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.
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.
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.
“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”.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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.
Therese and Léonie reminded me of this hard truth in a recent visit to a hospital in N’Djaména, Chad. One is a newborn girl and the other is a veteran of the campaign to eradicate a human disease for only the second time in history –polio-.
As a Gender Champion for Polio Eradication, I have committed to supporting the global initiative to eradicate polio and the women who work tirelessly to protect children from lifelong paralysis. During my visit to Chad, I had the honour of giving two drops of life-saving oral polio vaccine to two newborns.
Protected from a disease which once struck millions of children, Therese now has a better chance of a healthy life. Thanks to the Global Polio Eradication Initiative (GPEI) – spearheaded by Rotary International, national governments, the World Health Organization, UNICEF, CDC, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance – she is one of more than 2.5 billion children who have received the oral polio vaccine, as the global polio caseload has been reduced by 99% since 1988.
But as I looked at Therese, I also wished that she would have a better chance not just for health, but also for opportunities to prosper. I thought of a recent WHO report I had read – Delivered by Women, Led by Men – which observed that women make up 70% of the global health workforce but hold only 25% of senior roles – a situation that is no different for the polio program. Would Therese’s future reflect that disparity?
I found both frustration and hope in answer to my question when I listened to Ms. Léonie Ngaordoum, the woman responsible for the campaign which brought the vaccine to Therese.
Léonie is head of vaccine operations for Chad’s immunization programme. It is women like her who have brought us this far in the long fight against polio. It is women like her who have gone the extra mile to keep their countries safe when, in 2020, the polio programme faced unprecedented challenges in the face of a new pandemic- COVID-19.
Her journey to a senior public health position in Chad has been difficult. Driven to remote areas on dangerous roads to oversee vaccination campaigns, she has twice suffered accidents, one of which left her with severe spinal injuries. She has faced gender discrimination, countered vaccine misinformation, convinced vaccine sceptics, and stayed the course despite the severe strain of COVID-19, and struggling for respect and recognition in a male-dominated environment.
Today she has a clear vision to share: “I speak about vaccination as if it were a vocation…the program change needed to achieve polio eradication is to empower enough women.” Léonie’s experience highlights the necessity of increasing senior roles among women in the health workforce and involving them in policy decisions.
Women like her frequently operate in dangerous and conflict-affected areas, putting their own personal safety at risk – all in efforts to protect communities from deadly diseases. Women have a greater level of trust with other women and thus are able to enter households and have interactions with mothers and children necessary to deliver the polio vaccine. And this way they can also provide other services, such as health education, antenatal care, routine immunization, and maternal health.
The knowledge and skills gained by this workforce are already being deployed against COVID-19, in surveillance, contact tracing, and raising public awareness. Indeed, more than 50 percent of the time spent by GPEI health workers is already dedicated to diseases and threats beyond polio. It’s clear that the future of public health is inextricably linked to the status of women. Their heroic actions provide nothing less than a blueprint for the future of disease prevention. The Resolution on “Women, girls and the response to COVID-19”, adopted last year by the UN General Assembly, should play a key role when addressing these challenges and the specific needs of women and girls in conflict situations.
The centrality of women to the success of public health projects has for too long gone unrecognised, and must be formalized. That is why today, on International Women’s Day, we must pay tribute to the tremendous contribution of women like Léonie around the world in protecting their communities from deadly diseases such as polio. But at the same time, thinking of the world in which Therese will come of age, we need to commit to empower every woman and girl. It will not only make for a more just world – but a healthier one too.
PN: President Knaack, thank you for taking the time to speak to us. A little more than a year into the global COVID-19 pandemic, what is your take on the current situation, also with a view of the global effort to eradicate polio?
HK: There are many interesting lessons we learned over the past 12 months. The first is the value of strong health systems, which perhaps in countries like mine – Germany – we have over the past decades taken for granted. But we have seen how important strong health systems are to a functional society, and how fragile that society is if those systems are at risk of collapse. In terms of PolioPlus, of course, the reality is that it is precisely children who live in areas with poor health systems who are most at risk of contracting diseases such as polio. So everything must be done to strengthen health systems systematically, everywhere, to help prevent any disease.
The second lesson is the value of scientific knowledge. COVID-19 is of course a new pathogen affecting the world, and there remain many unanswered questions. How does it really transmit? Who and where are the primary transmittors? How significant and widespread are asymptomatic (meaning undetected) infections and what role do they play in the pandemic? And most importantly, how best to protect our populations, with a minimum impact on everyday life? These are precisely the same questions that were posed about polio in the 1950s. People felt the same fear back then about polio, as we do now about COVID. Polio would indiscriminately hit communities, seemingly without rhyme or reason. Parents would send their children to school in the morning, and they would be stricken by polio later that same day. Lack of knowledge is what is so terrifying about the COVID-19 pandemic. It also means we are to a large degree unable to really target strategies in the most effective way. What polio has shown us is the true value of scientific knowledge. We know how polio transmits, where it is circulating, who is most at risk, and most importantly, we have the tools and the knowledge to protect our populations. This knowledge enables us to target our eradication strategies in the most effective manner, and the result is that the disease has been beaten back over the past few decades to just two endemic countries worldwide. Most recently, Africa was certified as free of all wild polioviruses, a tremendous achievement which could not have been possible without scientific knowledge guiding us. So while we grapple for answers with COVID, for polio eradication, we must now focus entirely on operational implementation. If we optimize implementation, success will follow.
