GPEI-G7 Heads of State and Health Ministers call for global support to achieving lasting polio-free world by 2026, ahead of WHA

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

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

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

A child receiving the life-saving polio drops. © WHO

A key priority in 2023 is to end both wild- and variant polio transmission around the world is focusing on the most consequential geographies where children are at the highest risk of encountering and spreading the virus, and which collectively accounted for 90% of all new polio cases worldwide in 2022. Northern Nigeria is one of these seven subnational areas that now hold the key to a polio-free world.

In Nigeria increased vaccination and surveillance efforts have yielded positive results in 2022: No isolates from the country’s main historical transmission chain, the Jigawa lineage, which was responsible for most cases and international spread to many neighbouring countries in West Africa, have been detected since February 2022. There was a decline from 1028 cases as on 31st December 2021 to 168 cases as on the 31st December 2022. As a result, the virus is currently confined primarily to two states in the northwest zone of the country, namely Sokoto and Zamfara. This presents a distinctive opportunity for Nigeria to interrupt transmission by December 2023, according to the Expert Review Committee for Polio Eradication and Routine Immunization (ERC), the independent technical group advising the country on its eradication efforts.

In February 2023, the ERC convened its 39th meeting in Nigeria to make recommendations aimed at interrupting transmission of variant type 2 polio and maintaining its indigenous wild poliovirus-free certification status along with the entire African Region. Led by the Ministry of Health’s National Primary Healthcare Development Agency and supported by GPEI partners, Nigerian civil society and Rotarians across the country, efforts are intensifying to fully implement the National Polio Emergency Action Plan (NPEAP).

The country has developed a comprehensive National Polio Emergency Action Plan (NPEAP) to address the risks of all poliovirus types in order to ensure Nigeria and the entire Region’s certification status is maintained, within the context of the political transitioning process, the impact of COVID-19 on the national health systems and economy as well as the increasing concerns of insecurity affecting surveillance and vaccination reach. All recommendations made by the ERC are aimed at aligning the NPEAP with the 2022-2026 Global Polio Eradication Initiative (GPEI) Polio Eradication Strategy.

Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria

The ERC noted that the proposed activities for 2023 are contingent on three critical enablers, namely the global stockpile of novel oral polio vaccines (nOPV2) and bivalent oral polio vaccines (bOPV), constraints in financial resources, and a smooth political transition to drive political commitments at sub-national levels. Given the impact of variant type 2 poliovirus over the last few years, there should be limited room for complacency to reach the finish line for the interruption of these strains. The ERC, therefore, called on all partners to support the implementation of the NPEAP for 2023.

The conference also highlighted some of the achievements made in the fight against polio in Nigeria. The conference also highlighted some of the achievements made in the fight against polio in Nigeria. In 2022, there was an 84% decline in variant type 2 poliovirus cases, reduced from 415 cases in 2021 to 48 in 2022. The quality of Supplemental Immunization Activities (SIAs) improved, especially in the last quarter of 2022, and there were narrowed surveillance gaps at sub-national levels. Routine immunization (RI) coverage also improved from 33% in 2016 to 57% in 2022, and COVID-19 vaccination was also optimized to improve demand generation and delivery of other essential immunization vaccines.

The ERC made recommendations in nine thematic areas to fully implement the National Polio Emergency Action Plan, including by continuing to strengthen surveillance, mitigate risks due to inaccessibility and insecurity, build a more resilient routine immunization programme, assure solid vaccine management and advocate for a polio-free Nigeria.

In conclusion, 2023 is a critical year for polio eradication efforts in northern Nigeria and the other most consequential geographies for poliovirus transmission. The global community must continue to support these efforts to ensure that no child is left behind, and we can finally achieve a polio-free world.

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

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

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

Vaccinators: the backbone of programme

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

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

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

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

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

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

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

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

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

One house done, now on to the next one.

