Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO
Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO

Contracting the infectious virus at 11 months of age, few believed Soni would ever be able to work. Today, she’s a nominee for one of Pakistan’s most prestigious awards.

Soni started out in the programme in 1999, initially as a vaccinator. Now a mother of three children, these days, Soni works with the programme as a social mobilizer. Her role includes dispelling people’s misconceptions about the vaccine and engaging with parents about the importance of vaccinating their children.

When Soni received a notification from the Government of Pakistan that she had been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work, she didn’t quite know how she felt. “I’m not really interested in accolades, but my son and my husband were very excited” she said.

Soni says her work with the polio eradication programme has given her life meaning and purpose. “People would look at my leg and say, ‘How will she work?! She can’t work. But when I started working, then everyone could see, ‘yes, yes she can’,” she says.

“The polio programme has given me so much confidence. After I started working in polio, I had the confidence of meeting new people. Meeting family, going to weddings, all of it became easier. Before that, I had no confidence to even step out of the house,” she continues.

Soni recalls how hesitant her father was when she first told him she wanted to join the programme. “He was concerned I won’t be able to manage because of my health, but he understood very soon that this was something I just had to do. He told my mother ‘let her do it’.”

During her early training as a vaccinator, Soni recalls the words of one of her trainers – ‘If you can save one child from polio, then you would have served the purpose of your life’. “I knew, then, this was it, “she says. “This is what I had to do.”

The year Soni was diagnosed with polio – 1984 – nearly 200 other children in her neighbourhood of Liaquatabad in Karachi were also diagnosed with the virus. At the time, there were no door-to-door campaigns and children could only be vaccinated at health centres.

Today, Pakistan and Afghanistan are the last two countries in the world where wild poliovirus is endemic. In 2021, only one child was paralyzed by the virus in Pakistan and four in neighbouring Afghanistan. In 2020, a total of 84 cases were reported in Pakistan and 56 in Afghanistan.

The eldest of six siblings, Soni came from a very conservative family, where her grandmother would not let children leave the house. “In our family, all the children were born at home because the women were not allowed to leave the house, and so I was never taken to a health centre for vaccination.”

“My father always lived with the regret of not vaccinating his daughter,” she says. “Often parents make these decisions, and it is the child who has to suffer for all their life.”

Both Soni’s parents tried everything they could to heal her condition – visiting different doctors, acupuncture specialists, and anyone they could find who might offer any assurances. She also went through a very extensive operation, with steel bolts put in her leg resulting in excruciating pain that lasted for months.

“No matter what you do, whatever you try, there is no cure for polio,” she says. “I wanted to study sciences, and my teacher didn’t allow me to because she would say how will you stand in labs all day. I would go to college and one of the women in the bus would see me and say ‘Look at her, such a beautiful girl and look at what happened to her foot’.”

Soni says that when she is working on campaigns and some people see her, they immediately want to vaccinate their children, while others question why she is telling them to vaccinate while having polio herself.

“To them I say, I am here because I know exactly how hard it is if you are not vaccinated.”

In December:

  • No case of WPV1 was confirmed
  • 43.5 million children were vaccinated during the December NID.
  • 0.9 million children were vaccinated at 73 Permanent Transit Points

Downloads

In November:

  • No case of WPV1 was confirmed
  • 35 million children were vaccinated during the MR Campaign in November 2021.
  • 1 million children were vaccinated at 73 Permanent Transit Points

Downloads

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

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

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

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

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

Containment area monitoring in India. ©WHO

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

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

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

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

WHO Regional Director, Dr Ahmed Al-Mandhari, observes polio vaccination in Karachi. ©WHO EMRO

In November, George Laryea-Adjei (Regional Director for South Asia, UNICEF) and Dr Ahmed Al-Mandhari ( WHO Regional Director for the Eastern Mediterranean ) joined fellow GPEI leaders on a visit to Pakistan. The regional directors met with government stakeholders and health workers, and commended Pakistan on its impressive progress interrupting poliovirus transmission. See why the regional directors emphasized that there is no room for complacency on the path to a polio-free Pakistan.  For more information please visit WHO Regional Office for the Eastern Mediterranean and UNICEF websites.