And the third lesson is perhaps the most important: we cannot indefinitely sustain the effort to eradicate polio. We have been on the ‘final stretch’ for several years now. Tantalizingly close to global eradication, but still falling one percent short. In 2020, we saw tremendous disruptions to our operations due to COVID-19. We never know when the next COVID-19 will come along, to again disrupt everything. Last year, the polio program came away with a very serious black eye, so to speak. But we have the opportunity to come back stronger. We must now capitalize on it. We know what we need to do to finish polio. We must now finish the job. We must all recommit and redouble our efforts. If we do that, we will give the world one less infectious disease to worry about once and for all.
PN: You recently called on the Rotary network worldwide to use its experiences from PolioPlus in supporting the COVID-19 response. Could you elaborate on that?
HK: We have a global network of more than 1.2 million volunteers worldwide. This network has been consistently and systematically utilized to help engage everyone from heads of state to mothers in the most remote areas of rural India for polio eradication. We have helped secure vaccine supply and distribution, and increased trust in vaccines among communities. In the process, we have learned many lessons on what it takes to address a public health threat and these same lessons now should be applied to the COVID-19 response, especially as vaccines are now starting to be rolled out. That is why I thought it was important to call on our membership network to use their experiences and apply it to the COVID-19 response.
PN: What has been the reaction so far?
HK: Overwhelmingly supportive, I would say. As an example, in Germany, Switzerland, Liechtenstein, Austria and other countries in Europe, Rotarians are encouraging active participation of the provided vaccination service. And because COVID vaccination is provided free of charge, vaccinated individuals are encouraged to instead donate the cost of what this vaccine would have cost them – approximately US$25 – to PolioPlus. This has a dual benefit: they are protected from COVID and contributing to the global response, and they are ensuring children are also protected against polio, critically important now as the COVID-pandemic has significantly disrupted health services and an estimated more than 80 million children worldwide are at increased risk of diseases such as polio.
PN: And from what we understand, the Rotary PolioPlus network of National PolioPlus Committees has in any event been supporting global pandemic response over the past 12 months already, is that correct?
HK: The ‘Plus’ in PolioPlus has always stood for the fact that we are eradicating polio, but doing it in such a way that we are in fact doing much more, by supporting broader public health efforts. I’m extremely proud that Rotary and Rotarians around the world have helped bring the world to the threshold of being wild polio-free. But I’m perhaps even more proud of the ‘plus’ – or ‘added’ value – that this network has provided in the process. Things that are largely unseen, but which are very evident and concrete. So indeed, Rotarians have been actively engaged in the pandemic response, particularly in high-risk areas such as Pakistan, and Nigeria. We have supported contact tracing, educated communities on hygiene and distancing measures, supporting testing and other tactics. We have a unique set of experiences, and more importantly a unique infrastructure and network, to help during such crises. It’s morally the only way to operate. And actually, it is operationally beneficial also to polio eradication, as we are engaging with communities on broader terms, and not just on polio.
PN: Thank you again for taking the time to speak with us. Do you have any final thoughts or reflections for our readers?
HK: If we did not know it before, we certainly know now how quickly and dangerously infectious diseases spread around the globe. Polio is no different, and we know that it will not stay confined to Pakistan and Afghanistan if we don’t stop transmission there as soon as possible. We know that given the chance, this disease will come roaring back, and within ten years, we would again see 200,000 children paralysed every single year, all over the world. Perhaps even in my country, Germany. That would be a humanitarian catastrophe that must be averted at all costs.
The good news is that it can be averted. We know what it takes. Pakistan and Afghanistan are re-launching their national eradication efforts in an intensified, emergency manner, following a disrupted 2020. This is encouraging to see. Mirroring this engagement must be the strengthened commitments by the international development community. We must ensure that the financial resources are urgently mobilised to finish polio once and for all. I am particularly proud that my own government, Germany, for example, has just recently committed an additional 35 million EURO to the effort, along with an additional 10 million EURO for efforts in Nigeria and Pakistan. Such support is particularly critical now, given that more than 80 million children are at heightened risk of diseases such a polio due to COVID-19 disruptions, and late last year, UNICEF and WHO issued an emergency call for action to urgently address this. And as we have seen, by supporting polio eradication, donors effectively get twice as much for their contribution: they help contribute to polio eradication, but also by doing so help contribute to the polio network’s support to public health emergencies such as COVID-19.
