GPEI-Polio campaigns resume with strict COVID-19 prevention measures

Nabeela, a polio frontline worker in Pakistan, vaccinates a child in Liaqatabad using the ‘no touch’ method. © UNICEF/Pakistan

Vaccinators in countries including Afghanistan, Angola, Burkina Faso and Pakistan took to the streets this month to fill urgent immunity gaps that have widened in the under-five population during a four month pause to polio campaigns due to COVID-19.

Campaigns resumed in alignment with strict COVID-19 prevention measures, including screening of vaccinators for symptoms of COVID-19, regular handwashing, provision of masks and a ‘no touch’ vaccination method to ensure that distance is maintained between the frontline worker and child. Only workers from local communities provided house-to-house vaccination to prevent introduction of SARS-CoV2 infection in non-infected areas.

Although necessary to protect both health workers and communities from COVID-19, the temporary pause in house-to-house campaigns, coupled with pandemic-related disruptions to routine immunization and other essential health services, has resulted in expanding transmission of poliovirus in communities worldwide. Modelling by the polio programme suggests a potentially devastating cost to eradication efforts if campaigns do not resume.

A child has their finger marked during the campaign in Angola. ©WHO/AFRO

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. Vaccinators were trained on COVID-19 infection control and prevention measures and were equipped to answer parents’ questions about the pandemic. Through the campaign, teams distributed 500 000 posters and 380 000 flyers featuring COVID-19 prevention messages.

In Angola, 1 287 717 children under five years of age were reached by over 4000 vaccinators observing COVID-19 infection prevention and control measures. All health workers were trained on infection risk, and 90 000 masks and 23 000 hand sanitizers were distributed by the Ministry of Health.

In Burkina Faso, 174 304 children under five years of age were vaccinated in two high-risk districts by 2000 frontline workers. Vaccinators and health care workers were trained on maintaining physical distancing while conducting the vaccination. 41 250 masks and 200 litres of hand sanitizer were made available through the COVID-19 committee in the country to protect frontline workers and families during the campaign.

In Pakistan, almost 800 000 children under the age of five were reached by vaccinators in districts where there is an outbreak of circulating vaccine-derived poliovirus. Staff were trained on preventive measures to be followed during vaccination, including keeping physical distance inside homes and ensuring safe handling of a child while vaccinating and finger marking them.

Farzana, a polio worker in Karachi’s Liaqatabad Town, Pakistan uses hand sanitizer during the campaign. ©UNICEF/Pakistan

“Our early stage analysis suggests that almost 80 million vaccination opportunities have been missed by children in our Region due to COVID-19, based on polio vaccination activities that had to be paused,” said Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean Region. “That’s close to 60 million children who would have received important protection by vaccines against paralytic polio.”

Over the coming months, more countries plan to hold campaigns to close polio outbreaks and prevent further spread, when the local epidemiological situation permits.

“Our teams have been working across the Region to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio,” said Dr Hamid Jafari. “We must now ensure that we work with communities to protect vulnerable children with vaccines, whilst ensuring strict safety and hygiene measures to prevent any further spread of COVID-19”.

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. ©WHO/Afghanistan

Dr Matshidiso Moeti, WHO Regional Director for Africa, commented, “We cannot wait for the COVID-19 pandemic to be contained to resume immunization activities. If we stop immunization for too long, including for polio, vaccine-preventable diseases will have a detrimental effect on children’s health across the region.”

“The campaigns run by the Polio Eradication Programme demonstrate that mass immunization can be safely conducted under the strict implementation of COVID-19 infection prevention and control guidelines.”

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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.”

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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.”

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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.”

During March, polio social mobilisers provided routine immunization referral services to over 37,000 children. ©UNICEF Afghanistan

In March 2020, polio social mobilisers from the UNICEF-run Immunization Communication Network (ICN) provided routine immunization referral services to over 37,000 children in southern and eastern Afghanistan.

The polio programme’s routine immunization efforts in Afghanistan have made important gains, especially in the country’s east, in the areas bordering Pakistan. Polio social mobilisers support mother and child health referral services, and help families keep track of their children’s health records. As the mobilisers are recruited from their community, they know the families in their neighborhood and can trace each child’s planned immunization schedule from birth.

