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.”
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.
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.
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.
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.
Forty-year-old Auta A. Kawu says the only thing predictable about working in the conflict-affected northeastern Nigerian State of Borno is its unpredictability.
“No two days in my week are alike,” he says.
As a Vaccine Security and Logistics facilitator, Auta is one of 44 specialists working with the Government, UNICEF and partners in Nigeria, who strive to ensure sufficient vaccine stock, appropriate distribution and overall accountability for vaccines in the country. Through careful management, Auta works to give every accessible child in Borno protection from vaccine-preventable diseases, including polio.
Describing a typical week in his life, he explains that if on Monday he is arranging for the vaccination of eligible children among a group of Nigerians returning back from neighbouring countries where they had fled due to fear of violence, by Tuesday he could be speaking with government personnel to find a way to safely send vaccines to security compromised areas. On Wednesday, he may find himself rushing extra vaccines to an internally displaced persons (IDP) camp, where more people have arrived than initially expected, whilst on Thursday you may find him trying to locate a cold chain technician to fix a fridge where the heat-sensitive polio vaccine must be stored.
Evidencing the energy and commitment required to work on the frontline of vaccination, Auta notes that the work never lets up. Despite an exhausting week, on a typical Friday, you might find him on the road again, travelling to a remote location where health workers have just been given access. When he gets there, he will help out once more – trying to ensure that vaccines are distributed as effectively as possible to maximize the number of children reached.
He recounts a recent story of reaching the reception area of an IDP camp in Dalori, which is located in a highly volatile area of the state. Arriving with 300 doses of oral polio vaccine, and 200 doses of measles vaccine, he was told that new arrivals were expected later that day. Many of the people coming had been under siege by non-state armed groups since 2016, and had taken the opportunity of improved security and mobility to flee to the nearest town. Very few of the young children arriving had ever been reached with vaccines.
With the screening of children eligible for measles and polio vaccines starting around 9 am, and plenty more children yet to arrive, it was quickly clear that the available doses would not be enough.
Springing into action, Auta notified the head of the security team accompanying him of the need to go to nearest health facility to bring additional doses. Once clearance was given, he rushed to Jere Local Government, a district nearby, to collect more vaccines.
In the meantime, however, there were sudden changes in the security environment. The return journey to Dalori was not cleared until late noon.
Luckily, giving up isn’t in Auta’s nature.
By the end of the day, he had successfully delivered 580 doses of oral polio vaccine and 460 doses of measles vaccines for the children in the camp, providing some of them with their first ever interaction with a health system.
The crucial role of Vaccine Security and Logistics facilitators like Auta cannot be over-emphasized. In addition to his central work, Auta also conducts advocacy visits to traditional and religious leaders and supports the planning and implementation of vaccination campaigns in inaccessible areas.
Vaccine facilitation may be unpredictable work, but Auta is secure on one thing. Thanks to the work of him, and thousands of other determined health workers, community mobilizers and with support from donors and partners including the Bill & Melinda Gates Foundation, the Government of Canada, the Dangote Foundation, the European Union, Gavi – The Vaccine Alliance, the Government of Germany, the Government of Japan, the Japan International Cooperation Agency (JICA), Rotary International, the US Centers for Disease Control and Prevention, the World Bank and others, Nigeria is steadily on its way to being declared polio-free.
To supplement Global Action Plan III for the containment of polioviruses, WHO has published guidance for non-polio facilities to help them identify, destroy, or safely and securely handle and store sample collections potentially infectious for poliovirus.
Dr Mark Pallansch from CDC explains what the guidance means for facilities worldwide.
Poliovirus potentially infectious materials (PIM) include fecal, nasopharyngeal, or sewage samples collected in a time and place where wild polioviruses/vaccine-derived polioviruses (WPV/VDPV), or OPV-derived viruses were circulating or oral polio vaccines (OPV/Sabin) were in use. Non-polio research facilities with a high probability of storing such materials include those working with rotavirus or other enteric agents, hepatitis viruses, influenza/respiratory viruses, and measles virus. Other facilities could include those conducting nutrition research or environmental facilities.