In short, we have it in our own hands to achieve success. There are no technical or biological reasons why polio should persist anywhere in the world. It is now a question of political and societal will. If we all redouble our efforts, success will follow.
Please consider making a contribution to Rotary’s PolioPlus fund, and have your donation matched 2-to-1 by the Bill & Melinda Gates Foundation.
As COVID-19 reached Somalia, Mohamed readied himself to respond. For years, he had been building strong relationships with local health officers and communities to deliver polio vaccines to every child. Now, he would use those relationships to try to track the spread of the pandemic.
In Nigeria, Dr Rosemary Onyibe, a Polio Eradication Zonal Coordinator for WHO, felt her duty was calling. “My expertise is needed to serve my community,” she remembers thinking. Within days, she was working on Nigeria’s COVID-19 response.
These two individuals are part of a team of 5923 polio eradication personnel, who pivoted in a matter of weeks to fight COVID-19 in some of the most vulnerable settings in the world. A recent report published by WHO comprehensively documents the significant role played by polio eradication personnel during the pandemic, and urges strong action to sustain this network to deliver essential public health services after polio is eradicated. By doing so, we can ensure we are ready to respond to established and emergent diseases in future.
The polio programme has a long history of stepping up during health emergencies to fill the gaps that no one else can. As COVID-19 changed lives around the globe, polio staff led outbreak response teams and trained laboratory staff to detect the virus. Polio disease surveillance officers searched for COVID-19 cases and thousands of frontline polio workers shared information on the disease with their communities. In some countries, polio emergency operations centres were converted for the pandemic response. As the situation has evolved, so have polio programme contributions – in coming months, the programme plans to use its expertise in immunization to help to deliver COVID-19 vaccines, as well as urgently reach at least 80 million childrenwho have missed out on vital vaccines during the pandemic.
As one of WHO’s largest operational workforces, comprising nearly 18% of the organization’s programme budget in 2020-21, the widespread utilisation of polio-funded infrastructure and human resources for COVID-19 has brought into focus why we must retain this network for the future. When polio is eradicated, funding for the programme’s vast infrastructure will end. Through the “polio transition” process, WHO is working to transfer the polio network to serve other public health goals, including the broader immunization, health emergencies and health systems strengthening agenda. This is no easy task – detailed planning and dedicated funding is needed to permanently integrate assets and functions into national health systems.
The report finds that COVID-19, whilst presenting challenges, provides an opportunity to accelerate this “transition” process. In the coming months, WHO regional offices will begin to launch ‘integrated public health teams’, which will bring together individuals with expertise in polio eradication, emergency response and immunization to work collaboratively on the next stages of COVID-19 response and recovery. Showing “transition in action”, these teams will exemplify one way via which health systems could be supported in future. Simultaneously, WHO is continuing work to support countries to develop detailed plans modelling how polio capabilities can be sustained.
The critical role that polio assets have played in tackling multiple health emergencies, in supporting immunization activities and in COVID-19 response, demonstrate that these assets have a clear role to advance future national and global health security. This will also help to sustain a polio-free world. In the South East Asia Region, which was certified free of wild polio in 2014, almost 2600 polio and immunization staff used their experience of managing immunization programmes in emergency settings to respond to COVID-19. Their work included undertaking training of health staff and village governors in Indonesia, acting as a focal point for the COVID-19 response in Cox’s Bazar, Bangladesh, and drafting vaccination plans for Rohingya refugees. In Nepal, the network supported COVID-19 field investigations and case clusters, whilst in Myanmar, personnel formed part of the pandemic incident management team, and supported disease surveillance. These contributions underline that sustaining polio and immunization capacity puts us in a better position to respond when health crises arise.
The report also details how polio assets were able to reach nomadic communities in Kenya to warn them about virus spread, deliver an integrated digital platform for tracking case investigations across the African region, and answer 70 000 calls a day through a polio call centre adapted for COVID-19 in Pakistan. In Uttar Pradesh, India, polio micro-plans were adapted to survey 208 million people twice in three months for COVID-19, resulting in the identification of over 200 000 individuals with symptoms of the virus. Such diversity of operations plays a key role in protecting our collective health.
In a time when sturdy public health systems are particularly vital, we must ensure that polio infrastructure is transitioned to tackle pressing health issues long into the future.
For a detailed costing of polio contributions to COVID-19 response and a country-level breakdown of how the polio network stepped up, please see the report annexes.
In a newly-released statement following the final meeting of the Polio Oversight Board (POB) that was held virtually on 18 December 2020, the POB looks back at the support that the programme provided to respond to the COVID-19 pandemic, while remaining strongly devoted to the goal of a polio-free world. The POB reaffirms its commitment that polio-funded assets are available to countries to respond to the COVID-19 pandemic, especially in the next phase of COVID-19 vaccine introduction and delivery.
