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.
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.
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.
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.”
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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.
Meeting virtually this week at the 74th World Health Assembly (WHA), global health leaders and ministers of health noted the new Global Polio Eradication Initiative Strategic Plan 2022-2026 and highlighted the importance of collective action to achieve success.
Member States emphasised the urgency of implementation of the strategic plan and urged the WHO Secretariat and Member States to build on recent advances to keep surveillance high, ensure sustained, improved coverage in campaigns and respond rapidly to outbreaks. Several Members States welcomed the establishment of a new EMRO Ministerial Regional Subcommittee on Polio Eradication and Outbreaks, and roll-out of the novel oral polio vaccine type 2 (nOPV2) to more effectively and sustainably address outbreaks of circulating vaccine-derived polioviruses (cVDPVs). The Minister of Health of Egypt, Dr Hala Zaid, as a Co-Chair of the Regional Sub-Committee said: “The Regional Subcommittee offers a new, ministerial-level channel to galvanize political support, leverage funding, particularly domestic funding, and raise the profile of polio as a Public Health Emergency of International Concern. Its establishment reflects the firm commitment of the Eastern Mediterranean Region to do whatever it takes to stamp out poliovirus transmission and achieve eradication.”
Dr Ahmed Al-Mandhari, the Regional Director for the Eastern Mediterranean, addressed the delegates and noted a year of hard work across the Region. He emphasised the critical step of establishing the ministerial Sub-Committee to ensure more coordinated support for the remaining wild poliovirus-endemic and polio outbreak-affected countries in the Region. Speaking of the new vaccine, Dr Al-Mandhari said, “We are also at the dawn of what we hope will be a new era in responding to VDPV type-2 outbreaks, with an improved vaccine, the novel oral poliovirus type 2, approved for Emergency Use Listing and soon to be used in the Region.”
Member States noted support for local community, progress on closing outbreaks and welcomed efforts to unite with other initiatives to close gaps in immunization. The WHA paid tribute to female frontline workers and highlighted their role in building community relationships. Amid the new COVID-19 reality, the WHA also expressed deep appreciation for the GPEI’s ongoing support to COVID-19 response. WHO’s Deputy Director-General, Dr Zsuzsanna Jakab, highlighted the value of the polio infrastructure in addressing public health emergences, noting that the polio network has been the first in line of defence for COVID-19 response in many countries, and now providing valuable support to the rollout of Covid-19 vaccines. “It is our chance to retain the polio knowledge and expertise to build back stronger and more robust health systems. If we don’t act now, we will lose this enormous opportunity,” said Dr Jakab.
The Regional Director for the African Region, Dr Matshidiso Moeti, thanked African countries and partners for rapidly restarting and innovating to deliver polio activities after a pause during the COVID-19 pandemic, especially following the successful certification of eradication of wild polioviruses last year in the region. Integrating polio functions into other programmes will be critical to maximising the gains against this disease, she said, and to leveraging the wealth of expertise and experience that has been built.
Rotary International welcomed the new strategy and its priority on integration and extended collaboration with partners, as well as its focus on gender equality. Gavi, the Vaccine Alliance, highlighted the new strategy’s alignment with the Immunization Agenda 2030 and Gavi’s new 5-year strategy, and shared importance of reaching 0-dose children and missed communities with comprehensive and equitable immunization services.
Aidan O’Leary, WHO Director for Polio Eradication, addressed delegates, saying: “Wild poliovirus transmission is restricted to Afghanistan and Pakistan, and while we have seen a sharp decrease in incidence this year, this is no time for complacency. Gaining and sustaining access to all children in Afghanistan and increasing coverage of missed children in core reservoir areas of Pakistan remain the key challenges, and we must all work together to overcome these to achieve and sustain zero cases. At the same time, we must continue to respond to cVDPV2s. The solutions focus not just on the new nOPV2, but also more timely detection, more timely and higher quality outbreak response and strengthening essential immunization services in zero-dose communities and children, aligned with the IA2030 agenda. The new strategy addresses the broader needs of communities through expanded integration and partnership efforts along six distinct workstreams. Implementation will be strengthened through a more systematic approach to performance, risk management and accountability at all levels.”
