Adapted from the Annual Letter

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

Mark Suzman,
CEO, Bill & Melinda Gates Foundation

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

Continuing work in endemic countries

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

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

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

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

Progress on variant polio outbreaks

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

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

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

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

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

A global effort

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

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

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

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

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

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

Read more

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related Documents:

On 17 May, GPEI held a high-level influencer briefing with polio experts from around the world in which over 200 attendees from 63 countries took part.

Watch the recording of the event.

 

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

With more than twenty years’ experience on the ground in Afghanistan, WHO’s polio eradication programme continues to leverage its extensive operational capacity to deliver better health outcomes for all Afghans, including providing vital support to the recent nationwide measles vaccination campaign.

Measles outbreaks were reported across Afghanistan throughout 2022, with more than 5,000 cases and an estimated 300 deaths reported by November. Complications from the measles virus include severe diarrhea and dehydration, pneumonia, ear and eye complications, encephalitis or swelling of the brain, permanent disability and death. Most cases are children under the age of 5 years. There is no treatment for measles, the only reliable protection is vaccination.

While a series of sub national measles vaccination campaigns took place in 2022 reaching approximately three million children in 141 districts, the nationwide campaign from November 26 to December 5 represented the first national measles drive since the political transition in August 2021. The campaign covered 329 districts in all 34 provinces, vaccinating 5.36 million children aged between from 9 to 59 months against measles. 6.1 million children between 0 to 59 months received oral polio vaccine.

WHO’s polio eradication programme has significant reach in Afghanistan, with a presence in every district in the country. The polio programme leveraged this presence to recruit vaccinators, organize vaccination sites, and train campaign staff. With longstanding relationships with local authorities, the polio programme assisted in the selection of local schools, clinics, or mosques to serve as vaccinations sites. The programme’s established relationships with health institutions and communities enabled polio staff to recruit local health workers and other staff to fill the roles of measles vaccinators and provide training. Sharing their experience of implementing polio vaccination campaigns helped measles vaccinators prepare and plan for the task ahead.

The detection of measles cases and collection of data by WHO’s extensive polio surveillance network also played a crucial role in providing evidence-based planning for the campaign. WHO’s polio programme also provided logistical support, transporting measles and polio vaccines, ensuring the cold chain was maintained and vaccines were delivered to every district. Polio staff played additional roles in campaign monitoring and supervision.

“Measles is a highly contagious disease. WHO Afghanistan is very proud of its work immunizing and protecting children against both measles and polio in this campaign,” said Dr Luo Dapeng, WHO Representative in Afghanistan. “I am very grateful to all health workers, partners and donors who made this possible.”

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

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

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

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

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

Addressing social norms

Dr Amira Zaghloul ©WHO/Pakistan

Giza, Egypt, is home to the ancient world-renowned pyramids and a medical marvel of the modern age — the accredited Polio Regional Reference Laboratory (RRL) at the Egyptian Holding Company for Biological Products and Vaccines (VACSERA). Director of the polio regional reference laboratory,

Amira Zaghloul oversees five different departments, working closely with her 25-member team. They regularly conduct poliovirus diagnostic tests on stool samples obtained from children as well as sewage samples from Egypt. Additionally, they carry out sequencing of samples that have been identified as positive for polio in Egypt, Iran, Iraq, Jordan, Sudan, and Syria, which determines if the polioviruses confirmed are related to any other ones. Their goal is to meet tight deadlines, to swiftly respond to any detection of the poliovirus.

Like her counterparts across the Region, Ms Zaghloul and her colleagues rely on the latest laboratory and digital technology. With support from partners, they regularly upgrade their technology and skills to ensure the shortest possible time between sample collection and churning out results. Soon, for example, Ms Zaghloul and her team will acquire the next generation of sequencing technology – that will help test the entire genome of a virus, or genetic materials that make up a virus, and identify any mutations. This will also help to determine the origin of detected polioviruses, and track epidemiological patterns of spread.

Her work doesn’t come without challenges though. When she first took on this role, Ms Zaghloul faced negative social perceptions of being a female leader of a mixed team of men and women. To address this, Ms Zaghloul introduced rules and regulations that apply to all, regardless of age and gender.

People working in health should exemplify a spirit of perseverance, devotion, hope and ambition – regardless of their gender – she emphasizes.

Negotiating to receive samples for polio tests

Dr Hanan Al Kindi ©WHO/Pakistan
Dr Hanan Al Kindi ©WHO/Pakistan

When Dr Hanan Al Kindi finally settled on what to study − over virology, medicine or business — she had no idea she would need negotiation skills in her job. As the head of nine polio and measles laboratory departments that test samples from Bahrain, Qatar, United Arab Emirates and Yemen for polioviruses, Dr Al Kindi ensures everything runs like clockwork.

