GPEI-COVID-19 vaccination efforts prove value of polio network for resilient health systems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On 21 March, the Federal Government of Somalia, World Health Organization (WHO) and members of the Global Polio Eradication Initiative (GPEI) recommitted to stopping the ongoing outbreak of circulating poliovirus type 2 (cVDPV2) in Somalia at a three-day meeting convened in Nairobi, Kenya. High-level delegates at the meeting included HE Fawziya Abikar Nur, Federal Minister of Health and Human Services, Dr Mamunur Rahman Malik, WHO Representative to Somalia and Head of Mission, alongside senior representation from the Bill & Melinda Gates Foundation (BMGF), the Centers for Disease Control and Prevention (CDC), Rotary International, Save the Children, the United Nations Children’s Fund (UNICEF), and other UN agencies and partners.

Together, the Government, GPEI partners, which include WHO, UNICEF, the BMGF, CDC, Rotary International, GAVI, the Vaccine Alliance, and other key partners endorsed the Somalia Polio Eradication Action Plan 2022 to reaffirm their commitment.

The Somalia Polio Eradication Action Plan 2022 outlines a four-point call to action to stop the spread of the current outbreak, which is one of the longest lasting cVDPV2 outbreaks to be reported so far. The robust plan aims to direct partners’ efforts and resources towards boosting population immunity, making concerted efforts to reach high-risk populations — including inaccessible and nomadic communities and internally displaced persons — to strengthen their immunity, enhancing the search for poliovirus circulation, and strengthening coordination among all stakeholders. Some of the strategies that will be deployed include intensifying efforts to offer 5 opportunities for vaccination against polio in 2022, providing routine childhood immunization in high-risk locations, where children have missed out on vaccinations, and strengthening community engagement. Given how easy it is for the cVDPV2 virus to spill over international borders, the emergency plan also advocates for stronger cross-border coordination among the polio eradication programmes in Somalia, Kenya, Ethiopia and Djibouti.

“In the midst of the ongoing drought, and while recovering from the effects of the COVID-19 pandemic, our stakeholders must not forget how important it is to contain the ongoing poliovirus outbreak so that it does not spread any further and does not affect any more children’s lives,” said HE Fawziya Abikar Nur, Federal Minister of Health and Human Services. “On this occasion, I would like to extend my sincere gratitude to all our partners, and donors, for the immense efforts they have put into shielding millions of Somali children from polio over the years.”

“Since its inception 25 years ago, Somalia’s polio eradication programme has made progress, including by stopping outbreaks of wild poliovirus and, recently, one of circulating poliovirus type 3 in 2021. The programme has established a vast network of polio workforce and assets and we can do more not only to stop the current outbreak but to achieve broader health system goals through integration and effective use of our human and operational resources. Since 2018, Somalia has conducted several supplementary immunization campaigns. Despite these efforts, pockets of unvaccinated children remain, due to insecurity and limited access to health services,” said Dr Mamunur Rahman Malik, WHO Representative to Somalia.

The Somalia Polio Eradication Action Plan, which will be implemented in 2022, complements one of the goals outlined in the GPEI ‘Polio Eradication Strategy 2022–2026: Delivering on a Promise’, to stop cVDPV transmission and prevent outbreaks in non-endemic countries. It is also in line with Somalia’s national goals and UN Sustainable Development Goals (SDGs).

The Global Polio Eradication Initiative (GPEI) is extremely concerned about the unfolding effects of the current crisis in Ukraine on the country’s health system. A functioning health system must be kept neutral and protected from all political or security issues affecting countries, to ensure that people have continued access to critical and essential care.

At the same time, we have seen time and again that large-scale population movements, insecurity and hampered access contribute greatly to the emergence and/or spread of infectious diseases, such as polio.

Ukraine is currently affected by a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak, with the most recent case detected in January 2022 (with disease onset in December 2021).

A national supplemental polio immunization campaign targeting nearly 140,000 children throughout Ukraine who had not been vaccinated against polio began on 1 February 2022, but is currently paused, as health authorities have shifted focus towards emergency services. Surveillance to detect and report new cases of polio is also disrupted, increasing the risk of undetected spread of the disease among vulnerable populations. The GPEI is working to urgently develop contingency plans to support Ukraine and prevent further spread of polio.

The GPEI has a long history of working in a variety of complex environments, and will continue to adapt its operations to the reality on the ground, to the degree possible, without compromising on the safety and security of health workers. At the same time, immunization and surveillance is being assessed in neighbouring countries, to minimize the risk and consequences of any potential infectious disease emergence/spread resulting from the current large-scale population movements. It is critical that necessary resources are mobilized and made available to assist with the humanitarian needs, including relief, disease response/prevention efforts both in Ukraine and in neighbouring countries.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Containment area monitoring in India. ©WHO

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

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

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

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

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

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

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

An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated.

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

Three-year-old Madsa is carried by her sister after receiving a polio vaccine during a door-to-door campaign in Maroua, Cameroon. ©Gates Archive/Dominique Catton

In 1996, wild poliovirus was paralysing more than 75 000 children in the African Region every year, and Nelson Mandela and Rotary International issued a call to “Kick Polio Out of Africa!” The task was daunting. Polio staff had to deal with highly mobile populations, restricted access to children because of conflict and insecurity, fragile health systems and a fast-moving virus. Nigeria, as recently as 2012, accounted for more than half of all wild polio cases worldwide.