The new strategy – Delivering on a Promise – will be officially launched at a virtual event on 10 June 2021. Details about the event are available here.
The Global Polio Eradication Initiative (GPEI) is greatly concerned by the United Kingdom’s proposed cuts to contributions toward polio eradication in 2021. The proposed 95% reduction will result in an enormous setback to the eradication effort at a critical moment.
The UK has a long legacy as a leader in global health and its leadership in polio eradication, including financial contributions to the GPEI, have driven wild poliovirus out of all but two countries in the world. The GPEI values the UK government’s steadfast partnership and shared commitment to eradicating polio, and UK citizens have generously championed the drive to end polio. This has helped bring the world to the cusp of being polio-free, whilst providing an investment in broader public health capacity.
In 2019, the UK government pledged to help vaccinate more than 400 million children a year against polio and to support 20 million health workers and volunteers in this vital work. In addition to their life-saving work to end polio, these health workers have been in the frontline of the fight against COVID-19 and have helped some of the world’s most vulnerable countries protect their citizens. The UK’s ongoing support is needed to ensure that the polio infrastructure can continue supporting COVID-19 response efforts, while also resuming lifesaving immunization services against other deadly childhood diseases. In 2020, the UK government’s contributions ensured that the GPEI could continue to support outbreak response in 25 countries and conduct surveillance in nearly 50, all whilst strengthening health systems. The continuation of such support will not be possible unless replacement funds are identified, and as such, this funding cut will have a potentially devastating impact on the polio eradication program.
The GPEI recognises the challenging economic circumstances faced by the UK government and a host of other countries. Governments worldwide are making critical investments in the health of their citizens, as well as evaluating global commitments. Cutting the UK government’s contributions by 95% will, however, put millions of children at increased risk of diseases such as polio and will weaken the ability of countries to detect and respond to outbreaks of polio and other infectious diseases, including COVID-19. Furthermore, it risks delaying polio eradication and the dismantling of one of the most effective disease surveillance and response networks at a time when the COVID-19 pandemic continues its devastation.
GPEI looks forward to working with the UK and the broader global community to address these urgent issues, which jeopardize the collective investment and progress toward a polio free world. Together we can end polio forever and ensure that polio infrastructure and its assets continue to strengthen preparedness and response and save lives.
In his English writing class, Mujahid Miran was asked to write an essay titled the “Aim of life”. This was a space for the students to imagine who they could be and what they saw themselves as when they grew up.
Miran wanted to be a captain in the army and he eagerly shared this ‘aim of life’ in his essay. After his hopes made it to the page, his teacher immediately shot it down: There was no way he would make it, she told him, because he had polio.
Born in 1985, Miran grew up in Kohat and contracted polio when he was two. This was a year before the Global Polio Eradication Initiative was founded in 1988, leading to a worldwide vaccination campaign to fight the spread of the disease. In the decade of the ’80s, the estimated number of cases was over 350 000 per year, while the disease was still prevalent in 125 countries. With focused efforts around the world to eradicate the poliovirus, the number of paralytic cases was reduced by 99.99% with 42 cases in 2016.
For Miran, school was among the most challenging periods of his life. “School life was generally very hard. It must be easier for polio survivors to study in special schools, but in a usual school, I was always referred to as langra, mazoor (derogatory words in Urdu for people with disabilities). I was always made to feel different.”
The challenges were frequent, never letting him forget that he couldn’t walk from one leg. “Among the things that would hurt a lot was sports class or recess. “Every time kids would be chosen for a sports activity, I was completely sidelined – as if I wasn’t even there.” he says.
Academically, Miran always performed well in class and would usually be among the top three students. I always had among the best grades, but I would never be nominated to be the class monitor or get a position as part of the student council, he says. “Every week I’d go to my teacher and ask her why I was never nominated because other students who would be poorer than me academically would be chosen instead. A part of me knew even back then that it was my disability, but now looking back, I know it was exactly that.”
After having lived with polio for 33 years now, Miran is now based in Karachi and is part of a small seafood export business. He buys seafood from factories in Pakistan to sell in southeast Asia and makes an income for the commission he makes per sale.
