News Category: Financing and donors

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?”

Polio vaccinators. © WHO/EMRO

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

©WHO
©WHO

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.

© WHO/Afghanistan

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

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

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

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

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

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

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

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

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

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

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

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

Children show their inked fingers - a sign they have been vaccinated against polio. © WHO/Afghanistan
Children show their inked fingers – a sign they have been vaccinated against polio. © WHO/Afghanistan

2022 may well go down in history as the year of contrasts in the global effort to eradicate polio. At first glance, with polio detections in places such as New York and London and an increase in cases in Pakistan, it may seem that the effort is backsliding. And while any detection of any poliovirus is a setback—particularly in areas where the disease had been long gone, like southeast Africa—a deeper analysis reveals a more encouraging story: 2022 saw perhaps some of the most significant progress in the programme’s history, and has set up the global polio effort for a unique opportunity to achieve success in 2023.

Endemic wild poliovirus transmission in both Pakistan and Afghanistan is becoming increasingly geographically restricted, with fewer virus lineages remaining active. The bulk of variant type 2 polio (cVDPV2) cases are also becoming more restricted, with 90% of all global cases restricted to three ‘consequential geographies’ (eastern Democratic Republic of Congo, northern Yemen and northern Nigeria). And emergency outbreak response efforts to wild poliovirus type 1 in southeast Africa continue to gain momentum.

To evaluate this progress as 2022 draws to a close, independent technical expert and advisory groups are taking an in-depth look at the prevailing epidemiology, assessing impact of eradication efforts and putting forth key strategic approaches to enable an all-out effort against the virus in the first half of 2023.

The first of these groups met in early October, when the Technical Advisory Group (TAG) for Pakistan reviewed vaccination coverage and disease surveillance across the country. Despite the increase in new cases, the TAG found the outbreak to be extremely geographically confined, thanks to concerted emergency efforts led by the government and supported by partners. Today, polio transmission is restricted to the six districts of southern Khyber Pakhtunkhwa province—a fraction of the country’s 180 districts. Encouragingly, the virus has not re-established a foothold outside the core outbreak zone, meaning the traditional reservoirs of  Karachi, Peshawar and Quetta are no longer endemic to the virus, a historical first.

More good news came out of the TAG’s analysis of the genetic biodiversity of virus transmission. In 2020, Pakistan had 11 separate chains of virus transmission. This was reduced to four in 2021, and today, just one family of the virus remains in the country. The approaches being implemented in Pakistan are working—despite some serious challenges.

Pakistan’s polio team supporting flood relief efforts © NEOC

In September, Pakistan experienced catastrophic flooding that impacted more than 33 million people and submerged one third of the country under water. In the face of this tragedy, and despite being affected themselves, polio staff supported the broader relief efforts while adapting polio operations to ensure that the eradication effort could continue unabated. Long-time polio eradicator and Director for Polio Eradication in WHO’s Eastern Mediterranean Region, Dr Hamid Jafari, said: “Rarely have I seen such commitment and dedication than I have seen in Pakistan – from national leaders, to health workers, right to the mother and father on the ground.

They are making a huge difference to people’s lives, which goes far beyond the effort to eradicate polio.”

In December, a high-level delegation led by GPEI Polio Oversight Board (POB) Chair Dr Chris Elias, WHO Regional Director Dr Ahmed Al-Mandhari and UNICEF Regional Director George Laryea-Adjei visited Pakistan during a nationwide vaccination campaign. After meeting with women health workers, provincial and national polio coordinators and even the Prime Minister, the group concluded that there is unprecedented support and commitment to ending polio in the country in 2023.

In Afghanistan too, an epidemiological deep dive reveals a promising picture: just over twelve months on from the political developments in the country in 2021, access to all children in the country continues to improve, albeit against a tragic backdrop of a severe and acute humanitarian crisis. More than 3.5 million children in Afghanistan who had been out-of-reach for almost five years can now be reached with polio vaccines, and thanks to strong vaccination and disease surveillance efforts, polio transmission has been restricted to just two chains in two provinces. And following the country’s devastating earthquake in June, polio teams sprang into immediate action to both support the broader emergency relief effort and adapt polio operations.

This progress in Pakistan and Afghanistan is identical to what epidemiologists observed during the ‘end game’ efforts in global polio reservoirs in the past, notably Nigeria, India and Egypt, giving rise to optimism that these remaining two endemic countries are on the right track.

Expert groups focus on outbreaks…

2022 saw a number of high-profile polio events, like the detections in New York City and London, but it is important to recognize the distinction between these and the outbreaks that have the capacity to endanger, or at least significantly delay, the global eradication goal.

Aidan O’Leary, Director of the Global Polio Eradication Initiative (GPEI) at the World Health Organization (WHO), contextualized the situation: “90 percent of global media attention has been on the polio emergence in New York, London and Israel. However, 90 percent of actual cases are in eastern Democratic Republic of Congo, northern Yemen and northern Nigeria.” It is in those areas, commonly referred to as consequential geographies, that programmatic efforts must maintain their focus. Notably, these areas also overlap with some of the highest proportions of ‘zero-dose’ children—those who are either un- or under-vaccinated.

WHO medical officer Dr Audu Idowu conducts an acute flaccid paralysis examination in Jere Local Government Area, Borno State. ©WHO/Nigeria
WHO medical officer Dr Audu Idowu conducts an acute flaccid paralysis examination in Jere Local Government Area, Borno State. ©WHO/Nigeria

While the outbreaks in northern Yemen and eastern DR Congo continue to expand at an alarming rate in 2022, the situation in northern Nigeria is far more encouraging. Nigeria accounted for two-thirds of all global cases in 2021, seeding outbreaks in 19 countries. In the second half of 2022, however, there has been a dramatic decrease in new detections, with just nine cases reported during that time.

In November, the Nigerian Government, with GPEI partners in attendance, hosted the Global Roundtable Discussion on variant type 2 polio outbreaks, reviewing progress in outbreak response following the upsurge in cases in 2021. The Roundtable recognized efforts to reach zero-dose children in consequential geographies throughout the country, in particular with the novel oral polio vaccine type 2 (nOPV2), as well as Nigeria’s focus on strengthening routine immunization with bivalent OPV and inactivated polio vaccine (IPV). Whichever strategy is used, however, the group cautioned: “coverage is king!” Any vaccine is only as good as the proportion of children it reaches.

