GPEI will also help us detect and respond to other health emergencies. We can’t waver now. Let’s all take this opportunity to fully support GPEI, and create a world in which no child is paralyzed by polio ever again,” said Bill Gates, Co-chair, Bill & Melinda Gates Foundation.

“An investment in polio eradication goes further than fighting one disease. It is the ultimate investment in both equity and sustainability – it is for everyone and forever. An important component of GPEI’s Strategy focuses on integrating the planning and coordination of polio activities and essential health services to reach zero-dose children who have never been immunized with routine vaccines, therefore contributing to the goals of the Immunization Agenda 2030.” said Seth Berkley, Chief Executive Officer, Gavi, the Vaccine Alliance.

“Twenty million people are walking today because of polio vaccination, and we have learned, improved and innovated along the way. We are stronger and more resilient as we enter the last lap of this marathon to protect all future generations of the world’s children from polio. Please join us; with our will and our collective resources, we can seize the unprecedented opportunity to cross the finish line that lies before us,” said Mike McGovern, Chair, International PolioPlus Committee, Rotary International.

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Investment Case 2022-2026

Media contacts:

Oliver Rosenbauer
Communications Officer, World Health Organization
Email: rosenbauero@who.int
Tel: +41 79 500 6536

Ben Winkel
Communications Director, Global Health Strategies
Email: bwinkel@globalhealthstrategies.com
Tel: +1 323 382 2290

Sabrina Sidhu
UNICEF New York
Email: ssidhu@unicef.org
Tel: +19174761537

April 2022 – Convening this month in Geneva, Switzerland, the Strategic Advisory Group of Experts on immunization (SAGE), the global advisory body to the World Health Organization (WHO) on all things immunization, urged concerted action to finish wild polioviruses once and for all.

The group, reviewing the global wild poliovirus epidemiology, highlighted the unique opportunity, given current record low levels of this strain. At the same time, it noted the continuing risks, highlighted in particular by detection of wild poliovirus in Malawi in February, linked to wild poliovirus originating in Pakistan.

On circulating vaccine-derived poliovirus (cVDPV) outbreaks, SAGE expressed concern at continuing transmission, in particular in Nigeria which now accounts for close to 90% of all global cVDPV type 2 cases, as well as the situation in Ukraine, and its disruption to health services, urging for strengthening of immunization and surveillance across Europe. It also noted the recent detection of cVDPV type 3 in Israel in children, and in environmental samples in occupied Palestinian territories, and urged high-quality vaccination activities and strengthened surveillance.

Preparing for the post-certification era, the group underscored the importance of global cessation of all live, attenuated oral polio vaccine (OPV) use from routine immunization, planned one year after global certification of wild poliovirus eradication. To ensure appropriate planning, coordination and implementation, the group endorsed the establishment of an ‘OPV Cessation Team’, to consist of wider-than-GPEI stakeholder participation and ensure leadership on all aspects of OPV cessation.

SAGE will continue to review available evidence and best practices on a broad range of GPEI-related programmatic interventions, including as relevant the increasing role of inactivated polio vaccine (IPV), including in outbreak response and effects of novel oral polio vaccine type 2 (nOPV2), as part of global efforts to secure a lasting world free of all forms of poliovirus.

This International Women’s Day, we get to meet some of the women leading the polio eradication efforts in Pakistan.

Cairo, 10 February 2022 – The fourth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks was convened on Wednesday 9 February, by WHO’s Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari. The meeting was attended by health ministers or their representatives from Djibouti, Egypt, the Islamic Republic of Iran, Pakistan, Qatar, Saudi Arabia, Sudan, United Arab Emirates and Yemen.

The Subcommittee declared the ongoing circulation of any strain of poliovirus in the Region to be a regional public health emergency and called on all authorities to enable uninterrupted access to the youngest and most vulnerable children through the resumption of house-to-house vaccination campaigns. It issued statements on wild poliovirus circulation in Afghanistan and Pakistan and on the circulation of vaccine-derived poliovirus strains in Yemen, where limits on house-to-house vaccination are preventing access to the most vulnerable children.

The spread of polio in the Eastern Mediterranean Region is a pressing emergency and it remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005).

Members noted a sharp decrease in cases of wild poliovirus in Afghanistan and Pakistan in 2021 but warned against complacency.

“Wild poliovirus transmission is at a historic low in the endemic countries of Afghanistan and Pakistan. The progress is remarkable, but it is fragile. The opportunity to end polio is knocking at our door, and we must seize it,” said Dr Al-Mandhari.

Speaking to the progress made in the last year, the Special Assistant to the Prime Minister on Health, Dr Faisal Sultan, assured members that the programme in Pakistan was leaving no stone unturned in the pursuit of zero polio transmission.

“We have intensified efforts in the hardest districts and core reservoirs and we are closely monitoring transmission across the border in coordination with Afghanistan, taking measures to respond to outbreaks if they occur and making every effort to ensure that the virus doesn’t spill over in either direction. To boost the confidence of marginalized communities, we are also providing essential services and vaccination of other antigens and diseases,” he said.

Outbreaks of circulating vaccine-derived polioviruses type 1 (cVDPV1) and type 2 (cVDPV2) continued to emerge and spread in the Region in 2021. As of February 2022, Afghanistan, Djibouti, Egypt, Pakistan, Somalia, Sudan and Yemen are responding to transmission of vaccine-derived polioviruses.