The POB also believes that for countries introducing COVID-19 vaccine, there are lessons and experiences to be learnt from the rollout of nOPV2 under the EUL recommendation, if emergency regulatory pathways such as WHO EUL are used, including in the areas of monitoring readiness-verification, safety surveillance, and regulatory considerations.
The COVID-19 pandemic has brought the need for strong health systems and global health security into sharp focus. Last week, the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO) agreed a £30 million increase in the first payment to the World Health Organization of their 2019 – 2023 pledge, meaning that the total amount released for polio eradication activities is £70 million. Coming amidst challenges posed by the COVID-19 pandemic, including a growing immunity gap, this gesture is a testament to the UK government’s strong commitment to investing in high impact programmes that strengthen global health security – including the polio programme.
Throughout the COVID-19 pandemic, the Global Polio Eradication Initiative (GPEI) has played an integral role in the global response, contributing physical assets, outbreak response expertise and a trained workforce to slow the spread of the novel coronavirus. This support was largely made possible thank to donors like the United Kingdom.
The United Kingdom is a historic donor to efforts to end polio, committing an exceptional £400 million to eradication activities in the period from 2019 – 2023. Since 1985, the UK has contributed over US $1.6 billion, and has played an integral role in preventing the paralysis of more than 18 million children.
Widespread polio vaccination efforts over the past 30 years have led to a 99.9% decrease in global polio cases. Health workers, local governments, global partners and generous donors have made this progress possible. The increased payment by the UK will ensure that this progress against polio is not lost due to disruptions by the COVID-19 pandemic, and that the polio programme can continue to play an essential role in supporting pandemic response efforts around the world.
As the U.K. prepares to host the upcoming G7 meeting, the GPEI is hopeful that issues around global health security and health systems strengthening, to which polio can contribute, will be prioritized.
Ms. Rina Dey has spent over 25 years working in health and development, including front-line efforts to eradicate polio in India and globally.
“Unless we work at the community level, we’re not getting the full story. Ensuring community participation is the only way to achieve social transformation and to ensure that all children get immunized,” she explains.
In her role as Director of Communications for the CORE Group Polio Project, Ms. Dey works tirelessly to bring community perspectives to decision-makers at the national and state levels. Ms. Dey also continues to share lessons and innovative strategies from her work in India with other parts of the world impacted by polio.
Regardless of the location, her message is the same, “We need to take the time to listen. All questions and concerns are valid when it comes to making decisions about the health of one’s family – each deserves to be heard, understood and acted upon – without this, we will not be successful in protecting children.”
India, once thought to be the most difficult place in the world to end polio, was declared wild polio-free on March 27, 2014. A large part of this huge success was the ability to work one-on-one with communities in high-risk areas.
Ms. Dey began working in polio as a front-line Health Information, Education and Communication Officer with UNICEF and WHO.
She remembers, “Early in my career, during a field visit to Meerut, Uttar Pradesh, I came with a vaccination team to a house for polio immunization. A man came to the door, armed with a sword, and shouted that he would kill his nine-month old daughter, if we tried to enter and give her polio drops. I took a step back and directed our team to leave the house. It shook me.”
After taking the time to listen to the man’s concerns, Ms. Dey learned that the man was receiving a lot of misinformation from friends as well as his workplace. Out of fear and misunderstanding, he made the most severe threat possible to try and keep the health workers away from his family – in his mind to protect them.
“After taking the time to really listen to him and his friends, we began talking. I assured him that no one would vaccinate his daughter without his permission.”
Health workers need the knowledge and skills to effectively deal with these types of situations and to ensure that communities are receiving accurate information to make choices about the health of their families.
“The key is to address their questions and to build trust. By the following day, he welcomed the vaccination of his daughter and even went on to become an influential member of the community helping to address the concerns of other families.”
Ms. Dey decided to re-shape the way frontline health workers were trained.
“We needed to equip the health worker and vaccination teams with accurate knowledge and enhanced communication skills to understand and address the concerns of the families. There were many myths and misunderstandings to dispel, so I have put a lot of thinking into developing simple and user-friendly materials and methods which are local and participatory.”
“Investing in building capacities of frontline workers works! If they are not technically sound, they won’t be able to answer people’s queries.”
The Moradabad district in Uttar Pradesh was once an epicenter for polio outbreaks globally. Today, a monument to the district’s success stands tall above the bustling traffic of Moradabad City.
The monument is comprised of a large mother and child sculpture surrounded by the slogan “Two drops of life“. A polio vaccine vial sits on a base with four panels describing the partnership, strategies and journey to a polio-free India.
