Broader benefits of the polio programme

When a 5.9-magnitude earthquake struck south-eastern Afghanistan in the early hours of 22 June 2022, WHO’s polio workers were among the first responders. As dawn broke in Khost and Paktika provinces, and the extent of the devastation became evident, they helped attend to the many injured.

WHO’s polio teams dressed wounds, provided trauma care and generally gave a helping hand wherever needed. This included digging for survivors, putting up tents, unpacking trucks and distributing shipments of WHO emergency and surgical kits, medical supplies and equipment. Polio workers were also involved in the heartbreaking task of preparing the dead for burial.

Here they reflect on their experiences.

Mr Najibullah, District Polio Officer, Gyan district, Paktika

My name is Najibullah, and I am the District Polio Officer for Gyan district in Paktika province. When the earthquake struck Gyan, I was at home, sleeping. I woke up because the house was shaking and dust was falling on me. It was dark and I didn’t know what had happened until I heard people’s shouts.

“We used a tent and beds and chairs from people’s houses and by late morning we had built a small temporary clinic.”

The phones were still working so I called our Provincial Polio Officer and let him know what had happened. I was the first person to report the earthquake in Gyan. After finishing my call, I ran to help rescue the injured.

It was dark but I could see houses were destroyed and could hear people screaming and crying. We used any cars that were available to transport the injured to the nearest clinic for first aid. But there were many injured and the clinic was 4 kilometres away, so we established a makeshift clinic in the village. Our polio staff, who live all over the district, came to help. We used a tent and beds and chairs from people’s houses and by late morning we had built a small temporary clinic.

I have worked for the Polio Eradication Programme in Gyan for 20 years. Over the next 5 days, I used my local knowledge to help guide partners and other agencies, directing them to the most affected areas. I accompanied United Nations partners to every village – anywhere people needed assistance and medical services – and used my familiarity with the region to help map out the UN-wide response.

In Gyan district, we have 11 villages, and more than 19 000 people were affected by the earthquake. It was difficult to move from one village to another because the roads, which are unpaved, were badly damaged by the earthquake.

In such a devastating time of need, I did everything I could to help my people, both day and night. I remember I even helped rescue livestock trapped in the rubble.

Dr Gul Mohammad Marufkhil, Coordinator of the Polio Eradication Programme, Paktika

My name is Dr Gul Mohammad Marufkhil, and I am the coordinator of the polio programme in Paktika province. I was in Sharan district, about 80 kilometres from Gyan, when the earthquake struck.

“We did all we could to make sure we provided support and help to our communities.”

When Mr Najibullah called me to tell me what had happened in Gyan, I immediately called WHO’s field office in Gardez. It was the middle of the night, but I organized an emergency meeting with all our local partners to begin to respond to the earthquake. We requested medical kits, food and tents to be sent to the affected area as soon as possible.

I was tasked with communication, coordination, and arranging aid packages for communities affected by the earthquake. My job was to gather information about the number of injured, the casualties and the level of destruction to buildings and infrastructure and share this with our partners.

In the morning, equipment including medical kits, food packages and tents began to arrive from Gardez, Ghazni, Kabul and Khost. I worked with our teams to transport and distribute these items in both Bermel and Gyan districts.

I am very proud of all our work during that difficult time. We did all we could to make sure we provided support and help to our communities.

Dr Sultan Ahmad, Polio Provincial Officer, Paktika

My name is Dr Sultan Ahmad, and I serve as the Polio Provincial Officer in Paktika province. I was in Urgun, a neighbouring district to Gyan, when the earthquake struck. The shaking woke me up, but there was no destruction near me.

“I managed the flow of injured people to ensure that those who could be treated at Urgun were seen to there and the critically injured transported to Gardez or Kabul.”

After Mr Najibullah called and told me about what had happened in Gyan, I immediately went to the district hospital and alerted the doctors and other staff to prepare to receive the injured. I then dispatched a team of doctors and nurses and 7 ambulances to Gyan as well as to Bermel district, which had also been severely damaged.

As the sun rose, more ambulances and medical teams arrived in Urgun. I managed the flow of injured people to ensure that those who could be treated at Urgun were seen to there and the critically injured transported to Gardez or Kabul for further treatment. When medicines and medical kits began to arrive, I coordinated their distribution to the district clinics where the injured were being treated.

Many, many people were injured as a result of the earthquake, and I am very proud of my role in organizing teams and helping save lives.

Mr. Jan Mohammad, District Polio Officer, Bermel district, Paktika

My name is Jan Mohammad, and I am the District Polio Officer in Bermel district in Paktika province. I was in Bermel when the earthquake happened. I felt the earthquake; it was very strong, so I knew people would be affected. I immediately mobilized our local polio workers to travel with me to the affected area and assist the survivors.

“About 9000 people live in the area but there are no clinics and no doctors, so we provided essential first aid to those in need.”

It took us about 5 hours to drive there. When we arrived, we saw buildings had collapsed and people were trapped. We jumped out of the car and began digging in the rubble to extract people trapped beneath their damaged houses. About 9000 people live in the area but there are no clinics and no doctors, so we provided essential first aid to those in need. As makeshift clinics were set up and mobile health teams arrived, our team facilitated the transportation of the injured to the clinics.

I worked with other UN agencies, using my local knowledge to help guide them to the location of communities where there might be more injured people. I also advised on where to set up temporary clinics and distribution points for food packages to reach as many people as possible.

I took great pride in everything my team did to help the people of my district at such a critical time.

24-30 April marks World Immunization Week, an opportunity to highlight vaccines as one of humanity’s greatest achievements, saving millions of lives every year. This year, World Immunization Week will celebrate 50 years of the Expanded Programme on Immunization (EPI) – a collaborative initiative aimed at ensuring universal access to life-saving vaccines for everyone, everywhere. EPI served as an inspiration for Rotary International to launch PolioPlus in 1985, which led to the founding of the Global Polio Eradication Initiative three years later. The GPEI continues to work with its partners around the world to help strengthen immunization systems everywhere.

To mark EPI’s 50^th anniversary, WHO, UNICEF, Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation are collectively launching ‘Humanly Possible’, a global campaign to mark the profound achievements of EPI, and to call on leaders to prioritize investments in immunization. A dedicated campaign website, with key data, messages and calls to action will go live on 24 April.

Polio transition involves repurposing polio assets – knowledge, network and infrastructure – to strengthen the broader public health functions of a country within the overall context of strengthening the national health system. These wider functions include immunization, vaccine-preventable diseases surveillance, and emergency preparedness and response.

To safeguard polio essential functions through sustainable resources, it is crucial to achieve the full transition by shifting from external to domestic financing. In turn, successful polio transition and the integration and maintenance of polio assets to strengthen routine immunization, disease surveillance and outbreak response have social and economic benefits and offer a very high return on investment.

Read more on the WHO EMRO website.

On 27 March 2014, India was officially certified wild polio-free. This pivotal moment not only marked a triumph for the country itself, but as the last country battling the virus in the WHO South-East Asia Region (SEARO), it also paved the way for the entire SEARO region to be certified wild polio-free—a massive undertaking for the world’s largest region, spanning from India to Indonesia.

As we celebrate the 10-year anniversary of this triumph, we catch up with a few experts who worked on polio eradication India – Deepak Kapur (Chairman, Rotary International’s Polio Plus Committee), Dr. Roma Solomon (Former Executive Director, CORE Group Partners Project India Secretariat), Dr. Jay Wenger (Director, Polio, Bill & Melinda Gates Foundation), and Dr. Naveen Thacker (President, The International Pediatric Association). Their reflections serve to remind us of the collective will and commitment that made overcoming a seemingly insurmountable health challenge possible.

