Financing and donors

The Strategic Round Table “All for Health, Health for All: the WHO Investment Case, 2025-2028” at the 77th World Health Assembly on 28 May 2024 in Geneva, Switzerland.

Ministers of Health, policy makers and public health experts from around the world met this week at the annual World Health Assembly (WHA) in Geneva, Switzerland, to set global public health policy. Aiming to agree ways forward on issues ranging from reaching all children with vaccines during the year that the world celebrates the 50^th anniversary of the EPI programme to dealing with growing antimicrobial resistance and reaching people living in areas of conflict with basic health services, delegates also discussed developments related to the Global Polio Eradication Initiative (GPEI). But why is this important? The decision to eradicate polio was taken long ago by the WHA – so why does it continue to feature on the agenda of the body that governs the World Health Organization?

While the GPEI is composed of six partners, the eradication effort and its strategy are fully owned and implemented by national governments, the Member States of the WHA. WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Gates Foundation and Gavi, the Vaccine Alliance support the global eradication strategy, monitor and evaluate implementation and fine-tune approaches. Between them, they provide expertise on the ground, scientific research, policy direction, financing, community engagement and advocacy. However, it is governments who are the primary owners of the global eradication effort, and communities who are the primary beneficiaries. All Member States and their populations will benefit equally from a polio-free world. The WHA is the primary convening mechanism for Member States, and the global ownership and decision-making related to polio eradication is taken by the WHA. In short, it is the ultimate and final oversight mechanism of the GPEI.

It started in 1988, when Member States adopted the goal of worldwide polio eradication. But that only marked the beginning of its oversight. Over the years, the WHA has adopted a number of strategic approaches to intensify the eradication effort, endorse new global vaccine solutions including the phased removal of oral polio vaccines (OPV), and to transition the polio assets, tools and knowledge to contribute to broader public health, agree on containment measures needed to safeguard a lasting polio-free world, address the need to minimize the international spread of polioviruses – which culminated in polio eradication being designated a Public Health Emergency of International Concern under the International Health Regulations.

Recognizing the unique nature of an eradication effort, the WHA has requested a comprehensive update on efforts to reach global eradication and to sustain a polio-free world at each annual WHA session (and via its Executive Board, typically held at the beginning of each year). This ensures that polio remains at the top of the global public health agenda, even as new global or regional public health threats emerge. In a demonstration of Member States holding one another accountable, the WHA expects the most up-to-date epidemiological and programmatic reports, a very clear picture of what challenges must be overcome, and who will be responsible to overcome them. This is particularly critical with a highly infectious disease that does not respect international borders.

So it is anything but ‘business as usual’, when Member States at the WHA examine the global polio situation and prospects for success. This year again, despite all the other critical public health issues being discussed, Member States spent time collectively reviewing the situation, examining challenges, celebrating successes and cautioning against complacence. Member States focused their discussions on the remaining endemic wild poliovirus type 1 (WPV1) strains in only a handful of districts of just two countries; reviewed the global emergency related to variant poliovirus type 2 outbreaks, limited to parts of a few countries with the most intense transmission; celebrated the African continent again becoming free of WPV1 following detection in 2022 of an imported poliovirus; called for bolstered integration efforts, and recognized recent announcements of new commitments by long-standing and new partners. Member States also discussed the new strategic framework for polio transition, which builds on lessons learned, and recognized the need for strong ownership and accountability during the polio post-certification era, to sustain a polio-free world.

Rotary International, representing its 1.2 million members worldwide as well as broader civil society, addressed Member States and reiterated its support to all countries in the effort. Most importantly, Member States unanimously reaffirmed their collected resolve to achieve a lasting polio-free world and committed to fully implementing strategic approaches in all areas, by mobilizing strong support and necessary resources.

“Progress in reducing both wild and variant polio virus in 2023, renewed access in areas critical to polio eradication, and recent investments renew hope and confidence that we will achieve our goal.

We applaud increased collaboration among the GPEI, Gavi and EPI to protect all children from vaccine preventable diseases. Such collaboration is essential to overcome challenges and fulfill the promise of a polio free world while also providing broader essential immunizations and services,” said Professor Pierre Hoffmeyer, Rotary International Representative to the United Nations in Geneva, addressing the WHA.

As GPEI partners, we take this opportunity to express our sincere and deepest gratitude, on behalf of the children of the world, for the WHA’s unwavering commitment to polio eradication. We in turn commit to doing everything we can to support you, the Member States. Together, let us realise the dream first dreamed up by Rotary International, and ensure that no child anywhere will ever again be paralysed by poliovirus.

Brazzaville, May 14, 2024 – Following thorough assessments in Malawi and Mozambique, an independent Polio Outbreak Response Assessment Team (OBRA) today recommended the closure of the wild poliovirus type 1 (WPV1) outbreak in Malawi and Mozambique, marking a significant milestone in the fight against polio in the African region.

The last WPV1 case in the African Region, linked to a strain circulating in Pakistan, was reported in Mozambique´s Tete Province in August 2022. A total of nine cases were detected in Mozambique and neighbouring Malawi, where the outbreak was declared in February 2022. In a coordinated response, more than 50 million children have been vaccinated to date against the virus in southern Africa.

The meticulous evaluation carried out by the OBRA team included two in-depth field reviews and supplementary data review, concluding that there is no evidence of ongoing wild polio transmission. The assessment considered the quality of the outbreak response, including the overall population immunity, supplementary immunization campaigns, routine immunization coverage, surveillance systems, vaccine management practices, and the level of community engagement.

The successful stopping of this outbreak reflects the unwavering commitment and collaborative efforts of African governments, health workers, communities and Global Polio Eradication Initiative (GPEI) partners, including Rotarians on the ground. Through robust surveillance, quality vaccination campaigns and enhanced community engagement, both countries have effectively controlled the spread of the virus, safeguarding the health and well-being of their children.

“This achievement is a testament to what can be accomplished when we work together with dedication and determination,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “I commend the governments of Malawi and Mozambique, as well as all those involved in the response, for their tireless efforts to contain the outbreak. It is now imperative that we continue to strengthen our immunization systems, enhance surveillance, and reach every child with life-saving vaccines.”

Health authorities, with high-quality technical support from GPEI, have put in place national prevention strategies in Malawi and Mozambique, as well as in all districts bordering other countries involved in the response. These include Tanzania, Zimbabwe and Zambia.

To date, more than 100 million vaccine doses have been administered in the most at-risk areas. The strategy to get ahead of this outbreak and stop it before it got out of hand relied on detailed micro-planning, including mapping of cross-border communities, migratory routes, cross-border entry/exit points, and transit routes for each of the cross-border facilities. Synchronization and coordination of vaccination plans across five countries, as well as the monitoring of vaccination activities, proved key to identifying and reaching all eligible children in the cross-border areas, to avoid the risk of paralysis due to the virus.

“The official closure of the outbreak is truly a success due to unfaltering determination and strong collaboration between the governments of Mozambique, Malawi and neighbouring countries, as well as between all partners and health workers. I want to particularly recognise the strong efforts of the vaccination teams working on the frontline to reach every last child,” said Etleva Kadilli, UNICEF Regional Director for Eastern and Southern Africa. “Going forward, routine immunisation must remain high up the priority list; no child is safe from polio until all children are vaccinated.”

To enhance polio surveillance, over the past two years, 15 new wastewater surveillance sites were established in the affected countries. These sites have a critical role to play in detecting silent circulating poliovirus in wastewater, ensuring that quality samples are sent to laboratories for timely confirmation and response to poliovirus presence.

Additionally, countries have scaled up efforts to protect children in high-risk areas by strengthening surveillance, and data and information management. World Health Organization (WHO) in the African Region’s Geographic Information Systems (GIS) Centre has analysed spatial and geographic data on visual maps, providing geographic real-time coverage information, including locating missing settlements, to improve vaccination coverage.

“Closing polio outbreaks is possible when national governments, local health workers, community mobilizers, and global partners come together to prioritize a rapid and timely response to protect children from this devastating disease,” said Dr. Chris Elias, president of Global Development at the Bill & Melinda Gates Foundation. “Malawi, Mozambique, and the entire Southern-African region are setting the example for what it takes to urgently improve vaccination campaigns and disease surveillance systems. Commitments like these will help us achieve a world free of all forms of poliovirus.”

Health experts, the OBRA team and GPEI coordinators on the ground underscored the pivotal role of enhanced polio surveillance, high quality community engagement in vaccination campaigns and timely outbreak response, including rapid deployment of experts and other field responders, to curb the virus.

Note to editors:

The notification of imported wild poliovirus in 2022 did not alter the certification of the African region as free of indigenous wild polio in August 2020, as the strain that was confirmed in southern Africa was imported.

Polio has no cure and can cause irreversible paralysis. However, the disease can be prevented and eradicated through administration of a safe, simple and effective vaccine.

As per the advice of an Emergency Committee convened under the International Health Regulations (2005), the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency, ensure the vaccination of residents and long-term visitors and restrict at the point of departure travel of individuals, who have not been vaccinated or cannot prove the vaccination status.

The Global Polio Eradication Initiative is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance. Since 1988, the incidence of wild poliovirus has been reduced by more than 99%, from more 350,000 annual cases in more than 125 endemic countries, to four cases in 2024 from two endemic countries (Pakistan and Afghanistan). In 2023, only 12 cases of WPV1 were detected globally.

The fight against polio in Pakistan reaches a critical juncture as a high-level delegation from the Global Polio Eradication Initiative (GPEI) concludes their visit from April 30 to May 3, underscoring the urgency for innovative strategies to reach children not being vaccinated and enhanced political commitment to achieve eradication.

Led by Dr. Chris Elias, Chair of the Polio Oversight Board (POB) and President of Global Development at the Bill & Melinda Gates Foundation, the delegation engaged in discussions with Pakistan’s political and security leadership to address persistent challenges in the final stages of eradication efforts. The delegation also comprised of WHO Regional Director for the Eastern Mediterranean Region, Dr Hanan Balkhy, UNICEF South Asia Regional Director, Sanjay Wijesekera, CDC’s Polio Eradication Branch Chief, Dr Omotayo Bolu, and Trustee Rotary Foundation and National Polio Plus Committee Chair, Aziz Memon.

In Islamabad, they met with Prime Minister Shehbaz Sharif, Acting Foreign Secretary Rahim Hayat Qureshi, Coordinator to the PM on Health Dr Malik Mukhtar Ahmed Bharath and Pakistan Army’s Engineer-in-Chief Lt-Gen Kashif Nazir.

The POB is the highest decision-making and oversight body of the GPEI – the largest international public health initiative aiming to end polio globally. This was the first high-level GPEI visit to Pakistan since the formation of the new government in March. The focus of the visit was to strengthen political commitment in Pakistan to eradicate polio.

“During my time in Pakistan, I have once again been impressed by the commitment from the federal and provincial governments to stopping polio transmission. With continued commitment across the country from leaders, and at all levels, I know the final push to defeat polio will be possible,” said POB Chair Dr Chris Elias.