Ridding Africa of the wild poliovirus in the face of such daunting obstacles was, in the words of WHO Director-General Dr Tedros Adhanom Ghebreyesus, “one of the greatest public health achievements of our time”. It is an achievement built on the dedication of health workers – mainly women – who traveled by every available means – foot, car, boat, bike and more – to reach children with the polio vaccine.

One of the greatest public health achievements of our time.

One of those workers, Lami Isah Kyadawa, supported polio “immunization plus days” for almost 12 years before joining the network of volunteer community mobilizers in Sokoto State, Nigeria, in 2015. In her time fighting polio, she has overcome vaccine hesitancy, countered misinformation and even lost the sight in one eye in an accident returning from a polio mobilization campaign. But, for Lami, the sacrifices have all been worth it:

“It makes me proud to know that I was part of those that ensured the eradication of polio came to pass in Nigeria and now we can focus on improving routine immunization and other diseases.”

Eradicating wild polio in the African Region is a monumental feat, not just because of the scale of the task but because of the coordination and leadership required at all levels of the Global Polio Eradication Initiative (GPEI) to get the job done. It involved strategists with imagination, who found solutions to reaching children in regions rife with conflict and insecurity. It required constant surveillance to test cases of paralysis and check sewage for the virus, and it relied upon the commitment of all 47 countries in the African Region.

Health workers in Maiduguri, Borno State, tallying vaccine count. © Rotary International

Since 1996, nine billion doses of oral polio vaccine have been provided, averting an estimated 1.8 million cases of wild poliovirus on the continent. Building on this success, countries in the African Region are now using the polio eradication infrastructure’s robust immunization and surveillance capacities to strengthen their health systems. The infrastructure, with thousands of health workers and volunteers, community and religious leaders, parents and families mobilized to “Kick Polio Out of Africa”, provides a strong foundation for countering other public health threats.

Responding to the pandemic and laying a foundation for the future

Long before the coronavirus pandemic, stopping wild polio brought far-reaching benefits beyond saving children from paralysis, including protecting them from other vaccine-preventable diseases and detecting and responding to outbreaks.

Thus, when COVID-19 struck, the GPEI’s staff and infrastructure were in place and equipped to be the first to respond. Thousands of polio workers in the WHO’s African, Eastern Mediterranean and South-East Asian Regions shifted their focus to COVID-19. Polio emergency operation centres quickly adapted to respond to the pandemic through surveillance, contact tracing and specimen transport, provision of soap and hand sanitizer, distribution of training materials for medical personnel and front-line workers and coordinated engagement with community and religious leaders and media on mitigation measures.

Polio staff have long been the eyes and ears of national health systems. In one example, polio laboratories in Pakistan provided COVID-19 testing and sequencing, while the polio eradication call centre became (and remains) the national COVID-19 hotline, dealing with up to 70 000 calls a day

Polio staff trained more than 18 600 health professionals, and polio community mobilizers engaged 7000 religious leaders and 26 000 influencers to provide information on COVID-19 to their communities. Through messaging applications, mosque announcements and public address systems on motorbikes and rickshaws, polio community outreach networks have reached millions of households.

How polio staff in Pakistan shifted their focus to COVID-19:

The pandemic has shown that the polio network can continue to serve other public health programmes, especially in health emergencies. For instance, in Pakistan, active polio surveillance at high-priority sites helped to confirm more than 1000 COVID-19 cases, more than 4400 suspected cases and nearly 500 probable cases. Staff have also used their expertise in data management to improve the quality and timeliness of data during the pandemic. This adaptable skill set makes polio personnel invaluable to health systems and communities.

Looking ahead, transition of polio personnel and infrastructure into public health systems is being planned in countries with large polio eradication programmes, led by national authorities. In places where there is insufficient national capacity, critical immunization, disease detection, emergency preparedness and response capacities will be supported by WHO’s immunization and emergencies programmes until national authorities can fully take over. Sustaining these capacities will require sustainable funding, but, as Africa’s remarkable achievement confirms, the wisdom of investing in polio eradication and sustaining its legacy is clear, as the networks set up for polio eradication will prove vital to advancing global public health security and achieving healthier populations.

Reposted from who.int.

Anisa speaks with mothers about the polio virus and the importance of vaccinating children. © UNICEF Afghanistan/2021/Sayed Maroof Hamdard

Anisa’s story epitomizes the heroic contribution of women polio workers in Afghanistan who continue building trust in vaccines among parents and caregivers in the quest to immunize every last child and end polio.

The yellow taxi drives slowly on an unpaved Afghan road. It has rained heavily turning the detritus on the ground into a muddy quagmire, and the car labours in its efforts not to get stuck.

Stopping near a house, a young woman in a black scarf and traditional dress climbs out of the car. This woman is Anisa, a UNICEF consultant for the polio programme. Today she is visiting parents who are refusing to let their children be vaccinated, to explain why the two drops of oral polio vaccine (OPV) are critical for their health and wellbeing.

We enter one of the houses and meet an elderly woman.

“I am not vaccinating my grandchildren!” The woman sounds resolute, but we stay anyway. “Can we talk about something else?” Anisa asks calmly. Shortly thereafter, we’re drinking tea and praising the mild weather. The grandmother tells us her left leg was almost fully paralyzed half a year ago and she can’t walk normally.

“This is horrible. You should go to the clinic. I can recommend a good doctor for you. And do you also know that children who are not immunized can also be paralysed because of polio?” Anisa starts getting to the point of our visit. “You have two wonderful granddaughters and it’s easy to protect them.”