Miran is able to independently support his family of his wife and two children, aged six and two, but the everyday realities of living with polio make the smallest of tasks harder.
“There is such little awareness in Pakistan, and it’s even within government institutions. I had to get my special driver’s license and when I went to get it made, the officer on duty asked me to raise my shalwar in front of a group of people and stand on one foot to prove I had a disability, he adds. “The humiliation is too much.”
This virus has also been an obstacle in maintaining friendships, as most places for leisure in Pakistan have no access for people with disabilities. “Plus, there is also so much shame in it. I was in Dubai once and I was walking with a friend who turned around to me and said that the way I was walking was embarrassing for him. This virus impacts your life in every way.”
Last year, Africa was declared wild polio-free after Nigeria, the last remaining country in the region that had polio and accounted for more than half of all global cases less than a decade ago, had no cases of wild poliovirus for the fourth year running.
Today, Pakistan and Afghanistan are the only two endemic countries in the world and global efforts continue to vaccine children in this epidemiological block, and finally make the dream of a polio-free world possible.
Miran says this interview is his personal effort to spread awareness on polio. “I talk to everyone in my friends and family circle who have young children. I give them my example and tell them they can’t afford to miss out on vaccination. I am very regular with my children’s vaccination too. Whenever polio teams come to our house, I make sure the children take polio drops.”
At many times in the interview, Miran mentions how the physical pain caused by the disease is often unbearable. “I almost never express how much pain I feel because people will think I’m asking them for financial help or wanting their sympathy. But I just want everyone to know that living with polio is hard. Very, very hard.”
The new Regional Subcommittee brings together ministers of health from Member States across the Eastern Mediterranean Region to tackle some of the persistent high-level challenges to polio eradication. Those include raising the visibility of polio eradication as a regional public health emergency and priority and mustering the political support and domestic financial support needed to finish the job.
During the inaugural meeting convened by the Regional Director, Dr Ahmed Al-Mandhari, two co-chairs were elected to drive the regional push: Egypt’s Minister of Health and Population, H.E Dr Hala Zayed, and the Minister of Health and Prevention of the United Arab Emirates, H.E. Abdul Rahman Mohammed Al Oweis.
H.E. Abdul Rahman Mohammed Al Oweis was represented at the meeting by Dr Hussain Al Rand, the Assistant Undersecretary for Health Centres and Clinics and Public Health, United Arab Emirates. Both Member States flagged the urgency of the state of polio transmission in the last polio-endemic region at present, but also the opportunity to leverage greater regional coordination to achieve eradication.
Polio eradicators around the world know that ours is, in many ways, a grassroots programme: we use microplans to work through neighbourhoods door to door, household to household. But big-picture solidarity is needed to maximize the success of our ground-level efforts.
Wild poliovirus transmission has spread beyond core reservoirs of polio endemic Afghanistan and Pakistan, infecting 140 children in 2020. Outbreaks of circulating vaccine-derived poliovirus type 1 (cVDPV1) paralysed 29 children in Yemen. Type 2 outbreaks spread across the Region in 2020, paralysing 308 children in Afghanistan, 135 in Pakistan, 58 in Sudan and 14 in Somalia. At a time like this, moving forward as a region and as blocs, rather than on a country-by-country basis, is critical.
One of the issues identified by Member States as critical to stopping transmission is the movement of people across borders, and ensuring that surveillance and vaccination efforts target the increasing number of people who regularly cross borders across the region – whether they are moving as a consequence of conflict, environmental crises or economic necessity.
Interventions were made by Afghanistan, Egypt, the Islamic Republic of Iran, Iraq, Oman, Pakistan, Saudi Arabia and the United Arab Emirates. All statements reaffirmed strong support for the establishment of the subcommittee under the Regional Committee Resolution on polio eradication adopted in 2020.
Members of the subcommittee were unanimous in their commitment to engage in coordinated action and support of regional polio eradication efforts in four strategic areas. These include raising the visibility of the polio emergency in the Region, pushing for collective public health action, strengthening efforts to transition polio assets and infrastructure and advocating for the mobilization of national and international funding to achieve and sustain polio eradication.
