Supporting vaccine equity

© WHO/Iraq

As an epidemiologist in Iraq with 25 years’ experience eight of which were in immunization, Dr Israa Tariq Mahmoud is responsible for providing vaccines to all health centres and institutions that work within the Rasafa District of Baghdad.  She also follows up on the availability and distribution of vaccines to ensure they reach children across the area she covers.

Dr Israa chose to work in immunization as it would allow her to build relationships with the children and families in her community. She feels a strong sense of social justice in her efforts to ensure that all children, regardless of their social status, have equal access to vaccination.

She adds that she and her colleagues who are health care workers are all cogs in the chain of efforts required to eradicate polio, from surveillance to vaccine follow-up. That follow-up includes checking that children have taken all doses of the vaccine and monitoring for any adverse events following immunization (AEFIs). They also conduct disease surveillance as they visit children’s homes.

Dr Israa says she feels the same drive a parent or caregiver does when they look after their own child. She has advice for health workers, especially young ones: “We all, males and females, have a role, no matter how small, in building our country.”

Delivering health on wheels

© A Taqveem/Punjab EOC

Defying norms take guts – which Shiza Ilyas has no shortage of. Ten years ago, she joined Pakistan’s polio eradication programme in Lahore as a vaccinator to support her family after her father, the main breadwinner, passed away. Going from one door to another, talking to families, and protecting children from lifelong disability has brought her both purpose and peace.

Shiza is the first woman to serve as Area-in-Charge in Lahore. Responsible for running vaccination campaigns in Lahore’s Union Council 44, she is well known and respected among her peers. More extraordinarily though, she carries out her vaccination duties on a motorbike – a rare sight in Pakistan.

When Shiza expressed interest in serving as an Area-in-Charge, her supervisor chuckled and said no woman in Lahore had ever wanted to take on this role before. At the very least, he said, she would need to be on a motorbike to travel long distances and check on polio teams.

With support from her grandfather, and eventually her mother, and with riding instructions from a cousin, Shiza was soon whizzing through the streets, after a quick stop at her supervisor’s office.

Shiza’s work involves supervising polio campaigns in her area and checking in on teams during the day as they go from house to house. She tallies their data and at the end of the day, if any children have been missed, she personally visits their houses and vaccinates them.

“I never paid attention to negative comments from anyone about being a woman on a bike,” she says. “I always believed in myself and did what I wanted to do.”

“When you put polio drops in a child’s mouth, you feel happiness inside, happiness that you have saved a child,” she says. “I urge people to come and work for this feeling. This work brings a lot of peace.”

When vaccination involves detective work

© WHO/Djibouti

In Djibouti, every day, Houda Houssein Okeih vaccinates people who visit the health facility where she has been working since 2015. During polio vaccination campaigns, she focuses her efforts on children under five years of age.

Working with parents, mothers, and their children on a daily basis has made Houda a popular figure in the neighbourhood. With 20 years of experience as a nursing assistant, Houda is known for her outspokenness, clarity and passion for engaging mothers. She makes a point of ensuring that parents know and follow vaccination schedules and keep records. Sometimes, she needs to pester them a little, she adds, laughing, so that parents take timely vaccination seriously.

Houda enjoys being among the community. To follow up with her patients, she often scouts the neighbourhood, similar to a detective, to look for families who haven’t followed their children’s vaccination schedule. She then directs them to her health facility, to encourage them to vaccinate their children and give them a healthier and brighter future.

Inspired by a television programme

Over in Afghanistan, Farida* is a vaccinator who is pleased to be serving her community through polio campaigns.

Farida feels lucky to be contributing to eradicating polio. The best part of this job, she says, is that she can see the impact of her efforts to prevent Afghan children from becoming paralyzed. In 2022 to date, just two children have developed paralytic polio in Afghanistan.

© WHO/Afghanistan

Farida was inspired to work as a vaccinator after she watched a television programme that depicted children paralyzed by polio. The story of these children’s lives and struggles resonated with her and gave her a sense of professional purpose.

In efforts to support women like Farida to play an important role in polio eradication, the GPEI in 2019 endorsed a Gender Equality Strategy. It also aims to promote the integration of a gender perspective into programming, and to support countries to address gender-related barriers to vaccination.

In WHO’s Eastern Mediterranean Region, the polio eradication programme is working on addressing gender-related barriers to vaccination of children and surveillance for poliovirus. To this end, two Technical Advisory Group (TAG) meetings recently conducted for Afghanistan and Pakistan, the countries where the wild poliovirus is still endemic, also provided guidance on integrating solutions to gender-related barriers into eradication efforts.

Mounting speedy responses by rapid testing

When she was young, Dr Nabila Mohammed Al Moalimi dreamt of being a pediatrician. But when her father was misdiagnosed and given the wrong medical treatment, she decided to play a role in strengthening her country’s laboratories. Now, Dr Nabila serves as the Director of the Molecular Biology Department in Sana’a, Yemen.  

© WHO/Yemen

After a two-week training session in a polio laboratory in Pakistan, Dr Nabila and a colleague returned to Yemen to start up a new laboratory division in the Ministry of Health’s Central Public Health Laboratory, Sana’a. This will solve a major problem for the polio eradication programme in Yemen.  

Previously, the polio laboratory in Sana’a would collect polio samples and ship them to the Regional Reference Lab in Cairo, Egypt, for testing – all with no delays. But after the war broke out, stool samples had to be sent to the KEMRI laboratory in Nairobi, Kenya. The return of results could take up to three months – a costly delay that could exacerbate the spread of polio outbreaks.  

During her mission to Pakistan, Dr Nabila and her colleague were trained in conducting rapid tests to flag polio infection in stool samples before sending them to a laboratory from the WHO-accredited Global Polio Laboratories Network for poliovirus diagnosis. In the event a sample tests positive, the team can now immediately alert technical experts and health authorities to plan a response. This response can include testing samples from contacts of the child who tested positive for polio, and vaccinating children to boost their immunity in affected locations. This response, especially when done quickly, prevents further spread of polioviruses.  

Thanks to the expertise of Dr Nabila and her colleague, alongside several others, the polio laboratory in Sana’a may soon be able to perform direct detection of poliovirus from stool samples. They can also tell whether a polio virus is wild or a variant type, which informs an appropriate response.

24 October is World Polio Day, a global day to raise awareness and resources for the worldwide effort to eradicate polio.  Communities, Rotarians, civil society, governments and partners around the world are organizing events to mark the occasion and draw attention to the opportunity to rid the world of an infectious disease once and for all, including at a special event at WHO’s European Regional Office with keynote speakers from partners and the Global Certification Commission for Polio Eradication.