 

In October:

  • No case of WPV1 was confirmed
  • 3.53 million children were vaccinated during October 2021 in KP outbreak response.
  • 0.6 million children were vaccinated at 73 Permanent Transit Points

Downloads

 

In September:

  • No case of WPV1 was confirmed
  • 41.5 million children were vaccinated during NIDs.
  • 0.8 million children were vaccinated at 72 Permanent Transit Points

Downloads

 

In August:

  • No case of WPV1 was confirmed
  • 23.4 million children were vaccinated during sNIDs.
  • 1 million children were vaccinated at 121 Permanent Transit Points

Downloads

The Health Ministers of the G20 countries, meeting in Rome, Italy, on 5-6 September 2021, recommitted to helping secure a lasting polio-free world once and for all.  In their official communiqué, the Health Ministers said:  “We re-affirm our commitment to eradicate polio… We note the critical role that adaptable surveillance capacity, like that found in the Global Polio Eradication Initiative, has in the ability to reach vulnerable communities to prevent and respond to pandemics.”

The importance to eradicate polio, and the GPEI’s unique value in supporting COVID-19 response efforts, had previously been underscored by other global fora, including at the recent WHO Regional Committee for Africa, the G7 Heads of State meeting, the G7 health ministers meeting and the World Health Assembly.

An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated.  Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized.

The GPEI also recognizes the critical role of women in the delivery of health services and has committed to ensuring their empowered engagement in polio eradication efforts in order to reach every last child.

©WHO Afghanistan/RaMin Afshar

25 August 2021 – “Poliovirus circulation does not stop during conflicts, it does not stop during emergencies. If anything, it makes children and families even more vulnerable by adding a layer of risk”, says a Polio Provincial Officer from Balkh province.

Despite risks and challenges due to the recent insecurity, the polio programme is staying and delivering for the children of Afghanistan. Our 315 staff and more than 70,000 polio health workers across the country remain firm in their resolve to eradicate polio. Their work ensures that critical polio activities continue while adapting to the rapidly changing situation and carry on even when hostility levels are high.

In 2021, one wild poliovirus type 1 (WPV1) and 43 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases have been confirmed in Afghanistan. All cases have been reported in areas of the country that have for years been inaccessible for door-to-door vaccination campaigns, which left at least 3 million children repeatedly deprived of polio vaccination. Population displacement brought about by the current situation could further impact the programme’s access to children and increase immunity gaps against polio, triggering a rise in transmission. It is also feared that the mixing and movement of unvaccinated populations due to the upheaval faced by thousands of Afghans may spur polio transmission.

“We are working with all actors, to ensure there are no delays or disruptions to polio vaccination campaigns and overall routine immunization. Gains of the past twenty years cannot be lost. Children need immunization now, they must not bear the brunt of conflict and instability. We are calling for unimpeded access to all children,” says Dr. Dapeng Luo, WHO Representative in Afghanistan.

Pre-planning and resilience measures

While the current situation is a challenge, it is by no means the first the polio programme has faced. Using its wealth of knowledge from many years of operating in complex environments, the programme has invested in robust, pre-emptive contingency planning to be able to adapt and continue delivering. Regular monitoring of the security situation has allowed for nimble decision making.

The programme has moved swiftly to ensure safety and security of its staff. Its international staff footprint has been significantly reduced and vulnerable national staff and their dependants have been temporarily relocated to Kabul. Flexible working arrangements and salary advances have been provided to cover urgent needs of staff and polio health workers, who are the backbone of polio operations.

Around eighty percent of polio staff remain at their field locations and working to maintain essential polio services, supported remotely by colleagues who have needed to relocate.

“I am filled with pride for my team and their strong resolve, courage and passion. They are the heroes children of Afghanistan need right now. Thanks to their efforts, Acute Flaccid Paralysis (AFP) and environmental surveillance never stopped.  Except for a few locations that experienced temporary disruptions last week, stool sample collection, visits to active health facilities, case investigation, the shipment of samples to Pakistan for laboratory testing, and the collection and transport of sewage samples for polio environmental surveillance remain unaffected. COVID-19 surveillance, which the polio programme has been supporting since last year, has also continued,” says Irfan Elahi Akbar, Polio Team Leader, WHO Afghanistan.

©WHO EMRO

Vaccination continues

Polio vaccinations are continuing through permanent transit teams in most regions and at cross-border sites, including Friendship Gate (between Afghanistan and Pakistan).

After a brief pause, the National Emergency Operation Center is back up-and-running and undertaking planning needed to implement future campaigns. Discussions are ongoing with local authorities to safeguard the resumption of critical immunization activities across the country. The programme remains optimistic that polio vaccination campaigns planned for later this year can go ahead, however, is maintaining a flexible approach.