Welcome to Poliopolis! You’ll spend the next 28 days in a container village to help us test a new polio vaccine. Poliopolis is equipped with all the amenities to make your stay comfortable: air-conditioned private rooms with workstations and sinks, a lounge area with a flat screen TV and foosball table, a fitness room with a variety of exercise equipment, and a bright, sunny dining area. Enjoy your stay!
Sounds like a scene from a science fiction story, right? But this is a real polio vaccine trial that took place in a parking lot at the University of Antwerp, Belgium in mid-2017. The study, funded by the Bill and Melinda Gates Foundation, evaluated two novel oral polio vaccine candidates. These vaccine candidates were developed by scientists from the US Centers for Disease Control and Prevention’s polio laboratory, the National Institute for Biological Standards and Control in the United Kingdom, and the University of California, in San Francisco, with support from the US Food and Drug Administration.
Once fully developed and tested, these new, more genetically-stable, live, attenuated vaccines will prove a critical resource to ensure global polio eradication.
A unique group of people gathered last month in Sokoto state to commit to the twin goals of eradicating polio, and working to rapidly strengthen routine immunization. Bill Gates, and Africa’s richest man, Alhaji Aliko Dangote, joined traditional leaders from across northern Nigeria, Federal Ministry of Health officials, representatives from several State governments, and partners including UNICEF and WHO.
The two billionaires play a significant role in the fight to eliminate polio in Nigeria, where no wild virus has been detected since 2016. The Bill & Melinda Gates Foundation has committed US$1.6 billion in the country to date to fund pilot projects targeted at health care, agriculture and financial inclusion, a contribution which makes up their biggest investment in Africa. Aliko Dangote, who is Nigerian, has previously worked with Mr Gates to help interrupt transmission of the poliovirus in his country, and helps fund other health programmes as president of the Dangote Foundation.
During their visit, Mr Gates and Mr Dangote witnessed first-hand the progress Nigeria is making in polio eradication, routine immunization and primary health care provision.
At meetings held at the Sultan’s Palace and Governor’s House, Mr Gates highlighted the commitment of traditional leaders and reiterated the importance of engaging communities to reach every child with vaccines. Expressing his concern over the high infant mortality rate in Nigeria, he noted that vaccination is a cost effective way to save children’s lives.
Mr Gates also talked about the need to plan for the future of a polio-free Nigeria. Looking to how the polio eradication infrastructure can be used to help meet other health needs, Mr Gates said that the strong existing polio infrastructure – including vaccine supply chains, disease surveillance, laboratory systems and social mobilization networks – can be used to develop and improve routine immunization coverage for other diseases.
“We can prevent millions of deaths through routine immunization,” Mr Gates said. “We will not relent in our commitment towards this.”
Mr Dangote further highlighted that the fight against polio requires commitment from all stakeholders.
Drawing attention to malnutrition as one of the biggest factors undermining Nigeria’s progress, Mr Dangote urged the government and partners to reach out to private sector companies and ask them to donate at minimum 1% of their profits to financing the health sector.
At the meeting, the governors of Bauchi, Borno, Kebbi, Kaduna, Kano, and Sokoto States signed extensions of their Memorandum of Understanding on routine immunization. In doing so they reaffirmed their commitment to maximizing immunization coverage in their respective states, helping to protect every child against polio and other vaccine-preventable diseases.
Zulaihatu Abdullahi is well known in her community, particularly to the mothers. As a volunteer community mobilizer in Kaduna state, northern Nigeria, her mission is to ensure that no child contracts polio, or any other preventable childhood disease.
This is difficult, as immunization programmes are sometimes treated with suspicion in her part of Nigeria. As a ‘change agent’, Zulaihatu’s job is to go door to door, counselling parents about the importance of the polio vaccine.
This particular lunchtime, she is visiting an 18 year-old mother living in a compound in a densely-populated, urban district of Kaduna State.
The young mother puts down the pole she is using to pound millet and welcomes Zulaihatu, recognising her royal-blue UNICEF hijab. She sits, and pulls on a hijab for cover as she settles down to breastfeed her baby. She has three other small children at home, a fifth on the way and she is new to the area.