Economic and social benefits totalling an estimated US$ 289.2 billion arise from sustaining polio assets and integrating them into expanded immunization, surveillance and emergency response programmes in 8 countries of the Eastern Mediterranean Region, the study reveals. As the present cost of this work is US$ 7.5 billion, this means that for every dollar spent, the return on investment is nearly US$ 39.

WHO commissioned the Victoria Institute of Strategic Economic Studies, Australia, to conduct the study, which is the first of its kind. It covers 8 polio transition priority countries in the Region: Afghanistan, Iraq, Libya, Pakistan, Somalia, Sudan, Syria and Yemen. Many of these countries are fragile, with challenges ranging from weak health systems and low routine vaccination coverage to political instability.

Read more on the WHO EMRO website.

Integration involves using polio tools, staff, expertise, and other resources to deliver important health interventions alongside polio vaccines – from measles vaccines and other essential immunizations to birth registration, counselling on breastfeeding, hand soap and more. It also includes incorporating polio vaccines into other planned health interventions when possible, delivering more services with fewer resources.

There is no one-size-fits-all approach to integration. From the remaining endemic countries to countries affected by variant poliovirus outbreaks, activities must be country-driven and adapted to fit the unique challenges and needs of different communities.

Humanitarian engagement in Afghanistan:

In Afghanistan, supplementary immunization activities are essential to vaccinating children. However, in the context of an unprecedented humanitarian crisis and extremely fragile health system, integrating polio efforts with other health services has helped the program reach even more children.

Endemic transmission of WPV1 in Afghanistan has been restricted to the east region. Remaining pockets of inaccessible, unvaccinated children amid a broader humanitarian crisis pose challenges to stopping the virus for good. Today, more than two-thirds of the country’s population is in serious need of food, clean water, functioning sanitation facilities, and basic health services.

WHO Representative in Afghanistan, Dr. Luo Dapeng, vaccinating children against measles in a mobile clinic in Baba Wali Village of Kandahar province. © WHO/Afghanistan

Building upon a strategy that has been in place for several years, ongoing collaboration with humanitarian organizations has demonstrated the value of integrating polio efforts with other health needs in the country. In 2023, the program began engagement with ten humanitarian partners operating in 12 high-risk provinces for polio across Afghanistan. Through these collaborations, the program and its partners have mapped and supported communities that lack basic health services, which has helped better identify and reach children still vulnerable to polio.

Between January and October 2023, more than 1 million polio vaccinations have been delivered through the engagement with humanitarian partners. Through this effort, it’s estimated that more than 30,000 children have been vaccinated who would have otherwise remained inaccessible to the polio program during its standard campaigns¹.

The Far-Reaching Integrated Delivery partnership in Somalia:

In Somalia, children are at high risk of encountering and spreading the poliovirus due to longstanding security challenges and a lack of health infrastructure, particularly in the south-central part of the country. As a result, the country has historically low routine immunization levels and faces the world’s longest-running outbreak of type 2 variant poliovirus.

A health worker administers polio vaccine (nOPV2) drops to a child at Luley IDP camp during a door-to-door polio immunization campaign in Kahda district, Mogadishu, Somalia on May 28, 2023. © Ismail Taxta/Getty Images

To help address these challenges, in October 2022, the GPEI partnered with the World Food Program Innovation Hub, Save the Children, Acasus, and World Vision’s CORE group, amongst others, to launch the Far-Reaching Integrated Delivery (FARID) partnership. The partnership’s primary goal is to stop poliovirus transmission and reduce deaths from preventable diseases and malnutrition.

To do this, the polio program and its partners have established a series of health camps across 20 districts in the country that provide families with vaccinations for polio and other infectious diseases, maternal health services, nutrition screening and supplements, and primary health consultations². These camps are tailored to address each community’s specific needs and aim to re-establish sustainable health systems that will continue providing primary health services on a routine basis.

Between October 2022 and June 2023, FARID partners have visited 136 high-risk communities in Somalia, reaching almost 30,000 people; vaccinating more than 8,000 children, 6,000 of which had never received any kind of vaccine; and conducting over 10,000 maternal health and 4,000 nutrition consultations³.

Read more about the polio program’s latest integration efforts here.

Influencers from the French gaming community holding PSG scarfs made to support the #ENDPOLIO campaign

The Global Polio Eradication Initiative and the Paris Saint Germain Endowment Fund (PSG) call for one last push in the fight to eradicate polio
Renowned footballers, influencers from the French gaming community, Bill Gates, co-chair of the Bill & Melinda Gates Foundation and Emmanuel Macron unite to create excitement among the younger generation
An innovative activation resulted in the creation online of the gamer, “@P0L__10” —a pseudonym for polio— as all corners joined forces in the fight against the disease at the Gustave Eiffel Lounge on the first floor of the Eiffel Tower

PARIS (6 December): Last night, the French gaming community made a call for collective action to defeat a common adversary – only it was not an online gaming threat, but poliovirus, a debilitating infection that has been paralysing children for centuries.

Throughout the event, gamers battled on the EA SPORTS FC 24 pitch in a tournament to determine who would be the player chosen to defeat @P0L__10, a seemingly unbeatable opponent who had been tormenting players online in the preceding days. As the challenger was decided, it was revealed that this common adversary, @P0L__10, was in truth an alias for polio, a persistent foe that the world is on the brink of eradicating.

Since the Global Polio Eradication Initiative was formed in 1988, cases of the once ubiquitous polio have fallen by over 99%, and today the wild virus is confined to pockets of just two countries – Pakistan and Afghanistan. Still, poliovirus continues to threaten millions of children around the world, and until we stop all forms of polio everywhere, we all remain at risk. Thankfully, because this virus has been eliminated in most places, younger generations in much of the world have never witnessed this highly infectious and devastating virus impact on their friends and family members.

Participants being introduced ahead of the EA Sports FC24 tournament

“As long as this virus continues to exist anywhere, young people everywhere, including here in France, remain at risk,” said Les Twins, a famous duo of Franco-American content creators on FC24, who hosted and broadcast on their Twitch channel (229K subscribers) Tuesday evening’s event at the Salle Gustave Eiffel, on the first floor of the Eiffel Tower. “The young, vibrant esports community in France is strong and capable, and tonight we showed that when we rally behind a cause we can make great things happen.”

“Gaming is important, but not as important as the lives of children around the world. This is our generation’s chance to really make a difference”, said Arsène Froon, Paris Saint-Germain (PSG), host whom the tournament’s winner was given the chance to challenge after the audience discovered he was hiding behind the character of P0L__10. Arsène delivered his message to an audience that included not just influential figures in gaming, but also PSG players from the female team, Ana Vitória, Océane Toussaint and Constance Picaud, e-players Nkantee and Amarr as well as European polio advocates. Our commitment to this cause is also a homage to Guy Crescent, the pioneer and founder of PSG, who himself was affected by poliomyelitis and contributed greatly to the club’s development.

French President Emmanuel Macron and Bill Gates, co-chair of the Bill & Melinda Gates Foundation, spoke to the crowd via video as polio was revealed to be the true adversary, echoing the sentiment that it is only with collective support and action that the eradication of this disease can be achieved. Just hours before the event, the Agence Française de Développement (AFD) announced up to €55 million in support to Pakistan, filling a critical funding gap in the country’s commitment to stop polio. These funds build on France’s monumental pledge of €50 million at the 2022 GPEI Pledging Moment in Berlin.

