GPEI-Launch of Polio Endgame Strategy 2019-2023

Dr Rebecca Martin, Centers for Disease Control and Prevention, delivering the welcome address at the event ”To succeed by 2023—Reaching Every Last Child for a Polio-free World” to celebrate the launch of the Polio Endgame Strategy 2019-2023. ©WHO.

The 72^nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.

The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.

The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations, and Coordination, seen with Seth Berkley, CEO of Gavi, the Vaccine Alliance, at the GPEI informal event during the 72nd World Health Assembly. ©WHO

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”

Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”

Dr Ferozuddin Feroz, Minister of Public Health, Afghanistan, talking about the remaining challenges for polio eradication and the need for continued partner support in the last mile. ©WHO

Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.

Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”

Representing Nigeria, Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency, talked about the challenges, innovations and tools used to bring Nigeria to the brink of polio eradication. ©WHO

Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners: Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”

Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, remains confident in continued political commitment in the endemic countries, the tireless support of partners, donors, and the Polio Endgame Strategy 2019-2023 to deliver a polio-free world. ©WHO

In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”

As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”

Reposted with permission from Rotary.org

International PolioPlus Committee Chair Mike McGovern. ©Rotary International

1. There were more cases of wild poliovirus in 2018 than in 2017. Should we be discouraged?

No, not at all. We’ve always expected the number of cases to fluctuate somewhat as we get closer to zero. We’ve gone four straight years with fewer than 100 cases per year. That’s an indicator of great progress. With dedication from governments and Rotarians in areas still affected by polio, we’ll get there.

2. Why is it so difficult to eradicate a disease like polio?

Remember that even in the United States, where the polio vaccine was readily available, it still took 20 years to become polio-free. And the areas we are working in now don’t have health systems that are as well-developed as in the United States.

3. What challenges are you seeing now?

We have been working intensely in the endemic countries — Afghanistan, Nigeria, and Pakistan — for a number of years, and some of the citizens in those countries are getting concerned that we are spending money on polio eradication when they have so many other needs. There’s some resistance to keep on receiving immunizations for polio, and polio alone. Our challenge is to find ways to provide other services to the citizens and children, so we still have the parental support we need — to provide the “plus” in PolioPlus.

4. What role does armed conflict play in those areas?

It makes the logistics of immunization far more difficult. The Global Polio Eradication Initiative partnership is not only dealing with governments — we’re dealing with anti-government elements as well. While we’ve worked to gain everyone’s trust and support, we’ve had areas that were inaccessible to immunization teams for months and sometimes years at a time.

National Immunization Day activities in New Delhi, India. ©Rotary International

5. Do immunization teams know when they miss children? Or are there children they don’t even know about?

I think we have a good handle now on knowing when and where we’re missing children. The challenge is to keep reducing the number we miss. In Nigeria, we have done a lot of work since the discovery of several polio cases in Borno state in 2016. But access, immunity levels and surveillance are much better today than they were in 2016, when we did detect those cases. We are cautiously optimistic.

6. Where are we seeing successes?

We haven’t had any cases of wild poliovirus anywhere in the world in nearly five years except in the three endemic countries. And in Nigeria, it’s been almost three years since we detected any wild poliovirus cases, and those occurred in a small area of the country. But we are not there yet. Complacency is one of our biggest enemies, and we cannot take our foot off the accelerator until success is achieved.

7. What’s the most important thing Rotarians should know?

I’ve been extremely impressed with the dedication and persistence of Rotarians in Afghanistan, Nigeria, and Pakistan. They are working hard to make sure polio is eradicated. It’s pretty amazing what they do in those countries.

Rotarians should continue to be optimistic and to support eradication. We also need Rotarians to bring the need for continued funding to the attention of their government leaders. We can’t lose sight of the goal.

On 15 March 2019 in Islamabad, representatives from the Embassy of Japan and the Japan International Cooperation Agency (JICA) were given a general update on the progress of the Polio Regional Lab and the surveillance network. Thanks to Japan’s funding, 70% of the latest molecular biology equipment has been procured, installed and made operational. JICA representatives also toured the facility and the works in process.

Representatives from JICA and the Embassy of Japan touring the Pakistan Regional Polio Lab facilities. ©WHO/Pakistan

The Government of Japan through JICA is a long-standing and committed donor to the polio eradication efforts by funding initiatives and broader immunization activities in Pakistan since 1996.

As a part of its more recent commitment, JICA is supporting Pakistan in strengthening disease surveillance through a state-of-the-art equipment of the Regional Reference Laboratory at the National Institute of Health in Islamabad.

The Pakistan Regional Polio Lab will go a long way in facilitating poliovirus detection in stool samples and the environment. At present, the lab tests more than 30,000 stool samples from people with paralysis and 950 environmental samples each year, including samples from both Afghanistan and Pakistan. The new soon-to-be operational lab equipment will speed up the ability to process and respond quickly wherever the poliovirus may be hiding. This is critical work in ensuring Pakistan targets its last remaining core reservoirs of poliovirus.

In this last mile of polio eradication, support from JICA is crucial and much appreciated. Pakistan is one of the last remaining polio endemic countries in world, along with Afghanistan and Nigeria. The political and financial commitment from the Government of Japan over the years has already helped Pakistan in reducing the number of polio cases by 96% since 2014. With only 12 cases reported in 2018, Pakistan has a fighting chance of finally consigning polio to the history books.

The Japan International Cooperation Agency (JICA)

The Japan International Cooperation Agency (JICA) assists and supports developing countries as the executing agency of Japanese ODA. In accordance with its vision of “Inclusive and Dynamic Development,” JICA supports the resolution of issues of developing countries by using the most suitable tools of various assistance methods, such as technical cooperation, ODA loans and grant aid in an integrated manner.

Reposted with permission from Rotary.org

Dr Ujala Nayyar dreams, both figuratively and literally, about a world that is free from polio. Nayyar, the World Health Organization’s surveillance officer in Pakistan’s Punjab province, says she often imagines the outcome of her work in her sleep.

In her waking life, she leads a team of health workers who crisscross Punjab to hunt down every potential incidence of poliovirus, testing sewage and investigating any reports of paralysis that might be polio. Pakistan is one of just two countries that continue to report cases of polio caused by the wild virus. In addition to the challenges of polio surveillance, Nayyar faces substantial gender-related barriers that can hinder her team’s ability to count cases and take environmental samples. From households to security checkpoints, she encounters resistance from men. But her tactic is to push past the barriers with a balance of sensitivity and assertiveness.

“I’m not very polite,” Nayyar says with a chuckle. “We don’t have time to be stopped. Ending polio is urgent and time-sensitive.”

Dr Ujala Nayyar during one of her field visits. © Rotary International

Women are critical in the fight against polio, Nayyar says. About 56% of frontline workers in Pakistan are women. More than 70% of mothers in Pakistan prefer to have women vaccinate their children.

That hasn’t stopped families from slamming doors in health workers’ faces, though. When polio is detected in a community, teams have to make repeated visits to each home to ensure that every child is protected by the vaccine. Multiple vaccinations add to the skepticism and anger that some parents express. It’s an attitude that Nayyar and other health workers deal with daily.

“You can’t react negatively in those situations. It’s important to listen. Our female workers are the best at that,” says Nayyar.

With polio on the verge of eradication, surveillance activities, which, Nayyar calls the “back of polio eradication”, have never been more important.

Q: What exactly does polio surveillance involve?

A: There are two types of surveillance systems. One is surveillance of cases of acute flaccid paralysis (AFP), and the second is environmental surveillance. The surveillance process continues after eradication.

Q: How are you made aware of potential polio cases?

