GPEI-2018 in review

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

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

Cornering wild poliovirus

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

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

Program innovation

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

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

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

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

Battling circulating vaccine-derived poliovirus

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

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

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

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

New policy decisions

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

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

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

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

Spotlight on gender

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

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

Donor and country commitments

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

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

Looking ahead: 2019 and beyond

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

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

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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.

Joint statement by of the main, independent, advisory and oversight committees of the GPEI

Response to the statement by WHO Director-General and Chair of Polio Oversight Board Dr Tedros Ghebreyesus

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

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

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

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

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

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

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

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

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“On the way to global certification” was the theme of this year’s Regional Meeting on Polio, which convened on 6 December 2018 in Guatemala City. Pan American Health Organization (PAHO) urged collective action to not only ensure that there is no re-emergence of polio in the Americas, but also to lend support in the global fight against polio.

Cuauhtémoc Ruiz-Matus, Chief of the Comprehensive Family Immunization Unit at the Pan American Health Organization (PAHO), addressing the meeting. © WHO/PAHO

The last reported case of polio in the Americas was documented in 1991 and in 1994 the region became the first to be certified free of the disease. But that is not to say there is room for complacency. Echoing the Global Polio Eradication Initiative’s goal of a polio-free world, Cuauhtémoc Ruiz-Matus, Chief of the Comprehensive Family Immunization Unit at the Pan American Health Organization (PAHO) said, “As long as there is even one infected child, children in all countries are at risk of contracting polio,” during the inauguration.

With recent reports emerging that some of the countries in the Americas have vaccination coverage hovering below 95% — the minimum baseline required to prevent circulation — there is a real chance of outbreak through importation of virus or the emergence of circulating vaccine-derived poliovirus.

“We know that there is a risk of reintroduction of polio, which is why Guatemala has committed to adhere to PAHO’s strategic plan so that the Region remains polio-free,” said the Deputy Health Minister of Guatemala, Roberto Molina. The country recorded its last case of polio in 1990.

Participants at the 6th Regional Meeting on Polio in Guatemala. © WHO/PAHO

Reiterating the need for continued efforts, PAHO Representative in Guatemala, Oscar Barreneche, highlighted that “maintaining standards of surveillance, containment and response to outbreaks, and vaccination is key.”

As the world reaches closer to poliovirus eradication, the countries of the Americas will play an instrumental role in sustaining the momentum for the cause and preventing reintroduction of the disease in the continent.

Read about the meeting.

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©Gavi/2018/Brendan Esposito.
A health worker administering polio vaccine to a young child.

In the wake of a polio outbreak confirmed on June 26 2018, the Government of Papua New Guinea declared polio a national health emergency. It was imperative that all children under the age of five be vaccinated, even those living in the most inaccessible regions of the country.

As part of the outbreak response, a team from Madang Provincial Health Authority, supported by WHO, travelled for over half a day by road and helicopter to reach the Hagahai people who live in the highlands of Madang province in Papua New Guinea, which is one of the most geographically isolated places in the world.

Ever wondered what it is like to be on the forefront of the fight against polio? Watch and learn how the team made their way to the remote mountain top to deliver vaccines.

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Barry Rassin, Rotary International President, presenting an award to Theresa May, UK Prime Minister, as received by MP Alastair Burt on her behalf

On 27 November, Barry Rassin, Rotary International President, presented the Polio Eradication Champion Award to UK Prime Minister, Theresa May, for her exemplary leadership role in driving the cause of eradicating polio. In 2017, the UK pledged US$ 130 million to the Global Polio Eradication Initiative (GPEI) for 2017-2019. So far, the country’s total financial contribution is US$ 1.6 billion, the second highest amount from a G7 donor. The UK has also been a strong advocate of the cause.

The Polio Eradication Champion Award was established in 1996 to honour heads of state, leaders of health agencies, and other inspiring individuals who have played an instrumental role in ending polio. Theresa May joins an illustrious list of past award winners including Canadian Prime Minister Justin Trudeau, German Chancellor Angela Merkel, and former UN Secretary-General, Ban Ki-moon.
“Britain’s leadership in making multiyear commitments in support of global polio eradication has been an example for other countries to follow,” said Barry Rassin at the occasion.

