News Category: Broader benefits of the polio programme

Mohamed, the Regional Polio Eradication Officer for Banadir, Somalia, participates in an integrated immunization campaign held in September 2020 with strict COVID-19 safety measures in place. In addition to their polio duties, programme personnel have provided substantial support to the pandemic response. ©WHO/Somalia

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 children who have missed out on vital vaccines during the pandemic.

Dr. Samreen Khalil, WHO Polio Eradication Officer in Pakistan, collects a sample from Muhammad Shabir in order to test for COVID-19 in July 2020. ©WHO/Blink

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.

Syed Razzaq, technical officer for MIS/IT information management team lead shows data on Pakistan’s COVID-19 response at the operations room at National Emergency Operation Centre (NEOC) for Polio Eradication, located inside the National Institute of Health. © WHO/EMRO

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.

Download the statement.

A vaccinator administering polio vaccine to a child during a vaccination campaign in Yemen, July 2020. ©WHO/EMRO

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.

“Investing in building capacities of frontline health workers works” ©Frank Conlon

A pivotal moment

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.”

Nothing for us, without us

Education and listening to communities is at the core of Rina Dey’s work. ©CORE Group Polio Project

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.”

Two female vaccinators in Borno, Nigeria, the last stronghold of the wild poliovirus in Africa. ©Andrew Esiebo/2020

Rotary’s 2020 World Polio Day Online Global Update programme on 24 October hails this year’s historic achievement in polio eradication: Africa being declared free of the wild poliovirus.

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.”

A child in Afghanistan receives a polio vaccine in a COVID-19 safe way. ©WHO/Afghanistan

A collective effort

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.”

A child in Pakistan receives polio drops during the first campaign to resume in the country after vaccination activities were temporarily paused in the early stages of the COVID-19 pandemic. ©UNICEF/Pakistan

The challenges of 2020

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.

Dr Samreen Khalil, a WHO Polio Eradication Officer, has pivoted her skillset to serve the COVID-19 response in Pakistan. She and thousands of her colleagues are on the frontlines fighting the pandemic and the poliovirus. ©WHO

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.”

The programme 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.

A child is vaccinated against the poliovirus in Afghanistan. ©WHO/Afghanistan

The future of the fight against polio

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.

Consider making a donation to Rotary’s PolioPlus Fund in honor of World Polio Day.

Learn more.

Dr. Tunji Funsho

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.

Read more.

Professor Rose Leke speaks to members of the media during an ARCC meeting in Dakar, Senegal, 2018. © WHO

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.”

ARCC member Dr Zacharia Maiga questions health staff on their polio cold chain facilities during an ARCC verification visit to Nigeria in 2019. © ARCC
ARCC member Dr Zacharia Maiga questions health staff on their polio cold chain facilities during an ARCC verification visit to Nigeria in 2019. © ARCC

Personal commitment to end polio

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.”

Professor Rose Leke, chairperson of the Africa Regional Certification Commission (ARCC) for Polio Eradication ©WHO/M. Henley

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.

Members of the Africa Regional Certification Commission (ARCC) for Polio Eradication during an annual meeting in Yaoundé, Cameroon in 2017. ARCC chairperson Professor Rose Leke is in the front row, fourth from the left © WHO

A lasting legacy

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.”

Read more from Professor Leke on the Kick Polio Out Of Africa site.

 

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.”

 

Community surveillance teams for COVID-19 and acute flaccid paralysis speak to households about any individuals with symptoms in their area. The Somali polio team is currently steering the COVID-19 response and fighting ongoing polio outbreaks amidst challenging conditions. ©WHO/Somalia

For Somalis, COVID-19 is the most immediate crisis in a seemingly unending cycle of floods, food insecurity, conflict and outbreaks of vaccine-preventable diseases like measles, cholera and polio. Against this backdrop, the World Health Organization’s polio programme is working to steer the COVID response and, more broadly, maintain vaccine immunity levels and improve access to healthcare. It’s no easy feat.

Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, is in awe of the commitment shown by health staff. He recently phoned a Polio Logistician diagnosed with COVID-19 who was experiencing symptoms, to insist he stop working remotely from his sickbed. Dr Kamil recalls, “He said, “No Sir, I will continue.”

Since the first COVID-19 case was diagnosed in Somalia on 16 March 2020, the polio programme has fought the pandemic from the ground up. Dr Kamil explains, “No other health programme has comparable expertise to serve the Somali population during COVID-19. During their time in the programme, members of the polio team have responded to many different disease outbreaks. This means they were well placed and well trained to respond to COVID-19.”

“The polio programme has spent years building staff capacity and systems to implement vaccination campaigns and detect the poliovirus in the community. In some ways, the team are the first and last line of defense.”

The response includes education, case identification, contact tracing, case management and data support. As of June, polio staff working as part of rapid response teams (RRTs) had reached 2.6 million people with messages about COVID-19 prevention. District Polio Officers within the RRTs have led the investigation of over 4500 people with suspected COVID-19 across the country. The country has set up three COVID-19 testing facilities and the polio structure established for the collection and shipment of stool samples from AFP cases has been used for the transportation of COVID-19 samples.

Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, speaks to a polio vaccinator before the onset of the pandemic. ©WHO/Somalia

Throughout, polio personnel have continued their full-time work to end the circulating vaccine-derived poliovirus (cVDPV) outbreaks that have thus far paralyzed sixteen children since 2017.

The team are driven by a humanitarian commitment to the Somali population, who have suffered over 30 years of protracted conflict and insecurity. At least 5.2 million people are in need of humanitarian assistance, and secondary and tertiary healthcare is virtually non-existent outside of a few large cities. Health literacy is low, and populations are highly vulnerable to diseases like polio, measles, cholera and now COVID-19. In November 2019, widespread flooding brought further turmoil and danger to Somali families.

The team’s work is made more difficult by the emotional toll wrought by the pandemic. To date at least 143 health workers have been identified with COVID-19 infection. In April, Ibrahim Elmi Mohamed, a District Polio Officer who spent 19 years striving for a polio-free Somalia, died of a COVID-19-related illness. His death, one of many frontline staff around the world due to COVID-19, remind us of the risks they face every time they go to work.

Challenges lie ahead to defeat polio

Dr Kamil is clear that the polio programme will require ongoing funding and the support of authorities, partners and communities in order to maintain polio activities amidst the pandemic.

“To sustain the immunity gains we must implement a number of polio vaccination campaigns each year until the routine immunization programme can reach every Somali child with all polio vaccines. Somalia is extremely fragile and at high risk of becoming endemic for poliovirus if we do not maintain and support the polio infrastructure,” he says.

Since the cVDPV outbreaks were first detected in 2017, the programme has streamlined disease surveillance for cases of acute flaccid paralysis and other preventable diseases, including by introducing mobile technology to record details of suspected cases. For the first time, environmental disease surveillance was introduced. Over three years, frontline health workers have implemented more than 15 polio campaigns, including integrated campaigns with the measles programme.

A volunteer vaccinator gives two drops of the polio vaccine to a Somali child in August 2019. Despite efforts, many inaccessible areas remain where the programme cannot deliver vaccines. ©WHO/Ilyas Ahmed

Dr Kamil explains, “We still don’t know where the virus is coming from exactly. There are many inaccessible areas, where we cannot deliver vaccines or respond with immunization campaigns. We suspect that the virus is circulating among vulnerable children and communities living in these areas.”

