News Category: GPEI partners
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.
Using serosurveys in at-risk countries
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.
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.”
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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.
- The global effort was declared a Public Health Emergency of International Concern under the International Health Regulations.
- 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.”
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.
“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
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
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
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.”