Vaccines: two drops for every child

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

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

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

Tally Sheets: supporting real-time corrective actions

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

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

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

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

Getting past the finish line

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

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

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

By Rimsha Qureshi,
Communications Officer, GPEI Hub Amman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Zehra Abid,
Communications Officer, WHO Pakistan

By Aidan O’Leary, Director for Polio Eradication, World Health Organization, and
Chair of the Global Polio Eradication Initiative Strategy Committee

2023 is a critical year for the Global Polio Eradication Initiative (GPEI). It is the target year to interrupt all remaining wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) transmission chains, per the GPEI Polio Eradication Strategy 2022-2026. A rigorous independent review will be undertaken by the third quarter of 2023, to assess whether the programme is on track to meeting Goal 1 and Goal 2 of the Strategy: permanently interrupt all poliovirus transmission in endemic countries; and, stop transmission of cVDPV2 and prevent outbreaks in non-endemic countries.

Despite the detection last year – the first operational year of the Polio Eradication Strategy – of several high-profile polio emergences, including in places such as New York and London, 2022 saw perhaps some of the most significant progress in the programme’s history, and has set up the global polio effort for a unique opportunity to achieve success in 2023. A unique, but limited, epidemiological window of opportunity exists at the beginning of 2023. Key to success is reaching remaining ‘zero dose’ children (children who are either un- or under-vaccinated) in seven, subnational ‘most consequential geographies’. These geographies – eastern Afghanistan, the southern area of Khyber Pakhtunkhwa in Pakistan, Tete province in northern Mozambique, north-western Nigeria, eastern Democratic Republic of the Congo (DR Congo), northern Yemen and south-central Somalia – which now together account for 80% of all polio cases worldwide (WPV1 – 100%, cVDPV2 – 80% and cVDPV1 – 76%) over the past 12 months (as at 28 March 2023).

As the first quarter of 2023 draws to a close, the GPEI’s analysis is that the programme remains on track to interrupt all remaining wild poliovirus transmission in 2023 – both endemically in Pakistan and Afghanistan, and in the outbreak setting of south-east Africa. Not-withstanding the challenging operational contexts in eastern Afghanistan and the southern area of Khyber Pakhtunkhwa, intensified country efforts have resulted in a historically-low number of biologically-distinct virus lineages remaining in circulation and an ever-shrinking number of infected districts.

The situation with interrupting cVDPV2 transmission is more mixed. Compared to other most consequential geographies, increased efforts in Nigeria have yielded positive results through 2022 and beyond. The country’s main historical transmission chain, the Jigawa lineage, which was responsible for the majority of cases and international spread, appears to have been effectively halted. New cases continued to decline in the second half of 2022. As a result, the virus is currently confined primarily to specific regions in the north-west. In Somalia, where we have witnessed unbroken transmission since 2016, the numbers of inaccessible districts have been reduced to zero and inaccessible children to <80,000 by the end of the first quarter of 2023.

Polio Eradication Strategy 2022-2026 planning and budgeting timeline, 2021-2027+

In eastern DR Congo and northern Yemen, ongoing issues of access, acceptance and the delivery of high quality immunisation activities to maximise coverage remain concerning as both outbreaks continue to expand (including internationally) at the start of 2023. Both contexts are protracted, complex humanitarian emergencies. The programme at all levels is in the process of implementing a range of corrective course measures to urgently reverse this trend and get outbreak response in both contexts onto a footing to achieve success. Pending the effective and sustained impact of these measures, it is unlikely that the end-2023 interruption target would be successfully met.

Independent review to provide clearer and independent assessment of status

At the time of the launch of the GPEI Strategy, a commitment was made to undertake a rigorous review of its implementation. This review will be conducted by the Independent Monitoring Board (IMB), an independent group of public health experts established at the request of the World Health Assembly in 2010, to monitor and independently verify progress towards the achievement of a lasting polio-free world.

The IMB has a long history in evaluating the GPEI’s cross-cutting work, and recommending measures to help strengthen strategic approaches. Its long-standing and independent input and analyses has over the years significantly contributed to sensitising strategic approaches. At the same time, again thanks to its long-standing engagement with the GPEI, IMB members have in fact become ‘polio’ experts, and not simply public health experts.

The independent review now planned will be geared specifically to:

evaluate progress towards Goals 1 and 2 of the Polio Eradication Strategy 2022-2026;
assess whether the strategic plan is a) on track, b) at risk, c) off track or d) missed; and,
identify areas where corrective action plans are required and evaluate the quality, implementation and impact of corrective action plans.