© UNICEF Afghanistan/Sayed Maroof Hamdard

The grandmother doesn’t seem convinced but asks questions about the rumours around the vaccine. Anisa explains that OPV is safe, halal for Muslims, and it is the only way to protect children from getting polio. One hour later, the grandmother nods – she finally agreed to vaccinate. It is hard to say what was the turning point that convinced her. Maybe the photos of paralyzed polio survivors that Anisa showed her on her phone; maybe information that polio vaccination is required for Hajj and Umrah (religious pilgrimages to Mecca which must be done at least once in lifetime by all Muslims); or simply the fact that Anisa vaccinated her own two children, and they are safe and well. The fact that the grandmother finally agreed to vaccination feels like a big victory – but it’s just a small step in the battle against polio.

Anisa has been working in the health sector for almost 10 years – as a midwife, female mobiliser vaccinator, nutrition officer and a clinical mentor. She first started to support the polio programme as a Provincial Communication Officer (PCO), supervising over a hundred communication cluster supervisors.

During the national immunization campaigns, even during the COVID-19 pandemic, Anisa supports the teams by conducting information sessions for refusal families and arranging discussion sessions for community groups. She also holds awareness raising sessions on how to prevent the spread of COVID-19.

“After my first day working with refusal families, I wanted to leave the job. I didn’t convince anyone. But then I managed to convince one family with five children, who have never been vaccinated and it felt like such a victory that I decided to stay,” remembers Anisa. “Now I know how to approach different people; I understand what type of information is important to persuade them to make the right decision.”

PN: President Knaack, thank you for taking the time to speak to us. A little more than a year into the global COVID-19 pandemic, what is your take on the current situation, also with a view of the global effort to eradicate polio?

Holger Knaack, 2020-2021 Rotary International president. © Rotary International

HK: There are many interesting lessons we learned over the past 12 months. The first is the value of strong health systems, which perhaps in countries like mine – Germany – we have over the past decades taken for granted. But we have seen how important strong health systems are to a functional society, and how fragile that society is if those systems are at risk of collapse. In terms of PolioPlus, of course, the reality is that it is precisely children who live in areas with poor health systems who are most at risk of contracting diseases such as polio. So everything must be done to strengthen health systems systematically, everywhere, to help prevent any disease.

The second lesson is the value of scientific knowledge. COVID-19 is of course a new pathogen affecting the world, and there remain many unanswered questions. How does it really transmit? Who and where are the primary transmittors? How significant and widespread are asymptomatic (meaning undetected) infections and what role do they play in the pandemic? And most importantly, how best to protect our populations, with a minimum impact on everyday life? These are precisely the same questions that were posed about polio in the 1950s. People felt the same fear back then about polio, as we do now about COVID. Polio would indiscriminately hit communities, seemingly without rhyme or reason. Parents would send their children to school in the morning, and they would be stricken by polio later that same day. Lack of knowledge is what is so terrifying about the COVID-19 pandemic. It also means we are to a large degree unable to really target strategies in the most effective way. What polio has shown us is the true value of scientific knowledge. We know how polio transmits, where it is circulating, who is most at risk, and most importantly, we have the tools and the knowledge to protect our populations. This knowledge enables us to target our eradication strategies in the most effective manner, and the result is that the disease has been beaten back over the past few decades to just two endemic countries worldwide. Most recently, Africa was certified as free of all wild polioviruses, a tremendous achievement which could not have been possible without scientific knowledge guiding us. So while we grapple for answers with COVID, for polio eradication, we must now focus entirely on operational implementation. If we optimize implementation, success will follow.

And the third lesson is perhaps the most important: we cannot indefinitely sustain the effort to eradicate polio. We have been on the ‘final stretch’ for several years now. Tantalizingly close to global eradication, but still falling one percent short. In 2020, we saw tremendous disruptions to our operations due to COVID-19. We never know when the next COVID-19 will come along, to again disrupt everything. Last year, the polio program came away with a very serious black eye, so to speak. But we have the opportunity to come back stronger. We must now capitalize on it. We know what we need to do to finish polio. We must now finish the job. We must all recommit and redouble our efforts. If we do that, we will give the world one less infectious disease to worry about once and for all.

During the COVID-19 pandemic, members of the Rotary Club of Boa Vista-Cacari (D4720) deliver bleach to a shelter for Venezuelan refugees in Boa Vista, Roraima, Brazil. © Rotary International

PN: You recently called on the Rotary network worldwide to use its experiences from PolioPlus in supporting the COVID-19 response. Could you elaborate on that?

HK: We have a global network of more than 1.2 million volunteers worldwide. This network has been consistently and systematically utilized to help engage everyone from heads of state to mothers in the most remote areas of rural India for polio eradication. We have helped secure vaccine supply and distribution, and increased trust in vaccines among communities. In the process, we have learned many lessons on what it takes to address a public health threat and these same lessons now should be applied to the COVID-19 response, especially as vaccines are now starting to be rolled out. That is why I thought it was important to call on our membership network to use their experiences and apply it to the COVID-19 response.

PN: What has been the reaction so far?

HK: Overwhelmingly supportive, I would say. As an example, in Germany, Switzerland, Liechtenstein, Austria and other countries in Europe, Rotarians are encouraging active participation of the provided vaccination service. And because COVID vaccination is provided free of charge, vaccinated individuals are encouraged to instead donate the cost of what this vaccine would have cost them – approximately US$25 – to PolioPlus. This has a dual benefit: they are protected from COVID and contributing to the global response, and they are ensuring children are also protected against polio, critically important now as the COVID-pandemic has significantly disrupted health services and an estimated more than 80 million children worldwide are at increased risk of diseases such as polio.