On 21-22 October, Rotarians and WHO are meeting to examine how their joint collaboration on polio eradication can be applied to broader public health efforts, at an event called:  World Polio Day and Beyond:  a healthier future for mothers and children.  Director-General Dr. Tedros Adhanom Ghebreyesus and Rotary International President for 2022-2023 Jennifer Jones will discuss the work the two organizations have done together for decades to eradicate polio and how they will continue to work together on a healthier future for mothers and children.

World Polio Day this year comes on the heels, of a global GPEI pledging moment, co-hosted by the German Government, held on 18 October at the World Health Summit in Berlin, Germany.  At this event, the global community committed US$2.6 billion to the global effort to eradicate polio.  It was an important first step, and clear sign of global solidarity, to ensuring all resources to achieve success are mobilized.  We will all benefit equally from a polio-free world, so all of us have clear responsibility to help achieve it.  Together, we end polio!

Addressing the pledging event in Berlin by video, Sadiya, a vaccinator from Nigeria, said:  “Together, we end polio!  I will do my best.  I hope you will too.”  World Polio Day is the ideal opportunity to follow Sadiya’s lead, and also do all of our best.

BERLIN, 18 October 2022 – Today, global leaders confirmed US$ 2.6 billion in funding toward the Global Polio Eradication Initiative’s (GPEI) 2022-2026 Strategy to end polio at a pledging moment co-hosted by Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) at the World Health Summit in Berlin.

The funding will support global efforts to overcome the final hurdles to polio eradication, vaccinate 370 million children annually over the next five years and continue disease surveillance across 50 countries.

“No place is safe until polio has been eradicated everywhere. As long as the virus still exists somewhere in the world, it can spread – including in our own country. We now have a realistic chance to eradicate polio completely, and we want to jointly seize that chance,” said Svenja Schulze, Federal Minister for Economic Cooperation and Development, Germany. “Germany will remain a strong and committed partner in the global fight against polio. This year, it is providing EUR 35 million for this cause. And next year we plan to further strengthen our efforts and support GPEI with EUR 37 million – pending parliamentary approval. By supporting the GPEI, we are also strengthening national health systems. That leads to healthier societies, far beyond the polio response.”

Wild poliovirus is endemic in just two countries – Pakistan and Afghanistan. However, after just six cases were recorded in 2021, 29 cases have been recorded so far this year, including a small number of new detections in southeast Africa linked to a strain originating in Pakistan. Additionally, outbreaks of cVDPV, variants of the poliovirus that can emerge in places where not enough people have been immunized, continue to spread across parts of Africa, Asia and Europe, with new outbreaks detected in the United States, Israel and the United Kingdom in recent months.

“The new detections of polio this year in previously polio-free countries are a stark reminder that if we do not deliver our goal of ending polio everywhere, it may resurge globally,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We are grateful for donors’ new and continued support for eradication, but there is further work to do to fully fund the 2022-2026 Strategy. We must remember the significant challenges we have overcome to get this far against polio, stay the course and finish the job once and for all.”

At a challenging time for countries around the world, governments and partners have stepped forward to demonstrate their collective resolve to eradicate the second human disease ever. In addition to existing pledges, new commitments to the 2022-2026 Strategy this fall include:

  • Australia pledged AUD 43.55 million
  • France pledged EUR 50 million
  • Germany pledged EUR 72 million
  • Japan pledged USD 11 million
  • Republic of Korea pledged KRW 4.5 billion
  • Liechtenstein pledged Sw.fr. 25 000
  • Luxembourg pledged EUR 1.7 million
  • Malta pledged EUR 30 000
  • Monaco pledged EUR 450 000
  • Spain pledged EUR 100 000
  • Turkey pledged USD 20 000
  • United States pledged USD 114 million
  • Bill & Melinda Gates Foundation pledged USD 1.2 billion
  • Bloomberg Philanthropies pledged USD 50 million
  • Islamic Food and Nutrition Council of America pledged USD 1.8 million
  • Latter-day Saint Charities pledged USD 400 000
  • Rotary International pledged USD 150 million
  • UNICEF pledged USD 5 million

The pledging moment in Berlin marked the first major opportunity to pledge support toward the USD 4.8 billion needed to fully implement the 2022-2026 Strategy. If the Strategy is fully funded and eradication achieved, it is estimated that it would result in USD 33.1 billion in health cost savings this century compared to the price of controlling outbreaks. Further, continued support for GPEI will enable it to deliver additional health services and immunizations alongside polio vaccines to underserved communities.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. “UNICEF is grateful for the generosity of our donors and the pledges made today, which will help us finish the job of eradicating polio. When we invest in immunization and health systems, we are investing in a safer, healthier future for everyone, everywhere.”

In addition to the funding for GPEI announced today, a group of more than 3000 influential scientists, physicians, and public health experts from around the world released a declaration endorsing the 2022-2026 Strategy and calling on donors to stay committed to eradication and ensure GPEI is fully funded. The group points to new tactics contained in the program’s strategy, like the continued roll-out of the novel oral polio vaccine type 2 (nOPV2), that make them confident in GPEI’s ability to end polio. Five hundred million doses of nOPV2 have already been administered across 23 countries, and field data continue to show its promise as a tool to more sustainably stop outbreaks of type 2 cVDPV. The group further asserts that support for eradication significantly strengthens immunization systems and pandemic preparedness around the world—pointing to GPEI’s support for the COVID-19 response—and urges endemic and polio-affected country leadership to stay committed to expanded vaccination and disease surveillance activities.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” says Dr Zulfi Bhutta (Chair of Child Global Health, Hospital for Sick Children, Canada, and Distinguished University Professor, Aga Khan University, Pakistan). “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere. Stopping this disease is not just urgently needed now, it’s within our grasp. That’s why I’ve joined more than three thousand health experts from around the world to launch the 2022 Scientific Declaration on Polio Eradication. With strong financial and political commitments, our long-awaited vision of a polio-free world can become a reality.”

Additional quotes from the pledging moment:

Mark Suzman, CEO, Bill & Melinda Gates Foundation, said: “The question is not whether it’s possible to eradicate polio—it’s whether we can summon the will and the resources to finish the job. The Bill & Melinda Gates Foundation is grateful to Germany, Rotarians, donors, countries, scientists, and partners who stood together today to show that we are united in this goal. We look forward to working together to create a polio-free future and build more equitable and resilient health systems for all.”

Seth Berkley, CEO, Gavi, the Vaccine Alliance, said: “As we work together to stop the transmission of all polioviruses globally, we are more grateful than ever for the generosity of our donors, the leadership of governments and the mobilization of communities. Today’s pledges will support GPEI’s new strategy which correctly focuses on mass vaccination campaigns, concerted efforts by partners to strengthen essential immunization and integration with other critical health interventions and a further roll out of next-generation oral polio vaccines. These three measures combined are essential if we are to eradicate polio once and for all.”

