In March 2020, polio social mobilisers from the UNICEF-run Immunization Communication Network (ICN) provided routine immunization referral services to over 37,000 children in southern and eastern Afghanistan.
The polio programme’s routine immunization efforts in Afghanistan have made important gains, especially in the country’s east, in the areas bordering Pakistan. Polio social mobilisers support mother and child health referral services, and help families keep track of their children’s health records. As the mobilisers are recruited from their community, they know the families in their neighborhood and can trace each child’s planned immunization schedule from birth.
It is critical that routine immunization continues throughout the pandemic to protect children from life-threatening diseases including polio. Polio mobilisers have found their work is even more valued during the COVID-19 response.
Masoud, a polio mobiliser, says ‘’I used to announce the immunization sessions through the Mosque but not all the targeted children were brought to the health facility. Now through the ICN support to routine immunization, the number of missed children has reduced due to tracking of every child in the community and coordinating with the health facility.”
“This is critical during the ongoing pandemic, as families are not sure if they can leave their homes to take their children to the health facility for immunization. The polio mobilisers are their guide in the community.’’
This month, world leaders have joined together to make several important commitments to strengthening public health infrastructure during the COVID-19 response – investments that will go a long way in protecting the most vulnerable communities, including those affected by polio.
On 4 May 2020, heads of government, institutions and industry pledged USD $7.4 billion (of the USD $8 billion goal) to ensure equitable access to new tools for COVID-19 globally. The funding will support the Access to COVID-19 Tools Accelerator, which will help develop new global health technology solutions to test, treat and protect people, and prevent the disease from spreading.
A day later, several donors pledged new funding to Gavi, one of the partners of the Global Polio Eradication Initiative (GPEI), ahead of its upcoming replenishment in June 2020. This funding will not only help vaccinate hundreds of millions of children against diseases such as polio, but also ensure that immunization delivery systems are sustained through the pandemic.
The GPEI greatly appreciates outstanding donor community support for both the COVID-19 response effort and routine immunization programmes around the world.
The GPEI is continuing to do its part to support the COVID-19 pandemic, in solidarity with other health initiatives. In March, the Polio Oversight Board made the recommendation to pause polio vaccination campaigns to limit further spread of the disease. Countries extended their key polio eradication assets, like infrastructure and human resources, to support countries’ COVID-19 response efforts, while continuing essential activities. As of May, GPEI resources, including surveillance laboratories, and social mobilization and communication networks, are supporting COVID-19 response in at least 55 countries.
The pause of vaccination campaigns and the disruption of routine immunization services leaves millions of children at high risk of contracting polio, measles and other vaccine preventable diseases (VPDs). The COVID-19 pandemic has demonstrated that vaccines, against both COVID-19 and VPDs, are crucial to protecting individuals, communities and economies.
As countries continue to implement their COVID-19 response plans, WHO and UNICEF are working with emergency and immunization partners to ensure the polio infrastructure not only supports the response, but also is fully funded in alignment with the ongoing efforts to finance COVID-19. While work is ongoing to cost those requirements, the GPEI hopes that specific COVID funds will be able to contribute towards its response efforts.
It is critical that essential health services and systems, including polio eradication efforts, have necessary support during both the response and recovery phases of this pandemic. While the GPEI has extended its assets to the global COVID-19 response effort, sustaining these programmatic resources is imperative. Continued donor commitments will enable the safe and effective resumption of polio vaccination campaigns as the situation evolves.
“Tears were rolling down her cheeks. She was a true embodiment of pain and fatigue. She had huddled to her chest an eleven-year-old boy whose thin legs were hanging down, hampering her while she walked. I was stunned by the scene and stopped. I was curious to ask the woman what had happened to the child she was carrying. The poor woman wiped her tears to reply to me and revealed that out of her six children, three were suffering polio paralysis.”
Aziz Memon is narrating his first encounter with a child suffering from polio. The experience proved lifechanging. Over 22 years, he has risen to become one of the most influential philanthropists working to end polio in Pakistan.
22 years, 200,000 vaccine carriers, and millions raised to end polio
Aziz Memon is a good person to speak to if you want to get an insight into Rotary’s work in Pakistan. Chair of the Pakistan National PolioPlus Committee, Aziz is also a member of the International PolioPlus Committee. He has won multiple awards for his work to defeat the virus, and in October was announced as the first incoming Rotary Foundation Trustee to be appointed from Pakistan.
Aziz is most proud of his national committee’s work. He explains, “The committee has funded over 200,000 vaccine carriers for the entire EPI programme in Pakistan.”
“We have also supported vaccination at borders through permanent transit points, improved routine immunization at Permanent Immunization Centers, and helped provide basic medical care through female health workers. We have improved quality of life for families through solar filtration plants to provide clean water and have educated illiterate communities through providing speaking books. Rotarians create advocacy in schools, colleges, with Ulemas [Islamic religious scholars] and in their communities.”
With the support of Aziz and others, Rotary International has contributed millions of dollars to eradicate polio in Pakistan through the Government, WHO and UNICEF.
The global drive to root out polio has some way to go still, with the poliovirus remaining in Afghanistan and Pakistan. To break the impasse an intensive, innovative and persistent effort is required.
“Rotary International’s mission to eradicate polio globally is our top priority and Rotary has taken this mission forward and helped and supported governments in other polio endemic countries to eradicate this terrible disease. It will be a privilege to be part of history when polio is eradicated, the second disease to be wiped out after smallpox,” Aziz explains.
Aziz reiterates that vaccine hesitancy and misinformation are two of the remaining challenges in the fight against polio in Pakistan.
“Misinformation spread through social media creates fear of the polio vaccine. Some security concerns still persist in tribal areas and there is weak accountability in places.”
In response, Rotary is supporting innovative strategies to address the challenges related to vaccine hesitancy. Aziz says, “Hesitancies must be skillfully addressed. We are working with Ulemas and religious scholars in all four provinces to create a positive image. Social media is playing a very strong role in averting misconceptions.”
Rotary is also a critical support to polio survivors who cannot afford their medical expenses. Aziz explains, “Rotary funds WHO to support a rehabilitation programme for polio victims. The Rotary Club of Karachi also sponsors a community project called the Artificial Limb Center which provided prosthesis, caliphers, crutches and wheelchair for polio victims and amputees as well as those injured in accidents.”
Dreaming of a polio-free Pakistan
Polio eradication in Pakistan has been a long journey but Aziz is motivated to overcome the remaining challenges.
“I motivate my fellows by nominating them for the Polio Free Service awards; publicizing their projects and activities in the monthly PolioPlus newsletter and honoring their services during the annual District Conference.”
A polio-free country is a dream for Pakistan. Reflecting on his feelings when India ended polio, to the joy of Rotarians worldwide, Aziz says, “It was good to know that a country like India could eradicate polio. It gives us hope that Pakistan can do it too, and we will soon be polio free.”
“Rotary was there at the beginning of the global effort to eradicate polio. If we stop now, polio may bounce back. We’ve done too much: we’ve made too much progress to walk away before we finish.”
The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution to Rotary will be tripled. Donate now.
ABU DHABI, 19 November 2019 – Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.
This pledging event comes on the heels of a major announcement last month that the world has eradicated two of the three wild poliovirus strains, leaving only wild poliovirus type 1 (WPV1) still in circulation. Additionally, Nigeria – the last country in Africa to have cases of wild polio – has not seen wild polio since 2016 and the entire WHO African region could be certified wild polio-free in 2020. Thanks to the dedicated efforts of health workers, governments, donors and partners, wild polio only circulates in two countries: Pakistan and Afghanistan.
“From supporting one of the world’s largest health workforces, to reaching every last child with vaccines, the Global Polio Eradication Initiative is not only moving us closer to a polio-free world, it’s also building essential health infrastructure to address a range of other health needs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board. “We are grateful for the generous pledges made today and thank governments, donors and partners for standing with us. In particular, I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi for hosting the GPEI pledging moment and for his long-term support for polio eradication.”