Photo of Emmanuel Macron and Bill Gates’ video played during the event

The vibrant event was a testament to the power of collaboration across sectors, bringing together the worlds of gaming, sport, and health advocacy in an historic collaboration, by captivating and engaging the younger generations to work together to end @P0L__10 and continue the fight to make polio history.

Further voices have joined the movement, including Gims, the Congolese-French singer, rapper, and activist who added, “I am super excited to join the efforts of Bill Gates, the Global Polio Eradication Initiative, and government leaders in the mission to eradicate polio in the Democratic Republic of Congo and around the world. Together, we will end polio and save tens of thousands of children from this devastating disease.”

About GPEI

The Global Polio Eradication Initiative is a public-private partnership led by national governments with six partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Its goal is to eradicate polio worldwide.

For press inquiries, please contact Jacob Baskes, jbaskes@globalhealthstrategies.com

About the PARIS SAINT-GERMAIN FOUNDATION AND ENDOWMENT FUND:

Since its creation in 2000, the Paris Saint-Germain Foundation has sought to help disadvantaged and sick children and deprived communities. It organises educational and sport programmes in France and around the world that use sport and its values as levers for learning, self-fulfilment and solidarity. In 2013, the Paris Saint-Germain Foundation set up an endowment fund to collect donations made by individuals and companies to help it develop its social responsibility and community programmes. Through these programmes, which enable disadvantaged people to integrate into society and the world of work, and through its Red and Blue Schools, its support for refugees and its charity donations, the Paris Saint-Germain Foundation harnesses the educational and emotional benefits of sport to come to the aid of people in need.

For press inquiries, please contact: Sarah Machkor, smachkor@psg.fr

A polio worker marking a child’s finger during the first polio campaign after the floods. © WHO/Pakistan

Pakistan, one of the last two endemic countries for wild polio, is closer than ever before to ending this devastating disease for good. However, many experts say Pakistan is among the countries most vulnerable to the climate crisis. As the world becomes hotter, more frequent and severe heatwaves, intense droughts, and devastating floods, threaten the incredible progress that has been made against polio.  

Just last year, from May to October 2022, a historic heat wave was followed by heavy monsoon rains and melting Himalayan glaciers, causing the worst floods in Pakistan’s history—almost one-third of the country was under water at its peak. One in seven people in the country were affected by these floods and close to eight million people were displaced, including thousands of polio workers themselves.¹  

Critical infrastructure across the country was also damaged, from roads and bridges to health and sanitation systems. Such devastation following floods and storms leads to wastewater overflow, compromising safe drinking water and spreading pathogens like cholera and polio.² This increases the risk of people encountering these life-threatening diseases while making it even harder to reach every child with the necessary vaccines to protect them. 

In response to this climate emergency,³ the programme activated extreme weather contingency plans to resume immunization activities for polio and other vaccine-preventable diseases as soon as possible. This included adjusting campaign schedules and strategies, such as conducting vaccinations at health camps, at transit points, and in settlements for displaced persons. In some cases, this meant wading through deep water to reach children with life-saving vaccines. Despite the extraordinary circumstances, the programme managed to reach nearly 32 million children in the country during its August 2022 campaign. 

Health worker Shahida Saleem sits outside her house in Fatehpur, Rajanpur district during a polio campaign in September 2022. © WHO/Pakistan

The GPEI also committed to supporting more than 12,500 polio workers across the country who were impacted by the floods.⁴ Nasreen Faiz, a team member who took part in polio campaigns following the floods, was among those affected. “One after the other, house after house was destroyed… My entire village was finished. The crops were gone, the homes were gone, the animals were dead,” she recounted. Shahida Saleem, another polio worker, evacuated her home for the floods and came back to find it severely damaged and her belongings under three-feet deep water. 

The GPEI quickly secured funds to compensate those workers who suffered full or partial damage to their homes, like Nasreen and Shahida. As of April 2023, cheques worth Rs216 million (approximately US$752,000) had been distributed to 10,500 polio workers. While no amount of money can offset the loss and havoc from these devastating floods, the GPEI worked to support the workforce as much as possible.  

Lastly, the programme drew on its long history of supporting humanitarian crises to help address the impacts of this climate emergency in the communities it serves. It helped establish critical health camps in flood-affected districts to provide basic health services, from the administration of routine immunizations and treatment of diseases to the distribution of water purification tablets and provision of nutrition services. To continue fighting polio and other infectious diseases, programme staff also actively conducted disease surveillance and collected and analysed data to help target outbreak response strategies in these high-risk settings. 

Above all, working hand-in-hand with communities and local authorities, the polio programme was able to adapt its operations to ensure progress against polio in Pakistan was not lost and the polio workforce and affected communities were supported in the aftermath of this climate disaster. While the programme was able to successfully respond in this instance, it will face even more disruptions like this on the road to ending polio as the world becomes hotter. Learnings from its work in Pakistan following the floods will be essential to ensure that the fight against this devastating disease can continue amid future disruptions, and that its staff and communities are protected along the way. 

[1] https://www.usaid.gov/sites/default/files/2022-12/2022-09-30_USG_Pakistan_Floods_Fact_Sheet_8.pdf
[2] https://www.gavi.org/vaccineswork/over-half-infectious-diseases-made-worse-climate-change
[3] https://polioeradication.org/news-post/pakistan-polio-infrastructure-continues-support-to-flood-relief-while-intensifying-efforts-to-eradicate-polio/
[4] https://polioeradication.org/news-post/after-the-floods/

Since 1988, the number of children affected by polio has reduced by 99 per cent. While the end of polio is within reach, immunization efforts can easily be derailed by the rapid spread of vaccine misinformation, putting vulnerable children at risk.

Take for example Pakistan, one of the two countries where polio remains endemic, where fake videos of children falling sick after receiving polio vaccination spread like wildfire on social media a few years ago. The misinformation caused mass panic and derailed long-fought efforts to immunize millions of children across the country.

While it is near impossible to eliminate misinformation after it has spread, national health systems can actively monitor for and address misinformation as it arises. This is where the Digital Community Engagement (DCE) initiative is proving effective. Based on the Vaccine Misinformation Management Guide, the DCE was launched as a first-of-its kind misinformation management model in 2021 by UNICEF and The Public Good Projects.

The DCE is made up of a central hub that tracks polio misinformation online, develops accurate messaging, and supports digital volunteers and UNICEF country offices. The hub is driven by a global team of experts spread across public health, social behaviour change, online social listening, advertising, content design and influencer marketing.

“In many countries, UNICEF and partners are already working to combat online misinformation in various ways. DCE’s aim is not to replace these systems but strengthen their existing efforts,” said Adnan Shahzad, the Digital Communication Manager of the UNICEF Polio Eradication Team.

The polio ‘listening post’

“Social listening is like a disease surveillance system, but instead of the virus, we track and analyze misinformation. Using cutting-edge digital media and tools we collect and analyze publicly available data on polio and vaccines across social media, digital media, broadcast news and print media platforms,” said Shahzad.

In 2022, over 5 million online social listening results were analysed from 41 countries in more than 100 languages. The most common misinformation pieces claimed that vaccines were unsafe and that they could cause other diseases. Other fear-inducing misinformation involved how vaccines are being used by rich countries or individuals to control the world and depopulate certain continents.