“No one thought it could be done when we started, but people from Uttar Pradesh, Delhi and West Bengal supported the polio eradication cause with high spirit and the job was done peacefully. A sense of great pride remains in Moradabad, and the whole of India.”
“When communities are heard and feel a sense of pride in the effort, sustained change is possible. But the flip side is also true.”
Ms. Dey remembers how children would come running with excitement, waving and cheering to interact with her team.
“When we were out on visits, the children would run to greet us. They wanted to know who we were, why we were in their neighbourhood and what we were doing. We would talk with them – we knew their names and what they were studying.”
“However, after some time, I realized that the children stopped coming, and some even began hiding from us. This was heartbreaking.”
Communities were being told that the vaccines could cause infertility, and parents were telling their children to run away from immunization teams. Dey took these insights to heart. She pushed her team, government officials and partners to think differently.
“I never thought of quitting. I want to see a polio-free world in my lifetime. I love children. I am working so that they can have a healthy life.”
She decided to develop strategies that would ramp up the involvement of influential members of the community, parents, schools, local government and families to ensure that accurate information was accessible to community members.
“We worked hard, and the scenario changed. Parents deserve to have accurate information so that they can make informed decisions about their children’s health. Many of those we engaged in this project are still advocates for polio eradication and immunization today.”
Women’s contributions cannot be overlooked
The Moradabad monument celebrating polio eradication in India.
“At ground level, we have lots of female health workers. In many countries a majority of frontline health workers and vaccinators are women, but at the higher levels, we find that the majority of leadership positions are held by men.”
“Women can often be sidelined in meetings. Things have improved, but we have more work to do. When women are in leadership positions, you find that other women are promoted and women’s voices from community level are more often heard.”
Ms. Dey recalls her own experience, “Once during a discussion with community leaders, I was not allowed inside one of the prestigious religious institutions. Even as a senior member of the team, I was made to wait outside for hours, while my male colleagues were permitted to speak with the officials inside.”
When asked what advice she would give to women beginning their careers in public health, Ms. Dey says, “Be a good listener. You must visit communities, spend time with them and build strategies for your work that are grounded in the realities of the people you are aiming to reach. You must make communications simple and always put appropriate ingredients into your approaches.”
“The health of our children and families is a very personal and foundational aspect of human life. Ultimately to increase vaccine acceptance, we have to relate to people on a human level first before launching into the science.”
“We’re always ready to give answers, but we also have to listen – at every level,” says Ms. Dey. “We must move away from being instructive and take the time to see people’s concerns as valid and to help people understand the science behind what we’re asking them to do.”
Paralympic medalist and TV presenter Ade Adepitan, who co-hosts this year’s programme, says that the eradication of wild polio in Africa was personal for him. “Since I was born in Nigeria, this achievement is close to my heart,” says Adepitan, a polio survivor who contracted the disease as a child. “I’ve been waiting for this day since I was young.”
He notes that, just a decade ago, three-quarters of all of the world’s polio cases caused by the wild virus were contracted in Africa. Now, more than a billion Africans are safe from the disease. “But we’re not done,” Adepitan cautions. “We’re in pursuit of an even greater triumph — a world without polio. And I can’t wait.”
Rotary Foundation Trustee Geeta Manek, who co-hosts the programme with Adepitan, says that World Polio Day is an opportunity for Rotary members to be motivated to “continue this fight.”
She adds, “Rotarians around the world are working tirelessly to support the global effort to end polio.”
Now that the World Health Organization (WHO) has declared that its African region is free of the wild poliovirus, five of the WHO’s six regions, representing more than 90 percent of the world’s population, are now free of the disease. It is still endemic in Afghanistan and Pakistan, both in the WHO’s Eastern Mediterranean region.
“This effort required incredible coordination and cooperation between governments, UN agencies, civil organizations, health workers, and parents,” says Manek, a member of the Rotary Club of Muthaiga, Kenya. “I’m proud of what we’ve accomplished.”
Dr. Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee and a member of the Rotary Club of Lekki Phase 1, Lagos State, Nigeria, tells online viewers that the milestone couldn’t have been reached without the efforts of Rotary members and leaders in Africa and around the world.
Funsho, who was recently named one of TIME magazine’s 100 Most Influential People of 2020, says countless Rotarians helped by holding events to raise awareness and to raise funds or by working with governments to secure funding and other support for polio eradication.
“Polio eradication is truly a collective effort … This accomplishment belongs to all of us,” says Funsho.
Rotary and its members have contributed nearly $890 million toward polio eradication efforts in the African region. The funds have allowed Rotary to award PolioPlus grants to fund polio surveillance, transportation, awareness campaigns, and National Immunization Days.