At times, this involves thinking out of the box. After noting huge time lags in the delivery of stool samples – used to test for polioviruses – from Yemen to Oman, Dr Al Kindi rolled up her sleeves and got to action. She learnt that after driving through mountains and deserts to reach Oman’s borders, the refrigerated trucks that transport stool samples were kept at the border for hours of inspection. Dr Al Kindi and her team got the contacts of officials at the border and invited them over for a chat.

Her determined negotiation skills and ability to read the room – to understand when peripheral stakeholders such as officials at the border and couriers needed more context about the laboratory’s role in saving children from polio — eventually helped reduce the red tape at the border. This means Dr Al Kindi and her team can test for polioviruses and turn over their results to the polio programme in Yemen in less time than before. This steers timely and appropriate outbreak response activities, including polio immunization campaigns to protect children from polio.

Working in an equitable environment

Dr Nayab Mahmood ©WHO/Pakistan

Dr Nayab Mahmood plays a vital role in ensuring samples are tested for poliovirus as swiftly as possible for timely interventions in Afghanistan and Pakistan – the only two countries left with naturally occurring poliovirus.

Dr Mahmood is a virologist serving the polio programme of the Regional Reference Polio Laboratory at Pakistan’s National Institutes of Health in Islamabad. Her role involves intricate technical procedures, including molecular diagnostics, and genetic sequencing of the poliovirus genome. This work helps to determine how wild polioviruses are spreading across both endemic countries.

Being part of an emergency programme means that Dr Mahmood and her colleagues need to be available 24 hours a day – a pace that is impossible to maintain without feeling an impact in one’s personal life. She feels that the best way to maintain a work-life balance is for each member of a team to communicate their needs with each other, which further helps the programme’s leaders like her to shape policies and programmes that enable a good work-life balance.

Grateful that she hasn’t had to challenge any stereotypes related to gender dynamics in her role,
Dr Mahmood credits this to directives in her workplace that support gender equality, and to the culture of her individual team. These attributes have blended to create an equitable environment where everyone can use their abilities.

Sharing rare, much-needed skills

Professor Henda Triki ©WHO/Pakistan

Chief of the Laboratory of Clinical Virology in the Pasteur Institute of Tunis, Professor Henda Triki makes a concerted effort to share her knowledge with others. Her altruistic spirit goes beyond her laboratory, especially as her specialty of work is still rare in North Africa: She teaches virology at the Faculty of Medicine of Tunis, and constantly keeps an eye on how best to upgrade her team’s skills and technology at work.

Professor Henda Professor Triki has a collaborative leadership style at work, which results in her sharing her team-building skills with her colleagues – which has helped them address challenges many times before, including during the COVID-19 pandemic. Amidst the chaos and anxiety during the pandemic, Professor Triki and her team had strong moments of solidarity and collaborative work.

Professor Triki wants her fellow female colleagues to be proud of working for the polio eradication programme, as it offers great opportunities. It has allowed women to distinguish themselves from others by acquiring skills that other laboratories do not have. She is pleased to note now that there are many women who are the face of specialized laboratory work in the Eastern Mediterranean Region.

This year, the UN’s theme for International Women’s Day is ‘DigitALL: Innovation and technology for gender equality’.

Originally published here.

©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/Bruno Pereira
WHO/Bruno Pereira

Under the leadership of the Ministry of Health, with support from Rotary and other GPEI partners, a multi-round polio vaccination campaign is being implemented in Mozambique. Six rounds of vaccination were completed in 2022, covering all provinces of the country and reaching 8.7 million children.

A further four rounds of vaccination are planned for 2023. Rotary and GPEI partners are jointly working together to support health authorities to deliver training on community-based surveillance, procuring and distributing 30 million vaccine doses and 8000 vaccine carriers, expanding field surveillance efforts, supporting vaccine management and social behaviour change activities. The GPEI are also supporting the deployment of vaccination teams, under the overall coordination of the Ministry of Health.

During a visit to Mozambique from 21 to 23 February 2023, representatives of the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), Bill & Melinda Gates Foundation, Rotary Foundation and the United States Centers for Disease Control and Prevention, emphasized the importance of building on lessons learnt and successful approaches used in polio eradication to strengthen the country’s response to other health emergencies, including the ongoing cholera outbreak.

The polio outbreak response in Mozambique comes as the country is also addressing other emergencies, including the COVID-19 pandemic, cholera, floods and insecurity in the northern Cabo Delgado region.

