Outbreak countries

Abuja, 28 February 2025 – As Nigeria intensifies efforts to halt the transmission of type 2 variant poliovirus, a high-level delegation from the Global Polio Eradication Initiative (GPEI), visited Abuja, Nigeria, 27-28 February 2025. During the visit, government, traditional leaders, and partners renewed their commitment to overcome remaining challenges to end polio in Nigeria.

The visit, conducted by the Polio Oversight Board (POB) which is the highest decision-making body of GPEI, focused on reviewing progress, addressing challenges such as insecurity and vaccine misinformation, and mobilizing increased domestic and international support for polio eradication.

Led by Dr Chris Elias, Chair of the POB, the delegation engaged in conversations with Nigeria’s government and the Sultan of Sokoto, to emphasize the need for renewed country leadership and ownership at all levels of government in the effort to stop the ongoing transmission of type 2 variant poliovirus.

Other members of the delegation included Dr Chikwe Ihekweazu, Acting WHO Regional Director for Africa, Mr Gilles Fagninou, UNICEF’s Regional Director for West and Central Africa, Mr Mike McGovern, Chair of Rotary International PolioPlus Committee, Mr Derrick Sim, Interim Chief Vaccine Programmes & Markets Officer, Gavi, the Vaccine Alliance; Mr. Massimo De Luca, Head of Cooperation at the Delegation of the European Union to the Federal Republic of Nigeria and ECOWAS and GPEI Donor Representative.

In Abuja, the delegation met with Prof Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare, who emphasized the country’s longstanding commitment to polio eradication and underscored that further dedication across the country is necessary to implement corrective measures and stop transmission for good. The POB delegation also met His Royale Highness Abubakar, Umar Suleiman, Mai Bade, representing the Sultan of Sokoto, who reaffirmed Nigeria’s steadfast commitment to polio eradication and routine immunization strengthening.

Additionally, the delegation met with Dr Muyi Aina, Executive Director and CEO of the National Primary Health Care Development Agency, and leadership from the National Emergency Operations Center. They assessed the current epidemiology of the virus and discussed the recommendations from the 42nd Expert Review Committee (ERC) on Polio Eradication and Routine Immunization in Nigeria.

The ERC, a technical body composed of experts who regularly assess the progress of a country’s polio eradication programme, met in Abuja on 29-30 January 2025 and gave a series of recommendations. To close immunity gaps and end polio transmission, the ERC urged greater political leadership, calling for active engagement of government officials and stronger accountability measures.

The ERC recommended surveillance efforts and campaign quality must be improved through proven strategies to ensure targeted vaccine coverage. To enhance operations, the ERC recommended digitalizing vaccine tracking, strengthening cold chain logistics and ensuring timely fund disbursements. Additionally, the ERC recommended routine immunization must be strengthened through integration with polio campaigns and by deploying effective social mobilization strategies to counter misinformation and vaccine hesitancy.

Throughout 2023-2024, type 2 variant poliovirus transmission levels were static despite tremendous efforts at all levels to reach every under-5 child with polio vaccines in the states that are affected by variant poliovirus. As of 15 February 2025, there were 94 confirmed polio affected children across 15 States during 2024. No type 2 variant poliovirus cases have been confirmed in Nigeria so far in 2025.

The POB delegation underscored that renewed commitment from stakeholders at all levels of the country’s robust polio eradication programme is critical to stopping the type 2 variant poliovirus from spreading within Nigeria and across neighbouring countries. Delegates further emphasized the need to accelerate the strengthening of routine immunization systems, given that optimal routine immunization coverage is key to breaking the ongoing transmission of type 2 variant poliovirus.

Together with the government, the delegation agreed that rapid progress can be possible with significant efforts coordinating across states and federal ministries. Nigerian leaders reaffirmed their commitment to bolstering polio outbreak response activities and routine immunization to protect all children against polio.

Contacts:

UNICEF Nigeria: Susan Akila, sakila@unicef.org
WHO Nigeria: Dr Walter Kazadi Mulombo, kazadimulombow@who.int
Rotary International: Olugbenga Olayiwole, National Program Coordinator, golayiwole@yahoo.com
Gates Foundation: media@gatesfoundation.org

28 February 2025, Jerusalem/Amman/Geneva – A five-day mass polio vaccination campaign in the Gaza Strip concluded on Wednesday, reaching nearly 603 000 children under 10 years of age with novel oral polio vaccine type 2 (nOPV2) following comprehensive, simultaneous access to all five governorates during the ongoing ceasefire. The campaign was conducted as part of emergency efforts to end an ongoing poliovirus outbreak and prevent further spread in the Gaza Strip.

During this round, an additional 40 000 children were vaccinated as compared to the previous two rounds conducted in September and October 2024, after poliovirus was detected in the Gaza Strip. The ceasefire enabled health workers to reach more children who had missed vaccinations due to displacement during the phased approach, living in areas that previously required special coordination for access, or being unreachable during the October 2024 round due to insecurity in North Gaza, including Jabalia, Beit Lahiya, and Beit Hanoun.

Strong community engagement and awareness of vaccination benefits had maintained high immunization rates in the Gaza Strip, where 89% of children received the third dose of oral polio vaccine in 2023, before the conflict. This round drew upon 1660 vaccination teams, 1242 of which were mobile, and deployed 1242 social mobilizers. Despite bad weather conditions, families welcomed the initiative and brought their children to points where they could receive the polio vaccine.

The campaign was conducted by the Palestinian Ministry of Health and implemented with support from the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), and other partners.

As part of the Global Polio Eradication Initiative’s commitment to mount a robust poliovirus outbreak response, surveillance for disease in children and for virus circulation in the environment has also been intensified since July 2024. It was this timely surveillance that detected ongoing environmental circulation of the virus, and the need to conduct additional vaccination to protect children.

As the ceasefire provides an opportunity to resume critical public health functions, working to recover Gaza’s previously strong disease surveillance and routine immunization are the best ways to protect children from polio and other vaccine-preventable diseases. Ending polio hinges on fully vaccinating every last child with polio vaccines. Ensuring uninterrupted access to safe water, sanitation and hygiene, and proper nutrition will protect children from many diseases including polio.

WHO, UNICEF and partners continue to call for a lasting ceasefire that leads to long-term health and peace.

26 July 2024, Cairo, Egypt – Health ministers from across the Eastern Mediterranean Region have united to address the polio emergency in the occupied Palestinian territory. The urgent need for coordinated, collective regional action to combat circulating variant poliovirus type 2 (cVDPV2) in the Gaza Strip was the focus of the 11th meeting of the Regional Subcommittee on Polio Eradication and Outbreaks. WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy convened the meeting, held virtually on 25 July 2024.

The confirmation of poliovirus adds to the multiple threats faced today by children in the Gaza Strip, who had access to robust routine vaccination services prior to the war – and raises concerns about the potential for widespread poliovirus transmission and paralytic polio. While an estimated 99% of children in the occupied Palestinian territory received their third dose of polio vaccine in 2022, this fell to 89% in 2023 according to the latest routine immunization estimates by WHO and the United Nations Children’s Fund (UNICEF).