Franz Fayot, Minister for Development Cooperation and Humanitarian Affairs, Luxembourg, said: “Luxembourg is proud to be a longstanding supporter of global efforts to eradicate polio. Building on the remarkable progress achieved so far, Luxembourg will continue to support the fight against polio until we ensure the protection of every child.”

Ian Riseley, Chair, Rotary Foundation, said: “While polio exists anywhere, it is a threat everywhere. This is an opportune moment for the global community to recommit to the goal and ensure the resources and political will are fully available to protect children from polio paralysis while building stronger health systems. That is why today, Rotary is reaffirming its commitment of an additional USD 150 million to the global effort to eradicate polio.”

His Excellency Abdul Rahman Al Owais, Minister of Health and Prevention, United Arab Emirates, said: “Polio outbreaks this year have emphasized that polio anywhere is a threat to communities everywhere. While we are encouraged by steady progress in Pakistan and Afghanistan in the drive towards polio eradication, and we know that there is a ways to go to finish the job. We also know that this progress would not have been possible without the courageous contributions of frontline health workers, who have remained steadfast in their commitment to protecting their communities from polio in the face of the pandemic, natural disasters and threats to their physical safety. Under the leadership of His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of the UAE, we join our international partners in reiterating our commitment to a polio free world.”

For photos from the pledging moment at World Health Summit, please see here

Pledging table

Media contacts:

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

Tess Ingram
Media Officer, United Nations Children Fund
Email: tingram@unicef.org
Tel: +1 347 593 2593

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


Notes for editors:

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

Related links

Polio https://www.who.int/health-topics/poliomyelitis#tab=tab_1

Fact sheet

Polio https://www.who.int/news-room/fact-sheets/detail/poliomyelitis

Dr Hamid Jafari, EMRO Director for Polio Eradication. © WHO/EMRO

Members of the Regional Subcommittee for Polio Eradication and Outbreaks in the Eastern Mediterranean reviewed recent progress during the 69th session of the Regional Committee. It was the sixth meeting of the subcommittee since it was formed during the 67th Regional Committee.

During the meeting Member States and partners reiterated their commitment to freeing current and future generations of children from polio and called for sustained efforts to end polio once and for all, including the pockets of wild poliovirus that linger in Afghanistan and Pakistan.

Visit the EMRO website for the full story.

Today, more than 2,800 leading scientists, physicians, and global health experts from 110 endemic, polio-affected, at-risk, and partner countries launched the 2022 Scientific Declaration on Polio Eradication. The GPEI welcomes this declaration, which sends a powerful message to the world that eradication is feasible and urgently needed now.  

Although remarkable progress has been made, recent detections in countries that haven’t seen the virus for many years and persistent transmission in countries long plagued by the disease demonstrate that polio anywhere remains a threat to people everywhere. The GPEI is hopeful that this declaration can reenergize the global community around our shared vision of a polio-free world. It offers expert perspective on the promise of new tools and tactics, the benefits of polio investments to health systems, and the unacceptable consequences of failing to eradicate the disease.   

The launch of the Scientific Declaration comes one week ahead of the polio pledging moment at the World Health Summit on 18 October 2022, where the GPEI seeks to raise funds in support of its 2022-2026 Strategy. The thousands of experts who have signed the Declaration endorse the GPEI’s strategic plan, while calling on partners, donors, polio-affected country leaders, and communities to recommit to the goal of eradication and ensure children everywhere are protected from this devastating preventable disease. With their support and the commitment of the world, we can and will end polio. 

HRH Prince Charles observing the vaccination of children in a village on the outskirts of New Delhi. © Kiron Pasricha
HRH Prince Charles observing the vaccination of children in a village on the outskirts of New Delhi. © Kiron Pasricha

The Global Polio Eradication Initiative is deeply saddened by the passing of Her Majesty Queen Elizabeth II.  Her leadership, steadfastness and commitment to service was exemplary throughout her life, and made her a globally-respected moral voice for some of the most marginalized people in our world.  We wish to express our deepest sympathy to her family and of course to all the people of the UK and indeed the Commonwealth.

The UK, Commonwealth and indeed the Royal Family have long been a proud and important supporter to the global eradication effort, and none has arguably been a more committed advocate than His Majesty King Charles III.  While still HRH Prince of Wales, Charles III engaged personally in this effort, adding his voice and commitment to ensuring children around the world are fully protected from lifelong polio paralysis.

In October 2003 in India, HRH Prince Charles participated in Polio National Immunization Days, observing the vaccination of children in villages on the outskirts of New Delhi.  In 2018, at the Commonwealth Leaders Summit, HRH Prince Charles highlighted the polio programme as an example of successful, joint action against disease, noting that hundreds of millions of children have benefitted from polio vaccination thanks to the Global Polio Eradication Initiative.  In 2013, during another visit to India, he acknowledged Rotary’s tremendous efforts in eradicating polio in India, as he accepted and posed with a Rotary ‘End Polio Now’ scarf for media photographers.

The Global Polio Eradication Initiative would like to extend our very best wishes to His Majesty King Charles III, for a long and successful reign.  Under his leadership, and indeed the UK and the Commonwealth’s, the effort to eradicate polio will continue unabated until our common goal of achieving a lasting world free of all forms of poliovirus is fully achieved.

 

A child is vaccinated during a nationwide vaccination campaign in Jabuary 2022. Seven national and one sub national campaigns have taken place since 15 August last year. © WHO/Afghanistan
A child is vaccinated during a nationwide vaccination campaign in Jabuary 2022. Seven national and one sub national campaigns have taken place since 15 August last year. © WHO/Afghanistan

Wild poliovirus transmission in Afghanistan is currently at its lowest level in history. Fifty six children were paralysed by wild polio in 2020. In 2021, the number fell to four. This year to date, only one child has been paralysed, giving the country an extraordinary opportunity to end polio.

The resumption of nationwide polio vaccination campaigns targeting 9.9 million children has been a critical step. Since 2018, local-level bans on polio vaccination activities in some districts controlled by the Taliban had significantly reduced the programme’s ability to vaccinate every child across the country. With access to the entire country following the August transition, seven nationwide vaccination campaigns took place between November 2021 and June 2022, and a sub national campaign targeting 6.7 million children in 28 provinces took place in July. Of the 3.6 million children who had been inaccessible to the programme, 2.6 million were reached during the November, December and January campaigns. With improved reach to previously inaccessible children throughout the February to July campaigns, the number children has been reduced to 0.7 million. Further campaigns are planned for the remainder of the year.