“Before I came here I was rejecting all vaccines,” she says, “but because of this woman, Zulaihatu, I decided to accept. She told me the usefulness and I was convinced to do it.”
Thanks to Zulaihatu’s patience, and her work to build trust with the younger woman through regular visits, four more children are now protected against polio who might otherwise still be at risk. The mother has also been encouraged to seek anti-natal care, and the youngest child has just received his routine immunization shots.
“Sister Zulaihatu was one of the first women I met when we moved here,” the mother recalls. “She came here every day. She told me how she takes care of her own children. What she feeds them. How they all take vaccines. Little by little I started to change my thinking.”
Zulaihatu is trained to make her community aware of important household and parenting practices to keep their children thriving. The list is extensive and includes tips to treat diarrhoea, the importance of basic hygiene and sanitation, how to protect the family from malaria, the benefits of neonatal care and breastfeeding for infants, and the importance of registering their births.
She is one of nearly 20 000 UNICEF-trained community mobilizers, influencers and communication experts spread across 14 northern ‘high risk’ Nigerian states. With the support of donor and partners including the Bill and Melinda Gates Foundation, CDC, Dangote Foundation, European Union, Rotary, GAVI, JICA, the World Bank and the Governments of Canada, Germany, Japan, and others, the mobilizers are a key part of UNICEF’s ongoing support to the Government of Nigeria’s immunization programme.
Despite their achievements, Zulaihatu and other mobilizers know that there is much is still left to be done in their communities. Tomorrow, Zulaihatu will continue her work, going from household to household to keep every child safe.
Reducing polio cases by 99.9% globally is an incredible feat, achieved through innovative strategies and years of trial and error.
While the polio eradication programme is focused on getting to zero, now is the time to make sure everything we’ve learned isn’t lost and can be used to inform future global health programmes. Just as the polio eradication effort applied lessons learned from the successful smallpox campaign to its own work, the goal is for future health programmes to understand and build on the knowledge of the polio effort.
Under a new grant from the Bill & Melinda Gates Foundation, the Johns Hopkins Bloomberg School of Public Health (JHSPH) will be working to do exactly this.
JHSPH will partner with academic institutions from around the world to document lessons and develop graduate-level courses and hands-on training clinics for public health students and professionals, including an online open course available to the public and implementation courses for managers from other health programmes.
Under the leadership of Dr Olakunle Alonge, the team at JHSPH will collaborate with a global team from public health institutions in seven countries: Nigeria, India, Afghanistan, Ethiopia, the Democratic Republic of the Congo, Bangladesh and Indonesia. This will not only ensure a balanced and diverse perspective, but also enable the exchange of public health training strategies between the institutions.
To develop the content of each course, JHSPH will be identifying “change agents” at the local, national and global levels who have expertise in polio eradication that may not otherwise be captured. This unique global strategy promises to yield coursework that speaks to the issues faced by a broad range of global health programmes and actors.
“Without an active strategy to map, package and deliver the knowledge from the global polio eradication efforts to other programs and global health actors, I’m afraid that these knowledge assets may not find any useful purpose beyond the end of the polio campaign, which could come to an end within a few years,” said Alonge.
Alonge expects to glean lessons that will apply to immunization systems, public health emergency response, primary health care, disease eradication and infectious diseases—ensuring that the polio programme continues to positively impact global health for years to come.
Outside a sandy coloured building in a village in Burkina Faso, a young girl on crutches is making her way out onto the street. In front of her home is a new wheelchair – child-sized, brightly painted and specially adapted to the unpaved streets of her neighbourhood.
Countries around the world are united in their efforts to eradicate polio so that it will never again cause a child to be paralysed. This is important because there is no cure to this paralysing disease. For polio survivors in Burkina Faso, the opportunity to be independently mobile in their own communities can be life changing.
Independence after disability
For children living in poor communities whose limbs are paralyzed by polio, there is often very little support available to make them independently mobile. Giving a child a wheelchair puts previously inaccessible opportunities within reach so that children can reach their potential; such as going to school, playing outside with friends and learning new skills. In many cases the children are free to explore the world around them for the first time without a friend or family member to help.