Dr Kamil feels strongly that the polio programme has a duty to support other health interventions. He says, “COVID-19 shows what the frontline polio staff can achieve and the strength of surveillance and response systems.’’

Despite the challenges, Dr Kamil retains his belief that with ongoing funding and support, the cVDPV outbreaks in Somalia can be brought to a close. He reflects, “COVID-19 is a huge emergency in Somalia. Our staff are working flat out, and we expect to see many more cases, but at the same time we must continue to fight polio. The Somali community and the world deserve to be free of this disease.”

“We must reschedule our March polio vaccination campaign which was delayed because of the COVID 19 outbreak. We must do everything possible to keep health workers safe from COVID-19. It’s a hard situation, but we must not stop until we overcome both viruses.”

Related resources

Training health workers to fight COVID-19 in Sudan
Polio eradication expertise backs Africa’s COVID-19 response
Watching a video with COVID-19 prevention messages, designed to be easily be shared using messaging applications. ©2020/UNICEF Pakistan

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

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

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

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

Engaging religious and community influencers

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

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

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

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

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

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

The ‘new normal’ for community outreach work

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

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

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

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

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

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

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

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

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

 

Dr Niazy trains medical staff on handwashing during a COVID-19 training session in River Nile state. Credit: WHO-POL/Sudan

The polio eradication programme has stepped up to help the Sudanese Ministry of Health limit spread of the COVID-19 virus. The programme is working in 14 states in the country supporting COVID-19 surveillance, information dissemination and training of health workers.

Dr Niazy Abd Alhameed Abd Alwahab, a National Medical Officer for the polio programme since 2013, is one of the personnel playing a key role. He and colleagues recently led two WHO COVID-19 trainings in River Nile state, one for Rapid Response Teams (RRTs) and one for local hospital staff, in addition to supporting trainings run by the State Ministry of Health.

Thanks to the trainings, health workers in all seven localities in the state are ready to help individuals who are showing symptoms of COVID-19. In total, more than 3000 RRT members have been trained across Sudan with support from polio National Medical Officers.

By early May, River Nile state had suffered seven cases of COVID-19, with two fatalities. “The state is organized to respond”, Dr Niazy explains, “All patients are being treated in dedicated isolation facilities in hospitals, and medical staff are on high alert for more cases. We helped train teams so that they are able to serve the population.”

Training Rapid Response Teams

A five-day training of Rapid Response Teams, funded by WHO, was targeted at seven teams, one from each state locality. Of the 42 individuals trained, 30 were women and 12 were men. The Rapid Response Teams have been created for the COVID-19 response. Each team contains individuals with the collective public health experience to contribute to local efforts to fight the virus, spearheading work in contact tracing and engagement with the community.

The first day of training was attended by the Director General Health of the State Ministry of Health and the Head of the Emergency Humanitarian Assistance (EHA) department.

Dr Niazy explains that over the five days, participants gained a comprehensive understanding of Sudan’s COVID-19 surveillance and contact tracing systems, infection prevention and control practices, case management methods, and how to collect samples and arrange shipment to the national laboratory in Khartoum. Participants were also trained on how to use PPE safely and how best to wash their hands.

“Participants were encouraged to take part in interactive exercises to test and strengthen their knowledge, as well as take part in discussions,” he says.

“By the end of the training, all participants were fully trained and able to pass on their knowledge in their localities.”

Training local health staff

The polio programme also supported a two-day COVID-19 training for 34 women and 22 men who work in state hospitals as doctors, lab technicians, or other medical personnel. The programme continues to support the State Ministry of Health with further local trainings, including for medical registrars.

Ongoing challenges

The situation in River Nile state is very challenging. There are chronic shortages of PPE, hand sanitizer and masks, and WHO is offering urgent support to help procure these. Severe shortages of fuel and currency are making response more difficult. Social norms in some communities dissuade individuals with COVID-19 symptoms from seeking medical assistance, and work must be carried out to build trust and ensure people with COVID-19 are found and offered care.

To serve the COVID-19 response and prevent virus spread, the polio eradication programme has had to scale back some of its usual work. Dr Niazy explains, “Vaccination campaigns are paused, and many private clinics are closed, some of the public health centres are turned into isolation centres as part of the response to this emergency. This makes detecting acute flaccid paralysis (AFP) more difficult, as health personnel are trained to report children with AFP who come to the health centres.”

Efforts are being made across the Eastern Mediterranean Region to minimize the impact of COVID-19 on the overall health of populations, during a time when many health activities cannot go ahead. In Sudan, a number of children do not have full immunity against polio, and it is critical that routine immunization continues where possible until vaccination campaigns resume.

Dr Hoda Youssef Atta, WHO Representative a,i, explains, “During the COVID-19 emergency the polio eradication programme is committed to providing expertise, training and medical skills to protect Sudan. However, as soon as it is safe to do so, we must scale up programme operations once more to protect vulnerable populations from polio.”

Related resources

Polio eradication expertise backs Africa’s COVID-19 response
Personnel from WHO’s polio eradication programme provide training on COVID-19 surveillance to 31 contact tracers from the Zimbabwean Health Ministry of Health. ©WHO/AFRO

Expertise in polio eradication that has put Africa on the verge of being certified free of wild poliovirus has been brought to the frontlines of the COVID-19 fight. A network of responders from the World Health Organization (WHO) polio eradication programme and partner organizations is providing critical resources and skills to tackle the COVID-19 pandemic.

To boost testing in the WHO African Region, the WHO-coordinated polio laboratory network comprising 16 laboratories in 15 countries is now dedicating 50% of its capacity to COVID-19 testing. Hundreds of tests are carried out every day using polio testing machines in Algeria, Cameroon, Cote d’Ivoire, Ethiopia, Madagascar, Nigeria, Senegal and South Africa.

“In Africa, no one has the footprint of the polio programme nor the expertise for mounting effective response campaigns. So with COVID-19 threatening to overwhelm health systems, the extensive polio response network is once again lending crucial support as countries build up systems to contain COVID-19,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa.

Contact tracing has also been a central pillar of the WHO polio programme’s support to the COVID-19 response. Mobile phone applications originally developed for health workers to use in polio outbreak response and disease surveillance have been adapted by WHO to be used against COVID-19. In Zimbabwe, for example, over 100 disease surveillance officers are using these tools for case investigations and contact tracing in many provinces where COVID-19 has been confirmed.

In addition, the WHO Geographic Information System (GIS) centre in Brazzaville, Congo – which was opened in 2017 to support the polio programme with adapted technologies and data management – is using its huge experience in outbreak response and disease surveillance to support countries with a range of GIS and software technology and manual solutions to respond to COVID-19. The GIS team is now working around the clock supporting countries to take up the technology for COVID-19 responses.

More than 2000 polio response experts from WHO, UNICEF, Rotary, as well as STOP consultants from the United States Centers for Disease Control and Prevention are supporting the COVID-19 response in the African Region. A quarter of WHO polio staff are dedicating more than 80% of their time towards COVID-19 efforts, with 65% anticipating a commitment of six months or more.