During the COVID-19 pandemic, members of Rotary and Rotaract clubs in D3281 (Bangladesh) package and distribute 10,000 bottles of hand sanitizer to underserved people in the cities of Dhaka, Dinajpur, Khulna, Rajshahi, and Rangpur in Bagladesh. © Rotary International

PN: And from what we understand, the Rotary PolioPlus network of National PolioPlus Committees has in any event been supporting global pandemic response over the past 12 months already, is that correct?

HK: The ‘Plus’ in PolioPlus has always stood for the fact that we are eradicating polio, but doing it in such a way that we are in fact doing much more, by supporting broader public health efforts. I’m extremely proud that Rotary and Rotarians around the world have helped bring the world to the threshold of being wild polio-free. But I’m perhaps even more proud of the ‘plus’ – or ‘added’ value – that this network has provided in the process. Things that are largely unseen, but which are very evident and concrete. So indeed, Rotarians have been actively engaged in the pandemic response, particularly in high-risk areas such as Pakistan, and Nigeria. We have supported contact tracing, educated communities on hygiene and distancing measures, supporting testing and other tactics. We have a unique set of experiences, and more importantly a unique infrastructure and network, to help during such crises. It’s morally the only way to operate. And actually, it is operationally beneficial also to polio eradication, as we are engaging with communities on broader terms, and not just on polio.

PN: Thank you again for taking the time to speak with us. Do you have any final thoughts or reflections for our readers?

HK: If we did not know it before, we certainly know now how quickly and dangerously infectious diseases spread around the globe. Polio is no different, and we know that it will not stay confined to Pakistan and Afghanistan if we don’t stop transmission there as soon as possible. We know that given the chance, this disease will come roaring back, and within ten years, we would again see 200,000 children paralysed every single year, all over the world. Perhaps even in my country, Germany. That would be a humanitarian catastrophe that must be averted at all costs.

During the COVID-19 pandemic, members of Rotary clubs in D9212 in Kenya established an emergency support team to distribute water stations to communities and informal settlements across the country for sanitary handwashing and other needs. © Rotary International

The good news is that it can be averted. We know what it takes. Pakistan and Afghanistan are re-launching their national eradication efforts in an intensified, emergency manner, following a disrupted 2020. This is encouraging to see. Mirroring this engagement must be the strengthened commitments by the international development community. We must ensure that the financial resources are urgently mobilised to finish polio once and for all. I am particularly proud that my own government, Germany, for example, has just recently committed an additional 35 million EURO to the effort, along with an additional 10 million EURO for efforts in Nigeria and Pakistan. Such support is particularly critical now, given that more than 80 million children are at heightened risk of diseases such a polio due to COVID-19 disruptions, and late last year, UNICEF and WHO issued an emergency call for action to urgently address this. And as we have seen, by supporting polio eradication, donors effectively get twice as much for their contribution: they help contribute to polio eradication, but also by doing so help contribute to the polio network’s support to public health emergencies such as COVID-19.

In short, we have it in our own hands to achieve success. There are no technical or biological reasons why polio should persist anywhere in the world. It is now a question of political and societal will. If we all redouble our efforts, success will follow.

Please consider making a contribution to Rotary’s PolioPlus fund, and have your donation matched 2-to-1 by the Bill & Melinda Gates Foundation.

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.

148th session of the WHO Executive Board in Geneva, Switzerland. ©WHO / Christopher Black

Meeting virtually at this week’s WHO Executive Board (EB), global health leaders and ministers of health urged for concerted and emergency efforts to finally rid the world of polio, noting a global and collective responsibility to finish the disease once and for all. Delegates also reiterated their support for the sustainable transitioning of polio assets, recognizing that successful polio transition and polio eradication are twin goals.

Noting that endemic wild poliovirus is now restricted to just two countries – the lowest number in history – with the African region being certified as wild polio-free in August 2020, delegates urged intensified efforts to wipe out the remaining chains of transmission of this strain and prevent global resurgence. The representatives of both Pakistan and Afghanistan demonstrated strong commitments to this goal and urged collective responsibility to achieve success. Delegates also expressed strong appreciation for the establishment of the Eastern Mediterranean Ministerial Regional Subcommittee on Polio Eradication and Outbreaks, by WHO Regional Director Dr Ahmed Al-Mandhari, which focuses on critical barriers to overcome to achieve zero poliovirus.

The EB urged all stakeholders to follow WHO and UNICEF’s joint emergency call to action, launched 6 November 2020, including by prioritising polio in national budgets as they rebuild their immunization programmes in the wake of COVID-19, and urgently mobilising additional resources for polio emergency outbreak response. To address the increasing global health emergency associated with circulating vaccine-derived poliovirus (cVDPV) outbreaks, delegates expressed appreciation of new strategic approaches, including the roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation OPV aimed at more effectively and sustainably addressing these outbreaks. This vaccine, which was recently granted a WHO Emergency Use Listing recommendation, is anticipated to be initially rolled-out in the first quarter of 2021. The GPEI is working with countries affected and at high risk of cVDPV2 to prepare for possible use of the vaccine.

Amid the new COVID-19 reality, the EB also expressed deep appreciation for the GPEI’s ongoing support to COVID-19 response. In December 2020, the heads of the GPEI core partners at their final Polio Oversight Board (POB) meeting of the year, confirmed that the polio infrastructure will continue to provide such support, including to the COVID-19 vaccine roll-out.

Member States additionally reiterated their support of polio transition, emphasising the need to ensure sustained, robust public health programming. Several EB members urged for strengthening the links built between the polio, immunization and emergencies programmes during COVID-19 response in the next phase of the pandemic, including for the effective rollout of the COVID-19 vaccine.