The GPEI will work closely with the IMB to ensure that it has all the necessary inputs, analytics and modelling required to inform its deliberations during a planned meeting during 11-13 July 2023. The IMB is anticipated to present its findings and recommendations to the GPEI Polio Oversight Board (POB) for decision at its face-to-face meeting in September/October 2023. Our collective aim is clear – to redouble all efforts and focus on the critical path to zero and delivering on the promise of a polio free-world.

Jennifer warned Rotarians against polio fatigue by insisting that the world has never been closer to winning the battle against the disease.

Speaking at an End Polio Now event at the House of Commons, the Canadian said she was mindful how Rotarians have heard over many years how close the world was the seizing victory.

“We get fatigued sometimes and people wonder when is it going to happen,” said Jennifer.

“But the reason for nights like tonight is to let you know that we are within reach and we have to have the confidence that we are doing to do this and keep our promise to the children of the world.”

Read more on Rotary’s Great Britain and Ireland website.

The European Polio Conference, organized by Polio-France in cooperation with the European Polio Union (EPU), will be held on 25-27 May in Nancy, France. Registration details and further information are available here.

This congress will not be a congress like any other, with a learned society that addresses its colleagues. It will be organized by a patient association that wishes to create the necessary conditions for the exchange of knowledge in order to perpetuate its dissemination, but above all to motivate research and innovation in care. This congress is aimed at people with polio and post-polio syndrome from all over the world, and health professionals concerned by the management of polio and post-polio syndrome.

PAKISTAN marked a historic moment for polio eradication a year ago. On Jan 27, 2022, for the first time, we clocked in a year without polio paralysing a child. There was a euphoric feeling that the country had finally turned a corner. The long battle to end this disease was thought to be close to an end. But the virus had other ideas.

Despite aggressive vaccination efforts, polio was surviving and continuing to spread in a small area in southern KP. First detected only in sewage water, the virus then paralysed a 15-month boy in North Waziristan. It was the first case of polio in nearly 15 months. I was in Karachi with several members of our team when the news came. Although not surprising given the circulation detected in the environment, it was heartbreaking to hear that another child in Pakistan would never walk again because of an easily preventable disease.

Emergency responses were immediately finalised. While preparing for the work ahead, memories took me back to Borno in Nigeria, a country where I spent a decade fighting polio. After the ‘last case’ of polio in Nigeria was reported in 2014, I started to check my phone every morning, relieved that another day had passed without the virus resurfacing. Typically, it takes three years without any poliovirus for a country to be declared polio-free. But in August 2016, 30 months after the last detection of the virus, a child from a security-compromised area of Borno was found paralysed by polio. As there was poor surveillance and no ability to vaccinate, the virus had found its hiding place. One paralysed child became three. And the outbreak brought Nigeria back to square one.

I knew that the case in North Waziristan was following a familiar pattern, but it was greatly challenging, nonetheless. The year 2022 was excruciatingly demanding. It was a year of feeling the weight of huge challenges, but moving on and choosing courage, commitment and hope every time.

We have aggressively responded to any outbreak in the country, restricting the virus to just seven districts in southern KP. Our virus surveillance network has nearly doubled. We have charted the movement patterns of nomads to reach children otherwise deprived of essential immunisation. We have launched a novel project that allows us to listen to hundreds of front-line women health workers and hear their recommendations for reaching the end goal. And we are consistently working towards improving overall healthcare in areas most at risk from polio.

Polio eradication has had remarkable support and remained a priority in one of the hardest years for the country. The prime minister holds quarterly meetings on polio eradication, bringing provincial and federal leadership together. The federal health minister has visited different provinces to encourage and support provincial health ministries. There is uniform consensus and commitment across all political parties that Pakistan must win this battle against polio, and now is the time.

This commitment is there at every level, from federal health secretaries, chief secretaries and chief ministers, to the deputy commissioners directly overseeing implementation. The military and law enforcement have given the programme their absolute support, making immunisation possible in some of the hardest areas to reach, while global advocates for polio eradication, including Bill Gates and the regional directors of WHO and Unicef, have made polio eradication a top priority in their visits to the country.

We have begun 2023 with great hope and greater commitment. The first nationwide campaign was recently concluded. Despite rain, cold, snow and ice, polio workers carried on with inspirational dedication. They are the face of Pakistan’s sincerity, perseverance and hard work.