Alongside the support to the COVID-19 response, WHO polio staff are also maintaining critical functions including disease surveillance and planning to resume mass polio immunization campaigns once the situation permits to reduce the risk of new polio outbreaks.

“It is important that the support to COVID-19 response does not jeopardize the progress made in stopping all forms of polio transmission in the region. The fight against the pandemic should not come at the detriment of other health emergencies,” emphasized Dr Moeti.

Focus: Using digital tools for contract tracing in Zimbabwe

“With Zimbabwe’s first COVID-19 case, we used paper tools to facilitate data management during case investigation and contact tracing, but our contact tracers faced many challenges with follow up and reporting,” says Manes Munyanyi, Deputy Director Health Information and Surveillance Systems for Zimbabwe’s Ministry of Health and Child Care.

Contact tracers in Zimbabwe learn how to use the mobile phone applications developed by the regional polio programme. ©WHO/AFRO

“Using digital tools [provided by the polio programme] for outbreak responses cannot be overemphasized as the technology provides responders with data management, visualization and information dissemination platforms that support informed decision making at all levels.”

Polio programme staff are conducting disease surveillance for COVID-19 as well as educating communities on the symptoms of the virus, how to prevent transmission, and how to report suspected cases. ©WHO/Somalia

“The road to the mountain village was rough. It’s only 50 kilometres, but it took more than 3 hours,” says Dr Fatima Ismail, a disease surveillance officer working in Somaliland. “We were bouncing in the car.”

In early 2020, Dr Fatima’s team headed to a remote village near Djibouti to check on a small boy. The boy’s right arm and leg showed a kind of paralysis that sometimes indicates polio. “The village polio volunteer in this mountainous area, geographically inaccessible, found an acute flaccid paralysis (AFP) case,” Dr Fatima remembers.

When children show signs of this paralysis, it is critical to get stool samples to a laboratory to determine whether they have polio. Polio teams ride camels in the desert or donkeys in the mountains when they have to. They brave conflict to get samples to laboratories. In brutally hot climates, they plug mini-freezers into car dashboards to keep samples cool.

All over the world, polio surveillance systems that have been built up over decades track infection sources, evaluate symptoms and transport samples to the laboratory — despite distance, natural disasters, and sometimes war. Now, disease surveillance network — reaching into the most far-flung corners of the globe — is being tapped to address the COVID-19 pandemic.

“In Somalia, the polio programme pivoted its workforce of thousands of frontline staff to support the effort as the cases of COVID-19 spread. Rapid response teams — made up of disease surveillance officers, community health care workers and volunteers — were trained to educate people about the virus and to test suspected cases. By April 2020, the teams were deployed in the field,” said Dr Mamunur Malik, WHO Representative in Somalia.

“In Somalia’s remote villages, they know us as their polio teams, and once they see us, what comes to their minds is that we’re giving them information about polio,” says Mohamed*, a surveillance officer. “So we also give them information about COVID-19. Social mobilisers tell them about COVID-19 symptoms, how to prevent getting infected, physical distancing, cleaning their hands very well with running water and soap.”

The careful procedures that the teams learned for polio surveillance have been adapted for COVID-19, where the required sample is a naso-pharyngeal swab. “We’ve trained our surveillance people on the case definition and how to collect the samples correctly, from people that meet the definition of a suspected case of COVID-19,” says Dr Fatima. “It’s the same infrastructure. After, when we collect the samples from the patient, we send it to the laboratory in Hargeisa.” WHO has given the laboratory equipment and supplies to test samples for COVID-19.

“As with polio samples, the samples of COVID-19 have to be refrigerated, the ice packs should be VERY cold,” says Mohamed. Teams are used to monitoring the packs’ temperature, even in Somalia’s hot weather.

“The logistical challenges we face with AFP/polio surveillance are still the same. This is the rainy season and the roads tend to be terrible,” says Mohamed. “You can’t get to certain places you normally get to, because of the situation on the road. Most of our vehicles can’t make it through the mud.” In those situations, teams work with other United Nations agencies to arrange special humanitarian flights to ship samples.

Frontline staff put their own lives on the line. In April 2020, the polio team lost a colleague due to COVID-19-related infection. Ibrahim Elmi Mohamed, who joined WHO in 2001, was working as a district polio officer in Lower Shabelle. His tragic death, one of many frontline staff around the world due to COVID-19, reminds us of the risks they face every day they go to work.

“Despite overwhelming challenges, teams are committed to continuing their polio work in tandem with the COVID-19 response. It is critical that polio surveillance continues during the pandemic, as Somalia is also fighting outbreaks of vaccine-derived polio type 2 and 3. With polio vaccination campaigns temporarily paused, the teams must be able to track any resulting spread of poliovirus and get ready to respond as soon as it is safe to do so,” says Dr Malik.

“All of us are still doing polio surveillance at the same time as we do surveillance for COVID-19,” says Dr Fatima. “I used to hear from my colleagues that the polio surveillance system is the strongest disease surveillance system. Any polio surveillance team can work in the detection of COVID-19 cases because of the system’s structure, the capacity and experience of the teams.”

Mohamed agrees. “My surveillance coordinator said don’t leave the AFP surveillance behind, follow that normal routine, don’t forget it and leave it aside.’”

As Somalia grapples with the COVID-19 pandemic, its trained teams are working quickly to prevent the spread of both COVID-19 and polioviruses. “What gives me hope in the COVID-19 response is when I look behind and I see what we have done with the polio teams, the impact we’ve had on so many lives,” says Mohamed. “We face everything and we overcome it.”

*Family name withheld for security reasons

Related news

Polio workers distribute soap and information in fight against COVID-19
Supporting COVID-19 Response: Call 1166 in Pakistan
Tahira and daughter Dua attend a routine immunization session in Punjab province, Pakistan in January 2018. It is critical that immunization delivery systems are sustained through the COVID-19 pandemic. ©WHO Pakistan/Asad Zaidi

This month, world leaders have joined together to make several important commitments to strengthening public health infrastructure during the COVID-19 response – investments that will go a long way in protecting the most vulnerable communities, including those affected by polio.

On 4 May 2020, heads of government, institutions and industry pledged USD $7.4 billion (of the USD $8 billion goal) to ensure equitable access to new tools for COVID-19 globally. The funding will support the Access to COVID-19 Tools Accelerator, which will help develop new global health technology solutions to test, treat and protect people, and prevent the disease from spreading.

A day later, several donors pledged new funding to Gavi, one of the partners of the Global Polio Eradication Initiative (GPEI), ahead of its upcoming replenishment in June 2020. This funding will not only help vaccinate hundreds of millions of children against diseases such as polio, but also ensure that immunization delivery systems are sustained through the pandemic.

The GPEI greatly appreciates outstanding donor community support for both the COVID-19 response effort and routine immunization programmes around the world.

The GPEI is continuing to do its part to support the COVID-19 pandemic, in solidarity with other health initiatives. In March, the Polio Oversight Board made the recommendation to pause polio vaccination campaigns to limit further spread of the disease. Countries extended their key polio eradication assets, like infrastructure and human resources, to support countries’ COVID-19 response efforts, while continuing essential activities. As of May, GPEI resources, including surveillance laboratories, and social mobilization and communication networks, are supporting COVID-19 response in at least 55 countries.