The group’s conclusions and recommendations will be further evaluated by Nigeria’s Expert Review Committee on Polio Eradication and Routine Immunization (ERC).

Meanwhile, in southeast Africa, a comprehensive Outbreak Response Assessment reviewed the regional response to wild poliovirus type 1 (WPV1), linked to virus originating from Pakistan, with cases confirmed in Malawi and Mozambique.  Experts noted the high-level, comprehensive support for the outbreak response across the region, and that vaccination campaigns have been consistently improving with time.

At the same time, the group concluded that the outbreaks are not over. With simultaneous outbreaks of WPV1, cVDPV1 and cVDPV2 affecting in particular Mozambique, the group put forward key recommendations and strategies, building on the momentum and knowledge gained over the past six months. These conclusions were further endorsed by the Africa Regional Certification Commission for Eradication (ARCC), which met in South Africa.

Challenges remain ahead. Zero-dose children must be reached, particularly in consequential geographies. Remaining financial resources to achieve success must be mobilized. Campaigns must be strengthened in southeast Africa. But despite initial appearances, 2022 put the world on an extremely strong footing to interrupt all remaining chains of poliovirus transmission by end 2023—the goal of the GPEI Strategy 2022-2026.

There is a clear momentum as the year draws to a close. We must carry it into 2023 for a final, concerted push. Success is in our hands.

Pledging table

 

Both were exceptionally talented researchers, so united in their desire to rid the world of polio that they inoculated themselves and their families with disabled versions of the virus. Yet the rivalry between Jonas Salk and Albert Sabin was intense, with Sabin once suggesting that Salk’s efforts could be achieved in a kitchen sink.

The source of their hostility was a disagreement about the best way to immunise people against polio. Salk believed the answer lay in a “killed” virus vaccine – where the virus particles had been chemically inactivated, so they could no longer replicate or cause disease. Sabin favoured using a “live” oral vaccine – one containing live, but weakened, virus particles that could replicate but couldn’t cause paralysis.

The incidence of polio has reduced by 99.9% and GPEI and its partners have achieved what many had assumed would be impossible: the eradication of polio from all but a handful of countries.

Salk’s inactivated polio vaccine (IPV) entered human trials and was approved first. But it was Sabin’s oral polio vaccine (OPV) that became the global workhorse in polio eradication efforts and has been largely responsible for driving polio to the brink of extinction. However, polio isn’t gone, and the combination of COVID-19, ongoing conflict and political turmoil, has given polio the space it needed to fight back. Now, as polio eradication approaches its endgame, it is a combination of Salk’s and Sabin’s approaches that experts are hoping will prove to be humanity’s winning hand.

War on polio

Before the COVID-19 pandemic hit, progress towards eradicating polio was proceeding at a remarkable rate. During the 1940s and ’50s, when polio outbreaks were a common scourge of the summer months, the disease killed or paralysed more than half a million people worldwide each year – mostly children. The introduction of inactivated poliovirus vaccine (IPV) and, later, live attenuated oral poliovirus vaccine (OPV) led to a dramatic reduction in the incidence of polio in higher-income countries during the 1960s and ’70s.

But it wasn’t until the 1980s that the battle against polio really commenced. At that time, community- and school-based surveys revealed that polio was the leading cause of paralysis in lower-income countries, with one in every 200 polio infections causing paralysis. In 1988, the World Health Assembly adopted a resolution for the worldwide eradication of the disease, and a public-private partnership called the Global Polio Eradication Initiative (GPEI) was launched. Led by national governments, together with the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention, UNICEF, and later joined by the Bill & Melinda Gates Foundation and Gavi, The Vaccine Alliance, GPEI has made huge progress in protecting countries’ populations against polio through widespread OPV campaigns.

During this time, the incidence of polio has reduced by 99.9%, and GPEI and its partners have achieved what many had assumed would be impossible: the eradication of polio from all but a handful of countries.

Eradication endgame

In 2019, an independent commission of experts announced that wild poliovirus type 3 (WPV3) – one of three forms of the virus – had been eradicated worldwide. Type 2 poliovirus was declared eradicated in September 2015 – with the last virus detected in India in 1999 – leaving only Type 1 wild poliovirus at large in two endemic countries: Pakistan and Afghanistan.

In August 2020, when most people were preoccupied with fighting COVID-19, the WHO announced that all 47 countries in its Africa Region had been certified wild poliovirus-free following a long programme of vaccination and surveillance. Afghanistan and Pakistan were now the only places where wild poliovirus remained endemic, meaning it continued to circulate naturally in the environment.

“The past two years have demonstrated very clearly that there’s a very finite window to interrupt polio transmission and finish the job. Because if we do not eradicate polio, this virus will resurge globally.”

However, between 2019 and 2020, outbreaks of circulating vaccine-derived poliovirus (cVDPV) – a rare form of polio that occurs only in areas of low vaccination coverage – tripled, resulting in more than 1,100 children becoming paralysed. This year, cVDPVs have also been detected in the UK, US, and Israel, with some signs of limited community transmission. Wild poliovirus has also reappeared in south-east Africa, with a case detected in Malawi and seven cases in Mozambique.

“The new detections of polio this year in previously polio-free countries are a stark reminder that if we do not deliver our goal of ending polio everywhere, it may resurge globally,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We must remember the significant challenges we have overcome to get this far against polio, stay the course and finish the job once and for all.”

Disheartening as these setbacks are, they have provided a wake-up call to GPEI and its partners, and invigorated efforts to push polio eradication across the line. “I think the past two years have demonstrated very clearly that there’s a very finite window to interrupt polio transmission and finish the job,” said Aidan O’Leary, Director for Polio Eradication at the WHO. “Because if we do not eradicate polio, this virus will resurge globally.”

In 2020, GPEI launched a new roadmap to polio eradication, which set out two ambitious targets: firstly to permanently interrupt all poliovirus transmission in Pakistan and Afghanistan, stop transmission of cVDPV and prevent outbreaks in non-endemic countries by 2023. The second target is to certify the world free from polio – meaning no cases have been detected for three years – by 2026.

Achieving these goals will require a massive and concerted effort – with both OPV and IPV playing an integral role.