Misinformation pieces are analysed and categorised as low, medium or high risks based on its potential impact to vaccination efforts and how quickly it is spreading. When a high-risk misinformation is going viral (within a 24-hour period), the DCE central hub sends an urgent alert to UNICEF country and regional offices and also sends a weekly compilation of news and alerts in the form of a newsletter

Examples of high-risk misinformation alerted to country teams:

Clear and accurate messages are crucial

“What we say must be accurate and easy to understand for everyone,” says Soterine Tsanga, Polio Outbreak Response SBC specialist with UNICEF, who is also involved in the roll out of DCE to countries. “When there’s a polio outbreak, our goal is to respond swiftly to reach children with vaccination and stop further spread of the virus. We cannot afford to have our own messaging causing confusion among mothers and fathers,” she adds.

Backed by scientific evidence and facts, messages on polio are carefully prepared at the DCE hub in English, French, Urdu and Pashto. The team organizes content into a bank for quick retrieval based on reoccurring themes, such as vaccine effectiveness, safety and side effects.

Quashing rumours

“A big part of UNICEF’s social behaviour change work for polio eradication involves engaging local community mobilisers who continuously listen to concerns about vaccines, clarify doubts and encourage parents and caregivers to vaccinate their children. DCE is the online version of this approach aimed at engaging online communities to quash false information before it becomes viral,” said Sheeba Afghani, the Chief of Social Behaviour Change with the UNICEF Polio Eradication Programme.

The DCE hub recruits digital volunteers through an interactive online platform called uInfluence to promote accurate polio and vaccine information. Digital volunteers or ‘uInfluencers’ are everyday social media users, many of them young people who are already active in online communities.

“I grew up seeing many people suffering from polio and other diseases. We struggled to find solutions for the problems in our community. I want to help by being a source of accurate information about polio,” said Liam, a 26-year-old digital volunteer.

20-year-old Mariam is a first-year student in Management living in Dakar, Senegal. In her spare time, she supported UNICEF as a digital volunteer for a media campaign to share information about polio, tracking misinformation and responding to questions about polio. © UNICEF/Joire

Liam is one of 75,000 digital volunteers working with uInfluence. They repurpose content shared by uInfluence on Facebook and Instagram, dispel vaccine and polio misinformation, and increase engagement on social posts. In 2022, content posted through uInfluence channels and amplified by digital volunteers reached 74 million people.

DCE’s general population advertisement (ad) campaign has also yielded positive results. An ad campaign in January 20203 on Facebook and Instagram encouraged parents and caregivers between ages 18–45 years in Egypt, Mozambique, Nigeria, Pakistan, Somalia, Togo and Zambia to visit the “Polio Facts” page on the uInfluence website. By March 2023, the campaign had reached 7.6 million parents. A post-campaign survey with the target populations helped identify knowledge, attitudes, and perceptions about vaccine safety, efficacy (See Figure 1.) , and polio risk, likelihood of vaccinating children, recommending the vaccine to others, and sharing information on the vaccine.

Local outreach and digital engagement

“The concept behind establishing the DCE central hub was to offer enduring tools for country offices, enabling them to craft localized digital health communications and establish a system that mirrors the central hub,” said Andrea Valencia, the Global Program Manager at PGP.

“DCE presents a significant opportunity for countries to prioritize their communication efforts by employing best practices in messaging. This enables them to bridge the gap between their on-the-groundwork and digital communities, while fostering trust in childhood immunization,” she added.

Pakistan’s polio eradication programme has managed several misinformation crises in the past, many of them about the polio vaccine. In October 2022, a Facebook post falsely claimed that a child had died after receiving the polio vaccine in Balochistan, when in fact she had succumbed to severe pneumonia. The polio social media team responded quickly with a video message from the doctor who had examined the child, stating the real cause of death. Meta and the Pakistan Telecom Authority were alerted as it posed a high risk to the polio vaccination campaign. Meta’s independent Fact Check Team called Soch launched an independent investigation and published an articlediscrediting the misinformation.

Proportion of parents and caregivers in Egypt, Mozambique, Nigeria, Pakistan, Somalia, Togo and Zambia who believe vaccines are effective in protecting children from polio (DCE’s general population ad campaign Jan-March 2023)

In the Democratic Republic of Congo, UNICEF is tapping into its network of young fact checkers (Veilleurs du Web) and U-Reporters to tackle misinformation online and offline using DCE tools. During a polio vaccination campaign in July 2023, U-Reporters spoke with mothers and fathers about polio vaccines in markets, churches and mosques while the fact checkers tracked and responded to fake news and rumours related to polio vaccines.

In Afghanistan, religious leaders are building trust in polio vaccines through their sermons in madrassas, or Islamic schools, and mosques. In Kandahar, an Islamic radio programme helps assuage fears and misinformation about vaccines. The national authorities have also offered their support in managing polio vaccine misinformation. Moving forward, the country is planning to establish a misinformation management taskforce at regional and national level to effectively manage polio vaccine misinformation.

In Yemen, DCE trainings helped the Ministry of Public Health, Social Services Centre, Community Radio stations and a Helpline for Internally Displaced Persons collaborate in establishing basic tools to track rumours and misinformation. They have also expanded the existing COVID-19 helpline managed by medical doctors to track misinformation, respond with accurate information on other health issues, and shar monthly reports with all health partners. Based on the DCE polio message bank model, Yemen is now developing similar resources on measles and oral cholera vaccines.

More opportunities ahead

“DCE can be used for other programmes too. It is an invaluable asset for countering misinformation in health, immunization, and other programmes for the well-being of children,” said Shahzad.

While there has been tremendous progress in getting the social listening and misinformation alert systems up and running, there is always more to do. DCE is now focused on strengthening local misinformation response teams while continuing to engage online communities through digital volunteers.

For Gulzar Ahmed Khan, a 28-year-old polio social mobilizer in Pakistan, tracking and addressing polio misinformation is more important than ever.

“Where I work, people have poor understanding of health matters, especially around vaccines. They fear vaccines, they fear us, the polio workers. I explain to them: I’m here for you, for the health and safety of your children. I’m here despite the intense heat and the biting cold. When you refuse to vaccinate, it is the children who will suffer the most. My only motivation is that children and families are spared the suffering of polio,” says Khan.

Representatives from regions and countries share lessons learned from transition. © WHO/HQ

In Somalia, integrated public health teams, built on the polio network, deliver a broad range of health services, despite challenges posed by ongoing polio outbreaks and the impact of the COVID-19 pandemic. In the Central African Republic, thanks to strong advocacy by the civil society, sustaining polio eradication remains on the health agenda. Meanwhile, India’s significant progress, builds on transforming the networks built initially to eradicate polio to strengthen the country’s essential immunization programme.

From 25 – 26 April, national, regional and global stakeholders, including country representatives, global health partners and donors, and members of civil society, gathered in Geneva to share their experiences of polio transition. The objective of the two-day forum was to agree on the future direction of polio transition, including adjustments that are needed, building on lessons learned.

In his opening remarks at the forum, Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), underscored the rationale for the transition process, “As we move closer to a polio-free world, we must work to sustain the incredible infrastructure that has been set up to eradicate polio.”

“A transformation of this scale and complexity has never been done in public health. We have a huge challenge, and a huge opportunity.”

