Little girl receiving polio drops © WHO/AFRO

13 March 2021, Brazzaville – To rapidly and sustainably stop outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) in African countries, a modified vaccine, known as novel oral polio vaccine type 2 (nOPV2) is now being rolled out.

Last year, on 25 August 2020, Africa made history with the African Region Certification Commission for Polio Eradication independently certifying that the Region was free of wild poliovirus. This is the second disease to be kicked out of Africa after smallpox more than 40 years ago.

This achievement is remarkable, considering that in the 1990s wild poliovirus paralysed more than 75,000 African children every single year – a situation that prompted Nelson Mandela in 1996, joined by Rotary International and other partners, to issue a stark call to action: Kick Polio Out of Africa!

All strains of wild poliovirus have now been interrupted in the continent. The last case of wild poliovirus was in August 2016.

However, this tremendous progress remains an unfinished success story. Although Africa is free of wild poliovirus, countries continue to be affected by another form of the virus, known as circulating vaccine-derived poliovirus type 2 (cVDPV2). Such strains are rare, but can occur in under-immunized communities with limited access to safe water and sanitation.

Populations that are adequately immunized are protected from both wild and vaccine-derived strains of poliovirus. However, because of gaps in immunization coverage across Africa, 20 countries have been affected by cVDPV2 outbreaks since 2018.

Now, intensified efforts are being launched to finish polio once and for all, to ensure no child in Africa will ever be paralysed by any strain of this virus.

The novel OPV2 vaccine has been in development since 2011, and in November 2020, WHO’s Prequalification Team issued an emergency use listing (EUL) recommendation enabling initial roll-out in countries affected by cVDPV2 outbreaks. Soon after the issuance of the EUL, the WHO Regional Director for Africa, Dr Matshidiso Moeti, advocated to countries to use this additional tool to stop all forms of polio in Africa.

For nOPV2 to be deployed and used under the EUL, special readiness requirements and criteria need to be met. The Polio Rapid Response Team at WHO’s Regional Office for Africa, in close coordination with other Global Polio Eradication Initiative partners, has been working intensely with countries and partners across the continent to respond to outbreaks of cVDPV2 and prepare for the roll out of nOPV2.

As countries in the Region gear up to roll out this new tool for outbreak response, with WHO’s support they are developing supply, demand and deployment plans; ensuring expedited pathways for national regulatory approvals; enhancing surveillance and laboratory capacity; investing in meeting cold-chain capacity and vaccine management requirements; ensuring vaccine safety monitoring and follow-up mechanisms are in place; and developing communication plans and engaging communities to enhance understanding of the vaccine and risks posed by cVDPV2.

These preparations continue even amidst the COVID-19 pandemic, and the existing polio eradication infrastructure has been instrumental in preparing for the nOPV2 vaccine as well as more broadly supporting COVID-19 response efforts across the continent.

Years of extensive development and preparations are now about to pay off, as nOPV2 will now be utilized for outbreak response. “This is tremendous news for Africa’s polio eradication effort, and in particular for Africa’s children who are currently at risk of lifelong paralysis due to circulating vaccine-derived poliovirus,” said Dr Moeti. “This tool can stop cVDPV2 but only if it reaches all at-risk children. We must apply the lessons from the decades of action to kick wild polio out of Africa. This will require the collective action of political leaders, traditional and religious leaders, public health experts, partners, donors, frontline health workers and of course parents and caregivers. Together, we can protect all African children from all forms of this virus.”

More information on nOPV2.

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O’Leary took over as Director for Polio Eradication at WHO on 1 January 2021, from Michel Zaffran, who will enter a well-deserved retirement end-February. O’Leary brings with him a vast array of experience in both polio eradication and emergencies, including through the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).

Outgoing Director Michel Zaffran (L) and Aidan O’Leary (R) ©WHO/Katerina Alves

PN:  Aidan, Michel, thank you both for taking the time to speak with us today. Aidan – you are taking over from Michel as Director for Polio Eradication at WHO. Polio is 99% eradicated globally, but it has been at 99% for many years. Ultimately, your job will be to achieve that elusive 100%. Do you find the task ahead daunting?