The six months ahead are crucial to eradication. This is the closest Pakistan has ever been to interrupting transmission. But the risk of the virus continuing to circulate in the seven districts of KP’s south, and the risk of it exploding beyond and bringing the virus back to polio-free areas, is real.

Polio eradication now needs a renewed countrywide sense of urgency. It needs to be important to all of us to see this virus vanquished. After three decades of the polio programme in Pakistan, there is understandable fatigue. But this is not the time to tire. This is the time to believe. A world free of polio was the birth of a dream. In countless countries at countless times, it has felt like an impossible dream — until it was possible and actually happened.

Over 99 per cent of the world has made this dream come true. And it will come true for our children too if we take this as a collective fight and finish the job. Now is the time to strengthen that resolve, to come together and make the end of polio possible.

Written by Shahzad Baig, Lead, Pakistan Polio Eradication Initiative.

This article was originally published in Dawn on January 27, 2023.

3 February 2023, Geneva, Switzerland – At this week’s WHO Executive Board in Geneva, Switzerland, global health and policy experts urged a razor-sharp focus on finishing polio in the remaining highest-burden areas, from where the virus would continue to spread if given the chance.

In his opening address to the Executive Board, WHO Director-General Dr Tedros Adhanom Ghebreyesus noted that no wild poliovirus cases had been reported anywhere since September 2022, and commended support for this effort globally, including through the pledging of US$2.6 billion to the effort in October.

Experts noted the unique window of opportunity presenting itself to achieve success in 2023, the target year for stopping all remaining poliovirus transmission globally. They also provided guidance to develop a new vision for polio transition that will go beyond 2023, supported by tailored regional action plans to drive country progress.

Endemic wild poliovirus transmission is now limited to geographically-restricted areas of just two countries: Pakistan and Afghanistan. Intensified efforts in both countries have resulted in a historically-low number of biologically-distinct virus lineages remaining in circulation. Individual virus lineages are being successfully knocked out, demonstrating the effectiveness of strategies. Commenting on this current trend, Regional Director for WHO’s Eastern Mediterranean Dr Ahmed Al-Mandhari said: “Never have we looked so hard for the virus and found so little of it.”

Poliovirus transmission, either due to wild poliovirus or circulating vaccine-derived poliovirus, is now primarily affecting just seven subnational geographic areas, which together now account for 90% of all new polio cases worldwide. These “most consequential geographies” share certain key programmatic characteristics: they are home to some of the largest populations of “zero-dose” children, in other words, children who are either un- or under-vaccinated, and are affected by broader humanitarian, complex emergencies.

The overriding programmatic goal in particular in the first half of 2023 must be: to reach the remaining zero-dose children in each of these geographies by adapting operations to the nature of the complex humanitarian emergencies in each of these settings. This means operating effectively within the broader humanitarian context. It means working with broader humanitarian partners, to deliver polio vaccine alongside other interventions, in the most culturally-relevant and appropriate manner.

The Board noted of course the re-emergence of polio in the past year in previously polio-free areas, and commended local public health authorities for successfully managing these events. But more than anything, these events are a stark reminder of what would occur if we did not achieve global eradication – a global resurgence of the disease. Within that context, experts urged countries not to lose sight of the need to plan for securing a lasting polio-free world, including by fully implementing containment activities.

The meeting also noted that the capacities developed to eradicate polio underpin the health system in many places. As we move towards eradication, we must ensure that this expertise is not lost, and is instead integrated to strengthen national health systems, which are the backbone to prevent a future resurgence of polio. In 2022, ‘proof of concept’ was demonstrated, through the successful transition of over 50 polio-free countries out of Global Polio Eradication Initiative support. In these countries, the expertise and tools of the eradication programme have been repurposed to support essential immunization, primary health care, emergency preparedness and resilience and response capacities. The guidance provided by Member States at the Executive Board will be instrumental to shape the next stage of polio transition, through the development of a new global vision, guided by tailored action plans at the regional level, to ensure that transition efforts are fully aligned with global, regional and national health priorities.