The challenges and opportunities of a successful transition were recurring themes during the forum. Although much progress has been made since 2018, the COVID-19 pandemic, political and economic instability and a more constrained fiscal environment have complicated transition efforts and strained health systems in many countries. To overcome this, countries have continually adapted transition planning for their contexts, guided by national health priorities, towards strengthening health outcomes, especially in the areas of essential immunization, health emergencies, and primary health care.

Reflecting on these lessons, stakeholders agreed that the renewed global vision for transition should be inspiring, actionable, practical and relevant to all countries. They emphasized that providing coordinated technical and financial support, aligned with country priorities, is critical for success. At the national level, countries should adapt flexible strategies, with realistic milestones.

Strong essential immunization programmes were recognized as crucial for achieving and sustaining polio eradication. Meanwhile, maintaining the poliovirus surveillance system and laboratory network was identified as a critical priority to protect a polio-free world and strengthen broader disease surveillance efforts. It was recognized that there is scope to systematically integrate gender, equity, human rights and the health of refugees and migrants into transition planning, aligned with the country context. Stakeholders also discussed the potential ‘enabling factors’ to make transition a success, and ‘risks’ that need to be mitigated during transition, as well as the specific responsibilities of different stakeholders.

The outcomes of the forum will inform the new Global Vision for Polio Transition that will be shaped by the end of 2023. The vision is an essential component of the post-2023 strategic framework, alongside Regional Strategic Plans, tailored to regional and national context, and a Monitoring and Evaluation Framework to track progress and ensure transparency and accountability.

Dr Tedros concluded his remarks by noting the potential to strengthen health systems through a successful transition.

“Eradicating polio and safeguarding its legacy with stronger health systems will be a gift for our children, and our children’s children.”

Following the forum, Member States offered further guidance on transition during the 76^th World Health Assembly, building on interventions made during the 152nd Executive Board meeting. Member States highlighted that the polio transition strategic framework should aim to integrate polio functions into Primary Health Care towards Universal Health Coverage, align with WHO’s evolving work on pandemic preparedness, resilience and response, and focus on strengthening routine immunization, surveillance, outbreak management and response, national capacity building and partnerships. Considering the ongoing risk of spread of polio, Member States emphasized to have a risk-based approach to transition, backed up by realistic timelines and clear milestones.

The strategic framework will be developed through a consultative process to ensure that the next phase of transition is fit for purpose.

FATEHPUR – In Fatehpur, any mention of the month of August is followed by the word ‘qayamat’.

In Urdu, qayamat is used to express what the end of the world would look like. It could be a physical or metaphorical experience and is often used to describe a feeling, a feeling of utter devastation and destruction, when all is reduced to nothingness.

The world really did seem to end for the people here in Fatehpur, Rajanpur district, when the monsoons, once a celebrated time of the year in Pakistan, brought with them the climate’s wrath. Fatehpur was among the 90 calamity-hit districts in the country after the super floods and rains left a third of Pakistan under water and affected one in seven people in the country of over 220 million.

“We only had 25 minutes to leave the house. All I did was lock the door and run with my family after we heard the announcements to evacuate,” says Sughra Javed, a Lady Health Vaccinator, part of the polio immunization campaign.

But locks could provide little protection from the scale of the disaster that was to come. Shahida left for her mother’s house and came back two weeks later, only to find three-feet-deep water all around and the belongings she had gathered for years, old cotton blankets, a TV set, clothes folded in trunks, all gone.

There was little time here to process this loss. Around a week later, the health workers were back on the field serving at health camps that began in late August, nearly 10 days after Rajanpur experienced its worst floods in history.

“I would be working, vaccinating, but it was so difficult to focus. Seeing the broken structure of my house made me want to run away when I was home, and when in the field at work, it was unbearable to see so many people suffering. One after the other, house after house was destroyed,” says Nasreen Faiz, who was among polio team members part of the September campaign.

“My entire village was finished. The crops were gone, the homes were gone, the animals were dead. But at least we had work, I would keep thinking of the people who didn’t even have work,” she adds.

Rajanpur was among districts where the nationwide immunization campaign was suspended as the calamity unfolded. But polio work continued a month after, in between the destroyed cotton crops and cracked land, still too soft to step on.

For Dr. Shahzad Baig, the Coordinator of the National Emergency Operations Centre (NEOC), it was painful to witness his country experience a humanitarian crisis of this scale. “In the Polio Program, we are all part of one large family. When the floods came, it felt like I was sitting at a distance in Islamabad and witnessing my family members suffer. The very first thing I wanted us to do as a program was to find a way to support our people. On every forum, I would request for help to rebuild the homes of our frontline workers.”

The process of assessing the damage was an arduous one. There are over 350,000 health workers part of the program and to identify the people impacted as well as the extent of their loss, was challenging.

Dr Altaf Bosan, the National Technical Focal Person, explains the challenges of determining the impact of the floods with a workforce as large as that of the polio program.

“It was really a very difficult exercise. We went through multiple layers of verification to determine the number of people affected by the floods. This was done at three levels: through the Emergency Operation Centres at the district and province, and the NEOC,” says Dr Bosan.

Through a comprehensive assessment, the Polio Program determined that more than 12,500 polio workers across the country were affected, and funds were secured for the frontline workers who suffered full or partial damage to their homes. In total, cheques worth Rs216 million have been distributed among 10,500 polio workers so far.

On the first working day of the new year, January 2, Mr. Abdul Qadir Patel, the Federal Health Minister handed over cheques to the Provincial Coordinators of the Emergency Operations Centres (EOC). In Sindh, the process was completed at the end of last year following an inauguration by the Health Minister in Thatta district.

“I really commend the team working on it. It really was not an easy task to manage cheques for each individual and deliver them across the country,” Dr Bosan adds.

Nasreen has also received the cheque for financial support as have some of her other colleagues. It is a good time to receive it, she says, because “the winter is too harsh and the need for rebuilding so much greater.”

“I don’t know what can really compensate for their loss, if anything,” says Dr Baig. “Our purpose was to help support as much as we possibly could.”

By Zehra Abid,
Communications Officer, WHO Pakistan

With more than twenty years’ experience on the ground in Afghanistan, WHO’s polio eradication programme continues to leverage its extensive operational capacity to deliver better health outcomes for all Afghans, including providing vital support to the recent nationwide measles vaccination campaign.

Measles outbreaks were reported across Afghanistan throughout 2022, with more than 5,000 cases and an estimated 300 deaths reported by November. Complications from the measles virus include severe diarrhea and dehydration, pneumonia, ear and eye complications, encephalitis or swelling of the brain, permanent disability and death. Most cases are children under the age of 5 years. There is no treatment for measles, the only reliable protection is vaccination.

While a series of sub national measles vaccination campaigns took place in 2022 reaching approximately three million children in 141 districts, the nationwide campaign from November 26 to December 5 represented the first national measles drive since the political transition in August 2021. The campaign covered 329 districts in all 34 provinces, vaccinating 5.36 million children aged between from 9 to 59 months against measles. 6.1 million children between 0 to 59 months received oral polio vaccine.

WHO’s polio eradication programme has significant reach in Afghanistan, with a presence in every district in the country. The polio programme leveraged this presence to recruit vaccinators, organize vaccination sites, and train campaign staff. With longstanding relationships with local authorities, the polio programme assisted in the selection of local schools, clinics, or mosques to serve as vaccinations sites. The programme’s established relationships with health institutions and communities enabled polio staff to recruit local health workers and other staff to fill the roles of measles vaccinators and provide training. Sharing their experience of implementing polio vaccination campaigns helped measles vaccinators prepare and plan for the task ahead.