The senior leaders included UNICEF Regional Director for Eastern and Southern Africa, Mr Mohamed Fall, WHO Regional Director for Arica, Dr Matshidiso Moeti, Mr Chris Elias, the Chair of the Polio Oversight Board of the Global Polio Eradication Initiative (GPEI), Mr Mike McGovern, Chair of the Rotary International PolioPlus Committee, Dr Omotayo Bolu, Polio Eradication Branch Chief for the United States Centers for Disease Control and Prevention, and other partners.

They met with Mozambican Prime Minister Adriano Afonso Maleiane and visited Mozambique’s northern Tete province, where eight wild poliovirus cases were detected last year.

During their visit to Tete province, the delegation witnessed polio response efforts in the field, engaged with health workers and support staff, supervisors, religious and community leaders. They also visited an Emergency Operations Centre and a Cholera Treatment Centre to better understand challenges and progress in the polio and cholera responses.

“The Government of Mozambique has shown strong leadership in the response to polio, ensuring that all eligible children are reached and protected with the vaccine through effective immunization campaigns,” said Dr Moeti. “We must not relent nor spare efforts to finish the job of ending polio once and for all.”

Polio, a debilitating viral disease that was once the leading cause of paralysis among children worldwide, is very close to being eradicated. Since 1988, the number of children affected by polio has reduced by 99 per cent. But outbreaks continue to occur, including in Mozambique, and ensuring every last child is immunised against the virus is a global priority.

Originally published here.

@WHO

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

24 October is World Polio Day, a global day to raise awareness and resources for the worldwide effort to eradicate polio.  Communities, Rotarians, civil society, governments and partners around the world are organizing events to mark the occasion and draw attention to the opportunity to rid the world of an infectious disease once and for all, including at a special event at WHO’s European Regional Office with keynote speakers from partners and the Global Certification Commission for Polio Eradication.

On 21-22 October, Rotarians and WHO are meeting to examine how their joint collaboration on polio eradication can be applied to broader public health efforts, at an event called:  World Polio Day and Beyond:  a healthier future for mothers and children.  Director-General Dr. Tedros Adhanom Ghebreyesus and Rotary International President for 2022-2023 Jennifer Jones will discuss the work the two organizations have done together for decades to eradicate polio and how they will continue to work together on a healthier future for mothers and children.

World Polio Day this year comes on the heels, of a global GPEI pledging moment, co-hosted by the German Government, held on 18 October at the World Health Summit in Berlin, Germany.  At this event, the global community committed US$2.6 billion to the global effort to eradicate polio.  It was an important first step, and clear sign of global solidarity, to ensuring all resources to achieve success are mobilized.  We will all benefit equally from a polio-free world, so all of us have clear responsibility to help achieve it.  Together, we end polio!

Addressing the pledging event in Berlin by video, Sadiya, a vaccinator from Nigeria, said:  “Together, we end polio!  I will do my best.  I hope you will too.”  World Polio Day is the ideal opportunity to follow Sadiya’s lead, and also do all of our best.

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

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

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

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

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

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

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

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

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

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

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

Additional quotes from the pledging moment:

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

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

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

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

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

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

Pledging table

Media contacts:

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

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

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


Notes for editors:

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

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

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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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.

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.

It is a hot afternoon in Chagai, a small community on the south bank of the River Gambia when the polio vaccination team arrives to a rapturous welcome. Children and women jump to their feet, some waving and swinging their hands as they pound their feet on the ground in near perfect sync with the beat of the drum.

This excitement is caused by one certain member of the vaccination team wearing a bush hat and playing the drums. Lamin Keita, 60, is a cultural musician supporting the vaccination team in raising awareness about polio and encouraging parents to vaccinate their children.  Lamin, popularly called Takatiti, because of one of his songs, is immediately surrounded by excited children, as he adjusts his beats to respond to the ecstasy and rigor of the dancers.

“When I arrive on the back of a pick-up truck with my megaphone and drums, children from the communities run after us in full excitement and jump up and down and ask me to play my drums,” Takatiti explains.

Whenever Takatiti enters a village with his drums, children and adults flock around him and jump and dance to his music, which gives him the opportunity to speak with community members about polio and the importance of vaccination in protecting children from the deadly disease. Photo: © UNICEF/UN0624019/ Lerneryd

This is what Takatiti is popular for – pulling crowds with his drums to communicate important messages like polio vaccination. For almost four decades, he has toured communities in the region, accompanying health workers as they seek to persuade parents and caregivers to vaccinate their children during mass vaccination campaigns like the polio campaign.