With Afghanistan and Pakistan sharing one epidemiological block, the two countries continue to coordinate cross border activities. December and May’s campaigns were synchronized with Pakistan’s national campaigns, focusing on high risk populations including nomadic groups, seasonal workers and communities straddling both borders.

Improved access also had a significant impact on polio surveillance activities. Afghanistan’s surveillance indicators remained above global standards throughout the transition. With access to all districts since August, the quality of activities has improved significantly including early case detection and reporting.

In June, the first review of the polio surveillance system in six years took place with WHO hosting a team of technical experts including epidemiologists and virologists. A small team visited in 2016 but insecurity and lack of access to much of the country limited the visitors’ movements to Kabul, Herat, Kandahar, Jalalabad, Mazar-e-sharif and Kunduz. This year, the 16-strong team visited 76 districts across 25 of the country’s 34 provinces. The review determined the likelihood of undetected poliovirus transmission in Afghanistan to be low. Recommendations, including upscaling surveillance in the country’s south and south east, are being implemented.

With more than twenty years on the ground in Afghanistan, the polio programme continues to leverage its extensive operational capacity to deliver better health outcomes for all Afghans. In the face of an unprecedented humanitarian crisis, in addition to day-to-day polio activities, polio staff continue to regularly monitor the functionality of health facilities across the country as well as support ongoing vaccination campaigns including measles and COVID 19. WHO’s polio team in the southeast were among the first responders following the devastating earthquake in Paktika and Khost provinces in June. In addition to providing critical health care, the team’s experience working among local communities provided the foundations of an assessment tool that mapped affected communities and ensured accurate data guided a focused response in the immediate aftermath.

Although the number of children paralysed by polio has reduced significantly in Afghanistan, the threat is far from gone and the programme faces significant challenges. While access has improved across the country, accessing every child though house to house vaccination remains a challenge in some areas leaving immunity gaps and, with them, children at risk.

On 24 February, eight polio workers were killed in targeted attacks in the country’s north, not the first time polio workers had come under attack in the course of their life saving work. Four of those killed were women. Female polio workers play a critical role in the programme, building community trust and reaching all children.

The sharp rise in the number of wild polio cases in Pakistan is a cause for concern, and the detection of one case each in Malawi and Mozambique is a reminder of the continued risks of poliovirus and the urgencyrequired to permanently interrupt transmission in both Afghanistan and Pakistan.

While the polio programme has made important progress in the last 12 months, sustaining those gains with high quality campaigns that vaccinate all children and build enough immunity to end circulation of the virus for good is critical. A polio free Afghanistan is within reach – but there is still a long way to go.

File photo: WHO, Geneva, Switzerland – WHO Director-General Dr Tedros Adhanom Ghebreyesus (centre) with members of the GCC (from left to right): Dr Nobuhiko Okabe (Chair of Western Pacific RCC), Professor Yagoub Al-Mazrou (Chair of Eastern Mediterranean RCC), Professor Mahmudur Rahman (Chair of South-East Asian RCC), Professor David Salisbury (Chair of GCC and Chair of European RCC), Dr Arlene King (Chair of American RCC, and Chair of the GCC Containment Working Group); and, Professor Rose Leke (Chair of African RCC). © WHO

On 28-29 June 2022, the Global Commission for Certification of Poliomyelitis Eradication (GCC) met in-person in Geneva, Switzerland, to review the global criteria set for poliovirus certification. The work of the GCC, and the six Regional Certification Commissions (RCCs) is critical to independently verifying the achievement of a world free of all polioviruses. Five of six WHO Regions are certified wild poliovirus-free and two of three strains of wild poliovirus are certified as globally eradicated.

The GCC reviewed the latest global epidemiology, both of wild and vaccine-derived polioviruses (VDPVs), and examined remaining challenges such as subnational surveillance and immunity gaps, and recent and high-profile virus detections, including from Malawi, Mozambique, the UK, Israel and Ukraine.

The GCC noted the epidemiological opportunity that has presented itself in Pakistan and Afghanistan to finally interrupt wild poliovirus. The group cautioned, however, that any remaining immunity gap now poses a significant risk to success, as evidenced by the recent outbreak of wild poliovirus type 1 in North Waziristan, Khyber Pakhtunkhwa, Pakistan.

Recognizing programme advancements in genomic analysis and that widespread use of environmental surveillance in many countries means that confidence in achievement of eradication could come sooner than the traditional three years, the Commission concluded that the traditional approach to certification may no longer be justifiable to verify the absence of wild poliovirus transmission. Historically, Regions had to provide evidence of three years, without detection of wild poliovirus, from any source. Instead, the GCC is recommending the adoption of a ‘flexible’ approach to certification, by examining traditional surveillance indicators in a broader geo-political, area-specific context.

“The world has seen tremendous changes in this third decade of the 21st century, and the old rules may no longer necessarily apply,” commented Professor David Salisbury, Chair of the GCC. “We have to recognize that different geo-political realities affect countries – and subsequently health system performance – in very individual manners. Therefore, we must also look at each area in a very individual and targeted manner, to determine the most effective certification criteria that should be applied. Our aim must be clear: to fully verify, independently and in the most certain manner, that wild polioviruses have indeed been eradicated. And how to do that, is precisely what our group’s discussions this week have focused on.”

The aim of the global eradication effort is of course to ensure that no child will ever again be paralysed by any form of poliovirus, be it wild- or vaccine-derived. To this effect, another focus of the meeting was to discuss concrete criteria for the eventual verification of VDPVs, including the necessary timelines that might be needed without detection of circulating VDPV from any source, following the global cessation of use of oral polio vaccines from routine immunization programmes.

The full report from the GCC’s meeting will be made available over the coming weeks at www.polioeradication.org.

 

As south-east Africa continues to intensify efforts to stop a wild poliovirus type 1 (WPV1) outbreak detected in Malawi in February, the Africa Regional Certification Commission for Polio Eradication (ARCC) – the independent regional advisory body guiding Africa’s eradication effort – called for urgent action to stop all forms of poliovirus affecting the continent, be it wild or variant.

Reviewing the regional epidemiology at its bi-annual meeting on 6 June, the ARCC commended the governments’ commitments in Malawi, Mozambique, Tanzania and Zambia, in launching a series of emergency outbreak response campaigns, in response to the detected WPV1 in February.  With two campaigns already implemented, further activities planned later in the summer will also feature Zimbabwe participating in the subregional outbreak response effort.  The campaigns are supported by partners of the Global Polio Eradication Initiative (GPEI), notably WHO, UNICEF, BMGF, US CDC, GAVI, and local Rotarians, and by the Africa Rapid Response team.