Children waiting at a polio vaccination campaign in Al-Mualla district, Yemen. ©WHO/EMRO

Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, commented, “We share the understanding that polio eradication and transition are equally important targets: as we work towards eradication we must think about the future. This is how we will ensure that health systems retain capacity and are strengthened long after polio is ended.”

WHO’s Deputy Director-General, Dr Zsuzsanna Jakab, noted the increasing cross-programmatic integration between polio and other public health programmes, including the introduction of integrated public health teams in countries prioritized for polio transition, bringing together polio, emergencies and immunization expertise. The Regional Director for the African Region, Dr Matshidiso Moeti, emphasised that the work of polio personnel to support the pandemic response, “highlight[s]… the importance of working in interconnected ways going forward.” Dr Al-Mandhari, addressing the delegates, said: “Polio continues to be a public health emergency of international concern. Now is the time to be shoring up the polio programme and mobilizing funding, including domestic funds, so that this remarkable public health and pandemic response mechanism can remain robust and can be integrated into broader public health services across the region. Now is the time for full regional solidarity and mobilization.”

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked global health leaders for their continued dedication to polio eradication and public health, sentiments echoed by several other partners, including the United Nations Foundation (UNF). UNF expressed concern about the drop in population immunity, especially for polio and measles, declared support for the joint emergency call to action to prioritize investments for preventing and responding to polio and measles outbreaks, and urged continued focus on strengthening immunization programmes.

The EB discussion will also help inform the finalization of the new strategic plan. This strengthened strategic plan – being developed in broad consultation with partners, stakeholders and countries – is based on best practices and lessons learned, and focuses on fully implementing approaches proven to work. It is expected to be presented to the World Health Assembly in May.

“If we did not know it before, we certainly know now how quickly infectious diseases can spread across the world and wild polio is one such infectious disease. Unlike with COVID-19, where many medical and scientific questions remain unanswered, we know precisely what it takes to stop polio,” said Aidan O’Leary, newly-appointed Director of the Global Polio Eradication Initiative at WHO. “We know how polio transmits, who is primarily at risk and we have all the tools and approaches needed to stop it. That is what this strengthened strategic plan is all about – to bring all the solutions together into a single roadmap to achieve success and through focusing on more effective implementation. What discussions at the EB this week clearly displayed is a strong global sense of commitment and solidarity to do just that: better implementation of what we know works. Together, if we do that, success will follow and we will be able to give the world one less infectious disease to worry about, once and for all.”

Speaking more broadly on global public health issues, the EB welcomed confirmation by the United States of its intention to remain a member of WHO. In a statement by the United States, the country underscored WHO’s critical role in the world’s fight against COVID-19 and countless other threats to global health and health security, confirming it would continue to be a full participant and global leader in confronting such threats and advancing global health and health security.

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

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

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

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

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

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

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

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

Polio Worker Aliza Mukhtiyar Using Hand Sanitizer ©WHO/EMRO

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

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

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

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

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

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

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

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

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

O’Leary took over as Director for Polio Eradication at WHO on 1 January 2021, from Michel Zaffran, who will enter a well-deserved retirement end-February. O’Leary brings with him a vast array of experience in both polio eradication and emergencies, including through the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).

Outgoing Director Michel Zaffran (L) and Aidan O’Leary (R) ©WHO/Katerina Alves

PN: Aidan, Michel, thank you both for taking the time to speak with us today. Aidan – you are taking over from Michel as Director for Polio Eradication at WHO. Polio is 99% eradicated globally, but it has been at 99% for many years. Ultimately, your job will be to achieve that elusive 100%. Do you find the task ahead daunting?

A-O’L: I’m not sure ‘daunting’ is the adjective I would use. But ‘challenging’ for sure. As you say, we have been at 99% for many years now. We have reduced the incidence of polio from 350,000 children paralysed every year in 1988, to less than 1,000 in 2020. But that is not enough, not if we are trying to eradicate a disease. Polio is a highly-infectious disease, and if we did not know it before COVID-19, we certainly know now how quickly infectious diseases can spread globally. If we do not eradicate polio, this virus will resurge globally.

PN: As new Director, what will be your priorities?

A-O’L: My priority, and all of our priorities, must be simply this: find and vaccinate every last child. If we do that, poliovirus will have nowhere to hide. That means in the first instance finding out where those last remaining unreached children are, and what obstacles stand in the way to vaccinating them. Is it because of lack of infrastructure? Insecurity or inaccessibility? Lack of proper operational planning? Population movements? Resistance? Gender-related barriers? If we can identify the underlying reasons, we can adapt our operations and really zero in on those last remaining virus strains.

Amna showing her marked finger after receiving the life-saving polio vaccine in Karachi, Pakistan – one of the two remaining endemic countries.© WHO/EMRO

PN: Michel, you have led this effort for the past five years, and during that time have guided the effort to restrict wild poliovirus transmission to just Pakistan and Afghanistan. You have overseen the achievement of a wild polio-free Africa, an incredible achievement. However, this time has also seen an increase in emergence of circulating vaccine-derived poliovirus, or cVDPV, outbreaks. How do you see the priorities going forward?