The pause of vaccination campaigns and the disruption of routine immunization services leaves millions of children at high risk of contracting polio, measles and other vaccine preventable diseases (VPDs). The COVID-19 pandemic has demonstrated that vaccines, against both COVID-19 and VPDs, are crucial to protecting individuals, communities and economies.

As countries continue to implement their COVID-19 response plans, WHO and UNICEF are working with emergency and immunization partners to ensure the polio infrastructure not only supports the response, but also is fully funded in alignment with the ongoing efforts to finance COVID-19. While work is ongoing to cost those requirements, the GPEI hopes that specific COVID funds will be able to contribute towards its response efforts.

It is critical that essential health services and systems, including polio eradication efforts, have necessary support during both the response and recovery phases of this pandemic. While the GPEI has extended its assets to the global COVID-19 response effort, sustaining these programmatic resources is imperative. Continued donor commitments will enable the safe and effective resumption of polio vaccination campaigns as the situation evolves.

Related resources

Supporting COVID-19 response: call 1166 in Pakistan
More than 3,750 polio social mobilisers have been diverted for COVID-19 response. ©UNICEF/Afghanistan

In response to the COVID-19 pandemic, the polio programme has diverted thousands of personnel to fight the virus. Repurposing extensive experience eradicating polio, the programme is supporting country response in areas including information dissemination, disease surveillance, risk communications and data management.

Community social mobilizers stepped up in March to deliver soap bars and information on COVID-19 to some of Afghanistan’s poorest and most vulnerable communities.

Social mobilizers are local people trained to communicate with the public about specific health issues in ways that are understandable and encourage behaviours to protect health. In Afghanistan, UNICEF coordinates a network of 3,750 mobilizers.

Social mobilizer Feroz explained the importance of his mission. “The families were especially happy with the soap distribution. If the social mobilisers were not here, people would have remained uneducated about COVID-19.”

Just a few days after the decision to mobilize polio teams for COVID-19 response, Feroz’s team distributed thousands of soap bars and educational materials on the virus to communities across his province. Many of the families served have limited access to adequate sanitation products or facilities. Providing a bar of soap and demonstrating its use is a simple COVID-19 prevention measure.

During the distribution, the teams emphasized the importance of routine immunization continuing throughout the pandemic, reminding parents to take their children to health facilities. With house-to-house polio vaccination campaigns paused for the time being, many more children may be vulnerable to polio and other vaccine-preventable diseases if they do not receive vaccinations at health clinics.

The soap packaging carried a pro-vaccine message, reading ‘let’s come together for a polio-free Afghanistan.

Zuhal and a colleague demonstrate the best way to wash hands to help prevent spread of COVID-19 and other diseases ©UNICEF/Afghanistan

Zuhal, a colleague of Feroz, explained that she has noticed a change in how vaccine hesitant families react to the polio social mobilisers since the beginning of COVID-19 pandemic. ‘’The number of people who were interested exceeded our expectations. We were able to attract our communities’ attention. Parents who used to refuse polio vaccine in campaigns have participated in COVID-19 discussions and eagerly asked for information.’’

She added, ‘’During the last polio campaign, I had to wait 30 minutes in front of one house. When the door was opened, a man told me, “Go, we do not want to vaccinate our children. Never come here again”. The same man looked for me in his neighbourhood during our COVID-19 information and soap distribution, and this time he was desperate for information. This shows that people in the community recognize that we are a source of information when they are concerned about their health, even if they have rejected polio vaccines in the past.’’

Feroz agreed, saying, “The community has more trust in us now we are trying to minimize the risk of COVID-19 infection through public education.’’

It is hoped that the trust built up between the mobilizers and communities during this time will translate into stronger relationships far into the future. This may help the polio programme reach out to children in families where vaccination has previously been viewed with suspicion.

Feroz is pleased to serve his community. He says, “I feel proud seeing the results of my work, when children receive routine immunization on time and pregnant women deliver safely at the hospital. Knowledge matters.”

He adds, “Information at the time of crises can be lifesaving. The polio programme has a mission to protect every child against diseases – polio and now COVID-19.”

Related resources

Polio eradication and COVID-19
Supporting COVID-19 Response: Call 1166 in Pakistan
The NEOC “Sehat Tahaffuz 1166” Helpline provides lifesaving information. ©UNICEF Pakistan/2020/Sharmin

“How can I help you?” Pause. “Have you travelled out of the country recently?” Pause. “Please stay on the line. I am connecting you to a doctor,” says a young woman reassuringly to someone at the other end of the line.

The call operator works at the ‘Sehat Tahaffuz 1166’ COVID-19 Helpline Centre at the National Emergency Operations Centre (NEOC) for Polio Eradication in Islamabad, Pakistan.

Until last month, Sehat Tahaffuz 1166 was a polio eradication helpline to help caregivers share concerns and receive accurate information about polio and other vaccines. As the pandemic spread, the Government expanded the centre to fight COVID-19.

A vital support system during a difficult time

Like many other countries, the global outbreak of COVID-19 poses an enormous challenge to health services in Pakistan. The Sehat Tahaffuz 1166 call centre is increasingly becoming an important platform to listen to the concerns of people, provide correct information, and connect them to a doctor when required.

Sadia Saleem (24), a proud Helpline agent. ©UNICEF Pakistan/2020/Sharmin

“I received a phone call from a 75-year-old man this morning. He was so scared and confused because of the coronavirus situation. He asked if sunbathing could help him stay protected from the virus,” said Sadia Saleem, a 24 year old helpline agent. “I explained to him the symptoms of the virus, and the preventive measures. He seemed relieved and thanked me,” she added.

Sadia is one of the 55 call agents currently supporting the helpline, which operates in shifts, from 8am to midnight every day, seven days a week.

“I’ve been working for the 1166 helpline since its inception. It’s stressful work but I feel proud that I’m serving the people during this challenging time. In addition to receiving reliable information, I think most people feel some comfort just speaking with someone from the health system,” said Sadia of her experiences.

Alongside the agents, the government has assigned six doctors to support the Helpline. Dr. Rabia Basri is one of them.

“I am forwarded calls that are critical and need expert medical advice. Every day, I receive about forty calls, some twenty minutes long. These are difficult times for everyone. I often advise people about personal hygiene and physical distancing, and if they are having symptoms, help connect them with a hospital for the coronavirus test and further medical support,” said Dr. Rabia.

Dr. Rabia Basri is one of six doctors stationed at the Helpline, responding to critical calls with expert medical guidance and referrals. ©UNICEF Pakistan/2020/Sharmin

70,000 calls a day

“Initially, we were receiving about a thousand calls a day. During the National Polio Immunization Campaign in February 2020 for example, people were calling to report missed children, clarify doubts about vaccines and lodge complaints when health and vaccine services were not working,” said Huma Shaukat, the Helpline Liaison Officer.

However, since the outbreak of COVID-19, the call volume has increased dramatically, to about 70,000 calls a day.

“Each call agent responds to about 150 callers a day. To increase the capacity of the helpline, thirty more agents have joined to manage the growing number of calls,” added Huma.