The commitments announced today come at a critical time for the polio eradication effort. Barriers to reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine – have led to ongoing transmission of the wild poliovirus in Pakistan and Afghanistan. Further, low immunity to the virus in parts of Africa and Asia where not all children are vaccinated has sparked outbreaks of a rare form of the virus. To surmount these obstacles and protect 450 million children from polio every year, governments and donors announced significant new financial commitments toward the $3.27 billion needed to support the Polio Endgame Strategy.
Pledges are from a diverse array of donors, including: US$160 million from the host of the pledging moment His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi; countries, including US$215.92 million from the United States, US$160 million from the Islamic Republic of Pakistan, US$105.05 million from Germany, US$84.17 million from the Federal Government ofNigeria, US$10.83 million from Norway, US$10.29 million from Australia, US$7.4 million from Japan, US$2.22 million from Luxembourg, US$1.34 million from New Zealand, US$116,000 from Spain, and US$10,000 from Liechtenstein; GPEI partners, including US$1.08 billion from the Bill & Melinda Gates Foundation and US$150 million from Rotary International; philanthropic organizations, including US$50 million from Bloomberg Philanthropies, US$25 million from Dalio Philanthropies, US$15 million from the Tahir Foundation, US$6.4 million from the United Nations Foundation, US$2 million from Alwaleed Philanthropies, US$1 million from the Charina Endowment Fund, and US$1 million from Ningxia Yanbao Charity Foundation; and the private sector, including US$1 million from AhmedAl Abdulla Group, US$1 million from Al Ansari Exchange, and US$340,000 from Kasta Technologies. Earlier this month, the United Kingdom announced it would contribute up to US$514.8 million to the GPEI.
“We are proud to host the GPEI pledging moment in Abu Dhabi and thank all the attendees for their continued commitment to the eradication of polio,” said Her Excellency Reem Al Hashimy, UAE Cabinet Member and Minister of State for International Cooperation. “Since launching in 2014, the Emirates Polio Campaign has delivered more than 430 million polio vaccines in some of the most remote areas of Pakistan. We remain firm in our mission to reach every last child and believe together we can consign polio to the pages of history.”
In addition to overcoming barriers to reach every child, this funding will ensure the resources and infrastructure built by the GPEI can support other health needs today and in the future. Polio workers deliver Vitamin A supplements, provide other vaccines like those for measles and yellow fever, counsel new mothers on breastfeeding, and strengthen disease surveillance systems to anticipate and respond to outbreaks. As part of its commitment to advance gender equality and women’s empowerment, the GPEI is also working to ensure equal participation of women at all levels of the programme.
The future of polio eradication hinges on support and engagement at all levels of the programme – from individuals to communities to local and national governments to donors. If the strategies needed to reach and vaccinate children are fully implemented and funded, we are confident that we can deliver a world where no child lives in fear of polio.
Pledge values are expressed in US dollars. View the full list of donors and pledge amounts.
When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.
This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases. In part two, we look at another lifechanging intervention: providing clean water for communities.
Providing clean water
Addressing a critical long-term need such as access to clean water helps build relationships and trust with community members. Within camps for displaced people in northern Nigeria, the polio vaccinators who regularly visit communities are sometimes met with frustration. “People say, ‘We don’t have water, and you’re giving us polio drops,’” Tunji Funsho explains. Rotary and its partners have responded by funding 31 solar-powered boreholes to provide clean water in northern Nigeria, and the effort is ongoing.
Supplying clean water to vulnerable communities is a priority of the PolioPlus programme not only in Nigeria, but also in Afghanistan and Pakistan — the only other remaining polio-endemic nations, where transmission of the virus has never been interrupted.
“Giving water is noble work also,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee.
Access to safe drinking water is also an important aspect of the The Polio Endgame Strategy 2019-2023, which aims to “ensure populations reached for polio campaigns are also able to access much-needed basic services, such as clean water, sanitation, and nutrition.” The poliovirus spreads through human waste, so making sure people aren’t drinking or bathing in contaminated water is critical to eradicating the disease. Bunmi Lagunju, the PolioPlus project coordinator in Nigeria, says that installing the boreholes has helped prevent the spread of cholera and other diseases in the displaced persons camps.
Communities with a reliable source of clean water have a reduced rate of disease and a better quality of life. “When we came [to the camp], there was no borehole. We had to go to the nearby block factory to get water, and this was difficult because the factory only gave us limited amounts of water,” says Jumai Alhassan, as she gives her child a bucket-bath. “We are thankful for people who provided us with the water.”
By looking holistically at the needs of communities, Rotarians are ending polio, and making a significant contribution to overall health.
This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine. Read part one.
The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.
G20 Health Ministers met in Okayama, Japan, on 19 and 20 October 2019 to address major global health issues in order to pave the way towards a more inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.
Ministers put a strong emphasis on ending polio in the resulting declaration, reaffirming their “commitment to eradicate polio”, and recognizing the remaining challenges.
Ministers welcomed next month’s pledging event. With the support of G20 members and other important global donors, the Global Polio Eradication Initiative aims to successfully raise funds to overcome the remaining challenges that face the world as we work to end polio. The pledging event will be generously hosted by the UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, as part of the Reaching the Last Mile Forum on 19 November 2019, and intends to secure the financial commitments needed for the programme to finish the job.
Ministers noted, “We are concerned with the rising number of vaccine-derived polio outbreaks. We call for a strong cross-border cooperation and strict implementation of vaccine requirements for travelers as specified in the International Health Regulations (IHR, 2005).”
The polio programme is currently responding to vaccine-derived poliovirus outbreaks in 18 countries. The encouragements of the G20 Health Ministers regarding the pledging event, IHR implementation and cross-border collaboration are welcomed as part of measures to ensure high quality comprehensive outbreak response and the ability of the programme to eradicate the virus.
In addition, Ministers expressed support for “the efforts of the Global Polio Eradication Initiative (GPEI), Gavi, the Vaccine Alliance (Gavi), WHO, UNICEF, and other stakeholders in strengthening routine and supplemental immunization,” and highlighted the “leadership role of WHO”. This year, Gavi has joined the Polio Oversight Board, becoming the sixth partner of the initiative. Ministers referred to the importance of “the transition of relevant polio assets” to other health programmes, a process that will be strengthened by Gavi’s partnership.
Polio eradication has an important role to play in the implementation of other global health goals. Considering this broader context, Ministers recognized that “high quality and safe primary health care including access to vaccination is a cornerstone for UHC”. Ministers noted, “We recognize that immunization is one of the most cost-effective health investments with proven strategies that make it accessible to all segments of the population with an emphasis on women and girls, the most hard-to-reach as well as the vulnerable and marginalized populations. We express our concern about vaccine hesitancy as mentioned in the WHO’s Ten threats to global health in 2019.”
Vaccination is the only way to eradicate polio and the GPEI is working tirelessly in some of the most challenging contexts to ensure all children, boys and girls, regardless of where they live, have access to life-saving vaccines.
This important statement from G20 Ministers of Health represents a continuation of the strong historical political support for polio eradication from both the G7 and the G20, at the highest levels.
The statement also follows the reaffirmation of support for polio eradication by G20 health leaders during their June 2019 summit. In this meeting, they discussed major challenges facing the world and once more communicated that “we reaffirm our commitment to eradicate polio”.
In 2020, Saudi Arabia will hold the presidency of the G20 and the US Government will hold the Presidency of the G7.
The Government of Japan, current host of the G20, is committed to the eradication of polio, providing US$ 563 million in grants to the GPEI since 1988.
Yesterday was World Polio Day, a global awareness-raising day on the need to complete the job of polio eradication, and here at the World Health Organization (WHO) headquarters, it was my great honour to make a truly phenomenal announcement: that wild poliovirus type 3 has been certified as globally eradicated, by the Global Commission for the Certification of Poliomyelitis Eradication.