Read the entire story here.

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Participants of the Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) in Nairobi, Kenya, from 12-16 November 2018. WHO AFRO/2018

Efforts to end polio across the WHO African Region came under the microscope at a meeting of the Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) held in Nairobi, Kenya, from 12 – 16 November 2018.

Seven countries (Cameroon, Nigeria, Guinea-Bissau, the Central African Republic, South Sudan Equatorial Guinea and South Africa) made presentations to the ARCC on their efforts to eradicate polio, presenting evidence on their level of confidence that there is no wild polio in their borders, the strength of their surveillance systems, vaccination coverage, containment measures and outbreak preparedness. Kenya, the host country, alongside the Democratic Republic of the Congo and Namibia, presented updated reports on their efforts to maintain their wild poliovirus- free status.

Professor Rose Leke, Chair of the ARCC, speaking to the participants. WHO AFRO/2018

A total of 109 participants including partners of the Global Polio Eradication Initiative, non-governmental organisations and Health Ministries were in attendance to hear the reports.

The ARCC is an independent body appointed in 1998 by the WHO Regional Director for Africa to oversee the certification and containment processes in the region. It is the only body with the power to certify the Africa region free from wild polio. The African Regional Office and the Eastern Mediterranean Regional Office are the two WHO regions globally that remain to be certified free from wild poliovirus.

Professor Rose Leke, Chair of the ARCC, reflected on the importance of this meeting: “The rich, open and in-depth discussions held this week with each of the ten countries will allow these countries to strengthen ongoing efforts to further improve the quality of surveillance and routine immunization including in security compromised and hard to reach areas as well as in special populations such as nomads, refugees and internally displaced persons.”

Recommendations made

The ARCC, made up of 16 health experts, made recommendations to the ten countries. They noted with concern that outbreaks of circulating vaccine-derived poliovirus in the Democratic Republic of Congo, Kenya, Niger, Nigeria and Somalia were symptoms of low population immunity and varied quality vaccination campaigns. These countries were encouraged to conduct a high-quality outbreak response. Neighbouring countries were advised that they should assess the risk of spread or outbreaks within their borders. Low population immunity was identified as a significant concern, given the risk further emergences of vaccine-derived poliovirus strains.

Inaccessibility and insecurity were also flagged as a significant concern, with limits to the number of children who were being reached with polio vaccines and the coverage of surveillance efforts in affected areas. Countries were advised to scale up strategies that have proved in the past to be effective in the face of these challenges and to build relationships with civil society and humanitarian organisations who could provide immunization services.

Recommendations were made across the board to address chronic surveillance gaps, especially related to factors affecting the quality and transportation of stool samples reaching the laboratory for testing. The introduction of innovative technologies was commended, and a call was made for countries to expand their use, especially in inaccessible and hard-to-reach areas. Countries were also encouraged to accelerate their progress towards poliovirus containment.

In addition, all of the presenting countries received specific recommendations to support their efforts towards improving surveillance, immunization and containment in order to achieve a level that would give the ARCC the confidence needed to declare the region to have eradicated polio.

Dr Rudi Eggers, WHO Kenya Country Representative, said: “I commend all the countries on the efforts that have gone into achieving the results presented in their reports. It gives us hope that eradication is achievable in the midst of the unique challenges faced by all countries. We appeal to all the countries to fully implement all ARCC recommendations.”

Polio eradication efforts in Kenya

Dr Jackson Kioko, Director of Medical Services, the Kenyan Ministry of Health, said: “Kenya has worked hard to rid the country of wild poliovirus, and we will continue to do so until Africa and the world are certified polio-free.”

While Nigeria remains the only country in Africa to be endemic for wild poliovirus, responses are underway to stop outbreaks of circulating vaccine-derived poliovirus in the Democratic Republic of the Congo, Kenya, Niger and Somalia.

The circulating vaccine-derived poliovirus in Kenya was found in a sewage sample in Eastleigh, Nairobi, in March 2018, closely related to viruses found in Somalia. The Ministry Health, with the support of WHO, UNICEF and partners, has done several polio vaccination campaigns since then to ensure that every child’s immunity is fully built and no virus can infect them.