A-O’L:  I’m not sure ‘daunting’ is the adjective I would use. But ‘challenging’ for sure. As you say, we have been at 99% for many years now. We have reduced the incidence of polio from 350,000 children paralysed every year in 1988, to less than 1,000 in 2020. But that is not enough, not if we are trying to eradicate a disease. Polio is a highly-infectious disease, and if we did not know it before COVID-19, we certainly know now how quickly infectious diseases can spread globally.  If we do not eradicate polio, this virus will resurge globally.

PN:  As new Director, what will be your priorities?

A-O’L:  My priority, and all of our priorities, must be simply this: find and vaccinate every last child. If we do that, poliovirus will have nowhere to hide. That means in the first instance finding out where those last remaining unreached children are, and what obstacles stand in the way to vaccinating them. Is it because of lack of infrastructure? Insecurity or inaccessibility?  Lack of proper operational planning? Population movements? Resistance? Gender-related barriers? If we can identify the underlying reasons, we can adapt our operations and really zero in on those last remaining virus strains.

Amna showing her marked finger after receiving the life-saving polio vaccine in Karachi, Pakistan – one of the two remaining endemic countries.© WHO/EMRO

 PN:  Michel, you have led this effort for the past five years, and during that time have guided the effort to restrict wild poliovirus transmission to just Pakistan and Afghanistan. You have overseen the achievement of a wild polio-free Africa, an incredible achievement. However, this time has also seen an increase in emergence of circulating vaccine-derived poliovirus, or cVDPV, outbreaks.  How do you see the priorities going forward?

MZ:  The goal of this effort is of course to ensure that no child will ever again be paralysed by any poliovirus, be it wild or vaccine-derived.  This we have to achieve in phases.  First, we have to interrupt all remaining wild poliovirus strains, before we can then ultimately stop use of oral polio vaccine, or OPV for short, in order to eliminate the long-term risks of cVDPVs. Aidan has tremendous experience, in both remaining wild poliovirus endemic countries, having led the OCHA office in Afghanistan and having been Chief of Polio Eradication in Pakistan for UNICEF. So he knows the challenges and realities involved. Eradicating the last remaining strains of wild poliovirus must be the overriding priority – success ultimately hinges on that.

At the same time, we have new strategies, tools and approaches to address the increasing cVDPV emergency, notably the novel OPV type 2, or nOPV2 for short, to more effectively and sustainably stop such strains. Ultimately, though, we need to reach children. Only vaccinations save lives, not vaccines.

A-O’L:  Michel just mentioned an important word: emergency. And that is precisely what we are facing with polio, whether it’s wild or vaccine-derived. I believe my experience working in emergency settings can help us achieve our goal, including by linking polio operations more closely to other emergency efforts. That is also one of the reasons why WHO and UNICEF recently jointly issued an emergency call for action on polio and measles, and we hope all stakeholders will respond accordingly.

MZ:  I would echo that. Particularly in a post-COVID world, the programme must also continue to adapt its approaches and operations, and no longer work so much in isolation. We have to integrate with other efforts including emergency response and broader routine immunization efforts.

©WHO/Katerina Alves

A-O’L:  I would just add that Michel is really leaving me with a solid base to operate from. He and his teams across the GPEI partnership have built up such a strong infrastructure. I’m thinking here for example of the gender equality work of the programme – it has really been trail-blazing and I know other health and development efforts are looking to our experience on this. It’s a great opportunity to further leverage and expand collaboration with others. So we’ve really become a global leader in many new ways of working, and ultimately, that can only mean more support for this effort.

PN:  Thank you so much for speaking with us today.  Could we ask for final thoughts from both of you?

A-O’L:  We have many challenges, but if any network can achieve success, it is the GPEI network. Our greatest strength that we have is partnerships. Starting with Rotary International and Rotarians worldwide who are tirelessly working towards success, to our other partners including at my old organization UNICEF and our newest partner Gavi who is helping to integrate the programme, and of course ultimately to donor and country governments and communities: this is where our strength and power lies. If we harness this partnership effectively, if we all work together, then we will reach that last remaining child, and we will ensure that this disease is eradicated once and for all.