Polio vaccines

Polio is caused by a highly infectious virus that initially replicates in the nose or throat, before moving to the intestines and multiplying. From here, it can enter the bloodstream and invade the central nervous system, causing nerve damage and paralysis in around one in 200 people. Some survivors also develop post-polio syndrome, a disorder characterised by progressive muscle weakness and fatigue, which can severely impair their quality of life. However, around 70% of infected individuals are asymptomatic or have only mild symptoms, such as headache, fever and neck stiffness.

The development of vaccines against poliovirus has had a huge impact on its ability to circulate and cause disease, but OPV and IPV work in slightly different ways. IPV contains inactivated viral particles from all three poliovirus strains. Injected into the arm or leg, it is extremely effective at triggering antibodies against poliovirus in the blood, preventing the virus from travelling to the nerves and causing paralysis. However, it is less effective at triggering antibodies in the intestines, meaning vaccinated people can still become infected with poliovirus and transmit it to other people.

OPV, on the other hand, contains a mixture of poliovirus strains that have been weakened, meaning they can still replicate, but are not strong enough to cause paralysis. Because OPV is given via the mouth, it triggers the production of antibodies in both the intestines and the blood. This means that if a vaccinated person is exposed to poliovirus in the future, the virus won’t be able to replicate and infect other people.

This ability to block transmission, as well as being cheaper and easier to administer than IPV, led to the widespread adoption of OPV in most countries, and it has played a crucial role in eradicating wild poliovirus from all but a handful of places. However, because OPV contains weakened viruses that can replicate, some of them may be excreted by vaccinated individuals and transmitted to unvaccinated ones – particularly in areas with poor sanitation. This can be beneficial because exposure to weakened polioviruses helps to protect them against future infection.

However, it can also be problematic. In communities with high vaccine coverage, any onward transmission of vaccine-derived virus quickly fizzles out. But in those where fewer people have been vaccinated, weakened poliovirus may continue to circulate for months or years. Very rarely, these viruses can accumulate genetic changes that enable them to cause paralysis once more. If these strains continue to circulate, they can trigger outbreaks of what are called circulating vaccine-derived polio.

Under-immunised

Vaccine-derived polio is extremely rare, and only emerges in under-immunised populations. Between 2000 and 2021, more than 20 billion doses of OPV were given to nearly three billion children worldwide, and only 2,299 cases of cVDPV paralysis were registered during that period.

In the past decade, new types of OPV have been developed that reduce the risk of future cVDPVs emerging. Whereas earlier forms of OPV contained weakened forms of type 1, 2 and 3 polioviruses, since April 2016, all countries have switched to using bivalent OPV, which contains just types 1 and 3. This is helpful, because the weakened type 2 strain is responsible for nearly 90% of all cVDPVs.

“In all the areas where we face challenges, it’s due to a combination of issues around inaccessibility and security, non-functioning health systems, and communities that have become marginalised from the state, for a whole variety of reasons.”

Even so, vaccine-derived polio has emerged as a key challenge in the final stage of polio eradication. Three geographical locations, in particular, currently account for more than 90% of all global cases of cVDPV caused by the type 2 strain: northern Yemen, eastern Democratic Republic of the Congo, and northern Nigeria. Ongoing conflict in south central Somalia is another concern.

“In all the areas where we face challenges, it’s due to a combination of issues around inaccessibility and security, non-functioning health systems, and communities that have become marginalised from the state, for a whole variety of reasons,” said O’Leary.

The situation in Yemen is particularly worrying, because of ongoing restrictions on childhood vaccination imposed by the Houthi administration in Sanaa, Yemen’s largest city. “We understand that a lifting of these restrictions may be imminent, but a delay of more than 12 months has allowed the virus to continue to spread in a situation where the essential immunisation system is either non-existent, or very poorly performing. And it has wreaked havoc with more than 200 children being paralysed over the course of this period,” O’Leary said.

These pockets of cVDPV are bad enough, but international travel also means that infections can be seeded elsewhere – which is thought to explain recent detections of cVDPV in London, New York and Israel. The good news is that such outbreaks can be stopped using the same tactics that have so successfully stamped out wild poliovirus – strengthening polio surveillance and ensuring high vaccination coverage.

Race against the clock

In an outbreak scenario, time is of the essence, making OPV the vaccine of choice. “The key with OPV is that it’s safe, effective, cheap and very easy to use,” said O’Leary. “Particularly the children that we’re most concerned about, which is infants under the age of one or two, it is not an easy task to bring them – sometimes very extensive distances – to receive an injectable vaccine in a clinic. So, we flip it, and bring the vaccine directly to households to make immunisation as simple and straightforward as possible, while maximising the coverage that can be achieved.”

The risk of new cVDPVs emerging during these emergency campaigns should be further reduced through the recent introduction of another new OPV, called type 2 novel oral polio vaccine (nOPV2), which is specifically designed to extinguish cVDPV2 outbreaks in a more sustainable way. Like earlier OPVs, it contains weakened type 2 polioviruses, but they have been further modified to make them more stable, meaning they are significantly less likely to revert into a threatening form.

To eliminate the primary risk of emergence of all types of vaccine-derived polio cases, the Polio Eradication and Endgame Strategic Plan (PEESP) called for the phased removal of the current Sabin-strain oral polio vaccine (OPV) – a critical and necessary step towards polio eradication. It’s important to clarify that the risk is not associated with the vaccine itself but rather low vaccination coverage. If a population is fully immunised, they will be protected against both vaccine-derived and wild polioviruses.

Endgame strategy

Ultimately though, the plan is to phase out OPV altogether. The problem lies not with the vaccine itself, but rather low vaccination coverage and the possibility of new cVDPVs emerging.

⌈If OPV has been the artillery in the war against polio, then IPV provides the cavalry needed to finish the job.⌉

Enter IPV. With polio eradicated from most continents and countries, the key to keeping it that way is maintaining high levels of population immunity – not just in adults and children who have previously been vaccinated against polio, but in children being born today and in the coming years – through routine childhood immunisation with IPV.

If OPV has been the artillery in the war against polio, then IPV provides the cavalry needed to finish the job, said O’Leary: “It needs to be significantly bolstered up everywhere, to sustain the gains that have been made. That ultimately means strengthening essential immunisation systems across the board.”

Until the COVID-19 pandemic hit, these efforts had been proceeding at pace. Nepal became the first country to introduce routine immunisation with IPV with Gavi support in 2014. Within five years all Gavi-supported countries had successfully completed their introductions – collectively immunising more than 112 million children.