For both polio eradication and transition, success depends on continued political and financial resources, and experts appreciate the tremendous show of support by the international development community demonstrated in the last quarter of 2022, including through the pledging of an additional US$2.6 billion in Berlin, Germany, in October 2022 at the World Health Summit, to the polio eradication effort. And while more resources must still be mobilized, in that context, the meeting especially appreciated the efforts of Rotary International, for their ongoing work in helping secure both public and civil society commitment to this effort. Speaking on behalf of Rotarians worldwide, Judith Diment MBE, Chair of the Polio Advocacy Task Force, said: “ Rotary proudly joined donors in Berlin to collectively pledge more than half of the funds needed for the GPEI’s strategy. We urge further investment by all sectors to overcome challenges and sustain these gains for future years.”

Dr Tedros, in closing the polio discussion, addressed the assembled delegates: “We are in a much better situation now than we were previously. But the last mile is the hardest. There can be no room for complacency. Now is actually the moment to double down on our efforts. Let’s continue to push on.”

In conclusion: there is a very real window of opportunity for success this year. But this window will not remain open for long. The virus will again gain in strength. 2023 is our chance. Let us take it. Let us keep the focus on our collective and clear objectives: reaching zero dose children in the most consequential geographies, and taking steps towards a sustainable transition, to ensure that a polio-free world, once achieved, stays that way. We all have a role to play in achieving this. We have a collective responsibility.

Experts urged therefore never to get distracted from that focus. If we are razor-sharp in our focus, success will follow.

In October 2022, the Technical Advisory Group (TAG) for Afghanistan and Pakistan met in Muscat, Oman, to conduct a thorough review of ongoing polio eradication efforts in the remaining polio endemic countries. During the 6-day meeting they also provided strategic technical guidance on steering efforts towards successful interruption of the poliovirus in both countries in 2023.

Polio programmes make significant progress, despite challenges

The TAG recognized the accomplishments of the polio programmes despite longstanding humanitarian crisis in Afghanistan and unprecedented levels of flooding across Pakistan that affected almost 33 million people. The progress comes due to concerted efforts by all stakeholders across all levels, intense vaccination schedule, timely programmatic pivots to changing epidemiology and the full support of law enforcement and security agencies in implementation of polio vaccination campaigns.

Members noted the high level of sustained political commitment to polio in both countries. In Afghanistan, since the political transition, nationwide campaigns have allowed the polio programme access to almost 10 million children, 3.5 million of whom were previously inaccessible. In Pakistan, intensified vaccination activities and strategic approaches were used to reach missed children.

The TAG also acknowledged the strategic role played by the Emergency Operations Centres (EOCs) in strengthening coordination and providing programmatic oversight at the national and regional levels.

Promising epidemiological trends provide a window of opportunity

Remarkable improvements in epidemiology in Afghanistan and Pakistan provide a window of opportunity for interrupting transmission of wild poliovirus. In Pakistan, the virus is endemic only in the southern districts of Khyber Pakhtunkhwa province, and in Afghanistan both cases have been reported from the eastern region. However, no cross-border transmission was recorded in 2022.

In addition to the limited geographical spread, the biodiversity of the genetic clusters is also at an all-time low: down from 8 in 2020 to 2 in 2022 in Afghanistan and from 11 in 2020 to one in 2022 in Pakistan.

Moreover, there has been no detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in either country in the last year. The last cVDPV2 case in Afghanistan had onset of paralysis on 9 July 2021, and the last cVDPV2 case in Pakistan had onset of paralysis on 23 April 2021.

Given the promising epidemiological trends seen in 2022, the TAG noted the possibility of full interruption of polioviruses this year. However, for the 2 programmes to succeed, the TAG proposed major strategic shifts in categorization of risks based on the epidemiological trends. The group of experts’ recommendations include context-specific tactics and technical guidance on activities to prioritize until mid-2023, when the TAGs for Afghanistan and Pakistan will meet again.

This new categorization redefines and re-demarcates the endemic zones in Afghanistan and Pakistan from the outbreak districts and the rest of the country where it is important to maintain children’s immunity. Additionally, it identifies highly vulnerable and consequential areas that are an additional risk category for Pakistan, where historically core reservoirs may play a role in establishing circulation in an event of reinfection.

The TAG also endorsed the 2023 polio supplementary immunization activities’ calendars for Afghanistan and Pakistan and emphasized continued cross-border coordination between the 2 countries, particularly in the key corridors. Finally, the TAG encouraged the continued use of strategies to integrate gender and social behavioural change communication into the programme’s activities, to reach every last child.

To read the reports from the Technical Advisory Group meeting on Afghanistan and Pakistan, click here.