A: There’s a network of reporting sites. They include all the medical facilities, the government, and the hospitals, plus informal health care providers and community leaders. The level of awareness is so high, and our community education has worked so well, that sometimes the parents call us directly.

Dr Ujala Nayyar, the surveillance officer for the World Health Organization in Punjab, Pakistan, navigates through barriers to hunt down cases of polio. © Rotary International.

Q: What happens if evidence of poliovirus is found?

A: In response to cases in humans as well as viruses detected in the environment, we implement three rounds of supplementary immunization campaigns. The scope of our response depends on the epidemiology and our risk assessment.

We look at the drainage systems. Some systems are filtered, but there are also areas that have open drains. We have maps of the sewer systems. We either cover the specific drainage areas or we do an expanded response in a larger area.

Q: What are the special challenges in Pakistan?

A: We have mobile populations that are at high risk, and we have special health camps for these populations. Routine vaccination is every child’s right, but because of poverty and lack of education, many of these people are not accessing these services.

Q: How do you convince people who are skeptical about the polio vaccine?

A: We have community mobilizers who tell people about the benefits of the vaccine. We have made it this far in the program only because of these frontline workers. One issue we are facing right now is that people are tired of vaccination. If a positive environmental sample has been found in the vicinity, then we have to go back three times within a very short time period. Every month you go to their doorstep, you knock on the door. There are times when people throw garbage. It has happened to me. But we do not react. We have to tolerate their anger; we have to listen.

Q: What role does Rotary play in what you do?

A: Whenever I need anything, I call on Rotary. Umbrellas for the teams? Call Rotary. Train tickets? Call Rotary. It’s the longest-running eradication program in the history of public health, but still the support of Rotary is there.

Global health leaders at the opening session of the 144th Executive Board Meeting. © WHO

WHO Director-General Dr Tedros Adhanom Ghebreyesus opened the Organization’s Executive Board (EB) on 24 January with a report from his first visit of the year, to the polio endemic countries of Afghanistan and Pakistan: “This year I have taken over as chair of the Polio Oversight Board. That’s why my first trip of the new year was to Afghanistan and Pakistan. These are the two countries that are the last frontiers of wild poliovirus. We are so close to ridding humanity of this disease, and I am personally committed to ensuring that we do. I was really impressed by the commitment of the governments of Afghanistan and Pakistan.”

The Executive Board, comprised of 34 Member States’ designated experts in the field of health, convened in Geneva in late January to discuss a wide-ranging agenda on the most pressing and urgent health concerns of our times, including the urgency to rev up efforts in this last mile of polio eradication efforts.

The EB was encouraged by the progress achieved through the Endgame Strategic Plan 2013-2018, which has led the world to the brink of polio eradication and laid the groundwork for the new strategy – the Global Polio Eradication Initiative Strategic Plan 2019-2023. The new strategy will aim to sharpen the tools and tactics that led to the global progress in bringing down the case load from 350 000 annual wild polio virus cases in 1988 to only 33 cases in 2018. Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all.

In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero. On the sidelines of the EB, the DG held a stakeholder consultation to ensure that the 2019-2023 Strategic Plan reflects a transparent and inclusive stakeholder participation. The DG stressed the need for strengthened and systematic collaboration between partners, health, and non-health actors across cross-cutting areas of management, research and financing activities for polio eradication. Given that polio eradication effort continues to be a global priority, one of the salient features of the consultation was a renewed commitment to transparent long-term budgets for eradication efforts, including key post-certification costs such as stockpiles and inactivated polio vaccine to help protect more than 430 million children from polio each year.

“In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero.”

Voicing similar sentiments earlier, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all stakeholders, partners, countries, and individuals to strengthen their collective resolve to seeing polio fully eradicated for good. Polio continues to be a global health risk as confirmed at the end of last year, the Emergency Committee reiterated its advice that polio remains a public health emergency of international concern.

Polio resources for over three decades have helped reduce the number of endemic countries from 135 down to only 3 (Pakistan, Afghanistan, and Nigeria), eradicate polio from some of the most challenging areas in the world, and continue to enable countries around the world in advancing other national health goals.

With the continued commitment of all donors and partners, 2019 may very well become the decisive year when we finally stop wild polio virus transmission in Afghanistan and Pakistan.

The Endgame Plan through 2018 brought the world another year closer to being polio-free. While we had hoped to be finished by now, 2018 set the tone for the new strategic plan, building on the lessons learned and mapping out a certification strategy by 2023. 2018 was also marked by expanded efforts to reach children with vaccines, the launch of innovative tools and strategies, critical policy decisions and renewed donor commitment to the fight.

Dr Tedros Adhanom Ghebreysus, WHO Director General and Chair Polio Oversight Board, administering polio drops to a young child in Pakistan. WHO/Jinni — Dr Tedros Adhanom Ghebreysus, WHO Director General and Chair Polio Oversight Board, administering polio drops to a young child in Pakistan. © WHO/Jinni

Cornering wild poliovirus

Circulation of wild poliovirus (WPV) continues in the common epidemiological block in Afghanistan and Pakistan. However, both countries steadily worked to improve the quality of their vaccination campaigns in 2018 through National Emergency Action Plans, with a particular focus on closing any immunity gaps to put the countries on track to successfully stop WPV in the near future. Given the priority on polio eradication, WHO Director General, WHO Regional Director for the Eastern Mediterranean and President, Global Development at Bill & Melinda Gates Foundation started off the new year with a four-day visit to meet the heads of state and have a first-hand experience of the on-the-ground eradication efforts in both the countries.

In August, Nigeria marked two years since detecting any WPV. With continuing improvements in access to the country’s northeast, as well as efforts to strengthen surveillance and routine immunization, the entire African region may be eligible for being certified WPV-free as early as late this year or early 2020. What’s more, the world has not detected type 3 WPV since 2012 and the strain could be certified eradicated sometime this year.

Program innovation

The programme is constantly developing new ways to more effectively track the virus, vaccinate more children and harness new tools to help end the disease for good.
In Nigeria and the surrounding region, health workers launched new tools to enable faster, more comprehensive disease surveillance. e-Surve, a smartphone app, guides officers through conversations with local health officials, offering prompts on how to identify and report suspected cases of disease. Then, with the touch of a button, responses are submitted to a central database where health officials can analyze and track outbreaks across multiple districts in real-time.

Beyond surveillance, health workers worked tirelessly to bring the polio vaccine to the remote communities of Lake Chad. Dotted with hundreds of small islands, the lake is one of the most challenging places on earth to deliver health services. Vaccinators must travel by boat on multi-day trips to deliver polio vaccines to isolated island villages, using solar-powered refrigerators to keep their precious cargo cool. In 2018, vaccination campaigns on the lake reached thousands of children for the first time – children who would otherwise have gone unprotected.

Lake Chad Polio Task Team wave to polio vaccinators and community members on Ngorerom island, Lake Chad. © Christine McNab/UN Foundation

The programme also took important steps in developing new tools including, novel oral polio vaccine (nOPV), if studies show to be successful, could provide a safer form of OPV that provides the same level of protection without the small risk of vaccine-derived polio in under-immunized populations.

Battling circulating vaccine-derived poliovirus

In 2018, the Democratic Republic of the Congo, Niger, Nigeria, Papua New Guinea, Kenya, Somalia and Mozambique experienced outbreaks of circulating vaccine-derived polio (cVDPV). Although these cases are still rare – and only happen in places where immunity is low. The polio eradication initiative has two urgent tasks: eradicate WPV quickly as possible and stop the use of OPV globally, which in tandem will prevent new cVDPV strains from cropping up.

The program uses the same proven strategies for stopping wild polio in responding to cVDPV cases. These strategies, coupled with the rapid mobilization of resources on the ground, can bring outbreaks under control.