A theme that ran through all Member States’ interventions was the idea of maximizing the resources already in place – including the workers, the polio and EPI infrastructure a across the region, and the array of community leadership groups with which the polio programme has worked in past.
“Last year or the year before the year before there was a meeting in Muscat with religious leaders from different countries, and I think we need to capitalize on their support. We need to give them ownership,” said Dr Ahmed Al Saidi, Minister of Health, Oman.
The COVID-19 pandemic has had an outsized impact on polio programmes across the region. The four-month pause in vaccination, from March-July 2020, gave the virus a window to spread almost unchecked. While we are immensely proud to have shouldered much of the COVID response burden, with GPEI infrastructure still supporting that response, this has come at a cost: nearly 80 million vaccination opportunities were lost.
“But we are moving forward, making up lost ground and, through this new Regional Subcommittee, leveraging the credibility that the polio programme has built through its pivot to COVID-19 and back again to polio,” said Dr Hamid Jafari, Director of the regional polio programme and co-facilitator of the Regional Subcommittee.
That credibility is now the polio’s most valuable asset: the proof that polio programmes are not just a means to battle polio, but sophisticated, fast-moving public health assets skilled in pandemic response.
The subcommittee will report its progress to WHO’s governing bodies meetings, including the World Health Assembly and the Regional Committee for the Eastern Mediterranean.
The Secretariat, which is made up of the office of the Regional Director and members of the regional polio eradication programme from WHO’s Eastern Mediterranean Region, will support the subcommittee to develop a programme of work based on the key outputs of the group.
13 March 2021, Brazzaville – To rapidly and sustainably stop outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) in African countries, a modified vaccine, known as novel oral polio vaccine type 2 (nOPV2) is now being rolled out.
Last year, on 25 August 2020, Africa made history with the African Region Certification Commission for Polio Eradication independently certifying that the Region was free of wild poliovirus. This is the second disease to be kicked out of Africa after smallpox more than 40 years ago.
This achievement is remarkable, considering that in the 1990s wild poliovirus paralysed more than 75,000 African children every single year – a situation that prompted Nelson Mandela in 1996, joined by Rotary International and other partners, to issue a stark call to action: Kick Polio Out of Africa!
All strains of wild poliovirus have now been interrupted in the continent. The last case of wild poliovirus was in August 2016.
However, this tremendous progress remains an unfinished success story. Although Africa is free of wild poliovirus, countries continue to be affected by another form of the virus, known as circulating vaccine-derived poliovirus type 2 (cVDPV2). Such strains are rare, but can occur in under-immunized communities with limited access to safe water and sanitation.
Populations that are adequately immunized are protected from both wild and vaccine-derived strains of poliovirus. However, because of gaps in immunization coverage across Africa, 20 countries have been affected by cVDPV2 outbreaks since 2018.
Now, intensified efforts are being launched to finish polio once and for all, to ensure no child in Africa will ever be paralysed by any strain of this virus.
The novel OPV2 vaccine has been in development since 2011, and in November 2020, WHO’s Prequalification Team issued an emergency use listing (EUL) recommendation enabling initial roll-out in countries affected by cVDPV2 outbreaks. Soon after the issuance of the EUL, the WHO Regional Director for Africa, Dr Matshidiso Moeti, advocated to countries to use this additional tool to stop all forms of polio in Africa.
For nOPV2 to be deployed and used under the EUL, special readiness requirements and criteria need to be met. The Polio Rapid Response Team at WHO’s Regional Office for Africa, in close coordination with other Global Polio Eradication Initiative partners, has been working intensely with countries and partners across the continent to respond to outbreaks of cVDPV2 and prepare for the roll out of nOPV2.
As countries in the Region gear up to roll out this new tool for outbreak response, with WHO’s support they are developing supply, demand and deployment plans; ensuring expedited pathways for national regulatory approvals; enhancing surveillance and laboratory capacity; investing in meeting cold-chain capacity and vaccine management requirements; ensuring vaccine safety monitoring and follow-up mechanisms are in place; and developing communication plans and engaging communities to enhance understanding of the vaccine and risks posed by cVDPV2.