The detection of measles cases and collection of data by WHO’s extensive polio surveillance network also played a crucial role in providing evidence-based planning for the campaign. WHO’s polio programme also provided logistical support, transporting measles and polio vaccines, ensuring the cold chain was maintained and vaccines were delivered to every district. Polio staff played additional roles in campaign monitoring and supervision.

“Measles is a highly contagious disease. WHO Afghanistan is very proud of its work immunizing and protecting children against both measles and polio in this campaign,” said Dr Luo Dapeng, WHO Representative in Afghanistan. “I am very grateful to all health workers, partners and donors who made this possible.”

Community Sensitization for the Whole Family Approach (WFA) activities in Abuja, Nigeria. Photo: Vaccine Network for Disease Control (VNDC)

According to the United Nations, a civil society organization (CSO) is any non-profit, voluntary citizens’ group which is organized on a local, national, or international level. CSOs have a vital role to play in the control of infectious diseases. Some CSOs play an advocacy role to sustain commitments of governments, communities, and donors, some support implementation of program activities, and some do both.

The UN Foundation’s new report, “Leveraging CSO Contributions to Advance Polio Transition and Integration Efforts in the African Region” outlines specific areas where CSO support can be of value for polio transition and integration. In particular, this report describes the initiatives implemented by four CSOs supported by the UN Foundation to enhance polio transition and integration efforts in the Democratic Republic of the Congo (DRC), Ethiopia, Nigeria, and South Sudan.

STATUS OF POLIO IN THE AFRICAN REGION

The African region was declared free of wild poliovirus (WPV) in August 2020. This incredible achievement was a result of decades of work by a coalition of international health bodies, national and local governments, civil society and community volunteers. Notwithstanding this significant milestone, the African Region is still experiencing outbreaks of the non-wild variant of poliovirus, known as circulating vaccine-derived poliovirus (cVDPV) in 25 countries. Furthermore, in 2022, WPV importations were reported in two countries that had been polio-free for over three decades, Malawi and Mozambique. These detections highlight that until all forms of polio are eradicated everywhere, the risk of importation remains a constant threat. This further emphasizes the importance of maintaining the Global Polio Eradication Initiative (GPEI) infrastructure in order to both achieve and maintain a polio-free world.

Read more on the UNF website.

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.

Dashboard showing real-time data on active case finding and routine immunization from integrated supportive supervisory visits to priority sites in Senegal. © WHO

While the WHO Africa Region (AFRO) has been facing its last hurdle in eradicating polio of all types since being certified indigenous wild polio free in 2020, a circulating variant of polio virus type two has been present in 26 countries with more than 1,000 cases between them, coupled with the recent importation of two wild polio type 1 cases. To help reverse this trend, the WHO/AFRO Geographic Information Systems (GIS) Center is equipping over 200 key country office focal points and Ministry of Health personnel across 47 countries with essential innovative technologies to better address outbreaks with necessary speed and quality.

Concluding a series of one-week capacity-building workshops over the past six months and targeting of the WHO regions of Central, East & Southern, and West Africa – – the AFRO GIS Center, with the support of the Bill & Melinda Gates Foundation (BMGF), WHO HQ Polio Unit and GIS Centre for Health, the United States Centers for Disease Control and Prevention (CDC), and Novel-t on-boarded digital GIS and Mobile Health (mHealth) technologies to support regional and national agendas particularly on planning and analysis for improvement of surveillance, campaigns and outbreak response for polio and all other routine immunization and outbreaks. While the initial investment was made by polio these tools are being leveraged for all health interventions.

A group of participants from the AFRO Geographic Information System (GIS) and Information Visualization Capacity Building Training session, in Dakar, Senegal. © WHO

“These are solutions to advance national and regional agendas even beyond polio” stated Kebba Touray, Technical Manager – AFRO GIS Centre, “the COVID-19 pandemic response was able to advance using the AFRO polio GIS Centre’s technical support with the development of real-time data collection, analysis and monitoring tools and generated several products including dashboards (providing easy availability and visualization of information), which facilitated rapid decision making for response activities across the region.”

The GIS Capacity Building training transferred knowledge to key country office focal points and Ministry of Health personnel across Africa on innovations to better enable countries to:

Design country-level specific static and dynamic maps – using platforms such as Microsoft Power BI, and ArcGIS – for the outbreak response and provide real time analysis through the dashboards.
Provide country specific information visualization (using Dashboards) to publish in the existing AFR-mHealth workspace at AFRO and in their respective public health systems.
Develop data collection, data validation and monitoring mechanisms that provides increased accuracy on immunization information and populations through the Open Data Kit (ODK) platform to enhance mobile data collection.
Use AFRO GIS and information visualization innovative solutions at country level to receive real-time information on active surveillance visits conducted at health facility level, environmental surveillance site performance, rapid population estimates data, vaccination team movement during polio campaigns, among others.

“I am particularly eager to take back the new capacity I have on ODK and PowerBI when monitoring our entire Expanded Programme on Immunization (‎EPI)‎ interventions” stated participant Dexter Merchant, Assistant Director for Monitoring and Evaluation at the Ministry of Health in Liberia, “using ODK as the process to collect data on where we have essential services and where we don’t is going to make things move a lot faster and more efficiently in identifying gap, I am confident these tools will now be integrated in Liberia”.

John Kipterer and Frank Salet moderating a PowerBI training session at the GIS capacity building workshop in the Dakar. © WHO

To ensure sustainability, country accountability and ownership, in-country GIS working groups which will constitute personnel from WHO and Ministries of Health will be established to continue efforts of knowledge transfer and capacity building principally amongst data managers, GIS analysts, and surveillance officers.

In closing, the WHO Representative in Senegal, Dr. Lucile Imboua and host of the last training series emphasized the “need to ensure harmonization of all the GIS tools and to be flexible to accommodate the use of other tools across different programs.”

The underlining consensus from all WHO, government and partner participants is that in order to end polio and strengthen health systems, the region heavily relies on the innovative technologies of GIS in executing health responses. The use of GIS innovations with precision in accuracy, transparency, accountability and ease of application and sustainability provides a huge opportunity to reach every last child across the 47 countries, eradicate polio from the region, and serve public health for all.

Emergency health centres provide the most urgent medical support to families © WHO

When disaster strikes, co-ordination is key. Within hours of the 5.9 magnitude earthquake striking the communities of Afghanistan’s South East in the early morning of 22 June, WHO’s polio team was on the ground joining forces with UN agencies and NGOs to ensure an effective and coordinated relief effort.

As dawn broke across the provinces of Paktika and Khost, and the extent of the devastation became evident, polio teams worked across both provinces to establish communications and share reports of the length and breadth of the destruction.

The team’s invaluable experience and local knowledge gained from more than two decades working among local communities in both Paktika and Khost provided the foundations of an assessment tool to map communities and assess the number and extent of casualties as well as the destruction to homes and buildings. This ensured accurate data guided a focused response in the immediate aftermath including the rapid construction of tents for shelter as well as housing ad hoc health camps.

Helping clear rubble following the devastating earthquake © WHO

In the districts of Giyan, Geru and Barmal in Paktika, polio teams assisted in attending the injured, providing trauma care and dressing wounds. One team member was despatched to Spera district in neighbouring Khost province to assist with trauma care.

Polio teams turned a helping hand wherever needed including digging for survivors, building tents, unpacking trucks and distributing shipments of WHO emergency and surgical kits, medical supplies and equipment, and the heartbreaking task of preparing and assisting in transporting the dead for burial.