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

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

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

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

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

After 25 years with the polio programme, it’s easier to list the things the World Health Organization’s Chris Maher hasn’t seen than the things he has. © Courtesy of The Australian/Photo: Jake Nowakowski

After more than 25 years on the hunt for polio, it’s easier to list the things the World Health Organization’s Chris Maher hasn’t seen than the things he has. He began his career with WHO five years after the global health community vowed to eradicate polio, which was then found in over a hundred countries. Since then, Maher has progressed to spearhead on-the-ground operations for the global polio eradication initiative, a partnership that has seen the disease beaten back by 99%. In a ceremony in May 2018, the Australian Government awarded him the Order of Australia, recognizing his immense contributions to the fight against a disease that has gone from paralyzing more than 350 000 children every year in 1988, to fewer than 22 cases worldwide today.

In 1993, Maher had several years of experience in public health, but none in polio-endemic countries. “I don’t think I’d ever seen an active polio case,” he recalled. Upon joining the WHO immunization team in a region that spanned from Mongolia to the Pacific Islands, polio was suddenly at the top of his agenda.

Maher and his colleagues worked as disease detectives, stalking the wild poliovirus through hard-to-reach communities in south-east Asia. From immunizing small communities on the Pacific Islands to taking on massive campaigns targeting millions of children in China, the complexity made his head spin.

The Philippines was the first country to go polio-free on Maher’s watch, seeing its last case that year.

Tracking unimmunized children through a population maze

Chris in his early days of fighting polio. © WHO

It was here that Maher came face to face with polio’s full force of devastation, after a Khmer nurse at a district health clinic invited him home to meet her son. Maher and a colleague followed the woman to a house on stilts in a flooded field, where a quadriplegic teenager lay on a rattan bed.

“I realized very early on, he had polio. It was typical of the kind of polio that had no rehabilitation whatsoever”, Maher said.

Maher recalls being struck by the young man’s intelligence and his interest in the world, despite his isolation. As polio destroyed his body, his mother bestowed constant care.

“While she was working every day, somehow she had managed to look after him, to provide for him. As an example of motherly love I had never seen anything like that in my life.”

By the 2000s, it seemed that the most challenging country to eradicate polio was India. With its vast population and sprawling slums, in Maher’s words, “If technically we couldn’t do it, India would be the place we’d fail.”

Maher recalls Bihar, India as “the most extraordinary place that I ever worked on polio.” Eighty million people live in the state. Widespread illiteracy, a lack of infrastructure and high levels of population movement compounded the complexity of polio eradication there.

Despite the daunting challenges, Maher and his colleagues developed systematic plans to administer vaccine to all children across the country, taking a critical step in a journey to eradication. By the end of 2011, India was polio-free.

The risk of doing something different

At the start of the global push to eradicate polio, those involved in the operation would sometimes encounter skepticism from those who thought it simply couldn’t be done. The scale of the project, the size of activities and the time, energy, effort and cost involved had never been seen before.

Today, wild polio is endemic in three countries: Afghanistan, Pakistan and Nigeria. Immense efforts to battle the virus into extinction in these places are ongoing. Outbreaks of vaccine-derived polio virus (VDPV) add complexity to the end goal. Conflict, low routine immunization and population movement in the most at-risk areas complicate things further. Some of the approaches Maher and his eradication colleagues take to navigate these and myriad other challenges are astonishing – feats of logistics, diplomacy and detection that would not be out of place in a textbook.

“We’ve learned a lot about reaching every community, the most difficult access places, we’ve learned a lot about the importance about communicating what we are trying to achieve, to bring communities along with us in what we were doing. We’ve learned that there are certain things that are too big to do yourself. You need to build coalitions, you need partnerships to be able to make something happen, and the broader that partnership is, the greater the likelihood that you are going to be able to achieve something significant,” he said.

For Maher, the real risk is not that polio won’t be defeated, but that the world might one day forget how it was done. He sees the lessons learned during eradication as critical to the global health community.