These preparations continue even amidst the COVID-19 pandemic, and the existing polio eradication infrastructure has been instrumental in preparing for the nOPV2 vaccine as well as more broadly supporting COVID-19 response efforts across the continent.
Years of extensive development and preparations are now about to pay off, as nOPV2 will now be utilized for outbreak response. “This is tremendous news for Africa’s polio eradication effort, and in particular for Africa’s children who are currently at risk of lifelong paralysis due to circulating vaccine-derived poliovirus,” said Dr Moeti. “This tool can stop cVDPV2 but only if it reaches all at-risk children. We must apply the lessons from the decades of action to kick wild polio out of Africa. This will require the collective action of political leaders, traditional and religious leaders, public health experts, partners, donors, frontline health workers and of course parents and caregivers. Together, we can protect all African children from all forms of this virus.”
More information on nOPV2.
O’Leary took over as Director for Polio Eradication at WHO on 1 January 2021, from Michel Zaffran, who will enter a well-deserved retirement end-February. O’Leary brings with him a vast array of experience in both polio eradication and emergencies, including through the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).
PN: Aidan, Michel, thank you both for taking the time to speak with us today. Aidan – you are taking over from Michel as Director for Polio Eradication at WHO. Polio is 99% eradicated globally, but it has been at 99% for many years. Ultimately, your job will be to achieve that elusive 100%. Do you find the task ahead daunting?
A-O’L: I’m not sure ‘daunting’ is the adjective I would use. But ‘challenging’ for sure. As you say, we have been at 99% for many years now. We have reduced the incidence of polio from 350,000 children paralysed every year in 1988, to less than 1,000 in 2020. But that is not enough, not if we are trying to eradicate a disease. Polio is a highly-infectious disease, and if we did not know it before COVID-19, we certainly know now how quickly infectious diseases can spread globally. If we do not eradicate polio, this virus will resurge globally.
PN: As new Director, what will be your priorities?
A-O’L: My priority, and all of our priorities, must be simply this: find and vaccinate every last child. If we do that, poliovirus will have nowhere to hide. That means in the first instance finding out where those last remaining unreached children are, and what obstacles stand in the way to vaccinating them. Is it because of lack of infrastructure? Insecurity or inaccessibility? Lack of proper operational planning? Population movements? Resistance? Gender-related barriers? If we can identify the underlying reasons, we can adapt our operations and really zero in on those last remaining virus strains.
PN: Michel, you have led this effort for the past five years, and during that time have guided the effort to restrict wild poliovirus transmission to just Pakistan and Afghanistan. You have overseen the achievement of a wild polio-free Africa, an incredible achievement. However, this time has also seen an increase in emergence of circulating vaccine-derived poliovirus, or cVDPV, outbreaks. How do you see the priorities going forward?
MZ: The goal of this effort is of course to ensure that no child will ever again be paralysed by any poliovirus, be it wild or vaccine-derived. This we have to achieve in phases. First, we have to interrupt all remaining wild poliovirus strains, before we can then ultimately stop use of oral polio vaccine, or OPV for short, in order to eliminate the long-term risks of cVDPVs. Aidan has tremendous experience, in both remaining wild poliovirus endemic countries, having led the OCHA office in Afghanistan and having been Chief of Polio Eradication in Pakistan for UNICEF. So he knows the challenges and realities involved. Eradicating the last remaining strains of wild poliovirus must be the overriding priority – success ultimately hinges on that.
At the same time, we have new strategies, tools and approaches to address the increasing cVDPV emergency, notably the novel OPV type 2, or nOPV2 for short, to more effectively and sustainably stop such strains. Ultimately, though, we need to reach children. Only vaccinations save lives, not vaccines.
A-O’L: Michel just mentioned an important word: emergency. And that is precisely what we are facing with polio, whether it’s wild or vaccine-derived. I believe my experience working in emergency settings can help us achieve our goal, including by linking polio operations more closely to other emergency efforts. That is also one of the reasons why WHO and UNICEF recently jointly issued an emergency call for action on polio and measles, and we hope all stakeholders will respond accordingly.