The ARCC put forward four key recommendations to help ensure the outbreak can be rapidly stopped, namely:

  • implementing plans to improve campaign quality, based on lessons learned and quality-response assessments from the initial two rounds;
  • assessing WPV1 risks for older age groups and, as appropriate, expand target age groups of further outbreak response;
  • further expanding and strengthening subnational surveillance sensitivity to more clearly assess potential spread of this outbreak and eventually verify that the outbreak has been successfully stopped; and,
  • implementing surveillance-focused assessments in all five participating countries.

Commenting on the outbreak response and the group’s deliberations, ARCC chair, Professor Rose Leke said: “Countries must be reminded that wild poliovirus is endemic in Afghanistan and Pakistan, and south-east Africa is now infected.  The risk of poliovirus being re-introduced or re-emerging is high, and the best thing countries can do to minimize the risk and consequences of polio is to strengthen immunity levels and subnational surveillance sensitivity.”

Countries, supported by GPEI partners, are also intensifying efforts to stop a number of variant poliovirus outbreaks in the Region, notably in Nigeria, the Democratic Republic of the Congo (DR Congo) and other areas.  To combat this development, the ARCC encouraged partners and countries to prioritize the new novel oral polio vaccine type 2 (nOPV2) supply to highest-risk areas.

“Novel OPV type 2 is an important new tool,” continued Professor Leke.  “But at the same time, it must reach the children it is intended to reach.  Variant polioviruses paralyze children and affect their families and communities in the same way that wild polioviruses do, and hence must be responded to with the same level of urgency and political commitment and oversight.”

Professor Leke and the ARCC members underscored the importance of building up routine immunization capabilities and surveillance sensitivity, both of which are critical in combatting a wide range of infectious diseases, including COVID-19 on the continent.  According to Professor Leke: “The decline of routine immunization in the Region is of particular concern and puts the most vulnerable children at an increased risk to diseases such as polio.”  An immunization and surveillance gap formed in many African countries due to the Covid-19 pandemic, as health workers were limited in routine activities by social distancing restrictions.  While national surveillance activities have been renewed, persistent gaps remain at subnational levels.  The various outbreaks across Africa in 2022 demonstrate that surveillance and routine immunization activities must be improved.

In its concluding remarks, the ARCC noted with appreciation critical milestones achieved, including the recent successful closure of 32 outbreaks from ten countries, at the end of Q1 2022, clearly demonstrating that outbreak response strategies work when fully implemented and resourced.  “We have the opportunity of reaching zero polio cases,” concluded Professor Leke, “but only if we reach the remaining zero-dose children.  Let us all focus our efforts on that, and if that happens, success will follow.”

World Cup winners, Olympic champions and celebrities aren’t the first people who come to mind when thinking of those involved in the effort to end polio. But on 12 June, they’ll unite for the world’s biggest celebrity football match and raise support toward ensuring no child is paralysed by this disease again.

Usain Bolt, Damian Lewis, Carli Lloyd and Andriy Shevchenko are among those who will play in Soccer Aid for UNICEF this year, as an England XI take on the Soccer Aid World XI in London. Through public donations, they’ll be raising funds to help UNICEF provide vaccines, fight malnutrition, and provide safe spaces to protect children in times of crisis.

For polio specifically, these funds will help support the incredible work of polio workers like the brave women in Nigeria who are the backbone of eradication efforts. This volunteer community mobilizer network of 20,000 people is crucial to reaching every child with polio vaccines, and was a key reason behind Nigeria’s success in stamping out wild polio and contributing to the African region being certified free of the virus.

This year is a critical moment in the fight to achieve a polio-free world. Thanks to the 2022-2026 GPEI Strategy and low rates of wild polio transmission globally—the virus is endemic in just two countries—we have an historic opportunity to end this disease.

But achieving that goal needs a team effort to overcome the final challenges, such as reaching children in insecure areas and vaccine hesitancy. As we’ve seen recently with two wild polio cases in southeast Africa imported from Pakistan where it is endemic, while polio persists anywhere in the world no child is safe.

The polio program is co-hosting its pledging moment for the 2022-2026 Strategy with Germany this October at the World Health Summit, where it will be vital for donors and governments to commit the $4.8 billion necessary to fully fund the programme and finish the job.

You can play your part in the eradication effort, too, by heading to the Soccer Aid page to find out how you can ensure children receive the polio vaccine and are protected from lifelong polio paralysis.

Opening of the 75th World Health Assembly – 22 May 2022. © WHO

May 2022, Geneva, Switzerland – Global public health leaders convening last week at the World Health Assembly called for urgent action to end polio once and for all before a unique window of opportunity closes for good.

Recent efforts have had a clear impact on the global epidemiology of poliovirus, with endemic wild poliovirus transmission at extremely low levels, with just Pakistan and Afghanistan remaining endemic, and efforts to curb circulating vaccine-derived polioviruses (cVDPVs) showing fruit. Steps have been taken towards securing the legacy of polio eradication systems and know-how, under the Strategic Action Plan for Polio Transition. But delegates cautioned that this ‘window of opportunity’ will not remain open indefinitely, as experts pointed to recent concerning developments such as new wild poliovirus cases confirmed in Pakistan (the first cases reported in 15 months), wild poliovirus detected in south-east Africa (the first on the African continent since 2016), and polio re-emergence in Ukraine and Israel.

“Worrying developments in recent months highlight how fragile this progress is,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, addressing the Assembly.  “These developments are tragic for the children affected and their families.  But the reality is that in the final stages of an eradication effort, this is expected.  This year, we have the real opportunity to halt wild poliovirus transmission.  At the same time, we must respond faster and better to cVDPV outbreaks, to interrupt all transmission by end-2023.”

Success, however, depends on reaching remaining children who have not been immunized – the ‘zero-dose’ children at the heart of the Immunization Agenda 2030 (IA2030).

Such a need was identified at this month’s G7 joint Development and Health Ministers meeting in Berlin, Germany, where discussions focused on “supporting vaccine equity and pandemic preparedness in developing countries”. The meeting cautioned against letting global crises interfere with other development and public health priorities and urged continued support for existing efforts, including global polio eradication.  Polio eradication is a clear and concrete example of the value of working in close integration with other public health and development efforts. Polio staff continue to contribute to the COVID-19 pandemic response and immunization recovery efforts, together with supporting the introduction and roll-out of COVID-19 vaccines.

Ministers and high-level delegations from 20 countries of regions affected by both WPV1 and cVDPV met with senior GPEI leaders for focused discussions on concrete ways to close the final chains of virus transmission. The meetings were chaired by Polio Oversight Board chair Dr Chris Elias from the Bill & Melinda Gates Foundation and respective WHO AFRO and EMRO Regional Directors, Dr Matshidiso Rebecca Moeti and Dr Ahmed Al-Mandhari.  Key priorities were the importance of reaching zero-dose children, the challenges of complex emergencies and weak health systems, as well as the importance of inter-country coordination and collaboration.