In December, an international group of public health experts determined that the 2017 cVDPV2 outbreak in Syria has been successfully stopped. This news follows 18 months of intensive vaccination and surveillance efforts led by the GPEI and local partners in conflict-affected, previously inaccessible areas. In Papua New Guinea, the programme carried out 100 days of emergency response this past summer and is continuing to vaccinate and expand surveillance across the country.

Bringing an end to ongoing cVDPV outbreaks remains an urgent priority for the program in 2019.

New policy decisions

At the World Health Assembly in May, Member States adopted a landmark resolution on poliovirus containment to help accelerate progress in this field and ensure that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions. The programme also finalized a comprehensive Post-Certification Strategy that specifies the global, technical standards for containment, vaccination and surveillance activities that will be essential to maintaining a polio-free world in the decade following certification.

Recognizing the ongoing challenge posed by cVDPVs, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) met in November and recommended an updated process for declaring the world polio-free. This plan will start with the certification of WPV3 eradication, followed by WPV1, and include a separate independent process to validate the absence of vaccine-derived polio.

Comprised of members, advisers, and invited Member States, the 19^th IHR Emergency Committee met in November. The Committee unanimously agreed that poliovirus continues to be a global emergency and complacency at this stage could become the biggest hindrance. “We have the tools, we need to focus on what works, we need to get to every child,” commented Prof. Helen Rees, Chairperson of the Committee. “The reality is that there is no reason why we should not be able to finish this job, but we have to keep at it.” “We have achieved eradication of a disease once before, with smallpox,” Rees concluded. “The world is a much better place without smallpox. It’s now more urgent than ever that we redouble our efforts and finish this job once and for all as well.”

Six-year old Gafo was the first polio case in Papua New Guinea in decades, which prompted a national emergency and an outbreak response. © WHO/PNG

Spotlight on gender

In 2018, the GPEI took major steps in adopting a more gender-responsive approach and strengthening gender mainstreaming across its interventions. The GPEI Gender Technical Brief highlighted the programme’s commitment to gender equality and included a thorough analysis of various gender-related barriers to immunization, surveillance and communication.

The programme introduced new gender-sensitive indicators to ensure that girls and boys are equally reached with polio vaccines, to track the timeliness of disease surveillance for girls and boys, and to monitor the rate of women’s participation as frontline workers in the endemic countries. The GPEI continues to regularly collect and analyze sex-disaggregated data and conduct gender analysis to further strengthen the reach and effectiveness of vaccination campaigns.

Donor and country commitments

Throughout 2018, political leaders around the world voiced their support for the programme’s efforts, including Prime Minister Trudeau, WHO Director General Dr Tedros, Prime Minister Theresa May, His Highness Sheikh Mohamed bin Zayed Al Nahyan and His Royal Highness Prince Charles. Leaders demonstrated commitment by advocating for a polio-free world at various global events, including the G7, G20, CHOGM, and the annual Rotary Convention.

Donor countries made new financial contributions to the programme in 2018. Polio-affected countries also demonstrated continued political commitment to eradication efforts. The Democratic Republic of the Congo signed the Kinshasa Declaration committing to improve vaccination coverage rates in sixteen provinces throughout the country, and Nigeria approved a $150 million loan from the World Bank to scale up immunization services and end polio.

Looking ahead: 2019 and beyond

Over the last five years, the programme has been guided by the 2013-2018 Polio Eradication & Endgame Strategic Plan, helping to bring the world to the brink of polio eradication. This spring, the programme will finalize a new strategy –GPEI Strategic Plan 2019-2023– which will aim to sharpen the tools and tactics that led to this incredible progress. In 2019, the GPEI will also launch its first-ever Gender Strategy to further guide its gender-responsive programming and to increase women’s meaningful and equal participation at all levels of the programme.

Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all. Echoing similar sentiments, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all to step up their performance to end polio. 2019 may very well be the watershed year that the world will finally eradicate polio, thanks to the global expertise and experience over 3 decades.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board, administering polio drops to a child during a four-day joint visit to Pakistan and Afghanistan. © WHO/Pakistan

For Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, the start to the new year was marked with a four-day visit to Afghanistan and Pakistan from 5-8 January. The visit came at the heels of his new role as the Chair of the Polio Oversight Board (POB) on 1 January, a committee which oversees and guides the Global Polio Eradication Initiative, signalling the Board’s utmost commitment towards eradication of polio for good.

Accompanied by WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, Dr Tedros’ well-knit, compact visit covered a lot of bases from field visits to high-level meetings with heads of state from both the countries, giving the POB an opportunity to see that while polio may still be in endemic in Afghanistan and Pakistan, but the process to achieve the goal of ending polio is not far from realization.

“We must all give our best on this last mile to eradicate polio once and for all. My wish for 2019 is for zero polio transmission. You have WHO’s full support to help reach every child and stop this virus for good,” Dr Tedros said.

During his first stop in Afghanistan on 5-6 January, Dr Tedros met with His Excellency President Dr Ashraf Ghani, His Excellency Chief Executive Dr Abdullah Abdullah, the Council of Ministers, representatives of key partners and nongovernmental organizations working in the field of public health. He also visited to the WHO-supported Trauma Care Hospital in Kabul.

In Pakistan on 7-8 January, Dr Tedros met with the Prime Mister Imran Khan, Federal Minister for National Health Regulations & Coordination Mr Aamer, Mehmood Kiani, Minister of Foreign Affairs and Federal Minister for Human Rights Dr Shireen Mazari.

Dr Tedros accompanied the President of Pakistan, Arif Alvi, to the launch of the first Pakistan Nursing and Midwifery Summit and the Nursing Now campaign. He also visited a basic health centre in Shah Allah Ditta where WHO signed an agreement with the Government of Pakistan to develop a model health care system for universal health coverage in Islamabad.

In the last mile of the polio eradication journey, Dr Tedros’ visit serves as a reminder that now more than ever we need to have social, political and global will to make polio the second human disease in history to be wiped from earth.

Related resources

At the G20 Health Ministerial meeting in the coastal city of Mar del Plata on 4 October, senior health officials “recognized the importance of eradicating polio and building on best practices and assets to strengthen routine immunization programs and health systems, while also planning for an eventual transition of assets”. This commitment follows previous statements by the group in favour of polio eradication.

The meeting was chaired by Argentine Secretary of Health, Adolfo Rubinstein; items on the agenda included antimicrobial resistance, malnutrition as it related to childhood overweight and obesity, the strengthening of health systems and the responsiveness of health systems to crises and pandemics.

Senior officials from G20 member and guest countries were joined by representatives from the Food and Agriculture Organization (FAO), the Global Fund, the Organization for Economic Co-operation and Development (OECD), the World Bank, the World Health Organization (WHO), the World Organization for Animal Health (OIE) and Unitaid.

The Health Working Group was created in China in 2016 and provides a platform to continue to address global health policies at the G20 level and advance on global policy commitments in the area of public health.

The G20 is made up of 19 countries and the European Union. The 19 countries are Argentina, Australia, Brazil, Canada, China, Germany, France, India, Indonesia, Italy, Japan, Mexico, Russia, Saudi Arabia, South Africa, South Korea, Turkey, the United Kingdom and the United States.

The passing of former Secretary-General of the United Nations Kofi Annan earlier this month was a significant loss to the world of international diplomacy, peace, and efforts to deliver a more equitable life to millions worldwide. Charismatic, strongly opinionated, and perpetually kind, Annan captured the imagination of thousands working in international affairs across the world.