The delegation also visited Peshawar and Lahore where they held meetings with the provincial chief ministers of Khyber Pakhtunkhwa and Punjab as well as provincial health ministers and chief secretaries to discuss their respective provinces’ progress and challenges on polio eradication.

“Engaging with Pakistan’s new political leadership during this visit has demonstrated the commitment of all partners to polio eradication, but we must use the coming months to leverage this commitment wisely, or we risk losing the momentum and the confidence that we can get the job done,” Dr Hanan Balkhy, WHO’s Regional Director for the Eastern Mediterranean Region.

She added: “Pakistan has the real opportunity to stop the endemic strain of poliovirus that has been restricted to south Khyber Pakhtunkhwa province. Strengthening the tailored responses to the increased detections of the imported poliovirus in the historic reservoirs is going to be critical to prevent largescale outbreaks in the coming months.”

Pakistan is one of only two polio-endemic countries. The country has made significant progress in reducing polio cases and eliminating diverse poliovirus strains in recent years. However, several challenges persist in its last mile of eradication, including disruptions to vaccination campaigns caused by insecurity, children being missed in vaccine campaigns and community distrust.

“We know what to do; we know how to do it. It is incumbent on all of us – government, health workers, partners and communities – to work together determinedly to keep every child in Pakistan safe from this deadly and preventable disease,” said UNICEF Regional Director for South Asia Mr Sanjay Wijesekera.

Recognizing the significance of tailored strategies, the delegation highlighted the imperative of reaching migrant populations in infected and high-risk districts. Drawing from successful experiences in India, where vaccination efforts focused on thoroughly mapped migrant populations were pivotal, it was stressed that similar approaches are indispensable for further progress. The delegation also underscored the indispensable role of Routine Immunization (RI) in sustaining hard-won gains in polio eradication. Collaboration with the Expanded Programme on Immunization (EPI) was highlighted as paramount, particularly in areas with pressing health needs.

Stronger political commitment was identified as a linchpin for addressing legitimate demands of deprived communities for services and galvanizing health workers. The delegation advocated for leveraging influence and support to engage community influencers, ensuring comprehensive community participation in vaccination.

Aziz Memon, Trustee Rotary Foundation/National Chair, Pakistan PolioPlus Committee said: “Rotary International congratulates the Government of Pakistan on its progress in the fight against polio and encourages a renewed and urgent commitment to addressing the remaining challenges the Polio Programme faces.”

“Rotary has invested almost US$427 million in polio eradication efforts in the country and affirms our continued support to the Polio Programme until the goal is accomplished and all children in Pakistan are protected from polio,” he said.

The visit coincided with the ongoing immunization campaign from April 29 to May 6, aimed at vaccinating over 24.4 million children under the age of five in 91 districts. Amidst these efforts, the GPEI delegation’s engagement signifies a pivotal moment in Pakistan’s fight against polio, urging concerted action and unwavering commitment from all stakeholders.

Note:

Polio is a highly infectious disease caused by poliovirus mainly affecting children under the age of five years. It invades the nervous system and can cause paralysis or even death. While there is no cure for polio, vaccination is the most effective way to protect children from this crippling disease. Each time a child under the age of five is vaccinated, their protection against the virus is increased. Repeated immunisations have protected millions of children from polio, allowing almost all countries in the world to become polio-free, except for the two endemic countries of Pakistan and Afghanistan.

For further information, please contact: Ms Hania Naeem, Communications Officer, NEOC,

Contact No:+923431101988

Email: hanianaim17@gmail.com

Islamic Development Bank Golden Jubilee, held in Riyadh, Saudi Arabia 28-04-24. © Tasneem Alsultan

On 28 April, the Islamic Development Bank (IsDB) and partners convened to celebrate the IsDB’s Golden Jubilee in Riyadh, Saudi Arabia. Over the last 50 years, the IsDB has been a leading partner in advancing health and development around the world, including through the polio eradication effort. Since 2013, the IsDB has provided US$ 587 million to the Global Polio Eradication Initiative (GPEI) and has been a key partner in promoting eradication and access to life-saving vaccines. To date, the IsDB is one of the largest providers of funding to the national polio eradication program in Pakistan – one of the last two countries where wild poliovirus remains endemic.

The same day, Saudi Arabia announced US$ 100 million in new funding to support the second phase of the IsDB’s Lives and Livelihoods Fund (LLF), which was launched last May. The LLF aims to lift the poorest out of poverty across 33 IsDB member countries through investments in primary health care, preventing infectious diseases like polio, enhancing smallholder farming, and improving infrastructure. This commitment follows a renewed pledge of US$ 50 million from the UAE to the LLF announced last week. To maximize the impact of every dollar, the Bill & Melinda Gates Foundation (BMGF) provides a 20% match of the total granted by donors to the LLF, up to US$ 100 million.

These pledges were part of a broader partnership of more than US$ 620 million announced by Saudi Arabia and BMGF, which also included US$ 500 million from Saudi Arabia to support the GPEI.

“The Islamic Development Bank warmly welcomes the Kingdom of Saudi Arabia’s generous contribution to the Global Polio Eradication Initiative. This vital support strengthens GPEI’s efforts to eliminate this devastating disease. We’re proud that IsDB and ISFD, our poverty alleviation arm, have been among the top financiers for Pakistan’s polio eradication efforts, providing over US$ 555 million since 2012,” stated Dr. Muhammad Al Jasser, IsDB President.

“We also applaud the Kingdom of Saudi Arabia’s new funding for the Lives and Livelihoods Fund. This innovative initiative tackles poverty barriers faced by families, communities, and entire countries. We express our sincere gratitude to all partners, existing and new, for their continued collaboration and commitment. Together, through these concerted efforts, we can achieve the critical last-mile results needed to create a truly polio-free world,” added the IsDB President.

“The fight to eradicate polio is a global effort, and it wouldn’t be possible without global partners. I’m grateful for the Islamic Development Bank’s ongoing support for polio eradication—through joint investments like the Lives and Livelihoods Fund, and particularly in Pakistan, one of only two countries where wild polio is still endemic. Eradicating polio is one of the most important legacies we can leave for future generations. And it will only be possible thanks to support from partners like the Islamic Development Bank,“ said Bill Gates, co-chair of the Bill & Melinda Gates Foundation.

Today, wild poliovirus is now endemic in just two countries – Pakistan and Afghanistan – and most variant poliovirus cases are increasingly confined to high-risk areas in just four countries – Nigeria, the Democratic Republic of the Congo, Somalia, and Yemen.

“The IsDB has played a key role in the fight against polio, helping the program reach millions of children with vaccines and strengthen health systems in the most critical areas to end this devastating disease.” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, “We thank them for their partnership in global health over the past 50 years and look forward to many more.”

“Communities all over the world are healthier today because of long-standing commitments to global health from partners, including the IsDB. Together, with donors, governments, and health workers, we can deliver a historic win for children and families everywhere and end polio for good,” said Catherine Russell, Executive Director of UNICEF.

The GPEI has the tools and strategies needed to ensure children today and for generations to come are protected from paralysis or even death due to polio. But in many of the places where polio remains, there are complex challenges to reaching all children with vaccines and other life-saving interventions, including vaccine misinformation, political insecurity, environmental disasters, and broader humanitarian crises. Continued support from donors like the IsDB will be critical to help countries build better health systems and overcome the final obstacles to stop polio for good.

“Raising funds to eradicate polio has been a long-standing mission of Rotary International, and we recognize the critical role every dollar plays in immunizing children. On behalf of the organization, I want to thank the Islamic Development Bank for their great partnership spanning 50 years in the fight against polio. We’ve come a long way in as many years, showing that together with full support and collaboration, we can overcome any obstacle in our path to achieve our promise to deliver a polio-free world to children everywhere,” said Mike McGovern, Chair of the International PolioPlus Committee at Rotary International.

For more information on the IsDB and its Golden Jubilee celebrations, see here.

About Islamic Development Bank (IsDB) Group

Rated AAA by the major rating agencies of the world, the Islamic Development Bank is the premier multilateral development bank of the Global South that has been working for 50 years to improve the lives of the communities it serves by delivering impact at scale. The Bank brings together 57 Member Countries across four continents, touching the lives of nearly 1 in 5 of the world population. Its mission is to equip people to drive their own economic and social progress at scale, putting the infrastructure in place enabling them to fulfil their potential. Headquartered in Jeddah, Kingdom of Saudi Arabia, IsDB has regional hubs and centers of excellence in 11 of its Member Countries. Over the years, the Bank has evolved from a single entity into a group comprising five entities: Islamic Development Bank (IsDB), the Islamic Development Bank Institute (IsDBI) tasked with research and training, the Islamic Corporation for the Insurance of Investment and Export Credit (ICIEC), the Islamic Corporation for the Development of the Private Sector (ICD), and the International Islamic Trade Finance Corporation (ITFC).

RIYADH (28 APRIL 2024) – Today, at the first-ever World Economic Forum (WEF) Special Meeting hosted in Riyadh, the Kingdom of Saudi Arabia has pledged US$ 500 million over the next five years to support the work of the Global Polio Eradication Initiative (GPEI).

This announcement marks a significant increase in funding for the global effort to eradicate polio – a devastating virus that paralyzes and can be fatal for children but is preventable with vaccines. The funds announced today will enable GPEI partners – the Bill & Melinda Gates Foundation (BMGF), Gavi, the Vaccine Alliance, Rotary International, the United Nations Children’s Fund (UNICEF), the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) – spearheaded by national governments, to protect more than 370 million children with polio vaccines every year. It will also facilitate the delivery of other life-saving interventions like nutritional supplements and bed nets to underserved communities and strengthen health systems to better prepare countries for emerging health threats.

The commitment was made as part of a broader more than US$ 620 million partnership by Saudi Arabia and BMGF to support polio eradication and contribute to other global health initiatives, including the Lives and Livelihood Fund. The partnership was announced at the WEF Special Meeting by His Excellency Dr. Abdullah A. Al Rabeeah, Advisor to the Royal Court and Supervisor General of the King Salman Humanitarian Aid & Relief Centre (KSrelief) and His Excellency Fahad bin Abdurrahman Al-Jalajel, Minister of Health of the Kingdom of Saudi Arabia, in the presence of Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, and Bill Gates, co-chair of BMGF.

H.E. Dr. Abdullah A. Al Rabeeah commented, “In Afghanistan and Pakistan, the last remaining polio-endemic countries, we have seen significant progress, yet work remains to be done as the world pushes towards making eradication possible. The pledge from Saudi Arabia today will enhance the innovation and collaboration needed to eradicate this disease. Together with our partners, the Bill & Melinda Gates Foundation, the Global Polio Eradication Initiative, the Islamic Development Bank and key countries across the region, our support will not only aim to end polio but to also strengthen health systems in these countries.”