Underscoring the urgency in giving the world one less infectious disease to worry about once and for all, WHO Director-General Dr Tedros issued a clear challenge to the Assembly:  “For countries affected by polio, it is imperative that you reach every last child, and that you respond to vaccine-derived strains with the same urgency as you would to a wild strain.   For countries that are now polio-free, it is crucial to accelerate  efforts to use your polio assets and infrastructure to build stronger, more resilient health systems.  And for all partners and donors, please help us seize the moment to raise predicable funding, for eradication and transition.  I urge you to join us in Berlin this October at the pledging event* generously co-hosted by the Government of Germany.  Your decision this week to support a stronger, sustainably financed WHO will enable us to sustain capacity in countries that are now polio-free and on the pathway to transition.  Thank you all once again for your commitment to consigning polio to the history books.”

This call to action was echoed by Rotary International, the civil society partner of the global eradication effort.  Addressing the Assembly on behalf of its 1.2 million members worldwide, Rotarian and Rotary Representative to the UN in Geneva, Professor Dr Pierre Hoffmeyer, concluded:  “We call on all countries to address gaps in routine immunization levels and ensure robust surveillance to prevent further virus spread and avert future outbreaks.”


*In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.  In October 2022, Germany will generously co-host a global pledging moment, giving the international development community the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

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

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

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

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

April 2022 – Convening this month in Geneva, Switzerland, the Strategic Advisory Group of Experts on immunization (SAGE), the global advisory body to the World Health Organization (WHO) on all things immunization, urged concerted action to finish wild polioviruses once and for all.

The group, reviewing the global wild poliovirus epidemiology, highlighted the unique opportunity, given current record low levels of this strain. At the same time, it noted the continuing risks, highlighted in particular by detection of wild poliovirus in Malawi in February, linked to wild poliovirus originating in Pakistan.

On circulating vaccine-derived poliovirus (cVDPV) outbreaks, SAGE expressed concern at continuing transmission, in particular in Nigeria which now accounts for close to 90% of all global cVDPV type 2 cases, as well as the situation in Ukraine, and its disruption to health services, urging for strengthening of immunization and surveillance across Europe.  It also noted the recent detection of cVDPV type 3 in Israel in children, and in environmental samples in occupied Palestinian territories, and urged high-quality vaccination activities and strengthened surveillance.

Preparing for the post-certification era, the group underscored the importance of global cessation of all live, attenuated oral polio vaccine (OPV) use from routine immunization, planned one year after global certification of wild poliovirus eradication.  To ensure appropriate planning, coordination and implementation, the group endorsed the establishment of an ‘OPV Cessation Team’, to consist of wider-than-GPEI stakeholder participation and ensure leadership on all aspects of OPV cessation.

SAGE will continue to review available evidence and best practices on a broad range of GPEI-related programmatic interventions, including as relevant the increasing role of inactivated polio vaccine (IPV), including in outbreak response and effects of novel oral polio vaccine type 2 (nOPV2), as part of global efforts to secure a lasting world free of all forms of poliovirus.

17 March 2022 — On Monday 7 March 2022, a case of circulating vaccine-derived poliovirus type 3 (cVDPV3) was confirmed in an unvaccinated girl aged three years and nine months in Israel. The girl had developed acute flaccid paralysis and upon testing of her stool, poliovirus was confirmed.

Further testing of the virus isolated from the girl revealed genetic links to VDPV3-strains detected in environmental samples collected between September 2021 and January 2022 from sites in Jerusalem and Bethlehem.

Circulating VDPV3 has also been confirmed in a sample taken from a contact in Jerusalem.  This child does not display any symptoms of paralysis.

A previous statement published on 10 March 2022 had indicated circulation of this VDPV3 also in occupied Palestinian territory; further field investigations concluded that at this time, circulation can only be confirmed in Israel.  This classification does not however change the risk this cVDPV3 presents to children in Israel and in the occupied Palestinian territory, nor the planned response activities.

 Although there is currently no evidence of circulation of this cVDPV3 in occupied Palestinian territory, the proximity and interconnectedness of communities on both sides of the border and the volume and frequency of cross-border population movement underscore the risk to unvaccinated children in both places.

Local health authorities in both Israel and occupied Palestinian territory are conducting field, epidemiological and virological investigations, to determine more clearly the source and origin of the isolated virus and potential risk of further spread associated with it. Discussions are ongoing to plan an immunization response as appropriate (extent and scale to be determined, potentially to include a series of immunization outreaches with both inactivated polio vaccine and bivalent oral polio vaccine, both in high-risk areas of Israel and occupied Palestinian territory).  At the same time, efforts are continuing to strengthen surveillance comprehensively in both Israel and occupied Palestinian territory.

Experts from headquarters, regional and country offices of the Global Polio Eradication Initiative (GPEI) partnership, which includes WHO, Rotary International (RI), the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation (BMGF) and Gavi, the Vaccine Alliance, are working together to help ensure an appropriate response and cessation of this outbreak.

Detection of this cVDPV3 underscores the importance of strong disease surveillance and high population immunity levels, in order to minimize the risk and consequences of any poliovirus introduction or emergence.

The GPEI partnership urges all health authorities to enhance surveillance for poliovirus and implement enhanced vaccination response to prevent further transmission, so that no child is at risk of lifelong paralysis from a disease that can so easily be prevented. GPEI is committed to assisting the health authorities in their efforts to stop the cVDPV3 outbreak.

17 February 2022 As a result of ongoing disease surveillance, the Global Polio Laboratory Network (GPLN) has confirmed the presence of type 1 wild poliovirus (WPV1) in a child suffering from paralysis in Tsabango, Lilongwe, Malawi. Analysis shows that the virus is genetically linked to WPV1 that was detected in Pakistan’s Sindh province in October 2019.

The three-year-old girl in Malawi experienced onset of paralysis on 19 November 2021, and stool specimens were collected for testing on 26 and 27 November. Sequencing of the virus conducted in February by the National Institute for Communicable Diseases in South Africa and the U.S. Centers for Disease Control and Prevention confirmed this case as WPV1.

Detection of WPV1 outside the world’s two remaining endemic countries, Pakistan and Afghanistan, is a serious concern and underscores the importance of prioritizing polio immunization activities. Until polio is fully eradicated, all countries remain at risk of importation and must maintain high vaccination coverage to protect all children from polio.

The GPEI is supporting health authorities in Malawi to conduct a thorough assessment of the situation and begin urgent immunization activities in the subregion to mitigate any risk of spread. Surveillance measures are also being expanded in Malawi and neighboring countries to detect any other potential undetected transmission.