This year’s World Polio Day Online Global Update is streamed on Facebook in several languages and in a number of time zones around the world. The programme, which is sponsored by the Bill & Melinda Gates Foundation, features Jeffrey Kluger, editor at large for TIME magazine; Mark Wright, TV news host and member of the Rotary Club of Seattle, Washington, USA; and Angélique Kidjo, a Grammy Award-winning singer who performs her song “M’Baamba.”
It’s impossible to talk about 2020 without mentioning the coronavirus pandemic, which has killed more than a million people and devastated economies around the world.
In the programme, a panel of global health experts from Rotary’s partners in the Global Polio Eradication Initiative (GPEI) discuss how the infrastructure that Rotary and the GPEI have built to eradicate polio has helped communities tackle needs caused by the COVID-19 pandemic too.
“The infrastructure we built through polio in terms of how to engage communities, how to work with communities, how to rapidly teach communities to actually deliver health interventions, do disease surveillance, et cetera, has been an extremely important part of the effort to tackle so many other diseases,” says Dr. Bruce Aylward, Senior Adviser to the Director General at the WHO.
Panelists also include Dr. Christopher Elias, President of the Global Development Division of the Bill & Melinda Gates Foundation; Henrietta H. Fore, Executive Director of UNICEF; and Rebecca Martin, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention.
Elias says that when there are global health emergencies, such as outbreaks of other contagious diseases, Rotarians always help. “They take whatever they’ve learned from doing successful polio campaigns that have reached all the children in the village, and they apply that to reaching them with yellow fever or measles vaccine.”
Theprogramme discusses several pandemic response tactics that rely on polio eradication infrastructure: Polio surveillance teams in Ethiopia are reporting COVID-19 cases, and emergency operation centers in Afghanistan, Nigeria, and Pakistan that are usually used to fight polio are now also being used as coordination centers for COVID-19 response.
The online programme also includes a video of brave volunteer health workers immunizing children in the restive state of Borno, Nigeria, and profiles a community mobilizer in Afghanistan who works tirelessly to ensure that children are protected from polio.
Kluger speaks with several people, including three Rotary members, about their childhood experiences as “Polio Pioneers” — they were among more than a million children who took part in a huge trial of Jonas Salk’s polio vaccine in the 1950s.
Rotary’s challenge now is to eradicate the wild poliovirus in the two countries where the disease has never been stopped: Afghanistan and Pakistan. Routine immunizations must also be strengthened in Africa to keep the virus from returning there. The polio partnership is working to rid the world of all strains of poliovirus, so that no child is affected by polio paralysis ever again.
To eradicate polio, multiple high-quality immunization campaigns must be carried out each year in polio-affected and high-risk countries. During the COVID-19 pandemic, it is necessary to maintain populations’ immunity against polio while also protecting health workers from the coronavirus and making sure they don’t transmit it.
Rotary has contributed more than $2.1 billion to polio eradication since it launched the PolioPlus programme in 1985, and it’s committed to raising $50 million each year for polio eradication activities. Because of a 2-to-1 matching agreement with the Bill & Melinda Gates Foundation, each year, $150 million goes toward fulfilling Rotary’s promise to the children of the world: No child will ever again suffer the devastating effects of polio.
Dr. Tunji Funsho, chair of Rotary’s Nigeria National PolioPlus Committee, joins 100 pioneers, artists, leaders, icons, and titans as one of TIME’s 100 Most Influential People. TIME announced its 2020 honorees during a 22 September television broadcast on ABC, recognizing Funsho for his instrumental leadership and work with Rotary members and partners to achieve the eradication of wild polio in the African region.
He is the first Rotary member to receive this honor for work toward eradicating polio.
A Rotarian for 35 years, Funsho is a member of the Rotary Club of Lekki, Nigeria, past governor of District 9110, and serves on Rotary’s International PolioPlus Committee. Funsho is a cardiologist and a fellow of the Royal College of Physicians of London. He lives in Lagos, Nigeria with his wife Aisha. They have four children; Habeeb, Kike, Abdullahi and Fatima; and five grandchildren.
TIME 100 comprises individuals whose leadership, talent, discoveries, and philanthropy have made a difference in the world. Past honorees include Bono, the Dalai Lama, Bill Gates, Nelson Mandela, Angela Merkel, Oprah Winfrey, and Malala Yousafzai.
After the World Health Assembly passed a resolution to eradicate polio worldwide in 1988, the Global Certification Commission led the way in establishing a formal certification process, asking each of the six WHO regions to set up a Regional Certification Commission. Then in 1996, the WHO Regional Director for Africa created the Africa Regional Certification Commission (ARCC) for Polio Eradication: a 16-person independent body tasked with overseeing this process, and later on containment activities in the African region.
Professor Rose Leke, an infectious disease specialist, has been the chairperson of the ARCC since it was set up in 1998. A trailblazer for women in global health, Leke has fought throughout her career to improve women’s representation in science and global health leadership. In 2018, she was one of nine women honored with a Heroine of Health award, recognizing her outstanding contribution to health care.