MZ: I would echo that. Particularly in a post-COVID world, the programme must also continue to adapt its approaches and operations, and no longer work so much in isolation. We have to integrate with other efforts including emergency response and broader routine immunization efforts.
A-O’L: I would just add that Michel is really leaving me with a solid base to operate from. He and his teams across the GPEI partnership have built up such a strong infrastructure. I’m thinking here for example of the gender equality work of the programme – it has really been trail-blazing and I know other health and development efforts are looking to our experience on this. It’s a great opportunity to further leverage and expand collaboration with others. So we’ve really become a global leader in many new ways of working, and ultimately, that can only mean more support for this effort.
PN: Thank you so much for speaking with us today. Could we ask for final thoughts from both of you?
A-O’L: We have many challenges, but if any network can achieve success, it is the GPEI network. Our greatest strength that we have is partnerships. Starting with Rotary International and Rotarians worldwide who are tirelessly working towards success, to our other partners including at my old organization UNICEF and our newest partner Gavi who is helping to integrate the programme, and of course ultimately to donor and country governments and communities: this is where our strength and power lies. If we harness this partnership effectively, if we all work together, then we will reach that last remaining child, and we will ensure that this disease is eradicated once and for all.
MZ: For me it has been an absolute honour and privilege to lead this effort for the past years, and I leave with a sense of real optimism. I believe Aidan is the right person for this job right now. In November, at the World Health Assembly, we saw tremendous support for polio eradication from Member States. We have new tools, such as nOPV2, and tremendous new commitments. We are working on a new strategy, to lead us to success. But ultimately, all comes down now to implementation. 2020, the COVID year, taught us many lessons. Many of the questions that are still being asked about COVID – how does it transmit, where is it primarily circulating, what are the best tools and strategies to stop it – have been answered for polio. We know what the virus is doing, how it is behaving, and who it is affecting. Most importantly, we know what we have to do to stop it, and we have all the tools to stop it. But what 2020 also taught us is that this cannot last forever. We never know when a next COVID emergency comes along, which will disrupt everything. In polio eradication, we are being given another chance in 2021, after a bruising 2020. We have to capitalize on it. We have to focus everything on implementation. If we do that, success will follow.
In a newly-released statement following the final meeting of the Polio Oversight Board (POB) that was held virtually on 18 December 2020, the POB looks back at the support that the programme provided to respond to the COVID-19 pandemic, while remaining strongly devoted to the goal of a polio-free world. The POB reaffirms its commitment that polio-funded assets are available to countries to respond to the COVID-19 pandemic, especially in the next phase of COVID-19 vaccine introduction and delivery.
The POB also believes that for countries introducing COVID-19 vaccine, there are lessons and experiences to be learnt from the rollout of nOPV2 under the EUL recommendation, if emergency regulatory pathways such as WHO EUL are used, including in the areas of monitoring readiness-verification, safety surveillance, and regulatory considerations.
In 2018, Jawahir Habib, a Programme Officer in UNICEF’s Polio Outbreak Team based in Geneva, received a letter. It was from a Pakistani woman she had met while working in the Quetta block – one of the most high-risk polio areas of Pakistan. The letter read:
“I have four daughters, and my daughters are in school because of the polio programme. I can afford to teach my girls which my husband opposed. Now they too can get education and live an independent life. I will make sure every child is covered and this is my mission.”
Words like these inspired Jawahir and set her on a path to a ten year career in polio eradication. She recalls her first day at work, “That day was very interesting – I was chased by dogs in the Kharoatabad area of Quetta. Although I managed to save myself, I spent the whole day crying and realizing that polio workers face this type of adversity day to day. I knew that I must become a part of this and ten years later, I am still working to eradicate polio”.
The more Jawahir became involved in the polio programme, the more she witnessed women facing social challenges. At the time, suboptimal campaigns in the polio reservoirs was one of the major hurdles faced by the programme and the number of missed children in Quetta block remained very high. More than 70% of frontline workers were male or non-locals, resulting in limited access to households.