Read more on the WHO EMRO website.

Circulating variant type 2 poliovirus (cVDPV) has been confirmed in the Gaza Strip. Virus was isolated from six environmental (sewage) samples, collected from two different collection sites in two sub-regions within Gaza, collected on 23 June 2024.

The variant poliovirus strains detected in six wastewater samples, collected from two environmental surveillance sites in Khan Younis and Deir al Balah. Further genomic sequencing of poliovirus isolates has identified that these strains have close genetic links with each other and are also closely related to the poliovirus variant that was circulating in Egypt during the second half of 2023. The last detection of the related variant polioviruses in Egypt was in samples collected in December 2023. Based on the analysis of genetic changes in the isolates, the variant poliovirus could have been introduced in Gaza as early as September 2023. It is important to note that virus has been isolated from the environment only at this time; no associated paralytic cases have been detected.

A risk assessment is being implemented, led by the Ministry of Health, including to assess surveillance sensitivity for the detection of acute flaccid paralysis (AFP) and environmental surveillance, and subnational immunity levels are being more clearly assessed.

WHO, UNICEF and UNRWA continue to work with all public health authorities on the ground, as part of urgent efforts to mitigate the impact of the current crisis on the health of populations in Gaza.  The ongoing crisis continues to pose a significant challenge to the ability to implement full disease surveillance and outreach with immunization services.

Routine immunization rates in the occupied Palestinian territory (oPt) were optimal before the start of conflict in October 2023. Polio vaccination coverage (POL3), primarily conducted through routine immunization, was estimated at 99% in 2022. This has declined to 89% in 2023, according to the latest WHO-UNICEF routine immunization estimates (WUENIC).

Currently, only 16 out of 36 hospitals are partially functional and 45 out of 105 primary health care facilities are operational. The impact on health system, insecurity, inaccessibility, population displacement, and shortages of medical supplies, coupled with poor quality of water and weakened sanitation, have contributed to reduced routine immunization rates and an increased risk of vaccine-preventable diseases, including polio.

WHO considers there to be a high risk of spread of this strain within Gaza, and internationally, particularly given the impact the current situation continues to have on public health services.

This statement was published on 19 July and was updated with additional information on 21 July.

Polio vaccination in Malawi, March24, 2022 ©WHO/AFRO

On 14 May 2024, the wild poliovirus outbreak in Malawi and Mozambique – which paralyzed nine children across the countries between February and August 2022 – was officially stopped. The virus, linked to a strain originally found in Pakistan, was unable to regain a foothold in the African region.

This incredible achievement was made possible by the tireless efforts of health workers and authorities across five countries – Malawi, Mozambique, Tanzania, Zambia, and Zimbabwe. Over two years, with support from the Global Polio Eradication Initiative (GPEI), they reached more than 50 million children through massive, coordinated vaccination campaigns and set up 15 new wastewater surveillance sites to quickly detect and respond to any trace of polio.

But that wasn’t all. The gender norms, roles, and relationships that can impact a health worker’s ability to access every household and guide a family’s decision to vaccinate their child were considered every step of the way. From planning campaigns to dropping the vaccine in children’s mouths, acknowledging and addressing these nuances was key to ensuring that every child was protected from this devastating disease.

For example, in Malawi, the program partnered closely with the Ministry of Gender to use a new tool first deployed during the COVID-19 pandemic – the Rapid Gender Assessment Tool. This tool analyzes the different impacts a disease has on women and men, with a particular focus on disadvantaged groups like women living in rural areas, to ensure policies and interventions around outbreaks provide equal protection for all. The insights from this tool proved vital for the wild polio outbreak in southern Africa.

The Ministry of Gender and the GPEI employed a gender-specific approach to tackle cultural barriers hindering immunization access. This strategy, informed by the Rapid Gender Assessment Tool and COVID-19 data, addressed key gaps. This included ensuring plans considered the different needs and roles of men and women in the community and tracking immunization rates by gender to identify and address any disparities in reaching boys and girls.

Gender-balanced vaccination teams navigated local customs to ensure access to all households. Community meetings at markets, schools and local health facilities further fostered dialogue with both men and women, ensuring everyone was informed and empowered to participate in vaccination campaigns.

Recognizing the importance of a data-driven approach, the country team developed additional monitoring and reporting formats to improve data collection. These formats captured information on gender not only of children vaccinated but also of polio teams working at all levels including decision-making, campaign implementation, monitoring and supervision.

Approaches like these, with gender at the center, helped the program make significant strides against the virus across southern Africa.

Malawi, Mozambique, and many countries still battle another threat – variant poliovirus – and as long as any kind of polio exists, every child remains at risk. The tools and tactics used to respond to the wild polio outbreak will be invaluable as countries work to end all forms of the virus for good.

MONROVIA, Liberia, 04 June 2024 – Michael Essien, the celebrated football icon and coach, along with his wife, Akosua Puni Essien, are visiting Liberia to advocate for the eradication of polio. This visit aims to support the Liberian government’s ongoing efforts to eradicate polio, and increase child immunization, coinciding with the synchronized polio campaign across Liberia and six West African countries.

Liberia, having reported a resurgence of variant polio type 2 in wastewater, is now at the forefront of a critical fight against this disease. The nation has embarked on two rounds of nationwide immunization campaigns using the novel oral polio vaccine (nOPV2) to quickly stop the spread of the virus, with the second round set to begin on 7 June. While vaccine coverage rates are showing promising progress, the battle against polio requires unwavering commitment and action.

Mr. Adolphus Clark, Expanded Programme on Immunization (EPI) Manager in Liberia, has expressed his optimism about the campaign, stating, “Our collective efforts have brought us closer than ever to a polio-free Liberia. With the support of Michael and Akosua Essien and our global partners, we are renewing our commitment to ensure that every child is protected from this preventable disease.”

The campaign is one of hope and determination. Despite the challenges, the number of variant poliovirus cases has significantly declined, with no children paralyzed by polio since 2021. The focus remains on reaching zero cases and maintaining vigilance until polio is eradicated from the region and the world.

During their visit, the Essiens have engaged in a learning trip focused on immunization and polio eradication efforts in Liberia, understanding the vaccine infrastructure, and listening to personal stories from families and children receiving vaccines as well as the health care workers administering them. Michael also participated in a friendly football game with young athletes in Liberia.

Akosua Puni Essien has expressed her enthusiasm for the eradication efforts in Liberia, stating, “It is inspiring to see the coordinated efforts in Liberia to ensure every child receives vaccination to protect them from the polio virus. I urge all parents and caregivers to ensure that children under the age of five-years-old receive their vaccines – the polio vaccine is free, safe, and crucial for protecting our children from this devastating disease.”

The collective efforts of frontline workers, communities, local governments, Rotarians, and other global partners have been instrumental in the fight against polio in Liberia and worldwide. With continued dedication and support, the goal of eradicating polio in Liberia and Africa is within reach.