Despite adding more agents, the call volume has become unmanageable for the helpline centre. The situation has prompted the government to assign additional resources. The Digital Pakistan initiative of the Prime Minister’s Office is helping recruit an additional 165 agents while the National Institute of Health is assigning ten more doctors to the technical team.

Managing the 1166 helpline centre

“Training and commitment of call agents are very important. Otherwise the helpline will not work,” said Huma. “We have four supervisors managing the team of call agents and support them when required as the work here is highly challenging, especially now with the high number of calls every day.”

Daniyal Kiyani (20) is a newly recruited Helpline agent committed to helping people during the COVID-19 pandemic. ©UNICEF Pakistan/2020/Sharmin

All call agents undergo a comprehensive training on COVID-19 basic information and primary symptoms facilitated by the National Institute of Health, followed by sessions on the helpline technology and interpersonal communication.

“We generate a daily report and share with relevant sections and the helpline management team. This is very important as it helps us review and manage problems, to continue functioning as an efficient helpline supporting people in their time of need,” Huma explained.

With the leadership of the Government of Pakistan and the support of Global Polio Eradication Initiative (GPEI) partners – the United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and Bill & Melinda Gates Foundation (BMGF), the Sehat Tahaffuz 1166 Helpline has become an essential support system for the people of Pakistan.

“GPEI partners are supporting the Government in utilizing existing polio eradication resources for the COVID-19 response in Pakistan. We are striving together to support as much as we can to ensure the health and safety of all children and families in the country during this challenging time,” said Dennis Chimenya, the UNICEF C4D team lead supporting the helpline in Pakistan.

Related resources

Polio eradication and COVID-19
"The first call"

Notice: Trying to access array offset on value of type bool in /var/www/vhosts/polioeradication.org/httpdocs/wp-content/themes/gpei/classes/GPEI/ShortCodeHTML.php on line 126

Notice: Trying to access array offset on value of type bool in /var/www/vhosts/polioeradication.org/httpdocs/wp-content/themes/gpei/classes/GPEI/ShortCodeHTML.php on line 137

Notice: Trying to access array offset on value of type bool in /var/www/vhosts/polioeradication.org/httpdocs/wp-content/themes/gpei/classes/GPEI/ShortCodeHTML.php on line 126

Notice: Trying to access array offset on value of type bool in /var/www/vhosts/polioeradication.org/httpdocs/wp-content/themes/gpei/classes/GPEI/ShortCodeHTML.php on line 137

The COVID-19 pandemic response requires worldwide solidarity and an urgent global effort.  The Global Polio Eradication Initiative (GPEI) stands ready to respond.

GPEI’s response to COVID-19 is driven by two principles.  The first is our public health imperative to ensure that the polio programme fully plays its part in the COVID-19 response, supported by our second, underlying principle that when the emergency ends we will be ready to end polio with urgency and determination.

GPEI assets at service of COVID-19 response

The Polio Oversight Board (POB) has agreed that for the next four to six months, GPEI programmatic and operational assets and human resources, from global to country level, will be made available to enable a strong response to COVID-19, while maintaining critical polio functions, such as surveillance and global vaccine supply management.

GPEI will continue to deploy polio-funded personnel to the COVID-19 response and make available coordination mechanisms, such as emergency operations centers, and physical assets such as transportation or IT hardware.  Through our extensive front-line worker networks in many countries, we will ensure the collection of information to provide evidence-informed guidance in line with WHO recommendations. At country level, the polio surveillance network is being trained on COVID-19 case detection, case and contact tracing, laboratory testing and data management.   Our data management systems and front-line staff are already ramping up action in many countries, and wherever the polio programme has a presence we will continue to serve the response.

GPEI will also seek assurances that when GPEI staff is supporting COVID-19 front line activities, they will be provided with the necessary training, materials, equipment and logistics support to do so safely, in line with infection prevention and control measures. The GPEI is conscious that women, who make up most caregivers and health workers, are likely to bear a heavier burden as the pandemic plays out in polio-affected countries. Their health and safety are a priority and we are working on ways to mitigate impact including making sure that their voices are heard in management and leadership positions.

Pause in immunization campaigns

All countries planning to conduct poliovirus preventative campaigns are advised to temporarily postpone these campaigns until the second half of 2020. Countries which were planning to conduct poliovirus outbreak response campaigns are advised to postpone these campaigns until 1 June 2020 and then reevaluate based on the status of the COVID-19 pandemic.

The final decision to proceed with outbreak response rests with countries, who will need to evaluate the risks of a delayed response to detection of poliovirus against the risks of an immediate response, which could contribute to further spread of SARS-CoV-2 and more cases of COVID-19.   Should an outbreak response campaign be pursued, countries should ensure measures needed to uphold infection prevention and control, protect health workers and safeguard the public are in place.

We take this decision with deep regret, knowing more children may be paralyzed by polio as a result. Nonetheless, GPEI believes it is the correct decision, given the imperative to save lives in the current emergency and not contribute to the further spread of COVID-19.

To mitigate the risks of lower immunity levels and to protect children from paralysis, GPEI will continue to work to the extent possible on strengthening essential immunization in the highest-risk areas for spread of poliovirus.   This will be carried out under relevant WHO recommendations including the recommendation to prioritize vaccines for outbreak prone diseases such as polio, measles, diphtheria and yellow fever.

To more effectively meet communities’ health needs, the polio network will support delivery of basic services where it has the capacity to do so, including in Afghanistan, for example, through advocating for the establishment of health facilities in the most high-risk areas. We believe that the delivery of such basic services would contribute both to a successful COVID-19 response in these areas and to build trust and valuable engagement opportunities.   As soon as it judged safe to do so, GPEI will support countries in conducting the appropriate catch-up vaccination campaigns.

Maintain surveillance

GPEI will place the highest priority on the continuation of poliovirus surveillance (acute flaccid paralysis and environmental) to closely monitor the circulation of wild and vaccine-derived polioviruses. GPEI will provide guidance and active support for countries on issues such as managing disruptions to shipping of stool samples, use of community surveillance and digital platforms and expanding environmental surveillance, where acute flaccid paralysis surveillance cannot be carried out.

Ready to end polio

GPEI will keep momentum on strategic areas to minimize loss of ground.  We will ensure that we will come back stronger and faster when the COVID-19 emergency subsides, driven by our determination to achieve a polio-free world.

To prepare for this scale-up GPEI will work over the coming months to ensure the availability and readiness of polio vaccines with the goal of rapidly vaccinating at-risk communities as soon as the situation allows.  Work will continue at full speed on the development and use of novel Oral Polio Vaccine type 2, with the aim of rolling out the new vaccine by the third quarter of 2020.

 Over the coming months, continued partnership and support from donors and stakeholders will be critical to ensure GPEI continues driving progress toward polio eradication, given the likelihood that postponement of vaccination campaigns will lead to lengthened eradication timelines and increased resource needs.  GPEI commits to keeping our donors and other stakeholders updated as the polio programme adjusts to the evolving COVID-19 global emergency.

Solidarity with the most vulnerable.