MZ:  For me it has been an absolute honour and privilege to lead this effort for the past years, and I leave with a sense of real optimism. I believe Aidan is the right person for this job right now. In November, at the World Health Assembly, we saw tremendous support for polio eradication from Member States. We have new tools, such as nOPV2, and tremendous new commitments. We are working on a new strategy, to lead us to success. But ultimately, all comes down now to implementation. 2020, the COVID year, taught us many lessons. Many of the questions that are still being asked about COVID – how does it transmit, where is it primarily circulating, what are the best tools and strategies to stop it – have been answered for polio. We know what the virus is doing, how it is behaving, and who it is affecting. Most importantly, we know what we have to do to stop it, and we have all the tools to stop it. But what 2020 also taught us is that this cannot last forever. We never know when a next COVID emergency comes along, which will disrupt everything.  In polio eradication, we are being given another chance in 2021, after a bruising 2020. We have to capitalize on it. We have to focus everything on implementation. If we do that, success will follow.

Syed Razzaq, technical officer for MIS/IT information management team lead shows data on Pakistan’s COVID-19 response at the operations room at National Emergency Operation Centre (NEOC) for Polio Eradication, located inside the National Institute of Health. © WHO/EMRO

In a newly-released statement following the final meeting of the Polio Oversight Board (POB) that was held virtually on 18 December 2020, the POB looks back at the support that the programme provided to respond to the COVID-19 pandemic, while remaining  strongly devoted to the goal of a polio-free world. The POB reaffirms its commitment that polio-funded assets are available to countries to respond to the COVID-19 pandemic, especially in the next phase of COVID-19 vaccine introduction and delivery.

The POB also believes that for countries introducing COVID-19 vaccine, there are lessons and experiences to be learnt from the rollout of nOPV2 under the EUL recommendation, if emergency regulatory pathways such as WHO EUL are used, including in the areas of monitoring readiness-verification, safety surveillance, and regulatory considerations.

Download the statement.

Polio worker Aliza Mukhtyar vaccinates a child in Saddar town, Karachi, during an August 2020 campaign. Work continues to support women’s full participation in the polio programme. ©UNICEF/Pakistan

In 2018, Jawahir Habib, a Programme Officer in UNICEF’s Polio Outbreak Team based in Geneva, received a letter. It was from a Pakistani woman she had met while working in the Quetta block – one of the most high-risk polio areas of Pakistan. The letter read:

“I have four daughters, and my daughters are in school because of the polio programme. I can afford to teach my girls which my husband opposed. Now they too can get education and live an independent life. I will make sure every child is covered and this is my mission.”

Words like these inspired Jawahir and set her on a path to a ten year career in polio eradication. She recalls her first day at work, “That day was very interesting – I was chased by dogs in the Kharoatabad area of Quetta. Although I managed to save myself, I spent the whole day crying and realizing that polio workers face this type of adversity day to day. I knew that I must become a part of this and ten years later, I am still working to eradicate polio”.

Jawahir has over ten years’ experience in polio eradication. Despite the challenges, she has stayed motivated throughout.

The more Jawahir became involved in the polio programme, the more she witnessed women facing social challenges. At the time, suboptimal campaigns in the polio reservoirs was one of the major hurdles faced by the programme and the number of missed children in Quetta block remained very high.  More than 70% of frontline workers were male or non-locals, resulting in limited access to households.

It was then that the Pakistan programme began looking at success stories from other parts of the world, including Nigeria, where Volunteer Community Mobilizers (VCMs) were making significant strides in eradicating polio. The need to build a network of local female health workers who were trusted and could gain access became more and more clear. Balochistan, where Jawahir is originally from, is one of the most remote and conflict-ridden areas of Pakistan and strict conservative religious and cultural norms, tribal conflicts and insecurity would prove very challenging.

When Jawahir’s team started recruiting, training and deploying women frontline workers in Quetta block, she was told it was impossible. “I was told that there was no way we could manage a workforce comprising of women working in these areas”. As a team leader, Jawahir had to create an enabling environment for women to work, keep them motivated and ensure systems were in place for them to reach every child in the block. “At a personal level, I had to lead by example and show everyone that women could work in these difficult areas, face resistance and achieve what a man could – in this case, even more.”