“The safety and security of staff and polio health workers is our top priority. Their commitment to ending polio is nothing short of inspirational. I stand ready to support their critical work in any way I can. I say this with absolute conviction: We will achieve a polio-free world,” said Dr. Hamid Jafari, Director of Polio Eradication, WHO Eastern Mediterranean Region.

See link to story on WHO EMRO’s website.

The Global Polio Eradication Initiative (GPEI) is closely monitoring developments in Afghanistan. GPEI partners and staff are currently assessing immediate disruptions to polio eradication efforts and the delivery of other essential health services, to ensure continuity of surveillance and immunization activities while prioritizing the safety and security of staff and frontline health workers in the country.

The polio programme in Afghanistan has operated for many years amid insecurity and conflict, and will continue working with all actors, agencies and organizations who enable delivery of immunization as well as deliver humanitarian assistance to populations in need across the country. The GPEI remains steadfastly committed to protecting all children from polio and supporting the provision of other essential immunizations and health services.

We strongly believe that the delivery of health care – including polio vaccination – is essential to prevent diseases and safeguard communities. Together with our partners, the people of Afghanistan, national and provincial authorities, we will do everything in our power to continue this critical work.

The Global Polio Eradication Initiative (GPEI) was deeply saddened by the UK parliament’s decision to support significant cuts to international aid, which will continue for at least five years. The cuts include a proposed 95% reduction in the contributions made to the GPEI by the UK for 2021. It is not clear whether this percentage reduction will apply in subsequent years but given the lower overall available funding, the GPEI will have to plan for significant funding cuts in the future.    

The UK pledged at the 2019 Reaching the Last Mile Conference in Abu Dhabi to help vaccinate more than 400 million children a year against polio. The GPEI already began incorporating those funds into its plans for global activities, and the process of implementing changes during the 2020-21 financial year will be deeply disruptive to the GPEI’s programmatic planning. The COVID-19 pandemic has left more children vulnerable to vaccine-preventable diseases such as polio and the impact of the cuts – now approved by parliament – will be profound.

The polio programme’s importance to global health security cannot be overstated. During the pandemic, the GPEI’s resources and expertise have been deployed extensively to assist the COVID-19 response. The unique value of the polio infrastructure was recently highlighted during the G7 meeting that took place in the UK when world leaders called for a global pandemic radar built on the existing surveillance networks of the polio and influenza programme.

That we are so close to a polio-free world is thanks in large part to longstanding UK leadership and investment. The GPEI looks forward to working with the UK and its other longstanding partners to protect progress and address the urgent issues that will arise from this shortfall in funding, and ultimately secure a world free of polio.

The funding will be used to vaccinate approximately 16 million children in 84 highest-risk districts. © UAE

The United Arab Emirates (UAE) on July 24 announced an additional US$9.5 million support to the Pakistan Polio Eradication Initiative (PEI). The funding will be used to vaccinate approximately 16 million children during door-to-door immunization campaigns in 84 highest-risk districts as well as an additional US$376,000 to provide personal protective equipment against COVID-19 for the frontline campaign workers.

The funding, which will be utilized from July to December, brings to more than US$23 million made available by the UAE in 2021. The Emirates, a long-time supporter of Pakistan’s polio programme and its main funder, has provided over US$200 million in financial support since 2014. Pakistan is one of two countries where wild poliovirus remains endemic.

Speaking on behalf of the Global Polio Eradication Initiative, Dr Palitha Mahipala, the World Health Organization Representative in Pakistan, thanked the UAE for its generous contribution, noting the UAE’s steadfast commitment not only to protecting children from lifelong paralysis but to the overall goal of polio eradication.

“The UAE has firmly stood by the polio programme with vital yearly contributions and in pleas for extra funding to address unforeseen challenges such as COVID-19,” he said. “This would not be possible without their support.”

Only one case of wild poliovirus has been reported in Pakistan in the first six months of the year, a significant decrease from the 59 cases reported during the same period in 2020. In order to be certified polio-free, Pakistan is required to report zero cases of wild poliovirus over a three-year period. The Government of Pakistan remains fully committed to reaching the goal of zero in the coming months.

The Emirates Polio Campaign plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. © UAE

Through the Emirates Polio Campaign initiative, the UAE Pakistan Assistance Programme (UAE-PAP) plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. In 2020, as part of the Emirates Polio Campaign, UAE-PAP support ensured close to 16 million children under five years of age received protection through repeated polio campaigns and all frontline workers in 84 districts received personal protective equipment and training to facilitate protection from COVID-19.