However, the COVID-19 pandemic has set back the delivery of all routine childhood immunisations. “The big area of concern has been the jump from just under 19 million children who were categorised as zero-dose – meaning they are not receiving a single dose of routine vaccines – to more than 25 million,” said O’ Leary.

The final mile

Contained within GPEI’s new roadmap, The Polio Eradication Strategy 2022–2026, is a commitment to reverse this trend by rapidly rebuilding coverage rates in those areas where shortfalls are being recorded.

Whether GPEI and its partners can really make up enough ground to stop the transmission of wild poliovirus globally by the end of 2023, remains to be seen, but their resolve and commitment to go the final mile is unwavering.

“It’s not the first time such targets have been offered. But what’s different this time around is that, in addition to mass vaccination campaigns, the initiative’s new strategy will be intensely focused on finding targeted ways to reach missed communities and take advantage of opportunities to become more integrated with other essential services.” said Seth Berkley, Gavi’s CEO. “In these communities, children are not just consistently missing out on protection from polio, they are also missing out on a whole range of other critical health interventions and other vaccines.”

If the eradication of polio is successful, it would only be the second human disease, after smallpox, to have been scrubbed from the face of Earth. “Notwithstanding all the doom and gloom with the COVID-19 pandemic and other challenges, it really is feasible – if we remain very focused on that goal,” said O’Leary. “And it absolutely requires both types of vaccine.”

Re-posted with permission from GAVI.

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

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

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

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

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

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

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

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

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

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

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

Additional quotes from the pledging moment:

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

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

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

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

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

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

Pledging table

Media contacts:

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

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

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

Notes for editors:

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

Related links

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

Fact sheet

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

A polio worker administers the oral polio vaccine to a child in Karachi. Credit: @SalmanMahar

Polio is one of the world’s most devastating diseases. It mainly affects children under five and in one in 200 cases it results in lifelong paralysis. Amazing progress has been made in fighting polio globally: according to UNICEF, there were a reported 20,000 children paralysed by polio in Pakistan in 1994. By 2021, new paralysis cases had dropped to just one child. However, as long as just one child remains infected, all children are at risk.

Identifying and reaching unvaccinated children has been a challenge, but big data startups like Zenysis, in partnership with Pakistan government partners, are making inroads.

Vaccination data is only useful if it’s accurate

Abid Hasan is the project manager for Zenysis – a Gavi INFUSE pacesetter since 2017 – in Pakistan, and he explains the barriers to a more effective vaccination programme in the country:

“Data is like people, in that if data sets don’t talk to each other then they won’t work well. Zenysis gets data and data sets talking.”

Community health workers employed through Pakistan’s Polio Eradication Programme and the Expanded Programme of Immunisation go door to door to collect vaccination data, sometimes using datasheets, sometimes paper, sometimes recording data through WhatsApp. It can be difficult to track families with no formal address, or mobile communities with no fixed address. With 14 million children requiring a polio vaccination every two months, recording accurate data is a mammoth task.

The resulting data can be imperfect, with duplication a particular challenge. This is where Zenysis’s platform comes in. Zenysis software integrates, de-deplicates and harmonises more than 20 siloed datasets, including polio data, immunisation registries and population data.

Combined, the data can be used far more effectively for analysis and, importantly, action on the ground. The result? A new and improved vaccination plan, personalised for each vaccinator’s district – known as a microplan.

A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register. Credit: @SalmanMahar
A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register.
Credit: @SalmanMahar

Microplans help health workers target zero-dose children

The enhanced microplans provide health workers with granular information on each child in a region, including their vaccination status, age and address. This information can be used to identify individual children and highlight neighbourhoods where there are clusters of unvaccinated (zero-dose) children. This in turn means better use of time and energy, and better outcomes for communities.

The effect, explains Hasan, is seen in three key areas. “Firstly, the newmicroplans give community health workers the real picture. Second, frontline workers now have a plan to follow and are no longer using broad or inflated data that is hard to actionize. Third, this approach is measurable – when you reach a target, that goes into the system. With accurate data, you can really see the impact.”

Health workers on the ground have seen the difference. Sadaf, a community health worker for Polio, in Karachi, says: “Before the microplans the vaccinators were given a long list of children with duplicate entries in them, and they were extremely difficult to track. After receiving these microplans we can easily decide where to set up our outreach sites and mobilise children to bring them there for vaccination in a systematic manner.”

The impact has been impressive. Since January 2022, the Expanded Programme on Immunisation in the Sindh region has used the Zenysis platform to identify over 28,500 true zero-dose children in the region and vaccinate 12,724 of them with the aid of microplans. In March to June of this year, 3,854 zero-dose children were vaccinated with the help of the new microplans in the regions where they have been implemented.

Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi. Credit: @SalmanMahar
Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi.
Credit: @SalmanMahar

Gavi support has been vital in creating goals and driving change

Zenysis was part of Gavi’s INFUSE programme, which connects high-impact innovations with the countries that need them most. Hasan explains that for countries like Pakistan, the investment from Gavi is vital to enhance healthcare budgets, but also to help provide momentum and set goals for vaccination programmes.

Looking ahead, Zenysis is collaborating closely with government partners to expand the platform and vaccination approach throughout Sindh province, tackle other vaccine-preventable diseases, and improve the government’s technical platform management capacity.

As Hasan says, “Not everyone is a data expert – but if you can go on a platform, go into a dashboard, and see all your data into one workspace then you can reach a zero-dose child and their family, and get them vaccinated.”

And with each child vaccinated, we get a step closer to a world where infection by wild poliovirus is a thing of the past.

Reposted with permission from gavi.org

 

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

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

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

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

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

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

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

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

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

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

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

The Global Polio Eradication Initiative (GPEI) has been informed of a case of paralytic polio in an unvaccinated individual in Rockland County, New York, United States.  

The US Centers for Disease Control and Prevention (CDC) are coordinating with New York State health authorities on their investigation. Initial sequencing confirmed by CDC indicates that the case is type 2 VDPV.  

Following the detection, the Global Polio Laboratory Network (GPLN) has confirmed that the VDPV2 isolated from the case is genetically linked to two Sabin-like type 2 (SL2) isolates, collected from environmental samples in early June in both New York and greater Jerusalem, Israel, as well as to the recently-detected VDPV2 from environmental samples in London, UK. Further investigations – both genetic and epidemiological – are ongoing to determine possible spread of the virus and potential risk associated with these various isolates detected from different locations around the world.