Beginning his career at the World Health Organization, he never lost sight of good health as a right owed to all. Sharp and precise, he was also quick to recognise and commit to public-private partnerships, and health investments which make social and economic sense – interventions which deliver a decisively positive return on investment.

The need to “reach every child” – no matter where – with a simple health intervention giving life-long benefits, was the principle that led him to commit so strongly to the global cause of polio eradication. Over the course of his tenure, he consistently and strongly supported polio eradication efforts in some of the most difficult settings worldwide.

In doing so, he bolstered the efforts of the programme, bringing us closer to a polio-free world, and enabling the 99.9% reduction in cases achieved since the beginning of eradication efforts.

Days of Tranquillity

Kofi Annan administering polio vaccine in a refugee camp in Pakistan, March 2001. © WHO

Annan’s impact on polio eradication was both visible and invisible.

He supported the first-ever Global Summit on Polio Eradication during the UN General Assembly in 2000, and called for “greater mobilization of people and funds” and “commitment at the highest levels” in the race to reach the last child. He declared that polio eradication was a model for effective public-private partnerships in global health.

Staying close to his humanitarian principles, he urged Member States and all parties to cease hostilities to allow polio vaccination activities to continue in many regions of the world, and was unafraid to directly target the source of tensions. He was involved in securing access to vulnerable populations through ‘Days of Tranquillity’ in Iraq, the Democratic Republic of the Congo and Cote d’Ivoire. To support these critical vaccination campaigns, he directed the UN to provide logistical support, including the use of UN helicopters to deliver vaccines to the hardest to reach, and conflict affected communities.

Significantly, he appointed a Special Envoy for polio eradication in Nigeria in the early 2000s to help negotiate complex issues around a ban on polio vaccinations in areas of the country. This helped to resolve the issue, stemming a devastating spread of the virus that threatened global eradication efforts.

In 2000, Annan spoke of the wider impact of tranquillity days, “In war zones around the world, guns have fallen silent to allow immunization days to take place – demonstrating that even in the most intractable of conflicts, warring parties can call a halt to destruction in the cause of life.”

Lifelong commitment

Behind the scenes, he was quick to recognize the important contributions of donor states to eradication efforts, and maintained interest in the polio programme even during his busiest times in office.

Calling on WHO headquarters staff to provide briefing notes and regular updates, he kept key policy makers on their toes, and helped push the sense of urgency which continues to this day in the fight to eradicate polio. He actively sought polio talking points ahead of his travel to polio priority countries. Each year, he wrote to the heads of endemic states to thank them for their continuing commitment to defeating the paralysing virus, and urged them to take specific actions to strengthen operations.

Using his connections to the African Union, the Organisation of Islamic Cooperation countries, and the G7, he helped to inspire states to enhance their political commitment, and donate to the cause of ending polio. He was grateful for their support, as evidenced by numerous letters of thanks in the archives which chronicle his commitment to and belief in eradication.

A career diplomat, Annan was unafraid to use other methods of strengthening multilateral commitment. To the joy of communications specialists in the programme, he was ahead of the game in agreeing to take part in polio eradication videos, newspaper opinion editorials, and to launch polio vaccination campaigns with his wife, Nane.

Indeed, this was perhaps one of the most touching symbols of his commitment. Inspired by the commitment of polio eradication volunteers in the field, Annan continued to support the programme even after the end of his time as Secretary-General.

As a board member of the United Nations Foundation, and through his own foundation, he continued to advocate for polio eradication.

On the day that polio is declared eradicated, there will be many people to thank. Kofi Annan, this humanitarian, this diplomat, this visionary, will be one of those people.

Kofi Annan passed away on 18 August 2018. During his time as Secretary-General of the United Nations he made significant contributions to global health, global security, and global diplomacy. The Global Polio Eradication Initiative extends its condolences to his wife, children, family, and all those who worked with him, and were inspired by his life and work.

Justin Trudeau, prime minister of Canada, speaks to Rotarians. Rotary has been the driving force behind polio eradication from the beginning. © Rotary International/Alyce Henson

More than 25,000 members of Rotary clubs from 175 countries and territories gathered in Toronto, Canada this week for Rotary’s annual International Convention.

On the convention’s final day, Justin Trudeau, prime minister of Canada, was presented with Rotary’s Polio Eradication Champion Award in recognition of his leadership and Canada’s contributions to polio eradication. In his remarks to Rotarians, Trudeau highlighted Canada’s continued commitment to working towards a world without polio, a world with gender equity, and a world where everyone has a chance to succeed. He expressed a wish that his children would grow up in a polio-free world, and encouraged Rotarians to continue their important work to achieve eradication worldwide.

Rotary International President Ian Riseley presented the award to the Prime Minister, drawing attention to Canada’s recent pledge of C$100 million toward global polio eradication—made last year at Rotary’s 2017 convention—and noting that Canada had already fulfilled that commitment. He also recognized the Prime Minister’s leadership at the recent G7 summit, stating, “Prime Minister, we are grateful for your partnership: your personal commitment to polio eradication and your nation’s longstanding support of this historic effort. We promise that we will continue to do our very best to live up to that confidence —for the benefit of all the world’s children, now and forever.”

Progress toward global polio eradication was a recurring theme in major speeches and workshops throughout the convention, including a keynote address by World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus. In his remarks, Dr. Tedros thanked Rotarians for their tireless efforts and appealed for continued focus in the fight for a polio-free world, stating, “We cannot be complacent. We must finish the job. We must wipe polio from the face of the earth.”

The convention also featured a session highlighting the critical role women play in the global effort to end polio, including Rotary volunteers who have been involved in all aspects of polio eradication, such as immunization activities in the field, fundraising, public awareness, and advocacy. Thanks to an onsite virtual reality booth, attendees even had the opportunity to walk in the shoes of a volunteer immunizer in Uganda.

Since Rotary launched its PolioPlus program in 1985, the efforts of millions of Rotarians worldwide have helped reduce polio cases by 99.9%. PolioPlus has become the largest internationally-coordinated public health initiative in history. At the conference this week, it was clear that Rotarians around the globe are continuing to lead the way – ensuring that every last child receives a life-saving vaccine, and celebrating everyone committed to ensuring a polio-free world.

A girl receives two drops of the oral polio vaccine during an immunization campaign in Somalia. © UNICEF

21 June 2018 – The Ministry of Foreign Affairs of the Republic of Korea announced today an additional US$ 2 million to fund polio outbreak response and surveillance activities in the Horn of Africa. This commitment makes Korea the first country to support outbreak response efforts in the region, critical to protecting global progress toward ending polio.

The Global Polio Eradication Initiative (GPEI) welcomed the contribution, with $1.5 million for UNICEF and $0.5 million for WHO.

This funding was raised through an innovative financing mechanism called the Global Disease Eradication Fund, through which KRW₩1,000 was collected from each international passenger flying out of Korean airports by the Government of Korea. Thanks to this Fund, every passenger flying from Korea directly supports global efforts to stop polio, an infectious disease that can lead to paralysis or even death, and can travel long distances undetected.

When the GPEI first began in 1988, polio paralysed more than 350,000 children each year in over 125 countries in the world. Today, there have only been eight cases to date in 2018, and polio is closer than ever to becoming the second human disease to ever be eradicated.

This progress is made possible through the ongoing support of donors, partners, and countless health workers around the world. Contributions from donors like Korea allow the GPEI to vaccinate and protect more than 450 million children against polio each year.

This additional funding follows a US$ 4 million commitment from the Republic of Korea announced at the Global Polio Pledging Event around the Rotary International Convention in June 2017. This contribution was matched by the Bill & Melinda Gates Foundation, doubling its impact to US$ 8 million.