“This investment towards global health isn’t just a good to have; it’s a strategic imperative for a thriving, more resilient future together,” said H.E. Fahad bin Abdurrahman Al-Jalajel, “the world faces many health challenges, and it is part of our responsibility and leadership to contribute with our partners in bridging the gaps, and through concerted efforts, we will be able to alleviate the suffering of many people.”

Thanks to decades of country leadership and global collaboration in delivering life-saving vaccines to billions of children, wild polio cases have fallen by 99.9% since the GPEI was founded in 1988 under the leadership of the World Health Assembly. More than 20 million people are walking today who would have otherwise been paralyzed by the virus. Just four cases of wild poliovirus have been recorded this year and 12 cases recorded last year in the remaining wild polio endemic countries of Pakistan and Afghanistan.

Meanwhile, outbreaks of variant poliovirus, which can emerge in places where not enough children are vaccinated against polio, are increasingly confined to high-risk areas in just four countries – Nigeria, the Democratic Republic of the Congo, Somalia, and Yemen. Still, in places where polio remains today, there are serious challenges to reaching all children with polio vaccines and other life-saving interventions, including vaccine misinformation, political insecurity, environmental disasters, and broader humanitarian crises.

“For decades, polio inflicted lifelong suffering on children and families. Today, we take another step toward finally eradicating it, thanks to the generous contributions of the Kingdom of Saudi Arabia. When we invest in eradicating polio, we make immunization and health systems more resilient, we equip nations to better respond to public health challenges, and most importantly, we ensure that more children will be able to live healthy lives,” said Bill Gates.

The announcement builds on a long history of support from Saudi Arabia and regional partners to the global polio eradication effort as well as across the Eastern Mediterranean – the last region where wild polio is endemic. For more than two decades, Saudi Arabia has not only financially supported the GPEI, but has also advocated for polio eradication and access to other life-saving vaccines in the Eastern Mediterranean and beyond. This support ranges from championing the cause among communities and religious leaders to advocating within major global convenings like the G20 and regional forums like the World Health Organization’s Eastern Mediterranean Regional Subcommittee for Polio Eradication and Outbreaks.

“Reaching all children with lifesaving vaccines is critical to ending polio and protecting children and communities everywhere from other preventable diseases and emerging health threats,” said Dr. Tedros Adhanom Ghebreyesus. “With this new funding, Saudi Arabia will help to protect children in even the hardest-to-reach areas, and move towards a healthier, polio-free world.”

“This important support will help bring us one step closer to eradicating polio once and for all,” said Catherine Russell, UNICEF Executive Director. “Together with communities, health workers, global partners, and donors like Saudi Arabia, we can help ensure that no child suffers from paralysis or dies from polio, and that more children have access to better health systems.”

To strengthen Afghanistan’s health systems and encourage a continued focus on achieving polio eradication in one of the world’s last polio-endemic countries, Saudi Arabia and the Gates Foundation have pledged US$ 3 million and US$ 15 million respectively over three years to support the Polio Legacy Challenge. This Challenge is a results-based financing initiative spearheaded by ministers of health in the region, including Saudi Arabia, the United Arab Emirates (UAE), and Qatar, under the auspices of the WHO EMRO Regional Subcommittee on Polio Eradication and Outbreaks.

Also today, as the Islamic Development Bank (IsDB) celebrates its 50th anniversary, Saudi Arabia announced US$ 100 million in new funding to support the IsDB’s Lives and Livelihoods Fund (LLF), which aims to lift the poorest out of poverty across 33 IsDB member countries through investments in primary health care, eliminating preventable infectious diseases like polio, supporting smallholder farming and rural agriculture, and improving basic infrastructure. This follows the UAE’s renewed pledge of US $50 million to the LLF announced earlier this week, continuing its support for the largest development fund in the region, which aids millions in low-income communities.

On the occasion, IsDB President Dr. Muhammad Al Jasser stated: “The Islamic Development Bank warmly welcomes the Kingdom of Saudi Arabia’s generous contribution to the Global Polio Eradication Initiative. This vital support strengthens GPEI’s efforts to eliminate this devastating disease. We’re proud that IsDB and ISFD, our poverty alleviation arm, have been among the top financiers for Pakistan’s polio eradication efforts, providing over US$ 555 million since 2012.”

Additional quotes on the funding announcement:

Mike McGovern, Chair of the International PolioPlus Committee at Rotary International, said: “I extend heartfelt gratitude to Saudi Arabia for their commitment to the cause of polio eradication, which has been instrumental in advancing our collective mission towards a polio-free world. Together, we’ve witnessed the remarkable resilience of the polio eradication program, proving that with full support and collaboration, we can overcome any obstacle in our path. Let us continue to stand united in our efforts until polio is eradicated, ensuring a healthier, safer future for generations to come.”

Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, said: “This new commitment from the Kingdom of Saudi Arabia will not only help us achieve a polio-free world, it will help countries build stronger health systems, protecting families, communities and economies from other existing and emerging health threats.”

About the Global Polio Eradication Initiative

The Global Polio Eradication Initiative is a public-private partnership, spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance. Since its launch in 1988, this partnership has helped prevent more than 20 million cases of paralysis, prevented more than 1.5 million childhood deaths and reduced the incidence of wild poliovirus by 99.9 percent, from more than 350,000 cases in more than 125 endemic countries, to twelve cases in two endemic countries in 2023.

Media Contact: Ally Rogers, Global Health Strategies (arogers@globalhealthstrategies.com)

About Islamic Development Bank (IsDB) Group

The President of the Republic of Madagascar, Andry Rajoelina, and the First Lady, Mialy Rajoelina, received a high-level delegation from the Global Polio Eradication Initiative (GPEI) on April 25, 2024 in Ambohitsorohitra palace in the capital, Antananarivo.

The delegation included the Regional Director of the World Health Organization (WHO) for Africa, Dr Matshidiso Moeti, the President of the Polio Oversight Board, Dr Chris Elias, the Regional Director of UNICEF for Eastern and Southern Africa, Etleva Kadilli, and the Director of Health Systems Strengthening and Immunization from Gavi, the Vaccine Alliance, Alex de Jonquieres.

To read more about the meeting, a press release is available here in French.

Adapted from the Annual Letter

The story of wild poliovirus is one powerful example of how philanthropy can catalyze progress. At one point, 7,000 children were paralyzed from wild poliovirus every week. Philanthropists, like Rotarians—who are able to take risks and dedicate resources that others could not—organized efforts to support eradication solutions, government efforts in polio-affected countries, and frontline heroes to reach children in even the most remote parts of the world. As a result of these global efforts, in 2023, the number of people infected by wild poliovirus dropped to 12 for the entire year.In the case of polio, philanthropy helped make the seemingly impossible possible. Many more of the greatest challenges that face our world today already have solutions—existing and emerging—that can save lives. As I share in my letter, philanthropy now has a chance to step forward and turn those solutions into real impact for people.There’s already so much generosity in the world, and together, we can tap into it and make certain everyone has the opportunity to live a healthy and productive life. Find out what we can achieve in my 2024 annual letter.

Mark Suzman,
CEO, Bill & Melinda Gates Foundation

Geneva, Switzerland, January 2024 – Convening this week at the World Health Organization (WHO) headquarters, global health leaders and Ministers of Health at the WHO Executive Board (EB) reaffirmed their commitment to eradicate polio once and for all and use the polio investments to build strong, equitable and resilient health systems.

Opening the EB amid a wide array of public health topics on the agenda, WHO Director-General Dr Tedros Adhanom Ghebreyesus told assembled delegates: “We continue to intensify our efforts to eradicate polio. Last year, six cases of wild poliovirus were reported in Pakistan, and six in Afghanistan, the second-lowest number of cases reported in a calendar year. Our target is to interrupt transmission of wild poliovirus this year.”

Member States noted the unique opportunity to eradicate remaining wild poliovirus type 1 endemic transmission, which is now limited to just a handful of areas of eastern Afghanistan and three districts of southern Khyber Pakhtunkhwa, Pakistan, and urged for continued intensified efforts to reaching all remaining un- or under-immunized children in those areas. Delegates also reiterated the importance of intensifying efforts to combat variant poliovirus outbreaks (circulating vaccine-derived polioviruses), including through strengthened outbreak response and the continued roll-out of novel oral polio vaccine type 2, which became the first vaccine used under Emergency Use Listing (EUL) to be pre-qualified by WHO. The engines of transmission for such strains are in clearly-identified and known most consequential geographies, namely north-western Nigeria, eastern Democratic Republic of the Congo, south-central Somalia and northern Yemen.

Speaking on behalf of WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al Mandhari, Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean said: “In Afghanistan and Pakistan, the national programmes deployed innovative strategies and strengthened partnerships with humanitarian actors to reach more children. And across the region, the programme also identified pathways for sustaining essential polio functions, through integration with existing programmes. In particular, I am proud of the work of the Regional Subcommittee for Polio Eradication and Outbreaks that we started back in 2021. Their advocacy and support have successfully carved out clear pathways towards protecting children in the Region from polio and other vaccine-preventable diseases.”

Within this context, delegates thanked current Regional Director Dr Ahmed Al Mandhari, for his personal engagement and leadership in bringing the region to the threshold of success; and welcomed his successor, Dr Hanan H Balkhy, who committed to leading the region across the finish line.

“On behalf of the core partners of the Global Polio Eradication Initiative, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we would like to thank all Member States for their tremendous efforts,” said Aidan O’Leary, WHO Director for Polio Eradication and Chair of the Global Polio Eradication Initiative Strategy Committee. “Last year, thanks to your efforts, upwards of 800 million children were immunized, many in areas with protracted and complex emergencies. The reality is that it is precisely in such areas of complex emergencies where polio persists, and unfortunately those emergencies are becoming even more complex. We need the continued political will of Member States to overcoming whatever geo-political challenges might currently stand in the way of reaching that remaining last unreached child in these areas. Be assured that together with our partners, we stand ready to support you in your incredible efforts.” Underscoring WHO’s commitment to the effort, O’Leary reminded the EB that WHO now considered the effort to eradicate polio as its only Public Health Emergency of International Concern (PHEIC), under the International Health Regulations (IHR).

O’Leary also reminded delegates of our collective duty to prepare for a lasting polio-free world. He referenced specifically the new approach to polio transition, which draws upon lessons-learned, and puts countries at the forefront, as solutions need to be country-specific, tailored to each country’s own context. Within that context, delegates emphasized the importance of implementing all activities to not only achieve a polio-free world, but also to sustain it through strengthening essential immunization, surveillance, integration and transition, reiterating their support and commitment to fully finance the Global Polio Eradication Initiative Strategy and the WHO base budget.

Speaking on behalf of Rotarians around the world and civil society as a whole, Judith Diment of Rotary International’s PolioPlus Committee, congratulated delegates on ongoing efforts to protect children from devastating diseases such as polio. “The Global Polio Eradication Initiative is closing in on zero, with fewer cases in fewer places in 2023, reaching more children through tailored approaches to increase public demand and identifying missed children. We applaud the use of targeted, integrated activities.”