It is vital that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level and at the lowest administrative level to protect children from polio and to minimize the consequences of any new virus being introduced. 

Any form of poliovirus anywhere is a threat to children everywhere. It is critical that the GPEI Polio Eradication Strategy 2022-2026 is fully resourced and fully implemented everywhere, to ensure a world free of all forms of poliovirus can be achieved.  

Hon. Shinzo Abe © Getty Images

The Global Polio Eradication Initiative (GPEI) is deeply saddened by the death of the former Prime Minister of Japan, Hon. Shinzo Abe, and extends our heartfelt condolences to his family and friends.Prime Minister Abe was a valuable advocate for global health equity and achieving a world where no child is paralyzed by polio. In 2015, Rotary presented Hon. Abe with its Polio Eradication Champion Award for his outstanding commitment to ending polio. Hon. Abe played a central role in reconfirming Japan’s support for global polio eradication efforts during the 2017 pledge event held during the Rotary Convention in Atlanta.

元内閣総理大臣 安倍晋三氏を偲んで
ステートメント

世界ポリオ根絶イニシアティブ（GPEI）は、安倍晋三元首相が亡くなられたことを深く悲しみ、ご遺族とご友人に心からの哀悼の意を表します。
安倍元首相は、世界的な保健の公平性と、ポリオで身体が麻痺する子どもがいない世界を実現するための貴重な提唱者でした。2015年、ロータリーは、ポリオ根絶への卓越した取り組みに対し、安倍首相（当時）にポリオ根絶チャンピオン賞を授与しました。安倍首相（当時）は、アトランタで開催されたロータリー国際大会中に行われた2017年の誓約行事で、世界のポリオ根絶活動に対する日本の支援を再確認する上で中心的な役割を果たしました。
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Dashboard showing real-time data on active case finding and routine immunization from integrated supportive supervisory visits to priority sites in Senegal. © WHO
Dashboard showing real-time data on active case finding and routine immunization from integrated supportive supervisory visits to priority sites in Senegal. © WHO

While the WHO Africa Region (AFRO) has been facing its last hurdle in eradicating polio of all types since being certified indigenous wild polio free in 2020, a circulating variant of polio virus type two has been present in 26 countries with more than 1,000 cases between them, coupled with the recent importation of two wild polio type 1 cases. To help reverse this trend, the WHO/AFRO Geographic Information Systems (GIS) Center is equipping over 200 key country office focal points and Ministry of Health personnel across 47 countries with essential innovative technologies to better address outbreaks with necessary speed and quality.

Concluding a series of one-week capacity-building workshops over the past six months and targeting of the WHO  regions of Central, East & Southern, and West Africa –  – the AFRO GIS Center, with the support of the Bill & Melinda Gates Foundation (BMGF), WHO HQ Polio Unit and GIS Centre for Health, the United States Centers for Disease Control and Prevention (CDC), and Novel-t on-boarded digital GIS and Mobile Health (mHealth) technologies to support regional and national agendas particularly on planning and analysis for improvement of surveillance, campaigns and outbreak response for polio and all other routine immunization and outbreaks. While the initial investment was made by polio these tools are being leveraged for all health interventions.

A group of participants from the AFRO Geographic Information System (GIS) and Information Visualization Capacity Building Training session, in Dakar, Senegal. © WHO
A group of participants from the AFRO Geographic Information System (GIS) and Information Visualization Capacity Building Training session, in Dakar, Senegal. © WHO

“These are solutions to advance national and regional agendas even beyond polio” stated Kebba Touray, Technical Manager – AFRO GIS Centre, “the COVID-19 pandemic response was able to advance using the AFRO polio GIS Centre’s technical support with the development of real-time data collection, analysis and monitoring tools and generated several products including dashboards (providing easy availability and visualization of information), which facilitated rapid decision making for response activities across the region.”

The GIS Capacity Building training transferred knowledge to key country office focal points and Ministry of Health personnel across Africa on innovations to better enable countries to:

  • Design country-level specific static and dynamic maps – using platforms such as Microsoft Power BI, and ArcGIS – for the outbreak response and provide real time analysis through the dashboards.
  • Provide country specific information visualization (using Dashboards) to publish in the existing AFR-mHealth workspace at AFRO and in their respective public health systems.
  • Develop data collection, data validation and monitoring mechanisms that provides increased accuracy on immunization information and populations through the Open Data Kit (ODK) platform to enhance mobile data collection.
  • Use AFRO GIS and information visualization innovative solutions at country level to receive real-time information on active surveillance visits conducted at health facility level, environmental surveillance site performance, rapid population estimates data, vaccination team movement during polio campaigns, among others.

“I am particularly eager to take back the new capacity I have on ODK and PowerBI when monitoring our entire Expanded Programme on Immunization (‎EPI)‎ interventions” stated participant Dexter Merchant, Assistant Director for Monitoring and Evaluation at the Ministry of Health in Liberia, “using ODK as the process to collect data on where we have essential services and where we don’t is going to make things move a lot faster and more efficiently in identifying gap, I am confident these tools will now be integrated in Liberia”.

John Kipterer and Frank Salet moderating a PowerBI training session at the GIS capacity building workshop in the Dakar. © WHO
John Kipterer and Frank Salet moderating a PowerBI training session at the GIS capacity building workshop in the Dakar. © WHO

To ensure sustainability, country accountability and ownership, in-country GIS working groups which will constitute personnel from WHO and Ministries of Health will be established to continue efforts of knowledge transfer and capacity building principally amongst data managers, GIS analysts, and surveillance officers.

In closing, the WHO Representative in Senegal, Dr. Lucile Imboua and host of the last training series emphasized the “need to ensure harmonization of all the GIS tools and to be flexible to accommodate the use of other tools across different programs.”

The underlining consensus from all WHO, government and partner participants is that in order to end polio and strengthen health systems, the region heavily relies on the innovative technologies of GIS in executing health responses. The use of GIS innovations with precision in accuracy, transparency, accountability and ease of application and sustainability provides a huge opportunity to reach every last child across the 47 countries, eradicate polio from the region, and serve public health for all.