Rotary International, along with partners such as Sahel, are providing support to the AMPO Association in Ouagadougou to provide services and facilities for children, teenagers, young mothers and people with disabilities often caused by polio.
Custom-made wheelchairs
The tricycles are hand-crank operated by the individual to navigate the difficult roads of Burkina Faso. A wider version is also available for adults riding with children and the chairs can be personalized in a variety of colours.
For many of those coming to the workshop, it is the first time they have had a custom-built mobility aid. They enter the workshop with assistance, but leave under their own steam.
The success of the project is largely due to the determined efforts of Project Director Edouard Norgho. He is a wheelchair user himself and so he fully appreciates the needs of his clients. Ouagadougou has more than two million inhabitants with no public transport systems, so Edouard makes sure that each wheelchair he makes is robust enough to cover long distances every day.
The five wheelchair makers at AMPO are all people with disabilities. Trained on the job, the workshop offers employment to people who often face discrimination on the labour market.
Spreading their expertise beyond the city, staff from the workshop travel further afield to reach up to 1600 people in rural areas. With the support of Rotary Germany the project receives funds and wheelchair parts, helping more and more polio survivors live a mobile life every year.
For the young girl in her new wheelchair, an exciting future awaits. In Burkina Faso more than 70% of children with disabilities have no access to education. Now, able to navigate to school by herself, she can become part of the 30% who do have the opportunity to learn. With the support of Rotary and other partners, AMPO is well on the way to helping more people like her, the target being to provide increased mobility to every polio survivor in Ouagadougou.
To find out more about this project, or provide financial support (US$250 will pay for a wheelchair for a child with disability), please visit sahel.org or contact info@sahel.de.
In Afghanistan this year, staff from the non-governmental organization Care of Afghan Families collected 420 blood samples from children under 4 at the Mirwais Regional Hospital in Kandahar province. The aim? To find out whether polio vaccination campaigns have been reaching enough children, and whether the vaccines have been generating full protection against this paralysing disease. These ‘serosurveys’ showed that immunity in Afghanistan is high – and also identified where vaccination campaigns need to reach out further.
Whenever a polio vaccination campaign takes place, a purple dot of ink is painted onto the little finger nail of every immunised child to show that they have received the lifesaving vaccine. This data is collected and allows people to monitor the campaign and know exactly where children have been reached.
Now, with more children being vaccinated than ever before, the polio eradication programme needs to know more than how many children are being reached: we need specific data on where children are being missed.
Serosurveys testing for immunity
Serosurveys are simple tests of the serum in a child’s blood, which measures their immunity (or seroprevalence) to different diseases. The polio eradication programme uses this test to see what level of protection a child has against wild poliovirus types 1, 2 and 3, allowing them to assess whether the vaccination campaigns are reaching enough children, enough times, to give them immunity.
At the Mirwais Regional Hospital, the children tested were from a diverse range of provinces. Their results were sent to Aga Khan University for initial testing, and then sent for further analysis to one of the Global Polio Eradication Initiative partners, the US Centers for Disease Control and Prevention in Atlanta. Through mapping both where they live and their immunity results, scientists at both institutions helped polio eradicators to discover the areas where a child is at most risk of being missed by vaccination campaigns.
Serosurvey results can be crucial for planning campaign strategies – making sure that every last child is reached, no matter where they live.
For Ondrej Mach, team lead for clinical trials and research in the WHO’s Polio Eradication Department, serosurveys “… are increasingly important for eradication efforts, allowing us to form an accurate picture of our progress so far, and the locations where we are being most effective.”
High immunity in Afghanistan
The Mirwais serosurvey proved that Afghanistan is closer than ever to eradicating polio, with more than 95% of children surveyed immune to wild poliovirus type 1, the virus type still circulating in some areas of Afghanistan, Pakistan and Nigeria, and more than 90% immune to type 3, which hasn’t been found anywhere in the world since November 2012. The tests also pointed to where gaps in immunity are, so that missed children can be found and protected.
These results are a strong reflection of the devoted work of polio vaccinators and community workers throughout the country, using their expertise to reach into every family, and spread awareness of the importance of polio vaccination.