Eradication is about reaching the unreached and the most vulnerable.  GPEI has been able to focus resources and strategies on how best to reach these communities, how to build trust and how to engage with them. These are also relevant challenges for implementing a successful COVID-19 response in the highest risk communities.  All those working on and investing in a polio-free world should be proud of their contribution to the challenge of COVID-19.  They are providing an important input into stronger health systems and global health security. They are supporting the ability of countries to prepare for and respond to emergencies, and ultimately to serve their most vulnerable.

Now, more than ever, is the time for solidarity and service above self.

Download the statement: English | French | Arabic | Spanish |

Related Documents

Urgent country and regional recommendations from the Polio Oversight Board
Polio eradication programme continuity planning

The COVID -19 pandemic response requires worldwide solidarity. The Global Polio Eradication Initiative (GPEI) has a public health imperative to ensure that its resources are used to support countries in their preparedness and response. The COVID-19 emergency also means that polio eradication will be affected. We will continue to communicate on impact, plans and guidance as they evolve.

Policy statements


Urgent updated country and regional recommendations from the Polio Oversight Board – 26 May 2020
| English |


Use of bi-valent Oral Polio Vaccine supplied for polio Supplementary Immunization Activities in Routine Immunization activities | English | French |


Use of oral polio vaccine (OPV) to prevent SARS-CoV2 | English |



Safeguarding in-country mOPV2 stocks during COVID-19 pandemic pause | English |

Technical and operational guidance documents


Polio eradication programme continuity: implementation in the context of the COVID-19 pandemic | English | French |



Interim guidelines for frontline workers on safe implementation of house-to-house vaccination campaigns |English| French |


Interim guidance for the polio surveillance network in the context of coronavirus (COVID-19) | English |

 

 

 

This story is also available in other languages: French, German, Italian, Japanese, Korean, Portuguese and Spanish

Polio staff conduct COVID-19 awareness training in Gadap, Pakistan. ©WHO Pakistan

Using the vast infrastructure developed to identify the poliovirus and deliver vaccination campaigns, the polio eradication programme is pitching in to protect the vulnerable from COVID-19, especially in polio-endemic countries. From Pakistan to Nigeria, the programme is drawing on years of experience fighting outbreaks to support governments as they respond to the new virus.

Pakistan

Few health programmes have as much practice tracking virus or reaching out to communities as the Pakistan polio eradication programme. This means the polio team is in a strong position to support the Government of Pakistan in COVID-19 preparedness and response.

Currently, the polio team is providing assistance across the entire country, with a special focus on strengthening surveillance and awareness raising. Working side-by-side with the Government of Pakistan, within three weeks the team has managed to train over 280 surveillance officers in COVID-19 surveillance. It has also supported the development of a new data system that’s fully integrated with existing data management system for polio.  All polio surveillance staff are now doubling up and supporting disease surveillance for COVID-19. Through cascade trainings, they have sensitized over 6,260 health professionals on COVID-19, alongside their polio duties, in light of the national emergency. These efforts will continue unabated as the virus continues to spread.

Adding to the capacity of the government and WHO Emergency team, the polio team are also engaged in COVID-19 contact tracing and improving testing in six reference laboratories. They have been trained to support and supplement the current efforts, preparing for a sudden surge in cases and responding to the increase in travelers that need to be traced as a result of the rise in cases. The regional reference laboratory for polio in Islamabad is also providing technical support to COVID-19 testing and has been evolving to cater to the increased demands.

As this is a new disease, polio staff are lending their skills as health risk communicators – providing accurate information and listening to people’s concerns. The government of Pakistan extended a national help line originally used for polio-related calls to now cater to the public’s need for information on COVID-19. The help line was quickly adapted by the polio communication team once the first COVID-19 case was announced. The polio communications team is using strategies routinely used to promote polio vaccines to disseminate information about the COVID-19 virus, including working with Facebook, to ensure accurate information sharing, and airing television adverts.  As time goes on, the teams will train more and more people ensuring the provision of positive health practices messages that can curb the transmission of the virus.

Afghanistan

Currently, community volunteers who work for the polio programme to report children with acute flaccid paralysis (AFP) are delivering messages on handwashing to reduce spread of COVID-19, in addition to polio. UNICEF is similarly using its Immunization Communication Network to disseminate information on personal hygiene.

Field staff have taken the initiative of using their routine visits to health facilities, during which they check for children with AFP, to check for and report people who may have COVID-19. Meanwhile, programme staff are building the capacity of health workers to respond to the novel coronavirus.

To coordinate approaches, the WHO Afghanistan polio team has a designated focal point connecting with the wider COVID-19 operation led by the Government of Afghanistan. The polio eradication teams at regional and provincial levels are working closely with the Ministry of Public Health, non-governmental organizations delivering Afghanistan’s Basic Package of Health Services and other partners to enhance Afghanistan’s preparedness.

Nigeria

“In the field, when there is an emergency, WHO’s first call for support to the state governments is the polio personnel,” says Fiona Braka, WHO polio team lead in Nigeria.

In Ogun and Lagos states, where two cases of COVID-19 have been detected, over 50 WHO polio programme medical staff are working flat out to mitigate further spread, using lessons learnt from their years battling the poliovirus. Staff are engaged in integrated disease surveillance, contact tracing, and data collection and analysis. Public health experts working for the Stop Transmission of Polio programme, supported by the US Centers for Disease Control and Prevention, are using their skills to undertake COVID-19 case investigations.

The WHO Field Offices -which are usually used for polio eradication coordination- are doubling up as coordination hubs for WHO teams supporting the COVID-19 response. The programme is also lending phones, vehicles and administrative support to the COVID-19 effort.

In states where no cases of COVID-19 have been reported, polio staff are supporting preparedness activities. At a local level, polio programme infrastructure is being used to strengthen disease surveillance. Polio staff are working closely with government counterparts and facilitating capacity building on COVID-19 response protocols and are working to build awareness of the virus in the community. Specials efforts are being undertaken to train frontline workers as they are at high risk of contagion.

Beyond polio-endemic countries

Trained specialists in the STOP program, part of the Global Polio Eradication Initiative, are actively supporting preparations or response to COVID-19 in 13 countries worldwide. The WHO Regional Office for Africa’s Rapid Response Team, who usually respond to polio outbreaks, are aiding COVID-19 preparedness in countries including Angola, Cameroon and the Central African Republic. Meanwhile, polio staff in other offices are ready to lend support, or are already lending support, to colleagues working to mitigate and respond to the new virus.

In our work to end polio, the programme sees the devastating impact that communicable diseases have. With this in mind, we are fully committed to supporting national health systems by engaging our expertise and assets to help mitigate and contain the COVID-19 pandemic, alongside continuing concerted efforts to eradicate polio.

For the latest information and advice on the COVID-19 disease outbreak visit the WHO website.

Related news

Polio Eradication in the context of the COVID-19 pandemic
Global Polio Eradication Initiative statement on COVID-19

In Karachi’s Gadap Town, many families lack basic health and municipal services. To fill the gap, the Polio Emergency Operations Centre in Pakistan’s Sindh province has recently renovated an abandoned hospital to create an Emergency Response Unit (ERU). The unit provides polio vaccination to communities alongside PolioPlus activities to improve overall health. The unit was built with the support of Rotary International, WHO, UNICEF and the Bill & Melinda Gates Foundation.