As an imported case from Pakistan, this detection does not affect the WHO African Region’s wild poliovirus-free certification status officially marked in August 2020. Malawi last recorded a case of wild poliovirus in 1992. The polio eradication programme has seen importations from endemic countries to regions that have been certified wild poliovirus-free in the past, and has moved quickly to successfully stop transmission of the virus in these areas.

Polio anywhere is a threat to children everywhere. Now is the time for all parties to recommit to ending all forms of polio for good.

The Executive Board Room at WHO Headquarters during the 150th EB session. © WHO

January 2022, Geneva, Switzerland – As the world enters 2022, and with it the year when the new GPEI Strategy 2022-2026 – Delivering on a Promise – takes effect, global public health leaders at this week’s WHO Executive Board urged for intensified eradication efforts to capitalize on a unique epidemiological window of opportunity.  2021 saw the lowest ever levels of wild poliovirus cases in history, with five cases reported from the remaining two endemic countries, Pakistan and Afghanistan.  Cases of circulating vaccine-derived poliovirus have also declined compared to 2020.

Delegates attributed this favourable situation to sustained commitment from the highest levels in polio-affected areas, but issued severe warnings against complacency.  “2021 set the stage for success,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “We must now not lower our guard.”

“What is clear is that in 2022, we have a very real and realistically achievable opportunity to finish wild poliovirus from the world once and for all,” said Aidan O’Leary, Director of the Global Polio Eradication Initiative, WHO.  “But what is equally clear from the discussions at the Executive Board is that there is virtually no room for error now.  If we take our foot off the accelerator even by a little bit, this virus will come roaring back, and we will perhaps have lost the best chance yet for success.  The resounding message from this week’s meeting is this:  we cannot allow this to happen.  Success is the only acceptable outcome.”

Time and again, delegates, experts and partners such as Rotary International underscored the need to fully implement and finance the GPEI Strategy 2022-2026, highlighting that it clearly laid 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, including the novel oral polio vaccine type 2.

Delegates expressed appreciation at the polio programme’s ability to adapt to programmatic, epidemilogical and political developments, as demonstrated in Afghanistan last year, where – for the first time in more than three years – nationwide immunization campaigns resumed. At the same time, 2021 again saw the broader benefits of polio eradication, with health workers at the forefront supporting global COVID-19 response, vaccination and immunization recovery efforts, and the polio infrastructure now increasingly being integrated into broader public health systems in polio-free countries across the world. ​

With over 50 countries transitioning out of GPEI support in 2022, Member States also supported efforts to sustain the gains in polio-free countries, calling on WHO to continue its technical support in polio-free countries, and to ensure that polio assets, tools and expertise are effectively integrated into broader immunization, disease surveillance, primary health care, and outbreak preparedness and response efforts.

“Together with our partners at Rotary International, CDC, UNICEF the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we will continue to support Member States in their eradication efforts,” concluded O’Leary.  “But much is on the line.  We have everything in place – we need to focus now fully on optimizing our tools and tactics, and ensuring the resources to do so are available.  If those two things come together, we will be able to give the world one less infectious disease to worry about once and for all.”

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 Faisal 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.”

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.

For many of the women and men who spent their careers fighting polio, retirement offers not rest and relaxation, but a continuation of their life’s work towards eradication. Across the Eastern Mediterranean Region, once and forever polio fighters are inspiring the next generation of eradicators with their commitment to the cause, and belief in the benefits of a polio-free future.

Meet some of the Region’s most beloved polio fighters as they look back on their careers and try to capture their unusual motivation to continue their quest, as long as it takes.

© Dr Ali Farah

Dr Ali Farah, Somalia

Back in 1997, during the devastating civil war, Dr Ali Farah started a pilot project to conduct Somalia’s first-ever national immunization days. Today, that pilot project is one of the reasons Somalia hasn’t seen a case of wild poliovirus in more than seven years.

Dr Farah retired in 2015 after years of hard work in a highly complex, volatile, and risky context. Yet he continues to fight polio by providing technical support to the polio programme team, participating in social mobilization activities and training district-level polio officers and vaccinators.

“I always feel that we must keep working to fight polio. It’s a humanitarian action,” he said. “Technical staff still call me occasionally to receive guidance about AFP cases and other technical areas. I feel so happy to provide advice and support when needed.”

Dr Farah has also utilized his long experience with the polio programme to support COVID-19 immunization in Somalia.

“This COVID-19 campaign wouldn’t succeed if there was no polio infrastructure. We used the polio system and network to make it happen,” he said.

© Professor Elsadig Mahgoub

Professor Elsadig Mahgoub, Sudan

After completing his bachelor’s degree in 1969, Professor Elsadig Mahgoub trained as a physician and epidemiologist. He devoted his career to infectious diseases, largely focusing on disease surveillance. In February 2000, he focused his efforts on polio, particularly surveillance for acute flaccid paralysis (APF), the primary symptom of paralytic polio.

Although he retired four years later, Prof Elsadig hasn’t stopped working or providing his technical support to polio programmes in Sudan and across the Region.

“I’m obliged to continue working. My enjoyment is when I see progress towards polio eradication,” he said. “The service we’re providing is critical. We always need to be vigilant to avoid any setback to our achievements towards polio eradication. When we end polio for good, then I will truly resign.”

Dr Mohammed Hajar, Yemen

© Dr Mohammed Hajar

Yemen’s Dr Mohammad Hajar is one of the oldest, most veteran health professionals in Yemen, having served the health sector and combated infectious diseases, including polio, for around 50 years.

In 1977, Dr Hajar was one of the founders of Yemen’s expanded programme on immunization. He played a major role in planning and conducting the first-ever polio campaigns in the country, and he contributed substantially to setting up the epidemiological surveillance system for polio and other diseases.

“Even after reaching retirement age in 2009, I continued to work for the polio programme, which I consider as one of my sons. Until now, I follow up and evaluate the activities of the immunization programme and polio campaigns,” said Dr Hajar.

“I had the privilege of working with nine WHO representatives and more than ten ministers of health in Yemen to help Yemen reach a polio-free status.”

Dr Ibrahim Barakat, Egypt

© Dr Ibrahim Barakat

When Dr Ibrahim Barakat was appointed as a manager of Egypt’s expanded programme on immunization in 2000, he was determined to achieve something remarkable – a polio-free Egypt.

“It was a hard journey, but we did it. Egypt was declared polio-free in 2006,” he said.

In 2009, Dr Barakat retired, but he hardly rested. “I cannot stop working when it comes to polio eradication. I take great comfort in working hard to combat this disease whether in Egypt or any place in the world.”