As in Afghanistan, serosurveys are increasingly used in other countries where polio remains or poses a threat, to help identify the last remaining pockets of under-immunized children in high risk areas. This is especially important because with polio in fewer places than ever before, it is these unreached children that will take us over the finishing line.
By getting an increasingly accurate picture of where vaccination campaigns are operating successfully, as well as where the programme needs to renew efforts, we can move further towards the goal of reaching every child.
This helps us reach our ultimate goal – ensuring that every last child, everywhere, can be polio free.
“I am the king of this village! Every child belongs to me and I will spread my poison to a new person every day,” screams the snake, bursting onto the stage.
In the audience, children gasp and jump backwards, their eyes wide.
Hamid, clutching his precious box of vaccines, attacks the snake, managing to defeat him. The crowd cheers.
“Vaccinating your children will destroy this disease!” cries Hamid. “Make sure your whole village takes these droplets and you will see how strong you and your children can be.”
This poisonous snake – mor zaharia as it’s called in Dari – represents the dangerous threat of polio, a disease that Afghanistan is fighting hard to eradicate.
Hamid leads a touring youth circus group made up of children and teenagers from all across the capital, Kabul, who performs juggling, acrobatics and theatre routines for local audiences around the city and beyond.
Today the circus is in Qargha, Kabul, Afghanistan. It was started 14 years ago by Mobile Mini Circus for Children and is supported by UNICEF.
The circus enables the children who join – often from internally displaced communities around Kabul – to go to school every day and then practise circus skills at their centre after school and on weekends.
Part of their impressive performance includes passing on vital messages about healthcare and social issues to the audience, who may otherwise not have access to this information.
“Our circus is entertainment and it is so much fun for the performers and for the audience,” says Hamid.
“We pass on these important messages in a fun way which people listen to and they understand. Giving a message without fun means people will not take that message away.”
This is especially true of the children, who flock to the circus the moment they see youngsters their own ages pull out their juggling sticks and begin clowning around on the makeshift stage.
“We often perform in the internally displaced persons camps,” says Hamid. “These areas are not peaceful and the people have no proper shelters, no electricity and no running water.”
These conditions provide the perfect environment for communicable diseases like polio to spread; yet a simple oral vaccination, just two drops in the mouth, can bring a child closer to a life without polio. Children in Afghanistan will be vaccinated against polio multiple times, until the disease is stopped for good.
During the August and September 2017 National Immunization Days 9.9 million children under five across Afghanistan were targeted with repeat doses of the oral polio vaccine.
Ambassador Lanteri has handed over to Ambassador Shino as co-chair of the Polio Partners Group. WHO.
The movement to eradicate polio is a global effort that has attracted support from the highest level from country governments, formed partnerships and relied upon millions working on the frontline. This network is making history as part of the biggest public health programme in the world, which has the opportunity to eradicate a disease for only the second time in history.
The Polio Partners Group (PPG) serves as the voice of many of these committed stakeholders to give input into the work being done by the Global Polio Eradication Initiative and to bring together polio-affected countries, donors and other partners to ensure that the GPEI has the necessary political and financial resources to end polio.
At the group’s latest meeting in June, Ambassador Carole Lanteri of the Permanent Mission of Monaco ended her time as Co-Chair after two years fostering the PPG’s engagement in-depth and high-level dialogue on key programmatic issues with the Initiative’s stakeholders. Monaco is a key partner and donor of the global effort, providing financial and political support. Ambassador Lanteri handed over to Ambassador/Deputy Permanent Representative Mitsuko Shino of the Permanent Mission of Japan.
Japan, the fifth largest donor government to the Initiative, recently reaffirmed its commitment at the Rotary Convention in Atlanta where global health leaders came together to pledge US$ 1.2 billion to polio eradication efforts.
Michel Zaffran, Director of Polio Eradication at WHO, thanked Monaco for their support, noting that “Ambassador Carole Lanteri has brought the highest levels of political commitment to the PPG meetings. With thanks to her continued leadership, we have seen Ambassadors and senior representatives from endemic and donor countries and partners engaging in very technical discussions on the programme. This is testament to the extraordinary convening power of Ambassador Lanteri. She has forged a partnership of political will among diplomats and stakeholders in Geneva, all determined to work for a polio-free world.”