Stopping the ‘havoc’ of polio in Africa
Professors Leke explains her motivation to join the polio eradication cause, “When I was invited to be part of the ARCC in 1998, I was not involved in any polio-related work. But I could see the havoc that polio was reaping on the continent. I had a nephew who was paralyzed from polio and suffered brain damage, and another relative who contracted polio and continues to inspire me. Back then, you saw so many paralyzed young people on the streets. You don’t see that today.”
Ridding the African continent of wild poliovirus is a huge achievement, many years in the making. Nigeria, the last bastion of the wild virus, proved a particularly tough setting in which to vaccinate every child and ensure that no trace of the virus remained.
Professor Leke reflects, “It’s been such a long road. When Nigeria didn’t report any cases of wild polio for two years between 2014 to 2016, we were apprehensive but satisfied. We were so close to eradication as a region, everything was going so well, and then wild polio was reported again in Nigeria in August 2016, and certification had to go on the back burner.”
“The Nigerian response to their outbreaks has been extraordinary. Everyone is committed and highly involved. In Sokoto and Kano states, where I was recently for a field verification visit, and in all other states, everyone – from government officials, traditional leaders, health staff and field teams, community health workers and informants, polio survivors to traditional birth attendants – was heavily engaged in the response. The innovative technologies that have emerged have similarly been incredible. The Nigerian Emergency Operations Centre is a well-coordinated structure that is behind Nigeria’s success. Other disease programs in Africa are learning from this.”
Professor Leke never lost her drive to end polio, even during difficult years and despite the tough choices her role sometimes presented.
“When we started, we were aiming for wild polio to be eradicated by 2000; the thought of this success really kept me motivated and still does. At times it has been a huge sacrifice; as Temporary Advisers, ARCC members are not paid, and I’ve sometimes given up consultancies to do this work. My husband, children and grandchildren will tell you, there was a huge amount of traveling and many meetings. But I don’t regret the time spent for a moment on such a cause.”
“When Dr Moeti was appointed as WHO Africa Regional Director in 2011, this was further motivation to continue: I wanted to support a fellow woman. In the beginning, I was the only female in the Global Certification Commission. The commission has addressed this imbalance and we are now two females out of the six members. We need more women in senior positions on the African continent.”
Fighting for gender equality in global health and science
In 2011, Professor Leke won the Kwame Nkrumah Award for the best female scientist in Central Africa for her research on malaria. As part of her acceptance of the award, she took a pledge “to help promote the participation of women in science in Cameroon.”
Within a year, she had helped set up HIGHER Women, a mentoring programme for senior female scientists to deliver hard and soft skills training to their early career counterparts. To support the programme, Professor Leke contributed some of her own funds.
Professor Leke says, “As a woman I encountered blocks on the way during my career – at times men asked me to leave the laboratory space I was working in.”
“Science can be a pyramid – there are many early women researchers, but far fewer at the top of the field. Research and academia have a ‘publish or perish’ culture which disadvantages women who have responsibilities outside of the lab – such as raising a family.”
Professor Leke has continually used her position to promote women in science and global health, even sharing her favorite motivational track about women’s empowerment.
Whilst great progress towards gender balance has been made since she started her career, Professor Leke is firm in noting that there is more to do. In the African regional polio programme, women still lead only a small number of national committees.
Professor Leke is proud of the public health legacy that the polio eradication programme will leave in the African region. She says, “The polio response has brought many skilled technicians into Africa’s health systems. The GPEI paved the way for working closely with traditional healers and community leaders and has really helped to strengthen the systems that report on other diseases. The polio laboratory network is being used for other diseases, giving capacity in the region for doing all sorts of other diagnostics. You’ll find the one person in the health center who was there for polio is reporting on many other diseases.”
“After we declare Africa as free of the wild poliovirus, the ARCC will work with countries to ensure they keep up good quality surveillance, and improve routine immunization, keeping population immunity as high as possible. We will also continue to guide countries in continuing to monitor population immunity to prevent importations of wild poliovirus from outside the African region, while ensuring that the threat of circulating vaccine derived polio viruses (cVDPVs) is addressed.”
“Our work continues until all forms of polio have been eradicated globally.”
Dr. Ana Elena Chevez with her medical school cohort in El Salvador. During her career, Dr. Ana has made an immense contribution to polio eradication and broader public health. Credit: Provided by Dr. Ana Elena Chevez
Little Ana first learned about the importance of vaccines from her father, a pediatrician. Growing up during El Salvador’s 12-year civil war meant that electricity cuts were a common occurrence. Whenever the electricity went out, Ana’s father would rush the vaccines he kept in his clinic to the nearby hospital, where generators kept the cold chain refrigerators working. Seeing her father’s dedication to his work, Ana knew she would also become a doctor.