Click through the gallery to see how the Gadap Emergency Response Unit has changed health delivery:

Image
©WHO Pakistan/Dawood Batozai

Gadap Town is home to many informal doctors who are not sufficiently trained to provide basic health services to the community. Often, they put their patients at risk. Before the creation of the Emergency Response Unit (ERU), most people had no choice but to rely on them for basic healthcare.

Image
©WHO Pakistan/Dawood Batozai

Now, the PolioPlus programme has helped turn the once abandoned Jannat Gul Hospital into a vibrant health centre. The hospital was renovated in record time and was inaugurated by the Minister of Health for Sindh Dr. Azra Fazal Pechuho, EOC Coordinator Mr. Umer Farooq Bullo and Rotary Pakistan PolioPlus Committee Chair Mr. Aziz Memon.

Image
©WHO Pakistan/Dawood Batozai

The new ERU hosts essential immunization services for children, including polio vaccination. The site also houses equipment to keep vaccines cold and ready for use.

Image
©WHO Pakistan/Dawood Batozai

Outside, a lawn with play equipment has been set up. Gadap is one of Pakistan’s largest slums, and the provision of a rare child-friendly environment as part of the health facility is helping to build community trust and acceptance of the polio eradication programme.

Image
©WHO Pakistan/Dawood Batozai

One room is for use by children suffering Acute Flaccid Paralysis and is also used to monitor any child having a reaction to immunization. The room is managed by a Government Medical Officer, supported by WHO provincial and federal monitors during polio vaccination campaigns.

Image
©WHO Pakistan/Dawood Batozai

A multipurpose room is used for trainings and planning before and during polio vaccination campaigns.

The ERU also hosts a data support centre that allows staff to relay live updates on polio campaign performance to the Sindh Emergency Operations Centre.

Image
©WHO Pakistan/Dawood Batozai

Five health dispensaries have been set up Gadap Town as part of the project, whilst a local Maternity Home is also being renovated.
These facilities will improve essential immunization and provide basic primary health services. They will also provide gynecological and maternal health services, which are in extremely high demand in Gadap.

Image
©WHO Pakistan/Dawood Batozai

The Government envisages that the ERU will continue to provide vital health services to families long after polio is eradicated. Rather than resorting to the care of informal doctors and nurses, the community can now access better quality healthcare, funded by the public sector.

From an abandoned hospital to a successful community health project: This is what the ‘plus’ in PolioPlus looks like.

Image
© UNICEF Pakistan/2010/Asad Zaidi
2010: Dr Ni’ma Abid and the Pakistan Polio Programme

Following flood damage “beyond imagination” in Pakistan, all polio-funded technical staff – polio epidemiologists and surveillance officers – were relocated to the worst-affected areas of the country to assist in the recovery and run vaccination campaigns for displaced populations. While controlling outbreaks of disease and conducting immunizations were a necessary focus, team leader Dr. Abid noted that “the priority is still for food and shelter more than anything else”. Over months of relief and rebuilding, the polio team rallied around to work with humanitarian colleagues on the ground.

Image
©WHO/Reuben Ngofa
2011: The vaccination teams of Karu ward, Nigeria

In November 2011, five vaccination teams in Karu ward, AMAC Local Government Area in Nigeria took part in an innovative pilot study. Equipped with Geographic Information Systems (GIS) devices, their movements were tracked and mapped. Analysis of real-time data on which homes they had visited with vaccines allowed for the immediate identification of possible missed children. Since that first trial, GIS software has been rolled out globally to thousands of vaccinators and disease surveillance officers, transforming data insights in some of the world’s most remote locations.

Image
©UNICEF Africa
2012: Blaise, a volunteer vaccinator in Benin

2012 saw a United Nations-backed effort aiming to vaccinate 111 million children against polio in just four days across west and central Africa. Blaise was one of tens of thousands of polio volunteers taking part across twenty nations. Reporting live from the campaign for UNICEF, he described the reaction from the community, "Today I was able to immunize 384 children. My team encountered no problems. When some children were sleeping, we wanted to come back later but their mothers didn’t want us to leave. ‘Let us wake them up; there is no way we could miss this opportunity to get them vaccinated’, the mothers told us.”

Image
©WHO Archives
2013: Ali Maalin, the last individual to contract smallpox

Ali Maalin passed away in 2013 after a truly exceptional life spent eradicating first smallpox, and then working to eradicate polio as a vaccinator in Somalia. Never vaccinated against smallpox himself, he was determined that his experiences would serve as a powerful reminder of why immunization is so important. “When I meet parents who refuse to give their children the polio vaccine, I tell them my story,” said Ali in 2006. “I tell them how important these [polio] vaccines are.”

Image
©UNICEF/Iraq-2014/Brecher
2014: Feria, who went from refugee to vaccinator

Feria, a trained social worker, fled violence in Syria to find shelter at an Iraqi refugee camp alongside her two young sons. At the time, in response to a polio outbreak in Syria, WHO and UNICEF, along with the Regional Government, were launching an accelerated series of polio vaccination campaigns to protect every child. Describing her new role as a polio vaccinator, Feria explained, “Polio campaigns are very important for children under the age of five. The oral vaccine is the only way to make sure they won’t be infected and to avoid polio spreading into the camps. After what these children have gone through they should not be sacrificed. One day, they will go back to Syria. One day, we’ll all go back to Syria.”

Image
©UNICEF
2015: Sajid Ali, a volunteer inspired by his studies

Sajid Ali, a student in his early twenties, was one of thousands of volunteers who committed to fight polio after attending the Jirga – a Pashtun tribal assembly of elders – in Lahore in 2015. At the same time as pursuing his religious studies in Lahore, Ali volunteered his time going door-to-door to reduce family and community hesitancy to vaccination. Nearly 80% of the polio-affected children in Pakistan at the time came from Pashtu speaking communities, rendering the work of trusted religious scholars from the community crucial. The situation is little changed today, and the work of religious leaders is more important than ever to build trust.

Image
©UNF/Christine McNab
2016: Martha Dodray, vaccinator for hard-to-reach communities in India’s Kosi River Basin

2016 marked five years of polio-free India. This enormous achievement was possible thanks to the efforts of individuals like Martha who personally overcame exceptional hurdles to reach children with vaccine. “Sometimes I’d have to walk by foot or travel by boat and reach these areas, and sometimes I’d have to wade through water to reach my destination. It was quite challenging to face the elements,” she remembers. Innovative thinking led to huge progress however, with Martha’s colleague Dr. Sunil Bahl remembering, “Within a few months we had accelerated from vaccinating children in hundreds of field huts, to reaching 250,000 of them."

Image
©WHO/S.Ramo
2017: Abdullah Khalid, vaccinator at the border between Afghanistan and Pakistan

The poliovirus knows no borders, making children on both sides of the border between Afghanistan and Pakistan vulnerable to contracting the debilitating disease. In 2017, Abdullah Khalid led a team responsible for vaccination at the Torkham crossing. He had been working for the polio programme for 14 years. “I wanted to join the eradication programme when I heard that polio is a contagious disease that affects children. I wanted to serve children and our community. I learned about polio on the TV and radio and the health workers who came to our home to share information about the virus,” he said. “I am proud when we can reach every child and when I see my team vaccinating children, making sure that no child is missed. This makes me very happy.”