“It would be a terrible pity if we lost that, if after eradication we kind of collectively heaved a sigh of relief and said, ‘well thank goodness that’s over, let’s do something else now’.”

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

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

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

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

Days of Tranquillity

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

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

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

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

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

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

Lifelong commitment

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

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

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

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

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

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

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

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

In April 2016, the polio programme embarked on a massive, coordinated effort to withdraw Sabin type-2 from routine use, through a synchronized switch from the trivalent formulation of the oral poliovirus vaccine (tOPV) to the bivalent form (bOPV). Over a two-week period, 155 countries and territories successfully made this change, marking the largest and fastest vaccine rollout in history.

Referred to as simply “the switch,” this global undertaking was a major programmatic achievement, but it was also a necessary step on the road to eradication. That’s because, in rare cases, the live, weakened virus contained in OPV can mutate and spread, resulting in cases of circulating vaccine-derived polioviruses (cVDPVs). The vast majority of these cases are caused by just one of the three components contained in tOPV (Sabin type-2 virus), so switching to a bivalent form that doesn’t contain this component was an attempt to significantly minimize the risk of further cVDPV2 cases – a decision that was endorsed by the global health community. Further, with Sabin type-2 responsible for 40% of vaccine-associated paralytic polio (VAPP) occurrences – a much rarer phenomenon at 2-4 cases per 1 million ‒ there was even stronger justification for the switch.

To assess whether the switch was successful, a group of researchers from Imperial College London, the World Health Organization and the Bill & Melinda Gates Foundation analysed stool and sewage samples from 112 countries collected in the first 15 months after the switch. The results, published in The New England Journal of Medicine, show that VDPVs and Sabin type-2 excreted into the environment after vaccination disappeared rapidly after the switch, shrinking to a much smaller geographic area.

These findings validate the GPEI decision to withdraw tOPV and demonstrate that the switch achieved its desired goal of reducing VDPVs and VAPP. This research also provides important evidence that the complete withdrawal of OPV after eradication of all wild polioviruses will eventually eliminate the risk of VDPVs, provided high immunity and effective surveillance are maintained. Eradication is simply not compatible with continued use of OPV.

The study also showed, however, that while some outbreaks of VDPV were expected post-switch, the number and magnitude of some of these outbreaks in different geographies has proven more difficult to control than expected. Type-2 VDPV outbreaks outside of Africa have been responded to with monovalent type-2 OPV (mOPV2) and controlled. However, outbreaks in the Horn of Africa, DR Congo and Nigeria have been very difficult to bring to a rapid close.

VDPV outbreaks emerge in areas with very low population immunity, due to low immunization coverage. Factors which enable them ‒ insecurity and resulting inaccessibility, weak health systems, and poor campaign performance – are the same that need to be addressed to stop their transmission. While the programme is aware of these risk factors and has proven experience and strategies to respond to them, the longer outbreaks persist, the harder they can be to stop.

The key to stopping these outbreaks will be to increase the focus on improving the quality of vaccination campaigns in accessible areas. In inaccessible areas, we need to use all available means to negotiate access and implement vaccination campaigns. Achieving high quality campaign activities will give us the best chance to stop all types of poliovirus for good and prevent any child from being paralysed by the virus ever again.

Reposted with permission from gavi.org.

Member of Provincial Scholars Task Force Molvi Hameedullah Hameedi vaccinating a child whose parents used to refuse vaccination. Killa Abdullah, Balochistan, July 2018. © D. Khan

Molvi Hameedullah Hameedi is a prominent religious scholar in a mountainous rural area of Killa Abdullah district, one of the poorest districts in Balochistan province, Pakistan. With a close connection to his community, who are mostly Pashtuns, he delivers the sermon each week during Friday prayers, and runs a religious seminary.

He is also a determined supporter of routine vaccination for all children, and an advocate for better health.

This might come as a surprise if you met Molvi Hameedullah just a year or two ago. For most of his life, he did not believe in the safety and effectiveness of the oral polio vaccine, the key tool of polio eradication.

“I was a religious scholar who was very sceptical of non-governmental organizations and the polio vaccine,” he reflects.