With the very real risk of increased communicable diseases in the wake of any natural disaster, polio staff drew on the polio surveillance system to strengthen post-earthquake surveillance for acute watery diarrhea, measles, tetanus and COVID 19.

Emergency provision of trauma care. © WHO

More than 1,000 people died in the quake and nearly 3,000 were injured; homes buildings and livelihoods have been destroyed. The polio team will continue to work as part of WHO Afghanistan’s earthquake response including providing trauma care, physical rehabilitation and disability assistance.

The earthquake struck five days before the start of the fifth nationwide polio vaccination campaign for 2022. The campaign was postponed for one week in Paktika province and in Spera district of Khost province and will begin on 4 July.

A polio worker speaks to a family in Borno State, Nigeria. In Nigeria, polio personnel have played a vital role to educate communities on COVID-19 and register individuals for their vaccination, underlining the necessity of sustaining these networks. © WHO/Andrew Esiebo

As the first COVID-19 vaccines arrived into Somalia, polio programme staff were in position. Drawing on years of experience working to tackle polio and other health threats, staff had taken on key roles in logistics, cold-chain management and monitoring to ensure the success of the vaccine rollout.

Mohamud Shire, a WHO polio eradication officer working in the central zone of Somalia, explained, “Regional and district polio officers acted as supervisors of the vaccine rollout. Some of the polio health workers worked as COVID-19 vaccinators, whereas others were social mobilizers.”

A new WHO report entitled, ‘Role of the polio network in COVID-19 vaccine delivery and essential immunization: lessons learned for successful transition’, underscores the value of the polio network as an agile and experienced public health workforce, able to pivot to support national health programmes to deliver COVID-19 vaccines, and strengthen essential immunization. The introduction of COVID-19 vaccines in 2021 stretched country health systems, requiring all hands on deck to deliver vaccines to the most vulnerable. In this challenging context, hundreds of polio eradication staff led efforts in areas ranging from coordination and community mobilization, to training and surveillance. This work proves that sustaining these capacities is the way forward to build stronger, more equitable and resilient health systems.

The polio transition process aims to sustain the workforce and infrastructure set up to eradicate polio to strengthen immunization programmes, protect against outbreaks, and deliver essential health services to communities. A 2020 report documented the outstanding contributions of the polio network to the emergency stage of the COVID-19 pandemic, with over 5900 staff in the 20 priority countries for polio transition stepping up. The new report provides evidence of the role of polio staff to support essential immunization, and makes the case to transition their valuable skills and expertise to strengthen immunization programmes, building on the COVID-19 experience.

Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia. © WHO/Indonesia

In Sudan, 13 polio staff coordinated with partner agencies, trained vaccinators and provided comprehensive technical support for the COVID-19 rollout. In Nepal, 15 polio and immunization officers monitored the quality of COVID-19 vaccine sessions, whilst in India, polio and immunization Open Data Kit software was used to record data from more than 450,000 COVID-19 vaccination sessions. In Nigeria, at least 121 polio staff worked to sensitize communities to COVID-19, support trainings for the e-registration of vaccine recipients, and manage Adverse Events Following Immunization (AEFI). In these countries, this work builds upon historical contributions of polio staff to essential immunization, including working with national essential immunization programmes for the co-delivery of polio with other vaccines, and using electronic surveillance tools developed for polio eradication to detect other vaccine-preventable diseases.

The report also details lessons learned from the COVID-19 vaccine rollout. One is the value of integrating polio functions into other health programmes. The pandemic response showed that with an integrated approach it is possible to achieve more with limited resources. For instance, in the Eastern Mediterranean Region, the pandemic experience has led to the introduction of Integrated Public Health Teams, which bring together public health staff to provide broader services to communities.

Another lesson is the value of transferable skills that can contribute to vaccination across the life-course. Polio personnel have specific strengths in childhood vaccination, but the pandemic has shown that their cross-cutting skills – including coordination, disease surveillance, monitoring, data management and microplanning – can be used to make progress towards global immunization goals. The pandemic has impacted rates of routine immunization, leading to an increase in numbers of un- or under-vaccinated children. Harnessing the skills of polio personnel, and integrating them into other programmes, is key to achieving the goals of the Immunization Agenda 2030.

Polio vaccinators travel on camel during the November 2021 integrated measles-rubella and polio campaign in Pakistan. Close collaboration between the polio and immunization programmes helped to reach over 90 million children. © Gavi/Asad Zaidi

The report further serves to emphasise that polio transition and polio eradication are interdependent, and must go hand-in-hand. In the context of ongoing polio outbreaks, the sustainable transition of functions in polio-free counties is a necessary step to ensure that health systems are resilient to future health threats, including poliovirus importations.

To support these aspects, sustainable financing for the integration and transition of polio essential public health functions is vital. As of 2022, over 50 countries have transitioned out of GPEI support, but still require funding and technical support from WHO and other partners. Long-term domestic and international support is needed to ensure that the knowledge, expertise and lessons learned from polio eradication continue to serve populations. This is especially important as governments face long-term financial constraints on their health spending due to the pandemic.

As we move towards health systems recovery, we must ensure that the polio infrastructure is transitioned in a sustainable manner, to support more resilient health systems.

Partners in the Global Polio Eradication Initiative (GPEI) are extremely saddened to learn of the recent passing of Danny Graymore OBE, and wish to extend our condolences and love to his family and friends.

Danny was compassionate, fiercely intelligent and a tireless advocate for polio eradication, global health and human rights. He inspired many in his work for a fairer, more equitable world.

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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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

WHO staff completing a seroprevalence survey, which estimates the percentage of people in a population who have antibodies against COVID-19, in Cox’s Bazar, Bangladesh, December 2020. © WHO/Bangladesh

When the first consignment of COVID-19 vaccines arrived in Rumbek, the capital of Lakes State in South Sudan, WHO State Polio Officer Dr Jiel Jiel was prepared. In support of the Ministry of Health, and in collaboration with partners, he had been working for weeks to help coordinate the vaccine rollout, using skills gained from working to eradicate polio.

He explains, “For the COVID-19 rollout, the implementing partner turned to us, as they know we have experience in delivering vaccines. The expertise from the top to the bottom of the polio team was utilised.”

In countries where the polio programme has a large footprint, staff provided exceptional support to the initial stages of COVID-19 pandemic response. Since then, polio teams have been assisting with COVID-19 vaccination. Their contributions – including to vaccine logistics, social mobilization, surveillance, training and data management – demonstrate their wide skillset and their ability to help make progress on broader health priorities.

In the African Region, over 500 polio eradication staff assisted with the COVID-19 vaccine rollout in 2021. 39% of that workforce reported spending between 20 – 50% of their time on COVID-19 vaccination efforts, whilst 37% reported dedicating more than 50% of their time. Staff balanced this work with resumed polio vaccination campaigns, which were paused to protect against possible spread of COVID-19 in the early stages of the pandemic.

State Polio Officer Dr Jiel Jiel (far left) with colleagues at a COVID-19 vaccination site in South Sudan, July 2021. © WHO South Sudan

Their efforts demonstrate the potential for the polio workforce and assets to contribute in the long term to strengthening health systems and building back better. The polio transition process aims to leverage the skills, relationships and reach of the polio workforce in an integrated manner to make progress on a range of health priorities – especially essential immunization, vaccine-preventable disease surveillance and emergency response. The indispensable work of the polio workforce during the COVID-19 pandemic shows that sustaining this network is a good investment for national and global health priorities.