Image
©UNF/Christine McNab
2018: Dr Adèle Daleke Lisi Aluma, consultant for the Lake Chad Task Team

Dr Aluma spent 2018 working in one of the most challenging areas of the world in which to vaccinate. On Lake Chad, 45% of children live on difficult-to-access, remote islands, where geographical barriers, violence, insecurity, and poverty mean people usually do not receive health or other government services. Canoeing through reeds for hours at a time, Dr Adele reached villages never before accessed with vaccines. In February 2018 in Bol District where Dr. Aluma worked, 83 settlements were reached and 15,600 children under ten years of age were vaccinated. In June, the campaign reached more than 53,200 children in almost 500 settlements.

Image
©Reaching The Last Mile Forum
2019: Rahane Lawal, polio vaccinator and unsung hero

Rahane Lawal is a polio worker in Nigeria, and winner of the 2019 Unsung Hero Award at the Reaching the Last Mile Forum in Abu Dhabi. She has shown exceptional bravery and dedication towards keeping her community safe from polio, despite being kidnapped and witnessing the murder of a family member. Her abductors knew she worked for the polio programme, and assumed she earnt a lot of money. Despite her horrific experience, she remains fully committed to ending polio in Nigeria.

Reposted with permission from Rotary.org.

Isiaku Musa Maaji, a polio survivor himself, makes a living by building tricycles for people with mobility impairments. © Rotary International
Isiaku Musa Maaji, a polio survivor himself, makes a living by building tricycles for people with mobility impairments. © Rotary International

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases, and in part two we investigated how Rotary contributes to clean water provision. In our final article, we consider how Rotarians support those who have contracted polio, and who now live with permanent paralysis.

Creating jobs

Polio paralysis left Isiaku Musa Maaji, who lives in Nigeria, with few ways to make a living. At 24, he learned to build hand-operated tricycles designed to provide mobility for adults and children with physical disabilities, and later started his own business assembling them. His first break came, he says, when his local government placed a trial order. Officials were impressed with his product, and the orders continued.

Rotary’s Nigeria PolioPlus Committee recently ordered 150 tricycles from Maaji to distribute to polio survivors and others with mobility problems. The relationship he has built with local Rotarians has motivated him to take part in door-to-door polio vaccination campaigns.

“It is not easy to be physically challenged,” he says. “I go out to educate other people on the importance of polio vaccine because I don’t want any other person to fall victim to polio.”

Aliyu Issah is now a strong advocate for polio immunization. © Rotary International
Aliyu Issah is now a strong advocate for polio immunization. © Rotary International

Aliyu Issah, another polio survivor, feels lucky; he’s able to support himself running a small convenience store. He knows others with polio paralysis who have attended skills training programmes but lacked the money to start a similar business. In the absence of ready employment, some of them were forced to beg on the street.

He notes however that the polio eradication programme provides a job that is uniquely suited to polio survivors: educating others about the effects of the disease.

“Some of my friends who used to be street beggars now run their own small business with money they earn from working on the door-to-door immunization campaign,” Issah says.

Improving health care

In Maiduguri, Nigeria, Falmata Mustapha rides a hand-operated tricycle donated to her by Rotary’s Nigeria PolioPlus Committee. She is joined by several health workers for a door-to-door immunization campaign, bringing polio drops to areas without basic health care.

Falmata Mustapha uses her hand-operated tricycle for door-to-door campaigns. ©Rotary International
Falmata Mustapha uses her hand-operated tricycle for door-to-door campaigns. ©Rotary International

UNICEF data show that polio survivors like Mustapha have a remarkable success rate persuading reluctant parents to vaccinate their children — on average, survivors convince seven of every ten parents they talk to. In places where misinformation and rumours have left people hesitant to vaccinate, the survivors’ role in the final phase of the eradication effort is critical.

“Since working with the team, I have seen an increase in immunization compliance in the community,” Mustapha says. “I am well-regarded in the community because of my work, and I am happy about this.”

Related resources

The 'plus' in rotary polioplus: providing clean water
We are doing so much more than eradicating polio

Reposted with permission from who.int

Film has the unique ability to make us feel. To make us laugh, cry and think. Through the creation of compelling human-interest stories, filmmakers have the potential to influence health and catalyze change. Films are a powerful way to raise awareness, improve understanding and encourage action. That’s why in May 2020, on the occasion of the 73rd World Health Assembly, WHO will host the first-ever Health for All Film Festival in Geneva.

Whether you are an amateur filmmaker seeking to tell the story of change-makers in your community through the lens of your smartphone or you’re working with a production company to promote dialogue around global health challenges and solutions, WHO wants to see your story.

The Health for All Film Festival aims to put storytelling power in the hands of people and seeks to showcase the role of individuals and communities as champions for health and well-being.

Read more.

Reposted with permission from Rotary.org.

Women and children collect water from a borehole in the Madinatu settlement, where about 5000 displaced people live. © Rotary International
Women and children collect water from a borehole in the Madinatu settlement, where about 5000 displaced people live. © Rotary International

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases. In part two, we look at another lifechanging intervention: providing clean water for communities.

Providing clean water

Addressing a critical long-term need such as access to clean water helps build relationships and trust with community members. Within camps for displaced people in northern Nigeria, the polio vaccinators who regularly visit communities are sometimes met with frustration. “People say, ‘We don’t have water, and you’re giving us polio drops,’” Tunji Funsho explains. Rotary and its partners have responded by funding 31 solar-powered boreholes to provide clean water in northern Nigeria, and the effort is ongoing.

Supplying clean water to vulnerable communities is a priority of the PolioPlus programme not only in Nigeria, but also in Afghanistan and Pakistan — the only other remaining polio-endemic nations, where transmission of the virus has never been interrupted.

Water, Sanitation, and Hygiene (WASH) and polio eradication efforts go together. © Rotary International
Water, Sanitation, and Hygiene (WASH) and polio eradication efforts go together. © Rotary International

“Giving water is noble work also,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee.

Access to safe drinking water is also an important aspect of the The Polio Endgame Strategy 2019-2023, which aims to “ensure populations reached for polio campaigns are also able to access much-needed basic services, such as clean water, sanitation, and nutrition.” The poliovirus spreads through human waste, so making sure people aren’t drinking or bathing in contaminated water is critical to eradicating the disease. Bunmi Lagunju, the PolioPlus project coordinator in Nigeria, says that installing the boreholes has helped prevent the spread of cholera and other diseases in the displaced persons camps.

Communities with a reliable source of clean water have a reduced rate of disease and a better quality of life. “When we came [to the camp], there was no borehole. We had to go to the nearby block factory to get water, and this was difficult because the factory only gave us limited amounts of water,” says Jumai Alhassan, as she gives her child a bucket-bath. “We are thankful for people who provided us with the water.”

By looking holistically at the needs of communities, Rotarians are ending polio, and making a significant contribution to overall health.

This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine. Read part one.

 The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.

Related resources

We are doing so much more than eradicating polio