After 12 years of retirement, Dr Barakat still considers his office in the Ministry of Health as “a second home.”

“I continue going to the office every working day to plan, supervise and evaluate different polio activities, including polio vaccination campaigns, risk assessment and AFP surveillance. I can never be complacent,” he said.

“This is my life. My real retirement starts when I see this disease completely wiped out from all parts of the world.”

Mr. Alam and Mrs. Fatima, Pakistan

Khursheed Alam, 68, and Kaneez Fatima, 56, are a married couple who have spent 25 years working in the polio eradication programme in Batagram district of Khyber Pakhtunkhwa province, Pakistan.

Rain or shine, Mr. Alam and Mrs. Fatima have taken part in countless door-to-door vaccination campaigns, helping to vaccinate thousands of children.

© Mr. Alam and Mrs. Fatima

“Now those little children have grown up, some have gotten married and had children who we have also vaccinated. This is fascinating and rewarding for us,” said Mr. Alam. “Wherever we go, people welcome us and don’t let us go without offering food.”

Mrs. Fatima personally knows every child in her neighborhood, including the newborns. She maintains close relationships with the mothers in her community and gives them health and hygiene advice.

Despite their age and medical complications such as asthma, their commitment to the polio programme remains strong.

“We take our work as a divine duty to serve our community for the sake of God. To see healthy children with smiles on their faces is our reward. This has kept us going for so long,” said Mrs. Fatima.

Dr Faten Kamel, Egypt

Dr Faten Kamel took a leading role in polio eradication efforts in the 1990s and early 2000s – years where the Global Polio Eradication Initiative made considerable gains against polio.

Growing up in Alexandria, Egypt, Dr Faten was exposed to the life-altering effects of polio on the people around her. She saw the human toll of the disease, and was inspired by the work of her father, a surgeon and Rotarian.

© Dr Faten Kamel

“We pushed the boundaries to make the programme more effective, shifting to house-to-house vaccination, detailed microplanning and mapping, retrieval of missed children and independent monitoring,” she said.

For Dr Faten, every child can, and must, be reached.

“If someone comes and says this area is inaccessible, this is not an answer for me. I ask: What should we do to reach? I like to make use of the ideas and experience that come from local people,” she said.

Dr Faten is proud to continue to be part of the polio eradication programme and looks forward to the day when polio eradication is achieved. After that, she plans to spend more time with her family in Australia.

“As a grandmother, I am especially determined to finish the job. I want my grandkids to grow up in a world free of polio. This will be my contribution to their futures.”

 

Reposted with permission from Gavi.

Anand Kumar learned to walk later than other children. When he did, he walked with difficulty, dragging his right leg. He was around three years old when his parents reached out for a diagnosis. “I’m sure that they tried all the doctors in Bangalore to just get it corrected. But the thing was: couldn’t do it,” he says.

His route to being an athlete was not remotely expected when he was a toddler. The doctors’ verdict ruled out recovery. Kumar had suffered irreversible damage to both his right arm and right leg as a result of an infection with poliovirus during infancy. He was unlucky: in most babies, the disease would have passed all-but-unnoticed, mistakable for a bout of the flu. But approximately one in 200 poliomyelitis patients suffer permanent paralysis. Around 5 – 10% of people paralysed risk dying if the muscles in their respiratory systems are immobilised.

Although the world’s first safe and effective polio vaccine – the Oral Polio Vaccine (OPV)1  – had been introduced decades before, and countries like the USA were newly polio-free, in the early 1980s, just 2% of India’s children had been administered the recommended three doses. During 1981 alone, India recorded more than 38,000 polio cases. The real tally may have stood much higher: researchers have pegged the actual incidence during the 1980s at closer to 200,000 cases a year.

By 1990, the annual infection figures were in decline. But the trend towards zero cases was halting, and jagged. In 2002, India’s depleted but persistent polio case-load jumped six-fold. A year later, India was home to 83% of all the new polio cases in the world. Uttar Pradesh alone, the vast and troubled northern state in which UNICEF had recently been obliged to launch a social mobilisation scheme to counter vaccine hesitancy, accounted for 64% of the world’s polio burden. The Global Polio Eradication Initiative redoubled its immunisation efforts, but as certain leading anti-polio campaigners would later admit, to some onlookers, the challenges of elimination in India looked at times simply too steep to surmount.

© Gavi/Prakhar Deep Jain

Meanwhile, in the late 1990s, Anand Kumar was leaving school for college with the frustrated awareness that he had been passed over. “Due to my disability, I was not active like other kids, so I was not taken into consideration for cultural activities or sports,” he says. “I was feeling that I was missing something.”

As such, he found his way to badminton late: aged nineteen, years too old to be taken on as a beginner by the coaches he approached for training, but newly cognisant of the existence and possibilities of para-sport. He  watched the coach at his local club from the bleachers – “luckily, the coach was a left-hander, and I’m always a left-hand player” – then practised the technique he observed on the court on his own. He improved quickly, began beating his able-bodied opponents.

In 2001, he was invited to represent India at a para-badminton tournament in Germany. “I thought, okay: I’m defeating the able-bodied players – and I can defeat the disabled players also.” Instead, he lost every match. Looking back, he calls it “a very good experience.” That was the year he decided to practice “most seriously.”

Success, Anand Kumar earnestly points out, has not come easily. “I have had to prove myself in each and every field,” he says. He meets young players inspired by his achievements – some 110 medals, including an Asian Games bronze, a BWF Para-Badminton World Championship doubles gold and a prestigious Ekalavya sporting award – “but I always like to share my other part of the story – which was very difficult, in which I struggled hard to come to this level,” he says. “Like, I started in the year 2001 to play an international tournament, but it took 15 long years to be a World Champion”.

© Gavi/Prakhar Deep Jain

That struggle has only been incidentally shaped by his disability, he clarifies. “Life is always challenging, whether it’s in an able body or a disabled body,” he says. The message he shares with the students he now coaches at his own Academy, able-bodied and disabled alike, is to take up life’s challenge with determination – put simply, to never give up.

Likewise, it took a number of tacks and switches to drive down polio in India – the introduction of improved bivalent polio vaccine in 2010; the institution of rolling vaccination at strategic transport hubs; hand-washing and sanitation campaigns to tackle the diarrhoea epidemic that was found to be weakening polio vaccine effectiveness, to name just a few – but in 2012, India finally arrived at zero polio cases.

“Today we are calling India polio-free,” Kumar says. “It’s only because of vaccination.” He’s right. But he’ll also tell you that no victory is ever quite that straightforward.

©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.

On June 10 2021, the GPEI held a virtual event to launch the new strategy. Here is a recording of the event. The video is also available with subtitles in: French | Arabic |