In late December 2023, the World Health Organization issued its first-ever prequalification approval for a vaccine being used under its Emergency Use Listing (EUL) regulatory pathway – novel oral polio vaccine type 2 (nOPV2). Since rollout of this next-generation vaccine began in March 2021, the Global Polio Eradication Initiative (GPEI) has administered nearly 1 billion doses of nOPV2 across 35 countries, protecting millions of children against illness and paralysis. Prequalification will enable additional countries to access the vaccine more easily for more sustainable response to outbreaks of type 2 variant poliovirus (cVDPV2).

“This is a historic milestone for polio eradication and for public health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Novel oral polio vaccine type 2 has blazed a trail for other new vaccines that address critical health emergencies, and its use demonstrates the utility of the EUL mechanism in helping to rapidly get new products to where they’re needed most.”

The EUL to PQ pathway

WHO EUL is reserved for the use of yet-to-be-licensed vaccines, medicines and diagnostic tools during public health emergencies like polio outbreaks. Following rigorous assessments of existing quality, safety and efficacy data from completed clinical trials, the pathway enables expedited availability of products to the places impacted by these emergencies. The vaccine’s manufacturer, Bio Farma Indonesia, has been instrumental in ensuring supply and enabling nOPV2 to earn full licensure from the Indonesian regulatory authority, Badan POM. WHO Prequalification (PQ) is the final step of the process, allowing for streamlined regulatory approval for nOPV2 use in countries that need it.

“This key step illustrates how innovation can help protect children against the variant poliovirus type 2, with thanks to the support of donors and partners, and the commitment of governments and community health workers,” said UNICEF Executive Director Catherine Russell. “UNICEF is committed to helping ensure the safe and adequate supply of vaccines to countries, while working with communities to build trust in vaccines. We need to keep going till we reach every child, and eradicate polio once and for all.”

nOPV2’s performance and the power of innovation

To date, nOPV2 has been used in 35 countries under EUL, predominantly in the African region which is most affected by cVDPV2 outbreaks. Throughout its clinical development and field use, nOPV2 has proven to be as safe to use and effective at stopping outbreaks as its predecessor, monovalent type 2 oral vaccine (mOPV2), but, importantly, is more genetically stable. After nearly three years of use, estimates show that nOPV2 is 80% less likely to seed new variant polio outbreaks, making it the tool of choice to stop these outbreaks for good.

Nigeria has played an outsized role in nOPV2 rollout in the leadup to WHO Prequalification, administering nearly half a billion doses to children across the country to date. The vaccine has helped bring about an 85% reduction in variant poliovirus cases in Nigeria since 2021, and its impact is visible through this and other data in a new story from the GPEI.

Development of the vaccine began in 2011 through a consortium of experts led by the Bill & Melinda Gates Foundation, including the UK National Institute for Biological Standards and Controls (NIBSC), the U.S. Centers for Disease Control and Prevention (US-CDC), the US Food and Drug Administration, PATH and the University of California at San Francisco.

“Supporting the development of new vaccines is one of the most important investments we can make to protect people against preventable diseases like polio,” said Mark Suzman, CEO of the Bill & Melinda Gates Foundation. “With easier access to nOPV2 for more countries, this vaccine will keep even more children safe in areas still grappling with poliovirus. We look forward to working with partners across sectors to support more groundbreaking innovations.”

Next steps in the fight against type 2 variant poliovirus

As of 3 January 2024, 325 cases of cVDPV2 had been reported in 2023, compared to 689 cases in 2022. While nOPV2 has played a key part in this reduction, its success, like any polio vaccine, depends on the ability to rapidly implement high-quality immunization campaigns that reach every child.

To overcome the final challenges that remain in polio eradication, the GPEI is finding new ways to access children living in hard-to-reach areas, promote community acceptance of vaccines, and improve early detection and response to outbreaks. These efforts are being prioritized in the places where children are at the highest risk of encountering and spreading the virus.

“It is critical to protect all children against polio with timely administration of vaccines. Along with our global partners, CDC is committed to ensuring rapid detection of type 2 polio outbreaks and response with the novel oral vaccine,” said Dr. Mandy Cohen, Director of the US-CDC.

A prequalified nOPV2 will help to make important headway against cVDPV2 outbreaks, and with renewed support from global partners, donors and leaders of polio-affected countries to fully implement the program’s strategy, we can stop all forms of polio for good.

END

—

About the GPEI:
The Global Polio Eradication Initiative is a public-private partnership led by national governments with six partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Its goal is to eradicate polio worldwide.

For media enquiries:
WHO
For prequalification specific enquiries:
Sarah Sheppard – Communications Officer sheppards@who.int
For polio and nOPV2 enquiries:
Joseph Swan – Communications Officer swanj@who.int

UNICEF
Helen Wylie, Communications Specialist hwylie@unicef.org

Bill & Melinda Gates Foundation
Amber Zeddies, Senior Program Officer amber.zeddies@gatesfoundation.org

US CDC
Chelsea Toledo, Health Communications Specialist rnv8@cdc.gov

The Global Polio Eradication Initiative has two goals laid out in its current strategy: to interrupt all remaining transmission of endemic wild poliovirus type 1 (WPV1) and to stop all outbreaks of variant poliovirus type 2 (cVDPV2). 2023 was a critical year for progressing on each of these, and while our urgent and diligent work to end polio must continue into 2024, the GPEI achieved incredible things in the past twelve months.

Continuing work in endemic countries

Despite significant geo-political and environmental challenges in the two remaining WPV1-endemic countries, Pakistan and Afghanistan, the polio programme has continued to reach greater numbers of children with polio vaccines.

WHO Representative in Afghanistan, Dr. Luo Dapeng, vaccinating children against measles in a mobile clinic in Baba Wali Village of Kandahar province. © WHO/Afghanistan

Wild polio transmission was beaten back to just a handful of districts in eastern Afghanistan and the southern area of Khyber Pakhtunkhwa province in Pakistan. In both countries, efforts are increasingly focused on reaching and vaccinating the last remaining ‘zero dose’ children – children who have received no vaccines of any kind. The number of these missed children continues to dwindle, with the success of improved collaboration with the national immunisation program, new efforts like Pakistan’s Nomad Vaccination Initiative and focused vaccination activities at border crossings between the two countries. Just one family of the virus remains endemic in each country, and coupled with this increasing geographic restriction, the situation resembles the end of wild polio eradication efforts in former virus hotspots like India, Nigeria and Egypt.

In addition, after a wild poliovirus outbreak that was confirmed in southeast Africa in early 2022, neither Malawi nor Mozambique has reported a WPV case since August 2022 thanks to a concerted subregional emergency response across five neighbouring countries. We are hopeful that this outbreak will be officially closed in the coming months, affirming that countries have what it takes to protect children from this devastating disease and keep wild polio out of Africa.

Progress on variant polio outbreaks

Thanks to the novel oral polio vaccine type 2 (nOPV2), strong political commitment and community-based efforts to reach more children with the vaccine, the number of cases of variant poliovirus type 2 (cVDPV2) continued to decline in 2023.

Nearly 1 billion doses of nOPV2, a comparably safe, effective, but more genetically stable version of the existing type 2 oral polio vaccine (mOPV2), have now been administered across 35 countries, protecting millions of children from illness and paralysis.

Emergency response to variant polio outbreaks is continuing, notably in the most consequential geographies for the programme—where children are at the highest risk of encountering and spreading poliovirus. In northern Nigeria, for example, variant polio cases have fallen by 90% since a peak in 2021, thanks to concerted commitment from government, unique community programs to improve the reach of vaccines and the extensive rollout of nOPV2. Across these consequential geographies, the programme will continue to focus on increasing access, acceptance and campaign quality, which have helped make incredible progress in Nigeria, and continue to innovate until we end polio for good everywhere.

Finally, In September 2023, after a massive vaccination response in the shadow of ongoing war, Ukraine officially stopped its outbreak of type 2 variant polio that began in 2021. New York, London and Jerusalem, where high-profile outbreaks began in 2022, have not detected the virus in recent months. Still, the emergence of polio in these areas is a reminder that as long as poliovirus exists anywhere, it is a threat to people everywhere.

nOPV2 Vaccination at Guilding Angel School Tunga, Minna, Niger. © WHO/AFRO

A global effort

Most importantly, thanks to the efforts of the GPEI and its partners, health workers vaccinated more than 400 million children in 2023, preventing an estimated 650,000 cases of paralysis from polio and saving the lives of up to 60,000 children. Building full, healthy futures was at the core of Rotary International’s mission when it began this fight to end polio for good in 1985, and when the GPEI was launched in 1988—35 years ago.

This year, the Independent Monitoring Board (IMB) conducted a rigorous mid-term review of the GPEI’s progress towards its strategic goals. This welcome counsel is already helping inform and guide the GPEI’s own ongoing analysis and strengthening of its strategic approaches to achieve a polio-free world, as the programme published its initial response to the mid-term review, under the guidance of the Polio Oversight Board (POB).

Achieving and sustaining a polio-free world has proven harder – and taken longer – than anyone could have imagined. But making history is never easy, and we are confident that together we can eradicate a second human disease from this earth, and build stronger, more resilient health systems along the way.

2023 has firmly set the stage for success. With the complexities of the world today, this programme still inspires to bring about the very best in our humanity.

Thank you to all who have contributed to this effort so far and continue to do so. Let us double down and make the dream of a polio-free world a reality.

Influencers from the French gaming community holding PSG scarfs made to support the #ENDPOLIO campaign

The Global Polio Eradication Initiative and the Paris Saint Germain Endowment Fund (PSG) call for one last push in the fight to eradicate polio
Renowned footballers, influencers from the French gaming community, Bill Gates, co-chair of the Bill & Melinda Gates Foundation and Emmanuel Macron unite to create excitement among the younger generation
An innovative activation resulted in the creation online of the gamer, “@P0L__10” —a pseudonym for polio— as all corners joined forces in the fight against the disease at the Gustave Eiffel Lounge on the first floor of the Eiffel Tower

PARIS (6 December): Last night, the French gaming community made a call for collective action to defeat a common adversary – only it was not an online gaming threat, but poliovirus, a debilitating infection that has been paralysing children for centuries.

Throughout the event, gamers battled on the EA SPORTS FC 24 pitch in a tournament to determine who would be the player chosen to defeat @P0L__10, a seemingly unbeatable opponent who had been tormenting players online in the preceding days. As the challenger was decided, it was revealed that this common adversary, @P0L__10, was in truth an alias for polio, a persistent foe that the world is on the brink of eradicating.