“After reading anti-vaccine books and papers, I began following the work of anti-vaccine campaigners. Soon, I came to consider it my religious duty to spread awareness against the polio vaccine.”

“But it all changed when I was invited to a two-day International Ulema conference in Islamabad where religious scholars from all over Pakistan and other Islamic countries were invited to debate polio vaccination.”

The conference Molvi Hameedullah attended was hosted by the Islamic Advisory Group for Polio Eradication (IAG). The IAG was launched in 2014 by leading Islamic institutions including Al-Azhar University, the International Islamic Fiqh Academy (IIFA), the Islamic Development Bank (IsDB) and the Organization of Islamic Cooperation (OIC).

For Molvi Hameedullah, attending the conference marked the beginning of a change in perspective. “At the conference, I was given an opportunity to discuss my apprehensions towards polio vaccine. The talks I had motivated me to further research the pro-polio vaccine stance, and I started meeting with religious scholars in Karachi to debate polio vaccination.”

“Through talking to these people, I was getting a completely different picture to what I had believed earlier.”

By educating religious leaders and scholars about the poliovirus, and explaining religious justifications for vaccine acceptance, the IAG and its national equivalent equip people like Molvi Hameedullah with the tools to act as health advocates. The same skills that help scholars engage with parents about the polio vaccine are applicable for wider health, including improving routine immunization, hygiene practices, and maternal and child health.

After the conference Molvi Hameedullah was offered support by other vaccine-promoting scholars.

“I received a book from a religious support person working for polio vaccination in my area. Included were dozens of fatwas from highly esteemed madrassahs and religious teachers. I was initially sceptical, so I telephoned the madrassahs who had written them. To my surprise, all the fatwas were genuinely issued by them, and they also urged me to support vaccination wherever I called.”

Today, Molvi Hameedullah teaches similar fatwas as a member of the Provincial Scholar Task Force under the National Islamic Advisory Group. Most Task Force members have an honorary position, and are not paid a salary. Instead, the local government facilitates their transport and communication needs during immunization campaigns. Of his new role Molvi Hameedullah says, “I was faced with a different problem. I had been working against polio vaccination for many years, and now felt that I had done a great damage to the children and parents of my community. I felt it was now my absolute religious duty to negate all that I had taught before. I decided to step forth, and started working in the community voluntarily to promote vaccination.”

Religious refusals in Molvi Hameedullah’s area have declined. He has begun supporting other ways of ensuring that every child receives a vaccine, including by recruiting women vaccinators.

He acknowledges that the work he does now is not easy. He and his fellow scholars sometimes face challenges from those accusing them of having a political agenda, and changing beliefs informed by years of cultural and religious tradition takes time and patience. But he vows to continue his new mission until eradication.

There have been no cases of polio in the area of the district that Molvi Hameedullah covers since he joined the Provincial Scholars Task Force. Looking ahead, he is determined not to stop until all of Pakistan is polio-free.

Since he joined the Provincial Scholars Task Force, there have been no polio cases in Molvi Hameedullah Hameedi’s district. © D. Khan

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

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

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

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

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

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

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

A child is protected from lifelong polio paralysis through OPV vaccination. © WHO

Following identification last month of an acute flaccid paralysis (AFP) case from which vaccine-derived poliovirus type 1 (VDPV1) had been isolated, genetic sequencing of two VDPV1s from two non-household contacts of the AFP case has now confirmed that VDPV1 is circulating and is being officially classified as a ‘circulating’ VDPV type 1 (cVDPV1).

The National Department of Health (NDOH) of Papua New Guinea is closely working with the GPEI partners in launching a comprehensive response. Some of the immediate steps include conducting large-scale immunization campaigns and strengthening surveillance systems that help detect the virus early. These activities are also being strengthened in neighboring provinces.

The GPEI and its partners are continuing to work with regional and country counterparts and partners in supporting the Government of Papua New Guinea and local public health authorities in conducting a full field investigation, risk assessment and to support the planning, implementation and monitoring of the outbreak response.