“The Global Disease Eradication Fund is an incredibly innovative financing mechanism, and the funds raised will support UNICEF’s efforts to protect every last child from polio,” said Akhil Iyer, UNICEF Director of Polio Eradication. “We remain grateful to the Republic of Korea for their continued commitment to halting polio outbreaks and driving progress to eradicating polio once and for all.”

“The unique support of the Republic of Korea has been crucial for the remarkable progress we have made in polio eradication, especially in responding to outbreaks,” said Dr Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization. “These additional funds come at a critical time as we support the outbreak response in the Horn of Africa region by scaling up surveillance to ensure no virus goes undetected.”

The Republic of Korea has been a longtime supporter of the GPEI, contributing to outbreak response efforts in Syria, the Democratic Republic of Congo and the Lake Chad region, with a broad range of activities including delivering polio vaccines, intensifying surveillance, and convincing caregivers to vaccinate their children through community engagement.

Generous support from donors like the Republic of Korea remains essential to stopping outbreaks, ending this paralysing disease and ultimately achieving a polio-free world.

Dr Ranieri Guerra, Assistant Director-General for Strategic Initiatives at WHO, thanks Mr Lee Jang-Keun, Deputy Permanent Representative of the Republic of Korea, for his country’s generous contribution at a grant signing ceremony in Geneva. © WHO/S. Ramo

Young girls outside their home during vaccination activities in Punjab province, Pakistan. © WHO EMRO

World leaders gathered in Charlevoix, Canada last week to discuss the most critical issues facing the planet today, including their reaffirmed commitment to a polio-free world.

The final communique of the 44^th G7 summit on 8-9 June 2018 highlighted global health as part of the foundation for investing in growth that works for all: “To support growth and equal participation that benefits everyone, and ensure our citizens lead healthy and productive lives, we commit to supporting strong, sustainable health systems that promote access to quality and affordable healthcare.” As part of this commitment, the communique refers to the important tasks of achieving the goal of polio eradication and ensuring a smooth post-eradication transition as key global priorities. World leaders stated: “We reconfirm our resolve to work with partners to eradicate polio and effectively manage the post-polio transition.”

The communique also stressed the importance of preparing for health emergencies and strengthening the implementation of the International Health Regulations. As emphasized in the 13th General Programme of Work of the World Health Organization, which was approved by the World Health Assembly in May 2018, the GPEI has “helped to strengthen health systems, and these wider gains must be maintained as the polio programme is being ramped down.” The programme has extensive experience in disease surveillance and quality laboratory networks, outbreak response, disease prevention through vaccination, and inter-country collaboration – all necessary components of emergency preparedness. As planning continues for the post-eradication era, it remains a priority that the infrastructure, data and tools built up over the past 30 years be transitioned effectively to support resilient health systems and public health infrastructure in the future.

Canada, the host of this year’s G7, continued in the footprints of its predecessors and maintained attention on health – as the country has throughout its G7 presidencies. Canada has been a longtime supporter of the Global Polio Eradication Initiative and plays an active role in keeping polio on the global agenda. In 2002, then-Prime Minister Jean Chrétien gathered his counterparts from the G8 in Kananaskis, Canada to pledge to provide sufficient resources for polio elimination in Africa – the first time polio was included in the communique. Since then, G7 countries have provided significant political and financial support for the global polio programme, and have repeatedly expressed commitment to polio eradication. Most recently, leaders’ statements at the 2016 G7 Summit and at a 2017 Group of 7 Health Ministers meeting included commitments to polio eradication. G7 leadership on the issue was expanded to the G20 in 2017. Polio was mentioned at both the G20 leaders’ summit and the first-ever G20 Health Ministers’ meeting, which recognized the historic opportunity that exists to end polio for good and the important role played by polio-funded assets in achieving broader health goals.

The communique also emphasized the need to advance gender equality and women’s empowerment. The polio programme recognizes women’s critical contributions to eradication and is constantly working to recruit more women to work as frontline workers in polio endemic countries. In Afghanistan, the polio programme accounts for one of the largest female workforces in the country. On a global level, the GPEI is working to analyze sex-disaggregated data to track progress towards eradication, echoing the communique in affirming women and girls as powerful agents of change.

The 2018 G20 Buenos Aires summit in November is next on the world stage, providing an additional opportunity for governments to focus on the importance of global health, and commit to fulfilling and maintaining the promise of a polio-free future.

A child receives an IPV (inactivated poliovirus vaccine) vaccination during routine immunization activities in Bangladesh. © Gavi

In the fight against the virus, two important tools are used to help prevent polio – two safe, effective vaccines. Only through full funding of these vaccines can worldwide immunity be achieved, and the virus eradicated.

Redoubling commitment towards this goal, last week, Gavi, The Vaccine Alliance, approve core funding for the inactivated poliovirus vaccine (IPV) for 2019 and 2020, to continue work to end polio, and protect every child.

Announcing this support, Gavi Board Chair Dr Ngozi Okonjo-Iweala said, “Polio will remain a threat until every child is protected against this crippling disease. That is why the vaccination of every child is the corner stone of the polio eradication effort. Introducing IPV to all countries to interrupt polio transmission and maintain zero cases represents an unprecedented push, and Gavi is proud to be part of it.”

Since 2013, the Gavi Board has supported IPV in all 70 Gavi-supported countries, through a dedicated funding stream financed by the Global Polio Eradication Initiative (GPEI) budget. Responding to continued wild poliovirus circulation in 2018, this most recent Gavi support represents an additional contribution, which will help ensure that the programme can continue its valuable work to protect every child worldwide.

The Gavi Board also approved an exceptional extension of support for Nigeria up to 2028, to help reach over 4.3 million under-immunized children in the country, who remain at risk of vaccine-preventable diseases including polio.

Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization, extended his thanks to the Gavi Board for their generous contribution, saying, “GPEI and Gavi are committing to work closer together than ever before, and take one more step towards the immunization of all children, to deliver and to sustain a polio-free world.”

The Rotary National Chair gives a child oral polio vaccine, protecting her against the virus for life. © WHO Pakistan

Karachi, the capital of Sindh province, is Pakistan’s largest city, with an estimated population of more than 16 million people. It is also by far the most challenging place in Pakistan to eradicate polio. Difficulties include the large and frequent movement of people, poor water and sanitation conditions, and pockets of community resistance to vaccination.

In 2017, two of Pakistan’s eight total cases of polio were located in Karachi, and multiple environmental samples continue to test positive for the virus.

In the northwestern part of the city lies Orangi Town. The fifth largest slum in the world today, it is a tough place to live for the children who run around and play games in the streets outside their homes.

One of their most pressing needs is a supply of clean, drinkable water. In Orangi Town, the sewage system is basic, and poorly maintained. At many points, human waste mixes with drinking water lines. The quality of potable water is low and filled with pathogens including bacteria and viruses, and it is the main cause of many water-borne illnesses in adults and children, including hepatitis A, acute watery diarrhea and typhoid. Polio can also be spread through drinking water contaminated with the stools of an infected person.

Health workers for the polio eradication programme work tirelessly to immunize every child. But there are other ways to reduce the spread of the virus – and provision of uncontaminated drinking water is one of them.

The new water filtration plant will provide 55 000 people with clean water. © WHO Pakistan

Thanks to the efforts of Rotarians, who raised 50% of funds, 55 000 residents of Orangi now have access to a new water filtration plant. By ensuing that there are no viruses or bacteria present in the water, the plant will protect children from water-borne illness. As the plant runs using solar energy, it will work consistently through the regular power outages that affect the city, and won’t require expensive oil or electricity to run, placing fresh water within the reach of all.