The programme is focusing on reaching zero-dose children (children who are either un- or under-immunized), in identified ‘consequential geographies’.

But what exactly are consequential geographies, and why are they so vital to the global effort to eradicate polio?

In this explanatory video, long-time polio eradicator and Director for polio eradication at WHO’s Eastern Mediterranean Region, Dr Hamid Jafari, explains more.

Martha Dodray is a health worker in the Kosi River Basin area of Bihar. In order to protect all children against polio, Martha has walked, waded, boated, and rode on motorcycles to reach the communities which are spread throughout the area. The region was one of the last to have polio transmission in India, which was certified polio-free in 2014. Kosi River Basin area near Darbhanga, Bihar State, India. November 2017.

India’s journey from the world’s epicentre of a highly infectious viral disease to turning polio-free was like walking on eggshells: Every step we took mattered.

On 13 January 2023, India completes 12 polio-free years – a remarkable achievement that was made as a result of consistent, determined efforts and genuine commitment at all levels.

I spent close to six enriching years of my life serving as the project manager of the National Polio Surveillance Project (NPSP) for WHO India. My work entailed providing technical assistance and strategic guidance to the national programme. I was also in charge of poliovirus surveillance, monitoring mass vaccination campaigns, crafting corrective measures and strategies, and working closely with government counterparts at all levels to ensure every child was vaccinated enough times to build their immunity. We delivered around 1 billion doses of polio vaccine to 172 million children each year over the course of four years leading up to the last case. And many more in the years after.

Taking a step back to reflect on this journey, there were several factors contributing to the monumental success of ending polio in India. The first fundamental factor was government commitment that consistently translated into diligent administrative action at the operational level. Even the district administrators were fully aligned with and committed to taking corrective measures based on evidence: accepting programmatic gaps and challenges and then committing to addressing them urgently.

Read more on the EMRO website.

A child in Karachi receiving the polio vaccine. @WHO

There is unprecedented support and commitment to ending polio in Pakistan by 2023, and with the current momentum maintained, the country will be able to interrupt transmission in the coming year, a high-level global delegation on polio concluded at the end of its visit to the country on Thursday.

The delegation was led by Chair of the Polio Oversight Board (POB) Dr Chris Elias, WHO Regional Director Dr Ahmed Al-Mandhari and UNICEF Regional Director George Laryea-Adjei.

“The last steps to ending polio are the toughest but eradication is within reach thanks to the hard work happening in Pakistan,” Dr Elias said.

“During my three-day visit, I was again impressed by the resolve of the government and community, especially frontline workers, to ensure polio is gone forever,” he added. “Reaching every child during the upcoming polio campaigns and strengthening the routine immunization system are now critical to success.”

The Polio Oversight Board is the highest decision-making body of the Global Polio Eradication Initiative. This is the delegation’s second visit together to Pakistan this year. The earlier visit was in May following the detection of a polio case in Pakistan after nearly 15 months. The recent visit comes following the destruction of several health facilities and mass displacement due to catastrophic floods, which increased the risk of polio transmission.

WHO Regional Director Dr Ahmed Al-Mandhari reaffirmed that Pakistan is in the “final stretch” of the road to eradication.

“The progress this year has well-positioned the country to end all poliovirus transmission in 2023. However, ensuring that we reach our goal will require sustained political and administrative commitment during 2023, a year of elections and political transition,” he said. “Under our regional vision of health for all by all, we all have a role to play in ending polio through our collective solidarity and action.”

UNICEF Regional Director for South Asia George Laryea-Adjei said that Pakistan’s success in containing the spread of polio through joint efforts by the government, donors, frontline health workers and partners is truly commendable.

“The recent flooding has exacerbated health risks for millions of children, especially those living in districts historically at the highest risk for polio, so we must redouble efforts to engage parents and caregivers to protect these children,” he said. “The end of polio is near, and we must now go the last mile to ensure every child is protected against this debilitating disease.”

During the visit, the delegation met the prime minister, federal health minister, Pakistan Army’s engineer-in-chief and the heads of provincial governments of Balochistan, Khyber Pakhtunkhwa and Sindh, and reiterated support to help Pakistan end poliovirus transmission by 2023.

Supporting vaccine equity

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

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

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.

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.

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.

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

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

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 21^st 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.