“Through unity and determination, most of the world has overcome the shadow of polio. Let its eradication be a beacon of hope, reminding us that with perseverance, even the most daunting challenges can be conquered,” said Michael Essien. “I am inspired by the tenacity of the Liberian people, and I know that together, we will finish the job so no child ever has to live in fear of polio again.”

The Essiens’ visit has been organized by the Gates Foundation and UNICEF, in coordination with the government of Liberia.

“The visit of Michael and Akosua Essien underscores the power of partnership in our fight against polio. Their presence boosts confidence in vaccination and highlights our shared commitment to a polio-free future for every child in West and Central Africa. Together, we can make polio history,” said Andy Brooks, UNICEF Representative in Liberia.

Notes to Editors

Photos from the visit are available upon request from: Mostafa Omar mosomar@unicef.org

Liberia Polio Situation

Liberia reported two variant polio type 2 detections from environmental sampling in 2023 and 6 so far in 2024. Environmental surveillance involves testing sewage or other environmental samples for the presence of poliovirus, often confirming it in the absence of clinical cases of paralysis. This comes after a period of almost two years without any detection of variant polio type 2 in Liberia. There have been no symptomatic cases in children since 2021. As a result, Liberia has been prioritized for 2 rounds of nationwide nOPV2 campaigns, with the first round implemented on 10 May synchronized with six West African countries and the second round scheduled to begin on 7 June.

Routine Immunization Overview in Liberia

Liberia has introduced seven vaccines into their routine immunization schedule: Pneumococcal Conjugate Vaccine (PCV), Rotavirus (RV), Inactive Polio Virus (IPV), Haemophilus Influenzae Tue B (HIB), Typhoid, and Measles containing vaccine (MCV2). Latest coverage rates from the 2023 WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) data report range from 78% for HIB to 59% for MCV2. IPV coverage rates have recently improved from 66% in 2019 to 71% in 2022.

The President of the Republic of Madagascar, Andry Rajoelina, and the First Lady, Mialy Rajoelina, received a high-level delegation from the Global Polio Eradication Initiative (GPEI) on April 25, 2024 in Ambohitsorohitra palace in the capital, Antananarivo.

The delegation included the Regional Director of the World Health Organization (WHO) for Africa, Dr Matshidiso Moeti, the President of the Polio Oversight Board, Dr Chris Elias, the Regional Director of UNICEF for Eastern and Southern Africa, Etleva Kadilli, and the Director of Health Systems Strengthening and Immunization from Gavi, the Vaccine Alliance, Alex de Jonquieres.

To read more about the meeting, a press release is available here in French.

To strengthen the fight against polio, health ministers from across the WHO Eastern Mediterranean Region gathered virtually for the 10th meeting of the Regional Subcommittee on Polio Eradication and Outbreaks. It was the first meeting of the Subcommittee convened by the new WHO Regional Director for the Eastern Mediterranean, Dr Hanan Balhky.

Her Excellency Dr Hanan Al-Kuwari, Minister of Public Health, Qatar, and Subcommittee Co-chair, welcomed Dr Balhky’s determination to end polio during her tenure. His Excellency Mr Abdul Rahman Mohammed Al Oweis, Minister of Health and Prevention of the United Arab Emirates, and Subcommittee Co-chair, represented by His Excellency Dr Hussain Al Rand, also expressed enthusiasm that Dr Balkhy’s vision and expertise promise to propel regional efforts, bringing the world closer to eradication.

Read more on the WHO EMRO website

The stories below highlight some ways in which women are breaking barriers, driving change and inching us closer to a polio-free world wherever they take charge – from doorsteps to laboratories to decision-making tables.

Driving regional solidarity for polio eradication

Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean

Dr Hanan Balkhy made history in February 2024 when she became the first woman to take up the post of WHO Regional Director for the Eastern Mediterranean. With unwavering determination, she embarked on her new role with a clear vision: to eradicate polio during her tenure.

In her nomination speech, she shared her inspiration, drawn from success stories of joint efforts across the WHO Eastern Mediterranean Region. Dr Balkhy fervently believes in the need for collective action to overcome the obstacles in the path to polio eradication.

Dr Balkhy will convene the Regional Subcommittee for Polio Eradication and Outbreaks. To champion the Region’s work to consign polio to history, she will support the regional polio eradication programme, remove obstacles and work closely with global and regional decision-making bodies.

She calls upon all stakeholders to unite with resolute determination until polio becomes nothing more than a distant memory.

Blazing a trail with the Regional Subcommittee

Her Excellency Dr Hanan Mohamed Al Kuwari, Minister of Public Health, Qatar

An inspiration to women globally, Qatari Minister of Public Health H.E. Dr Hanan Mohamed Al Kuwari has been harnessing decision-makers’ power to galvanize action for polio eradication.

As Co-Chair of the Regional Subcommittee for Polio Eradication and Outbreaks since 2022, she has created a strong sense of solidarity among Member States of the Region and partners, reminding them of the urgent need to prioritize polio eradication. Using every possible chance to highlight the challenges faced by countries with wild or variant poliovirus cases, she has mobilized action to reach vulnerable children with polio vaccines and other health services.

Dr Al Kuwari has used her platform and voice to reveal issues faced by polio eradicators in the Region and offer solutions. At the same time, she has raised the visibility of the trailblazing Regional Subcommittee’s goals and work.

Read more on the WHO EMRO website.

Economic and social benefits totalling an estimated US$ 289.2 billion arise from sustaining polio assets and integrating them into expanded immunization, surveillance and emergency response programmes in 8 countries of the Eastern Mediterranean Region, the study reveals. As the present cost of this work is US$ 7.5 billion, this means that for every dollar spent, the return on investment is nearly US$ 39.

WHO commissioned the Victoria Institute of Strategic Economic Studies, Australia, to conduct the study, which is the first of its kind. It covers 8 polio transition priority countries in the Region: Afghanistan, Iraq, Libya, Pakistan, Somalia, Sudan, Syria and Yemen. Many of these countries are fragile, with challenges ranging from weak health systems and low routine vaccination coverage to political instability.

[1] Energizing health: accelerating electricity access in health-care facilities. Geneva: World Health Organization, the World Bank, Sustainable Energy for All and the International Renewable Energy Agency; 2023. Licence: CC BY-NC-SA 3.0 IGO
[2] https://www.unicef.org/innovation/stories/using-sun-keep-vaccines-cool
[3] https://apps.who.int/iris/bitstream/handle/10665/254715/WHO-IVB-17.01-eng.pdf;sequence=1
[4] https://www.gavi.org/vaccineswork/drcs-solar-revolution
[5] https://polioeradication.org/news-post/protecting-against-polio-in-lake-chad/
[6] https://www.afro.who.int/news/who-delivers-solar-panels-accredited-polio-laboratory-borno-state

Stopping any polio outbreak starts with vaccine procurement, transport by airplanes and trucks, distribution involving complex logistics, and eventually the oral administration of the vaccine by drops in the mouths of every eligible child.

However, there is another, lesser known but equally important process that must also take place to halt transmission of the poliovirus. It begins with a humble stool sample – a thumb-sized smudge of poop – taken from a child with acute flaccid paralysis (AFP), then delivered to the nearest laboratory that can test the sample specifically for poliovirus.

But nowhere in Yemen is there any such lab. So the long and arduous journey of any stool sample from a Yemeni child to a receiving lab can take up to several days – following an easterly route, to the neighboring country of Oman.

An explanation of how stool samples are transported over such a distance starts with why: monitoring children under 15 years of age for signs of AFP, which is the most common sign of poliovirus infection. The Global Polio Eradication Initiative has set a benchmark of at least three AFP cases per 100,000 children under 15 years of age, a standard that Yemen has consistently met, thanks to the effectiveness of its surveillance system. This achievement is all the more remarkable considering that Yemen is entering its ninth year of internal conflict, with resulting population displacements, widespread food and fuel shortages, and a devastated health system (in which only 46% of hospitals and health facilities are only partially functioning or completely out of service).

Read the rest of the story here.

Antananarivo – Quality assurance surveyor Anja Mandimbisoa arrives at a random lot numerically selected, throws her pen in the air, and whichever house it is pointing at when it lands is the next on her evaluation list. With their consent, she then sits down with the family to verify whether the children in the household have the mark on their little fingers confirming they have been vaccinated against polio.

“The fact that it is a random selection provides a true picture of immunization coverage at the district level,” explains Mandimbisoa, one of 16 external Lot Quality Assurance Sampling (LQAS) surveyors trained by World Health Organization (WHO) in Analamanga region, Madagascar, to identify any missed children.

As the country concludes its third round of polio vaccinations this year, the response reflects that the job to end polio does not end with the conclusion of a vaccination round. Instead, it is the actions between rounds that make all the difference.

Read more on the WHO AFRO website.

A child from the Roma community receives oral polio vaccine at a community health care centre in Mukachevo district, Ukraine, on 27 February 2023. © WHO/EURO

WHO/Europe has declared an outbreak of poliovirus in Ukraine, detected in October 2021, officially closed. The European Regional Commission for the Certification of Poliomyelitis Eradication endorsed the closure of the outbreak during its annual meeting on 8 September 2023. The country has achieved this milestone – stopping transmission of the virus that threatened the lives and futures of its children and preventing spread to other countries – in the face of the ongoing war.

The comprehensive outbreak response, initiated by the Ministry of Health of Ukraine in December 2021, faced multiple challenges since the end of February 2022, including massive population displacement, destruction of health-care infrastructure and disruption of logistical routes for medical product deliveries.

“Stopping the spread of poliovirus in the midst of a devastating war is a major achievement and a clear demonstration of the highest level of political commitment of the Government of Ukraine to the welfare of its population,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

“In the face of unprecedented challenges, the necessary steps taken by the Ministry of Health of Ukraine to prevent the spread of poliovirus within and beyond the borders of Ukraine are immensely commendable.”

The decision to close the outbreak was based on:

the recommendations of a poliovirus outbreak response assessment (OBRA) conducted by Global Polio Eradication Initiative (GPEI) partners, including WHO, in May 2023;
additional documentation provided by Ukraine in support of the ongoing surveillance, immunization and communication efforts since May; and
a comprehensive review of poliovirus surveillance and vaccination performance in the countries hosting the majority of the Ukrainian refugee population.

The outbreak was first detected in a young child in Ukraine in October 2021, following the importation of a poliovirus that had emerged in Pakistan and was previously detected in Tajikistan in 2021. A second child became paralysed in December 2021, and an additional 19 close contacts tested positive without developing symptoms.

“The Ministry of Health of Ukraine declared importation of this poliovirus a local public health emergency, and acted swiftly since its detection in close coordination with the global public health community,” said Dr Viktor Liashko, Minister of Health of Ukraine.

Dr Liashko continued, “The outbreak is now closed, but our work to prevent polio and other vaccine-preventable diseases in Ukraine continues despite all obstacles. As long as polio remains a threat globally, Ukraine will remain vulnerable. The Ministry of Health is committed to strengthening vaccine-preventable disease surveillance and working to achieve and sustain high routine immunization coverage nationwide to protect every child.”

What does it take to stop a polio outbreak?

In October 2021 the detection of poliovirus in Ukraine triggered the declaration of a public health emergency in affected oblasts, the creation of a response working group with technical support from GPEI and WHO specialists, and an immediate epidemiological investigation including contact tracing and environmental sampling at a summer camp, school and residences where the virus had been initially detected.

Health workers take a wastewater sample at a sewage site near Uzhgorod, Ukraine on 28 February 2023. © WHO/EURO

On 30 December 2021 the Ministry of Health approved an action plan in response to the outbreak that included, among other initiatives, an accelerated immunization catch-up campaign for children aged 6 months to 6 years who had not received the required doses through routine immunization.

The campaign began in mid-February 2022, but its scale and pace were significantly affected by the war in Ukraine. GPEI partners including WHO provided technical and operational support tailored to the context to build capacity and strengthen routine immunization services, disease surveillance, communication and transportation of samples to reference laboratories abroad.

Dr Jarno Habicht, WHO Representative in Ukraine, coordinated the WHO response within the country. “WHO and GPEI partners have been on the ground from day one, supporting Ukraine’s health authorities, medical and public-health professionals, laboratory staff, and communities to keep this virus from spreading,” he explained. “The excellent collaboration and perseverance of the local and international teams to protect children in the most difficult of circumstances has been truly inspiring.”

Despite the many challenges in implementing the national action plan for the outbreak response, no new detections of poliovirus were identified after December 2021. The OBRA conducted in May 2023 assessed the critical components of the outbreak response, such as the quality of surveillance (and thereby the risk of undetected poliovirus transmission), planning and coordination, the vaccination campaign, routine immunization performance, communication, and vaccine management. Based on the field assessment and review of the documentation, the OBRA concluded that poliovirus was no longer circulating in Ukraine.

The OBRA in Ukraine was followed by a comprehensive review of actions taken by Bulgaria, Czechia, Hungary, Poland, the Republic of Moldova, Romania and Slovakia. This was coordinated by WHO/Europe with financial support from the United States Agency for International Development (USAID).

The review assessed the actions to expand capacities to detect the virus, identify gaps in vaccination coverage and increase coverage of the local populations hosting Ukrainian refugees, and offer vaccination to refugees entering from Ukraine. This review, along with the additional information provided by Ukraine on actions implemented during the months following the OBRA, enabled WHO/Europe to declare the outbreak officially closed.

Mr Robb Butler, Director of the Division of Communicable Diseases, Environment and Health at WHO/Europe, stated, “Ukraine has been steadfast in recent years in its efforts to achieve and sustain high routine vaccination coverage, and within the realm of the European Immunization Agenda 2030, WHO/Europe will continue to support health authorities to prevent further outbreaks of vaccine-preventable diseases including polio, measles, diphtheria and many more.”

Mr Butler concluded, “Tremendous credit goes to the health professionals and parents who continue to make every effort to vaccinate children on schedule to protect them from the threat of polio and other diseases, even while navigating the daily realities and dangers of war.”

Geospatial Tracking Systems have a critical role to play in the monitoring of vaccination teams during polio outbreak response campaigns. With support from the World Health Organization (WHO) and the rest of the Global Polio Eradication Initiative (GPEI), the mobile application was most recently utilized in Brazzaville during a national vaccination campaign from June 9 to 11, 2023, led by Congo’s Ministry of Health. Read more on the WHO Afro website.

Dr Abdellatif Abdelwahab, Public Health Officer of White Nile State (left), collecting stool samples from Sennar State on his way to Gezira State. © WHO/Sudan

One of the first tasks they took on was to find ways to detect the possible spread of an outbreak of variant poliovirus that was confirmed in December 2022 after a paralysed child living near the border with Chad tested positive for the virus. Immediately after the start of the conflict, they worked to maintain the essential function of surveillance for acute flaccid paralysis (AFP) – the most common symptom of polio – in children.

Prioritizing essential polio functions

Much like a relay race, in AFP surveillance, speed and coordination are key. Once health teams find a child with AFP, the race begins. But emergencies often present additional hurdles. In one of the localities in Sudan’s White Nile state, Ahmed Masaood, a health worker, was tasked with collecting two stool samples from a child presenting with AFP. However, when the roads outside turned unsafe during Ahmed’s visit, he ended up having to seek refuge with the family he was visiting for two nights. As soon as he could, he rushed to the state cold room with his stool carrier to drop off the samples for storage until they could be tested.

The next lap of the race involves getting children’s stool samples to a WHO-accredited laboratory for testing. Due to the conflict, Sudan’s polio laboratory is not functioning, which meant the polio programme urgently needed to look for another laboratory to test stool samples to determine if children presenting with AFP had indeed been infected with poliovirus.

In a remarkable partnership, Sudan’s polio programme teamed up with Egypt’s health authorities to use the VACSERA laboratory in Giza for this crucial task. Senior decision makers at the Egyptian Ministry of Health not only approved the collaboration but instructed for it to begin as soon as possible.

Finding solutions for new challenges

Dr Ameir Ibrahim, WHO Public Health Officer of Gezira State (right), and the State Cold Chain Officer of the Ministry of Health checking that stool samples are stored at optimum temperature. © WHO/Sudan

In June, the polio programme in Sudan completed a pilot mission to transport stool samples to the VACSERA laboratory for testing. With the conflict impacting movement and security on the roads, creativity was required to get the samples from collection points identified, such as Gezira to Port Sudan to Dongola, all the way to the border. Throughout, health workers relied on two criteria to ensure safe passage for themselves and their cargo: first, their neutrality, and second, their status in communities. The health workers who made this happen are known to and trusted by the communities they serve, and that trust, in many cases built over decades, facilitated their travel by road.

The first shipment of stool carriers passed through five stops in different states following a pathway assessed for security considerations. In Red Sea state, Dr Thabit Mohammed Elsadig, a WHO Public Health Officer, spent three days pulling together all the resources drivers would need, from permits and security clearances to cash, fuel and food. As the situation was formally graded as a level three emergency, this triggered WHO’s Emergency Response Procedures, effectively enabling staff to respond and repurpose resources at speed. In some cases, Dr Thabit and others used their own resources to make things happen.

At each stop, health workers picked up more stool samples from their colleagues. They checked temperature controls in the sample carrier and replaced old ice packs with fresh ones to maintain temperature and handling protocols of the reverse cold chain.

With the occupation of the National Public Health Lab in Khartoum by one of the parties, Hatim Babiker Othman, National Coordinator for the Polio Lab in Sudan, moved to Port Sudan during the first month of the conflict and started to restructure the polio lab’s functions. He organized samples in small boxes, assigned lab numbers, and established effective communication with the focal point in Egypt, to coordinate the handover of samples. Hatim traveled with the samples from Port Sudan to Atbara, Dongola, and finally, the Argeen border crossing point.

Meanwhile, WHO colleagues contacted the Egyptian Ministry of Health to confirm that, at last, the samples were on their way to the border. At the Argeen Gate, border officials examined the boxes and their contents. Dr Thabit recalled thinking that if anything went wrong at this point, all their efforts – days of planning and transport by road – would have gone to waste.

“The sample carriers were like trunks of gold for us. We hoped they would treat them well, and they did,” he said, with reference to their value in signaling any epidemiological developments related to the ongoing variant poliovirus outbreak.

Exemplary inter-country support

Once they received a prompt from WHO, a team from Egypt’s Aswan Governorate of Health set out on a six-hour journey to the shared border. There, they collected the samples and headed back to the health facility in Aswan for more fresh ice packs before driving to the VACSERA laboratory in Giza, a 14-hour drive away. The entire journey from Madani, Sudan, to Giza, Egypt, can take up to 56 hours and demands absolute precision in planning and execution.

Acknowledging Egypt’s generous support, Dr Ni’ma Saeed Abid, WHO’s Representative in Sudan said, “Our partners in Egypt have demonstrated how strong inter-country collaboration can help in ending diseases. We remain grateful to them for their timely support, and to every link in this chain of coordination. This support is a demonstration of ‘delivering as one WHO’.”

On 16 June 2023, VACSERA received a shipment of 56 stool samples for testing for poliovirus. Lab personnel prioritized Sudan’s samples for immediate testing, and the testing process began on the day of arrival. Final results were shared in 11 days — a full 10 days less than the standard three weeks. The results were also good news: no sample tested positive for variant poliovirus.

“Our heroic health workers stayed to deliver our mandate and support the most vulnerable communities in the face of the ongoing conflict,”
Dr Nima said. “They are continuously finding extraordinary solutions to continue to protect children from polio and other vaccine-preventable diseases. This is a lesson to be followed by the integrated disease surveillance team. It reinforces what we believe in: everything is possible, with strong determination and will.”

Dr Thabit (extreme right) and Hatim Babiker (second from left) handing over stool samples to the focal points from Egypt, at the Argeen border crossing point. © WHO/Sudan

For additional information on how the Sudan conflict affected the polio programme and health systems in the country, please watch this video.

Once children are vaccinated against polio, they are marked on their fingers to confirm their vaccination status. © WHO/AFRO

With 117 confirmed cases of circulating variant polioviruses and 107 detections in sampled wastewater so far in the African Region in 2023, the Africa Regional Certification Commission (ARCC) has urged countries and health partners to urgently address gaps in polio immunity to avert outbreaks.

The ARCC, which held it 31st meeting in the Democratic Republic of the Congo from 3 to 7 July, also called for an accelerate implementation of supplementary immunization activities, while considering challenges in accessibility to services including gender-related issues. The commission stressed the importance of gender equality in the polio fight, noting the crucial role women play in management, supervision, decision-making, message development and monitoring for polio control. The ARCC also urged countries to conduct robust preparations and ensure the vaccination campaigns are of the highest quality.

“The guidance will allow health authorities and partners to provide focused support to strengthen microplanning and social mobilization in areas with poor campaign performance, among other key areas of action“ said Professor Rose Leke, head of the Africa Regional Certification Commission.

The meeting gathered representatives of national and provincial health authorities from Chad, the Democratic Republic of the Congo, Ethiopia, Madagascar, Mali and Mozambique who committed to strengthen disease surveillance and consolidate the Expanded Programme on Immunization in hard-to-reach areas, with the support of the World Health Organization (WHO) and health partners.

Attendees took note of the increasing risk of poliovirus type 1 beyond Madagascar and the DRC, especially with the deterioration of routine immunization during the COVID-19 pandemic. Concerns were also raised regarding the persistently security-compromised areas, especially in Nigeria, that are impeding the elimination of circulating variant poliovirus type 2 (cVDPV2).

The commission, therefore, encouraged health authorities to also expand the use of Geospatial Information Systems to improve quality of surveillance and outbreak response.

“We are looking forward to implementing the additional ARCC recommendations to guide how we can deliver on the promise of polio-free Democratic Republic of the Congo and Africa,” said Dr Serge Emmanuel Holenn, Deputy Minister of Health of the Democratic Republic of the Congo, who applauded the commission, WHO and the Global Polio Eradication Initiative partners for the continued financial and technical support in the fight against polio in the country.

In addition to the DRC, Chad, Ethiopia, Madagascar, Mali and Mozambique also presented progress in polio control and lessons learned. Although certification of polio eradication occurs at the regional level, all countries with polio-free status are required to provide the certification commission with annual updates. These containment reports and outbreak preparedness plans allow for continuous monitoring.

The ARCC commended health authorities for their leadership in responding to ongoing polio outbreaks, as “this reflects the deep commitment and continued collective efforts by African countries and partner organizations to the fight against polio,” said Professor Leke.

The ARCC is an independent body established in 1998 to oversee the certification status of the African region as free from indigenous wild poliovirus. It continues to evaluate reliability of data in documentation submitted by National Certification Committees to ensure that countries are adhering to the criteria set for the global certification of wild polio virus. The ARCC meets twice a year to review progress made in the annual certification updates of selected countries on polio eradication activities of all the 47 member’s state of the WHO African region.

Originally published on the WHO AFRO website.

Global leaders and stakeholders have been unanimously declaring their solidarity to achieving a lasting world free of all forms of polioviruses.

Convening this week at the World Health Assembly in Geneva, Switzerland, Ministers of Health from around the globe evaluated the unique epidemiological opportunity which currently exists, in particular in eradicating all remaining chains of endemic wild poliovirus in a handful of districts of just two countries – Pakistan and Afghanistan. As a record number of Member States and civil society partners took to the floor, key to success, all experts agreed, must be on adapting operations and reaching remaining un- or under-immunized children in just seven subnational most consequential geographies, with collectively account for 90% of all new polio cases, including in a gender-equitable and integrated manner. To ensure lasting success, delegates urged country-specific solutions for polio transition. In response to both a wild poliovirus outbreak in south-eastern Africa and multi-country circulating vaccine-derived poliovirus outbreaks, extraordinary special sessions were led by WHO and its Regional Office for Africa between affected Member States and partners, to discuss concrete steps to stopping all outbreaks affecting the Region by end of year.

The World Health Assembly comes on the heels of last week’s G7 Leaders and G7 Health Ministers meetings in Japan, where both meetings highlighted the urgent need to ensure a world free of polio can be rapidly achieved. Next week, Rotarians from around the world are convening at the Rotary International Convention in Melbourne, Australia, to ensure civil society support for the effort will go hand-in-hand with public sector engagement.

Speaking on behalf of both Pakistan and the entire Eastern Mediterranean, Mr A.Q. Patel, Pakistan Federal Minister for National Health Services, Regulations and Coordination, said: “We are in the final leg of eradication and we are doing everything we have to do to achieve success. The virus is restricted to its smallest-ever geographical footprint, and the (polio) programmes in both Pakistan and Afghanistan continue to vastly expand their hunt for the virus and mount robust campaigns to reach all children, not just with polio vaccine, but indeed other antigens as well. We could not have come this far without the strong support and goodwill of all Member States, however there is still more to be done at the heart of all our work, and for the future of all generations of children. We need continued and sustained financial and political support from all Member States and partners, in order to give every child, no matter where they live, the promise of a polio-free world.”

H.E. Dr Hanan Mohammad Al-Kuwari, Minister of Public Health of Qatar, and Co-Chair of the Eastern Mediterranean Regional Subcommittee for Polio Eradication and Outbreaks, commented: “In our Region, we have made significant progress in both containing the spread of wild poliovirus and closing outbreaks of vaccine variant polio. Afghanistan and Pakistan have restricted the virus to the smallest geographical footprint in history and are now doubling up efforts to fully interrupt the remaining transmission. The engines fueling this progress are manifold, but the two most powerful, and the two I truly believe will get us across the line, are improved immunity and better surveillance. We are reaching and vaccinating more children, more often, and we are using the most sensitive and robust surveillance measures in history to ensure that if the virus is there, we are not missing it. Excellencies, partners and colleagues, I ask this as clearly as I can: Stay the course. Dig deep to do what needs to be done. Stand with us and be part of history.”

Noting the global commitments being made, Jean-Luc Perrin, Rotary International’s Representative to the United Nations in Geneva, told the global health community at the Assembly: “Polio eradication is a rare example of enduring, truly global collaboration toward a goal whose achievement will benefit all nations in perpetuity, while contributing toward broader global health priorities. We cannot take progress or possible victory for granted. Let us make collective history and End Polio Now!”

In conclusion: global leaders continue to note the very real window of opportunity for success this year, but that this window will not remain open for long. The virus will again gain in strength. Only collective and global collaboration will result in ultimate success, and delegates and leaders urge all stakeholders to keep the focus firmly on one overriding objective: reaching remaining un- or under-vaccinated children in the most consequential geographies. A collective responsibility, but if achieved, will result in success in 2023.

Additional quotes from the World Health Assembly:

“WHO and our partners remain steadfastly committed to finishing the job of consigning polio to history. Last year, three million children previously inaccessible in Afghanistan received polio vaccines for the first time. And in October, donors pledged US$2.6 billion to support the push for eradication. At the same time, as part of the polio transition, more than 50 countries have integrated polio assets to support immunization, disease detection and emergency response. We must make sure that the significant investments in polio eradication do not die with polio, but are used to build the health systems to deliver the services that these communities so badly need.”- Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

“Wild poliovirus transmission has been cornered to the smallest ever geographic locations in the Eastern Region of Afghanistan and seven districts in southern part of Khyber Pakhtunkhwa in Pakistan. However, the last 100-metre dash presents its own challenges and we must do all we can to achieve success.” Dr Hamid Jafari, Director for Polio Eradication for the Eastern Mediterranean, on behalf of Dr Ahmed Al-Mandhari, Regional Director, World Health Organization Eastern Mediterranean Region

“The African Region, which was certified free of wild poliovirus in 2020, has set itself the objective of stopping the transmission of all types of 2 polioviruses by the end of 2023 and integrating polio assets into activities that strengthen broader disease surveillance. It is also deploying integrated public health teams to respond to other emergencies, building on experiences from past poliovirus outbreaks and leveraging the polio network and infrastructure for response activities.” – Delegation of Burkina Faso, speaking on behalf of the entire African Region.

A child receiving the life-saving polio drops. © WHO

A key priority in 2023 is to end both wild- and variant polio transmission around the world is focusing on the most consequential geographies where children are at the highest risk of encountering and spreading the virus, and which collectively accounted for 90% of all new polio cases worldwide in 2022. Northern Nigeria is one of these seven subnational areas that now hold the key to a polio-free world.

In Nigeria increased vaccination and surveillance efforts have yielded positive results in 2022: No isolates from the country’s main historical transmission chain, the Jigawa lineage, which was responsible for most cases and international spread to many neighbouring countries in West Africa, have been detected since February 2022. There was a decline from 1028 cases as on 31st December 2021 to 168 cases as on the 31st December 2022. As a result, the virus is currently confined primarily to two states in the northwest zone of the country, namely Sokoto and Zamfara. This presents a distinctive opportunity for Nigeria to interrupt transmission by December 2023, according to the Expert Review Committee for Polio Eradication and Routine Immunization (ERC), the independent technical group advising the country on its eradication efforts.

In February 2023, the ERC convened its 39th meeting in Nigeria to make recommendations aimed at interrupting transmission of variant type 2 polio and maintaining its indigenous wild poliovirus-free certification status along with the entire African Region. Led by the Ministry of Health’s National Primary Healthcare Development Agency and supported by GPEI partners, Nigerian civil society and Rotarians across the country, efforts are intensifying to fully implement the National Polio Emergency Action Plan (NPEAP).

The country has developed a comprehensive National Polio Emergency Action Plan (NPEAP) to address the risks of all poliovirus types in order to ensure Nigeria and the entire Region’s certification status is maintained, within the context of the political transitioning process, the impact of COVID-19 on the national health systems and economy as well as the increasing concerns of insecurity affecting surveillance and vaccination reach. All recommendations made by the ERC are aimed at aligning the NPEAP with the 2022-2026 Global Polio Eradication Initiative (GPEI) Polio Eradication Strategy.

Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria

The ERC noted that the proposed activities for 2023 are contingent on three critical enablers, namely the global stockpile of novel oral polio vaccines (nOPV2) and bivalent oral polio vaccines (bOPV), constraints in financial resources, and a smooth political transition to drive political commitments at sub-national levels. Given the impact of variant type 2 poliovirus over the last few years, there should be limited room for complacency to reach the finish line for the interruption of these strains. The ERC, therefore, called on all partners to support the implementation of the NPEAP for 2023.

The conference also highlighted some of the achievements made in the fight against polio in Nigeria. The conference also highlighted some of the achievements made in the fight against polio in Nigeria. In 2022, there was an 84% decline in variant type 2 poliovirus cases, reduced from 415 cases in 2021 to 48 in 2022. The quality of Supplemental Immunization Activities (SIAs) improved, especially in the last quarter of 2022, and there were narrowed surveillance gaps at sub-national levels. Routine immunization (RI) coverage also improved from 33% in 2016 to 57% in 2022, and COVID-19 vaccination was also optimized to improve demand generation and delivery of other essential immunization vaccines.

The ERC made recommendations in nine thematic areas to fully implement the National Polio Emergency Action Plan, including by continuing to strengthen surveillance, mitigate risks due to inaccessibility and insecurity, build a more resilient routine immunization programme, assure solid vaccine management and advocate for a polio-free Nigeria.

In conclusion, 2023 is a critical year for polio eradication efforts in northern Nigeria and the other most consequential geographies for poliovirus transmission. The global community must continue to support these efforts to ensure that no child is left behind, and we can finally achieve a polio-free world.

The meeting came at a time of contrasts for polio eradication efforts. On the one hand, the Region’s most recent case of wild poliovirus was reported almost 5 months ago, in Pakistan, and the footprint of the virus is the smallest it has ever been. Additionally, efforts to search for polioviruses have never been stronger and the polio programme has made significant progress in accessing under-immunized children across a number of high-risk countries in the last year. On the other hand, the Region hosts 4 of the world’s 7 ‘consequential geographies’ – low-resource, high-risk areas in Afghanistan, Pakistan, Somalia and Yemen that the programme has identified as carrying a significant risk of spread of polio.

WHO’s Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, who convened this virtual meeting, set the tone for the event by coining 2023 as a “defining year” for polio eradication.

He urged all Member States and partners to leverage the opportunity and momentum of the current moment and scale up collective efforts to wipe out polio. “Going forward, our regional solidarity and concerted action will be even more important, as we move closer to making history and ending polio,” said Dr Al-Mandhari.

Leading the demonstration of regional support to polio were the Co-chairs, Minister of Public Health of Qatar, HE Dr Hanan Al Kuwari, and Minister of Health and Prevention United Arab Emirates, HE Mr Abdul Rahman Mohammed Al Owais. They urged participating Member States to strengthen routine immunization and consider polio as “all of our problem” until transmission ends everywhere. They also called on Member States to offer all they can – funding, advocacy or technical expertise – to reach every child with vaccines.

Participants at the meeting also included ministers of health and senior delegates from countries in the Region, in addition to representatives from the Bill & Melinda Gates Foundation (BMGF), the Centers for Disease Prevention and Control (CDC), Gavi, Rotary and UNICEF.

In his address, the Minister of National Health Services Regulations and Coordination of Pakistan updated the audience of the timely and robust programmatic actions the country has been taking to end polio. In the face of catastrophic floods, the country turned response efforts into an opportunity to offer polio vaccines to children wherever possible. Additionally, Pakistan is using creative ways, such as truck art, to reach out to vulnerable communities living in hard-to-reach areas.

During discussions, the delegate from Egypt and the Minister of Health of Yemen offered updates on their polio eradication efforts, while delegates from Iraq and Saudi Arabia proposed actions to prevent the spread of polio during mass religious gatherings in their countries.

Member States and partners acknowledged the immense efforts directed at ending polio in the 2 countries where it is still endemic – Afghanistan and Pakistan – particularly in the wake of the earthquake and catastrophic flooding that took place in 2022, and the extraordinary political will and engagement in both countries. They also noted the work ongoing in countries witnessing outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2), and lauded health workers for their valour and dedication to their work.

Member States issued 2 statements following the meeting. One called for the international development and humanitarian communities and donors to scale up support to the National Emergency Action Plans for Afghanistan and Pakistan. A second statement called for international partners to provide essential services, including a robust vaccination response, to polio outbreaks in Somalia and Yemen. In Yemen’s northern governorates, amidst a surge of anti-vaccine propaganda, a long-overdue outbreak response has still not been launched, and Somalia is experiencing the longest ever cVDPV2 outbreak.

Member States also reiterated the importance of focusing on zero-dose children, and strengthening routine immunization and surveillance in countries that are polio-free and those that currently have polioviruses. They also commended Regional Director Dr Al-Mandhari for his leadership and requested him to continue to support Member States in the Region to push towards ending polio and attaining Health for All by All.

While updating participants on a recent visit made by a high-level mission to Pakistan last year, a representative from the BMGF, on behalf of Dr Chris Elias, the Chair of the Polio Oversight Board, acknowledged the extraordinary and unmatched efforts made in Pakistan by the political and health leadership, law enforcement and security agencies, to prevent any further spread of polio. Despite the flooding and political changes the country has faced, the polio programme continued to “shift gears” and mount a swift and robust response to polio. This was one of several visits that high-level missions have been making to Pakistan in support of eradication efforts.

In closing remarks, WHO representatives recognized Iraq and Syria for the strides both countries have taken to maintain essential polio functions, including in polio surveillance, while concurrently transitioning away from funding from the Global Polio Eradication Initiative.

The seventh meeting of the Regional Subcommittee for Polio Eradication and Outbreaks demonstrated the high level of confidence that Member States and partners have in the 2 remaining polio-endemic countries, Afghanistan and Pakistan. As polio remains a Public Health Emergency of International Concern under the International Health Regulations (2005), the intensified regional- and international-level collaboration of Member States and partners at events like this will serve as a springboard for focused action in 2023.

Note for editors

The Polio Oversight Board is the highest decision-making body in the Global Polio Eradication Initiative (GPEI). It brings together senior leadership of the 6 GPEI partner agencies—the Bill & Melinda Gates Foundation (BMGF), U.S. Centers for Disease Control and Prevention (CDC), Gavi, Rotary International, UNICEF, and the World Health Organization (WHO)—along with a representative of the GPEI’s donor community.

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, visited Pakistan in his role as Chair of the Polio Oversight Board at the time. Following this, since mid-2021, the Polio Oversight Board* made 3 visits, and Mr Bill Gates of the BMGF visited in February 2022.

Acknowledging that our common goal is to attain ‘Health for All by All’, which is a call for solidarity and action among all stakeholders;

Noting the progress achieved globally in eradicating poliovirus transmission since 1988;

Noting with deep concern the challenges involved in stopping ongoing outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Region, without full access to vaccinate all vulnerable children in the affected populations;

Observing with alarm the prolonged outbreak in Yemen and the persistent restrictions on implementing outbreak response vaccination in the country’s northern governorates, and further observing that the cVDPV2 outbreak which has been continuing since 2017 is the world’s longest ongoing such outbreak;

Recognizing the Global Polio Eradication Initiative’s efforts to target its resources in the most impactful way by identifying particular areas affected by polio, including Yemen’s northern governorates and south-central Somalia, as “consequential geographies” – two of seven subnational geographies globally which together accounted for 90% of all polio cases in 2022 and which are all affected by broader humanitarian emergencies;

Recognizing the high risk of expansion of the polio outbreaks within and from the two Regional consequential geographies due to their complex emergency settings, limited access to high-risk populations, weak immunization services, gaps in coverage of supplementary vaccination campaigns, and unmitigated spread of misinformation and disinformation in northern governorates of Yemen;

Recalling that the international spread of polio is a Public Health Emergency of International Concern under the International Health Regulations (2005);

Observing with alarm that 197 children have been paralyzed by cVDPV2 in Yemen’s northern governorates, representing almost one-third of all global cases of this strain in 2022, and that the international spread of poliovirus from Yemen to Djibouti, Egypt and Somalia has been confirmed;

Recognizing the best operational approach and experience to vaccinate all children, especially infants and young children, against polio, and achieve more than 90% coverage to stop an outbreak is through house-to-house delivery of vaccination; and if that is not possible, to implement an intensified fixed site vaccination with effective mobilization of families and young children to fixed sites near their homes;

Recognizing the continued threat to all children posed by vaccine-derived poliovirus and the importance of regional solidarity and support to deliver on the goals of the 2022-2026 Polio Eradication Strategy, which have been endorsed and supported by a wide range of committed donors, such as Rotary International and Member States of the Region, in particular the UAE through the sustained commitment of His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of the UAE;

We, the Member States of the Regional Subcommittee on Polio Eradication and Outbreaks for the Eastern Mediterranean:

DECLARE THAT:

The ongoing circulation of any strain of poliovirus in the Region is a Regional Public Health Emergency;

COMMIT TO:

Mobilizing all needed engagement and support by all political, community and civil society leaders and sectors at all levels to successfully end polio as a Regional Public Health Emergency;
Advocating with relevant community and subnational leaders to increase access and ensure full implementation of polio outbreak response in the most programmatically and epidemiologically impactful operational manner, ideally through house-to-house vaccination campaigns in all areas;
Focusing efforts on reaching remaining zero-dose children in the consequential geographies of the northern governorates of Yemen and south-central Somalia, working in the broader humanitarian emergency response context;
Helping to mobilize needed resources and highest-level international commitment to finalize and fully implement the Somalia Polio Eradication Action Plan 2023, in the context of competing health response priorities such as ongoing drought and the effects of the COVID-19 pandemic;
Helping to mobilize resources for the Global Polio Eradication Initiative partners to support the outbreak response in Yemen; and
Helping to strengthen coordination with other public health and humanitarian efforts in Somalia and Yemen, to ensure closer integration in particular with routine immunization and the delivery of essential health and nutrition services to children;

REQUEST THAT:

The international humanitarian and development communities scale up their support for providing essential services, including a robust vaccination response to the polio outbreaks in Somalia and Yemen using modalities that will deliver an acceptable level of coverage;
The authorities and polio eradication partners in Somalia accelerate high-quality and rigorous implementation of the Somalia Polio Eradication Action Plan 2023 to stop the longest-running outbreak in the country and prevent the further spread of cVDPV2 by the end of 2023;

10. The national authorities and the Regional Polio Eradication programme strengthen cross-border coordination across Somalia, Kenya, Ethiopia, Yemen and Djibouti, considering the documented importation of cVDPV2 from Somalia into Kenya and Ethiopia, and from Yemen into Djibouti, Egypt and Somalia, and the high risk of further instances of cVDPV2 crossing international borders;

11. Authorities in northern governorates of Yemen, all immunization partners and the humanitarian development community respond urgently to the unmitigated vaccine-related misinformation and disinformation that is being disseminated, which is risking the lives of thousands of children in Yemen and across the Region;

12. All authorities in northern governorates in Yemen facilitate the resumption of house-to-house vaccination campaigns in all areas to ensure the delivery of vaccines to the youngest and most vulnerable children, and in areas where house-to-house vaccination is not feasible, make all efforts to implement intensified fixed-site vaccination through a modality that also includes robust social mobilization and outreach to ensure high coverage; and

13. The Regional Director continue his strong leadership and efforts to support the cessation of polio outbreaks in Somalia and Yemen, including by advocating for all necessary financial and technical support, reviewing progress, implementing corrective actions as necessary, and regularly informing Member States of the aforementioned and of any eventual further action required, through the World Health Organization’s Executive Board, the World Health Assembly and the Regional Committee for the Eastern Mediterranean.

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

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

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

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

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

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

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

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

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

Originally published here.