Jawahir knew well the challenges of being a young woman in a male dominated society. Born in Kili Mengal Noshki, a remote village in Balochistan bordering Afghanistan, she faced a lot of challenges. Despite this, Jawahir got her bachelors degree, a postgraduate diploma in public health management and a masters degree in health communication from the University of Sydney.

While working on polio, she had to work twice as hard as men, facing threats, gender biases and intimidation. What kept her inspired and motivated was being a part of something much bigger which she believed could change the world.

During this time, Jawahir’s team managed to identify, train and deploy a workforce of 3500 Community Based Workers (CBV) where 85% of the frontline vaccinators were women. During the first few campaigns 700,000 children in the core reservoir area were registered and vaccinated and more than 150,000 children who had previously been missed during the campaigns were mapped and given oral polio vaccine. One of the notable success of female teams was seen in Chaman Tehsil, on the border with Afghanistan, where within four months, the number of chronic vaccine refusals went from 15,000 to 400 children. That was a huge success for Pakistan’s polio eradication goal.

A father and daughter polio vaccination team at a refugee camp in Pakistan. Women play an integral role to build trust with communities and reach as many children as possible with vaccines. ©UNICEF Pakistan / Jawahir Habib

Jawahir attributes the success to the brave women who have made a major contribution to their society. She sees the empowerment of woman in one of the most difficult parts of the world as GPEI’s legacy of social change now and for the future. “Imagine a workforce of thousands of women having access to every household – imagine the venues we have for routine immunization, for nutrition, health and even education”.

The COVID-19 pandemic has compounded a rise in polio cases in Pakistan in 2019 and 2020, and polio eradicators once more have their work cut out to bring down virus transmission and protect populations.

“I believe now it is the responsibility of each and every one of us in the polio programme, whether a polio worker in Chaman or an Officer in Geneva, to ensure that this disease is eradicated once and for all. We will carry on no matter the hurdles and obstacles placed on our road, and we will finish the race.”

Aidan O’Leary (left) during a field visit.

Mr Aidan O’Leary has been officially appointed as the new Director for Polio Eradication at the World Health Organization, with effect from 1 January 2021.  O’Leary is taking over from Michel Zaffran, who will enter retirement end-February.

O’Leary brings with him a wealth of emergencies and public health experience.  Originally from Ireland, he is currently Head of Office in Yemen for the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), in addition to having extensive experience in emergency settings such as Iraq and Syria, where he also served as Head of Office for OCHA.

O’Leary also has strong experience of working on polio eradication in the remaining wild poliovirus endemic countries.  He was Chief of Polio Eradication in Pakistan for UNICEF from 2015-2017 and Head of Office for OCHA in Afghanistan from 2011-2014.

Aidan O’Leary

“I’m excited to join this incredible programme,” commented O’Leary on his appointment. “COVID-19 led to a tough year for polio eradication in 2020, but we have adapted our strategies and I believe this programme has a real opportunity to reboost our efforts in 2021. I’ve been so impressed by how this programme has taken on challenges and continues to innovate, and all of it rooted in its strong partnership. I look forward to working with all partners, including my old organization UNICEF, and of course Rotarians from around the world.”

“With this appointment, I am able to enter my retirement with a sense of reassurance,” said Michel Zaffran.  “He is the right person for the job at this time, given his set of experiences both in the polio programme and emergencies, and in particular in Pakistan and Afghanistan.  I am confident his leadership will help drive this programme to ultimate success.”

O’Leary joins the GPEI in 2021, and will focus on capitalizing on new commitments displayed at the World Health Assembly in November, the introduction of new tools and innovations such as novel oral polio vaccine type 2 (nOPV2), and an optimization of new governance and strategy structures currently being developed across the partnership.

The GPEI welcomes Aidan O’Leary to the GPEI family.