It is critical that routine immunization continues throughout the pandemic to protect children from life-threatening diseases including polio. Polio mobilisers have found their work is even more valued during the COVID-19 response.

Masoud, a polio mobiliser, says ‘’I used to announce the immunization sessions through the Mosque but not all the targeted children were brought to the health facility. Now through the ICN support to routine immunization, the number of missed children has reduced due to tracking of every child in the community and coordinating with the health facility.”

“This is critical during the ongoing pandemic, as families are not sure if they can leave their homes to take their children to the health facility for immunization. The polio mobilisers are their guide in the community.’’

Nurse Madelein Semo vaccinates a young baby with inactivated polio vaccine (IPV) at the Ngbaka health centre in Kinshasa, Democratic Republic of the Congo, on April 29, 2015. Gavi’s support for IPV represents the insurance policy for the success of the Polio Endgame Strategy. ©GAVI/2015/Phil Moore

On 4 June 2020, the UK Government hosted Gavi’s third donor pledging conference, the Global Vaccine Summit, to mobilize at least US$ 7.4 billion to protect the next generation with vaccines, reduce disease inequality and create a healthier, safer and more prosperous world. Responding to this unique call for global solidarity, leaders from donor countries and the private sector made unprecedented commitments of US$ 8.8 billion in order to save up to 8 million lives.

Since 2019, the Global Polio Eradication Initiative (GPEI) has strengthened its collaboration with Gavi, inviting Gavi to become the sixth core partner of the GPEI. While the GPEI will continue its focus on interrupting virus transmission and eradicating polio through immunization campaigns using the oral polio vaccine (OPV), Gavi’s support for the inactivated polio vaccine (IPV) at an estimated cost of US$ 800 million during its 2021-25 strategic period represents the insurance policy for the success of the Polio Endgame Strategy.

Thanks to the remarkable mobilization and solidarity of leaders worldwide, Gavi will be able to maintain immunization in developing countries, mitigating the impact of the COVID-19 pandemic. Gavi will also be able to sustain health systems so that countries are ready to rapidly introduce COVID-19 vaccines. And by 2025 Gavi will have immunized more than 1.1 billion children, saving 22 million lives. Ngozi Okonjo-Iweala, Chair of the Gavi Board, highlighted why this is so important, saying, “Vaccinations should be recognized as a global public good. With your support and commitment, we can generate US$ 70 to US$ 80 billion additional economic benefits.”

Henrietta Fore, Executive Director of UNICEF, added, “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.” UN Secretary-General Antonio Guterres urged partners to “find safe ways to continue to deliver vaccinations during COVID-19.” GPEI, Gavi, WHO and UNICEF have issued guidance for countries to encourage resuming immunization activities once it is safe to do so, in recognition of the fact that numerous countries are facing COVID-19 and multiple other disease outbreaks.

During the Summit, top Gavi donors reaffirmed their leadership, including Norway, the UK and the USA, as well as the Bill & Melinda Gates Foundation. Prime Minister Boris Johnson pledged £1.65 billion, recommitting the UK as Gavi’s leading donor while the Gates Foundation committed US$ 1.6 billion. More than 60 leaders from all regions of the world in the Asia-Pacific, Middle East, Africa, Europe and the Americas pledged support to Gavi, the Vaccine Alliance both for its upcoming strategic period as well as for COVID-19 response.

The COVID-19 pandemic reminds us of the power of vaccines. WHO Director-General Tedros Adhanom noted, “COVID-19 is a devastating reminder that life is fragile, and that in our global village our individual health depends on our collective health. … Now is the moment for the world to come together in solidarity to realise the power of vaccines for everyone.” Responding to this challenge, Gavi has launched the Gavi Advance Market Commitment for COVID-19 (Gavi Covax AMC), which aims to raise additional funding in late June under the leadership of the European Union. Bill Gates, noted, “We would have to create Gavi if it did not exist today to solve the COVID-19 crisis.”

Michel Zaffran, director of the WHO polio eradication programme, said, “Congratulations to the Gavi family for this exemplary mobilization and demonstration of global solidarity. We are immensely grateful to Gavi and its donors for their precious partnership and generous support for the inactivated polio vaccine (IPV). The COVID-19 pandemic is a terrible tragedy, which brings us together more than ever and requires to think collectively how best to address the needs of the communities.”

Rotary, one of the six GPEI partners, echoed statements from other agencies. “Rotary and its members applaud the commitment of the donors and governments who have pledged their support to ensuring that vulnerable communities can receive lifesaving vaccinations,” said Michael K. McGovern, Polio Oversight Board and Chair of Rotary’s International PolioPlus Committee. “Continued investment from the global community in programmes such as the Global Polio Eradication Initiative is crucial to not only achieving the eradication of polio, but ensuring stronger health systems worldwide. This firm commitment truly embodies the “Plus” in PolioPlus.”

While the Global Vaccine Summit secured the IPV requirements for polio eradication efforts through 2025, further financial commitment is needed for the GPEI to restart the immunizations campaigns that have been paused during the COVID-19 pandemic. More intensive and integrated immunization activities are needed to finish the job and to strengthen the capacities of the governments, health workers and networks, so that the investment in polio eradication can serve as a foundation for future pandemic response. While celebrating the success of the Global Vaccine Summit, GPEI calls for reiterated donor support to eradicate polio once and for all.

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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

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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.

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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.”

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It was a somber day when Ihsanullah was told that two of his youngest children will never be able to walk again. His two year old daughter Safia, and Masood, his five month old son, were both diagnosed with polio.

When they began running a high fever in December, Ihsanullah rushed them to the nearest hospital in the city of Tank, Pakistan. After a series of tests, doctors confirmed that both children had contracted polio. Further investigations revealed that neither child had been vaccinated during any previous routine immunization or polio campaign rounds.

Like many other parents in his village, Ihsanullah had never accepted the polio vaccine. “I had a negative opinion about vaccination from the start. Many people told me that the polio vaccine was made of haram[forbidden] ingredients and was part of a larger conspiracy to make Muslim children sterile,” he said.

A farmer and labourer by profession, 27-year-old Ihsanullah lives in a village named Latti Kallay in Khyber Pakthunkwa, Pakistan. Polio teams often face hesitancy from communities in Latti Kallay during campaign rounds, with many parents citing religion as the primary reason for refusing the polio vaccine. In Tank city and the immediate surrounding areas, six wild polio virus cases were reported in 2019.

Sadly, it sometimes takes a case of polio for communities to fully realize the importance of vaccinating their children. Asghar and Khadim, neighbours of Ihsanullah, told polio teams that they had started ensuring that their children are vaccinated, despite being staunch refusers of the vaccine previously.

Ihsanullah said, “It pains me to imagine that Safia and Masood will never be able to walk again. If I knew that this would be the outcome, I would never have stopped the polio teams from vaccinating my children. I deeply regret my decision, but I will make sure that my other children are vaccinated”.

For now, the COVID-19 pandemic has necessitated the temporary pause of polio vaccination campaigns. This leaves unvaccinated children who cannot access routine immunization services vulnerable to paralysis. The situation also underlines the vital importance of increasing trust in vaccines amongst parents, so their children are protected from polio no matter what happens.

Gohar Mumtaz, the Union Council Polio Officer of the district, has hope. He says that a routine immunization session with the community, conducted before the pandemic spread to Pakistan, seemed to be more popular than usual. “Although there is still hesitancy, the situation seems to be improving. People will understand the need to vaccinate and no child will suffer like Safia and Masood in the future.”

To overcome barriers to polio eradication, the Pakistan polio programme conducted a top-to-bottom review during 2019. Areas where improvement is required were identified, and innovations introduced. This is vital work, as there are many other children in Pakistan besides Safia and Masood whose futures have been marred by the poliovirus. Last year saw increased transmission of the poliovirus across all provinces with a total of 147 wild cases reported.

The COVID-19 pandemic has added an additional hurdle to defeating polio in Pakistan. It is vital that the programme makes up for lost time as soon as it is safe to conduct house-to-house vaccination activities again. Whilst the pandemic is ongoing, the programme continues to build trust with communities by providing information about COVID-19 as well as the poliovirus. Where routine immunization continues in health centres, polio personnel are emphasizing the importance of maintaining children’s vaccination schedules as far as possible.

In a time when our health feels especially precious, Ihsanullah, Safia and Masood’s story serves to remind us why vaccination is so important.

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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.

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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 |

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

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.

News Category: COVID-19

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