Fast-forward to 2020. Dr. Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. She has worked in four countries across two regions, and currently serves as a Regional Immunization Advisor for polio at the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization, supporting the 52 countries and territories of the Americas to maintain polio-free status.
Throughout her career, she has never stopped dreaming high – advice given to her by family, mentors and colleagues.
Dr. Ana’s first job in public health was as a national immunization manager in El Salvador. Her mentor was PAHO/WHO immunization advisor Dr. Salvador Garcia. “Dr. Garcia taught me everything I needed to know about running an immunization programme. I knew that I could call him at any time, and I would get the answer that I needed,” she said.
The last mile of polio eradication in Nigeria
As polio cases surged in the African region in 2007, Dr. Ana was selected to go to Nigeria to support outbreak response. In a twist of fate, a three-month assignment turned into four years as Nigeria’s Supplementary Immunization Activity (SIA) coordinator.
It was in Nigeria that Dr. Ana refined her skills as a polio eradicator, as well as finding a ‘home away from home’. Credit: Dr. Ana Elena Chevez
This experience was pivotal for Dr. Ana’s career – it solidified her passion for polio eradication and introduced her to new colleagues and a new
country, which would soon become Dr. Ana’s second family and her home-away-from-home.
Dr. Ana was inspired by the constant innovation she saw in Nigeria. “We were always looking for ways to improve quality of the campaigns – improve training, surveillance, cold chain. It was always innovation, innovation, innovation.”
Dr. Ana believes that way of thinking really took Nigeria to the next level. “We started seeing fewer cases, more children vaccinated, and a higher level of acceptance among parents and leaders.”
As SIA coordinator, Dr. Ana oversaw all polio campaigns in the country. During these years, polio campaigns were happening on an almost monthly basis, alongside campaigns for yellow fever, tetanus elimination, and measles. It was overwhelming. “By the time we returned from the field to analyze one campaign, it was already time to start preparation for the next one. It was tiring for everyone – for us (the WHO staff), the partners, for the national/state/local health authorities, and of course for the vaccinators.”
Despite the pressure, Dr. Ana said, “If you were to ask me if I would do it again, I would say yes in a heartbeat. For me, it was being a part of an important moment in history – for the country, for public health, and for the polio programme.”
Maintaining momentum in a region certified free of polio for over 25 years
In 2017, Dr. Ana became PAHO/WHO’s Regional Advisor in charge of polio. The last case of wild poliovirus in the Americas was in 1991 and the region was certified free of polio in 1994. Although more than 25 years have passed since the Americas received polio free status, until polio is eradicated everywhere, the disease is still a risk.
25 years since the Americas were certified polio-free, Dr. Ana emphasizes that the region remains at risk until polio is eradicated everywhere. Credit: Dr. Ana Elena Chevez
Dr. Ana explains, “Even though new generations of nurses, doctors, and epidemiologists have not seen a case of polio firsthand, they understand the risk remains.” There have been 26 meetings of PAHO’s Technical Advisory Group (TAG) meeting on vaccine preventable diseases, and polio has been included on the agenda for every meeting.
It has not always been easy to keep this momentum. In recent years, countries in the Americas have had trouble meeting the indicators required to prove sensitive surveillance systems. For the last few years, PAHO has been holding almost yearly regional polio meetings to sensitize countries on the GPEI’s requirements for eradication and stress the importance of achieving high immunization coverage rates for polio and high standards of surveillance.
Dr. David Salisbury, chair of the Global Certification Commission for Polio Eradication, said at the regional PAHO polio meeting in 2017 that “there will be no free pass” for countries that are polio-free. All nations must provide documentation of certification standard surveillance to back up their belief that polio is eliminated amongst their population.
For Dr. Ana, these words hit home, “The work done by those that here before me has helped the countries to be aware. It has been my role to keep that momentum alive and help countries meet the required goals established in the Endgame Strategy.”
A message for the new generation of women public health leaders
In recent decades, women leaders in public health and immunization made important contributions to a field once dominated by men.
Dr. Ana recalls many of the women leaders that she’s worked with and considers that they have gone above and beyond what is expected. “They have raised the bar and have given the message that other women can work in public heath – it doesn’t matter your religion or colour – it matters that you care.”
Dr. Ana is excited to see more women step into leadership roles. “The new generation is coming. We need them – we need to prepare them. We are close to polio eradication, but we must think about what is next and prepare the new generation to tackle these issues with confidence. I tell my nieces that they can go and contribute to the world and make an impact.”
Reflecting on her own motivation, Dr. Ana says, “I always believed that I could make an impact, I just needed the tools, time and opportunity.”
“Young women leaders: Keep dreaming high. Keep dreaming that you can influence the health of whole populations. Don’t be afraid to set high goals– don’t be afraid to think that it is possible to control, eliminate, or even eradicate a disease.”