MZ: The goal of this effort is of course to ensure that no child will ever again be paralysed by any poliovirus, be it wild or vaccine-derived. This we have to achieve in phases. First, we have to interrupt all remaining wild poliovirus strains, before we can then ultimately stop use of oral polio vaccine, or OPV for short, in order to eliminate the long-term risks of cVDPVs. Aidan has tremendous experience, in both remaining wild poliovirus endemic countries, having led the OCHA office in Afghanistan and having been Chief of Polio Eradication in Pakistan for UNICEF. So he knows the challenges and realities involved. Eradicating the last remaining strains of wild poliovirus must be the overriding priority – success ultimately hinges on that.

At the same time, we have new strategies, tools and approaches to address the increasing cVDPV emergency, notably the novel OPV type 2, or nOPV2 for short, to more effectively and sustainably stop such strains. Ultimately, though, we need to reach children. Only vaccinations save lives, not vaccines.

A-O’L: Michel just mentioned an important word: emergency. And that is precisely what we are facing with polio, whether it’s wild or vaccine-derived. I believe my experience working in emergency settings can help us achieve our goal, including by linking polio operations more closely to other emergency efforts. That is also one of the reasons why WHO and UNICEF recently jointly issued an emergency call for action on polio and measles, and we hope all stakeholders will respond accordingly.

MZ: I would echo that. Particularly in a post-COVID world, the programme must also continue to adapt its approaches and operations, and no longer work so much in isolation. We have to integrate with other efforts including emergency response and broader routine immunization efforts.

A-O’L: I would just add that Michel is really leaving me with a solid base to operate from. He and his teams across the GPEI partnership have built up such a strong infrastructure. I’m thinking here for example of the gender equality work of the programme – it has really been trail-blazing and I know other health and development efforts are looking to our experience on this. It’s a great opportunity to further leverage and expand collaboration with others. So we’ve really become a global leader in many new ways of working, and ultimately, that can only mean more support for this effort.

PN: Thank you so much for speaking with us today. Could we ask for final thoughts from both of you?

A-O’L: We have many challenges, but if any network can achieve success, it is the GPEI network. Our greatest strength that we have is partnerships. Starting with Rotary International and Rotarians worldwide who are tirelessly working towards success, to our other partners including at my old organization UNICEF and our newest partner Gavi who is helping to integrate the programme, and of course ultimately to donor and country governments and communities: this is where our strength and power lies. If we harness this partnership effectively, if we all work together, then we will reach that last remaining child, and we will ensure that this disease is eradicated once and for all.

MZ: For me it has been an absolute honour and privilege to lead this effort for the past years, and I leave with a sense of real optimism. I believe Aidan is the right person for this job right now. In November, at the World Health Assembly, we saw tremendous support for polio eradication from Member States. We have new tools, such as nOPV2, and tremendous new commitments. We are working on a new strategy, to lead us to success. But ultimately, all comes down now to implementation. 2020, the COVID year, taught us many lessons. Many of the questions that are still being asked about COVID – how does it transmit, where is it primarily circulating, what are the best tools and strategies to stop it – have been answered for polio. We know what the virus is doing, how it is behaving, and who it is affecting. Most importantly, we know what we have to do to stop it, and we have all the tools to stop it. But what 2020 also taught us is that this cannot last forever. We never know when a next COVID emergency comes along, which will disrupt everything. In polio eradication, we are being given another chance in 2021, after a bruising 2020. We have to capitalize on it. We have to focus everything on implementation. If we do that, success will follow.

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.

Volunteers Abdul Basit and Misbahuddin trek up a hill in Aab-e-barik village, Argo district, Badakhshan province. ©Shaim Shahin/WHO Afghanistan

On a wintery November day, vaccinators across Afghanistan wrapped up warm, checked that they had facemasks and hand sanitizer, and headed out into the cold morning. Their mission? To reach 9.9 million children with polio vaccines, before snowfall blocked their way.

From valleys to muddy lanes, we look at some of the environments where vaccinators work, as well as some of the key challenges that have made 2020 one of the toughest years for polio eradicators.

Panjshir province

For some vaccinators, the first snows had already arrived. At the top of the Panjshir valley, Ziaullah and Nawid Ahmad started their day at 7am.

“We walked six hours to Sar-e Tangi and back to take polio drops to the last houses in the valley”, said Ziaullah. The mountainous roads in this area are impassable by car, so vaccinators walk many kilometers to the most remote villages. Sar-e Tangi means ‘top narrow edge’, and the view during the long winter is of snowy peaks.

A few kilometers from Sar-e Tangi, father Arsalan Khan was proud to have protected his own and other children in the extended family with polio drops. He said, “I ensure all the children in the family are vaccinated during each round the drops were offered and of course I will keep vaccinating them each time the vaccinators visit our village”.

Khan continued, “The vaccinators walk long distances across the mountain slopes to our villages, sometimes during harsh weather conditions, to bring polio drops to our doors.”

“Thanks to the people and countries that support the vaccination campaigns and make it possible for the drops to reach our doorsteps.”

Volunteers Ziaullah and Nawid Ahmad give polio drops to Sanaullah and Khadija in Doshakh village, Rukha district, Panjshir province. ©Ahmadullah Amarkhil/WHO Afghanistan

Badakhshan province

In Badakhstan, Mr. Azizullah had COVID-19 safety measures on his mind. Like all vaccinators working for the polio programme, he had been trained on how to safely deliver polio drops during the pandemic. The temperature was below zero, with the first snow on the ground, as Mr. Azizullah walked through the rugged terrain from home to home, ensuring to wear his mask and regularly sanitize his hands.

Mr. Abdul Basit and Misbahuddin, volunteers in nearby Aab Barik village said, “It is cold and walking through muddy lanes is not easy, but we have to do our job. There was one case of polio in Badakhshan so that means there is probably virus circulation and we have to stop that”.