Speaking on 8 May at the opening of the plant, Mr Aziz Memon, Chairman of Pakistan’s National Rotary PolioPlus Committee said: “This is the 15th water filtration plant installed in Pakistan, and the sixth in Karachi, and we will do all that we can with our partners to help raise the community’s standard of living including health.”

Dr Shafiq, a representative of Orangi Town, thanked Rotary International for its continuous support of polio eradication in the area. Combined with vaccination activities, children drinking the clean water provided by the new plant will now have an improved chance to grow up polio-free.

National Chair Aziz Memon said: “Orangi Town is one of the most underprivileged urban slums in Karachi and the supply of safe drinking water will improve health issues of the community and save children from water borne diseases.”

He added that “Rotary is making intensified efforts in this impoverished area and has established a Resource Center in Bijli Nagar Orangi Town.”

These extra steps towards ensuring that children are safe from disease also help to gain community trust, and form part of Rotary’s work to raise awareness of polio, and overcome vaccine hesitancy. In 2016, Rotary International contributed over US$ 106 million to polio eradication worldwide, and in Pakistan, Rotarians are at the forefront of the fight against the virus.

By chance, the opening ceremony of the plant coincided with the second day of this month’s subnational immunization days, when over 20 million children across different parts of the country were targeted with oral polio drops. Emphasizing the link between safer water, and polio eradication, children were given polio vaccine by high profile individuals attending the event.

Kicking off a safer future for some of Orangi’s children, Mr Memon and Rotary District Governor Ovais Kohari pushed a button at the plant to allow clear, safe water to flow from the taps. They then had a drink of water to test the quality and taste.

Simultaneously, polio vaccinators were going from house to house all over the city. For some families, Rotary was providing two life changing interventions in just one day – an effective vaccine, and water that they could finally trust.

By providing communities with clean water, Rotary International is helping to improve child health and reduce poliovirus spread. Those attending the opening of the sixth water filtration plant in Karachi included representatives from the World Health Organization, UNICEF, the Bill & Melinda Gates Foundation, Rotary International, Qatar Hospital, and community stakeholders. © WHO Pakistan

A female vaccinator administers polio vaccine during a campaign in Kabul, Afghanistan. © WHO/J Swan

Last month, Canada signed a generous pledge of Can$ 100 million to help eradicate polio in Afghanistan as well as in the two other endemic countries, Nigeria and Pakistan, and to continue to protect many polio-free countries. The pledge was announced by the Honourable Marie-Claude Bibeau, Minister of International Development and La Francophonie, at the 2017 Rotary International Convention in Atlanta.

In addition to previous donations of approximately Can$ 650 million, this most recent funding consists of Can$ 30 million to WHO and UNICEF to support programme activities in Afghanistan, and Can$ 70 million of flexible funding that can be used to support vaccination campaigns, rapid outbreak response, poliovirus surveillance and other critical eradication strategies and activities to reach every last child worldwide with a safe vaccine.

This latter funding is especially valuable to the programme, as it will help sustain the priority areas of work that make global polio eradication possible. In 2017, there were 22 cases of wild poliovirus reported worldwide, from only two countries, Afghanistan and Pakistan. In Nigeria, wild poliovirus was last detected in 2016. However, since 2001, there have been wild polio outbreaks in 41 countries that were previously polio-free.

Flexible funding, such as that provided by Canada, is critical to allow the programme to react quickly to the most urgent needs, successfully stopping each outbreak, and ensuring that every child is protected from polio worldwide.

Minister Marie-Claude Bibeau used the signing as an opportunity to underline Canada’s ongoing commitment. “Canada has been a supporter in the fight against polio from the very beginning and we are committed to seeing it through to the end,” she said. “Keeping the momentum is key, particularly in Afghanistan, Pakistan and Nigeria, where polio still exists. Canada remains committed to ensuring every child is immunized, particularly girls, who continue to face barriers.”

As a champion of feminist development, Canada has particularly emphasized the role played by women in the programme, from the front lines, to programme management and political leadership. Polio eradication moreover forms a crucial part of Canada’s “Right to Health” commitment, and has the potential to become one of the first tangible outcomes of the UN Sustainable Development Goals.

Akhil Iyer, Director of the Polio Eradication Programme at UNICEF said, “Whilst polio exists in the smallest geographic area in history, this includes some of the most dangerous and difficult-to-reach parts of the world. Canada’s long-standing political and financial commitment helps our dedicated health workers, mostly women, go the extra mile and vaccinate every child to build a polio-free world.”

With this funding and ongoing support, Canada is striving to protect every girl and boy child. In doing so, Canada is making history.

The funding is also a testament to the major role played by the Canadian people at every level of the polio eradication programme. To date, Canadian Rotarians have raised and contributed more than US$ 52 million to eradication efforts, whilst Canada’s citizens have played an important role in tracking progress and publically voicing their support to end polio through the Scientific Declaration on Polio Eradication, and the One Last Push Campaign.

Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization said, “The ongoing support of Canada is fundamental to the programme’s success. With their global advocacy in international forums such as the G20 and G7 and their strategic and high quality support in Afghanistan and across the world, we can ensure that polio is eradicated forever.”

Canada’s contribution comes at an important time for the programme, in the run up to the 2018 G7 Summit. Previous summits have recognized polio eradication efforts, noting that programme assets also help to strengthen other aspects of health and development. This year, the Presidency is held by Canada, the first country to place polio eradication on the G7 agenda.

The Global Polio Eradication Initiative partners extend their profound gratitude to the Government and to the citizens of Canada for their tremendous support and engagement to end polio globally.

Minister Marie-Claude Bibeau announced Canada’s generous commitment at the 2017 Rotary International Convention in Atlanta. This latest funding comes on top of significant and long term support from the Canadian people. © Global Polio Eradication Initiative

Throughout the course of the Commonwealth summit and related events, individual leaders voiced their continued support for eradication. © Malaria No More UK

In London on 19-20 April, leaders of the 53 member states of the Commonwealth affirmed their commitment to end polio in the final Communique of the 2018 meeting. Leaders emphasized renewed support for international efforts to tackle polio and other diseases, and called for an increase in national health expenditure throughout the Commonwealth.

This outcome was largely thanks to the efforts of civil society, including outreach by members of Rotary clubs in Commonwealth countries, Global Citizen, and numerous other partners who urged Commonwealth leaders to uphold their commitment to polio eradication. This included the delivery of over 4000 messages to UK Prime Minister Theresa May appealing for her continued commitment to a polio free world.

Throughout the course of the summit and related events, individual leaders also voiced their continued support for eradication. Prince Charles, who will one day succeed Queen Elizabeth II as Head of the Commonwealth, held up the polio programme as an example of successful joint action against disease and noted that hundreds of millions of children have benefitted from polio vaccine because of the GPEI. The end of polio, he noted, will serve as an example of the Commonwealth’s proven track record in effecting change. Once eradication is achieved, polio infrastructure will be leveraged to address other health challenges, and may pave the way for malaria elimination. Incoming Chair of the Commonwealth Theresa May, in a direct letter to advocates, acknowledged that eradication “remains a top global priority,” and promised that the UK will “work closely with polio-endemic countries to ensure we eradicate this cruel disease, once and for all.” Malta’s Prime Minister Joseph Muscat, who has championed polio throughout his tenure as Commonwealth Chair, pledged during a speech to help end polio in Commonwealth countries Pakistan and Nigeria.

With a collective investment of more than US$ 4 billion and previous statements of commitment to polio eradication, Commonwealth governments have long-been leading champions to end polio. As Bill Gates noted during his summit remarks, “success [against polio] really goes back to the substantial commitments made in part at the Commonwealth meetings.” With a record low 22 cases registered last year, continued global support is vital to get the world over the finish line. The renewed support from the Commonwealth, which represents a wide range of countries, provides hope that governments remain firmly committed to fulfilling the promise of a polio-free world.