“The efforts and sacrifices of the field vaccination teams, who faced difficult field conditions and dangerous challenges, greatly contribute to the success of the campaigns and reducing the spread of poliovirus in the Islamic Republic of Pakistan,” said Mr. Abdullah Alghfeli, Director of the UAE-PAP.

Mr. Abdullah praised the humanitarian approach and the generous support of His Highness Sheikh Mohamed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, adding that His Highness’s humanitarian initiative to eradicate polio is a major factor contributing to the elimination of the disease.

Dr Shahzad Baig, National Coordinator of the National Emergency Operations Centre (NEOC) for polio eradication warmly welcomed the contribution as an important boost in ensuring the programme continued door-to-door polio campaigns, the most effective way of immunizing against the virus, and ending polio in Pakistan.

“We are getting closer to our goal but this is not the time to be complacent,” he warned. “We are re-doubling our efforts to ensure the gains of the past don’t slip away.”

Zubaida Bibi leads a team in Khyber Pakhtunkhwa province in the country’s north. © WHO/EMRO

Health interventions and immunization activities are most effective when delivered by women.  During each nationwide polio vaccination campaign in Pakistan, women make up around 62 percent of the 280, 000+ frontline workforce vaccinating millions of children across the country.

With each campaign depending on the dedication of staff to reach all children, given their trusted roles and responsibilities in communities, female polio frontline workers are playing a key role in eradicating polio.

Breaking barriers to immunization

After three years as a monitor of campaign activities, Zubaida Bibi has progressed from being a polio team member to a team leader in Khyber Pakhtunkhwa province in the country’s north, one of the most affected areas in Pakistan.

Breaking the gender-related barriers to immunization, Zubaida travels extensively including hard-to-reach areas. Not even the winter season, when the roads and tracks are covered with snow, deters Zubaida.

“I would always tell them that the polio vaccine is totally safe for their children,” says Shumaila Majeed at work in Lahore. © Hassan Raza

“It leaves us with no option but to travel for miles and hours on foot to reach the children,” she says “Despite the challenges, I always try and motivate my teams, telling them that we are on a national mission to save the future of our children,” she says.

“It gives me a feeling of gratitude and satisfaction when the community appreciates our efforts for improving the health of their children,” adds Zubaida.

Building trust

For nine years, Shumaila Majeed has worked as a community-based health worker in Lahore, with a firm belief in empowering women and supporting their important presence in the polio programme.

Mothers would frequently ask her about the safety of the polio vaccine. “I would always tell them that the polio vaccine is totally safe for their children and build their trust,” says Shumaila.

“It’s very important to have women in every walk of life,” she explains. “Not only because women and grandmothers feel more comfortable when their children are vaccinated but to give more opportunities for woman to grow and excel.”

Through her work Shumaila wants to give young girls a message: stay focused on their goals and leave no stone unturned to make their dreams come true.

Persuading parents

In Pakistan, a significant number of parents and caregivers still doubt the effectiveness of vaccines. Karachi has long been a core reservoir for the poliovirus, with continuous and intense circulation.

Shagufta Naz, a community-based health worker in charge of Gulshan town, has been working for 21 years to ensure all children in her area are vaccinated on time. “Initially, parents used to hide their children from us due to their fear,” she explains.

Shagufta Naz is a trusted source of information about polio for her community in Karachi. © WHO/EMRO

Everyone who works with Shagufta is immediately impressed by her great care, her attention to detail and her meticulous record-keeping which is key to achieving vaccination targets. As a result of Shagufta’s hard work, vaccine refusals have reduced significantly. Her work is now so highly regarded that some parents will only have their children vaccinated by Shagufta, asking for her by name with each polio campaign.

“I got to know the community very well, built their trust,” she explains. “I know every pregnant woman and can tell you when she is due. Now, mothers regularly ask me about the next vaccination campaign.”

Going against all odds

Gul Parana, a Tehsil Communication Officer for the polio eradication programme in Balochistan province in the country’s southwest, recently graduated with a master’s degree.

Assigned to raise awareness about the benefits of vaccination in Chaman District, one of the most challenging areas for the polio programme, she is proud of her work despite many challenges.

Gul Parana raises awareness about the benefits of vaccination in remote Chaman District in Balochistan province. © WHO/EMRO

“Since Chaman is a very remote and conservative area, it’s not easy for a young girl like me to go out of the house. Most of my friends are not allowed to work. But I have a mission to save our children and give them a healthy future,” she says.