This is the second of the three types of wild poliovirus to have been globally eradicated. Only wild poliovirus type 1 remains in circulation, in just two countries worldwide. Africa has not detected any wild poliovirus of any type since September 2016, and the entire African Region is eligible to be certified free of all wild poliovirus next June.
Global wild poliovirus type 3 eradication is a tremendous achievement and is an important milestone on the road to eradicate all poliovirus strains. This shows us that the tactics are working, as individual family lines of the virus are being successfully knocked out.
But the job is not finished until ALL strains of poliovirus are fully eradicated – and stay eradicated. We must achieve final success or face the consequences of renewed global resurgence of this ancient scourge. We must eradicate the remaining strains of WPV1 and also address the increasing circulating vaccine-derived poliovirus outbreaks, in particular in Africa.
And here too we are making strong inroads. New strategies are helping us reach the most vulnerable populations, particularly in the remaining reservoir areas. New tools, including a brand-new vaccine, are being developed, to ensure the long-term risk of vaccine-derived polioviruses can be comprehensively addressed.
But these tools and tactics only work if they are fully funded, and fully implemented.
And so today, on the day after this tremendous announcement, I really have two messages for you.
The first is a simple and whole-hearted ‘thank you’. Thank you for making a world free of wild poliovirus type 3 a reality. Thank you to all countries, to all donors, to all stakeholders, partners, advisory and oversight groups, policy makers, Rotarians. Most importantly, thank you to all communities, to all parents. To all frontline health workers. They are the real heroes of this achievement.
And my second message is: please do not stop now. The Reaching the Last Mile Forum, hosted in the United Arab Emirates this November by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, will provide an opportunity for many of our stakeholders to recommit their efforts to a polio-free world. I urge all of you to stay committed and redouble determination in this final push to the finish line.
Together, the partners of the Global Polio Eradication Initiative (GPEI) – WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance – stand ready to support this global effort. But it will take collective and global collaboration, from all public- and private-sector stakeholders, to ensure every last child is reached and protected from all polioviruses.
Together, let us achieve history: let us ensure that no child anywhere will ever again by paralysed by any poliovirus.
24 October 2019 – In a historic announcement on World Polio Day, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a historic achievement for humanity.
“The achievement of polio eradication will be a milestone for global health. Commitment from partners and countries, coupled with innovation, means of the three wild polio serotypes, only type one remains,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board “We remain fully committed to ensuring that all necessary resources are made available to eradicate all poliovirus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” he added.
There are three individual and immunologically-distinct wild poliovirus strains: wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3). Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains three separate viruses that must each be eradicated individually.
WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Since then, the strength and reach of the eradication programme’s global surveillance system has been critical to verify that this strain is truly gone. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.
At a celebration event at the headquarters of the World Health Organization in Geneva, Switzerland, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury. “This this is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1. This virus remains in circulation in just two countries: Afghanistan and Pakistan. We cannot stop our efforts now: we must eradicate all remaining strains of all polioviruses. We do have good news from Africa: no wild poliovirus type 1 has been detected anywhere on the continent since 2016 in the face of ever improving surveillance. Although the region is affected by circulating vaccine-derived polioviruses, which must urgently be stopped, it does appear as if the continent is free of all wild polioviruses, a tremendous achievement.”
Eradicating WPV3 proves that a polio-free world is achievable. Key to success will be the ongoing commitment of the international development community. To this effect, as part of a Global Health Week in Abu Dhabi, United Arab Emirates, in November 2019, the Reaching the Last Mile Forum will focus international attention on eradication of the world’s deadliest diseases and provide an opportunity for world leaders and civil society organizations, notably Rotary International which is at the origin of this effort, to contribute to the last mile of polio eradication. The GPEI 2019–2023 Investment Case lays out the impact of investing in polio eradication. The polio eradication efforts have saved the world more than US$27 billion in health costs since 1988. A sustained polio-free world will generate further US$14 billion in savings by 2050, compared to the cost countries would incur for controlling the virus indefinitely.
Reposted with permission from Rotary.org When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The “plus” is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap. This series takes a look at the ‘Pluses’, starting with prevention of other diseases. A 2010 study estimates that vitamin A drops given to children at the same time as the polio vaccine had at that time already prevented 1.25 million deaths by decreasing susceptibility to infectious diseases.
We take you to Nigeria, which could soon be declared free of wild poliovirus, to show you some of the many ways the polio eradication campaign is improving lives.
Polio vaccination campaigns are difficult to carry out in northern Nigeria, where insurgency has displaced millions of people, leading to malnutrition and spikes in disease. When security allows, health workers diligently work to bring the polio vaccine and other health services to every child, including going tent to tent in camps for displaced people.
The Global Polio Eradication Initiative (GPEI), of which Rotary is a spearheading partner, funds 91% of all immunization staff in the World Health Organization’s Africa region. These staff members are key figures in the fight against polio — and other diseases: 85% give half their time to immunization, surveillance, and outbreak response for other initiatives. For example, health workers in Borno use the polio surveillance system, which detects new cases of polio and determines where and how they originated, to find people with symptoms of yellow fever. During a 2018 yellow fever outbreak, this was one of many strategies that resulted in the vaccination of 8 million people. And during an outbreak of Ebola in Nigeria in 2014, health workers prevented that disease from spreading beyond 19 reported cases by using methods developed for the polio eradication campaign to find anyone who might have come in contact with an infected person.
Children protected from polio still face other illnesses. In Borno, malaria kills more people than all other diseases combined. To prevent its spread, insecticide-treated bed nets — such as the one Hurera Idris is pictured installing in her home above — are often distributed for free during polio immunization events. In 2017, the World Health Organization organized a campaign to deliver antimalarial medicines to children in Borno using polio eradication staff and infrastructure. It was the first time that antimalarial medicines were delivered on a large scale alongside the polio vaccine, and the effort reached 1.2 million children.
Rotary and its partners also distribute soap and organize health camps to treat other conditions. “The pluses vary from one area to another. Depending on the environment and what is seen as a need, we try to bridge the gap,” says Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee. “Part of the reason you get rejections when you immunize children is that we’ve been doing this for so long. In our part of the world, people look at things that are free and persistent with suspicion. When they know something else is coming, reluctant families will bring their children out to have them immunized.”
Rotarians’ contributions to PolioPlus help fund planning by technical experts, large-scale communication efforts to make people aware of the benefits of vaccinations, and support for volunteers who go door to door.
Volunteer community mobilizers are a critical part of vaccination campaigns in Nigeria’s hardest-to-reach communities. The volunteers are selected and trained by UNICEF, one of Rotary’s partners in the GPEI, and then deployed in the community or displaced persons camp where they live. They take advantage of the time they spend connecting with community members about polio to talk about other strategies to improve their families’ health.
Nigerian Rotarians have been at the forefront of raising support for Rotary’s polio efforts. For example, Sir Emeka Offor, a member of the Rotary Club of Abuja Ministers Hill, and his foundation collaborated with Rotary and UNICEF to produce an audiobook called Yes to Health, No to Polio that health workers use.
This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine.
The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.
Pakistan and the Global Polio Eradication Initiative (GPEI) are facing a new challenge, driven by technological advancement and an increasing number of people using social media to seek and share news. Rumors and misinformation about polio vaccination and the program spread like wildfire on social media, including in Pakistan where the number of people with access to internet and smartphones have significantly increased over the past years, and continues to increase.
The polio eradication team in Pakistan, have partnered with Rotary, Spencer Trask & Co. and WHO and are looking for innovative ideas to help quickly detect, control and/or respond to the spread of anti-vaccination propaganda on social media in an urban population. These organizations have engaged crowdsourcing pioneer InnoCentive to oversee this challenge and award $10,000 to each of the top three solutions (some restrictions apply).