Herat Province

Mr. Abdullah, a university lecturer observing vaccination activities in Herat, said, “I believe a vaccinator’s job is more important than mine. I really appreciate their work and appreciate the international community for making the polio immunization operations possible in Afghanistan with their financial support.”

“I believe that all these efforts will be fruitful, hopefully soon, and we will get rid of the virus in our country”.

The November campaign was particularly aimed at boosting the immunity of unvaccinated children, and children who have not received their full vaccine doses. Many children have missed out on polio vaccines and other routine immunizations due to a pause in vaccination activities in the first few months of the COVID-19 pandemic. Health workers are now racing against time to protect the youngest children from the poliovirus.

Ms. Sitara, mother of Yasameen, who was wrapped up warm against the elements, said, “I am very happy to be able to immunize my daughter and protect her against polio”.

Yasameen, two months old, and her mother Sitara. Yasmeen lost her father recently and her mother does domestic work to support the family. ©Ramin Afshar/WHO Afghanistan

Jalalabad Province

In the east region of Afghanistan, 8,530 volunteers, 160 district coordinators and 786 cluster supervisors were hard at work, aiming to reach as many children as possible during the campaign.

Dr. Akram Hussain, Polio Eradication Initiative Team Lead for WHO in the region explained, “We were not able to do house to house campaigns in some parts of the region. As a result many children were missed during the October vaccination campaigns”.

Despite the best efforts of vaccinators, in October, 3.4 million children nationwide missed vaccines due to factors including insecurity, the COVID-19 pandemic and vaccine mistrust. The year 2020 has seen a significant rise in polio cases and detection of the virus in the environment, and the disease is present in almost all provinces.

The programme is aiming to reach more children and tackle virus spread next year. Activities include targeted campaigns in high risk districts, collaborating with the religious scholars from the Islamic Advisory Group to encourage vaccine uptake and communicating more effectively with communities.

Twin brothers, Habib-u Rahman and Hamid-u Rahman, and their niece, show their inked fingers after being vaccinated against polio in Botawar village, Rukha district of Panjshir province. ©Ahmadullah Amarkhil/WHO Afghanistan

The incredible contributions of the polio programme to COVID-19 response are testimony to the agility and adaptability of Afghanistan’s programme in the most difficult circumstances. Many hope that lessons learnt from this experience can be applied to achieving the eradication goal.

Ending polio requires everyone – including polio personnel, communities, parents, governments and stakeholders – to commit to overcoming challenges. As the weather turns colder and snow continues to fall, many are looking ahead to what 2021 holds for polio eradication in Afghanistan.

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.

Polio outbreak response in Chad, 2018 ©WHO/D Levison

N’Djamena – One of the largest polio immunization campaigns in the African Region this year has just concluded in Chad, where over 3.3 million children in 91 districts were vaccinated. This pushes the total number of children vaccinated against polio to over forty million across 16 countries in the Region, since campaigns resumed following a necessary pause in immunizations due to the COVID-19 pandemic.

While Africa was declared free of the wild poliovirus in August 2020, another form of polio continues to affect children: circulating vaccine-derived poliovirus, or cVDPV. This type of polio is rare and can only occur in areas where not enough children are immunized. The only way to stop spread of cVDPV is through immunization.

The current type 2 cVDPV outbreak in Chad was detected in February 2020—yet immunizations were halted due to COVID-19 and the virus spread to 36 districts across the country, paralyzing more than 80 children and even leading to cases in neighbouring Sudan and the Central African Republic.

“Viruses do not respect national borders,” said Dr Ndoutabé Modjirom, head of the polio Rapid Response Team at the World Health Organization (WHO) African Region. “Given Chad’s central geographic location and its mobile populations, it was important to carry out a large-scale campaign that targeted key populations and high-risk areas throughout the country.”

The vaccination campaign was carried out in two phases, the first taking place between 13-15 November and the second from 27-29 November.

While mass polio vaccination campaigns were stopped across Africa due to COVID-19 restrictions, they resumed in July 2020. The response in the region overall, and in Chad in particular, demonstrates the commitment by Global Polio Eradication Initiative partners and countries across Africa to stop polio, even amidst the difficult operating context of COVID-19.

“The number of children reached since polio campaigns have resumed is extremely encouraging,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This large-scale campaign in Chad during COVID-19 is a reflection of the Region’s commitment and ability to face multiple difficult health challenges and protect the health of all children.”

Although campaigns were on hold for several months, work did not stop. Chad’s team of national and international polio experts together with the AFRO Rapid Response Team tracked the virus, conducted a comprehensive risk assessment, and planned an outbreak response to take place as soon as it was safe to do so, taking into account timelines in outbreak response standards of practice. Consultations were also held with the national COVID-19 task force to ensure that best practices in infection prevention and control would be followed. The commitment and efforts of the Ministry of Health and other key national and regional health leaders and partners, including UNICEF, were instrumental in conducting the campaign.

“With increased immunizations and the continued commitment of health leaders and partners, we are confident that we will soon see the end of this outbreak and the end of all forms of polio in Africa,” said Dr Jean Bosco Ndihokubwayo, WHO representative for Chad.

About polio eradication

The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

On 6 November, WHO and UNICEF jointly issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases. Learn more about the call to action.

Fahima Ahmed Hassan is a 25-year-old community mobilizer who goes the extra mile to ensure parents of children under the age of five are informed of Somalia’s polio vaccination campaigns and are ready for their children to be vaccinated.