As the PPG thanked Ambassador Lanteri for her service and leadership, a warm welcome was extended to the new Co-Chair, Ambassador/Deputy Permanent Representative Mitsuko Shino of the Permanent Mission of Japan. As a new co-chair, Ambassador Shino will bring her long standing experience and passion in the field of human rights to polio eradication. “Polio is about equity, reaching every child with safe vaccines to realize a world in which no child is left suffering from this preventable disease. It would be a great honor for us to witness the realization of human and child rights to enjoy healthy lives.”
In her very first address to all Ministers of Health, partners and stakeholders at the World Health Assembly in 2006, the new Director-General elect Dr Margaret Chan made it clear that polio eradication would be one of her main priorities. Indeed, under her leadership, the effort would become WHO’s number 1 operational priority.
Polio has been reduced globally with only six cases reported from two countries as of June 2017, down from nearly 2000 cases in 17 countries in 2006 when she became Director General. But as Dr Chan herself says, these are still six cases too many.
Every year, more than 450 million children are vaccinated around the world and protected for life against this disease. India, once thought of as the most technically-challenging place from where to eradicate polio, became polio-free, along with the rest of the South-East Asia Region. One strain of wild poliovirus (type 2) has been globally certified as eradicated.
Dr Chan’s leadership has seen a revolution take place in the effort to eradicate polio, resulting in major impact:
A brand-new vaccine, bivalent oral polio vaccine, was developed as a more powerful tool to stop the virus
New strategic oversight and accountability mechanisms were put in place, as overseen by a specifically-established global Independent Monitoring Board.
A globally-agreed strategic roadmap was put in place to not only eradicate polio but secure its lasting success.
All this, Dr Chan achieved in close coordination with the heads of agencies of the other spearheading partners in the Global Polio Eradication Initiative, namely Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF and the Bill & Melinda Gates Foundation, and most importantly of all in close collaboration with all Member States.
“On behalf of the GPEI, and most importantly on behalf of the millions of children who can walk as a result of her efforts, we would like to thank her for her passion, leadership, engagement, enthusiasm and inspiration. Over the last ten years, she has led this effort and the world to the threshold of being polio-free,” said Michel Zaffran, Director of the Polio Eradication Department at WHO, speaking on behalf of the Global Polio Eradication Initiative.
Dr Tedros Adhanom Ghebreyesus, the new WHO Director-General elect who takes over from Dr Chan on 1 July, has vowed to follow in Dr Clan’s footsteps and strive to lead this effort over the threshold. Travelling to Atlanta, USA, earlier this month to address more than 30,000 Rotarians gathered at the annual Rotary Convention, Dr Tedros said: “The end of polio is now in sight. This is the most critical moment of covering the last mile. We must keep our eyes firmly on the final goal.”
New funding and political commitment will enable the GPEI to protect 450 million children from polio every single year. WHO/L.Dore
Atlanta, USA, 12 June – Public health leaders gathered at the Rotary Convention in Atlanta to unite in their commitment to securing a polio-free world. Endemic countries and donors together pledged US$ 1.2 billion to finance the polio endgame.
The Global Polio Eradication Initiative was launched in 1988, spearheaded by Rotary International. For the past three decades, Rotary has brought political commitment, funding and energy to the fight against polio. At this pledging event, Rotary committed a further US$ 150 million to the cause.
At a time when polio eradication has never been closer, new funding and political commitment is more important than ever. The poliovirus has been cornered to just three remaining countries – Afghanistan, Nigeria and Pakistan – but this progress is fragile. While polio continues to exist anywhere in the world, children everywhere remain at risk. Each year, the GPEI reaches 450 million children to vaccinate them against the virus, in polio endemic countries and elsewhere, and maintains disease surveillance systems in more than 70 countries to find and stop every last virus.
Today, 16 million people are walking who would have been paralysed if they had not been protected against polio thanks to the extraordinary efforts of public health workers. This new injection of funding and commitment will ensure that in the future, no child will ever again suffer from the consequences of this incurable, but preventable, disease.