Dr Eshetu Wassie, a National Polio Officer in Ethiopia, explains that the polio workforce is well positioned to assist with reaching health goals.

“The polio experience has helped to bring the WHO workforce together, as COVID-19 required a multisectoral response. This was easier to organize through the polio platform, which was used to bringing partners together.”

Polio staff have undertaken a wide range of tasks. In Nigeria, ensuring the availability of both COVID-19 and polio vaccines has reduced the number of visits families need to make to health facilities, whilst in Cameroon, polio staff have developed communications and advocacy materials to promote COVID-19 vaccine uptake. In many countries, the polio workforce have supported the collection of data on Adverse Events Following Immunization (AEFI) for COVID-19, and have used their experiences in polio eradication to help coordinate effective rollout of the COVID-19 vaccine in different contexts.

A man is vaccinated against COVID-19 in Banadir Hospital, Mogadishu, Somalia, March 2021. © WHO Somalia/ Ismail Taxta

In the Eastern Mediterranean Region, the polio workforce in Somalia helped to rollout COVID-19 vaccines throughout 2021. Mohamud Shire, a Senior Polio Eradication Officer in Somalia, explains, “Some of the polio volunteers worked as vaccinators, whilst others were social mobilizers. Regional and District Polio Officers were supervisors of the vaccine rollout. And it helped that communities know and trust us.”

In the South East Asian Region, the integrated immunization and surveillance networks used their experience of introducing new vaccines, including Inactivated Polio Vaccine, to help ensure a smooth rollout of the COVID-19 vaccines. In India and Nepal, support provided by the network has included capacity building, campaign monitoring and contributing to guideline development. In Bangladesh, polio and measles campaign microplans were used to conduct a successful pilot of the COVID-19 vaccine rollout. In Indonesia and Myanmar network support included dissemination of guidelines and cold chain monitoring.

With populations in low-income countries around the world still un- or under-vaccinated against COVID-19, and health systems under severe strain, the continued support of the polio network is likely to be critical to recover from the pandemic. Looking ahead, Dr Jiel Jiel underlines the importance of transitioning and sustaining the polio workforce in polio-free contexts so that they can contribute to health systems recovery, “If we were not present, it would be more difficult for the health system to reach the vaccine coverage that is desired.”

“WHO staff have built up our skills, we have institutional memory and you can rely on us to produce results.”

The Health Ministers of the G20 countries, meeting in Rome, Italy, on 5-6 September 2021, recommitted to helping secure a lasting polio-free world once and for all. In their official communiqué, the Health Ministers said: “We re-affirm our commitment to eradicate polio… We note the critical role that adaptable surveillance capacity, like that found in the Global Polio Eradication Initiative, has in the ability to reach vulnerable communities to prevent and respond to pandemics.”

The importance to eradicate polio, and the GPEI’s unique value in supporting COVID-19 response efforts, had previously been underscored by other global fora, including at the recent WHO Regional Committee for Africa, the G7 Heads of State meeting, the G7 health ministers meeting and the World Health Assembly.

An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated. Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized.

The GPEI also recognizes the critical role of women in the delivery of health services and has committed to ensuring their empowered engagement in polio eradication efforts in order to reach every last child.

25 August 2021 – “Poliovirus circulation does not stop during conflicts, it does not stop during emergencies. If anything, it makes children and families even more vulnerable by adding a layer of risk”, says a Polio Provincial Officer from Balkh province.

Despite risks and challenges due to the recent insecurity, the polio programme is staying and delivering for the children of Afghanistan. Our 315 staff and more than 70,000 polio health workers across the country remain firm in their resolve to eradicate polio. Their work ensures that critical polio activities continue while adapting to the rapidly changing situation and carry on even when hostility levels are high.

In 2021, one wild poliovirus type 1 (WPV1) and 43 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases have been confirmed in Afghanistan. All cases have been reported in areas of the country that have for years been inaccessible for door-to-door vaccination campaigns, which left at least 3 million children repeatedly deprived of polio vaccination. Population displacement brought about by the current situation could further impact the programme’s access to children and increase immunity gaps against polio, triggering a rise in transmission. It is also feared that the mixing and movement of unvaccinated populations due to the upheaval faced by thousands of Afghans may spur polio transmission.

“We are working with all actors, to ensure there are no delays or disruptions to polio vaccination campaigns and overall routine immunization. Gains of the past twenty years cannot be lost. Children need immunization now, they must not bear the brunt of conflict and instability. We are calling for unimpeded access to all children,” says Dr. Dapeng Luo, WHO Representative in Afghanistan.

Pre-planning and resilience measures

While the current situation is a challenge, it is by no means the first the polio programme has faced. Using its wealth of knowledge from many years of operating in complex environments, the programme has invested in robust, pre-emptive contingency planning to be able to adapt and continue delivering. Regular monitoring of the security situation has allowed for nimble decision making.

The programme has moved swiftly to ensure safety and security of its staff. Its international staff footprint has been significantly reduced and vulnerable national staff and their dependants have been temporarily relocated to Kabul. Flexible working arrangements and salary advances have been provided to cover urgent needs of staff and polio health workers, who are the backbone of polio operations.

Around eighty percent of polio staff remain at their field locations and working to maintain essential polio services, supported remotely by colleagues who have needed to relocate.

“I am filled with pride for my team and their strong resolve, courage and passion. They are the heroes children of Afghanistan need right now. Thanks to their efforts, Acute Flaccid Paralysis (AFP) and environmental surveillance never stopped. Except for a few locations that experienced temporary disruptions last week, stool sample collection, visits to active health facilities, case investigation, the shipment of samples to Pakistan for laboratory testing, and the collection and transport of sewage samples for polio environmental surveillance remain unaffected. COVID-19 surveillance, which the polio programme has been supporting since last year, has also continued,” says Irfan Elahi Akbar, Polio Team Leader, WHO Afghanistan.

Vaccination continues

Polio vaccinations are continuing through permanent transit teams in most regions and at cross-border sites, including Friendship Gate (between Afghanistan and Pakistan).

After a brief pause, the National Emergency Operation Center is back up-and-running and undertaking planning needed to implement future campaigns. Discussions are ongoing with local authorities to safeguard the resumption of critical immunization activities across the country. The programme remains optimistic that polio vaccination campaigns planned for later this year can go ahead, however, is maintaining a flexible approach.

“The safety and security of staff and polio health workers is our top priority. Their commitment to ending polio is nothing short of inspirational. I stand ready to support their critical work in any way I can. I say this with absolute conviction: We will achieve a polio-free world,” said Dr. Hamid Jafari, Director of Polio Eradication, WHO Eastern Mediterranean Region.

See link to story on WHO EMRO’s website.

Chaudhry Hakim Ali and Muhammad Usman enter data after collecting samples for COVID-19 testing at a laboratory located at the National Institute of Health in Islamabad, Pakistan. © WHO/EMRO

The Heads of State of the G7 countries, at the annual meeting held in the UK on 11-13 June 2021, highlighted the need for increased global efforts to detect global public health threats, by building international surveillance on existing networks such as polio surveillance. In the context of COVID-19, and in their official communiqué, the G7 stated: “we support the establishment… of a global pandemic radar… that builds on existing detection systems such as the influenza and polio programmes.”

The unique value of the polio infrastructure in supporting COVID-19 response efforts was recently underscored by other global fora, including the World Health Assembly in May, and the G7 health ministers meeting in June.

Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized.