KARACHI – The only life Huma Ashraf has known outside her home is of a health worker. That’s what made her step out on September 11, 2023, when she was verifiying microplans in a slum behind a railway track.

Hours later, in a moment that would redefine her life, she was rushing to Karachi’s Jinnah Hospital in an ambulance all by herself, following a train accident.

“It all happened so fast. I had to verify the homes behind the tracks and the only way to get there is crossing the railway track,” she says, recalling that day of the accident with exceptional calm.  “The train seemed far away, and I thought I could cross over, but there was a gush of wind and my dupatta was caught in the train.”

In a mere matter of minutes, her life changed as she lost both feet.

The people who witnessed the accident called for an ambulance. With startling presence of mind, she collected the feet in the hope of a surgical reattachment and specified which hospital she wanted to go to.

Hina, her younger sister, is amazed by Huma’s courage that day. Showing the text message she received, she shares how Huma wrote to her with striking clarity. “Pair kat gaye hain, hospital ja rahi hun. Ammi abbu ko mat batana” (Have lost my feet, going to the hospital, don’t tell mom and dad.)

By the time Huma was taken into surgery, nearly five hours later, the damage was irreversible.

Hina worked up the courage to tell their parents about the accident after the surgery. Her mother initially thought Huma’s toes were affected. “I couldn’t fathom the extent of it,” says her mother Rukhsana.

A Legacy of Healing

Since Huma was 14, she has known what an aspirin could do, the contraceptives women would seek and that two drops of the oral polio vaccine could protect a child from lifelong, paralytic polio. These were her mother’s teachings. As she grew older, she also learnt how to administer injections. Rukhsana would ask Huma to try injections on her, consistently training her on how to provide basic health services to the community.

Rukhsana, a lady health worker, started working in 1995. As the eldest child, Huma would go along, and the mother-daughter duo would navigate the streets of Karachi, bringing essential healthcare within reach to women and children, and making friends along the way.

All of Rukhsana’s five children have worked for the Polio Eradication Initiative at some point, but it was Huma who stayed on as a frontline health worker, working in the Polio Programme as a team member and eventually rising in the ranks to become an area in-charge.

As vaccinators, there was a time when Huma and Rukhsana were one team, a team that they were very proud of. “When important people came in big cars, we were the team that would be introduced to them because everyone knew we did our job well,” Rukhsana says. “Everyone who saw Huma was amazed at how much she could walk in a day and now…I would have never imagined that one day Huma won’t be able to walk.”

“Both of us still forget what happened. Last night, someone came knocking on the door with some tea and I couldn’t find my slippers, so I asked Huma where hers were, but then I remembered that they would be somewhere on the railway tracks that day,” she adds.

Much of Huma’s nights are spent in pain, especially in the feet that are no longer there. “I think it’s the nerves, my nerves still feel the pain. I can feel my toes hurting, and then realize that they aren’t there anymore.”

Despite a life-changing loss, this is the work Huma still wants to do. “I want to return to work in polio,” she says with a belief that better days are yet to come. The accident has offererd a new level of acceptance and grace. “If God has put me through this difficult time, then I will also be given the strength to bear it.”

“My father cries a lot about this. I told him we have to accept things as they are. This has happened, Allah has put us through a difficult time. If one door closes, another one opens.”

The Bonds That Strengthen

The accident has redefined the meaning of family for Huma. The outpouring of support from colleagues and leaders in the Polio Programme has been overwhelming. For Irshad Sodhar, Coordinator for Sindh’s Emergency Operations Centre, ensuring Huma’s recovery is a mission.

“Looking after the wellbeing of frontline workers is most important. While they do this arduous job selflessly, it is the programme’s duty to support them when they face any adverse situation, especially in the course of their work,” he says.

He is a frequent visitor to the family, and Huma and Rukhsana both look forward to seeing him.

“It is my mission to ensure that Huma gets back on her feet. After the accident, I mobilized everyone we could, from the National EOC Coordinator to the Sindh Health Minister and Deputy Commissioner. We have worked to ensure the family has enough funds and the house is made disability friendly with toilets remade and all parts of it accessible for her. I am amazed by her resilience. After all this, she still wants to work to end polio,” he says, adding “Global polio eradication depends on the motivation of frontline workers. We can’t finish the job without the utmost support of frontline teams on ground.”

When Dr Shahzad Baig, the National EOC Coordinator, talks about Huma, the word that is oft repeated is of family. “Huma is one of the most remarkable people I have ever met,” he says. “We met soon after the accident and I was amazed to see how unbroken her spirit was. She only had gratitude and determination to be better. This feeling of awe stayed with me for days after I met her,” he says.

“She is the true spirit of our polio family. We will make sure she recovers completely and is able to walk on prosthetic feet. Our polio partner, Rotary, has already provided the support for the prosthesis.”

For Dr Zainul Abedin, the WHO National Polio Team Lead, Huma’s unbreakable spirit exemplifies the strength within the polio family. “Huma’s journey, marked by both loss and unyielding hope, mirrors the dedication of health workers across the country. There are many brave souls like Huma who are part of this noble mission to end polio from Pakistan,” he said.

Dr Abedin added: “We salute Huma and every frontline worker, acknowledging their sacrifices and commitment, and will continue to ensure a highly supportive environment for them.”

Huma’s journey and resilience caught the nation’s attention on October 24, 2023, World Polio Day.

In a ceremony that highlighted the relentless efforts of health workers in the fight against polio, Prime Minister Anwaarul Haq Kakar honoured Huma with a shield appreciating her services. This recognition was not just for her contributions to public health but also for her unyielding spirit in the face of adversity. Huma was unable to travel to Islamabad. Dr Baig accepted the award on her behalf and the PM vowed to bring it to her himself.

As Huma prepares for a new chapter in her life, her story is not just one of loss and hardship, but of immense strength, community support, and unwavering hope. “Things have changed, but life goes on,” Huma says with a smile. “We have to embrace it, whatever it brings.”

Huma is eager to start working for polio eradication again.

Sindh EOC Coordinator Irshad Sodhar got frontline workers from across Pakistan to send her messages, all of them expressing their belief in her and wishing for her strength. Huma had a message for them too: “You are not alone. There is a huge programme behind you, which is there for your support. Your work is greater than you think.”

Rukhsana says she has never felt as supported since she started working in 1995. “In this time, I have really felt what it means to be part of a family.”

By Zehra Abid,
Communications Officer, WHO Pakistan (Video by NEOC)

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

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

Humanitarian engagement in Afghanistan: 

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

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

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

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

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

The Far-Reaching Integrated Delivery partnership in Somalia: 

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

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

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

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

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

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

The sound of drums is enough to rouse even the sun, prompting it to wrestle the early morning smog for a front-row seat in a local Pashtun community in Rawalpindi, Pakistan. As tea stall owners set up shop for the day, curious women peek out of their windows, and excited children rush out of their houses to flock around the mysterious drummer. And as he moves from street to street, they run alongside him. Flushed with excitement, they start dancing to the familiar local tunes, some of them falling over each other. All smiling. It is a welcome distraction on a cold January morning.

This lively scene, however, is no accident. A banner draped around the drummer carries a powerful message: “Let’s vaccinate our children regularly to eradicate polio. The upcoming vaccination campaign begins on 8th January. Help us vaccinate your children whenever a health team visits your house.” This ‘attention-grabbing’ approach, blending cultural traditions with polio awareness campaigns, is the brainchild of UNICEF’s Social Behavior Change team working with the government’s Provincial Polio Emergency Operations Centre in Punjab.

Leading this creative team is Sajida Mansoor, who understands that information overload on polio vaccination can overwhelm parents, at times to the point of inaction.

“Out-of-the-box thinking was required to respond to the challenge. That’s how we came up with this unconventional but fun idea of using drums to spread awareness and highlight key immunization dates to reach children, especially those who were consistently missing polio vaccination,” says Sajida, a long time UNICEF staffer supporting polio eradication efforts in the country.

Zafar, the drummer, uses his rhythmic beats to attract a crowd of children and adults to share information about the upcoming polio campaign, in a neighborhood in Rawalpindi, Punjab, Pakistan. © UNICEF/Pakistan
Zafar, the drummer, uses his rhythmic beats to attract a crowd of children and adults to share information about the upcoming polio campaign, in a neighborhood in Rawalpindi, Punjab, Pakistan. © UNICEF/Pakistan

Zafar Iqbal, the drummer, suddenly stops playing, to allow the call for prayers from the local mosque to be heard in the community. Zafar is a seasoned professional musician who sustains his livelihood by showcasing his talent at various cultural events when he is not engaged with the polio eradication programme.

But the polio percussion show isn’t over yet. Joining Zafar at center-stage is seven-year-old Gul Bahisht. She confidently delivers a brief speech she has composed: “Do you know Pakistan is very close to finishing off polio? But I learnt that the virus is still spreading in our area and can paralyze children. We must vaccinate all children and protect them from being hurt and disabled from polio. I have been vaccinated. Why not vaccinate your child too. It’s easy and simple. Just two drops for your child in every campaign and we will all be free from polio forever.”

Zafar picks up where he left off and the rhythmic beat of his drums resume, bringing immense laughter and joy to the delighted children and their families in the neighborhood.

This engaging strategy has struck a chord with local communities. In neighborhoods where the initiative was first introduced, parents became more receptive. Mother and fathers happily opened their doors to polio vaccination teams. It enabled them to vaccinate a large cohort of children who had consistently missed vaccination due to reasons cited as ‘not available,’ which often meant the parents did not open their doors to vaccinators.   Children embraced the teams without distrust, resulting in more efficient vaccination coverage.

This achievement underscores the importance of extending the initiative to other neighborhoods in future campaigns, particularly in communities where some children consistently miss their vaccinations.

A polio worker, Shazia Bibi (right) vaccinates a seven month old boy held by his mother in a neighborhood in Rawalpindi, Pakistan. © UNICEF/Pakistan/Bokhari.
A polio worker, Shazia Bibi (right) vaccinates a seven month old boy held by his mother in a neighborhood in Rawalpindi, Pakistan. © UNICEF/Pakistan/Bokhari.

“This approach has helped us break down the barriers with caregivers and they are more receptive to communicating with us.  We are dedicated to ensuring that our teams on the ground actively respect the religious and cultural norms of the local community. For instance, drummers like Zafar pause their beats during calls for prayer, demonstrating social and religious sensitivity. Additionally, the musical elements are in accordance with the cultural norms of the community,” adds Sajida.

In communities across Lahore and Rawalpindi where the ‘drummer’ strategy was introduced, polio teams managed to vaccinate every single available child. This was a significant contribution to the 96 per cent vaccination coverage achieved in the Punjab province during the recent campaign.

Meanwhile, back in Rawalpindi, Zafar’s percussion jam for polio eradication continues to reverberate in the neighborhood. A father himself, he made sure his youngest two-month-old daughter was vaccinated during the recent vaccination campaign.

“I feel very happy and blessed that the beats from my drums bring joy to people, and at the same time support an important cause that protects our children in Pakistan from deadly diseases like polio,” says Zafar with a smile.

By Wasif Mahmood,
UNICEF Polio Communication Officer, Provincial Emergency Operations Center, Punjab

Geneva, Switzerland, January 2024 Convening this week at the World Health Organization (WHO) headquarters, global health leaders and Ministers of Health at the WHO Executive Board (EB) reaffirmed their commitment to eradicate polio once and for all and use the polio investments to build strong, equitable and resilient health systems.

Opening the EB amid a wide array of public health topics on the agenda, WHO Director-General Dr Tedros Adhanom Ghebreyesus told assembled delegates:  “We continue to intensify our efforts to eradicate polio. Last year, six cases of wild poliovirus were reported in Pakistan, and six in Afghanistan, the second-lowest number of cases reported in a calendar year. Our target is to interrupt transmission of wild poliovirus this year.”

Member States noted the unique opportunity to eradicate remaining wild poliovirus type 1 endemic transmission, which is now limited to just a handful of areas of eastern Afghanistan and three districts of southern Khyber Pakhtunkhwa, Pakistan, and urged for continued intensified efforts to reaching all remaining un- or under-immunized children in those areas.  Delegates also reiterated the importance of intensifying efforts to combat variant poliovirus outbreaks (circulating vaccine-derived polioviruses), including through strengthened outbreak response and the continued roll-out of novel oral polio vaccine type 2, which became the first vaccine used under Emergency Use Listing (EUL) to be pre-qualified by WHO.  The engines of transmission for such strains are in clearly-identified and known most consequential geographies, namely north-western Nigeria, eastern Democratic Republic of the Congo, south-central Somalia and northern Yemen.

Speaking on behalf of WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al Mandhari, Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean said:  “In Afghanistan and Pakistan, the national programmes deployed innovative strategies and strengthened partnerships with humanitarian actors to reach more children. And across the region, the programme also identified pathways for sustaining essential polio functions, through integration with existing programmes. In particular, I am proud of the work of the Regional Subcommittee for Polio Eradication and Outbreaks that we started back in 2021. Their advocacy and support have successfully carved out clear pathways towards protecting children in the Region from polio and other vaccine-preventable diseases.”

Within this context, delegates thanked current Regional Director Dr Ahmed Al Mandhari, for his personal engagement and leadership in bringing the region to the threshold of success; and welcomed his successor, Dr Hanan H Balkhy, who committed to leading the region across the finish line.

“On behalf of the core partners of the Global Polio Eradication Initiative, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we would like to thank all Member States for their tremendous efforts,” said Aidan O’Leary, WHO Director for Polio Eradication and Chair of the Global Polio Eradication Initiative Strategy Committee.  “Last year, thanks to your efforts, upwards of 800 million children were immunized, many in areas with protracted and complex emergencies.  The reality is that it is precisely in such areas of complex emergencies where polio persists, and unfortunately those emergencies are becoming even more complex.  We need the continued political will of Member States to overcoming whatever geo-political challenges might currently stand in the way of reaching that remaining last unreached child in these areas.  Be assured that together with our partners, we stand ready to support you in your incredible efforts.”  Underscoring WHO’s commitment to the effort, O’Leary reminded the EB that WHO now considered the effort to eradicate polio as its only Public Health Emergency of International Concern (PHEIC), under the International Health Regulations (IHR).

O’Leary also reminded delegates of our collective duty to prepare for a lasting polio-free world. He referenced specifically the new approach to polio transition, which draws upon lessons-learned, and puts countries at the forefront, as solutions need to be country-specific, tailored to each country’s own context.  Within that context, delegates emphasized the importance of implementing all activities to not only achieve a polio-free world, but also to sustain it through strengthening essential immunization, surveillance, integration and transition, reiterating their support and commitment to fully finance the Global Polio Eradication Initiative Strategy and the WHO base budget.

Speaking on behalf of Rotarians around the world and civil society as a whole, Judith Diment of Rotary International’s PolioPlus Committee, congratulated delegates on ongoing efforts to protect children from devastating diseases such as polio.  “The Global Polio Eradication Initiative is closing in on zero, with fewer cases in fewer places in 2023, reaching more children through tailored approaches to increase public demand and identifying missed children.  We applaud the use of targeted, integrated activities.”

The Global Polio Eradication Initiative has two goals laid out in its current strategy: to interrupt all remaining transmission of endemic wild poliovirus type 1 (WPV1) and to stop all outbreaks of variant poliovirus type 2 (cVDPV2). 2023 was a critical year for progressing on each of these, and while our urgent and diligent work to end polio must continue into 2024, the GPEI achieved incredible things in the past twelve months.

Continuing work in endemic countries

Despite significant geo-political and environmental challenges in the two remaining WPV1-endemic countries, Pakistan and Afghanistan, the polio programme has continued to reach greater numbers of children with polio vaccines.

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

Wild polio transmission was beaten back to just a handful of districts in eastern Afghanistan and the southern area of Khyber Pakhtunkhwa province in Pakistan. In both countries, efforts are increasingly focused on reaching and vaccinating the last remaining ‘zero dose’ children – children who have received no vaccines of any kind. The number of these missed children continues to dwindle, with the success of improved collaboration with the national immunisation program, new efforts like Pakistan’s Nomad Vaccination Initiative and focused vaccination activities at border crossings between the two countries. Just one family of the virus remains endemic in each country, and coupled with this increasing geographic restriction, the situation resembles the end of wild polio eradication efforts in former virus hotspots like India, Nigeria and Egypt.

In addition, after a wild poliovirus outbreak that was confirmed in southeast Africa in early 2022, neither Malawi nor Mozambique has reported a WPV case since August 2022 thanks to a concerted subregional emergency response across five neighbouring countries. We are hopeful that this outbreak will be officially closed in the coming months, affirming that countries have what it takes to protect children from this devastating disease and keep wild polio out of Africa.

Progress on variant polio outbreaks

Thanks to the novel oral polio vaccine type 2 (nOPV2), strong political commitment and community-based efforts to reach more children with the vaccine, the number of cases of variant poliovirus type 2 (cVDPV2) continued to decline in 2023.

Nearly 1 billion doses of nOPV2, a comparably safe, effective, but more genetically stable version of the existing type 2 oral polio vaccine (mOPV2), have now been administered across 35 countries, protecting millions of children from illness and paralysis.

Emergency response to variant polio outbreaks is continuing, notably in the most consequential geographies for the programme—where children are at the highest risk of encountering and spreading poliovirus. In northern Nigeria, for example, variant polio cases have fallen by 90% since a peak in 2021, thanks to concerted commitment from government, unique community programs to improve the reach of vaccines and the extensive rollout of nOPV2. Across these consequential geographies, the programme will continue to focus on increasing access, acceptance and campaign quality, which have helped make incredible progress in Nigeria, and continue to innovate until we end polio for good everywhere.

Finally, In September 2023, after a massive vaccination response in the shadow of ongoing war, Ukraine officially stopped its outbreak of type 2 variant polio that began in 2021. New York, London and Jerusalem, where high-profile outbreaks began in 2022, have not detected the virus in recent months. Still, the emergence of polio in these areas is a reminder that as long as poliovirus exists anywhere, it is a threat to people everywhere.

nOPV2 Vaccination at Guilding Angel School Tunga, Minna, Niger. © WHO/AFRO

A global effort

Most importantly, thanks to the efforts of the GPEI and its partners, health workers vaccinated more than 400 million children in 2023, preventing an estimated 650,000 cases of paralysis from polio and saving the lives of up to 60,000 children. Building full, healthy futures was at the core of Rotary International’s mission when it began this fight to end polio for good in 1985, and when the GPEI was launched in 1988—35 years ago.

This year, the Independent Monitoring Board (IMB) conducted a rigorous mid-term review of the GPEI’s progress towards its strategic goals. This welcome counsel is already helping inform and guide the GPEI’s own ongoing analysis and strengthening of its strategic approaches to achieve a polio-free world, as the programme published its initial response to the mid-term review, under the guidance of the Polio Oversight Board (POB).

Achieving and sustaining a polio-free world has proven harder – and taken longer – than anyone could have imagined. But making history is never easy, and we are confident that together we can eradicate a second human disease from this earth, and build stronger, more resilient health systems along the way.

2023 has firmly set the stage for success. With the complexities of the world today, this programme still inspires to bring about the very best in our humanity.

Thank you to all who have contributed to this effort so far and continue to do so. Let us double down and make the dream of a polio-free world a reality.

PARIS (5 December 2023) – Bill Gates, co-chair of the Bill & Melinda Gates Foundation and Remy Rioux, CEO of the Agence Française de Développement (AFD) announced today new commitments that implement the Paris Pact principles combining official development assistance and private investment and support the objective of global polio eradication by 2026.

The funding – an up to €55 million concessional loan, with an up to €20 million principal buy-down from the Gates Foundation will support Pakistan’s national health institutions and the Pakistan Polio Eradication Initiative to recover following impacts from the devastating floods in August 2022.

Supporting healthcare system resilience to climate change  

The floods in 2022 were Pakistan’s worst natural disaster in decades highlighting multiple climatic vulnerabilities faced by the country. The human toll was tragically high with one third of the country submerged underwater, approximately 15,000 killed or injured and 8 million displaced. Damage to infrastructure was also catastrophic: over 2 million homes, 13,000 kilometers of highways, 439 bridges and 888 health centers were damaged or destroyed leaving the populations affected by the floods without access to healthcare. Flooding also triggers an upsurge in water-borne diseases (severe diarrhea and cholera) and diseases carried by insects (dengue fever and malaria).

The new project is a contribution to the Pakistani efforts to chart progress towards a climate resilient health system capable of anticipating, recovering from, and adapting to climate-related shocks and stresses, so as to bring about sustained improvements in population health, despite an unstable climate. By supporting the Pakistan Polio Eradication Programme (PEI), through the World Health Organization (WHO), in immunization activities, disease surveillance, polio campaign monitoring and other technical areas, the AFD investment will enhance systems able to target climate-sensitive diseases and their risk sources.  Importantly, this funding will also provide further support for female polio health care workers, whose efforts and experiences are central to Pakistan’s success against polio and other diseases.

 Pakistan Polio Eradication Program

Pakistan has reported five cases of paralysis from polio so far this year. The virus has also been detected in sewage water in 20 districts in the four major provinces, reaffirming that polio continues to pose a threat to children living in poor sanitary conditions with low immunity and poor nutrition.

Dr. Chrysoula Zacharopoulou, Secretary of State in charge of Development, Francophonie and International Partnerships for the French Government, said: “I would like to thank the Agence Française de Développement and the Bill & Melinda Gates Foundation for their commitment to Pakistan. This €55 million investment helps to address a dual challenge that is central to the Ministry of Europe and Foreign Affairs’ global health strategy and its international partnerships policy: strengthening our partners’ health systems while taking into account the impact of climate change on public health. This programme is an excellent illustration of this.”

Dr. Nadeem Jan, Federal Minister of National Health Services Regulations & Coordination in Pakistan emphasized the significance of this funding and polio infrastructure in Pakistan: “We welcome the support of the French Government and the Gates Foundation as we near the finish line on polio eradication. The Pakistan Polio Eradication Programme is a vital part of our healthcare system and investing in polio builds the country’s overall health system.”

Pakistan has made incredible progress toward eradication, and by addressing barriers to eradication—including gender-related barriers—will continue to do so” said Dr. Ahmad Al-Mandhari, WHO Regional Director. Commitments like this will help keep the country on track to interrupt transmission of wild poliovirus for good and help deliver a more resilient, polio-free world.”

Since 1994, the Pakistan Polio Eradication Programme has been fighting to end the crippling poliovirus from the country. The national initiative is driven by trained and dedicated polio workers, the largest surveillance network in the world, quality data collection and analysis, behavioral change communication, state of the art laboratories, and some of the best epidemiologists and public health experts in Pakistan and the world.

Thank you to the Government of France and the Government of Pakistan for their continued leadership in the fight to end polio.” said Mark Suzman, CEO of the Bill & Melinda Gates Foundation. “From France’s commitment to the Global Polio Eradication Initiative last year to today’s new financing partnership between the French Development Agency and the Government of Pakistan, these additional resources are essential to ensuring no child suffers from this devastating disease again.”

“Six months after signing our strengthened strategic and financial partnership for gender equality and human development in Africa and South Asia, I am honored to announce our first joint investment with the Bill & Melinda Gates Foundation. We will both support Pakistan’s polio eradication program and work towards a strengthened integrated national epidemiological surveillance system.  This partnership is one of the long-term responses to the August 2022 devastating floods, which severely affected national health institutions. From eradicating polio to strengthening health systems as a whole, we are committed to investing in global levers of change to promote sustainable health for all” said Remy Rioux, CEO of the Agence Française de Développement.

==

For 15 years, the Bill & Melinda Gates Foundation has worked with the French government to amplify the positive impact of development assistance and scientific expertise in low-income countries by supporting research and the translation of scientific discoveries into sustainable solutions, particularly as part of global alliances, including Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Health Organization. France and the Gates Foundation are also key partners in:

 About the Agence Française de Développement

Agence Française de Développement (AFD) implements France’s policy on international development and solidarity. Through its financing of NGOs and the public sector, as well as its research and publications, AFD supports and accelerates transitions towards a fairer, more resilient world. With our partners, we are building shared solutions with and for the people of the Global South. Our teams are at work on more than 4,000 projects in the field, in 115 countries and in regions in crisis. We strive to protect global public goods – promoting a stable climate, biodiversity and peace, as well as gender equality, education and healthcare. In this way, we contribute to the commitment of France and the French people to achieve the Sustainable Development Goals (SDGs). Towards a world in common.

https://www.afd.fr/en

About the Bill & Melinda Gates Foundation

The Bill & Melinda Gates Foundation is a nonprofit fighting poverty, disease, and inequity around the world. For over 20 years, it has focused on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. Based in Seattle, Washington, the foundation is led by CEO Mark Suzman, under the direction of Co-chairs Bill Gates and Melinda French Gates and the board of trustees.

https://www.gatesfoundation.org/

Contacts

  • Isabelle Dedieu, dedieui@afd.fr, AFD Press officer
  • media@gatesfoundation.org

Published by the Bill & Melinda Gates Foundation on 5 December 2023.

DUBAI, UAE, 3 December 2023 – The Islamic Development Bank (IsDB), together with the Government of Pakistan, announced a US$100 million loan to support Pakistan’s polio eradication efforts, today, at the Reaching the Last Mile Forum held on the sidelines of the ongoing COP28 events in Dubai, UAE.

This loan builds on a previous support from the IsDB and includes a US$35 million principal buy-down from the Bill & Melinda Gates Foundation. The new funding complements previous loans and will be used to secure and deliver the millions of polio vaccines needed to protect all children across Pakistan against this debilitating yet preventable virus.

“I am very pleased to announce that the IsDB approved US$100 million financing in the 4th Phase of Polio Eradication Program for Pakistan in April 2023, which brings the IsDB total financing for Polio eradication in Pakistan to US$ 587 million, making the Bank one of the largest providers of finance to the national polio eradication program in Pakistan. Under this latest phase, I am happy to note that US$ 60 million of this amount was disbursed in mid-November 2023. We and our partners remain committed and are working hard to win this battle against this disease. We really are at the last mile in this long journey as only 5 cases of wild poliovirus have been reported in the country in 2023,” IsDB President and Group Chairman, H.E. Dr. Muhammad Al Jasser, reiterated in his statement read out by IsDB Vice President Finance, Dr. Zamir Iqbal, at the Forum. “I would like to thank the Government of Pakistan, as well as our partners, the Bill and Melinda Gates Foundation, UNICEF and WHO for their steadfast commitment,” added the statement.

Today, Pakistan and Afghanistan are the only countries where wild poliovirus remains endemic.

“We welcome the support of the IsDB and the Bill & Melinda Gates Foundation in contributing to the critical effort of ending polio in Pakistan,” said H.E. Dr. Nadeem Jan, Minister of National Health Services Regulations and Coordination. “Interrupting poliovirus transmission remains a core focus for the Government of Pakistan, and thanks to the heroic efforts of community health workers, global partners and contributors like the IsDB and the foundation, we have pushed the virus to the brink of eradication,” the Minister added.

The Bill & Melinda Gates Foundation sees this loan as an important step forward for eradication efforts in Pakistan. “We are pleased to partner again with the IsDB and the Government of Pakistan to ensure funding opportunities to provide the needed resources to reach every child with polio vaccines. I remain inspired by the strong commitment from leaders across Pakistan to ending polio at both the provincial and national levels,” said Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation and Chair of the Global Polio Eradication Initiative Polio Oversight Board. “With continued support to health workers and the efforts from partners like the IsDB, I am confident we will end polio in Pakistan,” he reiterated.

On the occasion, WHO Director General, Dr. Tedros Adhanom Ghebreyesus, stated: “WHO remains committed to working with our partners to support Pakistan’s effort to end polio for good.” He added: “These funds will allow Pakistan to raise immunization coverage, improve its ability to find and respond to this virus, and make polio history for children in Pakistan and around the world.”

This loan will enable the Pakistan polio program to reach all children and communities with this life-saving vaccine to ensure no one suffers from this debilitating disease in the future. It will also help meet the country’s commitment of US$155 million towards its national polio program supported by the partners of the Global Polio Eradication Initiative (GPEI).

As one of the two implementing partners of the GPEI in Pakistan, UNICEF will support the government to procure and deliver vaccines to children, protect communities from polio and reach families with other essential health services. “We are at a critical moment in Pakistan, and we cannot ease up the fight against polio until every child is protected,” UNICEF Deputy Executive Director Omar Abdi said, adding: “UNICEF is committed to ending polio in Pakistan because we know it is possible. We have seen polio disappear from country after country across the globe. Today there are only two countries where it persists. Together, we can reach every child with polio vaccines, especially those who have not been vaccinated before, and we can end wild poliovirus transmission in Pakistan for good.”

Originally published by the Islamic Development Bank on 3 December 2023

 

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

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

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

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

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

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

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

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

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

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


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

Led by Dr Chris Elias, Chair of the Polio Oversight Board and President Global Development, Bill & Melinda Gates Foundation, the delegation included WHO Regional Director for the Eastern Mediterranean Region Dr Ahmad Al-Mandhari, UNICEF South Asia’s Deputy Regional Director Noala Skinner, CDC’s Polio Eradication Branch Chief Dr Omotayo Bolu, Chief Programme Strategy Officer from Gavi-the Vaccine Alliance, Aurelia Nguyen, Trustee of Rotary International Foundation Aziz Memon, and High Commissioner of Canada in Pakistan Leslie Scanlon, who represented all donors to the GPEI.

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

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

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

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

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

The polio ‘listening post’  

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

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

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

Examples of high-risk misinformation alerted to country teams:

Clear and accurate messages are crucial

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

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

 Quashing rumours

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

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

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

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

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

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

Local outreach and digital engagement

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

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

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

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

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

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

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

More opportunities ahead

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

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

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

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

Manzoor (second right, pictured here with his uncle, brothers and sisters) will make a full recovery from polio paralysis. ©UNICEF/Karimi

By Kate Pond, UNICEF Afghanistan

“Manzoor is our miracle child!” exclaims the young man, face shining. Two-and-a-half-year-old Manzoor is unmoved by his uncle’s excitement; he is busy eyeing the boiled sweet in the outstretched hand of a village elder on the other side of the room. The boy gets up decisively, and trots across the carpet. He grabs the candy in a pudgy hand and gobbles it down with relish.

Just a few months ago, Manzoor could not walk. His left leg was paralyzed by the polio virus.

In a neighbouring district, Saima, fidgets with her hennaed fingers while her father pours tea. Small for her 11 years, Saima still favours her right side, although the paralysis caused by the virus is easing. As her father tells the story of her recent illness, her grandfather puts his arm around the girl’s shoulders, embracing her warmly.

Polio is still endemic in Afghanistan – one of the last two countries in the world. Since the start of 2023, six children have been diagnosed with the disease, all of them in Nangarhar Province, a rural area in the east of the country. Saima and Manzoor are lucky: six months after the onset of symptoms, it looks like they will make a full recovery. Two of the six were not so lucky; one boy remains very weak in the limbs affected, and one girl died.

The national polio vaccination campaign, led by the National Emergency Operations Centre in coordination with UNICEF and WHO, is in full swing. Last year, 9.4 million children were vaccinated under the campaign, and the target for 2023 is 10 million. The monthly campaigns are boosted by educational campaigns for mothers and other caregivers, run by UNICEF and partners.

Saima and Manzoor received vaccine drops in recent campaigns, and their parents were well aware of the signs and symptoms of polio, how it is caught, and the importance of vaccination as the only preventative measure. In fact, the speed at which their parents acted to get tests and treatment for their children are testament to the commitment and hard work of over 30,000 polio social mobilisers and influencers building public trust in the programme, and the deep-seated desire of the Afghan community to eradicate the virus once and for all.

The combination of vaccination campaigns and regular routine vaccination is the gold standard to eradicate polio forever. Nangarhar ranks above the national average for full childhood vaccinations, with 27 per cent of children fully covered, although it is also slightly higher than average for children in the same age bracket to be unvaccinated (Ref: UNICEF MICS 2022-23). In each of the six new polio cases, the children had missed one vital vaccination – usually the intravenous jab given to babies and toddlers – which left a gap in their immunity, and the virus was able to break through.

Nothing happens in a vacuum. For a vaccine to work effectively, the child receiving it needs to be healthy, adequately nourished, and living in a sanitary environment. The polio virus is contracted from water sources that are contaminated by raw sewage infected with the virus. Wild polio is detected in the samples WHO collects in regions across Afghanistan, including in the east.

Less than half the population of Afghanistan has access to basic sanitation, and a third do not have access to clean drinking water. In rural areas, like Saima and Manzoor’s districts, the streams the children play in are often the same streams that household waste and effluent flow into. Nangarhar residents benefit from higher-than-average access to clean drinking water, but sanitation is considerably lower than average, and 20 per cent practice open defecation. In Manzoor’s district, for example, only 30 per cent of the population benefit from a piped water supply. Without the necessary infrastructure in place to provide these services, children will continue to be exposed to the virus in their living environment and run the risk of contracting the disease.

The polio vaccination campaign is striding forward in Afghanistan, and the virus is fighting to survive. But while the water in which children play is contaminated, the risk of them catching the virus hangs heavily over communities. Winning the battle involves recognizing the interconnectedness of health and nutrition, clean water and sanitation, community education and vaccination, and responding with a comprehensive package of services. As Saima’s father put it: “Mashallah my daughter is lucky. She will make a full recovery. But without better sanitation we will continue to live in fear of the virus.”

To celebrate this year’s World Polio Day, supporters from over 30 countries, across every region of the world, joined the Make Polio History campaign to tell global partners, donors, and polio-affected country governments that eradication is possible and urgently needed now. 

The Global Polio Eradication Initiative (GPEI) has the knowledge and tools to end polio for good, but we cannot do it alone. Throughout the campaign, polio champions around the world built a long list of some of the greatest wins for humanity—from the creation of the first vaccine to the harnessing of electricity—and shared why polio eradication can and must be added to this list.  

Well-known figures like Bill Nye, Adina Porter, Prue Leith and Itzhak Perlman voiced their support for a healthier future for children everywhere. Health workers in Afghanistan and Cameroon joined in as well, along with Fiocruz President Mario Moreira, Dr. Naveen Thacker of the International Pediatric Association, GPEI Gender Champion Minister Andrew Mitchell, and other doctors and researchers from India, Brazil and the United Kingdom 

We know that eradicating polio is not easy, but making history never is. The polio eradication effort—from global partners to country governments to local frontline health workers—has a long history of innovating and adapting in the face of adversity. 

GPEI partners know this well, from WHO leadership in the Eastern Mediterranean and African Regional Offices to UNICEF teams in Sudan and Ethiopia, who also participated in the campaign. Rotary International has been there since the beginning, as CEO John Hewko was proud to share, and will continue to be until the end. And finally, members of the GPEI’s Polio Oversight Board recognized the global support shown throughout the campaign, and committed their efforts to delivering a polio-free world. 

Today, there are proven strategies and new tools to deliver vaccines in the highest-risk areas for polio, which are also some of the world’s most challenging and hard-to-reach settings. Promising trends in polio-affected countries that have been seen in other places now polio-free suggest that today, the virus is truly on its last leg. With continued attention and support from donors, partners and affected country governments, polio eradication is within reach. 

It will take all of us, but together, we can make history again and end polio for good. 

Visit the Make Polio History website to hear more perspectives from polio champions from around the world, and to lend your voice to the effort.  

Last month, the Bill & Melinda Gates Foundation partnered with The Moth to host an exceptional storytelling event, Don’t Stop Now: Stories from the Final Push to End Polio. Held in New York City during the UN General Assembly, the event was an inspiring night of powerful personal stories from individuals whose lives have been impacted by polio.

The event was hosted by Dr. Richard Besser, President and CEO of the Robert Wood Johnson Foundation, and opening remarks were provided by Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation. Storytellers included Safia Ibrahim (Public Engagement Manager at Results Canada and polio survivor), Wasif Mahmood (Head of Communications at UNICEF Pakistan), and Oyewale Tomori (past President of the Nigerian Academy of Science, past Virologist at WHO AFRFO), who all told powerful stories about their lived polio experiences, inspiring the audience to keep up the fight to end this devastating disease. Special guest EXILE TETSUYA (Japanese artist and polio advocate) also provide remarks on his own polio eradication advocacy efforts.

 

BRUSSELS, 11 October 2023 – Today, the European Commission (EC), the European Investment Bank (EIB) and the Bill & Melinda Gates Foundation (BMGF), along with the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) announced a new financing partnership to advance polio eradication efforts and strengthen healthcare systems. Of the expected €1.1 billion, €500 million in new funding will go to the Global Polio Eradication Initiative (GPEI) – specifically to its implementing partners, WHO and UNICEF – and €500 million to programs that expand innovation and research capacity in low- and middle-income countries. 

This announcement comes at a critical time for global eradication efforts. When the GPEI was established in 1988, wild poliovirus paralyzed an estimated 350,000 children in over 125 countries every year. Today, only two endemic countries remain – Pakistan and Afghanistan – and 80% of variant poliovirus cases are found in only four subnational regions. Promising trends in affected countries, like shrinking genetic diversity of the virus and increasingly geographically confined outbreaks, suggest that in most places the virus is on its last leg.  

Now, new commitments from European leaders puts the program one step closer to seizing the historic opportunity we have to overcome final hurdles and end polio for good. The expected funds will allow polio vaccinations to reach nearly 370 million children annually, with a focus on targeting remaining un- or under-vaccinated children who typically live in some of the world’s hardest-to-reach areas.  

By focusing on such communities, the program is able to deliver broader health benefits to low resource settings, including routine immunizations, counseling on breastfeeding, Vitamin A supplementation and more. This not only fosters healthier communities today, but also strengthens health systems to better prepare for and respond to emerging health threats, as the polio program and workforce has done against COVID-19, Ebola, and other diseases. 

Partners announced the new financing partnership at the “Healthy Hopes: Reasons for optimism in science and global cooperation” event in Brussels. The event featured a keynote speech from Stella Kyriakides, European Commissioner for Health and Food Safety, remarks from Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, and a panel discussion featuring Catherine Russell, Executive Director of UNICEF and European leaders – Koen Doens, Director-General at the EC’s Directorate General for International Partnerships, Werner Hoyer, President of the EIB, and Caroline Gennez, Belgium’s Minister for Development. The event concluded with a fireside chat with Bill Gates, Co-Chair of the BMGF. 

European leaders re-affirmed their commitment to ending polio for good and called on the rest of the world to join them and the GPEI partners in the fight for a polio-free world. They underscored the need for global cooperation in the final stretch to eradicate this devastating disease.   

In his remarks, Dr. Tedros reminded attendees about the incredible progress that has been made toward a polio-free world, the tools and strategies we have at our disposal that will get the job done, and the importance of donors like the EC and EIB in unlocking the GPEI’s ability to utilize them. Catherine Russell reinforced the ever-narrowing window of opportunity we have to end polio for good and affirmed her confidence in the program’s ability to stop all virus transmission in the immediate future while meeting the broader health needs of communities now.  

During the fireside chat, Bill Gates expressed his optimism about what this new investment represents for the future of eradication efforts and global health. By finding innovative ways to partner, European leaders are helping us achieve a world where no child is paralyzed by this preventable disease.  

Increased support from donors, leaders of polio-affected countries and partners is essential to protect the incredible progress made so far, achieve high vaccination coverage and end polio for good. A polio-free world is in sight, but stakeholders at all levels must stay committed to achieving this goal and building strong health systems to protect children today and future generations.  

Dr Nadeem Jan, newly-appointed interim Federal Health Minister Pakistan, and Aidan O’Leary, Chair of the GPEI Strategy Committee. © NEOC Pakistan

4 September 2023 – Recognising the importance of Pakistan in the global polio eradication effort, as one of the last two WPV1-endemic countries, the operational polio leadership of WHO and the US Centers for Disease Control and Prevention (CDC) travelled this week to Pakistan to observe first-hand operations, latest developments and innovations, and meet with newly-appointed political leadership.  The delegation, which was in-country from 29 August to 1 September, consisted of Director of Polio Eradication at WHO Headquarters and Chair of the Global Polio Eradication Initiative (GPEI) Strategy Committee Aidan O’Leary from WHO and Richard Franka, Team Lead of the Pakistan Team at Polio Eradication Branch, CDC.

The GPEI leaders noted the unprecedented historic opportunity to achieve success in the country this year, with WPV1 transmission at record-low levels.  At the same time, the group noted the high level of engagement and political will for the effort, at all levels.  Meeting with Dr Nadeem Jan, newly-appointed interim Federal Health Minister who visited the polio National Emergency Operations Centre (NEOC) on his very first day in office last month, the delegation received assurance that polio eradication is a key operational priority for Dr Jan’s tenure.

Provincial caretaker Health Minister Dr Saad Niaz and Aidan O’Leary discuss steps the programme is taking to keep track of polio cases in Karachi. © NEOC Pakistan

Dr Jan stated:  “It is important for us that our country and global partners and donors stand together in this final leg of the eradication journey.  I am a polio worker at heart.  I will ensure that not only does polio remain a priority at all tiers of governance, but efforts are more targeted and intensified.”

This level of commitment was further mirrored at meetings with other national and provincial political and health leaders, including the Engineer-in-Chief at the General Headquarters in Islamabad, provincial health ministers of Khyber Pakhtunkhwa and Sindh, and the Chief Secretary of Sindh, to ensure the new interim administration in the country carries the positive momentum forward.  Together, concrete ways to capitalize on the current epidemiological opportunity were discussed, including in fully implementing recommendations by the recent Technical Advisory Group (TAG) for Polio Eradication in Pakistan and Afghanistan, in particular in implementing area-specific and tailored tactics to overcome area-specific challenges to reaching remaining un- or under-vaccinated children.  The delegation also visited field activities and witnessed first-hand the tremendous efforts, innovations and commitments undertaken by polio workers and local communities, including in the remaining WPV1-endemic districts of the southern area of Khyber Pakhtunkhwa.

Speaking on behalf of the delegation, Aidan O’Leary commented:  “Rarely have I seen this level of commitment to achieve success.  On behalf of the GPEI, and on behalf of children and parents everywhere, I would like to thank and commend authorities at all levels in Pakistan for their tremendous engagement, leadership and commitment to reaching every last child.  Literally no stone is being left unturned to find and vaccinate all remaining unvaccinated children, in particular in the remaining endemic areas of the southern area of Khyber Pakhtunkhwa province.  With this level of commitment, I am confident a polio-free Pakistan will soon be achieved, and GPEI partners of course remain committed in supporting Pakistan’s authorities in this quest.”

The delegation was also attended by members of the international development community, including local representatives of Rotary International.

ISLAMABAD, JULY 21, 2023 – A high-level delegation of the Global Polio Eradication Initiative (GPEI), including the Polio Oversight Board, visited Pakistan to discuss the impact of political transition on eradication efforts and the strategies in place to vaccinate children that remain unreached in the polio-endemic districts of southern Khyber Pakhtunkhwa.

Led by Dr Chris Elias, Chair of the Polio Oversight Board and President Global Development, Bill & Melinda Gates Foundation, the delegation included WHO Regional Director for the Eastern Mediterranean Region Dr Ahmad Al-Mandhari, UNICEF South Asia’s Deputy Regional Director Noala Skinner, CDC’s Polio Eradication Branch Chief Dr Omotayo Bolu, Chief Programme Strategy Officer from Gavi-the Vaccine Alliance, Aurelia Nguyen, Trustee of Rotary International Foundation Aziz Memon, and High Commissioner of Canada in Pakistan Leslie Scanlon, who represented all donors to the GPEI.

This was the first visit by the POB and representatives from all GPEI partners to Pakistan in 2023. The POB is the highest decision-making and oversight body of the GPEI.

During the four-day visit from 16 – 20 July that included Lahore, Peshawar and Islamabad, the delegates visited the National and Provincial Emergency Operations Centers, attended a meeting of the National Task Force on Polio Eradication, and held separate meetings with the leadership of the Pakistan Army, Health Minister Abdul Qadir Patel and Foreign Minister Bilawal Bhutto Zardari.

“Pakistan continues to make important progress in the fight to eradicate polio. I’m impressed by the commitment I’ve seen again this week from the federal and provincial governments in getting the job done,” said POB Chair Dr Chris Elias. “The experience globally is that strong government leadership is key in the final push to defeat polio.”

The delegation also met the Governor of Punjab, Chief Minister of Khyber Pakhtunkhwa and provincial chief secretaries, health secretaries, commissioners and deputy commissioners of priority districts of Punjab and Khyber Pakhtunkhwa in Lahore and Peshawar, respectively, and met with the Chief Secretary of Balochistan.

“While the challenges before us are formidable and complex, I remain cautiously optimistic about the goal of interrupting transmission of poliovirus in Pakistan by the end of this year. This will require solidarity and collective action at all levels to enable rigorous implementation of the strategy, that must be fully supported by communities and the political, administrative and security leadership,” said WHO Regional Director Dr Ahmed Al-Mandhari.

Endemic transmission of wild poliovirus remains restricted to seven districts in the south of Khyber Pakhtunkhwa province, namely Tank, Bannu, North Waziristan, South Waziristan Upper, South Waziristan Lower, DI Khan and Lakki Marwat.

A vaccination campaign is ongoing in the seven endemic districts named “Reaching the Unreached.” The campaign specifically targets over 270,000 children under five in 69 low-performing union councils where vaccine coverage for polio and other essential immunization has been inadequate.

 “Under our regional vision of health for all by all, WHO will continue supporting Pakistan’s polio programme to give our future generations a world free from polio,” Dr Al-Mandhari added.

UNICEF’s Deputy Regional Director Noala Skinner appreciated the leadership. “We applaud the leadership of Pakistan and the dedication of frontline workers, including thousands of women, who tirelessly vaccinate and protect millions of children from the deadly poliovirus,” she said, adding, “The next six months are critical for Pakistan’s efforts to eradicate polio.  We are so close to our goal of reaching all children with polio vaccines. Together, we must ensure that the programme is able to reach every child in Pakistan, regardless of where they live.”

©WHO

Global leaders and stakeholders have been unanimously declaring their solidarity to achieving a lasting world free of all forms of polioviruses.

Convening this week at the World Health Assembly in Geneva, Switzerland, Ministers of Health from around the globe evaluated the unique epidemiological opportunity which currently exists, in particular in eradicating all remaining chains of endemic wild poliovirus in a handful of districts of just two countries – Pakistan and Afghanistan.  As a record number of Member States and civil society partners took to the floor, key to success, all experts agreed, must be on adapting operations and reaching remaining un- or under-immunized children in just seven subnational most consequential geographies, with collectively account for 90% of all new polio cases, including in a gender-equitable and integrated manner.  To ensure lasting success, delegates urged country-specific solutions for polio transition.  In response to both a wild poliovirus outbreak in south-eastern Africa and multi-country circulating vaccine-derived poliovirus outbreaks, extraordinary special sessions were led by WHO and its Regional Office for Africa between affected Member States and partners, to discuss concrete steps to stopping all outbreaks affecting the Region by end of year.

The World Health Assembly comes on the heels of last week’s G7 Leaders and G7 Health Ministers meetings in Japan, where both meetings highlighted the urgent need to ensure a world free of polio can be rapidly achieved. Next week, Rotarians from around the world are convening at the Rotary International Convention in Melbourne, Australia, to ensure civil society support for the effort will go hand-in-hand with public sector engagement.

Speaking on behalf of both Pakistan and the entire Eastern Mediterranean, Mr A.Q. Patel, Pakistan Federal Minister for National Health Services, Regulations and Coordination, said:  “We are in the final leg of eradication and we are doing everything we have to do to achieve success.  The virus is restricted to its smallest-ever geographical footprint, and the (polio) programmes in both Pakistan and Afghanistan continue to vastly expand their hunt for the virus and mount robust campaigns to reach all children, not just with polio vaccine, but indeed other antigens as well.  We could not have come this far without the strong support and goodwill of all Member States, however there is still more to be done at the heart of all our work, and for the future of all generations of children.  We need continued and sustained financial and political support from all Member States and partners, in order to give every child, no matter where they live, the promise of a polio-free world.”

H.E. Dr Hanan Mohammad Al-Kuwari, Minister of Public Health of Qatar, and Co-Chair of the Eastern Mediterranean Regional Subcommittee for Polio Eradication and Outbreaks, commented:  “In our Region, we have made significant progress in both containing the spread of wild poliovirus and closing outbreaks of vaccine variant polio.  Afghanistan and Pakistan have restricted the virus to the smallest geographical footprint in history and are now doubling up efforts to fully interrupt the remaining transmission.  The engines fueling this progress are manifold, but the two most powerful, and the two I truly believe will get us across the line, are improved immunity and better surveillance. We are reaching and vaccinating more children, more often, and we are using the most sensitive and robust surveillance measures in history to ensure that if the virus is there, we are not missing it.  Excellencies, partners and colleagues, I ask this as clearly as I can: Stay the course. Dig deep to do what needs to be done. Stand with us and be part of history.”

Noting the global commitments being made, Jean-Luc Perrin, Rotary International’s Representative to the United Nations in Geneva, told the global health community at the Assembly:  “Polio eradication is a rare example of enduring, truly global collaboration toward a goal whose achievement will benefit all nations in perpetuity, while contributing toward broader global health priorities.  We cannot take progress or possible victory for granted. Let us make collective history and End Polio Now!”

In conclusion: global leaders continue to note the very real window of opportunity for success this year, but that this window will not remain open for long.  The virus will again gain in strength. Only collective and global collaboration will result in ultimate success, and delegates and leaders urge all stakeholders to keep the focus firmly on one overriding objective:  reaching remaining un- or under-vaccinated children in the most consequential geographies.  A collective responsibility, but if achieved, will result in success in 2023.

Additional quotes from the World Health Assembly:

“WHO and our partners remain steadfastly committed to finishing the job of consigning polio to history.  Last year, three million children previously inaccessible in Afghanistan received polio vaccines for the first time.  And in October, donors pledged US$2.6 billion to support the push for eradication.  At the same time, as part of the polio transition, more than 50 countries have integrated polio assets to support immunization, disease detection and emergency response.  We must make sure that the significant investments in polio eradication do not die with polio, but are used to build the health systems to deliver the services that these communities so badly need.”- Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

“Wild poliovirus transmission has been cornered to the smallest ever geographic locations in the Eastern Region of Afghanistan and seven districts in southern part of Khyber Pakhtunkhwa in Pakistan.  However, the last 100-metre dash presents its own challenges and we must do all we can to achieve success.” Dr Hamid Jafari, Director for Polio Eradication for the Eastern Mediterranean, on behalf of Dr Ahmed Al-Mandhari, Regional Director, World Health Organization Eastern Mediterranean Region

“The African Region, which was certified free of wild poliovirus in 2020, has set itself the objective of stopping the transmission of all types of 2 polioviruses by the end of 2023 and integrating polio assets into activities that strengthen broader disease surveillance. It is also deploying integrated public health teams to respond to other emergencies, building on experiences from past poliovirus outbreaks and leveraging the polio network and infrastructure for response activities.” – Delegation of Burkina Faso, speaking on behalf of the entire African Region.

A doctor and surveillance volunteer checks a child for signs of paralysis in a clinic in Shawalikot district, Afghanistan. ©WHO / Jawad Jalali
A doctor and surveillance volunteer checks a child for signs of paralysis in a clinic in Shawalikot district, Afghanistan. ©WHO / Jawad Jalali

In May 2014, the WHO Director-General declared the international spread of poliovirus a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005), a designation that allows for accelerated response, emergency disbursement of funding and mitigation measures, such as vaccination of international travellers, to reduce the risk of spread of poliovirus. Nine years and several expert-led reviews later, polio retains its PHEIC status. COVID-19 and mpox have joined and recently left the list of diseases with this designation, but poliovirus still poses a risk of international spread. As noted with detections of variant poliovirus around the world in several previously polio-free countries, including Canada, Israel, the United Kingdom of Great Britain and Northern Ireland and the United States of America, poliovirus anywhere is a threat to children everywhere.

Despite retaining its PHEIC status, the polio eradication programme has made tremendous strides in the last 3 and a half decades. These efforts have brought the world to the best yet position in terms of achieving our goal of eradication.

In WHO’s Eastern Mediterranean Region, home to constantly brewing humanitarian crises and the last 2 countries endemic for wild poliovirus – Afghanistan and Pakistan – transmission has been cornered to the smallest ever geographical location. Up until now, in 2023, 2 cases of wild poliovirus have been reported from Afghanistan and one from Pakistan – all from the endemic zone in the East Region of Afghanistan and southern districts of Khyber Pakhtunkhwa, Pakistan. Both countries have also cut down the genetic diversity of the virus since 2020 – from 8 to one in Afghanistan and 11 to one in Pakistan.

Years of extraordinary efforts by frontline workers, national and local authorities, the partners of the Global Polio Eradication Initiative (GPEI) and donors the world over have led us to our best yet opportunity to snuff out this virus once and forever.

The footprint of circulating variant poliovirus in the Region has also reduced considerably in recent years. The Region has fewer outbreaks today than it had a year ago. Last year, Sudan closed its 2020 cVDPV2 outbreak and Islamic Republic of Iran closed a poliovirus event, while both Djibouti and Egypt are no longer detecting any poliovirus in environmental samples and are poised to formally close their outbreaks in a few weeks.

Polio surveillance systems have never been more sensitive. 18 of the Region’s 22 countries have established environmental surveillance systems to complement the networks of surveillance workers and health care providers actively searching for acute flaccid paralysis in children. In addition to countries at high risk of polio, the list also includes longstanding polio-free countries, such as Bahrain and Saudi Arabia, underscoring the importance of surveillance in all countries as the Region moves towards certification.

Investments made in polio have demonstrated their value for broader healthcare, such as during COVID-19 when the polio assets supported testing, vaccination and risk communication. The Region is making progress with polio transition to ensure countries maintain much-needed essential functions, even as funding transitions away from GPEI financing to national domestic resources or WHO base budget. These efforts will strengthen disease surveillance, routine immunization for children, and outbreak preparedness and response capacities.

The polio programme regularly engages with Member States through governing bodies such as the Regional Subcommittee for Polio Eradication and Outbreaks and uses expert advice by technical advisory groups of experts to review progress in the Region and support countries to stop transmission and maintain robust surveillance and immunization programmes. But to deliver on the promise of a polio-free world for future generations, there is still more work to be done. Across the Region, we are in a race against time to intensify surveillance, enhance the quality of immunization campaigns, and strengthen preparedness for and response to polio outbreaks, while ensuring any gender-related barriers are mitigated across all levels of the programme.

As WHO Member States gather in Geneva for the 76th annual World Health Assembly, now is the time to dig deep, draw on our strength as a partnership and the strength of donors and host governments, and achieve the goal we declared more than 3 decades ago.

Originally published on WHO’s EMRO website.

On 17 May, GPEI held a high-level influencer briefing with polio experts from around the world in which over 200 attendees from 63 countries took part.

Watch the recording of the event.

 

Meeting in Japan this month, leaders of the G7 urged for global support to the Global Polio Eradication Initiative (GPEI). In their official Communiqué issued at their Summit, G7 Health Ministers “recognize the value-added contribution of the global polio eradication infrastructure and workforce towards global surveillance capacity, national pandemic preparedness and response capacity, and the wider global health architecture. We call for continued support to the GPEI to fully leverage this vital resource for public health emergencies and to stay on track for polio eradication by 2026.”

This call was subsequently echoed by the G7 Leaders, following the group’s Summit, who called for “continued support to the GPEI to stay on track for polio eradication by 2026.”

The G7 forum and leaders have a long history of supporting the global effort to eradicate polio, and this reiterated support is further testimony to their commitment to the GPEI.  These latest commitments come ahead of this week’s World Health Assembly (WHA), where global health leaders from around the world are convening at the World Health Organization (WHO) in Geneva, Switzerland, to discuss global public health issues, including polio eradication.

Islamabad – An announcement over a loudspeaker from the mosque captures the attention of parents and their children. The voice announces that a polio campaign is taking place in the settlement and vaccinators will be coming to give two drops to children under five. Eight teams of two vaccinators each are already on their way, each starting their day from the farthest house in the community and making their way to the center.

In January, when Pakistan detected a positive wild poliovirus from a sewage sample with genetic links to the virus circulating in Afghanistan, the polio teams jointly conducted a detailed epidemiological investigation to trace the routes of virus movement and identify infected populations. In a matter of weeks, a response was planned and implemented, vaccinating around 6.37 million children from 13 – 17 February. In this article we take you to an Afghan refugee settlement in Islamabad, one of the 30 districts that were covered partially and where the outbreak response focused on mobile and cross-border populations.

The story looks at three important components of a campaign: vaccinators, vaccines and tally sheets.

Vaccinators: the backbone of programme

“Who is there”, asks a man from inside the house, in Pushto.

“Polio team,” responds Salma who speaks Pushto. “We are here to give polio drops. Do you have children under five at home?”

Polio vaccinators. © WHO/EMRO

A tall man with a three-year-old boy in his arms, opens the door and welcomes the two vaccinators. Salma introduces herself and her team member Amina and asks the father if either of their children had received polio drops that day. The father confirms that in this round, his children did not receive any polio drops.

“Can I give them the polio drops?”, asks Salma.

The father responded back energetically, “Of course, you can! I want my child to grow up healthy!”

This is when Salma opens the blue box. Inside it are ice packs and vials of oral polio vaccine. She talks to the little daughter and asks her to open her mouth and gives her two drops from the vial.

After giving the drops, she marks the girl’s little finger. “You can show this incase anyone asks if you got the polio drops.”

Amina, on the other hand, fills out the tally sheet that she will later submit to her supervisor. If this information is incorrect, it can impact the overall operational coverage data for the campaign.

On leaving the house, Amina takes out her chalk and marks the door of the house with key information that will mention what day they visited, the number of children under five in the house and if there was any child with symptoms of acute flaccid paralysis.

One house done, now on to the next one.

Vaccines: two drops for every child 

“It is not always this straightforward,” says Amina. “Sometimes parents are skeptical about the vaccine and don’t want us to vaccinate their children. I often take the drops myself to show them how safe the vaccines are. When they see me taking these drops, it helps us build confidence with them.”

The polio programme has a long history of systematically listening to community concerns and addressing them, often engaging influencers such as religious leaders, to underscore the safety and efficacy of polio vaccines. This has helped address vaccine hesitancy and reached more children, building their immunity against this debilitating disease. At this settlement, occasional announcements were made through the mosque, informing people that a polio campaign was taking place and encouraging them to vaccinate their children. The result of these efforts has helped the programme significantly reduce the number of refusals across the country.

The blue box Amina carries with her has a large red “End Polio” sticker and it can carry up to 20 vaccine vials, nestled between the ice packs. Each vial contains 20 doses. She pays special attention to the box making sure the temperature is always maintained and the vaccines are kept out of direct sunlight. Vials that have been used, those that are unused and the ones in use are all kept in separate bags in the cold box.

Tally Sheets: supporting real-time corrective actions

The third important piece of a polio campaign is the tally sheet. In rudimentary terms, it is a piece of paper with many tiny boxes that deliver a telling story of number and ages of children, those who were vaccinated, those who were missed, location where the campaign is taking place and number of doses delivered. In case of any refusals, the vaccinator mentions the reason for refusal at the back of the tally sheet. It tells how well an area has been covered and the remaining gaps.

Markings on a house entrance after visitation by polio vaccinators. © WHO/EMRO

The authenticity of this data is a crucial component of operational coverage. It allows supervisors to identify gaps, present progress and advise corrective actions for vaccination teams. Each evening, this data is used to measure the campaign’s operational coverage.

In one of the houses where the vaccinators entered, the mother mentioned that the child had already been vaccinated. However,  no finger of the child was marked , while the others each had a blue mark on their pinky finger. Taking no chances, the vaccinator took out the vial and gave the child drops and then marked the finger. The tally sheet cannot be marked unless a child has been vaccinated and finger-marked.

Getting past the finish line

Up until April, Pakistan has conducted four polio vaccination campaigns. With the support of 390,000 polio workers, almost 43 million children under-five were vaccinated during a five-day nationwide vaccination campaign. There are multiple campaigns planned for the year ahead, requiring hours of strategic and evidence-based planning led by the national and provincial emergency operations centres.

Leaving nothing to chance during this last 100 meter dash towards eradication, the programme has also started implementing innovative interventions, such as the nomad population mapping and vaccination of high-risk mobile populations, engaging public health students for monitoring campaigns through the Lot Quality Assurance Sampling survey and the co-design initiative that engages women polio workers to develop solutions for improving campaigns and identifying potential livelihood opportunities for them in the future.

For Amina and Salma, the conclusion of the February round meant that children under five had received the vaccine to build strong immunity against the poliovirus. However, the journey to eradication continues. After a short break, the programme will begin working on validating the next set of microplans. All of this work is essential to ensure that the virus really finds no place left to hide and no child left to paralyze.

By Rimsha Qureshi,
Communications Officer, GPEI Hub Amman

Islamabad – As he rode his motorbike out of the relative safety of Bannu city on a September morning, Danyal Sikandri was nervous. It was his first day on a new assignment, and he was riding out into the district outskirts with colleague Yasir Shah in search of a reclusive group of people – nomads.

Their task was to find nomadic settlements and vaccinate the children there against polio and other vaccine-preventable diseases. Sikandri has been involved with the Pakistan Polio Eradication Programme since 2019, first as vaccinator and then area in-charge. Therefore, he was no stranger to interacting with people. But with this assignment, he didn’t know what to expect, since he would be travelling long distances to find people who might not speak the same language, might be unwelcoming or worse, he could end up in an area which may not be secure.

After travelling for about 36 kilometers, the team found a nomadic settlement in Domel. A group of families clustered together in makeshift tents made of plastic sheets and cloth. Sikandri approached the elders and explained why they were there. The nomads, who had come from Afghanistan and were temporarily camped in Domel, warmly welcomed the vaccinators in their midst.

As Sikandri vaccinated 14 children in the camp that day, his nervousness dissipated, and a resolve set in – to bring life-saving vaccines to as many nomadic children as he could.

“When I met them, I saw how different their lifestyle is, since they are constantly on the move and far from health facilities,” says Sikandri. “They want to protect their children from diseases too, so they are happy to see us. They tell us that it is the first time that vaccinators have come to their tents to vaccinate their children.”

Sikandri is one half of a two-member special mobile team which works under Pakistan Polio Programme’s latest initiative to reach segments of the population with polio and essential vaccines, which they would otherwise not have access to. The nomad vaccination initiative was launched in September 2022 in the seven endemic districts of southern Khyber-Pakhtunkhwa (KP) and expanded to four districts of Punjab neighboring these districts in October. The initiative was further expanded to include more districts from Punjab in January and Balochistan in early March. A total of 80 mobile teams in 22 districts have been deployed so far to reach nomadic children.

“With this initiative, we are filling a crucial gap. In the past, we were vaccinating children on the move, in buses, on train stations and other transit points, but the children that were being left out were from nomadic populations. This initiative is a product of extensive research, where we mapped out population movements and based on that information, made mobile vaccination teams to reach nomadic children with polio as well as all essential immunization necessary for their health and safety,” said Dr Zainul Abedin Khan, the National Team Lead for WHO’s Polio Operations in Pakistan.

“This is an excellent initiative of the Government of Pakistan, with support of polio partners, to protect children who had never been vaccinated before. This initiative will keep expanding based on the movement patterns. With this, we hope that population immunity is increased, and poliovirus is interrupted permanently,” he added.

“They want to protect their children from diseases too, so they are happy to see us. They tell us that it is the first time that vaccinators have come to their tents to vaccinate their children.”

Since nomads are highly mobile, the children in these communities are missed during routine vaccination campaigns or even at transit vaccination sites because they may not be passing through formal routes. This means their immunity remains weak, they are vulnerable to disease and can potentially transmit poliovirus as they travel across country and district borders.

In 2022, the program conducted a comprehensive survey of nomadic movement patterns in February and March in 14 districts of KP, Punjab and Balochistan. The survey found that nomadic movement begins in southern KP in September and ends in March, with the nomads setting up temporary camps as they pass through various districts.

“It is difficult for our door-to-door vaccination teams to reach them since a majority of nomads live on district borders or peripheries and it is not even known when they are coming,” said Muhammad Asif Javaid, who leads the program’s High-Risk and Mobile Population Unit (HRMU) and is spearheading this initiative. “They are frequently on the move, staying in places temporarily, never settling, so they miss the opportunity to receive polio and routine immunization.”

In the first phase of implementation, two special mobile teams – consisting of a trained vaccinator and a team assistant – were deployed in each of the seven districts of southern KP and four districts of Punjab. Subsequently, the project was expanded to cover 22 districts of the country.

Union council staff collect data on nomads visiting their areas. This information along with weekly micro-plans and targets are provided to vaccinators, who travel across their assigned UCs to visit these settlements. They provide polio and other essential vaccinations to children in the camps and issue vaccination cards to the families to ensure the data remains on record.

Javaid said that these teams are also helping with surveillance for cases of acute flaccid paralysis (AFP) by asking families and looking for any children who might have AFP, and then ensuring that it is reported to relevant authorities for further testing.

As of March 31, more than 114,600 children under the age of five had received the oral polio vaccine, 71,206 had received the inactivated polio vaccine, while nearly 20,000 routine immunization antigens have been administered to eligible children, under this initiative.

“Currently the program is actively working to vaccinate chronically missed children and is focusing on reaching missed populations rather than prioritizing geography alone,” Dr Zainul Abedin Khan added.

The task is challenging for vaccinators, who travel many kilometers out of urban centers to find nomadic settlements. They might run out of fuel, the settlement might have packed up and left by the time they arrive, or they may encounter hostility, but the vaccinators take it in their stride, happy to be safeguarding children’s futures.

For Sikandri, the experience has been rewarding. He has seen areas of his native district now that he had never seen before, and he feels his communication skills have improved since he began working on this project.

“We have received a lot of love from these people. When we vaccinate their children, they are thankful and pray for us. It feels good that people like them and their children are also being taken care of,” said Sikandri.

By Suzanna Masih,
Communications Officer, WHO Pakistan (Video by NEOC)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Zehra Abid,
Communications Officer, WHO Pakistan

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

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

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

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

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

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

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