Since the Global Polio Eradication Initiative was formed in 1988, cases of the once ubiquitous polio have fallen by over 99%, and today the wild virus is confined to pockets of just two countries – Pakistan and Afghanistan. Still, poliovirus continues to threaten millions of children around the world, and until we stop all forms of polio everywhere, we all remain at risk. Thankfully, because this virus has been eliminated in most places, younger generations in much of the world have never witnessed this highly infectious and devastating virus impact on their friends and family members.

Participants being introduced ahead of the EA Sports FC24 tournament

“As long as this virus continues to exist anywhere, young people everywhere, including here in France, remain at risk,” said Les Twins, a famous duo of Franco-American content creators on FC24, who hosted and broadcast on their Twitch channel (229K subscribers) Tuesday evening’s event at the Salle Gustave Eiffel, on the first floor of the Eiffel Tower. “The young, vibrant esports community in France is strong and capable, and tonight we showed that when we rally behind a cause we can make great things happen.”

“Gaming is important, but not as important as the lives of children around the world. This is our generation’s chance to really make a difference”, said Arsène Froon, Paris Saint-Germain (PSG), host whom the tournament’s winner was given the chance to challenge after the audience discovered he was hiding behind the character of P0L__10. Arsène delivered his message to an audience that included not just influential figures in gaming, but also PSG players from the female team, Ana Vitória, Océane Toussaint and Constance Picaud, e-players Nkantee and Amarr as well as European polio advocates. Our commitment to this cause is also a homage to Guy Crescent, the pioneer and founder of PSG, who himself was affected by poliomyelitis and contributed greatly to the club’s development.

French President Emmanuel Macron and Bill Gates, co-chair of the Bill & Melinda Gates Foundation, spoke to the crowd via video as polio was revealed to be the true adversary, echoing the sentiment that it is only with collective support and action that the eradication of this disease can be achieved. Just hours before the event, the Agence Française de Développement (AFD) announced up to €55 million in support to Pakistan, filling a critical funding gap in the country’s commitment to stop polio. These funds build on France’s monumental pledge of €50 million at the 2022 GPEI Pledging Moment in Berlin.

Photo of Emmanuel Macron and Bill Gates’ video played during the event

The vibrant event was a testament to the power of collaboration across sectors, bringing together the worlds of gaming, sport, and health advocacy in an historic collaboration, by captivating and engaging the younger generations to work together to end @P0L__10 and continue the fight to make polio history.

Further voices have joined the movement, including Gims, the Congolese-French singer, rapper, and activist who added, “I am super excited to join the efforts of Bill Gates, the Global Polio Eradication Initiative, and government leaders in the mission to eradicate polio in the Democratic Republic of Congo and around the world. Together, we will end polio and save tens of thousands of children from this devastating disease.”

About GPEI

The Global Polio Eradication Initiative is a public-private partnership led by national governments with six partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Its goal is to eradicate polio worldwide.

For press inquiries, please contact Jacob Baskes, jbaskes@globalhealthstrategies.com

About the PARIS SAINT-GERMAIN FOUNDATION AND ENDOWMENT FUND:

Since its creation in 2000, the Paris Saint-Germain Foundation has sought to help disadvantaged and sick children and deprived communities. It organises educational and sport programmes in France and around the world that use sport and its values as levers for learning, self-fulfilment and solidarity. In 2013, the Paris Saint-Germain Foundation set up an endowment fund to collect donations made by individuals and companies to help it develop its social responsibility and community programmes. Through these programmes, which enable disadvantaged people to integrate into society and the world of work, and through its Red and Blue Schools, its support for refugees and its charity donations, the Paris Saint-Germain Foundation harnesses the educational and emotional benefits of sport to come to the aid of people in need.

For press inquiries, please contact: Sarah Machkor, smachkor@psg.fr

PARIS (5 December 2023) – Bill Gates, co-chair of the Bill & Melinda Gates Foundation and Remy Rioux, CEO of the Agence Française de Développement (AFD) announced today new commitments that implement the Paris Pact principles combining official development assistance and private investment and support the objective of global polio eradication by 2026.

The funding – an up to €55 million concessional loan, with an up to €20 million principal buy-down from the Gates Foundation will support Pakistan’s national health institutions and the Pakistan Polio Eradication Initiative to recover following impacts from the devastating floods in August 2022.

Supporting healthcare system resilience to climate change

The floods in 2022 were Pakistan’s worst natural disaster in decades highlighting multiple climatic vulnerabilities faced by the country. The human toll was tragically high with one third of the country submerged underwater, approximately 15,000 killed or injured and 8 million displaced. Damage to infrastructure was also catastrophic: over 2 million homes, 13,000 kilometers of highways, 439 bridges and 888 health centers were damaged or destroyed leaving the populations affected by the floods without access to healthcare. Flooding also triggers an upsurge in water-borne diseases (severe diarrhea and cholera) and diseases carried by insects (dengue fever and malaria).

The new project is a contribution to the Pakistani efforts to chart progress towards a climate resilient health system capable of anticipating, recovering from, and adapting to climate-related shocks and stresses, so as to bring about sustained improvements in population health, despite an unstable climate. By supporting the Pakistan Polio Eradication Programme (PEI), through the World Health Organization (WHO), in immunization activities, disease surveillance, polio campaign monitoring and other technical areas, the AFD investment will enhance systems able to target climate-sensitive diseases and their risk sources. Importantly, this funding will also provide further support for female polio health care workers, whose efforts and experiences are central to Pakistan’s success against polio and other diseases.

Pakistan Polio Eradication Program

Pakistan has reported five cases of paralysis from polio so far this year. The virus has also been detected in sewage water in 20 districts in the four major provinces, reaffirming that polio continues to pose a threat to children living in poor sanitary conditions with low immunity and poor nutrition.

Dr. Chrysoula Zacharopoulou, Secretary of State in charge of Development, Francophonie and International Partnerships for the French Government, said: “I would like to thank the Agence Française de Développement and the Bill & Melinda Gates Foundation for their commitment to Pakistan. This €55 million investment helps to address a dual challenge that is central to the Ministry of Europe and Foreign Affairs’ global health strategy and its international partnerships policy: strengthening our partners’ health systems while taking into account the impact of climate change on public health. This programme is an excellent illustration of this.”

Dr. Nadeem Jan, Federal Minister of National Health Services Regulations & Coordination in Pakistan emphasized the significance of this funding and polio infrastructure in Pakistan: “We welcome the support of the French Government and the Gates Foundation as we near the finish line on polio eradication. The Pakistan Polio Eradication Programme is a vital part of our healthcare system and investing in polio builds the country’s overall health system.”

“Pakistan has made incredible progress toward eradication, and by addressing barriers to eradication—including gender-related barriers—will continue to do so” said Dr. Ahmad Al-Mandhari, WHO Regional Director. “Commitments like this will help keep the country on track to interrupt transmission of wild poliovirus for good and help deliver a more resilient, polio-free world.”

Since 1994, the Pakistan Polio Eradication Programme has been fighting to end the crippling poliovirus from the country. The national initiative is driven by trained and dedicated polio workers, the largest surveillance network in the world, quality data collection and analysis, behavioral change communication, state of the art laboratories, and some of the best epidemiologists and public health experts in Pakistan and the world.

“Thank you to the Government of France and the Government of Pakistan for their continued leadership in the fight to end polio.” said Mark Suzman, CEO of the Bill & Melinda Gates Foundation. “From France’s commitment to the Global Polio Eradication Initiative last year to today’s new financing partnership between the French Development Agency and the Government of Pakistan, these additional resources are essential to ensuring no child suffers from this devastating disease again.”

“Six months after signing our strengthened strategic and financial partnership for gender equality and human development in Africa and South Asia, I am honored to announce our first joint investment with the Bill & Melinda Gates Foundation. We will both support Pakistan’s polio eradication program and work towards a strengthened integrated national epidemiological surveillance system. This partnership is one of the long-term responses to the August 2022 devastating floods, which severely affected national health institutions. From eradicating polio to strengthening health systems as a whole, we are committed to investing in global levers of change to promote sustainable health for all” said Remy Rioux, CEO of the Agence Française de Développement.

For 15 years, the Bill & Melinda Gates Foundation has worked with the French government to amplify the positive impact of development assistance and scientific expertise in low-income countries by supporting research and the translation of scientific discoveries into sustainable solutions, particularly as part of global alliances, including Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Health Organization. France and the Gates Foundation are also key partners in:

the Ouagadougou Partnership, which works to expand access to family planning services across nine countries in French-speaking West Africa.
digital financial inclusion for women in low-income countries, to harness digital technologies and build more inclusive economies.
addressing the global food security crisis and advancing women and children’s access to better nutrition

About the Agence Française de Développement

Agence Française de Développement (AFD) implements France’s policy on international development and solidarity. Through its financing of NGOs and the public sector, as well as its research and publications, AFD supports and accelerates transitions towards a fairer, more resilient world. With our partners, we are building shared solutions with and for the people of the Global South. Our teams are at work on more than 4,000 projects in the field, in 115 countries and in regions in crisis. We strive to protect global public goods – promoting a stable climate, biodiversity and peace, as well as gender equality, education and healthcare. In this way, we contribute to the commitment of France and the French people to achieve the Sustainable Development Goals (SDGs). Towards a world in common.

https://www.afd.fr/en

About the Bill & Melinda Gates Foundation

The Bill & Melinda Gates Foundation is a nonprofit fighting poverty, disease, and inequity around the world. For over 20 years, it has focused on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. Based in Seattle, Washington, the foundation is led by CEO Mark Suzman, under the direction of Co-chairs Bill Gates and Melinda French Gates and the board of trustees.

https://www.gatesfoundation.org/

Contacts

Isabelle Dedieu, dedieui@afd.fr, AFD Press officer
media@gatesfoundation.org

Published by the Bill & Melinda Gates Foundation on 5 December 2023.

DUBAI, UAE, 3 December 2023 – The Islamic Development Bank (IsDB), together with the Government of Pakistan, announced a US$100 million loan to support Pakistan’s polio eradication efforts, today, at the Reaching the Last Mile Forum held on the sidelines of the ongoing COP28 events in Dubai, UAE.

This loan builds on a previous support from the IsDB and includes a US$35 million principal buy-down from the Bill & Melinda Gates Foundation. The new funding complements previous loans and will be used to secure and deliver the millions of polio vaccines needed to protect all children across Pakistan against this debilitating yet preventable virus.

“I am very pleased to announce that the IsDB approved US$100 million financing in the 4th Phase of Polio Eradication Program for Pakistan in April 2023, which brings the IsDB total financing for Polio eradication in Pakistan to US$ 587 million, making the Bank one of the largest providers of finance to the national polio eradication program in Pakistan. Under this latest phase, I am happy to note that US$ 60 million of this amount was disbursed in mid-November 2023. We and our partners remain committed and are working hard to win this battle against this disease. We really are at the last mile in this long journey as only 5 cases of wild poliovirus have been reported in the country in 2023,” IsDB President and Group Chairman, H.E. Dr. Muhammad Al Jasser, reiterated in his statement read out by IsDB Vice President Finance, Dr. Zamir Iqbal, at the Forum. “I would like to thank the Government of Pakistan, as well as our partners, the Bill and Melinda Gates Foundation, UNICEF and WHO for their steadfast commitment,” added the statement.