Young mothers waiting to vaccinate their children receive information on exclusive breastfeeding from a polio-funded Volunteer Community Mobilizer. @ UNICEF/R. Curtis
“Are you watching me?” “Yes, ma’am.”
“Are you seeing me?” “Yes ma’am.”
Along two rows of benches under the awning of the Chikun Primary Health Centre in northern Nigeria’s Kaduna State, about 50 young mothers sit still, their babies swaying on their laps. All eyes are fixed on Lidia, the assured polio social mobilizer who is not delivering polio vaccine, but showing the women how to correctly breastfeed.
Lidia is a grandmother, a one-time community midwife now employed with Nigeria’s polio eradication programme as a UNICEF-supported Volunteer Community Mobilizer (VCM). During the monthly polio vaccination campaigns, she goes house to house with the vaccination team, opening doors through her trusted relationship with the mothers, tackling refusals where they occur and tracking any children missed in the campaigns through her field book containing the names and ages of all children in her area. But it is between campaigns where Lidia’s full worth is realized.
Trust
Helen Jatau, a supervisor in this Local Government Area, supervises 50 VCMs and five first-level supervisors. She is convinced the health care polio frontline workers provide between campaigns provides benefits beyond the surface value – it establishes trust. “When we bring different things to the mothers, it helps the community live better and even accept us more, because we are giving more than just polio vaccines.”
Between polio vaccination campaigns, mobilizers like Lidia track pregnant women and ensure the mothers undertake four Ante-Natal Care visits, including immunization against tetanus. They advise mothers-to-be to give birth at the government health facility, provide them with the first dose of oral polio vaccine, facilitate birth registration and connect them to the routine immunization system. In houses and at monthly community meetings, the mobilizers also provide information on exclusive breastfeeding, hand washing, the benefits of Insecticide Treated Bed Nets, Routine Immunization and the polio vaccination campaign.
Ante-Natal Care
VCM Charity Ogwuche stands before the mothers at the health centre and peels over the pages of a colourful flip book. “Breastmilk builds the soldiers inside your child,” she shouts. “It will save you money. You don’t need to find food for your child to eat. You don’t need to find water: 80% of breastmilk is water. It will protect your child.”
Adiza, a young mother holding her first child, Musa, carries a routine immunization card including messaging on breast feeding and birth registration. “Aminatu talked to me about antenatal care. She asked me to get the tetanus shot, and today she has brought me here to receive routine immunization for my baby. I am really grateful. If she wasn’t here I wouldn’t be here. I wouldn’t know about it. She is the only one who tells me about this.”
Charity is proud of her work. “The women are so familiar with me, it makes me happy. They call me Aunty. I provide most of the health information for them. Really there is no other in our community. They are very young mothers and they need me.”
Birth registration
Aminatu Zubairu, in her trademark blue VCM shawl, displays the birth registration cards she will carry back to mothers in her village. @ UNICEF/R.Curtis
Every Tuesday is birth registration day. Once, hardly a soul turned up to register their newborns, but today, a long line of VCMs are standing clutching handfuls of registration forms, waiting to register the newborns within their catchment area.
Aminatu Zubairu, wrapped in the trademark blue hijab of the VCM, explains how all social mobilizers must come from their own community, and how that familiarity breeds the trust that has enabled her to register hundreds of children in her area. “I go to their houses and ask if they had the birth registration. If they say no I take all the information. Now I will register them and get the certificate of birth and carry it to their house to give back to them. In a month I can do 50 of these. This year there are plenty of newborns.”
Danboyi Juma, the district’s Birth Registration Officer, believes birth registrations have increased by 95% since VCMs assumed responsibility for the service. “They are helping us so much because they go house to house,” he says. “They have increased the number of birth registrations in this area by so much – oh, that’s sure.”
Routine Immunization
Jamila and her baby Arjera, who was vaccinated for the first time, following the persistent efforts of her VCM Rashida Murtala. @ UNICEF/R.Curtis
Despite stifling heat, on this Tuesday, there are more than 50 mothers and several fathers sitting on benches, waiting for their turn to have their babies vaccinated. More than 80% of them carry the cardboard cards given to them by VCMs to remind them their baby is scheduled for routine immunization.