With support of her family, Gul Parana has become a symbol of strength for the girls of her locality. “I want to inspire other girls so they can also get an education and work. We need to have equal opportunities for every girl in Balochistan,” she adds.

In April:

  • No case of WPV1 was confirmed
  • 2,500,000 children were vaccinated during the April National Immunization Days (NIDs) in Balochistan
  • 800,000 children were vaccinated 126 Permanent Transit Points

Download

A vaccinator marking a vaccinated child during the March 2021 NIDs in Punjab district, Pakistan. © WHO/EMRO

The health ministers of the G7 countries reaffirmed their commitment to polio eradication, at their annual meeting held in Oxford, UK and virtually, on 3-4 June 2021.  As part of their official communique, the health ministers affirmed:  “We need to continue supporting the Global Polio Eradication Initiative, whose surveillance capacity and ability to reach vulnerable communities are critical in many countries to prevent and respond to pandemics.”

The statement was welcomed by the Global Polio Eradication Initiative (GPEI) core partners, which comes ahead of the launch of the new GPEI Strategy 2022-2026, developed in close collaboration with partners, countries and donors, and which lays out the roadmap to achieving and sustaining a world free of all polioviruses.  At the same time, the new plan will ensure that the benefits of the polio eradication infrastructure will be able to continue to benefit broader public health efforts long after the disease is gone.  In 2020 and 2021, for example, the GPEI infrastructure continues to provide crucial support to the COVID-19 pandemic response, and will continue to do so, as global response continues to accelerate vaccine roll-out efforts.  The G7 has recognized that the GPEI has one of the most effective disease surveillance and response networks in the world at a time when the COVID-19 pandemic continues its devastation. It has the ability to respond to not only polio but also other disease outbreaks, contributing to larger global health systems and security.

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

 

GENEVA, 10 June 2021 – Today, the Global Polio Eradication Initiative (GPEI) will launch the Polio Eradication Strategy 2022-2026: Delivering on a Promise at a virtual event, to overcome the remaining challenges to ending polio, including setbacks caused by COVID-19. While polio cases have fallen 99.9% since 1988, polio remains a Public Health Emergency of International Concern (PHEIC) and persistent barriers to reaching every child with polio vaccines and the pandemic have contributed to an increase in polio cases. Last year, 1226 cases of all forms of polio were recorded compared to 138 in 2018.

In 2020, the GPEI paused polio door-to-door campaigns for four months to protect communities from the spread of COVID-19 and contributed up to 30,000 programme staff and over $100 million in polio resources to support pandemic response in almost 50 countries.

Leaders from the two countries yet to interrupt wild polio transmission—Pakistan and Afghanistan—called for renewed global solidarity and the continued resources necessary to eradicate this vaccine-preventable disease. They committed to strengthening their partnership with GPEI to improve vaccination campaigns and engagement with communities at high risk of polio.

Dr Faisal Sultan, Special Assistant to the Prime Minister of Pakistan on Health, said, “We are already hard at work with our GPEI partners to address the final barriers to ending polio in Pakistan, particularly through strengthening vaccination campaigns and our engagement with high-risk communities. Eradication remains a top health priority and Pakistan is committed to fully implementing the new GPEI strategy. We look forward to working with international partners to achieve a polio-free world.”

The 2022-2026 Strategy underscores the urgency of getting eradication efforts back on track and offers a comprehensive set of actions that will position the GPEI to achieve a polio-free world. These actions, many of which are underway in 2021, include:

  • further integrating polio activities with essential health services—including routine immunization—and building closer partnerships with high-risk communities to co-design immunization events and better meet their health needs, particularly in Pakistan and Afghanistan;
  • applying a gender equality lens to the implementation of programme activities, recognizing the importance of female workers to build community trust and improve vaccine acceptance;
  • strengthening advocacy to urge greater accountability and ownership of the program at all levels, including enhanced performance measurement and engagement with new partners, such as the new Eastern Mediterranean Regional Subcommittee on Polio Eradication and Outbreaks; and,
  • implementing innovative new tools, such as digital payments to frontline health workers, to further improve the impact and efficiency of polio campaigns.

“With this new Strategy, the GPEI has clearly outlined how to overcome the final barriers to securing a polio-free world and improve the health and wellbeing of communities for generations to come,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and member of the Polio Oversight Board. “But to succeed, we urgently need renewed political and financial commitments from governments and donors. Polio eradication is at a pivotal moment. It is important we capitalise on the momentum of the new Strategy and make history together by ending this disease.”