Today, Pakistan and Afghanistan are the only countries where wild poliovirus remains endemic.

“We welcome the support of the IsDB and the Bill & Melinda Gates Foundation in contributing to the critical effort of ending polio in Pakistan,” said H.E. Dr. Nadeem Jan, Minister of National Health Services Regulations and Coordination. “Interrupting poliovirus transmission remains a core focus for the Government of Pakistan, and thanks to the heroic efforts of community health workers, global partners and contributors like the IsDB and the foundation, we have pushed the virus to the brink of eradication,” the Minister added.

The Bill & Melinda Gates Foundation sees this loan as an important step forward for eradication efforts in Pakistan. “We are pleased to partner again with the IsDB and the Government of Pakistan to ensure funding opportunities to provide the needed resources to reach every child with polio vaccines. I remain inspired by the strong commitment from leaders across Pakistan to ending polio at both the provincial and national levels,” said Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation and Chair of the Global Polio Eradication Initiative Polio Oversight Board. “With continued support to health workers and the efforts from partners like the IsDB, I am confident we will end polio in Pakistan,” he reiterated.

On the occasion, WHO Director General, Dr. Tedros Adhanom Ghebreyesus, stated: “WHO remains committed to working with our partners to support Pakistan’s effort to end polio for good.” He added: “These funds will allow Pakistan to raise immunization coverage, improve its ability to find and respond to this virus, and make polio history for children in Pakistan and around the world.”

This loan will enable the Pakistan polio program to reach all children and communities with this life-saving vaccine to ensure no one suffers from this debilitating disease in the future. It will also help meet the country’s commitment of US$155 million towards its national polio program supported by the partners of the Global Polio Eradication Initiative (GPEI).

As one of the two implementing partners of the GPEI in Pakistan, UNICEF will support the government to procure and deliver vaccines to children, protect communities from polio and reach families with other essential health services. “We are at a critical moment in Pakistan, and we cannot ease up the fight against polio until every child is protected,” UNICEF Deputy Executive Director Omar Abdi said, adding: “UNICEF is committed to ending polio in Pakistan because we know it is possible. We have seen polio disappear from country after country across the globe. Today there are only two countries where it persists. Together, we can reach every child with polio vaccines, especially those who have not been vaccinated before, and we can end wild poliovirus transmission in Pakistan for good.”

Originally published by the Islamic Development Bank on 3 December 2023

A polio worker marking a child’s finger during the first polio campaign after the floods. © WHO/Pakistan

Pakistan, one of the last two endemic countries for wild polio, is closer than ever before to ending this devastating disease for good. However, many experts say Pakistan is among the countries most vulnerable to the climate crisis. As the world becomes hotter, more frequent and severe heatwaves, intense droughts, and devastating floods, threaten the incredible progress that has been made against polio.  

Just last year, from May to October 2022, a historic heat wave was followed by heavy monsoon rains and melting Himalayan glaciers, causing the worst floods in Pakistan’s history—almost one-third of the country was under water at its peak. One in seven people in the country were affected by these floods and close to eight million people were displaced, including thousands of polio workers themselves.¹  

Critical infrastructure across the country was also damaged, from roads and bridges to health and sanitation systems. Such devastation following floods and storms leads to wastewater overflow, compromising safe drinking water and spreading pathogens like cholera and polio.² This increases the risk of people encountering these life-threatening diseases while making it even harder to reach every child with the necessary vaccines to protect them. 

In response to this climate emergency,³ the programme activated extreme weather contingency plans to resume immunization activities for polio and other vaccine-preventable diseases as soon as possible. This included adjusting campaign schedules and strategies, such as conducting vaccinations at health camps, at transit points, and in settlements for displaced persons. In some cases, this meant wading through deep water to reach children with life-saving vaccines. Despite the extraordinary circumstances, the programme managed to reach nearly 32 million children in the country during its August 2022 campaign. 

Health worker Shahida Saleem sits outside her house in Fatehpur, Rajanpur district during a polio campaign in September 2022. © WHO/Pakistan

The GPEI also committed to supporting more than 12,500 polio workers across the country who were impacted by the floods.⁴ Nasreen Faiz, a team member who took part in polio campaigns following the floods, was among those affected. “One after the other, house after house was destroyed… My entire village was finished. The crops were gone, the homes were gone, the animals were dead,” she recounted. Shahida Saleem, another polio worker, evacuated her home for the floods and came back to find it severely damaged and her belongings under three-feet deep water. 

The GPEI quickly secured funds to compensate those workers who suffered full or partial damage to their homes, like Nasreen and Shahida. As of April 2023, cheques worth Rs216 million (approximately US$752,000) had been distributed to 10,500 polio workers. While no amount of money can offset the loss and havoc from these devastating floods, the GPEI worked to support the workforce as much as possible.  

Lastly, the programme drew on its long history of supporting humanitarian crises to help address the impacts of this climate emergency in the communities it serves. It helped establish critical health camps in flood-affected districts to provide basic health services, from the administration of routine immunizations and treatment of diseases to the distribution of water purification tablets and provision of nutrition services. To continue fighting polio and other infectious diseases, programme staff also actively conducted disease surveillance and collected and analysed data to help target outbreak response strategies in these high-risk settings. 

Above all, working hand-in-hand with communities and local authorities, the polio programme was able to adapt its operations to ensure progress against polio in Pakistan was not lost and the polio workforce and affected communities were supported in the aftermath of this climate disaster. While the programme was able to successfully respond in this instance, it will face even more disruptions like this on the road to ending polio as the world becomes hotter. Learnings from its work in Pakistan following the floods will be essential to ensure that the fight against this devastating disease can continue amid future disruptions, and that its staff and communities are protected along the way. 

[1] https://www.usaid.gov/sites/default/files/2022-12/2022-09-30_USG_Pakistan_Floods_Fact_Sheet_8.pdf
[2] https://www.gavi.org/vaccineswork/over-half-infectious-diseases-made-worse-climate-change
[3] https://polioeradication.org/news-post/pakistan-polio-infrastructure-continues-support-to-flood-relief-while-intensifying-efforts-to-eradicate-polio/
[4] https://polioeradication.org/news-post/after-the-floods/

Led by Dr Chris Elias, Chair of the Polio Oversight Board and President Global Development, Bill & Melinda Gates Foundation, the delegation included WHO Regional Director for the Eastern Mediterranean Region Dr Ahmad Al-Mandhari, UNICEF South Asia’s Deputy Regional Director Noala Skinner, CDC’s Polio Eradication Branch Chief Dr Omotayo Bolu, Chief Programme Strategy Officer from Gavi-the Vaccine Alliance, Aurelia Nguyen, Trustee of Rotary International Foundation Aziz Memon, and High Commissioner of Canada in Pakistan Leslie Scanlon, who represented all donors to the GPEI.

Read more

Manzoor (second right, pictured here with his uncle, brothers and sisters) will make a full recovery from polio paralysis. ©UNICEF/Karimi

By Kate Pond, UNICEF Afghanistan

“Manzoor is our miracle child!” exclaims the young man, face shining. Two-and-a-half-year-old Manzoor is unmoved by his uncle’s excitement; he is busy eyeing the boiled sweet in the outstretched hand of a village elder on the other side of the room. The boy gets up decisively, and trots across the carpet. He grabs the candy in a pudgy hand and gobbles it down with relish.

Just a few months ago, Manzoor could not walk. His left leg was paralyzed by the polio virus.

In a neighbouring district, Saima, fidgets with her hennaed fingers while her father pours tea. Small for her 11 years, Saima still favours her right side, although the paralysis caused by the virus is easing. As her father tells the story of her recent illness, her grandfather puts his arm around the girl’s shoulders, embracing her warmly.

Polio is still endemic in Afghanistan – one of the last two countries in the world. Since the start of 2023, six children have been diagnosed with the disease, all of them in Nangarhar Province, a rural area in the east of the country. Saima and Manzoor are lucky: six months after the onset of symptoms, it looks like they will make a full recovery. Two of the six were not so lucky; one boy remains very weak in the limbs affected, and one girl died.

The national polio vaccination campaign, led by the National Emergency Operations Centre in coordination with UNICEF and WHO, is in full swing. Last year, 9.4 million children were vaccinated under the campaign, and the target for 2023 is 10 million. The monthly campaigns are boosted by educational campaigns for mothers and other caregivers, run by UNICEF and partners.

Saima and Manzoor received vaccine drops in recent campaigns, and their parents were well aware of the signs and symptoms of polio, how it is caught, and the importance of vaccination as the only preventative measure. In fact, the speed at which their parents acted to get tests and treatment for their children are testament to the commitment and hard work of over 30,000 polio social mobilisers and influencers building public trust in the programme, and the deep-seated desire of the Afghan community to eradicate the virus once and for all.

The combination of vaccination campaigns and regular routine vaccination is the gold standard to eradicate polio forever. Nangarhar ranks above the national average for full childhood vaccinations, with 27 per cent of children fully covered, although it is also slightly higher than average for children in the same age bracket to be unvaccinated (Ref: UNICEF MICS 2022-23). In each of the six new polio cases, the children had missed one vital vaccination – usually the intravenous jab given to babies and toddlers – which left a gap in their immunity, and the virus was able to break through.

Nothing happens in a vacuum. For a vaccine to work effectively, the child receiving it needs to be healthy, adequately nourished, and living in a sanitary environment. The polio virus is contracted from water sources that are contaminated by raw sewage infected with the virus. Wild polio is detected in the samples WHO collects in regions across Afghanistan, including in the east.

Less than half the population of Afghanistan has access to basic sanitation, and a third do not have access to clean drinking water. In rural areas, like Saima and Manzoor’s districts, the streams the children play in are often the same streams that household waste and effluent flow into. Nangarhar residents benefit from higher-than-average access to clean drinking water, but sanitation is considerably lower than average, and 20 per cent practice open defecation. In Manzoor’s district, for example, only 30 per cent of the population benefit from a piped water supply. Without the necessary infrastructure in place to provide these services, children will continue to be exposed to the virus in their living environment and run the risk of contracting the disease.

The polio vaccination campaign is striding forward in Afghanistan, and the virus is fighting to survive. But while the water in which children play is contaminated, the risk of them catching the virus hangs heavily over communities. Winning the battle involves recognizing the interconnectedness of health and nutrition, clean water and sanitation, community education and vaccination, and responding with a comprehensive package of services. As Saima’s father put it: “Mashallah my daughter is lucky. She will make a full recovery. But without better sanitation we will continue to live in fear of the virus.”

Last month, the Bill & Melinda Gates Foundation partnered with The Moth to host an exceptional storytelling event, Don’t Stop Now: Stories from the Final Push to End Polio. Held in New York City during the UN General Assembly, the event was an inspiring night of powerful personal stories from individuals whose lives have been impacted by polio.