For more information:

Contact Oliver Rosenbauer, Communications Officer, Global Polio Eradication Initiative, tel: +41 79 500 6536

Related resources

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

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

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

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

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

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

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

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

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

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

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

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

A 34-month old child had presented with symptoms of acute flaccid paralysis (AFP) on 29 April, from a community with low vaccination coverage in Orinoco delta, Delta Amacuro state.

A Sabin type 3 poliovirus was isolated from stool samples of the child. Isolation of Sabin type 3 poliovirus can be expected in children and communities immunized with bivalent oral polio vaccine, which contains attenuated (weakened) type 1 and type 3 Sabin strains. Final laboratory analysis received today has confirmed that the AFP symptoms are not associated with wild or vaccine-derived poliovirus.

A number of conditions or infections can lead to AFP, poliovirus being just one of them. As part of global polio surveillance efforts, every year more than 100 000 AFP cases are detected and investigated worldwide. Clinical evaluation of the child is underway to determine the cause of the paralysis. The most important point is that the child should be provided with appropriate care and support.

While wild and vaccine-derived polio have both been ruled out as the cause of this child’s symptoms, this area of Venezuela is experiencing vaccination coverage gaps. It is critical that countries maintain high immunity to polio in all communities, and strong disease surveillance, to minimize the risk and consequences of any eventual poliovirus re-introduction or re-emergence.

The partners of the Global Polio Eradication Initiative (GPEI) – WHO, the US Centers for Disease Control and Prevention, Rotary International, UNICEF and the Bill & Melinda Gates Foundation – will continue to support national and local public health authorities in these efforts, together with the Pan American Health Organization, which serves as the Americas Regional Office of WHO.

For more information, please contact:

Media team
PAHO
Tel: +1 202 974 3440
Email: mediateam[AT]paho[DOT]org

Oliver Rosenbauer
Communications Officer
Global Polio Eradication Initiative
WHO Geneva
Tel +41 (0)79 500 6536
Email: rosenbauero[AT]who[DOT]int

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

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

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

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

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

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

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

An acute flaccid paralysis (AFP) case, a symptom which is caused by a number of different diseases (polio being just one of them), is currently being investigated. The child is 34 months old, and had onset of paralysis on 29 April, from an under-immunized community in Orinoco delta, Delta Amacura state.

A Sabin type 3 poliovirus was isolated from stool samples of the AFP case, and is being further analysed, including to determine if the paralysis was caused by the isolated strain. Final laboratory results are expected next week.

Isolation of Sabin 3 poliovirus is not unusual, and can be expected in children and communities immunized with bivalent oral polio vaccine, which contains both attenuated type 1 and type 3 Sabin strains. As part of global polio surveillance efforts, every year more than 100,000 AFP cases are detected and investigated worldwide.

WHO’s Pan American Health Organization (PAHO) and the GPEI continue to support local public health authorities in conducting an epidemiological and field investigation into this event.

For 15 years Daeng Xayaseng has been travelling through rugged, undulating countryside by motorbike and by foot to deliver vaccines to children in some of the most remote villages in Laos.

It’s hard work but she is determined: “We have a target of children to reach and we’ll achieve that no matter how long it takes,” she says. “We’ll keep working until we reach every child.”

Today her team visits Nampoung village, 4 hours north of the capital of Laos, to deliver polio vaccines.

“For 15 years I’ve been working on campaigns like this,” she says. “Today we’re here with our outreach team to vaccinate children against polio. We’ll also go house to house to make sure no child misses out on being vaccinated.”

“We don’t want there to be another outbreak of polio so we have to reach everyone,” says Daeng. “In order to do that, immunizing every child in remote communities like this is a priority to ensure everyone is protected.”

UNICEF and other partners of the Global Polio Eradication Initiative are supporting the Lao Government to reach nearly half a million children under five with potentially life-saving vaccines. More than 7,200 volunteers and 1,400 health workers like Daeng and her team have been mobilized to deliver the oral polio vaccine as well as other vaccinations such as measles-rubella.

“I’m very happy and proud to do this job,” says Daeng once the team has packed up. “I’m proud to do this job to serve the community and help in any way I can.”

Unicef blog – Ending polio in Laos

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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