Fahima and the other mobilisers are from the local community and they lay the groundwork for vaccinators ahead of campaigns. They work tirelessly to reach every house, speaking to families to help them understand, trust, and accept the vaccine.

On a mid-October morning, children and their families are waiting anxiously. They have been informed, by Fahima and through loudspeaker announcements, that a team of vaccinators will be visiting their community.

Amid the COVID-19 pandemic, some people are concerned and worried about taking their children for vaccinations. They fear they might contract the virus or expose their children to it. Together with her team, Fahima takes every precaution to keep herself and the community she serves protected.

She explains that it is critical to show the community that vaccination can go ahead while maintaining physical distancing, wearing protective masks and using hand sanitizer.

Somalia’s vaccine advocates

Some people do not need to be convinced about the benefits of immunization. Asha Osman Yarow is one of them. She is patiently waiting for her son to be vaccinated.

“I decided to vaccinate my children because their health is important to me,” Asha says, holding her young son. “Vaccines protect children against diseases, like polio, measles and others.”

“Praise be to Allah that these services come to us,” chimes in Sahro Mohamed Haile. “I encourage all mothers to take care of their children, vaccinate them and keep records of their vaccination status. Me, I’m here today with my grandson,” she adds with a smile.

Others in the community are more reluctant to accept vaccines. “At first, I refused to vaccinate my children. I heard people say that the vaccines were no good and that they were made by non-Muslims. I was scared,” explains 30-year-old Wardo. “After speaking to the community mobilizers, I realized that the vaccines are good for my children’s health – and I changed my mind.”

“I understand where they are coming from, and I do my best to give them information and convince them that vaccinations are beneficial,” says Fahima. “Illiteracy, lack of education and myths make people reject the vaccines.”

Together with the other community mobilizers, Fahima engages elders, religious leaders and community influencers as well as urging parents until the very last minute to come forward.

“I’ve vaccinated all of my children and I was one of the first people in my community to support vaccines,” says Isha Hassan Saney, a fellow community mobilizer. She believes showing a good example helps to convince others in the community to vaccinate their children.

“I am motivated to serve the community, especially the mothers and children, because they need to be taken care of,” Fahima says. “There is no better reward than seeing them healthy.”

COVID-19 shows why vaccines are so important

Despite COVID-19, and the enhanced risk of infecting her husband and her extended family members when she comes home, Fahima continues to show up for work and doesn’t let fear take over.

The COVID-19 pandemic has revealed what is at stake when communities do not have the protective shield of immunization against an infectious disease. When vaccines are available, they are the most effective tool to prevent dangerous disease outbreaks.

Staying informed about their benefits and understanding the risks of not getting vaccinated has never been so important. Fahima and the other community mobilizers play an instrumental role in this.

During the recent polio immunization campaign, 8 951 vaccinators went door to door and 3 390 community mobilizers, including Fahima and her team, sensitized communities. The two-part campaign, organized by the Federal Ministry of Health, UNICEF and WHO, reached more than a million children under the age of five in south and central regions of Somalia.

Read this story on the UNICEF Somalia site.

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

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

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

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

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

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

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

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GENEVA/ NEW YORK, 6 November 2020 – UNICEF and the World Health Organization (WHO) today issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases.

The two organizations estimate that US$655 million (US$400 million for polio and US$255 million for measles) are needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.

“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”

“We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “Addressing the global COVID-19 pandemic is critical. However, other deadly diseases also threaten the lives of millions of children in some of the poorest areas of the world. That is why today we are urgently calling for global action from country leaders, donors and partners. We need additional financial resources to safely resume vaccination campaigns and prioritize immunization systems that are critical to protect children and avert other epidemics besides COVID-19.”

In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world. Vaccination coverage gaps have been further exacerbated in 2020 by COVID-19. In 2019, measles climbed to the highest number of new infections in more than two decades. Annual measles mortality data for 2019 to be released next week will show the continued negative toll that sustained outbreaks are having in many countries around the world.

At the same time, poliovirus transmission is expected to increase in Pakistan and Afghanistan and in many under-immunized areas of Africa. Failure to eradicate polio now would lead to global resurgence of the disease, resulting in as many as 200,000 new cases annually, within 10 years.

New tools, including a next-generation novel oral polio vaccine and the forthcoming Measles Outbreak Strategic Response Plan are expected to be deployed over the coming months to help tackle these growing threats in a more effective and sustainable manner, and ultimately save lives. The Plan is a worldwide strategy to quickly and effectively prevent, detect and respond to measles outbreaks.

Notes to editors:

Download photos and broll on vaccinations, including polio and measles vaccinations here

Generous support from Gavi, the Vaccine Alliance, has enabled previous access to funding for outbreak response, preventive campaigns and routine immunization strengthening, including additional support for catch-up vaccination for children who were missed due to COVID-19 disruptions in Gavi-eligible countries. However, significant financing gaps remain in middle-income countries which are not Gavi-eligible. This call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. To know more about UNICEF’s work on immunization, visit https://www.unicef.org/immunization

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About the Global Polio Eradication Initiative

About the Measles & Rubella Initiative

The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, the United Nations Foundation and the World Health Organization. Working with Gavi, the Vaccine Alliance, and other stakeholders, the Initiative is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 23 million lives by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and supporting demand for vaccine.

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In August:

6 cases of Wild Polio Virus (WPV1) were confirmed – 2 from Kandahar, 2 from Hilmand, 1 from Uruzgan, and 1 from Khost
221 children with Acute Flaccid Paralysis (AFP) -96 girls and 125 boys – were reported.

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In July

722,500 children were vaccinated during the SNID campaign.