The event was hosted by Dr. Richard Besser, President and CEO of the Robert Wood Johnson Foundation, and opening remarks were provided by Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation. Storytellers included Safia Ibrahim (Public Engagement Manager at Results Canada and polio survivor), Wasif Mahmood (Head of Communications at UNICEF Pakistan), and Oyewale Tomori (past President of the Nigerian Academy of Science, past Virologist at WHO AFRFO), who all told powerful stories about their lived polio experiences, inspiring the audience to keep up the fight to end this devastating disease. Special guest EXILE TETSUYA (Japanese artist and polio advocate) also provide remarks on his own polio eradication advocacy efforts.

BRUSSELS, 11 October 2023 – Today, the European Commission (EC), the European Investment Bank (EIB) and the Bill & Melinda Gates Foundation (BMGF), along with the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) announced a new financing partnership to advance polio eradication efforts and strengthen healthcare systems. Of the expected €1.1 billion, €500 million in new funding will go to the Global Polio Eradication Initiative (GPEI) – specifically to its implementing partners, WHO and UNICEF – and €500 million to programs that expand innovation and research capacity in low- and middle-income countries.

This announcement comes at a critical time for global eradication efforts. When the GPEI was established in 1988, wild poliovirus paralyzed an estimated 350,000 children in over 125 countries every year. Today, only two endemic countries remain – Pakistan and Afghanistan – and 80% of variant poliovirus cases are found in only four subnational regions. Promising trends in affected countries, like shrinking genetic diversity of the virus and increasingly geographically confined outbreaks, suggest that in most places the virus is on its last leg.

Now, new commitments from European leaders puts the program one step closer to seizing the historic opportunity we have to overcome final hurdles and end polio for good. The expected funds will allow polio vaccinations to reach nearly 370 million children annually, with a focus on targeting remaining un- or under-vaccinated children who typically live in some of the world’s hardest-to-reach areas.

By focusing on such communities, the program is able to deliver broader health benefits to low resource settings, including routine immunizations, counseling on breastfeeding, Vitamin A supplementation and more. This not only fosters healthier communities today, but also strengthens health systems to better prepare for and respond to emerging health threats, as the polio program and workforce has done against COVID-19, Ebola, and other diseases.

Partners announced the new financing partnership at the “Healthy Hopes: Reasons for optimism in science and global cooperation” event in Brussels. The event featured a keynote speech from Stella Kyriakides, European Commissioner for Health and Food Safety, remarks from Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, and a panel discussion featuring Catherine Russell, Executive Director of UNICEF and European leaders – Koen Doens, Director-General at the EC’s Directorate General for International Partnerships, Werner Hoyer, President of the EIB, and Caroline Gennez, Belgium’s Minister for Development. The event concluded with a fireside chat with Bill Gates, Co-Chair of the BMGF.

European leaders re-affirmed their commitment to ending polio for good and called on the rest of the world to join them and the GPEI partners in the fight for a polio-free world. They underscored the need for global cooperation in the final stretch to eradicate this devastating disease.

In his remarks, Dr. Tedros reminded attendees about the incredible progress that has been made toward a polio-free world, the tools and strategies we have at our disposal that will get the job done, and the importance of donors like the EC and EIB in unlocking the GPEI’s ability to utilize them. Catherine Russell reinforced the ever-narrowing window of opportunity we have to end polio for good and affirmed her confidence in the program’s ability to stop all virus transmission in the immediate future while meeting the broader health needs of communities now.

During the fireside chat, Bill Gates expressed his optimism about what this new investment represents for the future of eradication efforts and global health. By finding innovative ways to partner, European leaders are helping us achieve a world where no child is paralyzed by this preventable disease.

Increased support from donors, leaders of polio-affected countries and partners is essential to protect the incredible progress made so far, achieve high vaccination coverage and end polio for good. A polio-free world is in sight, but stakeholders at all levels must stay committed to achieving this goal and building strong health systems to protect children today and future generations.

The Global Polio Eradication Initiative (GPEI) welcomes the latest report from the Independent Monitoring Board (IMB), which presents a rigorous independent review of the programme’s progress toward its goals — aiming to interrupt all remaining wild poliovirus type 1 (WPV1) transmission and circulating variant poliovirus type 2 (cVDPV2) transmission by the end of 2023. The IMB concludes that despite recent progress toward eradication, remaining challenges make stopping transmission of WPV1 this year unlikely, while ending all variant poliovirus outbreaks will take even more time.

The IMB notes the encouraging restriction of WPV1 transmission in the two remaining endemic countries, Afghanistan and Pakistan, the continuous work to reach every child with polio vaccines, and the political commitment to maintaining the progress that has been made. The IMB also noted improvements in combating variant poliovirus outbreaks, including the GPEI’s targeted efforts to implement large-scale campaigns that protect more children and strengthen surveillance systems. The report underscores the urgent need to stop all forms of the virus – because polio anywhere remains a threat to people everywhere.

The GPEI understands that recent progress against poliovirus is fragile and serious challenges remain. Many of the challenges outlined by the IMB are recognized barriers in the areas most vital to the success of eradication, including complex security and humanitarian situations, operational issues hindering campaign performance, and hurdles to effective integration of the polio programme with other health efforts. The GPEI remains confident that it can innovate and adapt in the face of this adversity to reach all children in the world’s most challenging settings. Still, the IMB notes that without adequate financial resources and political commitment at all levels, the programme will not be able to fully implement needed solutions.

The GPEI appreciates the IMB’s continued scrutiny and shared commitment to ending polio. In October 2023, the GPEI Polio Oversight Board will meet to analyse the IMB’s recommendations along with input from Technical Advisory Groups and country teams to adopt corrective actions that ensure the programme’s strategic goals are met.

The GPEI will continue working closely with the IMB, polio-affected countries, donors, and partners to optimize the polio programme’s response, improve immunization campaigns and disease surveillance, and ultimately overcome the remaining hurdles to deliver a world in which no child is paralyzed by this deadly disease. 

Related Documents:

22nd Report of The Independent Monitoring Board (IMB)

Polio Eradication Strategy: GPEI response to the midterm review (pre-final draft)

ISLAMABAD, JULY 21, 2023 – A high-level delegation of the Global Polio Eradication Initiative (GPEI), including the Polio Oversight Board, visited Pakistan to discuss the impact of political transition on eradication efforts and the strategies in place to vaccinate children that remain unreached in the polio-endemic districts of southern Khyber Pakhtunkhwa.

This was the first visit by the POB and representatives from all GPEI partners to Pakistan in 2023. The POB is the highest decision-making and oversight body of the GPEI.

During the four-day visit from 16 – 20 July that included Lahore, Peshawar and Islamabad, the delegates visited the National and Provincial Emergency Operations Centers, attended a meeting of the National Task Force on Polio Eradication, and held separate meetings with the leadership of the Pakistan Army, Health Minister Abdul Qadir Patel and Foreign Minister Bilawal Bhutto Zardari.

“Pakistan continues to make important progress in the fight to eradicate polio. I’m impressed by the commitment I’ve seen again this week from the federal and provincial governments in getting the job done,” said POB Chair Dr Chris Elias. “The experience globally is that strong government leadership is key in the final push to defeat polio.”

The delegation also met the Governor of Punjab, Chief Minister of Khyber Pakhtunkhwa and provincial chief secretaries, health secretaries, commissioners and deputy commissioners of priority districts of Punjab and Khyber Pakhtunkhwa in Lahore and Peshawar, respectively, and met with the Chief Secretary of Balochistan.

“While the challenges before us are formidable and complex, I remain cautiously optimistic about the goal of interrupting transmission of poliovirus in Pakistan by the end of this year. This will require solidarity and collective action at all levels to enable rigorous implementation of the strategy, that must be fully supported by communities and the political, administrative and security leadership,” said WHO Regional Director Dr Ahmed Al-Mandhari.

Endemic transmission of wild poliovirus remains restricted to seven districts in the south of Khyber Pakhtunkhwa province, namely Tank, Bannu, North Waziristan, South Waziristan Upper, South Waziristan Lower, DI Khan and Lakki Marwat.

A vaccination campaign is ongoing in the seven endemic districts named “Reaching the Unreached.” The campaign specifically targets over 270,000 children under five in 69 low-performing union councils where vaccine coverage for polio and other essential immunization has been inadequate.

“Under our regional vision of health for all by all, WHO will continue supporting Pakistan’s polio programme to give our future generations a world free from polio,” Dr Al-Mandhari added.

UNICEF’s Deputy Regional Director Noala Skinner appreciated the leadership. “We applaud the leadership of Pakistan and the dedication of frontline workers, including thousands of women, who tirelessly vaccinate and protect millions of children from the deadly poliovirus,” she said, adding, “The next six months are critical for Pakistan’s efforts to eradicate polio. We are so close to our goal of reaching all children with polio vaccines. Together, we must ensure that the programme is able to reach every child in Pakistan, regardless of where they live.”

Global leaders and stakeholders have been unanimously declaring their solidarity to achieving a lasting world free of all forms of polioviruses.

Convening this week at the World Health Assembly in Geneva, Switzerland, Ministers of Health from around the globe evaluated the unique epidemiological opportunity which currently exists, in particular in eradicating all remaining chains of endemic wild poliovirus in a handful of districts of just two countries – Pakistan and Afghanistan. As a record number of Member States and civil society partners took to the floor, key to success, all experts agreed, must be on adapting operations and reaching remaining un- or under-immunized children in just seven subnational most consequential geographies, with collectively account for 90% of all new polio cases, including in a gender-equitable and integrated manner. To ensure lasting success, delegates urged country-specific solutions for polio transition. In response to both a wild poliovirus outbreak in south-eastern Africa and multi-country circulating vaccine-derived poliovirus outbreaks, extraordinary special sessions were led by WHO and its Regional Office for Africa between affected Member States and partners, to discuss concrete steps to stopping all outbreaks affecting the Region by end of year.

The World Health Assembly comes on the heels of last week’s G7 Leaders and G7 Health Ministers meetings in Japan, where both meetings highlighted the urgent need to ensure a world free of polio can be rapidly achieved. Next week, Rotarians from around the world are convening at the Rotary International Convention in Melbourne, Australia, to ensure civil society support for the effort will go hand-in-hand with public sector engagement.

Speaking on behalf of both Pakistan and the entire Eastern Mediterranean, Mr A.Q. Patel, Pakistan Federal Minister for National Health Services, Regulations and Coordination, said: “We are in the final leg of eradication and we are doing everything we have to do to achieve success. The virus is restricted to its smallest-ever geographical footprint, and the (polio) programmes in both Pakistan and Afghanistan continue to vastly expand their hunt for the virus and mount robust campaigns to reach all children, not just with polio vaccine, but indeed other antigens as well. We could not have come this far without the strong support and goodwill of all Member States, however there is still more to be done at the heart of all our work, and for the future of all generations of children. We need continued and sustained financial and political support from all Member States and partners, in order to give every child, no matter where they live, the promise of a polio-free world.”