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

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

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

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

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

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

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

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

Emergency health centres provide the most urgent medical support to families © WHO
Emergency health centres provide the most urgent medical support to families © WHO

When disaster strikes, co-ordination is key. Within hours of the 5.9 magnitude earthquake striking the communities of Afghanistan’s South East in the early morning of 22 June, WHO’s polio team was on the ground joining forces with UN agencies and NGOs to ensure an effective and coordinated relief effort.

As dawn broke across the provinces of Paktika and Khost, and the extent of the devastation became evident, polio teams worked across both provinces to establish communications and share reports of the length and breadth of the destruction.

The team’s invaluable experience and local knowledge gained from more than two decades working among local communities in both Paktika and Khost provided the foundations of an assessment tool to map communities and assess the number and extent of casualties as well as the destruction to homes and buildings. This ensured accurate data guided a focused response in the immediate aftermath including the rapid construction of tents for shelter as well as housing ad hoc health camps.

Helping clear rubble following the devastating earthquake © WHO
Helping clear rubble following the devastating earthquake © WHO

In the districts of Giyan, Geru and Barmal in Paktika, polio teams assisted in attending the injured, providing trauma care and dressing wounds. One team member was despatched to Spera district in neighbouring Khost province to assist with trauma care.

Polio teams turned a helping hand wherever needed including digging for survivors, building tents, unpacking trucks and distributing shipments of WHO emergency and surgical kits, medical supplies and equipment, and the heartbreaking task of preparing and assisting in transporting the dead for burial.

With the very real risk of increased communicable diseases in the wake of any natural disaster, polio staff drew on the polio surveillance system to strengthen post-earthquake surveillance for acute watery diarrhea, measles, tetanus and COVID 19.

Emergency provision of trauma care. © WHO
Emergency provision of trauma care. © WHO

More than 1,000 people died in the quake and nearly 3,000 were injured; homes buildings and livelihoods have been destroyed. The polio team will continue to work as part of WHO Afghanistan’s earthquake response including providing trauma care, physical rehabilitation and disability assistance.

The earthquake struck five days before the start of the fifth nationwide polio vaccination campaign for 2022. The campaign was postponed for one week in Paktika province and in Spera district of Khost province and will begin on 4 July.

Children show their inked fingers - a sign they have been vaccinated against polio. © WHO/Afghanistan
Children show their inked fingers – a sign they have been vaccinated against polio. © WHO/Afghanistan

Leaders at this week’s G7 Head of State meeting in Germany and last week’s Commonwealth Heads of Government meeting in Rwanda renewed global commitment to polio eradication.  In their official Communiqué, the Leaders of the Group of Seven (G7) vowed to ‘continue our support for polio eradication through the Global Polio Eradication Initiative’, while the Commonwealth Heads of Government, in their joint Communiqué on ‘Delivering a Common Future’, urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues.  These calls and commitments follow similar engagements made at previous global political fora this year, notably the recently-held G7 Development and Health Ministers meeting, and the World Health Assembly.

Global partners of the eradication effort, notably led by Rotary International and Rotarians around the world, are working with the public sector to ensure political commitments are fully operationalized.

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

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

 

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

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

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

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

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

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

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

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

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

The Global Polio Laboratory Network (GPLN) has confirmed the isolation of type 2 vaccine-derived poliovirus (VDPV2) from environmental samples in London, United Kingdom (UK), which were detected as part of ongoing disease surveillance.  It is important to note that the virus has been isolated from environmental samples only – no associated cases of paralysis have been detected.  Recent coverage for the primary course of DTaP/IPV/Hib/HepB vaccination, which protects against several diseases including polio, in London suggests immunization coverage of 86.6%.

Initially, vaccine-like type 2 poliovirus (SL2) had been isolated from samples taken from the same site between February and May 2022. Genetic analysis suggests that the new VDPV2 and previous SL2 isolates have a common origin, still to be identified, but the technical definition and criteria for ‘circulation’ of VDPV2 are not met at this time.  Additional sewage samples collected upstream from the main waste-water treatment plant’s inlet are being analysed.

Investigations and response by the UK Health Security Agency are ongoing  to:

  • assess both origin and risk of circulation associated with these isolates;
  • strengthen poliovirus surveillance including enterovirus and environmental;
  • explore routine immunization catch-up of children who are under-immunized, including of families that have recently arrived in the UK from countries with recent use of type 2-containing oral polio vaccine; and,
  • enhance communications about this incident to health professionals and caregivers.

It is important that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level and at the lowest administrative level to protect children from polio and to minimize the consequences of any new virus being introduced.

Any form of poliovirus anywhere is a threat to children everywhere. It is critical that the GPEI Polio Eradication Strategy 2022-2026 is fully resourced and fully implemented everywhere, to ensure a world free of all forms of poliovirus can be attained.

A polio worker speaks to a family in Borno State, Nigeria. In Nigeria, polio personnel have played a vital role to educate communities on COVID-19 and register individuals for their vaccination, underlining the necessity of sustaining these networks. © WHO/Andrew Esiebo

As the first COVID-19 vaccines arrived into Somalia, polio programme staff were in position. Drawing on years of experience working to tackle polio and other health threats, staff had taken on key roles in logistics, cold-chain management and monitoring to ensure the success of the vaccine rollout.

Mohamud Shire, a WHO polio eradication officer working in the central zone of Somalia, explained, “Regional and district polio officers acted as supervisors of the vaccine rollout. Some of the polio health workers worked as COVID-19 vaccinators, whereas others were social mobilizers.”

A new WHO report entitled, ‘Role of the polio network in COVID-19 vaccine delivery and essential immunization: lessons learned for successful transition’, underscores the value of the polio network as an agile and experienced public health workforce, able to pivot to support national health programmes to deliver COVID-19 vaccines, and strengthen essential immunization. The introduction of COVID-19 vaccines in 2021 stretched country health systems, requiring all hands on deck to deliver vaccines to the most vulnerable. In this challenging context, hundreds of polio eradication staff led efforts in areas ranging from coordination and community mobilization, to training and surveillance. This work proves that sustaining these capacities is the way forward to build stronger, more equitable and resilient health systems.

The polio transition process aims to sustain the workforce and infrastructure set up to eradicate polio to strengthen immunization programmes, protect against outbreaks, and deliver essential health services to communities. A 2020 report documented the outstanding contributions of the polio network to the emergency stage of the COVID-19 pandemic, with over 5900 staff in the 20 priority countries for polio transition stepping up. The new report provides evidence of the role of polio staff to support essential immunization, and makes the case to transition their valuable skills and expertise to strengthen immunization programmes, building on the COVID-19 experience.

Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia. © WHO/Indonesia

In Sudan, 13 polio staff coordinated with partner agencies, trained vaccinators and provided comprehensive technical support for the COVID-19 rollout. In Nepal, 15 polio and immunization officers monitored the quality of COVID-19 vaccine sessions, whilst in India, polio and immunization Open Data Kit software was used to record data from more than 450,000 COVID-19 vaccination sessions. In Nigeria, at least 121 polio staff worked to sensitize communities to COVID-19, support trainings for the e-registration of vaccine recipients, and manage Adverse Events Following Immunization (AEFI). In these countries, this work builds upon historical contributions of polio staff to essential immunization, including working with national essential immunization programmes for the co-delivery of polio with other vaccines, and using electronic surveillance tools developed for polio eradication to detect other vaccine-preventable diseases.

The report also details lessons learned from the COVID-19 vaccine rollout. One is the value of integrating polio functions into other health programmes. The pandemic response showed that with an integrated approach it is possible to achieve more with limited resources. For instance, in the Eastern Mediterranean Region, the pandemic experience has led to the introduction of Integrated Public Health Teams, which bring together public health staff to provide broader services to communities.

Another lesson is the value of transferable skills that can contribute to vaccination across the life-course. Polio personnel have specific strengths in childhood vaccination, but the pandemic has shown that their cross-cutting skills – including coordination, disease surveillance, monitoring, data management and microplanning – can be used to make progress towards global immunization goals. The pandemic has impacted rates of routine immunization, leading to an increase in numbers of un- or under-vaccinated children. Harnessing the skills of polio personnel, and integrating them into other programmes, is key to achieving the goals of the Immunization Agenda 2030.

Polio vaccinators travel on camel during the November 2021 integrated measles-rubella and polio campaign in Pakistan. Close collaboration between the polio and immunization programmes helped to reach over 90 million children. © Gavi/Asad Zaidi

The report further serves to emphasise that polio transition and polio eradication are interdependent, and must go hand-in-hand. In the context of ongoing polio outbreaks, the sustainable transition of functions in polio-free counties is a necessary step to ensure that health systems are resilient to future health threats, including poliovirus importations.

To support these aspects, sustainable financing for the integration and transition of polio essential public health functions is vital. As of 2022, over 50 countries have transitioned out of GPEI support, but still require funding and technical support from WHO and other partners. Long-term domestic and international support is needed to ensure that the knowledge, expertise and lessons learned from polio eradication continue to serve populations. This is especially important as governments face long-term financial constraints on their health spending due to the pandemic.

As we move towards health systems recovery, we must ensure that the polio infrastructure is transitioned in a sustainable manner, to support more resilient health systems.

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

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

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

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

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

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

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

Partners in the Global Polio Eradication Initiative (GPEI) are extremely saddened to learn of the recent passing of Danny Graymore OBE, and wish to extend our condolences and love to his family and friends.

Danny was compassionate, fiercely intelligent and a tireless advocate for polio eradication, global health and human rights. He inspired many in his work for a fairer, more equitable world.

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

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

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

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

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

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

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

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

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

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

GENEVA, 26 April 2022

Today, the Global Polio Eradication Initiative (GPEI) announced that it is seeking new commitments to fund its 2022-2026 Strategy at a virtual event to launch its investment case. The strategy, if fully funded, will see the vaccination of 370 million children annually for the next five years and the continuation of global surveillance activities for polio and other diseases in 50 countries.

During the virtual launch, the Government of Germany, which holds the G7 presidency in 2022, announced that the country will co-host the pledging moment for the GPEI Strategy during the 2022 World Health Summit in October.

“A strong and fully funded polio programme will benefit health systems around the world. That is why it is so crucial that all stakeholders now commit to ensuring that the new eradication strategy can be implemented in full,” said Niels Annen, Parliamentary State Secretary to the Federal Minister for Economic Cooperation and Development, Germany. “The polio pledging moment at the World Health Summit this October is a critical opportunity for donors and partners to reiterate their support for a polio-free world. We can only succeed if we make polio eradication our shared priority.”

Wild poliovirus cases are at a historic low and the disease is endemic in just Pakistan and Afghanistan, presenting a unique opportunity to interrupt transmission. However, recent developments, due in part to impacts of the COVID-19 pandemic, underscore the fragility of this progress. In February 2022, Malawi confirmed its first case of wild polio in three decades and the first on the African continent since 2016, linked to virus originating in Pakistan, and in April 2022 Pakistan recorded its first wild polio case since January 2021. Meanwhile, outbreaks of cVDPV, variants of the poliovirus that can emerge in under-immunized communities, were recently detected in Israel and Ukraine and circulate in several countries in Africa and Asia.

The investment case outlines new modelling that shows achieving eradication could save an estimated US $33.1 billion this century, compared to the price of controlling polio outbreaks. At the launch event, GPEI leaders and polio-affected countries urged renewed political and financial support to end polio and protect children and future generations from the paralysis it causes.

“Despite enormous progress, polio still paralyses far too many children around the world – and even one child is too many,” said UNICEF Executive Director Catherine Russell.  “We simply cannot allow another child to suffer from this devastating disease – not when we know how to prevent it. Not when we are so close. We must do whatever it takes to finish the fight – and achieve a polio-free world for every child.”

“The re-emergence of polio in Malawi after three decades was a tragic reminder that until polio is wiped off the face of the earth, it can spread globally and harm children anywhere. I urge all countries to unite behind the Global Polio Eradication Initiative and ensure it has the support and resources it needs to end polio for everyone everywhere,” said Hon. Khumbize Kandodo Chiponda MP, Minister of Health, Malawi.

The new eradication strategy centres on integrating polio activities with other essential health programs in affected countries, better reaching children in the highest risk communities who have never been vaccinated, andstrengthening engagement with local leaders and influencers to build trust and vaccine acceptance.

“The children of Pakistan and Afghanistan deserve to live a life free of an incurable, paralyzing disease. With continued global support, we can make polio a disease of the past,” said Dr Shahzad Baig, National Coordinator, Pakistan Polio Eradication Programme. “The polio programme is also working to increase overall health equity in the highest-risk communities by addressing area needs holistically, including by strengthening routine immunization, improving health facilities, and organizing health camps.”