“The increasing outbreaks of circulating vaccine-derived poliovirus type 2 in the Eastern Mediterranean Region and neighbouring countries of Africa are deeply concerning and must be stopped rapidly. To do so, we need to ensure that we are creating an enabling environment for health workers to reach children with those two drops of polio vaccine,” said newly nominated co-chair H.E. Dr Hanan Mohamed Al Kuwari, Minister of Public Health of Qatar.

During the meeting, Djibouti’s Public Health Minister, Dr Ahmed Robleh Abdilleh, shared plans for vaccination campaigns and increased surveillance in response to the transmission of cVDPV2, recently detected through the newly launched environmental sampling programme.

Reflecting on the work of the Subcommittee, co-chair and Minister of Health and Prevention of the United Arab Emirates H.E. Abdul Rahman Mohammed Al Owais urged members to sustain the commitment seen in in 2021.

“We have together advocated for an increase in domestic funds, we have driven collaborative public health action in our own countries, and collectively pushed for a regional response to address the regional public health emergency of the poliovirus. But these things alone will not end transmission,” he said.

Dr Al-Mandhari expressed appreciation for Egypt’s role as the first country in the Region to roll out a nationwide vaccination campaign using the novel poliovirus vaccine, and Chris Elias, Chair of the Polio Oversight Board, praised the remarkable progress made in polio eradication in Pakistan with support of the United Arab Emirate’s Pakistan Assistance Programme.

“This regional solidarity and commitment we have seen, through this Subcommittee, is something I am proud of. It is this commitment to the end goal that will help push us over the last mile,” said Dr Hamid Jafari, director of the regional polio programme and co-facilitator of the Regional Subcommittee.

Dr. Nida vaccinating a young boy. © Nida Ali

Dr Nida Ali joined the Polio Eradication Programme in her native Pakistan in 2017. A graduate of the medical faculty at Hamdard University in Karachi, she reflects on her time with the programme, the role of women and the eradication of polio in one of the last countries where it remains endemic.

I worked for the polio programme in Pakistan for four years and 10 months. It wasn’t easy – but then, what is? I look back at those long years and cry at the times when I laughed and laugh at the times when I cried. The programme gave me lot: exposure, experience, learning opportunities, knowledge, skills, and excellent colleagues from whom I learned a lot. But the ultimate gain was, of course, the children in my own country, including my son, who took polio drops in every polio immunization campaign.

I joined the programme in 2017, as Polio Emergency Response Officer in the provincial office in Punjab. I’m originally from Rawalpindi and before joining the programme, I worked on a government-led Reproductive Health programme which sparked my interest in public health.

I’d read about polio as part of my paediatrics study at medical school but I didn’t see a case of polio until I joined the programme. It was WPV (Wild Poliovirus Type 1) and it was in Punjab, a very small child who wasn’t even a year old. The second case I saw was a case I investigated when I was working as a Polio Eradication Officer in Islamabad. All the signs were there – the child lived in a very densely populated household where the hygiene conditions weren’t good, in a part of town where a lot of travellers were coming and going. He’d also been what we call a ‘refusal’, meaning that his caregivers had refused to allow him to be vaccinated. I examined the child and it was a classic case of Acute Flaccid Paralysis, or AFP, one of the signs that the virus may be circulating in the community. The ankle reflex was present but the knee reflex was lost. We sent samples to the laboratory and it was declared as a positive case of polio.

I held a number of roles during my time with the programme – Area Coordinator, Rapid Response Officer, Divisional Surveillance Officer – and I was fortunate enough to travel to other provinces. I went to northern KP (Khyber Pakhtunkhwa) to respond to a WPV outbreak, and to southern KP and Gilgit-Baltistan for post campaign monitoring. I learned some phrases of the local language in northern KP – how many children do you have in the house, the numbers from one to ten, how many children are vaccinated, can I see their finger mark – phrases that helped me make a connection with mothers and understand their responses. I also used to take out my phone and show them photos of my son – he was four years old at the time – and tell them that he takes the polio drops in every campaign. It was great to make such a human connection and I was able to convince many refusals that way.

Seeing the programme at field level gave me great insights but so did working at the National Emergency Operations Centre (EOC) in Islamabad. It’s where all the work and knowledge comes together, and where staff from all the different the provinces come so it was a great opportunity to meet them and exchange experiences.

Women make up around 40 percent of the polio programme but mainly as frontline workers who go from house to house to vaccinate millions of children across the country. There aren’t so many women at higher levels, often because women don’t apply for these positions, which is a shame. On many occasions I found myself to be the only woman in a large meeting room, particularly the meetings where policies and protocols are discussed. I think the presence of more women in leadership roles will bring an interesting perspective to the programme, particularly given our roles as mothers and caregivers.

Today I’m in Atlanta, studying Global Health at Emory University. It was my experience with the polio programme that helped me get through all the stages of obtaining scholarship and a placement in such a reputed University. This is an interesting opportunity of learning from the experts, which again, is not new to me as this is exactly what I’ve been doing at the polio programme in Pakistan. I’m not sure where this will lead me – back to polio or to another part of public health, I don’t yet know. All I know is that I will go where my expertise leads me.

I hope one day I can tell my son the story of how polio was eradicated and how no child will ever be paralyzed by this virus again. I hope by that time, we direct our resources for protecting children from other diseases or, even better, to curb the infections that have potential to lock the whole world down.

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 Faisal 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 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

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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

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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