The Executive Board Room at WHO Headquarters during the first ever virtually-held World Health Assembly. © WHO/C. Black

In a year marked by the global COVID-19 pandemic, global health leaders convening virtually at this week’s World Health Assembly called for continued urgent action on polio eradication. The Assembly congratulated the African region on reaching the public health milestone of certification as wild polio free, but highlighted the importance of global solidarity to achieve the goal of global eradication and certification.

Member States, including from polio-affected and high-risk countries, underscored the damage COVID-19 has caused to immunization systems around the world, leaving children at much more risk of preventable diseases such as polio.  Delegates urged all stakeholders to follow WHO and UNICEF’s joint call for emergency action launched on 6 November to prioritise polio in national budgets as they rebuild their immunization systems in the wake of COVID-19, and the need to urgently mobilise an additional US$ 400 million for polio for emergency outbreak response over the next 14 months.  In particular, Turkey and Vietnam have already responded to the call, mobilising additional resources and commitments to the effort.

The Assembly expressed appreciation at the GPEI’s ongoing and strategic efforts to maintain the programme amidst the ‘new reality’, in particular the support the polio infrastructure provides to COVID-19-response efforts. Many interventions underscored the critical role that polio staff and assets play in public health globally and underline the urgency of integrating these assets into the wider public health infrastructure.

At the same time, the GPEI’s work on gender was recognized, with thanks to the Foreign Ministers of Australia, Spain and the UK for their roles as Gender Champions for polio eradication.

Delegates expressed concern at the increase in circulating vaccine-derived poliovirus (cVDPV) outbreaks, and urged rapid roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation oral polio vaccine aimed at more effectively and sustainably addressing these outbreaks.  This vaccine is anticipated to be initially rolled-out by January 2021.

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked the global health leaders for their continued dedication to polio eradication and public health, and appealed for intensified global action to address immunization coverage gaps, by prioritizing investment in robust immunization systems to prevent deadly and debilitating diseases such as polio and measles.

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GENEVA/ NEW YORK, 6 November 2020 UNICEF and the World Health Organization (WHO) today issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases.

The two organizations estimate that US$655 million (US$400 million for polio and US$255 million for measles) are needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.

“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”

“We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “Addressing the global COVID-19 pandemic is critical. However, other deadly diseases also threaten the lives of millions of children in some of the poorest areas of the world. That is why today we are urgently calling for global action from country leaders, donors and partners. We need additional financial resources to safely resume vaccination campaigns and prioritize immunization systems that are critical to protect children and avert other epidemics besides COVID-19.”

In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world.  Vaccination coverage gaps have been further exacerbated in 2020 by COVID-19. In 2019, measles climbed to the highest number of new infections in more than two decades. Annual measles mortality data for 2019 to be released next week will show the continued negative toll that sustained outbreaks are having in many countries around the world.

At the same time, poliovirus transmission is expected to increase in Pakistan and  Afghanistan and in many under-immunized areas of Africa. Failure to eradicate polio now would lead to global resurgence of the disease, resulting in as many as 200,000 new cases annually, within 10 years.

New tools, including a next-generation novel oral polio vaccine and the forthcoming Measles Outbreak Strategic Response Plan are expected to be deployed over the coming months to help tackle these growing threats in a more effective and sustainable manner, and ultimately save lives. The Plan is a worldwide strategy to quickly and effectively prevent, detect and respond to measles outbreaks.

Notes to editors:

Download photos and broll on vaccinations, including polio and measles vaccinations here

Generous support from Gavi, the Vaccine Alliance, has enabled previous access to funding for outbreak response, preventive campaigns and routine immunization strengthening, including additional support for catch-up vaccination for children who were missed due to COVID-19 disruptions in Gavi-eligible countries.  However, significant financing gaps remain in middle-income countries which are not Gavi-eligible.  This call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. To know more about UNICEF’s work on immunization, visit https://www.unicef.org/immunization

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About the Global Polio Eradication Initiative

The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

About the Measles & Rubella Initiative

The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, the United Nations Foundation and the World Health Organization. Working with Gavi, the Vaccine Alliance, and other stakeholders, the Initiative is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 23 million lives by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and supporting demand for vaccine.

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