Jamila, a young mother wrapped in a white shawl around her orange head-dress, is bringing her six-month-old baby Arjera to be vaccinated for the first time. Her VCM, Rashida Murtala, badgered her for months before Jamila finally accepted.
“Oh, she refused and refused,” Rashida says. “She’s fed up with me visiting. I went to see her today and finally she followed me. I’m happy to see her here.”
Jamila smiles. “She has been disturbing me every day that I have to take this child to the health centre. I know she’s right, so today I followed her.”
Priscilla Francis, the Routine Immunization provider who vaccinates young Arjera, believes VCMs are key to strong vaccination coverage in Chikun district. “There is much improvement in attendance since the VCMs started. They are well trained. They do a good job of informing mothers to come. If we lost them we would lose our clients – no doubt. When they come we tell them to come back, but no one else is going to their house to bring them.”
Hassana Ibrahim, a Volunteer Ward Supervisor, knows her mobilizers are important. “I have 10 VCMs, five in this ward. Non-compliance used to be a big problem but not now. Now with the routine immunization, the community sees they are providing a package of health care and now people comply with the polio vaccination.”
Naming ceremonies
New mother Naima with newly named Jibrin and her friends and family was happy to welcome her VCM to immunize children at her son’s naming ceremony: “She is my friend.” @ UNICEF/R.Curtis
Following the routine immunization session, the VCMs fan out to attend the naming ceremonies of newborns in their catchment area. Naming ceremonies provide an important opportunity to vaccinate lots of children, as family gathers around to celebrate. On average, they attend 10 naming ceremonies a month. Today we visit Naima, the young mother of a 7-day-old boy, who as per tradition has just been named Jibrin by his grandfather. Naima is surrounded by her sisters, family and village friends, who cook and eat with them, and their 68 children under five. Within minutes, the VCM has walked among them all, vaccinating them as they sit waiting with their mouths open to the sky like little birds.
Naima is happy to see her trusted VCM, and encourages her to vaccinate the children. “I know her well,” she says. “She taught me to go for ante-natal care, to deliver at the hospital and to go for immunization. She is the only health care worker who comes. We are from the same community. She is my friend.”
Leaders of the G7 at their heads of state summit in Italy. Ministers of Health from around the world at last month’s World Health Assembly. A broad swathe of civil society at the Rotary International annual convention in Singapore. All these bodies have restated the importance of eradicating polio and their determination to do so. Polio eradication is classified as a Public Health Emergency of International Concern under the International Health Regulations, and polio is the only such disease. Public health advisory bodies, including the Eastern Mediterranean Regional Subcommittee for Polio Eradication and Outbreaks, continue to foster the necessary commitments to achieve success.
But with so many other priorities, both health and non-health related, affecting the world, why is it that commitment to this particular effort remains so solid, even after all these years? Carol Pandak, Director PolioPlus at Rotary International – the global service organization which launched the global quest to eradicate polio back in 1985 and civil society arm of the Global Polio Eradication Initiative – has some very clear views. “Ultimately, it is on the one hand the unique opportunity that we collectively have right now to eradicate a human disease for only the second time in history,” she explains, “with all the benefits that go along with it. But on the other hand, the consequences that we would face if we collectively do not achieve in finishing the disease, with global resurgence of the disease.”
Pandak points out that the global effort to eradicate polio is unique, in that it managed to do something quite unprecedented in human history: commitment by all, towards a single common goal. “I cannot think of another effort, that has literally seen every single country, every single government, all communities, community leaders, the private sector, parents and health workers unite, all over the world, towards achieving a common goal. Not since the eradication of smallpox, at least. And look at the benefits the smallpox effort has brought to the world: from half a billion deaths caused in the 20th century alone, to no infections every again since it was certified as globally eradicated in 1980. This is what the eradication of a disease means. All countries and all sectors of civil society all coming together, working together, achieving success together, and benefitting equally and together of the results.”
All this, Dr Chan achieved in close coordination with the heads of agencies of the other spearheading partners in the Global Polio Eradication Initiative, namely Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF and the Bill & Melinda Gates Foundation, and most importantly of all in close collaboration with all Member States.