On top of the US$ 120 million committed in 2013, last year, HH Sheikh Mohamed bin Zayed pledged an additional US$ 30 million towards polio eradication, and the UAE is active on the ground in Pakistan through the UAE-Pakistan Assistance Program
UAE support also funded more than 5000 committed full-time vaccinators in highest-risk districts of Pakistan
Last year saw the lowest number of wild poliovirus cases in history (22 worldwide); Pakistan reported a 97 percent decline in cases between 2014 and 2017

GENEVA (16 April 2018) – The Global Polio Eradication Initiative (GPEI) announced today that the UAE has completed the US$ 120 million commitment made by His Highness Sheikh Mohamed bin Zayed Al Nahyan at the 2013 Global Vaccine Summit in Abu Dhabi.

“We thank the UAE for their long-term generous support and unwavering dedication to polio eradication, and particularly the personal commitment of His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi,” WHO Director General Dr Tedros Adhanom Ghebreyesus said. “This is the kind of support that will ensure we reach every last child to complete the job and to show the way to delivering health to all.”

Polio is a highly infectious disease that can cause lifelong paralysis, but it is entirely preventable with vaccines. Only three countries remain which have never stopped polio: Afghanistan, Pakistan and Nigeria. When the polio eradication effort was launched in 1988, 350 000 children were paralyzed by polio every year across 125 countries.

Polio eradication efforts have since made remarkable progress and there were only 22 cases in 2017 – the lowest ever recorded number. However, a number of key challenges remain. Reaching the most vulnerable children with the polio vaccine is hampered by a range of hurdles including difficult terrain, insecurity, and large-scale population movements.

Following the Global Vaccine Summit, the UAE expanded its role through the UAE Pakistan Assistance Program (UAE-PAP) to ensure that further gains would be made where it was needed the most. Through the “Emirates Polio Campaign” initiative, the UAE has helped drive on-the-ground eradication efforts within the most vulnerable communities in Pakistan.

Speaking about the UAE’s work, His Excellency Mohamed Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi said: “The UAE’s pivotal role in eradicating polio completely is not limited to being a donor only, but extends to include its capacity to convene key groups and provide on-ground support to deliver vaccines in the highest risk areas of Pakistan.

“The UAE’s support – both as a leading donor and passionate advocate – has been critical for getting as close as we’ve ever been to making history by eradicating polio,” UNICEF Director of Polio Eradication Akhil Iyer said. “This is a gift not only to the children of Pakistan but to all future generations of children, everywhere, who are so close to the goal of being able to be born and be raised in a polio-free world.”

Dr. Chris Elias, President of the Global Development Program, Bill & Melinda Gates Foundation, said: “The UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan have shown an unwavering commitment to end polio, and we are delighted to partner with them in this effort. Without their involvement, achieving a record low number of polio cases in 2017 would not have been possible.”

The UAE is a longtime supporter of the polio eradication program. In addition to the US$ 120 million that His Highness Sheikh Mohamed bin Zayed Al Nahyan pledged in 2013, he pledged a further US$ 30 million to polio eradication, announced by Bill Gates at the Rotary International Convention in Atlanta, USA in June 2017. With additional commitments in 2011 and 2014, in total, the UAE has contributed US$ 167.8 million since 2011 to help end polio, with direct support to Pakistan, Afghanistan, Somalia, Ethiopia, Kenya, and Sudan.

About GPEI

The Global Polio Eradication Initiative (GPEI) is led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF), with the support of the Bill & Melinda Gates Foundation. Since its launch at the World Health Assembly in 1988, the GPEI has reduced the global incidence of polio by more than 99%.

The GPEI receives financial support from governments of countries affected by polio, private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and non-governmental organizations and corporate partners. A full list of all contributors is available on the GPEI website, http://polioeradication.org/financing/donors/

Bill Gates and Aliko Dangote underlined their commitment to polio eradication, alongside other health interventions. © UNICEF Nigeria

A unique group of people gathered last month in Sokoto state to commit to the twin goals of eradicating polio, and working to rapidly strengthen routine immunization. Bill Gates, and Africa’s richest man, Alhaji Aliko Dangote, joined traditional leaders from across northern Nigeria, Federal Ministry of Health officials, representatives from several State governments, and partners including UNICEF and WHO.

The two billionaires play a significant role in the fight to eliminate polio in Nigeria, where no wild virus has been detected since 2016. The Bill & Melinda Gates Foundation has committed US$1.6 billion in the country to date to fund pilot projects targeted at health care, agriculture and financial inclusion, a contribution which makes up their biggest investment in Africa. Aliko Dangote, who is Nigerian, has previously worked with Mr Gates to help interrupt transmission of the poliovirus in his country, and helps fund other health programmes as president of the Dangote Foundation.

During their visit, Mr Gates and Mr Dangote witnessed first-hand the progress Nigeria is making in polio eradication, routine immunization and primary health care provision.

At meetings held at the Sultan’s Palace and Governor’s House, Mr Gates highlighted the commitment of traditional leaders and reiterated the importance of engaging communities to reach every child with vaccines. Expressing his concern over the high infant mortality rate in Nigeria, he noted that vaccination is a cost effective way to save children’s lives.

Mr Gates also talked about the need to plan for the future of a polio-free Nigeria. Looking to how the polio eradication infrastructure can be used to help meet other health needs, Mr Gates said that the strong existing polio infrastructure – including vaccine supply chains, disease surveillance, laboratory systems and social mobilization networks – can be used to develop and improve routine immunization coverage for other diseases.

“We can prevent millions of deaths through routine immunization,” Mr Gates said. “We will not relent in our commitment towards this.”

Mr Dangote further highlighted that the fight against polio requires commitment from all stakeholders.

Drawing attention to malnutrition as one of the biggest factors undermining Nigeria’s progress, Mr Dangote urged the government and partners to reach out to private sector companies and ask them to donate at minimum 1% of their profits to financing the health sector.

At the meeting, the governors of Bauchi, Borno, Kebbi, Kaduna, Kano, and Sokoto States signed extensions of their Memorandum of Understanding on routine immunization. In doing so they reaffirmed their commitment to maximizing immunization coverage in their respective states, helping to protect every child against polio and other vaccine-preventable diseases.

Polio personnel are keeping children safe from polio, and are also helping to strengthen outbreak response for other diseases. © WHO Nigeria

“When I received the confirmation of the first case of Lassa fever…nothing prepared me for the tasks ahead other than my work in polio eradication” – Mrs Faith Ireye, WHO State Coordinator in Edo state.

In the first two months of 2018, there were 110 deaths in Nigeria from suspected Lassa fever. Outbreak response, led by the Nigerian government and WHO, is focused on detecting every case, and tracing the virus wherever it is hiding.

Bolstering this effort are individuals with experience of guarding against a different disease – polio.

Ms Ireye, who has worked with the Global Polio Eradication Initiative for over ten years, is currently helping to coordinate the Lassa fever outbreak response in Edo State, one of the hardest hit by the outbreak.

“My experiences in polio eradication activities allowed me to immediately swing into action. So, when the [Lassa fever] outbreak was confirmed, I realized the need to use my expertise to serve communities at risk,” she says.

Part of her job is to help coordinate surveillance, specifically ensuring that everyone who has come into contact with someone with Lassa fever is found, and tested for the virus.

Her work is critical to help prevent further fever cases. Deputy Governor of Edo State, His Excellency Philip Shaibu said, “WHO…is one of the pillars that have helped lead surveillance in Edo state… In this particular outbreak, WHO was the first to draw attention to the fact that we need to galvanize resources from all partners, from other parts of the country, to ensure that things get done.”