H.E. Dr Hanan Mohammad Al-Kuwari, Minister of Public Health of Qatar, and Co-Chair of the Eastern Mediterranean Regional Subcommittee for Polio Eradication and Outbreaks, commented: “In our Region, we have made significant progress in both containing the spread of wild poliovirus and closing outbreaks of vaccine variant polio. Afghanistan and Pakistan have restricted the virus to the smallest geographical footprint in history and are now doubling up efforts to fully interrupt the remaining transmission. The engines fueling this progress are manifold, but the two most powerful, and the two I truly believe will get us across the line, are improved immunity and better surveillance. We are reaching and vaccinating more children, more often, and we are using the most sensitive and robust surveillance measures in history to ensure that if the virus is there, we are not missing it. Excellencies, partners and colleagues, I ask this as clearly as I can: Stay the course. Dig deep to do what needs to be done. Stand with us and be part of history.”

Noting the global commitments being made, Jean-Luc Perrin, Rotary International’s Representative to the United Nations in Geneva, told the global health community at the Assembly: “Polio eradication is a rare example of enduring, truly global collaboration toward a goal whose achievement will benefit all nations in perpetuity, while contributing toward broader global health priorities. We cannot take progress or possible victory for granted. Let us make collective history and End Polio Now!”

In conclusion: global leaders continue to note the very real window of opportunity for success this year, but that this window will not remain open for long. The virus will again gain in strength. Only collective and global collaboration will result in ultimate success, and delegates and leaders urge all stakeholders to keep the focus firmly on one overriding objective: reaching remaining un- or under-vaccinated children in the most consequential geographies. A collective responsibility, but if achieved, will result in success in 2023.

Additional quotes from the World Health Assembly:

“WHO and our partners remain steadfastly committed to finishing the job of consigning polio to history. Last year, three million children previously inaccessible in Afghanistan received polio vaccines for the first time. And in October, donors pledged US$2.6 billion to support the push for eradication. At the same time, as part of the polio transition, more than 50 countries have integrated polio assets to support immunization, disease detection and emergency response. We must make sure that the significant investments in polio eradication do not die with polio, but are used to build the health systems to deliver the services that these communities so badly need.”- Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

“Wild poliovirus transmission has been cornered to the smallest ever geographic locations in the Eastern Region of Afghanistan and seven districts in southern part of Khyber Pakhtunkhwa in Pakistan. However, the last 100-metre dash presents its own challenges and we must do all we can to achieve success.” Dr Hamid Jafari, Director for Polio Eradication for the Eastern Mediterranean, on behalf of Dr Ahmed Al-Mandhari, Regional Director, World Health Organization Eastern Mediterranean Region

“The African Region, which was certified free of wild poliovirus in 2020, has set itself the objective of stopping the transmission of all types of 2 polioviruses by the end of 2023 and integrating polio assets into activities that strengthen broader disease surveillance. It is also deploying integrated public health teams to respond to other emergencies, building on experiences from past poliovirus outbreaks and leveraging the polio network and infrastructure for response activities.” – Delegation of Burkina Faso, speaking on behalf of the entire African Region.

A doctor and surveillance volunteer checks a child for signs of paralysis in a clinic in Shawalikot district, Afghanistan. ©WHO / Jawad Jalali

In May 2014, the WHO Director-General declared the international spread of poliovirus a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005), a designation that allows for accelerated response, emergency disbursement of funding and mitigation measures, such as vaccination of international travellers, to reduce the risk of spread of poliovirus. Nine years and several expert-led reviews later, polio retains its PHEIC status. COVID-19 and mpox have joined and recently left the list of diseases with this designation, but poliovirus still poses a risk of international spread. As noted with detections of variant poliovirus around the world in several previously polio-free countries, including Canada, Israel, the United Kingdom of Great Britain and Northern Ireland and the United States of America, poliovirus anywhere is a threat to children everywhere.

Despite retaining its PHEIC status, the polio eradication programme has made tremendous strides in the last 3 and a half decades. These efforts have brought the world to the best yet position in terms of achieving our goal of eradication.

In WHO’s Eastern Mediterranean Region, home to constantly brewing humanitarian crises and the last 2 countries endemic for wild poliovirus – Afghanistan and Pakistan – transmission has been cornered to the smallest ever geographical location. Up until now, in 2023, 2 cases of wild poliovirus have been reported from Afghanistan and one from Pakistan – all from the endemic zone in the East Region of Afghanistan and southern districts of Khyber Pakhtunkhwa, Pakistan. Both countries have also cut down the genetic diversity of the virus since 2020 – from 8 to one in Afghanistan and 11 to one in Pakistan.

Years of extraordinary efforts by frontline workers, national and local authorities, the partners of the Global Polio Eradication Initiative (GPEI) and donors the world over have led us to our best yet opportunity to snuff out this virus once and forever.

The footprint of circulating variant poliovirus in the Region has also reduced considerably in recent years. The Region has fewer outbreaks today than it had a year ago. Last year, Sudan closed its 2020 cVDPV2 outbreak and Islamic Republic of Iran closed a poliovirus event, while both Djibouti and Egypt are no longer detecting any poliovirus in environmental samples and are poised to formally close their outbreaks in a few weeks.

Polio surveillance systems have never been more sensitive. 18 of the Region’s 22 countries have established environmental surveillance systems to complement the networks of surveillance workers and health care providers actively searching for acute flaccid paralysis in children. In addition to countries at high risk of polio, the list also includes longstanding polio-free countries, such as Bahrain and Saudi Arabia, underscoring the importance of surveillance in all countries as the Region moves towards certification.

Investments made in polio have demonstrated their value for broader healthcare, such as during COVID-19 when the polio assets supported testing, vaccination and risk communication. The Region is making progress with polio transition to ensure countries maintain much-needed essential functions, even as funding transitions away from GPEI financing to national domestic resources or WHO base budget. These efforts will strengthen disease surveillance, routine immunization for children, and outbreak preparedness and response capacities.

The polio programme regularly engages with Member States through governing bodies such as the Regional Subcommittee for Polio Eradication and Outbreaks and uses expert advice by technical advisory groups of experts to review progress in the Region and support countries to stop transmission and maintain robust surveillance and immunization programmes. But to deliver on the promise of a polio-free world for future generations, there is still more work to be done. Across the Region, we are in a race against time to intensify surveillance, enhance the quality of immunization campaigns, and strengthen preparedness for and response to polio outbreaks, while ensuring any gender-related barriers are mitigated across all levels of the programme.

As WHO Member States gather in Geneva for the 76th annual World Health Assembly, now is the time to dig deep, draw on our strength as a partnership and the strength of donors and host governments, and achieve the goal we declared more than 3 decades ago.

Originally published on WHO’s EMRO website.

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.

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

Acknowledging that our common goal is to attain ‘Health for All by All’, which is a call for solidarity and action among all stakeholders;

Noting the progress achieved globally in eradicating wild poliovirus transmission since 1988, with endemic wild poliovirus transmission restricted to just two countries – Afghanistan and Pakistan;

Recalling that 2023 is the target year for interrupting all remaining poliovirus transmission globally, as per the Global Polio Eradication Initiative Strategy 2022–2026: Delivering on a Promise;

Appreciating the recent, intensified efforts made by both Afghanistan and Pakistan, resulting in a unique epidemiological window of opportunity to achieve success in 2023, as characterized by:

the geographic restriction of wild poliovirus transmission in 2022 to eastern Afghanistan and a few districts of north-western Pakistan;

the absence of any wild poliovirus case since September 2022;

the significant decline in genetic biodiversity of wild poliovirus to just a single lineage in each country; and

the successful interruption of circulating vaccine-derived polioviruses;

Emphasizing that the opportunity to interrupt wild poliovirus transmission must be seized now, given the unprecedented epidemiological progress and the inherent risks of delays in stopping polio, which would likely result in resurgence of polio;

Underscoring the ongoing risk of transmission of wild poliovirus, with detection of wild poliovirus from environmental samples in both countries since January 2023, confirming cross-border transmission ;

Highlighting that the key to success lies in reaching remaining zero-dose children (children who are un- or under-immunized) with oral polio vaccine in the most consequential geographies,¹ operating within a broader humanitarian emergency response, including increasing access to all populations in some areas;

Underscoring the importance and heroic work of health workers at the forefront in insecure settings, especially women, whose support and participation is critical to the eradication effort;

Recognizing the sustained commitment by leaders at all levels, notably by political leaders and law enforcement agencies, community and religious leaders, civil society, Global Polio Eradication Initiative partners, especially Rotary International, parents, caregivers and all health workers;

Recalling that the international spread of poliovirus constitutes a Public Health Emergency of International Concern under the International Health Regulations (2005);

Appreciating the support provided by the GPEI in responding to the devastating floods affecting Pakistan and the tragic earthquake affecting Afghanistan in 2022;

Appreciating the commitment of the United Arab Emirates through the initiative of His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of UAE, to promote and support polio eradication in Pakistan through the UAE Pakistan Assistance Programme;

Recognizing the longstanding support of donors like Rotary International and acknowledging the historical financial support of other Member States to the eradication effort, including the Kingdom of Saudi Arabia, Kuwait, Oman and Qatar;

Appreciating and supporting the decision of the WHO Regional Director for the Eastern Mediterranean to formally grade all polio emergencies and to apply relevant emergency standard operating procedures to WHO operations to address polio emergencies;

We, Member States of the Regional Subcommittee for Polio Eradication and Outbreaks for the Eastern Mediterranean,

DECLARE THAT:

1. We will focus all efforts on reaching remaining missed children with oral polio vaccine, within a broader humanitarian response context in the remaining most consequential geography of eastern Afghanistan and in north-western Pakistan;

COMMIT TO:

2. Mobilizing all necessary engagement and support by all political, community and civil society leaders and sectors across the Region, to fully achieve interruption of wild poliovirus transmission in the Region;

3. Facilitating the necessary support to fully implement all aspects of the Global Polio Eradication Initiative Strategy 2022–2026, including by ensuring rapid detection of and response to any poliovirus from any source, and implementing high-quality outbreak response;

4. Fostering coordination with other public health efforts, to ensure closer integration in particular with routine immunization efforts;

REQUEST THAT:

5. The international development and humanitarian communities and donors strengthen their support for full implementation of the National Emergency Action Plans to Eradicate Polio in Afghanistan and Pakistan; and

6. The Regional Director continue his strong leadership and efforts to achieve a Region free of all polioviruses for good, including by advocating for all necessary financial and technical support, reviewing progress, planning corrective actions as necessary and regularly informing Member States of the aforementioned and of any further action required through the World Health Organization Executive Board, World Health Assembly and Regional Committee for the Eastern Mediterranean.