The investment case outlines how support for eradication efforts will enable essential health services in under-served communities and strengthen the world’s defences against future health threats.

Since 2020, GPEI infrastructure and staff have provided critical support to governments as they respond to the COVID-19 pandemic, including by promoting COVID-safe practices, leveraging polio surveillance and lab networks to detect the virus, and assisting COVID-19 vaccination efforts through health worker trainings, community mobilization, data management and other activities.

“The global effort to consign polio to the history books will not only help to spare future generations from this devastating disease, but serve to strengthen health systems and health security,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

Additional quotes from the GPEI Investment Case:

“We have the knowledge and tools to wipe polio off the face of the earth. GPEI needs the resources to take us the last mile to eradicating this awful disease. Investing in GPEI will also help us detect and respond to other health emergencies. We can’t waver now. Let’s all take this opportunity to fully support GPEI, and create a world in which no child is paralyzed by polio ever again,” said Bill Gates, Co-chair, Bill & Melinda Gates Foundation.

“An investment in polio eradication goes further than fighting one disease. It is the ultimate investment in both equity and sustainability – it is for everyone and forever. An important component of GPEI’s Strategy focuses on integrating the planning and coordination of polio activities and essential health services to reach zero-dose children who have never been immunized with routine vaccines, therefore contributing to the goals of the Immunization Agenda 2030.” said Seth Berkley, Chief Executive Officer, Gavi, the Vaccine Alliance.

“Twenty million people are walking today because of polio vaccination, and we have learned, improved and innovated along the way. We are stronger and more resilient as we enter the last lap of this marathon to protect all future generations of the world’s children from polio. Please join us; with our will and our collective resources, we can seize the unprecedented opportunity to cross the finish line that lies before us,” said Mike McGovern, Chair, International PolioPlus Committee, Rotary International.

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Media contacts:

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

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

Sabrina Sidhu
UNICEF New York
Email: ssidhu@unicef.org
Tel: +19174761537

Yemen is currently experiencing twin outbreaks of circulating vaccine-derived poliovirus type 1 and type 2 (cVDPV1 and cVDPV2). Both strains of poliovirus emerge in populations with low immunity and both can result in lifelong paralysis and even death.

Since 2019, 35 and 14 children have been paralysed by cVDPV1 and cVDPV2 respectively, three of the cVDPV2 cases confirmed in the past 10 days alone. The cVDPV2 outbreak, in particular, is ongoing and expanding and has already spread to other countries in WHO’s Eastern Mediterranean Region and UNICEF’s Middle East and North Africa Region.  At its fourth meeting on 9 February 2022, the Eastern Mediterranean Ministerial Regional Subcommittee on Polio Eradication and Outbreaks issued a statement, expressing deep concern around these expanding outbreaks and requesting all authorities in Yemen to facilitate resumption of house-to-house vaccination campaigns in all areas.

The Global Polio Eradication Initiative (GPEI) partners strongly recommend high-coverage mass vaccination campaigns to stop a cVDPV outbreak.  The vaccination response must achieve at least 90% of children vaccinated repeatedly with polio vaccine to protect them from polio and prevent seeding new vaccine-derived emergences. Therefore, the guidelines in the Polio Outbreak Response Standard Operating Procedures recommend that the vaccination response to polio outbreaks should be conducted using the house-to-house vaccine delivery strategy to maximize coverage of vulnerable children.

The GPEI urges the health authorities in Sana’a to conduct high quality house-to-house vaccination campaigns to stop the two concurrent outbreaks as soon as possible. If the current conditions in parts of Yemen do not permit house-to-house vaccination, then an intensified fixed-site vaccination campaign with appropriate social mobilization by the community and religious leaders trusted by the local communities should be implemented to maximize coverage among all vulnerable children.

Yemeni children face no shortage of threats: prolonged conflict, a devastated healthcare system, hunger and disease. But polio is one disease that can easily be prevented. Its circulation can be stopped in Yemen or anywhere else by vaccinating all children with oral polio vaccine.

The GPEI partners – WHO, Rotary International, the U.S. Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and Gavi – are committed to providing support to all stakeholders in Yemen for responding to the polio outbreaks including in conducting polio vaccination campaigns that can reach all vulnerable children.

The Global Polio Eradication Initiative (GPEI) is extremely concerned about the unfolding effects of the current crisis in Ukraine on the country’s health system.  A functioning health system must be kept neutral and protected from all political or security issues affecting countries, to ensure that people have continued access to critical and essential care.

At the same time, we have seen time and again that large-scale population movements, insecurity and hampered access contribute greatly to the emergence and/or spread of infectious diseases, such as polio.

Ukraine is currently affected by a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak, with the most recent case detected in January 2022 (with disease onset in December 2021).

A national supplemental polio immunization campaign targeting nearly 140,000 children throughout Ukraine who had not been vaccinated against polio began on 1 February 2022, but is currently paused, as health authorities have shifted focus towards emergency services. Surveillance to detect and report new cases of polio is also disrupted, increasing the risk of undetected spread of the disease among vulnerable populations. The GPEI is working to urgently develop contingency plans to support Ukraine and prevent further spread of polio.

The GPEI has a long history of working in a variety of complex environments, and will continue to adapt its operations to the reality on the ground, to the degree possible, without compromising on the safety and security of health workers.  At the same time, immunization and surveillance is being assessed in neighbouring countries, to minimize the risk and consequences of any potential infectious disease emergence/spread resulting from the current large-scale population movements.  It is critical that necessary resources are mobilized and made available to assist with the humanitarian needs, including relief, disease response/prevention efforts both in Ukraine and in neighbouring countries.

After the safe and successful rollout of nationwide polio campaigns since November 2021, we have received tragic news that 8 health workers at the forefront have been killed this morning in a series of shootings in Takhar and Kunduz in northeast Afghanistan.  The vaccination campaign has been suspended in both provinces.

A statement has been issued by the Regional Director of WHO’s Eastern Mediterranean Region, Dr Ahmed Al-Mandhari, as well as by the United Nations in the country, condemning these attacks, expressing condolences to the families and underscoring that the provision of health and the safety of healthworkers at the forefront are paramount, and must be kept neutral to any geo-political situation anywhere.

Our thoughts and prayers are both with the families and our teams on the ground at this time.