Local voices are the most powerful voices

Building trust in vaccines among parents and caregivers is the first critical step towards achieving high immunization coverage to stop the spread of polio. UNICEF, as a leading partner of the Global Polio Eradication Initiative (GPEI) for social and behaviour change, supports the government in strengthening engagements with communities, as the voices of local leaders and influencers like Takatiti play a powerful role in helping allay fears and concerns of parents and caregivers about vaccines.

“I have been making town announcements since the mid-1980s. I am aware of polio and its terrible consequences. Families hear myths and rumours and get concerned about vaccines. As they already know and trust me, I try my best to give them accurate information and clear their doubts, so that they can vaccinate their children against polio and other dangerous diseases,” Takatiti says.

“It’s important to deliver messages that are supported by facts in an effective way”

Days before the start of a polio vaccination campaign and during the campaign itself, Takatiti walks up and down the streets of villages, playing his drums and using his megaphone to talk to communities about the dangers of polio, how vaccination is the only way to protect children, and that polio vaccines are safe and free.

Awa plays with her baby, Abdoulay, after he was vaccinated during the a polio vaccination campaign in Jenoi, The Gambia, on 21 March 2022. Photo: © UNICEF/UN0623991/Lerneryd
Awa plays with her baby, Abdoulay, after he was vaccinated during the a polio vaccination campaign in Jenoi, The Gambia, on 21 March 2022. Photo: © UNICEF/UN0623991/Lerneryd

“I always try to promote peace and healthy life for all. It’s important to deliver messages that are supported by facts in an effective way. The Government and UNICEF provided me correct information and facts about polio and vaccines, so I am happy to volunteer for the campaign.”

A country mobilizes to stop polio

“If people trust health workers to cure other diseases, then it makes sense to trust the same health workers to protect our children from polio. Health workers even give the polio vaccine to their own children – so we should not doubt their good intentions. It is my job to let people know this truth, without offending them, and encourage them to vaccinate their kids,” Takatiti said.

In August 2021, The Gambia declared a national public health emergency in response to outbreaks of non-wild variants of polio in the country.

Sainabou, a healthcare worker, administers the polio vaccine to school children at New Town School during a vaccination campaign in Bakau, The Gambia, on 19 March 2022. Photo: © UNICEF/UN0624057/Lerneryd
Sainabou, a healthcare worker, administers the polio vaccine to school children at New Town School during a vaccination campaign in Bakau, The Gambia, on 19 March 2022. Photo: © UNICEF/UN0624057/Lerneryd

The Gambian government, with support from WHO, UNICEF, US Centres for Disease Control and Prevention (CDC)and GPEI partners, quickly responded and started preparing for nationwide immunization campaigns – managing supply and safe storage of vaccines, strengthening surveillance and monitoring, training health workers and vaccinators, and engaging with local leaders and influencers to build trust in vaccines.

The country undertook its first national polio vaccination campaign in November 2021 and followed up with a second round in March 2022.

Thanks to thousands of health workers, vaccinators, and community influencers like Takatiti, the vaccination campaigns have reached over 380,000 children aged five years and below in The Gambia.

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

17 February 2022 As a result of ongoing disease surveillance, the Global Polio Laboratory Network (GPLN) has confirmed the presence of type 1 wild poliovirus (WPV1) in a child suffering from paralysis in Tsabango, Lilongwe, Malawi. Analysis shows that the virus is genetically linked to WPV1 that was detected in Pakistan’s Sindh province in October 2019.

The three-year-old girl in Malawi experienced onset of paralysis on 19 November 2021, and stool specimens were collected for testing on 26 and 27 November. Sequencing of the virus conducted in February by the National Institute for Communicable Diseases in South Africa and the U.S. Centers for Disease Control and Prevention confirmed this case as WPV1.

Detection of WPV1 outside the world’s two remaining endemic countries, Pakistan and Afghanistan, is a serious concern and underscores the importance of prioritizing polio immunization activities. Until polio is fully eradicated, all countries remain at risk of importation and must maintain high vaccination coverage to protect all children from polio.

The GPEI is supporting health authorities in Malawi to conduct a thorough assessment of the situation and begin urgent immunization activities in the subregion to mitigate any risk of spread. Surveillance measures are also being expanded in Malawi and neighboring countries to detect any other potential undetected transmission.

As an imported case from Pakistan, this detection does not affect the WHO African Region’s wild poliovirus-free certification status officially marked in August 2020. Malawi last recorded a case of wild poliovirus in 1992. The polio eradication programme has seen importations from endemic countries to regions that have been certified wild poliovirus-free in the past, and has moved quickly to successfully stop transmission of the virus in these areas.

Polio anywhere is a threat to children everywhere. Now is the time for all parties to recommit to ending all forms of polio for good.