It was then that the Pakistan programme began looking at success stories from other parts of the world, including Nigeria, where Volunteer Community Mobilizers (VCMs) were making significant strides in eradicating polio. The need to build a network of local female health workers who were trusted and could gain access became more and more clear. Balochistan, where Jawahir is originally from, is one of the most remote and conflict-ridden areas of Pakistan and strict conservative religious and cultural norms, tribal conflicts and insecurity would prove very challenging.
When Jawahir’s team started recruiting, training and deploying women frontline workers in Quetta block, she was told it was impossible. “I was told that there was no way we could manage a workforce comprising of women working in these areas”. As a team leader, Jawahir had to create an enabling environment for women to work, keep them motivated and ensure systems were in place for them to reach every child in the block. “At a personal level, I had to lead by example and show everyone that women could work in these difficult areas, face resistance and achieve what a man could – in this case, even more.”
Jawahir knew well the challenges of being a young woman in a male dominated society. Born in Kili Mengal Noshki, a remote village in Balochistan bordering Afghanistan, she faced a lot of challenges. Despite this, Jawahir got her bachelors degree, a postgraduate diploma in public health management and a masters degree in health communication from the University of Sydney.
While working on polio, she had to work twice as hard as men, facing threats, gender biases and intimidation. What kept her inspired and motivated was being a part of something much bigger which she believed could change the world.
During this time, Jawahir’s team managed to identify, train and deploy a workforce of 3500 Community Based Workers (CBV) where 85% of the frontline vaccinators were women. During the first few campaigns 700,000 children in the core reservoir area were registered and vaccinated and more than 150,000 children who had previously been missed during the campaigns were mapped and given oral polio vaccine. One of the notable success of female teams was seen in Chaman Tehsil, on the border with Afghanistan, where within four months, the number of chronic vaccine refusals went from 15,000 to 400 children. That was a huge success for Pakistan’s polio eradication goal.
Jawahir attributes the success to the brave women who have made a major contribution to their society. She sees the empowerment of woman in one of the most difficult parts of the world as GPEI’s legacy of social change now and for the future. “Imagine a workforce of thousands of women having access to every household – imagine the venues we have for routine immunization, for nutrition, health and even education”.
The COVID-19 pandemic has compounded a rise in polio cases in Pakistan in 2019 and 2020, and polio eradicators once more have their work cut out to bring down virus transmission and protect populations.
“I believe now it is the responsibility of each and every one of us in the polio programme, whether a polio worker in Chaman or an Officer in Geneva, to ensure that this disease is eradicated once and for all. We will carry on no matter the hurdles and obstacles placed on our road, and we will finish the race.”
Mr Aidan O’Leary has been officially appointed as the new Director for Polio Eradication at the World Health Organization, with effect from 1 January 2021. O’Leary is taking over from Michel Zaffran, who will enter retirement end-February.
O’Leary brings with him a wealth of emergencies and public health experience. Originally from Ireland, he is currently Head of Office in Yemen for the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), in addition to having extensive experience in emergency settings such as Iraq and Syria, where he also served as Head of Office for OCHA.
O’Leary also has strong experience of working on polio eradication in the remaining wild poliovirus endemic countries. He was Chief of Polio Eradication in Pakistan for UNICEF from 2015-2017 and Head of Office for OCHA in Afghanistan from 2011-2014.
“I’m excited to join this incredible programme,” commented O’Leary on his appointment. “COVID-19 led to a tough year for polio eradication in 2020, but we have adapted our strategies and I believe this programme has a real opportunity to reboost our efforts in 2021. I’ve been so impressed by how this programme has taken on challenges and continues to innovate, and all of it rooted in its strong partnership. I look forward to working with all partners, including my old organization UNICEF, and of course Rotarians from around the world.”
“With this appointment, I am able to enter my retirement with a sense of reassurance,” said Michel Zaffran. “He is the right person for the job at this time, given his set of experiences both in the polio programme and emergencies, and in particular in Pakistan and Afghanistan. I am confident his leadership will help drive this programme to ultimate success.”
O’Leary joins the GPEI in 2021, and will focus on capitalizing on new commitments displayed at the World Health Assembly in November, the introduction of new tools and innovations such as novel oral polio vaccine type 2 (nOPV2), and an optimization of new governance and strategy structures currently being developed across the partnership.