The polio infrastructure

When outbreaks of other diseases happen, the knowledge and experience of polio personnel like Ms Ireye can make a significant difference to outbreak response. For example, polio workers were essential to containing the Ebola virus outbreak in 2014. For the Lassa fever response, 271 polio workers are involved in active case search, 235 in contact tracing, and 320 in community sensitization activities across the 18 at-risk states.

“The polio infrastructure was originally designed towards achieving the polio eradication goals,” said Dr Wondimagegnehu Alemu, WHO Country Representative to Nigeria. “Now polio infrastructure has expanded its support to broader disease surveillance strengthening, outbreak response and basic health care services including immunization.”

The benefits of experienced personnel

WHO staff gather with clinicians from the Jos University Teaching Hospital, Nigeria, after training them on active case search. © WHO Nigeria

Other activities carried out by polio workers include data collation and analysis, and case reporting.

“The polio teams on ground in the states were crucial for mounting the initial response to the Lassa fever outbreak, and have continued to be WHO’s frontline technical support to the NCDC, States Ministry of Health and local government area teams,” Dr Emmanuel Musa, WHO Incident Manager for Lassa fever Management Team in Nigeria observed.

A legacy for posterity

Investments by donors and partners have gone far beyond polio eradication. Reflecting the positive impact that polio infrastructure and knowledge has had on other health priorities such as Lassa fever, WHO and other partners are currently supporting the development of a national transition plan. This will ensure that the investments that have brought the world to the brink of eradication are made available to support other national public health efforts, long after polio has been defeated.

“We must carefully consider how we transition many of the polio workers and the polio infrastructure to help with managing other health needs,” Dr Alemu said. “Future funding and partnerships will be a key part of this work.”

For now, experienced polio personnel continue their work to end the Lassa fever outbreak. Thanks to them, and the support of governments, partners and donors, we are ending polio, and are also helping to strengthen other health interventions.

Support for immunization to the Federal Government of Nigeria through the World Health Organization is made possible by funding from the Bill & Melinda Gates Foundation (BMGF), the United Kingdom, the European Union (EU), Gavi, Global Affairs Canada (GAC), the Government of Germany, the Japan International Cooperation Agency (JICA), the Korea Foundation for International Healthcare (KOFIH), the Measles and Rubella Initiative (M&RI) through the United Nations Foundation (UNF), Rotary International, the United States Agency for International Development (USAID), the United States Centers for Disease Control and Prevention (CDC) and the World Bank.

Deputy Governor of Edo State speaks with the WHO State Coordinator, as part of efforts to implement strong outbreak response. © WHO Nigeria

Zulaihatu Abdullahi, a volunteer community mobilizer in Kaduna State, goes door-to-door to ensure that every child is vaccinated against polio. © UNICEF Nigeria / Jasmine Pittenger

Zulaihatu Abdullahi is well known in her community, particularly to the mothers. As a volunteer community mobilizer in Kaduna state, northern Nigeria, her mission is to ensure that no child contracts polio, or any other preventable childhood disease.

This is difficult, as immunization programmes are sometimes treated with suspicion in her part of Nigeria. As a ‘change agent’, Zulaihatu’s job is to go door to door, counselling parents about the importance of the polio vaccine.

This particular lunchtime, she is visiting an 18 year-old mother living in a compound in a densely-populated, urban district of Kaduna State.

The young mother puts down the pole she is using to pound millet and welcomes Zulaihatu, recognising her royal-blue UNICEF hijab. She sits, and pulls on a hijab for cover as she settles down to breastfeed her baby. She has three other small children at home, a fifth on the way and she is new to the area.

“Before I came here I was rejecting all vaccines,” she says, “but because of this woman, Zulaihatu, I decided to accept. She told me the usefulness and I was convinced to do it.”

Thanks to Zulaihatu’s patience, and her work to build trust with the younger woman through regular visits, four more children are now protected against polio who might otherwise still be at risk. The mother has also been encouraged to seek anti-natal care, and the youngest child has just received his routine immunization shots.

“Sister Zulaihatu was one of the first women I met when we moved here,” the mother recalls. “She came here every day. She told me how she takes care of her own children. What she feeds them. How they all take vaccines. Little by little I started to change my thinking.”

Zulaihatu is trained to make her community aware of important household and parenting practices to keep their children thriving. The list is extensive and includes tips to treat diarrhoea, the importance of basic hygiene and sanitation, how to protect the family from malaria, the benefits of neonatal care and breastfeeding for infants, and the importance of registering their births.

She is one of nearly 20 000 UNICEF-trained community mobilizers, influencers and communication experts spread across 14 northern ‘high risk’ Nigerian states. With the support of donor and partners including the Bill and Melinda Gates Foundation, CDC, Dangote Foundation, European Union, Rotary, GAVI, JICA, the World Bank and the Governments of Canada, Germany, Japan, and others, the mobilizers are a key part of UNICEF’s ongoing support to the Government of Nigeria’s immunization programme.

Despite their achievements, Zulaihatu and other mobilizers know that there is much is still left to be done in their communities. Tomorrow, Zulaihatu will continue her work, going from household to household to keep every child safe.

Zulaihatu is one of nearly 20 000 UNICEF-trained community mobilizers, influencers and communication experts in Nigeria, who offer advice and support to parents to keep their children healthy. © UNICEF Nigeria / Jasmine Pittenger

More resources

Learn more about the poliovirus surveillance system by watching our award-winning animation, available in multiple languages including Japanese.

Mr Yasuhiro Tojo, Chief Representative, JICA Pakistan Office and Chris Maher, Polio Eradication and Emergency Support Manager, WHO, sign the grant agreement. ©WHO/Pakistan

Zarifa, 4, gets her finger marked after receiving oral polio vaccination. Kandahar City, 19 December 2017. ©WHO EMRO / Tuuli Hongisto

Reducing polio cases by 99.9% globally is an incredible feat, achieved through innovative strategies and years of trial and error.

While the polio eradication programme is focused on getting to zero, now is the time to make sure everything we’ve learned isn’t lost and can be used to inform future global health programmes. Just as the polio eradication effort applied lessons learned from the successful smallpox campaign to its own work, the goal is for future health programmes to understand and build on the knowledge of the polio effort.

Under a new grant from the Bill & Melinda Gates Foundation, the Johns Hopkins Bloomberg School of Public Health (JHSPH) will be working to do exactly this.

JHSPH will partner with academic institutions from around the world to document lessons and develop graduate-level courses and hands-on training clinics for public health students and professionals, including an online open course available to the public and implementation courses for managers from other health programmes.

Under the leadership of Dr Olakunle Alonge, the team at JHSPH will collaborate with a global team from public health institutions in seven countries: Nigeria, India, Afghanistan, Ethiopia, the Democratic Republic of the Congo, Bangladesh and Indonesia. This will not only ensure a balanced and diverse perspective, but also enable the exchange of public health training strategies between the institutions.

To develop the content of each course, JHSPH will be identifying “change agents” at the local, national and global levels who have expertise in polio eradication that may not otherwise be captured. This unique global strategy promises to yield coursework that speaks to the issues faced by a broad range of global health programmes and actors.

“Without an active strategy to map, package and deliver the knowledge from the global polio eradication efforts to other programs and global health actors, I’m afraid that these knowledge assets may not find any useful purpose beyond the end of the polio campaign, which could come to an end within a few years,” said Alonge.

Alonge expects to glean lessons that will apply to immunization systems, public health emergency response, primary health care, disease eradication and infectious diseases—ensuring that the polio programme continues to positively impact global health for years to come.