The Emirates Polio Campaign works with communities at risk for polio. Through coordinated efforts, the Campaign provides vaccines along with food aid, sanitation and infrastructure projects. Photo courtesy Reaching the Last Mile
On 9 September 2019, the Global Polio Eradication Initiative (GPEI) partners and the United Arab Emirates co-hosted an informal reception as a pre-event ahead of the Polio Pledging Moment in the United Arab Emirates’-hosted Reaching the Last Mile Forum in Abu Dhabi, in November 2019. The GPEI also presented the 2019-2023 GPEI Investment Case.
The reception brought together GPEI stakeholders including, Rotary International, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), representatives from the UAE; WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus; partners, and representatives from donor countries.
Following the GPEI Endgame Strategy 2019-2023, which spells-out a comprehensive five-year plan to ‘finish the job,’ the 2019-2023 Investment Case presents an economic case for investing in polio eradication as an important public health cause. Committing to eradication and achieving the goal of reaching every last child with the polio vaccine, an estimated US$ 14 billion are expected in cumulative cost savings by 2050, with efforts to eradicate polio having already saved more than US$27 billion since 1988. The need of the hour now is a bold financial and political commitment from leaders, donors, and governments around the world to rally behind a polio-free future.
As the GPEI launches its new investment case for 2019-2023, it recognizes important stakeholders who have gotten the programme to where it is today. One of the most notable donors is His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi.
His Highness Sheikh Mohamed bin Zayed has been a critical partner and champion of the GPEI. His support has helped spur significant progress toward stopping polio in the remaining endemic countries, with a specific focus on strengthening immunization efforts in Pakistan and Afghanistan. In 2018, the GPEI was proud to announce that His Highness’ support for polio eradication activities through the GPEI and the UAE Pakistan Assistance Programme and helped deliver 417 million vaccines to protect some of the most vulnerable and hard-to-reach children in the highest risk districts across the country.
Starting off the reception, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), gave insight into the UAE’s long-standing commitment to polio eradication efforts: “UAE, together with its partners, has played a leading role in polio eradication, has supported the delivery of vaccines to protect over 16 million children…and supported polio outbreak efforts in Afghanistan, Pakistan, Somalia, Ethiopia, Kenya and Sudan. For the implementation of the GPEI Endgame Strategy 2019-2023, which aims for a world free of wild poliovirus, the UAE in cooperation with the WHO will host a pledging event in Abu Dhabi in November 2019.”
WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus, also recognized the strong political and financial will of the donors —spanning over decades— which have helped the GPEI mark important milestones on the road to global polio eradication. “We have made good progress in accessing hard-to-reach communities…increasing cross-border efforts, enhancing surveillance, improving Supplementary Immunization Activities (SIAs), and focusing on social and behavioural change.”
“Unfortunately, we have seen an increase in the number of cases this year. This is a reminder that polio eradication is not a forgone conclusion…the last mile is the hardest. This will take a determined and unrelenting effort from all of us. Global progress to end polio would not be possible without partners like the UAE. On behalf of our partners at the GPEI, I would like to thank His Highness, Sheikh Mohammed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event on 19 November.”
Rounding off the event, Chair of Rotary International Polio Eradication Advocacy Task Force, Judith Diment, officially presented the GPEI 2019-2023 Investment Case and called for concerted global efforts —both political and financial— to ensure that the hard-won gains in the fight against polio see us through the finish line. “Building on past progress and overcoming remaining hurdles requires continued support and (polio eradication) is a sound value-added investment. Today, we are proud to present the new 2019-2023 GPEI Investment Case…and thank all our partners for their input. This support and engagement are invaluable, given that this is a document that argues that polio can be eradicated but only with sufficient financial and political support. To ensure success, the Initiative needs US$ 3.27 billion through 2023… any investor is looking for measurable progress, tangible dividends, and return on investment— the GPEI has all of these. Rotary looks forward to joining all partners to make a funding pledge in Abu Dhabi, and to continued collaboration towards the fulfilment of a polio-free world from which we will all reap the dividends in perpetuity.”
The informal reception serves as a pre-event to the Reaching the Last Mile (RLM) Forum in November 2019, which will convene global health leaders to find solutions, best practices and eradication strategies to the most pressing health concerns of our times, including the global eradication of poliovirus. On the sidelines, the GPEI will also be hosting the Polio Pledging Moment to secure funding for the implementation of the Polio Endgame Strategy 2019-2023.
Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) is driven by a singular purpose: defeat the poliovirus and secure the world from this disease.
While there may be no cure from polio, it is preventable and eradicable. Thanks to global immunizations efforts of national health authorities backed by international partners – WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance — cases of wild poliovirus have dropped from 350 000 in 1988 to 33 cases reported in 2018, and four Regions of the world have been certified free of wild poliovirus.
Another milestone was achieved last week: Nigeria crossing three years without detection of wild poliovirus. With this, the African Region can now possibly start the official process to certify the WHO African Region free of wild poliovirus.
This milestone was a slow and steady win, which would not have been possible without the people who make up the very fabric of Nigerian communities. Trust-building efforts by traditional leaders and the network of women making household visits across the country, made it possible to overcome socio-cultural and operational barriers to vaccination.
Read about the innovative practices for polio eradication in Nigeria.
Reposted with permission from Rotary International
Five core partners— Rotary International, World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), and the Bill & Melinda Gates Foundation— 20 million volunteers, over 2.5 billion children vaccinated, and an initiative spanning over 30 years across 200 countries.
These are the impressive numbers, people power, and the resources behind one of the biggest public-private partnerships in history: The Global Polio Eradication Initiative.
But why is polio eradication a global public health cause transcending generations, geographical boundaries, and socio-cultural constructs? Read on:
Poliovirus causes acute, non-persistent infections
The virus causes acute, short term infections, meaning that a person infected with polio can only transmit the virus for a limited amount of time. Prolonged infection with wild polioviruses has never been documented and in most cases infected people can only transmit the virus for 1-2 weeks.
Virus is transmitted only by infectious people or their waste
Some diseases can be transmitted in a multitude of ways, which can make a disease an impossible candidate for eradication. But the poliovirus is typically transmitted just one way: through human waste. Eradicating polio is not an easy task, but the way polio is transmitted simplifies our ability to tackle the disease.
Survival of virus in the environment is finite
Did you know there’s just one strain of wild poliovirus that continues to infect humans? (There used to be three strains of poliovirus that regularly infected humans.) The wild poliovirus cannot survive for long periods outside of the human body. If the virus cannot find an unvaccinated person to infect, it will die out. This is why we have to keep every single child vaccinated—so the virus cannot find any humans to infect. The length of poliovirus survival varies according to conditions like temperature, and the poliovirus infectivity decreases over time.
People are the only reservoir
Hundreds of diseases can be transmitted between insects, animals and humans. One of the things that makes polio eradicable is the fact that humans are the only reservoir. No poliovirus has been found to exist and spread among animals despite repeated attempts to document this.
Immunization with polio vaccine interrupts virus transmission
Not only are there two safe and effective polio vaccines, but vaccination against polio generates herd immunity, which increases the percentage of the population that is immune to the disease.
Mass campaigns using oral polio vaccine, where all children in a specified geographic area are immunized simultaneously, interrupts wild poliovirus circulation by boosting population immunity to the point that transmission of polio cannot be sustained.
But what truly drives our conviction in numbers results. Since the world took up the cause of eradicating polio globally in 1988: we have eliminated polio from 125 countries and reduced the global incidence of polio cases by 99%; and, successfully eradicated certain strains of the virus.
There are now only 3 countries that have never stopped polio transmission. This marathon of a public health endeavour is in the last mile.