The GPEI welcomes Aidan O’Leary to the GPEI family.
In a year marked by the global COVID-19 pandemic, global health leaders convening virtually at this week’s World Health Assembly called for continued urgent action on polio eradication. The Assembly congratulated the African region on reaching the public health milestone of certification as wild polio free, but highlighted the importance of global solidarity to achieve the goal of global eradication and certification.
Member States, including from polio-affected and high-risk countries, underscored the damage COVID-19 has caused to immunization systems around the world, leaving children at much more risk of preventable diseases such as polio. Delegates urged all stakeholders to follow WHO and UNICEF’s joint call for emergency action launched on 6 November to prioritise polio in national budgets as they rebuild their immunization systems in the wake of COVID-19, and the need to urgently mobilise an additional US$ 400 million for polio for emergency outbreak response over the next 14 months. In particular, Turkey and Vietnam have already responded to the call, mobilising additional resources and commitments to the effort.
The Assembly expressed appreciation at the GPEI’s ongoing and strategic efforts to maintain the programme amidst the ‘new reality’, in particular the support the polio infrastructure provides to COVID-19-response efforts. Many interventions underscored the critical role that polio staff and assets play in public health globally and underline the urgency of integrating these assets into the wider public health infrastructure.
At the same time, the GPEI’s work on gender was recognized, with thanks to the Foreign Ministers of Australia, Spain and the UK for their roles as Gender Champions for polio eradication.
Delegates expressed concern at the increase in circulating vaccine-derived poliovirus (cVDPV) outbreaks, and urged rapid roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation oral polio vaccine aimed at more effectively and sustainably addressing these outbreaks. This vaccine is anticipated to be initially rolled-out by January 2021.
Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked the global health leaders for their continued dedication to polio eradication and public health, and appealed for intensified global action to address immunization coverage gaps, by prioritizing investment in robust immunization systems to prevent deadly and debilitating diseases such as polio and measles.
GENEVA/ NEW YORK, 6 November 2020 – UNICEF and the World Health Organization (WHO) today issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases.
The two organizations estimate that US$655 million (US$400 million for polio and US$255 million for measles) are needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.
“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”
“We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “Addressing the global COVID-19 pandemic is critical. However, other deadly diseases also threaten the lives of millions of children in some of the poorest areas of the world. That is why today we are urgently calling for global action from country leaders, donors and partners. We need additional financial resources to safely resume vaccination campaigns and prioritize immunization systems that are critical to protect children and avert other epidemics besides COVID-19.”
In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world. Vaccination coverage gaps have been further exacerbated in 2020 by COVID-19. In 2019, measles climbed to the highest number of new infections in more than two decades. Annual measles mortality data for 2019 to be released next week will show the continued negative toll that sustained outbreaks are having in many countries around the world.
At the same time, poliovirus transmission is expected to increase in Pakistan and Afghanistan and in many under-immunized areas of Africa. Failure to eradicate polio now would lead to global resurgence of the disease, resulting in as many as 200,000 new cases annually, within 10 years.
New tools, including a next-generation novel oral polio vaccine and the forthcoming Measles Outbreak Strategic Response Plan are expected to be deployed over the coming months to help tackle these growing threats in a more effective and sustainable manner, and ultimately save lives. The Plan is a worldwide strategy to quickly and effectively prevent, detect and respond to measles outbreaks.
Notes to editors:
Download photos and broll on vaccinations, including polio and measles vaccinations here
Generous support from Gavi, the Vaccine Alliance, has enabled previous access to funding for outbreak response, preventive campaigns and routine immunization strengthening, including additional support for catch-up vaccination for children who were missed due to COVID-19 disruptions in Gavi-eligible countries. However, significant financing gaps remain in middle-income countries which are not Gavi-eligible. This call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. To know more about UNICEF’s work on immunization, visit https://www.unicef.org/immunization
About the Global Polio Eradication Initiative
The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
About the Measles & Rubella Initiative
The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, the United Nations Foundation and the World Health Organization. Working with Gavi, the Vaccine Alliance, and other stakeholders, the Initiative is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 23 million lives by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and supporting demand for vaccine.