Dr Wahid Majrooh, Acting Minister of Public Health for Afghanistan, said, “Afghanistan is fully committed to implementing the new GPEI strategic plan and eradicating polio from its borders. Together we have come so far. Let us take this final step together and make the dream of a polio-free world a reality.”

In addition to eradicating wild polio, GPEI will strengthen efforts to stop outbreaks of circulating vaccine-derived poliovirus (cVDPV) that continue to spread in under-immunized communities across Africa and Asia. This includes deploying proven tactics used against wild polio, improving outbreak response and streamlining management through the launch of new global and regional rapid response teams and broadening the use of a promising new tool – novel oral polio vaccine type 2 (nOPV2) – to combat type 2 cVDPVs, the most prominent variant.

H.E. Félix Tshisekedi, President of the Democratic Republic of the Congo, said “As Chair of the African Union, I call on every government to increase their commitment to protecting the gains of our monumental efforts and finishing the job against polio in Africa. Only then, we will be able to say we delivered on our promise of a safer, healthier future for all our children.”

Select countries began using nOPV2 in March of this year after WHO issued an Emergency Use Listing recommendation for the vaccine last November. Clinical trials have shown that nOPV2 is safe and effective against type 2 polio, while having the potential to stop cVDPV2 outbreaks in a more sustainable way compared to the existing type 2 oral polio vaccine.

In addition to supporting the COVID-19 response, polio assets and infrastructure have historically helped tackle the emergence of health crises in several countries around the world, including the Ebola outbreak in Nigeria in 2014. Without the support needed for the new GPEI Strategy, there is a risk not only that polio could resurge, but also that countries will be more vulnerable to future health threats.

Additional quotes:

Henrietta Fore, Executive Director, UNICEF: We will not allow the fight against one deadly disease to cause us to lose ground in the fight against polio and other childhood diseases. Renewed government and donor support will enable us to reach and immunize over 400 million children against polio every year and ensure that no family has to live with the fear of their child being paralyzed by this deadly disease ever again.”

Rochelle P. Walensky, MD, MPH, Director, CDC: “As the GPEI’s support for the COVID-19 response shows, polio infrastructure is vital to helping countries tackle emerging health threats. The U.S. CDC is committed to achieving polio eradication and delivering, through the GPEI’s new strategy, on the promise we made to protect the world’s children. To improve health equity, we must ensure that polio assets are secured and that countries are increasing their immunization coverage through integrated service delivery and demand for vaccines.”

Seth Berkley, CEO, Gavi, the Vaccine Alliance: “Polio eradication is possible and essential. Through the increased integration of polio activities with essential immunization and health services, including our joint work to extend the health system to reach “zero-dose” children and missed communities with all routine vaccines, we believe that we can better meet the needs of high-risk communities and secure a polio-free world together.”

Mike McGovern, Chair, Rotary’s International PolioPlus Committee: “More than 19 million people are walking today who would have otherwise been paralysed by polio, thanks to the incredible progress we’ve made in protecting children with polio vaccines since 1988. When Rotary helped found the GPEI, we made a commitment to ensure that no child or family should live in fear of polio ever again. We are committed to delivering on this promise and urge governments and donors to help us achieve a polio-free world.”

Chris Elias, President, Global Development, Bill & Melinda Gates Foundation: “After setbacks in recent years, and indications that some donors may reduce funding to the GPEI, there has never been a more important moment than right now in the history of polio eradication. With adequate support for the new strategy, we can secure a world where no child will be paralyzed by polio ever again and we urge all donors to stay committed and consign this disease to history.”

Media contacts:

Oliver Rosenbauer
Communications Officer, World Health Organization
Email: rosenbauero@who.int
Tel: +41 79 500 6536

Ben Winkel,
Communications Manager, Global Health Strategies
Email: bwinkel@globalhealthstrategies.com
Tel: +1 323 382 2290

Note for editors:

The Global Polio Eradication Initiative is a public-private partnership led by national governments with six core partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Watch launch the event.

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

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

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

One of the greatest public health achievements of our time.

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

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

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

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

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

Responding to the pandemic and laying a foundation for the future

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

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

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

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

© WHO/EMRO

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

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

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

Reposted from who.int.

In March:

  • No case of WPV1 was confirmed
  • 37.7 children under the age of five were vaccinated during the March National Immunisation Days (NIDs)

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