“Our area is a pretty difficult terrain because we live in the water and it is not easy for the teams coming from outside the community to gain access. So, the (hand-drawn) maps make it possible for us to identify areas we have yet to reach during the immunization exercise”, says Peter Idowu, a veteran community mobilizer and team supervisor in Makoko — a riverine shanty town located on the coast of mainland Lagos city, southwest Nigeria. Native to the village, Peter is the man to go to whenever the polio immunization teams face challenges navigating the waterways or the community.
The sprawling water city Makoko is a slum located across the Third Mainland Bridge on the lagoon. It is a largely low-income community with half the population on water and the other half on land. Informal, makeshift houses with corrugated iron roofs sit precariously atop stilts. Down below, narrow wooden boats act as a form of aquatic taxi ferrying goods and people around the bustling community. Nobody knows the exact population of this slum district of Lagos, but it is estimated to be as high as 100 000. It is mostly a fishing community inhabited by the Egun people.
“My goal is to see that all the kids in our community are immunized and live healthy lives. That is why I engage our teams in sensitizing parents all the time on the importance of routine immunization and the dangers of polio. As a member of the community and with a passion of becoming a health worker myself, I kept on mobilizing our people for easy accessibility, because our language is different from Yoruba and most of the Polio teams can’t speak the language. It is always easy with me being in the Polio team as our people will readily accept the vaccine without rejecting,” says Peter.
Nigeria is the only country in Africa and one of the only three in the world endemic to wild poliovirus, alongside Afghanistan and Pakistan. Nigeria is also affected by circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.
UNICEF works closely together with Global Polio Eradication Initiative (GPEI), key polio partners and the Nigerian government. There is a vast network of over 20 000 community mobilizers focusing on demand creation and improving health-seeking behaviors of caregivers.
In Osaka, Japan, G20 Leaders met on 28-29 June 2019, and discussed major challenges facing the world and the importance of eradicating polio. The G20 declaration states, “We reaffirm our commitment to eradicate polio as well as to end the epidemics of AIDS, tuberculosis and malaria and look forward to the success of the sixth replenishment of the Global Fund to fight AIDS, Tuberculosis, and Malaria.”
The pledging event of the Global Polio Eradication Initiative will be hosted by the UAE in November 2019 to ensure full financing and implementation of the efforts to finish the job.
There has been strong historical political support for polio eradication from both the G7 and the G20, at leaders- and Ministers of health-levels.
The G20 Declaration outlines that “Primary healthcare, including access to medicines, vaccination, nutrition, water and sanitation, health promotion and disease prevention is a cornerstone for advancing health and inclusion.”
The Japanese Presidency has been promoting a powerful global health agenda, both during its G7 Presidency in 2016 and this year at the G20, as a recognition that health is a prerequisite for sustainable and inclusive economic growth. Japan’s leadership has focused on Universal Healthcare Coverage (UHC) and demonstrated essential linkages with programmes contributing to health systems strengthening, and forming integral part of primary health care, including routine immunization and polio eradication.
Japan will be leading the organization of the United Nations General Assembly (UNGA) high-level meeting on UHC in September 2019 and the consultation process to finalize the political declaration “UHC: Moving Together to Build a Healthier World”.
In addition to the G20 Health Ministers meeting in Okayama in October 2019, Japan will also organize the Tokyo International Conference on African Development (TICAD) in Yokohama in the summer 2019, during which it will host the replenishment launch of Gavi, the Global Polio Eradication Initiative’s newest partner.
Exciting research is underway on a novel oral polio vaccine for type 2 polio (nOPV2), which – if further trials are successful – could be a potential new tool to provide the same level of protection against poliovirus as the current oral polio vaccine (OPV), but without the same risk of mutating into vaccine-derived poliovirus in under-immunised populations.
Results from a phase I study to test two nOPV2 candidates were published in The Lancet in early June 2019. The study, led by the University of Antwerp in partnership with a global consortium of researchers and funded by the Bill & Melinda Gates Foundation, was conducted in 2017 at a unique container park named “Poliopolis” at the University of Antwerp. To test the vaccine, 30 individuals volunteered to spend a month living in the container park – complete with private, air-conditioned rooms, a lounge area and foosball table, fitness room, dining area, daily schedules of entertainment, exercise and health check-ups.
The initial findings from this study are promising, showing that the two vaccines tested at Poliopolis are safe and produce the immune response needed to protect individuals against polio. Results from phase II trials are expected in the coming months, which is when the program will learn whether nOPV2 is a tool that can ultimately be deployed for children at risk of poliovirus transmission.
About nOPV
The nOPV2 vaccine candidates were designed by a consortium of scientists from the UK National Institute for Biological Standards and Control (NIBSC), the US Centers for Disease Control and Prevention (CDC) and the University of California, San Francisco (UCSF), and manufactured by Bio Farma – with several other institutions playing key roles in the development process. Current clinical trials testing the vaccine candidates are taking place in Belgium and Panama. If ongoing and future trials are successful, nOPV2 could be kept in stockpiles and used in case of a VDPV2 outbreak in the near future or after eradication. This would make it a potentially vital tool for keeping the world free of all forms of the poliovirus.
OPV, which has been responsible for reducing the number of global polio cases by over 99% since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, remains the best available tool to eradicate wild poliovirus. It is a safe and effective vaccine that will continue being used widely.
This exciting research on nOPV, however, is just one more way in which the GPEI has continued to innovate to overcome hurdles over the past three decades. We look forward to seeing the results of further research that will tell us if we can add this vaccine to our “toolbox” to protect all children from polio.
“We had not seen vaccination teams in our community for a very long time. Sometimes we go for months without vaccinating our children, if we don’t take our children to the mainland to get them vaccinated”, says Mr. Atebakuro Oton George, a fisherman and father of five, residing in Minibie ward of Nigeria’s Bayelsa State.
A largely riverine state, Bayelsa accounts for over 60% of the delta mangrove of the Niger Delta. Many children here continue to miss their chances at life-saving vaccination, as transport is precarious in the tangle of creeks and rivers that crisscross the state. In 2018 a number of innovative strategies such as, immunization boats at sea and community engagement through the traditional hierarchy and sensitization activities, supported by World Health Organization (WHO) through the Government of Bayelsa were introduced to reach a wider net of children.
“Now on weekly basis, health workers brave the seas and visit our communities to vaccinate our children”, an elated Mr. George continues.
Subsistence farming and fishing are the mainstay of the local population’s economy and diet. Health services are provided by primary health care centers located within the island communities.
“The difficulty of accessing healthcare services is due to suboptimal and expensive coastal and waterway transportation from the distant communities to healthcare centers, hence, innovative strategies are being employed to reach the underserved and vulnerable population with vaccination and other health interventions especially during Supplemental Immunization Activities (SIAs)”, says Dr Edmund Egbe, WHO State Coordinator in Bayelsa.
To reach ‘missed’ children, community engagement activities to increase demand for immunization have been initiated to bolster willingness of caregivers to readily access the interventions even when in the middle of the river or the ocean. The successful implementation of the community engagement framework has resulted in high-level acceptance of immunization services in the State. From April 2018 to April 2019, over 169 836 children received vaccination.
Routine immunization coverage has improved remarkably: the first quarter RI Lot Quality Assurance Survey (LQAS)— a quarterly activity organized by the National Emergency Routine Immunization Coordinator Centre (NERICC) to assess routine immunization performance, reasons for non-immunization as well as efforts to improve uptake and utilization of RI in Nigeria—conducted in April 2019 indicate that the State is second best in the country. Previously, the State was ranked amongst others in the country as poor-performing from the last National Immunization Coverage Survey (NICS) conducted in 2016; this led to the inauguration of an emergency response committee in March 2018.
King Diete-Spiff, the Chairman and the ‘Amanayanbo’ of Town-Brass, in his meeting with the State Traditional Rulers Council said, “Sustaining the innovative strategies of vaccinating vulnerable populations will undoubtedly increase immunity against vaccine preventable diseases and reduce the mortality and morbidity rate in difficult to access communities”. He described the polio infrastructure in Bayelsa, supported by WHO and partners, as the bedrock of driving successful healthcare intervention at the grassroots.
Support for polio eradication and routine immunization to Nigeria through WHO is made possible by funding from the Bill & Melinda Gates Foundation, the Department for International Development (DFID – UK), the European Union, Gavi, the Vaccine Alliance, the Government of Germany through KfW Bank, Global Affairs Canada, the United States Agency for International Development (USAID), Rotary International and the World Bank.
2017 REACH Award winners: Dr. Adamu Keana Sallau, Director for Integrated Health Programs in the Imo/Abia States, The Carter Center, Nigeria; Dr. Nabil Aziz Awad Alla, Former National Guinea Worm Disease Eradication Program Coordinator, Ministry of Health, Sudan; Regina Lotubai Lomare Lochilangole, Social Mobilizer, Federal Ministry of Health, South Sudan; Daniel Madit Kuol Madut, Senior Program Officer, Federal Ministry of Health, South Sudan.
This November, the United Arab Emirates will hold the Reaching the Last Mile Forum in Abu Dhabi, where global health leaders will convene to share insights and best practices on how to map out, eliminate and eradicate infectious diseases. On 22 May 2019, the UAE announced that nominations are officially open for the 2019 REACH Awards, which will be presented at the RLM Forum.
The REACH Awards honor frontline health workers and innovators on disease elimination – the true heroes of disease eradication. These awards are a moment to recognize and celebrate the dedicated polio vaccinators who tirelessly overcome difficult terrain and areas of insecurity to reach every last child with lifesaving polio vaccines.
The Reaching the Last Mile Forum will also host The Global Polio Eradication Initiative’s 2019 pledging moment.
Awards established by Crown Prince of Abu Dhabi and adjudicated by prominent global health leaders; recipients to be announced at Reaching the Last Mile Forum in November
Abu Dhabi, 22 May 2019: Today the 2019 REACH (Recognizing Excellence around Champions of Health) Awards opened for nominations to recognize frontline health workers and innovators who have demonstrated extraordinary leadership and commitment to eliminate global diseases. The Awards were established by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and will be presented at the Reaching the Last Mile Forum in Abu Dhabi in November.
His Excellency Mohamed Mubarak Al Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi, commented: “In many communities around the world, especially the most vulnerable and poor, frontline health workers are the only source of health care. Through their efforts, millions of lives are saved and enhanced, strengthening families and societies. With gratitude for the efforts of these committed workers, as well as global health innovators and champions, we announce that nominations are now open for the 2019 REACH Awards.”
The REACH Awards aim to recognize stories of unsung achievement in global health and disease elimination – and raise awareness of the role of the frontline health worker and game-changing innovator within the larger global health community. “Often making heroic sacrifices, frontline health workers are leading the charge to eliminate the world’s most deadly and debilitating diseases,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Together with scientists, advocates and other innovators, these inspiring individuals are defending everyone’s right to attain the highest standard of health.”
The 2019 REACH Awards will be judged by jury of prominent leaders from across global health disciplines. The panel will include, among others:
Professor Baron Peter Piot, Director of the London School of Hygiene & Tropical Medicine
Her Excellency Ms. Louise Mushikiwabo, Secretary-General of the Organisation internationale de la Francophonie
Rt. Hon. Professor Lord Kakkar PC, Professor of Surgery University College London and Director Thrombosis Research Institute London UK
Doctor Christopher Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation
Doctor Maha Taysir Barakat, Executive Chair-Elect of the Roll Back Malaria Partnership
Ms. Robyn Calder, Executive Director of the ELMA Philanthropies Services
Mr. Ray Chambers, Ambassador to The World Health Organization for Global Strategy
The call for nominations for the 2019 REACH Awards was launched at the World Health Assembly in Geneva. Nominations can be made in three categories at www.reachingthelastmile.com and must be submitted by July 12, 2019. Award recipients will be announced at the Reaching the Last Mile Forum in Abu Dhabi on November 19, a biennial convening where global health leaders share insights and best practice on how to map out, eliminate and eradicate infectious diseases.
The REACH Awards were first established in 2017. Past Awards include the Lifetime Achievement Award to Jimmy Carter, 39th President of the United States and Founder of the Carter Center, for the Carter Center’s role at the forefront of combatting the Guinea worm disease.
The 2019 REACH Awards will recognize individuals working on a wide range of diseases and workers from interdisciplinary teams. Categories include:
The Unsung Hero Award honors an extraordinary individual who has played a transformative, frontline role in the field of disease elimination, but has been under-recognized for their efforts.
The Game Changing Innovator Award recognizes an individual who has developed and implemented a creative technology or practice in support of disease elimination, acknowledging the need to constantly innovate in the field.
The new Rising Champion Award recognizes an individual who is championing a cause related to disease elimination, acknowledging the significant impact that can be made through advocacy – from shifting attitudes around disease and treatment to working with governments to evolve policies.
An individual who has dedicated his or her career to disease elimination will be honored with the Lifetime Achievement Award.
More than one billion people around the world, especially in remote areas, lack access to healthcare due to weak health systems, and limited access to facilities and trained health workers. Frontline health care workers play a critical role in reaching the most remote communities, often the last stronghold for preventable, infectious diseases. But given the on-the-ground nature of their work, these skilled and committed individuals are often overlooked. The World Health Assembly recognized this week the importance of frontline workers through the adoption of resolutions on community health workers and primary health care.
The United Arab Emirates (UAE) leadership’s dedication to disease elimination builds on the commitment of the late Sheikh Zayed Al Nahyan, Founder of the UAE, and has since continued through a series of contributions from His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the UAE, and His Highness Mohamed bin Zayed, Crown Prince of Abu Dhabi. Since 2011, His Highness Mohamed bin Zayed, Crown Prince of Abu Dhabi has personally committed US $250 million to global efforts to eliminate deadly and debilitating diseases.
Polio eradication was in high-level spotlight this week in the top echelons of global leadership as World Health Organization (WHO) Member States, donors, partners, civil society organizations, health and development actors gathered this week at the 72nd World Health Assembly (WHA) in Geneva, Switzerland.
In his opening address to delegates, WHO Director-General and Chair of the Polio Oversight Board (POB), Dr Tedros Adhanom Ghebreyesus talked about the long-winding journey of polio eradication since its adoption as a landmark resolution at the WHA in 1988 and the hopes of finishing eradication in the near future: “Together with our partners at Rotary, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance in the Global Polio Eradication Initiative, we have launched a new strategy to address the most difficult remaining areas in Afghanistan and Pakistan. Earlier this year I came across a video of a man called Irfanullah, wading through snow to deliver polio vaccines in Pakistan. With the dedication and commitment of people like him, I have no doubt we will succeed in making polio history.”
Member States expressed overwhelming support of the Polio Endgame Strategy 2019-2023. The new strategy sets the stage for a decisive win against polio through the parallel pursuit of the wild poliovirus and circulating vaccine-derived poliovirus. The Strategic Plan incorporates collaboration with other health interventions, fostering stronger alliances and managerial innovations by working in close coordination with governments in endemic countries. The Member States welcomed the trifecta of Eradication, Integration, and Containment/Certification, which set the foundations of a sustainable polio-free world by anchoring polio activities within the broader immunization system, ensuring an effective transition of eradication knowledge and assets and ensuring that no poliovirus can paralyze children again.
With an eye towards an inclusive and sustainable polio-free future, there was broad consensus that all stakeholders—governments, GPEI partners, private and public donors, policy makers, health, and non-health actors— are in this together. One of the recurring themes was the need to ensure concerted efforts—financial and programmatic— to get over the hump in this last mile over to the finish line.
The general air was that of cautious optimism, as all Member States acknowledged that the path to finishing polio eradication is well within sight, all thanks to the Endgame Plan 2013-2018 which succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus, possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.
The delegates particularly appreciated the strong commitments espoused by Afghanistan and Pakistan for a more systematic collaboration to jointly target the common wild poliovirus reservoir on all fronts with an approach that combines the scientific with the social and anthropological. Pakistan’s representative said, “We remain resolute with the highest level of political commitment… strengthening routine immunization, addressing prevalent malnutrition, and provision of safe water and sanitation are strategies being implemented in tandem. Communication challenges of low-risk perception and concerns around vaccine safety and efficacy are being addressed through a revised communication strategy. We continue to coordinate with Afghanistan programme to share experience in strategies to manage the common epidemiological block. In light of the recent cases, the Government of Pakistan has decided to carry out a comprehensive programme review on an urgent footing. I would like to sincerely thank our partners and donors who are a part of this initiative and helped us get this far. We pledge our complete commitment to reach every last child, so no future generations have to suffer from a crippling disease like polio.”
Rotary International, one of the pioneering partners of the GPEI, maintained that wild poliovirus eradication remains the overriding priority, and to that end, re-affirmed collective commitment of their 1.2 million members around the world: “It is easy to forget the hurdles we have overcome—such as: addressing outbreaks in more than 20 countries in Africa, or how India had 80% burden of the total polio caseload in the world. Our challenge is not feasibility, but determination…global commitment has brought us to the threshold of a polio-free world. Let us act with urgency to end polio forever.”
In his closing remarks, Dr Tedros thanked the Crown Prince of Abu Dhabi and the United Arab Emirates for hosting a pledging moment for the Global Polio Eradication Initiative, “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space.”
The 72nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.
The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.
The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.
Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”
Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”
Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.
Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”
Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners: Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”
In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”
As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”
Today, the Global Polio Eradication Initiative (GPEI) launched the Polio Endgame Strategy 2019-2023, which will guide the programme and its partners to overcome the final hurdles to eradication and move toward sustaining a polio-free future.
The new plan hones in on addressing today’s most pressing obstacles to end poliovirus transmission imminently, integrate polio programme resources into health and development programmes globally, and certify the world polio-free. In addition to building on the programme’s core strategies to expand access to vaccination and improve surveillance around the world, the 2019-2023 Endgame Strategy offers responsive and innovative solutions tailored to communities’ needs. These include establishing a regional hub in Amman, Jordan to enhance coordinated support to Afghanistan and Pakistan and creating permanent Rapid Response Teams to accelerate the programme’s response to outbreaks.
The programme will also work to improve immunisation coverage and support basic development needs through strengthened collaboration with immunisation partners such as Gavi, the Vaccine Alliance and the humanitarian and emergency response communities.
To reach its goals and achieve eradication, the Endgame Strategy requires a US$4.2 billion budget, of which US$3.27 billion is to be raised by the GPEI. In support of the Strategy and to encourage additional commitments, a pledging event will be hosted this November at the Reaching the Last Mile Forum in Abu Dhabi, a gathering of leaders from across the global health space held once every two years. The pledging event will be hosted by the GPEI, with the support of His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, a longtime champion of the polio programme.
The 2019-2023 Endgame Strategy builds on the 2013-2018 Strategic Plan, which brought the world to the brink of polio eradication. Despite this impressive progress, the last steps to eradication have proved to be the most difficult.
Wild poliovirus transmission continues in Afghanistan and Pakistan, and circulating vaccine-derived poliovirus outbreaks are ongoing in several countries across Africa and Asia. To overcome these challenges, the new Strategy must be fully implemented with sufficient resources and commitments from governments, donors, multilateral organisations, and local communities.
1. There were more cases of wild poliovirus in 2018 than in 2017. Should we be discouraged?
No, not at all. We’ve always expected the number of cases to fluctuate somewhat as we get closer to zero. We’ve gone four straight years with fewer than 100 cases per year. That’s an indicator of great progress. With dedication from governments and Rotarians in areas still affected by polio, we’ll get there.
2. Why is it so difficult to eradicate a disease like polio?
Remember that even in the United States, where the polio vaccine was readily available, it still took 20 years to become polio-free. And the areas we are working in now don’t have health systems that are as well-developed as in the United States.
3. What challenges are you seeing now?
We have been working intensely in the endemic countries — Afghanistan, Nigeria, and Pakistan — for a number of years, and some of the citizens in those countries are getting concerned that we are spending money on polio eradication when they have so many other needs. There’s some resistance to keep on receiving immunizations for polio, and polio alone. Our challenge is to find ways to provide other services to the citizens and children, so we still have the parental support we need — to provide the “plus” in PolioPlus.
4. What role does armed conflict play in those areas?
It makes the logistics of immunization far more difficult. The Global Polio Eradication Initiative partnership is not only dealing with governments — we’re dealing with anti-government elements as well. While we’ve worked to gain everyone’s trust and support, we’ve had areas that were inaccessible to immunization teams for months and sometimes years at a time.
5. Do immunization teams know when they miss children? Or are there children they don’t even know about?
I think we have a good handle now on knowing when and where we’re missing children. The challenge is to keep reducing the number we miss. In Nigeria, we have done a lot of work since the discovery of several polio cases in Borno state in 2016. But access, immunity levels and surveillance are much better today than they were in 2016, when we did detect those cases. We are cautiously optimistic.
6. Where are we seeing successes?
We haven’t had any cases of wild poliovirus anywhere in the world in nearly five years except in the three endemic countries. And in Nigeria, it’s been almost three years since we detected any wild poliovirus cases, and those occurred in a small area of the country. But we are not there yet. Complacency is one of our biggest enemies, and we cannot take our foot off the accelerator until success is achieved.
7. What’s the most important thing Rotarians should know?
I’ve been extremely impressed with the dedication and persistence of Rotarians in Afghanistan, Nigeria, and Pakistan. They are working hard to make sure polio is eradicated. It’s pretty amazing what they do in those countries.
Rotarians should continue to be optimistic and to support eradication. We also need Rotarians to bring the need for continued funding to the attention of their government leaders. We can’t lose sight of the goal.
The Endgame Plan through 2018 brought the world another year closer to being polio-free. While we had hoped to be finished by now, 2018 set the tone for the new strategic plan, building on the lessons learned and mapping out a certification strategy by 2023. 2018 was also marked by expanded efforts to reach children with vaccines, the launch of innovative tools and strategies, critical policy decisions and renewed donor commitment to the fight.
Circulation of wild poliovirus (WPV) continues in the common epidemiological block in Afghanistan and Pakistan. However, both countries steadily worked to improve the quality of their vaccination campaigns in 2018 through National Emergency Action Plans, with a particular focus on closing any immunity gaps to put the countries on track to successfully stop WPV in the near future. Given the priority on polio eradication, WHO Director General, WHO Regional Director for the Eastern Mediterranean and President, Global Development at Bill & Melinda Gates Foundation started off the new year with a four-day visit to meet the heads of state and have a first-hand experience of the on-the-ground eradication efforts in both the countries.
In August, Nigeria marked two years since detecting any WPV. With continuing improvements in access to the country’s northeast, as well as efforts to strengthen surveillance and routine immunization, the entire African region may be eligible for being certified WPV-free as early as late this year or early 2020. What’s more, the world has not detected type 3 WPV since 2012 and the strain could be certified eradicated sometime this year.
Program innovation
The programme is constantly developing new ways to more effectively track the virus, vaccinate more children and harness new tools to help end the disease for good.
In Nigeria and the surrounding region, health workers launched new tools to enable faster, more comprehensive disease surveillance. e-Surve, a smartphone app, guides officers through conversations with local health officials, offering prompts on how to identify and report suspected cases of disease. Then, with the touch of a button, responses are submitted to a central database where health officials can analyze and track outbreaks across multiple districts in real-time.
Beyond surveillance, health workers worked tirelessly to bring the polio vaccine to the remote communities of Lake Chad. Dotted with hundreds of small islands, the lake is one of the most challenging places on earth to deliver health services. Vaccinators must travel by boat on multi-day trips to deliver polio vaccines to isolated island villages, using solar-powered refrigerators to keep their precious cargo cool. In 2018, vaccination campaigns on the lake reached thousands of children for the first time – children who would otherwise have gone unprotected.
The programme also took important steps in developing new tools including, novel oral polio vaccine (nOPV), if studies show to be successful, could provide a safer form of OPV that provides the same level of protection without the small risk of vaccine-derived polio in under-immunized populations.
Battling circulating vaccine-derived poliovirus
In 2018, the Democratic Republic of the Congo, Niger, Nigeria, Papua New Guinea, Kenya, Somalia and Mozambique experienced outbreaks of circulating vaccine-derived polio (cVDPV). Although these cases are still rare – and only happen in places where immunity is low. The polio eradication initiative has two urgent tasks: eradicate WPV quickly as possible and stop the use of OPV globally, which in tandem will prevent new cVDPV strains from cropping up.
The program uses the same proven strategies for stopping wild polio in responding to cVDPV cases. These strategies, coupled with the rapid mobilization of resources on the ground, can bring outbreaks under control.
In December, an international group of public health experts determined that the 2017 cVDPV2 outbreak in Syria has been successfully stopped. This news follows 18 months of intensive vaccination and surveillance efforts led by the GPEI and local partners in conflict-affected, previously inaccessible areas. In Papua New Guinea, the programme carried out 100 days of emergency response this past summer and is continuing to vaccinate and expand surveillance across the country.
Bringing an end to ongoing cVDPV outbreaks remains an urgent priority for the program in 2019.
New policy decisions
At the World Health Assembly in May, Member States adopted a landmark resolution on poliovirus containment to help accelerate progress in this field and ensure that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions. The programme also finalized a comprehensive Post-Certification Strategy that specifies the global, technical standards for containment, vaccination and surveillance activities that will be essential to maintaining a polio-free world in the decade following certification.
Recognizing the ongoing challenge posed by cVDPVs, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) met in November and recommended an updated process for declaring the world polio-free. This plan will start with the certification of WPV3 eradication, followed by WPV1, and include a separate independent process to validate the absence of vaccine-derived polio.
Comprised of members, advisers, and invited Member States, the 19th IHR Emergency Committee met in November. The Committee unanimously agreed that poliovirus continues to be a global emergency and complacency at this stage could become the biggest hindrance. “We have the tools, we need to focus on what works, we need to get to every child,” commented Prof. Helen Rees, Chairperson of the Committee. “The reality is that there is no reason why we should not be able to finish this job, but we have to keep at it.” “We have achieved eradication of a disease once before, with smallpox,” Rees concluded. “The world is a much better place without smallpox. It’s now more urgent than ever that we redouble our efforts and finish this job once and for all as well.”
In 2018, the GPEI took major steps in adopting a more gender-responsive approach and strengthening gender mainstreaming across its interventions. The GPEI Gender Technical Brief highlighted the programme’s commitment to gender equality and included a thorough analysis of various gender-related barriers to immunization, surveillance and communication.
The programme introduced new gender-sensitive indicators to ensure that girls and boys are equally reached with polio vaccines, to track the timeliness of disease surveillance for girls and boys, and to monitor the rate of women’s participation as frontline workers in the endemic countries. The GPEI continues to regularly collect and analyze sex-disaggregated data and conduct gender analysis to further strengthen the reach and effectiveness of vaccination campaigns.
Donor countries made new financial contributions to the programme in 2018. Polio-affected countries also demonstrated continued political commitment to eradication efforts. The Democratic Republic of the Congo signed the Kinshasa Declaration committing to improve vaccination coverage rates in sixteen provinces throughout the country, and Nigeria approved a $150 million loan from the World Bank to scale up immunization services and end polio.
Looking ahead: 2019 and beyond
Over the last five years, the programme has been guided by the 2013-2018 Polio Eradication & Endgame Strategic Plan, helping to bring the world to the brink of polio eradication. This spring, the programme will finalize a new strategy –GPEI Strategic Plan 2019-2023– which will aim to sharpen the tools and tactics that led to this incredible progress. In 2019, the GPEI will also launch its first-ever Gender Strategy to further guide its gender-responsive programming and to increase women’s meaningful and equal participation at all levels of the programme.
Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all. Echoing similar sentiments, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all to step up their performance to end polio. 2019 may very well be the watershed year that the world will finally eradicate polio, thanks to the global expertise and experience over 3 decades.
In an extraordinary joint statement by the Chairs of the main independent, advisory and oversight committees of the GPEI, the Chairs urge everyone involved in polio eradication to ensure polio will finally be assigned to the history books by 2023. The authors are the chairs of the Strategic Advisory Group of Experts on immunization (SAGE), the Independent Monitoring Board, the Emergency Committee of the International Health Regulations (IHR) Regarding International Spread of Poliovirus and the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC).
The Endgame Plan through 2018 has brought the world to the brink of being polio-free. A new Strategic Plan 2019-2023 aims to build on the lessons learned since 2013.
The joint statement urges everyone involved in the effort to find ways to excel in their roles. If this happens, the statement continues, success will follow. But otherwise, come 2023, the world will find itself exactly where it is today: tantalizingly close. But in an eradication effort, tantalizingly close is not good enough.
The statement therefore issues an impassioned plea to everyone to dedicate themselves to one clear objective: to reach that very last child with polio vaccine. By excelling in our roles. It means stepping up the level of performance even further. It means using the proven tools of eradication and building blocks that have been established in parts of the world that have been free of polio for years.
The Chairs remind us that as a global community, we have stood where we stand today once before, with smallpox. And we achieved the eradication of smallpox. And the world is a much better place without smallpox.
So, let us make the world again a better place. Together. Let us eradicate polio.
For Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, the start to the new year was marked with a four-day visit to Afghanistan and Pakistan from 5-8 January. The visit came at the heels of his new role as the Chair of the Polio Oversight Board (POB) on 1 January, a committee which oversees and guides the Global Polio Eradication Initiative, signalling the Board’s utmost commitment towards eradication of polio for good.
Accompanied by WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, Dr Tedros’ well-knit, compact visit covered a lot of bases from field visits to high-level meetings with heads of state from both the countries, giving the POB an opportunity to see that while polio may still be in endemic in Afghanistan and Pakistan, but the process to achieve the goal of ending polio is not far from realization.
“We must all give our best on this last mile to eradicate polio once and for all. My wish for 2019 is for zero polio transmission. You have WHO’s full support to help reach every child and stop this virus for good,” Dr Tedros said.
During his first stop in Afghanistan on 5-6 January, Dr Tedros met with His Excellency President Dr Ashraf Ghani, His Excellency Chief Executive Dr Abdullah Abdullah, the Council of Ministers, representatives of key partners and nongovernmental organizations working in the field of public health. He also visited to the WHO-supported Trauma Care Hospital in Kabul.
In Pakistan on 7-8 January, Dr Tedros met with the Prime Mister Imran Khan, Federal Minister for National Health Regulations & Coordination Mr Aamer, Mehmood Kiani, Minister of Foreign Affairs and Federal Minister for Human Rights Dr Shireen Mazari.
Dr Tedros accompanied the President of Pakistan, Arif Alvi, to the launch of the first Pakistan Nursing and Midwifery Summit and the Nursing Now campaign. He also visited a basic health centre in Shah Allah Ditta where WHO signed an agreement with the Government of Pakistan to develop a model health care system for universal health coverage in Islamabad.
In the last mile of the polio eradication journey, Dr Tedros’ visit serves as a reminder that now more than ever we need to have social, political and global will to make polio the second human disease in history to be wiped from earth.
